An Important Year for Neurology

By Wolfgang Grisold

Wolfgang Grisold

Wolfgang Grisold

Welcome to this first issue of World Neurology in 2023. This newsletter is an important information instrument for the WFN, and each issue reaches at least 15,000 readers. I encourage members to use this instrument and submit news and important aspects regarding neurology in your region.

The year 2023 will be an important year for neurology, and for the WFN. The year will bring face-to-face meetings and personal encounters and will reveal how stable and useful our newly developed communication tools are. My prediction is that our communication has dramatically increased during the COVID crisis, and several aspects of electronic communication will remain. The issue of traveling is increasingly also discussed with environmental considerations, and the carbon footprint is increasingly important. The numerous worldwide crises have also complicated traveling and visa issues are gaining importance.

2023 will be the year of a World Congress of Neurology (WCN), this time in Montreal Canada, and follows the WFN concept of traveling with meetings from region to region. Canada is a region rich with research, concepts, education, and also very advanced neurology services. We are glad and honored that the Canadian Neurological Society is holding this congress with us, and we believe world congresses always have a positive effect in the regions to promote the awareness of neurology.

We are looking forward to the global participation and hope many delegates from all parts the Americas (as the hosting region) will be able to attend. We are aware of visa issues, and we appreciate that our hosts are doing the utmost to make the entry for members of societies from other global regions possible.

At the WCN, we will also see three elections: a new treasurer replacing Prof. Stark, a new trustee replacing Prof. Freedman, and the decision on the congress site 2027 in the Arab/African region. Both Prof. Stark and Prof. Freedman have served two terms in the WFN, and we are grateful for their continuous efforts.

For the WCN, from the practical point, the congress committees have created an interesting program with selected plenary lectures, scientific, and educational topics. We are glad to see that almost all participants from the global neurologic alliance are involved in the program, and the distribution of speakers includes more regional speakers than before.

Free lectures and guided poster sessions are waiting for your participation. Please look at the WFN and WCN congress site for the abstract submission. Again, please also check your travel possibilities and your visa requirements.

With the help of our professional congress organizer Kenes, we will add more interactivity in the congress, and we also will have several joint sessions with the WHO and members of the Global Neurology Alliance, such as the World Psychiatric Association and the World Federation of Neurosurgery, among others. The WFN educational subcommittee of “young neurologists” will organize two important sessions.

A patient day will be organized with the Canadian Neurologic Society (CNS), and the WFN is aiming to establish a global patient platform.

We are aware that traveling might not be easy for several reasons, yet there is need to make this congress available worldwide to all member societies. The WCN 2023 will have a virtual component, which will allow access to the program at low costs in low and low-middle income countries. Participation and dissemination of the developments in neurology are the main aims of the WCN. There will be reduced fees for low and low-middle income countries, and as always also congress bursaries will be available.

The WCN is one important aspect of the WFN’s activities, but there are others

Education: The work with educational activities progresses, and a department visit program for Asian candidates is being established by the Indian Academy of Neurology and will be announced soon.

We will continue the educational days, with the WFN day (which will be in December and devoted to neuropathies) and the joint (with the International Headache Society) IHS Headache Day in May. As a new addition, we are planning an educational day in cooperation with the Asian Oceanian Academy of Neurology (AOAN).

WHO and UN-ECOSOC: The cooperation with the WHO continues and, as in the last year, brain health and the implementation of IGAP are major tasks among others. This year’s World Brain Day (WBD) will be organized by regions in cooperation with the WFNR (World Federation of Neurorehabilitation) and is dedicated to “Brain health and disability.” Please follow WBD on the website, and we hope that all member societies will be able to contribute locally.

The global neurology alliance (GNA), consisting of world societies, specialist societies, regions, and the WFN specialty groups, will have a meeting at the WCN in Montreal. It is a powerful network, and the WFN will continue its efforts to cooperate with global societies and specialist societies.

Prof. Steven Lewis and I met with the president and other dignitaries of the World Psychiatric Association in Vienna in January (photo), to discuss future cooperations in regard to brain health and mental health.

The WFN wishes a successful and prosperous year in your region, and globally for neurology. •

Late AAN President Sacco Strengthened International Relationships

By Orly Avitzur, MD, MBA, FAAN

Ralph L. Sacco, MD, MS, FAHA, FAAN

The untimely passing of Ralph L. Sacco, MD, MS, FAHA, FAAN, has saddened not only his colleagues at the American Academy of Neurology, where he served as president from 2017 to 2019, but the wider world of neurology as well. Sacco succumbed from a brain tumor on Jan. 17, 2023, at his home in New York with his family by his side.

During Sacco’s term as AAN president, its international membership climbed from 7,000 to 8,000—a record representing 21% of total membership and 141 countries. The number of International Scholarships, enabling young physician recipients from around the world to receive a $2,500 scholarship to the AAN Annual Meeting, doubled from 15 to 30 and set the stage for an increase to 35 for the 2020 Annual Meeting.

Sacco also strongly supported the AAN International Subcommittee, charged with promoting and developing strategies focusing on outreach and education for neurology in resource-limited countries or regions of the world to facilitate better care for patients with neurologic disease. The subcommittee continues to focus on meeting the needs of our global members, including improved access to membership benefits in low and low-middle income countries and supporting scholarships to the AAN Annual Meeting.

The opportunity to represent American neurology and the AAN to the international community delighted Sacco. He and Academy leadership attended the World Federation of Neurology’s 23rd World Congress of Neurology in September 2017 in Kyoto, Japan. Cohosted by the Japanese Society of Neurology and Asian and Oceanian Association of Neurology, the event’s theme was “Defining the Future of Neurology,” a topic of great interest to Sacco. He was the regional representative and the AAN’s delegate to the general assembly meeting, and chaired the North American Regional Symposium, which focused on prevention and treating common neurologic conditions. He spoke on treatment and prevention of stroke.

In December 2018, he and AAN CEO Catherine M. Rydell, CAE, traveled to Israel, where he gave presentations at the Israel Neurological Association (INA) annual meeting about the AAN and stroke, his specialty, and shared the stage with Dr. David Tanne, president of the INA; Natan Bornstein, past president of the INA; and Dr. Martin Dichgans, president of the European Stroke Organization. He also met with Israeli dignitaries, including the Israeli Minister of Health Rabbi Yaakov Litzman and president of the Israeli Medical Association Prof. Zion Hagay. He enjoyed touring Jerusalem’s Old City, Tel Aviv, and Jaffa.

“We traveled together to Santiago, Chile; Kyoto, Japan; Lisbon, Portugal; Tel Aviv, Israel; and Amsterdam, the Netherlands; among others,” said Rydell. “Ralph and I always felt so welcomed at each and every international society gathering including those hosted by the World Federation of Neurology, the European Academy of Neurology, and other international conferences and meetings that were so honored to have Ralph there to lecture and advise. It was a joy to see him interact with professionals who admired his intellect, his welcoming demeanor, and his one-of-a-kind Sacco smile.”

Sacco attended annual meetings of the Mexican Academy of Neurology, most recently in November 2021 as chair of the AAN Academic Neurology Committee, where he shared how the AAN is helping academic neurology in the U.S. meet a variety of challenges from revenue and funding issues to research and student recruitment.

In June 2019, Sacco was interviewed by AAN staff about the successes, challenges, and opportunities during his recently concluded term as president. He spoke with great joy and at length about the AAN’s relationship with the international neurology community and its leading organizations.

“Although we are the American Academy of Neurology, we do have an international mission, and that’s been important, and prior presidents have really helped push that. We recognize that we only have so much in terms of revenue and we probably can’t especially alone solve the problems, for example, in places like Africa, where there is just a totally insufficient number of neurologists to meet the demands.

“So, a lot of the things that we do to meet the demands and to help with international mission include collaborations. Part of it was working with important other organizations—the World Federation of Neurology, that really does have a truly global mission. We have developed a very close working relationship with the leaders of the World Federation of Neurology, contributing financially and contributing our ideas and thoughts to help with their mission. Working with the European Academy of Neurology, for example, in the course that’s provided particularly for training young members in African nations. We have a great relationship to the Mexican Academy of Neurology. I happened to go to their meetings and developed a close relationship with the Mexican Academy of Neurology.

“Because of some personal relationships, I got to go to the Pan Arab United Neurological Societies’ meeting in Jordan, and that was great to actually work with that group. Also, we were invited to go for the first time to the Israeli Neurological Association. Through this collaborative relationship-building with these other organizations, I think the Academy can help meet the needs of its international mission.

“We also further developed the International Subcommittee under Jerome Chin [Jerome H. Chin, MD, PhD, MPH, FAAN] which is a subcommittee of our Membership Engagement Committee. We expanded the number of international scholarships. When we give out money to bring young people from other nations to come to our Annual Meeting, that has an incredible impact on their career. I can’t tell you the number of people out there who say that that was life-changing for them when they attended the Academy of Neurology. So that was helpful to expand the number.

“We provide Continuum® free to many countries where they’re underserved or under-financed, and that has had a major impact on getting them exposed to a high-quality information to improve their careers. So, there are many, many ways that we work both with other organizations and within the Academy to expand our international mission.”

Sacco was the chairman of neurology; Olemberg Family Chair in Neurological Disorders; Miller Professor of Neurology Public Health Sciences, Human Genetics, and Neurosurgery; executive director of the Evelyn McKnight Brain Institute; senior associate dean for Clinical and Translational Science, University of Miami, Miller School of Medicine; and chief of the neurology service at Jackson Memorial Hospital.

A graduate of Cornell University and a cum laude graduate of Boston University School of Medicine, Sacco received a master’s in epidemiology from Columbia University, School of Public Health. He completed his neurology residency training and postdoctoral training in stroke and epidemiology at Columbia Presbyterian in New York. He was previously professor of neurology, chief of Stroke and Critical Care Division, and associate chairman at Columbia University before taking his most recent position in 2007.

Sacco was an international expert in stroke epidemiology and health disparities. He was the founding principal investigator of the Northern Manhattan Study, the Florida Puerto Rico Collaboration to Reduce Stroke Disparities, and the Miami Clinical Translational Science Institute, as well as co-investigator of multiple other NIH grants. Sacco published extensively with over 1,000 peer-reviewed articles (h-index 109) in the areas of stroke prevention, treatment, epidemiology, risk factors, vascular cognitive impairment, human genetics, and outcomes and has been listed as a Web of Science Highly Cited Researcher since 2017.

He was the recipient of numerous awards, including the AAN Wartenberg Lecture, AHA Feinberg Award of Excellence in Clinical Stroke, the WSO Global Stroke Leadership Award, AHA Gold Heart Award, the NINDS Javits Award in neuroscience, and numerous named lectures.

Sacco was a fellow of both the Stroke and Epidemiology Councils of the American Heart Association, a fellow of the ANA, and an elected member of the Association of American Physicians and National Academy of Medicine. He was the first neurologist to serve as the president of the American Heart Association from 2010 to 2011.

Visit AAN.com/Sacco to learn more about this giant of neurology and to leave memories. •

First Pan-European University Course on Clinical Autonomic Neuroscience

The course is provided at the Danube University and supported by the European Federation of Autonomic Societies.

By Walter Struhal

Walter Struhal

The autonomic nervous system (ANS) regulates the synergistic action of all visceral organs and homeodynamic processes. ANS is involved in the course of many neurologic and systemic diseases. Recently, ANS involvement including postural tachycardia syndrome was identified to play a significant role in cases with post-COVID condition.

ANS diseases may cause various dysfunctions, for example, transient loss of consciousness, sweating disorders, digestion, and urinary and sexual function. Autonomic involvement may be generalized, or focal. It may involve central, and/or peripheral ANS structures. The transformation of this appealingly complex pathophysiology into a clinical picture helps to explain the patient’s symptoms, define the syndrome and initiate treatment. A number of therapies are well-investigated but “off-label.” Diligent transformation of literature research into state-of-the-art therapeutic strategies is therefore an important competence of a clinical autonomic neuroscientist.

European Program of Clinical Autonomic Neuroscience

The European Federation of Autonomic Societies (EFAS), together with the Danube University Krems, and the Karl Landsteiner University of Health Sciences have initiated the first Pan-European University Course to study techniques on bedside and lab investigations of ANS disorders and common strategies of therapeutic management. This academic postgraduate course takes one year and will be completed with a university diploma.

This program is open to medical doctors in training and specialists of all disciplines. This program is open for registration. Register now. •

From the Editors

By Steven L. Lewis, MD, Editor, and Walter Struhal, MD, Co-Editor

Steven L. Lewis, MD, Walter Struhal, MD

We’d like to welcome all readers to the February 2023 issue of World Neurology.

This issue begins with the President’s Column, where World Federation of Neurology (WFN) President Dr. Wolfgang Grisold describes the many international activities being planned by the WFN this year, including the work done with WHO and the UN, World Brain Day 2023, and the exciting plans for the World Congress of Neurology in Montreal in October.

Dr. Orly Avitzur, current president of the American Academy of Neurology, provides a heartfelt memorial piece dedicated to the late AAN President Ralph Sacco, who passed away last month and who touched the lives of so many neurologists and patients and whose dedication to international relationships will be one of many long-lasting legacies of his countless accomplishments.

This issue also features an important notice by the WFN Nominating Committee with a call for nominations for the positions of WFN Treasurer and WFN Elected Trustee. In another announcement, Dr. Struhal describes the first pan-European university course on clinical autonomic neuroscience at Danube University, supported by the European Federation of Autonomic Societies. Dr. Carlos N. Ketzoian then reports on the highly successful Ninth International Course of Neuroepidemiology that took place in Erice, Italy, this past November.

In this issue’s History article, Dr. Peter J. Koehler provides an informative and remarkably thorough overview of the historical dignitaries memorialized by the many named lectures at the World Congress of Neurology (WCN). Dr. Augustina Charway-Felli and Dr. Amadou Gallo Diop report on the outcome of the biennial Francophone contest held at the headquarters of the African and Malagasy Council for Higher Education, and the significance of this event with regard to growing the African neurological and scientific workforce with these successful candidates.

Dr. Vladimir Hachinski, a past president of the WFN, provides an overview of the importance of dementia prevention in global efforts to reduce the impact of this highly prevalent entity, which is increasing in overall incidence worldwide.

Four articles represent thoughtful and well-illustrated reminiscences by four young neurologists from sub-Saharan Africa who participated in the WFN Department Visit Programs in Austria (Graz, Innsbruck, and Salzburg) and Germany (Leipzig). We would like to add our deep thank you to the neurologic societies in Austria and Germany for their wonderful support, hard work, and attentiveness in making these observerships a success, increasing the exposure of high-level neurologic infrastructure to these young neurologists to inform and enhance their clinical practices.

Dr. Tissa Wijeratne and Dr. David Dodick (Co-Chairs of World Brain Day) and Dr. Lewis and Wolfgang Grisold next report on the plans for this year’s World Brain Day 2023, which will be dedicated to “Brain Health and Disability. It will include collaborations between the WFN, our global regions, national neurologic societies, and the World Federation of Neurorehabilitation.

Finally, Dr. Richard Stark, WFN Treasurer and past chair of the WCN Tournament Committee, provides historical background about the Tournament of Minds at the World Congresses of Neurology (WCNs), with an announcement about this year’s Tournament of Minds. The tournament will be held at this year’s WCN in Montreal in October, welcoming and pitting department teams from around the world to compete in this exciting and well-loved component of the WCN.

In closing, we want to thank all readers for their interest in and attention to World Neurology. Please don’t forget to sign up for your free subscriptions online at worldneurologyonline.com. We sincerely hope everyone is marking their calendars, making plans to attend, and submitting their abstracts for the WCN in Montreal in October 2023. We look forward to seeing so many neurologists from around the world participate in this remarkable event. •

Report on the Ninth International Course of Neuroepidemiology: Methods and Clinical Applications

By Dr. Carlos N. Ketzoian

Participants in the Ninth International Course of Neuroepidemiology: Methods and Clinical Applications.

Last November, the ninth edition of the International Course of Neuroepidemiology:  Methods and Clinical Applications took place in Erice, Sicily, Italy, with the WFN’s endorsement.

An historical first course of neuroepidemiology was held in San Miniato, Pisa, Italy, in 1981, and was organized by Prof. Bruce Schoenberg.

Prof. Schoenberg passed away six years later. He laid the foundation for the development of neuroepidemiological research in different continents as a legacy. The activities that he promoted were oriented both to support researchers and to prioritize the training of human resources in this area of knowledge.

Almost 20 years after these historical events, Professors Walter Rocca (Mayo Clinic, Minnesota, U.S.) and Giovanni Savattieri (University of Palermo, Italy) resumed the training activities pioneered by Prof. Schoenberg. Starting in 2000, the nine offerings of the “International Course in Neuroepidemiology: Principles and Clinical Applications” in Erice, have become an essential point of reference for those of us who are interested in the subject.

Over the years, the structure, thematic content, and methodology have evolved in order to adapt to the new needs of a changing international public and to the new methodological developments.

Flyer of the Ninth International Course of Neuroepidemiology: Methods and Clinical applications.

Professors Paolo Ragonese and Marco D’Amelio from the University of Palermo, Italy, who participated as students in the 2000 course, are the current coordinators. The course has a Scientific Committee and a Teaching Team, including more than 15 worldwide leaders in neuroepidemiology and other related sciences. It is a high-level full-immersion course where participants share five days of training, exchange experiences, and establish professional collaborations that go beyond the course.

Forty-six students from five continents participated in this Ninth International Course of Neuroepidemiology: Methods and Clinical Applications” in Erice 2022. Methodological aspects of neuroepidemiology were discussed in the morning, and applications of the methods to the study of specific neurological diseases were presented in the afternoon (epilepsy, dementia, Parkinson’s disease, stroke, multiple sclerosis, neurological manifestations of COVID, among others). General concepts of genetic epidemiology and of applied statistics complemented the epidemiologic methods essential for neuroepidemiology.

The infrastructure of the Ettore Majorana Foundation Centre for Scientific Culture provided a unique framework to achieve the aims. As we climbed the winding road that took us up Mount San Giulano to Erice, a medieval city, the air became fresh and the landscape splendid. Cloistered for a week in this inspiring environment, we felt invited to expand our knowledge as if we were part of a renaissance movement in neuroepidemiology.

The current coordinators, Professors Paolo Ragonese and Marco D’Amelio, organized a special tribute to Professors Walter Rocca and Giovanni Savattieri in recognition for their work in establishing the Erice courses and for their commitment to the development and the diffusion of neuroepidemiology. The Erice courses have become one of the points of reference for the training of young neurologists in clinical and epidemiological research. •

Dr. Carlos N. Ketzoian is chairman of the Specialty Group on Neuroepidemiology of the World Federation of Neurology.

Reference:

  1. Walter A. Rocca, Paolo Ragonese, Marco D’Amelio, Giovanni Savettieri (2022) Teaching Research Methods to Young Neurologists: The Erice International Courses. J Mov Disord 2022;15(3):227-231

Nominating Committee Announcement 2023

On behalf of the World Federation of Neurology, the Nominating Committee invites nominations for the positions of Treasurer (four-year term) and Elected Trustee (three-year term).

Treasurer to take office from Jan. 1, 2024. (Position vacated by Dr. Richard Stark, who is not eligible for re-election.) Having previous similar experience as a treasurer would be an advantage.

One Elected Trustee to take office immediately following the election. (Position vacated by Dr. Morris Freedman, not eligible for re-election.) A nominee must be a member of an eligible WFN member society, should have a national and international reputation, have made contributions to regional and global neurology, and be committed to the WFN.

A WFN Member Society must submit the name(s) of the candidate(s), together with a statement signed by the candidate of confirmation of their willingness to stand for election, provide a brief curriculum vitae (a single type-written page) and letter of support from the Member Society. This has a deadline of April 3, 2023.

Nominations made after this deadline are possible. In addition to the criteria above, the candidate must also be supported with signatures from a minimum of five WFN Member Society Delegates, and all documents must be received by the London office 30 days prior to the Annual General Meeting.

Please address the nomination documents to the Chair of the Nominating Committee, all of which should reach the London Secretariat office, as soon as possible and prior to the deadlines in the text above.

Electronic format is requested. •

Named Lectures at the World Congress of Neurology (WCN)

By Peter J. Koehler

Giving names to lectures has been a general phenomenon in various fields of society, including the humanities and sciences, since at least over 100 years ago. These may be public lectures or lectures presented for members of an association. Through the years, the World Federation of Neurology (WFN) started a tradition of named lectures at the WFN’s World Congress of Neurology (WCN) and one may wonder, who were the people behind these names. What did they do to become well-known within the neurological community? In this article, I will provide biographical sketches of these persons.

Victor and Clara Soriano Award Lectures and the Soriano Lecture of the Fulton Society Symposium

John Farquhar Fulton (courtesy Wellcome Institute)

With respect to the Soriano lectures, the WFN webpage mentions that “The Fulton Society, Victor and Clara Soriano, and the Soriano Lectureship, are endowed lectures presented at the World Congresses of Neurology.”1 So let us first discuss John Farquhar Fulton (1899-1960) and then come back to the Sorianos. Born the son of ophthalmologist John Farquhar Fulton and Edith Stanley Wheaton in St. Paul (Minnesota),2 John Jr. graduated at Harvard with the degree of Bachelor of Science magna cum laude in 1921. He went to Oxford, England, receiving a BA with first class honors in physiology (Oxford). In 1923, he had married Lucia Pickering Wheatland, who was descending from a rich family in Salem, Massachusetts. The marriage remained childless.

John worked in the laboratory of the famous neurophysiologist and Nobel laureate (1932) Charles Scott Sherrington (1857-1952) and published a 644-page monograph Muscular Contraction and the Reflex Control of Movement in 1926. With a Doctor of Philosophy degree, he returned to Harvard, where he was awarded his MD, magna cum laude (1927). He spent a year at the Peter Bent Brigham Hospital in Boston with neurosurgeon Harvey Cushing, and they became life-long friends. He went to Sherrington’s laboratory for another period, and in 1930, he was appointed Sterling Professor at Yale University, the youngest at the University, establishing the first U.S. primate physiology laboratory. His contribution to functional localization in the cerebral cortex is of paramount importance. The combination of his training in physiology under Sherrington and clinical medicine, including his training under Cushing, later resulted in the book Physiology of the Nervous System (1938), which was translated into at least six languages. He attracted neurologists, neurosurgeons, and physiologists from the U.S. as well as from abroad.

In cooperation with Johannes G. Dusser de Barenne (1885-1940), he founded the Journal of Neurophysiology (1938). During the war, Fulton worked in the field of aviation physiology. His interest in the history of science culminated in one of the greatest collections of the history of medicine in the world at Yale and in a biography of Harvey Cushing (1946). In 1951, Fulton became professor of the history of medicine at the new homonymic department, a decision in which his hard working and health may have played a role. He acquired Cushing’s book collection and became editor of Journal of the History of Medicine and Allied Sciences.3,4

Victor Soriano (from World Neurology, May 14th, 2018)

Victor Soriano (1909-2005) was one of the many fellows of Fulton at Yale University. With his wife Clara, he was among the founders of the Fulton Society, perhaps inspired by the Harvey Cushing Society5 and the Osler Society,6 and started the Fulton Society Symposium, including the Soriano Lecture, at the World Congress of Neurology in New Delhi in 1989.7

Born from Jewish parents on the Mediterranean isle Rhodes, when it was still belonging to the Ottoman Empire, but becoming an Italian possession in 1912, the family emigrated to Montevideo, Uruguay, when he was 9 months old. Therefore, he considered himself Turkish, Italian, which is not quite correct, and Uruguayan. His father, a respected tailor, founded the Sephardic synagogue of Montevideo. Victor received his MD in 1934 and had been particularly interested in the physician Américo Ricaldoni’s (1867-1928) teaching in clinical neurology. Founded in 1926, Soriano became neurologist at the Instituto de Neurología of Montevideo in 1935, and in 1937, a new professor was appointed to succeed Ricaldoni, notably Alejandro Schroeder (1890-1954), who had trained at various German and French hospitals and institutes. Soriano taught neurology and worked at several hospitals and institutes in Montevideo. He was appointed assistant professor of medicine in 1943.

In the meantime, he had married Clara, also known as Clarita Benzecry, in 1939. She supported and encouraged his work in several social and medical activities. When Victor founded the Uruguayan Committee of Friends of the Weizmann Institute of Israel, she organized meetings at their home. Moreover, she hosted weekly scientific, literary, and musical events. Supported by the Rockefeller Foundation, Soriano stayed with Fulton at Yale in 1945 and with Hiram Houston Merritt Jr. (1902-1979) at the Montefiore Hospital affiliated to Columbia University in 1947. From 1948 on and accompanied by Clarita, he attended all American Neurological Association (ANA) meetings as well as a number of World Congresses of Neurology (WCNs). The year following Fulton’s death, at the Rome meeting of 1961, Soriano and Giuseppe Moruzzi (1910-1986), who had discovered the ARAS (ascending reticular arousing system) and its relation to sleep and waking with Horace W. Magoun (1907-1991) in the 1940s, founded the Fulton Society. The society was commended to organize a special symposium at meetings of the ANA and the WCN. Selected researchers of neuroscience were to present lectures on the advances of research in the nervous system. In 1987, the Sorianos decided to become sponsor of a lectureship at the ANA meetings. The WFN has two types of lectures associated with the Sorianos, including the one mentioned above at the Fulton Society Symposium (Soriano Lecture) and the other named Victor and Clara Soriano Award Lecture.8 The lecturers through the years can be found at Soriano Award Lectures and include Nobel Prize winners Rita Levi-Montalcini (1909-2012), Stanley B. Prusiner (born 1942), and Bert Sakmann (born 1942). More information on Soriano can be found in the May 2018 issue of World Neurology.

The Richard L. and Mary Masland Lecture

Richard L. Masland (Courtesy NLM Digital Collections, Public Domain

Richard Lambert Masland (1910-2003) was born the son of a textile executive in Philadelphia. He received his Bachelor’s degree from Haverford College and his MD from the University of Pennsylvania. During WWII, he was in charge of altitude flight training for flight surgeons at the School of Aviation Medicine in San Antonio, Texas. In 1947, he certified for neurology and psychiatry. He worked as a neurologist at Bowman Gray School of Medicine in Winston Salem, North Carolina. He had a special interest in the origin of mental retardation and tried to find ways to decrease its prevalence. He joined the National Association for Retarded Children, and his research results were published in the book Mental Subnormality: Biological, Psychological, and Cultural Factors (1958), of which he was first author. These achievements resulted in his recruitment as assistant director (1957) and director (1959) of the National Institute of Neurologic Diseases and Blindness (NINDB) of the NIH, where he worked until 1968.

He led a landmark study on the causes of birth defects, notably the National Collaborative Perinatal Project, a study of pregnancy and child development (1959-1966). It was designed to study risk factors in pregnancy for cerebral palsy and included over 50,000 pregnant women and their children through age 7. It led to over 400 scientific articles and dozens of books and monographs, in which factors like smoking and rubella virus could be associated with mental retardation.

In 1968, Masland became chairman of neurology at the College of Physicians and Surgeons of Columbia University. He directed the Neurologic Service at the Neurological Institute of New York at the Presbyterian Hospital. Neurologist Lewis P. Rowland (1925-2017) said “The residents were very fond of him. They called him the ‘white rabbit’ for his prematurely white hair and for his scurrying around.”9

Masland served as president of the American Epilepsy Society and of the WFN (1981-1989). In the latter position he was instrumental in changing the newsletter into a scientific journal (Journal of the Neurological Sciences). He was married to Mary Wootton of Englewood, a speech and language pathologist, with whom he had four children.10 He published many articles and received various awards, including the Award of Merit from the National Association for Retarded Children, which was presented to him by President John F. Kennedy in 1963.

Dr. Bhim S. Singhal Lecture11

Bhim Sen Singhal (Public Domain CCA 3.0)

Born in Mount Abu (in Rajasthan, north-west India) in 1933, Bhimsen Sen Singhal studied medicine, receiving his MD in 1956, and trained for neurology in Mumbai at the Grand Medical College under professor Noshir H. Wadia (1925-2016). He continued his training at the University College of London (UCL) Queen Square Institute of Neurology and became MRCP (Edinburgh, 1960) and MRCP (London, 1961).

Upon his return to India in 1962, he worked at the department of neurology at Grant Medical College and Sir. J. J. Group of Hospitals, where he became professor and chairman of the department. He was also active at the Bombay Hospital Institute of Medical Sciences in Mumbai. In 1991, he retired from the Grant Medical College, but continued his activities at the Bombay Hospital Institute. He trained many neurologists and published numerous articles and book chapters. He was interested in particular in multiple sclerosis,12 myasthenia gravis,13 and Parkinson’s disease. Singhal and co-workers described the entity of megalencephalic leukodystrophy (1996), especially prevalent in the Agarwal (anglicized term for Agrawal) community.14 In 2004, with international collaboration, he was one of the authors of a report in which the identification of its gene defect was described.15

Singhal served for many national and international organizations, including the Neurological Society of India, of which he was president in 1986, and the WFN as regional director. He was honored with a number of prestigious national awards, including the Padma Shri. This is awarded annually on India’s Republic Day and is the fourth-highest civilian award of the country. The award was not only a recognition for his clinical and academic work, but also his efforts through non-profit national foundations. An example of the latter was his initiative to establish the Neurology Foundation in 1998, to improve knowledge and provide assistance in patient care. This includes financial assistance for medical treatment, rehabilitation therapies for children and adults from low socio-economic areas, community outreach, and support for professional organizations such as the Multiple Sclerosis Society of India and the Indian Epilepsy Association. The foundation also started biennial Neurology Update conferences that became very popular. In 2001, Singhal founded the Parkinson’s Disease and Movement Disorder Society (PDMDS), an all-India “Registered Charity Society.” This is a nonprofit charitable organization that supports patients and their caregivers and is also active in the rehabilitation of patients. He is honored by two lectureships, notably one at the WCN and the other at the Indian Academy of Neurology

Dr. Singhal is married to Dr. Asha Singhal, who is an obstetrician and gynecologist. Like her husband, she has devoted her life to underprivileged people. They have a son, who is a stroke neurologist at the Massachusetts General Hospital, and a daughter, who is a professor of medicine (hematology and oncology) in Chicago.

Bharucha Lecture16,17,18

Eddie Bharucha (from World Neurology, May 14th, 2018)

Eddie Phiroz Bharucha (1916-2017) was born in a privileged family. His father Phiroz C. Bharucha (1882-1952) was a physician in Bombay (the present Mumbai) and his mother Bachha descended from a business family in Karachi. Eddie’s mother died when he was 2 years old, and he was educated mainly by an English governess. He studied medicine in Bombay and London, after which he became Honorary Physician in Medicine at the King Edward Memorial and Seth G S Medical College (KEM) Hospital in Bombay (1945).

In the 1949-1952 period, he trained for neurology at the National Hospital for Nervous Diseases (Queen Square) in London that had been amalgamated with the Maida Vale Hospital in 1948. In this period, he also spent some time at Columbia University in New York (with Houston H. Merritt Jr.) and Boston City Hospital (with Derek Denny Brown (1901-1981)). When he returned to India and the KEM Hospital, he was the first neurologist in Bombay19 and in cooperation with neurosurgeon Ramchandra G. Ginde (1912-1974), who trained with Wilder Penfield (1891-1976) in Montreal, started a department of neurology and neurosurgery, with 12 beds each (1953). Bharuch also worked at the Bombay Hospital, which is a large private hospital that became a teaching hospital.

Eddie married pediatrician Dr. Piloo (Kohiyar) Bharucha in 1947 and together they practiced multidisciplinary care in pediatric neurology.20 They treated children with poliomyelitis and cerebral palsy at the Children’s Orthopedic Hospital. With respect to his research and publications, he was active in stroke, infections, nutritional and toxic (for instance, lathyrism) disorders, and epilepsy. He was a member of the editorial board of Vinken’s & Bruyn’s Handbook of Clinical Neurology from 1973. He was considered an empathic physician with an important sense for social responsibility for the underprivileged. He invested personal financial means for the purchase of an EEG machine and the import of D-penicillamine (to treat Wilson’s disease). Piloo and Eddie had three sons.

Eddie Bharucha held several positions in India and received the Dhanvantari Award for his outstanding contributions to medical sciences (1991). He was elected president of the Neurological Society of India (1956),20 vice president of the WFN (1969-1973), and president of the World Congress of Neurology in New Delhi, 1989. He was honorary member of several organizations, including the ANA. During the last 20 years of his life, he suffered from severe visual handicap. In anticipation of his decreasing vision, he read journal texts onto a Dictaphone so that he could later listen to the contents. With respect to his character, one of his sons, the neurologist Nadir Bharucha wrote, “He did not seek positions of power or prestige, was unconcerned about material remuneration, and perennially radiated good cheer, kindness, and caring.”16 The Bharucha family, students, and friends established the Eddie & Piloo Bharucha Fund for lectures to be held during World Congresses of Neurology.

The Melvin D. Yahr Lecture 22,23,24

Melvin D. Yahr (Courtesy Mount Sinai School of Medicine) see Melvin D Yahr – The Lancet]

Melvin D. Yahr (1917-2004) was born in New York City as the youngest of six children. His parents were orthodox Jewish immigrants from Austria-Hungary. His father was a baker. Melvin studied medicine, receiving his MD from New York University College of Medicine in 1943. Interrupted by military services, he specialized in neuropsychiatry and neurology at various New York hospitals during the following next six years. He married Felice Yahr, with whom he had four daughters. He worked at the College of Physicians and Surgeons, Columbia University, where he became H. Houston Merritt professor of neurology (1973) and at Mount Sinai School of Medicine (City University of New York), where he was professor and chair (1973-1992).

He created the first U.S. multidisciplinary center for research in Parkinson’s disease and related disorders, which he later took to Mount Sinai. He played a role in the training of over 100 neurologists. His name and that of the Canadian neurologist Margaret May Hoehn (1930-2005), who was associate professor at Columbia University at the time, were eponymized by the Hoehn and Yahr scale for determining the severity of Parkinson’s disease.25 The article was referred to in the following way: “Their work established that the average age of onset of PD [Parkinson’s disease] was in the sixth decade (ie, between ages 50-59 years), described a broad spectrum of rates of progression, established that PD was associated with an increased mortality rate, and concluded that there were no treatments that affected life expectancy”.23 Yahr was (co-) author of over 300 articles, including the first double-blind levodopa study (1969).26 He served at a number of U.S. Advisory Committees and held positions at various neurological organizations and congresses, including the ANA (president) and the WFN. From 1963, Parkinson’s disease became his main research subject.

He took the initiative to establish the Research Committee on Extrapyramidal Disorders of the WFN (1959) and chaired the Research Group (1972-2001). It transformed into the International Association of Parkinsonism and Related Disorders.27 He was member of the Editorial Boards of several journals, including the Archives of Neurology (now known as JAMA Neurology). He became honorary member of several national neurological societies. In one of the obituaries, he was described as follows: “His, with very few sentences precisely described situations, analyses and thoughts, which he performed in a dark, sometimes rough appearing lingo and often with a mischievous but wise facial expression, eyes only a wee bit open, will be unforgettable to everyone who got acquainted to Melvin Yahr”.24

Conclusion

The persons described in this article were hard working neurologists, with the exception of Fulton, who became an experimental neurophysiologist and historian of medicine. Several, if not all, of their wives, some of whom being physicians themselves, contributed to their success. Whereas the Soriano, Singhal, and Bharucha Lectures were founded by the respective families (and friends), the Richard L. and Mary Masland Lecture and the Melvin D. Yahr Lecture were sponsored by the World Neurology Foundation (U.S. based) that was created in 1999. Another difference perhaps is that next to scientific, social efforts may have been a more important part of the careers and subsequent initiatives of Soriano, Singhal, and Bharucha. In contrast, scientific achievements may have been the more important motivation for the founding of the Masland and Yahr Lectures. •

 

References and Footnotes

  1. See Soriano Award Lectures; accessed December 17th, 2022
  2. Gariepy TP. John Farquhar Fulton and the History of Science Society. Isis 1999;90:S7-27.
  3. Davey LM. Obituary. John Farquhar Fulton, 1899-1960. J Neurosurg. 1960;17:1119-23.
  4. Igual MM. John F. Fulton (1899-1960): neurophysiologist, bibliophile, and historian. His relationship with Spain. Neurosci Hist  2019;7:62-76.
  5. It became American Association of Neurological Surgeons (AANS) in 1967; see Introduction (aans.org); accessed December 17th, 2022.
  6. In fact there are several Osler Societies, including the American Osler Society dedicated to the history of medicine and the William Osler Society of Australia & New Zealand.
  7. For a list of lecturers since the foundation see Soriano Award Lectures.
  8. An important source for the information in this biographical sketch is Victor Soriano.
  9. Oransky I. Obituary: Richard L Masland. Lancet 2004;363:663.
  10. Pedley TA, Rowland LP. In Memoriam: Richard Lambert Masland, MD (1910-2003). Neurology 2004;62:1056-7.
  11. This article is partly based on: Meshram C. Padma Shri for Dr. Bhimsen Singhal. World Neurology 2022, May 15th.
  12. See for instance Singhal BS, Advani H. Multiple sclerosis in India: An overview. Ann Indian Acad Neurol. 2015 Sep;18(Suppl 1):S2-5.
  13. Singhal BS, Bhatia NS, Umesh T, Menon S. Myasthenia gravis: a study from India. Neurol India. 2008;56:352-5.
  14. Singhal BS, Gursahani RD, Udani VP, Biniwale AA. Megalencephalic leukodystrophy in an Asian Indian ethnic group. Pediatr Neurol. 1996;14:291-6.
  15. Gorospe JR, Singhal BS, Kainu T, Wu F, Stephan D, Trent J, Hoffman EP, Naidu S. Indian Agarwal megalencephalic leukodystrophy with cysts is caused by a common MLC1 mutation. Neurology. 2004;62:878-82.
  16. Bharucha N. Eddie Phiroz Bharucha. World Neurology 2018, May 14th.
  17. Shah P, Seshia S. Dr. Eddie P. Bharucha (December 28, 1916–December 14, 2017). Ann Indian Acad Neurol 2018;21:91-2.
  18. Shah PU, Saxena VS. Dr. Eddie Phiroze Bharucha (December 28, 1916–December 14, 2017). Int J Epilepsy 2018;5:53-5.
  19. Poser CM, Crawford Poser J. Neurology in the developing world. Brain 2006;129:1624-9.
  20. Bharucha, 2018.
  21. Culebras A. Named Lectures at the World Congress of Neurology. Neurology 2005;65:31-2a.
  22. Charatan F. Melvin Yahr. Neurologist who revolutionised the treatment of Parkinson’s disease. BMJ 2004;328:290.
  23. Oransky I. Melvin D. Yarh. Lancet 2004;363:903.
  24. Riederer PF, Hirsch E, Youdim MB, Calne DB. A tribute for Prof. Dr. Melvin D. Yahr, M.D. (1917-2004). J Neural Transm (Vienna). 2004;111:1205-8.
  25. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967;17:427-42.
  26. Yahr MD, Duvoisin RC, Schear MJ, Barrett RE, Hoehn MM. Treatment of parkinsonism with levodopa. Arch Neurol 1969;21:343-54.

27.       See About IAPRD – IAPRD 2023 (iaprd-world-congress.com); accessed December 26th, 2022.

Growing the African Neurological and Scientific Workforce

Spreading the reach of neurology across the continent.

By Augustina Charway-Felli and Amadou Gallo Diop

Photos from the biannual francophone contest November 2022, in Abidjan, Cote d’Ivoire, involving 10 new African professors of neurology and three psychiatrists

Nov. 12, 2022, marked the end of the biennial Francophone contest of the headquarters of the African and Malagasy Council for Higher Education (Conseil Africain et Malgache pour l’Enseignement Superieur [CAMES]). Congratulations to the 10 new African professors of neurology (and three psychiatrists) who were successful at the contest that concluded in Abidjan in Cote d’Ivoire.

The first ranked candidate, Prof. Medinatou Atoukè Agbetou, from Benin, coincidentally benefited from a sponsored one-year epileptology training fellowship in Dakar, Senegal, at the World Federation of Neurology (WFN) accredited neurology department of Universitaire Cheikh Anta Diop (Cheikh Anta Diop University-UCAD) three years prior.

Photos from the biannual francophone contest November 2022, in Abidjan, Cote d’Ivoire, involving 10 new African professors of neurology and three psychiatrists

Other individuals and countries represented were: Maouli Fall and Ndiaga Matar Gaye from Senegal; Kokou Mensah Guinhouya (Togo); Seybou Hassane (Mali); Lompo Labodi and Anselme Dabilgou (Burkina Faso); Ghislain Armel Mpandzou and Prince Eliot Gallieni Sounga Bandzouzi (Congo); and Emmanuel Yangatimbi (Central African Republic).

CAMES is the coordinating body for higher education and research systems in francophone Africa. It serves also as the accreditation body for various degrees (Bachelor’s, Master’s, Doctorates, etc.) in its member countries. The UCAD Neurology Department has a longstanding tradition of training in neurology for trainees across French-speaking Africa and several of the above-mentioned successful candidates have their roots in this department.

Though a seemingly small number of new professors, these individuals now serve to continue sharing knowledge and training new cadres in neurology and build on the foundation set by the likes of Michel Dumas, Amadou Gallo Diop, Riadh Gouider, and Therese Sonan, to name a few. Examples of similar growth of neurological departments and local training of neurologists are plentiful across other parts of the continent in luso- and anglophone countries. The African Academy of Neurology (AFAN) is proud of all these efforts and will continue to support individual, country, and regional efforts to build up the neurological workforce with internal resources and reduce the brain drain that is threatening the African Continent. •

Augustina Charway-Felli is president of the African Academy of Neurology. Amadou Gallo Diop is head of the department of neurology at Cheikh Anta Diop University, Dakar, Senegal, and is past trustee of the WFN.

Dementia Prevention: Can We Do Better?

By Vladimir Hachinski, MD, DSc, FRCPC, FRSC

Note from the Editors: This photo is of Prof. Hachinski being awarded the Potemkin prize (sometimes referred to as the “Nobel Prize of Alzheimer’s research”) at the American Brain Foundation gala at the 2022 AAN Annual Meeting in Seattle, Washington. Andi Potamkin, the grandaughter of Luba and Victor Potemkin, who endowed the Potemkin Prize in 1988, is shown presenting the award to Prof. Hachinski.

The publication of the results of lecanemab for the treatment of early Alzheimer’s disease has generated hype, hope, and questions. Questions include:

Can we do better in dementia prevention than finding a “silver bullet” drug?

Are we doing enough to stem the rising wave of neurological disorders that are now the leading causes of disability adjusted life years (DALY), particularly stroke and dementia, that account for 62% of these?1

Although the absolute numbers of stroke and dementia cases continue to rise in most countries, the stroke cases per thousand have declined in 165 of 209 countries. Dementia has proven more intractable; only 18 out of 204 countries have had a decline in incidence.2 What accounts for the decreased incidence in these countries? What are we doing right? Looks like a great opportunity to find out and begin preventing some dementias systematically.

However, so far the bulk of funds and efforts have been to find an effective drug against dementia. The clinical trials have yielded equivocal results. Part of the reason lies in the concomitant multiple causes of dementia in older adults that result in Alzheimer’s disease. In older adults, it is not a disease, but a syndrome of up to eight different pathologies.3 To date only one drug, lecanemab, might have some minimal effect in the early stages of Alzheimer’s disease.”4 However, it will probably cost tens of thousands of dollars, it requires the inconvenience and costs of intravenous infusions, and carries the risk of brain edema and hemorrhage. Nevertheless, the search to find drugs for specific etiologies needs to go on, so that at some point in the future we can target the different causes that lead to dementia. But what do we do in the meantime?

One encouraging development has been the FINGER study, showing that intensive lifestyle management can slow cognitive progression in persons at risk of dementia.5 This approach has now been expanded to a series of similar studies in several countries.6 This is promising and deserves testing in different settings and populations. Limitations include the considerable resources required to implement the extensive interventions and the fact that it targets only a fragment of a given population.

The WHO’s Global Action Plan7 is more comprehensive and advocates a life course approach. It provides excellent information, but little on motivation and less on implementation, this being up to the governments of the member countries. Some countries have national dementia plans, but most focus on caring for those afflicted, with little funding left for prevention.

The news is more encouraging in smaller jurisdictions. The province of Ontario, Canada, introduced a stroke strategy associated with a 32% decrease in the incidence of stroke and 7% of dementia over 12 years.8 We now are trying to find out what accounts for the decline. We are using a comprehensive approach, including environmental, socioeconomic, and individual risk and protective factors, customized, focusing on the most promising targets and assuring that it is cost effective, to justify the investment.9

We consider it important to carry out prevention at the level of “actionable units.” This means a group or population that has a sense of community. In our case, it will be a health region comprising 525,000 inhabitants. Moreover, we will target stroke, heart disease, and dementia together10 around a positive message of “brain health for all, now” and work through the leaders of government, businesses, labor, voluntary organizations, and with the help of the Heart and Stroke Foundation of Canada, Hypertension Canada, and the Alzheimer Society of Canada.

Prevention remains the best way to stem the tide of stroke, heart disease, and dementia, but we have to foster new approaches such as the comprehensive, customized, cost effective (The Triple C) approach, to complement the current ones. We can, we must, we will do better in dementia prevention; millions of brains depend on it. •

Vladimir Hachinski is past president of the World Federation of Neurology and the 2022 recipient of the Potamkin Prize.

 

References

  1. Avan A, Hachinski V. Stroke and dementia, leading causes of neurological disability and death, potential for prevention. Alzheimers Dement. 2021 Jun;17(6):1072-1076. Epub 2021 May 31. PMID: 34057294. DOI: 10.1002/alz.12340
  2. Avan A, Hachinski V. Global, regional, and national trends of dementia incidence and risk factors, 1990-2019: A Global Burden of Disease study. Alzheimers Dement. 2022 Aug 31. doi: 10.1002/alz.12764. Online ahead of print.PMID: 36044376
  3. Boyle PA, Yu L, Wilson RS, Leurgans SE, Schneider JA, Bennett DA. Person-specific contribution of neuropathologies to cognitive loss in old age. Ann Neurol. 2018 Jan;83(1):74-83. doi: 10.1002/ana.25123. Epub 2018 Jan 14. PMID: 29244218 Free PMC article.
  4. van Dyck CH, Swanson CJ, Aisen P, Bateman RJ, Chen C, Gee M, Kanekiyo M et al. Lecanemab in Early Alzheimer’s Disease. November 29, 2022. DOI: 10.1056/NEJMoa2212948
  5. Ngandu T, Lehtisalo J, Solomon A, et al. A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomised controlled trial. The Lancet 2015;385:2255-2263
  6. Kivipelto M, Mangialasche F, Snyder HM, et al. World-Wide FINGERS network: a global approach to risk reduction and prevention of dementia. Alzheimers Dement. 2020;16:1078-1094.
  7. WHO Global Action Plan. https://www.who.int/publications/i/item/global-action-plan-on-the-public-health-response-to-dementia-2017—2025
  8. Sposato LA, Kapral MK, Wu J, Gill SS, Hackam DG, Cipriano LE, Hachinski V. Declining incidence of stroke and dementia: Coincidence or prevention opportunity? JAMA Neurol. 2015;72:1529-1531
  9. Hachinski V, Dementia Prevention Initiative. The comprehensive, customized, cost-effective approach (CCCAP) to prevention of dementia Alzheimers Dement. 2022 Feb 1. doi: 10.1002/alz.12586. Online ahead of print. PMID: 35103397. DOI: 10.1002/alz.12586
  10. Hachinski V. Brain Health-Curbing Stroke, Heart Disease, and Dementia: The 2020 Wartenberg Lecture. Neurology. 2021 Aug 10;97(6):273-279. Epub 2021 Apr 21. PMID: 33883239 DOI: 10.1212/WNL.0000000000012103

My Experience at the Medical University of Graz, Austria

By Seblewongel Asmare Seyoum

The neurology department building at Medical University of Graz.

I had the chance to participate in the department visit program of Austria 2022, which was organized in collaboration between the Austrian Neurological Society (OEGN) and the WFN.  I stayed for four weeks in the beautiful and historic city of Graz, Austria. I had a lot of experiences and exposure during my stay.

On my first day, I met with a welcoming secretary of the department, Michaela Schweiger, who gave me a tour of the department and the hospital compound to familiarize me with the property as soon as possible. She also introduced me to Prof. Christian Enzinger, and we had a brief discussion about how to spend the four weeks in the department. I was assigned to the neurointensive care unit and started to work on the same day.  At the unit, I met a team of specialists who are hard-working and dedicated. I joined them in every activity, including rounds, case discussions, and bedside procedures. I appreciated how the patients get quality and scientific care.

Prof. Christian Enzinger and the general neurology ward team.

In my second week, I joined the stroke unit team. I met different stroke specialists who are expert both in clinical and research activities. We did rounds and discussed each clinical case. We also discussed some published articles. The team also introduced me to the radiology department, and I was able to see some neurointerventional procedures in the operation room, such as aneurysm coiling, diagnostic digital subtraction angiography, and other procedures.

I spent the third week rotating at different outpatient clinics. I got to see many different cases and up-to-date management. I had the chance to see many new drugs being used and procedures being done routinely like EEG, NCS/EMG, and nerve ultrasound. It was the best week since I got to meet many experienced doctors and discuss each case in detail.

On my last week, I stayed in the general neurology ward, where I got to see some cases that I don’t usually see in my country.  Meanwhile, the international office of the university was able to arrange a guided city tour and intercultural get-together, which allowed me to connect with many other students and doctors who come from different countries.

Overall, my stay was pleasant and overwhelming with all the new hospital setup, the culture, and the weather too. I did all to get the best out of my stay. It motivated me to take and implement all the experience I gained to my country and to pursue more in my neurology career. One of the challenges I faced was the language barrier, but the staff was so helpful to translate and discuss in English.

As a recommendation, it would be great if these observership programs were available for more neurologists and if more fellowship programs are open to supporting the physicians and the society at large.

Last but not least, I would like to thank all the staff of the department of neurology at the Medical University of Graz, the Austrian Neurological Society (OEGN), and the WFN for giving me this great opportunity. •

Seblewongel Asmare Seyoum is a a neurologist at Bahir Dar University in Ethiopia.