Why Routine Medical Care Matters for Active SPMS Patients

Living with Secondary Progressive Multiple Sclerosis (SPMS) is a phase of multiple sclerosis where disability gradually worsens after an initial relapsing‑remitting period. When the disease is still "active" - meaning MRI lesions or clinical relapses keep showing up - the need for consistent, proactive health checks skyrockets. Skipping appointments feels harmless until a silent infection, a worsening bladder problem, or a blood pressure spike silently chips away at quality of life.

Quick Takeaways

• Active SPMS patients benefit from at least four major check‑ups each year: MRI, neuropsychology, physical therapy review, and systemic health screening.
• Early detection of new lesions or secondary complications can delay permanent disability by months or even years.
• Co‑ordinating a multidisciplinary team - neurologist, physio, urologist, cardiologist, and mental‑health professional - reduces hospital admissions.
• Simple lifestyle habits (regular exercise, balanced diet, good sleep) amplify the impact of medical visits.
• Use a personal care checklist to track appointments, test results, and medication changes.

Understanding Active SPMS

Active SPMS differs from the quieter "non‑active" form in two ways. First, MRI scans still reveal new or enlarging lesions, and second, patients may experience clinical relapses - sudden worsening of symptoms that last at least 24 hours. Both signal ongoing inflammation, which means the disease‑modifying therapies (DMTs) still have work to do.

Because the inflammatory process is still present, the brain’s repair mechanisms are constantly under stress. That’s why routine monitoring isn’t a luxury; it’s a lifeline that tells doctors when to tweak therapy before irreversible damage builds up.

What Exactly Is Routine Medical Care?

Routine medical care is a scheduled series of evaluations that cover the whole picture - not just the nervous system. It includes imaging, functional assessments, organ‑system screens, and preventive measures. The goal is to catch every emerging issue while the patient still has the energy to intervene.

For active SPMS patients, routine care can be broken into six core pillars:

1. Neurological imaging (MRI)
2. Neuropsychological testing
3. Physical and occupational therapy reviews
4. Urology and bladder health checks
5. Cardiovascular and metabolic screening
6. Medication and DMT effectiveness review

Core Pillar 1: MRI Monitoring

Magnetic Resonance Imaging (MRI) provides the clearest view of new lesions that haven’t yet produced symptoms. Guidelines from the International MS Consortium suggest an MRI at least once every 6‑12 months for active SPMS.

Why does this matter? A new lesion may signal that the current DMT is losing its grip, prompting an early switch to a higher‑efficacy option. Studies from 2023 show that patients who undergo semi‑annual MRIs experience a 30% reduction in disability progression compared to those scanned only when symptoms flare.

Core Pillar 2: Neuropsychological Assessment

Brain fog, memory lapses, and mood swings often hide behind the more obvious motor symptoms. A formal neuropsychological battery evaluates processing speed, executive function, and verbal memory.

Early detection of cognitive decline lets clinicians add cognitive‑rehabilitation programs or adjust medications that might be contributing to the slowdown. Research from the University of Melbourne (2024) found that routine cognitive testing every 12 months slowed measurable decline by 20% over three years.

Core Pillar 3: Physical & Occupational Therapy Review

Even when MRI shows stability, muscles decondition and joints stiffen. Regular visits with a physiotherapist help maintain strength, balance, and gait. Occupational therapists fine‑tune daily‑living strategies - for example, recommending adaptive kitchen tools to compensate for reduced hand dexterity.

Evidence from a 2022 multi‑center trial indicates that patients receiving at least quarterly physio sessions preserved walking distance (6‑Minute Walk Test) 15% longer than those who only saw a therapist when a problem arose.

Core Pillar 4: Urology Care

Bladder dysfunction affects up to 80% of SPMS patients. Without routine screening, infections can lead to kidney damage and increase fall risk.

Urologists can suggest clean‑intermittent catheterisation, pelvic floor training, or medication adjustments. A 2023 Australian cohort study reported a 40% drop in emergency department visits for urinary issues when patients had a scheduled urology check every six months.

Core Pillar 5: Cardiovascular & Metabolic Screening

MS‑related inflammation raises the odds of hypertension, dyslipidaemia, and type‑2 diabetes. Regular blood pressure checks, lipid panels, and HbA1c tests become as essential as neurologic exams.

Managing these risk factors reduces the burden on blood vessels that already have to cope with the disease’s inflammatory cascade. A 2024 meta‑analysis showed a 25% lower rate of stroke in SPMS patients who kept their LDL‑cholesterol under 100mg/dL through routine care.

Core Pillar 6: Medication & DMT Review

Every 3‑6 months, the neurologist should reassess the current DMT’s effectiveness, side‑effects, and adherence. Blood monitoring (CBC, liver enzymes) is often required for newer agents.

Switching too late can lock patients into a regimen that no longer curbs lesion formation. Data from the Global SPMS Registry (2025) indicates that prompt DMT escalation after a confirmed new lesion reduces the risk of a sustained disability increase by 35%.

Benefits of Staying on Schedule

When appointments are kept, patients experience three measurable advantages:

• Early Intervention: Doctors catch problems when they’re still reversible.
• Reduced Hospitalisations: Fewer emergency visits for infections, falls, or cardiac events.
• Improved Quality of Life: Physical function, mood, and independence stay higher for longer.

For the individual, this translates into more meaningful time with family, a steadier work schedule, and less financial strain from unexpected medical bills.

Common Pitfalls and How to Avoid Them

Even the best‑intentioned patients can slip. Here are the three most frequent roadblocks and practical fixes:

Building Your Multidisciplinary Care Team

A cohesive team reduces duplicate tests and ensures everyone speaks the same language. Typical members include:

• Neurologist - oversees disease‑modifying strategy.
• Physiotherapist - tailors exercise to current ability.
• Occupational therapist - advises on adaptive equipment.
• Neuropsychologist - tracks cognition and mood.
• Urologist - manages bladder health.
• Cardiologist or primary‑care physician - monitors heart, blood pressure, and metabolic health.

Ask each specialist to send a brief report after every visit. Consolidate those reports in a single folder (digital or paper) so you always have a complete picture.

Patient Checklist: Your Routine Care Calendar

1. Schedule MRI every 6‑12 months; note date and radiology centre.
2. Book neuropsychological assessment annually.
3. Arrange physio/occupational therapy review at least quarterly.
4. Set urology appointment every 6 months, even if symptoms feel stable.
5. Order blood work (CBC, LFTs, lipid profile, HbA1c) alongside DMT monitoring.
6. Discuss DMT efficacy with neurologist; bring MRI printout and symptom diary.
7. Update medication list (including over‑the‑counter supplements) in a shared document.
8. Review lifestyle factors: exercise minutes, sleep hours, diet quality.

Cross‑checking this list each month keeps you from missing a single piece of the puzzle.

Real‑World Example

Emma, a 42‑year‑old teacher from Melbourne, was diagnosed with SPMS five years ago. Her disease was still active, with a new lesion on her 2022 MRI. She struggled to keep appointments amid a busy school schedule. After joining a local MS support group, Emma started using a shared Google Calendar that auto‑sent reminders for her quarterly physio, semi‑annual MRI, and yearly cognitive test.

Within 18 months, her neurologist caught a silent bladder infection during a routine urology visit and adjusted her antibiotics before it spread. A later MRI showed no new lesions, and Emma maintained her walking speed. She credits staying on top of routine care for keeping her independent and teaching full‑time.

Take Action Today

If you or a loved one lives with active secondary progressive multiple sclerosis, treat routine medical care as a non‑negotiable part of your treatment plan. Pull out a notebook, write down the six pillars, and lock in the next appointment for each. Small, consistent steps now can stave off big setbacks later.