Multiple sclerosis (MS) is a chronic condition affecting the brain, spinal cord, and optic nerves, which together form the central nervous system. MS interferes with the body’s ability to control its functions, potentially leading to disability. Progressive MS is a specific form of the disease characterized by a continuous worsening of symptoms, distinguishing it from relapsing-remitting MS (RRMS), where symptoms appear in distinct attacks followed by periods of recovery.
Understanding Progressive Multiple Sclerosis
Progressive MS is broadly categorized into primary progressive MS (PPMS) and secondary progressive MS (SPMS). PPMS affects about 10-15% of individuals with MS and is marked by steadily worsening symptoms from the very beginning. SPMS develops in many individuals who initially had RRMS, where after years of relapses and remissions, the disease transitions into a progressive phase with steady symptom worsening and less frequent flares.
Individuals with progressive MS often experience more spinal cord lesions than brain lesions, leading to common issues with walking and mobility. The onset of symptoms in PPMS can be insidious and slow, making diagnosis challenging.
Disease-Modifying Therapies for Progressive MS
Disease-modifying therapies (DMTs) for progressive MS aim to slow disease progression and reduce the accumulation of disability. These treatments often target the immune system to mitigate the ongoing damage to the central nervous system. Currently, a limited number of DMTs are specifically approved for progressive MS.
One such therapy is ocrelizumab (Ocrevus), a monoclonal antibody approved for both relapsing-remitting MS and primary progressive MS. Ocrelizumab works by targeting CD20-positive B cells, which are immune cells believed to play a role in MS inflammation and nerve damage. Clinical trials have shown that ocrelizumab can slow the progression of disability in individuals with PPMS.
Siponimod (Mayzent) is another oral DMT approved for secondary progressive MS, particularly for those with active disease. This medication is a selective sphingosine-1-phosphate (S1P) receptor modulator, trapping immune cells in lymph nodes to prevent central nervous system damage. Siponimod has been shown to reduce relapse rates and slow the progression of disability in SPMS. While these therapies offer important benefits, research continues to explore additional options, particularly for those with less inflammatory progressive MS.
Symptom Management and Supportive Care
Managing the diverse symptoms of progressive MS is a comprehensive effort, often involving a multidisciplinary healthcare team. This approach focuses on improving daily function and enhancing quality of life, alongside disease-modifying treatments. Therapies like physical therapy, occupational therapy, and speech therapy are integral components of this care.
Physical therapy addresses mobility challenges, muscle weakness, spasticity, and balance problems through tailored exercises and movement strategies. Occupational therapy assists individuals in adapting to daily activities, providing strategies and equipment to maintain independence despite physical limitations. Speech and language therapists help manage speech difficulties, such as dysarthria, and swallowing problems, which can impact nutrition and lead to aspiration risks.
Medications are often prescribed to alleviate specific symptoms:
Spasticity, a common and often painful symptom, is managed with muscle relaxants.
Fatigue, which affects many individuals with MS, is addressed through medication and lifestyle adjustments.
Bladder dysfunction is managed with specific medications and behavioral interventions.
Pain, including headaches and neuropathic pain, is addressed with appropriate medications like antiseizure or antispasmodic drugs.
Mental health support, including counseling or cognitive behavioral therapy, helps individuals cope with the emotional and psychological impacts of MS.
Emerging Treatments and Research
The landscape of progressive MS treatment is continuously evolving with ongoing research into new therapies. Scientists are exploring various avenues, including neuroprotection, remyelination strategies, and novel immune modulators. Neuroprotection aims to safeguard nerve cells from further damage, a significant component in progressive MS.
Remyelination therapies focus on repairing the damaged myelin sheath that surrounds nerve fibers, potentially restoring lost function. Researchers are investigating compounds like anti-LINGO-1 antibodies, which block proteins inhibiting myelin growth, and exploring stem cell therapy to regenerate myelin. Additionally, new immune modulators, such as Bruton’s tyrosine kinase (BTK) inhibitors and S1P receptor modulators, are being studied for their potential to reduce inflammation and slow disease progression. These ongoing clinical trials offer hope for a broader range of effective treatment options for progressive MS in the future.