Editorial - Volume 16, Issue 1 - March 2014

As the new editor in chief of the IJMSC, I am pleased to introduce the Spring 2014 issue. I am excited to take on this role at a time of continued growth of the journal, which strives to bring to its readers the evidence and expert knowledge needed to promote multidisciplinary MS care. It is a humbling experience to follow in the steps of Dr. Lael Stone, who, with the help of an outstanding editorial team and editorial board, has created a momentum of growth and maturation that will continue to bear fruit in the years to come. Thanks to Dr. Stone’s careful planning, I have had the opportunity to work with the editorial team, the editorial board, our publisher, and the leadership of the Consortium of Multiple Sclerosis Centers (CMSC) during the months leading to the official transition. Following a very productive strategic planning meeting in Cleveland, Ohio, in December 2013, we are implementing new initiatives that will benefit our readers and authors, and will help further the mission of the journal.

The contents of this issue of the IJMSC reflect its multidisciplinary nature. Dr. Mary Filipi and colleagues developed a consensus statement regarding the management of flu-like symptoms associated with interferon therapy in MS. Side effects from medications jeopardize treatment adherence, which is primordial in a chronic condition requiring long-term treatment such as MS. Even though the number of available disease-modifying therapies (DMTs) has increased, it still holds true that treatment efficacy cannot be fully assessed if side effects compromise adherence. The authors’ recommendations, based on published evidence and opinion from experts in MS nursing care, give clear and practical guidance that can be applied in day-to-day clinical practice.

While there is a strong research focus on the early stages of MS, with the goal of initiating comprehensive management early to lessen the long-term impact of the disease, the challenges faced by our patients as they age with a chronic progressive disease should not be forgotten. Dr. Marijean Buhse and colleagues remind us that caregivers should pay attention to factors affecting health-related quality of life in older individuals with MS. Detecting and managing problems such as depression and cognitive limitations could have a positive impact on these patients’ lives.

Two articles cover issues related to pelvic floor dysfunction in MS. Although it has been established that bladder function is frequently affected by MS, and that urinary symptoms (particularly incontinence) reduce patients’ quality of life, there is a lack of evidence regarding the impact of DMTs on bladder function. The article from Dr. Bhupendra Khatri and colleagues provides evidence of improved patient-reported quality of life related to incontinence, using validated symptom-specific questionnaires, 6 months after initiation of treatment with natalizumab. Even though no definitive conclusions can be drawn from an open-label uncontrolled study, their findings are encouraging and will be helpful in designing future studies.

Dr. Sangeeta Mahajan and colleagues administered a survey on pelvic floor disorders to a large sample (over 9000 respondents) of participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry, a nonprofit project of the CMSC. They found that, for each area of pelvic dysfunction (bladder, bowel, sexual), moderate to severe symptoms were reported by one-third or more of respondents. The fact that most respondents had been asked about, and were satisfied with, the care they received for bladder and bowel dysfunction suggests that comprehensive MS care is a reality. However, the authors identified a gap with regard to sexual dysfunction. This finding should prompt clinicians to pay more attention to this frequent consequence of MS, which has significant repercussions for patients and their families yet may improve with adequate management.

Easy-to-use and validated instruments are essential for clinicians and researchers to evaluate and monitor various aspects of neurologic dysfunction resulting from MS. This need has been highlighted recently by an increased demand for quantified measurement of the outcomes of care, in order to optimize the delivery of health care. Two articles discuss assessments of distinct consequences of MS, cognitive impairment and walking limitations, which were shown in other publications to affect each other. Dr. Heather Becker and colleagues report on the psychometric properties of two short self-report assessments of perceived cognitive function, the PROMIS Cognitive Abilities and Cognitive Concerns Scales. These eight-item questionnaires are derived from a broad National Institutes of Health initiative, the Patient Reported Outcomes Measurement Information System (PROMIS). Mr. Brian Sandroff and colleagues compare two modes of administration of one of the most validated tests of walking endurance in MS, the 6-Minute Walk. The use of walking performance tests is sometimes limited by practical constraints, particularly space limitations. As most performance tests were initially validated under specific conditions, well-designed comparisons offer clinicians and researchers additional options that will help generalize their use.

Finally, the article by Dr. Michael Halpern and colleagues sheds light on interest in MS among neurology residents. It is important that individuals with MS have access to health-care professionals who specialize in the disease, given the complexity of needs and treatment decisions. Considering a predicted shortage of MS-specialized neurologists, it is somewhat reassuring that two-thirds of the survey respondents were interested in providing some MS care, and one-third were interested in MS subspecialization. The survey results provide insight into potential strategies to increase the interest of neurology residents in treating MS patients.

In her editorial published in the Winter 2013 issue, Dr. Stone announced the signing of a participation agreement between the CMSC and PubMed Central (PMC), the US National Library of Medicine’s archive of freely accessible literature in the life sciences, to include the journal’s full-text articles in its database. All articles published in IJMSC since 2011 are now accessible in PMC, with citations and abstracts retrievable through searches in PubMed. We believe that this increase in the journal’s visibility will help advance research in MS care, and ultimately benefit our patients.

In closing, we hope that you plan to attend the 2014 annual meeting of the CMSC, which will be held in Dallas, Texas, from May 28 to 31. This will be the sixth cooperative meeting of the CMSC and the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), and we look forward to the opportunity for in-person discussions of important topics related to comprehensive care for our MS patients.

Enjoy reading the articles in this issue, and see you in Dallas!