100 Years of Expanding Networks in Neurology

Peter J. Koehler

Peter J. Koehler

Peter J. Koehler, MD, PhD, FAAN

Since we started this history column in 2010, we have paid attention to international relationships in the neurosciences, in particular the exchange of students and neurologists among institutes. In this essay, I will describe another way of international cooperation that coincided with the evolution of the specialization of neurology.

In general, specialization in medicine is considered to have started in the second half of the 19th century. It was accompanied by the establishment of journals, societies, university chairs, the invention and application of new instruments (ophthalmoscope, reflex hammers, etc., for neurology), and the publication of comprehensive textbooks.

Editorial advisory board of Vinken and Bruyn in the 1960s: (L-R) M. Critchley, A. Biemond, R. Garcin, K.J. Zülch, S. Refsum, P.J. Vinken, E. van Tongeren and G.W. Bruyn.

Editorial advisory board of Vinken and Bruyn in the 1960s: (L-R) M. Critchley, A. Biemond, R. Garcin, K.J. Zülch, S. Refsum, P.J. Vinken, E. van Tongeren and G.W. Bruyn.

During the 19th century, neurological textbooks appeared in several countries, usually written by one person. Examples are John Cooke’s Treatise of Nervous Diseases (1820), Moritz Romberg’s Lehrbuch der Nervenkrankheiten (1840), William Hammond’s Treatise on Diseases of the Nervous System (1871), Joseph Grasset’s Traité Pratique des Maladies du Systè
me Nerveux
(1878), and Alexey Kozhevnikov’s Rukovodstvo k Nervnym Boleznyam i Psichiatrii [Treatise of Nervous Diseases and Psychiatry; 1883].

During this period, however, multivolume, multi-authored books of general medicine started to appear (Reynolds System in five volumes, 1866-79; Albutt’s System in eight volumes, 1896-9, Ziemssen’s  Handbuch). Although Dercum’s 1895 Textbook of Nervous Diseases was multi-authored (24), it comprised one volume. Hermann Nothnagel’s Specielle Pathologie und Therapie (1895-1915) was on general medicine, but possibly because of his interest in neurology, 17 of the 41 volumes were on neurological subjects, including well-known books by Freud, Hitzig,  Möbius, Monakow and Oppenheim. With respect to neurology, it may be considered a kind of transitional book.

From volume 10 of Bumke's and Foerster's  Handbuch: pneumococcal meningitis.

From volume 10 of Bumke’s and Foerster’s Handbuch: pneumococcal meningitis.

This year is the centenary of the completion of the first multi-authored and multivolume “handbook” devoted entirely to neurological subjects: Handbuch der Neurologie (1910-4). It was edited by the Berlin neurologist Max Lewandowsky (1876-1918). In the preface, he stated that “Until today, the field of neurology has not been mapped out by means of a student handbook. By such a treatment in handbook form, I mean a publication approach that circumscribes and integrates the whole field, with a uniform thoroughness and professionalism and which, in distinction with a shorter textbook, is based on an extensive presentation of the available literature in a documentary style.”

The handbook appeared in six volumes and was written by 81 authors, including 21 foreign authors. Due to Lewandowsky’s untimely death, supplements were edited by Oswald Bumke and Otfrid Foerster. Interestingly, the second supplementary volume contained almost entirely observations from war injuries of the peripheral nerves and spinal cord and was written by Foerster himself (altogether 1,152 pages). The same Bumke and Foerster continued the project with a new series of 18 volumes, published between 1935 and 1937. It is clear that the area of neurology had expanded and knowledge increased, but also became a more international undertaking with no less than 133 authors, of whom 45 were from 14 non-German countries.

After World War II, a new project was started in the 1960s, when the Dutch neurosurgeon Pierre Vinken and neurologist George Bruyn launched the Handbook of Clinical Neurology. This project became even more comprehensive than Bumke’s and Foerster’s Handbuch. It was clear for them that the new series should be published in English (like Exerpta Medica that inspired them, for which they both worked and that was started in the late 1940s). They were able to engage a large international network of authors. The number of authors of the 78 volumes that Vinken and Bruyn edited (between 1968 and 2002) was 2,799 of which 48 percent was American.

From volume 3 of Lewandowsky's Handbuch: chapter on paralysis agitans by Forster and Lewy.

From volume 3 of Lewandowsky’s Handbuch: chapter on paralysis agitans by Forster and Lewy.

Considering the publication of these three 20th century multivolume neurological textbooks, several changes in the field of neurology may be distinguished. Obviously, knowledge increased and more space was needed to describe it. Subspecialization within neurology is becoming evident in the course of publication of these volumes. Language now changed from German to English, reflecting the ever-changing teaching centers of medicine through the ages.

While Paris, after Leiden and Edinburgh in the 18th century, had played an important role as the major center of medical teaching in the first part of the 19th century — resulting in a change from Latin to English and French — this gradually shifted to Austria and Germany in the 1860s. Following the two World Wars, English became the major language in (medical) science. Although basic neurological knowledge was spread throughout the pre-WWII German handbooks, Vinken and Bruyn emphasized the clinical aspect. Today, the three handbooks may be considered important sources for the history of neurology, reflecting the emergence of the specialty of neurology as a scientific and clinical entity. Moreover, it shows the increasing international cooperation throughout the 20th century.

Koehler is neurologist at AtriumMedicalCenter, Heerlen, The Netherlands. Visit his website at  http://www.neurohistory.nl.



  • Koehler PJ, Jennekens FGI. Vinken and Bruyn’s Handbook of Clinical Neurology: A witness of late 20th century neurological progress. J Hist Neurosci 2008;17:46–55.
  • Stahnisch FW, Koehler PJ. Three 20th-century multiauthored handbooks serving as vital catalyzers of an emerging specialization: a case study from the history of neurology and psychiatry. J Nerv Ment Dis. 2012;200:1067-75
  • Koehler PJ, Stahnisch FW. Three Twentieth-Century Multiauthored Neurological Handbooks – A Historical Analysis and Bibliometric Comparison. J Hist Neurosci. 2013 Oct 1. [Epub ahead of print]

From the Editor-In-Chief: In This Issue

Donald H. Silberberg

Donald H. Silberberg

World Neurology now has a superb Editorial Advisory Board, representing every region, and equally important, representing the WFN’s website and Journal of Neurological Sciences.  In “@WFNeurology” on page 9, Walter Struhal and Peter Engel discuss the advantages of these linkages.

Also in this issue, for the first time, you can see a list of some of the current articles in the JNS, with hyperlinks to the PDFs of selected articles.  Similarly, when I receive announcements that require immediate display, I forward them to Engel for posting on the WFN website.

This issue is the fifth online, with subsequent issues to come every two months. This is a good time to remind you that the content of World Neurology is entirely what you wish to make it.  Please send me reports from your region, historical or personal reflections, notices of future events, letters to the editor, and of course, original articles on a topic that interests you. When you publish work that will later be submitted to a peer-reviewed journal, you don’t need to worry about copyright issues on the part of World Neurology or the WFN.

You can help with our distribution list.  Because many national societies are reluctant to release email addresses due to privacy concerns, our list serve is incomplete.

Please ask your colleagues if they are receiving communications from World Neurology.  If not, please advise them to send their address to me or to Keith Newton, assistant editor, at  keith@wfneurology.org, in order to  become a subscriber.  If your national society can provide a list, please ask that it be sent to us.

Finally, a wish for a happy, productive and healthy 2014 to all.

Enhanced Academic and Outreach Services of the Indian Academy of Neurology

By Man Mohan Mehndiratta, MD, DM (Neurology), FAMS, FRCP

Figure 1. International speakers on the occasion of IAN Conference Oct. 24-27, 2013:  Upper panel from left to right are Robert H. Brown (USA), Marco T. Medina (Honduras), Olivier Dulac (France), Shuu Jiun Wang (Taiwan), Page B. Pennell (U.S.), Shri K. Mishra (U.S.), Beom S. Jeon (South Korea) and Keun Hwa Jung (South Korea). Lower panel from left to right are Vijay Sharma (Singapore), Barry Snow (New Zealand), Neeraj Kumar (U.S.), Martin J. Brodie (Scotland), William Carroll (Australia) and Bhupendra O. Khatri (U.S.).

Figure 1. International speakers on the occasion of IAN Conference Oct. 24-27, 2013: Upper panel from left to right are Robert H. Brown (USA), Marco T. Medina (Honduras), Olivier Dulac (France), Shuu Jiun Wang (Taiwan), Page B. Pennell (U.S.), Shri K. Mishra (U.S.), Beom S. Jeon (South Korea) and Keun Hwa Jung (South Korea). Lower panel from left to right are Vijay Sharma (Singapore), Barry Snow (New Zealand), Neeraj Kumar (U.S.), Martin J. Brodie (Scotland), William Carroll (Australia) and Bhupendra O. Khatri (U.S.).

The Indian Academy of Neurology (IAN), with its primary objective of imparting education, coordinates various activities that support and supplement formal neurology education. It has been instrumental in organizing various national and international conferences, workshops and Continuing Medical Education (CME) programs with national and international outreach programs1.

Professor Marco T. Medina, professor of Neurology from Honduras was one of the faculty invited as part of this outreach program. Other invited international faculty members were Beom S. Jeon, vice president of the Asian Oceanian Association of Neurology; William Carroll, vice president of the World Federation of Neurology; Robert H. Brown, president of the American Neurological Association; Shri K. Mishra; Bhupendra O. Khatri; Neeraj Kumar and Page Pennel; J. D. Khandekar (USA); Barry Snow; Olivier Dulac and Martin Brodie. (See Figure 1.) These academic outreach programs foster critical and analytical thinking, professional and experiential learning and promotes research2,3. It has an advocacy subsection convened by Man Mohan Mehndiratta and ably assisted by other committed members of IAN — Apoorva Pauranik and Lakshmi Narsimhan. It had been their sincere endeavor to improve the status of public awareness, education and care in India. This subsection organizes workshops to train the members in skills, organizes the neurology quiz, neurology education courses, public awareness and education series, CMEs and camps. Hence, it streamlines and disseminates authentic and comprehensive outreach public health education.

Like every year, the 21st Annual Conference of Indian Academy of Neurology, the IANCON2013, was held at Indore Oct. 24-27, 2013. It was hosted and organized by the Department of Neurosciences, ChoithramHospital and Research Centre and Neuro Club Indore. The conference featured the major breakthroughs and developments in the field of neurology — from clinical practice to research and technology and was attended by renowned national and international faculty and approximately 1,000 delegates. It included a highly informative and interesting scientific program starting with CME on neurological manifestations of systemic diseases, which addressed a wide range of conditions such as nutritional deficiencies, SLE and antiphospholipid antibody syndrome, liver disease, pregnancy, lymphoma and leukemia and small vessel disease. This was followed by symposia and seminars. The theme of one of the symposia was neurotechnology and e-learning, which was chaired by Mehndiratta and Medina from Honduras. Both technical and clinical perspectives regarding the benefits, challenges and limiting factors of developing robotics in neurorehabilitation were discussed. The integration of e-learning in traditional learning was emphasized.

Man Mohan Mehndiratta

Man Mohan Mehndiratta

Four orations were presented and the Presidential Oration was delivered by Mehndiratta. His presentation was titled “My Journey Through Indian Academy of Neurology and Academy’s Past, Present and Future.” He portrayed the establishment of the IAN, his 14 years of journey in the academy, growth of IAN in terms of academic activities such as conferences, public education and awareness programs and official publications both online (website) and offline (newsletter, reviews in Neurology, Journal- Annals of Indian Academy of Neurology). According to his foresight, the way forward for IAN includes collaboration and synergy, young talent recognition and continental and intercontinental outreach.

William Carroll, vice president of World Federation of Neurology, also graced the occasion and presented his oration on demyelinating diseases and challenges. Another interesting symposium focused on the diagnosis and management of cerebrovascular and neuromuscular diseases using point of care neurosonology.

For the first time in the history of IAN, an Asian and Oceanian Association of Neurology (AOAN) symposium was held in which one of the speakers was Beom S. Jeon, vice president of AOAN from South Korea. He provided valuable insight into how genetic disorders present in dystonia.  He also participated in the workshop on videos in clinical neurology. To encourage young neurologists, a paper presentation competition was held, and first, second and third positions were awarded.

A high point of this conference like earlier years was clinicopathological conference (CPC) on a case of fever, rapidly progress altered sensorium, raised intracranial pressure and seizures. The clinical discussant suggested the possiblity of Balamuthia granulomatous amebic encephalitis (GAE) and was confirmed as Balamuthia mandrillaris encephalitis on histopathology.

In the executive committee meeting, Robert H. Brown, president of the American Neurological Association (ANA) was invited to discuss the logistics to foster collaboration of ANA and IAN, which would be really helpful in achieving intercontinental educational outreach.

Looking ahead, IAN will continue to support the neurologists through its key functions, mentor young neurologists and provide opportunities for research. It will continue to develop more outreach initiatives to prepare students and practicing neurologists for academic excellence1.

Mehndiratta is the director, professor and department head, Department of Neurology, JanakpuriSuperspecialityHospital, New Delhi-110058. He may be contacted at mmehndi@hotmail.com.



  1. IndianAcademy of Neurology. Available at http://www.ian.net.in/index.html. Assessed on Nov. 8, 2013
  2. O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis DA, Haynes RB, Harvey EL Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007 Oct 17;(4)
  3. Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD.Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009 Apr 15;(2)

Join us for AOCN 2014

166723243Please join us for the 14th Asian and Oceanian Congress of Neurology (AOCN) March 2-5 at the Convention and Exhibition Centre of The Venetian® Macao.

AOCN will become a biennial conference starting in 2014. The Hong Kong Neurological Society (HKNS) is honored to host AOCN 2014 and will bring this special occasion to Macao, which is only 60 km from Hong Kong. There are direct flights between Macao and the cities in Mainland China, Taiwan, Korea, Japan, Singapore, Malaysia, Thailand, The Philippines, Indonesia, Europe and the United States. Also, there is frequent ferry service between Hong Kong and Macao Ferry Terminal.

Hong Kong and Macao are at the center of Asia with easy access to Asian neurologists.  Macao is an interesting place with perfect blending of East and West.

Following the footsteps of the previous successful congresses, the Organizing Committee has been working closely with AOAN to provide you with a valuable opportunity to learn new advances in the field of neurology, an interactive platform for exchange of experiences and a warm atmosphere for establishing collaboration networks.

AOCN 2014 will cover the latest in the speciality of neurology as well as in the allied subspecialties. The Scientific Program Committee has prepared an academically rich scientific program with the regional specialty societies, including The Asian Pacific Stroke Organization (APSO), The Asian Society Against Dementia (ASAD), Commission for Asian Oceanian Affairs (CAOA) of The International League Against Epilepsy (ILAE), Asian and Oceanian Chapter International Federation of Clinical Neurophysiology (IFCN), Asian Regional Committee for Headache of International Headache Society (IHS), The Movement Disorder Society (MDS), The Pan-Asian Committee on Treatment and Research of Multiple Sclerosis (PACTRIMS) and The World Federation for NeuroRehabilitation (WFNR).  Besides these societies, we acknowledge The Chinese Society of Neurology under the Chinese Medical Association to be one of the supporting organizations of the congress.

Lectures in a wide range of topics in multiple sclerosis, epilepsy, infection, headache and pain, dementia, movement disorder, stroke, neurogenetics, neurorehabilitation, neuromuscular diseases and neurophysiology as well as the pre-congress workshops have been organized.  Renowned speakers from all around the world as well as local experts from the Asia-Pacific are invited to share their experience and expertise with more than 1,500 neurologists, researchers and other health care professionals from related medical disciplines. An exhibition also will be held concurrently to show you the latest products and services offered by the health care industry.

To promote the development of neurology in the region, the Scientific Program Committee of the AOCN 2014 will be presenting oral and poster presentations from neurologists and neurology trainees at the congress.

Plan to attend this important neurology event, and register online now. We look forward to seeing you at AOCN 2014!

For more information, visit  www.aocn2014.org.

Global, Interdisciplinary, Integrative

By Thomas H. Bak and Facundo Manes

Attendees and participants in Hyderabad.

Attendees and participants in Hyderabad.

The WFN Research Group on Aphasia, Dementia and Cognitive Disorders  (RG ADCD) goes back to the Problem Commission on Aphasiology, founded in Varenna on Lago di Como in 1966, as one of the first “problem commissions” (as the research groups were initially called) of the WFN.

From early on, the group’s activities have been strongly influenced by two complementary developments. The first one is the continuous move toward a broader, interdisciplinary, collaborative and integrative approach. Early in its history, the group recognized the close connection between aphasia and other aspects of cognition.

Cognitive symptoms can occur in a wide range of neurological diseases, such as stroke, neurodegeneration, inflammation, neoplasms, trauma, epilepsy or even migraine. Accordingly, our group has always been keen to establish collaborations with other research groups. The most lasting and fruitful one has been the collaboration with the WFN Research Group on Motor Diseases (RG MD). It has been given a strong impetus by recent advances in clinical studies as well as in basic sciences, such as the discovery of the C9ORF72 gene, which can cause both Motor Neuron Disease (MND) as well as Frontotemporal Dementia (FTD).

Within a few years, MND changed from a classical prototype of a purely motor disorder to a prime example of the overlap between movement and cognition. The collaboration between RG ADCD and  RG MD kept up with these developments. We have organized joint symposia and teaching courses across the world and the official journal of the RG MD, Amyotrophic Lateral Sclerosis, has been renamed to Amyotrophic Lateral Sclerosis and Frontotemporal Degenerations and is now also endorsed by our group.

The second development, which has defined our activities in the last decades, is a move to an increasingly global perspective. Originally, the biennial meetings of the group alternated between North America and Western Europe. From the late 20th century, they expanded to encompass Central/Eastern Europe (Prague), South America (Praia do Forte, Buenos Aires) and Asia (Istanbul, Hyderabad) with the next meeting due to take place in Hong Kong this year.

This has led with time to an increasingly diverse, international membership as well as to a more global focus of our meetings. Thanks to the Cognitive Clinics Worldwide grant from the WFN, our group has been able to organize teaching courses in cognitive neurology in Hyderabad, Kolkata and Bangalore in India, as well as in Beijing, Ulan Bator, Havana and Cartagena.

We are in process of establishing local networks of expertise throughout the world as well as websites containing relevant information about cognitive tests available in different countries and languages. This will provide valuable information to practitioners wishing to establish cognitive clinics in their countries.

An important part of our strategy to be globally inclusive is to make sure that our meetings and courses are affordable to everyone interested. This is particularly relevant for the young neurologists, who we welcome into our group as members of Forum of Young Researchers (FYRE). At our last meeting in Hyderabad, the FYRE members were invited to stay free of charge with local families, a way of creating personal friendships as well as professional partnerships.

These activities belong to the very core of our mission. Our growing interaction with neurologists across the world made us increasingly aware of the importance of linguistic, cultural and social factors in the diagnosis and treatment of aphasia, dementia and cognitive disorders. The same disease, such as FTD, can present differently in different countries and cultures1—an observation that has to be taken into account when developing universally applicable diagnostic criteria. Likewise, cognitive tests cannot be applied across the world without being properly translated, adapted and validated. But the challenge of a global approach to cognitive disorders also brings opportunities.

Studies extending beyond the Western world can avoid certain confounding variables and contribute to new insights, as illustrated by recent research on the relationship between bilingualism and dementia2. Our courses and meetings highlight such topics, raise the awareness and offer practical advice and help to researchers as well as clinicians. We hope that in the future, while consolidating our programs in Asia and Latin America, we will be able to extend our activities further to encompass Africa.

The recent change in our name to the WFN Research Group on Aphasia, Dementia and Cognitive Disorders (RG ADCD) is the next, logical step in our group’s continuous development. The change was suggested at the World Congress of Neurology in Vienna and approved by the WFN  Nov. 1, 2013.

The new name reflects changes, which have happened in the group gradually over the past decades. A large number of our members focus their research on different types of dementia, in particular FTD1,3, as well as Alzheimer’s Disease and vascular dementia2.Our biennial meetings as well as our teaching courses cover many dementia-relevant topics, with a particular emphasis on cognitive assessment. Moreover, research on progressive aphasias, reflected in the recent diagnostic criteria4 brought together aphasias and dementias, highlighting clinical as well as biological connections between both disease groups.

We hope that the broader scope of our group will attract both scientists and clinicians from all over the world with an interest in research on aphasia, dementia or any other cognitive disorder.

If you are interested in joining the group or attending our biennial meeting in December 2014 in Hong Kong, contact thomas.bak@ed.ac.uk.

Bak and Manes are the chair and co-chair, respectively, of the WFN Research Group on Aphasia, Dementia and Cognitive Disorders.


  1. Ghosh A, Dutt A, Ghosh M, Bhargava P, Rao S. Using the revised diagnostic criteria for Frontotemporal Dementia in India: Evidence of an advanced and florid disease. PloS one. 2013;8(4):e60999.
  2. Alladi S, Bak TH, Duggirala V, Surampudi B, Shailaja M, Shukla AK, et al. Bilingualism delays age at onset of dementia, independent of education and immigration status.  Neurology. 2013;81(22):1938-44.
  3. Rascovsky K, Hodges JR, Knopman D, Mendez MF,  Kramer JH, Neuhaus J, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134:2456–2477.
  4. Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF et al. Classification of primary progressive aphasia and its variants. Neurology. 2011;76(11):1006-14.

WFN Online Services Reach Out to Gen-Y Young Neurologists

By W. Struhal and Prof. P. Engel

PrintYoung individuals born between 1981 and 1999 belong to Generation Y (Gen-Y). They are also called Digital Natives. In contrast to their parents belonging to the Baby Boomer generation, Gen-Y individuals are comfortable with the World Wide Web. They expect to find all information online, they rapidly adopt new online services and appreciate interacting digitally.  Residents and young neurologists are mainly now recruiting from this new generation. Gen-Y neurologists do show fundamental different knowledge acquisition strategies mainly focused on online resources, challenging not only online services, but also training and teaching1,2.

WFN has a fundamental interest in attracting these young neurologists to its organization and to including them in WFN’s activities and projects. In addition, WFN aims to support and foster active contributions of Gen-Y neurologists to the biannual world congresses of neurology (WCN).

To achieve this aim, the WFN Website Committee has extended its online footprint from website alone to social media. There are distinct differences between the online service of a website and  social media. A website provides one-directional information like other mass media (one sender-many recipients). In contrast, social media offers the opportunity to discuss a topic, add personal opinions or simply show that the topic is appealing by “liking” it (many senders-many recipients). While Baby Boomers  appreciate the mass media approach of a website, Gen-Y’ers are used to social media and  expect to have the chance to interact with information online rather than simply consume it. Another difference between websites and social media is that with websites users become aware of news published only if they revisit the website (the user comes to website content). On global organizations, users usually visit the website only infrequently and rather  search for specific content. Social media, in contrast, broadcasts news onto the social media of users, which for Gen-Y, are often smartphone based. This means that WFN has the chance to attract individuals to WFN content even when these individuals do not intend to visit the WFN’s website (website content comes to the user).

The Website Committee has decided to offer three different social media services via Facebook, LinkedIn and Twitter, under responsibility of Walter Struhal (@walterstruhal).




Facebook is the largest social media site with 1,110 million active users worldwide (by March 2013). It allows users to present a personal profile, to follow friends and organizations, exchange and “like” messages. Facebook is used by many individuals for personal networking. WFN has started a Facebook page, which currently has 1,456 followers (Dec. 14).

In preparation for the 2013 World Congress, WCN initiated a Facebook photo contest. The contest winner Daehyun Kim proposed to his girlfriend while he was collecting his prize — WFN wishes the couple all the best for a wonderful future together!


LinkedIn has 259 million active users worldwide (by June 2013) and offers similar services as Facebook. However, LinkedIn is aimed at individuals in professional occupations and is mainly used for professional networking. Users do present their affiliations and skills and interconnect with other professionals. Interconnecting is more restricted in LinkedIn, which tries to prevent interconnections between people who don’t know each other in real life. WFN has started a LinkedIn group, which currently has 864 members (December 14).




Twitter has 200 million active users worldwide (by February 2013) and has a different approach to social networking. In fact, it is rather a micro-blogging service, which allows users to write short messages with up to 140 characters. All messages are online and open to the public to read, even for non-members of the service. WFN currently has 346 registered followers (December 14). Interesting content on WFN’s social media services as well as lively discussions lead to a growing fan audience. We invite you and your residents to follow our social media footage.

Follow and interact with WFN on



  1. Elkind MSV. Teaching the next generation of neurologists. Neurology 2009; 72(7):657-663.
  2. Struhal W, Falup-Pecurariu C, Sztriha LK, Grisold W, Sellner J. European Association of Young Neurologists and Trainees: position paper on teaching courses for Generation Y. Eur Neurol 2011; 65(6):352-354.

Paroxysmal Diseases and PRRT2 Mutations

By Mark Hallett, MD, NINDS, Bethesda

Faculty at Changsha meeting.

Faculty at Changsha meeting.

The paroxysmal dyskinesias are rare familial disorders, but very dramatic.  There are three main types: paroxysmal kinesigenic dyskinesia (PKD), paroxysmal non-kinesigenic dyskinesia (PNKD) and paroxysmal exertional dyskinesia (PED).

PKD is typically precipitated by a quick movement, PNKD is precipitated by stressors such as coffee, tea and alcohol, and PED is produced after long periods of exercise.  In the past few years, the main mutations responsible for all three have been determined.  The gene for PNKD is myofibrillogenesis regulator 1, now called PNKD gene, and the gene from PED is the SLC2A1 gene that leads to GLUT-1 deficiency.  Only recently has the gene for PKD been found to be PRRT2.  As is often the case, when a gene has been found, some surprises emerge.

On Oct. 24, 2013, the Xiangya Hospital of Central South University in Changsha, China, held its Fifth Xiangya International Congress on the Clinical and Basic Research of Neurodegenerative Disorders focused on PRRT2 related diseases.  The basic phenotype of typical PKD cases had been refined by Louis Ptacek’s group in 2004, and this certainly helped in narrowing the gene search.  Already at that time, it became clear that there was a significant overlap between PKD and infantile convulsions.  At about the same time, two years ago, Bei-Sha Tang’s group from CentralSouthUniversity and Ptacek’s group from University of California, San Francisco, identified PRRT2 as the relevant gene.  Tang and his group as well as Ptacek came to the meeting.

Clinically, the PRRT2 mutation brings PKD and Benign Familial Infantile Convulsions (BFIC) together. Lu Shen, also from XiangyaHospital, discussed the clinical aspects of the BFIC cases.  Another significant phenotype is hemiplegic migraine, as discussed by Pierre Szepetowski from Marseille.  Zhi-Ying Wu from FudanHospital, Shanghai, widened the spectrum further by pointing out that PRRT2 mutations also have been seen in some cases of paroxysmal torticollis, episodic ataxia, childhood-absence epilepsy, febrile seizures, and  both surprisingly and confusingly, in cases of PED and PNKD.  Hence, while there is a most typical phenotype of PRRT2, it appears to be able to cause a variety of paroxysmal disorders, mostly in young persons.

Qing Liu from PekingUnionHospital, Beijing, speaking for Li-ying Cui, reported on SPECT neuroimaging in ictal attacks of PKD.  There have only been a few cases and findings are not completely concordant, but it appears that there is hypermetabolism of the basal ganglia or thalamus during an attack.  This confirms the general suspicion that the basal ganglia are the site of origin of PKD, but the nature of the abnormal activity is still unclear.  There was discussion as to whether this might be a subcortical seizure, but clearly more data would be needed to determine this.

Ptacek led the discussion about the basic cellular mechanism of PRRT2.  It is a novel protein and its role is not yet clear, but it interacts with SNAP-25.  SNAP-25 is a SNARE protein that plays a critical role in synaptic release mechanisms, and is well known by neurologists as the target for botulinum toxin type A.  He speculated that PKD might be a type of synaptopathy, a new general mechanism for paroxysmal disease, distinct from channelopathies, which cause other types of paroxysmal disorders.  He noted that the PNKD protein also plays a role in exocytosis at the synapse.

Thus, PRRT2 mutations can lead to a variety of paroxysmal diseases that at the meeting were referred to as the PRRT2-related paroxysmal diseases (PRPDs).  Taken all together, this class is not as rare as it might first appear.  Moreover, knowledge of the gene function is leading to a new general mechanism for paroxysmal disorders.

The meeting, organized by Hong Jiang of Xiangya Hospital, provided a worthwhile current synthesis of this field, which certainly will have more surprises coming.

Report of WFN CME

By S. M. Katrak, MD, DM, FRCPE

As president of the IndianAcademy of Neurology (IAN) (2004-2005), I was disturbed by the fact that the WFN sponsored CME program had a weak presence in Asia, particularly India.  This stimulated me to take over the reins as coordinator for this program in India.  As per the advice and guidelines provided by Ted Munsat, I initially started the program in Mumbai.  The first CME was held on July 17, 2005, on the topic of multiple sclerosis.  From the feedback given by the postgraduate students, it was evident that they enjoyed the CME and found it to be unique and useful.

Considering the success of the program in Mumbai, I decided to “export” the program to other centers in India.  I have received enthusiastic support from my colleagues in nine centers all over India: R. S. Wadia (Pune); C. S. Meshram (Nagpur); S. Prabhakar (Chandigarh); J. S. Kathpal (Indore); S. K. Jabeen/Subhash Kaul (Hyderabad); Mutharasu (Chennai); P. C. Gilvaz (Thissur); Birinder Paul/Gagandeep Singh (Ludhiana) and P. S. Gorthi (New Delhi). I would like to thank them for their support in making this program a success in India.

In all these centers, the postgraduates, young and senior neurologists and internists attend these CMEs depending on the topic of discussion.  Usually the postgraduates take up each chapter of the continuum highlighting the “take-home” messages.  They are usually coupled with a consultant who highlights the salient points and gives the Indian perspective because of the geographical differences in the pattern of neurological diseases.

It is difficult coordinating nine centers in India, but gentle reminders are sent to each coordinator at three- and six-month intervals about their “backlogs.”  What really works is a message that we owe the WFN and AAN a debt of gratitude for the gift of these issues of Continuum. Filling out the evaluations forms is just a small way of showing our appreciation. We have been able to get 659 evaluation forms for the year 2012 and 823 for the year 2013.

For the last two years, I got accreditation from the Maharashtra Medical Council (MMC), and they give two credit hours to every participant.  This is an added incentive to attend at least in Mumbai and the other two centers in the state of Maharahtra (Pune and Nagpur).

No program can be sustained without some financial support.  I was fortunate to get a generous grant from the Australian Association of Neurologists for a sum of $5,000 (Australia) in August 2005 and again in July 2006.  We have used these funds frugally to send the evaluation forms to the U.K. and to courier the journals to the various centers in India.  The balance funds are now low and soon we may need more funds.

We also are fortunate to get an unconditional educational grant from Intas Pharma, which has supported these CME session in many centers across India — particularly Mumbai. On behalf of the IAN, I would like to thank them for promoting neuro-education in India.  I also would like to thank Satish V. Khadilkar who shares the responsibility of coordinator with me in Mumbai with the view of taking over as coordinator for India in the near future.

Katrak is the national coordinator of WFN CME program in India.


By W. Struhal and Prof. P. Engel

WFNwebsite_tabletThe World Federation of Neurology (WFN) is a huge and complex structure, representing neurologists worldwide. To achieve its aim, many international neurologists collaborate and work on WFN projects, represent the organization as officers or serve as editors or authors for WFN media. These initiatives play an important role in advocating the interests of neurologists on a global scale.

You can follow all of these activities and more at www.wfneurology.org.


A major aim of WFN is supporting educational initiatives and encouraging global networking. The website provides a sound insight into WFN educational activities. These include WFN seminars in clinical neurology, which provide teaching and training materials and patient care guidelines. Exchange among young neurologists is encouraged by WFN through programs such as the Turkish Department Visit, and available grants and awards for young neurologists interested in extending their training internationally. Reports are published on projects such as the Zambia Project, which aims to improve medical care in Zambia. Young neurologists are encouraged to participate in the WFN, and the website lists representatives of young neurologists. A singularly interesting section is neurology for non-neurologists, which provides educational materials for areas where there is a severe shortage of neurologists.

WFNWorldNeuro_ComputerBringing worldwide science  and patient care closer together is a strong objective of the WFN. At  www.wfneurology.org, you will find details on the World Brain Alliance, an umbrella group of international neurological organizations.  WFN applied research groups organize scientific projects and educational activities in neurology subspecialties, and publish their activities on the website on an annual basis.

Some additional important topics presented at www.wfneurology.org:

  • WFN initiatives (e.g. the WFN Africa Initiative)
  • Candidates for 2013 election, including the president of WFN
  • WFN officers, national WFN delegates, WFN regional directors

Do you want to keep up to date?

The WFN website provides insights into our organization, but it offers more than that. Neurology news of major global importance is published in WFN’s publication World Neurology (www.worldneurologyonline.com). Because one aim of the WFN web strategy is to establish direct interaction with its users, social media channels are offered. You may follow WFN updates and actively exchange your thoughts with WFN on Facebook (www.facebook.com/wfneurology), Twitter (www.twitter.com/wfneurology), or the World Federation of Neurology LinkedIn group (linkedin.com). You can use these social networks to interact and get to know other participants of the XXI World Congress of Neurology in Vienna – the first World Congress where social media channels were offered. For Twitter users, please follow our official hashtag (#) and don’t hesitate to use it in your tweets: #WCNeurology.

Aims and vision of the WFN website

The WFN website and WFN digital footprint comprise a platform for neurologists who advocate neurology through WFN initiatives and projects, and inform the public on activities of WFN. Social media platforms offer the prospect of increased online interactivity and the hope that neurologists worldwide will interconnect more. The future vision is that these digital resources will help to build a strong network of neurologists worldwide and strengthen scientific collaboration in neurological research and services.

We warmly invite you to visit www.wfneurology.org.

In Memoriam: Ted Munsat

By John Walton (Lord Walton of Detchant) Kt, TD, MA, MD, DSc, FRCP, FMedSci

John Walton

John Walton

Ted Munsat was a close and much-valued friend whom I admired as a man, as a neurologist, as a teacher, and as an administrator and lifelong supporter of the World Federation of Neurology.  I first met him many years ago (more years than I can remember with accuracy) when we both attended a conference in the United States on neuromuscular disease. I recognized at once that here was a man of outstanding ability and exceptional merit.  Subsequently, we corresponded, and I think we even wrote one short paper together.

But perhaps my memory is sharpest of the time that he came to spend a year in my department in Newcastle. During that time, working with Peter Hudgson and others, he did some important original work leading to the publication of a number of papers, and he was widely respected and admired by the junior staff and by those working in research in the Muscular Dystrophy laboratories.

He was an immensely approachable man, full of advice and sensible comments.  His contributions to the department’s work were exceptional, and I remember how proud he was when his young son took up soccer at a Newcastle school and ended up playing for the junior first team, where he was regarded as one of its stars.

Subsequently, I kept in close touch with him when he became head of department in Boston, and I forgave him, eventually, for stealing Walter Bradley from Newcastle to work with him, before Bradley went off to independent chairs, first in New Hampshire and later in Miami.

We continued to keep in close touch, and I was impressed with the work that he did on various WFN committees, and above all his contributions to continuing education in neurology through the publication of Continuum.

His wife Carla was a great charmer with a wonderful, twinkling attitude about life.  They loved the social life in Newcastle, and later still, I met them both on many occasions at international meetings, and shared not only reminiscences but also their joint views about the future of neurology on a worldwide scale.  Munsat has left a mark on international neurology that can never be erased, and he will be remembered by all who knew him with respect, pleasure and affection.