Articles – Page 49

Bringing Back Neurology Following WWII

By Frank W. Stahnisch, MD, MSc, PhD

Frank W. Stahnisch, MD, MSc, PhD

World War II drew to a close in Europe on May 8, 1945. Many institutes for brain research, psychology, and psychiatry of the former Kaiser Wilhelm Society (KWG) were destroyed. Numerous scientists and scholars had died or were forced into exile in America, Britain, and elsewhere around the globe, where they found new working environments after the Nazis had seized political power 12 years before.

Institute estates, scientific instruments, and large quantities of archival material had been put on trucks and train carts, making their way to the allied occupation zones of West Germany and evading the Soviet zone in the East.

A prominent example is the former Institute for Brain Research of the KWG, headed by neuroanatomist Oskar Vogt (1870-1959) and his wife Cécile Vogt-Mugnier (1875-1962). The institute was scattered over as many places as Bochum, Cologne, Duesseldorf, Dillenburg/Giessen, and Frankfurt am Main.

The Max Planck Institute for Brain Research in Frankfurt am Main, Germany, ca. 1962. Courtesy of Max Planck Society.

Since the new founding of the Max Planck Society (Max-Planck-Gesellschaft or MPG) in 1948, many questions were posed regarding the reconstruction of destroyed research buildings, brain research laboratories, and pathology collections during the postwar period.

Despite the strenuous effort of coming to terms with the past (“Vergangenheitsbewaeltigung”) of the KWG and its problematic research tendencies (such as in eugenics, inherited nervous diseases, and military-related neurophysiological research) in the wider field of neurology and psychiatry, most of these processes were similarly embedded in the contemporary histories of the Federal Republic of Germany and even Western Europe. Economic and administrative parallels can, for example, be drawn to the founding of the Medical Research Council (1919) and the National Health Service (1948) in Great Britain or the French National Institute of Health and Medical Research (Institut national de la santé et de la recherche médicale or INSERM) in 1964.

These occurrences were tightly interconnected with history of science and cultural trends. They influenced the life and working contexts of MPG staff as well, commencing with an initial restoration period in the immediate postwar period (1945-1955) to the reconfiguration of the field during prolonged times of economic prosperity (1955-1972). Profound reforms and research consolidation emanated between 1972 and 1990, triggered by prevailing economic and energy crises, to finally lead to an advanced growth after German re-unification and an increasing process of globalization in Western industrialized countries (1990-2002).

Reconstruction

The general reconstruction process in and of the neurosciences, behavioral sciences, and cognitive sciences in the Max Planck Society was, however, not determined through research priorities alone. Considerations for training junior staff were equally as important. It received important attention through MPG leadership that tried to rebuild its international linkages to catch up with the world level in neuroscience research.

The exchanges with the American Neuroscience Research Program (NRP), founded by MIT neurophysiologist Francis O. Schmitt (1903-1995), played an important part in the rebuilding of and the interdisciplinary formation of the neuroscience field in West Germany. Schmitt, who was of German ancestry, had great sympathy for this European country and upheld close personal relations, for example, with neurochemist and later Nobel laureate Manfred Eigen (b. 1927) in Goettingen, Germany.

Eigen was engaged with the idea of the NRP and managed to find substantial financial support through the German Volkswagen Foundation (Volkswagenstiftung) — although not quite a philanthropic institution like the American Rockefeller Foundation. It enabled many young investigators and students to participate in cutting-edge meetings of the NRP and the legendary Boulder meetings at the Rocky Mountains campus of the University of Colorado.

As a consequence, German neuroscientists took part in the events in comparatively high proportion, as did British, Scandinavian, and later, Japanese researchers during the postwar period. To German neuroscientists, the monetary endowment and infrastructure of the NRP appeared unimaginably affluent, as there seemed to be no limits. Since the inception of the program, Schmitt had organized a private foundation to sustain these endeavors. His Neuroscience Research Foundation (NRF), with its bylaws modeled after those of the Massachusetts General Hospital in Boston, enabled NRP associates to organize several work sessions in their own fields and at their full liberty, including only the expectation that cutting-edge topics in neurology and neuroscience had to be addressed.

Moving Forward

Special emphasis was thereby given to fringe areas, such as molecular neurobiology and quantum computing. Sometimes, non-associates had to organize them, while participants looked overwhelmed by the possibilities given to them. Those who took active part in the NRP as (Senior) Fellows in Residence at Brandegee Mansion and Estate near Boston described it as a “castle” or “palace.” Some of the early German participants were “really jealous” about its affluence. It offered many rooms, a big dining hall, and a ballroom for many types of gatherings. There was even a possibility to stay and work in the library of the building. Many of the directors of the relevant postwar Max Planck Institutes had themselves studied at the NRP for professional reasons and advanced their own academic careers.

The chemistry building with lecture halls (in 2013) in which many of the NRP sessions were held at the University of Colorado Boulder Campus during the 1960s and 1970s. Courtesy of Frank W. Stahnisch.

Nearly everyone who got a professorship in West German neurosciences during the 1970s and 1980s had actively taken part in the legendary Boulder meetings of the NRP and published in the Neurosciences Research Bulletin^® (MIT press journals). As a corollary of these personal and institutional efforts, at least 15 years after the beginning of the NRP, West Germany had reached back on the international level of neuroscientific research and overcome some of the devastating effects on the field through World War II.

Given the enormous scope of this historical research project, four major levels of investigation have been singled out. They question the field of neuroscience as an area of specific research clusters and groups of disciplines:

Which MPG institutes in West Germany were part of the neuroscience-related clusters? (Even if “neuroscience” was not included in their titles and/or contributed to it with their specific divisions?)
How did these institutes and divisions compare to other institutes in the biomedical section of the MPG or to comparable international institutions?
Why was the MPG specifically interested in the area of neuroscience, behavioral science, and cognitive science? Were decisions made to support other areas of biomedical science in the same way and why? Internal developments of science (such as opportunities for innovation, methodical re-directions, and the inclusion of global developments in the neurosciences), as well as societal and political expectations impacted the decision-making processes in this para-university research institution for advanced science.
Where did the planning ideas for research programs originate and through which agendas could they be realized at the time?

Is it possible to determine the meaning of the cluster for the MPG further, while also looking at the MPG’s administrative and economic roles for the cluster (and its resources)?

Which actors and networks played specific roles in the formation and development of the cluster as a whole? What were main trends in the research developments for the development of the neuroscientific area during the postwar period as a whole?

During a period of five years, many of these matters shall be answered and documented through historical sources. They will be analyzed under the auspices of the History of the Max Planck Society Research Program, leading to several scholarly articles and an overview book. •

The author currently contributes as a senior visiting scholar to the research program on the history of the Max Planck Society, inaugurated by the MPG president, Professor Martin Stratmann, and is led by a group of directors around Professor Juergen Renn from the Max Planck Institute for the History of Science (For more information, see the English website at gmpg.mpiwg-berlin.mpg.de/en/). The author collaborates with the research group, seeking to analyze and reconstruct the development of the neurosciences, behavioral sciences, and cognitive sciences in the relevant institutes of the Max Planck Society.

The neuroscience-related institutes have formed a central field of research in the Max Planck Society since its foundation in 1948. Their shared social references and thematic overlap constitute an interface between the life sciences, medicine, and the humanities (including psychology and cognitive science). For this reason, they are of particular scientific interest for several aspects of the research program addressing the wider cultural context and implications of the neurosciences.

The author seeks assistance from the international community of neurological investigators regarding personal recollections from research stays at neuroscience-related Max Planck Institutes, archival materials (outside of collections held in the Max Planck Society), along with information related to international collaborations between global institutions and individual Max Planck Institutes between 1948 and 2006. His contact details can be found at hom.ucalgary.ca.

For a preliminary publication indicating the scope and depth of the research project, see Stahnisch, F.W.: “Mapping Mind and Brain in ‘Modern’ Ways — On the Emergence of Interdisciplinary Approaches in the German Neuromorphological Sciences,” Journal of the History of the Neurosciences, 21 (2012): 96-7.

Dr. Stahnisch is a medical historian at the University of Calgary in Alberta, Canada. Visit the website of the history of medicine and health care program at hom.ucalgary.ca.

He is currently pursuing a collaborative research project with colleagues in Berlin and Jerusalem that investigates the development and differentiation of modern neuroscience at the German Max Planck Society.

Report of the XXIII World Congress of Neurology

By Wolfgang Grisold and
Steven L. Lewis, Editor

Participants in the Tournament of the Minds gather for a photo at the completion of the tournament in Kyoto, Japan, at the XXIII World Congress of Neurology. See more photos from the World Congress of Neurology.

The XXIII Congress of the World Federation of Neurology took place Sept. 16-21, 2017, in Kyoto, Japan.

The congress was successfully organized in cooperation with the Japanese Society of Neurology. Preparation over the past several years led to this impressive achievement. More than 8,600 participants visited the congress, which is the highest number of attendees at any World Congress of Neurology (WCN). This reflects the high interest in the brand of WFN World Congresses as well as the high global interest in neurology.

The motto of the congress was “Defining the Future of Neurology.” In doing so, the World Federation of Neurology (WFN) provided scientific input from the World Health Organization (WHO), the Global Neurology Network, and the six WFN regions.

The opening ceremony of the WCN was remarkable as the Crown Prince and his wife hosted a small meeting with the representatives of the WFN and the Japanese Society of Neurology and then gave a nice welcome and introduction at the opening. The WFN is honored that this prestigious visit was possible, which underlines the importance of the WFN and its global activities.

Scientifically, Nobel laureate Edvard Moser spoke on grid cells and the medial-entorhinal space networks. Two additional Nobel laureates presented. Susumu Tonegawa explored monitoring and engineering memory engram cells and their circuits, and Shinya Yamanaka spoke on recent progress in induced plutipotent stem cell research and applications. The WFN medal for Services to International Neurology was presented to Jun Kimura, the WFN Medal for Scientific Achievement in Neurology was presented to Angela Vincent, and the WFN Lifetime Achievement Award was presented to Chandrashekhar Meshram.

As in previous congresses, the scientific program was intertwined with teaching courses. For the first time, access to all teaching courses was free, and many teaching courses were packed full with interested attendees. Also for the first time, the World Congress included midday sessions where Japanese attendees participated in large and highly attended sessions in their native language, a novelty for WFN congresses.

There were other interesting aspects to the program besides the scientific highlights. For example, Tarun Dua presented the new Atlas of Neurology, which was released during the World Congress. This second edition of the atlas, which was created jointly with the WFN, highlights the worldwide distribution of neurologic services and neurologic possibilities. It will serve as a basis for many health politicians in regard to neurologic services. Also timely, Valery Feigin’s presentation on global neurology health statistic clearly showed the importance of neurologic diseases worldwide and demonstrated that neurology is the second-most frequent cause of death and the most frequent for disability in the world. These statistical analyses will influence many aspects of health policies worldwide.

These are just some examples of the many scientific presentations, reports and educational activities that occurred throughout this remarkable and highly attended conference, all with the goal to positively impact neurologic patient care.

From an organizational standpoint, the World Congress of Neurology also is the time when all the bodies of the WFN, including the committees and research groups, meet. The productive educational endeavors by the WFN, including the spreading of its educational activities in Africa, South America, and, hopefully soon, in Asia were acknowledged and approved by all committees. In addition, the World Congress included the important activity of a Patient Day, an activity that was first introduced at the WCN Vienna, and included the presence of President Prof. Raad Shakir. This patient day gave a strong signal that patients are important for the structure and development of the WFN.

The Council of Delegates meeting was held as the formal meeting of the delegates of the World Federation and several elections were made.

For the position of the new president of the WFN, Professor William M. Carroll from Australia was elected; for vice president, Professor Ryuji Kaji from Japan was elected; and for the open trustee position, Dr. Riadh Gouider was elected for a second term. After the next World Congress in Dubai in 2019, the next congress site will be in Europe and there was strong competition between four cities: Copenhagen, London, Marseille, and Rome. The Council of Delegates voted Rome to the be the site for the World Congress of Neurology in 2021.

In addition to the scientific and educational program, the Japanese organizers did a tremendous job accommodating their guests in a beautiful congress center. There was time for interaction and the beautiful gardens surrounding this unique place were also appreciated by all of the attendees.

The social program was wonderfully organized and beautiful events gave time and opportunity to observe and participate in the remarkable local culture as well as network and connect with colleagues from all over the world.

The closing ceremony was a beautiful event as the culmination of a tremendously successful congress in Kyoto. Included in the closing event were presentations to the recipients of the Elsevier Prize for Best Clinical Paper (awarded to Sharon Savage from the United Kingdom, for her and her colleagues’ report on the Long-Term Prognosis of Transient Epileptic Amnesia: Evidence from the TIME Project) and for Best Research Paper (awarded to Gen Shiihashi, Japan, for his and his colleagues’ report, A Novel ALS/FTD Model Mouse Expressing Cytoplasmic Mutant FUS Leads Neurodegeneration via Dendritic Homeostasis Disruption). The Ted Munsat award, a new WFN award for educational contributions to the WFN, was awarded to Walter Struhal and Tissa Wijeratne. Closing remarks were made from many dignitaries, including President Shakir and incoming President Bill Carroll, and Congress President Hidehiro Mizusawa, and culminated in the ceremonial exchange of gifts between Prof. Mizusawa and Suhail Al Rukn, the congress president for the next World Congress to be held in Dubai.

We hope you all enjoy the accompanying photographs as just some examples of many of the wonderful memories from the XXIII World Congress of Neurology in Kyoto. All readers are also encouraged to go to the WFN website for links to videos from many of the plenary lectures from WCN XXIII.

See more photos from the World Congress of Neurology.

XXIII World Congress of Neurology Kyoto Photos

Report on the Department Visit Program to Canada

Vanessa Benjumea-Cuartas

By Vanessa Benjumea-Cuartas, Medellín, Colombia

During my visit to the Montreal Neurological Institute and Hospital, everything was wonderful from beginning to end. I submitted a special request in order to do my fellowship in the epilepsy department because most of my patients in Colombia have this diagnosis. I really love to help patients and their relatives with epilepsy.

The positive response was immediate, and Dr. Andrea Bernasconi and Dr. Anne-Louise Lafontaine allowed me to spend the entire month in the epilepsy department, doing different types of academic activities.

Dr. Vanessa Benjumea-Cuartas (center) with her mentors Dr. Andrea Bernasconi (left) and Dr. Neda Ladbon-Bernasconi.

These included:

Reading EEG and video EEG every day with different physicians and listening to their points of view.
Attending the epilepsy meetings to discuss cases of patients admitted to the video/EEG unit.
Attending the first International Training Course on Neuroimaging of Epilepsy. For this, I am deeply grateful to Dr. Bernasconi for allowing me to attend the course for free.
Attending the academic meeting with the epilepsy fellows every Friday. I had the opportunity to give a lecture about the new classification of epilepsy and seizures proposed by the International League Against Epilepsy, discussing different scenarios and cases.

(From left) Dr. Vanessa Benjumea-Cuartas, Dr. Karina Gonzalez-Otarula, Dr. Eliane Kobayashi, and Dr. Aathi Pathmanathan at the seminar “Discussion of the Position Papers of the ILAE for the Classification of Seizures.”

I met wonderful people who welcomed me with open arms, including the doctors. Those people include Drs. Neda Ladbon-Bernasconi, Bernasconi, Elaine Kobayashi, Francois Dubeau, Jean Gotman, Martin Veilleux, Eva Andermann, and Boris Bernhardt. Others I worked with included epilepsy fellows, EEG technicians, and general people from the hospital, such as the administrative staff and the librarian. It also was a joy to meet people from Asia and South America — mainly from Argentina, the country where I lived for a year while I was doing my epilepsy fellowship.

Having the opportunity to perform training like this opens the mind in terms of academic and social skills. It allowed me to explore different approaches to the clinical questions of patients with epilepsy that arise in the course of daily patient care. It allowed me to learn how countries with a better economic background than mine solve different clinical questions because they have the resources to solve the smallest details. At the end, the real challenge is to come home to try to figure out what do with what we have.

Growing up in less privileged countries, such as Colombia, can be a challenge. However, it is clear to me after all of these years that with effort and dedication I can always achieve what I really want.

My educational pursuits would not be possible without generous support, like this scholarship. Thank you to the WFN and the Canadian Neurological Society for enabling this opportunity! •

Dr. Hachinski Named to Medical Hall of Fame

Vladimir Hachinski, MD

Vladimir Hachinski, MD, is among several prominent physicians selected for induction into the Canadian Medical Hall of Fame. He will be recognized at a ceremony April 12, 2018, held in association with Schulich School of Medicine & Dentistry, Western University at the London Convention Center in London, Ontario.

Canadian Medical Hall of Fame Laureates are individuals whose contributions to medicine and the health sciences have led to extraordinary improvements in human health. Their work may be a single meritorious contribution or a lifetime of superior accomplishments.

Dr. Hachinski is a renowned neurologist who has helped transform the understanding, diagnosis, treatment, and prevention of the two greatest threats to the brain — stroke and dementia. Together with John W. Norris, Dr. Hachinski pioneered acute stroke units, now the standard of care yielding the best outcomes for stroke patients of all ages, severities, and kinds. He coined the term “brain attack” for stroke to emphasize urgency in dealing with stroke symptoms.

Dr. Hachinski and his colleagues, David Cechetto and Shawn Whitehead, identified a link between Alzheimer’s disease and stroke and the brain’s insular role in sudden death. That led to the development of a host of new concepts captured in his new terminology: multi-infarct dementia, leukoaraiosis, vascular cognitive impairment, and brain at risk stage. The eponymic Hachinski Ischemic Score (HIS) is now a standard means for identifying the treatable components of dementia.

A distinguished university professor of neurology at Western University, Dr. Hachinski has written, co-written, or co-edited 17 books and more than 800 frequently cited scientific publications. He led the adoption of a proclamation on behalf of the World Stroke Organization and all major international brain organizations aimed at uniting stroke and dementia communities in their joint prevention of stroke and potentially preventable dementias.

Also being inducted into the Canadian Medical Hall of Fame will be Drs. Philip Berger, B. Brett Finlay, Balfour Mount, Cheryl Rockman-Greenberg, and the late Emily Stowe.

WCN Report: Palliative Care Is Gaining Momentum

By Professor Gian Domenico Borasio, Lausanne, Switzerland
and Professor David Oliver, Canterbury, U.K.

Modern palliative care traces its origins to the pioneering work of Dame Cicely Saunders who founded the first modern hospice, St. Christopher’s Hospice, in 1967 in London. Although most patients in St. Christopher’s suffered from cancer (as indeed most patients followed by palliative care teams to this day), a small group of patients did not. From the beginning, a few beds were reserved for patients with amyotrophic lateral sclerosis (ALS).

ALS has since become a paradigm disease for non-oncological palliative care, and it was the first non-cancer disease to have a textbook devoted to its palliative care to be published (albeit as late as in 2000).¹ In 2016, a consensus document on palliative care and neurology was produced by the European Academy of Neurology and the European Association for Palliative Care.²

The World Health Organization (WHO) definition of palliative care states that “palliative care is an approach which improves quality of life of patients and their families facing life-threatening illness.”³ There can be little doubt that a large proportion of neurological patients fall into this category.⁴ Indeed, given the progressive clinical course and the lack of curative options for most neurodegenerative disorders, one would assume that neurological patients and their families would stand to benefit greatly from an integration of the palliative approach into neurological practice.

Palliative Care on the Program

For the first time in the history of the World Congress of Neurology, two sessions on palliative care were held as part of the scientific program in Kyoto. The sessions were organized by Professor Wolfgang Grisold, secretary general of the WFN, and Professor Gian Domenico Borasio, neurologist and chair in palliative medicine at the University of Lausanne in Switzerland.

The first session, which covered the general concepts of palliative care, opened with a remarkable talk by Dr. Rajagopal from Kerala, India. Dr. Rajagopal has created an impressive palliative care network in an extremely resource-poor environment. He poignantly reminded us that palliative care in developing countries must respond to other problems than in industrialized ones, but that it is no less important. Following up on this, Professor Ogino, of Narita, Japan, described the challenges of palliative care from a transcultural perspective. There are large differences between Asian and European countries in the percentage of people dying at home, the opioid administration at the end of life, and the legal regulations for the end of life. However, a common feature across many countries is the fact that palliative care is mostly, if not exclusively, available for cancer patients, while access to palliative care for neurological patients remains challenging. Prof. Borasio approached the sensitive topic of end-of-life decisions in neurology, focusing on the crucial role of medical indication and the need for good communication skills on the neurologists’ side.⁵

In the second session, which was devoted to clinical examples of neurological palliative care, Professor Monika Führer, of Munich, Germany, showed impressive data on neurological involvement in pediatric palliative care, which turns out to be present and significant in 75 percent of patients.⁶ Cancer accounts for only about 20 percent of pediatric palliative care patients, further underscoring the importance of neurological palliative care in this context.

Prof. Grisold provided a description of the needs and problems faced by patients with advanced neuro-oncological disorders, which are compounded by the progressive loss in decision-making capacity and the emergence of behavioral disturbances.⁷ Professor David Oliver, who also is a board member of the European Association for Palliative Care, described in detail the manifold possibilities that palliative care offers to improve the quality of life of patients with ALS and their families. Often enough, these measures also have a demonstrable positive effect on patient survival as well.⁸

The sessions were well attended, and the discussants highlighted their own experiences from places as diverse as Australia, Europe, Japan, and Sri Lanka. Common themes were the difficulty to provide adequate palliative care to neurological patients, the lack of evidence-based guidelines, and the challenge of colleagues confusing palliative care with terminal care.

We sincerely hope that future WCN meetings will continue to offer attendees the possibility to hear about the most recent developments for this crucial topic for clinical neurological practice.

References

Oliver D, Borasio GD, Johnston W.(eds) Palliative care in amyotrophic lateral sclerosis: form diagnosis to bereavement. 3rd edition. 2014. Oxford. Oxford University Press.
Oliver DJ, Borasio GD, Caraceni A, de Visser M, Grisold W, Lorenzl S, Veronese S, Voltz R. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease. Eur J Neurol 2016;23:30-38.
Sepulveda C, Marlin A, Yoshida T, Ullrich A. Palliative Care: The World Health’s Organization global perspective. J Pain Symptom Manage 2002;24:91-96
Borasio GD. The role of palliative care for patients with neurological diseases. Nat Rev Neurol 2013;9:292-295
Borasio GD, Jox R. Choosing wisely at the end of life: the crucial role of medical indication. Swiss Med Wkly 2016:146:w14369
Bender HU, Riester MB, Borasio GD, Führer M. “Let’s bring her home first.” Patient characteristics and place of death in specialized pediatric palliative home care. J Pain Symptom Manage 2017;54:159-166
Pace A, Dirven L, Koekkoek JAF, et al. European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma. Lancet Oncol 2017;18(6):e330-e340
Mitchell D, Borasio GD. Amyotrophic lateral sclerosis/motor neurone disease. Lancet 2007;369:2031-2041

Editor’s Update and Selected Articles

John D. England

John D. England, Editor-in-Chief

The primary missions of the Journal of the Neurological Sciences are to respond to the requests of the readership and to fulfill the goals of the World Federation of Neurology (WFN). Along those lines, the journal’s Editorial Board has received many requests to publish reviews and guidelines on relevant clinical neurological topics. We are responding by soliciting and publishing more of these types of articles. We also are planning two new special issues within the next several months.

The first special issue will deal with the topic of tardive dyskinesia. Traditionally, tardive dyskinesia has been almost impossible to treat effectively. However, two new drugs, valbenazine and deutetrabenazine, are now available for treatment of tardive dyskinesia, making a special issue dealing with the topic of tardive dyskinesia timely. Dr. Daniel Truong, an associate editor of the journal and an expert in this area, will edit this issue.

The second special issue will focus on tropical neurology/infectious diseases. Infectious diseases are an extremely important area of tropical neurology, and many readers have indicated that they would like to read a comprehensive review on the topic. The review will cover the most important tropical infectious diseases. As highlighted by the recent epidemic of Zika virus infection, international travel makes it relatively easy for infected patients to arrive in many regions of the world. Thus, health care providers in all parts of the world should have some familiarity with these traditionally tropical diseases. Dr. Chandrashekhar Meshram, Dr. Marco T. Medina, and I will edit this set of articles. The journal and WFN will provide general notification when articles from these special issues are available.

Free-Access Articles

In our ongoing attempt to inform readers of important and interesting new developments in the journal, the editorial staff has selected two new “free-access” articles for our readership.

The first selected article is a review of post-traumatic dystonia by Karen Frei. This article covers the well-recognized dystonia that follows significant head trauma (i.e., central post-traumatic dystonia) as well as the somewhat controversial dystonia that may follow trauma outside of the central nervous system (i.e., peripheral post-traumatic dystonia). The possible pathogenesis and treatment options are discussed in detail.

K. Frei, Posttraumatic dystonia, J. Neurol. Sci. 379 (2017) 183-191.

The second article is a nationwide, multicenter retrospective cohort study from 118 stroke centers in Japan examining the safety of intravenous thrombolysis (IVT) and endovascular therapy (EVT) in patients with acute ischemic stroke who were being treated with direct oral anti-coagulants (DOAC). The use of DOACs, including dabigatran, rivaroxaban, apixaban, or edoxaban has increased, especially in patients with atrial fibrillation. However, guidelines for stroke management in patients who are treated with DOACs differ. The major reason for these differences is that the safety of thrombolysis in acute stroke patients on a DOAC is not well known. Thus, the results of this study are timely. It is important to note that the frequency of symptomatic (2 percent) and asymptomatic (18 percent) intracerebral hemorrhage (ICH) within 24 hours for patients on a DOAC were not significantly different from that of patients on vitamin K-antagonists or on no anticoagulant. The combined use of IVT and EVT did not increase the risk of intracerebral hemorrhage (ICH) in these patients. Multivariate analysis suggested that elevated systolic blood pressure and high blood glucose were independent risk factors for ICH. Data about DOAC last-administration time were available for 52 patients. Among these patients, the rate of ICH was higher in patients who had received a DOAC less than four hours from stroke treatment. If the results of this study are confirmed, reperfusion therapy in acute ischemic stroke may be safer than has been supposed, especially if the above-noted risk factors are considered.

K. Suzuki, J. Aoki, Y. Sakamoto, A. Abe, S. Suda, S. Okubo, T. Nagao, K. Kimura, Low risk of ICH after reperfusion therapy in acute stroke patients treated with direct oral anti-coagulant, J. Neurol. Sci. 379 (2017) 207-211.

AFAN Supports Young Neurologists

By Prisca-Rolande Bassolé, Professor Amadou Gallo Diop, and Professor
Mouhamadou Mansour Ndiaye

Young neurologist Prisca-Rolande Bassolé, (center), meets WFN President Raad Shakir (left) and Amadou Gallo Diop, the Africa Initiative Task and Advisory Force for Africa Trustee, at the first AFAN Conference in Tunisia.

The inaugural meeting of the African Academy of Neurology (AFAN) took place in August 2015 in Dakar, Senegal. In a brief presentation, two young African neurologists identified and summarized the expectations of their generation about this African academy¹.

Two years later, the first AFAN conference took place March 15-18 in Yasmine- Hammamet, Tunisia. It was co-organized by the Tunisian Society of Neurology and the Pan Arab Union of Neurological Societies, which met at the same time with the help of the International Auspices. Members of the International Auspices are the World Federation of Neurology, the European Academy of Neurology, the American Academy of Neurology, the Movement Disorders Society, the International League Against Epilepsy, and the Middle East North African Committee for Treatment and Research in Multiple Sclerosis².

The conference represented a great opportunity to enhance regional and international cooperation with these other societies and organizations and to improve the education of young African neurologists.

Residents and young neurologists with the teachers at the International Course of Neurology on the Peripheral Nerve and Muscular Diseases, presented May 8-9 at Cheikh Anta Diop University.

AFAN is committed to participating in the training and continuing medical education of young neurologists. Two months after this first conference, AFAN organized the International Course of Neurology on Peripheral Nerve and Muscular Diseases with the Pan African Association of Neurological Sciences and the French Society of Neurology. The course took place May 8-9 at Cheikh Anta Diop University in Dakar, Senegal. Seventy residents and young neurologists from 18 countries attended the course. The attendees represented Benin, Burkina Faso, Burundi, Cameroon, Congo, Congo Brazzaville, the Democratic Republic of Congo, Djibouti, Gabon, Guinea Conakry, Ivory Coast, Mali, Maroc, Niger, Rwanda, Senegal, Tchad, and Tunisia.

Attendees benefited from the interactive topics that were presented over two days by teachers from France, Ivory Coast, and Senegal.

This is an excellent initiative of AFAN that the younger generation of African neurologists encourages. We hope that other courses like this one will be organized periodically to foster interregional and international cooperation and to improve the training of neurologists. •

References

Bassolé PR, Fogang FY, The African Academy of Neurology: Young African Neurologists’ Message and Point of View; World Neurology, 2016 Jul;31(4):6
Gouider R, Grisold W, AFAN-PAUNS Congress: Two societies achieve a milestone of joint regional meetings; World Neurology, 2017 May-Jun;32(3):12

Prisca-Rolande Bassolé is an African neurologist from Burkina Faso. Amadou Gallo Diop is an Africa Initiative Task and Advisory Force for Africa Trustee. Mouhamadou Mansour Ndiaye is the first president of AFAN and a member of the Neurology Department/FANN Teaching Hospital in Dakar, Senegal. The authors declare no conflicts of interest.

From Islamabad to Kyoto: A Dream Come True

By Dr. Qurat Ul Ain
Islamabad, Pakistan

Dr. Quratul Ain (center), Professor Arsalan Ahmad (second from right), and Professor Hideki Mochizuki (third from right) at one of the WCN 2017 events they attended.

The XXIII World Congress of Neurology 2017 took place Sept. 16-21 in Kyoto, Japan. It was organized by the World Federation of Neurology (WFN) and co-hosted by the Japanese Society of Neurology (JSN) and Asian and Oceanian Association of Neurology (AOAN). More than 8,600 delegates attended this conference from 121 countries.

As a medical student and an intern, I have presented papers and posters in local and national neurology conferences in Pakistan over the last three years. When my teacher and mentor, Professor Arsalan Ahmad, asked me to submit our abstract to the WCN in Kyoto, I asked him who would sponsor it. “Apply for a bursary” was his immediate response. I was overjoyed when my abstract was accepted for a poster presentation and I was awarded a travel bursary of $1,000 with free registration. Preparing the poster and traveling to Japan was a long journey from Pakistan, yet an amazing one to write about.

The International Conference Center Kyoto is a striking architectural beauty with breath-taking scenery and lakes surrounded by green mountains. The main hall offers an amazing interior and a huge seating capacity; the smaller halls are equally as beautiful.

The scientific sessions, teaching courses, plenary lectures, and the hall filled with research posters and enthusiastic presenters each day was very interesting. The Japanese cultural flavor and politeness displayed throughout the conference was impressive. Professor Edvard I. Moser, the Norwegian Nobel laureate, presented a lecture during the Presidential Symposium that was both exciting and inspiring. A session on the Zika virus with graphic visuals by Professor Andre Pessoa of Brazil also was interesting.

Despite an unexpected typhoon threat, the Opening Ceremony on Sept. 17, in the presence of the prince and princess of Japan, was superb. The reception dinner featured a dramatic Taiko drum performance. The thundering Taiko beats in the air were mesmerizing. It filled the exhibition hall with immense energy.

I enjoyed my brief visit to Kyoto, a city that is rich in tradition, with its sprawling street markets and ancient temples. During my morning walk on Manjuyacho Street near my hotel, I heard the temple bell at 6 a.m. Following the resonance, I reached an ancient Buddhist temple. It provided a serene aura, and the glimpse of that moment will be remembered. I later learned that the temple bell is also called “bonsho” in Japan. It is used to summon monks for prayer or to demarcate time.

The icing on the cake was a dinner hosted by Congress President Professor Hidehiro Mizusawa. I attended the dinner with Prof. Ahmad. It was a majestic traditional event that included a martial arts performance by children and adults as well as a traditional dance performance by Maikos. I had the rare opportunity to talk to a Maiko and learn more about them. This was followed by a sumptuous nine-course meal. Professor Hideki Mochizuki from Osaka University went out of his way to elaborate on the cultural performances and taught me to eat sushi with chopsticks.

The hospitality of the Japanese nation, the energy of the conference, and enlightening lectures from renowned neurologists throughout the conference provides an experience and memories that I will cherish for a long, long time.

From the Editors

By Steven L. Lewis, MD, Editor,
and Walter Struhal, MD, Co-Editor

Walter Struhal, MD

Steven L. Lewis

We are pleased to present the September/October 2017 issue of World Neurology, subsequent to the remarkably successful World Congress of Neurology XXIII held Sept. 16-21 in Kyoto, Japan. This issue opens with WFN President Professor Raad Shakir’s report from the World Congress. Dr. Wolfgang Grisold and Dr. Lewis also summarize many of the key events from the congress, including some representative photographs from this attendance record-breaking event. To round out the congress reports, this issue also offers an enthusiastic report from one of the many young bursary awardees who participated in the congress.

This issue features also reports and images from World Brain Day 2017 from around the globe, with reports from Moldovia; Myanmar; Nagpur, India; and Pakistan. Dr. Grisold also updates us on the outcome of the recent European Board examination as well the World Health Organization meeting that took place in September in Budapest, which the WFN was privileged to take part in.

Professor John D. England, editor-in-chief of the Journal of Neurological Sciences, provides his report of the most recent issue of the journal. This issue’s history article, by Dr. Frank Stahnisch, explores the transition from the Kaiser Wilhelm Society to the Max Planck Society.
Dr. Prisca-Rolande Bassolé and colleagues update us on their thoughts, from the perspective of young African neurologists, two years after the founding of the African Academy of Neurology. Also from Africa, Drs. Philip Adebayo and Funimola Taiwo report on a novel approach to improve neurologic education in Nigeria.

This issue also includes an enthusiastic report from Dr. Vanessa Benjumea-Cuartas from Colombia after her recent Canadian/WFN Department visit at the Montreal Neurologic Institute. You also will find news of the prestigious award recently presented to Dr. Vladimir Hachinksi, past president of the WFN.

We hope you enjoy this issue. We are pleased that so many of you were able to attend the recent World Congress in Kyoto. We look forward to seeing you in 2019 in Dubai.

Regional WHO Meeting Update

By Wolfgang Grisold

The World Federation of Neurology (WFN) was invited to participate in the World Health Organization (WHO) meeting that took place Sept. 11-14 in Budapest.

Regional Director Zsuzsanna Jakab (left) speaks with WFN Professor Wolfgang Grisold, WFN secretary general.

The agenda included a review of the current work of the WHO, presented by the regional director, Zsuzsanna Jakab. Statements came from the Hungarian government (Prime Minister Viktor Orban) and individual European countries. WHO Director General Dr. Tedros Adhanom Ghebreyesus explained his ideas on the future development of the WHO.

The WFN was invited as a permanent member. Several non-governmental organizations (NGOs) and non-state actors participated, including the World Stroke Organization (WSO), represented by Professor Patrik Michel.

WHO Director General Dr. Tedros Adhanom Ghebreyesus outlines his vision of the WHO during its regional meeting for Europe.

The WFN was invited to provide a statement, which it chose from agenda item 5b referring to the environment and neurology. This statement was developed by using the work done by a WFN applied research group on neurology and the environment. This research group met in 2016 in Strasbourg and emphasized the importance of the environment and its effect on neurologic diseases. The final version of the report as accepted is posted at who.int/en/. The written statement has been posted at euro.who.int/en/about-us/governance/regional-committee-for-europe/67th-session/statements-from-non-state-actors.

Crown Princess Mary of Denmark, the patron of WHO European region, speaks at the WHO Regional Committee for Europe.

Also present were the WSO and several other NGOs with overlapping fields in neurology, such as palliative care, occupational therapy, and student representation (IFSMA).

The cooperation of the WFN with the WHO is important and has included several successful projects, such as the Atlas of Neurology, the ICD-11 classification, and future work on non-communicable diseases.

The WFN participating with the WHO in regional meetings is extremely important as it gives neurology a local voice in the important regional aspects of WHO work.