Tour Through the WFN Continues

The Finance Committee and the Specialty Group on Neuroepidemiology

By Wolfgang Grisold

Wolfgang Grisold

Wolfgang Grisold

In this issue of World Neurology, we would like to continue to introduce you to one committee and one specialty group. The committee/specialty group is introduced by the respective chairs, who were asked to explain their tasks and activities to our membership. Further details, such as the list of committee/specialty group members can be found on the WFN website, as well as email addresses of the chairs and members, which will be helpful if you want additional information.

The Finance Committee

Bo Norrving

Bo Norrving

The Finance Committee is chaired by Prof. Bo Norrving. He is senior professor in neurology and a consultant neurologist at Lund University Hospital in Sweden. He has been active in several functions in the WFN oven many years. He has a long experience in governance and leadership of scientific societies, including being president of the World Stroke Organization.

The Finance Committee has several experienced members with a global representation. The task of the WFN Finance Committee is to regularly review the economic strategies and financial situation of the WFN, functioning as an independent body from the WFN executives. The Finance Committee identifies strengths, weaknesses, opportunities, and threats for the WFN, and tries to look into the future taking the global economic situation, and environmental and political issues into account.

The committee also considers the need for adaptations of WFN educational and training activities related to information technology issues, educational tools, and practical issues. The committee helps to ensure that the WFN has a strategy to maintain an economic corpus that is a sufficient reserve for any upcoming disruptions and other threats. In particular, it is essential to have a sustainable balance to support future core projects (fostering best neurological practices, education, and research) and maintaining reserves in case of a downturn in congress income in the future. For this purpose, the assets are composed of short- to medium-term working capital and a longer-term reserve fund. WFN finances and corporate structure are regularly audited.

Over the years, the views of the Finance Committee and those of the trustees have been in excellent agreement. The committee acknowledges the careful strategic planning that has been in constant function at the WFN leadership over the past decades and continues into the future.

Specialty Group on Neuroepidemiology

Carlos N. Ketzoian

Carlos N. Ketzoian

The Specialty Group on Neuroepidemiology is chaired by Prof. Carlos N. Ketzoian, neurologist, epidemiologist, and neurophysiologist from the Neuroepidemiology Section, Institute of Neurology, University Hospital, School of Medicine, Montevideo, Uruguay. ( He has been chairing and researching in several neuroepidemiology activities, is the past-president of the Pan American Society of Neuroepidemiology, and participates in national and international scientific activities. He is also a member of the editorial board of neuroepidemiology.

The Specialty Group on Neuroepidemiology has a long history in the WFN. The proceedings of the group are oriented toward activities of teaching, research, and presentation of neuroepidemiologic results in academic activities, either in the congresses of the WFN or in congresses in different regions such as the Pan American Congresses of Neurology and Pre-Congress Symposia organized by the Pan American Society of Neuroepidemiology.

At the WCN 2021, a scientific session on neuroepidemiology will take place themed “The impact of socio-demographic, economic, and cultural factors on the epidemiology of neurological disorders (WFN Specialty Group on Neuroepidemiology)” on Oct. 6, 2021, in Rome, which is now a virtual meeting.

Research courses and projects have been developed for low- and middle-income as well as high-income countries, favoring a North-South interaction and collaboration. This has had a positive impact on the training of human resources in the area of neuroepidemiology.

Future projects will offer neuroepidemiology training activities in low-income countries. The II Latin American Neuroepidemiology Course scheduled for March 2020 has been postponed without a still-confirmed date of completion given the COVID-19 pandemic global situation. The current situation will need adaptation and virtual as well as hybrid courses will need to be implemented. •

Prestigious WFN Medals Announced

These medals will be awarded at World Congress of Neurology 2021.

WFN Medal Service to International Neurology
Prof. Vladimir Hachinski

WFN Scientific Achievement in Neurology
Prof. Jerry Mendell

WFN Meritorious Service Medals
Prof. Donna Bergen and Keith Newton

Munsat Prize for Service to Education
Prof. Erich Schmutzhard



A Neurology and Psychiatry Clinic in Central America

With Suggestions for Starting a Clinic

By Lawrence Robbins, MD

Neurology/psychiatry clinic near Tegucigalpa, Honduras.

Neurology/psychiatry clinic near Tegucigalpa, Honduras.

Starting the Clinic: The clinic is located within an excellent rural medical center near the main city (Tegucigalpa). Associating with an established medical center has been ideal. Ninety-five percent of the population has no access to neurology or psychiatry. I decided that it was crucial to supply various neurology and psychiatry medications. Locating the clinic relatively close to a big city was important. Close access has allowed me to teach in the public hospital, bring in other physicians, and refer patients for tests, Suggestion: Look for an established, well-run clinic, and locate within proximity to an international airport. This may not be feasible in all locations.

Associating With an Organization: It is difficult to start a clinic completely independently. I have had a close association with a well-established organization that runs our medical center. They provide room and board, and also help with security, transportation, and hiring clinic personnel. Suggestion: If possible, find community support. Establish close ties with an organization as there are many benefits.

Funding: Alas, it takes money. Lots of it. The plan was to establish a not-for-profit, which I did. With more resources, I was able to build out infrastructure, supply additional medications, and hire extra staff. Fundraising is important, but is one of the most difficult aspects of the venture. I am lucky to have a number of generous donors. Suggestion: If possible, start a nonprofit organization. This is vital for fundraising.

Staff of the neurology/psychiatry clinic.

Staff of the neurology/psychiatry clinic.

Personnel: I began with myself, one chart, and one patient. Over time, we have added two psychiatrists and two neurologists, a nurse administrator, and a psychotherapist. We pay the staff approximately what they would make working in their own private practice. The Honduran physicians are young and idealistic. Networking in neurology and psychiatry circles within the country helped me to connect. Connecting with the local neurology/psychiatry societies has been helpful. Neurologists and psychiatrists are in relatively short supply. The Honduran physicians are excellent, but often underpaid. I occasionally bring in another physician from the United States with me. This is usually a rewarding experience. The nurse administrator is a major key to success. The nurse administrator handles recruitment of patients, scheduling, managing patients in the clinic, medications, and other tasks. Suggestion: An administrator, preferably a nurse, is an invaluable part of the team. The downside of bringing in other physicians, or other personnel from another country, is that you are (somewhat) responsible for their trip and safety.

Charting: We are on paper charts, which is easy, and we keep a medication flow sheet. Our paperwork is minimal. Some notes are in English (mine), most are in Spanish. Since we treat each other’s patients, it helps if we list our thoughts for future considerations. In the beginning, we did not need medication or diagnosis flow sheets, as there were only one or two notes to review. Over time, after 15 or 20 visits, the need for flow sheets becomes apparent. Suggestion: Try to keep medication and diagnoses flow charts. It is beneficial to develop uniform charting, as multiple providers may be treating the patient.

Clinic Infrastructure: We have built out a neurology and psychiatry suite, along with a small pharmacy. If our budget were smaller, we would share space with the medical center, and minimize testing. We have supplied computers, and installed internet capability. The internet (usually) works, allowing me to research various conditions that I encounter. Books are convenient to store on my phone or laptop. However, it is more efficient to actually have the physical book handy. Suggestion: It is helpful to have a section of the pharmacy dedicated to the neurology clinic. Internet capability is extremely useful.

Recruiting Patients: In our clinic, the nurse administrator is in charge of recruitment. We have informed various medical clinics of our existence. We also placed a number of public service ads on radio. The neurologists and psychiatrists in nearby cities refer patients. Eventually, word of mouth drives most of the new patients. We draw patients from the entire country and surrounding countries. Suggestion: By alerting other clinics of your neurology clinic, word of mouth spreads quickly. It is helpful to let other physicians know about the existence of the clinic.

Our Services: Our primary purpose is to provide diagnosis and treatment for the vast underserved population. In addition, we offer free medications. We provide free blood tests and EEGs as well. Much needed psychotherapy services are offered on a limited basis. Psychotherapists are difficult to come by. In some settings, a layperson may be trained to be an “active listener.” We have run into barriers with providing therapy services. These barriers include stigma, reluctance to divulge personal information in a rural community, and lack of therapists. We provide patients with a safe place and offer emotional support. We are usually patients’ sole access to care. Suggestion: If possible, supplying medications is invaluable. If therapists are not available, training lay people is a possibility.

Medications and Pharmacy: The basic meds we provide include: antidepressants, anticonvulsants, mood stabilizers, migraine meds, and Parkinson’s medications. I decided that levetiracetam would be a mainstay. It is safe and does not require blood tests.

Our small neurology/psychiatry pharmacy is kept locked at all times. Suggestion: Choose medications that are relatively safe and do not require blood tests. If you purchase medications locally, you can often negotiate a better price.

Telemedicine: Since we have equipped the clinic with internet access, we have been able to connect remotely. Technically, it is a bit cumbersome. I am in Chicago with an interpreter but no chart, and the patient sits in Honduras with a nurse. The lack of insurance (and other) paperwork is helpful. These visits are not ideal, but better than no access at all. Suggestion: Telemedicine can work if there is adequate internet access.

Tests: Lab, MRI, EEG, etc: We do a limited number of blood tests. These tests are relatively expensive in Honduras. We are performing 20 EEGs on a monthly basis out of our clinic. This has been extremely helpful, as many epilepsy patients have not had an EEG, or any access to neurology. MRI/CT is expensive and not easy to obtain. However, many patients do pay for their MRI (about two weeks’ salary) and they bring in the films. We try to use as little testing as is feasible. Suggestion: Blood tests are important, and negotiating a better price is worthwhile. Diagnosis and treatment are often determined without advanced imaging.

Emergencies: We occasionally have a patient in status epilepticus or other neurologic emergencies. I am available from the U.S. for advice. WhatsApp works the best for remote communication. We stock the Emergency Room with basic medications (eg, fosphenytoin and diazepam for seizures). There is a Public Hospital in the main city, but transporting patients there is an adventure. There is only one local ambulance, and we need permission to use it. Suggestions: Neurologic advice often proves invaluable to the ER doctors. It helps to provide basic neurologic emergency medications.

Teaching/Publications/Videos: I teach neurology and psychiatry residents in Tegucigalpa. We have written a manual in Spanish on management of headache. This manual was distributed to many of the Honduran physicians. Suggestion: Teaching the local physicians is a rewarding experience. Articles document your experience and may spur others to follow your path. Videos of the clinic bring the clinic and patients to life. The videos can be instrumental for fundraising and promotion.

Acknowledgements: It takes a number of people to make this clinic a success. Our incredible donors have provided the crucial funding All of the personnel in SAN (Honduras) have provided vital support. The Honduras clinic staff and doctors are the mainstay. •

Lawrence Robbins, MD, is an assistant professor of deurology at Chicago Medical School.; (Honduras Project Section with videos/blogs)

Neurology Update in Kazakhstan 2021

By Aida Kondybayeva, MD, PhD

Aida Kondybayeva

Aida Kondybayeva

The International Educational Online Forum: Neurology Update in Kazakhstan was held April 23-24, 2021. Forums of this scale in Kazakhstan are held every two years, and this forum was being held online for the first time. The event was attended by 985 doctors, including neurologists, internists, GPs, rehabilitation specialists, and intensive care specialists from Kazakhstan, Kyrgyzstan, Uzbekistan, Belarus, and Ukraine.

At the first day within the framework of the International Educational Online Forum: Neurology Update in Kazakhstan, the EAN-Day in Kazakhstan was held. This event was held with the joint work of the European Academy of Neurology, Kazakh National Association of Neurologist Neuroscience, and al-Farabi Kazazakh National University.

Welcoming speeches to the participants were given by Prof. Saltanat Kamenova, president of KNANN; Nadezhda Petuhova, chair of the Public Council of the Ministry of Health of the Republic of Kazakhstan; Prof. Raushan Isayeva, director of High School of Medicine, Faculty of Medicine and Health, al-Farabi Kazazakh National University; and Mikhail Mazurchak, vice president of KNANN. They noted the special significance of the EAN-Day in Kazakhstan for all practicing doctors who took part in this event.

The speakers of the EAN-Day in Kazakhstan were Prof. Aksel Siva from the Department of Neurology of Istanbul University, Cerrahpaşa School of Medicine (Istanbul Turkey); Prof. Erik Taubøll from the Department of Neurology Oslo University Hospital (Oslo, Norway); and Prof. Maxwell Simon Damian, Department of Medicine, Cambridge University (Cambridge, UK).

The professors presented reports on the situation with MS, epilepsy, and neuromuscular diseases before and during the COVID-19 pandemic; these presentations aroused great interest among all participants of the event.

Luca Caffaro, the youngest speaker of this event, presented an interesting report on the work of the Residents and Research Fellows Section (RRFS) of the EAN, and on professional development opportunities for young neurologists and residents. EAN-Day in Kazakhstan received positive feedback from all registered participants of the event.

In the second half of the event, workshops were held, in which speakers presented analyses of difficult clinical cases and the possibilities of their resolution. The second day, the forum was no less eventful, and included reports of doctors from Spain (Jerzy Krupinski-Bilecki), Afghanistan (Ayesha Khaideri), Ukraine (Sergey Moskovko), Russia (Dmitry Kasatkin, Evgeny Evdoshenko, and Natalia Khachanova), and Kazakhstan (Gulsum Duschanova, Saltanat Kamenova, Gulnar Kabdrakhmanova, Mikhail Mazurchak, Maksharip Martazanov, Karlygash Kuzhibaeva, Aida Kondybayeva, and Asel Aralbayeva). Topics including MS, pain, neuromuscular diseases, and epilepsy were discussed. •

Aida Kondybayeva, MD, PhD, is a neurologist and chair of the Educational Committee at Kazakhstan National Association of Neurologist “Neuroscience” Institutional Delegate of the European Academy of Neurology from Kazakhstan.