Dear Member Society, 

William Carroll, MD

At this time of what we all hope is the peaking of the COVID-19 crisis, I write to assure you that the WFN remains functioning normally with none of the trustees, staff, or executives physically affected. We trust that this continues and ask that if any member society is affected adversely in any way that they think we should be aware of, or that we might be able to assist, then please contact the London Office. 

For those of you who have been following our Facebook or Twitter feeds or the information on the WFN website or in the WFN newsletter, World Neurology, you will have noticed that the WFN had planned this year to ramp up its visibility, the promotion of brain health in parallel with this year’s World Brain Day, to commence the promotion of the 2021 World Congress of Neurology, and pursue and address the inequities of access to quality neurological care. Most of these activities were to combine both physical attendance at major international meetings and new press campaigns.  

With the impact of COVID-19 and the uncertainty of how long this will last, we will be transferring more emphasis of these efforts to the media. The cancellation of the 2020 American Academy of Neurology, the world’s largest neurological meeting, illustrates the likely direction for other major neurological meetings.  

It is paramount that neurological disorders and especially non-communicable neurological disorders do not become subsumed by the COVID-19 crisis and the response to it. In addition to providing our full support for the battle with COVID-19 by governments, their health services, institutions and hospitals, we also owe our patients with neurological disorders our reassurance and our vigilance.  

Most importantly, drug supply chains, access to medicines and pre-emptive information to those receiving neuro-immunological and other treatments, as to where to find the most appropriate and up-to-date information, will be invaluable to patients in jurisdictions where such services are already fragile. Most of the major neurological disease organizations and national and regional neurological organizations have done these preparations or are making them so it may just be a matter of ensuring the information pertinent to certain member societies is available. Fortunately, COVID-19 appears not to be neurotropic, and although there has been some earlier discussion on this in the literature, there has been no firm evidence to change this view.  

In closing, I wish all member societies, their individual members and their families, and above all, our patients, safe passage through this pandemic. 

William Carroll
WFN President

The World Federation of Neurology successfully supported the International League Against Epilepsy (ILAE) in the adoption of a decision by the WHO Executive Board in relation to epilepsy and other neurological disorders. Support for the draft decision proposed by the Russian Federation and co-sponsored by China, Guyana, and many other member states, including the European Union, was overwhelming. 

This is the first time that neurological disorders have been referred to collectively in a WHO decision and provides an opportunity to promote neurological disorders, including inequities of access to quality neurological care within the global organization. It also provides significant impetus to the longstanding campaign the ILAE has conducted to have epilepsy considered a public health imperative and the adoption of coordinated care campaigns. 

The WFN acknowledges the hard work done by the ILAE; Prof. Samuel Wiebe, its president; the Russian Federation; and Dr. Alla Guehkt, WFN trustee. 

William M. Carroll
WFN president

By Nils Erik Gilhus, Aud Kvalbein, and Anette Storstein

The Norwegian Brain Council (NBC), established in 2007, has been a pioneer in combining health worker organizations, patients, and research. The council is recognized nationally and seen as a key contributor to the Norwegian health system.

NBC is an umbrella organization made up of 58 member organizations. Membership includes 13 health professional organizations, 25 patient and user organizations, 12 leading research groups, and eight health institutions. Commercial companies cannot be members nor has the Council individual membership. NBC has only two permanent employees. Thus, many activities are based on voluntary work and work in the member organizations. From 2016, the council has received permanent funding directly from the government. Project funding from various sources remains crucial.

People waiting in a line to attend an open brain council meeting on sleep disturbances in Oslo.

The NBC works in the interface between health authorities, politicians, and society to promote better treatment and research for disorders affecting the brain. It was instrumental in launching a government-approved, national brain health program in 2017. This was probably the first such national brain health initiative taken. Hopefully, this program will represent a framework for future funding of specific projects in Norway supporting research and better treatment for patients with brain disease.

The first results of the brain health program have already appeared. Some neurodegenerative diseases have been selected as the focus of the first national Norwegian research center for patient treatment. This Neuro-SysMed group will concentrate its activities on dementia, Parkinson’s disease, ALS, and multiple sclerosis. The center will combine clinical trials and more basic research, and with funding directly from the government for up to eight years. Another consequence of the brain health program has been the establishment of two networks funded by the Research Council of Norway, Epilepsy-Net, and Norwegian Vision in Stroke Network. The Research Council of Norway would most probably not have selected brain disorders as the pioneers for new research instruments in clinical medicine without the hard work of the NBC.

The previous leader Hanne F. Harbo and CEO Aud Kvalbein in front of Stortinget, the Norwegian parliament, after a successful meeting.

The NBC aims to improve brain health through research, prevention, treatment, and follow-up. This should be fulfilled through information to the community, government agencies, health professionals, patients, users, and caregivers. The council will promote correct diagnosis and optimal treatment, prevention and rehabilitation of brain disorders, and furthermore strengthen and support research regarding the functions, diseases, injuries, and disorders of the brain and other parts of the nervous system. NBC has established a separate subcommittee for research.

The NBC is eager to join forces with other organizations and institutions for well-defined projects. Such partnerships can also include the pharmaceutical industry and other commercial companies. NBC has recently established a partnership with the Norwegian Council for Mental Help, thus emphasizing the policy of including mental disorders in brain disease.

The initiative to launch NBC was taken by neurologists. The Norwegian Neurological Association has from the beginning been an active member with an adequate representation on the NBC board. However, brain health involves more than neurology. Psychiatry and mental help organizations are active members as well as pediatrics, neurosurgery, and rehabilitation medicine. The members also include organizations for non-medical professionals, for example, neuropsychologists and speech therapists. The research membership spans from basic neurobiology to health-registry-based groups. The research group of the Nobel Prize winners (2014) May-Britt and Edvard Moser is a highly supportive NBC member. NBC has a stronger voice than each organization alone and should be able to compete with the forceful cancer and heart associations.

The NBC has made an impact in promoting better treatment and diagnosis for patients with brain disorders in Norway, and in increasing the support for neuroscience. Through joint action, the neurologists and other health professionals, patients, and neuroscientists who make up the NBC have influenced decisionmakers in national and regional health authorities and governing bodies. The NBC has grown in strength and stature during its 12 years of existence. With its ambitious aims and well-defined strategies, the council is looking forward to a brighter future for patients with brain disease. •

Nils Erik Gilhus is in the department of clinical medicine at the University of Bergen, Norway; Aud Kvalbein is in the department of neurology at Haukeland University Hospital in Norway; and Anette Storstein is on the Norwegian Brain Council in Oslo, Norway.

By Simon Shorvon and Alastair Compston, Cambridge University Press, Cambridge, 2019

Reviewed by Mark Hallett, MD, DM(hon)

Like most neurologists, I had always known about Queen Square as a mecca for neurology, and I got the opportunity to see it in action when I did a fellowship in London 1975-1976 with David Marsden. At that time, Marsden was at the Institute of Psychiatry in Denmark Hill, but I would go to the clinical demonstrations at Queen Square on Wednesdays and Saturdays. I paid my 50p, sat in the back, and observed the master clinicians.

McDonald Critchley examined a patient with alexia without agraphia and tried to determine whether she had lost her aesthetic abilities. M.J. (Sean) McArdle dazzled me with a 20-minute differential diagnosis of a “dropped index finger” that he observed on physical examination. A nice introduction. Later on, after Marsden moved to Queen Square, I became a frequent visitor. So, as many others, Queen Square has been part of my education. How did it get to be the center of British neurology and have so many achievements?

I was excited to see the book by Simon Shorvon and Alastair Compston. It is a book about the place, the people, and how they related. There are long sections about the important neurologists, but the authors decided not to discuss in detail those persons still alive (leaving later historians to clarify their roles). A bit disappointing, but understandable. The book is meticulous in detail, well researched, and can certainly serve as a single source for essentially everything you would ever want to know about Queen Square and its (deceased) inhabitants up until 1997 when it became a part of University College London.

The National Hospital for the Relief and Cure of the Paralyzed and Epileptic, formally founded in 1859, began admitting patients to a house in Queen Square in 1860 as the first hospital in the world specializing in neurology. The hospital was the idea of Johanna Chandler, and the book details her and her family and all the steps taken for the founding.

We learn the first patient was Margaret Warwick of 7 Hayes Court, Soho. The diagnosis is not noted, but we learn that she was cured! The first physician appointed was Jabez Spence Ramskill who worked there for 38 years. His appointment was followed by the first surgeon, Sir William Fergusson, who might never have actually shown up at the hospital. Three weeks later, Charles-Edouard Brown-Séquard was appointed. We learn in the book that he was already famous, having described his eponymous syndrome, and he was the first of the many accomplished neurologists who followed him. Brown-Séquard lasted only four years at the National Hospital, was hired by Harvard, lasted there only three years, and then bounced around until he succeeded Claude Bernard in the chair of Experimental Medicine at the Collége de France in Paris.

Shorvon and Compston describe the buildings, government relationships, the administrator, and the finances in detail, but I found myself more interested in the neurologists. The biographies, like that of Brown-Séquard, are full of colorful anecdotes. Jackson, Ferrier, Gowers, and Horsley are the “National Hospital Quadrumvirate.”

Jackson is also often referred to as Hughlings Jackson, and you can read the debate as to whether there should be a hyphen. Gowers was the first registrar at the hospital. His powers of observation and obsessive note-taking enabled him to make pioneering observations and become a master diagnostician. Osler described him as “arguably the greatest ever British neurologist”; Critchley wrote that he was the “greatest clinical neurologist who ever lived.” He was a popular lecturer and his textbook, Manual of Diseases of the Nervous System, is described here as “widely considered to be the most authoritative textbook of neurology ever written.”

Holmes, Wilson, Symonds, Walshe, and Critchley, the “five dominant physicians,” also get long biographies that are fun to read. Interestingly, Holmes and Wilson did not get along, as we learn in this quote:

“There was particular animosity between Holmes and Wilson, and, when making their respective rounds at Queen Square, each with his own retinue of doctors of all ranks, neither of them would move aside for the other, so that lengthy blockages ensued.”

Big personalities with big egos, but also many accomplishments.

Coming in to more modern times and persons that I knew, there are excellent biographies of Denny-Brown, one of my teachers at Harvard Medical School; Gilliatt, who joined me at NIH when he retired from Queen Square; Thomas, Newson-Davis, McDonald, Marsden, and finishing with Harding. Their personalities are well captured as well as the impressive elements of their curricula vitae. There is an appendix listing all of the neurologists and other physicians appointed at the National Hospital with their dates of appointment.

As a clinical neurophysiologist, I would be remiss not to mention some early highlights in that area as described in the book. While the first clinical EEG in the world was at the Massachusetts General Hospital, Queen Square was close behind. On the other hand, the EEG Society in Britain was founded in 1943 while that in the U.S. not until 1947. And, it is perhaps for that reason that the first international congress of EEG was held at the National Hospital in 1947. William Cobb and Denis Williams ran the lab at the beginning along with George Dawson. The latter got interested in somatosensory evoked potentials, discovered the giant SEP in cortical myoclonus, and then invented the averager to record these potentials with better signal-to-noise ratio.

The book is well illustrated, including the hospital building at various ages including architectural designs, and, of course, the people. There is a painting of Johanna Chandler and other early principals and photos of those in more modern times. A number are standard headshots or the groups of doctors or nurses, but there are some more interesting ones too, like that of Roger Gilliatt as the best man at the wedding of Princess Margaret and Anthony Armstrong-Jones, and the young Ian McDonald in the evoked potential laboratory.

The book is recommended highly as a valuable historical reference, but also for some entertaining reading about the history of neurology, many important neurologists, and the interesting place where they worked. •

Mark Hallett, MD, DM(hon) is the chief of the Human Motor Control Section of the National Institute of Neurological Disorders and Stroke at the National Institutes of Health in Bethesda, Maryland.

Meeting discussed use of transcranial Doppler ultrasonography as an ancillary test for brain death clinical diagnosis

By Marina Alpaidze, MD, and Gia Tomadze, MD

The Neurosonology Specialty Group (NSG) of the WFN, formerly known as Neurosonology Applied Research Group, is dedicated to the promotion of science and research as well as of education and training in the field of ultrasonic techniques and its clinical utilization. Therefore, international cooperation and the dissemination of scientific information within the field of neurosonology is part of NSG WFN activities.

On Oct. 19, 2019, the Georgian Association of Transplantology and Georgian Chapter of NSG in cooperation with NSG WFN organized a one-day workshop dedicated to transcranial Doppler (TCD) ultrasonography utilization as an ancillary test for confirmation of the clinical diagnosis of brain death. Among the faculty were Prof. Gia Tomadze, MD, PhD, chair of the surgery department at Tbilisi State Medical University; Prof. Marina Janelidze, MD, chair of the neurology department, Tbilisi State Medical University; Prof. Marina Alpaidze, president of the Georgian Chapter of NSG WFN; and Alexander Razumovsky, PhD, FAHA, secretary of the NSG WFN.

This one-day course was designed for individuals who are interested in performing and interpreting TCD studies specifically related to clinical yield of TCD for confirmation of the clinical diagnosis of brain death. The faculty discussed current clinical guidelines for death confirmation, potential false positive or false negative clinical cases, and reasons when use of ancillary tests for brain death confirmation could be appropriate. In addition, discussion also focused on cultural and religious barriers that are often limiting procedures for organ donation and requirements to streamline processes for organ transplants. Finally, the clinical value of TCD for confirmation of total cerebral blood flow cessation in the patient with a clinical diagnosis of brain death was debated in detail.

The next NSG WFN accredited course will take place April 3-5, 2020, during the European Society of Neurosonology and Cerebral Hemodynamics in Belgrade, Serbia. •

On behalf of the World Federation of Neurology, the Nominating Committee invites nominations for the position of Elected Trustee for a three-year period.

• One Elected Trustee to take office immediately following the election (position vacated by Riadh Gouider)

A nominee should be a member of a financial WFN member society, have a national and international reputation, made contributions to neurology, and contributed and committed to the WFN.

Submit the name(s) of the individual(s) in question, together with a signed statement of confirmation of their willingness to stand for election, a brief Curriculum Vitae (a single type-written page), and evidence of support from their member society.

Address the nomination documents to the Chair of the Nominating Committee, all of which should reach the London Secretariat office no later than May 1, 2020.

Nominations made after this deadline must be supported by a minimum of five WFN member societies, be accompanied by the same statement for World Neurology, Curriculum Vitae, and be received by the London office before Aug. 9, 2020. Electronic format is preferred.

Email nominations to: info@wfneurology.org

or mail them to:
World Federation of Neurology,
Chester House, Fulham Green,
81-83 Fulham High St.,
London SW6 3JA,
United Kingdom.