Tropical Neurology: INTROPICON 2018


The second International Tropical and Geographical Neurology Conference (INTROPICON) was held in conjunction with the 28th Brazilian Congress of Neurology and the 15th Pan American Congress of Neurology Oct. 11-14, 2018, in Sao Paulo, Brazil. The congress was huge and was attended by more than 3,800 delegates from all over Latin America and across the world.

The Tropical and Geographical Neurology Applied Research Group of the World Federation of Neurology (WFN) is the oldest group, established in 1961, and has had many meetings over the years. This congress was decided following the reconstruction of the research group in Mumbai during INTROPICON in 2017. The chair of the research group is Dr. Chandrashekhar Meshram from Nagpur, India. This second congress was co-chaired by Dr. Meshram and the late Prof. Amilton Barreira, Sao Paulo, Brazil. It is with great sadness that the whole world of neurology, and in particular tropical and Latin American neurology, will sorely miss Prof. Barreira. His contributions were immense.

INTROPICON 2018 covered the field with fascinating presentations on a variety of topics. The congress featured an in-depth look at cysticercosis, amebic encephalomyelitis, cerebral malaria, Chagas disease, schistosomiasis, toxoplasmosis, trypanosomiasis, cerebral venous thrombosis in India, paracoccidioidomycosis, arboviruses, Zika virus status, congenital Zika virus, chikungunya, dengue status in Latin America and Asia, yellow fever, and vaccinations for arboviruses. Videos of live cysticerci floating in the third and lateral ventricles seen on endoscopy were mesmerizing.

INTROPICON 2018 also discussed the status of meningitis across the world. The current human T-lymphotropic virus type 1 (HTLV1) status and HIV were presented and discussed. Poliomyelitis and post-polio syndrome are still ongoing problems, which was addressed. Cytomegalovirus infection and Ebola were issues affecting individuals, and their current statuses were presented. Fungal disease received its share of discussion and time. Snakebites still kill thousands in many countries. Their management remains challenging and, at times, difficult.

Amilton Barreira

In addition, major issues such as stroke, dementia, epilepsy, and Parkinson’s disease were discussed. Their unique management and long-term care in resource-poor settings were the main points of discussion. The availability of simple drugs for epilepsy and Parkinson’s disease was a major hindrance to neurological care. The lack of manpower and funding remains a major obstacle to neurological service provision. It is astounding that drugs as cheap as simple anticonvulsants, levodopa, and warfarin, among others, are still not available to billions of individuals living in low- and middle-income countries.

There remains a huge discrepancy in the provision of care in various parts of the tropics. In all, neurological expertise is concentrated in major cities, and in some of those, advanced imaging, genetic testing, and management (including interventional procedures) is available. However, this is by and large in fee-paying settings, which is not accessible to the majority of those who need the service.

Neurology training for young doctors is a priority, and it is heartening to see the increasing numbers of budding training programs across the world. There is nothing like training locally to master the vast number of conditions discussed, but just as important is exposure to training in more advanced settings. The Tropical and Geographical Neurology Applied Research Group of the WFN is working hard toward these goals. The meeting of this research group is biennial, and the next meeting is planned to be with the African Academy of Neurology in 2021. •

World Stroke Day 2018: BEYINDER


The Turkish Stroke Patient Society (BEYINDER), a member of the Stroke Alliance for Europe (SAFE), organized the first symposium for stroke survivors and their caregivers in Turkey on World Stroke Day 2018, acknowledging the importance of acute management in stroke, long-term commitment, and attention to the needs and rights of stroke patients for better outcomes. The full day symposium was titled “İnme Hasta ve Hasta Yakınları Sempozyumu,” which is Turkish for the “Symposium of the Stroke Survivors and Their Caregivers.”

BEYINDER was founded in 2017 and became a member of SAFE shortly after. We have strong collaborations with SAFE to raise awareness with respect to strokes. Every year, 15 million people suffer strokes worldwide, and it is the leading cause of disability. BEYINDER also publishes a stroke magazine for patients every three months.

The symposium, organized at the Altunizade Event Center in Istanbul, was attended by stroke survivors and their caregivers with the participation of health directors and heads of emergency services. The most important target of this event was the public; we created simple messages to promote via social media, newspapers, and press. The event relevance and the topics of the sessions (importance of primary prevention, emergency management interventions, and life after stroke for better outcome) were appraised by the TV channels, social media, news agencies, and newspapers. They focused on our activity on their main bulletins.

The main aim of this symposium was to provide close collaborations between stroke survivors, stroke neurologists, and policymakers to solve the main problems. In one of the sessions, we gave the microphone to the patients and discussed the problems they experienced and the needs of those patients. The second important target for this event was policymakers and the Ministry of Health. BEYINDER is now working to prepare a report about the conclusion of the symposium and the tribulations of those patients, and will contact the Ministry of Health to discuss and facilitate the solutions.

In Memoriam: Professor Jagjit S. Chopra

The following was distributed by the Indian Academy of Neurology.

It is with deep sorrow and regret that we inform you about the demise of Professor Jagjit S. Chopra, the founder President of the Indian Academy of Neurology on Jan. 19, 2019. He was the driving force in the formation of the IAN and the person who guided it to maturity.

He had a profound influence on the development of the academy as well as the professional careers of many members of the IAN.

Our prayers and thoughts are with the family members, friends, and students of Prof. Chopra.

— Satish Khadilkar, President, IAN, and Gagandeep Singh, Secretary, IAN

12-Month Dashboard Report

As I write this first column for 2019, the business of the World Federation of Neurology (WFN) is well under way. It is, however, the first anniversary of the new administration, and I will therefore present a dashboard, or update, of where we are at this point.

William Carroll, MD

London Office

To deal first with the heart of the WFN, I will summarize the state of the London office. A new computer-based calendar system known as Asana has been employed successfully.

It provides a common base for the office, individuals within the office, and trustees and committee chairs as required. Also, projects related to different calendar times or that operate throughout the year can be allocated to members of the team. Not only does it provide a readily accessible timeline for all projects, it also records the operating framework for all WFN activities. It should provide the flexibility to enable any team member to step into the role of any other team member at the same level of operational competence.

Thus far, it has been of considerable assistance, and I am sure we will develop its use even more profitably over time.

During this last year, a review of the website and its contents has been undertaken. Sections of the website have been updated, and others, including those related to committees and Specialty Groups (formally known as Applied Research Groups), particularly their roles and responsibilities, are currently undergoing the same process under the direction of the Secretary-General Wolfgang Grisold. The website is now also under more regular and systematic review to ensure that information is current. Through the efforts of Walter Struhal and his committee, e-communications using social media have increased in volume and professionalism.

An important part of the office and website changes is the development of uniform internal and external branding. A draft document currently before the trustees details logos, brands, and symbols that can be used and how they must be used. It is hoped that this will improve the recognition of WFN material. All office staff have participated in these revisions and improvements.

Finally, operational procedures and policies have been revised and, in instances, clarified. Regional teaching center memorandums of understanding (MOUs), WFN loans for educational meetings sought by Specialty Groups, and guidelines for applying for research grants have been implemented and/or revised to bring improved clarity and accessibility.


Moving to the trustees: They continue to meet by conference call each month. All have a particular area of responsibility within the WFN aside from their general duty of guiding the organization. The Council of Delegates meeting held during the Berlin European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting saw the election of Dr. Alla Guekht as one of three elected trustees. She replaced Dr. Morris Freedman, who had made notable contributions to the educational efforts of the WFN, particularly in the electronic form, and for which we owe him considerable thanks. He continues to serve as chair of the membership committee, for which we are also most appreciative. Also, the Secretary-General, Dr. Wolfgang Grisold, was reelected for another term.

Strategic Issues

The trustees have dealt with and are continuing to deal with several strategic issues. These include the Global Neurological Alliance (GNA), about which I have written previously. With the release of the latest global burden of neurological disorders (Lancet Neurology 2018) showing the considerable rise in numbers of people affected by neurological noncommunicable diseases, the GNA is likely to have a pivotal role in the relationship with the WFN and in turn its relationship with the World Health Organization (WHO). It is worth mentioning that the revised International Classification of Disease (ICD11), is due to be released this year, with the major change being the reclassification of stroke as a brain disease rather than a cardiovascular disease. At the January executive board meeting of the WHO in Geneva, the WFN took the opportunity to post a statement on this matter. Other posts published during this meeting included those on combating noncommunicable diseases, access to medicines, the action plan for epilepsy, and World Brain Day as part of the WHO review of world health days.

In addition to these matters, the WFN has been active in other global health matters, most notably WHO conferences on dementia (attended by Riadh Gouider), the Regional WHO meeting in September in Rome, and the WHO general assembly in  New York (attended by Wolfgang Grisold), and the Global Burden of Neurological Disorders World Summit (which I attended).

World Congress of Neurology: Dubai

In closing, allow me to remind everyone of this upcoming World Congress of Neurology to be held Oct. 27-31, 2019, in Dubai. It will be a most fulfilling educational experience for all, and I urge everyone to encourage younger colleagues and trainees to attend. Provision has been made for all levels of accommodation, and travel grants and bursaries will be as abundant as they were for the Kyoto meeting. Visas will be procurable for all. If in doubt on any of these matters, please visit the WFN/WCN website, or contact Jade at the London office of the WFN or Tami Gaon of Kenes, the point of contact for the WFN. •

From the Editors

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

Walter Struhal, MD

Steven L. Lewis

Welcome to the January/February 2019 issue of World Neurology, the official newsletter of the World Federation of Neurology (WFN). This issue begins with the report by Dr. Chandrashekhar Meshram and Dr. Raad Shakir (WFN immediate past President), who report on the second International Tropical and Geographical Neurology Conference (INTROPICON) held in Sao Paolo, Brazil, by the Tropical and Geographical Neurology Applied Research Group (ARG) of the WFN.

Next, Dr. Derya Uluduz reports on the many activities that occurred throughout Turkey during World Stroke Day 2018. In this issue’s President’s Column, WFN President William Carroll provides his update and summary of the first 12 months of the new WFN executive administration and an important reminder to all neurologists of the upcoming World Congress of Neurology (WCN) to be held in Dubai Oct. 27-31, 2019.

Dr. Mustapha el Alaoui Faris next provides a summary of the neurology in migrants meeting recently held in Marrakech by the WFN ARG on Migrant Neurology. WFN Secretary General Wolfgang Grisold then reports on the “Advances in Neuroscience and New Strategies for Preventing and Treating Brain Diseases” Conference recently held in Moscow. In this issue’s History Column, Peter Koehler informs us about the rich history of Dutch neuroscientists in Beijing with Rockefeller Foundation support.

This issue also features a number of reports from recipients of WFN Junior Traveling Fellowships to present their work at international conferences, as well as recipients of department visits (observerships cosponsored by national neurological societies and the WFN), highlighting the success of these international educational initiatives and fruitful partnerships.

This issue features a brief announcement of the very recent passing of Professor Jagjit S. Chopra, the founding President of the Indian Academy of Neurology and previous editor of World Neurology. The upcoming issue of World Neurology will feature more on the lives and remarkable contributions of  both Dr. Chopra and Professor James W. Lance, a past Vice President of the WFN, who also recently passed away as the current issue went to press.

Finally, this issue features an important announcement and reminder of the Tournament of the Minds at the WCN in Dubai, and the benefits of member societies’ teams registering for this very entertaining and educational aspect of the WCN. More information can be found at

Neurology in Migrants Meeting

by Prof. Mustapha El Alaoui Faris, Chair of the WFN Migrant Neurology Applied Research Group in Marrakech, Morocco

The meeting of the World Federation of Neurology (WFN) Migrant Neurology Applied Research Group took place Dec. 14, 2018, in Marrakech, Morocco, during the 12th Maghreb Congress of Neurology. This meeting coincided with the meeting of the Intergovernmental Conference on the Global Compact for Migration, a United Nations meeting held Dec. 10-11, 2018, in Marrakech. The charter of the global alliance was adopted by the U.N. General Assembly on Dec. 19, 2018, and this constitutes real progress for the cause of migrant people.

The topics covered in this meeting included: “Migration and Global Health” (Mustapha El Alaoui Faris, Rabat, Morocco), “Neurology and Migration: What We Know, What We Learn by Neurosciences, What We Can Do” (Antonio Federico, Italy), “Vascular Risk Factors in Migrants” (Serefnur Ozturk, Turkey), “Neuroinfections in Migrants” (Erich Schmutzhard, Austria), “Multiple Sclerosis in Migrants” (Riadh Gouider, Tunisia), “Somatization in Migrants” (Maria Benabdeljlil, Morocco), and “Neuro-oncology and Palliative Care in Migrants” (Wolfgang Grisold, Austria). The following is a short summary of the communications.

Most human migration is in search of better opportunities, reflecting the desire for an improved quality of life. The current international migration is a reflection of the world, resulting from the dynamics generated by changes in political, economic, and cultural structures. It reflects the advent of an interdependent world, stimulating new cultural and economic exchanges, and contributing to the social reconfiguration of host and departure societies. Since the beginning of the 21st century, migration has changed. In the past, people migrated to survive; now they migrate to realize themselves. It is the educated middle classes with high human capital and skills who most migrate. Migration can also have political causes such as civil wars in some parts of the world, including the Middle East or sub-Saharan Africa. In the near future, two particular reasons will have a dramatic role in the migration of people around the world. First, climate change, which could create enormous refugee flows. The second is the world demographic imbalance between the number of people living in low- and middle-income countries and those living in high-income countries that are aging and have low fertility.

Studies on the health of migrants show that migrants have more health problems than the hosting populations. They are more vulnerable to communicable diseases but also to some noncommunicable diseases, such as hypertension, diabetes mellitus, or obesity. The majority of migrants are initially healthier than non-migrant populations, the so-called “healthy immigrant effect.”

The health vulnerability of migrants may be due to several factors, such as difficulties in early childhood (e.g., poverty and malnutrition), poor living conditions in the host country, and dangerous work and psychological problems related to the migration process. The prevalence of neurological diseases among migrants remains largely unknown. But, given the high prevalence of neurological diseases in low- and middle-income countries, where the majority of migrants are originating, a high frequency of diseases of the nervous system should be expected among migrants.

However, the incidence, prevalence, and clinical presentation of neurological diseases may differ in migrant people depending on the epidemiology, geography, and genetic background of the native country. Adult migrants who may have experienced early childhood deprivation are particularly vulnerable to subsequent disorders of the nervous system.

Here are the particularities of some neurological diseases in migrant people. Migrants have more infectious diseases. Tuberculosis, which can cause severe neurological complications, has seen a re-emergence among migrant people living in socioeconomically disadvantaged conditions in host countries. The prevalence of human immunodeficiency virus (HIV) is high in African migrants and may be resistant to HIV drugs, and these patients have more severe cognitive disorders. Some tropical infectious diseases (such as malaria or neurocysticercosis) may occur in host countries either in migrants or in tourists who have been living in areas of high prevalence of these diseases.

Stroke is a major public health problem among migrants given the high prevalence of vascular risk factors such as hypertension, diabetes mellitus, obesity, and smoking. Migrants can have severe strokes at a younger age with high mortality rates and persistent neurological disability for a long time. In some host countries, migrants with cerebrovascular diseases appear to be less likely to benefit from appropriate treatment such as thrombolysis or thrombectomy.

Studies on the epidemiology of multiple sclerosis (MS) have shown that migration at the beginning of life from a low-risk area to a high-risk area can increase the risk of MS in this migrant population. Likewise, MS in some migrants is much more severe than in the native population (such in North Africans living in France).

Somatization and functional neurological disorders are common among migrant people, and their clinical presentation depends on the native culture of the migrants.

The severity of some neurological diseases that reduce the life expectancy of patients, such as neuro-oncological disorders, raises the problem of palliative care of migrant people. Palliative, hospice, and end-of-life care can be incompatible with culture and religious beliefs of some migrants and requires an appropriate approach.

The WFN Migrant Neurology Applied Research Group plans more meetings dedicated to other neurological diseases in migrant people, such as cognitive disorders in elderly migrants, epilepsy, neurogenetics, migraines and headaches, neuromuscular diseases, movement disorders, anxiety, and depression. •

World Stroke Congress, Montreal

by Subasree Ramakrishnan

Subasree Ramakrishnan

I received a World Federation of Neurology Junior Traveling Fellowship to attend and present the oral presentation “Clinical and Imaging Profile of Takayasu Arteritis Presenting as Young Stroke Syndromes: A Neurological Perspective from South India” at the Top 10 Young Investigators forum at the World Stroke Congress 2018, which was conducted from Oct. 17-20 in Montreal.

I was able to participate and present at the World Stroke Congress and learn, discuss, and interact with other faculty working in the field of strokes. Thanks for the support and encouragement. •

Francophone Society of Chronobiology

by Éric Bila

Éric Bila

I would like to express my deep gratitude to the World Federation of Neurology for granting me a 2018 WFN Junior Traveling Fellowship to participate in the 46th Conference of the Francophone Society of Chronobiology Oct. 22-25, 2018. We had the participation of world experts who presented to us their different works and their experiences. I had the opportunity to present my poster titled “Rhythm Disturbances and Epilepsy in Africa.” It was a rich experience in teaching and meeting other researchers of the world about the disorders of biological rhythm and the impact on humans as well as on animals.

At the end of this congress, I understood the close link between biological rhythm disorders and some neurological pathologies, which strengthens my approach in the care and follow-up of patients. •

Spanish Society of Epilepsy in Málaga, Spain

By Pâmela Ayala

Pâmela Ayala

Thanks to the World Federation of Neurology, I had the opportunity to attend the fifth Congress of the Spanish Society of Epilepsy in Málaga, Spain.

Throughout the conference, I exchanged ideas and established contacts with great professionals in the field of epilepsy. During the lectures and discussions, news advancements in epilepsy were presented, and I became familiar with some medications that are not yet available in Latin America.

I also had the opportunity to present my work as ​a poster and oral presentation. My work was entitled “​ENCEFALOPATÍA EPILÉPTICA SENSIBLE A URIDINA ASOCIADA AL GEN CAD,” or Epileptic Encephalopathy Sensitive to Uridine Associated with CAD Gene.”

Epilepsy is one of my passions, and day after day I try to perfect my technical scientific skills. I just have to thank the WFN for promoting my growth. •

Advances in Neuroscience

New Strategies for Preventing and Treating Brain Diseases

By Wolfgang Grisold

The conference on “Advances in Neuroscience and New Strategies for Preventing and Treating Brain Diseases” took place Nov. 12-13, 2018, in the Buyanov City Clinical Hospital, one of the largest multidisciplinary hospitals in Moscow. It was organized and chaired by Prof. Eugene Gusev and Prof. Alla Guekht in cooperation with the Russian Ministry of Health, the Moscow Healthcare Department, and the World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, among other institutions.

In addition to the local and international board, the chair of the WHO European Office in Moscow, João Breda, attended the opening. Extensive press coverage and TV presence demonstrated the interest in brain diseases.

Speakers gathered at the Buyanov City Clinical Hospital in Moscow to discuss strategies in preventing and treating brain diseases.

The conference was attended by an international faculty, speakers from Russia, and more than 400 doctors from Moscow and 16 cities of the Russian Federation, as well as from Kazakhstan, and Tajikistan. It provided an update on current issues in neurology with the main topics being brain diseases from bench to bedside, cerebrovascular disease, neuropsychiatry, and epilepsy. Also, translational studies and multidisciplinary strategies in brain diseases, autoimmune disorders, and diseases of the peripheral nervous system were highlighted. An innovative feature was the interactive case conferences in neuro-oncology and epilepsy. Based on case presentations, a multidisciplinary session was held demonstrating the importance of interdisciplinary work.

The lectures were a good synthesis of international and local speakers and served the purpose of an update of current neurological concepts, ranging from epidemiology toward new concepts of therapy. In addition to the program, the congress speakers were also able to visit the neurological and neurosurgical departments of the hospital, which demonstrated the high standard of the clinical practice in Moscow. The local faculty also produced a book of the lectures, which contains Russian and international contributions, based on the conference topics; this book is registered with an ISBN number.

Following the congress, the speakers were invited to a meeting of the international advisory board in the Research and Clinical Center for Neuropsychiatry of the Moscow Healthcare Department. The center is a modern clinical facility specializing in research and treatment of mental disorders and neurological diseases, including depression, anxiety disorders, suicidal ideation, epilepsy, neuropathic pain, post-stroke rehabilitation, and cognitive decline. On site, the faculty was able to visit the neuroimaging and neurophysiology laboratories and other research units, appreciating the up-to-date equipment and highly professional staff. It was also a good introduction to the interactive research seminar.

The research groups of the hospital presented their valuable studies, covering a broad range from bench to bedside to several practically applied projects. In addition to cerebrovascular disease and epilepsy, several projects touched on neuropsychiatric issues, which underlines the important issue of brain diseases as a multiprotocol and multidisciplinary task.

Speakers for the Moscow conference.

Following the presentations, faculty members were asked to continue with small working groups on several topics and projects being carried out. This was a rich source of interaction, and not only advice and input, but also cooperation and joint projects were initiated.

In summary, this interesting and internationally well-attended meeting could fill the gap from high level interaction of neurology with official and global institutions toward interaction and practical work toward joint projects with international cooperation. As such, it is an important template for advocacy in neurology. •