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Rivera. Neuroimmunol Neuroinflammation 2018;5:12 Neuroimmunology and
DOI: 10.20517/2347-8659.2018.16 Neuroinflammation

Commentary Open Access

Multiple sclerosis: depression and disability are
globally shared issues of concern

Victor M. Rivera

Department of Neurology, Baylor College of Medicine, Houston, TX 77025, USA.

Correspondence to: Dr. Victor M. Rivera, Department of Neurology, Baylor College of Medicine, Cambridge Street 7200, 9th Floor,
Houston, TX 77025, USA. E-mail: vrivera@bcm.edu

How to cite this article: Rivera VM. Multiple sclerosis: depression and disability are globally shared issues of concern.
Neuroimmunol Neuroinflammation 2018;5:12. http://dx.doi.org/10.20517/2347-8659.2018.16

Received: 30 Mar 2018 Accepted: 31 Mar 2018 Published: 18 Apr 2018
Science Editor: Athanassios P. Kyritsis Copy Editor: Guang-Zhe Zhu Production Editor: Huan-Liang Wu

While multiple sclerosis (MS) is more common among Caucasian populations, its prevalence is increasingly
noted in ethnic groups that had previously been considered to have a low frequency of the disease.
Epidemiologic studies indicate a considerable augmentation of MS presence in areas such the Middle
[2]
[1]
East and Latin American countries . Along with the general clinical effects of this complex neurological
disorder is the impact exerted by some of its comorbid neuropsychiatric manifestations particularly
[3]
depression, described as affecting three times higher MS patients than the general population . Literature
and general perceptions had suggested clinical depression, although chronic in most MS cases, was
[4,5]
unrelated to disability progression or disease course .

[6]
A Saudi Arabia study published in Neuroimmunology and Neuroinflammation, acquired data from all
geographic regions of the Kingdom involving 598 MS patients, and finding that 97.7% had some degrees
of depression as assessed with the patient health questionnaire, a reliable and valid measure of depression
severity. In this study, most had mild-to-moderate depression. The Saudi Arabian investigators correlated
these data with scores obtained from disability quantified with the patient determined disease steps which
has a strong correlation with the scores derived from the expanded disability status scale, the cardinal
marker of neurological disability in MS. There was a significant association between patients’ level of
neurological disability and severity of depression (P < 0.001). Interestingly, none of the patients reported
absence of depression had a moderate or severe disability while those with moderately severe or severe
depression had the highest percentages of severe disability. Aspects that escaped the authors explanation
was the fact that severe depression was more prominent in patients residing in the northern areas of the
country and that 13% of the subjects were foreigners, their country origin was not reported. Saudi Arabia
[7]
has a medium to high MS prevalence (≥ 40/100,000) has substantial immigrant population from nearby

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