As a PPMSer, I've never had an enhancing lesion in my life. At first, reading my MRI report I was thrilled. Small, not enhancing, it all sounded good for MS. Then I found out it was PPMS. I have one spasming leg, but that's occasional and I don't need to medicate, my fatigue level is not overwhelming ( thouh I do get tired but I am older). Sometimes I read and don't sleep during my afternoon break. Some write about RR and my PP, while affecting my legs, has not been real hurtful in other ways. What I'm trying to say, everyone is different. My MS is not your MS. Someone said "location, location, location. As some men say, "size doesn't always matter". Well, I've found this to be true. In PPMS I mean.