Neurology, neurological disorders and neurologists
Srimathy Vijayan discusses the global burden of neurological conditions
A consequence of increased life expectancy is the higher incidence of age related neurological disorders, such as dementia and stroke. Many of these disorders have evolved from detailed descriptions seen in medical textbooks to those with many diagnostic and therapeutic options supported by an increasingly robust evidence base. (1) They include neuro-degenerative diseases, neuro-infective diseases, neuro-vascular diseases, neuro-psychiatric diseases, neuro-surgical diseases, and as one may appreciate, are closely linked with various other divisions of medicine. Consequently, it is highly probable that future medical professionals, regardless of specialty pursued will be caring for patients with neurological disorders.
Global trends in Neurological disorders
Below is a list of some common neurological diseases and their estimated “burden”:
Dementia: Globally 24.3 million people have dementia today, with 4.6 million diagnosed this year alone. (2)
Epilepsy: 50 million people worldwide have epilepsy, 85% of which inhabit less developed countries. There are 2 million new cases occurring in the world per year. Regrettably, up to 70% of people with epilepsy do not receive proper treatment and are therefore unable to live a normal life. (3)
Parkinson’s Disease (PD): Dorsey et al (4) tried to project the rate of PD based on the age specific prevalence of the disease for Western Europe and the world’s most populous countries. The number of individuals over the age of 50 with PD in 2005 was between 4.1 and 4.6 million. They project that this number will more than double by 2030 to between 8.7 and 9.3 million. (4) According to The Parkinson’s Disease Society UK, there are 120 000 individuals with Parkinsonism in the UK. There are about 10 000 new cases per year. (5)
Stroke: Each year stroke causes about 5.54 million deaths worldwide (6), and is thought to be the second most common cause of mortality in the world. Stroke is a major cause of long-term disability, causing a loss of 49 million disability-adjusted life years (DALYs) worldwide each year. (5) By 2015, over 50 million healthy life years will be lost to stroke. (7) By 2020 stroke, together with coronary heart disease, is expected to be the leading causes of lost healthy life years globally.
Neurological disorders - a significant global disease burden
Only in recent years has the global disease burden that neurological disorders been brought to the forefront of international debate. The Global Burden of Disease study, an international collaborative project between WHO, the World Bank and the Harvard School of Public Health, produced evidence showing that the global health impact of neurological disorders had been previously underestimated, highlighting neurological disorders as one of the greatest threats to public health. (8) Despite neurological and psychiatric disorders comprising just 1.4% of all deaths, they account for a remarkable 28% of all years of life lived with a disability. (9) A series of other timely publications further emphasized neurological disorders as a significant health concern stating that 1 in every 9 individuals die from a neurological disorder. (10) (11)
The late director-general JW Lee, emphasized the WHO’s vigorous engagement in Neurological diseases by considering ways of making neurological disorders and their impact more recognised. (12) In response, WHO has launched the “global initiative on neurology and public health” whose main purpose is to increase professional and public awareness of the frequency, severity and costs of neurological disorders and to emphasize the need to provide neurological care at all levels including primary care. As part of the initiative, Neurological disorders: a Public Health challenge (13) was published by the WHO to further address the disparities that existed in neurological care across the globe. Its recommendations for action include the following points:
-Gaining commitment from decision-makers
-Increasing public and professional awareness
-Minimising stigma and eradicating discrimination
-Strengthening neurological care within the existing health systems
-Incorporating rehabilitation into the key strategies
-Developing national strategies and international collaborations
-Establishing links to related sectors
-Defining priorities for research
In order to successfully treat and care for patients with neurological disorders it is imperative to include other medical divisions, national and international organizations, governmental support and last but by far not least, patients themselves along with their families and carers.
The problem
Neurology is a sparsely populated specialty. Bergens estimated that seventy-one countries have fewer than one neurologist per million population, or no neurologist at all, compared with one neurologist per 137,000, 63,000, or 16,900 people in New Zealand, Japan, and Norway, respectively. (14) Furthermore, the WHO/WFN Survey of neurological services highlighted the fact that there are inadequate resources for patients with neurological disorders in most parts of the world, particularly for those living in low-income countries and developing regions of the world. (15) One must therefore appreciate the difficulties inherent in delivering high-quality care to patients suffering from neurological disorders which, at present, remain imperfect in many countries. It is evident that more neurologists need to be trained to work in developing countries. However, how best to implement this is under much discussion and still yet to be decided. (16) (17)
Conclusion
Despite recognizing the importance of focusing on neurological disorders, there remains a paucity of information about best practice in the specialty. This in turn makes service planning and delivery challenging, moreso in developing countries. Additionally, the lack of neurologists in certain populations means that many patients do not have access to specialist care; these patients remain unaccounted for in global surveys of neurological disorders. Conclusively, we are yet to encounter the true prevalence of neurological disorders and the speciality remains in search of potential recruits.
Srimathy Vijayan
Medical Student
University of East Anglia
Norwich
NR4 7TJ
s.vijayan@uea.ac.uk
(1) Wiebe S, Nicolle MW. Recent developments: Recent developments in Neurology. BMJ 2002;324;656-660.
(2) Ferri CP et al. Global prevelance of dementia: a Delphi consensus study. Lancet. 2005. 366:2112-17
(3) Shorvon SD et al. Epilepsy in developing countires: a review of epidemiological , socicultural and treatment aspects. Epilepsia. 1988, 29(Suppl. 1):36-54
(4) Dorsey ER, Constantinescu R, et al. Neurology. 2007 Jan 30;68(5):384-6. Epub 2006 Nov 2.
(5) Parkinson’s Disease Society of the United Kingdom. http://www.parkinsons.org.uk/about-parkinsons/what-is-parkinsons/how-many-people-have-parkinson.aspx (accessed 30 October 2007).
(6) The world health report 2004 - Changing history. Geneva, World Health Organization. 2004 (statistical annex)
(7) Preventing chronic diseases: a vital investment. Geneva, World Health organization. 2005
(8) Murray CJL, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA, Harvard School of Public Health on behalf of the World Health Organization and the World Bank, 1996 (Global Burden of Disease and Injury Series, Vol. I).
(9) Menken M, Munsat TL, Toole JF. The global burden of disease study: implications for neurology. Arch Neurol. 2000 Mar;57(3):418-20.
(10) Bergen DC. Preventable neurological diseases worldwide. Neuroepidemiology.1998;17(2):67-73.
(11) Bergen DC, Silberberg D. Nervous system disorders: a global epidemic. Arch Neurol. 2002 Jul;59(7):1194-6.
(12) Lee JW. WHO will be “vigourously engaged” in neurological disorders. Lancet Neurol. 2003 Jul;2(7):394.
(13) Neurological Disorders: public health challenges. World Health Organization. 2006.
(14) Bergen DC. Training and distribution of neurologists worldwide. J Neurol Sci 2002;198.
(15) Janca A, Aarli JA, Prilipko L, Dua T, Saxena S, Saraceno B.WHO/WFN Survey of neurological services: a worldwide perspective. J Neurol Sci. 2006 Aug 15;247(1):29-34.
(16) Menken M. Neurologic care and the care provided by neurologists: Implications of the World Federation of Neurology workforce survey. Journal of the Neurological Sciences 198 (2002) 1 - 2
(17) Bergen DC, Good D. Neurology training programs worldwide: a world federation of neurology survey. J Neurol Sci. 2006 Jul 15;246(1-2):59-64. Epub 2006 Mar 6
Bookmark on delicious | Digg