From the WFN – Page 6

SPECIAL REPORT: History of the WFN Environmental Neurology Applied Research Group

By Jacques Reis, MD, Serefnur Öztürk, MD, Gustavo C. Román, MD, and Peter Spencer, PhD

We present here a brief overview of the history of the creation of the Environmental Neurology Applied Research Group (ENRG) of the World Federation of Neurology (WFN).

World Congress of Neurology, Sydney, 2007

JACQUES REIS, MD

After the session of the Neurotoxicology Research Group, Leon Prockop, Tampa, Florida, acting as chair of this group, gathered people interested in the field of neurotoxicology. We were few. Our goals were to better fit with the new challenges in our field. Peter S. Spencer, Oregon Health and Science University, Portland, proposed expanding the goals of the group and pointed to the interaction between genes and environment. Jacques Reis, a clinical neurologist at the University of Strasbourg, France, presented the experience and success of a new and small French group, Le Club de Neurologie de l’Environnement, created in 2003. Prockop liked the idea of gathering energies around the charismatic word, “environment.” We hoped to bring a new and powerful concept to neurology, which would be able to amalgamate researchers in fields related to the environment (e.g., neuroepidemiology, tropical neurology, nutrition, and neurotoxicology). The decision to modify the name of the Neurotoxicology Research Group to the ENRG was taken. Prockop‘s proposal was accepted by the WFN. Donna Bergen of the WFN Research Committee actively supported the newly born group.

For the first time, a neurologic academic international federation had put the environment on its agenda. Prockop was the chair, and Reis served as co-chair and link with Le Club de Neurologie de l’Environnement. Each year, the club offers two sessions of review topics on environmental neurology to general neurologists during the Journées de Neurologie de Langue Française, the worldwide meeting of French-speaking neurologists. The club is connected with neurologists and neuroscientists from Quebec, Oran, Algeria, Tunisia, and Luxemburg.

SEREFNUR ÖZTàœRK, MD

Thus, 2007 was a wonderful year that saw the founding of the ENGR. This was crowned with the publication of a successful special issue of the Journal of the Neurological Sciences, the official publication of the WFN, on “Environmental Neurology: A Promising New Field of Practice and Research,” edited by Gustavo C. Román, Reis, Gilles Defer, and Prockop (J Neurol Sci Nov. 15, 2007; 262 (1-2):1-174). This issue contained the proceedings of the meetings of Le Club de Neurologie de l’Environnement held in Paris, France, Dec. 2-3, 2005, and in Metz, France, Feb. 7, 2007, under the aegis of the French Society of Neurology, the University of Metz, and the ENRG.

This publication greatly contributed to better define this new research field, but the challenges for the ENRG are huge. As for clinical neurotoxicology, there is still no teaching on this topic available anywhere in the world. We have to explain, to persuade and to raise interest in other fields of neurology, of course without any support from the regular neurological partners. Furthermore, experts in these fields are rarely neurologists. Prockop, Román, Spencer, and Reis have become advocates for the ENRG when invited to talk by the Société Française de Neurology (Paris, France), by the Association des Journées de Neurologie de Langue Française, or by the International Neurotoxicological Association, Porvoo, Finland.

Lorraine, France, June 2009

The first meeting organized by the ENRG took place in Sarreguemines, a small city of east France, near the German border. We gathered, with the collaboration of Le Club de Neurologie et Environnement, well known scientists under the presidency of Prockop and Bertrand Rihn, Nancy, France. The ENRG session was dedicated to genetics, neurodevelopmental, and neurotoxicological topics. The titles of the talks were: “Genes and Environment in the Pathogenesis of Parkinson’s Disease,” presented by Rejko Krüger, University of Tübingen and now at the University of Luxembourg; “Epigenetics,” presented by Massimo Pandolfo, Brussels Free University, Belgium; “Developmental Aspects of Environmental Neurotoxicology,” presented by Gerhard Winneke, Heinrich-Heine-Universität, Düsseldorf; “Multiple Sclerosis Oligoclonal IgG and the Environment, the Vital Clue,” presented by Frederick Gay, Oxford, United Kingdom; and “Carbon Monoxide: The Under-Noticed Poison of the 21st Century,” presented by Prockop.

World Congress of Neurology, Marrakech, 2011

Prockop and Reis were on the program with topics related to CO intoxication and neurological consequences of climate change in two sessions dedicated to the environment, culture, and neurosciences. Román addressed neuroepidemiological issues, and other talks explored different issues of interest to ENRG. Our business meeting gathered people from Africa and Asia interested in environmental neurology. Building a new research group is a real challenge, especially when the field is completely new and has neither academic nor financial support.

GUSTAVO C. ROMàN, MD

ICNE 2, Nice, France, 2012

Professor Valery Feigin, Auckland, New Zealand, chair of the International Congress on Neurology and Epidemiology, invited the ENRG to run a symposium during the Congress. For the first time, our group organized a joint meeting, sharing common themes with neurologists and epidemiologists. Our satellite symposium answered a common question: What is an environmental factor? An introduction to the topic was provided by Reis. Spencer lectured on when the environmental factor appears multifactorial: nodding syndrome, and Walter Rocca, Mayo Clinic, discussed the role of pesticides and risk of Parkinson’s disease.

World Congress of Neurology, Vienna, 2013

For the first time, our group was on the official program and managed two sessions. Roman and Reis invited an international panel of speakers who tackled some aspects of environmental neurology, including “Space Medicine,” presented by F. Gerstenbrand, Austria; “Environmental Intolerance and Multiple Chemical Sensitivity,” presented by Reis; “Neurotoxic Effects of Solvents and Nanoparticles,” presented by G. van der Laan, the Netherlands; “Stroke and Weather Association,” presented by Feigin; “The Fukushima Earthquake,” presented by Y. Ugawa, Japan; and “The Spread of the West Nile Virus,” presented by Román. The success of this meeting was crowned by an article that appeared in the special issue of Neurologisch, the official journal of the Austrian Society of Neurology; Román and Reis summarized the different talks (Kongress-Highlights, Neurologisch 2013). Our business meeting followed, and we gained support from leading members of the WFN board.

ICNE 3, Abu Dhabi, 2013

The ENRG contributed to this meeting with a satellite symposium. We kept expanding on the notion of environmental factors. With three talks, we focused on time-related issues of some environmental factors: “When and How Do Environmental Factors Act on Living Organisms?” presented by Reis, “Epigenetic and Environmental Determinants of Tauopathies,” presented by N. Zawia, University of Rhode Island, Providence, and “Early Life Risk Factors in Parkinson’s Disease,” presented by G. Logroscino, Bari, Italy.

Collaboration With the Applied Research Group on Nutrition and the Central Nervous System and the World Health Organization, 2014

In March 2014, Professor Marco T. Medina, Tegucigalpa, Honduras, invited our group to participate to the working group on nutritional and toxic disorders of the nervous system to improve the International Classification of Diseases-11, edited by the WHO.

ICNE 4, Kuala Lumpur, 2014

Our third symposium was dedicated to global environmental factors. We tackled “The Boomerang Effect: Health Risks (for the brain) from Global Change” with two speakers, Reis and Spencer.

World Congress of Neurology, Santiago de Chile, 2015

The ENRG managed one session. We addressed three important topics, which are beginning to gain widespread attention: “Air Pollution and the Neurological Impact,” presented by L. Calderon-Garciaduena, Missoula, Montana, “New Promising Hypotheses for the Nodding Syndrome,” presented by Spencer, and “Multiple Sclerosis,” presented by Reis.

Antalya, Turkey, 2015

Reis has been invited by Professor Serefnur Öztürk on behalf of the Turkish Neurological Society (TNS) to give two talks related to environmental neurology, one about global warming and neurological consequences and the second about the bacterial hypothesis of multiple sclerosis. For the first time, the Turkish Neurological Society, under the presidency of Öztürk, had proposed a workshop on “Occupational Diseases, Neurology, and Environmental Health.” Two other topics were dedicated to “Coal, Clean Air Rights, and the TNS,” presented by Semih Ayta, Istanbul, and “Occupational Diseases,” presented by Ibrahim Akkurt, Ankara.

2015 was an important year. The TNS had begun a partnership with a Non-Governmental Organization in a platform dedicated to global challenges, notably coal energy, air pollution, and global warming. This important issue is challenging the WFN and all medical associations. What should we do? What is possible? How do we do it? Should we be acting as experts? Is a greater commitment acceptable and necessary?

Overview of Facts in Environmental Neurology: The Goals of the ENRG

PETER SPENCER, PHD, FANA, FRCP

The importance of environmental risk factors is well accepted in all health and medical fields. Risk factors may include all external factors that adversely impact normal neurological function, whether acting in isolation or in concert with an intrinsic factor, such as malnourishment. External (extrinsic) factors include a wealth of physical, chemical, and other stressors that may act alone or in concert with an internal factor, such as a covert genetic susceptibility. This subject is of particular relevance in the search for the majority of neurodegenerative disorders in which gene-environment causation is widely acknowledged, but the latter is rarely subjected to intensive research. Indeed, a 2015 WHO research prioritization exercise focused on dementia stated the need to “understand the contribution of environmental factors to neurodegenerative diseases causing dementia and their interaction with other pathophysiological processes at the epigenetic, molecular, and systems levels.”

Recognition that environmental science is involved in understanding mainstream neurological diseases, in addition to the plethora of regional disorders relating to physical extremes (heat, cold, height, depth), nutritional challenges, and diverse exposures to chemical and biological agents, indicates the importance for neurology to nourish the nascent and multidisciplinary science of environmental neurology.

At the present time, neurologists face the foregoing medical challenges with virtually no relevant training. There are no special education courses available for neurologists. While the adverse effects on the nervous system of alcohol and other drugs are known, as are the relevant side effects of medications with neurotoxic potential, there is no formal study of neurotoxicology, despite the availability of several compendia on the topic. Additionally, neurologists may not be skilled in understanding and deciphering the interactive effects on the brain of multiple extrinsic factors, let alone the knowledge to launch an in-depth investigation of environmental contributions to the genesis of neurodevelopmental disorders, neurodegenerative disease, vascular dementia, epilepsy, or central nervous system malignancies.

While we recognize these training deficiencies, many neurologists pay only lip service to the role of environmental factors in neurological disease. Most significantly, the poverty of research funds provided by granting agencies toward increasing knowledge on environmental factors and research on a wide range of neurological disorders is a major concern. From the WFN, the ENRG will continue to face these challenges and to increase the overall support among neurologists.

We intend to address these education and training deficiencies through an expansion of ENRG and by interacting with diverse neurology groups interested in this topic, as well as with other biomedical disciplines. There is a real need to satisfy these demands at the international level. Expanding our base is needed to advance the discipline of environmental neurology. This is our goal. To achieve this goal, it will be necessary to interact with other research groups because none has either the human weight or the financial strength to act in isolation. WFN could put on its agenda the environment. Our proposal is, for example, to organize during the next Congress a Day of the Environment. All research groups interested in and dealing with environmental neurology could interact easily, and the visibility among Congress attendees would increase.

To face these challenges and the exciting potential to broaden and deepen the education, understanding, and research impact of neurology, the ENRG needs and requests the help of the WFN, which for neurology is the only institution that can promote these views.

If anyone is interested in joining our group, participants, and countries, please contact the authors. We are also pleased to invite you to the first ENRG meeting in Strasbourg (Nov. 30-Dec. 1, 2016).

The authors have no conflicts of interest related to this work. Jacques Reis, MD, AEA, is a clinical neurologist at the University of Strasbourg, France, Jacques.reis@wanadoo.fr; Serefnur Öztürk is on the faculty of department of neurology at Selcuk University, Konya, Turkey, and on staff at the Turkish Neurological Society, serefnur.ozturk@noroloji.org.tr; Gustavo C. Román, MD, DrHC, is the Jack S. Blanton Distinguished Endowed Chair and professor of neurology, Methodist Hospital, Houston, Texas, and Weill Cornell Medical College, New York, gcroman@houstonmethodist.org; and Peter Spencer, PhD, FANA, FRCP, is a professor of neurology at the School of Medicine and a senior scientist at the Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, spencer@ohsu.edu.

IN MEMORIAM: John Nicholas Walton, MD

By Johan A. Aarli, MD, and Raad Shakir, MD

The World Federation of Neurology is remembering John Nicholas Walton, MD, who passed away in April at the age of 93. Walton, who served two terms as president of the WFN following his election in 1989, knew the organization better than anyone. His work in the WFN started from its inception in 1957. He succeeded Macdonald Critchley as editor of the Journal of Neurological Sciences when Critchley later became WFN president in 1965. He worked with Henry Miller as secretary general to shape the organization. Walton saved the WFN from bankruptcy with his compromise during the creation and later dissolution of the World Association of Neurological Commissions (WANC), which resolved the financial crisis of the WFN in 1966. He started the research group on neuromuscular disorders. He was elected first vice president during Richard Masland´s presidency. During this busy time at the WFN, he wrote Essentials of Neurology, which became a standard textbook for medical students. In 1968, he was promoted to a personal chair in neurology at England’s Newcastle University, and in 1971 he was appointed dean of the Newcastle Medical School. He was knighted in 1979, was appointed life peer in 1989 as Baron Walton of Detchant, and he sat in the House of Lords as a crossbencher.

Walton´s presidency became the most constructive modernization phase in the history of the WFN, and he took personal care that the changes were constitutional. A central step of the reorganization was to establish a corporate status for the WFN. The chairs of the publications and the finance committees were now better integrated in the WFN structure. The responsibilities of the committees were now defined, and the committee structure was overhauled into a solid structure.

The secretariat became better integrated with the general structure of the WFN, resulting in the Research Committee having three directors at large and four-year terms. The Management Committee was renamed into a standing committee, and there was full agreement that the research groups should continue to play a central role in the federation’s activities. From then on, the WFN was to be governed by a board of directors to include the president, vice president, secretary-treasurer general, and Research Committee chair.

Walton was the fifth WFN president, and he kept in contact with the development of the organization. His last attendance at the World Congress was in Vienna 2013.

Walton’s achievements outside the WFN were immense. It has been said, “He did not join an organization unless he became president.” This includes his own medical school, where he was dean, warden of Green College Oxford, and president of the Association of British Neurologists, the Royal Society of Medicine, the General Medical Council, and the British Medical Association. His proudest position was as president of his beloved Bamburgh Golf Club in Northumberland.

It is said, that as a very keen golfer, he never won a trophy. To rectify that, at the age of 90, he managed to convince the golf club to buy a large cup for the oldest golfer to finish a round, and then he presented it to himself. Such was his wit and wonderful sense of humour.

All who knew him were very much aware of his sharp mind and his vast attention to detail. His advice on all matters related to the WFN and world neurology were most valuable to us all. The late Frank Clifford-Rose, who was WFN secretary-treasurer general, wrote about Walton in his biography in 1992, that there were few doctors who were legends, and very few were legends in their lifetime. His work throughout his career focused on muscular dystrophy, and he co-founded Muscular Dystrophy UK. It must have been very rewarding that the first drug for muscular dystrophy, ataluren, was licensed in 2016 during his lifetime.

Walton died of a glioblastoma multiforme, a diagnosis he announced in his bulletin to all United Kingdom neurologists, just before he passed away. Walton is survived by three children, five grandchildren, and 10 great-grandchildren.

Johan A. Aarli, MD, is WFN’s eighth president. Raad Shakir, MD, is WFN’s 10th and current president.

PRESIDENT’S COLUMN: Long Established WHO, WFN Relationship Continues to Prosper

Raad Shakir, MD

The WFN is a non-governmental organization (NGO) in official relationship with the WHO. The relationship is symbiotic and solid. It started back in the 1960s during the first term of the presidency of MacDonald Critchley from 1965 to 1969. Initially, it was small and dealt with special problems related to tropical neurology. The association continued following the establishment of the mental health section during Sigvald Refsum’s presidency from 1973 to 1981. Diana Bolis was a major contributor at the time. The relationship continued when the WHO contacted the WFN regarding the revision of the neurological section of the International Classification of Diseases (ICD)-10. At the time, the WHO included stroke in the section of cardiovascular disease, in spite of WFN objections. Walter Bradley and Jean-Marc Orgogozo gave expert advice.

The relationship between the WFN and the WHO has not always been smooth and straightforward. When Richard Masland took over as president in 1981, one of his challenges was to define mental health. Later, during John Walton’s presidency from 1989 to 1997, Norman Sartorius, who was the director of the WHO Division of Mental Health, invited the leaders of the NGOs in neurosciences to an annual meeting at the end of the year. Walton, James Toole, and Andre Lowenthal met with Sartorius. The relationship continued during subsequent years. During Jun Kimura’s presidency, Johan Aarli chaired the Public Relations Committee and subsequently became first vice president and was appointed as the liaison officer between the WFN and the WHO. The relationship flourished during Aalri’s presidency from 2005 to 2009. Under the WHO leadership of Assistant Director General Ala Alwan, succeeded by Oleg Chestnov, head of section Benedetto Saraceno, and his successor Shekhar Saxena, the relationship moved full steam ahead. This was strongly cemented by the appointment of Tarun Dua, coordinator of the WHO’s Evidence, Research and Action on Mental and Brain Disorders Unit, and a pediatric neurologist who took the role as the officer responsible for neurology in the mental health section. The WFN provided several grants to joint activities, which were most rewarding. The publications of the first Neurology Atlas in 2004 and Neurological Disorders: Public Health Challenges are excellent examples.

The WHO activities in our field are crucial for the specialty. If neurology and brain health is to find its rightful place in the agenda of governments across the world, the only way is to go through the WHO. There were, over the last 40 years, several collaborative efforts and, in all, the relationship proved enduring and productive. If we look at the present time and evolving issues, neurologists are at the heart of the WHO activities.

ICD-11

Raad Shakir (left) and Walter Bradley chair the topic advisory groups for ICD-11 and ICD-10.

There are four areas which I would like to highlight. The first is the ICD-11 project, which has now matured and is coming to publication. We have to remember that the ICD is a WHO and not a WFN process, as neurological diagnoses only form a small part of the whole ICD revision program. The ICD-11 will have short definitions for all entities, and it is crucial that the WHO secretariat, represented in our case by Dua, has the support to discuss the issues with the central classification team at the WHO. The common version to be presented in October 2016 is the Joint Linearization for Mortality and Morbidity Statistics (JLMMS) and not the neurology specialty version, which will come later. This is a crucial step to the WHO, as member states will follow this classification. It is most important to point out that, with the help of the WHO team, stroke is now part of the neurology section, which is most important for brain health future statistics. We still have some fine-tuning to do until the end of June 2016. It is inevitable that some neurology specialists, patient organizations, and others may find some of the ICD layout and content not to their liking. All of us have made efforts to reconcile the opinions and needs of neurological and neurosurgical associations and interest groups, at the same time satisfying public health needs and clinical utility, as well as other medical and surgical specialties.

I would like to use this opportunity to thank all my fellow neurologists and neurosurgeons who contributed their time and expertise over the past seven years in making the neurology ICD-11 a viable and meaningful project. The support of the WHO is vital to us in our work and continues to be so. The comments made by the central classification team were taken and acted upon. My fellow members of the Topic Advisory Group (TAG) have been wonderful in their advice and work over the years, and I had the honor to chair the neurology TAG.

WHO Non-Communicable Diseases

Left to right: Oleg Chestnov, WHO assistant director general; Bente Mikkelsen, GCM NCDs chair; and Raad Shakir, WFN president.

The second issue is that of the WHO non-communicable diseases (NCD) project. The NCDs launch did not initially include neurological diseases. However, since 2013, it has become clear that the neurological, mental, developmental, and substance use (NMDS) group surpasses, in numbers and in Disability Adjusted Life Years (DALYs), the cancer and cardiac disease group. Moreover, prevention is now clearly possible in many such conditions. This has led to the involvement of the WFN in the global coordinating mechanism for NCDs (GCM/NCD), headed by Dr. Bente Mikkelsen. The WFN is an official member and attended meetings for the NCD project. This is very important as the G8 London declaration on dementia states, “the G8 has an ambition to identify a cure or a disease-modifying therapy for dementia by 2025 and to increase collectively and significantly the amount of funding for dementia research to reach that goal.” The WFN has declared that there is “No health without brain health.” This has been met with approval by those involved in health provision from various parts of the world.

In the WHO structure, neurology falls under the administrative charge of the assistant director general for non-communicable diseases and mental health. The WFN has long argued to replace mental health with brain health. This, in our opinion, is more descriptive and inclusive. However, we all appreciate that there are many administrative issues and channels to convince at the WHO, as well as those involved in all aspects of brain health.

Neurology Atlas 2015

The third project nearing finalization is that of the second edition of the Neurology Atlas 2015. The first atlas was published in 2004 and was a WHO best seller. The second edition is coming this year, and we await the final publication. The countries’ resources will be detailed, and again the policies on neurological care and provisions for management will be presented. One can say, even with the preliminary data, that the provisions in low- and low, middle-income countries remain abysmal compared to high-income economies. It is also possibly true to say that the situation regarding the number of health care professionals has improved over the past 10 years. This will have to await final statistical analysis. As for WHO regions, the deficiencies remain in Africa, South Asia, Latin America, and parts of the Eastern Mediterranean region. The atlas, when published, will be of a huge benefit and impact on neurological care provision and training across the world. The WFN would like to thank the WHO secretariat, in particular Tarun Dua and her team, for all their hard work in this endeavor. The WFN is also proud to have contributed to the project financially, as well as with experts helping in the process.

World Health Assembly

Raad Shakir (left) and Tarun Dua, coordinator of the WHO’s Evidence, Research and Action on Mental and Brain Disorders Unit.

The fourth issue is representing the interests of neurology during the World Health Assembly (WHA). The WHA is the decision-making body of the WHO. It is attended by delegations from all WHO member states and focuses on a specific health agenda prepared by the Executive Board. The WHA meets annually at the end of May. NGOs, like us, can apply to make a statement through a request, and we need to influence the secretariat well in advance to have resolutions adopted by some member states to be presented. The best example of this is the resolution on epilepsy during the 68th WHA meeting in 2015. The delegates endorsed a resolution urging member states to strengthen their ongoing efforts in providing care for people with epilepsy. Although affordable treatment for epilepsy exists, up to 90 percent of people with the condition may not be properly diagnosed or treated in resource-poor settings. The resolution highlights the need for governments to formulate, strengthen, and implement national policies and legislation to promote and protect the rights of people with epilepsy. It also stresses the need to reinforce health information and surveillance systems to get a clearer picture of the burden of disease and to measure progress in improving access to care.

Such declarations need years to achieve and the WFN congratulates the International League Against Epilepsy for its diligent work in bringing this to a conclusion. This can only help the 50 million epilepsy sufferers across the world.

For all these and many other issues, the collaboration between the WHO and the WFN will continue to flourish.

FROM THE EDITORS

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

Steven L. Lewis, MD

Walter Struhal, MD

We are pleased to introduce this issue of World Neurology. In this issue, Raad Shakir, MD, president of the World Federation of Neurology (WFN), provides us with a historical view of the long-standing and important collaborative relationship between the World Health Organization and the WFN, working together for the overall goal of improving brain health.

Marco T. Medina, MD, and Gustavo C. Román, MD, update us on the Pan-American Federation of the Neurological Societies, an organization with the vision to reach the highest level of neurological health in all the countries of the American continent.

Prisca-Rolande Bassolé, MD, and Yannick Fogang Fogoum, MD, provide their insights and opinions (from their standpoint as young African neurologists) about their hopes for the African Academy of Neurology, an organization whose inaugural meeting was less than one year ago.

Mohammad Wasay, MD, and Professor Wolfgang Grisold, MD, secretary-general of the WFN, remind us about the upcoming World Brain Day 2016: “Brain Health in an Aging Population.”

Dr. Román and Rodrigo Pardo-Turriago, MD, report on the XII Annual Colombian Congress of Neurology and the development of the guidelines for the diagnosis and treatment of Zika virus-associated Guillain-Barré syndrome in Colombia that was prepared for the Ministry of Health of Colombia. This issue also features a report on the breaking news session on Zika virus held at the recent European Academy of Neurology meeting in Copenhagen, Denmark.

Jacques Reis, MD, Serefnur Öztürk, MD, Dr. Román, and Peter Spencer, PhD, provide a detailed overview of the history and ongoing activities of the Environmental Neurology Applied Research Group of the WFN.

In our regular columns, Katharina M. Busl, MD, MS, reviews the recent book by Eelco F. M. Wijdicks, MD, on emergency and critical care neurology, and in our history of neurology column, Peter Koehler, MD, PhD, discusses the pioneering medical and biological insights of an 18th century European physician from his travels to Surinam.

Also in this issue, Sarosh M. Katrak, MD, and Steven L. Lewis, MD, provide their nominating statements for the position of elected WFN trustee, to be voted on by the WFN delegates in Prague, Czech Republic, in September 2016.

Finally, two neurological giants are celebrated and memorialized in this issue. Johan A. Aarli, MD, (eighth WFN president) and professor Shakir report on the life and legacy of Lord John Walton, MD, who served as the fifth WFN president, while Dr. Katrak and Bhim Sen Singhal, MD, report on the life and accomplishments of Professor Noshir H. Wadia, MD.

We hope you enjoy reading this issue of World Neurology. We look forward to continuing to receive your outstanding submissions and helpful suggestions for the benefit of all of the readers of World Neurology.

Day of the Brain: July 22, 2016

By Wolfgang Grisold, MD, and Mohammed Wasay, MD

“The Aging Brain“ and changes in neurological function in age is the topic of this year’s Day of the Brain.

On July 22, 2016, the World Federation of Neurology (WFN) will celebrate its 3rd Annual Day of the Brain. The topic will be “The Aging Brain” and should alert all member countries on the emerging problems of the aging population and also the increase in dementia.

Press material and information has been sent to WFN delegates. Please plan to participate and improve the fate of aging persons with neurological disease.

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

By John D. England, MD
Editor-in-Chief

John D. England

On February 1, 2016, the World Health Organization (WHO) declared that the Zika outbreak in the Americas is a Public Health Emergency of International Concern (PHEIC). This recommendation was based upon the growing concern that Zika virus infection is linked to the increasing number of cases of neonatal microcephaly and other neurological conditions such as Guillain-Barré syndrome (GBS). As of April 6, 2016, the Zika virus has been reported in 62 countries or territories, and is circulating in 39 of them. Of great concern is the fact that the geographical distribution of the virus has steadily and rapidly expanded. Since Zika virus is transmitted to humans by Aedes mosquitoes, there is great concern that the virus outbreak will continue to spread to other countries and territories. Although most people who are infected with Zika virus appear to have few symptoms, the latest evidence suggests a clear association of the virus with a congenital syndrome of brain malformation/microcephaly, and an increased incidence of GBS and other neurological conditions (e.g., myelitis and meningoencephalitis). The Zika virus congenital syndrome (microcephaly) has been seen in French Polynesia and especially in Brazil, where several thousand cases have been reported. Thirteen countries or territories have reported an increase in the incidence of GBS in conjunction with the wave of Zika virus outbreak. Assessment of this growing body of information has led the WHO to conclude that Zika virus is a cause of microcephaly and GBS. WHO has called for a coordinated global response to help affected countries and health care providers deal with the crisis. Management of the complications of Zika virus infection is already straining health care systems in affected regions, and there is a serious lack of financial resources available.

JNSJan WHO has convened several meetings to address the Zika virus epidemic. Several WHO peer-reviewed guidelines have been generated. WHO is posting these guidelines and is providing frequent updates about the Zika virus situation on its website. WHO provides the most comprehensive global information on Zika virus, and I encourage everyone to visit the WHO website, www.who.int/en/ for the most current information.

The Pan American Health Organization (PAHO) is also working with WHO to provide informational resources and support for this crisis. Of course, increased surveillance, enhanced vector (mosquito) control measures, development of reliable diagnostic tests, and vaccine development are priorities.

Collaborative interdisciplinary research on Zika infection and its neurological complications is already being organized, but funding is severely lacking at this time. As an important first step to enhance research collaboration and provide for transparent data sharing, the Neurovirus Emerging in the Americas Study (NEAS) (www.neasstudy.org/en/home/) is being organized and is supported by an approved Johns Hopkins Medical Institutions IRB protocol. Researchers are encouraged to visit the NEAS website for additional information. The situation is rapidly evolving; therefore, all information is subject to modification as we learn more about this emerging crisis.

Since the Journal of the Neurological Sciences represents the World Federation of Neurology, I encourage clinicians and investigators to provide us with the newest information available on this evolving crisis.

Of course, new and interesting information about other neurological diseases is always published in our journal, and in this and the previous issue we have selected new “free-access” articles for our readership.

Kyum-Yil Kwon, et al provide data on a retrospective study comparing 28 patients with classic essential tremor (ET) and 24 patients with typical Parkinson’s disease-tremor dominant type (PD-TDT). Although there was some overlap in motor and non-motor symptoms, the authors found certain specific features which helped to distinguish ET from PD-TDT. ET presented with relatively symmetric tremor, whereas PD-TDT presented with asymmetric tremor. Leg tremor was seen only in patients with PD-TDT, and this was the most specific tremor sign to differentiate the two groups. Interestingly, the presence of head tremor did not differentiate between the groups. Patients with PD-TDT exhibited more frequent non-motor symptoms compared to patients with ET. The most common non-motor symptoms experienced by the patients with PD-TDT were hyposmia, orthostatic dizziness, REM sleep behavior disorder (RBD), urinary frequency, and memory disturbance. The authors concluded that evaluation of both motor and non-motor symptoms/signs is necessary to distinguish ET and PD-TDT. Kyum-Yil Kwon, Hye Mi Lee, Seon-Min Lee, Sung Hoon Kang, Seong-Beom Koh, Comparison of motor and non-motor features between essential tremor and tremor dominant Parkinson’s disease, J. Neurol. Sci. 361 (2016) 34-38. www.jns-journal.com/article/S0022-510X(15)30082-4/fulltext
Ari Shemesh, David Arkadir and Marc Gotkine reviewed the clinical characteristics of 346 patients with amyotrophic lateral sclerosis (ALS). They found that finger flexion was relatively preserved when compared to finger extension. In many patients with ALS, finger flexion was only mildly affected when finger extension was severely affected or even paralyzed. Along with the well-known “split hand” sign (ie, preferential involvement of lateral intrinsic hand muscles), the authors have described another useful clinical clue which suggests the possibility of ALS.Ari Shemesh, David Arkadir, Marc Gotkine, Relative preservation of finger flexion in amyotrophic lateral sclerosis, J. Neurol. Sci. 361 (2016) 128-130. www.jns-journal.com/article/S0022-510X(15)30095-2/fulltext
Oscar H. Del Brutto and Hector H. Garcia provide an excellent review on the history of human Taenia solium (the pork tapeworm) cysticercosis. Neurocysticercosis is a major cause of seizures and neurological disability throughout the world, and this article succinctly reviews how our understanding of this disease has evolved. O.H. Del Brutto, H.H. Garcia, Taenia solium cysticercosis-The lessons of history, J.Neurol.Sci. 359 (2015) 392-395.
Rachel Ventura, Laura Balcer, Steven Galetta, and Janet Rucker from New York University School of Medicine provide an overview of eye movement abnormalities that can occur with concussion. Sports concussions are increasingly recognized as a serious problem with potential long-lasting neurological sequelae. As such, there is a great need to understand concussion and to develop sensitive tests to identify and evaluate patients with concussion. Since ocular motor function is controlled by diffuse and multiple areas of the brain, neuro-ophthalmologic tests can provide a sensitive means of assessing brain dysfunction. The King-Devick test, which measures visual performance, is already being used on the sidelines to assess concussion. In this paper, the authors explain how eye movements are compromised by concussion, and how ocular motor assessment tasks can be used to monitor patients. R.E. Ventura, L.J. Balcer, S.I. Galetta, J.C. Rucker, Ocular motor assessment in concussion: Current status and future directions, J. Neurol. Sci. 361 (2016) 79-86.

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

WFN and the Canadian Neurological Society Announce a New Department Visit Program

Morris Freedman, MD, FRCPC; Guy Rouleau, MD, PhD, FRCPC, OQ; Wolfgang Grisold, MD; Colin Chalk, MD, CM, FRCPC; JeanneTeitelbaum, MD, FRCPC; and Dan Morin

Morris Freedman, MD, FRCPC

The World Federation of Neurology (WFN) Department Visit Program was initially developed in support of the WFN’s Africa Initiative to provide educational opportunities for young neurologists living in Africa. The success of the program is exemplified by the participation of Turkey, Austria, and Norway, which have served as host countries to African neurologists and have provided funding for the visits.

Guy Rouleau, MD, PhD, FRCPC, OQ

At the World Congress of Neurology in Chile last year, Dr. Raad Shakir, president of the WFN, suggested to Dr. Morris Freedman, newly elected WFN trustee from Canada, that the Department Visit Program be expanded to include Canada as a host country. The proposed goal was to support the Central and South America Initiative Network. Canada welcomed Dr. Shakir’s suggestion as an opportunity to contribute to the international education of neurologists.

Wolfgang Grisold

Dr. Guy Rouleau, director of the Montreal Neurological Institute and newly appointed Canadian delegate to the WFN, along with Dr. Colin Chalk, president of the Canadian Neurological Society, Dr. Jeanne Teitelbaum, president of the Canadian Neurological Sciences Federation, the umbrella organization of which the Canadian Neurological Society is a member, and Dan Morin, CEO of the Canadian Neurological Sciences Federation, all enthusiastically endorsed the concept of the Department Visits. Shortly afterwards, with the guidance and assistance of WFN Secretary General Dr. Wolfgang Grisold, and WFN Education Committee Chair and Co-Opted Trustee, Dr. Steven Lewis, the joint WFN-Canada Department Visit Program was launched with a formal announcement and call for applications in early March 2016.

Colin Chalk, MD, CM, FRCPC

Under Dr. Guy Rouleau’s supervision, the Montreal Neurological Institute will be the host site for the first Department Visit to Canada. The Montreal Neurological Institute 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, muscle 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 neurosurgeons performed some 1,800 procedures. The Montreal Neurological Institute has long been a leader in the training of neurologists and neurosurgeons, and it is the principal site of McGill University’s Integrated Program in Neuroscience, the largest graduate neuroscience program in North America. Always at the forefront of innovation, the Montreal Neurological Institute has been the gateway to Canada for technologies such as encephalography (EEG), magnetic resonance imaging (MRI), positron emission tomography (PET), and computer-assisted tomography (CT). More information about the Montreal Neurological Institute can be found at www.mcgill.ca/neuro/about.

Dan Morin

Jeanne Teitelbaum, MD, FRCPC

The Canadian Neurological Society will be the host society of this Department Visit program. The Canadian Neurological Society was established in 1948 as an organization of neurologists and neurosurgeons. In 1965, the original Canadian Neurological Society was dissolved and two new societies were created to represent the two distinct groups, i.e., the modern day Canadian Neurological Society and the Canadian Neurosurgical Society. The mission of the Canadian Neurological Society 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 Canadian Neurological Society and the Canadian Neurosurgical Society, along with the Canadian Association of Child Neurology and the Canadian Society of Clinical Neurophysiologists, are all member societies of the Canadian Neurological Sciences Federation. More information about the Canadian Neurological Society and the Canadian Neurological Sciences Federation can be found at www.cnsfederation.org/.

The Montreal Neurological Institute, founded in 1934 by renowned neurosurgeon Dr. Wilder Penfield, is the largest specialized neuroscience research and clinical center in Canada, and one of the largest in the world.

The Montreal Neurological Institute and the Canadian Neurological Society will host two neurology trainees or junior faculty who are within five years of certification in neurology to visit the Montreal Neurological Institute for four weeks. To qualify, applicants must be residents of a country in Central or South America. The focus for the visiting neurologists and neurology trainees will be to experience the Canadian neurological system in an international environment, meet new colleagues, and foster future cooperation.

Pioneering research and treatment of epilepsy at the Montreal Neurological Institute, the “Montreal Procedure,” a surgical treatment for epilepsy developed by Dr. Penfield and colleagues, is used all over the world.

Support will be provided for travel expenses, accommodation, living expenses, and cost of health insurance during the stay in Canada.

The evaluation committee consists of two representatives from each of the following: the Canadian Neurological Society, the WFN Education Committee, and the Central and South America Initiative Network.

The initial department visit will take place during late 2016 or 2017, and applications will be accepted until May 30, 2016. More information can be found at www.wfneurology.org/wfn-mni-cns-montreal-department-visit-programme.

Morris Freedman is a WFN trustee, and is with the department of medicine, division of neurology, Baycrest Health Sciences, Mt. Sinai Hospital, and University of Toronto; Sam and Ida Ross Memory Clinic Baycrest; Rotman Research Institute, Baycrest, Toronto, Canada.

Guy Rouleau is with the Montreal Neurological Institute, department of neurology and neurosurgery, McGill University, Montreal, Quebec, Canada.

Wolfgang Grisold is WFN co-chair of the Education Committee and secretary general, and is with the department of neurology, Kaiser Franz Josef Hospital of Vienna, Austria; Medical University of Vienna, Austria.

Colin Chalk is with the department of neurology and neurosurgery, McGill University, Montreal, Canada.

Jeanne Teitelbaum is with the department of neurology, McGill University, department of medicine and neurology, Université de Montréal, Montreal, Quebec.

Dan Morin is CEO, Canadian Neurological Sciences Federation.

Training in Neurology – a Future Regular Column in World Neurology

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

World Neurology is planning a column in each issue devoted to neurological education. This new feature will help promote educational concepts and also will serve as a platform for new educational ideas and structures.

Neurologic education and education research are of crucial interest to promote high quality neurologic care throughout the world, and is one of the critical roles of the World Federation of Neurology (WFN).

For example, within the current issue and the previous issue, World Neurology has covered “training stories”— individual experiences reflecting an exchange program or a national curriculum. These and similar articles are important contributions for our global readers.

In future issues, we plan to implement a regular column on neurologic education and educational concepts and ideas. We encourage submissions on educational topics, including but not limited to the following:

Post-graduate neurologic education
Continuing medical education
Quality assurance on a national or international level
Assessment techniques
International harmonization of training projects
Advocacy activities to promote neurologic education nationally or internationally
Patient education
Caregiver education
Public education

World Neurology encourages the submission of short articles with a maximum of 750 words, a short summary, a maximum up to five key references, and up to one figure and one table.

World Neurology appears six times a year, is free, and reaches approximately 18,000 readers. Your contribution will have an impact worldwide.

Wolfgang Grisold, Walter Struhal, and Steven L. Lewis will edit this new initiative. We look forward to reviewing your submissions. Submissions should be sent to traininginneurology@wfneurology.org.

World Neurology is encouraging submissions on a variety of topics related to neurologic education, including, but not limited, to education of neurologic trainees, continuing education, and education of the public. Clockwise top, from left to right. Figure 1 shows neurologists in training in Vienna, Austria, figure 2 shows neurologists attending a continuing neurologic education symposium in Almaty, Kazakhstan in August 2015, and figure 3 shows Patient Day at the World Congress of Neurology in Santiago Chile, October 31, 2015.

WFN and the German Neurological Society
Department Visit Program

Ralf Gold, MD, Wolfgang Grisold, MD, Albert Ludolph, MD, and Thomas ThiekÖtter, MD

Ralf Gold, MD, Albert Ludolph, MD, and Thomas Thiekötter, MD

The World Federation of Neurology (WFN) and the German Neurological Society (DGN) are pleased to announce a new partnership to invite two colleagues from Africa to visit the neurology department of the St. Josef-Hospital in Bochum, Germany, part of the University Hospital of the Ruhr University Bochum and the department of neurology at the Hospital of Ulm University.

Wilhelm Erb initially founded the German Neurological Society (DGN) as the “Gesellschaft Deutscher Nervenärzte” in 1907. In 1935, the society was dissolved by the Nazi government. The re-establishment of the society took place in 1950 by Heinrich Pette. The DGN is part of the Association of the Scientific Medical Societies in Germany (AWMF). The current chairman is Professor Ralf Gold from Bochum. In recent years the DGN has become a fast-growing society, which represents more than 8,000 members.

The WFN was formed in Brussels in 1957 as an association of national neurological societies. Today, the WFN represents 119 professional societies in 118 countries in all regions of the world. WFN’s mission is to foster quality neurology and brain health worldwide, a goal it seeks to achieve by promoting global neurological education and training, with the emphasis placed firmly on under-resourced parts of the world.

About the Project

The German Neurological Society supports the WFN’s African initiative by inviting two African colleagues to visit the department of neurology in the St. Josef-Hospital in Bochum (University Clinic of the Ruhr University) and the department of neurology at the Hospital of Ulm University for four weeks. The purpose of the visit is to experience the German neurological system in an international environment, meet new colleagues, and foster future cooperation.

About the Host Institutions

St. Josef-Hospital, Ruhr University Bochum: The department of neurology at St. Josef-Hospital is part of the University Hospital of the Ruhr University Bochum. The chair of the department is Professor Ralf Gold, who is also the current president of the German Neurological Society. The department comprises a total of 106 beds, including an intensive care unit, an intermediate care unit, and a certified supra-regional stroke unit. Neuroimmunological diseases represent the main clinical and scientific focus. The department of neurology has its own CSF-lab and its own plasma exchange unit. Neurosonology of the central as well as of the peripheral nerve system, constitutes a further focus, and the neurosonology lab is one of the few DEGUM-certified labs in Germany. Cerebrovascular diseases are treated according to the latest state of medicine, including mechanical thrombectomies. Furthermore, there is special expertise in the treatment of neurodegenerative disorders such as Parkinson’s or Huntington’s disease.

The Ruhr University Bochum (RUB) was founded in 1962 as the first new public university in Germany since 1945. Today, the RUB is one of the largest universities in Germany and harbors more than 20 faculties.

University Hospital of Ulm (RKU): The department of neurology, University Hospital of Ulm (RKU), chaired by Professor Albert C. Ludolph, is a maximum care hospital for neurology (tertiary referral) for 93 inpatients, including a certified supra-regional stroke unit/intermediate care ward for 27 inpatients, plus additional beds in an interdisciplinary intensive care unit and an additional neurological rehabilitation clinic with all levels of rehabilitation care. The department of neurology has its own CSF-lab and its own immune adsorption unit. The clinic has a dedicated imaging facility with MRI (where neurologists are specifically trained) and a state-of-the-art angiography unit where mechanical thrombectomies are performed. The outpatient clinic includes multiple, highly specialized outpatient clinics (including those for amyotrophic lateral sclerosis, Huntington´s disease, Parkinson´s disease and other movement disorders, multiple sclerosis, dementias, epilepsy, pain, brain tumors, etc.) and a dedicated neurological clinical study center. The main clinical and scientific focus is motor neuron disorders/amyotrophic lateral sclerosis for which the department is one of the world´s largest and most renowned centers.

The visit will take place in mid-October 2016.

Details about support

The German Neurological Society will provide the following support:

Travel expenses: Country of Residence — Germany — Country of Residence
Accommodations for four weeks
Living expenses (food and beverage) during the four weeks
Costs of health insurance during the stay in Germany

Criteria for applications:

The applicant must be a resident of a country in a low or lower, middle-income country in the African continent
The applicant must have been born after December 12, 1975

Evaluation Committee:

Two representatives of the German Neurological Society

Two representatives of the WFN Education Committee

Two representatives from the African Academy of Neurology

Deadline for application:

To apply, applicants must email their CV, a supporting statement, and a letter of recommendation from their head of department by May 30, 2016 to the WFN Education Coordinator, Ella Nkanagu, enkanagu@kenes.com.

For any questions regarding your application, or to apply, please contact the administrative office of the WFN Education Committee at +41 22 908 0164 or enkanagu@kenes.com.

Ralf Gold, MD, is professor and chair, department of neurology, Ruhr University, Bochum, Germany; Wolfgang Grisold, MD, is WFN secretary general and a professor in the department of neurology, Kaiser Franz Josef Hospital of Vienna, Austria; Albert Ludolph, MD, is chairman, department of neurology, University of Ulm, Germany; and Thomas Thiekötter, MD, is CEO, German Neurological Society, Berlin.

PRESIDENT’S COLUMN:
When Neurology Is Under the Spotlight

Raad Shakir

Over the last three months, the world has been facing a most serious and devastating epidemic. The World Health Organization (WHO) declared Zika virus infection as a Public Health Emergency of International Concern (PHEIC). This has triggered a massive international response not only in the Americas, but also across the world. Cases of Zika virus infection are being reported in the thousands across the northern parts of South and Central America. To date, the WHO reports the infection to be present in 62 countries between 2007 and 2016. The transmission is not only reported in Latin America, but in Cape Verde, and recently Vietnam reported mosquito-borne Zika virus infection.

The issue is compounded by the fact that the symptoms of the Zika virus infection are mild, and none disabling. However, the neurological complications are most serious. Zika virus infection is described as the most devastating viral infection during pregnancy. The reported microcephaly is most serious, and we have no idea what the future holds for those babies born to mothers without obvious microcephaly. One can reasonably conclude that the reported Zika virus isolated from post mortem cases of invasion of brain and spinal cord suggests that we may be facing a future group of affected children with many neurological complications of as yet unknown nature.

Figure 2- left to right, Dr. Iledefonso Rodriguez Leyva, Dr. Karina Velez Jimenez, Professor Raad Shakir, Dr. Minerva Lopez, Dr. Steven L. Lewis, during the WFN visit to neurology training programs in Mexico City.

The second neurological condition which has increased in those affected with Zika virus infection is Guillain-Barre syndrome. This, in a way, is expected following a viral infection. The seriousness of the condition is made much worse by the lack of local availability of supportive treatment. Generally, at least a fifth of GBS patients may require respiratory support, which is compounded with lack of availability of IV immunoglobulin. The cost of both modalities is prohibitive. In some parts of Latin America, the use of plasma exchange is the way GBS is treated rather than IV immunoglobulin. Even with this, many locations in affected areas do not have the facilities or the training to use plasma exchange machines. This puts lives at risk.

One has to remember that the diagnosis and management of GBS requires neurological expertise, which is scarce to say the least. It would be reasonable to state that the 1 in 20 mortality rate reported in the developed world will be much higher for those affected by GBS in the currently Zika virus affected areas.

All this prompted the WFN to mount a concerted effort to tackle the problem. The WFN Zika Virus Working Group was formed, and the committee is chaired by John England, MD, New Orleans. The membership includes experts in child neurology and GBS, with neurologists from the most affected countries in South and Central America. See more at www.wfneurology.org/committees?tab=16016.

Meeting of the WFN with some of the members of the Zika Working Group at the American Academy of Neurology Annual Meeting in Vancouver on April 18, 2016. From left to right: Raad Shakir, MD; David Bearden MD; Ildefonso Rodriguez-Leyva, MD; Miguel Osorno Guerra, MD; Minerva Lopez Ruiz, MD; Karina Velez Jimenez, MD; Allen Aksamit, MD; and Russell Bartt, MD; Also participating in the meeting, but not in the photo, were William Carroll, MD, Wolfgang Grisold, MD, Steven Lewis, MD, and Marco T. Medina, MD.

Meeting of the WFN with some of the members of the Zika Working Group at the American Academy of Neurology Annual Meeting April 18 in Vancouver. From left to right: Raad Shakir, MD; David Bearden MD; Ildefonso Rodriguez-Leyva, MD; Miguel Osorno Guerra, MD; Minerva Lopez Ruiz, MD; Karina Velez Jimenez, MD; Allen Aksamit, MD; and Russell Bartt, MD; Also participating in the meeting, but not in the photo, were William Carroll, MD, Wolfgang Grisold, MD, Steven Lewis, MD, and Marco T. Medina, MD.

Meeting of the WFN with some of the members of the Zika Working Group at the American Academy of Neurology Annual Meeting April 18 in Vancouver. Meeting of the WFN with some of the members of the Zika Working Group at the American Academy of Neurology Annual Meeting April 18 in Vancouver.

The WFN is also an active contributor to the WHO committee on Zika. This committee met in Geneva, and according to Dr. England’s executive summary, “Collaborative interdisciplinary research on Zika infection and its neurological complications is already being organized, but funding is severely lacking at this time. As an important first step to enhance research collaboration and provide for transparent data sharing, the Neurovirus Emerging in the Americas Study (NEAS), www.neasstudy.org/en/home/, is being organized and is supported by an approved Johns Hopkins Medical Institutions IRB protocol. Researchers are encouraged to visit the NEAS website for additional information. The situation is rapidly evolving; therefore, all information is subject to modification as we learn more about this emerging crisis.”

The WHO situation report on April 7, 2016 concludes “The global prevention and control strategy launched by the World Health Organization (WHO) as a Strategic Response Framework encompasses surveillance, response activities, and research. This situation report is organized under those headings.”

The WFN Zika virus committee met on Monday, April 18th in Vancouver during the 68th AAN meeting to further discuss the issues. The following questions were put to the experts for a response.

Do we have a diagnostic ELISA test or the like, for quick diagnosis?
Can individuals have the neurological complications without exhibiting the febrile illness, and if so how can we be sure of diagnosis?
Do we know the spectrum of all the fetal neurological deficits?
How long is the period of viral human-to-human infectivity after the Zika virus infection illness?
Do we have a registry of morbidity and mortality related to GBS resulting from Zika virus infection?
It is important to understand whether the variant of GBS associated with Zika is different than other varieties of GBS.
Is there a registry of cases of neurological Zika virus infection other than GBS?
Any report on vaccine development?
Is Zika virus present in breast milk and what is the risk to breast-fed infants?

Legend Fig. 1 Neurology Atlas 2015. Editor’s note: The data in the Neurology Atlas figure are a draft and the definitive data may be different when the final WHO version is produced.

One can easily see that the brunt of the neurological complications fall in the child neurology world. The WFN is working very closely with the International Child Neurology Association to collaborate and come up with a joint stance in combating this most devastating viral infection during pregnancy. The ICNA is dedicating a session of its forthcoming world congress to Zika viral infection.

The division of mental health, substance abuse, and neurosciences in the WHO is very keen on informing member states on the importance of neurological expertise in the fight against Zika virus infection. This has brought into focus the dire lack of neurologists both for adults and children across the world. The second edition of the Neurology Atlas jointly produced by the WHO and the WFN has demonstrated in its figures that the mean number of neurologists per 100,000 people is 0.7 in the Americas, compared to 6.6 in Europe (Fig1). The figures are more poignant as the Pan American region includes the U.S. and Canada. The logical conclusion is that there is a vast shortage in the areas affected by Zika virus infection.

The WFN is collaborating with the Canadian Neurological Society to join the worldwide program for short-term training of young neurologists and in this case neurologists will be chosen from Latin America for short training periods in Canada. The WFN has already had such a program with four European countries for training African Neurologists, and now the program is branching out to the Americas.

In March 2016, the neurology training program in Mexico has been inspected and accredited by the WFN, and a similar short-term training will start. Mexico already trains young neurologists from across Central America (Fig2).

Perhaps Zika virus infection has produced a momentum for all of us to demonstrate our willingness to cooperate and act quickly in the face of this pandemic. We are at the beginning of a long, difficult, and tortuous road.