Hachinski Receives the Prince Mahidol Award in Public Health

Vladimir Hachinski, MD, receives the Prince Mahidol Award at the Grand Palace from Princess Maha Chakri Sirindhorn of Thailand. Also in attendance were Prime Minister Prayut Chan-ocha and Canada’s Ambassador to Thailand Donica Pottie.

Vladimir Hachinski, MD, past president of the World Federation of Neurology, received the Prince Mahidol Award in Public Health for “contributions to the treatment of stroke, vascular cognitive impairment, and brain/heart interactions.”

He received the award from Princess Maha Chakri Sirindhorn of Thailand. Also in attendance were Prime Minister Prayut Chan-ocha and Donica Pottie, Canada’s ambassador to Thailand.

The Prince Mahidol Awards are considered the Nobel Prize of Asia, primarily because a number of awardees have gone on to receive the Nobel Prize in Medicine and Physiology from Sweden.

Dr. Hachinski continues to be active in research and is working to advance the updated World Stroke Proclamation, calling for the joint prevention of stroke and dementia, endorsed by the World Federation of Neurology, the International Brain Research Organization, the World Psychiatric Association, the European Academy of Neurology, and 18 other international, regional, and national organizations. •

JNS Editor’s Update and Selected Articles

By John D. England, Editor-in-Chief

John D. England

One of the prime missions of the Journal of the Neurological Sciences is to highlight activities of the World Federation of Neurology (WFN). Along those lines, I wish to remind everyone that the XXIII World Congress of Neurology (WCN) will be held Sept. 16-21, 2017, in Kyoto, Japan. The Congress will be co-hosted by the Japanese Society of Neurology and the Asian and Oceanic Association of Neurology. The theme of WCN 2017 is “Defining the Future of Neurology.” The WCN will feature a series of programs and lectures led by leading scientists, clinicians, public health experts, and policymakers from around the world. Some of the cutting-edge topics will include gene therapy, stem/iPS cell medicine, brain-machine interface, and robotics in medicine. Traditional topics of neurology and neuroscience also will be presented. I encourage all of our readers to consider attending the meeting. Detailed information about XXIII WCN can be accessed at www.2017.wcn-neurology.com/.

In our effort to inform readers of important and interesting developments in the journal, the editorial staff has selected two new “free-access” articles for our readership. This issue’s selected articles deal with cardiac transplantation in Friedreich’s ataxia (FRDA). Although ataxia is the clinical hallmark of FRDA, cardiac disease is the leading cause of death. There is no known cure for the cardiomyopathy of FRDA, and its course is independent of the neurological manifestations. For these reasons, a few patients with FRDA and severe cardiomyopathy have undergone cardiac transplantation. The results have been generally positive.

Ashley McCormick and colleagues describe their experience and long-term follow-up of three patients with FRDA who underwent successful cardiac transplantation. Although each patient experienced progression of the neurological manifestations of FRDA, all maintained stable cardiac status several years post-transplant. The patients remain alive and socially engaged at five years, eight years, and 19 years post-transplant, respectively. The authors conclude that cardiac transplantation can be a reasonable treatment for patients with FRDA who develop end-stage cardiomyopathy.

Ashley McCormick, et al., Cardiac transplantation in Friedreich Ataxia: Extended follow-up, J. Neurol. Sci. 375 (2017) 471-473. http://www.jns-journal.com/article/S0022-510X(17)30028-X/fulltext?rss=yes

In an accompanying editorial, David Pleasure reaffirms that cardiac transplantation might be a viable option for selected patients with FRDA who have life-threatening cardiomyopathy. He points out that the transplanted hearts in these and other patients have shown no signs of cardiomyopathy, suggesting that the heart disease in FRDA is independent of its other manifestations. He also outlines potential future treatment interventions for the cardiomyopathy of patients with FRDA. 

David Pleasure, New hearts for Friedreich patients, J. Neurol. Sci. 375 (2017) 474-475. 

From the Editors

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

Walter Struhal

Steven L. Lewis

We are very pleased to introduce the March/April 2017 issue of World Neurology. Much of this issue revolves around the educational activities of the WFN, starting with the article by Wolfgang Grisold, MD, and Steven Lewis, MD, who provide an update on the many and varied educational activities of the WFN and its partners. This issue also includes enthusiastic and vivid reports from several African neurologists who were recent participantsin the Neurology Department Visit programs in Germany, Norway, and Turkey. We would like to add our sincere thanks here to our partner societies who make these WFN/partner society department visits so successful and fruitful for everyone involved.

In his President’s Column, WFN President Raad Shakir, MD, provides a powerful proposition about the need for neurologists to work together, including educating the public, other providers, and our governments about the importance of brain health and systems of care delivery to combat brain diseases. We also report on the great honor recently bestowed on  Vladimir Hachinski, MD, past president of the World Federation of Neurology, when he received the the Prince Mahidol Award in Public Health in Thailand. In his Editor-in-Chief’s Update from the Journal of the Neurological Sciences, the official journal of the WFN, John D. England, MD, describes his selected two new “free access” articles selected for the readership, which deal with the interesting issue of cardiac transplantation in Friedreich’s Ataxia.

In this issue’s history column, Dr. Peter Koehler provides a wonderful synopsis of the many contributions of Charles-Edouard Brown-Séquard (on the bicentennial of his birth), including but certainly not limited to, his eponymous syndrome. Finally, Prof. G. Logroscino and his colleagues from Italy and France report on the recent International Course of Neuroepidemiology, Clinical Neurology, and Research Methods in Low-Income Countries that took place in Phnom Penh, Cambodia.

We sincerely hope that you will enjoy the contributions in this issue, and, as always, we look forward to ongoing submissions on news of interest to neurologists around the globe. Please send any contributions to slewis@rush.edu. •

Cambodian Neurologists Participate in Research Methods Course

Prof. G. Logroscino
University of Bari, Italy
Prof. P.M. Preux
University of Limoges, France
Prof. B. Marin
University of Limoges, France
Dr. F. Boumediene
University of Limoges, France

Pierre Marie Preux

Giancarlo Logroscino

An intensive five-day course on research methods, with a focus on practice in low- and medium-income countries, was presented Feb. 7-11 in Phnom Penh, Cambodia. The course was developed to help Cambodian neurologists establish clinical and population-based research programs on topics of utmost interest, including epilepsy, stroke, dementia, and infectious disease.

“The International Course of Neuroepidemiology, Clinical Neurology, and Research Methods in Low-Income Countries” was organized by Prof. Giancarlo Logroscino, from the University of Bari; Prof. Pierre Marie Preux, Dr. Farid Boumédiene, and Prof. Benoît Marin, all from the University of Limoges; and Prof. Chan Samleng, president of the Cambodian Society of Neurology and chair of Neurology at the University of Health Sciences of Phnom Penh.

Farid
Boumédiene

Benoît Marin

The course was made possible through the support of a World Federation of Neurology (WFN) Grant in Aid 2015, and supplemented by grants from the University of Bari and the University of Limoges.

Cambodia is experiencing a transition characterized by a rapid increase in life expectancy and of chronic diseases. In this context, neurology plays a major role within medicine but has to change perspective on education, clinics, and research.

The course was held at the University of Health Sciences of Phnom Penh. The faculty were Prof. Logroscino, Prof. Marin, and Dr. Boumediene. It was attended by 14 of 16 members of the Cambodian Neurological Society (eight neurologists out of nine). Also attending were 14 students of the School of Medicine, selected by the faculty.

The course faculty met with the dean of the University of the Health Sciences and the chair of medical affairs of the Calmette Hospital. Both praised WFN for its support and asked for the development of new courses on research and on new developments of specific sectors of clinical neurology.

The chair of medical affairs expressed interest in a course developed specifically for the heads of the clinical departments to provide basic epidemiologic skills through a short seminar series. The general director of the Calmette Hospital also announced his goal to create a clinical research unit.

The course was characterized by great enthusiasm and a high level of interaction between attendees and the faculty. Pre-course and post-course evaluations of the attendees’ skills in epidemiology were performed. Scores improved 4-10 points between the pre- and post-course evaluations.

A satisfaction survey was performed. Attendees reported:

  •  a high level of satisfaction
  • an adequate course level
  • a wish to progress to other courses at higher levels
  • a longer period of teaching

The course concluded with a discussion between the faculty and the neurologists of the Cambodian Neurological Society. Because two programs on the epidemiology of epilepsy are being presented by the Cambodian Neurological Society and the University of Limoges, discussion was focused on other diseases, particularly research prospects in the fields of stroke and dementia.

An additional theme has been proposed for future courses: amyotrophic lateral sclerosis. This last area has been proposed because of the paucity of epidemiological and clinical data from Asian countries, with the exception of Japan.

Prof. Samleng called for the Cambodian Neurological Society to collaborate with the WFN in the future.

World Brain Day 2017 Topic Announced

Wolfgang Grisold
and Mohammed Wasay

World Brain Day 2017 will be centered on stroke, and will be jointly prepared and celebrated with the World Stroke Organization. This topic emphasizes the importance of stroke and should alert towards prevention and introduce advances in treatment.

We hope that many national societies will be able to join us again this year. Material for the campaign, as well as suggestions for press releases, will follow.

World Brain Day 2017 will also have an international press conference centered on the important topic of stroke.

For the status of ongoing preparation please follow our website and social media.

There is also a WFN website dedicated for this event, where you can communicate with us. •

Gazi University of Ankara

Dr. Maouly Fall
Fann Teaching Hospital, Neurology Department of Cheikh Anta Diop University

Residents at Gazi University of Ankara.

Many thanks to the Turkish Neurological Society and World Federation of Neurology (WFN) for allowing me to perform this visit to the neurology department of the Gazi University of Ankara from Nov. 15 to Dec. 15, 2016.

My first day in Ankara was devoted to a visit to the city and the headquarters of the Turkish Neurology Society with Burak Tokdemir, manager of the Turkish Neurological Society. The next day was effectively my first day in the neurological department, with Tokdemir, where we first met Prof. Ayşe Bora Tokçaer, the head of the neurology department. After welcoming me, she give me my program, which began with a visit to different parts of the department with Dr. Serhat, a resident in neurology.

Gazi University staff from left: Prof. Reha Kuruoglu, Prof. Ayşe Bora Tokçaer, Dr. Maouly Fall, Prof. Bulent Cengiz, Dr. Hale Zeynep Caglayan, Prof. Bijen Nazliel, and Prof. Yahya Karaman.

We went to the offices of different professors and associate professors, the outpatient clinic, the inpatient clinic with the intensive unit care, and the EEG and EMG laboratories.

During my visit to the neurology department of Gazi University, I attended several activities, which were important for me and for my practice in Senegal. I participated in the activities of the EMG laboratory observing the basic techniques of nerve conduction, needle EMG with several muscles, which I never seen evaluated before, and single-fiber EMG, which is not available in Senegal. Also, I went to both a standard EEG laboratory and to long-term monitoring video EEG and interpretation, where I acquired many experiences.

In the EMG laboratory with the EMG team.

I spent each week in the outpatient clinic with different specialties to learn and perform several situations in clinical neurology: headache disorders management, neuromuscular diseases, epilepsy management, multiple sclerosis, Parkinson’s diseases and other movement disorders, and neuro-ophthalmological diseases. I saw many cases of epilepsy, movement disorders, headache, MS, pseudotumor cerebri, as well as many videos and photos. I also participated in some sessions of botulinum toxin injections and apomorphine test, which are not available in Senegal. These activities were helpful and useful to me because since I returned to Senegal my approach and management of patients have improved considerably.

In the EEG laboratory with the EEG team.

I also spent two days of the week in the intensive care unit and inpatient area to see how to manage some rare neurological disorders and emergency cases.

My best experience was the morning of Dec. 7, when I joined the neurosurgery team of  Prof. Ayşe Bora Tokçaer and Prof. Tylan Altiparmak to see the operation on a female patient with generalized dystonia. She was operated on for globus pallidus interna DBS. During the operation, I saw how they target the globus pallidus (GPi) and microrecording. I was lucky to attend this surgery session all the more because it was something I had only read about before. It was a great experience.

I also had the opportunity to visit the school of physiotherapy and rehabilitation and talk with physicians about the management of patients in the outpatient and inpatient clinics.

During the last day of my visit, I was invited to talk about neurology in Senegal. I talked about my country, the academic neurological team, the different hospitals and their specialities, the neurological diseases in our setting, how neurology is being practiced, which neurological disorders are common and how we manage them, and with what means. The audience was attentive, and the discussion after was essential.

My experience during this visit was well above my expectations and gave me a broader understanding of the management of neurological disease in our conditions of work in Senegal.

Once again, I thank the Turkish Neurological Society, the WFN, and all the teachers, all the doctors, and all the staff of the neurology department of Gazi University of Ankara. •

Germany’s University Hospital Ulm

Samy Mohamed Lemine, dadah
Nouakchott- Mauritania

It was my great pleasure to be accepted for a department visit at University Hospital Ulm in Germany.

I arrived there on Oct. 3, 2016. I started the next day in the neurology department. Prof. Kasubek, who is the vice head of department, introduced me and showed me around the neurological department.

For three weeks, I stayed in the emergency room. It was an opportunity for me to see how they receive patients and how they manage them. When the emergency room was empty, I had the opportunity to assist senior physicians in the stroke unit. I also spent time visiting hospitalized patients.

During my time there, I assisted in a thrombectomy procedure with a radiologist. It was a wonderful and interesting experience.

I spent my last week there in the neuro-inflammatory part of the neurology department. I discovered many things there, such as immunoadsorption, plasmapheresis, and immunoglobulin administration.

Every time a patient was examined by a German physician, I received a translation in English. I asked questions and received responses. My stay was enjoyable, and I was happy to discover another way to practice medicine.

At the end of my stay, I realized that there was great benefit for me to discover the German neurological model.

I thank the World Federation of Neurology and the Deutsch Neurological Association for having invited me to this department visit program in Germany. •

Norway’s Riks, Ullevål and National Epilepsy Center

Marieme Soda Diop-Sene
Neurologist, Fann University Hospital
Dakar/Senegal

Marième Soda Diop-Sene with Professor Espen Dietrichs, the Head of the Department of Neurology, Oslo University Hospital

From Oct. 22 to Nov. 19, 2016, we had a study trip in Oslo. We arrived on Saturday, Oct. 22, and stayed in the researcher house in Blindern. It was a comfortable house with all of the amenities, located between Riks Hospital and Ullevål Hospital.

We spent the first two weeks at Riks Hospital, the third week at Ullevål Hospital, and the last week at the National Epilepsy Center.

At Riks Hospital, we met Prof. Espen Dietrich and all of the teaching staff of the neurology department. We participated in morning staff meetings at the neurology ward and at the radiology ward, where we learned a lot about neuroradiology. We also visited patients.

At the clinical ward, we participated in the consultation of movement disorders with Prof. Inger Marie Skogseid, whose patients had severe dystonia and Parkinson’s disease. Some of them had deep brain stimulation (DBS), and others received botulinum toxin injections. It was the first time we saw patients who had DBS and botulinum toxin for movement disorders.

We attended headache consultation and neurovascular disease consultation with Prof. Anne Hege Aamodt. We saw patients with vascular disease (classical stroke) as well as a rare case of middle cerebral artery vasospasm in a young woman.

With Prof. Aamodt, we attended headache consultations and saw patients with migraines and occipital headaches. We also witnessed the administration of botulinum toxin and local anaesthetic injections for headaches.

Even if sometimes such cases are found in our daily practice, the management (exploration and treatment) is totally different. The main fact we learned is to use alternative treatment, such as botulinum toxin or local anaesthetic injection, for the treatment of headache and movement disorders.

We also had a great interest in attending neurophysiology interventions. We performed EEGs and EMGs, and we had really interesting cases, including diabetic amyotrophy and severe peripheral polyneuropathies of different etiologies.

The third week, we visited Ullevål Hospital, where the daily routine is different from Riks Hospital; indeed it’s mostly an emergency hospital. We met Prof. Sigrud Kierulf Braekken and her team. We witnessed some cases of refractory epilepsy, myasthenia gravis, and trigeminal neuralgia at the emergency unit, but no cases of acute stroke and thrombolysis.

We also met Dr. Angelina Maniaol, whose principal interest is myasthenia gravis, and discussed juvenile myasthenia gravis, which is one of our main research subjects.

The last week, we visited the National Epilepsy Center, a really amazing experience. We met Prof. Rune Markhus and Prof. Ellen Molteberg, and their teams.

We had some rich exchanges about research topics we could do together. We discussed research methodology with Prof. Morten Lossius and Prof. Cecilie Johanssen Landmark.

At the morning staff meeting, we discussed polysomnography recordings in a patient with a parasomnia; we read and discussed EEG recordings of children with epilepsy.

With Prof. Anette Ramm Pettersen, we also exchanged information about neurophysiology and neuropsychological comorbidities in children with epilepsy.

We shared our daily experience in Senegal through two talks: “Neurology in Senegal” and “Two Clinical Cases of Tropical Neurology.” The first one was about a stroke in a patient with HIV-1 and HIV-2 co-infection, and the second case was about Pott’s disease in an HIV-1 patient.

We attended a meeting on deep brain stimulation at the congress center with Prof. Skogseid, organized by the Norwegian Neurological Association.

We focused on movement disorders, neurophysiology and epileptology, and myasthenia gravis because those topics are our main interests.

On the social part of the stay, we visited Oslo with Prof. Geir Slapø and his wife. We had a social evening at Prof. Aamodt’s House, where we met the members of the Norwegian Neurological Association.

We saw snow for the first time, and all of this made our trip unforgettable.

We acknowledge all of the members of the Norwegian Neurological Association and the WFN for having made this trip possible.

We are thankful for the precious moments we shared at work and in their family lives. •

Norwegian Neurological Association Oslo University

Yohannes Debebe Gelan, MD
Neurologist and Assistant Professor at Addis Ababa University, Department of Neurology
Ethiopia.

Yohannes Debebe Gelan, MD, (center) together with the chairman of the Norwegian Brain Council and the chief physician at Oslo University Hospital during a social event.

I am Yohannes D. Gelan, a final-year neurology resident at Addis Ababa University, Ethiopia, at the time of the visit. I was very lucky to be selected to the prestigious WFN Department Visit program. I knew ahead of my visit that I would have a once-in-a-lifetime experience in Oslo. I visited the neurology units of Oslo University Hospitals (OUH) with a fellow African neurologist from Senegal named Marième Diop Sene.

My visit surpassed all my expectations. I was thrilled by the amount of attention and respect I received from the people I met in OUH. The visit took place from Oct. 21 to Nov. 18, 2016.

The first person I met in Oslo was Prof. Kari Anne Bjørnarå who took care of everything that I needed to survive the first few days in cold Oslo. On Saturday, Oct. 22, we toured the beautiful city of Oslo with Prof. Geir Slapø and his wife, Prof. Andrea Slapø. They were very welcoming. They took us to the Holmenkollbakken. I can’t imagine how people are brave enough to do skiing from that height. I rode on the zipline, which was fun.

We spent the first two weeks in Rikshospitalet, which is a highly specialized national referral center for Norway. We were introduced by Prof. Anne Hege Aamodt and Prof. Espen Dietrichs to all of the staffs of the OUH neurology department on the first day in their morning meeting. We were quite surprised that the method of communication was changed to English not only for the first days but also for most of the month we stayed with the department. The majority of the patients also were willing to speak to us in English. That helped to make my visit productive.

I was a little bit scared when we were asked to do a mandatory methicillin-resistant Staphylococcus aureus (MRSA) test before getting access to the wards. We were told that Norway has the lowest MRSA prevalence rate. Fortunately, the tests were negative, and we were given keys, IDs, and all the other things required to wander around the hospital.

A typical day in OUH starts with a morning meeting followed by radiology sessions. I was impressed by the level of communication between radiologists and neurologists. I have taken a lesson on the importance of working in tandem with radiologists for all neurologists. I hope we will start a similar system in our department as well. There were short presentations on Monday morning and Tuesday at lunch time.

The first week, I followed Prof. Aamodt in the vascular neurology and headache units. She was enthusiastic to show me everything despite her busy schedule at both the stroke and the headache units. I saw patients with rare causes of stroke. I observed how extracranial and transcranial Doppler ultrasound is useful in the evaluation of patients with acute stroke. Even though I wasn’t lucky enough to watch a thrombectomy being done, I saw how it may bring dramatic changes in a patient with vertebral artery thrombosis. I also witnessed occipital and supraorbital nerve blocks while Prof. Aamodt was working with her headache patients.

On the second week, I joined the movement disorder team. Prof. Inger Marie Skogseid showed us two cases of Wilson’s Disease and many more interesting cases. I was able to accompany her to the operating room when she was called to adjust the intraoperative deep brain stimulation (DBS) current setup for a patient with essential tremor. She also shared with us her vast experience on the use of DBS in dystonic patients. I also saw botulinium toxin injections for various movement disorders and chronic pain disorders. At the end of the second week, I visited the electrophysiology unit. Apart from the routine nerve conduction studies and EMG, I was able to observe quantitative sensory testing for the first time in my clinical experience.

During the third week, we went to Ullevål Hospital, which is the center for most of the neurological emergencies for the Oslo region. They also have a specialized center for multiple sclerosis. We were introduced by Prof. Sigrun Kierulf Braekken, the head of the neurology unit. The neurology staff in Ullevål hospital also made English their primary method of communication for us. The first days in Ullevål hospital were a bit difficult as the hospital architecture was so complicated, unlike the Rikshospitalet. I accompanied neurologists on the general neurology ward, and I observed the sophisticated care delivered at the center. It was interesting to see the long list of tests that are done from CSF samples. On the second day, I accompanied the neurologist in the emergency room. It was fascinating to see how the emergency multidisciplinary team works with such coherence and speed. The infrastructure and the equipment in the ER are quite astonishing. I had a chance to visit the stroke unit and neurology ICU.

I attended the neurological physical examination session on the third day of my stay in Ullevål hospital. It was good to see how the basics are done even in the high-tech setup. Finally, I joined the electrophysiology unit, and I got a great lesson in EEG interpretation from an electrophysiology fellow.

On the last week of my stay, I visited the Sunnaas Rehabilitation Hospital. The hospital is built on the hillside with an amazing view of the fjords. Prof. Frank Becker briefed me on the hospital. It is the highest rehabilitation center for Norway. It was interesting to hear about their experience with lifelong rehabilitation follow-up of some neurologic disorders. It is also a national center for locked-in-patients and rare neuromuscular disorders. I attended case discussions held between Prof. Tor Haugstad, the head of traumatic brain injury rehabilitation, and his colleague. Afterward, he showed me around the individual patients’ rooms, the gymnasium, the swimming pool, and the workshop for occupational rehabilitation. The meticulousness of their approach in rehabilitation of patients is something I should dream of establishing in my home country.

At last, I went to visit Spesialsykehuset for Epilepsy (SSE). Prof. Ellen Molteberg showed us around the adult and pediatric wards, epilepsy monitoring unit, the center for mentally handicapped children, and the special school for children and adolescents with epilepsy. I visited the kitchen for ketogenic diet preparation. I also was able to observe when ambulatory EEG is applied and the results are read. I learned a lot from morning discussions on peculiar EEGs on new admissions. We were really impressed by the clinical work as well as by the dedication for research activities in epilepsy. Prof. Cecilie Landmark showed us the sophisticated antiepileptic pharmacologic laboratory. She also briefed us about ongoing trials in their laboratory.

I believe this kind of visit to advanced neurological units is a source of inspiration for young neurologists like me from a developing country. I have acquired new clinical skills. I have gotten ideas on how to implement some of the things I observed in accordance with our available resources in Ethiopia. I would like to thank all members of the neurology department. I would like to thank Andrea and Geir Slapø. They are amazing people who made our weekends exciting. My special gratitude goes to Anne Hege Aamodt for inviting us to the Halloween and the neurology staff dinner party and for all of the support she provided during my entire stay. •

An Update on WFN Educational Activities

Wolfgang Grisold
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and
Steven Lewis
World Federation of Neurology

Dr. Stefan Meng demonstrates nerve ultrasound at a peripheral nerve meeting in Vienna.

One of the most important and fascinating tasks of the WFN is education. This is an implicit task of a scientific society. Scientific societies have many other tasks, such as promoting science, exchange of knowledge, development, and cooperation. However, their most prudent and important task is to keep preparing for the coming generation and maintaining the present generation with education and knowledge to make them the best in their specialty. This ensures the optimal care for patients with neurological diseases.

Wolfgang Griswold

Neurology presence and workforce varies considerably around the world (Steck, Struhal et al. 2013) and also medical systems and educational systems. The WFN has had a number of educational programs throughout its history. Notably, the World Congress of Neurology (WCN) has served the purpose of fostering new development as well as educating neurologists in the field with the development of teaching courses to promote knowledge on a practical level. The World Congresses of Neurology has been doing this for a long time. As a whole, the WCN has been considered a primarily educational effort (Munsat, Aarli et al. 2009).

The WFN also provides Applied Research Groups, which serve to promote their subspecialty, for example motor neuron disease, neuromuscular diseases, neurosonology, and who, in addition to their scientific work, also engage in congresses and teaching courses. The Applied Research Groups are invited to engage on the structure and content of WFN teaching courses at each WCN.

WCN 2017
This year, the XVIII WCN will take place in Kyoto. It will be jointly hosted with the Japanese Society of Neurology. The congress will offer many educational components and disseminate the latest news and developments, as well as deliver many scientific sessions, teaching courses, and presentations and poster sessions, which all contribute to education in neurology. The WCN is a live event and is accredited by the EACCME for 8 CME hours a day, which is mutually recognized by the AMA and the Royal College of Physicians and Surgeons of Canada, thus being evaluated by high international standards.

Several attractive opportunities are implemented at WCN 2017. There will be congress bursaries, which in addition to the waiving of the congress fee will offer travel grants. This is aimed at young neurologists and is supported by the congress and, also in part, by the professional conference organizer Kenes. This year, travel grants for 80-90 persons are planned.

For the first time, the Munsat1 prize on education will be rewarded, named after Theodore Munsat (Medina 2014), who was very active in education and chaired the WFN education committee for several years. This prize will be awarded for the first time in Kyoto and will be an acknowledgement for persons involved in the promotion of education in neurology, and in particular educational activities within the WFN.

In addition to the scientific program, the WFN organizes teaching courses at several levels, hands-on courses, and educational sessions. The joint AAN-WFN Advocacy Palatucci workshop is a good example of a session teaching the skills of advocacy and leadership.

From the World Congress to Enduring Materials
Increasingly, the WFN also produces enduring materials, which are journal-published Congress abstracts, the Journal of Neurological Sciences (JNS) and eNS, the dissemination and organization of Continuum with the AAN for use in Continuum user groups, and, increasingly, the WFN website and social media.

Educationalists distinguish between live events and enduring materials. Enduring materials can be anything from printed, written material or media available as educational audio or video.

The WFN is in the good position to be able to use several publication materials, such as the website and social media, including Facebook, which among other activities also spread news and developments in timely ways and reach the groups of both young and middle-aged neurologists, and possibly also other health-related groups.

The JNS is the official journal of the WFN, and publishes material from studies, reviews, and cases, and has a large international participation. Two editor-selected CME articles appear on the website each month and can be downloaded free. The JNS is a continued success and is now edited by Prof. John England.

The journal eNS has been founded as an electronic open access journal, also serving as a platform for articles and cases, and has published several local features. It is meant to work in conjunction with the JNS. As it is an open access journal, fees for publication for open access articles are necessary, and this may be a hindrance in low-income areas; However, eNS is increasingly picking up momentum.

Continuum: Lifelong Learning in Neurology is a product of the AAN and published by Wolters Kluwer . Graciously over the years, the AAN has donated print copies of the journal to countries in need, on the condition that workgroups are constituted, that articles will be read and discussed, and these conferences will be reported back to the WFN. The logistics of the dissemination of this program is done by the WFN, which includes the mailing, sending, receiving, and accumulating the reports. This is an ongoing success story and the WFN and the AAN are happy to provide this service. For an example of a Continuum program, see the recent article on the Moroccan Continuum program.

Books: In the recent past, the WFN also produced a book series, Seminars in Neurology, which was aimed at countries with low education standards and limited resources of health care. Despite being a success, they became outdated and have been replaced by the other educational materials and endeavors discussed in this article.

Video conferences are presently launched on the WFN website and it is expected that video conferences on cases or diseases held between several departments will provide a useful academic support for training. Increasingly, video-type seminars will be used for educational purposes

The public: One of our main aims is the promotion of neurology, which is much wider that any training and education we do specifically for the specialty. Individual health groups, committed nongovernment organizations (NGOs), and patients need to be aware
of neurologic symptoms, diseases, and emergencies, and be encouraged to seek help for neurological conditions for themselves or others.

The aim of public education is to spread information on neurology, raise awareness and understanding, and improve the fate of patients with neurological diseases. All in all, this could be called advocacy work for neurology. Indeed, this is the greatest gap we need to fill. At present, a good example of educational aspects are the Days of the Brain, which are topic-focused and try to improve awareness with regard to specific neurological diseases.

World Brain Day: Education of the Public on a Larger Scale
A major initiative from the WFN is World Brain Day which had its origins at the WCN 2013 in Vienna, and will take place for the fourth time this year at the WCN in Kyoto, presented jointly with the World Stroke Organization.

The previous World Brain Day topics were epilepsy (with the International League Against Epilepsy [ILAE])  and dementia. The day commemorates the founding day of the WFN and is July 22.

Members are encouraged to celebrate this World Brain Day and receive educational matter, suggestions for press mailings, and printout material. Last year, a virtual press conference was added for the first time. Press mailings, articles, and local activities are considered as measures for success and were observed and counted.

Patient Day
The WFN has introduced the concept of a Patient Day at the World Congress of Neurology, which is a day and a session devoted to patients, careers, and health groups for the purpose of spreading news and interest of the Congress. This was successful in Vienna and in Santiago, and will need to be continued at further congresses. Common diseases such as stroke, epilepsy, and movement disorders are usually selected, and speakers from the Congress give talks in an understandable format.

Other Efforts
Public Relations and Press Conferences also serve to promote the content of neurology and serve the purpose of reaching out.

Junior Traveling Fellowships
Junior traveling fellowships (JTFs) provide support for individuals to attend meetings and congresses. The applications can be made worldwide, and applications from low- and middle-income countries are preferred. The participation in the meeting needs to be “active,” which means a presentation or a poster should be in the program. A final report is requested, which might be used for publication in World Neurology. In the last years, an average of 30 JTFs could be granted per year. Applications are announced on the WFN website.

WCN Congress Bursaries
The WFN also offers congress bursaries to attend the World Congresses. The bursaries are devoted to younger neurologists, with preference to applicants from low- and middle-income countries, and include a travel grant and free attendance to the Congress. The number grantees allowed depends on the Congress budget. Over the last several years, 55 bursaries were given in Marrakech, 120 in Vienna, and 30 in Santiago. This year, we are planning for 100 in Japan. In part, this is also supported by the professional conference organizer, Kenes.

IFMSA
The International Federation of Medical Students’ Associations is an international association of medical students. The WFN has cooperated with regard to students‘ medical curricula concerning neurology, and also provides free entrance for two students at the World Congresses.

Courses, Caravans and Regional Teaching Courses
The needs for education differ worldwide, and they are not limited to live events and enduring materials. Courses with nurses, paramedical professionals and other health groups can be necessary, as well as small standalone meetings. Some of these meetings have been funded by the WFN with grants.

A good example of a continuing joint activity by the EAN and WFN is to hold teaching/training courses in Subsaharan Africa each year. Last year the course took place in Maputo, Mozambique in November, and this year it will be in Ouagadougou, Burkina Faso. These EAN regional teaching courses usually attract 70-80 persons, have a lean teaching staff of 10-15 persons, and attract trainees from Africa to offer scientifically valuable and highly interactive courses. This education of trainees and young neurologists is important, as they will act as multipliers for the future development of neurology in Africa.

WFN Grants are Available Each Year
The idea of WFN grants was first introduced in 2011. Grants allocate a sum of money for a purpose and a project, which in many instances are projects related to neurologic education. The website shows details about the grant application. The WFN is also eager to share and participate in grants with other scientific societies such as the International League Against Epilepsy, the World Stroke Organization, and the Movement Disorder Society.

WFN grants are awarded once a year, and applications are scrutinized and selected by a grant committee.

Department Visits
In past years, the WFN, jointly with partner members, has developed a program of Department Visits, where young neurologists from low-income countries can go and stay for four to six weeks to study the procedures, techniques, and observe the neurologic work at a major neurological center. This program was introduced for African countries.

Turkey started this initiative with us, and it has now been followed by department visits in Austria, Germany, and Norway, and soon Italy. Names of fellows and reports can be seen in World Neurology articles.

Both the participants and the sponsors have been enthusiastic about this initiative, which not only introduces the participants to recent developments and up-to-date procedures, but also introduces new insights into other medical and social systems.

This year, North America is joining, and the Canadian Neurological Society is introducing a department program dedicated to countries in South America. This will expand this successful educational tools in the Americas.

WFN Teaching Centers
The development of WFN Teaching Centers was successfully introduced with the first WFN Teaching Center in Rabat Morocco in 2013. The idea is to train neurologists locally with high standards, and also acknowledge the high standard of the training center. The first Teaching Centers were successively established in Africa in Rabat, Cairo, and Dakar, and offer both “full training” and fellowship opportunities, which include electrophysiology and epileptology.

WFN Teaching Centers undergo a process of evaluation, a site visit, and re-evaluation after four years. The Teaching Centers also need to be embedded in a publicly accessible university, along with facilities and services that include internal medicine, radiology, neurosurgery, neuropathology, and rehabilitation.

At present, Rabat has had one fellow each year for the past three years, and will start to train a second fellow this year. Cairo is now starting with one fellow and Dakar will start with both a complete training position and one fellow on epileptology.

The WFN organizes the Teaching Centers with regard to administration, and also supports the WFN fellows. The applications for these training positions are announced via the WFN website and media. A committee, consisting of members of the WFN education committee, the local university, and the regional society, scrutinizes and selects the candidates.

The Applied Research Group on neuromuscular diseases held a very successful congress in Toronto in 2016. This Congress, ICNMD 2016 (icnmd2016.org/), also yielded a share of profit to the WFN, and the WFN has decided to use this money for additional funding of two successive training fellowships in neurophysiology, which will take place in Rabat, and possible cooperation with the international society of electrophysiology is planned.

In the Americas, Mexico has excellent neurological training programs, several of which were visited by the WFN in 2016 and received the status of WFN Teaching Centers. In 2017, attempts will be made by the WFN to sponsor one trainee from South America to train in a Mexican Teaching Center, and the preparations for this department visit are ongoing.

A further potential development for the WFN Teaching Centers could be regular visits from an international professor, who would stay a few days, give lectures, and make rounds in the department for a short time (e.g, a week). This would also help the WFN to identify the needs of the Teaching Centers more clearly.

The concept of the WFN Teaching Centers is expanding, to potentially include a Teaching Center in South Africa, and already for Rabat a re-evaluation process will be needed. The WFN is also aware that a Teaching Center should be available in Asia, which, while having very highly developed and scientifically active countries, still has several countries with significant needs with regard to neurology training. This will be an upcoming project.

Vision
Education is an ongoing process of innovation and renewal, and the prediction of the future is not easy.

There is a need for research into the most efficient and best educational methods. Apart from practical learning, training curricula and the apprenticeship type models prevail. In addition, much time now seems potentially spent (and perhaps wasted) on routine work, and some training curricula, too.

There is no doubt that time and experience count, but could we not improve in the efficiency of knowledge transfer? It will be an important effort and task for the WFN to stimulate research in the field of education.

With the rapidly expanding developments in neurology, training curricula and teaching concepts have an increasingly shorter half-life. In addition to the need for trainees and practicing neurologists to accumulate new knowledge at a fast pace, we must also invest in mechanisms to investigate and assess which skills and knowledge trainees need to acquire (e.g., the milestones that were developed by the Accreditation Council for graduate Medical Education [ACGME] and American Board of Medical Specialties [ABMS] in the U.S. [Lewis et al, 2014), and also mechanisms to replace “old knowledge” with new (unlearning).

There are, however more tangible projects currently in our sights, such as the expansion of the WFN Teaching Centers, development of education on electronic WFN platforms, and the development of a global curriculum for training of neurology, aiming for suggestions with regard to the teaching and training methods, taking into consideration differences in local needs and resources.

Most important is the vision to increase efforts on public education and involvement of patients and patient groups. Awareness, prevention, understanding, and care for patients with neurological diseases need to be one of our major tasks.

References

  • Theodore L. Munsat (1930-2013). US neurologist, long term chair of the WFN education committee and also founding director of “Continuum.” See: http://worldneurologyonline.com/article/theodore-l-munsat-1930-2013-an-outstanding-legacy-with-the-wfn/
  • JA, A. “The History of the World Federation of Neurology: The First 50 Years von Johan A. Aarli.” OUP Book: 2014
  • Medina, M. T. (2014). “In memoriam of Professor Theodore L. Munsat (1930-2013): his outstanding legacy with the WFN.” J Neurol Sci 339(1-2): 1-2.
  • Munsat, T., J. Aarli, M. Medina, G. Birbeck and A. Weiss (2009). “International Issues: educational programs of the World Federation of Neurology.” Neurology 72(10): e46-49.
  • Steck, A., W. Struhal, S. M. Sergay, W. Grisold and N. Education Committee of the World Federation of Neurology (2013). “The global perspective on neurology training: the World Federation of Neurology survey.” J Neurol Sci 334(1-2): 30-47.
  • Lewis SL, Józefowicz RF, Kilgore S, Dhand A, Edgar L. Introducing the neurology milestones. J Grad Med Educ. 2014; 6(1 Suppl 1):102-4.
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