This type of multiple sclerosis affects just 15% of MS patients.
Multiple sclerosis, an autoimmune disease that attacks the central nervous system, can be split into two main trajectories: primary progressive MS and relapsing-remitting MS. While people with either type of MS may experience similar MS symptoms, the condition follows a different course in each.
“Primary progressive MS is a slow thing that happens over months to years,” says Michelle Fabian, MD, a neurologist at The Mount Sinai Hospital in New York City. “It’s more of a gradual symptom, and then it doesn’t typically go away.”
Affecting just 15 percent of MS patients, primary progressive MS is significantly less common than relapsing-remitting. The average age of onset is between 35 and 39, according to John Hopkins Medicine, which is older than the average age of diagnosis for MS overall.
Both types of MS occur when the immune system turns against itself. This part of the body is supposed to protect the body from dangerous pathogens, but instead, the immune system of someone with MS begins attacking crucial parts of the central nervous system: the brain, the spinal cord, and optic nerve, which connects the brain to the eyes.
Patients with relapsing-remitting MS alternate between relapses, or periods when new symptoms emerge or worsen, and remission, when symptoms subside.
With primary progressive MS, patients don’t experience relapses. “It comes on slowly, and it’s usually a walking challenge that happens over months and years,” says Dr. Fabian. With difficulty walking comes other challenges, such as fulfilling job responsibilities or everyday activities.
In MRIs, patients with either form of MS tend to show nearly identical results. Those with primary progressive MS sometimes have more lesions in their spinal cord than their brain, according to Dr. Fabian, but not necessarily. (Learn how multiple sclerosis affects the body here.)
Because test results cannot always distinguish between the two forms, talking to the patient is often the most revealing way to detect primary progressive MS. “Five years ago, they might have had just a touch of a trouble walking,” says Dr. Fabian. “Two years ago, it was more, and now it’s more. It’s a very different story.”
Treating primary progressive MS has posed more of a challenge than relapsing-remitting. A new treatment has recently been approved that can treat both forms of MS and will hopefully begin to change the outlook for the men and women diagnosed with primary progressive MS.
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Primary progressive MS is a slow thing
that happens over months to years.
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So it's more of a gradual symptom,
and then it doesn't typically go away.
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It might kind of plateau,
flatten out, but it doesn't go away.
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Multiple sclerosis is a disease
of the central nervous system.
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Is an autoimmune condition.
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So that means the immune system
is activated against itself.
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The immune system is the system that we
have in our body to protect against virus,
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bacteria, any sort of infection.
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And instead of doing that, for some reason
in multiple sclerosis, it turns inward and
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the immune system attacks the parts of
the central nervous system, the brain,
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spinal cord, and the optic nerve, which is
the connection from the eye to the brain.
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The two main sorts of MS
are relapsing-remitting MS and
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primary progressive MS.
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In MS relapse, is a patient that has a new
symptom that is somewhere on their body,
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localized on their body, and
it lasts longer than 24 hours.
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And it comes on usually over
the course of days to weeks,
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and then it goes over days to weeks.
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Primary progressive MS, so the difference
with that is that a patient won't have
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these relapses where it's something that's
new over days and weeks, and goes away.
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With Primary Progressive MS,
they've never had a relapse, and
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it's usually just something
that's a little bit insidious.
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It comes on slowly and
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it's usually a walking challenge
that happens over months and years.
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On MRI, relapsing-remitting MS and primary
progressive MS can look almost identical.
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There is a slight difference at times
where patients with the primary
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they may have more lesions in their
spinal cord compared to their brain.
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But truthfully, they also may not.
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The most important thing always
is just to listen to the patient.
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And the patient will tell you the story.
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And it's either one where they've had
some episodes that came and went.
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Or a person with primary progressive MS,
in contrast, they would just tell you that
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five years ago, they might of had
just a touch of a trouble walking.
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Two years ago, it was more,
and now it's more.
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So, it's a very different story.
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Primary progressive MS, and progressive
MS in general, has been a greater
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challenge in terms of getting treatments
available for those patients, but
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just recently we had the first treatment
approved for primary progressive MS.
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It is a treatment that also works for
relapsing remitting MS.
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And so it's another one of these
treatments that decreases inflammation.
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But it showed that it worked in a group
of primary progressive patients.
Abdelhak A, Weber MS, Tumani H. Primary progressive multiple sclerosis: putting together the puzzle. Front Neurol. 2017;8:234.
Primary progressive MS (PPMS). New York, NY: National Multiple Sclerosis Society. (Accessed on January 26, 2018 at https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS.)
Primary progressive multiple sclerosis. Baltimore, MD: John Hopkins Medicine. (Accessed on January 26, 2018 at https://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/primary_progressive_multiple_sclerosis_134,55.)