Stroke classified as neurological disease – Experts welcome the decision in the WHO ICD-11 process

"The medical rationale for stroke being a neurological condition has always been compelling. We therefore welcome the latest decision by the Department of Statistics at the WHO to move the thematic block of cerebrovascular diseases from the circulatory diseases chapter to diseases of the nervous system," noted Prof Raad Shakir, head of the WHO Neurology Topic Advisory Group and President of the World Federation of Neurology (WFN).

Public support for the latest WHO move on the issue of stroke classification follows a period of expert discussions and major concern in the neurological community. Last October, leading international neurology and stroke specialists publicly expressed their concern in an editorial in the Lancet about the classification of stroke in the draft revision of the “International Statistical Classification of Diseases and Related Health Problems” (ICD). This step was in response to an unexpected change in the classification system by which the newly created group of cerebrovascular diseases was moved from neurological to circulatory diseases.

The ICD-10 currently in place is based on outdated medical knowledge and concepts from the 1950s. The new ICD-11, which has been under discussion since 2009, is aimed at reflecting the changes in science and practice and is slated for release in 2018. Although it has taken 62 years to make the change, it is now a reality and a benefit to patients, treating doctors and researchers, and the public at large.

Prof Shakir: “There are very good reasons why the WHO Neurology Topic Advisory Group advocated all throughout this process that all types of stroke should form a single block in the new classification and be part of the nervous system disease chapter. All manifestations of cerebrovascular disease are related to brain dysfunction. We are relieved and fully support the prudent and farsighted changes implemented by the WHO team."

According to the WFN President the latest classification decision with respect to stroke serves the interests of patients’ needs. Prof Shakir: "It also ensures that health care provision and funding will be based on correct figures, which has not been the case thus far." 

“Stroke clearly is a brain disease” International experts concerned about WHO moves in classification process

“The medical rationale for stroke being a disease of the brain is overwhelming.” This is the key message of an urgent appeal launched by leading neurology experts in The Lancet. The authors are making public their concern about the classification of stroke in the draft revision of the “International Statistical Classification of Diseases and Related Health Problems” (ICD) after an unexpected and uncoordinated change in the classification scheme made by WHO staff.

The ICD-10 currently in place is based on outdated medical knowledge and concepts from the 1980s. The new ICD-11, which has been under discussion since 2009, is aimed at reflecting the changes in science and practice.

“There are very good reasons that we agreed five years ago, in a transparent process and after extensive debate in the WHO Neuroscience Topic Advisory Group and with WHO representatives, that all types of stroke should form a single block in the new classification that should be part of the nervous system disease chapter”, explained Prof Raad Shakir, head of the advisory body and President of the World Federation of Neurology. “All manifestations of cerebrovascular disease are related to brain dysfunction. The relationship with dementia and particularly Alzheimer’s disease is becoming clearer.”

According to Prof Shakir, the unilateral decision by WHO staff to move the newly created cerebrovascular thematic block from neurology to circulatory disease is not only incomprehensible, but also “did not follow the expected transparency of WHO decision-making.”

“The main purpose of any enduring classification should be to serve the interests of patients, which is not the case unless stroke is acknowledged as being a brain disease”, the authors of the comment cautioned. “The latest classification decision with respect to stroke needs to be reversed in order to safeguard patient care and provide correct figures and funding for health care provision.”

 

Portuguese study did not find an increased stroke risk for football fans

Being excited for your team, rooting them on and suffering vicariously with them are the grand emotions that wash over spectators of football matches. If this increases the risk of stroke remains to be elucidated, as the number of strokes that occur on days with major matches is not significantly higher than on days when no football is played. This is the conclusion of a Portuguese study that was presented today at the Second Congress of the European Academy of Neurology (EAN) in Copenhagen.

Many studies suggest that stress during crucial matches can trigger heart attacks or strokes in passionate football fans. A group of researchers from Lisbon has now examined data from 2012 to 2015 to determine how high the risk actually is of enthusiasm at a football match triggering a stroke. The study focused on hospital statistics around crucial matches of the three best Portuguese clubs. As it turned out, there were 72 strokes on and after match days and 52 during comparable periods when no matches were played. Study author Dr Cláudia Borbinha from Hospital Egas Moniz, Lisbon, Portugal, issued an all-clear signal anyway: “The absolute number of strokes during football matches may have been higher but it was not an above-average outlier. Our data therefore furnishes no significant indications of a correlation between enthusiasm for football and increased risk of stroke.”

Stroke second leading cause of death – experts discuss strong link between stroke and dementia

 “Stroke has finally been recognized at international level – for example at the UN Post-2015 Sustainable Development summit – as one of the core diseases globally in need of prevention, improved management and continued surveillance,” Bo Norrving, Professor of Neurology at Lund University, Sweden, said at the World Congress of Neurology (WCN 2015). About 3,500 participants are gathered in the Chilean capital Santiago for the world's leading neurology event. “This reflects the high burden the disease imposes on individuals, their families and societies. Stroke is the second leading cause of death, and the most common cause of disability in adults. Modern neurology is making major advances in the prevention, therapy and rehabilitation of stroke. Nonetheless, the disorder still poses major challenges,” he added. 

The latest data on the incidence, prevalence, mortality and socioeconomic consequences of stroke at global, regional and national levels have been published just in time for World Stroke Day on 29 October in a special issue of the journal Neuroepidemiology (www.karger.com/ned), “The Global Burden of Stroke”, which is co-edited by Prof Norrving. These papers are offered open access to readers worldwide. One of the major findings of the comprehensive research programme which assesses mortality and disability from major diseases, injuries and risk factors is that there is still no country in the world, where the burden of stroke, in terms of the absolute number of individuals affected by or dying from stroke, has declined over the last two decades. The bulk of stroke burden continues to be borne by developing countries. The overall incidence of stroke in younger adults is increasing globally and now represents almost half of the total burden.

“At this year’s WCN the spotlight is firmly on the strong link between the two largest neurological diseases: stroke and dementia. One in three people will develop either of these,” noted Prof Norrving. “The pathologies of both conditions seem to interact, and it is important to point out that they have virtually the same risk factors, which include high blood pressure, cigarette smoking, obesity or lack of physical activity. These findings represent an opportunity to prevent or delay both conditions.”

The potential for modifying risk factors is set to be underlined in a WCN lecture by the internationally renowned stroke expert Prof Vladimir Hachinski from Western University, London, Canada. “In the past 20 years, stroke incidence has increased by 225 percent in low and middle income countries while it has declined by 42 percent in high income countries”, he said. “Trends in the latter also reflect decreasing incidence of dementia. The data suggests that the big differences are not due to changes in the genetic makeup, but improvements in risk factor control,” he concluded.