Primary Progressive Multiple Sclerosis
What is primary progressive multiple sclerosis?
Multiple sclerosis (MS) is a neurodegenerative disease. It interferes with your brain's
ability to control your body. It can be disabling.
There are 4 main types of MS:
Relapsing-remitting MS (RRMS)
Primary progressive MS (PPMS)
Secondary progressive MS (SPMS)
Each type may be mild, moderate, or severe. Each type affects people differently.
With PPMS, nervous system problems get worse from the beginning. There are no symptom
flare-ups (relapses or attacks). And there is no recovery (remission). How fast the
disease gets worse may vary. There can be times when things are stable. And there
can be periods of short-term (temporary) minor improvements. But nervous system problems
steadily get worse.
Men and women are evenly affected by this type of MS.
About 1 in 10 people diagnosed with MS have PPMS. On average, people with PPMS start
having symptoms between ages 35 and 39.
What causes primary progressive MS?
Doctors don’t know the exact cause of MS. It may develop when your immune system attacks
a substance called myelin.
Myelin acts as a type of insulation for your nerve cells. This process can lead to
damage in and around the nerves in your brain and spinal cord. It can also damage
nerves used for vision.
What are the symptoms of primary progressive MS?
Symptoms can be a bit different for each person. Symptoms can include:
Pain, such as pain in the legs and feet, back pain, and muscle spasms
Electric-shock sensations that run down the back and limbs when the neck is bent (Lhermitte
Trouble staying balanced
Trouble thinking clearly
Trouble with bowel and bladder control
How is primary progressive MS diagnosed?
Methods that your healthcare provider may use to diagnose MS include:
Discussion. Your healthcare provider will talk with you about your symptoms.
Physical exam. This is done to see how your nerves and muscles are working.
MRI scans of your brain and spinal cord. These images will help your healthcare provider look for signs of damage that suggest
Optical coherence tomography (OCT). This test measures nerve fibers in the retina.
Blood work. This is to look for infections or health conditions that can look like MS.
Spinal tap (lumbar puncture). Your healthcare provider removes a sample of spinal fluid to check for signs of MS.
Visual evoked potentials (VEP). This test is done to see how well your optic nerves are working.
After the general diagnosis of MS, the diagnosis of PPMS is based almost entirely
on your symptom history. Because of this, it may take time for the PPMS diagnosis
to be made.
How is primary progressive MS treated?
Oocrelizumab is currently the only medicine approved to treat primary progressive
Your healthcare provider will also try to provide treatments that ease symptoms and
improve your quality of life. These may address problems such as depression, sexual
problems, and extreme tiredness (fatigue).
How can I prevent primary progressive MS?
Experts don't know how to prevent MS or the PPMS type of MS. Some people limit MS
relapses by staying away from certain triggers such as stress and overheating.
How do I manage primary progressive MS?
Physical and occupational therapy may be helpful. For example, therapists may teach
you exercise strategies and how to manage new symptoms that develop. Your healthcare
provider will also likely want to meet with you on a regular basis to check your disease.
Regular exercise and plenty of sleep may also help. If your body temperature goes
up, it may make your symptoms worse for a short time. So it’s best to not do things
that could lead to overheating. This includes spending long periods of time in the
sun or overexerting yourself.
Managing MS can be difficult, frustrating, and frightening. If you have feelings of
anxiety or depression, ask your provider for help. Support groups for patients and
families, and individual therapy, can help people deal with the challenges and changes
that people with MS and their loved ones face.
Key points about primary progressive multiple sclerosis
Multiple sclerosis (MS) is a disease that interferes with your brain's ability to
control your body.
Primary progressive MS (PPMS) is a type of MS. It has no symptom flare-ups. And there
is no recovery. Nervous system problems get worse.
Symptoms may include pain, trouble walking, vision problems, and muscle weakness.
Your healthcare provider may give you a medicine to slow the disease as well as to
help manage your symptoms and improve your quality of life.
Physical and occupational therapy may be help you manage PPMS. Regular exercise and
plenty of sleep may also help.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your provider if you have questions.