Burden of Neurological Disorders

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Recently, the first comprehensive estimates of disease burden due to neurological disorders and their trends in every State of India.

About the Study

• The findings have been published under the title of ‘The burden of neurological disorders across states of India: the Global Burden of Disease Study 1990–2019’.
• It is based on collaboration with leading neurology experts in India.
• The study aimed at increasing awareness about these disorders, early identification, cost-effective treatment and rehabilitation.
• It provides policy-relevant insights into the trends of neurological disorders across the States.
• It presented a comprehensive perspective of the burden of neurological disorders over the last 30 years and systematically highlights the variations between the States.
• It has been released and published by the India State-Level Disease Burden Initiative.
  • It was launched in October 2015 to address the knowledge gap with support from the Ministry of Health and Family Welfare.
  • This is a collaborative effort between the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), Institute for Health Metrics and Evaluation (IHME) and experts and stakeholders from about 100 institutions across India.
  • The work of this Initiative is overseen by an Advisory Board consisting of eminent policymakers and involves extensive engagement of 14 domain expert groups with the estimation process.
  • It reported an unprecedented comprehensive assessment of the diseases causing the most premature deaths and ill-health in each state of the country, the risk factors responsible for this burden, and their trends spanning 26 years from 1990 to 2016.
    • The burden from 333 disease conditions and injuries and 84 risk factors are computed for each state of India as part of the Global Burden of Disease Studies.

Neurological Disorders

• These are diseases of the central and peripheral nervous system.
  • In other words, the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscles.
• These neurological disorders include:
  • Non-communicable neurological disorders like stroke, headache disorders, epilepsy, cerebral palsy, Alzheimer’s disease and other dementias, brain and central nervous system cancer, Parkinson’s disease, multiple sclerosis, motor neuron diseases, and other neurological disorders.
  • Communicable neurological disorders like encephalitis, meningitis, and tetanus.
  • Injury-related neurological disorders like traumatic brain injuries and spinal cord injuries.
• Many bacterial, viral, fungal and parasitic infections can affect the nervous system. Neurological symptoms may occur due to the infection itself, or due to an immune response.
• Prevalence
  • Hundreds of millions of people worldwide are affected by neurological disorders. 
  • More than 6 million people die because of stroke each year and over 80 per cent of these deaths take place in low- and middle-income countries.
  • More than 50 million people have epilepsy worldwide.
  • It is estimated that there are globally 47.5 million people with dementia with 7.7 million new cases every year. Alzheimer’s disease is the most common cause of dementia and may contribute to 60–70 per cent of cases.
  • The prevalence of migraine is more than 10 per cent worldwide.

Major Findings

• Neurological disorders contributed 10 per cent of the total disease burden in India.
• High blood pressure, air pollution, dietary risks, high fasting plasma glucose and high body-mass index (BMI) were found to be the leading contributors among the known risk factors for neurological disorders burden.
• The burden of many neurological disorders vary substantially across the States.
• In 2019, the largest contributors to the total neurological disorder DALYs (disability adjusted life-years) in India were stroke (37.9 per cent), headache disorders (17.5 per cent), epilepsy (11.3 per cent), cerebral palsy (5.7 per cent), and encephalitis (5.3% per cent).
• While communicable diseases contributed to the majority of total neurological disorders burden in children younger than five years, non-communicable neurological disorders were the highest contributor in all other age groups.
• Contribution of non-communicable and injury-related neurological disorder to the total disease burden has more than doubled between 1990 and 2019.
  • The burden of non-communicable neurological disorders was increasing in the country, mainly due to the ageing of the population.
• While the burden of communicable neurological disorders has fallen in India, this burden is higher in less developed States.
• On the other hand, the burden of injury related neurological disorders related to injury is higher in more developed States.
• Among non-communicable neurological disorders, stroke is the third leading cause of death in India and dementia is the fastest growing neurological disorder.

(Image Courtesy: Lancet)

Recommendations

• Several government policies and initiatives are in place to address the burden of neurological disorders across India, however, more focused efforts are required for the planning of specific neurology services in each State.
  • Related Government Initiatives
    • Rashtriya Bal Swasthya Karyakram
    • Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana
    • National Programme for Health Care of the Elderly
    • Janani Surakhya Yojana and Janani Shishu Suraksha Karyakram
    • National Programme for Prevention and Management of Trauma and Burn Injuries, etc.
• Prevention and early management which are key in reduction in neurological burden.
  • On the prevention side, simple lifestyle modifications like a healthy diet, healthy oils, no smoking, blood pressure control, avoiding refined foods, staying physically active, reducing stress etc. can be done
  • Early treatment can save irreversible damage be it from stroke, epilepsy, status epilepticus etc as time is crucial, with neurons (nerve cells) once lost do not replenish and regain function again.
• There is a need to address the shortage of trained neurology workforce and strengthen early detection and cost-effective management of neurological disorders in the country to deal with their growing burden.

Source: TH