Multiple Sclerosis and Related Disorders (2014) 3, 667

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Editors’ Welcome The fall is always an exciting time for those working in the field of MS as the annual European Committee for Treatment and Research in MS (ECTRIMS) meeting is held. The added bonus this year was the triennial joint meeting of ECTRIMS and the Americas Committee for Treatment and Research in MS (ACTRIMS) in Boston (MSBoston 2014), September 10–13. The event was attended by 9000 persons from all across the globe. There were 40 teaching courses, 42 invited presentations, 94 platform presentations, and over 900 poster presentations covering all aspects of MS and related disorders, especially neuromyelitis optica (NMO). Many themes highlighted by the papers in this issue of MSARD were prominently reviewed at MSBoston. The concept of modifiable risk factors in MS has moved from folklore to near reality in recent years. Some progress has been made around the role of diet, childhood obesity, salt intake, Epstein–Barr viral infection and vitamin D. Brenton and colleagues, in this issue, report no difference in prevalence of vitamin D insufficiency between childhood and adult onset MS but they did observe an increase in obesity that affected the childhood-onset cohort. Predicting outcome in MS is a long-sought after goal. Maghzi and colleagues examine correlations between MRI changes and clinical metrics in a longitudinal cohort-based study. Similarly, Kinkel et al., demonstrate that individuals treated with interferon beta, after an initial clinical event, are at higher risk of subsequent relapse if there is early MRI activity. The economic impact of relapses is discussed by O’Connell and collaborators from Dublin who evaluated prospectively the direct and indirect costs of MS relapses of varying degree. They demonstrated that all relapses, even those of low intensity, produce significant financial implications for patients and society. The cost of a relapse was determined by the severity of the event and the baseline level of disability. In this regard, Lublin and colleagues demonstrate that patients treated with natalizumab had less severe exacerbations and made better recovery from these episodes: accordingly, step-wise accumulation of disability was limited and perhaps reduced economic cost, thus echoing the findings by O’Connell et al. In another paper related to economic impact in Austria, Walter and Deisenhammer use decision-analytical modeling to demonstrate the cost effectiveness of routine testing for interferon neutralizing antibodies (Nab). According to their model, Nab testing resulted in both lowered number of relapses and reduced net health care spending. Two papers report 2211-0348/& 2014 Elsevier B.V. All rights reserved.

potential side effects of medications. Berger and colleagues describe a case of posterior reversible encephalopathy syndrome (PRES) that resembled progressive multifocal leukoencephalopathy in a patient receiving rituximab for NMO. They provide an approach for distinguishing these two conditions. Gioia et al., report a case of hepatic injury associated with glatiramer acetate. Further observation will be important for this novel observation. With the ongoing activity of the international pediatric MS network, increased attention has focused on children with MS. Lulu and colleagues debate the challenges of transitioning youths into adult care, highlighting issues of cognitive impairment and levels of disability. In a reminder of the importance of a careful neurologic exam, despite the advances in paraclinical technology, Hawkes and Neffendorf highlight Kestenbaum's capillary number test in patients with borderline optic disk pallor. Lastly, Lublin and collaborators report on a safety study using placental derived stromal cells as a potential repair strategy in MS. In this study, no unwanted effects were seen and there was no worsening of the MRI. There are a few studies now reporting or soon to report on early efforts at repair of the damaged nervous system; an exciting frontier. A recent single case report, from London and Poland, of improved function after transplantation of nasal olfactory ensheathing cells highlights the potential for this approach. It is important for those of us treating patients with MS to make sure these potentially exciting developments are put in context and to counsel our patients against seeking unlicensed stem cell therapies. The only place for unproven stem cell treatments are in well controlled clinical trials that have been peer-reviewed and assessed by an appropriate ethics committee. MS has become a more global disease than previously recognized. In response to this worldwide challenge, new regional MS associations have developed, following on the success of ECTRIMS. In this issue we are pleased to publish the poster and speaker abstracts for the inaugural Middle East North Africa Committee for Research and Treatment in Multiple Sclerosis (MENACTRIMS) Congress held October 17–18, 2014 in Dubai. Editors in Chief Brenda Banwell, Gavin Giovannoni, Chris Hawkes, Fred Lublin

Editors' welcome.

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