18 msfocusmagazine.org Medicine & Research Management of Progressive Multiple Sclerosis Treatment options are available and vary by Dr. Ben Thrower, M.D. The past 25years have seen rapid advances in our ability to alter the course of multiple sclerosis.We have gone from no FDA-approved treatment options until 1993 to 16 approved options in 2018. Challenges remain, however. One of these challenges is the management of progressive forms of MS. Before we can effectively manage a progressive form of MS, we must accurately diagnose it.There are two forms of progressive MS – primary and secondary. Primary progressive MS is felt to represent about 10 percent of the MS community. It typicallystarts later in life than relapsing forms of MS and, unlikerelapsingformsofMS,isjustascommon in men as it is in women. Primary progressive MS typically presents with slow progression of walking impairment over a period of years. Secondaryprogressive can be more difficult to define.Approximately 85 percent of people begin their MS journey with a relapsing form of MS. The natural history of untreated MS sees people moving towards a secondary progressive form of the disease over time. Without treatment, approximately 50 percent of relapsing forms of MSwill have transitioned to a secondary progressive form over 10 years. Relapsing-remitting MS and secondary progressive MS should not be thought of as different "boxes," but as a spectrum. People with secondary progressive MS can still have relapses and new lesions on MRI. The management of any form of MS can typically be broken down into: • Treating and managing relapses • Managing symptoms • Altering the disease course by lessening the likelihood of new MRI lesions, relapses, or progression of disability Research is shedding newlight and moving us closer to a fourth treatment possibility – reversal of disability. Symptom management In the previous issue of the magazine, we focused on relapse management and will not do so here. In a moment, we will talk about treatment options for altering the course of progressive forms of MS, but let’s not forget symptom management. In terms of improving aperson'squalityoflife,symptommanagement should not be overlooked. Regardless of whether a person is struggling with fatigue, spasticity, bowel and bladder symptoms, or mobilityissues, treatment options are available. While all forms of MS benefit from a comprehensive and integrated treatment approach, this is especially true with progressive forms of MS. The management of symptoms in progressive MS does not