Estimated reading time: 5 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
Multiple sclerosis (MS) is, in a word, unpredictable. This complex disease affects the central nervous system and leads to a wide range of symptoms. It can take a few different forms! Some see a regular progression of the disease. Others see sudden relapses followed by remission. One of the lesser-known forms of MS is non-relapsing secondary progressive multiple sclerosis (nrSPMS). Understanding any complicated condition is hard, especially for people without a medical background. But you need to know how it will affect you or your loved one, how it is treated, and what you can expect over time. Here, PatientsLikeMe will explain what nrSPMS is, how it is different from other forms of MS, and what a diagnosis means.
The Stages of MS
MS can be classified into a few different categories depending on how the disease progresses. There is:
- Relapsing-remitting MS (RRMS)
- Secondary-progressive MS (SPMS)
- Primary-progressive MS (PPMS)
The most common form of MS is RRMS. This affects about 85% of all patients diagnosed with the condition. As the name suggests, in this type people with the condition have periods where they see relapses followed by periods of recovery. Think of it as a sort of yo-yo effect. There are periods where symptoms get worse, called relapses, followed by improvements, called remission. Eventually, RRMS can turn into SPMS. SPMS is a progressive form of the disease. PPMS on the other hand starts as a progressive disease from the outset.
What Is nrSPMS?
As the name suggests, nrSPMS is a form of SPMS. In this phase, the disease progresses steadily without relapses. Instead, symptoms just get worse over time because of ongoing nerve damage. What "nr" means is that the version of SPMS is non-relapsing. A relapse is a period where the disease suddenly gets worse. In nrSPMS, there are no periods of relapse. There are also no periods where the condition improves. Instead, the damage from the condition just steadily worsens. It is sometimes also referred to as "non-active" SPMS.
Another change from RRMS to SPMS is how the disease is driven. As an autoimmune disease, MS causes the body to attack its own central nervous system. At its onset, the damage to myelin sheaths from RRMS leads to inflammation. This inflammation is also linked to relapses. In SPMS, the brain and spinal cord instead see slow, progressive damage over time.
Why Does RRMS Transition to SPMS?
The first is smoking. Smokers covert from RRMS to SPMS faster than people who do not smoke. The level to which the spinal cord is involved is another factor. People who had more spinal cord atrophy, which is when it shrinks and loses mass, developed SPMS more quickly. The age at which you develop the condition and how severe it is at the start are the final two factors. The older you are when you are diagnosed with RRMS the more likely it is to progress quickly. Similarly, if your RRMS is more severe at the onset, it is more likely to lead to SPMS.
However, not everyone with Relapsing-Remitting MS (RRMS) transitions to Secondary-Progressive MS (SPMS), especially with the availability of modern disease-modifying therapies (DMTs). In the absence of treatment, studies have shown that over 50% of people with RRMS transitioned to SPMS within 10 years, and up to 90% within 25 years. These numbers were based on historical data, and with current therapies, the transition rate has significantly decreased.
The exact reasons behind the transition to SPMS are still being studied, but it is believed to result from a shift from inflammatory-driven damage (which causes relapses) to progressive neurodegeneration. Unlike early RRMS, where inflammation causes periods of relapse and remission, SPMS is associated with ongoing nerve damage and loss of function over time, even without relapses.
How Is nrSPMS Diagnosed?
Diagnosing Secondary-Progressive Multiple Sclerosis (SPMS) is challenging because symptoms worsen gradually over time. Unlike Relapsing-Remitting MS (RRMS), which has relapses and recovery, SPMS involves steady progression that can occur with or without relapses. There is no single test for SPMS, so doctors rely on medical history, neurological exams, and MRI scans to assess brain and spinal cord changes. MRI helps detect disease activity, atrophy, and lesion patterns, while blood tests or lumbar punctures may be used to rule out other conditions. A key sign of SPMS is worsening disability over at least six months, independent of relapses. Some people still experience occasional relapses, but the main indicator is continuous nerve damage. Because progression varies, diagnosis can take time and requires careful monitoring. Doctors confirm SPMS when a clear pattern of decline emerges without significant recovery.
What Does a Diagnosis Mean?
Receiving a diagnosis of MS can feel overwhelming, bringing new medications, lifestyle adjustments, and uncertainty. While there is no cure right now for non-relapsing secondary progressive MS (nrSPMS), treatments help patients manage symptoms like mobility issues, fatigue, pain, and trouble thinking. Some disease-modifying therapies (DMTs) may slow progression, while others focus on symptom relief. Physical therapy, diet changes, and assistive devices can improve mobility and daily function. Emotional and mental health support are just as important for both patients and caregivers. Unlike RRMS, which has relapses, nrSPMS progresses gradually without true inflammatory relapses, though temporary symptom fluctuations may still occur.
Understanding the condition, recognizing symptoms, and exploring treatments can help you take control of your health. Although there is no cure, ongoing research continues to bring new treatment options and hope for better disease management.
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