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, 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



  1. IndianAcademy of Neurology. Available at 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

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

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.

Featured Articles from JNS

John D. England

John D. England

By John D. England, MD

Beginning with this issue of World Neurology, we will feature an “Editor’s Selection” of articles from the Journal of the Neurological Sciences (JNS).  Elsevier, the publisher of JNS, has agreed to provide free access to these articles in PDF format to the members of the World Federation of Neurology.  Simply click on the PDF of the article to access it.

For this issue, we will feature two recent articles:

  • Andreas Steck and members of the Education Committee of the World Federation of Neurology (WFN) provide the results of a survey, which examined the current global state of training in neurology.  These results were compared with a previous survey done in 2006.  The paper outlines the areas where advances have occurred and also indicates areas where improvements are needed.  The findings provide important data which JNS_Magshould be helpful in guiding the future training of neurologists around the world.  The major disappointing aspect of the survey was that only 39 out of the 113 WFN member organizations provided answers to the survey.  Most respondents were from Europe and Asia.  Notable non-responders were Canada, France, India, Italy, Japan, United Kingdom and The United States.
    Manuscript # JNS-D-13-00728
  • Maria Nagel and others from the University of Colorado, U.S. present a remarkable case of a patient suspected of having giant cell arteritis (GCA) whose temporal artery biopsy was initially negative for GCA.  Further analysis demonstrated varicella zoster virus (VZV) antigen and VZV DNA in the temporal artery and adjacent skeletal muscle.  More extensive pathological analysis of temporal artery sections adjacent to those containing VZV antigen showed classic features of GCA.  These findings build upon the previous research from this group, which detected VZV in the temporal arteries of 5/24 patients with clinically suspected GCA.  Taken together, these findings raise important questions about the role of VZV in both suspected and proven GCA.  Manuscript # JNS-D-13-01090R1

We hope that this new feature of highlighted articles from JNS will be a useful addition for readers of World Neurology.

England is Editor-in-Chief, Journal of the Neurological Sciences.

Book Review: Breaking Down Neurophobia

By Sarah Matteson Kranick, MD

Sarah Matteson Kranick

Sarah Matteson Kranick

A recent study asked medical students and internal medicine residents to rate eight medical subspecialties with regards to the students’ feelings of competency and perceived difficulty.  The 150+ respondents identified neurology as the specialty in which they had least knowledge  (p<0.001) and was most difficult  (p<0.001).  [Winchuk AV BMC Medical Education 2010]

Similar studies in Europe and elsewhere have led to much consternation in the medical education literature over an emerging epidemic of “neurophobia.”  The demand for neurologists is predicted by the Workforce Task Force of the AAN to overtake supply by 2020, making “neurophobia” not just a problem for academic neurologists, but for all of primary medical education.  Primary care doctors will be increasingly called upon to triage, diagnose and treat neurological disorders at a time when subspecialization is increasingly common among neurologists.  How do we prevent “neurophobia” and increase the number of neurophiles among all of our medical students and medicine resident rotators?

BookReview_CvrThe new edition of “DeJong’s The Neurological Examination,” by William W. Campbell, will appeal to neurophiles.  It has been modernized in many ways — the four-color edition is much easier on the eye, for one thing.  There are more images accompanying the text, with clearer photographs and MRIs to supplement the clinical vignettes.

The text has been reorganized somewhat, but still follows the general neurological encounter as most of us practice it.  This book is longer than the prior edition by almost 200 pages, but the expanded material is primarily clinical in nature, and the neuroscience underlying these observations remain mostly the same.  Most of us in practice will appreciate the balance of anatomy and pathophysiology here, as we are typically consulting such texts when we have just seen a patient with bilateral cortical ptosis, for example, and we are trying to remember whether supranuclear cortical control of the levator muscles has a left or right predominance.  This is the sort of question Campbell answers for us time and time again, with a concise description of the anatomy involved.  The “voice” of this textbook will remind you of a favorite professor from residency, and makes me envious of Campbell’s students at USUHS.

Throughout this edition, links have been inserted to various videos of the neurological exam and clinical examples of abnormal neurological signs.  Having the Kindle edition would certainly make these (hyper)links easier to use, although some reviewers on Amazon have noted that the Kindle edition makes viewing tables less ideal.  Unfortunately, after typing in four examples of links from the print edition, I found non-working videos each time.  Future editions would benefit from a webpage devoted to accompanying videos, or a DVD included in the print version.

Frequently DeJong’s is described as a book for residents, fellows or practicing neurologists.  I agree that the level of detail is likely too much for medical students, and that basic neuroscience must be mastered before attempting to understand clinical neurology.  This textbook, however, can play an important role in medical education at all levels.

For many of us neurophiles, it was the detection of some abnormal neurological sign in a patient we saw as medical students that started our lifelong interest in neurology.  In the short span of a four-week clinical rotation, we cannot expect every student to have enough patient encounters to prevent neurophobia.  Showing them how we practice the neurological exam, and what resources we use to put abnormal findings into context, like this text, may break down some of the intimidation that surrounds our specialty.

Kranick is chief of Neurology Consult Service,  National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md.

DeJong’s The Neurological Examination
By William C. Campbell
830 pages

Parkinson’s Disease: Web-Based Education Program for Health Providers in Cameroon


Participants in the web-based program in Cameroon.

Due to rapid demographic changes, the prevalence of Parkinson´s disease (PD) is increasing in sub-Saharan (SS) countries.1  In contrast to developed countries, evidence suggests that most patients with PD are underdiagnosed and untreated, with markedly increased mortality and shortage of qualified personnel.2  In the last years, there has been renewed interest from the World Health Organization, telecomunications companies and medical associations about the use of telemedicine in Africa.3

To help increase access to care and to train providers around the world using technology, the International Parkinson´s disease and Movement Disorder Society (MDS) has sponsored pilot projects in care and education that can lay the foundation for reaching the majority of people with PD. In this regard, a telemedicine program for health providers has been developed at Hospital Laquintinie in Douala, a 3 million inhabitants city of Cameroon.

The course is a web-based program that will provide participants with access to specialized education in the field of movement disorders, which is currently unavailable in their region. Local neurologists and professors at the University of Douala, including Jacques Doumbe, MD, chairman of the Department of Neurology (Hospital Laquintinie), and Erero Njiengwe, PhD (University of Douala) have significantly contributed to the implementation of this course at Hospital Laquintinie in Doula, Cameroon.

The course consists of 12 lectures over the course of a year, which will connect participants with experts in the field of movement disorders using live video, slides, chat and audioconferencing.  The participants will have the opportunity to receive MDS membership and its benefits, including special education to certify them to use the MDS rating scales.  Two courses have been launched — one designed for doctors (neurologists, neurology residents, primary care and internists) and another one for other health professionals (nurses, physiotherapists and psychologists).

The course will be taught by professors from Hospital Universitario de Burgos, Hospital 12 de Octubre, Hospital Clinico San Carlos, Hospital Sant Pau and Hospital Central de Asturias all from Spain; Rush University Medical Center, Columbia University, Rochester University, all in the United States, Parkinson Victoria Association, Health Sciences University all in Australia,Hospital Universitario Asturias, Spain,  North Tyneside General Hospital in Great Britain and Hospital Galway and Parkinson Galway Association in Ireland. The main objectives of this pilot telemedicine education program will be to analyze the feasibility and adherence from participants, as well as satisfaction of users.

However, telemedicine for PD strategy development in Africa is challenging.  It is still expensive, and most of the SS countries have inadequate and communication technologies infrastructure, which creates difficult implementation and little access to the population. Telemedicine also needs to demonstrate success and sustainability, and this type of initiative has to survive beyond the end of the initial funding period.  Therefore, networking provides opportunities to spread the cost of infrastructure of telemedicine development between the local governments, business, foreign education providers and health sectors; therefore the cost burden should not be borne by just one sector.  Telemedicine for PD should be recognized to remove or at least mitigate the barriers that society and physical geography imposes, especially rural areas in Africa, and to be culturally appropriate if they are to be adopted and sustained.



  1. Dotchin CL, Msuya O, Walker RW. The challenge of Parkinson’s disease management in Africa. Age Ageing 2007;36:122-7.
  2. Dotchin C, Walker R. The management of Parkinson’s disease in sub-Saharan Africa. Expert Rev Neurother;12:661-6.
  3. Scott RE, Mars M. Principles and framework for eHealth strategy development. J Med Internet Res. 2013 Jul 30;15(7):e155. doi: 10.2196/jmir.2250.


Esther Cubo MD, PhD

Academic Collaborators

Jacques Doumbe, MD; Erero Njiengwe, PhD; Sixto Cubo, PhD

Computer Engineers Team 

Centro Servicios Avanzados (CSA), Burgos (Spain), Paul Onana, Computer Engineer, Douala (Cameroon)

Faculty Members 

Ray Dorsey, MD; Christopher G. Goetz, MD; Katie Kompoliti, MD; Leo Verhagen, MD, PhD; Ellan Louis, MD; Richard Walker, MD; German Moris; Maria José Catalan, MD, PhD; Emily Wang, PhD; Meg Morris, PhD; Victor McConvey, RN; Antonio Campolungo, RN; Marie Cahill; Patrick Browne, RN; Jose Maria Trejo Gabriel y Galán MD, PhD


International Parkinson´s disease and Movement Disorder Society, through the Telemedicine Task Force


Neurology Training for Non-Neurologists in West Africa Sept. 15-18, 2013

Organizers of the neurology training: Albert Akpalu (left), Korle Bu Teaching Hospital in Accra, Ghana, and Roberto Cilia, Parkinson Institute, Milan, Italy.

Organizers of the neurology training: Albert Akpalu (left), Korle Bu Teaching Hospital in Accra, Ghana, and Roberto Cilia, Parkinson Institute, Milan, Italy.

This course was jointly funded by the Movement Disorder Society (MDS) and the World Federation of Neurology. Additional co-sponsors were the Fondazione Grigioni per il Morbo di Parkinson (Italy) and the Society of Worldwide Medical Exchange (U.S.). This was the first neurology course designed for medical doctors who are not specialized in neurology. It was also open to neurologists interested in training in the field of movement disorders and dementia.

Participants were invited from throughout West Africa. Thirty-six participants attended the course, from Ghana (24), Nigeria (6), Sierra Leone (3), Gambia (2), and Cameroon (1).

The international faculty consisted of 16 international and local members, including neurologists, geriatricians, nurse specialists, a neuropsychologist, a physiotherapist, a nutrition specialist and a general practitioner from rural Ghana. The opening ceremony included guests such as the representative of the Minister of Health and of the nursing system in Ghana, the Italian Ambassador in Ghana, the chairman of Internal Medicine Department of the Teaching Hospital in Accra.

The course was run in English and included slide presentations and practical sessions with assessment of patients. Slide sessions focused on Parkinson’s disease (PD), dementia and other neurodegenerative disorders, covering epidemiology, diagnosis, pharmacological and non-pharmacological therapy. For the practical sessions with patients, participants were divided into small groups of five to six each, under the guidance of a faculty member, aiming to teach how to perform a neurological examination, neuropsychological scales screening for global and frontal-lobe cognitive functions and examples of physical therapy focused on gait and balance. Twelve patients attended these sessions, including PD, Lewy body dementia, Alzheimer’s disease and spino-cerebellar ataxia. In a session titled Bring Your Own Patient,” participants presented a patient from their own clinic and discussed with faculties the most relevant diagnostic and management challenges.

There were joint sessions with the PD Nurse Specialist Course, organized by Richard Walker (chair of the MDS Task Force on Africa).

Doctors and nurses had the opportunity to interact and share experiences about caring for patients. In particular, we included a Beyond the Neurologist session, dealing with the importance of a multidisciplinary approach to patients, especially in settings where medications are limited.

Educational material has been prepared and released for this course, including basic information about motor and non-motor features of PD and/or dementia. These booklets were drafted by different health care professionals (nurses, nutrition specialist, physiotherapists, neuropsychologists) and were full of pictures and photographs to be suitable for patients and caregivers with low education.

The course was a great success and participants’ feedback was positive in large part due to the practical sessions with patients and the interactive sessions. Each participant was given a DVD including all the slide presentations of the course, the UPDRS and the cognitive screening scales, the two educational booklets and photographs of the course. An email list was created including all the participants as well as the Italian and Ghanaian faculty, to share information and help in challenges of everyday clinical practice.

One of our aims was to make this course an opportunity to boost the education in the field of neurodegenerative disorders in developing countries. We promoted two initiatives:

  • The entire course was professionally videotaped to make it available online.
  • We provided two travel grants for the MDS events in 2014, the International Congress in Stockholm and the MDS summer school.

Course Organizers


Roberto Cilia (Italy);

Albert Akpalu (Ghana)

Teaching Center Update

By Wolfgang Grisold and Raad Shakir

Wolfgang Grisold

Wolfgang Grisold

The WFN mission is to foster quality neurology and brain health worldwide. One of the cornerstones of this mission is to sponsor and support worldwide concepts of education. This is the function of the WFN Education Committee. In addition to other valuable tools as congresses, symposia, departmental visits and traveling fellowships.

The WFN has developed the concept of worldwide approved teaching centers. These centers should fulfill standards defined by the WFN in order to fulfill the role for training neurologists and perform this in a standardized internationally recognized manner.  Moreover, these centers will be able to train neurologists from low income countries to further their education and improve their clinical and research abilities.

Raad Shakir

Raad Shakir

Once these centers are approved, they can offer training  fellowships, in a neurological subspecialty as well as  a full  training program to produce neurologists who will go back and serve in their own countries. The WFN approval will therefore carry the stamp of international recognition on the status and performance of a training program.

The department visit process has been adapted from the UEMS (  department visitation process. This process assesses training centers, their hospital resources and equipment, and the training facilities, and has a system of assessing the opinions of all persons involved in the training process using standardized questionnaires. In addition to structured personal interviews, a randomly selected person from all groups is involved in the process. The analysis of the questionnaires and of the structured interviews are all part of the report, which also includes the activities of the hospital, access to other related fields (e.g., neurosurgery) and the completeness of the training program. The report concludes on the status of the present situation and also gives recommendations for further improvement and development.

The WFN Education Committee (Chair Steven Sergay and Co-Chair Wolfgang Grisold) has developed a structured and a well-organized questionnaire, which covers all aspects of a neurological training center.  Prior to any visit, the size, structure as well as the personnel are to be explored. In addition, residents, trainers and hospital staff will be asked to answer standardized questionnaires, aimed at various educational aspects.

The NeurologyCenter in Rabat was the first neurological center worldwide to apply for this status.

The WFN committee consisted of Wolfgang Grisold (trustee, co-chair of the Education Committee), Raad Shakir (then WFN secretary-treasurer general) and Riadh Gouider (president of the Pan African Association of Neurosciences Societies). The visitors were welcomed by the faculty of the hospital and academic members of RabatUniversity.  All information and facts about the hospital and the Moroccan neurology training system were presented.

The Rabat neurological department consists of several sections: an outpatient’s service which is closely associated with neurosurgery, neuroradiology, neuropathology and with the national center of rehabilitation and neurosciences.

The practical visit was guided through the neurological departments, as well as the laboratories, including histopathology, chemistry and genetics. During the visit, patients and trainees, as well as post-graduate and undergraduate students, were met and some questions and discussion were carried out.

The visit also included the electrophysiology laboratories, where practical teaching was observed. The associated departments of neurosurgery and neuroradiology were well equipped, modern CT, MRI, angiography suites and gamma knife were all observed.  There is also a newly adapted rehabilitation unit. The outpatient and emergency as well as the consultation system of the hospital were looked at in detail. The academic research unit of the university provides laboratories including an animal house with space for scientific cooperation, which are open to projects from the neurological department.

The structure of the visit was supplemented by interviews with residents, teaching professors and hospital staff. These interviews were performed in a standardized written format, which was distributed prior to the visit to faculty and current residents. In addition, three teachers and four residents were randomly selected and attended personal interviews. They were asked standardized questions. Also the director of the hospital was personally interviewed. The visiting WFN committee carried out the confidential interviews. A résumé was contained in the report.

Based on the visit, including discussions, there were presentations of the faculty, and detailed analysis of the various aspects of the department.  The visiting committee was fully satisfied that the Hospital Center Ibnou Sina, Rabat, is fully compliant with all aspects of a WFN training center. It will be able and willing to train not only its own national neurologists, but neurologists from Africa and elsewhere and will be providing one year fellowships, as well as a full four year training programs.

The concept of WFN teaching centers will be further developed, and the WFN website will provide a detailed definition of teaching centers, as well as the requirements, questionnaires and application details.  Being a WFN teaching center is a sign of excellence and clearly conveys international recognition of the teaching center in that it fulfills all of the criteria in its structure, equipment and the teaching facilities needed to participate in the important role of neurology education in the future.