June 2014

Maynard M. Cohen (1920-2014)

Maynard M. Cohen, MD, PhD

Great scientist, one of the pioneers of the American modern neurology, lover of philosophy and culture, philanthropist. Maynard M. Cohen, MD, PhD, professor and chairman emeritus in the Department of Neurological Sciences at the Rush-Presbyterian-St. Luke’s MedicalCenter in Chicago, and past AAN president, died on Feb. 18, 2014, in Miami in his 94th year.

As the world-renowned neurologist, he was the U.S. delegate to the World Federation of Neurology (1985-1989). At the delegates’ preparatory meeting (1987) in New Delhi for the XIVth WCN, he strongly supported the organization of the symposium, proposed by Yugoslav and Indian neurologists: “Neurology in Developing Countries” during the New Delhi WCN in 1989. After the successful symposium, in which our respected friend gave a beautiful contribution, the then-WFN President Richard Masland and the then-Chairman of the WFN Research Council John Walton proposed to form a new Research Group on Organization and Delivery of Neurological Services (WFN RG ODNS) in order to search for best solutions in delivery of neurological services around the world (both in industrial and developing countries), respecting local and regional, social and economic conditions.

Cohen accepted to serve as secretary treasurer of the new research group, participating in the new activities in the Federation. As co-editor of the book, he cared that contributions from less developed countries find a place in it. He concluded his own chapter with visionary words: “This symposium, the support of the World Federation of Neurology, and the formation of the Research Group on Organization and Delivery of Neurological Services are but the initial steps. The larger task still lies ahead.” (Neurology in Developing Countries, B.I. Churchill Livingstone, 1991, p.75).

Despite his years, he showed remarkable enthusiasm and energy as co-organizer of our meetings (New Delhi, Vienna, Marrakesh, Vancouver and others), as well as initiatives in many parts of the world. He organized an important symposium, “Ethical Problems in Neurology,” concerning problems in managing neurological ailments due to various cultural and religious traditions (XVth WCN Vancouver 1993), engaging the leading experts in the field from the U.S. and other countries of the globe.

During his service (until 1995), he supported activities of the group. When we needed new, experienced colleagues for the organization, he proposed new active members for the RG Committee: Donna Bergen and Don Silberberg, who have stayed active in the WFN. His wife, Doris Vidaver, participated kindly with her experience in humanities and in medicine, especially in neurology.

The World Federation of Neurology will memorialize his activities, for which he received in 1993 the WFN Certificate of Appreciation. They are now being continued also as an integrative part of the WFN mission and programs. Many neurologists active in those years still remember our early initiatives and the humane care of Maynard M. Cohen for people around the world.

Bosko Barac, MD, DMS, is the founding chairman of the WFN RG ODNS (ret.).

Theodore L. Munsat, MD: A Tribute from the Sociedad Neurologica Argentina

Ted Munsat worked with the WFN to improve education in developing countries like Argentina in 1997.

Never too late for a tribute, especially for a man like Theodore Leon Munsat (1930-2013). He was an extraordinary man and a natural educator who gave the opportunity to improve neurology worldwide.

Among other educational activities, Munsat helped launch the American Academy of Neurology’s (AAN´s) continuing education publication, Continuum, was chairman of the World Federation of Neurology (WFN) Amyotrophic Lateral Sclerosis (ALS), chairman of WFN Research and Education Committees, served as president of the AAN (1989-91), and was emeritus professor of neurology at Tufts University School of Medicine, between other relevant activities. Indeed, exceptional merits for only one man.

He was honored with the A.B. Baker Award for Education from the AAN, the Sheila Essey Award for ALS Research and the Lifetime Achievement Award from the WFN Research Group on Neuromuscular Diseases.

He developed a number of successful educational programs. More than 42 countries all over the world were benefited with a continuing medical education (CME), using the journal Continuum, generously donated by the AAN with an extraordinary local impact.

He worked within the WFN to improve neurology and education in many developing countries, including educational programs in Honduras and Argentina. He directed his energies to teaching neurology internationally.

I met Munsat at the WFN World Congress of Neurology 1997 in Argentina with his wife Carla. We invited him to an International Symposium as part of the scientific activities after the congress, in Tucumán, CalchaquiesValleys, in the North of Argentina, where several conferences of ALS took place, with Alan Mac Comas, Roberto Sica and other international leaders in neuromuscular diseases.

In that opportunity began the idea to develop an educational program for Argentina.

The educational program began in 2003 and benefitted over a decade of continuity to hundreds of neurologists in our country with a significant educational imprint.

I want to highlight his passion for education, intelligence, humor, kindness with a great ability to make easier the hardest things, a natural leader, a gentleman, an honorable man. He had a warm and sincere personality. he loved helping others every chance he could.

I admired and respected him as a man, as a professional and as a teacher. He has left a profound mark on the world of neurology. The Sociedad Neurológica Argentina wishes to give this tribute and extend our gratitude. Dear Ted, thank you very much for all you have done; we shall remember your legacy always.

Editor’s Update and Selected Articles From JNS

By John D. England, MD

John D. England, MD

On behalf of the Editorial Board, I would like to thank all of the individuals who review articles for the Journal of the Neurological Sciences (JNS). The integrity of a scientific journal such as JNS depends heavily upon the quality of independent peer-review.

I continue to be impressed with the high quality and thoroughness of the reviewers’ critiques of manuscripts. I am especially impressed and thankful that such busy and committed individuals still take the time to review articles. One of my goals for this year is to seek advice from the Editorial Board and Elsevier about how we might be able to recognize the efforts and importance of our reviewers in a more tangible manner.

Most readers are becoming aware of the fact that Elsevier, the publisher of JNS, now provides free access to selected articles from JNS for members of the World Federation of Neurology. In consultation with members of the Editorial Board, I select two “free-access” articles, which are profiled in each issue of World Neurology.

In this issue, we feature two paired articles:

Hellmann, et al. reviewed the response to maintenance intravenous immununoglobulin (IVIg) in a cohort of 52 patients with myasthenia gravis (MG) who had not responded adequately to pyridostigmine, prednisone, azathioprine, or combinations of these medications. Fifteen of the patients did not respond to an initial trial of IVIg, and were not treated with additional doses of IVIg. Thirty-seven patients responded to the initial trial and were treated with maintenance IVIg (0.4 g/kg every three to six weeks) for an average of 5.9 years (range 1 to 17 years). Twenty-three patients achieved mild improvement, and 14 patients achieved moderate improvement as measured by the Myasthenia Gravis Foundation of America (MGFA) clinical classification scheme. A beneficial response was associated with bulbar onset, seropositivity and high titer of acetylcholine receptor antibody, and older age of disease onset. Probably the most important observation in this study was that none of the patients achieved full remission with maintenance IVIg. Although IVIg improved symptoms of MG and allowed reduction of other medications, it did not provide a sustained effect or true remission of the disease. (Hellmann MA, Mosberg-Galili R, Lotan I, Steiner I. Maintenance IVIg therapy in myasthenia gravis does not affect disease activity. J Neurol Sci 2014;338:39-42)
Marinos Dalakas provides a thoughtful editorial on the above-noted article and places its results into the perspective of current treatment options for myasthenia gravis (MG). He emphasizes the point that IVIg appears to exert only a short-term and transient immunomodulation in MG and does not provide immunosuppression of the disease. At this time, the evidence supports restricting the use of IVIg in MG to short-term treatment of unstable patients until immunosuppressive treatments become effective. However, only a prospective trial of IVIg therapy for MG will provide definitive conclusions regarding its long-term effectiveness in managing this disease. (Dalakas M. IVIg in the chronic management of myasthenia gravis: Is it enough for your money? J Neurol Sci 2014;338:1-2)

England is editor-in-chief of the Journal of the Neurological Sciences.

What Have You Learned at the AAN Annual Meeting That You Will Take Back to Your Practice?

“I attended the Global Health Challenges: Neurology in Developing Countries. It was eye-opening to learn about the global burden of disease and specifically the difficulties in treating epilepsy in developing countries.

It won’t affect my current practice but reminds me of the need to think outside of the small world in which I practice. It also reignited an interest in participating in short-term medical mission work like I was able to do in medical school.”

David B. Watson, MD
Morgantown, West Virginia

“I live in Zambia and there are only two neurologists in Zambia for 13 million people. It’s a very small community! Coming here, I get to meet the people face-to-face that I’ve emailed, spoken to and trained with over the years. We are talking about collaboration and building our global health programs. This AAN meeting — it’s neurology on steroids!”

Omar Siddiqi, MD
Lusaka, Zambia

“I like that the issue of ethics was addressed in the Presidential Plenary Session and its impact to medicine. We are all living with ethics in our daily lives.”

Barbara A. Dworetzky, MD
Boston

“I attended a very educational series of debates on the controversies pertaining to ICU EEG monitoring of critically ill patients. It was great to hear from experts in the field arguing their viewpoints on an important unanswered question in neurocritical care. This has inspired me to review the literature myself and come to my own conclusion. Clearly, there is more research that needs to be done.”

Krishnan Vaishnav
Boston, MA

“The clinical sessions, especially those on the new agents for multiple sclerosis, are very good. MS treatment has been closed, very routine and patients are getting tired of the same injections.

It’s good to see that clinical research is progressing in this area. Hopefully in a few years — not 10 years — there will be new drugs available for MS patients. Patients are being included earlier in studies and being treated better and earlier.”

Douglas Sato, MD
Sendai-Miyagi, Japan

“I really appreciate the speakers who gave a high level interpretation of the clinical trials. We all know the data. It’s the interpretation that really helps us start a discussion and collaborate nationally.”

Ishida Koto, MD
New York

“The ICU monitoring session was very helpful. I work at the V.A. We are short-staffed, and we are short on staff qualified to perform multiple tasks such as ICU monitoring. The ideas I learned about ICU monitoring is directly applicable to my facility.”

Gabriel Bucurescu, MD
Philadelphia

“For me, it’s learning the research ideas for the future. I’m a junior resident so I’m enjoying all the sessions, especially the genetic talks.”

Janice Wong, MD
Boston, MA

“What I’m hearing is confirmatory: In stroke, there often is no clear decision. So, it’s confirmation to what’s been discussed here.”

Markus Naumann, MD
Augsburg, Germany

Book Review: Neuroanatomy of Language Regions of the Human Brain

Academic Press, 2014; 186 pages

The human brain contains billions of neurons, and these neurons interact in a variety of ways that are only beginning to be understood. One of the great challenges that humans confront is determining the way in which the human brain can support complex behaviors such as reading and understanding this text. We can begin to confront this challenge by improving our understanding of human neuroanatomy.

Michael Petrides is an internationally renowned neuroanatomist. His new, large format book is titled, “Neuroanatomy of Language Regions of the Human Brain.” The book is generously illustrated in color, including unique illustrations from his own work. The illustrations are clearly labeled. The accompanying text is authoritative and describes the relevant anatomical features in clear language.

The book is divided into three major sections. The first section of the book focuses on gross anatomy of the human brain. There is a comprehensive discussion of the gross morphological features of the brain. This is accompanied by images that can be obtained with MRI. Petrides illustrates gross anatomy in axial, sagittal and coronal orientations with a T1 sequence obtained at 3 tesla with 1 mm isotropic voxels, but few additional details of the imaging sequence are provided. These illustrations are useful since most volumetric imaging is obtained at 3 tesla with 1 mm3 voxels, although a 7 tesla scanner may have illustrated the anatomy with additional detail. Slices are provided at approximately every 4 mm. Each slice is associated with an orienting location in the space of the Montreal Neurological Institute ICBM152 generation VI average brain, and most sulci are labeled on each slice of each image.

The second section of the book focuses on cytoarchitecture. Large format images are provided that illustrate the layers of the cortex from each of the critical areas of the brain. Brodmann labeling is used for most illustrations, although Economo and Koskinas labels are used for some critical areas. The location of most samples is illustrated with images of gross location on a brain illustrating Brodmann’s areas, and some corresponding anatomic loci in the macaque monkey brain are also provided.

The third section of the book describes the named, long white matter projections of the human brain. Corresponding projections in the macaque monkey brain are illustrated as well. White matter connectivity is illustrated primarily within the left hemisphere, and hemispheric differences are not detailed. In addition to the averaged results of white matter projections, in situ tractography in individual subjects is provided to demonstrate each of the major white matter fasciculi. The text provides an important discussion of the distinction between the superior longitudinal fasciculus and the arcuate fasciculus, and considers in detail the dual-route hypothesis the postulates dorsal and ventral projections between anterior language regions in the frontal lobe and posterior temporal language regions.

Petrides provides an interesting historical discussion of the development of our understanding of the neuroanatomy of language, beginning with Pierre Paul Broca’s revolutionary presentation of Leborgne and Lelong. He also provides interesting illustrations of MRIs of the brains of these two patients. Major figures such as Wernicke, Marie and Dejerine are mentioned as well, although other seminal early investigators such as Lichtheim are not acknowledged. Petrides also reviews the seminal electrical stimulation studies of Penfield. Indeed, interesting historical perspectives are provided throughout the book.

It is appropriate that a volume about neuroanatomy focuses on language since this topic is the historical origin of our study of human cerebral anatomy. Petrides notes at the beginning of the book that most areas of the brain are arguably related to language. The focus of the book is tilted toward the language regions of the brain, but Petrides generously describes essentially all cerebral regions and provides key illustrations from macaque monkey.

A truly positive feature of this book is the multiple perspectives that are adopted in a single, comprehensive volume. An additional perspective might have been provided by the anatomically based neurotransmitter work from Zilles and Amunts.

This book was reviewed by Murray Grossman, professor of neurology, director of the Fronto-TemporalDementiaCenter at the University of Pennsylvania School of Medicine.

Stroke in Literary Works Around the World

By Axel Karenberg

Axel Karenberg

There are few other neurological disorders with such a constant presence in literary works as apoplexy. As early as 1600, the notions “apoplexy” and “apoplejàa” appear in dramas written by Shakespeare and Lope de Vega. More detailed descriptions of the disease enrich popular novels of the 19th century. Authors such as Balzac, Dumas, Flaubert and Zola must be mentioned here as well as the epical sagas of Dostojewski and Tolstoi ^1,2. The American author John Steinbeck used a “stroke” in his work East of Eden as did Philip Roth in his morbid narratives. In the German-speaking world, stroke is dealt with in more than 100 fictional works.

Naturally, literary productions treating this subject resort to contemporary medical knowledge³. Until the middle of the 20th century, literature focused mainly on two aspects of apoplexy: its typical symptoms and explanations of its origin. The presentation of symptoms abide by a strict code: sudden onset, motor deficiency and unfavorable outcome. The majority of authors was deeply impressed by the loss of the ability to produce speech — above all after Goethe’s early depiction of motor aphasia in Wilhelm Meister’s Apprenticeship (VII,6; 1795/96): “Altogether unexpectedly my father had a shock of palsy; it lamed his right side, and deprived him of the proper use of speech. We had to guess at everything that he required; for he never could pronounce the word that he intended … His impatience mounted to the highest pitch: his situation touched me to the inmost heart.”

Johann Wolfgang von Goethe (1749-1832), author of “Wilhelm Meister’s Apprenticeship.”

The diverse causes of the disease taken up in the “belles lettres” reflect its multifactorial origin conceived in premodern medicine. Melancholic “gloominess” or “thick blood” was grounded on the ancient idea of an abnormal blending of the bodily humors. In this perspective, the disease could be provoked by the “cold and moist evening air” or by “taking a bath at 9° C.” (e.g. in E.T.A. Hoffmann, 1825 and in Theodor Fontane’s Effi Briest, 1894/95). Only approaching present times, the thematic focus and the narrative perspective shifted slowly but constantly. Along with a more detailed description of the symptoms, the story is now set in hospitals and rehab centers and supplemented by technical diagnosis and therapeutic options. To exemplify this shift, there are George Simenon with his Non-Maigret book The Bells of Bicetre (1962) and Kathrin Schmidt’s novel You Won’t Die (2009).

In literary works, apoplexy serves different goals. The sudden outbreak of the disease can set the plot going, let take it the defining turn or end a story line. Above all, in recent prose texts, the symptoms bring the fictional patients to get to the bottom of their former life. But the illness also can assume a metaphoric function. The recurrent cerebral insults of the protagonist Oblomow in Iwan A. Gontscharows’ homonymous epic (1859) were meant to illustrate the agonizing czaristic feudal system. In a similar way, the American author John Griesemer in his New York novel Heart Attack (2009) fixed the acute symptoms of his protagonist on 9-11 in order to link individual and collective fate, facts and fiction to a meaningful picture.

Effi Briest by Theodor Fontane. Original cover of the first edition (1896).

Fictional texts are never bare clinical case histories, they never render exclusively neurological textbook knowledge. It is the components that lie beyond the medical horizon that arouse the interest of physicians and a broader public. The anthropological dimension, the look at human despair and hope can further the understanding of a patient’s fate and help to support present-day stroke medicine.

References

Perkin JD. The neurology of literature. In: Bogousslavsky J et al. (eds.): Neurological Disorders in Famous Artists, Part 3. Basel: Karger 2010, pp. 227-37.
van den Doel EM. Balzac’s serous apoplexies. Arch Neurol 1987; 44:1303-5.
von Engelhardt D. Neurologische Erkrankungen im Medium der Literatur. In: Kömpf D (ed.). 100 Jahre Deutsche Gesellschaft für Neurologie. Berlin: DGN 2007, pp. 346-53.

Karenberg is from the Institute for the History of Medicine and Medical Ethics, at the University of Cologne, Germany.

President’s Column: Neurology Cooperation Around the World

Since I wrote my last column, many events have occurred. The neurological world is moving so fast. The WFN remains at the forefront of developments of international activities and is leading in cooperation and promotion of neurology.

In January, the Sudanese Neurological Society held its ninth annual meeting in Khartoum. I had the privilege to be invited as well as the president of the Pan African Association of Neurological Sciences, Prof. Riadh Gouider, and the president of the Pan Arab Union of Neurological Societies Prof. Mohammad Tamawy. The attendance and interest was large and intense. There was an impressive eagerness to learn among young neurology trainees in all topics, and the hands-on workshops with bedside patients were fully subscribed. It is heartening to see that relatively small societies in Africa can provide so much high-quality teaching and care. Congratulations to Prof. Ammar El Tahir and Prof. Osheik Seidi for their efforts.

The 15th Cairo Neurology Congress was held in February and again the topics and attendance were impressive. Prof. Wolfgang Grisold, WFN Secretary-Treasurer General attended the meeting. Tamawy and Prof. Osama Abdul Ghani are to be congratulated for an excellent effort. I am sure that across the world many national societies have had their annual congresses and this only enriches the field. The WFN will be delighted to be involved in any way and to help promote and advertise these congresses.

Figure 1. (From left to right) Jonas Yeung, president of the Hong Kong Neurological Society; Man Mohan Mehndiratta, president of AOAN; Wai-Sin Chan, deputy director, Health Bureau, Macau Special Administrative Region; Chin Ion Lei, director, Health Bureau, Macau Special Administrative Region; Patrick Li, president of the Hong Kong College of Physicians; Ping Wing NG, co-chair of AOCN 2014; Leonard Li, co-chair of AOCN 2014; Lawrence Wong, secretary of AOAN and chair, Scientific Committee, AOCN 2014.

From national to regional congresses. The Asian Oceanian Congress of Neurology (AOCN) 2014 was organized by the Hong Kong Neurological Society and held in Macau. The congress was attended by members from all over Asia. The Hong Kong Society in collaboration with the Chinese Neurological Society was instrumental in producing an excellent program. Prof. William Carroll, WFN first vice president, attended the congress, and Man Mohan Mehedirata, AOAN president, was also present; the organization was excellent. Profs. Wing-Ping Ng and Laurence Wong are again to be congratulated. (See Figure 1.)

It seems that wherever in the world neurologists meet, there is always a sense of camaraderie and togetherness. It is also clear that topics vary in their scientific slant and their emphasis on training; but the eagerness to learn among neurologists in training is the same across the world. Teaching courses with live and videotaped cases attract a huge interest and create lively discussions.

The WFN grants round is now open, and we hope to receive as many applications as possible. The Grants Committee will start work after the closing date, and decisions will be conveyed to the applicants immediately. The plan is that the WFN will partner with other organizations to increase the amounts of the grants.

The Vienna World Congress was not only a scientific success but also a great financial success for the WFN. I, on behalf of the WFN, am most indebted to the Austrian Society for its hard work; and to the EFNS which suspended its annual congress for 2013 to allow just one major neurology congress to take place in Europe. The financial returns to all indeed exceeded expectations, which bodes well for the financial survival and strength of the WFN.

As this issue is being published, the amalgamation of the EFNS/ENS in the joint meeting in Istanbul will have taken place. This will create a most solid association. The WFN looks forward to the birth of the EuropeanAcademy of Neurology (EAN) and the elections of its officers so that our relations and close collaboration will continue as before with its two predecessors. The WFN’s strength and ability to reach its goals can only be achieved with the help of strong regional associations willing to collaborate to further the cause of advancing neurology globally. If one reads the EAN’s Purpose and Values, these goals are well laid out in Article 4 of its bylaws.

The WFN was born on the July 22, 1957, and during the Vienna World Congress, the Council of Delegates voted to commemorate that day every year as the World Brain Day. The task was given to Prof. Mohammad Wasay, chair of the Public Awareness and Advocacy Committee. The details are in the April issue of World Neurology. By the time this is published, all delegates should have received further correspondence.

The WFN history is rich and diverse. Prof. Johan Aarli, WFN past president, is the author of The WFN History: The First 50 years, published by Oxford University Press. By the time this issue of World Neurology is distributed, the book will be launched during the joint EFNS/ENS meeting in Istanbul. The book is essential reading for all.

The WFN and other peer organizations have created the World Brain Alliance. See http://www.wfneurology.org. This was started during the previous presidency, and I had the honor of being present during its inception in 2010. The presidents of peer societies last met in Vienna and will meet again to formulate a structure and proceed as the force speaking for all those involved in brain health.

Other activities to report are the collaboration with the WHO. This has matured and is progressing well. The Department of Mental Health and Substance Abuse is where neurology lies in the WHO structure. Shekhar Saxena and Tarun Dua are major contributors to the success of the collaboration. Moreover, Oleg Chestnov, WHO’s assistant director general, has agreed to talk to the attendees of the World Congress of Neurology in 2015 in Santiago, Chile. The WFN is a major funder to our WHO activities and will continue to be so. The ICD11 process is being finalized, and the process is on target. The WFN and the WHO are again collaborating in the production of the successful Neurology Atlas, second edition, as the first edition is now 10 years old. This process involves gathering information from Ministries of Health and all WFN member societies so that the data are verified and are useful tools for all.

The involvement of the WFN with the Non Communicable Diseases (NCDs) declaration is vital for the future of neurology. There is now a clear perception that the WHO is moving from the preventative mode, which has fully dominated its activities, to the area of disease management and appreciation of the huge burden of neurological diseases in the world. This, when it evolves further, is a seismic shift in thinking, and the WFN should be ready when it happens. The close collaboration and financing of many projects through the WHO is crucial for neurology, and the WFN should be at the top table in the decision-making process.

Many tasks lie ahead for the WFN trustees. For examples, finding and hiring a PCO when the contract with the current PCO Kenes expires with the last contracted congress in WCN 2015 in Santiago; and finding a publisher for JNS when the contract with Elsevier expires at the end of 2014. These are important decisions, and the trustees will have to look at all of the options and come up with the most suitable ones for the WFN.

As delegates were informed, the Nominating Committee is soliciting nominations for the post of elected trustee. Prof. Gustavo Roman will finish his second term and is not eligible for re-election. His contributions to the WFN as a trustee and as chair of the Latin America Initiative are immense. I, on behalf of all trustees, committees and member societies, would like to thank him for a wonderful job, which was done with grace, elegance and professionalism.

The next Council of Delegates meeting will be held in September in Boston, Massachusetts. This will be during the joint meeting of the American and European MS societies, and we look forward to seeing as many society representatives there as possible.

Raad Shakir
President

IAPRD and PSN Join Hands: First Movement Disorder Course and Botox Workshop

By Abdul Malik, MBBS, DCN, MD

PSN conference organizers and faculty with Erik Wolters, Daniel Truong and R. Pfeiffer.

The specialty of neurology shows remarkable growth in last decade in Pakistan. The 21st meeting of the Pakistan Society of Neurology (PSN) was organized in collaboration with the International Association of Parkinson’s and Related Disorders (IAPRD) March 28-30 in Karachi, Pakistan.

There were eight scientific sessions and a half-day Botox Hands-On Workshop in this conference. The speakers from Netherlands, the United States, Saudi Arabia and Pakistan shared their experiences pertaining to neurology. The core of the discussion was the advances in movement disorders and the newer therapies now emerging. The guest faculty from the IAPRD had given a detailed overview on the topic.

An ample demonstration on patients was given with the title of “Botulinum Toxin Hands-On Use in Dystonia” by Prof. Daniel Truong from The Parkinson and Movement Disorder Institute (U.S.). He also delivered a lecture on Clinical Approach and Management of Dystonias. Prof. Ronald Pfeiffer, vice chair of the Department of Neurology at the University of Tennessee Health Science Center (U.S.) gave us an updated overview on Autonomic Dysfunction in Parkinson’s Disease and Drug-Induced Movement Disorders. The keynote speaker was Prof. Erik Wolters, IAPRD president, who is working in the Universities of Maastricht and Zurich. He delivered his lectures on the topics of Behavioral Dysfunction in Parkinson’s Disease and Parkinson’s Disease — Revisited.

More than 200 exceedingly participative audiences from all parts of the country attended all of the scientific sessions. In the inaugural session of the three-day conference, the Sardar Alam, outgoing Pakistan Society of Neurology (PSN) president, welcomed the delegates and presented the report of the last two years of the society’s works. Prof. M. Wasay, chairman of the organizing committee, stated the statistics of neurology care and neurologist in Pakistan. He said that for every one million people only one neurologist is available.

In the scientific sessions, Asif Moin, from Saudi Arabia, delivered the talk on utilization of SPECT and PET in epilepsy; Qasim Bashir discussed initial experience in establishing an interventional neurology/neuroendovascular surgery program in Lahore: procedural types and outcomes; Qurat Khan from AKU deliberated on introduction to behavioral neurology; Bushra Afroze talked on biotinidase deficiency — clinical presentation, diagnosis and treatment while neurodegeneration in children: diagnostic issues in developing countries was presented by Tipu Sultan from Children Hospital Lahore. A unique and thought-provoking session of this was in the Neurology Training and Advocacy session. This session highlighted the glimpses on post-graduate neurology in Pakistan by Sarwar Siddiqi, psychiatric care and interface with neurology by Prof. Iqbal Afridi, neurosurgery care and interface with neurology by Prof. Junaid Ashraf and advocacy for neurological care in Pakistan Prof. Rasheed Jooma.

There were 15 original oral presentations and 20 poster presentations from all major institutes of the country. This year, PSN officially had given best oral presentation and poster presentation awards. There was also an inaugural dinner in which the primary guest was Prof. Asghar Butt, vice president of CPSP. Prof. Masood Hameed Khan, vice chair of DUHS was honored during the social portion of the evening.

The conference was a great success in terms of participation, and the quality of training and education was superb.

AAN Meeting in Review

By Donald Silberberg

Donald H. Silberberg

As an addendum to the report from the AmericanAcademy of Neurology in this issue, I wish to add that in 2012 the AAN established a Global Health Section. At the section meeting during the 2014 AAN meeting in Philadelphia, Jerome Chin, the outgoing president of the section, announced that the section now has more than 300 members, including many from outside the U.S.

The section elected Farrah Mateen from in the Department of Neurology at Massachusetts GeneralHospital as its new president. If you are interested in seeing the activities of the Global Health Section, contact Franziska Schwarz at FBSchwarz@aan.com.

International activities during the Philadelphia meeting included:

a conference titled “Controversies in Global Health: Corticosteroids for Meningitis,” a seminar on “Global Health Challenges: Neurology in Developing Countries,” an International Colloquium that included topics such as “Dealing With Common Disorders With Limited Resources,” “Successful Examples of International Collaboration,” and Information on fellowships in the U.S. An Integrated Neuroscience Session featured oral presentations on the “Global Impact of Non-Communicable Neurological Diseases,” with poster sessions before and after. Finally, an Ethics Colloquium included a presentation on “Clinical Trials Involving International Subjects.”

In these ways, the AAN is now playing an important role in global neurology together with the World Federation of Neurology.

The World of Neurology Comes Together at the AAN Annual Meeting

AAN_0733 The 2014 Annual Meeting of the American Academy of Neurology (AAN) attracted more than 13,000 neurology professionals to Philadelphia, a city rich in its own neurology-related history. More than 2,500 presentations of cutting-edge research were available to attendees from across the world. The number of non-U.S. attendees was nearly 4,000.

Science and continuing medical education are the main draws to the Annual Meeting, and this year was no exception. One of the highlights was the Presidential Plenary Session, the AAN’s premier lecture awards for clinically relevant research. James L. Bernat, MD, FAAN, gave the Presidential Lecture on “Challenges to Ethics and Professionalism Facing the Contemporary Neurologist.” The George C. Cotzias Lecture featured Stefan M. Pulst, MD, FAAN, speaking on “Degenerative Ataxias: From Genes to Therapies.” The Sidney Carter Award in Child Neurology went to Darryl C. De Vivo, MD, FAAN, who expounded on “Rare Diseases and Neurological Phenotypes.” Finally, David M. Holtzman, MD, FAAN, shared “Alzheimer’s Disease in 2014: Mapping a Road Forward,” as the Robert Wartenberg lecturer.

The Hot Topics Plenary Session presented recent research findings and clinical implications regarding identification of a unique molecular and functional microglia signature in health and disease; emerging concepts in chronic traumatic encephalopathy; functional connectivity and functional imaging in movement disorders; and the global epidemic in stroke.

Abstracts related to new therapeutic developments, clinical applications of basic and translational research, and innovative technical developments were shared and discussed at the Contemporary Clinical Issues Plenary Session. This year’s topics were acute ischemic stroke, Friedreich’s ataxia, insomnia, epilepsy, functional (psychogenic) disorders and the Parkinson’s disease Progression Marker Initiative.

At the Frontiers in Translational Neuroscience Plenary Session, attendees heard about the clinical aspects of tissue environments for brain repair; opportunities and challenges of robot-assisted and facilitated neurorecovery; network-based neurodegeneration; using fixed circuits to generate flexible behaviors; advances in the Human Connectome Project; and the nightlife of astrocytes.

The Controversies in Neuroscience Plenary Session featured pairs of experts debating three of the most current and controversial issues in neurology: “Does preventing relapses protect against progressive MS?,” “Is intervention for asymptomatic AVM useful?” and “Should neurologists prescribe marijuana for neurological disorders?”

The Clinical Trials Plenary Session addressed important topics that affect patient care identified from submitted abstracts that had recently been presented at other society meetings, including stroke, MS, migraine, intracranial hypertension and glioblastoma. The week concluded with the Neurology Year in Review Plenary Session, which examined advances in MS, headache/pain, neuromuscular diseases, movement disorders, neurocritical care and Alzheimer’s disease.

More science was available at numerous platform sessions, seven poster sessions and a new, fast-paced series of Poster Blitz presentations.

Another new feature at this year’s meeting was an International Lounge, which provided an opportunity for foreign guests to mingle, network with leading neurologists from the U.S. and other countries, and relax before the next session.

A significant portion of the meeting was devoted to helping U.S. neurologists understand the many changes initiated by Congress and federal regulatory agencies as part of health care reform. Neurologists, like other physicians, are under tremendous pressure to reduce treatment costs without compromising the quality of care.

The AAN works hard to guide members through these issues using a variety of resources and tools, while advocating on their behalf with members of Congress and administration officials in Washington, DC. U.S. Senator Bob Casey (D-PA) spoke with neurologists concerned about cuts to federal health programs for the elderly and the economically disadvantaged.

Another Pennsylvania legislator, Congressman Chaka Fattah of the U.S. House of Representatives, spoke at the Brain Health Fair about his initiative to support brain research. This fair is a free public event presented by the American Brain Foundation. The fair typically draws 1,000 to 2,000 people from the region who are living with brain disease or caring for a family member or friend. They hear about new research and treatments from neurologists, health organizations and the medical industry.

Media from across the globe gathered to provide powerful coverage of neurology’s largest meeting. Reporters and photographers shared the latest news in brain research with their readers and listeners back home. The AAN pressroom was lively with representatives from major national and international news outlets and neurology trade publications.

AAN President Timothy A. Pedley, MD, FAAN, remarked on the strong media interest in the meeting.

“The frequently tragic and debilitating nature of so many brain diseases provides a focus for our attention when we come together at the Annual Meeting to share our experiences and chart our progress,” said Pedley. “The scale of media coverage and public interest reminds us of the tremendous responsibility we have to work even harder to discover more effective treatments and, eventually, cures or preventive strategies for the neurologic diseases that can be so devastating to our patients.”

Plans are already under way for the 2015 Annual Meeting, to be held April 18-25 in Washington, DC. Until then, the AAN will continue to connect neurologists with the best in science and education through several gatherings, including The Sports Concussion Conference in July; the AAN Fall Conference in October; and Breakthroughs in Neurology 2014: Translating Today’s Discoveries into Tomorrow’s Clinic, to be held in December.

As always, the world is invited.