Letter: The World Health Organization's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031

Abstract

To the Editor: Neurological disorders are a leading cause of mortality and disability worldwide.1 Up to 9 million deaths each year are attributable to neurological diseases.1 Surgery plays a major role in managing neurological disorders, especially stroke, which is the single largest contributor of neurological morbidity and mortality1,2 and maybe treated with endovascular or neurosurgical modalities. Unfortunately, the burden of neurological disease is disproportionately distributed, with low- and middle-income countries (LMICs) bearing more than 90% of the global burden.1,3 GLOBAL ACTION PLAN The global health community recognizes the need to reduce the burden of neurological disease. On January 12, 2022, the World Health Organization (WHO) published the final draft of the 2022 to 2031 intersectoral global action plan on epilepsy and other neurological disorders.4 The global action plan has 6 guiding principles, including intersectoral action, which the WHO defines as a “comprehensive and coordinated response to neurological disorders resulting from partnerships and collaboration among all stakeholders.”5 The action plan aims to reduce stigma regarding neurological conditions and barriers to comprehensive, safe, and affordable neurological care worldwide by 2031.5 The WHO sets 5 strategic objectives to attain this ambitious goal: (1) prioritization of policies and governance that decrease the global burden of neurological disease; (2) increased access to safe, evidence-based, and timely neurological diagnosis, treatment, and care; (3) design and implementation of neurological health prevention and promotion strategies; (4) support of global neurological research and strengthening of information systems; and (5) health systems strengthening for epilepsy.5 Progress toward the attainment of each strategic objective will be tracked by 2 global targets (Table). TABLE. - Global Targets for the 2022 to 2031 Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders6 Strategic objectives Global targets Monitoring and evaluation 1. Raise policy prioritization and strengthen governance 1.1. 75% of countries will have adapted or updated existing national policies, strategies, plans, or frameworks to include neurological disorders by 2031 Existence of a physically available policy, strategy, plan, or framework provided by the national authority's response to epilepsy and other neurological disorders and confirmed on review 1.2. 100% of countries will have at least 1 functioning awareness campaign or advocacy program for neurological disorders by 2031 Inventory of currently implemented and functioning neurological disorders awareness or advocacy campaigns, described project by project, provided by the national authority's response to epilepsy and other neurological disorders 2. Provide effective, timely and responsive diagnosis, treatment, and care 2.1. 75% of countries will have included neurological disorders in the universal health coverage benefits package by 2031 Documented universal health coverage—priority benefits package based on information provided by the national authority's response to epilepsy and other neurological disorders and confirmed on review 2.2. 80% of countries will provide the essential medicines and basic technologies required to manage neurological disorders in primary care by 2031 Proportion of countries that report having a core set of relevant essential medicines and basic technologies for neurological disorders available and affordable in primary care facilities on a sustainable basis 3. Implement strategies for promotion and prevention 3.1. 80% of countries will have at least 1 functioning intersectoral program for brain health promotion and the prevention of neurological disorders across the life course by 2031 Inventory of currently implemented and functioning brain health awareness and neurological disorder prevention/risk reduction campaigns, described project by project, provided by national authority's response to epilepsy and other neurological disorders 3.2. The global targets relevant for prevention of neurological disorders are achieved as defined in: • the noncommunicable diseases global action plan;• defeating meningitis by 2030: a global road map; and every new born: an action plan to end preventable deaths Reporting to World Health Organization's governing bodies as provided for in the Global ActionPlan for prevention and control of noncommunicable diseases 2013-2030 4. Foster research and innovation and strengthen information systems 4.1. 80% of countries routinely collect and report on a core set of indicators for neurological disorders through their national health data and information systems at least every 3 years by 2031 Can occur by means of a patient registry, aggregate data, or medical records from various sources measured at a system level (national, subnational, or local level)Responses provided by the national authority. 4.2. The output of global research on neurological disorders doubles by 2031 Literature searches centrally conducted every 3 years, stratified by country of origin, topics, and types of research, using bibliometric data sourced for the most recent calendar year 5. Strengthen the public health approach to epilepsy 5.1. By 2031, countries will have increased service coverage for epilepsy by 50% from the current coverage in 2021 Coverage of services for epilepsy calculated as the number of people receiving defined services by the population in need of the intervention 5.2. 80% of countries will have developed or updated their legislation with a view to promoting and protecting the human rights of people with epilepsy by 2031 Physically available legislations relevant to epilepsy and confirmation that they accord with international and regional human rights standards The global action plan working group selected epilepsy as an entry point for other neurological disorders because epilepsy shares etiologies, diagnostic resources, and therapeutic modalities with a wide variety of disorders.5 This decision is noteworthy because global neurosurgery has used traumatic brain and spine injuries as an entry point for efforts to expand access to care for adult neurological diseases and hydrocephalus and spina bifida for pediatric neurological diseases.7-11 Although 70% to 75% of epilepsy is treatable with antiseizure medications,12 the core challenge in global epilepsy care is a lack of access to these medications. The epilepsy treatment gap is more than 75% in low-income countries and more than 50% in most middle-income countries.13 Nonetheless, patients with medication-refractory epilepsy may benefit from epilepsy surgery. Despite evidence demonstrating the efficacy of epilepsy surgery, the rate of epilepsy surgery has stagnated or declined over time.14 Subspecialty organizations such as the World Society for Stereotactic and Functional Neurosurgery have researched global access to functional neurosurgery and advocated for care expansion.9 The 2022 to 2031 global action plan is an opportunity for greater involvement in decreasing the burden of neurological disorders from the wider global neurosurgery community. Meeting all 5 goals will require structured and coordinated health policy and advocacy efforts. Health policy initiatives for epilepsy and other functional diseases can learn from successful traumatic and pediatric neurosurgery interventions such as the Comprehensive Policy Recommendations for Head and Spine Injury7 and Spina Bifida and Hydrocephalus8 Care in LMICs. A Comprehensive Policy Recommendation for Epilepsy white paper will facilitate the design, implementation, and integration of epilepsy-related health policies in national health agendas by identifying evidence-based priorities for increasing access to epilepsy care. From an international health policy and advocacy perspective, organized neurosurgery groups should consider joining and contributing to the global action plan working group. For example, the World Society for Stereotactic and Functional Neurosurgery can emulate the World Federation of Neurosurgical Societies-WHO liaison committee10 and appoint an emissary to the global action plan working group. Regarding global target 4.2, the wider global neurosurgery community has supported research capacity building15 and increased scholarly productivity in LMICs through the creation of special sections within specialty journals and conferences.16,17 However, no global epilepsy-specific special issue of a neurosurgical journal has been created. We believe this is an opportunity for stereotactic and functional neurosurgery journals and conferences to contribute not only to global target 4.2 but also to other targets by encouraging research that evaluates progress toward each target in the form of publications, abstract awards, and grants. CONCLUSION The WHO's intersectoral global action plan on epilepsy and other neurological disorders is a road map for the fight against avertable morbidity and mortality. The neurosurgical community can and should play a part in this intersectoral strategy. In this letter, we present an overview of the global action plan and highlight opportunities for global neurosurgery. Specifically, we detail how the functional neurosurgery community may increase access to treatment for medication-refractory epilepsy. We argue that neurosurgery is essential for preventing and minimizing neurological disability and death. As such, neurosurgeons should contribute to international health policy and advocacy efforts. In addition, we discuss how global neurosurgery can use epilepsy as an entry into international health policy and advocacy forums and committees. Taken together, we believe the recommendations in this letter can help reduce the global burden of neurological diseases.

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