In an interaction with Dr Pankaj Agarwal, Head of the Parkinson’s and Movement Disorders Clinic and DBS Program at Global Hospital, Mumbai, talks about the rising incidence of neurological disorders in India and how awareness on early detection and management is critical for treating neurological conditions.
Q: Over the years, how has been the incidence of neurological diseases in India?
Dr Pankaj Agarwal: Over a period of time, burden of neurological conditions has increased in the country. A very detailed, first-of-its-kind study that has been published in The Lancet Global Health, reported the rate of non-communicable neurological disorders and neurological injuries in India has more than doubled — from 4 percent to 8.2 percent during the past 2 decades.
This comprehensive study collected data and studied neurological trends from every state in the country from 1990 to 2019. It is reported in the study that stroke, cerebral palsy, epilepsy, headache disorders, alzheimer’s disease, and other dementias, brain and central nervous system cancer, parkinson’s disease, multiple sclerosis, motor neuron diseases, and other neurological disorders account for 82.8 percent of all neurological disorders. Communicable encephalitis, meningitis, and tetanus accounted for 11.2 percent, with the remaining 6 percent comprising of injury-related diseases.
This massive two-fold increase in the burden of neurological disorders can be attributed to the lack of awareness amongst the Indian population about neurological disorders, which leads to delayed detection, paired with a lack of access to quality healthcare and rehabilitation centers. Key important factors like diet, lifestyle, and genetic make-up can make us prone to diseases such as diabetes and high cholesterol which could be responsible for the rise in common neurological conditions such as dementia and stroke.
Q: Has the SARS COV 2 virus impacted the incidence of neurological manifestations?
Dr Pankaj Agarwal: The present outbreak of severe acute respiratory syndrome coronavirus 2 showcases that it is not restricted to the respiratory system or other organs like heart, kidney and lungs. The influenza virus also present neurological manifestations like brain swelling or encephalitis, stroke, epilepsy as well as peripheral nerve involvement such as guillain-barre syndrome.
Meanwhile, new manifestations are being discovered every other day. Whether COVID-19 could have long-term neurological consequences is unknown, the presence of olfactory involvement in the initial stages is also a familiar early feature of parkinson’s disease. However, establishing any link between covid to future parkinson’s disease is currently being debated. Only long-term research will be able to answer this question with definitive backing.
One more important aspect for patients suffering from chronic neurological problems such as parkinson’s disease is that they may face deteriorating conditions for their neurological disease due to the stress of the COVID-19 infection. Patients with other conditions such as multiple sclerosis and other immune-mediated disorders, especially those on immune suppressions for myasthenia, can be at higher risk of COVID infection because of the ongoing immunosuppression.
Q: What is the level of preparedness to tackle the increasing burden? How do you find the Indian healthcare system’s approach towards the management of neurological diseases?
Dr Pankaj Agarwal: The government has already undertaken a variety of measures including public health schemes to improve healthcare in general, neurological healthcare will also benefit as an effect of these measures. Treatment coverage of epilepsy in governmental schemes such as Ayushman Bharat and Rashtriya Bal Swasthya Karyakram can be enhanced. Promoting practices and behavioural and lifestyle modification focusing on preventing stroke for instance, and avoiding head injury, and safe birthing practices would help in reducing a large proportion of epilepsy burden. Prevention and early management are key.
Q: Which are the diseases where treatment modalities have really improved over the years? Which neurological disorders need more focus?
Dr Pankaj Agarwal: While the prevalence of epilepsy has increased over the past three decades in India, it is gratifying to note that over this period we have also made some gains in reducing premature deaths and morbidity of people with epilepsy by reducing treatment gaps according to this Lancet study. Further efforts on a public scale are needed to reduce the burden of stroke, head injuries, and headache disorders.
Q: What are the preventive measures that can help in early detection and better management of neurological diseases?
Dr Pankaj Agarwal: Awareness about neurological conditions, scope of their treatment is the most important step to aid people suffering from neurological diseases. It helps in achieving early detection and management, which is critical for treating neurological conditions. People suffering from neurological conditions must also be provided with the option of access to inexpensive universal health aid along with increased availability of rehabilitative treatments.
Awareness of dietary and lifestyle variables that increase the risk of stroke and dementia in India will help improve the quality of life for many. Simple lifestyle changes such as consuming a healthy diet, not smoking, controlling blood pressure, preventing diabetes, managing weight through exercise and walking, avoiding unhealthy refined foods, staying physically active, and paying attention to one’s own mental health regularly will go a long way to aid one’s neurological health.