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Müller. Neuroimmunol Neuroinflammation 2018;5:23 Neuroimmunology and
DOI: 10.20517/2347-8659.2018.27 Neuroinflammation

Commentary Open Access

Commentary on “Depression severity and its
predictors among multiple sclerosis patients in
Saudi Arabia: a cross-sectional study”

Thomas Müller

Department of Neurology, St. Joseph Hospital Berlin - Weissensee, Berlin 13088, Germany.
Correspondence to: Prof. Thomas Müller, Department of Neurology, St. Joseph Hospital Berlin - Weißensee, Gartenstr. 1, Berlin
13088, Germany. E-mail: th.mueller@alexianer.de, thomas.mueller@ruhr-uni-bochum.de

How to cite this article: Müller T. Commentary on “Depression severity and its predictors among multiple sclerosis patients in Saudi
Arabia: a cross-sectional study”. Neuroimmunol Neuroinflammation 2018;5:23. http://dx.doi.org/10.20517/2347-8659.2018.27

Received: 9 May 2018 Accepted: 11 May 2018 Published: 7 Jun 2018

Science Editor: Athanassios P. Kyritsis Copy Editor: Guang-Zhe Zhu Production Editor: Huan-Liang Wu

Multiple sclerosis (MS) is looked upon as chronic autoimmune disease. Current therapeutic research
focus on the prevention of relapses in association with morphological magnet resonance imaging (MRI)
parameters. This paper again describes that depression is one of the most common symptoms in MS.
Components of depression for manifestation in MS are exogenous, such as disability, or endogenous, i.e.,
due to localisation of lesions, which predispose for onset of depression. This paper points out that depression
and related neuropsychiatric symptoms, i.e., apathy and fatigue, should not be underestimated in the clinical
maintenance of MS patients. This paper supports the view, that further research is warranted beyond past
and future ongoing trials on cognitive deficits, which frequently disregard the impact of apathy and fatigur
on standardised neuropsychological testing in association with chronic intake immune system modulating
compounds. Therefore it is promising that efforts are undertaken on standardisation of neuropsychological
[1]
assessment tools, i.e. for cognition, in trials , whereas the MiniMental State Examination score have a
considerable bias by the educational level of the patient. Clinicians repeatedly point out, that non-cognition
related signs are often essential limiting for quality of life. As a result, they investigate the efficacy of already
available compounds often in observational or naturalistic small trials, like in this paper. Clinicians point out
that non-cognition related signs are often essential limiting for quality of life. As a result, they investigate the
efficacy of already available compounds often in observational or naturalistic small trials. These outcomes
are frequently considered as less essential by the authorities driven evidence-based-medicine classification of
trials. One must consider that most of the used assessment instruments are not objective. They are biased by
the attitude and habits of the investigator. One underestimates that the rating situation and the stress for the

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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