Articles – Page 39

WFN Junior Traveling Fellowship: The 2018 Alzheimer’s Association International Conference

By Jorge J. Llibre Guerra

The 2018 Alzheimer’s Association International Conference (AAIC) was held in July in Chicago, Illinois. The AAIC is the largest and most influential international meeting dedicated to advancing dementia science. Each year, AAIC convenes the world’s leading basic science and clinical researchers, next-generation investigators, clinicians, and the care research community to share research discoveries that will lead to methods of prevention and treatment, and improvements in diagnosis for Alzheimer’s disease.

The AAIC was followed by the 33rd International Conference of Alzheimer’s Disease International meeting organized by the Alzheimer’s Disease International Society. This meeting is the place for gathering all of the regional and country societies from all over the world, making it possible to develop regional collaboration and advance the development of international policies in dementia.

This year, it was a great pleasure to receive the WFN Junior Traveling Fellowship, making it possible to attend the lectures and discussions on ongoing research projects in both meetings. This was also a unique opportunity to make new contacts and expand collaboration. It was also an honor to have and actively participate in the meeting and present the results of our ongoing research project as oral and poster presentation.

Presentations included:

Oral Presentations: African Admixture: Implications for Cognitive Decline in AD. ISTAART Diversity and Disparities Professional Interest Area leadership. Ancestry Background: Implications for Cognitive Decline and Mortality in Dementia.

Poster Presentation: Prevalence and Incidence of Mild Cognitive Impairment and Dementia in Older Frailty in Latin America, China and India. a 10/66 Population Based Survey.

The projects presented during the conferences are also the result of teamwork and collaboration. I would like to acknowledge our research team for the accomplished results. In overall, attendance to both meetings was successful and helpful for my future development as a clinician and researcher. Knowledge acquired during the conference and the newly develop collaborations will improve future research projects.

Finally, attendance of the Congress was supported by the WFN, and I want to share my gratitude to the WFN for this great opportunity. Thank you also to the WFN staff and leadership for their support. The WFN Junior Traveling Fellowship is a unique opportunity to create access and share experiences among junior researchers. •

Jorge J. Llibre Guerra, MD, MSc, is from the National Institute of Neurology in Havana, Cuba.

WFN Junior Traveling Award: Report of My Attendance at the Peripheral Nerve Society Meeting

By Dr. Alagoma Iyagba

The 2018 Peripheral Nerve Society Meeting took place July 21-25 in Baltimore, Maryland.

It started with an all-day educational course (basic and clinical aspect of peripheral nerve and neuromuscular diseases). The conference proper started July 22. It featured plenary sessions, oral poster sessions, poster sessions, and industry sessions. (These took place at the end of each day.)

The meeting afforded me the opportunity to see groundbreaking and cutting-edge research on diseases of the peripheral nerve and neuromuscular disorders.

I had two poster presentations:

– Development and psychometric properties of the HANP-Q: a new instrument for measuring neuropathic pain in HIV-AIDS (Poster 13).

– Diagnostic accuracy of the HANP-Q: a novel tool for measuring neuropathic pain in HIV-AIDS persons (Poster 25).

The presentations were well received. The questionnaire was said to be simple to understand and easy to apply in clinical and research settings. Suggestions for future research include doing an external validation of the questionnaire.

The conference afforded me the opportunity to network with colleagues. Of special mention are Prof. Mary Reilly, Dr. Alexander Rossor, and Dr. Mohammed Mahdi-Rogers (all from the Center for Neuromuscular Diseases at King’s College in London), Prof. Hans-Peter Hartung (Germany) and Dr. Catherine Mamah (U.S.). They were all excited at my attending the meeting and gave me encouragement and guidance for the future.

On the fourth day of the conference, we had the Annual General Meeting. When the map of participating countries was projected, I was the only participant from Africa save for some South Africans.

On the last day of the meeting, I was part of the inaugural meeting (foundation member) of the Toxic Neuropathy Consortium of the Peripheral Nerve Society, which was initiated by Prof. Guido Cavalleti (Milan, Italy) in February 2018.

On the whole, the meeting was an eye opener for me with respect to this very rare field of neurology in Africa. It has exposed me to the state of the art and science of peripheral nerve and neuromuscular diseases.

I am grateful to the World Federation of Neurology and the Education Committee for selecting me for this travel fellowship. •

Dr. Alagoma Iyagba is from the Neurology Unit, Department of Internal Medicine at the University of Port Harcourt Teaching Hospital, Nigeria University of Port Harcourt in Port Harcourt, Nigeria.

German Neurological Society and World Federation of Neurology: Department Visit Report

By Biniyam Alemayehu

I would like to thank WFN and the German Neurological Society for giving me this rare educational opportunity to visit one of the state-of-the-art neurology centers. On my first day at the Universitätsklinikum-Erlangen, Department of Neurology, I was warmly welcomed and introduced to all the staff by Prof. Hagen B. Huttner, as Prof. Stefan Schwab was on the leave, who I had an opportunity to meet on the following Monday. He also warmly welcomed me. Prof. Huttner arranged weekly rotational visits for me in the following fashion:

Week 1: Emergency room

Week 2: Stroke unit and neurointensive care unit

Week 3: Electrophysiology unit

Week 4: Epilepsy unit

Week 1:

During my one-week observation in the ER, I had the opportunity to observe first-hand how patients are handed over from paramedics to a treating ER neurologist. I also saw how they quickly engage in evaluating the patients and investigating the patients based on patient complains, especially their approach to stroke patients. These patients are possible candidates for IV thrombolysis, in which the neurologist and ER nurses are highly organized and coordinated in immediately preparing the tPA kit and taking the patient to the CT scan room, in the overall effort to minimize door to needle time.

I had an opportunity to observe the “Teleneurology” service at the ER, in which those nearby health facilities, networked with Universitätsklinikum-Erlangen, had a real-time video discussion with the neurologist in charge and consult the patient’s condition and imaging.

Week 2:

During my second week, I had the opportunity to attend daily rounds at the stroke unit and was able to observe the quality of care that intermediately sick patients with different neurological disorders, including stroke, TIA, GBS, and brain tumor patients, get during their admission to the unit.

I also had an opportunity to visit the neurointensive care unit, a 12-bed unit, equipped with state-of-the-art neurocritical care equipment, including continuous EEG monitoring.

Week 3:

In my one-week observation in the electrophysiologic unit, I had an opportunity to observe how ultrasound guided EMG is done in different patients with neurological disorders. I also had an opportunity to observe while other EDx tests are done, including NCS, and evoked potentials. Finally, I had an opportunity to observe botulinum toxin injection sessions for patients with blepharospasm, hemifacial spasm, and spasticity.

Week 4:

During my final week at the hospital, I attached to the epilepsy unit, helping with 24-hour EEG monitoring in patients who need pre-surgical evaluation and for diagnostic purposes.

In our Setup

During my four week stay at U.K.-Erlangen hospital, I had an opportunity to observe how patients with different neurological disorders are managed in an ideal setup. As the second most populous country in Africa and home to different international organizations, its high time for us to establish at least one neurology care center that can give a standard neurological care to our patients and become a center for neuroscience research.

I am fully aware that this is a long shot, but we need to work hard and push the policymakers to give due attention on the need to have at least one excellent neurology center, which will have a well-equipped ER, neurocritical care units, stroke unit, and epilepsy units in Ethiopia. In the meantime, I am highly motivated and enthusiastic to improve the current neurology care in our facility by using the experiences I acquired at U.K.-Erlangen. I am planning to work hard in the following areas as a priority:

Creating public awareness about stroke and TIA and establishing a referral network system with nearby hospitals.
Short of availability of tPA, optimizing stroke care, by establishing a stroke unit and improving neurorehablitation for our patients.
Optimizing emergency management of patients with neurological disorders.
Strengthening our electrodiagnostic unit by increasing the number and quality of the tests we do currently.
Strengthening the care we are giving our epilepsy patients currently.
Training our staff in different neurology fellowship training in order to keep improving the current care and ability to accommodate ever increasing neurosciences care.

I’m optimistic that the future is brighter for neurologists like me. Such a departmental visit gave us the highlight of how care for patients with neurological disorders are much advanced and ever growing in the future.

I am hopeful that both WFN and DGN will keep helping our hospital in the future, especially in capacity building of our staffs and in our effort to improve the neurology care in Ethiopia. I’m really fortunate to have met Prof. Stefan Schwab, who is really interested in establishing future collaboration between his hospital and our hospital. I hope he will visit our center in the near future and support our endeavors.

Finally, I would like to thank all the staff at Universitätsklinikum-Erlangen for their hospitality during my rotation at different units. •

Biniyam Alemayehu is assistant professor of Neurology at the AAU College of Health Sciences in Addis Ababa, Ethiopia.

WFN Junior Traveling Fellowship: 13th European Congress on Epileptology

By Dr. Prisca-Rolande Bassolé

I am Dr. Prisca-Rolande Bassolé, a young neurologist, epileptologist, clinical neurophysiologist, teaching and research assistant in neurology at El Hadj Ibrahima Niasse private University / College of Medicine Saint Christopher Iba Mar Diop of Dakar, Senegal.

I had a great honor to participate in the 13th European Congress on Epileptology (ECE) in Vienna, Austria. I’m grateful to the World Federation of Neurology for supporting my attendance at this international congress.

The conference was held Aug. 26-30 at the Messe Wien Congress Center in the beautiful city of Vienna.

During my training in neurology, I developed an interest in epileptology so it was a personal, educational, and impactful experience for me.

I appreciated all of the topic sessions, especially those on epilepsy in childhood, the gut microbiota and epilepsy: is there a link?, clinical neurophysiology, epilepsy and stroke, can we do better? I also enjoyed the teaching courses that I attended. They included how to diagnose epilepsy, which helped me to enhance my knowledge of epilepsy.

I presented my abstract, ‘‘Early Epileptic Encephalopathies with Suppression Burst’’ Aug. 27. The abstract presentation afforded me the opportunity to meet other specialists in epileptology and clinical neurophysiologists, working on similar research areas.

Discussing with them made us develop other research topics that could help improve the diagnosis and follow-up of our patients, particularly in developing countries.

Thank you to my mentor, Prof. Mansour Ndiaye, who supported my application. Thank you again to the WFN for giving me this international scientific opportunity. •

Neurology, Environment and World Brain Day

By Wolfgang Grisold, Mohammad Wasay, and Jacques Reis

The World Brain Day (WBD) was established to commemorate the foundation of the WFN, at the WCN 2013, in Vienna. The idea is to gather all member societies for a yearly event, to promote the interest of neurology.

Jacques Reis, along with Serfnur Ozturk from the Turkish Neurologic Society, during World Brain Day 2018

Several topics such as stroke, dementia, and epilepsy were used in previous WBDs in cooperation with other societies.

After WBDs with topics involving epilepsy and stroke, this year’s topic was the environment. The title “Clean Air for a Healthy Brain” was chosen to signify that air pollution is a major problem relating to brain health. So far, we are aware of stroke and pollution, and there is substantial evidence that worldwide many more persons are compromised by the effects of pollution.

This WBD has brought the important message to all policy- and decision-makers around the world: Take care of our environment, notably air quality; healthy air is mandatory for our brain’s health!

The second message is for neurologists: The tremendous impact of environmental factors in the pathogenicity of many neurological diseases should not be neglected.

Presently, neurologists are not trained to manage such environmental issues. Prevention and mitigation of these environmental consequences will be important.

An important issue is prevention. For example, indoor air quality issues, such as “home fire” for cooking is still prevalent in many countries, due to lack of resources.

The great lesson, which comes from the stroke Global Burden of Disease study, shows that prevention is no longer only a personal concern but a societal challenge. Neurologists must act and advocate for a better environment.

Yet environment for many neurologists is still not as tangible as conventional neurological problems such as symptoms and diseases, and for some societies these seemed a remote topic and of less evidence than we are usually trained to think of. This may be wrong, as evidence shows that environmental factors are increasingly important for the generation of a number of diseases, including in neurology. An example is the Turkish Neurological Society, which has brought the debate to the societal level.

It has been the privilege of the WFN Applied Research Group on the environment to promote their topic, by yearly meetings, publications, and this year their effort was recognized as the topic of the WBD.

The World Brain Day team consisted of Jacques Reis, M. Wasay, Walter Struhal, and Wolfgang Grisold, with great help from Jade Levy and Laura Druce at the WFN offices in London, and we used press and promotional advice from Birgit Kofler.

This year the American Academy of Neurology (AAN) actively participated, which is a significant acknowledgement of the WBD activities, and also a sign of fruitful cooperation! We thank the AAN for their involvement.

In the past years, we have aimed to make virtual press conferences. Last year, we had a webinar to receive statements on the topic. This year, we collected a number of videos from specialists worldwide on the topic, and we hope that these interviews will be a source of ongoing information on environment and neurology.

The best immediate results of WBD are press and media echoes, as well as reports from our members on their celebration of WBD. All of this material will be collected, and will be subsequently displayed on the website to give an overall impression of this year’s WBD.

Please use our material, report on your WBD, and join us again for the next World Brain Day in 2019. The theme for 2019 World Brain Day is related to headache disorders.

RISE and the ENRG are pleased to invite you to the third meeting dedicated to the environmental impact on brain, which will be held in Strasbourg, Council of Europe Nov. 28-30, 2018. Visit asso-rise.com for more information. •

World Brain Day in Albania

By Jera Kruja

Albania, acknowledging the importance of air pollution as a risk factor for neurological disorders, organized a special event during World Brain Day. The conference was titled “Dita Botërore e Trurit: Ajër i Pastër për Tru të Shëndetshëm,” (“Clean air for brain health”).

Prof. Dr. Jera Kruja, head of the neurology service at the University Hospital Center “Mother Teresa,” advocated with the faculty of medicine at the University of Medicine, Tirana, and the Albanian Institute of Public Health to join efforts toward raising awareness on air pollution and its deleterious effects exerted on the brain. As a result, all three institutions participated actively in organizing and disseminating the information to health professionals and general public.

Besides Prof. Dr. Jera Kruja, speakers included Prof. Dr. Enver Roshi, head of the department of public health (faculty of medicine at the University of Medicine), Elida Mataj, MD, PhD, head of the environmental epidemiology and air quality department (Institute of Public Health), Aida Quka, MD, neurologist, Neurology Service (University Hospital Center “Mother Teresa”).

The event, organized at the faculty of medicine, was attended by health professionals and the general public, which recognized the importance of air pollution and its consequences highlighting the seriousness, gravity, and urgency of public health preventive interventions tackling environmental pollution in general and air pollution in particular.

Moreover, the topic relevance and the speakers’ excellence were appraised from the National Center of Continuous Medical Education by accrediting the event with two CME credits. Additionally, special acknowledgment was attained from the Albanian representatives of the European Industrially Contaminated Sites and Health Network.

Furthermore, the conference was reported by national television and press, and special interviews were given by the speakers addressing the general public in an effort to raise awareness on air pollution. •

Jera Kruja, MD, is a professor of neurology and head of the neurology service at the University of Medicine, Tirana, UHC Mother Teresa, Tirana, Albania, a member of the WFN Teaching Courses Committee, a former member of the European Academy of Neurology Scientific Committee, and Lancet commissioner for LMIC.

Toward a More Meaningful WHO/WFN Relationship

By William Carroll
WFN President

The WFN and WHO share a number of common features and have had useful collaborations in the recent past. Both organizations have a global perspective with regional organizations, parallel mission and goals, and the development of the Atlas of Neurology and the neurology section of the 11th revision of the International Classification of Disease (ICD11) to its present stage.

William Carroll, MD

In addition, the WHO and WFN have collaborated during the Zika virus Public Health Emergency of International Concern of 2016, and the recognition of stroke as a disease of the brain and dementia and on other degenerative neurological disorders being included in the WHO non-communicable disease (NCD) initiative. The two organizations diverge only in the magnitude of the tasks confronting them.

The WFN mission is to foster quality neurology and brain health worldwide; the WHO to improve equity in health, reduce health risks, promote healthy lifestyles and settings, and respond to the underlying determinants of health. Arguably, the two organizations are a natural fit with the potential for beneficial cooperative activity. Both have regional organizations of similar geographic distribution pursuing the same goals as above. For the WHO, member states are grouped into six regions: African, the Americas, South-East Asian, European, Eastern Mediterranean, and Western Pacific. WFN member societies are in five regions; the American (represented by the American Academy of Neurology and the Canadian Neurological Society) and the Pan American Federation of Neurological Societies, representing Central and South American members, the European region comprising the European Academy of Neurology, the Middle East and North African region represented by the Pan Arab Union of Neurological Societies, the African region represented by the newly formed African Academy of Neurology, and the Asia Pacific region represented by the Asian and Oceanian Association of Neurology.

DRAFT AGENDA

1300–1305
Introduction and welcome to delegates by the President, Dr. William Carroll (BC)

1305–1320
Roll call and proxies Dr. Wolfgang Grisold (SG)

1320–1325
Minutes of the COD Meeting in Kyoto 2017 (BC)

1325-1345
Presentation of the WCN 2023 intending candidate venues (5 minutes each)
a. Canada, Montreal
b. Mexico
c. Brazil

1345-1355
Receipt of Annual Report 2017
President’s report (WHO, GNA, Brief Dubai, Needs Registry)

1355-1405
First Vice President’s report (RK)
WCN 2019 progress report

1405-1415
Secretary General’s report (WG)
London Office
Overview

1415-1425
Treasurer’s report (RST)
Receipt of the accounts of the Federation for the financial year
Dec. 31, 2017.
Appointment of auditor.

1425-1450
Election: Candidate statements (5 minutes each)

Secretary General
Wolfgang Grisold

Elected Trustee
Morris Freedman
Alla Guekht
Jean-Marc Leger
Daniel Truong

1450-1515
Election: Voting

Secretary General
Wolfgang Grisold

Trustee
First round voting
Second round voting

1515-1525
Education Committee Report (SL)
Continuum
Training Centres/Teaching courses
World Neurology

1525-1535
Membership Committee Report (MF)

1535-1545
Public Awareness and Advocacy Committee (WBD MW)

1545-1555
Publications Committee (Journals JE)

1555-1605
E-Communications Committee (WS)

1605-1615
Africa Education Report (RG)

1615-1620
AOB

1620-1625
Announcement of all voting results

Close

Draft agenda for the upcoming WFN council of delegates meeting in Berlin Tuesday, Oct. 9, 2018.

The WHO is the lead organization for all matters in health.Its constituency is the national health organizations representing national governments in most instances.

The WHO does interact with many non-governmental organizations termed “non state actors” but it recognizes only one type of formal relationship known as “official relations.” Other informal contact includes “working relations” which have their own set of criteria. Official relations are usually between the WHO and global organizations which share common goals as does the WFN. Further, “official relations” is conferred by the WHO for a specified period and for designated topics. The WFN has greatly appreciated having “official relations” status for its partnership in the Atlas of Neurology and with the topic advisory neurology group for ICD-11 extended to 2019. It is the seemingly arbitrary nature of this collaborative effort and that the WHO does not have the same ready access to medical specialties and their global, regional, and national organizations as does the WFN for neurology and others such as the World Heart Foundation, the International Union of Immunological Societies and the International Society of Nephrology, that the WFN believes could be reviewed and probably optimized.

In the neurological sphere, it became apparent some years ago that there might be benefit in a closer alignment between two existing groups of “neurological” organizations. One roughly represented those with more specialty-focused neurological interests such as stroke (World Stroke Organization), epilepsy (International League Against Epilepsy), dementia (Alzheimers Disease International) movement disorders (International Parkinson and Movement Disorder Society ) and multiple sclerosis (Multiple Sclerosis International Federation). The other included those with neurologically related interests such as the World Federation of Neurosurgical Societies, the World Federation of Neurorehabilitation, the World Psychiatry Association, the International Child Neurology Association and the International Brain Research Organization.

During recent in-depth discussions with the WHO over ICD11 and the classification of stroke, these two groupings worked more closely than previously to the benefit of the WHO, the WFN, and members of these two groups. Emerging from this experience was a sentiment that had first been expressed during the meeting of representatives attending the WCN 2015 in Santiago; that a more formal unified structure interacting more regularly to share information, acting concertedly and advocating more cohesively could be mutually beneficial. This organization, at present in formal development, would be known as the Global Neurological Alliance (GNA).

It should bolster many areas to do with brain health not least by providing ready access to neurological specialties and speciality perspectives. In effect, it adds a valuable third dimension for the promotion of brain health by the WFN and GNA. Recognizing the role the WFN will play as the communication hub for this new alliance, the trustees have committed to provide the personnel and resources required to ensure its success.

The WFN has also recommitted to ensure all alliance members have the opportunity to participate in the biennial World Congress of Neurology; a practice developed by the immediate WFN past President. Finally, it is hoped that the WFN will be able to offer to GNA members free advertisements in World Neurology and on its website.

The immediate benefits of establishing the GNA are recognizable and have little or no risk to it or its members. These include a more influential voice in matters of advocacy, a more rapid response to global government and non-government calls for action, the provision of specialist task forces, the promotion of brain health in general, and the continued evolution of World Brain Day (WBD) in partnership with other GNA members.

WBD themes have been epilepsy and stroke in previous years, the environment this year, and headache for next year. Indeed, the risk of not proceeding to establish the GNA are possibly a greater threat to the common goals than doing so. Most importantly among tasks suitable for the GNA is the ability of the GNA to provide greater support for the WHO in its NCD and Air Pollution and Health initiatives, its global action plan for dementia, in addition to the call by the WSO for the WHO to increase awareness, treatment access, and removal of inequities in stroke care.

From my position, it is to be hoped that the ability to interact successfully at this global level will be facilitated by the WFN retaining “official relations” status with the WHO to pursue areas of common interest mentioned above and in the other major concern for us, that of the inequities of access to health care in general and neurological care in particular.

In closing, let me remind all member societies of the WFN AGM and COD meeting to be held 1 p.m. on Tuesday, Oct. 9, 2018, in the Ulm room City Cube Messedamm 26 in Berlin. A draft agenda for this meeting is provided on page 3. We must have sufficient member society delegates to be quorate in order to elect a trustee from the four excellent candidates. •

From the Editors

We’d like to welcome neurologists worldwide to the August 2018 issue of World Neurology. In this issue, Drs. Mohammed Wasay and Wolfgang Grisold report on the activities that surrounded World Brain Day 2018 from around the globe, with an additional report by Jera Kruja about the activities in Albania. Dr. Grisold also reports on the highly successful meeting of the International Congress of Neuromuscular Disease that was recently held in Vienna; Dr. Grisold and Javier Cardenas update us on the Palatucci Advocacy Workshops from the American Academy of Neurology in 2018. Reporting on another international meeting, Dr. Peter Sandercock provides a report on Brain Diseases – From Bench to Bedside that was recently held in Moscow.

In the President’s Column, Dr. William Carroll describes the parallels and the relationship between WHO and WFN and updates us on purpose and aims of the Global Neurology Network. Dr. David Oliver informs and updates us on the important topic of palliative care in neurology, and in this issue’s well-illustrated history column, Dr. Peter Koehler describes the neurological aspects of the work of the Dutch physician and anatomist Frederik Ruysch.

Education is an important aspect of the WFN and the joint AAN/WFN Continuum program is an excellent example of collaboration to promote worldwide neurology education. In this issue, Dr. Aaron Berkowitz reports on the recent introduction of Continuum to the trainees in Haiti. Finally, this issue includes two reports from recent recipients of WFN Junior Traveling Fellowships to attend June’s EAN Congress that was held in Lisbon, Portugal.

We hope you all enjoy the many and varied contributions in this issue, and we continue to look forward to receiving contributions from and about neurologists around the globe for publication in World Neurology. •

Neurological Aspects in the Work of Frederik Ruysch

By Peter J. Koehler

In the first chapter of Peau de chagrin (1831), one of the novels in the Comédie Humaine series by French writer Honoré de Balzac, it is written “Là dormait un enfant en cire, sauvé du cabinet de Ruysch, et cette ravissante créature lui rappelait les joies de son jeune âge.” [There, a child in wax slept, saved from the cabinet of Ruysch, and that splendid creature reminded him of the joys of his youth; p.36].

Apparently, 100 years after the death of Dutch physician and anatomist Frederik Ruysch (1638-1731), his work was still known in non-medical circles in Paris. Moreover, almost 1,000 of his anatomical preparations are still displayed at the Kunstcamera Museum in St. Petersburg.

Figure 1. Anatomical lecture of Frederik Ruysch by Adriaen Backer (1670; courtesy Amsterdam Museum).

Ruysch’s Life

Following his examination to become an apothecary, Frederik Ruysch studied medicine in Leiden. (See Figure 1.) At age 28, he became praelector anatomiae of the Amsterdam surgery guild, succeeding Johannes Deijman, whose name was immortalized in Rembrandt’s “Anatomical Lesson of Dr. Deijman” (1656, Figure 2). Ruysch kept the position for over 60 years. He developed a successful method to embalm corpses, probably based on alcohol. Child bodies seemed like sleeping children. (See Figure 3.) His collection (“cabinet”) of anatomical (and other) preparations became a real touristic Amsterdam attraction.

Figure 2. Rembrandt’s Anatomical Lesson of Dr. Deijman (1656); Deijman is working on the brain of the cadaver; his head and several other persons on the original painting were lost by a fire (1723). Courtesy Hermitage, Amsterdam.

In 1717, he sold the collection to tsar Peter the Great of Russia for the amount of 30.000 guilders. He preferred to teach with his preparations rather than with recently deceased corpses. As an empirical physician, his device was “come and see.” Next to anatomy and teaching, Ruysch examined midwives and was appointed professor of botany. In this position, he taught at the city’s botanical garden, which had been founded in 1638.

Figure 3. Picture of a child’s head taken from above. (Courtesy, Kunstkamera, St. Petersburg, Frederik Ruysch’s Collection 4070 – 176).

Ruysch as (Neuro)Anatomist

Today, Ruysch’s Opera Omnia are available online, but unfortunately only in Latin and Dutch. (See Figure 4.) These contain the descriptions of the anatomical preparations including the figures. Furthermore, we find his correspondence with other scholars on anatomical subjects. These include the German anatomist Abraham Vater (1684-1751), the physician Michael Ettmüller (1644-1683), and Andreas Goelicke (1670-1744), who spent some time in Leiden and Amsterdam. Ruysch improved his method to prepare anatomical specimens in the 1690s by adding vascular injections with fluid wax. Preparations could now be conserved in liquor balsamicus for longer periods. Moreover, this technique also allowed him to study the blood vessels. Herewith, he was able to refute the theory of the Italian physician Marcello Malpighi (1628-1694) who believed the cerebral cortex consisted of glands. After all, by his method, Ruysch was able to show that the cortex consisted largely of small blood vessels. However, his findings were not accepted by everyone. He wrote:

Figure 4. Frontispice of Ruysch’s Opera Omnia (1721)

Marcellus Malpighius, in the treatise on the bark of the brain, writes that this consists of an abundance of very small glands that spring in the twisting wrinkles; and apparently pressed against each other, constitute the external surface of the brain. After I filled the blood vessels with such a great accuracy that the smallest branches were filled and appeared like down, we may clearly see that the bark-like substance of the brain consists merely of joined blood vessels (Ruysch, 1744, p.350)

Figure 5. Brain preparation (air is blown between the pia mater and arachnoid)

One of the figures in the Opera Omnia (Tablet 10, Figure 5) “shows the head of a young man that has been kept for several years already as if it was alive” and shows a “small tube put between the arachnoid and pia mater so that these will yield by wind blown between.” Another figure shows the lifted arachnoid. Another interesting figure depicted in his Opera Omnia is that of “the brain taken from the skull of an approximately 10-year-old boy, to which is added the course of the arteries spread out through the pia mater, as well as the emerging nerves from the medulla oblongata.” (See Figure 6.) Ruysch and his contemporaries distinguished 10 cranial nerves. “Our” 7th and 8th were considered one pair. Only at the end of the 18th century, German physician Thomas von Sömmering (1755-1830) described 12 cranial nerves.

Figure 6. Brain preparation with arteries and 10 cranial nerves.

Ruysch as Physician

In this period, many physicians published case reports, and so did Ruysch. Usually, disorders of the whole body were discussed a capite ad calcem [from head to feet]. In his Hundred anatomical and surgical comments, several are of neurological interest. Case 34 describes a “child with a spine split in two” as well as a “lumbar growth” (Spina bifida; Figure 7). The child also suffered from hydrocephalus.

Figure 7. Spina bifida and split spine.

“When we have examined this growth meticulously, we will see clearly that this is a dropsy of a part of the spinal cord and that this is the same ailment as which is called hydrocephalus in the head of an infant.” Ruysch was aware of the grave prognosis. “With respect to the treatment of this ailment, it can hardly or never be dispelled. As none of the children that I have seen, survived.”

Referring to his Amsterdam colleague Nicolaas Tulp (1593-1674; of Rembrandt’s “Anatomical lesson of Dr. Tulp”) he warned not to open the cyst “as we experienced, when it is opened or burst, that death was precipitated.”

“A Headache that Stroke Root”

Another case describes the 18-year-old daughter of a merchant who suffered from headaches that did not react to the usual treatments. “Laxatives, bloodletting alternating from the feet and other locations, Spanish flies [used in the past for blistering, nowadays as aphrodiciacum], sniffing, cupping, etc. At last, she permitted an incision crosswise on the skull … as proposed by us, upon which a considerable amount of blood was lost, but with the slightest relief.” Ruysch now intended to perforate the skull with a small drill,” but beforehand tried a seton on the skin of the neck.

“Soon after the start of this treatment, the pains disappeared.” After a few days, she removed the seton, after which the headache recurred, but after the installment of a new seton, “the pains that tormented her stopped immediately and being more prudent than the first time, she kept it until nature expelled the seton.” Following a third seton, the headache did not recur at all, and she “started to live cheerfully and merrily and she remained in this condition up to the present.”

One of Rachel Ruysch’s flower still lifes (courtesy Rijksmuseum, Amsterdam).

Apparently, the case report had impressed Gerard van Swieten (1700-1772), who published it in his own Commentaries on the Aphorisms of Boerhaave (his Leiden teacher). This practice was not unusual in those days.

In 1715, Ruysch became fellow of the prestigious Royal Society and continued to teach anatomy up to the age of 85. He received letters, of which he was only able to answer a quarter. He received famous foreign physicians, including his former pupil, the Danish-born French anatomist Jakob Winslow (1669-1750), who had become a member of the Académie de Sciences in Paris. He referred to Ruysch as “plus grand pionnier parmi les anatomistes de ce siècle” [the greatest pioneer among the anatomists of the century].

Another visitor was the French surgeon Guillaume Desnoues (1650-1735) well-known by his wax anatomy model) who, in the guest book of Ruysch’s cabinet, wrote, “qu’il a surpassé les autres anatomistes dans les injections des vesseaux” [that he had surpassed other anatomists by injections into blood vessels].

Ruysch died at age 93 in 1731. His daughter Rachel became a well-known painter of flower still lifes, many of which are displayed at the Rijksmuseum in Amsterdam (See Figure 8.) •

Literature
Koehler PJ, Boes CJ. A history of non-drug treatment in headache, particularly migraine. Brain 2010;133:2489-500.

Kooijmans L. De doodskunstenaar. De anatomische lessen van Frederik Ruysch. Houten, NTVG/Bohn Stafleu Van Loghum, 2004.

Ruysch W. Alle de ontleed- genees- en heelkundige werken. Amsterdam, Janssoons van Waesberge, 1744.

ICNMD 2018 Update

By Wolfgang Grisold, MD

The 15th International Congress on Neuromuscular Diseases (ICNMD 2018) took place July 6-10 in Vienna, Austria. The congress was organized on behalf of the Applied Research Group on Neuromuscular Disorders of the World Federation of Neurology.

There were participants from 69 countries at the ICNMD 2018. The distribution from the top 6 represented countries is shown here.

The venue for ICNMD 2018 was Austria’s largest conference hotel, the Hilton Vienna Am Stadtpark. Combining the magnificent location in the heart of the city with great amenities and services, the Hilton Vienna provided the perfect location for the meeting.

For the first time, a conjoint meeting was organized with the European Federation of Autonomic Societies (EFAS). Joint sessions were organized with the Peripheral Nerve Society (PNS) and the European Neuromuscular Centre (ENMC).

The congress was attended by over 1,450 delegates from 69 countries, which made it a truly international event. This great participation showed that there is a continuous need for neuromuscular research and treatment worldwide.

The meeting was preceded by a day of teaching courses. For the first time, a hands-on teaching course in cooperation with the Anatomical Institute of the City of Vienna was organized by Prof. Meng. Only a small group of participants were able to participate in this course and experience ultrasound on anatomic specimens, which were also demonstrated in detail later in the course. Participants received a botulinum toxin introduction, which was presented by Prof. Truong.

Scientific Program Development

For the scientific program development, the online blogging tool “Basecamp” was used. The blog contained a headquarter channel, and each topic channel and its content access was limited to ICNMD committee members and organizers. The general congress information and program development announcements were delivered by the organizers via the headquarter channel, and the program ideas were shared by committee members, each via topic channels that they specialize in. This sharing blogging system gave the whole committee an interactive program development process, which was highly appreciated by the individual members.

Public Patient Day

For the first time, ICNMD also hosted a Public Patient Day (held in German only). More than 70 people participated in the Public Patient Day raising questions on neuropathy, muscle disease, and myasthenia among others.

Opening Ceremony

The ICNMD 2018 Opening Ceremony represented the Austrian as well as the Viennese culture. Classical music by Franz Schubert and typical Carinthian folklore built the musical framework for the official opening of ICNMD 2018.

Prof. Wolfgang Grisold, ICNMD 2018 Congress president and Master of Ceremony, had the honor of welcoming Mag. Beate Hartinger-Klein, the Austrian Minister of Health, Prof. John England (ICNMD) and Prof. Walter Struhal (EFAS 2018 president).

Dr. Laïla Belarabi in front of her poster at the ICNMD 2018 in Vienna. She is the recipient of the ICNMD-WFN training position in Rabat, and was invited by the ICNMD congress to attend the Vienna meeting.

Furthermore, the ICNMD – WFN Fellow Program Winner, Dr. Laila Belarabi, training in Rabat, was honored during the ICNMD opening ceremony.

Scientific Program

The scientific program was divided into four main topics: muscle disease, peripheral neuropathy, motor neuron disease and neuromuscular junction. Each congress day was devoted to one of these topics and started with a plenary session followed by scientific breakout sessions and problem-oriented workshops.

ICNMD 2018 incorporated innovative ideas into its scientific program which introduced overarching sessions and joint sessions with EFAS, Peripheral Nerve Society (PNS), and European Neuromuscular Centers societies. The congress also brought new subtopics such as cranial nerve diseases and aspects of cancer on the PNS.

Another innovation was an interactive virtual session with an HIV Research Center in Cape Town, South Africa. Three cases were presented virtually by speakers from Cape Town, which were discussed live with the audience at the congress in Vienna.

This new session type helped in solving an unforeseen speaker travel issue where one of the plenary speakers was unable to travel from Japan. He was able to use the same virtual session method to deliver his presentation virtually as well as interact with delegates in real time.

The well attended plenary sessions were recorded onsite, and the videos will be made available to the delegates on the congress website as well as the WFN website.

This meeting also demonstrates the important need for interdisciplinary and multiprofessional collaboration.

The congress was able to present several new treatments, and new therapies such as gene therapy, enzyme replacement therapy, new immune therapies, and others mark a new area in the treatment of neuromuscular disease. These novel concepts were not only part of the scientific sessions, but also several industry supported satellite symposia of high quality. High traffic and much interaction in the exhibit hall allowed delegates and exhibitors to network and share the most up-to-date information in the field.

In addition to the neuromuscular topics, the congress also integrated palliative care and patient related issues into the program. Several historical epochs also were discussed in the history session.

Poster Sessions

A total of 357 posters were presented throughout the three guided poster sessions. All posters were reviewed onsite by the invited poster chairs using a mobile-friendly poster rating page. Based on the submitted evaluation results, eight Best Poster Award winners were selected, and the winners received a certificate and Viennese souvenir during the closing ceremony.

EACCME

ICNMD2018 has been accredited by the European Accreditation Council for Continuing Medical Education (EACCME®) with 34 European CME credits (ECMEC®s). Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians may convert EACCME® credits to an equivalent number of AMA PRA Category 1 Credits™.

Networking Events

To round out the extensive scientific program and to allow more time for delegates to visit with colleagues, the congress offered various networking opportunities.

The President’s Committee Mystery Dinner (invitation only) showcased the beauty of the Danube with a short boat ride followed by a traditional Austrian fish dinner in a traditional Austrian restaurant along the river.

The ICNMD 2018 Congress Dinner was held at the historic Vienna Town Hall. This prestigious venue represented traditional Viennese flair. After a delicious Austrian dinner, participants were introduced to the Waltz and could give it a try themselves.

Finally, delegates were invited to a Heurigen Evening, a traditional Viennese wine tavern where delegates enjoyed the typical Viennese “Gemütlichkeit” by enjoying some delicious Austrian dishes and wines.

The closing ceremony highlighted the great success of ICNMD 2018. Prof. Juan Jesús Vílchez Padilla was inaugurated as the congress president for ICNMD 2020 with the traditional handover of the ICNMD trophy, a wooden stick carved by indigenous communities of the city of Vancouver.

The 16th International Congress on Neuromuscular Diseases (ICNMD 2020) will take place July 10-14, 2020 in Valencia, Spain. ICNMD 2022 will take place in Brussels, Belgium.

The international cooperation needed to organize and develop the scientific content by the congress and scientific committee worked smoothly.

Welcome to Valencia in 2020, and we do hope that the present speed of drug development for neuromuscular diseases continues, or even increases. •