Félix Bermejo-Parej, Luis Calandre, Teodoro del Ser
Alberto Portera-Sánchez when he was around seventy years old.
Prof. Alberto Portera-Sánchez died on November 30, 2019, in Madrid at the age of 91. He was born in Caspe, Saragossa, Spain. He graduated in medicine in 1950 in Spain and then he obtained the specialization in pediatrics and neurology in Paris and in the U.S. (at the Universities of Georgetown in Washington and in Maryland). In 1960, he returned to Spain and worked as a clinical neurologist in Madrid in several hospitals (private and public), mainly in the Clínico de San Carlos Hospital, where his neurological clinical sessions were successful and crowded with colleagues and medical students. In 1973, he gained the position of head of the Department of Neurology in the Hospital 1 de Octubre of Madrid, later called University Hospital 12 de Octubre (UH12O). From the beginning, his department was an exponent of the modern neurological organization of medical neurology in Spain.
Historical Perspective
It is necessary to comment briefly on the precarious situation of neurology practice during the 1950s and 1960s in Madrid (and in general in Spain, perhaps only with the exception of Catalonia). After the Spanish Civil War, many famous neurologists of the Madrid Neuroscientific School with foreign-based medical training and Republican ideology had to go into exile. This school was a renowned school with well-known neuropsychiatrists and neurohistologists, such as P. Rio Hortega, G. R. Lafora, and others that went from Madrid into exile and, in addition, the Cajal Institute disappeared1. During this time, the Spanish medical establishment had the neurologists as assistants to the neurosurgeons and medical internists that were the heads of Neurosurgery and Medicine departments respectively with rare exceptions. The few existing neurologists’ practice was undertaken without beds in their charge. There were no academic posts for neurologists and neuropsychiatrists, with scarce knowledge of clinical neurology, attended the neurological outpatients care in the Spanish public health Service
This situation was analogous in other countries2, but in Spain, and specifically in Madrid, it was extreme because the heads of neurology and neuropsychiatry had gone away.
Bearing this situation in mind, it is easy to understand the dramatic change that Portera-Sánchez made. He received a new department in a new and very large hospital (about 1,000 beds), which was modern and well equipped with current medical technology. He was able to select his collaborators and to organize the neurological service. He went for a large department, in accordance with the recommendations of the American neurology style. (He was a member of the American Academy of Neurology.) Long before, the NINDS had indicated the benefits of neurological sub-specialties and the importance of adequate training for future neurological staff2. The neurologists in his department practiced clinical neurology and all sub-specialties of neurology, that is to say, general neurology, child neurology, and clinical electrophysiology (EEG and EMG), including the study of muscle disorders. Additionally, every day a clinical neurologist was on duty in the emergency department of the UH12O to attend to acute neurological disorders (stroke, meningitis, head trauma, and so on). Furthermore, his neurologists had neuroradiology knowledge, although the official report came from the Neuroradiology Department. This organization was an exception in neurological care at this time in Spain and an example for the Spanish neurological service.
Career Highlights
The Consulting Section (Comisión Nacional de la Especialidad de Neurología) of the Spanish Ministry of Health named Portera-Sánchez as the president of this section that advised this ministry on the organization of the numbers and programs of the Residency in Neurology in Spain. In this position, he was able to introduce the rules to expand this modern (for Spain) model of neurology practice, and changed the previous model of neurologist as only assistants of internal medicine and neurosurgery. The Ministry of Health accepted these first recommendations and the following Consulting Sections prolonged this model. This increased the number of clinical neurologists and decreased the number of neurophysiologists in order to adopt an American model of neurological assistance with a great number of neurologists who were able to undertake all neurology sub-specialties. Gradually, Spanish neurology began to have services all over Spain, academic posts, and the number of neurologists increased greatly with young neurologists. Neurological care is now present in all medium-sized and large hospitals, and it works as an outpatient specialty because the Spanish National Health Service would like to include the main medical specialties near the population. This is the only point that Portera-Sánchez did not like. He thought that neurology should be practiced mainly in hospitals and probably for the progress of scientific practice it would be true3. Many young Spanish neurologists (now more than 3,500) do not know the precarious beginning of Spanish neurology in the third part of the last century.
Portera-Sánchez: Leader, Humanist, Friend
Early in the 20th century, Spanish neuroscience had a high international profile, personified by Santiago Ramon y Cajal. He was a winner of the Nobel Prize in Physiology and Medicine and last year his publications were cited 1,559 times, 85 years after his death. The Spanish Civil War (1936-1939) proved disastrous for neuroscience because of the exile of some of the most eminent and many promising scientists. Pio Rio Hortega, discoverer of microglia, ended up in Argentina, and the physiologist August Pi Suñer in Venezuela and then Mexico. They are but two of the many exiles. Neuroscience and neurology entered a long penumbra under the Francisco Franco regime.
Portera-Sanchez did part of his training in the United States and gained a faculty position. However, he returned to Spain to become the founder of modern Spanish neurology. He linked it internationally as demonstrated by his role in the World Federation of Neurology and the symposia that he organized, including a pioneering and memorable one on neuroplasticity. He was also leader in trying to link the brain with the arts and humanities. He organized a series of colloquia on “El cerebero en si mismo” (roughly translated “The brain in itself”) that featured a neuroscientist and an eminent artist or humanist. One example was a neuroscientist specializing in vision and a leading Spanish artist. I was paired with Cristobal Halffter, a Spanish leading composer on the topic “Music and the brain.” The presentations and commentaries were published as booklets.
He was a respected art collector and critic. He recognized talented young artists early in their careers and bought their paintings when they were affordable. He often wrote and commented on art, including publishing a book on the subject.
He had many pupils, admirers, and friends. He hosted innumerable international guests at his country home with his gracious wife Catherine.
At meetings, one could spot Portera-Sanchez easily. He was the person with the most people gathered around him.
Portera-Sanchez will continue to live in our memories and through his deeds and teachings, multiplied by his many pupils. •
Past President, World Federation of Neurology
Portera-Sánchez was not only an organizer of the neurological service of the UH12O, he was a brilliant clinical neurologist and an untiring “neurological business man” who made contacts all over the neurology world. He invited to his department many prestigious neurologists to give lectures, such as Carleton Gajdusek, when he was Nobel laureate, Vladimir Hachinski, Luigi Amaducci, David Marsden, and many others. It is worth remembering that Bruce Schoenberg, when he was chief of the Neuroepidemiology Branch in the NINDS of the National Institutes of Health, visited our neurology department at UH12O and gave a course on neuroepidemiology, and then designed a community study of the main neurological diseases in Madrid4. This interest for Neuroepidemiology continued in his department. At the end of the 1980s, Portera-Sánchez and his team formed part of the Age-Associated Dementia Project of the World Health Organization consortium (AAD SPRA-WHO) that would implement a dementia study in six countries (Canada, Chile, Malta, Spain, and in black populations of the U.S. and Nigeria). Luigi Amaducci, standing neuroepidemiologist, directed the Coordinating Center of this WHO study in Florence, Italy, and took as advisors leaders of the dementia field such as Z. Khachaturian, R. Katzman, and others. The study did a panel concordance in the diagnosis of dementia5 and a validation of the main screening tools6 for the future study. However, the Canadian team had advanced its own study (Canadian Study of Health and Aging) and declined to participate in the new study as well as the Nigeria-U.S. (African Americans and Yoruba-Nigerians) study, which had designed a complex investigation. The only study that continued with the validated methodology was the NEDICES in Spain funded by the official Spanish Research Agency (FIS).
Portera-Sánchez had an interest in many fields of neurology, but mainly in dementias and edited the first dementia book in Spain7. Additionally, he had great interest in cerebrovascular disorder8,9. Moreover, he and his neurological team of the UH12O worked in other neurological fields, such as peripheral neuritis, brain infections, neuroimaging, and others.
The International Stage
We must underline his international neurological affairs. He was elected as vice president of the World Federation of Neurology (WFN) from 1989 to 1993. In addition, he formed part of the WFN Education Committee10, the education committee of the Federation of Neurological Societies11, and was an honorary member of the American Academy of Neurology in 2003.
In Spain, after many years of being professor of neurology, he obtained the first chair in neurology in Madrid in the Complutense University (UCM) in 1996. Previously, in 1993, he was elected to membership of the select Spanish Royal Academy of Medicine.
Supporting the Arts
This remembering of his life would fall short if we omitted an important part of his life. Portera-Sánchez was a man of vast culture and love for the arts. He was a friend of many famous contemporary painters such as Chillida, Guerrero, Millares, Mompó, Saura, and others. Additionally, filmmakers and other well-known artists formed part of his frequent social gatherings, where it was possible to find neurologists, scientists, and people from the arts. In fact, Portera-Sánchez was an art (paintings) collector, and his love for painting was a passion throughout his life, which he passed on to one of his sons12. To recognize this dedication to art works, he was rewarded as corresponding academic of the Royal Fine Arts Academy of San Fernando and member of the Patronage of the National Museum of the Queen Reina Sofia in Madrid.
Finally, the community of Spanish neurologists is grateful to Portera-Sánchez for his contribution to the development of clinical neurology in our country. In addition, as his pupils, we rend our gratitude for having shared with us his neurological skills, his brilliant teaching, his spirit open to the culture and to the scientific innovations, and his permanent cordial, warm, and human manners. •
Félix Bermejo-Pareja, Research Institute,
University Hospital 12 de Octubre,” Madrid, Spain
Luis Calandre, department of neurology,
University Hospital “12 de Octubre,” Spain
Teodoro del Ser, Alzheimer disease research unit, CIEN Foundation, Madrid, Spain
Reprinted with permission from the Journal of the Neurological Sciences 411 (2020) 1167032
References
1. J.S. Dosil, The footprint in Mexican neurosciencee of Spanish exile, a legacy of Cajal overseas, Neurosci. Hist. 1 (2013) 154–161 (http://nah.sen.es/es/100-revistas/ vol1/numero-4/158; ISSN: 2254–6146).
2. H.H. Merritt, Influences of the national institute of neurological and communicative disorders and stroke on clinical neurology, in: D.B. Tower (Ed.), The Nervous System, Vol. 2 Raven Press, NY, 1975, pp. 1–3 (ISBN: 0–89004-076-I).
3. F. Bermejo-Pareja, Neurology and neurologists in Spain: the consolidation of the family neurologist? Neurología 22 (2007) 221–235 17492516.
4. M.C. Gutierrez-del-Olmo, B.S. Schoenberg, A. Portera-Sánchez, Prevalence of neurological diseases in Madrid, Spain, Neuroepidemiology 8 (1989) 43–47, https://doi.org/10.1159/000110164.
5. M. Baldereschi, M.P. Amato, P. Nencini, et al., Cross-national interrater agreement on the clinical diagnostic criteria for dementia, Neurology 44 (1994) 239–242, https://doi.org/10.1212/wnl.44.2.239.
6. M. Baldereschi, F. Meneghini, P. Quiroga, et al., Cognitive versus functional screening for dementia across different countries: cross-cultural validation of the mini-mental state examination (MMSE) and the Pfeffer activities questionnaire (PFAQ) against the standardized clinical diagnosis of dementia, Neurology 44 (Suppl. 2) (1994) A365.
7. Dementias, A. Portera, F. Bermejo (Eds.), Asociación Española de Neuropsiquiatría, Mayoría, Madrid, 1980(ISBN: 84–85.300-11-4).
8. A. Portera-Sánchez, L. Calandre, Evaluation of the patient with suspected cerebrovascular disease, in: P.J. Vinken, G.W. Bruyn, H.L. Klawans, J.F. Tool (Eds.), Handbook of Clinical Neurology, Vol. 53 Elsevier Sci. Pub., Amsterdam, 1988, pp. 175–199 (ISBN: 0-444-90404-2).
9. T. del Ser, F. Bermejo, A. Portera, J.M. Arredondo, C. Bouras, J. Constantinidis, Vascular dementia. A clinicopathological study, J. Neurol. Sci. 96 (1990) 1–17, https://doi.org/10.1016/0022-510x(90)90052-o.
10. M.T. Medina, T. Munsat, A. Portera-Sánchez, et al., Developing a neurology training program in Honduras: a joint project of neurologists in Honduras and the world Federation of Neurology, J. Neurol. Sci. 253 (2007) 7–17, https://doi.org/10.1016/ j.jns.2006.07.005.
11. W. Grisold, Z. Ambler, A. Hopkins, et al., FENS task force for continuing medical education (CME). European Federation of Neurological Societies (EFNS) – approval (co-sponsorship) of continuing medical education (CME) meetings, Eur. J. Neurol. 6 (1999) 259–265 10210904.
12. A. Portera Sánchez, Abstract painting, a mental esthetic construction without exact correspondence with reality (José Guerrero: manual and corporal expressions in his paintings), An R Acad. Nac. Med. (Madr) 123 (2006) 543–550 17451097. Félix Bermejo-Parejaa,b, Luis Calandreb, Teodoro del Serb,c*
a. Research Institute, University Hospital “12 de Octubre”, Madrid, Spain
b. Department of Neurology, University Hospital “12 de Octubre”, Spain
c. Alzheimer Disease Research Unit, CIEN Foundation, Madrid, Spain
E-mail address: tdelser@fundacioncien.es (T. del Ser).
