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World Congress of Neurology, Montreal, Canada, 15-19 October, 2023

By Priscilla Lynch - 01st Jan 2024


Reference: January 2024 | Issue 1 | Vol 10 | Page 3


Number of people living with brain disease expected to double by 2050

Neurological disorders are currently the second highest cause of death and the leading cause of disability worldwide. A new Global Burden of Disease (GBD) study presented during the 2023 World Congress of Neurology shows that the number of people living with brain disease is expected to double by 2050.

“Our study found that over 40 per cent of the global population currently suffer from some kind of neurological condition and this burden is projected to nearly double by 2050,” said Prof Valery Feigin, Professor of Neurology and Epidemiology, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand. “This is a warning – if we do not do enough to combat neurological disorders the whole health system will be in crisis.”

The GBD study is the most comprehensive effort to date to chart the global burden of neurological disorders and is designed to help guide policymaking and healthcare decisions at global and national levels. The findings will drive research into the most burdensome disorders and direct investment to areas experiencing the highest levels of burden.

The study includes data on the 36 most common neurological disorders and conditions worldwide and provides estimates on the prevalence, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) for each condition.

Currently, 10 conditions account for around 90 per cent of total neurological DALYs:

  • Stroke;
  • Neonatal encephalopathy;
  • Migraine;
  • Dementia;
  • Meningitis;
  • Epilepsy;
  • Neurological complications associated with preterm birth;
  • Nervous system cancers;
  • Autism spectrum disorders;
  • Parkinson’s disease.

“These diseases were the 10 greatest contributors to nervous system burden worldwide,” said Prof Feigin. “If we focus on combating these 10 diseases, we can reduce the global burden dramatically, but we need to identify causes, risk factors, the most effective treatments, and rehabilitation strategies through research.”

Significant geographical and economical disparity is increasing the burden of neurological conditions in low- and middle-income countries. While 80 per cent of the world’s population live in low- and middle-income countries, these countries account for over 90 per cent of neurological disability, and 84 per cent of all deaths due to neurological conditions worldwide.

“Given that neurological disorders are already the global leading cause of disability and death combined, the fastest-growing cause of death, and that the projected increase of their burden outpace the burden of most other non-communicable disorders, I believe neurological disorders should no longer be ‘a’ global health priority – they should be considered ‘the’ global health priority,” said Prof Feigin.

A paper published last month in The Lancet Neurology added to the projections made in the GBD study. According to this paper titled ‘Pragmatic solutions to reduce the global burden of stroke: A World Stroke Organisation – Lancet Neurology Commission’ – unless urgent action is taken, the number of people who die from stroke globally is estimated to increase by 50 per cent, to 9.7 million deaths per year, by 2050.

Based on a review of evidence-based guidelines, recent surveys and in-depth interviews with stroke experts around the world, the authors make evidence-based pragmatic recommendations to reduce the global burden, including measures to improve stroke surveillance, prevention, acute care, and rehabilitation.

“Stroke exerts an enormous toll on the world’s population, leading to the death and permanent disability of millions of people each year and costing billions of dollars,” said Prof Feigin, who is also the Lancet Neurology Commission co-chair.

Visit www.wcn-neurology.com to learn more about Prof Feigin and all the featured research at this year’s World Congress of Neurology, which took place in Montreal, Canada.

New research into Rett syndrome

A ground-breaking discovery into the mechanisms driving Rett syndrome was unveiled during the 2023 World Congress of Neurology.

Research by Prof Huda Zoghbi, Professor of Molecular and Human Genetics, Baylor College of Medicine, Texas, US, shows that mutations in the MECP2 gene are responsible for causing Rett syndrome, a childhood disorder that primarily affects females and is diagnosed in around one-in-10,000 girls born each year.

Rett syndrome is a delayed-onset childhood disorder that causes a broad range of severe neurological disabilities, including loss of the ability to speak and socialise, and the development of tremors, ataxia, seizures, autonomic dysfunction, and stereotypic hand-wringing movements.

Prof Zoghbi’s ground-breaking research not only enhances understanding of Rett syndrome, but also reveals its connection to a spectrum of neuropsychiatric phenotypes, from autism to bipolar disorders.

Using genetically-engineered mice, Prof Zoghbi and her team learned that the brain is acutely sensitive to MeCP2 levels. Both decreases and increases in the amount of MeCP2 protein can lead to neurological problems that are also observed in humans.

Prof Zoghbi found that normalising MeCP2 levels in a mouse model can reverse disease-like features of the human MECP2 duplication syndrome, a disorder that is usually found in boys and results from excess MeCP2 protein.

Her research also pinpointed the specific neurons and circuit abnormalities that mediate the various symptoms of Rett syndrome. Using either deep brain stimulation or intense pre-symptomatic training of a Rett syndrome mouse model, her team showed that many symptoms can be normalised.

“The fact that either deep brain stimulation or intense pre-symptomatic training can normalise circuit function and behaviour is quite exciting as it tells us that such interventions have the potential to help patients,” said Prof Zoghbi.

Ground-breaking new model on Parkinson’s

During a plenary lecture at the World Congress of Neurology, Prof Anthony Lang, Professor of Neurology and Jack Clark Chair for Parkinson’s Disease Research, University of Toronto, revealed a ground-breaking new model for identifying and studying Parkinson’s disease. This new approach will help researchers investigate biological aspects of the disease that may be detectable many years before symptoms begin to show.

The new model outlines three criteria for identifying Parkinson’s disease based on distinct, measurable biological factors. Prof Lang explained that this new biological model will allow doctors and researchers to understand Parkinson’s in a deeper and more complex way than current clinical models, which are limited to observing symptoms in individual patients.

“We believe this is a radically different way of looking at Parkinson’s disease,” said Prof Lang. “We’ve reached a point where, in the era of novel biomarkers… our research needs to be driven by biological determinants of the disease rather than simply limited to a clinical description of the signs and symptoms.”

In recent decades, researchers have uncovered a number of potential biological causes for the disease – including genetic factors and the presence of the synuclein protein in the brain – but until recently, methods to test for these biomarkers in living patients have been largely unavailable.

Prof Lang hopes this major step toward a biological model will drive research to investigate these biomarkers and give scientists a more complex understanding of the disease. This in turn may drive development of new diagnosis and treatment methods.

Prof Lang and his colleagues call this new model ‘SynNeurGe’ (pronounced ‘synergy’), based on the three key biological aspects used to identify the disease and their important interactions:

Syn – The presence of the alpha-synuclein protein – often referred to as the Parkinson’s protein – which can currently be measured in bodily fluids like spinal fluid as well as in the skin and, hopefully in the near future, in the blood.
Neur – The presence of neurodegeneration that occurs as Parkinson’s progresses.
Ge – The presence of genetic factors known to cause the disease.

This new three-part classification aims to account for the many different ways Parkinson’s disease presents in patients. For example, based on current, limited testing methods, some patients with genetic forms of Parkinson’s disease do not show signs of the synuclein protein in the brain after death. Prof Lang hopes future research will ultimately enable doctors to classify patients based on different categories and types of Parkinson’s.

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