Monkeypox and Neurology

By Chandrashekhar Meshram

Chandrashekhar Meshram

The World Health Organization recently declared monkeypox a global public health emergency of international concern. Monkeypox is a viral zoonosis caused by a double-stranded DNA virus in the Orthopoxvirus genus, transmitted to humans from animals—with symptoms similar to smallpox although clinically less severe. Details about the disease are available on WHO’s website.1

Since early May 2022, cases of monkeypox have been reported in countries where the disease is not endemic and continue to be reported in several endemic countries. Most confirmed cases with travel history reported travel to countries in Europe and North America, rather than West or Central Africa, where the monkeypox virus is endemic. This is the first time that many monkeypox cases and clusters have been reported concurrently in non-endemic and endemic countries in widely disparate geographical areas.2 As of Aug. 8, 30,189 cases have been reported from 88 countries, out of which 29,844 cases are from countries that have not historically reported monkeypox3.

Most reported cases so far have been identified through sexual health or other health services in primary and secondary health care facilities and have involved mainly, but not exclusively, men who have sex with men.

Human infection with monkeypox virus was initially identified in 1970, with almost all subsequent cases confined to rainforest regions of central and west Africa. In Africa, human case fatality rates from monkeypox infection are approximately 10%, and nearly half of infected individuals develop severe complications. In recent times, case fatality rate is around 3% to 6%1.

In the summer of 2003, there was an outbreak of monkeypox virus infection in 72 individuals (34 confirmed cases) in the midwestern United States, the first human infections reported from outside the African continent5. Fifteen percent of the confirmed cases were seriously ill, including one patient with severe encephalitis.

The most common symptoms included rash, fever, chills and/or rigors, adenopathy, headache, myalgia, sweats, and cough. Rash, predominantly centrifugal involving palms and soles, follows the viral-like prodrome after one to three days.

Neurological manifestations in the form of headache and malaise are observed in more than 50% of patients, while more serious complications like encephalitis and seizures are seen in less than 3% of patients.6 Anxiety and depression are common in hospitalized patients. Two cases of encephalitis due to monkeypox, both in girls requiring intubation and mechanical ventilation, are reported in the literature during past outbreaks7.

The U.S. patient with monkeypox encephalitis was a 6-year-old girl who initially presented with fever, pharyngitis, anorexia, malaise, and headache and was noted to have adenopathy and a vesiculopapular rash. She subsequently became somnolent and unresponsive and developed presumed seizure activity. Her MRI brain, EEG, and cerebrospinal fluid (CSF) revealed abnormalities. Diagnosis was confirmed by detection of monkeypox virus IgG and IgM in serum and IgM in CSF and by positive culture, immunohistochemical, and PCR results on skin lesion material. The patient gradually improved over several weeks, eventually recovering fully8,4. The other was a 3-year-old girl who died on day 2 of hospitalization but CSF diagnostics were not performed7.

Because IgM does not generally cross the blood-brain barrier, the presence of IgM in CSF indicates active central nervous system infection with intrathecal antibody production. The absence of demyelination, cytotoxic changes caused by diffuse and focal edema, and intrathecal antibodies (IgM) all point to monkeypox as a possible cause of acute encephalitis7.

Monkeypox appears to have a fatal course almost exclusively in infants and young children, specifically those who have not received vaccination against smallpox.

These are early days, and we may find more cases with neurological involvement in the coming weeks or months. Any person with fever, rash, lymphadenopathy, and altered sensorium should be suspected as a case of monkeypox encephalitis. •

Chandrashekhar Meshram is co-opted trustee of the WFN.

References and further reading

  4. Tyler KL emerging viral infections of central nervous system part 2. Arch Neurol 2009:66(9):1065-1074.
  5. Reed KDMelski JWGraham MB et al. The detection of monkeypox in humans in the Western hemisphere. N Engl J Med 2004;350 (4) 342- 350
  6. James B Badenoch, Isabella Conti, Emma R Rengasamy, Cameron J Watson, Matt Butler, Zain Hussain, Alasdair G Rooney, Michael S Zandi, Glyn Lewis, Anthony S David, Catherine F Houlihan, Ava Easton, Benedict D Michael, Krutika Kuppalli, Timothy R Nicholson, Thomas A Pollak , Jonathan P Roger Neurological and psychiatric presentations associated with human monkeypox virus infection: a systematic review and meta-analysis medRxiv preprint doi:
  7. Caleb RS McEntire, Kun-Wei Song, Robert P McInnis, John Y Rhee, Michael Young, Erica Williams, Leah L Wibecan, Neal Noha, Amanda M Nagy, Jeffrey Gluckstein, Shibani S Mukerji and Farrah J Matin Neurologic Manifestations of the World Health Organization’s List of Pandemic and Epidemic Diseases Front. Neurol., 22nd February 2021 Sec. Neuroinfectious Diseases
  8. Sejvar JJ, Chowdary Y, Schomogyi M, et al. Human monkeypox infection: a family cluster in the Midwestern United States. J Infect Dis. 2004;190(10):1833-1840.
  9. Shafaati M, Zandi M. Monkeypox virus neurological manifestations in comparison to other orthopoxviruses Travel Medicine and infectious diseases Volume 49, September October 2022, 102414

President’s Column

Wolfgang Grisold

This issue of World Neurology contains the statements of the candidates for the new Secretary General and one Elected Trustee. They are all well prepared and focus on different angles to these important positions. Most importantly, all of the applicants radiate energy and enthusiasm, which is the important content of fuel of neurology and the WFN. I want to thank them all for standing up and “running.” I know from experience that this engagement needs much energy and efforts. Only two of the seven candidates will be successful, but despite the results, we will need you all in the future.

We look forward to the Council of Delegates (COD) meeting as this is the formal presentation of the past year, contains the trustees reports, and statements from committees. As a U.K. charity, we have a privileged status, but need to comply with all charity rules.

We will hear the state of the preparation for the WCN 2023 in Montreal, a closer look at the WCN in Korea in 2025, and the call will also allow us a first glance for possible applicants for the WCN 2027 in Africa and the Panarab region.

The regions are not only represented with the trustees, but we have regional meetings every three months and have composed the committees strictly by members recommended by regions, and also the World Brain Day (WBD) committee for the first time was not neurological topic related, and was composed of representatives of the regions.

In the following visions, we have three more important tasks:

  • Install gender and diversity at all levels (including subcommittees)
  • Establish structures for young neurologists (subcommittee)
  • We are creating a global patient platform to have this important input.

Most advanced of these visions is the subcommittee for young neurologists (chaired by Dr. Lehmann from Germany), who will make a proposal for a young first neurologists’ program at WCN 2023.

The past month has been interesting and exciting, not only because of the final acceptance of the IGAP, and the release of the WHO Brain Health paper and statement on Brain Health, but resulting from this, an enormous momentum for neurology worldwide. These plans define the importance of the IGAP in politics, treatment, prevention, innovation and research, and public health. All the WHO member states (all have agreed) to implement the concepts in their health systems within 10 years. Due to circumstances, income, regions, and per health capita, this is not a linear task, but it has been put out and is now ready to be implemented. The WFN is aligning with the WHO and other non-state actors and NGOs to implement and advocate, and it will be an important task to implement and progressively develop. The momentum could not be bigger, and the time is now.

We have had a successful WBD, themed “Brain Health for All,” which was a good and useful alignment with IGAP and Brain Health. We are glad that so many countries took this up, and please look also at our website for more reports.

The WHO is not the only international body for the WFN; also the target to be part of Economic and Social Council (ECOSOC) (UN) was reached, and the WFN will be allowed to attend the ECOSOC meetings at the UN and will have a stronger voice internationally. The ECOSOC has issued the Sustainable Development Goals (SDGs) as a call for action by all countries—developed and developing—in a global partnership to end poverty and other deprivations and improve health and education among other goals.

Education is the backbone of the WFN, and reaches from congresses, individual support, grants toward Department Visits and Teaching Centers, and as a successful new implantation the WFN has created the Educational Days.

Publications, CME: The issue of CME  is important, and needs to be free from industrial influence. See “Education, Congresses, and CME: Sponsoring and Influence of Industry” by Wolfgang Grisold and Steven Lewis on this page.

The WFN Teaching Centers are well under way and it is now planned to add a four-year training post in Rabat and a one-year stroke fellowship in Cape Town.

Since the implementation of the Teaching Centers in Rabat in 2013 and the subsequent Teaching Centers and the Department Visits, these have become successful educational tools. For the last two calls for Department Visits, we had as many as 18 applicants for one country.

With regard to the WFN Department Visit development, we are glad to have Spain host a Department Visit from Latin America, and India will invite a Department Visit from Asia in the near future.

The model of the WFN educational days has proved a successful concept. After sessions devoted to stroke and epilepsy, this year the topic was “Movement Disorders” and took place Sept. 3, in a joint activity with AFAN and the MDS and also endorsed by the AAN and the EAN.

The EAN is holding its regional teaching course (RTC) in Douala, Cameroon, this year, and the WFN will continue to support RTCs.

Our WFN Specialty Group on Neuromuscular Disease had a successful ICNMD 2023 Congress in Brussels with 1,400 participants. The next ICNMD meeting will be in Perth in 2024, and the call for 2026 is presently out.

We are happy to say that the Journal of the Neurological Sciences, the official journal of the WFN, has reached a new, higher Impact Factor, and is also renovating the editorial board. The eNS is flourishing under Walter Struhal’s leadership, and still has a way to go in the rankings.

Our most frequented media are World Neurology (Steven Lewis) and social media, which have ever-expanding readerships, and the social media that started a long time ago is now gaining momentum, with approximately 14,000 followers on Facebook, 7,000 on Twitter, and 4,000 on LinkedIn.

Special thanks go to Steven Lewis, Kimberly Karlshoej, Chiu Keung Man, and Walter Struhal, who are enthusiastically working on these information loops. •

Education, Congresses, and CME: Sponsoring and Influence of Industry

By Wolfgang Grisold and Steven L. Lewis

The WFN’s policies regarding industry sponsorship, continuing medical education (CME), and conflicts of interest (COI) are provided here.

In many countries and regions, the separation of scientific content and industry events is strictly carried out. Examples include the United States via the Accreditation Council for Continuing Medical Education (ACCME), and in Europe via the European Union of Medical Specialists (UEMS) and its European Accreditation Council for Continuing Medical Education (EACCME), and these policies of separation of CME and Continuing Professional Development accreditation of Congresses and Meetings from industry events is strictly defined and monitored.

Educational programs point out this separation and strive to avoid influence of industry on education. CME rules need to be strictly adhered to, and only unrestricted sponsoring of industry can be accepted.

The pharmaceutical and device manufacturers have great merits in research and in producing products that are prescribed and used, and we have observed incredible developments in vaccines and genetic and other therapies in the past years.

Industry is often a main sponsor of scientific events and congresses, as well as online events, yet these sponsorships must be strictly separated from industry sales and advertisement, either overt or hidden.

For neurologists worldwide, all proceedings with industry, and possibly other stakeholders with specific competing interests, need to be transparent, and need to be declared.


The policy of the WFN is to abstain from direct pharma sponsoring and remain as autonomous as possible to perform its duties and obligations in an equitable and unbiased role worldwide.

Congresses, including the WFN’s World Congress of Neurology (WCN), are usually organized by professional conference organizers (PCOs) who have a clear mission to accept industry support for exhibition halls as well as industrially sponsored symposia, which need to be clearly indicated and separated from the scientific program. In the UEMS regulations, these industry symposia may only appear in a separate program, or at the end of the program.

For most CME accreditors, there is a clear distinction between a scientific program and industry sponsored symposium. This distinction needs always to be adhered to.

Grants and supports of industry should be unrestricted, or in case of a project or research, must be defined to what extent the support is made, and what is expected from the recipient. Research internationally is often supported by industry or other sources, which need to be defined, and also mentioned in disclosures, such as in the disclosures of WCN speakers.

The WFN is aware that regulations and industry relations with scientific and professional societies vary worldwide, but it is important to openly declare any COI that comes from relations with industry or other organizations and institutions.

Lectures and Publications

Currently, one or more declared COIs are often found in the announcement of a lecture or a paper, and just define and explain that some relations could be seen as a COI and depending on the content of the COI this could be explored in more detail. It is often criticized that in lectures these slides appear only within a few seconds, and the audience would not be able to perceive the content. One possible solution would be to add the COI after the speaker’s name in the program.

We must also be aware that indirectly or directly, the main interests of industry and new products for specific diseases may influence the programs of industry. Studies show that popular congress themes are often driven by recent topics related to new products related to disorders such as headache and MS, and other topics may be neglected.

Equity and Access

There is also another important point to be made in regard to mainly lower-middle income and low-income countries, where activities either depend on industry money, or are restricted because of the lack thereof. We are painfully aware that even those drugs on the WHO list of essential medications are often not available, with issues related to access and equity.


For the moment, our homework will be to keep education, congresses, and CME free from direct influence of industry and other stakeholders. Disclosures at meetings, congresses, and papers need to be clear and tangible. In addition to individual responsibility, international neurological societies including the WFN need to have their own locally adapted policy regarding sponsoring and industry.

The WFN seizes on this opportunity to make the neurological community introspective and aware of its relations with industry which are often fruitful and necessary but need to be strictly regulated and adhered to.

The WFN is committed to full disclosure and adherence to independence from industrial and pharma influence. •

Wolfgang Grisold is president of the WFN. Steven Lewis is acting secretary general of the WFN.

World Brain Day in India

By Chandrashekhar Meshram, Nirmal Surya and U. Meenakshisundaram

World Brain Day 2022 was celebrated with great fanfare and enthusiasm in India, and the campaign was extended over a week. This year’s theme “Brain Health for All” was appropriate, and it generated a lot of interest. Although the Dynamic President of the Indian Academy of Neurology (IAN) Nirmal Surya had given an ambitious target of 100 activities during the week, we ended up doing many more events across the country. The activities were focused on increasing awareness of common people and students about brain health and neurological diseases.

Dr. Chandrashekhar Meshram, chief coordinator of public education activities of IAN, had issued the press release. Participation of WFN President Prof. Wolfgang Grisold in four national webinars brought a lot of cheers for the organizers.

The spectrum of activities included webinars, drawings, paintings and poster competitions, sports events, a walkathon, Run for Brain, school and college talks, public talks, interviews on radio, television, and newspapers, and social media interactions.

The weeklong celebration ended with a concluding function attended by Prof. Grisold. Doing so many activities was an extremely satisfying experience, and this event will certainly contribute toward promotion of brain health and early diagnosis, treatment, and prevention of neurological disorders and in turn improving patient care.

Subsection Webinars—6 Activities

Man Monahan Mehndiratta, chair, and Abhishek Shrivastava, convener of Neurorehabilitation subsection of IAN, conducted four webinars: Brain Health, Neuroplasticity—Rewiring the Brain, Cognition and Brain Health, and Update on Neuromodulation.

The webinar by Epilepsy Foundation was organized by Nirmal Surya.

The webinar was organized by Tamil Nādu and Puducherry Association of Neurologists under guidance of Sunil Narayan and K. Ramadoss.

Activities at Different Centers

Nagpur—14 Activities Plus 43 Publications

All India Radia talks and interviews of Chandrashekhar Meshram on Brain Health for All, Dhruv Batra on Parkinson’s Disease, Satish Lahoti on Stroke, Vasant Dangra on Epilepsy, Abhishek Wankar on Dementia, Vaibhav Nasre on Head Injury, and Shyam Babhulkar on Headache were relayed daily during the week.

Talks in four Schools: Hadas High School, Somalwar High School, Sainath High School, and Gayatri Convent in Nagpur by Vasant Dangra, Dhruv Batra, Anand Somkuwar.

Two interviews of Chandrashekhar Meshram on Awaaz India TV and Doordarshan TV

Walk for Your Brain Walkathon was organized in Nagpur on July 24 and various placards carrying important messages were displayed.

Newspaper Publications—43 publications during the week highlighted the event, as these contributed immensely toward public health awareness and education.

Chennai—10 Activities

World Brain Week started with a cake-cutting ceremony. Daily lectures: U. Meenakshisundaram on Brain Health, Ritesh Nair on Stroke, U. Meenashisundaram on Parkinsonson’s Disease, Head Injury, Ravikumar on Headache, Epilepsy, and Brain Tumors. Poster and quiz competition received overwhelming response. The posters were exhibited, and the best entries were given awards. U. Meenakshisundaram gave a talk on Red FM on Brain Health.

Bangalore—14 Activities

Suvarna Alladi and NIMHANs team organized a cricket match with cricketer Robin Uthappa who is brand ambassador of Karnataka’s brain health initiative. Policymakers, patients, care givers, institutional heads, and neurologists participated in the event. Karnataka Health Minister K. Sudhakar inaugurated the first of its kind brain health clinic in the Bangalore Hospital. It was supported by six newspaper publications. Amit Kulkarni delivered a public talk at Global Institute of Technology. Suryanarayan Sharma gave lectures in two colleges, and also at Toyota Industries. He organized the painting competition for school children. His interview was published in the newspaper and he did two digital platform activities. B. K. Madhusudan gave a talk at the university and had one Facebook live event on brain health.

Nellore—8 Activities

Bindu Menon organized eight activities in Nellore during the week.

Day 1: Awareness to Shar Employees on stroke prevention. Awareness to Lions Club of Nellore. Time Is Brain: Adani Group. Webinar on neurological health, hero group of employees. Topic on stroke, SembCorp Group employees. Topic on responding to stroke and preventing stroke, SBI Main branch. Interactive session on improving children’s brain health, NeuroVoice podcast welcomed Mrs. Padma Subrahmanyam, founder and Director Rainbow School, Nellore who spoke about the challenges children face, the way forward, and how to improve brain health. Eight stalls were arranged for patients, caregivers, and accompanying persons at Apollo Hospital premises. Each stall focused on the prevention campaign run on one risk factor.

Delhi—9 Activities

Public health lecture on brain health issues in school children was organized by Sheffali Gulati and her team at AIIMS, New Delhi. Web-based application for dyslexia children was launched on occasion of WBD.

Program of Sheffali Gulati, Debashish Choudhary on DD Kissan. Public lecture series was organized at G B Pant Hospital. Debashish Chaudhury gave a talk on brain health, Rohit Bhatia on stroke, Ashish Duggal on headache and Swapan Gupta on epilepsy. This was followed by a panel discussion. The event was also showcased on Doordarshan. Rajinder Dhamija gave a talk at Institute of Human Behavior and Allied Sciences. Two talks were given by P. N. Ranjan.

Gurgaon—7 Activities

Manish Mahajan and Sumit Singh organized the press conference and explained the concept of brain health. Talks in Amity International School and Shiv Nagar School Gurgaon by Sumit Singh and Manish Mahajan of Artemis Institute. Students of AIS performed the nukkad to convey the message of brain health. Manish Mahajan gave a talk on Facebook Live. Health talk at Make My Trip head office was given. Article was published in Punjab Keasari newspaper.

Chandigarh—5 Activities

Director PGIMER Chandigarh Dr. Vivek Lal conducted innovative sessions during the week. Programs like Train the Brain poster-making competition in Chandigarh Schools, Games for brain slogan writing competition, No Stain on Brain distribution of educative material and public awareness talks, Food for thought avoidance of addiction, Don’t drain your brain – importance of sleep were organized.

Mumbai—9 Activities

Talks were given at Jaslok Hospital Mumbai

Fali Poncha on Stroke, Joy Desai on Dementia, Pettarusp Wadia on Parkinson’s Disease, Joy Desai on Sleep, Ravishankar on Migraine, Anaita Udwadia on Epilepsy, and Azad Irani on Rehabilitation. Interviews of Nirmal Surya were published in two newspapers.

Ludhiana—2 Activities

Gagandeep Singh arranged two talks on epilepsy for the general public.

Trichy—4 Activities

Brain health awareness and a talent detection program for special children was organized at Trichy Central Library. M. A. Aleem gave a talk in school. Aleem published interview in newspaper. Talk on brain health on YouTube by M. A. Aleem.

Amaravati—2 Activities

Sikander Advani arranged a painting competition on World Brain Day. There were 157 entries. Exhibition of paintings was held, and prizes were given to best creative works.

Nanded—3 Activities

Pramod Dhonde held a painting competition on brain health for school children. He also organized a Brain Quiz and gave a talk on stroke, migraine, and brain.

Cuttack—3 Activities

Siumyadarshan Nayak organized an essay writing competition in School in Barhampur and held a drawing competition for school children. He also did an awareness program for school children.

Hyderabad—2 Activities

Interviews of Subhash Kaul and Suresh Kumar were published in newspapers.

Lucknow—2 Activities

Two interviews of Rajesh Verma were published in Live Hindustan and Jagran.

Pune—1 Activity

Talk by Shripad Pujari on lifestyle modification.

Amritsar—1 Activity

Jaslovleen Kaur has written a poem on dementia.

Patna—1 Activity

Ujjawal Roy composed a song on brain health.

Jaipur—1 Activity

Talk by Bhawna Sharma on brain health.

Ahmedabad—4 Activities

Interviews of Sudhir Shah and Heli Shah were published in four newspapers and periodicals.

More activities were done at other centers but their reports were not available at press time.

FM Radio

Twenty two neurologists gave messages on brain health on FM radio.

There were 45 interviews of neurologists on Red FM Radio.

Social Media

114 tweets, 360 posts on social media. 1,410 viewers on Instagram, 6,458 on Facebook and 11.5 K on Twitter.

Run for Brain

Twenty eight neurologists in runners groups from different regions participated in this event and completed 2.4 million steps during the week. •

Chandrashekhar Meshram is co-opted trustee of the WFN. Nirmal Surya is president of the Indian Academy of Neurology. U. Meenakshisundaram is head of the department of neurology at SIMS hospital in Chennai, India.

Latin America Joined the World Brain Day 2022

By Jessi Arita and Marco T. Medina, FAAN, FEAN


Latin America joined the World Federation of Neurology (WFN) and the Pan-American Federation of Neurological Societies (PAFNS) on the celebration of the World Brain Day 2022, which took place every July 22, with the purpose of sharing information and optimizing brain health, creating awareness on the prevalence of brain disorders, and reducing the global burden of neurological disorders.

The World Brain Day was promoted through webinars, social media posts, graphics, and journalistic articles about the proclamation of the World Brain Day, promotion of brain health, and functions of the brain.

México, Cuba, Honduras, Perú, Argentina, and Uruguay, among other countries, as well as academic institutions such as the National University of Córdoba, Argentina, and National Autonomous University of Honduras (UNAH), Honduras, contributed in creating attention on non-communicable neurological diseases, that according to the Brain Health Initiative WFN, represent 6.3% of all global disability, including stroke, migraine, tension-type headache, Alzheimer´s disease, dementia, Parkinson´s disease, epilepsy, multiple sclerosis, and motor-neuron diseases.

The faculty of Medical Sciences of the National University of Córdoba remembered the day as a chance to carry out campaigns so that society is aware of brain disease and on how the WFN took the initiative to give importance to brain health.

The official newspaper of the National Autonomous University of Honduras (UNAH), Presencia Universitaria, through the article “UNAH and PAFNS invite to the World Brain Day,” motivated the university community to the World Brain Day and to the webinar “Brain Health for All,” featuring Prof. Wolfgang Grisold, WFN president, Prof. David Dodick, WFN co-chair, Prof. Tissa Wijeratne, WFN co-chair, and Dr. Tarun Dua, medical officer of the Brain Health Unit, the World Health Organization.

It encouraged the sharing of WFN posts, messages, and videos with friends and colleagues; partnering with local neurological societies and organizations to promote such activities, and the use of free educational resources to lead World Brain Day campaigns.

Likewise, the newspaper socialized that through the editorial “Brain health as a global priority,” view from WHO: Editorial from the World Federation of Neurology in the Journal of the Neurological Sciences, the WFN shared support for the concepts that the brain is the mediator of all human action and experience, and that neurology requires a multidisciplinary approach with a person-centered approach.

Presencia Universitaria also informed that through a correspondence letter published in The Lancet Neurology “Brain health for all on World Brain Day 2022,” WFN members invited readers to participate

World Brain Day 2022 in Malaysia

By Shanthi Viswanathan

Display of banners, balloons, and pamphlets at the Tunku Abdul Rahman Neuroscience Institute.

On the July 22, 2022, the Neurology Department at Kuala Lumpur Hospital, Malaysia, celebrated “World Brain Day” in conjunction with the World Federation of Neurology’s theme of “ Brain Health for All.” The theme for this year’s celebration is very meaningful, inclusive, and diverse. The neurology department at Kuala Lumpur Hospital is part of the Tunku Abdul Rahman Institute of Neurosciences. It is a major national tertiary referral center for neurological conditions.

Hospital Deputy Directors, Dr. Hajjah Shahrum and Dr. Fairoz officiating the World Brain Day on July 22, 2022, at the department of neurology at the Kuala Lumpur Hospital in Malaysia.

As part of the World Brain Day celebrations, there were posters, banners, and pamphlets on common neurological conditions such as epilepsy, stroke, headache, and multiple sclerosis and related disorders, as well as electronic gimmicks such as a brain model with decorative lighting and music in the clinics at the Specialist Ambulatory Care Center and IKTAR ground floor.

Display of World Brain Day corner at the Neurology Clinic, SCACC.

During the celebration on the July 22 and the week following, all members of the neurology department including the porters, department clerks, secretaries, medical assistants, nurses, neurophysiology technicians, medical officers, specialist registrars, and consultants participated in creating awareness about common neurological conditions and preventive measures emphasizing a healthy diet and exercise to reduce the occurrence of a number of these debilitating conditions. A number of the department registrars also came up with useful short educational videos in English and the national language Bahasa Melayu with useful infographics on stroke, epilepsy, headaches and multiple sclerosis to be played continuously during the peak clinic hours from 7:30 a.m.- 5 p.m. Monday through Friday. During the clinic hours, senior day care nurses also taught patients attending the Tuesday and Thursday clinics finger exercises and mind exercises to stay alert and engaged. By participating, we hope to empower patients with neurological diseases to be more self aware and mentally positive about their diseases. We also hope this will spur patients, caregivers, and the public to work toward improved access to investigations and treatments for neurological diseases such as epilepsy, stroke, and multiple sclerosis and related disorders.

World Brain Day celebration with the neurology department staff.

Our department hopes to continue to celebrate this wonderful event in the future and further improve awareness, knowledge, and access to both preventive and maintenance treatments for neurological disorders among Malaysian patients.

We sincerely thank the World Federation of Neurology for spearheading this initiative and collectively look forward to next years “World Brain Day Celebrations.” •


Dr. Shanthi Viswanathan MBBS (India), FRCP(Ireland), Fellowship in Neurology (Malaysia) is consultant neurologist and head of the department of neurology at the Kuala Lumpur Hospital in Malaysia.

Written on behalf of the World Brain Day Neurology Department Celebration Committee

  • Dr. Ahmad Shahir
  • Dr. Suganthi Chinnasami
  • Dr. Chey Shin Yee
  • Dr. Izyan
  • Dr. Elaine Chew
  • Dr. Nurasyikin Bt Arriffin
  • Staff Nurse Izwan
  • Sister Halizan
  • Matron Habibah
  • Matron Norizian
  • Puan Norhafizah Murad

Update on the AAN/WFN Continuum Education Program

By Steven L. Lewis, MD, and Andrea J. Weiss, MA

Steven L. Lewis, MD

Andrea J. Weiss

As this year marks my (SL’s) 10th year as editor-in-chief of Continuum: Lifelong Learning in Neurology, we’ve written this article to provide a brief update on the AAN/WFN Continuum Education Program for low- and lower-middle-income countries, a program that we are privileged to administer.

Continuum is the official CME Journal of the AAN and is currently in its 29th year of publication. Continuum is published six times per year, within a three-year curricular cycle of topics. This means that over every three-year period, all 15 “core” Continuum topics in neurology are covered, with three issues devoted to “noncore” topics (for example, topics such as the neurology of pregnancy) which are not necessarily covered in every three-year curricular cycle. See Table 1 for a list of core topics covered over every three-year cycle in Continuum.

The WFN/AAN Continuum program for low- and lower-middle-income countries occurs through the generous donation of 400 print copies of each issue of Continuum from the AAN and its publisher, Wolters-Kluwer, while also providing online access to issues. The program allows access for continuing education and self-assessment, point-of-care use, as well as use in Continuum user groups where the content is used as the basis for joint educational activities. Now being distributed to 49 countries worldwide, this important educational resource has been integral in the education and continued education for neurologists worldwide. Continuum user groups have included in-person and (increasingly) virtual meetings, using the material in each issue as a source of content for presentations and group discussions.

Continuum and the WFN

Given the importance of Continuum in worldwide neurology education, and in particular the continued education of neurologists in low- and lower-middle-income countries, the WFN has now created a Continuum subcommittee of the Education Committee, consisting of members from the AAN Continuum editorial office and members of the WFN executive leadership. This will enable enhanced mutual collaboration to continue to optimize the program’s evolution for the purpose of ensuring that this vital resource is available and utilized as optimally as possible globally.

Continuum’s Commitment to Equity, Diversity, and Inclusion

Continuum is committed to diversity, including within its editorial board as well as in the selection of guest editors and in the selection of content experts to write articles for each issue. All authors for Continuum are instructed to include relevant information in each article about health care inequities and disparities and some issues have even begun to incorporate entire articles devoted to this critically important topic1.


We are pleased that this vital resource has been so well received and used by so many neurologists (and trainees) worldwide. We look forward to continuing to provide this important educational journal to neurologists in low- and lower-middle-income countries and look forward to hearing from neurologists to learn of any ways that we can enhance this program for the goal of providing the most up-to-date information to neurologists throughout the world. •

Steven Lewis is acting secretary general of the WFN, editor-in-chief of Continuum: Lifelong Learning in Neurology, and editor of World Neurology. Andrea Weiss is executive editor for Education and News Publications for the AAN.




  1. Balls-Berry JE, Babulal GM. Health disparities in dementia. Continuum (Minneap Minn) 2022;28:872-884.


Continuum Core Topics

(always covered over every three-year curricular cycle of issues).

  • Behavioral Neurology and Psychiatry
  • Cerebrovascular Diseases
  • Dementia
  • Epilepsy
  • Headache
  • Movement Disorders
  • Multiple Sclerosis and Other Demyelinating Diseases
  • Muscle and Neuromuscular Junction Disorders
  • Neurocritical Care
  • Neuro-Infectious Diseases
  • Neurology of Systemic Disease
  • Neuro-Oncology
  • Peripheral Nerve and Motor Neuron Disorders
  • Sleep Neurology
  • Spinal Cord Disorders


Candidate Statements for WFN Secretary General, Elected Trustee

Below are the Candidate Statements for Secretary General and Elected Trustee. Three statements for Secretary General and four statements for Elected Trustee are listed in each category.

The Secretary General Candidate Statements, for the three candidates, in alphabetical order, are from:

  • Marianne de Visser
  • Steven Lewis
  • Tissa Wijeratne

The Elected Trustee Candidate Statements, for the four candidates, in alphabetical order, are from:

  • Chandrashekhar Meshram
  • Bo Norrving
  • Minerva López Ruis
  • Mohammad Wasay


Candidates sorted alphabetically

Marianne de Visser

Marianne de Visser

My name is Marianne de Visser. I am an adult neurologist from Amsterdam, The Netherlands, and (emeritus) professor of Neuromuscular Diseases at the University of Amsterdam.

I would like to apply for the position of Secretary General and I am deeply honored that the Nominating Committee recommended me—together with two other candidates—to the Membership.

I have been committed to the good cause of the WFN for several decades. First as a delegate on behalf of the Netherlands Society of Neurology, subsequently as an elected trustee (2002-2008), chair of the Nominating Committee, co-opted trustee (July 2020 through December 2021) and recently President Wolfgang Grisold appointed me as chair of the Membership Committee and vice chair of the WFN Congress Committee. I have witnessed the growth of WFN. The increasing membership, but also the expanding role of the WFN in several impactful initiatives worldwide are clear signs of leadership.

The close collaboration with the WHO has borne fruit for neurology. The then President Johan Aarli coordinated the Atlas Project, resulting in the publication of its first edition in 2004, showing the country resources for neurological disorders. In 2017, the second edition was published, coordinated by past President Raad Shakir and Donna Bergen. The data shows that while the burden of neurological disorders is disproportionately high in low- and middle-income countries, health care services and resources are often scarce.

Another highlight of the collaboration with the WHO is the recent unanimous approval by the WHO Member States of the Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders. Elected Trustee Alla Guekht and Immediate Past President Bill Carroll together with the Global Neurological Alliance played a significant role in this.

The WFN puts many efforts in fulfilling its mission “Fostering quality neurology and brain health worldwide.” Among others by the launch of the Brain Health Initiative to promote prevention of brain diseases and improving the outcomes of those living with brain diseases. The World Brain Day is an extremely successful recurring event on July 22, this year focusing on “Brain Health for All” conveying five important messages: Awareness, Prevention, Advocacy, Education, and Access.

Several WFN programs focus on education, in particular aimed at residents and early career neurologists. The COVID-19 pandemic was a tragedy in many aspects, but the coronavirus silver lining was the huge uptake of virtual meetings and the implementation of virtual health care. Both developments greatly facilitate access to education and health care.

President Grisold states in his column in World Neurology that the WFN will need to take diversity, equity, and inclusion into consideration in its strategy, that the needs of early career neurologists require specific attention and action, and that a platform for patient organizations should be installed in the WFN infrastructure. I embrace those initiatives, and I am fully committed to serve the WFN as Secretary General to make those initiatives a success in close collaboration with the trustees and the indispensable colleagues from the head office. •


Steven Lewis

Steven Lewis

It has been a privilege serving as WFN acting secretary general since January 2022, elected trustee since 2016, and co-opted trustee prior to that. In these and many other WFN roles, I remain indebted to this organization and the opportunities it has provided me to help achieve the WFN mission.

My involvement with the WFN occurred coincident with my AAN appointment as editor-in-chief of Continuum, where a joint WFN/AAN program provides print and online access to Continuum to neurologists from over 49 neurological societies from low/lower-middle income countries. As a general neurologist, educator, academician, and editor, I have worked tirelessly on this critical resource while continuing to find ways to enhance the program and its access.

In my expanding roles at the WFN, and for which I am available 24 hours a day given our worldwide constituency, I have become integrated into the daily workings of this organization for global neurologic education, training, practice, and advocacy.

As editor of World Neurology for the past seven years, I have the responsibility to report on news about neurology to neurologists worldwide. As chair of the Education Committee, I have the privilege to help create and hone educational opportunities in the form of department visits, fellowships, and full neurologic training, junior travelling fellowships, and many other educational programs and research grants to neurologists/trainees especially from lower- and lower-middle income countries who otherwise wouldn’t be able to access such opportunities. As Teaching Course chair of WCN 2019 (Dubai), 2021 (Rome/virtual), and Congress Committee Chair of WCN 2023 (Montreal), I have led the creation of programs attended by thousands of participants to learn from world-class speakers.

In all my WFN responsibilities, I have the privilege of collaborating with esteemed colleagues from regional and national societies and committees and related organizations, co-trustees, and WFN presidents, and from our talented hard-working staff. The knowledge, expertise, and camaraderie of all has been invaluable in improving my effectiveness to our organization.

If elected as Secretary General, I pledge to continue in this role to help achieve the WFN’s mission via ongoing collaboration with national and regional neurologic societies and organizations (including the WHO in our increasing partnership); grow our regional teaching centers and department visits for neurologic training to expand within and beyond the current regions to include any region where neurologists are underrepresented; leverage virtual opportunities; increase awareness of all WFN opportunities for all neurologists worldwide; and react quickly to novel regional or global neurological threats. I also look forward to completing the initiative President Grisold and I spearheaded to develop and distribute a practical Global Neurologic Core Curriculum addressing the minimal required knowledge, skills, training experiences, and overall competencies of neurologists, while recognizing regional variations in resources, funding, and diseases.

I would be honored to be elected to continue as WFN Secretary General, in which I would continue to work around the clock to faithfully serve our delegates and all neurologists for the mutual goal of improved neurological access and the highest quality of neurology and neurological health worldwide. •


Tissa Wijeratne

Tissa Wijeratne

What an exciting time to be in WFN! It is an incredible honor to have been nominated for the WFN Secretary General election this year. Brain health is in peril globally. One in three of us has a brain disorder. Brain disorders are the leading cause of disability and the second leading cause of death globally. Two-thirds of these occur in low- to middle-income countries. Different regions of high-income countries demonstrate vast disparities in awareness, education, access to care, prevention, and rehabilitation. I have seen this imbalance in care firsthand during my youth in rural Sri Lanka, followed by culturally and linguistically diverse communities representing 166 nations in Western suburbs of Melbourne, Australia. I believe WFN can build on the successes of the last few decades, capitalize on IGAP, and advocate more for quality neurology and better brain health by improving local engagement and activities.

If elected, I will seek to enhance the inclusiveness and constant collaboration already at our society’s heart. We shall continue to work hard to support movers and shakers in brain health worldwide—not only neurologists, academics, and industry but also the billions of patients and families experiencing the effects of brain disorders. Advocacy and supporting local advocates will be a crucial component of my global vision for quality neurology and better brain health. We will continue to assist national societies, health ministers and ministries, aiming to deliver the IGAP for all neurological disorders in all regions during the next decade. Educational programs, grants, symposia, CME, traveling fellowships, accreditation, and postgraduate training programs will all be added to, enhanced or, in some cases, newly developed to help address this need globally. We are already doing a lot, but we can and will do more. Our many activities will continue to bring neurologists worldwide together, ensuring everyone’s voice is heard. Committee representation, additional scientific activities, and other advocacy campaigns shall be the tools we use to achieve this goal.

The WFN needs hard-working men and women who can dedicate themselves to improving brain health worldwide. To cohesively solve the issues facing neurologists across the globe, we can listen to, discuss, and assimilate the ideas of many. I will bring these qualities to our leadership group. As you know, I have already represented the global neurology community in WFN activities for nearly two decades. I am ideally poised to take up the responsibilities of Secretary General, as I bring experience from both sides of the world—from rural Sri Lanka to Australia and beyond. The World Brain Day campaign has already reached out to over one billion people since its genesis in 2014. Yet, there is more ground to cover, but our goals are achievable. With our already talented team, we can work together on this critically important task now.

More about me on my website I am on WhatsApp at +61430048730 if you need to clarify anything with me directly. •


Candidates sorted alphabetically

Chandrashekhar Meshram

Chandrashekhar Meshram

I am grateful to the Indian Academy of Neurology and the WFN for considering me worthy for the position of Elected Trustee.

Services to the WFN

I am indebted to WFN for giving me the opportunity to serve as co-opted trustee and as the president of Tropical and Geographical Neurology Specialty Group (TGNSG). In these roles, I have contributed to the mission of WFN “fostering quality neurology and brain health worldwide.” Through TGNSG, I organized 16 webinar sessions on neuro infections and gave opportunity to trainees from different regions of the world to sharpen their clinical skills through interaction with the experts. Our ongoing series “Inspiring People in Neurosciences” is a step in the same direction. All of these sessions are available on the WFN website. TGNSG also provides monthly updates of COVID-19 for the WFN website. I was also instrumental in getting the teaching sessions by Indian Academy of Neurology on the WFN website. I have planned the department visit program in India for residents from poor countries.

I have served on the Constitution and Bylaws Committee as a member for three terms and the WFN Scientific Program Committee for two terms. I took the challenge to resurrect Tropical Neurology SG by successfully organizing the first International Tropical Neurology Conference in 2017 in India. I was then given the responsibility as president of TGNSG. I was co-chair for INTROPICON II held in Brazil. TGNSG now is one of the most vibrant and active SGs of WFN. Because of these activities, I was appointed as a co-editor for the special issue of JNS on Tropical Neurology, section editor of Encyclopedia of Neurosciences for the section on Bacterial and Fungal infections, including Tropical Diseases and assistant editor of eNeurologicalSci.

The World Brain Day is the most eminent public awareness initiative of WFN. The public education campaigns are close to my heart. I have been actively organizing World Brain Day activities, and this year, we have planned 100 such activities in India. I have been the coordinator for the National Brain Week in India for the last 8 years. I have published about 350 articles for public education, including several in World Neurology.

The global burden of neurological diseases is massive, and there is a shortage of neurologists to deal with it. Therefore, I have been organizing educational programs for general physicians and pediatricians.


There is a glaring inequality in neurology care and education worldwide. The developing and underdeveloped countries lag behind in both these aspects because of lack of resources.  WFN is making every attempt to help them catch up, and I am committed to addressing it. We need to focus on the management and long-term care of neurological diseases in these resource crunch settings. Collaboration with WHO and other societies is important for brain health. If elected, I look forward to implementing recently adopted IGAP on Epilepsy and other neurological disorders.

The WFN board of trustees needs representation from developing countries. This need and a passion to work for the WFN are the reasons for standing for the post of an elected trustee. I would be grateful for your support. •


Bo Norrving

Bo Norrving

I am honored by my nomination as candidate for elected trustee of the WFN from the Swedish Neurological Society.

My work as a neurologist spans over several decades. I received my training at Lund University and had several short but very formative post-doc periods at Massachusetts General Hospital/Harvard with Bob Ackermann and C. Miller Fisher. I have authored more than 600 publications, have an h-index of 111, and more than 100,000 citations. I am fully trained in general neurology, but my main focus has been clinical stroke with several seminal contributions that include pioneering clinical trials, clinical-imaging correlations, epidemiology, and development of stroke services

As a young neurologist, I attended my first World Congress in Neurology in Kyoto 1981. This event sparked my interest in the global aspects of neurology, international networking, and engagements in neurological societies. I served as president of the World Stroke Organization (WSO) from 2008 to 2012, and served as an executive till 2020. During my term as president, the WSO underwent a rapid expansion, with several new initiatives, and became closely involved with the WHO and the U.N. placing stroke in the focus on prioritized actions on non-communicable diseases. I participated in several high-level NCD meetings, including the landmark 2011 U.N. general assembly meeting, and I was portraited in Lancet Neurology 2013 as “Bo Norrving: Putting stroke on the world map.” I also had the opportunity to visit a large number of high income as well as low-middle income countries, get insights in stroke and neurology services in very different circumstances, and to establish a very large network.

I chaired the revision work of the cerebrovascular section for the ICD 11 at WHO. I played a key role in the important change to have all cerebrovascular diseases to form a single block under the section of Diseases of the Nervous System, which will have a profound effect on the positioning of stroke in several aspects in the future. I am currently a member of the Strategic and Technical Advisory Group on the Prevention and Control of NCDs (STAG-NCD) at WHO.

I have a longstanding and strong connection with the WFN as well as with regional neurological societies. During my terms as WSO executive, WSO and WFN established several collaborations, including the formation of the Brain Health Alliance. I have served for the WFN Educational, Scientific Program, and Finance Committees. I have been the Swedish delegate at the WFN on several occasions.

The WFN is the only global neurological organization and has an enormous potential to strengthen the position of neurology and improve neurological services. The Brain Health initiative, and the WHO Intersectorial Action Plan on Epilepsy and Other Neurological Disorders provide unique possibilities to make a change but will require hard work and advocacy skills. If elected as a WFN trustee, I will bring on my long experience in working with strategic development, governmental bodies, and advocacy in neurology. I am hard working and prestige free. Serving the WFN as an elected trustee would be a privilege.  •


Minerva López Ruis

Minerva López Ruis

I am Minerva López Ruiz, MD, and I have applied as a candidate for trustee of the WFN.

Among my relevant data, I am past president of the Mexican Academy of Neurology (MAN), current secretary of the Mexican Board of Neurology, representative for Latin America of the MAN, undergraduate professor at the medical schools of the Anahuac University and the Autonomous University of Mexico, as well as postgraduate professor at the General Hospital of Mexico (the largest public hospital in Mexico).

Within my activities in the WFN, I highlight that, in 2016, being president of the MAN and Dr. Raad Shakir being president of the WFN, it was my turn to organize and finance (getting support and sponsorships), the Pan-American Congress of Neurology. An event that I consider very successful, not only because of the more than 1,200 attendees and 149 speakers, but also because it allowed the re-foundation of PAFNS, by sponsoring the attendance of the Latin American representatives so that, during its assembly, they could achieve the necessary participation and votes to approve its new bylaws. Also, during that meeting, the logo was designed, and when it was approved, it was given to PAFNS as a gift and is still used today.

But I do not want this communication to focus on what I have done and my commitment to the WFN, but rather on my proposals to achieve growth of the WFN in the world, especially in Latin America, which I believe is a region where we still have little influence.

To achieve this goal, we have to consider that Spanish is spoken by more than 450 million people in the world (the majority in Latin America), being according to most statistics the second most spoken language in the world. That is why one of my proposals is that the educational material published by the WFN should also have a Spanish version.

A priority for me is education. I believe that we have a great area of opportunity to positively influence the dissemination of educational material, both for neurologists (specialists and trainees) as well as the general population. I will also propose, if elected, the realization of online, interactive clinical-pathological sessions, with the participation of the different neurological training centers, and transmitted to the entire Spanish-speaking world.

Another area of opportunity is, with the support of the neurological societies of each country, to develop diverse educational messages on neurological diseases, aimed at the general population, messages that address issues in which the stigma that marginalizes patients still prevails, for example, epilepsy in women (pregnancy, breastfeeding, etc.). Promoting these topics will bring the WFN closer to the neurological societies, to the societies with their population, but above all, it will benefit the patients.

For all the above, I would like to ask for your vote in the next WFN elections, with the promise that, if elected as trustee, I will work on these proposals and all those that you suggest to me and to which I am open to listen. •


Mohammad Wasay

Mohammad Wasay

I am currently Alicharan endowed professor of neurology at Aga Khan University Karachi, past president—Pakistan Society of Neurology and Pakistan stroke Society, president, Neurology Awareness and Research Foundation, Editor—Pakistan Journal of Neurological Sciences, Chief Editor—Jahan e Aasab (Neurology public awareness magazine), and Distinguished scholar COMSTECH (OIC). I have also served as a director of World Stroke Organization (WSO) and currently serving as Fellow of Pakistan Academy of Medical Sciences and Pakistan Academy of Sciences and Secretary of the Environmental Neurology speciality group (ENSG) of WFN.

I have worked with WFN for more than a decade as an active neurology advocate and researcher from South Asia. I was trained at Palatucci Forum and then received Advocacy Leader of the Year Award by American Academy of Neurology for my global advocacy contributions. I served as chair of theWFN Advocacy Committee for four years. This committee was instrumental in starting and organizing World Brain Day activities and promoting brain health across the globe. We organized many advocacy workshops during the Asian Oceanian Association of Neurology Conferences, Asian Pacific Stroke Conference, and World Congress of Neurology.

We are working at Aga Khan University to establish a network of neurology training and research in Kenya, Tanzania, Afghanistan, and Central Asia. We established the Asian Stroke Network with more than 20 centers in 10 Asian countries. This network has published many multicenter and multinational studies related to stroke in young and Asian women, stroke in pregnancy, and cerebral venous thrombosis in Asia. Currently, I am leading an initiative to establish OIC neurology academy to promote neurological care and training in developing Islamic countries. Recently, I have been appointed chair, specialty groups committee, by the WFN president.

I have trained more than 48 neurologists under my supervision. I have published more than 200 papers in peer-reviewed medical journals with impressive publications metrics (IF: 576; citations=5300, H- index 33 and I10 index 85) for a clinical neurologist in a developing third-world country. I have received many awards, including the Teachers Recognition Award by American Academy of Neurology, Gold Medal by Pakistan Academy of Medical Sciences, Gold Medal by Pakistan Academy of Sciences and Research Productivity Awards by Pakistan Council of Science and Technology. I have received 27 research and training grants (intramural and extra mural) as PI and co-PI. I have been an invited speaker at more than 120 conferences in 73 countries.

The growing burden of neurological diseases in the world has established WFN as an important stakeholder in global health. WHO has recently approved an intersectoral action plan for promotion of neurological care, training, and advocacy across the globe. We plan to promote brain health as a top agenda for WHO and United Nations. There is an inequity in neurology training and care across globe. South Asia, Central Asia, and Africa should be a center point for our future interventions. As a trustee, I could play a valuable role in promoting both agendas. Our advocacy committee and ENSG could play an important role in establishing WFN as a key player in global health. •