title: Neurologic manifestations of the neglected tropical diseases.
abstract: BACKGROUND
  The World Health Organization has identified 17 neglected tropical diseases (NTDs) that disproportionately affect the world's poorest populations. The neurologic aspects of many of these NTDs have received relatively little attention.
  
  
  METHODS
  A review was performed in PubMed (MedLine) for each NTD by disease name, name of its causative organism, and neurology, neurosurgery, neurologist, brain, spinal cord, peripheral nerve, muscle, nervous system, encephalitis, meningitis, encephalopathy, stroke, neuropathy, and myopathy (1968-Sept. 2013). The Oxford Center for Evidence-based Medicine guidelines were used to determine the level of evidence of neurological involvement and treatment based on the reports identified.
  
  
  RESULTS
  Neurologic manifestations were reported for all NTDs except yaws. Neurologic involvement was described in systematic reviews for four NTDs (Chagas disease, echinococcosis, rabies, cysticercosis) (levels 2a-3a), retrospective cohort studies for six (dengue, human African trypanosomiasis, leishmaniasis, leprosy, onchocerciasis, schistosomiasis) (levels 2b-3b), case series for one (foodborne trematodiasis) (level 4), and case reports for five (Buruli ulcer, dracunculiasis, filariasis, soil-transmitted helminthes, and trachoma). Level 1 evidence for treatment of neurologic manifestations of NTDs was found for human African trypanosomiasis, leprosy, and cysticercosis and level 2 evidence exists for treatment of neurologic involvement in Chagas disease. For the remaining NTDs, treatment of neurologic complications is described in case series and case reports only.
  
  
  CONCLUSIONS
  Neurologic manifestations of NTDs cause significant morbidity and mortality, although limited evidence exists on how best to treat these neurologic complications. Increased awareness of neurologic manifestations of the NTDs can increase their early identification and treatment, contributing to ongoing elimination and eradication campaigns.
authors.affiliation: Brigham and Women's Hospital, Department of Neurology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Berkowitz
authors.affiliation: Brigham and Women's Hospital, Department of Neurology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Department of Neurology, Boston, MA, United States.
authors.forename: Pooja
authors.initials: P
authors.lastname: Raibagkar
authors.affiliation: Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, United States.
authors.forename: Bobbi S
authors.initials: BS
authors.lastname: Pritt
authors.affiliation: Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Department of Neurology, Boston, MA, United States. Electronic address: fmateen@partners.org.
authors.forename: Farrah J
authors.initials: FJ
authors.lastname: Mateen
mesh_terms: D001921:Brain / Q000503:physiopathology*; D019317:Evidence-Based Medicine; D006801:Humans; D058069:Neglected Diseases / Q000150:complications* / Q000503:physiopathology; D017933:Peripheral Nervous System / Q000503:physiopathology*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000503:physiopathology*; D014330:Tropical Medicine
keywords: Central nervous system helminthiasis; Central nervous system parasitic infections; Central nervous system protozoal infections; Neglected diseases; Tropical medicine