Dr. Chandrashekhar Meshram Recognized for Public Service

The Padma Shri Award is one of the highest civilian honors in India.

By Dr. Gagandeep Singh

Gagandeep Singh

India’s Padma Awards recognize public service and significant achievements across a variety of disciplines such as art, engineering, medicine, social work, literature, education, and sports. They are announced annually on the eve of India’s Republic Day and conferred by the president at a ceremony in New Delhi.

This year, Dr. Chandrashekhar Meshram was presented with the Padma Shri Award. Dr. Meshram is a trustee of the World Federation of Neurology (WFN). He is a multifaceted personality who has excelled in clinical neurology, academic leadership, research, teaching, public health awareness, and social activities.

Coming from a humble rural background, he grew up with commitment, hard work, and innovative ideas to eventually become a WFN elected trustee. He earned his MD and doctorate of medicine in neurology from the Post Graduate Institute of Medical Education and Research in Chandigarh, India. He is currently director and consultant neurologist at the Brain and Mind Institute in Nagpur, India.

He served as president of the Tropical and Geographical Neurology Specialty Group (TGNSG) within WFN for two terms. Under his tenure, the TGNSG became one of the most vibrant specialty groups of WFN. He represented the Indian Academy of Neurology as a national delegate in seven WFN Council of Delegates meetings. He also served the WFN as a member of its Constitution and Bylaws Committee for three terms and as a member of the Scientific Program Committee for two terms.

Dr. Meshram served the Indian Academy of Neurology (IAN) as a member of its executive committee, secretary, and then as president. He was instrumental in transforming the scientific program for the IAN annual conferences. The academy conferred on him Fellow of Indian Academy of Neurology (FIAN) status in 2012.

Known for his phenomenal organizational capabilities, he successfully assembled the 12th Annual Conference of the Indian Academy of Neurology in 2004 in Nagpur, and the first International Tropical Neurology Conference in 2017 in Mumbai. He was co-chair of the Second International Tropical Neurology Conference in 2018 in Sao Paolo, Brazil. As a course director, he organized 16 sessions of a unique education activity — the WFN-IAN-FINE Neuro Infection Series, and 13 sessions of the Inspiring People in Neurosciences Series, a first-of-its-kind activity by WFN.

Dr. Meshram (left) receiving the 2024 Padma Shri Award from Droupadi Murmu, the Honorable President of India.

Dr. Meshram is the WFN representative for the Western Pacific region of the World Health Organization. He was co-editor of a special issue of the Journal of Neurological Sciences that focused on tropical neurology. He is a section editor of the Encyclopedia of Neurosciences for the section on bacterial and fungal infections, including tropical diseases, and is assistant editor of the international journal eNeurologicalSci. He also serves on the editorial board of the Journal of Neurosciences. He is a member of the infectious disease panel of the European Academy of Neurology.

Dr. Meshram is passionate about public awareness programs and has promoted them for more than 30 years through meetings, radio talks, television, and newspapers. During his 10 years as a chief coordinator for public health education and awareness activities for IAN, he organized programs throughout the country. He developed and furthered several highly acclaimed programs, including “Music, Masala, and Brain,” a sports meet for people with neurological disorders, and painting competitions for school children to raise awareness about the importance of autism, brain health, CNS tuberculosis, dementia, the environment, epilepsy, headache, multiple sclerosis, Parkinson’s disease, and stroke.

He has published more than 450 newspaper articles for public awareness and contributes regularly to World Neurology. He also published a book containing children’s paintings themed on brain disorders.

Dr. Meshram has received other awards, including the Samman Award, conferred on him by the Indian Income Tax Department. He was presented with the Rashtrasant Tukadoji Maharaj Jeevan Sadhana Award in 2017, the highest honor of Rashtrasant Tukadoji Maharaj Nagpur University. He was nominated as brand ambassador of Nagpur by the Nagpur Municipal Corporation for Swachh Bharat Abhiyan (Clean India Mission). The Indian Medical Association presented him with the Dr. Wankar Gold Medal and Lifetime Achievement Award in 2019.

He is a trustee of Baba Amte’s, Maharogi Sewa Samiti, and Vidarbha Sahitya Sangh, a literary and cultural organization. He is the founder and president of the Samyak Medical Foundation, which provides scholarships to meritorious students from low-income areas encouraging them to pursue a higher education. He is also the founder and president of the Orange City Cultural Foundation and has organized six Orange City international film festivals.

Dr. Meshram has been well supported by his family, colleagues, well-wishers, media, and grateful patients. He has the unconditional support of his loving wife Namrata. The couple is blessed with two sons, Aashay and Aviral. Aashay lives in Vancouver and is excelling in his profession as an animation designer, while Aviral is doing a residency in neurology. Dr. Meshram’s father, Dr. Mahadeorao Meshram, was conferred with the national lifetime achievement award, Vayoshrestha Samman, by the Honorable President of India in 2017, for his outstanding and selfless service for the elderly.

Dr. Meshram richly deserves this Padma Shri award. It will undoubtedly inspire future generations of neurologists and promote the growth of neurology in India and other parts of the world. •

Dr. Gagandeep Singh, DM, FRCP, FAMS, is the past president of the Indian Academy of Neurology

Get the Latest in Headache Treatment and Research

Free virtual symposium to take place in November.

By Dr. Olivia Begasse de Dhaem

The World Federation of Neurology (WFN), African Academy of Neurology (AFAN), Global Patient Advocacy Coalition (GPAC), and International Headache Society (IHS) announce the fourth Education in Headache to Healthcare Professionals in Africa (EHHPA) Symposium. It will take place virtually on Nov. 23, 2024. Registration is free and open to health care workers of all levels.

Participation in EHHPA has grown from 550 participants in 2021 to 1,029 participants in 2023. That includes participants from all parts of the world, with the majority (84%) from 38 different countries in Africa. Attendees included neurologists (37%), general practitioners (17%), and neurologists in training (13%).

As a result of the program, 80% of participants have indicated they can distinguish migraine from other headache disorders, and 55% gained confidence in terms of headache management. The top three most-attended sessions were Infection & Headache, Trigeminal Autonomic Cephalalgias, and Secondary Headaches.

This year’s event brings world-renowned speakers to cover practical topics, such as headache evaluation and management in both the primary care and emergency room settings, headache in systemic diseases, the epidemiology of headache in low- and middle-income countries, and headache considerations in and around pregnancy. The symposium will be offered in English with live parallel sessions in French.

Register for the free symposium and share with colleagues and health care workers of all levels. •

Dr. Olivia Begasse de Dhaem, MD, FAHS, is vice chair of the Global Patient Advocacy Coalition (GPAC), medical director and founder of the Institute for Headache and Brain Health, and an assistant professor of neurology at the University of Connecticut.

A Call for Articles for World Neurology from Young Neurologists Worldwide

Welcome to the August 2024 issue of World Neurology. In this issue’s President’s Column, WFN President Prof. Wolfgang Grisold provides updates on several ongoing activities, including the upcoming Council of Delegates (COD) meeting in September, the recent success of World Brain Day 2024, the introduction of the WHO IGAP toolkit, the upcoming World Federation of Neurology (WFN) Digital Neurology Updates (WNU) 2024 (an important educational initiative also planned for September), as well as many other ongoing global initiatives.

Dr. Mohammad Wasay and Dr. Safa Younis provide an up-to-date summary on central nervous system tuberculosis (CNS-TB), which continues to be a global problem. Dr. Gagandeep Singh provides a report on the highly prestigious Padma Shri, which was recently awarded by the president of India to Dr. Chandrashekhar Meshram, WFN trustee. The editors send their congratulations to Dr. Meshram for this remarkable and so richly deserved honor. We thank him for his contributions to neurology in India and throughout the globe, and for his many contributions to World Neurology.

In this issue’s History article, Dr. Peter Koehler provides his thought-provoking and well-illustrated report about a 17th century Dutch physician and the speculation surrounding a “renowned painter” whose treatment he described. Dr. Kevin Rostasy and Dr. Anna Jansen report on the activities of the European Paediatric Neurology Society (EPNS), raising the voice of the remarkably advancing field of pediatric neurology.

This issue also includes two thoughtful reports from recipients of WFN Junior Traveling Fellowships to attend the Fourth Congress of the African Academy of Neurology (AFAN), which was held in conjunction with the Fifth Congress of the Association Senegalese of Neurology (ASN), in July in Dakar, Senegal.

Dr. Olivia Begasse de Dhaem reports on the upcoming course, “Education in Headache to Health Care Professionals in Africa (EHHPA),” sponsored by the WFN, AFAN, the Global Patient Advocacy Coalition (GPAC), and the International Headache Society (IHS). The free course will take place virtually on Nov. 23, 2024, and registration is now open. Dr. László Vécsei provides an update about the ongoing activities of the International Danube Neurology Symposium for Neurological Sciences, including continuing education and international disease-based registries.

Prof. Renato Verdugo and Prof. Marco T. Medina report on the successful Latin American workshop on the Intersectoral Global Action Plan (IGAP) that took place in June in Santo Domingo, Dominican Republic. The workshop was organized by the Chilean League Against Epilepsy and the Autonomous University of Honduras with the support of the Pan-American Health Organization (PAHO).

This issue also includes an important reminder to all readers to register to attend the WFN WNU course occurring Sept. 26-27, 2024. We encourage all readers globally to attend!

Finally, we would like to remind and encourage all our younger readers from all regions of the globe, such as those neurologists in training or early in their careers, to consider contributing to World Neurology. We especially encourage contributions about programs and activities unique to your regions to inform our many thousands of readers worldwide. Please feel free to send any inquiries about possible articles to the editors. Email addresses can be found in the masthead on the left side of this page.

Thank you for your interest in the WFN and World Neurology. We look forward to continuing to share more details about upcoming activities for neurologists worldwide in future issues. •

Was it Rembrandt?

Figure 1. Rembrandts Anatomical Lesson of Dr. Nicolaes Tulp (1632); © Mauritshuis, The Hague.

A centuries-old mystery shrouds a renowned painter and his imagination.

By Peter J. Koehler

The Dutch physician and mayor of Amsterdam Nicolaes Tulp (1593-1674) is known for being depicted in the 1632 painting The Anatomy Lesson of Dr. Nicolaes Tulp by Rembrandt van Rijn (1606-1669). (See Figure 1.) The criminal Aris’t Kint, the person on whom an autopsy is performed in the painting, was sentenced to “punishment with the cord,” which was carried out on Jan. 31 of that year. His corpse was made available to the Amsterdam surgeons’ guild, of which Tulp was praelector anatomiae, a term the guild used for anatomy instructors. Tulp had already been in contact several times with the 26-year-old Rembrandt to discuss a painting of an anatomy lesson. In his composition, Rembrandt broke with the traditions of the group portrait for the time.1

Figure 2. Tulp’s Observationes Medicae (second edition 1652).

Observationes Medicae (1641)

Tulp studied medicine at Leiden University and settled in Amsterdam. He chose his surname from the tulips that graced the facade of his house. He was the first Amsterdam physician to visit his patients by coach. One of his contemporaries described him as an intelligent and capable man, with a practice large enough “so that it was necessary to drive a coach … having prepared a place in the cellar under his house …”

His Observationes Medicae was published in 1641 and contained three books. The second edition, published in 1651, contained four books and 233 cases. (See Figure 2.) Many editions followed as the work was popular and praised by many, including the Swiss physician Albrecht von Haller (1708-1777). Some of the neurological cases in Observationes Medicae have been discussed in recent medical literature. These include spina bifida,2 cluster headache,3 head injury4 including a case with a depressed fracture for which the trepan was applied, cerebral hemorrhage, beri-beri (polyneuropathy that is now known to be caused by thiamine deficiency), hydrocephalus, diastematomyelia, posttraumatic amnesia,5 and several types of tremors.6

Figure 3. Thijssen’s second dissertation dedicated to Charcot (1888).

Traumatic Hysteria

There is an interesting case from Tulp’s book that was referred to by the Dutch physician Eduard Hendrik Marie Thijssen (1856-1932), but it has not been discussed in more recent history.

Thijssen was the son of Amsterdam professor of medicine Henricus Franciscus (1820-1915). After studying medicine, young Thijssen defended his dissertation on Nicolaes Tulp in 1881.7 He settled in Paris, where he was taught by Jean-Martin Charcot (1825-1893) at the Salpêtrière.

Like his grandfather Henricus Franciscus Thijssen (1787-1830), who also published on hysteria, Eduard Thijssen had a special interest in this condition. He wrote a second dissertation, Contribution à l’étude de l’hystérie traumatique (1888), which he dedicated to “Mon cher et vénéré maitre M. le Professeur Charcot” (My dear and revered master Professor Charcot). (See Figure 3.) In this dissertation, he mentioned an interesting case, which he had read in Tulp’s Observationes, of “a famous painter of Rembrandt’s time (perhaps even Rembrandt himself), who was bedridden for an entire winter with mental paralysis of the legs.”8

Figure 4. Chapter 18 of Tulp’s Observationes on Imaginaria ossium mollities (Imagined softness of the bones).

Melancholy

In Chapter 18 of the first book of Tulp’s Observationes Medicae, we indeed find the case with the title “Imaginaria ossium mollities” or “Imagined softness of the bones.” (See Figure 4.) Tulp introduced his case with information on diseases caused by “atra bile” (literally “black bile” which at the time was thought to cause melancholy) and imagined symptoms.

Tulp referred to “the ingenious invention of Philodotus Medicus” for treating a melancholic king, who imagined his head had been cut off. Philodotus put a leaden hat on the king’s head. The weight of the hat made the king think that he had recovered his head, so that he was free from his delusion.

The case has been referred to by many scholars, including English author Robert Burton (1577-1640) in his famous Anatomy of Melancholy of 1621.9 (See Figure 5.) Not much has been discovered about Philodotus since the anecdote was first published by Alexander of Tralles (c. 525- c. 605).10

With respect to the treatment of such patients, Tulp also referred to the Roman encyclopedist Cornelius Celsus (c. 25 BCE – c. 50 CE), who wrote in his famous De Medicinae “… in others, melancholy thoughts are to be dissipated, for which purpose music, cymbals, and noises are of use. More often, however, the patient is to be agreed with rather than opposed, and his mind slowly and imperceptibly is to be turned from the irrational talk to something better.”11

Figure 5. Robert Burton’s Anatomy of Melancholy, in which he referred to Philodotus’ case.

Softness of the Bones

Tulp described his own patient as “Insignis Pictor infestatus aliquandiu, ab atrâ bile” or “a renowned painter, plagued for some time with the black bile.” The patient imagined that the bones of his body were so soft and pliable that they would easily fold if he put the slightest pressure on them.

“Which imagination being deeply engraved in his soul, kept himself in bed a whole winter; fearing, when he arose from it, of some calamity, which was more certain than certain to befall him, which he had hitherto dreaded, a deformity of his legs, or rather of his whole body,” Tulp wrote.

Understanding the patient’s fear, Tulp did not want to oppose him. He visited him secretly to slowly ease his imagination, assuring him that this softness was not unknown to physicians. Here he referred to De abditis rerum causis (Of the hidden causes of things; 1548) by the French physician Jean François Fernel (1497-1558), who introduced the term “physiology.”

Tulp told the painter that as wax can be made soft and hard, medicine could do the same in his legs. Tulp said that within three days the painter’s legs would be restored to their former firmness, and by the sixth day, he would have the ability to go anywhere, but only if he listened to Tulp’s advice.

“One can hardly say, how great hopes these promises raised to regain health, and how obedient they made him, to use the remedies prescribed for the black bile. Which being duly driven from the body, we were easily able to keep our word, ordering him to rise from the bed in which he had lain a whole winter,” Tulp wrote.

At first, the painter was told to stand on his feet and not allowed to walk. He would not have permission to go where he wished until the sixth day. “But the sixth day now approaching, we showed openly the truth of our promise: giving him not only freedom to walk about the room, but also to appear in public, and to perform all the activities of a healthy man at once.” Tulp concluded by wondering how this painter had not been able to see that the inability to walk, which had kept him in bed all winter, had only been in his imagination, although he was otherwise a great craftsman, “having scarcely anyone equal to him.”12

Figure 6. Portrait of Nicolaes Tulp by Frans Hals (1633); © Collection Six, Amsterdam.

Who Was This Painter?

The question now is, which “renowned painter” had Tulp been secretly treating? In other cases he described in his book, he often provided the full name of his patients, as in the case of cluster headache in the 13th chapter of the first book: Isaak van Halmaal.3 He must have seen the patient between 1614, the year in which he obtained his MD, and 1641, the year in which Observationes Medicae was published.

Could it have been one of the painters who did a portrait of Tulp? There were at least six painters who did, including Frans Hals (1580-1666; see Figure 6), Cornelis van der Voort (1576-1624), Adriaen Cornelisz Beeldemaker (1620-1709), Jurgen Ovens (1623-1678), Nicolaes Eliasz Pickenoy (1588-1650/6), and the aforementioned Rembrandt van Rijn. If it was one of these six painters, which one was famous in the 1630s and suffered from melancholy or depression?

Figure 7. The expensive house Rembrandt bought in 1639, presently Rembrandt House Museum, Amsterdam.

Retrospective diagnoses are always hazardous. Several physicians have written about depression that would have been recognizable in Rembrandt. One author wrote that he was depressed, as seen in several of his many self-portraits,13 but he was contradicted by a critic.14 Yet another wrote about “Rembrandt’s metaphoric portrayal of the depressed mind” in reference to his etching of Saint Jerome in a Dark Chamber in 1642, the year in which his wife Saskia van Uylenburgh died.15 This was a year after Tulp published his Observationes.

In 1640, Rembrandt’s mother died and prior to that his first three children died.15,16 In 1639, he bought the expensive three-story house on St. Anthony Breestraat (today’s Rembrandt House Museum) and received the commission for The Night Watch (1642), on which he would work for three years. (See Figure 7.) One of his biographers, art historian Jakob Rosenberg (1893-1980), used the term “crisis” in reference to this period of his life.17

As Tulp visited his patient secretly and did not mention him by name in his case description, we will probably never be sure about the identity of the painter, but it could have been Rembrandt van Rijn. •

References

1. Keeman JN. Nicolaes Tulp en het Amsterdame chirurgijnsgilde. In: Beijer T et al. Nicolaes Tulp. Leven en -werk van een Amsterdams geneesheer en magistraat. Amsterdam, Six Art Promotion bv, 1991, pp. 157-83.

2. Koehler PJ. Chiari’s description of cerebellar ectopy (1891). With a summary of Cleland’s and Arnold’s contributions and some early observations on neural-tube defects.
J Neurosurg. 1991 Nov;75(5):823.

3. Koehler PJ. Prevalence of headache in Tulp’s Observationes Medicae (1641) with a description of cluster headache. Cephalalgia. 1993 Oct;13(5):318-20.

4. Kompanje EJ, Maas AI. ‘De dreuning der daverende hersenen’; behandeling van traumatisch schedel-hersenletsel in Nederland in de 17e eeuw: 7 ziektegeschiedenissen uit Observationes medicae van Nicolaes Tulp [‘The rumbling of shaking brains’; the treatment of traumatic skull and brain injury in the Netherlands in the 17th century: 7 case reports from Observationes medicae by Nicolaes Tulp]. Ned Tijdschr Geneeskd. 2004 Apr 3;148(14):677-82.

5. Koehler PJ. Neurology in Tulp’s Observationes Medicae. J Hist Neurosci. 1996 Aug;5(2):143-51.

6. Koehler PJ, Keyser A. Tremor in Latin texts of Dutch physicians: 16th-18th centuries. Mov Disord. 1997 Sep;12(5):798-806.

7. Thijssen EHM. Nicolaas Tulp als geneeskundige geschetst: eene bijdrage tot de geschiedenis der geneeskunde in de XVIIde eeuw. Amsterdam, Schröder, 1881.

8. Thijssen EHM. Contribution à l’étude de l’hystérie traumatique. Paris: Imprimerie de la Faculté de Médicine, Davy, 1888.

9. Burton R. The Anatomy of Melancholy. Part 2, Section 2. Philadelphia, Wardle, p. 448.

10. Smith W. Dictionary of Greek and Roman biography and mythology. Vol. III. Boston, Little & Brown, 1849, 304.

11. Celsus. De Medicinae. New York, The Classics of Medicine Library. 1989, p.295.

12. Tulp N. Observationes Medicae second edition. Amsterdam, Elsevirium, 1652.

13. Espinel CH. Depression, physical illness, and the faces of Rembrandt. Lancet. 1999 Jul 17;354(9174):262-3.

14. Rothenberg A. Depression, physical illness, and the faces of Rembrandt. Lancet. 1999 Oct 16; 354(9187):1392.

15. Schildkraut JJ. Saint Jerome in a dark chamber: Rembrandt’s metaphoric portrayal of the depressed mind. Am J Psychiatry. 2004 Jan;161(1):26-7.

16. Schildkraut JJ, Cohn MB, Hawkins H. Then melancholy, now depression: a modern interpretation of Rembrandt’s mental state in midlife. J Nerv Ment Dis. 2007 Jan;195(1):3-9.

17. Rosenberg J. Rembrandt. His life and work. Rev. Edition. Ithaca (NY), Phaidon, 1964, p. 23.

European Paediatric Neurology Society

Raising the voice of pediatric neurology.

Kevin Rostasy and Anna Jansen

By Kevin Rostasy and Anna Jansen

Pediatric neurology is a discipline focused on diagnosis, comprehensive management, and research into diseases of the central and peripheral nervous system from fetal life to transition into adulthood. It is a field that has grown in the last half century and has recently seen leaps in innovation, including diagnostic methods, novel treatments including gene therapy, interventions, and research. It is vital that the significant burden of neurological diseases in childhood is addressed through research and education as these disorders have a lifelong impact on the individual, their careers, and society as a whole.

In 1996, the European Paediatric Neurology Society (EPNS) was legally registered in France based on open individual membership, with English as the official language. The EPNS is now an established international, independent non-profit society for physicians, health professionals, scientists, and students with research and/or clinical interest in pediatric neurology. It is governed by a board of 30 elected members.

The EPNS mission statement is to promote excellence in patient care, research, and education to improve the neurological outcome of children and young people in Europe and across the world. With about 2,500 members, the EPNS membership base has been steadily increasing and strengthening every year. The European Journal of Paediatric Neurology is the official society journal, and is published six times a year. It publishes high-quality papers primarily of a clinical research nature on the whole spectrum of pediatric neurological disease.  

A major focus of the society is to advocate for pediatric neurology at the highest level by nurturing national, multidisciplinary, and international collaborations with similar societies, policymakers, patient groups, and other major stakeholders. The Committee of National Training Advisers (CNA) serves as a vital advisory group to the EPNS and as a link to the national pediatric neurology societies.

In 2023, the EPNS started to build a framework centering on the 10-year Intersectoral Global Action Plan on Epilepsy & Neurological Disorders (IGAP), with the goal of implementing the plan with specific reference to pediatric neurology. IGAP is an unprecedented opportunity to lobby for the importance of brain health, and easy equitable access to the highest standard of patient care in neurology across the patient’s lifespan, while supporting their caregivers and other family members. The EPNS has appointed IGAP representatives in 41 European countries working with the EPNS to implement IGAP at a national level.

The EPNS promotes excellence in education, providing a comprehensive learning environment in pediatric neurology to students, trainees, and qualified professionals in all stages of their careers to improve the neurological outcome of children and young people. For example, a new EPNS Exam has been introduced to assess the basic knowledge needed to underpin pediatric neurology training. In addition, the EPNS Moodle is available to provide a learning platform for EPNS members. The society offers many other regular educational opportunities, including the well-established weekly EPNS webinars, 3-year EPNS rolling training courses covering the major topics in the pediatric neurology syllabus, EPNS Central Eurasia Workshops, and the EPNS Caucasus teaching courses. The EPNS continues to award EPNS Fellowships and EPNS Visiting Teachers to selected EPNS members who benefit from these unique opportunities.

The EPNS strives to foster, expand, and support science and clinical research in child neurology by bringing together the best clinicians and scientists in the field. This includes the society’s flagship biennial EPNS Congresses where delegates enjoy a scientifically stimulating program and interaction. The next EPNS Congress will take place on July 8-12, 2025, in Munich.

The EPNS Research Meeting takes place every other year. It is a forum for researchers in pediatric neurology to present their work, creating the possibility for future collaborative research. The EPNS looks forward to welcoming pediatric neurologist researchers at all stages of their careers to the next EPNS Research Meeting, which will take place Oct. 17-18, 2024, in Ljubljana, Slovenia.

The Young EPNS (YEPNS) is a motivated group bringing together younger members to learn, collaborate, and network. They have made a significant contribution to EPNS activities, including contributing to the EPNS Guidelines Committee, which was created to promote high-quality, homogenous evidence-based patient care.

If you would like to join the EPNS, contact our administration team at info@epns.info.

Education, Promotion, Networking, Science for pediatric neurology •

Kevin Rostasy is president of the EPNS, and Anna Jansen is chair of the EPNS Advocacy and Collaboration Committee.

Honduras Neurology/Psychiatry Clinic:Patient Satisfaction Survey

Medications and services can be costly and difficult to obtain for many Honduran patients.

By Kaitlyn Alleman, Prof. Lawrence Robbins, Genesis Mejias, MD, Sofia Dubon, MD, and Nelson Betancourt, MD

Our rural Honduras neurology and psychiatry clinic conducted a simple survey. The primary purpose of the survey was to assess patient satisfaction. We also asked the patient to rate the most important aspect of the clinic. We collected diagnoses and demographics.

This free clinic was established by neurologist Lawrence Robbins, MD, in 2017, and was featured in the Aug. 9, 2021, issue of World Neurology. There are three neurologists, an EEG technician, two psychiatrists, and a clinic nurse. The neurologists and psychiatrists are dedicated and idealistic. Several thousand patients regularly attend the clinic. The clinic provides free physicians, tests, and medications.

Sixty-seven patients were surveyed: 41 were female and and 26 were male. The ages ranged from 18 to 86. The specific age breakouts were:

Ages 18 to 20: 11 patients

Ages 21 to 40: 23 patients

Ages 41 to 60: 13 patients

Ages 60 and up: 20 patients

The majority of patients resided in rural areas surrounding the main city of Tegucigalpa (there are neurologists in the main cities of Honduras). Most of the patients could not afford neurology or psychiatry services. The patients were randomly chosen, and the survey results were anonymous. Verbal consent was obtained. An Institutional Review Board was used.

The survey collected basic demographic data and diagnoses. Three questions were asked:

What is the most important reason for coming to our clinic?

a. To see the doctor and find out what is wrong

b. To receive medicines

Are you satisfied with the services at the clinic?

a. Yes

b. No

Has your life changed for the better since coming to the clinic?

a. Yes

b. No

The survey also solicited additional comments regarding the clinic.

Results

Question 1: Sixty-two out of 67 patients indicated that seeing the doctor and finding out what was wrong was most important. Only five patients listed receiving the medications as most important. Of these five patients, three had epilepsy as the primary diagnosis, one had migraine, and one was diagnosed with Parkinson’s disease. This was surprising, as we thought the free neurologic and psychiatric medications would be the primary reason for attending.

Question 2: All 67 of the patients listed themselves as satisfied. This is not surprising, as these patients have had no access to neurologic or psychiatric services.

Question 3: Sixty-six patients indicated that their lives had changed as a result of coming to the clinic. One patient did not provide an answer.

Patient comments: Forty patients made positive comments. There were three negative comments. Thirteen comments expressed thanks, 12 mentioned the good service, 10 praised the physicians or staff, three mentioned that everything was free, while two said they liked the medications. The negative comments mentioned that the pharmacy could improve, other specialties were needed, and the clinic should offer better instructions on how to pay.

Neurology Diagnoses in 67 Patients 

Epilepsy: 16 patients (10 females, six males)

Headache (primarily migraine): 13 patients (nine females, four males)

Parkinson disease: 9 patients (two females, seven males)

Miscellaneous: one patient each: dystonia, cysticercosis, muscle disease, fibromyalgia.

Psychiatric Diagnoses 

Depression (includes unipolar and bipolar): 12 patients (eight females, four males)

Anxiety: 11 patients (seven females, four males)

Insomnia: 1 patient (female)

Discussion

The Honduran patients expressed a high degree of satisfaction with the clinic. Most patients indicated their life had changed for the better. One main reason for attending the clinic was to receive a diagnosis. This was surprising, as we would have thought that obtaining the free medications was most important. If we only surveyed patients who had been attending the clinic for some time, the medications may have become the most important aspect.

Epilepsy was the most common neurologic diagnosis, followed by headache and Parkinson’s disease. Depression and anxiety were the primary psychiatric diagnoses. This was a limited number of patients. If we had surveyed 2,000 of our patients, headache probably would have been the most common diagnosis, followed by epilepsy. Although headache is more prevalent than epilepsy in Honduras, patients with epilepsy may be more motivated to seek medical care.

Most Hondurans cannot afford more than basic medical care. There are numerous free clinics providing this care. Medical missions to Honduras are numerous. The Honduran neurologists and psychiatrists are excellent. However, neurologic and psychiatric care is scarce for most of the population. Access to free neurology services is available in the main city of Tegucigalpa, but wait times are long, and rural patients usually cannot make the arduous trip. Patients must pay for an EEG or MRI, both of which are usually unaffordable. An MRI may cost three or four weeks of wages. In our rural clinic, we do 25 EEGs per month at no cost.

Honduran patients have access to basic neurologic medicines. For epilepsy, these include phenobarbital and phenytoin. But even these basic meds may be difficult to access. There is a reasonable selection in Honduras of the various anti-seizure medications. These include carbamazepine, lacosamide, valproic acid, vigabatrin, and others. These are usually unaffordable for most Honduran patients.

For migraines, basic preventives are available, including amitriptyline, beta blockers, topiramate, valproic acid, and a few others. However, only a fraction of patients with migraine are prescribed the preventives. Most cannot afford these medications. Triptans are available but are unaffordable for 95% or more of patients. NSAIDS (both PO and injections) and ergotamine compounds are often prescribed. Opioids are almost never used.

Epilepsy is frequently encountered in Honduras. There is a relatively high prevalence of epilepsy in Latin America. Infectious disease and trauma may account for some of this. Many patients are never diagnosed or treated. Despite the difficulty in obtaining MRIs and EEGs, Honduran neurologists are adept at treating epilepsy. There is an epilepsy surgery program in Tegucigalpa.

Migraine is a major health issue in Honduras. Migraine greatly affects the Honduran patients’ work and home life. For many of the impoverished patients, missing work due to a migraine presents an enormous financial burden. Migraine is vastly undertreated in Honduras.

We can provide many of the neurologic and psychiatric medications, although the Honduran health system does provide basic drugs for neurologic disorders. In this clinic, we provide about 19 neurologic and psychiatric medications. We try to choose medications that are relatively safe and do not require blood testing. They also must be available in Honduras. Although Dr. Robbins can obtain the medications in the U.S., when we run short, we purchase them in Honduras until we can get resupplied from the U.S. Many of the medications are expensive in Honduras.

In summary, this survey indicates a high degree of satisfaction with a rural clinic that provides basic neurologic and psychiatric care. Even though technology and advanced laboratory tests are scarce, the patients greatly appreciate being able to see a neurologist or psychiatrist. The free medications are also a vital part of their care. By providing basic neurologic and psychiatric care, we can significantly improve quality of life. •

Kaitlyn Alleman is a medical student at Rosalind Franklin University in Chicago. Lawrence Robbins is an associate professor of neurology at the Chicago Medical School. Genesis Mejias, MD, is a physician from Venezuela. Sofia Dubon, MD, is a neurologist in Tegucigalpa, Honduras. Nelson Betancourt, MD, is a neurologist in Tegucigalpa, Honduras.

World Brain Day 2024 in China

On the occasion of World Brain Day (WBD) 2024, a brain health conference was held July 20-21, 2024, at the China National Convention Center in Beijing. The conference was centered on the theme of “World Brain Day 2024: Brain Health and Prevention.” The goal was to enhance public awareness of brain health, foster scientific advancement in brain health, and prevent and treat significant neurological and psychiatric disorders.

Read more about this conference in the upcoming WFN Service Page in the Journal of the Neurological Sciences. •

Multiple Sclerosis Surveys, Research, and Neurology News

The activities of the International Danube Neurology Symposium for Neurological Sciences and continuing education.

By Prof. László Vécsei

László Vécsei

The Symposium for Multiple Sclerosis (SMS), under the auspices of the International Danube Neurology Symposium for Neurological Sciences, has organized an international survey related to the Multiple Sclerosis (MS) Registry in different countries. It includes approximately 107 million people.

The findings from the international data have been published in the January 2023 edition of Multiple Sclerosis and Related Disorders. Furthermore, the Hungarian data is available in PLoS One. (See the abstract “Real-World Operation of Multiple Sclerosis Centers in Central-Eastern European Countries Covering 107 Million Inhabitants.”

We are currently working on two more MS surveys about neuroimaging and special molecular biomarkers in the cerebrospinal fluid.

In the future, we plan to organize similar research surveys related to other neurological disorders, such as migraine and extrapyramidal diseases.

In recent years, we have established the Danube Neuroscience Research Laboratory network. Under its auspices, we focus on the pathomechanisms of neurological disorders in in vitro experiments, animal research, and clinical studies. In doing so, we aim to create a collaboration between different research activities.

We also publish the Danube Neurology Newsletter. It contains summaries of the present and future activities of the Danube Symposium, important news (for example WFN news, international neurology news, and national neurological activities), and reports or advertisements about international congresses. •

Prof. László Vécsei is general secretary of the International Danube Neurology Association of Central and East Europe, and head of the Neuroscience Research Group in the department of neurology at the University of Szeged Faculty of Medicine in Szeged, Hungary.

Expanding IGAP in Latin America

IGAP Santo Domingo.

By Prof. Renato Verdugo and Prof. Marco T. Medina

The Intersectional Global Action Plan (IGAP) Latin American workshop took place June 13, 2024, in Santo Domingo, Dominican Republic. IGAP is a worldwide plan to combat neurological diseases through 2031. It was launched by the WHO in 2022.

The event in Santo Domingo was organized by the Chilean League Against Epilepsy and the Autonomous University of Honduras, with the support of the Pan-American Health Organization (PAHO). The meeting was directed by Profs. Carlos Acevedo and Keryma Acevedo from Chile and Prof. Marco Tulio Medina from Honduras. Dr. Carmen Martinez-Viciana attended on behalf of PAHO.

(Left to right) Profs. Fernando Cendes, Renato Verdugo, and Marco Tulio Medina.

The World Federation of Neurology (WFN) was present through the participation of the president of the Pan-American Federation of Neurological Societies (PAFNS) and the regional division of the WFN for Latin America and Caribe Prof. Renato Verdugo of Chile, PAFNS Past President Prof. Marco Tulio Medina, and PAFNS Vice President Prof. Fernando Cendes of Brazil.

The meeting was successful regarding attendance and the relevance of the discussion. The overall theme was “IGAP: Challenges for its Implementation in Latin America.” Several topics were discussed, including:

  • Knowing IGAP, its scope, implications, relevance, and indicators
  • Identifying priorities and regional leaderships
  • Promoting regional development, sharing successful local strategies, and exchanging ideas to promote IGAP in the Latin American region
  • Generating actions and technical visions that may be implemented to support the region locally
  • Generating an epilepsy work model that includes stakeholders in Latin America

Working in small groups.

Prof. Verdugo gave a talk describing some of the most prevalent and growing neurological disorders in Latin America, with a focus on stroke and dementia. After a general conference, the participants were divided into groups that discussed the different subjects and presented their conclusions.

Ultimately, the meeting drew attention to the need to establish a Latin American regional IGAP group between the WHO/PAHO, regional WHO Collaborating Centers, the International Bureau of Epilepsy, and PAFNS/EFN. •

Prof. Renato Verdugo is president of the Pan-American Federation of Neurological Societies (PAFNS) and Prof. Marco Tulio Medina is past president of PAFNS and former co-opted trustee of the WFN.

Reports of Attendance at the AFAN and ASN Congresses

Both of this issue’s Junior Traveling Fellowship recipients attended the Fourth Congress of the African Academy of Neurology (AFAN), held in conjunction with the Fifth Congress of the Association Senegalese of Neurology (ASN), July 11-17, in Dakar, Senegal. Each brings their own perspective on what they saw and did during the meeting.

Movement Disorders Society course on Day 1.

Mahamadou Kotioumbe

My participation in the joint congress was made possible by the WFN Junior Traveling Fellowships Grant awarded by the World Federation of Neurology (WFN).

The congress included the Movement Disorders Society (MDS) course, the main congress sessions, and the Teaching Courses.

MDS Course

The MDS course covered a range of topics in movement disorders, including:

  • Parkinson’s disease: Advances in diagnosis, including genetic aspects, treatment, and management
  • Management of atypical Parkinsonian syndromes
  • Hyperkinetic movement disorders: Diagnosis, management, and treatment
  • Treatable movement disorders

There were a number of take-home messages from the course, including the importance of early and accurate diagnosis in improving patient outcomes. We also learned about novel therapeutic strategies, including deep brain stimulation and pharmacological interventions. And there was much said about the role of genetics in movement disorders and the potential for personalized medicine.

(Left to right) Prof. Wolfgang Grisold, Mahamadou Kotioumbe, and Prof. Riadh Gouider.

Congress Sessions

The main congress sessions featured plenary lectures, oral presentations, and poster sessions on various neurological conditions. The key topics included sleep disorders, stroke, and headaches. Epilepsy, neuroinfectious diseases, and neuro-environment diseases were also covered. I also had the opportunity to present an oral communication, titled “Unusual Presentation of Intracerebral Hemorrhage: A Report From Mali.”

Teaching Courses

The Teaching Courses focused on practical skills and knowledge essential for neurologists in the region.

Sessions included:

  • Neuropathies, clinical neurological examination, and EMG
  • Practical approaches in resource-constrained environments to autoimmune encephalopathies, HIV-related CNS infections, status epilepticus, and stroke.
  • Guidance on writing a scientific article, research project, leadership, and networking

Students came away from the courses with improved proficiency in conducting comprehensive clinical neurological examinations and using EMG for diagnosing neuropathies. We also gained practical approaches for managing critical neurological conditions in resource-constrained environments, such as utoimmune encephalopathies, HIV-related CNS infections, status epilepticus, and stroke. Finally, we received guidance on writing scientific articles and research projects, which is crucial for contributing to the body of neurological research.

Networking and Collaborations

The congress provided an excellent platform for networking with neurologists from around the world. I had the opportunity to meet and interact with leading experts, including:

Prof. Amadou Gallo Diop, Prof. Osheik Seidi, Prof. Riadh Gouider, Prof. Wolfgang Grisold, and many others.

Acknowledgments

Attending the joint congress of the AFAN and the ASN was an invaluable experience. It significantly enhanced my knowledge and skills, provided opportunities for networking and collaboration, and inspired new ideas for future research and clinical practice.

I would like to extend my sincere gratitude to the World Federation of Neurology for the travel grant, which made this enriching experience possible, to the organizers of the congress, and to all of the professors and colleagues I had the pleasure of meeting and learning from during this conference.

Carlos Othon Guelngar

Carlos Othon Guelngar

It was a great privilege for me to participate in the Fourth Congress of the African Academy of Neurology (AFAN), held in conjunction with the Fifth Congress of the Association Senegalese of Neurology (ASN).

The meeting featured an exciting mix of eminent speakers from English- and French-speaking Africa, as well as from Europe and the U.S.

During the meetings, I had the opportunity to present my work on gait disorders revealing a probable sporadic form of Creutzfeldt-Jakob disease, which was diagnosed in the neurology department of the Center Hospitalier de Montluçon.

I also discussed the burden of neurological diseases in Africa. Sleep disorders, strokes, and headaches are real public health problems. The first days of the congress were rich in themes focusing on abnormal movements in neurological conditions. This was organized by the International Parkinson and Movement Disorder Society – African Section (MDS-AS). At the end of the post-congress session, we also enjoyed presentations on neurophysiology, followed by a visit to the MDS neurophysiology training center.

I would like to thank the World Federation of Neurology (WFN) for the Junior Traveling Fellowship that granted me this opportunity, which enabled me to travel, present my work, and forge relationships with our neurophysiological colleagues.

Thanks also to the organizers of the ASN and AFAN. •

Mahamadou Kotioumbe is a neurology resident from Mali. Carlos Othon Guelngar is a young neurologist from Chad.

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