II Latin American Course of Neuroepidemiology

Punta del Este, Maldonado, Uruguay | March 6-10, 2023

 

By Dr. Carlos N. Ketzoian

Participants in the II Latin American Course of Neuroepidemiology, Punta del Este, Maldonado, Uruguay, March 6th to 10th, 2023. In the center, Dr. Daniel Salinas, Minister of Public Health of Uruguay.

Last March, the II Latin American Course of Neuroepidemiology took place in Punta del Este, Maldonado, Uruguay. This course was organized by the neuroepidemiology section of the Institute of Neurology at the University of the Republic in Uruguay, and the Université de Limoges in France, with the endorsement of the World Federation of Neurology (WFN). The course was held at the Eastern Regional University Center (C.U.R.E.) of the University of the Republic, Uruguay.

The I Latin American Course of Neuroepidemiology took place in Panama City, Panama, in April 2018. This II course was initially planned to take place in March 2020. Unfortunately, the COVID pandemic forced the organizers to postpone it until 2023. The structure and the content of these Latin American courses are based on the experience of the Erice’s International Course of Neuroepidemiology. (See World Neurology, posted Feb. 24, 2023. Report on the Ninth International Course of Neuroepidemiology: Methods and Clinical Applications worldneurologyonline.com).

Twenty-one students, five teachers, three coordinators, and two invited speakers participated in five intense and enriching days of learning. Apart from local participants from Uruguay, the remaining students came from different Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, and Peru. Two participants came from outside of the region (Republic of Armenia).

Profs. Walter Rocca (U.S.), Giancarlo Logroscino (Italy), Pierre-Marie Preux (France), Ruth Ottman (U.S.), Brandon Coombes (U.S.), and Carlos Ketzoian (Uruguay) were part of the teaching team. The course was coordinated by Prof. Carlos Ketzoian (Uruguay), Prof. Regina Alvarenga (Brazil), and Drs. Fabián Gómez Elso and Lucía Castro (Uruguay).

Dr. Sebastián Ameriso from Argentina gave a lecture on the epidemiology of stroke in Argentina and Prof. Abayubá Perna from Uruguay gave a lecture on the genetic epidemiology of limb-girdle muscular dystrophy (LGMD) in Uruguay.

Study design aspects, genetic epidemiology, and statistical methods applied to neuroepidemiology were discussed in the morning. After lunch, the participants analyzed published clinical-epidemiological studies in which the different methodologies presented in the mornings were addressed. Each day, the activities ended with lectures on different topics.

The course activities also included the IV Journée d’Amitié Neurologique Franco-Panamericaine with lectures by Profs. Abayubá Perna (Uruguay), Regina Alvarenga (Brazil), and Pierre Marie Preux (France). The program was endorsed by the French Embassy in Uruguay. A cocktail reception took place after the lectures. The Minister of Public Health of Uruguay, Dr. Daniel Salinas, who is a neurologist, participated in this opening academic and social event. On Friday, March 10, the course closed with a social dinner of traditional “Asado Criollo” (Uruguayan barbecue).

Participants, professors, and coordinators had the opportunity to discuss in-depth different aspects of the clinical-epidemiological methodology for the study of neurological diseases. This full-immersion course format allowed total focus on the subjects, and the participants were not distracted by other activities during the day.  The participants worked together for eight hours a day for five days.

We would like to emphasize that this kind of course corresponds to the objectives defined by the WFN Specialty Group on Neuroepidemiology during the meeting which took place Oct. 30, 2019, at the World Congress of Neurology in Dubai. •

Carlos N. Ketzoian is chair of the WFN Specialty Group on Neuroepidemiology.

Book Review: The Idea of Epilepsy 

A Medical and Social History of Epilepsy in the Modern Era (1860-2020), Simon D. Shorvon, Cambridge University Press

 

By Peter J. Koehler

“Diseases can be considered as acts or invasions by gods, demons, or evil spirits, and treated by the invocation of supposedly supernatural powers. Or they are considered the effects of natural causes and are consequently treated by natural means. In the struggle between magic and the scientific conception, the latter has gradually emerged victorious in the western word. The fight has been long and eventful, and in it epilepsy held one of the key positions. Showing both physical and psychic symptoms, epilepsy more than any other disease was open to interpretation both as a physiological process and as the effect of spiritual influences.” — Owsei Temkin, 1945 

The Falling Sickness

These are the first sentences in Owsei Temkin’s classic book The Falling Sickness. A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology. First published in 1945, a revised edition appeared in 1971, and in 1994 it was published again. The book begins with the “sacred disease” in antiquity, discusses ancient medical science, and touches upon magic, superstition, possession, and lunacy in the Middle Ages. It then passes through the Renaissance period with the “theological debate” on possession and witchcraft, describes theoretical ideas on epilepsy in the great systems (including iatrochemistry, iatromechanics, and animism), discusses the Enlightenment, including pathology and nosology, and then enters into the nineteenth century. Here Temkin dwelt on reflex therapy, described some of the important “Jackson forerunners,” including Richard Bright (1789-1858) and Louis-François Bravais (1801-1843), whose name is sometimes eponymized in the term Bravais-Jacksonian epilepsy. The book ends with an extensive description of the ideas of John Hughlings Jackson (1835-1911) in the second half of the nineteenth century. 

As apparent from the title, the present book by Simon Shorvon, The Idea of Epilepsy. A Medical and Social History of Epilepsy in the Modern Era (1860-2020), begins approximately, where Owsei Temkin (1902-2002) ended, although there is some overlap, in particular with respect to Bénédict Morel (1809-1873), Wilhelm Griesinger (1817-1868), Jules Falret (1824-1902), and Théodore Herpin (1799-1865), who are mentioned in both books.

The Authors

Temkin and Shorvon have quite different backgrounds. Temkin was born in Minsk (in the present Belarus) and received his MD from the University of Leipzig (1927), where he was in contact with well-known medical historians like Henry E. Sigerist (1891-1957) and Karl Sudhoff (1853-1938). Following his MD, he worked at the Leipziger Medizinhistorischen Institut. Both Sigerist and Temkin emigrated to the U.S. (Johns Hopkins University, Baltimore) in 1932 and Temkin remained a medical historian. Some of his important books are Galenism: Rise and Decline of a Medical Philosophy (1973) and Hippocrates in a World of Pagans and Christians. Shorvon, on the other hand, has a background in clinical medicine. He is an emeritus professor of clinical neurology at the University College of London (UCL) Queen Square Institute of Neurology and Hon. Consultant Neurologist at the National Hospital for Neurology and Neurosurgery. In the latter hospital, he specialized in epilepsy. He published books not only on epilepsy, but also on the history of neurology, including ILAE [International League Against Epilepsy] 1909-2009, A Century of History (2009), Physicians at War (2016), 500 Years of the Royal College of Physicians (2018), and the acclaimed Queen Square. A History of the National Hospital and its Institute of Neurology (in cooperation with Alastair Compston; 2019). 

The Idea of Epilepsy

These two books by Temkin and Shorvon complete a fantastic review of the history of epilepsy. Whereas Temkin’s 1994 edition on the early history of epilepsy comprised 488 pages, Shorvon’s new book on the 1860-2020 period has as many as 750 pages. The latter book contains a wealth of information about the latest 160 years, in which knowledge of epilepsy increased tremendously. In the introduction, the author appropriately uses the metaphor of a ship named “Epilepsy” sailing through the long twentieth century. Very appropriately, he is aware that the medical and scientific aspects of the history of epilepsy are not the only that need to receive attention. A disease such as epilepsy in particular has many important aspects that deserve to be addressed. Therefore, the author chose to examine the history of epilepsy from four perspectives, not only including the medical and scientific, but also the societal and personal perspective. Furthermore, he tried not just to answer the question, “What happened?” but also “why it happened,” the latter of course being much more difficult and even “hazardous.”

The reason why he chose to begin in 1860 is that he considered this the period of the first modern conceptions of epilepsy. Indeed, the mid-nineteenth century was the period in which medicine definitely became based upon science. This was related to August Comte’s (1798-1857) positivistic philosophy. Scientific knowledge was obtained by representing results in measure and number. Claude Bernard (1813-1878) and Rudolf Virchow (1821-1902) were important proponents of the scientific method in medicine. Their respective books Introduction à l’étude de la médecine expérimentale (CB 1865) and Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre (RV 1858) may be considered milestones of the scientific method in medicine.

Epilepsy and Psychiatry

The 160 years that are discussed in Shorvon’s book are divided into five periods: 

1. 1860-1914 (“The birth of modern epilepsy”)

2. 1914-1945 (“Epilepsy in the age of catastrophe”)

3. 1945-1970 (“Epilepsy and the new world order”)

4. 1970-1995 (“Epilepsy in a globalized world”)

5. 1995-2020 (“The epilepsy floods are too recent”) 

Cesare Lombroso (courtesy Wellcome Collection)

In each period, the four mentioned perspectives pass in review. The relationship between epilepsy and psychiatry in the first mentioned period is intriguing.  The author mentions Cesare Lombroso’s (1835-1909) and his famous book L’uomo delinquente (1876), in which the author focused on the link between epilepsy and crime. Furthermore, Shorvon stated that “it was in the context of the study of mental symptoms in epilepsy that the theory of dégénérescence (degeneration) was proposed, again by Morel,” referring to his 1857 Traité des dégénérescences physiques, intellectuelles et morales de l’espèce humaine et des causes qui produisent ces variétés maladives [A treatise on the physical, intellectual and moral degenerations of the human species and the causes that produce these morbid varieties]. Indeed, Morel published on the relationship between epilepsy and his degeneration concept, but it was in a number of articles in the Gazette hebdomadaire that he described his concept of épilepsie larvée (masked epilepsy).1 The degeneration concept started in psychiatry with proponents such as Morel and Valentin Magnan (1835-1916). 

“Insanity gradually came to be considered a brain condition and a product of degeneration rather than a psychological disorder. … A ‘taint’ or sickly deviation from the norm initially caused by a pathogenic environment, poor nutrition, or alcoholic abuse, and subsequently transmitted in the Lamarckian manner through heredity, becoming progressively more severe with each generation until the family line became sterile and, finally, extinct”.2  

Later in his career (1880s), Jean-Martin Charcot (1825-1893) believed that heredity also played an important role in neurological conditions and thought these afflictions could be interrelated by means of inheritance.3 It is of interest to mention that the degeneration concept had a tremendous impact on the fin de siècle society, including its literature. In one of his lectures, he said, “Gentlemen, I will now present for clinical examination, two unfortunate creatures who deserve compassion. One may say that one as well as the other have been touched by the antique fatality that nowadays has been substituted by hereditary fatality.” 

Among other fictional characters, Shorvon provides the example of Emile Zola’s (1840-1902) La Bête Humaine, in which a character carried “the physical stigmata of epilepsy.” In fact, the concept of degeneration can be found in the whole 20-volumes Rougon-Macquart series. It should be realized that the fin de siècle was characterized by cultural malaise partly caused by these ideas of degeneration, but also by the uncertainty and anxiety of approaching the end of a century. Fear for decay and disaster reigned. The notion of degeneration was perceived by the lay public as well as by artists.3,4  

An interesting section is dedicated to “psychoanalytic theory and epilepsy.” The author tells us that psychoanalysis provided a novel explanation of epilepsy. “As its theories matured, the view grew that essential epilepsy was the result of inhibited psychological development caused by inherited traits which prevented normal psychic development and were manifest both by epileptic seizure and abnormalities of personality” (p. 166). Indeed, it is a general phenomenon that new ideas and therapies in medicine initially have a much broader area of indications, to become much narrower or disappearing after some time. As for neurology, another affliction in which this happened, i.e. psychotherapy, was dystonia.5 A few other issues of interest discussed here are the idea of the epileptic personality and the psychiatric effects of temporal lobe epilepsy.

Stigma

Fjodor Dostoievsky (public domain)

Shorvon dedicates a paragraph on “eugenics and epilepsy.” Indeed, it did not escape involuntary sterilization in some countries, not just in Nazi Germany in the 1930s and 1940s. Furthermore, it is fascinating to read about the early pathophysiological ideas, including the reflex theory, the idea of autointoxication, and the Bacillus epilepticus (1916). And, of course, he mentions the asylums and colonies established for epileptic patients, in a period when drugs where less successful than today. The stigma of having epilepsy and the patient’s experience are discussed in detail. Several celebrities are mentioned in the context, like Queen Victoria’s epileptic son Prince Leopold of Albany and the Russian writer Fjodor Dostoievsky (1821-1881).  He not only suffered from epilepsy himself, but also wrote about it in several of his novels. Although it is not certain, he may have been treated by the optimistic Herpin. He was one of the doctors Dostoevsky listed on his visa application of 1863, the year in which he traveled abroad for the official purpose of consulting the greatest European authorities on epilepsy, including Moritz Romberg (1795-1873), Armand Trousseau (1801-1867), and Herpin. It is likely Dostoevsky had Herpin in mind when writing The Idiot.6,7

The importance of the introduction of the EEG (1929) and the early twentieth-century drugs are all mentioned in the book, including those that have disappeared later. A paragraph is dedicated to the role of the pharmaceutical industries through history. A table on the chemical and physiological basis of neurotransmission between 1900 and 1970 is also provided. Several “new” pictures can be seen in the book, like the one of Horsley in the operating theatre with Samuel A. Kinnier Wilson (1878-1937) and Emil T. Kocher (1841-1917), c. 1906.

Why not Brown-Séquard?

Charles-Edouard Brown-Séquard (public domain)

Although it is impractical to include all historical texts dealing with epilepsy, I would have expected a more extensive discussion of Charles-Edouard Brown-Séquard (1817-1894) and his views on epilepsy. Having written my dissertation on Brown-Séquard’s localization concept, I am of course biased, but in the present book only a sentence and two footnotes are dedicated to him. I was surprised all the more so, since he was in fact the predecessor of Shorvon himself. After all, considered an expert in epilepsy, Brown-Séquard was the one of the founder-physicians to be appointed at the National Hospital for the Paralyzed and Epileptic (1859), where he became a teacher of Hughlings Jackson. Jackson’s colleague and life-long friend Jonathan Hutchinson (1828-1913) wrote: “My friend fell, soon after he joined me in London life, under the influence of Dr. Brown-Sequard, who told him strongly that it was foolish to waste his efforts in wide observation of disease in general, and that if he wished to attain anything he must keep to the nervous system.” 

John Hughlings Jackson (public domain)

Furthermore, it was Brown-Sequard who told Hughlings Jackson that a vacancy for the post of assistant physician would be advertised. He indeed applied and was appointed on in May 1862.8 Brown-Séquard was among the first to prescribe bromide for epilepsy9, pp. 102-14 and between 1850 and 1872 published many articles as well as a book on epilepsy.10 Furthermore, he had found an experimental model for what he called spinal epilepsy, which became also known as Brown-Séquard’s epilepsy.11,12 

Finally, from today’s perspective, it is doubtful whether it was truly an epileptic phenomenon, as it was related to the ankle clonus by Wilhelm Heinrich Erb (1840-1921) and Charcot. However, it aroused interest for several decades.9, pp.183-93 Perhaps Shorvon did not discuss him, because it was partly before 1860, although the same is true for Herpin and his book Du pronostic et du traitement curatif de l’épilepsie [Prognosis and treatment of epilepsy] that was published in 1852. Or perhaps it is due to the fact the Brown-Séquard’s concept was finally rejected as epilepsy in the sense of having its origin in cortical cells. 

Neurosis 

I may be in error, but sometimes I wondered whether the author sufficiently distinguished between the old neurosis concept and the modern post-Freudian term (psycho)neurosis. On page 58, we find that “epilepsy was still viewed generally as a mental disorder in the period under consideration, and treated largely in the arena of psychiatry.” It is of importance to understand the history of the term neurosis, as its meaning underwent an important evolution, which is related to neurology as well as psychiatry.13 William Cullen (1710 – 1790) of Edinburgh coined the term neurosis, applying it to what his Edinburgh colleague and predecessor Robert Whytt (1714-1766) called nervous diseases. This functional orientation of neurosis remained during almost the whole nineteenth century,14 though the category of neuroses became smaller as more diseases were found to have a neuropathologic substrate, beginning with general paralysis of the insane in the 1820s. In the 1880s, for example, William Gowers (1845-1915) mentioned the following functional disorders: chorea, paralysis agitans, tremor, tetanus, tetany, occupation neurosis, etc.15 

During the twentieth century, even more of these neuroses were found to have an organic basis. The present sense of the term neurosis dates from the period of dynamic psychiatry in the beginning of the twentieth century and may be called psychoneurosis, e.g. anxiety neurosis, obsessional neurosis, etc. Interestingly, neurologists have treated these patients with “nervous disorders” or “nerves” for a long period.16,17 Therefore, I am not sure whether the old concept of neurosis can be equated with mental disorder, as it was associated rather with the fact that no pathological substrate was found. As for the “arena of psychiatry,” we have to realize that in many countries, particularly the German-speaking and those adopting the German system, neurology was included in psychiatry for several decades.

Criticism

The author is to be lauded that he tried to write not only for physicians, neurologists in particular, but wished to write also for the “informed public.” Therefore, he included a glossary of technical terms. Furthermore, he tried to avoid making it a book on “Great Men” and find a balanced choice with respect to the level of details. Indeed, the book is not based on important physicians in the field of epilepsy.

One shortcoming, which the author mentions himself in the introduction, is that there is a bias of language. He examined texts mainly in English. That does not mean, by the way, that he does not mention French and German researchers, but I suppose he often will have used existing translations for that purpose. And indeed, he does describe important players in the field of epilepsy from other countries than England and the United States. 

Perhaps among the minor criticisms the fact could be mentioned that the author often refers to the Pitié-Salpêtrière hospital. The “new” Pitié hospital (where Joseph Babinski [1857-1932] worked since 1895), however, was built near the Salpêtrière only in 1911 and the merging of the two took place in 1964. And Paul Broca of course did not show that “the expression of speech was localized in the left frontal gyrus in 1871” (p. 74). He localized it in the frontal convolution in 1861 and only in the 1863-5 period, he realized that most cases were in the left hemisphere. Furthermore, we read “The first systematic studies of anatomical-topographical analysis using electrical stimulation were by Fritsch and Hitzig.” Indeed, they found positive results of their cortical stimulation experiments in 1870, however, in the early nineteenth century, many other experimenters preceded them, without seeing any limb movements. As medical historian Michael Hagner wrote: “These results were repeatedly reproduced by distinguished physiologists like François Magendie, François-Achille Longet, Carlo Matteucci, Julius Budge, and Moriz Schiff, and, moreover, these physiologists failed in attempts to evoke muscle twitching through cortical stimulation, whether with electrical stimulation, cauterization, or compression.” And I am not sure whether the experiments by Fritsch and Hitzig were really more systematic than the previous. Continuing in Hagner’s article “Several divergent paths led to the emergence of this stimulus experiment. They led through realms of clinical medicine that had nothing to do with localized diseases of the brain, through therapeutic practices, and not least through alternate experiments and theories that arose from entirely other lines of questioning.”19 

The End of Epilepsy?

Perhaps, in a book on the history of a certain subject, one would not expect to continue the story up to the present. On the other hand, in this book on epilepsy, the story is told by an experienced epileptologist, who was part of that story for 40 years. Therefore, it is obvious that he provides his own opinion in the Epilogue, where he writes: “Even if fascinating in its own right, any history of epilepsy can be useful only if it helps make sense of the reality of epilepsy today” (p. 585), although he realizes and explains, in the accompanying footnote, that history can only stimulate new thinking about the present. 

It would be a mistake to think that events in history and today are homologous, referring to philosopher Hannah Arendt (1906-1975). Using the appropriate metaphor of epilepsy as ideas, “like leaves, seeming strong and vigorous at one time, wither and fall with a transience and an insignificance unthinkable at the time,” the author states that the tree also has permanent structures like branches and a trunk that grow. Indeed, he also attempted to make up an “epilepsy balance sheet” with theories and practices that have improved or harmed epilepsy through the long twentieth century. In the accompanying text, he contemplates about what happened and what deserves criticism in the various fields, including the political and economic context, legislation and social attitude, delivery of epilepsy healthcare, pharmaceutical attitude, etc. An interesting paragraph in the Epilogue is “The harm caused by medicine.”

In the introduction and Epilogue again, Shorvon tries to answer the question, whether “Epilepsy really exists” today, or stated differently “The end of epilepsy?” Hereby he follows up on Temkin, who titled the final section of his book “The end of the falling sickness.” May it still be considered a disease, as in the past, or did the progress in knowledge result in disappearance of the disease, now only being a symptom (pp. 7 and 623)? 

From the medical and scientific perspective there are, Shorvon believes, numerous arguments to drop the term epilepsy as a disease and continue to use epileptic seizure as a clinical manifestation or symptom. Referring to the German neurologist/medical historian and émigré Walther Riese (1890-1976), he realized that epilepsy is not just a medical and scientific concept, but also an idea laden with social and personal signification. Thinking of the disadvantages of the stigma, the author concludes: “Given that it does not exist as a disease, that it carries with it dark and deeply engrained archetypal memories of heredity, mental disease and impairment, and that it confers prejudice and social exclusion, I think the removal of the term ‘epilepsy’ from public discourse is at least worthy of debate. My personal opinion is that the gain might well outweigh the drawbacks. Much as Temkin had hoped, perhaps at this juncture, the end of epilepsy is possible to envisage. This would indeed be a goal worth achieving” (p. 629).

In conclusion, this book is a rich source of interesting aspects of the history of epilepsy in the past 160 years. It is recommended for physicians, in particular neurologists, and those non-medically trained persons interested in epilepsy and its history. •

 

References:

  1. Lund M. On Morel’s ‘épilepsie larvée: the first Danish epileptologist Frederik Hallager’s opposition in 1884 against Morel’s psychical epileptic equivalents. J Hist Neurosci. 1996;5:241-53.
  2. Goldstein J. Psychiatry. In: Bynum WF, Porter R, eds. Companion encyclopedia of the history of Medicine. London, Routledge, 1997.
  3. Koehler P. About medicine and the arts. Charcot and French literature at the fin-de-siècle. J Hist Neurosci. 2001;10:27-40.
  4. Koehler PJ. Charcot, la salpêtrière, and hysteria as represented in European literature. Prog Brain Res. 2013;206:93-122.
  5. Munts AG, Koehler PJ. How psychogenic is dystonia? Views from past to present. Brain. 2010;133:1552-64
  6. Johnson BR. Diagnosing Prince Myshkin. The Slavic and East European Journal 2012;56:377-93.
  7. Rice JL. Dostoevky’s Medical History: Diagnosis and Dialectic. The Russian Review. 1983;42:131-61.
  8. Critchley M, Critchley EA. John Hughlings Jackson. Father of Englsih Neurology. New York, Oxford University Press, 1998, pp. 37-8.
  9. Aminoff MJ. Brown-Séquard. An Improbable Genius Who Transformed Medicine. New York, Oxford University Press, 2011.
  10. Brown-Séquard CE. Researches on epilepsy. Its artificial production in animals and its etiology, nature and treatment in man. Boston: Clapp, 1857
  11. Koehler PJ. Brown-Séquard’s spinal epilepsy. Med Hist. 1994;38:189-203.
  12. Koehler PJ. Het localisatieconcept in de neurologie van Brown-Séquard. Amsterdam, Rodopi, 1989, pp. 59-63.
  13. López Piñero JM. Historical origins of the concept of neurosis. Cambridge: University Press, 1983.
  14. Bynum WF. The nervous patient in eighteenth- and nineteenth-century Britain: the psychiatric origins of British neurology. In: Bynum WF, Porter R, Shepherd M, editors. The anatomy of madness. Vol.1, ,  London, Tavistock, 1985, pp.89-102.
  15. Gowers WR. A manual of diseases of the nervous system. 2 vols. London, Churchill, 1886-1888.
  16. Shorter E. A history of psychiatry. New York, Wiley, 1997, pp.113-144.
  17. Koehler PJ. Development of neurology as a specialty in Europe. In: Education Program Syllabus: History of neurology, American Academy of Neurology, 2007, pp. 72-89
  18. Philippon J, Poirier J. Joseph Babinski : A Biography. New York, Oxford University Press, 2009, pp. 151-66.
  19. Hagner M. The electrical excitability of the brain: toward the emergence of an experiment. J Hist Neurosci. 2012;21:237-49.

An Important Year for Neurology

By Wolfgang Grisold

Wolfgang Grisold

Wolfgang Grisold

Welcome to this first issue of World Neurology in 2023. This newsletter is an important information instrument for the WFN, and each issue reaches at least 15,000 readers. I encourage members to use this instrument and submit news and important aspects regarding neurology in your region.

The year 2023 will be an important year for neurology, and for the WFN. The year will bring face-to-face meetings and personal encounters and will reveal how stable and useful our newly developed communication tools are. My prediction is that our communication has dramatically increased during the COVID crisis, and several aspects of electronic communication will remain. The issue of traveling is increasingly also discussed with environmental considerations, and the carbon footprint is increasingly important. The numerous worldwide crises have also complicated traveling and visa issues are gaining importance.

2023 will be the year of a World Congress of Neurology (WCN), this time in Montreal Canada, and follows the WFN concept of traveling with meetings from region to region. Canada is a region rich with research, concepts, education, and also very advanced neurology services. We are glad and honored that the Canadian Neurological Society is holding this congress with us, and we believe world congresses always have a positive effect in the regions to promote the awareness of neurology.

We are looking forward to the global participation and hope many delegates from all parts the Americas (as the hosting region) will be able to attend. We are aware of visa issues, and we appreciate that our hosts are doing the utmost to make the entry for members of societies from other global regions possible.

At the WCN, we will also see three elections: a new treasurer replacing Prof. Stark, a new trustee replacing Prof. Freedman, and the decision on the congress site 2027 in the Arab/African region. Both Prof. Stark and Prof. Freedman have served two terms in the WFN, and we are grateful for their continuous efforts.

For the WCN, from the practical point, the congress committees have created an interesting program with selected plenary lectures, scientific, and educational topics. We are glad to see that almost all participants from the global neurologic alliance are involved in the program, and the distribution of speakers includes more regional speakers than before.

Free lectures and guided poster sessions are waiting for your participation. Please look at the WFN and WCN congress site for the abstract submission. Again, please also check your travel possibilities and your visa requirements.

With the help of our professional congress organizer Kenes, we will add more interactivity in the congress, and we also will have several joint sessions with the WHO and members of the Global Neurology Alliance, such as the World Psychiatric Association and the World Federation of Neurosurgery, among others. The WFN educational subcommittee of “young neurologists” will organize two important sessions.

A patient day will be organized with the Canadian Neurologic Society (CNS), and the WFN is aiming to establish a global patient platform.

We are aware that traveling might not be easy for several reasons, yet there is need to make this congress available worldwide to all member societies. The WCN 2023 will have a virtual component, which will allow access to the program at low costs in low and low-middle income countries. Participation and dissemination of the developments in neurology are the main aims of the WCN. There will be reduced fees for low and low-middle income countries, and as always also congress bursaries will be available.

The WCN is one important aspect of the WFN’s activities, but there are others

Education: The work with educational activities progresses, and a department visit program for Asian candidates is being established by the Indian Academy of Neurology and will be announced soon.

We will continue the educational days, with the WFN day (which will be in December and devoted to neuropathies) and the joint (with the International Headache Society) IHS Headache Day in May. As a new addition, we are planning an educational day in cooperation with the Asian Oceanian Academy of Neurology (AOAN).

WHO and UN-ECOSOC: The cooperation with the WHO continues and, as in the last year, brain health and the implementation of IGAP are major tasks among others. This year’s World Brain Day (WBD) will be organized by regions in cooperation with the WFNR (World Federation of Neurorehabilitation) and is dedicated to “Brain health and disability.” Please follow WBD on the website, and we hope that all member societies will be able to contribute locally.

The global neurology alliance (GNA), consisting of world societies, specialist societies, regions, and the WFN specialty groups, will have a meeting at the WCN in Montreal. It is a powerful network, and the WFN will continue its efforts to cooperate with global societies and specialist societies.

Prof. Steven Lewis and I met with the president and other dignitaries of the World Psychiatric Association in Vienna in January (photo), to discuss future cooperations in regard to brain health and mental health.

The WFN wishes a successful and prosperous year in your region, and globally for neurology. •

Late AAN President Sacco Strengthened International Relationships

By Orly Avitzur, MD, MBA, FAAN

Ralph L. Sacco, MD, MS, FAHA, FAAN

The untimely passing of Ralph L. Sacco, MD, MS, FAHA, FAAN, has saddened not only his colleagues at the American Academy of Neurology, where he served as president from 2017 to 2019, but the wider world of neurology as well. Sacco succumbed from a brain tumor on Jan. 17, 2023, at his home in New York with his family by his side.

During Sacco’s term as AAN president, its international membership climbed from 7,000 to 8,000—a record representing 21% of total membership and 141 countries. The number of International Scholarships, enabling young physician recipients from around the world to receive a $2,500 scholarship to the AAN Annual Meeting, doubled from 15 to 30 and set the stage for an increase to 35 for the 2020 Annual Meeting.

Sacco also strongly supported the AAN International Subcommittee, charged with promoting and developing strategies focusing on outreach and education for neurology in resource-limited countries or regions of the world to facilitate better care for patients with neurologic disease. The subcommittee continues to focus on meeting the needs of our global members, including improved access to membership benefits in low and low-middle income countries and supporting scholarships to the AAN Annual Meeting.

The opportunity to represent American neurology and the AAN to the international community delighted Sacco. He and Academy leadership attended the World Federation of Neurology’s 23rd World Congress of Neurology in September 2017 in Kyoto, Japan. Cohosted by the Japanese Society of Neurology and Asian and Oceanian Association of Neurology, the event’s theme was “Defining the Future of Neurology,” a topic of great interest to Sacco. He was the regional representative and the AAN’s delegate to the general assembly meeting, and chaired the North American Regional Symposium, which focused on prevention and treating common neurologic conditions. He spoke on treatment and prevention of stroke.

In December 2018, he and AAN CEO Catherine M. Rydell, CAE, traveled to Israel, where he gave presentations at the Israel Neurological Association (INA) annual meeting about the AAN and stroke, his specialty, and shared the stage with Dr. David Tanne, president of the INA; Natan Bornstein, past president of the INA; and Dr. Martin Dichgans, president of the European Stroke Organization. He also met with Israeli dignitaries, including the Israeli Minister of Health Rabbi Yaakov Litzman and president of the Israeli Medical Association Prof. Zion Hagay. He enjoyed touring Jerusalem’s Old City, Tel Aviv, and Jaffa.

“We traveled together to Santiago, Chile; Kyoto, Japan; Lisbon, Portugal; Tel Aviv, Israel; and Amsterdam, the Netherlands; among others,” said Rydell. “Ralph and I always felt so welcomed at each and every international society gathering including those hosted by the World Federation of Neurology, the European Academy of Neurology, and other international conferences and meetings that were so honored to have Ralph there to lecture and advise. It was a joy to see him interact with professionals who admired his intellect, his welcoming demeanor, and his one-of-a-kind Sacco smile.”

Sacco attended annual meetings of the Mexican Academy of Neurology, most recently in November 2021 as chair of the AAN Academic Neurology Committee, where he shared how the AAN is helping academic neurology in the U.S. meet a variety of challenges from revenue and funding issues to research and student recruitment.

In June 2019, Sacco was interviewed by AAN staff about the successes, challenges, and opportunities during his recently concluded term as president. He spoke with great joy and at length about the AAN’s relationship with the international neurology community and its leading organizations.

“Although we are the American Academy of Neurology, we do have an international mission, and that’s been important, and prior presidents have really helped push that. We recognize that we only have so much in terms of revenue and we probably can’t especially alone solve the problems, for example, in places like Africa, where there is just a totally insufficient number of neurologists to meet the demands.

“So, a lot of the things that we do to meet the demands and to help with international mission include collaborations. Part of it was working with important other organizations—the World Federation of Neurology, that really does have a truly global mission. We have developed a very close working relationship with the leaders of the World Federation of Neurology, contributing financially and contributing our ideas and thoughts to help with their mission. Working with the European Academy of Neurology, for example, in the course that’s provided particularly for training young members in African nations. We have a great relationship to the Mexican Academy of Neurology. I happened to go to their meetings and developed a close relationship with the Mexican Academy of Neurology.

“Because of some personal relationships, I got to go to the Pan Arab United Neurological Societies’ meeting in Jordan, and that was great to actually work with that group. Also, we were invited to go for the first time to the Israeli Neurological Association. Through this collaborative relationship-building with these other organizations, I think the Academy can help meet the needs of its international mission.

“We also further developed the International Subcommittee under Jerome Chin [Jerome H. Chin, MD, PhD, MPH, FAAN] which is a subcommittee of our Membership Engagement Committee. We expanded the number of international scholarships. When we give out money to bring young people from other nations to come to our Annual Meeting, that has an incredible impact on their career. I can’t tell you the number of people out there who say that that was life-changing for them when they attended the Academy of Neurology. So that was helpful to expand the number.

“We provide Continuum® free to many countries where they’re underserved or under-financed, and that has had a major impact on getting them exposed to a high-quality information to improve their careers. So, there are many, many ways that we work both with other organizations and within the Academy to expand our international mission.”

Sacco was the chairman of neurology; Olemberg Family Chair in Neurological Disorders; Miller Professor of Neurology Public Health Sciences, Human Genetics, and Neurosurgery; executive director of the Evelyn McKnight Brain Institute; senior associate dean for Clinical and Translational Science, University of Miami, Miller School of Medicine; and chief of the neurology service at Jackson Memorial Hospital.

A graduate of Cornell University and a cum laude graduate of Boston University School of Medicine, Sacco received a master’s in epidemiology from Columbia University, School of Public Health. He completed his neurology residency training and postdoctoral training in stroke and epidemiology at Columbia Presbyterian in New York. He was previously professor of neurology, chief of Stroke and Critical Care Division, and associate chairman at Columbia University before taking his most recent position in 2007.

Sacco was an international expert in stroke epidemiology and health disparities. He was the founding principal investigator of the Northern Manhattan Study, the Florida Puerto Rico Collaboration to Reduce Stroke Disparities, and the Miami Clinical Translational Science Institute, as well as co-investigator of multiple other NIH grants. Sacco published extensively with over 1,000 peer-reviewed articles (h-index 109) in the areas of stroke prevention, treatment, epidemiology, risk factors, vascular cognitive impairment, human genetics, and outcomes and has been listed as a Web of Science Highly Cited Researcher since 2017.

He was the recipient of numerous awards, including the AAN Wartenberg Lecture, AHA Feinberg Award of Excellence in Clinical Stroke, the WSO Global Stroke Leadership Award, AHA Gold Heart Award, the NINDS Javits Award in neuroscience, and numerous named lectures.

Sacco was a fellow of both the Stroke and Epidemiology Councils of the American Heart Association, a fellow of the ANA, and an elected member of the Association of American Physicians and National Academy of Medicine. He was the first neurologist to serve as the president of the American Heart Association from 2010 to 2011.

Visit AAN.com/Sacco to learn more about this giant of neurology and to leave memories. •

First Pan-European University Course on Clinical Autonomic Neuroscience

The course is provided at the Danube University and supported by the European Federation of Autonomic Societies.

By Walter Struhal

Walter Struhal

The autonomic nervous system (ANS) regulates the synergistic action of all visceral organs and homeodynamic processes. ANS is involved in the course of many neurologic and systemic diseases. Recently, ANS involvement including postural tachycardia syndrome was identified to play a significant role in cases with post-COVID condition.

ANS diseases may cause various dysfunctions, for example, transient loss of consciousness, sweating disorders, digestion, and urinary and sexual function. Autonomic involvement may be generalized, or focal. It may involve central, and/or peripheral ANS structures. The transformation of this appealingly complex pathophysiology into a clinical picture helps to explain the patient’s symptoms, define the syndrome and initiate treatment. A number of therapies are well-investigated but “off-label.” Diligent transformation of literature research into state-of-the-art therapeutic strategies is therefore an important competence of a clinical autonomic neuroscientist.

European Program of Clinical Autonomic Neuroscience

The European Federation of Autonomic Societies (EFAS), together with the Danube University Krems, and the Karl Landsteiner University of Health Sciences have initiated the first Pan-European University Course to study techniques on bedside and lab investigations of ANS disorders and common strategies of therapeutic management. This academic postgraduate course takes one year and will be completed with a university diploma.

This program is open to medical doctors in training and specialists of all disciplines. This program is open for registration. Register now. •

From the Editors

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

Steven L. Lewis, MD, Walter Struhal, MD

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

This issue begins with the President’s Column, where World Federation of Neurology (WFN) President Dr. Wolfgang Grisold describes the many international activities being planned by the WFN this year, including the work done with WHO and the UN, World Brain Day 2023, and the exciting plans for the World Congress of Neurology in Montreal in October.

Dr. Orly Avitzur, current president of the American Academy of Neurology, provides a heartfelt memorial piece dedicated to the late AAN President Ralph Sacco, who passed away last month and who touched the lives of so many neurologists and patients and whose dedication to international relationships will be one of many long-lasting legacies of his countless accomplishments.

This issue also features an important notice by the WFN Nominating Committee with a call for nominations for the positions of WFN Treasurer and WFN Elected Trustee. In another announcement, Dr. Struhal describes the first pan-European university course on clinical autonomic neuroscience at Danube University, supported by the European Federation of Autonomic Societies. Dr. Carlos N. Ketzoian then reports on the highly successful Ninth International Course of Neuroepidemiology that took place in Erice, Italy, this past November.

In this issue’s History article, Dr. Peter J. Koehler provides an informative and remarkably thorough overview of the historical dignitaries memorialized by the many named lectures at the World Congress of Neurology (WCN). Dr. Augustina Charway-Felli and Dr. Amadou Gallo Diop report on the outcome of the biennial Francophone contest held at the headquarters of the African and Malagasy Council for Higher Education, and the significance of this event with regard to growing the African neurological and scientific workforce with these successful candidates.

Dr. Vladimir Hachinski, a past president of the WFN, provides an overview of the importance of dementia prevention in global efforts to reduce the impact of this highly prevalent entity, which is increasing in overall incidence worldwide.

Four articles represent thoughtful and well-illustrated reminiscences by four young neurologists from sub-Saharan Africa who participated in the WFN Department Visit Programs in Austria (Graz, Innsbruck, and Salzburg) and Germany (Leipzig). We would like to add our deep thank you to the neurologic societies in Austria and Germany for their wonderful support, hard work, and attentiveness in making these observerships a success, increasing the exposure of high-level neurologic infrastructure to these young neurologists to inform and enhance their clinical practices.

Dr. Tissa Wijeratne and Dr. David Dodick (Co-Chairs of World Brain Day) and Dr. Lewis and Wolfgang Grisold next report on the plans for this year’s World Brain Day 2023, which will be dedicated to “Brain Health and Disability. It will include collaborations between the WFN, our global regions, national neurologic societies, and the World Federation of Neurorehabilitation.

Finally, Dr. Richard Stark, WFN Treasurer and past chair of the WCN Tournament Committee, provides historical background about the Tournament of Minds at the World Congresses of Neurology (WCNs), with an announcement about this year’s Tournament of Minds. The tournament will be held at this year’s WCN in Montreal in October, welcoming and pitting department teams from around the world to compete in this exciting and well-loved component of the WCN.

In closing, we want to thank all readers for their interest in and attention to World Neurology. Please don’t forget to sign up for your free subscriptions online at worldneurologyonline.com. We sincerely hope everyone is marking their calendars, making plans to attend, and submitting their abstracts for the WCN in Montreal in October 2023. We look forward to seeing so many neurologists from around the world participate in this remarkable event. •

Report on the Ninth International Course of Neuroepidemiology: Methods and Clinical Applications

By Dr. Carlos N. Ketzoian

Participants in the Ninth International Course of Neuroepidemiology: Methods and Clinical Applications.

Last November, the ninth edition of the International Course of Neuroepidemiology:  Methods and Clinical Applications took place in Erice, Sicily, Italy, with the WFN’s endorsement.

An historical first course of neuroepidemiology was held in San Miniato, Pisa, Italy, in 1981, and was organized by Prof. Bruce Schoenberg.

Prof. Schoenberg passed away six years later. He laid the foundation for the development of neuroepidemiological research in different continents as a legacy. The activities that he promoted were oriented both to support researchers and to prioritize the training of human resources in this area of knowledge.

Almost 20 years after these historical events, Professors Walter Rocca (Mayo Clinic, Minnesota, U.S.) and Giovanni Savattieri (University of Palermo, Italy) resumed the training activities pioneered by Prof. Schoenberg. Starting in 2000, the nine offerings of the “International Course in Neuroepidemiology: Principles and Clinical Applications” in Erice, have become an essential point of reference for those of us who are interested in the subject.

Over the years, the structure, thematic content, and methodology have evolved in order to adapt to the new needs of a changing international public and to the new methodological developments.

Flyer of the Ninth International Course of Neuroepidemiology: Methods and Clinical applications.

Professors Paolo Ragonese and Marco D’Amelio from the University of Palermo, Italy, who participated as students in the 2000 course, are the current coordinators. The course has a Scientific Committee and a Teaching Team, including more than 15 worldwide leaders in neuroepidemiology and other related sciences. It is a high-level full-immersion course where participants share five days of training, exchange experiences, and establish professional collaborations that go beyond the course.

Forty-six students from five continents participated in this Ninth International Course of Neuroepidemiology: Methods and Clinical Applications” in Erice 2022. Methodological aspects of neuroepidemiology were discussed in the morning, and applications of the methods to the study of specific neurological diseases were presented in the afternoon (epilepsy, dementia, Parkinson’s disease, stroke, multiple sclerosis, neurological manifestations of COVID, among others). General concepts of genetic epidemiology and of applied statistics complemented the epidemiologic methods essential for neuroepidemiology.

The infrastructure of the Ettore Majorana Foundation Centre for Scientific Culture provided a unique framework to achieve the aims. As we climbed the winding road that took us up Mount San Giulano to Erice, a medieval city, the air became fresh and the landscape splendid. Cloistered for a week in this inspiring environment, we felt invited to expand our knowledge as if we were part of a renaissance movement in neuroepidemiology.

The current coordinators, Professors Paolo Ragonese and Marco D’Amelio, organized a special tribute to Professors Walter Rocca and Giovanni Savattieri in recognition for their work in establishing the Erice courses and for their commitment to the development and the diffusion of neuroepidemiology. The Erice courses have become one of the points of reference for the training of young neurologists in clinical and epidemiological research. •

Dr. Carlos N. Ketzoian is chairman of the Specialty Group on Neuroepidemiology of the World Federation of Neurology.

Reference:

  1. Walter A. Rocca, Paolo Ragonese, Marco D’Amelio, Giovanni Savettieri (2022) Teaching Research Methods to Young Neurologists: The Erice International Courses. J Mov Disord 2022;15(3):227-231

Nominating Committee Announcement 2023

On behalf of the World Federation of Neurology, the Nominating Committee invites nominations for the positions of Treasurer (four-year term) and Elected Trustee (three-year term).

Treasurer to take office from Jan. 1, 2024. (Position vacated by Dr. Richard Stark, who is not eligible for re-election.) Having previous similar experience as a treasurer would be an advantage.

One Elected Trustee to take office immediately following the election. (Position vacated by Dr. Morris Freedman, not eligible for re-election.) A nominee must be a member of an eligible WFN member society, should have a national and international reputation, have made contributions to regional and global neurology, and be committed to the WFN.

A WFN Member Society must submit the name(s) of the candidate(s), together with a statement signed by the candidate of confirmation of their willingness to stand for election, provide a brief curriculum vitae (a single type-written page) and letter of support from the Member Society. This has a deadline of April 3, 2023.

Nominations made after this deadline are possible. In addition to the criteria above, the candidate must also be supported with signatures from a minimum of five WFN Member Society Delegates, and all documents must be received by the London office 30 days prior to the Annual General Meeting.

Please address the nomination documents to the Chair of the Nominating Committee, all of which should reach the London Secretariat office, as soon as possible and prior to the deadlines in the text above.

Electronic format is requested. •

Named Lectures at the World Congress of Neurology (WCN)

By Peter J. Koehler

Giving names to lectures has been a general phenomenon in various fields of society, including the humanities and sciences, since at least over 100 years ago. These may be public lectures or lectures presented for members of an association. Through the years, the World Federation of Neurology (WFN) started a tradition of named lectures at the WFN’s World Congress of Neurology (WCN) and one may wonder, who were the people behind these names. What did they do to become well-known within the neurological community? In this article, I will provide biographical sketches of these persons.

Victor and Clara Soriano Award Lectures and the Soriano Lecture of the Fulton Society Symposium

John Farquhar Fulton (courtesy Wellcome Institute)

With respect to the Soriano lectures, the WFN webpage mentions that “The Fulton Society, Victor and Clara Soriano, and the Soriano Lectureship, are endowed lectures presented at the World Congresses of Neurology.”1 So let us first discuss John Farquhar Fulton (1899-1960) and then come back to the Sorianos. Born the son of ophthalmologist John Farquhar Fulton and Edith Stanley Wheaton in St. Paul (Minnesota),2 John Jr. graduated at Harvard with the degree of Bachelor of Science magna cum laude in 1921. He went to Oxford, England, receiving a BA with first class honors in physiology (Oxford). In 1923, he had married Lucia Pickering Wheatland, who was descending from a rich family in Salem, Massachusetts. The marriage remained childless.

John worked in the laboratory of the famous neurophysiologist and Nobel laureate (1932) Charles Scott Sherrington (1857-1952) and published a 644-page monograph Muscular Contraction and the Reflex Control of Movement in 1926. With a Doctor of Philosophy degree, he returned to Harvard, where he was awarded his MD, magna cum laude (1927). He spent a year at the Peter Bent Brigham Hospital in Boston with neurosurgeon Harvey Cushing, and they became life-long friends. He went to Sherrington’s laboratory for another period, and in 1930, he was appointed Sterling Professor at Yale University, the youngest at the University, establishing the first U.S. primate physiology laboratory. His contribution to functional localization in the cerebral cortex is of paramount importance. The combination of his training in physiology under Sherrington and clinical medicine, including his training under Cushing, later resulted in the book Physiology of the Nervous System (1938), which was translated into at least six languages. He attracted neurologists, neurosurgeons, and physiologists from the U.S. as well as from abroad.

In cooperation with Johannes G. Dusser de Barenne (1885-1940), he founded the Journal of Neurophysiology (1938). During the war, Fulton worked in the field of aviation physiology. His interest in the history of science culminated in one of the greatest collections of the history of medicine in the world at Yale and in a biography of Harvey Cushing (1946). In 1951, Fulton became professor of the history of medicine at the new homonymic department, a decision in which his hard working and health may have played a role. He acquired Cushing’s book collection and became editor of Journal of the History of Medicine and Allied Sciences.3,4

Victor Soriano (from World Neurology, May 14th, 2018)

Victor Soriano (1909-2005) was one of the many fellows of Fulton at Yale University. With his wife Clara, he was among the founders of the Fulton Society, perhaps inspired by the Harvey Cushing Society5 and the Osler Society,6 and started the Fulton Society Symposium, including the Soriano Lecture, at the World Congress of Neurology in New Delhi in 1989.7

Born from Jewish parents on the Mediterranean isle Rhodes, when it was still belonging to the Ottoman Empire, but becoming an Italian possession in 1912, the family emigrated to Montevideo, Uruguay, when he was 9 months old. Therefore, he considered himself Turkish, Italian, which is not quite correct, and Uruguayan. His father, a respected tailor, founded the Sephardic synagogue of Montevideo. Victor received his MD in 1934 and had been particularly interested in the physician Américo Ricaldoni’s (1867-1928) teaching in clinical neurology. Founded in 1926, Soriano became neurologist at the Instituto de Neurología of Montevideo in 1935, and in 1937, a new professor was appointed to succeed Ricaldoni, notably Alejandro Schroeder (1890-1954), who had trained at various German and French hospitals and institutes. Soriano taught neurology and worked at several hospitals and institutes in Montevideo. He was appointed assistant professor of medicine in 1943.

In the meantime, he had married Clara, also known as Clarita Benzecry, in 1939. She supported and encouraged his work in several social and medical activities. When Victor founded the Uruguayan Committee of Friends of the Weizmann Institute of Israel, she organized meetings at their home. Moreover, she hosted weekly scientific, literary, and musical events. Supported by the Rockefeller Foundation, Soriano stayed with Fulton at Yale in 1945 and with Hiram Houston Merritt Jr. (1902-1979) at the Montefiore Hospital affiliated to Columbia University in 1947. From 1948 on and accompanied by Clarita, he attended all American Neurological Association (ANA) meetings as well as a number of World Congresses of Neurology (WCNs). The year following Fulton’s death, at the Rome meeting of 1961, Soriano and Giuseppe Moruzzi (1910-1986), who had discovered the ARAS (ascending reticular arousing system) and its relation to sleep and waking with Horace W. Magoun (1907-1991) in the 1940s, founded the Fulton Society. The society was commended to organize a special symposium at meetings of the ANA and the WCN. Selected researchers of neuroscience were to present lectures on the advances of research in the nervous system. In 1987, the Sorianos decided to become sponsor of a lectureship at the ANA meetings. The WFN has two types of lectures associated with the Sorianos, including the one mentioned above at the Fulton Society Symposium (Soriano Lecture) and the other named Victor and Clara Soriano Award Lecture.8 The lecturers through the years can be found at Soriano Award Lectures and include Nobel Prize winners Rita Levi-Montalcini (1909-2012), Stanley B. Prusiner (born 1942), and Bert Sakmann (born 1942). More information on Soriano can be found in the May 2018 issue of World Neurology.

The Richard L. and Mary Masland Lecture

Richard L. Masland (Courtesy NLM Digital Collections, Public Domain

Richard Lambert Masland (1910-2003) was born the son of a textile executive in Philadelphia. He received his Bachelor’s degree from Haverford College and his MD from the University of Pennsylvania. During WWII, he was in charge of altitude flight training for flight surgeons at the School of Aviation Medicine in San Antonio, Texas. In 1947, he certified for neurology and psychiatry. He worked as a neurologist at Bowman Gray School of Medicine in Winston Salem, North Carolina. He had a special interest in the origin of mental retardation and tried to find ways to decrease its prevalence. He joined the National Association for Retarded Children, and his research results were published in the book Mental Subnormality: Biological, Psychological, and Cultural Factors (1958), of which he was first author. These achievements resulted in his recruitment as assistant director (1957) and director (1959) of the National Institute of Neurologic Diseases and Blindness (NINDB) of the NIH, where he worked until 1968.

He led a landmark study on the causes of birth defects, notably the National Collaborative Perinatal Project, a study of pregnancy and child development (1959-1966). It was designed to study risk factors in pregnancy for cerebral palsy and included over 50,000 pregnant women and their children through age 7. It led to over 400 scientific articles and dozens of books and monographs, in which factors like smoking and rubella virus could be associated with mental retardation.

In 1968, Masland became chairman of neurology at the College of Physicians and Surgeons of Columbia University. He directed the Neurologic Service at the Neurological Institute of New York at the Presbyterian Hospital. Neurologist Lewis P. Rowland (1925-2017) said “The residents were very fond of him. They called him the ‘white rabbit’ for his prematurely white hair and for his scurrying around.”9

Masland served as president of the American Epilepsy Society and of the WFN (1981-1989). In the latter position he was instrumental in changing the newsletter into a scientific journal (Journal of the Neurological Sciences). He was married to Mary Wootton of Englewood, a speech and language pathologist, with whom he had four children.10 He published many articles and received various awards, including the Award of Merit from the National Association for Retarded Children, which was presented to him by President John F. Kennedy in 1963.

Dr. Bhim S. Singhal Lecture11

Bhim Sen Singhal (Public Domain CCA 3.0)

Born in Mount Abu (in Rajasthan, north-west India) in 1933, Bhimsen Sen Singhal studied medicine, receiving his MD in 1956, and trained for neurology in Mumbai at the Grand Medical College under professor Noshir H. Wadia (1925-2016). He continued his training at the University College of London (UCL) Queen Square Institute of Neurology and became MRCP (Edinburgh, 1960) and MRCP (London, 1961).

Upon his return to India in 1962, he worked at the department of neurology at Grant Medical College and Sir. J. J. Group of Hospitals, where he became professor and chairman of the department. He was also active at the Bombay Hospital Institute of Medical Sciences in Mumbai. In 1991, he retired from the Grant Medical College, but continued his activities at the Bombay Hospital Institute. He trained many neurologists and published numerous articles and book chapters. He was interested in particular in multiple sclerosis,12 myasthenia gravis,13 and Parkinson’s disease. Singhal and co-workers described the entity of megalencephalic leukodystrophy (1996), especially prevalent in the Agarwal (anglicized term for Agrawal) community.14 In 2004, with international collaboration, he was one of the authors of a report in which the identification of its gene defect was described.15

Singhal served for many national and international organizations, including the Neurological Society of India, of which he was president in 1986, and the WFN as regional director. He was honored with a number of prestigious national awards, including the Padma Shri. This is awarded annually on India’s Republic Day and is the fourth-highest civilian award of the country. The award was not only a recognition for his clinical and academic work, but also his efforts through non-profit national foundations. An example of the latter was his initiative to establish the Neurology Foundation in 1998, to improve knowledge and provide assistance in patient care. This includes financial assistance for medical treatment, rehabilitation therapies for children and adults from low socio-economic areas, community outreach, and support for professional organizations such as the Multiple Sclerosis Society of India and the Indian Epilepsy Association. The foundation also started biennial Neurology Update conferences that became very popular. In 2001, Singhal founded the Parkinson’s Disease and Movement Disorder Society (PDMDS), an all-India “Registered Charity Society.” This is a nonprofit charitable organization that supports patients and their caregivers and is also active in the rehabilitation of patients. He is honored by two lectureships, notably one at the WCN and the other at the Indian Academy of Neurology

Dr. Singhal is married to Dr. Asha Singhal, who is an obstetrician and gynecologist. Like her husband, she has devoted her life to underprivileged people. They have a son, who is a stroke neurologist at the Massachusetts General Hospital, and a daughter, who is a professor of medicine (hematology and oncology) in Chicago.

Bharucha Lecture16,17,18

Eddie Bharucha (from World Neurology, May 14th, 2018)

Eddie Phiroz Bharucha (1916-2017) was born in a privileged family. His father Phiroz C. Bharucha (1882-1952) was a physician in Bombay (the present Mumbai) and his mother Bachha descended from a business family in Karachi. Eddie’s mother died when he was 2 years old, and he was educated mainly by an English governess. He studied medicine in Bombay and London, after which he became Honorary Physician in Medicine at the King Edward Memorial and Seth G S Medical College (KEM) Hospital in Bombay (1945).

In the 1949-1952 period, he trained for neurology at the National Hospital for Nervous Diseases (Queen Square) in London that had been amalgamated with the Maida Vale Hospital in 1948. In this period, he also spent some time at Columbia University in New York (with Houston H. Merritt Jr.) and Boston City Hospital (with Derek Denny Brown (1901-1981)). When he returned to India and the KEM Hospital, he was the first neurologist in Bombay19 and in cooperation with neurosurgeon Ramchandra G. Ginde (1912-1974), who trained with Wilder Penfield (1891-1976) in Montreal, started a department of neurology and neurosurgery, with 12 beds each (1953). Bharuch also worked at the Bombay Hospital, which is a large private hospital that became a teaching hospital.

Eddie married pediatrician Dr. Piloo (Kohiyar) Bharucha in 1947 and together they practiced multidisciplinary care in pediatric neurology.20 They treated children with poliomyelitis and cerebral palsy at the Children’s Orthopedic Hospital. With respect to his research and publications, he was active in stroke, infections, nutritional and toxic (for instance, lathyrism) disorders, and epilepsy. He was a member of the editorial board of Vinken’s & Bruyn’s Handbook of Clinical Neurology from 1973. He was considered an empathic physician with an important sense for social responsibility for the underprivileged. He invested personal financial means for the purchase of an EEG machine and the import of D-penicillamine (to treat Wilson’s disease). Piloo and Eddie had three sons.

Eddie Bharucha held several positions in India and received the Dhanvantari Award for his outstanding contributions to medical sciences (1991). He was elected president of the Neurological Society of India (1956),20 vice president of the WFN (1969-1973), and president of the World Congress of Neurology in New Delhi, 1989. He was honorary member of several organizations, including the ANA. During the last 20 years of his life, he suffered from severe visual handicap. In anticipation of his decreasing vision, he read journal texts onto a Dictaphone so that he could later listen to the contents. With respect to his character, one of his sons, the neurologist Nadir Bharucha wrote, “He did not seek positions of power or prestige, was unconcerned about material remuneration, and perennially radiated good cheer, kindness, and caring.”16 The Bharucha family, students, and friends established the Eddie & Piloo Bharucha Fund for lectures to be held during World Congresses of Neurology.

The Melvin D. Yahr Lecture 22,23,24

Melvin D. Yahr (Courtesy Mount Sinai School of Medicine) see Melvin D Yahr – The Lancet]

Melvin D. Yahr (1917-2004) was born in New York City as the youngest of six children. His parents were orthodox Jewish immigrants from Austria-Hungary. His father was a baker. Melvin studied medicine, receiving his MD from New York University College of Medicine in 1943. Interrupted by military services, he specialized in neuropsychiatry and neurology at various New York hospitals during the following next six years. He married Felice Yahr, with whom he had four daughters. He worked at the College of Physicians and Surgeons, Columbia University, where he became H. Houston Merritt professor of neurology (1973) and at Mount Sinai School of Medicine (City University of New York), where he was professor and chair (1973-1992).

He created the first U.S. multidisciplinary center for research in Parkinson’s disease and related disorders, which he later took to Mount Sinai. He played a role in the training of over 100 neurologists. His name and that of the Canadian neurologist Margaret May Hoehn (1930-2005), who was associate professor at Columbia University at the time, were eponymized by the Hoehn and Yahr scale for determining the severity of Parkinson’s disease.25 The article was referred to in the following way: “Their work established that the average age of onset of PD [Parkinson’s disease] was in the sixth decade (ie, between ages 50-59 years), described a broad spectrum of rates of progression, established that PD was associated with an increased mortality rate, and concluded that there were no treatments that affected life expectancy”.23 Yahr was (co-) author of over 300 articles, including the first double-blind levodopa study (1969).26 He served at a number of U.S. Advisory Committees and held positions at various neurological organizations and congresses, including the ANA (president) and the WFN. From 1963, Parkinson’s disease became his main research subject.

He took the initiative to establish the Research Committee on Extrapyramidal Disorders of the WFN (1959) and chaired the Research Group (1972-2001). It transformed into the International Association of Parkinsonism and Related Disorders.27 He was member of the Editorial Boards of several journals, including the Archives of Neurology (now known as JAMA Neurology). He became honorary member of several national neurological societies. In one of the obituaries, he was described as follows: “His, with very few sentences precisely described situations, analyses and thoughts, which he performed in a dark, sometimes rough appearing lingo and often with a mischievous but wise facial expression, eyes only a wee bit open, will be unforgettable to everyone who got acquainted to Melvin Yahr”.24

Conclusion

The persons described in this article were hard working neurologists, with the exception of Fulton, who became an experimental neurophysiologist and historian of medicine. Several, if not all, of their wives, some of whom being physicians themselves, contributed to their success. Whereas the Soriano, Singhal, and Bharucha Lectures were founded by the respective families (and friends), the Richard L. and Mary Masland Lecture and the Melvin D. Yahr Lecture were sponsored by the World Neurology Foundation (U.S. based) that was created in 1999. Another difference perhaps is that next to scientific, social efforts may have been a more important part of the careers and subsequent initiatives of Soriano, Singhal, and Bharucha. In contrast, scientific achievements may have been the more important motivation for the founding of the Masland and Yahr Lectures. •

 

References and Footnotes

  1. See Soriano Award Lectures; accessed December 17th, 2022
  2. Gariepy TP. John Farquhar Fulton and the History of Science Society. Isis 1999;90:S7-27.
  3. Davey LM. Obituary. John Farquhar Fulton, 1899-1960. J Neurosurg. 1960;17:1119-23.
  4. Igual MM. John F. Fulton (1899-1960): neurophysiologist, bibliophile, and historian. His relationship with Spain. Neurosci Hist  2019;7:62-76.
  5. It became American Association of Neurological Surgeons (AANS) in 1967; see Introduction (aans.org); accessed December 17th, 2022.
  6. In fact there are several Osler Societies, including the American Osler Society dedicated to the history of medicine and the William Osler Society of Australia & New Zealand.
  7. For a list of lecturers since the foundation see Soriano Award Lectures.
  8. An important source for the information in this biographical sketch is Victor Soriano.
  9. Oransky I. Obituary: Richard L Masland. Lancet 2004;363:663.
  10. Pedley TA, Rowland LP. In Memoriam: Richard Lambert Masland, MD (1910-2003). Neurology 2004;62:1056-7.
  11. This article is partly based on: Meshram C. Padma Shri for Dr. Bhimsen Singhal. World Neurology 2022, May 15th.
  12. See for instance Singhal BS, Advani H. Multiple sclerosis in India: An overview. Ann Indian Acad Neurol. 2015 Sep;18(Suppl 1):S2-5.
  13. Singhal BS, Bhatia NS, Umesh T, Menon S. Myasthenia gravis: a study from India. Neurol India. 2008;56:352-5.
  14. Singhal BS, Gursahani RD, Udani VP, Biniwale AA. Megalencephalic leukodystrophy in an Asian Indian ethnic group. Pediatr Neurol. 1996;14:291-6.
  15. Gorospe JR, Singhal BS, Kainu T, Wu F, Stephan D, Trent J, Hoffman EP, Naidu S. Indian Agarwal megalencephalic leukodystrophy with cysts is caused by a common MLC1 mutation. Neurology. 2004;62:878-82.
  16. Bharucha N. Eddie Phiroz Bharucha. World Neurology 2018, May 14th.
  17. Shah P, Seshia S. Dr. Eddie P. Bharucha (December 28, 1916–December 14, 2017). Ann Indian Acad Neurol 2018;21:91-2.
  18. Shah PU, Saxena VS. Dr. Eddie Phiroze Bharucha (December 28, 1916–December 14, 2017). Int J Epilepsy 2018;5:53-5.
  19. Poser CM, Crawford Poser J. Neurology in the developing world. Brain 2006;129:1624-9.
  20. Bharucha, 2018.
  21. Culebras A. Named Lectures at the World Congress of Neurology. Neurology 2005;65:31-2a.
  22. Charatan F. Melvin Yahr. Neurologist who revolutionised the treatment of Parkinson’s disease. BMJ 2004;328:290.
  23. Oransky I. Melvin D. Yarh. Lancet 2004;363:903.
  24. Riederer PF, Hirsch E, Youdim MB, Calne DB. A tribute for Prof. Dr. Melvin D. Yahr, M.D. (1917-2004). J Neural Transm (Vienna). 2004;111:1205-8.
  25. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967;17:427-42.
  26. Yahr MD, Duvoisin RC, Schear MJ, Barrett RE, Hoehn MM. Treatment of parkinsonism with levodopa. Arch Neurol 1969;21:343-54.

27.       See About IAPRD – IAPRD 2023 (iaprd-world-congress.com); accessed December 26th, 2022.

Growing the African Neurological and Scientific Workforce

Spreading the reach of neurology across the continent.

By Augustina Charway-Felli and Amadou Gallo Diop

Photos from the biannual francophone contest November 2022, in Abidjan, Cote d’Ivoire, involving 10 new African professors of neurology and three psychiatrists

Nov. 12, 2022, marked the end of the biennial Francophone contest of the headquarters of the African and Malagasy Council for Higher Education (Conseil Africain et Malgache pour l’Enseignement Superieur [CAMES]). Congratulations to the 10 new African professors of neurology (and three psychiatrists) who were successful at the contest that concluded in Abidjan in Cote d’Ivoire.

The first ranked candidate, Prof. Medinatou Atoukè Agbetou, from Benin, coincidentally benefited from a sponsored one-year epileptology training fellowship in Dakar, Senegal, at the World Federation of Neurology (WFN) accredited neurology department of Universitaire Cheikh Anta Diop (Cheikh Anta Diop University-UCAD) three years prior.

Photos from the biannual francophone contest November 2022, in Abidjan, Cote d’Ivoire, involving 10 new African professors of neurology and three psychiatrists

Other individuals and countries represented were: Maouli Fall and Ndiaga Matar Gaye from Senegal; Kokou Mensah Guinhouya (Togo); Seybou Hassane (Mali); Lompo Labodi and Anselme Dabilgou (Burkina Faso); Ghislain Armel Mpandzou and Prince Eliot Gallieni Sounga Bandzouzi (Congo); and Emmanuel Yangatimbi (Central African Republic).

CAMES is the coordinating body for higher education and research systems in francophone Africa. It serves also as the accreditation body for various degrees (Bachelor’s, Master’s, Doctorates, etc.) in its member countries. The UCAD Neurology Department has a longstanding tradition of training in neurology for trainees across French-speaking Africa and several of the above-mentioned successful candidates have their roots in this department.

Though a seemingly small number of new professors, these individuals now serve to continue sharing knowledge and training new cadres in neurology and build on the foundation set by the likes of Michel Dumas, Amadou Gallo Diop, Riadh Gouider, and Therese Sonan, to name a few. Examples of similar growth of neurological departments and local training of neurologists are plentiful across other parts of the continent in luso- and anglophone countries. The African Academy of Neurology (AFAN) is proud of all these efforts and will continue to support individual, country, and regional efforts to build up the neurological workforce with internal resources and reduce the brain drain that is threatening the African Continent. •

Augustina Charway-Felli is president of the African Academy of Neurology. Amadou Gallo Diop is head of the department of neurology at Cheikh Anta Diop University, Dakar, Senegal, and is past trustee of the WFN.

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