Transitioning to Progressive MS

Question:
​My neurologist does not believe in doing MRIs unless "something changes." Two recent bouts of vertigo prompted him to order my first MRI since diagnosis 14 years ago. I’m awaiting the results, but prior to the test, he suggested that I might be transitioning to secondary-progressive MS and that - given my age (55) and duration of disease (20-25 years from commencement of symptoms) - I could consider discontinuing my Copaxone treatment. This is obviously a very big decision for me, and I want to be sure that it’s well-grounded. In the absence of regular MRIs, what evidence should I be looking for to substantiate this transition? What new MRI findings and other clinical observations would point to an SPMS diagnosis? Should my age be a factor in making the decision to discontinue treatment? What other questions should I be asking my neurologist? And is it fair to ask for a second opinion?

​Answer:
We prefer now to characterize MS as Relapsing or Progressive. This is entirely determined by clinical features. Relapsing patients have periodic, often rare relapses, with little if any continuous worsening of their condition between relapses that can be measured. Progressive patients slowly worsen over periods in excess of 6 months in a way that we can measure in clinic. Progressive patients may also experience rare relapses (see below for activity definition).

Once we decide if a person is relapsing or progressive, we determine their activity over a certain interval, such as a year. Active MS means you’ve experienced a verified relapse or a definite new T2 (white spot) or enhancing lesion on MRI. We tend to use disease-modifying therapies (DMTs) in those patients indicated by the X in the boxes of the above table. Those with long standing progressive disease without any activity do not respond to any of our current therapies.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego
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