BY PROF. CHANDRASHEKHAR MESHRAM, NAGPUR, INDIA, AND PROF. RAAD SHAKIR, LONDON.

The second International Tropical and Geographical Neurology Conference (INTROPICON) was held in conjunction with the 28th Brazilian Congress of Neurology and the 15th Pan American Congress of Neurology Oct. 11-14, 2018, in Sao Paulo, Brazil. The congress was huge and was attended by more than 3,800 delegates from all over Latin America and across the world.

The Tropical and Geographical Neurology Applied Research Group of the World Federation of Neurology (WFN) is the oldest group, established in 1961, and has had many meetings over the years. This congress was decided following the reconstruction of the research group in Mumbai during INTROPICON in 2017. The chair of the research group is Dr. Chandrashekhar Meshram from Nagpur, India. This second congress was co-chaired by Dr. Meshram and the late Prof. Amilton Barreira, Sao Paulo, Brazil. It is with great sadness that the whole world of neurology, and in particular tropical and Latin American neurology, will sorely miss Prof. Barreira. His contributions were immense.

INTROPICON 2018 covered the field with fascinating presentations on a variety of topics. The congress featured an in-depth look at cysticercosis, amebic encephalomyelitis, cerebral malaria, Chagas disease, schistosomiasis, toxoplasmosis, trypanosomiasis, cerebral venous thrombosis in India, paracoccidioidomycosis, arboviruses, Zika virus status, congenital Zika virus, chikungunya, dengue status in Latin America and Asia, yellow fever, and vaccinations for arboviruses. Videos of live cysticerci floating in the third and lateral ventricles seen on endoscopy were mesmerizing.

INTROPICON 2018 also discussed the status of meningitis across the world. The current human T-lymphotropic virus type 1 (HTLV1) status and HIV were presented and discussed. Poliomyelitis and post-polio syndrome are still ongoing problems, which was addressed. Cytomegalovirus infection and Ebola were issues affecting individuals, and their current statuses were presented. Fungal disease received its share of discussion and time. Snakebites still kill thousands in many countries. Their management remains challenging and, at times, difficult.

Amilton Barreira

In addition, major issues such as stroke, dementia, epilepsy, and Parkinson’s disease were discussed. Their unique management and long-term care in resource-poor settings were the main points of discussion. The availability of simple drugs for epilepsy and Parkinson’s disease was a major hindrance to neurological care. The lack of manpower and funding remains a major obstacle to neurological service provision. It is astounding that drugs as cheap as simple anticonvulsants, levodopa, and warfarin, among others, are still not available to billions of individuals living in low- and middle-income countries.

There remains a huge discrepancy in the provision of care in various parts of the tropics. In all, neurological expertise is concentrated in major cities, and in some of those, advanced imaging, genetic testing, and management (including interventional procedures) is available. However, this is by and large in fee-paying settings, which is not accessible to the majority of those who need the service.

Neurology training for young doctors is a priority, and it is heartening to see the increasing numbers of budding training programs across the world. There is nothing like training locally to master the vast number of conditions discussed, but just as important is exposure to training in more advanced settings. The Tropical and Geographical Neurology Applied Research Group of the WFN is working hard toward these goals. The meeting of this research group is biennial, and the next meeting is planned to be with the African Academy of Neurology in 2021. •

BY DERYA ULUDUZ

The Turkish Stroke Patient Society (BEYINDER), a member of the Stroke Alliance for Europe (SAFE), organized the first symposium for stroke survivors and their caregivers in Turkey on World Stroke Day 2018, acknowledging the importance of acute management in stroke, long-term commitment, and attention to the needs and rights of stroke patients for better outcomes. The full day symposium was titled “İnme Hasta ve Hasta Yakınları Sempozyumu,” which is Turkish for the “Symposium of the Stroke Survivors and Their Caregivers.”

BEYINDER was founded in 2017 and became a member of SAFE shortly after. We have strong collaborations with SAFE to raise awareness with respect to strokes. Every year, 15 million people suffer strokes worldwide, and it is the leading cause of disability. BEYINDER also publishes a stroke magazine for patients every three months.

The symposium, organized at the Altunizade Event Center in Istanbul, was attended by stroke survivors and their caregivers with the participation of health directors and heads of emergency services. The most important target of this event was the public; we created simple messages to promote via social media, newspapers, and press. The event relevance and the topics of the sessions (importance of primary prevention, emergency management interventions, and life after stroke for better outcome) were appraised by the TV channels, social media, news agencies, and newspapers. They focused on our activity on their main bulletins.

The main aim of this symposium was to provide close collaborations between stroke survivors, stroke neurologists, and policymakers to solve the main problems. In one of the sessions, we gave the microphone to the patients and discussed the problems they experienced and the needs of those patients. The second important target for this event was policymakers and the Ministry of Health. BEYINDER is now working to prepare a report about the conclusion of the symposium and the tribulations of those patients, and will contact the Ministry of Health to discuss and facilitate the solutions.

by Prof. Mustapha El Alaoui Faris, Chair of the WFN Migrant Neurology Applied Research Group in Marrakech, Morocco

The meeting of the World Federation of Neurology (WFN) Migrant Neurology Applied Research Group took place Dec. 14, 2018, in Marrakech, Morocco, during the 12th Maghreb Congress of Neurology. This meeting coincided with the meeting of the Intergovernmental Conference on the Global Compact for Migration, a United Nations meeting held Dec. 10-11, 2018, in Marrakech. The charter of the global alliance was adopted by the U.N. General Assembly on Dec. 19, 2018, and this constitutes real progress for the cause of migrant people.

The topics covered in this meeting included: “Migration and Global Health” (Mustapha El Alaoui Faris, Rabat, Morocco), “Neurology and Migration: What We Know, What We Learn by Neurosciences, What We Can Do” (Antonio Federico, Italy), “Vascular Risk Factors in Migrants” (Serefnur Ozturk, Turkey), “Neuroinfections in Migrants” (Erich Schmutzhard, Austria), “Multiple Sclerosis in Migrants” (Riadh Gouider, Tunisia), “Somatization in Migrants” (Maria Benabdeljlil, Morocco), and “Neuro-oncology and Palliative Care in Migrants” (Wolfgang Grisold, Austria). The following is a short summary of the communications.

Most human migration is in search of better opportunities, reflecting the desire for an improved quality of life. The current international migration is a reflection of the world, resulting from the dynamics generated by changes in political, economic, and cultural structures. It reflects the advent of an interdependent world, stimulating new cultural and economic exchanges, and contributing to the social reconfiguration of host and departure societies. Since the beginning of the 21st century, migration has changed. In the past, people migrated to survive; now they migrate to realize themselves. It is the educated middle classes with high human capital and skills who most migrate. Migration can also have political causes such as civil wars in some parts of the world, including the Middle East or sub-Saharan Africa. In the near future, two particular reasons will have a dramatic role in the migration of people around the world. First, climate change, which could create enormous refugee flows. The second is the world demographic imbalance between the number of people living in low- and middle-income countries and those living in high-income countries that are aging and have low fertility.

Studies on the health of migrants show that migrants have more health problems than the hosting populations. They are more vulnerable to communicable diseases but also to some noncommunicable diseases, such as hypertension, diabetes mellitus, or obesity. The majority of migrants are initially healthier than non-migrant populations, the so-called “healthy immigrant effect.”

The health vulnerability of migrants may be due to several factors, such as difficulties in early childhood (e.g., poverty and malnutrition), poor living conditions in the host country, and dangerous work and psychological problems related to the migration process. The prevalence of neurological diseases among migrants remains largely unknown. But, given the high prevalence of neurological diseases in low- and middle-income countries, where the majority of migrants are originating, a high frequency of diseases of the nervous system should be expected among migrants.

However, the incidence, prevalence, and clinical presentation of neurological diseases may differ in migrant people depending on the epidemiology, geography, and genetic background of the native country. Adult migrants who may have experienced early childhood deprivation are particularly vulnerable to subsequent disorders of the nervous system.

Here are the particularities of some neurological diseases in migrant people. Migrants have more infectious diseases. Tuberculosis, which can cause severe neurological complications, has seen a re-emergence among migrant people living in socioeconomically disadvantaged conditions in host countries. The prevalence of human immunodeficiency virus (HIV) is high in African migrants and may be resistant to HIV drugs, and these patients have more severe cognitive disorders. Some tropical infectious diseases (such as malaria or neurocysticercosis) may occur in host countries either in migrants or in tourists who have been living in areas of high prevalence of these diseases.

Stroke is a major public health problem among migrants given the high prevalence of vascular risk factors such as hypertension, diabetes mellitus, obesity, and smoking. Migrants can have severe strokes at a younger age with high mortality rates and persistent neurological disability for a long time. In some host countries, migrants with cerebrovascular diseases appear to be less likely to benefit from appropriate treatment such as thrombolysis or thrombectomy.

Studies on the epidemiology of multiple sclerosis (MS) have shown that migration at the beginning of life from a low-risk area to a high-risk area can increase the risk of MS in this migrant population. Likewise, MS in some migrants is much more severe than in the native population (such in North Africans living in France).

Somatization and functional neurological disorders are common among migrant people, and their clinical presentation depends on the native culture of the migrants.

The severity of some neurological diseases that reduce the life expectancy of patients, such as neuro-oncological disorders, raises the problem of palliative care of migrant people. Palliative, hospice, and end-of-life care can be incompatible with culture and religious beliefs of some migrants and requires an appropriate approach.

The WFN Migrant Neurology Applied Research Group plans more meetings dedicated to other neurological diseases in migrant people, such as cognitive disorders in elderly migrants, epilepsy, neurogenetics, migraines and headaches, neuromuscular diseases, movement disorders, anxiety, and depression. •