El desafío de la neuropatía óptica epidémica cubana / The challenge of the Cuban epidemic optic neuropathy

A partir del trienio 1989-1991 la economía cubana comenzó a debilitarse por la caída de los precios del azúcar y el petróleo, así como por el descenso de la cotización del dólar americano y la desintegración de la Unión Soviética, que trajo aparejada la carencia de divisas convertibles, combustibles, alimentos, y además imposibilitó la solicitud de créditos a instituciones financieras internacionales. Se inició, así, el llamado «período especial¼, fundamentado en un plan para enfrentar un posible bloqueo militar en tiempos de paz, y durante el cual fueron racionalizados estrictamente los alimentos y disminuyeron las industrias esenciales y el transporte. En tales circunstancias apareció una rara enfermedad que se convirtió en epidemia, la cual fue nombrada neuropatía óptica epidémica cubana; esta afectó a más de 50 000 cubanos y se convirtió en un verdadero desafío para la comunidad médica del país. Al respecto, en el presente artículo se analizan sucesos históricos relacionados con el surgimiento de dicha oftalmopatía, se defiende la teoría de su causa tóxico-nutricional debido a la situación de Cuba en aquel momento y se destaca el liderazgo del Comandante en Jefe Fidel en la conducción de las acciones multidisciplinarias que llevaron a controlar dicha epidemia, lo que resultó un logro para el Sistema Nacional de Salud y un triunfo de la Revolución cubana.

Since the triennium 1989-1991 the Cuban economy began to weaken due to the fall of sugar and petroleum prices, as well as due to the descent in the rate of the American dollar and due to the disintegration of the Soviet Union that brought the lack of convertible foreign currencies, fuels, foods, and disabled the application of credits to international financial institutions. This way, began the so call "special period", based in a plan to face a possible military blockade in times of peace, and during which foods were strictly rationalized and the essential industries and transport diminished. In such circumstances a strange disease appeared that became epidemic, which was named Cuban epidemic optic neuropathy; it affected more than 50 000 Cubans and became a true challenge for the medical community of the country. In this respect, historical events related to the emergence of this ophtalmopathy are analyzed in this work, that defends the theory of its toxic-nutritional cause due to the situation of Cuba in that moment and the leadership of Commander in Chief Fidel is outstanding in the conduction of the multidisciplinary actions that lead to control this epidemic, what became an achievement for the Health National System and a victory of the Cuban Revolution.

Cuban Epidemic Neuropathy: Insights into the Toxic-Nutritional Hypothesis through International Collaboration.

From 1991 to 1993, an epidemic of optic and peripheral neuropathy-the largest of the century-broke out in Cuba, affecting more than 50,000 people. Initially the main clinical features were decreased visual acuity, central and cecocentral scotomas, impaired color vision and absence of the papillomacular bundle. Later, peripheral and mixed optic-peripheral forms began to appear. Due to the magnitude of the epidemic, the Cuban government requested help from the international community at the 46th World Health Assembly in 1993. PAHO and WHO immediately responded by sending a mission of international experts. Several hypotheses regarding the pathogenesis of Cuban epidemic neuropathy were put forward including: toxic, nutritional, genetic and infectious. The authors refer to extensive studies by researchers sponsored by the Cuban government and PAHO/WHO, joined by scientists from several other countries, including the USA. This paper describes their multidisciplinary work, particularly devoted to investigating the hypothesis of a primary toxic-nutritional cause of the epidemic. Clinical aspects, such as case definition and clinical description, were vital issues from the start. Cuban physicians who first examined patients received a clear impression of its toxic-nutritional origin, later confirmed by international experts. Research then focused on the mechanisms contributing to damage under the toxic-nutritional hypothesis. These included injuries to the mitochondrial oxidative phosphorylation pathway, nutritional deficiencies, excitotoxicity, formate toxicity and dysfunction of the blood-brain barrier. It was expected that the results of such international collaboration into this major health problem would also shed more light on mechanisms underlying other nutritional or tropical myeloneuropathies. KEYWORDS Optic neuritis, optic neuropathy, peripheral neuropathy, neurotoxicity syndromes, disease outbreaks, international cooperation, Cuba Erratum: Page 30, first complete paragraph, line 7, "Two models were developed independently by Cuban researchers" should read "Two models were developed independently by AAS and AGQ."