So Matt I will take a shot at some kind of answer for you. Lots of MS medications have long lists of side effects. They are not always consistent from one person to the next. Neurologists can be hard to get the right one. You need someone to work with you not just prescribe medications. Disease modifying therapy’s are very different from one MS sufferer to the next. Watch closely for side effects. You have to be your own strongest advocate. Grill your Dr’s hard and make sure you get full answers. As for more lesions showing up on your MRI. Some do not show up as symptoms but none the less your disease is active is what this MRI is telling you. As far as determining whether you are secondary progressive that is hard to determine. Because MS is an incurable disease some Dr’s hesitate to say that you have progressed to that. You have to judge if you are experiencing effects from your last relapse or if you are experiencing new symptoms that remain persistent. I don’t mean to be depressing but ultimately the decision of how you are going to treat your MS will be up to you so information is critical. Best wishes.