Editorial - Volume 17, Issue 5 - September 2015

Recently, the United States (US) House of Representatives passed the 21st Century Cure Act, which has received much praise from the multiple sclerosis (MS) community. In addition to providing additional funding for the National Institutes of Health and the US Food and Drug Administration, and to promoting the integration of patients' perspectives into the medication review process, the act establishes the National Neurological Diseases Surveillance System, in which MS would be included. The creation of a national registry would allow more precise tracking of the incidence and prevalence of MS, and provide opportunities to better understand factors associated with the onset and progression of the disease. National registries are already in place in other parts of the world, including Canada and Europe. Existing MS registries in the United States, such as the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, a special project of the Consortium of Multiple Sclerosis Centers, have generated a substantial body of evidence (some of which was published in the International Journal of MS Care), but include only a fraction of the total population of MS patients. We look forward to contributing to this effort by making new findings available to our readers, and to all of those involved in the fight against MS.

Several articles in this issue report on risks affecting our patients. A large number of people with MS experience falls, which can lead to morbidity and further functional limitations. Cameron and colleagues studied a cohort of 248 MS patients in the United States and Australia, and found that the use of medications, particularly neurologically active medications, is associated with falls and falls resulting in injury, while the use of disease-modifying therapies is associated with decreased odds of falling. In keeping with medication-associated risks, Phillips and colleagues reported on gastrointestinal side effects and flushing with delayed-release dimethyl fumarate, and confirmed prior findings showing that these adverse effects are most frequent in the first month of treatment, are usually mild to moderate in intensity, and infrequently lead to treatment discontinuation. Based on data from a large cohort of patients in the US Department of Veterans Affairs (VA) health-care system, Nelson and colleagues observed that veterans with MS have a greater risk of infections leading to hospitalization and death than veterans without MS.

In addition to health-related risks, people with MS, who are affected by the disease in the most productive years of their lives, face socioeconomic risks, such as loss or modification of their work activities. Coyne and colleagues, using qualitative research methods, interviewed patients who experienced a change in their employment due to MS. Combinations of symptoms were identified by patients as the reason for the change in employment, including physical symptoms (fatigue being the most frequently cited) and perceived cognitive limitations.

There is a growing interest in measuring physical activity in our patients' daily lives. The article by Fjeldstad and colleagues shows that physical activity data from accelerometers correlate with the level of disability from MS, further establishing the validity of this simple and relatively inexpensive method.

Finally, Ikeda and colleagues present an interesting case report of acute tumefactive MS resistant to corticosteroids but responsive to plasmapheresis. I invite our readers to submit more case reports to the IJMSC, as they are an important source of preliminary information on unusual clinical presentations and novel treatment approaches.

The IJMSC editorial team hopes that you will enjoy reading this issue, and looks forward to receiving your feedback.