2016 Ended with a Neuro-bang

Welcome to 2017! Certainly 2016 closed with a bank in terms of interesting work relevant to Global Neurology. The WHO’s World Malaria Report 2016 was released near the end of 2016 and provides encouraging details of the impressive gains made in the past 5+ years to decrease the burden of this ancient scourge 1. The numbers are still daunting with over 400,000 deaths from malaria in 2016, most of these being among children in sub-Saharan Africa.

The evolving epidemiology of malaria is going to prove interesting to watch. As malaria control improves and children under 5 are having less exposure even in endemic regions, the age at which children are at risk for severe disease appears to be increasing. A recent clinical trial in Senegal determined that chemoprophylaxis for malaria should be extended from under 5s to under 10 year olds in their region 2. Williamson et al 3 provide a comprehensive, informative review of cryptococcal meningitis relevant in both high and low income settings that includes new developments in the basic and translation sciences and discussion of cryptococcal meningitis in HIV negative populations. This is a not-to-be missed review. In a recent publication in Neurol Neuroimmunol Neuroinflamm, Carpio and colleagues 4 provide details on PCR diagnostics for neurocysticercosis (NCC). Their findings suggest CSF PCR may be especially valuable for diagnosis in extra-parenchymal NCC which may difficult to identify with imaging (sensitivity 90.9% with 95% CI 70.8-98.9%). What I wasn’t able to find last month was evidence of much engagement by neurologists in the 65th Annual Meeting for the American Society of Tropical Medicine and Hygiene. Without Borders is committed to publicizing relevant international meetings through reports from professionals working in Neurology or a closely allied field who attend the meeting. I was unsuccessful in finding anyone to provide such a report. In looking at the program, I was surprised at the very limited representation of neurologic topics there appeared to be. Delving deeper, a search on “brain” yielded 18 hits but at 18 different sessions and a review of the individual sessions suggested that neurologic issues would be only addressed tangentially and then only in 1 or 2 of the associated talk. “Nervous system” search yielded 61 hits but similarly over a vast number of session, often concurrent sessions, and again, with only tangential coverage. I think one must consider whether US Neurologists with Global Health interest are missing an opportunity to partner with our Tropical Medicine colleagues in medical education and research dissemination activities?

References

  1. WHO. World Malaria Report 2016. 2016.
  2. Cisse B, Ba EH, Sokhna C, et al. Effectiveness of Seasonal Malaria Chemoprevention in Children under Ten Years of Age in Senegal: A Stepped-Wedge Cluster-Randomised Trial. PLoS Med 2016;13:e1002175.
  3. Williamson PR, Jarvis JN, Panackal AA, et al. Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. Nat Rev Neurol 2017;13:13-24.
  4. Carpio A, Campoverde A, Romo ML, et al. Validity of a PCR assay in CSF for the diagnosis of neurocysticercosis. Neurol Neuroimmunol Neuroinflamm 2017;4:e324.
Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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