We studied 89 MS patients comprising 38 males and 51 females seen over a 10-year period. The hospital frequency was 25/100,000 patients. The diagnosis was mainly clinical and was supported by neuroimaging, cerebrospinal fluid analysis and neurophysiological tests. Sixty-five patients (73%) were Saudis and the peak age of onset was in the third decade. Fifty-two patients (58.4%) had clinically definite MS, 17 (19.1%) had laboratory-supported definite MS, 15 (16.9%) were clinically probable MS cases and the remaining 5 (5.6%) had laboratory-supported probable MS. The mean age at onset of Saudi patients (25.9 years) was lower than that of the non-Saudis (29.4 years; p < 0.001). Involvement of the pyramidal system was the commonest mode of presentation. The clinical course was relapsing-remitting in 60.7%, progressive-relapsing in 20.2% and primary progressive in 19.1%. The number of systems involved was significantly associated with the duration of disease (p < 0.001). The demographic features and the variability of clinical presentation of Saudi MS patients is similar to the results from neighbouring countries. Combination of clinical features and paraclinical tests is essential for accurate determination of extent of dissemination and for unmasking clinically silent lesions.

Accepted 15 December 1987 Case reports Case 1 A 26 year old right handed Sudanese was admitted with a day's history of headache, vomiting, drowsiness, confusion and fever. He had experienced intermittent bifrontal headache with no special features for 8 months. During this period he had recurrent fever, was anorexic and had lost weight. Four months prior to admission he had been having episodes of weakness in the right limbs associated with difficulties in choosing the correct words although he could understand what was said to him. Most of these episodes lasted about 10 minutes and none lasted more than an hour. He often drank unpasteurised goat and camel milk.On examination he looked ill, was wasted and had a temperature of 39°C. He was drowsy and confused but easily rousable. He had neck stiffness, positive Kernig's sign and mild left hemiparesis. Clinical and CSF findings (table 1) were compatible with tuberculosis and he was started on streptomycin, rifampicin, INH and ethambutol while awaiting further laboratory results including tests for brucellosis. The following day he was fully alert, orientated and apryexial. Brucella species were later isolated from the CSF and brucella agglutination titres were raised in both serum and CSF (Table 1). Detailed investigations for stroke risk factors such as echocardiography, electrocardiography, haemoglobin electrophoresis, serum lipid analysis and serological tests for collagen disorders were normal.The antituberculosis drugs, except rifampicin, were discontinued and replaced by trimethoprim-sulfamethoxazole (TMP-SMZ). The patient continued to improve clinically and his antibody titres declined. He was discharged symptom free 5 weeks later. When reviewed 9 months after discharge he was well without any recurrence clinically and the brucella agglutination titres were 1/ 160 for both abortus and melitensis respectively. However, minimal pyramidal tract signs (pathologically brisk tendon jerks) were still present in the left limbs. Case 2 A 60 year old Saudi female was admitted with recurrent vertigo, nausea, vomiting, anorexia and weight loss for 3 months. The vertigo was worsened by exercise or change of position of the head. There was no history of headache, tinnitus, loss of hearing or visual disturbance. Six

Objectives:To develop and test the psychometric properties of an Arabic version of Fatigue Severity Scale (FSS-Ar) that can be used to measure fatigue in Arabic patients with disorders where fatigue is a major symptom.Methods:Forward and backward translations of FSS were undertaken to develop an Arabic version. The validity and reliability of the FSS-Ar was then tested on 28 patients with systemic lupus erythematosus (SLE), 24 patients with multiple sclerosis (MS), and 31 healthy subjects. Exploratory factor analysis and hypothesis testing methods were used to examine construct validity. The correlation between FSS-Ar and the vitality domain of the RAND 36-Item Health was examined to test construct validity. The study was conducted at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between February and June 2012.Results:Using a score of ≥4.05 to define fatigue, 39 of 52 (75%) participants were fatigued compared with 10 out of 31 (32%) healthy participants. The correlation between the FSS-Ar and the vitality domain of the RAND-36 was acceptable (r = -0.46). Factor analysis showed that items of the FSS-Ar measured one underlying construct, namely, fatigue. Test-retest reliability and internal consistency of the FSS-Ar was acceptable (intraclass correlation coefficient model 2,1 = 0.80; Cronbach’s alpha = 0.84).Conclusion:The Arabic version of the FSS demonstrated acceptable psychometric properties and was able to differentiate between patients with SLE or MS, and healthy subjects.

S Al-Rajeh, A Ogunniyi, A Awada, A Daif, R Zaidan, Preliminary Assessment of an Arabic Version of the MiniMental State Examination. 1999; 19(2): 150-152 The Mini-Mental State Examination (MMSE) is one of the most widely used instruments for quantitative assessment of cognitive functions and for dementia screening.1,2 It assesses many cognitive domains, including orientation, memory, language, calculation and visual construction. The test, however, shows educational as well as cultural bias, and appears to be more suited to Western culture. [2][3][4] The use of the MMSE in other cultures, therefore, entails translation into the specific languages, modification and/or substitution of some of the items with culturally relevant ones, and pilot-testing these for reliability, sensitivity and specificity. There are many versions and translations of the MMSE, including Chinese, German, Spanish and Nigerian, which have been used for studies in the respective cultures. [4][5][6][7] An Arabic version of the MMSE was developed and pilot-tested on Saudi patients. The results are presented in this report. Materials and MethodsThe MMSE was translated into the Arabic language, with many items left unchanged from the original version. The names of the area of the Kingdom and its location were substituted for the name of the country and the particular state, which appear in the original version. Date (a popular palm produce), chair and money, were the three items most often used. We used serial subtraction of 3s from 100 for assessing calculation, attention and concentration. We omitted spelling "world" backwards because the concept appeared difficult in a predominantly illiterate population. The expression "no ifs, ands or buts" was replaced by an Arabic phrase. The Arabic version produced was then translated back into English to ensure consistency of the items. The questionnaire was then administered by the same interviewer to 33 subjects, comprising 27 males and 6 females, who volunteered to take part in the study. The participants were mainly relations of inpatients at the King Khalid University Hospital, Riyadh (KKUH), who had no evidence of central nervous system dysfunction and were not on medications that could depress cognitive function or alertness. The responses were recorded as either correct or incorrect. The educational status of the individuals was obtained at the end of the administration of the questionnaire. Individuals who had not attended school or had spent less than six years in school were regarded as uneducated.Using sequential analysis, the questionnaire was administered by the same interviewer to four clinically diagnosed demented patients (based on DSM-IV criteria) 8 being managed at KKUH, for the determination of its psychometric properties. The dementia diagnoses were vascular (two cases), probable Alzheimer's disease (one case) and dementia associated with meningioma (one case). The patients included three females and one male, with a mean age of 69.8±11.2 years (range, 54-80 years), who were uned...