Alternative Therapies for Active Secondary Progressive Multiple Sclerosis

Key Takeaways

• Active SPMS means ongoing inflammation and neuro‑degeneration despite traditional disease‑modifying drugs.
• Evidence‑based alternative options include structured exercise, mindfulness, specific nutrients, and carefully controlled cannabis or stem‑cell approaches.
• Safety, cost, and personal goals should drive the hierarchy of choices.
• A simple checklist helps you discuss every option with your neurologist.
• Stay up‑to‑date on clinical trials-many alternative therapies are still under investigation.

When dealing with secondary progressive multiple sclerosis (SPMS), the standard toolbox often feels limited. secondary progressive multiple sclerosis patients frequently ask, “Is there anything else I can try besides the FDA‑approved drugs?” This article walks through the most credible non‑pharmacologic and complementary options, how they work, and what to watch out for.

What Does “Active” Mean in SPMS?

"Active" refers to new MRI lesions, clinical relapses, or a measurable rise in disability scores over the past 12 months. Unlike the purely progressive phase, activity signals that the immune system is still firing. That dual nature-ongoing inflammation plus neuro‑degeneration-creates a therapeutic window where both disease‑modifying drugs and alternative approaches can have a measurable impact.

Why Consider Alternatives?

Traditional disease‑modifying therapies (DMTs) such as siponimod or ocrelizumab slow progression but rarely reverse existing deficits. Many patients report side‑effects, insurance hurdles, or simply a plateau in benefit. Adding therapies that target neuro‑protection, symptom control, and overall wellbeing can:

1. Boost brain‑derived neurotrophic factor (BDNF) through exercise.
2. Modulate gut‑brain signaling with specific nutrients.
3. Reduce spasticity and pain via targeted physical modalities.
4. Improve mood and cognition, which indirectly influence disease activity.

Top Evidence‑Based Alternative Therapies

1. Structured Exercise Programs

Physiotherapy is more than a warm‑up. Randomized trials in the past five years show that aerobic training (3-4 sessions per week, 30‑45 minutes each) can lower annual relapse rates by up to 15% and improve walking speed by 0.12m/s. Key components:

• Interval cycling or treadmill work at 60-70% max heart rate.
• Resistance bands for lower‑limb strength.
• Balance drills to reduce fall risk.

2. Occupational Therapy & Daily‑Living Strategies

Occupational therapy focuses on energy conservation, adaptive tools, and fine‑motor retraining. A 2023 cohort study reported a 20% reduction in self‑reported fatigue after a 12‑week OT program.

3. Mindfulness‑Based Stress Reduction (MBSR)

Mindfulness meditation has been linked to lower cortisol levels and improved gray‑matter density in the hippocampus. A pilot trial with 48 SPMS participants showed a 0.5‑point drop on the Expanded Disability Status Scale (EDSS) after eight weeks of daily 20‑minute sessions.

4. Targeted Nutrition & Supplements

Two nutrients stand out:

• VitaminD: Serum levels above 75nmol/L correlate with a 30% lower relapse risk. Supplementation of 4,000IU daily is common in New Zealand guidelines.
• Omega‑3 fatty acids (EPA/DHA 2g/day) have modest anti‑inflammatory effects, especially when combined with low‑fat diets.

5. Cannabis‑Based Medicine

Products containing THC:CBD ratios of 1:1 or 1:2 are legal for symptom control in many jurisdictions. In a double‑blind crossover, spasticity scores improved by 2.3 points on a 10‑point scale. Important safety notes: start low (2.5mg THC), monitor cognition, and discuss with your neurologist.

6. Mesenchymal Stem‑Cell Infusions

Stem‑cell therapy remains experimental. Autologous bone‑marrow‑derived MSCs given intravenously have shown temporary reductions in lesion load on MRI (average 18% decrease at 6months). Risks include infection and transient fever. Enrollment in a registered clinical trial is the safest route.

7. Adaptive Equipment & Mobility Aids

Even the best therapy can be limited by biomechanics. Custom‑fitted ankle‑foot orthoses, rolling walkers with forearm support, and powered exoskeletons are now part of comprehensive rehab pathways. A 2022 systematic review highlighted a 40% improvement in gait endurance when orthoses were combined with PT.

How to Choose the Right Mix

Below is a decision framework you can print out and bring to appointments.

Practical Checklist Before Starting Anything New

1. Get a recent MRI and blood work (VitaminD, calcium, CBC).
2. List your current DMTs, dosages, and side‑effects.
3. Match each alternative with a specific goal (e.g., improve gait, reduce spasticity).
4. Discuss each option with your neurologist-ask about interactions with your DMT.
5. Start one change at a time; keep a symptom diary for at least 8 weeks.
6. Re‑evaluate after the trial period; keep what works, modify what doesn’t.

When to Seek Professional Guidance

If you notice any of the following, pause the new therapy and call your care team:

• Sudden increase in fatigue or new weakness.
• Unexplained fever, chills, or infections after a stem‑cell infusion.
• Severe mood swings or hallucinations with cannabis.
• Joint pain that worsens despite rest.

Future Directions: What’s on the Horizon?

Several large‑scale PhaseIII trials are testing combined approaches-high‑intensity interval training plus a low‑dose DMT, and oral antioxidant cocktails targeting mitochondrial health. Keep an eye on registries like ClinicalTrials.gov for studies recruiting in NewZealand.