Learn more about World Brain Day on July 22.
https://wfneurology.org/world-brain-day-background and https://wfneurology.org/world-brain-day-2022
Environment, Climate, and Neurological Diseases
Webinar by the Environmental Neurology Specialty Group (ENSG).
By Safa Younis and Mohammad Wasay
Safa Younis and Mohammad Wasay
In honor of World Environment Day celebrated annually on June 5, the World Federation of Neurology (WFN) hosted a webinar to raise awareness and explore the relationship between environmental factors and the brain. This webinar unpacked variables such as climate change and chemical pollutants as risk factors for neurological disorders.
Esteemed neurologists from around the world spoke at this event, including Dr. Mohammad Wasay, who moderated the webinar, Dr. Wolfgang Grisold (WFN president), Dr. Gustavo Roman (ENSG president), Dr. Jacques Reis, Dr. Anna Ranta, Dr. Peter Spencer, Dr. Philip Landrigan, Dr. Serefenur Ozturk, Dr. Augustina Charway Felli, Dr. Hidehiro Mizusawa, Dr. Teresa Corona, and Dr. Alla Guekht.
Of the many themes discussed, Dr. Reis elaborated on environmental challenges that society faces and the neurologists’ role as the climate changes. He specifically examined the correlation between climate change and an increase in neurological diseases. He said that according to the World Economic Forum Davos: The Global Risks Report 2022 — climate action failure, extreme weather events, and biodiversity losses will likely be the most concerning global risks over the next decade. Further, Dr. Anna Ranta conferred the benefits of green spaces on vascular brain health. There is evidence that exposure to green spaces has a positive impact on stroke prevention, severity, and mortality. Dr. Peter Spencer discussed the climate-relevant neurotoxic botanicals linked with human motor-neuron diseases such as Lathyrus sativus, Cycas micronesica, Manihot esculenta, and Gyromitra esculenta. He demonstrated that these botanicals can be linked to certain neurological diseases such as Lathyrism, Cassavism, and Amyotrophic Lateral Sclerosis-Parkinsonism-Dementia Complex.
Dr. Philip Landrigan spoke about climate change, chemical pollution and the developing human brain. There is growing evidence that toxic chemicals can cause neurodevelopmental disorders in children, since they are more sensitive to chemicals in the environment compared to adults. Dr. Landrigan also expressed that there may be countless unrecognized chemicals causing neurotoxicity in children. He stated a great example of how lead was removed from gasoline, which was known to cause neurotoxicity. The benefits for this action included a 2- to 5-point gain in population mean IQ and a $200 billion annual economic benefit to the U.S. through increased economic productivity of more intelligent and creative children, simply by removing one neurotoxic chemical from the environment. Dr. Gustavo Roman shared lessons learned from COVID-19 from an environmental point of view.
Dr. Wolfgang Grisold concluded the program by emphasizing the importance of this discussion in our everyday lives. This enlightening webinar encourages future research that assesses the correlation between environmental factors and neurological conditions.
Dr. Serefnur Ozturk (ENSG vice president) emphasized policy changes to improve air pollution and brain health. Dr. Augustina Charway (African Academy of Neurology president) discussed brain health challenges in Africa. •
Mohammad Wasay is Alicharan Endowed Professor of Neurology, Department of Medicine, Aga
Khan University, Karachi, and Secretary General, Environmental Neurology Specialty group, WFN.
Todd, Faraday, and the Electrical Activity of the Brain
By Edward Reynolds
Electrical concepts of brain activity became widely established in neurology and psychiatry in the 1930s following the discovery of the human electro-encephalograph by Hans Berger (1873-1941) in the 1920s. However, such concepts were first formulated and confirmed almost a century earlier in the 1840s by Robert Bentley Todd (1809-1860), influenced by his contemporary in London, Michael Faraday (1791-1867), who at that time was laying the foundations of our modern understanding of the interchangeable polar forces of electricity and magnetism.
Robert Bentley Todd
Robert Bentley Todd (1809-1860)
Todd was born in Dublin, the second son of a large and distinguished Anglo-Irish family, whose father, Charles Hawkes Todd, was professor of anatomy and surgery at the Royal College of Surgeons in Ireland of which he was also president in 1821. He trained in Medicine at Trinity College and the Richmond Hospital, where he was influenced by Robert Graves (1796-1853). He qualified at his father’s college in 1831 and immediately proceeded to England where in 1833 he was awarded a BM by Oxford University. In 1836, at the remarkable age of 27 years, he was appointed to the chair of physiology and morbid anatomy at King’s College in London. Todd was the prime mover in founding King’s College Hospital in 1840 where he became its most eminent physician. He was a gifted teacher and administrator who transformed the fortunes of the Medical School of which he became the first dean in 1842. His lectures on physiology were the first of their kind in the U.K. and prompted other medical schools to emulate. By 1838, he was already elected a Fellow of the Royal College of Physicians and the Royal Society in London.
As a scientific physician, Todd made several contributions to the understanding and treatment of infectious, gastro-intestinal, and rheumatic diseases, but his main interest was always the nervous system. His many outstanding observations in neuroanatomy, neurohistology, neurophysiology, neuropathology, and clinical neurology are described in several major works. He was the first to identify the functions of the posterior columns of the spinal cord and to separate spinal ataxia from spinal paraplegia. Gowers credits Todd with the first exact account of locomotor ataxia or tabes dorsalis and “if any name is attached to it, that of Todd alone can be right.” His clinical lectures on paralysis, based on the clinical and pathological study of 83 cases, are a milestone in the history of stroke. They include the first description of transient post-ictal paralysis, which a generation later John Hughlings-Jackson (1835-1911) referred to as “Todd’s Paralysis” and for which Todd is perhaps best remembered today, although it is a small part of his contribution to neurology. He also distinguished the “irritating” (epileptic) from the “paralyzing” phenomena of cerebral lesions, which are now associated with the later similar concepts of Jackson who used the words “discharging” and “destroying.”
Michael Faraday
Michael Faraday (1791-1867)
Michael Faraday was born in London into a poor blacksmith’s family. He had little education but, as an apprentice bookbinder, he devoured the scientific books he was binding. Through his own initiative and good fortune, he was appointed in 1813 as a laboratory technician to Sir Humphrey Davy (1778-1829), professor of chemistry and director at the Royal Institution in Albemarle St., London, close to King’s College in the Strand. Among Davy’s important achievements, he discovered sodium, potassium, chlorine, calcium, and magnesium, using the Voltaic Pile. Faraday remained at the Royal Institution for more than 50 years, rising to surpass Davy and to become one of the greatest experimental philosophers of all time. The practical consequences of his discoveries have profoundly influenced the nature of civilized life.
Faraday studied all forms of electricity: voltaic, common, magneto, thermo, and so-called “animal” electricity, and considered that the various types were fundamentally the same. He examined the inter-conversion of energies, not only electricity and magnetism, but also light, heat, and gravity, which was the basis for the later law of the conservation of energy. His meticulous diaries record that on Oct. 22, 1838, Todd was present during his experiments on the “animal” electricity generated by the electric eel (Gymnotus). Also present on that occasion were two of Todd’s distinguished colleagues from King’s College: Prof. John Frederick Daniell (1790-1845), who was the first professor of chemistry (1831-1845) and invented the first constant cell battery (the Daniell battery) and Prof. Charles Wheatstone (1802-1875), who was the first professor of experimental philosophy (1834-1875) and developed the first electric telegraph. Both were good friends of Faraday, sharing a common interest in electricity, and no doubt they introduced him to Todd, their new, young technical scientific colleague.
The Electrical Basis of Nerve Conduction and Brain Activity
A central nervous system “vesicle” and related “fibers” (neurone in later terminology). From Todd R.B. and Bowman W. The physiological anatomy and physiology of man – Volume 1, Parker, London, 1845
Todd applied the electrical concepts of Faraday to nervous conduction and to brain activity, especially epilepsy. He wrote: “Adopting the language of the illustrious Faraday which expressed with clearness and precision the fundamental phenomena of the electric force, we may call the nervous power a polar force, generated in the centres and propagated by the rapid polarization of the neighboring particles in various directions.”
With his junior colleague William Bowman (1816-1872), Todd was a pioneering microscopist and neurohistologist. He was the first in the U.K. to apply Schwann’s (1839) cell theory to the nervous system. He recognized that the “vesicles” he observed corresponded to Schwann’s cell bodies. Furthermore, the vesicles had one or several nerve fibers (later called axons) connected to them and that every nerve fiber was connected to a vesicle which was the point of departure for one or many fibers. He brilliantly foresaw that each nerve vesicle and its associated fibers, i.e. neurone in later terminology, was a distinct apparatus for the generation and propagation of “nervous polarity.” Todd was unquestionably the first to develop the concept of nervous polarity to explain nerve cell conduction, facilitated by the insulating properties of Schwann’s white matter (myelin). In the process, he introduced the concept of “afferent” and “efferent” into neuroscience to explain the direction of conduction. These were the foundation stones of what decades later became known as the “neurone doctrine.”
The Electrical Basis of Epilepsy
In his 1849 Lumleian Lectures to the Royal College of Physicians, Todd discarded current vascular or inflammatory theories of epilepsy and developed a radically new electrical theory based on his new understanding of nervous polarity, influenced by Faraday’s concepts of the interchangeable polar forces of electricity and magnetism. He had learned from Faraday how a rise in electrical tension could, at a certain threshold, result in a sudden change in polar state, like the spark from a battery or lightning. Todd conceived of epilepsy as “periodical evolutions of the nervous force comparable to the electrical phenomena described by Faraday under the name of ‘disruptive discharge’.” In convulsions, he envisaged the polar tension in the grey vesicular matter of the hemispheres and mesocephale rising to the highest degree and a rapid discharge taking place “exciting the other parts of the brain and spinal cord with all the violence of the discharge from a highly charged Leyden Jar.”
Todd investigated and confirmed his theory in rabbits utilizing galvanic stimulation with a magnetoelectric machine designed by Faraday. Tonic-clonic seizures were elicited by stimulation of the mesocephale and corpora quadrigemina. Stimulation of the spinal cord and medulla elicited tetanic muscular phenomena. The loss of consciousness in epilepsy he attributed to the involvement of the highest hemispheric vesicular grey matter. It was not until 20 years later that Fritsch and Hitzig discovered the motor cortex in electrical stimulation experiments in dogs, but Todd was aware that superficial tuberculous or syphilitic lesions of the human cortex could result in unilateral motor convulsions in the limbs on the opposite side of the body. He stated: “Hence, we must not deny to these hemispheric lobes a certain power of exciting motion either directly or indirectly through their influence on other ganglia of the brain.”
Subsequent Developments
Electrical concepts of brain activity were not widely accepted until the discovery of the human EEG by Berger in the 1920s although further hints can be traced to the cortical stimulation experiments of Gustav Fritsch (1838-1927) and Eduard Hitzig (1839-1907) and of David Ferrier (1843-1928), and also the evoked potential studies of Richard Caton (1842-1926), all in the 1870s. Epilepsy continued to be widely viewed as a disorder of the cerebral circulation until the 1930s, when EEG studies confirmed the concept of electrical discharges in seizures of different types.
By then, Todd’s studies, concepts, and priority had been forgotten. Some retrospectively gave credit to Jackson for his concept of “discharges of grey matter,” but Jackson never acknowledged Todd’s priority even in his own Lumleian Lectures on the same topic of epilepsy a generation later in 1890. The philosophical Jackson admitted he had no knowledge of physics, and he tended to rely on Ferrier on scientific matters. It is unlikely that the neurophysiologist Ferrier was unaware of Todd’s priority as he worked at the same King’s College Hospital and regularly passed Todd’s statue in the lobby of the hospital.
In 1906, Santiago Ramón y Cajal (1852-1934) and Camillo Golgi (1843-1926) received the Nobel prize for their contribution to the “neurone doctrine,” the foundations of which were already laid by Todd but not acknowledged. In 1963, Alan Hodgkin (1914-1998) and Andrew Fielding Huxley (1917-2012) received the Nobel prize for identifying the ionic basis of Todd’s nervous polarity. Interestingly, the theory involved the same ions that Faraday’s mentor, Sir Humphrey Davy, had discovered, i.e. sodium, potassium, chlorine, calcium, and magnesium. The table illustrates the progression over a century and a half of our knowledge of brain electricity or nervous polarity from Davy’s discovery of the appropriate ions through the work of his pupil Faraday, who so profoundly influenced his clinical and scientific contemporary in London, Todd, down to the discovery of the ionic basis of neurotransmission by Hodgkin and Huxley.
Conclusion
Todd died in 1860, the same year as the foundation of the National Hospital for the Paralysed and Epileptic in Queen Square, a short walk from the first King’s College Hospital founded by Todd. His colleagues were so impressed with his many achievements that they commissioned a statue which stands today outside the third King’s College Hospital on Denmark Hill, South London. This was in recognition of his contribution to King’s College, to the hospital, to clinical and scientific medicine, including paralysis, and to medical and nursing education. What is not mentioned and was little understood at the time was his contribution to neuroscience, especially the electrical basis of nerve conduction and brain activity, and its application to neurology, especially epilepsy, influenced by his contact with and understanding of the scientific achievements of Faraday. Todd was so far ahead of his time that many of his neuroscientific achievements were overlooked, soon forgotten and credited to others, but now deserve greater recognition by historians of neuroscience and neurology. •
Edward H. Reynolds MD, FRCP, FRCPsych, works in the Department of Clinical Neurosciences at King’s College, London, U.K.
References
Binder/ DK, Rajneesh/ KF, Lee/ DJ, Reynolds E.H, Robert Bentley Todd’s contribution to cell theory and the neuron doctrine. Journal of the History of the Neurosciences 2011;20:123-134
Reynolds E.H. Todd, Faraday and the electrical basis of brain activity. Lancet Neurology 2004;3: 557-563
Reynolds E.H. Jackson, Todd and the concept of ‘discharge’ in epilepsy. Epilepsia 2007;48:2016-2022
Reynolds E.H. Robert Bentley Todd. In: Pioneers of Irish Neuroscience: a history of brain science in Ireland. Eds: Kelly A, Zarka Z, Roche R. Lettertec Publishing, Cork, 2022, pp47-51
Election Announcement
In March, the Nominating Committee of the WFN invited nominations for the positions of:
Secretary General [4-year term]
To take office from Jan. 1, 2023
Position vacated by Prof. Dr. Wolfgang Grisold
Candidates (in alphabetical order)
- Marianne de Visser
- Steven Lewis
- Tissa Wijeratne
One Elected Trustee [3-year term]
To take office immediately following the council of delegates meeting.
Position vacated by Dr. Steven Lewis upon the end of his second term of office
Candidates (in alphabetical order)
- Minerva López Ruiz
- Chandrashekhar Meshram
- Bo Norrving
- Mohammad Wasay
As in the previous two elections—2020 and 2021—voting will take place by remote online ballot. This method of voting enables all member societies to vote in the elections, regardless of whether or not they are able to attend the Council of Delegates meeting, but also reduces the impact that adverse conditions, such as differences in time zone or difficulties caused by COVID restricted travel, may have to sound decision-making when voting.
Voting will take place between Oct. 3-16, 2022, before the WFN AGM Council of Delegates meeting.
Further information on how to vote, including an instructional video, will be sent out to WFN member societies on Sept. 5 together with online registration to attend the AGM.
The results of the voting will be announced during the Council of Delegates meeting. •
Announcing the 32nd International Congress of Clinical Neurophysiology
The 32nd ICCN 2022 in Geneva, Switzerland, encompasses 38 education courses and 66 scientific sessions, with 286 speakers. The “Eighth International Conference on Non-Invasive Brain Stimulation” will take place as part of ICCN, consisting of 38 Brain Stim talks (both courses and sessions as a continuous track).
Course and symposium tracks are organized into these topics:
- EEG and MEG
- Brain Stimulation
- Peripheral Neurophysiology
- Brainstem Neurophysiology
- Pediatric Neurophysiology
- Intraoperative Neuromonitoring
- Intensive Care Neurophysiology
Plus, ICCN will host over 300 posters, plus an exhibit hall of related products and services.
Late-breaking poster abstracts can be submitted until June 30.
Here is the link to the preliminary program: https://ifcn.site-ym.com/mpage/ProgrammeOverview.
For more information, visit: http://www.iccn-congress.org. See you in Geneva! •
International Headache Society Global Patient Advocacy Coalition (IHS-GPAC)
IHS-GPAC recognizes Fujitsu as a world leader in migraine awareness, education, and employee support in the workplace
Fumihiko Sakai, David W. Dodick
On behalf of Prof David Dodick, chair of IHS-GPAC (right, on the screen), Prof. Fumihiko Sakai (third from the left) in Japan presented the plaque “International Headache Society Global Patient Advocacy Coalition recognizes Fujitsu Limited as a World Leader Migraine Workplace Awareness, Education, and Employer Support Program,” 2019-2022. CEO of Fujitsu; Takahito Tokita (second from the left). Dr. Hitoshi Miyake (head of Health Promotion Unit-left) and Dr. Hisaka Igarashi-right). Also speaking at this event were Prof. Cristina Tassorelli, president of the International Headache Society and Prof. Wolfgang Grisold, president of the World Federation of Neurology.
The impact of migraine on people’s professional lives, work productivity, and interpersonal relationships at work eventually affects everyone, has a significant detrimental effect on people with migraine, and exacts a huge cost in terms of lost productivity. People with migraine want to work, so they do their best to work despite intense pain and debilitating neurological symptoms. Most of migraine-related productivity loss1 is due to presenteeism. People are less than half effective during a migraine attack due to the pain, neurological symptoms, attack unpredictability, other diseases associated with migraine, emotional impact, under-diagnosis and under-management, and stigma. Migraine-related productivity loss may negatively affect people’s career choice, job security, opportunities for promotion, financial status, work relationships, mood, and confidence.
The International Headache Society Global Patient Advocacy Coalition (IHS-GPAC) was created to “understand and promote the global, regional, and local interests of people with recurrent headache disorders”2. Given the significant impact of migraine during people’s peak productive years, one of the priorities of the IHS-GPAC was to create a migraine at work fitness program to enhance awareness and disease education, empower employees to seek treatment, reduce stigma, and ensure access to support and care3.
The IHS-GPAC has collaborated with Fujitsu, one of the largest information technologies (IT) companies in Japan. This project has an emphasis on migraine awareness, education, and employee support. Fujitsu and the IHS-GPAC developed and implemented training programs for employees globally in the workplace to promote awareness and treatment of headache disorders, as well as prevention programs for employees who have headache disorders. Fujitsu’s efforts were recognized by the IHS-GPAC, and a certificate of excellence was awarded on March 2, 2022, as a model case of corporate measures to support employees living with headache disorders4.
IHS-GPAC Awarded Fujitsu Project
The CEO of Fujitsu reported in his bulletin on the company’s Headache Project:
“Since 2018, in collaboration with the World Health Organization, the International Headache Society, and the Japanese Headache Society, Fujitsu has conducted employee surveys on the degree to which chronic headaches interfere with work in the workplace. As a result, we learned that 85% of employees were aware of having headaches, of which 84% had never been treated. The knowledge prompted us to start the Fujitsu Headache Project in 2019. To date, 73,000 employees in Japan have completed an e-Learning module that is designed to improve understanding of headaches, the impact they have on our lives, and how to deal with them. In addition, in cooperation with Fujitsu Clinic, we started a headache counseling program run by specialists for employees and their families. In recognition of these initiatives, on March 2 the Global Patient Advocacy Coalition of the International Headache Society named Fujitsu as “a world leader” in migraine workplace awareness, education, and employee support programs. Fujitsu is the first corporation in the world to be designated as a leader in this way.
What is most important in dealing with headaches is raising everyone’s awareness of headaches and getting them to think about headaches as an issue that may affect them. For people who suffer from headaches, it is important for them to learn and put into practice appropriate ways of dealing with headaches, and for people who do not suffer from headaches, it is important that they learn the true facts about headaches and support their colleagues who suffer from them.
In Japan, already over 90% of employees have taken part in Fujitsu’s headache education e-Learning program, and we also want to promote a better understanding of headaches to our employees outside of Japan, as well.”
One of the typical examples who received benefit from the project was a woman with chronic migraine whose work productivity was negatively affected by migraine, yet she was patient and diligent. Since she has been receiving migraine treatment through the headache clinic, the negative impact of migraine on her functioning and quality of life decreased to 10% to 20% of the pretreatment. Her senior colleagues congratulated her success in regaining healthy work.
The leadership demonstrated by Fujitsu serves as a model to emulate and will guide future IHS-GPAC activities. We will continue our effort to implement the migraine fitness at work program in other companies throughout Japan and around the world. •
References
- Shimizu T, Sakai F, Miyake H, Sone T, Sato M, Tanabe S, et al. Disability, quality of life, productivity impairment and employer costs of migraine in the workplace. J Headache Pain. 2021 Apr 21;22(1):29.
- Dodick D, Edvinsson L, Makino T, Grisold W, Sakai F, Jensen R, et al. Vancouver Declaration on Global Headache Patient Advocacy 2018. Cephalalgia. 2018 Nov;38(13):1899–909.
- Dodick DW, Ashina M, Sakai F, Grisold W, Miyake H, Henscheid-Lorenz D, et al. Vancouver Declaration II on Global Headache Patient Advocacy 2019. Cephalalgia. 2020 Sep;40(10):1017–25.
- Fujitsu Honored by the International Headache Society – Global Patient Advocacy Coalition as a World Leader in Migraine Workplace Awareness, Education, and Employee Support Programs [Internet]. Fujitsu Global. [cited 2022 Mar 19]. Available from:
https://www.fujitsu.com/global/about/resources/news/press-releases/2022/0302-01.html
Note: The WFN has no financial relationship or any other conflicting interests with Fujitsu.
COVID-19 and Neurology Update
By B. Jeanne Billioux, MD, and Avindra Nath, MD, and edited by Chandrashekhar Meshram, MD
In this month’s neurology and COVID-19 review, we’ve included several topics that have arisen in the literature and news, including new updates regarding long COVID/PASC and neurologic outcomes of infants born to mothers with COVID-19.
Post-acute sequelae of SARS-CoV-2 (PASC) or long COVID continues to be a puzzling entity. However, numerous new studies are underway to help better understand the nature of this syndrome and the mechanisms involved in its pathogenesis, including neurologic aspects.
This month, the initial findings from the University of San Diego NeuCOVID longitudinal cohort study was published, describing the neurologic manifestations in two cohorts: Patients referred to the neurology department after recovering from COVID-19, and patients with pre-existing neurologic disorders who subsequently were diagnosed with COVID-19.
In this cohort of 56 patients, fatigue was the most commonly reported symptom at baseline (89.3%), followed by headache (80.4%), insomnia (66.1%), and memory impairment (64.3%). Almost all patients had a baseline assessment at least 28 days after onset of neurological symptoms, with a median of 16 weeks from infection. In those who were able to follow up six months later, a small number (n=9) noted resolution of their symptoms, but others reported persistent fatigue (52.2%), memory complaints (68.8%), insomnia (51.3%), headache (45%), and difficulty concentrating (47.6%). However, many of these symptoms had lessened in severity.
MOCA scores generally improved over time in patients who were able to follow up (from average score of 26 to 28/30), although MOCA scores declined in about one quarter or these patients. Interestingly, a small subset of patients (7.1%) displayed a triad of symptoms, including tremor, ataxia, and cognitive dysfunction (Shanley 2022).
Another neurologic post-COVID study from Italy found that PASC patients could usually be grouped into two cohorts of PASC/long-COVID based on their neurologic symptoms. The first cohort typically presented with a constellation of memory issues, headache, psychological issues, anosmia, and ageusia; the second cohort presented with symptoms referrable to the peripheral nervous system (PNS). Upon analysis of risk factors for either cohort, the cohort with PNS-related symptoms was found to be more likely to have had a larger number of comorbidities at onset, a more severe course of COVID-19, as well as a higher number of non-neurologic COVID complications (Grisanti 2022). Longitudinal cohorts such as these will be informative for the natural history of PASC and its neurologic manifestations, as well as the potential long-term socioeconomic impact, and will help guide modes of intervention.
Several studies are ongoing to elucidate the pathogenesis of the neurologic sequelae of COVID-19. A paper published in Cell this month described diffuse microglial cell activation in the brain of patients who had died despite a mild respiratory infection with SARS-CoV-2. This was replicated in a humanized mice model of a mild form of SARS-CoV-2 infection. There was no evidence of SARS-CoV-2 neuroinvasiveness (as evidenced by lack of virus in the CNS), however the mice displayed elevated levels of cytokines in both the serum and CSF at 7 days post-infection. Moreover, these mice were found to have increased levels of microglial/macrophage reactivity in the subcortical white matter, as well as upregulation of inflammatory gene expression in these microglia. They also found that the hippocampi of these mice had microglial/macrophage activation with impairment of neurogenesis that persisted several weeks post infection. This was accompanied by decreased levels of oligodendrocytes and oligodendrocyte precursor cells in the subcortical white matter. These findings suggest that even mild infections with SARS-CoV-2 may lead to persistent neurologic inflammation, myelin dysregulation, and decreased hippocampal neurogenesis, which may lead to the neurologic symptoms currently seen in long COVID/PASC, such as memory impairment and “brain fog” (Fernández-Castañeda 2022).
Another interesting topic in the news this month is on the outcome of infants born to mothers infected with SARS-CoV-2. A cohort study of 7,772 infants, with 222 infants born to mothers who tested positive for SARS-CoV-2 during pregnancy, found that infants born to mothers with COVID-19 during pregnancy had a higher risk of being diagnosed with neurodevelopmental abnormalities over a 12-month time period (OR 2.17), with a higher risk (OR 2.34) associated with infections during the third trimester. This risk was present after adjusting for a variety of factors, including preterm labor (which can be associated with SARS-CoV-2 infection (Edlow 2022). These findings warrant further evaluation, but could reflect potential detrimental effects of SARS-CoV-2-related inflammation on fetal brain development, similar to other known maternal infections. •
Avindra Nath, MD, is chief of the Section of Infections of the Nervous System and Clinical Director, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health in Bethesda, Maryland.
B. Jeanne Billioux, MD, is staff clinician and head of the program in International Neuroinfectious Diseases within NINDS. Her research focus is on emerging infectious diseases and conducting research on the neurological consequences of infections in an International setting.
Chandrashekhar Meshran is co-opted trustee of the WFN.
References
Shanley JE, Valenciano AF, Timmons G, Miner AE, Kakarla V, Rempe T, Yang JH, Gooding A, Norman MA, Banks SJ, Ritter ML, Ellis RJ, Horton L, Graves JS. Longitudinal evaluation of neurologic-post acute sequelae SARS-CoV-2 infection symptoms. Ann Clin Transl Neurol. 2022 Jun 15. doi: 10.1002/acn3.51578. Epub ahead of print. PMID: 35702954. DOI: 10.1002/acn3.51578
Grisanti SG, Garbarino S, Barisione E, Aloè T, Grosso M, Schenone C, Pardini M, Biassoni E, Zaottini F, Picasso R, Morbelli S, Campi C, Pesce G, Massa F, Girtler N, Battaglini D, Cabona C, Bassetti M, Uccelli A, Schenone A, Piana M, Benedetti L. Neurological long-COVID in the outpatient clinic: Two subtypes, two courses. J Neurol Sci. 2022 Jun 3;439:120315. doi: 10.1016/j.jns.2022.120315. Epub ahead of print. PMID: 35717880; PMCID: PMC9212262. DOI: 10.1016/j.jns.2022.120315
Fernández-Castañeda A, Lu P, Geraghty AC, Song E, Lee MH, Wood J, O’Dea MR, Dutton S, Shamardani K, Nwangwu K, Mancusi R, Yalçın B, Taylor KR, Acosta-Alvarez L, Malacon K, Keough MB, Ni L, Woo PJ, Contreras-Esquivel D, Toland AMS, Gehlhausen JR, Klein J, Takahashi T, Silva J, Israelow B, Lucas C, Mao T, Peña-Hernández MA, Tabachnikova A, Homer RJ, Tabacof L, Tosto-Mancuso J, Breyman E, Kontorovich A, McCarthy D, Quezado M, Vogel H, Hefti MM, Perl DP, Liddelow S, Folkerth R, Putrino D, Nath A, Iwasaki A, Monje M. Mild respiratory COVID can cause multi-lineage neural cell and myelin dysregulation. Cell. 2022 Jun 13:S0092-8674(22)00713-9. doi: 10.1016/j.cell.2022.06.008. Epub ahead of print. PMID: 35768006; PMCID: PMC9189143. DOI: 10.1016/j.cell.2022.06.008
Edlow AG, Castro VM, Shook LL, Kaimal AJ, Perlis RH. Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy. JAMA Netw Open. 2022 Jun 1;5(6):e2215787. doi: 10.1001/jamanetworkopen.2022.15787. PMID: 35679048; PMCID: PMC9185175. DOI: 10.1001/jamanetworkopen.2022.15787
Public Education Activities in India
By Chandrashekhar Meshram, Nirmal Surya, U Meenakshisundaram, and Gagandeep Singh.
The Indian Academy of Neurology is highly committed to public education and awareness activities regarding neurological disorders. It carries these events throughout the year. The idea is to educate general public about the disorders in order to help them for early diagnosis and better patient care. In view of the COVID pandemic, these activities were organized as virtual meetings and were well attended. The audience also got the opportunity to interact with the experts.
IAN President Nirmal Surya inaugurated the events. National coordinator for IAN public awareness programs, Chandrashekhar Meshram, had prepared and released the press notes and organized the sessions. Articles were published in leading newspapers. Some sessions were also organized in regional languages.
World Neglected Tropical Diseases Day – Jan. 30
NTDs are widespread in the world’s poorest regions, where water safety, sanitation, and access to health care are substandard. NTDs affect over 1 billion people globally and are caused mostly by a variety of pathogens including viruses, bacteria, parasites, fungi, and toxins. Gagandeep Singh, president-elect of IAN, Manish Modi, Shripad Pujari, Devashish Ruikar, Rajesh Verma, and Chandrashekhar Meshram were the expert panelists. Rahul Kulkarni, chair of Tropical Neurology subsection of IAN, was the moderator.
International Epilepsy Day – Feb 14
Epilepsy is a social stigma and the attitude of the community toward people with epilepsy is negative. Although epilepsy can be controlled by medicines in 75% of people, there is a treatment gap of 80% in those living in low middle income countries due to lack of knowledge and unavailability of medicines. Sangeeta Rawat, Chaturbhuj Rathod, Sita Jayalakshmi, and Dinesh Nayak participated in panel discussion. IAN Secretary U Meenakshisundaram moderated the session. Programs were also organized regionally by Gautam Ganguly, M A Aleem, K Ummer, and U Meenakshisundaram.
World Tuberculosis Day – March 24
Tuberculosis is the deadliest infectious disease killer and is endemic in 22 countries. The theme for the year is “invest in TB to save lives.” About one lakh cases of TB meningitis are diagnosed each year with mortality of about 30%. Sarosh Katrak, Ravindra Kumar Garg, Rohit Bhatia, and Thomas Lype interacted with moderators Rahul Kulkarni and Manish Modi to highlight different aspects of CNS TB.
Purple Day – March 26
Purple Day is an international grassroots effort dedicated to increasing awareness about epilepsy worldwide. Mamta Bhushan Singh, Ashalata, Amit Haldar, and Jayanti Mani participated in the event moderated by Sita Jayalkshmi. M A Aleem’s interview was published in the newspaper.
World Autism Awareness Day – April 2
Autism Spectrum Disorders are on the rise, and one out of 150 children may suffer from the same. A child who has difficulty in communication, difficulty in socialization, and peculiar traits like repetitive speech and behavior, usually should be suspected for autism. It is important to diagnose and intervene early. The condition is four times more common in boys as compared to girls. Environmental and genetic factors may be responsible.
There is no cure for autism but through a multidisciplinary team approach, patients can be helped to a great extent. Vrujesh Udani, Alka Subramanyam, Shefali Gulati, Koyeli Sengupta, Sonal Chitnis, Trupti Nikhalje were the panelists. Pediatric Neurology Subsection Convener K P Vinayan moderated the session. Priyadarshini Raut, parent of autistic child, narrated her experiences and triumph over the condition of her son who became an engineer and is working for a software company.
World Parkinson’s Day – April 11
This day symbolizes a time to raise awareness and advance research toward better therapies and a cure for Parkinson’s disease (PD). There are about 9 million patients with Parkinson’s Disease worldwide. With increase in life expectancy, the prevalence of this neuro-degenerative disease is on the rise.
Sanjay Pande, Rajinder Dhamija, U Meenakshisundaram, and Sumit Singh shared their views and interacted with movement disorder subsection chair Achal Shrivastava and convener Ravi Yadav.
World Multiple Sclerosis Day – May 30
Every five minutes, someone receives the life-altering diagnosis of multiple sclerosis. More than 2.8 million people of all ages live with multiple sclerosis around the world. This neurological disease impacts every aspect of a person’s life, with effects ranging from cognitive impairment to significant physical disability. Early diagnosis and access to proven disease-modifying treatments are vital to improving patient quality of life and significantly halting disease progression. Dheeraj Khurana, Lekha Pandit, R. Suresh Kumar, and Kunal Bahrani were the panellists while Manish Mahajan moderated the session.
IAN is planning to celebrate World Brain Day on July 22 in grand way with 100 activities over the week. •
Chandrashekhar is the co-opted trustee of the WFN, U Meenaksshisundaram is IAN secretary, Gagandeep Singh, is president-elect of IAN, and Nirmal Surya is IAN president.
A View From the Top
Wolfgang Grisold
This is the second issue of World Neurology this year, and I will take the opportunity to update you on the activities of the WFN. I will comment on the global situation, and then describe the internal developments of the WFN also in regard to future aspects, the persistence of COVID, the important advent of the “Intersectoral Global Action Plan” (IGAP) and World Brain Day 2022, “Brain Health for All.”
Global Situation
Due to ongoing wars, conflicts, and crises worldwide, I would like to emphasize the WFN‘s statements on armed conflict and wars and also encourage donation to professional organizations.
The global situation on wars, conflicts, refugees, displaced persons, and the effects on neurology and neurological patients is severe, and the WFN is deeply concerned. The WFN condemns any conflicts of war. It cannot be stressed enough that our role is to advocate for neurology, patients and caregivers who are endangered in these situations, and the reduction of access to care and treatment. Any armed conflict will also cause new casualties and victims, many of them with neurological sequelae and also subsequent mental conditions.
The role of the WFN as a scientific society, composed of 123 member societies, is building bridges between societies, members, medical disciplines, patients, and caregivers.
The WFN encourages the support to migrants, refugees, displaced and stateless persons, and victims of conflict worldwide. As a charity, we are primarily concerned with people with neurological disorders, their access to care, and the provision of essential drugs. We have indicated organizations that are experienced in global crises, and encourage donations for the purpose to support neurological patients.
Internal Developments
The year 2022 marked the time of a new administration. The strategy is to build on established structures and evolution as well as the integration of new developments.
The WFN is working on the improvement of communication with its member societies, further developing educational tools, such as the e-learning hub and educational days, among others. The experience with the previous WFN e-learning days has been successful, and the format and time of these events has been well accepted. The possibility of short-term educational interventions has been demonstrated in a recent SNO-WFN webinar on scientific advances on neuro-oncology, which was well-attended. We want to thank our partners including AFAN, EAN, AAN, IHS-GPAC, and SNO for their support. We believe these newly added educational concepts of virtual interventions will be important.
Basic administrative structure of the WFN in London. The office presently has four staff members who administer and coordinate the WFN affairs. External IT aspects and the management of Continuum are conducted by local and experienced collaborators (IT=information technology; PCO=professional conference organizer; PR=public relations)
The WFN has several committees, which act on behalf of the trustees. For the new administrative period, we have decided to adapt some of the committees and also add several subcommittees for specific purposes such as gender and diversity, young neurologists, teaching centers as well as a patient platform, among others. Based on the virtual WFN regional meeting in January-February 2022, we have selected chairs and filled the positions with suggestions from the regions. We have also increased the ratio of females from 10% to 40%, and we are committed to continue to adapt gender balance.
At this point, I also want to thank the outgoing chairs and members of the committees for their devotion and dedication to the WFN. Rotation of positions is necessary in such a large organization, and even if the terms end, we hope that all previous members will continue working with us supporting the WFN or in other future functions. The list of the new committees will be available on the website, and we will continue to introduce committees in World Neurology.
Other current tasks include preparation for the next Council of Delegates (COD) meeting this October 2022 in Amsterdam, where a new Secretary General and and one trustee will be elected. The WFN met with the AAN in a leadership meeting, and this is also planned with the EAN and with AOAN.
The preparation of the WCN 2023 is proceeding, and the WCN program committees have started their work. A preliminary program will appear soon. The preliminary work for WCN 2025 in Korea is also ongoing.
Define the Future
The WFN has reached a critical size and has globally a wide span of activities, which make a permanent and reliable organizing, planning and administrative structure necessary. This includes long-term planning and decisions, and availability with regard to resources both personal and financial.
The WFN, being a U.K. charity, guarantees a strict and well-assessed structure, which is taken care of by the trustees with the support of the WFN staff in London and is regularly audited each year. These administrative tasks, projects, and communicative tasks, are carried out by the office staff and externally with the help of Chiu, Helen Gallagher, our professional conference organizer (PCO), Freedman (our financial consultant), and Yakkety Yak, our public relations consultant, which make the WFN a complex structure.
Congress organization is done by a PCO, and the organization of WBD and Brain Health by a PR expert company.
We appreciate that the interest and trust in the WFN is high and increasing from the standpoint of cooperations. Any project taken up by the WFN needs administration and monitoring, and increasingly, project management tools will have to be used to define capacities to the extent that projects can be supported.
For education, the projects will be based on a needs assessment, which will be the basis of future development of all educational activities. We are also supportive of the concept of CME and Continuous Professional Development, which is lifelong learning for neurologists. There are several worldwide concepts such as the AAN’s Continuum, and the European EACCME model, which offer a widespread and detailed choice of CME educational methods and models. We are happy to say that the WFN congresses (World Congress of Neurology) are always accredited with up to 40 credits from EACCME , and we have always passed the strict and thorough definitions for these meetings. They are valid for AMA and the Canadian Royal College of Physicians.
Education in neurology is needed at all levels and is a continuous process. In addition to practical and scientific content, the importance of advocacy as well as leadership will have to be implemented in the strategy of our educational programs. We are committed to our concepts of department visits and training centers, and will report on these developments in the next issue.
COVID Is Continuing
I want to remind our readers that the COVID pandemic is not over yet, and travel and communication is still at risk. This also relates to the planning of the World Health Assembly (WHA) meeting in Geneva as well as to the COD meeting in Amsterdam.
The WFN has updated the COVID website and the Specialty Group on Tropical Neurology is providing monthly updates. Also Elsevier will provide a collection of COVID papers published in ENS (and in the future, JNS) and can be found on the COVID site: https://www.sciencedirect.com/journal/eneurologicalsci/special-issue/1006JKSX5HX.
The WFN also actively works with the WHO in several working groups on the neurological effects of COVID in both acute and late effects.
The pandemic had and still has catastrophic effects on patients and caregivers, not only as limited access to care and reduced capacities, but also medical and bureaucratic hurdles. It has to be assumed that the indirect damage to acute and chronic neurological patients is high and will take considerable time to return to normal.
As neurologists, we have to take care of the so-called soft facts such as communication, personal interaction, quality of life, and that the needs of patients and caregivers are addressed.
Intersectoral Global Action Plan (IGAP)
Much energy and effort is being invested in the WHO’s International Global Action Plan (IGAP). I want to thank my predecessor William Carroll and Alla Guekht and Kimberly Karlshoej for their continuous efforts. This is a good example of a project that will have a worldwide impact, but is also a good example of worldwide cooperation.
IGAP is about to be accepted at the WHA in Geneva in May 2022. The WFN has been working with other societies such as the ILAE, the World Stroke Organization, Movement Disorders Society, and the International Headache Society on this development.
It is based on a long and fruitful cooperation with the WHO, which has several landmarks and previous books, including two editions of the Atlas and also the development of ICD 11. This IGAP will elevate the importance of neurology worldwide and will enable countries to use this WHO initiative for the establishment or development of neurology.
A brain health unit has been created by the WHO, which indicates the importance of brain health worldwide. (https://www.who.int/health-topics/brain-health#tab=tab_1).
Once the IGAP is accepted, the implementation of the IGAP will need the full attention for new projects with the WHO and with individual societies to implement this exciting program.
World Brain Day Topic
This year‘s World Brain Day (WBD) will be dedicated to “Brain Health for All.”
It is chaired and organized by our Public Awareness Committee by Tissa Wijeratne and David Dodick, with professional assistance from Yakkety Yak, which has taken care of the last WBDs. The committee consists of representatives from the WFN regions, and it is hoped that this WBD will underline the importance of brain health globally. We hope to align with the WHO in this important activity. The intent is not only to reach as many regions as possible, but also customize our WBD tools for individual use and we hope that many, if not all, WFN member societies will be able to celebrate with the WBD in their regions and use this topic to promote neurology at all levels. The topic of this year’s WBD also aligns with the upcoming IGAP, which will be approved by the WHA in May.
The view of the WFN is that brain health has a wide span from intrauterine life toward childhood, adulthood, and into aging in regard to neurological function, dysfunction, rehabilitation, and palliative care.
The selection of the topic “Brain Health for All” is based on the WFN’s 2021 brain health campaign (https://wfneurology.org/brain-health-initiative) and the cooperation with the WHO. Also regional societies including the EAN are committed to brain health, such as the European Brain Health Summit meeting in May 2022 (https://www.ean.org/ean/advocacy/brain-health). There will also be a brain health session at the EAN congress in Vienna.
This was a short update on the current proceedings of the WFN, including several cooperations and developments. Please follow us on the website and social media.
If you have comments or questions, please contact us at info@wfneurology.org. •
Prof. Jun Kimura (1935-2022) Father of Electrodiagnostic Neurology
By Ryuji Kaji
Dr. Jun Kimura was born on Feb. 25, 1935, in Kyoto, Japan, and was brought up in Takayama, a scenic rural place near Kyoto. He once graduated from School of Technology in 1957, but re-entered Medical School of Kyoto University, and obtained MD (1961). He was granted a Fulbright Scholarship (1962-1967), and began his career at the University of Iowa School of Medicine as a medical resident and fellow (1962-1968), associate professor (1972-1977), and professor (1977-1988).
I first met him in my junior neurology residency in 1981, when he was invited to give a lecture on blink reflex and facial palsy at the time of the World Congress of Neurology in Kyoto. I was fascinated by his unique way of presentation, both informative and amusing. After his talk, I tried to talk to him in English, but was surprised to hear his Japanese reply. Having had a few minutes of conversation, I became aware of his kindness, generosity, and humility. He published a famous textbook, “Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice,” in 1983, which at once became the standard for neurologists, and determined my career as an electromyographer.
After completing my MD, PhD course in Kyoto, I was fortunate to have a position of clinical fellow at the Hospital of the University of Pennsylvania in 1985, and Dr. Austin Sumner became my first mentor of EMG. Dr. John England, currently the editor of Journal of the Neurological Sciences, was my colleague at Dr. Sumner’s EMG laboratory. We used to bet a box lunch on the diagnosis. At that time (1985 – 1986), Dr. Kimura served as president of American Association of Electrodiagnostic Medicine. In 1987, I received an international call from the dean of my alma mater, the head of the search committee, who asked me to persuade Dr. Kimura to go back to Kyoto University as professor and chair of the department of neurology. First, he declined the offer, since he already had a solid background, reputation, and family in the United States. I had to visit his home in Iowa to ask him to change his mind. After a while, he agreed to go back to Kyoto on the condition that I follow him to help adjust to the Japanese style of life. For possible projects, we discussed starting botulinum toxin injections for neurological disorders with the skill of EMG for the first time in Japan, and Kyoto became a center for botulinum toxin therapy.
His wife, Mrs. Junko Kimura, was kind enough to go back with him, which made my task much easier. In fact, she was helping edit the journal Muscle and Nerve in Kyoto, while Dr. Kimura was the chief editor. Dr. Kimura thus became my second mentor of EMG, and I learned much from him not only on science, but also on career. He was soon elected as the president of the International Federation of Clinical Neurophysiology (IFCN) in 1990.
Despite his busy professional activities, he encouraged us to run research activities in Kyoto: discovery of the use of IVIg for multifocal motor neuropathy (1989, 1991), clinical trials of Japanese botulinum toxins including type F, exploring the pathophysiology of dystonia, and clinical development of ultra-high dose methylcobalamin for ALS, which will be officially approved soon in Japan.
He was humble enough not to put his contribution too much on every work, and was kindly looking after every young fellow, including myself. His mottos included “Care for the patients” and “To see central (nervous system) from peripheral.” He attracted dozens of medical students to become neurologists. In 1991, we were fortunate enough to have Dr. Hiroshi Shibasaki as the professor of clinical neurophysiology, while Dr. Kimura served as the neurology chair, and both groups collaborated successfully, making Kyoto the mecca of clinical neurophysiology then.
During those productive years, we decided to convene the International Congress of EMG and Clinical Neurophysiology (10th ICEMGCN), the official congress of IFCN, 1995, in Kyoto. Because Dr. Kimura had few connections with the industry then, we tried our best to raise funds for the congress. Fortunately, the meeting was very successful with a record number of participants, and the surplus funds were donated to the national funds for neuropsychiatric diseases.
After he was elected as the first vice president of the WFN in 1998, he asked the national fund to further donate the money to help publish World Neurology. On his retirement in 1998 in Kyoto, he returned to Iowa, but was often seen in Kyoto with his wife and disciples in later years.
When he was inaugurated as president of the WFN in 2002, he made a number of reforms to the federation, such as constitution and bylaws, finance, and membership of the WFN. During and after his presidency, he was keen about education of young neurologists in Asian, Arab, and Latin American countries, and traveled virtually all around the globe many times. Wherever he went for EMG hands-on, he packed the room with young neurologists. His educational activities went on tirelessly for the rest of his life. When he was asked to visit some developing countries, he was kind enough to travel in economy class using his mileage of the airline company.
I was appointed as the chair of the neurology department in Tokushima in 2000, and thanks to his promotion, I took an executive position (member-at-large) of IFCN during 2001-2006. At the end of my term, Dr. Kimura, Dr. Andrew Eisen (treasurer of IFCN), and I discussed the need for new electrodiagnostic criteria for ALS, which make it possible to start any test drug for ALS as early as possible in clinical trials, since we knew that the number of spinal motoneurons are decreased below 30% of normal at the time of diagnosis using El Escorial criteria. Thus, we held a consensus meeting in Awaji Island near Tokushima to set the currently known “Awaji Criteria.” A pivotal phase 3 trial of ultra-high dose methylcobalamin (JETALS), funded by the Japanese government, used these criteria for entry, and was successful in detecting ALS at the early stage.
During 2007-2013, I served as trustee of the WFN for two terms. For the second term, I was appointed as the chair of the Asia Initiative by Dr. Vladimir Hachinski, then-president of WFN, to revitalize neurology in Asia, which is the most densely populated region in the world. The mission was tough, but Dr. Kimura’s seeds in young Asian neurologists became the fruitful core of many Asian neurological societies.
At the WCN 2016, the second congress in Kyoto, I was elected as first vice president of the WFN and worked mainly on organizing the congress. At the end of my term in 2021, Dr. Kimura was helping me to run for the president with all his might. After the results were announced, he seemed to be extremely exhausted. He passed away unexpectedly in his sleep on March 3, 2022. My last e-mail to him was to celebrate his 87th birthday on Feb. 25. He replied with a message that he was writing the new version of his textbook and looking forward to coming back to Kyoto in April.
He is survived by his wife Junko and three sons: Ken, Ray, and Joe and his wife Lori, and his grandchildren.
His last but the most important motto was “use EMG like a hammer,” and I believe he is still enjoying teaching EMG in heaven. •
Ryuji Kaji, former vice president of WFN, is a Distinguished Professor of Neurology at Tokushima University. He is also the director of Utano National Hospital in Kyoto.
