Cat: Is there a point where there are so many lesions that you can die, similar to not having a brain?
Professor Gavin Giovannoni, Neurologist: Can you die from not having a brain? No. I mean there is a point in time where the MS causes a lot of damage, so much damage that you can die from the complications of the damage. I mean to be honest with you, MS itself is very, very rarely life threatening, a cause of death itself. The one, the exception is when it affects the so-called brain stem and some people have a big relapse there and it can affect the breathing, for example. And that’s incredibly unusual. What normally happens is over time the damage accumulates and then people develop secondary complications like they get a bladder infection, septicaemia, it spreads to the blood and they die from the infection. Or they don’t swallow properly and they aspirate into their lungs and they die from a complication of the infection. That’s usually the most common way people with multiple sclerosis die, it’s not from the disease itself but the complications of the disease.
And that usually occurs in old age, because most people with MS live an almost normal life span, so the life expectancy of somebody with MS is just between five and eight years shorter than normal, so it’s usually a normal life span. The big issue is they often live it being disabled because they develop complications, so that’s the real issue, is how do we stop people becoming disabled. So it’s not about the brain disappearing and having too many lesions, it’s about the damage it’s left behind. And somebody can have almost a normal brain and all the lesions are in the spinal cord And we see that particularly in people with primary progressive MS, is their brain lesion load is often low, their brains are fine and they’re functioning relatively well, but all the damage is occurring in the spinal cord. So that question’s not quite correct in the sense that MS will destroy the brain completely and you’ll die from your MS. No, you’ll usually die from the complications that MS causes, and it’s usually infector complications.
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Professor Gavin Giovannoni has an MBBCh, PhD, FCP (Neurol., SA), FRCP, FRCPath amongst his qualifications. He is the Chair of Neurology at Barts and The London School of Medicine. His research interests have focused around multiple sclerosis and inflammatory disorders of the central nervous system. His teaching focuses on clinical neurology and neuroimmunology.