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Neurological aspects of tropical disease
  1. JEREMY FARRAR
  1. Wellcome Trust Clinical Research Group, Centre for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam
  2. Department of Paediatric Neurosciences and International Child Health, PO Box 230, Kilifi, Kenya
    1. CHARLES NEWTON
    1. Wellcome Trust Clinical Research Group, Centre for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam
    2. Department of Paediatric Neurosciences and International Child Health, PO Box 230, Kilifi, Kenya

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      The set of six review articles Neurological aspects of tropical disease published in this and subsequent issues of the Journal is an attempt to highlight some of the important neurological diseases in the tropics. We make no apologies for choosing six infectious diseases, as we think that such diseases still represent the major burden of disease in the developing world. We cannot hope to provide a comprehensive review of the subject and the selection of what to include may not be everyone's choice. All the authors are currently (or were until very recently) involved in clinical practice or in research in the conditions that they review. In the United Kingdom, tropical medicine has traditionally been the preserve of specialists, usually allied to departments of infectious diseases. There are strong historical and contemporary reasons for this and on balance the discipline has been well served by the arrangement. However, the subspecialiies in internal medicine in the developed world have progressed so much over the past few years that it is almost impossible for the true generalist (the tropical medicine specialist) to maintain an up to date grasp of each specialty. Such knowledge is critical in tropical medicine. Although a patient may present with malaria or tetanus the management challenges are often those of the paediatrician, the renal physician, the cardiologist, or the neurologist. The development of subspecialties in paediatrics has lagged behind those in adult medicine. For example there are only a handful of paediatricians who have been trained in paediatric neurology and developmental medicine working in sub-Saharan Africa, besides South Africa. The impact of infectious diseases and nutritional deficiencies has only become evident recently.

      We hope that this series will achieve three things. The first is to provide a contemporary review of neurological infectious diseases important in the tropics. The increased mobility of people and globalisation of disease means that neurologists world wide may be asked to see such patients in their own practice. We hope that the reviews will be helpful in guiding management in that setting. Access to medical information is still difficult in much of the tropical world. Our second hope is that the Journalwill make this series available to areas of the world where it is not usually read.

      Our third hope is that these articles may stimulate neurologists, paediatricians, and psychiatrists (and those in training in these specialties) in the United Kingdom and beyond to become more actively involved in clinical practice and research in neurological diseases in the tropical world. There is no doubt that infectious diseases will continue to be a major cause of morbidity and mortality in the tropics and hence the emphasis in this series on such diseases. However, the Global Burden of Disease Study has predicted that patterns of disease will change dramatically by the year 2020 with an increase in the incidence of non-communicable diseases. There is very little reliable information on the burden of psychiatric conditions, epilepsy, cerebrovascular disease, or other diseases affecting the nervous system in the tropical world. As the specialty of tropical medicine evolves to become a specialty of medicine in the tropics the interaction with other disciplines such as neurology, developmental medicine, psychiatry, and rehabilitation should become increasingly important.

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