My visit to Innsbruck Hospital, Austria

Stimulating and eye-opening! If I were to neatly describe my experience at Innsbruck Hospital in Austria, this would be it.

Neurology consultants at Innsbruck Medical University Hospital. (Left to right) Bettina Pfausler, Heena Narotam Jeena, and Martin Sojer.

I am deeply indebted to the World Federation of Neurology and Austrian Neurology Society for providing me with the opportunity to take part in this African Initiative project. My gratitude extends to Sophia Huppmann (social secretary of the Austrian Neurology Society) for tirelessly coordinating the logistics of my stay and to the consultant neurologists Michael Knoflach, Martin Sojer, and Bettina Pfausler for their hospitality and for ensuring I gain the most from my time in and out of the hospital in Innsbruck. Lastly, to my home institution of Tygerberg Hospital and my colleagues, thank you for affording me the time away from work in order to pursue this opportunity.

From the moment I peered through the aeroplane window upon our descent into Salzburg, marveling at the view of the rolling green hills, snow-capped Alps, and scattered village-like dwellings, I knew a unique and enriching experience was about to unfold.

I landed the evening in Salzburg and took the train to Innsbruck the next morning. It did not take me long to realize that I was, for all intents and purposes, functionally aphasic and that my German needed some work. I invested more time into learning the language, and on my first morning at the hospital could thankfully access some basic necessities with ease: “ein große americano, bitte!” (one large americano, please!).

The Innsbruck Medical University.

Every morning I would kit up and brace the refreshing cold air as I walked a short distance of 1 km to get to the hospital. The neurology division at the hospital consists of four wards (stroke unit, general neurology, epilepsy, and intensive care unit).

I spent my first two weeks in the stroke unit, where I was exposed to a multitude of stroke cases. I witnessed impressive door-to-needle times and had first-hand exposure to the day-to-day running of the unit. I quickly realized that access to direct oral anticoagulants and administration of intravenous heparin was easily accessible and formed part of standard practice; warfarin is not routinely used. MRI brain and Doppler of the neck vessels is the investigation of choice for stroke aetiology workup, and this is sometimes followed by angiography and FDG-PET, where indicated. The European guidelines are followed when evaluating the ultrasonography findings to make a decision with regards to management.

The health care worker to patient ratio is impressive, and access to diagnostic tests is readily available. An electronic recordkeeping system, which instantly uploads test results, diagnostic images, and patient notes, is used. Each staff member is equipped with a mobile telephone to use for communication within the hospital, as well as to contact external hospitals and patient family members. Each ward has a secretary who is responsible for arranging the relevant diagnostic tests as well as assisting with administration related to patient care.

View of Innsbruck from the top of Arzler Alm in Innsbruck.

I also spent time in the outpatient department and was exposed to various specialised clinics such as the Huntington’s clinic, ataxia clinic, Parkinson’s clinic, and botulinum toxin clinic. The Medical Emergency Department was another favorite place of mine to visit. Here, I would join the neurology resident and consultant as they attended to various neurological cases, including headache, backache, seizures, and strokes, to name but a few examples.

My last two weeks were spent in the neurology intensive care unit. The team of consultants managing the unit are neurointensivists, and residents spend part of their training time learning to manage critically ill neurological patients. These patients may, however, also have multiorgan involvement and co-management with other disciplines.

All in all, my experience at the Innsbruck Medical University Hospital has been excellent. The partial language barrier has been to my benefit — I was forced to really look at the patients, their body language, and clinical signs and listen to the prosody of their speech in order to gain an understanding of their impairments. In neurology, we can learn so much through observing our patients. I trust that the exposure to a broad spectrum of neurological disease will prove to be beneficial to my future practice in the field. Furthermore, the opportunity for personal growth which this experience has afforded me is far-reaching.

As the adage goes, all good things must come to an end. I look forward to the next part of my journey where I am able to offer greater insight and expertise into the management of patients with neurological disorders. The relationships that have been fostered with experts in the field are invaluable, and we are already exploring avenues with which to facilitate continuous education, research, and collaboration in the near future. Ending my stay with a stimulating and engaging meeting with Prof. Wolfgang Grisold, WFN president, has reawakened the advocate inside me and reminded me that kindness and humility are the highest accolades to strive toward. •

Heena Narotam Jeena is a registrar in the division of neurology at Tygerberg Hospital/University of Stellenbosch in Cape Town, South Africa.

Austrian Neurology Department in Salzburg

Visit for a young Nigerian neurologist: a generosity beyond measure

By Daniel Ekhaeyouno Ezuduemoih

Dr. Ezuduemoih with Marco Medina, WFN co-opted trustee, and Wolfgang Grisold, WFN president in Dr. Grisold’s office in Vienna.

Taking an academic voyage in medicine as a student and then a resident in neurology in a densely populated country like Nigeria with a teeming number of patients with neurological diseases has come with its own two sides of the same coin: one with knowledge-based learning driven by experienced teachers in a technology disadvantaged setting, where some neurological diseases are attributed to cultural causes for want of a better explanation. Honing one’s clinical skills in this setting and the desire to continuously improve oneself quickly became a non-negotiable requirement. Learning was made worthwhile by being blessed and mentored by seasoned tutors whom themselves have extensive clinical experience from many years of practice.

My training center, Lagos University Teaching Hospital, designed the neurology residency to accommodate a variety of seminar presentations, didactic sessions, and learning opportunities. Despite these opportunities for learning, the urge to see how things are done in a more advanced setting sprang from a deep-seated craving yearning for fulfillment. I applied as soon as a position for a department visit to the Austrian Neurology Department became available, so I could see how the system works. Fortunately, I was selected.

On arrival in Vienna, I boarded a train to Salzburg, where I would start my posting cum observership the next day in the neurology department of the Christian Doppler Clinic with my designated mentor, Prof. Eugen Trinka, a pleasant, joyful, and highly regarded epileptologist. Dr. Giorgi Kuchukhidze and the department’s secretary, Christa Muller were on hand to welcome me the next morning. They walked me through the paperwork and showed me around Salzburg’s facilities and the surrounding areas.

I was more than thrilled to be able to participate in daily morning reviews of patients from the prior day’s call duty. Dr. Bosque Pilar, a Spanish PhD student in epilepsy, was always willing to translate German into English for me. Every morning, I looked forward to this meeting not only for its rich educational substance but also for the show of genuine patient empathy. Everyone welcomed me with open arms. I witnessed timeliness, orderliness, team spirit, and astute attention to duty in all ages. Doctors, nurses, and other support staff worked well together.

Dr. Susanne Grinzinger, who specialized in NCS and EMG, and her resident, Dr. Bernadette Wigand, would take turns explaining the fundamentals of NCS and EMG to me during nerve conduction and electromyography sessions, and they made the process seamless. On weekends, she would give me textbooks to study NCS and EMG. My gratitude is indeed beyond words.

Drs. Markus Leitinger, Kalss Gudrun, Fabio Rossini, and other staff members of the epilepsy unit assisted me. I witnessed first-hand the use of video electroencephalography to monitor patients and received instructions on how the procedure operates and guidance on EEG interpretations. I would get explanations from Dr. Leitinger, who had a specialty in evoked potentials, on the concept and how to interpret this in a clinical setting.

Dr. Ezuduemoih with Marco Medina, WFN co-opted trustee, and Wolfgang Grisold, WFN president.

The acute stroke unit served as an example of the benefits of teamwork and the blending of various disciplines. Here, all patients were connected to centrally transmitting monitors, allowing for the monitoring of all patients from one place. Dr. Slaven Pikija showed me around various departments, including the emergency room, where paramedics and community doctors at the ambulance unit would communicate the patient’s condition and diagnosis to the hospital over an intercom. I also took note of the triage processes, which assigned each patient to a unit based on their state of consciousness and potential diagnoses. The point-of-care services provided here were excellent. We also briefly visited the well-equipped Neurorehabilitation Center built to meet every individual patient’s needs.

Finally, I am grateful for the mentorship of my teachers at the neurology unit at Lagos University Teaching Hospital, Professors Frank Ojini, Njideka Okubadejo, and Drs. Oluwadamilola Ojo, Osigwe Agabi, and my immediate senior colleague, Dr. Uchechi Agulunna.

Maya Angelou sums up my experience with the words: “This is a wonderful day. I have never seen this one before.” Indeed, it was an exceptional exposure to kindness beyond limits and the Austrian Neurological Society’s desire to make the world a better place. I have truly never seen it before. Thank you, the Austrian Neurological Society, I am forever grateful! Thank you, the World Federation of Neurology for your selflessness. The world is certainly a better place because of you all.

Ich schlafe jeden Tag und träume von deiner Freundlichkeit, die Tiefe meiner Dankbarkeit ist unbeschreiblich.  Danke nochmal. •

 

Daniel Ekhaeyouno Ezuduemoih, MBBS (Benin), MWACP (Intl Med) is a senior registrar in the neurology unit at Lagos University Teaching Hospital in Nigeria.

Program at the Universitätsklinikum Leipzig, Germany

By Prisca-Rolande Bassolé

Prisca-Rolande Bassolé

I am Dr. Prisca-Rolande Bassolé, neurologist from Dakar, Senegal. I would like to thank the World Federation of Neurology and the German Neurological Society for giving me this great opportunity to visit the department of neurology, Nov. 21-Dec. 16, 2022, at Universitätsklinikum Leipzig.

I was warmly welcomed since I arrived at the airport by Prof. Joseph Classen, department head, who introduced me to the staff the first day. He arranged weekly rotational visits for me.

Week 1: Stroke and neurointensive care unit

During my first week, I had the opportunity to attend the twice-daily rounds.  I was able to observe the quality of the multidisciplinary medical and nursing care of patients who had undergone thrombolysis, who were awaiting further examinations or who were being investigated for the etiological diagnosis of acute paroxysmal neurological symptoms. I especially remember the clinico-electrophysiological management in the context of the diagnosis of a very acute onset of Guillain-Barre Syndrome, which was thus able to benefit from plasmapheresis.

Left to right: Prof. Joseph Classen (Head of Department), Prof. Petra Baum, Dr. Prisca-Rolande Bassolé, Prof. Dorothée Saur, Dr. Caroline Awiss, Dr. Daniela M. V. Kuenheim, and Dr. Christoph Mühlberg.

Week 2 and 4: Functional Diagnosis Unit

In my two-weeks of observation in this unit, I had the opportunity to observe Doppler and Duplex sonography of intra- and extra-cranial arteries. I also observed the exciting botulinum toxin injection sessions. I took part in the rewarding sessions of discussion and interpretation of neurophysiological tests (EP, EEG, EMG, and nerve conduction). I also attended consultation on movement disorders, and I had the great opportunity to attend a deep brain stimulation surgery. I particularly enjoyed my time in this unit. Prof. Petra Baum gives her time for each member of her team and is patient and didactic. Thanks to Prof. Baum and all members of her team (Daniela, Caroline, Clément, and Christoph).

Week 3: Emergency room (ER)

During my stay in the ER, I was particularly impressed by the implementation of the “Time is Brain” theory. I saw how acute stroke is managed from arrival to treatment with thrombolysis or thrombectomy. Neurologists and nurses in the ER are well organized and coordinated with the radiology and stroke units. I have also seen the management of other acute and paroxysmal neurological disorders. What really impressed me about this unit was the fluidity of information regarding the arrival of new patients and the resulting speed of care but also the higher age of patients with acute cerebrovascular events compared to my country. This is probably due to the youthfulness of our population and the negative lifestyle changes. I would like to thank Dr. Hannes, who despite the urgency of the place, found the time to explain each procedure to me.

I also had time to visit the city of Leipzig

This department visit program was a wonderful exchange of experiences and practices and an opportunity to create an academic network for future cooperation.

I will especially try to improve the practice of clinical neurophysiology in my department with all that I have learned. I will also try, with the support of the head of my department and all faculty members, to draw the attention of the political health authorities to the importance and necessity of setting up the conditions for acute stroke management.

Finally, I would like to thank Herwig-Landry who arranged my visit, and Mrs. Tetzlaff who helped me a lot with all administrative procedures during my stay.

Thanks to all the staff at Universitätsklinikum-Leipzig for their hospitality during my rotation at different units. •

Prisca-Rolande Bassolé is Associate Lecturer in Neurology at Fann Teaching Hospital in Dakar, Senegal.

World Brain Day 2023: Brain Health and Disability

The WFN, global regions, and the World Federation of Neurorehabilitation

By Tissa Wijeratne, David Dodick, Steven Lewis, and Wolfgang Grisold

Key Message

  • World Brain Day (WBD) 2023 jointly with the global regions and World Federation of Neurorehabilitation (WFNR).
  • Spread the news on Brain Health and Disability, World Brain Day 2023 campaign in your community, hospital, village, and city-region.
  • Follow us on the WFN website and social media.
  • Six regional societies: American Academy of Neurology (AAN), African Academy of Neurology (AFAN), Asian and Oceanian Association of Neurology (AOAN), European Academy of Neurology (EAN), Pan-American Federation of Neurological Societies (PAFNS), and the Pan Arab Union of Neurological Societies (PAUNS) will lead regional activities on brain health and disability.

The WFN World Brain Day (WBD) was launched in 2014. Since then, the WFN, jointly with other international societies such as International League Against Epilepsy, World Stroke Organization, the International Headache Society, and the Movement Disorders Society selects a topic with a view to drive home the importance of brain health and promoting better neurological care globally. (https://wfneurology.org/world-brain-day-past-years)

For 2023, the WFN selected Brain Health and Disability, continuing our efforts to drive awareness for brain health, and also aligning with the WHO efforts to fight disability worldwide. Disability can be prevented, rehabilitated, and also needs to be under neurological care in chronic and chronic progressive diseases.

The aim of WBD 2023 is to alert not only its member societies, but also the public on the critical neurological issues issue of disability. The organizing committee will represent the global regions, and we partner with the WFNR..

Member societies of the WFN will receive a toolkit, which includes templates for press releases and educational PowerPoint presentation sets to assist in their local WBD activities and to advocate for brain health and disability. Local press conferences, press coverages (such as print, electronic, radio, TV, YouTube channels) are strongly encouraged to reach the public.

Please join the World Brain Day 2023 campaign for Brain Health and Disability, as this is an important priority.

Correspondence: Prof. Tissa Wijeratne, Chair, Neurology, Western Health, Melbourne, St Albans, Victoria,3021, Australia; Co-Chair, World Brain Day 2023. World Federation of Neurology, Tissa.Wijeratne@wfneurology.org •

Tissa Wijeratne and David Dodick are Co-Chairs of World Brain Day for the WFN. Steven Lewis is Secretary General of the WFN and Wolfgang Grisold is President of the WFN.

The Tournament of Minds at the World Congresses of Neurology

By Richard Stark

Richard Stark

The Tournament of Minds has been a well-loved component of the world Congress of Neurology since 2001.

The inaugural tournament  was held in London in 2001. This set the tone for future events. The idea behind the tournament was to produce a series of questions on neurological topics with an entertaining as well as educational element. Member societies were invited to enter a national representative team of four neurologists. The initial tournament was hotly contested over elimination, semi-final, and final rounds.

A similar format was put in place for the Sydney 2005 WCN. These first two tournaments were composed by the host society on each occasion without formal input from the WFN office and the sessions were chaired by the local committee members who had been involved in producing the questions.

Photo montage from the Tournament of Minds at WCN 2019 in Dubai.

With the success of the tournament in 2001 and 2005, it was decided that there should be a formal structure and a WFN tournament committee was established. This was initially chaired by Raad Shakir. In the 2009 WCN in Bangkok, the tournament questions were produced by the local Thai organizing committee as they had been by the UK and Australia in earlier tournaments. However, on this occasion, the questions were reviewed and edited by the WFN tournament committee in consultation with the local committee and chairmanship of the sessions was shared between WFN and local contributors, resulting in a professional and even smoother production.

A similar format continued through the WCNs of 2011 in Marrakesh, 2013 in Vienna, 2015 in Santiago, 2017 in Kyoto, and 2019 in Dubai. In all cases, local organizing committees produced marvelous sets of questions with a significant local flavor. The senior contributors would in most cases join the WFN tournament committee for subsequent congresses adding their acquired experience and wisdom to make a process even better. When Raad Shakir became president of WFN in 2013, he handed chairmanship of the Tournament committee to Richard Stark who in turn has handed it on to Nicholas Davies for 2021 and 2023.

In 2021, the pandemic resulted in the conference being held as a virtual event rather than in person in Rome. This produced organizational challenges in running the tournament, but these were overcome. The host society from Italy again produced the questions which gave the tournament a local flavor. One consequence of these challenges was that it would be difficult to get a truly national team together in a single room to engage in the virtual tournament, as often team members would come from a range of different cities within a nation. It was therefore decided to open the tournament to departmental teams, and this proved highly successful.

The plan for Montréal in 2023 is that the tournament will be held both in person and virtually and once again departmental teams will be encouraged to participate. We are looking forward to welcoming teams from around the world.

I have been involved in the Tournament since 2001 (as a participant) and since 2005 as a contributor and chair. Throughout this time, I have been amazed and gratified to see the talent and knowledge that has been displayed by all contestants, many of them early in their careers, from all parts of the world: It is truly uplifting to see and makes one strongly optimistic about the future of neurology. •

Richard Stark is treasurer of the WFN and past chair of the WCN tournament committee.

President’s Column

Grisold

This year’s Council of Delegates meeting occurred in Amsterdam, just before the ECTRIMS Congress. The meeting was held at the excellent RAI facilities and was preceded by a one-day seminar-like trustee meeting, which was the first in-person meeting of the trustees in a long time. All trustees attended the meeting. However, Prof. Guy Rouleau attended virtually, as he was being awarded the prestigious Gairdner award in Canada at the time. All of us at WFN congratulate him on this award.

In total, 60 people attended the Council of Delegates (CoD), 20 in person, three of whom were delegates. This confirmed the need for future CoD meetings to be hybrid. The WFN trustees recommended and the members approved, a change in wording to the articles of association to ensure that future meetings can be held electronically without ambiguity. Trends show that traveling is still limited and costly since the pandemic, and with visa restrictions, it can be difficult to arrange. The WFN leadership hopes this meeting format will allow more people to participate in future CoD meetings.

The meeting was opened with a minute of silence for Jun Kimura, Ettore Beghi, and all those who served the WFN and are not with us any longer.

The president’s, first vice president’s, and treasurer’s reports were well received. They were followed by reports from each trustee and several committee chairs, which provided an overview of the present state of WFN activities.

A key highlight of the meeting was the election results. Prof Steven Lewis (U.S.) was elected secretary general, taking office from Jan. 1, 2023, and Prof. Chandrashekhar Meshram (India) was elected as a trustee. Both have long experience with the WFN and are motivated and eager to participate in further WFN developments.

The WCN site visit team in Montreal. From left to right: Maya Smith, Steven Lewis, Wolfgang Grisold, Anne-Louise Lafontaine, Marcel Dekker, Steven Peters, Guy Rouleau, Karine Garneau

The terms of two co-opted trustees, Riadh Gouider (Tunisia) and Marco Medina (Honduras) ended. The WFN leadership is grateful for their work and input. The co-opted trustees came from Africa (Pan-Arab Region), Asia, and Latin America, which has meant that the WFN has benefitted from a wide de facto regional representation. I am happy to report that both Prof. Medina and Prof. Gouider have agreed to be co-opted again for an additional term.

The WFN will continue to seek a wide geographic diversity on the Board of Trustees. In addition, quarterly meetings are planned with the leadership of the regions (AAN, EAN, AFAN, PAUNS, PAFNS, and AOAN) to ensure wide regional influence in WFN.

IGAP

The Intersectoral Global Action Plan (IGAP) and its implementation worldwide is of much interest and was emphasized during the CoD. Alla Guekht reported on this and the importance of the WFN’s cooperation with the WHO.

In a follow-up WHO meeting on IGAP, the WFN and ILAE were asked to provide joint proposals to the WHO on implementation. A small working group consisting of Helen Cross, ILAE president; Julie Hall, ILAE executive director; Kimberly Karlshoej, WFN strategy and program director; and me have created a general statement and are working on a series of joint webinars to introduce important elements of IGAP to member societies and the wider public.

Site visit team inside the congress center, in the large multipurpose hall.

WFN has agreed to fund the WHO’s Brain Health Unit to employ a consultant for one year to work on the implementation of IGAP and to develop an implementation toolkit. The trustees are convinced that supporting WHO in this activity is crucial.

In summary, IGAP’s 10-year timeline aims to implement neurology at country-level. It is an ambitious project and a unique opportunity for neurology and neurologists with benefits for patients and carers. We will continue to keep WFN Member Societies informed about progress.

Member Societies

The AFAN Congress and the Regional Teaching Course were financially supported by the WFN. In addition, the trustees have participated in several meetings. For example, we attended and had joint meetings with the World Stroke Organization in Singapore; the Mexican Academy of Neurology, León; and the Indian Academy of Neurology as well as the AOAN in Delhi. I was honored to give the Dr. Gilberto Gomez Memorial Lecture at the Philippine Neurological Association Annual Convention and was on the panel for the launch of the Optimizing Brain Health Across the Life Course: WHO position paper.

The WFN appreciates every opportunity to participate in and contribute to WFN member societies’ meetings. All regular communication between the WFN and our member societies is valued, and we believe it helps to improve brain health and quality neurology.

Educational Activities

The Palais des congrès de Montréal at night.

The educational activities of the WFN continue, and the Education Committee and several subcommittees have been appointed. Current priorities are creating a core curriculum, a practical global neurology training blueprint, addressing the minimal required knowledge, clinical and technical skills, and overall competencies for neurologists, while recognizing regional variations in resources, funding, and spectrum of diseases. The needs of faculty, trainers, and the structure of the teaching facility will be included.

WFN has also appointed a Young Neurologist Subcommittee. At the World Congress in Montreal, the subcommittee is hosting two sessions created for other young neurologists. It is the strong wish of the WFN to inspire and empower young neurologists in their education around the globe.

eLearning

The WFN and AFAN will continue the highly successful eLearning Day next year, and WFN plans a joint AFAN and International Headache Society eLearning Day on headaches in 2023.

World Congress

Organizing the World Congress of Neurology is an enormous task. In September, we did the first site visit to the excellent facilities with the engaged local team. We look forward to seeing you all in Montréal in October 2023. •

The Journey of a Stroke Patient in Cairo: A Story of Success

Hany Naref and Nevine El Nahas

Hany Naref, Nevine El Nahas

On the afternoon of June 30, 2014, while she was preparing food for her family in a fasting day of Ramadan, she suddenly felt weakness in her left arm, with speech difficulty, and she asked her daughters for help. Two hours later, she presented to our stroke unit.

Knowing the importance of acting rapidly, the resident immediately ordered a CT scan brain and laboratory workup. Then the resident discussed the feasibility of thrombolysis. However, the responses of the radiology and laboratory staff were rather slow, as they did not appreciate the urgency of the situation.

The brain CT eventually showed that she was eligible for thrombolysis; however, we were left with one and a half hours for the window to close. Moreover, rtPA was not available in our hospital. Also, we had to pay for it. The senior staff (having donations from the department staff) decided to buy it from the nearest pharmacy. Several pharmacies were contacted until it was finally sourced and dispatched just 15 minutes before the end of the window.

The patient started to move her limbs one hour after receiving rtPA.

“Ma’am, what were you been doing when you got this stroke?” our resident asked.

In an intelligible speech, she said:

“I was cooking chicken and soup for my children to eat after a long fasting day. I thought I would never be able to cook for my kids anymore.”

With a smile of satisfaction, our resident said:

“Well, Happy Ramadan. Now you have recovered from the stroke, and you will go back and cook for your children.”

Certificate of accreditation of Ain Shams University stroke centers.

In 2014, rtPA was used in less than 1% of stroke cases and was not reimbursed by the Egyptian Ministry of Health (MOH). This case was a spark that ignited a sequence of corrective actions for acute stroke management. The stroke team at Ain Shams University (ASU) conducted research to identify the obstacles for reperfusion therapy, and by the end of 2015, an action plan was instituted. Neurology residents and nursing staff received training, and a guidelines manual for reperfusion therapy was established. Concomitantly, fundraising started in the ASU stroke unit to provide rtPA through donations. In a 6-month period, the rate of thrombolysis increased significantly to reach 12.3% of all cases of ischemic strokes1.

As a result of this advocacy, the MOH was convinced to reimburse rtPA, and all the Egyptian universities were tempted to pursue the same track as ASU. The number of stroke units increased from 20 to reach 95 by 2020. Then, in collaboration with the Ministry of Higher Education, university stroke units became hubs for satellite stroke-ready hospitals that are under the umbrella of MOH2.

Due to the progress in stroke services, in 2018, thrombectomy became reimbursed by MOH. Thus, the number of thrombectomies increased from 17 cases in 2016 to 172 in 2019.

In addition, by 2018, the first telestroke unit in Egypt was introduced in ASU. It started to provide consultation to neurologists for stroke management in remote hospitals2.

The rate of acute stroke therapy kept steadily developing with a reduction of door-to-needle time and improvement of patient outcomes. This ultimately led to accreditation of the two stroke units of ASU by the German Stroke Society in August 2019 in addition to receiving ESO and WSO Angels awards3.

We started our journey by searching for rtPA in nearby private pharmacies, and now all types of reperfusion therapies are available and reimbursable, with door-to-needle time less than 1 hour4. Currently, we are expecting the launch of our new stroke unit with an angio-suite installed inside the unit to achieve door-to-angio service. It also comprises an acute rehabilitation facility, gait lab, and a dedicated neurosonology unit. The stroke patient journey in Cairo now is smooth with a much-improved outcome than it was 10 years ago. •

Hany Naref is professor of neurology at Ain Shams University, and Nevine El Nahas is professor of neurology and head of the stroke unit and neuromodulation lab at Ain Shams University.

 

References:

  1. Zakaria MF, Aref H, Abd ElNasser A, Fahmy N, Tork MA, Fouad MM, et al. Egyptian experience in increasing utilization of reperfusion therapies in acute ischemic stroke. Int J Stroke. 2018; 13(5): 525–9.
  2. Hacke W, Caso V, Esagunde RU, Aref HM, Martina S, Mikulik R. Stroke care taking flight with the wings of ANGELS. A symposium presented by Boehringer Ingelheim at the ESO-WSO Virtual Conference 2020 Nov 8. 2021; 6: 8–25.
  3. “ESO and WSO”. Available from: https: //www.angels-initiative.com/angels-awards.
  4. El Nahas NM, Shokri HM, Roushdy TM, Dawood NL, Abushady EM, Georgy SS, Zaki AS, Bedros RY, Aref HM. Door to Needle Count Down: A 3-Years Experience in an Egyptian University Stroke Center. Neurologist. 2021 Nov 30;27(2):61-64. doi: 10.1097/NRL.0000000000000372. PMID: 34855665.

The Canadian Neurological Sciences Federation: Stronger Together

By Steven Peters, MD

Steven Peters

The Canadian Neurological Sciences Federation (CNSF) has been a unifying organization in Canada since 2006, though its roots stretch back to the 1940s. Neurosurgeons, adult and pediatric neurologists, neuroradiologists, and electrophysiologists all have a home under a single federation. In this unique arrangement, each member society also maintains its own executive and specific initiatives but works collaboratively with all CNSF societies. The cooperation between societies enriches the annual national congress, where the entire spectrum of physicians in the neurosciences are able to join together for networking and to address issues specific to Canadian health care.

Canada has long supported innovations in neurologic and neurosurgical care, from the pioneering epilepsy surgeries of Wilder Penfield to the endovascular stroke trials of today. Despite an abundance of expertise and innovation, Canada’s relatively small population, spread out over vast distances, has required unique solutions to maintaining a national organization

The CNSF Today

This unique partnership of neurologists, neurosurgeons, clinical neurophysiologists, child neurologists, and neuroradiologists continues to hold a combined annual Congress in June every year, with rotating locations from the Pacific to Atlantic oceans, from the Rocky Mountains to the skyscrapers of Toronto and Montréal. The CNSF has approximately 1,100 members and four staff in the Secretariat Head Office. Both the CNSF and member societies support advocacy initiatives across the country. Additionally, the CNSF publishes the Canadian Journal of Neurological Sciences (CJNS).

History of the Federated Model 

The current close relationship between clinical neurosciences specialties has developed over many years. The Canadian Neurological Association was founded in 1948 in Montreal and was attended by Wilder Penfield, Allan Waters, Walter Hyland, Jean Saucier, Francis McNaughton, and Roma Amyot. Thirty-eight members attended the inaugural general meeting.

In 1965, the Canadian Neurological Society, representing both neurologists and neurosurgeons, was dissolved, and two new societies were formed representing two distinct disciplines: the new Canadian Neurological Society for neurologists and the Canadian Neurosurgical Society for neurosurgeons. A liaison committee, with executive officers from the two societies, was formed to administer conjoint activities. This committee was important in planning the first annual joint meeting held in 1965: the first Canadian Congress of Neurological Sciences. In subsequent years, the two societies were joined by the Canadian EEG Society (later named the Canadian Society of Clinical Neurophysiologists) and the Canadian Association of Child Neurology.

In 1990, the Canadian Congress of Neurological Sciences was formally incorporated with a Board of Directors representing each of the four member societies, with a permanent Secretariat Office in Calgary. In 2006, the name was changed to the Canadian Neurological Sciences Federation (CNSF).  The Canadian Society of Neuroradiology and Canadian Stroke Consortium have since joined the family.

Eyes to the Future

Canada’s federation of neurologic and neurosurgical physicians and surgeons combines the advantages of a large organization with the focus and specificity of smaller, tailored organizations. Although the organization will undoubtedly continue to evolve and adapt, the CNSF organizational structure can be a successful model for many small and mid-sized countries with growing expertise in the neurosciences. Canada is ecstatic to host both the 2023 World Congress of Neurology in Montréal and the 2023 World Stroke Congress in Toronto.  Come join us! •

Steven Ray Peters, MD, is president of the Canadian Neurological Society.

RISE 2022: Fifth International Meeting on Environmental Health

Hybrid meeting Sept. 6-7, 2022, Strasbourg, France

By Christina Zjukovskaja, MSc, and Jacques Reis, MD, PhD

This year’s meeting on environmental health took place over two days and in a hybrid format in order to allow active participation unencumbered by travel. Participants and speakers from all over the world were able to gather, report findings as well as discuss relevant topics. Day 1 included sessions on neurotoxicology, exposure science, and the clinical approach of exposure sciences. Day 2 included neurological impacts of climate change, health impacts of air pollution, long COVID as well as diseases and environmental risk factors.

The first day’s session on neurotoxicology started off with a look at animal models that both referenced the autism spectrum disorder and delved into the impact of red meat on neuroinflammation.

The exposure science session brought to light the indoor exposome and the current projects in the EU that are driving progress in the field. Also, surveillance of volatile organic compounds was discussed along with the ongoing attempts to connect the exposome and immunome.

The clinical approach of exposure sciences session introduced the audience to the extensive French network PREVENIR, which is used as a measure of prevention of reprotoxic exposure from the perspective of environmental and occupational hazards. This was followed by a thorough review of the new hypotheses surrounding environmental factors and amyotrophic lateral sclerosis. The session was closed with an engaging report on the experience of UPRISE, a course in Uppsala, Sweden, co-founded by RISE, that attempts to enlighten the young science and medical community about environmental health issues.

The second day’s session on neurological impacts of climate change introduced the audience to the issue of how human sleep is and will be further affected by a warmer climate. This was preceded by the topic of global warning and neurology and the impact of increasing temperature on neurological diseases. These topics were well complimented by the following lectures on multiple sclerosis and climate change as well as the perception of risk of ticks for Lyme disease.

The health impacts of air pollution session started with an in-depth look at air pollution and stroke, including direct and indirect affects, as well as its global burden. This was followed by a report on the short-term effects of air pollution on respiratory health using a time series.  Finally, a comparison of the impact of first lockdown by COVID-19 in 2020 on the hospitalization rates of stroke and myocardial infraction in France debated and stipulated the cause of the drop in rates.

The long COVID session opened with reflections on the management of the pandemic. This was followed by several lectures on the impact of COVID on the brain and cognition. Along with long COVID and its impact, the pathogenesis and treatment of the neurological aspects were also discussed.

The concluding session, relating to diseases and environmental risk factors, delved deeper into the interdependent aspects of environmental impact on possibly overlooked health aspects. Along with brain and risk perception, vestibular function, balance, and dementia were all thoroughly discussed. Additionally, the hurdle of contamination dating back to inadequate World War I ammunition disposal and the issues within research in the intersection of the fields of neurodegenerative disease and environmental factors were reviewed and deliberated over.

With the conclusion of the Fifth International Meeting on Environmental Health, the audience was left with an appreciation of the work done the world over, the progress yet to be made, camaraderie, and the inspiration to reach new heights. This will undoubtedly help expedite the search for solutions to current and future environmental health challenges. •

The 17th International Summer School of Neurology

By Ovidiu Selejan and Dafin Muresanu

The 17th International Summer School of Neurology took place July 8-10, 2022, and was organized as a hybrid event. This educational activity along with the Fifth Teaching Course on Rare Neurological Diseases, brought together a lively audience of over 1,400 participants in a hybrid format, both online and on-site. In addition, the 3-day event hosted an online parallel session, “Psychiatry Perspectives in Neurocognitive Disorders” and a satellite session (on-site, on the shores of the Black Sea in Romania), focused on clinical case studies. This session was coordinated by Prof. Raad Shakir (UK), CBE, former World Federation of Neurology (WFN) president. The event was organized by Prof. Dafin Muresanu (Romania) and presided over by well-established international specialists, such as WFN President Wolfgang Grisold (Austria), Natan Bornstein (Israel), Volker Homberg (Germany), and Raad Shakir (UK). In addition, the events featured strong collaboration and endorsement from the World Federation of Neurology (WFN), the World Federation of Neurorehabilitation (WFNR), the European Federation of Neurorehabilitation Societies (EFNR), and the European Academy of Neurology (EAN), among other institutions.

The EFNR, presided by Prof. Dafin F. Muresanu (Romania), represents a forum dedicated to creating an academic, scientific, and work environment with a focus on patient care. EFNR welcomes all professionals interested in neurorehabilitation across Europe to create a multidisciplinary hub for knowledge exchange. The EFNR stands out through projects such as “The young European Federation for Neurorehabilitation” (yEFNR), a group dedicated to connecting professionals in the early stage of their careers who share a common interest in neurorehabilitation; the annual European Teaching Course on Neurorehabilitation; a wide range of educational programs; and the newly developed blog acting as a platform for promoting education and awareness on neurorehabilitation matters to a broad and diverse audience.

Strongly endorsed by the WFNR, EFNR acts as the umbrella society for European societies centered on neurorehabilitation and focuses its activity on three pillars:

  1. Supporting the development of neurorehabilitation across European countries.
  2. Hosting a forum for all health professionals involved in the neurorehabilitation process across Europe.
  3. Enabling young professionals (scientists and clinicians) to work on a joint platform and support education and training.

During the The 17th International Summer School of Neurology, personalities from the world of neuroscience presided over the sessions and offered insight into inspiring topics from neurology and neurosciences.

Wolfgang Grisold (Austria), WFN president, discussed the educational activities of the WFN, showcasing the IGAP (Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders) and also presented the WFN mission and activities, along with the eLearningHub and the Young Neurologists program.

Dafin Muresanu (Romania), EFNR president, showcased updates in the post-stroke neurorecovery, underlining the need for more evidence-based approaches supported on three pillars: theory and basic research, evidence-based parameters, and external validity. In addition, Prof. Muresanu discussed the EAN guidelines, pinpointed the role of multimodal agents in neurorehabilitation, and underlined the relationship between microcirculation and stroke.

Natan Bornstein (Israel), director of the Brain Division and chair of the Israeli Stroke Society (ISS), offered a presentation on the topic of diabetes and stroke, showcasing the role of primary and tertiary prevention and the importance of neurologists in the management of patients with type-2 diabetes Mellitus.

Volker Homberg (Germany), WFNR president-elect, presented future perspectives on neurorehabilitation in the context of the WFNR pillars based on the improvement of science, services, and education in neurorehabilitation. In addition, Prof. Homberg discussed neurorehabilitation methods, including high-tech developments, enriched environments, and pharmacological options.

Michel Brainin (Austria), immediate past president of World Stroke Organization (WSO) and Emeritus Professor of Neurology and chair at the Department of Clinical Neurosciences and Preventive Medicine of Danube University in Krems (Austria), discussed vascular diseases leading to cognitive impairment, the risk and protective factors for dementia and stroke, and also touched upon subjects of small vessel disease and strategic infarct.

The presentations from the three days of the Summer School on Neurology centered on common themes in the world of neurology and neuroscience research, such as:

  • Stroke and cerebrovascular diseases
  • Neurodegenerative diseases
  • Neuropathies
  • Neuroprotective and recovery-enhancing drugs, and many more.

Broader perspectives from public health and sociological points of view were showcased through presentations on the burden of neurological disorders in Europe and on the aspects of neurology and neurosciences in migrants and refugees. In addition, the learning process was enhanced through insightful clinical case studies on stroke, rare diseases, and headaches.

During the parallel psychiatry session, psychiatrists discussed inspiring case studies from their practice on various topics showcasing that addressing “brain health” through collaborative efforts among psychiatry and neurology represents a stepping stone to improving patient care and research outcomes worldwide.

The satellite session took place on the shores of the Black Sea, featuring Romanian speakers who approached various perspectives on Parkinson’s Disease (PD) – diagnostic challenges, guidelines, and recommendations, on-time optimization, patient journey, and life with PD – among other topics. Moreover, the session included a roundtable session on the opportunities and challenges in the multidisciplinary approach, featuring Romanian centers from Targu Mures, Constanta, Cluj, and Bucharest.

To further support and encourage the development of multimodal intersectoral approaches to the inspiring world of neurosciences, the organizers stated their wish for future on-site scientific events and hands-on programs.

More information on the event, including the complete program and list of speakers, can be accessed here. •

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