World Brain Day 2016

Brain Health in an Aging Population: “The Aging Brain”
By Mohammad Wasay, MD, FRCP, FAAN, and Wolfgang Grisold, MD

An Aging Population

World-Brain-Day-imageThe global share of older people (age 60 and over) is more than 800 million (12 percent of the population) and is growing, with the expectation that it will reach more than two billion (21 percent of the population) by 2050. Currently 70 percent of the world’s older population lives in developed and developing countries, but by 2025, 80 percent of the older population will be living in less developed countries. Older persons are projected to exceed the number of children in 2047. It has already started in developed countries. In 2015, Japan became the first country in the world where more adult diapers than baby diapers were sold.

Population aging has major social, health, and economic consequences. The prevalence of non-communicable diseases and disability increases with age. Poverty is high among older persons. There is increased pressure on social support systems for older persons. The growing burden of diseases and disability, and reducing financial and social support in an aging population will be among the huge challenges for societies and governments with respect to their social and health care systems in coming years.

Brain Diseases in the Aging Population

The prevalence of a number of neurological diseases increases with age, including stroke, dementia, and Parkinson’s disease. It is estimated that 10 to 20 percent of people aged 60 to 80 years suffer from one or more of these diseases. More than 30 percent of persons who are 80 years or older suffer from at least one neurological disease.

Disability due to neurological diseases and other musculoskeletal diseases is very high and growing. It is estimated that more than 20 percent of people over 60 years old need support for activities of daily living.

The economic burden of this is huge. It is estimated that almost half of the health care expenditure is related to the care of older persons in developed countries today, and it is projected to become two-thirds by 2030. The same trends are expected in developing and less developed countries by 2050.

The medical community, however, must be cautious on the wording when “burden” with regards to costs of the aging populations is mentioned. We need to be aware that the word “burden” has a potentially negative connotation, which rather should be replaced with a more positive wording— which we feel is better stated as a responsibility.

World Brain Day Theme: “Brain Health in an Aging Population”

It is clear that brain health is going to be the most important determinant of social and economic well being of older persons in the future. On the one hand, health care authorities are deeply concerned with the current status and future trends of our growing population, but little has been done to handle these growing needs.

The World Federation of Neurology has stepped forward to dedicate this year’s World Brain Day to the aging population and has chosen the motto: “The aging brain.” Our intention for this World Brain Day is to increase awareness about the treatment and prevention of brain and neuromuscular diseases affecting mostly elderly persons. The first step of prevention is to improve concepts and means of brain health also among the younger population in order to help prevent brain disease later in life and to improve the quality of life for older persons.

Disease prevention is the concept. However, a much larger number of individuals will be affected by diseases of the brain and the neuromuscular system, which are not (yet) preventable. Thus it is also the duty of society to care for the elderly with progressed neurological disease, and to provide the framework for quality of life, dignity, and the necessary care.

In this group of patients, the focus has to shift from the aspect of a curative condition, towards the inevitable death of all individuals. The concept of palliative care and hospice needs to be implemented in the aging population and in neurological care.

How Can we Improve Brain Health and Prevent or Treat Neurologic Diseases and Care for Persons with Advanced Brain Disease?

Stroke and vascular dementia are among the most important neurological diseases affecting persons of higher age. For these conditions, there are preventable and modifiable risk factors. Education, cognitive exercises, physical activity, and nutrition are important areas of intervention for prevention and slowing down of cognitive decline. Parkinson’s disease is a neurodegenerative disorder, but effective symptomatic treatment is available.

Emotional health is as important as cognitive health in elderly persons. Quality of life and a lack of disability can be associated with emotional well-being. Effective interventions are available for maintenance and promotion of emotional health.

Despite prevention strategies, age is a non-modifiable risk factor, just as effects of degenerative and hereditary diseases on the brain and the neuromuscular system. Supportive, palliative care, and the hospice concept need to be integrated into the concept of neurological care in dealing with an aging population.

WFN and National Societies Activities

To raise awareness with respect to the aging brain and neurologic diseases in the elderly, the WFN is asking its members to use this year‘s “Day of the Brain” to advocate and campaign in their country for these emerging problems.

The WFN public awareness and advocacy committee will prepare publicity material for this campaign, which includes logos, banner ads for web sites, handbills, brochures, posters, billboards, and presentations.

There will be a press conference. A template press release will be prepared and circulated to delegate societies. They can be adapted for local use with respect to national/regional data, priorities, or by adding quotes from national/regional experts.

The most important target of this campaign is the public. We need to create simple messages in local languages and promote them via print, electronic and social media, billboards, banner, events, etc.

Other important areas of intervention are health care authorities and policy makers. Our campaign should result in policy and priority shift at the national or local level. We have to plan targeted activities to facilitate this outcome.

Another important area of intervention is awareness and training of general practitioners, nurses, and paramedical staff.

Involvement of the media is a must. Celebrities or scientists could be a part of this advocacy campaign.

Delegate societies are strongly encouraged to organize awareness activities that may include press conferences, media briefing sessions involving local media, seminars, conferences, public awareness sessions, presentations at local schools, colleges, universities, posters, essays, drawing competitions, and newspaper and magazine articles.

Collaborators

As in the past, the WFN will work with various health entities, and professional and welfare organizations to promote awareness for World Brain Day.

The WFN is hoping for your collaboration to improve the health and future of patients with an aging brain. Please follow our website, www.worldneurologyonline.com and our social media. If you have suggestions, or ideas for World Brain Day 2017, please do not hesitate to contact us at wbd2016@wfneurology.org.

 

 

From The Editors

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

Walter Struhal

Walter Struhal

STEVEN L. LEWIS

Steven L. Lewis

We are pleased to introduce this issue of World Neurology, which includes topics of interest to all readers. In this issue, Raad Shakir, MD, the president of the WFN, reports on the work being done to address the Zika virus epidemic, including efforts via the World Health Organization (WHO) and the WFN. Mamta Bhushan Singh, MD, and Michael F Finkel, MD, discuss the challenges and issues involved in tackling the problem of epilepsy in the developing world. Mohammad Wasay, MD, and Professor Wolfgang Grisold, MD, the secretary-general of the WFN, review the background and planning for this year’s day of the brain, World Brain Day 2016: Brain Health in an Aging Population. J. Eduardo San Esteban, MD, discusses the past, present, and hopes for the future of Pan American neurology and collaboration to address neurological diseases throughout the Americas. Also in this issue, Morris Freedman, MD, trustee of the WFN, with colleagues from the WFN and the Canadian Neurological Society, announce a new joint initiative between our two organizations for neurology trainees or junior faculty from Central or South America to visit the Montreal Neurological Institute for a four-week department visit. Similarly, in this issue, the WFN and the German Neurological Society announce a new department visit program for 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. As an example of the outcome from such a visit, Kalpesh Deraji Jivan, MD, from South Africa writes an enthusiastic report from his four-week visit to the neurology intensive care unit at Innsbruck Medical University in Austria, sponsored by the WFN and the Austrian Neurological Society. Vera Bril, MD, discusses the plans for the upcoming 14th International Congress on Neuromuscular Diseases being held in collaboration with the WFN in July 2016 in Toronto. Finally, in our regular columns, John D. England, MD, editor-in-chief of the Journal of the Neurological Sciences, provides his editor’s update and selected free-access articles from the two most recent issues of the journal; John F. Brandsema, MD, reviews a recent book on Duchenne muscular dystrophy; and M. J. Eadie, MD, provides a biography of a pioneer in the epidemiology of multiple sclerosis.

We hope you enjoy reading this issue of World Neurology. Within this issue, Dr. Grisold and the editors also announce a call for articles on neurologic education for future issues. We look forward to these and other submissions of interest to the readers of World Neurology.

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

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

John D. England

John D. England

The Journal of the Neurological Sciences will soon feature a section devoted to global neurology. We have seen a significant increase in the number of high quality submissions from around the world, and many of these address important issues in regions beyond the traditional high-income countries. In this new section, we will profile original research, topical reviews and commentaries that address important regional and global neurological topics. We extend a special invitation to individuals who are working in or collaborating with neurologists or scientists in lower or middle-income countries. Dr. Donald Silberberg will edit the global neurology section. Dr. Silberberg is ideally suited to edit this section. He is currently emeritus professor of neurology, and he served as chair of neurology (1982-1994) and senior associate dean for international programs (1994-2004) at the University of Pennsylvania Perelman School of Medicine. He is an associate editor for the Journal of the Neurological Sciences and is the retiring editor for World Neurology. Dr. Silberberg is dedicated to improving neurological care in developing countries. His expertise in the global community is a great asset to the World Federation of Neurology and the Journal of the Neurological Sciences. Authors who wish to submit manuscripts for this new section should use the Elsevier Editorial System and follow the instructions for authors.

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

JNSJan1) Ivana Vodopivec, et al. provides a glimpse of the heterogeneity of patients with Susac syndrome. Susac syndrome is a rare disease, which is usually characterized by a triad of encephalopathy, visual disturbances and hearing loss attributed to a pauci-inflammatory vasculopathy of the brain, eye and inner ear. However, at initial presentation, none of the five patients in this case series demonstrated the complete triad, and diagnosis was difficult and delayed. The authors provide two important conclusions: a) Microinfarcts were noted on MRI diffusion weighted imaging (DWI) of the brain, as well as branch retinal artery occlusions and vessel wall hyperfluorescence on fluorescein angiography in all patients with acute encephalopathy, and b) glucocorticoid and IVIg treatments were insufficient in halting the disease in patients with severe encephalopathy. Additional immunosuppressive treatment was required.

1) Vodopivec, N. Venna, J.F. Rizzo III, S. Prasad, Clinical features, diagnostic findings, and treatment of Susac syndrome: A case series, J.Neurol.Sci. 357 (2015) 50-57.

2) Kristin Galetta and Don Gilden provide a well-written and comprehensive review of varicella zoster virus (VZV). This article covers the history, protean clinical presentations, prevention/vaccination and future directions for research. I believe that this article is a must read for any clinical neurologist. K.M. Galetta, D. Gilden, Zeroing in on zoster:  A tale of many disorders produced by one virus, J. Neurol. Sci. 358 (2015) 38-45.

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

Apply for Junior Traveling Fellowships

By Steven L. Lewis and Wolfgang Grisold

This year, the WFN will again offer Junior Traveling Fellowships for young neurologists representing countries classified by the World Bank as low or lower middle income to attend approved international meetings. The deadline for applications is March 15.

In total, there will be 30 awards. Applicants should hold a post not above that of an associate professor and be no older than 45 years of age. Candidates are asked to send the name and dates of the meeting they wish to attend, a CV and bibliography. Applicants must also send a letter of recommendation from the head of his or her department and an estimate of expenses, to a maximum of $1,440. No excess will be granted.

Applicants must actively participate in the meeting they attend (presentation, poster, etc.). WFN also encourages applicants to submit an abstract and attach a copy of the abstract to the application.

WFN’s Education Committee will review all applications and announce the awards soon thereafter.

Dr. Lewis is chair, and Dr. Grisold is co–chair of WFN’s Education Committee.

President’s Column

Raad Shakir

Raad Shakir

Is there a place for a general neurologist? The time has come for us to have a fresh look at our specialty and decide whether we need to modify how we train and practice. In most parts of the world, the answer to the question is simple: We need to continue to train general neurologists to cover a huge need. There are so few of us, that we cannot afford the “luxury” of subspecialization. However, in a minority of countries, the field has expanded to the degree that subspecialists are the norm. The issue is that, in such a diverse situation, for the vast majority of the world population, we are only providing basic neurological care. Do we have to accept the less optimal situation, or should we push hard for subspecialization to happen worldwide?

There is no doubt that in many parts of the world, the idea of a general neurologist is fast receding. The argument is that the enormous change in practice and the need to be able to deal with complicated issues is far beyond the capability of a generalist.

The explosions in genetics and imaging have led to the need for an in depth knowledge of a rapidly changing field. The generalist can decide on the primary clinical presentation and then what direct management is necessary. However, there will come a point where his or her abilities will not be sufficient to advise further.

If we take the example of acute neurological care: How many neurologists are capable of administering tPA in acute ischemic stroke or feel able to do so? The technology has been available for nearly two decades, and up till now, few centers, even in the developed world, are able fully to provide the required treatment not only in tPA provision but also more specialized intravascular thrombectomy. It is true that we need a highly sophisticated technical support from interventional radiology to neurosurgery. But the fact remains; there should be on-the-ground expertise far beyond the training and confidence of a general neurologist.

The field is now so complicated that a generalist feels uncomfortable in dealing and advising, for instance, on the use of disease-modifying therapy for MS. The plethora of licensed drugs makes it very difficult to advise on the suitability of certain long-term expensive medications. Moreover, side effects of disease-modifying drugs require care at special centers with neurologists and specialist nurses to look after the needs of patients.

Moving to other common conditions, such as epilepsy, we are all trained in the diagnosis of epilepsy, despite the complexity of seizure semiology. However, it is also true that in many cases, there are inevitable errors in diagnosis leading to erroneous management. Therefore, it is important that specialist epilepsy services are available for referral of the difficult, of the poorly controlled or for those needing surgical intervention. This means we need to train specialists in the field of epilepsy to provide accurate and appropriate care.

The world of movement disorders has really moved on. We are now in a new era of deciding on correct diagnosis and then advising on management. The field is even more complex with the availability of surgical interventions. It is true that a general neurologist is fully able to make a correct diagnosis of rather complicated Parkinsonism syndromes, but when it comes to decisions on the suitability for deep brain stimulation or Duodopa therapy, then expertise in the field is mandatory. This makes the need for specialist referral centers necessary if we are to offer full treatment packages to patients.

The diagnosis and management of genetically derived disorders is another major area for the specialist. The generalist is in many cases able to decide on the clinical phenotype, but that will need a further in-depth look at the genetics and will require a neurogeneticist to give advice on mode of inheritance and progression following appropriate DNA analysis. This is not an area to venture into without full training in clinical genetics, especially if there are predictive tests in healthy carriers and the implications of that on life and childbearing in future generations. The most important issue perhaps is the increasing possibility of the availability of stem cell and genetic modifications in combating many neurological conditions.

Many CME programs are aimed at updating the neurologist in dealing with the conditions faced in daily practice. If we look at the programs of the major international, regional and national neurological congresses, we see that specialists in various fields impart their knowledge and advice to general neurologists. This has led to a plethora of guidelines, with which neurologists are being bombarded, and, at times, it is very difficult to apply the most up-to-date pathways to every problem faced. These guidelines are aimed at practitioners in general, but in most parts of the world the contained technologies are, by and large, not available and therefore the supposed “best practice” is not applicable. This means that many neurologists looking after huge populations, however diligent they may be in keeping abreast of the latest guidelines, are totally unable to follow them and subsequently, their patients are disadvantaged.

Logically, it follows that postgraduate teaching material and guidelines have to take into account the fact that not all that is most up to date is applicable in all situations. The requirement of obtaining enough annual CME is only effective if it is targeted to the individuals concerned. The general neurology societies and continental associations have to produce guidelines which are for the general neurologist, and which may well be different in a way to those targeting the specialists in the field. This is rather difficult and may lead to confusion and errors.

Unfortunately, in many parts of the world, there is little opportunity for patients to see the neurologist of their choice. This is very common in both resource rich and poor countries. The healthcare systems in many, if not the majority of resource rich settings, provide neurological care in an anonymous way, and the patient referred with a specific problem may be seen by a general neurologist or by someone with a different special interest. In the grand scheme of things, this does not matter as neurologists know their field and can ask for advice as and when required.

However, in resource poor settings, the way in which patients are seen by neurologists varies considerably. Some neurologists sit in crowded outpatient clinics, where tens of patients wait in line, and where it is only possible to give each of them only a minuscule amount of time. In some settings, this is compensated for by the availability of inpatient beds, and what may seem like a complicated problem in the crowded outpatient setting can be admitted for a more detailed evaluation and more thorough investigation.

In other settings, neurology is by and large an outpatient service, with large, short-stay and smaller long-term inpatient facilities that vary according to locality and country. Looking after long-term disabled patients is dependent on the availability of ancillary services. Neurological rehabilitation is a separate specialty, which is totally dependent on the close collaboration with physiotherapists, occupational therapists, speech and language therapists, neuropsychologists and neurology nurse practitioners. Without that, delivery of a comprehensive package of care is not really complete. This approach may not satisfy the expectations of patients who, in the age of the smartphone, have access to the latest advances and will demand care, which may not be possible in their settings. This may well be useful for neurologists, as it will create pressure on health authorities to provide financial and manpower support to achieve better results. This is why it is crucial to work with patients’ groups to push for change at all levels.

Now we have to come to the crux of the matter: Do we now have a two-tier neurological practice, or is it a continuum of evolving care starting with the general neurologist and narrowing expertise to the highly skilled specialist? Moreover, how do international bodies like the WFN, as well as regional and national organizations, influence and promote the evolution?  Alternatively, should we decide that the deficiencies we face are so enormous that they are insurmountable and we have to get on with improving what we have and let slow evolution take its course? There is probably some truth in the latter view as the financial cost across the world is so vast, that we have to keep plugging away with our programs and slowly increase the number of neurologists in resource poor settings, eventually leading to specialization in our field and reducing the huge treatment gap that now exists.

To answer the question raised in the first paragraph, for the time being, it is a clear, yes there is a place for a general neurologist.

From The Editors

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

Walter Struhal

Walter Struhal

STEVEN L. LEWIS

Steven L. Lewis

We are pleased and honored to be taking on the editorship of World Neurology, the official newsletter of the World Federation of Neurology (WFN). We would like to thank President Raad Shakir and the officers and trustees of the WFN, as well as the members of WFN’s Publication Committee, for entrusting us with this responsibility. We also wish to give our sincere thanks to Dr. Donald Silberberg for his outstanding editorial leadership of World Neurology for the last three years, as well as for providing the two of us with the benefit and generosity of his ongoing guidance and knowledge as we take on this position, and for having done the work alone that is now deemed necessary for two people to perform.

We have planned a number of new initiatives for the readers of World Neurology, including contributions from authorities on breaking neurological topics that affect neurologist readers worldwide, such as the article in this issue about the Zika virus epidemic from Avi Nath, MD, and James Sejvar, MD. We also plan to develop new sections and columns over the coming issues to cover such entities as global neurological training and many other topics of interest to all neurologists worldwide.

Our plans for World Neurology include offering additional content formats (e.g., video). We will tighten the interconnection with WFN´s online footage and are currently working on implementing social media into World Neurology. This new feature will provide a convenient way to interact with other readers and discuss our articles.

We look forward to continuing to make World Neurology a trusted and sought-after resource for news and information of interest to all neurologists throughout the globe. We are also happy to field any suggestions from readers about ways to continue to make this publication evolve and be as valuable as possible for all neurologists worldwide.

Neurological Board Certification in Europe

By Jan B.M. Kuks

Jan B.M. Kuks

Jan B.M. Kuks

Young neurologists can rise to the challenge in Denmark on May 27, 2016. On that day, the 8th European Board Examination in Neurology will take place in Copenhagen.

Medical specialties in Europe are working together with the European Union of Medical Specialists (UEMS) (www.uems.eu), an organization containing 43 specialist-sections, one of these being the European Board of Neurology (EBN). Setting standards for training and practice is among the organization’s key activities. Therefore, the EBN is involved in developing harmonized models for the high-level training of the next generation of neurologists, in order to improve standards of clinical practice and, hence, patient care throughout Europe.

To achieve this, the EBN set up a core curriculum for the training of young neurologists, and — as testing drives learning — a board exam is provided as well.

Professor Wolfgang Grisold, now WFN secretary general, was the founder of this process and organized the first EBN examination in 2009. The 8th examination will take place at the site of the European Academy of Neurology (EAN) Congress. This illustrates the close cooperation between the UEMS Board of Neurology and the Academy of Neurology in Europe, an alliance without which a European training program for Neurologists would not exist.

Education in these times is not only for transferring knowledge, but is also directed toward achieving other competencies.

Successful candidates of the 7th EBN Exam in Berlin June 19, 2015 displaying their certificates

Successful candidates of the 7th EBN Exam in Berlin June 19, 2015 displaying their certificates

As in earlier days, the ability to retrieve knowledge from memory may be essential for clinical practice. But don’t we all use electronic devices in our clinics and on our ward rounds to find up-to-date knowledge as soon as possible for practicing evidence-based medicine and to offer our patients the latest achievements in our field? Is there any specialist in neurology who does not regularly want to have the opportunity for a peek inside an anatomical atlas, a handbook of neurophysiology or whatever textbook, before making a decision in clinical practice? So, today, we can’t restrict ourselves to information known by heart. We should be able to combine it with recent facts and developments. The ability to handle knowledge will become more and more important. This is the reason we offer our candidates the opportunity to take their own favorite textbooks (and in the future, electronic devices) to the examination to solve higher-order, open-book questions derived from real life, as they do in real life. Beside the great textbooks, guidelines and electronic courses from the EAN are the basis for the questions provided.

This isn’t all. Further competencies important for being a good specialist are described in several systems, such as in the CanMEDs roles (www.royalcollege.ca). In this system, a neurologist should not just be a medical expert, and the EBN exam should not be confined to testing neurological knowledge. Testing abilities in other CanMEDs roles like communicator, health advocate, professional and scholar comprise another and more essential part of the EBN examination.

Candidates taking the written test on the 7th EBN Exam in Berlin

Candidates taking the written test on the 7th EBN Exam in Berlin

How should we test these abilities within the other competencies? Does this need just another couple of multiple choice questions? We feel that this cannot be achieved by written computer examinations. For example, public health or global health issues (being a heath advocate) have their national emphases, and ethical points of view vary in different countries. Thus, there is no absolute truth to be tested. A face-to-face discussion is more suitable than making a choice in the closed format of a multiple-choice question for testing these competencies. Therefore we invite our candidates to prepare themselves properly for a discussion by writing essays for an oral examination. Being a scholar demands the ability to make one’s own vision clear and to dive into a problem to be solved in a scientific way. Therefore we ask our candidates to make a critical appraisal of a topic of their own choice to be presented for an oral discussion.

So taking a European Board Exam for Neurology is not being dependent on having a lucky day; it can be prepared for in advance, and candidates can develop abilities over a long period of time to be successful.

CanMedsThe validity of the examination needs the input of the scientific experts at the European Academy of Neurology. The reliability of the outcome depends on the number and quality of the participating candidates. A statistical evaluation to eliminate “bad questions” only can be realized in a group of sufficient size. Establishing a passing score can be determined by specialists prior to the test. However, modification of such a score may be necessary after getting data from a sufficient number of adequate participants.

We are happy to see the number of participants grow each year. The exam becomes attractive to more candidates from inside, but also from outside Europe — many of whom want to take the exam to increase the possibility of moving between European countries or to test their abilities on a European level. In this respect, Turkey, Belgium and Italy now take a leading role by sponsoring their young neurologists to take the EBN exam, in addition to their national exit exams.

Unfortunately, by now, board exams do not yet have a legal value in Europe, and this restrains many young neurologists from taking the examination. With increasing interest in Europe and the cooperation between European countries, we are likely to establish a goal of a European exam to be taken as an exit test in order to work as a neurologist in the European continent in the near future. Striving for such a pretentious goal forces us to look at the American board exams for neurology to try to reach their high quality level, while keeping the European flavor in our own tests.

More information about the EBN Examination can be found on our website: www.uems-neuroboard.org. We would be delighted to welcome you there.

Jan B.M. Kuks is professor of clinical neurology and medical education, University Medical Centre  Groningen, Netherlands, and chair of the Examination Committee European Board of
Neurology.

 

Teaching Courses Expand Education at WCN

By Wolfgang Grisold

Table 1: Teaching Courses The free early morning teaching courses have remained the most visited teaching courses, despite the early hour. Teaching courses on education, advocacy and career received little attendance, yet these topics are inherent topics of the WFN. Also, palliative care received little attention as teaching courses. This shows that the topic needs promotion within the scientific sessions. All teaching courses will be available on the WFN website after the Congress.

Table 1: Teaching Courses The free early morning teaching courses have remained the most visited teaching courses, despite the early hour. Teaching courses on education, advocacy and career received little attendance, yet these topics are inherent topics of the WFN. Also, palliative care received little attention as teaching courses. This shows that the topic needs promotion within the scientific sessions. All teaching courses will be available on the WFN website after the Congress.

The WCN took place Oct. 31-Nov 5, 2015, at the CasaPiedra Conference Center in Santiago, Chile, with 3,500 delegates from 112 countries participating and creating a joint sense of neurology worldwide. The lectures from the World Health Organization (WHO) and the presentation of the new WHO Atlas of Neurology showed the disparity of neurological workforces around the world and documented the importance of the WFN activities in the work with global organizations. One of the goals and aims of the WFN is to spread neurological development and neurological science and update participants on current issues, but also to highlight new neurological fields of development.

Scientific sessions and topics are an excellent venue and bring participants close to the leading persons in the field. This concept was successfully used in plenary lectures and scientific main topic sessions.

The WFN also has long kept the tradition of offering teaching courses at its congress. This concept has been broadened since Marrakesh, as the WFN teaching courses now are being offered on all days of the congress. The teaching courses were co-chaired by Sergio Castillio (local committee, Chile) and Wolfgang Grisold (teaching course committee, WFN). The topics presented include many general and common topics, such as stroke, dementia, epilepsy and others.

Also, several courses with hands-on opportunities were offered to include and engage participants in practical issues, such as EMG, ultrasound and botulinum toxin treatment. Experience at the WCN in Marrakesh and Vienna has shown that these types of highly interactive teaching courses, despite often technical issues and difficulties, are well appreciated by attendees.

In Chile, 36 teaching courses were held. The list (Table 1) shows the topics presented, which helped to disseminate educational news and expert knowledge. Teaching courses offer attendees the advantage of being in a smaller group and interacting with renowned experts. This facilitates a climate of interaction by allowing questions and discussion of opinions.

Dr. Freedman lectures on education.

Dr. Freedman lectures on education.

One special component of the WCN teaching courses are the early morning free teaching courses, a one-hour teaching session presented by a single expert in the field. This expert has the privilege to create his or her talk in the form of a lecture, deviating from the usually shorter teaching course lectures, and allowing the speaker to emphasize and shape the message that he or she considers important. Despite the early time of these teaching courses, the number of participants was between 100 and 200 per course (and 339 for the topic of epilepsy). The topics included MS (95), chronic inflammatory demyelinating polyneuropathy (125) and the top 10 advances in neurology (95).

Cynthia L. Harden presents a morning teaching course on epilepsy.

Cynthia L. Harden presents a morning teaching course on epilepsy.

Knowledge, skills and tutoring from experienced lecturers cover many aspects of neurology. The issue of palliative care is a topic with an increasing scientific basis1. Still palliative care is often confounded with end of life care, or worse, a situation of helplessness. The WFN has established a Research Group on this topic, and the Teaching Course on palliative care was an important step in establishing this important topic into our future curricula.

Dr. Nitrini speaks on education in Latin America.

Dr. Nitrini speaks on education in Latin America.

All neurologists, working in any part of the world, also are aware of the importance of training, lecturing and teaching, and also that the diversity of careers from hospital to consultant level and from academic career to nonacademic career is wide. For this reason, a teaching course on education in neurology covered the topics on how to establish a curriculum, as well as how to integrate neurologic knowledge and procedures into the national situation, politics and legislation. It is important to define new learning strategies and teaching methods, to eventually support or replace the traditional apprenticeship model of neurologic education. Also the classic concept of knowledge, skills and competence will need to include aspects of professionalism and attitude. Knowledge is acquired in an incremental, almost pyramidal way. Yet, individuals and institutions also will need to adapt to new developments, and this procedure of systemic approach to replace old content or procedures is termed unlearning

Several speakers and participants gather for a photo opp.

Several speakers and participants gather for a photo opp.

One lecture by Dr. Freedman focused on the merging and growing possibilities of e-learning. He presented his own experience with video conferences worldwide and gave important clues to enlarge the scope of this project.

The local flavor of Latin American neurology was presented by Prof. Nitrini of Brazil, who outlined educational activities in Latin America. He discussed the rise of impact factors among publications from Latin America in the past years.

Within the topic of applied teaching and education, translation was discussed by Prof. Camfield of Canada. This term describes the often difficult transfer of young patients from pediatric neurology into adult neurology. Translation also has been well described in other fields of pediatrics and demonstrates a clash of concepts between different concepts of patient care and involvement of careers.

Prof. Raad Shakir outlines the role of the WFN in the Palatucci course.

Prof. Raad Shakir outlines the role of the WFN in the Palatucci course.

Patient advocacy is an emerging concept, which empowers physicians to not only be involved in the provision of the best medical care, but also to advocate for patients in the micro- and macro-environment. This concept in neurology is carried forward by the American Academy of Neurology (AAN) Palatucci courses in the United States, and the AAN and WFN implemented a joint AAN-WFN one-day course in Chile. Topics on advocacy, press work and presentations were given to a small, but soon to be powerful group. Also WFN President Raad Shakir presented his concept of worldwide engagement of the WFN in health matters.

A good turnout attends a day programming.

A good turnout attends a day of programming.

Last but not least, some of the most important targets of education are patients and caregivers. Despite the importance of these groups, patient awareness days are, surprisingly, often not included in congresses. Since WCN 2015, the WFN implemented a patient day into it congresses. This year’s topics included stroke, epilepsy, MS and dementia, and WFN Past-President Vladimir Hachinski served as convenor and engaged in the discussion.

Footnote

  1. Oliver DJ, Borasio GD, Caraceni A, de Visser M, Grisold W, Lorenzl S, Veronese S, Voltz R. “A consensus review on the development of palliative care for patients with chronic and progressive neurological disease.” Eur J Neurol. (Oct 1, 2015): doi: 10.1111/ene.12889).

 

CALL FOR SUBMISSIONS
Special Issue on ‘Neurological Diseases in South America’

This is a call for submissions of papers to a forthcoming special issue of eNeurologicalSci (eNS) on “Neurological Diseases in South America,” which will be published in July 2016. The guest editors of this issue welcome submissions of original manuscripts and reviews that deal with basic, clinical and epidemiological studies addressing research on neurological disorders in South America.

In particular, we invite research focusing on regional specific features related to epidemiology, diagnosis, clinical manifestations, and treatment strategies and outcomes. All submissions will be peer reviewed and selected for publication based on scientific merit, novelty, timeliness and topical balance.

Before submission, authors should carefully read over the journal’s Author Guidelines.

Prospective authors should submit an electronic copy of their complete manuscript through the journal Manuscript Tracking System.

For more information, visit the website.

Editor-in-Chief

Bruce Ovbiagele, MD, MSc, FRCP (London), FAAN, Pihl Professor and Chairman of Neurology, Medical University of South Carolina

Special Issue Guest Editors

Paulo Caramelli, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

Adriana Conforto, Hospital das Clinicas/Sao Paulo University and Hospital Israelita Albert Einstein, Sao Paulo, Brazil

Renato J. Verdugo, Faculty of Medicine, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile

Ricardo Allegri, Neurological Research Institute Raú
l Carrea, Buenos Aires, Argentina

 

President’s Column

By Raad Shakir

Raad Shakir

Raad Shakir

Now the 22nd World Congress of Neurology (WCN) in Santiago, Chile, is over with huge success both scientifically and socially. There is a specific and enduring success story I would like to mention in this column. In every WCN, the program committee makes a specific point of bringing together all brain health sister disciplines to be present and to participate. So in the Congress, the World Psychiatric Association, World Federation of Neurosurgical Societies, International Child Neurology Association, World Federation of Neurorehabilitation and International Brain Research Organization were all present.

These organizations constitute the umbrella for brain health. The World Congress of Neurology in Santiago had sessions for each of these organizations, which were well attended and presented a showcase for each one of them. The WFN leaves the convening of the sessions and the choice of topics to the federations. It is absolutely correct that they should feel free to inform attending neurologists on what they think is of interest to us in their fields.

Representatives from the World Brain Alliance and sister organization in the Global Neurology Network met during the World Congress of Neurology (WCN) Nov. 3, 2015 in Santiago, Chile.

Representatives from the World Brain Alliance and sister organization in the Global Neurology Network met during the World Congress of Neurology (WCN) Nov. 3, 2015 in Santiago, Chile.
Front row (from left): Ingrid Tein, president, International Child Neurology Association; Gunther Deuschl, president, European Association of Neurology; Rana Karabudak, Neuroimmunology; Bill Carroll, vice-president and Global Neurology Network chair, WFN; Stephanie Clarke, president, World Federation of Neuro-rehabilitation, Raad Shakir, president, WFN; Yong-Kwang Tu, president, World Federation of Neurosurgical Societies; Cathy Rydell, CEO, American Academy of Neurology; Tarun Dua, medical officer, Program for Neurological Diseases, World Health Organization; Terrence Cascino, president, American Academy of Neurology; and Riadh Gouider, trustee, WFN.
Back row (left to right): Renato Verdugo, president, WCN Santiago; Steven Lewis, WFN co-opted trustee and editor continuum, American Academy of Neurology; Erik Wolters, president, International Association of Parkinsonism and Related Disorders; Riccardo Soffietti, European Association of Neuro-Oncology; Sam Wiebe, International League Against Epilepsy; Geoff Donnan, World Stroke Organization; Alan Thompson, Multiple Sclerosis International Federation; Amadou Gallo Diop, trustee, WFN, chair, Africa Intiative; Mark Hallet, president, International Federation of Clinical Neurophysiology; Claudia Trenkwalder, World Association of Sleep Medicine; and Jes Olesen, International Headache Society.

The World Brain Alliance (WBA) is therefore moving full steam ahead, and the collaboration is now so close that the time has come for tackling major issues, which can be dealt with jointly. Forming small working groups to tackle specific common disorders is underway. Three topics already have been agreed upon, those being dementia, epilepsy and traumatic brain injury. It is absolutely correct that working together, the WBA is a much more powerful entity rather than each of us acting separately. Moreover, in many situations we are tackling the same issues at the international level. The World Health Organization is going ahead on Global Coordination Mechanism on Noncommunicable Diseases (GCM NCDs). The place for neurology NCDs was not initially prominent, in spite of the fact that generally brain disorders cause major death and disability more than HIV, malaria and tuberculosis put together.

The role of the WBA is to fill the gap and inform, as well as educate public health authorities on the devastating effects of brain health disorders, whether they are neurological, mental, developmental or substance (NMDS) use issues. The shortcomings of neurological health provisions were highlighted yet again in the second edition of the Neurology Atlas 2015. This is a combined effort between WHO and WFN. The Atlas was presented in a preliminary manner at the World Congress. It will be published in early 2016. It gives details of the current status of manpower, service provisions, social support and drug availability for neurological, neurosurgical, child neurology and rehabilitation facilities across the world.

For the WBA to gel with our specialty sister organizations in the Global Neurology Network, a joint meeting with the representatives of all organizations present in Santiago was arranged. These global neurology associations convened sessions at the WCN and were represented at the highest level. The World Stroke Organization, International League Against Epilepsy, International Parkinson’s and Movement Disorders Society, MS International, Alzheimer’s International, International Headaches Society, Peripheral Nerve society, Neuro-ophthalmology, Neuro-Otology, Neuro oncology, History of Neurology all had sessions which were of most interest to participants.

The issues of brain health are crucial to the major exposure we would like to have at the highest level of international health care. If we are going to influence public policy, we need to be at the forefront of issues when decision-makers look into allocating budgets and resources. The only way to do this is for NMDS to be looked at together. Then the combined grouping is big enough to compete for funding and support, compared with similar big groupings such as cancer or cardiac diseases.

PC_AtlasThe big drive of WHO toward global coordinating GCM NCDs is gathering pace. Although the scope of the process is not yet complete, one can see WHO trying to listen to all stakeholders, and the matter of WHO dealing with disease management is now a reality. The United Nations has produced the declaration on NCDs and 17 Sustainable Development Goals (SDGs) in 2015. In all these initiatives and targets, brain health should be at the forefront, and we as neurologists should push hard to have neurological issues right in the middle of governmental thinking. Financial support for our patients will only come if we have clear publically supported initiatives in a language that makes sense and shows targets, which are realistic and achievable.

The WHO GCM NCDs is an excellent platform to put forward our views on how to achieve early diagnosis and prevention of neuro NCDs. The issue, which attracts WHO and its agencies, is prevention and coping with various disorders at the primary care level. This is fine and commendable, however, in our world there is a follow on to this, which is management of many disorders, which are chronic, and for many lifelong. The fact that NMDS cause major disability adjusted life years is an important fact, which always should be at the front of all measures carried out by health authorities. It is also true that the cost of coping with NMDS conditions will be beyond health budgets even with high-income, let alone low- and middle-income economies.

The emphasis on management, including prevention, is a change in WHO thinking, which we need to embrace and welcome. WHO is receptive and recognizes that advances in genetics and imaging have created a new era in early diagnosis and at times preclinical recognition, which means specialists are needed and in numbers so there shall be no difference in care between various income groups. There is no doubt that recommendations to national governments at the GCM NCDs to train more doctors are commendable and welcome. We should also bring forward the idea that although a figure of 50 percent of those young doctors were recommended to be in primary care, there is an urgent need to increase the number of specialists in brain diseases across the world. It is true that this may be a long-term policy and to a degree wishful thinking, but if we look at the SDGs, many of which are long term but all of them have been approved at the highest level of the United Nations.

The way ahead is long but brain health, when presented to decision-makers, has so far been received with a positive and understanding attitude. We should all work at every level to promote brain health.

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