To learn about the status of neurological disease (ND) in the Middle East and North Africa (MENA) and its changes since 1990.

There is scarcity of evidence about epidemiological burden of ND from MENA.

We summarise latest estimates of disability-adjusted life years (DALYs), deaths, mortality, incidence, and prevalence for NDs and injuries stratified by age, sex, and risk factors in 21 countries of MENA following GATHER guidelines for reporting. Morbidity and mortality data are presented in absolute numbers and age-standardised rates; risk factors data are presented as population-attributable fractions (PAFs) of a neurological disorder due to a particular risk factor, with their associated 95% uncertainty intervals (UI).

In 2019, burden of NDs was 17·6 million DALYs (11·7%) in MENA. Total neurological deaths were estimated at 441·1 thousand (14·2%) with 64·6 million new events per year and 221·1 million (38·1%) prevalent neurological patients. Stroke (45·2%), migraine (21·6%), and dementia (6·9%) were the leading causes of DALYs. Likewise, stroke (70·8%) and dementia (16·0%) were the leading causes of neurological deaths. From 1990 to 2019, the crude number of DALYs and deaths related to meningitis, tetanus, and subarachnoid hemorrhage decreased, but all other NDs almost doubled. The highest increases in the number of deaths were respectively related to dementias (1·9-fold increase) and Parkinson's disease (1·8-fold). The age-standardised rates of NDs were either declining or showed minimal changes. In the region, up to 89·1% of age-standardised strokes and up to 54·7% of dementia DALYs per 100,000 were attributed to potentially modifiable risk factors and were thus preventable.

Stroke and dementia are the leading causes of neurological DALYs (52%) and deaths (87%). A large proportion of NDs (up to 89% of stroke and up to 55% of dementia) are attributable to modifiable risk factors that demand a synergistic lifetime intervention to minimise their burden.