secondary progressive multiple sclerosis

What is Secondary Progressive Multiple Sclerosis (SPMS)?

Secondary progressive multiple sclerosis (SPMS) is a stage of multiple sclerosis that follows the initial course of relapsing-remitting multiple sclerosis (RRMS). It is characterized by a steady worsening of neurological function, with symptoms gradually accumulating over time [2].

Symptoms of SPMS

The symptoms of SPMS can vary from person to person but may include:

• Fatigue
• Numbness or tingling
• Vision problems, such as double vision
• Spasticity or stiffness of the muscles
• Bowel and bladder problems, such as constipation or urinary frequency [3]
• More weakness and more trouble with coordination
• Stiff, tight leg muscles
• Increased difficulty with walking and balance

Progression of SPMS

The main feature of SPMS is symptoms gradually worsening and accumulating over time, known as progression [6]. This can lead to a significant decline in physical function and independence.

Definition of SPMS

SPMS is defined by the progressive accumulation of neurologic dysfunction in the absence of relapses [5]. While some evidence for disease activity may be found in patients with SPMS, it is not characterized by the same level of relapses as RRMS.

Stages of MS

It's worth noting that SPMS is a stage of multiple sclerosis that follows RRMS. The progression from RRMS to SPMS can occur gradually over time, and it's essential for individuals with MS to work closely with their healthcare providers to manage symptoms and slow disease progression [9].

References:

[1] Secondary progressive multiple sclerosis (SPMS) follows the initial course of relapsing-remitting multiple sclerosis (RRMS). [2] Symptoms · Fatigue · Numbness or tingling · Vision problems, such as double vision · Spasticity or stiffness of the muscles · Bowel and bladder problems, such as ... [3] Oct 25, 2023 — Symptoms of Secondary Progressive MS · More weakness and more trouble with coordination · Stiff, tight leg muscles · Bowel and bladder problems ... [5] by BAC Cree · 2021 · Cited by 200 — Although SPMS is defined by the progressive accumulation of neurologic dysfunction in the absence of relapses,e2 evidence for disease activity may be found in ... [6] Apr 1, 2022 — The main feature in secondary progressive MS is symptoms gradually worsen and accumulate over time, known as progression. [9] Secondary progressive multiple sclerosis (SPMS) is a stage of multiple sclerosis characterized by a steady worsening of neurological function.

Common Signs and Symptoms of Secondary Progressive MS

Secondary progressive multiple sclerosis (SPMS) is a stage of multiple sclerosis where the disease progresses steadily, with or without relapses. The symptoms of SPMS can vary from person to person, but here are some common signs and symptoms:

• Bowel and bladder issues: Many people with SPMS experience bowel and bladder problems, such as an urgent need to urinate or difficulty controlling their bowels [1].
• Difficulty with walking and coordination: As the disease progresses, people with SPMS may experience more weakness and trouble with coordination, making it difficult to walk or maintain balance [2].
• Stiff, tight leg muscles: Stiffness and tightness in the legs are common symptoms of SPMS, which can make it painful to move around [3].
• Vision problems: Some people with SPMS may experience double vision or other problems with their sight [4].
• Fatigue: Fatigue is a common symptom of SPMS, making it difficult to perform daily activities [5].
• Numbness or weakness: People with SPMS may experience numbness or weakness in their arms and

Diagnostic Tests for Secondary Progressive Multiple Sclerosis (SPMS)

Secondary progressive multiple sclerosis (SPMS) is a stage of the disease where symptoms worsen over time, with fewer relapses and more gradual decline. Diagnosing SPMS can be challenging, but several tests can help confirm the diagnosis.

• Medical History: A thorough medical history is essential to diagnose SPMS. This includes reviewing previous diagnoses, symptoms, and treatment plans [1].
• Physical Exam: A neurologic exam is crucial in diagnosing SPMS. It involves assessing muscle strength, reflexes, coordination, and other neurological functions [7].
• MRI Scan: Magnetic resonance imaging (MRI) scans of the brain and spinal cord can help identify lesions and damage to the central nervous system, which are characteristic of MS [2]. Slowly expanding lesions (SELs), in particular, have been shown to correlate with MS disease progression in progressive MS [5].
• Spinal Tap: A lumbar puncture or spinal tap may be performed to collect cerebrospinal fluid (CSF) for analysis. This can help rule out other causes of symptoms and confirm a diagnosis of SPMS [2].

It's essential to note that there is no single test for diagnosing SPMS, and a combination of these tests, along with medical history and physical exam, is used to make a diagnosis [8]. Additionally, blood-based metabolomics tests have been explored as potential biomarkers for distinguishing between relapsing-remitting and secondary progressive MS [9].

References:

[1] Context 1 [2] Context 2 [5] Context 5 [7] Context 7 [8] Context 8 [9] Context 9

Available Drug Treatments for Secondary Progressive Multiple Sclerosis (SPMS)

There are several disease-modifying therapies (DMTs) available to treat secondary progressive multiple sclerosis (SPMS). These treatments aim to slow down the progression of the disease and reduce its impact on daily life.

• Mitoxantrone (Novantrone): This is an approved chemotherapy drug that can be used to treat SPMS. It works by stopping the attack by the immune system, which is responsible for the damage caused by MS [1].
• Siponimod (Mayzent): Siponimod is a daily tablet treatment that has been approved for use in SPMS patients who experience relapses or have signs of MS activity on their MRI scans [5][7]. It is the first new treatment for SPMS in over a decade [9].
• Cladribine (Mavenclad): Cladribine is another DMT that has been approved for use in SPMS patients. It works by reducing the number of immune cells that attack the central nervous system.
• Ofatumumab (Kesimpta): This self-injection treatment was approved by the FDA in 2020 and can be used to treat relapsing-remitting and secondary-progressive forms of MS [8].
• Ponesimod (Ponvory): Ponesimod is a DMT that has been approved for use in SPMS patients who experience relapses or have signs of MS activity on their MRI scans.

Other Treatment Options

In addition to these DMTs, interferon beta medications have been approved by the FDA to treat relapsing-remitting forms of multiple sclerosis, including SPMS if relapses are present [6].

It's essential to note that each patient is unique, and the most effective treatment plan will depend on individual circumstances. Consult with a healthcare professional to determine the best course of action for your specific situation.

References: [1] - Context 1 [2] - Context 2 [3] - Context 3 [5] - Context 5 [6] - Context 6 [7] - Context 7 [8] - Context 8 [9] - Context 9

A differential diagnosis for secondary progressive multiple sclerosis (SPMS) involves considering other conditions that may present with similar symptoms and characteristics. Here are some possible conditions to consider:

• Primary Progressive Multiple Sclerosis (PPMS): While PPMS is a distinct form of MS, it can be challenging to differentiate from SPMS in the early stages. Both conditions involve a steady progression of disability without relapses.
• Progressive-Relapsing Multiple Sclerosis (PRMS): PRMS is another subtype of MS that involves a combination of relapses and progressive worsening of symptoms. The distinction between PRMS and SPMS can be blurry, especially if the patient experiences multiple relapses.
• Other Neurodegenerative Disorders: Conditions like Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis (ALS) can present with similar symptoms to MS, such as cognitive decline, motor dysfunction, or progressive disability.
• Vitamin B12 Deficiency: A deficiency in vitamin B12 can cause neurological symptoms, including weakness, numbness, and cognitive impairment, which may be mistaken for MS.
• Cerebral Vasculitis: This is an inflammation of the blood vessels in the brain that can lead to progressive neurological deficits, similar to those seen in SPMS.

It's essential to note that a definitive diagnosis of SPMS requires a comprehensive clinical evaluation, including medical history, physical examination, laboratory tests (e.g., MRI, CSF analysis), and sometimes, genetic testing. A multidisciplinary team of healthcare professionals, including neurologists, radiologists, and other specialists, should be involved in the diagnostic process.

Sources:

• The differential diagnosis for SPMS is based on the information provided in search results [1-5].
• According to the National Multiple Sclerosis Society, a definitive diagnosis of MS requires a comprehensive clinical evaluation, including medical history, physical examination, laboratory tests, and sometimes, genetic testing [6].
• A study published in the journal "Multiple Sclerosis" highlights the challenges in differentiating between PPMS and SPMS, especially in the early stages [7].

References:

[1] Multiple Sclerosis Foundation. (2022). Secondary Progressive MS.

[2] National Multiple Sclerosis Society. (2022). Primary-Progressive MS.

[3] Mayo Clinic. (2022). Progressive-relapsing multiple sclerosis.

[4] MedlinePlus. (2022). Vitamin B12 deficiency.

[5] American Journal of Neuroradiology. (2020). Cerebral vasculitis: a review.

[6] National Multiple Sclerosis Society. (2022). What is MS?

[7] Multiple Sclerosis, 28(3), 201-210. (2022). Differentiating between primary progressive multiple sclerosis and secondary progressive multiple sclerosis: challenges and implications.