32. Neurological Disorders

Abstract

The suffering caused by neurological diseases can be prolonged, and the burden can be particularly devastating among poor populations in developing countries with inadequate or strained health care resources. Developing countries are beginning to experience high incidences of such neurological disorders as dementia caused by Alzheimer's disease (AD) as well as epilepsy, Parkinson's disease (PD), and acute ischemic stroke, with large numbers of people going untreated. The impact on the poor includes loss of gainful employment, further loss of family income if a family member becomes the caregiver, inability to pay for medications, and, in some instances, stigmatization and discrimination, which further limit access to treatment.

The immediate challenge for developing countries is to identify culturally appropriate interventions that can be delivered with existing resources, which entails supporting families in their role as caregivers. This is especially critical in the case of AD and other dementias, because care giving can result in social isolation, psychological stress, and high rates of depression. Narrowing the treatment gap also is essential. For example, in developing countries a staggering 90 percent of people with epilepsy are inadequately treated.

Cost–effective remedies include giving dementia patients with behavioral problems low doses of antipsychotic medication, thereby alleviating caregiver stress; using Phenobarbital to manage epilepsy; applying indigenous systems of medicine, such as the ayurvedic medicines used in India, to manage patients with PD; and giving aspirin both to treat acute stroke and prevent recurrences.

Some of these remedies have existed for decades, but have been largely ignored in the developing world. All of these interventions are inexpensive and effective, with the added benefit that they can be applied on a large scale through primary care.