The progressive phase of multiple sclerosis (MS) is most often associated with a permanent disability. MS has two generally known progressive classes, primary progressive multiple sclerosis (PPMS) and secondary progressive multiple sclerosis (SPMS).
The difference between PPMS and SPMS is that a person can be diagnosed with PPMS, but SPMS is not an initial diagnosis. SPMS always follows an initial relapsing-remitting course. Sometimes, even though the person may have already developed SPMS from relapsing-remitting MS (RRMS) at the time of evaluation, the initial diagnosis would remain RRMS.
Primary vs. secondary progressive MS chart
| Factors | Secondary progressive multiple sclerosis (SPMS) | Primary progressive multiple sclerosis (PPMS) |
|---|---|---|
| Age of onset | 30 years | 40 years |
| Sex | Females are more commonly affected than males | Both males and females are affected in an equal ratio (1:1) |
| Incidence | 65 percent of people with remitting MS will develop SPMS | 10 percent of the general population will develop PPMS |
| Magnetic resonance imaging (MRI) brain findings | A large gathering of T2 lesions, large T1 lesions, and atrophy of the brain and spinal cord | A few brain lesions, diffuse abnormalities in the brain and spinal cord |
| Pathological data | Inflammatory lesions are present in the brain as seen in MRI | The number of inflammatory cells is less in the lesions and perivascular cuffs of the brain as seen in MRI |
SLIDESHOW
What Is Multiple Sclerosis? MS Symptoms, Causes, Diagnosis See SlideshowWhat is primary progressive multiple sclerosis (PPMS)?
Primary progressive MS (PPMS) is characterized by progressively worsening neurological functions. Some people can be diagnosed with PPMS at the first time of symptom onset. However, only a small number of people, about 10 percent are diagnosed with PPMS.
People with PPMS usually do not have any recovery (remission) stage, and their disability worsens gradually. The progression rate of the condition may vary with people. The neurological condition deteriorates constantly with PPMS, but flare-ups are seen with or without remission.
16 symptoms of PPMS
- Pain (for example, headaches, pain in the legs and feet, back pain, and muscle spasms)
- When the neck is bent, electric shock sensations flow down the back and limbs (Lhermitte sign)
- Difficulty walking
- Muscle fatigue
- Difficulty balancing the body
- Tingling sensations
- Paralysis
- Numbness
- Shakiness
- Dizziness
- Mood swings
- Depression
- Cognitive difficulty
- Sexual issues
- Vision problems
- Bowel and bladder incontinence
What is secondary progressive multiple sclerosis (SPMS)?
Secondary progressive MS (SPMS) is the condition that follows the initial course of multiple sclerosis (MS) called relapsing-remitting MS (RRMS). The person may gradually develop SPMS from RRMS, which means their neurological functions are progressively worsening over time.
Eighty-five percent of people are initially diagnosed with RRMS, and 65 percent of people with RRMS develop SPMS. During RRMS, the person may have relapses or exacerbations, which can either be new symptoms or existing symptoms with increased intensity. These exacerbations go on for over a period followed by a symptom-free period for some time until another exacerbation. However, with SPMS, some people may not have such relapses but a slow progression.
Most people with multiple sclerosis (MS) belong to the class of RRMS.
SPMS is again of two types: active and nonactive SPMS. During active SPMS, people may experience flare-ups called relapses even though they are not in complete remission. Nonactive SPMS is a continuous, progressively worsening condition and relapses are absent.
6 symptoms of SPMS
What is multiple sclerosis?
Multiple sclerosis (MS) is an autoimmune neurological disorder, which is progressive and causes various neurological disorders. The immune cells attack and destroy the myelin sheath around the healthy neurons in the central nervous system, and this process is called demyelination. Myelin sheath transfers the impulses between the neurons, and due to demyelination, the signals slow down or are completely disrupted, leading to various neurological disorders.
Depending on the progression of the disease multiple sclerosis is classified into four types.
- Clinically isolated syndrome (CIS)
- Relapsing-remitting MS (RRMS)
- Primary-progressive MS (PPMS)
- Secondary-progressive MS (SPMS)
Though there is no cure for MS, several therapies can decrease the growth of the disease and manage symptoms.
MS might manifest itself differently in various people. Furthermore, illness course and symptoms differ widely among people. Each person's treatment strategy will be unique due to these two reasons.
Treatment with symptomatic drugs, disease-modifying drugs, immunomodulators, monoclonal antibodies, and stem cell therapies are administered to control the immune system from damaging the central nervous system, as well as promote repair and growth of the cells of the central nervous system.
How to support someone with multiple sclerosis toward the end of life
People with multiple sclerosis (MS) are more likely to develop advanced or severe MS in their final year of life. The symptoms of severe MS are similar to those of other stages of MS. The difference is that a person with severe MS will present with several, if not all, symptoms at once. They will be further along on the expanded impairment status scale, which evaluates a person's level of disability over time with MS.
- Make sure the person can get palliative care or end-of-life care.
- MS is an unpredictable condition; the person could be affected in many ways and might need assistance to address personal needs.
- Their symptoms should be always monitored, and their disability levels measured.
- Cognitive and communication issues hinder one's capacity to communicate, so the caregiver should work toward supportive interventions to make the life of the person easier.
National Multiple Sclerosis Society. Types of MS. https://www.nationalmssociety.org/What-is-MS/Types-of-MS
WebMD. What Are the Different Types of Multiple Sclerosis? https://www.webmd.com/multiple-sclerosis/multiple-sclerosis-understanding-the-differences-in-ms
Cedars-Sinai. Primary-Progressive Multiple Sclerosis (PPMS). https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/--primary-progressive-multiple-sclerosis-ppms.html
Cedars-Sinai. Secondary-Progressive Multiple Sclerosis. https://www.cedars-sinai.org/health-library/diseases-and-conditions/s/secondary-progressive-multiple-sclerosis.html
Top Primary vs. Secondary Progressive MS Related Articles
MS (Multiple Sclerosis) vs. ALS (Amyotrophic Lateral Sclerosis)
ALS (amyotrophic lateral sclerosis, Lou Gehrig's disease) and MS (multiple sclerosis) are both diseases of the nervous system (neurodegenerative). ALS is a disease in which the nerve cells in the body are attacked by the immune system, although it's not considered an autoimmune disease by some scientists. MS is an autoimmune disease in which the insulated covering of the nerves (myelin sheath) in the CNS (central nervous system) degenerate, or deteriorate.
Scientists don't know the exact cause of either problem. However, they have discovered that mutations in the gene that produces the SOD1 enzyme were associated with some cases of familial ALS. Scientists also theorize that multiple sclerosis may be caused by infection or vitamin D deficiency. ALS occurs between 50-70 years of age (the average age of occurrence ALS is 55), and mostly affects men. While MS occurs between 20-60 years of age, and mostly affects women. About 30,000 people in the US have ALS, and an average of 5,000 new diagnoses per year (that's about 15 new cases per week). Worldwide, MS affects more than 2.3 million people, with about 10,000 new cases diagnosed each year (that's about 200 new diagnoses per week).
Some of the signs and symptoms of both diseases include muscle weakness, muscle spasms, problems walking, fatigue, slurred speech, and problems swallowing. ALS signs and symptoms that are different from MS include problems holding the head upright, clumsiness, muscle cramps and twitches, problems holding objects, and uncontrollable periods of laughing or crying. MS signs and symptoms that are different from ALS include vision problems, vertigo and balance problems, sexual problems, memory problems, depression, mood swings, and digestive problems.There is no cure for either disease, however the prognosis and life expectancy are different. Multiple sclerosis is not a fatal condition, while ALS progresses rapidly and leads to death.
Alternative Treatment (CAM) for MS
The term alternative therapy, in general, is used to describe any medical treatment or intervention that has not been scientifically documented or identified as safe or effective for a specific condition. Alternative therapy encompasses a variety of disciplines that range from diet and exercise to mental conditioning to lifestyle changes.
Botox to Treat Multiple Sclerosis (MS)
Botulinum toxin is a muscle-relaxing medication used to decrease spasticity related to multiple sclerosis and other neurological conditions. Botulinum toxin is derived from the bacterium Clostridium botulinum. There are three types of botulinum toxin available for therapeutic use.
Can Stress Cause Multiple Sclerosis (MS)?
Multiple sclerosis (MS) results when your immune system attacks the cells of the brain and spinal cord. It is an autoimmune disease, a condition in which the body's immune system is misdirected and attacks its own cells. Stress can make it difficult for a person to manage MS symptoms. Regular exercise and mindful eating have been found to control the stress levels and overall health of people with MS.
Is Multiple Sclerosis (MS) Contagious?
Multiple sclerosis, or MS, is a degenerative disease of the covering around the nerves in the central nervous system (CNS). Researchers and doctors don't know the exact cause, but many theorize that it may be due to environmental triggers, an autoimmune disease, and viruses (infections). Symptoms and signs of MS include vision changes, paralysis, vertigo, heat intolerance, slurred speech, sexual dysfunction, and urinary incontinence (the inability to urinate). There's no vaccine or cure for MS, but the progression and symptoms of the disease can be treated.
Multiple Sclerosis (MS) Symptoms and Treatments
Multiple sclerosis (MS) symptoms vary from person to person and can last for days to months without periods of remission. Symptoms of MS include sexual problems and problems with the bowel, bladder, eyes, muscles, speech, swallowing, brain, and nervous system. The early symptoms and signs of multiple sclerosis usually start between ages 20-40. MS in children, teens, and those over age 40 is rare. Treatment options for multiple sclerosis vary depending on the type and severity of symptoms. Medications may be prescribed to manage MS symptoms.
Multiple Sclerosis (MS)
Multiple sclerosis or MS is an autoimmune disorder in which brain and spinal cord nerve cells become demyelinated. This damage results in symptoms that may include numbness, weakness, vertigo, paralysis, and involuntary muscle contractions. Different forms of MS can follow variable courses from relatively benign to life-threatening. MS is treated with disease-modifying therapies. Some MS symptoms can be treated with medications.
Making an MS Friendly Home
Adults with multiple sclerosis may be at risk for injuries, hazards, and falling at home. Some simple home modifications can protect your health and safety and facilitate fall prevention. Reduce your risk of accidents and prevent hazards with these tips.
Multiple Sclerosis (MS) and Pregnancy
Multiple sclerosis or MS is a central nervous system disease in which the immune system attacks the myelin sheath (the protective coating around nerves). Symptoms of MS include pain, sexual problems, fatigue, numbness and tingling, emotional changes, and depression.Women who are pregnant and have multiple sclerosis may have more difficulty carrying a pregnancy. Multiple sclerosis does not affect ability to conceive, and does not seem to affect fertility. MS symptoms during pregnancy may stay the same or get better; however, they may worsen after giving birth. Pregnancy decreases the number of relapses, but flares increase in the first 3-6 months after delivery. Pregnant women with MS may carrying a pregnancy more difficult to tell when labor starts, and there is an increased need to use forceps or vacuum to assist with delivery or b7 C-section (Cesarean birth) increases.
Some treatment MS drugs may be safe to use during pregnancy; however, some drugs should not be taken, for example, baclofen (Gablofen, Lioresal), fluoxetine (Prozac, Sarafem), or solifenacin succinate (VESIcare), and most disease-modifying therapies (DMTs).
Talk with your healthcare team about vitamins, supplements, and medications that you are taking if you are pregnant and have MS.
Multiple Sclerosis (MS) Early Warning Signs and Types
Multiple sclerosis (MS) can be thought of as an immune-mediated inflammatory process involving different areas of the central nervous system (CNS) at various points in time. Early warning signs and symptoms of MS in children, teens, and adults are similar; however, children and teens with pediatric also may have seizures and a complete lack of energy. Adults with MS do not have these signs and symptoms. Other signs and symptoms of MS include inflammation of the optic nerve (optic neuritis), changes in vision, Wiping or having tissues around the eye and moving the eye may be painful, and double vision. There are four types of MS, relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS), and progressive relapsing MD (PRMS).
MS Quiz
Multiple Sclerosis is a debilitating neurological condition. Take the MS Quiz to test your knowledge of the causes, symptoms, risks and treatments.
Famous Faces of MS
Learn about celebrities, such as Montel Williams and Jack Osbourne, who are living with multiple sclerosis.
Multiple Sclerosis Symptoms Picture
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Multiple Sclerosis: Signs of Multiple Sclerosis Relapse
Signs of an MS relapse can vary in type and intensity. This WebMD slideshow lists some of the more common relapse symptoms.
Who Is at High Risk for Multiple Sclerosis?
The cause of multiple sclerosis (MS) is not known. But scientists believe that a combination of various factors may put an individual at a higher risk for MS. These factors include immunologic factors, environmental factors, low vitamin D levels, smoking, obesity, Epstein-Barr virus, genetics, and the female gender.