Year: 2026
Type: article
Abstract: Introduction: Cuban epidemic neuropathy (CEN), which emerged in the early 1990s during Cuba's Special Period, was one of the largest neurological epidemics of the 20th century and became the subject of a scientific and political controversy. Objective: To revisit the epidemic and examine the lessons learned from the scientific debates, institutional responses, and political context that shaped its investigation and management. Development: This perspective integrates epidemiological, clinical, neuropathological, therapeutic and health evidence, to analyze competing etiological hypotheses and the influence of geopolitical and institutional factors on scientific interpretation. Accumulated evidence-including severe dietary restriction, depletion of B-group vitamins and other nutrients, increased metabolic demands, tobacco and alcohol exposure, and axonal pathology-supports a multifactorial toxic-nutritional model, over a viral agent. Nutritional depletion may have reduced mitochondrial metabolic reserve, antioxidant and detoxification capacity, and increased oxidative stress. Mitochondrial dysfunction and oxidative injury provide a convergent mechanism for selective vulnerability of the optic nerve and peripheral axons. Therapeutic implications underscore the benefit of early nutritional intervention even when the specific contributions of individual nutrients or toxins remain uncertain. The scientific controversy illustrates how geopolitical and institutional factors influenced the interpretation of science, research priorities, communication, and public health decision-making. Conclusion: CEN demonstrates the importance of multidisciplinary evidence, scientific independence, transparent communication, early intervention, and recognition of social determinants in neurological epidemics. These lessons remain highly relevant as Cuba today confronts renewed economic hardship and disturbing geopolitical challenges in progress.
Source: Frontiers in Pharmacology
Institutions: Instituto de Neurologia Y Neurocirugia, University of Havana
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
Funder: FrontierSI
Award: G9001250027
OpenAlex ID: W7221753195