From the Editors

We would like to welcome you to the December 2024 issue of World Neurology, the final issue of this calendar year. In the President’s Column, WFN President Prof. Wolfgang Grisold provides updates on several ongoing WFN activities, including operational and global developments, education, and the introduction of the new World Brain Day 2025 theme.

Also, this issue includes an important call for nominations for the three WFN positions that will be elected in 2025.

This issue includes several reports of recent national and regional meetings, including a report by Dr. Daniel Gams Massi on the hybrid Presidential Symposium of the Fourth Congress of the Cameroon Academy of Neurology, a report by Profs. Marina Alpaidze, George Chakhava, and Alex Razumovsky on the joint meeting of the WFN Neurosonology Specialty Group and the Georgian Association of Medical Specialties, and a report by Prof. Bruno Giometto on the inauguration of the first clinical neuroscience course at the University of Trento in Italy.

In the History column, Dr. Peter Koehler explores the life of the other Babinski: Ali-bab, the author of a French cookbook, and its interface with the history of neurology. This issue also includes an opinion piece from Prof. Raad Shakir regarding the current clinical status of anti-amyloid therapy, specifically lecanemab, for Alzheimer’s disease. Readers should note that opinions in World Neurology represent those of the author(s) and are not necessarily the opinions of the WFN, its trustees, or its member societies.   

We also have two obituaries for prominent neurologists who we recently lost. Dr. Natalia Acosta-Baena and Dr. Ricardo Nitrini provide their heartfelt tribute to the life and legacy of Prof. Francisco Javier Lopera Restrepo, a prominent Alzheimer’s disease researcher from Latin America. Dr. Duygu Selcen and Dr. P. James B. Dyck provide their remembrance of Prof. Andrew Engel, a legend in the field of neuromuscular disease.

In closing, thank you to all neurologists and neurologic trainee readers in all regions of the world for your interest in the WFN and World Neurology over this past year. We look forward to continuing to share more details about the upcoming activities for neurologists worldwide in future issues and invite your contributions to the following email addresses: Dr. Lewis at steven.lewis@wfneurology.org or Dr. Struhal at walter.struhal@wfneurology.org.

The WFN Announces Positions up for Election by the Council of Delegates in 2025

By Wolfgang Grisold, WFN president, and Laura Druce, WFN CEO

  • The president of the WFN (2026-2029)
  • The first vice president of the WFN (2026-2029)
  • An elected WFN Trustee (2025-2027)

The World Federation of Neurology (WFN) encourages all member societies to suggest suitable candidates for the positions of WFN president, first vice president, and elected trustee. Engagement for the WFN and neurology in a global context are expected. Availability, readiness for communication, and experience with international and global societies are required. English is the communication language of the WFN.

The President of the WFN

The term of the current president, Prof. Wolfgang Grisold, will end on Dec. 31, 2025. The office of the newly elected president will begin on Jan. 1, 2026.

The WFN president is supported by the Board of Trustees and the London WFN office structures. The president also has support from the committees and advisors on specific topics. This individual is expected to continue the structure and long-term activities of the WFN — in particular education and global activities — and add their own vision for the development of neurology worldwide.

The term for the position of president is four years. The newly elected president will also be expected to stay for one additional year to serve as an advisor to the past president on the board after the term ends.

At the last COD meeting, the delegates approved the creation of a president-elect position, to begin one year before the conclusion of the president’s 4-year term. The president-elect will be an advisor to the board. The election of the WFN first president-elect will take place in 2028.

Persons applying for the position of the president should have experience with WFN procedures and its global work and should have a global outlook. During the time served as president, no conflict of interest with other societies is expected.

WFN First Vice President

The term of the current first vice president, Prof. Guy Rouleau, will end on Dec. 31, 2025. The office of the new first vice president will begin on Jan. 1, 2026.

The first vice president is one of the four WFN officers. The first vice president is an important part of, and advisor to, the board. This individual is involved in all major decisions. Traditionally, the vice president is involved in the development of the WFN Congresses, the new Digital Neurology Update (WNU) activity, the educational portion of the World Congress of Neurology, and the WFN educational days.

The first vice president is also part ex officio in the Permanent Congress Committee (PCC), which is a permanent WFN committee to decide on future congresses and developments.

An Elected WFN Trustee

The term of elected WFN trustee, Prof. Chandrashekhar Meshram (India), ends immediately following the COD meeting and is eligible for re-election.

Elected trustees are members of the WFN trustee board and have voting rights for all decisions. Equally, co-opted trustees have the same rights.

Each trustee is a trustee under U.K. charity law and has full responsibility for the WFN. All trustees have special tasks and a personal portfolio. They are involved in short and long-term decisions and also support the WFN in their region. The present trustee participates in many activities such as communication, regional representation, and website activities, among others.

General Nomination and Election Information

All applications must be sent electronically.
Email to: elections@wfneurology.org

Nominees can only apply for one position.

A nominee must:

  • Be a member of an eligible WFN member society in good standing
  • Have a national and international reputation
  • Have made contributions to regional and global neurology
  • Be committed to the WFN
  • Have no conflict of interest with other societies

The Nominating Committee will consider all applicants for their suitability for the positions. Gender and geography are considered. The current elected trustees are from three of the six WFN regions. The WFN expects to have participation from as many regions as possible.

A WFN Member Society must submit the name(s) of the candidate(s), together with a signed statement by the candidate confirming their willingness to stand for election. Candidates must also provide a brief curriculum vitae (CV) no longer than a single typewritten page and letter of support from the Member Society. The deadline for sumbissions is Friday, Feb. 14, 2025.

The recommendations of the Nominating Committee, along with a CV and the individual plans of the applicants, will be published in World Neurology and on the WFN website.

Nominations made after this deadline are possible. However, in addition to the criteria above, candidates with late applications must also be supported with signatures from a minimum of five WFN Member Society Delegates. An explanation for the late application is required. All documents must be received by the London office 30 days prior to the start of electronic voting. The deadline for additional nominations is 30 days prior to the start of electronic voting. Visit the WFN website for more information.

Send the nomination documents to the WFN London Secretariat office at  elections@wfneurology.org. That office will scrutinize the applications for completeness and forward them to the Nomination Committee for further elaboration. All applications are handled confidentially.

The voting will be electronic, and the results of the vote will be published by the current president Oct. 12-15, 2025, at the next COD meeting in Seoul, South Korea.

Advancing Neurological Education

The University of Trento and the WFN celebrate the inaugural clinical neuroscience course at the university.

By Prof. Bruno Giometto

Bruno Giometto

In a milestone for neurological education, the University of Trento in Italy marked the launch of its inaugural clinical neuroscience course within the framework of its five-year-old master’s degree in medicine and surgery. The course inauguration was highlighted by the presence of Prof. Wolfgang Grisold, president of the World Federation of Neurology (WFN), who delivered a master class on the global perspectives of teaching neurology. This event underscored the commitment of both the WFN and the University of Trento to advance education and foster collaboration in the field of neuroscience.

The course represents a pioneering step for the University of Trento, which has rapidly emerged as a hub for innovative medical education since the inception of its medical program. Prof. Bruno Giometto, course chair, hosted the event and introduced Prof. Grisold to an audience comprising faculty members, students, and representatives of the neurological community.

Prof. Giometto emphasized the course’s unique design, integrating cutting-edge research with clinical practice, and highlighted the importance of international perspectives in enriching the curriculum.

“The presence of Prof. Grisold symbolizes the alignment of our vision with global efforts to standardize and elevate neurology education,” he said.

Neurology Education on a Global Stage

Prof. Grisold’s master class, titled “Teaching Neurology: A Global Perspective,” offered a comprehensive overview of the current landscape of neurology education, including its challenges and opportunities. He stressed the critical role of the WFN in promoting high-quality training models worldwide and the importance of adapting these models to the diverse health care needs of different regions.

“The World Federation of Neurology is committed to ensuring that neurological education is not just accessible but also relevant and sustainable,” Prof. Grisold said. He outlined key WFN initiatives, such as:

  • Training Centers in low- and middle-income countries: The WFN has established partnerships with institutions in underserved regions to provide specialized training programs.
  • Standardized curriculum development: Collaborative efforts to create curricula that balance foundational knowledge with region-specific clinical priorities.
  • Digital learning platforms: Leveraging technology to bridge gaps in access and enable continuous professional development.

Challenges and Innovations in Neurology Education

In his address, Prof. Grisold lauded the University of Trento’s clinical neuroscience course for its emphasis on a multidisciplinary approach.

“Incorporating neuroscience into the broader framework of medicine ensures that future physicians are not only knowledgeable but also empathetic in addressing the complexities of neurological disorders,” he said.

Prof. Grisold’s visit to Trento also underscored the WFN’s mission to foster collaborations among neurological societies, academic institutions, and international organizations. Through its global reach, the WFN has established itself as a pivotal entity in shaping the future of neurology.

One of the WFN’s landmark initiatives is World Brain Day, which raises awareness about neurological conditions and the importance of brain health. The annual event exemplifies the WFN’s ability to mobilize resources and stakeholders for a common cause. Also, the WFN’s work in research advocacy, policy formulation, and the promotion of neurological services complements its educational endeavors.

A Vision for the Future

The launch of the clinical neuroscience course at the University of Trento represents more than just an academic milestone; it is a testament to the power of collaboration in advancing medical education. The partnership between the university and the WFN sets a precedent for other institutions to emulate, demonstrating that a global perspective can significantly enhance local educational initiatives.

In his concluding remarks, Prof. Grisold encouraged students to embrace their role as future leaders in neurology.

“The study of the brain and nervous system is not merely an academic pursuit; it is a calling to improve lives,” he said.

Prof. Giometto expressed his gratitude to Prof. Grisold and the WFN for their support, reiterating the university’s commitment to fostering excellence in medical education.

“We are at the beginning of a journey, but with partners like the WFN, the path ahead is bright,” he said.

The University of Trento’s medical program is rapidly gaining recognition for its innovative approach, combining rigorous academic standards with opportunities for interdisciplinary research. The addition of the clinical neuroscience course strengthens its reputation as a center for academic and clinical excellence.

The event concluded with a panel discussion featuring faculty members and students, exploring the future of neuroscience education and the potential for further collaborations with international organizations.

Looking Ahead

The successful inauguration of the clinical neuroscience course, marked by Prof. Grisold’s inspiring lecture, is a reminder of the shared commitment of institutions like the WFN and the University of Trento to advancing neurology education. It also highlights the importance of fostering connections across borders to tackle the global burden of neurological disorders.

As the University of Trento continues to develop its medical program, its collaboration with the WFN will undoubtedly serve as a model for other institutions seeking to innovate and excel in the field of neuroscience.

This landmark event is not just a celebration of academic achievement, but also a call to action for the global neurology community to work together in building a future where access to quality neurological education and care is a reality for all. •

Prof. Bruno Giometto is director of neurology at Trento and Roverto Hospitals and a professor of neurology at the Interdepartmental Center of Medical Sciences at the University of Trento.

WFN NSG Holds Joint Meeting With GAMS 

The Neurosonology Specialty Group explored the use of ultrasonography as a critical care modality at the Georgian Association of Medical Specialties (GAMS) conference.

By Marina Alpaidze, MD, PhD, George Chakhava, MD, PhD, and Alex Razumovsky, PhD, FAHA, NVS

Prof. Marina Alpaidze lecture.

The Neurosonology Specialty Group (NSG) of the World Federation of Neurology (WFN) is dedicated to the promotion of science and research as well as education and training in the field of ultrasonic techniques and its clinical utilization. International cooperation and the dissemination of scientific information within the field of neurosonology is part of the group’s regular activities.

During the IX International Conference of the Georgian Association of Medical Specialties (GAMS) on Oct. 6-8, 2024, in Kutaisi, Georgia, the GAMS Radiology Section and the Georgian Chapter of the NSG, in cooperation with the NSG WFN, organized a joint session dedicated to ultrasound and imaging utilization.

Main auditorium of the IX GAMS Conference.

Among the faculty were Prof. Marina Alpaidze, MD, president of the Georgian Chapter of the WFN NSG at Tbilisi State Medical University, Prof. Nikoloz Sainishvili, MD, PhD, representative of GAMS in the board radiology section of the European Union of Medical Specialists, Prof. Oleg Sabelnikovs, MD, department of anesthesiology and intensive care in Riga, Latvia, Alex Razumovsky, PhD, FAHA, advisory board member of the WFN NSG, and others.

The conference focused on novel approaches in the management of personalized and evidence-based medicine. Specific topics included stroke, cognitive disorders as complications of stroke, post-stroke dementia, neuro-infections, and more.

This joint session was designed for individuals who are interested in performing and interpreting transcranial Doppler (TCD) studies specifically related to the clinical yield of neurosonology for patients in the critical care environment. Special consideration of functional TCD ultrasonography and its role in the assessment of cerebral autoregulation and vasomotor reactivity in different neurological disorders that allows early detection of cerebrovascular disease was also discussed.

A group of attendees at the IX GAMS.

Kutaisi has a rich history that dates back over 3,000 years. The city was the capital of Georgia from the eighth century BCE until the 11th century. Kutaisi features notable landmarks, including the Bagrati Cathedral, a UNESCO World Heritage Site that dates back to the 11th century, and the Gelati Monastery, also a UNESCO site.

This conference was accredited by the European Accreditation Council for Continuing Medical Education (EACCME), and the joint session was guided and directed under the auspices of the NSG of the WFN. •

Marina Alpaidze is a professor at Tbilisi State Medical University in Tbilisi, Georgia, and a member of the executive committee for the WFN Neurosonology Research Group. George Chakhava is a neurologist at the Georgian-American clinic at David Tvildiani Medical University in Tbilisi, Georgia. Alex Razumovsky is president of TCD Global and secretary of the WFN NSG.

Dr. Francisco Javier Lopera Restrepo (1951-2024)

The legacy of this Alzheimer’s researcher was to live life as it came.

By Natalia Acosta-Baena, AND Ricardo Nitrini

Francisco Javier Lopera Restrepo passed away on Sept. 10, 2024, a great loss for his family, friends, collaborators, for all of science, and for neurosciences in Latin America. He leaves the advances brought by his studies as well as a great legacy that includes important developments and a large number of high-quality disciples.

Dr. Lopera was born on June 10, 1951, in Aragón, a small town in Santa Rosa de Osos, a municipality of Antioquia, Colombia. He came from a rural family with strong roots. His parents taught him everything he practiced. From his mother, he got his drive and humility. From his father, his love for knowledge. One anecdote he shared recalled when his father bought all his children a Larousse dictionary and exclaimed: “The summary of knowledge.” His mother sewed shorts from sackcloth for each of her 13 children. She also always knew how to make sure they were well. When Dr. Lopera got married, the bride’s father told her: “Remember that you are also marrying science.” And so it was. His life was neuroscience.

After receiving the title of neurologist, when he left Colombia in 1987 to complete his neuropsychology training at the Catholic University of Louvain, Belgium, he carried under his arm the genealogies of the families with early Alzheimer’s that he had identified and described while he was a neurology resident.1 But nobody paid attention to him.

He returned to Colombia in 1989 and served as coordinator of the Neurosciences Group of the University of Antioquia (GNA). It was not until 1995 that a mutation (E280A) was found in the presenilin 1 gene, in collaboration with Kenneth Kosik and Alison Goate.2  A longitudinal follow-up was carried out on all subjects identified to date, and 15 years later, a description was made of the natural evolution of the disease in this population, identifying the ages of onset for the preclinical and clinical stages.3

This study was the only one carried out solely by Colombian researchers. It was crucial for the design of the clinical trial with crenezumab that came later, and it was the basis for determining the ages of the cohort and detecting protective genes. The beginning of gains and strength in research in Colombia and Latin America arrived in the 2000s.

Alzheimer’s Research

Much will be written about the importance of Dr. Lopera for advancing knowledge about Alzheimer’s disease, but there are some aspects that may be considered more important for the entire research community, especially for those from low- and middle-income countries.

Most of Dr. Lopera’s publications are about autosomal dominant Alzheimer’s disease caused by the E280A mutation of the presenilin 1 gene. From his careful studies of this kindred, he was able to obtain enough data to transform it into the world’s largest autosomal dominant Alzheimer’s disease kindred, which contributed to the knowledge of several steps in the evolution of Alzheimer’s disease.

There were two groups of studies that came from Dr. Lopera’s research. The first group made it possible to verify the first changes in biomarkers, the time interval between these changes and the first symptoms hallmarking the onset of dementia. These discoveries revealed that the interval between changes in biomarkers and dementia is greater than 20 years.3,4

The second group is related to the case of a patient named Aliria who, having the E280A mutation of presenilin 1, did not develop mild cognitive impairment until her 70s, three decades after the expected age of clinical onset.3,5 Aliria died at the age of 77 without dementia; the average age at which dementia occurs in the disease caused by this mutation is about 49 years.5,6 

The neuropathological examination confirmed the presence of unusually high brain amyloid levels and limited tau and neurodegenerative measurements,6 which had already been revealed by amyloid and tau PETs performed years before.5 The patient had two copies of the APOE3 Christchurch (R136S) mutation, which points to the role of apolipoprotein E (APOE) in the pathogenesis, treatment, and prevention of Alzheimer’s disease.5,6

Lifetime Achievements

These and many other contributions made by Dr. Lopera were rightly awarded, most notably the Bengt Winblad Lifetime Achievement Award, presented by the Alzheimer’s Association in 2020, and the Potamkin Prize (often called the “Nobel Prize of Alzheimer’s Research”) from the American Academy of Neurology (AAN) and the American Brain Foundation (ABF) in 2024.

In addition to the importance of these studies for scientific knowledge, there is much to be learned from them by all researchers in Latin America.

First, Dr. Lopera demonstrated tenacity, persistence, focus, and the firm conviction that this work would lead to additional important discoveries. Between the first publication on this autosomal dominant Alzheimer’s disease and the Aliria case, 32 years of continued studies passed.1,5

Second, but no less important, Dr. Lopera had good collaborators among his colleagues and students. He also chose the best international collaborators who did not look at a researcher from a low- and middle-income country as a mere data provider to enrich their own research. Even though he would not have achieved this depth of research without international collaboration, Dr. Lopera always remained the main researcher and unquestionable leader of his publications.

Like many neurologists of his time, Dr. Lopera began studying dementia through studies in neuropsychology, as can be seen from some articles on these topics among his first publications.7,8 During his career, he also kept an in-depth knowledge of cognitive and behavioral neurology.

Another highlight of Dr. Lopera’s career is the research with social commitment that he sought to develop. For example, he conducted field work to evaluate patients with a social plan, where the genetic risk of the disease was disclosed along with the possibility of monitoring and accompanying the sick. Researching patients and helping to improve their quality of life at the same time was somewhat revolutionary. Maintaining a balance between consent without falling into coercion continues to be a significant challenge in vulnerable populations.

Face of Hope

The social plan was consolidated to improve the living conditions of the sick and their caregivers with money from some projects. Support groups, dance, painting, rehabilitation, and mental health were included in the course of the Global Neurology Academy (GNA) learning process. Diapers and wheelchairs were more useful to people than any medication. Unfortunately, it is still the same. And that is why Dr. Lopera used the social plan when starting any clinical trial in these families. Every year, GNA celebrated Christmas with all of the research participants.

Dr. Lopera defended the idea that if one day a medicine tested on this population proves effective, the families of Colombia should be compensated. The thousands of patients in Colombia saw in him the face of hope. They remind us of a worldwide desire: a life-changing medicine that can also be distributed with equity and justice.

Dr. Lopera was a joyful person. He enjoyed food, music, dancing, and everything that life gave him. “Live life as it comes” was one of his last thoughts. Words consistent with his medical practice when speaking to the patients who need to be reminded that they can live with Alzheimer’s. •

Natalia Acosta-Baena is a researcher with Grupo de Neurociencias de Antioquia (GNA), Facultad de Medicina at the Universidad de Antioquia, Colombia. Ricardo Nitrini is a senior professor of neurology with Grupo de Neurologia Cognitiva e do Comportamento (GNCC), Faculdade de Medicina da Universidade de São Paulo, Brazil.

References:

1. Cornejo, W., Lopera, F., Uribe, C. S., & Salinas, M. (1987). Descripción de una familia con demencia presenil tipo Alzheimer. Acta Médica Colombiana, 12(2), 55-61. https://www.actamedicacolombiana.com/ojs/index.php/actamed/article/view/3695.

2. Alzheimer’s Disease Collaborative Group. The structure of the presenilin 1 (S182) gene and identification of six novel mutations in early onset AD families. Nat Genet. 1995 Oct;11(2):219-22. doi: 10.1038/ng1095-219. PMID: 7550356.

3. Acosta-Baena N, Sepulveda-Falla D, Lopera-Gómez CM, Jaramillo-Elorza MC, Moreno S, Aguirre-Acevedo DC, Saldarriaga A, Lopera F. Pre-dementia clinical stages in presenilin 1 E280A familial early-onset Alzheimer’s disease: a retrospective cohort study. Lancet Neurol. 2011 Mar;10(3):213-20. doi: 10.1016/S1474-4422(10)70323-9. Epub 2011 Feb 4. PMID: 21296022.

4. Reiman EM, Quiroz YT, Fleisher AS, Chen K, Velez-Pardo C, Jimenez-Del-Rio M, Fagan AM, Shah AR, Alvarez S, Arbelaez A, Giraldo M, Acosta-Baena N, Sperling RA, Dickerson B, Stern CE, Tirado V, Munoz C, Reiman RA, Huentelman MJ, Alexander GE, Langbaum JB, Kosik KS, Tariot PN, Lopera F. Brain imaging and fluid biomarker analysis in young adults at genetic risk for autosomal dominant Alzheimer’s disease in the presenilin 1 E280A kindred: a case-control study. Lancet Neurol. 2012 Dec;11(12):1048-56. doi: 10.1016/S1474-4422(12)70228-4. Epub 2012 Nov 6. PMID: 23137948; PMCID: PMC4181671.

5. Arboleda-Velasquez JF, Lopera F, O’Hare M, Delgado-Tirado S, Marino C, Chmielewska N, Saez-Torres KL, Amarnani D, Schultz AP, Sperling RA, Leyton-Cifuentes D, Chen K, Baena A, Aguillon D, Rios-Romenets S, Giraldo M, Guzmán-Vélez E, Norton DJ, Pardilla-Delgado E, Artola A, Sanchez JS, Acosta-Uribe J, Lalli M, Kosik KS, Huentelman MJ, Zetterberg H, Blennow K, Reiman RA, Luo J, Chen Y, Thiyyagura P, Su Y, Jun GR, Naymik M, Gai X, Bootwalla M, Ji J, Shen L, Miller JB, Kim LA, Tariot PN, Johnson KA, Reiman EM, Quiroz YT. Resistance to autosomal dominant Alzheimer’s disease in an APOE3 Christchurch homozygote: a case report. Nat Med. 2019 Nov;25(11):1680-1683. doi: 10.1038/s41591-019-0611-3. Epub 2019 Nov 4. PMID: 31686034; PMCID: PMC6898984.

6. Sepulveda-Falla D, Sanchez JS, Almeida MC, Boassa D, Acosta-Uribe J, Vila-Castelar C, Ramirez-Gomez L, Baena A, Aguillon D, Villalba-Moreno ND, Littau JL, Villegas A, Beach TG, White CL 3rd, Ellisman M, Krasemann S, Glatzel M, Johnson KA, Sperling RA, Reiman EM, Arboleda-Velasquez JF, Kosik KS, Lopera F, Quiroz YT. Distinct tau neuropathology and cellular profiles of an APOE3 Christchurch homozygote protected against autosomal dominant Alzheimer’s dementia. Acta Neuropathol. 2022 Sep;144(3):589-601. doi: 10.1007/s00401-022-02467-8. Epub 2022 Jul 15. PMID: 35838824; PMCID: PMC9381462.

7. Lopera F. Procesamiento de caras: bases neurológicas, trastornos y evaluación [Procesing of faces: neurological bases, disorders and evaluation]. Rev Neurol. 2000 Mar 1-15;30(5):486-90. Spanish. PMID: 10775980.

8. Sierra M, Lopera F, Lambert MV, Phillips ML, David AS. Separating depersonalisation and derealisation: the relevance of the “lesion method.” J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):530-2. doi: 10.1136/jnnp.72.4.530. PMID: 11909918; PMCID: PMC1737835.

Central African Neurology Takes Center Stage

The Hybrid Presidential Symposium of the Fourth Congress of the Cameroon Academy of Neurology.

By Daniel Gams Massi

Daniel Gams Massi

During its fourth congress from Oct. 18-20, 2024, in Douala, the Cameroon Academy of Neurology (CAN) organized its second hybrid Presidential Symposium. This session was enhanced by the participation of Profs. Wolfgang Grisold, president of the World Federation of Neurology (WFN), Prof. Lawrence Tucker, president of the African Academy of Neurology (AFAN), Prof. Amadou Gallo Diop, immediate past-director of the WFN Training Center of Dakar, Senegal, and Prof. Riadh Gouider, past trustee of the WFN and head of the neurology department of Razi University Hospital in Tunis. The symposium was chaired by Dr. Daniel Gams Massi, CAN secretary-general and AFAN treasurer.

Prof. Grisold opened the symposium with a presentation on the implementation of the Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders (IGAP). He outlined the concept of brain health and its five dimensions: advocacy, research, therapy, public health, and prevention. He also presented the vision, goals, and strategic objectives of IGAP:

  • Raise policy prioritization and strengthen governance
  • Provide effective, timely, and responsive diagnosis, treatment, and care
  • Implement strategies for promotion and prevention
  • Foster research and innovation and strengthen information systems
  • Strengthen the public health approach to epilepsy

Prof. Wolfgang Grisold gave an online talk on implementation of IGAP in Africa.

The audience was able to see the essential role the WFN plays in the implementation and promotion of IGAP worldwide, as well as the many opportunities the WFN offers for the development of neurology in Africa through training, research, and advocacy. This is an opportunity to recall that for several years the WFN has contributed to the training of Cameroonian neurologists through various programs. And through Education in Headache to Health Care Providers in Africa, the WFN also contributes to the continuing education of health care professionals in Cameroon.

Prof. Diop illustrated the idea of ​​the African neurologist of tomorrow. He said that to carry out his missions, the African neurologist must be a good clinician, an ambitious researcher, a dedicated trainer, a skilled communicator, a community actor close to the population, and a citizen of the world capable of collaborating with African and foreign partners.

The WFN Training Center of Dakar has trained and continues to train several Cameroonian neurologists. Prof. Gouider spoke about the challenges in the African integration of this neurology training, including how Africa’s rich ethnic, cultural, and linguistic diversities may contribute to constraints on this integration. Other contributing factors include a lack of human resources due to significant disparities in the numbers of doctors and neurologists, insufficient specialized center structures, and a lack of diagnostic resources and treatment.

Despite these issues, there is hope because the number of neurologists trained in the continent has increased with the contribution of the WFN Training Centers in Senegal, South Africa, Egypt, Morocco, Tunisia, and several more recent Training Centers in Sub-Saharan Africa. However, the number of trained neurologists remains largely insufficient, especially in the context of brain drain as more qualified individuals leave the area.

The audience during the hybrid Presidential Symposium.

Although Africa has historically been one of the cradles of neurology research going back to ancient Egypt, it contributes little to modern global research. These challenges can be addressed by reinforcing intra-African and international collaborations.

The symposium was closed by Prof. Tucker who discussed the integration of online training in EEG for residents and young neurologists. He shared the experience of the University of Cape Town’s online EEG course. It is a hybrid program with web-based courses, virtual seminars, and in-person clinical neurophysiology fellowships for recently qualified neurologists. Since 2018, numerous neurologists, neurology residents, and neurotechnologists from Africa and other continents have benefited from quality EEG training.

The symposium hosted 224 attendees, including neurologists, pediatric neurologists, neurosurgeons, pediatricians, psychiatrists, internists, residents of neurology, psychiatry, pediatrics, and general practitioners, nurses, and physiotherapists from 16 countries.

On behalf of the CAN, we would like to express our gratitude to the WFN and AFAN for the unconditional support of the activities of our young society throughout the years. These activities have contributed to educating community and health care professionals on neurological disease, and to the opportunity to train more neurologists through the opening of the University of Douala neurology Training Center in 2023.

Even if there is more work to be done, we know that by continuing these activities and working with our partners, we will be able to significantly improve access to quality neurological care for populations in Cameroon and Central Africa. •

Daniel Gams Massi, MD, is secretary-general of the Cameroon Academy of Neurology.

Gastronomy by Ali-bab, the Other Babinski

A tale of two brothers and one cookbook.

By Peter J. Koehler

Figure 1. Une leçon clinique à la Salpêtrière by André Brouillet (1887), oil on canvas, Paris, Musée de l’histoire de médecine.

In the introduction of a relatively well-known French cookbook, we find the following text: “Les principes fondamentaux de l’art culinaire sont très simples. (The basic principles of the culinary arts are very simple.)” Looking through the book, I doubt the recipes described are that simple. However, it is an interesting cookbook as it relates to neurology.

Two Brothers

The story begins in 1848, a year in which several revolutions took place in Europe, including in Poland. Fleeing this revolution, a Polish couple moved to Paris the following year, where two sons — Henri and Joseph — were born in 1855 and 1857, respectively. Henri attended the École des Mines, after which he worked in South America for about 20 years. After their parents’ deaths in the late 1890s, he returned to Paris and shared an apartment with his younger brother.1

Figure 2. Babinski sign from Arthur van Gehuchten’s 1908 film10 (the Belgian neurologist Van Gehuchten was the first to use the eponym in 1898).11

Meanwhile, Joseph studied medicine and served internships in various Parisian clinics during the 1880s. From November 1885 to October 1887, he was chef-de-clinique at the Salpêtrière under Jean-Martin Charcot (1825-1893), whose bicentennial will be celebrated in July 2025 in Paris. He also met Sigmund Freud (1856-1939), who visited Charcot during the winter of 1885-1886 and translated two of Charcot’s books into German.2 This was the period during which Charcot showed particular interest in the condition then called hysteria.3

Joseph, who later disagreed with his teacher about the condition, is depicted in the famous portrait from that clinic. (See Figure 1.) He is the bearded young man catching one of the patients, Blanche Wittmann (1859-1913) in his arms. The Norwegian writer Per Olov Enquist (b. 1934) wrote a novel about Blanche not long ago: The Story of Blanche and Marie (2004). A study on Blanche and other patients was published by Asti Hustvedt,4 the sister of novelist Siri Hustvedt, who referred to Charcot and the Salpêtrière in her novel What I Loved. Several famous people are depicted in the painting, including Pierre Marie, Georges Gilles de la Tourette, Henri Parinaud, and Désiré-Magloire Bourneville.5

Pathological Plantar Reflex

In 1890, Joseph became médecin des hôpitaux, and beginning in 1895, he worked as a neurologist at Hôpital de la Pitié. He was one of the neurologists who described several components of current neurological examination,6,7,8 the most famous of which is the pathological plantar reflex. It was named after him: the Babinski plantar sign (1896).9

At a time when there was no CT or MR scan — even pneumoencephalography and arterial encephalography had to wait a few decades12 — it was even more important than today to use this to distinguish organic paralysis from hysterical paralysis as it was then called. Nowadays, we would call it a functional disorder.13

Figure 3. Gastronomie Pratique by Ali-bab, first edition of 1907.

Surréalism

Joseph played an important role in the life of André Breton (1896-1966), the French poet and founder of surrealism. From January to September 1917, Breton worked as a student under Babinski at La Pitié. He ultimately did not take exams to become a physician. The Surrealist Manifesto of 1924 includes the following passage on this subject:

“I have seen the inventor of the cutaneous plantar reflex at work; he manipulated his subjects without respite, it was much more than an “examination” he was employing; it was obvious that he was following no set plan. Here and there he formulated a remark, distantly, without nonetheless setting down his needle, while his hammer was never still. He left to others the futile task of curing patients. He was wholly consumed by and devoted to that sacred fever.”

Besides neurology, Joseph had an interest in music and drama. He would often be seen at the Paris Opéra. In 1956, Breton revealed that Babinski was one of the authors of the play Les Détraquées (1920) written by Pierre Palau (1883-1966) “with Olaff’s help.” Olaff turned out to be a pseudonym of Joseph Babinski.14

Figure 4. Henri is smaller and more corpulent than Joseph Babinski.

Gastronomy

After suffering hardships in the interior of South America, Henri Babinski returned to Paris and moved into a bachelor apartment — at one point, the brothers lived on Boulevard Haussmann — to devote himself to cooking. The two brothers became inseparable. Joseph’s student Clovis Vincent (1879-1947), who later became a pioneer of French neurosurgery, wrote of them, “His brother and Joseph had a veritable cult for each other, which never waned. Joseph lived for his career and for science; Henri lived for Joseph. Without Henri, Joseph would ultimately have achieved much less.”1

Henri’s interest in gastronomy led to a second career. In 1907, he published Gastronomie Pratique, which was subsequently republished several times, even as recently as 2013.

Henri was smaller than his brother Joseph and corpulent. (See Figure 4.) The full title of the book is probably related to this: Gastronomie pratique. Études culinaires suivies du Traitement de l›Obésité des Gourmands (Practical Gastronomy. Culinary Studies Followed by Treatment of Obesity in Gourmands). Regarding the latter, Henri noted in the introduction, “Tous mes amis connaissent l’ancien obèse sujet principal de mon expérimentation; ils sont prêts à témoigner de la réalité de la cure, comme ils sont prèts à attester les qualités de ma cuisine. C’est sous leurs auspices que je présente ce petit livre au public. (All my friends know the former obese subject of my experimentation; they are willing to testify to the reality of the cure, just as they are willing to testify to the qualities of my cooking. It is under their auspices that I present this little book to the public.)”

Figure 5. English-language edition of Henri Babinski’s cookbook.

Ali-bab

Why Henri chose the pseudonym Ali-bab is not exactly known. Possibly “Ali” stands for “the other” Babinski, but several alternative possibilities have been mentioned.1 The book was successful, given its many editions, and was widely acclaimed. A specialist in gastronomic literature, Gérard Oberlé (b. 1945), in his Les Fastes de Bacchus et de Comus, ou histoire du boire et du manger en Europe de l’Antiquité à nos jours, à travers les livres (The Annals of Bacchus and Comus, or the history of eating and drinking in Europe from antiquity to the present day, through books), wrote the following about Gastronomie Pratique: “one of the most famous recipe collections of the 20th century. … Contrary to what he claims in the preface, not everyone is up to the challenge of Babinski’s dishes. You have to be quite well-off to afford the ingredients and be well versed in the art of cooking. Lots of truffles, fat capons, sauterne sauces, and foie gras.”

An enjoyer of the culinary life, Ali-bab, or Henri, wrote on the last page of his book, “ … s’il est indécent de vivre pour manger, il convient, tout en mangeant pour vivre, de chercher à s’acquitter de cette tâche, comme de toutes les autres, de son mieux, avec plaisir (… if it is indecent to live to eat, it is advisable, while eating to live, to try to perform this task, like all others, to the best of your ability, with pleasure).”

Figure 6a. Cervelle de veau sauce hollandaise à la ravigotte.

On the occasion of my PhD on a medical history topic in 1989, I received a copy of Gastronomie Pratique from my teacher Lambertus J. Endtz (1927-1989). Although I must confess that I have never used a recipe from the book — after all, I do not have that gift that Ali-bab mentions in the introduction: “les cuisiniers habiles voient le moment précis où la cuisson est à point, ils ont l’instinct des proportions de condiments qu’il convient d’employer. (skilled cooks who see the exact moment when a dish is perfectly cooked and have an instinct for the right proportions of the condiments to be used.)”

I want to challenge readers to take a look at this book. Although it is still sold in bookstores, it is also available for download from the internet.15 There is even an English-language edition, in fact enlarged to become an encyclopedia. (See Figure 5.)16

Figure 6b. Cervelle de veau (uit de Engelse editie).

Brains and Truffles

The following recipe may be something his brother Joseph enjoyed: Cervelle de veau sauce hollandaise à la ravigotte (Calf’s brains with hollandaise sauce à la ravigotte).8 (See Figure 6a.)

Figure 7. Filets de levraut rôtis sauce aux truffes.

In the English edition, I found the following translation. (See Figure 6b.)

Should you manage to get your hands on truffles — at the Alba auction in Piedmont, Italy, they go for several tens of thousands of Euros17 — I can recommend Filets de levraut rôtis sauce aux truffes (roasted young hare fillets with truffle sauce.)(See Figure 7.)

I was unable to find this dish in the English translation. Fortunately, it contains many other dishes that may be easier to prepare today, such as Pot-au-feu de famille, which Gastronomie Pratique begins with. •

References:

1. Philippon J, Poirier J. Joseph Babinski. A Biography. Oxford University Press, 2009.

2. Koehler PJ. Freud’s comparative study of hysterical and organic paralyses: how Charcot’s assignment turned out. Arch Neurol. 2003 Nov;60(11):1646-50.

3. Goetz CG, Bonduelle M, Gelfand T. Charcot: Constructing Neurology. New York, Oxford University Press, 1995.

4. Hustvedt A. Medical Muses. Hysteria in Nineteenth Century Paris. London, Bloomsbury, 2011.

5. See SHMR-95: Le docteur Joseph Babinski (shmr95.fr); accessed October 5, 2024.

6. Okun MS, Koehler PJ. Babinski’s clinical differentiation of organic paralysis from hysterical paralysis: effect on US neurology. Arch Neurol. 2004 May;61(5):778-83.

7. Koehler PJ, Okun MS. Important observations prior to the description of the Hoover sign. Neurology. 2004 Nov 9;63(9):1693-7.

8. Voogd J, Koehler PJ. Historic notes on anatomic, physiologic, and clinical research on the cerebellum. Handb Clin Neurol. 2018;154:3-26.

9. Van Gijn J. The Babinski sign: a centenary. Utrecht University, Publication Department.

10. Aubert G. Arthur van Gehuchten takes neurology to the movies. Neurology. 2002 Nov 26;59(10):1612-8.

11. Van Gijn J. Babinski’s sign. In: Koehler PJ, Bruyn GW, Pearce JMS. Neurological Eponyms, New York, Oxford University Press, 2000, p. 117.

12. Lutters B, Koehler PJ. Cerebral pneumography and the 20th century localization of brain tumours. Brain. 2018 Mar 1;141(3):927-933.

13. Stone J. Neurologic approaches to hysteria, psychogenic and functional disorders from the late 19th century onwards. Handb Clin Neurol. 2016;139:25-36.

14. Haan J, Koehler PJ, Bogousslavsky J. Neurology and surrealism: André Breton and Joseph Babinski. Brain. 2012 Dec;135(Pt 12):3830-8.

15. Original French edition of 1907 : Gastronomie pratique: études culinaires suivies du Traitement de l’obésité…: Ali-Bab: Free Download, Borrow, and Streaming: Internet Archive

16. Engelse editie uit 1973: The encyclopedia of practical gastronomy: Ali-Bab, 1855-1931: Free Download, Borrow, and StreamingInternet Archive; accessed November 10th, 2024.

17. Alba White Truffle World Auction (castellogrinzane.com); accessed November 10th, 2024.

Dr. Andrew Engel (1930-2024)

The award-winning neuromuscular clinician, educator, and researcher made many contributions in neuromuscular disease research.

By Duygu Selcen, MD and P. James B. Dyck, MD 

Dr. Andrew Engel

Dr. Andrew Engel, one of the legends in the field of neuromuscular disease, passed away on Oct. 20, 2024.

Dr. Engel was born in Budapest, Hungary, and immigrated to the United States in his teens with his family. He earned his medical degree from McGill University in 1955 with a gold medal for achieving the highest academic standing upon graduation. After an internship at Philadelphia General Hospital, he began an internal medicine residency at the Mayo Clinic, but his training was interrupted in 1958 when he had to sign up for National Service. He chose the U.S. Public Health Service where he was eventually assigned to the Division of Neurology directed by G. Milton Shy at the National Institutes of Health.

During this period, he decided to become a neurologist. In 1960, he returned to the Mayo Clinic to complete his training in internal medicine and neurology. From 1962 to 1965, he was a postdoctoral fellow in neuropathology at Columbia University in New York. In 1965, Dr. Engel was appointed to the staff of the Mayo Clinic in Rochester, Minnesota.

Dr. Engel was an internationally renowned neuromuscular clinician, educator, and researcher whose impact on the field truly cannot be overstated. He was a beacon of excellence in the field of neuromuscular diseases, cherished by patients as an astute and caring clinician, nurturing numerous fellows as a dedicated mentor and teacher, and sharing his expertise in muscle pathology, biochemistry, electrophysiology, and molecular genetics. Dr. Engel discovered many novel neuromuscular diseases and unraveled the pathogenesis of many others. His contributions to the field over the decades have been extraordinary.

Dr. Engel wrote more than 350 peer-reviewed papers and numerous reviews. He also edited and was a key contributor to three editions of “Myology: Basic and Clinical,” the most highly regarded text in the field. Dr. Engel’s remarkable accomplishments in the field of neuroscience have been recognized with many awards and accolades, including:

  • The Jacob Javits Neuroscience Investigator Award (twice)
  • The Duchenne-Erb-Prize of the German Muscular Dystrophy Group
  • The Jerry Lewis Research Award from the Muscular Dystrophy Association
  • The Carrell-Krusen Award from the Texas Scottish Rite Hospital for Children
  • The Bernard Sachs Award of the Child Neurology Society
  • The Gaetano Conte Prize of the Mediterranean Society of Myology
  • The Lifetime Achievement Award for Neuromuscular Diseases by the World Federation of Neurology

In 1994, he presented the prestigious Wartenberg Lecture at the American Academy of Neurology (AAN), and in the same year, the Mayo Clinic honored him with the Distinguished Investigator Award. He was awarded honorary membership in the AAN, American Neurological Association (ANA), and the European, German, and Spanish Societies of Neurology. In 2003, he was elected to the Institute of Medicine of the National Academy of Science.

We are privileged to have learned and worked alongside such an amazing colleague. We will miss him greatly. Andy’s legacy will live on through his colleagues, collaborators, and countless former mentees here at Mayo Clinic and throughout the world. •

Dr. Duygu Selcen is a consultant and professor of neurology and pediatrics at the Mayo Clinic. Dr. P. James Dyck is a professor and consultant neurologist at the Mayo Clinic.

Rethinking High-Risk Strategies in Stroke Prevention

Primary health care providers and the Stroke Center at Central City Clinical Hospital in Almaty, Kazakhstan, collaborate on stroke prevention.

By Aida Kondybayeva

Aida Kondybayeva, MD, PhD, FEAN, Head of the Scientific and Educational Center for Neurology and Applied Neurosciences» at Asfendiyarov Kazakh National Medical University.

Aliya Abenova PhD, Deputy Director for Medical Affairs, Central City Clinical Hospital, Almaty.

“Stroke and Cardiovascular Disease Prevention: Time to Action!” was the theme of a World Stroke Day event, which was held on Nov. 5, 2024, at the Central City Clinical Hospital in Almaty, Kazakhstan. Organized by Asfendiyarov Kazakh National Medical University and the Central City Clinical Hospital of Almaty, the meeting brought together health care professionals to discuss new approaches in stroke prevention.

The speakers shared current data on a range of topics:

  • Aziz Ismailov, head of the Stroke Center at Central City Clinical Hospital in Almaty, presented statistics and key indicators of the center’s work.
  • Makpal Makasheva, a medical expert from the Situational-Analytical Center at Outpatient Clinic 4 in Almaty, shared an analysis of stroke and cardiovascular diseases in the Bostandyk district.
  • Gauhar Kasenova, deputy director of outpatient services at City Hospital 5 in Almaty, discussed data from the Medeu district.
  • Aida Kondybayeva, MD, PhD, FEAN, head of the Scientific and Educational Center for Neurology and Applied Neurosciences at Asfendiyarov Kazakh National Medical University, highlighted the need to rethink approaches to stroke prevention.
  • Aliya Abenova, PhD, deputy medical director at Central City Clinical Hospital, discussed methods for preventing recurrent strokes and complications.

Aziz Ismailov, Head of the Stroke Center at the Central City Clinical Hospital, Almaty, speaks with panelists.

Faculty of the World Stroke Day event.

The discussions underscored the importance of establishing a strong and collaborative framework between primary health care (PHC) providers and specialized stroke centers to ensure a comprehensive approach to stroke prevention and patient care. This collaboration aims to bridge the gap between early intervention and specialized treatment, offering a continuum of care that addresses both preventive measures and timely response for high-risk patients.

Participants emphasized that by aligning efforts, PHC services, and stroke centers can create a more effective system that improves patient outcomes, reduces the risk of recurrent stroke events, and ultimately strengthens public health efforts in combating stroke-related challenges.

Aida Kondybayeva, MD, PhD, FEAN, is head of the Scientific and Educational Center for Neurology and Applied Neuroscience at Asfendiyarov Kazakh National Medical University.

Opinion | Lecanemab for Alzheimer’s: Not Just Yet

Readers should note that opinion pieces in World Neurology represent those of the author(s) and are not necessarily the opinions of the WFN, its trustees, or its member societies.

In this author’s opinion, this drug shows promise but isn’t quite ready.

By Raad Shakir, CBE FRCP

Raad Shakir

The whole world continues to wait for neuroscientists to come up with an effective treatment for Alzheimer’s disease. The condition attracts huge public interest, and there is intense focus on treatment availability. The “accumulation of soluble and insoluble aggregated amyloid-beta (Aβ) may initiate or potentiate pathological processes in Alzheimer’s disease. Lecanemab, a humanized IgG1 monoclonal antibody that binds with high affinity to Aβ soluble protofibrils, was tested in persons with early Alzheimer’s disease.”1

Neurologists had been waiting for the double-blind study confirming the efficacy of lecanemab in early Alzheimer’s and mild cognitive impairment (MCI). Alzheimer’s is the main cause of dementia with a high mortality needing huge resources globally. By 2050, the prevalence of dementia will double in Europe and triple globally.2 There is therefore an urgent global need to come up with a medication that is reasonably inexpensive, easy to transport, easy to administer, and widely available to counter this deadly pandemic.

The world as well as neurologists were rather optimistic when lecanemab passed its approval hurdle with the U.S. Food and Drug Administration (FDA).3 This approval came despite a black box safety warning because of side effects. This was soon followed by statements from the European Medicines Agency (EMA)4 and more recently the National Institute for Health and Care Excellent (NICE) of England and Wales. Both clearly stated that benefits of lecanemab are “just too small” to justify cost.5 However, the EMA revised its earlier decision to approve lecanemab in a small group that has one or no copy of the ApoE4 gene.6

Lecanemab must be administered by intravenous infusion in the hospital every two weeks. The individuals need to undergo exhaustive assessments. The clinical examination requires specialists in cognitive neurology, detailed psychology examinations, and imaging. The latter requires repeated MRI scanning before commencement and during treatment. Amyloid positron emission tomography (PET) is needed before and following the treatment. Physicians will need to have access to a cyclotron to obtain the isotope. All this is in addition to the cost of the drug, which is approximately $26,500 per patient per year.

Intense monitoring is required to detect amyloid related imaging abnormalities (ARIA) such as brain swelling and bleeding. ARIA is usually asymptomatic, although rarely serious, and life-threatening events can occur. Serious intracerebral hemorrhaging greater than 1 cm have occurred in patients treated with this class of medications.

Looking at the bare facts, lecanemab reduces the amyloid load significantly.1 However, the improvement in cognitive decline in the trial of those with MCI and early Alzheimer’s disease was modest, with a 27% reduction of decline after 18 months compared to placebo. This equates to slowing in disease progression of between four and six months.

All that said, there is no doubt that we could be seeing the dawn of Alzheimer’s disease treatment, albeit with a rather cumbersome drug with many side effects at an exorbitant cost. •

Dr. Raad Shakir is a professor in the Division of Brain Sciences at Imperial College in London. He is a previous WFN president and current chair of the WFN Nomination Committee.

References:

1. van Dyck CH, Swanson CJ, Aisen P, et al. Lecanemab in Early Alzheimer’s Disease. New Eng J Medicine 2023; 388: 9-21.

2. Scheltens P, De Strooper B, Kivipelto, M et al. Alzheimer’s Disease. Lancet 2021; 396:1577-90.

3. Mahase E. Alzheimer’s disease. Lecanemab gets full FDA approval and black box safety warning. Br Med J 2023; 382:1580.

4. Mahase E. Lecanemab: European drug agency rejects Alzheimer’s drug amid debate over efficacy and safety. Br Med J 2024;386: 1692.

5. Kmietowicz Z, Mahase E. Lacnemab: Benefits of Alzheimer’s drug are “just to small” to justify cost, says NICE. Br Med J 2024; 386:1853.

6. https://www.ema.europa.eu/en/news/meeting-highlights-committee-medicinal-products-human-use-chmp-11-14-november-2024.

« Previous Page
Next Page »