Shortage of neurologists to cope with an annual 20,000 strokes

In the report, based on computerized data from all the hospitals, there were a number of alarming figures.

December 7, 2017 16:37
3 minute read.
Brain scan

Brain scan (illustrative). (photo credit: ING IMAGE/ASAP)

The health system is unprepared to cope with the number of strokes – 20,000 a year – a statistic that is about 30% higher than the estimates before the National Stroke Registry began collecting data. This is the first time that data based on the report have been published.

The Israel Neurological Association presented preliminary data from the registry – part of the Health Ministry’s Center for Disease Control – at its annual conference on Wednesday.

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Prof. David Tanne, director of the Center for Prevention and Treatment of Stroke at Sheba Medical Center at Tel Hashomer, said that additional neurologists must urgently be trained to cope with the disease.

Tanne is a senior neurologist and expert in vascular brain disease who chairs the registry’s advisory committee, and the incoming chairman of the Israel Neurological Association.

Based on the average rate of neurologists in European countries, there should be about 500 to 600 neurologists in Israel. There are fewer than 400, said Tanne.

There are three types of strokes.

Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. Hemorrhagic stroke occurs when a weakened blood vessel ruptures and there is bleeding that damages the brain.

A transient ischemic attack (TIA) is caused by a temporary clot that disappears on its own and does not cause immediate damage.

In the report, based on computerized data from all the hospitals, there were a number of alarming figures, including the fact that 20,000 brain events occur in Israel each year, a number that is significantly higher than previously estimated by the Health Ministry. According to the report, the rate of (age-adjusted) cases in men is about 40% higher than among women; in the Arab sector, it is 40% higher than in the Jewish population.

A shocking revelation in the report was that fewer than a third of stroke victims are hospitalized in neurological or stroke units. Some hospitals in Israel do not have neurological departments, or the number of beds in those that exist is small, forcing the hospital to admit stroke patients to internal medicine wards that have less expertise and equipment for coping with stroke, Tanne said.

There is an increase in the rate of patients who are treated with tissue plasminogen activator (TPA) to melt the ischemic blood clot in the brain and the technology of urgent brain catheterization to remove the clot. In 2015, 7.4% of all patients with ischemic stroke were treated with TPA.

The rate of patients undergoing catheterization has increased by about 70% between 2014 and 2015.

A year after having an ischemic stroke, 23% of patients had died; 43% of those with cerebral hemorrhage died.

The World Health Organization has issued a new atlas on the allocation of resources by countries to treat neurological diseases based on the average number of neurologists in Europe, Every year, too few new neurologists are added to the Israeli health system.

As part of a global “burden of morbidity” project in which Israel is a partner, neurological diseases in general – including stroke, dementia, Parkinson’s disease, multiple sclerosis, migraine and the like – are a major cause of illness. World estimates indicate that neurological diseases cause about 250 million cases of disability.

The training of more neurologists is the order of the hour, concluded Tena. “Minimizing brain damage from strokes translates into reducing the dramatic burden on the health and welfare systems and saving hundreds of millions of shekels a year. But we have a long way to go reduce brain diseases in Israel.”

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