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Friday, December 20, 2013

Future of Management of Multiple Sclerosis in the Middle East:

Future of Management of Multiple Sclerosis in the Middle East: A Consensus View from Specialists in Ten Countries

Multiple Sclerosis International
Volume 2013 (2013), Article ID 952321, 6 pages


The prevalence of multiple sclerosis (MS) is now considered to be medium-to-high in the Middle East and is rising, particularly among women. While the characteristics of the disease and the response of patients to disease-modifying therapies are generally comparable between the Middle East and other areas, significant barriers to achieving optimal care for MS exist in these developing nations. A group of physicians involved in the management of MS in ten Middle Eastern countries met to consider the future of MS care in the region, using a structured process to reach a consensus. Six key priorities were identified: early diagnosis and management of MS, the provision of multidisciplinary MS centres, patient engagement and better communication with stakeholders, regulatory body education and reimbursement, a commitment to research, and more therapy options with better benefit-to-risk ratios. The experts distilled these priorities into a single vision statement: “Optimization of patient-centred multidisciplinary strategies to improve the quality of life of people with MS.” These core principles will contribute to the development of a broader consensus on the future of care for MS in the Middle East.

1. Introduction

MS commonly appears in young adults and requires lifelong management, with significant potential for disability among people of working age. Indeed, the World Health Organisation and Multiple Sclerosis International Federation have estimated that about 60% of patients with MS will no longer have full ambulatory function twenty years following diagnosis of the disease [1]. There is a clear need to optimise the care of MS. A group of European experts in MS care recently used a structured process of information sharing and consensus building to define a new vision for optimal MS care in the 21st century [2]. As therapeutic practices and cultural influences vary between regions, it is important that such initiatives be conducted in other parts of the world where MS has a major impact on public health. Accordingly, a group of physicians involved in the care of MS patients from ten Middle Eastern countries recently considered the current and future management of MS within this region.

2. Methods

The methodology used previously by a European expert group was adapted for use here [3]. The expert group are all coauthors of this paper and drawn from a panel of experts convened for this purpose (on the basis academic and research history in the field of MS and representation of countries across the Middle East and North Africa) at a closed meeting; additionally, KE acted as Chair and PR (who led the European expert group) acted as Moderator. All suggestions for items of interest were contributed by the Middle-Eastern experts.
Firstly, a list of perceived needs in MS care in the Middle East was generated by participants, in terms of how care for MS might develop in the future, what barriers might prevent the achievement of optimum standards of care, and what factors might drive the change required. Following discussion, this initial list was condensed into a series of principles, which were displayed in view of the group. These items were narrowed down using a voting system in which each participant had five votes which could be allocated in any combination among the principles identified above (e.g., each participant could distribute the votes singly among five different items or, alternatively, up to all five votes could be given to a single item that the individual expert considered to be of major importance). Voting was open and the six principles with the highest total of votes were selected. Participants discussed these further and generated a consensus statement encapsulating their vision for future MS care in the region.

3. Overview of the Epidemiology of Multiple Sclerosis in the Middle East

Limited epidemiological data are available from the Middle Eastern countries regarding the prevalence, incidence or natural history (including prognosis and economic impact) of MS, or with regard to the increasing expanding cost of managing the condition. Based on the Kurtzke classification, the Middle East is located in a low-risk zone for MS; however, recent studies suggest a moderate-to-high prevalence in areas within the region (31–55 MS per 100,000 individuals), with an increase in incidence and prevalence in recent years, especially among women [138]. Thus, the countries of the Middle East bear a considerable burden of MS. Reliable epidemiological data will be needed for healthcare planning in particular.
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