From the Field – Page 16

World Brain Day Celebrated at Janakpuri Superspeciality Hospital, New Delhi

By Dr. Man Mohan Mehndiratta, Dr. Natasha Singh Gulati, Dr. Ashok Kumar, Dr. Bhawna Sachdeva and Dr. Madhu Sinha

Figure 1. A: Dr. Man Mohan Mehndiratta, director (JSSH) in India and Prof. Raad Shakir, president, World Federation of Neurology, from London addressing the delegates through video conferencing. B: Expert panelists from various hospitals in New Delhi for World Brain Day at Janakpuri Superspeciality Hospital, New Delhi C: Prof. Mohammad Wasay, chairman advocacy subsection World Federation of Neurology from Pakistan addressing the delegates through video conferencing. D and E: Patients and their caregivers attending the program.

The brain: the body’s most complex organ harbors about 80 million neurons and controls every thought and action¹. It can be affected by various diseases and disorders affecting about one billion people worldwide and causing around 6.8 million deaths annually. Neurological diseases and disorders have now been declared as a global epidemic. Knowledge and awareness of brain diseases by individuals and communities can play a crucial role in the prevention, detection and treatment, thus emphasizing outreach public health approach². Recognizing the magnitude of the burden and disability and mortality consequent to neurological disorders the World Federation of Neurology (WFN) took the initiative to celebrate the first World Brain Day on July 22, 2014¹. To take this forward and foster brain health in our community, we celebrated World Brain Day (WBD) at our Institute, Janakpuri Super Speciality Hospital (An Autonomous Post Graduate Institute under N.C.T of Delhi) in Janakpuri, New Delhi, under the aegis of Indian Academy of Neurology (IAN). (See Figure 1.) In India, the day was also celebrated in cities like Indore, Nagpur, Kolkata and Bangalore.

Programs like these are very beneficial in a developing country like India where there are many barriers to the neurological education and care such as poor neurologist to population ratio, geographical barriers, illiteracy, lack of trained staff and inadequate resources³. These barriers pose a great challenge to our health care system, which can be overcome by such advocacy campaigns.

The objective of this program was

To emphasize the types of neurological disorders and their frequency and severity
To inform that most of these disorders are preventable and curable
To answer the queries and problems of the patients and their caregivers and understand their needs
To alleviate the myths and misconceptions related to these disorders
To serve as a platform for various national and international experts to interact with the patients and their caregivers through video conferencing and panel discussions

More than 250 persons with neurological disorder and their caregivers attended the program and asked the queries related to neurological disorders and patients felt satisfied to get the answer and to interact.

A highlight of WBD celebration was address by Prof. Raad Shakir, president, WFN, from London and Prof. Mohammad Wasay, chairman advocacy subsection, WFN, through video conferencing and distinguished faculty comprising of neurologists, epilepsy surgeon, psychiatrist and neurosurgeon from the public and corporate hospitals. Prof. Shakir and Wasay answered the issues raised by the public and the faculty members had an introduction session with the president.

Dr. Man Mohan Mehndiratta, director (JSSH) and past president, Indian Academy of Neurology, briefed about WBD and its importance, vision and mission of the institution.

Doctors from various hospitals were invited to interact with the patients. Dr. C.S. Meshram, president, IAN, could not make it because of other commitments.

The expert panelists who attended the program include: Dr. Sumit Singh, senior consultant neurologist, Medanta, Medicity, Gurgaon; Dr. Shamsher Dwivedi, Prof. and HOD, Neurology, Fortis Gurgaon; Dr. Anuj Mittal, HOD, Psychiatry, Deen Dayal Upadhaya Hospital, Delhi; Dr. (Brig.) S.P.Gorthi, senior consultant neurologist, R & R, Army Hospital, New Delhi; Dr. Rajeev Anand, senior consultant neurologist, B.L.Kapoor Hospital, New Delhi; Dr. Vikash Gupta, senior consultant, neurosurgeon, B.L.Kapoor Hospital, New Delhi; Dr. Subodh Gupta, neurosurgeon, Deen Dayal Upadhaya Hospital, Delhi; Dr.Solanki, neurosurgeon, B.R.Ambedkar Hospital; Dr. Nilesh Kurwale, epilepsy surgeon, All India Institute of Medical Sciences, New Delhi; and Rehabilitation Experts, JSSH.

The program continued for more than two hours and still the patients had keenness to ask several questions related to various neurological disorders. Patients, rehabilitation experts, doctors, nurses and technical staff joined for refreshment after the event. Initial feedback from patients and their caregivers included appreciation for the program and a number requested more awareness programs in future.

The Internet is a leading source of disseminating public awareness worldwide both for people seeking health information and those who access it for entertainment and social networking purpose as they are passively influenced by health associated content⁴. The function’s videos and photographs are on the video-sharing website YouTube⁵ and social networking site Facebook⁶.

In conclusion: raising awareness is an ongoing effort which is never done so IAN will continue to build strong grassroots movement all over the country to increase public understanding about neurological disorders and diseases to combat this global epidemic. The World Day program in our hospital as well as other cities in India has paved the way for future programs.

References

1. World Federation of Neurology. Fostering quality neurology and brain health world wide. Available at: http://www.wfneurology.org/world-brain-day Accessed on 8th August 2014.

2. Gourie-Devi M. Organization of neurology services in India: unmet needs and the way forward. Neurol India. 2008 Jan-Mar;56(1):4-12.

3. Mehndiratta MM, Mehndiratta P, Gulati NS, Wasay M. Heterogeneity in Neurological Education and care in Asian and Oceanian region. Neurology (in press 2013).

4. England MJ, Liverman CT, Schultz AM, Strawbridge LM. Epilepsy across the spectrum: promoting health and understanding. A summary of the Institute of Medicine report. Epilepsy Behav. 2012 Oct;25(2):266-76

5. World Brain Day Celebration at Janakpuri Super specialty Hospital, New Delhi on 22nd July 2014. Available at: https://www.youtube.com/watch?v=kceBkyP4uHs . Last Accessed on 23rd August 2014

6. World Brain Day Celebration at Janakpuri Super specialty Hospital, New Delhi on 22nd July 2014. Available at: https://www.facebook.com/pages/Janakpuri-Superspeciality-Hospital/465836126847575?ref=br_tf . Posts to page. Last Accessed on 23rd August 2014

Dr. Mehndiratta, MD, DM (Neurology), FAAN, FAMS, FANA, MNAMS, FRCP, FICP, FIAN is the director, professor and head of department, department of neurology at Janakpuri Super Speciality Hospital in Janakpuri, New Delhi. Dr. Gulati, M.D. is the senior resident pathology at Janakpuri Superspeciality Hospital in New Delhi. Dr. Kumar, M.D. is the assistent medical superintendent at Janakpuri Superspeciality Hospital in New Delhi. Dr. Sachdeva, M.D. is the specialist pathology at Janakpuri Superspeciality Hospital in New Delhi. Dr. Sinha, M.D. is the specialist pathology at Janakpuri Superspeciality Hospital in New Delhi.

World Brain Day in Croatia

By Vida Demarin

Public health action during World Brain Day in Croatia.

In celebration of the first World Brain Day, the Croatian Stroke Society in cooperation with Zagreb’s Institute for the Culture of Health, Associations of People’s Health Andrija Å tampar, Society for Neuropsychiatry and the Student Council of the Faculty of Medicine in Zagreb, organized a public health action in Zagreb, Croatia, on July 27, 2014.

The public health action, which was held on Kvaternik’s square in the center of the city of Zagreb, was to celebrate World Brain Day by promoting the activities of the associations and to raise the awareness among community that brain diseases are mostly

Volunteers measuring stroke risk factors.

preventable and that actual perception of the brain should be changed. The day’s activities included measuring stroke risk factors such as blood pressure, blood sugar and body mass index. More than 250 people have measured their stroke risk factors, and more than 1,000 promotional materials were distributed during a day.

TV broadcasting with Prof. Vida Demarin during public health action.

Prof. Vida Demarin, president of the Croatian Stroke Society and the Zagreb’s Institute for the Culture of Health, was a guest at a TV and a radio show dedicated to celebration of World Brain Day. She pointed out the necessity of such activities in promotion of brain health and prevention of brain diseases.

The community response was more than great, even though it was time of summer vacations in Croatia, which encourages us to continue with such activities in the future.

Demarin is the president of the Croatian Stroke Society and Zagreb’s Institute for the Culture of Health.

World Brain Day Celebration in India

By Dr. Chandrashekhar Meshram and Dr. Sanjeev Thomas

WBDIndia On July 22, 2014, the World Federation of Neurology (WFN) launched the first World Brain Day – Our Brain, Our Future. It was dedicated to bring more attention to the importance of human brain in health and disease and highlight the need to prevent the neurological and psychiatric illnesses prevalent in the society. In India, the first World Brain Day was celebrated under the aegis of Indian Academy of Neurology all over the country with great enthusiasm. The banners, brochures and press release from WFN were circulated to all IAN members. The event helped in spreading the awareness regarding brain health, brain diseases and their prevention. A breakdown of how different centers celebrated activities follows.

Nagpur

Dr. Chandrashekhar Meshram, president, Indian Academy of Neurology, convened the meeting of neurologists, neurosurgeons, physicians, psychiatrists and media. It was decided that looking at the magnitude of the issue deserves more than one day so the activities were held for the whole week. A press conference was held on July 18 and a press release in English and local languages was distributed to media. Accordingly, on July 22, a symbolic rally walkathon was organized in the city which was flagged off by Commisioner of Police, K.K. Pathak. Three hundred persons including doctors, school children and senior citizens wearing World Brain Day t-shirts and caps, holding banners and playcards participated in the rally despite the rain. An interview with Dr. Meshram was broadcasted by Aii India Radio.

Three billboards carrying the message of World Brain Day were displayed at prominent places in the city.

Lectures for common public and interactive sessions were organized at ESIS Hospital, Government Medical College and Hospital, Indira Gandhi Medical College and Hospital and Lata Mangeshkar Hospital on July 23-30, respectively. Dr. Poornima Karandikar, Dr. Pravir Waradkar, Dr. Avinash Joshi, Dr. Fulare and Dr. Anand Saoji delivered the lectures and answered questions .

On July 25, a program was organized at Dayanand College. Dr. Meshram presented Talks on Brain Health Supreme Wealth and Neurosurgeon Dr. Nilesh Agrawal presented on Head Injury. It was attended by 500 college students, their parents and teachers.

On July 26, a large public forum was organized at IMA Auditorium. Members of parliament Vijay Darda and Ajay Sancheti and Senior Neurologist Dr. G.M. Taori graced this occasion and addresed the gathering. Dr. Meshram highlighted the importance of World Brain Day celebration. Lectures on stroke, dementia, brain functions, epilepsy and head injury were delivered by Dr. Dinesh Kabra, Dr. Prafull Shembalkar, Dr. Poornima Karandikar, Dr. Sangram Wagh, Dr. Nilesh Agrawal and Dr. Lokendra Singh. Dr Nitin Chandak showed clippings of movies.The program was attended by about 400 people. Television channels covered the program and televised it.

On July 27, a painting competition for school children was organized in collaboration with Basoli group. 150 children from 65 schools displayed their creativity on the theme “Our Brain — Our Future.” 11 prizes were given to the students by Girish Gandhi and Dr. Meshram.

Visits to the Brain and Mind Museum were organized daily for students and common public. Specimens of human brain and some animal brains were shown, while brain structure, function and manifestations of various diseases were explained to visitors with the help of models and charts by neurologists, psychiatists and neurosurgeons.

World Brain Day and Brain Awareness week was celebrated under the aegis of Indian Academy of Neurology in collaboration with Nagpur Neuro Society, Indian Psychiatry Society Nagpur branch, Indian Medical Association Nagpur, Academy of Medical Sciences Nagpur, Nagpur Union of Working Journalists and Basoli Group.

The activities for the whole week were extensively covered by all newpapers in the city with publlication of articles, interviews, news items and photographs.

Janakpuri Superspeciality Hospital, New Delhi

World Brain Day was celebrated at Janakpuri Superspeciality Hospital on July 22, 2014, under the aegis of Advocacy Subsection of Indian Academy of Neurology. More than 250 persons with neurological disorders and their caregivers attended the program and asked the queries related to neurological disorders. The activity was organized by Dr. Man Mohan Mehndiratta, past president of Indian Academy of Neurology. Dr. Sumit Singh, Dr. Shamsher Dwivedi, Dr. Anuj Mittal, Dr. (Brig.) S.P.Gorthi, Dr. Rajeev Anand, Dr. Vikash Gupta,Dr. Subodh Gupta, Dr.Solanki and Dr. Nilesh Kurwale participated in the panel.

A highlight of the World Brain Day celebration was the address by Prof. Raad Shakir, president, WFN, from London, and Prof. Mohammad Wasay, chairman advocacy subsection, WFN, through video conferencing and distinguished faculty comprising of neurologists, epilepsy surgeon, psychiatrist and neurosurgeon from the public and corporate hospitals. Prof. Shakir and Wasay answered the issues raised by the public, and the faculty members had an introduction session with the president.

Army Hospital (R&R) Delhi Cantt

World Brain Day was celebrated by Army Hospital (R&R) Delhi Cantt on July 24, 2014, due to service commitments. The program was chaired by Maj. Gen. CS Narayanan, dean, Army Hospital (R&R) Delhi, and the following talks were delivered.

Neurology from Bench to Bedside – Brig. SP Gorthi, professor and head of department of neurology
Approach to Headache – Dr. Sumit Singh, professor neurology, Medanta Medicity
Deep Brain Stimulation in Movement Disorders – Dr. Vinay Goyal, professor neurology at AIIMS

The program was well attended.

A cap was released in honor of the occasion to popularize the day.

In addition, stroke club was organized on July 25 and multiple sclerosis meet was organized on July 28 as part of promotion of World Health Day.

The event was organized by Brig. S.P. Gorthi, Col. Y. S. Sirohi, Lt. Col. Pawan Dhul and the Neurology Team at Army Hospital (R&R) Delhi.

NIMHANS, Bangalore

National Institute of Mental Health and Neuroscience (NIMHANS) at Bangalore, a premiere institute in the country dedicated to the diagnosis and treatment of neurological and psychiatric disorders is also committed to promoting positive mental health. NIMHANS has established a unique facility “Center for Wellbeing” away from the hospital environment, but managed by NIMHANS’ senior faculties from the Departments of Social Psychology and Psychiatry to counsel the seekers in psychological stress. NIMHANS has been actively involved in assisting the Ministry of Health and Family Welfare, Govt. of India in planning and execution of National Mental Health Programs, especially in the areas of neurotrauma, epilepsy and psychiatric disorders. NIMHANS has also established Human Brain Bank for research and Neuropathology Brain Museum to promote public awareness about neurological disorders and the strategies to prevent them.

Keeping in the spirit of World Federation of Neurology, NIMHANS celebrated World Brain Day – Our Brain, Our Future on July 22, 2014.

An event was organized at Neurobiology Research Center, NIMHANS, addressing 200 school children and teachers who visited the Human Brain Museum. In addition, a few from the general public and senior citizens also joined the celebrations. We dedicated this first celebrations to the children in whom we are kindling curiosity in the field of neurosciences. The students were from Class X and XI, preparing to enter college, thus representing the young minds who can participate in leading the country.

Director/Vice Chancellor Prof. P. Satishchandra and In-charge Registrar Prof. S.K.Chaturvedi, professor of psychiatry, addressed the students highlighting the need to understand the brain-mind axis and their role in neuropsychiatric disorders. In addition, they stressed healthy living by proper food intake, exercise and strictly avoiding addiction forming drugs. The session was interactive; the students actively participated in the discussion.

Dr. S.K. Shankar, emeritus professor, neuropathology and principal coordinator of Human Brain Bank, addressed the gathering on the topic “Let Us Learn Neuroscience Together” talking through the evolution of nervous system in animals and human and human brain in disease states. Subsequently, the structure of the human brain and the internal anatomical areas with their physiological and psychological functions were demonstrated using the human brains collected at autopsy with informed consent of close relatives.

“Human Brain in Health and Disease” was conducted showing the real human specimens, including the human articulated skeleton. The faculty, post doctoral fellows of Department of Neuropathology, staff of Human Brain Bank and volunteers from Neurovirology Department explained the specimens in an interactive basis. Finally the young students were thrilled touching the real human brain, heart, lung, kidney and intestine and had the real feel of the organs in their hands.

Simultaneously, the College of Nursing, NIMHANS organized a day-long exhibition with health awareness posters in English/Kannada and human brain specimens in the outpatient section of the hospital. The exhibition was inaugurated by Prof.Lalitha, head of the Department of Nursing. The faculty and the tutors of nursing college actively participated taking the knowledge about the brain to the common man visiting the hospital for treatment.

The public greatly appreciated the opportunity to see and touch the real human brain and fruitful discussion about food habits, the common infections of nervous system and the useful strategies to prevent them.

The Director/Vice Chancellor visited the exhibition organized by the Nursing Department and appreciated their efforts for taking the knowledge to the common man.

NIMHANS, Bangalore, decided to continue the tradition with greater scientific inputs in the future as well.

St. Paul College, Kolkata

The Institute organized the World Brain Day in a prominent school locally at Burdwan on July 22.

It was attended by students from class six and above along with teachers. Dr. Shyamal Kumar Das and two of his residents gave nice speeches about nervous system and their importance including basic illness such as epilpesy, stroke, dementia, etc. The meeting was well organized by the school authorities. It was a very stimulating experience, and the students and teachers enjoyed the program.

We have planned to celebrate next year as well.

Calcutta Medical Research Institute, Kolkata

World Brain Day was celebrated at Calcutta Medical Research Institute, Kolkata, on July 22 under the aegis of World Federation of Neurology and Indian Academy of Neurology. The goal was to increase the awareness regarding common neurological diseases. The half-day program consisted of a seminar where eminent neurologists of the city discussed on topics like stroke, epilepsy, dementia and neurotrauma. The seminar was attended by about 75, including doctors, patients, social workers and press.The event was organized by Dr. Arabinda Mukherjee, president elect, Indian Academy of Neurology.

The event was extensively covered by print and electronic media like Times of India and Door Darshan TV .

Madras Medical College, Chennai

World Brain Day was celebrated at Madras Medical College. Dr. Bhanu, head, Institute of Neurology, welcomed the gathering. Dean Dr. Vimala delivered the presidential address. Dr. A.V. Srivasan, emeritus professor, Dr. Lakshmi Nrasimhan, Dr. S. Balasubramanian spoke on the importance of brain functions. The event had wide media coverage in The Hindu, dinamaalar, dinathandhi etc. About 200 people participated and benefitted.

It is a good initiative to talk more on protection than on treatment of illness, though that is also important.

Mumbai

The first World Brain Day with the theme of Our Brain – Our Future was celebrated by Epilepsy Foundation India, on the July 22, 2014. Chief guest Dr. B. K. Upadhyay, Jt. Commissioner of Police, (Traffic) inaugurated and Dr. Nirmal Surya chaired the program.

A total of 150 people attended the program, most of them were patients suffering with epilepsy and other neurological disorder and their caregivers.

Dr. Nirmal Surya, founder trustee and chairman of Epilepsy Foundation in his presentation, informed the audience about the brain, its function and its disorder and how the injury to brain can affect the individual life in local and regional language. He also explained about the early intervention and treatment in disease like stroke epilepsy and head injury.

Dr. B. K. Upadhyay, Jt. Commissioner (Traffic) Mumbai, Chief Guest was delighted to be part of this function. He mentioned the importance of protecting brain while riding a bike, using a seatbelt while driving car and obeying traffic rules. He made the audience aware about following four simple traffic rules and stressed the need to safeguard your brain like gold, which is the most important organ of body. In the end, there was a session where the audience participated to know more about brain and its disorders.

Varanasi

World Brain Day was celebrated at the Department of Neurology, Institute of Medical Sciences, Banaras Hindu University Varanasi, a central government university, on July 22 under the aegis of advocacy subsection of Indian Academy of Neurology.

About 150 persons with neurological disorders and their caregivers were present.

Prof. M.K. Thakur, Prof. R.K. Goel, Prof. Deepika Joshi, Prof. S.P. Singh, Dr. N.K. Agarwal, Dr. V.N. Mishra and Dr. R.N. Chaurasia participated in the activity. They addressed the public and gave knowledge about our brain and its importance in life and how we can keep our brain healthy and answered the questions asked by public.

Rohatak

On the occasion of World Brain Day, Dr. Pawan Sharma organized public awareness program in Rohtak.

Indore

On the occasion of the first World Brain Day Neuro-Club Indore and Rotary Club of Indore Uptown organized a series of lectures at secondary schools where Dr. Apoorva Pauranik addressed hundreds of adolescents (class 10-11-12) about the anatomy and physiology of brain along with introduction for common neurological diseases. The presentation and interaction was lively and interesting with the help of charts, posters and models. The curiosity, intelligence, inquisitiveness of the boys and girls was impressive.

Karimnagar

World Brain Day was celebrated in Vijaya Hospital. Dr. E. Pawankumar conducted awareness program on hospital premises on the importance of brain and disorders of brain, mainly stroke, epilepsy and head injury and risk factors in our local language i.e telugu. Around 100 people were educated and given advice to prevent brain diseases.They really appreciated the program, and it was a grand success.

He prepared 4,000 posters about symptoms, risk factors, prevention and treatment of stroke and pasted it across various public places, offices and local hospitals in our entire district to bring awareness about stroke and received good feedback from many people.

The event was also celebrated at other centers, but they were late in sending the report.We would like to compliment WFN for this very impotant public health initiative. It was the best way to reach out to the people and interact with them.Some members expressed that they did not get enough time to organize the activity to their potential and expectations. We are sure next year the event will explode and reach greater heights as some members have already started planning.

Dr. Meshram is the president of Indian Academy of Neurology. Dr. Thomas is the secretary of Indian Academy of Neurology.

Rabat Center

Following the accreditation of the Center of Rabat as a training center of African neurologists, the Department of Neurology at the Mohamed V University hosted Dr. Mohamed Albakay from Mali Sept. 9, 2014, as the first African intern.

Albakay received a grant from the World Federation of Neurology of 12,000 Euros to cover the stay in Rabat, the accommodation, a return ticket Bamako-Casablanca and health insurance.

Following the agreement between the WFN and the Moroccan Foundation Against Neurological Diseases, the scholarship of Albakay will be managed by the foundation.

Albakay has already begun his training in electromyography in the Department of Clinical Neurophysiology of the Hà´spital des Specialtés, headed by Prof. Rida Ouazzani. During this stage, he also experienced the expertise of the team in the diagnosis of myopathies and peripheral neuropathies.

The second part of the course will take place in the Department of Clinical Neurophysiology of Mohammed-V Military Hospital, headed by Prof. Hamid Ouhabi. This department is well known for its expertise in EEG, video EEG and in the treatment of epilepsy.

Albakay may participate in the various multidisciplinary staffs organized by our department.

Furthermore, the Moroccan Society of Neurology decided to support his participation to the Maghrebin Congress of Neurology that will be held Nov. 13-15, 2014, in Agadir.

Prof. Mustapha El Alaoui Faris, Department of Neurology and Neuropsychology, Mohamed-V University, Rabat, Morocco

54th International Neuropsychiatric Congress

Opening of the 54th International Neuropsychiatric Congress in Pula.

The 54th International Neuropsychiatric Pula Congress (INPC) was held in Pula June 18-21, 2014, under the auspices of the Croatian President of Republic Prof. Dr. Ivo Josipovi.

The organizers of the Congress are: Kuratorium International Neuropsychiatric Congress, Department of Medical Sciences of the Croatian Academy of Arts and Sciences, the Association of Neuropsychiatry and Zagreb’s Institute for the Culture of Health. It was endorsed by the World Federation of Neurology and supported by the European Psychiatric Association, the Central and Eastern European Stroke Society (CEESS) and International Interdisciplinary Medical Association of Russia. The main

President of the INPC Congress, Prof. Vida Demarin and Prof. Michael Chopp with his wife.

sponsors of the congress were the Ministry of Science, Education and Sports of the Republic of Croatian, City of Zagreb, City of Graz, and Istria County. There were more than 350 participants from Croatian, Albania, Austria, Bosnia and Herzegovina, Montenegro, Czech Republic, Greece, Iran, Italy, Ireland, Hungary, Macedonia, Germany, Poland, Romania, Russia, United States, South Korea, Slovenia, Serbia, Ukraine, United Kingdom.

The main theme of the congress was “Lifestyle and Prevention of Brain Impairment.” In addition to lectures on the main theme, there were numerous accompanying symposia, in particular: third European Summer School of Psychopathology, seventh International Symposium on Epilepsy, second Neuro-Interdisciplinary School, third Symposium on the Interface Providers in Neurorehabilitation, psychiatric symposia on the new Croatian law on the protection of persons with mental disorders, forensic psychiatry, ADHD, treatment of advanced Parkinson’s disease, the activities of the Association of Public Health “Andrija Stampar” in stroke prevention, a common approach to diagnosis, treatment and follow-up of Anderson Fabry’s disease in

Prof. Vida Demarin with representatives of the Association of Public Health “Andrija Å tampar.”

South-East European region, cerebral aneurysms, palliative care and atrial fibrillation as a risk factor for stroke. A joint meeting with Alps-Adria Neuroscience Section, WFN Applied Research Group on the Organization and Delivery of Care and Central and Eastern European Stroke Society was held dealing with different therapeutic approaches in the treatment of neurological and psychiatric diseases.

Poster sessions

Invited lecturers from all over the world gave 76 lectures, followed by vivid discussions. Special attention was also given to the poster session with numerous posters from neurology and from psychiatry and two best posters from each discipline got the prize given by the City of Graz.

International Neuropsychiatric Pula Congress, organized continuously for the past 54 years, is one of the congresses with the longest tradition in the world in the field of neurology, psychiatry and neuropsychiatry. With its multidisciplinary approach, covering many interesting topics in psychiatry, neurology, and in other related fields of medicine, it is still promoting the fundamental idea of long-established “Pula School of Science and Humanism.”

Arthur Simons and Tonic Neck Reflexes in Hemiplegic Persons

By Bernd Holdorff

Bernd Holdorff

Tonic neck reflexes in animals and men were described by Magnus and de Kleyn in 1912.

It became his most important publication and remained unsurpassed for the next years. A film from the years 1916-1919, with Arthur Simons as examiner, shows these nearly forgotten phenomena. (See Figure 1.) He already emphasized their everyday significance in 1920, long before the rules of antispastic positions were defined by Bobath.

After several clinical activities, mostly in unpaid positions, and subsequently as the leading assistant in the outpatient service (Poliklinik) of Hermann Oppenheim in the years before WWI, Simons (1877-1942) had to do military service as a physician from 1914 to 1918. He succeeded in assembling neurological case reports and publications to fulfill the academic requirements for the “Privatdozent” or “Habilitation Act” in 1921 and for a professorship (a.o.= extraordinary professor) in 1923.

After Oppenheim’s death in 1919, he worked in an outpatient practice and as consultant neurologist in Berlin hospitals until 1933, where he was continuously deprived by the Nazi regime, because of his Jewish origin. Requests for immigration to England failed and meanwhile his private practice lost more and more patients. In 1938, he lost his medical license and had to accept the profession of “Krankenbehandler.” Alimony for his divorced wife forced him to sell more and more of his art collections as well as his household. In September 1942, he did not return from a citation to the Gestapo, and after intermediate detention in October 1942, he was taken to Reval (the present Tallinn, Estonia) where he was murdered.

Figure 1. Still with Arthur Simons as examiner. Upper part: left hemiplegia after brainshot wound, metal rod loosely in the right hand, paretic leg slightly bent and passively held by Simons Lower part: head rotated to right, hemiplegic associated reactions (Mitbewegungen) on the left side elicited by voluntarily right forced grasp: abduction of upper arm, elbow flexion, elevation of the left hand and fist clench, flexion of hip and knee, adduction of the thigh, dorsiflexion of the foot and the toes as well as inversion. (Not shown here: head rotation to the left in combination with voluntarily forced grasp of the right hand resulting in slight extension, adduction and pronation of the forearm, hand extension and clench of the fingers, as well as left leg in strong extension, inward rotation, foot flexion and toe extension.)

In 1912, Magnus and de Kleyn, in the Netherlands, studied in detail the labyrinthine and the postural reflexes in animals as well as humans. Following Rudolf Magnus, tonic neck reflexes are the consequence of a change of the position of the head in relation to the trunk, which causes an increase or decrease of tonus of ipsilateral muscles (asymmetrical tonic neck reflexes), while dorsi- and retro-flexion of the head results in bilateral change of tonus (symmetrical tonic neck reflexes).

As a result of Magnus’ animal experiments, the anatomical basis of tonic neck reflexes could be located in the upper cervical spine. They are decreased after extirpation of the first cervical root and completely disappear after cutting of the second cervical root. Tonic neck reflexes are elicited in the newborn during the first weeks and reappear only in cerebral disease.

After the coincidental observation in his first patient at the military hospital, Simons wrote: “In the autumn 1916, I examined a hemiplegic patient in the field two months after an injury by gunshot in the head”¹. Simons undertook a thorough series of investigations, and at the end of the war, he had observed 31 hemiplegics. By 1919, he had seen 248 cases, of which 25 percent presented tonic neck reflexes with hemiplegic “Mitbewegungen” (synkinesias). He produced a film (Filmarchiv, Bundesarchiv, Berlin) that shows 11 cases from the years 1916-1919, mostly with war brain injuries.

The asymmetric neck reflexes with flexion or extension on the hemiplegic side, called “Mitbewegungen” (synkinesias), identical to Francis Walshe’s “associated reactions” (1923)², are induced (increased or varied) by neck rotation with simultaneous co-contraction of the non-affected extremities, e.g. by closure of the fist. They are restricted to the paralyzed side. The stills shown in Figure 1 are taken from the film.

Investigations by Simons and Walshe were done exclusively in the adult and awake hemiplegic, show that tonic neck reflexes are bound to a lesion of the pyramidal tract and should be understood as a form of decerebrate rigidity. They belong to Magnus’ postural reflexes, or “Stellreflexe,” the English term of which is “position” or “righting reflexes” and are situated in the brain stem.

Walshe was fair enough to acknowledge Simons’ milestone discovery in his final addendum. In 1925, the Hamburg neurologist Heinrich Pette stated in his own investigation on tonic neck reflexes that “up to now, they remain unique in this manner of large scale work.” The reproduction of Simons’ film stills by Magnus in his 1924 Körperstellung³, by Rademaker in his 1931 Das Stehen, as well as by Stenvers in his chapter in Bumke’s & Foerster’s Handbook of Neurology (Vol. 5, 1936) bestowed them a historical value.

After that period, the couple Berta and Karl Bobath, in their English exile, used the neck reflexes in physiotherapy and position of hemiplegics in order to decrease their spastic tonus, unfortunately relying only on Walshe’s work and not on Simons’ efforts.

References

1. Simons A (1923) Kopfhaltung and Muskeltonus. Ges.Z. Neurol.Psychiatr. 80: 499-549.

2. Walshe FMR (1923) On certain or postural reflexes in hemiplegia, with special reference to the so-called “associated movements.” Brain 46: 1-37.

3. Holdorff B (2012): Arthur Simons (1877-1942) über tonische Halsreflexe beim Hemiplegiker aus den Jahren 1916-1919. Nervenarxt 83: 514-520.

Holdorff is the former head of the neurologic department Schlossparkklinik, Berlin. Koehler is the editor of this history column. He is neurologist at Atrium Medical Centre, Heerlen, The Netherlands.

Do’s and Don’t’s in Neurology

EAYNT SPECIAL SESSIONS AT EFNS-ENS JOINT CONGRESS

Dr. Laszlo Sztriha discussed mobility across countries.

By Monica Moarcas, Antonella Macerollo, Johann Sellner and Walter Struhal

During neurology training, there are crossroads where the best decision is based on advice from more experienced colleagues and professors. The choice to dedicate to research or pursue the clinical path is among the first steps, and visiting departments of other sites may aid in building a career plan.

The European Association of Young Neurologists and Trainees (EAYNT) is a non-profit independent organization aimed at linking young neurologists across Europe in respect to educational and exchange of experience opportunities. In the last 14 years, it has brought together young neurologists at its Special Sessions organized at EFNS meetings where experienced speakers have discussed aspects of training and planning professional development.

During the EAYNT Special Session at EFNS-ENS Joint Congress Istanbul 2014, Prof. Jose Ferro, Prof. Walter Paulus and Dr. Laszlo Sztriha offered lectures on the “Do’s and Don’t’s in Neurology Training” covering the complementary perspectives of research and clinical work of young neurologists.

Sztriha from King’s College Hospital, London, talked about mobility across Europe during training in neurology as seen by a young neurologist. He showed that the goals of visiting a hospital in a different country include improving clinical expertise, research opportunities and possibilities to apply the new knowledge in home department. He also recommended identifying the most suitable place to visit — based on language compatibility — by looking for opportunities published on department homepages or journals or by meeting staff members at conferences or through special mobility programs that offer the opportunity to visit departments. He also discussed funding for EFNS and ENS programs, fellowship from home departments or from host institution. Sztriha also offered valuable practical advice regarding opportunities for experience exchanges for young neurologists.

Prof. Jose Ferro identified research challenges.

Prof. Jose Ferro from Santa Maria Hospital, Lisbon, Portugal, talked about the do’s and don’t’s of research. Ferro presented the steps a young researcher needs to take to build a successful career based on skills and knowledge and focused on the mission, which is determined by goals and values. He emphasized personal and interpersonal competencies of a researcher, as well as the importance of self-analysis. He also discussed the essential role of a mentor. He shared aspects from his own professional path as a researcher and presented the importance of working in foreign departments. The importance of being constant in the research topic and issues regarding authorship of papers were two important points of this talk. Ferro concluded by highlighting that determination and hard work are key characteristics of researchers who should never forget their missions.

Prof. Walter Paulus from University Medical Center Goettingen, Germany, focused on do’s and don’t’s of clinicians. Paulus presented data regarding how satisfied trainees are with their training process through a German survey. Next, he showed the current work situation of a clinician, which is between growing clinical demands, the competition for research, more administrative issues to handle that are partially compensated by stability of job and a less stressful environment after work. The lecture continued with focus on attributes a successful clinician should have, including empathy, perseverance, ambition, structured thinking, curiosity and good clinical skills. On the contrary, he discussed characteristics that a clinician should not have: a lack of interest, insufficient skills, inappropriate attitude toward colleagues and forcing the symptoms into a diagnosis.

Prof. Walter Paulus discussed clinician training.

Paulus highlighted the importance of minimizing the clinician’s own mental distress in order to ensure patient safety, and a good working atmosphere is a collective effort along with the information exchange and acquisition.

He also talked about problems he observes in residents, including poor clinical judgment, patient management, absenteeism, inappropriate interaction and management through better supervision. He highlighted the importance of mentoring residents throughout their training.

Neurology training represents a sequential process that needs personal effort to improve knowledge and skills, determination, understanding of the aims and goals and of methods to achieve them. In addition, there needs to be the touch of personality of a true mentor who not only teaches and supervises, but also serves as a model.

The three lectures gave young neurologists the opportunity to have a better understanding of aspects of training both in clinical field and research, in home departments and abroad.

Moarcas is with the Department of Neurology, Emergency University County Hospital Brasov, Romania.

Editor’s Update and Selected Articles From JNS

By John D. England, MD

John D. England, MD

Readers of the Journal of the Neurological Sciences will soon notice a few changes between the covers. The Editorial Board and I are gradually changing the way in which case reports are handled and published. JNS continues to receive a large number of manuscripts submitted from around the world.

Because of publication limitations, we can accept only a minority of these manuscripts for publication. Although case reports are usually considered reports of “anecdotal” observations, most clinical neurologists find them educational and interesting. Rather than reject all of these case reports, we have decided to publish many of them as “Letters to the Editor.” In this way, we can accommodate them within JNS.

The journal also will be featuring more “editorials” to highlight and enhance important original articles, which will be published simultaneously. These will usually be solicited by invitation from one of the associate editors or me. However, if you are asked to review a manuscript for JNS and believe that an accompanying editorial would be useful, please provide this as a recommendation in your review.

In our ongoing attempt to enhance accessibility of JNS articles to members of the World Federation of Neurology (WFN), we have selected two “free–access” articles, which are profiled in this issue of World Neurology.

In this issue, we feature two paired articles:

1) In the first article, Dennis Paul and colleagues provide new observations about the ubiquitous and important Na⁺-K⁺ ATPase pump. This research team previously documented that inflammation results in an up-regulation of sodium channels (especially Nav1.7) in dorsal root ganglia (DRG). Using the same experimental paradigm, they have now demonstrated that there is a simultaneous up-regulation of the Na⁺-K⁺ ATPase pump. The researchers had hypothesized that this would occur since without an up-regulation of the Na⁺-K⁺ ATPase to pump Na⁺ out of the cells, an increase in Na⁺influx would lead to an osmotic influx of water. Consequently, the DRG cells would swell and burst. As proof of the protective mechanism provided by an increase in the Na⁺-K⁺ ATPase pump, the authors blocked the activity of the pump with ouabain. This pharmacologic blockade resulted in the swelling and death of the DRG cells which had an inflammation-induced increase in Na⁺ channels. These observations have important implications for the pathophysiology of inflammatory conditions and concomitant neuropathic pain. They may have broader importance for the pathophysiology of other diseases such as diabetes mellitus, which is known to interfere with Na⁺-K⁺ ATPase pump expression and function. Specifically, interference with the function or blockade of the Na⁺-K⁺ ATPase pump might cause premature cell death in susceptible cells. Paul D, Soignier RD, Minor L, Tau H, Singu-Mize E, Gould HJ. Regulation and pharmacological blockade of sodium-potassium ATPase: A novel pathway to neuropathy. J Neurol Sci 2014;340:139-143.

2) In the second article, Craig Stevens provides a thoughtful and comprehensive editorial about the biological importance of the Na⁺-K⁺ ATPase pump. This paper serves as a brief primer on the importance of the Na⁺-K⁺ ATPase pump for maintaining the resting membrane potential and volume in all cells. He also highlights the growing evidence that Na⁺-K⁺ ATPase dysfunction may be involved in several neurological diseases in addition to peripheral neuropathy. Stevens CW. New pathways for an old molecule: The role of the Na+-K+ ATPase pump in peripheral neuropathy. J Neurol Sci 2014;340:3-4.

England is editor-in-chief of the Journal of the Neurological Sciences.

European Academy of Neurology Sixth Regional Teaching Course in Sub-Saharan Africa

Wolfgang Grisold

By Wolfgang Grisold

The Sixth Regional Teaching Course (RTC) of the EAN took place in June in Lusaka, Zambia. There were 124 participants from 20 Sub-Saharan countries in attendance.

The course, which was organized by the EAN, was supported by a consortium of European and international scientific societies also by the WFN.

American Academy of Neurology (AAN)
Epilepsy Association of Zambia
International Brain Research Organization (IBRO)
International Parkinson and Movement Disorder Society (MDS)
Pan African Association of Neuroscience Societies (PAANS)
University of Zambia
World Federation of Neurology (WFN)
World Stroke Organization (WSO)
Zambian Ministry of Health

An unrestricted educational grant was obtained from the Lundbeck International Neuroscience Foundation. The course faculty of international educators included: Erich Schmutzhard and Wolfgang Grisold (Austria); Riadh Gouider (Tunisia); William Howlett (Tanzania); Jean-Michel Vallat (France); Anthony Zimba and Masharip Atadzhanov (Zambia); Raj Kalaria, Peter Sandercock and Tim Steiner (UK); Amadou Gallo Diop (Senegal); Angelo Antonini (Italy); James Bower (U.S.); Osheik Seidi (Sudan); and Mehila Zebeginus (Ethiopia).

This three-day RTC covered infection and nervous system disorders, including stroke and movement disorders and disorders of the peripheral nervous system.

The topics were relevant and up to date. In addition to the teaching aspects, all of the visiting professors emphasized how the latest developments and ideas involved in the diseases under discussion could be implemented.

The program was selected by participants from the previous year, based on a poll. The lectures were presented with PowerPoints. Some sessions were supported by video demonstrations. All presentations were followed by discussions, and there was time for questions after each main lecture session. At the end of each block, a question-and-answer session was allowed, which was highly interactive. The faculty joined in guessing the answers and in the discussions, and several academic points of view were aired.

In the afternoon teaching sessions, a pair of lecturers demonstrated cases and encouraged participants to be actively involved in breakout sessions. These cases were either based on video demonstrations, images or classic narrative case descriptions. Participants were asked for their opinions. In some instances, an emphasis on a structural approach was studiously followed. This proved to be interesting, and the teaching sessions were highly informative. In addition, the participants were exposed to the different teaching styles of the faculty depending on the school of teaching (U.K., France, Italy, U.S.) or personal styles.

Both the case discussions as well as the general discussions revealed positive and critical aspects: It seems that young neurologists are exposed to a huge quantity of diseases and patient needs in their countries, but they have limited resources in so many ways. But their knowledge and interest is great, and this is what makes this course exciting.

Also, as a critical remark, their sometimes limited knowledge of English can be noted, and there is often some hesitancy to express their opinions in discussions with the teaching professors. Notably, however, the interaction between residents and faculty improved considerably during the course.

Some selected lectures were given by young neurologists, which were technically well prepared, and discussed with the audience.

A special experience was the session on “How to Write Paper.” Three experienced teachers — Dr. Gallo (Senegal), Dr. Kalaria (UK) and Dr. Bowers (US) — each gave a presentation and discussed many aspects, from the selection of a topic, the preparation, technical aspects of the manuscript and how to deal with journal editors and reviewers.

Social Interaction

There was an official reception on Thursday, which was attended by the First Lady of the State Christine Kaseba-Sata, Goodwill Ambassador to WHO, who gave the meeting an official standing. This cannot be estimated highly enough in a country with 40 million inhabitants and only one neurologist. This meeting also was covered by local news and TV, which will likely increase the awareness of neurology in Zambia.

Lunch and coffee breaks were used eagerly for information and exchange.

Local Society of Neurology and Psychiatry

The local neurology department is based on the work of Anthony Zimba and Masharip Atadzhanov. The department in Lusaka contains a WFN-sponsored neurological institute, which now has established EEG and EMG. The university has one MRI and laboratory investigation also offering PCR techniques for neuro-infectious diseases.

Impression

This sixth course seems like a big effort to make, demanding a lot of resources for a small group of attendees in relation to the large number of countries without neurology services. However, all of the attendees are devotedly involved in neurology and are important proponents for neurology.

Furthermore, this course can be considered the ignition or spark for newly developing neurological societies, units and neurologists. The fuel is the knowledge of the importance of neurology and education, which will drive the development in individual countries. An example is Ethiopia, which has profited from the first TC and which has since produced a training program.

WFN’s role is to keep up this spirit of teaching, and encourage and partner with other organizations to improve this momentum of teaching, learning and creating neurology in Africa.

To meet this continuing need, the EAN-led planning group met in Lusaka to plan the next course. The participants were asked to list three topics of interest they would like to see addressed in a future RTC. From the compilation of the suggested topics, two that had the highest number of requests were identified for the 2015 RTC. The seventh RTC will be held in October 2014 in Khartoum, Sudan, and will be hosted by Prof. Osheik Seidi and the University of Khartoum. The themes of the conference will be neuro-pediatrics and stroke.

Grisold is with the Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.

Visiting the Neurology Department

Young neurologists and trainees during the hospital visit at the Istanbul University Cerrahpasa School of Medicine Neurology Department, EFNS-ENS Joint Congress in Istanbul.

ISTANBUL UNIVERSITY CERRAHPASA SCHOOL OF MEDICINE

By Anna Sauerbier, Walter Struhal and Antonella Macerollo

The first Joint Congress of Neurology, combining both the European Federation of Neurological Societies (EFNS) and European Neurological Society (ENS), was held in June in Istanbul, Turkey.

Each year, the European Association of Young Neurologists and Trainees (EAYNT) organizes several activities during the conference to give young neurologists and trainees from different cultural backgrounds all over Europe the opportunity to get together and exchange their individual, professional and personal experiences.

In addition to the lottery, the photo contest and the special EAYNT session, one of the annual highlights of the EAYNT activities is a local hospital visit followed by a get-together. This year’s hospital visit led 90 interested and curious young neurologists and trainees to the Istanbul University Cerrahpasa School of Medicine Neurology department. The visit organized by the Congress President Prof. Aksel Siva and the Turkish Neurological Society.

The participants learned about the general history of the hospital and the educational system in Turkey from hospital residents.

Young neurologists and trainees during their visit to the Istanbul University Cerrahpasa School of Medicine.

In 1933, the Neurology Department was established. This makes it to one of the oldest institutions of higher education in Turkey. The current name Cerrahapasa School of Medicine was introduced in 1963 when the hospital was restructured and an additional Istanbul School of Medicine was founded.

The Istanbul University Cerrahpasa School of Medicine is now one of the three Government Medical Universities in Istanbul and one of the main medical schools in Turkey offering Turkish and English Medical programs. The Neurology Department consists of 36 adult and six children beds. In total, six consultants, 16 residents, seven fellows and 24 master students in electroneurophysiology work in the department.

The undergraduate (medical school) training is followed by a minimum of four years of residency training in neurology, which includes three-month rotations in each neurology division, and laboratories and short periods in different other specialities. In addition, numerous graduate and postgraduate educational programs are available at the Istanbul University Cerrahpasa School of Medicine Neurology Department.

Due to the large variety of divisions and units covering the complete field of neuroscience complemented by a multidisciplinary approach, the Neurology Department is able to provide comprehensive services for the diagnosis, treatment and care of patients with a wide range of neurological conditions. Further, it is one of the most esteemed centers for research and education in Turkey.

The young neurologists and trainees then enjoyed a guided hospital visit through the Neurology Department where each unit’s health professional welcomed them and explained their field of expertise. The divisions in the Neurology Department include Clinical Neurophysiology and Epilepsy, General Neurology, Pain Disorders and Headache, Neuromuscular Disorders, Neuroimmunology/Multiple Sclerosis, Sleep Medicine, Paediatric Neurology, Vascular Neurology and Movement Disorders.

This allowed the participants to discover the Clinical Neurophysiology/EMG unit where more than 3,000 patients are investigated annually. In addition, more than 500 patients are followed up for various neuromuscular disorders and more than 300 patients for botulinum toxin injections.

Afterward, the neurologists visited the epilepsy center with an electroencephalography laboratory where annually more than 2,000 patients referred from all over Turkey are seen, and more than 6,000 patients are followed up with different epileptic disorders.

At the end, Siva invited all participants to a dinner and get-together at the restaurant of the Istanbul University. Besides this profound insight into the clinical practice and the education system of neurology in Turkey, the 90 impressed young trainees and neurologists were able to experience another important aspect of the Turkish culture by tasting the delicious flavor of original Turkish food ranging from different forms of kebab, kofte, dolma, borek, mezes and other lovely desserts.

Acknowledgment: The EAYNT is grateful to Siva and the Turkish Neurological Society for their friendly invitation and excellent organization of the hospital visit. In addition, we would like to thank Siva and the team of the Neurology Department for their kind provision of the presentations and pictures during the hospital visit.