Transitions in Perspective: The “Global Burden of Disease” project and Neurology

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”

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Study abroad brought home to Ghana

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.

Disconcerting data from analysis of the Women’s Interagency HIV Study database

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.

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Inflammation, anxiety and depression

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.

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As Summer Peaks, the US House of Representative Appropriations Committee Proposes Budget that Keeps Fogarty International Center Intact

Most in the ‘global know’ were dumbfounded in March when both President Trump’s “skinny” budget and the subsequent detailed one explicitly targeted the Fogarty International Center (FIC) for closure.¹

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Humanitarian crises and the use of teleneurology

For an interesting read, check out this report on Teleneurology from Saadi and Mateen detailing neurology referrals from Doctors without Borders delivered via a Collegium Telemedicus platform. As is so often the case with relatively new healthcare services, the report raises as many questions as it answers. If anyone reading this has utilized this system for MSF neurology consultation requests, it would be fascinating to better understand what the barriers are to referral given the relatively low numbers received. So few referrals were requested, I was reminded of the Peanuts cartoon with Lucy sitting all alone in her consultation booth awaiting the opportunity to give Psychiatry consultations for ¢5. Having provided these asynchronous telemedicine consultations myself, I must say my comfort level when offering advice to physicians located in regions where I have professional experience working and am very familiar with local clinical epidemiology, disease burden and health services capacity is quite high. In contrast, I am frankly uncomfortable when asked for my opinion on cases from regions where I lack these basic insights.

Acute symptomatic seizures in the tropics—The need to improve outcomes

Regarding¹ acute symptomatic seizure associated with tropical conditions such as cerebral malaria² and Japanese encephalitis virus³ as being well-recognized to frequently result in neurologic sequelae including epilepsy, neurodevelopmental abnormalities and behavioral disorders, in the June issue of Seizure, Soni et al¹ working in Chandigarh, India detail neurologic outcomes in a cohort of 604 children with acute symptomatic seizures due to a number of conditions.

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Looking at risk factors for peripheral neuropathy in Uganda

In this week’s Neurology, Saylor et al. report findings from Uganda looking at risk factors for peripheral neuropathy (PN) among 800 adults in the Rakai Community Cohort Study. Based upon the requirement for at least one symptom AND least one sign on physical examination, 13% of adults assessed had evidence of neuropathy. HIV was certainly a risk factor for PN, but 7% of HIV negative participants also had PN. Risk factors included age, neurotoxic medications and tobacco use. As the authors point out, these rates of PN warrant further investigations into possible causes, especially environmental exposures and nutritional vulnerabilities especially since the presence of PN was associated with impaired function.