What Is Active Secondary Progressive MS?

Active Secondary Progressive MS (SPMS) occurs when a person with relapsing-remitting multiple sclerosis (RRMS) transitions to a phase characterized by steadily worsening neurological function. The term active indicates that inflammation still occurs, leading to new or enhancing lesions visible on MRI scans, alongside measurable relapses or flare-ups of symptoms.

The progression in Active SPMS happens independently of relapses, meaning neurological decline continues even between inflammatory episodes. This phase typically develops gradually, making it sometimes difficult for patients and healthcare providers to identify precisely when the transition from RRMS occurs. Key indicators include worsening disability that persists for at least six months, with less recovery after relapses compared to earlier disease stages.

How Active Secondary Progressive MS Affects Patients

The impact of Active SPMS varies significantly among patients, with symptoms that can affect multiple bodily systems. Common manifestations include progressive mobility issues, increasing fatigue, cognitive changes, bladder and bowel dysfunction, and visual disturbances. These symptoms tend to worsen gradually over time, though the rate of progression differs between individuals.

For many patients, the transition to Active SPMS represents a significant psychological adjustment. The unpredictable nature of relapses combined with the certainty of progression creates unique challenges. Many report that the most difficult aspect is adapting to the knowledge that symptoms will likely worsen over time, requiring ongoing adaptations to daily activities and living environments.

Support systems become increasingly important during this phase, with many patients requiring modifications to their home and work environments. Assistive devices such as mobility aids may become necessary, and occupational therapy often plays a crucial role in maintaining independence and quality of life.

Treatment Approaches and Medication Options

Managing Active SPMS requires a comprehensive approach targeting both the inflammatory and neurodegenerative aspects of the disease. Several disease-modifying therapies (DMTs) have received approval specifically for Active SPMS, representing significant advances in treatment options.

Novartis manufactures Siponimod (Mayzent), which became the first oral treatment specifically approved for Active SPMS. This medication works by preventing lymphocytes from leaving lymph nodes, reducing their ability to enter the central nervous system and cause damage.

EMD Serono produces Cladribine (Mavenclad), another oral medication that selectively targets and reduces B and T lymphocytes, which are involved in the MS inflammatory process. For patients with highly active disease, Biogen's Natalizumab (Tysabri) and Ocrelizumab (Ocrevus) remain important treatment options.

Symptom management represents another crucial aspect of treatment, often involving medications for specific issues like spasticity, pain, fatigue, and bladder dysfunction. Physical therapy, occupational therapy, and cognitive rehabilitation also play vital roles in maintaining function and quality of life.

Provider Comparison for Active SPMS Management

When seeking care for Active SPMS, patients have several options regarding where and how to receive treatment. The table below compares key aspects of different provider types:

Provider Type Expertise Level Accessibility Comprehensive Care
MS Centers Highest specialization May require travel Most comprehensive
Neurologists Good to excellent More widely available Varies by practice
VA Medical Centers Variable For veterans only Integrated services
Telehealth Services Variable Highest Limited physical exams

MS Foundation recommends that patients with Active SPMS seek care from specialists familiar with the latest treatment approaches. MS-specialized neurologists typically have more experience managing the complex symptoms and medication regimens required for this phase of the disease.

Many patients benefit from a multidisciplinary approach involving coordination between neurologists, rehabilitation specialists, urologists, and mental health professionals. Consortium of MS Centers provides resources for finding comprehensive care centers that offer this integrated approach.

Lifestyle Adaptations and Supportive Therapies

Beyond medical treatments, lifestyle modifications play a crucial role in managing Active SPMS. Regular physical activity adapted to individual ability levels helps maintain strength, balance, and flexibility. Research indicates that exercise may also have neuroprotective effects, potentially slowing disability progression.

Nutritional approaches focusing on anti-inflammatory diets have gained attention, though evidence remains preliminary. Some patients report benefits from Mediterranean-style eating patterns rich in fruits, vegetables, whole grains, and healthy fats. Multiple Sclerosis International Federation emphasizes the importance of maintaining healthy weight, as obesity can exacerbate mobility issues and increase inflammation.

Cognitive rehabilitation exercises help address the cognitive changes that often accompany Active SPMS. These structured activities target specific cognitive domains like processing speed, memory, and executive function. Can Do MS offers programs that combine physical and cognitive approaches to maximize function and quality of life.

Stress management techniques including mindfulness meditation, progressive muscle relaxation, and guided imagery can help manage the psychological impact of living with a progressive condition. Many patients find that joining support groups, either in-person or online, provides valuable emotional support and practical advice for navigating the challenges of Active SPMS.

Conclusion

Active Secondary Progressive MS presents unique challenges that require a multifaceted approach to management. With advances in disease-modifying therapies from companies like Novartis and Biogen, patients now have more options than ever before to address both the inflammatory and neurodegenerative aspects of their condition. The combination of medication, rehabilitation therapies, and lifestyle modifications offers the best chance for maintaining function and quality of life.

While Active SPMS remains a challenging diagnosis, the landscape of treatment continues to evolve. Patients who work closely with specialized healthcare providers, stay informed about treatment options, and actively participate in their care plan can optimize their outcomes. Organizations like the National MS Society provide valuable resources to help navigate the journey ahead with confidence and support.

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This content was written by AI and reviewed by a human for quality and compliance.