Motor Neuron Disease (MND) And Its Impact on The Health of New Zealand
Glenda and Grant Lovatt. Grant has motor neurone disease and his wife cares for him full-time. Photo / Greg Bowker
In June 2018，New Zealand Herald revealed a commentary by Emma Russell coverage a brand new study has found that New Zealand’s motor neuron disease (MND) death rate is that the highest in the world and five times the worldwide average (Cao et al., 2018).
In New Zealand, MND affects more than 800 people and kills two people a week, and neurological disease data researched by Global Burden of Disease (GBD) found New Zealand motor neuron disease mortality rates as high as 2.2 per 100,00 (Feigin et al., 2017, Logroscino et al., 2018). According to the study, People in New Zealand may have a higher risk of developing the MND than one in 300 people, most of whom die within 15 to 20 months of the attack (Chiò et al., 2013, Scotter, 2015). In mobile nerve cell systems, death usually occurs every 2 to 5 years when the main symptoms of weakness occur. Amyotrophic lateral inhibition accounts for 70% of cases, and the alternatives are progressive muscular atrophy, progressive paralysis of neural structures, and lateral sclerosis (Chiò et al., 2013).
According to the World Health Organization’s (2018) Noncommunicable Diseases （NCDs） Country Profiles, NCDs are estimated to account for 89% of all deaths in New Zealand. GBD further identifies trends in health loss(Logroscino et al., 2018). While it does not tell us why New Zealand has the highest mortality rates for MND, it does help to set priorities for global health research and funding. Governments need to give better consideration to funding research priorities, as neurological disorders are the world’s leading cause of disability and the burden is increasing rapidly. A severe shortage of neurologists in New Zealand may also be a factor to be addressed, as MND patients wait up to 15 months to consult a specialist. Although the disease is incurable, early diagnosis can help slow progression (Karikari et al., 2018).
So far, there are many theories about the causes of MND. These include exposure to environmental toxins and chemicals, infection by viral agents, immune-mediated damage, premature aging of motor neurons, loss of growth factors required to maintain motor neuron survival, and genetic susceptibility (Goldstein et al., 2002). Studies have identified possible links to previous exposure to pesticides, pesticides and various heavy metals, high-intensity exercise, and exposure to mechanical or electric shock injuries (Harwood et al., 2009). However, the evidence obtained in these studies is often unconvincing and there are no clear conclusions.
In addition to exposure to environmental factors that may lead to the development of distributive MND. The risk of NMD may be associated with certain occupations and industries in New Zealand, in particular, some agricultural occupations associated with increased risk (Kiernan et al., 2011). The occurrence of the NMD may also be genetically related, with studies showing higher rates of moroseness among Maori and Pacific populations, but further research is needed to understand the causes of higher mortality rates than in other countries (Chancellor and Warlow, 1992).
There is no suggestion on how to reduce the risk of MND, and researchers around the world continue to try to figure out what causes MND, with the ultimate goal of finding out how to stop, slow down, or prevent the disease.
Reference List:
CAO, M. C., CHANCELLOR, A., CHARLESTON, A., DRAGUNOW, M. & SCOTTER, E. L. 2018. Motor neuron disease mortality rates in New Zealand 1992–2013. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 19, 285-293.
CHANCELLOR, A. & WARLOW, C. 1992. Adult onset motor neuron disease: worldwide mortality, incidence and distribution since 1950. Journal of Neurology, Neurosurgery & Psychiatry, 55, 1106-1115.
CHIÒ, A., LOGROSCINO, G., TRAYNOR, B., COLLINS, J., SIMEONE, J., GOLDSTEIN, L. & WHITE, L. 2013. Global epidemiology of amyotrophic lateral sclerosis: a systematic review of the published literature. Neuroepidemiology, 41, 118-130.
FEIGIN, V. L., ABAJOBIR, A. A., ABATE, K. H., ABD-ALLAH, F., ABDULLE, A. M., ABERA, S. F., ABYU, G. Y., AHMED, M. B., AICHOUR, A. N. & AICHOUR, I. 2017. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet Neurology, 16, 877-897.
GOLDSTEIN, L., ATKINS, L. & LEIGH, P. 2002. Correlates of quality of life in people with motor neuron disease (MND). Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders, 3, 123-129.
HARWOOD, C. A., MCDERMOTT, C. J. & SHAW, P. J. 2009. Physical activity as an exogenous risk factor in motor neuron disease (MND): a review of the evidence. Amyotrophic Lateral Sclerosis, 10, 191-204.
KARIKARI, T. K., CHARWAY-FELLI, A., HÖGLUND, K., BLENNOW, K. & ZETTERBERG, H. 2018. Commentary: global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Frontiers in neurology, 9, 201.
KIERNAN, M. C., VUCIC, S., CHEAH, B. C., TURNER, M. R., EISEN, A., HARDIMAN, O., BURRELL, J. R. & ZOING, M. C. 2011. Amyotrophic lateral sclerosis. The lancet, 377, 942-955.
LOGROSCINO, G., PICCININNI, M., MARIN, B., NICHOLS, E., ABD-ALLAH, F., ABDELALIM, A., ALAHDAB, F., ASGEDOM, S. W., AWASTHI, A. & CHAIAH, Y. 2018. Global, regional, and national burden of motor neuron diseases 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 17, 1083-1097.
SCOTTER, E. L. 2015. Motor Neurone Disease: bringing New Zealand patients onto the world stage. NZ Med J, 128, 12-4.
Hi Lejia
Thanks for drawing my attention to MND in NZ, I was totally unaware that the prevalence was so much higher there. What an emotional, physical, and economic burden for individuals, families and the country as a whole. I really see the urgent need for more neurologists; however, it also seems like far more scientific/medical studies are needed to see if the cause of this increased incidence of MND can be isolated. I have only been to NZ a few times, but agriculture is clearly very dominate on the South Island, and in last year’s Sustainable Food Systems course the country seemed to be leading on agricultural technology and innovations, so it’s worrying to think that agriculture may play a contributing role in terms of environmental factors causing MND. Farming is one of the country’s biggest sources of employment with 6% of the workforce, which is large for a HIC (USA 2%; UK 1.5%) so on a simplistic level it would therefore make sense that ‘if’ there is a link between farming and MND the higher proportion of people in this field may explain it. In terms of genetic predisposition by the Maori, that sounds fascinating, and I am really surprised that more studies have not looked into this. Do you think the underfunding of studies is due to the low total population of NZ and or its relative geographic isolation which limits accessibility for primary data collection? I am also wondering if this is a relatively recent phenomena?
Thanks for the great read,
Bridget
Hi Bridget,
Thanks for your comment and I am inspired to have a more depth analysis about the causes of MND.
The following article may have new implications for MND triggers.
https://oem.bmj.com/content/76/5/309.abstract?casa_token=Y25sbHS9vCMAAAAA:rUe8hukAoyAWbGYD76scCYyjmsXsHayOrFP_oAY_ovdfR3hvOVpRvK6_hR0_0_fBCciZMaa1-1W_
The government’s chronic lack of funding for NMD has limited MND research to some extent, but in recent years MND-related conferences organized by academic researchers and private-owned organizations have made a remarkable contribution to the implementation of new and further research, such as ‘MND New Zealand’
You can find out more about ‘MND New Zealand’ at the link below: https://mnd-org-nz.translate.goog/?_x_tr_sl=en&_x_tr_tl=zh-CN&_x_tr_hl=zh-CN&_x_tr_pto=nui,sc
Thank you again!
Lejia
This is really interesting. I do think that MND isn’t spoken about enough and especially in a developed country like New Zealand this is surprising. You would think that there would be more interest and funding into researching MND as it affects so many. Do you know why so little research has been done? I think that MND definitely could be genetic but regardless, in your opinion, do you think there is anything that can be done to reduce the risk? (apart from more research…)
Hi,
Thanks for your comment.
As you mentioned, MND’s threat to New Zealand’s entire public health system is not proportional to government funding, but it is gratifying that in recent years there have been growing interest in research teams working on MND and making progress, such as ‘MND New Zealand’
An interesting phenomenon is ‘MND New Zealand’ relies almost all on the generosity of the New Zealand community to the to provide support, educate, advocate and progress research.
If you are interested, you can find out more at the link below: https://mnd-org-nz.translate.goog/?_x_tr_sl=en&_x_tr_tl=zh-CN&_x_tr_hl=zh-CN&_x_tr_pto=nui,sc
Lejia
Thanks for drawing my attention to MND in NZ, I was totally unaware that the prevalence was so much higher there. What an emotional, physical, and economic burden for individuals, families and the country as a whole. I really see the urgent need for more neurologists; however, it also seems like far more scientific/medical studies are needed to see if the cause of this increased incidence of MND can be isolated. I have only been to NZ a few times, but agriculture is clearly very dominate on the South Island, and in last year’s Sustainable Food Systems course the country seemed to be leading on agricultural technology and innovations, so its worrying to think that agriculture may play a contributing role in terms of environmental factor causes MND. Farming is one of the country’s largest sources of employment with 6% of the workforce, which is large for a HIC (USA 2%; UK 1.5%) so on a simplistic level it would make sense that ‘if’ there is a link to farming and MND the higher proportion of people in this field may explain it. In terms of genetic predisposition by the Maori, that sounds fascinating, and I am really surprised that more studies have not looked into this. Do you think the underfunding of studies is due to the low total population of NZ and or its relative geographic isolation which limits accessibility for primary data collection?
Bridget
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