From the Field

World Stroke Day Congress in Moscow

Three days of powerful presentations on stroke

By Peter Sandercock, MD, DM, FRCPE, FMedSci, FESO

Peter Sandercock, MD, DM, FRCPE, FMedSci, FESO

More than 2,800 neurologists and other physicians involved in stroke care attended World Stroke Day Congress Oct. 25-27 in Moscow. Attendees were from Moscow and more than 60 regions of Russia and 10 other countries, mostly Eastern European. There also were representatives of stroke support groups.

The meeting was held in the iconic Ukraina Radisson Royal Hotel Conference Center in central Moscow. The conference was organized by Prof. Eugene Gusev, president of the All-Russian Society of Neurologists, and Prof. Alla Guekht, secretary of the All-Russian Society of Neurologists and the World Stroke Organization, with the support of the Ministry of Health of the Russian Federation, the Russian Academy of Sciences, Moscow Healthcare Department, Pirogov Russian National Research Medical University, All-Russian Society of Neurologists, and the Moscow Research and Clinical Center For Neuropsychiatry.

In the spirit of international collaboration and scientific exchange of ideas and solutions to tackle the global burden of stroke, the conference was supported by representatives from major international stroke and neurological organizations: the World Federation of Neurology (WFN), European Academy of Neurology (EAN), American Academy of Neurology (AAN), European Stroke Organization (ESO), and the International League Against Epilepsy (ILAE).

The congress focused on the latest developments in stroke prevention, acute management, and restorative care after stroke, as well as on raising awareness about stroke and the need for better resources, sharing experiences in dealing with problems resulting from stroke, and providing relevant information to stroke survivors and their caregivers.

The congress book contained extended abstracts of all of the talks and was published in English and Russian. The participants of the congress received the book for free. As many doctors in the former Soviet Union know English poorly, these books are extremely valuable for them.

Education Sessions and Symposia

Demonstration of innovative stroke rehab technology at Moscow Research and Clinical Center of Neuropsychiatry.

Day 1: The congress got off to a great start, with the program for the day including sessions on stroke in the young, rehabilitation after stroke, chronic cerebrovascular disease, clinical pharmacology and pharmacotherapy of stroke, current technologies in endovascular treatment of acute ischemic stroke, management of stroke — challenges and solutions, organization of stroke care, and a master class on multiple organ failure in severe stroke.

The WSO members on the faculty who gave talks on Day 1 were Geoff Donnan on “Thrombolysis, Modern State and Perspectives,” Peter Sandercock on “Personalized Medicine: Can it Be Applied in Stroke and Can it Be Tested in Trials?” and Wolfgang Grisold (from WFN) on “Stroke and Cancer.”

Main Scientific Sessions

Day 2: The scientific congress was formally opened by a Praesidium of Representatives of all the key organizations in contributing to the congress, with welcoming words from Parliament of the Russian Federation, Russian Academy of Sciences, local organizers A. Guekht and E. Gusev, and W. Hacke (representing WSO). The ESO was represented by V. Caso, EAN by D. Leys, WFN by W. Grisold, and ILAE by E. Perucca.

It was followed by a series of expert talks from Russian colleagues, covering a wide variety of issues on current stroke care in the region. The afternoon sessions included updates on current standards in stroke diagnosis, the role of neuropsychiatry in stroke, novel opportunities in stroke recovery, thrombolysis, and a masterclass in chromotherapy. There was an important session on cerebrovascular disease in ICD-11 with talks by S. Murasev and E. Salakhov (representatives of the Ministry of Health) on the “Role of the Russian Federation in International Program Against Brain Diseases,” B. Norrving (WSO) on “Stroke as a Brain Disease in ICD-11 – What Does it Mean?”, R. Sacco (AAN) on “Stroke Prevention and Brain Health Support” and V. Caso (ESO) on “Gender Differences in People with Ischemic Stroke.” There also was a key session on post-stroke epilepsy with talks by A. Hauser and S. Moshe from the U.S., Prof. Guekht and E. Perucca (Italy).

Scientific Sessions

Prof. Guekht, Prof. N. Bornstein, and Immediate Past President of WSO Prof. S. Davies discuss stroke rehabilitation.

Day 3: The main plenary session was opened by Prof. Veronika Skvortsova, the Minister of Health, and was followed by the Award of Diploma of the Foreign Members of the Russian Academy of Sciences. This was followed by a series of talks on major stroke topics: “Intravenous Thrombolysis — Is it Still the Most Important and Specific Method of Acute Stroke Therapy?” W. Hacke; “Cognitive Impairment After Stroke Is a Heavy Burden for Patients, Their Families, and Society,” M. Brainin; “Reperfusion Therapy and Ischemic Penumbra,” S. Davis; “Arterial Hypertension and Stroke,” E. Chazov, I. Chasova; “Approaches to Lowering Cardiovascular Disease Mortality in Russia,” S. Boitsov; “Surgical Treatment of Stroke in Russia,” V. Krylov; and “Spinal Cord Circulation Disorders,” A. Skomorets.

This session outlined the great progress that has been made in reducing the burden of stroke and vascular disease over the past decade, but also highlighted the priority actions for the future. Other interesting contributions of the day included sessions on stroke in childhood, ultrasound in diagnosis, “Eye as a Mirror of the Brain,” by N. Bornstein and a session on post-stroke cognitive impairment.

Visit to Moscow Research and Clinical Center For Neuropsychiatry

Prof. Guekht arranged a fascinating and most enjoyable visit for the international faculty to her institution, at which research fellows presented their work on various aspects of cognition, neuroimaging, neuropsychiatry, and rehabilitation. She invited her colleagues and collaborators to attend this meeting and present their institutions, so there was a possibility to get acquainted with the best University Hospitals/Clinical Centers in Moscow: the Clinical Medical Center of the Moscow University of Medicine & Dentistry, Buyanov Moscow City Hospital of the Healthcare Department of Moscow, and others.

This was an excellent opportunity for scientific exchange and discussion. The significant achievements in the Moscow medical system — modern equipment, new technologies, and well-trained doctors — were very impressive; the Buyanov Moscow City Hospital and the Moscow Research and Clinical Center of Neuropsychiatry were the perfect examples. The grounds of the center include new buildings as well as some beautiful historic ones that have been renovated and preserved as monuments to the long scientific heritage of the unit.•

Sandercock is Emeritus Professor of Medical Neurology at the University of Edinburgh, U.K.

Jan Swasthya Sahyog Diaries

The inspiring work and legacy of JSS

By Mamta Bhushan Singh

Health worker, physiotherapist, and visiting neurologist visit the home of a stroke patient to check on her progress and provide some guidance on rehabilitation.

Eight thousand neurologists descended upon Kyoto where we are attending the XXIII World Congress of Neurology, and where this article was written. If the best that humankind can be, do, and achieve has to be witnessed, Kyoto may be the correct place.

I am not making this statement lightly, but sharing my assessment of the city and its people after being here for a few days. There are very few places that inspire; Kyoto is certainly one of them.

Jan Swasthya Sahyog, or JSS, which I write about here, is also an inspirational place. Why did I think of JSS while I am in this world-class amalgamation of the ancient, traditional, and cutting-edge modern? Well, so is JSS! While JSS makes a serious attempt to make available to the local tribal Indian communities every effective modern treatment, there is an equally passionate commitment to preserve all that is good, wholesome, and healthy in the traditions, practices, and environment of the region.

JSS is in Ganiyari, Bilaspur, in the central Indian state of Chattisgarh. This is a remote, rural, neglected region, and JSS is carrying almost the entire burden of providing health care here.

Being Struck

Patients come to JSS from far, traveling for up to two days to reach there. In spite of JSS having long 12 to 14 hours of clinics, patients may have to wait up to several days for their turn. This is how they leave a bag or tie a piece of cloth to mark their place in the queue.

On the way from JSS to some of its outreach clinics is a forest called Achanakmar. For non-Hindi-speaking friends, this would roughly translate into “being struck, suddenly.” I am not sure how many people in or around the forest have been “struck” by animals from this forest. In the gentler surrounds of Ganiyari, the tribal Baigas, Gonds, Abhuj Maria, and many others are being struck with far more regularity and finality by something else. We would like to believe that what is striking them is disease; and in some ways, it is. Yet, what is striking them far more frequently and harder, I believe, is poverty. And apathy.

The local population that JSS serves is chronically malnourished. Life is hard, regular employment only available in certain seasons. Alcoholism adds another layer to the population’s challenges. The favored spirits are derived locally from the Mahua tree. Men and women are equally afflicted. Families often tend to be large with many families having five or more children.

Under such circumstances, if disease strikes, the blow can be final. Diseases are rampant. Tuberculosis and diabetes may be major problems, but anemia, infections, infestations, deficiency syndromes, sickle cell disease, bites, stings, and every other disease one can think of, jostle for attention and resources.

Health Care

The health worker exchanges pleasantries with me as I go through patients who have been specially called to the epilepsy clinic at Bahmni. Bahmni has one of the outreach clinics that JSS runs in the region.

If you look around for the available public health care for these indigenous people, you are not surprised. There is almost nothing. These people do not matter, and we are too busy and important to be bothered about them. So people continue to fall sick, suffer, and die. God forbid, they show a little spunk and try getting treatment in one of the private clinics or hospitals at the nearby Bilaspur or the slightly further Raipur. There is an extremely high likelihood of them then falling into an endless spiral of debt from which they might never recover.

Enter JSS. Each word in this name is meaningful. A few bold, committed, and extremely unusual doctors initiated the project more than a decade ago. Spend a few days at JSS and what impresses you is how rooted the idea is in the local community and how organically the community connects with it. Each one is an equal stakeholder. The founder doctors had the audacity to not only conceive such a project but have also dedicated their lives to bringing their vision to fruition. The community in its response surpasses my expectations. Every time I visit JSS, I wonder why we do not more often engage with the communities that we work in?

Miracles

JSS is not only a hospital. It is people working for themselves, facilitated by the guidance and mentoring of committed doctors. Attention is crucially being paid not only to the cure of disease but also to its prevention in the community. People are being educated and made aware of sickness and health. Treatments are being re-thought and re-designed in accordance with local needs and within the framework of available logistics. The role of the generalist, which has long lost any shine in the medical profession, is being explored, even celebrated.

What Is JSS?

The vision of Jan Swasthya Sahyog, found at http://www.jssbilaspur.org/: “To develop a low-cost and effective health program that provides both preventive and curative services in the tribal and rural areas of Bilaspur and surrounding areas of Chhattisgarh in central India. We strongly believe that access to health care should not be denied to anyone due to lack of money or due to discrimination on account of caste, sex, religion, and social class.”

Even if I tried, I do not think I could better describe what JSS does. Visit the JSS FaceBook page to see some of their projects: https://www.facebook.com/jssbilaspur/.

One often gets to see miracles of the generalist at JSS. While I am there, a 60-year-old farmer walks in with recently appeared symptoms of difficulty in using language. His brain imaging is urgently arranged from Bilaspur. The scanner looks far worse than the patient.

We discuss this patient around 4 p.m., and I am worried about where we are going to find a neurosurgeon. This seems to be a brain abscess, and surgery is needed both for confirmation of the infectious nature of the lesion as well as for treatment. There is not much time to fret over it, and I get busy with epilepsy patients. Later in the evening, I discover that the quiet, unassuming, soft-spoken person trained to be a pediatric surgeon has gone rogue and performed neurosurgery.

It is a success. I would consider this otherwise modest surgery life saving over here. I did not hear any applause anywhere or even much surprise. This is what everyone at JSS does quite regularly. They challenge themselves and break boundaries.

Over the last 10 years, I have traveled a lot and been to scores of Indian small towns and villages and met hundreds of health care professionals. Many of them come across as being very committed and caring. Yet, I have never seen a patient being brought for a consultation not by his family but by a health worker. At JSS, I was surprised to see that this happens quite regularly.

I am told that 13-year-old Birju’s parents have recently migrated to Allahabad in search of a livelihood. He and two of his siblings are staying with grandparents. The village health worker has brought Birju to the epilepsy clinic. Another young patient’s parents are erratic in getting her to the epilepsy clinic. I am informed that they are Mahua addicts and often inebriated. The village health worker who has brought her knows all the details that I need and does not seem judgmental or annoyed. I feel guilty because I am feeling both of these emotions very intensely. I have so much to learn from these villagers.

People can be very poor. They can be so poor that they are unable to afford medicines that they desperately need to remain seizure-free and that cost as little as 100 rupees per month (~USD 1.20). I met a few patients who told me that they knew that their medicines should not be missed. Yet, every once in a while, they just do not have the money to refill their prescription. My long-held dream of setting up an “Epilepsy Drug Bank” reappears. When will I be able to get this done?

The guiding light and driving force at JSS is empathy and concern for the community. Cost of care is designed thoughtfully and not set in stone. Individual patient circumstances are kept in mind while handing over bills. Patients open up and talk. They do not appear overwhelmed, as they seem to be in the tall steel and glass structures called “hospitals” in big cities. I wonder why we do not have more JSSs. This health provision model works and has profound lessons especially for doctors, health planners, and governments. Are we ready to listen yet?

Regional Teaching Course in Sub-Saharan Africa

Highlights of the ninth neurology training course

By Wolfgang Grisold

This is a report from the Ninth Regional Teaching Course in Sub-Saharan Africa, organized by the European Academy of Neurology (EAN) and EAN Task Force, under the leadership of Prof. Schmutzhard and Eveline Sipido. The local organizer was Prof. Jean Kabore.

The Ninth Regional Teaching Course in Sub-Saharan Africa took place Nov. 8-11 in Ouagadougou, Burkina Faso. The EAN Regional Teaching Course was co-sponsored by the African Academy of Neurology, Le Burkine Faso Society of Neurology, the American Academy of Neurology (AAN), the International Brain Research Organization (IBRO), the International Parkinson and Movement Disorders Society, The World Stroke Organization, and the World Federation of Neurology.

Three successful and knowledgeable residents: (left to right) Nomena Finiavana Rasaholiarison, Madagascar; Girma Diltata Muzie, Ethiopia; and Ratsitohara Santatra Razafindrasata, Madagascar.

The aim of this Regional Teaching Course is fostering neurology training in Sub-Saharan Africa. The topics were determined by the faculty and also by residents of the last meeting that took place in 2016. The format of the course contained plenary lectures, new highlights, clinical grand rounds, and afternoon interactive case discussions with the faculty. An examination tested the knowledge of the participants. The success rate of the participants at this course was 85 percent.

Teaching Course Topics

On Day 1, the topic of stroke in Sub-Saharan Africa was discussed. The session was opened by Prof. Schmutzhard and Prof. Kabore. Also, the director of the faculty of medical sciences and the dean of the university participated. Reviews of basic principles of epidemiology, clinical presentations, and the state-of-art in diagnostic work-up and therapeutic management were discussed. Prof. Yomi Ogun, president of AFAN, gave an outline on diagnostic and therapeutic management in urban and rural Sub-Saharan Africa.

Following this, in the clinical grand rounds, patients were presented and discussed by the audience. The interactive clinical case discussions consisted of four groups (stroke, movement disorders, spinal cord, and muscle diseases) which were changed every day. Each day, every group had the opportunity to discuss these subtopics with the faculty.

The faculty of the EAN teaching course in Burkina Faso.]

On Day 2, the topic of Movement Disorders and Dementia in Sub-Saharan Africa was discussed. Following the talk on Epidemiology and Classification, the presenter from the AAN, Prof. Reilly, gave a talk on clinical presentations and diagnostic work-up. Prof. Rac Kalaria from Kenya/U.K. gave a comprehensive review on the clinical presentations, diagnostic work-up, and therapeutic management in dementia. There were also grand rounds and interactive case discussions.

On Day 3, the topic of Spinal Cord Diseases in Sub-Saharan Africa was discussed. This was an interactive session. Epidemiology and classification, clinical presentation, signs and symptoms, diagnostic work-up and therapeutic management were discussed. The following grand rounds were controversial, and many different opinions from the audience, faculty and investigators had to be discussed.

On Day 4, the course on Neuromuscular Diseases in Sub-Saharan Africa was given. It was clearly pointed out by Prof. Kabore that epidemiology in Africa is lacking in Africa, and the few available epidemiology studies come from North or South Africa. W. Grisold talked on the clinical presentations, signs, and symptoms of neuromuscular disease, and Prof. J.M. Vallat from France gave a good overview in the diagnostic work-up, therapeutic management, and electrophysiological examples. Also, this course was followed by clinical grand rounds that showed the increased spectrum of discussed cases. The interaction between the faculty and the participants was very good.

A social program was used for interaction and networking. On Thursday, there was a joint reception, and on Friday, there was a final joint dinner. This dinner will be memorable, as all representatives from participating countries gave a short statement about their home countries and particularly medical services and neurological possibilities. These talks provided a view of the spectrum of the personalities of young neurologists in Sub-Saharan Africa.

The meeting closed on Saturday after the last interactive session with a farewell of the faculty and a farewell speech from all participating societies.


The 75 participants came from 18 countries:
• Burkina Faso • Burundi • Cameroon • Congo Brazzaville	• Congo Demo- cratic Republic • Ethiopia • Ghana • Guinea	• Ivory Coast • Madagascar • Mozambique • Niger • Nigeria	• Senegal • Sudan • Tanzania • Togo • Uganda

Mexican Academy of Neurology

Wide range of topics were addressed at the 16th meeting, ranging from dementia to stroke

By Wolfgang Grisold

The large exhibition of the history of neurology in Mexico. The walk-through at the congress opening.

The 16th meeting of the Academia Mexicana de Neurologica took place Oct. 31 to Nov. 5, in the town of Veracruz, Mexico. Veracruz, also known as Mexico’s door to the world, is a historic city and presently a critical seaport.

The famous Fort San Juan de Ulúa gives vision to the historic development. Several arches document different time epochs, and the first arch on the image reminds one of an Arabic arch.

The congress is the Mexican Academy of Neurology’s most important academic event of the year. This year’s slogan was Building Bridges and Breaking Walls. The Academy invited many international experts to speak on scientific developments and new aspects of neurologic diseases. It is noteworthy that special sessions were dedicated to nursing in neurology. In the same manner, teaching sessions for non-neurologists were also held. This is a valuable step into multiprofessional education to improve care.

Model of a brain in the exhibition hall.

The WFN has close connections with Mexico, and the first WFN Teaching Center in the Americas will commence its work in January next year.

The congress opened with an impressive opening ceremony, followed by a tour through the history of neurology in Mexico. (See photo above and the related article by Dr. San-Esteban.) Sessions were dedicated to brain tumors, dementia, epilepsy, headache, neuroimmunology, neuromuscular disease, stroke, substance abuse, and several other important topics. The local and international faculty was large, and representatives included neurologists from Austria, Canada, Spain, Switzerland, and the U.S., Dr. Ralph Sacco, president of the American Academy of Neurology, reassured Mexico on the cooperation of the AAN.

Stroke

Picture of the hippocampus, based on the drawings of Ramon y Cajal.

Among the many interesting and outstanding topics, the stroke sessions increased participants’ knowledge toward the recent important developments in stroke management.

Several topics were directed toward autoimmune disease, and also the important topics of neoplastic disease and autoimmune encephalitis were discussed. Dr. Dalmau from Barcelona held a fascinating talk on the current situation of autoimmune encephalitis and expected future developments.

Opening Ceremony with a marine instrumental band.

Many of the health problems in neurology in Mexico and in the Americas were discussed in various talks. The huge population of Mexico and the large variety of health services, ranging from world-renowned institutions to the need for basic neurological care across the population, are challenges for the Mexican Society of Neurology.

This high-quality program will contribute to the understanding of neurology in Mexico as well as in Central and South America. All efforts to decrease the treatment gap will continue to need to be made, and the WFN is privileged to contribute with the establishment of the WFN Teaching Center in Mexico.

Montreal Neurological Institute and Canadian Neurological Society

Department Visit Program

The World Federation of Neurology (WFN) and the Montreal Neurological Institute (MNI), together with the Canadian Neurological Society (CNS), are pleased to invite two colleagues from Central and South America to visit the Neurology Department of the Montreal Neurological Institute of McGill University in Quebec, Canada.

The MNI was founded in 1934 by Dr. Wilder Penfield and has become the largest specialized neuroscience complex in Canada. Among its specialized clinics are those for movement disorders, epilepsy, multiple sclerosis, rare diseases, pain, brain tumors and amyotrophic lateral sclerosis.

Last year, it received more than 42,000 ambulatory patient visits, more than 28,000 diagnostic tests were carried out and brain surgeons performed some 1,800 procedures. Always at the forefront of innovation, the MNI was the gateway to Canada for technologies like encephalography (EEG), magnetic resonance imaging (MRI), positron emission tomography (PET), and computer-assisted tomography.

The CNS was established in 1948 and represented both neurologists and neurosurgeons. In 1965, the original CNS was dissolved, and two new societies were created to represent the two distinct groups, i.e., the Canadian Neurological Society (modern day CNS) and the Canadian Neurosurgical Society.

The mission of the CNS is to enhance the care of patients with diseases of the nervous system through education, advocacy, and improved methods of diagnosis, treatment, and rehabilitation.

The WFN was formed in Brussels in 1957 as an association of national neurological societies. Today, the WFN represents 120 professional societies in all regions of the world. The mission of the WFN is to foster quality neurology and brain health worldwide, a goal we seek to achieve by promoting global neurological education and training, with the emphasis placed firmly on under-resourced parts of the world.

PROJECT DESCRIPTION

The MNI and CNS would like to support the Central and South American initiative of the WFN by inviting two neurology trainees or junior faculty who are within five years of certification in neurology to visit the MNI for a duration of four weeks.

The purpose is to experience the Canadian neurological system in an international environment, meet new colleagues and foster future cooperation.

More information about the MNI can be found at https://www.mcgill.ca/neuro/about.

The visit will take place during Spring 2018.

DETAILS

The MNI will provide the following support:

Travel expenses: Central or South America — Montreal, Canada — Central or South America
Accommodations for four weeks
Living expenses (food and beverage) during the four weeks
Costs of health insurance during the stay in Canada

CRITERIA FOR APPLICATION

The applicant must be a resident of a country in Central or South America
The applicant must be a neurology resident or junior neurology faculty within five years of completion of training
Evaluation Committee: Two representatives of the Canadian Neurological Society (CNS), two representatives of the WFN Education Committee, and two representatives from the Pan American Federation of Neurological Societies (PAFNS)

DEADLINE FOR APPLICATION

To apply, submit your CV, a supporting statement, and a letter of recommendation from the head of the department by Friday, Jan. 26, 2018, to Jade Roberts, WFN education coordinator, at jade@wfneurology.org.

Countries report on their celebration of World Brain Day

This year’s World Brain Day was celebrated on July 22, 2017. The prior World Brain Day topics were aimed at epilepsy and dementia, and this year it was aimed at stroke. We partnered with the World Stroke Organization (WSO), which puts great global effort into the prevention and treatment of stroke.

India

Nagpur Mayor Nandatai Jichkar (right) inaugurated World Brain Day and Tropical Neurology Week with the assistance of (from left) Samar Nakhate, Dr. Jabbar Patel, and Dr. Chandrashekahr Meshram.

World Brain Day was celebrated with great enthusiasm on July 22 in Nagpur, India, where a public education program on stroke was presented. The program was inaugurated by Nandatai Jichkar, Nagpur’s mayor.

Chandrashekhar Meshram, MD, highlighted the importance of World Brain Day and public education activities. He also explained the risk factors for stroke and identified steps to take for stroke prevention. Dr. Dinesh Kabra spoke about symptoms of stroke and its management. Dr. Sheetal Mundra stressed stroke rehabilitation, while Dr. Sudhir Bhave highlighted the psychiatric problems associated with stroke and ways to cope with it.

Following the presentations, they screened 1000 to 1, an educational movie based on the inspiring story of Cory Weissman. The movie is about a first-year college basketball player who suffers a stroke due to an intracerebral hemorrhage secondary to rupture of an arteriovenous malformation. Weissman overcame the stroke to return to the basketball court.

Chandrashekhar Meshram, MD

After the movie, Dr. Meshram reviewed the important neurological aspects covered in the movie. The overarching message to the general public was to never give up when dealing with stroke or any neurological disorder. Dr. Jabbar Patel, renowned film director, and Samar Nakhate, the former dean of the Film and Television Institute of India, interacted with the audience and explained several of the movie’s finer aspects.

Dr. Meshram also gave a detailed interview on All India Radio, detailing various aspects of stroke.

After World Brain Day, the public awareness activity extended through Tropical Neurology Week. Dr. Meshram had written articles for newspapers in English and local languages on litchi encephalopathy, rabies, neurocysticercosis, Zika virus, arsenic toxicity, scrub typhus, and mosquito-borne diseases. Print media followed the campaign with great interest, with a whopping 48 publications during this period. The World Brain Day and Tropical Neurology Week activity was informative and educational, and created a lasting, positive impact.

Moldava

Vitalie Lisnic, MD

By Vitalie Lisnic, MD

In Moldova, stroke is the second-leading cause of death and the main cause of disability. The annual mortality rate from stroke is 168 per 100,000 citizens. To reduce stroke’s impact, the nation’s neurologists embraced the theme of World Brain Day 2017, “Stroke is a brain attack: Prevent it and treat it.”

The Society of Neurologists of the Republic of Moldova developed a poster to increase awareness of stroke risk factors and symptoms among the population. The country’s 300 neurologists take care of stroke patients. But measures to prevent stroke, recognize stroke symptoms and signs, and hospital admission with adequate thrombolytic treatment are still inefficient.

The poster consists of two parts. The first part is related to prevention of stroke risk factors because research shows that 90 percent of strokes can be prevented. The second part is dedicated to recognizing the first symptoms of stroke.

The risk factors highlighted are arterial hypertension, glucose and cholesterol levels, inadequate physical activity, obesity, cardiac arrhythmias, alcohol consumption, smoking, and diet.

The symptoms of stroke highlighted are headache, blurred vision, speech disturbances, balance problems, weakness, and numbness in the upper and lower limbs, and loss of consciousness. In acute cases, emergency medical care should be called immediately.

The content of the poster was approved by the Ministry of Health and distributed to the medical community. It was sent electronically to all neurologists in hospital and ambulatory settings. More than 300 copies were printed and placed in inpatient and outpatient departments, physicians’ offices, classrooms for medical students and residents, and lecture halls.

The poster received thousands of likes on Facebook from physicians and patients. In their weekly conferences, hospitals were told about World Brain Day and the importance of cerebrovascular pathology, treatment, and prevention among the citizens.

Vitalie Lisnic, MD, is a professor at Moldava State University of Medicine and Pharmacy at the Department of Neurology.

Myanmar

By Win Min Thit

The pamphlet (top) developed by Yangon General Hospital neurologists in Myanmar. Educational presentations (lower photos) on stroke drew large crowds.

Myanmar neurologists celebrated World Brain Day by distributing World Stroke Organization promotional materials to patients and caregivers. The effort built on the World Brain Day 2017 theme: “Stroke is a brain attack: Prevent it and treat it.”

The materials were translated and distributed by neurologists at the Department of Neurology at Yangon General Hospital in Yangon, Myanmar. We developed a health education talk on stroke, stroke risk factors, prevention, and management. We also showed a health education video on stroke, which we developed at our last World Stroke Day celebration.

Dr. Win Min Thit is professor and head senior consultant neurologist at the Yangon General Hospital’s University of Medicine Department of Neurology in Yangon, Myanmar, and president of the Myanmar Neurological Society.

Pakistan

By Dr. Abdul Malik

Media coverage, stroke screenings, and the use of awareness posters at major hospitals were part of the effort to spread the word about World Brain Day in Pakistan.

World Brain Day is an initiative of the World Federation of Neurology (WFN). It is observed annually for increasing awareness, prevention, and advocacy about brain diseases. World Brain Day is observed in 119 WFN member countries, including Pakistan, every year. Four years ago, the WFN decided to observe the day to create awareness about neurological disease on a global scale.

This year, WFN member countries observed World Brain Day on July 22. Activities were held in all four provincial headquarters as well as in rural cities across Pakistan. This year’s focus for World Brain Day was “Stroke (FALIJ),” and the theme of the campaign was “Stroke is a brain attack: Prevent it and treat it.” In this vein, free stroke screening camps, awareness seminars, press conferences, and awareness walks were held across the country.

This year‘s World Brain Day activities in Pakistan were a coordinated effort of the Pakistan Stroke Society and the Neurology Awareness Research Foundation, with the cooperation of Al-Khidmat Foundation and the largest doctors body in Pakistan, the Pakistan Islamic Medical Association. Efforts were made to create the utmost awareness about stroke.

There was a mega news briefing for all print and electronic channels at a local hotel on July 20. Speaking were Professor Shaukat Ali Khan, the former President of the Pakistan Society of Neurology; Professor Muhammad Wasay, president of the Neurology Awareness and Research Foundation (NARF) and the Pakistan Stroke Society; Professor Khalid Sher, Head of Neurology at Jinnah Hospital; Professor Arif Herekar, head of the Neurology Department of Baqai Medical University; Dr. Ahmed Salman Ghori, president of the Pakistan Islamic Medical Association, Sindh; Dr. Syed Tabassam Jafery, president of the Al-Khidmat Foundation, Sindh; Dr. Maimoona Siddiqui, vice president of the Pakistan Stroke Society; and Dr. Abdul Malik, assistant professor of Neurology, General Secretary Pakistan Stroke Society & NARF, at a press briefing held in connection with World Brain Day 2017.

There were 14 free stroke screening camps held across Sindh province, specifically the rural areas where there is no such awareness and even a lack of neurologists. Almost 1,300 people received free screening facilities from these camps.

Three press conferences and five public awareness walks were organized on July 22 in different Pakistani cities. News coverage as well as articles were published in almost 55 different local and national newspapers along with the participation on different electronic media shows.

Awareness posters were displayed across the country in almost all major hospitals, and roadside Panaflex streamers were displayed for the general public. Three formal press releases were issued related to the activities of World Brain Day 2017.

All activities were uploaded with pictures on the Facebook page. Interviews and different academic activities were displayed on social media. In different local languages, social media messages for the general public were issued in collaboration with the web-based channel.

Chat Group Helps Improve Effect of Neurophobia

By Philip B. Adebayo and
Funmilola T. Taiwo

Neurophobia has been widely described by medical students¹ as a fearful perception of neurology and neurological sciences. A survey among medical students in three Nigerian medical schools has indicated factors for neurophobia such as difficulty in understanding neuroanatomy, lack of teaching aids/models, and poor teaching of neurosciences subjects.²

In contrast to persisting manpower deficits in Nigeria, neurological disorders are on the rise. Therefore, there is a need to increase the neurological workforce. This would be difficult if neurophobia is highly prevalent. A number of strategies to address neurophobia, including practicable, stimulating, and novel teaching methods, are indicated.

Figure 1

Our approach to ameliorate neurophobia in the past was to support additional bedside tutorials and improved usage of online resources. Those initiatives aimed at increasing small group discussions among students. Small group sessions are active models of learning. The main advantage is the student-centered approach, which also helps students develop the ability for self‑assessment.³ Small group learning sessions have been found to make students more active in the learning process while building their competence in information seeking.³

In September 2015, final-year medical students of Ladoke Akintola University of Technology in Ogbomoşo, Nigeria, were engaged in a group discussion via an online chat platform (Whatsapp) with the neurology lecturer and the class representatives as the group administrators. The student representative added interested members of the class to the chat group while the lecturer posted tutorial questions to the platform twice weekly. The tutorial questions (case vignettes) were posted for discussion and included topography, neuroimaging, case videos, EEG charts, and laboratory results. (See Figure 1.) Students were encouraged to make contributions regarding the case in focus. The neurology lecturer, Philip B. Adebayo, moderated the chat to ensure it remained strictly academic. We also posted web links for additional readings with regard to the case in focus.

Figure 2

In December 2015, we sought feedback from the students to ascertain the level of interest and whether the platform helped reduce their fear of neurology. The responses were gathered in a non-structured qualitative manner. One student said, “It has been an eventful neuro year. I’m beginning to enjoy neurology.” A second student replied, “Am I really becoming a neuro fan? I can’t believe myself.” (See Figure 2.)

The chat platform seems to be having an effect on increasing interest in neurology. Small group learning sessions have been found to enhance learning, and Sharan et al⁴ attributed this to cooperative learning kinetics.

Even though our observations are anecdotal, we propose a welcoming hybrid model (teacher-driven, online, and social media small group discussions in a team-based problem-solving paradigm).

Our strategy is not new, but it underscores the importance of a multifaceted approach, synonymous with multidrug therapy in fighting neurophobia. Different approaches may be employed within a single platform. Although a well-designed randomized study may better evaluate the overall benefit of employing Whatsapp in fighting neurophobia, we think that this approach will increase interest in neurology, which is the first step in conquering neurophobia. We suggest the use of e-learning methods adopting common platforms like Whatsapp to augment traditional method of teaching neurology. •

References

Jozefowicz RF: Neurophobia: The fear of neurology among medical student. Arch Neurol 1994, 51:328-9.
Sanya EO, Ayodele OE, Olanrewaju TO. Interest in neurology during medical clerkship in three Nigerian medical schools. BMC Med Educ 2010 May 20;10:36.doi:10.1186/1472-6920-10-36
Biswas SS, Jain V, Agrawal V, Bindra M. small group learning: effect on item analysis and accuracy of self-assessment of medical students. Educ Health (Abingdon).2015; 1:16-21
Sharan S. Cooperative Learning in Small Groups: Recent Methods and Effects on Achievement, Attitudes, and Ethnic Relations. Rev Educ Res 1980; 50: 241‑71.

Philip B. Adebay is from the Neurology Unit of the Department of Medicine at Ladoke Akintola University of Technology and Teaching Hospital in Ogbomoşo, Nigeria. Funmilola T. Taiwo is from the Neurology Unit of the Department of Medicine at Benjamin Carson Sr. School of Medicine at Babcock University in Ilishan-Remo, Nigeria.

European Board Exam Presented at EAN

By Wolfgang Grisold

Successful candidates, with faculty, at the European Board Examination of Neurology during the EAN meeting in Amsterdam.

The Ninth European Board Examination Neurology took place during the European Academy of Neurology (EAN) Congress in June in Amsterdam.

During the congress, 63 participants were recorded and 58 passed the examination. The examination is not restricted to Europeans. For several years, participants from all over the world have been welcomed. For this examination, there were 39 European participants and 24 participants from Bahrein, Egypt, India, Iraq, Nepal, Saudi Arabia, Sri Lanka, Sudan, Syria, and Tunisia.

The examination included different formats, such as multiple-choice questions, open book questions, and the oral examination with critical appraisal of a topic (CAT) and essays. For the first time, the Swedish database company Orzone was active and helped to improve the registration and payment process. It also assisted with the question database as well as the evaluation.

The written examination, which is the backbone of the examination, contained 100 multiple-choice questions and 60 open-book questions. Open-book questions allowed the candidates to search for items that correspond with a real-life situation. This parallels situations in which doctors use several aids to come to a proper diagnosis.

In advance, the candidates provided a CAT and an essay on global health. The development of CATs and essays for the candidates was assisted and monitored by the chair of the examination, Professor Jan Kuks, who checked on style, plagiarism, and topics. He also gave advice.

The topics were interesting and covered a wide range of common neurological problems, local neurological problems (such as driving with epilepsy), and ethical aspects.

The candidates presented the CAT and essay in a short oral communication to a pair of examiners. The pairs were assigned according to the native language of the candidate, if feasible. As a novelty, successful candidates from last year’s examinations took part as examiners in the oral examination, which gave it a new and dynamic note.

It is noteworthy that neurologic societies from Belgium, France, Germany, Italy, and Turkey subsidized some of the candidates for the examination.

For next year’s examination, information is now available at uems-neuroboard.org/web/ and ean.org. Additional information and details on how to write a CAT or develop an essay can be found at uems-neuroboard.org/web/.

The WFN education committee participates in this examination as an observer. It is pleased with the development of the UEMS EBN/EAN examination because it also offers a platform for non-European countries to participate. The format is in continuous development. With the inclusion of the open-book questions, CATs, and essays, it has reached a timely format.

The goal is that more European countries will use this examination, and eventually, the UEMS/EAN examination will replace the national European board examinations.

Report of the XXIII World Congress of Neurology

By Wolfgang Grisold and
Steven L. Lewis, Editor

Participants in the Tournament of the Minds gather for a photo at the completion of the tournament in Kyoto, Japan, at the XXIII World Congress of Neurology. See more photos from the World Congress of Neurology.

The XXIII Congress of the World Federation of Neurology took place Sept. 16-21, 2017, in Kyoto, Japan.

The congress was successfully organized in cooperation with the Japanese Society of Neurology. Preparation over the past several years led to this impressive achievement. More than 8,600 participants visited the congress, which is the highest number of attendees at any World Congress of Neurology (WCN). This reflects the high interest in the brand of WFN World Congresses as well as the high global interest in neurology.

The motto of the congress was “Defining the Future of Neurology.” In doing so, the World Federation of Neurology (WFN) provided scientific input from the World Health Organization (WHO), the Global Neurology Network, and the six WFN regions.

The opening ceremony of the WCN was remarkable as the Crown Prince and his wife hosted a small meeting with the representatives of the WFN and the Japanese Society of Neurology and then gave a nice welcome and introduction at the opening. The WFN is honored that this prestigious visit was possible, which underlines the importance of the WFN and its global activities.

Scientifically, Nobel laureate Edvard Moser spoke on grid cells and the medial-entorhinal space networks. Two additional Nobel laureates presented. Susumu Tonegawa explored monitoring and engineering memory engram cells and their circuits, and Shinya Yamanaka spoke on recent progress in induced plutipotent stem cell research and applications. The WFN medal for Services to International Neurology was presented to Jun Kimura, the WFN Medal for Scientific Achievement in Neurology was presented to Angela Vincent, and the WFN Lifetime Achievement Award was presented to Chandrashekhar Meshram.

As in previous congresses, the scientific program was intertwined with teaching courses. For the first time, access to all teaching courses was free, and many teaching courses were packed full with interested attendees. Also for the first time, the World Congress included midday sessions where Japanese attendees participated in large and highly attended sessions in their native language, a novelty for WFN congresses.

There were other interesting aspects to the program besides the scientific highlights. For example, Tarun Dua presented the new Atlas of Neurology, which was released during the World Congress. This second edition of the atlas, which was created jointly with the WFN, highlights the worldwide distribution of neurologic services and neurologic possibilities. It will serve as a basis for many health politicians in regard to neurologic services. Also timely, Valery Feigin’s presentation on global neurology health statistic clearly showed the importance of neurologic diseases worldwide and demonstrated that neurology is the second-most frequent cause of death and the most frequent for disability in the world. These statistical analyses will influence many aspects of health policies worldwide.

These are just some examples of the many scientific presentations, reports and educational activities that occurred throughout this remarkable and highly attended conference, all with the goal to positively impact neurologic patient care.

From an organizational standpoint, the World Congress of Neurology also is the time when all the bodies of the WFN, including the committees and research groups, meet. The productive educational endeavors by the WFN, including the spreading of its educational activities in Africa, South America, and, hopefully soon, in Asia were acknowledged and approved by all committees. In addition, the World Congress included the important activity of a Patient Day, an activity that was first introduced at the WCN Vienna, and included the presence of President Prof. Raad Shakir. This patient day gave a strong signal that patients are important for the structure and development of the WFN.

The Council of Delegates meeting was held as the formal meeting of the delegates of the World Federation and several elections were made.

For the position of the new president of the WFN, Professor William M. Carroll from Australia was elected; for vice president, Professor Ryuji Kaji from Japan was elected; and for the open trustee position, Dr. Riadh Gouider was elected for a second term. After the next World Congress in Dubai in 2019, the next congress site will be in Europe and there was strong competition between four cities: Copenhagen, London, Marseille, and Rome. The Council of Delegates voted Rome to the be the site for the World Congress of Neurology in 2021.

In addition to the scientific and educational program, the Japanese organizers did a tremendous job accommodating their guests in a beautiful congress center. There was time for interaction and the beautiful gardens surrounding this unique place were also appreciated by all of the attendees.

The social program was wonderfully organized and beautiful events gave time and opportunity to observe and participate in the remarkable local culture as well as network and connect with colleagues from all over the world.

The closing ceremony was a beautiful event as the culmination of a tremendously successful congress in Kyoto. Included in the closing event were presentations to the recipients of the Elsevier Prize for Best Clinical Paper (awarded to Sharon Savage from the United Kingdom, for her and her colleagues’ report on the Long-Term Prognosis of Transient Epileptic Amnesia: Evidence from the TIME Project) and for Best Research Paper (awarded to Gen Shiihashi, Japan, for his and his colleagues’ report, A Novel ALS/FTD Model Mouse Expressing Cytoplasmic Mutant FUS Leads Neurodegeneration via Dendritic Homeostasis Disruption). The Ted Munsat award, a new WFN award for educational contributions to the WFN, was awarded to Walter Struhal and Tissa Wijeratne. Closing remarks were made from many dignitaries, including President Shakir and incoming President Bill Carroll, and Congress President Hidehiro Mizusawa, and culminated in the ceremonial exchange of gifts between Prof. Mizusawa and Suhail Al Rukn, the congress president for the next World Congress to be held in Dubai.

We hope you all enjoy the accompanying photographs as just some examples of many of the wonderful memories from the XXIII World Congress of Neurology in Kyoto. All readers are also encouraged to go to the WFN website for links to videos from many of the plenary lectures from WCN XXIII.

See more photos from the World Congress of Neurology.

XXIII World Congress of Neurology Kyoto Photos

Dr. Hachinski Named to Medical Hall of Fame

Vladimir Hachinski, MD

Vladimir Hachinski, MD, is among several prominent physicians selected for induction into the Canadian Medical Hall of Fame. He will be recognized at a ceremony April 12, 2018, held in association with Schulich School of Medicine & Dentistry, Western University at the London Convention Center in London, Ontario.

Canadian Medical Hall of Fame Laureates are individuals whose contributions to medicine and the health sciences have led to extraordinary improvements in human health. Their work may be a single meritorious contribution or a lifetime of superior accomplishments.

Dr. Hachinski is a renowned neurologist who has helped transform the understanding, diagnosis, treatment, and prevention of the two greatest threats to the brain — stroke and dementia. Together with John W. Norris, Dr. Hachinski pioneered acute stroke units, now the standard of care yielding the best outcomes for stroke patients of all ages, severities, and kinds. He coined the term “brain attack” for stroke to emphasize urgency in dealing with stroke symptoms.

Dr. Hachinski and his colleagues, David Cechetto and Shawn Whitehead, identified a link between Alzheimer’s disease and stroke and the brain’s insular role in sudden death. That led to the development of a host of new concepts captured in his new terminology: multi-infarct dementia, leukoaraiosis, vascular cognitive impairment, and brain at risk stage. The eponymic Hachinski Ischemic Score (HIS) is now a standard means for identifying the treatable components of dementia.

A distinguished university professor of neurology at Western University, Dr. Hachinski has written, co-written, or co-edited 17 books and more than 800 frequently cited scientific publications. He led the adoption of a proclamation on behalf of the World Stroke Organization and all major international brain organizations aimed at uniting stroke and dementia communities in their joint prevention of stroke and potentially preventable dementias.

Also being inducted into the Canadian Medical Hall of Fame will be Drs. Philip Berger, B. Brett Finlay, Balfour Mount, Cheryl Rockman-Greenberg, and the late Emily Stowe.