What Is the Treatment for Secondary Progressive Multiple Sclerosis?
Understanding Secondary Progressive Multiple Sclerosis
Secondary Progressive Multiple Sclerosis (SPMS) often develops after a person has experienced Relapsing-Remitting Multiple Sclerosis (RRMS) for several years.
In RRMS, individuals experience periods of relapse (new or worsening symptoms) followed by remissions (partial or complete recovery). Over time, however, some people with RRMS may transition to SPMS, where the disease gradually worsens without the clear relapses and remissions characteristic of RRMS.
Unlike the relapsing-remitting phase, SPMS is characterized by a steady worsening of neurological function. This means that the patient’s symptoms tend to get worse over time, with or without distinct relapse events.
While relapses (or flare-ups) may still occur in the early stages of SPMS, they become less frequent as the disease progresses. In many cases, symptoms worsen steadily without noticeable relapses.
As SPMS progresses, it can lead to significant disability in mobility, coordination, and balance.
Cognitive abilities like memory and attention may also be affected. The condition can also cause difficulties with speech, swallowing, and coordination.
Secondary Progressive Multiple Sclerosis: Causes and Mechanisms
The cause of SPMS is still not fully known, though it is thought to result from both long-term inflammation and neurodegeneration, which involves the loss of nerve cells and their functions. This progressive damage to the central nervous system can result in permanent disability.
What Is the Treatment for Secondary Progressive Multiple Sclerosis?
Treatment Goals for Secondary Progressive Multiple Sclerosis
The main aim of treating SPMS is to slow disease progression, alleviate symptoms, and enhance the patient’s quality of life.
While there is currently no cure for SPMS, advances in treatment are helping patients manage the disease more effectively. Treatment options may involve medications, physical therapy, and changes to lifestyle.
Symptom Management for SPMS
In addition to DMTs, symptom management is a key component of SPMS treatment. As the disease advances, patients may face growing challenges with mobility, spasticity, pain, fatigue, and cognitive changes.
Various therapies can help manage these symptoms and improve the quality of life for patients with SPMS.
1- Physical Therapy: For patients with SPMS, physical therapy is essential for maintaining mobility and boosting strength.
A tailored exercise program can help prevent muscle weakness and improve balance, coordination, and walking ability. Physical therapists assist patients in developing a personalized plan that aligns with their abilities and restrictions.
2- Spasticity Management: Spasticity, or muscle stiffness, is a common symptom of SPMS. Medications like baclofen or tizanidine can aid in relaxing muscles and alleviating stiffness.
For some patients, physical therapy and stretching exercises may also be beneficial. In severe cases, more invasive treatments like intrathecal baclofen therapy (delivered directly to the spinal cord) may be considered.
3- Fatigue Management: Fatigue is one of the most disabling symptoms of MS, particularly in its progressive stages.
Managing fatigue often involves a combination of strategies, including energy conservation techniques, proper sleep hygiene, and medications like amantadine or modafinil that can help increase alertness.
4- Pain Management: Chronic pain in MS patients can be treated with medications like gabapentin, pregabalin, or tricyclic antidepressants. In some cases, physical therapy, acupuncture, or relaxation techniques may help alleviate pain.
5- Cognitive Rehabilitation: Many patients with SPMS experience cognitive changes, including memory problems and difficulty concentrating.
Cognitive rehabilitation, which includes working with a skilled therapist to enhance cognitive abilities, can assist patients in maintaining mental clarity and adjusting to cognitive changes.
Lifestyle Adjustments and Support
Managing SPMS requires more than just medical treatments; lifestyle modifications and emotional support are also crucial. Patients should focus on adopting a healthy lifestyle by incorporating regular exercise, a balanced diet, effective stress management, and enough rest.
Additionally, connecting with support groups and seeking guidance from mental health professionals can assist patients in navigating the emotional challenges of living with a long-term condition.
Though there is no cure for secondary progressive multiple sclerosis, significant advancements in treatment have allowed patients to manage the disease more effectively.
Disease-modifying therapies like siponimod and ocrelizumab can help slow progression, while symptom management strategies such as physical therapy, spasticity control, and fatigue management can significantly improve quality of life.
Dr. Miguel Ley Nacher is committed to helping patients with SPMS navigate their treatment options and enhance their well-being with personalized care. If you or a loved one are living with SPMS, we encourage you to schedule a consultation to explore the best treatment plan for your unique needs.
