Institute of Neurological Diseases and Rehabilitation Center will be established within few years – Prof. Wasay

By Mubarak Ali

KARACHI: Karachi institute of Neurological Diseases and Rehabilitation Center will be established within two to three years for which funding is being arranged. Burden of Neurological Diseases in Pakistan is very high and it is quite common in children. In fifty hundred thousand disabled population twenty percent are children having mental retardation and developmental disorders. Mortality of stroke is also very high. Epilepsy, Dementia and Parkinson’s disease, CNS infections, Headache, Back Pain, Neck Pain etc. are the other neurological disorders. It affects mental health, increases suicide and addictions besides disability burden. This was stated by Prof. M. Wasay, President Neurology Awareness and Research Foundation (NARF) while speaking in the inaugural session of Transformation of Neurology in Pakistan Conference 2018 organized by (NARF) held at JPMC, Karachi from August 11-12, 2018. Dr. Seemin Jamali, Executive Director JPMC Karachi was the Guest of Honor while Prof. Shaukat Ali, former President Pakistan Society of Neurology was the chief guest at the occasion.

Prof. Shaukat Ali, Prof. M. Wasay, Prof. Iqbal Afridi, Prof. Tipu Sultan, Mr. Khalid Mehmood Zia and
Dr. Abdul Malik speaking at the Transformation of Neurology in Pakistan Conference 2018
organized by (NARF) held at JPMC, Karachi from August 11-12, 2018.

Prof. Wasay further said that workforce for neurological/mental health consists of six hundred Psychiatrists, three hundred fifty Neurosurgeons, two hundred Neurologists, forty five Rehabilitation experts and seven thousand Physiotherapists. We have 200 neurologists for 210 million (1 per million) ideally it should be one neurologist per ten thousand. We have six stroke units though we need many more. We have limited awareness among GPs, patients, policy makers besides lack of prevalence/ incidence data. Lot of work has been done in this field during the last ten years, we have increased almost one hundred Neurologists, doubled the training Centers, started FCPS, MD, DCN programs, Afghan Neurology training programs, Neurophysiology, stroke, movement disorder training, Neurological Research. Lot of work in neurological research is going on besides establishment of National Neurology Data Base (supported by PHRC), National Stroke Registry, National MS Registry, Population based neurological/ mental health study protocol has been submitted to Higher Education Commission. Awareness programs are regularly organized by local chapters and institutions on the occasion of World Brain Day, Stroke Day, Epilepsy Day, Parkinson’s Day, Dementia Day and MS Day. We have trained 2500 GP’s and have succeeded to organize a good team of Neurologists which will help to further improve the management of neurological diseases in the country.

Dr. Seemin Jamali offered every possible help and assistance for the management of neurological problems and lauded the services of Pakistan Society of Neurology and Neurology Awareness and Research Foundation for their efforts to promote neurology care in Pakistan. Prof. Shaukat Ali in his remarks said that in 1990’s no one was aware of this disease and only two neurologist one in Karachi and one in Lahore were practicing. Due to advocacy of Society of Neurology and dedicated efforts of its members lot of awareness has been created about this specialty in Pakistan.

Dr. Abdul Malik, General Secretary NARF in his welcome address stated that our aim is to promote the exchange of ideas and create awareness among the community about neurology and its related sub specialties like stroke, headache, movement disorders, muscular disorders and memory impairment disorders. During the last ten years from 2007 t0 2017 NARF in its program Advocacy, Education and Impact has done a lot besides arranging over 200 CME workshops and conducted neurological disease survey.

During the scientific session Mr. Khalid Mehmood Zia highlighted the activities of PMWO (Lifesaving Organization) Incorporated In 1990 for the Welfare & Care of Patients with Neurological Disorders. PMWO, he claimed is the only Health Organization in Pakistan for the treatment of Myasthenia Gravis and GBS / CIDP through Plasmapheresis. It was established to provide a comprehensive care to needy patients. To improve the quality of life of individuals and families affected by MG, GBS, CIDP and variants. PMWO vision is that every person affected by MG, GBS, CIDP and variants should have convenient access to early and accurate diagnosis and treatment. PMWO was founded by Prof. Muhammad Tariq & Khalid Mehmood Zia (Myasthenia Gravis) patient in 1990.

Mr. Khalid disclosed that Myasthenia Gravis (MG) which is a serious neuromuscular disorder. He was affected by MG in 1988 and faced disability condition due to the severe symptoms of generalized MG. Spent one month in ICU with fears & questions. He decided to establish a charity for MG patients. It had a humble beginning. Today PWMO has become an international organization with incredible achievements. Plasmapheresis he further stated is a cost effective treatment. Cost of Plasmapheresis with four to five procedures is 60-65 thousand rupees. Alternative treatment is IVIG which cost eight to thirteen lac of rupees. Both treatments are internationally recognized and equally effective.

Dr. Naseebullah Kakar from Quetta in his presentation pointed out that the estimated incidence of stroke in Pakistan was 250/100,000. Up to sixty three percent of all stroke patients develop complication and 89% are dependent for activities of daily living. The cost of acute stroke care is extremely high. CT scan facilities are not available except in big cities, lack of recognition of posterior circulation infarcts, Faith Healers increase the tragedy. Acute stroke Care at District level in Pakistan is limited to oral aspirin, unnecessary aggressive BP lowering and immense delays in reaching to tertiary care facilities Leeds to severe complications.

Currently only two Centers (one at Islamabad and one at Karachi) provide the facility of ER triage of thrombolysis for acute ischemic stroke and TIAs. It is also very expensive. There is a single vascular neurology training facility in Pakistan with only one fellow trained per year. In general neurology the total number of registered Residents are around 230 at eighteen centers approved by CPSP for neurology training.

Prof. Sarwar Jamal Siddiqui from Aga Khan University discussed career counseling and pointed out that basic sciences are foundation stone of medical education. Ideal time for counseling is final year and during house job. Passion, opportunities/training and money are the three important things. Availability of training slots, opportunity, personal, family circumstances, financial commitments responsibilities, financial resources and visa issues need to be considered. PSN Education cell provides one three to six months scholarship for young neurologist every year with the condition that he/she have to serve the country for five years after completion of scholarship period.

Prof. Nadir Ali Syed speaking at the occasion said that now in the field of Neurology, we are going in sub specialties. Movement disorder is getting lot of attention now a days. Parkinson’s Society was established ten years ago and Pakistani doctors abroad helped us a lot in this venture. Movement Disorders Society was established last year, we have training opportunities and research is going on. Information technology is available and has provided level playing field. We should rely on our own experiences. DBS is also on horizon now a days , it is expensive but quiet useful, he added.

Prof. Tipu Sultan from Lahore talking about pediatric neurological disorders said that it is rapidly developing super specialty within the domain of pediatrics. Its management requires multi-disciplinary approach. Every child needs are different and a particular therapy style cannot be generalized. Epilepsy is most common in children besides cerebral palsy. DBD is also having a major chunk in pediatrics and autism is also have lot of awareness now a days. Hypothyroidism is preventable if its treatment is started at early stage, he added.

Dr. Mughis Sheerani from SIUT, Karachi discussed the Multiple Sclerosis which he stated is a demyelinating disease. It is characterized clinically by episodes of focal disorders of optic nerves, spinal cord and brain which remit to varying extent and recur over a period of many years. Prevalence of MS is five in one hundred thousand and estimated numbers of patients are seven thousand fifty and there are three hundred new cases per year. Approximately five percent of RRMS patients are on DMTs. All other DMTs are on special import and affordability is a major concern. Due to high cost of treatment most of the patients are treated for acute attacks with corticosteroids, anti-spastic medication, anti-fatigue medications, vitamins, minerals, and supplements. MS is treatable disease but early treatment is advisable to prevent disability. Several new immunomodulatary treatments are now available and some newer medications like Ocrelizumab can cover different types of MS. NMO is separate but closely related disorder and needs to be kept in different diagnosis.

Dr. Khalid Sher highlighted the advances in dementia, Dr. Aziz B. Sonawala talked about Headache Disorder in Pakistan. Dr. Alam Ibrahim spoke about neurological care in rural settings, Farooq Rathore highlighted Neuro Rehabilitation in Pakistan while Dr. Iqbal Afridi talked about status of mental health & psychiatric diseases in Pakistan. Dr. Akhtar Sherin discussed in detail the progress of medical journalism in Pakistan during the last ten years. Status of Neurosurgical diseases and status of Epilepsy was highlighted by Dr. Atiq Ahmed and Dr. Fowzia Siddiqui respectively. Four pre conference workshops on Clinical neurophysiology, Electroencephalography (EEG), Nerve conduction studies/Electromyography and management of post stroke spasticity and ultrasound guided botulinum toxin injection therapy were also part of the conference.

Azadi Mushairah sponsored by PharmEvo Was presided by Pirzada Qasim Raza Siddiqui. Other Poets included Khawaja Razi Haider, Ajmal Siraj, Salman Siddiqui, Kashif Ghair, Iqbal Pirzada Kashif Hussain. Pirzada Qasim Raza Siddiqui urged the Government to increase allocation for health. He also appreciated the efforts of PharmEvo for organizing such literary activities on regular basis from the platform of Jehan-e-Maseeha Adibi Forum which aims at creating a healthier society.

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