Enumerating neurology

DN Robertson - Brain, 2000 - academic.oup.com
DN Robertson
Brain, 2000academic.oup.com
The last decade has seen huge advances in technology and Undoubtedly there is some
selection bias, including in the understanding of pathological mechanisms in human
ethnicity and age structure as well as the questionable effect disease. After this period of
rapid change, it is appropriate of performing a study such as this in the vicinity of a major for
investigators to pause to survey the burden of neuro- neuroscience centre by a group with
an established interest logical disease that surrounds them, and to ask questions in …
The last decade has seen huge advances in technology and Undoubtedly there is some selection bias, including in the understanding of pathological mechanisms in human ethnicity and age structure as well as the questionable effect disease. After this period of rapid change, it is appropriate of performing a study such as this in the vicinity of a major for investigators to pause to survey the burden of neuro- neuroscience centre by a group with an established interest logical disease that surrounds them, and to ask questions in epilepsy. However, these are unlikely to have had any concerning the practical application of these new techno- great impact on the overall figures, and this is confirmed by logies and their relevance within the broader spectrum of the representative nature of figures compared with previous neurological disease. work addressing the frequency of single diseases. Practical Previous attempts to enumerate neurological disease were limitations resulted in some notable exclusions, including made during the 1980s (Marsden, 1981), when concerns dementia, migraine and tension headache, leading to arose regarding the role of neurologists given the limitations difficulties in comparing these results with other studies. of clinical resources. Recognizing the considerable logistics However, this study strikingly underlines the huge burden of of community-based epidemiology, most investigators have neurological disease within our society: 625 per 100 000 chosen to examine a pre-selected population or to summarize population per year consult their family doctor regarding a information culled from multiple single-disease studies neurological disorder, rates between the sexes being similar.(Kurtzke, 1982). These have resulted in a number of reports Six per cent of the population have had a neurological concerning neurological practice within a district general disorder during their lifetime. By nature of the way the data hospital or regional neurology clinic. By contrast, few were collected, these figures are likely to underestimate the attempts have been made to record accurately disease burden true figure, particularly since they exclude a number of within a large unselected community-based population. Since conditions for which neurological advice is commonly sought. that time there have been substantial changes in what is The hierarchy of disease incidence and prevalence is perceived as the clinical responsibility of neurologists. also illuminating. Cerebrovascular disease is predictably The United Kingdom provides a favourable environment at the head of the list, followed, in order of frequency, for epidemiological studies, largely because of the structure by diabetic polyneuropathy, compressive neuropathies, and delivery of health care and the compact nature of epilepsy, Parkinson’s disease and other neuropathies. This the population. These provide a number of advantages for compares with headache, epilepsy, multiple sclerosis and investigators who have previously provided definitive non-organic disease in hospital-based neurological clinics information on a number of neurological diseases (Sander,(Wiles, 1996). Although the discrepancy between community 1990; The Scottish Motor Neuron Disease Research Group, and specialist neurology clinic may be related to a number of 1992; Robertson, 1995). However, the diverse burden of factors, includinglocalreferralpractices, clinicalaccessibility neurological disease has rarely been addressed. In this issue and length of waiting lists, this is likely to change as the MacDonald and colleagues, building on previous work, have impact of new treatments becomes apparent and the …
Oxford University Press