What does it mean to be diagnosed with secondary progressive MS?
Multiple sclerosis is a lifelong condition which affects the central nervous system (the brain and spinal cord). MS affects everyone differently and there’s a wide range of possible symptoms.
This information is an introduction to secondary progressive MS, you can find more detailed information in our publication, Secondary progressive MS. Here are some key facts about secondary progressive MS.
What is secondary progressive MS?
Many people who are initially diagnosed with relapsing remitting MS find that, over time, their MS changes so that there are fewer or no relapses but disability is increasing. This is called secondary progressive MS (often abbreviated to SPMS). It is called 'secondary' because the progressive phase happens second, after the relapsing remitting stage. 'Progressive' is the word used to describe the change towards more disability.
However, a small number of people will be diagnosed with secondary progressive MS from the very beginning. In hindsight, they may have experienced relapses in the past but these may have been mild or their significance was missed. Alternatively, there may have been lesions (small patches of damage caused by MS) but they were in areas of the brain or spinal cord that did not give rise to any symptoms.
Some people may have been given a different diagnosis (not MS) to begin with. This will have been changed to a diagnosis of MS once the pattern of symptoms became clearer or because later tests were able to detect damage due to MS. This change of diagnosis may have been upsetting but it can be very difficult sometimes for health professionals to tell the difference between MS and some other conditions so, usually, no one is to blame.
People with secondary progressive MS may have an occasional relapse but, generally speaking, relapses don't happen in SPMS. Although disability increases in secondary progressive MS, the rate at which this happens varies from one person to another and there may be times of improvement and times when symptoms stay the same.
What are the symptoms?
There is a wide range of possible symptoms but most people only experience a small number around the time of diagnosis and don't go on to experience them all.
It is common to experience walking difficulties or poor balance and coordination. Bladder and bowel problems, pain or depression may occur. As with the other types of MS some people may experience some sexual difficulties - these can be seen in both men and women.
People with secondary progressive MS may have difficulties with short-term memory, concentration, finding the right word and thinking things through. These are collectively known as cognitive symptoms.
Fatigue is very common. This is not normal tiredness but an exhaustion which is out of all proportion to the task that has been undertaken. Fatigue can be mental tiredness or physical tiredness.
There are other symptoms which people with secondary progressive MS may experience. As with all types of MS, the symptoms vary a lot from one person to another and not everyone will have all of them. Which symptoms are experienced depends on where the lesions are located in the brain and spinal cord.
Not all symptoms are obvious to other people. For example, problems with fatigue or cognitive symptoms can have a big impact on the person who is experiencing them but they may be invisible to others.
It will take time to learn about your MS, how to manage it well and to become your own expert. You may find that a task that is easy one day may be surprisingly difficult on another if your symptoms have kicked in. Try to accept that this is typical of life with MS and that you are not to blame.
What treatments are there?
Some people have the impression that there are no treatments for people with secondary progressive MS. This is not true.
The confusion may arise because many of the disease modifying drugs (DMDs) are not generally available to people with secondary progressive MS. These treatments can decrease the number and impact of relapses and, because people with secondary progressive MS do not typically have relapses, these treatments are not usually appropriate.
However, the distinction between relapsing remitting MS and secondary progressive MS (SPMS) is not clear-cut. Some DMDs are licensed for use if you have SPMS, and you still have relapses or evidence of active disease. However, after some time, you may be asked to stop taking disease modifying drugs, once the risks to your health outweigh the benefits of taking them.
DMDs licensed for SPMS include:
There is a wide range of treatments for individual symptoms which you can discuss with your health professionals. The treatment options include:
- drug treatments
- therapies, such as physiotherapy or cognitive behavioural therapy
- management techniques, for example pacing yourself to minimise fatigue
- rehabilitation which involves helping someone to achieve their personal goals
If your symptoms are changing, you can ask for a review if you haven't got an appointment lined up fairly soon.
Is there disability in secondary progressive MS?
What is disability?
People who are diagnosed with secondary progressive MS may worry about becoming disabled. Disability means different things to different people. What one person considers disabling may not count as disability to someone else. Much of disability is not about the person but the environment in which we all live. For example, if a shop has steps, then it will not be accessible to all. If products in the supermarket have labels with tiny writing, then not everyone will be able to read them.
There are various definitions of disability. A dictionary would typically say that disability is any result of having a condition that limits what you can do. For example, if you have a bit of numbness in your fingertips, it could make it hard to put in your earrings. Some people might class this as disability but many wouldn't.
The Equality Act covers people with MS from the point of diagnosis even though they may not see themselves as disabled at all.
The public's idea of disability can be different again. People often look for outward symbols of disability like walking sticks or wheelchairs. This is not surprising, given that the symbol of a wheelchair is often used to represent disability.
Will I become disabled?
You will have your own way of thinking about disability and it will be up to you how you define yourself. MS may affect what you can do but only you can decide if this is disabling. As the symptoms of MS vary, you may have different views of yourself at different times.
It can be worrying to be told that disability is likely to increase from the beginning of your MS. However, this is not always a fast or a continuous increase as there can be times of improvement and times when symptoms remain the same. As with all types of MS, symptoms tend to be up and down from day to day and each person's MS is different so no one can say how much your MS might, or might not, affect you.
You will have support from your MS team and many symptoms can be improved by trying different treatments. For some activities in daily life, it can be a question of doing the same thing but in a slightly different way. For example, to help manage fatigue, you might find it helpful to sit on a stool or chair to do the ironing or prepare food.
Although the word 'disability' may be uncomfortable or feel inappropriate, it can help you access support. It may be particularly helpful at work or when considering whether any government assistance or financial benefits apply to you. There is no countrywide scheme to register as disabled so each benefit has its own definition of disability.
At work, the Equality Act covers everyone with MS and requires employers to make reasonable adjustments so that you are not at a disadvantage because of any difficulty caused by your MS. Examples of reasonable adjustments may include allowing you to return to work by gradually increasing your hours or, if heat makes your symptoms worse, allowing you to sit in a cooler part of the office. You may not need any adjustments or protection but it can be good to know where the law stands.
Similarly, you may find that you are eligible for some government benefits especially if you have difficulties with walking or the activities of daily life. Possible benefits include Personal Independence Payments and the council-run Blue Badge scheme which gives access to reserved parking places.
Diaries and reviews
Some people find it helpful to keep a simple symptom diary.
It could list any new or worsening symptoms, when they happened and whether they went away or lingered. You could add in when you started or stopped any medication and whether this improved your symptoms or caused any side effects. You could add the date and outcome of your appointments with health professionals.
A symptoms diary can be on paper or it could be on your smartphone, tablet or PC. It may be useful to choose something that's easy to carry with you to your appointment.
It can be good to look back over a year and see if you need to take any action. Would you like to discuss anything in particular with your health professionals at your next review? Some people will need a review of their MS more often than others but it is important that everyone has a review every so often. Once a year would be typical but those with no change in their symptoms may be seen less often. However, if you haven't had a review for a while, you should take the initiative and ask your GP or MS nurse to arrange one, rather than assuming that the system will contact you at some point.
Find out more about how to make the most of appointments.
Secondary progressive MS book
Looks at how this type of MS is identified and diagnosed and at how a range of health professionals can you help manage the condition.
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