14 msfocusmagazine.org Health & Wellness subgroups of MS, including PPMS. However,therehavebeenstudiessuggesting subtle differences between PPMS and RRMS. PPMS is less frequent than RRMS. Estimates of the frequency of PPMS have varied widely, from8percentto40percent,withmostobservers documenting figures of between 10 percent and 20 percent of the total MS population. There also appears to have been a gradual decline in frequency of PPMS since the 1980s. The reasons for this are unclear, but may reflect patterns of earlierreferral and diagnosis, and more accurate and earlier classification of disease. All of these studies suggest that PPMS and RRMS are different clinical manifestations of the same disease, perhaps with associated prognostic features that suggest a more rapid progression in PPMS patients. How do we approach the treatment of PPMS? One of the main issues to understand is that despite the poor prognosis commonly assumed in patients with progressive disease, progression of disability in MS is slow. Large studies suggest that only 6.3 percent of patients had reached disability milestones within two years of disease onset, and 24.9 percent after five years. More importantly, it has been confirmed in several studies that the earlier PPMS patients start treatment for their disease, the greater the benefits on overall prognosis. The FDA recentlyapprovedocrelizumab,thefirstdisease- modifying therapy for the treatment of PPMS patients.The medicationwas studied in a large clinical trial and was found to significantly decreasethelikelihoodofPPMSpatientsreaching disability milestones. It also demonstrated a significant reduction on worsening MRI outcomes. Previous studies in PPMS patients receiving Rituximab also suggested benefit, particularly in patients younger than 51 years of age, and in those patients who had MRI evidence of active lesions. In addition to disease modifying therapies, we always payattention towellness and overall health. It is well-demonstrated that physical activity, exercise, and cognitive rehabilitation prevents further progression of disability and, in some cases, improves clinical outcomes. It is always important to have a team of experts to help you develop a personalized treatment approach to your disease. Often patients need to see not only a neurologist, but also a physical therapist, occupational therapist, psychologist, nutritionist, urologist, etc. Every person is different and might have different needs atvarious stages of the disease. Hence,itisimportanttoregularlyseeyourteam and make sure everybody works together to be as proactive as possible to ensure an excellent quality of life.