If you\’ve been living with Relapsing Remitting Multiple Sclerosis for a while, chances are you might experience Secondary Progressive Multiple Sclerosis. During this stage, you will no longer experience quite as many disease flare-ups, and symptoms may decline more steadily. Here, we offer a quick guide on what to expect with Secondary Progressive Multiple Sclerosis and how you can manage your symptoms better.
Understanding Secondary Progressive Multiple Sclerosis
Multiple Sclerosis (MS) is a chronic inflammatory condition of the central nervous system. It is an Autoimmune Demyelinating Disease, which means the immune system mistakenly attacks normal tissues — in this case, the myelin or protective covering around nerve fibers. This leaves scarred tissues or lesions in multiple areas, disrupting electrical impulses throughout the body. When the myelin sheath is damaged, nerve impulses slow down or even stop, causing neurological problems.
Secondary Progressive Multiple Sclerosis occurs as a second stage of the disease, after the patient has had Relapsing Remitting Multiple Sclerosis for some years. It is characterized by a gradual worsening of symptoms, along with fewer periods of inflammation (relapses) in the central nervous system. Patients are generally older at the time of onset and symptoms may be harder to deal with even if the relapses don’t occur anymore.
Symptoms of Secondary Progressive Multiple Sclerosis
In SPMS, the nature of the condition changes gradually from intermittent flare-ups caused by inflammation to a more steady disease progression, as the nerves become damaged. There may be periods during which symptoms remain steady, and even periods during which there are relapses. In general, SPMS manifests as an increase in the intensity of existing Multiple Sclerosis symptoms. Some Secondary Progressive Multiple Sclerosis symptoms you might notice include:
- Increased spasticity or stiffness in leg muscles
- Bladder / bowel issues
- Increased fatigue
- Coordination issues
- Double vision or other vision problems
- Increased cognitive impairment
In addition, the patient may experience periods of remission from relapses during which symptoms tend to linger.
Causes of Secondary Progressive Multiple Sclerosis
The exact cause of Multiple Sclerosis is unknown. A combination of genetic and environmental factors are usually held responsible. Studies show that between 50% and 90% of those with RRMS will develop SPMS within 25 years of onset. However, each individual case may progress at its own rate, and it is hard to tell exactly why RRMS shifts to SPMS when it does. Research indicates that it could be because of a lasting nerve injury that occurred in the early stages of the disease. Other known factors that increase your likelihood of getting SPMS include:
- Having lived with RRMS for at least 15-20 years
- Having had frequent and severe relapses
- Having extensive nerve damage in the central nervous system
Research also suggests that SPMS affects Caucasian patients more than other ethnicities, and men more than women.
Diagnosing Secondary Progressive Multiple Sclerosis
Since the transition from RRMS to SPMS is a gradual one, it can be tough to diagnose. If the patient\’s symptoms are getting worse, it is up to the doctor to determine whether this is the result of a flare-up or not. Typically, doctors will wait at least six months after the patient first comes in for a checkup before declaring SPMS. You may need to undergo multiple tests such as an MRI, a cerebrospinal fluid test, and a neurological exam. Generally, patients with SPMS will have no further lesions in their brain or on their MRI scans. It is important for the patient to relay exactly how and when symptoms become worse, as well as any new symptoms that come to light.This is so that the doctor can track how nerve damage has progressed.
Treatment for Secondary Progressive Multiple Sclerosis
Depending on the rate of symptom progression and whether or not there are flare-ups, there are several options of medication to keep SPMS under control. There are also certain medications that can delay the onset of SPMS when taken during the RRMS stage. In addition, the doctor can prescribe medication to control specific symptoms, such as dizziness, bladder problems, depression, sleep problems, or pain.
Given that there can be periods of activity and non-activity in SPMS, patients should get a yearly neurological checkup. This will enable a decision on whether to go for more aggressive forms of treatment to avoid or mitigate a relapse. In addition, check-ups help to identify signs of disease progression and disability. Patients can then consider treatment options to improve functionality and maintain their independence.
Living with Secondary Progressive Multiple Sclerosis
While patients might be relieved to have fewer flare-ups than before, it can be hard when their condition gradually declines. The doctor can prescribe a rehabilitative treatment program to maintain functionality and energy levels. This usually includes a combination of:
- Physical Therapy: Focus is on the patient\’s ability to move safely and with as much range of motion as possible. It typically focuses on strengthening exercises as well as stretches to relieve spasticity or tightness.
- Occupational Therapy: Focus is on enabling the patient to complete as many daily activities as independently as possible, especially those related to eating, getting dressed, and moving around the house.
- Speech Therapy: Multiple Sclerosis can impede the functioning of the muscles in the mouth and tongue. Speech Therapy can help the patient speak and swallow correctly.
- Cognitive Therapy: Focus is on the patient’s ability to think, make decisions, and remember. There are several exercises that sharpen mental skills, especially when done over a period of time.
- Vocational Therapy: Focus is on the patient’s occupation, and making adjustments to better suit a life with Multiple Sclerosis. Therapists can suggest modifications to the patient’s current job and workplace, or provide alternatives should the current job be too difficult or risky.
In addition, there are several general lifestyle adjustments patients can make to better their health, such as:
- Getting enough exercise — cardio activity and strength training
- Eating a diet rich in fiber, green leafy vegetables, and lean protein
- Maintaining a healthy body weight
- Avoiding alcohol and tobacco
- Using aids to move around as necessary
- Sustaining emotional wellness through counselling, meditation, or yoga
- Taking prescribed supplements — herbal treatments or prebiotics
- How long do you live with Secondary Progressive MS?
On average, the life expectancy for people with Multiple Sclerosis is about seven years shorter than the average lifespan.
- Does Secondary Progressive MS cause death?
Secondary Progressive Multiple Sclerosis itself is not a fatal disease. However, patients may die of complications brought on by the condition, including respiratory distress from nerve damage in or around the lungs.
- How quickly does SPMS progress?
Studies have shown that about 90% of people with RRMS can expect to get SPMS within 25 years. However, this varies greatly depending on the individual and what treatment they are taking.
- What is the difference between Relapsing Remitting MS and Secondary Progressive MS?
Secondary Progressive Multiple Sclerosis occurs as a second stage after RRMS. During RRMS, relapses occur more frequently, followed by periods of recovery. During SPMS, attacks happen less often, but recoveries are not quite as complete.
- What is the most aggressive form of MS?
There is a rapidly progressive version of Multiple Sclerosis known as Fulminate MS, in which relapses become severe as soon as five years after diagnosis. It is also known as Marburg MS or Malignant MS. The condition, however, is fairly rare.
- Do steroids help MS relapse?
While steroids do not play any role in your ultimate recovery from a relapse, they can help with faster recovery from the symptoms.
- How long does end stage MS last?
Most patients are diagnosed with MS between 20 and 50 years of age and live at least 25 to 35 years more. End-stage MS is not fatal in itself, although it can lead to disabilities stemming from worsening symptoms.
- When should you go to the hospital for MS relapse?
If your relapse causes severe symptoms such as greatly reduced mobility, pain, or vision loss, you may need to visit a hospital.
- What are the four stages of MS?
The four stages of Multiple Sclerosis are Clinically Isolated Syndrome, RRMS, SPMS, and PPMS.
- How long does it take for MS to disable you?
In advanced stages, Multiple Sclerosis can impact a patient’s quality of life significantly, including the ability to move around, speak, or eat.