Farrah Mateen, MD, PhD, divides her time between seeing patients at Massachusetts General Hospital and traveling across the globe researching innovative solutions for global neurological care.

In addition to seeing neurology patients here at Massachusetts General Hospital, Farrah J. Mateen, MD, PhD, is committed to finding innovative solutions to neurological health challenges in resource-limited settings worldwide.

In a recent interview, Mateen explained that many of the countries that she works with lack practicing neurologists and do not have the resources to provide a Western standard of medical care. In order to help patients with neurological disorders, innovative solutions must be found that blend affordability and accessibility. Mobile technology and out-of-the-box thinking play key roles in her work.

In the small Himalayan country of Bhutan, for example, Mateen has been testing a smartphone-based EEG cap that can be used to provide a remote diagnosis of epilepsy. This study, called The Bhutan Epilepsy Project, may revolutionize neurological care in one of the last countries in the world with a 90% rural population. It could also help to de-stigmatize a widely misunderstood disorder.

In Africa, Mateen has launched two more creatively designed research projects that seek to improve care for patients with neurological issues.

HIV and Stroke in Tanzania

Mateen’s first project consists of obtaining preliminary data for a clinical trial investigating the potential of fluoxetine, more commonly known as Prozac, as a drug for stroke recovery in patients living with HIV in Tanzania.

Funded by the Harvard Center for AIDS Research (CFAR), the study is being conducted at the Muhimbili National Hospital.

“HIV is a large-scale pandemic problem. What has become especially important nowadays is people surviving with HIV.” Mateen explained. "Now the recognition is on co-morbidity, or chronic diseases that can be accelerated or have early onset in people living with HIV."

People with HIV tend to have strokes more often and earlier in life due to the impact of the disease on the immune system, the side effects of HIV antivirals, and common co-infections, according to Mateen. The Muhimbili National Hospital generally sees three new stroke patients per day, and about a third of those patients also have HIV.

In the US, stroke patients are given clot busters immediately after onset of the stroke to help restore blood flow to the brain. But patients in Africa don’t have access to these expensive drugs, which contributes to an estimated 50% mortality rate.

Mateen says it can also be difficult for those living in Africa to obtain medical attention in a timely manner, since many patients live in areas without adequate resources for treatment. When patients finally do access treatment (sometimes days after their stroke), stroke, doctors don’t have many options left to assist with repairing brain function.

“You can do some bits of preventative treatment so they don’t get a clot in their legs from lying down, but there’s not a lot you can offer them for the pathophysiology of stroke,” she said. “So we’ve been trying to figure out...what are other repairing drugs?”

The answer may be fluoxetine, more commonly known by the brand name Prozac. Mateen says there is evidence the antidepressant can act as a repairing drug for stroke by stimulating neuroplasticity, or the ability of the brain to create new neural pathways. However, the drug has not been universally accepted as a treatment for stroke.

“Many doctors here in the United States will give fluoxetine right after stroke, but not everyone,” she said. “Two people who are both knowledgeable and have read the same papers will come to different conclusions [regarding its effectiveness]. So there’s still a need to know on this side of the earth, but even more so in a resource-limited setting, where no such research has been done.”

To determine whether fluoxetine can be the solution for HIV-positive stroke patients in Africa, Mateen aims to first recruit 200 adults with stroke into a baseline study with 90-day follow-ups to observe motor recovery. Comparing the progress of HIV-positive and HIV-negative patients, she’ll also gather data on how common post-stroke depression and mortality is before introducing fluoxetine in the following round.

Mateen also notes the possibility of creating a pediatric clinical trial, since many more children have strokes in Africa than they do in the US. “There’s a lot of opportunity to do some of this work really well, and we’re just trying to set some of it up,” she said.

However, no clinical trial is without difficulties. Because it is unknown if the brain will benefit from fluoxetine if the treatment is started more than a month after the stroke, Mateen needs to be able to get treatment to patients in a timely manner.

Neurocognitive Assessment in African and Asian Schoolchildren

Dr. Mateen’s second project aims to assess the cognitive development of children in Africa and Asia by using optical coherence tomography (OCT). OCT is a well tolerated imaging technique that creates 3D images by measuring how light scatters when it makes contact with tissue.

In this project, the OCT scan will focus on the retina and eye curve—parts of the eye that have an embryological link to the brain—in order to glean information about the brain itself.

Neurocognitive assessments in the U.S. typically rely on magnetic resonance imaging (MRI) scans and assessment tools such as tricycles and playing cards to test cognitive skills, but Mateen says many of these tests don’t translate to children in Africa.

“One of the other things that’s really missing from global health and neurology is that we don’t really have a good way to look at neurodevelopment in kids,” she said. “American tests are helpful for our population, but what do you do for populations that don’t speak English and don’t have access to the same toys?”

Using OCT scanning combined with common growth metrics and cognitive scoring, Mateen hopes to see if it is possible to establish a uniform standard of cognitive status throughout Africa and Asia. She’ll also take in factors like the HIV status of the parents and preterm birth to see whether they worsen the cognitive ability of affected children in Africa.

The OCT scan itself is painless and easy to operate, and Mateen hopes doctors will be able to use this quick procedure to accurately determine which children need MRI scans and early intervention to improve. “You can’t afford to do this for everyone, but how do you separate out who needs better care?”

Mateen’s exploratory work is supported by the Bill & Melinda Gates Foundation, and the bulky $30,000 OCT scanner machine is on loan from Optovue Inc. in California. Smaller handheld OCT machines do exist, but Mateen says the data quality is better with this larger version.

Through her ongoing work in developing countries, Mateen hopes to find practical solutions to serious public health issues that can be easily implemented given resource limitations and cultural sensitivities. “I think the trick is not just to have the answer, but to make the answer user-friendly.”