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
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.
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.
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.
In this innovative intervention study in Gambia, Jaiteh et al. developed standard operative procedures (SOPs) for the care of common neurologic emergencies based upon syndromic diagnoses for stroke, fever with headache and seizure and found that in both rural and urban settings the availability of SOPs led to more appropriate evaluations and care. Larger studies with longitudinal assessments are likely needed to evaluate the impact on outcomes, but these findings suggest that a key role for the neurologist working in resource limited settings should be developing SOPs of this nature and assisting with implementation nationally.
China now has the dubious honor of having a stroke incidence rate on par with high-income Western countries but a stroke mortality rate that remains typical of a lower middle income country. Risk factors are the usual suspects—hypertension, a family history of stroke, dyslipidemia, atrial fibrillation, diabetes, physical inactivity, tobacco use and an elevated body mass index. Read more about this in the Neurology® article Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013.
In this case-control study in a southern Han Chinese population, HLA-A* 24:02 was identified as a risk factor for Stevens-Johnson Syndrome (SJS) from exposure to antiepileptic drugs including carbamazepine, lamotrigine, and phenytoin. HLA-B* 15:02 polymorphisms in this population were an already recognized risk factor for SJS after similar exposures. The prevalence of the HLA-A* 24:02 polymorphism in this population remains unknown making it difficult to determine if routine screening is indicated.
We learned in January perhaps something that many of us already instinctly knew—burnout among U.S. neurologists is a real and probably growing problem1. This week in Neurology, U.S. Neurologists may be comforted somewhat to find they are not alone.
We invite you to listen to our latest podcast covering global public health activities that address neurological disorders. Dr. Kiran T. Thakur interviews Dr. Tarun Dua, Medical Officer at the World Health Organization working on the Program for Neurological Diseases and Neuroscience, Management of Mental and Brain Disorders in the Department of Mental Health and Substance Abuse.
“We are not focusing on the basic science part or any of the clinical aspects, because we feel there are many centers, many organizations, and institutions involved in doing that work. The focus of our work is on public health, meaning understanding: what’s the problem, and what kind of resources or services are available at country-level? Thinking in terms of simple guidance, and prevention and management of neurological disorders in non-specialized settings.” – Dr. Tarun Dua
One of the daily pleasures of neurology is ‘solving the mystery’ of a patient’s complaints and/or deficits, integrating the pathophysiology of the condition through localization and pattern recognition sometimes armed only with our own minds and a reflex hammer. Less often, we have the opportunity to watch as researchers begin to unravel the mystery of a neurologic disorders that has remained unsolved for more than a century.