TO WIN, SOMETIMES, YOU MUST LOSE - The unwanted effects of treatments for MS

Although it's a chronic disease (i.e., uncured), degenerative, multiple sclerosis has a treatment and can be controlled. Currently, in the US and the world, there are several treatment options for multiple sclerosis, ranging from oral capsules, administered once or twice a day, even daily, weekly or monthly injections. In addition to reducing the occurrence and severity of relapses - and hence reducing the problems caused by it - some drugs already act preventively in relation to the accelerated degeneration of the brain (cerebral atrophy) caused by the disease. To follow a treatment to control a chronic disease appears to be a natural behavior of patients, however, it is not always what happens. And the abandonment or lack of rigor in relation to the prescribed treatment may compromise the results or even worsen the health status of the patient. Poor adherence to treatment is a universal phenomenon and a concern to doctors, health authorities and bodies such as the World Health Organization (WHO).

WHO appraises membership as "the degree to which the behavior of a person taking medication,

following a diet and / or performing changes in lifestyle, corresponds to the guidelines agreed with the health team." The organization claims that adherence to treatment is a fundamental tool for the management of chronic diseases. Its benefits extend to the patient, who happens to have a controlled condition and can, in most cases, maintain a normal and economically active life; the family, who can put aside their caretaker role and engage in other activities; and the health system, which saves by reducing emergency admissions and surgical interventions, promoting increased productivity. There are different levels of acceptance. At the highest level are the patients who follow all prescriptions, not only in relation to medication as the adoption of new behaviors, such as exercise and physical therapy and the adoption of a diet, among others. At the intermediate level are those limited to the medicine, without, however, changing their behavior. There is also the lowest level, which are the individuals who now and then "forget" to take the medicine. On the opposite side of accession are those who abandon treatment. Among the factors that affect and often lead patients to abandon treatment are: the incorrect perception or ignorance of the seriousness of the problem; the absence of symptoms; the high cost of medication; complex drug administration schemes (for example, taking several times a day); and especially the unwanted side effects and adverse reactions.

Doctors prescribe - and we take - drugs because they have the goal of producing a positive effect. However, possibly, unwanted and even dangerous side effects can occur. WHO defines adverse drug reaction (ADR) as "any harmful or undesirable and unintended response that occurs with medication in doses normally used for prophylaxis, diagnosis, disease treatment or modification of physiological function". Adverse reactions are classified, based on different criteria in A and B. Type A are the predictable reactions, while the Type B reactions are unpredictable. The type A reaction are the result of an action or an exaggerated pharmacological effect after administration of a drug in the usual therapeutic dose. Are common, pharmacologically possible, can occur in any individual and, although damaging, will not cause serious concerns. This is the case, for example, of skin reactions when doing injections, or stomach irritation due to the intake of oral medications. The Type A reactions can be treated by dose adjustment, prescribed some other drug or a specific action, such as taking your medication with meals to avoid stomach problems, for instance. Now, the type B reactions are characterized by being totally unexpected in relation to properties of the administered drug, and are unusual and independent of dose, occurring only in susceptible individuals. Adverse reactions of type B are usually serious and worrying. This is the case of PML / PML (progressive multifocal leukoencephalopathy), for example, which can occur in some patients infected by the JC virus that perform particular treatments. The classification of adverse reactions have been gradually extended and called by other letters of the alphabet, including C (dose dependent reactions and time), D (delayed reactions), and (withdrawal syndromes) and F (reactions that produce therapeutic failures) . Side effects, are different. Side effects are the consequences of using the drug. Although they are sometimes annoying and problematic, they usually are not dangerous and can be managed. In fact, any change in our behavior results in a side effect, or, in other words, it is a reaction to the different action you going to have. Changing your diet, for example, has side effects: you can lose or gain weight; have more or less power. In the case of medication, is cited as an example the temporary amnesia caused by some sedatives and drowsiness in antihistamines, effects that can be beneficial or not depending on the situation. Every medication cause reactions (adverse or not) in our bodies. The difference between the "common" medications (such as antipyretics and analgesics, for example) and those used in the treatment of multiple sclerosis and frequency, dosage and intensity of treatment. i.e., drugs for multiple sclerosis, to fulfill their goals, are more "strong" and consequently have adverse reactions and side effects. We patients must learn to deal with the side effects and, with proper medical care, prevent and control adverse reactions of drugs, so that adherence to treatment is at the highest level possible. New possible ideas of drugs, especially in regards to oral therapies, have facilitated adherence to treatments for Multiple Sclerosis, however, it is important to note that the choice of therapy should be analysed very carefully, because each patient has a profile and should be evaluated and accompanied individually, in order to understand what is the most appropriate approach.