Secondary progressive MS
                     Secondary Progressive Multiple Sclerosis: Causes, 
Symptoms & Treatment
Understanding Secondary Progressive Multiple Sclerosis
➔ Multiple Sclerosis (MS) is a chronic inflammatory condition of the central nervous system. 
It is an Autoimmune Demyelinating Disease – the immune system mistakenly attacks normal 
tissues, in this case, the myelin or protective covering around nerve fibers. When the myelin sheath 
is damaged, nerve impulses slow down or even stop, causing neurological problems.
➔ Secondary Progressive Multiple Sclerosis (SPMS) 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. 
Symptoms of Secondary Progressive Multiple Sclerosis
In SPMS, the nature of the condition changes gradually, as the nerves become damaged:
Intermittent flare-ups caused by inflammation → a more steady disease progression
Symptoms may remain steady, or even cause relapses. SPMS manifests as an increase in the intensity 
of existing MS 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
Additionally, patients 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 – usually a combination of genetic and 
environmental factors.
Studies show that 50-90% of those with RRMS develop SPMS within approximately 25 years of onset. 
However, it may vary for each individual. 
Why does RRMS shift to SPMS when it does? 
Research indicates that it could be a lasting nerve injury that occurred in the early stages of the disease. 
Other known factors 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 suggests that SPMS affects Caucasian patients more than other ethnicities, and men 
more than women
Diagnosing Secondary Progressive Multiple Sclerosis
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 6 months after the patient first comes in for a checkup before 
declaring SPMS. 
Patients may need to undergo multiple tests such as an MRI, a cerebrospinal fluid test, and a 
neurological exam. 
It is important for the patient to relay exactly how and when symptoms become worse, and 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.
There can be periods of activity and non-activity in SPMS, therefore patients should get a yearly 
neurological checkup. This enables decision making on whether to adopt 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
Patients can relieve themselves of frequent flare-ups, but 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, on strengthening exercises, and stretches to relieve spasticity or tightness.
● Occupational Therapy: Focus is on enabling the patient to complete as many daily activities as 
independently as possible.
● Speech Therapy: MS can impede the muscle functioning 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 time.
● Vocational Therapy: Focus is on the patient’s occupation, and making adjustments to better suit a 
life with MS. 
Living with Secondary Progressive Multiple Sclerosis
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 
Thank you.