WFN Activities Update

By Wolfgang Grisold

Wolfgang Grisold

Wolfgang Grisold

Welcome to World Neurology. We are glad to be able to share WFN proceedings in this issue. Unfortunately, the worldwide situation in regard to armed conflicts has not improved. In addition, we witnessed the earthquake in the region of Turkey and Syria, and we all want to express our sympathies. We are also aware of the critique that we omit many other disasters that occur in our member societies, and I apologize for not mentioning all of them.

To continue with the bad news, our past president, Prof. Johan Aarli, died March 26, 2023. His merits for the WFN were enormous in regard to the relations with the WHO, the Africa initiative, and the history book on the WFN. His funeral was April 4, 2023, and was attended by past-President Raad Shakir and myself. (Please also see the obituaries and tributes in this issue of WFN).

The London office is keeping busy with our agendas. In addition to Laura, Jade, and Carlos, we have help from Yannik and, increasingly Chiu, with our expanding activities and website as well as social media. Kimberly Karlshoej, who served as the strategic and program director and has added much vigor and great ideas for the WFN, had to resign for personal reasons. We thank her for all of her work. We will implement a new structure of a voluntary project-based assistant, called an “internship,” which will help with our communication with the global societies such as the WHO and UN ECOSOC under the supervision of Alla Guekht and the London office.

The cooperations with the WHO are invaluable, and the main project presently is the further implementation of the intersectoral action plan for epilepsy and other neurological disorders (IGAP). As you may recall, the IGAP was approved at the World Health Assembly (WHA) in Geneva in May 2022, and has a time of 10 years for the duration of the program. It focuses on advocacy, treatment, prevention, research and innovation, and public health awareness, and is meant to implement neurology in all countries of the world and also empower the existing neurological structures. The WHO has outlined the important indicators and is currently working on the further development of the toolkit for optimal use. The WFN is proud to say that it is able to support the WHO in this important task as a donor, and we will be involved in the further process of advancing the IGAP. Our recent article on IGAP can be openly accessed here:

One important aspect of our activities is brain health. Despite several definitions, interests, and a number of stakeholders, the concept of brain health is important, and also closely connected with the IGAP. I want to remind readers that the next WFN World Brain Day (WBD) bears the title “Brain Health and Disability,” and thus indicates that the WFN is following the route to support the brain health concept, which was initiated in 2020.  Although brain health is a universal concept, it needs to be targeted from many perspectives. The function of a healthy brain in all developmental stages from the prenatal period into old age, as well as the close connection of brain function with mental disorders, are pragmatic directions for neurologists. These need to be supported by many initiatives as delineated in the IGAP and by the WHO paper on brain health.

The 2023 topic of “Brain Health and Disability” also aligns with initiatives of the WHO.  We are developing the WBD program jointly with the six WFN regions and have also invited the World Federation of Neurorehabilitation as a partner. This worldwide society has its focus on neurorehabilitation and promotes development and research.

The progress of the WBD toolkits and activities can be found on the WFN website, and here for updates. The WBD is chaired by Tissa Wijnerate, and David Dodick. We are again supported by Yakkety Yak as a professional public relations agency.

Education: From our numerous educational activities, we are glad to report that another four-year neurology trainee has started training in Dakar. The department visits will be extended to Asia for Asians. This year’s African educational day’s topic will be “neuropathies.” There will also be a joint educational day on headache jointly with IHS GPAC, and we are on the way to establish an Asian educational day jointly with AOAN, which will have stroke in Asia as a topic.

The concept of the World Federation of Neurology Teaching Centers (WFN TCs) was first introduced in 2013, and it is an excellent occasion to celebrate 10 years at the World Congress of Neurology (WCN) in Montreal.

The first TC in Africa was established in Rabat, Morocco, with significant support from the Moroccan society, followed by TCs in Cairo, and Dakar. Another TC was opened in Mexico City for Latin America, and followed by Cape Town. The intention now is the establishment of a WFN TC in the Asian region.

The concept of the teaching centers is to create centers of excellence and also to empower local teaching. Starting with one-year general training, the concept has dynamically grown and has a diversification in fellowships and full four-year training.

We are all excited and looking forward to the WCN in Montreal, organized jointly with the Canadian Neurological Society (CNS). The congress will take place Oct. 15-19 in Montreal, Canada. The WCN will feature plenary lectures, topics, free presentations, debates, poster sessions, and an attractive teaching course program. The WFN has increased the outreach to other societies and global institutions, and we expect several joint sessions. As new items, we will have a patient platform, a patient day, debates, and several smaller events allowing for more direct contact to our speakers.

The WFN sent out three surveys to member societies and delegates: one on rare diseases, one on education for young neurologists, and one on the awareness of IGAP.  Unfortunately, the questionnaire on IGAP received least attention by our membership, and we would like to remind the members on the importance of IGAP as a true joint global project with the WHO.

The Council of Delegates (COD) meeting this year will be at the Montreal Congress, and we hope that many of the delegates will be able to come in person. The COD will also be hybrid due to travel issues, finances, or other reasons some delegates may not be able to attend in person. There will be two elections, one for the Treasurer (to follow Richard Stark), and one for the position of an elected trustee (to follow Morris Freedman). Also, this year’s election will be electronic, and details and instructions will be sent out in the near future.

All in all, we have an exciting year ahead of us, and we hope to be able to continue with this pace. We look forward to the WCN in Montreal. •

From the Editors

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

We’d like to welcome all readers to the April 2023 issue of World Neurology.

Walter Struhal, MD

Steven L. Lewis, MD

This issue includes heartfelt articles and tributes to recently departed neurologists, including the article by Dr. M. Akif Topcuoglu, president of the Turkish Neurological Society, about the devastating Turkiye-Syria earthquakes, with tributes to each of the five neurologists who passed away in the disaster.

This issue also includes obituaries and tributes to the late Prof. Johan Arli, a past-president of the World Federation of Neurology (WFN), written by WFN Past-President Raad Shakir and other colleagues of Prof. Arli from around the globe, including Nils Erik Gilhis, Ole-Björn Tysnes, Christian A. Vedeler, and Amadou Gallo Diop.

In this issue’s President’s Column, WFN President Dr. Wolfgang Grisold updates us on the many international activities in progress and being planned by the WFN, including the work being done with WHO and the Intersectoral Action Plan (IGAP), and the exciting plans for the World Congress of Neurology in Montreal this October, including the planning for the Annual Council of Delegates meeting.

Drs. Tissa Wijeratne and David Dodick (Co-Chairs of World Brain Day) as well as Drs. Lewis and Grisold provide a followup report on the plans for this year’s World Brain Day 2023, which will be dedicated to “Brain Health and Disability,” including collaborations between the WFN, our global regions, national neurologic societies, and the World Federation of Neurorehabilitation. Dr. Wijeratne is also congratulated on receiving the prestigious medal of the Order of Australia.

This issue’s History Column, by Dr. Peter J. Koehler, is devoted to an extensive book review on “The Idea of Epilepsy: A Medical and Social History of Epilepsy in the Modern Era” (1860-2020), by Dr. Simon D. Shorvon.

This issue also features several reports from recent national and international conferences. Kurt Niederkorn, Yong-Jae Kim, Hee-Jung Song, and Alex Razumovsky report on the joint conference of the Korean Society of Neurosonology and the WFN Neurosonology Research Group help in November 2022. Aida Kondybayeva reports on the Fifth International Educational Forum, the Neurology Update in Kazakhstan 2023 that was held in March 2023. Stefan Kiechl and Deidre De Silva report on the World Stroke Congress that occurred in October 2022 in Singapore. Finally, Carlos N. Ketzoian reports on the Second Latin American Course on Neuroepidemiology that was held in Punta del Este, Maldonado, Uruguay, this past March.

In closing, we want to thank all readers for their interest in and attention to World Neurology and the chance to report such important updates about neurology and neurologists from around the globe. We sincerely hope many of you are planning on attending the WCN in Montreal in October 2023 in person (for the first time since 2019) or virtually. •

Prof. Johan Arild Aarli (1936-2023)

By Raad Shakir

Johan Aarli

Johan Arild Aarli, former president of the World Federation of Neurology (WFN), passed away on the March 24, 2023, at the age of 86 years. His name is recognized and admired by neurologists across the world.

Johan graduated from Bergen in 1961, where he also did his training in neurology and basic training in immunology. He obtained his specialist in neurology status in 1970, defended his doctoral thesis in 1972 (muscle antibodies in myasthenia gravis) and was appointed professor in 1977.

Prof. Aarli developed the department of neurology at Bergen University Hospital making it a leading center of neuroimmunological research. He was subsequently appointed dean of the faculty of medicine at Bergen, and chair of the Norwegian Association of Neurology.

In addition to his vast number of scientific writings, he was a pioneer in the field studying the impact of neurobiology on culture and history. He was a prominent member of the Norwegian Neuro-Literary Club, contributing to all their books on neurology, art, and history and co-authored the book on the history of Norwegian neurology. He was a member of the steering committee of the successful Norwegian Year of the Brain 1995. Johan’s work in Norway was so distinguished that in 1996, he was made a Knight, First Class of the order of Saint Olav by King Harald V.

When the European Federation of Neurological Societies (EFNS) was founded, he was the first Norwegian delegate (1991-1998) and was quickly appointed Chair of the Teaching Committee of the EFNS (1997- 2002) and then appointed EFNS Secretary-General (2003-05). Internationally, Prof. Aarli was the Norwegian delegate to the WFN 1998-2001, elected as WFN vice president, and was thereafter elected WFN president during the Sydney World Congress of Neurology in 2005.

Having had the honor of working with him, Johan had the extraordinary ability to calmly drive the WFN to many new areas and initiatives. He developed the collaboration between the WFN and WHO, which started with the publication of the Neurology Atlas in 2004 followed by “Neurological Disorders: Public Health Challenges” in 2006. In June 2019, he represented the WFN in the 10-year project to produce the ICD11. The collaboration continues today.

In 2007, his calm diplomacy and negotiation skills enormously helped in bringing the Chinese Neurological Society to become a full member of the WFN.

Johan saw the need to develop improved delivery and increased rural distribution of neurological care, and is considered by our African colleagues as the father of the WFN Africa Initiative. He started the Africa Task force in 2005, which eventually evolved into the African Academy of Neurology. Site visits to establish training centres in Africa and Latin America started during his presidency.

As if all this was not enough, Prof. Aarli wrote the “History of the WFN, the First 50 Years” published by Oxford University Press in 2014. Another eminent previous WFN president Lord Walton described the book, “without question a major scholarly work based upon careful historical research and an encyclopedic knowledge.” It is the principal source on the history of neurology in the second half of the twentieth and the early twenty-first centuries.

Prof. Aarli’s enormous achievements for international neurology were deservedly recognized by the WFN when he was awarded the medal for services to international neurology during the 2013 Vienna World Congress.

Johan was a soft-spoken, gentle, charming, pleasant man, with a disarming demeanor. His requests for neurologists from all parts of the world to serve the WFN in various capacities were asked simply in a calming manner “would you have a little time to give to the WFN.” I do not think anyone ever refused. He was generous, a wonderful host and a real friend. You could go to him with any problem or issue and come out fully satisfied by his wise and sound opinion. He was known to take time to think and ask for advice prior to making major decisions. He always made all those around him feel comfortable with his decisions as they would have been thoroughly thought through. A leader, who shall certainly be sorely missed.

He is survived by a loving family, Gullborg his wife of 62 years, five children, Anen, Ragna, Gunn, Bernt and Maria, 15 grandchildren, and one great grandchild.

Johan Aarli´s last years were overshadowed by chronic ill heath that finally ended the life of this remarkable neurologist. •

Prof. Raad Shakir is a past-president of the World Federation of Neurology.

Tribute From Africa to Johan Aarli

By Prof. Amadou Gallo DIOP, MD, PhD

Johan Aarli

We, in Africa, definitively consider Johan Aarli as the great and generous man who, as president of WFN, put Africa on the map of world neurology. He met with Prof. Michel Dumas in 2005 at the Sydney World Congress of Neurology (WCN). Prof. Dumas is one of the first French pioneers who installed neurology in Africa, Senegal, in the late 1950s. Prof. Aarli argued that African neurologists could not be absent in the new global affairs he was leading during his World Federation of Neurology (WFN) presidency. He rapidly cemented it by inviting, for the first time, African neurology leaders to attend a business meeting at the London headquarters in 2006. He generously accepted us and listened to our dreams and goals. He set up the WFN Africa Initiative with robust, sustainable, and efficient programs of training, bursaries, and exchanges.

He traveled to Africa (the first for a WFN president) because he was curious and excited to know us better for more substantial and structured support of neurological sciences in Africa. He endorsed, with respect and high consideration, the slogan we proposed to him: “With Africa; for Africa,” which became the WCN’s slogan in Marrakech (the wonderful and first WCN in Africa) in 2011. The outcome of Prof. Aarli’s “WFN Africa Initiative” is concrete, visible, measurable, and impacting:

  1. Four Regional Training Centers “in Africa, for Africa” (Cairo, Cape Town, Dakar, Rabat) receiving four-year and one-year trainees from African countries with priority for the those lacking neurosciences human resources. It led to training neurologists on site, in the continent, increasing their number and combating the brain drain.
  2. Travel bursaries for complementary hyperspecialized training for post-doctoral African fellows to voluntary hosting sites, such as Austria, Germany, France, Italy, Norway (Prof. Aarli’s country), and Turkey.
  3. Strong support to regional teaching courses (RTCs) with a powerful implication of institutions such as the AAN, EAN, and others.
  4. Facilities and bursaries for young African neurologists for attending the WCN and other major neuroscience congresses around the world.
  5. The establishment of the African Academy of Neurology (AFAN), in Dakar in 2010, was a tremendous and historic administration outcome of Johan Aarli’s global initiative and legacy.

Definitively, the smiley, generous gentleman Johan Aarli will count a lot in the history of neurology in developing countries, particularly in Africa, from where we send our condolences to his extraordinary wife, Gullburg, who was with him at every WFN event around the world. Also, to his colleagues in Norway and the successive WFN staff all these last years.

Thank you, dear Johan. Africa is grateful to you. God bless you. •

Prof. Amadou Gallo is head of the Dakar WFN Regional Training Center and past WFN trustee (2013-2016)

Johan A. Aarli: An Inspiring Teacher and Leader of Neurology

By Nils Erik Gilhus, Ole-Bjørn Tysnes, and Christian A. Vedeler

Johan A. Aarli was an inspiring and highly respected neurologist with a worldwide influence. Sadly, he died March 24, 2023, at age of 86 years after a long illness. He made a huge professional impact locally, nationally, and globally. Prof. Aarli was a successful president of the World Federation of Neurology 2005-2009, and a general secretary of the European Association of Neurological Societies 2003-2005.

Prof. Aarli’s aim throughout his professional career was to improve the treatment for patients with disorders in the brain and nervous system. His tools were teaching, research, leadership, and organization of neurologists and neuroservices. He combined clinical education and improvement, research, and innovation. As a WFN president, he was famous for his African initiative. He regarded better services for patients in poor countries as the major challenge for WFN. Furthermore, he was instrumental in building a true global alliance in neurology and neuromedicine with activities on all continents.

Prof. Aarli was the head of the department of neurology at Haukeland University Hospital for nearly 30 years, combined with a professorship at University of Bergen, until he retired in 2006. He built a modern and expansive department with specialized units for neurophysiology, neurorehabilitation, and occupational neurology, and with systematic multiprofessional treatment for well-defined neurological patient groups, such as ALS, epilepsy, multiple sclerosis, and stroke.

A main aim for Prof. Aarli was to combine clinical practice with research and education. His personal research focus was clinical neuroimmunology, and myasthenia gravis in particular. He contributed to the understanding of autoimmune disease mechanisms, and he helped in developing the field internationally through his widely distributed textbook from 1987. His research policy was to combine detailed clinical information with biomarker data from laboratory investigations. As a professor, department head, and university dean, he inspired and supported research in clinical neuroscience relevant for all neurological patient groups, including the development of clinical registries and biobanks.

His ability to lead, to teach, and to build networks stemmed from his sharp intellect combined with his friendly interest in people. His short- and long-term strategies were successful because he worked so well together with colleagues and patients, and with administrators and politicians. He appreciated people, and they appreciated him.

Prof. Aarli was born in Kvinesdal, a small village valley in Southern Norway. Together with his father, he wrote the local history of that valley. He was interested in history and literature, and he was co-founder of the Norwegian Neuroliterature Club. He was open-minded, optimistic, and honorable. He listened and discussed, was a true democrat, but he combined this with an ability to make decisions and see projects through.

We miss Johan A. Aarli in Bergen and Norway, but his impact is still here. We are sure that this is true also for many of his friends and activities globally. Our warm condolences go to his wife, his five children, and a big family. •

From the department of neurology at the Haukeland University Hospital and University of Bergen in Bergen, Norway.

Prof. Wijeratne honored during Australia Day 2023

Prof. Tissa Wijeratne

The World Federation of Neurology (WFN) is pleased to report that Prof. Tissa Wijeratne, OAM MBBS, MD, PhD, FRACP, FRCP, FAAN, FEAN, co-chair of Public Awareness and Advocacy and World Brain Day, was honored during the Australia Day 2023 with the medal of the Order of Australia (OAM). Congratulations to Prof. Wijeratne. •

Joint Korean Society of Neurosonology and WFN Neurosonology Specialty Group Conference

The meeting in Seoul, Korea, explored the use of neurosonology as an essential modality for neurologists.


By Kurt Niederkorn, MD, Yong-Jae Kim, MD, PhD, Hee-Jung Song, MD, PhD, and Alex Razumovsky, PhD, FAHA, NVS

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

On Nov. 3-5, 2022, a joint conference of the Korean Society of Neurosonology (KSN) and NSG WFN considering clinical applications of carotid duplex, transcranial Doppler and transcranial color-coded duplex utilization in the wide arrays of different aspects of neurology, neurocritical care, and neurosurgery was conducted in Seoul, Korea. Invited speakers included prominent experts from Austria, Egypt, Germany, Japan, Korea, Portugal, Singapore, Switzerland, and the United States. Numerous speakers from Korean medical schools and universities were involved and presented high-quality clinical and research lectures.

A program full of lectures including teaching courses, hands-on sessions, poster sessions, international certification examination, and special interest events covering diverse topics, with networking and social activities, was presented. A special session was dedicated to sonography education where experts from Germany, Korea, and the United States exchanged opinions and presented country-specific approaches to neurosonology and ultrasound education in medical schools. However, the wide application of ultrasound, including neurosonology across many medical specialties, increased portability and decreased cost of ultrasound devices, and enhancement of learning both basic and clinical sciences with ultrasonography will continue to demand appropriate teaching and training on ultrasound in undergraduate medical education.

A special issue of the Korean Journal of Neurosonology and Neuroimaging (JNN) published all lectures and presentations (JNN, volume 14, supplement 2, November 2022).

Neurosonology has been developed based on ultrasound diagnosis in cerebrovascular diseases, like ischemic stroke and extracranial and intracranial stenosis, but is currently being applied and used clinically in various fields ranging from diagnosis and monitoring of cerebral vasospasm after subarachnoid hemorrhage and traumatic brain injury, and cerebral degenerative diseases, and to diagnose and follow up on peripheral nerve and muscle diseases.

This Joint KSN and NSG WFN conference will definitely create a better cooperation of neuroscience researchers around the world who are conducting clinical and translational research beyond ultrasound diagnosis. •

Kurt Niederkorn, MD, is professor of neurology and chair of the NSG of the WFN. Yong-Jae Kim, MD, PhD, is professor of neurology and chair of the Korean Society of Neurosonology. Hee-Jung Song, MD, PhD, is president of the Korean Society of Neurosonology. Alex Razumovsky, PhD, FAHA, NVS is secretary of NSG of the WFN.

The Fifth International Educational Forum

Neurology Update in Kazakhstan 2023

By Aida Kondybayeva, MD, PhD

Aida Kondybayeva

The Fifth International Educational Forum Neurology Update in Kazakhstan 2023 was held March 10-11, 2023. The forum was held in hybrid mode. With the joint work of the Kazakhstan National Association of Neurologists Neuroscience (KNANN) and the faculty of medicine and health at the al-Farabi Kazakh National University (al-Farabi KazNU). The event was attended by 846 doctors, including neurologists, internists, GPs, rehabilitation specialists, and intensive care specialists from Kazakhstan, Kyrgyzstan, and Uzbekistan.

Welcoming speeches to the participants were given by Prof. Saltanat Kamenova, president of KNANN; Prof. Zhanna Kalmataeva, dean of the faculty of medicine and health at al-Farabi KazNU; Aizhan Sadykova, president of the National Medical Association; and Symbat Abzalieva, deputy director of the Higher School of Medicine at al-Farabi KazNU. They noted the special significance of the forum for all practitioners who took part in this event.

The speakers of the Forum were Prof. Valery Feigin (New Zealand), Prof. Natan M. Bornstein (Israel), Prof. Adnan Siddiqui (U.S.), Prof. Afshin Divani (U.S.), Prof. Mesoud Ashina (Denmark), Prof. Tatyana Negrich (Ukraine), Prof. Aksel Siva (Turkey), as well as doctors from Kazakhstan: Saltanat Kamenova, Bagyzhan Syzdykova, Korlan Saduakasova, Tatiana Kaimak, Maksharip Martazanov, Aigul Akimniyazova, Gulnar Kabdrakhmanova, Karlygash Kuzhibaeva, and Aida Kondybaeva.

Current issues of neurological diseases were discussed, including autism, migraine, multiple sclerosis, myasthenia gravis, pain, and stroke.

Within the framework of the forum, there was a master class titled, “Evidence-Based Neurology. How to Search for Information to Answer Specific Clinical Questions, Interpret and Critically Evaluate Scientific Evidence.” This training course was organized for young doctors and discussed the basic concepts and tools of evidence-based medicine, as well as their application in clinical and scientific practice. The course was conducted by doctors Maurizio Leone (Italy), Luca Vignatelli (Italy), Katina Aleksovska (Macedonia), and Teia Kobulashvili (Austria). •

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



Earthquake Disaster and Turkish Neurology

By Prof. M. Akif Topcuoglu

On Feb. 6, 2023, two major earthquakes occurred, nine hours apart, with epicenters in Gaziantep and Kahramanmaraş in Turkiye. In this disaster, called the 2023 Turkiye-Syria earthquakes,” nearly 43,000 people died in Turkiye and 6,000 people in Syria. A total of approximately 150,000 people were injured, of which 120,000 were in Turkiye. It is estimated that at least 3 million people migrated from the affected zone to different cities after the earthquakes. Aftershocks still continue and pose a serious risk for rescue teams. Earthquakes affected 13.5 million Turkish people in an area of 1,000 square kilometers. This refers to about one-seventh of Turkiye’s population.

From the first news of the catastrophe, both state institutions, organizations, and volunteers rushed to the earthquake zone. Especially in Hatay and Maraş, there was such a severe destruction that the emergency response teams were also affected. The frigid, snowy weather and the fact that people were caught asleep increased our loss and made emergent intervention difficult. Significant assistance came from many countries around the world. As a result of these efforts, many lives were saved in a short time, and life was attempted to be restored as fast as possible. This effort still continues at the highest level.

Turkish medicine intervened in the earthquake with great effort. Although there was a short-term overcapacity in some regions, all of the injured could be taken to hospitals, and all necessary interventions could be made with the system created all over the country. The Turkish Neurological Society provided containers, heaters, portable beds, and generators in line with the demands of the regional neurology clinics and within its capacity. Our society is going to continue its academic and physical aids so that life in the region can be re-established as soon as possible.

Unfortunately, nearly 100 doctors died in the earthquake, and five of them were neurologists. These friends passed away in the most hopeful and productive period of their lives. Our sadness is endless and unbearable. We have written this article to share this disaster experienced with the neurologists all over the world. As the Turkish Neurological Society, we want to keep the memory of these five colleagues alive. We will miss them very much. •

Prof. M. Akif Topcuoglu is president of the Turkish Neurological Society


Bessam Ezelsoy, MD

Bessam Ezelsoy, MD

Bessam Ezelsoy was born in 1961 in Hatay. He graduated from Istanbul University Faculty of Medicine in 1985. He completed his neurology residency training at Bakırköy/Istanbul Sadi Konuk Training and Research Hospital in 1994. He was working as a neurologist at Hatay Training and Research Hospital. He was recognized by his patients as a warm, tolerant, and understanding doctor. In 2015, he was selected as the doctor of the year in Hatay. We unfortunately lost Dr. Ezelsoy and his beloved wife in the 7.7 magnitude earthquake that occurred in our country on Feb. 6, 2023. Dr. Ezelsoy’s two children survived the earthquake. That was our only consolation.


Eda Kahiloğulları Aşkar, MD

Eda Kahiloğulları Aşkar, MD

Eda Kahiloğulları Aşkar was born in 1995 in Antakya. She was continuing her neurology residency training at Mustafa Kemal University, Tayfur Sökmen Medical Faculty, Department of Neurology. Colleagues remember her for her kindness, helpfulness, sincere smile, and hard work. Unfortunately, she passed away in the earthquake with her beloved husband. She loved neurology very much, and there is no doubt that she would have been a very good neurologist.



Bircan Turunc, MD

Bircan Turunc, MD

Bircan Turunc was born in Antakya in 1992. She graduated from Maltepe University Faculty of Medicine in 2019. Her friends describe her as “beautiful on the outside but more beautiful inside.” We lost our angelic and devoted friend and cat guardian, Dr. Turunç, at a very young age. Had she lived, we are sure that she would have touched many patients and become a very successful physician and neurologist. Unfortunately, we live in a time when words become meaningless in Turkiye.


Murat Güntel, MD

Murat Güntel, MD

Murat Güntel was born in 1984. He graduated from Mersin University Faculty of Medicine in 2009. He completed his neurology residency training at Hatay Mustafa Kemal University Faculty of Medicine in 2015. Between 2015 and 2016, he worked as a neurologist at Elazig Training and Research Hospital. He had been working as an assistant professor at Mustafa Kemal University Tayfur Sökmen Faculty of Medicine, Department of Neurology since then. He was a prolific academic with numerous case and research articles in international journals. He was described by his colleagues as a friendly, hardworking, kind, and wonderful person. He was loved by his students and patients. He died in the earthquake disaster with his beloved mother and two cats.


Tülay Yücel, MD

Tülay Yücel, MD  

Tülay Yücel was born in 1959 in İzmir. She graduated from Ankara University Faculty of Medicine in 1984. She completed her neurology specialization training at Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital in 1991. Dr. Yücel was working as a retired-freelance neurologist. She, her daughter-in-law, and 6-month-old granddaughter lost their lives in the earthquake in Hatay.

Book Review: The Idea of Epilepsy 

A Medical and Social History of Epilepsy in the Modern Era (1860-2020), Simon D. Shorvon, Cambridge University Press


By Peter J. Koehler

“Diseases can be considered as acts or invasions by gods, demons, or evil spirits, and treated by the invocation of supposedly supernatural powers. Or they are considered the effects of natural causes and are consequently treated by natural means. In the struggle between magic and the scientific conception, the latter has gradually emerged victorious in the western word. The fight has been long and eventful, and in it epilepsy held one of the key positions. Showing both physical and psychic symptoms, epilepsy more than any other disease was open to interpretation both as a physiological process and as the effect of spiritual influences.” — Owsei Temkin, 1945 

The Falling Sickness

These are the first sentences in Owsei Temkin’s classic book The Falling Sickness. A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology. First published in 1945, a revised edition appeared in 1971, and in 1994 it was published again. The book begins with the “sacred disease” in antiquity, discusses ancient medical science, and touches upon magic, superstition, possession, and lunacy in the Middle Ages. It then passes through the Renaissance period with the “theological debate” on possession and witchcraft, describes theoretical ideas on epilepsy in the great systems (including iatrochemistry, iatromechanics, and animism), discusses the Enlightenment, including pathology and nosology, and then enters into the nineteenth century. Here Temkin dwelt on reflex therapy, described some of the important “Jackson forerunners,” including Richard Bright (1789-1858) and Louis-François Bravais (1801-1843), whose name is sometimes eponymized in the term Bravais-Jacksonian epilepsy. The book ends with an extensive description of the ideas of John Hughlings Jackson (1835-1911) in the second half of the nineteenth century. 

As apparent from the title, the present book by Simon Shorvon, The Idea of Epilepsy. A Medical and Social History of Epilepsy in the Modern Era (1860-2020), begins approximately, where Owsei Temkin (1902-2002) ended, although there is some overlap, in particular with respect to Bénédict Morel (1809-1873), Wilhelm Griesinger (1817-1868), Jules Falret (1824-1902), and Théodore Herpin (1799-1865), who are mentioned in both books.

The Authors

Temkin and Shorvon have quite different backgrounds. Temkin was born in Minsk (in the present Belarus) and received his MD from the University of Leipzig (1927), where he was in contact with well-known medical historians like Henry E. Sigerist (1891-1957) and Karl Sudhoff (1853-1938). Following his MD, he worked at the Leipziger Medizinhistorischen Institut. Both Sigerist and Temkin emigrated to the U.S. (Johns Hopkins University, Baltimore) in 1932 and Temkin remained a medical historian. Some of his important books are Galenism: Rise and Decline of a Medical Philosophy (1973) and Hippocrates in a World of Pagans and Christians. Shorvon, on the other hand, has a background in clinical medicine. He is an emeritus professor of clinical neurology at the University College of London (UCL) Queen Square Institute of Neurology and Hon. Consultant Neurologist at the National Hospital for Neurology and Neurosurgery. In the latter hospital, he specialized in epilepsy. He published books not only on epilepsy, but also on the history of neurology, including ILAE [International League Against Epilepsy] 1909-2009, A Century of History (2009), Physicians at War (2016), 500 Years of the Royal College of Physicians (2018), and the acclaimed Queen Square. A History of the National Hospital and its Institute of Neurology (in cooperation with Alastair Compston; 2019). 

The Idea of Epilepsy

These two books by Temkin and Shorvon complete a fantastic review of the history of epilepsy. Whereas Temkin’s 1994 edition on the early history of epilepsy comprised 488 pages, Shorvon’s new book on the 1860-2020 period has as many as 750 pages. The latter book contains a wealth of information about the latest 160 years, in which knowledge of epilepsy increased tremendously. In the introduction, the author appropriately uses the metaphor of a ship named “Epilepsy” sailing through the long twentieth century. Very appropriately, he is aware that the medical and scientific aspects of the history of epilepsy are not the only that need to receive attention. A disease such as epilepsy in particular has many important aspects that deserve to be addressed. Therefore, the author chose to examine the history of epilepsy from four perspectives, not only including the medical and scientific, but also the societal and personal perspective. Furthermore, he tried not just to answer the question, “What happened?” but also “why it happened,” the latter of course being much more difficult and even “hazardous.”

The reason why he chose to begin in 1860 is that he considered this the period of the first modern conceptions of epilepsy. Indeed, the mid-nineteenth century was the period in which medicine definitely became based upon science. This was related to August Comte’s (1798-1857) positivistic philosophy. Scientific knowledge was obtained by representing results in measure and number. Claude Bernard (1813-1878) and Rudolf Virchow (1821-1902) were important proponents of the scientific method in medicine. Their respective books Introduction à l’étude de la médecine expérimentale (CB 1865) and Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre (RV 1858) may be considered milestones of the scientific method in medicine.

Epilepsy and Psychiatry

The 160 years that are discussed in Shorvon’s book are divided into five periods: 

1. 1860-1914 (“The birth of modern epilepsy”)

2. 1914-1945 (“Epilepsy in the age of catastrophe”)

3. 1945-1970 (“Epilepsy and the new world order”)

4. 1970-1995 (“Epilepsy in a globalized world”)

5. 1995-2020 (“The epilepsy floods are too recent”) 

Cesare Lombroso (courtesy Wellcome Collection)

In each period, the four mentioned perspectives pass in review. The relationship between epilepsy and psychiatry in the first mentioned period is intriguing.  The author mentions Cesare Lombroso’s (1835-1909) and his famous book L’uomo delinquente (1876), in which the author focused on the link between epilepsy and crime. Furthermore, Shorvon stated that “it was in the context of the study of mental symptoms in epilepsy that the theory of dégénérescence (degeneration) was proposed, again by Morel,” referring to his 1857 Traité des dégénérescences physiques, intellectuelles et morales de l’espèce humaine et des causes qui produisent ces variétés maladives [A treatise on the physical, intellectual and moral degenerations of the human species and the causes that produce these morbid varieties]. Indeed, Morel published on the relationship between epilepsy and his degeneration concept, but it was in a number of articles in the Gazette hebdomadaire that he described his concept of épilepsie larvée (masked epilepsy).1 The degeneration concept started in psychiatry with proponents such as Morel and Valentin Magnan (1835-1916). 

“Insanity gradually came to be considered a brain condition and a product of degeneration rather than a psychological disorder. … A ‘taint’ or sickly deviation from the norm initially caused by a pathogenic environment, poor nutrition, or alcoholic abuse, and subsequently transmitted in the Lamarckian manner through heredity, becoming progressively more severe with each generation until the family line became sterile and, finally, extinct”.2  

Later in his career (1880s), Jean-Martin Charcot (1825-1893) believed that heredity also played an important role in neurological conditions and thought these afflictions could be interrelated by means of inheritance.3 It is of interest to mention that the degeneration concept had a tremendous impact on the fin de siècle society, including its literature. In one of his lectures, he said, “Gentlemen, I will now present for clinical examination, two unfortunate creatures who deserve compassion. One may say that one as well as the other have been touched by the antique fatality that nowadays has been substituted by hereditary fatality.” 

Among other fictional characters, Shorvon provides the example of Emile Zola’s (1840-1902) La Bête Humaine, in which a character carried “the physical stigmata of epilepsy.” In fact, the concept of degeneration can be found in the whole 20-volumes Rougon-Macquart series. It should be realized that the fin de siècle was characterized by cultural malaise partly caused by these ideas of degeneration, but also by the uncertainty and anxiety of approaching the end of a century. Fear for decay and disaster reigned. The notion of degeneration was perceived by the lay public as well as by artists.3,4  

An interesting section is dedicated to “psychoanalytic theory and epilepsy.” The author tells us that psychoanalysis provided a novel explanation of epilepsy. “As its theories matured, the view grew that essential epilepsy was the result of inhibited psychological development caused by inherited traits which prevented normal psychic development and were manifest both by epileptic seizure and abnormalities of personality” (p. 166). Indeed, it is a general phenomenon that new ideas and therapies in medicine initially have a much broader area of indications, to become much narrower or disappearing after some time. As for neurology, another affliction in which this happened, i.e. psychotherapy, was dystonia.5 A few other issues of interest discussed here are the idea of the epileptic personality and the psychiatric effects of temporal lobe epilepsy.


Fjodor Dostoievsky (public domain)

Shorvon dedicates a paragraph on “eugenics and epilepsy.” Indeed, it did not escape involuntary sterilization in some countries, not just in Nazi Germany in the 1930s and 1940s. Furthermore, it is fascinating to read about the early pathophysiological ideas, including the reflex theory, the idea of autointoxication, and the Bacillus epilepticus (1916). And, of course, he mentions the asylums and colonies established for epileptic patients, in a period when drugs where less successful than today. The stigma of having epilepsy and the patient’s experience are discussed in detail. Several celebrities are mentioned in the context, like Queen Victoria’s epileptic son Prince Leopold of Albany and the Russian writer Fjodor Dostoievsky (1821-1881).  He not only suffered from epilepsy himself, but also wrote about it in several of his novels. Although it is not certain, he may have been treated by the optimistic Herpin. He was one of the doctors Dostoevsky listed on his visa application of 1863, the year in which he traveled abroad for the official purpose of consulting the greatest European authorities on epilepsy, including Moritz Romberg (1795-1873), Armand Trousseau (1801-1867), and Herpin. It is likely Dostoevsky had Herpin in mind when writing The Idiot.6,7

The importance of the introduction of the EEG (1929) and the early twentieth-century drugs are all mentioned in the book, including those that have disappeared later. A paragraph is dedicated to the role of the pharmaceutical industries through history. A table on the chemical and physiological basis of neurotransmission between 1900 and 1970 is also provided. Several “new” pictures can be seen in the book, like the one of Horsley in the operating theatre with Samuel A. Kinnier Wilson (1878-1937) and Emil T. Kocher (1841-1917), c. 1906.

Why not Brown-Séquard?

Charles-Edouard Brown-Séquard (public domain)

Although it is impractical to include all historical texts dealing with epilepsy, I would have expected a more extensive discussion of Charles-Edouard Brown-Séquard (1817-1894) and his views on epilepsy. Having written my dissertation on Brown-Séquard’s localization concept, I am of course biased, but in the present book only a sentence and two footnotes are dedicated to him. I was surprised all the more so, since he was in fact the predecessor of Shorvon himself. After all, considered an expert in epilepsy, Brown-Séquard was the one of the founder-physicians to be appointed at the National Hospital for the Paralyzed and Epileptic (1859), where he became a teacher of Hughlings Jackson. Jackson’s colleague and life-long friend Jonathan Hutchinson (1828-1913) wrote: “My friend fell, soon after he joined me in London life, under the influence of Dr. Brown-Sequard, who told him strongly that it was foolish to waste his efforts in wide observation of disease in general, and that if he wished to attain anything he must keep to the nervous system.” 

John Hughlings Jackson (public domain)

Furthermore, it was Brown-Sequard who told Hughlings Jackson that a vacancy for the post of assistant physician would be advertised. He indeed applied and was appointed on in May 1862.8 Brown-Séquard was among the first to prescribe bromide for epilepsy9, pp. 102-14 and between 1850 and 1872 published many articles as well as a book on epilepsy.10 Furthermore, he had found an experimental model for what he called spinal epilepsy, which became also known as Brown-Séquard’s epilepsy.11,12 

Finally, from today’s perspective, it is doubtful whether it was truly an epileptic phenomenon, as it was related to the ankle clonus by Wilhelm Heinrich Erb (1840-1921) and Charcot. However, it aroused interest for several decades.9, pp.183-93 Perhaps Shorvon did not discuss him, because it was partly before 1860, although the same is true for Herpin and his book Du pronostic et du traitement curatif de l’épilepsie [Prognosis and treatment of epilepsy] that was published in 1852. Or perhaps it is due to the fact the Brown-Séquard’s concept was finally rejected as epilepsy in the sense of having its origin in cortical cells. 


I may be in error, but sometimes I wondered whether the author sufficiently distinguished between the old neurosis concept and the modern post-Freudian term (psycho)neurosis. On page 58, we find that “epilepsy was still viewed generally as a mental disorder in the period under consideration, and treated largely in the arena of psychiatry.” It is of importance to understand the history of the term neurosis, as its meaning underwent an important evolution, which is related to neurology as well as psychiatry.13 William Cullen (1710 – 1790) of Edinburgh coined the term neurosis, applying it to what his Edinburgh colleague and predecessor Robert Whytt (1714-1766) called nervous diseases. This functional orientation of neurosis remained during almost the whole nineteenth century,14 though the category of neuroses became smaller as more diseases were found to have a neuropathologic substrate, beginning with general paralysis of the insane in the 1820s. In the 1880s, for example, William Gowers (1845-1915) mentioned the following functional disorders: chorea, paralysis agitans, tremor, tetanus, tetany, occupation neurosis, etc.15 

During the twentieth century, even more of these neuroses were found to have an organic basis. The present sense of the term neurosis dates from the period of dynamic psychiatry in the beginning of the twentieth century and may be called psychoneurosis, e.g. anxiety neurosis, obsessional neurosis, etc. Interestingly, neurologists have treated these patients with “nervous disorders” or “nerves” for a long period.16,17 Therefore, I am not sure whether the old concept of neurosis can be equated with mental disorder, as it was associated rather with the fact that no pathological substrate was found. As for the “arena of psychiatry,” we have to realize that in many countries, particularly the German-speaking and those adopting the German system, neurology was included in psychiatry for several decades.


The author is to be lauded that he tried to write not only for physicians, neurologists in particular, but wished to write also for the “informed public.” Therefore, he included a glossary of technical terms. Furthermore, he tried to avoid making it a book on “Great Men” and find a balanced choice with respect to the level of details. Indeed, the book is not based on important physicians in the field of epilepsy.

One shortcoming, which the author mentions himself in the introduction, is that there is a bias of language. He examined texts mainly in English. That does not mean, by the way, that he does not mention French and German researchers, but I suppose he often will have used existing translations for that purpose. And indeed, he does describe important players in the field of epilepsy from other countries than England and the United States. 

Perhaps among the minor criticisms the fact could be mentioned that the author often refers to the Pitié-Salpêtrière hospital. The “new” Pitié hospital (where Joseph Babinski [1857-1932] worked since 1895), however, was built near the Salpêtrière only in 1911 and the merging of the two took place in 1964. And Paul Broca of course did not show that “the expression of speech was localized in the left frontal gyrus in 1871” (p. 74). He localized it in the frontal convolution in 1861 and only in the 1863-5 period, he realized that most cases were in the left hemisphere. Furthermore, we read “The first systematic studies of anatomical-topographical analysis using electrical stimulation were by Fritsch and Hitzig.” Indeed, they found positive results of their cortical stimulation experiments in 1870, however, in the early nineteenth century, many other experimenters preceded them, without seeing any limb movements. As medical historian Michael Hagner wrote: “These results were repeatedly reproduced by distinguished physiologists like François Magendie, François-Achille Longet, Carlo Matteucci, Julius Budge, and Moriz Schiff, and, moreover, these physiologists failed in attempts to evoke muscle twitching through cortical stimulation, whether with electrical stimulation, cauterization, or compression.” And I am not sure whether the experiments by Fritsch and Hitzig were really more systematic than the previous. Continuing in Hagner’s article “Several divergent paths led to the emergence of this stimulus experiment. They led through realms of clinical medicine that had nothing to do with localized diseases of the brain, through therapeutic practices, and not least through alternate experiments and theories that arose from entirely other lines of questioning.”19 

The End of Epilepsy?

Perhaps, in a book on the history of a certain subject, one would not expect to continue the story up to the present. On the other hand, in this book on epilepsy, the story is told by an experienced epileptologist, who was part of that story for 40 years. Therefore, it is obvious that he provides his own opinion in the Epilogue, where he writes: “Even if fascinating in its own right, any history of epilepsy can be useful only if it helps make sense of the reality of epilepsy today” (p. 585), although he realizes and explains, in the accompanying footnote, that history can only stimulate new thinking about the present. 

It would be a mistake to think that events in history and today are homologous, referring to philosopher Hannah Arendt (1906-1975). Using the appropriate metaphor of epilepsy as ideas, “like leaves, seeming strong and vigorous at one time, wither and fall with a transience and an insignificance unthinkable at the time,” the author states that the tree also has permanent structures like branches and a trunk that grow. Indeed, he also attempted to make up an “epilepsy balance sheet” with theories and practices that have improved or harmed epilepsy through the long twentieth century. In the accompanying text, he contemplates about what happened and what deserves criticism in the various fields, including the political and economic context, legislation and social attitude, delivery of epilepsy healthcare, pharmaceutical attitude, etc. An interesting paragraph in the Epilogue is “The harm caused by medicine.”

In the introduction and Epilogue again, Shorvon tries to answer the question, whether “Epilepsy really exists” today, or stated differently “The end of epilepsy?” Hereby he follows up on Temkin, who titled the final section of his book “The end of the falling sickness.” May it still be considered a disease, as in the past, or did the progress in knowledge result in disappearance of the disease, now only being a symptom (pp. 7 and 623)? 

From the medical and scientific perspective there are, Shorvon believes, numerous arguments to drop the term epilepsy as a disease and continue to use epileptic seizure as a clinical manifestation or symptom. Referring to the German neurologist/medical historian and émigré Walther Riese (1890-1976), he realized that epilepsy is not just a medical and scientific concept, but also an idea laden with social and personal signification. Thinking of the disadvantages of the stigma, the author concludes: “Given that it does not exist as a disease, that it carries with it dark and deeply engrained archetypal memories of heredity, mental disease and impairment, and that it confers prejudice and social exclusion, I think the removal of the term ‘epilepsy’ from public discourse is at least worthy of debate. My personal opinion is that the gain might well outweigh the drawbacks. Much as Temkin had hoped, perhaps at this juncture, the end of epilepsy is possible to envisage. This would indeed be a goal worth achieving” (p. 629).

In conclusion, this book is a rich source of interesting aspects of the history of epilepsy in the past 160 years. It is recommended for physicians, in particular neurologists, and those non-medically trained persons interested in epilepsy and its history. •



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