From the WFN – Page 4

Germany’s University Hospital Ulm

Samy Mohamed Lemine, dadah
Nouakchott- Mauritania

It was my great pleasure to be accepted for a department visit at University Hospital Ulm in Germany.

I arrived there on Oct. 3, 2016. I started the next day in the neurology department. Prof. Kasubek, who is the vice head of department, introduced me and showed me around the neurological department.

For three weeks, I stayed in the emergency room. It was an opportunity for me to see how they receive patients and how they manage them. When the emergency room was empty, I had the opportunity to assist senior physicians in the stroke unit. I also spent time visiting hospitalized patients.

During my time there, I assisted in a thrombectomy procedure with a radiologist. It was a wonderful and interesting experience.

I spent my last week there in the neuro-inflammatory part of the neurology department. I discovered many things there, such as immunoadsorption, plasmapheresis, and immunoglobulin administration.

Every time a patient was examined by a German physician, I received a translation in English. I asked questions and received responses. My stay was enjoyable, and I was happy to discover another way to practice medicine.

At the end of my stay, I realized that there was great benefit for me to discover the German neurological model.

I thank the World Federation of Neurology and the Deutsch Neurological Association for having invited me to this department visit program in Germany. •

Norway’s Riks, Ullevål and National Epilepsy Center

Marieme Soda Diop-Sene
Neurologist, Fann University Hospital
Dakar/Senegal

Marième Soda Diop-Sene with Professor Espen Dietrichs, the Head of the Department of Neurology, Oslo University Hospital

From Oct. 22 to Nov. 19, 2016, we had a study trip in Oslo. We arrived on Saturday, Oct. 22, and stayed in the researcher house in Blindern. It was a comfortable house with all of the amenities, located between Riks Hospital and Ullevål Hospital.

We spent the first two weeks at Riks Hospital, the third week at Ullevål Hospital, and the last week at the National Epilepsy Center.

At Riks Hospital, we met Prof. Espen Dietrich and all of the teaching staff of the neurology department. We participated in morning staff meetings at the neurology ward and at the radiology ward, where we learned a lot about neuroradiology. We also visited patients.

At the clinical ward, we participated in the consultation of movement disorders with Prof. Inger Marie Skogseid, whose patients had severe dystonia and Parkinson’s disease. Some of them had deep brain stimulation (DBS), and others received botulinum toxin injections. It was the first time we saw patients who had DBS and botulinum toxin for movement disorders.

We attended headache consultation and neurovascular disease consultation with Prof. Anne Hege Aamodt. We saw patients with vascular disease (classical stroke) as well as a rare case of middle cerebral artery vasospasm in a young woman.

With Prof. Aamodt, we attended headache consultations and saw patients with migraines and occipital headaches. We also witnessed the administration of botulinum toxin and local anaesthetic injections for headaches.

Even if sometimes such cases are found in our daily practice, the management (exploration and treatment) is totally different. The main fact we learned is to use alternative treatment, such as botulinum toxin or local anaesthetic injection, for the treatment of headache and movement disorders.

We also had a great interest in attending neurophysiology interventions. We performed EEGs and EMGs, and we had really interesting cases, including diabetic amyotrophy and severe peripheral polyneuropathies of different etiologies.

The third week, we visited Ullevål Hospital, where the daily routine is different from Riks Hospital; indeed it’s mostly an emergency hospital. We met Prof. Sigrud Kierulf Braekken and her team. We witnessed some cases of refractory epilepsy, myasthenia gravis, and trigeminal neuralgia at the emergency unit, but no cases of acute stroke and thrombolysis.

We also met Dr. Angelina Maniaol, whose principal interest is myasthenia gravis, and discussed juvenile myasthenia gravis, which is one of our main research subjects.

The last week, we visited the National Epilepsy Center, a really amazing experience. We met Prof. Rune Markhus and Prof. Ellen Molteberg, and their teams.

We had some rich exchanges about research topics we could do together. We discussed research methodology with Prof. Morten Lossius and Prof. Cecilie Johanssen Landmark.

At the morning staff meeting, we discussed polysomnography recordings in a patient with a parasomnia; we read and discussed EEG recordings of children with epilepsy.

With Prof. Anette Ramm Pettersen, we also exchanged information about neurophysiology and neuropsychological comorbidities in children with epilepsy.

We shared our daily experience in Senegal through two talks: “Neurology in Senegal” and “Two Clinical Cases of Tropical Neurology.” The first one was about a stroke in a patient with HIV-1 and HIV-2 co-infection, and the second case was about Pott’s disease in an HIV-1 patient.

We attended a meeting on deep brain stimulation at the congress center with Prof. Skogseid, organized by the Norwegian Neurological Association.

We focused on movement disorders, neurophysiology and epileptology, and myasthenia gravis because those topics are our main interests.

On the social part of the stay, we visited Oslo with Prof. Geir Slapø and his wife. We had a social evening at Prof. Aamodt’s House, where we met the members of the Norwegian Neurological Association.

We saw snow for the first time, and all of this made our trip unforgettable.

We acknowledge all of the members of the Norwegian Neurological Association and the WFN for having made this trip possible.

We are thankful for the precious moments we shared at work and in their family lives. •

Norwegian Neurological Association Oslo University

Yohannes Debebe Gelan, MD
Neurologist and Assistant Professor at Addis Ababa University, Department of Neurology
Ethiopia.

Yohannes Debebe Gelan, MD, (center) together with the chairman of the Norwegian Brain Council and the chief physician at Oslo University Hospital during a social event.

I am Yohannes D. Gelan, a final-year neurology resident at Addis Ababa University, Ethiopia, at the time of the visit. I was very lucky to be selected to the prestigious WFN Department Visit program. I knew ahead of my visit that I would have a once-in-a-lifetime experience in Oslo. I visited the neurology units of Oslo University Hospitals (OUH) with a fellow African neurologist from Senegal named Marième Diop Sene.

My visit surpassed all my expectations. I was thrilled by the amount of attention and respect I received from the people I met in OUH. The visit took place from Oct. 21 to Nov. 18, 2016.

The first person I met in Oslo was Prof. Kari Anne Bjørnarå who took care of everything that I needed to survive the first few days in cold Oslo. On Saturday, Oct. 22, we toured the beautiful city of Oslo with Prof. Geir Slapø and his wife, Prof. Andrea Slapø. They were very welcoming. They took us to the Holmenkollbakken. I can’t imagine how people are brave enough to do skiing from that height. I rode on the zipline, which was fun.

We spent the first two weeks in Rikshospitalet, which is a highly specialized national referral center for Norway. We were introduced by Prof. Anne Hege Aamodt and Prof. Espen Dietrichs to all of the staffs of the OUH neurology department on the first day in their morning meeting. We were quite surprised that the method of communication was changed to English not only for the first days but also for most of the month we stayed with the department. The majority of the patients also were willing to speak to us in English. That helped to make my visit productive.

I was a little bit scared when we were asked to do a mandatory methicillin-resistant Staphylococcus aureus (MRSA) test before getting access to the wards. We were told that Norway has the lowest MRSA prevalence rate. Fortunately, the tests were negative, and we were given keys, IDs, and all the other things required to wander around the hospital.

A typical day in OUH starts with a morning meeting followed by radiology sessions. I was impressed by the level of communication between radiologists and neurologists. I have taken a lesson on the importance of working in tandem with radiologists for all neurologists. I hope we will start a similar system in our department as well. There were short presentations on Monday morning and Tuesday at lunch time.

The first week, I followed Prof. Aamodt in the vascular neurology and headache units. She was enthusiastic to show me everything despite her busy schedule at both the stroke and the headache units. I saw patients with rare causes of stroke. I observed how extracranial and transcranial Doppler ultrasound is useful in the evaluation of patients with acute stroke. Even though I wasn’t lucky enough to watch a thrombectomy being done, I saw how it may bring dramatic changes in a patient with vertebral artery thrombosis. I also witnessed occipital and supraorbital nerve blocks while Prof. Aamodt was working with her headache patients.

On the second week, I joined the movement disorder team. Prof. Inger Marie Skogseid showed us two cases of Wilson’s Disease and many more interesting cases. I was able to accompany her to the operating room when she was called to adjust the intraoperative deep brain stimulation (DBS) current setup for a patient with essential tremor. She also shared with us her vast experience on the use of DBS in dystonic patients. I also saw botulinium toxin injections for various movement disorders and chronic pain disorders. At the end of the second week, I visited the electrophysiology unit. Apart from the routine nerve conduction studies and EMG, I was able to observe quantitative sensory testing for the first time in my clinical experience.

During the third week, we went to Ullevål Hospital, which is the center for most of the neurological emergencies for the Oslo region. They also have a specialized center for multiple sclerosis. We were introduced by Prof. Sigrun Kierulf Braekken, the head of the neurology unit. The neurology staff in Ullevål hospital also made English their primary method of communication for us. The first days in Ullevål hospital were a bit difficult as the hospital architecture was so complicated, unlike the Rikshospitalet. I accompanied neurologists on the general neurology ward, and I observed the sophisticated care delivered at the center. It was interesting to see the long list of tests that are done from CSF samples. On the second day, I accompanied the neurologist in the emergency room. It was fascinating to see how the emergency multidisciplinary team works with such coherence and speed. The infrastructure and the equipment in the ER are quite astonishing. I had a chance to visit the stroke unit and neurology ICU.

I attended the neurological physical examination session on the third day of my stay in Ullevål hospital. It was good to see how the basics are done even in the high-tech setup. Finally, I joined the electrophysiology unit, and I got a great lesson in EEG interpretation from an electrophysiology fellow.

On the last week of my stay, I visited the Sunnaas Rehabilitation Hospital. The hospital is built on the hillside with an amazing view of the fjords. Prof. Frank Becker briefed me on the hospital. It is the highest rehabilitation center for Norway. It was interesting to hear about their experience with lifelong rehabilitation follow-up of some neurologic disorders. It is also a national center for locked-in-patients and rare neuromuscular disorders. I attended case discussions held between Prof. Tor Haugstad, the head of traumatic brain injury rehabilitation, and his colleague. Afterward, he showed me around the individual patients’ rooms, the gymnasium, the swimming pool, and the workshop for occupational rehabilitation. The meticulousness of their approach in rehabilitation of patients is something I should dream of establishing in my home country.

At last, I went to visit Spesialsykehuset for Epilepsy (SSE). Prof. Ellen Molteberg showed us around the adult and pediatric wards, epilepsy monitoring unit, the center for mentally handicapped children, and the special school for children and adolescents with epilepsy. I visited the kitchen for ketogenic diet preparation. I also was able to observe when ambulatory EEG is applied and the results are read. I learned a lot from morning discussions on peculiar EEGs on new admissions. We were really impressed by the clinical work as well as by the dedication for research activities in epilepsy. Prof. Cecilie Landmark showed us the sophisticated antiepileptic pharmacologic laboratory. She also briefed us about ongoing trials in their laboratory.

I believe this kind of visit to advanced neurological units is a source of inspiration for young neurologists like me from a developing country. I have acquired new clinical skills. I have gotten ideas on how to implement some of the things I observed in accordance with our available resources in Ethiopia. I would like to thank all members of the neurology department. I would like to thank Andrea and Geir Slapø. They are amazing people who made our weekends exciting. My special gratitude goes to Anne Hege Aamodt for inviting us to the Halloween and the neurology staff dinner party and for all of the support she provided during my entire stay. •

An Update on WFN Educational Activities

Wolfgang Grisold
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and
Steven Lewis
World Federation of Neurology

Dr. Stefan Meng demonstrates nerve ultrasound at a peripheral nerve meeting in Vienna.

One of the most important and fascinating tasks of the WFN is education. This is an implicit task of a scientific society. Scientific societies have many other tasks, such as promoting science, exchange of knowledge, development, and cooperation. However, their most prudent and important task is to keep preparing for the coming generation and maintaining the present generation with education and knowledge to make them the best in their specialty. This ensures the optimal care for patients with neurological diseases.

Wolfgang Griswold

Neurology presence and workforce varies considerably around the world (Steck, Struhal et al. 2013) and also medical systems and educational systems. The WFN has had a number of educational programs throughout its history. Notably, the World Congress of Neurology (WCN) has served the purpose of fostering new development as well as educating neurologists in the field with the development of teaching courses to promote knowledge on a practical level. The World Congresses of Neurology has been doing this for a long time. As a whole, the WCN has been considered a primarily educational effort (Munsat, Aarli et al. 2009).

The WFN also provides Applied Research Groups, which serve to promote their subspecialty, for example motor neuron disease, neuromuscular diseases, neurosonology, and who, in addition to their scientific work, also engage in congresses and teaching courses. The Applied Research Groups are invited to engage on the structure and content of WFN teaching courses at each WCN.

WCN 2017
This year, the XVIII WCN will take place in Kyoto. It will be jointly hosted with the Japanese Society of Neurology. The congress will offer many educational components and disseminate the latest news and developments, as well as deliver many scientific sessions, teaching courses, and presentations and poster sessions, which all contribute to education in neurology. The WCN is a live event and is accredited by the EACCME for 8 CME hours a day, which is mutually recognized by the AMA and the Royal College of Physicians and Surgeons of Canada, thus being evaluated by high international standards.

Several attractive opportunities are implemented at WCN 2017. There will be congress bursaries, which in addition to the waiving of the congress fee will offer travel grants. This is aimed at young neurologists and is supported by the congress and, also in part, by the professional conference organizer Kenes. This year, travel grants for 80-90 persons are planned.

For the first time, the Munsat¹ prize on education will be rewarded, named after Theodore Munsat (Medina 2014), who was very active in education and chaired the WFN education committee for several years. This prize will be awarded for the first time in Kyoto and will be an acknowledgement for persons involved in the promotion of education in neurology, and in particular educational activities within the WFN.

In addition to the scientific program, the WFN organizes teaching courses at several levels, hands-on courses, and educational sessions. The joint AAN-WFN Advocacy Palatucci workshop is a good example of a session teaching the skills of advocacy and leadership.

From the World Congress to Enduring Materials
Increasingly, the WFN also produces enduring materials, which are journal-published Congress abstracts, the Journal of Neurological Sciences (JNS) and eNS, the dissemination and organization of Continuum with the AAN for use in Continuum user groups, and, increasingly, the WFN website and social media.

Educationalists distinguish between live events and enduring materials. Enduring materials can be anything from printed, written material or media available as educational audio or video.

The WFN is in the good position to be able to use several publication materials, such as the website and social media, including Facebook, which among other activities also spread news and developments in timely ways and reach the groups of both young and middle-aged neurologists, and possibly also other health-related groups.

The JNS is the official journal of the WFN, and publishes material from studies, reviews, and cases, and has a large international participation. Two editor-selected CME articles appear on the website each month and can be downloaded free. The JNS is a continued success and is now edited by Prof. John England.

The journal eNS has been founded as an electronic open access journal, also serving as a platform for articles and cases, and has published several local features. It is meant to work in conjunction with the JNS. As it is an open access journal, fees for publication for open access articles are necessary, and this may be a hindrance in low-income areas; However, eNS is increasingly picking up momentum.

Continuum: Lifelong Learning in Neurology is a product of the AAN and published by Wolters Kluwer . Graciously over the years, the AAN has donated print copies of the journal to countries in need, on the condition that workgroups are constituted, that articles will be read and discussed, and these conferences will be reported back to the WFN. The logistics of the dissemination of this program is done by the WFN, which includes the mailing, sending, receiving, and accumulating the reports. This is an ongoing success story and the WFN and the AAN are happy to provide this service. For an example of a Continuum program, see the recent article on the Moroccan Continuum program.

Books: In the recent past, the WFN also produced a book series, Seminars in Neurology, which was aimed at countries with low education standards and limited resources of health care. Despite being a success, they became outdated and have been replaced by the other educational materials and endeavors discussed in this article.

Video conferences are presently launched on the WFN website and it is expected that video conferences on cases or diseases held between several departments will provide a useful academic support for training. Increasingly, video-type seminars will be used for educational purposes

The public: One of our main aims is the promotion of neurology, which is much wider that any training and education we do specifically for the specialty. Individual health groups, committed nongovernment organizations (NGOs), and patients need to be aware
of neurologic symptoms, diseases, and emergencies, and be encouraged to seek help for neurological conditions for themselves or others.

The aim of public education is to spread information on neurology, raise awareness and understanding, and improve the fate of patients with neurological diseases. All in all, this could be called advocacy work for neurology. Indeed, this is the greatest gap we need to fill. At present, a good example of educational aspects are the Days of the Brain, which are topic-focused and try to improve awareness with regard to specific neurological diseases.

World Brain Day: Education of the Public on a Larger Scale
A major initiative from the WFN is World Brain Day which had its origins at the WCN 2013 in Vienna, and will take place for the fourth time this year at the WCN in Kyoto, presented jointly with the World Stroke Organization.

The previous World Brain Day topics were epilepsy (with the International League Against Epilepsy [ILAE]) and dementia. The day commemorates the founding day of the WFN and is July 22.

Members are encouraged to celebrate this World Brain Day and receive educational matter, suggestions for press mailings, and printout material. Last year, a virtual press conference was added for the first time. Press mailings, articles, and local activities are considered as measures for success and were observed and counted.

Patient Day
The WFN has introduced the concept of a Patient Day at the World Congress of Neurology, which is a day and a session devoted to patients, careers, and health groups for the purpose of spreading news and interest of the Congress. This was successful in Vienna and in Santiago, and will need to be continued at further congresses. Common diseases such as stroke, epilepsy, and movement disorders are usually selected, and speakers from the Congress give talks in an understandable format.

Other Efforts
Public Relations and Press Conferences also serve to promote the content of neurology and serve the purpose of reaching out.

Junior Traveling Fellowships
Junior traveling fellowships (JTFs) provide support for individuals to attend meetings and congresses. The applications can be made worldwide, and applications from low- and middle-income countries are preferred. The participation in the meeting needs to be “active,” which means a presentation or a poster should be in the program. A final report is requested, which might be used for publication in World Neurology. In the last years, an average of 30 JTFs could be granted per year. Applications are announced on the WFN website.

WCN Congress Bursaries
The WFN also offers congress bursaries to attend the World Congresses. The bursaries are devoted to younger neurologists, with preference to applicants from low- and middle-income countries, and include a travel grant and free attendance to the Congress. The number grantees allowed depends on the Congress budget. Over the last several years, 55 bursaries were given in Marrakech, 120 in Vienna, and 30 in Santiago. This year, we are planning for 100 in Japan. In part, this is also supported by the professional conference organizer, Kenes.

IFMSA
The International Federation of Medical Students’ Associations is an international association of medical students. The WFN has cooperated with regard to students‘ medical curricula concerning neurology, and also provides free entrance for two students at the World Congresses.

Courses, Caravans and Regional Teaching Courses
The needs for education differ worldwide, and they are not limited to live events and enduring materials. Courses with nurses, paramedical professionals and other health groups can be necessary, as well as small standalone meetings. Some of these meetings have been funded by the WFN with grants.

A good example of a continuing joint activity by the EAN and WFN is to hold teaching/training courses in Subsaharan Africa each year. Last year the course took place in Maputo, Mozambique in November, and this year it will be in Ouagadougou, Burkina Faso. These EAN regional teaching courses usually attract 70-80 persons, have a lean teaching staff of 10-15 persons, and attract trainees from Africa to offer scientifically valuable and highly interactive courses. This education of trainees and young neurologists is important, as they will act as multipliers for the future development of neurology in Africa.

WFN Grants are Available Each Year
The idea of WFN grants was first introduced in 2011. Grants allocate a sum of money for a purpose and a project, which in many instances are projects related to neurologic education. The website shows details about the grant application. The WFN is also eager to share and participate in grants with other scientific societies such as the International League Against Epilepsy, the World Stroke Organization, and the Movement Disorder Society.

WFN grants are awarded once a year, and applications are scrutinized and selected by a grant committee.

Department Visits
In past years, the WFN, jointly with partner members, has developed a program of Department Visits, where young neurologists from low-income countries can go and stay for four to six weeks to study the procedures, techniques, and observe the neurologic work at a major neurological center. This program was introduced for African countries.

Turkey started this initiative with us, and it has now been followed by department visits in Austria, Germany, and Norway, and soon Italy. Names of fellows and reports can be seen in World Neurology articles.

Both the participants and the sponsors have been enthusiastic about this initiative, which not only introduces the participants to recent developments and up-to-date procedures, but also introduces new insights into other medical and social systems.

This year, North America is joining, and the Canadian Neurological Society is introducing a department program dedicated to countries in South America. This will expand this successful educational tools in the Americas.

WFN Teaching Centers
The development of WFN Teaching Centers was successfully introduced with the first WFN Teaching Center in Rabat Morocco in 2013. The idea is to train neurologists locally with high standards, and also acknowledge the high standard of the training center. The first Teaching Centers were successively established in Africa in Rabat, Cairo, and Dakar, and offer both “full training” and fellowship opportunities, which include electrophysiology and epileptology.

WFN Teaching Centers undergo a process of evaluation, a site visit, and re-evaluation after four years. The Teaching Centers also need to be embedded in a publicly accessible university, along with facilities and services that include internal medicine, radiology, neurosurgery, neuropathology, and rehabilitation.

At present, Rabat has had one fellow each year for the past three years, and will start to train a second fellow this year. Cairo is now starting with one fellow and Dakar will start with both a complete training position and one fellow on epileptology.

The WFN organizes the Teaching Centers with regard to administration, and also supports the WFN fellows. The applications for these training positions are announced via the WFN website and media. A committee, consisting of members of the WFN education committee, the local university, and the regional society, scrutinizes and selects the candidates.

The Applied Research Group on neuromuscular diseases held a very successful congress in Toronto in 2016. This Congress, ICNMD 2016 (icnmd2016.org/), also yielded a share of profit to the WFN, and the WFN has decided to use this money for additional funding of two successive training fellowships in neurophysiology, which will take place in Rabat, and possible cooperation with the international society of electrophysiology is planned.

In the Americas, Mexico has excellent neurological training programs, several of which were visited by the WFN in 2016 and received the status of WFN Teaching Centers. In 2017, attempts will be made by the WFN to sponsor one trainee from South America to train in a Mexican Teaching Center, and the preparations for this department visit are ongoing.

A further potential development for the WFN Teaching Centers could be regular visits from an international professor, who would stay a few days, give lectures, and make rounds in the department for a short time (e.g, a week). This would also help the WFN to identify the needs of the Teaching Centers more clearly.

The concept of the WFN Teaching Centers is expanding, to potentially include a Teaching Center in South Africa, and already for Rabat a re-evaluation process will be needed. The WFN is also aware that a Teaching Center should be available in Asia, which, while having very highly developed and scientifically active countries, still has several countries with significant needs with regard to neurology training. This will be an upcoming project.

Vision
Education is an ongoing process of innovation and renewal, and the prediction of the future is not easy.

There is a need for research into the most efficient and best educational methods. Apart from practical learning, training curricula and the apprenticeship type models prevail. In addition, much time now seems potentially spent (and perhaps wasted) on routine work, and some training curricula, too.

There is no doubt that time and experience count, but could we not improve in the efficiency of knowledge transfer? It will be an important effort and task for the WFN to stimulate research in the field of education.

With the rapidly expanding developments in neurology, training curricula and teaching concepts have an increasingly shorter half-life. In addition to the need for trainees and practicing neurologists to accumulate new knowledge at a fast pace, we must also invest in mechanisms to investigate and assess which skills and knowledge trainees need to acquire (e.g., the milestones that were developed by the Accreditation Council for graduate Medical Education [ACGME] and American Board of Medical Specialties [ABMS] in the U.S. [Lewis et al, 2014), and also mechanisms to replace “old knowledge” with new (unlearning).

There are, however more tangible projects currently in our sights, such as the expansion of the WFN Teaching Centers, development of education on electronic WFN platforms, and the development of a global curriculum for training of neurology, aiming for suggestions with regard to the teaching and training methods, taking into consideration differences in local needs and resources.

Most important is the vision to increase efforts on public education and involvement of patients and patient groups. Awareness, prevention, understanding, and care for patients with neurological diseases need to be one of our major tasks.

References

Theodore L. Munsat (1930-2013). US neurologist, long term chair of the WFN education committee and also founding director of “Continuum.” See: http://worldneurologyonline.com/article/theodore-l-munsat-1930-2013-an-outstanding-legacy-with-the-wfn/
JA, A. “The History of the World Federation of Neurology: The First 50 Years von Johan A. Aarli.” OUP Book: 2014
Medina, M. T. (2014). “In memoriam of Professor Theodore L. Munsat (1930-2013): his outstanding legacy with the WFN.” J Neurol Sci 339(1-2): 1-2.
Munsat, T., J. Aarli, M. Medina, G. Birbeck and A. Weiss (2009). “International Issues: educational programs of the World Federation of Neurology.” Neurology 72(10): e46-49.
Steck, A., W. Struhal, S. M. Sergay, W. Grisold and N. Education Committee of the World Federation of Neurology (2013). “The global perspective on neurology training: the World Federation of Neurology survey.” J Neurol Sci 334(1-2): 30-47.
Lewis SL, Józefowicz RF, Kilgore S, Dhand A, Edgar L. Introducing the neurology milestones. J Grad Med Educ. 2014; 6(1 Suppl 1):102-4.

Call for Applications for 2017 WFN Junior Traveling Fellowships

By Steven L. Lewis, MD,
and Wolfgang Grisold, MD

This year, the WFN is again able to offer Junior Traveling Fellowships for young neurologists from countries classified by the World Bank as Low or Lower Middle Income, to attend approved international meetings.

Applications for 2017 would be most welcome.

There will be 30 awards; applicants should be neurologists in training or early in their careers, have an MD degree or equivalent medical degree, hold a post not above that of associate professor, and be no older than 45 years of age.

Candidates are asked to apply online via www.wfneurology.org/junior-travelling-fellowship-grants-form.

You will be asked to provide:

The name and dates of the meeting for which you wish to register
A CV and bibliography
A letter of recommendation from the Head of your Department
An estimate of expenses, to a maximum of £1,000, no excess will be granted

It is expected that applicants participate actively in the meeting (e.g. presentation, poster) that they attend. The submission of an abstract is encouraged. A copy of the abstract also should be included. Preference will be given to candidates who have not previously received an award and to candidates who intend to attend the 2017 World Congress of Neurology in Kyoto, Japan.

Applications must be received at the WFN office no later than Wednesday, March 15. All applications will be reviewed by the education committee, and the awards will be announced as soon as possible thereafter.

WFN 2017 Elections: Submit Your Candidate Recommendations

On Sept. 17, 2017, at the Annual General Meeting of the World Federation of Neurology Council of Delegates during the World Congress of Neurology in Kyoto, Japan, elections will be held for the following posts:

President to take up office from Jan. 1, 2018 (position vacated by Raad Shakir, MD, not eligible for re-election)
First vice president to take up office from Jan. 1, 2018 (position vacated by William M. Carroll, MD, not eligible for re-election as first vice president)
One elected trustee to take up office from Sept. 18, 2017 (position vacated by Riadh Gouider, MD, eligible for re-election)

Candidate names may be submitted together with written confirmation of their willingness to stand for election, a brief curriculum vitae (a single type-written page), and written support from their national society. This should reach the London secretariat office by Jan. 31, 2017.

The Nominating Committee will draw up an official list six months before the date of the election and will scrutinize all submissions received. Candidates for the positions of president and first vice president also will be required to provide a statement of their goals and objectives for the organization if elected, which will be published in World Neurology. They also will be required to present a short statement at the Council of Delegates on the day of the election.

Please note that following the closing date, additional nominations can be submitted by five or more national delegates acting jointly up to 30 days before the Council of Delegates meeting (Aug. 18, 2017).

Editor’s Update and Selected Articles From the Journal of the Neurological Sciences

John D. England, MD

By John D. England, MD

August 2016 was an awful month for the world of neurology and the Journal of the Neurological Sciences. We suffered the loss of two outstanding academic neurologists, Omar Khan, MD, and Donald Gilden, MD. Both were valuable members of the Editorial Board of the Journal of the Neurological Sciences, and both were outstanding neurologists and academic teachers and researchers. Their loss creates a great void in the world of neurology.

Dr. Khan, professor and chair of the department of neurology at Wayne State University, passed away Aug. 13 at age 53. He had been a faculty member at Wayne State since 1998 and chair of the department of neurology since 2012. He was an internationally known expert in multiple sclerosis and served as the director of the Wayne State University Multiple Sclerosis Center and Magnetic Resonance Image Analysis Laboratory. He served as principal investigator of more than 55 clinical trials and published extensively in the field of multiple sclerosis. He was extraordinarily helpful as a reviewer and Editorial Board member of the Journal of the Neurological Sciences.

JNSJan Dr. Gilden, professor and former chair of the department of neurology at the University of Colorado School of Medicine, passed away Aug. 22 at age 78. He was the department’s longest-serving chair (1985-2009) and led the department into an era of prominence. He exemplified the fast-disappearing triple threat academic with his outstanding abilities in clinical neurology, education, and basic research. He was internationally renowned as a foremost expert in the biology and pathogenesis of varicella zoster virus (VZV). He was the first to demonstrate that VZV DNA can be found in normal human sensory ganglia neurons, and described VZV-vasculopathy of brain. His most recent studies concentrated upon the association of VZV with giant cell (temporal) arteritis. He authored or co-authored 420 papers, many of which are now seminal articles in the field of neuro-virology and neurology. On a personal note, I owe him a great debt of gratitude since he offered me my first academic faculty position and helped guide my academic career. He was a tireless and gifted reviewer and contributor to the Journal of the Neurological Sciences.

In our ongoing attempt to inform readers of important and interesting new developments in the journal, the editorial staff has selected two new “free-access” articles for our readership.

Joel Huovinen and colleagues from Finland describe a probable familial subgroup of idiopathic normal pressure hydrocephalus (iNPH) from a nation-wide Finnish cohort of 375 shunt-operated patients with iNPH. A total of 60 patients (16%) had possible or probable familial iNPH. Eighteen (4.8%) had probable iNPH and 42 (11%) had possible familial iNPH. The familial iNPH patients had an approximately threefold risk of dementia compared to the sporadic iNPH patients. This study suggests that screening for familial iNPH is indicated for both clinical and research purposes. Identified familial cases should provide an opportunity to study the characteristics and genetic markers of this disease. Joel Huovinen et al., Familial Idiopathic Normal Pressure Hydrocephalus, J. Neurol. Sci. 368 (2016) 11-18. http://www.jns-journal.com/article/S0022-510X(16)30384-7/fulltext.
The Zika virus epidemic has become an important topic for public health and global neurology. Several neurological complications of Zika virus infection have been described, including the congenital Zika virus infection syndrome in babies, and meningoencephalitis, acute myelitis, and post-infectious Guillain-Barre syndrome in adults. In conjunction with the World Federation of Neurology Zika Work Group, Marco Medina, MD, and colleagues describe the first reported case of a reversible sensory polyneuropathy associated with acute Zika virus infection. The patient was a 62-year old Honduran man who developed an acute “patchy” non-fiber-length-dependent sensory polyneuropathy associated with acute (laboratory-proven) Zika virus infection. The sensory polyneuropathy affected mainly the small sensory fibers and to a much lesser extent larger myelinated sensory fibers. The fact that the neuropathy began during the acute stage of the infection suggests a probable direct viral inflammatory process affecting sensory nerves. Marco Medina, et al., Zika Virus Associated With Sensory Polyneuropathy, J. Neurol. Sci. 369 (2016) 271-272. http://www.jns-journal.com/article/S0022-510X(16)30535-4/fulltext.

John D. England, MD, is editor-in-chief of the Journal of the Neurological Sciences.

PRESIDENT’S COLUMN
How Does the WCN Enhance Regions?

Raad Shakir, MD

By Raad Shakir, MD

The World Congress of Neurology (WCN) is the major event for a host society and is as important for the regions. There is no doubt that in each of the last four congresses the impact on the regions was positive, but to a varying degree as expected. This is one of the main reasons for holding congresses in rotation across continents.

If we start with Bangkok in 2009, the Congress was well attended and drew delegates from neighboring countries. This success resulted in the consolidation and formal establishment of the Asian Oceanian Association of Neurology (AOAN). The World Federation of Neurology (WFN) provided the AOAN with seed money to establish its legal status, produce its bylaws, and hire its own professional conference organizer. This indeed happened, and the AOAN is now a well established and financially viable association based in Singapore. This was further consolidated by their most successful subsequent Congress in Melbourne in 2012. This was made even more successful as they drew on the huge experience of the Australian and New Zealand Association of Neurology. We have to remember that Sydney hosted a successful WCN in 2005. This made the Australian neurologists experts in making congresses work. The AOAN was well organized, and the excellent Congress reinforced the status of the AOAN. Subsequent meetings in Macao and Kuala Lumpur this year continued the progress. It is clear that although the AOAN was established in 1961 with its first meeting in Tokyo, its legal status, bylaws, and financial structure only started to happen following the success of WCN Bangkok.

If we move now to WCN Marrakesh, the situation is even more spectacular. The Congress banner was “With Africa For Africa.” Prior to the WCN, the only African association was a combination of neurologists and neurosurgeons. The Pan African Association of Neurosciences (PAANS) has been in existence for nearly 40 years, but the structure and function has never been brought to the modern age. Moreover, the neurosurgeons, except a few, decided to form their own African setup and left PAANS. It was high time to organize African neurology in one solid organization with proper membership, a constitution, and bylaws as well as legal status. This aim was paramount for African neurologists who saw the Marrakesh Congress as the opportunity to establish their academy. The Moroccan society and the WFN agreed to create an Africa fund. This came from the profits of the WCN and was specifically dedicated for the establishment of an African neurology association. Although it took four years, with good will and massive organization of the head of the Africa initiative Gallo Diop, MD, PhD, of Senegal, and the WFN Regional Chair Riadh Gouider, MD, of Tunisia, it all came to fruition.

In August 2015, a meeting in Dakar of 27 African associations established the African Academy of Neurology (AFAN). The bylaws and constitution were approved, democratically elected officers were chosen, and now the organization is officially registered as a nonprofit organization in Cape Town, South Africa. The needs of Africa are massive. President Johan Aarli, MD, established the WFN Africa task force in December 2006, and we are delighted that the organization is now fully functional. The first Congress of AFAN is going to be held jointly with the Congress of the Pan Arab Union of Neurological Societies in March 2017 in Tunisia.

One might rightly think that neurology in Europe is well organized and education is advanced, which is certainly the case. However, at the time of the WCN 2013 in Vienna, there were two continental neurological organizations in deep discussions and negotiations on a merger. At the time of the WCN Vienna, one of the two regional organizations, the European Federation of Neurological Societies (EFNS) fully participated in the WCN as a partner and canceled its own Congress for that year. This resulted in consolidating the attendance for the WCN. The Austrian society worked closely with the EFNS to make the Congress a huge success. The birth of the European Academy of Neurology (EAN) followed with the merger of EFNS and the European Neurological Society. This merger started with the 2015 joint meeting in Istanbul, and the first EAN Congress was held in 2016 in Copenhagen.

Moving on to Latin America, the Santiago WCN was held in 2015. This was the second Congress in the continent following Buenos Aires in 1993, and the Chilean colleagues performed marvelously. The Congress was a success scientifically, socially, and financially. The regional association was in the process of being formed. Although neurological congresses had been held since the 1960s, they followed the same pattern as elsewhere in the world. A host country holds the Congress with the full responsibility of organization and outcome; there was no set structure and the region, although participating, did not reap the rewards of the Congress. There had been an intense discussion between Latin American neurologists over the previous four years, which culminated in a pivotal meeting during the Marrakesh Congress and proceeded to further meetings under the auspices of the WFN. These deliberations were financially supported fully by the WFN and culminated in the formation of the Pan American Federation of Neurological Societies (PAFNS). The constitution and bylaws were written, and the final step was in Santiago, when it was decided to host the PAFNS administrative office in Chile. The Chilean society agreed to offer office facilities, and the constitution and bylaws were translated into Spanish. The PAFNS is now registered as a nonprofit foundation in Chile. This will allow future developments and financial stability to disseminate neurological training in Latin America.

Again like Africa, the Santiago Congress provided financial provision for PAFNS. The WFN and Sonepsyn (Chilean Society) have given up some of their profits to facilitate the establishment of the PAFNS. This was supplemented by a grant from the American Academy of Neurology, and the three organizations are involved in providing seeding for the nascent PAFNS. It has been most heartening to see that the Mexican Academy of Neurology stepped up to host the first PAFNS Congress in October 2016 in Cancun.

All of this only demonstrates the close relationship and tight collaboration of the six WFN regional organizations in doing all they can to consolidate their status and support each other, which is the essence of regional empowerment as one of the pillars of the WFN strategy for improving neurology worldwide.

IN MEMORIAM
Donald Gilden, MD: A Unique Neurologist And Scientist

Donald Gilden, MD

By Donald H. Silberberg, MD

For Donald Gilden, MD, his beginnings in Baltimore in many ways foreshadowed what was to become a distinguished career in neurology and virology. Don excelled in his studies while developing into a talented baseball pitcher, good enough to receive an offer from the Baltimore Orioles to join its leading farm team as a prospective big-leaguer. When Don broke the exciting news to his father, his father looked at him — an ace student who had been accepted to Dartmouth College — and said he was destined for great things: in college, not on a baseball field. Don accepted his father’s advice, bringing his combination of a competitive spirit, persistence, and teamwork when he enrolled at Dartmouth. So, how did his early years contribute to the development of such a remarkable career?

Don returned to Baltimore for medical school and the University of Maryland, which later recognized him as one of its most distinguished alumni. He trained in neurology at the University of Chicago, which recognized him as a distinguished alumnus. There he met his wife Audrey and began their devoted 49 years together. He then spent two years as a neurologist at the Walter Reed National Military Medical Center. He correctly saw that the field of neurovirology held great promise with so many unanswered questions. In 1969, he began his scientific career as a fellow in neurovirology at the Johns Hopkins School of Medicine. In 1970, his background uniquely qualified him for the faculty of the University of Pennsylvania’s department of neurology and its affiliate the Wistar Institute to attempt to find the virus that causes multiple sclerosis. Penn and Wistar had just established the first comprehensive research and clinical care center for MS, and Don quickly became a key member of the team.

A powerful technique at that time for detecting latent viruses was so-called co-cultivation, growing human cells that might contain a virus together with well-characterized lines of cells that had been maintained for many generations in vitro, and were known to be free of viruses. This required finding fresh brain and spinal cord tissue from recently deceased individuals with MS and from individuals known to not have MS. A brain bank registry was established. Don made countless trips to autopsy suites throughout Pennsylvania, often on short notice in the middle of the night. The nearby Philadelphia medical examiner’s office became a source of control tissues. In the course of these many unrewarding attempts to find an MS virus, Don discovered that the two principal human herpes viruses, Herpes simplex virus (HSV) and varicella zoster virus (VZV), could be found in latent forms in virtually all dorsal root and trigeminal ganglia at postmortem, whether from individuals with MS or controls.

This remarkable finding soon became a major focus of Don’s research: How did the virions remained latent, what activated them, and how could VZV cause chicken pox in children and then shingles later in life? In order to further develop his molecular biology skills, in 1980 and 1981 Don joined Yechiel Becker’s laboratory in the department of molecular virology at the Hebrew University-Hadassah Medical Center in Jerusalem as a visiting professor. While in Jerusalem, Don found time to join a fast pitch softball league and become captain of the Israeli team with teammates who were 15 to 20 years younger than Don, playing the position of catcher. They played in the Maccabiah Games, Israel’s Olympics.

Returning to Penn, he began to explore the many facets of VZV, leading to landmark discoveries that link the virus to giant cell arteritis in its many clinical phenotypes, shingles, temporal arteritis, ischemic optic neuropathy, cerebral and multi-organ vasculitis, and, most recently, Takayasu’s arteritis. This opened the way to revolutionize treatment. At the ztime of his death, scores of colleagues throughout the United States who had provided biopsy samples, or were aware of his findings, reported to Don that their patients who were doing poorly with conventional corticosteroid treatment responded quickly to anti-viral agents, e.g. valacyclovir. This reinforced what he was seeing at the University Colorado, and undoubtedly will be the subject of clinical trials (if they are really needed) and future publications.

While conducting his research at Penn, Don quickly gained the reputation as a go-to neurologist for colleagues in many departments throughout Philadelphia, and ultimately the United States, for help in solving difficult neurological problems as an expert clinician and later as a neurovirologist. He was a true triple threat in every respect, an outstanding teacher, astute clinician, and extraordinary scientist.

In 1985, Don became professor and chair of the department of neurology at the University of Colorado, remaining chair until 2009. Notably, he expanded his successful research program while developing a nationally prominent department of neurology. His abilities and energy as a teacher were recognized when he received the Outstanding Teacher Award from neurology residents four times. Don was honored with many other national and international awards, including the Alumni Award for Distinguished Service from the University of Chicago, the Pioneer Award of the International Society of Neurovirology, and the 2008 Honor Award and Gold Key for outstanding contributions to medicine and distinguished service to mankind from the University of Maryland School of Medicine. He was elected to the Association of American Physicians, to fellowship in the American Association for the Advancement of Science, and to the Johns Hopkins Society of Scholars. He held leadership positions in many professional societies during his career, and he remained active on many editorial boards, with the National Institutes of Health (NIH) and the National Multiple Sclerosis Society study sections until his death.

A measure of the friendship and loyalty that he inspired was the fact that his principal laboratory assistants who joined his laboratory in the late 1970s stayed as members of his team, from Philadelphia, to Jerusalem, to Denver, and until their retirements over the last several years.

Don continued his research even after discovering that he had an aggressive renal carcinoma, enduring a difficult 18 months of therapies, finally succumbing on Aug. 22, 2016. In his last months, he identified five genes actively expressed during the process of latency. This was consistent with his having lived his life to the fullest. As late as early August, he worked with his colleagues to ensure that his grants would continue funding the research team and that the decades of advances he made in unraveling the nature of the varicella zoster virus would continue.

To cite some numbers: Don was an author on more 420 papers and remained the principal investigator on both an NIH Program Project Grant and an R01 until his death. He trained 26 graduate students and postdoctoral fellows, all of whom but the most recent hold important faculty positions in the United States, Canada, Japan, and Norway. He was mentor to countless medical students and residents, and consultant to his peers throughout the world. He held leadership positions in numerous professional societies and remained active on many editorial boards and NIH study sections until his death.

Don played to win at everything he did. He enjoyed skiing, becoming so accomplished that one could mistake him for a professional. He enjoyed teaching his friends and colleagues (including me) how to better navigate the slopes.

He was a serious violinist, never traveling without his instrument and practicing every day, even throughout his illness. In addition to recitals at national meetings, I enjoyed hearing him practice in hotel rooms in many countries as we attended meetings and in his home in Denver. When possible, Don added attendance each year to a national or international violin competition, including the International Violin Competition of Indianapolis, to his neurology and virology meetings schedules.

Don had a warm and engaging personality that endeared him to many of us. He and his wife maintained enduring friendships and were extremely hospitable to those of us who showed up in Denver from time to time.

However, where Don really devoted his energies and love was with his family, Audrey, their sons Daniel, Adam, and Paul, and their families. He and Audrey have been fully involved in their lives, leading to incredibly close ties among all of them. Although theirs is the greatest loss, Don’s passing leaves a tremendous void in neurology and virology, and he will be sorely missed by his many students, trainees, friends, and colleagues. May he rest in peace.

Don Silberberg, MD, is an emeritus professor and chair of the department of neurology at the University of Pennsylvania, Philadelphia.

References

Gilden, D.H., Rozenman, Y., Murray, R., Devlin, M., Vafai, A.: Detection of Varicella Zoster Virus Nucleic Acid In Neurons of Normal Human Thoracic Ganglia. Ann. Neurol. 22:377-380, 1987
Gilden, D.H., Devlin, M., Wellish, M., Mahalingam, R., Huff, C., Hayward, A., Vafai, A.: Persistence of Varicella Zoster Virus DNA in Blood Mononuclear Cells of Patients With Varicella Or Zoster. Virus Genes 2:299-305, 1988.
Gilden, D., White, T.M., Nagae, L., Gurdin, W.H., Boyer, P.J., Nagel, M.A.: Successful antiviral treatment of giant cell arteritis and Takayasu’s arteritis. JAMA Neurology, 72:943-6,2015.
Golas, L., Bennett, J.L., White, T.M., Skarf, B., Lesser, R., Nagel, M.A., Gilden, D.: Varicella Zoster Virus in Ischemic Optic Neuropathy. Ophthalmology, 122: 2142-5, 2015.

From the Editors

Walter Struhal, MD

Steven L. Lewis, MD

By Steven L. Lewis, MD, Editor, and Walter Struhal, MD, Co-Editor

We are very pleased to introduce the November/December 2016 issue of World Neurology, which starts with the report from the Sept 12, 2016, Council of Delegates meeting that was held in Prague, Czech Republic. In his President’s Column, Raad Shakir, MD, describes the close relationship and tight collaboration of the World Federation of Neurology (WFN) and the six WFN regional organizations and the role of the World Congress of Neurology in enhancing the regions.

Wolfgang Grisold, MD, the secretary-general of the WFN, reports on the activities of the Austrian Society of Neurology related to the July 22, 2016 third Day of the Brain, and Federico Pelli-Noble, MD, reports on the Day of the Brain activities that occurred on the same day in Tucuman, Argentina. Christopher Gardner-Thorpe, MD, also provides a thoughtful discussion on neurology and international relations.

Kate Riney, MD, PhD, updates us on epilepsydiagnosis.org, an extensive and unique online tool for diagnostic information on the epilepsies, which can be of benefit to all neurologists (and our patients) globally. There are also a number of book reviews in this issue, including one from Edward J. Fine, MD, on Brain Renaissance from Vesalius to Modern Neuroscience. Dr. Grisold reviews Teaching and Tuition of Neurology and Neurosurgery in Indonesia During One Century: 1850-1950, and Yuri Takeuchi, MD, reviews Mentored by a Madman: The William Burroughs Experiment.

Also in this issue, Mustapha El Alaoui Faris, MD, provides us with an overview of the Continuum program in Morocco, as a model for other regional programs based on Continuum, the official continuing medical education publication of the American Academy of Neurology (AAN) and with which a joint AAN-WFN effort helps provide Continuum to user groups in various countries where this resource is needed. We look forward to future contributions from other regional Continuum user groups to highlight how this important educational resource is being utilized to support neurologic education and patient care. Also, in what we hope will be the model of many similar contributions for future issues, we know readers will appreciate seeing a “Photo of the Issue” that was provided by Dr. Shakir, showing Jun Kimura, MD, giving a recent EMG workshop at the Lebanese Society of Neurology in Beirut.

John D. England, MD, provides his editor-in-chief’s update from the Journal of the Neurological Sciences, the official journal of the WFN, and personally reflects on the recent loss of two leaders in academic neurology, Donald Gilden, MD, and Omar Khan, MD, Finally, Donald Silberberg, MD, the past editor of World Neurology, provides an extemely heartfelt tribute in his obituary for Dr. Gilden.

We sincerely hope that you will enjoy the articles in this issue, and we continue to encourage your outstanding submissions and helpful suggestions for the benefit of all of the readers of World Neurology.