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.
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.
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.
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.
Travel can be illuminating. But perhaps none more so than the professional journey of Dr. Charles Hammond of Ghana who had to leave him home country for Child Neurology training in South Africa. Check out our Global Stuff You Should Know section to learn more about Dr. Hammond’s work as he settled back into “home” after years abroad.
In this issue of Neurology, Rubin and colleagues report disconcerting data from their analysis of the Women’s Interagency HIV Study database. In longitudinal assessments of cognitive and motor function in women with and without HIV infection, even among women with continuous viral suppression HIV-associated differences were evident. Perhaps even more disturbingly, in some domains women with continuous suppression performed more poorly than those with HIV who were not suppressed.
A newly published systematic review and meta-analysis in Neurology looks at the complications of sickle cell disease in Africa. In an accompanying editorial, Dr. Ralph Green and I consider the unmet challenges of these neurologic complications. As we note in the editorial, “Sometimes an important scientific report is more notable for what it cannot tell us than for what it can”.
Rossi and colleagues have published an interesting report on CNS inflammation in multiple sclerosis as it relates to anxiety and depression that may be more relevant to resource-limited tropical settings than one might imagine. Their paper makes an important contribution to the growing body of clinical data supporting the importance of CNS inflammation-induced anxiety and depression in persons with neurologic disorders. The potential for these psychiatric symptoms to serve as a possible warning sign of ongoing CNS inflammation warrants further study and the range of conditions for which this might be relevant is extensive.