Editorial - Volume 21, Issue 3 - May 2019

Attendees of the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) are gathering at the Washington State Convention Center in Seattle. This city and its surrounding area are known for being home to famous companies with complementary offerings (have you ever typed a document while sipping coffee on an airplane?). Fewer people realize that the Seattle area is also a hub for MS multidisciplinary care, with one of the highest concentrations of MS physiatrists in the country (I acknowledge a personal bias for this profession). I do hope that you will enjoy networking with local MS providers, as much as you will enjoy the local culture, food, and scenery (only after attending all of the educational offerings from the Annual Meeting, this goes without saying).

In this May/June issue, educational credit can be obtained after reading the article by Luhoway and colleagues, which deals with anatomico-clinical correlation. The authors tested, in almost 80 individuals with MS, a previously stated hypothesis linking posterior fossa MS lesions to the presence of pathological laughing and crying (PLC). Their findings did not support the hypothesis, with no association found between posterior fossa lesion load and the presence of PLC. Furthermore, removing patients with depression from the analysis resulted in an inverse association (fewer posterior fossa lesions were associated with the presence of PLC). Thus, the question remains open, and may be further explored with advanced imaging techniques in the future.

Two other articles focus on symptoms and comorbidities associated with MS and related disorders. The literature review by Ratajska and colleagues suggests that computerized cognitive behavioral therapy for depression, despite concerns about the absence of one-on-one human interaction, could be a valuable option, particularly for patients who cannot have access to a therapist. Mealy and colleagues find that, among several consequences of neuromyelitis optica spectrum disorder, only pain is significantly associated with quality-of-life scores, underscoring the importance of optimizing central neuropathic pain management in this patient group.

Health care providers (HCPs) play a key role in allowing patients timely access to the most appropriate care. In the survey study by Asano and colleagues, the presence of HCPs helping a person access rehabilitation services is one of the three factors (the only modifiable one) associated with the use of these services. Healey and colleagues highlight the benefits of an initiative driven by a group of HCPs, the Multiple Sclerosis at Home Access (MAHA) program, among persons with progressive MS and significant disability.

Finally, the case report and overview of the literature proposed by Kahovec and Levin illustrates how alemtuzumab-associated disease activation can be treated with steroids and plasma exchange when rituximab is not available.

“Art imitates nature,” wrote Aristotle. “Life imitates Art far more than Art imitates Life,” said Oscar Wilde. I invite all of you to ponder on this philosophical debate while contemplating the artwork on the cover of this issue; the artist is from…Seattle.