When Does SPMS Begin?
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One of the most common questions I get from readers of this column and other social media — perhaps because I’ve been at this for so long that the bulk of my audience is a couple of decades (or more) into their life with MS — is how one is to know if they are shifting from relapsing-remitting MS (RRMS) to secondary-progressive MS (SPMS).
It’s a tough one to know and diagnose, but in general, if you are experiencing progression of symptoms without a relapse for at least six months (but have had relapses and remissions in the past) and the progression is not linked to any symptoms of past relapses, this is a good indicator that you may be slipping into the SPMS phase of the disease.
It may help to take a look at the infamous progression graphs created by the neurologist Fred Lublin, MD, and featured on the website of the National Multiple Sclerosis Society.
More Treatments and Attention for Progressive MS
In the not-too-distant past, there was no course of action for our medical teams to suggest to curb the progression of SPMS. Now, however, there are treatments approved for active SPMS; “active SPMS” means a person still experiences occasional relapses, and new lesions are still seen on their MRIs.
International focus on progressive forms of MS (both primary-progressive and secondary-progressive) has increased in the past few years, particularly after the publication in 2015 of an editorial in the Lancet Neurology by myself and two prominent voices in the MS world, calling for more research in these areas.
Just three years earlier, in 2012, the six members of the Multiple Sclerosis International Federation (MSIF) formed the International Progressive MS Alliance, with the goal of speeding up research on primary-progressive MS.
Recent Research on MS Progression
A couple of recent studies on the subject of MS progression caught my attention.
One study looked at a particular type of MS lesion (called paramagnetic rim lesions) and concluded they may be linked to higher clinical disease severity and relapse frequency. There is some conjecture that higher frequency and severity of relapses may also be an indicator of likelihood of advancing to SPMS.
The other study looked into what the researchers termed “progression independent of relapse activity” in pediatric-onset MS. The researchers concluded that such progression can happen at any age, but that individuals with pediatric-onset MS were less likely to experience it than other groups during a decade of follow-up.
So … When Does SPMS Start?
It must be noted that many people who were diagnosed with MS in the later stages of the disease may have had the relapsing form of MS for years before being properly diagnosed, and may have already entered the SPMS phase when they hear that they have multiple sclerosis.
The long story short about SPMS is that can be difficult to diagnose, there are now treatments considered viable for this course of MS, and that progression independent of relapses may be a part of MS well before SPMS.
I don’t know if that makes it easier or more difficult to answer that question, “How do I know?” but it’s still a question worth asking.
Wishing you and your family the best of health.
Cheers,
Trevis
My new book, Living Well With Multiple Sclerosis, is now available. Follow me on the Life With MS Facebook page, and read more on Life With Multiple Sclerosis.
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