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Disorders Neurological



  • Disorders Neurological
  • Tackling Neurological Disorders in New Ways
  • 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

    Whether this program reduced the incidence of epilepsy caused by taenia solium was not examined, but the findings represent a positive step. These approaches are listed in box 5.

    Preventive chemotherapy of human taeniasis through mass or targeted treatment of humans Mass treatment and vaccination of pigs. Civil rights violations, such as unequal access to health and life insurance or prejudicial weighting of health insurance provisions, are common.

    Discrimination in the workplace and restricted access to education are frequent. School teachers often have poor knowledge and negative attitudes toward children with seizure disorders Akpan, Ikpeme, and Utuk Stigma is associated with social and economic consequences. Persons with epilepsy may not seek treatment or convey related health concerns to their care providers, further widening the treatment gap.

    Improved knowledge about epilepsy is associated with positive attitudes and reduced stigma, but the sustainability and impact remain to be determined Fiest and others A broad approach is needed to target stigma at the population level through legislation and advocacy.

    In addition, education and information provision to dispel myths and enhance seizure management among employers and teachers should empower those with epilepsy to seek treatment and encourage them to be more actively engaged in their communities. The cost-effectiveness of interventions to reduce stigma has not been formally assessed.

    One of the greatest contributors to the epilepsy treatment gap in LMICs is the lack of availability of anti-epileptic drugs. The second-generation medications are not available in the majority of countries, and even the older anti-epileptic drugs are only available sporadically. Investigators in Zambia who surveyed pharmacies found that Pediatric syrups that are extensively used in HICs were universally unavailable Chomba and others Regrettably, personal communications with epilepsy care providers in other LMICs suggested that this problem may be widespread Chomba and others Clearly, policies are warranted to guarantee the ongoing availability of affordable and efficacious anti-epileptic drugs to patients worldwide.

    Few countries have a separate budget for epilepsy services, and national funding support for epilepsy care is needed. Out-of-pocket expenses are the primary source of financing epilepsy care in 73 percent of low-income countries, including many countries in Africa, the Eastern Mediterranean, and South-East Asia, where the burden is highest WHO Disability benefits do not exist in many regions, and patients are unable to receive monetary support.

    Self-management is empowering patients to participate more actively in managing their care. Patients are likely to improve their understanding, adopt healthier lifestyles, and improve adherence to treatment Fitzsimons and others Self-management can help those with epilepsy better identify and manage their seizure triggers, which can reduce frequency and decrease health services utilization and health care costs Fitzsimons and others A few studies have examined the effectiveness of self-management education programs in adults and children and demonstrated some evidence of benefits; future research is needed to examine the cost-effectiveness of such programs in LMICs Bradley and Lindsay ; Lindsay and Bradley The decision to initiate treatment with anti-epileptic drugs can be challenging.

    Analysis of the Multicentre trial for Early Epilepsy and Single Seizures suggests little benefit in initiating treatment for those who present with a single seizure, with no known neurological disorder, and normal electroencephalograms EEGs Kim and others However, medical management should be considered in those who are at moderate to high risk, defined as more than two to three seizures at presentation, underlying neurological disorders, and abnormal EEGs Kim and others More than 60 randomized control trials RCTs , mostly in HICs, have examined the efficacy of anti-epileptic drugs, but there continues to be a lack of well-designed RCTs examining the efficacy of these medications for patients with generalized epilepsy syndromes and for children Glauser and others Newer AEDs tend to be better tolerated, with fewer long-term side effects, but otherwise their superiority has not been proven.

    Studies comparing the cost-effectiveness of anti-epileptic drugs in new onset epilepsy have not been conducted. A recent systematic review summarizes the evidence regarding their efficacy as initial monotherapy in those with epilepsy.

    Monotherapy with any of the standard anti-epileptic drugs carbamazepine, phenobarbital, phenytoin, and valproic acid should be offered to children and adults with convulsive epilepsy. Several lower-quality studies have demonstrated efficacy for phenobarbital in adults and children with partial onset seizures and generalized onset tonic-clonic seizures Glauser and others Given the acquisition costs, phenobarbital should be offered as a first option if availability can be ensured.

    If available, carbamazepine should be offered to children and adults with partial onset seizures WHO b. Using the lowest possible dose should minimize side effects, improve seizure outcomes, and decrease the treatment gap.

    Valproic acid and ethosuximide have been shown to be most effective in the management of absence seizures, especially in children, although valproic acid is recommended, as it is on the list of essential medicines. Ethosuximide is available as a complementary medication.

    However, the medication should be avoided, when possible, in women of childbearing potential because of its higher association with major congenital malformations and poorer neurodevelopmental outcomes. Although newer therapeutic agents that are not metabolized by the liver are available, such as levetiracetam, the cost-effectiveness of such therapies has not been studied in LMICs.

    Unfortunately, in LMICs, the availability and affordability of standard medications are poor and constitute barriers to treatment. One study found that the average availability of generic medications in the public sector is less than 50 percent for all medicines, except diazepam injection.

    The private sector availability of generic oral medications ranged from 42 percent for phenytoin to 70 percent for phenobarbital. Public sector patient prices for generic carbamazepine and phenytoin were 5 and 18 times higher than international reference prices, respectively; private sector patient prices were 11 and 25 times higher, respectively.

    For both medicines, originator brand prices were about 30 times higher. The highest prices were observed in the lowest-income countries Cameron and others Ensuring a consistent supply at affordable prices should be a priority. Approximately 60 percent of patients in Sub-Saharan Africa do not have access to AEDs, increasing the risk of seizures, accidents related to seizures, and status epilepticus, a significant cause of morbidity and mortality in patients with epilepsy Ba-Diop and others Some of the best patient-related strategies to avoid status epilepticus include adherence to treatment and avoidance of other seizure triggers.

    On a population level, the best way to avoid the morbidity and mortality associated with status epilepticus is through health policy to increase the availability of and access to AEDs, and through health professional education such that health professionals are aware that time is brain. Aggressive treatment of status epilepticus should be implemented after five minutes, not after 30 minutes of ongoing seizures, in accordance with the current operational definition of status epilepticus Lowenstein and others Neurocysticercosis is a common cause of epilepsy in LMICs.

    Recent evidence-based guidelines are available to guide the treatment of parenchymal neurocysticercosis Baird and others These guidelines suggest that therapy with albendazole, with or without corticosteroids, along with AEDs, is likely to be effective in improving outcomes Baird and others The guidelines state that it may be important to avoid enzyme-inducing AEDs in people on antiretroviral regimens that include protease inhibitors or nonnucleoside reverse transcriptase inhibitors, because pharmacokinetic interactions may result in virologic failure.

    If such regimens are required for seizure control, patients may be monitored through pharmacokinetic assessments to ensure the efficacy of the antiretroviral regimen Birbeck and others 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. In those who have failed three anti-epileptic drugs, attempting to treat with additional anti-epileptic drugs is unlikely to achieve sustained seizure freedom Jette, Reid, and Wiebe Experts generally agree that those who are drug resistant and have failed two appropriate AED trials should be considered for a surgical evaluation Jette, Reid, and Wiebe ; Kwan and others ; Wiebe and Jette Other patients who should be referred to a comprehensive epilepsy program for a surgical evaluation include children with complex syndromes, patients with stereotyped or lateralized seizures or focal findings, and children with a magnetic resonance imaging lesion amenable to surgical resection regardless of seizure frequency Jette, Reid, and Wiebe ; Wiebe and Jette Strategies for surgical therapy of epilepsies in resource-poor settings have been proposed, and epilepsy surgery is increasingly performed in LMICs, with excellent outcomes Asadi-Pooya and Sperling Proposed alternative therapies for epilepsy include dietary therapies, medical marijuana, and acupuncture; only dietary therapies have been subjected to randomized trials.

    The ketogenic diet can improve seizure outcome in those with drug-resistant epilepsy, but is difficult to tolerate, particularly in adults Levy, Cooper, and Giri The Atkins diet was associated with improved seizure control in one observational study, but future studies are required to examine its benefit and the benefit of other dietary therapies, such as the modified Atkins diet and the low glycemic index diet Levy, Cooper, and Giri Despite their increased use, dietary therapies are resource intensive, costly, and remain largely limited to HICs Cross Cost-effective and simpler means of implementing these therapies in LMICs are needed.

    The efficacy of oral cannabinoids and acupuncture for the treatment of epilepsy remains uncertain Cheuk and Wong ; Koppel and others 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. Regrettably, those living in LMICs, where the burden of epilepsy is extensive, are the most affected by the epilepsy treatment gap Jette and Trevathan The treatment gap is more than 75 percent in low-income countries, more than 50 percent in many LMICs and upper-middle-income countries, and less than 10 percent in most HICs figure 5.

    Proposed mechanisms for the epilepsy treatment gap can be divided into two broad categories: Health care system issues include lack of availability of anti-epileptic drugs, missed or delayed diagnosis, wrong treatment prescribed, treatment not offered to patients, and lack of resources and personnel Cameron and others ; Kale ; Mbuba and others Epilepsy diagnosis is predominantly based on clinical history, and primary care physicians can be trained to provide basic treatment.

    Patient-related potential mechanisms for the treatment gap include cultural beliefs, stigma, fear of side effects, the hassle factor, and cost of treatment Cameron and others ; Kale ; Mbuba and others All these reasons for the epilepsy treatment gap should be considered as potential targets for evaluation and action.

    One study examined the availability, price, and affordability of anti-epileptic drugs in 46 countries Cameron and others The study found that not only is the availability of these medications lower in LMICs, but their costs are highest where the treatment gap is the greatest Cameron and others This study supports the view that availability and affordability of anti-epileptic drugs are likely major drivers in resource-poor countries.

    Health Care System Improve access to anti-epilectic drugs. Two of the most impactful approaches to target the treatment gap are legislative and anti-stigma interventions. Unfortunately, their cost-effectiveness has not been evaluated.

    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. A recent study in India showed that covering costs for both first- and second-line therapy and other medical costs alleviates the financial burden from epilepsy and is cost-effective across wealth quintiles and in all Indian states Megiddo and others Both studies found that first-line medications, such as phenobarbital, represent a highly cost-effective use of resources for health see also chapter 12 in this volume [ Levin and Chisholm ].

    Surgery has been shown to be cost-effective in appropriately selected candidates in HICs, with health care costs declining significantly after successful surgery Jette, Reid, and Wiebe , Langfitt and others Unfortunately, economic evaluations of epilepsy surgery in children, older adults, and from LMICs are generally lacking.

    In addition, most economic analyses focus on temporal lobe surgery. The dire consequences of poorly treated epilepsy include significant morbidity and mortality caused by seizures and related injuries. The ongoing stigma associated with seizures remains a major challenge to clinical care in many regions, as well as the poor access to proper medications that can adequately treat this population. Ultimately, it is likely that the most effective target to address the treatment gap of epilepsy globally will be legislative changes and anti-stigma interventions.

    Among the required legislative efforts are those that advocate better provision of benefits for functionally disabled persons with epilepsy, especially in resource-poor countries where they are most needed. Dementia poses a unique burden to those affected, their families, and societies. Substantial projected increases of patients with dementia in LMICs will pose additional economic and social burdens.

    Dementia is often erroneously considered an unavoidable part of aging or a condition for which nothing can be done; limited understanding and the persistence of stigma and discrimination limit help-seeking. Consequently, timely diagnosis is the exception rather than the norm; most people are not diagnosed and have limited access to adequate health or social care.

    Because pharmacotherapy and psychological and psychosocial interventions that can ameliorate symptoms and lessen the impact on family members and caregivers are often unavailable, the treatment gap remains very large, particularly in countries where cultural and infrastructure barriers persist.

    Dementia is a neuropsychiatric syndrome characterized by a combination of cognitive decline, progressive behavioral and psychological symptoms BPSD , and functional disability WHO Dementia is usually chronic and progressive; its insidious onset is typically characterized by objective deficits in one or more cognitive domains, such as memory, orientation, language, and executive function that are at the late stages accompanied by behavioral disturbances.

    Although age is the most significant risk factor, dementia is not a normal part of aging Ganguli and others ; Kukull and others ; Launer and others The clinical onset of dementia is marked by the impact of cognitive decline in everyday activities, and diagnosis is often made by physical and neurological examination with supporting evidence from informant interviews.

    Although brain pathological lesions differ across dementia subtypes, mixed forms of dementia are common, and vascular brain damage often co-occurs. The most significant risk factor of dementia is increasing age; the incidence doubles with every five-year increment after age 65 WHO The graying of societies in all global regions is expected to increase the number affected substantially.

    In , approximately 47 million people had some form of dementia; 63 percent of those were in LMICs. This figure will nearly double to 76 million in and to million by The majority 71 percent of new cases will occur in LMICs figure 5. The steepest projected increases in numbers of people with dementia are expected in these settings because of rapid demographic changes. A new dementia case is diagnosed every four seconds in the world, leading to 7. In community-based samples, the prevalence of dementia varies from 38 to per , inhabitants, with an increasing incidence over 55 years.

    Although dementia is more common in older age, some people develop symptoms at a younger age compatible with EOD, a poorly understood and frequently underdiagnosed condition.

    Independent of the age at onset, most patients are cared for at home by close relatives. Need for one-on-one care starts early, becomes increasingly intense, and may change significantly throughout the natural history of the disease. Mood and behavioral changes, memory impairment for recent events, and spatiotemporal disorientation, as well as problem-solving deficits that characterize the early stage, may expose people with dementia and their families to stressful situations well before the clinical diagnosis is made.

    Later, mood and behavioral disorders further increase the burden of the disease. The later stages are characterized by diffuse involvement with psychological and behavioral symptoms, including repetitive behaviors, hallucinations, aggression, and wandering Kales and others In contrast to cognitive deficits, these symptoms are strongly related to institutionalization Richardson and others 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. The signs of neurological disorders can vary significantly, depending upon the type of disorder as well as the specific area of the body that is affected.

    In some instances, you might experience emotional symptoms while in other cases physical symptoms may be the result. While many people often first look for physical symptoms of a disorder, it is important to understand that there can also be emotional symptoms of neurological problems. For instance, you might experience mood swings or sudden outbursts.

    Individuals who suffer from neurological problems may also experience depression or delusions. It should be understood that these symptoms could also be indicative of other disorders and conditions. If you have noticed these symptoms in yourself or someone close to you, it is important to seek help right away. Please contact us at to speak to someone about your situation.

    If left untreated, neurological disorders can result in a number of serious consequences. The short-term and long-term effects of neurological instability can vary greatly, depending upon the disorder and the severity of your condition.

    For instance, according to MSWatch, 50 percent of individuals who suffer from multiple sclerosis experience depression at least once. The most important step you can take if you believe that you or someone you care about may be suffering from a neurological disorder is to seek assistance without delay.

    If you are concerned about a possible neurological disorder, it is important to seek professional medical assistance. A number of medical examinations can be performed to diagnose the presence of a possible neurological condition.

    Such tests may include genetic screening, a neurological exam, brain scans and other tests. Even though all self-administered tests or self-assessments cannot positively identify the presence of a neurological disorder, if you have noticed any of the following complaints, you may wish to seek professional assistance:. While it is understandable that the thought of being diagnosed with a neurological disorder may be frightening, it is important to understand that drug options for neurological issues are available.

    Such options can help you or your loved one to better manage your condition, reduce symptoms and improve your quality of life. The type of medication that may be used for the treatment of your neurological disorder will depend on your condition.

    Possible options for neurological drugs may include corticosteroids, which are often indicated for the treatment of multiple sclerosis. This type of medication may assist with decreasing inflammation. When taking medication for the treatment of any condition or disorder, it is important to understand that you may experience certain side effects.

    Medication side effects related to the treatment of neurological disorders can vary based on your own situation and the type of medication in question. In some instances, it may be possible to develop dependence to the medication you are taking. This can occur even if it is a prescription medication, and you are taking it for the treatment of a serious health problem, such as a neurological disorder.

    If you have developed a drug addiction, dependence and withdrawal are two critical components you need to understand. Dependence can develop when you take medication over a period of time.

    Depending on the addictive nature of the medication and your own personal situation, dependence can sometimes develop quickly. If you do become dependent on your medication, you will experience withdrawal symptoms when you abruptly stop taking the medication. Symptoms can include headaches, nausea and tremors. Addiction generally means you also have a psychological dependence on the medication in addition to a physical dependence. The potential for medication overdose is quite real and should not be taken lightly.

    In instances where an individual has become dependent on a medication, they may begin taking increasingly larger doses of the medication in order to achieve the same effects.

    This can result in an overdose — a serious medical situation that can be fatal. If you believe that you or someone you know may be taking too much medication and could be at risk for overdose, it is important to seek help right away.

    Please contact us at. Depression and neurological problems are often interrelated. Due to the debilitating nature of depression, individuals who suffer from it as well as neurological problems may find recovery to be challenging without professional assistance. Many different treatment options are available that can assist you with the treatment of your depression, including therapy in combination with medication. Seeking help from a facility that offers the ability to make a dual diagnosis, such as a diagnose of an addiction compounded by a neurological disorder, is critical for achieving an optimal recovery.

    Tackling Neurological Disorders in New Ways

    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.

    AD and Other Dementias



    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.


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


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


    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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