Advancing Neurological Care Worldwide
The Global Research Neurology Group, led by Farrah Mateen, MD, PhD, is dedicated to finding practical solutions for improving the level of neurological care and treatment in low- and middle-income countries.
Neurological disorders such as epilepsy, stroke, dementia and traumatic brain injuries are more common in low- and middle income countries, where 86% of the world’s population is concentrated.
These neurological disorders can be disabling both physically and mentally, and there is a high human and economic cost associated with them. Many of these diseases come with a stigma attached since they are often misunderstood.
Compounding this problem is that many of these diseases are not well diagnosed or treated due to a lack of trained neurologists and limited access to medical care in these settings.
When last studied, there were 12 African countries with no neurologists, and an additional 23 countries with a ratio of one neurologist to more than five million people in the population.
The Global Neurology Research Group at Mass General works on projects designed to improve the diagnosis, care and treatment of neurological diseases in these resource-limited settings:
Help Us Improve Global Neurological Care
Your donation will provide care for people with neurological disorders such as epilepsy, stroke and paralysis in resource-limited settings in Africa and Asia. Donations will go towards EEG readings to diagnose seizures ($30 dollars for one EEG reading) and medications for stroke ($5 per person per month). Donations will also fund research to help people with brain disorders in refugee and post-conflict zones. Please consider a donation today.
Discover resources for the care and treatment of people with neurological disorders in resource-limited settings.
Farrah Mateen, MD, PhD
Approximately 80-90% of people with epilepsy are from low- and middle-income countries due to the higher risk rates for perinatal birth injuries, traumatic brain injury, stroke, and intracranial infections such as cerebral malaria and neurocysticerosis, a parasitic infection of the nervous system and a main cause of acquired epilepsy in developing countries.
Most forms of epilepsy are highly treatable with inexpensive medications such as phenobarbital, phenytoin, cabamazepine or valproate. More than 60% of people with epilepsy can be successfully treated with a regimen of one drug, while another 15-20% can be treated with a two-drug regimen.
Mass General EEG technician Joseph Cohen uses red ink to mark the head of a child prior to conducting an EEG scan during a recent trip to Bhutan.
Left untreated, individuals with epilepsy in resource-poor settings may have multiple negative medical, social and economic consequences including premature mortality, high rates of unintentional injury such as burns and drowning, societal prohibitions against working, marrying or driving, and other limitations to independence.
There are multiple challenges to diagnosing and treating epilepsy in resource-poor settings:
EEG is a dynamic and non-invasive technique that assesses brain function. It is the diagnostic test of choice in epilepsy, allowing for the classification of seizures and directing the choice of antiepileptic drug treatment.
The Global Neurology Research Group is exploring the use of a portable, real-time EEG device that can be incorporated into the routine initial diagnosis of patients with epilepsy and help to direct their care.
A portable EEG device would overcome many of the barriers to epilepsy by allowing health care workers to travel to potential patients for testing, reducing the need for patients to make a costly trip for care. The device would also be able to transmit real-time EEG data via smartphone, which would enable the readings to be diagnosed by a qualified neurologist from anywhere in the world.
Farah Mateen, MD, PhD, is currently leading a research team that is studying more than 200 people with epilepsy in Bhutan, a resource-poor, landlocked country between China and India.
The team, which includes several specialists from Mass General, will make a statistical analysis of EEG readings that were made using a traditional machine versus those using the smartphone-based device to ensure that the readings on the portable device are accurate for diagnosis.
The study is also designed to determine if the device is user-friendly for children, and if it is a practical tool for health care workers to use in a low-income setting.
Stroke is a leading cause of death and disability globally, and accounts for more deaths than HIV/AIDS, malaria and tuberculosis combined. The incidence of stroke is much higher in resource-limited countries, where 85% of strokes occur.
Adding to this problem is that the damage suffered by stroke patients in these countries is often more severe, as many are not aware of the warning signs of stroke and do not have access to immediate emergency medical care.
The Global Neurology Research Group is working to extend a global FLAME (Fluoxetine for Motor Recovery of Patients with Acute Ischemic Stroke) study in Zimbabwe.
This is an extension of a study that is investigating whether Fluoxetine, a selective serotonin reuptake inhibitor, will enhance motor recovery if given soon after stroke to ischemic stroke patients who are experiencing motor deficits.
One recent Phase III clinical study in France showed improved motor recovery among 118 ischemic stroke patients who were given Fluoxetine, which is thought to have a neuroprotective effect by reducing inflammation within the central nervous system and promoting neuroplasticity.
The Global Neurology Research Group’s study will seek to determine if a clinically meaningful difference exists in motor recovery post-stroke in acute ischemic stroke patients taking Fluoxetine vs. placebo in a resource-limited African setting, where factors such as patient age, preexisting medical conditions and access to medical care differ from those in developed countries.
Neurological Disorders in Refugee Populations
The Global Neurology Research Group is also studying refugee populations to determine the prevalence of neurological disorders among these displaced groups, and to find ways to improve the quality of neurological diagnosis and care in refugee settings.
In recent years, Dr. Mateen has visited Lebanon, Jordan and Syria to study the health needs of refugees resulting from the armed conflicts in the Middle East.
The needs of these refugees are different than those typically found in refugees from tropical settings, where the biggest needs are vaccines and clean drinking water.
Studying refugees from the Iraq War in Jordan in 2011, Dr. Mateen discovered a surprisingly high number of neurological disorders among patients who sought health care via United Nations health agencies.
Refugees with neurological disorders can find their symptoms worsening in times of stress, and some neurological conditions—such as traumatic brain disorders—are a direct result of armed conflict.
Approximately one in six refugees from Iraq who sought medical assistance was diagnosed with a neurological disorder, according to data from the United Nations Refugee Assistance Information System (RAIS).
The most frequent neurological disorders experienced by refugees were:
Dr. Mateen is working to develop cost-effective solutions that will enable better neurological interventions in refugee settings, such as providing aid workers with kits that contain essential neurological medications to treat patients in the event of a humanitarian crisis or natural disaster.
Mateen FJ, Carone M, Haskew C, Spiegel P.Reportable neurologic diseases in refugee camps in 19 countries. Neurology 2012;79:937-40.
Mateen FJ, Niu J, Gao S, Li S, Carone M, Wijdicks EF, Xu WH. Persistent vegetative state: a comparative study at a Chinese and U.S. referral hospital. Neurocrit Care 2013;18:266-70.
Mateen FJ, Bahl S, Khera A, Sutter RW. Diphtheritic polyneuropathy as detected by acute flaccid paralysis surveillance, India. Emerging Infect Dis 2013;19:1368-73.
Berkowitz AL, Mittal M, McLane HC, Shen GC, Muralidharan R, Lyons JL, Shinohara RT, Shuaib A, Mateen FJ. Worldwide reported use of IV-tissue plasminogen activator for acute ischemic stroke. Int J Stroke 2014;9:349-55.
Mateen FJ, Post WS, Sacktor N, Abraham AG, Becker JT, Smith BR, Detels R, Martin E, Phair JP, Shinohara RT; for the Multi-Center AIDS Cohort Study (MACS) Investigators. Long-term predictive value of the Framingham risk score for stroke in HIV-infected vs. HIV-uninfected men. Neurology 2013;81:2094-102.
Schwamm LH. Telehealth: seven strategies to successfully implement disruptive technology and transform health care. Health Aff (Millwood). 2014;33:200-6.
Lyons JL, Coleman M, Engstrom JW, Mateen FJ. International electives in neurology training: a survey of U.S. and Canadian program directors. Neurology 2014;82:119-25.
Bucheli ME, Calderón A, Chicaiza D, Franco C, López R, Digga E, Atassi N, Salameh J, Berry JD. Feedback interaction of research, advocacy, and clinical care applied to ALS research in South America. Neurology 2013;81:1959-61.
Mateen FJ, Martins N. A health systems constraints analysis for neurological diseases: the example of Timor-Leste. Neurology 2014. In press
Fugate JE, Lyons JL, Thakur KT, Smith BR, Hedley-Whyte ET, Mateen FJ. Infectious causes of stroke. Lancet Infect Dis 2014;Epub May 30, 2014
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