Multiple sclerosis (MS) is an immune mediated inflammatory demyelinating disorder that affects the central nervous system and damages the myelin sheath and axons to varying degrees (Dobson and Giovannoni, 2019). The Atlas of MS (third edition) estimated that as of 2020, 2.8 million people (36 per 100,000 population) had MS worldwide, representing an increase of 30% since 2013 (Atlas of MS Edition - MS International Federation 2022). Among various World Health Organization (WHO) regions, prevalence of MS was the highest in Europe (133 cases per 100,000 population), followed by the Americas (112), and the Eastern Mediterranean (33). The lowest prevalence rates (5–9 cases per 100,000 population) were in the WHO regions of Western Pacific, Africa, and Southeast Asia (Atlas of MS Edition - MS International Federation 2022).

The most common subtype of MS is relapsing-remitting MS, in which periods of neurological deficits are punctuated by periods of clinical improvement or latency (Kremenchutzky et al., 2006). Other subtypes include primary progressive and secondary progressive MS (Martinelli et al., 2004). Symptoms usually begin in early adulthood and course variably; progressive forms of MS gradually cause physical disability leading to diminishing productivity and capacity to work (Martinelli et al., 2004; Tremlett et al., 2006; Lublin and Reingold, 1996). Thus, MS can progressively burden the patients and their families with job loss, rising medical costs, caregiver costs, ultimately impacting the national productivity and healthcare system (Kobelt et al., 2017; Nicholas et al., 2019).

As per the McDonald criteria (2017), a diagnosis of MS is dependent upon clinical findings, identification of characteristic lesions on brain and spine via magnetic resonance imaging (MRI), and the presence of OCB and/or high levels of immunoglobulin G in the cerebrospinal fluid (Polman et al., 2011; Thompson et al., 2018).

In Oman, so far only one study by Tharakan et al., based on 1990–2000 data, has sought to describe the clinical characteristics of MS patients (Tharakan et al., 2005). Using a small sample of 30 patients, the researchers suggested a low prevalence of MS in Oman at 4 cases per 100,000 population (Tharakan et al., 2005). However, a recent study in Oman raised the estimate to 15.9 per 100,000 (Al-Senani et al., 2021). Oman's neighbors in the Arabian Gulf region have shown even higher prevalence of MS, with recent reports from the Gulf region reported higher prevalence rates ranging from 40 to 104/100,000, being lowest in Saudi Arabia and highest in Kuwait (Alroughani et al., 2019; AlJumah et al., 2020; Inshasi and Thakre, 2011; Deleu et al., 2013).

Accordingly, the aim of the current study was to determine the initial clinical and neuroimaging characteristics of patients presenting with MS in Oman, along with the rate of MS-associated disability and demographic risk factors for MS in the Omani population. Our findings are expected to enhance physicians’ understanding of the common clinical presentations of MS in Omani society, thereby facilitating early diagnosis and treatment, thus slowing down the disease progression.