President’s Column: The Way Ahead

By Raad Shakir

Raad Shakir

Raad Shakir

It is an honor to write to you as the 10th president of the WFN.  I follow a long and distinguished line of presidents over the past 56 years.  Each president has complemented and strengthened the work of his predecessor and added his own touch to maintain the upward curve of our federation and carry on the torch of neurology.  Our history is indeed illustrious and glorious thanks to their achievements.  It was a great opportunity to have four previous presidents join me in Vienna.  (See photo on page 14.) Unfortunately, James Toole was unable to join us.  The contributions and wisdom of all of our presidents will be our guide for the future.

Our predecessors have laid out the path. As president, I will move full speed ahead with determination to carry out the tasks entrusted to me and to all the trustees.  The newly elected officers — William Carroll (Australia) as first vice president and Wolfgang Grisold (Austria) secretary-treasurer general — have vast experience and the zeal to work.  Gallo Diop (Senegal) is the first sub-Saharan African trustee, and he will add another dimension to the group.

Since my first involvement with the WFN over 33 years ago, I have learned that the way to make progress is to bring neurologists together, and to respond to their requests to be put in touch with colleagues.  In an electronic world, communication is instantaneous and those with ideas may be anywhere in that world. To provide access to others with similar interests but who perhaps live in communities where the technology and financial support is  different is what the WFN is all about.

My task and that of my fellow trustees is huge and daunting.  As I said in my election statement, my plan is to involve all societies and their members in our activities. This will need openness and transparency to achieve inclusivity and collaboration. Transparency of our decisions is vital and will be adhered to in the years to come. As new trustees, our plan of action will be formulated in the first year of office, and we will fulfill our responsibilities with the diligence that the Council of Delegates expects of us.  At least for me, and I hope for the WFN, the elections in Vienna were a turning point toward Global Involvement Through Regional Empowerment.  This in my opinion is crucial for the future success of the WFN.

We now live in a world of change both in our scientific understanding of our speciality and the need for cooperation between all our six regions.  Many will need to interact closely with each other for advancement of their scientific progress, education, training and provision of care to patients. This needs an organizer, a go-between, a fixer, and the WFN can and should be all of that.

Front Row (L-R): Jun Kimura (2002-2005); Lord Walton of Detchant (1990-1997); Johan Aarli (2006-2009) Back Row (L-R): Vladimir Hachinski (2010-2013); Raad Shakir (2014-2017)

Front Row (L-R): Jun Kimura (2002-2005); Lord Walton of Detchant (1990-1997); Johan Aarli (2006-2009) Back Row (L-R): Vladimir Hachinski (2010-2013); Raad Shakir (2014-2017)

Collaboration through WFN member societies is possible because we all have the ability to help each other and strong reasons to do so.  Moreover, our neurology specialty associations are also strong and willing to participate. This is the way forward.

The newly elected trustees started work in earnest in January by holding a first meeting at the headquarters in London.  It brought together the regional directors and chairs of initiatives, and will culminate in the reconfiguration of our committees.  The work will begin immediately.  I think that the outcome will determine our future for the next four years.  I am under no illusion about the seriousness of the task ahead but with widespread advice and participation, I am confident we will identify the priorities for the future.

The WFN is but one of the organizations necessary to achieve these goals. It will do its best to be the catalyst and listen to all stakeholders.  We have inherited a wonderful set-up from all our predecessors, and we should rise to the challenge to harness our legacy and add as much as we can with everyone’s support.

As secretary-treasurer general for the last seven years, I have learned that change is important and necessary, but in order to be implemented successfully it has to have relevance and be introduced with the agreement of the stakeholders. This will be possible with the involvement of all our members. The new trustees have made clear commitments in their manifestos, which were clearly endorsed by the Council of Delegates.  We will all work, consult, have our different points of view and then come to the appropriate collective conclusions.  We will all work hard to justify the trust placed in us.

Delegate Vote and Election Results

By Keith Newton, WFN Executive Director

Raad Shakir

Raad Shakir

Almost 80 delegates and representatives assembled Sept. 22, 2013, in Vienna, for the Annual General Meeting of the Council of Delegates.  They arrived for registration to be greeted by a colorful oriental display from the three cities bidding to host the 2017 World Congress of Neurology — Hong Kong, Kyoto and Seoul.

The importance of the occasion was evident to everyone, even more so because, in addition to the selection of the WCN 2017 venue, delegates were asked to choose three new officers and one new elected trustee.

William Carroll

William Carroll

As well as presentations from the three member societies, delegates heard an assessment from the Federation’s Professional Congress Organizer (PCO) and received reports from members of the site visit team to help them make up their minds.  It was a difficult choice, but eventually Kyoto won the day.

Just as keenly contested were the elections for officers and trustee, where 11 highly qualified candidates from across the globe stood for President, First

Vice President, Secretary-Treasurer General and Elected Trustee.  All of them addressed the assembly to present their vision and goals if elected.  Ballot papers were collected and counted outside the meeting by WFN Executive Director Keith Newton with assistance from Austrian Society Executive Secretary Tanja Weinhart, under the close supervision of WFN Past President Johan Aarli and EFNS Vice President Marianne de Visser.  The results, announced at the close of the meeting, were:

Wolfgang Grisold

Wolfgang Grisold

  • WFN President, Raad Shakir (UK)
  • WFN First Vice President, William Carroll (Australia)
  • WFN Secretary-Treasurer General, Wolfgang Grisold (Austria)
  • WFN Elected Trustee, Amadou Gallo Diop (Senegal)

 

vote

Delegates also received reports from officers and committee chairs, including chairs and co-chairs of the Education and Applied Research Committees.  The former gave a PowerPoint presentation of the activities of the Education Committee, including the development of standard operating procedures for committee activities, such as the monitoring of educational grants, departmental visit programs, and teaching center accreditation.  Donna Bergen, chair of the Applied Research Committee, reported that new Applied Research Groups have been established on coma, neuro-oncology and neuro-infectious diseases.

The Membership Committee has proposed the introduction of a category of Pending Membership to speed up the process of assimilating new societies into the Federation.  Only voting rights will be temporarily withheld until all formalities are completed.  This year, three new societies joined the WFN — Oman, Tanzania and Uzbekistan — bringing the total number of neurological associations in the organization to 117.

Amadou Gallo Diop

Amadou Gallo Diop

Regional Initiatives in Africa, Asia and Latin America have already begun to lay the foundations for the future and look set to build on them under the next administration now that Raad Shakir has promised “Global Involvement Through Regional Empowerment.”

By common consent, the Vienna Congress was a resounding success.  Planning for Chile 2015 has already begun; Kyoto, Japan is our destination in 2017; and members are now urged to think ahead to 2019, when we return to the region of Africa or the Middle East for our biennial World Congress of Neurology.

Nano-Neuromedicine

By Girish Modi and Viness Pillay

Figure 1. Different type of nanomaterials for biomedical use. Nanomaterials are commonly defined as objects with dimensions of 1-100 nm, which includes nanogels, nanofibers, nanotubes and nanoparticles (NP). In this illustration is represented the morphology of the most commonly used NP for therapy and diagnosis of neurodegenerative diseases (ND). (Ref. 3; reproduced with permission from Elsevier B.V. Ltd. © 2012.)

Figure 1. Different type of nanomaterials for biomedical use. Nanomaterials are commonly defined as objects with dimensions of 1-100 nm, which includes nanogels, nanofibers, nanotubes and nanoparticles (NP). In this illustration is represented the morphology of the most commonly used NP for therapy and diagnosis of neurodegenerative diseases (ND). (Ref. 3; reproduced with permission from Elsevier B.V. Ltd. © 2012.)

Nanotechnology employs engineered materials or devices (nanomaterials) with the smallest functional organization on the nanometer scale (1–100 nm) that are able to interact with biological systems at the molecular level1. They stimulate, respond to and interact with target sites to induce physiological responses while minimizing side effects1. By definition, nanomaterials are natural, incidental or manufactured materials containing particles (nanoparticles), in an unbound state or as an aggregate or as an agglomerate2. There are various methods of preparation of nanoparticles such as emulsion polymerization, interfacial –polymerization, –polycondensation, or –deposition, solvent –evaporation and –displacement, salting-out and emulsion/solvent diffusion, to name a few. There are several different types of nanostructures. These include polymeric nanoparticles, nanocapsules, nanospheres, nanogels, nanosuspensions, nanomicelles, nanoliposomes, carbon nanotubes and nanofibers3  (See Figure 1.)

Nanoparticulate matter and related materials possess an inherent capability to efficiently and effectively cross the blood brain barrier (BBB) leading to an increased concentration of encapsulated bioactives and drugs in the cerebrospinal fluid (CSF). In addition to drug delivery, this BBB crossing ability of the nanoparticles can be employed to develop various real-time diagnostic tools.

Promising features of nanosystems in targeted CNS drug delivery are that

  • their chemical properties can be easily modified to achieve organ-, tissue-, or cell-specific and selective drug delivery
  • the delivery of the drugs can be  controlled
  • they increase the bioavailability and efficacy of incorporated drugs by masking the physicochemical characteristics and thus increase the transfer of drug across the BBB
  • they protect incorporated drugs against enzymatic degradation
  • they have fewer side effects.1
Figure 2. The neurovascular unit (bottom right panel) regulates the dynamic and continuous crosstalk between circulating blood elements and brain cellular components, including perivascular macrophages, astrocytes and neurons. At the interface between blood and brain (the blood-brain barrier), endothelial cells and associated astrocytes are stitched together by structures called tight junctions. The blood-brain barrier hinders the delivery of many potentially important diagnostic and therapeutic drugs to the CNS. The barrier results from the selectivity of the tight junctions between endothelial cells in the blood vessels that restricts the passage of solutes. Astrocyte cell projections called astrocytic feet surround the endothelial cells of the blood-brain barrier, providing biochemical support to those cells. The pericytes shown in this figure are undifferentiated mesenchymal-like cells that also line and support these vessels contributing to the complex layering of cells forming the blood-brain barrier. Nanocarriers (top right panel) are materials that can be configured into several different shapes (tubes, spheres, particles, rods, etc.) and can be loaded with drugs for sustained delivery to specific sites that are targeted by coating the surface of the material with peptides. In this figure, the nanocarrier contains a therapeutic drug, a targeting peptide to increase the penetration of the drug into the brain tissue and a functionalized surface consisting of, for example, an antibody to target a specific antigen or a steric coating made of polyethylene glycol or dextrans. Active targeting (left panel) enhances the biodistribution of drug-loaded nanocarriers in the brain tissue, improving the therapeutic efficacy of drugs. Once particles have extravasated in the target tissue, the presence of ligands on the particle surface facilitates their interaction with receptors that are present on target cells resulting in enhanced accumulation and cellular uptake through receptor-mediated processes (Ref. 4; reproduced with permission from Nature Publishing Group © 2009)

Figure 2. The neurovascular unit (bottom right panel) regulates the dynamic and continuous crosstalk between circulating blood elements and brain cellular components, including perivascular macrophages, astrocytes and neurons. At the interface between blood and brain (the blood-brain barrier), endothelial cells and associated astrocytes are stitched together by structures called tight junctions. The blood-brain barrier hinders the delivery of many potentially important diagnostic and therapeutic drugs to the CNS. The barrier results from the selectivity of the tight junctions between endothelial cells in the blood vessels that restricts the passage of solutes. Astrocyte cell projections called astrocytic feet surround the endothelial cells of the blood-brain barrier, providing biochemical support to those cells. The pericytes shown in this figure are undifferentiated mesenchymal-like cells that also line and support these vessels contributing to the complex layering of cells forming the blood-brain barrier. Nanocarriers (top right panel) are materials that can be configured into several different shapes (tubes, spheres, particles, rods, etc.) and can be loaded with drugs for sustained delivery to specific sites that are targeted by coating the surface of the material with peptides. In this figure, the nanocarrier contains a therapeutic drug, a targeting peptide to increase the penetration of the drug into the brain tissue and a functionalized surface consisting of, for example, an antibody to target a specific antigen or a steric coating made of polyethylene glycol or dextrans. Active targeting (left panel) enhances the biodistribution of drug-loaded nanocarriers in the brain tissue, improving the therapeutic efficacy of drugs. Once particles have extravasated in the target tissue, the presence of ligands on the particle surface facilitates their interaction with receptors that are present on target cells resulting in enhanced accumulation and cellular uptake through receptor-mediated processes (Ref. 4; reproduced with permission from Nature Publishing Group © 2009)

Taking these benefits into consideration, nanotechnology has immense potential such as in the field of neuromolecular diagnostics, discovery of neurodegenerative markers, nano-enabled drug delivery and neuroactive discovery with implications reaching to the prevention, management and treatment of neurological disorders.

In terms of delivery across the BBB, two basic approaches, namely the molecular approach and the polymeric carrier approach can be applied. In the molecular approach, nanonization or ligand attachment of the drugs can be employed to target brain cells, and the drugs can further be enzymatically activated afterward inside the target cell4. However, the availability of such modifiable drugs is low, and only certain drugs with specific functionality can be targeted molecularly. Additionally, a metabolic pathway is always required to activate these drugs inside CNS — further narrowing the options. The second approach of employing polymeric carriers such as drug-loaded nanoparticles can be termed as a universal approach with flexibility of choosing the matrix or polymer system and additionally can be administered by the route of choice: intravenously, intrathecally or as an implantable cerebral device.  (See Figure 2.)

In this way, the BBB can be circumvented via systemic administration or CNS implantation with an ability to control as well as target the release of various bioactive agents used in the treatment of neurodegenerative disorders (NDs). The majority of nanotechnological drug delivery systems for the treatment of NDs are in the form of polymeric nanoparticles. Polymeric nanoparticles are promising for the treatment of NDs as they can pass through tight cell junctions, cross the BBB, achieve a high drug-loading capacity, and be targeted toward the mutagenic proteins.

Specific nanosystems explored for advanced experimental treatment of Alzheimer’s disease (AD), Parkinson’s disease and other CNS disorders are listed in Table 1.

Nano-enabled systems in the form of biodegradable and non-biodegradable templates for regeneration of damaged neurons and peptide-based self-assembling molecules have been employed as scaffolds for tissue engineering, neuroregeneration, neuroprotection and photolithography etching5. Nanoparticulate strategies in the form of bioactive nanoparticles are being employed to provide resealing, repair, regeneration, restoration and reorganization of neural tissue after traumatic spinal cord injury. Nanoparticles are capable of achieving this via the control of secondary injury cascade, reassembly of the tethered membranous structures, creating a neuropermissive microenvironment, rebooting the neuropathophysiologica; connections, and recovery of the sensorimotor responses6,7  (See Figure 3.) Silva and co-workers, 2004, reported the potential of self-assembling peptide nanofibers (SAPN) in neural tissue engineering wherein the nanofibers provided the “neurite-promoting laminin epitope  IKVAV,” thereby inducing a rapid differentiation of cells into neurons via the amplification of bioactive epitope presentation and further restricting the development of astrocytes8.

The current therapeutic paradigms (using conventional drug delivery systems) employed to provide functional recovery in NDs lack adequate cyto-architecture restoration and connection patterns required to overcome the restrictive blood-brain barrier. In addition to the restrictive blood brain barrier; the neuroactive drug therapies present various other challenges such as:

  • higher doses are required to provide significant therapeutic benefit
  • low bioavailability further aggravating the first condition
  • poor absorption even after systemic delivery
  • the unwanted severe side-effects due to preferential uptake of drugs by peripheral cells.
Applications of nanotechnology in clinical neuroscience. Nanotechnology can be used to limit and/or reverse neuropathological disease processes at a molecular level or facilitate and support other approaches with this goal. (a) Nanoparticles that promote neuroprotection by limiting the effects of free radicals produced following trauma (for example, those produced by CNS secondary injury mechanisms). (b) The development and use of nanoengineered scaffold materials that mimic the extracellular matrix and provide a physical and/or bioactive environment for neural regeneration. (c) Nanoparticles designed to allow the transport of drugs and small molecules across the blood-brain barrier (Ref. 7; reproduced with permission from Nature Publishing Group © 2006.)

Applications of nanotechnology in clinical neuroscience. Nanotechnology can be used to limit and/or reverse neuropathological disease processes at a molecular level or facilitate and support other approaches with this goal. (a) Nanoparticles that promote neuroprotection by limiting the effects of free radicals produced following trauma (for example, those produced by CNS secondary injury mechanisms). (b) The development and use of nanoengineered scaffold materials that mimic the extracellular matrix and provide a physical and/or bioactive environment for neural regeneration. (c) Nanoparticles designed to allow the transport of drugs and small molecules across the blood-brain barrier (Ref. 7; reproduced with permission from Nature Publishing Group © 2006.)

The introduction and application of nanotechnological strategies may help in overcoming and even completely removing these neurotherapeutic challenges5.

Although various studies have claimed and demonstrated the potential of nanoparticles for CNS targeting, drug release and even gene delivery, rapidly biodegradable poly(butylcyanoacrylate) (PBCA) nanoparticulate system is the only successful nano-based drug delivery system that is being employed for the  in vivo administration of drugs targeted to the brain. However, the mechanism of performance of this successful system has not been confirmed yet with three different reports stating entirely different mechanisms:

  1. polysorbate 80 coated PBCA nanoparticles reportedly cross the BBB via a carrier based approach by plasma adsorption of apolipoproteins resulting in receptor-mediated endocytosis by brain capillary endothelial cells9
  2. Kreuter and co-workers, 2002, suggested phagocytosis or endocytosis by endothelial cells as the possible transport mechanism through the BBB10
  3. Vauthier and co-workers, 2003, suggested that nanoparticle adhere to the cell membrane with subsequent escape by the P-glycoprotein efflux system to reach the CNS11.

These contrasting reports may lead to delay in regulatory approval of these promising nanosystems, and hence, further research into the exact elucidation of the mechanism of nanoparticle transport across the BBB is required.

Nanoscale classes of neuroactives will widen the scope of therapeutic action beyond merely modifying transmitter function to include stem cell and gene therapies that could offer a more selective mode of targeting. Nanoresearch focused on the regeneration and neuroprotection of the CNS will significantly benefit from the parallel advances in neurophysiology and neuropathology research. Therefore, for nanotechnology applications in neurology and neurosurgery to come to fruition, the following need to be considered:

  • advancements in pharmaceutical chemistry and materials science that produce sophisticated synthetic and characterized approaches
  • advancements in molecular biology, neurophysiology and neuropathology of the nervous system
  • the design and integration of specific nano-enabled applications to the CNS which take advantage of the first two points.
  • If these areas are developed in an integrated and parallel manner, nanotechnology based applications for NDs may begin to reach the clinic. As with all therapeutic approaches, for the treatment of CNS disorders, the challenge of targeting the material, device or drug to the site where it is needed always remains. Therefore, in order for nanotechnology applications directed toward NDs to be fully exploited, it would be
    Table 1. Overview of various nano-enabled neurotherapies and interventions for CNS disorders (Ref. 5; reproduced with permission from Elsevier B.V. Ltd. © 2009.)

    Table 1. Overview of various nano-enabled neurotherapies and interventions for CNS disorders (Ref. 5; reproduced with permission from Elsevier B.V. Ltd. © 2009.)

    important for neurosurgeons, neurologists and neuroscientists to contribute to the scientific process along with pharmaceutical scientists and engineers. True to the highly interdisciplinary nature of this area of research, it is important that technological advancements occur in conjunction with basic and clinical neuroscience advancements5.

Modi is professor and head of Neurology, and the academic head of clinical neurosciences, Faculty of Health Sciences, University of the Witwatersrand. Pillay is professor of Pharmaceutics, Faculty of Health Sciences, University of the Witwatersrand.

 

References

  1. Modi G, Pillay V, Choonara YE. Advances in the treatment of neurodegenerative disorders employing nanotechnology. Ann NY Acad Sci. 2010;1184:154–172.
  2. Nanomaterials. http://ec.europa.eu/environment/chemicals/nanotech/faq/definition_en.htm (accessed on 20 November, 2013)
  3. Re F, Gregori M, Masserini M. Nanotechnology for neurodegenerative disorders. Nanomedicine: NBMedicine 2012;8:S51–S58.
  4. Orive G, Anitua E, Pedraz JL, Emerich DF. Biomaterials for promoting brain protection, repair and regeneration. Nat Rev Neurosci. 2009;10:682-692.
  5. Modi G, Pillay V, Choonara YE, Ndesendo VMK, du Toit LC, Naidoo D. Nanotechnological applications for the treatment of neurodegenerative disorders. Prog Neurobiol. 2009;88:272–285.
  6. Kumar P, Choonara YE, Modi G, Naidoo D, Pillay V. Nanoparticulate strategies for the 5 R’s of traumatic spinal cord injury intervention: restriction, repair, regeneration, restoration and reorganization. Nanomedicine, Manuscript accepted, In press, To be published in Feb 2014.
  7. Silva GA. Neuroscience nanotechnology: progress, opportunities and challenges. Nat Rev Neurosci.  2006;7:65-74.
  8. Silva GA, Czeisler C, Niece KL, Beniash E, Harrington DA, Kessler JA, Stupp SI. Selective differentiation of neural progenitor cells by high–epitope density nanofibers. Science, 2004;303:1352-1355
  9. Kreuter J, Ramge P, Petrov V, Hamm S, Gelperina SE, Engelhardt B, Alyautdin R, von Briesen H, Begley DJ. Direct evidence that polysorbate-80-coated poly(butylcyanoacrylate) nanoparticles deliver drugs to the CNS via specific mechanisms requiring prior binding of drug to the nanoparticles. Pharm Res. 2003;20: 409–416.
  10. Kreuter J, Shamenkov D, Petrov V, Ramge P, Koch-Brandt C. Apolipoprotein-mediated transport of nanoparticle-bound drugs across the blood–brain barrier. J Drug Target. 2002;10:317–325.
  11. Vauthier C, Dubernet C, Chauvierre C, Brigger I, Couvreur P. Drug delivery to resistant tumors: the potential of poly(alkyl cyanoacrylate) nanoparticles. J Control Release 2003;93:151–160.

Our Brains, Our Future

By Mohammad Wasay MD, FRCP, FAAN

There are many days related to neurological diseases being celebrated by professional organizations in collaboration with the World Health Organization, national organizations and local health ministries, including World Stroke Day, Epilepsy Day and Rabies Day. These days have proved 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. In 2012, Brazil, and in 2013, Sri Lanka won the competition creating a huge impact at the national level as well as the regional level. All of the days related to neurology are linked to neurological diseases.

A few years ago, Vladimir Hachinsky, then-WFN president, asked, “Why don’t we celebrate a day for the healthy brain?” The human brain is so fascinating and is so closely linked to the health of the 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 with the slogan: “Our brains, our future.” This was suggested by the Public Awareness and Advocacy Committee.

Because the World Federation of Neurology was established on July 21, the Public Awareness and Advocacy Committee suggested that World Brain Day should be celebrated on the same date. This proposal was announced at the WCN Council of Delegates meeting in September, and the proposal was received with a warm welcome by delegates; Hachinsky; Raad Shakir, WFN president-elect; Werner Hacke, WFN vice president; and other officials. 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 can we make it work better.

We should target to approach one billion people around globe to educate about the brain in 2014. Most activities will focus near World Brain Day but it is a year-long campaign.  National societies should plan activities aimed at young school and college students, and 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 organizations with the highest impact public awareness activities should be awarded.

We should especially focus efforts 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 Chinese, Spanish, French, Arabic, Hindi and German. We also could develop a 5-minute promotional video with a brief introduction of WFN in multiple languages. This video could be shared by millions through YouTube and Facebook. We have more than 140 member societies. If we are able to organize a few hundred programs on July 21 in all of those countries, it is bound to create an impact.

Complexity of brain and neurological diseases often becomes a barrier for public awareness. “You should speak plain when you speak brain,” said Keith Newton of 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 design 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, the International Brain Research Organization, the AmericanAcademy 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 WHO is important. If WHO adopts this day in the future, this could be a great success for WFN.

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

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.

 

References

  • 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.

 

References

  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.

References

  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

Facebook

Facebook

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

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

Twitter

Twitter

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

 

References

  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.