Coma and Disorders of Consciousness Specialty Group

Call for Chair Position

The WFN Specialty Group on Coma and Disorders of Consciousness is an important part of the Specialty Groups of the WFN.

We are looking for a new chair for this position, and we encourage you to send us your interest and qualifications. The basic condition is that you are a neurologist and come from a country that is a WFN member society. Your applications will be reviewed by a committee, and the region where you come from will be asked for advice. The WFN will make a final decision, and there will be no further elaboration on the decision.

The position will be for two years, renewable once, and is not remunerated. The task is to identify and bring in the most current aspects of this field and suggest topics and educational activities for the WCN.

For information on the other WFN Specialty Groups, visit the WFN website.

If you are interested, please send: why you are interested and why you are qualified a brief CV present experience.

Address correspondence to: Wolfgang Grisold, President, WFN; c/o laura@wfneurology.org.

Letter from the editors

Welcome to the January-February 2022 issue of World Neurology.

Steven L. Lewis, MD, Walter Struhal, MD

The issue begins with the President’s Column, where new WFN President Wolfgang Grisold discusses the past, present, and future of the WFN as well as many activities and goals currently planned under his presidency. This report is also followed by an announcement and photos of all of the new WFN trustees.

Dr. Arina Tamborska announces an ongoing survey of neurologic complications of COVID-19 from the University of Liverpool with support from the World Health Organization (WHO) and the World Federation of Neurology (WFN).

In this issue’s column about the WFN Committees and Specialty Groups, edited by WFN President Wolfgang Grisold, the activities of the WFN Education Committee and the WFN Environmental Neurology Specialty Group are highlighted. This issue also includes a call for a new chair for the WFN Coma and Disorders of Consciousness Specialty Group.

In the History Column, Dr. Peter Koehler discusses the history of insulin coma therapy (ICT) and its historical role as a treatment for neuropsychiatric disease and the observations of the neurological signs induced by this procedure.

Dr. Gaminit Pathirana, president of the Association of Sri Lankan Neurologists (ASN), reports on the history and activities of the ASN, which includes its recent and successful meeting.

In the WFN Training Center report, Dr. Ndayisenga Arlène provides a wonderful report of her WFN-sponsored full neurology training at the WFN Training Center at the Cheikh Anta Diop University in Senegal, where she is the first fully trained neurologist to graduate as a WFN-sponsored trainee from this center. She has now successfully returned to Rwanda as the fifth neurologist in that country.

Dr. Tissa Wijeratne provides a brief history of World Brain Day and the success of World Brain Day 2021 devoted to multiple sclerosis. The theme for this year’s World Brain Day 2022 is also announced in this issue and is devoted to Brain Health for All.

As always, we would like to thank all readers for their interest in World Neurology and invite ideas for contributions to be sent to Dr. Lewis or Dr. Struhal •

How Do You Diagnose COVID-19 Patients With Neurological Complications?

Call for Survey Respondents

By Dr. Arina Tamborska

Arina Tamborska

Researchers with the Global COVID Neurology Survey are calling on clinicians to help them better understand how neurological complications of COVID-19 are diagnosed around the world.

The project is being led by the University of Liverpool with support from the World Health Organization (WHO) and the World Federation of Neurology (WFN).

“We need clinicians around the world to share their experiences of how they diagnose neurological and neuropsychiatric syndromes and perceive their association with COVID-19,” said Dr. Arina Tamborska, NIHR academic clinical fellow in neurology at the University of Liverpool. “Your responses will play a role in the validation of a prospective WHO clinical record form, which will then be made openly available to everyone following the study’s completion.”

The survey will take up to 30 minutes to complete and involves questions about your clinical experience and several short case scenarios, describing patients with neurological complications as a result of COVID-19.

Participants will be named as a collaborator in any publications arising from the survey. All clinicians who treat patients with COVID-19 are eligible to participate, including trainees.

“Whether you are a neurologist or any other health care professional involved in the care of COVID-19 patients, your help would be greatly appreciated with this study, which we hope will lead to better treatments and outcomes for patients,” said Dr. Benedict Michael, senior clinician scientist fellow at the University of Liverpool.

Visit https://redcap.link/covidneurosurvey to take part. •

Dr. Arina Tamborska is a NIHR academic clinical fellow in neurology, brain infections group at the University of Liverpool, The Walton Centre NHS Foundation Trust, Liverpool, U.K.

Announcement of New WFN Trustees

Congratulations to the new WFN trustees.

The roles and responsibilities of the WFN trustees are expansive and include everything from creating educational programs, to planning the biennial World Congress and overseeing all WFN charity and fiduciary responsibilities.

The new trustees all bring unique skills and experience as well as perspectives from their regions to the trustee discussions and deliberations that will help guide WFN in the future.

We are pleased to have these leaders join the WFN trustees and are certain they will have a positive impact on improving the quality of the WFN’s activities to promote quality neurology and brain health worldwide. •

Inducing Neurological Signs by Hypoglycemia

By Peter J. Koehler

Nearly every neurologist will have experienced the satisfaction of diagnosing hypoglycemia with more or less severe neurological signs and curing the patient “on the needle” by the administration of glucose. However, few will have done so to treat hypoglycemia that was induced on purpose.

Somatic Treatments in Psychiatry

To understand this, we have to go back to the 1920s and 1930s when severe (neuro) psychiatric diseases were treated with extraordinary therapies. We already read about malaria fever therapy by Nobel laureate Julius Wagner-Jauregg (1857-1940) in the 1920s to treat dementia paralytica (general paralysis of the insane or GPI; see Volume 35, Issue no. 4 of October/November 2020, pp. 5 and 10).

Up to that period, the somatic treatments of psychosis had mainly consisted of morphine, hyoscine, bedrest, and hydrotherapy. Sleep therapy became one of the first specific treatments.

At first, it was induced by bromides that had been used for the treatment of epilepsy since 18571, and after the turn of the century by barbiturates, as for instance applied by the Swiss psychiatrist Jakob Klaesi (1883-1980) at the Burghölzli asylum in Zurich in the early 1920s.

Manfred Sakel

Manfred Sakel (courtesy nlm_nlmuid-101427953-img)

As happens so often in medicine, a new drug was investigated for alternative indications. Insulin had been discovered in 1922, and soon after the Austrian-Jewish Manfred Sakel (1900-1957), who was working with Kurt Mendel (1874-1946; eponomist of the Mendel-Bekhterev reflex) at the Lichterfelde Sanatorium in Berlin, used low dosages in patients suffering from symptoms of morphine withdrawal (cold-turkey). In some patients, he had induced disorders of consciousness unintentionally—“entweder durch Überdosierung von Insulin oder unzureichende Nahrungsaufname seitens der Patienten”2 [either from overdosing of insulin or from inadequate food intake by the patient]—and found the desire for morphine and restlessness disappeared.

He published the findings in 1933, and the idea occurred that insulin coma might be effective for severe psychiatric disorders. Moving back to Vienna in that year, he worked at the university psychiatric clinic and presented a lecture at a meeting of the Medical Society of Vienna, “A new type of treatment for schizophrenics and patients with confused excitation.”3

After persuading his chief, Wagner-Jauregg’s successor Otto Pötzl (1877-1962), Sakel started experimenting with the method in schizophrenic patients. The effects seemed to be quite impressive—“die Erfolge meiner Methodik [waren] geradezu erstaunlich und eindeutig” [the successes of my methodology (were) downright astonishing and clear]—and he now wished to publish on a larger number of patients in a series of 13 articles in 1934-1935. As occurs from the title “Schizophreniebehandlung mittels Insulin-Hypoglykämie sowie hypoglykämischer Shocks,” he distinguished “insulin-hypoglycemia” from “hypoglycemic shock.” The latter had been carefully prevented initially, but in his method for the treatment of schizophrenia this was “die wirksame Kardinalpunkte” [the effective cardinal point].

Four Phases

Sakel’s 1934 publication.

He started with increasing dosages of insulin intramuscularly every 4-4.5 hours. The patient’s symptoms and signs or the level of glucose and blood pressure / pulse determined the moment to provide glucose to end the hypoglycemic period. In phase two, the purpose was to achieve a severe hypoglycemic shock, which could be recognized either by profuse sweating or gradual increasing somnolence. The latter condition could be interrupted by psychotic excitement and would finally result in coma.

“In dieser Phase treten bereits pathologischen Reflexe auf. Pyramidenzeichen: Babinski, Oppenheim, Mendel-Bechterew. Bei längerem Zuwarten kann das Koma eine solche Tiefe erreichen, dass sämtliche Reflexe, erlöschen. Also völlige Areflexie mit völliger Atonie der gesamten Muskulatur“

[At this stage, pathological reflexes already appear. Pyramid signs: Babinski, Oppenheim, Mendel-Bechterew. If you wait a long time, the coma can reach such a depth that all reflexes are extinguished. So complete areflexia with complete atony of the entire musculature]. (For the Oppenheim and Mendel-Bechterew signs, I refer to the World Neurology issue of October 2010 “Foot eponyms leave their mark.)

If no complications occurred, bradycardia down to 34 / minute could be observed. More rarely, an epileptic seizure was seen, including tonic-clonic cramps, tongue bite, and “bad pulse.” “Sehr bedrohlich, cave!” [Very threatening, beware!]

The problem was that it was difficult to predict the patients’ reaction from the dosage of insulin. Phase three lasted one or several days, during which no or very little insulin was administered. Recovery and registration of the effect were the purposes of this phase.

Extensor plantar (Babinski) sign during ICT (still from the film).

Sometimes it was sufficient only to induce phase one, which did not always mean that the hypoglycemia had been less severe, as sometimes lower glucose levels were found than in patients, who had become deeply comatose.

If it was not necessary to return to phase two, the patient would enter phase four, “Stabilisierung und Ordnung des Zustandsbild.” Even in this phase, the patient received low doses of insulin three times a day. During the treatment, the patient would be checked regularly and several medications should be standby, including adrenaline, glucose solution with gastric tube, as well as lockjaw, “cardiaca und analeptica.” Therefore, the treatment took up much time of the nursing staff. Intravenous glucose was only used in acutely dangerous situations.

Following the series of papers in the Viennese journal, Sakel published a book in 1935: Neue Behandlungsmethode der Schizophrenie [A New Method of Treating Schizophrenia]. The reactions to Sakel’s new therapy were very positive. Although Sakel moved to New York in 1936, ICT had already been introduced in the United States by Joseph Wortis (1906-1995), who had graduated from the University of Vienna and trained in psychiatry at the Bellevue Hospital in New York, after he had seen Sakel at work in Vienna in 1934. He translated Sakel’s monograph into English4.

Early Trials

As for the mechanism of action, Sakel compared hypoglycemia to hypoxia and believed that certain nerve cells, responsible for the psychotic phenomena, would be damaged selectively. Although he claimed improvement in 88% and recovery in 70%, it was much debated afterward.

Kurt Kolle (1898-1975), neuropsychiatrist in Frankfurt and later professor of psychiatry in Munich, mentioned the figure of 45% of lasting full remissions, in comparison to only 10% of spontaneous improvement. The convulsions were believed to be the essential element and not the insulin or hypoglycemia.

Later comparisons with Electroconvulsive Treatment (ECT), developed by professor of neuropsychiatry in Rome Ugo Cerletti (1877-1963) in 1938, and leucotomy (a limited form of psychosurgery), were believed to show an advantage over insulin coma therapy (ICT), but opposite opinions were also seen. A randomly controlled trial of ICT and chlorpromazine, that became available for trials in 1952, demonstrated improved safety as well as effectiveness of the latter (1958)5. However, this did not stop the practice of ICT.

New Methods to Induce Convulsions

Preparing for sucrose solution administration by gastric tube to end the ICT (still taken from the film).

Around the first publications of ICT for schizophrenia, the Hungarian-Jewish neuropathologist and neuropsychiatrist Ladislas Meduna (1896-1964), working at Károly Schaffer’s (1864-1939) Brain Research Institute in Budapest, introduced a new chemically induced shock therapy that produced convulsions without coma. A report of the first 26 patients treated with camphor or metrazol was published in 1936. Meduna emigrated to the United States (Chicago) in 1939. In fact, this was the first convulsive therapy, as in ICT convulsions were not the purpose.

The safer ECT was applied for the first time in 1938 and would later take over the chemical methods. Severe depressions may still be an indication of ECT.

 

Filmlink: Insuline coma therapy demonstrating several patients. The film is accessible from the MedFilm teaching and research database at Metrazol, electric and insulin treatment of functional psychoses (1934) – Medfilm (unistra.fr). On the film, the various phases of ICT can be observed. Restlessness, coma, Babinski signs, myoclonus, and seizures are all shown. The hypoglycemia is stopped by sucrose solution via gastric tube. If this did not result in improvement soon enough or in case of a seizure intravenous glucose was applied. After the treatment the patients received a carbohydrate-rich meal.

MedFilm: is a collaborative initiative accommodated by the University of Strasbourg, France. They archive and thus preserve medical and other health-related films, TV programs, commercials, and internet videos ranging from the very late 19th century to the early 21st century. They do not just store them online. Describing the films, putting them in context, and analyzing them fuels their and others’ research in the fields of history of medicine, science, and media history.

Acknowledgements: I am grateful to Elisabeth Fuchs and Prof. Christian Bonah of the department of the history of life and health sciences of the University of Strasbourg, France. •

Literature

  1. Eadie MJ. Sir Charles Locock and potassium bromide. J R Coll Physicians Edinb. 2012;42:274-9.
  2. Sakel M. Schizophreniebehandlung mittels Insulin-Hypoglykämie sowie hypoglykämischer Schocks. Wiener medizinische Wochenschrift 1934; 84: 1211-4.
  3. Shorter E. Sakel versus Meduna: different strokes, different styles of scientific discovery. J ECT. 2009 25:12-4.
  4. Shorter E. A history of psychiatry. New York, Wiley, 1997, pp.207-214.
  5. Shorter E. A historical dictionary of psychiatry. Oxford, University Press, 2005, pp. 142-4.

 

 

Report of the Association of Sri Lankan Neurologists

By Gamini Pathirana, ASN president

Gamini Pathirana

Sri Lanka is a beautiful island located south of India and southwest of the Bay of Bengal. Its documented history goes back 3,000 years, with evidence of prehistoric human settlements dating back 125,000 years. In terms of biodiversity, it is one of the richest regions of Asia. Excellent topographical and climatic variability throughout the country makes it favorable for a wide variety of flora and fauna, some of which had been unique to Sri Lanka.

Sri Lanka has a population of 22.1 million people. It is a multiethnic society of whom 74% are Sinhalese, 18% are Tamils, and 7% are Muslims.

The provision of health care had been a priority in Sri Lanka since the time of ancient kings. The Portuguese introduced western style medical care to Sri Lanka while it was a Portuguese colony. Later, the Dutch established a few hospitals in Sri Lanka’s maritime provinces, followed by the British expanding this by establishing a military and estate health care system.

To this day, Sri Lankans enjoy free public health care. The private health care system has since undergone considerable development as well. The history of neurology in Sri Lanka dates to the 1950s. From 1970 to around two decades later, the entire country was served by a single neurologist practicing in Colombo, the capital of Sri Lanka. At present, there are established neurology units in most large hospitals, including teaching hospitals and provincial general hospitals. Currently, almost 60 professionals in Sri Lanka have been board certified as either neurologists, pediatric neurologists, or neurophysiologists, 54 of which are serving the country at present.

Council of the Sri Lankan Association of Neurologists.

The association of Sri Lankan neurologists (ASN) was formed in 2007. Dr. Johan Aarli, the then-WFN president, attended as the chief guest when the ASN was officially launched. Dr. J.B. Peiris was then elected as the patron of the association. Since its inception, the ASN have been carrying out annual academic sessions every year. In 2012, the ASN launched its annual journal, the Sri Lanka Journal of Neurology (https://research.asn.lk/sri-lanka-journal-of-neurology/). In addition to its annual academic sessions usually held in February each year, the ASN has managed many regional collaborative meetings in various regional centers within the country. Furthermore, the ASN awards two research grants for local researchers in neurology every year.

2021 has been a challenging year for the ASN due to travel restrictions across the country. We were compelled to seek alternative methods to carry out our activities. Among the activities conducted this year were virtual neurology updates, virtual grand rounds, virtual young neurologist lectures, and virtual neurology quizzes among university students as well as other medical officers. This allowed us to reach a much wider audience, which was further enabled by the government decision to reduce the cost of the zoom platform for students.

The ASN annual Congress for the year 2022 (ASNAC 2022) was held Feb. 18-20, 2022. The event was a hybrid event with a significant virtual component event. We are grateful for the support from 25 international speakers participating with four symposia. This year, the ASN had a successful pre-congress in neuro ophthalmology, coupled with two days of plenaries and symposia.

The ASN is a member society of the WFN. Prof. Wolfgang Grisold, the current president of the WFN, was the chief guest at the inauguration ceremony. We will provide you with a full report of the congress in in a subsequent issue of World Neurology. •

Report of Four-Year Neurology Trainee in Dakar, Senegal

WFN Training Center Report

My name is Ndayisenga Arlène, a Burundian resident in Rwanda. I received my bachelor of medicine and bachelor of surgery in 2012 at the University of Rwanda. Working at the neuropsychiatric hospital of Ndera at Kigali, I received a WFN scholarship in 2017 to attend the WFN Training Center at Cheikh Anta Diop University in Senegal. I recently finished my training and returned working as the fifth neurologist in Rwanda.

I would like to thank the World Federation of Neurology for granting me a scholarship to specialize in neurology. It was a great opportunity for me to have been chosen as the recipient of this scholarship.

My four years of training in neurology at Dakar were enriching in my learning.

The first two years were focused on the follow-up of inpatients, where stroke was the leading cause of hospitalization.

The professors’ visits, the good collaboration between DES “Diplômes des Etudes spécialisées” and hospital interns as well as the supervision of young students in general medicine allowed me to broaden my knowledge of neurological pathologies and their short- and long-term management.

The third year was focused on neurophysiology with three months of EEG and the other three months on EMG, combined with outpatient consultations and duties in the department. This allowed me to know the fundamental bases of neurophysiology, which is really an indispensable branch in neurology on epilepsies and pathologies of the peripheral nervous system.

Other rotations such as neuroradiology and psychiatry were done in the fourth year. I have also done a few months at Kigali (Rwanda) in the neurology department of Ndera neuropsychiatric hospital where I took the opportunity to do my data collection for my thesis topic. The fourth year ended with the defense of my thesis.

I extend my sincere thanks to the professors and assistants at Ibrahima Pierre NDIAYE neuroscience clinic for their investment in my learning, whether by participating in their outpatient consultations, in hospitalization, but especially in the various course presentations where they supervised me.

To all the staff of the neurology department of CHNU de Fann, I say: Thanks for the teranga!

To the WFN, thank you for investing in my future. I will do my best to achieve my academic and professional goals.

Please accept the expression of my highest sentiments. •

World Brain Day: Summary of Activities and Report

By Prof. Tissa Wijeratne, MD, PhD, FRACP, FRCP, FAAN, FEAN

Tissa Wijeratne

Let us convey our most sincere gratitude to all member societies for the engagement and strong support with yet another successful world brain day campaign. Neurological disorders are the leading cause of disability, and the overall burden will continue to rise with the pandemic’s ongoing impact and the problems associated with post COVID-19 neurological syndromes (Long-COVID).1-4 The burden of neurological disorders impacts mostly low to middle-income countries, where a larger percentage of the world’s population continue to experience the double whammy of disease burden and the impact of the pandemic.5-7

In this context, the WFN World Brain Day (WBD) campaign is of major importance. WBD was established in 2013 and first executed in 2014. Since then, this global advocacy campaign has been very successful.

Every year on July 22, the ambitious WBD campaign advocates brain health globally. In 2021, the WFN worked with the Multiple Sclerosis International Federation (MSIF), along with other broader global patient support organizations and WFN member societies, with the theme of “Stop Multiple Sclerosis” over several months until the World Congress of Neurology and ECTRIMS Congress in October.

Thousands of public awareness programs, educational programs, and social media activities were promoted worldwide as part of this massive advocacy campaign from July 22 until the end of October 2021.

Summary of Achievements

Outstanding social media reach during July 2021 with key statistics of 247,000 Twitter impressions in July. The website saw an increase in traffic:

  • 47,000 users: an increase of 66.9%
  • 57,000 sessions: 55%
  • 281.7% increase in traffic during WBD week, for roughly 7,821 users.
  • 48 promotional videos united the international community in support of World Brain Day (These interviews are highly inspirational, and I strongly recommend you check these out here).

Five social media videos attracted additional attention from the global audience. On World Brain Day, the WFN hosted a worldwide webinar to elevate multiple sclerosis awareness, focusing on the key impact points:

  • Prof. William Carroll, then-president of the World Federation of Neurology
  • Prof. Tissa Wijeratne, chair of World Brain Day, World Federation of Neurology
  • Prof. Wolfgang Grisold, Secretary-General of the World Federation of Neurology
  • Associate Prof. Brenda Banwell, chair of MSIF’s International Medical and Scientific Board
  • Prof. Mai Sharawy, co-founder of MS Care Egypt and chair of the board of MSIF

In summary, the 2021 WBD campaign was a resounding success as the campaign reached out to over 148 million people worldwide.

We are also pleased to announce that the 2022 World Brain Day campaign will be devoted to Brain Health for All (see box on the right and the following link: https://wfneurology.org/world-brain-day-2022) •

Prof. Tissa Wijeratne is the chair of Public Awareness and Advocacy at the World Federation of Neurology. Tissa.Wijeratne@wfneurology.org

 

References:

  1. Carroll, W.M., The global burden of neurological disorders. Lancet Neurol, 2019. 18(5): p. 418-419.
  2. Feigin, V.L., et al., The global burden of neurological disorders: translating evidence into policy. Lancet Neurol, 2020. 19(3): p. 255-265.
  3. Wijeratne, T., et al., COVID-19 Pathophysiology Predicts That Ischemic Stroke Occurrence Is an Expectation, Not an Exception-A Systematic Review. Front Neurol, 2020. 11: p. 607221.
  4. Wijeratne, T. and S. Crewther, Post-COVID 19 Neurological Syndrome (PCNS); a novel syndrome with challenges for the global neurology community. J Neurol Sci, 2020. 419: p. 117179.
  5. World Brain Day 2021 ‘Stopping MS’: an interview with Tissa Wijeratne and Joanna Laurson-Doube. Communications Biology, 2021. 4(1): p. 873.
  6. Wijeratne, T. and W. Carroll, World Brain Day 2021: Global campaign to stop multiple sclerosis. Mult Scler, 2021. 27(9): p. 1318-1319.
  7. Wijeratne, T., et al., World Brain Day 2021: a call to stop multiple sclerosis. Lancet Neurol, 2021. 20(8): p. 597-598.

 

Previous World Brain Day Topics

2014          Our Brain Our Future

2015          Epilepsy (ILAE)

2016          Brain Health and the Aging Population (ADI)

2017          Stroke (WSO)

2018          Clean Air for Brain Health

(WFN Environmental Neurology SG)

2019          Migraine (IHS)

2020          Parkinson’s Disease

(IPD and MDS)

2021          Stop Multiple Sclerosis (MSIF)

 

Announcing World Brain Day 2022

This year’s WBD will be devoted to Brain Health for All and will follow the WFN Brain Health campaign from last year.

Our goals are:

Awareness: Brain health is vital for mental, social, and physical wellbeing.

Prevention: Many brain diseases are preventable.

Advocacy: Global efforts are required for optimal brain health.

Education: Education for all is key for brain health.

Access: Equitable access to resources, treatment, and rehabilitation is essential for brain health.

Please follow us on social media and website for ongoing activities.

WFN ENSG and the WFN Education Committee

By Wolfgang Grisold, MD

Grisold

This column on the Committees and Specialty Groups is the latest of this series, which has been edited by me in my previous role as the secretary general. It serves to provide more insight into the role of the WFN committees as well as the specialty groups. It also allows the international readers to see the works and activity of the committees and groups as well as to allow them to engage in a particular topic. The duration of leadership in the Specialty Groups and Committees is limited. The trustees may consider to rearrange some committees to adapt to ongoing needs. Therefore, we will continue this column so that we can explain the composition, but also the tasks and the people behind them.

This month, we will introduce the Education committee, chaired by Steven Lewis. He will outline this committee’s work. Being part of this committee over the years, I am proud of its achievements and am aware that this content is one of the main tasks and missions of the WFN. The present activities have been reduced by COVID in almost all aspects, but the new administration will support continued evolution of our activities; in addition to resuming the Teaching Centers and Department Visits, we will be able to provide a core curriculum, as well to look into new activities related to education, such as advocacy and leadership.

From the Specialty Groups, we choose the Environmental Neurology Specialty Group, which is presently chaired by Gustavo Román, and has made us aware of the importance to consider environment on neurology. Much credit goes to Jacques Reis who organized meetings in Strasbourg and made environment the topic of the WBD 2018. At that time, the significance of the topic was not appreciated by some, but over time, this initiative has become extremely valuable. This group has also been active since the beginning of the pandemic and has written an important paper.

WFN Education Committee

The chair of the WFN Education Committee is Steven Lewis (U.S.), the current acting secretary general of the WFN, and the co-chair is Riadh Gouider (Tunisia), current co-opted WFN Trustee. For a list of current members, please see the WFN website.

The task of the WFN Education Committee is to provide strategic direction and oversight to the many current and future educational activities of the WFN, in keeping with the mission of the WFN to foster quality neurology and brain health worldwide by promoting global neurological education and training, with the emphasis placed firmly on underresourced parts of the world.

Current activities of the Education Committee include the WFN Department Visit Program, where trainees from low- and lower-middle-income countries, primarily from Africa, can attend four-week observerships. This allows these trainees to witness the breadth of neurology in outstanding institutions in Europe (for African trainees) and Canada (for trainees from Africa and Central and South America), due to the generous support and hospitality of these local societies and institutions.

In addition, the Education Committee organizes and oversees the WFN Teaching (Training) Centers to provide neurological training opportunities for residents of low- and lower-middle income countries. There are currently five WFN Teaching Centers, two for Anglophone African trainees (Cairo, Cape Town), two for Francophone African trainees (Dakar, Rabat), and one for trainees from Central and South America (in Mexico City).

Both the Department Visit Programs and the Teaching Centers were “on hold” during the COVID-19 pandemic, but all are resuming this year to provide much needed short- and long-term training for young neurologists in low- and lower-middle-income countries. Likewise, the WFN Junior Traveling Fellowships provide bursaries for up to 30 young neurologists and trainees annually to attend national and international meetings; this program is also resuming this year after being on hold during the pandemic. A recent call for JTF applicants for 2022 was just announced.

Please see previous issue of World Neurology for reports from many of the trainees who participated in the Department Visit Program, Regional Training Centers, and recipients of Junior Traveling Fellowships.

In addition to the above, another important activity of the WFN Education Committee is oversight of the AAN/WFN Continuum program, where hard copies and online access of Continuum, the AAN’s official CME journal, is provided free (in both hard copy and online form, depending on preference) for the education of neurologists in low- and lower-middle-income countries.

These are just some of the many activities of the WFN Education Committee, with many additional activities and projects organized and supported by a growing number of educational subcommittees, including those involved in eLearning and various other critical educational offerings to improve neurologic education and care throughout the world.

WFN Environmental Neurology Specialty Group

Gustavo Roman

The chair of the Environmental Neurology Specialty Group is Gustavo Román (U.S.) and the vice chair is Şerefnur Öztürk (Turkey). For a list of current members, please see the WFN website.

History of the WFN Environmental Neurology Specialty Group (ENSG)

The idea of creating a dedicated research group on environmental issues in neurology arose during the World Congress of Neurology (WCN) in Sydney in 2005. In 2007, Prof. Prockop announced its creation in a letter published in the Journal of the Neurological Sciences (JNS). The Environmental Neurology Applied Research Group (ENARG), as it was originally called, became the successor of the former neurotoxicological group, created and chaired by Prof. Prockop. The first members considered that interactions between man and his environment, as well as the environmental impact on our health, notably brain health, have a major importance for neurologists. The recent pandemic illustrates the pertinence of the holistic and transdisciplinary approach that characterizes environmental neurology.

Aim and vision: The goals of the ENSG are to increase awareness of the relationship for the environment and neurological disorders, to promote education and clinical research in all matters having to do with the adverse effects of environmental substances of interest, including agents that occur naturally (algal toxins, phytotoxins, and mycotoxins associated with neurological disease, in addition to neurotropic viruses), as well as pollutants that arise as a result of human activity.

Humans may be exposed to these substances/events in industrial/occupations/situations or as a result of terrorism or forced displacements. There are important global threats, such as water pollution, environmental triggers of sporadic neurodegenerative diseases, global warming, and COVID -19 (including long COVID).

Members of the ENSG.

Activities: Since our 2015 report, the ENSG has had a major impact on the activities of the WFN. We have participated in 2017 Kyoto, 2019 Dubai, and 2021 Rome (virtual) congresses. In 2018, the ENSG acted as scientific adviser for World Brain Day and issued a dedicated article. The impact was interesting, although this day was ignored by several societies. In 2020, anticipating the huge neurological impact of the COVID-19 pandemic, our group launched a call for registries in neurology and issued one of the most cited articles summarizing the knowledge about the neurological involvement of COVID-19.

In our presentations at the WCN in Rome, we summarized the first lessons from the COVID -19 pandemic. Our goal is to provide quickly to all neurologists worldwide accurate information about the diagnosis as well as of the therapies, and to improve our knowledge by managing dedicated easy-fulfilled registeries worldwide. A good example of such absence is illustrated by the difficulties in studying the neurological aspects of the Long-COVID. International comparisons are obviously needed from neurologists as for decision-makers in health policies.

Our most important project is to involve worldwide neurologist in a survey by questionnaire and then to promote an education a course online.

To our knowledge, no other specialty has ever created a group dedicated to environmental aspects in their discipline. For a list of publications of this group, please see the box. •

 

Publications by the Group Members Related to Environment and Neurology

  1. Special Reports: History of the WFN Environmental Neurology Applied Research Group. https://worldneurologyonline.com/article/special-report-history-of-the-wfn-environmental-neurology-applied-research-group/
  2. Reis J, Román GC. Environmental neurology: a promising new field of practice and research. J Neurol Sci. 2007 Nov 15;262(1-2):3-6. doi: 10.1016/j.jns.2007.06.017. Epub 2007 Jul 24. PMID: 17651758.
  3. Román GC, Spencer PS, Reis J, Buguet A, Faris MEA, Katrak SM, Láinez M, Medina MT, Meshram C, Mizusawa H, Öztürk S, Wasay M; WFN Environmental Neurology Specialty Group. The neurology of COVID-19 revisited: A proposal from the Environmental Neurology Specialty Group of the World Federation of Neurology to implement international neurological registries. J Neurol Sci. 2020 Jul 15;414:116884. doi: 10.1016/j.jns.2020.116884. Epub 2020 May 7. PMID: 32464367; PMCID: PMC720473
  4. Wasay M, Khoja A. Environment and Neurological Diseases: Growing Evidence for Direct Relationship. J Coll Physicians Surg Pak. 2018 May;28(5):337-338. doi: 10.29271/jcpsp.2018.05.337. PMID: 29690958.
  5. Reis J, Spencer PS, Wasay M, Grisold W, Carroll WM. Clean air for Brain Heath; ongoing agenda of 2018 World Brain Day. J Neurol Sci. 2019 Feb 15;397:61-62. doi: 10.1016/j.jns.2018.12.015. Epub 2018 Dec 12. PMID: 30594104.
  6. Béjot Y, Reis J, Giroud M, Feigin V. A review of epidemiological research on stroke and dementia and exposure to air pollution. Int J Stroke. 2018 Oct;13(7):687-695. doi: 10.1177/1747493018772800. Epub 2018 Apr 27. PMID: 29699457.
  7. le Moal J, Reis J. Do we need a specialization in Environmental Medicine? J Neurol Sci. 2011 Mar 15;302(1-2):106-7. doi: 10.1016/j.jns.2010.05.023. Epub 2010 Jun 9. PMID: 20542523.
  8. Reis J, Grisold W, Öztürk Ş, Wasay M, Román GC, Carroll WM. The World Federation of Neurology and the challenges in Environment Neurology. Rev Neurol (Paris). 2019 Dec;175(10):742-744. doi: 10.1016/j.neurol.2019.08.006. Epub 2019 Sep 17. PMID: 31540677.
  9. Reis J, Spencer PS, Román GC, Buguet A. Environmental neurology in the tropics. J Neurol Sci. 2021 Feb 15;421:117287. doi: 10.1016/j.jns.2020.117287. Epub 2020 Dec 19. PMID: 33445007.
  10. Spencer PS, Lagrange E, Camu W. ALS and environment: Clues from spatial clustering? Rev Neurol (Paris). 2019 Dec;175(10):652-663. doi: 10.1016/j.neurol.2019.04.007. Epub 2019 Jun 21. PMID: 31230725.

A January Column in December

William Carroll, MD

A column of two parts: the first looking back on the success of the first virtual WCN, and the second looking forward to the future of the WFN.

This is my last President’s Column before a new administration takes over the WFN in January. I have drawn on the Janus theme as it is popularly believed January was so derived to be the ending of the old year and the beginning of the new year. Other interpretations emphasize the relationship of Janus to gateways. Yet others suggest the beginning and ending of conflict.

No matter how January was selected to be the first month of the Gregorian calendar, there is no doubt that Janus was Roman and it was Rome that was to have held the XXV World Congress of Neurology. Despite the pandemic, the XXV WCN was thematically Roman thanks to the Society of Italian Neurologists (SIN).

From the outset, members of the SIN were enthusiastic and energetic in their approach to the Rome World Congress of Neurology. Like everyone, SIN was extremely disappointed by having to move to a fully virtual World Congress of Neurology. The combined efforts of SIN, the WFN PCO, Kenes International, and the WFN resulted in one of our most successful congresses. Although having no comparable meeting to benchmark, I have listed below features generally acknowledged as outstanding achievements.

The Opening Ceremony featured thematic Rome as participants entered the congress through the Colosseum. Prof. Antonio Federico, president of the World Congress of Neurology, read the Papal letter of encouragement from Pope Francis as part of his welcome, followed by welcomes from Prof. Gioacchino Tedeschi, president of the Society of Italian Neurologists, and myself as president of the World Federation of Neurology. The ceremony concluded with Andrea Bocelli’s rendition of Ave Maria.

Photograph from the WCN XXV Opening Ceremony video showing the presidents of SIN, WCN, and WFN (from right to left: Gioacchino Tedeschi, Antonio Federico, and Bill Carroll) joined for the ceremony electronically while physically separated by half a world through the expertise of the WCN PCO Kenes International.

From the floor of the virtual Colosseum, participants selected from the Scientific Program, the Teaching Course Program, Poster and Industry Exhibitions. Most, if not all, appreciated the ease with which access to the program was gained and the quality of the lectures. Foremost among the lectures were those by Giovanna Malucci on Mechanisms to Medicines in Neurodegeneration, Alastair Compston on the Life and Times of Thomas Willis, Gero Meisenbok on Lighting Up the Brain, Peter Doherty on A Nobel Laureate Speaks about the Pandemic and many other outstanding plenary and topic lectures. Altogether there were a total of 10 plenary lectures, 67 topic and main topic sessions comprising 205 scientific lectures, and 49 teaching courses and workshops, which included 161 lectures.

With the six regional symposia, a total of 270 faculty provided these presentations. The 31 free communication sessions featured 233 presentations. A total of 2,298 abstracts were submitted and 1414 e-posters exhibited. We were again the beneficiaries of the excellent work by the Scientific Program Committee and its chair Chris Kennard. Another most pleasing feature was the number and age of attendees. A total of 4,459 attendees joined the WCN, 30% of whom were from Italy, 75% were from Western Europe, East Asia and the Pacific, and 32.5% were under 45 years of age.

This congress also supported a record number of 300 young neurologists to attend the WCN with bursaries provided by SIN and the WFN.

A popular feature of a WCN is the Tournament of the Minds. For this WCN, it was prepared by Dr. Nicholas Davies and the TOM Committee with slight variations to allow a virtual format. This year, a record number of 24 teams were nominated and the successful team was from the Kerala Institute of Medical Science. (See page 5.)

It is worth reiterating that the biennial World Congress of Neurology is the pre-eminent educational activity of the World Federation of Neurology and provides the federation with its principle financial support. Without the WCN underpinning the WFN, all educational activities are threatened. It appears that by the measure of net income, this XXV World Congress of Neurology will have been as successful as those held previously. We especially applaud the generous offer by SIN, and its president, Prof. Gioacchino Tedeschi, to contribute part of their share of the financial success to WFN educational activities. The WFN is delighted with both the financial and educational success of this first virtual World Congress of Neurology and acknowledges the innovative efforts developed and employed for its presentation by all concerned and by the attendees who supported it.

The WCN is also the most visible of the WFN’s educational activities and the press and social media reach for this WCN was extremely gratifying. A special feature in this regard were the informal daily “chats” by WFN trustees and others on each day’s program highlights.

In looking forward, and with apologies to George Santayana, Winston Churchill, and others, knowing what we have done and where we have succeeded and failed will provide guidance for the future. I do think we have learned many lessons in recent times and particularly during the pandemic. These lessons have changed how we operate, how we communicate, and how we will advance our mission to foster quality neurology and brain health worldwide. These are highlighted by the following:

Communicability

We have improved enormously our ability to communicate, and we now have to do it. There is no doubt that the efforts to update and maintain updated contacts with member societies and regional organizations has underpinned a significant increase in the level of interaction within the WFN. This, and not having to travel, meant that there have never been so many member societies engaged in the COD. I have no doubt that this was due to both improved accessibility between the London Office and member societies and the interest in the WFN activities.

Process of Voting

In 2020, the WFN held its first elections electronically. Six excellent aspiring trustees competed for the trustee position vacated by Prof. Riadh Gouider, which was won by Dr. Morris Freedman. Such a number would have proved extremely, if not insurmountably, difficult if conducted by pen and ballot papers. The voting system adopted by the trustees known as Instant Run-Off (Full Preferential Ranked Choice) was proposed by Chiu Keung Man, the WFN IT consultant.

In 2021, the WFN electronic system was again employed. Prof. Wolfgang Grisold and Prof. Guy Rouleau were elected to be the next president and first vice president, the process adding an element of uniqueness. In both the 2020 and 2021 elections, voting was possible over several days, greatly improving the number of member societies able to contribute to this process. Hopefully, as we move back into a less restrictive environment, we may accommodate this process with a physical meeting. One of the laments of the electronic meeting is the inability to view, to listen to, and to talk with the candidates and their supporters. Holding the electronic voting process after the Annual General Meeting no matter whether virtual, in-person, or hybrid, would facilitate both such interactive activity and voting participation.

There will likely be a healthy discussion by member societies, member society delegates, and trustees on how to shape the best arrangements for the WFN Council of Delegates Annual General Meeting and elections, but the WFN has a proven and effective option for electronic voting in the future.

Electronic Education

Our move into a more electronic operational system has seen improvements and new endeavors. The website has been enhanced considerably through the efforts of the London Office and e-Learning Committee chaired admirably by Walter Struhal. New educational activities such as e-Learning Days with AFAN and the commencement of an e-Learning hub showcase two aspects of this new approach. The WFN/AFAN e-Learning Days have each focused on a specific topic whereas the WFN e-Learning hub provides great depth and breadth of quality educational information accessed through the WFN website. Expansion of the World Brain Day campaigns from July 22 alone to several months maximizes the message of each World Brain Day. The completion of the online Needs Registry survey, to which 117 member societies have contributed, provides a base from which to derive data to support advocacy campaigns to improve resources in areas of need. Our first steps into the public relations arena with the five module Brain Health Initiative is aimed at increasing the general awareness of neurology and the importance of brain health.

WHO and GNA Relationships and IGAP

In the same way that the WFN relationship with the AAN and EAN have flourished in recent years, so too is the WFN ever mindful of the importance of its relations with the Global Neurology Alliance (GNA) and with the World Health Organization (WHO).

The GNA contributes to the WFN efforts through its collaboration for themes, main topics, convenors, and speakers for the WCN, annually through the WFN World Brain Day and numerous other matters. Over the last two years, there has been additional collaboration between members of the GNA and the WFN at the World Health Organization.

First, the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) received strong support from the WFN for the development of a Global Action Plan for Epilepsy. This blossomed with the adoption of Resolution 73.10 by the World Health Assembly, which directed the WHO to prepare an Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders (IGAP). As part of the WFN contribution to this Action Plan, several submissions were made jointly by members of the GNA with the WFN. The ILAE, IBE, International Child Neurology Association, World Stroke Organization, International Headache Society, and International Parkinson’s Disease and Movement Disorders Society strongly supported submissions made by the WFN. The second draft of IGAP is due for completion shortly, and the WFN is indebted to the efforts made by all for this important outcome. As a result, the plan is now shaping to be more balanced and flexible in its approach to both epilepsy and all other neurological disorders. It is by any measure a landmark event, not only for people with neurological disorders, including epilepsy around the world, but also for the recognition the WHO has given to neurological disorders and in turn to non-communicable neurological diseases.

In closing, let me say thank you to all who have supported the WFN, its trustees, and administrative staff in its endeavors over the last four years and to wish the WFN and its new administration every success. It has been both an honor and a privilege to have served as president of our organization but above all it has been a pleasure to work with so many fine people. •

William (Bill) Carroll

President, World Federation of Neurology

Awards and recipients made during XXV World Congress of Neurology

WFN Medal for Scientific Achievement in Neurology  Prof. Jerry Mendell

WFN Medal for Service to International Neurology  Prof. Vladimir Hachinski

WFN Meritorious Service Award  Dr. Donna Bergen

WFN Meritorious Service Award Mr. Keith Newton

Munsat Award for Service to Neurological Education  Prof. Erich Schmutzhard

Angela Vincent Award for Young Investigators in Neurology Dr. Gianfranco De Stefano

Elsevier Best Research Paper Award Dr. Prajwal Ghimire

Elsevier Best Clinical Paper Award  Dr. Umberto Pensato

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