Editorial - Volume 15, Issue 2 - June 2013

As those of us in the Northern Hemisphere enjoy summer, our southern neighbors head into winter—but in the digital realm, there are no particular seasons or even times of day. The online world is active 24 hours a day, 365 days a year, ensuring constant accessibility of the International Journal of MS Care via our website at ijmsc.org. This past spring, we celebrated the first anniversary of the launch of IJMSC's fully searchable online edition, and the current issue includes an update on our progress in the digital realm by our managing editor, Annette Theuring.

Multiple sclerosis patients and their families also occupy a “24/7” realm, having no vacations from the disease and its symptoms. This constant burden can lead to mental health problems, as described in two of the articles in this issue, one on caregivers' mental health and the other on depression in MS patients themselves. Dr. Buchanan, formerly of Mississippi State University, and Dr. Huang of Indiana University used survey data to examine the need for mental health care among informal caregivers of MS patients due to the physical and emotional toil of assisting these patients. The authors highlight these issues so that MS clinicians can be more mindful of them before the caregivers of their patients experience caregiver fatigue or “burnout.” Ms. Vargas and Dr. Arnett of The Pennsylvania State University apply research on a well-known model of depression, the learned helplessness model, to depression in MS. They suggest that attributional style may be a reasonable target for cognitive therapy in MS, and that addressing attributional style may assist patients with overall stress management. They also discuss the potentially valuable role of counseling on employment issues in the MS population.

Two other articles on somewhat related topics of behavioral and mental health also form a pair, both addressing the issue of self-management by the person with MS. Dr. Fraser, Dr. Ehde, and colleagues at the University of Washington and Western Washington University report on the results of a consensus conference that was supported in part by IJMSC's sponsoring organization, the Consortium of Multiple Sclerosis Centers, to explore ways in which people with MS can achieve enhanced management of their day-to-day lives to minimize the effects and interferences of MS. Dr. Wollin, formerly of Griffith University, and her colleagues at various other institutions in Australia address changes in quality of life and related psychosocial variables over a 2-year period in Australians with MS. They note that while the quality of life of people with MS is affected by their levels of self-efficacy, depression, and stress, mental health problems such as depression may prevent them from taking an active role in self-management.

The other two articles in the current issue represent what Elliot Frohman, a neurologist at UT Southwestern Medical Center, has called the “heads and tails” approach to symptom management in MS, in this case with “heads” being addressed by the study of headache in MS patients and “tails” being covered by the article on management of a type of bladder dysfunction in MS. While headache is generally not considered a symptom of MS per se except in certain cases such as those with accompanying optic neuritis or trigeminal neuralgia, MS patients do have an increased incidence of headache overall, and it often falls to MS clinicians to at least begin to handle this comorbidity. Dr. Tabby and colleagues at Drexel University College of Medicine examined various headache features as they pertain to the overall management of MS. They emphasize that stress and fatigue may also correlate with increased frequency of headache and that identification and alleviation of triggers may reduce the incidence of headache/head pain flares. Dr. Yonnet and colleagues at the University of Utah and the Salt Lake City Veterans Affairs Medical Center provide a very helpful review of the recent advances in management of a common difficulty with the urologic system in MS, namely, neurogenic detrusor overactivity. This condition is very bothersome to patients, as it disturbs their sleep and in many cases limits their ability to leave the house, forcing them to route their travels through the community based on the availability and accessibility of restroom facilities.

As the contents of this issue demonstrate, MS patients and their caregivers face challenges around the clock and throughout the year. With the growing digital presence of IJMSC, we hope to be increasingly available and effective in providing information and assistance to MS clinicians and their patients at any time as well.

With hopes for a pleasant few months, whichever season you are enjoying!