Neuroimaging techniques including magnetic resonance spectroscopy

James C. Johnston, MD, JD, is a board-certified neurologist and attorney whose current work focuses on global health issues in sub-Saharan Africa. He serves as an Honorary Professor in the Department of Neurology, Addis Ababa University, Ethiopia. In his quest to advance neurological care across the globe, Dr. James C. Johnston also serves as a Partner in Global Neurology Consultants and is the Founder and Director of Global NeuroCare, an NGO with UN Special Consultative Status.

Neuroimaging is an integral part of neurological practice for Dr. James C Johnston, whether in the United States or Africa. Neuroimaging entails the use of various techniques to directly or indirectly investigate the status of the brain or spine, and may include CT scans, MRI (magnetic resonance imaging), PET (positron emission tomography), ultrasonography, and functional imaging modalities. These tests are crucial for the accurate diagnosis and treatment of many patients with neurological diseases or disorders.

Magnetic resonance spectroscopy (MRS) is a non-invasive diagnostic test used to detect biochemical or metabolic changes in the brain, particularly for brain tumors as well as to detect tissue changes during strokes or epilepsy and evaluate Alzheimer’s disease and other conditions. This testing is typically performed in conjunction with more conventional studies in order to provide the most accurate diagnosis. For example, MRI may delineate the anatomical position of a brain tumor, while MRS detects the difference in chemical composition between normal brain tissue and the tumor which may, for example, allow differentiation of low grade from high grade gliomas, or distinguish recurrent brain tumor from radiation induced necrosis.

A conventional MRI machine is used to conduct MRS, which aims to analyze molecules such as protons or hydrogen ions. Proton MRS is the most common type of test. The spectroscopy consists of an additional series of tests to measure various metabolites of the metabolic processes, in order to differentiate between the various types of tissue and allow the most accurate diagnosis.

Many of these neuroimaging techniques including MRI are available globally, although scarce in the low resource nations. There are, for example, numerous CT machines and several MRI facilities in Addis Ababa, Ethiopia, but availability in the rural areas is limited to nonexistent, which precludes the accurate diagnosis and treatment of many patients. Dr. James C Johnston and one of his Ethiopian colleagues Dr. Mehila Zebenigus work through Global Neurocare to raise these concerns with various professional organizations, university medical centers, the World Health Organization and the United Nations.

Neurological Care in Developing Countries

Founder of non-profit NGO Global NeuroCare®, Neurologist James C. Johnston, MD, JD has dedicated significant time and resources to improving neurological care in some of the least developed regions in the world.

Dr. James C. Johnston focuses the NGO on sub-Saharan Africa (SSA), a region plagued by the ‘triple burden’ of ongoing communicable diseases, rapidly increasing non-communicable disorders such as cancer, stroke and heart disease, and escalating problems directly attributable to globalization including increased accidents, climate related health issues, and most notably, the current SARS-CoV-2 pandemic (also known as COVID-19 or the Wuhan virus).

The most significant factor beyond the current pandemic adding to the overall disease burden in SSA is the increasing incidence of non-communicable disorders. Ethiopian neurologist Dr. Mehila Zebenigus and Dr. James C. Johnston discussed these non-communicable disorders at the United Nations High Level Political Forum and last World Association for Medical Law conference, focusing on the neurological diseases which afflict tens of millions of people, typically the young, causing cognitive impairment and physical disability, leading to loss of employment, marginalization, increased vulnerability and exclusion, contributing to a profound impact on the economy. The Global Burden of Disease Study underscored the fact that these neurological disorders are the main cause of disability worldwide. (Global, regional and national burden of neurological disorders during 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurology 2017.).

There must be improved access to neurological care in SSA in order to manage the increasing incidence of these diseases, which mandates addressing extraordinarily complex challenges such as a severe shortage of healthcare workers, poor infrastructure, limited transportation, and a dearth of supplies, equipment and medications, all compounded by abject poverty with food and water insecurity.

Global NeuroCare® focuses on improving healthcare access by establishing collaborative partnerships to increase the number of neurologists in SSA, and has worked with the Addis Ababa University Department of Neurology for the past fifteen years. This autonomous training program has been extraordinarily successful, having graduated over fifty board certified neurologists since inception in 2006. These neurologists not only see tens of thousands of patients but more importantly they train the general physicians to manage some of the common neurological conditions such as stroke, epilepsy and neuropathy. This teaching is an essential means of improving care in SSA, where it is unlikely there will ever be enough neurologists to meet the burden of disease.

Drs. Zebenigus and Johnston will attend the upcoming UN Forum to discuss the importance of maintaining collaborative partnerships, and caution against withdrawing, limiting or redirecting resources from ongoing programs to address the pandemic, as this would lead to increased morbidity and mortality from neurological diseases.

Advancing Neurology in Africa

A neurologist and attorney, James C. Johnston, MD, JD, is the founder of Global NeuroCare, a nongovernment organization (NGO). Global NeuroCare was established by Dr. James C. Johnston to improve neurological services in developing regions. Dr. Johnston and one of his Ethiopian colleagues Dr. Mehila Zebenigus, serve as Directors of this organization.

Holding Special Consultative Status with the United Nations ECOSOC, the highest status granted to an NGO by the UN, Global NeuroCare has engaged in a long-term collaborative partnership with Addis Abada University Department of Neurology to advance the training of physicians in Ethiopia. The Neurology Residency Training Program has been an outstanding success, substantially increasing the number of practicing neurologists in the country, leading to the treatment of more patients. These neurologists are also teaching a new generation of doctors to manage common neurological problems which represents the most effective was to improve healthcare in regions with a severe shortage of doctors and other healthcare providers.

On behalf of Global NeuroCare, Dr. Johnston and one of his Ethiopian colleagues Dr. Mehila Zebenigus have discussed the medical, ethical and legal aspects of advancing healthcare in developing regions at several meetings over the recent years including the United Nations High Level Political Forums, World Congresses for Medical Law and American Academy of Neurology conferences. They have highlighted the serious concerns of short term medical missions which fail to provide any substantive benefit to the host nation, and may cause significant harm to the local population. An additional concern is that developing nations have inherently vulnerable populations that may be intentionally or unintentionally exploited by these types of brief self-serving medical missions.

Drs. Zebenigus and Johnston presented the Ethiopian model to demonstrate that effective capacity development requires increasing the recruitment, training and retention of medical staff, which mandates stable long-term collaborative North-South partnerships focused on establishing local training programs, staffed by local physicians, to address the particular local community needs. They recently published a white paper for the UN on this topic, and will be present those recommendations at the 26th Congress Meeting of the World Association for Medical Law.

GLOBALNEUROLOGY® REPORT: TUBERCULOSIS – WHO GLOBAL TB REPORT

Tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis, most often affects the lungs, and is spread through the air from person to person.  TB may involve the brain, spine, kidney, or joints, and less commonly other organs or body systems.  Almost one-quarter of the world’s population harbours latent TB, meaning they have been infected but are not yet ill with the disease.  TB is the leading cause of death from a single infectious agent, and remains one of the top ten causes of death globally.

The most recent WHO Global TB Report confirms that 7 million people were diagnosed and treated for TB in 2018, meeting one of the milestones towards the UN Political Declaration Targets on TB.  Although the number of new cases of TB has recently declined, the burden remains very high in the least developed nations especially in sub-Saharan Africa, and in India, China and Russia.  There are an estimated 3 million people with TB who are not receiving treatment, and progress must be accelerated in order to attain the Sustainable Development Goal (SDG 3.3) of ending TB by 2030.  https://www.who.int/tb/global-report-2019

In the least developed nations, the combination of limited infrastructure, severe shortages of physicians and other healthcare providers, and lack of medications precludes the effective diagnosis and treatment of many diseases including TB.  Drs. James C. Johnston and Mehila Zebenigus have discussed these concerns and provided recommendations to improve care in developing regions at the American Academy of Neurology meetings and World Congress of Medical Law conferences as well as in the peer-reviewed literature.  Comprehensive programs with international support and monitoring are essential, and there must be a focus on children since half of children with TB do not receive quality care and only one-quarter of children under 5 years of age in TB-affected households currently receive preventive treatment.

Another serious impediment to ending TB is drug resistance which affects half a million patients annually, with only one in three of those patients receiving treatment.   WHO recently provided new guidelines for improving treatment of multi-drug resistant TB and is working with civil society organizations (CSO) to address this problem.

Global NeuroCare® is a non-profit CSO in Special Consultative Status with the UN ECOSOC and fully supports the comprehensive efforts to achieve the 2030 SDG 3.3 of ending the TB epidemic.  Directors James C. Johnston, MD, JD and Mehila Zebenigus, MD provided recommendations for addressing TB and other conditions at the UN High Level Political Forum earlier this year, and at the 2018 Commission for Social Development.

Global Neurocare Works with the UN to Combat Neurological Disorders

A prominent neurologist and medical law specialist, Dr. James C. Johnston has been in private practice for nearly 30 years. In addition to his work as a neurologist, James C. Johnston, MD, JD, also serves as a partner with Global Neurology Consultants, where he is mostly concerned with improving health care quality and access in developing regions. To further this vision, Dr. Johnston founded Global Neurocare, a nonprofit organization dedicated to advancing patient care and increasing medical training and research in developing countries such as Ethiopia.

Neurologists are scarce and resources limited in these developing regions, resulting in the needless deaths of those suffering from neurological disorders every day. Global Neurocare was granted Special Consultative Status with the United Nations in 2013, the highest status granted to a non-governmental organization. The Economic and Social Council (ECOSOC) Committee at the United Nations looks at numerous applications to find non-governmental organizations that coincide with the aims and purposes of other United Nations programs.

Members of organizations granted Special Consultative Status are able to serve as UN delegates at sessions in various locations around the world. Global Neurocare’s status with the UN allows it to raise public awareness, implement international trade agreements, and provide expert analysis on relevant issues, among other benefits. Neurological disorders are recognized by the World Health Organization as one of the greatest threats to public health, and organizations such as Global Neurocare are poised to help with the crisis.