Earthquake Disaster and Turkish Neurology

By Prof. M. Akif Topcuoglu

On Feb. 6, 2023, two major earthquakes occurred, nine hours apart, with epicenters in Gaziantep and Kahramanmaraş in Turkiye. In this disaster, called the 2023 Turkiye-Syria earthquakes,” nearly 43,000 people died in Turkiye and 6,000 people in Syria. A total of approximately 150,000 people were injured, of which 120,000 were in Turkiye. It is estimated that at least 3 million people migrated from the affected zone to different cities after the earthquakes. Aftershocks still continue and pose a serious risk for rescue teams. Earthquakes affected 13.5 million Turkish people in an area of 1,000 square kilometers. This refers to about one-seventh of Turkiye’s population.

From the first news of the catastrophe, both state institutions, organizations, and volunteers rushed to the earthquake zone. Especially in Hatay and Maraş, there was such a severe destruction that the emergency response teams were also affected. The frigid, snowy weather and the fact that people were caught asleep increased our loss and made emergent intervention difficult. Significant assistance came from many countries around the world. As a result of these efforts, many lives were saved in a short time, and life was attempted to be restored as fast as possible. This effort still continues at the highest level.

Turkish medicine intervened in the earthquake with great effort. Although there was a short-term overcapacity in some regions, all of the injured could be taken to hospitals, and all necessary interventions could be made with the system created all over the country. The Turkish Neurological Society provided containers, heaters, portable beds, and generators in line with the demands of the regional neurology clinics and within its capacity. Our society is going to continue its academic and physical aids so that life in the region can be re-established as soon as possible.

Unfortunately, nearly 100 doctors died in the earthquake, and five of them were neurologists. These friends passed away in the most hopeful and productive period of their lives. Our sadness is endless and unbearable. We have written this article to share this disaster experienced with the neurologists all over the world. As the Turkish Neurological Society, we want to keep the memory of these five colleagues alive. We will miss them very much. •

Prof. M. Akif Topcuoglu is president of the Turkish Neurological Society

 

Bessam Ezelsoy, MD

Bessam Ezelsoy, MD

Bessam Ezelsoy was born in 1961 in Hatay. He graduated from Istanbul University Faculty of Medicine in 1985. He completed his neurology residency training at Bakırköy/Istanbul Sadi Konuk Training and Research Hospital in 1994. He was working as a neurologist at Hatay Training and Research Hospital. He was recognized by his patients as a warm, tolerant, and understanding doctor. In 2015, he was selected as the doctor of the year in Hatay. We unfortunately lost Dr. Ezelsoy and his beloved wife in the 7.7 magnitude earthquake that occurred in our country on Feb. 6, 2023. Dr. Ezelsoy’s two children survived the earthquake. That was our only consolation.

 

Eda Kahiloğulları Aşkar, MD

Eda Kahiloğulları Aşkar, MD

Eda Kahiloğulları Aşkar was born in 1995 in Antakya. She was continuing her neurology residency training at Mustafa Kemal University, Tayfur Sökmen Medical Faculty, Department of Neurology. Colleagues remember her for her kindness, helpfulness, sincere smile, and hard work. Unfortunately, she passed away in the earthquake with her beloved husband. She loved neurology very much, and there is no doubt that she would have been a very good neurologist.

 

 

Bircan Turunc, MD

Bircan Turunc, MD

Bircan Turunc was born in Antakya in 1992. She graduated from Maltepe University Faculty of Medicine in 2019. Her friends describe her as “beautiful on the outside but more beautiful inside.” We lost our angelic and devoted friend and cat guardian, Dr. Turunç, at a very young age. Had she lived, we are sure that she would have touched many patients and become a very successful physician and neurologist. Unfortunately, we live in a time when words become meaningless in Turkiye.

 

Murat Güntel, MD

Murat Güntel, MD

Murat Güntel was born in 1984. He graduated from Mersin University Faculty of Medicine in 2009. He completed his neurology residency training at Hatay Mustafa Kemal University Faculty of Medicine in 2015. Between 2015 and 2016, he worked as a neurologist at Elazig Training and Research Hospital. He had been working as an assistant professor at Mustafa Kemal University Tayfur Sökmen Faculty of Medicine, Department of Neurology since then. He was a prolific academic with numerous case and research articles in international journals. He was described by his colleagues as a friendly, hardworking, kind, and wonderful person. He was loved by his students and patients. He died in the earthquake disaster with his beloved mother and two cats.

 

Tülay Yücel, MD

Tülay Yücel, MD  

Tülay Yücel was born in 1959 in İzmir. She graduated from Ankara University Faculty of Medicine in 1984. She completed her neurology specialization training at Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital in 1991. Dr. Yücel was working as a retired-freelance neurologist. She, her daughter-in-law, and 6-month-old granddaughter lost their lives in the earthquake in Hatay.

The Success of the JSN 60th Congress

By Raad Shakir, Susumu Kusunoki, and Hidehiro Mizusawa

Neurology typically flourishes in the country that hosts a World Congress. It was most evident during Japan’s annual congress held May 22-25, 2019, in Osaka.  The sense of achievement of holding the largest ever WCN in Kyoto 2017 is clear to see.

There may also be a sense of internationalism and globalization driving the Japanese Society of Neurology in its efforts to showcase what is happening in Japan generally, and in neurology specifically.

The plenary session

The specific issues related to the Japanese aging population coupled with a diminishing workforce are much on the minds of all.  Neurology will play a major role in supporting this rather specific situation. It is clear that neurology needs to expand on the service side as well as in research and development. This will happen with the dedication and perseverance of JSN to show government that neurological diseases are a major cause of disability, especially in an aging population.

This year’s congress is the first in the new imperial era Reiwa, which best translates to “peaceful harmony.” It is clear that the future of neurology is secure and prospering. The congress attracted 7,900 participants, which is another record.  There were sessions in English throughout with 47% of scientific symposia and 43% of oral sessions being in English.

What was noticeable is that not only international speakers, but more importantly, Japanese neurologists and neuroscientists were presenting in English to packed halls. This trend extended to poster sessions, and 40% were in English. This makes international publication of Japanese work easier for all concerned. It was easy for the non-Japanese speakers to have a choice of topics throughout the day.

Prof. Susumu Kusunoki, congress president; Prof. Tatsushi Toda, president of JSN; Prof. Hidehiro Mizusawa, president of WCN 2017; and members of the board have worked hard to produce a rich program with 718 oral presentations and 1,200 posters.

Some of the speakers and the JSN board.

The Japanese scientific output is impressive and increasing, which was reflected in the topics of the congress. Work on neurogenetics, neuroimmunology, and other neuroscience new frontiers was most impressive, and the session halls offered standing room only.  There were 55 international invited speakers enriching the program.

It is most noticeable that East Asian original work was evident, and the support provided to neurologists from China, Korea, Mongolia, and Taiwan, among others, was important to showcase the involvement of the JSN in promoting regional neurology.

Post-WCN Kyoto 2017, neurology in Japan has definitely grown and prospered. Perhaps more importantly, it created a sense of even more internationalist engagement, which will prove to be crucial for the progress of neurology in Japan as well as globally.

The involvement of JSN in the Asian and Oceanian Association of Neurology (AOAN) is longstanding and fundamental. It is important to note the Japanese neurologists are founding members, and their continued support has been cemented by the success of WCN Kyoto 2017. The region certainly needs all of the support both financial and scientific as it has the largest world populations with its clear and enormous needs.  In order for neurology to flourish, the JSN has always played its role in support and participation in all regional and international activities.

The JSN currently has 9,169 members, which makes it one of the larger national societies and this places an obligation on the JSN board to advise, guide, and support neurologists from across the world especially those from low and low middle income countries.  This is certainly advanced by large congresses and provision of grants to young neurologists to attend and present their work. It is in a way the duty of larger societies in more prosperous countries to provide support and guidance to those from not so scientifically and economically advanced.

Although scientific congresses are by and large copies, there is always something unique about the Japanese ones. Multiple simultaneous sessions are a norm, but having them in two languages and seeing the delegates move seamlessly for one language to the other is impressive. The aim of the JSN is to attract more international participation with work not only from the region but from further afield.

Compared to other large annual national society meetings, the JSN congress compares favorably with others having the depth and breadth of science and educational values. It would be important for the JSN to obtain CME accreditation from the international bodies, such as the AMA and the EACCME, for certification. With the program as it stands, there should be no issues at all.

Promotion of all congresses is crucial; this depends on the aim of the organizers. How far should the JSN go in promoting and attracting speakers who will come under their own steam to present their work in Japan? On the other hand, does the JSN need to do this; the answer is simply yes.  The material presented is definitely of high caliber and would easily pass the muster. However, the JSN has to decide if its aim is to promote neurology nationally only or go on to a long-term aim of even more globalization. There is no doubt that serving the national need is made that much easier by creating a vibrant and rich international dimension.

The JSN has been in existence initially combined with psychiatry since 1902, and on its own for 60 years. It has certainly stood the test of time.  Proving its credentials has long happened, and now is the time to move on with ambitious zeal to the next horizon. The stage is set for such a move in order to further neurology in Japan, regionally and globally. •

Raad Shakir is with the Imperial College London UK and is immediate past president of the WFN. Susumu Kusunoki is president of the 60th JSN congress Osaka 2019. Hidehiro Mizusawa was president of the WCN 2017 Kyoto.

Neurosonology in Shymkent, Kazakhstan Meeting Promotes Ultrasonic Techniques and Research

By Nazira Zharkinbekova, MD

The Neurosonology Specialty Group (NSG) of the WFN, formerly known as the Neurosonology Applied Research Group, is dedicated to the promotion of science and research as well as of education and training in the field of ultrasonic techniques and its clinical utilization. Therefore, international cooperation and the dissemination of scientific information within the field of neurosciences and neurosonology is part of NSG WFN activities.

Participants of the first NSG of the WFN meeting in Kazakhstan.

In April, the South Kazakhstan Medical Academy (Shymkent, Kazakhstan) in cooperation with NSG of the WFN, successfully conducted a five-day transcranial doppler (TCD) workshop. There were 42 participants, mainly neurologists and a few neurosurgeons, surgeons, and neurointensivists from nine cities (Astana, Almaty, Shykment, Aktobe, Karaganda, Ust-Kamenogorsk, Turkestan, Kostanay, and Tara). This course was designed for individuals who are interested in performing and interpreting TCD studies.

The faculty discussed the current status of TCD and some specific clinical applications, including the clinical value of TCD for confirmation of total cerebral blood flow cessation in patient with clinical diagnosis of brain death. Part of the meeting was dedicated to the hands-on practice.

The lectures was delivered by A. Razumovsky, PhD, FAHA, who currently serves as a secretary for NSG of the WFN.

At the closing ceremony when the local course directors (Dr. Zharkinbekova, MD, Dr. Z. Bapayev, MD, first vice rector for strategic development and innovation for South Kazakhstan Medical Academy; K. Kabulov, dean of the faculty of advanced training; and Dr. Alexander Razumovsky, PhD, FAHA, as a representative of NSG of the WFN) delivered the participation certificates, there was much cheer and enthusiasm.

The next NSG WFN accredited course will take place at the WFN XXIV World Congress Oct. 27, 2019, in Dubai, UAE. •

Dr. N. Zharkinbekova, MD, is the head of the department of neurology, psychiatry, and psychology of the South Kazakhstan Medical Academy in Shymkent, Kazakhstan.

A Quest for New Horizons

NASA, AFAN Joint Congress

By Wolfgang Grisold

Key participants of the NASA and AFAN annual business meeting in East London, South Africa.

During this year‘s Neurological Association of South Africa (NASA) meeting, the AFAN had its annual business meeting and scientific meeting in East London, South Africa. Outgoing President Yomi Ogun opened the business meeting by giving a report on AFAN’s development and activities in the past year.

This report was followed by an update from Augustina Charway-Felli, AFAN secretary general. Lawrence Tucker, AFAN treasurer, reported that support of the American Academy of Neurology (AAN), European Academy of Neurology (EAN), the World Federation of Neurology (WFN), and the Movement Disorders Society (MDS) were received and allowed the meeting and the stability of AFAN. Yet, the financial resources still need attention. The AFAN goals to attain a financially independent status are moving closer.

WFN was mentioned in several reports, and it is acknowledged that the WFN had been helpful in the establishment of AFAN, and continues its efforts for Africa. WFN President William Carroll commented on the development of AFAN and neurology in Africa. He emphasized that AFAN will have to secure and stabilize its financial situation and independence.

In this meeting, new elections also took place, which were supervised by Raad Shakir, past WFN president. The new AFAN board (left) shows that the concept of regional representation is well established in the AFAN.

The current AFAN board (September 2019-2021) is:

President
Foad Abd-Allah (Egypt)
President-Elect
Augustina Charway-Felli (Ghana)
Secretary General
Daniel Gams Massi (Cameroon)
Treasurer
Ozayr Ameen (South Africa)
Vice Presidents
North Africa: Faouzi Belahsen (Morocco)
East Africa: Marieke Dekker (Tanzania)
South Africa: Lawrence Tucker (South Africa)
Central Africa: Yacouba Mapuore (Cameroon)
West Africa: Ange-Eric Kouame-Assouan (Cote d’Ivoire)

The main message from this business meeting was that AFAN is committed to the goals of increasing the visibility of neurology and ensuring improved access to neurological care for the population of the continent. This can only be achieved by training and advocacy.

The scientific meetings consisted of workshops on several topics. The meeting had sessions from both NASA and AFAN, and the sessions were well attended. The topics of the AFAN sessions concerned several disease entities, and most speakers were able to highlight the specific situation for neurology in Africa. Structural and educational topics and the future of African neurology were discussed.

This important joint meeting emphasized that the needs for Africa have many dimensions. One key figure is the Africa‘s population, which is now 1.3 billion, and composed of different languages, cultures, and many distinctive ethnicities. Africa needs empowerment in education and training from within. •

ICNMD 2018 Update

By Wolfgang Grisold, MD

The 15th International Congress on Neuromuscular Diseases (ICNMD 2018) took place July 6-10 in Vienna, Austria. The congress was organized on behalf of the Applied Research Group on Neuromuscular Disorders of the World Federation of Neurology.

There were participants from 69 countries at the ICNMD 2018. The distribution from the top 6 represented countries is shown here.

The venue for ICNMD 2018 was Austria’s largest conference hotel, the Hilton Vienna Am Stadtpark. Combining the magnificent location in the heart of the city with great amenities and services, the Hilton Vienna provided the perfect location for the meeting.

For the first time, a conjoint meeting was organized with the European Federation of Autonomic Societies (EFAS). Joint sessions were organized with the Peripheral Nerve Society (PNS) and the European Neuromuscular Centre (ENMC).

The congress was attended by over 1,450 delegates from 69 countries, which made it a truly international event. This great participation showed that there is a continuous need for neuromuscular research and treatment worldwide.

The meeting was preceded by a day of teaching courses. For the first time, a hands-on teaching course in cooperation with the Anatomical Institute of the City of Vienna was organized by Prof. Meng. Only a small group of participants were able to participate in this course and experience ultrasound on anatomic specimens, which were also demonstrated in detail later in the course. Participants received a botulinum toxin introduction, which was presented by Prof. Truong.

Scientific Program Development

For the scientific program development, the online blogging tool “Basecamp” was used. The blog contained a headquarter channel, and each topic channel and its content access was limited to ICNMD committee members and organizers. The general congress information and program development announcements were delivered by the organizers via the headquarter channel, and the program ideas were shared by committee members, each via topic channels that they specialize in. This sharing blogging system gave the whole committee an interactive program development process, which was highly appreciated by the individual members.

Public Patient Day

For the first time, ICNMD also hosted a Public Patient Day (held in German only). More than 70 people participated in the Public Patient Day raising questions on neuropathy, muscle disease, and myasthenia among others.

Opening Ceremony

The ICNMD 2018 Opening Ceremony represented the Austrian as well as the Viennese culture. Classical music by Franz Schubert and typical Carinthian folklore built the musical framework for the official opening of ICNMD 2018.

Prof. Wolfgang Grisold, ICNMD 2018 Congress president and Master of Ceremony, had the honor of welcoming Mag. Beate Hartinger-Klein, the Austrian Minister of Health, Prof. John England (ICNMD) and Prof. Walter Struhal (EFAS 2018 president).

Dr. Laïla Belarabi in front of her poster at the ICNMD 2018 in Vienna. She is the recipient of the ICNMD-WFN training position in Rabat, and was invited by the ICNMD congress to attend the Vienna meeting.

Furthermore, the ICNMD – WFN Fellow Program Winner, Dr. Laila Belarabi, training in Rabat, was honored during the ICNMD opening ceremony.

Scientific Program

The scientific program was divided into four main topics: muscle disease, peripheral neuropathy, motor neuron disease and neuromuscular junction. Each congress day was devoted to one of these topics and started with a plenary session followed by scientific breakout sessions and problem-oriented workshops.

ICNMD 2018 incorporated innovative ideas into its scientific program which introduced overarching sessions and joint sessions with EFAS, Peripheral Nerve Society (PNS), and European Neuromuscular Centers societies. The congress also brought new subtopics such as cranial nerve diseases and aspects of cancer on the PNS.

Another innovation was an interactive virtual session with an HIV Research Center in Cape Town, South Africa. Three cases were presented virtually by speakers from Cape Town, which were discussed live with the audience at the congress in Vienna.

This new session type helped in solving an unforeseen speaker travel issue where one of the plenary speakers was unable to travel from Japan. He was able to use the same virtual session method to deliver his presentation virtually as well as interact with delegates in real time.

The well attended plenary sessions were recorded onsite, and the videos will be made available to the delegates on the congress website as well as the WFN website.

This meeting also demonstrates the important need for interdisciplinary and multiprofessional collaboration.

The congress was able to present several new treatments, and new therapies such as gene therapy, enzyme replacement therapy, new immune therapies, and others mark a new area in the treatment of neuromuscular disease. These novel concepts were not only part of the scientific sessions, but also several industry supported satellite symposia of high quality. High traffic and much interaction in the exhibit hall allowed delegates and exhibitors to network and share the most up-to-date information in the field.

In addition to the neuromuscular topics, the congress also integrated palliative care and patient related issues into the program. Several historical epochs also were discussed in the history session.

Poster Sessions

A total of 357 posters were presented throughout the three guided poster sessions. All posters were reviewed onsite by the invited poster chairs using a mobile-friendly poster rating page. Based on the submitted evaluation results, eight Best Poster Award winners were selected, and the winners received a certificate and Viennese souvenir during the closing ceremony.

EACCME

ICNMD2018 has been accredited by the European Accreditation Council for Continuing Medical Education (EACCME®) with 34 European CME credits (ECMEC®s). Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians may convert EACCME® credits to an equivalent number of AMA PRA Category 1 Credits™.

Networking Events

To round out the extensive scientific program and to allow more time for delegates to visit with colleagues, the congress offered various networking opportunities.

The President’s Committee Mystery Dinner (invitation only) showcased the beauty of the Danube with a short boat ride followed by a traditional Austrian fish dinner in a traditional Austrian restaurant along the river.

The ICNMD 2018 Congress Dinner was held at the historic Vienna Town Hall. This prestigious venue represented traditional Viennese flair. After a delicious Austrian dinner, participants were introduced to the Waltz and could give it a try themselves.

Finally, delegates were invited to a Heurigen Evening, a traditional Viennese wine tavern where delegates enjoyed the typical Viennese “Gemütlichkeit” by enjoying some delicious Austrian dishes and wines.

The closing ceremony highlighted the great success of ICNMD 2018. Prof. Juan Jesús Vílchez Padilla was inaugurated as the congress president for ICNMD 2020 with the traditional handover of the ICNMD trophy, a wooden stick carved by indigenous communities of the city of Vancouver.

The 16th International Congress on Neuromuscular Diseases (ICNMD 2020) will take place July 10-14, 2020 in Valencia, Spain. ICNMD 2022 will take place in Brussels, Belgium.

The international cooperation needed to organize and develop the scientific content by the congress and scientific committee worked smoothly.

Welcome to Valencia in 2020, and we do hope that the present speed of drug development for neuromuscular diseases continues, or even increases. •

WFN Junior Traveling Fellowship Report

By Melody Asukile

The European Academy of Neurology (EAN) is the home of neurology in Europe and was formed in 2014 by the union of the EFNS (European Federation of Neurological Societies) and ENS (European Neurological Society). Their goal is to promote neurological excellence in Europe and the world.

I had the privilege of attending the Fourth EAN Congress held June 16-19 in the history-rich city of Lisbon, Portugal under the theme of Neurogenetics. The program was filled with a wide range of interesting topics, including but not limited to movement disorders, dementia, stroke, neuromuscular disorders, epilepsy, and multiple sclerosis with presentations from leaders in their respective fields.

The congress also had a lot of activities that catered for neurologists in training such as case-based workshops, focused topic workshops, hands-on courses, teaching courses, and several interactive sessions. I particularly enjoyed the interactive sessions as we had the opportunity to network with neurology experts and residents from all over the world. Examples of the interactive sessions were the EAN BrainChallenge, a case-based interactive quiz show, and real patient assessment and management by experts. These sessions were not only enjoyable but also informative regarding the clinical approach to neurology patients.

There were ePoster and ePresentation sessions on three days of the congress. My abstract was accepted as an ePoster presentation in the Epilepsy 3 session. My topic was “The Efficacy of an Online Learning Tool in Improving EEG Analysis and Interpretation Skills of Neurology Registrars, Neurologists and Technologists.” I had three minutes to present and discuss my findings that showed that the course had proved to be an effective EEG teaching resource. Some important points raised were the usefulness of the online course in resource-poor settings where EEG teachers were lacking, but also extending to better resourced areas; and the affordable cost of the 6-month program.

Overall, the congress was informative and showcased some of the ground-breaking research in-progress in Europe regarding the use of neurogenetics for the diagnosis and treatment of both “old and new” neurological conditions.

I am grateful to the WFN for affording me the opportunity to attend this meeting through the Junior Traveling Fellowship Grant.•

Melody Asukile is a Zambian neurology resident in Cape Town, South Africa.

Palatucci Events

By Wolfgang Grisold and Javier Cardenas

In May 2018, the Palatucci Advocacy Leadership Forum (PALF) took place May 16-20 at the Rancho Bernardo Inn in San Diego. The American Academy of Neurology (AAN) has a longstanding initiative to promote advocacy and leadership by inviting interested colleagues from the United States with international participation. These events are called Palatucci Events after Dr. Donald Palatucci who was an early founder of this idea. They offer a comprehensive  program on patient advocacy.

Palatucci Events teach  and  encourage participants to engage in learning advocacy and in practical engagement in regard to advocacy for patients and neurology. This activity started in 2001, and has recruited a network of Palatucci/PALF graduates.

The participants are from all age groups of practicing and training neurologists and bring an interesting mixture of professional knowledge and experience of both academic and practice level. The participants are divided into groups. Each group has a tutor who discusses with his/her group the participants and their work. Prior to the meeting, the participants need to develop a project, which is exposed to discussion and advice during the meeting. This is a valuable experience to create, promote, and subject projects to different people and to a different audience. In the follow-up of the Palatucci meetings, participants are encouraged to share the experience of their work. Positive developments and equally important roadblocks and setback are discussed.

One of the most important tasks is communication. Interviews with the press, the importance of short messages (sound bites) is taught and actively trained with professionals.

In addition to press news and communication, essentials about how to talk, discuss, and negotiate with politicians is thoroughly discussed. This content is important and helps to understand the mechanisms  in politics.

Being invited to testify and being able to present a case was part of an intensive training.

In addition to the tutors, a faculty of experienced Palatucci graduates were invited. They were able to share their often exciting experience in advocacy.

At this meeting, Representative Scott Peters of California talked about himself and interacted with the participants by engaging in communication. This activity shows that the content and the ideation of these Palatucci courses are highly specific and aim in the direction of interaction with policymakers, local authorities, and with policymaking on “The Hill.” The Palatucci courses demonstrate that being a good neurologist is not enough. Part of the agenda is to advocate for patients and, in the long term, for neurology. Advocacy and communication are important tools in neurology.

For several years, starting in Thailand, the World Federation of Neurology has had a regular American Academy joint World Federation Palatucci Meeting at its World Congresses of Neurology (WCN), which usually involves a full day of work devoted to project development, how to make a stand, how to present in press and how to appear in legal situations. This part of Palatucci is only a small copy of the American Academy of Neurology Palatucci Event but follows its pattern and is led by experts who are able to attend the Palatucci meeting. The idea still needs promotion and advocacy, and all levels of neurology are needed to promote neurology. •

WFN Junior Traveling Fellowship Report

By Ahmed Dahshan, MD

It is my pleasure to write this report about my attendance and participation in the Fourth European Academy of Neurology (EAN) Congress held June 16-19, 2018, in Lisbon, Portugal.

I presented a poster at that event. My poster title was “Normal Appearing Gray Matter in Multiple Sclerosis, Is It Really Functionally Normal?” I presented the poster to colleagues who attended the congress. It was useful to show them my work, listen to their comments, and answer their questions.

There were more than 5,000 participants in the congress, and it was a good opportunity to share knowledge in that area of research and make some agreements to have collaboration in some research work in the future. Attending the congress added a lot to my knowledge in neurology in general and particularly in the area of genetics and new treatments on the molecular level.

The congress proved fruitful, and I enjoyed attending the different symposiums, controversies, and the EAN brain challenge, which was a useful and exciting session. The most useful scientific activity apart from presenting my poster was attending the different interactive sessions. They were simple, updated and interesting with properly prepared scientific materials.

I would like to thank the WFN for its generous support, which helped me to attend such a great scientific event in neurology and present my work. I hope this support continues helping more young colleagues to increase their experience and attend scientific events all over the world. •

Ahmed Dahshan is neurology assistant lecturer at Cairo University, Cairo, Egypt.

Brain Diseases From Bench to Bedside Report

April 12-13, 2018, Moscow
By Peter Sandercock

The meeting, organized by Profs. Eugene Gusev and Alla Guekht, focused on the recent developments in translational research and treatment innovations in cerebrovascular diseases, epilepsy, cognitive impairment and dementia, depression, demyelinating diseases, and others. It was held at the Buyanov City Clinical hospital, and was organized in partnership with the following institutions: Ministry of Health of The Russian Federation, Russian Academy of Sciences, Moscow Healthcare Department, Pirogov Russian National Research Medical University, World Stroke Organization, European Stroke Organization, World Federation of Neurology, International League Against Epilepsy, European Federation of Neurorehabilitation, All-Russian Society of Neurologists, Moscow Research and Clinical Center for Neuropsychiatry.

Peter Sandercock

The International Stroke Faculty included Profs. P. Sandercock (WSO, UK), V. Caso (ESO, Italy),  M. Hilz (Germany), L. Østergaard (Denmark), and D. Muresanu, (EFNR, Romania). The WFN had been represented by Prof. M. Freedman (Canada); and the ILAE by Profs. S. Wiebe (Canada), I. Blumcke (Germany), A.Hauser (USA), E. Beghi (Italy), N. Speccio (Italy).

Opening ceremony. Left to right: V. Caso, E. Gusev, A. Guekht, and P. Sandercock.

The conference faculty had a high-level meeting with Prof. V. Skvortsova, Minister of Health for the Russian Federation, to discuss the management of stroke and brain disorders and highlight the priority this should be given both internationally and within the Russian Federation. An action plan on collaborative strategy in brain diseases has been discussed.

The conference proved popular and over 700 delegates from 42 cities of the Russian Federation attended with additional registrants from Belarus, Georgia, Kazakhstan, Tajikistan, Ukraine, and Uzbekistan. The conference attracted a high level of media coverage and both Profs. P. Sandercock and V. Caso gave video interviews for local media organizations.

The stroke session began with an update on controversies in thrombolysis by P. Sandercock, who highlighted the importance of not withholding thrombolysis to patients with ischemic stroke purely on the basis of age over 80.

Meeting with Prof. V. Skvortsova, Minister of Health for the Russian Federation (center). Left to right: M.Hilz, S. Wiebe, N. Specchio, E. Gusev, V. Caso, S.Muraviev, M. Martynov, E. Beghi, L.Østergaard, M. Freedman, A. Hauser, A. Guekht.

V. Caso gave a powerful talk on life after stroke in women. She highlighted the particulars of stroke management during pregnancy and demonstrated how gender inequality results in adverse effects in women’s health care in general and in stroke outcome in particular. M. Hilz gave a detailed overview of autonomic dysfunction in diseases requiring neurological intensive medicine.

V. Parfenov covered management of patients after stroke, highlighting the value of lifestyle changes (quitting smoking, increasing physical activity, and fresh fruit and vegetable consumption) and antithrombotic therapy with aspirin after ischaemic events.

I. Koltunov, N.Pechatnikova, and V. Kakaulina presented their work on cerebrovascular diseases associated with genetic metabolic disorders and demonstrated the program of genetic screening for rare diseases, supported by the Moscow government. A. Pryamikov, A.Mironkov, and O. Sazhina, doctors from the regional stroke center in the host hospital, closed the session with an interesting talk on their experience on carotid endarterectomy and internal carotid artery stenting in acute stroke.

Meeting in the Moscow Research and Clinical Center for Neuropsychiatry.

The clinical stroke-focused session was followed by a translational science session, which covered a broader range of topics.  I. Blumke reported work from the European Epilepsy Brain Bank Consortium: 25 years of interdisciplinary experience with epilepsy surgery in 9,579 children and adults, L. Østergaard presented novel data on the role of capillary pathways in stroke and cognitive decline, N. Gulyaeva highlighted how distant hippocampal damage in brain disorders may be related to corticoid-mediated mechanisms. A. Shpak spoke on neurotrophic factors in neuro-ophthalmology, showing their important role in glaucoma as the model of neurodegenerative diseases. D. Muresanu gave a talk titled, “From Neurobiology to Evidence-Based Medicine: Concepts in Neurorehabilitation After Stroke.”

The session on cognitive and affective disorders was opened by the lecture by M. Feedman focusing on the diagnostic and treatment challenges of frontotemporal dementia. R. Akzhigitov and co-authors gave an overview on depression in neurological diseases, presenting the huge experience of the Moscow Research and Clinical Center for Neuropsychiatry with the effective programs of multidisciplinary management of depressions and cognitive impairment, including post-stroke.

The session on the following day was dedicated to epilepsy. V. Krylov and I. Trifonov presented the results of the epilepsy surgery program, which is successfully developing in Moscow and other cities of the Russian Federation. S. Wiebe gave a thorough overview of the outcomes of epilepsy surgery. He emphasized that the novel way of conceptualizing surgical outcomes highlights the importance of longitudinal data. N. Specchio described special issues of epilepsy surgery in children. A. Hauser demonstrate how TBI and post-traumatic epilepsy represent a substantial societal burden. He reviewed the major risk factors and stated that studying the predictors of epilepsy after TBI should become one of the priorities. The successes and challenges in the implementation of the 68th WHA Resolution on Epilepsy were presented by E. Gusev and A. Guekht. They demonstrated that epilepsy is comorbid to stroke and other major noncommunicable diseases, dramatically increasing their severity and mortality.

The seminar on post-stroke cognitive impairment led by M. Freedman.

The last session was opened by E. Beghi with the talk describing the mechanisms and predictors of falls in neurological diseases, including stroke, Parkinson’s disease, multiple sclerosis, and others. He stressed that stroke can be the cause of balance disorders due to impaired ability to produce fast, accurate, and coordinated muscular patterns. Several interesting talks were presented by Russian colleagues on multiple sclerosis, including the burden of multiple sclerosis (V. Mkrtchyan, N. Pavlov) and therapeutic approaches (N. Khachanova and N. Arzymanian).

The novel techniques and experience of neurostimulation in gait disorders in multiple sclerosis patients were presented by the neurosurgery team of the Buyanov City Clinical Hospital (S. Asratyan). The significant part of the session was dedicated to management of ALS, presented by members of the Russian and foreign faculty.

The interactive video session concluded the conference with presentation of interesting cases in different aspects of neurology and with a lot of discussion.

On the next day, the international faculty and the leading Russian specialists on brain diseases visited the Moscow Research and Clinical Centre for Neuropsychiatry of the Healthcare Department of Moscow, one of the leading institutions for management of patients with post-stroke cognitive impairment, depression and anxiety, suicidal ideations, epilepsy, and other brain diseases. It was the second meeting of the international scientific advisory board of the Research and Clinical Centre, formed in October 2017 during the World Stroke Day Congress in Moscow.

The meeting started with an overview of the more than 100-year history of the center, presented by its director A. Guekht. The scientific achievements, patient management, and educational activity of the center, as well as the state-of-the-art facilities for diagnostics and research were quite impressive.

Prof. N. Gulyaeva (Institute of Higher Nervous Activity, RAS) presented the results of studies in translational neuroscience. Then, completed and ongoing research projects in post-stroke cognitive impairment, epilepsy, depression and suicide, and autonomic disorders were presented by the specialists of the center and of collaborative institutions (Pirogov Russian National Research Medical University, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Serbsky State Scientific Center for Social and Forensic Psychiatry, Institute of Higher Nervous Activity and Neurophysiology of RAS, N.V.Sklifosovsky Research Institute of Emergency Medicine and Buyanov City Clinical Hospital). The projects were extensively discussed by the faculty, and plans for international publications and new projects had been developed. The true highlights of the meeting were a series of seminars in stroke and other brain diseases led by the eminent members of the international faculty. These seminars were of high educational value for the doctors and researchers from Moscow clinics.

The conference closed with warm thanks from the organizing committee to the supporting organizations, the conference faculty, and conference participants for their efforts in improving the outcomes for people with stroke and brain disorders. The conference strengthens the international collaborative efforts to tackle these disorders, which place such a burden on patients, society and health systems.•

Prof. Peter Sandercock is emeritus professor of neurology at the University of Edinburgh.  He is a member of the Board of Directors of the World Stroke Organization and chairman of the WSO Education Committee.  He is commissioning editor for the World Stroke Academy, the WSO’s online global educational resource.

Palliative Care in Neurology

By David Oliver

There is increasing awareness of the role of palliative care for neurological patients, and this has been emphasized at two recent conferences.

David Oliver

At the Fourth Congress of the European Academy of Neurology in Lisbon, there was a European Association for Palliative Care / EAN Symposium on Palliative Care and Neurology as part of the program.  Over 100 people attended.

During the session, Prof. Raymond Voltz, Dr. Simone Veronese, and Prof. David Oliver spoke on developments within the field. The importance for all neurologists to provide a palliative care approach and to collaborate with specialist palliative care was emphasized, as has been emphasized in the EAN / EAPC Consensus on palliative care and neurology. There was good feedback, and several members of the audience discussed the issues afterward.

Within the same congress, there was a case-based workshop on end-of-life care for the neurological patient, looking at the use of interventions such as gastrostomy or ventilation at the end of life, coping with difficult patient and family situations, and how to be involved in difficult conversations.  Prof. Oliver also spoke at a scientific theater, a presentation within the poster and exhibition area,on the Consensus document on palliative care and neurology.

The 15th International Congress on Neuromuscular Disease (ICNMD) was held in Vienna in early July.  Over 1,400 delegates from 69 countries attended the meeting, which was held in collaboration with the European Federation of Autonomic Societies (EFAS).

Palliative care was included within the program, and the workshop on palliative care was attended by over 40 people who heard about the role of palliative care for neurological patients, the effectiveness of multidisciplinary care approach, the recognition of end of life care, and the experience of an ALS team in Moscow, Russia, in developing a clinic and increasing the availability of both palliative care and morphine use in symptom management.

Prof. Oliver, who is co-chair of the EAN Palliative Care Specialty Panel and chair of the EAPC Reference Group on palliative care and neurology, spoke in two other sessions. There was an “overarching session” on dysphagia, and he spoke on the ethical challenges of the management of dysphagia, including the assessment, use of interventions, discussions with patient and families and consideration of care at the end of life, including the consideration of withdrawal of treatment.  The session allowed a wider discussion of the issues of dysphagia, which may affect many with neuromuscular disease.

Palliative care also was featured in a plenary session on motor neurone disease. Prof. Oliver discussed the ethical issues in the management of motor neurone disease, discussing the telling of the diagnosis, the issues of genetics, cognitive change, nutritional support, ventilator support, and end-of-life issues.  The session was a new development at the congress with palliative care being discussed in the large plenary session, with over 500 people attending.

This was a wonderful opportunity to introduce palliative care and ethical discussions into the care of people with neuromuscular diseases. We are very grateful to Prof. Wolfgang Grissold, the chair of the ICNMD Scientific Committee and the organizers, for facilitating these opportunities to present at this congress. •

Further Information

https://www.eanpages.org/2018/06/17/lisbon-2018-report-on-symposium-4-ean-eapc-palliative-care-and-neurology/

Oliver DJ, Borasio GD, Caraceni A, de Visser M, Grisold W, Lorenzl S, Veronese S, Voltz R. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease. Eur J Neurol 2016; doi:10.1111/ene.12889

Prof. David Oliver is honorary professor at the University of Kent, an EAPC board member, and chair of Reference Group on Neurology and Palliative Care.

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