1,2Imen Kacem, 1,2Saloua Mrabet, 1,2Amira Souissi, 1,2Alya Gharbi, 1,2Lilia Hmissi, 1,2Firas Larnaout, 1,2Amina Gargouri, 1,2Riadh Gouider

1Razi University Hospital, Manouba, Tunisia; 2Faculty of medicine, University Tunis El Manar, Tunis, Tunisia


Multiple sclerosis (MS) is universally reported to be more prevalent in women than men. In Tunisia, gender ratio (women/men) has markedly increased in Tunisian patients with MS since the first reports of Ben Hmida in 1977. The effect of gender on MS prognosis, clinical profile and disability accrual have been reported to be critical. The aim of our study was to investigate the impact of gender on MS characteristics and disease progression in a Tunisian cohort.

Material(s) and Method(s):

A retrospective study was conducted in the department of Neurology of Razi hospital-Tunisia including patients diagnosed with MS according to 2017 McDonald criteria. Patients were compared according to gender on various aspects: MS phenotype (relapsing (RRMS), secondary progressive (SPMS) and primary progressive (PPMS)), first attack characteristics, presence of oligoclonal bands (OCBs), brain and spine MRI features and disability accrual evaluated by the MS severity score (MSSS) and the Progression index (PI).


A total of 504 patients were included: 359 females and 145 males (F/M=2.47). Female predominance was more pronounced during RRMS (n= 389; F/M=2.56) than during SPMS (n=70; F/M=2.88) and PPMS (n=45; F/M=1.5), but was not statistically significant (p=0.2). Gender did not influence first clinical attack symptoms regardless from MS phenotype (table1). However, in the RRMS group, gender was linked with the degree of recovery from the first relapse: partial recovery in 29.4% of males versus 15% of females (p=0.002). OCBs positivity and baseline MRI characteristics were also independent from gender. Males exhibited a higher disability accrual according to MSSS in the RRMS group (3.51 versus 2.79 for females; p=0.011), but not in the SPMS (7.64 versus 7.68; p=0.9) and PPMS groups (8.1 versus 7.42 for females; p=0.2). Females and males’ PI were comparable among the different groups: 0.32 versus 0.34 for RRMS (p=0.6), 0.5 versus 0.57 (p=0.4) for SPMS and 0.8 versus 0.5 (p=0.1).


Our results highlighted an increased MS susceptibility among females and an increased rate of disability progression among males, in particular during RRMS. The phenotype of the first attack, OCBs positivity rates and MRI features were independent from gender. These findings were consistent with previously published data and supported that sex hormones might contribute to or modulate brain damage in MS.