Re-emergence of Measles in the United States: A Warning to Neurologists

By Kiran Thakur, MD

Kiran Thakur

Kiran Thakur

Before the introduction of the measles vaccine in the United States in 1963, more than 500,000 cases of measles and at least 500 measles-associated deaths were reported annually1,2. Although measles elimination was declared in 2000, importations of cases from endemic areas of the world continue to occur, leading to secondary measles cases and outbreaks. This year, the United States is experiencing a record number of confirmed measles cases, with 592 cases and 18 outbreaks reported to the Centers for Disease Control’s (CDC’s) National Center for Immunization and Respiratory Diseases (NCIRD) between Jan. 1 and Aug. 29, 20143. (See Figure 1.) Recent increases in the incidence of measles in the United States are attributed to the importation of measles virus through travel to other countries, including the Philippines, where there is a large, ongoing measles outbreak. Approximately 20 million cases of measles occur each year globally, and importations into the United States continue to pose a risk for measles cases and outbreaks. This is also coupled with greater rates of transmission because of unvaccinated or incompletely vaccinated United States citizens, a significant portion of which are children4.

The large number of cases this year emphasizes the need for health care providers to have a heightened awareness of the potential for measles and the importance of vaccination to prevent infection, in particular in young children and travelers who are susceptible to severe infection. Health care providers should maintain a high level of suspicion for measles among febrile patients who present with rash, cough, coryza, and/or conjunctivitis. Patients should be asked about recent travel abroad and/or contact with returning travelers, and their vaccination status.

Figure 1. United States (U.S.) measles cases by year.

Figure 1. United States (U.S.) measles cases by year.

In particular, neurologists should be aware of the early and late neurological manifestations of the infection. Although neurological symptoms and signs have not been reported among the 592 cases in the United States reported this year, neurologists should be aware of the potential early and late central nervous system (CNS) complications of the infection. CNS manifestations are indeed rare, but devastating when they occur. The most common CNS manifestation of measles infection is acute measles encephalitis (AME) occurring in approximately 0.1 percent of cases5. In AME, the virus replicates within neurons and triggers a lymphocytic infiltration within the brain parenchyma and meninges6. AME typically occurs during the exanthem phase of the systemic illness, but can rarely precede the onset of rash. Cerebrospinal fluid (CSF) typically shows a lymphocytic pleocytosis and mildly elevated protein7. Treatment for AME is largely supportive and prognosis is guarded as approximately 20 percent of patients die, with at least one quarter of survivors developing permanent neurologic sequelae8. Post-measles encephalomyelitis (PME) occurs in approximately one in 1,000 patients, occurring within two weeks of the onset of rash and is characterized by seizures and focal neurological deficits. Periventricular demyelination, induction of immune responses to myelin basic protein, and absence of measles virus in the brain suggest that PME is an autoimmune disorder triggered by measles virus infection9. Other CNS complications that occur months to years after acute infection are measles inclusion body encephalitis (MIBE) and subacute sclerosing panencephalitis (SSPE), both of which are caused by persistent measles virus infection. MIBE is a rare, but fatal complication associated with progressive neurological deterioration that affects individuals with defective cellular immunity and typically occurs months after infection. SSPE is a rare delayed complication of measles that occurs in about one in 10,000–100,000 patients and is characterized by seizures and progressive deterioration of cognitive and motor function followed by death 5–15 years after measles virus infection10. On histopathology, neurons, oligodendrocytes, astrocytes and microvascular endothelial cells are infected11. SSPE most often occurs in people infected with measles virus before two years of age.

Rates of CNS manifestations due to measles infection have dramatically declined since the introduction of the measles vaccine, though with the resurgence of measles outbreaks around the world, and the increase in refusal of vaccines in resource-rich nations, the risk of these complications is now heightened. As travel to worldwide destinations becomes more accessible, neurologists should be aware of the potential neurological effects of acquired infections abroad, including measles and other neurotropic infections. Clinicians should also be aware of the increasing susceptibility to infection in those who are not vaccinated, including young children.


1. Campbell H, Andrews N, Brown KE, et al: Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol 36: 1334-1348, 2007 4

2. Hinman AR, Orenstein WA, Papania MJ: Evolution of measles elimination strategies in the United States. J Infect Dis 189(suppl 1):S17-S21, 2004

3. Accessed September 4th, 2014

4. Verla-Tebit E, Zhu X, Holsinger E, et al. Predictive value of immunization records and risk factors for immunization failure in internationally adopted children. Arch Pediatr Adolesc Med 2009;163:473-479

5. Schneider-Schaulies J, Meulen V, Schneider-Schaulies S. Measles infection of the central nervous system. Journal of Neurovirology 2003;9: 247–252

6. Johnson RT, Griffin DE, Hirsch RL, et al: Measles encephalomyelitis—clinical and immunologic studies. N Engl J Med 310:137-141, 1984

7. Johnson RT, Griffin DE, Hirsch RL, et al: Measles encephalomyelitis—clinical and immunologic studies. N Engl J Med 310:137-141, 1984

8. Perry RT, Halsey NA: The clinical significance of measles: A review. J Infect Dis 2004;189(suppl 1):s4-s16

9. Johnson RT, Griffin DE, Hirsch RL, et al. Measles encephalomyelitis—clinical and immunologic studies. N Engl J Med 1984; 310: 137–41.

10. Bellini WJ, Rota JS, Lowe LE, et al. Subacute sclerosing panencephalitis: more cases of this fatal disease are prevented by measles immunization than was previously recognized. J Infect Dis 2005; 192: 1686–93.

11. Allen IV, McQuaid S, McMahon J, et al. The significance of measles virus antigen and genome distribution in the CNS in SSPE for mechanisms of viral spread and demyelination. J Neuropathol Exp Neurol 1996;55:471–480.

Thakur is a post doctoral fellow with the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology at Johns Hopkins Hospital in Baltimore, Maryland.


HIV in Sub-Saharan Africa

By Girish Modi

Girish Modi

Girish Modi

According to data from the World Health Organization (WHO), almost   75 million people worldwide have been infected by the HIV virus. About 36 million people are estimated to have died as a result of being infected. At the end of 2012, globally 35.3 million [32.2–38.8 million] people were living with HIV. In the young, economically active adult population (15 – 49 years) 0.8 percent are living with HIV.

Sub-Saharan Africa bears the brunt of this burden and remains the most severely affected. In Sub-Saharan Africa, one in every 20 adults are HIV infected accounting for 71 percent of the people living with HIV worldwide.

In South Africa, the total number of persons living with HIV increased from an estimated 4 million in 2002 to 5.26 million by 2013. For 2013, an estimated 10 percent of the total population is HIV positive. Also, 17 percent of South African women in their reproductive ages are HIV positive.

These statistics are important to help understand the impact they have had on the practice of clinical medicine in Sub-Saharan Africa and for us here in South Africa. In the teaching public hospitals in South Africa, 40-60 percent of medical admissions are in some way linked to HIV infection. In the non-teaching rural hospitals, these figures are much higher.

Naturally, neurology has been affected and to a large extent has borne the brunt of this epidemic. Neurological involvement in HIV is described to affect 40-75 percent of HIV infected patients admitted to the medical wards in a tertiary care setting1. In a prospective study of 506 in-patients at the Helen Joseph Hospital, Johannesburg, South Africa, 75 percent of patients had some clinical neurological involvement, and in 11 percent neurological disease was the sole presenting feature. The neurological presentation of the patient is dependent and to an extent determined by the immunological state of the patient.

Seizures and Epilepsy in HIV

Seizures in HIV can occur at any stage of the infection and have been described in patients with presumed acute HIV induced seroconversion illnesses through to advanced disease or AIDS.

HIVSubSaharanAfricaIncidence data on seizures in HIV infection has mostly been focused on new onset seizures (NOS). All the studies have been hospital-based and most are retrospective. The incidence ranges from 2-20 percent. The differences in incidence can be explained by the different inclusion and exclusion criteria in the studies and the specific groups surveyed. The relatively low incidence of two percent was from a study in New York where patients with provoked seizures were excluded.  The high incidence of 20 percent came from Bangalore in India where the study population group was pre-selected in that all their patients had a pre-existing neurological disorder.

In terms of seizure types, in these study populations, generalized seizures were  by far the commonest occurring in 58-100 percent of patients. This high proportion may be due to the under-reporting of focal origin seizures that cause immediate secondary generalization or inaccurate details from eyewitnesses. Focal seizures may in some patients indicate the presence of an underlying focal brain lesion but they have also been described in patients with diffuse disease. Status epilepticus also occurs in this population group and has been described in 8-18 percent of patients.

In terms of causes, NOS in HIV positive persons can be categorized or grouped into:

  • Focal brain lesions (FBL)
  • Meningitis
  • Metabolic causes
  • No identifiable cause (NIC)

The majority of patients with NOS have a specific underlying cause for their seizure.

The most commonly identified causes are focal brain lesions (FBLs) and meningitis. FBLs occur in 30-50 percent of patients. FBLs can be infectious; neoplastic; demyelinating or due to cerebrovascular disease.  Toxoplasmosis has been identified as the commonest infectious cause of FBLs in patients with HIV and occurs in up to 88 percent of patients presenting with NOS in most of the studies that have been published. However, in populations where tuberculosis is endemic, this has been found to be the commonest cause of FBL in HIV patients with NOS. CNS lymphoma is recognized as the second most common cause of FBL and has been reported in up to 11 percent of patients. Other reported causes of FBL include Progressive Multi-focal Leukoencephalopathy (PML); neurocysticercosis and strokes.

Meningitis has been described in 10-22 percent of patients presenting with NOS.  Cryptococcal meningitis is the most frequent cause of meningitis except again in regions where tuberculosis is endemic.

The other aetiologies that need to be considered include metabolic abnormalities; medication side-effects and HIV-Associated Dementia (HAD).

In 6-46 percent of patients, NIC can be found for the seizure presentation and it is presumed that primary cerebral HIV infection is responsible. In keeping with this, SPECT scan studies have shown focal temporal lobe abnormalities.

Numerous abnormal electroencephalographic (EEG) findings have been reported in HIV-infected individuals presenting with seizures. The abnormalities have been both focal and generalized and are most commonly non-specific e.g. generalized slowing. Non-specific abnormalities have been well described in asymptomatic HIV-positive individuals and their significance in this setting is uncertain. Focal abnormalities on EEG do not necessarily signify an underlying focal lesion.

Seizures recurrence risk as expected from the potential causes listed above is high and therefore treatment even with a new onset first seizure requires medical intervention. Valproate has been described to increase viral replication but it has also been shown to be beneficial in HIV infected seizure patients and is therefore widely used. Phenytoin and carbamazepine induce the hepatic p450 system and interact with anti-retrovirals adversely and are therefore not recommended. Gabapentin, Levetiracetam and Lamotrigine do not have such interactions are preferred in the setting of HIV and seizures. Availability in resource limited regions is an issue with these anti-epileptics.

In an acute setting, standard epilepsy protocols should be adhered to. Long-term anti-epileptic therapy needs to be initiated in the majority of patients but this can be a difficult decision. Evidence-based guidelines (American Academy of Neurology) have been formulated for patients that require both HAART and anti-epileptics. The guidelines do not however specify when anti-epileptics should be initiated or how long they should be continued for.

Epilepsy and HIV remains a daunting neurological challenge.

Modi is a professor and head of neurology, chief specialist and chair at the Division of Neurology, Department of Neurosciences, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand in Johannesburg, South Africa.



World Brain Day Celebrated at Janakpuri Superspeciality Hospital, New Delhi

By Dr. Man Mohan Mehndiratta, Dr. Natasha Singh Gulati, Dr. Ashok Kumar, Dr. Bhawna Sachdeva and Dr. Madhu Sinha

Figure 1. A: Dr. Man Mohan Mehndiratta, director (JSSH) in India and Prof. Raad Shakir, president, World Federation of Neurology, from London addressing the delegates through video conferencing. B: Expert panelists from various hospitals in New Delhi for World Brain Day at Janakpuri Superspeciality Hospital, New Delhi C: Prof. Mohammad Wasay, chairman advocacy subsection World Federation of Neurology from Pakistan addressing the delegates through video conferencing. D and E: Patients and their caregivers attending the program.

Figure 1. A: Dr. Man Mohan Mehndiratta, director (JSSH) in India and Prof. Raad Shakir, president, World Federation of Neurology, from London addressing the delegates through video conferencing. B: Expert panelists from various hospitals in New Delhi for World Brain Day at Janakpuri Superspeciality Hospital, New Delhi C: Prof. Mohammad Wasay, chairman advocacy subsection World Federation of Neurology from Pakistan addressing the delegates through video conferencing. D and E: Patients and their caregivers attending the program.

The brain: the body’s most complex organ harbors about 80 million neurons and controls every thought and action1. It can be affected by various diseases and disorders affecting about one billion people worldwide and causing around 6.8 million deaths annually. Neurological diseases and disorders have now been declared as a global epidemic. Knowledge and awareness of brain diseases by individuals and communities can play a crucial role in the prevention, detection and treatment, thus emphasizing outreach public health approach2. Recognizing the magnitude of the burden and disability and mortality consequent to neurological disorders the World Federation of Neurology (WFN) took the initiative to celebrate the first World Brain Day on July 22, 20141. To take this forward and foster brain health in our community, we celebrated World Brain Day (WBD) at our Institute, Janakpuri Super Speciality Hospital (An Autonomous Post Graduate Institute under N.C.T of Delhi) in Janakpuri, New Delhi, under the aegis of Indian Academy of Neurology (IAN). (See Figure 1.) In India, the day was also celebrated in cities like Indore, Nagpur, Kolkata and Bangalore.

Programs like these are very beneficial in a developing country like India where there are many barriers to the neurological education and care such as poor neurologist to population ratio, geographical barriers, illiteracy, lack of trained staff and inadequate resources3. These barriers pose a great challenge to our health care system, which can be overcome by such advocacy campaigns.

The objective of this program was

  1. To emphasize the types of neurological disorders and their frequency and severity
  2. To inform that most of these disorders are preventable and curable
  3. To answer the queries and problems of the patients and their caregivers and understand their needs
  4. To alleviate the myths and misconceptions related to these disorders
  5. To serve as a platform for various national and international experts to interact with the patients and their caregivers through video conferencing and panel discussions

More than 250 persons with neurological disorder and their caregivers attended the program and asked the queries related to neurological disorders and patients felt satisfied to get the answer and to interact.

A highlight of WBD celebration was address by Prof. Raad Shakir, president, WFN, from London and Prof. Mohammad Wasay, chairman advocacy subsection, WFN, through video conferencing and distinguished faculty comprising of neurologists, epilepsy surgeon, psychiatrist and neurosurgeon from the public and corporate hospitals. Prof. Shakir and Wasay answered the issues raised by the public and the faculty members had an introduction session with the president.

Dr. Man Mohan Mehndiratta, director (JSSH) and past president, Indian Academy of Neurology, briefed about WBD and its importance, vision and mission of the institution.

Doctors from various hospitals were invited to interact with the patients. Dr. C.S. Meshram, president, IAN, could not make it because of other commitments.

The expert panelists who attended the program include: Dr. Sumit Singh, senior consultant neurologist, Medanta, Medicity, Gurgaon; Dr. Shamsher Dwivedi, Prof. and HOD, Neurology, Fortis Gurgaon; Dr. Anuj Mittal, HOD, Psychiatry, Deen Dayal Upadhaya Hospital, Delhi; Dr. (Brig.) S.P.Gorthi, senior consultant neurologist, R & R, Army Hospital, New Delhi; Dr. Rajeev Anand, senior consultant neurologist, B.L.Kapoor Hospital, New Delhi; Dr. Vikash Gupta, senior consultant, neurosurgeon, B.L.Kapoor Hospital, New Delhi; Dr. Subodh Gupta, neurosurgeon, Deen Dayal Upadhaya Hospital, Delhi; Dr.Solanki, neurosurgeon, B.R.Ambedkar Hospital; Dr. Nilesh Kurwale, epilepsy surgeon, All India Institute of Medical Sciences, New Delhi; and Rehabilitation Experts, JSSH.

The program continued for more than two hours and still the patients had keenness to ask several questions related to various neurological disorders. Patients, rehabilitation experts, doctors, nurses and technical staff joined for refreshment after the event. Initial feedback from patients and their caregivers included appreciation for the program and a number requested more awareness programs in future.

The Internet is a leading source of disseminating public awareness worldwide both for people seeking health information and those who access it for entertainment and social networking purpose as they are passively influenced by health associated content4. The function’s videos and photographs are on the video-sharing website YouTube5 and social networking site Facebook6.

In conclusion: raising awareness is an ongoing effort which is never done so IAN will continue to build strong grassroots movement all over the country to increase public understanding about neurological disorders and diseases to combat this global epidemic. The World Day program in our hospital as well as other cities in India has paved the way for future programs.



1.     World Federation of Neurology. Fostering quality neurology and brain health world wide. Available at: Accessed on 8th August 2014.

2.     Gourie-Devi M. Organization of neurology services in India: unmet needs and the way forward. Neurol India. 2008 Jan-Mar;56(1):4-12.

3.     Mehndiratta MM, Mehndiratta P, Gulati NS, Wasay M. Heterogeneity in Neurological Education and care in Asian and Oceanian region. Neurology (in press 2013).

4.     England MJ, Liverman CT, Schultz AM, Strawbridge LM. Epilepsy across the spectrum: promoting health and understanding. A summary of the Institute of Medicine report. Epilepsy Behav. 2012 Oct;25(2):266-76

5.     World Brain Day Celebration at Janakpuri Super specialty Hospital, New Delhi on 22nd July 2014. Available at: . Last Accessed on 23rd August 2014

6.     World Brain Day Celebration at Janakpuri Super specialty Hospital, New Delhi on 22nd July 2014. Available at: . Posts to page. Last Accessed on 23rd August 2014

Dr. Mehndiratta, MD, DM (Neurology), FAAN, FAMS, FANA, MNAMS, FRCP, FICP, FIAN is the director, professor and head of department, department of neurology at Janakpuri Super Speciality Hospital in Janakpuri, New Delhi. Dr. Gulati, M.D. is the senior resident pathology at Janakpuri Superspeciality Hospital in New Delhi. Dr. Kumar, M.D. is the assistent medical superintendent at Janakpuri Superspeciality Hospital in New Delhi. Dr. Sachdeva, M.D. is the specialist pathology at Janakpuri Superspeciality Hospital in New Delhi. Dr. Sinha, M.D. is the specialist pathology at Janakpuri Superspeciality Hospital in New Delhi.


World Brain Day in Croatia

By Vida Demarin       

Public health action during World Brain Day in Croatia.

Public health action during World Brain Day in Croatia.

In celebration of the first World Brain Day, the Croatian Stroke Society in cooperation with Zagreb’s Institute for the Culture of Health, Associations of People’s Health Andrija Å tampar, Society for Neuropsychiatry and the Student Council of the Faculty of Medicine in Zagreb, organized a public health action in Zagreb, Croatia, on July 27, 2014.

The public health action, which was held on Kvaternik’s square in the center of the city of Zagreb, was to celebrate World Brain Day by promoting the activities of the associations and to raise the awareness among community that brain diseases are mostly

Volunteers measuring stroke risk factors.

Volunteers measuring stroke risk factors.

preventable and that actual perception of the brain should be changed. The day’s activities included measuring stroke risk factors such as blood pressure, blood sugar and body mass index. More than 250 people have measured their stroke risk factors, and more than 1,000 promotional materials were distributed during a day.

TV broadcasting with Prof. Vida Demarin during public health action.

TV broadcasting with Prof. Vida Demarin during public health action.

Prof. Vida Demarin, president of the Croatian Stroke Society and the Zagreb’s Institute for the Culture of Health, was a guest at a TV and a radio show dedicated to celebration of World Brain Day. She pointed out the necessity of such activities in promotion of brain health and prevention of brain diseases.

The community response was more than great, even though it was time of summer vacations in Croatia, which encourages us to continue with such activities in the future.

Demarin is the president of the Croatian Stroke Society and Zagreb’s Institute for the Culture of Health.

World Brain Day Celebration in India

By Dr. Chandrashekhar Meshram and Dr. Sanjeev Thomas

WBDIndiaOn July 22, 2014, the World Federation of Neurology (WFN) launched the first World Brain Day – Our Brain, Our Future. It was dedicated to bring more attention to the importance of human brain in health and disease and highlight the need to prevent the neurological and psychiatric illnesses prevalent in the society. In India, the first World Brain Day was celebrated under the aegis of Indian Academy of Neurology all over the country with great enthusiasm. The banners, brochures and press release from WFN were circulated to all IAN members. The event helped in spreading the awareness regarding brain health, brain diseases and their prevention. A breakdown of how different centers celebrated activities follows.


Dr. Chandrashekhar Meshram, president, Indian Academy of Neurology, convened the meeting of neurologists, neurosurgeons, physicians, psychiatrists and media. It was decided that looking at the magnitude of the issue deserves more than one day so the activities were held for the whole week. A press conference was held on July 18 and a press release in English and local languages was distributed to media. Accordingly, on July 22, a symbolic rally walkathon was organized in the city which was flagged off by Commisioner of Police, K.K. Pathak. Three hundred persons including doctors, school children and senior citizens wearing World Brain Day t-shirts and caps, holding banners and playcards participated in the rally despite the rain. An interview with Dr. Meshram was broadcasted by Aii India Radio.

Three billboards carrying the message of World Brain Day were displayed at prominent places in the city.

Lectures for common public and interactive sessions were organized at ESIS Hospital, Government Medical College and Hospital, Indira Gandhi Medical College and Hospital and Lata Mangeshkar Hospital on July 23-30, respectively. Dr. Poornima Karandikar, Dr. Pravir Waradkar, Dr. Avinash Joshi, Dr. Fulare and Dr. Anand Saoji delivered the lectures and answered questions .

On July 25, a program was organized at Dayanand College. Dr. Meshram presented Talks on Brain Health Supreme Wealth and Neurosurgeon Dr. Nilesh Agrawal presented on Head Injury. It was attended by 500 college students, their parents and teachers.

On July 26, a large public forum was organized at IMA Auditorium. Members of parliament Vijay Darda and Ajay Sancheti and Senior Neurologist Dr. G.M. Taori graced this occasion and addresed the gathering. Dr. Meshram highlighted the importance of World Brain Day celebration. Lectures on stroke, dementia, brain functions, epilepsy and head injury were delivered by Dr. Dinesh Kabra, Dr. Prafull Shembalkar, Dr. Poornima Karandikar, Dr. Sangram Wagh, Dr. Nilesh Agrawal and Dr. Lokendra Singh. Dr Nitin Chandak showed clippings of movies.The program was attended by about 400 people. Television channels covered the program and televised it.

On July 27, a painting competition for school children was organized in collaboration with Basoli group. 150 children from 65 schools displayed their creativity on the theme “Our Brain — Our Future.” 11 prizes were given to the students by Girish Gandhi and Dr. Meshram.

Visits to the Brain and Mind Museum were organized daily for students and common public. Specimens of human brain and some animal brains were shown, while brain structure, function and manifestations of various diseases were explained to visitors with the help of models and charts by neurologists, psychiatists and neurosurgeons.

World Brain Day and Brain Awareness week was celebrated under the aegis of Indian Academy of Neurology in collaboration with Nagpur Neuro Society, Indian Psychiatry Society Nagpur branch, Indian Medical Association Nagpur, Academy of Medical Sciences Nagpur, Nagpur Union of Working Journalists and Basoli Group.

The activities for the whole week were extensively covered by all newpapers in the city with publlication of articles, interviews, news items and photographs.

Janakpuri Superspeciality Hospital, New Delhi

World Brain Day was celebrated at Janakpuri Superspeciality Hospital on July 22, 2014, under the aegis of Advocacy Subsection of Indian Academy of Neurology. More than 250 persons with neurological disorders and their caregivers attended the program and asked the queries related to neurological disorders. The activity was organized by Dr. Man Mohan Mehndiratta, past president of Indian Academy of Neurology. Dr. Sumit Singh, Dr. Shamsher Dwivedi, Dr. Anuj Mittal, Dr. (Brig.) S.P.Gorthi, Dr. Rajeev Anand, Dr. Vikash Gupta,Dr. Subodh Gupta, Dr.Solanki and Dr. Nilesh Kurwale participated in the panel.

A highlight of the World Brain Day celebration was the address by Prof. Raad Shakir, president, WFN, from London, and Prof. Mohammad Wasay, chairman advocacy subsection, WFN, through video conferencing and distinguished faculty comprising of neurologists, epilepsy surgeon, psychiatrist and neurosurgeon from the public and corporate hospitals. Prof. Shakir and Wasay answered the issues raised by the public, and the faculty members had an introduction session with the president.

Army Hospital (R&R) Delhi Cantt

World Brain Day was celebrated by Army Hospital (R&R) Delhi Cantt on July 24, 2014, due to service commitments. The program was chaired by Maj. Gen. CS Narayanan, dean, Army Hospital (R&R) Delhi, and the following talks were delivered.

  1. Neurology from Bench to Bedside – Brig. SP Gorthi, professor and head of department of neurology
  2. Approach to Headache – Dr. Sumit Singh, professor neurology, Medanta Medicity
  3. Deep Brain Stimulation in Movement Disorders – Dr. Vinay Goyal, professor neurology at AIIMS

The program was well attended.

A cap was released in honor of the occasion to popularize the day.

In addition, stroke club was organized on July 25 and multiple sclerosis meet was organized on July 28 as part of promotion of World Health Day.

The event was organized by Brig. S.P. Gorthi, Col. Y. S. Sirohi, Lt. Col. Pawan Dhul and the Neurology Team at Army Hospital (R&R) Delhi.

NIMHANS, Bangalore

National Institute of Mental Health and Neuroscience (NIMHANS) at Bangalore, a premiere institute in the country dedicated to the diagnosis and treatment of neurological and psychiatric disorders is also committed to promoting positive mental health. NIMHANS has established a unique facility “Center for Wellbeing” away from the hospital environment, but managed by NIMHANS’ senior faculties from the Departments of Social Psychology and Psychiatry to counsel the seekers in psychological stress. NIMHANS has been actively involved in assisting the Ministry of Health and Family Welfare, Govt. of India in planning and execution of National Mental Health Programs, especially in the areas of neurotrauma, epilepsy and psychiatric disorders. NIMHANS has also established Human Brain Bank for research and Neuropathology Brain Museum to promote public awareness about neurological disorders and the strategies to prevent them.

Keeping in the spirit of World Federation of Neurology, NIMHANS celebrated World Brain Day – Our Brain, Our Future on July 22, 2014.

An event was organized at Neurobiology Research Center, NIMHANS, addressing 200 school children and teachers who visited the Human Brain Museum. In addition, a few from the general public and senior citizens also joined the celebrations. We dedicated this first celebrations to the children in whom we are kindling curiosity in the field of neurosciences. The students were from Class X and XI, preparing to enter college, thus representing the young minds who can participate in leading the country.

Director/Vice Chancellor Prof. P. Satishchandra and In-charge Registrar Prof. S.K.Chaturvedi, professor of psychiatry, addressed the students highlighting the need to understand the brain-mind axis and their role in neuropsychiatric disorders. In addition, they stressed healthy living by proper food intake, exercise and strictly avoiding addiction forming drugs. The session was interactive; the students actively participated in the discussion.

Dr. S.K. Shankar, emeritus professor, neuropathology and principal coordinator of Human Brain Bank, addressed the gathering on the topic “Let Us Learn Neuroscience Together” talking through the evolution of nervous system in animals and human and human brain in disease states. Subsequently, the structure of the human brain and the internal anatomical areas with their physiological and psychological functions were demonstrated using the human brains collected at autopsy with informed consent of close relatives.

“Human Brain in Health and Disease” was conducted showing the real human specimens, including the human articulated skeleton. The faculty, post doctoral fellows of Department of Neuropathology, staff of Human Brain Bank and volunteers from Neurovirology Department explained the specimens in an interactive basis. Finally the young students were thrilled touching the real human brain, heart, lung, kidney and intestine and had the real feel of the organs in their hands.

Simultaneously, the College of Nursing, NIMHANS organized a day-long exhibition with health awareness posters in English/Kannada and human brain specimens in the outpatient section of the hospital. The exhibition was inaugurated by Prof.Lalitha, head of the Department of Nursing. The faculty and the tutors of nursing college actively participated taking the knowledge about the brain to the common man visiting the hospital for treatment.

The public greatly appreciated the opportunity to see and touch the real human brain and fruitful discussion about food habits, the common infections of nervous system and the useful strategies to prevent them.

The Director/Vice Chancellor visited the exhibition organized by the Nursing Department and appreciated their efforts for taking the knowledge to the common man.

NIMHANS, Bangalore, decided to continue the tradition with greater scientific inputs in the future as well.

St. Paul College, Kolkata

The Institute organized the World Brain Day in a prominent school locally at Burdwan on July 22.

It was attended by students from class six and above along with teachers. Dr. Shyamal Kumar Das and two of his residents gave nice speeches about nervous system and their importance including basic illness such as epilpesy, stroke, dementia, etc. The meeting was well organized by the school authorities. It was a very stimulating experience, and the students and teachers enjoyed the program.

We have planned to celebrate next year as well.

Calcutta Medical Research Institute, Kolkata

World Brain Day was celebrated at Calcutta Medical Research Institute, Kolkata, on July 22 under the aegis of World Federation of Neurology and Indian Academy of Neurology. The goal was to increase the awareness regarding common neurological diseases. The half-day program consisted of a seminar where eminent neurologists of the city discussed on topics like stroke, epilepsy, dementia and neurotrauma. The seminar was attended by about 75, including doctors, patients, social workers and press.The event was organized by Dr. Arabinda Mukherjee, president elect, Indian Academy of Neurology.

The event was extensively covered by print and electronic media like Times of India and Door Darshan TV .

Madras Medical College, Chennai

World Brain Day was celebrated at Madras Medical College. Dr. Bhanu, head, Institute of Neurology, welcomed the gathering. Dean Dr. Vimala delivered the presidential address. Dr. A.V. Srivasan, emeritus professor, Dr. Lakshmi Nrasimhan, Dr. S. Balasubramanian spoke on the importance of brain functions. The event had wide media coverage in The Hindu, dinamaalar, dinathandhi etc. About 200 people participated and benefitted.

It is a good initiative to talk more on protection than on treatment of illness, though that is also important.


The first World Brain Day with the theme of Our Brain – Our Future was celebrated by Epilepsy Foundation India, on the July 22, 2014. Chief guest Dr. B. K. Upadhyay, Jt. Commissioner of Police, (Traffic) inaugurated and Dr. Nirmal Surya chaired the program.

A total of 150 people attended the program, most of them were patients suffering with epilepsy and other neurological disorder and their caregivers.

Dr. Nirmal Surya, founder trustee and chairman of Epilepsy Foundation in his presentation, informed the audience about the brain, its function and its disorder and how the injury to brain can affect the individual life in local and regional language. He also explained about the early intervention and treatment in disease like stroke epilepsy and head injury.

Dr. B. K. Upadhyay, Jt. Commissioner (Traffic) Mumbai, Chief Guest was delighted to be part of this function. He mentioned the importance of protecting brain while riding a bike, using a seatbelt while driving car and obeying traffic rules. He made the audience aware about following four simple traffic rules and stressed the need to safeguard your brain like gold, which is the most important organ of body. In the end, there was a session where the audience participated to know more about brain and its disorders.


World Brain Day was celebrated at the Department of Neurology, Institute of Medical Sciences, Banaras Hindu University Varanasi, a central government university, on July 22 under the aegis of advocacy subsection of Indian Academy of Neurology.

About 150 persons with neurological disorders and their caregivers were present.

Prof. M.K. Thakur, Prof. R.K. Goel, Prof. Deepika Joshi, Prof. S.P. Singh, Dr. N.K. Agarwal, Dr. V.N. Mishra and Dr. R.N. Chaurasia participated in the activity. They addressed the public and gave knowledge about our brain and its importance in life and how we can keep our brain healthy and answered the questions asked by public.


On the occasion of World Brain Day, Dr. Pawan Sharma organized public awareness program in Rohtak.


On the occasion of the first World Brain Day Neuro-Club Indore and Rotary Club of Indore Uptown organized a series of lectures at secondary schools where Dr. Apoorva Pauranik addressed hundreds of adolescents (class 10-11-12) about the anatomy and physiology of brain along with introduction for common neurological diseases. The presentation and interaction was lively and interesting with the help of charts, posters and models. The curiosity, intelligence, inquisitiveness of the boys and girls was impressive.


World Brain Day was celebrated in Vijaya Hospital. Dr. E. Pawankumar conducted awareness program on hospital premises on the  importance of brain and disorders of brain, mainly stroke, epilepsy and head injury and risk factors in our local language i.e telugu. Around 100 people were educated and given advice to prevent brain diseases.They really appreciated the program, and it was a grand success.

He prepared 4,000 posters about symptoms, risk factors, prevention and treatment of stroke and pasted it across various public places, offices and local hospitals in our entire district to bring awareness about stroke and received good feedback from many people.

The event was also celebrated at other centers, but they were late in sending the report.We would like to compliment WFN for this very impotant public health initiative. It was the best way to reach out to the people and interact with them.Some members expressed that they did not get enough time to organize the activity to their potential and expectations. We are sure next year the event will explode and reach greater heights as some members have already started planning.

Dr. Meshram is the president of Indian Academy of Neurology. Dr. Thomas is the secretary of Indian Academy of Neurology.


World Brain Day 2014


Raad Shakir

Raad Shakir

During the summer of 2014, an important date was introduced into the neurological calendar with the creation of the first World Brain Day (WBD) on July 22 – the anniversary of the founding in 1957 of the WFN.  This was celebrated across the world.  Many neurological associations publicized the marvels of the brain and promoted neurological care.  The impact on decision makers and on the public will take time to evaluate.

World Brain Day Across the Globe

There were many examples. The Times of India published a World Brain Day Supplement and its reporter from Nagpur detailed the events happening in that city, which lies at the heart of India:

Figure 1. Prof. Serefnur Ozturk, president of the Turkish Neurological Society.  Article in a local newspaper (Anadolu manjet, konya, 23 temmuz) talking about the World Brain Day.

Figure 1. Prof. Serefnur Ozturk, president of the Turkish Neurological Society. Article in a local newspaper (Anadolu manjet, konya, 23 temmuz) talking about the World Brain Day.

“Listen to the heart, goes a saying. But science eulogizes the brain, which controls every organ, including the heart. Unfortunately, the general public as well as doctors have not accepted the importance of the brain over the heart. Hence, the World Neurological Federation (WNF) has declared July 22 as World Brain Day to create awareness about early detection of brain diseases and trauma, and understand their importance over other diseases.  Dr. Chandrashekhar Meshram, national president of Indian Academy of Neurology, has extended the awareness drive to a ‘Brain Week’.”

The Supplement highlighted many facts and figures on neurological diseases including the fact that “15 percent people suffer from neurological (brain) disorders.”

Prof. Mohammad Wasay, chair of the public awareness committee, WFN, and I had the pleasure of participating in a Skype appearance at the Janakapuri Super Speciality Hospital in New Delhi organized by Prof. Man Mohan Mehndiratta.  This was well attended, and there was a lively question-and-answer session. Similar events happened elsewhere: for instance, in Kolkata with Prof. Arabinda Mukherjee, president-elect of the Indian Academy of Neurology.

Another example of the intense media coverage of WBD was in Turkey. (See Figure 1.) Prof. Serefnur Ozturk, president, Turkish Neurological Society, worked hard to promote the day, and many Turkish newspapers covered the activities.

In Zagreb, Croatia, Prof. Vida Demarin and Olga Plazibat, secretary of the Croatian Stroke Society, are pictured in Kvaternik’s Square promoting WBD. (See Figure 2.)

The WFN is most grateful to the EAN for the coverage WBD had in Europe with the publication in Neuropenews.  Prof. David Vodusek (Slovenia), one of the current editors, had the poster and news publicized across Europe.

Prof. Marco Medina notified all Latin American societies to celebrate WBD in their countries.

Following this global success, the WFN is looking to consolidate the first WBD by involving the WHO and all its regions in the next one on July 22, 2015.

WFN Grants

The WFN has decided on its grants allocations for 2014.  The number of applicants was again healthy, and the reviewers were active in their advice.  Perhaps one of the most important aspects of the process is the collaboration with neurology specialty organizations and World Brain Alliance members in partnering the WFN for funding.  This is the essence of international collaboration for the advancement of neurology.

World Health Organization

The collaboration with the WHO continues, and the time has come for all to participate in the second edition of the Neurology Atlas.  All WFN member societies have received a questionnaire from the WHO on the status of neurology in their countries.  This coupled with information from governmental health authorities should produce a comprehensive picture on the status of neurological services and availability of all facilities needed in neurological practice.  I am positive that all neurological societies will provide information to update the current atlas, which is now 10 years old.

Figure 2. Prof. Vida Demarin (right) and Olga Palzibat at World Brain Day in Zagreb.

Figure 2. Prof. Vida Demarin (right) and Olga Palzibat at World Brain Day in Zagreb.

The WHO is moving full speed ahead with ICD11, and the process is making progress.  The neurology section is nearly complete, but there remains a number of issues, which need further action. Many of you have contributed and given of your time and experience to the project.  As with any major endeavor, at the end of the day, the WHO coding team will have the final say in the layout of the classification, and we may have to accept some compromises.  There are many areas up for discussion, and one has to say that the WHO has been most helpful and accommodating to the neurosciences and has agreed to many reasonable requests without any major difficulties.  As an example; the issue of Prion diseases is under discussion now.  In ICD10, it was classified under ‘slow virus infection’.  Now the whole classification and etiology is clarified; however, the issue of transmissibility is being discussed, with the infectious diseases group. Double parenting of various conditions and their coding is being discussed, and compromises are happening across the classification.

Changes in the Constitution and Bylaws

The WFN is embarking on a major change in its trustees’ structure.  Over many years, the organization of the WFN has been under review, and we have had several recommendations to divide the position of secretary-treasurer general into two posts.  This has gone through many committees, in particular the Constitution and Bylaws Committee. The WFN’s legal adviser has now looked at the proposal, and it was put to the Council of Delegates as a recommendation from the trustees at their meeting in Boston. Thereafter, the Nominating Committee will look for suitable applicants for the post of treasurer, and the Council of Delegates will make a selection during the forthcoming World Congress in Santiago in November 2015.

Election of a Trustee

By the time this column is published, the Council of Delegates meeting will have elected a new trustee to replace Prof. Gustavo Roman who has completed two terms of office. My two predecessors Vladimir Hachinski and Johan Aarli, both of whom have worked with Gustavo, and I would like to register our appreciation for all of the years of service he has given to the WFN.  His work globally and in particular in Latin America has come to fruition in the establishment of the Pan American Federation of Neurological Societies.  His expertise will be called upon to continue working for the WFN. There are four candidates competing for the position of trustee.  The trustees welcome the election of Dr. Riadh Gouider as a new trustee; Dr. Gouider will add depth and experience to the WFN management team.

WCN 2015 Santiago

The preparations for WCN 2015 are well under way, and the program is now practically finalized, the abstract submissions opened in October for six months.  The scientific program is finalized and the speakers will provide the highest quality of current neurological information for those neurologists in clinical practice and research.  Having been to Chile, I can only say that the organization is impeccable, and the country is delightful.  I am sure all of us will have a memorable congress in Santiago.


Rabat Center

Following the accreditation of the Center of Rabat as a training center of African neurologists, the Department of Neurology at the Mohamed V University hosted Dr. Mohamed Albakay from Mali Sept. 9, 2014, as the first African intern.

Albakay received a grant  from the World Federation of Neurology  of 12,000 Euros to cover the stay in Rabat, the accommodation, a return ticket Bamako-Casablanca and health insurance.

Following the agreement between the WFN and the Moroccan  Foundation Against  Neurological Diseases, the scholarship of Albakay will be managed by the foundation.

Albakay has already begun his training in electromyography in the Department of Clinical Neurophysiology of the Hà´spital des Specialtés, headed by Prof. Rida Ouazzani. During this stage, he also experienced the expertise of the team in the diagnosis of myopathies and peripheral neuropathies.

The second part of the course will take place in the Department of Clinical Neurophysiology of Mohammed-V Military Hospital, headed by Prof. Hamid Ouhabi. This department is well known for its expertise in EEG, video EEG and in the treatment of epilepsy.

Albakay may participate in the various multidisciplinary staffs organized by our department.

Furthermore, the Moroccan Society of Neurology decided to support his participation to the Maghrebin Congress of Neurology that will be held Nov. 13-15, 2014, in Agadir.

Prof. Mustapha El Alaoui Faris, Department of Neurology and Neuropsychology, Mohamed-V University, Rabat, Morocco


Putting the Brain on the World Map

Report of a highly successful debut World Brain Day

By Mohammad Wasay, MD, FRCP, FAAN

Mohammad Wasay

Mohammad Wasay

The idea of World Brain Day received a lot of appreciation and enthusiasm since its approval by World Federation of Neurology (WFN). Time was short, and the task was huge but the Public Awareness Committee (PAC) and Grisold Wolfgang, secretary-general, WFN, worked over a three-month period to make it a success.

Developing a public message and theme was the foremost task. AAN’s palatucci list serve made it easier. Many slogans, themes and messages were discussed and finally PAC suggested a list of themes, logos, messages and publication material.

All member country delegates were sent a memo by President Raad Shakir regarding information and suggested activities for World Brain Day. World Neurology’s article on World Brain Day also created awareness and momentum for this day.

Publication material including banners, posters and brochures were designed by a professional team of an advertising agency. These materials were made available to all delegate societies by the WFN website. The WFN Facebook page actively posted these materials that were shared by thousands. The number of WFN Facebook page likes were increased by 500 percent over one month. A special post on our Facebook page was a specially recorded video briefing of World Brain Day by Shakir. This video was shared by thousands creating awareness about World Brain Day.

An international media agency was hired to prepare a press briefing and disseminated throughout world media in four languages (English, German, Spanish and French). It was additionally translated into Urdu, Arabic, Hindi and other local languages. July 22, 2014, was a memorable day for WFN in terms of media propagation. Hundreds of newspapers around the world published our press briefing in more than 10 languages. Radio and TV programs were produced and telecast.

Member societies played an exceptional role in the day’s success. Despite limited time, more than 50 member societies organized public awareness activities in their countries. These included press conferences, seminars, patient awareness activities, briefings to media, students and health care workers.  The largest numbers of activities were organized in India, Turkey and Pakistan. In India, other professional organizations including epilepsy foundation and Indian Neurorehab society organized activities. A prominent feature of World Brain Day activity in Janakpuri Hospital, New Delhi (organized by M.M. Mehndiratta) was Skype address of Raad Shakir.

The highest impact of this day was created on social media. Many societies shared and posted the World Brain Day banner on their websites. The American Academy of Neurology posted World Brain Day info on its website and Facebook pages with thousands of sharing.

Activities were largely organized by WFN and member societies. Due to a shortage of time, we were not able to actively involve other professional organizations especially Brain Council and Brain Research Organizations, World Health Organization and affiliated organizations like UNICEF.

In my knowledge, none of world days have received so much attention and media coverage as World Brain Day in its debut year. Our goal is to establish it as a joint WFN-WHO day. That requires years of awareness and advocacy. We should start planning for 2015 World Brain Day now with a target to approach millions of people, thousands of doctors (especially neurologists) and hundreds of health care and government officials in 2015.

Wasay is a professor in the Department of Neurology, Aga Khan University, Karachi, Pakistan, and the chair, public awareness and advocacy committee, World Federation of Neurology.


54th International Neuropsychiatric Congress

Opening of the 54th International Neuropsychiatric Congress in Pula.

Opening of the 54th International Neuropsychiatric Congress in Pula.

The 54th International Neuropsychiatric Pula Congress (INPC) was held in Pula June 18-21, 2014, under the auspices of the Croatian President of Republic Prof. Dr. Ivo Josipovi.

The organizers of the Congress are: Kuratorium International Neuropsychiatric Congress, Department of Medical Sciences of the Croatian Academy of Arts and Sciences, the Association of Neuropsychiatry and Zagreb’s Institute for the Culture of Health. It was endorsed by the World Federation of Neurology and supported by the European Psychiatric Association, the Central and Eastern European Stroke Society (CEESS) and International Interdisciplinary Medical Association of Russia. The main

President of the INPC Congress, Prof. Vida Demarin and Prof. Michael Chopp with his wife.

President of the INPC Congress, Prof. Vida Demarin and Prof. Michael Chopp with his wife.

sponsors of the congress were the Ministry of Science, Education and Sports of the Republic of Croatian, City of Zagreb, City of Graz, and Istria County. There were more than 350 participants from Croatian, Albania, Austria, Bosnia and Herzegovina, Montenegro, Czech Republic, Greece, Iran, Italy, Ireland, Hungary, Macedonia, Germany, Poland, Romania, Russia, United States, South Korea, Slovenia, Serbia, Ukraine, United Kingdom.

The main theme of the congress was “Lifestyle and Prevention of Brain Impairment.” In addition to lectures on the main theme, there were numerous accompanying symposia, in particular: third European Summer School of Psychopathology, seventh International Symposium on Epilepsy, second Neuro-Interdisciplinary School, third Symposium on the Interface Providers in Neurorehabilitation, psychiatric symposia on the new Croatian law on the protection of persons with mental disorders, forensic psychiatry, ADHD, treatment of advanced Parkinson’s disease, the activities of the Association of Public Health “Andrija Stampar” in stroke prevention, a common approach to diagnosis, treatment and follow-up of Anderson Fabry’s disease in

Prof. Vida Demarin with representatives of the Association of Public Health

Prof. Vida Demarin with representatives of the Association of Public Health “Andrija Å tampar.”

South-East European region, cerebral aneurysms, palliative care and atrial fibrillation as a risk factor for stroke. A joint meeting with Alps-Adria Neuroscience Section, WFN Applied Research Group on the Organization and Delivery of Care and Central and Eastern European Stroke Society was held dealing with different therapeutic approaches in the treatment of neurological and psychiatric diseases.

Poster sessions

Poster sessions

Invited lecturers from all over the world gave 76 lectures, followed by vivid discussions. Special attention was also given to the poster session with numerous posters from neurology and from psychiatry and two best posters from each discipline got the prize given by the City of Graz.

International Neuropsychiatric Pula Congress, organized continuously for the past 54 years, is one of the congresses with the longest tradition in the world in the field of neurology, psychiatry and neuropsychiatry. With its multidisciplinary approach, covering many interesting topics in psychiatry, neurology, and in other related fields of medicine, it is still promoting the fundamental idea of long-established “Pula School of Science and Humanism.”


Council of Delegates 2014

Report to WFN Members

By Raad Shakir, President, WFN

COD-RS-Pic2The WFN holds an annual general meeting. As a U.K. registered charity, it is legally required to be accountable to its membership and report its activities and finances on an annual basis.

The Council of Delegates is the highest authority of the WFN. It holds the elected officers and trustees to account and has the full power over all matters related to the activities of the WFN as stated in the WFN Memorandum and Articles of Association. These can be found on the WFN website.

The 2014 Council of Delegates (COD) was held on Sept. 11, 2014, during the joint ACTRIMS/ECTRIMS meeting in Boston, Massachusetts. A total of 34 out of 116 delegates, including those with proxies, were eligible to vote. (See Figure 1 on page 15)

This was my first COD as WFN president, and I thanked the delegates for their trust in electing me as well as thanked my predecessor Vladimir Hachinski for his role in developing the WFN during his term of office. I will do my best to move the organization forward.

The continued collaboration with peer organizations through the World Brain Alliance will be further cemented to ensure that it will prosper. The creation of the Regional Directors Liaison Committee under the chairmanship of Tim Pedley, WFN North America regional director, was reported to council. This committee is independent from WFN officers and is charged with implementing the principle of global involvement through regional empowerment.

Figure 1. Delegates voting on business at the Council of Delegates.

Figure 1. Delegates voting on business at the Council of Delegates.

The COD approved several items presented by the trustees. Changes to the WFN Memorandum and Articles of Association were presented. This is an important amendment, which has been recommended by WFN reviewers and endorsed by successive Constitution and Bylaws Committees. The WFN trustees, following legal advice from Hunters, WFN lawyers, approved this change. This specifically separates the post of secretary-treasurer general into two, one of secretary general and the other of treasurer. The reasoning and background was presented to Council. Prof. Alastair Compston (UK) previous chairman of the Constitution and Bylaws Committee further explained the background. The amendment was accepted by unanimous vote. This means that there shall be two posts for COD to elect in Santiago 2015; that of treasurer and another trustee to replace the vacated post of Wolfgang Grisold following his election as secretary-treasurer general.

The Nominating Committee presented the COD with four candidates for the post of trustee. The vacancy was created by the end of the second term of Prof. Gustavo Roman. Prof. Roman has served the WFN for many years and will continue to do so as the chairman of the Latin America Initiative. He served with three WFN presidents; his wisdom and considered advice were invaluable.

The four candidates were Jose Biller (U.S.), Riadh Gouider (Tunisia), Man Mohan Mehndiratta (India) and Serefnur Ozturk (Turkey). Following a second ballot, Prof. Gouider was duly elected as WFN trustee. (See Figure 2.) The officers and trustees welcome Riadh to the team. His experience in the WFN goes back many years and his current position as president of the Pan African Association of Neurosciences Societies would be most useful to the WFN. The WFN is most indebted to Prof. Eduard Auff (Austria), president of WCN 2013 Vienna for supervising the election process.

Figure 2. Prof. Riadh Gouider being elected WFN trustee.

Figure 2. Prof. Riadh Gouider being elected WFN trustee.

Prof. William Carroll, WFN first vice president, who chairs the WFN Congress Committee and the Specialty Network, spoke at the meeting. He informed the council of the current status of the preparations for the forthcoming congresses in Santiago, Chile, Oct. 30-Nov. 4, 2015, and Kyoto, Japan, Nov. 14-19, 2017. The preparations for Chile are well on target and the submission of abstracts is open. As with all World Congresses, there are a substantial number of travelling fellowships to encourage young neurologists to attend. Prof. Carroll detailed the current status of the close relationship with specialty neurology organizations in partnered educational endeavors and members of the World Brain Alliance in matters of global advocacy; both of which are highly valued by the WFN. The existing disparity between the six WFN regions was emphasized. The trustees are keen to see the growth of stable and independent functioning regional organizations through the coordinated endeavors of the regional directors and initiative chairs.

Prof. Wolfgang Grisold, secretary-treasurer general, presented the WFN financial status. The audited accounts were already sent to all delegates. The WFN is in good financial standing. The WFN is a lean organization run efficiently by two full-time and three part-time staff. The cost of the central office in London and elsewhere is relatively small. The total assets of the WFN at the end of 2013 amounted to £ 3,155,812. The rise in assets in spite of increased spending is mainly due to the excellent profit made by the Vienna WCN. We have to give our gratitude to the Austrian Society of Neurology and the now amalgamated European Federation of Neurological Societies for their efforts and close collaboration. The excellent collaboration will continue with the European Academy of Neurology.

A decision of the WFN trustees was made to allocate 30 percent of the annual budget to grants. The grants for 2013 were already dispersed and those for 2014 were decided and have started to be awarded. The WFN is most grateful to grant reviewers and to members of the World Brain Alliance and Specialty Network for their support and agreement to be partners in financing grants.

Prof. Grisold detailed the success of the World Brain Day, which was held on July 22, 2014. All member societies that participated were duly thanked. The day will be expanded in 2015, and more activities are planned. The WFN publications and website report were detailed and activities on social media were brought to the attention of the council, these continue to grow and expand.

Prof. Grisold outlined the activities of the education committee chaired by Steven Lewis (U.S.) announcing the departmental visiting programs, which successfully started in Turkey, and have now been agreed to start in Austria. The start of the Rabat training program was mentioned, and Prof. Gallo Diop detailed this in his Africa initiative report. Negotiations are under way to establish further WFN accredited training centers.

Prof. Diop, WFN trustee, chair of the Africa Initiative, gave an account of the status of neurology across Africa. Although the situation is still dire in many countries, there is clear increase in neurological services and manpower. This is most welcome and plans to expand the role of the WFN on its own and in partnership with others including EAN, IBRO, IPMDS and AAN were detailed. The WFN is committed to the Africa initiative, which receives financial support through grants, and the reserved fund created following WCN Marrakesh.

Prof. Diop pointed out the start of training African neurologists in Africa with the commencement of training in September 2014, in the first WFN accredited training center in Rabat, Morocco. The WFN is most indebted to the Moroccan Neurological Society and the Moroccan Neurology Foundation for their continuous and indefatigable support for all WFN activities and in particular their commitment to training African neurologists in Africa.

Prof. Roman informed the council of the final stages of the formation of the Pan American Federation of Neurological Societies (PAFNS) to represent Neurology in Latin America. The WFN has designated grants for three developing regions: Asia, Africa and Latin America. This newly formed federation should unite the Latin American neurological world by the time the 22nd WCN is held in Chile.

Prof. Ryuji Kaji (Japan), chair of the Asia Initiative could not be in Boston. I pointed out the huge success of the Asian Oceanian Association of Neurologists. The association is now mature and active. First Vice President William Carroll and I had the pleasure of attending the Asian Oceanian Congress of Neurology in Macau in March 2014. The organization is moving ahead with its activities and is participating in the organization of the 23rd WCN Kyoto.

The COD official business is crucial and its decisions are legally binding to the WFN, but perhaps as importantly, is the interaction and relationships of delegates to renew friendships, start new ones, exchange ideas and news of the past year. There is no replacement for face-to-face meetings. The annual council of delegates meeting is that and much more. The next COD meeting will be held Oct. 31, 2015, in Santiago, Chile.