Medical management, prevention and mitigation of environmental risks factors in Neurology

Abstract

The human environment and exposures arising therefrom are major contributors to neurological disorders ranging from stroke to neurodegenerative diseases. Reduction of exposure to environmental risk factors, with the goal of disease prevention or control, is addressed at the individual as well as the societal level and in recognition of differential subject vulnerability. We examine some practical solutions in high-income countries that may allow a better adaptation to environmental risks and reduce their adverse impact on the nervous system. We consider the citizen's role in reducing unhealthy exposures and explore new approaches to treatment.

Introduction

Protection of human health is the mandate of Neurology, as with any other branch of Medicine although, in practice and of necessity, the focus is often placed on human disease. Clinicians are required to diagnose, treat and thereby control or cure disease, while researchers more often seek causation so disease can be dissected, controlled or prevented. While primary disease prevention is the goal of all who practice Neurology, if the disease is already smouldering, secondary intervention at a subclinical stage has great merit, too. Alas, eventually all medical efforts will fail because life is a terminal condition, but it is surely better to die with disease than from disease. The question is what causes disease to begin in the first place, and the answer appears to be the interaction of factors internal and external to the human body, where the first is controlled by the genome/epigenome and the second by the exposome, meaning the totality of exogenous influences from conception forward.

We address issues related to the management, prevention and mitigation of environmental risks factors relevant to neurologists, to the extent they apply to adults living in mostly high-income countries. We underline the concepts of vulnerability and risk management, of which risk assessment is an integral component. We examine possible therapeutic solutions that may allow for better adaptation to these risks and even a remediation of their adverse effects on the human brain. Personalised medical advice and public health policies are scrutinized, as well as the influence of citizens’ concerns in health-policy decisions.