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Brain Disorders and the Mental Capital

TherearemanyexpectationswithregardtotheoutcomeoftheDecadeoftheBrain(1).Thisisjustlyso,fornotonlyistherethepromiseofsolvingthe essential enigma of human consciousness,thereisalsohopeoffindingwaysofdealingwiththe brain disorders, a grouping of dysfunctions

Editorial

that account for more than 34% of the globalburdenofdiseasemeasuredindisability-adjustedlife years (2).Consider thenumbers inFigure 1(3). These disorders cripple the developmentof nations, subtracting substantially from theirmentalcapital(4)—asituationdramaticallymorecriticalindevelopingcountries.

Abstract Braindisordersaccountformorethan34%oftheglobalburdenofdisease,cripplingnationsbydecreasingtheir“mentalcapital”—withgreatereffectindevelopingcountries.Earlydetectionisthekeytotheirmanagement,butestablishingsuchprogrammesseemsnearlyimpossibleduetothehighprevalenceofthedysfunctionsascomparedwiththehighcostofneuroimagingdevices.Thus,atfirstsight,theresearchoftheDecadeoftheBrainandtheinternationalHumanBrainMappingProjectmightseemtobecondemnedtobenefitonlyasmallelite.Cubahasshownthatisnotsobyusingneurotechnologyforthelast3decadestoimplementstratifiedactivescreeningprogrammesforbraindisordersatthepopulationlevel.Thisexperiencehasshownthat,bythetransformationofhealthindicators,anappropriateuseoftechnologycanbeintegratedwithattentiontothepopulationattheprimarylevelsofbothhealthcareandeducation.Anessentialcomponentofneurotechnologyis neuroinformatics, which—like its counterpart bioinformatics—combines databases, analysistools,andtheoreticalmodelstocrafttoolsforearlydiseasediagnosisandmanagement.Muchworkremains tobedoneandwilldependcriticallyon south–southcooperation to solveproblems forcountrieswithsimilarsituations.

Keywords: brain disorders, international cooperation, medical informatics, neuroimaging, neurosciences, technology

Coping with Brain Disorders using Neurotechnology

Pedro A Valdes-sosa

Cuban Neuroscience Center, Ave 25, Esq. 158, #15202, Cubanacan, Playa, Havana, Cuba

Submitted: 7Dec2011Accepted:15Dec2011

Malays J Med Sci. Jan-Mar 2012; 19(1): 1-31

Figure1: Braindisordersaffectmillionsofpeople intheworld,affectingthementalwealthofnations.

2 www.mjms.usm.my

Malays J Med Sci. Jan-Mar 2012; 19(1): 1-3

Many look for solutions to these problemsfrom research in the neurosciences, an effortthat has reached an unprecedented level.Of note is theHuman BrainMapping Project—agiganticexerciseinsystemsneuroscience—thatis assembling what is known of brain structureand function along the full span of levels frommoleculargeneticstobehaviour.Acriticalfeatureis that all levels are linked by different types ofneuroimages. Central to these endeavours isneuroinformatics: the use of shared databases,toolsforimageanalysis,andtheoreticalmodellingtodevelop, validate, anddeploy instruments forearlydetectionandoptimalmanagementofbraindisease, as well as the support of clinical trials(Figure2).AnoverviewofthisfieldcanbefoundattheInternationalNeuroinformaticsCoordinatingFacilitywebsite(5). Current neuroscience research (includingneuroinformatics) has even spawned a newindustry, neurotechnology, that now rivals ingrowthandimportancethatofbiotechnology.Inspite of these encouraging developments, manyexpressconcernthatthisgiganticeffortmayfallshort and not justify the expenditure involved.Similar misgivings have been voiced about theHumanGenome Project (6).What is needed todealwithbraindisorders,accordingtothisview,is not more technology but rather more publichealthmeasures. These critics point to the highcostofneuroimagingdevicesandtheimpossibilityofdeployingthemwheremostneeded. Cubahashadtodealwithitsownproblemsunder tight economic constraints. This has lednot to less but rather more neurotechnology—with a twist (7). This has been to insert theuseofneurotechnologyinapublichealthframeworkof stratified active screening of brain disorders.This approach uses the appropriate technologyat each health level. A prime example of thishas been the programme of early screening forhearing loss (Figure 3), initiated in 1983,whichhasalreadypushedthechildrendetectedwiththeproblem5yearsof languagedevelopmentaheadofwhatwasexpectedwithoutscreening(8).Thisis an increase of mental capital indeed! Theseprogrammesarenowactivelybeing extended tootherLatinAmericancountries. Cuba considers that this model canbe extended to other brain disorders(Figure4) and is now embarkedonprojects fortheearlydetectionandappropriatemanagementof neurodevelopmental disorders, learning

disabilities, stroke, as well as several types ofcognitive disorders. Conscious that combiningresearcheffortsanddataisessential,ourcountryhasbeenactiveinpromotinginitiativesthatgroupnations with similar problems, recent examplesbeingtheLatinAmericanBrainMappingNetwork(9)andtheChinese/CubanBrainnettomeProject.

Figure 2:Neuroinformatics is the intersectionof neuroimaging databases, toolsfor managing them, and theoreticalmodelling to interpret normal andpathologicalbrainfunctions.

Figure 3: Cuba has used its own nationalneurotechnology industry to carryout stratified active screening, anexampleofwhichisthedetectionofhearingloss.

Editorial |Copingwithbraindisordersusingneurotechnology

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Malaysiaispoisedtoplayamajorroleinthetranslation of neuroscience research into healthandeducation.Itseekstocomplementitsrecentestablishment of a neuroimaging infrastructurewith the development of neuroinformatics toallowthestructuredorganisationof the imagingdata gathered and its integration with othertypesof informationfromthecountryaswellastheworld.IwasluckytobeabletogivearecentcourseinneuroinformaticsthatwasorganisedbyUniversitiSainsMalaysia.Asaresult,Malaysianand Cuban neuroscience groups have recentlydecidedonaroadmaptojoineffortsinresearch,technologydevelopment,andmedicalevaluationgeared towards collaboratively solving mentalhealthproblemsofourcountriesandtoestablishlinks to other groups.We have a major role toplayintransformingthementalhealthlandscapeofdevelopingcountries.This isanexciting timein which we who are engaged in neurosciencehave the possibility and the responsibility ofguaranteeingthatthegoalisreached.

Correspondence

ProfessorDrPedroAValdes-SosaMD (LaHabanaUniversity), PhDBiological Sciences(NationalCenterforScientificResearch),DScCubanNeuroscienceCenterAve25,Esq.158,#15202Cubanacan,PlayaHavana,CubaTel:+(537)2085296,2086321Email:peter@cneuro.edu.cu

References

1. AbdullahJM.TheDecadeoftheMind2010to2020:HowMalaysianneuroscientistscancreateknowledge,skills and innovative research to drive the 10th and11thMalaysiaPlanwithintheNewEconomicModel.KualaLumpur(MY):AkademiSainsMalaysia;2010.

2. Wittchen HU, Jacobi F, Rehm J, Gustavsson A,SvenssonM, Jonsson B, et al. The size and burdenofmentaldisordersandotherdisordersofthebrainin Europe 2010. Eur Neuropsychopharmacol.2011;21(9):655–679.

3. Lynch CC, Lynch Z.The Neurotechnology Industry 2010 Report. San Francisco (CA): NeuroInsights;2010.

4. Beddington J, Cooper CL, Field J, Goswami U,HuppertFA, JenkinsR, et al.Thementalwealth ofnations.Nature.2008;455(7216):1057–1060.

5. International Neuroinformatics CoordinatingFacility [Internet]. Stockholm (SE): InternationalNeuroinformatics Coordinating Facility; 2011 [cited2011Jan3].Availablefrom:http://www.incf.org/

6. Hall SS. Revolution postponed: Why the HumanGenome Project has been disappointing. Scientific American.2010Oct:42–49.

7. ValdesSosaPA,Obrador-FragosoA.Stratifiedactivescreening: Where neurotechnology meets publichealth.MEDICC Rev.2009;9(1):7–10.

8. Perez-Abalo MC, Gaya-Vazquez JA, Savio-LopezG, Perera-Gonzalez M, M. Ponce de Leon-MolaM, Sanchez-Castillo M. A 25-year review of Cuba’sscreeningprogramforearlydetectionofhearingloss.MEDICC Rev.2009;11(1):21–28.

9. Uludag K, Evans AC, Della-Maggiore V, KochenS, Amaro E, Sierra O, et al. Latin American BrainMapping Network (LABMAN). Neuroimage.2009:47(1):312–313.

Figure 4: The active screening for braindisorders is based on theappropriateuseofneurotechnologyandneuroinformatics.