MS Quality of Life in Morocco: Unaddressed Needs and Future Directions

We greatly appreciate the valuable work by Lotfi et al. on health-related quality of life among Moroccan patients with multiple sclerosis (MS) 1. As one of the largest-scale studies in North Africa using the validated Arabic version of the MS Quality of Life-54 (MSQOL-54) scale, it effectively identifies age and MS phenotype, relapsing–remitting multiple sclerosis (RRMS) versus primary progressive multiple sclerosis (PPMS), as key determinants of health-related quality of life (HRQoL) while highlighting critical impairments in energy and fatigue, physical, and emotional role limitations. This study fills a long-standing gap in regional neuroimmunology research and provides a solid foundation for clinical practice and policy-making in Morocco. Several important gaps remain unaddressed, however, including the lack of integration of objective clinical indicators such as the Expanded Disability Status Scale (EDSS) scores, insufficient attention to culture-specific social determinants such as family caregiver burden, and the absence of actionable policy and intervention frameworks tailored to Morocco's healthcare context. These gaps make it difficult to translate research findings into tangible improvements for patients, especially vulnerable subgroups like older adults and those without medical insurance. First, future research should integrate objective clinical metrics with patient-reported HRQoL data. Lotfi et al.'s study relies solely on self-reported outcomes, which misses the opportunity to link quality of life (QoL) deficits to disease severity such as EDSS scores or treatment adherence. These factors are known to have a significant impact on MS prognosis 2. Incorporating EDSS assessments and detailed treatment histories would help clarify whether age-related QoL declines stem from disease progression or comorbidities, enabling the development of more precise targeted interventions. Second, cultural and social structural factors deserve deeper exploration. Morocco's collectivist society means family caregivers play a pivotal role in patient care, but the study does not assess caregiver burden or its bidirectional impact on patient HRQoL 3. Additionally, traditional medicine use is prevalent among Moroccans for chronic conditions, yet its influence on treatment decisions and QoL remains unexamined. Investigating these factors would ensure interventions are culturally congruent and better suited to local needs. Third, policy and practice interventions should be refined based on the study's findings. Given that 53.9% of patients lack medical insurance and MS care is concentrated in urban centers, policy measures should prioritize expanding insurance coverage for disease-modifying therapies while establishing telemedicine services to reach rural areas. Clinically, age-stratified programs, such as fatigue management and psychological support for patients aged 47 years and older, and digital self-management tools, leveraging the study's WhatsApp recruitment network, could serve as cost-effective solutions 4. In conclusion, Lotfi et al.'s study lays crucial groundwork for understanding MS-related QoL in Morocco 1. Addressing the identified gaps through integrating clinical metrics, exploring cultural determinants, and developing context-specific interventions will enable future research to further advance equitable, patient-centered MS care in Morocco and similar middle-income countries. Qiuyu Wang: contributed to conceptualization and writing – original draft. Yu Geng: contributed to conceptualization and writing – review and editing. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing is not applicable.