The World Stroke Organisation (WSO) is observing October 29th as World Stroke Day (WSD) to create public awareness that stroke indeed is declared a public health emergency in the world. I would reiterate that stroke is a ‘Human tragedy’ for several plausible reasons. It is a cause of permanent neurologic disability, and researchers in India have clearly declared a ‘silent epidemic’ of ‘neurologic disability’ sweeping across India, predominantly due to Stroke, Dementia and Traumatic Brain Injury. 80 million people suffer from stroke in the world, 50% of stroke survivors unfortunately have permanent neurologic disability, and one death from stroke occurs every 6 seconds in the world. In India, about 1.8 million strokes are estimated to occur per year.
Stroke, Dementia and many other non-communicable disorders, I would say, is the price we are paying for the 21st century lifestyle, the so called ‘mismatch/lifestyle diseases’. Stroke in India has a different backdrop when compared to the affluent West and Caucasians. India has the “Triple Burden” of Communicable Disorders, Non Communicable Disorders (NCD) and Nutritional Disorders. Stroke is not only a problem of the elderly or geriatric age group, but indeed we have a high prevalence of ‘Stroke in the Young’ (below 40 years of age) in India and in the world. I would extrapolate by logical thinking and wisdom surmise that if India is the Diabesity capital of the world with the Triple burden of diseases, along with the special Asian phenotype of Diabetes Mellitus and Coronary Heart Disease, Stroke in the Young would be a looming threat in Young Indians.
On this day of World Stroke Day 2018, it is imperative and there is a need for an urgent call for action to disseminate the concept of Stroke as a ‘Brain Attack’ akin to a ‘Heart Attack’ because both disorders are fundamentally due to blockage of blood supply to the brain and heart respectively. By promoting the concept of ‘Brain Attack’ it is easily conceivable to put forward a FAST action plan for transporting stroke victims to the hospital on a ‘time priority’ for hyperacute stroke treatment. 1.9 million cells in the brain die every minute, i.e. 32000 neurones die every second, hence in a Brain Attack-TIME IS BRAIN, BRAIN IS TIME, ACT FAST will be the Voice for the public campaign against the menace and disability of Stroke.
Using the FAST acronym as a public campaign, the symptoms of stroke are indeed recognised in a timely manner and the stroke victims should be transported to a hospital with ‘stroke units’ where the patients are urgently triaged through a ‘Hyperacute Stroke Protocol’, patients are stratified to receive ‘Clot busters’ to dissolve the blood clots and revascularize the brain, prevent further neuronal death, salvage the ‘ischemic penumbra’ and substantially reduce the stroke related neurologic disability. Stroke NeuroInterventional procedures (similar to cardiac catheterisation for coronary angiogram in Heart Attack) may also be done in selected victims.
It is my understanding that in the ‘Politics of Health’, there is a ‘War politics-Combating Illness’ and on the opposite side of the coin a ‘Peace politics’ which is a ‘peace-keeping process’ of promoting health-ease. Here I would reflect on the quote by Lois Pasteur in 1822 “When meditating over a disease, I never think of finding a remedy for it, but, instead, a means of preventing it.” Putting in a poetic manner ‘The shield is nobler than the Spear’ and ‘War is never a lasting solution for any problem’.
My message for WSD 2018 would be a World Stroke Campaign and a Voice for Stroke from the Preventive Neurology perspective. Right from the cradle (paediatrics, our children in schools, young adults in colleges) to the ‘grave’ (our elderly people, senior citizens, and the geriatric population) must be taught, not caught by lifestyle disorders, on Brain Health Lifestyle and Brain Wellness Concepts. Public campaigns, public health strategies, Community strategies (NGOs, Public Private Partnership, Schools, Colleges, Workplaces, Corporate Social Responsibility Initiative), Social Media (e-health, m-health, facebook, Twitter) should be harnessed to spread the message for a Brain Healthy Lifestyle to prevent Stroke and Dementias. The WSO and World Stroke Academy has endorsed App based ‘Stroke Riskometers’, Stroke Risk Assessment Tool Kit, and Stroke Education which helps the public to change and develop an ‘health behaviour attitude’ and ‘health seeking behaviour’ in lines with the concept of Brain Attack.
Stroke Riskometer Pro mobile App will increase stroke awareness, awareness of stroke risk factors, empowering citizens to estimate their stroke risk rate, and judiciously implement a ‘health behaviour attitude’ for a health brain lifestyle which will go a long way for Brain Wellness promotion. During World Stroke Campaigns there must be school and college Stroke oriented programs and contests which will inculcate a holistic understanding of Brain Wellness, Risk factors and its preventive strategies. The Indian Stroke Association has taken steps in this manner for organising college contests and awarding prizes for the best participants. The prevention of stroke must be a ‘social and public’ movement.
Recognise the link between our lifestyles, diet, nutrition, physical inactivity, mindfulness meditation, leisure activities, spirituality, yoga, pranayama, and even the ‘Sanskrit effect’. Aggressive treatment of primary hypertension, diabetes mellitus, obesity, modification of diet by reducing salt intake (<1.5G/day), reduce high energy foods with high glycemic index, fats and to increase fruits, vegetables, legumes, micronutrients, Vitamin B12, vitamins E, C, and beta carotene, whole grains, brown rice, fish, increase physical activity, leisure exercises for 30 minutes per day, and implementation of the Mediterranean-Asian Diet Style including our Ayurvedic Food Styles (ahar). The Sattvic diet (pure and balanced) is believed to increase energy and produce happiness, calmness, and mental clarity. Eating Brain Health Diet, Healthy eating and Stroke, and the “Lifestyle-Brain-Mind Connect” has to be taught from the ‘cradle to the grave’, or else, we will be caught with such devastating and crippling disorders such as Stroke, Dementia and the elderly will not be able to attain a ‘Positive, Creative and Successful’ Ageing.
To reduce the prevalence of Stroke in India, a ‘one size fits all’ approach will be futile and we need to strategise for pluralistic strategies. I call for a ‘perestroika’ in India to innovatively develop a ‘War Politics Strategy’ as well as a ‘Brain Health Promotion of Health-ease or Peace Keeping Politics’. This will be a long term viable, sustainable, economical public health policy model for India and other LMICs.
Providing a ‘Stroke-TIA’ Clinic Neurology subspecialty services at Yenepoya Medical College Hospital, I would conclude with an optimistic message. Stroke is “Treatable” (Brain Attack Concept) and “Preventable” (Preventive Neurology, Brain Health Lifestyle Strategy). According to the INTERSTROKE study published in the prestigious Lancet journal, 2016, 80% of strokes are indeed preventable by modification of about 10 modifiable risk factors. In addition, for the prevention of stroke, I would stress on Nutritional Neurology, Nutritional Psychiatry, Health Eating Index (HEI) and The Youth HEI. My slogan for 2018 WSD would be “Heart Smart is Brain Smart; Brain Smart is Mind Smart; and Healthy Brain Lifestyle Choices Prevents Stroke.” I end with a quote that has navigated my ‘cerebral musings’ on holistic health and Neurocentric Health. “Doing what is right is not the problem. It’s knowing what is right” by Lyndon B Johnson.
By Dr B P Shelley
Professor & Head, Department of Neurology
Fellowship in Behavioural Neurology (UK)
Fellowship in Cognitive Neurology & Disorders of Movement & Cognition (UK)
Editor in Chief, Archives of Medicine & Health Sciences Journal
Yenepoya Medical College, Yenepoya (deemed to be) University (NAAC accredited Grade ‘A’ University), Mangalore, Karnataka
