Editorial - Volume 20, Issue 2 - March 2018

At the time this issue of IJMSC goes to press, the Winter Olympic and Paralympic Games will be over, yet many will remember the impressive achievements of athletes from around the world. Watching the Olympic events reminded me how our patients often challenge themselves to perform daily activities despite the limitations imposed by their disease. Like athletes, persons with multiple sclerosis (MS) rely on a team to help them achieve their goals, including their family and health care providers.

One of the means to enhance or preserve daily function is exercise. However, it is not sufficient to give our patients a general recommendation to exercise on a regular basis. We need to provide them with concrete options backed by evidence, so they can choose exercise modalities that meet their needs and preferences. Duff and colleagues, in this issue's CME/CNE article, report preliminary evidence on the efficacy of Pilates exercise in individuals with MS who are able to walk. In a small randomized controlled trial, comparing Pilates exercise with massage versus massage alone, they observed a significantly greater improvement of performance on the 6-Minute Walk and Timed Up and Go tests in the Pilates group.

Another way to improve physical function is the prescription of devices. Torso-weighting is a sensory augmentation technique using light weights placed on a vest-like garment. Horn and colleagues observed significant improvement of postural stability and fall reduction during the Sensory Organization Test with torso-weighting in 60 persons with MS.

Two articles focus on the monitoring of MS symptoms and disease activity. Berard and colleagues evaluated a method to measure cognitive fatigue based on the Paced Auditory Serial Addition Test, by comparing performance during the first and last thirds of the test in 32 individuals with early relapsing-remitting MS. Cognitive fatigue may represent a more sensitive marker of cognitive impairment than overall performance on this test, although no significant change was detected over a 3-year period in their study. Guranda and colleagues found that “ultrabright” lesions on axial fluid-attenuated inversion recovery magnetic resonance images, identified via qualitative or quantitative method, are significantly associated with gadolinium enhancement.

Comorbidities have become a major topic in the management of MS, including mood disorders. Marrie and colleagues compared various methods of identifying depression and anxiety in individuals with MS. Their findings suggest that depression and anxiety, which are both associated with decreased health-related quality of life, are underdiagnosed in MS. Barker and colleagues, in a cross-sectional survey, found that family identity predicts mood, and argue for involving families early in the early stages of MS management.

As we continue in our 20th year of publication, we are proud to continue disseminating evidence supporting the multidisciplinary care of MS. We hope to connect with you during the upcoming Consortium of Multiple Sclerosis Centers (CMSC) annual meeting in Nashville.