Neurological diseases major challenge for health systems

Stroke finally classified as a brain disease

London (ptp026/28.09.2017/13:35) "The latest figures from the 'Global, Regional and National Burden of Neurological Disorders Study' clearly show the vast impact of neurological diseases", says Prof Raad Shakir, President of the World Federation of Neurology (WFN). "Neurological disorders rank as the leading cause of DALYs (disability-adjusted life years) and the second leading cause of death among all groups of diseases". These figures were revealed at the recent XXIII World Congress of Neurology in Kyoto, Japan. The study was also published in "The Lancet Neurology".

"The new study provides important evidence that brain diseases have moved on from an under-estimated, under-recognized and under-resourced group of conditions to a major challenge for health policy worldwide and that sufficient resources have to be provided for disease prevention and management," Prof Shakir says. "These are important insights as this year we celebrate the WFN's 60th anniversary and should use this opportunity to reflect upon the changes in the neurological practice since our inception."

According to the new study, in 2015 neurological diseases led to the loss of 250.7 million disability-adjusted life years (DALYs), which is 10.2% of global DALYs. In addition, brain diseases are the second commonest cause of death with 9.4 million, comprising 16.8% of global deaths. Among all neurological disorders, stroke accounted for the largest proportion of total DALYs (47.3%) and deaths (67.3%). Migraine, meningitis, and Alzheimer's disease and other dementias were the second, third, and fourth largest contributors of DALYs. The second largest contributor to deaths from neurological disorders was Alzheimer's disease and other dementias.

"The fact that neurological diseases have not been properly reflected in ICD classifications of the WHO have certainly contributed to lack of visibility of brain disorders and brain health", Prof Shakir stresses. "The international classification of diseases ICD by the WHO so far lacked clarity regarding neurological or brain diseases. Instead neurological diseases are partly contained in the category of neuropsychiatric disorders and partly classified as cardiovascular diseases."

Since ICD7 in 1955, stroke was not classified as a neurological disease but as a cardiovascular disease. Prof Shakir: "We have been working against the tide for many years to remedy this anomaly".

The classification policy has created a lack of data, WFN President Shakir underlines: "By not recognising the most common brain disorder as a neurological disease, international organisations and national governments over decades have vastly underestimated the need of neurologists. This has contributed to insufficient medical - and precisely neurological - care in many parts of the world. Following long discussions and negotiations, in April 2017 it was finally agreed with the statistics department of the WHO to classify stroke as a brain disease."

Another important discussion with respect to the ICD, according to Prof Shakir: "Dementia is still classified as a mental health disease, but we worked very hard to make sure the causes of dementia such as Alzheimer's disease, frontotemporal dementia, Lewy body disease, multi-infarct dementia etc. are classified as neurological disorders. This is another discussion which we are heading for."

Prof Shakir expects the not yet published new ICD11 to provide a starting point for better recognition of Neurology as a major cause of disability and death but expects change to take time. "This will take a decade or two to trickle down into the concepts of health care", the WFN president said.

Source: Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015; GBD 2015 Neurological Disorders Collaborator Group

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