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. •

Upcoming Educational Events for WFN

World Brain Day (WBD) and the World Congress of Neurology (WCN) are two major events for the World Federation of Neurology (WFN) in which we present our organization to the world.

William Carroll, MD

As we approach the first of these, which is also the 52nd anniversary of the establishment of the WFN, it is appropriate to share what I view as the highlights of WBD 2019, as well as the WCN.

Burj Khalifa, Dubai

World Brain Day

World Brain Day is July 22. The date was originally selected by a group of interested neurologists led by Prof. Mohammad Wasay with the idea of promoting brain health and raising WFN’s profile.

2019 will be our fifth World Brain Day. In previous years, the WFN has selected a particular topic and a related organization to promote awareness, activate interest, and where possible, effect positive change in relation to the topic. These topics have been:

  • Brain Health-Age and the Brain
  • Clean Air (partnered with the Environmental Neurology WFN Specialty Group)
  • Epilepsy (partnered with the International League Against Epilepsy)
  • Stroke (partnered with the World Stroke Organization)

This year, Migraine and Other Headache Disorders is the selected topic, and the WFN is pleased to collaborate with the International Headache Society (IHS) in celebrating this WBD.

With the release in November 2018 of the latest figures for the Global Burden of Neurological Disorders, noncommunicable neurological disorders (NCD) dominated the statistics. NCDs are now the leading cause of disability and the second leading cause of death globally. The principle causes of neurological NCDs are stroke, migraine, and Alzheimer’s Disease and related dementias. In Western Europe and Australia, migraine ranks ahead of stroke as a cause of disability.

Given that migraine is a relatively hidden disability, it has not attracted the emphasis that its effect on global health and economic burden indicates it deserves. Consequently, this year’s WBD will highlight the need for concerted action on migraine at all levels. These include individuals with migraine and headache, national health services, patient organizations and neurological societies through to the World Health Organization, which is an active partner in the Global Burden of Disease endeavor. This year’s WBD will also be expanded to enable it to be featured in a number of important events and meetings beyond July 22.

In addition to WBD itself, the IHS plans to promote migraine and other headaches at its meeting in in September in Dublin and at the World Congress of Neurology in October in Dubai. A more prominent promotional campaign for improved diagnosis and individual therapies for migraine will be undertaken in partnership with the IHS, including possibly a two-week advertisement in New York’s Times Square. Senior representatives of the World Health Organization will attend the IHS Meeting in Dublin and the World Congress in Dubai, where it is hoped there will be employee representatives at a press conference on migraine and WBD.

The expanded duration of the public relations effort for migraine and other headache disorders for this WBD is in line with sentiments expressed by members of the Global Neurology Alliance at its meeting during the EAN Congress in Lisbon in June last year. There, one of the desirable objectives of the Global Neurology Alliance was to increase the promotion of brain health and quality neurological care.

It is hoped that this approach will prove successful for both migraine this year and other topics in the coming years. The WFN and the IHS have been most fortunate to have an enterprising team working on this year’s WBD campaign. I thank them all for their hard work and vision. Experience with the WBD platform can be used to grow the public relations effort that is required to promote brain health globally.

XXIV World Congress of Neurology 2019

The World Congress of Neurology (WCN) is the pinnacle of the WFN’s overt promotion of brain health and quality neurological care. This October, the XXIV WCN will be showcased in Dubai by the WFN in partnership with the Emirates Neurological Society and the surrounding region. The WCN rotates through four main regions every eight years. This will be the second time it has been in the North African and Middle Eastern region. In 2011, the WFN partnered successfully with the Moroccan Neurological Society to host the XX WCN.

The 2019 WCN in Dubai promises to encapsulate all that is unique and special for this biennial congress in the region. Every WCN has its own character and cultural features, and Dubai will not disappoint. Located in the Gulf, it is a pivotal and vibrant center reflecting change in modern and established regional lifestyles, culture, cuisine, and neurology.

In addition to the highlights that I mention below, it will also feature a shortened duration in line with the tempo of progress in the world generally and in neurology specifically. Coincidentally, the new WCN format will also keep the faculty numbers lean in order to more appropriately support those who are speaking. At present, the number is 260, down from a high of 300 at the previous WCN in Kyoto.

The faculty has been selected to reflect the advances in the eight main themes of the meeting and also in 25 smaller but no less important topics. The program for each day will begin with an early morning teaching course on a specific topic followed by two high quality plenary lectures. Depending on the day, these are followed by one to three main themes, two to five teaching courses, and one to four scientific sessions, numerous workshops, free papers by topic, regional and specific symposia in a total of 10 to 12 concurrent sessions. There will be 166 sessions over the course of the four-and-a-half-day Congress. Each is thoughtfully planned by the Scientific Program Committee led by Chris Kennard, and each features speakers and chairs nominated by members of the Global Neurology Alliance and the WFN regions with attention to youth and gender diversity.

Stroke, headache, dementia, epilepsy, and demyelinating disorders are appropriately emphasized given their contribution to the global burden of neurological disorders as are topics of regional interest.

The Tournament of the Minds, a popular audience-oriented educational activity, has been revamped and incentives are being offered to the teams from different member societies. Although this tournament is recognized as a valuable learning experience, there has been less willingness for national member team participation over the last few congresses. In an attempt to reverse this trend, the 2019 WCN will offer registration reimbursement (free registration) for nominated teams of four from member societies that attend and also free registration for the victorious team at the XXV WCN to be held in Rome in 2021.

Finally, importantly and in keeping with past congresses, there will be a minimum of 100 travel and expense assistance bursaries offered to young neurologists from low- and low-middle-income World Bank ranked countries. Those interested should check the WCN and WFN websites for details and eligibility.

All in all, these two important events will display the most visible of the high-end educational activities promoted regularly by the WFN and provide the substrate for building collegial interaction and collaborative educational activities beyond the WBD and WCN. There are regular updates posted www.wfneurology.org and disseminated in World Neurology and WFN social media outlets. •

A Quest for New Horizons

NASA, AFAN Joint Congress

By Wolfgang Grisold

Key participants of the NASA and AFAN annual business meeting in East London, South Africa.

During this year‘s Neurological Association of South Africa (NASA) meeting, the AFAN had its annual business meeting and scientific meeting in East London, South Africa. Outgoing President Yomi Ogun opened the business meeting by giving a report on AFAN’s development and activities in the past year.

This report was followed by an update from Augustina Charway-Felli, AFAN secretary general. Lawrence Tucker, AFAN treasurer, reported that support of the American Academy of Neurology (AAN), European Academy of Neurology (EAN), the World Federation of Neurology (WFN), and the Movement Disorders Society (MDS) were received and allowed the meeting and the stability of AFAN. Yet, the financial resources still need attention. The AFAN goals to attain a financially independent status are moving closer.

WFN was mentioned in several reports, and it is acknowledged that the WFN had been helpful in the establishment of AFAN, and continues its efforts for Africa. WFN President William Carroll commented on the development of AFAN and neurology in Africa. He emphasized that AFAN will have to secure and stabilize its financial situation and independence.

In this meeting, new elections also took place, which were supervised by Raad Shakir, past WFN president. The new AFAN board (left) shows that the concept of regional representation is well established in the AFAN.

The current AFAN board (September 2019-2021) is:

President
Foad Abd-Allah (Egypt)
President-Elect
Augustina Charway-Felli (Ghana)
Secretary General
Daniel Gams Massi (Cameroon)
Treasurer
Ozayr Ameen (South Africa)
Vice Presidents
North Africa: Faouzi Belahsen (Morocco)
East Africa: Marieke Dekker (Tanzania)
South Africa: Lawrence Tucker (South Africa)
Central Africa: Yacouba Mapuore (Cameroon)
West Africa: Ange-Eric Kouame-Assouan (Cote d’Ivoire)

The main message from this business meeting was that AFAN is committed to the goals of increasing the visibility of neurology and ensuring improved access to neurological care for the population of the continent. This can only be achieved by training and advocacy.

The scientific meetings consisted of workshops on several topics. The meeting had sessions from both NASA and AFAN, and the sessions were well attended. The topics of the AFAN sessions concerned several disease entities, and most speakers were able to highlight the specific situation for neurology in Africa. Structural and educational topics and the future of African neurology were discussed.

This important joint meeting emphasized that the needs for Africa have many dimensions. One key figure is the Africa‘s population, which is now 1.3 billion, and composed of different languages, cultures, and many distinctive ethnicities. Africa needs empowerment in education and training from within. •

From the editors

Welcome to the March/April 2019 issue of World Neurology, the official newsletter of the World Federation of Neurology (WFN). This issue begins with the President’s column, where WFN President William Carroll discusses two of the major upcoming events of the WFN: World Brain Day and the World Congress of Neurology in Dubai. Next, WFN Secretary-General Wolfgang Grisold provides a summary of the recent Joint Congress of the Neurological Association of South Africa (NASA) and the African Academy of Neurology (AFAN) held in East London, South Africa. Raad Shakir, immediate past president of the WFN, reports on the ongoing successes and importance of the Regional Neurologic Congresses.

Walter Struhal, MD

Steven L. Lewis

Profs. Tissa Wijeratne, Wolfgang Grisold, David Dodick, Mohammad Wasay, and William Carroll report on the upcoming activities of this year’s World Brain Day, whose theme is Migraine and Headache, as a collaborative effort between the WFN and the International Headache Society.

Professor Maged Abdel Naseer then provides a brief report on the recent Cairo Neurologic Conference (CNC) held in Cairo, another successful and highly attended CNC conference and that one of the editors (SL) was privileged to participate in. This issue also features a call from the Multiple Sclerosis International Federation for grant applications from researchers from low- and middle-income countries.

In this issue’s History column, Prof. Peter Koehler provides an intriguing review of the historical evolution of the concept of aging. This issue also features an enthusiastic report from a trainee’s recent and successful department visit to Istanbul Turkey through the collaborative program of the Turkish Neurological Society and the WFN.

Finally, this issue features heartfelt obituaries about two remarkable neurologists who recently passed, Prof. Jagjit S. Chopra and Prof. James (Jim) Lance.

We look forward to further contributions from you for the pages of World Neurology and look forward to hearing of our societies’ participation and events around the globe related to the upcoming World Brain Day. •

Regional Congresses: Continued Success

By Raad Shakir

Over a period of six months, four major neurological congresses were held in four regions of the world. Each was organized by one of the regional organizations, which are part of the six regions of the WFN.

Pan Arab Union of Neurological Societies (PAUNS) in Amman, Jordan.

The total number of attendees was impressive; more than 5,000 neurologists attended, making the gatherings major events in their own rights. One has to emphasize that neurologists working in these four regional organizations provide care for roughly 85 percent of the world’s population. In some localities, the care may not be supported by up-to-date technology or the ability to provide high-end acute or long-term neurological care.

In the age of instant communications, online journals, free availability of information, free daily updates, expedited publications, in addition to the deluge of emails, tweets, Instagrams, WhatsApp groups, to mention a few, neurologists still attend congresses in droves.

Pan American Federation of Neurological Societies Congress (PAFNS) in Sao Paolo, Brazil.

You can say with certainty that we have not replaced face-to-face meetings and sitting in large lecture halls listening to scientific presentations. If you are wondering why we continue to do this, I can offer some answers.

First, all of the modern electronic communications media have not replaced the personal encounter with lecturers and having the opportunity to ask questions. Oral or poster presentations, whether on a board or electronically, are opportunities for young neurologists to interact with those in the field and be put on the spot when asked some probing questions. It also adds to self-esteem when neurologists return to their departments having presented his/her or their group’s work at an international congress.

Second, in each of the four congresses, the additional attraction of being regional is that neurologists come to meet friends, past trainees, colleagues in neighboring countries, as well as to listen and interact with top speakers from other parts of the world. The congresses are big but still manageable with perhaps two or at most three simultaneous sessions allowing better attendance to satisfy the requirements of the delegates. On the other hand, attending larger congresses of the two other regions, whether American or European academies, is a completely different experience. Similarly, the World Congress of Neurology (WCN) is a big jamboree. Each one runs about a dozen simultaneous sessions, making it practically impossible to hop sessions.

Third, cost plays a role in these congresses. There is no doubt that it is cheaper to go regionally, and sponsorship is more accessible compared to long distance travel. Moreover, pharmaceutical support is regional rather than global. Funding therefore comes from different budgets, and this helps the organizers to attract support for exhibition and travel.

Fourth, is the practical issue of the kind of passport the delegate holds. Visas are a major problem, and at times, it is easier to travel to a regional country than to one that requires a visa. It is not unknown that passports can be held in embassies for several weeks awaiting approval. Moreover, the cost of a visa can be prohibitive, especially as the sponsors rarely pay for such expenses.

Fifth, if you look at other major general neurology congresses, the topics are by and large similar. International speakers who are invited to regional congresses roughly present the same material. In some larger congresses, the halls may be full, and it is not uncommon for delegates to sit on the floor or stand.

Asian Oceanian Congress of Neurology (AOCN) in Seoul, Korea.

In each of the four congresses, an additional meeting has been tagged, such as specialty, national society, or others. It seems that general congresses still attract attendances and sponsorships in the presence of specialty meetings in the same region. None of the four congresses could have been possible without the support and the tagging of national congresses to the regional one.

Financial Considerations

The two other regions (American and European academies) have been represented in these four congresses, taking the form of leadership presence and certainly speakers. Moreover, financial sponsorship was available from one regional organization to another. The World Federation of Neurology is omnipresent and has been highly represented in all the congresses offering moral, scientific, and financial support. This makes a difference to the regions when the international bodies are there with them.

The experience for each regional organization is crucial for their self-assurance and long-term viability. All four congresses now have well established management boards with regular free and open elections. This is vital for the survival of all neurological bodies. Congresses make profits, and this is plowed back to support local training and postgraduate education.

In some and soon hopefully all the four regions, there shall be separate training especially for young neurologists in regional courses and visiting fellowships. This will supplement grants from the WFN and more wealthy regional bodies. The ability of young trainees to travel in their regions to observe, criticize, emulate, and practice is growing and can only be beneficial to all.

One issue that needs to be stated in some of the four regions is that of continuing medical education (CME) certification. It is noted that in all the four congresses a certificate of attendance was provided. However, the requirement of mandatory CME in some countries is not a legislation that is followed. It is vital for regional organizations to contact local ministries of health or other medical licensing bodies to stressing the importance of continuing medical education and making CME mandatory for recognition in the specialty.

The four congresses are biennial in the years when there is no World Congress. This is excellent so that neurologists will have the opportunity to attend a major general neurology congress annually. It is quite noticeable that each of the four neurological associations has clearly prospered in the last few years. The benefits are both scientific and financial. The administrative structure is taking shape, and when the leadership of one attends the congress of the others, many practices are observed and hopefully emulated later.

As an observer of congresses since the WCN Kyoto 1983, the world still has an insatiable appetite for congresses. Long may that continue. •

Prof. Raad Shakir is the immediate past president of the WFN

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