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A Brief History of Neurological Sciences

The journal of the Italian Society of Neurology (SIN) has provided 47 years of neurological insight and education.

By Antonio Federico

Neuroscientists from Italy and around the world gathered for the 2026 International Conference on Neuro-Symbolic Systems (NeuS). The conference, which took place March 26-27 in Milan, Italy, was organized by Neurological Sciences, the journal of the Italian Neurological Society (SIN), and by the SIN itself, to stimulate international exchanges between Italian and foreign neuroscientists and promote the Neurological Sciences journal.

From left to right: Prof. Mario Zappia, president of the Italian Society of Neurology; Prof. Antonio Federico, former president of SIN and past editor-in-chief of Neurological Sciences;
Prof. Marianne De Visser; Prof. Wolfgang Grisold; and Dr. Fabrizio Tagliavini, current editor-in-chief.

In addition to other international guests, Prof. Wolfgang Grisold and Prof. Marianne De Visser attended on behalf of the World Federation of Neurology and as active members of the Neurological Sciences editorial board.

Following is an overview of the opening lecture, which focused on the history of Neurological Sciences and its goals. View the complete program for the meeting.

The Italian Society of Neurology and its Journals

The first journal historically linked with the SIN was the Rivista di Patologia Nervose e Mentali, founded in 1896 by Eugenio Tanzi and Enrico Morselli. This journal was promoted at the founding of the SIN in 1907.

Figure 1. The first issue of the Italian Journal of Neurological Sciences.

It wasn’t until the 1970s that the SIN created a journal directly affiliated with the society. It was created by Prof. Renato Boeri, scientific director of the Besta Neurological Institute, who actively participated in a restructuring movement within the SIN, becoming its secretary under Prof. Fabio Visentini, president.

That journal, called The Italian Journal of Neurological Sciences, would become the official journal of the SIN, and was open to the international neurology community. Although it was written in English, it also featured contributions from the Italian neurological community. It maintained similar standards to the main international journals and promoted a multidisciplinary vision.

Prof. Boeri, with the approval of the SIN committee, developed an agreement with publishing company Masson to publish the journal. The SIN maintained ownership of the journal and was free to decide the editorial strategies and choose the editor. The first issue was published in November 1979. (See Figure 1.)

Prof. Boeri was named editor-in-chief. Carlo Loeb, Paolo Pinelli, Giorgio Macchi, and Luigi Amaducci — all eminent authorities in the history of the SIN — were named associate editors. The advisory board was comprised of 30 neuroscientists and Italian professors of neurology. Thirteen representatives from Australia, Europe, and the United States served on the board. Many of these individuals were Italian neuroscientists working abroad.

The journal was published every three months from 1980 to 1986. Due to a growing number of articles, the number of issues per year increased to six (1986-2012) and later to nine (1992-1995). In 1996, the journal changed to a larger format. Its frequency was increased to monthly in 2013.

Figure 3. The updated cover and new management committee (2012).

In 1994, Prof. Giuliano Avanzini, a former collaborator with Prof. Boeri, was appointed editor-in-chief and some changes were made to the publication. At the end of 1997, the SIN board decided to change publishers, signing an agreement with Springer Italia, which resulted in a new cover design. (See Figure 2a.) In 2000, to present a clearer internationalization of the journal, the SIN and the editorial board decided to name it Neurological Sciences, eliminating The Italian Journal. (See Figure 2b.)

Prof. Antonio Federico took over as editor-in-chief at the end of 2011. In 2012, the journal editors opted to change colors and add a number of international scientists to the list of associate editors. (See Figure 3.)

Conclusions and Personal Considerations

It was an honor to serve as editor-in-chief of our journal, and to participate in its development over the years. My colleagues and I dedicated all our efforts to this job, promoting international and Italian clinical neurological and neuroscientific research through this journal. But we also saw the journal as a representation of the reputation of Italian neurology.

Neurological Sciences has been published for 47 years, and we hope for a fantastic future for it and for international scientific research in a world of peace and harmony. •

Prof. Antonio Federico is an emeritus professor of neurology at the University of Siena, past editor-in-chief of Neurological Sciences, and chair of the WFN Subspecialist Group on Rare Neurologic Diseases.

Table 1. The key aspects of the journal.

Content Types: original articles, short communications, reviews, editorials, and letters to the editor.

Focus Areas: a broad range of topics, including neuromuscular diseases, dementia, epilepsy, stroke, neuroimaging, and neurogenetics.

Special Sections: “History of Neurology” and “Neurological Digressions,” which covered cultural topics related to the neurosciences.

Topical Focus: topical collections by international guest editors on emerging themes including rare neurological disorders.

Review Articles

Special Editorials

The most relevant articles are open to free access via the web during Rare Diseases Days, Brain Weeks, and other occasions.

Table 2. Journal by the numbers.

In 2012, the journal received 917 articles. By August 2025, that number increased to 2,700 with a peak reached during the COVID-19 pandemic.

The journal accepted 280 articles in 2012 versus 480 in 2025.

There were 223,297 full text article downloads in 2012. That number rose to 850,000 in 2022 and 2.2 million in 2025.

The 2-year impact factor of the journal increased from 1.315 in 2011 to a peak of 3.8 in 2021. The journal saw a slight decrease to 3.3 in 2022 and 2.7 in 2023. It stabilized to 2.4 and 2.5 in 2024 and 2025, respectively.  

The number of articles submitted to Neurological Sciences, with acceptance and rejection rates (2017-2025).

 

The countries of origin for the main authors of submitted and accepted manuscripts in 2024.

‘My FIGHT With PD’

Author Blacker shares his story of living with Parkinson’s disease.

By Prof. Tissa Wijeratne

Tissa Wijeratne

In 2020, the World Federation of Neurology (WFN) launched World Brain Day with the theme of “Stop Parkinson’s Disease.” The first voice heard on the global webinar was that of Prof. David Blacker, who movingly shared his own story as a neurologist living with Parkinson’s disease (PD). That video captured the attention of thousands of people worldwide, and his new book, “My FIGHT With PD,” builds on that moment with honesty, science, and hope.

The book traces Blacker’s journey from leading stroke neurologist to person with PD. He recounts the subtle early signs, the long road to diagnosis, and the challenge of balancing professional identity with the realities of illness. Written with clarity and humility, it provides both clinical insight and a deeply personal perspective rarely seen in medical literature.

Photo courtesy of Leschenault Press and the Book Reality Experience.

Central to the narrative is the creation of FIGHT-PD (Feasibility of Instituting Graduated High-Intensity Training), a noncontact boxing program developed with former boxing champion Rai Fazio. Blending neuroscience, exercise science, and lived experience, this project shows how physical training can improve function and outlook for people with PD. Blacker’s role as both researcher and participant gives the story unusual depth.

The latter sections reveal his resilience in facing COVID-19, eye surgery, depression, and prostate cancer, while continuing to advocate for exercise, patient support, and new research directions, such as the link between pesticides and PD. He also shares practical lessons about living with PD, offering encouragement to both patients and clinicians.

“My FIGHT With PD” is more than a memoir. It is an invitation to rethink how we support people with Parkinson’s disease through science, community, and compassion. It echoes the goals of World Brain Day and the World Health Organization’s Intersectoral Global Action Plan (IGAP): better care, more research, and stronger advocacy for brain health worldwide. I will soon be inviting you all to join a webinar on this book with him. Watch World Neurology for more information. •

Prof. Tissa Wijeratne is a WFN elected trustee and chair of World Brain Day.

The Hidden Power of Niche Publications

From case reports to citations, niche publications provide relevant clinical knowledge.

By Masaru Tanaka and László Vécsei

László VécseI

Masaru Tanaka

Case reports, once relegated to the sidelines of medical publishing, are re-emerging as powerful vehicles of discovery and innovation. Their renewed relevance lies in the intersection of open access models, digital discoverability, and artificial intelligence (AI)-driven indexing, which collectively amplify their visibility and influence.

In neurology, a single patient’s presentation can unveil the earliest markers of novel syndromes, atypical drug responses, or rare comorbidities. By filling gaps that randomized trials often overlook, case reports serve as fertile niches of clinical knowledge, transforming isolated observations into signals that shape diagnostics, therapeutics, and even public health preparedness.

Many landmark breakthroughs in neurology first appeared in the form of case reports, acting as sparks for broader scientific exploration. Early descriptions of autoimmune encephalitis, novel epilepsy syndromes, and the neurological sequelae of COVID-19 exemplify how single observations can shift entire paradigms. These narratives not only refine diagnostic reasoning, but also provide fertile ground for therapeutic innovation, as seen with precision approaches guided by exome sequencing in rare neurodevelopmental disorders. By translating isolated clinical puzzles into structured knowledge, case reports create a scaffold for systematic studies, ultimately informing guidelines and accelerating the path from bedside insight to bedside intervention.

The digital era has given case reports unprecedented visibility, transforming them from isolated anecdotes into globally accessible clinical resources. Open-access publishing ensures that rare and novel cases, such as paraneoplastic syndromes linked to unusual antibodies, can be consulted by physicians anywhere without subscription barriers. AI and natural language processing further accelerate this accessibility, enabling even the most specific observations to surface instantly in searches and databases.

Beyond access, curated metadata and electronic case reporting systems enhance interoperability, creating structured knowledge that informs both bedside care and population-level surveillance. This democratization of information ensures no clinical insight is ever too small to spark discovery or therapeutic innovation.

For practicing neurologists, case reports serve as direct bridges from literature to bedside, offering insights that randomized trials often fail to capture. They illuminate atypical trajectories of common diseases, highlight red flags in complex diagnostic puzzles, and showcase therapeutic strategies tested in real-world contexts. A single report of an unusual drug reaction or a multidisciplinary approach to refractory neuropsychiatric symptoms can alter daily practice far more rapidly than large-scale studies.

By mirroring the heterogeneity and unpredictability of clinical reality, case reports provide neurologists with immediate, pragmatic guidance. They also nurture hypothesis generation, fostering innovation where evidence is scarce and ensuring that patient-centered problem solving remains central to neurological care.

Bibliometric analyses reveal that case reports are no longer peripheral but increasingly cited across reviews, guidelines, and even meta-analyses, reflecting a cultural and technological shift in their perceived value. In neurology, citation growth is particularly striking in rare disease, neuroimmunology, and neuroinfectious disease, where single observations often carry outsized weight.

Open-access platforms and powerful indexing tools ensure that a report on, for example, an unusual antibody-mediated encephalitis can rapidly inform both clinical reasoning and research agendas. Case-based reviews further amplify this trend, transforming individual narratives into collective evidence streams that directly shape diagnostic frameworks and therapeutic strategies in complex neurological care.

A well-crafted case report can transform a single patient’s story into a driver of global clinical progress. In neurology, documenting rare syndromes or unexpected therapeutic responses provides immediate lessons while shaping broader frameworks for diagnosis and care. These small stories catalyze recognition, spark innovation, and enable knowledge to cross borders, ultimately improving outcomes for patients everywhere. •

Disclosure: This article has been previously published in the Danube Neurology Newsletter and is republished here with permission.

Masaru Tanaka is a senior researcher at Danube Neuroscience Research Laboratory, HUN-REN-SZTE Neuroscience Research Group, Hungarian Research Network, and the University of Szeged, in Szeged, Hungary. László Vécsei is a professor of neurology and head of the Neuroscience Research Group in the Department of Neurology at Albert Szent-Györgyi Medical School, University of Szeged, in Szeged, Hungary.

References:

  1. Polunosika E, Pastare D, Karelis G, Vasylovska V. (2025). Development of anti-NMDA receptor encephalitis in a patient with multiple sclerosis. BMJ case reports, 18(5), e263945. https://doi.org/10.1136/bcr-2024-263945
  2. Nan D, Zhang Y, Han J, Jin T. (2021). Clinical features and management of coexisting anti-N-methyl-D-aspartate receptor encephalitis and myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis: a case report and review of the literature. Neurological sciences: official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 42(3), 847–855. https://doi.org/10.1007/s10072-020-04942-0
  3. Vasilevska V, Guest PC, Bernstein HG, Schroeter ML, Geis C, Steiner J. (2021). Molecular mimicry of NMDA receptors may contribute to neuropsychiatric symptoms in severe COVID-19 cases. Journal of neuroinflammation, 18(1), 245. https://doi.org/10.1186/s12974-021-02293-x
  4. McHattie A W, Coebergh J, Khan F, Morgante F. (2021). Palilalia as a prominent feature of anti-NMDA receptor encephalitis in a woman with COVID-19. Journal of neurology, 268(11), 3995–3997. https://doi.org/10.1007/s00415-021-10542-5
  5. Schneider J, Ye D, Hill AM, Whitehorn AS. (2020). Continued post-retraction citation of a fraudulent clinical trial report, 11 years after it was retracted for falsifying data. Scientometrics, 125(3), 2877-2913.
  6. Gupta SM, Naqvi WM, Mutkure KN, Varma A, Thakur S, Umate R. (2022). Bibliometric Analysis on Bibliometric Studies of Case Reports in the Medical Field. Cureus, 14(10), e29905. https://doi.org/10.7759/cureus.29905
  7. Büyükkıdık S. (2022). A bibliometric analysis: A tutorial for the bibliometrix package in R using IRT literature. Journal of Measurement and Evaluation in Education and Psychology, 13(3), 164-193.
  8. Tsekhmister Y. (2023). Effectiveness of case-based learning in medical and pharmacy education: A meta-analysis. Electronic Journal of General Medicine, 20(5).
  9. Sayre JW, Toklu HZ, Ye F, Mazza J, Yale S. (2017). Case Reports, Case Series — From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education. Cureus, 9(8), e1546. https://doi.org/10.7759/cureus.1546
  10. Battaglia S, Schmidt A, Hassel S, Tanaka M. (2023). Editorial: Case reports in neuroimaging and stimulation. Frontiers in psychiatry, 14, 1264669. https://doi.org/10.3389/fpsyt.2023.1264669

Prof. Mark Hallett, MD (1943-2025)

A legacy of science, service, and humanity that helped shape modern neurology.

By Prof. Tissa Wijeratne

Prof. Mark Hallett (center) receives the WFN Award for Contribution to Neurological Science at the XXIV World Congress of Neurology in Dubai. He is flanked by World Federation of Neurology President William Carroll (left) and American Academy of Neurology President James Stevens.

The global neurology community mourns the loss of Prof. Mark Hallett, MD, whose passing in 2025 marks the end of an era in movement disorders and motor control research. Born in 1943, Prof. Hallett became one of the most influential neurologists of his generation, shaping both the science and spirit of modern neurology.

Prof. Hallett’s academic journey, which began at Harvard Medical School, progressed through his formative years in London and culminated in his decades of leadership at the National Institute of Neurological Disorders and Stroke (NINDS), reflects an unwavering commitment to scientific discovery. As chief of the NINDS Human Motor Control Section, he laid much of the foundation for how we currently understand dystonia, tremor, functional movement disorders, and the physiology of voluntary movement.

Beyond his scientific achievements, Prof. Hallett was a true citizen of world neurology. He served as president of the International Parkinson and Movement Disorder Society, vice president of the American Academy of Neurology, and editor-in-chief of World Neurology, where his vision strengthened global dialogue and collaboration. His leadership helped build durable bridges across continents, particularly with Asia-Oceania and Australia, regions he supported with genuine respect and enthusiasm.

For many of us who met him as young neurologists, Prof. Hallett embodied mentorship at its best: generous with his time, patient in his guidance, and sincerely invested in our success. I remember countless conversations with him at the World Congress of Neurology (WCN) and Movement Disorder Society (MDS) meetings, moments of quiet encouragement that stayed with me. In our most recent discussion, he spoke warmly about visiting Sri Lanka, a journey he was looking forward to. Sadly, this visit will remain unrealized.

During the height of the COVID-19 crisis, I had the privilege of conducting an extended, hour-long discussion with Prof. Hallett via Zoom. We explored his scientific journey, his views on mentorship, his reflections as past editor-in-chief of World Neurology, and his hopes for the future of our discipline. This conversation now stands as a precious historical record of his voice, his warmth, and his vision for global neurology.

Prof. Hallett leaves a profound legacy: rigorous science, global leadership, and a rare human warmth that shaped generations. The World Federation of Neurology extends our deepest condolences to his family, friends, and colleagues around the world. His impact will endure in every clinic, laboratory, and community touched by his work. •

Prof. Tissa Wijeratne, OAM, MD, PhD, FRACP, is a trustee of the World Federation of Neurology.

World Brain Day 2025 in Jaffna, Sri Lanka

World Brain Day in Sri Lanka’s Northern Province featured speeches from leading medical personnel as well as healthy activities for attendees.

By Dr. Ajantha Keshavaraj

World Brain Day was celebrated with a major public health campaign in Sri Lanka’s Northern Province for the first time, marking a watershed moment in national efforts to promote “Brain Health for All Ages.” The event, hosted on May 25, 2025, in Jaffna, was organized by the Association of Sri Lankan Neurologists (ASN) in partnership with the Northern Stroke Awareness Campaign. Activities were closely aligned with the World Federation of Neurology (WFN) and the World Health Organization (WHO) Intersectoral Global Action Plan (IGAP) for neurological disorders.

The centerpiece of the celebration was a simultaneous Stroke Awareness Walk and Marathon Relay, attracting more than 600 participants. The event unified children, professional athletes, patients, health and education professionals, military and police personnel, and local communities in a powerful display of solidarity and commitment to preventive brain health.

The 2 km Stroke Awareness Walk featured individuals living with diabetes, cardiac disease, and stroke survivors. They were joined by hospital directors, health officials, and families. In parallel, a 27 km Marathon Relay brought together schoolchildren, university athletes, and professional runners from across the province. These physical  activities were not only symbolic but served to educate and empower communities to adopt healthier lifestyles, reducing the burden of stroke and other neurological disorders.

The event was further amplified by live national media coverage from Sri Lanka Broadcasting Corporation and Dan TV, ensuring broad visibility and public engagement. A press conference, jointly convened by the Ministries of Health and Education, underscored the power of intersectoral collaboration and set a precedent for unified action in health promotion.

Keynote speeches were delivered by Dr. Ajantha Keshavaraj, ASN president, Dr. T. Sathiyamoorthy, director of Teaching Hospital Jaffna, and Dr. Saman Pathirana, provincial director of Health Services. They addressed the burden of brain disorders in the region, highlighting conditions such as hemorrhagic stroke, Parkinson’s disease, and traumatic brain injury, especially in the wake of the COVID-19 pandemic. They called for urgent preventive and early intervention strategies.

This historic World Brain Day celebration in Jaffna has set a national benchmark. It is a compelling reminder that brain health is a shared responsibility, and such inclusive, community-driven events are essential to building health equity, resilience, and awareness across all regions of Sri Lanka. •

Dr. Ajantha Keshavaraj is president of the Association of Sri Lankan Neurologists (ASN).

WFN Targets Advocacy and Teaching in 2025

A preview of upcoming WFN projects and goals this year.

By Prof. Wolfgang Grisold

Welcome to the new edition of World Neurology, the newsletter of the World Federation of Neurology (WFN). Since the last issue, several projects have been announced and are forthcoming.

The deadline for applications for WFN trustee positions ended Feb. 14, 2025, and the Nominating Committee has listed the candidates for the positions of president, vice president, and one trustee. The list of nominees, short biographies, and statements from the candidates can be found in this issue as well as on the WFN website.

According to the bylaws, additional candidates supported by any of the five member societies can apply for any position until one month before the election. The election will be held virtually. The date and deadline will be announced on the WFN website. We look forward to interested and motivated candidates who will work for the WFN in the future. Traditionally, the trustees are not involved in the process of recommendation.

Individuals with experience in the tasks of the WFN will be welcomed to apply, and their expertise is needed. Information on the work of the WFN can be found on the WFN website, the WFN essentials page, and the newest Journal of the Neurological Sciences (JNS) Service Page.

The main WFN activities can be summarized by two letters: A and T. A is for advocacy and global activities, and T is for teaching and training.

Advocacy

Dr. Tedros Adhanom Ghebreyesus (left), director general of the WHO at the Geneva meeting 2025, pleading for more attention for emergency activities.

Advocacy for neurology is a growing part of the WFN’s activities. The importance of advocacy is implemented in the World Health Organization’s (WHO) Intersectoral Global Action Plan (IGAP). It is the core of WFN’s activities to communicate and work with the WHO and the U.N. Economic and Social Council (ECOSOC).

We need to increase the teaching of advocacy at all levels of health services. In addition to the WFN patient forums, we have a joint project with the American Academy of Neurology (AAN), the Global Advocacy Leadership Program (GALP), which will be presented for the first time this year at the AAN Annual Meeting, the World Congress of Neurology (WCN), and virtually.

The WHO’s brain health initiatives and the IGAP are supported by the WFN. The WFN community of neurologists considers the IGAP a unique opportunity to implement neurology in countries in need, to encourage all countries to invest in research and innovation, and to engage more in public health.

The U.N. ECOSOC is well defined by the 17 Sustainable Development Goals (SDGs). In particular, SDG 3 (good health and well-being) and SDG 5 (gender equality) are important for the WFN. Health is a central, but not the only, component of the work of the U.N. ECOSOC. We are appreciative that the U.N. ECOSOC will support this year’s World Brain Day (WBD) on brain health.

The GALP is a unique project of the WFN and AAN to increase awareness of the need for advocacy and to teach both advocacy and leadership skills. The course has many elements of the successful AAN Palatucci Advocacy Leadership courses and will add several topics of global relevance.

Twenty people from low-middle and low-income countries were selected from 100 applicants and will be fully supported to attend. After a face-to-face meeting, which took place at the AAN Annual Meeting in April in San Diego, the participants will attend a series of five virtual meetings and a final meeting and graduation at the World Congress of Neurology in October in Seoul, South Korea. Also, both the AAN and the WFN will waive the congress fees, so that participants may attend both meetings.

Prof. El Alaoui (left) studies the recognition certificate for the Training Center in Rabat during the WFN site visit. Prof. Nahzda Birouk (center), incoming Training Center chair, looks on with Prof. Wolfgang Grisold, WFN president.

Teaching

The educational activities of the WFN have included a visit to all Training Centers in Africa. A visit to Mexico City is planned for this year. In addition to the numerous reports, the African Training Centers received an analysis summary of the site visits, and we hope to continue this important activity.

The financial burden of the Training Centers is almost entirely on the WFN, although we have help from the Association of British Neurologists (ABN) for the Training Center in Cairo, and our successful Specialty Group at the International Congress on Neuromuscular Diseases regularly supports a large number of trainees in Rabat on electrophysiologic and neuromuscular training.

In related news, Prof. Nahzda Birouk will take over responsibilities from Prof. El Alaoui as chair of the Training Center in Rabat. We thank Prof. El Alaoui for his longstanding support and merits from the WFN.

Watching the results from the EMG machine during the WFN site visit in Rabat.

There are three four-year trainees in Africa and five one-year fellowships in Africa (general neurology, neuromuscular, epilepsy, and stroke). In Mexico City, we have a one-year fellowship on stroke. This is a large number for the WFN, but only a small crystal to offer for the 1.4 billion inhabitants on the African and Central and South American continents. However, crystals grow at various speeds, from minutes to many years.

Over the last 10 years, the North African centers, along with Senegal and Cape Town, have trained additional people. Several African universities are also poised to take up neurology training. This emphasizes the need for, and the increasing efforts of, training in Africa for Africans. “Empower the regions” is not just a concept; it is producing powerful teaching instruments, which will have long and enduring effects.

Cynthia Marleny Aliñado Ramos, the present WFN trainee, at the Training Center in Mexico City.

The increase in the number of neurologists is hoped to be exponential. This is only the peak of a needs pyramid, requiring other health care professionals, structures such as labs, imaging, testing, and inpatient and outpatient facilities, and access for all in need.

Although trained neurologists are forming the top level of that pyramid, there is also the model of the inverted pyramid, which on its large base has the most frequent and most important content. Seeing and appreciating the large needs for neurology, our effort must be directed toward implementing neurological care and knowledge into primary care. Increasing awareness of the most frequent neurological symptoms and signs, as well as the most frequent neurological diseases, will be important.

Education Days

Figure 1: Word bubble from the participants of the AOAN Education Day with requests for future topics.

Education and teaching have been successfully achieved with the most recent Education Day, held jointly with WFN, the Asian and Oceanian Association of Neurology (AOAN), and the Movement Disorders Society (MDS). The quality of the course was excellent, and the topics were of worldwide importance. We had a record number of registrants, and more than 1,000 participants. We will continue to partner with AOAN on more Education Days in the future.

The past series of Education Days, which were held over several years with the International Headache Society (IHS) and the Global Patient Advocacy Coalition (GPAC) were also successful. The most recent African Education Day on neuropathies was held in 2024. The preparation, organization, and financing of these events is an important task of the WFN, which needs strong cooperating partners.

World Brain Day (WBD)

World Brain Day 2025 will feature the topic of brain health, which seems to be attracting attention worldwide. The full wording of this year’s theme is “Brain Health for All Ages.” This wording concurs with the United Nations SDG3 (good health and well-being) and is a fundamental part of healthy living. It will increase attention toward disease groups in different age groups and regions.

There is also a great divide between communicable and noncommunicable diseases (NCDs). Despite the global increase of NCDs, infections worldwide still present a challenge, which is often underestimated. The lessons from the COVID-19 pandemic concern all of us, and we can see that the WHO prepares and invests in emergency structures for the future.

World Congress of Neurology (WCN)

A successful Coffee Talk at the WCN 2023 in Montreal. Left to right: Ashley Logan (moderator), WFN President Prof. Wolfgang Grisold, with WFN past presidents Prof. Vladimir Hachinski, Prof. Bill Carroll, and Prof. Raad Shakir.

WCN 2025 will take place Oct. 12-15 in Seoul, South Korea. We are grateful to the Korean Neurological Association (KNA) and to the region for supporting this important showcase for neurology in Asia.

Asia is large in geography and population, and access to neurology varies in many countries. The WCN is not only intended to discuss developments and updates, but will also have a series of brain health topics, including plenary lectures, dedicated global lectures, and regional lectures. These topics are dedicated to global health, indicating the important role for neurologists to increase and add to their activities.

The WCN will also have five plenary lectures, with topics ranging from the importance of the WHO to advances in the concept of senescence. Several joint sessions are planned with world neurological societies such as the WHO, MDS, International League Against Epilepsy (ILAE), and the Peripheral Nerve Society (PNS).

A look at the future stage for Coffee Talks at the WCN 2025 in Seoul.

Much attention is dedicated to the Teaching Course program. Similar to the WCN in Montreal, we will expand our interactive programs, which will be a series of “coffee talks.” We will also feature a program on Continuum, and include young neurologists from the region. We will continue the concept of a hybrid meeting as the participation in the hybrid form was great, and we had a reach of 135 countries. Costs for hybrid attendance will be kept low to allow participants from low-middle and low-income countries to participate.

There will be social programs and opportunities to network and sightsee in Seoul.

Publications

It is the determination of the WFN to be heard in as many forms of publication as possible. The WFN website provides information on the structure and substance of the WFN. It is also used for news and information distribution. This is supported by our social media feeds, where the WFN teams post information.

World Neurology is the active newsletter, collecting articles worldwide. It is free to download and also offers access to the World Neurology archive. The official journal of the WFN is the Journal of the Neurological Sciences (JNS), with John England as the editor-in-chief, and the eNS with Walter Struhal as the editor-in-chief.

For the JNS, we are adding quarterly Service Pages, and the eNS now has 10 articles from the WFN Digital Update (WNU) course available as open access.

We are working on a collective book on neurology called the White Book of Neurology. It will be edited by Prof. Alla Guekht, Steven Lewis, Prof. Riadh Gouider, and myself, and will be published by Springer. The idea is to delineate and describe the present structure of neurology, from the historical development toward the future.

Monthly Google Analysis

The monthly Google analysis shows an increase in followers and interested colleagues and parties. We want to thank our constantly leading countries — the U.S., India, and Great Britain — for their interest. •

The Brain House at Davos 2025

Advancing brain health and economic resilience.

Prof. Freedman attended this meeting on behalf of the WFN.

By Morris Freedman

(Left to right): Prof. Morris Freedman, George Vradenburg, and Dr. Alfred Njamnshi.

The launch of the Brain House was held in conjunction with the World Economic Forum in January 2025 in Davos, Switzerland. It was hosted by the Davos Alzheimer’s Collaborative (DAC) under the leadership of George Vradenburg, chair of the DAC and founder of Brain House. Co-organized by Harris Eyre, who leads the Baker Institute Neuro-Policy Program at Rice University, Brain House served as a global platform to highlight the critical link between brain health and economic growth. I attended on behalf of the World Federation of Neurology (WFN) as a trustee and treasurer.

Brain health is a key priority for the WFN, as demonstrated by its strong global engagement and advocacy efforts. Over the past four years, the WFN has dedicated consecutive World Brain Day campaigns to the theme of brain health, highlighting its critical role in overall well-being. These initiatives have focused on brain health for all, prevention, and disability, with this year’s theme being “Brain Health for All Ages.” Through international collaboration, communication, and knowledge exchange, the WFN continues to promote brain health as a global concern, aligning with initiatives such as the Brain House at Davos to further drive awareness and action.

The event featured six expert-led sessions, bringing together stakeholders from diverse sectors — including funders, policymakers, industry leaders, nongovernment organizations (NGOs), and foundations — to discuss strategies for enhancing brain health and driving systemic change on a global scale. The Brain House aimed to build a global coalition to lead transformative efforts, explore the intersections between brain health and economic resilience, and mobilize resources and innovation to address shared challenges. Throughout the discussions, the role of partnerships and research in achieving these goals was emphasized.

Much of the discussion centered on prevention and early detection of cognitive impairment. However, during one of the discussion periods, I had the opportunity to emphasize that brain health encompasses the full spectrum of cognitive function — from normal cognition to severe dementia — with the goal of maximizing function at all stages. Thus, we must include individuals who are beyond the stage of prevention and early detection (i.e., those who already suffer from dementia) in our efforts to promote brain health worldwide.

Brain Capital and the Brain Economy

A recurring theme throughout the conference was the concept of brain capital, a form of human capital that integrates brain health with essential cognitive, emotional, and social skills, including analytical thinking, creativity, adaptability, and empathy. Closely related is the concept of the brain economy, an economic paradigm that positions brain capital as a core asset. This model, driven by advances in neuroscience, responds to the increasing demand for cognitive, emotional, and social brain skills in the modern workforce.1,2

(Left to right): Dr. Zul Merali, Dr. Harris Eyre, Dr. Alfred Njamnshi, and Dr. Morris Freedman.

Key Sessions

Session 1 | A Life Course Approach to Brain Health for the Future

This session explored how employers, consumers, governments, and investors can foster innovation across sectors and societies, promoting best practices and actionable models for progress. Dr. Catharina Boehme, assistant director-general of the World Health Organization (WHO), opened the panel discussion by presenting a report prepared by WHO Director-General Dr. Tedros Adhanom Ghebreyesus.

The report underscored the global challenge posed by aging populations, with over three billion people affected by neurological diseases. Given that nearly 50% of dementia cases are attributable to known modifiable risk factors, the report advocated for a life course approach to dementia prevention. Key recommendations included promoting maternal health, good nutrition, quality health care access, early education, and nurturing environments. It also emphasized the importance of a healthy workplace, access to mental health services, physical activity, social interaction, and managing risk factors such as hypertension and diabetes.

The report also outlined the WHO’s priorities, urging policymakers, industry leaders, health care providers, and innovators to champion brain health, educate communities on its significance, and foster lifelong learning and social connections.

Session 2 | Fueling Brain Health: The Innovation and Investment Imperative

The discussion emphasized the urgent need for innovation and investment in brain health to drive sustainable progress. Experts highlighted the importance of collaboration and the opportunity to leverage the convergence of emerging technologies.

Session 3 | Unlocking Global South Potential: Building Economic Resilience Through Brain Health

This session explored how brain health can strengthen economic resilience in the Global South, with a focus on Africa. Zul Merali, founding director of the Mind and Brain Institute at Aga Khan University, highlighted that Africa’s older population is growing rapidly and is expected to become one of the largest aging populations in the world.

Session 4 | Brain Resilience Strategies for Emerging Global Challenges

Panelists discussed strategies to enhance brain resilience in response to global challenges, including an aging population. They highlighted that most dementia cases over the next 50 years will arise in regions such as Africa, the Middle East, and Asia. The discussion also underscored the importance of implementing brain resilience strategies early in life to maximize their effectiveness.

Session 5 | Brain Capital: Unlocking Workforce Resilience and Long-Term Economic Growth

This session emphasized the vital role of brain capital in fostering workforce resilience and long-term economic growth. The discussion underscored the growing importance of investing in brain capital amid evolving global trends, including an aging population, shifts in the nature of work, the rising burden of neurological disorders, and an increasing understanding of early brain development.

Session 6 | Setting a Yearlong Course of Action: Launching a Global Brain Health Movement

As chair of this final session, George Vradenburg, chair and co-founder of UsAgainstAlzheimer’s, emphasized the pressing challenges posed by aging demographics and the rapid rise of chronic diseases associated with aging. He highlighted the economic burden of these conditions, projecting that associated costs will triple within the next 25 years.

Vradenburg also underscored the shrinking workforce due to declining birth rates and stressed the need to enhance brain resilience to improve productivity. He advocated for a strong focus on the Global South, where population growth will drive much of the world’s future economic expansion. He further emphasized the importance of integrating technology into brain health solutions in ways that are accessible and applicable in resource-limited settings.

Drawing a parallel to the global response to COVID-19, Vradenburg called for similar energy and commitment in tackling the pandemic of brain disorders.

Claudio Bassetti, past president of the European Academy of Neurology and vice chair of the European Brain Council, was another panelist during this final session. He indicated that next steps for advancing the goals of the Brain House include partnerships, a holistic approach, and setting priorities.

Watch videos of the sessions.

Conclusion

The Brain House served as a pivotal platform to underscore the indispensable link between brain health and economic security. By bringing together leaders from government, health care, academia, business, and advocacy, the event facilitated interdisciplinary discussions to shape comprehensive strategies for improving brain health globally. •

Prof. Morris Friedman is treasurer of the WFN.

References:

  1. Eyre HA, Ayadi R, Ellsworth W, et al. Building brain capital. Neuron 2021;109:1430-1432.
  2. Smith E, Ali D, Wilkerson B, et al. A Brain Capital Grand Strategy: Toward Economic Reimagination. Molecular Psychiatry 2021;26:3-22.

Brain Health Is Brain Wealth

Greater productivity, resilience, and well-being at the 2025 World Economic Forum.

Disclaimer: We thank Prof. Njamnshi and his co-authors for this report and detailed plans for future directions. This article represents the opinions of the authors and does not represent an official report of the WFN.

By Alfred K. Njamnshi, Harris A. Eyre, Zul Merali, Frédéric Destrebecq, Kristina Adorjan, and Claudio L. A. Bassetti

The launch of the Yaoundé Declaration on World Brain Day 2024 by SCAN, BRAIN, and the Technical Scientific Committee.

It has taken some time, but we have finally recognized that the brain is not only the most vital organ in the body — since anencephaly is incompatible with life — but that it is the seat of who we are as humans. What we do, feel, believe, aspire, and hope for, including a better socio-economic paradigm, is governed by the brain. Indeed, our brains carry the footprint of our past, present, and future, defining both our heritage and our legacy.

The officiating personalities with some members of the Cameroon government present at the endorsement ceremony for the Yaoundé Declaration.

Since the inaugural World Brain Day (WBD) on July 22, 2014, the World Federation of Neurology (WFN) has been celebrating the brain each year to raise global awareness about its vital importance.1 The celebration of WBD has been expanded in some parts of the world to a full week of activities focused on the brain. Brain Week in Cameroon and Africa (BWCA)2,3 by the Society of Cameroonian Neurologists (SCAN) and Brain Research Africa Initiative (BRAIN) is one example.

As part of the BWCA, the first “African high-level science summit on the brain economy, brain health, and brain capital” was organized on July 22 and Aug. 22, 2024, and the resulting Yaoundé Declaration on the brain economy, brain health, and brain capital was launched on World Brain Day 2024. The deliberate choice of this date for this official launch was to align with the vision of the WFN to further celebrate the brain and mobilize more stakeholders and partners around the world to do the same. The Yaoundé Declaration, the Swiss Brain Plan, and other regional and national initiatives have since been discussed at multiple meetings. These include:

The World Economic Forum (WEF) is held annually in Davos, Switzerland, with a mission to “bring together government, businesses, and civil society to improve the state of the world.” One of the standout innovations of the WEF this year was the launch of the Brain House, a groundbreaking concept introduced by the Davos Alzheimer’s Collaborative (DAC), under the leadership of George Vrandenburg.

The endorsement of the Yaoundé Declaration by the Cameroon Government on Aug. 22, 2024 (left to right): Messi Atangana Luc, mayor of Yaoundé City, Prof. A.K. Njamnshi, Naseri Paul Bea, governor of the Center Region of Cameroon, Prime Minister Dr. Joseph Dion Ngute, Prof. J. Fame Ndongo, minister of higher education, Prof. R.M. Etoua, rector, Yaoundé I University, and Prof. S.B. Chumbow, president of the Cameroon Academy of Sciences.

As to the connection between our brains and economic growth, health, and well-being, the DAC report states:

“At this year’s Davos gathering, DAC introduced the first-ever Brain House to spotlight the vital link between brain health and global challenges. Kicking off with an inspiring reception Monday evening, the event continued Tuesday with two standing-room-only panels on Life course and Investment…The history of economic growth is defined by breakthroughs that led to previously unimaginable productivity. From the steam engine that kicked off the Industrial Revolution to the transformation AI is driving today, key breakthroughs are constantly reshaping our world. We believe the next key breakthrough isn’t a tool, process, or technology. We believe it already exists in all of us — our brains. We believe by better understanding our brains, and by extension our motivations, needs, and natures, we’ll unlock the next great breakthrough. The Brain House exists to expand this pursuit beyond the halls of academia and medicine and center it in the world of capital markets and innovation needed to create a healthier, more resilient, and a more productive future.”

With this background, it is easy to understand why a Forbes article captured the spirit of Davos 2025 in these words: “Brain Health Emerges as Top Priority at Davos.” In the next paragraphs, we will attempt to summarize the main themes and highlights of the three-day experience at the Brain House in Davos WEF 2025. We will hopefully convey the urgent need for neurologists to engage and connect with other stakeholders, as we all seek “to foster neurology and brain health worldwide,” according to the WFN mission statement.

Day One

Participants at DAC Brain House launch at 2025 World Economic Forum in Davos, Switzerland. (Left to right): Prof. Zul Merali of the Brain & Mind Institute, Dr. Harris Eyre of the Brain Capital Alliance, Prof. Alfred K. Njamnshi, Prof. Morris Freedman, WFN representative, and Dr. Frederic Destrebecq of the European Brain Council.

One of the major highlights of day one of the DAC Brain House on Jan. 21, was the keynote speech written by Dr. Tedros Adhanom Ghebreyesus, World Health Organization (WHO) director general, and delivered by Dr. Catharina Boehme, WHO assistant director general:

“…prioritizing brain health for ourselves, for our families, and our communities across the life course, we can build a healthier, more resilient society for generations to come…Investing in brain health is critical to individual well-being as well as to the sustainable development of all humans…our one brain is the source of creativity, resilience, and human relationships.”

This speech opened the panel presentation and discussion titled “A Life Course Approach to Brain Health for the Future.” This perspective from a major WFN partner organization, especially given the recent adoption of the WHO Intersectoral Global Action Plan (IGAP), aligns with the WFN mission.

The second panel discussion of the day focused on “Fueling Brain Health: The Innovation and Investment Imperative.” It became evident that the brain health sector has not only emerged as a critical area for innovation, it is being recognized as a major sector for investments aimed at better productivity and well-being. This recognition will continue if current challenges are addressed.

Day Two

(Left to right): George Vradenburg, Lucy Pérez, Cara Altimus, Christa Studzinski, Claudio Bassetti, and Harris Eyre.

On day two, Jan. 22, the panel discussions focused on two themes.

The first panel was titled “Unlocking Global South Potential: Building Economic Resilience Through Brain Health.” The panelists represented esteemed organizations such as the WHO Foundation, Institute for Health Metrics and Evaluation, Wellcome Trust, and the Aga Khan University Brain and Mind Institute. They shared their insights on the future of brain health in the Global South, with a particular focus on Africa.

Africa is innovating in cheap, effective, and scalable solutions to brain health problems. One such solution is the Friendship Bench — a community-driven approach to mental health care originally developed and scientifically tested in Zimbabwe. This approach has been adapted by several countries around the world, including the Jordan, Kenya, Malawi, United States, Vietnam, and Zanzibar.

The audience for “A Life-Course Approach to Brain Health for the Future.”

Zul Merali presented the concept of “brainectome” as a consortium to address brain health issues across Africa. Prof. Alfred K. Njamnshi emphasized that the upcoming G20 Summit in South Africa later this year would provide an excellent opportunity for the summit leaders to be convinced to buy into and invest in brain health for the socio-economic development and well-being of Africa and the Global South in general. This would bring the region into alignment with the Yaoundé Declaration.

The issue of brain drain from the Global South was also discussed in the context of a new brain economy, which should be more brain positive, ensuring more diversity and less disparity. One favorite quote of the day by Byron Bitanihirwe from the Science for Africa Foundation was, “True progress lies in the Global North learning from the Global South’s experiences and innovations.”

In the second panel discussion of the day, “Brain Resilience Strategies that Address Emerging Global Challenges,” there was a lot to learn from experts in venture capital, neuroscience, neurotechnology, and academia. There was encouraging news about venture capital mechanisms and state governments investing significantly in university institutions in Houston and Rice (U.S.) for the development of neuroscience, neurotechnologies, and neuropolicies. These are expected to address the emerging global challenges and promote brain resilience.

Day Three

Panelists at the session titled “A Life-Course Approach to Brain Health for the Future.”

The third and last day, Jan. 23, was devoted to two conversations. The first was titled, “Brain Capital: Unlocking Workforce Resilience and Long-Term Economic Growth.”

Brain capital, simply put, is brain health plus brain skills. Some have qualified these as “soft” skills, including creativity, adaptability, emotional intelligence, and analytical and systems thinking.

The Brain Capital Dashboard defines it as: “a complex and productive stock composed of multidimensional factors that accumulate over the lifecycle. We consider brain capital as a multidimensional set of factors varying from physical to socio-cultural ones, enabling the brain to remain healthy, to develop, and to avoid deterioration.” It identifies key drivers of brain health (i.e. neurological and mental health), including food and nutritional security, lack of parental health care and general health services, the natural and cultural environments, and education.

Panelists at the session titled “Brain Resilience Strategies That Address Emerging Global Challenges.” (Left to right): George Vradenburg, Lucy Pérez, Cara Altimus, Christa Studzinski, and Claudio Bassetti.

The conversations on this theme at the Brain House focused on how employers and organizations can prioritize brain health and provide a workplace environment and culture that promotes brain health and the development of brain skills. That environment will, in turn, lead to better productivity while mitigating work-related stress, burnout, and depression. In that respect, lessons from the COVID-19 pandemic should not be forgotten or ignored.

This approach of unlocking work-force resilience and providing a brain-healthy environment for employers to continue to sharpen their brain capital would result in long-term economic growth and greater well-being. We have proposed ways of understanding the economy through neuroscience and how to transit into a more brain-healthy economy and build brain capital.7,8,9,10

The final event of the historical week was a vibrant roundtable, “Setting a Yearlong Course of Action,” moderated by George Vradenburg with interventions from Lucy Pérez, senior partner at McKinsey, Christa Studzinski of the Ontario Brain Institute, Caral Altimus of the Milken Institute, and Claudio Bassetti of the Swiss Brain Health Plan and the European Brain Council.

Panelists for the session titled “Brain Capital: Unlocking Workforce Resilience and Long-Term Economic Growth.” (Left to Right): Lucy Pérez, Tim Lash, Sheri Bronstein, Patrick Kennedy, and Steve Clemons.

The participants discussed the key actions necessary in the next 12 months to accelerate the ascension of the brain health agenda into major global conversations. These include the G7 in Canada (June 2025) and G20 Summit in South Africa later this year.

The following statements illustrate the ambiance of the day and indeed of the whole experience of the Brain House at Davos 2025:

  • Lucy Pérez, McKinsey Health Institute: “Public private partnerships are the key to aligning on our collective aspiration and driving systems change.”
  • Claudio Bassetti, EBC-vice president and chair of the Swiss Brain Health Plan: “One brain, one life, one approach: We need to join forces to make brain matters a public health priorities.”
  • Amy Kennedy, The Kennedy Forum: “Businesses introduced STEM into schools by highlighting the skills they needed. Now, it’s time for businesses to tell the education system that we need to invest in developing brain skills from an early age.”
  • Andy Moose, World Economic Forum: “Collaborative innovation is the theme this year and coming together physically and virtually under this common umbrella is critical. This allows us to do the work together to catalyze funding and find solutions.”
  • Sheri Bronstein, Bank of America: “Our health care costs amount to $2 billion. Every quarter, our CFO asks, ‘What are we doing about this?’ That’s why we prioritize brain health — it directly impacts our bottom line.”

In Conclusion

The three-day experience of the DAC Brain House provided everyone with a valuable opportunity to connect with business professionals, learn from their insights, and ultimately discover their genuine concern for our well-being and brain health. As neurologists, neuroscientists, and psychiatrists, we are focused on diagnosing and treating people with brain (neuropsychiatric) diseases and helping populations to have healthy brains as much as we can. We often are limited by the scarcity of resources, especially in the lower- and lower-middle income countries, and are devastated by the waste of resources in some high-income countries.

This three-day interaction with policy and lawmakers, business strategists, economic investors, communicators, innovators, academics, and civil society enabled us to understand the complexities as well as the commonalities that can be leveraged to get the brain health movement to the next gear. •

Alfred K. Njamnshi, MD, FRCP, is the World Federation of Neurology delegate for Cameroon, a member of the Society of Cameroonian Neurologists (SCAN), a convener of the 2024 Brain Research Africa Initiative (BRAIN), and serves in the Neuroscience Lab in the Faculty of Medicine & Biomedical Sciences at the University of Yaoundé I, in Cameroon. Harris A. Eyre, MBBS, PhD, is a Harry Z. Yan and Weiman Gao senior fellow in brain health and lead of the Rice University’s Baker Institute Neuropolicy Program at the Center for Health and Biosciences, a visiting senior fellow at the Wharton Neuroscience Initiative at the Wharton School, University of Pennsylvania in Philadelphia, and founder and director of Brain Capital Alliance. Zul Merali, PhD, is founding director of the Brain and Mind Institute at Aga Kan University in Nairobi, Kenya. Frédéric Destrebecq, PhD, is executive director of the European Brain Council in Brussels, Belgium. Kristina Adorjan, MD, is on the Board of Directors for the Swiss Brain Health Plan and serves on the faculty of medicine at the University of Bern, Switzerland. Claudio L. A. Bassetti, MD, is chair of the Swiss Brain Health Plan and dean of the Faculty of Medicine at the University of Bern, vice president of the European Brain Council, and past president of the European Academy of Neurology. •

References:

  1. https://wfneurology.org/world-brain-day-2014.
  2. Njamnshi AK; Migraine in Cameroon: From the Painful Truth to the Powerful Tribute. World Neurology, September 11, 2019; https://worldneurologyonline.com/article/migraine-in-cameroon-from-the-painful-truth-to-the-powerful-tribute/.
  3. Njamnshi AK, Ngarka L, Njamnshi WY, Ahidjo N, Chabwine JN, Hachinski V; BRAIN-SCAN Congress 1.5 Scientific Committee and Organising Secretariat. The Brain Research Africa Initiative (BRAIN). Lancet Neurol. 2023 Jun;22(6):467-468. doi: 10.1016/S1474-4422(23)00164-3. PMID: 37210092.
  4. Njamnshi AK, Fame Ndongo J, et al. African Leadership in Brain Diplomacy: The Yaoundé Declaration Advances the Global Brain Economy Playbook for Better Brain Health. Neuroscience 2024 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5018989.
  5. Bassetti CLA, Heldner MR, Adorjan K, et al. The Swiss Brain Health Plan 2023-2033. Clin Translat Neurosci 2023; 7: 38: https://doi.org/10.3390/ctn7040038.
  6. Bègue I, Flauhaut A, Bolon I, Vicedo A.M., Bassetti CLA. One brian, one mind, one helath, one planet: A call from Switzerland for a systemic approach in brain health research, policy and practice. Lancet Public Health 2025; 50: 101229.
  7. Harris A. Eyre, Jennie Z. Young, Julian Karaguesian, Alfred Njamnshi, et al. The Brain Advantage for a Thriving Economy: A Global Call to Action. https://sciencepolicy.ca/posts/the-brain-advantage-for-a-thriving-economy-a-global-call-to-action/ (Preparatory Workshop to the G7 Summit in June 2025).
  8. Eyre HA, Hynes W, Ayadi R, Swieboda P, Berk M, Ibanez A, Castelló ME, Jeste DV, Tempest M, Abdullah JM, O’Brien K, Carnevale S, Njamnshi AK, Martino M, Mannix D, Maestri K, Yu R, Chen S, Ng CH, Volmink HC, Ahuja R, Destrebecq F, Vradenburg G, Schmied A, Manes F, Platt ML. The Brain Economy: Advancing Brain Science to Better Understand the Modern Economy. Malays J Med Sci. 2024 Feb;31(1):1-13. doi: 10.21315/mjms2024.31.1.1. Epub 2024 Jan 15. PMID: 38456111; PMCID: PMC10917588.
  9. Olivia Nail-Beatty, Agustin Ibanez, Rym Ayadi, Pawel Swieboda, Alfred K. Njamnshi, Jo-An Occhipinti, et al. Eyre Brain health is essential for smooth economic transitions: toward socio-economic sustainability, productivity, and wellbeing. Brain Communications, 2024 Oct 30;6(6):fcae360. doi: 10.1093/braincomms/fcae360. PMID: 39670109; PMCID: PMC11635447, https://doi.org/10.1093/braincomms/fcae360.
  10. Eyre HA, Graham C, Njamnshi AK and Vradenburg G. 4 Ways to make our economy brain healthy. The Brookings Policy Paper Series; 2024 https://www.brookings.edu/articles/4-ways-to-make-our-economy-brain-healthy/.

Candidate Statement for WFN Elected Trustee: Chandrashekhar Meshram

Meshram

I am grateful to the Indian Academy of Neurology and the World Federation of Neurology (WFN) for considering me worthy for the position of elected trustee.

I am indebted to WFN for giving me the opportunity to serve as co-opted trustee, elected trustee, and president of the Tropical and Geographical Neurology Specialty Group (TGNSG). In these roles, I have contributed to the mission of WFN: fostering quality neurology and brain health worldwide. Through TGNSG, I organized 16 webinar sessions on neuro-infections and gave opportunity to trainees from different regions of the world to sharpen their clinical skills. The series “Inspiring People in Neurosciences” was a step in the same direction.

I contribute timely updates for the “Spotlight on COVID and Current Global Neuro-Infections” blog on the WFN website. I was instrumental in starting the WFN Department Visit program in India. In 2024, the president of India conferred on me Padma Shri, one of the highest civilian honors in India.

I have served as a member of the Constitution and Bylaws and Scientific Program Committees. I am a member of the Infectious disease panel of the European Academy of Neurology. I am section editor of the Encyclopedia of Neurological Sciences and assistant editor of eNeurologicalSci.

World Brain Day is the most eminent public awareness initiative of WFN. As part of that initiative, I organize public education campaigns throughout the year. I have published about 500 articles for public education, including several in World Neurology.

WFN is making every attempt to take care of inequality in neurology care and education worldwide, and I am committed to addressing it. Collaboration with WHO and other societies is important for brain health. My passion to work for the WFN is the main reason I am standing for the post of elected trustee. I would be grateful for your support. •

The Use of Telemedicine Devices and Telehealth in Neuromuscular Disease

The expansion of telemedicine use in NMDs and development of clinically relevant but easy-to-use remote monitoring systems has potential to improve patient access to expert care.

M. S. Damian, MD, FEAN, FNCS, and Prof. P. Laforet, MD, PhD

Patients with neuromuscular disorders (NMDs) have diverse and complex care requirements, typically served by highly specialized centers. However, these may be geographically remote, and the COVID-19 pandemic underlined the system’s fragility by leading to widespread suspension of diagnostic, support, and rehabilitative services.1 Cancelled routine visits and limited outreach resulted in morbidity and even deaths. The demand for telehealth and remote care to help resolve this situation increased. This article describes the concept and current options using telemedicine in the care of people with NMDs.

Telemedicine in NMD at the Onset of the COVID-19 Pandemic

Prior to COVID-19, telemedicine was mainly used to overcome geographical challenges in thinly populated or resource-poor regions, or for monitoring patients with impaired mobility at home. Small case series suggested efficacy and economic advantages by reducing hospitalization. Zamarron et al. demonstrated the long-term feasibility of telemonitoring with video consultations plus Sp02, BP, ECG, overnight oximetry in home-ventilated patients via a residential internet gateway with alarm system and monthly outreach nurse check-ups.2 Challenges included changes in the patient-carer relationship, and difficulty procuring individually adapted systems.

COVID-19 forced a hasty rethink of this position. Guidon and Amato discussed neuromuscular telemedicine consultation by phone or videolink.3 They perceived high potential for follow-up in myopathy, myasthenia gravis (MG), and polyneuropathy when stable, or for management of pain; moderate utility for new or unstable neuromuscular disorders, but low utility where there were discrepant symptom findings, for second opinions, and for primary management of unstable patients. Face-to-face clinics remained mandatory where electrodiagnostic studies and muscle and nerve biopsies were urgently needed, and where the results would change management, as in new onset amyotrophic lateral sclerosis (ALS), MG, and immune-mediated neuropathy or myopathy.

New scores and protocols may mitigate these shortcomings: Garibaldi et al. developed functional scores for myopathies and neuropathies (the Myo-FRS and N-FRS), taking reference to older disease-specific scores such as the MG-ADL for myasthenia gravis, and the ALSFR-R for amyotrophic lateral sclerosis.4 Ricciardi et al. suggested a protocol for remote clinical testing in MG, featuring:

  • Counting aloud test in one breath (CAT)
  • Hoarseness test (voice change with high-pitched vocalization)
  • Head-up test (10s head flexion from supine)
  • Swallowing test (3oz = 90ml water swallow)5

Other approaches included the Veteran Affairs Neuropathy Scale, which Wilson et al. piloted in telemedicine clinics6 and teleswallowing, a remote swallow assessment.7 This work provides a toolkit to perform a detailed clinical assessment, remotely via videolink. Purely audio remote interviews are more limited. Significant technical challenges for remote clinics remain regarding the availability of monitoring devices, broadband speed, audio-visual quality, internet lagtime for timed tests (10m walk, Timed-up and Go-test), users’ technical expertise, and computer literacy. To improve this, protocols to perform a video NMD clinic have been published.8,9 Videoconferencing platforms have been evaluated,10,11,12 and video platforms are available in a number of commercial patient management systems. Overall, the use of telemedicine in NMDs increased during the COVID-19 pandemic, but telemonitoring was used considerably less.13

Telemonitoring found its first application in clinical trials to optimize remote clinical assessment, but also to improve trial recruitment and monitoring. Reliability and strong correlations between wearable physical activity monitors (sensor-based systems using activity watches or body-worn sensors, PAMs) and neuromuscular measures confirmed PAMs’ utility as outcome measures and in long term monitoring.14 Mobility data can be gathered by PAMs, or by ambient measurement systems (AMS), which passively measures movement such as ambulation speed, rise-to-stand speed, and arm-raise speed when someone is in range of a sensor.

Remote monitoring of life-supporting technology, such as home mechanical ventilation (HMV), requires regular monitoring of physiological variables (spO2, spCO2, respiratory rate) by carers supported by specialist outreach, and requires a continuous data link to the monitoring center for analysis and troubleshooting.15 It can enable remote initiation of HMV and may reduce costs, and may help predict exacerbations, allow remote interventions and adjustments.16,17 Challenges about data security and privacy, caregiver involvement and acceptance, availability of high-speed internet, and misconceptions around time needed, remain.18,19

Mobile Phone-Based Clinical Assessment

Wearable monitors have the disadvantage that they are expensive pieces of advanced technology, and the proliferation of devices patients must wear to allow multimodal monitoring can be intrusive. This makes them both cumbersome as well as unsuitable for low-income health environments. Therefore, exploring the potential of a ubiquitous device, such as a smartphone to provide multimodal monitoring is attractive.

Digital technologies are currently expanding rapidly, especially in the field of NMDs. They can reduce data collection burden and increase knowledge of real-life data. MG is an autoimmune neuromuscular disease characterized by very heterogeneous symptoms potentially associating ocular, bulbar, respiratory and skeletal muscles weakness and fatigability.

In current practice, visits to the physician’s office are planned every three to six months. However, since patients might experience worsening symptoms outside of visits, clinicians must often rely on patient recollection during consultations, which present a recall and subjectivity bias that can compromise the estimation of disease status. In this context, it will be clinically relevant to allow patients to self-assess their symptoms and physicians to collect and analyze digital biomarkers for a closer monitoring.

Figure 1. Remote clinical assessment enabled on a smartphone.

As an example, an ongoing study (ME&MG™, NCT: 05564936) aims to validate a digital solution that runs on patients’ smartphones. It is intended to be used as an unsupervised digital self-assessment tool for the monitoring of muscle weakness, fatigability, and disability in patients living with MG. This application contains digital active tests for the assessment of ptosis, breathing, dysarthria, upper- and lower-limb weakness, treatment follow-up, and validated e-questionnaires related to daily activities, pain, fatigue, sleep, and depression. The objectives of this study are to validate the clinical performance of the unsupervised at-home self-assessment of symptoms on the patient’s smartphone with ME&MG™ compared to the standard in-clinic testing, including analytical performance as well as to evaluate the safety of the solution, its usability, and satisfaction. Eight sites in France and the United States will be involved in this study.20 A further study evaluating the device is ongoing in the U.S. and Canada (NCT05566964).21

Figure 1 demonstrates the remote clinical assessment enabled on smartphone using the ME&MG software.

Machine-Learning Models of Telemonitoring and AI-Based Analysis of Digital Biomarkers

Machine-learning (ML) and AI-based models can conceivably help establish objective, rapid, and more accurate interpretation of remote data acquired by telemedicine monitoring. Vieira et al. devised an objective measure for ALS disease severity based on voice samples and accelerometer measurements, correlated with ALS-FRS-R scores over a four-year period with an audio voice recording and Actigraph GT3X accelerometers on each limb. They also trained ML models to predict bulbar-related and limb-related ALSFRS-R scores.22

Similar approaches were used to assess changes in an edaravone-treated patient sample. Wearables can produce an objective severity score.23 There have been several approaches to wearables for therapy studies,24 though robust validation is still awaited.

Conclusion

The expansion of telemedicine use in NMDs and development of clinically relevant but easy-to-use remote monitoring systems has potential to improve patient access to expert care, even in situations where direct face-to-face access is interrupted, as in the recent pandemic, or where scarce resources or geography prevents patient access to specialist care. Going forward, telemedicine might expand the availability of high-quality specialist care to patients in low-income societies, who hitherto have had little access. Recent developments in effective treatment can also be seen as an obligation on global medicine to explore how inequality in provision can be mitigated — telemedicine technology may advance us one step in this direction. •

M. S. Damian, MD, FEAN, FNCS, works at the Essex Cardiothoracic Centre, in Basildon, UK, and Prof. P. Laforet, MD, PhD, works in the Neurology Department, Raymond Poincaré Hospital, APHP, Garches, APHP, FHU PHENIX, Centre de référence des maladies neuromusculaires Nord Est Ile-de-France in Filnemus. 

References

  1. Mauri E, Abati E, Musumeci O, et al. Estimating the impact of COVID-19 pandemic on services provided by Italian Neuromuscular Centers: an Italian Association of Myology survey of the acute phase. Acta Myol. 2020 Jun 1;39(2):57-66. doi: 10.36185/2532-1900-008.
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