Symptoms of PPMS progress from the time they first appear without remissions. Symptoms may include balance issues, cognitive decline, and muscle weakness, among others.

Multiple sclerosis (MS) is an autoimmune condition that affects the central nervous system (CNS).

It occurs when the immune system mistakenly attacks the myelin sheath, or coating on nerves, in your brain and spinal cord.

Primary progressive multiple sclerosis (PPMS) is a type of MS that affects about 1 in 10 people with MS.

Keep reading to learn more about the symptoms, causes, and treatments for PPMS.

There are four types of MS, whose names reflect the progression of symptoms over time. These include:

CIS and RRMS are characterized by acute attacks with symptoms (relapses), and periods of months or years with little to no symptoms (remissions).

On the other hand, symptoms of PPMS progress once they start to appear.

There may be periods where symptoms actively worsen or periods of inactive progression, but the defining feature of PPMS is that disability continues to accumulate or progress. In RRMS, you’ll typically have some degree of recovery from relapses or acute attacks.

PPMS is often diagnosed in people in their 40s, according to the MS Society UK. RRMS, on the other hand, usually presents in people in their 20s and 30s.

According to the National Multiple Sclerosis Society (NMSS), there are fewer treatment options for PPMS than for relapsing forms.

Learn more about the differences between PPMS and RRMS.

Symptoms of PPMS are similar to those of other types of MS.

However, PPMS symptoms progress over time. The NMSS notes that PPMS symptoms may also be more severe than other types of MS. For instance, people with PPMS are more likely to require assistance with daily activities.

Symptoms of PPMS may include:

  • muscle spasticity
  • muscle weakness
  • balance issues, such as dizziness and trouble walking
  • bladder dysfunction
  • sexual dysfunction
  • mood changes, such as depression
  • numbness or tingling (neuropathy)
  • fatigue
  • tremors
  • vision problems, such as double vision, blurred vision, and difficulty identifying colors
  • issues with cognition, such as difficulty remembering and processing information

No single test can confirm an MS diagnosis alone, so doctors use a combination of examinations to determine the underlying cause of your symptoms.

A doctor will likely conduct a medical history exam and ask you about any previous neurologic events. They’ll also do a thorough physical exam, specifically checking your nerves and muscles.

They may then order several tests, such as:

  • blood tests to rule out other conditions
  • MRI to check for lesions in the brain and spinal cord
  • evoked potentials (EP) test to check for electrical activity in the brain
  • spinal tap to look for signs of MS in the spinal fluid

PPMS has similar symptoms to other types of MS, as well as other nervous system disorders. As a result, it may take up to 3 years longer to receive a confirmed PPMS diagnosis than an RRMS diagnosis.

According to the NMSS, to get a confirmed PPMS diagnosis, you must:

  • have 1 year of progressively worsening neurologic function
  • meet two of the following criteria:
    • a brain lesion common to MS
    • two or more similar lesions in your spinal cord
    • presence of proteins called immunoglobulins

Receiving a diagnosis of PPMS may be difficult and lead to feelings like anxiety and stress.

Although there is no cure for PPMS, a healthcare professional can help develop a treatment plan to help improve symptoms and quality of life.

Treatment for MS includes disease-modifying therapy (DMT) drugs to help reduce inflammation in your CNS.

Over 20 DMTs are available for MS, but only one is approved by the Food and Drug Administration (FDA) for PPMS. This may be because PPMS is more likely caused by nerve degeneration, rather than inflammatory relapses.

The DMT ocrelizumab (Ocrevus) is approved for PPMS as well as relapsing forms of MS.

Along with medications, a doctor may help build a healthcare team to address different needs you may have.

For instance, a physical therapist may help you manage walking difficulties, while a psychologist could help with mental health and mood changes.

Other healthcare professionals that may be part of your healthcare team could specialize in:

  • speech pathology
  • gastrointestinal care
  • vision care

Some tips to help you manage symptoms of PPMS include:

  • getting regular exercise, including stretching, balance, and strength-building exercises
  • using assistive devices, such as walking aids and larger utensils
  • avoiding hot weather, if possible
  • relieving stress, such as meditation, yoga, or joining a PPMS support group

A doctor may also recommend medications to help manage various symptoms of PPMS, such as dizziness, gastrointestinal issues, and tremors.

Connecting with others living with PPMS may also help you manage your condition. You can speak with a healthcare professional about PPMS support groups in your local area or use the NMSS‘s service.

There are also many online communities you can join, such as Bezzy MS.

Although there’s no cure for PPMS, early diagnosis and treatment could help you manage symptoms.

The average life expectancy for someone with MS is shorter by 5 to 10 years, according to the United Kingdom’s National Health Service.

A 2023 review found that life expectancy is growing and has been nearly the same as that of the general population in the past 10 years.

However, the authors note that MS comorbidities are increasing.

A 2020 review found that high blood pressure (hypertension) and depression were the most common comorbidities associated with MS. Type 2 diabetes was also significantly higher in people with PPMS than with RRMS.

How fast can PPMS progress?

The progression rate for PPMS is different for each person. A 2021 review found that, on average, the majority of people with PPMS reach moderate disability within 5 years of symptom onset and severe disability within 15 years.

What is the first symptom of PPMS?

PPMS affects everyone differently. Early symptoms of PPMS are subtle but may affect your walking abilities more than other types of MS.

Does PPMS ever stop progressing?

You may experience periods when symptoms are settled and don’t worsen. However, unlike relapse types, symptoms will still be present.

PPMS is a type of MS in which symptoms progress from their onset.

Symptoms are similar to other types of MS. However, people with PPMS are more likely to experience difficulty walking.

There are ways to improve your symptoms and quality of life with the help of doctors, physical therapy professionals, speech pathologists, and mental health specialists.