How to Manage Inactive SPMS

If you have inactive secondary progressive multiple sclerosis (SPMS), you know firsthand that it can be difficult to manage. Unlike active SPMS, where you see clear signs of new relapses, inactive SPMS progresses gradually, with worsening symptoms sometimes going unnoticed and untreated.

While researchers work to close this treatment gap, there are other ways to manage inactive SPMS symptoms and feel better in your day-to-day life. “While there isn’t any disease-specific therapy, we still want to make sure we’re treating your symptoms and doing everything we can to improve your quality of life,” says Paunel Agyei, MD, a board-certified neurologist for the Mellen Program for MS at Cleveland Clinic in Weston, Florida.

Your care team can work with you to find symptom-targeted medications, therapies, and lifestyle habits to help you feel and move better. Keep reading to learn more about your options.

• Anticholinergic drugs to help with urinary incontinence or urgency
• Anticonvulsants to reduce nerve pain and tingling
• Antivirals to help with fatigue
• Muscle relaxants to ease muscle spasms and stiffness

Rehabilitation therapies can also help you live better with inactive SPMS. “We want you to maintain your strength and function, so having a multidisciplinary approach is very important,” says Agyei.

• Physical therapy to improve your balance, gait, and strength
  
• Cognitive therapy, to improve your ability to focus, remember things, and think
• Occupational therapy to make everyday activities, such as brushing your teeth and getting dressed, a bit easier
• Pelvic floor therapy to improve bladder, bowel, and sexual function
• Speech therapy to help improve communication or swallowing issues

Your daily habits also play a big role in managing symptoms. “Things like eating a well-balanced, healthy diet and doing regular exercise as tolerated can improve MS outcomes,” says Agyei.

• Eat a healthy diet. Research suggests that following a Mediterranean diet may lower your risk of worsening disability.

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  Focus on fruits and vegetables, legumes, nuts, and whole grains, and avoid red meat and sugar, which can lead to inflammation and worsening symptoms.

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• Exercise regularly. “Make sure you’re getting some form of exercise,” says Agyei. Moving your body can improve your balance, coordination, and strength. Plus, it’s a natural mood booster. Opt for mild-to-moderate exercises, such as biking, stretching, tai chi, walking, and yoga. You can also find MS-specific workout videos from Overcoming MS online, with moves you can do at home, Agyei notes.
• Stay cool. Getting overheated can make MS symptoms worse. Try to exercise in cool environments, or use cooling vests or neck wraps.
• Reduce stress. Stress may worsen MS symptoms, so it’s important to incorporate calming techniques into your day, such as deep breathing, meditation, and mindfulness.
• Try acupuncture. “Many of my patients find benefit from acupuncture in relieving pain and chronic symptoms like muscle spasms,” says Agyei. Research confirms that many people with MS report that acupuncture improves their quality of life, as well as bladder function, fatigue, and other symptoms.

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• Get restorative sleep. Make sure you’re getting good quality rest. Aim for seven to nine hours of sleep each night to support cognitive function and fight fatigue. If you aren’t sleeping well, make an appointment with a sleep specialist, who can evaluate you for obstructive sleep apnea (which is common in people with MS).

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• Prioritize your mental health. “We focus a lot on physical health, but your mental health is important, too,” says Agyei. If you’re experiencing symptoms of anxiety or depression, such as a consistent low mood or extensive worrying, you may find it helpful to work with a therapist who specializes in chronic conditions. They can help you find ways to cope and serve as a key part of your care team.
• Check in with your care team regularly. Seeing your primary care provider regularly is also an important step in preventing chronic conditions that are common with MS, such as diabetes, high blood pressure, and obesity, Agyei notes. “Managing chronic conditions helps improve your outcomes with MS,” she says.

Managing inactive SPMS comes with challenges, but the treatment landscape is becoming stronger than ever as targeted medications are studied in clinical trials. In the meantime, DMTs, complementary therapies, and lifestyle changes can support you and ease daily symptoms of MS.

• Currently, there are no medications that treat inactive SPMS specifically. But disease-modifying therapies can help you manage symptoms such as fatigue, muscle stiffness, and more.
• Rehabilitation therapies, such as occupational therapy, physical therapy, and speech therapy, can make daily tasks easier and improve your quality of life.
• Lifestyle habits, such as eating a Mediterranean diet, getting restorative sleep, and managing stress can help you feel and live better.