Editorial.

Abstract

It was only a few weeks ago that the 2018 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting was held in Nashville and welcomed yet another record number of attendees from many countries and disciplines. Consistent with the CMSC's dedication to excellence in multidisciplinary MS care, a greater variety of educational credits were offered during this meeting. The 2017 Herndon Award, recognizing the best article published in the International Journal of MS Care (IJMSC) last year, was announced by IJMSC founding editor Dr. Robert M. Herndon during the meeting. The winners are Mark M. Mañago, Jeffrey R. Hebert, and Margaret Schenkman for their article “Psychometric Properties of a Clinical Strength Assessment Protocol in People with Multiple Sclerosis,” which appeared in the September/October 2017 issue.In this issue of IJMSC, continuing education credit is offered for an article authored by Domingo and colleagues focused on a well-known, yet seldom investigated, consequence of MS: sexual dysfunction. In their sample of over 160 patients followed up at an MS clinic, close to two-thirds reported symptoms of sexual dysfunction, the presence of which was associated with higher MS-related disability and depressive symptom severity. While not surprising, these findings are a welcome reminder to systematically investigate the presence of sexual dysfunction in our patients, and to offer further evaluation and medical advice based on their goals and priorities.Cognitive dysfunction represents another common consequence of MS, which is of great concern to those affected and to their loved ones, since cognitive impairment may interfere with a wide range of activities and make it more difficult to compensate for physical limitations. The chart review by DiGiuseppe and colleagues, who found that only about one-third of patients within 1 year of being diagnosed with relapsing-remitting MS performed within the expected range on all cognitive tests of the Minimal Assessment of Cognitive Function in Multiple Sclerosis, reinforces the importance of systematic screening for cognitive impairment in the same way that we routinely assess physical impairment. Barbu and colleagues, however, observed that the performance of individuals with early relapsing-remitting MS differed from that of healthy controls solely on visual memory, after administering a comprehensive neuropsychological battery. Furthermore, there was no deterioration of cognitive performance within the early MS group over a 3-year period.Altered motor control constitutes the most visible cause of disability from MS, with walking and balance the most commonly tested motor functions. Combining a short walking speed test and a longer walking endurance test is recommended to thoroughly evaluate and monitor walking capacity. The case study by Willingham and colleagues illustrates the rationale for this recommendation: after antigravity treadmill training, their patient's walking endurance improved markedly on the 2-Minute Walk Test (along with muscle oxidative capacity and endurance), yet concomitantly fast walking speed on the Timed 25-Foot Walk test decreased. The article by Scalzitti and colleagues adds to the fast-growing body of evidence on the psychometric properties of long walking tests in MS by providing evidence of the construct and discriminant validity of the 2-Minute Walk Test.Balance impairment and resulting falls are of particular concern owing to the potential for injury, in addition to further activity reduction and social isolation due to fear of falling. Contributing to a growing body of evidence on the role of postural adjustment, Tajali and colleagues observed differences in anticipatory and compensatory postural adjustments between individuals with MS who reported at least one fall within the past 6 months compared with individuals with MS who reported no fall or with healthy controls.Finally, Enriquez-Marulanda and colleagues encourage us to be vigilant for unusual first manifestations of MS, such as rapid eye movement sleep behavior disorders.I am pleased to announce that IJMSC and Rehabilitation in MS (RIMS), the European network for best practice and research in MS rehabilitation, have signed a memorandum of understanding, which aims at strengthening the partnership between IJMSC and RIMS to facilitate the dissemination of evidence and ideas regarding the management of MS across the world.