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The response to dopamine replacement therapy in patients with degenerative parkinsonism is variable. Reasons for a poor therapy response include the type of parkinsonism, comorbidities, and differential effects on clinical features. An additional explanation, which has received much less attention, is sub-optimal therapy compliance. Single and multicentre studies of therapy compliance report significant under- and overuse of dopamine replacement therapy resulting in poor symptomatic control, or features of the dopamine dysregulation syndrome or other signs of dopaminergic excess (dyskinesia, confusion, visual hallucinations). In this article, the evidence for sub-optical adherence in Parkinson's disease (PD) is reviewed, and factors associated with sub-optimal compliance were examined, with two case vignettes to illustrate clinical consequences of deviation from the prescribed therapy regimen.

Stroke is second only to ischaemic heart disease as a cause of death, and over a third of stroke deaths occur in developing countries. Arab countries constitute populations with a similar lifestyle and diet that may influence stroke risk, type and survival after stroke, as well as other characteristics in comparison to Western and Oriental populations. Therefore, a review of published reports of stroke in Arab countries was undertaken to provide a background for designing future stroke studies in Arab populations. Thirty-one articles related to incidence, prevalence, types, risk factors and outcome of stroke in Arab countries were identified by keyword searching of Medline and Embase, and review of references in all relevant papers. Studies were available for Saudi Arabia (n=16), Qatar (n=4), Libya (n=3), Kuwait (n=2), Jordan (n=1), United Arab Emirates (n=1), Bahrain (n=1), Tunisia (n=1), Iraq (n=1), and Sudan (n=1). The publication dates ranged from 1983-2008. The annual stroke incidence ranged from 27.5 to 63 per 100,000 population and prevalence was between 42 and 68 per 100,000 population. Ischaemic stroke was the commonest subtype in all series. However, one series from Sudan had a 41% rate of intracerebral haemorrhage, which is more similar to East Asian countries. Non-lacunar infarction occurred more frequently than lacunar infarcts in all but two series. Hypertension, diabetes mellitus, hyperlipidaemia, and cardiac disease were the commonest risk factors. The case-fatality rate at 30 days was between 10 and 17.5%. Therefore, the incidence and prevalence of stroke in Arab countries are lower than the Western world but within the range reported in Chinese populations. Stroke types and risk factors are similar, but an apparently higher rate of lacunar infarction in some settings needs further investigation. There is therefore a significant opportunity for further evaluation of stroke in Arab countries, especially in unstudied areas such as the populous countries of Egypt, Algeria, Syria, and Morocco.

The susceptibility of various populations to multiple sclerosis (MS) and the clinical patterns of the disease are thought to be different. Nineteen articles related to incidence, prevalence and clinical patterns of MS in Arab populations were identified by keyword searching of Medline and Embase, and review of references in all relevant papers. Data were only available for the Kuwaiti, Jordanian, Libyan, Saudi, Iraqi, Palestinian (including Arabs living in Israel), and Omani populations. The publications ranged from 1975 to 2007. In Israel the incidence of MS was 0.7 per 100,000 per year in Arabs born and living in Greater Jerusalem. In Kuwait, the incidence of MS was 2.08 per 100,000. Prevalence varied from 4 to 42 per 100,000 population. The clinical pattern of MS was generally similar to that in western countries. However, one study from Oman found a high rate of optic-spinal disease (affecting one third of patients) and a low rate of oligoclonal bands (OGBs) (only one third of patients); this pattern resembles that of MS described in Asian countries. In conclusion, the prevalence of MS among Arabs has a wide reported range. The clinical pattern is generally similar to "Western type" MS but apparent differences in optic-spinal disease and OGBs positivity need further evaluation. There is significant opportunity for further evaluation of MS in Arabs, especially in unstudied areas, including the populous countries of Egypt, Algeria, Syria, and Morocco. Studies of Arab-Americans and Arab immigrants in Europe could help in defining the effect of immigration on MS. Such studies are likely to enhance our knowledge of the environmental, genetic and clinical variation of MS in Arabs.