Prospective Cohort Study

Summary Background Comparable data on the global and country-specific burden of neurological disorders and their trends are crucial for health-care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study provides such information but does not routinely aggregate results that are of interest to clinicians specialising in neurological conditions. In this systematic analysis, we quantified the global disease burden due to neurological disorders in 2015 and its relationship with country development level. Methods We estimated global and country-specific prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for various neurological disorders that in the GBD classification have been previously spread across multiple disease groupings. The more inclusive grouping of neurological disorders included stroke, meningitis, encephalitis, tetanus, Alzheimer's disease and other dementias, Parkinson's disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, medication overuse headache, brain and nervous system cancers, and a residual category of other neurological disorders. We also analysed results based on the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility, to identify patterns associated with development and how countries fare against expected outcomes relative to their level of development. Findings Neurological disorders ranked as the leading cause group of DALYs in 2015 (250·7 [95% uncertainty interval (UI) 229·1 to 274·7] million, comprising 10·2% of global DALYs) and the second-leading cause group of deaths (9·4 [9·1 to 9·7] million], comprising 16·8% of global deaths). The most prevalent neurological disorders were tension-type headache (1505·9 [UI 1337·3 to 1681·6 million cases]), migraine (958·8 [872·1 to 1055·6] million), medication overuse headache (58·5 [50·8 to 67·4 million]), and Alzheimer's disease and other dementias (46·0 [40·2 to 52·7 million]). Between 1990 and 2015, the number of deaths from neurological disorders increased by 36·7%, and the number of DALYs by 7·4%. These increases occurred despite decreases in age-standardised rates of death and DALYs of 26·1% and 29·7%, respectively; stroke and communicable neurological disorders were responsible for most of these decreases. Communicable neurological disorders were the largest cause of DALYs in countries with low SDI. Stroke rates were highest at middle levels of SDI and lowest at the highest SDI. Most of the changes in DALY rates of neurological disorders with development were driven by changes in YLLs. Interpretation Neurological disorders are an important cause of disability and death worldwide. Globally, the burden of neurological disorders has increased substantially over the past 25 years because of expanding population numbers and ageing, despite substantial decreases in mortality rates from stroke and communicable neurological disorders. The number of patients who will need care by clinicians with expertise in neurological conditions will continue to grow in coming decades. Policy makers and health-care providers should be aware of these trends to provide adequate services. Funding Bill & Melinda Gates Foundation.

/pdf/global-regional-and-national-burden-of-neurological-1dr97acwex.pdf

Global, regional, and national burden of neurological disorders, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016

The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings

This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-2982.2007.01288.x

The Global Burden of Headache: A Documentation of Headache Prevalence and Disability Worldwide:

: This report documents a collection of new techniques for image smoothing, and gives examples of their performance. The techniques involve averaging over half-neighborhoods, weighted averaging, and averaging based on local property probabilities.

Some new image smoothing techniques

Migraine with aura has been reported to increase the risk of clinically evident stroke or coronary artery disease and has been associated in magnetic resonance imaging (MRI) studies with a high-risk for cerebellar infarcts (indicating vascular disease). This population-based study investigated whether individuals with midlife migraine symptoms, especially aura, were at higher risk of late-life infarct-like lesions found on MRI compared to individuals not reporting headache. The study subjects, a random sample of 2693 women and 1996 men born between 1907 and 1935, were assessed both at midlife and late-life. Midlife assessments conducted at a mean age of 51 years (age range: 33-65) included measurement of cardiovascular risk factors, demographic characteristics, and questions about headache. Late-life assessments more than 26 years later also included brain MRI data and history of cardiovascular disease. Those reporting one or more headaches per month were asked whether the headaches were accompanied by features of migraine: nausea or vomiting, unilateral location, photophobia, visual disturbance, and unilateral numbness. Participants were classified as having non-migraine headache, migraine without aura, or migraine with aura. Infarct-like lesions in the brain were present in 39.3% of men and 24.6% of women. After adjustment for age, sex, and follow-up time, participants having midlife migraine with aura (n = 61) were at increased risk for total infarcts compared with those not reporting headaches (n = 3243); the adjusted odds ratio (OR) was 1.4, with a 95% confidence interval (CI) of 1.1 to 1.8. This increased risk was primarily associated with cerebellar lesions (adjusted OR, 1.6; 95% CI, 1.3-2.2). Infarcts in the cerebellum, but not in the cortical or subcortical locations, were more prevalent in women with migraine than in those without headache (23% vs. 15%; adjusted OR, 1.9; 95% CI, 1.4-2.6, P < 0.001). Unlike women, there was no difference in the prevalence of cerebellar infarcts among men with migraine compared to those without headache (19.3% vs. 21.3%); the adjusted OR, was 1.0, with a 95% CI of 0.6 to 1.8, P < 0.04 for interaction by sex. The results persisted after adjustment for cardiovascular risk factors in midlife or late life and history of cardiovascular disease. No increased risk was found for migraine without aura or nonmigraine headache. These findings suggest that the occurrence of migraine with aura in middle age women is associated with late-life prevalence of cerebellar vascular disease.

Migraine Headache in Middle Age and Late-Life Brain Infarcts

Objective: To identify patterns of noncephalic pain comorbidity in people with episodic migraine (EM; Methods: Data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a prospective, web-based study with cross-sectional modules embedded in a longitudinal design, were analyzed at baseline and the 3-month follow-up. Relationships between the number of noncephalic pain sites and 3-month onset of CM or persistent CM were assessed. Results: Of 8,908 eligible respondents, 8,139 (91.4%) had EM and 769 (8.6%) had CM at baseline. At 3 months, the incidence of CM among those with baseline EM was 3.4%. When adjusted for demographics and headache-day frequency, the odds of CM onset among those with baseline EM increased by 30% (95% confidence interval [CI] 1.21–1.40, p p Conclusions: These results suggest that noncephalic pain may be a marker for headache chronicity that could be used to identify people with EM at risk of the onset of CM and people with CM at risk of persistent CM.

https://n.neurology.org/content/neurology/89/5/461.full.pdf

Comorbid pain and migraine chronicity: The Chronic Migraine Epidemiology and Outcomes Study.

The well-studied C677T variant in the methylenetetrahydrofolate reductase (MTHFR) enzyme is a biologically plausible genetic risk factor for seizures or epilepsy. First, plasma/serum levels of homocysteine, a pro-convulsant, are moderately elevated in individuals with the homozygote TT genotype. Furthermore, the TT genotype has been previously linked with migraine with aura—a comorbid condition—and with alcohol withdrawal seizures. Finally, several small studies have suggested that the TT genotype may be overrepresented in epilepsy patients. In this study, we consider whether the MTHFR C677T or A1298C variants are associated with risk of epilepsy including post-traumatic epilepsy (PTE) in a representative military cohort. Study subjects were selected from the cohort of military personnel on active duty during the years 2003 through 2007 who had archived serum samples at the DoD Serum Repository, essentially all active duty personnel during this time frame. We randomly selected 800 epilepsy patien...

Ann I. Scher

Papers

Some new image smoothing techniques

Migraine Headache in Middle Age and Late-Life Brain Infarcts

Comorbid pain and migraine chronicity: The Chronic Migraine Epidemiology and Outcomes Study.

MTHFR C677T Genotype As a Risk Factor for Epilepsy Including Post-Traumatic Epilepsy in a Representative Military Cohort

Age effects on hippocampal structural changes in old men: the HAAS.