Articles – Page 37

World Brain Day in Turkey

By Prof. Serefnur Ozturk

The Turkish Neurological Society has been celebrating World Brain Day since 2014. Every year, we follow WFN guidelines and create public awareness by organizing meetings, public service announcements, and newsletters. This year, we partnered with İstanbul, Besiktas municipality, and organized a meeting about this year’s theme “Migraine: The Painful Truth.”

The meeting took place on July 22, World Brain Day, and was open to public attendance. Migraine is a common disorder in our population (reported as one of five women and one of 10 men). Banners were distributed throughout İstanbul promoting the meeting along with powerful support by social media and the national press.

We appreciate the WFN for supporting societies with toolboxes and webinars every year. We also encouraged our members to organize World Brain Day events, and this year, many meetings were held across Turkey. Furthermore, we collaborated with the International Headache Society to increase awareness for migraine.

Prof. Serefnur Ozturk is president of the Turkish Neurological Society.

Memoirs of Austria: Echos of Kindness

By Osigwe P. Agabi, MBBS (BENIN), MWACP, FMCP

Undertaking my residency training in neurology in Nigeria had its advantages. I got to learn and practice in a culture where my expertise would be deployed, and the diversity and sheer number of neurological cases and conditions enabled me to hone my clinical skills. The training also afforded me the privilege of providing answers (and some succor, I hope) to patients whose conditions had been undiagnosed or misdiagnosed, cursorily attributed to “spiritual” forces in the absence of a logical alternative explanation. This was enabled by the increase in availability of some technologies, including brain imaging and support laboratory diagnostics for those who could afford them.

Despite these, however, one gaping void was the absence of expertise and technology for electromyography and nerve conduction study (EMG/NCS) testing. Four decades prior was the last time my training center had functioning EMG/NCS, and the combination of competing financial commitments and lack of expertise ensured this was not revived.

That was until early 2018, when a good natured alumnus donated EMG equipment and conducted a preliminary workshop that whet my appetite. About the same time, serendipity brought my mentors together at the EAN regional teaching course in Ouagadougou, and discussions ensued that culminated in the opportunity to begin my formal training in EMG/NCS in Austria.

As I sat down on the Lufthansa flight bound to Vienna from Lagos, Nigeria, my thoughts wandered. What would Austria be like? What will this experience be? Will I achieve my objectives? Will the weather be kind? Will I have problems communicating, as I speak no German?

I reached for my phone and looked down at the pictures of Profs. Walter Struhal and Wolfgang Grisold I had downloaded before the journey. It was this duo of renowned neurologists who had graciously agreed to offer themselves to train me in nerve conduction studies and electromyography at no cost that informed this journey. I thought about my family and the neurology unit back at the Lagos University Teaching Hospital in Nigeria. I thought most especially about my teacher, mentor, and boss, Prof. Njideka Okubadejo who had given her all to the actualization of this dream and how lucky I was to have her. I was still in this train of thought when I was jolted into consciousness by the air hostess who was waiting to take my order of refreshment.

I arrived in Vienna and headed straight for the University Hospital in Tullin where Prof. Struhal is head of neurology. Prof. Struhal is a kind gentleman with a calm disposition. I was taken to my apartment that contained most of what I was going to require for the period of my stay.

The next day, I was formally introduced to the neurology department and completed some administrative formalities. Every morning, there was a presentation of all patients, new and old, by the consultants with their relevant investigations and neuroimaging. I looked forward to this exercise every morning not only for its robust intellectual nature but also for the demonstration of genuine patient empathy. I was received warmly by all. I observed the team spirit, astute dedication to duties of all, both young and old.

The synergy between doctors, nurses, and other support staff was exemplary. I worked closely with Drs. Andreas Seiser and Brigit Riemer who were the neurologists in charge of neurophysiology. They walked me through the rudiments of NCS and EMG. They loved to teach and made the process seamless. I cannot forget the patients who offered themselves freely to this exercise so I could learn. I was glad to observe sessions of transcranial magnetic stimulation, fiber-optic endoscopic evaluation of swallowing, and some autonomic nerve testing, among others.

Twice every week, I commuted by train to Vienna to catch up with Prof. Grisold in his private practice. In his office, he laid bare nerve conduction and electromyography. He taught with uncommon dedication and passion, making sure I had an untainted understanding of the concepts. He taught me many secrets that only years of practice could bring. He had sessions with me as the patient. It is a great privilege to have been tutored by him. I will forever remain grateful.

Prof. Grisold wanted me to broaden my horizons on my many spheres of neurology. He reached out to many of his colleagues, including Dr. Stefan Meng, a radiologist with expertise in nerve and muscle ultrasonograpy. Dr. Meng was warm and highly knowledgeable, yet humble. He had some teaching sessions with me at the KFJ hospital in Vienna. Before this experience, nerve and muscle ultrasonography was a distant reality for me.

I also had the rare privilege of visiting Prof. Michaela Auer-Grumbach, a renowned neurogeneticist who added the icing on the cake for me. Before long, my 32-day visit had come to an end.

I am overwhelmed by the unconditional kindness, efforts, and support of Profs. Struhal and Grisold for bringing this dream to reality. This experience has awakened in me a restlessness to develop that which I have acquired and to impart to others after me. Yes, St. Augustine was right when he opined that “the world is a book, and those who do not travel read only one page.”

Osigwe P. Agabi, MBBS (BENIN), MWACP, FMCP, is a consultant physician and neurologist in the neurology unit of Lagos University Teaching Hospital in Nigeria.

Statement for Elected Trustee

It has been a tremendous privilege serving as elected trustee of the World Federation of Neurology (WFN). In my current roles as WFN trustee, chair of the WFN Education Committee, and editor of World Neurology, I am indebted to this organization and the opportunities it has provided me to help achieve its mission to foster quality neurology and brain health worldwide via the promotion of global neurologic education and training.

Steven L. Lewis, MD

My initial involvement with the WFN occurred coincident with my appointment by the American Academy of Neurology (AAN) as editor-in-chief of Continuum. This joint program of the WFN and the AAN (and its publisher Wolters Kluwer) provides print and online access to Continuum to user groups from more than 40 neurological societies from low- and lower-middle income countries. I have appreciated being involved as our two organizations work closely together to provide this resource for participants who would otherwise be unable to obtain it, including recent and ongoing collaborative efforts to improve and enhance this important global educational program.

As WFN trustee and as chair of the WFN Education Committee for the last six years, I have become integrated into the critical workings of this organization in education, training, and practice of neurology around the globe. I have learned so much from our talented staff, my esteemed colleagues on the many WFN committees and related organizations, and all of the co-trustees up to the president(s) whom I have been so privileged to work with. Their knowledge and expertise have been invaluable in my continued personal development and improving my effectiveness to our organization. In my additional role as World Neurology editor, I have had the privilege to help report on news about neurology and neurologists worldwide, a role that I cherish continuing as well as honing.

In my roles and experiences with the WFN, I have continued to meet so many remarkably talented neurologists worldwide. I continue to be impressed by the similarities among us all, despite differences in resources and access to care within and between regions. If re-elected as trustee, I look forward to continuing to help the WFN achieve its mission via continued partnership with national, regional, and international neurologic societies and disease-based organizations, and the WHO; optimizing our current regional teaching centers for neurologic training—now four African training centers and one in the Americas, with plans for other region(s) as well; growing our department visit programs, which have recently included wonderful partnerships with many European countries for African trainees, and one in the Americas for South American trainees; increasing awareness of travel and research grants for young neurologists from low- and lower-middle income countries; and continuing to react quickly to novel regional or global neurological issues or threats as they arise.

I would be honored to be re-elected as WFN trustee, and if so, I pledge to continue to faithfully serve our delegates and member neurologists for the mutual goal of improved neurological access and the highest quality of neurology and neurological health worldwide.

Critical Minds on the Brain in the 17th Century

By Peter J. Koehler

A number of medical students of human and animal bodies in the 17^th century demonstrated a critical attitude toward the knowledge that was taught in books and by their teachers. Although inspired by the new mechanistic or iatrophysical physiology of René Descartes (1596-1650), they not only questioned the anatomical and physiological views of previous generations of anatomists and physicians (including Thomas Willis), but also Descartes’ own ideas. In this essay, I will discuss two of these critical young men.

Steno (by Justus Sustermans; public domain).

Danish Student Discovering a Duct

One was born and raised in Copenhagen, Denmark, where one of his teachers, the physician Thomas Bartholin (1616-1680) advised him to go to Holland, in particular Amsterdam. Armed with a letter of recommendation from Bartholin, the young man was welcomed by Gerard Blaes (Blasius, 1627-1682) who gave him lodging, a frequent custom at the time, and taught him anatomy.

Title page of Descartes’ De Homine (1662).

The relationship was soon disturbed, when the young man discovered a new anatomical structure in the head of a sheep, notably the duct of the parotid salivary gland that became eponymously related with his name: Niels Stensen (Steno, 1638-1686). His teacher Blaes, at several occasions, tried to turn the discovery to his own advantage. A few months later, Stensen continued his studies at Leiden University, where he was taught by Johannes van Horne (1621-1670) and Frans deleBoë (Sylvius, 1614-1672); his name is remembered in the term Sylvian fissure, both considered modern professors, stimulating practical research, in contrast to the men of learning, who kept to the old philosophy of Aristoteles.

Although the new philosophy of Descartes, who had stayed in the Netherlands for a large part of his career, had inspired him as well as many other scholars, and his world view incited study of the individual phenomena, Stensen found that many of his ideas were speculative. Mathematician/physicist and astronomer Christiaan Huygens (1629-1695), for instance, found that mechanical laws, upon which Descartes founded his physics, were not correct. Descartes obviously had put into perspective the significance of observation as the senses were fallible, but this seemed to be truth also for the power of reason.

The criticism increased by the posthumous publication of Descartes’ book on the functions of the human body, Tractatus de Homine (1662). Descartes had written the discourse already in 1632, but did not publish it, fearing the inquisition (as Galilei had experienced in Italy, 1632). Descartes had written his discourse to show that the function of the human body could be comprehended in mechanistic terms, controlled by the brain by means of the nervous system.

Swammerdam’s nerve-muscle preparation from the posthumously published Bybel der natuure of historie der insecten [Bible of nature or history of insects] (1737).

Dutch Student Making a Nerve-Muscle Preparation

This inspired Stensen. He decided to study the structure and physiology of the brain. He soon found that the old idea of spirits conducted by nerves to control the muscles, an old Galenic concept, was difficult to prove. Around the same time, another Leiden medical student worked on the same problem. Son of an Amsterdam pharmacist, he started his medical studies in Leiden in 1661, doing research on respiration with Frans deleBoë. The old view was still that the function of the lungs was to cool the blood. According to Galen, the heart had an innate warmth, with which organisms were born and which was the source of body warmth. DeleBoë changed the view based on his iatrochemical ideas, effervescence by the combination of acid and alkaline substances. Working on respiration, the student also had to study (frog) muscles and found that touching the nerve, even of a frog leg disconnected from the body, produced muscle contractions.

As there is no existing portrait of Swammerdam, the title page of his Historia Insectorum Generalis ofte Algemeene Verhandeling van de Bloedeloose Dierkens [General treatise of the bloodless animals] (1669) is shown here.

Like Stensen, he realized this was not in accordance with the idea of spirits being conducted by (hollow) nerves to the muscles. He observed similar phenomena while studying the diaphragm of living dogs. How could this be explained by material sent to the muscle from the brain so fast? Therefore, he devised an ingenious experiment with a muscle-nerve preparation in a glass tube, by which he was able to prove that no material was blown into the muscle upon contraction at all. His experiment stirred amazement, and several colleagues, including Stensen, visited his Leiden room, where he, Jan Swammerdam (1637-1680), as some of you may now have realized, demonstrated this and other experiments. Stensen told Bartholin about what he had seen in springtime of 1663.

Thomas Willis’ Cerebri Anatome (1664).

Clearly, Swammerdam and Stensen had a kindred spirit, both believing in their own critical insights to come to new knowledge, not merely accepting the ideas of previous generations. In this way, Stensen, experimenting with animals, found that the heart was a muscle and not an organ that produced heat.

Criticizing Willis and Descartes

Another subject Stensen wished to study was the anatomy and function of the brain. He experienced it was difficult to deduct its function from the anatomy. He reacted critically, when Thomas Willis’ (1621-1675) Cerebri Anatome was published (1664). Although it contained accurate anatomical plates (by Christopher Wren), and Willis described the well-known arterial circle (now known by the name circle of Willis) at the base of the brain, suggesting its function (“The joynings together of the Carotides, in most living Creatures, are made about the Basis of the Skull under the Dura Mater…”), Stensen was particular critical about his speculative discussion of the function of the brain.

Steno’s Discours sur l’anatomie du cerveau (published 350 years ago in 1669).

Both Descartes and Willis still adhered to the concept of spiritus animalis, being conducted by the ventricles and nerves, the first explaining it in a mechanical way (iatrophysical physiology), the second by chemical (iatrochemical physiology). He believed the little progress that had been made with respect to the knowledge of brain function was due to the fact that most physicians used the ancient doctrines as points of departure, rather than critically describing what was observed, although he realized that the methods available to study the brain were insufficient due to its soft structure.

These and other comments, Stensen presented in a lecture on the anatomy of the brain in Paris (1665, then 27 years old and already well-known), at wealthy amateur scientist and patron of many scientists Melchisédech Thévenot’s (1620-1692) group. It was published only in 1669 (350 years ago) with the title Discours sur l’anatomie du cerveau (à Messieurs de l’Assemblée de chez Monsieur Thevenot). He started the lecture in an unusual way: “Au lieu de vous promettre de contenter votre curiosité, touchant l’Anatomie du Cerveau; ie vous fais icy une confession sincere & publique, que ie n’y connois rien » [Instead of promising you to satisfy your curiosity, with respect to the brain; I here have to confess sincerely and in public that I do not know anything about it].

From Steno’s Discours (1669).

He ended the lecture by presenting suggestions how to continue research. The brain should be described accurately paying attention to all its aspects, including anatomy, embryology, comparative anatomy, function, etc. “Dans les animaux vivans, il y a a considerer toutes les choses que peuvent causer quelque alteration aux actions du cerveau, soit qu’elles viennent du dehors, comme les liqueurs, les blessures, les medicamens ; soit que les causes soient internes, commes les maladies, dont la medecine compte un grand nombre » [In living animals, one may consider all things that may cause any change to the actions of the brain, whether they may come from outside, as fluids, injuries, medicines; or be it internal causes, as diseases of which medicine counts a large number].

The publication was commented upon in the Transactions of the Royal Society (September 20, 1669) in which we find a three-page summary, containing the sentence “Next, he entertains the reader with an enumeration of the chief errors of anatomists touching the brain. And here he examins particularly the Systemes of dr. Willis and Monsieur Des Cartes.”

Stensen as well as Swammerdam were both sponsored by Thévenot, and the three worked together in 1665. Stensen moved to Florence in 1666, where he stayed with the Grand Duke of Tuscany, Ferdinando II) and his brother (Leopoldo de Medici), both interested in science, founding the Accademia del Cimento [Academy of Experiments] in 1657. Here, he published his Elementorum myologiae specimen, including detailed descriptions of the structure and contraction of muscles (1667). The work, however, was severely criticized by Mayow, Borelli, Bernoulli, and Boerhaave.

Section from the review of Steno’s Discours in Transactions of the Royal Society (September 20, 1669).

Interestingly, both Stensen and Swammerdam never practiced medicine. They made a religious turn in their lives. Although born in an orthodox Lutheran family, Stensen converted to Catholicism in 1667. Later, he became a priest and bishop in northern Germany. He died in Schwerin in 1686 (age 48). Swammerdam became depressive, possibly related to a long-lasting conflict with his father on providing means of sustaining life, but also by doubts about his future and a possible marriage. He became a member of the religious community of mystic Antoinette Bourignon (1616-1680). The last years of his life, he studied insects often using small microscopes that he made himself. He died in 1680 (age 43). His first biographer (Leiden professor Herman Boerhaave) published his Bybel der natuure of historie der insecten [Bible of nature or history of insects] in 1737, in which we find the experiments described above.

Literature

Kardel T. Steno. Life – Science – Philosophy. Acta Historica Scientiarum Naturalium et Medicinalium. 1994;42:1-159.

Kooijmans L. Gevaarlijke kennis. Inzicht en angst in de dagen van Jan Swammerdam. [Dangerous knowledge. Insight and fear in the days of Jan Swammerdam] Houten, Bohn, Stafleu Van Loghum, 2007

Stensen N. Discours sur l’anatomie du cerveau à Messieurs de l’Assemblée de chez Monsieur Thevenot. Paris, Robert de Ninville, 1669.

Swammerdam J. Bybel der natuure of historie der insecten [Bible of nature or history of insects]. Leiden, Severinus et al., 1736

WFN, AAN Present Invited Science Session on Infectious Disease

By John England, MD, FAAN, and Kiran Thakur

The American Academy of Neurology (AAN) held its 71st annual meeting in May in Philadelphia. During the meeting, the World Federation of Neurology (WFN) and the AAN co-sponsored a unique session on infectious disease and global health.

Left to right: John England, MD, FAAN, Kiran Thakur, MD, and Nischay Mishra, PHD. Photo courtesy of the American Academy of Neurology

The session was co-directed by John England, MD, FAAN, Richard M. Paddison professor of neurology and chair of the Department of Neurology at the Louisiana State University School of Medicine, and editor-in-chief of the Journal of the Neurological Sciences, and Kiran Thakur, the Winifred M. Pitkin assistant professor of neurology and neuroinfectious disease expert at Columbia University Irving Medical Center.

The session highlighted the joint efforts and partnership of the WFN and AAN to combat neurological diseases globally, and highlighted the work of world-renowned scientists on hot topics in infectious disease and global health. The session included presentations on the current acute encephalitis outbreaks (AES) in India, the acute flaccid myelitis (AFM) outbreaks in the United States and other global regions, the central nervous system (CNS) reservoir in HIV infection, and the newly recognized spectrum of post-infectious cases of autoimmune encephalitis.

The session’s first lecture was given by Prof. Manoj Murhekar, lead scientist and director of the National Institute of Epidemiology in Chennai, India, who spoke on acute encephalitis syndrome in Eastern Uttar Pradesh, India. His talk was followed by Dr. Nischay Mishra, a molecular biologist with expertise in advanced diagnostics and bioinformatics at the Center for Infection and Immunity at the Columbia University Irving Medical Center. He discussed molecular and serological discovery in CNS infectious diseases, highlighting his work identifying etiologies in AES outbreaks in India. Dr. Kevin Messacar and Dr. Kenneth Tyler (both at the University of Colorado School of Medicine), two major leaders of AFM investigations and members of the Center for Disease Control and Prevention (CDC) AFM taskforce, discussed features of enterovirus-associated AFM.

Audience at the invited science session. Photo courtesy of the American Academy of Neurology

Their presentations discussed human clinical features as well as an experimental mouse model, which was developed in Dr. Tyler’s laboratory. Dr. Serena Spudich, professor of neurology and division chief of infections and global neurology at Yale University School of Medicine, spoke on “Tapping into CNS reservoirs: single cell RNA sequencing of CSF in HIV.” She provided data on her recent studies using single-cell RNA sequencing, which identified a rare subset of myeloid cells that present a gene expression signature that significantly overlaps with neurodegenerative disease-associated microglia.

Prof. Josep Dalmau, director of the laboratory for the study of the pathogenesis of immune-mediated neuronal disorders at the University of Barcelona, Spain, and world authority on paraneoplastic disorders affecting the nervous system concluded the session with a lecture on viral triggers of autoimmune encephalitis. He highlighted his work in a multicenter prospective study showing that autoimmune encephalitis subsequently occurred in 27% of patients afflicted with herpes simplex encephalitis.

The session emphasized the importance of groundbreaking scientific work to combat neuroinfectious diseases globally and the importance of the WFN and AAN as organizations working together on global health initiatives. Further collaborative educational and scientific programs in infectious diseases, neuroscience, and world health will be presented at the upcoming World Congress of Neurology (WCN), which will be held Oct. 27-31 in Dubai, United Arab Emirates. •

World Congress of Neurology 2019

As this issue of World Neurology is published, the excitement and tension surrounding the upcoming XXIV World Congress of Neurology (WCN) is building. All of those involved are readying their final preparations for what should be one of the most exciting, educationally informative, and varied gathering of speakers, attendees, and delegates from all over the world.

William Carroll, MD

Being a true World Congress of Neurology, it will have all the local flavor, international participation, and opportunity for collegial interaction that uniquely characterizes such meetings, setting it apart from the more regular annual regional meetings.

The Dubai WCN promises much. As a major travel hub, Dubai will reduce overall delegate travel time and offer a wide range of accessible quality accommodation and novel attractions. Most importantly, it has a first-class scientific and teaching program, guaranteed to be of interest to all.

The World Federation of Neurology (WFN) is most grateful to all those who have accepted the invitation to speak and to teach during this meeting. By accepting both roles, most of the invited speakers have aided the organizers and the WFN in substantially reducing the faculty costs, thus allowing more generous support in keeping with the recognition they deserve for their contribution. Furthermore, through reduced faculty costs and in partnership with the local Emirates Neurological Society, this WCN has been able to offer a record number of travel bursaries to assist the attendance of more than 200 young neurologists from low- and low-middle-income countries.

A further consequence of the modestly reduced faculty and the attempts of the program committees to engage more younger speakers (while also attaining topic, regional, and gender balance) is that some regular participants from past congresses may feel overlooked. To those who may feel this way, I would like to say that we have greatly appreciated their WCN contributions and in turn those to the WFN.

Other extraordinary highlights will include increasing the attractiveness of the Tournament of the Minds as described in my last column, the continuation of posters on poster boards rather than by e-format, the use of news conferences to disseminate important messages from the WCN, and upgraded social media. The decision to retain physical poster sessions is based on the observations at a number of other conferences of the relative sterility of e-poster sessions and the organic interactive environment seen at physical poster sessions. Delegate feedback here remains important.

There are three important press conferences planned. It is no coincidence that these will focus on the three largest contributors to the global disability adjusted life years. The first is the final activity for the successful 2019 World Brain Day – Migraine the Painful Truth. This press event will be co-hosted by the International Headache Society (IHS) and the WFN and will emphasize the impact that migraine has not only on the individual and on them as employees but also on their employers.

The second press conference will focus on the nexus between stroke and dementia, and the third on the recent alignment of the World Health Organization (WHO), WFN and the World Stroke Organization (WSO) through the change in categorization of stroke in ICD-11 from a circulatory disease to a brain disease and the implications of this.

Council of Delegates

The WCN also provides an important opportunity for groups to meet and discuss a wide range of issues related to neurology and neurology specialties. For the WFN, this is one of the most important times. The WFN Council of Delegates (COD), comprising representatives from most of the WFN national member organizations, meets Oct. 26 to conduct its business.

On this occasion, there are two trustee positions to be filled. These are the treasurer and an elected trustee. An important vote will also be held to determine the site of the 2023 WCN. More on these important matters will be discussed in the next issue of World Neurology.

A final, and arguably the most important meeting, will also occur during the WCN. This will be the Global Neurology Alliance (GNA). The alliance represents most of the topic specialties of neurology, such as the World Stroke Organization, Alzheimers International, the International League Against Epilepsy, the International Parkinson’s Disease and Movement Disorders Society, the Multiple Sclerosis International Federation, the International Headache Society, the International Federation of Clinical Neurophysiology, and the major associated organizations, such as the World Federation of Neurosurgical Societies, the World Federation of Neurorehabilitation, the International Brain Research Organization, the World Psychiatry Association, and the International Child Neurology Association.

Also included are the major regional neurology organizations, such as the American Academy of Neurology, the European Academy of Neurology, the African Academy of Neurology, the Pan American Federation of Neurological Societies, the Pan Arab Union of Neurological Societies, and the Asian and Oceanian Association of Neurology.

WFN Specialty groups, such as Amyotrophic Lateral Sclerosis and Motor Neurone Disease, Huntington’s Disease, Tropical and Infectious Neurology, Environmental Neurology, Migrant Neurology, Epidemiology, Functional Neurological Disorders, and others, are also included.

At present, the GNA does not include solely neuroscience or patient advocacy groups. The GNA represents what is arguably the most comprehensive advocacy group for all aspects of neurology. Topics likely to be considered are increasing the importance of brain health, the inequities of access to neurological care, and the burden of non-communicable neurological disease.

All up, the 2019 World Congress of Neurology promises to be a most memorable event. It is, as the Global Neurology Alliance illustrates, a celebration of all things neurological. I look forward to seeing you all in October. •

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.

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.

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.