IN MEMORIAM
Donald Gilden, MD: A Unique Neurologist And Scientist

Donald Gilden, MD

Donald Gilden, MD

By Donald H. Silberberg, MD

For Donald Gilden, MD, his beginnings in Baltimore in many ways foreshadowed what was to become a distinguished career in neurology and virology. Don excelled in his studies while developing into a talented baseball pitcher, good enough to receive an offer from the Baltimore Orioles to join its leading farm team as a prospective big-leaguer. When Don broke the exciting news to his father, his father looked at him — an ace student who had been accepted to Dartmouth College — and said he was destined for great things: in college, not on a baseball field. Don accepted his father’s advice, bringing his combination of a competitive spirit, persistence, and teamwork when he enrolled at Dartmouth. So, how did his early years contribute to the development of such a remarkable career?

Don returned to Baltimore for medical school and the University of Maryland, which later recognized him as one of its most distinguished alumni. He trained in neurology at the University of Chicago, which recognized him as a distinguished alumnus. There he met his wife Audrey and began their devoted 49 years together. He then spent two years as a neurologist at the Walter Reed National Military Medical Center. He correctly saw that the field of neurovirology held great promise with so many unanswered questions. In 1969, he began his scientific career as a fellow in neurovirology at the Johns Hopkins School of Medicine. In 1970, his background uniquely qualified him for the faculty of the University of Pennsylvania’s department of neurology and its affiliate the Wistar Institute to attempt to find the virus that causes multiple sclerosis. Penn and Wistar had just established the first comprehensive research and clinical care center for MS, and Don quickly became a key member of the team.

A powerful technique at that time for detecting latent viruses was so-called co-cultivation, growing human cells that might contain a virus together with well-characterized lines of cells that had been maintained for many generations in vitro, and were known to be free of viruses. This required finding fresh brain and spinal cord tissue from recently deceased individuals with MS and from individuals known to not have MS. A brain bank registry was established. Don made countless trips to autopsy suites throughout Pennsylvania, often on short notice in the middle of the night. The nearby Philadelphia medical examiner’s office became a source of control tissues. In the course of these many unrewarding attempts to find an MS virus, Don discovered that the two principal human herpes viruses, Herpes simplex virus (HSV) and varicella zoster virus (VZV), could be found in latent forms in virtually all dorsal root and trigeminal ganglia at postmortem, whether from individuals with MS or controls.

This remarkable finding soon became a major focus of Don’s research: How did the virions remained latent, what activated them, and how could VZV cause chicken pox in children and then shingles later in life? In order to further develop his molecular biology skills, in 1980 and 1981 Don joined Yechiel Becker’s laboratory in the department of molecular virology at the Hebrew University-Hadassah Medical Center in Jerusalem as a visiting professor. While in Jerusalem, Don found time to join a fast pitch softball league and become captain of the Israeli team with teammates who were 15 to 20 years younger than Don, playing the position of catcher. They played in the Maccabiah Games, Israel’s Olympics.

Returning to Penn, he began to explore the many facets of VZV, leading to landmark discoveries that link the virus to giant cell arteritis in its many clinical phenotypes, shingles, temporal arteritis, ischemic optic neuropathy, cerebral and multi-organ vasculitis, and, most recently, Takayasu’s arteritis. This opened the way to revolutionize treatment. At the ztime of his death, scores of colleagues throughout the United States who had provided biopsy samples, or were aware of his findings, reported to Don that their patients who were doing poorly with conventional corticosteroid treatment responded quickly to anti-viral agents, e.g. valacyclovir. This reinforced what he was seeing at the University Colorado, and undoubtedly will be the subject of clinical trials (if they are really needed) and future publications.

While conducting his research at Penn, Don quickly gained the reputation as a go-to neurologist for colleagues in many departments throughout Philadelphia, and ultimately the United States, for help in solving difficult neurological problems as an expert clinician  and later as a neurovirologist. He was a true triple threat in every respect, an outstanding teacher, astute clinician, and extraordinary scientist.

In 1985, Don became professor and chair of the department of neurology at the University of Colorado, remaining chair until 2009. Notably, he expanded his successful research program while developing a nationally prominent department of neurology. His abilities and energy as a teacher were recognized when he received the Outstanding Teacher Award from neurology residents four times. Don was honored with many other national and international awards, including the Alumni Award for Distinguished Service from the University of Chicago, the Pioneer Award of the International Society of Neurovirology, and the 2008 Honor Award and Gold Key for outstanding contributions to medicine and distinguished service to mankind from the University of Maryland School of Medicine. He was elected to the Association of American Physicians, to fellowship in the American Association for the Advancement of Science, and to the Johns Hopkins Society of Scholars. He held leadership positions in many professional societies during his career, and he remained active on many editorial boards, with the National Institutes of Health (NIH) and the National Multiple Sclerosis Society study sections until his death.

A measure of the friendship and loyalty that he inspired was the fact that his principal laboratory assistants who joined his laboratory in the late 1970s stayed as members of his team, from Philadelphia, to Jerusalem, to Denver, and until their retirements over the last several years.

Don continued his research even after discovering that he had an aggressive renal carcinoma, enduring a difficult 18 months of therapies, finally succumbing on Aug. 22, 2016. In his last months, he identified five genes actively expressed during the process of latency. This was consistent with his having lived his life to the fullest. As late as early August, he worked with his colleagues to ensure that his grants would continue funding the research team and that the decades of advances he made in unraveling the nature of the varicella zoster virus would continue.

To cite some numbers: Don was an author on more 420 papers and remained the principal investigator on both an NIH Program Project Grant and an R01 until his death. He trained 26 graduate students and postdoctoral fellows, all of whom but the most recent hold important faculty positions in the United States, Canada, Japan, and Norway. He was mentor to countless medical students and residents, and consultant to his peers throughout the world. He held leadership positions in numerous professional societies and remained active on many editorial boards and NIH study sections until his death.

Don played to win at everything he did. He enjoyed skiing, becoming so accomplished that one could mistake him for a professional. He enjoyed teaching his friends and colleagues (including me) how to better navigate the slopes.

He was a serious violinist, never traveling without his instrument and practicing every day, even throughout his illness. In addition to recitals at national meetings, I enjoyed hearing him practice in hotel rooms in many countries as we attended meetings and in his home in Denver. When possible, Don added attendance each year to a national or international violin competition, including the International Violin Competition of Indianapolis, to his neurology and virology meetings schedules.

Don had a warm and engaging personality that endeared him to many of us. He and his wife maintained enduring friendships and were extremely hospitable to those of us who showed up in Denver from time to time.

However, where Don really devoted his energies and love was with his family, Audrey, their sons Daniel, Adam, and Paul, and their families. He and Audrey have been fully involved in their lives, leading to incredibly close ties among all of them. Although theirs is the greatest loss, Don’s passing leaves a tremendous void in neurology and virology, and he will be sorely missed by his many students, trainees, friends, and colleagues. May he rest in peace.

Don Silberberg, MD, is an emeritus professor and chair of the department of neurology at the University of Pennsylvania, Philadelphia.

References

  • Gilden, D.H., Rozenman, Y., Murray, R., Devlin, M., Vafai, A.: Detection of Varicella Zoster Virus Nucleic Acid In Neurons of Normal Human Thoracic Ganglia. Ann. Neurol. 22:377-380, 1987
  • Gilden, D.H., Devlin, M., Wellish, M., Mahalingam, R., Huff, C., Hayward, A., Vafai, A.: Persistence of Varicella Zoster Virus DNA in Blood Mononuclear Cells of Patients With Varicella Or Zoster. Virus Genes 2:299-305, 1988.
  • Gilden, D., White, T.M., Nagae, L., Gurdin, W.H., Boyer, P.J., Nagel, M.A.: Successful antiviral treatment of giant cell arteritis and Takayasu’s arteritis. JAMA Neurology, 72:943-6,2015.
  • Golas, L., Bennett, J.L., White, T.M., Skarf, B., Lesser, R., Nagel, M.A., Gilden, D.: Varicella Zoster Virus in Ischemic Optic Neuropathy. Ophthalmology, 122: 2142-5, 2015.

From the Editors

Walter Struhal

Walter Struhal, MD

STEVEN L. LEWIS, MD

Steven L. Lewis, MD

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

We are very pleased to introduce the November/December 2016 issue of World Neurology, which starts with the report from the Sept 12, 2016, Council of Delegates meeting that was held in Prague, Czech Republic. In his President’s Column, Raad Shakir, MD, describes the close relationship and tight collaboration of the World Federation of Neurology (WFN) and the six WFN regional organizations and the role of the World Congress of Neurology in enhancing the regions.

Wolfgang Grisold, MD, the secretary-general of the WFN, reports on the activities of the Austrian Society of Neurology related to the July 22, 2016 third Day of the Brain, and Federico Pelli-Noble, MD, reports on the Day of the Brain activities that occurred on the same day in Tucuman, Argentina. Christopher Gardner-Thorpe, MD, also provides a thoughtful discussion on neurology and international relations.

Kate Riney, MD, PhD, updates us on epilepsydiagnosis.org, an extensive and unique online tool for diagnostic information on the epilepsies, which can be of benefit to all neurologists (and our patients) globally. There are also a number of book reviews in this issue, including one from Edward J. Fine, MD, on Brain Renaissance from Vesalius to Modern Neuroscience. Dr. Grisold reviews Teaching and Tuition of Neurology and Neurosurgery in Indonesia During One Century: 1850-1950, and Yuri Takeuchi, MD, reviews Mentored by a Madman: The William Burroughs Experiment.

Also in this issue, Mustapha El Alaoui Faris, MD, provides us with an overview of the Continuum program in Morocco, as a model for other regional programs based on Continuum, the official continuing medical education publication of the American Academy of Neurology (AAN) and with which a joint AAN-WFN effort helps provide Continuum to user groups in various countries where this resource is needed. We look forward to future contributions from other regional Continuum user groups to highlight how this important educational resource is being utilized to support neurologic education and patient care. Also, in what we hope will be the model of many similar contributions for future issues, we know readers will appreciate seeing a “Photo of the Issue” that was provided by Dr. Shakir, showing Jun Kimura, MD, giving a recent EMG workshop at the Lebanese Society of Neurology in Beirut.

John D. England, MD, provides his editor-in-chief’s update from the Journal of the Neurological Sciences, the official journal of the WFN, and personally reflects on the recent loss of two leaders in academic neurology, Donald Gilden, MD, and Omar Khan, MD, Finally, Donald Silberberg, MD, the past editor of World Neurology, provides an extemely heartfelt tribute in his obituary for Dr. Gilden.

We sincerely hope that you will enjoy the articles in this issue, and we continue to encourage your outstanding submissions and helpful suggestions for the benefit of all of the readers of World Neurology.

Austrian Day of the Brain Sheds Light on Neurology Issues

By Wolfgang Grisold, MD

Wolfgang Grisold, MD, (from left) WFN secretary general, Elisabeth Fertl, MD, OEGN president; and Reinhold Schmidt, MD, OEGN past president, represent the OEGN during the World Brain Day 2016 press conference.

Wolfgang Grisold, MD, (from left) WFN secretary general, Elisabeth Fertl, MD, OEGN president, and Reinhold Schmidt, MD, OEGN past president, represent the OEGN during the World Brain Day 2016 press conference.

The Austrian Society of Neurology (OEGN) participated in the third Day of the Brain July 22, 2016, by discussing important topics at a press conference. The OEGN was represented by Elisabeth Fertl, MD, OEGN president, Reinhold Schmidt, MD, OEGN past president, and Wolfgang Grisold, MD, World Federation of Neurology (WFN) secretary general.

In Europe, 220 million people suffer from one or several neurological diseases. This is important because with increasing age, individuals experience disorders such as dementia, Parkinson’s disease, and stroke more frequently.

Austrian neurology, represented by the OEGN, has a strong presence with 970 neurologists, including previous neuropsychiatrists. Within Austria, there is a network of 38 acute departments with stroke units, a growing number of neurological rehabilitation centers, and other neurological centers devoted to care and rehabilitation. All stroke units are connected in a nationwide data and quality assurance system, and they have incorporated intravenous thrombolysis in their procedures. In 11 stroke units, interventional procedures can be performed for patients with acute stroke.

Dr. Schmidt gave an overview on dementia, emphasizing that efforts are needed to maintain cognitive abilities with age and in aged persons. In particular, in 75- and 80-year-old individuals, more risk for cognitive changes can be expected. The aim and strategy must be to identify the factors that positively enhance cognitive reserve. Increasingly, activity training of cognitive abilities and maintenance of social networks have been identified as positive factors.

Age is often identified as a burden (e.g., related to the burden of disease)and a contributor to increasing health care costs. This is, however, a naturally occurring phase in the life cycle with increasing needs. It is the duty of neurologists to act as advocates for our patients, to see the importance of these neurological needs for our patients, and to avoid classifying age as a burden.

Another important task in neurology is palliative care. Several neurological diseases need palliative settings of different types and time courses. For example, palliative care can be a long-term project in patients with degenerative diseases or a shorter time course in amyotrophic lateral sclerosis and brain tumors. Palliative care is not the same as end-of-life care, and it is important to include these concepts into neurology worldwide.

Worldwide, the WFN is engaged in intensive cooperation with the World Health Organization, including with ICD 11, noncommunicable diseases, and the present state of the Zika infection, where the WFN has created an international expert group.

The Austrian society had a strong echo in the media after the press conference, including several follow-up radio interviews.

WFN Council of Delegates Meets in Prague

: Emilio Perucca, MD, (right) president of the International League Against Epilepsy, welcomes the WFN Council of Delegates to Prague. Also pictured (from left): William Carroll, MD, WFN vice president, and Raad Shakir, MD, WFN president.

Emilio Perucca, MD, (right) president of the International League Against Epilepsy, welcomes the WFN Council of Delegates to Prague. Also pictured (from left): William Carroll, MD, WFN vice president, and Raad Shakir, MD, WFN president.

By Wolfgang Grisold, MD, and Steven L. Lewis, MD

The Council of Delegates of the World Federation of Neurology (WFN) met Sept. 12 during the 12th European Congress on Epileptology in Prague, Czech Republic. The meeting was opened by Emilio Perucca, MD, International League Against Epilepsy (ILAE) president, who welcomed the WFN delegates to Prague and emphasized the excellent connections between the WFN and the ILAE.

The introduction was followed by a welcome from WFN President Raad Shakir, MD. Secretary General Wolfgang Grisold, MD, identified 26 voting delegates, including proxies.

Gallo Diop, MD, PhD, recently ended his period as an elected trustee, and Dr. Shakir emphasized his achievements, in particular founding of the African Academy of Neurology (AFAN). For the open trustee position, two candidates, Sarosh M. Katrak, MD, and Steven L. Lewis, MD,  applied and each gave a five-minute introduction. This was followed by voting.

The WFN Council of Delegates cast ballots, electing Steven L. Lewis, MD, as WFN trustee.

The WFN Council of Delegates cast ballots, electing Steven L. Lewis, MD, as WFN trustee.

Dr. Shakir, Vice President William M. Carroll, MD, and Dr. Grisold each spoke on the achievements and work of the past year. Dr. Shakir informed attendees that John N. Walton, MD, and Noshir H. Wadia, MD, passed away in the the last year. The president also gave the final report from the the World Congress of Neurology (WCN) 2015 in Santiago, Chile, where 3,500 attendees made the meeting a success. Sixty percent of the profit made in Santiago was dedicated to the WFN and 40 percent to the Chilean Society of Neurology, Psychiatry, and Neurosurgery.

Collaborations with the World Health Organization (e.g., the Atlas), ICD 11, the Global Neurology Network, the WFN Zika working group (chaired by John England, MD), and the efforts of the WFN to improve neurology in all regions of the world were mentioned.

Dr. Carroll reported on the development of the next WCN in Kyoto, Japan, and the structure of the Congress. Three Nobel laureates will give lectures, and the number of sessions will be 210. The site of WCN 2019 is Dubai, United Arab Emirates. Applications from Europe for WCN 2021 were accepted until the end of September 2016.

The secretary general reported on five issues:

  1. The WFN office
  2. Zika
  3. The Day of the Brain
  4. WFN publications
  5. Outlook for the Congress

The Kenes Group will be the professional conference organizer for three more congresses. The secretary general also gave the reports from the Public Awareness Committee and the Applied Research Group Committee. The 2016 World Brain Day topic was “The Aging Brain.” The Day of the Brain will be continued in 2017, and the topic will be “Stroke.”

The WFN publications have a wide-ranging presence, from the website and social media, to World Neurology and the Journal of the Neurologic Sciences, to a new electronic journal, eNS.

The next neuromuscular congress — the International Congress on Neuromuscular Diseases (ICNMD 2018) — will be held in 2018 in Vienna.

Keith Newton, who served the WFN as executive director for 17 years, has retired, and his engagement and significant contributions to the WFN were acknowledged.

Richard Stark, MD, treasurer, presented the financial situation. Subsequent to the Congress in Chile, the financial situation has remained stable. Negative trends are the reduction of interest due to the economic situation in investments. The WFN will have to maintain the policy of lean management and careful budgeting, in particular, since in the years between congresses current costs exceed the income. The auditor’s report was approved, and the auditor was selected for the next financial period.

The Membership Committee received three applications, from Nepal, Togo, and Mauritania. Formally, Mauritania fulfilled all conditions and details and was accepted as a new WFN member. The other two countries were encouraged to resubmit their applications in Kyoto. For Guatemala, there are issues with regard to the presence of two societies accredited in 2001 by the WFN. The 2001 decision by the Council of Delegates to accept two Guatemalan associations has been reversed and approved by the South American delegates.

Education Committee Chair Dr. Lewis provided the report of the WFN educational activities, including the awarding of 30 Junior Travelling Fellowships in 2016. In addition, attendees were provided with an update on the the WFN department visit program for four-to-six-week visits, which now includes Austria, Canada, Germany, Norway, and Turkey. The status of the WFN Teaching Center program (for fellowship or full neurologic training) also was discussed. The program now includes two African centers, Rabat (a French-speaking site), Cairo (English-speaking), the newest center in Dakar (French-speaking), and the newest center in Mexico for Central and South America (Spanish speaking). The status and current usage of the Continuum program, an important joint educational initiative of the American Academy of Neurology and the WFN, also was discussed. Dr. Lewis and Walter Struhal, MD, editors of World Neurology, also reminded attendees of a call for articles on training in neurology around the world for publication in World Neurology.

Morris Freedman, MD, presented on distance learning, and he shared details about the Canadian-African interactive video conference as an example of future international medical video conferences that could possibly be supported by the Canadian government and include WFN involvement.

Dr. Struhal gave the report for the Publications and Communications Committee. He introduced the new and impressive WFN website and reported on the successful expansion on social media, including acknowledging the efforts of the social media group members.

Regional issues were presented by representatives from these regions:

  • AFAN: WFN Trustee Riadh Gouider, MD, presented on African initiatives by the AFAN, which was founded in 2015. The first meeting together with the Pan-Arab Union will take place in March 2017.
  • Asian and Oceanian Congress of Neurology (AOCN): The Asian Initiative was reported by Ryuji Kaji, MD, PhD, who presented on Asian initiatives, including the AOCN’s August 2016 meeting in Kuala Lumpur, which was organized by the Kenes Group. In 2016, at the Japanese Society of Neurology meeting in Kobe, there were several thousand attendees. This meeting also was attended by several WFN officers. Dr. Kaji also reported on positive developments with regard to planning of the WCN in Kyoto. Dr. Kaji also presented new features of Japanese research, including rehabilitation and treatment with stem cells in spinal cord injury.
  • Pan-American Federation of Neurological Societies (PAFNS): Marco Medina, MD, presented the update from PAFNS, whose constitution and bylaws were signed during the 2015 Congress in Chile. The organization is supported by the ILAE, the World Sleep Society, and the Iberoamerican Cerebrovascular Diseases Society, and its first official meeting was scheduled to be held Oct. 30-Nov. 3, 2016, in Cancun, Mexico.

The announcement of the result of the trustee election was presented. There were 26 votes, and, according to tradition, the number of votes for each candidate were not announced. The result was that Dr. Lewis of the United States became the newly elected trustee of the WFN.

Finally, the attendees were reminded to save the dates of Sept. 16-21 for WCN 2017 in Kyoto.

Mark Your Calendar

2023

XXVI World Congress of Neurology
15-19 October, 2023
Montreal, Canada

 

2018

4th Congress of the European Academy of Neurology (EAN 2018)
16 June 16-19, 2018
Lisbon Congress Centre

15th International Congress on Neuromuscular Diseases (ICNMD 2018)
6 Jul 8-10, 2018
Hilton Vienna

 

2017

Miami Neuro Symposium, Brain Symposium, Neuro Nursing Symposium 2017
Nov. 30-Dec. 2
The Biltmore Hotel
Miami

10th Congress of the Pan-Asian Committee for Treatment and Research in Multiple Sclerosis
November 23-25,
Ho Chi Minh City, Vietnam