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Wednesday, August 24, 2016

Primary Progressive Multiple Sclerosis (PPMS)


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By Susha Cheriyedath, MSc

Primary progressive multiple sclerosis (PPMS) is an uncommon form of MS that affects approximately 10-15% of MS patients. In PPMS, symptoms steadily get worse over time without frequent relapses or remission.

Unlike relapse-remitting MS (RRMS), which affects women more than men, PPMS affects an equal number of both genders. PPMS is usually diagnosed in older individuals between the ages of 40 to 60, yet it is sometimes diagnosed beyond this range.

Early symptoms in PPMS develop slowly over a period of time and usually involve issues with walking and general mobility. The pace and progress of PPMS can vary from patient to patient. In some people with PPMS, relapses can occur along with steady disease progression. This is referred to as progressive-relapsing MS (PRMS).

Diagnosis of PPMS

The diagnosis of PPMS is particularly difficult as it is diagnosed in the 40s and 50s when other health issues related to mobility tend to develop. Since PPMS is characterized by a gradual and steady accumulation of disability over time, the criteria for diagnosis of PPMS are different from that of other forms of MS.
The criteria include:
  • Steady disease progression
  • Worsening of neurological function for one year without remission
  • Brain lesions typical of MS
  • Multiple lesions in the spinal cord
  • Indications of immune activity in the CNS (such as elevated IgG index)
These criteria often take a long time to develop, hence PPMS diagnosis usually taking two to three years more than diagnosis of RRMS.

Management of PPMS

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