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Primary vs. Secondary Progressive MS: Differences, Symptoms, Tips

Difference Between Primary and Secondary Progressive MS
Learn the difference between primary and secondary progressive multiple sclerosis.

The progressive phase of multiple sclerosis (MS) is most often associated with a permanent disability. MS has two generally known progressive classes, primary progressive multiple sclerosis (PPMS) and secondary progressive multiple sclerosis (SPMS).

The difference between PPMS and SPMS is that a person can be diagnosed with PPMS, but SPMS is not an initial diagnosis. SPMS always follows an initial relapsing-remitting course. Sometimes, even though the person may have already developed SPMS from relapsing-remitting MS (RRMS) at the time of evaluation, the initial diagnosis would remain RRMS.

Primary vs. secondary progressive MS chart

Table. Other differences between primary progressive multiple sclerosis and secondary progressive multiple sclerosis Factors Secondary progressive multiple sclerosis (SPMS) Primary progressive multiple sclerosis (PPMS) Age of onset

30 years
40 years


Females are more commonly affected than males
Both males and females are affected in an equal ratio (1:1)


65 percent of people with remitting MS will develop SPMS
10 percent of the general population will develop PPMS

Magnetic resonance imaging (MRI) brain findings

A large gathering of T2 lesions, large T1 lesions, and atrophy of the brain and spinal cord
A few brain lesions, diffuse abnormalities in the brain and spinal cord

Pathological data

Inflammatory lesions are present in the brain as seen in MRI
The number of inflammatory cells is less in the lesions and perivascular cuffs of the brain as seen in MRI


What kind of disease is multiple sclerosis?
See Answer

What is primary progressive multiple sclerosis (PPMS)?

Primary progressive MS (PPMS) is characterized by progressively worsening neurological functions. Some people can be diagnosed with PPMS at the first time of symptom onset. However, only a small number of people, about 10 percent are diagnosed with PPMS. 

People with PPMS usually do not have any recovery (remission) stage, and their disability worsens gradually. The progression rate of the condition may vary with people. The neurological condition deteriorates constantly with PPMS, but flare-ups are seen with or without remission.

16 symptoms of PPMS

  1. Pain (for example, headaches, pain in the legs and feet, back pain, and muscle spasms)
  2. When the neck is bent, electric shock sensations flow down the back and limbs (Lhermitte sign)
  3. Difficulty walking
  4. Muscle fatigue
  5. Difficulty balancing the body
  6. Tingling sensations
  7. Paralysis
  8. Numbness
  9. Shakiness
  10. Dizziness
  11. Mood swings
  12. Depression
  13. Cognitive difficulty
  14. Sexual issues
  15. Vision problems
  16. Bowel and bladder incontinence

What is secondary progressive multiple sclerosis (SPMS)?

Secondary progressive MS (SPMS) is the condition that follows the initial course of multiple sclerosis (MS) called relapsing-remitting MS (RRMS). The person may gradually develop SPMS from RRMS, which means their neurological functions are progressively worsening over time.

Eighty-five percent of people are initially diagnosed with RRMS, and 65 percent of people with RRMS develop SPMS. During RRMS, the person may have relapses or exacerbations, which can either be new symptoms or existing symptoms with increased intensity. These exacerbations go on for over a period followed by a symptom-free period for some time until another exacerbation. However, with SPMS, some people may not have such relapses but a slow progression.

Most people with multiple sclerosis (MS) belong to the class of RRMS.

SPMS is again of two types: active and nonactive SPMS. During active SPMS, people may experience flare-ups called relapses even though they are not in complete remission. Nonactive SPMS is a continuous, progressively worsening condition and relapses are absent.

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6 symptoms of SPMS

  1. Instability (tight muscles)
  2. Fatigue
  3. Tingling and numbness
  4. Vision impairment
  5. Dizziness
  6. Problems with the bladder

What is multiple sclerosis?

Multiple sclerosis (MS) is an autoimmune neurological disorder, which is progressive and causes various neurological disorders. The immune cells attack and destroy the myelin sheath around the healthy neurons in the central nervous system, and this process is called demyelination. Myelin sheath transfers the impulses between the neurons, and due to demyelination, the signals slow down or are completely disrupted, leading to various neurological disorders.

Depending on the progression of the disease multiple sclerosis is classified into four types.

  1. Clinically isolated syndrome (CIS)
  2. Relapsing-remitting MS (RRMS)
  3. Primary-progressive MS (PPMS)
  4. Secondary-progressive MS (SPMS)

Though there is no cure for MS, several therapies can decrease the growth of the disease and manage symptoms.

MS might manifest itself differently in various people. Furthermore, illness course and symptoms differ widely among people. Each person's treatment strategy will be unique due to these two reasons.

Treatment with symptomatic drugs, disease-modifying drugs, immunomodulators, monoclonal antibodies, and stem cell therapies are administered to control the immune system from damaging the central nervous system, as well as promote repair and growth of the cells of the central nervous system.

How to support someone with multiple sclerosis toward the end of life

People with multiple sclerosis (MS) are more likely to develop advanced or severe MS in their final year of life. The symptoms of severe MS are similar to those of other stages of MS. The difference is that a person with severe MS will present with several, if not all, symptoms at once. They will be further along on the expanded impairment status scale, which evaluates a person's level of disability over time with MS.

  • Make sure the person can get palliative care or end-of-life care.
  • MS is an unpredictable condition; the person could be affected in many ways and might need assistance to address personal needs.
  • Their symptoms should be always monitored, and their disability levels measured.
  • Cognitive and communication issues hinder one's capacity to communicate, so the caregiver should work toward supportive interventions to make the life of the person easier.

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