The International Brain Commission (1903-1914)

Although often considered a predecessor of the International Brain Research Organization (IBRO, founded in 1961), the International Brain Commission (founded in 1903) played an important role in the history of neurology and its international organization. After all, many early brain researchers often were seeing patients with neurological or neuropsychiatric diseases, and the distinction between clinical and laboratory work was perhaps less evident.

Wilhelm His (1831-1904)

In 1899, leading European academies and scientific societies, in cooperation with the Washington, DC, Academy, joined efforts and founded the International Association of Academies (IAA). International cooperation was considered important in several fields of science, including geophysics and astronomy.

In 1903, the Central Commission for Brain Research, usually abbreviated as Brain Commission, was constituted in London. The IAA had accepted a motion, proposed by the Swiss-German (neuro)anatomist Wilhelm His (1831-1904) to this purpose a few years earlier, stating that the IAA:

Wilhelm Waldeyer (1836-1921)

Should set up a Special Commission to consider the ways and means of achieving the collection, preparation, and general utilization of reliable material for observation on the basis of common principles in the field of human and animal evolution, on the one hand, and on brain anatomy on the other (Richter, 2000).

The first part of the motion was dropped at the London meeting, limiting the purpose to brain research. The formulation accepted by the Brain Commission finally stated:

The several Academies and Societies, represented in the Association, should bring by the name of the Association before their respective governments, or other appropriate authorities, a proposal to establish special institutions of departments of institutions, for the investigation of the Central Nervous System, where such organizations are not already in existence or cannot be created otherwise (Richter, 2000).

Plate from the Swiss part of the International Brain Atlas (1916)

An important motivation was the time-consuming preparation of numerous serial brain sections for comparative neuroanatomic research, in which an international cooperation would be advantageous. A comparison was made with the cooperation in setting up an international network of astronomical observatories. The establishment of neuroanatomical research institutes was promoted with the purpose of providing brain banks and archives of histological preparations. The Constitution and Bye Laws of the Brain Commissions had 36 items, including one on the recognition of an institute:

Should an Institute desire to be recognized as an Interacademic Institute for Brain Study… application for this must be made to the President of the Central Commission. To the petition are to be added statements of the plan of work, organization, personnel, and financial resources. Action on this petition will be taken at the next regular meeting of the Central Commission. A simple majority of the members present decides, the President voting in case of a tie.

The Dutch neurologist Cornelis Winkler (1855-1941) wrote in his recollections that “they hoped, by influence from the academies, to convince the various governments of the importance of joint international work in this area and to motivate them to found central institutes for brain research,”

and the Swiss Constantin von Monakow (1853-1930) wrote in his Vita Mea that the “most important task,” announced by the IAA would be the “mutual scientific assistance and cooperation and if possible methodic organization of brain research.” He hoped that the “mischief of brain research” with “lack of any organization, chaos concerning research and publications” would be reduced. The Swedish Salomon E. Henschen (1847-1930) was rather critical about the Brain Commission in his autobiography, and the German Paul Flechsig (1847-1929) was not satisfied about the lack of scientific fruitful ideas.

Well-Known Brain Scientists

Plate from the Dutch part of the International Brain Atlas (1929)

Wilhelm His became the first president of the Brain Commission, and upon his death in 1904, was succeeded by Wilhelm Waldeyer (1836-1921). The first nine interacademic institutes for brain research were soon acknowledged (1904-1912). The institutes were directed by well-known brain scientists, including Santiago Ramón y Cajal (Madrid, 1904), Paul Flechsig (Leipzig, 1904), Ludwig Edinger (Frankfurt am Main, 1904), Heinrich Obersteiner (Vienna, 1906), Constantin von Monakow (Zurich, 1906), Henry H. Donaldson (Philadelphia, 1906), Vladimir M. Bekhterev (St. Petersburg, 1908), Cornelius U. Ariëns Kappers (Amsterdam, 1909), and Károly Schaffer (Budapest, 1912).

The first three of this list (Madrid, Leipzig, and Frankfurt am Main) were already existing institutes for the study of the central nervous system. Monakow’s Zurich institute and the Wistar Institute in Philadelphia were recognized in 1906. At least four Brain Research institutes owed their existence to the Brain Commission, including the Central Institute for Brain Research in Amsterdam, the Brain-Histological Institute in Budapest, and Bekhterev’s Psychoneurological Institute in St. Petersburg (Richter, 2000). Obviously, not every country was endowed with this honor, and it was prestigious to be elected head of an institute.

The Brain Commission had seven special subcommittees, including macroscopic morphology and phylogenetic research. Up to 1914, over 50 well-known “neuroscientists,” including physiologists, had become members, of whom three became Nobel Laureates, notably Golgi, Cajal, and Sherrington. Led by Waldeyer, a new nomenclature of brain-anatomical terms was set up by the Brain Commission.

International Brain Atlas

In the correspondence between Winkler and Monakow, kept in Amsterdam and Zurich (207 letters), activities of the Brain Commission were often subject of discussion. Winkler wrote to Monakow that subsequent to the planned neurology congress in September 1914 in Bern, he, in his function as member of the Brain Commission, intended to visit laboratories in Copenhagen, Kiel, and Hamburg to judge whether they would be eligible to become interacademic brain institutes. He also hoped to be able to receive Dutch grants for the International Brain Atlas project (Winkler to Von Monakow, July 26, 1914), a project initiated in particular by Waldeyer and Edinger.

More Reading

Holdorff B. Salomon Henschen’s short-lived project of an “Academia Neurologica Internationalis” (1929) for the revival of the International Brain Commission: documents from the Cécile and Oskar Vogt archives. J Hist Neurosci 2011; 20: 93–105.

 

Jagella C, Koehler PJ. The International Brain Commission (1903–1914): Dutch and Swiss Perspective (Toward Neurosciences Beyond Borders). Clinical & Translational Neuroscience 2018;1:1–10.

 

Koehler PJ, Jagella C. The correspondence between Winkler and Monakow during World War I. Eur Neurol. 2015;73:66-70

 

Monakow C von. Zur Frage nach Neugründung der “brainkommission” (internationale Hirnkommission) und einer international organisierten Hirnforschung. Schweiz Arch Neurol Psychiatr 1929; 24: 3–9.

 

Richter J. The brain commission of the international association of academies: the first international society of neurosciences. Brain Res Bull. 2000;52:445-57.

This ambitious project was not successful, however, because of WWI. Moreover, an important disadvantage of such a project became evident. There were too many differences between the Zurich (made by Gennosuke Fuse [1880-1946] and Von Monakow) and Amsterdam contribution (made by Ada Potter [1878-1961] and Winkler). Nevertheless, the Zurich part of the microscopic atlas on the medulla oblongata was published in 1916. With respect to the Amsterdam part, Winkler met with several problems and was looking for help from abroad: “Would it be possible that [Frederick] Mott and [Ludwig] Edinger and Pierre Marie also take care of drawing some of the plates?” (correspondence of Winkler to Monakow, Oct. 16, 1919). Furthermore, he wrote in the 1929 preface, “The war was the cause of financial obstacles, opposing themselves to the printing of the second volume, that had been drawn in Holland. There were so many that the publication of the second volume of the atlas was postponed from year to year. At the moment when the Royal Academy of Sciences was able to give a solution to the financial difficulties, in 1929, the second volume of the atlas was published.”

Collapse and Attempts of Reanimation

The Brain Commission more or less collapsed after the outbreak of WWI, and in January 1919, Winkler wrote to Monakow: “Wouldn’t it be time that you, Ramón y Cajal, and me attempt to bring together the Brain Commission again?” (correspondence of Winkler to Von Monakow, Jan. 10, 1919). The subject lapsed until 1927, when Monakow (then 74 years old) in his correspondence with Winkler (at age 72) expressed his regret that (Frederic) “Mott cannot be moved to install this again.” Furthermore, in 1927, Winkler asked two of his Dutch colleagues in Amsterdam, Cornelius U. Ariëns Kappers, director of the Amsterdam Brain Institute, and Bernard Brouwer, professor of neurology, to use their positions to help resuscitate the Brain Commission (correspondence of Winkler to Von Monakow, April 19, 1927).

Several more letters were exchanged between Monakow and Winkler to discuss resurrection of the Brain Commission. (See Jagella and Koehler, 2018.) The Swedish Henschen (then 82 years old; he had been consulted by Lenin, who had suffered a stroke, six years previously, with Foerster, Nonne, Bumke, and Strümpell), from his side, also made attempts to revive the organization, proposing the name Academia Neurologica Internationalis. (See Holdorff, 2011.) He received endorsements from Mingazzini, Cushing, Minor, Elliott Smith, and Pavlov.

In his correspondence with Cécile Vogt, he proposed to hold a conference in Amsterdam or Utrecht, but later changed to Stockholm. Eventually, neither of the proposals succeeded. In the meantime, a number of younger neurologists were preparing an International Congress of Neurology to be held in Berne, Switzerland (where the 1914 meeting had been cancelled due to the outbreak of WWI) in 1931. (See World Neurology 2018;33:no.1.) The reanimation of the Brain Commission had failed. •

Letter from the editor

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

We would like to welcome all neurologists from around the globe to the May-June 2019 issue of World Neurology, the official newsletter of the World Federation of Neurology (WFN). This issue begins with the report from Profs. John England and Kiran Thakur about the American Academy of Neurology and WFN co-sponsored invited science session on neuroinfectious disease and global health recently held at the AAN Annual Meeting in Philadelphia, Pennsylvania.

Steven L. Lewis, MD

Walter Struhal, MD

In this issue’s President’s Column, WFN President Prof. William Carroll provides a glimpse of the many important activities, and particularly the many important meetings, that will be held at the upcoming XXIV World Congress of Neurology (WCN) in October in Dubai.

Also in this issue, Prof. Nazira Zharkinbekova reports on the recent successful neurosonology teaching course held this past April in Shymkent, Kazakhstan.

Profs. Raad Shakir, Susumu Kusunoki, and Hidehiro Mizusawa report on the Japanese Society of Neurology’s successful annual congress held in late May in Osaka, coming on the heels of the remarkably successful WCN held in 2017 in Kyoto.

We would like to thank you for your interest in this publication for, by, and about neurologists around the globe. We look forward to reports from the many activities surrounding this year’s World Brain Day, which we will publish in an upcoming issue of World Neurology.

Prof. Giancarlo Logroscino reports on activities of the Neuroepidemiology Group of the WFN at the conclusion of his term as chair. WFN thanks Dr. Longroscino immensely for his service to these important scientific and educational endeavors.

In this issue’s History column, Prof. Peter Koehler provides a detailed report of the history of the International Brain Commission, an early neuroscience organization that was in existence in the early part of the 20th century.

Finally, as in many other issues of World Neurology, this issue features reports of young trainees who have participated in WFN sponsored Training Centers (including reports from the WFN training centers in Cairo and Dakar), and the Department Visit programs, including reports from the WFN co-sponsored department visits in Trento, Italy, and Innsbruck, Austria. Unique to the Innsbruck report is that the trainee looks back on his successful department visit and its effect on his career development four years after the life-changing experience.

We would like to thank you for your interest in this publication for, by, and about neurologists around the globe. We look forward to reports from the many activities surrounding this year’s World Brain Day, which we will publish in an upcoming issue of World Neurology. Finally, we look forward to seeing so many of you at the upcoming WCN Oct. 27-31, in Dubai. •

The Success of the JSN 60th Congress

By Raad Shakir, Susumu Kusunoki, and Hidehiro Mizusawa

Neurology typically flourishes in the country that hosts a World Congress. It was most evident during Japan’s annual congress held May 22-25, 2019, in Osaka.  The sense of achievement of holding the largest ever WCN in Kyoto 2017 is clear to see.

There may also be a sense of internationalism and globalization driving the Japanese Society of Neurology in its efforts to showcase what is happening in Japan generally, and in neurology specifically.

The plenary session

The specific issues related to the Japanese aging population coupled with a diminishing workforce are much on the minds of all.  Neurology will play a major role in supporting this rather specific situation. It is clear that neurology needs to expand on the service side as well as in research and development. This will happen with the dedication and perseverance of JSN to show government that neurological diseases are a major cause of disability, especially in an aging population.

This year’s congress is the first in the new imperial era Reiwa, which best translates to “peaceful harmony.” It is clear that the future of neurology is secure and prospering. The congress attracted 7,900 participants, which is another record.  There were sessions in English throughout with 47% of scientific symposia and 43% of oral sessions being in English.

What was noticeable is that not only international speakers, but more importantly, Japanese neurologists and neuroscientists were presenting in English to packed halls. This trend extended to poster sessions, and 40% were in English. This makes international publication of Japanese work easier for all concerned. It was easy for the non-Japanese speakers to have a choice of topics throughout the day.

Prof. Susumu Kusunoki, congress president; Prof. Tatsushi Toda, president of JSN; Prof. Hidehiro Mizusawa, president of WCN 2017; and members of the board have worked hard to produce a rich program with 718 oral presentations and 1,200 posters.

Some of the speakers and the JSN board.

The Japanese scientific output is impressive and increasing, which was reflected in the topics of the congress. Work on neurogenetics, neuroimmunology, and other neuroscience new frontiers was most impressive, and the session halls offered standing room only.  There were 55 international invited speakers enriching the program.

It is most noticeable that East Asian original work was evident, and the support provided to neurologists from China, Korea, Mongolia, and Taiwan, among others, was important to showcase the involvement of the JSN in promoting regional neurology.

Post-WCN Kyoto 2017, neurology in Japan has definitely grown and prospered. Perhaps more importantly, it created a sense of even more internationalist engagement, which will prove to be crucial for the progress of neurology in Japan as well as globally.

The involvement of JSN in the Asian and Oceanian Association of Neurology (AOAN) is longstanding and fundamental. It is important to note the Japanese neurologists are founding members, and their continued support has been cemented by the success of WCN Kyoto 2017. The region certainly needs all of the support both financial and scientific as it has the largest world populations with its clear and enormous needs.  In order for neurology to flourish, the JSN has always played its role in support and participation in all regional and international activities.

The JSN currently has 9,169 members, which makes it one of the larger national societies and this places an obligation on the JSN board to advise, guide, and support neurologists from across the world especially those from low and low middle income countries.  This is certainly advanced by large congresses and provision of grants to young neurologists to attend and present their work. It is in a way the duty of larger societies in more prosperous countries to provide support and guidance to those from not so scientifically and economically advanced.

Although scientific congresses are by and large copies, there is always something unique about the Japanese ones. Multiple simultaneous sessions are a norm, but having them in two languages and seeing the delegates move seamlessly for one language to the other is impressive. The aim of the JSN is to attract more international participation with work not only from the region but from further afield.

Compared to other large annual national society meetings, the JSN congress compares favorably with others having the depth and breadth of science and educational values. It would be important for the JSN to obtain CME accreditation from the international bodies, such as the AMA and the EACCME, for certification. With the program as it stands, there should be no issues at all.

Promotion of all congresses is crucial; this depends on the aim of the organizers. How far should the JSN go in promoting and attracting speakers who will come under their own steam to present their work in Japan? On the other hand, does the JSN need to do this; the answer is simply yes.  The material presented is definitely of high caliber and would easily pass the muster. However, the JSN has to decide if its aim is to promote neurology nationally only or go on to a long-term aim of even more globalization. There is no doubt that serving the national need is made that much easier by creating a vibrant and rich international dimension.

The JSN has been in existence initially combined with psychiatry since 1902, and on its own for 60 years. It has certainly stood the test of time.  Proving its credentials has long happened, and now is the time to move on with ambitious zeal to the next horizon. The stage is set for such a move in order to further neurology in Japan, regionally and globally. •

Raad Shakir is with the Imperial College London UK and is immediate past president of the WFN. Susumu Kusunoki is president of the 60th JSN congress Osaka 2019. Hidehiro Mizusawa was president of the WCN 2017 Kyoto.

WFN Neuroepidemiology Group Update

By Giancarlo Logroscino, MD, PhD

The Neuroepidemiology section of the World Federation of Neurology (WFN) has been particularly active in the area of teaching courses and research around the world, especially in areas where neurological research was at the starting point.

Giancarlo Logroscino, MD, PhD

The involvement of WFN members in the neurological group to the Global Burden of Disease (GBD) project has been an important asset. The GBD neurological group has been led by Valery Feigin from Auckland, New Zealand.

Two papers on the GBD of neurological diseases have been published by Lancet Neurology (Neurological Disorders Collaborator Group. Lancet Neurol. 2017 and 2019).

Lancet Neurology has launched an initiative to publish a special issue on specific neurological disorders. Disease-specific papers have been published on stroke, dementia, Parkinson disease, motor neuron diseases, and epilepsy. The activity of the GBD in the areas of the neurological disorders, even if not officially linked to WFN, have been carried out by active members of the WFN group, including Dr. Feigin, Beghi and myself.

The group has succeeded to get a small pilot grant to develop an epidemiologic course in low income countries. The first country where the WFN neuroepidemiological group decided to implement the course was Cambodia. The course with the endorsement of the WFN was held in February 2017 in Cambodia.

The overall goal was to train neurologists interested in neuroepidemiologic research and support their research activities. The chairs of the course were Giancarlo Logroscino, Italy; Pierre Marie Preux, Limoges, France; and Benoit Marin, Limoges, France.

The course was an intensive five-day course on research methods with focus on practice in low- and medium-income countries.

The course was conceived to help Cambodian neurologists to establish clinical and population-based research programs in topics of utmost interest including epilepsy, stroke, dementia, and infectious disease.

Cambodia is still experiencing a transition characterized by rapid increase both of expectation of life and incidence and prevalence of chronic diseases. In this context, neurology has a major role within medicine but has to change direction rapidly in education, clinical work, and research.

The course was held at the University of Health Sciences of Phnom Penh. It was attended by 14 out of 16 members of the Cambodian Neurological Society (eight neurologists out of nine). There was also attendance by 14 students of the School of Medicine, chosen by the faculty.

Prof. Samleng, chair of neurology in Phnom Penh, expressed the strong wish that the Cambodian Neurological Society could join the WFN, a process still ongoing.

With the same goals, we organized two courses in Albania with the endorsement of the WFN but no WFN financial support. The support was provided by a research and training grant of the University of Bari. Both courses were promoted and organized by Prof. Jera Kruja, from the University of Medicine Tirana and Prof. Giancarlo Logroscino from the University of Bari.

The first course, which was held in June 2017, focused on ALS and motor neuron diseases. The course focused on several aspects of amyotrophic lateral sclerosis: epidemiology, new classification and staging systems, biomarkers and advanced diagnostic technologies, multidisciplinary management of the disease (nutrition, pneumological assessment and supports, end of life approaches), cognition in ALS, and neuropsychological evaluation in subjects with motor impairment.

The role of hospital neurologists outside the academic centers was emphasized. The model for the care of neurodegenerative diseases patients choosing the patient home as the center of care was described. In this model, the role of the general practitioners and specialists working in the territorial unit (district) was emphasized.

Albanian and Montenegrin neurologists illustrated the available resources and the disease approach in their countries.

The second course was held in October 2017 in Albania on dementia for neuropychologists and neurologists with the participation of Thomas Bak, Edinburg, United Kingdom, chair of the aphasia and dementia group, and Prof. Raad Shakir, former WFN president. Prof. Shakir outlined the link of the public health and economic perspective in the dementias and other neurological diseases areas in the future.

The implementation of clinical care models for dementia in countries with limited resources was discussed. The changing epidemiology of dementia in the world with the general aging population has been debated with special focus on countries of the Balcanic area.

These courses were the initial framework for research for rare neurodegenerative diseases in Albania, pursuing the application of a model already established in Puglia region in Southeast Italy. A network of collaborators for the project has been established, including Albania, Kosovo, and Montenegro. An initial collection of data was started in Albania after the course.

Similar courses were held in Serbia (January 2019) and in South America, in Uruguay and Panama (August 2016 and April 2018). Both courses were primarly organized by Dr. Carlos Ketzoian from the University of Montevideo and Walter Rocca from Mayo Clinic.

I hope that the neuroepidemiological group will pursue further actions along these lines established in the next few years. It has been an honor and exceptional experience to serve for an extraordinary organization as the WFN, and the specialty group committee with interactions with recognized leaders in neurology as Prof. Shakir and Prof. Grisold.

In this perspective, Dr. Carlos Ketzoian, the new chair, has the background and the abilities to pursue the expansion of neuroepidemiology as areas of training and research all around the world with a specific emphasis in low- and medium-income countries. I will continue to serve the section with the same enthusiasm under the new leadership. •

Giancarlo Logroscino works in the Center for Neurodegenerative Diseases and the Aging Brain, Department of Basic Medicine, Center for Neuroscience and Sense Organs Department of Clinical Research in Neurology of the University of Bari at Pia Fondazione Card G. Panico Hospital Tricase (Le) University Aldo Moro Bari.

 

Visit to Santa Chiara Hospital in Trento

By Dr. Solomie Ayalew Tegegne

My visit to the Santa Chiara Hospital in Trento was interesting and educational. I stayed in the stroke unit for one week. During this time, I was able to observe and appreciate the organization and coordination needed to take care of stroke patients.

From the moment the patient arrives in the emergency department, it takes a highly trained team of paramedics, nurses, radiologists, neurologists, and physical therapists working together to achieve the best possible outcome for the patient.

I was able to see the effects of IV thrombolysis and endovascular surgery in preventing disability. In my home country of Ethiopia where stroke treatment and neurology as a whole is in its infancy, seeing patients benefit from stroke treatment inspires me to do more to improve the care I give to patients. My stay in the stroke unit also taught me rapid evaluation of patients to determine eligibility for IV thrombolysis.

I was fortunate enough to be able to spend time in the outpatient clinics for general neurology, epilepsy, multiple sclerosis, and movement disorders. I saw cases which we rarely see or diagnose in my country. The last week of my visit, I spent in the outpatient electrophysiology laboratory. This was most informative for me because EEG and NCS/EMG is not readily available for use in our setup.

The number of women neurologists in the hospital impressed me. I was able to make many good friends and learn a lot from these women.

In conclusion, my visit to Santa Chiara hospital benefited me not only in terms of improving my clinical knowledge and experience but gave me added energy and inspiration to improve the care we give to patients. I now understand that teamwork is important in stroke treatment and indeed in the treatment all neurologic diseases. My experience in Trento will help in planning and operating stroke units and other neurologic services in my hospital. •

Dr. Solomie Ayalew Tegegne is assistant professor of neurology at Addis Abeba University Department of Neurology.

Neurosonology in Shymkent, Kazakhstan Meeting Promotes Ultrasonic Techniques and Research

By Nazira Zharkinbekova, MD

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

Participants of the first NSG of the WFN meeting in Kazakhstan.

In April, the South Kazakhstan Medical Academy (Shymkent, Kazakhstan) in cooperation with NSG of the WFN, successfully conducted a five-day transcranial doppler (TCD) workshop. There were 42 participants, mainly neurologists and a few neurosurgeons, surgeons, and neurointensivists from nine cities (Astana, Almaty, Shykment, Aktobe, Karaganda, Ust-Kamenogorsk, Turkestan, Kostanay, and Tara). This course was designed for individuals who are interested in performing and interpreting TCD studies.

The faculty discussed the current status of TCD and some specific clinical applications, including the clinical value of TCD for confirmation of total cerebral blood flow cessation in patient with clinical diagnosis of brain death. Part of the meeting was dedicated to the hands-on practice.

The lectures was delivered by A. Razumovsky, PhD, FAHA, who currently serves as a secretary for NSG of the WFN.

At the closing ceremony when the local course directors (Dr. Zharkinbekova, MD, Dr. Z. Bapayev, MD, first vice rector for strategic development and innovation for South Kazakhstan Medical Academy; K. Kabulov, dean of the faculty of advanced training; and Dr. Alexander Razumovsky, PhD, FAHA, as a representative of NSG of the WFN) delivered the participation certificates, there was much cheer and enthusiasm.

The next NSG WFN accredited course will take place at the WFN XXIV World Congress Oct. 27, 2019, in Dubai, UAE. •

Dr. N. Zharkinbekova, MD, is the head of the department of neurology, psychiatry, and psychology of the South Kazakhstan Medical Academy in Shymkent, Kazakhstan.

Fellowship Experience at Cairo University Neurology Department 2018

WFN Training Center Report

By Wael Alwahchi

I would like thank WFN deeply; it was a good program that I hope will make a difference in my career, and change my future vision regarding neurology and the way of approaching and managing of neurological disorders.

My scientific trip started Jan. 5, 2018, when I arrived to the Kasr Al ainy Hospital. I was so impressed with regard to this old and historical place, which was big and great.

I met Dr. Husam Salah, a nice gentleman who was kind and welcomed me. He helped me to get settled regarding the accommodations.

The first week, I met the head of department and my supervisor, Prof. Mohamed El Tamawy and Prof. Maged Abdel Naseer, respectively, who provided a tour and introduced me to the staff of Kasr Al ainy.

My training program then started. I had rotations training in different subspecialties. My first three months targeted the Stroke Unit, where I was involved in the duties there, and I was also in the ER for one day. I also attended rounds in the ICU at the beginning of the week, and in the intermediate ICU at the end of the week. I was so impressed and satisfied in the discussions and management approach with Prof. Fouad Abdullah.

I saw a lot of cases of acute stroke management with rTPA and participated in post-stoke care. I was also in a variety of emergency neurological cases, such as myasthenic crisis, AIDP, SAH, coma, and stroke in the young.

I also had the opportunity to learn neurosonology, including carotid Doppler and transcranial Doppler, which were really interesting. Through this, I had the opportunity to understand vascular neurology more easily.

By the end, I was practicing how to assess a stroke patient using the NIHSS and recognized the indications for rTPA.

I then turned to the next subspecialty, which was epilepsy, where I spent about three months. I attended regularly epilepsy outpatient clinics, examined a huge number of patients and discussed the management plan and approach. I observed long-term EEG monitoring; at the beginning, it took time to understand the principles, but by the end, I found myself easily understanding EEG reporting and semiology of epilepsy. I also felt more confident dealing with pediatric epilepsy. I was involved in a variety of different cases of focal and generalized epilepsies, including Lennox Gastaut and JME. I then shifted to the multiple sclerosis unit for two months. I attended daily and learned how to treat acute exacerbations and how to manage symptomatic complaints and how to differentiate between multiple sclerosis and NMO. After finishing my MS rotation, I transferred to the neurophysiology department where I stayed for 55 days. I saw different neurological cases and observed nerve conduction studies and electromyography; during my first four weeks, I was an observer only, and then in the last two weeks, I was hands-on and participated in evaluating cases of carpal tunnel syndrome and repetitive nerve stimulation for myasthenia gravis.After finishing my rotation in neurophysiology, I rotated through movement disorders, dementia clinic, and general neurology.

I had an opportunity to attend most of continuing medical education programs, which were presented by different professors and lecturers, as well as the summer course, epilepsy school, multiple sclerosis conferences, and stroke and headache conferences.

In summary, it was a successful year! It was a nice experience, not easy, but I would like to thank all staff for helping me to finish my fellowship with success. The only concern is the delay of some official papers, which I hope will be resolved with the arrival of the next candidate. I will be so happy to help in sharing my experience for the next candidate.In the future, I hope to improve my hospital and construct a stroke unit, and raise our team of providers to the international levels.

Finally, in addition to my professors in Cairo, I would like to thank Mrs. Jade Roberts, Prof. Riadh Gouider, and Prof. William Carroll for their support. •

4-Year Followup Report of Department Visit

WFN and Austrian Neurological Society: Department Visit Program

By Dr. Kalpesh Deraji Jivan

In 2015, I was one of the inaugural recipients of the Austrian Neurology Department Observership Program facilitated by the World Federation of Neurology (WFN) and the Austrian Neurological Society.

Left to right: Prof. Wolfgang Grisold, Dr. Dera Jivan, and Prof. Erich Schmutzhard.

I spent one month in the neurology intensive care unit at Innsbruck Medical University under the supervision of Dr. Bettina Pfausler and Prof. Erich Schmutzhard. During that month, I also met with Prof. Wolfgang Grisold in Vienna.

Recently, I attended the Neurological Association of South Africa (NASA) 2019 Congress held in East London in the Eastern Cape province of South Africa from Feb. 26-March 1, 2019. This was a joint congress held with the African Academy of Neurology (AFAN) Second Congress. Profs. Schmutzhard and Grisold were present at the meeting representing the WFN and European Academy of Neurology (EAN) education committees. They were both invited speakers at the meeting. It was an absolute delight to once again meet them. They were interested to know how the observership assisted me and urged me to write a brief follow-up report.

Four years have passed, and I am still a consultant in the neurology department at the University of the Witwatersrand. The staff of this department services four academic hospitals in Johannesburg. Four years on, and public health care in South Africa is still severely underresourced.

There have been times when basic equipment is not available; equipment such as lumbar puncture manometry sets. In fact, for a few weeks earlier this year, our hospital had no intravenous anti-epileptics. Four years on, and there are still no specialised neuro-ICUs in South Africa. Critical care for patients with acute neurological illnesses still remains in the domain of our pulmonologists and anaesthetist. Does this mean my observership was a waste of time?

Certainly not! While in Insbruck, Prof. Schmutzhard recommended that I look at their acute stroke ward. The ever-helpful Dr. Pfausler obliged and introduced me to the acute stroke unit. I was shown their approach to the management of acute strokes; their unit boasting a world-class door to needle time. I have since implemented some of these strategies at our neurology unit. Although we do not have a formal acute stroke ward, we have certainly thrombolyzed more patients in the past four years and have reduced our door-to-needle time.

The point is that nothing goes in vain. I have bettered my neurological career. Were it not for the generosity of the Austrian Neurological Society, I would not be the neurologist I am today. I would definitely advise all young neurologists in low-income countries to apply for these department visits to empower themselves, their departments, and enhance the care for their patients. •

WFN Training Center, Dakar, Senegal

WFN Training Center Report

By Aboubacar Nahantchi Abdourahaman

Thanks to the World Federation of Neurology’s support, I participated in the University Diploma of Epileptology, organized by the Cheikh Anta Diop University in Dakar-Senegal.

The training took place in the only neurology department in Senegal. I.P Ndiaye Neurosciences Clinic is composed of a hospitalization block, a neuroradiology section, a section of physical medicine and rehabilitation, a neuroreanimation unit, and a neurophysiological exploration unit (EEG, ENMG,EP).

The neurophysiology unit includes two EEG recording rooms with three EEG machines and a replay room with four machines for interpreting EEG plots and an ENMG and EP room. During the training, we received advanced theoretical lessons, and we were involved in the preparation of the different themes developed. The theoretical teaching took place in three seminars (fundamentals on epilepsy, diagnosis of epilepsies, and management of epilepsies).

Each seminar is composed of about 20 topics. For my part, the themes that focused on newborn, infant, and child epilepsy were instructive in my experience as an attending physician in pediatric neurology. Clinically, I attended epileptology and neuropediatric consultations.

Thanks to these, I have gained practical experience both in establishing a diagnosis and in the management of epilepsy. On a neurophysiological level, I attended over a period of six continuous months the learning of the techniques of acquisitions of the EEG traces and interpretation of the EEG traces. Practical learning has been interactive and didactic. Indeed, I had the opportunity and the privilege to be framed on the interpretation of EEG routes by expert teachers in the field. Thanks to these quality frameworks, I have acquired a practical competence on the interpretation of the EEG traces.

Dear committee, your support has been invaluable. Thanks to this training, you have allowed my country, Niger, to have a qualified human resource in epileptology. This training allowed me to considerably improve the management of epileptic patients (especially newborns, infants, and children). By my voice and on behalf of all the people of Niger, I will be eternally grateful to you. •

Spanish Society of Epilepsy in Málaga, Spain

By Pâmela Ayala

Thanks to the World Federation of Neurology, I had the opportunity to attend the fifth Congress of the Spanish Society of Epilepsy in Málaga, Spain.

Throughout the conference, I exchanged ideas and established contacts with great professionals in the field of epilepsy. During the lectures and discussions, news advancements in epilepsy were presented, and I became familiar with some medications that are not yet available in Latin America.

I also had the opportunity to present my work as ​a poster and oral presentation. My work was entitled “ENCEFALOPATÍA EPILÉPTICA SENSIBLE A URIDINA ASOCIADA AL GEN CAD,” or Epileptic Encephalopathy Sensitive to Uridine Associated with CAD Gene.”

Epilepsy is one of my passions, and day after day I try to perfect my technical scientific skills. I just have to thank the WFN for promoting my growth. •

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