By Wolfgang Grisold and Raad Shakir

Wolfgang Grisold

The WFN mission is to foster quality neurology and brain health worldwide. One of the cornerstones of this mission is to sponsor and support worldwide concepts of education. This is the function of the WFN Education Committee. In addition to other valuable tools as congresses, symposia, departmental visits and traveling fellowships.

The WFN has developed the concept of worldwide approved teaching centers. These centers should fulfill standards defined by the WFN in order to fulfill the role for training neurologists and perform this in a standardized internationally recognized manner.  Moreover, these centers will be able to train neurologists from low income countries to further their education and improve their clinical and research abilities.

Raad Shakir

Once these centers are approved, they can offer training  fellowships, in a neurological subspecialty as well as  a full  training program to produce neurologists who will go back and serve in their own countries. The WFN approval will therefore carry the stamp of international recognition on the status and performance of a training program.

The department visit process has been adapted from the UEMS (UEMS.net)  department visitation process. This process assesses training centers, their hospital resources and equipment, and the training facilities, and has a system of assessing the opinions of all persons involved in the training process using standardized questionnaires. In addition to structured personal interviews, a randomly selected person from all groups is involved in the process. The analysis of the questionnaires and of the structured interviews are all part of the report, which also includes the activities of the hospital, access to other related fields (e.g., neurosurgery) and the completeness of the training program. The report concludes on the status of the present situation and also gives recommendations for further improvement and development.

The WFN Education Committee (Chair Steven Sergay and Co-Chair Wolfgang Grisold) has developed a structured and a well-organized questionnaire, which covers all aspects of a neurological training center.  Prior to any visit, the size, structure as well as the personnel are to be explored. In addition, residents, trainers and hospital staff will be asked to answer standardized questionnaires, aimed at various educational aspects.

The NeurologyCenter in Rabat was the first neurological center worldwide to apply for this status.

The WFN committee consisted of Wolfgang Grisold (trustee, co-chair of the Education Committee), Raad Shakir (then WFN secretary-treasurer general) and Riadh Gouider (president of the Pan African Association of Neurosciences Societies). The visitors were welcomed by the faculty of the hospital and academic members of RabatUniversity.  All information and facts about the hospital and the Moroccan neurology training system were presented.

The Rabat neurological department consists of several sections: an outpatient’s service which is closely associated with neurosurgery, neuroradiology, neuropathology and with the national center of rehabilitation and neurosciences.

The practical visit was guided through the neurological departments, as well as the laboratories, including histopathology, chemistry and genetics. During the visit, patients and trainees, as well as post-graduate and undergraduate students, were met and some questions and discussion were carried out.

The visit also included the electrophysiology laboratories, where practical teaching was observed. The associated departments of neurosurgery and neuroradiology were well equipped, modern CT, MRI, angiography suites and gamma knife were all observed.  There is also a newly adapted rehabilitation unit. The outpatient and emergency as well as the consultation system of the hospital were looked at in detail. The academic research unit of the university provides laboratories including an animal house with space for scientific cooperation, which are open to projects from the neurological department.

The structure of the visit was supplemented by interviews with residents, teaching professors and hospital staff. These interviews were performed in a standardized written format, which was distributed prior to the visit to faculty and current residents. In addition, three teachers and four residents were randomly selected and attended personal interviews. They were asked standardized questions. Also the director of the hospital was personally interviewed. The visiting WFN committee carried out the confidential interviews. A résumé was contained in the report.

Based on the visit, including discussions, there were presentations of the faculty, and detailed analysis of the various aspects of the department.  The visiting committee was fully satisfied that the Hospital Center Ibnou Sina, Rabat, is fully compliant with all aspects of a WFN training center. It will be able and willing to train not only its own national neurologists, but neurologists from Africa and elsewhere and will be providing one year fellowships, as well as a full four year training programs.

The concept of WFN teaching centers will be further developed, and the WFN website will provide a detailed definition of teaching centers, as well as the requirements, questionnaires and application details.  Being a WFN teaching center is a sign of excellence and clearly conveys international recognition of the teaching center in that it fulfills all of the criteria in its structure, equipment and the teaching facilities needed to participate in the important role of neurology education in the future.

By Donna Bergen, MD
Co-Chair, Scientific Program Committee

The 21st WFN World Congress of Neurology was held Sept. 21-26 in Vienna, with more than 6,300 attending from 135 countries.  It was the joint meeting with the European Federation of Neurological Societies, and constituted the EFNS’ annual meeting for 2013.  The Austrian Society of Neurology was the local host, with its president Eduard Auff, MD, presiding.

The joint production made for a particularly diverse, stimulating and memorable congress.  More than 350 of the world’s leading neuroscientists and educators provided more than 75 scientific sessions on virtually all aspects of neurology, and led over 60 teaching courses and workshops.

Few other conferences provide a venue for neurologists from all subspecialties to meet and learn, and for young neurologists and trainees to listen to and to talk with leading scientists who may otherwise be just names in textbooks and journals.  Accessibility was a major goal of the organizers, with a sliding conference fee scale designed to make it easier for those from countries with limited resources, young neurologists and trainees to attend.  The WFN also provided travel bursaries enabling 150 junior neurologists from low resource countries to attend the Congress.

One of the highlights of the meeting was the opening plenary session, when Nobel Laureate Eric Kandel gave a remarkable talk on three innovative Viennese artists of 1900: Gustav Klimpt, Egon Schiele and Oskar Kokoschka.   In his recently published book, Vienna and the Age of Insight, Kandel related their artistic choices to new theories of mind of Freud [another Viennese], and used 21st century discoveries in functional brain mapping to explain perceptual and aesthetic responses to viewing a painting.  Other plenary sessions were an opportunity to hear masterful synopses of developments in neurogenetics by John Hardy, PhD, (UK), the neurology of aging by Ayrton Massaro, MD, (Brazil), and recanalization in acute stroke by Werner Hacke, MD, (Germany), among others.

For the first time, the main scientific sessions included joint sessions with member organizations of the World Brain Alliance such as the World Psychiatric Association and the World Federation of Neurosurgical Societies.   Members of the recently formed network of international neurological subspecialty organizations also convened main sessions in their areas, bringing together the world’s top neuroscientists in nearly every aspect of neurology.   Reflecting its growing relationship with the WFN, the World Health Organization presented a session summarizing current programs aimed at neurological disorders such as its Non-Communicative Disease Initiative, which includes stroke as an important global target for prevention and care in the coming years.

The teaching courses took place on each day of the congress, each day covering the main topic of the next day’s scientific sessions.  The courses were attended by more than 4,500 participants.  Workshops on EMG, magnetic stimulation and ultrasound of nerve, muscle and intra- and extracranial arteries offered hands-on experience and an opportunity to confer with experts in these fields.  Although most of the courses were aimed at consultant neurologists, there was a course especially for young neurologists, and crucial issues such as advocacy, how to write a paper and palliative care were also covered.  An analysis of attendance will help guide programming of the WCN 2015 in Chile.

The Tournament of the Minds is a traditional contest, testing the neurological knowledge of teams nominated by their national societies.  The final round was fought between Australia/New Zealand, Chile, India and the United Kingdom.  Twenty questions brought the finalists down to the UK and Australia/New Zealand, with the latter winning the contest, medals and a large trophy.  The tournament will be repeated in Chile at WCN 2015.

The social program organized by the local host society included a concert at the stunning Wiener Musikverein Concert Hall.  The conductor of the orchestra was Norbert Pfafflmeyer, a practicing neurologist, and the program included the premier of a waltz composed by Vladimir Hachinski, who just finished his term as president of the WFN. The Heurigen evening at a traditional wine bar gave attendees a taste of the latest Austrian vintage and the local cuisine, and of course the splendors and history of Vienna were there to enjoy every day.

Abstracts of the platform and poster presentations presented at WCN 2013 will be published in the Journal of Neurological Sciences, the WFN’s affiliated journal.

1The next World Congress will take place in Santiago, Chile, in two years.  During WCN 2013, the WFN Council of Delegates chose Kyoto, Japan, to be the site of the following Congress in 2017.

By Vladimir Hachinski

Vladimir Hachinski

Missions set goals and guide actions.  The greatest change that took place in the past four years was an expansion of the WFN mission to “foster quality neurology and brain health worldwide.”   To accomplish this required partners, so we invited representatives from all of the major brain organizations for a meeting in Geneva on March 30, 2011, that resulted in the World Brain Alliance composed of:

• European Brain Council (EBC)
• International Brain Research Organization (IBRO)
• World Federation of Neurology (WFN)
• World Federation of Neurosurgeons (WFNS)
• World Federation of Neurorehabilitation (WFNR)
• World Psychiatry Association (WPA)
• International Child Neurology Association (ICNA)
• International League Against Epilepsy (ILAE)
• World Stroke Organization (WSO)
• Alzheimer’s Disease International (ADI)

The World Brain Alliance activities can be summarized as an ABC.

A = Advocacy
B = Brain Year
C = Cooperation

I took part in a high ministerial meeting in Moscow in April 2011, then  a consultation with the president of the United Nations General Assembly in June in New York and then a session of the General Assembly that adopted the Non-Communicable Diseases resolution in September 2011.  Subsequently, I continued to be involved with the WHO, including participating in meetings of the Executive Committee.

In addition to my own activities with the WHO, Raad Shakir has chaired and Donna Bergen has participated in the expert panel advising on the revision of the International Classification of Diseases 10 (ICD10) regarding brain disorders.   A major achievement has been the acceptance by the WHO of the recommendation of the subcommittee on cerebrovascular disorders chaired by Bo Norrving, of which I was a part, that stroke cease to be part of cardiovascular disorders and be classified under brain disorders in the ICD-11.

The Brain Year is a project of the European Brain Council, led ably by Mary Baker.  The intent is to proclaim a World Brain Year Europe 2014 at the European Parliament in Brussels. It is hoped that it will be followed by the World Brain Year Americas 2015, World Brain Year Asia 2016, and so on.

In terms of cooperation, the major initiative has been in the neurospecialty network founded and led by Werner Hacke, and now headed by William Carroll.  This aims to bring together all of the specialties related to the brain.  This complements the work done by Donna Bergen, chair of the Applied Research Committee, rationalizing research groups within the WFN whereby some have become largely irrelevant and have been dissolved while others have grown to become major organizations that now are reconnecting with the WFN.

A tangible proof of the new cooperative spirit is that several of the sessions of the World Congress of Neurology were co-sponsored by the Movement Disorders Society, the World Stroke Organization, the International League Against Epilepsy, the International Child Neurology and a session with the WHO.

Grassroots

We initiated a process whereby we offer modest amounts of money to individual neurologists who had ideas for projects that meet the criteria of value, viability, synergy and evaluation.  The first year all of the projects were funded by the WFN.  The second year, we asked leaders of other brain organizations to be part of the review process.  This resulted in leadership of the different organizations learning about what each was doing, allowing for cooperation and avoiding overlap.  Last year, there were 10 Grants-in-Aid, half of them were co-funded and half of them were in Africa.  This year, the total value of the 11 grants was $419,000, five co-funded and seven in Africa.

The geographic location of the Grants-in-Aid was based on the criteria alone so that it is encouraging that the largest number ended up being in the area of the greatest need, namely in Africa. The high quality of the projects makes it likely that some of them will produce enough pilot data to allow for applications to larger funding agencies such as the Fogarty Foundation.

Public Awareness  and Action Committee

The Public Awareness and Action Committee headed by Mohamed Wasay is trying to establish a World Brain Day inspired by the highly successful World Stroke Day, that I proclaimed when I was vice president of the WFN in Cape Town on Oct. 29, 2006, along with a World Stroke Agenda to which all of the major organizations dealing with stroke contributed.

Publications

During this administration at the recommendation of the Publications Committee, chaired by Christopher Kennard, a new editor was selected for the Journal of Neurological Sciences.  Robert Lisak who served as editor for 15 years steadily increased the journal’s impact factor and circulation for which the WFN is immensely grateful.  He was succeeded by John England who has co-opted highly capable associate editors in the areas of global neurology, translation research, outcomes research and practice standards that will give the journal a distinctive personality and a higher profile.

World Neurology is now totally digital, being capably edited by Donald Silberberg.  World Neurology is in dynamic interaction with the website that has been modernized, updated and made more useful under the editorship of Pete Engel and with the gifted technical capabilities of Chu Man.  Wolfgang Grisold has been  active in the website in close coordination with the activities of the Education Committee.

World Neurology Congresses:  Accelerating the Cycle

As vice president, I initiated the process that resulted in moving the World Congresses from a four-year cycle to a two-year cycle.  This has allowed for neurology to go where it is most needed.  The main aim of congresses is to take neurology to parts of the world where it becomes accessible to neurologists and others interested in the nervous system who have no means of traveling internationally.  The more frequent congresses also have allowed continuity in organization and the scientific program committee and have brought in more frequent income in an era of shrinking resources.

Finance

Our finances are sound, thanks to our able Secretary-General Raad Shakir and proceeds from a combination of successful congresses and sound investments. Our expanded activities also have required that we revamp the budgeting process, and we have implemented management accounting, whereby it is possible to monitor our income and expenditures on an ongoing basis that will allow for easier planning in the future.

The Standards  and Evaluation Committee

As part of our expanded mission, we established standards, so that anything endorsed by the WFN stands for quality and value.  This began as a working group headed by Aksel Siva, aided by Sarosh Katrak, and initially by Charles Warlow and later by Werner Hacke and has now been established as a new committee of the WFN.  The higher standards have made the WFN’s endorsements more valuable.

Continental Initiatives

Africa: My predecessor, President Johan Aarli made it his mission to do more with Africa, the continent in the greatest need of neurology.

It was at his behest that the first congress on the African continent took place in Marrakesh in 2011.  Our Moroccan colleagues, led by Moustafa El Aloui, not only hosted an exemplary congress, but used the proceeds from the congress to establish a foundation to further neurological endeavors.  Similarly, the WFN devoted part of its income to be used in Africa.

The WFN has been a participant of the annual neurology courses in Africa along with European Federation of Neurological Societies (EFNS), International Brain Research Organization and others.  The training neurology center in Rabat has now been approved by the WFN, and discussions are under way with colleagues in Ghana and Tanzania for the possibility of setting up a training program in an English-speaking African country.

At the initiative and with funding from the Turkish Neurological Society, a program for visiting trainees has been established between Turkey and East Africa.

The high proportion of grassroots grants funded in Africa reflects both the great need and great opportunities to advance neurology in Africa.

Asia: We began the Asia Initiative led by Ryuji Kaji with modest help from the WFN, helping organize an infrastructure for the now thriving Asian Oceanian Association of Neurology.

Latin America: The formation of a Latin American initiative led by Gustavo Roman resulted in the Latin American Federation of Neurological Societies and in the democratic election of a regional director: Marco Medina.

Regarding the established continental regional neurological societies, namely the North American region (Canada and the United States) and the European Federation of Neurological Societies, our administration made a point of having good and direct relationships with them.  Specifically, we initiated an annual meeting of the leaders of the WFN and the AAN (Berch Griggs, Bruce Sigsbee, Timothy Pedley and Cathy Rydell) that has fostered better understanding and greater cooperation between the two organizations.  Similarly, it has been a pleasure to deal with the president of the EFNS, Richard Hughes, who was most cooperative in co-sponsoring the World Congress of Neurology in Vienna and in dealing with matters of mutual interest.

Education Committee

The single largest activity of the WFN is directed by the Education Committee.  It has been led in an exemplary, complementary way by Stephen Sergay and Wolfgang Grisold who have organized, rationalized and focused the efforts of the Education Committee. Some of their achievements include the accreditation visits to training programs such as the one in Trujillo, Peru, and the activities reported under the Africa Initiative.

The WFN: An Organization  for All Ages and Career Stages

As vice president, I facilitated the incorporation of a young neurologists group led by Walter Struhal with the aim of making the WFN an organization for all ages and career stages.  I am happy to report that there has been a considerable expansion in the participation of younger neurologists, particularly in regard to the website and using modern technology for communication and education.  We also introduced a discount on the congress registration for senior neurologists in an attempt to make the World Congress of Neurology attractive and affordable throughout a full career span.

Leadership Training

Although the administration was elected for a four-year term, we divided it into two halves.  For the initial two years, the committees and initiatives were kept small so that the member could get to know each other and learn to work together.  For the second two years, the committees and initiatives were expanded and a number of vice chairs were appointed, typically younger individuals, more women and more individuals from different parts of the world.  The two-year cycle gives opportunities for promotion to the most active individuals and the possibility of being involved in different committees and initiatives in sequence.

Conclusion

It is not for me to judge what we have achieved, except that it resulted from a collective effort.

I would like to thank Vice President Hacke, Secretary-General Raad Shakir, and fellow Trustees, Donna Bergen, Wolfgang Grisold, Ryuji Kaji, Gustavo Roman and Stephen Sergay, in the central office, Keith Newton, Laura Druce and Helen Gallagher and in my office, Rebecca Clarke and the many around the world who know that they have made a difference.

I am particularly grateful to our Austrian colleagues under the leadership of the World Congress of Neurology, Eduard Auff who hosted a magnificent event. It would be hard to imagine a more splendid congress to culminate my presidency.  I was especially privileged to have my Dream Waltz (orchestrated by Jason Stanford) premiered at the Musikverein as part of the Gala Concert.  It is not too often that one can say that one’s presidency ended literally on a high note.

I congratulate President-Elect Raad Shakir, Vice President-Elect William Carroll, Secretary-General-Elect Wolfgang Grisold, elected Trustee Gallo Diop and continuing elected Trustee Gustavo Roman and wish them every success in fulfilling the mission of the WFN to “foster quality neurology and brain health worldwide.”