• SPMS is often diagnosed retrospectively with a delay of up to three years, as many of the subtle signs and symptoms marking progression (cognition, balance) are often missed1,2
  • Signs that can indicate progression from RRMS to SPMS include an overall worsening of symptoms; loss of cognitive function, worsening ambulation, muscle weakness, impaired vision, fatigue, and bladder symptoms are signs of progression2,3
    • A lack of clear recovery, increased severity, continued relapses and presence of new symptoms are also signs of progression with SPMS
  • No single sign or symptom indicates progression to SPMS2


Symptoms associated with and important in identifying SPMS, as reported by clinicians (N=16)2


Graph showing the no. clinicians reporting symptom important in progression to SPMS vs no. clinicians reporting that symptom

Adapted from: Ziemssen T, et al. Mult Scler Relat Disord. 2020;38:101861


More people with SPMS vs. RRMS generally rate their MS as being of greater severity (21.9% [n=105] vs. 5.7% [n=458], respectively; p<0.001)3

Circular arrow round person's head icon for ambulatory and balance-related issues

Prominent diagnostic symptoms of SPMS include loss of cognitive function, vision-related symptoms, and ambulatory and balance-related issues2,3

Cognition decline is a key sign of SPMS
  • Cognitive dysfunction is more common in SPMS than RRMS,4,5 with a higher number of patients with at least one or two deficient cognitive domain(s)6
    • In a large (N=1040; RRMS patients=759 and SPMS patients=74) sample study investigating cognitive dysfunction in MS, a significantly larger proportion of patients with SPMS vs. RRMS experienced cognitive impairments (79.4% vs. 44.5%, respectively)7
  • Other early signs of cognitive decline in MS include deterioration of verbal fluency, followed by attention and information processing deficits8


MS, multiple sclerosis; RRMS, relapsing-remitting multiple sclerosis; SPMS, secondary progressive multiple sclerosis.


  1. Katz Sand I, Krieger S, Farrell C, Miller AE. Mult Scler. 2014;20(12):1654–1657.
  2. Ziemssen T, Tolley C, Bennet B, et al. Mult Scler Relat Disord. 2020;38:101861.
  3. Gross HJ, Watson C. Neuropsychiatr Dis Treat. 2017;13:1349–1357.
  4. Oset M, Stasiolek M, Matysiak M. Curr Neurol Neurosci Rep. 2020;20(7):22.
  5. Brochet B, Ruet A. Front Neurol. 2019;10:26.
  6. Planche V, Gibelin M, Cregut D, et al. Eur J Neurol. 2016;23(2):282–289.
  7. Ruano L, Portaccio E, Goretti B, Niccolai C, Severo M, Patti F, et al. Mult Scler. 2017;23(9):1258–1267.
  8. Achiron A, Polliack M, Rao SM, et al. J Neurol Neurosurg Psychiatry. 2005;76(5):744–749.
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UK | December 2021 | 145902

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