Spinal adhesive arachnoiditis (SAA) is a severe and potentially disabling complication of neurocysticercosis (NCC), but it remains poorly characterised. We conducted a retrospective descriptive case series including patients evaluated between 2000 and 2025 at a tertiary care hospital in Mexico City. Inclusion criteria includeda definitive NCC diagnosis, SAAconfirmedby magnetic resonance imaging(MRI), complete clinical and radiological data, and a minimum follow-up of 12 months. Eight patients were included. All presented the basal subarachnoid form of NCC with parasites located in the pontobulbar cisterns. At NCC diagnosis, all patients had intracranial hypertension and markedly abnormal cerebrospinal fluid. SAA was diagnosed concomitantly with NCC in three patients, while in the remaining five,diagnosis was established between 12 and 108 months later. At SAA diagnosis, all patients presented lumbar pain, motor deficits were observed in five, and sensory deficits in six. MRI confirmed lumbosacral SAA in all patients. Despite antiparasitic and symptomatic treatment, functional outcomes were generally poor: mean Karnofsky Performance Scale score decreased from 81.25 at SAA diagnosis to 71.25 after a mean follow-up of 128 months, with four patients showing progressive functional decline. In conclusion, SAA is a rare but disabling and likely underdiagnosed complication of extraparenchymal-NCC, characterised by delayed onset, persistent inflammation, and progressive functional decline despite treatment. The large volume of the lumbar intradural subarachnoid space may explain the frequent asymptomatic period preceding SAA diagnosis. Early recognition through systematic spinal MRI in patients with pontobulbar cistern NCC may represent a critical window for intervention.

PURPOSE:Etiologic patterns of epilepsy in low- and middle-income countries (LMICs) remain insufficiently characterized. We aimed to describe the causes and clinical features of active epilepsy in adults from seven Latin American (LA) countries using the 2017 ILAE etiologic classification. METHODS:We performed a retrospective multicenter case series based on medical records from 12 tertiary hospitals in Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Uruguay (2019-2023). Adults (≥16 years) with active epilepsy, defined as at least one seizure in the past five years or ongoing antiseizure medication (ASM) use, were included. Etiology was categorized using the 2017 ILAE classification. RESULTS:A total of 3033 patients were included (mean age 32 years; 53 % women). Most had focal-onset seizures (73.5 %), and 63 % showed epileptiform EEG abnormalities. Etiology was identified in 65 % of cases and remained unknown in 35 %. Structural etiologies predominated (47 %), followed by genetic (10.5 %), infectious (5.4 %), immune (1 %), metabolic/toxic (0.8 %), and neurodegenerative (0.3 %). The most frequent structural causes were hippocampal sclerosis (25.8 %), malformations of cortical development (24.8 %), and stroke (18.6 %). Neurocysticercosis accounted for 41.6 % of infectious cases but only 2.3 % of the entire cohort. Etiologic distribution varied across countries and age groups. CONCLUSIONS:In this large Latin American case series, structural etiologies were the leading identified cause of active epilepsy, while one-third-of cases remained of unknown etiology. The relatively low prevalence of neurocysticercosis contrasts with classical assumptions and highlights the need for updated, region-specific data. Population-based and incident studies remain essential to better define etiologic determinants across Latin America.

BACKGROUND:While the incidence of neurocysticercosis (NC) with viable parasites has been declining in Mexico and some other countries, this trend is not observed globally, and the burden of patients who have previously suffered from NC remains considerable. Cognitive manifestations are often overlooked in the clinical management of NC. In routine practice, patients are generally considered cured once viable parasites are no longer detectable, despite the potential for persistent neurological sequelae. OBJECTIVES:To evaluate the frequency, characteristics, and severity of cognitive sequelae in patients with a history of NC. METHODS:We conducted a cross-sectional, descriptive study at the National Institute of Neurology and Neurosurgery in Mexico City, between 2022 and 2024, involving 105 patients with a history of neurocysticercosis who had no viable parasites at the time of inclusion. Patients were categorized into three groups: parenchymal NC with a single calcification, parenchymal NC with multiple calcifications, and healed extraparenchymal NC who, at the time of NC diagnosis, had intracranial hypertension requiring ventriculoperitoneal shunt placement. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Results were compared to those from a healthy control group, matched with patients by age, sex and educational level. RESULTS:The results highlight a significant cognitive impairment in patients with a history of NC compared to controls: MMSE: 22 (Boppré et al., 2001- (Tseng et al., 2024) vs. 26 (Tseng et al., 2024- (Helmstaedter and Witt, 2017), p < 0.0001; MoCA: 20 (Tombaugh and McIntyre, 1992; Aguilar-Navarro et al., 2018; Cervigni et al., 2022; Del Brutto et al., 2019; Boppré et al., 2001; Rodrigues et al., 2012; Rabearisoa et al., 2024) vs. 25 (Rabearisoa et al., 2024; Hamamoto Filho et al., 2019; Tseng et al., 2024; Koivisto et al., 2013; Xiao et al., 2022; Helmstaedter and Witt, 2017), p < 0.0001. When comparing the three groups of patients, MMSE results showed a higher frequency of dementia in the patients with history of extraparenchmal NC (18 %) compared to the patients with history of parenchymal NC (0 %), p=0.001, while frequency of mild cognitive impairment was higher in the parenchymal group (78 %) vs. extraparenchymal grup (47.3 %), p=0.003. Notably, cognitive function was not influenced by the presence of active epilepsy, its treatment, or prior pharmacological or surgical interventions specific to NC. The MMSE and MoCA scores showed a significant positive correlation when all individuals included in the study were taken into account (r = 0.65, p < 0.0001), and this correlation remained significant when each patient subgroup was analyzed separately. CONCLUSION:The results of this work indicate that NC is associated with substantial cognitive sequelae, that should be recognized and addressed as part of comprehensive patient care.

Neurocysticercosis (NCC) remains a major public health problem in endemic countries. Clinical manifestations and therapeutic strategies vary depending on the location of the parasite. While the benefits of cysticidal treatment are well established for parenchymal and subarachnoid NCC, the optimal management of intraventricular NCC (IVNCC) remains controversial. We conducted a retrospective study of 51 patients: 37 (72.54%) received cysticidal treatment as initial therapy and 14 (27.45%) underwent neurosurgical intervention. Although six months after treatment, the proportion of patients with inactive disease was higher in the surgical group, no significant difference was observed after one year. Patients in both groups showed significant improvement in functionality as measured by the Karnofsky Index (KI), with no significant difference between groups. These results are consistent with cysticidal treatment being a valid therapeutic option for IVNCC, with the choice of management largely determined by the available medical infrastructure and the degree of specialization of healthcare personnel.

Background: Neurocysticercosis (NCC) is a frequent cause of epilepsy in endemic regions. An association between NCC and hippocampal sclerosis (HS), a key pathological substrate of mesial temporal lobe epilepsy, has been increasingly reported but remains controversial. Summary: A literature search was conducted in PubMed, Scopus, and ScienceDirect focusing on publications describing epilepsy due to NCC with HS. Twenty-three original articles, identified through 2023, were retrieved from Brazil, Ecuador, India, Mexico, and Korea. The proposed relationships between NCC and HS include incidental coexistence, NCC as an initial precipitating injury, and the presence of a third variable. While multiple hypotheses have been discussed and reported cases compiled, the precise nature of this association remains unresolved. Key Messages: Although the mechanisms underlying the relationship between NCC and HS are not fully elucidated, evidence supports their coexistence in patients with epilepsy. Recognition of this association is important for clinical evaluation and may guide future research on pathogenesis and management.

Taenia solium cysticerci are the etiological agents of neurocysticercosis, a leading cause of acquired epilepsy worldwide and a significant public health problem in endemic regions. The chronicity of the infection reflects a complex host-parasite interaction in which the parasite establishes long-term persistence through immunomodulatory mechanisms. In recent years, extracellular vesicles (EVs) have emerged as important mediators for some of these interactions. EVs are membrane-bound structures released by virtually every organism studied, which carry a diverse set of molecules that mediate intercellular communication. We isolated Taenia solium extracellular vesicles (TsEVs) from racemose cysticerci recovered from a patient, subsequently cultured in vitro, in order to characterize them by transmission electron microscopy, nanoparticle tracking analysis, and mass spectrometry-based proteomics. Effect of TsEVs on the production of reactive oxygen species (ROS) and myeloperoxidase (MPO) activity was evaluated in human neutrophils using fluorometric and colorimetric assays under basal and chemically stimulated conditions. Obtained TsEVs were under 200 nm in diameter. Proteomic analysis of four independent TsEV samples allowed identification of a core set of 336 proteins. Gene Ontology analysis of these vesicles was consistent with exosomes, as a number of exosome-associated marker proteins such as tetraspanins were identified. Proteins linked to immunomodulation and redox metabolism were also identified, suggesting a potential role in interactions with host cells. Finally, the effect of TsEVs on the respiratory burst of human neutrophils was evaluated, revealing a reduction in ROS production, primarily through inhibition of MPO activity, adding up evidence for the role of these vesicles in parasite's survival against the host immune response.

Calcified neurocysticercosis, the final stage of the disease, was until recently regarded as residual inactive scarring, with no clinical relevance in most cases. However, episodes of inflammatory reaction around calcifications associated with clinical symptoms have recently been described. We report here the 20-year radiological follow-up of a patient presenting 16 calcifications with multiple episodes of asynchronous inflammatory phenomena around several of them, not always associated with clinical symptomatology. This case is unique, showing the possibility of chronicity of this phenomenon, and the need to better understand the factors involved in determining the best management.

Neurocysticercosis (NC) is defined as an infection of the central nervous system by the larvae of Taenia solium. Intraventricular involvement occurs in approximately 7-30 % of cases, with the fourth ventricle being the most frequently affected site. The main complication associated with this form is the development of hydrocephalus, and the optimal therapeutic approach remains under debate. This case report describes a patient with intraventricular NC who achieved a successful outcome with medical management. The case is notable for several uncommon features, including cyst migration, calcification, and subsequent disappearance of the calcified lesion. It provides a valuable opportunity to explore and discuss this rare and poorly understood form of NC.

Cysticercosis in humans caused by the parasite Taenia solium is one of the World Health Organization’s Neglected Tropical Diseases. The parasite is transmitted between the human host and pigs. Efforts to prevent the disease have relied mainly on treatment of people with anthelmintics. However, to date, there is no practical and effective control method that has been delivered as a public health program. Here we describe a large-scale, minimum inputs T. solium control program implemented as a public health program in Madagascar. Initially all pigs were vaccinated for porcine cysticercosis and medicated with oxfendazole, after which only young piglets and pigs imported into the program area were targeted for interventions. After piglet interventions were in place and on-going, a single mass drug administration (MDA) was delivered to the human population with a taeniacide. The outcomes were assessed one year after the human treatment, by comparing pre-and post-intervention levels of porcine cysticercosis caused by T. solium and human T. solium taeniasis. Over a twenty-two-month period, 96,735 pig vaccinations and oxfendazole medications were delivered and during the MDA, 117,216 people received taeniacide. Ninety percent of the pig population were receiving vaccination and medication at the end of the intervention period. Coverage of the eligible human population by the MDA was 62.5%. Prior to the intervention 30.8% of slaughter-age pigs had viable T. solium infection, reduced to 8% after the program. Human taeniasis was found to be 1.25% prior to the MDA and 0.6% one year after the MDA. The program successfully demonstrated effective control of T. solium transmission to pigs using minimum inputs and delivered as a public health program. Sustained control and expansion of the program could potentially lead to the elimination of the disease being a public health problem in Madagascar.

Mass drug administration (MDA) programs involving praziquantel are used in public health programs to control diseases such as schistosomiasis, taeniasis caused by Taenia solium, opisthorchiasis and clonorchiasis. Praziquantel is a systemically distributed anthelmintic drug also used to treat neurocysticercosis (NCC) caused by the larval stages of T. solium in the central nervous system. The doses of praziquantel used in MDA are low compared to those used for the treatment of NCC, but in people with latent NCC (without symptoms or signs), there is a potential risk of neurological adverse events (AE) due to the development of inflammation around the cysts following administration. In Madagascar two large MDA campaigns aimed at T. solium were conducted using praziquantel in the Vakinankaratra region. Prior to the first MDA campaign, we implemented a program designed to minimize the occurrence of neurological AE and improve their management, which included training of health agents and community workers as well as health centres staff, population awareness, post-MDA active and passive surveillance and the supply of basic medicines to health centres. This program was repeated for the second MDA campaign. A total of 117,216 and 163,089 people were treated during the first and second MDA campaign respectively, with 10 participants experiencing serious AE, which were successfully managed. The beneficial results from our program in Madagascar can help other programs and countries using MDA with praziquantel in T. solium endemic areas to improve the safety of these campaigns.

Neurocysticercosis is caused by the establishment of Taenia solium cysticerci in the central nervous system. The extraparenchymal form (ExP-NCC) is the most severe clinical presentation that may remain asymptomatic for years. Current treatment involves cysticidal drugs (albendazole and/or praziquantel) combined with glucocorticoids to manage the associated neuroinflammation; however, only ∼30% of patients respond effectively. This highlights the need to improve therapeutic strategies. Herein, the experimental murine model of human ExP-NCC was further characterized to improve its usefulness in testing new therapies. In humans, cysts grow slowly in the basal cisterns of the subarachnoid space, and patients become symptomatic years after the infection. Thus, a long-term follow-up was performed by using magnetic resonance imaging (MRI) with sequences allowing volumetric analysis. MRI confirmed NCC in 77% of infected rats, all exhibiting extraparenchymal localization and persistently elevated levels of HP10, a marker of viable cysticerci. Imaging also enabled precise cyst localization and estimation of the parasite-occupied volume.

Extraparenchymal neurocysticercosis (EP-NC) responds poorly to anthelmintic treatment. Several factors are involved in this low responsiveness, including the host's heterogeneous immune response and the ability of the parasite to evade it. In this study, we present radiological and in vitro findings that demonstrate that Taenia solium cysts have the capacity to repair from injuries. Six patients (three with cases of subarachnoid, two with cases of intraventricular, and one with a case of mixed subarachnoid and intraventricular cysts) presented with neurological complaints and underwent either medical or surgical treatment. Follow-up magnetic resonance imaging (MRI) showed apparent resolution of the cysts. However, months later (10-56) new MRI scans revealed cysts at the same sites observed before treatment. Cysts surgically removed were maintained in RPMI-1640 medium supplemented with 10% fetal bovine serum. Monthly assessments demonstrated the growth of the parasites and the release of HP-10. Our findings demonstrate the ability of T. solium extraparenchymal cysts to grow and repair themselves. This capacity is likely another factor involved in the disease's poor treatment response.

Neurenteric cysts (NECs) are rare congenital, benign lesions of the central nervous system (CNS), predominantly located within the spinal cord. However, they may also occur less frequently within the brainstem, fourth ventricle, or cerebellopontine angle (CPA). Originating from anomalous interactions between embryonic layers, NECs are recognized for their potential to compress adjacent structures. We report a unique case of disseminated NECs exhibiting few to absent symptoms, which represents an unusual presentation of this disease, with only six similar reports in the literature. A 22-year-old female presented to our institute with chronic headaches resistant to nonsteroidal anti-inflammatory drugs (NSAIDs). Initially treated for intracranial hypertension (ICH) secondary to a cyst in the quadrigeminal cistern at the age of 17 via neuroendoscopic surgery and subsequent ventriculoperitoneal shunting, she experienced transient relief. However, follow-up at 22 years of age revealed multiple cysts in the basal and spinal cisterns, with MRI findings suggestive of neurocysticercosis. Despite treatment with albendazole and corticosteroids, subsequent MRIs showed no change in the size or number of the cysts. Six years later, symptoms had worsened, previously identified cysts had grown, and the detection of new cysts prompted surgical intervention. Histopathological examination confirmed the presence of NECs. This case highlights the diagnostic challenges posed by NECs, especially in regions endemic for neurocysticercosis, where clinical and radiological findings may initially suggest this condition. It underscores the importance of considering NECs in the differential diagnosis of cystic lesions in the CNS, even in the absence of typical symptoms of spinal cord compression. The recurrence and spread of NECs post-treatment demand a comprehensive management approach, encompassing surgical intervention and close monitoring.

Oxidative stress is associated with several infectious diseases, as well as the severity of inflammatory reactions. The control of inflammation during parasite destruction is a target of neurocysticercosis treatment, as inflammation is strongly related to symptom severity. In this study, we investigated the presence of malondialdehyde and protein carbonyl, two by-products of reactive oxygen species (ROS), in an experimental model of extraparenchymal neurocysticercosis. Twenty male and twenty female rats were inoculated with 50 cysts of Taenia crassiceps in the subarachnoid space of the cisterna magna. Ten animals (five males and five females) were used as controls. Three months after inoculation, their brains were harvested for oxidative stress and histological assessments. Infected animals had higher scores for inflammatory cell infiltrates, malondialdehyde, and protein carbonyl. These results encourage future efforts to monitor oxidative stress status in neurocysticercosis, particularly in the context of controlling inflammation.

Abstract Background This study aimed at describing the epidemiology of (neuro)cysticercosis as well as its clinical and radiological characteristics in a Taenia solium endemic district of Zambia. Methods This was part of a cross-sectional community-based study conducted in Sinda district to evaluate an antibody-detecting T. solium point-of-care (TS POC) test for taeniosis and (neuro)cysticercosis. All TS POC cysticercosis positive (CC+) participants and a subset of the TS POC cysticercosis negative (CC-) received a clinical evaluation and cerebral computed tomography (CT) examination for neurocysticercosis (NCC) diagnosis and staging. Results Of the 1249 participants with a valid TS POC test result, 177 (14%) were TS POC CC+ . Cysticercosis sero-prevalence was estimated to be 20.1% (95% confidence intervals [CI] 14.6–27.0%). In total, 233 participants received a CT examination (151 TS POC CC+ , 82 TS POC CC-). Typical NCC lesions were present in 35/151 (23%) TS POC CC+ , and in 10/82 (12%) TS POC CC- participants. NCC prevalence was 13.5% (95% CI 8.4–21.1%) in the study population and 38.0% (95% CI 5.2–87.4%) among people reporting epileptic seizures. Participants with NCC were more likely to experience epileptic seizures (OR = 3.98, 95% CI 1.34–11.78, p = 0.01) than those without NCC, although only 7/45 (16%) people with NCC ever experienced epileptic seizures. The number of lesions did not differ by TS POC CC status (median: 3 [IQR 1–6] versus 2.5 [IQR 1–5.3], p = 0.64). Eight (23%) of the 35 TS POC CC+ participants with NCC had active stage lesions; in contrast none of the TS POC CC- participants was diagnosed with active NCC. Conclusion NCC is common in communities in the Eastern province of Zambia, but a large proportion of people remain asymptomatic.

Neurocysticercosis (NCC) is a common parasitic disease of the central nervous system (CNS) in low- and middle-income countries. The infection is pleomorphic, caused by the larval form of the cestode, Taenia solium, and part of the heterogeneity of its clinical presentations is associated with the localization of the parasite within the CNS. Changes in the current epidemiological trends of NCC indicate that extra-parenchymal NCC is proportionally becoming more frequent. Extraparenchymal NCC is commonly accompanied by raised intracranial hypertension due to hydrocephalus, which is an emergency requiring cyst extirpation by surgical intervention to relieve the symptoms. Although less frequent, parenchymal cysts may also reach giant sizes requiring urgent surgical treatment. Finally, there is an advancement in the comprehension of the association between NCC and epilepsy—and patients with drug-resistant seizures are candidates for surgical treatment. In this narrative review, we summarize the present state of knowledge to update the current trends in the role of surgery in the treatment of NCC.

Background: Experimental models of neurocysticercosis (NCC) are helpful for an improved understanding of the pathophysiological mechanisms of human diseases and for testing novel therapeutic approaches. Controlling inflammation without reducing the effectiveness of anthelmintics is an important challenge in treating neurocysticercosis. This study investigates the effects of currently used drugs (Albendazole and Dexamethasone) in treating murine extraparenchymal NCC. Methods: Twenty-two rats were inoculated with Taenia crassiceps in the subarachnoid space. The animals underwent magnetic resonance imaging to ascertain the success of infection 3 months after inoculation. The infected animals were randomly assigned to one of the three groups (five rats each): control (no treatment), Albendazole (ABZ), or Albendazole + Dexamethasone (ABZ + DXM) for 14 days. The animals were subsequently euthanised for morphological assessment 2 weeks after the end of treatment. Results: Macroscopically integrated cysts were found in all animals. The ABZ + DXM animals demonstrated lower ventricular sizes, lymphocyte infiltration rates, and immunopositivity for IL-6, with statistical differences in lymphocytes within the arachnoid region. Conclusions: This experimental model, which has previously shown similarities to human infections, is also helpful in reproducing the morphological changes upon treatment with Albendazole and Dexamethasone.

The recently published 2021 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) data on neurological disorders represents a comprehensive analysis of 37 neurological conditions, amounting to a staggering 443 million disability-adjusted life-years (DALYs) affecting 43·1% of the global population.1GBD 2021 Nervous System Disorders CollaboratorsGlobal, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021.Lancet Neurol. 2024; (published online March 14.)https://doi.org/10.1016/S1474-4422(24)00038-3Google Scholar The ten leading conditions, in descending order, are stroke, neonatal encephalopathy, migraine, dementias, diabetic neuropathy, meningitis, idiopathic epilepsy, neurological complications from preterm birth, autism spectrum disorder, and nervous system cancer. Interestingly, data disaggregation shows that the burden of neurological disorders lies largely with low-income and middle-income countries (LMICs).1GBD 2021 Nervous System Disorders CollaboratorsGlobal, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021.Lancet Neurol. 2024; (published online March 14.)https://doi.org/10.1016/S1474-4422(24)00038-3Google Scholar, 2Knauss S Stelzle D Emmrich JV Korsnes MS Sejvar JJ Winkler AS An emphasis on neurology in low and middle-income countries.Lancet Neurol. 2019; 18: 1078-1079Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar In addition, the 2019 global burden of psychiatric disorders was estimated at 125 million DALYs.3GBD 2019 Mental Disorders CollaboratorsGlobal, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Psychiatry. 2022; 9: 137-150Summary Full Text Full Text PDF PubMed Scopus (1098) Google Scholar Although there exists some overlap between the nervous system burden quantified recently and the mental health figures for 2019, most notably because of the inclusion of autism spectrum and attention-deficit hyperactivity disorders in both studies, other highly prevalent conditions are not reflected in either study—ie, alcohol and drug use disorders and self-harm.1GBD 2021 Nervous System Disorders CollaboratorsGlobal, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021.Lancet Neurol. 2024; (published online March 14.)https://doi.org/10.1016/S1474-4422(24)00038-3Google Scholar, 3GBD 2019 Mental Disorders CollaboratorsGlobal, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Psychiatry. 2022; 9: 137-150Summary Full Text Full Text PDF PubMed Scopus (1098) Google Scholar Irrespective of some gaps, the message is clear: the burden from global brain disorders is enormous and increasing further, disproportionately affecting LMICs and surpassing any other disease category, including cancer and cardiovascular diseases. Sadly, resource allocation to the global brain health agenda, including mental health, is disproportionate to its burden and remains virtually absent. Concerted action regarding brain health seems of paramount importance in the light of global health efforts, social change, demographic transition, and increasing disease burden. For example, all countries—even in sub-Saharan Africa, which has one of the youngest populations in the world—are experiencing rapid demographic shifts towards an ageing population. In addition, governments are increasing the statutory retirement age, which means people older than 60 years are staying in the workforce for longer. These trends have important and far-reaching implications for global economic and social development—eg, affecting the knowledge economy, which is an important factor in countries' competitiveness. An immediate focus on brain health is, therefore, required. Brain health transcends traditionally separate disciplines, including neurology, neurosurgery, mental health, and neurodevelopment. However, despite the ever-growing socioeconomic importance of brain health and the increased use of the term brain health in multiple settings, this term has been a cause of debate. The definition currently proposed by WHO states: "Brain health is the state of brain functioning across cognitive, sensory, social-emotional, behavioural, and motor domains, allowing a person to realize their full potential over the life course, irrespective of the presence or absence of disorders."4WHOOptimizing brain health across the life course: WHO position paper.https://www.who.int/publications/i/item/9789240054561Date accessed: December 7, 2023Google Scholar This definition suggests that brain health is not a binary concept involving optimal or suboptimal functioning but encompasses a spectrum ranging from good brain health and wellbeing to disorders and consequent disabilities. The WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (WHO IGAP) provides evidence-based guidance to countries to achieve optimal brain health, with clear, measurable targets.5WHOIntersectoral global action plan on epilepsy and other neurological disorders 2022–2031.https://www.who.int/publications/i/item/9789240076624Date accessed: December 7, 2023Google Scholar The goal of the WHO IGAP is to "reduce the stigma, impact, and burden of neurological disorders including their associated mortality, morbidity, and disability, and to improve the quality of life of people with neurological disorders, carers, and their families". The WHO IGAP states that "to achieve the vision and goals of the IGAP, the prevention, treatment, and care of epilepsy and other neurological disorders should be strengthened" with an interdisciplinary and multisectoral focus "wherever possible, using existing entry points and synergies to achieve the best results for all".5WHOIntersectoral global action plan on epilepsy and other neurological disorders 2022–2031.https://www.who.int/publications/i/item/9789240076624Date accessed: December 7, 2023Google Scholar For example, ideas around mental health care systems and systems for chronic disease might also work for neurological disorders—eg, epilepsy, dementia, and stroke.6Patel V Saxena S Lund C et al.Transforming mental health systems globally: principles and policy recommendations.Lancet. 2023; 402: 656-666Summary Full Text Full Text PDF PubMed Google Scholar, 7Patel V Re-imagining the care delivery system for chronic conditions.Lancet Reg Health Southeast Asia. 2023; 13100232Google Scholar In addition, efforts to promote optimal brain health, in combination with preventive measures, coincide with managing risk factors for other high-burden non-communicable diseases, creating an advantageous situation for advancing brain health in collaboration with other disciplines and sectors.8Ding C Wu Y Chen X et al.Global, regional, and national burden and attributable risk factors of neurological disorders: the Global Burden of Disease study 1990–2019.Front Public Health. 2022; 10952161Crossref Scopus (44) Google Scholar At a time when the world is not on track to meet UN Sustainable Development Goal 3.4 (reducing premature mortality from non-communicable diseases), optimising brain health provides an overarching framework to drive progress on several fronts. However, it is impossible to address the large burden of global brain disorders unless radical change happens now. Such change should include the scaling up of evidence-based interventions through better integration of health-care services, including diagnostic and management approaches that transcend disease categories and provide a continuum of care tailored to the needs of the individual. In addition, there is a need for concerted action that targets known risk factors to reduce the incidence of brain disorders and promote brain health. Large investment in prevention—eg, through improved brain health (digital) literacy—will be necessary. Innovative solutions to gaps and needs (eg, human resources, digital technology, big data, community engagement, and financing) must be sought, and research in different global contexts must be promoted to generate new knowledge on brain health, especially novel strategies for prevention and care. National and global implementation of the WHO IGAP must be strongly supported, including a call for a research agenda, measurable indicators, implementation pathways, and monitoring and evaluation plans. Recommendations for WHO IGAP implementation need to be developed with consideration of national and regional particularities and entry points, on the basis of brain health principles such as equity and approaches involving life course and human rights. ASW, SG, SC, and KBP contributed equally to authorship. This study was not funded. We thank colleagues from WHO (Katrin Seeher, Neerja Chowdhary, and Nicoline Schiess) for their support in drafting the manuscript. TD is a staff member of WHO. ASW received funding from the German Federal Ministry of Education and Research for her work on brain health. The authors alone are responsible for the views expressed in this article, which do not necessarily represent the views, decisions, or policies of the institutions with which the authors are affiliated. We declare no competing interests.