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countries (and most recently refugees from Syria and Yemen), Asian expatriates and many westerners
employed in professional and technical jobs. The reported phenomenon of people moving from a high-
risk to a low-risk area carry the MS risk with them if the migration took place after age 15 continues to be
[8]
discussed but these epidemiologic aspects deserve further study in Saudi Arabia. Recent attention has
been placed on the sociological and/or biological behavior of immigrants with MS moving from a lower to
[9]
a higher risk country . In this series, as it is universally observed, women’s prevalence was higher (64.2%)
with a female: male ratio of about 2:1. Other findings of note extracted from the data of the Saudi Arabian
study are the higher prevalence of depression in young individuals ages 26-35 years (P = 0.001) and with a
higher education (P = 0.001), but predominant as well in people with the lowest income (< 3000 monthly
SR, equivalent to 800 USD).

The Saudi Arabian study provides the first-time evidence of a direct and significant relationship between
depression and neurological disability in MS patients. In this sample, all the patients were being treated
with a disease modifying therapy. The association of depression with the medication class remains unclear
although the only two cases receiving Alemtuzumab (Lemtrada®) scored with severe depression and the
highest percentages of moderately severe and severe depression were noted with b interferons 1-a (Avonex®;
Rebif®) and 1-b (Betaferon®), as well as the oral product Dimethyl-fumarate (Tecfidera®). The presence of
depression with its tremendous variety of emotional states in the majority of people with MS, is a factor
requiring early identification and appropriate management in view of the impact to a person’s quality of
life and it is associated with progression of disease as well as neurological disability.

DECLARATIONS
Authors’ contributions
The author contributed solely to the paper.

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
Not applicable.

Ethics approval
Not applicable.

Copyright
© The Author(s) 2018.

REFERENCES
1. Browne P, Chandaratna D, Angood C. Atlas of multiple sclerosis 2014. Neurology 2014;83:1022-4.
2. Melcon MO, Melcon CM, Bartoloni L, Cristiano E, Duran JC, Grzesiuk AK, Cabrera Gomez JA. Towards establishing MS prevalence in
Latin America and the Caribbean. Mult Scler 2013;19:145-52.
3. Minden SL, Schiffer RB. Affective disorders in multiple sclerosis: review and recommendations for clinical research. Arch Neurol
1990;47:98-104.
4. Depression. Available from: www.nationalmssociety.org/depression [Last accessed on 29 Mar 2018].
5. Koch MW, Patten S, Berzins S, Zhornitsky S, Greenfield J, Wall W, Metz LM. Depression in multiple sclerosis: a long term longitudinal
study. Mult Scler J 2015;21:76-82.
6. Alhazzani AA, Alqahtani MS, Ogran H, Abuhawi OH, Asiri AY, Al-Hanash AM, AlQahtany RA, Alfaifi AA, Asiri AA, Asiri MA.
Depression severity and its predictors among multiple sclerosis patients in Saudi Arabia: a cross-sectional study. Neuroimmunol
Neuroinflammation 2018;5:8.