After sixty-two years of officially categorizing stroke as a
Disease of the Circulatory System, WHO has taken the major step of recognizing
stroke as a Disease of the Nervous System. The decision has been warmly welcomed
by the World Stroke Organization,
which has actively advocated for the change, arguing that correct
classification is fundamental to global efforts to address the massive challenge
of stroke. The change will be reflected in ICD11 the
latest document to provide the basis for classifying and monitoring diseases
globally. The ICD 11 is expected to be adopted by the World Health Assembly and
released in 2018
To find out why the WSO has made it a priority to achieve this
change, we talked to Bo Norrving, Chair of the organization’s Global Policy
Committee. Bo has also been chair of the Cerebrovascular Diseases group for the
ICD 11 and is a member of the WHO Neurology Topical Advisory Group, chaired by
Raad Shakir.
Why
does it really matter that stroke is classified as a brain disease, not a
disease of the circulatory system – aren’t the two closely related?
It’s
true that there are close links between cardiovascular disease and stroke; many
risk factors are shared and primary prevention will target both disorders
jointly. But the simple fact is that when
strokes happen, they happen in the
brain.
Delivering
stroke treatment early and efficiently with effective acute therapies such as
thrombolytic therapy and thrombectomy, depends on the early recognition of
symptoms from the brain and early actions to call an ambulance. This is why many
countries campaign to increase public knowledge of stroke symptoms (like the
FAST campaign) have been conducted in recognition that ‘time is brain’.
Similarly, providing early treatment of transient ischemic attacks (TIAs), which
are linked to stroke, depend on public knowledge of the symptoms and rapid
admittance to hospital.
The
impact of delivering effective treatment for acute stroke and the opportunity to
prevent a stroke where someone has had a TIA are huge and opportunities should
not be missed. Understanding the role of the brain in residual symptoms and
disabilities from stroke is also important to providing patients with effective
long-term rehabilitation and support.
Having
had stroke under diseases of the circulatory system has put stroke in the
shadows regarding the essential recognition of the brain symptoms of stroke as a
crucial element in delivering effective therapies. We are delighted that this is no longer the case.
How do you think this change will
help with the achievement the global goal to reduce avoidable deaths from
stroke?
Stroke
is the second biggest killer and the largest single cause of disability
worldwide and yet still struggles to get the policy attention and resources
commensurate with its global impact. Identifying stroke as a disease of the
brain and pulling all types of cerebro-vascular diseases into a single block in
the ICD 11 will, we believe, guide policy attention
to the right place and
enable us to develop 21st Century services for stroke. Stroke is
probably the best example there is of a non-communicable disease that is highly
preventable and highly treatable, more so than almost any other NCD. With the right focus and commitment to stroke we can make a massive impact on the achievement of sustainable development goals for health.
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Ø Visit the World Stroke
Campaign website for
information about the global campaign for better stroke prevention, treatment
and support
April 4 2017
The lectures were prepared by stroke neurologists, based on international practice guidelines, and has trained all professionals linked to stroke assistance, including primary care professionals to improve primary and secondary prevention.
