The Future of Neurology in India

A report of the 27th Annual Conference of Indian Academy of Neurology

By Gagandeep Singh, Satish Khadilkar, and Sita Jayalakshmi

The 27th Annual Conference of the Indian Academy of Neurology took place Oct. 3-6 in Hyderabad, India. The event, the most exalted professional event for the over 2,000 strong neurologists’ community in India, lasted for four days.

The Inaugural Ceremony of the 27th Annual Conference of the Indian Academy of Neurology: (From left to right) Prof. Gagandeep Singh, Secretary, Indian Academy of Neurology; Prof. Satish Khadilkar, President, Indian Academy of Neurology; Prof. Vinod Paul, Member NITI Aayog, India; Mr. Venkiah Naidu, His Excellency, Vice President of India; B Bhaskara Rao, CEO, KIMS, Hospital, Hyderabad; Prof. William Carroll, President, Worlf Federation of Neurology; Prof. Mohan Das, Chairman, Organising Committee; and Dr. Sita Jayalakshmi, Organising Secretary of the Conference.

India is a country with 1.4 billion people. This huge number is served by 2,500 neurologists, amounting to one neurologist for one million people. On the top of it all, the country is going through an unprecedented epidemiological transition commensurate with the recent strides made in the socio-economic sphere.

While neuro-infections and other neurological disorders associated with poverty and underdevelopment are only somewhat declining, there is a sweeping epidemic of non-communicable neurological disorders to confront. Subspecialty neurological practice is now in place in a few selected centers, but basic neurological care needs to be implemented in vast parts of the country. Clearly, neurologists in India have a formidable job at hand.

Prof. Satish Khadilkar, president, Indian Academy of Neurology with Prof. Carroll.

The annual conference of Indian neurologists was kicked off by Venkiah Naidu, the vice president of India, in the presence of Prof. Vinod Paul, chair of the Board of Governors, Medical Council of India and Member, National Institute for Transforming India, Prof. William Carroll, WFN president, and Prof. Wolfgang Grisold, WFN secretary general. Both the vice president and Prof. Paul emphasized the need and strategy for increasing the neurology workforce in India.

Prof. Khadilkar presenting Prof. Grisold with Honorary Membership of the Indian Academy of Neurology.

“No doubt, the number of training positions has increased from 30 in 1990 by nearly 15-fold – we now have over 450 training positions – but still we need more” said Prof. Paul. And besides, though the number of training posts have increased and there are many more neurologists than there were some 30 years ago, most of the neurologists are concentrated in a few metropolitan and larger cities of India. “We should really be having these neurologists, all equipped with computed tomography machines in the villages of India so that every individual with stroke who ought to be thrombolyzed is given his/her due” said Naidu. In his speech, Prof. Carroll outlined the philosophy of the World Federation of Neurology. In fact, he provided a roadmap for the future of neurology. Both he and Dr. Grisold agreed that the way forward was to make CT scanners and basic neurological care accessible to each village in India.

A speaker’s view of the audience.

Aside from the inaugural function, the Conference of Indian Neurologists had all of the ingredients for a successful meeting in assisting them to meet the challenges they faced. Themes and topics of over 40 symposia, quasi-workshops, continuing education programs, and hot topics varied from contemporary to futuristic, all cutting edge. Just to cite a few examples, there were symposia on artificial intelligence and continuous dopaminergic stimulation. Really, this meeting of Indian neurologists had something for everyone. There were neuroradiology rounds, grand rounds, panel discussions, a clinico-pathological conference, and even running, Yoga, and singing events for the members of the academy.

The Annual Conference of the Indian Academy of Neurology is always a glorious event, worthy of attendance by neurologists from all corners of the world. We warmly welcome neurologists form anywhere in the world to attend our future annual meetings. Just keep your eyes on www.ianindia.org for more information and updates. •

 

Gagandeep Singh, DM, FIAN, FICP, FAMS, FRCP, is secretary of the Indian Academy of Neurology. Satish Khadilkar, DM, FIAN, FRCP, FAMS, is president of the Indian Academy of Neurology. Sita Jayalakshmi, DM, FIAN, is organizing secretary of the 27th Annual Conference of the Indian Academy of Neurology.

A New Organization for an Old Disorder

By Jon Stone, Alan Carson, and Mark Hallett

Functional symptoms and disorders should be familiar to any practicing neurologist. The patient has a genuine and disabling symptom, such as limb weakness, tremor, blackouts, or dizziness, but the clinical history and examination shows positive evidence that the symptom is a disorder of function, not structure.

Figure 1. Photos and illustrations of functional neurologic disorders from Volume 1 of Nouvelle Iconographie de la Salpêtrière, Jean-Martin Charcot’s “in house” journal from 1889 show how the disorder has remained clinically unchanged over time3

Typically, findings of internal inconsistency, such as Hoover’s sign of functional leg weakness or typical findings of a functional (non-epileptic) seizure, should point the way and allow a positive diagnosis to be made. These are not diagnoses of exclusion, should not be made on the presence or absence of psychological factors, and can be diagnosed alongside neurological diseases that may commonly accompany them.

Studies in many parts of the world have shown that functional disorders are one of the most common reasons for neurological consultation. Despite this, the topic has often been invisible in curricula and training programs for neurologists. Patients commonly remain stigmatized and poorly treated.

It was not always so. Neurologists in the 19th century, such as Charcot, Gowers, and Oppenheim, recognized that hysteria as it was known then, was a fascinating, common, and potentially treatable part of their general neurology practice. (See Figure 1.) They devoted long sections to it in their textbooks, took a multidisciplinary view of its causes and treatment, and offered practical advice to all neurologists in how to manage it. With the rise of psychoanalytic theory and the clinico-pathological method, neurologists in the 20th century largely lost interest in the condition, although they never stopped seeing the patients.

The 4th International Conference on Functional Neurologic Disorders, and the first organized by the new Functional Neurological Disorder Society, will meet in June 2020.

Over the last 10 to 15 years, increasingly high quality research on clinical phenotyping and diagnosis, aetiology, mechanism, and  treatment has resulted in more awareness, interest, and evidence1. Developments in functional imaging have enabled us to study the “dynamic lesion” of FND that Charcot predicted in 18892.

The new Functional Neurological Disorder Society (FNDS) launched in 2019 and affiliated with the WFN represents another important step in neurology and medicine’s relationship with these disorders.

An international meeting held in Edinburgh in 2017, generously sponsored by the Movement Disorders Society, the National Institutes for Health, American Epilepsy Society, and others, attracted 550 delegates and highlighted how FND specific services, often originating in neurological centers, have been growing over time. The focus of our organization is providing a forum for health professionals to exchange ideas, and advance research and education for the benefit of patients with FND.

Applications are open to join the new FNDS as a founding member for a limited period until June 2020. We have organized another international meeting in Boston June 14-16, 2020, after which ordinary membership applications will be received. You are invited to join a multidisciplinary audience from neurology, psychiatry, psychology, allied health, nursing, and others. •

 

Jon Stone and Alan Carson are from the Centre for Clinical Brain Sciences, University of Edinburgh, in the United Kingdom. Mark Hallet is from the Human Motor Control Section of the National Institutes of Health in Bethesda, Maryland. The three also serve as leadership of FNDS: Hallet is president, Carson is treasurer, and Stone is secretary. For more information, contact Jon.Stone@ed.ac.uk.

 

References

  1. Hallett M, Stone J, Carson A (eds. . Functional Neurologic Disorders: Handbook of Clinical Neurology (Volume 139). Amsterdam: : Elsevier 2016.
  2. Aybek S. Corticolimbic fast-tracking in functional neurological disorders: towards understanding of the ‘dynamic lesion’ of Jean-Martin Charcot. J Neurol Neurosurg Psychiatry 2019;0:jnnp-2019-320597. doi:10.1136/jnnp-2019-320597
  3. Charcot J-M. Nouvelle Iconographie de Salpetriere. Clinique des maladies du systeme nerveux. Publiee sous la direction du par Paul Richer, Gilles de la Tourette, Albert Londe. Paris: : Lecrosnier et Babee 1888.

 

XXI Davidenkov Readings Neurological Congress: St. Petersburg, Russian Federation

Sergei V. Lobzin, V. Goldobin, and N. Tcinzerling

The XXI annual Davidenkov Readings Neurological Congress took place on the Sept. 26-27 in St. Petersburg, Russian Federation. The meeting is named in honor of the prominent Russian neurologist Prof. Sergei Davidenkov (1880-1961), who made substantial contributions to the development of neurogenetics and neuromuscular diseases. He described a new clinical form of myopathy, scapular-peroneal amyotrophy, and founded one of largest scientific neurological schools in Russia.

(Left to right) Prof. Alexander Skoromets (Russia), Prof. Nils Erik Gilhus (Norway), Prof. Sergei Lobzin (Russia), Prof. Raad Shakir (UK), and Prof. Wolfgang Grisold (Austria).

The congress was organized by S.N. Davidenkov, chair of neurology of I.I.Mechnikov North-Western State Medical University. The chair of neurology was founded in 1893 as the first Imperator Clinical Institution of the Grand Duchess Elena Pavlovna, which has continued since it remains as one of the leaders of neurology education in the Russian Federation.

Thousands of neurologists from different cities and countries from across the world gain more experience in neurology at the university annually. Close scientific and educational relationships connect our institution with the department of neurology at the University of Bergen (Norway) as a result of great efforts and perseverance of many, especially Prof. Nils Erik Gilhus, Prof. Ole-Bjorn Tysness, Prof. Tiina Rekand, and Prof. Lars Thomassen, among others.

These relationships allowed the establishment of a most creative exchange with university teachers and students as well as PhD postgraduate students.

Cooperative studies of myasthenia, spinal cord injuries, and other disorders of the nervous system were initiated as well as annual seminars about ”Neurology in Northern Europe,” which bring opinion leaders from Norway and the Russian Federation.

Prof. Vladimir Semenovich Lobzin

This year’s Davidenkov Readings Congress was devoted to a celebration of the 95th anniversary of honored scientist of Russia, Prof. Vladimir Semenovich Lobzin, who held our chair from 1982 until 1992.

Prof. V.S. Lobzin 1977.

Prof. Lobzin was the disciple of the legendary Prof. Alexander G. Panov, who in 1935 primarily described tick-born encephalitis in Vladivostok. Prof  Lobzin left a huge scientific legacy: 506 scientific publications, 28 books, mostly on challenging questions of clinical neurology, and 22 investigations. In 1957, he described a clinical test in myasthenia gravis (phenomenon of muscular fatigue generalization, oculopalpebral symptom). Prof. Lobzin published the first Russian monograph on myasthenia in 1960, and he managed to organize the All-Union Center for myasthenia investigation in 1971, which provided medical care for many patients with this severe disease from different parts of the then Soviet Union.

His eponymic reference contains seven symptoms and syndromes described by Prof. Lobzin. Among them were the ”three twins syndrome” in migraine (arterial hypotonia, hemicrania, and cholecystopathy, 1977), later completed by his son Prof. S. Lobzin with the “fourth twin” (craniovertebral dysplasia type Kimmerle and Chiari) in 2001.

The “phenomenon of pale spot” on the face after intravenous injection of nicotinic acid solution in patients with facial nerve palsy was also described by Prof. Lobzin, proving the compressive and ischemic origin of the pathology. Moreover, he described rhombencephalitic syndrome in mumps and myasthenic syndrome in patients following ionizing radiation due to nuclear reactor accidents.

The series of research investigations of Prof. Lobzin concerning hypokinesia and hypodynamy in young healthy adults trained in Cosmonaut Corps for prolonged space traveling is crucial. The disciples of Prof. Lobzin became leading professors of neurology in the Soviet Union and continued developing his scientific ideas. A significant part of Prof. Lobzin’s scientific creativity was devoted to research of neuroses, asthenic conditions, and autogenic training.

The investigations of Prof. Lobzin concerning infectious lesions of the nervous system were extremely interesting. He proposed a classification of meningitis, defined approaches to aetiologic and pathogenic treatment of these diseases and also for “arachnoiditis.”

Bekchterev Protege

The evolution of neurology in St. Petersburg owed much to dedicated scientists, such as Prof. Lobzin, who in turn can be considered continuation of the Russian neurological scientific school founded by Vladimir Bekchterev (1857-1927), because the teachers of Prof. Lobzin were disciples of V.Bekchterev. Unfortunately, the “iron curtain” and consequent limitations in scientific information exchange did not allow foreign colleagues to be familiar with the unique scientific achievements that Russian scientists made despite meager funding and nearly complete absence of feedback from leading foreign partners.

Fortunately, nowadays neurologists from St. Petersburg and also from other parts of the world have the opportunity for creative exchange of scientific information in most aspects of neurology aimed at further improvement of medical education quality and to provide adequate care to neurological patients. Nowadays, many staff members of the department of neurology named after S.N. Davidenkov are members of the European Academy of Neurology and the World Federation of Neurology, allowing direct exchange of views and experience in the diagnosis and treatment of a large number of severe pathologies of the nervous system.

The latest Davidenkov Readings Congress in 2019 was attended by 1,153 delegates, during which 117 scientific reports concerning important aspects of clinical neurology (such as stroke, degenerative pathology of the nervous system, neuromuscular diseases, neurooncology, neurocardiology, neurorheumatology, neurogerontology, child neurology, urgent neurology, headaches and migraine, neurorehabilitation, cognitive disorders, Alzheimer disease, Parkinson disease, peripheral nervous system pathology, cerebral and spinal cord injuries and their consequences) were presented. It should be emphasized that participation for neurologists is traditionally free of charge.

The delegates felt the real support from the World Federation of Neurology. The lectures for Russian neurologists from world-leading neurologists was met with a keen interest. The faculty included WFN Past-President Prof. Raad Shakir (U.K.), who devoted his lecture to the relationship between neurology and psychiatry, WFN Secretary General Prof. Wolfgang Grisold (Austria), who demonstrated difficulties in the differential diagnosis of neoplastic aetiology of cranial and other peripheral nerves, and Prof. Nils Erik Gilhus (Norway), who presented a review of neurological disorders and complications during pregnancy. These scientific lectures were closely followed by the audience with great interest and generated considerable debates among neurologists from Russia and other countries.

Challenging Discussions

During the congress symposia and roundtable discussions, the leading scientists from Russia and other countries shared views on challenging and difficult issues related to a large number of disease diagnostics and treatment; this is extremely important for the northernmost megametropolis of Europe – St. Petersburg, the population of which according to unofficial data is more than 7 million inhabitants. The importance of interaction with governmental and municipal services in cases of strokes is clear, and the local neurological community of St. Petersburg is concerned about the frequency, severity, and rehabilitation difficulties of stroke patients despite the setting up of 14 regional neurovascular centers that contain all of the necessary equipment and multidisciplinary teams. In addition, the elderly population of St. Petersburg is over 1 million people, making the situation of provision of care to the elderly more difficult, and creating an urgent need for international cooperation in cognitive disorders such as Alzheimer disease and other forms of dementia.

Thus, modern neurology in St. Petersburg continues to evolve, and it requires further support from the World Federation of Neurology, which will lead to improvement of neurological care all over the world. The Russian Federation is a unique country due to its multi-ethnic and multicultural background from the West and East. Our experience will certainly be useful for all neurologists across the world. We hope that continuation of the annual “Davidenkov Readings” will draw the attention of neurologists from all the countries, particularly as the meeting takes place in one of the mostly beautiful cities in the world with a well-developed and modern infrastructure. We invite all those who are interested to participate. •

Professor Sergei V. Lobzin is vice President of the St. Petersburg Association of neurologists, academician of Peter the Great Academy of Science and Art, professor, head of the Chair of Neurology named after S.N.Davidenkov of North-Western state medical university named after I.I.Mechnikov, where V. Goldobin and N. Tcinzerling are Associate Professors.

 

 

Early Ideas on the Localization of Vital Functions

From Cerebellum to Medulla Oblongata

By Peter J. Koehler

Nowadays, physicians know that spontaneous or (rarely) traumatic cerebellar hemorrhage may be lethal by causing hydrocephalus or brainstem compression. In the past, these observations were interpreted in a way that the cerebellum was considered an organ of vital importance. It lasted several centuries before researchers were able to distinguish cerebellar injury from pathology of the medulla oblongata.

Abraham Kaau Boerhaave’s Impetum Faciens dictum Hippocrati.

Influence of Willis

In a chapter in Thomas Willis’ (1621-1675; his name is associated with the arterial circle at the base of the brain) famous Cerebri Anatome (1664) titled “De spirituum in Cerebello productorum, propter functionis involuntariae actus varia diataxi, & Exercitio diversimodo,” the author states that the cerebellum is responsible for vital and involuntary functions (breathing, heartbeat, bowel movement). Still thinking in terms of the humoral (patho)physiology of the period, he supposed that animal spirits (a hypothetic volatile substance), originating in the cerebellum, passing through the vagus nerves, are conducted to these organs (lungs, heart). So, the medulla oblongata and vagus nerves were just considered to conduct stimuli that originate in the cerebellum.

On the other hand, experiments had been done showing that the heart could continue beating after removal from the body, and the Swiss physician Johann Jacob Wepfer (1620-1695) observed continuing heartbeat for several hours after decapitation, though still believing there is an important influence from the vagus nerves on the heart that continues for a longer period.

Following William Harvey’s (1578-1657) discovery of the circulation of blood earlier in that century (1628), indeed new ideas had originated on the function of the brain and its relationship to the heart. In the past, it was thought that the brain and cerebellum had equal functions, although the ancient ventricular localization theories localized memory in the third cell (our fourth ventricle). This idea was still present in some medical minds of the 17th century [for instance, in the German physician Johan Vesling’s (1598-1649) and Dutch physician Nicolaes Tulp’s (1593-1674) work].

Willis’ Cerebri Anatome (1664).

However, there had already been ideas about the important vital function of this ventricle. Willis was the first to localize vital and involuntary functions in the cerebellum. Experiments seemed to confirm these ideas as injuries and removal of the cerebellum led to arrest of heart and respiration. In contrast, removal of the cerebral hemispheres was sustained much longer. These observations were considered indirect proofs of Willis’s speculations.

Experimental Cerebellar Lesions Considered Lethal

From Willis’ Cerebri Anatome.

Several 17th century experimenters reported the fatal effect of removal of the cerebellum, including the Paris physician (and architect) Claude Perrault (1613-1688), Raymond Vieussens (1641-1717; working in Montpellier), Johannes Bohn (1640-1718, who worked in Leipzig) and German physician Johann Gottfried von Berger (1659-1736).

Charles Drelincourt (1633-1697), a French physician who moved to Leyden, where he preceded Herman Boerhaave (1668-1738)) stabbed a needle in the fourth ventricle, which immediately led to “epileptic cramps.” (Nowadays, we would probably call it extensor posturing and the differentiation from epileptic phenomena still may be a diagnostic clinical problem.)

“Acu in cerebelli ventriculum compulsa inter primam vertebram & os occipitis, canis, ceu epilepticus, ter quaterque concussus est universe, sed mox expiravit » (A needle was driven into the cerebellar ventricle between the occiput and first vertebra, the dog demonstrated three or four general shocks, but soon expired.) He believed to have confirmed Willis’ ideas herewith, not aware that he probably injured the medulla oblongata. However, even in this period, some observers presented results that contrasted with those mentioned before.

From Drelincourt’s
Experimenta anatomica
(1684).

French physician and anatomist Joseph-Guichard Du Verney (1648-1730) who did important work on the organ of hearing in his Traité de l’organe de l’ouïe of 1683, anticipating the work of Hermann von Helmholtz (1821-1894) for instance, was able to keep animals alive for some time after removal of the cerebral hemispheres and the cerebellum, and Pierre Chirac (1650-1732), who became personal physician of Louis XV, was able to produce survival for a while following removal of the cerebellum combined with artificial respiration (inflation of air).

“Mr. Chirac, by several experiments, he has made upon dogs, has clearly proved an animal may live some time wanting the brain and even sometimes de cerebellum.”

Experimental Cerebellar Lesions Not Lethal

During the subsequent century, several other experimenters observed that animals not always died upon removal of the cerebellum. It seemed that it depended rather on the caution with which the surgery was done. Some experimenters even pointed to the importance of the medulla oblongata.

Anne-Charles Lorry. Lorry’s 1760 Memoir on movements of the brain.

François Pourfour du Petit (1664-1741) a pioneer in ophthalmology who also described dysfunction of the contralateral hemisphere in injured soldiers, looking for the possible sensory function of the cerebellum, which he could not confirm, observed survival for several days. The Italian anatomist and physician Antonio Valsalva (1666-1723), teacher of Giovanni Battista Morgagni (1682-1771), who described several of his teacher’s cases in his famous De Sedibus of 1761, removed the cerebellum of pigeons, observing that they did not immediately die. Morgagni observed that isolated injury of the cerebellum was not immediately lethal and confirmed this by pathologic-anatomical examination.

Abraham Kaau-Boerhaave (1715-1758), one of Herman Boerhaave’s nephews who moved to St. Petersburg where he became medical superintendent at the navy-hospital, disliked speculation, and after several experiments damaging the brain, the cerebellum (“stylo vel cultro deinde adacto intra cerebellum, non uno momento fuisse actum de cordis & respirationis energia” [then a pen of knife was thrust inside the cerebellum, the cardiac and respiratory function do not stop immediately) or the medulla oblongata, became one of the first to recognize the vital role of the medulla oblongata.

French physician Anne-Charles Lorry (1726-1783), one of the founders of the Société Royale de Médecine, and the German physician Justus Arnemann (1763-1806) warned against the technical deficits in many of the previous experiments on the cerebellum, resulting in massive bleeding in the subtentorial space and tried to avoid this.

Lorry, in a memoir on “Les mouvemens du cerveau” [the movements of the brain] presented at the French Académie des Sciences (1760) and experienced that young cats and pigeons were better suited to avoid these complications.

From Drelincourt’s Experimenta anatomica (1684).

With our present knowledge, the mechanism of the following experiment can be easily comprehended:

Je pressois un jour latéralement & assez fort le cervelet d’un chien gros & adulte, le hasard me fit voir tout d’un coup ce chien tomber & ronfler très-fort & très-notablement: dans mon étonnement, je lui lâchai ce viscère, il fut réveillé au même instant &: fit des efforts pour crier. Je repris le cervelet de la même manière, il se rendormit: je recommençai cette expérience plusieurs fois, jusqu’à ce que tout d’un coup une compression encore plus forte lui excita des convulsions. [One day I compressed the cerebellum of a large and adult dog from the lateral side and sufficiently strong, by chance I saw the dog falling and snoring very hard and very strikingly suddenly: in my astonishment, I released that organ, he awoke at the same moment and made efforts to scream. I again took the cerebellum by the same way, he fell asleep again: I repeated the experiment several times, until suddenly an even stronger compression excited convulsions].

No Vital Functions in the Cerebellum

Swiss physician and pioneer experimental researcher Albrecht von Haller (1708-1777) considered the heart almost completely independent (1786), and his followers denied localization of functions in the brain, including the cerebellum. Haller, who did many experiments on all kinds of animals with improved techniques, believed Willis’ ideas were insufficiently based upon experiments and localized the soul (sensorium commune, the place in the brain, where all senses converge and result in a motor reaction) in all parts of the brain.

Charles Drelincourt.

Disorders of the cerebellum, he thought, do not lead to “certain and speedy death. For certain experiments, even of our own making, show that it has borne wounds and scirrhi, without taking away life; . . . not very rarely, wounds of the cerebellum cure” (Haller, 1786, p.217). He criticized previous physicians stating that “the source of the great error in physic has been owing to physicians … making few or no experiments, and substituting analogy instead of them” (Haller, 1755, p. 658).

Ethical Issues

Reading about these experiments and vivisection, one wonders about ethical issues at the time. Haller wrote in the introduction that he examined 190 animals since 1751, “a species of cruelty for which I felt such a reluctance, as could only be overcome by the desire of contributing to the benefit of mankind.” (Haller, 1755, p. 657) . Throughout the 19th century, the man-animal relationship, particularly with respect to cats and dogs, gradually became more emotional.

One of the possible explanations that have been presented is that pet-keeping became more common in early industrialized and urbanized countries. More information on the history of vivisection and ethical issues can be found in the work of medical historian Andreas-Holger Maehle and his pivotal article “The Ethical Discourse on Animal Experimentation, 1650-1900” (Maehle, 1993). •

Literature

Haller A. A dissertation on the sensible and irritable parts of animals. Translated from Latin by Tissot. London: Nourse, 1755/1936.

Haller  A. First lines of physiology (Vol. 1).  Johnson Reprint, New York, 1786.  (Reprinted in 1966).

Koehler PJ. Neurology in Tulp’s Observationes medicae. J Hist Neurosci 1996;5:143-51.

Koehler PJ. Neuroscience in the work of Boerhaave and Haller. In: Whitaker H, Finger S, Smith C. Brain, mind and medicine: essays in eighteenth century neuroscience. Springer, New York, 2007, pp. 213-231.

Koehler PJ, Lameris B. The Magnus-Rademaker Scientific Film Collection: Ethical Issues on Animal Experimentation (1908-1940). J Hist Neurosci. 2016;25:102-21.

Lorry CH.  Sur les mouvemens du cerveau. Second mémoire. Sur les mouvemens contre nature de ce viscère, et sur les organes qui sont le principe de son action. Mémoires de Mathématique et de Physique présentés à l’Académie Royale des Sciences. Paris, Imprimerie Royale, 1760, p.344.

Maehle AH. The ethical discourse on animal experimentation, 1650–1900. Clio Med 1993; 24: 203–251.

Neuburger M. Die historische Entwicklung der experimentellen Gehirn- und Rückenmarksphysiologie vor Flourens. Stuttgart, Enke, 1897. English edition published as The historical development of experimental brain and spinal cord physiology before Flourens. Transl. and edited, with additional material. Baltimore & London, Johns Hopkins University Press, 1981.

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

Willis T. Cerebri anatome: cui accessit nervorum descriptio et usus. Londini, Ja. Flesher, 1664.

 

 

The Nonaka Lecture at the 2019 Oxford Muscle Symposium

By Martin Krenn and Wolfgang Grisold

The Oxford muscle symposium is an annual meeting of muscle specialists under the leadership of David Hilton Jones and Monika Hofer. This year’s meeting took place July 12-13 in Worcester College in Oxford, United Kingdom.

Prof. Nonaka giving the Meryon lecture at the Oxford muscle symposium.

It is a unique meeting, based on lectures and case presentations in muscle disease (myology). It has a rich history, dating back 44 years. Over the years, the meeting has witnessed the change of techniques and methods and the remarkable switch from histology and morphology toward molecular medicine and genetics. The cases presented are well researched and a highly qualified audience discusses the cases.

One special aspect is the Meryon lecture, which is organized to commemorate  Edvard Meryon, by the Meryon Society. Meryon was a contemporary of Duchenne, and the naming of the disease is still controversial for the Meryon society1.

This year´s lecture was held by Prof. Ikuya Nonaka from Japan. It is a rare occasion to be privileged to listen to a researcher who has given the name to a rare disease2 Prof. Nonaka, from the National Center of Neurology and Psychiatry in Tokyo, Japan, gave his special lecture, titled “Special Aspects of Neuromuscular Diseases in Japan.”

In his lecture, Prof. Nonaka described neuromuscular diseases in Japan and the great discoveries of Prof. Myoshi, for whom he worked at the time. He also illustrated the history of Japanese neuromuscular departments that catered to neuromuscular patients, often dependent on ventilation. This has a long tradition in Japan and dates back to poliomyelitis epidemics. In this context, Prof. Nonaka told the story of one of his Duchenne patients, who despite his disorder was able to study law and attend university and worked as a lawyer.

Three giants of myology, discussing after Prof. Nonaka’s lecture. (From left to right) Prof. Nonaka, Prof. Hans Hilmar Goebel and Prof. Victor Dubowitz.

In 1981, Nonaka first described a subtype of distal myopathy, which was subsequently named after him (Nonaka Myopathy) and is now more commonly referred to as hereditary Inclusion Body Myopathy (hIBM) due to its hereditary (autosomal recessive) nature and its histological overlaps with classical inclusion body myositis. Later on, in the era of molecular genetics, the disorder was more precisely characterized and found to be caused by mutations in the gene GNE. While being considered as an ultra-rare (orphan) disease, the condition is also encountered outside Japan, most commonly in the United Kingdom, Bulgaria, India, and the Middle East.

From a clinical standpoint, the hallmarks of the disease remained widely unchanged since its first description by Nonaka almost 40 years ago. Neuromuscular symptoms usually start in early adulthood (third decade of life) with weakness and atrophy in distal limb muscles characteristically sparing the quadriceps. In spite of its slowly progressing natural course, it is a debilitating neuromuscular disorder, and most patients become wheelchair users 10 to 15 years after symptom onset. Although there is no approved treatment so far, modern advances in translational research give rise to the hope that targeted therapies may eventually also become available for GNE myopathy3.

Prof. Nonaka was able to give an overview not only on the detection of a rare neuromuscular disease, with tools of classical myology, which is now almost superseded by genetic studies, he also demonstrated his devotion to myology and above all to patients. •

Martin Krenn is in the department of neurology at the University Clinic of Vienna in Austria. Wolfgang Grisold is Secretary General of the WFN and works at the Ludwig Boltzmann Institute for Experimental und Clinical Traumatology.

References:

  1. Emery AE, Emery ML. Edward Meryon (1809-1880) and muscular dystrophy. J Med Genet. 1993 Jun; 30(6): 506–511.
  2. Nonaka, I., Sunohara, N., Ishiura, S., Satoyoshi, E. Familial distal myopathy with rimmed vacuole and lamellar (myeloid) body formation. J. Neurol. Sci. 51: 141-155.
  3. Pogoryelova O, González Coraspe JA, Nikolenko N, Lochmüller H, Roos A. GNE myopathy: from clinics and genetics to pathology and research strategies. Orphanet J Rare Dis. 2018 May 2;13(1):70

From the editors

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

Steven L. Lewis, MD

Walter Struhal, MD

We would like to welcome all of you to this issue of World Neurology, the official newsletter of the World Federation of Neurology (WFN), and the first issue since returning from the very successful 24th World Congress of Neurology (WCN) held in Dubai, United Arab Emirates at the end of October, 2019. As such, much of this issue is devoted to highlighting the many activities of this remarkable Congress, including the detailed report/President’s Column from WFN President Dr. William Carroll, who also highlights and details the many outstanding plenary sessions that the thousands of delegates who attended the WCN were privileged to attend, as well as the press releases and activities that informed countless others around the world. Dr Richard Stark, WFN Treasurer, provides his report of the exciting and highly attended Tournament of the Minds that culminated in a nailbiting final event that occurred just prior to the closing ceremony of the Congress. We’ve also chosen some representative images of the many activities that occurred during the WCN in a photo montage that we hope provides a flavor of the breadth of this important and remarkable international neurologic event.

With regard to other recent neurologic meetings, Drs Sergei V. Lobzin, V. Goldobin, and N. Tcinzerling report on the many activities, and the historical significance of, the 21st Davidenkov Readings Neurological Congress that was held in St. Petersburg, Russia in September 2019. Dr Martin Krenn and WFN Secretary General Wolfgang Grisold report on the Oxford Muscle Symposium, highlighting the historically significant presentation by Dr. Ikuya Nonaka on neuromuscular diseases in Japan and their discovery. In addition, Drs Gagandeep Singh, Satish Khadilkar, and Sita Jayalakshmi provide their detailed report of the 27th Annual Meeting of the Indian Academy of Neurology held in early October 2019 in Hyderabad, India.

This month’s history column, by Dr. Peter Koehler, focuses on the history of the concept of the localization of vital neurologic functions, especially related to concepts regarding this localization to the cerebellum versus the medulla. Also in this issue, Drs Jon Stone, Alan Carson, and Mark Hallett announce the creation of a new international organization devoted to functional neurologic disorders, and invite interested neurologists worldwide to join.

In concluding, it was wonderful seeing so many neurologists from around the globe (and of all stages of training and career) in Dubai, and we want everyone to start “saving the date” for the next WCN that will be held in Rome in early October 2021. Planning is already underway for what promises to be another highly attended and highly successful international meeting of the minds for all neurologists from across the globe. •

The Importance of WFN Council of Delegates Meeting

As all who receive the World Neurology publication know, the XXIV World Congress of Neurology is almost upon us. It will commence Oct. 27 in Dubai. The World Congress will showcase the most topical subjects in neurology, facilitate the learning experience of all attendees, and provide a forum for wide-ranging discussion of these. The World Congress will also host a range of important business meetings for the WFN. Foremost among these is the Annual Council of Delegates (COD) Meeting. The Global Neurology Alliance will also meet as will numerous WFN committees such as Education, Membership, Finance, Congress, e-Communications and Constitutions, and Bylaws, which all together represent the heart of the WFN.

William Carroll, MD

The Council of Delegates Meeting is held annually, as it must be according to the United Kingdom Charities’ Commission. It is at this meeting that decisions critical to the WFN will be made. The Annual COD Meeting that coincides with a WCN, as this one in Dubai does, often assumes greater significance than those in the intervening years. The simple reason is that more national member representatives attend the COD in a WCN. There is no doubt that the larger number of delegates increases the range of opinions that are offered by delegates on the topics discussed. It is also clear that the WFN benefits from this in the quality of the decisions that are made. This year’s COD will occur at 2 p.m., Saturday, Oct. 26. Seventy to eighty delegates or their proxies will be present from the 120 member societies, observers, trustees, and the London Office staff. Under the WFN rules, only member societies that are “financial” will be able to vote on resolutions and elections.

At this year’s COD, there are critical decisions to be made. Two elected trustee positions are to be decided, the 2023 WCN venue will be resolved and elections to membership of the WFN will be determined. The two trustee positions are those of treasurer, currently occupied by Richard Stark, and an elected trustee (Steven Lewis). Both are entitled to stand for re-election, and both are exercising this option. You will find their personal statements in this issue. That they are both standing unopposed may be regarded as a testament to the quality of their contribution to the WFN to date. Their personal statements provide important insights into their views of the WFN, its function and future role as the global neurological organization.

The 2023 WCN will be held in the Americas. It will be hotly contested by the Mexican Academy of Neurology (Mexico City), the Canadian Neurological Foundation (Montreal), and the Brazilian Society of Neurology (Rio de Janiero). The decision is a crucial matter for the WFN as its signature biennial education event. The promotional summaries from each member society vying to host the WCN are also contained in this issue. During the COD, each contender will have 10 minutes to present their case and 5 minutes to answer questions from the delegates. Kenes, professional conference organizer (PCO) for the WFN, will then present a summary of the pros and cons for each venue, which will be then followed by the vote. While not binding on the WFN, the vote is usually accepted given the democratic principles upon which the WFN functions.

Respect for democratic principles is at the heart of a third matter to be subjected to a vote at the COD. It is on the matter of two neurological societies applying for membership of the WFN. The applications are from the Nepalese Society of Neurology and the Kosovo Neurological Society and will be presented at the Council of Delegates. The process to be followed is first a recommendation from the Membership Committee to the Trustees, which after approval by the trustees, then goes forward to the Council of Delegates to vote on the application.

As judged by the Membership Committee, the application from the Nepalese Society was straightforward. The application from the Kosovo Neurological Society presented some challenges. While the Kosovo Neurological Society is properly constituted and satisfied all the representative requirements, there was an important additional consideration. This was whether Kosovo should be regarded as a separate independent country. In order for this to be judged fairly, the Membership Committee sought the views of the trustees, and more widely, before making a decision.

Essential to these views was whether Kosovo had the right to apply, whether it was already represented by the Serbian Society of Neurology and whether it had access to membership elsewhere, or placed restrictions on who could be members of the Kosovo Neurological Society. These matters were considered in detail, and formal and informal opinions solicited from other interested parties. The Membership Committee deemed that Kosovo was a separate country according to the WFN Articles of Association, had satisfied all requirements for membership, and that in the interests of fairness for it to represent Kosovo neurologists in the WFN, its application should go forward to the COD where the final decision would be made.

An important consideration in this decision was that the EAN apparently had to decline the same application by the Kosovo Neurological Society because Kosovo did not comply with EAN Bylaws in not being a WHO “European” country. This view differed from that of the WFN. In our situation, a country is determined to be such by the trustees on behalf of the WFN.

I have taken this time to detail the path that this application has followed to illustrate that these decisions are carefully considered before proceeding to the vote. It is, in some respects, similar to the due consideration given to the membership of the Hong Kong Neurological Society when the Chinese Neurological Society became a member. As long as the reasons are transparent and do not interfere with the function of other member societies, I feel confident that the COD will make a fair decision.

As mentioned at the commencement of this report, the Global Neurology Alliance will also meet at 12:30 p.m. on Monday, Oct. 28. This is an important element of the WCN and for international neurology. By combining the views of the members of the GNA in the WCN program and providing a forum for the GNA, the WFN seeks to maintain a working relationship between all the GNA participants. As I have mentioned before, the Global Neurology Alliance is essentially a topic-based global organization that strongly complements the national and geographic global structure of the WFN. In so doing, it provides world neurology the flexibility, expertise, and credibility to address almost any global matter requiring the attention of neurologists.

Central to this meeting of the GNA are at least three matters of substance. The first is the issue raised at the GNA meeting in Lisbon during the 2018 EAN meeting on the need for the GNA to formulate its role in raising the awareness of brain health. The second is to report on the success of the 2019 World Brain Day and to deliberate on themes and partnerships for World Brain Day 2020 and beyond. The WFN has previously partnered with a major topic group like the World Stroke Organization and the International League Against Epilepsy and this year with the International Headache Society. Third, the GNA will be asked to contribute to the 2021 WCN in Rome and how best to incorporate activities and topics from the GNA members.

Finally, by the time this issue of World Neurology is on your device, the program will have been finalized on the World Congress of Neurology website. The WCN will provide daily highlights throughout the Congress, teaching courses, and cutting-edge topics delivered by expert lecturers. Notable among these are several plenary lectures such as “The Battle to Beat Parkinson’s Disease” by Patrick Brundin; “Sleep and Circadian Rhythm” by Russell Foster; “Gene Therapy and Neurodegenerative Diseases” delivered by Sarah Tabrizi; “Brain-Machine Interfaces” by Miguel Nicoleilis; and “The Promise of the Brain Initiative for Those With Neuro/Mental/Substance Abuse Disorders” by Walter Koroshetz.

Each day will feature main topic lectures on stroke, epilepsy, dementia, demyelinating diseases, movement disorders, neuromuscular diseases, and headache. Interspersed are numerous teaching course sessions, free paper sessions, and poster sessions—all providing a lively interactive environment. The Tournament of the Minds, featuring teams of four, will provide a wealth of clinical learning in a good-natured, competitive spirit. The program will be WCN Congress app-based and social media platforms and the internet will be accessible throughout the Congress including a twitter wall.

The 2019 WCN promises to be an outstanding event, and the WFN is most grateful to all those who have worked to make it so.

 

 

Migraine in Cameroon: From the Painful Truth to the Powerful Tribute

By Alfred Kongnyu Njamnshi, MD, MA, DMS, FMH

In 2008, when then-president of the World Federation of Neurology (WFN) Prof. Johan A. Aarli set foot in Yaoundé for the 18th Congress of the Pan African Association of Neurological Sciences, (PAANS1), Cameroon—fondly referred to by its citizens as “Africa in miniature”2—was a peaceful, prosperous, powerful, and promising nation of the central African sub-region. At that time, there were only a handful of neurologists in Cameroon, and there was no training program for neurologists in the medical schools of the country.

Dr. Mbome Njie Victor, representing the prime minister, delivers the speech at the closing ceremony on WBD.

In organizing this congress, a great need was felt to reach out for the preparation of future neurologists in the country. This was done through a pre-congress activity that consisted of selecting the best students from some primary, secondary, and university institutions in Yaoundé, introducing them to the neurosciences, and evaluating their performances after a short educational intervention on the epilepsies3.

Concerning this innovative program, Prof. Aarli had this to say: “The type of outreach program presented in Cameroon is important because it makes neurosciences not a foreign and exotic subject, but a part of their daily life and of public health.”1 On the congress proper, he reported, “I had the pleasure to attend the PAANS congress in Yaoundé, Cameroon, in November 2008 … The PAANS Congress served as an important information and discussion forum for African neurology. The meeting also was attended by local politicians and representatives from the government, which is essential in increasing the visibility of neurology.”4

Dr. Edwige L. Mendo, neurologist trained in Cameroon and serving in the South region of the country, presenting the key message of the painful truth of migraine at the ST Muna Foundation on WBD.

The congress organizers had worked hard to convince the government of the Republic of Cameroon on the importance of neuroscience to national development. Indeed, this was the first time in the 36-year history of PAANS that the government of the host country was the unique sponsor of the entire congress. At the opening and closing ceremonies, several cabinet members accompanied the Vice Prime Minister H.E. Amadou Ali, the chair of the congress, which was held under the highly distinguished patronage of the president of the republic, head of state.

The primary theme of that congress was “The Epilepsies,” and the secondary theme was “Headaches.” It was attended by the then-president of the International League Against Epilepsy, Prof. Peter Wolf. The president of the International Headache Society could not attend due to a last-minute emergency. It was during this congress that Prof. Aarli challenged the government of Cameroon to start residency programs in the neurological sciences that could serve the country as well as the sub-region. This challenge was well received, and two years later, residency programs in neurology, neurosurgery, and psychiatry were established in the Yaoundé School of Medicine in the University of Yaoundé I. More details on the fruits of this development over the years shall be reported subsequently.

Currently, 11 neurologists (two from the Democratic Republic of Congo [DRC] and nine from Cameroon), five neurosurgeons, and six psychiatrists (one from DRC) have been trained in these programs. Also, our neurology department recently hosted a trainee neurologist from Belgium (now a practicing neurologist) for a period of six months5. It is worth noting that one of our youngest trainees just received his award as fellow of the European Board of Neurology on June 28, 2019, as the sole candidate from sub-Saharan Africa, following a tight examination in Oslo with his European counterparts and neurologists of other nationalities, in the international examination organized by the European Academy of Neurology.6

The Painful Truth

In recent years, however, the indescribable beauty of this young and healthy nation, like that of a young headache-stricken patient, has been significantly threatened and bruised by a series of crises that can be described by no other word than migraine, and that is the painful truth.

Closing ceremony group photograph with representative of the prime minister (4th), BRAIN Board Members (Pr Etya’ale Daniel, 1st , Pr Leke Rose 2nd) and president of ST Muna Foundation (Battonier Benard Muna, fifth from right, in front row)

Indeed, the pain has been throbbing, sparing no part of the country. First is the eastern tropical forest region of the country with the influx of refugees fleeing from their own internal crises in the Central African Republic and the multiple consequences thereof.

Second, more severe attacks have ravaged the western mountainous region of the Far North, spreading terror, panic, and chronic phobia in the populations.

Third, as if this were not enough, for the past three years, the North-West and the South-West regions of the country are the theater of a hemorrhagic conflict, and the populations of these two regions have been victims of uncountable, painful, persistent, and pervasive attacks, sometimes caught as it were between the hammer and the anvil.

The full extent of the reality of this extremely painful truth has not been and may never be adequately measured, but one thing is certain: the nausea and emesis accompanying the atrocities, the photophobia and sonophobia associated with the increasingly sophisticated firearms, will have long-lasting and far-reaching consequences on brain health and on health and development in general. It is disheartening to note that two-year-old internally displaced children are familiar with and easily recognize the sound of firearms.

You may be tempted to observe that what appeared to be a simple migraine aura, rapidly and unexpectedly developed into a hemiplegic migraine with one whole side of the nation completely paralyzed intermittently through the “ghost-towns,” then to chronic migraine or better still “chronic hemiplegic migraine.” The prevailing situation could best be described as a “chronic familial hemiplegic migraine” as many family members of the people of this one-time peaceful nation are now directly or indirectly affected.

The painful truth is that every part of the whole is seriously hurting. The migraine crisis in Cameroon, which is the most common crisis in the country, has severely impacted every aspect of national life and has been underrecognized, underdiagnosed, thus underresearched, and undertreated (crisis-treatment) despite many laudable efforts.

The country has become peaceless and sleepless, running short of its prosperous and promising nature. Land of promise, where is your promise? Land of glory, where is your glory? Nevertheless, together as a TEAM (Together Each Achieves More), we all can use our brains to make sure that the suffering brains and bodies of the people in Cameroon affected by this migraine receive the help they need as the key messages of the World Brain Day7 2019 suggest to become once again a peaceful and prosperous land of promise and glory.

May I remark in passing, but seriously so, that the migraine in Cameroon is not unique to Cameroon. Although some of the aggravating factors of these migraines generally tend to be environmental, not easily lending themselves to intrinsic control mechanisms in the context of a total absence of biofeedback mechanisms, it would appear that only a concerted, concentrated, and constant effort for lasting prophylactic solutions, coming from the ingenuity and strong will of endogenous healthy brains, will be effective.

This would involve a deliberate, directed, and delicate mix of multiple neuronal networks, that work together in synchrony and symphony, in promoting brain health and through brain health, promoting health at large as there is no health without brain health. To ensure success in this endeavor, in terms of effective and efficient neurophysiological mechanisms especially neurotransmission, neuromediation, and neuromodulation, this approach may also involve neuroepigenetics as we are dealing here with a migraine. This process, in itself is not pain free.

The Powerful Tribute: The novel concept of the “Brain Week in Cameroon”

In the midst of this deeply rooted pain and mounting pressure, Brain Research Africa Initiative (BRAIN) has chosen to hope for peace and to work for peace in this fatherland of Cameroon. Since inception by the WFN, we in Cameroon have always celebrated the World Brain Day (WBD) but this was generally limited to an academic or professional audience. This year, BRAIN created the concept of the “Brain Week in Cameroon” involving five main BRAIN activities beginning from a week before the WBD and climaxing with the celebration of the WBD. The goal was to have a nationwide campaign of:

Alfred K. Njamnshi, founder and executive director of BRAIN, delivering the inaugural Monekosso-Muna BRAIN Lecture: The Foundations of Neuroscience Research in Cameroon and Africa.

  • Bringing BRAIN health closer to the populations (diagnosing and treating disease in sick brains)
  • Raising BRAIN awareness among the populations (sensitizing healthy brains to remain healthy)
  • Activating BRAIN networks with the institutions (building partnerships for brain health)
  • Increasing BRAIN capacity in the professionals (training through professional education)
  • Nurturing future generations of BRAIN professionals (celebrating excellence to generate interest in neuroscience careers among the youth).

The inaugural “Brain Week in Cameroon” ran from July 15 to 22, 2019, under the distinguished patronage of the Prime Minister, Head of Government, Chief Dr. Joseph Dion Ngute and in partnership with the government of Cameroon.

First, free neurology, neurosurgery or psychiatry consultations in regional or tertiary health facilities took place in seven of the 10 administrative regions of the country (including some of the migrainous regions), thus bringing brain health care closer to the populations.

Second, multimedia sensitization talks, workshops, and symposia were carried out to raise brain awareness and the national communication media had at least a nationwide audience.

Third, the first two activities provided a forum for networking and building partnerships for the promotion of brain health. Specific public-private partnership agreements were also established between state and private institutions.

Fourth, with the participation of state universities, academic symposia were conducted in two faculties of medicine to increase the capacity of medical students, physicians, and other health personnel in the management of brain disease, particularly migraine.

Finally, a general symposium was conducted in the nation’s capital city of Yaoundé on primary headaches, with special emphasis on migraine, and the icing on the cake was the establishment of the novel concept of “The Monekosso-Muna BRAIN Lecture,” in honor of and as a tribute to the founding fathers of Cameroonian and African neuroscience research.

The late Prof. Gotlieb Lobe Monekosso employed field epidemiological and clinical approaches in the 1960s in Nigeria to study what was variably called at that time, endemic neuropathies, degenerative tropical neuropathies, tropical nutritional neuropathy, or tropical ataxic neuropathy while late Prof. Walinjom FT Muna since the 1990s set the pace for clinical research on HTLV-associated myelopathy, stroke, neuroAIDS, and the epilepsies in Cameroon.

The Monekosso-Muna BRAIN Lecture celebrates excellence in neuroscience and aims to stimulate and attract the young generations to consider taking up careers in neuroscience.

The theme of Brain Week in Cameroon 2019 was, “Promoting Brain Health and Conflict Resolution,” and the core messages highlighted the fact that we all need healthy brains, free from drugs and disease, in healthy bodies, for rational use in dialogue, constructive communication, and negotiations, and to resolve interpersonal, intergroup, or even international conflicts. Thus, BRAIN has attempted to extend and contextualize the WFN concept of “World Brain Day” to the concept of “Brain Week in Cameroon.”

Most of the activities of Brain Week in Cameroon were carried out by or under the leadership of brain health specialists or experts trained in Cameroon and serving in the different regions of the country, some of them under extremely difficult conditions. BRAIN received the partnering support of public and private media agencies as well as some private health institutions in this endeavor. Brain Week in Cameroon has come to stay and to grow, and the Prime Minister of Cameroon, writing on brain health, has encouraged BRAIN to “continue to sensitize the government and other partners on this important aspect of human health.”

The Way Forward

BRAIN, in partnership with the Cameroon Government, has chosen to light a candle, rather than curse the darkness of the migraine in Cameroon through the celebration of Brain Week in Cameroon and World Brain Day. BRAIN plans to cover all of the 10 administrative regions of Cameroon in the next edition of Brain Week in Cameroon and World Brain Day and to consolidate and spread this concept and strategy for the promotion of brain health in the region.

Past prime minister and board chair of BRAIN, H.E. Philemon Yang (center), took time off to attend a reception on WBD. He congratulated and encouraged the young BRAIN leaders from the seven regions of Cameroon to continue to work for brain health with courage, determination, and patience.

Since it has been said that every cloud has a silver lining, BRAIN hopes that the WFN and other partners such as the World Brain Alliance will find an interest in supporting BRAIN in its vision and mission so that as a team, we can work together toward the preventive treatment of the migraine in Cameroon, Africa, and the world, thus promoting brain health. •

Readers should note that articles in World Neurology represent the opinions of the author and not necessarily the view of the World Federation of Neurology.

Alfred Kongnyu Njamnshi, MD, MA, DMS, FMH is professor of neurology and neuroscience, faculty of medicine and biomedical sciences at the University of Yaoundé I, (FMBS-UYI), Yaoundé, Cameroon. He is also the founder and executive director of the Brain Research Africa Initiative (BRAIN), Geneva, Switzerland, and Yaoundé, Cameroon. He is head of the neurology department at the Yaoundé Central Hospital, chair of neurology-neuroscience training programs and head of the neuroscience lab, FMBS-UYI, and past president of PAANS, WFN delegate for Cameroon and emeritus regional director for Africa of the World Federation of Neurology.

 

References

  1. Schneider ME. PAANS: Reaching out to future neurologists, Success seen in African outreach. World Neurology, vol. 24, No. 1 February 2009, pp1 &4. www.wfneurology.org
  2. Johnson-Hanks J. Education, Ethnicity, and Reproductive Practice in Cameroon Population 2003/2 (Vol. 58) DOI : 10.3917/popu.302.0171 Pages 153 – 179.
  3. Akinyemi R, Yepnjio F, Njamnshi AK. Neuroscience in Africa: raising the next generation and changing attitudes towards epilepsy: IBRO (2008) brain campaign funds Pre-PAANS congress 2008, Yaoundé, Cameroon. http://www.braincampaign.org/Pub/Pub_Main_Display.asp?LC_Docs_ID=3740 (accessed December 5, 2008).
  4. Aarli JA, The President’s annual report: Outreach and Exchange. World Neurology, vol. 24, No. 1 February 2009, pp6. www.wfneurology.org
  5. Naeije G, Yepnjio FN, Bissek AC, Tabah EN, Tatah G, Fonsah JY, Fogang Y, Kuate C, Dachy B, Njamnshi AK. Yield of training exchanges between Europe and Sub-Saharan Africa. Acta Neurol Belg. 2013 Mar; 113(1):31-4.
  6. Brain Research Africa Initiative, BRAIN has a new Fellow of the European Board of Neurology, https://brainafrica.org/brain-has-a-new-fellow-of-european-board-of-neurology 2019.
  7. World Federation of Neurology, World Brain Day 2019, Migraine: The painful truth. https://www.wfneurology.org/world-brain-day-2019.

 

 

Candidate City Statement for WCN 2023: Brazil

With 95 certified residency programs in neurology, offering 375 PGY-1 annually, and 4,300 affiliated members, Brazil is a strong candidate to host the World Congress of Neurology 2023.

Many countries already have given their support to Rio during a meeting in October 2018 at the PAFNS Congress in Sao Paulo, Brazil. Holding the WFN Congress will provide a unique opportunity for this large population of neurologists and professionals in the field to join us in a memorable meeting.

Also, holding this Congress in Brazil will provide the WFN with an excellent opportunity to accomplish its mission to promote education in neurology in Brazil and Latin America. Rio de Janeiro, with a wide infrastructure of tourist services, receives more than 2 million foreign tourists annually.

Rio de Janeiro is ranked among the most popular destinations in the world for hosting cultural, commercial, technical, and scientific events—fairs, symposiums, congresses, and exhibitions.

The convention center is in a safe area of Barra da Tijuca and offers a variety of accommodations, food, entertainment, beaches, shopping areas, and among other things, an intense night.

 

 

Candidate City Statement for WCN 2023: Mexico

It is a pleasure and an honor to present Mexico’s candidacy to host the WFN World Congress in 2023.

Mexico represents the 15th largest economy in the world and the 15th largest exporting power.

One of the principal economic bases of the country is tourism. According to the World Tourism Organization, Mexico ranks sixth in terms of the number of visits by foreign tourists. Also, it promotes the diffusion of the natural, cultural, gastronomic, and historical attractions of the country.

Mexico has a well-earned reputation for being a hospitable country with people friendly to tourists. We currently have agreements with more than 97 countries whose citizens do not require a visa to visit us.

Due to its geographical location (in the center of the American continent), Mexico is the gateway to Central and South America. Its air connectivity is one of its advantages; today, there are daily direct international flights to 51 destinations so it is highly likely that attendees only have to take one or two flights to attend the congress. This significantly reduces travel costs for attendees.

Although a WFN world congress has never been held in Central America, we have experience in organizing international congresses, such as the congress of the Pan American Section of the WFN (PANFS) which took place in in 2016 in Cancun, Mexico. Other examples of international events held in Mexico City are International Conference on Emergency Medicine 2018 and World Congress of Cardiology and Cardiovascular Health 2016, among many others.

It is important to mention that Mexican government provides the possibility to calculate zero percent VAT for International Congresses when these are carried out by foreign organizations.

In addition to its economic, geographic, and logistical advantages, Mexico City has much more to offer its visitors.

Once known as the “City of Palaces,” Mexico City has four areas declared World Heritage Sites by the UNESCO. The first is the “Centro Histórico” or downtown area where many beautiful religious and historical buildings can be appreciated, including the Metropolitan Cathedral, the National Palace, and the Fine Arts Palace, a beautiful art nouveau style building. The second World Heritage Site is the Xochimilco Ecological Park, considered by many as the “Venice of Mexico,” thanks to its beautiful canals that can be visited on board a trajinera (a curious wooden gondola-type vessel decorated with flowers).

The third World Heritage Site is the Autonomous National University of Mexico, and the fourth one is the Luis Barragan´ studio. Mexico City offers a large variety of museums, including The National Museum of Anthropology, the National Museum of Art, and the National Museum of History (located in Chapultepec Castle). To the north of the city, you can visit the Guadalupe Basilica, the second-most visited religious sanctuary in the world after Saint Peter’s Basilica in the Vatican.

We hope to count on your support to continue promoting the development of neurology in this region of the world.

 

 

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