Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease of the central
nervous system (CNS)whose pathophysiologic mechanisms involve neuroinflammation and
neurodegeneration[1]. MS potentially cause permanent disability that could impair quality of life (QoL)[2],[3]. Neurologic deficits, fatigue and psychiatric manifestations[4] could prevent social inclusion and cause economic burden[5]. However, there are many other determinants of QoL perception such as cultural standards,
social conditions and coping skills[6].
Social network provides social support and includes all people linked by social relationships,
such as family, volunteer groups, sports and leisure meetings. A well-established
Social Support Network (SSN) helps to improve the QoL as it provides emotional and
financial support. SSN also ameliorates adherence to treatment and rehabilitation[7].
In this issue of Arquivos de Neuro-Psiquiatria, Costa et al.[8] evaluated the relationship between the SSN and health related quality of life (HRQoL)
in MS patients. They found a correlation between the SSN measured by the Medical Outcomes
Study Social Support Survey and the HRQoL measured by the Short-Form Health Survey
Questionnaire (SF-36) among 150 MS patients from Portugal. These results are similar
to studies in other diseases, suggesting that the perception of HRQoL is influenced
by the SSN[9].
Despite the importance of mental health and social inclusion in HRQoL shown in this
study, it is relatively common that physicians and patients have different perceptions
and goals related to the disease and its management. For example, Kremenchutzky et
al observed in 99 patients MS that physical functioning was the main goal for neurologists,
while patients have strong expectations on retaining good mental health[10]. Moreover, physicians usually focus on the treatments and the disease monitoring,
but patients’ QoL is strongly influenced by social integration and ability to have
a good performance at work.
Possa et al.[11] recently evaluated the impact of the diagnosis of MS in QoL and found a relevant
perception of change in health even in earlier phases of the disease and without association
with EDSS score or time from diagnosis, with the same pattern of responses of patients
with higher disability and disease duration. This suggests that self-perception and
psychological well-being are affected early in the disease course, indicating thatwe
should always seek patients’ satisfaction asone of the top goals of medical care.
In addition, we will probably improve long-term outcomes derived from patients’ perceptions
and facilitate adherence to treatments if we can include measures that help patients
to improve their SSN since the initial phases of MS.
In the last few years, an increasing number of drugs have been approved for MS, including
new oral drugs and monoclonal antibodies. All these drugs are effective on controlling
MS relapses reducing CNS inflammation, but they still have a limited effect on neurodegenerative
processes. Nevertheless, we can reduce the chance of permanent disability with optimal
MS management in order to maintain physical and psychosocial functionality. Unfortunately,
many MS patients experience high rates of unemployment despite the high level of education[5],[12]. SSN may help these patients to seek alternative social roles and life satisfaction,
providing important support to maintain their QoL.
