Neurological Disorders

Excerpt

Neurological disorders pose a large burden on worldwide health. The most recent estimates show that the neurological disorders included in the Global Burden of Disease (GBD) Study–Alzheimer’s and other dementias, Parkinson’s disease, multiple sclerosis, epilepsy, and headache disorders (migraine, tension-type headache [TTH], and medication-overuse headache [MOH])–represent 3 percent of the worldwide burden of disease. Although this is a seemingly small overall percentage, dementia, epilepsy, migraine, and stroke rank in the top 50 causes of disability-adjusted life years (DALYs) (Murray and others 2012).

Migraine and epilepsy represent one-third and one-fourth of this neurological burden, respectively (Murray and others 2012), and dementia and Parkinson’s disease are among the top 15 conditions with the most substantial increase in burden in the past decade. In 2010, neurological disorders constituted 5.5 percent of years lived with disability (YLDs), or 42.9 million YLDs; migraine, epilepsy, and dementia were among the top 25 causes of YLDs. Migraine leads the list of neurological disorders, representing more than 50 percent of neurological YLDs or 2.9 percent of global YLDs; epilepsy represents 1.1 percent of global YLDs (Vos and others 2012).

The neurological burden of disease is expected to grow exponentially in low- and middle-income countries (LMICs) in the next decade (Murray and others 2012). Despite the significant impact of neurological disorders on patients and societies, knowledge of their epidemiology, including variation in disease frequency across place and time and understanding of associated risk factors and outcomes, remains limited, particularly in LMICs. Patients with neurological disorders often require significant social and economic support because of physical, cognitive, and psychosocial limitations (WHO 2006). Despite the high prevalence of disability, there is increasing recognition that services and resources are disproportionately scarce, especially in LMICs (WHO 2004). In addition, knowledge of the cost-effectiveness of interventions to improve neurological care in these settings remains limited.

This chapter addresses three neurological disorders: epilepsy, dementia, and headache disorders. The chapter reviews current knowledge of the epidemiology, risk factors, and cost-effective interventions for these conditions. The focus is on interventions that provide meaningful reduction in the burden to the global population, with particular emphasis on applicability to LMICs. Neurological disorders are an emerging challenge to health care systems globally, requiring further study, government and social engagement, and improvements in health care infrastructure.

This chapter uses the World Health Organization (WHO) regions—African, the Americas, Eastern Mediterranean, European, South-East Asia, and Western Pacific—to describe the global burden of the highlighted neurological disorders.