Unusual Symptoms of SPMS

Unusual Symptoms of SPMS

Secondary progressive multiple sclerosis (SPMS) is a stage of multiple sclerosis (MS) that follows relapse-remitting multiple sclerosis (RRMS). Not all RRMS patients will progress to SPMS, but those who do usually do so around 15 years into their disease. Neurological examinations are necessary to confirm a transition to SPMS.

While symptoms such as fatigue, muscle spasms, bowel problems, pain, walking difficulties, and dysphagia (difficulties swallowing) are common in SPMS, patients may also experience some lesser known symptoms. Many of these symptoms, discussed below, are paroxysmal, meaning they are felt suddenly and disappear quickly, lasting for a few seconds or minutes at the most.

A burning sensation in the face

Some SPMS patients experience what is called trigeminal neuralgia (TN). TN is a condition that affects the trigeminal nerve — the nerve that carries information from the face to the brain — causing a sudden shock-like pain and burning sensation. TN episodes can be triggered by such everyday undertakings as brushing your teeth or putting on makeup, and these episodes can lengthen in MS patients. Usually, women are more affected than men.

Some patients may also experience glosso-pharyngeal neuralgia (GPN), which is similar to TN in terms of severity but is due to damage in the cranial nerve (glosso-pharyngeal nerve). GPN causes pain in the tongue, throat, ear, and tonsils. It can be triggered by laughing, coughing, swallowing, or speaking.

Unprovoked laughing or crying

SPMS patients can have uncontrolled bouts of laughing or crying without any evident trigger. This is called the pseudobulbar affect (PBA) or emotional incontinence. PBA is due to lesions in the part of the brain that controls emotions, called the amygdala. PBA can be distressing and prove challenging at work, school, and in social life; patients having these emotional bursts should discuss them with their healthcare team.

Feeling of electric shocks along the spine

A sudden feeling of electric shock that runs down the spine and the legs is called Lhermitte’s sign, and is due to inappropriate communication between damaged nerves in the neck and the brain (demyelination and hyperexcitability). This damage causes the brain to interpret signals as pain when, in reality, no physical stimulus exists. Lhermitte’s sign is not restricted to MS; it can occur in other neurological conditions as well.

Unusual sensory symptoms

Some SPMS patients may experience a strange sensation of cold and wetness along their limbs or elsewhere on the body. Some also feel numbness that may affect the positioning of the hands and feet, tingling sensations and pinpricks (paresthesia), vibrations, feelings of extra padding on the limbs, or the presence of an object that is not there.

Hugs and itches

Another symptom expressed by some SPMS patients is dysesthesia, a word that means a feeling that is “not normal.” Dysesthesia includes painful, burning sensations that create a feeling of a tight hug, and is commonly called the MS hug. It comes as a tight band or girdle-like sensation usually around the waist or chest (ribs), but can also affect the neck or limbs. It can be brief or long-lasting.

Dysesthesia also includes a symptom called pruritis, or itchiness, that is often severe and uncomfortable. Since the itchiness is the result of nerve damage, it does not respond to topical anti-itching creams and requires professional care.

Blurred vision

In some SPMS patients, vision blurs or worsens when body temperature increases because of overheating or exercise. This is called Uhthoff’s syndrome, and is triggered because the rise in body temperature affects nerve signal transmissions from the eyes to the brain. Uhthoff’s syndrome is usually resolved by cooling your internal temperature with a gel pack, by drinking cold water, or taking a shower.

Optical illusions

SPMS can, in some patients, cause a symptom called the Pulfrich phenomenon. Pulfrich phenomenon is due to inflammation of the optic nerve that runs from the eye to the brain (optic neuritis), creating a false sense of depth. For example, objects that are actually coming toward you in a straight line may appear to take a rounded or elliptical path, much like how planets circle the sun. Proper depth perception can be restored by using spectacles with special filters.

Spasms in the arms and legs

Abnormal electrical discharges in the brain can cause seizure-like spasms in the arms and legs. Patients may experience a sudden tightening of the limbs, twitching, or the kicking out of a leg. Spasms can also affect the muscles of the trunk and face.

Dizziness, vertigo, and migraines

Feelings of dizziness and vertigo are less common, but can affect daily life for SPMS patients when combined with symptoms such as muscle weakness. Headaches and migraines are also known to affect people with SPMS, causing nausea and sensitivity to sound and light.


Last updated: Oct. 30, 2019


Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Total Posts: 12
Özge has a MSc. in Molecular Genetics from the University of Leicester and a PhD in Developmental Biology from Queen Mary University of London. She worked as a Post-doctoral Research Associate at the University of Leicester for six years in the field of Behavioural Neurology before moving into science communication. She worked as the Research Communication Officer at a London based charity for almost two years.

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  1. Terry says:

    I’ve had MS since 1988. It started as RRMS, but am sure it graduated to SPMS years ago although nobody made an “official” announcement.

    Appreciated this list. Have had the MS hug off and on for ages along with a myriad of stuff. But the sensory and itching issues popped up just a few years ago. Figured they were MS-related. Gotta laugh at myself when I’m hunting for the water on the floor or the countertop that isn’t there…but my feet and hands tell me otherwise. One more adjustment.

  2. Cynthia says:

    I have had all of these symptoms for years….even when it was considered RRMS. I was diagnosed with SPMS about 10 years ago . My rehab specialist suggested tonic water with quinine in it to help the spasms…I haven’t had one since I started drinking it.It tasted awful the first time I tried it…but I have gotten to really enjoy my ”tonic” mixed with orange juice. It is very high in sugar, so I only drink about 3 or 4 oz. per day…and it works well for me.

  3. Kim Pedersen says:

    I wonder why doctors are so hesitant to say a persons RRMS has changed to SPMS. I wa diagnosed with MS 24 years ago. For the last 10 years plus I have had terrible burning in my legs that is getting worse all the time. I can no longer stand for more than 3 minutes or walk more than a few feet. Yet the doctor says I have RRMS, when I haven’t had a relapse in 15 years. I get strange feelings of cold and water, etc. Also get spasms lasting maybe 30 seconds where parts of my body are like an electric shock, tensing and straightening up. Seems like there is little help anyway. My doctor put me on hydromorphone, for my “bad days”. Every day is the same, so I’d be on it continually! That’s nuts!

    • Dory says:

      I was told Drs don’t diagnose because it limits your treatment options. My neurologist said I’m moving into SPMS but if diagnosed I couldn’t continue my current MS Tysabri infusion. She feels that is best for me. I agree.

  4. Greg bond says:

    I think many of these symptoms are common to all forms of MS and are not unique to SPMS. Some of them I experienced early on when I KNOW I was RRMS. I don’t think the stage of MS is as relevant as where your lesions are and areas of damage. Early on, I had lhermittes-sign, but it eventually went away and I never experienced it since. Then early on I started getting numbness in my legs and I still hav it, not any worse but not any better.

    Many of the symptoms you address are sensory in nature. The most debilitating symptom for me is MS fatigue which has gotten worse over the past 10 years but may also be due to the fact I’m 10 years older too.

  5. David Kadlec says:

    I was told by my neurologst that doctors don’t like to diagnose patients with spms because there wasn’t any treatment for spms. Now that there is a treatment for spms doctors may not be so hesitant to diagnose it.

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