While only about one in a thousand people are ever diagnosed with any type of multiple sclerosis, it is something that should be more widely understood by a larger population. This is especially true for women, who are three times as likely to develop it as men, and for type 1 diabetics, also at the same higher risk factor for MS.
In secondary progressive multiple sclerosis, it’s especially crucial to know about the variety of symptoms and treatment options so that progression can be slowed and symptoms can be managed, especially with the pain that can come with the disease. What defines secondary progressive MS? How is it different from other types of the disease, and how can it best be managed?
Facts about secondary progressive multiple sclerosis
Because there are multiple types of MS, defining the type is as important as the initial diagnosis. In most cases, people in their twenties (possibly in their thirties) are diagnosed with relapsing-remitting multiple sclerosis because their symptoms come and go and don’t seem to be worsening. However, over the years of back and forth, this most often becomes secondary progressive multiple sclerosis.
Since MS is an autoimmune disease, the initial symptoms are seen when the immune system attack myelin, the substance that coats and protects the nerves that are found in the brain and spinal cord. There’s no explanation as to why, much like no doctor or scientist has identified why the cells making insulin are attacked in type 1 diabetics. However, this first leads to inflammation in the brain and spinal cords around these nerves.
The inflammation causes problems with the ability of those nerves to fire properly and send signals, leading to common symptoms, such as:
- Tingling and numbness, especially in extremities
- Pain and spasms, usually in the legs first
- The weakness of muscles starting with the legs, as well as chronic fatigue
- Dizziness and difficulty maintaining balance
- Incontinence or extreme urgency to urinate frequently
- Some cognitive issues
However, in time, most patients with RRMS move on to be diagnosed with SPMS. Here, there is typically less inflammation and more nerve damage that is irreversible.
How secondary progressive multiple sclerosis works
Unlike its prior counterpart, with secondary progressive MS, there is no remittance. Therefore, the symptoms no longer reduce or go away. In fact, as the name of the disease implies, the symptoms begin to worsen over time. This is likely due to the progression of nerve damage in the affected areas as attacks on the protective coating continue and cause the myelin to wear away. And without so much inflammation, these nerves are difficult to protect.
Diagnosing secondary progressive multiple sclerosis
Unless early signs have been ignored for years, SPMS is typically diagnosed after years of dealing with RRMS. A doctor will already be aware of symptoms, and if those symptoms begin to worsen and no longer offer a break (or remission period), the diagnosis of SPMS will be made.
Of course, there are tests to be done initially to determine if a patient has a form of multiple sclerosis. The progression of discovering the disease typically follows a path, though some steps are interchangeable or may be left out due to directly conclusive evidence from another test.
- A discussion with the physician. A doctor needs to know about medical history, as well as the story of potential progressive symptoms, so this could be a very involved conversation to rule out other potential diagnoses.
- A physical exam. The doctor will examine the entire body, paying particular attention to the body’s response and reactiveness to certain stimuli. Likely, the physician will check for nerve responses to certain criteria to assess if there is weakness or damage related to specific nerve.
- An MRI. This test can show inflammation in the spine and brain, as well as alert the doctor to any damage that may have been done to the nerves within those crucial areas. The image is a great way to test non-invasively if damage to the spine or brain are suspected.
- Blood tests. These function in two ways when trying to diagnose MS. First, a blood test will often help rule out other potential diagnoses that are related to the symptoms the patient experiences. Second, there are some tentative tests being used in a “beta” atmosphere that looks for biomarkers related to the occurrence of MS that could raise flags, showing the patient likely has or may develop multiple sclerosis.
- Evoked potential tests. These tests involve interaction. The patient is given some kind of stimulus – something to watch or hear, or perhaps an electrical “spark” applied to the nerves in question. During the activity, electrodes are used to measure the speed with which information is sent through the neural pathways.
- Spinal tap or lumbar puncture. A sample of spinal fluid is taken from the spinal cord. Analysis in a lab can first rule out possible infections or other problems that may be causing the symptoms and then analyzed for markers of the antibodies produced to attack the myelin in MS patients.
Determining secondary progressive multiple sclerosis
Defining the initial diagnosis of relapsing-remitting multiple sclerosis is fairly cut and dry, since the patient history, symptoms, and tests work together to create a pretty black and white “yes or no” answer. However, because secondary progressive MS is borne out of a “switch from” this earlier form of MS, it’s harder to make the call. While an MRI might show more damage to the nerves, most of the diagnosis would be based on the patient identifying worsening symptoms that no longer go away.
Treatment for secondary progressive multiple sclerosis
There are no cures for secondary progressive multiple sclerosis, or any other type of MS. The autoimmune disease only has some therapy choices that could reduce the overall effect of symptoms.
Doctors can prescribe medications for inflammation and pain management, while physical therapists can help with motor control and stiffness. If speech problems occur, a speech therapist may be required to assist. And there are a few medications available to slow the advancement of symptoms in SPMS. This could change the course of the disease, as well as the prominence of certain symptoms based on the body’s reaction to the medications.