Moving Neurology Forward


Raad Shakir

Raad Shakir

Many important events shape our future, and in the neurology world, one of those has happened since the last issue of World Neurology. The WFN has six regions across the world and one of them is Europe. For historical reasons, two neurological societies were created in the continent, and through the diligent work of many people, the EFNS and the ENS have now joined together to create the European Academy of Neurology (EAN). This occurred through good will and compromise on both sides. The newly established organization has inherited the work and funds of the two previous ones. This puts it in an excellent position to hit the ground running.

This amalgamation would not have been possible were it not for the farsighted view taken by the leaders of the EFNS and ENS, Prof. Richard Hughes, EFNS president, and Prof. Claudio Bassetti, ENS president. The new constitution would not have been possible without the hard work of the transitional team: Prof. Jacques De Reuck and Prof. Gustave Moonen from Belgium; Jose Ferro, Portugal; Detlef Kömpf, Germany; and Gunhild Waldemar, Denmark.

I might add that, in a way, history repeats itself as the WFN itself was created in 1957 by the initial efforts of three Belgians: our first President, Ludo Van Bogaert; Charles Poser, our first editor of World Neurology and Armand Lowenthal. The two Belgian members of the EAN’s transitional team have again been instrumental in creating a new and rather ingenious constitution for the new European Academy. This is a unique structure that serves to instruct us all on how to overcome differences and create functional and egalitarian professional organizations.

Figure 1. Raad Shakir and Günther Deuschl.

Figure 1. Raad Shakir and Günther Deuschl.

It was my pleasure to attend the first general assembly and elections held June 3, 2014, in Istanbul. Prof. Günther Deuschl from Kiel, Germany, was elected president. (See picture at right.) The EAN is now the single organization that unites and supports all neurologists across Europe. Currently, 45 European national societies as well as 800 individual registered members constitute the assembly. The EAN represents 19,000 European neurologists.

The next regional organization, which is due to be formally created, is the Pan American Federation of Neurological Societies (PAFNS) representing the WFN Latin America region. The constitution and bylaws have been approved, and it is expected that the organization shall be incorporated during the next WFN Council of Delegates meeting on Sept. 11, 2014, in Boston. The forthcoming World Congress in Santiago, Chile, is the most appropriate place for PAFNS to do all of its future planning and activities across Latin America.

By the time this issue of World Neurology is published, the first World Brain Day will have happened in July 2014. (See program cover on this page.) This date was chosen as it is the date of the creation of the WFN in 1957. Prof. Mohamed Wasay, chairman of the Public Awareness and Advocacy Committee, has worked tirelessly with the close collaboration of Prof. Wolfgang Grisold, secretary-treasurer general, to make this first day a success across the world. The emphasis is on celebrating the brain and its wonders and informing the public of our activities as well as inviting anyone who is interested in participating in them. The plan is to build on this first experience for the future and create new and novel activities in years to come.

Figure 2. World Brain Day logo.

Figure 2. World Brain Day logo.

These events can only happen as the WFN has a rich history, and many of our activities have their roots going back decades. Prof. Johan Aarli’s book, “The History of the World Federation of Neurology, The First 50 Years,” was published June 2014, and launched during the joint EFNS/ENS Congress in Istanbul. This is an excellent effort from our past president, and a review by Prof. François Boller is published in this issue of World Neurology.

Many of our committees met in Istanbul. The Publications and Communications Committee now incorporates the website, and Prof. Christopher Kennard, U.K., as chair of the committee, held its first meeting with many issues discussed regarding the future of the WFN contract with Elsevier. The website has changed dramatically, and the configuration is now more responsive and will be updated regularly.

The WFN finances continue to grow and allow the organization to increase its grants and activities. The Finance Committee under the chairmanship of Prof. Eduard Auff, Austria, reviewed the 2013 finances including the WFN investments. The conclusion is that the WFN is in good financial shape and the trustees, on behalf of all member societies, want to register their gratitude to the Austrian society and the EFNS for partnering with the WFN in the Vienna Congress, which was a great scientific and financial success.

The grants applications have been received, and the reviewers will produce their final decisions by the end of the summer. Again, the WFN is partnering with speciality and regional organizations. This has proven to be an excellent way to have global involvement in neurology research. The administration and monitoring of the grants is an integral part of the WFN secretariat, and this is performed most successfully.

The recent meeting of members of the World Brain Alliance was most rewarding, and members of peer organizations have all agreed on close collaboration at various levels to promote our activities at the highest levels, especially at the WHO and the United Nations. The noncommunicable diseases project is crucial for brain health. The aim is to promote awareness and support for brain-related disorders with their massive consequences leading to death and disability.

A billboard for World Brain Day 2014 in Karachi, Pakistan. Submitted by Mohammad Wasay, Aka Khan University.

A billboard for World Brain Day 2014 in Karachi, Pakistan. Submitted by Mohammad Wasay, Aka Khan University.

The WFN has to have an annual Council of Delegates (COD) meeting to fulfill the requirements of being a U.K.-based charity. This year’s meeting will be held during the joint ACTRIMS/ECTRIMS meeting in Boston. The COD will meet at 9 a.m. on Sept. 11, 2014. The delegates will have the opportunity to hear all about our activities during the year and elect a new trustee to replace Prof. Gustavo Roman whose second term comes to an end. Roman has been involved in various activities of the WFN for many years. His contributions have moved the WFN forward. He will continue his role as WFN director of the Latin America Initiative.

The WFN is moving full steam ahead with its program of global involvement, and I welcome all ideas from all the membership.

Hachinski Addresses Dementia Prevention at Royal Symposium

Her Majesty Queen Sofia of Spain (center) and Prof. Vladimir Hachinski (left of Her Majesty), keynote speaker at the II International Symposium on the Advancement of Psychosocial Care and Research in Dementia. Photo courtesy of Agencia DiCYT.

Her Majesty Queen Sofia of Spain (center) and Prof. Vladimir Hachinski (left of Her Majesty), keynote speaker at the II International Symposium on the Advancement of Psychosocial Care and Research in Dementia. Photo courtesy of Agencia DiCYT.

Her Majesty Queen Sofia of Spain has a special interest in Alzheimer’s disease and chaired a symposium on The Advancement of Psychosocial Care and Research in Dementia in May in Salamanca, Spain. It was sponsored by the Fundación Reina Sofia, CRE Alzheimer’s (IMSERSO), Fundación General de la Universidad de Salamanca and other organizations.

Vladimir Hachinski, distinguished university professor, University of Western Ontario, London, Canada, speaking in Spanish on “Can We Prevent or Delay Dementia?” explained that stroke and Alzheimer’s pathologies increase with age, occur together in the same brain and may interact.

Lesions in the brain do not add up; they multiply making it important to control what pathology we can. Currently, no treatment exists for Alzheimer’s, except for the symptoms. On the other hand, all dementias have a vascular component, ranging from 60 percent in frontotemporal dementia to 80 percent in Alzheimer’s disease. Having Alzheimer’s pathology and a vascular component doubles the chances of developing dementia. Currently, Alzheimer’s disease and brain vascular disease are being managed as if they were separate and isolated entities.

An alternative approach is that of vascular cognitive impairment, which is any impairment caused by or associated with vascular factors. Vascular disease is treatable and preventable. Therefore, identifying the vascular components of all dementias offers the possibility to prevent or delay dementia.

Other participants included Ana Mato, Spanish Minister of Health; Benoit Lavallart, leader of Plan Alzheimer’s France, who spoke on “The French National Alzheimer’s Plan”; Marc Wortmann, Alzheimer’s Disease International (AD) on “Global Dementia Policy Overview”; Eamon O’Shea, Irish Center for Social Gerontology (ICSG) on “Psychosocial Interventions for People with Dementia” and Maria Isabel Gonzalez Ingelmo, director of CRE Alzheimer’s International.

Hachinski said he was glad to see the Queen again, whom he had met June 2013 at a symposium in Madrid. He was pleased to return to the University of Salamanca, where he was made a Doctor Honoris Causa in 2000.

Immune-Mediated Neurologic Disorders Recognition and Management in LMCs


Donald H. Silberberg

Donald H. Silberberg

By Donald Silberberg

Since Josep Dalmau’s 2007 report of Anti-N-Methyl-D-Aspartate Receptor Encephalitis associated with ovarian teratoma1, there have been several studies that make it clear that he and his colleagues uncovered just the tip of the iceberg. Clinical presentations ranging from seizures, movement disorders, autonomic dysfunction, behavioral changes to frank psychosis and disordered consciousness are being reported in association with a variety of antibodies, mostly directed against synaptic molecules2. Some proportion of what is being termed Pediatric Autoimmune Neuropsychiatric Disorders (PANS) also may be antibody-mediated3.

Although these seem to be uncommon disorders, their epidemiology at present is unknown. However, as is the case with virtually all neurologic disorders, immune-mediated disorders are likely to be at least as common in low- and middle-income countries (LMCs). In those situations in which a preceding infection plays a role, these disorders may even be more common. Their recognition depends on physician or other health care provider awareness; diagnosis depends entirely on sophisticated laboratory testing. This raises the problem of how to get affordable diagnostics and interventions to LMCs where they are needed.

This problem, of course, extends far beyond this group of disorders. More than 100 genetically determined disorders can now be detected before birth. Even more neurologic disorders can be accurately diagnosed throughout childhood and adolescence where the genetic testing is available.

Advances in the capacity to deal with this issue in LMCs will depend on raising awareness at many levels, training diagnostic laboratory personnel, lowering the cost of the reagents that are needed, and through developing partnerships with centers in wealthy countries.

World Neurology Online welcomes your commentary concerning this issue.



1. Dalmau J, Tuzun E, Wu HY, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61:25

2. Panzer JA, Gleichman AJ, Lynch DR. Glutamatergic autoencephalitides: an emerging field. Neuro Oncol. 2014 Mar 16. [Epub ahead of print]

3. Murphy ML, Pichichero ME, MD Prospective Identification and Treatment of Children With Pediatric Autoimmune Neuropsychiatric Disorder Associated With Group A Streptococcal Infection (PANDAS). J Neural Transmission. 2014 Jan 9 [Epub ahead of print]

Asia Initiative: Neurology Service and Beyond

Ryuji Kaji, MD, PhD

Ryuji Kaji MD, PhD

In his 2010 inauguration speech as the president of World Federation of Neurology (WFN), Prof. Vladimir Hachinski conveyed a message: “Asia has more than 60 percent of the global population, yet in some areas, the education of neurology to young neurologists does not keep up with the patients’ needs of neurological care.” He organized the Asia Initiative as a part of WFN to bring attention to this region. As the chair of this initiative, I have met many Asian neurologists and have begun to realize that there are unique problems that require attention from the rest of the world.

The 14th Asian & Oceanian Congress of Neurology was held in March in Macao, China. This is an official meeting of Asian Oceanian Association of Neurology, whose history dates back almost half a century ago. Charles M. Posner, a WFN representative, toured the Asian and Oceanian countries and challenged local neurologists to form an association that would promote and foster the advancement and exchange of information within the area. In response, Shigeo Okinaka, then the executive of Japanese Society of Neurology, invited the region’s neurologists to a planning meeting in Tokyo. This gave birth to the Asian and Oceanian Association of Neurology (AOAN) on June 26, 1961. Its official meeting, Asian & Oceanian Congress of Neurology (AOCN), had been held every four years until the current 14th meeting in China, which followed the 13th meeting in Melbourne in 2012 by two years. There was uncertainty over the financial and scientific outcomes of this short-interval meeting, but thanks to the dedication of the Hong Kong Society members, it became an unprecedented meeting with the largest number of international participants ever. Its surplus funds should significantly contribute to the activities of AOAN, chaired by Dr. Man Mohan Mehndiratta from India. The next AOCN will be held in 2016 in Malaysia.

On March 4, there was a plenary session on “Special Issues in Asia,” in which three speakers spoke. Prof. Chong-Tin Tan from Malaysia gave a talk on education in Asia. He serves as the editor of Neurology Asia, the official journal of AOAN and Association of Southeast Asian nations Neurological Association (ASNA). He pointed out that Asia accounts for 60 percent of the world population, but less than 20 percent of neurologists in the world, and stressed that education is the key to development of neurology in Asia. Next, Dr. Li-Ping Liu from China emphasized rapidly advancing frontiers of neuroscience research in China. At the last of this session, I gave a talk on neurology service in Asia. Asian countries are rapidly exploding in population and economy. Some are facing unique problems not experienced in other regions1.


Figure 1. Projected increase of the aged (>65) populations among nations.
Adapted from Current Status and Predictions for an Aging Society with Fewer Children, Japanese Ministry of Education, Sports, Culture, Science and Technology (with permission).

Figure 1 depicts the projected increase of the population over 65 years among nations. While Western countries have a linear increase of the aged over years, Asian countries (Japan, Korea and China) have S-shaped curves indicating a steep surge of the aged population during 2000-2020 (Japan) and 2020-2030 (Korea and China). India will probably join this group by the end of this century.

Japan is the first to be exposed to this surge, and medical needs for the aged people are highlighted. Among these, neurological disorders such as stroke and Alzheimer’s disease came to the forefront. For instance, the number of stroke survivors has steeply increased from 1.7 million in 2000 to 2.8 million by 2013. Stroke was the No. 2 killer in the 1970s, but it is currently the fourth, following cancer, heart disease and pneumonia. Although the number of stroke attacks is six times as frequent as heart attack, it has largely become non-fatal, although it typically leaves disabilities; two- thirds of the patients are unable to return to pre-morbid activities.

From the global point of view, stroke is the second leading cause of death after ischemic heart disease, with an estimated 5.5 million people dying from stroke every year worldwide. Two thirds of these deaths occur in countries with limited resources2. Approximately 80 percent of patients survive the acute phase of stroke, but are left with varying degrees of chronic disability.

Not only the number of deaths, but also the quality of life after stroke is an important aspect. Disease-adjusted life years (DALYs) are defined as number of years of healthy life lost by disease3. They reflect the impact of a disease in the aging societies.


Figure 2. Disease-adjusted life years (DALYs) of neurological diseases with respect to nation’s income status. Data from WHO (2005).

Figure 2 shows DALYs among various neurological diseases with respect to the economic status of a nation. Stroke is more important than Alzheimer’s disease, because many Asian nations are still in the state of low-middle income by World Bank Criteria. Japan had been among those with limited resources with high mortality of stroke, but her economy grew up in a short period to high income state, and other Asian nations should follow this path.

The drop of stroke mortality in Japan is due to change in diet, western lifestyle and the efficient social health care system. However, the main factor is the control of hypertension by medication, which decreased the number of fatal massive hemorrhages3. The impact of thrombolytic therapy is limited, rather increasing those disabled by preventing stroke deaths4.

The expense related to caring for stroke survivors is now exceeding $25 billion (U.S. dollars) per year in Japan. Now the Japanese economy is revolving around those aged patients and their care. In fact, a major diaper maker saw sales of adult diapers outpace infant diapers. Stroke centers with staff dedicated to thrombolytic therapy are urgently needed, and we are investing effort into increasing awareness of stroke among Asian people. Educating health professionals in neurology is the Asian Initiative’s first priority.

The roots of neurology lie in Europe and this specialty matured in the U.S. Asia has its own priorities in coping with neurological diseases. In this regard, I propose “autonomy” as a key word for activating regional neurological organizations. We need a forum to discuss the problems in each region, and to provide unique educational opportunities for neurologists, general practitioners, allied health professionals and the patients. With these aims in mind, the WFN has decided to make the best use of the existing regional neurological organizations such as AOAN to fulfill its mission.

Another key for success would be “synergy”. Symposia and workshops were held in collaboration with international organizations such as the Movement Disorder Society (MDS) and the International Federation of Clinical Neurophysiology (IFCN). These joint activities provided the financial support for the meeting and increased the attendance. The event also helped the supporting organizations increase their visibility. I hope that the March 2014 meeting in Macao becomes a model for the future meetings in Asia, and the meeting will serve as an equivalent to EFNS, ENS or American Academy of Neurology meetings.

Alzheimer’s disease is a little harder to tackle. Traditionally, Asian people had a large family, three generations living together. The aged people lived with younger family members. In my childhood in 1950s, the aged are naturally thought to have memory loss to some degree. It is still a virtue that children respect and take care of the parents by Asian standard. Re-appraisal of this system in the face of increasing Alzheimer’s disease might be a solution for countries with limited resources. For the aged, it would be appropriate to prepare for the intellectual decline.

Steve Jobs, the former CEO of Apple Computer, gave a speech at the commencement at Stanford in 2005. Facing the recurrence of cancer, his message on coping with imminent death might be a hint: in the morning he thought about his life as if ending in the evening. Whenever he thought the activities of the day were not what he really wanted to do, he changed his life. These were actually the words of the old Chinese philosopher, Confucius (551–479 BC), which he probably was familiar with. Alzheimer’s disease is still unpreventable and incurable probably for the next decades to come. “Think Oriental” might be the key for the societies and the neurological community in the world.



1. Kaji R Asian Neurology and Stroke (Perspectives) Neurology, in press

2. WHO, W. Neurology Atlas, (2003).

3. Murray, C.J. et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2197-223 (2012).

4. Kubo, M. et al. Secular trends in the incidence of and risk factors for ischemic stroke and Its subtypes in Japanese population. Circulation 118, 2672-8 (2008).


Kaji, is the Chair, Asia Initiative, World Federation of Neurology, Professor and Chairman, Department of Neurology, Institute of Health-Bioscience, Tokushima University.


Wolfgang Grisold

Wolfgang Grisold

By Wolfgang Grisold

Earlier this year, the first Joint Congress of European Neurology took place in Istanbul. This was the final stage in the process of merging the two European neurological societies — the European Neurological Society (ENS) and the European Federation of Neurological Societies (EFNS) — into the European Academy of Neurology (EAN). The first elections of the new society were held during the congress, naming G. Deuschl, Germany, as the first president of the EAN, and F. Fazekas, Austria, as its first vice president. The merger of the two societies was a logical step and now that it has occurred, it seems to be a natural development, but it took a huge effort and the engagement of many individuals to make it possible.

The ENS was the first European neurological society, founded in 1986. It held its first congress in Nice in 1989. That congress was organized by G. Said.

Said along with his co-founders, P. K. Thomas and Anita Harding, were the heart of the ENS at its founding. Their idea was to create a European society based on individual membership, with a strong emphasis on science and a structure similar to that of the American Academy of Neurology (AAN). As a consequence of this philosophy, the ENS traditionally has been less engaged in political aspects of neurology, fostering individual rather than national representation. The ENS, apart from holding excellent congresses, increasingly engaged in education through teaching, scholarships and internationalsupport for countries in need. Its major publication was the Journal of Neurology, which was supplemented by informative newsletter that appeared regularly.

The EFNS was founded in Vienna in 1991 by Prof. Gerstenbrand who had a vision of creating a large European society based on prior activities in Eastern Europe, such as the International Danube Symposia and the proposed Pan-European Society of Neurology. The philosophy of the EFNS was federal in constitution and structure, where individual European countries were the constitutional members. This construction was effective. Since its founding, the EFNS has contributed greatly to European neurology. The EFNS sponsored a number of activities, many of which were originally conceived within the EFNS, promoting education, CME accreditation and supporting neurology in the former Eastern European countries, by teaching courses, holding lectures and helping in the establishment of national neurological organizations. The primary publication of the EFNS is the European Journal of Neurology, which will become the official journal of the EAN. Neuropennews is an online publication serving the purpose of a newsletter.

Joint Congress of European NeurologyDue to differences in their philosophies, the two societies were effectively in competition, resulting in what many European neurologists concluded was an unnecessary duplication of effort. The initial event of their coming together was the creation of the European Board Examination in Neurology, where the examination’s creator, the UEMS – European Board of Neurology (UEMS/EBN) invited both societies to participate in its development. The presidents of the two organizations at that time — De Reuck of the EFNS and Moonen of the ENS — were both from Belgium. That facilitated the process of initiating a proposal for the creation of a joint EAN.

There were many additional steps necessary for the eventual merger. One major step was the agreement of the European delegates of the EFNS to this proposal in Florence 2009 and the subsequent agreement of ENS members. A joint task force was then formed that meticulously prepared the details for the merger and also created a new constitution and voting system.

The EAN combines the best of the developments of both societies. It is expected to foster neurology within Europe for the best of patient care, and to support and encourage science, teaching and education, as well as to be a transparent, open-minded and member-oriented society that provides an essential service for its members.

The WFN acknowledges this development toward a strong European society, and we hope to cooperate in further projects, especially where those involve furthering neurological education in countries in need of additional resources.

Grisold is from the Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.