Clean Air for a Healthy Brain

July 22, 2018
By Mohammad Wasay and Wolfgang Grisold

The theme for this year’s World Brain Day was carefully selected to raise awareness of the influence of air pollution on neurological diseases. We hope that this campaign will follow the success of previous World Brain Day campaigns and will touch an emerging, but equally important issue, which is the role of pollution and neurological disease.

In recent times, the effects of air pollution on our health has attracted increasing interest with international institutions providing growing mortality and morbidity data. The latest estimation of deaths attributable to air pollution worldwide is 9 million deaths annually. These deaths are related to cardiac diseases such as myocardial infarction or congestive heart failure, and neurological events such as stroke, lung diseases, and cancer. Stroke notwithstanding, the suspected impact of air pollution on the brain is an emerging and worrisome issue.

What Is Air Pollution?
Air pollution is a global and diffuse contamination by noxious bio-aerosols (pollen, germs, and toxins) and chemical compounds (manmade or of natural origin). Mostly long-term exposure to relatively high levels of certain chemicals in workplace air has resulted in many examples of nervous system damage over the past century.

In addition to air pollution, occupational and residential air pollution is emerging. An example is the exposure to chemotherapy and metabolites in hospital personnel and the biologic circle resulting in contamination of surface water.

Which Are These Pollutants?
The chemical nature of environmental pollutants is complex and variable. Some gases (carbon dioxide and methane) are emitted into the atmosphere naturally from the decay of organic waste. Many are entirely manmade.

What Are the Sources of the Pollutants?
Although there are some natural sources of air pollution such as volcanic eruptions and fires, most can be attributed to human activities. The major source derives from widespread reliance on combustible fossil fuels for energy needed by industries, transportation, and temperature control (both heating and cooling). Other human activities, such as agriculture practices, livestock, and deforestation, are important additional sources.

Impact on Brain Health
Recent publications have shown evidence for air pollution as a stroke risk.

The recent Global Burden of Disease study, for example, has investigated data from 1990 to 2013 in 188 countries. It demonstrated that air pollution contributes to up to 30 percent of the burden of stroke.
The adverse effects of air pollution are most important in low- and medium-income countries and for vulnerable patients with other vascular risk factors or a prior history of stroke.

Stroke is the leading cause of motor disability, the second cause of death in people older than 60 years, one of the main reasons for hospitalization, and a risk factor for dementia.

The list of possible air pollution and environmental pollution adverse effects is increasing. Neurodevelopmental disorders and neurodegenerative diseases, and possibly also neuroinflammatory diseases, are discussed among others as having a potential association to polluted air.

Awareness
Air pollution and environmental pollution is a potentially modifiable risk factor for some cerebrovascular and neurodegenerative diseases. The dogma has changed: Prevention is definitely not only an individual concern but must be considered at the societal level. This enlarging worldwide public health problem requires environmental health policies to reduce air pollution to protect brain health and not only lungs.

Next Steps
WFN material for the World Brain Day has been developed and will be sent to member neurologic societies. If you have any queries and suggestions, contact us at wbd2018@wfneurology.org.

We look forward to many activities around the 2018 World Brain Day! •

Mohammad Wasay is the WBD committee chair. Wolfgang Grisold is the WFN secretary general.

2018 Call for Applications for Grants

To further its mission to “foster quality neurology and brain health worldwide,” the WFN is offering up to six grants of $25,000 with a maximum spend of $100,000. To see the complete rules and regulations for the 2018 grants, The WFN has been offering grants since 2011. For the list of prior grantees and reports, click here.

To download Grants in Aid 2018 Rules and Regulations click here.

Eligibility
Young neurologists, less than 10 years from graduating in neurology, from WFN Member Societies are eligible. 

Preference will be given to residents in areas of World Bank low/lower middle-income countries.

The WFN wants to fund low-cost, high-impact educational and outcomes research projects. International cooperation is encouraged with a priority on low-income countries.

Note: Projects to provide routine health care and fund ongoing research proposals are not eligible.

Criteria
Projects should be in education, improvement of services (regional or national) or scientific, and require the collection of data to test a hypothesis.

Each grant will have to satisfy its terms of agreement. (See below.)

In the application, address the following points:

Relevance: How does the project directly address the mission of the WFN?

Value: What is the return on invested effort in funds and/or time?

Viability: Is this a time-limited project with a measurable outcome or is it an initiative that will grow and support the development of further research or care?

Synergy: Will this enhance interaction within and between the WFN and among committees, initiatives, and task forces, with outside partners, governmental and non-governmental organizations, the World Health Organization (WHO), and fundraising agencies?

Please suggest possible partners. For example: A project on stroke would probably be interesting for the World Stroke Organization (WSO); epilepsy possibly with the International League Against Epilepsy (ILAE).

Evaluation: How will the research outcome be measured? Outcomes and goals should be defined in the application.
Management: Good governance, transparent monitoring, and clear interim and financial reports are required.

Co-Sponsored Grants
The WFN encourages co-sponsored grants. These grants will be co-sponsored by the WFN and a partner organization. The partner organization can be a scientific society, such as ILAE or Movement Disorder Society (MDS), a regional society, or a national society. The partner organization will sign a sponsorship agreement with the WFN to define the shared costs and the role of the individual partners in this project.

Project responsibility and reporting will be shared by the WFN and the partner organization.

Deadlines

  • Application due by June 20, 2018.
  • Applicants notified of results by July 31, 2018.
  • Applicants informed of final results by Oct. 3, 2018.
  • Funding of successful applicants begins as soon as it can be arranged thereafter.
  • Applications are exclusively submitted using the WFN grant application and should include the following:

Application Checklist

  • The name of the sponsoring group and lead applicant with curriculum vitae
  • Title of the project
  • Description of the project
  • Direct relevance of the project to the mission of the WFN
  • Viability of the project
  • Timeline of the project, dates and duration
  • Detailed budget in U.S. dollars
  • Bank electronic funds transfer with confirmation of the same by that bank
  • Votum of the local ethics committee •

Neurology Training at St. Josef Hospital in Bochum

Training Dates:
Nov. 6-Dec. 4, 2017
The overall objective of my neurology department visit was capacity-building and strengthening of basic skills training in integrated management of essential emergency care in stroke, other neurological conditions, and procedures at Ruhr University Hospital for Neurology.

Martin Kaddumukasa, MD

Martin Kaddumukasa, MD

Specific Objectives
I trained in the use of the “Integrated Management Package on Stroke Emergency and Essential Stroke Care.” This included thrombolysis, exposure to new techniques and treatment modalities, specialist for education, and existing training programs. The training allowed me to improve knowledge and professional skills in stroke care in the five selected areas: neuroimaging, thrombolysis, inpatient care, transcranial Doppler scanning, and intensive care.

Achievements
This training exposed me to the following neurology areas to which I hadn’t been exposed before:

  • Multiple sclerosis care and management
  • Intrathecal treatment options for MS
  • Intensive care patient nutrition
  • Use and interpretation of ICU monitors
  • Management of seizures in stroke
  • Thrombolysis
  • Stroke diagnosis via trans-cranial Doppler scan

From the training, I am able to identify the gaps in stroke care protocols in Uganda from emergency patient assessment with international assessment scale, timely patient management, active rehabilitation, and 24-hour patient evaluation.

Acknowledgements
Special thanks to World Federation of Neurology and German Neurological Society for funding this training fellowship. In addition to the head of the neurology department, Prof. Dr. Med Ralf Gold, head of stroke and intensive care unit PD Dr. C. Krogias and all staff of Bochum Hospital. •

Sri Lanka Annual Academic Sessions Update

The Association of Sri Lankan Neurologists (ASN) held its 11th Annual Academic Sessions in November 2017 at the Cinnamon Grand, Colombo, under the theme of Neurology for Tomorrow. Prof. Raad Shakir, president of the World Federation of Neurology (WFN), was the chief guest at the Welcome Ceremony, and Prof. Man Mohan Mehndiratta, president of the Asia Pacific Stroke Organization (APSO), was the guest of honor. The Association of British Neurologists (ABN) was represented by an official ABN delegation.

Procession of guests at the Welcome Ceremony.

Prof. Shakir delivered the opening plenary on global neurology challenges. The JB Peiris Oration was delivered by A/Prof. Udaya Seneviratne from Monash University in Melbourne, Australia. The overseas faculty consisted of 19 speakers from Australia, India, Pakistan, Singapore, the United Kingdom, and the United States, and was complemented by the local faculty. The academic program spanned three days and had a strong emphasis on new advances in neurology.
Two half-day symposia were held on movement disorders and stroke. The other topics covered included epilepsy, demyelinating diseases, neurological infections, CNS vasculitis, neurology and sleep, neurology of autonomic dysfunction, eye movement disorders, myasthenia gravis, neuroplasticity, and neurorehabilitation.

Two post-lunch quizzes tested the neurology knowledge of participants and provided light entertainment in between the intense academic deliberations. A guided poster tour was introduced at the Annual Sessions, and provided young researchers a good opportunity to showcase their research. A parallel workshop on EEG was conducted for EEG technologists.

Prof. Udaya Ranawaka, ASN president, delivers the Welcome Address.

The Association of Sri Lankan Neurologists is still a fledgling organization, being only 10 years old, but remains strongly committed to the promotion of continuous education. It has held successful annual meetings every year over the last 10 years. Its membership is scattered rather thinly across the country, with only 41 neurologists serving 21 million people, with less than one neurologist per 500,000 population. During the calendar year of 2017, academic activities were conducted in eight of the nine provinces of the country, with a view to promoting professional development among those serving in the peripheries. In addition, monthly updates were held in the city of Colombo, primarily aimed at the postgraduate trainees in internal medicine and neurology.

The Annual Academic Sessions are the pinnacle of the academic activities of the ASN. The 2017 sessions went a long way toward meeting the key objectives of the ASN, of promoting continued education and training, fostering research, and facilitating networking and exchange of ideas. The social programs (the Welcome Ceremony, President’s Dinner, and the ASN Banquet) provided time for networking, camaraderie, as well as building and strengthening friendships. We hope these will lead to closer collaborations between the ASN and its friends across the globe, and ultimately improvements in neurological care in Sri Lanka.

Prof. Udaya K. Ranawaka, MD, FRCP, FCCP, FAAN, FAHA, is professor of neurology at the Faculty of Medicine, University of Kelaniya, and was the president of the Association of Sri Lankan Neurologists in 2017.

WFN Takes Stock and Moves Forward

This, my second column, is to inform you of some important steps taken by the new administration and the rationale for these. They comprise the essence of the strategy meeting held Feb. 12-13 in London.

William Carroll, MD

Such strategy meetings have been held from time to time previously. But due to the value of this strategy meeting, the trustees have decided it should become a regular biennial event for this administration. The World Federation of Neurology (WFN) was most fortunate that this meeting was attended by all of its elected representatives and the presidents or the representatives of the regional neurological organizations affiliated with the WFN.

These included Prof. Yomi Ogan, president of the newly formed African Academy of Neurology; Prof. Riadh Gouider, representing Prof. Chokri Mhiri , president of the Pan Arab Union of Neurological Societies; Prof. Marco Medina, president of the Pan American Federation of Neurological Societies; and Prof. Boon Soek Jeon, president of the Asian Oceanian Association of Neurology. We were also especially honored to have Prof. Ralph Sacco, president of the American Academy of Neurology, and Prof. Franz Fazekas, president-elect of the European Academy of Neurology and representing Prof. Gunther Deuschl.

New Committee Chairs

Nominating Committee Prof. Hidehiro Mizusawa
Constitution and Bylaws Committee Prof. Phil Smith
Finance Committee Prof. Bo Norrving
Regional Liaison Committee Prof. Ralph Sacco
Publications Committee Prof. John England
Public Awareness and Advocacy Committee Prof. Tissa Wijeratne
Education Committee Prof. Steven Lewis
Standards and Evaluations Committee Prof. Jan Kuks
Membership Committee Prof. Morris Freedman
Applied Research Committee Prof. Albert Ludolph
Congress Committee Prof. Ryuji Kaji
E-Communications Committee Prof. Walter Struhal

Over two days, all WFN activities were discussed, evaluated, and had action plans developed to proceed for each. All such plans were carefully scrutinized by Prof. Richard Stark, WFN treasurer. While the WFN activities have been largely centered on education in neurology, the WFN must ensure that such programs are not only properly established with oversight and clear communication channels but they must be financially sustainable and have clear and measurable outcomes. Through the careful diligence, foresight, and enterprise of the strategy meeting attendees, we have largely attained this goal. It was with much pleasure that I was able to observe enthusiastic contribution of all participants and a most successful outcome.

Here are the items that I believe to be of most interest to the membership.

Education

Regional Training Centers. There are five centers that are presently operating; four in Africa and one in Mexico. A proposition was received from Bangalore for which the WFN was most grateful.

The strategy meeting participants considered that the Asian proposition was different than that developed for Africa and required careful review by the Education Committee to clearly define the goals, location, collaborative organization, and the funding and outcome measures before proceeding. It is hoped this review will be completed quickly.

Regional Teaching Courses. These are predominantly held in Africa at the present time through a collaboration of the EAN, WFN, and specialty groups, such as the WSO, the MDS, and this year ECTRIMS. One proposition that was considered to have some merit was the linking of every second regional teaching course in Africa with the African Academy of Neurology.

The African Academy of Neurology is of fundamental importance, and this nascent but most essential development may require its organizational structure to be nurtured for the time being. Having a formal relationship in place facilitates its growth.

World Congress of Neurology (WCN). The Scientific Program Committee and Teaching Course Committee for the 2019 WCN, to be held in Dubai, will meet during the upcoming AAN meeting in Los Angeles. Under Prof. Chris Kennard and Prof. Steven Lewis, the program development is ahead of schedule.

We all remember the wonderful 2015 WCN held in Santiago, Chile. Notices have gone out to member national societies asking for nominations for the 2023 venue. In this year, the WCN is again scheduled to be hosted in the Americas. This WFN region encompasses North America (Canada and the U.S.), Central America, and South America.

Junior Traveling Fellowships. Applications closed after the receipt of 82 requests for one of 30 JTFs, each valued at GBP1,000. Applicants will be advised of the results shortly.

Grants. It was determined at the strategy meeting that these should be more focused and targeted with two principal aims. First, to provide young neurologists with the opportunity and funds to undertake a piece of original research. Second, that the research would result in both a publication for the author and provide data with which to launch a larger project or direct local resources to areas of need. Six grants of up to

U.S. ($) 25,000 to a maximum total of U.S. ($) 100,000 will be available this year. For more details, please refer to the grant announcement on page 5 of this issue of World Neurology.

Structure and Visibility

The London office has been relocated to a larger space within its present location in Chester house in Fulham. The office staff will continue to be led by Laura Druce and assisted by Jade Levy (nee Roberts) and Carlos Hunte and with Chiu Keung Man providing valuable IT support. Chiu will also review all electronic media to harmonize the WFN logo and livery across the website and all communication platforms (Facebook, Twitter, and the website) as well as Office Communications and all WCN material. He is also completing the insertion of the newly promulgated EU General Data Privacy Regulations into all the WFN member information.

A new committee, the e-Communications Committee, will oversee these activities and will be chaired by Prof. Walter Struhal. A subgroup of this committee, aided by Profs. Wolfgang Grisold, Morris Freedman, and Riadh Gouider, are preparing a paper on e-learning to guide the WFN on this aspect.

The new committee members will be posted on the WFN website shortly. The roles and charges for each committee will be updated by the new committees. On behalf of the trustees, I offer my thanks and congratulations on those who have assumed new roles. I also offer my most sincere thanks to those who have completed their two-year terms for jobs well done.

With increasing activities to be managed by the London Office and the WFN committees, Prof. Wolfgang Grisold, the secretary-general, is preparing a “universal calendar.” It is envisaged that this will contain the timelines for all routine office activities and those for all committees each year. It will be an important e-document that will be relatively easy to revise and update as required and to which the Standard Operating Procedures (SOP) for each and every function will be able to be added. It is hoped that this will aid the efficiency of the office for day-to-day work and its “corporate memory.”

With this base, the WFN will be in a position to explore and expand its educational and other activities. 

Research Progress Report: The Impact of Epilepsy on Arranged Marriages

Gagandeep Singh, MD, DM

Epilepsy affects an estimated 12 million people in South Asia. More than half of this population is comprised of young people. Besides the sizable quantum of disability adjusted life years (DALYs) there is a hidden burden associated with epilepsy as these young people are often unable to complete their education, get appropriate jobs, and marry.

Experts attending the WFN grant-supported meeting on “Arranged Marriages in People With Epilepsy in South Asia.”

Marriage, a socially compelling and momentous occasion in the lives of people with epilepsy as in the case of others, has not received the attention it requires from a psychosocial research perspective. To complicate matters, some of the unique social attributes of marriage in much of South Asia pose an enormous challenge in the lives of young people with epilepsy.

Two features deserve mention:

  • Marriages in the region are universal. That is, over 95 percent of the people choose to get married in comparison to the 60 percent in the rest of the world.
  • An overwhelming majority of marriages are arranged. That is, the parents/elders in the family find and finalize marital partners. The problem with arranged marriages is that the prospective bride and groom do not meet before marriage, and hence are unable to reveal significant discrediting traits to their prospective partners. Epilepsy is often hidden for fear of breakdown of marital negotiations. The consequences of hiding epilepsy during marital negotiations are immense and include breakdown of marital negotiations and poor marital satisfaction and outcome (an increased rate of divorce) in addition to serious health implications for the individual with epilepsy. Sadly however, these consequences have not been formally studied.

A highly considerate World Federation of Neurology (WFN)-International League Against Epilepsy (ILAE) grant enabled us to form a working group to tackle the immensely intricate and problematic issue of arranged marriages in people with epilepsy in South Asia. We were able to initiate a clinic-based knowledge, attitudes, and practice survey of unmarried and married people with epilepsy in the following centers in South Asia: Dayan and Medical College, Ludhiana (GS) Vedanta Hospital, Gurgaon (Dr. Atman Ram).

Further, the grant enabled us to meet on Aug. 12, 2017, at Hyderabad to discuss the findings of the survey. Investigators from each site attended the meeting. In addition, a social scientist (Dr. Manjistha Banerjee), neuropsychologists (Dr. Urvashi Shah and Dr. Parveen), social activists (Yashoda Wakankar), neurologists (Dr. Pravina Shah, Dr. Manjari Tripathi, Dr. Hitant Vohra, Dr. Archana Verma, Dr. Sanjaya Fernando, Dr. Lekhjung Thapa, Dr. Siby Gopinath, Dr. Sudhir Sharma and myself), statisticians (Namita), and other experts also took part.

An overarching theme for discussion was the gender bias in marital prospects, outcome, and satisfaction. Unmarried women with epilepsy seem to be disproportionately affected in comparison to young men with epilepsy. Besides discussing the findings of the survey, the group also discussed and initiated the development of a quality of marriage in epilepsy (QOMIE) scale for marital satisfaction, specifically for people with epilepsy and the merits and pitfalls of a web-based marriage portal specifically for people with epilepsy in the region.

We would like to express our gratitude to the WFN for funding this important social venture, which we hope to take forward in keeping with the resolution adopted by the World Health Assembly in 2015 to fight stigma and discrimination faced by people with epilepsy.

Looking Back and Forward

William Carroll, MD

It is with much pleasure that I write this, my first “President’s Column.”

It affords an opportunity to speak directly with neurologists worldwide and to update them of the changes in the World Federation of Neurology (WFN) that naturally follow a change in leadership and to acknowledge the contributions of many.

Officers and trustees at their first Trustees meeting Feb. 12, 2018, in London, before the combined
trustees and regional presidents strategy meeting. From left to right: Morris Freedman,
elected trustee; Richard Stark, treasurer; William Carroll, president; Ryuji Kaji, vice president;
Wolfgang Grisold, secretary-general; Riadh Gouider, elected trustee. Not pictured: Steven
Lewis, elected trustee, who joined the meeting on Tuesday.

To Raad Shakir, who has stepped down at the completion of his four-year term as president, the re-election of Riadh Gouider as trustee for another three years, and to those who unsuccessfully contested elections held during the WCN Kyoto, I offer my congratulations for their effort and gratitude for their demonstration of commitment to the work of the WFN.

This time also marks the end of the two years that the WFN committee chairs and many on the committees will have served. Traditionally, there is a change in personnel in all committees every two years. To them, on behalf of the WFN, I thank you wholeheartedly. Without their unselfish involvement and valuable contributions, the WFN would not run as smoothly and as successfully as it does. As with many committees, their contribution largely goes unnoticed by the membership but certainly not by the officers and trustees.

Without a doubt, however, the contributions of Raad Shakir as president for the last four years was outstanding. Consequently, although there is much to inform you of, I intend to limit this for now and spend the bulk of this report touching on the successes of Dr. Shakir’s term.

Dr. Shakir has been a prominent figure in neurology in the United Kingdom for more than 20 years and was one of the key people in the organization of the successful 2001 World Congress of Neurology, which was held in London. My acquaintance and knowledge of him began at that time and has largely paralleled my own involvement with the WFN. I have been fortunate to witness first-hand the contributions he has made to our organization.

Officers, trustees, and regional presidents attending the combined strategy meeting in London. From left to right: Riadh Gouider; Franz Fazekas, president-elect, European Academy of Neurology; Yomi Ogun, president, African Academy of Neurology; Morris Freedman; Richard Stark; William Carroll, WFN president; Marco Medina, president, Pan-American Federation of Neurological Societies; Wolfgang Grisold; Ralph Sacco, president, American Academy of Neurology; Beom-Seok Jeon, president, Asian and Oceanian Association of Neurology; and Ryuji Kaji.

He has provided dedicated service over many years, aided by his multicultural education and experience, and his seemingly boundless energy and enthusiasm. With his detailed understanding of the varied cultural sensitivities in the global neurological community, he has been a successful leader.

Before being elected to the position of WFN’s Secretary-Treasurer General in 2009, he had assumed this position in 2006 on the unexpected retirement of the incumbent and he immediately displayed these skills and commitment in this new role. With then-WFN-President Johan Aarli, he was able to negotiate an understanding with the Peoples Republic of China that enabled the Chinese Neurological Society to join the WFN without fracturing the memberships of the Hong Kong and Taiwanese neurological societies. This was no easy task, as two previous presidents had been unsuccessful in the same endeavor.

His presidency of the WFN commenced in 2013 and was marked by a commitment to empower the regional organizations of the WFN. This was crowned by the establishment of the African Academy of Neurology (AFAN) in 2015 and its first Congress in 2017 in Hammamet, Tunisia. Although Dr. Shakir did not instigate the WFN African initiative in 2006, there is no doubt in my mind that it was his vigor and leadership that enabled the initiative to be transformed into AFAN as an active and independent regional affiliated WFN organization.

At the same time, Dr. Shakir has also prosecuted the African initiative plan for the WFN to develop four neurological training centers, two in Anglophone and two in Francophone Africa. A major limitation has been the funding of trainees in these centers. Through his persistence and endeavor, enduring funding is now being established that will benefit neurology in Africa. Such an outcome will both free up valuable WFN funds for additional educational projects and elevate the visibility and support for the WFN. The benefit of the increasing recognition of the WFN as a leader in neurological education in one of the most difficult yet needful areas of the world will pay dividends for many years, particularly in lifting the standard of neurological care in Africa.

The final development and the establishment of the Pan American Federation of Neurological Societies (PAFNS) also occurred in Latin America during his presidency. It is fair to say that his influence and guidance were fundamental in driving this successful outcome. As a consequence of these two initiatives, the WFN now has affiliated regional organizations in six areas, approximating those of the World Health Organization (WHO). Importantly, these afford more effective and immediate interaction between the WFN and the regions and regional member societies. It is no boast to say that the vision of regional empowerment is transforming communication within the WFN and that this in turn advances engagement at all levels of the WFN.

Dr. Shakir has displayed the same dedication and skill in guiding the WFN dealings with the WHO. Intimate involvement with WHO-related activities such as the Neurology Atlas of 2017, and in him heading the neurology Topic Advisory Group for the revision of the International Classification of Diseases (ICD-11), have required enormous effort, patience, and skill over a considerable period of time.

The WFN and the global neurological and stroke communities are indebted to Dr. Shakir for his Churchillian doggedness in dealing with the WHO, which at times has appeared out of touch with reality and driven by internal bureaucratic imperatives. The interaction between the WFN and the WHO is leading to a fundamental change in the way the WHO views stroke (as a disease of the brain), and this should be reflected in ICD-11. Both will be advantageous to the advancement of neurological care worldwide.

The outbreak of the Zika virus in early 2015 afforded another example of Dr. Shakir’s ability to mobilize rapidly the required WFN response. Within weeks of it becoming recognized as a major threat to health, particularly to fetal health and a potential risk for children and adults of an acute paralytic illness resembling Guillain-Barre syndrome, the WFN had in place an international committee of experts headed by Prof. John England.

The WFN Zika experience, particularly the need to act rapidly with other organizations in developing a multiskilled response, gave direction to the role of the WFN as a natural lead point for like organizations. Both the World Brain Alliance and the Global Neurology Network, which commenced life under President Hachinski and Vice President Hacke, respectively, are natural partners for the WFN. Dr. Shakir has recognized this “natural fit” and has emphasized the important role all three may need to play in the future. To assist this relationship, he made special provision for all to be involved in the biennial WCN scientific program.

It is fitting that Dr. Shakir’s presidency should terminate with arguably one of our most successful World Congresses of Neurology, in Kyoto. By numbers of delegates (more than 8,500), number of participating countries (110), number of bursaries offered to young neurologists from low- and low-middle-income countries (200), and our most profitable despite the highest dollar value support for the faculty to make them feel appreciated, it was a success. As the chair of the Congress committee for 2017, I can attest to both the efforts of the Japanese Society of Neurology and Dr. Shakir’s guiding influence in the success of this WCN1.

Dr. Shakir will be missed, but as is his nature, he has offered his advice and service should they be needed in the future. We all wish him and his wife, Nada, the best of futures and more quality time for each other and their extended family.

New Developments

I will now briefly summarize some of the other developments since Jan. 1, which will be dealt with in more detail in my next reports.

1. The trustees and officers of the WFN met in London in mid-February for a strategic planning meeting and were joined by the presidents of the six regional organizations. The full complement of attendees met over two consecutive days of intense discussions, preceded and succeeded by more specific and focused topical meetings which all lasted four days.

2. The outcomes were a thorough review of WFN education and related programs, including the annual research Grant Program, Department Visits, regional teaching courses in Africa, regional training Centers in Africa, plans to ensure the successful continuation of the AFAN, interaction with the West African Academy of Medicine, and the goals, financing, and outcome measures of all training centers before they are established, and a review of support for trainees in these programs. All in all, once implemented, these measures should ensure their successful continuation.

3. Review and revamp of website, social media platforms, and publications (mainly World Neurology) with uniform external branding.

4. Preliminary work on the needs registry to be developed by the regional organizations with their member societies.

5. A review of each committee and its role, activity, and constituents.

6. An agreement to hold this same strategic review biennially.

7. A review of the AAN/WFN Continuum program developed new criteria for its continuation, which will be instituted gradually and involve an appeal process to minimize any inadvertent hardship.

8. Importantly, it was agreed to hold the following meetings during 2018.

8.1 Congress Committee incorporating the 2019 Scientific Program, Teaching Course Committee, and Tournament Committee meeting  in April during the Los Angeles AAN meeting — dates to be confirmed.

8.2 Finance Committee and other WFN Committee meetings during the EAN meeting in June in Lisbon — dates to be confirmed.

8.3 The Council of Delegates and AGM of the WFN including the election of a Secretary-General and an elected Trustee, in October during the Berlin ECTRIMS meeting — dates to be confirmed.

All 2016 constituted committees will be advised in the near future whether they will continue to operate into 2018, join with the newly constituted 2018 committees for a variable period, or disband.

It was clear to all who attended the strategy meeting that it was informative and empowering, and the inclusivity was team-building, which bodes well for the progress of the WFN through 2018.

Finally, in closing and in the interests of openness and transparency, the executive of the WFN would be pleased to engage in dialogue at any level on these and any other matters. Until next time, I wish all a successful and productive 2018.

Reference
1. Carroll W M (2017). The need for a Global  Neurological Alliance, JNeuroSci. 379;321-323.

Richard Godwin-Austen

Richard Bertram Godwin-Austen came from an illustrious English family. His ancestry can be traced to the reign of Richard II in the 14th century. His 19th century ancestors included two Fellows of the Royal Society, Robert Alfred Cloyne and Henry Haversham. The latter extensively surveyed the Karakoram region of the Himalayas establishing the height of K2 (for a while known as “Mt. Godwin-Austen”).

Richard Bertram Godwin-Austen

Richard was born in 1935, and during World War II, his father was posted as a surveyor for the colonial office in Cyprus. Richard and his brother were sent to South Africa for the period of the war. He returned to England in 1945 and was sent to a boarding school. He started his medical studies at St. Thomas’s hospital a few years after the establishment of the British National Health Service. He qualified in 1959 and did his early training in St. Thomas’s hospital in London.

Richard decided to train in neurology. In 1961, he married his first wife Jane. He did some of his early training in Exeter, returning to London in 1963. He worked with Michael Kremer at the Middlesex Hospital and Roger Gilliatt at Queen Square. Gilliatt was the son of the Queen’s obstetrician and fought in the Italian campaign and was awarded an MC. He had great power over British neurology for decades.

There were few consultant neurologist posts in the 1960s. At the time, Richard was working at the National Hospital as a senior registrar. In 1970, Michael Harrison (later professor) suggested to Richard that he should apply for a consultant post in Nottingham.

Harrison had already applied for the post, as he previously worked with the senior physician in Nottingham and they both thought it would be a good experience for Richard to attend a consultant interview. To the surprise of all, Richard was offered the job. He then spent all of his professional life in Nottingham.

In June 1996, he had to face a life-changing tragedy. He and his wife were involved in a terrible car accident, in which Jane died. Richard was devastated by the loss, badly injured himself, and soon after had to consider early retirement.

The relationship to the WFN started when Richard attended the World Congress of Neurology Kyoto 1981. He presented the first clinical paper on MRI imaging of six patients. The chair of the session moved the presentation forward, as the previous presenter did not attend. When Richard finished the presentation, the hall filled up and the chair was asked if Richard could present the paper again, which he did.

This was probably the first and only time that a paper was repeated in a World Congress. One has to mention that Bill Moore, a young physicist in Nottingham, conducted the initial research into the clinical application to create an image using magnetic resonance. The safety of the technique was tested on an onion, his wrist and his head. The other two involved were Peter Mansfield and Godfrey Hounsfield. Peter Mansfield received the Nobel Prize for his work; he died in 2017.

The Secretary-Treasurer General of the WFN is the dynamo of the Federation. Frank Clifford-Rose’s two terms in the post were coming to an end. Richard was asked to apply, and he was elected during the Buenos Aires WCN 1997. He served two terms, including a most successful WCN in London 2001. During that time, he worked tirelessly to organize the London office with the help of Keith Newton, the WFN administrator. He worked mainly with James Toole and Jun Kimura as WFN presidents. As the Secretary-Treasurer General term overlaps, he also worked with John Walton and Johan Aarli. These were formative years for the WFN when the basis of training centers and programs were initiated.

Meanwhile in 1997, Richard married again. He had known his second wife Sally since the 1950s. She had moved to the United States, and their paths had separated before his first marriage. By serendipity, they met again, and he found new happiness.

His involvement with the WFN continued until less than three months before his unexpected death. Richard presented a fantastic paper on “Nottingham and the Early Days of MRI Scanning” at the XXIII WCN in Kyoto in September 2017. The paper focused on the ideas (the Eureka moments), which contributed to the developments.

He and his wife Sally enjoyed their trip to Japan, and they met many friends in the World Congress. His involvement with the WFN started and ended in Kyoto, spanning a period of 36 years.

In the late 1960s, Richard was involved in research in Parkinson’s disease, and his book ‘The Parkinson’s Disease Handbook” has been a major resource for patients and their families. He was elected president of the Association of British Neurologists 1997-1999, vice president of the European Federation of Neurological Societies, as well as serving on the council of the Academy of Experts, the European Board of Neurology, Parkinson’s Disease Society, and the Nottingham Medico-Legal Society.

Of huge interest to his international friends was his appointment as the High Sherriff of Nottinghamshire. He was an enthusiast for whatever he did, whether it was in the field of art, music, fishing, dancing, Chinese snuff bottles or Japanese ceramics, or the paintings of David Bomberg, of which he owned a few.

His memoirs “Seizing Opportunities: The Reminiscences of a Physician” is a most delightful read for all to enjoy. His character was that of a true gentleman and has always been a loyal friend to all who knew him. He will certainly be missed.

Richard passed away suddenly on Dec. 3, 2017, at the age of 83 years. He is survived by his wife Sally, two children Jonathan and Alice, six grandchildren, and three stepsons.

Prof. Raad Shakir served as president of the WFN from 2014-2018.

The Lagos Experience

Use of Continuum® in the residency training curriculum in Nigeria

By Prof. Njideka U. Okubadejo

Neurology training at the Lagos University Teaching Hospital (LUTH) Nigeria is conducted using the guidelines of and under accreditation of the West African College of Physicians and the National Postgraduate Medical College of Nigeria.

The training features two stages: Junior Residency (initial 24 months in internal medicine, inclusive of a mandatory three-month rotation in neurology) and Senior Residency (specifically, for specialization in neurology, an additional 36 months in general neurology, including rotating through relevant subspecialties).

The LUTH program is one of the largest in Nigeria, and has an average of 90 resident doctors in internal medicine at any point in time. Of these, about half are junior residents, five are neurology senior residents, and the rest are senior residents in various specialties, such as cardiology and endocrinology who mandatorily undertake rotations in neurology also. The Neurology Unit also trains residents rotating from neurosurgery, ophthalmology, family medicine, anesthesia, and psychiatry.

The training format includes clinical teachings (outpatient and inpatient setting), self-directed learning, didactic lectures, grand rounds, postgraduate seminars, journal reviews, and conference attendances.

Implementation

The American Academy of Neurology’s (AAN’s) Continuum Lifelong Learning in Neurology® has been provided by a joint program of the World Federation of Neurology (WFN) and AAN to our training program for about nine years. During the early years of its use, neurology residents and the trainers (consultant neurologists) used the journal as part of the recommended reading and material for postgraduate seminars.

Over the course of the last four years, with increased appreciation of the systematic, logical, and comprehensive nature of the journal articles, the unit has formalized the use of Continuum in these ways:

  • Continuum-Based Early Bird Seminars: This is a year-round postgraduate seminar held on most Tuesday mornings from 8 a.m.– 9:30 a.m. The seminar topic is preselected from Continuum, topics are distributed to be read by all, and presented by one of the neurology senior residents. The seminar is attended by 10 to 12 residents rotating through the unit at the time, with consultants in attendance also. The format is via PowerPoint presentation, with interactions (questions, clarifications), and a brief post-test of a few (four to five) multiple-choice questions (MCQs) based on the content for the day. The residents have indicated that the sessions are valuable, and have improved their understanding and knowledge because of the combination of functional/anatomical/pathophysiological basis, real-world symptoms-based algorithms/approach to common neurological complaints, updates on classifications, diagnostic criteria, and evidence-based treatment guidelines. In addition, the post-reading MCQs and patient management problems with responses improve the understanding of the material.
  • Incorporation of Continuum Into Training Curriculum: As the chair of the Neurology Subspecialty of the National Postgraduate Medical College of Nigeria, in our recent curriculum revision, I have included the Continuum journal as part of the recommended reading material for all residents training in neurology. This is in recognition of the invaluable content delivered by global experts in each subject, and the realization that, with this exposure, our residents have access to a journal that is easily the best educational content for any training or practicing neurologist. Examiners at the postgraduate examinations have continued to be impressed by the level of knowledge displayed by our trainees, and how well rounded and balanced they are in their clinical approach, diagnostic evaluation, and grasp of evidence-based treatment modalities. Much of this is a testament to the ease of access to the comprehensive, up-to-date, yet clinically relevant compilation of neurology contained in the Continuum series. In the foreseeable future, as there is a plan to harmonize training curricula of all of the postgraduate medical colleges across the West African sub-region, it is highly probable that this existing curriculum recommendation will be reflected in the West African Neurology Training curriculum as well.

Recommendations

I strongly appeal that the program be continued. The level of confidence that comes from knowing that one is learning from global experts, and the knowledge is at par with what other neurologists globally are learning, is a boost to the confidence of our trainees and ourselves.

I also appeal that to further enhance the use of this access program, institutional access is considered for participating institutions to enable the residents have access to electronic versions of the journal. This would remove the need to make copies for individual readers and also make it easier to study the material in this electronic age. I understand that there would need to be restrictions to ensure that the access is not misused. •

Prof. Okubadejo is a consultant neurologist at the Lagos University Teaching Hospital and subspecialty chair (neurology) at the National Postgraduate Medical College of Nigeria.

The First International Congress of Neurology

Berne, Switzerland, 1931

By Peter J. Koehler

Specialization in medicine started during the second half of the 19th century. Several causes have been presented, including an increase in occupational diversity in Western society, the change from humoral to solid medicine, the appearance of theories on localized lesions versus diffuse causes (reflected for instance by monographs on diseases of one organ), the foundation of asylums and hospitals for particular diseases, and (later on) the fact that certain areas of medicine became too large to be dealt with by one type of physician. Although there was considerable opposition to this change, specialization continued as can be observed by the increasing number of specialized societies and journals, the publication of large specialized handbooks, the introduction of specialties in the medical curriculum, and the organization of congresses for specialist physicians.

Neurology as medical specialization was not among the first new specialties, and in many countries arose associated with psychiatry (which was an early specialization). Other diseases, nowadays belonging to neurology, were taken care of in internal medicine departments or special outpatient clinics arising from internal medicine (for instance outpatient clinics for electrotherapy).

Congresses for General Medicine

Figure 1. Members of the International Medical Congress, London, 1881. (Courtesy: Wellcome Images)

International congresses for (general) medicine were organized regularly, one of the best known being the one in 1881 in London. According to a report in the BMJ of Aug. 13, 1881, “3,000 men have been gathered in Congress throughout the week, and among them the choicest spirits of the age.” (See Figure 1.) Indeed, well-known names were mentioned, including Pasteur, Lister, Bastian, Bigelow, Erichsen, and Crichton Browne. It was at this congress that the famous discussions on cerebral localization, following Broca’s 1861 clinical findings and the electrical stimulation experiments by Fritsch and Hitzig in 1870, took place and David Ferrier demonstrated his experimental monkeys, urging Jean-Martin Charcot to exclaim that the monkey resembled hemiplegic patients. The large number of visitors at the congress was another indicator of the necessity of future meetings in smaller groups.

1907 Amsterdam Congress; Not Just Neurology

Figure 2. Harvey Cushing (picture taken a few years following the congress; Wellcome Images)

One of the first, possibly the first, neurology meeting, the International Congress for Psychiatry, Neurology, Psychology, and Care for the Insane was organized in Amsterdam in 1907. Even at this early specialized congress, 805 delegates were present (21 nationalities, price for registration 10 guilders/3 $).

Many well-known neurologists met, including the Belgian Arthur van Gehuchten, the Germans Arnold Pick and Hugo Liepmann, and the Swiss Constantin von Monakow. In 1914, the Swiss were organizing an international meeting solely for neurology in Berne. The correspondence between Swiss neurologist Constantin von Monakow and his Dutch colleague and friend Cornelis Winkler tells about the organization in September of that year.

On Aug. 1, 1914, Winkler wrote to Monakow: “I think that if the international relationships will not relax soon, I will not be able to come to Switzerland.” In a post scriptum to the letter, he noted, “I believe this Aug. 1, 1914, will become a historical day.” On the same day, Monakow wrote to him, “The war, the dreaded European war is imminent, and Switzerland too, is preparing to send troops to the threatened borders.” He realized that his colleagues in Europe were engaged in “obvious national and economic tasks and have other thoughts than discussing scientific questions; and that will probably mean – although we have not yet decided definitely – that the Berne Congress that has been prepared so well, will probably not take place.”

Although dozens of letters about resurrecting the International Brain Commission (founded in London in 1903 and an important platform for international communication with respect to neurology, including the basic fields) have been written between neurologists/ neuroanatomists during the period 1918-1931, the organization of the congress finally took place in 1931, now considered the first in a long series, such as the 23rd meeting in Kyoto, Japan (2017).

Proceedings of the Congress

Figure 3. Sir Charles Scott Sherrington (courtesy: Wellcome Images)

It is a pleasure to leaf through the Proceedings of the congress (published in 1932 by Stämpfli, Switzerland). The book was put together by a team of neurologists (Bernard Sachs and Henry Alsop Riley of New York, Charles Dubois, R.F. Fischer, and Pierre Schnyder of Berne), and chaired by Bernard Brouwer of Amsterdam. The introduction was written in four different languages (English, French, German, and Italian).

During the opening ceremonies on Monday, Aug. 31 (1931 at the Casino of Berne), the rector of the local university conferred honorary degrees of medicine to Harvey Cushing (see Figure 2), the famous founder neurosurgeon, who had done experimental research (with Theodor Kocher and Hugo Kronecker) in Berne 30 years previously, and to Sir Charles S. Sherrington (see Figure 3), the well-known neurophysiologist (who would be awarded the Nobel Prize in 1932).

The laudatios were read in Latin. The presidential address, also printed in the four languages, was given by Bernard Sachs, who at the time was also president of the American Neurological Association.

“The purpose of this congress is primarily to establish personal contact and to unite the neurologists of the entire world in the attempt to find a solution to the many important problems engaging their attention; to indicate other problems that will call for study in the immediate future, and to emphasize the important relation that neurology bears to every branch of medical and surgical science. Neurology is the fundamental specialty of medical art. Without a thorough appreciation of its truths, medical and surgical science is like a ship floundering about in a turbulent sea without helm or rudder.”

Presentations

Figure 4. Representatives of the various participating countries in Berne (1931); sitting from left to right: 1 Gheorghe Marinescu (?) 2 Max Nonne 3 Charles Sherrington 4 Bernard Sachs 5 6 and 7: unknown. Standing from left to right 1 unknown 2 Robert Bing 3 Otto Marburg 4 Ottorino Rossi 5 C.U. Ariëns Kappers 6 Henry Markus (?) 7 George Guillain 8 Robert Wartenberg or François Naville (?) 9 unknown 10 Henri Claude (?) 11 Ludo van Bogaert (?) 12 unknown 13 Henry Alsop Riley 14 unknown.

A number of scientific sessions was held during the congress. “Diagnostic and Therapeutic Procedures (Surgical and Otherwise) in Brain Tumors” with presentations by (among others) Clovis Vincent (the Paris neurosurgeon), Robert Foster-Kennedy (New York neurologist who was eponymized with the syndrome combining optic atrophy on one side and papilledema on the other), Wilder Penfield (neurosurgeon from Montreal), Otfrid Foerster (neurosurgeon from Breslau), and Harvey Cushing (with a lecture titled, “The Surgical Mortality Percentages Pertaining to a Series of 2,000 Verified Intracranial Tumors”). A peculiar presentation was the one by Tracy J. Putnam on “Organo-Therapy in Brain Tumors,” not that strange in a period that organotherapy (the use of animal tissue extracts, a precursor of endocrinology) culminated after the introduction of insulin in the early 1920s. Other sessions were on “Muscle Tonus; Anatomy, Physiology and Pathology,” “Neurological Surgery – Therapy,” “Clinical Neurology,” “Clinico-Pathology” (with a demonstration of two educational films on hydrocephalus and Wilson’s disease by the Viennese neurologist Otto Marburg), “Investigative Neurology” (with a film presentation by Walter Rudolf Hess of Zurich, later Nobel Prize laureate, 1949, on localized brain stem stimulation), “Acute Non-Suppurative Infections of the Nervous System” (with presentations by Constantin von Economo, who died a few month after the congress, on encephalitis and Friedrich Lewy on inclusion bodies), “Brain Tumors and Allied Subjects,” “Neuro-Pathology,” “Investigative Neurology” (with C.U. Ariëns Kappers of Amsterdam on “The Brain of Prehistoric and Recent Races,” and Robert Bárány on “The Theory of the Cortical Mechanisms of Association”), and “Clinical and Pathogenetic” (with Robert Wartenberg, then still working in Freiburg in Breisgau, on “Neuritis in the Hand”). The session “Constitutional Problems – Neuroses” could be considered a remnant of the past practice of neurology (with a presentation by the famous Ivan P. Pawlov of Leningrad, on “Experimental Neuroses”), although the association between neurology and psychiatry would continue for decades in many countries. Two sessions on traumatic brain injury included presentations by Charles P. Symonds  of London (“The Effects of Injury Upon the Brain”) and Harold G. Wolff / Maurice Levine of Boston on cerebral circulation. The last sessions were on multiple sclerosis/infections, brain tumors, experimental investigative neurology, clinical and biological (issues) with films on extrapyramidal arm reflexes (by Th. B. Wernöe of Copenhagen), and a film on movement disorders of the lower extremities by F. de Quervain (Berne). A picture of the various international representatives was made during the congress. (See Figure 4.)

Neurology an Independent Specialization

Figure 5. Chairman of the Congress New York neurologist Bernard Sachs (public domain).

On the evening of Friday, Sept. 4, a special conference titled, “Relation of Neurology to General Medicine and Psychiatry in Universities and Hospitals of the Various Countries” was organized at the Bellevue-Palace hotel. Neurologists/neuropsychiatrists from several countries spoke about the situation in their own country (Max Nonne on Germany, Constantin von Economo on Austria, Mieczyslaw Minkowski on Switzerland, Jean Lépine on France, Theodore Weissenburg on the U.S., Ottorino Rossi on Italy, and Bernard Brouwer on the Netherlands). Following the discussion, the chairman, Bernard Sachs, (See Figure 5.) asked the assembly to vote the resolution, as proposed by Otfrid Foerster: “Neurology represents an entirely independent specialty in medicine. Unfortunately, this fact has not been sufficiently recognized in various countries. The First International Neurological Congress hopes that the Universities and Hospital Authorities of the various states will take active steps to further the progress of Neurology.” The resolution was accepted unanimously. The influence of the congress and conference may be recognized by the foundations of several independent university chairs and neurological societies in several European countries.

It is interesting to note that the “Ladies reception committee” (mainly wives of Swiss delegates) is mentioned in the Proceedings with a report of the “Receptions and excursions.” The second International Neurological Congress would be held in London (1935), after the Association of British Neurologists had been founded in 1932 (at the house of Gordon Holmes).

Peter J. Koehler is editor of the History Column. (Visit his website at www.neurohistory.nl.)

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