Brain and Nervous System Disorders: 11 Things to Keep in Mind

Neurological disorders have been considered a significant threat to public health for some time now as evidenced by the 2007 World Health Organization document “Neurological Disorders: Public Health Challenges.”

Brain diseases alone (more than 1000 of them) are estimated to affect 100 million Americans at a cost of more than $5 billion.

Numbers certainly don’t tell the whole story, but consider these statistics on some common brain and nervous system conditions:

• Alzheimer disease, 4,500,000 cases

• ADHD, 17,400,000 cases

• Autism, 4,600,000 cases

• Developmental disorders, 48,600,000 cases

• Epilepsy, 2,300,000 cases

• Migraines/cluster headaches, 45,000,000 cases

• Neuromuscular diseases, 28,300,000 cases

• Pain (chronic), spinal cord injuries, phantom limb pain, 64,000,000 cases

• Parkinson disease, 1,500,000 cases

• Stroke, 4,700,000 cases

Many neurological conditions can be managed by primary care physicians if you know their epidemiology and the indications for referral to a neurologist. Take a look at these facts and figures:

1.Dementia has an economic impact on the United States as least as large as that of heart disease and cancer. The direct costs of dementia care were estimated at $109 billion in 2010, compared with direct health expenses of $102 billion for heart disease and $77 billion for cancer. Adding informal, unpaid care to the equation as much as doubled the estimated total national costs, up to nearly $215 billion.

2. An additional 48 genetic variants that influence the risk of multiple sclerosis have been identified by scientists of the International Multiple Sclerosis Genetics Consortium. The genes implicated by the new associations underline the central role the immune system plays in the development of MS and show substantial overlap with genes involved in other autoimmune diseases.

3. The risk of epilepsy later in life may be reduced in men who exercise vigorously as young adults. Epilepsy is 79% and 36% less likely to develop in men who have a high level of fitness than in those with low and medium fitness levels, respectively.

4. Taking vitamin B supplements may help reduce the risk of stroke. In studies, vitamin B lowered the risk of stroke overall by 7%, but taking supplements did not appear to affect the severity of strokes or risk of death from stroke.

5. Persons who have occasional migraines (14 or fewer migraine headaches per month) are more likely to be obese than those who do not. Obese persons in a recent study were 81% more likely to have episodic migraine of any frequency compared with persons of normal weight. The link between episodic migraine and obesity is stronger in persons younger than 50 years.

6. The structure of the brain may predict whether a person will experience chronic low back pain. Chronic pain affects close to 100 million Americans, and treatment costs up to $635 billion per year. LBP represents about 28% of causes of pain in the United States; about 23% of patients have chronic LBP.

7. To predict all functional connections underlying behavior, scientists developed a 2-photon technique for brain-wide calcium imaging in Caenorhabditis elegans-a worm. They demonstrated near-simultaneous recording of activity of up to 70% of head neurons. In combination with a lab-on-a-chip device, this method provides an enabling platform for establishing functional maps of neuronal networks.

8.Vagus nerve stimulation for epilepsy was associated with a greater than 50% seizure reduction in 55% of 470 children who had partial or generalized epilepsy and a greater than 50% seizure reduction in 55% of 113 patients with Lennox-Gastaut syndrome.

9. Up to 15% of patients with mild cognitive impairment will progress to dementia each year, but more than half of them will not progress. Many in whom dementia develops do not meet definitions of mild cognitive impairment before diagnosis. The drive to screen older persons for minor memory changes may be leading to unnecessary investigation and potentially harmful treatment.

10. As biomarkers to detect signals of Alzheimer disease improve at providing clinically meaningful information, most Alzheimer researchers support disclosing results to research subjects who have these tests. Three-fourths support disclosing amyloid imaging results to study participants who have mild cognitive impairment, and just more than half support giving amyloid imaging results to those who have normal cognition.

11. Urinary protein levels may be an early marker of future cognitive decline in patients with type 2 diabetes and normal kidney function. Persons who have DM have a 50% to 100% increased risk of cognitive impairment compared with those who do not.