Neurology congress in Lisbon devoted to neurogenetics

38 percent more deaths due to neurological diseases: experts call for closure of treatment gaps

Lisbon (ptp018/15.06.2018/11:50) "Brain disorders such as stroke, dementia, headache, multiple sclerosis and Parkinson's disease are the primary cause of disability in Europe, and the second most common cause of death. The human and economic implications - from lost life years to direct and indirect costs - should not just be something that just researchers focus on, but specifically politicians, too," said Prof Günther Deuschl, President of the European Academy of Neurology (EAN) at the start of the 4th EAN Congress in Lisbon.

An international group of researchers showed the prevalence of brain disorders in the Global Burden of Disease study: in 2015 a total of 250.7 million DALYs (disability-adjusted life years) - i.e. years of healthy life lost due to illness or early death - caused by neurological conditions were reported worldwide. This is more than 10 percent of all DALYs. Brain disorders were behind 9.4 million deaths in the same year - which was almost 17 percent of all deaths during the year.

Stroke and dementia the main causes of death or disability

The study also looked at the extent to which brain disorders had increased over the past 25 years. There was a 36.7 percent global increase in deaths attributable to these conditions between 1990 and 2015, even though the number of fatalities attributable to stroke or communicable neurological diseases decreased significantly during the period. The number of DALYs also rose during the same period, by 7.4 percent.

"There is no end in sight to this trend, which is mainly caused by population growth and demographic shifts. However, the main drivers behind these developments are stroke and dementia diseases," Prof Deuschl explained. On a global level, stroke accounts for the most DALYs (47.3 percent) of any brain disorder, as well as the most fatalities (67.3 percent). Alzheimer's and other forms of dementia are the fourth-largest cause of incapacity, and the second most common cause of death. "Brain disorders have gone from being a significantly underestimated and often undertreated group of conditions to a huge challenge facing social and health policy today," Prof Deuschl confirmed.

EAN calls for more resources for research and prevention

The European Academy of Neurology is currently analysing detailed data on the prevalence of brain disorders in Europe. "We want to process more facts and figures and present them to national societies and politicians," said EAN President elect Prof Franz Fazekas. "EU countries must face up to the question of whether they want to put the necessary money into preventing, curbing and healing brain disorders in future. Or whether they are going to have to spend the money anyway as the number of patients continues to rise," he added. The European Academy of Neurology is calling for more preventive measures and graduated preventive care structures for the major brain disorders.

As indicated by Prof Fazekas, research activities and political efforts are already starting to bear fruit in various areas such as stroke, where underlying death and incapacity rates are falling all the time. "Better prevention and the introduction of specialist stroke units are starting to have an effect. But there are still huge differences within Europe, and, in many cases, within individual countries." This was confirmed in The Value of Treatment-study conducted by the European Brain Council: Up to eight out of ten people in Europe living with a brain disorder remain untreated or are inadequately treated, even though effective therapies exist. In many cases, treatment paths are inadequately mapped out, there is a lack of specialist facilities, rehabilitation opportunities are missed or insufficient psychosocial support is provided to sufferers and their families.

Ensuring that sufficient funds are available to support and step up cross-border research projects is an essential aspect of getting to grips with the burden of brain disorders. "We hope that these facts will convince politicians and decision makers to invest into the future of our society and to generate research programs for reducing the burden of neurologic disorders," Prof Fazekas said.

Overarching theme: neurogenetics

The 4th EAN Congress in Lisbon has a special focus on neurogenetics this year, as new insights into the genetic influences on numerous brain disorders are coming to light all the time. Even more exciting gene therapy appears to enter clinical practice. "At the congress we are looking at what neurogenetics is already able to achieve, the direction the discipline is taking and where future approaches - and potential ethical red lines - could lie," EAN President Prof Deuschl explained. "Neurogenetics is not a panacea that holds the key to solving every problem. But it does help to reclassify diseases and groups of diseases, and promises to open up new treatment approaches.

Neurogenetics is an important tool to identify the many rare disorders which cause neurologic symptoms and which are often not recognized for long with the patients remaining uncertain about their condition. For several of these disorders there also exist already therapeutic options such as the replacement of specific enzymes, targeted medications or a specific diet. There are certain forms of small vessel disease (microangiopathy) which can be determined through specific genetic mutations, with consultation available for sufferers. In frequent neurologic disorders such as epilepsy, Alzheimer's and Parkinson's disease there exist hereditary forms that can now be detected, meaning that those affected can be informed of the risks which may impact their lives and that of offsprings. Finally gene replacement therapy is on the horizon and promises to even cure otherwise relentlessly progressive disorders such as spinal muscular atrophy and Friedreich's ataxia. "We would like to ensure that as many people in Europe as possible can benefit from the latest findings, and our congress is a valuable information hub where the best can learn from the best," Prof Fazekas concluded.

Sources: GBD 2015 Neurological Disorders Collaborator Group: Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet Neurol 2017; 16: 877-97 European Brain Council: The Value of Treatment: http://www.braincouncil.eu/activities/projects/the-value-of-treatment

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