Multiple sclerosis (MS) is a highly debilitating immune mediated disorder of the central nervous system and is often progressive and fatal. MS etiology seems to be determined by environmental factors and genetic predisposition [
1]. The contribution of each factor in MS etiology may vary in different geographic areas resulting into atypical spatial patterns of its incidence across the globe [
2]. Hitherto known spatial pattern of MS reflects the highest prevalence, morbidity and mortality rates in the temperate zones of both northern and southern hemispheres and with decreasing rates in the subtropics and tropics. For instance, Europe, Canada and the northern parts of United States are high risk areas, whereas the Asia, Africa and West Indies are regarded as low risk areas [
3]. So far, no specific exogenous or genetic basis for the spatial pattern has been identified, but it is speculated that some climatologic condition influences the frequency of the disease. It is unknown whether this effect is a direct on the patient or an indirect effect on the animal or plant life in his environment [
1],[
4].
Studies on migratory populations have indicated that the MS risk among those migrating from a high to a low risk area exceeds that of the population into which they have immigrated. Furthermore, those who migrate from a high-risk area to a low-risk area keep their high risk unless they migrate below the age of sixteen [
5]-[
7]. There are inconsistent reports regarding MS risk among immigrants from low risk areas such as Asia, East Africa and Caribbean to high MS risk areas. Additionally, as noted earlier, MS risk depends on age at the time of migration [
8]. Reportedly, MS was relatively uncommon among West Indian and Asian immigrants to UK [
8]-[
10]. However, children of Asian and West Indian immigrants born in England and Wales had MS prevalence similar to that in the general population of England and Wales [
11],[
12].
Based on Kurtzke classification, Arabian Gulf region is located in a low-risk zone for MS [
13]. However, recent studies suggest a moderate-to-high MS prevalence (range: 31–55 cases × 10
−5 individuals) with an increase in incidence in recent years [
14],[
15]. Arabian Gulf countries including Kuwait have a large population of migrant workers from Asian and African countries. Prior to first Gulf War in 1990, MS prevalence in Kuwait was significantly higher among non-Kuwaiti (mainly Palestinians) (23.8 × 10
−5) than Kuwaiti (9.5 ×10
−5) [
16]. However, the composition of population in Kuwait radically changed due to sociopolitical reasons since the first Gulf War in 1990. There was an influx of migrant workers from South and South-east Asia and other Arab countries replacing a pre-war a major expatriate group of Palestinians [
15]. Furthermore, during the post- Gulf War era, the MS prevalence in Kuwait increased from 6.7 × 10
−5 in 1993 to 14.8 ×10
−5 in 2000. Moreover, in a complete reversal of the pattern observed before 1990, this difference was more pronounced among Kuwaiti (31.2 × 10
−5) than non-Kuwaiti (5.6 × 10
−5) migrant workers. Therefore, in a geographic area with previously low MS prevalence, the local environment may be responsible for the dramatic change in MS risk [
15]. Seasonal pattern in MS births has been consistent of several studies conducted in a number of regions and countries [
17]. Month of birth is a surrogate for continuous environmental trait which might be present during the entire year and peak at certain period rather than being present only on month or season [
1]. Previously in Kuwait, we demonstrated birth of month effect on the MS risk among the Kuwaiti born in Kuwait using parametric statistical models. However, similar relationship did not hold for non-Kuwaiti born in Kuwait [
18]. This study assessed the overall MS incidence and evaluated the month of birth effect on MS risk among non-nationals born, lived and diagnosed with MS in Kuwait from January 1950 to April 2013 using non-parametric analysis of the data from Kuwait National MS Registry.