Neuroepidemiology最新文献

Background: Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyneuropathy that presents significant diagnostic and therapeutic challenges, particularly in low-resource settings. While GBS has been extensively studied in high-income countries, data from conflict-affected and resource-limited regions such as Syria remain scarce. Understanding regional disease patterns and atypical clinical variants is essential for timely diagnosis and management.

Methods: This prospective study was conducted at the National and Al-Mowasat University Hospitals in Damascus between September 2023 and February 2025. Patients who met the Brighton and NINDS criteria for GBS were enrolled in the study. Demographic, clinical, and electrophysiological data were collected and analysed, with subgroup comparisons between typical and atypical presentations.

Results: Forty-seven patients were included, of whom 54.4% were male. Classical ascending paralysis occurred in 83% of patients, with 55.3% classified as typical GBS and 44.7% as atypical GBS. Notable atypical features included acute anuria, isolated upper or lower limb weakness, Miller Fisher syndrome, and bilateral facial palsy or weakness with paraesthesia. AIDP was the most common subtype (59.6%), followed by AMSAN (17.0%) and AMAN (6.4%). Albuminocytologic dissociation was observed in 70.2% of cases. Atypical cases more frequently lacked a preceding infection, exhibited asymmetric or cranial nerve involvement, and showed a varied time to nadir.

Conclusions: This is the first prospective cohort study of GBS in Syria and highlights the diverse clinical spectrum of the disease in a resource-limited context. Atypical forms constitute nearly half of all cases and present distinct diagnostic challenges. These findings emphasise the need for heightened clinical awareness and tailored diagnostic approaches in such settings.

Introduction: Beyond its medical manifestations, people living with epilepsy face barriers to healthcare access and high levels of stigma. Educational interventions have been shown to improve knowledge and reduce stigma, particularly when adapted to diverse social and cultural contexts. This study aimed to evaluate the effects of an educational comic book on knowledge, attitudes, and practices (KAP) regarding epilepsy among adolescents in Quito, Ecuador.

Methods: A quasi-experimental study was conducted among students from urban and rural schools in Quito. Data were collected using a structured KAP questionnaire administered before and after the intervention. Changes in global and subscale KAP scores were analyzed, and logistic regression was used to identify factors associated with greater improvement of the score.

Results: A total of 344 students participated (mean age: 13.8 years; 52.9% male). The median global KAP score increased significantly from 11.5 (IQR: 8.8-13.7) before, to 15.1 (IQR: 13.2-16.4) after the intervention (p < 0.001). A very large majority of students showed significant improvement of the score regardless of baseline level, with the greatest gains observed among those with initially lower scores. Students who had previously witnessed an epileptic seizure were less likely to achieve a high improvement on the score (OR = 0.40; 95% CI: 0.24-0.68; p < 0.001).

Conclusion: The educational comic book improved adolescents' knowledge, attitudes, and practices related to epilepsy in both urban and rural schools in Quito. Comic books were therefore very effective, regardless of socio-demographic characteristics, highlighting the value of culturally adapted narrative tools in strengthening epilepsy education to help reduce stigma.

Introduction: The inclusion of Spinal Cord Injury (SCI) in the Global Burden of Diseases (GBD) study in 2016 as a distinct entity represented a significant milestone in recognizing and quantifying its global health impact. The study's purpose was to quantify the discrepancies between SCI incidence rates estimated by the GBD and those reported in published literature to assess the external validity of GBD outputs at the country level and propose methodological refinements to improve their utility for policymakers, clinicians, and global health stakeholders.

Methods: We compared GBD 2016, 2019, and 2021 country-level SCI incidence estimates with data from 10 systematic reviews and a scoping search in Embase. Studies were eligible for inclusion if they explicitly reported both case counts and incidence rates of SCI at the country level. Two authors checked the data for accuracy and reliability purposes. We categorized studies into two periods-pre-2000 and 2000 to 2024-to align with key GBD benchmark years: 1990 for pre-2000 data, and 2016, 2019, and 2021 for post-2000 data. A meta-analysis calculated SCI incidence rates for each country across two timeframes (pre-2000 and 2000-2024). We then computed a discrepancy ratio (DR) by dividing GBD estimates by literature-based rates, categorizing discrepancies as low (DR < 2), moderate (2 to < 5), substantial (5 to < 10), or significant (DR > 10). Further analysis explored countries with national registries, the impact of pre-hospital mortality, and GBD's SCI definition and reporting methodology.

Results: In our analysis of 30 countries, we identified a high proportion of significant (50%) and substantial (23.4%) discrepancies relative to GBD 2016 estimates. When compared against GBD 2021 data, significant discrepancies decreased to 6.6%, though substantial discrepancies rose to 50%; indicating an overall improvement but persistent overestimation. Japan, South Africa, Taiwan, and Tanzania showed low discrepancies, while Denmark, France, Italy, and Spain continued to have significant discrepancies in GBD 2021. We identified three key areas for GBD improvement: unclear inclusion of non-traumatic SCI, lack of incidence stratification by severity, and omission of sports-related SCI as a distinct etiology.

Conclusion: Early GBD SCI estimates were often overestimates, but continuous methodological refinements are leading to better alignment with real-world data. Future GBD reports should further enhance interpretability by integrating injury severity data and a more granular breakdown of SCI aetiologies.  .

Background: Alzheimer's disease and other dementias (ADOD) represent a growing global health challenge. This study aims to propose a comprehensive measure called the quality of care index (QCI) to assess disparities in quality of care (QC) for ADOD patients across global, regional, and national levels. We also evaluate temporal trends in QCI and explore associations with socioeconomic development, gender, and age.

Methods: Individuals aged 55 years and older with ADOD were included in this longitudinal study using data from the global burden of disease (GBD) database spanning 1990-2021. The QCI score was calculated using four indicators. Principal component analysis was employed to compute the QCI. The QCI was rescaled to a single index ranging from 0 to 100, where higher scores indicate better QC.

Results: The global QCI increased from 32.9 in 1990 to 50.2 in 2021, with a greater increase among females (68.8%) than males (52.4%). Significant gains were observed in regions with middle and high-middle sociodemographic index), while slight declines occurred in high- and low-middle SDI regions, and slow progress was seen in low SDI regions. The gender gap in QCI narrowed, with females outperforming males in low SDI regions. QCI scores showed a marked increase with age, reflecting lower QC access in younger age groups and a sharp rise in older age groups.

Conclusion: Substantial disparities in QCI exist globally and regionally across age cohorts and between men and women. Policymakers should prioritize targeted interventions to address these gaps, improve access to high-quality care, and alleviate the global burden of ADOD.

Background: This study aims to quantify the global, regional, and national burden of ischemic stroke attributable to high sugar-sweetened beverage consumption (IS-HSSBC), analyze temporal trends, and provide evidence to support public health policy development.

Methods: Data were obtained from the Global Burden of Disease (GBD) study (2021), covering 204 countries and territories. Disability-adjusted life years (DALYs) were used as a comprehensive measure of disease burden. Decomposition analysis, cross-country inequality analysis, and predictive modeling were employed to identify sources of burden changes, evaluate disparities between countries, and forecast future trends.

Results: In 2021, the global number of DALYs due to IS-HSSBC reached 144,643.88, and deaths totaled 6,792.78, representing increases of 85% and 65% compared to 1990, respectively. High-middle SDI regions bore the highest burden but showed a slowing growth trend; in contrast, middle SDI regions experienced rapid growth. The highest number of DALYs occurred in the 70-74 age-group, while the highest age-standardized DALY rate and age-standardized mortality rate were observed in the 95+ age-group. Cross-country inequality analysis revealed a slight increase in absolute inequality and a marked reduction in relative inequality. Predictive analysis suggests that by 2045, DALYs and deaths due to IS-HSSBC will increase significantly, with higher case numbers in females than males.

Conclusion: The impact of HSSBC on IS varies significantly across regions and countries, with middle-aged men and elderly women bearing a higher disease burden.

Background: Social determinants of health (SDoH) are increasingly recognized as key contributors to stroke prevalence, yet few studies have examined their cumulative impact. This study aimed to evaluate the associations between multiple SDoH and stroke prevalence, and identify the primary drivers of cumulative social disadvantage.

Methods: We analyzed data from 26703 participants in the 2005-2018 NHANES cycles. Stroke history was self-reported. Eight SDoH indicators-including income, education, employment, food security, housing stability, marital status, healthcare access, and insurance coverage-were assessed. Associations with stroke were examined using survey-weighted logistic regression. A weighted quantile sum (WQS) index was constructed from six of these indicators (excluding marital status and healthcare access) to evaluate the cumulative effect of SDoH and to determine the relative contribution of each factor.

Results: Of the study population, 992 (2.6%) reported a history of stroke. Low income, unemployment, food insecurity, and rental housing were significantly associated with stroke prevalence. WQS analysis demonstrated a strong cumulative association between adverse SDoH and stroke (OR = 4.20, 95% CI: 3.24-5.44, P < 0.001), with food insecurity (weight = 0.33), family poverty income ratio (0.33), and housing status (0.20) contributing the most. Subgroup and sensitivity analyses confirmed the robustness of these associations across age, sex, and racial/ethnic groups.

Conclusion: Cumulative social disadvantage, particularly food insecurity, low family poverty income ratio, and disadvantaged housing status, is strongly associated with stroke prevalence. Interventions addressing these key social determinants may help reduce stroke burden and underscore the importance of considering multiple SDoH in preventive strategies.

Background: Parkinson's disease (PD) and type 2 diabetes mellitus (T2DM) are common chronic conditions that may share biological mechanisms such as inflammation and insulin resistance. While T2DM is associated with increased PD risk, evidence for T2DM risk in newly diagnosed PD patients remains limited.

Objective: This study was designed to estimate the risk of T2DM among incident PD patients and assess the effect of T2DM on PD patient mortality.

Methods: A population-based retrospective cohort study was conducted in 7,976 incident PD patients without prior T2DM according to a validated registry in Maccabi Health Services medical data (2000-2019). Cox regression models, adjusted for age, sex, and comorbidities, were used to estimate hazard ratios (HRs) for both T2DM onset and the effect of T2DM on mortality risk among PD patients.

Results: During a mean follow-up of 7.1 years, 666 patients (8.4%) developed T2DM. Male sex was significantly associated with a reduced risk of T2DM onset (HR = 0.77; 95%CI: 0.66-0.89) compared to females. Furthermore, patients with T2DM but without complications had a significantly lower risk of mortality than those without T2DM (HR = 0.70; 95%CI: 0.62-0.78).

Conclusion: The risk of developing T2DM was relatively low in male PD patients without pre-existing diabetes. Moreover, PD patients with uncomplicated T2DM had a lower mortality risk than non-diabetic individuals. These findings highlight the importance of considering the timing of comorbidities and suggest sex-specific mechanisms linking PD and T2DM that warrant further investigation.

Objective: To evaluate the incidence, mortality, and disability-adjusted life years (DALYs) associated with idiopathic epilepsy in Asian region from 1990 to 2021, explore the influencing factors, and assess differences between countries, while also predicting prevalence and incidence trends of idiopathic epilepsy in Asian region up to 2036.

Methods: Based on the Global Burden of Disease (GBD) database, Joinpoint regression was used to analyze temporal trends. The age-period-cohort model was employed to analyze the effects of different factors. Das Gupta's decomposition method was used to evaluate the contributions of demographic and epidemiological factors. Data envelopment analysis was performed to assess the relationship between disease burden and socio-demographic index (SDI). ARIMA and Bayesian APC models were used to predict incidence rates from 2022 to 2036 based on historical trends.

Results: In 2021, the incidence of idiopathic epilepsy in Asia was 1,494,996.042 (95% UI: 1,096,849.405~1,886,986.598), with an age-standardized incidence rate (ASIR) of 34.035/100,000. Saudi Arabia had the highest ASIR (67.05/100,000), while Democratic People's Republic of Korea had the lowest (21.737/100,000). From 1990 to 2021, the global ASIR of idiopathic epilepsy showed an overall increasing trend with fluctuations. The increase in incidence was mainly driven by population growth. The incidence rate was generally higher in males than in females. With increasing SDI, the DALY rate generally decreased, but there is still room for improvement in some countries. The degree of inequality between high and low SDI regions decreased but still exists to some extent. Based on the identified historical patterns and model projections, the incidence rate is expected to continue rising through 2036.

Conclusions: The burden of idiopathic epilepsy in Asia shows an increasing trend with significant regional differences. Attention should be focused on high-risk populations, strengthening the balanced allocation of medical resources between regions, and formulating targeted prevention and control strategies.

Introduction and Aim of the work: Numerous studies have shown contradictory data regarding sex differences in pre-and in- hospital delays of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Our objective is to investigate these differences among Egyptian patients presenting with AIS. Methods: This prospective, single-center, open-label cohort study was conducted from September 2022 to December 2023. Patients with IVT-eligible acute ischemic stroke, who did not receive IVT, were included in the study. Patients were recruited from the largest tertiary stroke center in the south of Egypt. All participants underwent a full neurological assessment including NIHSS, laboratory work-up and computed tomography or magnetic resonance imaging. The patients were subjected to a structured questionnaire designed to determine the parameters and time metrics associated with pre-hospital and in-hospital delays. Results: A total of 897 patients, 41.8% of whom were females, were included in our study. General demographic characteristics were similar between both groups. 70.9 % of female and 65.1 % of male patients arrived at stroke ready hospital outside the therapeutic time window. Female patients experienced a significantly longer duration from symptom onset to hospital arrival (600 ± 618 minutes) compared to male patients (480 ± 438 minutes). Stroke misdiagnosis was non-significantly higher among the female group (58.9%). The time spent in the hospital did not significantly differ between males and female Conclusion: The study results indicate a significant disparity in the management of female stroke patients in both prehospital and in-hospital settings, with the most pronounced delays occurring during prehospital care.

Background: Neurological disorders affect approximately 3.4 billion people worldwide and are the leading cause of disability. We conducted this study to explore global neurorehabilitation requirements and project trends from 2022 to 2036.

Methods: The data on health conditions that may benefit from neurorehabilitation were sourced from the World Health Organization Rehabilitation Need Estimator. Prevalence and years lived with disability (YLDs) of neurorehabilitation needs were analyzed overall and by sex, age, region, country, and health condition. Estimated annual percentage changes (EAPCs) were calculated to quantify trends in age-standardized rates. A decomposition analysis was conducted to identify drivers of changes in neurorehabilitation needs. Projections of neurorehabilitation needs were made until 2036 using Bayesian age-period-cohort analysis (BAPC).

Results: Globally, in 2021, neurological disorders requiring rehabilitation affected 225.38 million (95% UI 215.84-235.21) individuals, contributing to 52.35 million (95% UI 37.57-67.46) YLDs. The age-standardized prevalence rate (ASPR) and YLD rate (ASYR) were 2,758.37 (95% UI 2,644.02-2,878.23) and 640.5 (95% UI 459.39-824.44) per 100,000 persons, respectively. From 1990 to 2021, neurorehabilitation needs increased significantly, with prevalent cases and YLDs rising by 97.5% and 96.4%, respectively. This trend was reflected in a significant annual increase in both ASPR and ASYR, with an EAPC of 0.17 (95% CI 0.15-0.19) and 0.13 (95% CI 0.11-0.15), respectively, and is expected to continue increasing by 2036. Furthermore, decomposition analysis identified population growth and aging as the primary drivers of this increase. Most neurorehabilitation needs occur in low- and middle-income countries (LMICs). From 2021 to 2036, the highest contributors to the global need for neurorehabilitation will remain stroke, cerebral palsy, and Alzheimer's disease and dementia.

Conclusions: Our findings reveal a large and escalating global burden of neurological disorders requiring rehabilitation, driven by demographic aging and population growth. It is essential to expand rehabilitation services and integrate them into primary healthcare systems, particularly in LMICs.