Deadline: April 21, 2014 – One-Year Visiting Fellow Program

The World Federation of Neurology (WFN) and the Department of Neurology of Mohamed V. Souissi University, Rabat, Morocco, announce a one-year Visiting Fellow Program for newly trained neurologists in Africa.

The Department of Neurology of MohamedV.SouissiUniversity is a WFN accredited teaching center.

The WFN has 117 member societies and aims to foster brain health worldwide, working in partnership with the World Health Organization (WHO), among others.

Project Description

Mohamed V. Souissi University would like to support the African initiative of the WFN by inviting an African colleague to participate in a one-year training course in clinical neurophysiology. The purpose is to experience the modern Moroccan medical system in an international environment, meet new colleagues and foster future cooperation.

The training course in clinical neurophysiology at the Mohamed V. Souissi University Department of Neurology will include electromyography, electroencephalography, epilepsy, neuropathy and muscle diseases. Teaching will be conducted in French.


The visit will take place for one academic year from September 2014 to June 2015.

Details About Support

The visiting Fellow will receive the following support:

  • Reimbursement for one economy flight from the Fellow’s country of residence to Rabat and the return journey.
  • Reimbursement of accommodations for the academic year.
  • A monthly allowance for living expenses (food and beverage) during the academic year.
  • Costs of health insurance and insurance for medical activity during the stay in Morocco (to be arranged by the applicant, the costs will be refunded).
  • Note that support is provided for the visiting Fellow only, and does not include family or dependents. WFN is not responsible for financial issues other than related to the project.

Criteria for Applications

  • The applicant must be a resident of a low or lower-middle income country from the African continent.
  • The applicant must be born after Dec. 31,1974.
  • The applicant must have recently completed his or her neurology training and be ranked first in his or her final evaluation of the last year of neurology training.

Evaluation Committee

Professor Wolfgang Grisold (Secretary Treasurer-General, WFN)

Professor Amadou Gallo Diop (WFN Trustee)

Professor Mostafa El Alaoui Faris (Head of Department Neurology and Neuropsychology, Mohamed V. Souissi University)

Professor Redouane Mrabet (President of Mohamed V SouissiUniversity)

Deadline for Application

To apply, applicants must submit their CV, a supporting statement and a letter of recommendation from the head of their department by April 21, 2014, by email to

For any questions regarding your application, or to apply, please contact the administrative office of the WFN Education Committee:

Laura Kennedy
Project Coordinator – WFN
Kenes Associations Worldwide
1-3 Rue de Chantepoulet
P.O. Box 1726
CH-1211 Geneva 1
Phone: +41 (0) 22 906 9165

Electroencephalogram Examples and Guides

By Elaine Wyllie, MD

EEG-Book-COVER-AIt is a privilege to introduce the book “Electroencephalogram Examples and Guides,” published in August 2013. The book provides a concise and comprehensive compilation of text and EEG recordings collected to shorten the learning curve toward competence in EEG interpretation.

This book will be valuable to a wide variety of readers. For specialists preparing for EEG certification examinations, such as those offered by the AsianEpilepsyAcademy – ASEAN Neurological Association (ASEPA-ASNA) or the American Board of Clinical Neurophysiology (ABCN), it could serve as an essential guide. For the practicing neurologist, it can serve as a useful quick reference. For beginners, including EEG technologists and neurology trainees, it can be an effective teaching resource.

Throughout the book, complex concepts are simplified without the sacrifice of fine details. Facts and comparisons are given in point forms and tables. Classifications of various EEG findings are presented in easy-to-understand algorithms. EEGs from common to rare conditions are presented in a stimulating quiz format. The index enables quick reference to EEG tracings from patients with different diagnoses.

Sections 1 and 2 deal with the basics of EEG, including indications, limitations and neurophysiologic principles. Section 3 provides actual EEG recordings, starting with normal findings, artifacts and benign variants and progressing through epileptiform and non-epileptiform abnormalities. Section 4 includes a systematic step-by-step approach to EEG interpretation, and Section 5 offers a quiz for readers to practice their EEG interpretation skills. Section 6 deals with EEG evaluation of syncope and blackout spells, while Section 7 deals with evaluation of coma and altered states of consciousness. Finally,  Section 8 provides an opportunity for self-assessment of the reader’s discernment of the various points in the book.

This innovative book is recommended for anyone who seeks to learn EEG in an effective and systematic way.  That the author also made the process pleasurable is a welcome benefit indeed.

Wylie is professor of the Lerner College of Medicine Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland

Committees for World Neurology

Constitution and Bylaws   
Committee Region
David Vodusek/Chairman Europe
Federico Pelli-Noble Latin America
Christopher Chen Asia-Oceania
Peter Newman Europe
Chandrashekhar Meshram Asia-Oceania
Terry Cascino North America
Raad Shakir Trustee Representative
Finance Committee Region
Eduard Auff/Chairman Europe
Nazha Birouk PAUNS
Lisa Shulman North America
Serefnur Öztürk Europe
Hadi Manji Europe
Hamidon Basri AOAN
Sergio Castillo Latin America
Wolfgang Grisold Trustee Representative
Publications  & Communications  
Committee Region
Christopher Kennard/Chairman Europe
Geoffrey Donnan Asia-Oceania
Walter Struhal Europe
Donald Silberberg North America
John D. England North America
Ricardo Nitrini Latin America
Saeed Bohlega PAUNS
Ahmed Bhigjee Africa
William Carroll Trustee Representative
Wolfgang Grisold Secretary-Treasurer General
Raad Shakir Ex officio
Public Awareness and Advocacy  
Committee Region
Mohamed Wasay/Chairman Asia-Oceania
Lakshmi Ranganathan Asia-Oceania
Violetta Diaz Latin America
Tissa Wijeratne Asia-Oceania
Pierre-Marie Preux Europe
Lala Seck Africa
Bruce Sigsbee North America
Vitalie Lisnic Europe
 Gallo Diop Trustee Representative
Education Committee Region
Steven Lewis/Chairman North America
Sarosh Katrak AOAN
Alla Guekht Europe
Bo Norrving Europe
Morris Freedman North America
Riadh Gouider PAANS
Teresa Corona Latin America
Dasheveg Shuren AOAN
Therese Sonan Africa
Mostafa El Alaoui Faris PAUNS
Daniel Truong North America
Eric Schmutzhardt Europe
Cynthia Comella North America
Wolfgang Grisold Trustee Representative
Amadou Gallo Diop Trustee Representative
Standards and Evaluations   
Committee Regions
Aksel Siva/Chairman Europe
B. S. Jeon Asia-Oceania
Natan Bornstein Europe
Gustavo Roman Trustee Representative
Membership Committee Region
Jacques L. De Reuck/Chairman Europe
Laszlo Vecsei Europe
E. Gusev Europe
Mohamed El-Tamawy PAUNS
Ana Robles Latin America
Stefan Pulst North America
Man Mohan Mehndiratta AOAN
Girish Modi Africa
William Carroll Trustee Representative


Applied Research Committee Region
Michael Weller/Chairman Europe
Sean Pittock North America
Michael Brainin Europe
Espen Dietrichs Europe
Akio Suzumura Asia-Oceania
Mario Rivera Latin America
Shamsedine Ogun Africa
ARG Chairs & Representatives
Gustavo Roman Trustee  Representative
Congress Standing Committee Region
William Carroll/Chairman Asia-Oceania
Renato Verdugo Latin America
Hidehiro Misuzawa Asia-Oceania
Eduard Auff Europe
Michael Weller Chairman, ARC
Wolfgang Grisold Ex officio
Raad Shakir Ex officio
Scientific Program Committee Region
Werner Poewe/Chairman Europe
Donna Bergen, USA North America
Claudio L. Bassetti Europe
Matthew Stern, USA (MDS) North America
John England, USA North America
Matthew Kiernan, Australia Asia-Oceania
Jose Ferro, Portugal Europe
Marc Fisher, USA North America
Shoji Tsuji, Japan Asia-Oceania
Michael Weller, Switzerland Europe
Jerome Engel, USA (ILAE) North America
Teaching Courses Committee Region
Sarosh Katrak/Chairman Asia-Oceania (AOAN)
Marco Medina Latin America
Chafiq Hicham PAUNS
Stephen Davis Asia-Oceania (AOAN)
Jera Kruja, Albania Europe
Pierre Luabeya Africa/Middle East
Steven Lewis/Chairman Education Committee
Wolfgang Grisold Trustee Representative
Tournament Committee Region
Richard Stark/Chairman Asia-Oceania (Australia)
Nicholas Davies Europe (UK)
Ricardo Fadic Latin America (Chile)
Andrea Vass Europe (Austria)
Faouzi Belahcen PAUNS (Morocco)
Pierre Clavelou Europe (France)
Nominating Committee Region
Marianne de Visser/Chair Europe
JM Léger Europe
Elza Dias Tosta Da Silva Latin America
KS Lawrence Wong Asia-Oceania
Ahmad Khalifa PAUNS
Elly Katabira Africa
Eva Feldman North America
Continental Activities  
Africa Initiative
Amadou Gallo Diop
Latin-America Initiative
Gustavo Roman
Asia Initiative
Ryuji Kaji
Regional Liaison Committee Region
Tim Pedley/Chairman North America
New EAN President EAN
Riadh Gouider PAANS
Mohamed El-Tamawy PAUNS
Man Mohan Mehndiratta AOAN
Marco Medina Latin America
Grants Committee Region
Raad Shakir/Chairman N/A
Amadou Gallo Diop Trustee
Massimo Pandolfo North America
Francisco Eduardo Cardoso Latin America
Mostafa El Alaoui Faris PAUNS
Josep Valls-Solé Europe
Wolfgang Grisold Ex officio
Advisory/Liaison Members
Solomon (Nico) Moshé ILAE liaison
Harry Chugani ICNA liaison
Matthew Stern IP&MDS liaison
New EAN President EAN liaison
Pierre J. Magistretti IBRO liaison
Tim Pedley, USA AAN liaison
Stephen Davis, Australia WSO liaison
Jack Antel MS liaison

Patient Day at the WCN 2013

By Wolfgang Grisold

Wolfgang Grisold

Wolfgang Grisold

The EFNS and the Austrian Society of Neurology (OEGN) hosted a Patient Day on Sept. 21, at the site of the World Congress of Neurology in Vienna. It was opened by Eduard Auff, the Congress president; Vladimir Hachinski, WFN then-president; and Richard Hughes, EFNS president; signaling a high value and interest for this event.

The event was announced and publicized by media in Austria prior to the meeting.

Patient Days are important events within congresses, where distinguished speakers present new developments of the field and, where in a discussion following their presentations, attendees are able to ask questions. For the first presentation, a video presentation of a patient with a brain tumor was selected. The other disease topics were stroke, Parkinson’s disease and MS, each followed by time for discussion. The presentations were in German, and Austrian groups and associations for specific diseases (e.g. MS, stroke, Parkinson) were invited, as well as the OEGN website reps and media. About 400 patients and relatives attended and listened to the presentation by experts.

Within the EFNS, a Patient Day, in cooperation with EFNA, took place in Helsinki in 2003. It was aimed at translating the patients’ needs into a dialogue toward better medical care and quality of life and has since become a permanent feature of the meeting. Other medical specialties, in particular oncology, have regular patient days to inform, and also learn about patients’ needs.

For the World Federation of Neurology, this was a new type of meeting, aimed at including patient and caregivers, assessing their needs and receiving input to improve neurological services.

Patient days also serve to inform patients and caregivers in an efficient way regarding new developments. This is important, as patients and caregivers often get information from media and from the Internet, and they may have difficulty determining what is the most correct information. Conversely, and perhaps more important, is the fact that the medical profession needs to know what it is that patients wish to know, and what patient and caregiver questions are.

Many aspects of the relationship  of patient/caregivers with their physicians are changing.

Medicine developed from a paternalism-defined structure into a more patient-driven autonomy structure. Sometimes, the bureaucracy is overarching into an “in-between” model of physician-patient/caregiver interaction. Thus, it is more important than ever that physicians and patients find ways to communicate and work together.  Health organizations often include patient representatives on their boards, and in many European guideline committees, patient representatives are already important constituents.

Another important way to look at this kind of meeting is its role in furthering advocacy — better communicating health needs to local and national institutions and bodies. The basic source of need in all matters of health issues is the needs of patients and their caregivers, which drive the need to enable progress in medicine and in health structures. Health structures depend on general policy, and the role of advocacy is to make needs of patient/caregivers and health professionals heard.

Finally, and this is the summary of this task, informed patients will be better partners in fighting neurological disease.

We hope that the patient day, after its successful introduction in Vienna, will become a regular part of WFN Congresses.

If you need more information, contact me at (WFN) or Tanja Weinhart (OEGN) at

Grisold is WFN’s Secretary-Treasurer General.


Moving Forward

By Raad Shakir

Raad Shakir

Raad Shakir

The first meeting of WFN trustees and regional directors was held Jan. 25-27 in London. The meeting was called for consultation and participation of all concerned in the formulation of policy and nominations for all WFN committees. This stems from the principle of global involvement through regional empowerment, which will drive WFN policy over the next four years.  The second principle is that all stakeholders should formulate policy in the first year of office and implement that policy in the ensuing three years.

The trustees and the six regional directors went through all activities making decisions on various WFN affairs for the next four years. (See photo.) All appointments to WFN committees came to an end Dec. 13, 2013. It was important that regional directors should suggest names for consideration; all trustees and directors did this. The duties and charges of all committees were circulated beforehand to be clear on the roles of committee chairs and members.

The size of committees was discussed. Although it could be desirable to have large committees for the sake of inclusiveness, it was agreed that a leaner structure will achieve more and work smoothly in a tightly knit fashion. The second principle was to have regional representation in all committees. This ensures that the regions are better informed and their input is made at all levels.

(From left to right) Professor Josep Valls-Solé (European Neurological Society); Professor Jacques De Reuck (European Federation of Neurological Societies); Univ.-Prof. Dr. Wolfgang Grisold (WFN Secretary-Treasurer General); Timothy Pedley (President, American Academy of Neurology and WFN North American Regional Director); Professor Mohamed El-Tamawy (WFN Pan-Arab Regional Director); Raad Shakir (WFN President); Riadh Gouider (WFN Pan-African Regional Director); Professor Man Mohan Mehndiratta (WFN Asian-Oceanian Regional Director); Professor William M. Carroll (WFN Vice President); Gustavo C. Roman (WFN Elected Trustee); Keith Newton (WFN Executive Director); Professor Amadou Gallo Diop (WFN Elected Trustee);  and Professor Marco Tulio Medina (WFN Latin American Regional Director).

(From left to right) Professor Josep Valls-Solé (European Neurological Society); Professor Jacques De Reuck (European Federation of Neurological Societies); Univ.-Prof. Dr. Wolfgang Grisold (WFN Secretary-Treasurer General); Timothy Pedley (President, American Academy of Neurology and WFN North American Regional Director); Professor Mohamed El-Tamawy (WFN Pan-Arab Regional Director); Raad Shakir (WFN President); Riadh Gouider (WFN Pan-African Regional Director); Professor Man Mohan Mehndiratta (WFN Asian-Oceanian Regional Director); Professor William M. Carroll (WFN Vice President); Gustavo C. Roman (WFN Elected Trustee); Keith Newton (WFN Executive Director); Professor Amadou Gallo Diop (WFN Elected Trustee); and Professor Marco Tulio Medina (WFN Latin American Regional Director).

The list of all committees is provided on page 8 of this issue of World Neurology. The committees will meet for the first time in 2014. Facilities for secretarial support and committee members’ interactions was decided, and the necessary support shall be provided.

The major issue of empowering the regions was discussed. This can take many forms of decentralization. Regions vary in their level of structure and activities. Some need much more support to form their own administrative and financial framework, while others are highly advanced and can help other regions in moving ahead. The WFN is the catalyst for interregional collaboration.

Regional directors are elected and have their portfolios; it is only correct that they should advise the WFN on the needs and policy in their parts of the world. A Regional Directors Committee has therefore been created.  The deliberations and decisions will not only be channeled to the WFN but it is planned that this will be the forum of region-to-region collaboration and interaction. It is likely that there will be more input into the needs of some regions from the experience and activity of another.

Activities such as traveling fellowships, regional symposia, departmental visits, short periods of training, research grants and other educational activities can be achieved with this form of empowerment and interaction. The well established and highly advanced regions have the ability to spread their knowledge and expertise worldwide. This is probably more achievable in a direct one-to-one manner rather than through a central administration

I am delighted to report that a decision was made to allocate 30 percent of our annual budget for grants. The WFN has become an international funder for projects from many parts of the world.  We also are grateful for the collaboration with neurology speciality organizations, including WSO, ILAE and MDS for sharing the cost of some of the grants. This only cements the close relationship with these organizations. The WFN total grants for 2013 were $413,000. The trustees decided that for 2014 a more structured system would be introduced.  The application process is now open, and awards will be made in this summer.

Training African neurologists in Africa has been on the boil for six years since a report to the then-President Johan Aarli was made by the WFN Special Representative Ragnar Stien (Oslo).  Two centers were visited then, and the first — Rabat, Morocco — was finally accredited by a special visit in September 2013.  The Rabat center will start receiving its first African trainee in September 2014.  The funding for this project, crucial for the future of African neurology, is set aside and is part of the WFN budget.

The second center in the Stien report is at the University of Cairo.  This center will cater to English-speaking trainees, and a Memorandum of Understanding has already been signed in 2012.  A visit by Secretary General Wolfgang Grisold and me in February 2014 will be followed by the formal accreditation visit soon.

The union of the two European neurological associations — European Federation of Neurological Societies and European Neurological Society — delights the WFN.  The creation of the EuropeanAcademy of Neurology is a most welcome event in international neurology.

The WFN was delighted to welcome Professor Jacques De Reuck representing EFNS and Professor Josep Valls-Solé representing the ENS to the London meeting. We look forward to the formal declaration of the birth of EAN in Istanbul during the joint meeting of EFNS/ENS in June 2014.

Two regions are holding their biennial meetings in the early part of 2014. The Asian and Oceanian Association of Neurology (AOAN) held its meeting in March and the Pan African Association of Neurosciences in April. Both meetings are happening at crucial times for both organizations to consolidate the excellent progress the first has made and to gather support to move ahead in the case of the second.

Your WFN is planning to move forward with all of its activities and needs your support and advice.  All ideas, which promote our goals and objectives, are welcome.

Peripheral Nerve Injuries During World War I

Growing knowledge despite a lack of international cooperation.

Peter Koehler

Peter Koehler

This column on historical aspects of international relationships in the neurosciences usually deals with forms of international cooperation. Exactly 100 years ago, not only political relations collapsed; scientific relationships followed, even though some scientists hoped that their relations would remain above the cataclysm.

Living in neutral countries (Netherlands and Switzerland), at least two neuroscientists, Cornelis Winkler and Constantin von Monakow, hoped that “we neutral countries are … now in the first place obliged to continue to take care of values of humanity and culture and keep upright the international scientific relationships with all energy” (from their correspondence in November 1914). Only shortly after the beginning of World War I, however, they observed that artists and writers declared support to the German military actions, including Paul Ehrlich, Ernst Häckel, and neurologists Wilhelm Heinrich Erb and Hermann Oppenheim, who had sent back their scientific decorations they had once received from England. Monakow opined that this was an injudicious, unfortunate step, estranging them to international science “that has nothing to do with politics.”

Neurological knowledge, however, kept on growing, simultaneously, but now separately. A striking example was the knowledge of peripheral nerve injuries which had only gradually increased in times of peace, but now, sadly, much faster. During World War I, books on peripheral nerve injuries were published in England, France, Germany and the U.S. Probably the best known book on the subject was written by the French Jules Tinel (1879-1952), who published his Blessures des nerfs in 1916. His book became influential, and within a year, it was translated into English and published in New York.

Froment sign (from Presse Médical, Thursday, Oct. 21, 1915)

Froment sign (from Presse Médical, Thursday, Oct. 21, 1915)

On the French side, women published on the subject, as is witnessed in Chiriachitza Athanassio-Bénisty, a pupil of Pierre Marie (Paris). She wrote two books with the aim not only to publish the results of clinical experience, but also to improve the quality of examination of peripheral nerve lesions by less experienced physicians. It was translated by Edward Farquhar Buzzard, the English physician, working a.o. at the NationalHospital. From the English ranks, Arthur Henry Evans and James Purves-Stewart published their experiences, largely observations of injured soldiers, many of whom had fought at the various battles near Ypres, Belgium.

From the German side, neurologist/neurosurgeon Otfrid Foerster (1873-1941), who served as an advisory physician to the health office of the VI German Army on the western front in France, gathered abundant information on injuries to the peripheral nervous system and spinal cord. He published his findings in a multivolume handbook of medical experiences from World War I, but also in the supplement to Lewandowsky’s Handbuch der Neurologie, which was entirely devoted to war injuries of the peripheral nerves and spinal cord (single-authored altogether 1,152 pages). In the chapter on surgical therapy of peripheral nerve injuries, he mentioned 4,117 peripheral nerve injuries. Nearly 25 percent underwent surgical procedures, including nerve sutures, nerve transplantations and arm and leg plexus surgeries.

Froment sign (from Presse Médical, Thursday, Oct. 21, 1915).

Froment sign (from Presse Médical, Thursday, Oct. 21, 1915).

The U.S. entered World War I in 1917. After submarines sank seven U.S. merchant ships, U.S. President Woodrow Wilson went to Congress calling for a declaration of war on Germany. The U.S. Congress voted on April 6 to do so. Figures with respect to American peripheral nerve injury casualties during World War I were provided by several sources, including neurosurgeon Charles Harrison Frazier (1870-1936). Returning casualties with peripheral nerve injuries were treated in 12 peripheral nerve centers, usually located in general hospitals, where medical officers with experience in neurosurgery as well as consultant neurologists were working. Frazier provided the anatomic location of almost 2,400 peripheral nerve injuries. Byron Stookey (1887-1966) served with the British Royal Army Medical Corps (1915-1916) and the U.S. Army Medical Corps. In his Surgical and Mechanical Treatment of Peripheral Nerves (1922), he published relative frequencies of peripheral nerve injuries of 1,210 war casualties.

Of all nerve injuries described in the four countries (more than 10,000 in the various publications), radial nerve lesions were generally the most frequent. Partial lesions of the radial nerve were rare, in contrast to the frequency of partial injuries of the ulnar and median nerves. At least two eponyms are remembered from this dark period in the history of neurology. Working on different sides of the front, a French (Tinel) and a German (Paul Hoffmann:1884-1962) neurologist are remembered in one eponym, notably the Tinel-Hoffmann sign. It indicates radiating tingling sensations in the otherwise anesthetic skin area innervated by an injured nerve, upon light percussion of the area. The sign was considered to indicate the presence of new sensitive regenerating nerve fibers. Another French neurologist, Jules Froment (1878-1946), once a co-worker of Joseph Babinski, is remembered by his “signe de journal,” based on the fact that in ulnar nerve neuropathy, the action of the paralyzed adductor pollicis muscle is compensated for by the flexor pollicis longus muscle, innervated by the median nerve, resulting in flexion of the distal phalanx of the thumb.

Further reading

  1. Koehler PJ. Lessons from peripheral nerve injuries; causalgia in particular. In: Fine E (ed). History course syllabus. Lessons from war. AmericanAcademy of Neurology, San Diego, 2013.
  2. Koehler PJ, Lanska DJ. Mitchell’s influence on European studies of peripheral nerve injuries during WorldWarI. J Hist Neurosci 2004;13:326-35
Koehler is neurologist at Atrium Medical Centre, Heerlen, The Netherlands. Visit his website at

World Brain Day

By Mohammad Wasay, MD, FRCP, FAAN

Mohammad Wasay

Mohammad Wasay

There are many days related to neurological diseases being celebrated by professional organizations in collaboration with the World Health Organization (WHO), national organizations and local health ministries, including World Stroke Day, Epilepsy Day and Rabies Day. These days have proven to be extremely helpful in promoting public awareness and generating advocacy throughout the globe, including non-developed Asian and African countries. For example, the World Stroke Organization announced a global competition for public awareness and advocacy campaign focusing on World Stroke Day.

Brazil in 2012 and Sri Lanka a year later won the competition creating a huge impact at the national as well as regional levels. All of the days related to neurology are linked to neurological diseases. A few years ago, Vladimir Hachinski suggested celebrating a day for healthy brains. The human brain is so fascinating and is so closely linked to the health of whole human being that we should promote healthy brains. The future of this universe is linked to our brains so we should start a global campaign. The Public Awareness and Advocacy Committee came up with the slogan of “Our Brains-Our Future.”

The World Federation of Neurology was established on July 22. The committee proposed that July 22 should be recognized as “World Brain Day.” This proposal was announced at the Council of Delegates meeting in September at the WCN. The proposal was received with a warm welcome by delegates, Hachinsky, WFN president; Raad Shakir, WFN president- elect; Werner Hacke, WFN vice president; and other officials. The BOT meeting in February approved this proposal as an annual activity.

Our target audience is young brains throughout the world, and we want to promote healthy brain and brain health. Young students and minds are highly interested in knowing how the brain works and how  we can make it work better. Brain health is a huge topic covering many areas, including understanding of brain function, optimization of brain function, disease prevention, mental health and treatment of brain disorders.

We should target to approach one billion people around the globe to educate about brain in 2014. Most activities will focus on World Brain Day, but it is a year-long campaign. National societies should plan activities focusing on young school and college students. With the help of social and electronic media, the information could go to millions of people. All societies should share their plans and activities, and those organizations with highest impact public awareness activities should be awarded.  We should especially focus on Facebook and Twitter to connect with millions of people. Our young neurologists’ network on Facebook could be a great resource for this campaign. We should use multiple languages, especially focusing on Arabic, Chinese, French, German, Hindi and Spanish. We also could develop a five-minute promotional video with brief introduction of WFN in multiple languages. This video could be shared by millions through YouTube and Facebook. We have more than 100 member societies. If we are able to organize a few hundred programs on July 22 in all of those countries, it is bound to create an impact. Member societies could organize press conferences, media briefing sessions, lectures, seminars, conferences and poster competitions. Quiz competitions (Brain Quiz) have been successful and popular among school and college students.

Complexity of brain and neurological diseases often become a barrier for public awareness. “You should speak plain when you speak brain” was suggested by Keith Newton of the WFN. Our message should be simple and easily understandable for lay people. We could design a logo for this purpose, which may be a simple global message. WFN and local organizations could start a poster- or cartoon-designing competition to explain brain function and improve public awareness. Best posters, designs or cartoons could be awarded. We expect thousands of entries for this competition and some of these entries could become logos for our future campaigns.

There are many organizations working in this area, including the International Brain Council, International Brain Research Organization, the American Academy of Neurology, the International League Against Epilepsy and the World Stroke Organization. We should work with them for this common agenda. Strong liaison and lobbying with the WHO is important. If the WHO adopts this day in future, then this could be a great success for the WFN. If we are able to build a momentum around the globe in the coming years, we are sure it will become a WHO day in the future.

Wasay is chair of the Public Awareness and Advocacy Committee for the World Federation of Neurology.

JNS: Editor’s Update and Selected Articles

By John D. England, MD

John D. England

John D. England

The Journal of the Neurological Sciences (JNS) and its publisher, Elsevier, are working together to improve the journal and to make the submission process easier for authors.

A major complaint from authors concerns the necessity to format manuscripts to fit the idiosyncratic requirements of journals.  Since many high volume journals like JNS have a high rejection rate, authors frequently must reformat their manuscripts for submission to a different journal. This is not only a hassle, but a time-consuming process for authors.

In order to simplify the submission process for authors, JNS has eliminated strict requirements for reference formatting. As of now, we will accept manuscripts with no strict requirements for reference formatting. Any style of reference formatting will be accepted as long as the style is consistent.

If the manuscript is accepted for publication, then Elsevier will change the reference formatting to fit the style for JNS. As an extension of this process, in the near future JNS and Elsevier will begin accepting entire manuscripts without strict formatting or referencing requirements.

WFN_BreakingNewsElsevier already has introduced this feature, which is named “Your Paper Your Way (YPYW),” for several other journals in its portfolio. It has been so well received by authors that we will shortly begin offering this service to authors of manuscripts submitted to JNS.   Taken together, these new options for manuscript formatting flexibility should make it easier for authors to submit manuscripts to JNS.

As noted in the previous issue of World Neurology, we have begun an “Editor’s Selection” of articles from JNS.  Elsevier has agreed to allow free access to selected articles for members of the World Federation of Neurology.  The process for viewing these articles is now streamlined: Click on one of the two featured articles on the World Neurology Online page, or use the “See all free JNS articles” link below the featured articles. It will take you directly to the free article page on the JNS website.  In this issue, we share these two recent articles:

The Clinical and Pathological Phenotypes of Frontotemporal Dementia with C9ORF72 Mutations. Ying Liu and others from China have written a review on the phenotypes of frontotemporal dementia associated with C9ORF72 mutations.  The expanded hexanucleotide repeat (GGGGCC) in the chromosome 9 open reading frame 72 (C9ORF72) is now recognized as one of the major causes of hereditary frontotemporal dementia (FTD). It is also the most frequent genetic cause of the ALS/FTD complex.  However, the clinical and pathological phenotypes associated with C9ORF72 mutations appear increasingly diverse, and the mechanisms of disease are not known.  See Liu Y, et al.

Journal of the Neurological Sciences 335 (2013) 26-35.  An Association Between Benzodiazepine Use and Occurrence of Benign Brain Tumors. Tomor Harnod and others analyzed data from the National Health Insurance System of Taiwan to ascertain whether there is an association between long-term benzodiazepine use and the development of brain tumors. They identified 62,186 patients who had been prescribed benzodiazepines for at least two months between Jan. 1, 2000, and Dec. 31, 2009. These patients were compared with a matched non-benzodiazepine cohort of 62,050 patients. The incidence rate for benign brain tumors was 3.33 times higher in the benzodiazepine cohort compared to the non-benzodiazepine cohort with an adjusted hazard ratio (HR) of 3.15 (95% CI = 2.37-4.20).  Additionally, the adjusted HRs for benign brain tumors increased with benzodiazepine dose. Thus, in this cohort study, the authors found a significant association of benign brain tumors with long-term benzodiazepine use. There are many possible explanations for such an association, and the authors correctly avoid the conclusion of causation. But, benzodiazepines are a commonly prescribed medication, and further studies of this important topic are warranted. See Harnod T, et al.

Journal of the Neurological Sciences 336 (2014) 8-12.

England is editor-in-chief of the Journal of the Neurological Sciences.

Palliative Care as a Human Right: Where Does the Neurologist Stand?

By Raymond Voltz

Raymond Voltz

Raymond Voltz

Two recent international publications have put the spotlight on the situation of worldwide provision of palliative care. These are the “World Cancer Report,” published by the International Association of Research in Cancer (IARC) and the “Global Atlas of Palliative Care at the End of Life,” published by the WHO in collaboration with the World Wide Palliative Care Alliance. The “World Cancer Report” reminds us that the war on cancer has not been won and that still much remains to be done when treatment fails.

“The Global Atlas of Palliative Care at the End of Life” highlights the need for more palliative care: It estimates that 19.2 million people worldwide require palliative care with about 38 percent of patients dying from cardiovascular diseases, 34 percent of cancer and 10 percent of COPD. In the remainder, specific diseases such as multiple sclerosis (MS) and Parkinson’s are mentioned, and although less important on the global scale, patients with MMD/ALS. The atlas highlights the worldwide skewed distribution of palliative care services and access to palliative care depending on income and geographical regions worldwide. They conclude that palliative care is a human right, and that therefore each country should take improvement of palliative care up as a national strategy.

In some countries, it starts at the beginning: the access to opioids. A few weeks ago, a well-known Russian military committed suicide, stating in his final letter, that he did so because of an unbearable pain due to cancer and that he was not able to get opioids. Some countries are proud of their drug protection programs, which also means that they protect cancer patients from getting the right drugs at the right time. Here, a sensible political balance has to be reached. Opioids, of course, are important for the treatment of pain as well as the treatment of dyspnea. Provision of multiprofessional high-skilled palliative care follows those basic tenets.

So what does this mean for neurology? Cancer patients, cardiovascular patients and specific neurological diseases are treated within the responsibility of neurologists worldwide. As the atlas also states, their estimates only refer to patients at the end of their lives. The concept of early integration of palliative care has now fully reached the oncological world with the ASCO stating that all cancer patients should have access to palliative care. So, the need for palliative care is even greater than stated in the atlas, which the authors fully acknowledge. So where is the relevant interest in neurology? Do all neurologists worldwide know what palliative care structures already exist in their neighborhoods? Do they refer refer patients there early enough for common management of patients and families? Where is the topic of palliative care in the training of neurologists worldwide? Where are the neurologists who help establishing palliative care structures in their region? Where are the ones who advocate for a national palliative care strategy including all relevant patient groups? And finally, where is the interest of moving the field forward by valid research? Still, many neurologists think this in an unscientific topic not relevant to them, and that is a pity — mainly for many patients worldwide suffering not only from devastating neurological diseases but also from clear palliative care mismanagement by their neurologists.

Voltz is chair of the Department of Palliative Medicine at the University Hospital of Cologne, Germany.

International Conference on Freezing of Gait

Nir Giladi

Nir Giladi

By Mark Hallett, MD

Management of patients with Parkinson’s disease has progressed well. Levodopa and the dopamine agonists are effective, and when complications arise such as dyskinesias and fluctuations, deep brain stimulation (DBS) can be effective. However, another significant problem is now emerging. That is gait difficulties later in the course of Parkinson’s disease that are not responsive to either the dopaminergic therapy or DBS. Patients can look pretty good in many ways, but will have trouble relatively isolated to balance and gait.

One interesting feature of the gait difficulty is freezing of gait (FOG). With FOG, there is a failure to move forward despite intent to do so.  FOG can occur at gait onset or in the middle of walking, particularly in some settings such as walking through a doorway or turning. At times, there can be off-freezing that is dopa responsive; the problematic situation is on-freezing. FOG also occurs in other Parkinsonian conditions such as progressive supranuclear palsy.

There have been two prior workshops devoted to the topic, but recently there was an international conference Feb. 5-7, organized by Professors Nir Giladi and Jeff Hausdorff at the Dead Sea. The conference was sponsored by TelAvivUniversity, the TelAvivMedicalCenter and the International Parkinson and Movement Disorder Society. More than 160 attendees came from 20 countries.

Jeff Hausdorff

Jeff Hausdorff

Freezing also can occur with upper extremity movements or speech, but gait is more commonly affected and more debilitating. The topic is now under intense scrutiny. Gait is a complex movement requiring integrated activity of all parts of the brain and spinal cord with both balancing and stepping. This is likely why gait is more commonly affected than other movements.

There are a number of theories as to the etiology, and, as freezing is likely to be multifactorial, many of these may well be relevant in different patients. One type of problem is the deterioration of motor control capabilities, such as loss of the internal drive for movement, difficulties with multitasking and difficulties in carrying out automatic movements. Lack of gait symmetry is often correlated with freezing.

Another interesting motor control problem in Parkinson’s disease is the sequence effect, the progressive decline of movement amplitude in a sequence of what should be similar movements. Step length often gradually declines prior to a freeze, so this seems important at least in some circumstances. Cognitive problems, importantly loss of executive function, appear relevant. There is clearly a role of environment factors, including the path that needs to be traversed; the narrow doorway, for example.

There was considerable discussion of therapy. In the end, given the multiplicity of causes, therapy may have to be individualized.  Certainly, there should be care to optimize dopaminergic therapy. Physical therapy can play a role. Much discussion focused on the value of DBS of the pedunculopontine nucleus (PPN). The PPN sits in a complex region at the junction of the midbrain and the pons and appears to be a part of, or at least close to, the mesencephalic locomotor region. The literature is really still sparse, and it is not clear that the DBS electrodes are actually in the PPN in all patients, but some patients do appear improved.

Gait freezing remains an important clinical phenomenon, a fascinating set of problems for physiology and a challenge for treatment. Giladi and Hausdorff have been leaders in all aspects, and the attendees were grateful to them for organizing a useful conference that will set the direction of research in the next few years.