Prevention of Neurological disorders: A biggest Public Health Challenge of 21st century

 
The Global Burden of Disease (GBD) study reported that neurological disorders are the leading cause of disability-adjusted life years (DALYs) in 2021, affecting over 43% of the global population. Neurological disorders affect the central and peripheral nervous systems, causing a wide range of health issues such as cognitive, motor, and sensory impairments. Common disorders like stroke, Alzheimer's, and migraines, Parkinson's, stroke, multiple sclerosis affects mental, sensory and motor functions, contributing significantly to global disease burden.  Neurological disorders affected 3.40 billion individuals worldwide in 2021,  DALYs  increased by 18.2% since 1990. Neurological conditions caused 11.1 million deaths in 2021, contributing significantly to global health loss. Neurological disorder DALYs were highest in sub-Saharan Africa and lowest in Australasia and high-income Asia-Pacific regions. The cognitive impairment post-COVID-19 and Guillain-Barre syndrome highlight new challenges as emerging neurological disorder. The Childhood Neurological Disorders like complications from preterm birth and neonatal conditions significantly impact early life health, especially in low-income countries. The modifiable risk factors like Stroke and Alzheimer’s are influenced by factors such as diet, physical inactivity, and smoking. Addressing these risk factors could reduce the burden of some neurological disorders. Increasing burden of aging i.e. e rise in life expectancy has led to more age-related neurological diseases, particularly Alzheimer’s and Parkinson’s, making prevention and care a priority. The challenges and disparities is healthcare access in low- and middle-income countries (LMICs) face a disproportionately high burden of neurological disorders due to limited healthcare infrastructure. The underrecognized disorders like neurodevelopmental conditions, often classified under mental health, represent a significant portion of neurological disease burden, especially in younger populations. The global response and future directions action plan on epilepsy and other neurological disorders (2022–2031) by the World Health Assembly aims to reduce the stigma and improve treatment access for neurological conditions worldwide. There is need for further future research for risk factors and treatment of neurological disorders to enhance global health strategies.

The public health challenges of neurological disorders in the 21st century includes; aging population, increased life expectancy has led to a rise in age-related disorders like Alzheimer’s and Parkinson’s. Healthcare Inequality, limited access to neurological care, especially in low- and middle-income countries. Prevention and Early Diagnosis: many neurological conditions have few modifiable risk factors and are diagnosed late. Chronic Disability: neurological diseases contribute significantly to long-term disability, placing a heavy burden on healthcare systems and families. Effective global strategies are required to address these growing challenges.

PRIMARY PREVENTION: The primary prevention is to prevent the onset of disease or avoid a targeted condition. The use of vaccine against poliomyelitis led to elimination of indigenous polioviruses from the countries with few exception. Take measures to control blood pressure, cholesterol levels and diabetes mellitus, to reduce tobacco use, and to promote overall healthy eating patterns and physical activity are advocated for primary prevention of stroke. Wearing a helmet is the single most effective way to reduce head injuries and fatalities resulting from motorcycle and cycle crashes. For example, wearing a helmet has been shown to decrease the risk and severity of injuries among motorcyclists by about 70%, the likelihood of death by almost 40%, and to substantially reduce the costs of health care associated with such crashes.

SECONDARY PREVENTION: Early and accurate diagnosis, appropriate treatment, management of risk factors, compliance. Medical treatment of epilepsy with first-line antiepileptic drugs can render up to 70% of patients seizure-free when adequately treated. Management of patients with stroke by an organized unit significantly reduces mortality and disability in comparison with standard care on a general medical ward.

 TERTIARY PREVENTION: Rehabilitation, palliative care, treatment of complications, patient and caregiver education, self-support groups, reduction of stigma and discrimination, social integration. Interventions targeting stress and depression among caregiver of patients with dementia, including training, counselling and support for caregivers, have shown positive results for the management of dementia. The strategy of community-based rehabilitation has been implemented in many low-income countries around the world; where it is practiced, it has successfully influenced the quality of life and participation of persons with disabilities in their societies. Methods to reduce stigma related to epilepsy in an African community successfully changed attitudes to epilepsy: traditional beliefs were weakened, fears were diminished, and community acceptance of people with epilepsy increased.

The public health intervention process is applied on two levels: The first refers to the guidance along the continuum of care, second to the provision of a specific service .From the guidance perspective: The assessment step includes the identification of the person’s problems and needs, the valuation of rehabilitation potential and prognosis and the definition of long-term service and goals of the intervention program. 

The challenges include limited diagnostic tools, lack of specialized care in LMICs, high costs of treatment, and slow progress in drug development. Neurological diseases often require long-term care and are difficult to treat​, therefore prevention is the only option to decrease global burden of neurological disorders through dietary and lifestyle modifications.

To effectively address the growing public health challenges of neurological disorders, several global strategies are essential: Prevention and risk reduction public health initiatives targeting modifiable risk factors like smoking, hypertension, and physical inactivity can reduce the incidence of neurological diseases. Healthcare Access: expanding access to neurological care and diagnostic tools, especially in low- and middle-income countries. Research and Innovation: Increased investment in research for new treatments and diagnostic methods for neurological disorders.

The vaccines for neurological disorders are limited but exist for conditions that involve neurological complications caused by infections. Key examples include: Meningitis vaccines for bacterial causes such as Neisseria meningitides (meningococcal vaccine), Streptococcus pneumoniae (pneumococcal vaccine), and Haemophilus influenza type B (Hib vaccine).  Rabies vaccine prevents the rabies virus, which affects the nervous system. Japanese Encephalitis: A vaccine is available for this mosquito-borne virus. Zika Virus: Still under research, as it affects brain development. These vaccines prevent diseases that can lead to neurological damage.