Pediatric-Onset Multiple Sclerosis in the Gulf: A Scoping Review of the Current Evidence Base and Research Gaps

Abstract

Background: MS begins before age 18 in 3–10% of cases (pediatric-onset MS, POMS). Adult MS epidemiology is increasingly characterized across the Gulf, but whether the pediatric literature is sufficiently mature and ho0m1ogeneous to support a quantitative meta-analysis, as opposed to a scoping review, remains unclear. Objective: To map published POMS evidence across the six Gulf Cooperation Council (GCC) states and identify evidence gaps. Methods: A scoping review followed the Arksey and O’Malley framework, reported per PRISMA-ScR. Eligibility followed a Population-Concept-Context framework: MS onset before 18 years; epidemiological, clinical, diagnostic, therapeutic, and outcome data; the six GCC states. Adult-inclusive studies that did not report a dedicated pediatric-onset subgroup were retained only as contextual evidence and were not counted as meeting the Population criterion (see Methods). MEDLINE/PubMed, Embase, Scopus, Web of Science, and IMEMR were searched from inception through August 2026. Results: Eleven studies were included. Dedicated, pediatric-specific POMS data were identified from three of six countries: Kuwait (three epidemiological/clinical registry studies and two pediatric monoclonal-antibody outcome studies), Saudi Arabia (one national-registry study), and the UAE (two hospital/multicenter cohorts and one pediatric monoclonal-antibody outcome study). Qatar and Oman contributed only adult-inclusive prevalence studies without a dedicated pediatric subgroup, and no eligible study was identified from Bahrain. Incidence ranged from 2.1/100,000 (Kuwait) to a UAE-reported 7.2/100,000 in a 15–19-year age band that extends beyond the review’s < 18-year POMS definition; prevalence (2.7–36/100,000) was highest in the UAE. A relapsing–remitting course, female preponderance, and brainstem/cerebellar or visual presentations predominated; MRI, cognitive, and quality-of-life data were sparse or absent. Three studies reported pediatric natalizumab/ocrelizumab outcomes (Kuwait, UAE). Conclusion: The Gulf POMS evidence base is real but narrow, concentrated, and heterogeneous; a scoping review, which maps the evidence base and treats geographic and domain gaps as findings in their own right, is currently the more informative synthesis than a quantitative meta-analysis. This supports a harmonized, multi-country Gulf pediatric MS registry with standardized outcome reporting, including neurocognitive and quality-of-life measures.