Neglected Tropical Diseases (NDTs) are comprised of a discrete list of infectious diseases mainly occurring in tropical or subtropical regions which affect over a billion people and occur largely as a result of extreme poverty. Although rarely acknowledged, a third of the NTDs are primarily disorders of the neurologic system (rabies, neurocysticercosis, African sleeping sickness, leprosy) OR have neurologic system involvement as part of their most extreme and/or end stage manifestations (Chagas, schistosomiasis).
Epidemiological studies of cerebral palsy (CP) in sub-Saharan Africa are challenging to conduct leaving us with limited insights into the most basic aspects of CP in Africa including prevalence and risk factors. If saving baby brains is a priority, understanding what injures infant nervous systems, when and how would seem a critical first step in any public health intervention aimed at improving child health. Two recent publications—a rural, population-based study in Uganda1 and a well-designed case-control study in Botswana2 offer important new findings on CP in the African setting.
Health care reimbursement is moving from volume-based fee-for-service to value-based systems. Value is defined as (quality + patient experience) divided by cost. This shift from volume to value is the central innovation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Both pathways of MACRA’s Medicare Quality Payment Program (QPP), the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), preferentially reward high quality, low cost care.
In this week’s Neurology, Parra et al. present a compelling appeal and thoughtful plan for addressing the devastating and growing burden of dementia in Latin America. This report, which has its early roots in a meeting of experts in Santiago during the World Congress of Neurology in 2015, identifies the key challenges and maps a way forward with a public health approach that emphasizes optimizing affordable diagnostics and care over biomarker research given the opportunity cost of such activities. Challenges are identified in the limited epidemiological insights available for Latin America and the dearth of clinical experts in dementia. They identify a need to focus new training programs on front line healthcare workers and to mobilize existing experts to leverage political will to address the rapidly growing burden of dementia in the region. Lessons learned and successful actions taken in Latin American could be important for informing the growing global burden of dementia countries across the economic spectrum.
Beginning in January 2018, there will be extensive design and formatting changes in Neurology. The updated website, including a Resident & Fellow Section (RFS) page, was already launched and has new exciting features such as rss feed for this blog, new e-Pearls presentation, and compilation of the latest RFS articles. There are also links to other residents and fellow resources on the Neurology website and at AAN. Readers will notice that the print version of Neurology has a new design on the cover and for the articles. Continue Reading “What does the “New Neurology” mean for the Resident & Fellow Section?”
It is a relatively rare occurrence for a physician, even over the course of a career, to witness the evolution of a disease from a universally fatal condition to a chronic but potentially manageable one. Dr. David Bearden, Assistant Professor in Neurology and Pediatrics at the University of Rochester, has done just that. From his earliest work with HIV in the US as the acute epidemic was waning to subsequent research and clinical care conducted in Botswana and now Zambia, Dr. Bearden’s perspective offers unique insights into the HIV epidemic across time and geography. Check it out as part of our “Global Stuff You Should Know” series.
Telehealth, which provides a means for long-distance clinical care, holds immense promise as a patient-centered care delivery model. This model has the potential to improve access to care in resource-limited settings (e.g., rural areas with few specialty providers) and for patients with limited mobility, transportation barriers, lack of caregivers and low funds. It may also improve the efficiency of a healthcare encounter by improving the timeliness and flexibility of visits. However, there are still several barriers to its widespread implementation. Beck and colleagues, through a randomized-controlled trial, test the feasibility and efficacy of adjunct telehealth visits with a movement disorders specialist compared to standard of care (as planned neurology visits) among participants with Parkinson’s disease to address one of these barriers. Namely, how does telehealth compare to what we currently do?
Eponyms are found all throughout medicine and perhaps there is no field more steeped in a rich collection of eponyms than neurology. As a young student I found eponymous signs and disease names to be antiquated and cumbersome to remember. When trying to learn the fundamentals of patient care, the names of historic clinicians seemed superfluous, and I held the belief that they had little to teach us about the practice of modern medicine.
Perspective is everything.
If you were around and interested in “Global Neurology” prior to 1994, then you felt mightily alone. The metric for assessing the burden or impact of a disease or health condition was essentially a body count. This rather primitive approach failed to capture at all the burden of diseases that devastate without necessarily causing rapid death. Think severe cerebral palsy. Untreated, primary progressive multiple sclerosis. Dementia. Treatment resistant epilepsy. You get the idea. So the development of the Disability Adjusted Life Year (DALY) and efforts to quantify this through the Global Burden of Disease work were transformative for global neurology.1, 2 Neuropsychiatric disorders rose out of oblivion to become recognized as one of the top causes of the global burden.3 Let’s call this “Transition in Perspective: Phase 1”
If you have not had an opportunity to attend a World Congress of Neurology, these are exciting and vibrant meetings well worth the travel. For a thorough overview of the September WCN in Kyoto, please check out Without Borders’ “On the Road” report from Steven Lewis and Wolfgang Griswold.