A highly competitive tournament tested the wits and smarts of 15 teams

The winning team members from Hong Kong.

The Tournament of the Minds was held at the 2019 World Congress of Neurology (WCN) in Dubai and was an outstanding success. Fifteen teams participated in the initial round, which was a record. It was particularly pleasing to see teams from several countries that had not previously participated in the event. The teams participating were from Australia and New Zealand, Brazil, Hong Kong, India, Iran, Kenya, Malaysia, Nigeria, Pakistan, Philippines, Republic of Moldova, Sri Lanka, Sudan, United Arab Emirates, and the United Kingdom.

The runner-up team from Sri Lanka.

The initial elimination round was an exciting affair with 20 multiple choice questions being asked of the teams. The room was full, and audience participation was possible through a voting app. For every question, the audience’s opinion about the answer could be displayed. Many of the questions were challenging, and at the end of this session, the two leading teams were Iran and India. Other teams to qualify for the semi-final round were Australia and New Zealand, Brazil, Hong Kong, Kenya, Malaysia, and Sri Lanka.

The questions which had largely been provided by Faouzi Belahsen and his team from Morocco were entertaining but also highly educational. Several had a local and regional quality to them.

Judges at the Tournament of the Minds Final. From left to right: Profs. Faouzi Belahsen, Nick Davies, and Richard Stark.

Two concurrent semi-final sessions were run. These required a somewhat different strategy as questions were presented often with information unfolding gradually. The first team to answer correctly scored the points. Points were deducted for teams providing a wrong answer, and of course, premature attempts to answer before all of the information was available ran a significant risk of providing the wrong answer. A number of the teams adapted their strategy well to this different task, and two teams from each semi-final proceeded to the grand final. These teams were India, Hong Kong, Malaysia, and Sri Lanka.
The final was the most exciting and the closest contest that has ever occurred in the Tournament of Minds. With 10 points being awarded for a correct answer and 10 points deducted for a wrong answer, the final scores after 20 questions were:

A tiebreak question resulted in Sri Lanka being declared the runner-up.

The members of the successful Hong Kong team were Drs. Wing Chi Fong, Ping Wing NG, Yuen Ni Annie Mew, and Lung Tat Andrew Chan. They were awarded the cup and medals, and we congratulate them.

All team members from the Tournament of the Minds finals.

The Tournament of the Minds requires considerable effort and input from many sources. The preparation of the questions requires a lot of work, both in sourcing the questions in the first place and also in revising the wording so that the disadvantage some teams have of not having English as their first language is minimized. I would like to thank the members of the Tournament of Minds Committee who contributed to this process and to chairing the sessions: Nick Davies, Faouzi Belahsen, Serenella Servidei, and Takashi Kanda. The presentation of the tournament is demanding with regard to audio-visual assistance and the support provided by the audio-visual team and Kenes was outstanding.

Finally, there is no doubt that the success of the tournament on this occasion was largely responsible to the generosity of the congress committee in allowing tournament participants refunds on registration costs.

The tournament has certainly become a popular component of the World Congress, and we look forward to a successful tournament in Rome in 2021. •

A report of the 27th Annual Conference of Indian Academy of Neurology

By Gagandeep Singh, Satish Khadilkar, and Sita Jayalakshmi

The 27th Annual Conference of the Indian Academy of Neurology took place Oct. 3-6 in Hyderabad, India. The event, the most exalted professional event for the over 2,000 strong neurologists’ community in India, lasted for four days.

The Inaugural Ceremony of the 27th Annual Conference of the Indian Academy of Neurology: (From left to right) Prof. Gagandeep Singh, Secretary, Indian Academy of Neurology; Prof. Satish Khadilkar, President, Indian Academy of Neurology; Prof. Vinod Paul, Member NITI Aayog, India; Mr. Venkiah Naidu, His Excellency, Vice President of India; B Bhaskara Rao, CEO, KIMS, Hospital, Hyderabad; Prof. William Carroll, President, Worlf Federation of Neurology; Prof. Mohan Das, Chairman, Organising Committee; and Dr. Sita Jayalakshmi, Organising Secretary of the Conference.

India is a country with 1.4 billion people. This huge number is served by 2,500 neurologists, amounting to one neurologist for one million people. On the top of it all, the country is going through an unprecedented epidemiological transition commensurate with the recent strides made in the socio-economic sphere.

While neuro-infections and other neurological disorders associated with poverty and underdevelopment are only somewhat declining, there is a sweeping epidemic of non-communicable neurological disorders to confront. Subspecialty neurological practice is now in place in a few selected centers, but basic neurological care needs to be implemented in vast parts of the country. Clearly, neurologists in India have a formidable job at hand.

Prof. Satish Khadilkar, president, Indian Academy of Neurology with Prof. Carroll.

The annual conference of Indian neurologists was kicked off by Venkiah Naidu, the vice president of India, in the presence of Prof. Vinod Paul, chair of the Board of Governors, Medical Council of India and Member, National Institute for Transforming India, Prof. William Carroll, WFN president, and Prof. Wolfgang Grisold, WFN secretary general. Both the vice president and Prof. Paul emphasized the need and strategy for increasing the neurology workforce in India.

Prof. Khadilkar presenting Prof. Grisold with Honorary Membership of the Indian Academy of Neurology.

“No doubt, the number of training positions has increased from 30 in 1990 by nearly 15-fold – we now have over 450 training positions – but still we need more” said Prof. Paul. And besides, though the number of training posts have increased and there are many more neurologists than there were some 30 years ago, most of the neurologists are concentrated in a few metropolitan and larger cities of India. “We should really be having these neurologists, all equipped with computed tomography machines in the villages of India so that every individual with stroke who ought to be thrombolyzed is given his/her due” said Naidu. In his speech, Prof. Carroll outlined the philosophy of the World Federation of Neurology. In fact, he provided a roadmap for the future of neurology. Both he and Dr. Grisold agreed that the way forward was to make CT scanners and basic neurological care accessible to each village in India.

A speaker’s view of the audience.

Aside from the inaugural function, the Conference of Indian Neurologists had all of the ingredients for a successful meeting in assisting them to meet the challenges they faced. Themes and topics of over 40 symposia, quasi-workshops, continuing education programs, and hot topics varied from contemporary to futuristic, all cutting edge. Just to cite a few examples, there were symposia on artificial intelligence and continuous dopaminergic stimulation. Really, this meeting of Indian neurologists had something for everyone. There were neuroradiology rounds, grand rounds, panel discussions, a clinico-pathological conference, and even running, Yoga, and singing events for the members of the academy.

The Annual Conference of the Indian Academy of Neurology is always a glorious event, worthy of attendance by neurologists from all corners of the world. We warmly welcome neurologists form anywhere in the world to attend our future annual meetings. Just keep your eyes on www.ianindia.org for more information and updates. •

Gagandeep Singh, DM, FIAN, FICP, FAMS, FRCP, is secretary of the Indian Academy of Neurology. Satish Khadilkar, DM, FIAN, FRCP, FAMS, is president of the Indian Academy of Neurology. Sita Jayalakshmi, DM, FIAN, is organizing secretary of the 27th Annual Conference of the Indian Academy of Neurology.

Sergei V. Lobzin, V. Goldobin, and N. Tcinzerling

The XXI annual Davidenkov Readings Neurological Congress took place on the Sept. 26-27 in St. Petersburg, Russian Federation. The meeting is named in honor of the prominent Russian neurologist Prof. Sergei Davidenkov (1880-1961), who made substantial contributions to the development of neurogenetics and neuromuscular diseases. He described a new clinical form of myopathy, scapular-peroneal amyotrophy, and founded one of largest scientific neurological schools in Russia.

(Left to right) Prof. Alexander Skoromets (Russia), Prof. Nils Erik Gilhus (Norway), Prof. Sergei Lobzin (Russia), Prof. Raad Shakir (UK), and Prof. Wolfgang Grisold (Austria).

The congress was organized by S.N. Davidenkov, chair of neurology of I.I.Mechnikov North-Western State Medical University. The chair of neurology was founded in 1893 as the first Imperator Clinical Institution of the Grand Duchess Elena Pavlovna, which has continued since it remains as one of the leaders of neurology education in the Russian Federation.

Thousands of neurologists from different cities and countries from across the world gain more experience in neurology at the university annually. Close scientific and educational relationships connect our institution with the department of neurology at the University of Bergen (Norway) as a result of great efforts and perseverance of many, especially Prof. Nils Erik Gilhus, Prof. Ole-Bjorn Tysness, Prof. Tiina Rekand, and Prof. Lars Thomassen, among others.

These relationships allowed the establishment of a most creative exchange with university teachers and students as well as PhD postgraduate students.

Cooperative studies of myasthenia, spinal cord injuries, and other disorders of the nervous system were initiated as well as annual seminars about ”Neurology in Northern Europe,” which bring opinion leaders from Norway and the Russian Federation.

Prof. Vladimir Semenovich Lobzin

This year’s Davidenkov Readings Congress was devoted to a celebration of the 95th anniversary of honored scientist of Russia, Prof. Vladimir Semenovich Lobzin, who held our chair from 1982 until 1992.

Prof. V.S. Lobzin 1977.

Prof. Lobzin was the disciple of the legendary Prof. Alexander G. Panov, who in 1935 primarily described tick-born encephalitis in Vladivostok. Prof  Lobzin left a huge scientific legacy: 506 scientific publications, 28 books, mostly on challenging questions of clinical neurology, and 22 investigations. In 1957, he described a clinical test in myasthenia gravis (phenomenon of muscular fatigue generalization, oculopalpebral symptom). Prof. Lobzin published the first Russian monograph on myasthenia in 1960, and he managed to organize the All-Union Center for myasthenia investigation in 1971, which provided medical care for many patients with this severe disease from different parts of the then Soviet Union.

His eponymic reference contains seven symptoms and syndromes described by Prof. Lobzin. Among them were the ”three twins syndrome” in migraine (arterial hypotonia, hemicrania, and cholecystopathy, 1977), later completed by his son Prof. S. Lobzin with the “fourth twin” (craniovertebral dysplasia type Kimmerle and Chiari) in 2001.

The “phenomenon of pale spot” on the face after intravenous injection of nicotinic acid solution in patients with facial nerve palsy was also described by Prof. Lobzin, proving the compressive and ischemic origin of the pathology. Moreover, he described rhombencephalitic syndrome in mumps and myasthenic syndrome in patients following ionizing radiation due to nuclear reactor accidents.

The series of research investigations of Prof. Lobzin concerning hypokinesia and hypodynamy in young healthy adults trained in Cosmonaut Corps for prolonged space traveling is crucial. The disciples of Prof. Lobzin became leading professors of neurology in the Soviet Union and continued developing his scientific ideas. A significant part of Prof. Lobzin’s scientific creativity was devoted to research of neuroses, asthenic conditions, and autogenic training.

The investigations of Prof. Lobzin concerning infectious lesions of the nervous system were extremely interesting. He proposed a classification of meningitis, defined approaches to aetiologic and pathogenic treatment of these diseases and also for “arachnoiditis.”

Bekchterev Protege

The evolution of neurology in St. Petersburg owed much to dedicated scientists, such as Prof. Lobzin, who in turn can be considered continuation of the Russian neurological scientific school founded by Vladimir Bekchterev (1857-1927), because the teachers of Prof. Lobzin were disciples of V.Bekchterev. Unfortunately, the “iron curtain” and consequent limitations in scientific information exchange did not allow foreign colleagues to be familiar with the unique scientific achievements that Russian scientists made despite meager funding and nearly complete absence of feedback from leading foreign partners.

Fortunately, nowadays neurologists from St. Petersburg and also from other parts of the world have the opportunity for creative exchange of scientific information in most aspects of neurology aimed at further improvement of medical education quality and to provide adequate care to neurological patients. Nowadays, many staff members of the department of neurology named after S.N. Davidenkov are members of the European Academy of Neurology and the World Federation of Neurology, allowing direct exchange of views and experience in the diagnosis and treatment of a large number of severe pathologies of the nervous system.

The latest Davidenkov Readings Congress in 2019 was attended by 1,153 delegates, during which 117 scientific reports concerning important aspects of clinical neurology (such as stroke, degenerative pathology of the nervous system, neuromuscular diseases, neurooncology, neurocardiology, neurorheumatology, neurogerontology, child neurology, urgent neurology, headaches and migraine, neurorehabilitation, cognitive disorders, Alzheimer disease, Parkinson disease, peripheral nervous system pathology, cerebral and spinal cord injuries and their consequences) were presented. It should be emphasized that participation for neurologists is traditionally free of charge.

The delegates felt the real support from the World Federation of Neurology. The lectures for Russian neurologists from world-leading neurologists was met with a keen interest. The faculty included WFN Past-President Prof. Raad Shakir (U.K.), who devoted his lecture to the relationship between neurology and psychiatry, WFN Secretary General Prof. Wolfgang Grisold (Austria), who demonstrated difficulties in the differential diagnosis of neoplastic aetiology of cranial and other peripheral nerves, and Prof. Nils Erik Gilhus (Norway), who presented a review of neurological disorders and complications during pregnancy. These scientific lectures were closely followed by the audience with great interest and generated considerable debates among neurologists from Russia and other countries.

Challenging Discussions

During the congress symposia and roundtable discussions, the leading scientists from Russia and other countries shared views on challenging and difficult issues related to a large number of disease diagnostics and treatment; this is extremely important for the northernmost megametropolis of Europe – St. Petersburg, the population of which according to unofficial data is more than 7 million inhabitants. The importance of interaction with governmental and municipal services in cases of strokes is clear, and the local neurological community of St. Petersburg is concerned about the frequency, severity, and rehabilitation difficulties of stroke patients despite the setting up of 14 regional neurovascular centers that contain all of the necessary equipment and multidisciplinary teams. In addition, the elderly population of St. Petersburg is over 1 million people, making the situation of provision of care to the elderly more difficult, and creating an urgent need for international cooperation in cognitive disorders such as Alzheimer disease and other forms of dementia.

Thus, modern neurology in St. Petersburg continues to evolve, and it requires further support from the World Federation of Neurology, which will lead to improvement of neurological care all over the world. The Russian Federation is a unique country due to its multi-ethnic and multicultural background from the West and East. Our experience will certainly be useful for all neurologists across the world. We hope that continuation of the annual “Davidenkov Readings” will draw the attention of neurologists from all the countries, particularly as the meeting takes place in one of the mostly beautiful cities in the world with a well-developed and modern infrastructure. We invite all those who are interested to participate. •

Professor Sergei V. Lobzin is vice President of the St. Petersburg Association of neurologists, academician of Peter the Great Academy of Science and Art, professor, head of the Chair of Neurology named after S.N.Davidenkov of North-Western state medical university named after I.I.Mechnikov, where V. Goldobin and N. Tcinzerling are Associate Professors.

By Martin Krenn and Wolfgang Grisold

The Oxford muscle symposium is an annual meeting of muscle specialists under the leadership of David Hilton Jones and Monika Hofer. This year’s meeting took place July 12-13 in Worcester College in Oxford, United Kingdom.

Prof. Nonaka giving the Meryon lecture at the Oxford muscle symposium.

It is a unique meeting, based on lectures and case presentations in muscle disease (myology). It has a rich history, dating back 44 years. Over the years, the meeting has witnessed the change of techniques and methods and the remarkable switch from histology and morphology toward molecular medicine and genetics. The cases presented are well researched and a highly qualified audience discusses the cases.

One special aspect is the Meryon lecture, which is organized to commemorate  Edvard Meryon, by the Meryon Society. Meryon was a contemporary of Duchenne, and the naming of the disease is still controversial for the Meryon society1.

This year´s lecture was held by Prof. Ikuya Nonaka from Japan. It is a rare occasion to be privileged to listen to a researcher who has given the name to a rare disease2 Prof. Nonaka, from the National Center of Neurology and Psychiatry in Tokyo, Japan, gave his special lecture, titled “Special Aspects of Neuromuscular Diseases in Japan.”

In his lecture, Prof. Nonaka described neuromuscular diseases in Japan and the great discoveries of Prof. Myoshi, for whom he worked at the time. He also illustrated the history of Japanese neuromuscular departments that catered to neuromuscular patients, often dependent on ventilation. This has a long tradition in Japan and dates back to poliomyelitis epidemics. In this context, Prof. Nonaka told the story of one of his Duchenne patients, who despite his disorder was able to study law and attend university and worked as a lawyer.

Three giants of myology, discussing after Prof. Nonaka’s lecture. (From left to right) Prof. Nonaka, Prof. Hans Hilmar Goebel and Prof. Victor Dubowitz.

In 1981, Nonaka first described a subtype of distal myopathy, which was subsequently named after him (Nonaka Myopathy) and is now more commonly referred to as hereditary Inclusion Body Myopathy (hIBM) due to its hereditary (autosomal recessive) nature and its histological overlaps with classical inclusion body myositis. Later on, in the era of molecular genetics, the disorder was more precisely characterized and found to be caused by mutations in the gene GNE. While being considered as an ultra-rare (orphan) disease, the condition is also encountered outside Japan, most commonly in the United Kingdom, Bulgaria, India, and the Middle East.

From a clinical standpoint, the hallmarks of the disease remained widely unchanged since its first description by Nonaka almost 40 years ago. Neuromuscular symptoms usually start in early adulthood (third decade of life) with weakness and atrophy in distal limb muscles characteristically sparing the quadriceps. In spite of its slowly progressing natural course, it is a debilitating neuromuscular disorder, and most patients become wheelchair users 10 to 15 years after symptom onset. Although there is no approved treatment so far, modern advances in translational research give rise to the hope that targeted therapies may eventually also become available for GNE myopathy3.

Prof. Nonaka was able to give an overview not only on the detection of a rare neuromuscular disease, with tools of classical myology, which is now almost superseded by genetic studies, he also demonstrated his devotion to myology and above all to patients. •

Martin Krenn is in the department of neurology at the University Clinic of Vienna in Austria. Wolfgang Grisold is Secretary General of the WFN and works at the Ludwig Boltzmann Institute for Experimental und Clinical Traumatology.

References:

1. Emery AE, Emery ML. Edward Meryon (1809-1880) and muscular dystrophy. J Med Genet. 1993 Jun; 30(6): 506–511.
2. Nonaka, I., Sunohara, N., Ishiura, S., Satoyoshi, E. Familial distal myopathy with rimmed vacuole and lamellar (myeloid) body formation. J. Neurol. Sci. 51: 141-155.
3. Pogoryelova O, González Coraspe JA, Nikolenko N, Lochmüller H, Roos A. GNE myopathy: from clinics and genetics to pathology and research strategies. Orphanet J Rare Dis. 2018 May 2;13(1):70