About 20% of Multiple Sclerosis patients remain asymptomatic or become only mildly symptomatic after an initial clinical event. On the other end of our disease spectrum 20% experience a rapidly progressive condition. Most MS patients will have some degree of disease progression. (May 27, 2015 HealthDay News)

There can be an emotional and philosophical divide between those two ends of the spectrum and each stage in between.  Some mildly effected MS patients state they do not want to hear about the severely affected Msers, because their fear is that all MS patients experience total paralysis and the need for 24hour care as they progress.  Others feel that the more severely progressed Msers did not maintain a healthy lifestyle or comply with medical treatment, which resulted in their level of disability.  Even with highly successful treatments, both pharmaceutical and natural, there is a percentage of MS patients with a disease course that does not respond.  I believe the key to understanding and respect between all MS patients, their loved ones, and caregivers is education and awareness.  With that in mind, let’s take a look at the process of neuron death in Multiple Sclerosis.

The nervous system is divided into the

• peripheral nervous system (PNS) and the
• central nervous system (CNS)

The PNS consists of

• sensory neurons running from stimulus receptors that inform the CNS of the stimuli
• motor neurons running from the CNS to the muscles and glands – called effectors – that take action.

The CNS consists of the

• spinal cord and the
• brain

The Autonomic Nervous System

The autonomic nervous system consists of sensory neurons and motor neurons that run between the central nervous system and various internal organs such as the heart, lungs, viscera, and glands.

One type of cells in your nervous system are Neurons (nerves) which are information messengers.  They use electrical impulses and chemical signals to transmit information between different areas of the brain, and between the brain and the rest of the nervous system.  The neuron receives it messages through the axon which is covered by the protective myelin sheath that is damaged by Multiple Sclerosis.  The nerve eventually withers.  For a small minority of cells there can be regeneration.  Hence, the rise in stem cell research and treatments.

 Because muscles and neurons supplying the muscle operate as a functional unit, disease of both systems results in muscular atrophy (wasting) and paralysis.  Neuron damage can lead to choking and swallowing problems from dysphagia, aspiration pneumonia, inability to speak, GI tract or bladder weakness or paralysis, and involuntary system muscle damage such as heart, lungs, and kidneys.  One nerve that can be damaged is the vagus nerve which transmits impulses to the stomach and intestines. Injury to the vagus nerve can impair gastric emptying.  This can lead to gastroparesis where motility issues can prevent food movement and digestion.  It can also lead to neurological ileus or paralytic ileus that can result in loss of all intestinal function.  Secondary infections with these disorders can be very dangerous or life threatening if not treated in time.

Neuron damage to our major organs can become quite debilitating or even life threatening, but does not always lead to early death.  The secondary infections caused by this lack of function, or arising from the use of devices to perform these functions can result in early death.  To give just a few examples of these devices; this neuron damage can lead to the use of nebulizers, oxygen, or trachs for lung damage, gastric pacemakers or button type feeding tubes for stomach damage, pacemakers for our hearts or bladders, and catheters, ostomies, and colostomies for loss of bladder or bowel function.  Sepsis and pneumonia are two of the top causes of death for a person with Multiple Sclerosis.  A recent study suggested people with multiple sclerosis may have twice the risk of dying prematurely compared to people without MS.  And the study also found that for people younger than 59 with MS, the risk of an early death seemed to be tripled, compared to people without the disease.  Overall, MS patients live an average 76 years, compared with 83 years for people who don’t have the disease, the study revealed.  “There are some suggestions that survival is improving over time, but there is still a gap of about six years,” said lead author Dr. Ruth Ann Marrie.  She is an associate professor of neurology and director of the Multiple Sclerosis Clinic at the University of Manitoba in Winnipeg, Canada.  The most common cause of death was multiple sclerosis itself, or complications related to the disease, the researchers found. (May 27, 2015, the journal Neurology)