From the Editors

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

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

Walter Struhal, MD

Steven L. Lewis, MD

This issue includes heartfelt articles and tributes to recently departed neurologists, including the article by Dr. M. Akif Topcuoglu, president of the Turkish Neurological Society, about the devastating Turkiye-Syria earthquakes, with tributes to each of the five neurologists who passed away in the disaster.

This issue also includes obituaries and tributes to the late Prof. Johan Arli, a past-president of the World Federation of Neurology (WFN), written by WFN Past-President Raad Shakir and other colleagues of Prof. Arli from around the globe, including Nils Erik Gilhis, Ole-Björn Tysnes, Christian A. Vedeler, and Amadou Gallo Diop.

In this issue’s President’s Column, WFN President Dr. Wolfgang Grisold updates us on the many international activities in progress and being planned by the WFN, including the work being done with WHO and the Intersectoral Action Plan (IGAP), and the exciting plans for the World Congress of Neurology in Montreal this October, including the planning for the Annual Council of Delegates meeting.

Drs. Tissa Wijeratne and David Dodick (Co-Chairs of World Brain Day) as well as Drs. Lewis and Grisold provide a followup report on the plans for this year’s World Brain Day 2023, which will be dedicated to “Brain Health and Disability,” including collaborations between the WFN, our global regions, national neurologic societies, and the World Federation of Neurorehabilitation. Dr. Wijeratne is also congratulated on receiving the prestigious medal of the Order of Australia.

This issue’s History Column, by Dr. Peter J. Koehler, is devoted to an extensive book review on “The Idea of Epilepsy: A Medical and Social History of Epilepsy in the Modern Era” (1860-2020), by Dr. Simon D. Shorvon.

This issue also features several reports from recent national and international conferences. Kurt Niederkorn, Yong-Jae Kim, Hee-Jung Song, and Alex Razumovsky report on the joint conference of the Korean Society of Neurosonology and the WFN Neurosonology Research Group help in November 2022. Aida Kondybayeva reports on the Fifth International Educational Forum, the Neurology Update in Kazakhstan 2023 that was held in March 2023. Stefan Kiechl and Deidre De Silva report on the World Stroke Congress that occurred in October 2022 in Singapore. Finally, Carlos N. Ketzoian reports on the Second Latin American Course on Neuroepidemiology that was held in Punta del Este, Maldonado, Uruguay, this past March.

In closing, we want to thank all readers for their interest in and attention to World Neurology and the chance to report such important updates about neurology and neurologists from around the globe. We sincerely hope many of you are planning on attending the WCN in Montreal in October 2023 in person (for the first time since 2019) or virtually. •

Prof. Johan Arild Aarli (1936-2023)

By Raad Shakir

Johan Aarli

Johan Arild Aarli, former president of the World Federation of Neurology (WFN), passed away on the March 24, 2023, at the age of 86 years. His name is recognized and admired by neurologists across the world.

Johan graduated from Bergen in 1961, where he also did his training in neurology and basic training in immunology. He obtained his specialist in neurology status in 1970, defended his doctoral thesis in 1972 (muscle antibodies in myasthenia gravis) and was appointed professor in 1977.

Prof. Aarli developed the department of neurology at Bergen University Hospital making it a leading center of neuroimmunological research. He was subsequently appointed dean of the faculty of medicine at Bergen, and chair of the Norwegian Association of Neurology.

In addition to his vast number of scientific writings, he was a pioneer in the field studying the impact of neurobiology on culture and history. He was a prominent member of the Norwegian Neuro-Literary Club, contributing to all their books on neurology, art, and history and co-authored the book on the history of Norwegian neurology. He was a member of the steering committee of the successful Norwegian Year of the Brain 1995. Johan’s work in Norway was so distinguished that in 1996, he was made a Knight, First Class of the order of Saint Olav by King Harald V.

When the European Federation of Neurological Societies (EFNS) was founded, he was the first Norwegian delegate (1991-1998) and was quickly appointed Chair of the Teaching Committee of the EFNS (1997- 2002) and then appointed EFNS Secretary-General (2003-05). Internationally, Prof. Aarli was the Norwegian delegate to the WFN 1998-2001, elected as WFN vice president, and was thereafter elected WFN president during the Sydney World Congress of Neurology in 2005.

Having had the honor of working with him, Johan had the extraordinary ability to calmly drive the WFN to many new areas and initiatives. He developed the collaboration between the WFN and WHO, which started with the publication of the Neurology Atlas in 2004 followed by “Neurological Disorders: Public Health Challenges” in 2006. In June 2019, he represented the WFN in the 10-year project to produce the ICD11. The collaboration continues today.

In 2007, his calm diplomacy and negotiation skills enormously helped in bringing the Chinese Neurological Society to become a full member of the WFN.

Johan saw the need to develop improved delivery and increased rural distribution of neurological care, and is considered by our African colleagues as the father of the WFN Africa Initiative. He started the Africa Task force in 2005, which eventually evolved into the African Academy of Neurology. Site visits to establish training centres in Africa and Latin America started during his presidency.

As if all this was not enough, Prof. Aarli wrote the “History of the WFN, the First 50 Years” published by Oxford University Press in 2014. Another eminent previous WFN president Lord Walton described the book, “without question a major scholarly work based upon careful historical research and an encyclopedic knowledge.” It is the principal source on the history of neurology in the second half of the twentieth and the early twenty-first centuries.

Prof. Aarli’s enormous achievements for international neurology were deservedly recognized by the WFN when he was awarded the medal for services to international neurology during the 2013 Vienna World Congress.

Johan was a soft-spoken, gentle, charming, pleasant man, with a disarming demeanor. His requests for neurologists from all parts of the world to serve the WFN in various capacities were asked simply in a calming manner “would you have a little time to give to the WFN.” I do not think anyone ever refused. He was generous, a wonderful host and a real friend. You could go to him with any problem or issue and come out fully satisfied by his wise and sound opinion. He was known to take time to think and ask for advice prior to making major decisions. He always made all those around him feel comfortable with his decisions as they would have been thoroughly thought through. A leader, who shall certainly be sorely missed.

He is survived by a loving family, Gullborg his wife of 62 years, five children, Anen, Ragna, Gunn, Bernt and Maria, 15 grandchildren, and one great grandchild.

Johan Aarli´s last years were overshadowed by chronic ill heath that finally ended the life of this remarkable neurologist. •

Prof. Raad Shakir is a past-president of the World Federation of Neurology.

Tribute From Africa to Johan Aarli

By Prof. Amadou Gallo DIOP, MD, PhD

Johan Aarli

We, in Africa, definitively consider Johan Aarli as the great and generous man who, as president of WFN, put Africa on the map of world neurology. He met with Prof. Michel Dumas in 2005 at the Sydney World Congress of Neurology (WCN). Prof. Dumas is one of the first French pioneers who installed neurology in Africa, Senegal, in the late 1950s. Prof. Aarli argued that African neurologists could not be absent in the new global affairs he was leading during his World Federation of Neurology (WFN) presidency. He rapidly cemented it by inviting, for the first time, African neurology leaders to attend a business meeting at the London headquarters in 2006. He generously accepted us and listened to our dreams and goals. He set up the WFN Africa Initiative with robust, sustainable, and efficient programs of training, bursaries, and exchanges.

He traveled to Africa (the first for a WFN president) because he was curious and excited to know us better for more substantial and structured support of neurological sciences in Africa. He endorsed, with respect and high consideration, the slogan we proposed to him: “With Africa; for Africa,” which became the WCN’s slogan in Marrakech (the wonderful and first WCN in Africa) in 2011. The outcome of Prof. Aarli’s “WFN Africa Initiative” is concrete, visible, measurable, and impacting:

Four Regional Training Centers “in Africa, for Africa” (Cairo, Cape Town, Dakar, Rabat) receiving four-year and one-year trainees from African countries with priority for the those lacking neurosciences human resources. It led to training neurologists on site, in the continent, increasing their number and combating the brain drain.
Travel bursaries for complementary hyperspecialized training for post-doctoral African fellows to voluntary hosting sites, such as Austria, Germany, France, Italy, Norway (Prof. Aarli’s country), and Turkey.
Strong support to regional teaching courses (RTCs) with a powerful implication of institutions such as the AAN, EAN, and others.
Facilities and bursaries for young African neurologists for attending the WCN and other major neuroscience congresses around the world.
The establishment of the African Academy of Neurology (AFAN), in Dakar in 2010, was a tremendous and historic administration outcome of Johan Aarli’s global initiative and legacy.

Definitively, the smiley, generous gentleman Johan Aarli will count a lot in the history of neurology in developing countries, particularly in Africa, from where we send our condolences to his extraordinary wife, Gullburg, who was with him at every WFN event around the world. Also, to his colleagues in Norway and the successive WFN staff all these last years.

Thank you, dear Johan. Africa is grateful to you. God bless you. •

Prof. Amadou Gallo is head of the Dakar WFN Regional Training Center and past WFN trustee (2013-2016)

Johan A. Aarli: An Inspiring Teacher and Leader of Neurology

By Nils Erik Gilhus, Ole-Bjørn Tysnes, and Christian A. Vedeler

Johan A. Aarli was an inspiring and highly respected neurologist with a worldwide influence. Sadly, he died March 24, 2023, at age of 86 years after a long illness. He made a huge professional impact locally, nationally, and globally. Prof. Aarli was a successful president of the World Federation of Neurology 2005-2009, and a general secretary of the European Association of Neurological Societies 2003-2005.

Prof. Aarli’s aim throughout his professional career was to improve the treatment for patients with disorders in the brain and nervous system. His tools were teaching, research, leadership, and organization of neurologists and neuroservices. He combined clinical education and improvement, research, and innovation. As a WFN president, he was famous for his African initiative. He regarded better services for patients in poor countries as the major challenge for WFN. Furthermore, he was instrumental in building a true global alliance in neurology and neuromedicine with activities on all continents.

Prof. Aarli was the head of the department of neurology at Haukeland University Hospital for nearly 30 years, combined with a professorship at University of Bergen, until he retired in 2006. He built a modern and expansive department with specialized units for neurophysiology, neurorehabilitation, and occupational neurology, and with systematic multiprofessional treatment for well-defined neurological patient groups, such as ALS, epilepsy, multiple sclerosis, and stroke.

A main aim for Prof. Aarli was to combine clinical practice with research and education. His personal research focus was clinical neuroimmunology, and myasthenia gravis in particular. He contributed to the understanding of autoimmune disease mechanisms, and he helped in developing the field internationally through his widely distributed textbook from 1987. His research policy was to combine detailed clinical information with biomarker data from laboratory investigations. As a professor, department head, and university dean, he inspired and supported research in clinical neuroscience relevant for all neurological patient groups, including the development of clinical registries and biobanks.

His ability to lead, to teach, and to build networks stemmed from his sharp intellect combined with his friendly interest in people. His short- and long-term strategies were successful because he worked so well together with colleagues and patients, and with administrators and politicians. He appreciated people, and they appreciated him.

Prof. Aarli was born in Kvinesdal, a small village valley in Southern Norway. Together with his father, he wrote the local history of that valley. He was interested in history and literature, and he was co-founder of the Norwegian Neuroliterature Club. He was open-minded, optimistic, and honorable. He listened and discussed, was a true democrat, but he combined this with an ability to make decisions and see projects through.

We miss Johan A. Aarli in Bergen and Norway, but his impact is still here. We are sure that this is true also for many of his friends and activities globally. Our warm condolences go to his wife, his five children, and a big family. •

From the department of neurology at the Haukeland University Hospital and University of Bergen in Bergen, Norway.

Prof. Wijeratne honored during Australia Day 2023

Prof. Tissa Wijeratne

The World Federation of Neurology (WFN) is pleased to report that Prof. Tissa Wijeratne, OAM MBBS, MD, PhD, FRACP, FRCP, FAAN, FEAN, co-chair of Public Awareness and Advocacy and World Brain Day, was honored during the Australia Day 2023 with the medal of the Order of Australia (OAM). Congratulations to Prof. Wijeratne. •

Joint Korean Society of Neurosonology and WFN Neurosonology Specialty Group Conference

The meeting in Seoul, Korea, explored the use of neurosonology as an essential modality for neurologists.

By Kurt Niederkorn, MD, Yong-Jae Kim, MD, PhD, Hee-Jung Song, MD, PhD, and Alex Razumovsky, PhD, FAHA, NVS

The Neurosonology Specialty Group (NSG) of the WFN is dedicated to the promotion of science and research as well as of education and training in the field of ultrasonic techniques and its clinical use. Therefore, international cooperation and the dissemination of scientific information within the field of neurosonology is part of NSG WFN activities.

On Nov. 3-5, 2022, a joint conference of the Korean Society of Neurosonology (KSN) and NSG WFN considering clinical applications of carotid duplex, transcranial Doppler and transcranial color-coded duplex utilization in the wide arrays of different aspects of neurology, neurocritical care, and neurosurgery was conducted in Seoul, Korea. Invited speakers included prominent experts from Austria, Egypt, Germany, Japan, Korea, Portugal, Singapore, Switzerland, and the United States. Numerous speakers from Korean medical schools and universities were involved and presented high-quality clinical and research lectures.

A program full of lectures including teaching courses, hands-on sessions, poster sessions, international certification examination, and special interest events covering diverse topics, with networking and social activities, was presented. A special session was dedicated to sonography education where experts from Germany, Korea, and the United States exchanged opinions and presented country-specific approaches to neurosonology and ultrasound education in medical schools. However, the wide application of ultrasound, including neurosonology across many medical specialties, increased portability and decreased cost of ultrasound devices, and enhancement of learning both basic and clinical sciences with ultrasonography will continue to demand appropriate teaching and training on ultrasound in undergraduate medical education.

A special issue of the Korean Journal of Neurosonology and Neuroimaging (JNN) published all lectures and presentations (JNN, volume 14, supplement 2, November 2022).

Neurosonology has been developed based on ultrasound diagnosis in cerebrovascular diseases, like ischemic stroke and extracranial and intracranial stenosis, but is currently being applied and used clinically in various fields ranging from diagnosis and monitoring of cerebral vasospasm after subarachnoid hemorrhage and traumatic brain injury, and cerebral degenerative diseases, and to diagnose and follow up on peripheral nerve and muscle diseases.

This Joint KSN and NSG WFN conference will definitely create a better cooperation of neuroscience researchers around the world who are conducting clinical and translational research beyond ultrasound diagnosis. •

Kurt Niederkorn, MD, is professor of neurology and chair of the NSG of the WFN. Yong-Jae Kim, MD, PhD, is professor of neurology and chair of the Korean Society of Neurosonology. Hee-Jung Song, MD, PhD, is president of the Korean Society of Neurosonology. Alex Razumovsky, PhD, FAHA, NVS is secretary of NSG of the WFN.

The Fifth International Educational Forum

Neurology Update in Kazakhstan 2023

By Aida Kondybayeva, MD, PhD

Aida Kondybayeva

The Fifth International Educational Forum Neurology Update in Kazakhstan 2023 was held March 10-11, 2023. The forum was held in hybrid mode. With the joint work of the Kazakhstan National Association of Neurologists Neuroscience (KNANN) and the faculty of medicine and health at the al-Farabi Kazakh National University (al-Farabi KazNU). The event was attended by 846 doctors, including neurologists, internists, GPs, rehabilitation specialists, and intensive care specialists from Kazakhstan, Kyrgyzstan, and Uzbekistan.

Welcoming speeches to the participants were given by Prof. Saltanat Kamenova, president of KNANN; Prof. Zhanna Kalmataeva, dean of the faculty of medicine and health at al-Farabi KazNU; Aizhan Sadykova, president of the National Medical Association; and Symbat Abzalieva, deputy director of the Higher School of Medicine at al-Farabi KazNU. They noted the special significance of the forum for all practitioners who took part in this event.

The speakers of the Forum were Prof. Valery Feigin (New Zealand), Prof. Natan M. Bornstein (Israel), Prof. Adnan Siddiqui (U.S.), Prof. Afshin Divani (U.S.), Prof. Mesoud Ashina (Denmark), Prof. Tatyana Negrich (Ukraine), Prof. Aksel Siva (Turkey), as well as doctors from Kazakhstan: Saltanat Kamenova, Bagyzhan Syzdykova, Korlan Saduakasova, Tatiana Kaimak, Maksharip Martazanov, Aigul Akimniyazova, Gulnar Kabdrakhmanova, Karlygash Kuzhibaeva, and Aida Kondybaeva.

Current issues of neurological diseases were discussed, including autism, migraine, multiple sclerosis, myasthenia gravis, pain, and stroke.

Within the framework of the forum, there was a master class titled, “Evidence-Based Neurology. How to Search for Information to Answer Specific Clinical Questions, Interpret and Critically Evaluate Scientific Evidence.” This training course was organized for young doctors and discussed the basic concepts and tools of evidence-based medicine, as well as their application in clinical and scientific practice. The course was conducted by doctors Maurizio Leone (Italy), Luca Vignatelli (Italy), Katina Aleksovska (Macedonia), and Teia Kobulashvili (Austria). •

Aida Kondybayeva, MD, PhD, is a neurologist and chair of the Educational Committee at Kazakhstan National Association of Neurologist “Neuroscience” Institutional Delegate of the European Academy of Neurology from Kazakhstan.

Earthquake Disaster and Turkish Neurology

By Prof. M. Akif Topcuoglu

On Feb. 6, 2023, two major earthquakes occurred, nine hours apart, with epicenters in Gaziantep and Kahramanmaraş in Turkiye. In this disaster, called the 2023 Turkiye-Syria earthquakes,” nearly 43,000 people died in Turkiye and 6,000 people in Syria. A total of approximately 150,000 people were injured, of which 120,000 were in Turkiye. It is estimated that at least 3 million people migrated from the affected zone to different cities after the earthquakes. Aftershocks still continue and pose a serious risk for rescue teams. Earthquakes affected 13.5 million Turkish people in an area of 1,000 square kilometers. This refers to about one-seventh of Turkiye’s population.

From the first news of the catastrophe, both state institutions, organizations, and volunteers rushed to the earthquake zone. Especially in Hatay and Maraş, there was such a severe destruction that the emergency response teams were also affected. The frigid, snowy weather and the fact that people were caught asleep increased our loss and made emergent intervention difficult. Significant assistance came from many countries around the world. As a result of these efforts, many lives were saved in a short time, and life was attempted to be restored as fast as possible. This effort still continues at the highest level.

Turkish medicine intervened in the earthquake with great effort. Although there was a short-term overcapacity in some regions, all of the injured could be taken to hospitals, and all necessary interventions could be made with the system created all over the country. The Turkish Neurological Society provided containers, heaters, portable beds, and generators in line with the demands of the regional neurology clinics and within its capacity. Our society is going to continue its academic and physical aids so that life in the region can be re-established as soon as possible.

Unfortunately, nearly 100 doctors died in the earthquake, and five of them were neurologists. These friends passed away in the most hopeful and productive period of their lives. Our sadness is endless and unbearable. We have written this article to share this disaster experienced with the neurologists all over the world. As the Turkish Neurological Society, we want to keep the memory of these five colleagues alive. We will miss them very much. •

Prof. M. Akif Topcuoglu is president of the Turkish Neurological Society

Bessam Ezelsoy, MD

Bessam Ezelsoy was born in 1961 in Hatay. He graduated from Istanbul University Faculty of Medicine in 1985. He completed his neurology residency training at Bakırköy/Istanbul Sadi Konuk Training and Research Hospital in 1994. He was working as a neurologist at Hatay Training and Research Hospital. He was recognized by his patients as a warm, tolerant, and understanding doctor. In 2015, he was selected as the doctor of the year in Hatay. We unfortunately lost Dr. Ezelsoy and his beloved wife in the 7.7 magnitude earthquake that occurred in our country on Feb. 6, 2023. Dr. Ezelsoy’s two children survived the earthquake. That was our only consolation.

Eda Kahiloğulları Aşkar, MD

Eda Kahiloğulları Aşkar was born in 1995 in Antakya. She was continuing her neurology residency training at Mustafa Kemal University, Tayfur Sökmen Medical Faculty, Department of Neurology. Colleagues remember her for her kindness, helpfulness, sincere smile, and hard work. Unfortunately, she passed away in the earthquake with her beloved husband. She loved neurology very much, and there is no doubt that she would have been a very good neurologist.

Bircan Turunc, MD

Bircan Turunc was born in Antakya in 1992. She graduated from Maltepe University Faculty of Medicine in 2019. Her friends describe her as “beautiful on the outside but more beautiful inside.” We lost our angelic and devoted friend and cat guardian, Dr. Turunç, at a very young age. Had she lived, we are sure that she would have touched many patients and become a very successful physician and neurologist. Unfortunately, we live in a time when words become meaningless in Turkiye.

Murat Güntel, MD

Murat Güntel was born in 1984. He graduated from Mersin University Faculty of Medicine in 2009. He completed his neurology residency training at Hatay Mustafa Kemal University Faculty of Medicine in 2015. Between 2015 and 2016, he worked as a neurologist at Elazig Training and Research Hospital. He had been working as an assistant professor at Mustafa Kemal University Tayfur Sökmen Faculty of Medicine, Department of Neurology since then. He was a prolific academic with numerous case and research articles in international journals. He was described by his colleagues as a friendly, hardworking, kind, and wonderful person. He was loved by his students and patients. He died in the earthquake disaster with his beloved mother and two cats.

Tülay Yücel, MD

Tülay Yücel was born in 1959 in İzmir. She graduated from Ankara University Faculty of Medicine in 1984. She completed her neurology specialization training at Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital in 1991. Dr. Yücel was working as a retired-freelance neurologist. She, her daughter-in-law, and 6-month-old granddaughter lost their lives in the earthquake in Hatay.

Brain Health and Disability: Leave No One Behind

The WFN, global regions, and the World Federation of Neurorehabilitation

By Tissa Wijeratne, David W. Dodick, Steven L. Lewis, and Wolfgang Grisold

World Brain Day 2023 annually commemorates the foundation of the World Federation of Neurology (WFN) on July 22. The previous World Brain Day themes focused on specific neurological diseases such as Parkinson’s disease, migraine, epilepsy, multiple sclerosis, and many others. We are again partnering with all six regions of the WFN as well as the World Federation for NeuroRehabilitation (WFNR) to unite the world on the disability that results when brain health compromised.

Brain disorders, affecting more than one billion people, are the leading cause of disability-adjusted life years (DALYs). Optimizing brain health, care, and rehabilitation for those with disability from neurological disease is a global priority, requires involvement of policy makers, health care providers, foundations, public health authorities, professional societies, patient advocacy organizations, and the private sector.

The World Health Organization (WHO) identified the following determinants for brain health:

Physical health
Healthy environments
Safety and security
Learning and social connections
Access to quality services

By addressing these determinants, we can optimize brain health, prevent neurological disease, facilitate early and rapid diagnosis, ensure universal access to care, and thus lower the prevalence and disability associated with most neurological diseases. For those with progressive, late-stage, and incurable disease, access to palliative care to ensure human dignity at the end of life is an imperative.

The Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022–2031 (IGAP) was initiated by WHO and unanimously adopted at the World Health Assembly on May 27, 2022. [https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_10Add4-en.pdf].

The IGAP provides a comprehensive response to the burden of neurological disorders; the global action plan suggests actions to Member States and national and international partners to close the treatment gap for people with neurological disorders and support quality management of these conditions.

Since the IGAP is also directed to organizations such as the WFN, this is an excellent opportunity to strengthen the collaboration between the WFN and WHO by linking our actions with the principles of the IGAP.

In this year’s World Brain Day | Brain Health and Disability: Leave No One Behind, we intend to highlight five key messages.

Prevention: Brain disabilities can be prevented, treated, and rehabilitated.

Awareness: Global brain health awareness can reduce the burden of brain disorders.

Access: Universal access to care, treatment, rehabilitation, and assistive technology is essential.

Education: Education increases equity for those living with brain disabilities.

Advocacy: Brain health is a human right that applies to everyone, everywhere.

As in the previous World Brain Days, a special logo and material have been produced and will be made widely available for local/regional use by health care professionals, regional and national societies, and all other stakeholders involved in neurological disease advocacy. Before World Brain Day, a template for press mailings will be distributed to help the local organizations. On World Brain Day, a webinar will be launched and, with invited participants from the press, key messaging on brain health and disability will be disseminated.

The ultimate success of World Brain Day depends on your local activities. Please make World Brain Day your own, use all the material we provide, and ask for more if needed. Experience has shown that this international day has created considerable press attention, but local activities and information make the difference.

Please involve patients, caregivers, the public, local, regional, and national policy makers, and patient groups that might be interested in this topic. Please be sure to post your activities on social media to help raise awareness. Join us on World Brain Day as we ensure no one is left behind.

Brain health care faces many global inequalities. Let’s change this together. Let’s leave no one behind.

We eagerly await your reports of your local plans on World Brain Day events so that we can publish them in World Neurology.

Learn more at www.wfneurology.org. •

Report of the World Stroke Congress 2022 in Singapore

By Stefan Kiechl and Deidre De Silva

The World Stroke Congress (WSC) is the flagship meeting of the World Stroke Organization (WSO). After the exclusively virtual events in 2021 and in 2020 (joint conference with the European Stroke Organization), the WSC 2022 in Singapore was the first international large-scale in-person meeting. With more than 4,400 attendees (approximately half in person and half online) this was the largest WSC ever. It served as an excellent opportunity to discuss latest clinical and research results with colleagues from all over the world. The participants were from 106 countries with highest attendance from colleagues from Australia, China, India, Indonesia, Malaysia, Philippines, Singapore, United Kingdom and the United States. The faculty of 204 invited speakers were well balanced across continents (Asia 34%, South and North America 24%, Europe 25%, Australia and Africa 18 %).

The opening ceremony included a video message from Tedros Adhanom Ghebreyesus, WHO director-general. In the three-and-a-half day program Oct. 26-29, the scientific program committee organized 97 sessions, teaching courses, joint symposia, and plenaries. These covered a broad range of topics, emphasizing the latest research and breakthrough discoveries across the globe, with priorities in acute stroke therapy, primary and secondary prevention, rehabilitation and recovery, cardiac aspects, and intracerebral haemorrhage.

One priority of WSC was the cross-link with partner organizations. The WSO and World Federation of Neurology (WFN) organized a joint symposium on education in stroke. With the conference being held in Asia, this granted the opportunity to collaborate with stroke societies from Asia, such as the Chinese Stroke Association, Asia Pacific Stroke Organization, Association of Southeast Asian Nations Neurological Association, and WHO South-East Asia Regional Office. Stroke support organizations substantially contributed to the WSC 2022, integrated into the main program and also in parallel independent sessions. During the coffee breaks, there was dialogues on non-communicable diseases (NCD).

The WSC 2022 had more than 20 late-breaking trials that were published in top journals like The New England Journal of Medicine and JAMA. One highlight was the first presentation of results of MR CLEAN-LATE. Patients admitted between 6 and 24 hours after stroke (NIH Stroke Scale ≥ 2, occlusion of the internal carotid artery or M1/2 segments of the middle cerebral artery), had a substantial benefit of endovascular stroke therapy. The only patients not considered in these trials were patients with large demarcated infarction (more than third of the territory of the middle cerebral artery) and patients with a collateral score of zero. Patients with indications of endovascular stroke therapy according to DAWN or DEFUSE-3 criteria were also not considered. Other highlights were the meta-analysis of six trials comparing endovascular stroke therapy alone against bridging (combined with intravenous thrombolysis). In this meta-analysis including 2314 patients, endovascular stroke therapy could not prove to be non-inferior to bridging therapy and this is also valid for multiple subgroups. The first phase 3 trial on stem cells in stroke recovery (TREASURE) was negative, a lowering of systolic blood pressure under 120 in successful endovascular stroke therapy has negative impact on the patients’ outcome (ENCHANTED2), and treatment by tenecteplase was non-inferior to alteplase treatment (AcT Study).

The WSC 2022 in Singapore contributed to a better clinical stroke management in the future and facilitated discussion about stroke care in various geographical regions. Hundreds of delegates, local organizers, and stroke advocates joined the annual Walkathon and with “One Voice” raised stroke awareness. The WSC 2023 will be organized in Toronto (Canada) between Oct. 10-12, a few days before the congress of the WFN in Montreal from Oct. 15-18. •

Stefan Kiechl and Deidre De Silva Chaired the Scientific Committee of WSC 2022.