Articles – Page 10

Candidate Statement for Treasurer: Barbara Tettenborn

Barbara Tettenborn

My name is Barbara Tettenborn. I am professor of neurology in Switzerland and Germany with both citizenships. I was born in Halle/Saale in East Germany, spent my later childhood and youth in West Berlin, studied medicine in Germany, England, and Ireland, and passed my neurological residency at the University Hospital in Mainz in Germany (Head of Department Prof. H.C. Hopf) followed by a stroke fellowship with Prof. L.R. Caplan in Boston in the United States.

I am a general neurologist with special interests in epilepsy, stroke, sports neurology, and brain health. After more than five years as vice chair of the department of neurology in Mainz, I was elected as head of the department of neurology in St. Gallen, Switzerland, in October 1999, and kept this position until my retirement in March 2023. I am still affiliated with the Johannes Gutenberg University in Mainz as professor of neurology continuing to give lectures and teaching courses on a regular basis. I am a member of the European Academy of Neurology (EAN) as editor-in-chief of e-Learning. Together with a great team from the EAN and the editorial board, we built up the new e-Learning platform in 2021/2022, which was launched at the EAN annual meeting in Vienna last summer.

Regarding my experience in administrative boards:

I was member of the board of the Swiss Neurological Society for more than eight years and treasurer of the Swiss Federation of Clinical Neuro-Societies for more than four years until the end of 2022.
I served as a member of the administrative board at the hospital in St. Gallen for four years.
I am president of the Swiss League against Epilepsy and president of the organization Women in Neurology (WIN) Switzerland.
I am vice president of the scientific board of highly specialized medicine in Switzerland. My special research interests are epilepsy in the elderly, seizures due to vascular lesions, new antiepileptic drugs, vertebrobasilar ischemia, gender aspects in neurology, and sports neurology.
I am author and co-author of numerous publications and editor and co-editor of several textbooks of neurology, including “Paroxysmal Disorders in Neurology”’ and “Sport as Prevention and Therapy of Neurological and Psychiatric Disorders.”

Neurology is not only my profession, but also my first and most favorite hobby, my second hobby being sports, especially triathlon and mountaineering. I like to cooperate and communicate with people and to encourage especially the next generation. Being recently retired from my position as head of department gives me the time and energy to take on new tasks. I have quite a lot of experience in administrative positions and political communication, including the position of treasurer of a large national society for several years.

It would be a great honor for me to serve the World Federation of Neurology as treasurer, and I promise to put all my energy, enthusiasm, time, and effort into this position in order to help to give neurology as much worldwide visibility and impact as possible. •

Candidate Statement for Treasurer: Morris Freedman*

Morris Freedman

I am honored to be nominated for WFN treasurer. This position comes with great responsibility to the WFN and its member societies, and requires in-depth knowledge of the WFN, as well as the experience, judgment, ethical character, equitable approach, and transparency, which are essential for managing the WFN’s finances. Moreover, in the currently uncertain financial times, serving as treasurer requires vision for creating novel approaches to maximize the WFN’s financial assets.

I believe that I bring the above qualities to the position of treasurer. I have been actively involved with the WFN since 2007, when I started by serving as the Canadian delegate, and I have continued to serve the WFN up to the present. I am now completing my second term as elected trustee. I am also chair of the innovative e-Learning Subcommittee of the Education Committee, and served as chair of the Membership Committee, member of the Education Committee, and co-chair of the eLearning Task Force together with Prof. Riadh Gouider. I also served as president of the Canadian Neurological Society and president of the Canadian Congress of Neurological Sciences. I also served as secretary-treasurer of the Canadian Neurological Society and Canadian Congress of Neurological Sciences.

We need new strategies to ensure the financial security of the WFN. The WFN’s mission is to foster quality neurology and brain health worldwide. If elected as WFN treasurer, I will use my skills in innovation to advance this mission, which is dear to the heart of people all over the world, by developing a mechanism to raise funds from donors across the world. The goal will be to generate financial support to significantly expand the implementation of the WFN mission, especially as applied to middle- and low-income countries where the need is greatest—and to do this in a way that is sustainable.

An example of my track record in innovation relates to my international leadership role in neurological education. I spearheaded the concept of the WFN e-Learning Hub, which will serve as an electronic library to access recorded educational materials from leading sites all over the world through links available on the WFN website. Thus, the WFN website will be the “go-to” place where health care professionals across the world can easily access a broad spectrum of educational videos.

I have a vision, a clear sense of direction, and the necessary personal qualities, as well as the focus and determination to serve as WFN treasurer in a way that will honor the tradition of this very important role, ensure the financial security of the WFN, and introduce innovation in generating financial support to significantly enhance implementation of the WFN mission. This will require extensive collaboration within the WFN, as well as with people with diverse needs and across many countries. Those who know me say that I am an excellent team player, organizer, and innovator, and that I am highly responsible, ethical, equitable, and fully transparent. These qualities are essential for serving as WFN treasurer. I hope that I have your support. •

* This is an additional candidate nominated under Article 6.3 of the constitution (nominated by five member societies). All other candidates are by recommendation of the WFN Nominations Committee.

Candidate Statement for elected Trustee: Lawrence Tucker

Lawrence Tucker

It is an immense honor to be nominated for the position of WFN trustee.

After completing a laboratory-based, neuroscience PhD in Cambridge as a young doctor in 1993, I returned to train as a neurologist in sub-Saharan Africa where neurologists to general population average one per five million. I now head of neurology at Groote Schuur Hospital and the University of Cape Town’s Neuroscience Institute. I am president of the College of Neurologists of South Africa and past president of the Neurological Association of South Africa. I also sit on the boards of various other national, neurological, professional, and academic bodies

I am a general neurologist with an interest in epilepsy, but my passions lie in the advancement of neurological education, training, clinical practice, and advocacy, especially in resource constrained environments. Little surprise, then, that working with the WFN over the past decade has been a privilege and source of great personal fulfilment. I have been a WFN delegate for almost a decade and served on many WFN committees (core education, grants, public awareness and advocacy, RTC, e-Learning, 2023 WCN, and finance). In these and other roles, it has been a pleasure and honor to interact with esteemed WFN colleagues, including four presidents, trustees, and many other office bearers.

I am grateful to the WFN for providing me with opportunities to pursue its mission. For example, using WFN seed sponsorship, our Cape Town group developed an intensive, annual, 6-month, distance learning program for electroencephalography training, which has enrolled well over 1,000 neurology residents and neurologists, predominantly from lower and middle income countries during the past seven years. However, I regard working closely with the WFN and African colleagues to establish the African Academy of Neurology (AFAN) in Dakar (2017), and setting up the Cape Town WFN Regional Training Center (2019) as two particularly significant personal achievements.

Since its inception, I have been treasurer, vice president and, most recently, president-elect of AFAN, which is now well-established and collaborates with the WFN and other international, regional, and national bodies globally to promote neurology in Africa. Among other activities, AFAN runs biennial congresses and, jointly with the WFN, virtual annual e-Learning days and advocacy programmes.

The Cape Town WFN regional training center (RTC), which I head, is the only Anglophone WFN RTC in the southern hemisphere. It offers career neurology training, as well as clinical fellowships (in stroke, epilepsy, neuroinfection, neuromuscular disorders, and clinical neurophysiology) for neurologists practicing in lower and middle income countries in sub-Saharan Africa.

If elected as trustee, I will continue to work with WFN colleagues toward our organization’s goal of quality neurology for all. This will involve strengthening established collaborations with national, regional, and international organizations, including the WHO; expanding the WFN’s existing and already successful educational, e-Learning, visiting fellowship and RTC programs; and supporting new, inclusive initiatives between the global north and south to promote the WFN’s mission in Africa, South and Central America, Asia, Oceania, and all regions in the world where neurologists and neurological expertise remain scarce. •

Candidate Statement for Elected Trustee: Mohammad Wasay

Mohammad Wasay

I am currently Alicharan Endowed Professor of Neurology at Aga Khan University Karachi, past president of the Pakistan Society of Neurology and Pakistan Stroke Society, president of the Neurology Awareness and Research Foundation and distinguished scholar of COMSTECH (OIC). I have also served as a director of World Stroke Organization (WSO) and am currently serving as fellow of Pakistan Academy of Sciences and Secretary of the Environmental Neurology Speciality Group (ENSG) and member global policy committee for WSO. I was recently elected as fellow of the World Academy of Sciences (TWAS).

I have worked with WFN for more than a decade as an active neurology advocate and researcher from South Asia. I was trained at Palatucci Forum, and then received Advocacy Leader of the Year Award by American Academy of Neurology for my global advocacy contributions. I served as chair of the World Federation of Neurology (WFN) Advocacy Committee for four years. This committee was instrumental in starting and organizing World Brain Day activities and promoting brain health across the globe. We organized many advocacy workshops and teaching courses during the Asian Oceanian Association of Neurology conferences, Asian Pacific Stroke Conference, and World Congress of Neurology.

I established a network of neurology training and research in Kenya, Tanzania, Afghanistan, and Central Asia. We established the Asian stroke network with more than 20 centers in 10 Asian countries. Currently, I am leading an initiative to establish the OIC Neurology Academy to promote neurological acre and training in developing Islamic countries. Recently, I have been appointed as chair of the specialty groups committee by the WFN president. As secretary of Environmental Neurology Specialty Group (ENSRG), I have organized many educational and awareness activities related to environment and neurological diseases.

I have trained more than 50 neurologists under my supervision. I have published more than 238 papers in peer-reviewed medical journals with impressive publications metrics (IF: 676; citations=6700, H-index 39 and I10 index 95). I have received many awards, including the Teachers Recognition Award by American Academy of Neurology, Gold Medal by Pakistan Academy of Medical Sciences, Gold Medal by Pakistan Academy of Sciences and Research productivity awards by Pakistan Council of Science and Technology. I have received 29 research and training grants (intramural and extra mural) as PI and co-PI. I have been an invited speaker at more than 130 conferences in 73 countries.

The growing burden of neurological diseases in the world has established WFN as an important stakeholder in global health. The WHO has recently approved an intersectoral action plan for promotion of neurological care, training, and advocacy across globe. We plan to promote brain health as a top agenda for WHO and United Nations. There is an inequity in neurology training and care across the globe. South Asia, Central Asia, and Africa should be a center point for our future interventions. As an expert in stroke from south Asia, active role in the World Federation of Neurology and World Stroke Organization, I could be a useful member of this global task force. •

Leave No One Behind

David Dodick, Wolfgang Grisold, Steven Lewis, Tissa Wijeratne

Working to promote brain health and disability.

By Tissa Wijeratne, David Dodick, Steven Lewis, Wolfgang Grisold

On World Brain Day, work continues to prevent brain disorders, diagnose brain disorders earlier, provide access to life-changing treatments and rehabilitation therapies, and improve the quality of life for those living with brain disorders with less disability and no stigma.

Health, defined by World Health Organization (WHO), is “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.”

Brain health, defined by WHO is “the state of brain functioning across cognitive, sensory, social-emotional, behavioral and motor domains, allowing a person to realize their full potential over the life course, irrespective of the presence or absence of disorders.”

Our brain health is the key to our overall health — it’s the agent for all human actions and experiences as a species.

Disorders affecting the health of our brains continue to be the leading cause of disability globally. However, many of these brain disorders can be prevented by modifying our risk factors.

For example, worldwide, around 50 million people have dementia — but nearly 50% of dementia cases can be prevented by taking steps that include maintaining a healthy weight, keeping away from smoking and too much alcohol consumption as well as learning new hobbies.

If we look at strokes, there are more than 80 million people currently living who have experienced stroke — and around 90% of those strokes could be prevented by addressing just over 10 modifiable risk factors that include things like treatment of hypertension, increased physical activity, and maintaining a healthy diet.

But there’s a lot to do to achieve these targets and save brains globally. A crucial step in changing these trends is to raise awareness of brain health.

World Brain Day was launched on July 22, 2014, as an annual, global World Federation of Neurology (WFN) advocacy campaign promoting brain health. It aims to educate everyone about the importance of keeping their brains healthy.

Every year, we focus on a different area of brain health.

This year, WFN and the World Federation of Neurorehabilitation (WFNR) have teamed up with the aim of raising awareness on brain health and disability: Leave no one behind globally.

Brain disorders such as stroke, migraine and headache disorders, dementia, head injuries, epilepsy, Parkinson’s disease, neuroinfections such as meningitis and over 400 disorders affect approximately over three billion people of all ages globally and the leading cause of disability and second leading cause of death globally.

Debilitating neurological diseases impact every aspect of a person’s life, with effects ranging from cognitive impairment to significant physical disability. Brain health-related disability will continue to increase as we continue to live longer. Raising awareness of brain health, preventative brain health is critical as we try and mitigate this issue globally.

Early diagnosis of brain disorders is important as appropriate treatment and rehabilitation programs culminating toward reduced disability. Supporting clinical research is key to the success of treating people with over 400 neurological disorders.

The past decades have shown an increase in research and many bench-to-bedside developments, which could and should be implemented in clinics around the world. Not only for the improvement and benefit of the patients, but to also change the concept of therapy in many neurological disorders radically.

By raising awareness of the treatments available and working with health care professionals around the world to recognize the signs and symptoms of neurological disorders, many more people can be diagnosed early and effectively treated.

For 2023, the WFN choose Brain Health and Disability as the theme, continuing our efforts on brain health, and aligning with WHO`s efforts to fight disability worldwide. Disability can be prevented, rehabilitated, and also needs to be under neurological care in chronic and chronic progressive diseases.

The aim of WBD 2023 is to alert not only its member societies but also the public on the critical neurological issues issue of disability. The organizing committee will represent the global regions, and we partner with the WFNR.

Member societies of the WFN will receive a “tool kit,“ templates for press releases, and educational PowerPoint presentation sets to assist in their local activity to promote WBD and advocate for brain health and disability. Local press conferences, press coverages (eg, print, electronic, radio, TV, YouTube channels) are strongly encouraged to reach the public.

Please join the World Brain Day 2023 campaign for Brain Health and Disability, as this is an important priority.

The World Federation of Neurology is hosting a global webinar on July 22, 2023, at 9 p.m. AEST with a live question-and-answer session. You can join the webinar and pre-register your interest here. •

For additional information, please see:

World Brain Day 2023 – Brain Health and Disability: “Leave no one behind.”

Wijeratne T, Dodick DW, Lewis SL, Guekht A, Pochigaeva K, Grisold W.

J Neurol Sci. 2023 Jun 29;451:120720. doi: 10.1016/j.jns.2023.120720. PMID: 37421882

The World Federation of Neurology World Brain Day 2023.

Grisold W, Dodick DW, Guekht A, Lewis S, Wijeratne T.

Lancet Neurol. 2023 Jun 29:S1474-4422(23)00240-5. doi: 10.1016/S1474-4422(23)00240-5. PMID: 37393928

Drs. Tissa Wijeratne and David Dodick are co-chairs of World Brain Day. Dr. Wolfgang Grisold is president of the World Federation of Neurology, and Dr. Steven Lewis is WFN secretary general and editor of World Neurology.

Candidate Statement for Elected Trustee: Prof. Tissa Wijeratne

Tissa Wijeratne

What an exciting time to be in the WFN. It is an incredible honor to have been nominated for the trustee position in the upcoming election this year. Brain health is in peril globally. One in three of us has a brain disorder. Every one of us will experience disability (temporary or permanent) during our lifetime. The potential for prevention is enormous. Brain disorders are the leading cause of disability and the second leading cause of death globally. Two-thirds of these occur in low- to middle-income countries. Different regions of high-income countries demonstrate vast disparities in awareness, education, access to care, prevention, and rehabilitation. I have seen this imbalance in care firsthand during my youth in rural Sri Lanka, followed by culturally and linguistically diverse communities representing 166 nations in Western suburbs in Melbourne, Australia.

I believe WFN can build on the successes of the last few decades, capitalize on IGAP, and advocate more for quality neurology and better brain health by improving local engagement and activities.

If elected, I will seek to enhance the inclusiveness and constant collaboration already at our society’s heart. We shall continue to work hard to support movers and shakers in brain health worldwide — not only neurologists, academics, and industry, but also the billions of patients and families experiencing the effects of brain disorders.

Advocacy and supporting local advocates will be a crucial component of my global vision for quality neurology and better brain health. We will continue to assist national societies, health ministers and ministries, aiming to deliver the IGAP for all neurological disorders in all regions during the next decade. Educational programs, grants, symposia, CME, traveling fellowships, accreditation, and postgraduate training programs will all be added to, enhanced or, in some cases, newly developed to help address this need globally. We are already doing a lot, but we can and will do more. Our many activities will continue to bring neurologists worldwide together, ensuring everyone’s voice is heard. Committee representation, additional scientific activities, and other advocacy campaigns shall be the tools we use to achieve this goal.

The WFN needs hard-working men and women who can dedicate themselves to improving brain health worldwide. To cohesively solve the issues facing neurologists across the globe, we can listen to, discuss, and assimilate the ideas of many. I will bring these qualities to our leadership group.

As you know, I have already represented the global neurology community in WFN activities for nearly two decades. I am ideally poised to take up the responsibilities of a trustee, as I bring experience from both sides of the world — from rural Sri Lanka to Australia and beyond.

The World Brain Day campaign has already reached out to over a billion people since its genesis in 2014. Yet, there is more ground to cover, but our goals are achievable. With our already talented team, we can work together on this critically important task now.

See more about me on my website. I am on WhatsApp at +61430048730 if you need to clarify anything with me directly. •

Update of WFN, WCN, and World Brain Day

Get an update on the latest activities of the World Federation of Neurology.

Wolfgang Grisold

By Wolfgang Grisold

Welcome to World Neurology. I want to update you on the proceedings of the WFN. This newsletter, which is edited by Steven Lewis and Walter Struhal, has approximately 15,000 readers and has become a valuable resource of information, not only for member societies, but all aspects of neurology worldwide.

Please follow us on our website, which is constantly updated as well as on social media. In addition to the front website page, look at the toolbar, and you will find more detailed information on World Brain Day, WFN activities, including with the WHO, and the World Congress of Neurology, where a link takes you to the congress page. Also, you will find the current issue of World Neurology on the website, and an archive of all existing World Neurology editions. We are constantly uploading new pieces of information on the front page as well as on the rotating banner.

The trustees, in addition to the monthly meeting, have two live meetings a year, one in the spring and the other in the autumn. This year, they met at the April AAN meeting in Boston. In addition to a leadership meeting with the American Academy of Neurology, we were also invited to several activities, such as Head Talks on global health topics and participation in the Joint Committee on the Continuum program.

Visit at the stand of the Peruvian Society of Neurology in Lima.

The AAN, as all regional societies, will also participate at the World Congress on Neurology with joint lectures, and we’re glad about these fruitful cooperations. At the upcoming EAN meeting, which is the regional European meeting, the WFN will participate in several meetings. I am happy to report that the WFN also participated in the Pan American Federation of Neurological Societies (PAFNS) meeting in Lima, Peru. The images show the historic program of the first American congress in 1963, the booth of the Peruvian society at the PAFNS congress, and an image showing the stroke unit in the National Institute of Neurology in Lima, Peru.

We will also participate in the next meeting of the Indian Academy of Neurology in September for the Asian region. As reported before, the WFN was able to attend the PAUNS meeting in Jeddah in January 2023. The AFAN will not hold a meeting this year, but we will participate in the joint Regional Training Course (RTC) asa well as organize two educational days for Africa.

World Congress of Neurology

The WCN will be in Montreal from Oct. 15-19, 2023, and we look forward to this in-person congress, which will also have a virtual part, and thus will be hybrid. This has several reasons. We consider a hybrid part important, we will be able to reach more persons worldwide, who can not travel for visa issues, financial reasons, or other causes. Also, the congress participants will be able to look at the program at sessions, which they may have missed.

The preparations are developing smoothly, and we have the great support of the Canadian Neurological Society and our Professional Congress Organizer (PCO) Kenes. On the day before the meeting, we will have a patient day, following the successful tradition of Vienna and Kyoto congresses, and will be targeted at patients and patient organizations, to communicate new developments in neurology, at the occasion of the congress.

Stroke Unit in the National Neurological Institute in Lima, Peru.

The WCN program will contain 10 plenary sessions, scientific topics often jointly with other societies, free presentations, posters (live and e-posters, for persons who can only participate virtually) and a large number of teaching courses. In addition this year, we will have a few new items such as lectures designed by young neurologists, debates, Meet the Professor sessions, and open “coffee” sessions where topics can be discussed with a small faculty. Needless to say, the Tournament of the Minds will be continued during the congress.

There will also be WFN awards given, such as the Angela Vincent Award for Young Researchers, as well as the Ted Munsat Award for Education, which will be co-sponsored by the AAN. Elsevier, the publisher of our journals JNS and eNS will donate three awards for the best scientific abstract and three awards for the best clinical abstract.

I am happy to report that the concept of the WFN Training Centers started in 2013 in Rabat, and we will take this opportunity to have a celebration session on the occasion of 10 years of training centers of the WFN. We welcome you to attend.

The meeting is expected to be accredited by the UEMS EACCME, which also includes accreditation by the Canadian Royal Society and the AMA. We are aware of the importance of CME/CPD for meetings, and we will have a special educational session by experts from the UEMS on this important topic.

We have also created an attractive opening and reception, and the networking event, which will give the opportunity for informal exchanges.

We are thankful for industry support, and we expect to also have exciting industry-sponsored symposia, as well an attractive exhibition.

There will be a Council of Delegates (CoD) meeting in Montreal giving an overview on the activities of the WFN. There will also be elections for the position of treasurer and of a trustee. The Nominating Committee of the WFN is an independent committee composed by regional experts, and chaired by Raad Shakir (past, past-president). We have had many valuable applications from the regions and the task of this committee was to create a shortlist of candidates. This shortlist is published now online, and also statements from the suggested candidates are in this issue. According to the rules of the WFN, any other candidate supported by five member societies can apply until 30 days before the election. These additional candidates will be published online according to that timeline. We thank all applicants for the position for their enthusiasm to support the WFN.

The next WCN will be in Seoul, South Korea, in 2025, and the first meetings will start taking place in Montreal as the preparation for such events usually last two years.

World Brain Day

Historic program cover from the first Panmerican Congress in 1963. Congress president Oscar Trelles.

In July 22, the WFN celebrates its foundation, and since 2014, we celebrate a WBD on different topics and with changing partners in previous years. This year’s topic is “Brain Health and Disability.” It is based on the successful campaign for brain health in the past year, and the regional societies as well as the World Federation of Neurorehabilitation are partnering with us. The topic was chosen to raise awareness on disability in neurological diseases. As neurological diseases are the most frequent cause of disability, this topic is highly relevant as according to the Global Burden of Diseases (GBD), neurological diseases are the most frequent cause of disability. Disability, looking from history until present times, has been subject to many cultural and ethical influences and stigma. For neurological diseases, it will be important to more clearly define the individual types of disability for different diseases.

Fortunately, a number of disabilities are transient and reversible or can be improved by rehabilitation. However, a large number are permanent, and often progressing. It is important that the U.N. considers disability as a human right, and not being subject to charity. Yet for many reasons, such as socioeconomic factors, regional, and cultural aspects, we still have a long way to go.

This WBD is intended to alert on the importance of disability in neurological diseases and alert awareness, and hopefully will create new working groups to define disability in neurological diseases, and most importantly, stimulate treatment and procedures.

We want to remind our readers that as in previous WBDs, we have created a toolkit, which is available for all member societies on the website. This toolkit can be used freely for the organization of a local WBD, which gives a good chance to bring awareness of disability and also the importance of neurology. We will be supporting this activity by press mailings, social media, and on the WBD, we will have a webinar on brain health and disability.

Global Activities

The WFN with 123 member states, six regions, and the Global Neurology Alliance, are a strong and powerful association. We are glad to fulfill the criteria to be a non-state actor (NSA) with the WHO and the UN ECOSOC. This gives us the opportunity to hear and learn of these global health activities, as well as attend some meetings and raise the voice of neurology, either in specific collaborations, or “interventions” at meetings. This year, we have attended several meeting virtually and in person, and I would like to mention the 75th Health Assembly in Geneva, where the WFN attendance was shared between trustee Alla Guekht and myself.

Also, on this occasion, the WFN was able to make an intervention. The introduction of the activities of the WHO in the past year are impressive, and from the standpoint of neurology the eradication programs of polio, and also the success in malaria vaccination will have direct influence on neurological diseases. Sadly, the Intersectoral Global Action Plan for Epilepsy and other Neurological Disorders (IGAP) and the importance of its implementation was not included in the achievements from last year.

The 75th World Health Assembly in Geneva. Report by the director general, Tedros Adhanom Ghebreyesus.

The main activity at present for neurology in cooperation with the WHO is the IGAP, which has been discussed several times in the editorial, and in World Neurology. Also, a short summary written by the trustees is available on the website, as published in the Journal of the Neurological Sciences. I want to remind readers that the WHO paper is a unique opportunity for neurology worldwide, and also reminds us that neurology is not only science and practice, but needs to involve public health work (World Health Organization. Draft intersectoral global action plan on epilepsy and other neurological disorders 2022-2031.)

The content of the IGAP could not be more favorable for the worldwide improvement or even implementation of neurology in all aspects of health care. Yet, from the neurological WFN community, and based on several personal interactions, as well as a survey from the WFN asking delegates and societies on their knowledge and awareness of the IGAP it created a response of only 20%, after two subsequent surveys we know that the acceptance and practical use of IGAP could be better. This raises concerns, as not being aware of this important tool, it does not allow to use it although it is bitterly needed in some parts of the world. There are of course exceptions, and efforts are being made to implement the IGAP in the health system by some member societies.

The WHO is working on a toolkit for better visibility and implementation of the IGAP, and the WFN will be pleased and helpful in distributing this activity.

Finally, I would like to add a list of important WFN dates.

WBD and the WBD webinar: July 22, 2023 (Free access)
WFN IHS Education Day: Sept. 23, 2023 (Free access)
WCN Montreal: Oct. 15-19, 2023: See the Congress website.
WFN AON Educational Day for Asia on Stroke: Nov. 18, 2023 (Free access)
ICNMD virtual update; Virtual Neuromuscular update conference by the Specialty Group on Neuromuscular diseases. Virtual 2-day meeting. For low-income countries, a contingent of free participation for young neurologists will be announced. Please check the website. Nov. 30-Dec. 1, 2023
WFN AFAN Education Day on Neuropathies: Dec. 2, 2023 (Free access) •

From the editors

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

We’d like to welcome all readers to the June 2023 issue of World Neurology.

The issue begins with the article and reminder by Dr. Tissa Wijeratne and Dr. David Dodick (co-chairs of World Brain Day) and Dr. Wolfgang Grisold (WFN president) and Dr. Steven Lewis (WFN secretary general) of the upcoming World Brain Day 2023, dedicated to “Brain Health and Disability,” including collaborations between the WFN, our global regions, national neurologic societies, and the World Federation of Neurorehabilitation. All WFN regions, societies, and neurologists worldwide are encouraged to take part in this year’s efforts.

In this issue’s President’s Column, WFN President Dr. Grisold updates us on the many international activities in progress with the WFN, including planning for the World Congress of Neurology in Montreal this October, World Brain Day, and many other global activities, including collaborations with the WHO and work being done in relation to the Intersectoral Action Plan (IGAP) and the UN ECOSOC among so many other ongoing collaborative WFN activities throughout the world.

In this issue’s History Column, Dr. Peter J. Koehler details the history of brain stimulation for psychiatric disorders, which he notes preceded the development of this modality for movement disorders. Dr. Massimo Leone next describes an important collaborative educational effort to improve treatment of epilepsy in sub-Saharan Africa, helping fulfill the promise of IGAP.

Dr. Bindu Menon and Dr. Medha Menon provide a well-illustrated report on their remarkable outreach program to improve the health of the patients in Nellore, Andhra Pradesh, India. Dr. B. Jeanne Billoux and Dr. Avindra Nath next provide a timely update of several current and emerging topics in neuroinfectious disease. Dr. Rabwa Fadol then reports on her experience in Sudan as a recipient of a grant to participate in the EEGonline Distance Learning Program created by Dr. Lawrence Tucker and colleagues in Cape Town.

Dr. Dilraj Singh Sokhi next reports on the highly successful Continuum program in Kenya, one of many worldwide examples of this successful collaborative effort between the AAN, the WFN, and our member societies.

Dr. Vladimir Hachinski, a WFN past president, provides a personal and heartfelt obituary on Dr. James F. Toole, WFN president from 1997-2001, who passed away in 2021.

The issue ends with the report from the WFN Nominations Committee regarding the nominating committee’s recommended candidates for the positions of WFN Treasurer and WFN Elected Trustee (followed by the statements from these candidates); the nominating committee report also provides a description of the method by which additional nominations can be made.

In closing, we want to again thank all readers for their interest in and attention to World Neurology and the privilege to report such important updates about neurology and neurologists from around the globe. We look forward to celebrating World Brain Day soon after this issue is published, and to seeing many of you at the WCN in Montreal (in person or virtually) this October! •

Brain Stimulation for Psychiatric Indications Preceded Movement Disorders

A historical sketch.

by Peter J. Koehler

Most neurologists are probably unfamiliar with the history of deep brain stimulation (DBS). Although Parkinson’s disease (PD) is probably the best-known indication, several refractory psychiatric disorders may be treated by DBS. Obsessive compulsive disorder (OCD) and depression may be mentioned with this respect. A recent dissertation from the University of Utrecht, Netherlands, by psychologist Max van der Linden shows that research in this field had already started in the 1950s.¹

Somatic Therapies in Psychiatry

Several types of so-called somatic therapies may be recognized in the history of psychiatry. These evolved in a period in which neurology and psychiatry were still taught and practiced simultaneously by neuropsychiatrists in most places, except a few large cities, where it had already been split. Nobel Prize winner and Austrian Julius Wagner-Jauregg (1857-1940) started with malaria therapy for general paralysis of the insane (GPI) in the early 20th century. We already read about this in World Neurology (Volume 35, issue no. 4 of October/November 2020, pp. 5 and 10).

In the 1920s, Austrian Manfred Sakel (1900-1957) developed insulin coma therapy for schizophrenia (see World Neurology, Volume 37, issue no. 1 of January/February 2022, pp. 4-5). This was soon followed by metrazol shock therapy in the 1930s, developed by Hungarian neuropathologist/neuropsychiatrist Ladislas Meduna (1896-1964) and by electroconvulsive therapy (ECT) invented by professor of neuropsychiatry in Rome Ugo Cerletti (1877-1963) in cooperation with Lucio Bini (1908-1964) in 1938. ECT soon replaced the earlier shock therapies, as it was easier and safer to apply. Psychiatrist and historian Joel Braslow, who also included hydrotherapy and sterilization in his review of somatic therapies, reported that within a year after the introduction of ECT in the United State (1941), 42% of 356 psychiatric institutes had electroshock machines.²

Less well-known is that Roy R. Grinker (1900-1993) in Chicago also made the step from animal to human experimentally applying electricity, in this case with nasopharyngeal electrodes.³ Interestingly, he and psychoanalyst Helen V. McLean (1894-1983) tried to combine neurophysiological and psychoanalytical ideas to explain the effects of shock therapy. The core of their theory was the existence of supposed tension between the emotional biological drives in the diencephalon and the suppressive influence of the superego, believed to be located in the cerebral cortex. Blocked brain pathways were thought to be the cause of mental health symptoms. This in fact shows that the separation between the biological and psychoanalytical perspectives in psychiatry in the United States between the 1930s and 1950s was less extensive than had previously been assumed.^{1, p. 107-19}

Victor Horsley (Courtesy Wellcome Institute, London). Robert Henry Clarke (Courtesy Wellcome Institute, London). Ernst A. Spiegel (Courtesy NIH, National Library of Medicine, Digital Collections). Henry T. Wycis (Courtesy NIH, National Library of Medicine, Digital Collections).

Ablative Treatments

In the meantime, the Portuguese neurologist António Egaz Moniz (18

74-1955) presented his ideas on leucotomy at the second Neurological Congress in London (1935). Frontal lobotomy was popularized by the American neurologist Walter Freeman (1895-1972) and neurosurgeon James W. Watts (1904-1994). Eventually Freeman was able to do the procedure on his own within a few minutes. Thousands of patients underwent this procedure, in particular in the U.S., England, and Scandinavia.^4,5 Because of the risk of severe complications, more limited surgical procedures were being explored, including orbital undercutting, topectomy (Brodmann areas 9 and 10), and open cingulotomy.⁶

Although stereotactic neurosurgery had already been introduced by neurosurgeon Victor Horsley (1857-1916) and house-surgeon/ anatomist/physiologist Robert Henry Clarke (1850-1926) in 1908, their apparatus was based on skull landmarks and therefore inaccurate. It was mainly used in animal experiments.

In 1918, Canadian neuroanatomist/neuropathologist Aubrey T. Mussen (1873-1975) developed a stereotactic device for human use.⁷ Practice with a stereotactic device in humans only started in the 1940s, when Spiegel and Wycis used radiographic techniques, imaging landmarks like the ventricles with pneumoencephalograms (PEG) and the calcified pineal gland. In fact, the introduction in 1947 of stereoencephalotomy by originally Austrian neurologist Ernst A. Spiegel (1895-1985), who emigrated to Philadelphia in 1930, and neurosurgeon Henry T. Wycis (1911-1972) was aimed in the first place to refine leucotomy in cases of obsessions, depression, schizophrenia, and pediatric mental deficiency.^6,9

“This apparatus is being used for psychosurgery. In a series of patients studied in collaboration with H. Freed [psychiatrist Herbert Freed (1908-1976)], lesions have been placed in the region of the medial nucleus of the thalamus (medial thalamotomy) in order to reduce the emotional reactivity by a procedure much less drastic than frontal lobotomy”.⁸ The thalamus had become the area of interest, as retrograde Wallerian degeneration in autopsied lobotomized patients pointed to this place. They later shifted their focus to movement disorders, starting with pallidoansotomies for chorea.¹⁰

(Left to right) Robert Galbraith Heath (Creative Common Licence). José M.R. Delgado (Courtesy NIH, National Library of Medicine, Digital Collections). Natalia Bechtereva (Creative Common BY 4.0). Cover of Van der Linden’s dissertation Elektrisch Evenwicht [Electic Equilibrium].

Deep Brain Stimulation (DBS) in Psychiatry

A similar motivation was given when searching for electrical stimulation methods that were less dramatic procedures than ECT. After the introduction of stereotactic neurosurgery, Heath and Delgado used this method to insert electrodes for registration as well as intermittent stimulation in these patients. Working at the department of psychiatry and neurology at Tulane University, New Orleans, psychiatrist Robert Galbraith Heath (1915-1999) was among the first to set up an interdisciplinary non-convulsive stimulation program for psychiatric patients. He started stimulating schizophrenic patients in the early 1950s and described the first 19 patients in his 1954 monograph Studies in Schizophrenia.

About the same time, neurophysiologist/neurobehaviorist José M. Delgado (1915-2011), who had moved on a grant from Madrid to Yale, was working with John F. Fulton (1899-1960), applying stimulation in the brains of animals. In 1951, he started cooperation with neurosurgeon Hannibal Hamlin (1904-1982), stimulating the frontal brain of schizophrenic patients before they underwent lobotomy. As for the animal experiments, he developed telemetric electrical stimulation for his laboratory animals so that they were able to move freely. Famous is Delgado’s experiment in the 1960s with a bull in the arena that he could stop by remote control.¹¹ In the first years, electrodes would remain projecting from the skull, but in the 1970s following the introduction of cardiac pacemakers in late 1950s and 1960, this could be avoided by the use of subcutaneous stimulators that could deliver continuous non-convulsive stimulation.

Although many other researchers were working in this field, I will mention one more, notably the Norwegian neurophysiologist Carl Sem-Jacobsen (1921-1991), who worked at the Mayo Clinic in Rochester, Minnesota. In cooperation with neurologist Reginald Bickford (1913-1998), he initially used depth registration of epileptic and psychotic patients before selecting the site of prefrontal leucotomy. Later, they investigated the effects of stimulation and found that behavioral responses of the patients often persisted long after the stimulation. Some patients improved remarkably from the stimulation experiments.^1,p.184-5

DBS for Parkinson Disease

Sem-Jacobsen eventually shifted his interest to the surgical treatment of PD applying this same technique and publishing the results in 1966. Chronic stimulation, sometimes for days or a week, was used to identify the best site for making the lesion.¹² Natalia P. Bechtereva (1924-2008) presented the idea of chronic subcortical stimulation as a permanent therapy in the early 1970s and coined the term therapeutic electrostimulation. However, as implantable neurostimulators were not available in the USSR at the time, small lesions were applied.⁹ Several other investigators were working in the field, until the most important work by neurosurgeon Alim L. Benabid (b. 1942) and neurologist Pierre Pollak (b. 1950) in Grenoble (France) was published in 1987. In PD patients with bilateral tremor, they performed thalamotomy contralateral to the most severe tremor and carried out continuous stimulation for the other side. They concluded that “VIM [thalamic nucleus ventralis intermedius] stimulation strongly decreased the tremor but failed to suppress it as completely as thalamotomy did… This therapeutic protocol appears to be of interest for patients with bilateral extrapyramidal movement disorders”.¹³ Indeed, bilateral thalamotomies had important long-term adverse effects, including dysathria and ataxia.¹⁴

Concluding Remarks

We learn that human stereotactic ablation as well as electric deep brain stimulation for psychiatric diseases preceded that for movement disorders. At present, intractable OCD is the main psychiatric indication for DBS and treatment-resistant depression is a promising second indication.¹⁵ Unfortunately, Van de Linden’s dissertation Elektisch Evenwicht [Electric Equilibrium], which can be downloaded from the University of Utrecht website (Elektrisch evenwicht: Een geschiedenis van diepe hersenstimulatie bij psychiatrische stoornissen (1860-2020) (uu.nl)), was written in Dutch. However, with modern tools the pdf of the book (470 pages) can easily be read in other languages. •

Literature

1. Linden M van der. Elektrisch evenwicht. A history of deep brain stimulation in psychiatric disorders (1860-2020) [in Dutch]. Utrecht, dissertation, 2023.

2. Braslow JT. History and evidence-based medicine: lessons from the history of somatic treatments from the 1900s to the 1950s. Ment Health Serv Res. 1999;1:231-40

3. Grinker RR. A method for studying and influencing cortico-hypothalamic relations. Science. 1938;87:73-4.

4. Pressman JD. Last Resort. Psychosurgery and the Limits of Medicine. Cambridge University Press, 1998.

5. El-Hai J. The Lobotomist. Hoboken (NJ), Wiley, 2005.

6. Rzesnitzek L, Hariz M, Krauss JK. Psychosurgery in the History of Stereotactic Functional Neurosurgery. Stereotact Funct Neurosurg. 2020;98:241-247.

7. Rahman M, Murad GJ, Mocco J. Early history of the stereotactic apparatus in neurosurgery. Neurosurg Focus. 2009;27:E12

9. Spiegel EA, Wycis HT, Marks M, Lee AJ. Stereotaxic Apparatus for Operations on the Human Brain. Science. 1947;106:349-50.

10. Hariz MI, Blomstedt P, Zrinzo L. Deep brain stimulation between 1947 and 1987: the untold story. Neurosurg Focus. 2010;29:E1.

11. Marzullo TC. The Missing Manuscript of Dr. Jose Delgado’s Radio Controlled Bulls. J Undergrad Neurosci Educ. 2017;15:R29-R35.

12. Sem-Jacobsen CW: Depth-electrographic observations related to Parkinson’s disease. Recording and electrical stimulation in the area around the third ventricle. J Neurosurg 1966;24:388–402.

13. Benabid AL, Pollak P, Louveau A, Henry S, de Rougemont J. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987;50:344-6.

14. Dallapiazza RF, Lee DJ, De Vloo P, Fomenko A, Hamani C, Hodaie M, Kalia SK, Fasano A, Lozano AM. Outcomes from stereotactic surgery for essential tremor. J Neurol Neurosurg Psychiatry. 2019;90:474-482.

15. Borron BM, Dougherty DD. Deep Brain Stimulation for Intractable Obsessive-Compulsive Disorder and Treatment-Resistant Depression. Focus (Am Psychiatr Publ). 2022;20:55-63.

AAN-WFN Continuum Education Program in Kenya

2019 series of educational lectures by the Neurological Society of Kenya, following the topics covered by Continuum.

Regional impact and backbone for the new fellowship in neurology.

By Dilraj Singh Sokhi

There are less than 20 neurologists in Kenya, yet this number is significantly more than neighboring countries, and enough to comprise a national professional organization. The Neurological Society of Kenya reinvigorated its education and advocacy mission in 2019 by launching the first series of educational lectures for the neurologist and general physician practicing in the region. But questions arose about which topics to cover, in what order, and how to ensure up-to-date information was being disseminated. The most appropriate solution that addressed these concerns was to refer to the Continuum series, delivered to us from the AAN-WFN Education Program, and follow the topics contemporaneously. And so, we had talks delivered by regional and international experts on dementia, epilepsy, multiple sclerosis, headache, and neuromuscular disease. The respective copies of the journal were also shared with attendees during each event.

Friday afternoon academic sessions with the new fellows.

The resulting bolstered regional collegiality from this lecture series seeded two ideas. The first idea was to launch a postgraduate fellowship in neurology in East Africa. Designing the first such program in the region from scratch was ripe with opportunities to combine best practices from different parts of the world, given our founding fellowship committee members included graduates from Europe, India, South Africa, the United Kingdom, and West Africa. We adapted (with permission) the curriculum from the UK to suit our environment, which was already mapped (by the author) to articles in the BMJ’s Practical Neurology journal.

Distribution of Continuum series across the region (and beyond).

The pandemic delayed the start of this novel training fellowship in the region by a couple of years, so our first two fellows joined in 2022, and we have two more joining this year. We dedicate Friday afternoons to deliver case-based discussions in a flipped classroom model and then follow the sequence of topics as covered by the Continuum series, which is also mandated as the main reference journal in the sessions. Our sights are now on applying for WFN accreditation of our training site in the coming years.

The pioneer postgraduate fellows Dr. Jamil Said (left) from Eldoret, Western Kenya, and Dr. Eunice Nyambane from Murang’a, Central Kenya, enjoying the Continuum series at Aga Khan University in Nairobi, Kenya.

The second idea was to organize a regional conference to bring together the few neurologists in neighboring countries. Again, the idea was shelved during the pandemic, but in May 2022, we held the first multiple sclerosis (MS) conference in East Africa, followed by a headache workshop supported by a grant from the International Headache Society. The success of the conference, together with entering a more quiescent phase of the pandemic, led to a second MS conference in May 2023. In both MS conferences, the Continuum series were distributed to participants from a breadth of countries, and we shared our model of using the journal as the main reference point for case discussions and didactic lectures. The journals have all gone to academic institutions and referral hospitals, and will no doubt be great sources of guidance for managing patients and educating the next generation of specialists in East Africa. •

Dilraj Singh Sokhi is the founding neurology fellowship director and associate professor of neurology at Aga Khan University in Nairobi, Kenya.