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The following pages present the results of the Neurology ...


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The following pages present the results of the Neurology ...

  1. 1. RESULTS BY THEM E S The following pages present the results of the Neurology Atlas by themes 15
  2. 2. 1 N E U R O L O GICAL DISORDERS IN PRIMARY CARE REPORTED FREQUENCY Definitions ◆ Primary care in this context refers to the provision of The respondents were asked to provide the five neurological basic preventive and curative health care at the first point disorders that are most frequently encountered in primary of entry into the health-care system. Usually, this means care settings. Ignoring the order of the responses, the pro- that care is provided by a non-specialist who can refer portion of countries that mentioned each of the following complex cases to a higher level. diseases was calculated globally and for each of the regions. Salient findings ◆ Globally, headache (including migraine) is the most com- ◆ Neurological problems caused by vertebral disorders are mon neurological disorder seen in primary care settings among the top five neurological conditions encountered (reported by 73.5% of respondents), followed by epi- in primary care settings as reported by respondents in lepsy and cerebrovascular disease (72.5% and 62.7% of 34.3% of countries. Neuroinfections (26.5% of respond- respondents, respectively). Neuropathies (attributable to ents), Alzheimer’s disease and other dementias (22.6% of diabetes, alcohol, nutritional deficiencies and entrapment) respondents) and Parkinson’s disease (19.6% of respond- are next in order (45.1% of respondents). ents) are the other neurological disorders most frequently encountered in primary care settings. ◆ Epilepsy, cerebrovascular disease and headache are also among the five neurological disorders most frequently ◆ The top ten neurological conditions seen in primary care encountered in primary care settings in all the regions. settings also included symptoms that had not yet led to a diagnosis such as vertigo, syncope and dizziness (17.6% of respondents). Limitations ◆ The frequency of neurological disorders in various set- ◆ Although this information is available from only 102 tings is a rough estimate; data were not collected and cal- countries, the data represent 90% of the global popula- culated using stringent epidemiological research methods tion. Regionally, the data represent more than 80% of the as for prevalence studies. The information is based on the population for all the regions except Africa, where they experience and impression of a key person in a country and represent 52% of the population. not necessarily on actual data from responding countries. Implications ◆ The information regarding the diseases most frequently ◆ Integration of neurological care for common illnesses into seen in primary care settings has implications for mak- primary health care is also essential for extending health ing decisions about resource allocation for health care services to underserved areas in both developed and and prevention, research goals, and education of medical developing countries. undergraduates and general practitioners. ◆ Treatment of common neurological disorders at primary care level would be a cost-effective way of improving the scope and utilization of neurological services. Review of literature Headache, epilepsy and neurological problems caused by vertebral disorders (9% each) also featured among the top five neurological disorders featured most frequently (82%, 64% and 64% of stud- disorders seen in primary care settings in some studies. ies, respectively) among the top five neurological disorders in the Cerebrovascular disorders (100% of studies) followed by epilepsy studies describing the prevalence of neurological disorders encoun- (83%), neuropathies and neuroinfections (67% each) were among tered in primary care settings (7–16). Cerebrovascular disorders the top five admitting diagnoses in the studies concerning the and dizziness or vertigo ranked next (36% each). Neuropathies, neurological content of general hospital admissions (14, 17–21). functional disorders and neuroinfections were also identified The other common reasons for admission included cranial trauma among the top five conditions each seen in primary care in 18% of (33%), dementia including Alzheimer’s disease (33%), tumours of the studies. Parkinson’s disease, cranial trauma and psychiatric the central nervous system (17%) and degenerative and demyeli- nating disorders (17%). 16
  3. 3. NEUROLOGICAL DISORDERS IN PRIMARY C A R E 1 REPORTED FREQUENCY 73.5% 72.5% t os ary r s m rim rde in p 62.7% iso ted ld r ica po s % ) og ly re trie tries ( ol nt ur e un un 45.1% Ne equ by co by co r e 1.1 f car orted ep 02 st y R N= 1 mo ar 34.3% e rs prim ord in l dis rted ns ica epo gio %) 26.5% log tly r O re tries ( e uro en H n a ch 22.6% Ne equ in W y cou ad ps y fr re ed b He e 1.2 pil ase 19.6% ca ortp E ise Re lar d ies y scu path rs ps va uro rde ile Ep ase bro Ne iso ns dis e ere ld tio r he C bra fec nti a ula da c rte roi n me sc a se Ve eu de se va He sea N r ea ro ’s d i ies he dis reb n ath do t ’s Ce so ns on n p an ns rki uro c tio se rki Pa Ne nfe tia ea Pa ro i en dis eu de m ers er’s N e r ord he im oth dis l Alz an d ebra se rt ea Ve s dis er’ im he 100% Alz ea n 87.5% 89.5% rr an ite 84.6% ed 31.3% ric as nM ric a me 3 47.4% ter Af 16 76.9% A E as 8 62.5% = 1 1 N N= 73.7% N= 18.8% 68.8% 10.5% 15.4% 53.6% 50% 15.4% 42.1% 38.5% 0% 30.8% 31.3 % 10.5% 21.1% 7.7% 83.3% ia ic As 75% a cif st nP e -Ea 75% 87.5% ter rop 66.7% uth es 73.7% Eu 38 So 6 W 8 73.7 % N= 66.7% N= N= 50% 0% 31.6% 66.7% 12.5% 36.8% 50% 50% 7.9% 0% 12.5% 34.2% 47.4% 50% 37.5% 37.5% 17