Articles – Page 49

WFN and the Canadian Neurological Society Provide a Learning Opportunity

By Giordani Rodrigues dos Passos, MD

Giordani Rodrigues dos Passos, observer (left), Mrs. Vanessa Spyropoulos, clinical nurse specialist in the MS program, and Dr. Yves Lapierre, director of the MNH Multiple Sclerosis Clinic.

One month after completing my neurology residency in Brazil, I had the opportunity in March to participate in the Canadian Department Visit Program, during which I served as an observer at the Montreal Neurological Institute (MNI).

The administrative staffs of the WFN and the MNI were excellent, both before and during my stay in Montreal. My schedule was arranged by Dr. Anne-Louise Lafontaine, who made sure to take my main interests into account.

My activities included:

Clinics of multiple sclerosis (MS), amyotrophic lateral sclerosis, neuromuscular disorders, and movement disorders at the Montreal Neurological Hospital (MNH) for three weeks
Neurology wards and consultation at the Montreal General Hospital (MGH) for one week
Weekly grand rounds and teaching sessions at both the MNH and the MGH
Weekly meetings with the PET team at both the Brain Imaging Center/MNH and the Douglas Institute
Meetings with professors and PhD students to discuss specific areas of interest

My main interest is MS, which is roughly 10 times more prevalent in Canada than it is in Brazil. From a clinical perspective, this observership was remarkable because I saw several dozen MS patients, covering a wide range of clinical aspects and treatment strategies.

A number of elements stood out for me relating to the functioning of the MNI and the health care system in Canada. They included:

Dr. Anne-Louise Lafontaine (center), chief of the Department of Neurology of the McGill University Health Center, and Giordani Rodrigues dos Passos (third from the right), observer, with neurology residents and medical students during rounds at the Montreal General Hospital.

Health care and research are closely integrated with mutual benefits.

The MNI is remarkably able to communicate its actions and achievements to the scientific community as well as the patients and society as a whole. This increases its ability to raise additional funds for research.

Multidisciplinary teams at the clinics and in the wards improve significantly both the neurologists’ work and patient outcomes.

Canadian neurology residents receive more in-depth training on neuroanatomy, pathophysiology, and semiology than most of their Brazilian counterparts.

Many of these elements could be implemented in my workplace, an 800-bed university hospital in southern Brazil. What I learned at the MNI will improve my practice as a neurologist and researcher in the coming years. It also will serve as a lesson when I have opportunities to participate in my hospital’s institutional decisions.

Dr. Jack Antel (left), professor at McGill University and president of the Americas Committee for Treatment and Research in Multiple Sclerosis, and Giordani Rodrigues dos Passos, observer, at the Montreal Neurological Hospital.

A minor drawback of my observership was the March break, which took place during my first couple of weeks there. During this time, some of the clinic’s work was suspended, and some of the attending neurologists were away from the hospital. Even though I was able to find alternative clinical or academic activities to fill my schedule, I suggest the next observers be advised of the March break and encouraged to choose another month for their MNI visit.

Overall, this was an inspiring, career-changing experience. I recommend the Canadian Department Visit Program for other young neurologists. I congratulate the WFN, the Canadian Neurological Society, and the MNI for fostering education in neurology, and I am grateful for this opportunity. •

Giordani Rodrigues dos Passos, MD, works in the Department of Neurology at São Lucas Hospital in Porto Alegre, Brazil.

Fellowship in Morocco Productive for Mali Neurologist

By Dr. Boubacar Maiga

The staff of the Department of Neurophysiology of Mohamed-V University of Rabat Sitting (from left): Prof. Halima Belaidi, Dr. Fatiha Lahjouji, and Prof. Nazha Birouk. Standing (from left): Dr. Bouchra Kably, and Profs. Alassane Dravé, Youannes Debebe, Boubacar Maiga, Fatima Hassane Djibo, Reda Ouazzani, and Leila Errguig.

I would like to thank the WFN for giving me the opportunity to have a fellowship in clinical neurophysiology at the University Mohamed-V in Rabat in Morocco. I would like to express my sincere gratitude to Prof. Mustapha El Alaoui Faris, the coordinator of the Rabat Center, for his advice and follow-up during my successful training. I also thank Prof. Reda Ouazzani, the head of the Department of Clinical Neurophysiology, for his warm welcome and nice teaching. I also thank the department team: Profs. Nazha Birouk, Halima Belaidi, and Leila Errguig, and Drs. Fatiha Lahjouji and Bouchra Kabli.

My training took place every week, from 9 a.m. to 3 p.m., Monday through Friday. I performed all of the neurophysiological explorations under the supervision of Prof. Ouazzani. In the department, I had the same activities as the Moroccan residents in neurology and neurophysiology.

Video EEG: I participated in the recording, reading, and interpretation of video EEGs for patients with epilepsy. I interpreted the EEGs alone at first, and then I discussed the EEG patterns with one of the professors in the department.

EMG: Initially, I practiced EMG under the supervision of the professors. Then, I practiced EMG alone and discussed the protocol and patterns with one of the professors in the department.

Evoked potential exploration: I did time-to-time evoked potentials with Dr. Kably.
Neuromuscular outpatient visits: I regularly attended the outpatient consultations on neuromuscular diseases with Prof. Birouk.
Epileptology: I attended the epileptology consultations with Profs. Ouazzani and Belaidi.

The first six months were focused on EEG and epilepsy, and the focus in the last six months was on EMG and neuromuscular diseases.

Scientific Activities

I attended the departmental conference from 2:30 to 4 p.m. on Thursdays. There, we discussed interesting EMG and EEG cases selected from Monday through Wednesday. The last Friday of every the month, we held a multidisciplinary conference in the morning involving all of the neurology departments of the hospital. An oral presentation was made by each department, and the presentation was debated. In the afternoon, we had a multidisciplinary conference that included neurologists, neurosurgeons, and neuroradiologists at the National Center of Neurosciences and Rehabilitation inside the hospital Hôpital des spécialités.

Congresses and Meetings

With the support of the Moroccan Society of Neurology, I had the opportunity to attend the following meetings and congresses:

May 5-7, 2016: The National Congress of the Moroccan Society of Neurology in Marrakesh
May 19-21, 2016: The Maghreb Congress of Neurology in Alger
Oct. 13-15, 2016: The course on Movement Disorders, organized by the Movement Disorders Society and the Moroccan Association of Movement Disorders in Marrakesh.
Nov. 10-12, 2016: The Autumn Congress of the Moroccan Society of Neurology in Rabat. At the conference, I received an award for the best poster communication.
March 15-18, 2017: I presented an oral communication, “Phrenic Nerve Conduction Study in Six Patients With Amyotrophic Lateral Sclerosis and Review of the Literature,” at the African Academy of Neurology Conference, in Hammamet, Tunisia.
March 28-31, 2017: Les Journées de Neurologie de Langue Française, the annual French meeting of neurology, in Toulouse.
April 27, 2016: I attended a course of Prof. Fabrice Bartolomei from Marseille on epilepsy and sleep.
I attended two seminars for residents of anatomy and physiology of the nervous system, organized by Faculty of Medicine of Rabat.
March 10-11, 2017: I attended an EMG Practical Workshop on Traumatic Nerve Injuries, animated by Prof. Emmanuel Fournier of Paris and Prof. Nazha Birouk of Rabat, in Marrakech.

To enhance my knowledge on the theoretical level, I enrolled in the University Diploma on EMG and on EEG.

I am satisfied with my fellowship in the Department of Neurophysiology at Rabat. Thank you for the scientific environment and the availability of the whole team of the department. I had an excellent stay in Rabat, during which I gained knowledge in both EEG and epileptology, as well as in EMG and in neuromuscular diseases.

I believe I will be able to pass on the knowledge in neurophysiology that I acquired in Rabat to my colleagues in Mali and help improve the practice of neurophysiology in my country.

I am planning to use EEG and EMG at the teaching hospital of Point G to support the clinical evaluation needs of patients with epilepsy. I will do an EEG evaluation of study participants in a research project on autism in Mali. I am currently designing a study on EEG biomarker identification in autistic children.

The Emergence of Clinical Neurology in Australia

By M. J. Eadie

M. J. Eadie

In Northern Hemisphere countries, from about 1860 onward, the specialty of clinical neurology emerged after increasing numbers of medical graduates focused their interests and restricted their clinical practices to the study and management of organic disease of the nervous system. A similar process occurred in Australia, but lagged by some four decades so that the specialty of clinical neurology there became firmly established only by the mid-20^th century.

Several factors contributed to the Australian delay. European migration to the country began in 1788. Initially, the migration was composed largely of convict settlements, with free settlers beginning to arrive a few decades later. The Australian population sites that developed were far from Northern Hemisphere cities and educational institutions and also were considerable distances from each other. The individual sites needed to become large enough before specialist medical practice was feasible in them.

In the latter third of the 19^th century, accounts of neurological disorders peculiar to Australia began to emerge. For example, children were being diagnosed with lead poisoning, and those who ate finger cherry fruit experienced acute bilateral visual failure. There were reports of disorders, such as leprosy, beriberi neuritis, and tick bite paralysis, not often seen in temperate climates. With few exceptions, Australian authors did not publish again on the same topic.

However, in the 1880s in Melbourne, John William Springthorpe became interested in epilepsy, and in the 1890s, S. Jamieson wrote on both syphilis and peripheral neuritis.

George Edward Rennie

The first man to take a major continuing interest in clinical neurology in Australia was George Edward Rennie (1861-1923). Originally from Sydney, he received his medical education (MB and MD) at the University College London and returned to Sydney. By 1898, Dr. Rennie became an honorary physician to the Royal Prince Alfred Hospital. He resigned that appointment and returned to London. He took the membership of the Royal College of Physicians, returned to Sydney in 1900, and re-ascended the honorary consultant ladder at his hospital to become its senior physician (from 1912 to 1921).

Dr. Rennie seems not to have carried out any significant original research, but wrote on neurological topics, such as the functional anatomy of the cerebellum, meralgia paraesthetica, the physiology of voluntary movement, the curability of epilepsy, the treatment of peripheral nerve diseases, the effects of spinal cord transection, and the possibility that occupation and peripheral trauma might determine the site of syphilitic cerebral pathology. He provided the neurological input to the main teaching hospital of Australia’s largest city but, with writings on topics such as pneumonia, tuberculosis, pernicious anemia, childhood deafness, and endocrine topics, he never restricted his activities to clinical neurology.

Alfred Walter Campbell

Alfred Walter Campbell

Alfred Walter Campbell (1868-1937) was the first person in Australia to practice purely as a clinical neurologist. He was born on a pastoral property in southern New South Wales, educated locally, and, at the age of 18, traveled to Edinburgh, Scotland, for medical studies. He graduated with an MB CM in 1889.

After short-term appointments in British psychiatric institutions and some months in Vienna with Richard von Krafft-Ebing, he spent a year at the State Asylum in Prague, where his histological research on “alcoholic neuritis” brought him an Edinburgh MD degree in 1892. He then became medical officer and resident pathologist at the Lancaster County Asylum (Rainhill), near Liverpool, where he spent the next 13 years publishing a considerable amount of neuropathological investigation into various topics, such as the degeneration of spinal tracts connected to the cerebellum. He was the sole author of all of this work, except for a lengthy account of the pathology of herpes zoster, co-authored with (the subsequently Sir) Henry Head. Head supplied the clinical data to correlate with Dr. Campbell’s histological findings in the nervous systems of 21 zoster sufferers. A map of the distribution of the human dermatomes resulted. Dr. Head’s role in this great achievement is still remembered, while Dr. Campbell’s is forgotten.

From about 1900 on, Dr. Campbell systematically investigated the histology of the entire normal human cerebral cortex, as a preliminary to searching for histological changes in the cortex that might correlate with mental illness, something that macroscopic pathology had failed to do. He studied serial sections from tissue blocks from 50 to 60 gyri per hemisphere in five hemispheres, staining alternate sections for myelinated nerve fibers and neuronal cell bodies, and in a further three hemispheres for nerve fibers only. He also sought retrograde cortical histological changes where altered brain function resulted from lesions below the cortex. He identified 12 histologically distinct areas in the cerebral cortex.

The future Nobel Laureate C.S. Sherrington, then professor of physiology in nearby Liverpool, read the findings on Dr. Campbell’s behalf to the Royal Society of London (1903 and 1904). The abstracts appeared in the society’s Philosophical Transactions, but the full paper was too extensive for publication. The society regarded the work highly enough to subsidize its publication by Cambridge University Press as Histological Studies on the Localization of Cerebral Function. The monograph appeared in late 1905, some three years before Korbinian Brodmann’s similar investigation was published.

Before his monograph was in print, Dr. Campbell returned to Australia, never leaving his homeland again except to serve with the Australian Army Medical Corps in Egypt during World War I. One factor in his abandoning his British career at his moment of triumph probably was his 1906 marriage in Sydney to a woman he had known since his rural childhood.

In Sydney, neuropathology was largely closed off to him by Froude Flashman and Oliver Latham in the State Asylum Service, while Dr. Rennie did much of the clinical neurology. Dr. Campbell began consultant practice in a mix of neurology and neuropsychiatry, with the latter progressively fading from his activities. He held honorary consultant positions at the Sydney Children’s and Coast Hospitals, and after World War I, to the Repatriation Department. He continued some neuropathological work, studying a gorilla brain given to him by Dr. Sherrington, and investigating in conjunction with Cleland the pathology and pathogenesis of a viral encephalitis termed Australian X disease, now believed to have been Murray Valley encephalitis. He also sought histological evidence consistent with localization of function in the human and Australian animal cerebellar cortex. He published those findings in so obscure a site that they went almost entirely unnoticed.

His other papers in Australia were more clinical. In 1937, he became ill with a malignancy, dying late in that year. He left behind no local school of clinical neurology. Sydney medicine, long reluctant to accept specialization within internal medicine, was not ready for it. Dr. Campbell’s reserved personality probably worked against him, and his earlier scientific attainments were little appreciated in his homeland.

J. Froude Flashman

J. Froude Flashman (1870-1917) followed a career course similar to Dr. Campbell’s. In 1910, he moved from neuropathology into consultant neurological and pathological practice in Sydney, largely to provide for his family. His original contributions to neuropathology, though appreciable, were not of the magnitude of Dr. Campbell’s. Dr. Flashman died of pneumonia while serving in the Australian Army Medical Corps in 1917 in France, soon after taking the MRCP qualification. Unfortunately, he did not have time to influence the development of Australian clinical neurology.

Leonard Bell Cox

Leonard Bell Cox

A young Melbourne medical graduate, Leonard Bell Cox (1894-1976) took the Edinburgh MRCP qualification (in hematology) before returning home after front-line service in France during World War I. In Melbourne, he first held appointments in pathology while building up practice as a physician. From 1925 onward, he increasingly devoted himself to clinical neurology, holding a formal appointment as a neurologist to the Alfred Hospital in that city. Among other investigations, he published some significant neuropathological research, including a major and influential study, “The Cytology of the Glioma Group With Special Reference to Inclusion of Cells Derived From the Invaded Tissue,” that appeared in the American Journal of Pathology (1933), and a co-authored monograph (with Jean Tolhurst) on Human Torulosis.

Edward Graeme Robertson

With the advent of Dr. Cox, leadership in the development of Australian clinical neurology shifted from Sydney to the country’s second city, Melbourne. There, (Sir) Sydney Sewell (1880-1949) held hospital consultant neurological appointments from a little before World War I, but afterward shifted his interest into the area of tuberculosis. Before doing that, he had encouraged Edward Graeme Robertson (1903-1975) to train in neurology in London where, after some distinguished clinical research work, he had already been appointed to a consultant post in neurology before returning to the Royal Melbourne Hospital in the mid-1930s. By that time, there also were physicians with major neurological interests, virtually de facto neurologists, in most of the Australian state capital cities, and the speciality of clinical neurology had arrived at its stage of self-sustaining expansion.

References:

Bladin P, Eadie MJ, Wehner V (2004) Leonard Bell Cox (1894-1976) — pioneer of Australian clinical neurology. Journal of Clinical Neuroscience 11: 819-824.
Eadie MJ (2000) The neurology of George Edward Rennie (1861-1923). Australian and New Zealand Journal of Medicine 30: 83-85.
Macmillan M (2016) Snowy Campbell. Australia’s pioneer investigator of the brain. Melbourne. Australian Scholarly Publishing.

M.J. Eadie is with the University of Queensland, Brisbane, Australia.

The Journey of One Neurologist from Sri Lanka to Melbourne

By Tissa Wijeratne, MD

Tissa Wijeratne, MD (right), with one of his mentors from his time as a student in Sri Lanka.

Born and raised in what I describe as “the jungle,” my life started in one of the remotest parts of Sri Lanka: a village called Kirioruwa-Bandarawela in the central mountainous area. Electricity, hot water, television, and telephone were all miles away from us at the time.

I fondly recall days spent reading in the shade of a tree in the rice fields that surrounded my family home — the place where sky and earth met, almost kissing each other daily. The mountains were covered with a layer of lush tea bushes. Our home sat on the top of one of these mountains.

As a young boy, I would spend hours reading my favorite magazine, the Mihira, a children’s weekly.

Fast forward several decades. I am now the director of stroke services, neuroscience research unit, director of academic affairs, and director of international affairs at a leading public health service and a leading academic institution in Melbourne, Australia. I have just been appointed to chair of the Department of Neurology at Western Health in Australia to promote better brain health through my leadership.

I have become the first Sri Lankan-born neurologist to lead an academic department of neurology in Australia.

The Journey

I was always dreaming, ravenously reading, thinking … trying to discover new things that others hadn’t, with a view to make life better for my fellow men and women.

I fell in love with the idea of medicine when I realized that the potential to change human life for the better was immeasurable.

I was accepted in to medical school at the University of Peradeniya in 1987 as a merit student. This was purely an accident. I had no idea that I could end up in medical school while I truly loved biology as a high school student. I preferred to do the biology track as I truly enjoyed learning about biology and chemistry. In the end, I did well and secured a ticket to get in to the medical school.

The day before I departed for the university, the whole village visited my parents with whatever treasure they could carry.

“We are very proud of you, son. Be a good doctor, and come back to the village. We will need you one day,” they said.

I still recall my father’s deep voice while he was walking me to the railway station to get to the University premises from Bandarawela.

“I am very proud of you. I have no doubt you will go all the way. It is very important for you to remember your roots,” he said. “Whatever you become, every time you come home, you are one of us, one of them.” (He pointed to a fellow villager who was working along a farm yard.) “You should always be very humble,” he said.

University life was a dream come true for me. There was no rice field to work; no need to offer physical labor on the farm. It was a heaven made for learning. I easily picked up high marks at the university exams.

I recall coming back to the village and sharing my experience with other boys and girls. The gates were open for them to enter universities away from the village.

Most of the boys and girls worked hard to get to the university.

Uprising

The good times did not last long. Things changed for the worse in a few months.

Suddenly, it was a tough time in Sri Lanka. I did not see this coming. It was depressing. Part-way through my first year of medical school life, a national youth uprising in 1987 resulted in several years of chaos in the country, with educational establishments closed for the period of insurgency.

Many of my batch mates were killed. They were suspected to have links with the youth-uprising group.

During what became a three-year hiatus, I tried to come to terms with the fact that I was not going to become a physician. I took solace in reading as much as I could, while helping my parents farm the surrounding rice fields and gardens in my rural village.

I really missed the university life. I missed the library the most. So, I began to convert my thoughts into words. I started to write.

I wrote poems and stories. In the end, many leading national newspapers and magazines in Sri Lanka published them one by one. In the end, I became well known in Sri Lanka, with over 3,000 written pieces. I would sit under a tree in the rice fields and write. My thoughts at that time were that if I could not be a physician, maybe I would become a journalist.

In 1990, the youth uprising was crushed, and the universities reopened. I faced a fork in the road. Should I continue with the new path and take up the post as deputy editor for a leading national science weekly in Sri Lanka, or return to my much-loved medical school and finish what I had started?

Ultimately, I chose medicine. I continued to work with media on a part-time basis, a decision that enabled me to pursue my tertiary studies without financially burdening my family. In my third year at the University of Peradeniya Medical School, I decided that the brain was the most fascinating organ in the whole body.

The Mind

The human mind always fascinated me. In fact, I was often found in the canteen, unofficially tutoring many of fellow medical students from my own class, as well as the juniors, on brain anatomy and neurological pathways. I was popular for demystifying neurosciences as a student at that time. I was quite interested in depression, anxiety, memory, and wisdom, and I often spoke on these topics on national radio at the time.

I had been learning about my own mind since I was a child, perhaps since I was about 10 or 11 years of age. A lot of people do not know their own minds. Most of us either live in the past or future, not the present, and we become daydreamers. We forget what we need to do now. We forget to live in the moment. We ruminate in the past or future. This is the root cause for suffering among us.

I graduated with high marks and secured one of the most prestigious internship appointments in Sri Lanka, at the professorial University Medical Unit and University Surgical Unit at National Hospital in Colombo, Sri Lanka.

Then fate intervened. I met a girl, who later became my wife. Born in Sri Lanka, she had moved to Australia as a young student in medicine and, as a fellow medical graduate, was taking an elective at a Sri Lankan hospital when she and I met.

At the completion of my internship, I was handpicked to be the youngest junior lecturer at the University of Peradeniya, being trained in neurology and stroke medicine under the mentorship of Prof. Nimal Senayanake. This was a highly competitive position. Prof. Senayanake is well known to the World Federation of Neurology thanks to his significant contributions in neurotoxicology in the past.

Family

At the time, I was observing the brain drain happening around me as my peers left for the U.K., Australia, and America. I hated them. I strongly felt that they had a duty to serve in the less green parts of the world.

Because of my marriage, I had to leave Sri Lanka in the end. The guilt I felt at leaving my beloved homeland in 1998 cut deep. It was some months before I could make progress in establishing a new life in Australia with my wife.

In 1999, my wife and I moved to New Zealand as part of her training in psychiatry. I then had the good fortune of working with a remarkable young infectious diseases physician, Dr. Richard Everts, who pushed me to complete physician training in Australasia while I was contemplating a neurobiology PhD at the time.

For the first time in my life, I could practice what I read in textbooks. I couldn’t do that in Sri Lanka.

After completing my basic physician training in New Zealand and having our first child in North Island, we moved south, to Christchurch, where I undertook my advanced training in neurology with Prof. Tim Anderson and colleagues. Here, I developed my skills in movement disorders, stroke medicine, and headache medicine. I was on call for the EPITHET trial as an investigator 24/7 for nearly three years.

We then moved back to Australia, and I took up a post at the Royal Adelaide Hospital, where our second child was born. I underwent further training in stroke and movement disorders under the leadership of Prof. Philip Thompson, then president of the Movement Disorders Society.

In 2006, Prof. Robert Helme invited me to set up a stroke program, neuroscience research program, and movement disorders program at Western Health, where resources were limited.

I went on to develop the fastest-growing stroke service in Australia at Western Health. A number of PhD students completed their higher degrees through the Western Health neuroscience research program. Our collaborations generated 10 to 15 high-quality publications in high-impact factor journals annually.

Prof. Helme is a remarkable person. We owe him a lot. He inspired a department, helped me establish a research program at Western Health, and encouraged my interest in stroke medicine. He is still my mentor. We meet every six weeks or so over a coffee, and even though he criticizes me for not doing more, he always smiles at my achievements.

I go back to Sri Lanka with surprising frequency, to promote better brain health in Sri Lanka. I have conducted more than 150 master classes in stroke medicine, headache medicine, and movement disorders throughout Sri Lanka since 2007. I have trained a young neurologist/physician from Sri Lanka at Western Health almost every year since 2008. At present, another Sri Lankan neurologist from Kandy is training with me in Melbourne, Australia.

I spend almost 70 percent of my annual leave returning to Sri Lanka. To my knowledge, I am the only permanent visiting professor of neurology to be officially appointed to a Sri Lankan University.

Australia has one of the best health care systems in the world, and I am proud to be a part of it. We deliver state-of-the-art care for our patients regardless of how much is in their pocket.

I don’t believe in complaining or whining about what we don’t have. Not so long ago, I did not have any office space or a personal assistant at Western Health while I was leading one the biggest stroke services in Australia. I was using a dustbin along the corridor to lean on and sign paperwork. The stroke service head from Colombo National Hospital and two other physicians who visited me noticed this in 2009. Just because I am in Melbourne does not mean I have a silver spoon.

I believe I am a link between the developing world and the developed world. If someone turned back the clock to 1998, and I was given the option of staying in Sri Lanka or coming to Australia, I would still come. I always wanted to do something great for the world and fellow human beings, and the Australian health system has given me the opportunities I never would have had in Sri Lanka.

Last year, I was very sick. I almost lost my life. At one point, I was told that I was not going to live more than two months. I recall the sleepless nights I had earlier in the illness.

“Did I get it wrong? I could have done more private practice and paid off the mortgage. Why did I spend time traveling back and forth to Sri Lanka rather than building my wealth and CV?”

I knew the answer right away. This is the best way to live my life. There is nothing that makes us happier than giving and expecting nothing in return.

I enjoy perfect health at the moment. I will continue to do my very best to dedicate my life to making life better for my fellow human beings. I have no boundaries for this purpose.

There is much more to do in this world. There is much more to do in the Asia-Pacific region. The World Federation of Neurology is our platform to do this work and to get the job done.

Make sure you sign up for the advocacy workshop at the upcoming world congress in Kyoto.

I look forward to seeing you all in Kyoto. Let’s get together and promote better brain health.

Let us bring our very best to get the best possible care for our patients, irrespective of the resources we have.

AFAN-PAUNS Congress: Two Societies Achieve a Milestone of Joint Regional Meetings

Delegates gathered for a photo at the conclusion of the first meeting of the African Academy of Neurology conference, in Yasmine-Hammamet, Tunisia.

By Riadh Gouider, MD, and Wolfgang Grisold, MD

The first African Academy of Neurology (AFAN) conference and the 15^th Pan Arab Union of Neurological Societies (PAUNS) meeting provided a unique opportunity for both societies to meet on the same premises and hold their first joint congress. More than 500 delegates attended; they represented 52 nationalities from five continents.

The Tunisian Society of Neurology, on behalf of the African Academy of Neurology and the Pan Arab Union of Neurological Societies, organized the meeting. To help young participants attend, the WFN, the American Academy of Neurology (AAN) and the European Academy of Neurology (EAN) initiated a joint sponsorship. The Tunisian Society of Neurology was helpful and generous in supporting this event.

The congress took place in Yasmine-Hammamet, Tunisia. The staff of the Neurology Department of Tunis served as host and conference organizer. Helping to make the conference a success was that it coincided with the Tunisian National Day of Traditional Dress.

Flags from several continents were carried across the stage during a colorful ceremony.

Important topics were presented each day of the meeting:

Day 1: Neurology training initiatives in Africa and infectious diseases of the central nervous system
Day 2: Epilepsy and movement disorders
Day 3: Inflammatory diseases and dementia
Day 4: Stroke and neuro-pediatrics

The sessions were well attended and featured lively discussions. The opening session tackled inflammatory neuropathies, coma, paraneoplastic syndromes, and recent advances in the understanding of Parkinson’s disease. Many topics deserved attention, including inflammatory aspects of the neuromuscular system, new investigation techniques, and new therapies.

The meeting’s scientific program contained courses on epilepsy, stroke, and botulinum toxin use in dystonias. The program featured interesting e-poster presentations, which were well organized and showed promise that e-posters will be an important aspect of future meetings. The Tournament of the Mind winners were Dr. Osheik Seïdi, from Sudan, and Dr. Sywar Triki, from Tunisia.

WFN President Raad Shakir, MD: ‘Now the world of neurology is correctly represented.’

The AFAN business meeting concluded with the selection of Prof. Fuad Abdallah, from Egypt, as president-elect, and Prof. Shamsideen Abayumi Ogun, from Nigeria, as president. The PAUNS business meeting also was held during the conference, with Prof. Chokri Mhiri, from Tunisia, elected president.

The WFN was represented by its president, vice president, general secretary, and two elected trustees. The EAN president and an AAN representative also attended.

Conference organizers overcame many challenges. Besides organizing a large meeting, they brought together different societies and interests, and coordinated the travel needs of participants from low-income countries to make it affordable.

World Congress of Neurology 2021 Bid: Copenhagen

Four European cities are bidding to host the World Congress of Neurology 2021, an international conference focused on advancing the diagnosis and treatment of neurological disorders. In this issue, World Neurology publishes four articles written by neurology organizations and professionals about why WCN 2021 should take place in Copenhagen, London, Marseille, or Rome.

Copenhagen, a candidate host city for WCN 2021, is known as a charming, clean, safe, green city, with numerous bicycles.

By Prof. Gunhild Waldemar and Jesper Erdal

We are happy to present Copenhagen as the possible host city for the World Congress of Neurology 2021.

Denmark and Scandinavia

The Danish Neurological Society (DNS) was founded in 1900, and is probably the world’s oldest neurological society. Although mature of age, DNS is an active and lively society that in recent years has attracted a lot of dedicated young doctors.

Leading Danish neurologists have been active in international neurological societies for many years, including Prof. Jes Olesen, Prof. Per Soelberg Sørensen, and Prof. Gunhild Waldemar, who we propose for Congress president for WCN 2021.

Greater Copenhagen is a world leader for research and development pending, clinical testing, and drug development. It comprises four life science universities with 50,000 students producing 2,000 PhDs every year, more than 150 biotech and 200 medtech companies as well as 11 university hospitals, leading researchers, clinicians, and academics.

The neurological communities in Scandinavia are closely linked and cooperate both clinically and academically. We are proud to have the full support of our friends and colleagues in the Swedish Neurological Association and the Norwegian Neurological Association.

Nordic Style

Copenhagen is a truly charming city with a distinct Nordic, cool style. It is famous for its many old buildings mixed with modern prize-winning architecture, new Nordic gastronomy, and green environment, with numerous bicycles. Copenhagen is a clean, safe city that has been voted the most livable city numerous times.

Copenhagen has the main hub airport in northern Europe and an outstandingly good infrastructure. It takes only 12 minutes to travel from the airport to city center by the inexpensive metro.

Bella Center

If Copenhagen were to win the bid, WCN 2021 would be held in October at Bella Center Copenhagen, Scandinavia’s leading and largest congress center. It is conveniently situated between the airport and the city center, only 10 minutes away from both downtown Copenhagen and the airport.

In recent years, Bella Center has been the venue of several large international medical congresses.

Reaching Out to the Public

We will strive to make new knowledge from WCN 2021 known to the public and to the health care authorities by collaborating closely with local and international media, patient organizations, and through various outreach activities.

The goal is to increase the public awareness of the frequent and often disabling neurological diseases, and the many new possibilities for treatment, rehabilitation, and care.

Academic-Industrial Cooperation

We wish to help create a congress in Copenhagen that promotes academic-industrial dialogue. This is crucial because of the obvious co-dependence. Along with the WFN, we will draw upon our international industrial networks to build a solid collaboration, both before, during, and after the congress. With an uncompromising focus on high academic quality, we wish to attract industrial participants and to help include relevant industrial themes.

Trainees, Young Neurologists, and Young Researchers

The congress in Copenhagen should serve as a hub for networking among young researchers, trainees, and young neurologists. Our goal is to support and help develop the work of the WFN International Working Group of Young Neurologists and Trainees. In connection with the WCN in Copenhagen, we will give young neurologists the opportunity to visit Danish neurological departments and research groups. The Danish Association of Young Neurologists will help take good care of our young foreign colleagues.

Our aim is creating friendship and international clinical and scientific networks that can last for years and develop further over time.

Support for Colleagues

It is important for our colleagues from low-income and low-middle income countries to have the opportunity to participate in the WCN 2021. Lundbeck Foundation has therefore offered to donate 50 bursaries of 1,000 euros ($1,100 U.S.) each to neurologists from low-income and low-middle income countries.

The Danish Neurological Society offers to donate half of the society’s profit from the congress to the World Federation of Neurology educational programs.

Welcome to Copenhagen in 2021

We sincerely hope to have the opportunity to welcome you to Scandinavia and Copenhagen for the World Congress of Neurology 2021. We will do our utmost to ensure that the congress will be a success, and that each and every delegate will have an exceptional and unforgettable visit.

Written on behalf of the Danish Neurological Society by Prof. Gunhild Waldemar and Jesper Erdal, president of the Danish Neurological Society.

World Congress of Neurology 2021 Bid: London

ABN conference delegates supporting the London WCN 2021 bid. Vote #NeurologyIsOpen #LondonIsOpen #WFN2021.

Members of the Association of British Neurologists (ABN) invite their colleagues throughout the world to join them in London to celebrate the 2021 World Congress of Neurology.

We last hosted this event in London in 2001, achieving a still unbroken record in delegate numbers. Much has happened in the intervening decades, both in London and in British neurology.

Excellent venue: Our proposed venue, London ExCeL, played its role as a sporting venue during the 2012 Olympics and has attracted a substantial number of successful medical congresses, consistently achieving higher delegate numbers than in previous or subsequent years. The Elizabeth Crossrail line, opening in 2018, should further enhance the venue’s appeal, reducing travel time into central London to just 15 minutes.

Neurology in the United Kingdom has grown significantly since 2001, from about 400 consultant neurologists in 2001 to almost 800 in 2016. The ABN has more than 1,500 members, more than half of whom are consultant neurologists, with a growing and enthusiastic younger membership of trainees, junior doctors, and medical students.

Successful meetings: Our 2016 annual conference, held in cooperation with the British Pediatric Neurology Association, attracted over 700 delegates supported by 100 abstract bursaries available to early career researchers. We hope to exceed that figure at our 85th anniversary meeting in 2017. Our regular pre-meeting training and development day, which includes sessions for foundation doctors, trainees, and general practitioners, has grown in popularity each year. Its work was reinforced in 2016 by the introduction of a Medical Students Day, which attracted over 100 delegates.

The association also held a joint symposium with the British Neuroscience Association in September 2016. It contributes symposia to its biennial Festival of Neuroscience and has commenced work with the Society of British Neurological Surgeons on a joint meeting planned for autumn 2018. We are confident that a London-based World Congress of Neurology would be of great interest to our colleagues in other neuroscience disciplines. Indeed, our bid is supported by 12 of our fellow U.K. and Irish neuroscience associations, and we offer these reasons we should host WCN 2021.

Engaged and active membership: The ABN has more than 150 consultant and trainee members directly involved in council, research, training, services, standards, and subspecialty advisory committee roles. These comprise an excellent pool of experience and enthusiasm from which to appoint our scientific program, teaching, social, and other congress committees.

Committed to education: We are committed to developing neurological training at home and abroad. Current projects include abstract bursaries (for early career researchers attending ABN meetings), travel bursaries (facilitating educational and research visits to developing countries), clinical research training fellowships (supporting the next generation of researchers), undergraduate prizes and intercalated degree bursaries (encouraging undergraduate interest in neurology). We provide speakers to many overseas meetings, and our international committee is charged with reviewing and extending this work.

Superb travel connections: Our chosen venue, London ExCeL, is in the best-connected city in the world that can be reached by more people, from more destinations, in less time, than any other global destination. WCN2021 will take place three years after the high-speed London Crossrail link opens, speeding conference attendees to the venue to hear the most cutting-edge neuroscience at a truly globally connected conference center. It will provide direct access from Heathrow Airport to ExCeL in 43 minutes, with 12 trains per hour that can carry 1,500 passengers.

U.K. is open: The ABN’s 2017 annual meeting theme in Liverpool is “A Port to a World.” This theme reflects our approach to neurology — welcoming colleagues from around the globe, treating patients from every land and every part of society, and traveling overseas to learn and to share skills. Thus for us, WCN2021 in London will be an even bigger “port” to welcome the global neurological community.

A notable anniversary: 2021 is a particularly appropriate year to invite the neurological world to London as it marks the 400^th anniversary of the birth of Thomas Willis, considered by many as the father of neurology. He was the first to coin the term “neurology” and to identify the Circle of Willis anatomically. What better place for the WFN to celebrate this anniversary than in the country of his birth?

We believe that a London-based World Congress of Neurology would be both popular and scientifically successful, and we hope that we will be given the opportunity to welcome the congress to London in 2021.

Hashtag: #NeurologyIsOpen #LondonIsOpen Vote London #WFN2021

World Congress of Neurology 2021 Bid: Marseille

By Prof. Gilles Edan, Prof. Jean-Marc Leger
and Prof. Jean-Philippe Azulay

France and the French Society of Neurology would like to be a candidate to host the World Congress of Neurology in 2021. France has never had this opportunity before and would be proud to convince the Council of Delegates to choose our country.

The Société de Neurologie de Paris was established on June 8, 1899, and its first meeting was held on July 6, 1899. It was renamed Société Française de Neurologie in 1949, and celebrated its 100th birthday June 16, 1999, in Paris. Our society is one of the oldest in the world, and a number of famous neurologists are part of our heritage.

The French Society of Neurology has an old and rich history, but also is a vivid society with an annual congress assembling more than 3,000 neurologists each year. The French teams are major contributors in all the fields of clinical neurosciences and will work with the international committee to develop an amazing scientific program. It is also the decision of the society to open the congress to participants from all around the world, with an intensive program of support dedicated to young neurologists.

To emphasize and symbolize this opening to the world, the city that the French Society of Neurology has chosen is Marseille. The oldest city of France was founded in 600 BC and became the main Greek city of the Western Mediterranean. Marseille is the second-largest city in France and is located in the south of the country by the Mediterranean Sea. It is the capital of Provence, one of the most visited parts of the world.

The Phocean City is a cosmopolitan port where people have met from around the world for centuries. Marseille is Europe’s door to all the Mediterranean countries, Africa, and Maghreb.

Marseille Provence Airport (MRS) welcomed 8.5 million passengers in 2016 and is currently linked to 96 destinations in 25 countries, with 129 scheduled services. MRS is well connected to all major hubs, providing easy access from all over the world at competitive airfares. Up to 36 daily flights are being offered to Paris-Charles de Gaulle (just a 90-minute flight), London-Heathrow, Frankfurt, Munich, Amsterdam, Brussels, Madrid, Rome, Lisbon, Istanbul, Montreal, Algiers, Casablanca, and Tunis. It is only a 25-minute drive from the airport to Marseille city center.

Marseille can be reached in less than three hours by high-speed train, with departures every hour. The train station is in the heart of the city.

October is a perfect time to come and visit the Provence Cote-d’Azur region and make a stop in Paris. The average temperature is 24°C/75°F, perfect weather to enjoy the Mediterranean Sea!

The entire French neurological community enthusiastically supports this candidacy and hopes that it will be successfully considered.

Prof. Gilles Edan is the 2017 SFN president. Prof. Jean-Marc Leger is the WFN French delegate. Prof. Jean-Philippe Azulay is a member of the local organizing committee.

World Congress of Neurology 2021 Bid: Rome

The legendary origins of Rome are seen in this sculpture of the wolf with the founders of Rome — Romulus and Remus.

The Italian Society of Neurology (SIN) is bidding to host the 25th World Congress of Neurology in 2021 in Rome. The Society was founded in 1907 with the mission to promote the study of neurology in Italy; foster scientific research, education, and specialist updating; and improve the quality of care delivered to patients with neurological diseases. SIN is an association of public and private neurology specialists, working in community, hospital, and university settings. It represents 3,000 members, making it the largest association of neurologists in Italy, providing a constantly growing number of education and training activities.

The Society’s training and updating activities are designed to enhance care activities, promote research studies into nervous system diseases, and facilitate interaction with patient organizations. Much research work is recognized at the highest international levels, contributing to the prestige of the Italian neurological community. SIN develops and promotes a wealth of clinical and scientific initiatives.

The vastness of the spheres of clinical neurology has prompted the development of working groups within SIN. Where required, these seek the expertise and contribution of specialists from other disciplines with a view to providing exhaustive responses to population needs. SIN’s official journal, Neurological Sciences, has a 2016 impact factor close to 2 and is among the leading European scientific journals in the field.

Italy is a valid representative of the European neurological community. The number of practicing neurologists in Italy is among the highest on the continent and its research activities hold top-ranking positions in international indexes.

Its geographic position and cultural vocation place Italy in a pivotal position among nations with a longstanding neurological tradition and North African and Middle Eastern regions keenly committed to the field of neurology. The Italian neurological community has many representative members in international societies in various branches of neurology, besides supporting projects to develop care, research, and scientific updates in all neurological subspecialties.

An active and positive member of the WFN, Italy has participated both at the structural level and in the WFN’s various ongoing activities. It should first be stressed that Rome was the venue of the WFN World Congress in 1961, and many Italian clinical neuroscientists have played an active role in WFN activities over at least the last 50 years.

Italy offers beautiful cities with modern conference venues, hotels, restaurants, infrastructure, and places of interest. Conference delegates coming to Italy will greatly enjoy the wide variety of suitable venues that provide a high standard of hospitality, with competitive prices compared to other European cities. No less important is that Italy, its history, and its culture attract high numbers of congress delegates.

For a variety of reasons, the presence of many active neurologists from all
over the world in Italy, be it temporarily or permanently, prompts the need to
host WCN.

Rome, often referred to as “The Eternal City,” is among the world’s most alluring venues, combining its leading role in the international multicultural scene with its millenary history. Alongside the splendors of ancient Rome and important archaeological remains, such as the Colosseum and the extensive Imperial Fora, visitors are party to some of the best examples of the world’s Renaissance art. Delegates will be able to admire the works of some of the greatest artists whose achievements continue to adorn the city as they have done over the centuries. The Italian capital is the home of important museums (including the Vatican buildings) and interesting permanent exhibitions. A visit to this city will enhance the artistic passion of enthusiasts of every art form (painting, sculpture, music, etc.).

Last but not least, being the world capital of Christianity, Catholic delegates from all over the world would have a wonderful opportunity to visit the Vatican.

Importantly, Rome can be easily reached from all corners of the globe. In addition, a modern, functional, attractive convention center, designed by one of the greatest living architects (Massimiliano Fuksas), has recently been opened in the city, rendering delegates’ time at the congress venue even more pleasant and productive. •

Brown-Séquard Syndrome and Networks

By Peter J. Koehler

Most neurologists will know about the Brown-Séquard syndrome, comprising an ipsilateral paresis and proprioception disorder with contralateral pain and temperature disturbances, resulting from hemisection of the spinal cord.

Charles-Edouard Brown-Séquard wrote his first publication on this finding between 1846 and 1849, starting at age 29. Born 200 years ago and raised on the isle of Mauritius, he moved to Paris in 1838 to study medicine. He worked at the private laboratory of physiologist Martin-Magron. This experience influenced him for the rest of his life.

Possibly because of his republican ideas, he left France after the coup d’état of 1851 by Louis Bonaparte, the later emperor Napoleon III. He went to Philadelphia with a letter of recommendation written by Paul Broca.

Later, Brown-Séquard worked in London, becoming one of the first physicians at the National Hospital for the Paralyzed and Epileptic. He was considered an expert in epilepsy.¹ From 1864-1866 (with interruptions), he was professor at Harvard University. He founded several journals, including Journal de la Physiologie (1858, Paris) and Archives de Physiologie normale et pathologique (in 1868 with Charcot and Vulpian).

In 1878, he succeeded Claude Bernard as the chair of physiology at the Collège de France in Paris. This brought more rest to someone who is said to have traveled the ocean 60 times. He worked and lectured at many places, in particular France, England, and the United States, but also on Mauritius. This restless traveling had several reasons, among which his birth at Mauritius, that was French originally, but became English following the defeat of Napoleon.

His father (Brown), whom he never met, was a sea captain from Philadelphia and died before his birth. Charles-Edouard added his mother’s name early in his career. Although a physician, his heart was always in the physiology laboratory, and he was always looking for such an appointment.

Spinal Cord Experiments
His 1846 thesis Recherches et expériences sur la physiologie de la moelle épinière described the fact that section of the posterior columns did not lead to loss of sensation, concluding that other parts of the spinal cord should contribute to the conduction of sensory impressions. In 1849, he found that hemisection of the spinal cord did not result in ipsilateral sensory loss. This is in contrast to earlier findings,² but in contralateral hypalgesia.^3,4 Although he worked on the spinal cord mainly between 1846-1855, he would return to the subject later.

Understanding the Sympathetic Nerves
He worked on numerous other subjects, including rigor mortis and the action of the vasomotor nerves, in which he competed for priority with his predecessor at the Collège de France (Paris), Claude Bernard. Experimental observations that eventually elucidated the mechanism and function of the vasomotor nerves were carried out in the 1850s.

In November 1852, Bernard found that section of the cervical sympathetic led to increased blood flow, rise in facial temperature and miosis, the latter phenomenon, which he attributed to the discovery, more than a century earlier, by his compatriot Pourfour du Petit (1727). However, in contrast to Brown-Séquard, Bernard did not understand the observed phenomena as, in his understanding, the sympathetic was considered the producer of the animal warmth. Therefore, he expected the contrary, notably cooling of the face and was quite surprised. In August 1852, Brown-Séquard published the results of his animal experiments during his stay in Philadelphia. He had galvanized (probably he meant faradized, using an induction coil invented by Emil Du Bois-Reymond) the cervical sympathetic of several animals and noticed constriction of the blood vessels in the ear and diminished temperature of the facial skin.

When Du Bois-Reymond, himself a migraine sufferer, published a paper stating that migraine was not a disease of the brain or cranial blood vessels, but of the cilio-spinal center in the spinal cord, leading to an increased sympathicotonic (vasoconstrictive) influence on the blood vessels of one side of the head, Brown-Séquard presented arguments to the contrary. From his animal experiments and clinical observations, he had concluded that stimulation of the cervical sympathetic causes epileptic seizures, rather than migraine attacks. He opined that Du Bois-Reymond’s observations better fit a sympathicoparalytic (vasoparalytic) model of migraine, in which he was seconded by other physicians, including Friedrich Wilhelm Möllendorff, until Peter Wallwork Latham proposed to unify both theories.⁵

Expert in Epilepsy
Brown-Séquard’s physiological and clinical work on epilepsy led him to be considered an expert in the field. His spinal cord experiments in the early 1850s resulted in observations that he interpreted as epileptiform convulsions originating in the spinal cord. His observation of convulsions in guinea pigs following spinal cord sections, and that their offspring showed the same phenomena, led to his idea of artificially induced hereditary epilepsy.

The ideas were used by Charles Darwin, who referenced him in several of his publications. Brown-Séquard realized it was not the same type of epilepsy as in human beings.⁶ It was later suggested that the animals were suffering from lice on the paralyzed parts. As for the clinical observation, it is important to realize that the brain was considered not irritable at the time (up to the famous 1870 experiments by Fritsch and Hitzig in Berlin). In Brown-Séquard’s concept, a reflex mechanism from the periphery conducted by nerves to the central nervous system was considered essential.

Antilocalizer Networks
Following Broca’s proof of cerebral localization of aphasia/aphemia in 1861, Brown-Séquard, although being a founding member of Broca’s Société d’Anthropologie, where the aphasia case was presented, made many observations that were not in agreement with the localization concept. He objected to the theory of circumscribed localization of functions in the brain, which prevailed at the time. He even warned against the use of the theory in brain surgery, which was emerging.⁷ He believed that many of his observations in humans and experimental animals could not be explained by the current of localization.

His own notion of localization was dynamic and based on the principles of distant action (action à distance), involving inhibition and excitation. (He called it dynamogénie. He probably coined the term dynamogénie, development of energy or power, in 1879, although he had come across the phenomenon itself when he performed his experiments on the spinal cord in 1840.) Irritation in one location of the nervous system may be transmitted to another part where it may change its function dynamically.

He presented this theory of “réseau de cellules anastomosées”(network of anastomized cells) in 1875 to the Société de Biologie. Cells serving the same function were supposed to be interconnected. Nerve cells endowed with any of the cerebral functions, instead of forming a cluster as is supposed, are disseminated through the whole encephalon, so that considerable alterations or destructive lesions can exist in one of the cerebral hemispheres, or in both, without the loss of voluntary movements of sensibility, or of any other brain function. Brown-Séquard defended his theories several times in papers and during meetings, including those at the Société de Biologie in the 1870s, where he debated with Charcot.

With this model, he was able to explain the fact that damage in several locations of the central nervous system may produce the same effect, and to account for observations that some functions remain unimpaired despite extensive brain injury.⁸ Based on these localization theories and new experimental findings, Brown-Séquard even withdrew the theory of crossed sensory action of the spinal cord in 1894,⁹ although he admitted that it remained valuable with respect to the clinical syndrome.

Although his arguments were not always valid, because they were sometimes based on imprecise observations, his dynamic model influenced “antilocalizers,” such as Friedrich Goltz, John Hughlings-Jackson and probably Constantin von Monakow and Charles Scott Sherrington. The theory is reminiscent of Sherrington’s later ideas. In fact, Sherrington referred to some of the ideas in 1893.¹⁰ One cannot claim that Brown-Séquard played a role in the development of modern network theories, yet one would wonder how interested he would have been reading about the relatively recent laws, to which all kinds of networks obey.^11,12

Endocrinology
In the last phase of his career, Brown-Séquard studied the effects of (animal) testicular extracts. It was not the first time he subjected himself to experimentation. He injected the extracts, hoping it would have a rejuvenating effect. Noticing positive effects, he started the production of the drug in cooperation with his assistant Jacques-Arsène d’Arsonval.

They offered extracts to colleagues, without charge, in order to let them try it on elderly patients. Brown-Séquard’s first presentation on the subject was before the Société de Biologie de Paris in 1889. Two years later, George Murray presented his ideas on the treatment of myxoedema with thyroid extracts from a sheep at a meeting in England.¹³ Probably as a consequence of Brown-Séquard’s claims, he was ridiculed, by a senior colleague who suggested this would be like treating locomotor ataxia with an emulsion of spinal cord. Although Brown-Séquard had serious intentions with his studies on this subject, introducing organotherapy in 1893, public reception was unfavorable, which harmed his reputation. Nevertheless, his contribution to endocrinology was acknowledged by several scientists, including the Swiss surgeon Theodor Kocher, who referred to him in his Nobel Award lecture of 1909. Brown-Séquard is still considered the father of endocrinology.

As events in science and medicine are often reflected in literature, Brown-Séquard may be recognized in the 20th volume of the Rougon-Macquart novel series by Emile Zola, Le Docteur Pascal. It is about the country physician Pascal Rougon, who made a genealogical tree of his own family with the purpose of studying heredity. He noted interesting details about his family members, proving that degenerative traits are inherited.

The concept of degeneration was a popular scientific issue at the end of the 19th century, following the degeneration ideas in psychiatry of Bénédict Augustin Morel and Valentin Magnan. Zola staged Rougon not just as a physician, but also as a scientist. He extracts sheep brains and injects the material into patients. Although considering himself to be successful at the beginning, he finally realized the placebo effect and turns to the injection of water. One day, experimenting with organ extracts, he is criticized by his relatives:
‘… il est encore a` sa cuisine du diable!’
[… he is still in his devilish kitchen…], referring to his home laboratory.^14, ¹⁵

Additional reading:

Michael J. Aminoff: Brown-Séquard: An improbable genius who transformed medicine. New York, Oxford University Press, 2011

References:

1 Koehler PJ. Brown-Séquard’s spinal epilepsy. Med Hist. 1994;38:189-203.
2 Koehler PJ, Endtz LJ. Between Magendie and Brown-Séquard: Isaäc van Deen’s spinal hemisections. Neurology. 1989;39:446-8.
3 Brown-Séquard CE. Recherches et expériences sur la physiologie de la moelle épinière. Paris, Rignoux, 1846
4 Koehler PJ, Endtz LJ. The Brown-Séquard syndrome. True or false? Arch Neurol. 1986;43:921-4.
5 Koehler PJ. Brown-Séquard’s comment on Du Bois-Reymond’s “hemikrania sympathicotonica”. Cephalalgia. 1995;15:370-2.
6 Koehler PJ. Brown-Séquard’s spinal epilepsy.Med Hist 1994; 38:189–203.
7 Brown-Séquard CE. The localization of the functions of the brain applied to the use of the trephine. Lancet 1877;107–8
8 Koehler PJ. Brown-Séquard and cerebral localization as illustrated by his ideas on aphasia J Hist Neurosci 1996;5:26–33.
9 Brown-Séquard CE. Remarques à propos des recherches du Dr. F.W.Mott sur les effets de la section d’une moitié latérale de la moelle épinière. Arch Physiol 1894; 26:195–8
10 oehler PJ.Brown-Séquard’s localization concept: the relationship with Sherrington’s “integrative action” of the nervous system. In: Rose, FC (ed): Neuroscience across the centuries. London, Smith-Gordon, 1989, pp.135–8
11 Stam CJ, Reijneveld JC. Graph theoretical analysis of complex networks in the brain. Nonlinear Biomed Phys 2007;1:3.
12 Koehler PJ. Book review essay: An improbable genius? On Michael J Aminoff’s Brown-Séquard: An improbably genius who transformed medicine. Brain 2011;134:1864-7.
13 Welbourn RB. The emergence of endocrinology. Gesnerus. 1992;49 Pt 2:137-50.
14 Koehler PJ. Charcot, la Salpêtrière, and hysteria as represented in European literature. Prog Brain Res. 2013;206:93-122.
15 Koehler PJ. About medicine and the arts. Charcot and French literature at the fin-de siècle. J. Hist. Neurosci. 2001;10: 27–40.

Peter J. Koehler is the editor of this history column. He is a neurologist at Zuyderland Medical Centre in Heerlen, The Netherlands. He is also co-editor of the Journal of the History of the Neurosciences. Visit his website at www.neurohistory.nl.