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Disorders Neurological

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17.06.2018

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  • Disorders Neurological
  • AmorChem invests in project targeting neurological disorders
  • AD and Other Dementias
  • Neurological disorders are diseases of the brain, spine and the nerves that connect them. There are more than diseases of the nervous system, such as . Alphabetical list of currently known Human Neurological Conditions including short definitions for each disorder. A neurological disorder is any disorder of the nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can.

    Disorders Neurological

    Caring for persons with dementia is associated with increasing physical and emotional stress. Studies show that caregivers often have feelings of isolation, anxiety, and depression that reduce the quality of life and may impact the quality of care they provide Reitz, Brayne, and Mayeux The cumulative distress of caregivers constitutes a central component of the dementia burden Donaldson and Burns Dementia has become a significant economic burden across the world figure 5.

    The disease is the leading cause of dependence in older adults in all world regions; up to 50 percent of older adults who need care have dementia. The dementia-attributable DALYs may increase further in LMICs, where life expectancy is increasing, and resources for the provision of health care for older adults are limited or unavailable. In HICs, the level of care needed is the single strongest predictor of institutionalization of older adults. In LMICs, institutionalization is less likely; people with dementia tend to stay in their homes through the very advanced stages of the disease, cared for by informal caregivers, who are almost invariably close relatives and women.

    The direct costs include health service use, health care, and institutionalization; the indirect costs include those associated with cutting back on work to provide care. Both pose significant financial burdens on individuals, families, and societies. The direct and indirect costs are proportionally higher in HICs. Moreover, the distribution of costs across medical, societal, and informal care varies strikingly across regions and health system organizations.

    Hospital inpatient costs contributed 70 percent of the direct costs for prevalent dementia, mainly related to psychiatric care Leibson and others The indirect costs of informal care likely go far beyond foregone income.

    There are potentially pernicious repercussions on families and social ties, caused by caring for persons with dementia, particularly in settings where there are false beliefs about the causes and course. The evidence does not support dementia screening in the general population at present. Screening tools in primary health services may be used for those who report initial concerns about their cognitive function. However, unlike the Mini-Mental State Examination, which has been validated in several settings and languages, none of the short versions has been validated in LMICs, and their use is not recommended at present.

    Diagnosis requires a clinical and informant interview and physical examination. Adaptations for use in clinical practice are required, but the feasibility and cost-effectiveness of laboratory tests used in HICs to exclude treatable forms of dementia may limit their use in LMICs. Evidence from HICs indicates that the good practice of disclosure of the dementia diagnosis allows better planning and may limit distress; evidence from LMICs is lacking.

    Appropriate adaptation to local culture, language, and beliefs should shape the design of programs and activities planned and implemented, and involve stakeholders, policy makers, the media, and local health care services. Health and social services should be enhanced to meet the projected increase in services. Information on care arrangements and resources should be considered along with the evaluation of BPSD and the severity.

    A careful physical assessment is very important to monitor hearing and visual impairment, pain, constipation, urinary tract infections, and bedsores that may explain exacerbation of psychological symptoms. Whether physical assessment improves dementia prognosis, particularly the course of cognitive impairment, remains largely unknown.

    Nutritional status should be carefully monitored during the course of the disease. Weight loss is common and may start even before diagnosis. Loss of body weight may increase morbidity and mortality; yet, caregivers may be instructed on simple practices and techniques to overcome problems related to apathy and aversive feeding behaviors and may receive nutritional education to improve the caloric and nutritional content of meals.

    Finally, monitoring and effective treatment of vascular risk factors—including high blood pressure, hypercholesterolemia, smoking, obesity, and diabetes—should be encouraged to improve secondary prevention of cerebrovascular events. Moreover, there is extensive and persuasive evidence from mechanistic and well-designed prospective cohort studies that reducing the exposure to high blood pressure and hypertension in mid-life, and to diabetes in mid- and late life, as well as the reduction in tobacco use and increase in educational level of populations, can effectively reduce the dementia risk for populations Prince and others Targets for pharmacological treatment include cognitive impairment; behavioral symptoms, such as agitation and aggression; and psychological symptoms, such as depression, anxiety, and psychosis.

    The use of each of these medications is associated with modest and short-term comparable improvements in cognitive function, global clinical state, and activities of daily living. Moreover, the efficacy of this class of drugs in severe dementia is unclear, although behavioral symptom improvement was identified for galantamine Institute for Quality and Efficiency in Healthcare A fourth drug for the treatment of cognitive impairment, memantine, has a different mode of action and is well tolerated, but evidence for its efficacy is limited to people with moderate to severe dementia.

    ChEIs and memantine are less efficacious in vascular dementia than other forms. Their efficacy in the treatment of behavioral disturbances is not established; manufacturer-sponsored licensing trials and post hoc analyses indicate small improvements. Use of haloperidol and atypical antipsychotic medications for the treatment of agitation and behavioral symptoms with BPSD indicate small treatment effects, most evident for aggression, although these must be weighed against the associated mortality risk Kales and others Atypical antipsychotic drugs have been widely prescribed for psychosis in dementia, but a meta-analysis of their efficacy indicated that only aripiprazole and risperidone had a statistically and clinically significant effect on psychiatric symptoms Tan and others An important caveat to the use of these medications in dementia is the associated increased risk of death and cerebrovascular adverse events.

    The literature of antipsychotic treatment in older people with dementia reveals that although improvement in behavioral disturbance was minimal after 6—12 weeks, there was a significant increase in absolute mortality risk of approximately 1 percent Banerjee, Filippi, and Allen Hauser As the literature suggests that prescribing antipsychotics in dementia continues beyond 6—12 weeks, the harm of continued antipsychotic treatment in dementia is likely to be substantial.

    Therefore, many recommend nonpharmacological treatments, such as psychological and training interventions, to reduce BPSD rather than antipsychotic management Deudon and others A meta-analysis of the efficacy of antidepressants in people with dementia was inconclusive Leong A well-conducted RCT of cognitive stimulation reality orientation, games, and discussions based on information processing rather than knowledge conducted in the United Kingdom as a group intervention, and a small pilot trial from Brazil, suggest that cognitive benefits from this intervention are similar to those for ChEIs Aguirre and others More specific cognitive training produced no benefits.

    Cognitive rehabilitation, an individualized therapy designed to enhance residual cognitive skills and the ability to cope with deficits, showed promise in uncontrolled case series in HICs. A meta-analysis of four trials of reminiscence therapy the discussion of past activities, events, and experiences provides evidence for short-term improvement in cognition, mood, and caregiver strain, but the quality of these trials was poor Bahar-Fuchs, Clare, and Woods ; Woods and others ; Woods and others A large literature attests to the benefits of caregiver interventions.

    These include psycho-educational interventions, often including caregiver training; psychological therapies, such as cognitive behavioral therapy and counseling; caregiver support; and respite care.

    Many interventions combine several of these elements. The outcomes studied include caregiver strain, depression, and subjective well-being; behavior disturbance and mood in the care recipient; and institutionalization.

    Caregiver training models have been developed for dementia care, including the Maximizing Independence at Home project Tanner and others Psycho-educational interventions required the active participation of the caregiver to be effective. Caregiver support increased well-being but no other outcomes. However, nonrandomized studies suggest that respite care significantly reduces caregiver strain and psychological morbidity Ornstein and others Interventions targeting the caregiver may also have small but significant beneficial effects on the behavior of the person with dementia.

    A systematic review of 10 RCTs indicated a 40 percent reduction in the pooled odds of institutionalization; the effective interventions were structured, intensive, and multicomponent, offering a choice of services and supports Tam-Tham and others Two small trials of a brief caregiver education and training intervention, one from India and one from Russia, indicated much larger treatment effects on caregiver psychological morbidity and strain than typically seen for such interventions in HICs Gavrilova and others ; Dias and others Raising awareness among the public, caregivers, and health workers can lead to increased demands for services.

    Intergenerational solidarity can be promoted through awareness-raising among children and young adults. In many LMICs, many people with dementia live in multigenerational households with young children, who are the most frequent caregivers and the most likely to initiate help-seeking. The provision of disability pensions and caregiver benefits in LMICs is likely to increase requests for diagnostic assessment. Importantly, however, efforts to increase awareness must be accompanied by health system and service reforms, so that help-seeking is met with a supply of better prepared, more responsive services.

    Primary health care services in LMICs often fail older people because the services are clinic-based, often focused on simple curative interventions, and face high workloads. Given the frailty of many older people with dementia, there is a need for outreach to assess and manage patients in their own homes.

    Dementia care should be an essential component of any chronic disease care strategy. Training of nonspecialist health professionals should focus on case-finding and conveying the diagnosis to patients and caregivers together with information, needs assessment, and training and support.

    Training can be service-based, as well as through changes to medical and nursing schools, public health, and rural health curricula. Medical and community care services should be planned and coordinated to respond to the increasing need for support as the disease progresses. Programs to support caregivers can be delivered individually or in groups by community health workers or experienced caregivers.

    Strain, possibly associated with BPSD, should trigger more intensive interventions that include psychological assessment and depression treatment for the caregiver, respite care, and caregiver education and training. Such interventions could be incorporated into horizontally constructed, community-based programs that address the generic needs of frail, dependent, older people and their caregivers, whether these needs arise from cognitive, mental, or physical disorders.

    Recent evidence has demonstrated the effectiveness of delivery of Internet—based caregiver interventions Czaja and Rubert ; Marziali and Garcia Direct costs include health service use and institutionalization; the indirect costs include those associated with inability to work and caregiver care. Both kinds of costs impose significant financial burdens on individuals, families, and societies. Informal care costs are proportionally highest in LMICs, while the direct costs for social care account for over half the costs in HICs Prince and others Several studies, most in HICs, have evaluated the cost effectiveness of interventions in dementia.

    Particular challenges in such studies are the heterogeneity in etiology of dementia and the capture of cost-effectiveness in patients with milder forms of cognitive impairment. The probability of screening being cost-effective was highest in the group over age 75 years in a wide range of willingness to pay WTP Yu and others The most cost-effective benefit of disease modifying therapies has been seen in moderate to severe dementia Plosker and Lyseng-Williamson Available pharmacoeconomic data from Europe and the United States support the use of memantine as a cost-effective treatment.

    Results were primarily driven by reductions in total caregiver costs, which included the opportunity cost of time spent in caregiving tasks, and in direct nonmedical costs, which included the cost of care in a nursing home or similar institution. In another study evaluating treatment with cholinesterase inhibitors or memantine for those with mild to moderate vascular dementia, donepezil 10 mg orally daily was found to be the most cost-effective treatment Wong and others An exercise intervention was found to have the potential to be cost-effective when considering behavioral and psychological symptoms but did not appear cost-effective when considering quality-adjusted life year gains.

    The START STrAtegies for RelaTives study, a randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy program in promoting the mental health of carers of people with dementia, found the intervention to be cost-effective with respect to caregiver and patient outcomes, and National Institute for Health and Care Excellence NICE thresholds Livingston and other In a health economic analysis of resource costs and costs of formal care on a psychosocial intervention for family caregivers of persons with dementia, those in the intervention group reported higher quality of life while their spouse was living at home Dahlrup and others Research for early diagnosis is important in view of the future availability of treatments that are likely to be more efficacious in the early stages of the disease, when diagnosis is more difficult.

    At present, there are no disease-modifying pharmacological treatments for dementia, and medications to treat symptoms appear to have limited efficacy Birks ; McShane, Areosa Sastre, and Minakaran However, the quest for a cure should not drain resources from research on modifiable risk factors, which remains crucial for prevention, to potentially delay the symptomatic onset or slow the disease progression.

    The first WHO Ministerial Conference on Global Action Against Dementia was held in March to foster awareness of the public health and economic challenges posed by dementia and improve the understanding of the roles and responsibilities of Member States and stakeholders; it led to a Call for Action supported by conference participants.

    Indeed, a broad public health approach to address the complex challenges of dementia is extremely important. Collectively, these three are the third most common cause of disability in populations throughout the world Murray and others ; Steiner and others ; Stovner and others ; Vos and others Headache disorders are the most frequent cause of consultation in primary care and neurology practice; it prompts many visits to internists; ear, nose, and throat specialists; ophthalmologists; dentists; psychologists; and proponents of a wide variety of complementary and alternative medical practices WHO Headache is a common presenting symptom in emergency departments.

    The consequences of recurring migraine include pain, disability, diminished productivity, financial losses, and impaired quality of life. Therefore, although headache rarely signals serious underlying illness, its causal association with personal burdens of pain, disability, and diminished quality of life makes it a major contributor to ill health.

    Migraine is a disorder commonly beginning in puberty and often lasting throughout life. Episodic attacks have a frequency of once or twice a month on average, but this may vary widely, subject to lifestyle and environmental factors. In women, prevalence is higher because of a hormonally-driven association with menstruation. Headache, nausea, and photophobia are the most characteristic attack features.

    In some attacks, about 10 percent overall, and in only one-third of people with migraine, headache is preceded by aura symptoms, most commonly visual.

    The headache itself, lasting for hours to two to three days, is typically moderate or severe and unilateral, pulsating, and aggravated by routine physical activity International Headache Society TTH is a highly variable disorder, commonly beginning in the teenage years and reaching peak levels for people in their 30s.

    It lacks the specific features and associated symptoms of migraine, with headache usually mild or moderate, generalized, and described as pressure or tightness International Headache Society MOH is earning recognition as a disorder of major public health importance for three reasons: MOH affects between 1 and 2 percent of the general population Westergaard and others , up to 67 percent of the chronic headache population, and 30—50 percent of patients seen in specialized headache centers Evers, Jensen, and European Federation of Neurological Societies The cause is chronic excessive use of medications taken initially to treat episodic headache Diener and Limmroth The overuse of all such medications is associated with this problem, although the mechanism through which it develops undoubtedly varies among drug classes Steiner and others Estimating the global burden of headache disorders is a challenging task, given data paucity for many LMICs, variations in methodologies in epidemiological studies, and variation of cultural attitudes related to the reporting of complaints.

    Regardless, estimations have been done and show that the global one-year prevalence of migraine constitutes The prevalence of all types of headache occurring on 15 or more days per month including chronic migraine, chronic TTH, and MOH is 3 percent Stovner and others Although the prevalence of migraine is markedly lower in Asia Stovner and others and was thought to be so in Africa, a study in Zambia has indicated a high one-year prevalence Professional health care, when needed, should be provided in primary care settings for the majority of cases WHO , and guidelines for the management of headache disorders in these settings are available Steiner and others History and examination should take due note of warning features that might suggest an underlying condition Steiner and others Many instruments, including the HALT questionnaire, are available to assess the burden of headache symptoms on individual patients.

    Steiner and Martelletti Realistic goals of management include understanding that primary headaches cannot be cured but can be managed effectively. We focus our further treatment discussions on migraine.

    Stress is a common predisposing factor for migraine. Improving the ability to cope is an alternative treatment approach, but the role of psychological therapies in migraine management is unclear. Most research has focused on high-end intensive treatment of individual cases of disabling and refractory headache, which has limited relevance to public health. This approach could be further explored in LMICs. Obesity is a risk factor for migraine, especially for frequent migraine Evans and others Regular exercise and keeping fit can be beneficial.

    A study among obese adolescents with migraine found a significant improvement in headache in those who participated in a month weight-loss program Evans and others Guidelines recommend a stepped-care approach commencing with acute treatment using simple analgesics aspirin or one of several other nonsteroidal anti-inflammatory drugs Steiner and others Good evidence demonstrates the efficacy and tolerability of aspirin Kirthi, Derry and Moore , ibuprofen Rabbie, Derry and Moore , and diclofenac potassium Derry, Rabbie, and Moore The most desirable outcome of acute treatment is complete relief from pain within two hours, without recurrence or need for further medication and without adverse events.

    This outcome is not commonly experienced with simple analgesics alone. The more easily achievable outcome referred to as sustained headache relief SHR is defined as reduction of pain to no worse than mild within two hours of treatment, also without recurrence or need for further medication. Mild pain is assumed not to be associated with disability, and SHR implies full functional recovery when functional impairment was present initially.

    Aspirin alone provides SHR in an estimated 39 percent of users Kirthi, Derry and Moore ; this is a modest effect in the sense that it leaves 61 percent without this benefit but at the same time is among the most cost-efficient interventions to improve public health Linde, Steiner, and Chisholm Ibuprofen provides SHR in a somewhat higher estimated proportion of users 45 percent Rabbie, Derry, and Moore , at variable but not always higher cost.

    Diclofenac is considerably more costly, without significantly greater efficacy Derry, Rabbie, and Moore It is argued that the anti-inflammatory effect is important in acute migraine treatment, and paracetamol is therefore rather less effective than aspirin at the same cost or other nonsteroidal anti-inflammatory drugs Derry and Moore ; Steiner and others Antiemetics should also be used in acute treatment, and should not be restricted to patients who are vomiting or likely to vomit.

    Nausea is one of the most aversive and disabling symptoms of a migraine attack and should be treated appropriately Silberstein and others Gastric stasis is a feature of migraine; prokinetic antiemetics, such as domperidone or metoclopramide, enhance gastric emptying and promote the efficacy of oral analgesics in migraine. The usual second step in management is still acute treatment, with the substitution or addition of specific anti-migraine therapy Steiner and others Ergotamine tartrate remains in use in many countries WHO , but it is poorly bioavailable, is not highly effective, and has potential side effects.

    Of the triptan class of agents—which are specific anti-migraine medications—seven are available in many countries. They differ somewhat in their pharmacokinetics, and they are not identical in efficacy; however, the differences between them are small when set against the up to tenfold price differences between sumatriptan available in generic versions and the other six.

    Sumatriptan is available in four formulations oral, intranasal, rectal, and subcutaneous. Sumatriptan 50 mg orally provides SHR in an estimated 35 percent of users Derry, Derry, and Moore , much the same as aspirin; however, it has a different mode of action, and responses to each drug are independent. When sumatriptan is used on its own, its cost-effectiveness is at least two orders of magnitude lower than that of aspirin Linde, Steiner, and Chisholm ; it is usually reserved as a second-line treatment for those who fail to respond to first-line treatments Steiner and others In adults and children, regular use of acute medications at high frequency more than two days per week risks the development of MOH.

    Prophylactic medications are used in step three to reduce the number of attacks occurring when acute therapy is inadequate Steiner and others There is adequate or good evidence of efficacy and tolerability for propranolol Linde and others b , amitriptyline Dodick and others , valproate as sodium valproate or valproic acid Linde and others b , and topiramate Diener and others ; Linde and others a.

    To assess outcome as migraine attacks averted requires comparison with an untreated base line, which is available for propranolol 28 percent Linde, Steiner, and Chisholm , amitriptyline 44 percent Linde, Steiner, and Chisholm In an American Academy of Neurology review, divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol were found to be effective for migraine prevention Silberstein and others In terms of cost, propranolol and amitriptyline are similar and very low, and topiramate is much higher; amitriptyline might be the choice of prophylactic drug when resource conservation is the key consideration Linde, Steiner, and Chisholm However, the mode of action of these medications in migraine is unknown, and failure of response to one does not predict the failure of others Steiner and others , which might be tried when amitriptyline is ineffective and resources permit.

    Acupuncture and physical therapies, such as spinal manipulation, requiring direct one-to-one therapist-patient interaction, are highly resource intensive, and have questionable efficacy Bronfort and others ; Linde and others to justify their recommendation. Even the limited benefits seen in clinical trials may not be replicated in the real world, where therapists operate under time constraints. Public education programs can help to improve migraine outcomes. Lifestyle factors may predispose people to or aggravate migraine.

    Although the evidence is poor that modifying lifestyle is an effective way of controlling migraine, avoidance of trigger factors is a logical stratagem Steiner and others Public education about the increasing risk of migraine with obesity Bronfort and others may achieve some benefits, because, unlike many other ill-health consequences of obesity, headache is experienced in the present.

    Public education also appears to offer the most effective means of controlling a potential epidemic of MOH as a consequence of mistreated migraine. Recent evidence from the Global Campaign against Headache Mbewe and others suggests this may be a particular problem in LMICs where medications are relatively more affordable and available than health care.

    The initial effectiveness of simple analgesics encourages their further use, which is not problematic at low frequency. With increasing frequency comes greater reliance and increasing risk of MOH. Once MOH is established, medication overuse is likely to escalate. The incremental health benefits obtained in LMICs from adding educational programs to the use of over-the-counter and prescription medications appear to be achievable at acceptable incremental costs Linde, Steiner, and Chisholm Pharmacists can be a key source of information to the public about headache disorders, treatments, and the dangers of medication overuse, but only if this role is explicitly recognized in their reimbursement, and only if their advice is sought.

    Further, the cost-effectiveness of treatments may increase with public education programs to improve adherence to treatments Linde, Steiner, and Chisholm In a global survey, one-third of responding countries recommended improved organization and delivery of health care for headache so that care would be efficient and equitable WHO The organization of services to achieve this goal is clearly a challenge, and no single solution may be appropriate in all settings.

    Most patients do not require specialist expertise or special investigations Steiner and others , and the three-tier service model developed by the Global Campaign against Headache for Europe Steiner and others is highly adaptable. This model had been used as part of demonstration projects to structure headache services in China Yu and others , and in Sverdlovsk Oblast in the Russian Federation Lebedeva and others Using the model, about 90 percent of patients are managed in first-level care, usually but not necessarily by physicians; 1 percent require specialist care that is necessarily hospital-based.

    The intermediate 9 percent do not require specialist care, but may have diagnostic or management difficulties that would benefit from second-level care. Provision of this level of care depends on resources and local health service organizations.

    Each level must maintain a gatekeeper role to higher levels to make the model work. Countries that have invested in headache services have, paradoxically, generally done so by setting up specialist headache clinics. Worldwide, the proportion of headache patients seen by specialists is 10 percent WHO , indicating considerable scope for resource reallocation for the benefit of more patients if the levels below were better utilized.

    Pharmacists need to be formally integrated into health care systems. The ability of first-level services to deliver effective care depends on the providers—physicians, clinical officers, or nurses—having the basic knowledge required. Training first-level doctors in the management of migraine is likely to improve outcomes, as well as to increase the cost-effectiveness of prescription medications Linde, Steiner, and Chisholm Furthermore, such training might reduce waste, through reductions in the high rates of unnecessary investigations to support diagnosis WHO There is a lack of nationally conducted cost-effectiveness studies to inform resource allocation decisions for headache disorders in LMICs.

    However, a recent cost-effectiveness modeling analysis of migraine treatment was carried out for four countries—China an upper-middle-income country , India a lower-middle-income country , Russia an HIC , and Zambia a lower-middle-income country.

    Cost-effectiveness analysis was not carried out for paracetamol specifically, because the only evidence of SHR came from 42 highly atypical patients in the United States Linde, Steiner, and Chisholm When sumatriptan is used on its own for acute management of migraine, its cost-effectiveness is at least two orders of magnitude less favorable than that of aspirin, which indicates why sumatriptan is reserved as a second-line treatment for those who fail to respond to first-line treatments Steiner and others Prophylactic medications are less cost-effective than acute therapy with simple analgesics, but considerably more cost-effective than acute therapy with the combination of analgesics and triptans when needed , but this may be true only if prophylactics are reserved for those with three or more attacks per month Linde, Steiner, and Chisholm The addition of educational programs posters and leaflets in pharmacies for the use of over-the-counter and prescription medications appears to increase population health gain at an acceptable incremental cost, as does training providers Linde, Steiner, and Chisholm It is clear that investment in structured headache services, with their basis in primary care and supported by educational initiatives aimed at professionals and the public, is the way forward for most countries.

    Such services require resource reallocation which is easily justified economically. Importantly, services for migraine would simultaneously provide for the other common and disabling headache disorders.

    The gains in population health achievable through effective headache management are substantial and independent of any recovery of indirect costs attributable to these disorders. The financial costs to society through lost productivity from migraine alone are enormous: Greater investment to treat migraine effectively through well-organized health services supported by education may well be cost-saving overall WHO Epilepsy, dementia, and headache disorders represent a significant burden on global health.

    Not only are these conditions prevalent, but they are associated with significant disability, poor psychosocial outcomes, and substantial economic costs. Innovative health care management approaches are required in LMICs because of the lack of specialist care.

    Some of these approaches are discussed, but few have been subjected to cost-effectiveness evaluations. Further data collection is needed in many areas of global neurology, including epidemiological studies, needs assessments, and cost-effectiveness analyses.

    For all three of these conditions, pharmacotherapies have advanced considerably in the past two decades, but these options are regrettably limited in LMICs.

    Indeed, the treatment gap for these conditions is substantial, driven by patient and health system factors, which are unlikely to improve without education of the public and health care professionals, legislation, and anti-stigma interventions. Fortunately, attitudes and knowledge about the burden of epilepsy, dementia, and migraine are starting to improve, and such progress can help reduce the treatment gap and enhance psychosocial outcomes for those suffering from these conditions. Ultimately, however, increased financial investments and legislative changes are required to improve neurological care in LMICs.

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    Turn recording back on. National Center for Biotechnology Information , U. Introduction Neurological disorders pose a large burden on worldwide health. Epilepsy Definitions Epilepsy is a brain disorder traditionally defined as the occurrence of two unprovoked seizures occurring more than 24 hours apart with an enduring predisposition to generate further seizures Fisher and others Epilepsies of unknown causes Berg and others Epidemiology and Burden of Disease A worldwide systematic review of prevalence has not yet been published; in general, the prevalence in door-to-door studies has been reported to range from 2.

    Interventions Population-Based Interventions Targeting Epilepsy Risk Factors Although genetic causes of epilepsy cannot be prevented, the more common structural or metabolic causes can be the target of primary prevention through public health policies. Anti-Stigma Interventions Civil rights violations, such as unequal access to health and life insurance or prejudicial weighting of health insurance provisions, are common.

    Legislation One of the greatest contributors to the epilepsy treatment gap in LMICs is the lack of availability of anti-epileptic drugs.

    Self-Management Self-management is empowering patients to participate more actively in managing their care. Pharmacological Interventions The decision to initiate treatment with anti-epileptic drugs can be challenging. Surgical Management The probability of achieving one-year seizure freedom after trying up to three anti-epileptic drugs occurs in the majority of cases 70 percent in those presenting with new onset epilepsy.

    Alternative Therapies Proposed alternative therapies for epilepsy include dietary therapies, medical marijuana, and acupuncture; only dietary therapies have been subjected to randomized trials.

    Interventions to Optimize Health Care Delivery The treatment gap is defined as the number of people with active epilepsy who need appropriate anti-epileptic treatment but do not receive adequate medical therapy.

    Cost-Effectiveness of Interventions The cost-effectiveness literature is focused on the pharmacological management of seizures, meaning that economic evidence concerning interventions at the population and community levels, such as stigma reduction strategies, are minimal. Conclusions The dire consequences of poorly treated epilepsy include significant morbidity and mortality caused by seizures and related injuries. Dementia Dementia poses a unique burden to those affected, their families, and societies.

    Definitions Dementia is a neuropsychiatric syndrome characterized by a combination of cognitive decline, progressive behavioral and psychological symptoms BPSD , and functional disability WHO Epidemiology and Burden of Dementia The most significant risk factor of dementia is increasing age; the incidence doubles with every five-year increment after age 65 WHO Global Burden of Dementia Dementia has become a significant economic burden across the world figure 5.

    Interventions Interventions need to address four key areas: Detection and Diagnosis of Dementia The evidence does not support dementia screening in the general population at present. Physical and Care Needs Assessment Information on care arrangements and resources should be considered along with the evaluation of BPSD and the severity. Pharmacological Interventions Targets for pharmacological treatment include cognitive impairment; behavioral symptoms, such as agitation and aggression; and psychological symptoms, such as depression, anxiety, and psychosis.

    Nonpharmacological Interventions A well-conducted RCT of cognitive stimulation reality orientation, games, and discussions based on information processing rather than knowledge conducted in the United Kingdom as a group intervention, and a small pilot trial from Brazil, suggest that cognitive benefits from this intervention are similar to those for ChEIs Aguirre and others Although the brain and spinal cord are surrounded by tough membranes , enclosed in the bones of the skull and spinal vertebrae , and chemically isolated by the blood—brain barrier , they are very susceptible if compromised.

    Nerves tend to lie deep under the skin but can still become exposed to damage. Individual neurons , and the neural circuits and nerves into which they form, are susceptible to electrochemical and structural disruption.

    Neuroregeneration may occur in the peripheral nervous system and thus overcome or work around injuries to some extents, but it is thought to be rare in the brain and spinal cord.

    The specific causes of neurological problems vary, but can include genetic disorders , congenital abnormalities or disorders , infections , lifestyle or environmental health problems including malnutrition , and brain injury , spinal cord injury or nerve injury. Metal poisoning, where metals accumulate in the human body and disrupt biological processes, has been reported to lead to neurological problems, at least in the case of lead.

    For example, cerebrovascular disorders involve brain injury due to problems with the blood vessels cardiovascular system supplying the brain; autoimmune disorders involve damage caused by the body's own immune system ; lysosomal storage diseases such as Niemann-Pick disease can lead to neurological deterioration.

    The National Institutes of Health recommend considering the evaluation of an underlying celiac disease in people with unexplained neurological symptoms, particularly peripheral neuropathy or ataxia. In a substantial minority of cases of neurological symptoms, no neural cause can be identified using current testing procedures, and such " idiopathic " conditions can invite different theories about what is occurring. Neurological disorders can be categorized according to the primary location affected, the primary type of dysfunction involved, or the primary type of cause.

    The broadest division is between central nervous system disorders and peripheral nervous system disorders. The Merck Manual lists brain, spinal cord and nerve disorders in the following overlapping categories: Many of the diseases and disorders listed above have neurosurgical treatments available e. Tourette's Syndrome , Parkinson's disease , Essential tremor and Obsessive compulsive disorder.

    Neurological disorders in non-human animals are treated by veterinarians. A neurological examination can, to some extent, assess the impact of neurological damage and disease on brain function in terms of behavior , memory or cognition. Behavioral neurology specializes in this area.

    In addition, clinical neuropsychology uses neuropsychological assessment to precisely identify and track problems in mental functioning, usually after some sort of brain injury or neurological impairment. Alternatively, a condition might first be detected through the presence of abnormalities in mental functioning, and further assessment may indicate an underlying neurological disorder. There are sometimes unclear boundaries in the distinction between disorders treated within neurology, and mental disorders treated within the other medical specialty of psychiatry , or other mental health professions such as clinical psychology.

    In practice, cases may present as one type but be assessed as more appropriate to the other. One area that can be contested is in cases of idiopathic neurological symptoms - conditions where the cause cannot be established. Classic examples are "functional" seizures , sensory numbness , "functional" limb weakness and functional neurological deficit "functional" in this context is usually contrasted with the old term " organic disease ". Such cases may be contentiously interpreted as being "psychological" rather than "neurological".

    Some cases may be classified as mental disorders, for example as conversion disorder , if the symptoms appear to be causally linked to emotional states or responses to social stress or social contexts. At one extreme this may be diagnosed as depersonalization disorder. There are also conditions viewed as neurological where a person appears to consciously register neurological stimuli that cannot possibly be coming from the part of the nervous system to which they would normally be attributed, such as phantom pain or synesthesia , or where limbs act without conscious direction, as in alien hand syndrome.

    Theories and assumptions about consciousness , free will , moral responsibility and social stigma can play a part in this, whether from the perspective of the clinician or the patient. Conditions that are classed as mental disorders , or learning disabilities and forms of intellectual disability , are not themselves usually dealt with as neurological disorders.

    AmorChem invests in project targeting neurological disorders

    Neurological disorders are diseases that affect the brain and the central and autonomic nervous systems. In recognizing the signs and symptoms of neurological. There are more than neurologic diseases. Major types include. Diseases caused by faulty genes, such as Huntington's disease and. A: Neurological disorders are diseases of the central and peripheral nervous brain tumours, traumatic disorders of the nervous system due to head trauma.

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    Comments

    se1987

    Neurological disorders are diseases that affect the brain and the central and autonomic nervous systems. In recognizing the signs and symptoms of neurological.

    agentzoom

    There are more than neurologic diseases. Major types include. Diseases caused by faulty genes, such as Huntington's disease and.

    alekseyt38

    A: Neurological disorders are diseases of the central and peripheral nervous brain tumours, traumatic disorders of the nervous system due to head trauma.

    Nemok

    Neurological disorders: public health challenges. gvax.infos system diseases. 2. Public health. gvax.info of illness. gvax.info Health Organization. ISBN 92 4

    se110110

    Shen et al. show that FMRP promotes mitochondrial fusion through HTT. FMRP loss caused fragmented mitochondria and oxidative stress in immature neurons, .

    shpionchik7

    Access a list of more than neurological disorders from the National Institute of Neurological Disorders and Stroke. Summaries give symptom descriptions.

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