WFN Neuroepidemiology Group Update

By Giancarlo Logroscino, MD, PhD

The Neuroepidemiology section of the World Federation of Neurology (WFN) has been particularly active in the area of teaching courses and research around the world, especially in areas where neurological research was at the starting point.

Giancarlo Logroscino, MD, PhD

The involvement of WFN members in the neurological group to the Global Burden of Disease (GBD) project has been an important asset. The GBD neurological group has been led by Valery Feigin from Auckland, New Zealand.

Two papers on the GBD of neurological diseases have been published by Lancet Neurology (Neurological Disorders Collaborator Group. Lancet Neurol. 2017 and 2019).

Lancet Neurology has launched an initiative to publish a special issue on specific neurological disorders. Disease-specific papers have been published on stroke, dementia, Parkinson disease, motor neuron diseases, and epilepsy. The activity of the GBD in the areas of the neurological disorders, even if not officially linked to WFN, have been carried out by active members of the WFN group, including Dr. Feigin, Beghi and myself.

The group has succeeded to get a small pilot grant to develop an epidemiologic course in low income countries. The first country where the WFN neuroepidemiological group decided to implement the course was Cambodia. The course with the endorsement of the WFN was held in February 2017 in Cambodia.

The overall goal was to train neurologists interested in neuroepidemiologic research and support their research activities. The chairs of the course were Giancarlo Logroscino, Italy; Pierre Marie Preux, Limoges, France; and Benoit Marin, Limoges, France.

The course was an intensive five-day course on research methods with focus on practice in low- and medium-income countries.

The course was conceived to help Cambodian neurologists to establish clinical and population-based research programs in topics of utmost interest including epilepsy, stroke, dementia, and infectious disease.

Cambodia is still experiencing a transition characterized by rapid increase both of expectation of life and incidence and prevalence of chronic diseases. In this context, neurology has a major role within medicine but has to change direction rapidly in education, clinical work, and research.

The course was held at the University of Health Sciences of Phnom Penh. It was attended by 14 out of 16 members of the Cambodian Neurological Society (eight neurologists out of nine). There was also attendance by 14 students of the School of Medicine, chosen by the faculty.

Prof. Samleng, chair of neurology in Phnom Penh, expressed the strong wish that the Cambodian Neurological Society could join the WFN, a process still ongoing.

With the same goals, we organized two courses in Albania with the endorsement of the WFN but no WFN financial support. The support was provided by a research and training grant of the University of Bari. Both courses were promoted and organized by Prof. Jera Kruja, from the University of Medicine Tirana and Prof. Giancarlo Logroscino from the University of Bari.

The first course, which was held in June 2017, focused on ALS and motor neuron diseases. The course focused on several aspects of amyotrophic lateral sclerosis: epidemiology, new classification and staging systems, biomarkers and advanced diagnostic technologies, multidisciplinary management of the disease (nutrition, pneumological assessment and supports, end of life approaches), cognition in ALS, and neuropsychological evaluation in subjects with motor impairment.

The role of hospital neurologists outside the academic centers was emphasized. The model for the care of neurodegenerative diseases patients choosing the patient home as the center of care was described. In this model, the role of the general practitioners and specialists working in the territorial unit (district) was emphasized.

Albanian and Montenegrin neurologists illustrated the available resources and the disease approach in their countries.

The second course was held in October 2017 in Albania on dementia for neuropychologists and neurologists with the participation of Thomas Bak, Edinburg, United Kingdom, chair of the aphasia and dementia group, and Prof. Raad Shakir, former WFN president. Prof. Shakir outlined the link of the public health and economic perspective in the dementias and other neurological diseases areas in the future.

The implementation of clinical care models for dementia in countries with limited resources was discussed. The changing epidemiology of dementia in the world with the general aging population has been debated with special focus on countries of the Balcanic area.

These courses were the initial framework for research for rare neurodegenerative diseases in Albania, pursuing the application of a model already established in Puglia region in Southeast Italy. A network of collaborators for the project has been established, including Albania, Kosovo, and Montenegro. An initial collection of data was started in Albania after the course.

Similar courses were held in Serbia (January 2019) and in South America, in Uruguay and Panama (August 2016 and April 2018). Both courses were primarly organized by Dr. Carlos Ketzoian from the University of Montevideo and Walter Rocca from Mayo Clinic.

I hope that the neuroepidemiological group will pursue further actions along these lines established in the next few years. It has been an honor and exceptional experience to serve for an extraordinary organization as the WFN, and the specialty group committee with interactions with recognized leaders in neurology as Prof. Shakir and Prof. Grisold.

In this perspective, Dr. Carlos Ketzoian, the new chair, has the background and the abilities to pursue the expansion of neuroepidemiology as areas of training and research all around the world with a specific emphasis in low- and medium-income countries. I will continue to serve the section with the same enthusiasm under the new leadership. •

Giancarlo Logroscino works in the Center for Neurodegenerative Diseases and the Aging Brain, Department of Basic Medicine, Center for Neuroscience and Sense Organs Department of Clinical Research in Neurology of the University of Bari at Pia Fondazione Card G. Panico Hospital Tricase (Le) University Aldo Moro Bari.