Dr. Francisco Javier Lopera Restrepo (1951-2024)

The legacy of this Alzheimer’s researcher was to live life as it came.

By Natalia Acosta-Baena, AND Ricardo Nitrini

Francisco Javier Lopera Restrepo passed away on Sept. 10, 2024, a great loss for his family, friends, collaborators, for all of science, and for neurosciences in Latin America. He leaves the advances brought by his studies as well as a great legacy that includes important developments and a large number of high-quality disciples.

Dr. Lopera was born on June 10, 1951, in Aragón, a small town in Santa Rosa de Osos, a municipality of Antioquia, Colombia. He came from a rural family with strong roots. His parents taught him everything he practiced. From his mother, he got his drive and humility. From his father, his love for knowledge. One anecdote he shared recalled when his father bought all his children a Larousse dictionary and exclaimed: “The summary of knowledge.” His mother sewed shorts from sackcloth for each of her 13 children. She also always knew how to make sure they were well. When Dr. Lopera got married, the bride’s father told her: “Remember that you are also marrying science.” And so it was. His life was neuroscience.

After receiving the title of neurologist, when he left Colombia in 1987 to complete his neuropsychology training at the Catholic University of Louvain, Belgium, he carried under his arm the genealogies of the families with early Alzheimer’s that he had identified and described while he was a neurology resident.1 But nobody paid attention to him.

He returned to Colombia in 1989 and served as coordinator of the Neurosciences Group of the University of Antioquia (GNA). It was not until 1995 that a mutation (E280A) was found in the presenilin 1 gene, in collaboration with Kenneth Kosik and Alison Goate.2  A longitudinal follow-up was carried out on all subjects identified to date, and 15 years later, a description was made of the natural evolution of the disease in this population, identifying the ages of onset for the preclinical and clinical stages.3

This study was the only one carried out solely by Colombian researchers. It was crucial for the design of the clinical trial with crenezumab that came later, and it was the basis for determining the ages of the cohort and detecting protective genes. The beginning of gains and strength in research in Colombia and Latin America arrived in the 2000s.

Alzheimer’s Research

Much will be written about the importance of Dr. Lopera for advancing knowledge about Alzheimer’s disease, but there are some aspects that may be considered more important for the entire research community, especially for those from low- and middle-income countries.

Most of Dr. Lopera’s publications are about autosomal dominant Alzheimer’s disease caused by the E280A mutation of the presenilin 1 gene. From his careful studies of this kindred, he was able to obtain enough data to transform it into the world’s largest autosomal dominant Alzheimer’s disease kindred, which contributed to the knowledge of several steps in the evolution of Alzheimer’s disease.

There were two groups of studies that came from Dr. Lopera’s research. The first group made it possible to verify the first changes in biomarkers, the time interval between these changes and the first symptoms hallmarking the onset of dementia. These discoveries revealed that the interval between changes in biomarkers and dementia is greater than 20 years.3,4

The second group is related to the case of a patient named Aliria who, having the E280A mutation of presenilin 1, did not develop mild cognitive impairment until her 70s, three decades after the expected age of clinical onset.3,5 Aliria died at the age of 77 without dementia; the average age at which dementia occurs in the disease caused by this mutation is about 49 years.5,6 

The neuropathological examination confirmed the presence of unusually high brain amyloid levels and limited tau and neurodegenerative measurements,6 which had already been revealed by amyloid and tau PETs performed years before.5 The patient had two copies of the APOE3 Christchurch (R136S) mutation, which points to the role of apolipoprotein E (APOE) in the pathogenesis, treatment, and prevention of Alzheimer’s disease.5,6

Lifetime Achievements

These and many other contributions made by Dr. Lopera were rightly awarded, most notably the Bengt Winblad Lifetime Achievement Award, presented by the Alzheimer’s Association in 2020, and the Potamkin Prize (often called the “Nobel Prize of Alzheimer’s Research”) from the American Academy of Neurology (AAN) and the American Brain Foundation (ABF) in 2024.

In addition to the importance of these studies for scientific knowledge, there is much to be learned from them by all researchers in Latin America.

First, Dr. Lopera demonstrated tenacity, persistence, focus, and the firm conviction that this work would lead to additional important discoveries. Between the first publication on this autosomal dominant Alzheimer’s disease and the Aliria case, 32 years of continued studies passed.1,5

Second, but no less important, Dr. Lopera had good collaborators among his colleagues and students. He also chose the best international collaborators who did not look at a researcher from a low- and middle-income country as a mere data provider to enrich their own research. Even though he would not have achieved this depth of research without international collaboration, Dr. Lopera always remained the main researcher and unquestionable leader of his publications.

Like many neurologists of his time, Dr. Lopera began studying dementia through studies in neuropsychology, as can be seen from some articles on these topics among his first publications.7,8 During his career, he also kept an in-depth knowledge of cognitive and behavioral neurology.

Another highlight of Dr. Lopera’s career is the research with social commitment that he sought to develop. For example, he conducted field work to evaluate patients with a social plan, where the genetic risk of the disease was disclosed along with the possibility of monitoring and accompanying the sick. Researching patients and helping to improve their quality of life at the same time was somewhat revolutionary. Maintaining a balance between consent without falling into coercion continues to be a significant challenge in vulnerable populations.

Face of Hope

The social plan was consolidated to improve the living conditions of the sick and their caregivers with money from some projects. Support groups, dance, painting, rehabilitation, and mental health were included in the course of the Global Neurology Academy (GNA) learning process. Diapers and wheelchairs were more useful to people than any medication. Unfortunately, it is still the same. And that is why Dr. Lopera used the social plan when starting any clinical trial in these families. Every year, GNA celebrated Christmas with all of the research participants.

Dr. Lopera defended the idea that if one day a medicine tested on this population proves effective, the families of Colombia should be compensated. The thousands of patients in Colombia saw in him the face of hope. They remind us of a worldwide desire: a life-changing medicine that can also be distributed with equity and justice.

Dr. Lopera was a joyful person. He enjoyed food, music, dancing, and everything that life gave him. “Live life as it comes” was one of his last thoughts. Words consistent with his medical practice when speaking to the patients who need to be reminded that they can live with Alzheimer’s. •

Natalia Acosta-Baena is a researcher with Grupo de Neurociencias de Antioquia (GNA), Facultad de Medicina at the Universidad de Antioquia, Colombia. Ricardo Nitrini is a senior professor of neurology with Grupo de Neurologia Cognitiva e do Comportamento (GNCC), Faculdade de Medicina da Universidade de São Paulo, Brazil.

References:

1. Cornejo, W., Lopera, F., Uribe, C. S., & Salinas, M. (1987). Descripción de una familia con demencia presenil tipo Alzheimer. Acta Médica Colombiana, 12(2), 55-61. https://www.actamedicacolombiana.com/ojs/index.php/actamed/article/view/3695.

2. Alzheimer’s Disease Collaborative Group. The structure of the presenilin 1 (S182) gene and identification of six novel mutations in early onset AD families. Nat Genet. 1995 Oct;11(2):219-22. doi: 10.1038/ng1095-219. PMID: 7550356.

3. Acosta-Baena N, Sepulveda-Falla D, Lopera-Gómez CM, Jaramillo-Elorza MC, Moreno S, Aguirre-Acevedo DC, Saldarriaga A, Lopera F. Pre-dementia clinical stages in presenilin 1 E280A familial early-onset Alzheimer’s disease: a retrospective cohort study. Lancet Neurol. 2011 Mar;10(3):213-20. doi: 10.1016/S1474-4422(10)70323-9. Epub 2011 Feb 4. PMID: 21296022.

4. Reiman EM, Quiroz YT, Fleisher AS, Chen K, Velez-Pardo C, Jimenez-Del-Rio M, Fagan AM, Shah AR, Alvarez S, Arbelaez A, Giraldo M, Acosta-Baena N, Sperling RA, Dickerson B, Stern CE, Tirado V, Munoz C, Reiman RA, Huentelman MJ, Alexander GE, Langbaum JB, Kosik KS, Tariot PN, Lopera F. Brain imaging and fluid biomarker analysis in young adults at genetic risk for autosomal dominant Alzheimer’s disease in the presenilin 1 E280A kindred: a case-control study. Lancet Neurol. 2012 Dec;11(12):1048-56. doi: 10.1016/S1474-4422(12)70228-4. Epub 2012 Nov 6. PMID: 23137948; PMCID: PMC4181671.

5. Arboleda-Velasquez JF, Lopera F, O’Hare M, Delgado-Tirado S, Marino C, Chmielewska N, Saez-Torres KL, Amarnani D, Schultz AP, Sperling RA, Leyton-Cifuentes D, Chen K, Baena A, Aguillon D, Rios-Romenets S, Giraldo M, Guzmán-Vélez E, Norton DJ, Pardilla-Delgado E, Artola A, Sanchez JS, Acosta-Uribe J, Lalli M, Kosik KS, Huentelman MJ, Zetterberg H, Blennow K, Reiman RA, Luo J, Chen Y, Thiyyagura P, Su Y, Jun GR, Naymik M, Gai X, Bootwalla M, Ji J, Shen L, Miller JB, Kim LA, Tariot PN, Johnson KA, Reiman EM, Quiroz YT. Resistance to autosomal dominant Alzheimer’s disease in an APOE3 Christchurch homozygote: a case report. Nat Med. 2019 Nov;25(11):1680-1683. doi: 10.1038/s41591-019-0611-3. Epub 2019 Nov 4. PMID: 31686034; PMCID: PMC6898984.

6. Sepulveda-Falla D, Sanchez JS, Almeida MC, Boassa D, Acosta-Uribe J, Vila-Castelar C, Ramirez-Gomez L, Baena A, Aguillon D, Villalba-Moreno ND, Littau JL, Villegas A, Beach TG, White CL 3rd, Ellisman M, Krasemann S, Glatzel M, Johnson KA, Sperling RA, Reiman EM, Arboleda-Velasquez JF, Kosik KS, Lopera F, Quiroz YT. Distinct tau neuropathology and cellular profiles of an APOE3 Christchurch homozygote protected against autosomal dominant Alzheimer’s dementia. Acta Neuropathol. 2022 Sep;144(3):589-601. doi: 10.1007/s00401-022-02467-8. Epub 2022 Jul 15. PMID: 35838824; PMCID: PMC9381462.

7. Lopera F. Procesamiento de caras: bases neurológicas, trastornos y evaluación [Procesing of faces: neurological bases, disorders and evaluation]. Rev Neurol. 2000 Mar 1-15;30(5):486-90. Spanish. PMID: 10775980.

8. Sierra M, Lopera F, Lambert MV, Phillips ML, David AS. Separating depersonalisation and derealisation: the relevance of the “lesion method.” J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):530-2. doi: 10.1136/jnnp.72.4.530. PMID: 11909918; PMCID: PMC1737835.

Central African Neurology Takes Center Stage

The Hybrid Presidential Symposium of the Fourth Congress of the Cameroon Academy of Neurology.

By Daniel Gams Massi

Daniel Gams Massi

During its fourth congress from Oct. 18-20, 2024, in Douala, the Cameroon Academy of Neurology (CAN) organized its second hybrid Presidential Symposium. This session was enhanced by the participation of Profs. Wolfgang Grisold, president of the World Federation of Neurology (WFN), Prof. Lawrence Tucker, president of the African Academy of Neurology (AFAN), Prof. Amadou Gallo Diop, immediate past-director of the WFN Training Center of Dakar, Senegal, and Prof. Riadh Gouider, past trustee of the WFN and head of the neurology department of Razi University Hospital in Tunis. The symposium was chaired by Dr. Daniel Gams Massi, CAN secretary-general and AFAN treasurer.

Prof. Grisold opened the symposium with a presentation on the implementation of the Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders (IGAP). He outlined the concept of brain health and its five dimensions: advocacy, research, therapy, public health, and prevention. He also presented the vision, goals, and strategic objectives of IGAP:

  • Raise policy prioritization and strengthen governance
  • Provide effective, timely, and responsive diagnosis, treatment, and care
  • Implement strategies for promotion and prevention
  • Foster research and innovation and strengthen information systems
  • Strengthen the public health approach to epilepsy

Prof. Wolfgang Grisold gave an online talk on implementation of IGAP in Africa.

The audience was able to see the essential role the WFN plays in the implementation and promotion of IGAP worldwide, as well as the many opportunities the WFN offers for the development of neurology in Africa through training, research, and advocacy. This is an opportunity to recall that for several years the WFN has contributed to the training of Cameroonian neurologists through various programs. And through Education in Headache to Health Care Providers in Africa, the WFN also contributes to the continuing education of health care professionals in Cameroon.

Prof. Diop illustrated the idea of ​​the African neurologist of tomorrow. He said that to carry out his missions, the African neurologist must be a good clinician, an ambitious researcher, a dedicated trainer, a skilled communicator, a community actor close to the population, and a citizen of the world capable of collaborating with African and foreign partners.

The WFN Training Center of Dakar has trained and continues to train several Cameroonian neurologists. Prof. Gouider spoke about the challenges in the African integration of this neurology training, including how Africa’s rich ethnic, cultural, and linguistic diversities may contribute to constraints on this integration. Other contributing factors include a lack of human resources due to significant disparities in the numbers of doctors and neurologists, insufficient specialized center structures, and a lack of diagnostic resources and treatment.

Despite these issues, there is hope because the number of neurologists trained in the continent has increased with the contribution of the WFN Training Centers in Senegal, South Africa, Egypt, Morocco, Tunisia, and several more recent Training Centers in Sub-Saharan Africa. However, the number of trained neurologists remains largely insufficient, especially in the context of brain drain as more qualified individuals leave the area.

The audience during the hybrid Presidential Symposium.

Although Africa has historically been one of the cradles of neurology research going back to ancient Egypt, it contributes little to modern global research. These challenges can be addressed by reinforcing intra-African and international collaborations.

The symposium was closed by Prof. Tucker who discussed the integration of online training in EEG for residents and young neurologists. He shared the experience of the University of Cape Town’s online EEG course. It is a hybrid program with web-based courses, virtual seminars, and in-person clinical neurophysiology fellowships for recently qualified neurologists. Since 2018, numerous neurologists, neurology residents, and neurotechnologists from Africa and other continents have benefited from quality EEG training.

The symposium hosted 224 attendees, including neurologists, pediatric neurologists, neurosurgeons, pediatricians, psychiatrists, internists, residents of neurology, psychiatry, pediatrics, and general practitioners, nurses, and physiotherapists from 16 countries.

On behalf of the CAN, we would like to express our gratitude to the WFN and AFAN for the unconditional support of the activities of our young society throughout the years. These activities have contributed to educating community and health care professionals on neurological disease, and to the opportunity to train more neurologists through the opening of the University of Douala neurology Training Center in 2023.

Even if there is more work to be done, we know that by continuing these activities and working with our partners, we will be able to significantly improve access to quality neurological care for populations in Cameroon and Central Africa. •

Daniel Gams Massi, MD, is secretary-general of the Cameroon Academy of Neurology.

Gastronomy by Ali-bab, the Other Babinski

A tale of two brothers and one cookbook.

By Peter J. Koehler

Figure 1. Une leçon clinique à la Salpêtrière by André Brouillet (1887), oil on canvas, Paris, Musée de l’histoire de médecine.

In the introduction of a relatively well-known French cookbook, we find the following text: “Les principes fondamentaux de l’art culinaire sont très simples. (The basic principles of the culinary arts are very simple.)” Looking through the book, I doubt the recipes described are that simple. However, it is an interesting cookbook as it relates to neurology.

Two Brothers

The story begins in 1848, a year in which several revolutions took place in Europe, including in Poland. Fleeing this revolution, a Polish couple moved to Paris the following year, where two sons — Henri and Joseph — were born in 1855 and 1857, respectively. Henri attended the École des Mines, after which he worked in South America for about 20 years. After their parents’ deaths in the late 1890s, he returned to Paris and shared an apartment with his younger brother.1

Figure 2. Babinski sign from Arthur van Gehuchten’s 1908 film10 (the Belgian neurologist Van Gehuchten was the first to use the eponym in 1898).11

Meanwhile, Joseph studied medicine and served internships in various Parisian clinics during the 1880s. From November 1885 to October 1887, he was chef-de-clinique at the Salpêtrière under Jean-Martin Charcot (1825-1893), whose bicentennial will be celebrated in July 2025 in Paris. He also met Sigmund Freud (1856-1939), who visited Charcot during the winter of 1885-1886 and translated two of Charcot’s books into German.2 This was the period during which Charcot showed particular interest in the condition then called hysteria.3

Joseph, who later disagreed with his teacher about the condition, is depicted in the famous portrait from that clinic. (See Figure 1.) He is the bearded young man catching one of the patients, Blanche Wittmann (1859-1913) in his arms. The Norwegian writer Per Olov Enquist (b. 1934) wrote a novel about Blanche not long ago: The Story of Blanche and Marie (2004). A study on Blanche and other patients was published by Asti Hustvedt,4 the sister of novelist Siri Hustvedt, who referred to Charcot and the Salpêtrière in her novel What I Loved. Several famous people are depicted in the painting, including Pierre Marie, Georges Gilles de la Tourette, Henri Parinaud, and Désiré-Magloire Bourneville.5

Pathological Plantar Reflex

In 1890, Joseph became médecin des hôpitaux, and beginning in 1895, he worked as a neurologist at Hôpital de la Pitié. He was one of the neurologists who described several components of current neurological examination,6,7,8 the most famous of which is the pathological plantar reflex. It was named after him: the Babinski plantar sign (1896).9

At a time when there was no CT or MR scan — even pneumoencephalography and arterial encephalography had to wait a few decades12 — it was even more important than today to use this to distinguish organic paralysis from hysterical paralysis as it was then called. Nowadays, we would call it a functional disorder.13

Figure 3. Gastronomie Pratique by Ali-bab, first edition of 1907.

Surréalism

Joseph played an important role in the life of André Breton (1896-1966), the French poet and founder of surrealism. From January to September 1917, Breton worked as a student under Babinski at La Pitié. He ultimately did not take exams to become a physician. The Surrealist Manifesto of 1924 includes the following passage on this subject:

“I have seen the inventor of the cutaneous plantar reflex at work; he manipulated his subjects without respite, it was much more than an “examination” he was employing; it was obvious that he was following no set plan. Here and there he formulated a remark, distantly, without nonetheless setting down his needle, while his hammer was never still. He left to others the futile task of curing patients. He was wholly consumed by and devoted to that sacred fever.”

Besides neurology, Joseph had an interest in music and drama. He would often be seen at the Paris Opéra. In 1956, Breton revealed that Babinski was one of the authors of the play Les Détraquées (1920) written by Pierre Palau (1883-1966) “with Olaff’s help.” Olaff turned out to be a pseudonym of Joseph Babinski.14

Figure 4. Henri is smaller and more corpulent than Joseph Babinski.

Gastronomy

After suffering hardships in the interior of South America, Henri Babinski returned to Paris and moved into a bachelor apartment — at one point, the brothers lived on Boulevard Haussmann — to devote himself to cooking. The two brothers became inseparable. Joseph’s student Clovis Vincent (1879-1947), who later became a pioneer of French neurosurgery, wrote of them, “His brother and Joseph had a veritable cult for each other, which never waned. Joseph lived for his career and for science; Henri lived for Joseph. Without Henri, Joseph would ultimately have achieved much less.”1

Henri’s interest in gastronomy led to a second career. In 1907, he published Gastronomie Pratique, which was subsequently republished several times, even as recently as 2013.

Henri was smaller than his brother Joseph and corpulent. (See Figure 4.) The full title of the book is probably related to this: Gastronomie pratique. Études culinaires suivies du Traitement de l›Obésité des Gourmands (Practical Gastronomy. Culinary Studies Followed by Treatment of Obesity in Gourmands). Regarding the latter, Henri noted in the introduction, “Tous mes amis connaissent l’ancien obèse sujet principal de mon expérimentation; ils sont prêts à témoigner de la réalité de la cure, comme ils sont prèts à attester les qualités de ma cuisine. C’est sous leurs auspices que je présente ce petit livre au public. (All my friends know the former obese subject of my experimentation; they are willing to testify to the reality of the cure, just as they are willing to testify to the qualities of my cooking. It is under their auspices that I present this little book to the public.)”

Figure 5. English-language edition of Henri Babinski’s cookbook.

Ali-bab

Why Henri chose the pseudonym Ali-bab is not exactly known. Possibly “Ali” stands for “the other” Babinski, but several alternative possibilities have been mentioned.1 The book was successful, given its many editions, and was widely acclaimed. A specialist in gastronomic literature, Gérard Oberlé (b. 1945), in his Les Fastes de Bacchus et de Comus, ou histoire du boire et du manger en Europe de l’Antiquité à nos jours, à travers les livres (The Annals of Bacchus and Comus, or the history of eating and drinking in Europe from antiquity to the present day, through books), wrote the following about Gastronomie Pratique: “one of the most famous recipe collections of the 20th century. … Contrary to what he claims in the preface, not everyone is up to the challenge of Babinski’s dishes. You have to be quite well-off to afford the ingredients and be well versed in the art of cooking. Lots of truffles, fat capons, sauterne sauces, and foie gras.”

An enjoyer of the culinary life, Ali-bab, or Henri, wrote on the last page of his book, “ … s’il est indécent de vivre pour manger, il convient, tout en mangeant pour vivre, de chercher à s’acquitter de cette tâche, comme de toutes les autres, de son mieux, avec plaisir (… if it is indecent to live to eat, it is advisable, while eating to live, to try to perform this task, like all others, to the best of your ability, with pleasure).”

Figure 6a. Cervelle de veau sauce hollandaise à la ravigotte.

On the occasion of my PhD on a medical history topic in 1989, I received a copy of Gastronomie Pratique from my teacher Lambertus J. Endtz (1927-1989). Although I must confess that I have never used a recipe from the book — after all, I do not have that gift that Ali-bab mentions in the introduction: “les cuisiniers habiles voient le moment précis où la cuisson est à point, ils ont l’instinct des proportions de condiments qu’il convient d’employer. (skilled cooks who see the exact moment when a dish is perfectly cooked and have an instinct for the right proportions of the condiments to be used.)”

I want to challenge readers to take a look at this book. Although it is still sold in bookstores, it is also available for download from the internet.15 There is even an English-language edition, in fact enlarged to become an encyclopedia. (See Figure 5.)16

Figure 6b. Cervelle de veau (uit de Engelse editie).

Brains and Truffles

The following recipe may be something his brother Joseph enjoyed: Cervelle de veau sauce hollandaise à la ravigotte (Calf’s brains with hollandaise sauce à la ravigotte).8 (See Figure 6a.)

Figure 7. Filets de levraut rôtis sauce aux truffes.

In the English edition, I found the following translation. (See Figure 6b.)

Should you manage to get your hands on truffles — at the Alba auction in Piedmont, Italy, they go for several tens of thousands of Euros17 — I can recommend Filets de levraut rôtis sauce aux truffes (roasted young hare fillets with truffle sauce.)(See Figure 7.)

I was unable to find this dish in the English translation. Fortunately, it contains many other dishes that may be easier to prepare today, such as Pot-au-feu de famille, which Gastronomie Pratique begins with. •

References:

1. Philippon J, Poirier J. Joseph Babinski. A Biography. Oxford University Press, 2009.

2. Koehler PJ. Freud’s comparative study of hysterical and organic paralyses: how Charcot’s assignment turned out. Arch Neurol. 2003 Nov;60(11):1646-50.

3. Goetz CG, Bonduelle M, Gelfand T. Charcot: Constructing Neurology. New York, Oxford University Press, 1995.

4. Hustvedt A. Medical Muses. Hysteria in Nineteenth Century Paris. London, Bloomsbury, 2011.

5. See SHMR-95: Le docteur Joseph Babinski (shmr95.fr); accessed October 5, 2024.

6. Okun MS, Koehler PJ. Babinski’s clinical differentiation of organic paralysis from hysterical paralysis: effect on US neurology. Arch Neurol. 2004 May;61(5):778-83.

7. Koehler PJ, Okun MS. Important observations prior to the description of the Hoover sign. Neurology. 2004 Nov 9;63(9):1693-7.

8. Voogd J, Koehler PJ. Historic notes on anatomic, physiologic, and clinical research on the cerebellum. Handb Clin Neurol. 2018;154:3-26.

9. Van Gijn J. The Babinski sign: a centenary. Utrecht University, Publication Department.

10. Aubert G. Arthur van Gehuchten takes neurology to the movies. Neurology. 2002 Nov 26;59(10):1612-8.

11. Van Gijn J. Babinski’s sign. In: Koehler PJ, Bruyn GW, Pearce JMS. Neurological Eponyms, New York, Oxford University Press, 2000, p. 117.

12. Lutters B, Koehler PJ. Cerebral pneumography and the 20th century localization of brain tumours. Brain. 2018 Mar 1;141(3):927-933.

13. Stone J. Neurologic approaches to hysteria, psychogenic and functional disorders from the late 19th century onwards. Handb Clin Neurol. 2016;139:25-36.

14. Haan J, Koehler PJ, Bogousslavsky J. Neurology and surrealism: André Breton and Joseph Babinski. Brain. 2012 Dec;135(Pt 12):3830-8.

15. Original French edition of 1907 : Gastronomie pratique: études culinaires suivies du Traitement de l’obésité…: Ali-Bab: Free Download, Borrow, and Streaming: Internet Archive

16. Engelse editie uit 1973: The encyclopedia of practical gastronomy: Ali-Bab, 1855-1931: Free Download, Borrow, and StreamingInternet Archive; accessed November 10th, 2024.

17. Alba White Truffle World Auction (castellogrinzane.com); accessed November 10th, 2024.

Dr. Andrew Engel (1930-2024)

The award-winning neuromuscular clinician, educator, and researcher made many contributions in neuromuscular disease research.

By Duygu Selcen, MD and P. James B. Dyck, MD 

Dr. Andrew Engel

Dr. Andrew Engel, one of the legends in the field of neuromuscular disease, passed away on Oct. 20, 2024.

Dr. Engel was born in Budapest, Hungary, and immigrated to the United States in his teens with his family. He earned his medical degree from McGill University in 1955 with a gold medal for achieving the highest academic standing upon graduation. After an internship at Philadelphia General Hospital, he began an internal medicine residency at the Mayo Clinic, but his training was interrupted in 1958 when he had to sign up for National Service. He chose the U.S. Public Health Service where he was eventually assigned to the Division of Neurology directed by G. Milton Shy at the National Institutes of Health.

During this period, he decided to become a neurologist. In 1960, he returned to the Mayo Clinic to complete his training in internal medicine and neurology. From 1962 to 1965, he was a postdoctoral fellow in neuropathology at Columbia University in New York. In 1965, Dr. Engel was appointed to the staff of the Mayo Clinic in Rochester, Minnesota.

Dr. Engel was an internationally renowned neuromuscular clinician, educator, and researcher whose impact on the field truly cannot be overstated. He was a beacon of excellence in the field of neuromuscular diseases, cherished by patients as an astute and caring clinician, nurturing numerous fellows as a dedicated mentor and teacher, and sharing his expertise in muscle pathology, biochemistry, electrophysiology, and molecular genetics. Dr. Engel discovered many novel neuromuscular diseases and unraveled the pathogenesis of many others. His contributions to the field over the decades have been extraordinary.

Dr. Engel wrote more than 350 peer-reviewed papers and numerous reviews. He also edited and was a key contributor to three editions of “Myology: Basic and Clinical,” the most highly regarded text in the field. Dr. Engel’s remarkable accomplishments in the field of neuroscience have been recognized with many awards and accolades, including:

  • The Jacob Javits Neuroscience Investigator Award (twice)
  • The Duchenne-Erb-Prize of the German Muscular Dystrophy Group
  • The Jerry Lewis Research Award from the Muscular Dystrophy Association
  • The Carrell-Krusen Award from the Texas Scottish Rite Hospital for Children
  • The Bernard Sachs Award of the Child Neurology Society
  • The Gaetano Conte Prize of the Mediterranean Society of Myology
  • The Lifetime Achievement Award for Neuromuscular Diseases by the World Federation of Neurology

In 1994, he presented the prestigious Wartenberg Lecture at the American Academy of Neurology (AAN), and in the same year, the Mayo Clinic honored him with the Distinguished Investigator Award. He was awarded honorary membership in the AAN, American Neurological Association (ANA), and the European, German, and Spanish Societies of Neurology. In 2003, he was elected to the Institute of Medicine of the National Academy of Science.

We are privileged to have learned and worked alongside such an amazing colleague. We will miss him greatly. Andy’s legacy will live on through his colleagues, collaborators, and countless former mentees here at Mayo Clinic and throughout the world. •

Dr. Duygu Selcen is a consultant and professor of neurology and pediatrics at the Mayo Clinic. Dr. P. James Dyck is a professor and consultant neurologist at the Mayo Clinic.

Rethinking High-Risk Strategies in Stroke Prevention

Primary health care providers and the Stroke Center at Central City Clinical Hospital in Almaty, Kazakhstan, collaborate on stroke prevention.

By Aida Kondybayeva

Aida Kondybayeva, MD, PhD, FEAN, Head of the Scientific and Educational Center for Neurology and Applied Neurosciences» at Asfendiyarov Kazakh National Medical University.

Aliya Abenova PhD, Deputy Director for Medical Affairs, Central City Clinical Hospital, Almaty.

“Stroke and Cardiovascular Disease Prevention: Time to Action!” was the theme of a World Stroke Day event, which was held on Nov. 5, 2024, at the Central City Clinical Hospital in Almaty, Kazakhstan. Organized by Asfendiyarov Kazakh National Medical University and the Central City Clinical Hospital of Almaty, the meeting brought together health care professionals to discuss new approaches in stroke prevention.

The speakers shared current data on a range of topics:

  • Aziz Ismailov, head of the Stroke Center at Central City Clinical Hospital in Almaty, presented statistics and key indicators of the center’s work.
  • Makpal Makasheva, a medical expert from the Situational-Analytical Center at Outpatient Clinic 4 in Almaty, shared an analysis of stroke and cardiovascular diseases in the Bostandyk district.
  • Gauhar Kasenova, deputy director of outpatient services at City Hospital 5 in Almaty, discussed data from the Medeu district.
  • Aida Kondybayeva, MD, PhD, FEAN, head of the Scientific and Educational Center for Neurology and Applied Neurosciences at Asfendiyarov Kazakh National Medical University, highlighted the need to rethink approaches to stroke prevention.
  • Aliya Abenova, PhD, deputy medical director at Central City Clinical Hospital, discussed methods for preventing recurrent strokes and complications.

Aziz Ismailov, Head of the Stroke Center at the Central City Clinical Hospital, Almaty, speaks with panelists.

Faculty of the World Stroke Day event.

The discussions underscored the importance of establishing a strong and collaborative framework between primary health care (PHC) providers and specialized stroke centers to ensure a comprehensive approach to stroke prevention and patient care. This collaboration aims to bridge the gap between early intervention and specialized treatment, offering a continuum of care that addresses both preventive measures and timely response for high-risk patients.

Participants emphasized that by aligning efforts, PHC services, and stroke centers can create a more effective system that improves patient outcomes, reduces the risk of recurrent stroke events, and ultimately strengthens public health efforts in combating stroke-related challenges.

Aida Kondybayeva, MD, PhD, FEAN, is head of the Scientific and Educational Center for Neurology and Applied Neuroscience at Asfendiyarov Kazakh National Medical University.

Opinion | Lecanemab for Alzheimer’s: Not Just Yet

Readers should note that opinion pieces in World Neurology represent those of the author(s) and are not necessarily the opinions of the WFN, its trustees, or its member societies.

In this author’s opinion, this drug shows promise but isn’t quite ready.

By Raad Shakir, CBE FRCP

Raad Shakir

The whole world continues to wait for neuroscientists to come up with an effective treatment for Alzheimer’s disease. The condition attracts huge public interest, and there is intense focus on treatment availability. The “accumulation of soluble and insoluble aggregated amyloid-beta (Aβ) may initiate or potentiate pathological processes in Alzheimer’s disease. Lecanemab, a humanized IgG1 monoclonal antibody that binds with high affinity to Aβ soluble protofibrils, was tested in persons with early Alzheimer’s disease.”1

Neurologists had been waiting for the double-blind study confirming the efficacy of lecanemab in early Alzheimer’s and mild cognitive impairment (MCI). Alzheimer’s is the main cause of dementia with a high mortality needing huge resources globally. By 2050, the prevalence of dementia will double in Europe and triple globally.2 There is therefore an urgent global need to come up with a medication that is reasonably inexpensive, easy to transport, easy to administer, and widely available to counter this deadly pandemic.

The world as well as neurologists were rather optimistic when lecanemab passed its approval hurdle with the U.S. Food and Drug Administration (FDA).3 This approval came despite a black box safety warning because of side effects. This was soon followed by statements from the European Medicines Agency (EMA)4 and more recently the National Institute for Health and Care Excellent (NICE) of England and Wales. Both clearly stated that benefits of lecanemab are “just too small” to justify cost.5 However, the EMA revised its earlier decision to approve lecanemab in a small group that has one or no copy of the ApoE4 gene.6

Lecanemab must be administered by intravenous infusion in the hospital every two weeks. The individuals need to undergo exhaustive assessments. The clinical examination requires specialists in cognitive neurology, detailed psychology examinations, and imaging. The latter requires repeated MRI scanning before commencement and during treatment. Amyloid positron emission tomography (PET) is needed before and following the treatment. Physicians will need to have access to a cyclotron to obtain the isotope. All this is in addition to the cost of the drug, which is approximately $26,500 per patient per year.

Intense monitoring is required to detect amyloid related imaging abnormalities (ARIA) such as brain swelling and bleeding. ARIA is usually asymptomatic, although rarely serious, and life-threatening events can occur. Serious intracerebral hemorrhaging greater than 1 cm have occurred in patients treated with this class of medications.

Looking at the bare facts, lecanemab reduces the amyloid load significantly.1 However, the improvement in cognitive decline in the trial of those with MCI and early Alzheimer’s disease was modest, with a 27% reduction of decline after 18 months compared to placebo. This equates to slowing in disease progression of between four and six months.

All that said, there is no doubt that we could be seeing the dawn of Alzheimer’s disease treatment, albeit with a rather cumbersome drug with many side effects at an exorbitant cost. •

Dr. Raad Shakir is a professor in the Division of Brain Sciences at Imperial College in London. He is a previous WFN president and current chair of the WFN Nomination Committee.

References:

1. van Dyck CH, Swanson CJ, Aisen P, et al. Lecanemab in Early Alzheimer’s Disease. New Eng J Medicine 2023; 388: 9-21.

2. Scheltens P, De Strooper B, Kivipelto, M et al. Alzheimer’s Disease. Lancet 2021; 396:1577-90.

3. Mahase E. Alzheimer’s disease. Lecanemab gets full FDA approval and black box safety warning. Br Med J 2023; 382:1580.

4. Mahase E. Lecanemab: European drug agency rejects Alzheimer’s drug amid debate over efficacy and safety. Br Med J 2024;386: 1692.

5. Kmietowicz Z, Mahase E. Lacnemab: Benefits of Alzheimer’s drug are “just to small” to justify cost, says NICE. Br Med J 2024; 386:1853.

6. https://www.ema.europa.eu/en/news/meeting-highlights-committee-medicinal-products-human-use-chmp-11-14-november-2024.

WFN Digital Update and a Recap of the Council of Delegates Meeting

Prof. Wolfgang Grisold highlights the latest WFN events around the world.

By Prof. Wolfgang Grisold, FAAN

The World Federation of Neurology (WFN) now has 125 members, as we welcome our latest addition, Ghana. The WHO has 194 member states, which leaves 69 more members to become part of WFN.

The WFN owns several publications, including World Neurology (WN), which has an estimated readership of 25,000. WN focuses on news from the scientific societies, updates on developments, regional issues, and historical content, among other topics.

Our newly applied WFN Google Analytics reveal that countries with the highest interest in the WFN website are the U.S., India, and Great Britain, followed by a stable number of countries all over the world .

We recently launched an initiative called WFN Digital Update (WNU), which has helped us reach countries worldwide with educational and training opportunities. We also remind our readers our official journals, the Journal of the Neurological Sciences (JNS) and the eNS, serve in the interest of the WFN. The JNS features a regular Service Page, which will add to communications from WN along with the website and social media.

Another important initiative is the Global Advocacy and Leadership Program (GALP), a joint effort between the WFN and the American Academy of Neurology (AAN). We had great interest in the first event, with 94 applicants from 44 low/middle- and low-income countries. The goal is to provide young and middle-aged neurologists with the tools they need to advocate for patients in neurology and to be leaders in neurology. This policy of advocacy and leadership is especially important in countries where neurology is developing. Insights regarding leadership negotiations help the progress of neurology in those countries.

Advocacy is also one of the strategic tasks of the WHO International Global Action Plan (IGAP), which increases awareness of the growing need for advocacy around the world. The GALP course will begin in person at the AAN Annual Meeting April 5-9 in San Diego, and will have several virtual updates culminating in a second face-to-face meeting at the World Congress of Neurology (WCN) in Seoul, which will include a public graduation.

Our other virtual activities, such as the educational days, have proved successful. We anticipate a new educational day with the Asian and Oceanian Association of Neurology (AOAN) in February on movement disorders, and another educational day with Africa next year on neuroimmunology. For this year, we look forward to the International Headache Society-Global Patient Advocacy Coalition Headache Day that will be on Nov. 23.

Trustees at their London meeting in September 2024.

Council of Delegates

At the recent Council of Delegates (COD) meeting, we confirmed the results of the elections and carried motions for changes to our bylaws. On Sept. 24 and 25, the WFN`s elected and co-opted trustees held a face-to-face meeting in the London office. They also met with the participants in the WFN COD on Sept. 25, as a virtual meeting.

For the COD, 72 people participated and 58 member societies attended.The president, officers, and several committee chairs reported on WFN proceedings. There were four motions that were accepted:

  • Approval of the Auditors’ Report for 2023.
  • Reappointment of Griffin Stone Moscrop & Co. as auditors.
  • Change of the WFN bylaws to have a president-elect and a past-president in the future.
  • Acceptance of Ghana as the 125th member of the WFN.

As many societies have done already, the WFN will have the position of a president-elect, and the immediate past-president will remain on the board for one year following his or her term in office. This is necessary to preserve continuity, which is important for many of the long-term tasks of the WFN.

Future WFN presidents should have previously held office either as a trustee or acted as chair of a WFN committee for at least one year to gain insight and establish a profile within the organization. In the future, conflicts of interest need to be transparent for all officers and trustees. In particular, the WFN president must not hold an executive position in another scientific society.

The vote for the first president-elect will be in three years, and the first past-president will be the newly elected president who takes office in 2025.

Prof. Alla Guekht receiving a WFN plaque for her services as a trustee.

For this COD meeting, elections were held for the position of one trustee, replacing Prof. Alla Guekht, whose second term ended. Votes were received electronically from 52 member societies for a new trustee. Prof. Tissa Wijeratne, who was nominated by the Association of Sri Lankan Neurologists, was elected. He has been engaged in many WFN activities for many years, in particular World Brain Day. I want to thank all of the applicants for their efforts in running for this important position.

Prof. Minerva Lopez Ruiz receiving a plaque for her service as co-opted trustee representing Latin America.

Following the COD meeting, the president and the trustees thanked Prof. Guekht for her relentless devotion to the WFN. The co-opted trustees Prof. Maria Benabdeljlil and Prof. Minerva Lopez Ruiz were also recognized. All were awarded with a WFN plaque.

For the 2025 election, the positions of president, vice president, and one elected trustee (Prof. Chandrashekhar Meshram — re-electable once) will be up for election. The call for candidates will be made next year. We expect many suitable applicants who will engage to bring the WFN forward and increase the presence and importance of neurology.

Maria Benabdeljlil receiving the Plaque for her outstanding services as a co-opted trustee, representing the Arab and African region.

Following the COD meeting, the first WNU took place. The WNU 2024 was a virtual 2-day meeting moderated by Profs. Steven Lewis, Riadh Gouider, and Wolfgang Grisold live from the London office. We welcomed speakers from many societies and had excellent faculty and talks. The meeting was accredited by the European Accreditation Council for Continuing Medical Education with 9 CME points. Participants came from 60 countries.

This was the first virtual interim meeting of the WFN, and the aim was to fill the gap between the biennial WCN with necessary and timely updates. Many speakers have agreed to submit a summary of their lectures to the journal, which will be a source of information and is accessible as an Open Access journal.

The main pillars of the WFN are education and global activities. Please see our latest updates on education on the WFN Essentials page.

In 11 years, we have established four Training Centers in Africa. From these, we have three four-year training positions in Africa and several one-year fellowship opportunities for epilepsy, general neurology, neuromuscular disease, and stroke. For the last call, we had 165 applicants for a 4-year training position in Cape Town.

We are aware that the WFN Training Centers cannot fill the gap in Africa. However, the WFN Training Centers help to crystallize education, and increasingly other universities have started neurology training programs.

Countries participating in the WNU.

We are open to suggestions and are aware that there is a strong tendency for subspecialization in Africa. WFN Training Centers are selected based on their capabilities to provide excellent inpatient and outpatient services and are connected with a network of other medical and surgical fields to provide excellent training. We already have a large number of alumni and are encouraged by the success of our trainees. We are indebted to the Association of British Neurologists (ABN) for sharing our costs in Cairo, and to the constant support of the International Congress on Neuromuscular Diseases for one training position in neuromuscular disease in Rabat.

Empower the Regions

In addition to the careful selection of Training Centers, regular communication and updates are necessary. We plan to visit all the African WFN Training Centers in 2024 as well as the Latin American center in Mexico City. This year, we have already visited Cairo and Dakar and were impressed by the spirit and activities of those Training Centers. Moreover, we had the opportunity to speak with trainees and the local staff.

Prof. Bruno Giometto and Prof. Wolfgang Grisold opening the neuroscience program in Trento, Italy.

We are planning to visit Rabat and Cape Town this year and will be reporting on those visits and impressions soon in the JNS service pages. These will be formal site visits, speaking with trainers and trainees and looking at the opportunities and results of the past years. The visitation committee will consist of the co-chair of the Education Committee along with WFN Secretary General Prof. Steven Lewis and myself as the president of the WFN.

During our discussions with member societies, the idea was presented that young neurologists from high-income countries should be given the opportunity to spend time in low-income countries to learn from them and contribute their own knowledge on a local and regional level. We will develop this as a project with a small committee.

Young neurologists are heavily involved in some WFN committees, in particular in education, where the core curriculum is advancing. We seek further possibilities to extend this, but we know that it must be implemented on a solid foundation and will take time.

Education should start among students, and the WFN is grateful for the cooperation of the International Federation of Medical Students. An interesting initiative is a neuroscience training course for medical students, which was created by Prof. Bruno Giometto at the University of Trento in Trento, Italy. A detailed report will be published in the WFN Service Pages.

World Brain Day 2025 will focus on brain health, in combination with a subtopic, which is still being discussed. We believe brain health is a powerful summary of activities in neurology. For example, several countries in Europe have incorporated the concept of brain health into their national health policies. This could be a template for many parts of the world to deal with the issues of brain health, equity and access, healthy lifestyle, and implementation of sustainable development goals (SDGs). It may be an important step in the future and help all member societies to promote neurology.

Global Activities

WHO meeting on mental health in Geneva. Prof. Grisold speaking on the implementation of the IGAP.

Our global activities with the WHO continue to focus on promoting the IGAP, the Brain Health initiative — Defeating Meningitis by 2030, and promoting the use and implementation of the WHO Essential Medicines List (EML) globally. The WHO and U.N. sections of our website contain lists of WFN-WHO and WFN-Economic and Social Council (ECOSOC) activities from 2023 and 2024. The work with the WHO and the U.N. ECOSOC takes a lot of responsibility and time. We thank Prof. Guekht, our past trustee, and Ksenia Pochigewa, our WFN intern, as well as the London office for making this possible.

Our most recent WHO activity was our participation at the WHO Mental Health Forum 2024 on Oct. 9-10, in Geneva, Switzerland.

Mental health is closely connected with neurology. The designation of the WHO unit, Mental Health, Brain Health, and Substance Use, emphasizes this close relationship. The WFN had two interventions at this meeting: one on the cooperation between the WFN and the WHO, and another to promote IGAP. Many interactions with multiple stakeholders took place and reaffirm the presence and activity of the WFN in promoting neurology on a global stage.

2025 will be an important year for the WFN in regard to elections and leadership, the WCN in Seoul, educational activities such as the recently launched GALP projects, and plenty of other projects within the organization.

Please continue to follow us on our website and in our newsletter and journals. •

Brain Health and Cherry Blossoms

Biennial meeting of the WFN Aphasia, Dementia, and Cognitive Disorders Specialty Group in Japan.

By Dr. Aida Suárez-González, Prof. Morris Freedman, Prof. Manabu Ikeda, Dr. Yutaka Tanaka, Prof. Masaru Mimura, and Prof. Suvarna Alladi.

Attendees of the WFN Specialty Group ADCD biennial meeting at the entrance of the conference venue, Nara Kasugano International Forum at Nara Park.

The attendants for the 2024 biennial meeting of the WFN Aphasia, Dementia, and Cognitive Disorders Specialty Group (ADCD SG) arrived in Nara, Japan, about the same time as the sakura (Japanese cherry trees) reached full bloom. This served as a timely metaphor to usher in the four vibrant days of all things cognitive neurology that followed, elegantly wrapped in the most exquisite Japanese hospitality.

The venue of the meeting was the beautiful Nara Kasugano International Forum in Nara Park, surrounded by local deer and a short walk from the famous Todai-ji Buddhist temple. The activity was organized by ADCD chair Prof. Suvarna Alladi and local organizing chairs Prof. Manabu Ikeda and Dr. Yutaka Tanaka, in partnership with the Neuropsychology Association of Japan and the Japan Society for Higher Brain Function. This was a memorable meeting, with more than 50 attendees from around the world. (Most were also speakers at the various symposiums that built on the 54-year tradition of scientific meetings of the group.)

Panelists and attendees appreciated the opportunity to delve into the contributions of Japanese behavioral neurology, which was one of the highlights of the event. Other highlights included:

  • Plenary sessions delivered by Prof. Etsuro Mori on innovation in dementia studies, and Prof. Manabu Ikeda on prodromal stages of dementia and primary psychiatric diseases.
  • Symposiums on physiology and pathology of brain disease (Chair: Prof. Riki Matsumoto), Asian studies in posterior cortical atrophy (PCA) (Chair: Prof. Kyoko Suzuki), cerebral amyloid angiopathy (Chair: Prof. Akihiro Sindo), and PET imaging (Chair: Prof. Masaru Mimura).

Local organizers (left to right) Prof. Manabu Ikeda, Prof. Masaru Mimura, and Dr. Yutaka Tanaka with early career researchers and Dr. Boon Lead Tee (center), posters session chair, at the poster presentation.

Science Bridges Cultures

Learning from Japanese scientists in their homeland while immersed in their cultural heritage was a unique experience. It underscored the importance of the ADCD meetings to continue rotating around the world to favor multicultural exchange and inclusive and diverse behavioral neurology.

Diversity was indeed a central and transversal element with a tangible presence during the meeting. There were specific symposiums about cross-cultural investigations in frontotemporal dementia and primary progressive aphasia (PPA), chaired by Prof. Olivier Piguet, semantics in Alzheimer’s disease and PPA with strong emphasis on language diversity, chaired by Prof. Jet Vonk, and a symposium on diversity, disparity, and precision science in brain health, chaired by Prof. Suvarna Alladi. In this diverse context, we learned about the International Network for Cross-Linguistic Research on Brain Health (INCLUDE), which aims to foster cross-linguistic research on brain disorders to identify generalizable markers.

Attendees pose with Noh dancers after a performance (a classical Japanese dance drama) at the conference venue.

Prof. Carlo Semenza delivered the second day’s plenary talk on the contributions of the right hemisphere to calculation. Prof. Lisa Cipolotti chaired a symposium on recent research into executive function and reading, and Prof. Peter Nestor chaired sessions on PPA due to AD pathology. The latter symposium covered automated analysis of speech in biologically confirmed PPA, linguistic and imaging features in AD-related PPA, and core impairment of logogenic variant PPA.

The cerebral small vessel diseases (SVD) symposium — chaired by Dr. Masafumi Ihara and Prof. Raj Kalaria — covered the clinical, imaging, and physiopathology of SVD, CADASIL, CARASIL, and outcomes of young stroke survivors. Dr. Morris Freedman chaired the Virtual Behavioral Medicine Symposium in which his team presented the development and implementation by Baycrest Health Sciences of a novel model of care for neuropsychiatric symptoms in severe dementia in Ontario, Canada. Dr. Aida Suarez-Gonzalez and Prof. Peter Nestor, behavioral interventions and rehabilitation chairs, were featured in six talks on PCA, AD, aphasia, and behavioral and neuropsychiatric symptoms.

We also had a taste of noh dance and the art of ikebana alongside delicious Japanese gastronomy at the welcome dinner and throughout the conference. Many early career researchers presented, and on the last day, the poster session by young international researchers was a highlight. To quote Prof. Hitomi Sato from Tokyo, “Like the cherry blossoms, the conference was in full bloom with each passing day.”

(Left to right) Jagger Smith, Prof. Suvarna Alladi, Dr. Aida Suárez-González, Deb Galet, and Prof. Morris Freedman at the conference venue.

Fruitful scientific discussion and networking continued outside official conference hours in group walks around pagodas, zen gardens, and Shinto shrines. We know that the seeds of a few international collaborations were planted in those walks under vermillion torii gates.

During the business meeting, new chair Dr. Aida Suárez-González took over from Prof. Suvarna Alladi, Prof. Manabu Ikeda was appointed new co-chair, and the executive committee was renewed, including members from Southeast Asia, Western Pacific, Europe, North and South America, and Africa.

The location of the 2026 meeting is Australia. Thanks to Prof. Peter Nestor who has volunteered to organize the meeting in the Gold Coast. In December 2024, we will travel to Nairobi to support the activities of our colleagues at the African Dementia Consortium. We will return to Asia in the autumn of 2025 to celebrate the XXVII World Congress of Neurology in Seoul. •

Dr. Aida Suárez-González is principal research fellow and consultant clinical neuropsychologist at UCL Queen Square Institute of Neurology, UCL, in London, U.K. Morris Freedman is professor in the department of medicine (neurology) at University of Toronto, head of the division of neurology and medical director of the Pamela and Paul Austin Centre for Neurology and Behavioral Support at Baycrest in Toronto, Canada. Manabu Ikeda is professor of psychiatry and chair of the department of psychiatry at Osaka University in Osaka, Japan. Dr. Yutaka Tanaka is director of Tanka Clinic in Nara, Japan. Masaru Mimura is professor emeritus at Keio University and past chair of the department of neuropsychiatry in Japan. Prof. Suvarna Alladi is professor of neurology at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India.

Letter from the Editors

We’d like to welcome all readers to the October-November 2024 issue of World Neurology. In this issue’s President’s Column, Prof. Wolfgang Grisold provides his updates on several ongoing activities, such as the outcome of the Council of Delegates (COD) meeting in September, including the results of the trustee election, and the addition of Ghana as the 125th neurologic society in the World Federation (WFN). The President‘s Column also details the recent changes to the WFN bylaws.

Prof. Grisold also reports on the status of the recent WFN Digital Neurology Updates (WNU), the ongoing Global Advocacy and Leadership Program (GALP) with the WFN and the American Academy of Neurology (AAN), and other current global initiatives.

This issue also includes early reports of the activities that surrounded World Brain Day 2024, including a report from Tunisia by Prof. Riadh Gouider, co-chair of the WFN Education Committee, and personal reflections about World Brain Day from World Brain Day co-chair, Prof. Tissa Wijeratne. In a related story, a protégé of Prof. Wijeratne, high school student Sarah McPartland from Victoria, Australia, outlines World Brain Day activities achievable in the secondary school and community level with excellent mentorship and support.

In this issue’s History column, Dr. Peter Koehler describes the fascinating history of organ-based extracts, including the pineal gland, for therapeutic interventions for disorders of the nervous system. Dr. Aida Suárez-González, Prof. Morris Freedman, Prof. Manabu Ikeda, Dr. Yutaka Tanaka, Prof. Masaru Mimura, and Prof. Suvarna Alladi chronicle the many activities at the biennial meeting of the WFN Aphasia, Dementia, and Cognitive Disorders Specialty Group that took place in April in Nara, Japan. This issue also includes exciting announcements by Prof. Carlos N. Ketzoian for two upcoming international courses on neuroepidemiology, sponsored by the WFN Specialty Group on Neuroepidemiology.

Also in this issue, Prof. Raad Shakir, on behalf of the WFN Nominating Committee, presents an important call for nominations for the WFN positions that will be elected in 2025.

Dr. Dilraj Singh Sokhi describes a neurology teaching course in two centers in Uganda as an example of international collaboration.

Thanks to all neurologists and neurologic trainee readers in all regions of the world for their interest in the WFN and World Neurology. We look forward to continuing to share more details about the many upcoming activities for neurologists worldwide in upcoming issues. •

 

The President‘s Column also details the recent changes to the WFN bylaws.

World Federation of Neurology Election 2025

The importance and role of the Nominating Committee.

Raad Shakir

By Raad Shakir CBE, FRCP
On behalf of the Nominations Committee

The World Federation of Neurology (WFN) is truly global with 125 member societies. The organization is run by seven elected trustees. Four of them are termed officers: the president, vice president, secretary general and treasurer, with three others termed elected trustees. It is crucial to point out that the WFN is run by all the trustees with equal voting rights. In case of a tie, the president casts the deciding vote.

The WFN operations depend on the quality and fair representation of the seven trustees. When deemed appropriate, two additional non– elected trustees can be co-opted for one year at a time. The composition of the trustees in turn depends on the good judgment, sense of fairness, and equity of member societies to pursue and elect trustees who will represent this global organization to further its goals and to clearly reflect geographic and gender diversity.

The WFN is a United Kingdom registered charity and is therefore exempt from U.K. taxes including income tax and value-added tax. The WFN is also a U.K. registered company limited by guarantee and does not have a share capital. It is therefore governed by the U.K. Charities Commission and the U.K. Companies Acts of 1985 and 1989 through its Articles of Association (Constitution). Changes to the articles must accord with Charities Commission and U.K. Companies Acts.

The Nominating Committee (NC) fulfills a vital role in the trustees’ election process. The NC procedures are contained in the WFN Articles of Association. Also, the WFN charge of the Nominating Committee states that the following factors are considered by the NC in assessing each nominee’s candidature:

  • national and international professional stature
  • contributions to the WFN in the past
  • commitment to the future growth and development of the WFN.

In evaluating nominations, consideration is also given to geography and gender.

If any of these considerations are lacking in the list of those proposed by the delegates, the NC may supplement them by identifying appropriate candidates from the WFN database.

Candidates who miss the application deadline (as per Clause 6.3 of the Articles of Association) can still be proposed by five authorized delegates to be considered by the NC up to 30 days prior to the start of electronic voting. These late applicants must be supported by their member society and shall be subject to the same scrutiny as other applicants. This route is for those who for unavoidable circumstances have missed the application deadline.

The current composition of the elected trustees is unbalanced to say the least. Of the seven men, three are from North America, three from Asia, and one is from Europe. Those ending their terms in 2025 are President Wolfgang Grisold (Europe), Vice President Guy Rouleau (North America), and one trustee, Dr. Chandrashekhar Meshram (Asia Oceania). Dr. Meshram will be finishing his first term and is eligible to stand for a second term.

The WFN aims to elect trustees on merit, trusting that member societies will take into full account geography and gender balance. To do otherwise risks trustees serving select constituencies with potential conflict rather than the benefit of the organization overall.

The election in 2025 will be vital to the future of the WFN. Member societies will need to consider all of the important and vital points made and make sure that we fulfill our goal of fostering quality neurology and brain health worldwide.

The Nominating Committee therefore urges all member societies to consider nominating appropriate candidates and actively participating in the election.

We await to receive your nominations before the deadline which will be announced soon on the WFN website. •

Prof. Raad Shakir is chair of the WFN Nominations Committee and a past president of the WFN.

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