Secondary-progressive multiple sclerosis (SPMS) is a form of multiple sclerosis that develops from relapsing-remitting MS (RRMS). But with SPMS, there are no longer periods of remission.

Doctors consider secondary-progressive multiple sclerosis (SPMS) to be the next stage of MS after relapsing-remitting MS (RRMS).

Keep reading to learn about what makes it different from RRMS, how progression works, and how the treatment options may differ.

Over time, RRMS can develop into SPMS. SPMS is a progressive form of MS.

People with SPMS can still have MS episodes and relapses, but they no longer experience periods of remission where symptoms improve or disappear.

Doctors recommend treatment for people with SPMS to help reduce attacks and slow the progression of disability.

Most people with RRMS develop SPMS at some point. Research suggests that 62% of people with an average age of 45 years at RRMS onset developed SPMS by age 75.

MS is a chronic autoimmune disease that comes in different forms and affects people differently. About 85% of people with MS develop RRMS first.

The first noticeable symptoms of RRMS may include:

RRMS symptoms can come and go. Some people may experience remission and not have any symptoms for several weeks or months. MS symptoms can come back or worsen, known as a flare-up or relapse. These terms describe episodes of new or worsening neurological symptoms that last at least 24 hours and are separated by at least 30 days from the previous episode.

A relapse typically lasts for several days to several weeks. The symptoms can gradually worsen initially and then improve gradually over time without treatment or sooner with IV steroids. RRMS is unpredictable.

At some point, many people with RRMS no longer have periods of remission or sudden relapses. Instead, their MS symptoms continue and worsen without any break.

Symptoms that continue to worsen indicate that RRMS has progressed to SPMS. This usually occurs 10 to 15 years after the first MS symptoms. However, effective treatment with MS disease-modifying therapies (DMTs) early on in the disease course might delay or even possibly prevent SPMS.

DMTs, like all medications, can potentially cause side effects. These may vary from one drug to another and from person to person.

All forms of MS present with similar symptoms. But SPMS involves progressive symptoms that don’t improve over time.

During the early stages of RRMS, you might notice various symptoms, but they may not necessarily be severe enough to interfere with everyday activities. Once MS progresses to the secondary-progressive stage, disability can accumulate, and symptoms can become more challenging.

SPMS can be different for each person.

Doctors diagnose SPMS in people who have a prior diagnosis of RRMS. SPMS, which develops as a result of neuronal loss and atrophy, decreases neurological function.

It can be challenging to tell the difference between relapse-related permanent deficits and disease progression. The transition period between RRMS and SPMS can feel uncertain.

SPMS can be active, with relapses and new MRI activity over time, or not active. It can also have progression, or worsening disease activity and disability, or no progression.

If you notice your MS symptoms worsening without any remission, a neurologic exam and an MRI scan may aid in diagnosing a progression to SPMS.

MRI scans can show the level of nerve cell injury and brain atrophy. An MRI usually shows increased contrast during an episode because the blood-brain barrier (comprised of cells that separate the brain from the bloodstream) becomes inflamed during an attack.

A clear indicator that a person has SPMS is the absence of remission, but it’s still possible to have relapses and flare-ups of symptoms. Flare-ups are usually worse in heat and during times of stress, including illness.

The Food and Drug Administration (FDA) has approved more than 20 DMTs for relapsing forms of MS, including SPMS with relapses. If you were taking one of these drugs to treat RRMS, your doctor may recommend continuing it until it stops controlling disease activity.

Other types of treatment can help improve symptoms and quality of life. These include:

Clinical trials test new medications and therapies on volunteers to improve treatment for SPMS. This process gives researchers a clearer sense of what’s effective and safe.

Participants in clinical trials may access new treatments or new combinations of treatments, but some risk is involved. The treatments may not help with SPMS, and in some cases, they may come with side effects.

Participants in clinical trials generally need to meet certain guidelines. When deciding whether to take part, it’s important to ask questions like how long the trial will last, what the potential side effects might be, and why researchers think it’ll help.

The National Multiple Sclerosis Society website lists clinical trials in the United States.

Current research is testing the safety and efficacy of:

Progression refers to symptoms becoming measurably worse over time. At some points, SPMS may be described as “without progression,” meaning the disease doesn’t seem to be measurably worsening.

Progression varies considerably among people with SPMS. In time, some may need a wheelchair, but many people remain mobile, with some using a cane or another device to assist them with walking.

SPMS modifiers

Modifiers are terms that indicate whether your SPMS is active or inactive. Knowing whether your SPMS is active or inactive can help inform conversations with your doctor about possible treatments and what you can expect going forward.

If you have active SPMS, you might discuss new treatment options. But with absent activity, you and your doctor may discuss rehabilitation options and ways to manage your symptoms that may include treatment with a DMT that carries fewer side effects.

The National Institutes of Health (NIH) notes that most people with MS can expect to live as long as somebody without MS..

Life expectancy for people with MS has increased in recent decades with improved treatment. However, as newer DMTs have only recently become available, there is no current data to show how they might affect the life expectancy of a person diagnosed with MS today.

However, some factors, including disability severity and smoking, may affect a person’s life expectancy.

According to 2022 research that compared life expectancy in people with MS based on their Expanded Disability Status Scale (EDSS) score and age suggests a life expectancy of:

  • 13.3 additional years after EDSS stage 6 to 6.5 (participants reached this EDSS stage at a mean age of 51.2), in which a person requires a walking aid to move independently

Research in Norway suggests the average life expectancy for people with MS tends to be about 8 to 9 years less than people without MS. Research in New Zealand suggests people with MS have an average life expectancy that’s 7 years less than the general population.

Apart from severe cases of MS, which are rare, the leading causes of death for people with MS are due to underlying medical conditions, like cancer and heart and lung disease.

Treatment for MS is essential to help manage symptoms and decrease disability worsening. Detecting and treating RRMS early can help prevent or delay the onset of SPMS.

Though the disease usually progresses, it’s important to treat SPMS as early as possible. There’s no cure, but MS isn’t fatal, and medical treatments can significantly improve your quality of life. If you have RRMS and notice worsening symptoms, it’s time to talk with a doctor.