Los pacientes con esclerosis múltiple (EM) arrastran consigo una enorme carga emocional, no sólo física, de la que apenas se habla pese al enorme impacto que tiene en su calidad de vida. De hecho, se estima que más de la mitad de los pacientes padece depresión en algún momento de la enfermedad ligada al curso degenerativo y progresivo de la misma, en el que irán apareciendo nuevos trastornos relacionados con la esfera sexual, el sueño o la función urinaria, lo que agrava aún más la psicopatología del afectado. Así se ha señalado durante la jornada “EM: la enfermedad de las mil caras”, celebrada por Biogen con los avales de la Sociedad Española de Neurología (SEN) y la Asociación Nacional de Informadores de la Salud (ANIS) con motivo del Día Mundial de esta enfermedad, que en nuestro país afecta a 46.000 personas.
“La iniciativa responde al compromiso de Biogen con la comunidad de pacientes con esclerosis múltiple: entender mejor cuáles son sus necesidades y cuál es la mejor forma de darles respuesta y mejorar así su calidad de vida”, ha señalado Sergio Teixeira, director general de Biogen en España y Portugal.
La carga emocional tiene mucho que ver con la edad del diagnóstico y el curso impredecible de la enfermedad, de ahí que se la conozca como la “enfermedad de las mil caras”, ya que a cada persona le afecta de una manera diferente, no habiendo dos pacientes iguales. Los primeros síntomas de la EM aparecen entre los 20 y 40 años, una etapa de la vida clave para la realización y el desarrollo personal y profesional de las personas, pero lejos de la realidad del paciente con EM, que debe aprender a aceptar y convivir con la enfermedad el resto de su vida. “El diagnóstico de la esclerosis múltiple tiene un importante impacto emocional, familiar, laboral y social. Lo impredecible resulta especialmente estresante, ya que no permite ni al paciente ni a su familia prepararse a la nueva situación. No conoce cómo será el curso de la enfermedad, si habrá periodos de mejoría o de empeoramiento, ni en qué consistirán, si dispondrá de ayuda o dependerá de uno mismo”, explica Silvia García de Sola, psicóloga sanitaria del Centro de Rehabilitación de la Fundación Privada Madrid.
El estrés emocional que sufre la mujer está especialmente ligado a su plan de familia: la angustia y el miedo que plantea la maternidad, el momento del postparto o en qué situación se encontrará -a nivel físico- para poder ocuparse y atender a sus hijos. A edades más tempranas, la familia tiene un papel muy importante en la gestión de las emociones– prosigue esta psicóloga sanitaria– “ya que se corre el riesgo de aislamiento social o desórdenes emocionales que afecten a su esfera más social, por lo que debemos atenderlo con especial cuidado”. En su opinión, es muy importante contar con información, tiempo y apoyo multidisciplinar para ayudar a identificar las emociones y aceptarlas como una parte natural del proceso que está viviendo.
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Trabajar con EM puede suponer un verdadero desafío y más en un entorno laboral tan competitivo como el actual, en el que el paciente se siente inseguro e indefenso. Un alto porcentaje de pacientes con EM abandona su puesto de trabajo siendo aún jóvenes y esta situación pone de relieve la necesidad de revisar las políticas en materia de empleo para garantizar su continuidad. Más allá del deseo de realización y superación personal, tan importante para cualquier trabajador, este problema impacta directamente sobre la economía familiar y el bienestar de la misma.
Cabe recordar que la EM es la primera causa de discapacidad por enfermedad entre los jóvenes españoles, explica Irene Bartolomé, coordinadora del Centro de Rehabilitación de la Fundación Privada Madrid. “Mientras que a algunos pacientes no les afecta nada o muy poco la enfermedad, otros tienen que cambiar de competencias, dejar su puesto de trabajo por otro e, incluso, solicitar una incapacidad laboral. Las limitaciones físicas van desde problemas de equilibrio, dificultad para caminar o subir y bajar escaleras hasta problemas para manipular con las manos”, puntualiza Bartolomé, quien destaca la importancia de la rehabilitación desde las primeras fases de la enfermedad para tratar de mejorar los síntomas cuando aún son leves y evitar así secuelas y complicaciones futuras. “Es fundamental encontrarse en las mejores condiciones físicas, emocionales y cognitivas la mayor parte del tiempo posible”, subraya.
En esta línea y con el objetivo de prolongar todo lo posible la vida laboral del paciente, desde Esclerosis Múltiple España se lucha por optar el pleno reconocimiento de la discapacidad con el diagnóstico, “un derecho básico con el que buscamos acceder a oportunidades laborales como el empleo protegido, la adaptación del puesto de trabajo o bonificaciones de la seguridad social”, señala su director ejecutivo, Pedro Carrascal. “Actualmente carecemos de medidas legales específicas que protejan a la persona con esclerosis múltiple frente a esta situación, que incentiven las cotizaciones a la seguridad social o permitan flexibilizar el puesto de trabajo a las nuevas necesidades del paciente desde los primeros momentos en los que surgen las necesidades”.
Estas medidas son aún más importantes si se tiene en cuenta cómo está cambiado el curso de la enfermedad. “Los pacientes recién diagnosticados de los últimos años van a tener una evolución muy diferente porque la enfermedad se diagnostica antes y el curso es más favorable, de ahí que debamos seguir avanzando todavía mucho en sensibilización y concienciación, pero también en las medidas legales que protejan al paciente”, concluye Carrascal.
Retos clínicos
El panorama de la EM ha cambiado radicalmente y en las dos últimas décadas se ha logrado reducir de siete a un año – e incluso a meses – el diagnóstico gracias a avances tecnológicos como la resonancia magnética. La fase diagnóstica es muy importante, precisa el doctor Óscar Fernández, investigador senior del Instituto de Investigación Biomédica de Málaga (IBIMA) y presidente de la Sociedad Española de Neurología. “Un diagnóstico temprano de la patología condiciona una evolución favorable del paciente. Sin embargo, este aspecto no es fácil porque la esclerosis múltiple comparte síntomas con hasta mil enfermedades diferentes”, explica este experto.
“La labor científica e investigación en esta enfermedad neurológica ha permitido controlar hasta en un 99% la fase inflamatoria de la enfermedad. En la actualidad hay disponibles hasta doce tratamientos diferentes – pendientes de otras dos nuevas aprobaciones – que han demostrado que son mucho más eficaces si se emplean cuanto antes, lo que nuevamente pone de relieve la importancia de un diagnóstico temprano”, prosigue el doctor Fernández.
Pese a todo el camino recorrido y los obstáculos salvados, la EM plantea un reto fundamental que es el componente neurodegenerativo de la enfermedad –precedida de la fase inflamatoria-, donde algunos estudios clínicos han demostrado resultados positivos. Asimismo, prosigue este experto, “las líneas de investigación actuales plantean terapias combinadas que engloben productos antiinflamatorios, que son muy eficaces, con productos diseñados para detener o enlentecer el proceso neurodegenerativo, con las que se logrará que el final de la vida de los pacientes sea prácticamente normal o muy normal”.
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