Report on the 23rd Annual Conference of the Indian Academy of Neurology

By Gagandeep Singh, Arabinda Mukherjee and Pardeep Kumar Maheshwari

The Taj Mahal plays as backdrop as delegates gather during the Clean India campaign held during the conference.

The Taj Mahal plays as backdrop as delegates gather during the Clean India campaign held during the conference.

The 23rd Annual Conference of the Indian Academy of Neurology (IAN) was held Oct. 1–4, 2015, at Agra, the city of Taj, in India. Planning the IAN scientific program with sizeable professional body of clinical neurologists in India is always a challenging task for two reasons. For one, India is a country with 1.28 billion people with about 1,800 neurologists, which amounts to one neurologist for 7,00,000.

This entails providing each neurologist with updated knowledge so as to be able to deal with a wide range of neurological disorders, including tropical infections and toxin-induced disorders, besides the usual neurological conditions managed by Western neurologists. The demand on neurologists requires the ability to deal with a large patient pool with diverse neurological conditions. At the same time, recent technological and conceptual advances require that neurologist have the ability to provide state-of-the-art tertiary care to patients who require such care.

WFN President Raad Shakir greets Shabana Azmi during the inaugural ceremony.

WFN President Raad Shakir greets Shabana Azmi during the inaugural ceremony.

A unique solution to this paradox is to have neurologists who practice high-technology neurology provide continuing education to neurologists involved largely in community care. This allows the Academy to be self-sufficient and caters to the educational needs of all. The scientific program of IANCON 2015 reflected the principle to ensure that public perception within the nation, as well as internationally, befitted. The distinguished guests included Shabana Azmi, a noted film actor and social activist, and WFN President Prof. Raad Shakir, president, World Federation of Neurology.

The Conference featured 14 breakfast and lunch symposia, a CME, four breakfast symposia, two guest lectures, four orations and 267 papers.

To cater to the tastes of trainee neurologists, a barbecue quiz — with an initial countrywide online round and a final round during the conference — and a clinic-pathological conference were other hallmarks of the conference.

Even as India needs many more neurologists, the number is increasing with 171 trained neurologists added each year. The scenario is certainly encouraging, as the IAN is becoming a stronger constituent of the World Federation of Neurology, the support of which we gladly acknowledge.

Gagandeep Singh is IAN secretary, Arabinda Mukherjee is IAN president and Pardeep Kumar Maheshwari is IANCON 2015 organizing secretary.


A Note of Thanks to Don Silberberg

By Raad Shakir

Raad Shakir

Raad Shakir

Since Don took over as editor of World Neurology (WN) in April 2013, we have seen a steady improvement in the quality of our newsletter with the publication of each of the 16 issues he has overseen. In his first editorial, he stated that the new electronic format would permit ready coordination among the two WFN publications, the Journal of Neurosurgery and WN, and the WFN website.

Part of the challenge, he said, would be to avoid all but essential redundancy among the three, and that has clearly been achieved through the World Neurology Editorial Advisory Board, which was created, and in other ways. In fact, so successful has this been that we have been able, during his editorship of World Neurology, to launch a third publication — the new open access journal, eNeurologicalSci (eNS), a sister journal to WFN’s longtime flagship scientific journal, the Journal of the Neurological Sciences (JNS). No doubt, we shall begin to seamlessly blend this too into the system, as it develops and grows as part of the WFN’s publications portfolio.

Don set out his plans to publish important news from the WFN, reports of WFN activities in the field and reports from the WFN’s committees and officers, but beyond this, he also targeted abstracts of articles that seemed to be the most important to global neurology. All of this has been an unqualified success, for which the trustees and I, and indeed the WFN as a whole, are most grateful.

World Neurology is now on sound footing for his successor to take it forward to the next stage. There is still much work to be done in developing the email database, as we all know, and we have begun to address that issue as well. Don will be succeeded by Prof. Steven Lewis of Chicago, Illinois, USA, as editor and Walter Struhal of Innsbruck, Austria, as co-editor.

I simply wish to express our collective gratitude for the contribution Don Silberberg has made and to thank him for his continuing efforts on behalf of the WFN. I hope the experience has been an enjoyable one and that Don has found the organization to have a useful role to play in neurology.


From the Editor-In-Chief

By Donald H. Silberberg

Donald H. Silberberg

Donald H. Silberberg

This issue of World Neurology is the last for which I will serve as editor. Fulfilling this role for the past three years has been an exciting endeavor. I greatly appreciate that I was invited, and that I accepted the challenge and opportunity to develop World Neurology as an online publication.

In late 2012, then WFN President Vladimir Hachinski invited me to assume the position as editor-in-chief and oversee the transition from paper to an online newsletter. Rhonda Wickham and her colleagues at Ascend Integrated Media, World Neurology’s publishing partner, taught me what I needed to know, and, in general, they helped to make the transition to electronic distribution smooth. In addition to my thanks to Rhonda, I am indebted to Vladimir Hachinski and WFN President Raad Shakir for their support and interesting contributions, and also at WFN to Keith Newton for managing the calendar and carefully proofing galleys. Peter Koehler has unfailingly personally contributed, or he asked a colleague to contribute important articles on the history of neurology and neurological sciences for every issue.

As Raad Shakir notes in his gracious article about the transition to the editorship of Steven Lewis, effective for the March 2016 issue, generating a comprehensive list of email addresses has remained a persistent problem. I am hopeful all the member organizations of WFN will help Steven address this.

So, as I finish my three-year term, I also want to thank the many other individuals who have contributed articles, book reviews, ideas and guidance. I have enjoyed my tenure, and I wish Steven Lewis the best as he assumes the editorship.


Brain Health: Why Time Matters in MS

Figure 1. We recommend a therapeutic strategy based on regular monitoring that aims to maximize lifelong brain health while generating robust real-world evidence.

Figure 1. We recommend a therapeutic strategy based on regular monitoring that aims to maximize lifelong brain health while generating robust real-world evidence.

By Gavin Giovannoni, MD, on behalf of the MS Brain Health Steering Committee.

The goal of treating patients with multiple sclerosis (MS) should be to maximize lifelong brain health. This is the central theme of a new international consensus report from a multidisciplinary author group. Brain Health: Time Matters in Multiple Sclerosis calls for greater urgency at every stage of diagnosing, treating and managing MS. Its recommendations aim to facilitate a therapeutic strategy that minimizes disease activity (Figure 1), involving:

  • Shared decision-making
  • Early intervention
  • Improved treatment access
  • Proactive monitoring

The report was launched during a symposium, “Is the MS Community Ready to Promote Brain Health?” on the eve of the European Committee for Treatment and Research in Multiple Sclerosis Congress Oct. 6, 2015.

MS-BrainHealthProfessor Tim Vollmer outlined the brain health perspective on MS, presenting recent data underpinning its scientific basis. People with relapsing–remitting MS can lose brain volume up to seven times faster on average than age-matched controls, according to a 2015 meta-analysis of clinical trials.1 Up to a point, this damage can be compensated for by neurological reserve — the brain’s finite capacity to reroute signals or adapt undamaged areas to take on new functions.2,3 Preserving neurological reserve protects against cognitive decline4 and physical disability progression5 in people with MS. Once neurological reserve is exhausted, however, the long-term progressive phase of the disease will be unmasked, Vollmer argued. Adopting a therapeutic strategy that preserves neurological reserve by minimizing disease activity therefore should be of primary concern when people with MS and their clinicians make treatment decisions.

Shared decision-making relies on education. People with MS need to understand the potential long-term effects of the disease as early as possible after diagnosis, stressed George Pepper. As co-founder of the patient forum, Pepper stated that engaging people with MS in their own health care could be “the blockbuster drug of the 21st century.”6 He concluded by encouraging health care professionals to help people with MS to take active roles in treatment decisions and disease management, starting at the time of diagnosis.

Early intervention is vital, in order to preserve cognitive function. This was emphasized in a joint presentation by Dr. Gisela Kobelt and Professor Helmut Butzkueven, who examined MS from economic and real-world perspectives. Dr Kobelt presented some of her own economic data demonstrating that the greatest effects of the disease on employment occur at relatively low levels of physical disability.7 Professor Butzkueven concurred, and referred to results from a recent study showing that people with cognitive impairment at diagnosis were three times more likely to reach a Kurtzke Expanded Disability Status Scale score of 4.0 and twice as likely to develop secondary progressive MS 10 years after diagnosis.8 This underscores the importance of the report’s recommendation of aiming to alter the disease course through lifestyle measures and early treatment with a disease-modifying therapy.

Improved treatment access will ultimately come from demonstrations of cost-effectiveness. Assessing the difference that treatment makes to long-term health and economic burden is of vital importance in a chronic progressive disease. To date, however, long-term economic evaluations largely have been based on models owing to a lack of data, explained Dr. Kobelt.

By monitoring disease activity and recording data in registries, health care professionals can generate robust real-world evidence that can be used to inform individual treatment decisions. Butzkueven demonstrated the power of registry data to compare the effectiveness of different disease-modifying therapies in propensity-matched people with MS.9 The overall conclusion was that the biggest change in long-term health and economic outcomes could come from targeted intervention to maximize lifelong brain health — and that real-world registry data should be generated and used to test whether this is the case. (See Figure 1)

Summing up, Symposium Chair Giovannoni stated: “I’d like every clinician, every health care professional, to think that someone with MS is giving us their brain to protect. It’s our responsibility to make sure that they get to old age with a healthy brain, so that they can withstand the ravages of aging. As a treatment philosophy, it’s as simple as that.”

Health care professionals who believe in this treatment philosophy are invited to pledge their commitment to embrace the recommendations of the report. Download the full report.


  1. Vollmer T et al. J Neurol Sci, 357 (2015):8-18.
  2. Rocca MA et al. Neuroimage, 18 (2003):847-55.
  3. Rocca MA, Filippi M. J Neuroimagin;17 Suppl 1 (2007):s36–41.
  4. Sumowski JF et al. Neurolog, 80 (2013):2186-93.
  5. Schwartz CE et al. Arch Phys Med Rehabil, 94 (2013):1971-81.
  6. Rieckmann P et al. Mult Scler Relat Disor, 4 (2015):202-18.
  7. Kobelt G et al. J Neurol Neurosurg Psychiatr, 77 (2006):918-26.
  8. Moccia M et al. Mult Scler (2015): doi:10.1177/1352458515599075.
  9. Spelman T et al. Ann Clin Transl Neuro, 2 (2015):373-87.
Gavin Giovannoni, MD, provided this piece on behalf of the MS Brain Health Steering Committee.


Independent writing and editing assistance for the preparation of this article was provided by Oxford PharmaGenesis, Oxford, UK, funded by grants from AbbVie and Genzyme and by educational grants from Biogen, F. Hoffmann-La Roche and Novartis, all of whom had no influence on the content.


Report on the XXII World Congress of Neurology

By William M. Carroll, MD

William M. Carroll

William M. Carroll

The XXII World Congress of Neurology opened Nov. 1, 2015, at the CasaPiedra Conference Center in Santiago, Chile. A total of 3,500 delegates were registered from 110 countries, and this Congress brought a significant rise in the number of participants under age 35 compared to those attending Vienna and Marrakesh. This demographic added a youthful look to the Congress. Delegates enjoyed the intimate Chilean décor of the CasaPiedra, comprehensive scientific and teaching course programs, and opportunities for social, educational and cultural discourse.

Opening Ceremony

The XXII World Congress of Neurology opens with a lively Chilean cultural performance.

The XXII World Congress of Neurology opens with a lively Chilean cultural performance.

The World Congress Sunday evening opening was one of the most enjoyable ceremonies for a long time. Not only was the cultural performance informative, lively and just the right duration, but so were the preceding addresses by World Federation of Neurology President Raad Shakir and World Congress of Neurology President Renato Verdugo, and the following address by Dr. Michelle Bachelet, president of Chile. A pediatrician by training, Dr. Bachelet spoke firmly on the need for global action on stroke and dementia, leading causes of the noncommunicable neurological disease burden in the world. She also highlighted the efforts of the Chilean Government through its Program of Explicit Guarantees in Health Care, which targets these and other noncommunicable disease states, such as traumatic brain injury, Parkinson’s disease and multiple sclerosis. She emphasized that the program was primarily preventative but also provided structured care.

Raad Shakir emphasized the need for both the fostering of quality neurology and equality of health care worldwide, Renato Verdugo gave an illuminating and much appreciated background on the history of Chile and the Chilean peoples.

Scientific Program

Michelle Bachelet, president of Chile, addresses the Congress.

Michelle Bachelet, president of Chile, addresses the Congress.

Earlier that day, Dr. Oleg Chestnov, Assistant Director-General of Noncommunicable Diseases and Mental Health at the World Health Organization (WHO), led a WHO Symposium. A former gastroenterologist, his opening address was replete with illustrative and amusing anecdotes. Importantly, he highlighted the lack of neurologists as evidenced in the upcoming latest edition of the Atlas of Neurology (a joint WHO and WFN initiative), and the WHO Action Plan 2013–2017 concentrating on noncommunicable diseases. Dr Chestnov drew attention to the following points.

  1. Epilepsy is now a WHO Assembly agenda item where the goals are to strengthen effective leadership, improve provisioning of care, integrate epilepsy into primary health care services and increase access to medications.
  2. It is estimated that in 2015, 47 million people globally have dementia, and this figure will double every 20 years. The global cost in 2010 was estimated at $US604 billion.
  3. Finally, he acknowledged the importance of the First Ministerial Conference on Global Action Against Dementia held earlier this year.
2013 Nobel Laureate in Physiology and Medicine Prof. Thomas Südhof presents a lecture on neurexins.

2013 Nobel Laureate in Physiology and Medicine Prof. Thomas Südhof presents a lecture on neurexins.

This important plenary session was completed by an authoritative review by Prof. Ingrid Scheffer of Melbourne, Australia, describing how genetics is influencing the management of epilepsy.

The scientific program was by all accounts one of the highlights of the meeting. Throughout, there were superb plenary lectures and symposia on all major neurological topics, providing clear insight into the robust pursuit of knowledge of basic science and its translation to clinical practice. It is only possible to mention a few of these.

Prof. Charlotte Cordonnier of Lille, France, addressed the vexatious issue of cerebral microhemorrhages and their relation to amyloid angiopathy, their management and risks with current stroke prophylaxis. Their investigation with the use of 7T Tesla to define stroke risk and new prospective studies defined lesser risks from ischaemic prophylaxis therapy for certain defined stratified groups.

World Health Organization (WHO) Assistant Director-General of Noncommunicable Diseases and Mental Health Oleg Chestnov leads a WHO symposium.

World Health Organization (WHO) Assistant Director-General of Noncommunicable Diseases and Mental Health Oleg Chestnov leads a WHO symposium.

Prof. Jes Olesen in presenting the Yahr Award Lecture reviewed the current state of headache research and treatment, describing the new version of the International Headache Classification, to be incorporated in ICD11, and then aspects of migraine. He drew attention to three monogenic loci for familial hemiplegic migraine. He contrasted this with the 42 loci identified in the International Headache Genetics Consortium Genome-Wide Association Study in common migraine, nine of which also affect gastrointestinal tract musculature. In reviewing treatment, he lamented the lack of medications to reduce migraine aura, especially tonabersat because of the high cost the effectiveness of the angiotensin-II receptor antagonist candesartan as prophylactic, the need for calcium gene related peptide monoclonal antibodies for chronic migraine and the development of headache centers to hasten research and its translation to clinical care.

Profs. Michael Brainin, Geoffrey Donnan and Nick Ward gave an overview of the long-term perspective in stroke, tackling early diagnosis, secondary prevention and brain recovery in a high-class exposition, respectively.

Prof. Shoji Tsuji receives recognition for scientific achievements from WFN President Raad Shakir.

Prof. Shoji Tsuji receives recognition for scientific achievements from WFN President Raad Shakir.

Prof. Neil Scolding’s thoughtful and practical lecture on the role of cell therapy in central nervous system disorders was a useful update in this much-anticipated therapeutic approach. Dr. Jon Stone’s lecture on the identification and management of functional disorders also was a well-received review of the current state of this sometimes difficult to manage topic. This theme also was the basis for the excellent review given by Prof. Mark Hallett of the National Institutes of Health during the Victor and Clara Soriano Award Lecture. His talk combined the electrophysiological study of motor acts with the psychology of the perception of functional and normal movements. Prof. Giacomo Rizzolatti updated the conference on mirror mechanisms and their clinical relevance together with the essential role of mirror neurones in this concept.

Prof. Kazuo Fujihara from Sendai, Japan, reviewed the current state of understanding of neuromyelitis optica spectrum disorders, highlighted the relatively uniform worldwide prevalence of this condition, the recently published Consensus Diagnostic Criteria and the increasing role of AQP4 seropositivity in the diagnosis.

Prof. Alan Thompson, of the University College London, gave an impeccably balanced update on the current state of research and treatment, the global initiative in progressive multiple sclerosis and the recent report of the first large-scale phase III trial of early anti B-cell treatment to modify the disease course.

Delegates gather to share ideas during the Congress.

Delegates gather to share ideas during
the Congress.

Prof. Thomas Südhof, 2013 Nobel laureate in physiology or medicine, treated delegates to an enthralling lecture on “Neurexins and Company: Towards a Molecular Logic of Neural Circuits,” describing their role in the function and dysfunction of neural networks in schizophrenia, autism and intellectual disability.

On the last day, the final Tournament of the Minds was held. The final teams buzzed in for their first right to answer to a question with a penalty for an incorrect answer. It was contested by the United Kingdom, Australia and Japan, and finished in that order. Congratulations to the United Kingdom team, which finished well ahead of the scheduled time for the completion of this session. The tournaments was followed by the closing ceremony with the presentation of a gavel to Prof. Yoshikazu (Kaz) Ugawa, President of the XXIII World Congress of Neurology, from the XXII World Congress of Neurology President Renato Verdugo, in order to have the 2017 Congress called to order.


A total of 272 oral lectures, and 36 teaching courses with three or four lectures each were presented; 1,230 posters were displayed from 1,668 abstracts, and there were five satellite symposia.

There were four named lectures:

  1. Yahr Award Lecture: Prof. Jes Olesen, “New Concepts in headache”
  2. Victor and Clara Soriano Award Lecture: Prof. Mark Hallett, “The Physiology of Will”
  3. The Fulton Society Symposium-Soriano Award Lecture: Prof. Giacomo Rizzolatti, “The Mirror Mechanism and Its Clinical Relevance”
  4. Bharucha Award Lecture: Prof. Richard Hughes, “Guillain-Barré Syndrome and CIDP: One disease or Many?”

The World Federation of Neurology also presented medals to two distinguished recipients. The first was for Service to Neurology and was presented to Dr. Michel Dumas for services to the development of neurology in Africa and elsewhere. The second was awarded to Prof. Shoji Tsuji of Japan for scientific achievements in neurology. Dr. Gallo Diop, WFN trustee, and Prof. Roger Rosenberg, University of Texas Southwestern, read the citations, respectively.

Social Event Program and WFN Business

The welcome reception was held immediately after the opening ceremony and was well attended. The Chilean networking event was held out of the city at a well-known winery and was enjoyed by the participants, after they recovered from the long bus ride inflicted by the Santiago evening traffic rush.

At the World Federation of Neurology Council of Delegates meeting held Nov. 1, a number or reports were presented, elections held and votes taken. Among these was the tightest decision for a WCN venue so far. For the XXIV World Congress of Neurology in 2019, Dubai triumphed with the slimmest of margins over Cape Town. Either would have been a fitting site for the XXIV World Congress of Neurology, a likely reason for the closeness of the final result. Dr. Richard Stark was elected to the new position of treasurer allowing Prof. Wolfgang Grisold to have more time for the secretary general’s role. Dr. Morris Freidman of Canada defeated an exceptional field of candidates for the position of elected trustee. The WFN wishes these new members of its executive team an enjoyable and productive term.

An issue, which arose and caused the trustees and organizers considerable concern, was the procurement of visas for the Chile World Congress of Neurology. Many delegates were forced to go to extreme lengths to obtain a visa. A number were unable to complete this, and even some of those who did obtain a visa were restricted to the duration of the Congress. The Council of Delegates recognized the difficult circumstances members of many national societies found themselves in as a consequence of the large flows of migrants in many parts of the world. In the future, the World Federation of Neurology hopes not only to have those bidding for future venues to declare freedom from restricted access to them, but also to identify and forewarn delegates of any practical difficulties they may encounter. These items will be placed on the website well before each upcoming World Congress of Neurology.

Finally, at the Trustees Meeting held during the XXII World Congress of Neurology, the suggestion made at the Kyoto site visit in September 2015 to restrict the number of faculty members to just more than 200 was endorsed with twin aims. The first was to control the cost of the World Congress of Neurology, but also to move to full funding of faculty members. The World Federation of Neurology recognizes that the best calibre lecturers are in a competitive environment and that it must make the invitation to the World Congress of Neurology most desirable.


As the curtain closes on the XXII World Congress of Neurology in Santiago, Chile, we should remember the spirit of giving so generously displayed by the Chilean society, the high level of educational endeavor, the friendships made and renewed, and the scientific, topical and cultural discussions that are part of the intangible benefits we and our colleagues derive from the World Congress of Neurology as we look forward to the XXIII World Congress of Neurology in Kyoto in 2017.

William M. Carroll, MD, is WFN First Vice President and Chair of the Congress Committee.