Multiple Sclerosis (MS) is an autoimmune and inflammatory demyelinating disease of the central nervous system that is found to be affecting 0.25-6% of the general population. Generally, MS appears in the young adulthood and has a female to male incidence ratio of 2:1. Some of the common symptoms observed in MS patients include numbness, tingling, muscle spasms, stiffness, exaggerated reflexes, mobility problems and poor bladder control. The most common form of MS is the relapsing-remitting form affecting 80% of the patients. Symptoms vary among these patients with relapsing episodes of the neurologic impairment preceded by remissions. Other recognized forms of MS are primary progressive MS, secondary progressive MS, and progressive relapsing MS.
Both genetic and environmental factors are found to affect the inheritance of MS. HLA genes including HLA-A, HLA-DRB1, HLA-DQB1, HLA-DRA, as well as, multiple loci on chromosome 1p36 and 12p13 are known to be associated with MS susceptibility.
Benamer et al. (2009) conducted a systematic review of published reports of MS in Arab populations using the Medline and Embase databases. Of the 38 reports identified, only 19, published between 1975 and 2007, were found to be suitable for inclusion. The mean age of onset of MS was found to be within the third decade, and in all studies, females were more often affected than males. The incidence in Arabs varied widely and ranged from 3.4-42 per 100,000. There was some evidence of this incidence increasing over time. Most patients (60-90%) were affected by the relapse-remitting form of the disease, followed by secondary progressive disease (15-25%), and primary progressive disease (8-19%). North Africans were noticed to have an earlier onset, more incomplete recovery after the first two attacks, higher number of relapses after the first 5-years, and a quicker progression on the expanded disability status scale. A positive family history status varied from 0-9%.
[See: Kuwait > Al-Din, 1986]
[See: Kuwait > Al-Din, 1986; Al-Din et al., 1990; Al Shubaili., 2005].
The first account for MS patients among the Iraqi population dates back to the 1950s (Shaby, 1958).
Benamer et al. (2009) conducted a systematic review of published reports of MS in Arab populations using the Medline and Embase databases. Optico-spinal MS was reported in 10% of Iraqi patients. Among 37 Iraqi patients, several parameters of the disease were improved following 2-years of interferon beta 1a therapy.
[See also: Arab > Benamer et al., 2009; Kuwait > Al-Din, 1986; Al-Din et al., 1990].
Al-Din et al. (1995) performed a 2-year hospital-based study on 131 MS patients in Jordan; including 84 Palestinians and 36 native Jordanians. It was found that MS was more frequent in Palestinians (42/100,000) than in Jordanians (20/100,000) with clinical features similar to the ones described in Caucasians in the west.
El-Salem et al. (2006) carried out a study to determine the clinical, epidemiological and demographic traits of MS in Jordan. During the period of 2004-2005, Jordanian patients fulfilling MS criteria in having either clinically definite or clinically probable MS were included in the study. El-Salem et al. (2005) found 224 cases (59 males and 165 females), with a mean age of onset of 29.3 years and a mean duration of illness of 3.9 years. It was found that the prevalence was 39/100,000 in Amman and 38/100,000 in Irbid. The clinical features that appeared in the Jordanian patients with MS were as follows: weakness (31%), optic neuritis (20%), sensory impairment (20%), and ataxia (14%). With the previous prevalence rates mentioned, the study concluded that Jordan falls in the medium risk zone for MS.
Benamer et al. (2009) conducted a systematic review of published reports of MS in Arab populations using the Medline and Embase databases. Among the 126 Arab MS patients in Jordan, only one had Devic's disease.
[See also: Arab > Benamer et al., 2009].
Al-Din (1986) conducted a clinical and epidemiological study in Kuwait to investigate the prevalence of MS in Arabs. The study involved 98 cases of MS, but only 89 were found to be contactable for assessment. Patients belonged to different ethnic groups, 70 were Arabs (27 Kuwaitis, 25 Palestinians, 8 Iraqis, 6 Egyptians, 4 Syrians, 2 Lebanese, 2 Bahraini, 1 Saudi, 1 Sudanese, and 1 Somali) and 19 were non-Arabs. Two Kuwaiti patients passed away during the study. The neurological signs and symptoms in patients with no difference to ethnicity were introduced as the presence of balance abnormalities and ataxia (67%), impaired sensations and paresthesia (62%), paraparesis (60%), and blurring of vision and optic neuritis (50%). The study concluded that the prevalence rate appeared to be 4.44/100,000 for Kuwaitis, while the prevalence rate for non-Kuwaitis after adjustment for age and sex to Kuwaitis was found to be 7.29/100,000. With this prevalence, Kuwait was considered to be in the medium risk zone with an overall prevalence rate of 8.3/100,000. Later, Al-Din et al. (1990) carried out a comparative study between Kuwaitis and Palestinians living in Kuwait to investigate the epidemiology of MS in Arabs. The 31st of December 1988 was considered as the prevalence day for the study, which involved 201 MS patients residing in Kuwait. Out of the 201 patients, 149 were grouped as clinically definite MS (CDMS), 13 as laboratory supported definite MS (LSDMS), 38 as clinically probable MS (CPMS) and one as laboratory supported SM (LSPMS). The mean age was 34.7 years, the female to male ratio was 1.3:1, and the overall prevalence rate was 10.2/100,000. Familial MS frequency was found in six Kuwaitis (including a mother and her son, a male patient and his paternal uncle, and a female patient and a third degree male cousin), four Palestinian cases (including two male siblings and two first degree female cousins), and one patient whose dizygotic twin was clear from MS. The 201 cohort consisted of 186 Arabs including 72 Palestinians, 51 Kuwaitis, 22 Egyptians, 12 Syrians, 12 Lebanese, 10 Iraqis, 5 non-Kuwaiti Bedouins, 1 Saudi, and 1 Yemeni. It was found that Palestinians (prevalence: 23.8/100,000) had age specific rates corresponding to Europeans and they were expected to acquire MS 2.5 times more frequently than Kuwaitis (prevalence: 9.5/100,000). In addition, Al-Din et al. (1990) found that in Palestinian MS cases there was a correlation with HLA-DR 2 and HLA-DQW 1, similar to the one described in Caucasians, while no such correlation was found among Kuwaitis.
Al-Shammari et al. (2003) carried out a study to investigate the occurrence of active human herpesvirus type-6 (HHV-6) infection revealed through the presence of HHV-6 DNA in serum (DNAaemia) in MS patients in Safat in Kuwait. The study employed and collected sera from 24 MS patients, 13 control cases of various neurological diseases, and 20 healthy volunteers using nested PCR. The results showed that all subjects were negative for HHV-6 DNAaemia except for one healthy control who was found positive, suggesting that there is no evidence for the virus to be involved in MS pathogenesis. One year later, Al-Shammri et al. (2004) aimed at determining the frequencies of HLA Class I and II antigens in Kuwaiti Arabs with MS and at measuring any possible inter-relationships among HLA Class II antigens and various clinical phenotypic variants in MS. Two groups were involved in the study, the first group consisted of 67 subjects with definite MS and the second group consisted of 145 unrelated healthy controls. Both groups underwent HLA Class I (A, B, C) and Class II (DR, DQ) antigens tissue typing using standard complement-dependent microlymphocytotoxicity method. The study resulted in showing a trend towards a correlation among HLA Class II antigens (DR4, DQ6, DQ7, and DQ8) and Kuwaiti MS subjects. Furthermore, results demonstrated a more frequent appearance of DR4 and DR15 in females and subjects with an early onset of MS.
Al Shubaili et al. (2005) performed a retrospective study to explore the incidence and prevalence variation of MS in Kuwait in between the years 1993 and 2000. The study included 338 MS cases (141 males and 197 females) from Ibn Sina Hospital in Kuwait. Kuwaitis represented 76% of the patients, while 11% were Lebanese, 4% Syrians, 2% Egyptians, and 2% Palestinians. In 2000, the prevalence rate for MS among Kuwaitis was found to be 31.15/100,000 while for non-Kuwaitis it was 5.55/100,000. In Kuwaiti women, MS incidence increased almost by threefold (from 2.26/100,000 in 1993 to 7.79/100,000 in 2000) proposing that teh Kuwaiti population underwent a genuine change in the susceptibility to MS compared to the non-Kuwaiti population.
In 2006, Al Hassan et al. reported the first case of pediatric MS in Kuwait. The patient was a 9-year old girl with a relapsing form of the disease. [Al Hassan H, Azeem HA, Hassan N. A 9 year-old girl with multiple sclerosis: first reported cases from Kuwait. New Egypt J Med. 2006; 34(1):44-9.]
Benamer et al. (2009) conducted a systematic review of published reports of MS in Arab populations using the Medline and Embase databases. The Kuwaiti population showed an increase in the incidence and prevalence of MS over time from 2.8 per 100,000 in 1993 to 5.91 in 2000. Benamer et al. (2009) attributed this either to the improved and free health care system, or to the changing age structure of the Kuwaiti population.
Radhakrishnan et al. (1985) explored the presence of MS among Libyans in Benghazi and found 21 clinically definite and probable MS cases. In 1983, the incidence rate was found to be 0.8/100,000, while in 1984 the prevalence rate was 4/100,000 for the total population, and for age-adjusted the prevalence rate was 5.9/100,000. This ratio of prevalence indicates that Benghazi descends in the medium frequency zone for MS.
Benamer et al. (2009) conducted a systematic review of published reports of MS in Arab populations using the Medline and Embase databases. Among the 21 Libyan patients, only one had Devic's disease.
Tharakan et al. (2005) conducted a study to illustrate the clinical properties of MS in Oman. The study included 30 native Omani MS patients, with 22 patients having clinically definite MS, 5 having laboratory supported definite MS, and 3 having clinically probable MS. The MS prevalence in Oman was found to be 4/100,000, male to female ratio of 1.1:1, and the disease had a mean age of onset of 27 years. Omani patients represented the following MS features: blurred vision (12 cases), sensory symptoms and paraparesis (6 cases), ataxia (5 cases), diplopia (3 cases), hemiplegia (2 cases). Tharakan et al. (2005) concluded that Oman falls in the low prevalence zone due to the low MS prevalence rate. [Tharakan J, Chand R, Jacob P. Multiple sclerosis in Oman. Neuro. 2005; 10(3):223-225.]
Benamer et al. (2009) conducted a systematic review of published reports of MS in Arab populations using the Medline and Embase databases. Optico-spinal MS was reported in 33% of Omani patients.
Al-Din et al. (1986) found that the prevalence rate for multiple sclerosis for Palestinians was found to be 7.8/100,000.
Karni et al. (2003) carried out a study to determine the incidence rate and prevalence rate of MS within Arabic and Jewish populations in Greater Jerusalem. It was found that the prevalence was similar among Arabs and Jews from Asia/Africa. It was suggested that this similarity was due to similar environmental etiologic factors for MS among subjects from Asia/Africa origin and Arab subjects from Greater Jerusalem.
Benamer et al. (2009) conducted a systematic review of published reports of MS in Arab populations using the Medline and Embase databases. The Palestinian Arab population showed an increase in the incidence and prevalence of MS over time from 7.8 per 100,000 in 1981 to 42 in 1992.
[See also: Arab > Benamer et al., 2009; Kuwait > Al-Din, 1986; Al-Din et al., 1990; Al Shubaili et al., 2005; Jordan > Al-Din et al., 1995].
Yaqub and Daif (1988) pointed out that MS incidence in Saudi Arabia is increasing by demonstrating that out of 806 neurology inpatients, 16 suffered from MS, 21 from myasthenia gravis, and 10 from amyotrophic lateral sclerosis.
Daif et al. (1998) studied 89 patients with multiple sclerosis (MS) in Saudi Arabia; 65 of which were Saudi nationals while the rest were non-Saudis. The total sample comprised 38 males and 51 females who were diagnosed over a 10-year period. MS was clinically confirmed in 52 patients, while 17 patients had laboratory-supported definite MS. Saudi patients displayed a significantly lower mean age at onset (25.9 years) compared to non-Saudi patients (29.4 years). Pyramidal signs were the commonest clinical finding and appeared more frequently in non-Saudis, while in Saudi patients the involvement of brain stem/cerebellum was slightly more frequent. Furthermore, the pathological profile of the latter group of patients had less disseminated lesions than in non-Saudi patients. The clinical course of the disorder was relapsing-remitting in 61%, progressive-relapsing in 20% and primary progressive in 19% of the patients. Interestingly, the study was conducted at King Khalid University Hospital (KKUH) in Riyadh where the hospital frequency for MS was 25/100,000.
Benamer et al. (2009) conducted a systematic review of published reports of MS in Arab populations using the Medline and Embase databases. Oligoclonal bands were positive in all five Saudi patients in one study, and in 75 of 89 Saudi patients in another study.
[See: Kuwait > Al-Din, 1986].
Inshasi and Thakre (2011) studied the prevalence of MS in Dubai between years 2000 and 2007. In this period, 284 cases with MS were reported; 158 of them were Dubai natives and 126 were immigrants. The male/female ratio among the Dubai natives was 2.81:1, and the age of onset was 26.66 ± 6.60. The annual incidence was 6.8/100,000 among Dubai natives during 2000-2007, while in 2007 the prevalence in Dubai natives was 54.8/100,000. This was calculated by the total number of existing MS cases over the native population in Dubai. The incidence in Dubai reflects a country with medium to high risk for MS.
The first account for MS patients among the Yemenite Jews dates back to the 1960s (Alter & Bornstein, 1962).
[See also: Kuwait > Al-Din et al., 1990].