Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system (CNS) that is a leading cause of disability in young adults. The course of MS is variable. For some, MS is a disease with one or two acute neurologic episodes and no further evidence of disease activity. In others, it is a chronic, relapsing, or progressive disease with an unpredictable clinical course that may span 10 to 20 years, during which time neurologic disability accumulates.
Treatment directed at the progressive phase of MS is typically more difficult than treatment of relapsing forms of MS. Immunosuppressive therapies such as total lymphoid radiation, cyclosporine, methotrexate, 2-chlorodeoxyadenosine, cyclophosphamide, mitoxantrone, azathioprine, interferon, steroids, and intravenous immune globulin have shown at least some positive clinical effects in progressive disease. However, all of these nonspecific immunosuppressants suffer from the same basic defect; they may temporarily halt a rapidly progressive downhill course, but it is difficult or dangerous to employ them for more than a few months to a year or two. Thus, since MS is an illness of decades, not months, immunosuppressive therapy is only a temporary solution at best.
This topic will discuss treatment of progressive forms of MS. The treatment of relapsing forms of MS is discussed separately. (See "Treatment of relapsing-remitting multiple sclerosis in adults".) Management of comorbid symptoms is likewise discussed separately. (See "Comorbid problems associated with multiple sclerosis in adults".)
Measures of disease progression and prognosis are discussed in more detail separately. (See "Epidemiology and clinical features of multiple sclerosis in adults" and "Diagnosis of multiple sclerosis in adults".)
PROGRESSIVE MS TYPES
Secondary progressive — Secondary progressive MS (SPMS) begins as relapsing-remitting disease (RRMS), but it later changes so that the course becomes characterized by a steady deterioration in function, unrelated to acute attacks. Typically, the attack rate is also reduced when the secondary progressive stage is reached. This type of MS, which ultimately develops in approximately 80 percent of RRMS patients, causes the greatest amount of neurologic disability.