Update on IGAP and DREAM work treating epilepsy in sub-Saharan Africa.

By Massimo Leone

Massimo Leone

The Intersectoral Global Action Plan (IGAP) on epilepsy and other neurologic disorders is the WHO’s neurology revolution calling neurologists and other stakeholders to become partners in order to contribute to improving access to care to people living with epilepsy (PLWE)  and other neurologic disorders, particularly in geographic areas with poor access to care as sub-Saharan Africa (SSA).

In the last 20 years, SSA population has doubled, and now PLWE exceeds 20 million. More than 75% have no access to treatment. There is about one neurologist for every 2 millions inhabitants so the vast majority of PLWE are managed at primary health care facilities by non-physician clinicians (NPC) whose education on the disease is insufficient. Lack of essential medicines, electricity supply interruptions, and malfunctioning sphygmomanometers are not so rare.

An epilepsy program in SSA was initiated as a partnership between the Disease Relief Through Excellent and Advanced Means (DREAM) program, the Italian Society of Neurology, the C. Besta Neurologic Institute IRCCS Milan, the Global Health Telemedicine (GHT), and the Mariani Foundation.

DREAM is a primary care program started in 2002 to prevent and treat HIV/AIDS in SSA now active in 10 nations with 50 health centers, 28 laboratories including molecular biology, more than 500,000 HIV+ patients under regular follow-up, more than 130,000 children free-from-HIV born from HIV+ mothers, more than 120 teaching courses for thousands of African health workers, and high patient retention with 1-3% lost to follow-up/year. Community health workers — activists — from the civil society play a key role. The program is part of the local public health system and has become a reliable platform to deliver and integrate care for chronic conditions as arterial hypertension, diabetes, cervical and breast cancer. The DREAM program offered the Italian neurologists the background to build a service also for PLWE.

Participants of teaching and training courses in Malawi, Central African Republic, and Mozambique.

The partnership started in 2020 in Malawi and Central African Republic, and recently was added in Mozambique. So far, 14 in-person teaching and training courses on epilepsy and other neurologic diseases (stroke and headache) have been delivered to 137 health care workers, each followed by periods of shared work on the ground (training on the job). A simplified questionnaire on basic neurological knowledge confirmed a post-course improvement. Two video-EEGs have been installed, and a third one will arrive soon. More than 500 EEG recordings have been sent to epilepsy specialists in Italy through the GHT telemedicine platform. In two years, local clinicians sent Italian neurologists more than 1,600 teleconsultation requests, mainly epilepsy. Neurologists can interact with other specialists of the GHT platform in case of complex patients, such as suffering from both epilepsy and HIV, post-stroke epilepsy and heart disease, etc. More than 1,350 PLWE are now receiving treatment and care at the DREAM centers.

At the end of a recent teaching course, an attendee stated, “We have learned a lot, but we are neither neurologists nor do we have the possibility of dealing with neurologists/epileptologists. It will be hard to go far alone.” Translated, this means IGAP requires more shared work between local NPC and neurologists, with a long-term perspective.

Video.EEG in Central African Republic and Malawi; teaching and training courses; tele-EEG; dedicated buildings to epilepsy care; integrating epilepsy with other health needs; awareness campaigns; solar panel (eco-sustainability).

Shortage of neurologists in SSA is expected to last for several decades, making education and training of NPC a priority in the fight against epilepsy. This requires a long-term approach, key also to develop effective teleneurology. Integrating epilepsy care with other diseases, such as HIV, TB, hypertension, and malaria, is another challenge for neurologists involved in IGAP. Enhanced cooperation between neurologists and primary health care NPCs will play an important role to make IGAP successful in SSA.

• https://www.dream-health.org/epilepsy-and-neurology/?lang=en
• https://ihs-headache.org/en/news/first-rope-ihs-meeting-held-in-malawi/
• https://www.neuro.it/web/procedure/contenuto.cfm?List=WsIdEvento,WsIdRisposta,WsRelease&c1=AGGCNGNEU&c2=105&c3=1

Dr. Massimo Leone is from The Foundation of the IRCCS C.Besta Neurologic Institute, Milan, Italy.

An outreach of care. The way forward.

By Dr. Bindu Menon MD, DM, and Dr. Medha Menon, MBBS

Bindu Menon

As goes the epidemiological transition from communicable to non-communicable diseases (NCDs), India stands at the precipice of having to balance the burden of both. While managing communicable diseases like a wound that has not yet scabbed, the rising trends of NCDs like stroke, cardiovascular events, and cancers further predispose the population to infections, making them difficult to curb.

The rapid rise in cases of NCDs requires its own scrutiny and care. The seemingly sudden increase in cases is a result of efficient screening services as well as the culmination of a lifetime of unhealthy lifestyle habits. One in four Indians risk dying from an NCD before they reach the age of 70¹. Of the NCDs, neurological disorders, such as stroke, epilepsy and dementia, are the major contributors to the global burden of disease. Often presenting with relatively subtler signs as compared to cardiovascular events, they tend to go unaccounted for, making it even more prudent for its detection and treatment. Of the cases coming under our radar, the prevalence of neurological disorders in India, which is more in rural areas, ranges from 967-4,070 with a mean of 2,394 patients for a population of one million².

Stroke is a major medical emergency that causes lifelong repercussions to a patient without timely medical care. The current incidence of stroke in India is much higher than western industrialized countries³.

India’s population has been set to overtake China’s by the end of April 2023, reaching 1,425,775,850⁴ with an overwhelming majority of 65% residing in rural India⁵.

Despite India having achieved the WHO-recommended doctor-patient ratio of one per thousand⁶, the lack of medical practice in rural areas shrouds their medical needs. With just over 2,500 neurologists, the reality is that a single neurologist caters to the medical needs of more than five million population. This ridiculous neurologist-patient ratio makes it nearly impossible to assure delivery of timely medical services to all. With increased medical facilities concentrating in cities, the urban-rural divide further widens.

Our job as service providers makes it our responsibility to look at the various factors that contribute to the meager medical attention received in rural areas. A deep dive into the conversations with the locals brings to light how awry education, economic constraints, and misguided prioritization contribute to this. Often the locals say, “I don’t have high blood pressure, I feel absolutely fine,” in response to showing them their chronically elevated levels, sometimes touching 200/120, or “I stopped my medications because I haven’t had a seizure in a while,” when asked why they were not compliant to medication, and sometimes, “I thought the paralysis of my face and hands were due to high sugars,” when asked why they didn’t go to the hospital for treatment. However, most times, they do have genuine reasons for not availing medical services. More often than not, their nearest hospitals are almost 100 kilometers away, which increases the time lost to treat any emergency as well as cost of travel which the family cannot bear. But of all, the most important factor would still be the lack of awareness about the disease at hand. This lack of awareness includes not knowing the symptoms of the disease, the importance of timely diagnosis and treatment, maintenance of drug compliance, complications of the disease, and how all of this will affect their livelihood. It is important because trying to eliminate this root cause empowers the people to identify their problem and take necessary steps as well as contribute to the decision making of their treatment. Once they make their first step to availing treatment, we can meet halfway to provide them with medical services.

We now see that it is not just the lack of medical services that increases disease burden in rural areas. Thus, a combined approach is deemed most useful to tackle the problem at hand. We must address the lack of awareness, the monetary constraints as well as lack of on-site medical services to effectively curb the problem.

For this reason, with the goal of raising awareness as well as providing free medical services in the resource-poor and remote rural sector, a novel project “Neurology on Wheels,” a first-time project by the Dr. Bindu Menon Foundation was started in Nellore, Andhra Pradesh, India. This project identifies a village from the 46 mandals by random selection. The team of the foundation then visits the village after the village head has been informed about the camp in advance. The village sarpanch is also asked to prime the ASHA/ Anganwadi workers/ANM (local women trained to act as health educators and promoters in their communities) for efficient coordination.

The motto followed is, “We reach, we teach, and we treat.” Upon reaching the village, an awareness program is held for all the people attending the camp. The talk is tailored to risk factors of stroke and recognition of its symptoms, epilepsy and its prevention, and the role of regular compliance of medicines. This way the practice of a holistic approach to healthy living is encouraged with the need to focus on dietary, exercise, and drug compliance.

Later, a free medical camp is held where screening and detection of hypertension, diabetes, epilepsy, and stroke is done, at the end of which the patients are distributed medicines. This way, new NCDs are detected, and early intervention is done to derail the original trajectory of a dangerous disease to a more controlled one. With the risk factors evaluation, the public is counseled regarding their stroke risk according to the stroke risk card. Furthermore, drug naïve stroke and epilepsy patients who are below the poverty line are incorporated into the foundation for their free medicines. This way, we can inch forward slowly to closing the treatment gap.

Neurology on Wheels is a project with potential to extrapolate to larger scales. Our team is limited, but with proper resources and manpower, it can provide as a mighty tool to bridge the urban-rural divide prevailing in India.

This project has covered 44 villages and has detected more than 416 new cases of hypertension, 133 of diabetes, 109 of untreated epilepsy, and 143 of stroke, which might not seem like a huge chunk off the actual burden of disease. However, humanizing these numbers shows us with extreme perspicuity how this project has imparted the much-needed help and treatment services to these patients who would have otherwise contributed to the ever-growing treatment gap of NCDs in rural India. •

Dr. Bindu Menon MD, DM, and Dr. Medha Menon, MBBS, are with the Dr. Bindu Menon Foundation in Nellore, Andhra Pradesh, India.

References:

1. https://www.wbhealth.gov.in/NCD/
2. Gourie-Devi M. Epidemiology of neurological disorders in India: review of background, prevalence and incidence of epilepsy, stroke, Parkinson’s disease and tremors. Neurol India. 2014 Nov-Dec;62(6):588-98. doi: 10.4103/0028-3886.149365. Erratum in: Neurol India. 2016 Sep-Oct;64(5):1110-1. PMID: 25591669.
3. Kamalakannan S, Gudlavalleti ASV, Gudlavalleti VSM, Goenka S, Kuper H. Incidence & prevalence of stroke in India: A systematic review. Indian J Med Res. 2017 Aug;146(2):175-185. doi: 10.4103/ijmr.IJMR_516_15. PMID: 29265018; PMCID: PMC5761027.
4. India to overtake China as world’s most populous country in April 2023, United Nations projects
5. https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=IN
6. Kumar R, Pal R. India achieves WHO recommended doctor population ratio: A call for paradigm shift in public health discourse! J Family Med Prim Care. 2018 Sep-Oct;7(5):841-844. doi: 10.4103/jfmpc.jfmpc_218_18. PMID: 30598921; PMCID: PMC6259525.

Update on several noteworthy neuroinfectious disease issues, including arboviruse as well as COVID-19 exposure in-utero.

By B. Jeanne Billioux, MD, and Avindra Nath, MD

The WHO has recently released reports denoting the expansion of cases of dengue and chikungunya beyond historical areas of transmission in the Americas, as well as warnings for increased expansion of transmission in areas of Europe that were previously unaffected (https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON448; https://www.bloomberg.com/news/articles/2023-04-05/europe-at-risk-of-dengue-and-zika-summer-outbreaks-who-warns#xj4y7vzkg).  Climate change may contribute to broadening habitat for certain viral-spreading arthropods, including the Aedes aegypti mosquitoes that harbor dengue, chikungunya, and zika viruses.

Dengue has been on the rise this season, with many South American countries including Colombia, Brazil, and Argentina, as well as Asian countries, such as the Philippines, recording increased caseloads compared to prior seasons (outbreaknewstoday.com). The U.S. has also recorded several cases in Southern Florida, most of them related to travel, as well as autochthonous transmission in Maricopa County in Arizona this year (https://www.floridahealth.gov/diseases-and-conditions/mosquito-borne-diseases/_documents/2023-week14-arbovirus-surveillance-report.pdf; https://www.cdc.gov/mmwr/volumes/72/wr/mm7211a5.htm). 

Dengue may present broadly, from asymptomatic cases to hemorrhagic fever; most typically, in symptomatic cases, it causes flu-like symptoms. Neurologic complications occur uncommonly, and include encephalopathy from multiorgan involvement, encephalitis, PRES, stroke (both ischemic and hemorrhagic), and immune-mediated syndromes such as transverse myelitis, Guillain-Barre syndrome, acute disseminated encephalomyelitis, myositis, mononeuropathies, and cyberelites. Some patients may develop hypokalemic paralysis (Trivedi 2022). No known treatments for Dengue exist, but several vaccines are in clinical trials or in various stages of gaining approval, including the recent approval in Brazil https://www.thepharmaletter.com/article/takeda-gains-approval-in-brazil-for-qdenga?print=1.

Chikungunya cases have also been increasing in early 2023, including a surge of cases in Paraguay and Brazil, with Brazil recording over twice as many cases compared to last year (http://outbreaknewstoday.com/author/news-desk/). Although the disease commonly causes fever, fatigue, malaise, and arthralgias (sometimes severe), over 200 cases of suspected meningoencephalitis have been reported due to chikungunya virus in Paraguay during this current outbreak, a rare presentation, (https://www.cidrap.umn.edu/chikungunya/paho-warns-rising-chikungunya-cases-americas-some-fatal) which needs to be closely watched since it could represent an evolution in viral tropism. Other known neurologic complications of Chikungunya include encephalopathy, encephalitis, myelopathy, and peripheral neuropathies, including Guillain-Barre syndrome (Brizzi 2017).

Of note, efforts to reduce transmission of dengue, chikungunya, and the neurovirulent zika virus by using Wolbachia bacteria infection in Aedes aegypti mosquitos have been underway in a number of different areas with varying levels of success. Wolbachia infection of these mosquitos essentially blocks viral replication of dengue, chikungunya, and zika in the mosquito, leading to decreased transmission of these viruses. Recent reports by the World Mosquito Program have noted decreased dengue spread in Java, Indonesia, and the Aburra Valley in Colombia, among other places, where the Wolbachia-infected mosquitos have been released (https://www.worldmosquitoprogram.org/en/learn/scientific-publications).

In COVID-19 related news, a recent case series has reported two neonates born with brain abnormalities thought to be related to in-utero exposure to SARS-CoV2. Both babies were born to mothers who had contracted SARS-CoV-2 in their second trimesters (one with re-infection during the third trimester). Both babies were SARS-CoV-2 negative at birth, but had microcephaly, seizures starting on the day of delivery, and developmental delay over time. Both infants had SARS-CoV-2 antibodies and elevated inflammatory markers, and the placenta from each case also displayed SARS-CoV-2 proteins, increased inflammatory markers, as well as evidence of decreased fetal perfusion. One infant died at 13 months of life; on autopsy, the infant was found to have white matter loss, gliosis, vacuolization, as well as evidence of SARS-CoV-2 viral proteins by immunofluorescence throughout the brain, indicating viral infection. The authors note that these two cases are extremely rare, but indicate that in-utero exposure to SARS-CoV-2 in the second trimester has the potential to cause neurodevelopmental sequelae (Benny 2023).  •

References:

1. Trivedi S, Chakravarty A. Neurological Complications of Dengue Fever. Curr Neurol Neurosci Rep. 2022 Aug;22(8):515-529. doi: 10.1007/s11910-022-01213-7. Epub 2022 Jun 21. PMID: 35727463; PMCID: PMC9210046.
2. Brizzi K. Neurologic Manifestation of Chikungunya Virus. Curr Infect Dis Rep. 2017 Feb;19(2):6. doi: 10.1007/s11908-017-0561-1. PMID: 28233188.
3. Benny M, Bandstra ES, Saad AG, Lopez-Alberola R, Saigal G, Paidas MJ, Jayakumar AR, Duara S. Maternal SARS-CoV-2, Placental Changes and Brain Injury in 2 Neonates. Pediatrics. 2023 Apr 6:e2022058271. doi: 10.1542/peds.2022-058271. https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2022-058271/191033/Maternal-SARS-CoV-2-Placental-Changes-and-Brain?autologincheck=redirected

Report of the WFN Nominations Committee

One Treasurer and one Elected Trustee are to be elected at the Council of Delegates (CoD) Annual General Meeting (AGM) in October during the World Congress of Neurology in Montreal. The nominating committee of the World Federation of Neurology (WFN) now recommends to the membership those listed here as candidates in accordance with the Federation’s Memorandum and Articles of Association.

Recommended candidates

(Click on each name for their candidate statement.)

Treasurer to take office Jan. 1, 2024

1. Prof. Marianne de Visser (The Netherlands)
2. Prof. Barbara Tettenborn (Switzerland)

Elected Trustee to take office immediately after the COD Meeting

1. Dr. Lawrence Tucker (South Africa)
2. Dr. Mohammed Wasay (Pakistan)
3. Dr. Tissa Wijeratne (Sri Lanka / Australia)

The deadline for submitting candidates for nomination was April 3, 2023. Nominations made after this deadline are possible. To nominate another individual (who must be a member of a WFN member society),

• Obtain the supporting signatures of five or more authorized WFN delegates.
• Submit the name(s) of the individual(s) in question to the Secretary General, along with a CV and a letter of the candidates agreement to stand.
• Send to WFN headquarters at info@wfneurology.org 30 days prior to the start of electronic voting on Sept. 22, 2023.

Voting Timetable

Voting will take place by electronic voting (remote online ballot). This method of voting enables all member societies to vote in the elections, regardless of whether they are attending the CoD meeting.

Voting will be carried out in advance of the WFN AGM of the CoD. The election results will be announced at the CoD meeting.

• Registration to attend the WFN AGM CoD Meeting and to vote will open Sept. 1, 2023.

• Voting will open for two weeks between Friday, Sept. 22, 2023, @ 12 p.m. UTC and Sunday, Oct. 8, 2023, @ 12 p.m. UTC.

The method of voting and timetable provides voters ample time and opportunity to register, and equity when making their vote without adverse conditions such as differences in time zones, or stresses due to travel restrictions that may impact their sound decision-making.

For more details on the method of voting, please contact info@wfneurology.org.

My name is Marianne de Visser. I am an adult neurologist and (emeritus) Professor of Neuromuscular Diseases at the University of Amsterdam, the Netherlands.

Marianne de Visser

I would like to apply for the position of treasurer.

I have been committed to the good cause of the WFN for several decades. I have served under inspiring presidents. First, as a delegate on behalf of the Netherlands Society of Neurology, subsequently as an elected trustee under the late Presidents Jun Kimura and Johan Aarli. Under Bill Carroll’s presidency, I was chair of the Nominating Committee, and most recently, co-opted trustee. President Wolfgang Grisold appointed me as chair of the Membership Committee and chair of the Committee for Diversity, Equity, and Inclusion.

I have witnessed the growth of WFN. The increasing membership, but also the expanding role of the WFN in several impactful initiatives worldwide, are clear signs of leadership.

The close collaboration with the WHO has borne fruit for neurology.

One example is the Neurology Atlas, showing the country resources for neurological disorders. The data highlight that while the burden of neurological disorders is disproportionately high in low- and middle-income countries, health care services and resources are often scarce. The main project presently is the implementation of the intersectoral action plan for epilepsy and other neurological disorders, IGAP, which was approved at the World Health Assembly in May 2022, and has a time of 10 years for the duration of the program. It focuses on advocacy, treatment, prevention, research, innovation, and public health awareness, and is meant to implement neurology in all countries of the world.

The WFN puts many efforts in fulfilling its mission: “Fostering quality neurology and brain health worldwide.” One example is by organizing the World Brain Day, together with the six regional societies. World Brain Day is an extremely successful recurring event on July 22. This year, World Brain Day focuses on Brain Health and Disability: Leave No One Behind, conveying five important messages: Awareness, Prevention, Advocacy, Education, and Access.

Several WFN Programs focus on education, in particular aimed at residents and early career neurologists. This year, we celebrate the 10-year anniversary of WFN training centers, which provide one-year fellowships but also four-year residency programs. Another great success is the department visit program which enables an exchange of experiences and practices and also creates an opportunity to create an academic network for future cooperation.

At the beginning of his term, President Grisold stated that the WFN will need to take diversity, equity, and inclusion into consideration in its strategy, that the needs of early career neurologists require specific attention and action, and a platform for patient organizations should be installed in the WFN infrastructure. I embrace those initiatives, and I am fully committed to serve the WFN as treasurer to make those initiatives to a success in close collaboration with the trustees and the indispensable colleagues from the Head Office. •

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.

Barbara Tettenborn

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.  •

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

Lawrence Tucker

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 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. •

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).

Mohammad Wasay

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, 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. 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. •