The World Federation of Neurology highlights one neurologic condition each year for World Brain Day. The focus this year is on MS. As an MS neurologist practicing in the United States, I sometimes take for granted the access to imaging that allows for early diagnosis and the availability of disease-modifying therapies and symptom management interventions in our health care system. The videos submitted to the World Brain Day 2021 website (wfneurology.org/world-brain-day-2021) remind me that we have much work to do in addressing barriers to care globally, improving education about MS, and advocating for improving quality of life for people with MS.
Symptoms and needed interventions vary throughout the course of MS, and patients sometimes have difficulty describing symptoms in a way that care providers can understand, and thus provide help. We have developed numerous checklists and questionnaires to quickly assess for the presence and severity of symptoms that affect quality of life. Newland and colleagues demonstrate that Web-based journaling can elicit perspectives on core symptoms. An open dialogue about symptoms is important for not only addressing symptoms but also identifying relapses. Waltrip and colleagues remind us that patients are more likely to report symptoms of a relapse early if health care practitioners have provided education on relapse identification and management.
The mechanisms for development of so-called invisible symptoms such as fatigue, cognitive dysfunction, and depression remain unclear. Haines and colleagues postulate a structural basis for higher irritability, anxiety, and social withdrawal (interpersonal depressive symptoms) in persons with MS. Lefferts and colleagues explore the effects of exercise on cognition and cerebral blood flow in MS. I hope in the near future that we will be able to use information such as regional brain atrophy and cerebrovascular dynamics in individualizing treatment for depression and cognition, which can be as disabling as physical symptoms.
Access to nonpharmacologic symptom management is limited throughout many parts of the world. Broadening access to treatments for which we have empiric support for quality-of-life improvement means consideration of community-based programs and alternative delivery strategies. This issue’s continuing education article by Herring and colleagues introduces the possibility of outdoor adventure programs, which aim to enhance quality of life and promote personal growth, to improve mood and physical function for people with MS. Harenberg and colleagues describe a three-dimensional multiple-object tracking program that can be used on a variety of widely available devices to improve attention and processing speed—both important cognitive skills required to maintain independence. In an ideal world, all 2.8 million people worldwide living with MS would have access to these interventions.
The advances in clinical care highlighted in every issue of our journal require persons with MS to participate in research. In a survey by the MS Minority Research Engagement Partnership Network (Pimentel Maldonado and colleagues), an overwhelming majority of respondents were open to some type of research involvement. By identifying and addressing barriers to research engagement among underrepresented groups, we can ensure that everyone has a chance to have a part in our quest to Stop MS.