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Bhidayasiri R. Old problems, new solutions: harnessing technology and innovation in Parkinson's disease-evidence and experiences from Thailand. J Neural Transm (Vienna) 2024; 131:721-738. [PMID: 38189972 DOI: 10.1007/s00702-023-02727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
The prevalence of Parkinson's disease (PD) is increasing rapidly worldwide, but there are notable inequalities in its distribution and in the availability of healthcare resources across different world regions. Low- and middle-income countries (LMICs), including Thailand, bear the highest burden of PD so there is an urgent need to develop effective solutions that can overcome the many regional challenges associated with delivering high-quality, and equitable care to a diverse population with limited resources. This article describes the evolution of healthcare delivery for PD in Thailand, as a case example of a LMIC. The discussions reflect the author's presentation at the Yoshikuni Mizuno Lectureship Award given during the 8th Asian and Oceanian Parkinson's Disease and Movement Disorders Congress in March 2023 for which he was the 2023 recipient. The specific challenges faced in Thailand are reviewed along with new solutions that have been implemented to improve the knowledge and skills of healthcare professionals nationally, the delivery of care, and the outcomes for PD patients. Technology and innovation have played an important role in this process with many new tools and devices being implemented in clinical practice. Without any realistic prospect of a curative therapy in the near future that could halt the current PD pandemic, it will be necessary to focus on preventative lifestyle strategies that can help reduce the risk of developing PD such as good nutrition (EAT), exercise (MOVE), good sleep hygiene (SLEEP), and minimizing environmental risks (PROTECT), which should be initiated and continued (REPEAT) as early as possible.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330, Thailand.
- The Academy of Science, The Royal Society of Thailand, Bangkok, 10330, Thailand.
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Aldaajani Z, Khalil H. Challenges in Managing Nonmotor Symptoms of Parkinson's Disease in Low-Resourced Settings with Unavailability of Newer Drugs. Mov Disord Clin Pract 2024; 11:123-128. [PMID: 38168114 PMCID: PMC10883395 DOI: 10.1002/mdc3.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Zakiyah Aldaajani
- Neurology Unit, Internal Medicine Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Hanan Khalil
- Department of Rehabilitation Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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3
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Moes HR, Henriksen T, Sławek J, Phokaewvarangkul O, Buskens E, van Laar T. Tools and criteria to select patients with advanced Parkinson's disease for device-aided therapies: a narrative review. J Neural Transm (Vienna) 2023; 130:1359-1377. [PMID: 37500937 PMCID: PMC10645650 DOI: 10.1007/s00702-023-02656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/29/2023]
Abstract
This article provides an overview of the various screening and selection tools which have been developed over the past 25 years to identify patients with Parkinson's disease (PD) possibly eligible for device-aided therapies (DATs). For the available screening tools, we describe the target therapies (subtypes of DAT), development methods, validation data, and their use in clinical practice. In addition, the historical background and potential utility of these screening tools are discussed. The challenges in developing and validating these tools are also addressed, taking into account the differences in population, the local health care organization, and resource availability.
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Affiliation(s)
- Harmen R Moes
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands
| | - Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jarosław Sławek
- Department of Neurology, St Adalbert Hospital Copernicus, Gdansk, Poland
- Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands.
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4
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Safiri S, Noori M, Nejadghaderi SA, Mousavi SE, Sullman MJM, Araj-Khodaei M, Singh K, Kolahi AA, Gharagozli K. The burden of Parkinson's disease in the Middle East and North Africa region, 1990-2019: results from the global burden of disease study 2019. BMC Public Health 2023; 23:107. [PMID: 36642724 PMCID: PMC9841703 DOI: 10.1186/s12889-023-15018-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/10/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) remains a common disabling progressive neurodegenerative disorder. We aimed to report the prevalence, death and disability-adjusted life-years (DALYs) attributable to PD in the Middle East and North Africa (MENA) region and its 21 countries by age, sex and socio-demographic index (SDI), between 1990 and 2019. METHODS Publicly available data on the burden of PD in the MENA countries were retrieved from the Global Burden of Disease (GBD) 2019 project. The results are presented with age-standardised numbers and rates per 100,000 population, along with their corresponding 95% uncertainty intervals (UIs). RESULTS In 2019, PD had an age-standardised point prevalence of 82.6 per 100,000 population in MENA and an age-standardised death rate of 5.3, which have increased from 1990 to 2019 by 15.4% and 2.3%, respectively. In 2019, the age-standardised DALY rate of PD was 84.4, which was 0.9% higher than in 1990. The highest and lowest age-standardised DALY rates of PD in 2019 were found in Qatar and Kuwait, respectively. Also in 2019, the highest number of prevalent cases and number of DALYs were found in the 75-79 age group for both sexes. In 2019, females in MENA had an overall higher DALY rate. Furthermore, from 1990 to 2019 the burden of PD generally decreased with increasing socio-economic development, up to an SDI of around 0.4, and then increased with higher levels of SDI. CONCLUSION An upward trend was observed in the point prevalence of PD over the last three decades. This highlights the need to allocate more resources for research. Furthermore, properly equipped healthcare services are needed for the increasing number of patients with PD.
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Affiliation(s)
- Saeid Safiri
- grid.412888.f0000 0001 2174 8913Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Noori
- grid.411746.10000 0004 4911 7066Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- grid.411600.2School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.510410.10000 0004 8010 4431Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Seyed Ehsan Mousavi
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark J. M. Sullman
- grid.413056.50000 0004 0383 4764Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus ,grid.413056.50000 0004 0383 4764Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Mostafa Araj-Khodaei
- grid.412888.f0000 0001 2174 8913Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kuljit Singh
- grid.1022.10000 0004 0437 5432Department of Medicine, Griffith University, Southport, QLD Australia
| | - Ali-Asghar Kolahi
- grid.411600.2Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kurosh Gharagozli
- grid.411600.2Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bhidayasiri R, Kalia LV, Bloem BR. Tackling Parkinson's Disease as a Global Challenge. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1277-1280. [PMID: 38143374 PMCID: PMC10741319 DOI: 10.3233/jpd-239005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Lorraine V. Kalia
- Division of Neurology, Department of Medicine, Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
- Krembil Research Institute, Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Bastiaan R. Bloem
- Radbound University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
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Mehanna R, Smilowska K, Fleisher J, Post B, Hatano T, Pimentel Piemonte ME, Kumar KR, McConvey V, Zhang B, Tan E, Savica R. Age Cutoff for Early-Onset Parkinson's Disease: Recommendations from the International Parkinson and Movement Disorder Society Task Force on Early Onset Parkinson's Disease. Mov Disord Clin Pract 2022; 9:869-878. [PMID: 36247919 PMCID: PMC9547138 DOI: 10.1002/mdc3.13523] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022] Open
Abstract
Background Early-onset Parkinson's disease (EOPD)/young-onset Parkinson's disease (YOPD) is defined as Parkinson's disease (PD) with an age at onset (AAO) after age 21 years but before the usual AAO for PD. Consensus is lacking, and the reported maximal age for EOPD/YOPD has varied from 40 to 60 years, leading to a lack of uniformity in published studies and difficulty in harmonization of data. EOPD and YOPD have both been used in the literature, somewhat interchangeably. Objective To define the nomenclature and AAO cutoff for EOPD/YOPD. Methods An extensive review of the literature and task force meetings were conducted. Conclusions were reached by consensus. Results First, the literature has seen a shift from the use of YOPD toward EOPD. This seems motivated by an attempt to avoid age-related stigmatization of patients. Second, in defining EOPD, 56% of the countries use 50 or 51 years as the cutoff age. Third, the majority of international genetic studies in PD use an age cutoff of younger than 50 years to define EOPD. Fourth, many studies suggest that changes in the estrogen level can affect the predisposition to develop PD, making the average age at menopause of 50 years an important factor to consider when defining EOPD. Fifth, considering the differential impact of the AAO of PD on professional and social life, using 50 years as the upper cutoff for the definition of EOPD seems reasonable. Conclusions This task force recommends the use of EOPD rather than YOPD. It defines EOPD as PD with AAO after 21 years but before 50 years.
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Affiliation(s)
- Raja Mehanna
- UTMove, Departement of NeurologyUniversity of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Katarzyna Smilowska
- Department of NeurologySilesian Center of NeurologyKatowicePoland
- Department of Neurology5th Regional HospitalSosnowiecPoland
| | - Jori Fleisher
- Department of Neurological SciencesRush University School of MedicineChicagoIllinoisUSA
| | - Bart Post
- Department of NeurologyRadboudumcNijmegenThe Netherlands
| | - Taku Hatano
- Department of NeurologyJuntendo University School of MedicineTokyoJapan
| | - Maria Elisa Pimentel Piemonte
- Physical Therapy, Speech Therapy, and Occupational TherapyDepartment, Medical School, University of São PauloSão PauloBrazil
| | - Kishore Raj Kumar
- Molecular Medicine Laboratory and Department of Neurology, Concord Repatriation General Hospital, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Kinghorn Centre for Clinical GenomicsGarvan Institute of Medical ResearchDarlinghurstNew South WalesAustralia
| | | | - Baorong Zhang
- Department of NeurologyThe Second Affiliated HospitalHangzhouChina
| | - Eng‐King Tan
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
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7
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Schiess N, Cataldi R, Okun MS, Fothergill-Misbah N, Dorsey ER, Bloem BR, Barretto M, Bhidayasiri R, Brown R, Chishimba L, Chowdhary N, Coslov M, Cubo E, Di Rocco A, Dolhun R, Dowrick C, Fung VSC, Gershanik OS, Gifford L, Gordon J, Khalil H, Kühn AA, Lew S, Lim SY, Marano MM, Micallef J, Mokaya J, Moukheiber E, Nwabuobi L, Okubadejo N, Pal PK, Shah H, Shalash A, Sherer T, Siddiqui B, Thompson T, Ullrich A, Walker R, Dua T. Six Action Steps to Address Global Disparities in Parkinson Disease: A World Health Organization Priority. JAMA Neurol 2022; 79:929-936. [PMID: 35816299 DOI: 10.1001/jamaneurol.2022.1783] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The Global Burden of Disease study conducted between 1990 and 2016, based on a global study of 195 countries and territories, identified Parkinson disease (PD) as the fastest growing neurological disorder when measured using death and disability. Most people affected by PD live in low- and middle-income countries (LMICs) and experience large inequalities in access to neurological care and essential medicines. This Special Communication describes 6 actions steps that are urgently needed to address global disparities in PD. Observations The adoption by the 73rd World Health Assembly (WHA) of resolution 73.10 to develop an intersectoral global action plan on epilepsy and other neurological disorders in consultation with member states was the stimulus to coordinate efforts and leverage momentum to advance the agenda of neurological conditions, such as PD. In April 2021, the Brain Health Unit at the World Health Organization convened a multidisciplinary, sex-balanced, international consultation workshop, which identified 6 workable avenues for action within the domains of disease burden; advocacy and awareness; prevention and risk reduction; diagnosis, treatment, and care; caregiver support; and research. Conclusions and Relevance The dramatic increase of PD cases in many world regions and the potential costs of PD-associated treatment will need to be addressed to prevent possible health service strain. Across the board, governments, multilateral agencies, donors, public health organizations, and health care professionals constitute potential stakeholders who are urged to make this a priority.
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Affiliation(s)
- Nicoline Schiess
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Rodrigo Cataldi
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville.,Associate Editor, JAMA Neurology
| | | | | | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Maria Barretto
- Parkinson's Disease and Movement Disorder Society, Mumbai, India
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Richard Brown
- Chemical Safety and Health Unit, Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | | | - Neerja Chowdhary
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Max Coslov
- Edmond J. Safra Foundation, Geneva, Switzerland
| | - Esther Cubo
- Hospital Universitario Burgos, Burgos, Spain
| | | | | | | | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and University of Sydney, Sydney, Australia
| | - Oscar S Gershanik
- Institute of Neuroscience, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Larry Gifford
- Person With Parkinsons, PD Avengers, Vancouver, British Columbia, Canada
| | - Joyce Gordon
- Neurological Health Charities Canada, Toronto, Ontario, Canada
| | - Hanan Khalil
- College of Health Sciences, Department of Physiotherapy, Qatar University, Doha, Qatar
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sara Lew
- Malaysian Parkinson's Disease Association, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Emile Moukheiber
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lynda Nwabuobi
- Weill Cornell Parkinson's Disease and Movement Disorders Institute, New York, New York
| | | | - Pramod Kumar Pal
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Hiral Shah
- Columbia University Medical Center, New York, New York
| | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Todd Sherer
- The Michael J. Fox Foundation, New York, New York
| | | | - Ted Thompson
- The Michael J. Fox Foundation, New York, New York
| | - Andreas Ullrich
- Department of Gynaecology and Gynaecological Oncology Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Tarun Dua
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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8
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Ojo OO, Abubakar SA, Iwuozo EU, Nwazor EO, Ekenze OS, Farombi TH, Akinyemi RO, Williams UE, Bello AH, Wahab KW, Iyagba AM, Arigbodi O, Erameh CO, Komolafe MA, Fawale MB, Onwuegbuzie GA, Obiabo YO, Taiwo FT, Agu CE, Ekeh BC, Osaigbovo GO, Achoru CO, Arabambi B, Adeniji O, Nwani PO, Nwosu CM, Ademiluyi BA, Oyakhire SI, Nyandaiti Y, Rabiu M, Chapp-Jumbo EN, Balarabe SA, Otubogun FM, Obehighe EE, Kehinde AJ, Ani-Osheku I, Imarhiagbe FA, Dike FO, Adebowale AA, Agabi OP, Akpekpe JE, Ali MW, Odeniyi OA, Odiase FE, Abiodun OV, Olowoyo P, Osemwegie N, Oshinaike OO, Owolabi LF, Zubair YA, Rizig M, Okubadejo NU. The Nigeria Parkinson Disease Registry: Process, Profile, and Prospects of a Collaborative Project. Mov Disord 2020; 35:1315-1322. [PMID: 32557840 DOI: 10.1002/mds.28123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical disease registries are useful for quality improvement in care, benchmarking standards, and facilitating research. Collaborative networks established thence can enhance national and international studies by generating more robust samples and credible data and promote knowledge sharing and capacity building. This report describes the methodology, baseline data, and prospects of the Nigeria Parkinson Disease Registry. METHODS This national registry was established in November 2016. Ethics approval was obtained for all sites. Basic anonymized data for consecutive cases fulfilling the United Kingdom Parkinson's Disease Brain Bank criteria (except the exclusion criterion of affected family members) are registered by participating neurologists via a secure registry website (www.parkinsonnigeria.com) using a minimal common data capture format. RESULTS The registry had captured 578 participants from 5 of 6 geopolitical zones in Nigeria by July 2019 (72.5% men). Mean age at onset was 60.3 ± 10.7 years; median disease duration (interquartile range) was 36 months (18-60.5 months). Young-onset disease (<50 years) represented 15.2%. A family history was documented in 4.5% and 7.8% with age at onset <50 and ≥ 50, respectively. The most frequent initial symptom was tremor (45.3%). At inclusion, 93.4% were on treatment (54.5% on levodopa monotherapy). Per-capita direct cost for the registry was $3.37. CONCLUSIONS This is the first published national Parkinson's disease registry in sub-Saharan Africa. The registry will serve as a platform for development of multipronged evidence-based policies and initiatives to improve quality of care of Parkinson's disease and research engagement in Nigeria. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Oluwadamilola O Ojo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria.,Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Sani A Abubakar
- Department of Medicine, Ahmadu Bello University/ Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Emmanuel U Iwuozo
- Neurology Unit, Benue State University/Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | - Ernest O Nwazor
- Department of Medicine, Federal Medical Center, Owerri, Imo State, Nigeria/ College of Medical Sciences, Madonna University, Elele, Rivers State, Nigeria
| | - Oluchi S Ekenze
- Neurology Unit, Department of Medicine, Faculty of Medical Sciences, University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | - Temitope H Farombi
- Chief Tony Anenih Geriatrics Center, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Uduak E Williams
- Department of Internal Medicine, University of Calabar/University of Calabar Teaching Hospital, Calabar, Cross Rivers State, Nigeria
| | - Abiodun H Bello
- University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Kolawole W Wahab
- Department of Medicine, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Alagoma M Iyagba
- University of Port Harcourt and University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Ohwotemu Arigbodi
- Department of Internal Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | | | - Morenikeji A Komolafe
- Neurology Unit, Department of Medicine, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Michael B Fawale
- Neurology Unit, Department of Medicine, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Gerald A Onwuegbuzie
- University of Abuja Teaching Hospital, Federal Capital Territory, Abuja, Nigeria
| | - Yahaya O Obiabo
- Department of Internal Medicine, Delta State University/ Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | | | - Christian E Agu
- Alex Ekwueme Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Bertha C Ekeh
- University of Uyo Teaching Hospital/ Ibom Specialist Hospital, Uyo, Akwa Ibom State, Nigeria
| | | | | | - Babawale Arabambi
- Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | | | - Paul O Nwani
- Neurology Unit, Department of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Cosmas M Nwosu
- Neurology Unit, Department of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | | | - Shyngle I Oyakhire
- Department of Internal Medicine, National Hospital, Abuja, Federal Capital Territory, Nigeria
| | - Yakub Nyandaiti
- University of Maiduguri/ University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Musbahu Rabiu
- Muritala Muhammed Specialist Hospital, Kano, Kano State, Nigeria
| | | | - Salisu A Balarabe
- Department of Medicine, College of Health Sciences, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Folajimi M Otubogun
- University of Medical Sciences Teaching Hospitals Complex, Akure, Ondo State, Nigeria
| | | | - Abiodun J Kehinde
- Federal Medical Center, Jabi, Federal capital Territory, Abuja, Nigeria
| | - Ifeyinwa Ani-Osheku
- Asokoro District Hospital, Asokoro, Federal Capital Territory, Abuja, Nigeria
| | - Frank A Imarhiagbe
- University of Benin/ University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Franklin O Dike
- University of Uyo Teaching Hospital/ Ibom Specialist Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Akintunde A Adebowale
- Neurology Unit, Department of Medicine, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Osigwe P Agabi
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | | | | | | | - Francis E Odiase
- University of Benin/ University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | | | - Paul Olowoyo
- Federal Teaching Hospital, Ido-Ekiti / Afe Babalola University Ado-Ekiti, Ekiti State, Nigeria
| | - Nosakhare Osemwegie
- University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Olajumoke O Oshinaike
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - Lukman F Owolabi
- Department of Medicine, Bayero University /Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Yusuf A Zubair
- Department of Internal Medicine, National Hospital, Abuja, Federal Capital Territory, Nigeria
| | - Mie Rizig
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London, United Kingdom
| | - Njideka U Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria.,Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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