Every year, globally, this disease is gaining more and more ground in the area of serious diseases, the cause of this alarming expansion being determined by a multitude of risk factors. At the same time, in-depth medical scientific research from this vast pathology is trying to develop innovative therapies to reduce the number of these diseases, deaths and, at the same time, a substantial improvement in the quality of life of patients.
Neurological disorders, mainly Stroke (CVD) and Cranio-Cerebral Traumas (CBT), have over the last decade worsened worrying barometric developments among the world's population, causing scientists to amplify the development of the concept of prevention, of rapid diagnosis, treatment innovative and, in particular, that of neurorecovery.
Under these grim auspices, researchers dedicated to the medical scientific world meet regularly to discuss current issues, but also the latest findings, along with professors and physicians in the fields of neurology, neurosurgery and neuroscience. In this regard, a large event took place on November 7-9, 2019, at Baku, Azerbaijan and convened the 15th edition of the Congress of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN) and that 12th edition of the Asian Conference on Neuroplasticity.
300 participants from 17 countries
The meeting of the two major events in the field of neurology was attended by 300 personalities from the world neurological medical world in 17 countries (USA, Russia, Germany, Israel, Poland, Sweden, Austria, Italy, Ukraine, Uzbekistan, Thailand, Republic of Moldova, South Korea, Vietnam, Argentina, Kazakhstan and Romania). In organizing this large event by Society for the Study of Neuroprotection and Neuroplasticity and the Academy for Multidisciplinary Neurotraumatology they joined The Neurology Society of Romania, the “Iuliu Haţieganu” University of Medicine and Pharmacy of Cluj Napoca, the Academy of Medical Sciences of Romania and the RoNeuro Research Institute of Cluj Napoca, as well as an international consortium of universities, under the aegis European Federation of Non-Rehabilitation Societies (EFNR) and World Federation of Non-Rehabilitation (WFNR).
"It is remarkable and encouraging that Romanian neurology, by its values, continues to be present and appreciated in such top debates that it participates annually, personalities of medical scientific research, neurological teachers and neurosurgeons from all over the world, which proves once again. that all the neurological scientific research in Romania and its applicability in medical practice are superimposed on those from countries with a strong degree of socio-economic development" he pointed out Prof. Dafin Mureşanu, president of SSNN and of the European Federation of Non-Rehabilitation Societies (EFNRS).
55 million CBT and over 27 million TVM
Traumatic brain injury or craniocerebral trauma (CBT) continues to be a leading cause of death and morbidity worldwide, being a major management problem for clinicians and a considerable source of frustration for patients. The mortality rate caused by CBT in the population under 35 is 3.5 times higher than that caused by cancer and heart disease together. CBT treatment is one of the most cost-effective medical interventions. The economic and social burden of CBT has implications on a global scale. In recent years CBT has been recognized as a serious public health problem, in emergency situations, the doctor's mission being extremely difficult.
Due to the limited resources, often in an emergency, patients with CBT needing more aggressive drug treatments and which patients can be safely sent home should be identified. CBT often leads to persistent disability, especially due to cognitive deficiencies. Most survivors are young and have an almost normal life expectancy.
Cognitive areas of memory, executive function and processing speed are frequently affected. In 2016, worldwide there were over 27 million new cases of CBT and nearly one million new cases of spinal cord trauma (spinal cord injury, TVM), the incidence being 369 new cases of CBT per 100,000 of residents and 13 new cases of TVM per 100,000 inhabitants. If we think about all the cases, which represent the sum of the new and the old, the data are impressive. According to the latest report published in 2019, the number registered is 55 million CBT and over 27 million TVM.
In Romania, 434,000 new and old cases
Road crashes and accidents were the main causes of trauma in most regions. In minors (0-18 years), about 50% of the cases with CBT present in emergency, have the main cause of the falls, this percentage reaching over 75% in the case of patients over 65 years. In older patients, falls are part of the clinical picture of many neurological diseases, such as stroke, Parkinson's disease, dementia or polyneuropathy. In about 20% of minors who come to UPU with trauma, the cause is to hit with or with an object. rough.
Increasing the incidence of CBT could continue over time, given the increase in population density in certain areas, the aging of the population and the increasing use of motor vehicles, motorcycles, bicycles and scooters. In the US, an average of 155 people die daily due to an trauma that also includes brain damage. The number of patients surviving a spinal cord trauma is expected to increase, which in some areas can become a huge economic burden, given the special care needs of these people, most of them in the chair with wheels. In Romania, the data are absolutely worrying. The latest report shows about 170,000 new cases and over 434,000 new and old cases, our country thus occupying the second place in Central Europe after Poland.
Effective recovery, only in multidisciplinary teams
The financial cost of the medical care needed for patients with CBT remains very high. The economic burden is even greater when victims of CBT develop one or more neurological complications, such as chronic headache, epilepsy or dementia. In addition to neurological complications, psychological, cognitive, behavioral and social complications can also occur. Most cranio-cerebral traumas are minor and do not require emergency medical intervention. But there are some warning signs that should not be overlooked by patients or their families, such as massive bleeding at the level of the hit area or at the level of the nose, mouth or ears, loss of consciousness, severe headache associated with dizziness , drowsiness or nausea with vomiting, paralysis, coordination, speech or vision problems. In the first hours or days after the trauma occurs, new symptoms / signs, unforeseen complications may occur, and the patient's condition may suddenly worsen, evolving in some cases until sudden death.
“For some patients, head trauma is the beginning of a lifelong disease. Many of those who have suffered trauma have sequelae, even those with mild head trauma. Cognitive (attention, memory, language, perception) affective and behavioral disorders are the most frequent and important ones that these patients face, having a special impact on the family as well as society. These deficits determine a social dependency of the patients, even in the absence of physical disabilities, affecting work capacity, family relationships, daily activities ” Prof. Dr. Dafin Mureșanu.
The most common short-term complications associated with CBT include cognitive dysfunction, difficulties in sensory processing and communication, immediate seizures, hydrocephalus, cerebrospinal fluid (CSF) loss, damage to nervous system structures, tinnitus, organ failure, and polytrauma. Polytrauma may include pulmonary, cardiovascular, gastrointestinal dysfunction, hydro-electrolytic and hormonal imbalances, deep vein thrombosis, excessive coagulation and nerve damage.
At the same time, Prof. Dr. Dafin Mureșanu "The most common psychiatric complications are depression, generalized anxiety, panic attacks, phobic disorders, post-traumatic stress disorder, dependence on various substances. Headache is a common complication of traumatic brain injury, especially of mild ones. . These headaches may have the characteristics of migraine, tension or other disorders of primary headache, but they are often mixed, unsystematic and can be difficult to manage. Headaches can occur very often, if not daily, and often the headache slows down after a trauma. "
He added that "adequate management in the efficient treatment of these cases implies the existence of multidisciplinary teams consisting of emergency medicine doctor, neurologist, neurosurgeon, psychologist and psychologist to fully evaluate the patients and to ensure an individualized treatment of neuropsychological recovery. ".
Costs and $ 4 million
Experts estimate that worldwide, $ 5-7 of 1,000 is spent on care for patients with CBT or because of the consequences of such injuries. Although impressive, these figures underestimate the magnitude of the problem, based only on the data provided by the hospitalized cases. About 80-90% of head and neck injuries are considered mild and do not require medical care. In the US, for a patient with head trauma, who needs recovery, the costs are about $ 200,000 in the first year. For patients with minor or medium injuries that do not require recovery, the expenses amount to about $ 15,000. The costs incurred for the care of a patient with severe head injury for the rest of his life can reach up to $ 4 million. In Europe, the annual direct costs for a patient with severe brain trauma are over 18,000 euros. On average, for a patient with brain trauma, about 9,000 euros are spent. In our country the average cost for a patient with a head injury is about 3,500 euros. In Romania, the number of cases of head injury is increasing alarmingly, the main cause being road accidents, 75% of the people who died in such cases suffered a head injury. Annually, in our country, there are approximately 170,000 new cases and over 434,000 new and old cases of Cranio Cerebrale Trauma.