Incidence of chronic subdural haematoma: a single-centre exploration of the effects of an ageing population with a review of the literature.

BACKGROUND: Chronic subdural haematoma (cSDH) is a common neurosurgical pathology frequently occurring in older patients. The impact of population ageing on cSDH caseload has not been examined, despite relevance for health system planning. METHODS: This is a single-centre study from the UK. Operated cases of cSDH (n = 446) for 2015-2018 were identified. Crude and directly standardised incidence rates were calculated. Medline and EMBASE were systematically searched to identify studies reporting on the incidence of cSDH by year, so an estimate of rate of incidence change could be determined. Local incidence rates were then applied to population projections for local catchment area to estimate operated cSDH numbers at 5 yearly intervals due to shifting demographics. RESULTS: We identified nine studies presenting incidence estimates. Crude estimates for operative cases ranged from 1.3/100,000/year (1.4-2.2) to 5.3/100,000/year (4.3-6.6). When non-operated cases were included, incidence was higher: 8.2/100,000/year (6.0-11.2) to 48/100,000/year (37.7-61.1). Four pairs of studies demonstrated incidence rate increases of 200-600% over the last 50 years, but data was deemed too heterogeneous to generate formal estimate of incidence change. Local crude incidence of operated cSDH was 3.50/100,000/year (3.19-3.85). Directly standardised incidence was 1.58/100,000/year (1.26-1.90). After applying local incidence rates to population projections, case numbers were predicted to increase by 53% over the next 20 years. CONCLUSIONS: The incidence of cSDH is increasing. We project a 53% increase in operative caseload within our region by 2040. These are important findings for guiding future healthcare planning.

Human embryonic stem cells: an experimental and therapeutic resource for neurological disease.

There is a great and unmet need for meaningful therapies that will deliver restorative solutions to patients with neurological disorders such as multiple sclerosis (MS), Parkinson's disease and stroke. The emergence of human embryonic stem cells as an experimental and therapeutic resource represents a major opportunity for brain repair. Embryonic stem cells offer the potential to study human cells, model disease, accelerate drug discovery and of themselves act as a cell-based therapy. In contrast to other organs, a "one size fits all" approach is inappropriate for repair of the brain; rather therapies need to be "bespoke". The design and development of embryonic stem-cell based CNS reparative strategies pose many challenges, both conceptual and practical. Using multiple sclerosis as an example, this paper addresses the needs for the translation of embryonic stem cell biology to regenerative neurology.