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The herald of secondary progression in multiple sclerosis (SPMS) is seen as a gloomy event by both patient and clinician, evoking the spectre of the wheelchair and an insidious loss of independent living. After the cut and thrust of the relapsing stage, when even unpleasant and disabling neurological constellations can potentially be reversed or ameliorated by corticosteroids, therapy intervention and natural history; where there is an ongoing dialogue as to exactly which disease modifying treatment would be appropriate at a particular time point; and where there exists the promise of upscaling to monoclonal strategies or commencing soon to be licensed oral agents. When both parties realise that progression has …