epidemiological study

1. Multiple Sclerosis:
An Inclusive Look
Manal Al-Romeih

2. A chronic, inflammatory, autoimmune,
demylenation disease affecting CNS where the
person's own immune system attacks the
insulating mylin sheath of the brain, spinal cord
and the optic nerve.
Lublin, Baier, Cutter (2003)

3. Defect of the mylin sheath affects stability
and speed of nerve impulse conductivity
resulting in neurological impairment,
symptoms, functional limitations and
potentially permanent disability.

4. Types
• Relapsing –remitting 76%
• Progressive relapsing 3%
• Primary progressive 4%
• Secondary progressive 7%
(MSIF,2012)

5. Symptoms

6. Genetics:
Saudi 1/5th
World 20%
Twins 200-300 x
(Al-Jumah et al, 2012)
Cluster:
Scotland
Frontier between Croatia and Slovenia –that have a large
proportion of the population from a Germanic descent.
Variation in Canada
(Rosati, 2001)

7. Environmental:

8. Environmental factors:
Geographical distribution relative to the equator
(Latitude theory)
Temperature & sun light exposure
UV immunosuppressive (2nd trimester)
Migration
Russians in Southern USSR
Poliomyelitis hypothesis & Epstein-Barr virus infection
(Hygiene theory)
Age of infection
Sanitization

9. Vitamin D
Month of birth
3rd trimester
T
lymphocyte
Low
production
& intake
Sun light exposure
Immuno-
suppressive UV
2nd trimester
Hypovitaminosis D

10. Associated factors:

11. Vaccination & childhood infections

12. Diagnosis
MRI
CSF analysis
Evoked potential

13. Treatment
Disease
modifying
Ease the
symptoms
QOL
assessment
Exercise
Healthy
diet

14. Prevalence
Prevalence (100.000)country
8 (40)? Yagob & Daif, 1998Saudi Arabia
31.15Kuwait
92.69Qatar
39Jordan (Amman)
35.3Arabs (Israel)
6Libya
10Tunisia

15. Prevalence
Prevalence (100.000)country
193, 168Scotland & N. Ireland
110Switzerland
37France
50Spain
11- 33Australia
55- 91,196Canada
22- 160USA

16. Prevalence
Prevalence (100.000)country
5, 30Brazil & Uruguay
41Siberia
1-28India
1, 4Taiwan & Japan
3South Africa
*reduction in infant mortality

17. Impact of the disease
Interaction &
connection
Employment
Family
support

18. The picture in Saudi Arabia

19. The picture in Saudi Arabia

20. The picture in Saudi Arabia
27% Didn’t
receive any

21. The picture in Saudi Arabia
50%
75.5%
33%
23%
21.6%
16.2%

22. The picture in Saudi Arabia

23. The picture in Saudi Arabia

24. Neurologists
Health
educators
Psychiatrist
Physio-
therapists
Social
Government Family
QOL
Drug
adherence

25. Thank you!