How Is It Determined When RRMS Changes to SPMS?

Question: 
How is it determined when your RRMS changes its status to the progressive MS diagnosis ? I see my daughter's baseline decline, yet she still has the RRMS status.

Answer:
When a person develops progressive MS after an initial relapsing remitting course, we call this secondary progressive MS (SPMS). Determining the onset of SPMS is very difficult; in most cases we observe a patient at multiple visits over a period of time, usually 1-5 years, and eventually decide that they are now secondary progressive.

There are certain features that suggest secondary progressive MS but all that is really required is progressive worsening of impairment without significant improvement or an alternative explanation over an interval usually in excess of 6 months.  Typical but not required features of secondary progressive MS are the following:

1. Age over 40 and disease duration over 10 years
2. Moderate impairment at onset, most commonly some limitation in ambulation ability such as inability to walk more that 5 city blocks without support and without a rest
3. Diminishing frequency of relapses although relapses can still occur
4. Less frequent gadolinium enhancing lesions
5. Larger “Burden of disease” on standard T2 weighted MRI
6. Evidence of brain atrophy in excess of that expected for age, either regional and global.
   

Rip Kinkel, MD