Primary progressive multiple sclerosis (PPMS) causes more severe symptoms than other types of MS, with almost no symptom-free period. PPMS is not considered fatal, but complications can reduce life expectancy by about 7-8 years.
What are possible complications of primary progressive MS?
Primary progressive MS is unpredictable. Possible complications that can lead to premature death include:
- Increased risk of infections, such as pneumonia, infected pressure sores, and urinary infections, causing systemic sepsis that can prove fatal, especially due to compromised immunity caused by steroid administration and the disease process.
- In the elderly, the disability can precipitate falls and head injuries, which may contribute to death.
- Often, comorbidities, such as diabetes and cardiovascular disease, are ignored to pay attention to MS; these may contribute to mortality in the long term.
- There is a higher rate of suicide-related deaths in people suffering from MS compared to others.
How is primary progressive MS treated?
The FDA has approved Ocrevus (ocrelizumab) for the treatment of primary progressive multiple sclerosis (PPMS), with varying degrees of success.
Other available drugs include Copaxone (glatiramer), methotrexate, and Rituxan, which may work on a case-to-case basis. Intravenous steroids and interferons along with immunoglobulin therapy may help alleviate symptoms in the acute phase of the disease.
The best drug in your case will depend on your symptom severity, drug tolerance, magnetic resonance imaging findings and cerebrospinal fluid examination report. The cornerstone of the PPMS therapy is rehabilitation and physiotherapy, which prevent muscle and joint stiffness and postpone disability.
It is important to note that most vaccinations are safe to take with multiple sclerosis (MS). However, their schedule and doses may differ depending on your flares and drug doses. Many vaccines cannot be taken if you have recently had intravenous steroids or methotrexate. You must discuss your case with your doctor and make sure your vaccination is complete as advised.
Though it may not be possible to completely prevent PPMS progression, some individuals may be able to limit MS relapses by avoiding specific triggers, such as stress or overheating. Regular exercise, vitamin D supplementation under supervision, and plenty of sleep may help in certain cases.
How fast can MS progress?
In most cases, progressive multiple sclerosis (PPMS) symptoms develop abruptly, within hours or days. These are called attacks or relapses. They typically reach their peak within a few days and then may or may not resolve slowly over the next several days or weeks. A typical symptom-free period is about 8 weeks.
In some individuals, there may be only a single MS attack (also called clinically isolated syndrome). They may have no further episodes. In general, the disability worsens considerably within about 10 years of symptom onset.
|Factors||Favorable prognosis||Unfavorable prognosis|
|Recovery after first attack||Was complete||Symptoms never fully went away|
|Interval between first and second attack||Was longer (more than 8 weeks)||Was short|
|Predominant symptoms||Sensory (pains, shock-like sensations, tingling)||Motor (muscle weakness, incontinence, stiffness)|
|Gait abnormality and tremors (cerebellar involvement)||Absent||Present|
|Disability progression in the first 5 years||Slow||Rapid|
National Institutes of Health. Multiple Sclerosis. https://www.ninds.nih.gov/health-information/disorders/multiple-sclerosis
Cedars-Sinai. Primary-Progressive Multiple Sclerosis (PPMS). https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/--primary-progressive-multiple-sclerosis-ppms.html
National Multiple Sclerosis Society. Treating PPMS. https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS/Treating-Primary-Progressive-MS
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