Multiple sclerosis in Iraq: Does it have the same features encountered in Western countries?

doi:10.1016/j.jns.2005.03.033

Journal of the Neurological Sciences

Volume 234, Issues 1–2, 15 July 2005, Pages 67-71

https://doi.org/10.1016/j.jns.2005.03.033 Get rights and content

Abstract

Objectives

To characterize the clinical, demographic and epidemiological features of MS patients from the only specialised MS centre in Iraq.

Methods

Data for consecutive Iraqi MS patients attending the Baghdad Multidiscipline MS Clinic between 2000 and 2002 who fulfilled Poser et al. criteria for clinically definite (CD) and clinically probable (CP) MS were reviewed.

Results

We identified a total of 300 MS patients (164 females, 54.7%; 136 males, 45.3%) with a mean age of onset being 29.2 ± 7.8 years and the duration being 8.6 ± 5.9 years. According to the year of clinical onset of MS, a progressive increase in cases in the last two decades and a trend towards more females was noted. Initial symptom was reported as motor in 31.7%, sensory in 28.3%, optic nerve in 24% and brainstem or cerebellar in 22.3% of patients. The course was relapsing–remitting in 199 (66.3%) patients, secondary progressive in 56 (18.7%) and primary progressive (PP) in 45 (15%) patients.

Conclusions

MS is not rare in Iraq; its demographic and clinical data were, in general, similar to those reported in Caucasian populations. There was some evidence for North–South gradient and a possible increasing incidence characterized by an increase in female preponderance during the last 2 decades.

Introduction

Multiple sclerosis (MS) is known to show variable prevalence rates, demographic, and clinical manifestations depending on geography and ethnic background [1].

Iraq is an Asian country located in the Middle East at latitudes 37°.25′–29°.5′. It has a population of approximately 25 million and an area of 435,000 km². Arabs represent about 80% of the population, Kurds about 15–18%, and the remainder being a mix of other ethnic minorities. The vast majority of the population is Muslim.

It is generally believed that MS prevalence is low in Middle Eastern countries [2]. A report in 1958 [3] on MS in Iraq described 13 patients, seen between 1944 and 1954.

Since then, there has been a lack of information on Iraqis with MS and the few reported studies have been limited by small numbers and no MRI data [4], [5]. The aim of this paper is to characterize the various clinical, demographic and epidemiological features of a well-defined Iraqi MS population ascertained from the main specialised MS centre in Iraq.

Section snippets

Methods

The current study included a chart review of the first consecutive 300 Iraqi MS patients attending Baghdad MS Clinic (hereafter referred to as the “Clinic”) who fulfilled Poser's Committee criteria for clinically definite (CD) and clinically probable (CP) MS [6]. The review was carried out from September to December 2002 inclusive. Although the data are retrospectively reviewed, these were originally collected with the intent of creating a database for subsequent analyses. The Clinic was

Demographic data

Of the 300 patients, 234 (78%) had two or more clinic assessments. Table 1 summarizes the demographics for this population. There were no significant gender differences with respect to age of onset, age at the time of first assessment, duration between clinical onset and diagnosis and duration of the disease (p > 0.05). The mean duration of the disease (from the clinical onset of MS to the first clinic assessment) was 8.6 ± S.D. 5.9 years (range 2 months–29 years). Of these, 92 (31%) had a duration

Clinical and demographic characteristics

This study is the only comprehensive description of clinical and demographic features for a consecutive series of Iraqi MS patients. In general our findings were comparable to the so-called “Western type” of MS reported in Caucasian patients [9], [10]. These included age at onset, clinical course distribution, PP cases being characterized by male predominance and older age of onset, frequency of initial presenting symptoms, cumulative neurological signs, disability status as assessed by EDSS

Acknowledgment

The authors thank Drs. A.D. Sadovnick, J. Oger and H. Tremlett at the UBC MS Clinic, Vancouver, Canada for reviewing the manuscript.

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A panel of experts consisting of 8 neurologists from Iraq and one international neurology expert from Germany convened to develop an expert opinion that would provide practical guidance for the pharmacological management of WCBA with MS in Iraq. They considered the latest label update and relevant published literature, along with local clinical practice and available resources.
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A retrospective observational study was conducted from year 2010 to 2019 among MS patients in West Bank. Demographic and clinical records of concerned patients were collected from the database of the Palestinian Ministry of Health. Age, sex, onset of symptoms, first symptom, year of diagnosis, family history, and smoking were noted. The crude 2019 prevalence and incidence rate were calculated.
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This is the first epidemiological study regarding MS disease in the West Bank of Palestine. Our results showed that crude incidence rate is increasing from 2010 to 2017. This is in part due to increasing awareness of the disease as well as the availability of diagnostic tools. Further researches will be necessary to closely monitor this increasing trend of the disease amongst Palestinian population in the coming future. Clinical features of the disease were similar to those described in the literature.
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The clinical phenotypes and disability progression of MS in LA, Africa, Asia and the MENA region have similarities to Western MS. In some regions and subpopulations there is evidence of a more aggressive course, possibly due to a combination of genetic and environmental factors. More population-based longitudinal data are needed, particularly in Sub-Saharan Africa.
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There is an unapprehended diversity in the epidemiology of multiple sclerosis (MS) in different geographical regions. In this study, for the first time, we systematically review the studies estimating the incidence and/or prevalence of MS in the Persian Gulf area. The goal is to obtain the overall incidence and prevalence of MS and elucidate the reasons for the geographical variation.
A comprehensive literature search was carried out using MEDLINE and EMBASE through articles published between January 1985 and December 2018 on MS epidemiology in Persian Gulf countries including Bahrain, Iran, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Search terms included 'Multiple sclerosis', 'Incidence', 'Prevalence', 'Epidemiology', 'Persian Gulf', 'Arabian Gulf' and name of each country. Only full-text articles published in English were included. All abstracts were considered and two trained reviewers evaluated the study quality using an assessment tool specifically designed for this study.
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Citation Excerpt :
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Multiple sclerosis in Iraq: Does it have the same features encountered in Western countries?

Abstract

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Demographic data

Clinical and demographic characteristics

Acknowledgment

J Neurol Sci

Lancet Neurol

Epidemiological evidence for multiple sclerosis as an infection

Clin Microbiol Rev

Multiple sclerosis in Iraq

Wien Z Nervenheilkd

Multiple sclerosis in Iraq: a clinical and geomedical survey

J Postgrad Med

Multiple sclerosis: clinical analysis

Iraqi Med J

New diagnostic criteria for multiple sclerosis: guidelines for research protocols

Ann Neurol

Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis

Neurology

Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS)

Neurology

The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability

Brain