Early diagnosis prevents sequelae in cases of multiple sclerosis

Established by Law 11.303/2006, the National Day of Awareness on Multiple Sclerosis, celebrated today (30), aims to give greater visibility to the disease, inform the population and warn of the importance of early diagnosis of the disease, which can be treated and prevented sequelae.

Professor of neurology at the Escola Paulista de Medicina, Federal University of São Paulo (Unifesp), and member of the Brazilian Academy of Neurology (ABN), Denis Bichuetti, told the Brazil Agency that from a clinical point of view, multiple sclerosis (MS) is a chronic and debilitating disease, but if it is diagnosed and treated early, that is, before the sequelae happen, “the patient can be very well, without sequelae for many years . What I mean is that it is a disease that, for me to need a cane to walk, takes 15 years; for me to need a walker, 20 years; and a wheelchair, 25 years old”.


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He warned, however, that as sclerosis is a disease that starts around 20 or 30 years of age and although it takes a long time to generate disability, it attacks people at the most productive time in life, between 20 and 55 years of age. .

The coordinator of Cerebrovascular Diseases at Hospital Icaraí and coordinator of neurology at the Hospital and Clinic of São Gonçalo, Guilherme Torezani, explained that multiple sclerosis is an autoimmune disease that ends up attacking some areas of the brain and compromising the central nervous system. Depending on the area of ​​the brain that is inflamed, various symptoms may appear suddenly, in flare-ups. “If the patient lets it go, he doesn’t investigate, the disease gets worse. It is important to have this awareness that new neurological symptoms should always be investigated by a neurologist. That’s why we talk about early diagnosis”, said Torezani.

early diagnosis

Denis Bichuetti stated that the first reason to diagnose the disease early is to treat it early and prevent the chain of sequelae. The first point to diagnose and treat early is to change the history of the disease, “how the history of polio, stroke, and the history of cancer has changed” in Brazil, he noted.

The second reason is social and economic. “If I treat the person before developing a sequel, the cost of medication, the cost paid for social benefits and the indirect cost of retirement will be much lower.” That’s if I keep the person walking and producing rather than waiting for a sequel to happen. Because I’m going to have to treat this sequel, which is much more expensive than the medicine to keep her going. And the person will stop producing and consuming social benefits”, explained Bichuetti.


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The third reason for early diagnosis and treatment is the good of the person, who is the most interested element, so that he/she stays close to the family, can develop leisure activities, have a job where they will produce and be paid.

I estimated

Data from the International Federation of Multiple Sclerosis and the World Health Organization (WHO), published in 2013, indicated that in Brazil there were 40 thousand cases of the disease. Denis Bichuetti said, however, that this number is underestimated. “Because it is a chronic disease and the person has lived with it for 30 or 40 years, there must be at least twice as many Brazilians with multiple sclerosis. The problem is that not everyone is fully diagnosed”.

According to the Ministry of Health, the average prevalence of the disease in Brazil is 8.69 per 100,000 inhabitants. Worldwide, it is estimated that between 2 and 2.5 million people live with multiple sclerosis.

Faced with sudden symptoms, which occur overnight, such as loss of vision in one eye, pain, changes in sensitivity, loss of limb function, double vision, exchange of words, the person should immediately seek a hospital because it could be a stroke. In general, the symptoms of multiple sclerosis evolve over several days or weeks. Therefore, the recommendation is to seek medical help.

Ideally, the person should go to a neurologist, but as not all cities in Brazil have this specialist, the recommendation is to look for a trustworthy clinician or an emergency room. Denis Bichuetti added that if symptoms are too acute, the patient should be taken to an emergency room, which has the mechanisms to assess whether something else needs to be treated. “Multiple sclerosis can wait until tomorrow. AVC cannot”, he exemplified.

Women

Guilherme Torezani reported that the disease affects twice as many women as men and is diagnosed, on average, at the age of 30 in women, at the most productive age, although it can affect children and older people. This goes for other autoimmune diseases, like lupus, Crohn’s disease, for example. As explained by Denis Bichuetti, women are more likely to develop autoimmune diseases due to genetic factors. “It’s not something exclusive to multiple sclerosis, but to women in general.’

Treatment is with medication. Currently, there are around 14 or 16 drugs approved by a regulatory agency in the world, with scientific recognition for the treatment. Of these, around 12 exist in Brazil and ten are available in the Unified Health System (SUS) network and within the list of the National Supplementary Health Agency.

“In Brazil, except for the issue of delay in diagnosis and the delay, many times, to reach a neurologist, we have medications approved by both the SUS and the private health sector that owe nothing to other countries. The big problem is for people to get to the neurologist, which in SUS is much more complicated than in the private system”, said the professor at Unifesp.


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Recommendation

Denis Bichuetti also said that, on this 30th, the message for the population is that the disease affects young people, it is potentially disabling, but it has treatment. “And with proper treatment, we can avoid sequelae. These people can and should be kept within their social circles and work environments.”

Bichuetti urged employers not to see employees with the disease as invalids, but as people who, if they receive proper treatment, will continue to produce very well and should not be fired. “Looked at as people with any other disease, who have ups and downs and deserve the same opportunity as everyone else.”

Guilherme Torezani also highlighted the importance of demystifying the disease. It is not a death sentence or a disability sentence, he assured. There are patients undergoing stable treatment, with no relapses for years, living an almost normal life. “That’s what we have to leave as a message”.

Neurosurgeon Claudio Fernandes Corrêa, creator and coordinator of the Center for Pain and Functional Neurosurgery at Hospital 9 de Julho, suggested to patients with the disease the regular practice of physical activities, combined with motor physiotherapy and association of medication for sphincter control, if this is the case. committed. For cases of change in muscle control, characterized by muscle rigidity and tension, Corrêa recommended physical rehabilitation physiotherapy added to medication, as well as neurosurgical procedures in more limiting scenarios.


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