Raad Shakir, MD

By Raad Shakir, MD

The World Congress of Neurology (WCN) is the major event for a host society and is as important for the regions. There is no doubt that in each of the last four congresses the impact on the regions was positive, but to a varying degree as expected. This is one of the main reasons for holding congresses in rotation across continents.

If we start with Bangkok in 2009, the Congress was well attended and drew delegates from neighboring countries. This success resulted in the consolidation and formal establishment of the Asian Oceanian Association of Neurology (AOAN). The World Federation of Neurology (WFN) provided the AOAN with seed money to establish its legal status, produce its bylaws, and hire its own professional conference organizer. This indeed happened, and the AOAN is now a well established and financially viable association based in Singapore. This was further consolidated by their most successful subsequent Congress in Melbourne in 2012. This was made even more successful as they drew on the huge experience of the Australian and New Zealand Association of Neurology. We have to remember that Sydney hosted a successful WCN in 2005. This made the Australian neurologists experts in making congresses work. The AOAN was well organized, and the excellent Congress reinforced the status of the AOAN. Subsequent meetings in Macao and Kuala Lumpur this year continued the progress. It is clear that although the AOAN was established in 1961 with its first meeting in Tokyo, its legal status, bylaws, and financial structure only started to happen following the success of WCN Bangkok.

If we move now to WCN Marrakesh, the situation is even more spectacular. The Congress banner was “With Africa For Africa.” Prior to the WCN, the only African association was a combination of neurologists and neurosurgeons. The Pan African Association of Neurosciences (PAANS) has been in existence for nearly 40 years, but the structure and function has never been brought to the modern age. Moreover, the neurosurgeons, except a few, decided to form their own African setup and left PAANS. It was high time to organize African neurology in one solid organization with proper membership, a constitution, and bylaws as well as legal status. This aim was paramount for African neurologists who saw the Marrakesh Congress as the opportunity to establish their academy. The Moroccan society and the WFN agreed to create an Africa fund. This came from the profits of the WCN and was specifically dedicated for the establishment of an African neurology association. Although it took four years, with good will and massive organization of the head of the Africa initiative Gallo Diop, MD, PhD, of Senegal, and the WFN Regional Chair Riadh Gouider, MD, of Tunisia, it all came to fruition.

In August 2015, a meeting in Dakar of 27 African associations established the African Academy of Neurology (AFAN). The bylaws and constitution were approved, democratically elected officers were chosen, and now the organization is officially registered as a nonprofit organization in Cape Town, South Africa. The needs of Africa are massive. President Johan Aarli, MD, established the WFN Africa task force in December 2006, and we are delighted that the organization is now fully functional. The first Congress of AFAN is going to be held jointly with the Congress of the Pan Arab Union of Neurological Societies in March 2017 in Tunisia.

One might rightly think that neurology in Europe is well organized and education is advanced, which is certainly the case. However, at the time of the WCN 2013 in Vienna, there were two continental neurological organizations in deep discussions and negotiations on a merger. At the time of the WCN Vienna, one of the two regional organizations, the European Federation of Neurological Societies (EFNS) fully participated in the WCN as a partner and canceled its own Congress for that year. This resulted in consolidating the attendance for the WCN. The Austrian society worked closely with the EFNS to make the Congress a huge success. The birth of the European Academy of Neurology (EAN) followed with the merger of EFNS and the European Neurological Society. This merger started with the 2015 joint meeting in Istanbul, and the first EAN Congress was held in 2016 in Copenhagen.

Moving on to Latin America, the Santiago WCN was held in 2015. This was the second Congress in the continent following Buenos Aires in 1993, and the Chilean colleagues performed marvelously. The Congress was a success scientifically, socially, and financially. The regional association was in the process of being formed. Although neurological congresses had been held since the 1960s, they followed the same pattern as elsewhere in the world. A host country holds the Congress with the full responsibility of organization and outcome; there was no set structure and the region, although participating, did not reap the rewards of the Congress. There had been an intense discussion between Latin American neurologists over the previous four years, which culminated in a pivotal meeting during the Marrakesh Congress and proceeded to further meetings under the auspices of the WFN. These deliberations were financially supported fully by the WFN and culminated in the formation of the Pan American Federation of Neurological Societies (PAFNS). The constitution and bylaws were written, and the final step was in Santiago, when it was decided to host the PAFNS administrative office in Chile. The Chilean society agreed to offer office facilities, and the constitution and bylaws were translated into Spanish. The PAFNS is now registered as a nonprofit foundation in Chile. This will allow future developments and financial stability to disseminate neurological training in Latin America.

Again like Africa, the Santiago Congress provided financial provision for PAFNS. The WFN and Sonepsyn (Chilean Society) have given up some of their profits to facilitate the establishment of the PAFNS. This was supplemented by a grant from the American Academy of Neurology, and the three organizations are involved in providing seeding for the nascent PAFNS. It has been most heartening to see that the Mexican Academy of Neurology stepped up to host the first PAFNS Congress in October 2016 in Cancun.

All of this only demonstrates the close relationship and tight collaboration of the six WFN regional organizations in doing all they can to consolidate their status and support each other, which is the essence of regional empowerment as one of the pillars of the WFN strategy for improving neurology worldwide.

Donald Gilden, MD

By Donald H. Silberberg, MD

For Donald Gilden, MD, his beginnings in Baltimore in many ways foreshadowed what was to become a distinguished career in neurology and virology. Don excelled in his studies while developing into a talented baseball pitcher, good enough to receive an offer from the Baltimore Orioles to join its leading farm team as a prospective big-leaguer. When Don broke the exciting news to his father, his father looked at him — an ace student who had been accepted to Dartmouth College — and said he was destined for great things: in college, not on a baseball field. Don accepted his father’s advice, bringing his combination of a competitive spirit, persistence, and teamwork when he enrolled at Dartmouth. So, how did his early years contribute to the development of such a remarkable career?

Don returned to Baltimore for medical school and the University of Maryland, which later recognized him as one of its most distinguished alumni. He trained in neurology at the University of Chicago, which recognized him as a distinguished alumnus. There he met his wife Audrey and began their devoted 49 years together. He then spent two years as a neurologist at the Walter Reed National Military Medical Center. He correctly saw that the field of neurovirology held great promise with so many unanswered questions. In 1969, he began his scientific career as a fellow in neurovirology at the Johns Hopkins School of Medicine. In 1970, his background uniquely qualified him for the faculty of the University of Pennsylvania’s department of neurology and its affiliate the Wistar Institute to attempt to find the virus that causes multiple sclerosis. Penn and Wistar had just established the first comprehensive research and clinical care center for MS, and Don quickly became a key member of the team.

A powerful technique at that time for detecting latent viruses was so-called co-cultivation, growing human cells that might contain a virus together with well-characterized lines of cells that had been maintained for many generations in vitro, and were known to be free of viruses. This required finding fresh brain and spinal cord tissue from recently deceased individuals with MS and from individuals known to not have MS. A brain bank registry was established. Don made countless trips to autopsy suites throughout Pennsylvania, often on short notice in the middle of the night. The nearby Philadelphia medical examiner’s office became a source of control tissues. In the course of these many unrewarding attempts to find an MS virus, Don discovered that the two principal human herpes viruses, Herpes simplex virus (HSV) and varicella zoster virus (VZV), could be found in latent forms in virtually all dorsal root and trigeminal ganglia at postmortem, whether from individuals with MS or controls.

This remarkable finding soon became a major focus of Don’s research: How did the virions remained latent, what activated them, and how could VZV cause chicken pox in children and then shingles later in life? In order to further develop his molecular biology skills, in 1980 and 1981 Don joined Yechiel Becker’s laboratory in the department of molecular virology at the Hebrew University-Hadassah Medical Center in Jerusalem as a visiting professor. While in Jerusalem, Don found time to join a fast pitch softball league and become captain of the Israeli team with teammates who were 15 to 20 years younger than Don, playing the position of catcher. They played in the Maccabiah Games, Israel’s Olympics.

Returning to Penn, he began to explore the many facets of VZV, leading to landmark discoveries that link the virus to giant cell arteritis in its many clinical phenotypes, shingles, temporal arteritis, ischemic optic neuropathy, cerebral and multi-organ vasculitis, and, most recently, Takayasu’s arteritis. This opened the way to revolutionize treatment. At the ztime of his death, scores of colleagues throughout the United States who had provided biopsy samples, or were aware of his findings, reported to Don that their patients who were doing poorly with conventional corticosteroid treatment responded quickly to anti-viral agents, e.g. valacyclovir. This reinforced what he was seeing at the University Colorado, and undoubtedly will be the subject of clinical trials (if they are really needed) and future publications.

While conducting his research at Penn, Don quickly gained the reputation as a go-to neurologist for colleagues in many departments throughout Philadelphia, and ultimately the United States, for help in solving difficult neurological problems as an expert clinician  and later as a neurovirologist. He was a true triple threat in every respect, an outstanding teacher, astute clinician, and extraordinary scientist.

In 1985, Don became professor and chair of the department of neurology at the University of Colorado, remaining chair until 2009. Notably, he expanded his successful research program while developing a nationally prominent department of neurology. His abilities and energy as a teacher were recognized when he received the Outstanding Teacher Award from neurology residents four times. Don was honored with many other national and international awards, including the Alumni Award for Distinguished Service from the University of Chicago, the Pioneer Award of the International Society of Neurovirology, and the 2008 Honor Award and Gold Key for outstanding contributions to medicine and distinguished service to mankind from the University of Maryland School of Medicine. He was elected to the Association of American Physicians, to fellowship in the American Association for the Advancement of Science, and to the Johns Hopkins Society of Scholars. He held leadership positions in many professional societies during his career, and he remained active on many editorial boards, with the National Institutes of Health (NIH) and the National Multiple Sclerosis Society study sections until his death.

A measure of the friendship and loyalty that he inspired was the fact that his principal laboratory assistants who joined his laboratory in the late 1970s stayed as members of his team, from Philadelphia, to Jerusalem, to Denver, and until their retirements over the last several years.

Don continued his research even after discovering that he had an aggressive renal carcinoma, enduring a difficult 18 months of therapies, finally succumbing on Aug. 22, 2016. In his last months, he identified five genes actively expressed during the process of latency. This was consistent with his having lived his life to the fullest. As late as early August, he worked with his colleagues to ensure that his grants would continue funding the research team and that the decades of advances he made in unraveling the nature of the varicella zoster virus would continue.

To cite some numbers: Don was an author on more 420 papers and remained the principal investigator on both an NIH Program Project Grant and an R01 until his death. He trained 26 graduate students and postdoctoral fellows, all of whom but the most recent hold important faculty positions in the United States, Canada, Japan, and Norway. He was mentor to countless medical students and residents, and consultant to his peers throughout the world. He held leadership positions in numerous professional societies and remained active on many editorial boards and NIH study sections until his death.

Don played to win at everything he did. He enjoyed skiing, becoming so accomplished that one could mistake him for a professional. He enjoyed teaching his friends and colleagues (including me) how to better navigate the slopes.

He was a serious violinist, never traveling without his instrument and practicing every day, even throughout his illness. In addition to recitals at national meetings, I enjoyed hearing him practice in hotel rooms in many countries as we attended meetings and in his home in Denver. When possible, Don added attendance each year to a national or international violin competition, including the International Violin Competition of Indianapolis, to his neurology and virology meetings schedules.

Don had a warm and engaging personality that endeared him to many of us. He and his wife maintained enduring friendships and were extremely hospitable to those of us who showed up in Denver from time to time.

However, where Don really devoted his energies and love was with his family, Audrey, their sons Daniel, Adam, and Paul, and their families. He and Audrey have been fully involved in their lives, leading to incredibly close ties among all of them. Although theirs is the greatest loss, Don’s passing leaves a tremendous void in neurology and virology, and he will be sorely missed by his many students, trainees, friends, and colleagues. May he rest in peace.

References

• Gilden, D.H., Rozenman, Y., Murray, R., Devlin, M., Vafai, A.: Detection of Varicella Zoster Virus Nucleic Acid In Neurons of Normal Human Thoracic Ganglia. Ann. Neurol. 22:377-380, 1987
• Gilden, D.H., Devlin, M., Wellish, M., Mahalingam, R., Huff, C., Hayward, A., Vafai, A.: Persistence of Varicella Zoster Virus DNA in Blood Mononuclear Cells of Patients With Varicella Or Zoster. Virus Genes 2:299-305, 1988.
• Gilden, D., White, T.M., Nagae, L., Gurdin, W.H., Boyer, P.J., Nagel, M.A.: Successful antiviral treatment of giant cell arteritis and Takayasu’s arteritis. JAMA Neurology, 72:943-6,2015.
• Golas, L., Bennett, J.L., White, T.M., Skarf, B., Lesser, R., Nagel, M.A., Gilden, D.: Varicella Zoster Virus in Ischemic Optic Neuropathy. Ophthalmology, 122: 2142-5, 2015.

Emilio Perucca, MD, (right) president of the International League Against Epilepsy, welcomes the WFN Council of Delegates to Prague. Also pictured (from left): William Carroll, MD, WFN vice president, and Raad Shakir, MD, WFN president.

By Wolfgang Grisold, MD, and Steven L. Lewis, MD

The Council of Delegates of the World Federation of Neurology (WFN) met Sept. 12 during the 12th European Congress on Epileptology in Prague, Czech Republic. The meeting was opened by Emilio Perucca, MD, International League Against Epilepsy (ILAE) president, who welcomed the WFN delegates to Prague and emphasized the excellent connections between the WFN and the ILAE.

The introduction was followed by a welcome from WFN President Raad Shakir, MD. Secretary General Wolfgang Grisold, MD, identified 26 voting delegates, including proxies.

Gallo Diop, MD, PhD, recently ended his period as an elected trustee, and Dr. Shakir emphasized his achievements, in particular founding of the African Academy of Neurology (AFAN). For the open trustee position, two candidates, Sarosh M. Katrak, MD, and Steven L. Lewis, MD,  applied and each gave a five-minute introduction. This was followed by voting.

The WFN Council of Delegates cast ballots, electing Steven L. Lewis, MD, as WFN trustee.

Dr. Shakir, Vice President William M. Carroll, MD, and Dr. Grisold each spoke on the achievements and work of the past year. Dr. Shakir informed attendees that John N. Walton, MD, and Noshir H. Wadia, MD, passed away in the the last year. The president also gave the final report from the the World Congress of Neurology (WCN) 2015 in Santiago, Chile, where 3,500 attendees made the meeting a success. Sixty percent of the profit made in Santiago was dedicated to the WFN and 40 percent to the Chilean Society of Neurology, Psychiatry, and Neurosurgery.

Collaborations with the World Health Organization (e.g., the Atlas), ICD 11, the Global Neurology Network, the WFN Zika working group (chaired by John England, MD), and the efforts of the WFN to improve neurology in all regions of the world were mentioned.

Dr. Carroll reported on the development of the next WCN in Kyoto, Japan, and the structure of the Congress. Three Nobel laureates will give lectures, and the number of sessions will be 210. The site of WCN 2019 is Dubai, United Arab Emirates. Applications from Europe for WCN 2021 were accepted until the end of September 2016.

The secretary general reported on five issues:

1. The WFN office
2. Zika
3. The Day of the Brain
4. WFN publications
5. Outlook for the Congress

The Kenes Group will be the professional conference organizer for three more congresses. The secretary general also gave the reports from the Public Awareness Committee and the Applied Research Group Committee. The 2016 World Brain Day topic was “The Aging Brain.” The Day of the Brain will be continued in 2017, and the topic will be “Stroke.”

The WFN publications have a wide-ranging presence, from the website and social media, to World Neurology and the Journal of the Neurologic Sciences, to a new electronic journal, eNS.

The next neuromuscular congress — the International Congress on Neuromuscular Diseases (ICNMD 2018) — will be held in 2018 in Vienna.

Keith Newton, who served the WFN as executive director for 17 years, has retired, and his engagement and significant contributions to the WFN were acknowledged.

Richard Stark, MD, treasurer, presented the financial situation. Subsequent to the Congress in Chile, the financial situation has remained stable. Negative trends are the reduction of interest due to the economic situation in investments. The WFN will have to maintain the policy of lean management and careful budgeting, in particular, since in the years between congresses current costs exceed the income. The auditor’s report was approved, and the auditor was selected for the next financial period.

The Membership Committee received three applications, from Nepal, Togo, and Mauritania. Formally, Mauritania fulfilled all conditions and details and was accepted as a new WFN member. The other two countries were encouraged to resubmit their applications in Kyoto. For Guatemala, there are issues with regard to the presence of two societies accredited in 2001 by the WFN. The 2001 decision by the Council of Delegates to accept two Guatemalan associations has been reversed and approved by the South American delegates.

Education Committee Chair Dr. Lewis provided the report of the WFN educational activities, including the awarding of 30 Junior Travelling Fellowships in 2016. In addition, attendees were provided with an update on the the WFN department visit program for four-to-six-week visits, which now includes Austria, Canada, Germany, Norway, and Turkey. The status of the WFN Teaching Center program (for fellowship or full neurologic training) also was discussed. The program now includes two African centers, Rabat (a French-speaking site), Cairo (English-speaking), the newest center in Dakar (French-speaking), and the newest center in Mexico for Central and South America (Spanish speaking). The status and current usage of the Continuum program, an important joint educational initiative of the American Academy of Neurology and the WFN, also was discussed. Dr. Lewis and Walter Struhal, MD, editors of World Neurology, also reminded attendees of a call for articles on training in neurology around the world for publication in World Neurology.

Morris Freedman, MD, presented on distance learning, and he shared details about the Canadian-African interactive video conference as an example of future international medical video conferences that could possibly be supported by the Canadian government and include WFN involvement.

Dr. Struhal gave the report for the Publications and Communications Committee. He introduced the new and impressive WFN website and reported on the successful expansion on social media, including acknowledging the efforts of the social media group members.

Regional issues were presented by representatives from these regions:

• AFAN: WFN Trustee Riadh Gouider, MD, presented on African initiatives by the AFAN, which was founded in 2015. The first meeting together with the Pan-Arab Union will take place in March 2017.
• Asian and Oceanian Congress of Neurology (AOCN): The Asian Initiative was reported by Ryuji Kaji, MD, PhD, who presented on Asian initiatives, including the AOCN’s August 2016 meeting in Kuala Lumpur, which was organized by the Kenes Group. In 2016, at the Japanese Society of Neurology meeting in Kobe, there were several thousand attendees. This meeting also was attended by several WFN officers. Dr. Kaji also reported on positive developments with regard to planning of the WCN in Kyoto. Dr. Kaji also presented new features of Japanese research, including rehabilitation and treatment with stem cells in spinal cord injury.
• Pan-American Federation of Neurological Societies (PAFNS): Marco Medina, MD, presented the update from PAFNS, whose constitution and bylaws were signed during the 2015 Congress in Chile. The organization is supported by the ILAE, the World Sleep Society, and the Iberoamerican Cerebrovascular Diseases Society, and its first official meeting was scheduled to be held Oct. 30-Nov. 3, 2016, in Cancun, Mexico.

The announcement of the result of the trustee election was presented. There were 26 votes, and, according to tradition, the number of votes for each candidate were not announced. The result was that Dr. Lewis of the United States became the newly elected trustee of the WFN.

Finally, the attendees were reminded to save the dates of Sept. 16-21 for WCN 2017 in Kyoto.