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An Important Year for Neurology

By Wolfgang Grisold

Wolfgang Grisold

Wolfgang Grisold

Welcome to this first issue of World Neurology in 2023. This newsletter is an important information instrument for the WFN, and each issue reaches at least 15,000 readers. I encourage members to use this instrument and submit news and important aspects regarding neurology in your region.

The year 2023 will be an important year for neurology, and for the WFN. The year will bring face-to-face meetings and personal encounters and will reveal how stable and useful our newly developed communication tools are. My prediction is that our communication has dramatically increased during the COVID crisis, and several aspects of electronic communication will remain. The issue of traveling is increasingly also discussed with environmental considerations, and the carbon footprint is increasingly important. The numerous worldwide crises have also complicated traveling and visa issues are gaining importance.

2023 will be the year of a World Congress of Neurology (WCN), this time in Montreal Canada, and follows the WFN concept of traveling with meetings from region to region. Canada is a region rich with research, concepts, education, and also very advanced neurology services. We are glad and honored that the Canadian Neurological Society is holding this congress with us, and we believe world congresses always have a positive effect in the regions to promote the awareness of neurology.

We are looking forward to the global participation and hope many delegates from all parts the Americas (as the hosting region) will be able to attend. We are aware of visa issues, and we appreciate that our hosts are doing the utmost to make the entry for members of societies from other global regions possible.

At the WCN, we will also see three elections: a new treasurer replacing Prof. Stark, a new trustee replacing Prof. Freedman, and the decision on the congress site 2027 in the Arab/African region. Both Prof. Stark and Prof. Freedman have served two terms in the WFN, and we are grateful for their continuous efforts.

For the WCN, from the practical point, the congress committees have created an interesting program with selected plenary lectures, scientific, and educational topics. We are glad to see that almost all participants from the global neurologic alliance are involved in the program, and the distribution of speakers includes more regional speakers than before.

Free lectures and guided poster sessions are waiting for your participation. Please look at the WFN and WCN congress site for the abstract submission. Again, please also check your travel possibilities and your visa requirements.

With the help of our professional congress organizer Kenes, we will add more interactivity in the congress, and we also will have several joint sessions with the WHO and members of the Global Neurology Alliance, such as the World Psychiatric Association and the World Federation of Neurosurgery, among others. The WFN educational subcommittee of “young neurologists” will organize two important sessions.

A patient day will be organized with the Canadian Neurologic Society (CNS), and the WFN is aiming to establish a global patient platform.

We are aware that traveling might not be easy for several reasons, yet there is need to make this congress available worldwide to all member societies. The WCN 2023 will have a virtual component, which will allow access to the program at low costs in low and low-middle income countries. Participation and dissemination of the developments in neurology are the main aims of the WCN. There will be reduced fees for low and low-middle income countries, and as always also congress bursaries will be available.

The WCN is one important aspect of the WFN’s activities, but there are others

Education: The work with educational activities progresses, and a department visit program for Asian candidates is being established by the Indian Academy of Neurology and will be announced soon.

We will continue the educational days, with the WFN day (which will be in December and devoted to neuropathies) and the joint (with the International Headache Society) IHS Headache Day in May. As a new addition, we are planning an educational day in cooperation with the Asian Oceanian Academy of Neurology (AOAN).

WHO and UN-ECOSOC: The cooperation with the WHO continues and, as in the last year, brain health and the implementation of IGAP are major tasks among others. This year’s World Brain Day (WBD) will be organized by regions in cooperation with the WFNR (World Federation of Neurorehabilitation) and is dedicated to “Brain health and disability.” Please follow WBD on the website, and we hope that all member societies will be able to contribute locally.

The global neurology alliance (GNA), consisting of world societies, specialist societies, regions, and the WFN specialty groups, will have a meeting at the WCN in Montreal. It is a powerful network, and the WFN will continue its efforts to cooperate with global societies and specialist societies.

Prof. Steven Lewis and I met with the president and other dignitaries of the World Psychiatric Association in Vienna in January (photo), to discuss future cooperations in regard to brain health and mental health.

The WFN wishes a successful and prosperous year in your region, and globally for neurology. •

First Pan-European University Course on Clinical Autonomic Neuroscience

The course is provided at the Danube University and supported by the European Federation of Autonomic Societies.

By Walter Struhal

Walter Struhal

The autonomic nervous system (ANS) regulates the synergistic action of all visceral organs and homeodynamic processes. ANS is involved in the course of many neurologic and systemic diseases. Recently, ANS involvement including postural tachycardia syndrome was identified to play a significant role in cases with post-COVID condition.

ANS diseases may cause various dysfunctions, for example, transient loss of consciousness, sweating disorders, digestion, and urinary and sexual function. Autonomic involvement may be generalized, or focal. It may involve central, and/or peripheral ANS structures. The transformation of this appealingly complex pathophysiology into a clinical picture helps to explain the patient’s symptoms, define the syndrome and initiate treatment. A number of therapies are well-investigated but “off-label.” Diligent transformation of literature research into state-of-the-art therapeutic strategies is therefore an important competence of a clinical autonomic neuroscientist.

European Program of Clinical Autonomic Neuroscience

The European Federation of Autonomic Societies (EFAS), together with the Danube University Krems, and the Karl Landsteiner University of Health Sciences have initiated the first Pan-European University Course to study techniques on bedside and lab investigations of ANS disorders and common strategies of therapeutic management. This academic postgraduate course takes one year and will be completed with a university diploma.

This program is open to medical doctors in training and specialists of all disciplines. This program is open for registration. Register now. •

Report on the Ninth International Course of Neuroepidemiology: Methods and Clinical Applications

By Dr. Carlos N. Ketzoian

Participants in the Ninth International Course of Neuroepidemiology: Methods and Clinical Applications.

Last November, the ninth edition of the International Course of Neuroepidemiology:  Methods and Clinical Applications took place in Erice, Sicily, Italy, with the WFN’s endorsement.

An historical first course of neuroepidemiology was held in San Miniato, Pisa, Italy, in 1981, and was organized by Prof. Bruce Schoenberg.

Prof. Schoenberg passed away six years later. He laid the foundation for the development of neuroepidemiological research in different continents as a legacy. The activities that he promoted were oriented both to support researchers and to prioritize the training of human resources in this area of knowledge.

Almost 20 years after these historical events, Professors Walter Rocca (Mayo Clinic, Minnesota, U.S.) and Giovanni Savattieri (University of Palermo, Italy) resumed the training activities pioneered by Prof. Schoenberg. Starting in 2000, the nine offerings of the “International Course in Neuroepidemiology: Principles and Clinical Applications” in Erice, have become an essential point of reference for those of us who are interested in the subject.

Over the years, the structure, thematic content, and methodology have evolved in order to adapt to the new needs of a changing international public and to the new methodological developments.

Flyer of the Ninth International Course of Neuroepidemiology: Methods and Clinical applications.

Professors Paolo Ragonese and Marco D’Amelio from the University of Palermo, Italy, who participated as students in the 2000 course, are the current coordinators. The course has a Scientific Committee and a Teaching Team, including more than 15 worldwide leaders in neuroepidemiology and other related sciences. It is a high-level full-immersion course where participants share five days of training, exchange experiences, and establish professional collaborations that go beyond the course.

Forty-six students from five continents participated in this Ninth International Course of Neuroepidemiology: Methods and Clinical Applications” in Erice 2022. Methodological aspects of neuroepidemiology were discussed in the morning, and applications of the methods to the study of specific neurological diseases were presented in the afternoon (epilepsy, dementia, Parkinson’s disease, stroke, multiple sclerosis, neurological manifestations of COVID, among others). General concepts of genetic epidemiology and of applied statistics complemented the epidemiologic methods essential for neuroepidemiology.

The infrastructure of the Ettore Majorana Foundation Centre for Scientific Culture provided a unique framework to achieve the aims. As we climbed the winding road that took us up Mount San Giulano to Erice, a medieval city, the air became fresh and the landscape splendid. Cloistered for a week in this inspiring environment, we felt invited to expand our knowledge as if we were part of a renaissance movement in neuroepidemiology.

The current coordinators, Professors Paolo Ragonese and Marco D’Amelio, organized a special tribute to Professors Walter Rocca and Giovanni Savattieri in recognition for their work in establishing the Erice courses and for their commitment to the development and the diffusion of neuroepidemiology. The Erice courses have become one of the points of reference for the training of young neurologists in clinical and epidemiological research. •

Dr. Carlos N. Ketzoian is chairman of the Specialty Group on Neuroepidemiology of the World Federation of Neurology.

Reference:

  1. Walter A. Rocca, Paolo Ragonese, Marco D’Amelio, Giovanni Savettieri (2022) Teaching Research Methods to Young Neurologists: The Erice International Courses. J Mov Disord 2022;15(3):227-231

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. •

Junior Traveling Fellowship 2022 report

EAN Congress

By Syrine Ben Mammou

Thanks to World Federation of Neurology, I had the opportunity to attend the Eighth European Academy of Neurology Congress June 25-28, 2022, in Vienna Austria.

Since the COVID-19 pandemic, many conferences were cancelled or presented virtually. This was my first participation in an international congress of neurology as a junior resident.

During the three days of the conference, I was in sessions revolving around different interesting topics in the field. I am highly interested in inflammatory diseases, and thanks to this opportunity I was able to attend multiple sclerosis discussions. The highlight of my journey was the plenary symposium about improving lives and reducing burden. It was interesting to me as a medical doctor from a low-income country.

Overall, it was an enriching experience during which I had the opportunity to meet and connect with professors and residents in neurology from all over the world. We had various talks about our countries’ health systems, our current work, and future projects. I also had the honor to meet Dr. Claudio Bassetti.

Finally, I hope that I will have the opportunity to attend a conference again in the upcoming years to do presentations about the work that we do in my country. I hope these opportunities of travel fellowships will be more accessible for junior doctors/residents from low-income countries. •

Dr. Ben Mammou is a neurology resident in Tunis, Tunisia.

Ettore Beghi

By Alla Guekht

Prof. Ettore Beghi, researcher at Istituto Di Ricerche Farmacologiche Mario Negri – IRCCS where he developed important contributions to the neuroepidemiological study of ALS and epilepsy, among other areas of neurological diseases.

Ettore Beghi passed away Oct. 10, 2022 at the age of 75 in Milan, Italy, fighting his last battle against a very serious illness with dignity.

Ettore Beghi was born in Milan, Italy, on Aug. 15, 1947. He  received his MD at the University of Milan (1972), completed post-doctoral clinical fellowship in neurology with graduation at the neurologic clinic of the same university (1976), obtained a masters of pharmacologic sciences research at the Istituto Mario Negri in Milan (1981), and served as a research fellow in the department of medical statistics and epidemiology at Mayo Clinic in Rochester Minnesota (1982–1983).

His professional life was also associated with his favorite city. He was the  head of the Laboratory of Neurological Disorders, Istituto di Ricerche Farmacologiche “Mario Negri,” contract professor of neuroepidemiology at the University of Milan;  past head of the neurophysiology unit and epilepsy center, Ospedale di Monza, Milan.

Although it is tragic to think of Ettore leaving us so early, he left behind a lifetime of extraordinary memories. He published more than 480 scientific articles, was one of the world leaders in neuroepidemiology with the special interest to epilepsy and motor neuron diseases, participated in the creation of registries for rare neurological diseases and COVID-19.

He made a prominent contribution to numerous working groups and research committees in the World Federation of Neurology (WFN), European Academy of Neurology (EAN), American Academy of Neurology (AAN),  International League against epilepsy (ILAE), extensively collaborated with the WHO, especially at the time of COVID-19 pandemic. He was a prominent member of the WFN, contributing significantly to the WFN Research Group on motor neuron diseases. He was a Fellow of the AAN, Fellow of the EAN, and received the Ambassador for Epilepsy Award of the ILAE. Prof. Beghi chaired the AAN Neuroepidemiology Section and ILAE Commission on the Epidemiology of Epilepsy. He was a coordinator of the European ALS registry and one of the founders of the EAN NEuro-covid ReGistrY (ENERGY). He worked very actively in the Italian Neurologic Society (INS), being the president of its neuroepidemiology section, served in the executive committee of the Italian League against Epilepsy. Prof. Beghi was a consultant for ENEA, editor of the Cochrane Epilepsy Group, member of Commission on the Burden of Epilepsy of the ILAE, International Committee “Epilepsy and the Law,” AAN Research Group in Neuroepidemiology. He was the associate editor of Epilepsia and Neuroepidemiology, served on the editorial boards of the journals Clinical Drug Investigation, Inpharma, Drugs R & D, Neurological Sciences, Clinical Neurology and Neurosurgery (CNN) and was a reviewer of the major journals in neurology.

Ettore Beghi was a great teacher and mentor to many young neurologists and researchers in many countries all over the world.  He was a very kind and remarkable person, great colleague, and collaborator. Prof. Beghi is survived by his beloved wife, Maria Lidia, his three children Massimilìano, Emanuele, and Nadia, and his grandchildren.

It was a great pleasure and honor to work with him, admiring his tireless passion for research and clinical practice, his excellence, humanity, and dignity.

We will always remember Ettore as a dear friend, remarkable scientist, excellent doctor.  He will always be in our thoughts and prayers. •

Obituary: Ettore Beghi

By Specialty Group on Neuroepidemiology, World Federation of Neurology

With deep sadness, we inform you that Ettore Beghi, after a long illness, has left us. We all remember the friendliness and devotion that Ettore has always shown in his excellent scientific work, presenting himself with humility, ready to pass on his skills to anyone who was close to him,

Prof. Beghi has been a key point of reference in neuroepidemiology, epilepsy, and motor neuron disease research in the global world by building new and original research paths. He worked closely with the World Federation of Neurology (WFN), being an active member of the WFN epidemiological group. In many instances, he was instrumental to build up the network of scientific and human relation of people from many countries that has been so characteristic of our group. In our meetings, he was always able with a smiling and calm leadership to convey a shared extraordinary and positive energy to all participants.

A great researcher and friend who will be missed by all of us.

Does Migraine Exist?

By Joost Haan, MD, PhD, BA

There is no objective test for migraine. Migraine cannot be proven with a scan, blood test, or EEG. The neurological examination during and outside attacks is usually normal. A diagnosis of “migraine” can only be made on the words with which patients describe past experiences. Their words must be “read” to get a diagnosis. Based on sparse, remembered, and metaphorical information, doctors worldwide make a diagnosis of migraine to distinguish it from, for example, tension-type headaches, a diagnosis that is also based on words.

There are strict rules that advise doctors when to diagnose migraine. These rules depend on an agreement. The currently used classification of headache is from 19881 with updates in 2004, 2013, and 2018. Most clinical features mentioned in the criteria for migraine (such as pain severity, pulsating, sensitivity to stimuli) have no reference in reality, except for the words of the patient. This may lead to the question of whether migraine really exists.

The criteria were seen as a major breakthrough and one of the most important developments in the headache field of the last 100 years2. The Danish neurologist Jes Olesen was the main force behind this classification. The preface of the 1988 classification mentions that “mistakes have inevitably been made.” Next to scientific use, the authors expected that the criteria would probably influence how to diagnose patients. Further, they stated that “only patients who really have the disease should have the diagnosis, but on the other hand, all patients who really have the disease should fulfill the diagnostic criteria.” The question here is what it really means in “patients who really have the disease.” How is this reality defined? The words of the patients have to be translated into the criteria. The criteria are used to give a name to a disease state. The “patients who really have the disease should fulfill the diagnostic criteria” make it a self-fulfilling prophesy.

This was recently illustrated in an article with Olesen as co-author. The article starts with: “Only when headache attacks fulfill specific diagnostic criteria consistently does a primary headache disorder occur3. Here, it even seems that the occurrence of the headache depends on the criteria.

Due to the nature of an agreement and not that of a biological test, the criteria are subjected to choices and interpretations. There is always the possibility that these choices and the selection are wrong. As such, the headache criteria strongly resemble a discourse.

There are numerous definitions of “discourse.” Here, I will use the definition of the French philosopher Michel Foucault (1926-1984). For him, “a discourse provides a set of possible statements about a given area, and organizes and gives structure to the manner in which a particular topic, object, process is to be talked about4.” An important aspect of this philosophy is that discourses construct reality and produce meaning. They include and exclude, and form a way of thinking. Discourses are based on arbitrary choices, but sometimes it becomes invisible that these only are assumptions. One had lost sight on the alternatives and the reasons for some of the choices. The human need to provide order, unfortunately, can have negative effects by blocking new thoughts and preventing from thinking otherwise. Such discourses will become the paradigm and make a paradigm shift very difficult. This is also true for the current headache classification.

It may be difficult at first sight to see the role of discourse when we are dealing with a biological process such as migraine. One of the reasons for this role is that natural and biological processes are not fixed and often depend on interpretations, shared opinions, and subjective observations. So, a diagnosis made by doctors can be seen as emerging as something that is simultaneously certain and uncertain. Except for the so-called “evidence-based medicine,” which exists between very narrow borders and must apply to very strict rules, most diagnoses are conceptual entities. This is not a problem as long as one realizes that it is not the “truth” or “reality.”

Foucault asks: “Who has the power to make a discourse?” He stresses the importance of persons with authority in the process4. Founders of discursivity are individuals whose ideas become so important that it is difficult to talk about a given domain without referring back to them. Obviously, Jes Olesen may be seen as the authority in this sense.

His criteria became the “truth” of headache diagnosis. The terminology of the criteria gradually took root in the daily conversation and writings of headache specialists. Although the criteria were created to separate recognizable and “pure” groups of patients for scientific investigations, they became also increasingly used to diagnose patients in daily practice. Thousands of scientific studies were based on the basis of these criteria, mainly published in devoted journals, such as Cephalalgia, Headache, and The Journal of Headache and Pain.

In these publications, it sufficed to mention that the diagnoses were “made according to the criteria of the International Headache Society” when describing the patient groups included. As Lane and Davies (2015) write, “it would now be impossible to publish a paper on headache without referencing the ICHD-3 beta or reiterating the ICHD-3 beta criteria for the headache entity under consideration5.” In most studies, a control of whether the diagnoses of the individual patients were correct was, however, never performed (and was also impossible from the point of view of the reviewers and the publishers of the articles). Medication trials and clinical and genetic studies were based on the semiology of the criteria; drugs were allowed to the market and only reimbursed by insurance companies when used for the “right” diagnosis according to the criteria and studied in the “right” trials.

The sparse criticism arguing that there is no real scientific basis for the classification has been ignored5,6. Nevertheless, the arguments of Shevel and Shevel that the required number of attacks, duration of headache, unilaterality, pulsating quality, severity of pain, and aggravation by activity are insufficiently supported by scientific and clinical observations (not to speak of its self-fulfilling prophesy) seems sound6. They were right in stating that the criteria were mainly based on opinions.

Likewise, Lane and Davies argue that “the ICHD-3 beta criteria have assumed a status that is not justified by evidence5.” It may be said that although the criteria are not the “truth” they have produced the reality of the headache patient. No doctor, scientist, or patient can ignore the discourse produced by these criteria, based on opinions and inclusions and exclusions. In 2014, Olesen admitted that there are “some problem areas” in the classification, but in the meantime also emphasized that there are “no competing classifications7.” Indeed, this is a dominant discourse.

The separation of “migraine” from other headache types is artificial, the distinction by criteria leads to a process of inclusion and exclusion. The headache diagnoses only exist due to the internationally accepted agreements of the dominant discourse offered by the International Headache Society. In fact, there is no place for alternatives, as even the inventors of the criteria admit themselves.

However, the reality of someone with “migraine” might not differ very much from that of someone with “tension-type headache.” There is much overlap between the various headache types, not only clinically, but also with regard to treatment. Also, different headache types often co-occur. The criteria, however, have categorized, split, and unfortunately also stigmatized headache and its sufferers. It even seems that being diagnosed as a migraine patient is a favor in contrast with getting a diagnosis of tension-type headache. Migraine gets more attention in the form of scientific research and funding, and therefore a better chance of effective treatment.

We have to do with the criteria as long as there is no robust identification available of migraine and other headache-types based on genes or other biomarkers. Only then, a transition of a symptomatic to an etiologic classification would be possible. In the meantime, we must rely on the words and the metaphors of the patients. It may be said that it “does not matter what we call migraine as long as all of us agree on what is called migraine8”, but we must always keep in mind the discursive (and therefore sometimes deforming) interpretation of the word “migraine.” The criteria have built a new entity, and its definition only results in a demarcation from other objects. Their significance does not lie in the fact that they offer a most detailed and accurate image of reality, but in the scientific consensus to use the word “migraine” in this particular way and to see this as what is really the matter.

Does migraine exist? Yes, in the form of a discursive definition, but also “No” in its real distinction from non-migraine headache types. In my opinion, this is what one should always keep in mind when dealing with headache patients. •

Joost Haan is a neurologist and headache specialist working in the Leiden University Medical Centre and the Alrijne Hospital,  Leiderdorp, the Netherlands.

References

  1. International Classification of Headache Disorders (1988). Cephalalgia 8, 1-96.
  2. Tfelt-Hansen, Peer C. and Peter J. Koehler (2011). “One Hundred Years of Migraine Research: Major Clinical and Scientific Observations from 1910 to 2010.” Headache 51, 752-778.
  3. Mitsikostas, Dimos D., Messoud Ashina, Alexander R. Craven, Hans C. Diener, Peter J. Goadsby, Michel D. Ferrari, Christian Lampl, Koen Paemeleire, Julio Pascual, Aksel Siva, Jes Olesen, Vera Osipova and Paolo Martelletti; on behalf of the EHF committee (2016). “European Headache Federation Consensus on Technical Investigation for Primary Headache Disorders.” Journal of Headache and Pain 17, 5.
  4. Foucault, Michel. The Archeology of Knowledge. London, Tavistock, 1972.
  5. Lane, Russell and Paul Davies (2015). Can Migraine be Defined?” Cephalalgia 35, 1339-1340.
  6. Shevel, Elliot and Daniel Shevel (2014). “The International Headache Society Classification of Migraine Headache – A Call for Substantiating Data.” The Journal of Biomedical Science and Engineering 7, 112-114.
  7. Olesen, Jes (2014). “Problem Areas in the International Classification of Headache Disorders, 3rd edition (beta).” Cephalalgia 34, 1193-1199.
  8. Schulte, Laura and Arne May (2015). “What Makes Migraine a Migraine – of the Importance of Disease Classifications in Scientific Research.” Cephalalgia 35, 1337-1338.

Commentary: Does Migraine Exist?
by Richard Stark

Dr. Haan raises some important points that have practical as well as semantic implications.

It is obviously legitimate to raise questions about the definition of migraine when this is based on criteria derived from the patient’s description of symptoms (without objective biomarkers) with the criteria determined by expert opinion. However, there would be few people who would deny the existence of a condition that approximates the current definition and which, one day, may have more precisely defined biomarkers.

If one accepts that a condition approximating the current definition of migraine exists, criteria for diagnosis are necessary to enable research into the underlying biology, including potential treatments. It has been argued that such criteria need to be strict so that studies of “migraine” exclude borderline, atypical, or “non-migrainous” cases from research studies to improve power and precision of conclusions.

A problem arises then when the same criteria are used in clinical practice. Borderline or atypical cases may share biological features with strictly defined migraine and may, for example, respond well to treatments for migraine. If the strict criteria for defining migraine are used by insurers or other health funders, these patients may be disadvantaged.

The distinction between migraine and tension-type headache (TTH) is an example of this dilemma. There appears to be a range of clinical opinion about the practicalities of distinguishing between these disorders. Some take the view that with detailed and directed history taking, most patients with disabling headache initially considered to be TTH will prove to meet criteria for migraine. As Dr. Haan points out, many effective treatments have been established for migraine and few for TTH, so patients carrying the diagnosis of TTH are disadvantaged compared with those carrying a diagnosis of migraine.

The incidence of migraine is so high that it is tempting to believe that we all have the pathophysiological substrate for this disorder which, if sufficiently provoked, may produce the clinical picture of migraine. Of course, some are clearly more susceptible than others, resulting in a range of thresholds and severity. This may help explain why some, but not all, patients suffering from mild traumatic brain injury, or idiopathic intracranial hypertension, or COVID-19 (for example) develop persistent headaches with a migrainous phenotype. These headaches would be considered secondary headaches under ICHD3, but may, in some cases at least, respond to migraine treatments.

I believe we would all accept that objective diagnostic criteria based on biomarkers derived from a sound understanding of the pathophysiological basis for migraine are preferable to the current consensus-based criteria derived from the patient’s history. But at present, no such biomarkers exist, and the ICHD3 criteria seem to most to be a practical solution. The ICHD has justifiably been considered one of the foundations on which our rapidly expanding understanding of migraine is based. We must remember however that these criteria can and must be changed as more information becomes available, and the criteria have been written primarily to ensure “purity” in clinical research studies rather than as a constraint to clinical practice. •

Richard Stark is treasurer of the WFN.

Candidate Statements for WFN Secretary General, Elected Trustee

Below are the Candidate Statements for Secretary General and Elected Trustee. Three statements for Secretary General and four statements for Elected Trustee are listed in each category.

The Secretary General Candidate Statements, for the three candidates, in alphabetical order, are from:

  • Marianne de Visser
  • Steven Lewis
  • Tissa Wijeratne

The Elected Trustee Candidate Statements, for the four candidates, in alphabetical order, are from:

  • Chandrashekhar Meshram
  • Bo Norrving
  • Minerva López Ruis
  • Mohammad Wasay

 


Candidates sorted alphabetically

Marianne de Visser

Marianne de Visser

My name is Marianne de Visser. I am an adult neurologist from Amsterdam, The Netherlands, and (emeritus) professor of Neuromuscular Diseases at the University of Amsterdam.

I would like to apply for the position of Secretary General and I am deeply honored that the Nominating Committee recommended me—together with two other candidates—to the Membership.

I have been committed to the good cause of the WFN for several decades. First as a delegate on behalf of the Netherlands Society of Neurology, subsequently as an elected trustee (2002-2008), chair of the Nominating Committee, co-opted trustee (July 2020 through December 2021) and recently President Wolfgang Grisold appointed me as chair of the Membership Committee and vice chair of the WFN Congress Committee. I have witnessed the growth of WFN. The increasing membership, but also the expanding role of the WFN in several impactful initiatives worldwide are clear signs of leadership.

The close collaboration with the WHO has borne fruit for neurology. The then President Johan Aarli coordinated the Atlas Project, resulting in the publication of its first edition in 2004, showing the country resources for neurological disorders. In 2017, the second edition was published, coordinated by past President Raad Shakir and Donna Bergen. The data shows that while the burden of neurological disorders is disproportionately high in low- and middle-income countries, health care services and resources are often scarce.

Another highlight of the collaboration with the WHO is the recent unanimous approval by the WHO Member States of the Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders. Elected Trustee Alla Guekht and Immediate Past President Bill Carroll together with the Global Neurological Alliance played a significant role in this.

The WFN puts many efforts in fulfilling its mission “Fostering quality neurology and brain health worldwide.” Among others by the launch of the Brain Health Initiative to promote prevention of brain diseases and improving the outcomes of those living with brain diseases. The World Brain Day is an extremely successful recurring event on July 22, this year focusing on “Brain Health for All” conveying five important messages: Awareness, Prevention, Advocacy, Education, and Access.

Several WFN programs focus on education, in particular aimed at residents and early career neurologists. The COVID-19 pandemic was a tragedy in many aspects, but the coronavirus silver lining was the huge uptake of virtual meetings and the implementation of virtual health care. Both developments greatly facilitate access to education and health care.

President Grisold states in his column in World Neurology that the WFN will need to take diversity, equity, and inclusion into consideration in its strategy, that the needs of early career neurologists require specific attention and action, and that a platform for patient organizations should be installed in the WFN infrastructure. I embrace those initiatives, and I am fully committed to serve the WFN as Secretary General to make those initiatives a success in close collaboration with the trustees and the indispensable colleagues from the head office. •

 

Steven Lewis

Steven Lewis

It has been a privilege serving as WFN acting secretary general since January 2022, elected trustee since 2016, and co-opted trustee prior to that. In these and many other WFN roles, I remain indebted to this organization and the opportunities it has provided me to help achieve the WFN mission.

My involvement with the WFN occurred coincident with my AAN appointment as editor-in-chief of Continuum, where a joint WFN/AAN program provides print and online access to Continuum to neurologists from over 49 neurological societies from low/lower-middle income countries. As a general neurologist, educator, academician, and editor, I have worked tirelessly on this critical resource while continuing to find ways to enhance the program and its access.

In my expanding roles at the WFN, and for which I am available 24 hours a day given our worldwide constituency, I have become integrated into the daily workings of this organization for global neurologic education, training, practice, and advocacy.

As editor of World Neurology for the past seven years, I have the responsibility to report on news about neurology to neurologists worldwide. As chair of the Education Committee, I have the privilege to help create and hone educational opportunities in the form of department visits, fellowships, and full neurologic training, junior travelling fellowships, and many other educational programs and research grants to neurologists/trainees especially from lower- and lower-middle income countries who otherwise wouldn’t be able to access such opportunities. As Teaching Course chair of WCN 2019 (Dubai), 2021 (Rome/virtual), and Congress Committee Chair of WCN 2023 (Montreal), I have led the creation of programs attended by thousands of participants to learn from world-class speakers.

In all my WFN responsibilities, I have the privilege of collaborating with esteemed colleagues from regional and national societies and committees and related organizations, co-trustees, and WFN presidents, and from our talented hard-working staff. The knowledge, expertise, and camaraderie of all has been invaluable in improving my effectiveness to our organization.

If elected as Secretary General, I pledge to continue in this role to help achieve the WFN’s mission via ongoing collaboration with national and regional neurologic societies and organizations (including the WHO in our increasing partnership); grow our regional teaching centers and department visits for neurologic training to expand within and beyond the current regions to include any region where neurologists are underrepresented; leverage virtual opportunities; increase awareness of all WFN opportunities for all neurologists worldwide; and react quickly to novel regional or global neurological threats. I also look forward to completing the initiative President Grisold and I spearheaded to develop and distribute a practical Global Neurologic Core Curriculum addressing the minimal required knowledge, skills, training experiences, and overall competencies of neurologists, while recognizing regional variations in resources, funding, and diseases.

I would be honored to be elected to continue as WFN Secretary General, in which I would continue to work around the clock to faithfully serve our delegates and all neurologists for the mutual goal of improved neurological access and the highest quality of neurology and neurological health worldwide. •

 

Tissa Wijeratne

Tissa Wijeratne

What an exciting time to be in WFN! It is an incredible honor to have been nominated for the WFN Secretary General election this year. Brain health is in peril globally. One in three of us has a brain disorder. Brain disorders are the leading cause of disability and the second leading cause of death globally. Two-thirds of these occur in low- to middle-income countries. Different regions of high-income countries demonstrate vast disparities in awareness, education, access to care, prevention, and rehabilitation. I have seen this imbalance in care firsthand during my youth in rural Sri Lanka, followed by culturally and linguistically diverse communities representing 166 nations in Western suburbs of Melbourne, Australia. I believe WFN can build on the successes of the last few decades, capitalize on IGAP, and advocate more for quality neurology and better brain health by improving local engagement and activities.

If elected, I will seek to enhance the inclusiveness and constant collaboration already at our society’s heart. We shall continue to work hard to support movers and shakers in brain health worldwide—not only neurologists, academics, and industry but also the billions of patients and families experiencing the effects of brain disorders. Advocacy and supporting local advocates will be a crucial component of my global vision for quality neurology and better brain health. We will continue to assist national societies, health ministers and ministries, aiming to deliver the IGAP for all neurological disorders in all regions during the next decade. Educational programs, grants, symposia, CME, traveling fellowships, accreditation, and postgraduate training programs will all be added to, enhanced or, in some cases, newly developed to help address this need globally. We are already doing a lot, but we can and will do more. Our many activities will continue to bring neurologists worldwide together, ensuring everyone’s voice is heard. Committee representation, additional scientific activities, and other advocacy campaigns shall be the tools we use to achieve this goal.

The WFN needs hard-working men and women who can dedicate themselves to improving brain health worldwide. To cohesively solve the issues facing neurologists across the globe, we can listen to, discuss, and assimilate the ideas of many. I will bring these qualities to our leadership group. As you know, I have already represented the global neurology community in WFN activities for nearly two decades. I am ideally poised to take up the responsibilities of Secretary General, as I bring experience from both sides of the world—from rural Sri Lanka to Australia and beyond. The World Brain Day campaign has already reached out to over one billion people since its genesis in 2014. Yet, there is more ground to cover, but our goals are achievable. With our already talented team, we can work together on this critically important task now.

More about me on my website www.tissawijeratne.net. I am on WhatsApp at +61430048730 if you need to clarify anything with me directly. •

 


Candidates sorted alphabetically

Chandrashekhar Meshram

Chandrashekhar Meshram

I am grateful to the Indian Academy of Neurology and the WFN for considering me worthy for the position of Elected Trustee.

Services to the WFN

I am indebted to WFN for giving me the opportunity to serve as co-opted trustee and as the president of 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 through interaction with the experts. Our ongoing series “Inspiring People in Neurosciences” is a step in the same direction. All of these sessions are available on the WFN website. TGNSG also provides monthly updates of COVID-19 for the WFN website. I was also instrumental in getting the teaching sessions by Indian Academy of Neurology on the WFN website. I have planned the department visit program in India for residents from poor countries.

I have served on the Constitution and Bylaws Committee as a member for three terms and the WFN Scientific Program Committee for two terms. I took the challenge to resurrect Tropical Neurology SG by successfully organizing the first International Tropical Neurology Conference in 2017 in India. I was then given the responsibility as president of TGNSG. I was co-chair for INTROPICON II held in Brazil. TGNSG now is one of the most vibrant and active SGs of WFN. Because of these activities, I was appointed as a co-editor for the special issue of JNS on Tropical Neurology, section editor of Encyclopedia of Neurosciences for the section on Bacterial and Fungal infections, including Tropical Diseases and assistant editor of eNeurologicalSci.

The World Brain Day is the most eminent public awareness initiative of WFN. The public education campaigns are close to my heart. I have been actively organizing World Brain Day activities, and this year, we have planned 100 such activities in India. I have been the coordinator for the National Brain Week in India for the last 8 years. I have published about 350 articles for public education, including several in World Neurology.

The global burden of neurological diseases is massive, and there is a shortage of neurologists to deal with it. Therefore, I have been organizing educational programs for general physicians and pediatricians.

Goals

There is a glaring inequality in neurology care and education worldwide. The developing and underdeveloped countries lag behind in both these aspects because of lack of resources.  WFN is making every attempt to help them catch up, and I am committed to addressing it. We need to focus on the management and long-term care of neurological diseases in these resource crunch settings. Collaboration with WHO and other societies is important for brain health. If elected, I look forward to implementing recently adopted IGAP on Epilepsy and other neurological disorders.

The WFN board of trustees needs representation from developing countries. This need and a passion to work for the WFN are the reasons for standing for the post of an elected trustee. I would be grateful for your support. •

 

Bo Norrving

Bo Norrving

I am honored by my nomination as candidate for elected trustee of the WFN from the Swedish Neurological Society.

My work as a neurologist spans over several decades. I received my training at Lund University and had several short but very formative post-doc periods at Massachusetts General Hospital/Harvard with Bob Ackermann and C. Miller Fisher. I have authored more than 600 publications, have an h-index of 111, and more than 100,000 citations. I am fully trained in general neurology, but my main focus has been clinical stroke with several seminal contributions that include pioneering clinical trials, clinical-imaging correlations, epidemiology, and development of stroke services

As a young neurologist, I attended my first World Congress in Neurology in Kyoto 1981. This event sparked my interest in the global aspects of neurology, international networking, and engagements in neurological societies. I served as president of the World Stroke Organization (WSO) from 2008 to 2012, and served as an executive till 2020. During my term as president, the WSO underwent a rapid expansion, with several new initiatives, and became closely involved with the WHO and the U.N. placing stroke in the focus on prioritized actions on non-communicable diseases. I participated in several high-level NCD meetings, including the landmark 2011 U.N. general assembly meeting, and I was portraited in Lancet Neurology 2013 as “Bo Norrving: Putting stroke on the world map.” I also had the opportunity to visit a large number of high income as well as low-middle income countries, get insights in stroke and neurology services in very different circumstances, and to establish a very large network.

I chaired the revision work of the cerebrovascular section for the ICD 11 at WHO. I played a key role in the important change to have all cerebrovascular diseases to form a single block under the section of Diseases of the Nervous System, which will have a profound effect on the positioning of stroke in several aspects in the future. I am currently a member of the Strategic and Technical Advisory Group on the Prevention and Control of NCDs (STAG-NCD) at WHO.

I have a longstanding and strong connection with the WFN as well as with regional neurological societies. During my terms as WSO executive, WSO and WFN established several collaborations, including the formation of the Brain Health Alliance. I have served for the WFN Educational, Scientific Program, and Finance Committees. I have been the Swedish delegate at the WFN on several occasions.

The WFN is the only global neurological organization and has an enormous potential to strengthen the position of neurology and improve neurological services. The Brain Health initiative, and the WHO Intersectorial Action Plan on Epilepsy and Other Neurological Disorders provide unique possibilities to make a change but will require hard work and advocacy skills. If elected as a WFN trustee, I will bring on my long experience in working with strategic development, governmental bodies, and advocacy in neurology. I am hard working and prestige free. Serving the WFN as an elected trustee would be a privilege.  •

 

Minerva López Ruis

Minerva López Ruis

I am Minerva López Ruiz, MD, and I have applied as a candidate for trustee of the WFN.

Among my relevant data, I am past president of the Mexican Academy of Neurology (MAN), current secretary of the Mexican Board of Neurology, representative for Latin America of the MAN, undergraduate professor at the medical schools of the Anahuac University and the Autonomous University of Mexico, as well as postgraduate professor at the General Hospital of Mexico (the largest public hospital in Mexico).

Within my activities in the WFN, I highlight that, in 2016, being president of the MAN and Dr. Raad Shakir being president of the WFN, it was my turn to organize and finance (getting support and sponsorships), the Pan-American Congress of Neurology. An event that I consider very successful, not only because of the more than 1,200 attendees and 149 speakers, but also because it allowed the re-foundation of PAFNS, by sponsoring the attendance of the Latin American representatives so that, during its assembly, they could achieve the necessary participation and votes to approve its new bylaws. Also, during that meeting, the logo was designed, and when it was approved, it was given to PAFNS as a gift and is still used today.

But I do not want this communication to focus on what I have done and my commitment to the WFN, but rather on my proposals to achieve growth of the WFN in the world, especially in Latin America, which I believe is a region where we still have little influence.

To achieve this goal, we have to consider that Spanish is spoken by more than 450 million people in the world (the majority in Latin America), being according to most statistics the second most spoken language in the world. That is why one of my proposals is that the educational material published by the WFN should also have a Spanish version.

A priority for me is education. I believe that we have a great area of opportunity to positively influence the dissemination of educational material, both for neurologists (specialists and trainees) as well as the general population. I will also propose, if elected, the realization of online, interactive clinical-pathological sessions, with the participation of the different neurological training centers, and transmitted to the entire Spanish-speaking world.

Another area of opportunity is, with the support of the neurological societies of each country, to develop diverse educational messages on neurological diseases, aimed at the general population, messages that address issues in which the stigma that marginalizes patients still prevails, for example, epilepsy in women (pregnancy, breastfeeding, etc.). Promoting these topics will bring the WFN closer to the neurological societies, to the societies with their population, but above all, it will benefit the patients.

For all the above, I would like to ask for your vote in the next WFN elections, with the promise that, if elected as trustee, I will work on these proposals and all those that you suggest to me and to which I am open to listen. •

 

Mohammad Wasay

Mohammad Wasay

I am currently Alicharan endowed professor of neurology at Aga Khan University Karachi, past president—Pakistan Society of Neurology and Pakistan stroke Society, president, Neurology Awareness and Research Foundation, Editor—Pakistan Journal of Neurological Sciences, Chief Editor—Jahan e Aasab (Neurology public awareness magazine), and Distinguished scholar COMSTECH (OIC). I have also served as a director of World Stroke Organization (WSO) and currently serving as Fellow of Pakistan Academy of Medical Sciences and Pakistan Academy of Sciences and Secretary of the Environmental Neurology speciality group (ENSG) of WFN.

I have worked with WFN for more than a decade as an active neurology advocate and researcher from South Asia. I was trained at Palatucci Forum and then received Advocacy Leader of the Year Award by American Academy of Neurology for my global advocacy contributions. I served as chair of theWFN Advocacy Committee for four years. This committee was instrumental in starting and organizing World Brain Day activities and promoting brain health across the globe. We organized many advocacy workshops during the Asian Oceanian Association of Neurology Conferences, Asian Pacific Stroke Conference, and World Congress of Neurology.

We are working at Aga Khan University to establish a network of neurology training and research in Kenya, Tanzania, Afghanistan, and Central Asia. We established the Asian Stroke Network with more than 20 centers in 10 Asian countries. This network has published many multicenter and multinational studies related to stroke in young and Asian women, stroke in pregnancy, and cerebral venous thrombosis in Asia. Currently, I am leading an initiative to establish OIC neurology academy to promote neurological care and training in developing Islamic countries. Recently, I have been appointed chair, specialty groups committee, by the WFN president.

I have trained more than 48 neurologists under my supervision. I have published more than 200 papers in peer-reviewed medical journals with impressive publications metrics (IF: 576; citations=5300, H- index 33 and I10 index 85) for a clinical neurologist in a developing third-world country. I have received many awards, including the Teachers Recognition Award by American Academy of Neurology, Gold Medal by Pakistan Academy of Medical Sciences, Gold Medal by Pakistan Academy of Sciences and Research Productivity Awards by Pakistan Council of Science and Technology. I have received 27 research and training grants (intramural and extra mural) as PI and co-PI. I have been an invited speaker at more than 120 conferences in 73 countries.

The growing burden of neurological diseases in the world has established WFN as an important stakeholder in global health. WHO has recently approved an intersectoral action plan for promotion of neurological care, training, and advocacy across the globe. We plan to promote brain health as a top agenda for WHO and United Nations. There is an inequity in neurology training and care across globe. South Asia, Central Asia, and Africa should be a center point for our future interventions. As a trustee, I could play a valuable role in promoting both agendas. Our advocacy committee and ENSG could play an important role in establishing WFN as a key player in global health. •

Major Activities of the WFN

By Wolfgang Grisold

Wolfgang Grisold

Wolfgang Grisold

Welcome to this issue of World Neurology.  We are glad to have several informative articles again. I wish to express my thanks to all concerned, including Steven Lewis and Walter Struhal, the editors of World Neurology. They make World Neurology successful and provide a valuable source of information on the WFN and global neurology.

WFN Major Events

Adoption of the Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders

The first event in late May 2022 was the acceptance of the international global action plan on epilepsy and other neurological disorders 2022- 2031 (IGAP) by WHO Member States at the 75th World Health Assembly (WHA) in Geneva. I was personally present for the entire week in Geneva and made a statement in support of the IGAP on behalf of WFN as a non-State actor in official relations with WHO. In addition to the fantastic news of the acceptance of IGAP, I was privileged to attend the WHA and witness the re-election of Secretary General Dr. Tedros Adhanom Ghebreyesus. I had time to attend two side events, one held by the Alzheimer’s  Association and one held by One Neurology with the European Federation of Neurologic Associations (EFNA), which gave valuable information on some neurology topics.

Geneva conference

I also want to make a note of a joint webinar done with the International League Against Epilepsy (ILAE) on the occasion of IGAP being adopted that occurred on May 28. There is more detail on IGAP below and on the WFN website.

The next issue of the Journal of the Neurological Sciences (JNS) will publish an article written by the WHO, titled “Brain Health as a Global Priority,” which explains the brain health conceptualization from the WHO for the IGAP and will be accompanied by an editorial by the WFN trustees.

Economic and Social Council (ECOSOC)

The second important news event is WFN’s application for the UN­—Economic and Social Council (ECOSOC).  The Committee on Non-Governmental Organizations at its 2022 Regular Session, held in May and June, decided to recommend the World Federation of Neurology for special consultative status with ECOSOC. This recommendation is subject to the endorsement of the Economic and Social Council, which will consider and take action on the committee’s recommendations at a management meeting in late July 2022.

Wolfgang Grisold at the WHO

One of the critical, wide-ranging activities of ECOSOC is the Sustainable Development Goals (SDGs). The SDGs are a “blueprint to achieve a better and more sustainable future for all.” They address the global challenges we face, including health, poverty, inequality, climate change, environmental degradation, peace, and justice.

World Brain Day

Brain health and IGAP are closely connected with WFN’s World Brain Day (WBD).  This year, the topic of World Brain Day is Brain Health, with the tagline “Brain Health for All.” The WBD organizing committee has all six WFN regional associations involved in planning, and we hope to continue the momentum of this positive communication after July 22.

Wolfgang Grisold delivering the WFN statement.

The topic of brain health also links with our previous Brain Health Initiative, WHO’s Brain Health unit, the IGAP, and many other activities such as the EAN Brain Health summit. To celebrate WBD on July 22, the WFN will host a webinar, which will focus on key messages of brain health, provide statements from the regions, and offer a Q/A session. We hope the WFN Member Societies will be able to celebrate WBD in their countries and regions. A toolbox with useful WBD material can be downloaded from the WFN website.

Council of Delegates

The Council of Delegates meeting (COD) is the annual decisive meeting of the WFN. This year’s meeting will take place

Oct. 25, 2022, in Amsterdam, in conjunction with the ECTRIMS conference. It will be a live meeting of delegates, but we will also provide a hybrid platform for those who cannot attend.

An Officer and Elected Trustee will be voted on 1) the position of the Secretary-General (vacated by myself), and the position of one trustee (vacated by Steven Lewis). The WFN Nominating Committee has scrutinized the applications, and you will find their proposal and all the candidates’ statements on the website soon. As in all COD meetings, the Trustees’ Report and several other reports and documents will be presented to the delegates.­­

Voting will be electronic, before the in-person portion of the meeting. Instructions and help will be provided by the WFN secretariat.

Education, Training Centers, and Department Visits

One of the core activities and mission of the WFN is to promote quality neurology through education. We are glad that the educational activities of the WFN prosper, and the trustees have decided to add a 4-year complete training to Rabat and also a fellowship on stroke in Cape Town.

This increases our 4-year training positions in Africa to three, and the WFN 1-year fellowships in Africa to four. We are indebted to our Specialty Group on Neuromuscular Disease and their International Congress on Neuromuscular Disease (ICNMD), which sponsors an additional fellowship for neuromuscular diseases in Rabat and also has invited the last ICNMD trainee to the ICNMD congress in Brussels this year.

The next fellowship calls will be for Cairo and Mexico. A site for the Asian Training Center has not been decided upon.

The WFN`s mission to provide education is aimed not only at supporting individual training but to help and empower the regions in their efforts to train neurologists in high-standard WFN teaching centers. This activity in Africa is achieved jointly with African Academy of Neurology (AFAN), and in Latin America with the Mexican Academy of Neurology and Pan American Federation of Neurology (PAFNS).

The WFN Department Visits were paused during the COVID pandemic, and we have now advertised Department Visits for Austria, Canada, and Germany, with a total of nine positions open. We are grateful to our Member Societies for giving young neurologists this important opportunity.

Educational Days

The WFN has developed the concept of E-learning Days, which were initially aimed at Africa. This is a one-day concept with a mix of regional and international speakers. The WFN and AFAN have organized E-learning Days on stroke and epilepsy. This year‘s theme is movement disorders, to be held on Sept. 3.

In cooperation with AFAN and the International Headache Society Global Patient Coalition (IHS GPAC), we have had another virtual program on “Education in Headache to Healthcare Providers in Africa.” We want to thank our partners for their generous support.

Participation in the educational days is free, and a certificate of attendance can be obtained after providing feedback on the event.

The platform for the educational days has been well established, and many thanks to Riadh Gouider, who spent considerable time building this structure jointly with a Tunisian professional conference organizer (PCO).

Webinar

In March, the WFN held a webinar on “The Neural Regulation of Cancer,” organized by the WFN Specialty Group on Neuro-Oncology on the topic of “The Neural Regulation of Cancer.”

It was a high-quality webinar focusing on new aspects of neurobiology. This webinar was hosted with the successful cooperation of the Society for Neuro-Oncology (SNO) and had 300 attendees.

Congresses and Meetings

International Congress of Neuromuscular Diseases ICNMD

The WFN Neuromuscular Specialty Group, the ICNMD, is preparing for the congress in Brussels in July. All topics of neuromuscular diseases are covered, and it seems the large number of participants that was reached at the ICNMD 2018 in Vienna will be reached again. The local organizing chair is Prof. Gauthier Remiche from Brussels, and the PCO is ICS.

The WFN ICNMD will have a session on neuromuscular issues in low-income parts of the world, and will be chaired by Riadh Gouider and Wolfgang Grisold.

The next ICNMD congress will be in Perth in 2025, and a call for the ICNMD following Perth is going out soon.

World Congress of Neurology (WCN) 2023

The next WCN will be in Montreal, Canada, from Oct. 13-19, 2023.

The Canadian Neurological Society will co-host this congress, and the congress chair is Prof. Guy Rouleaux, WFN vice president.

The preparations for the scientific program are in full development and chaired by Prof. Matthew Kiernan. Please follow our website and social media for further developments and announcements. For the second time, this congress will be in part also virtually available as a hybrid.

World Congress of Neurology WCN 2025 Seoul

Following the WCN in Montreal, the next WCN in 2025 will take place in Seoul, South Korea, and the organizational work has been initiated.

EAN Vienna, June 2022 

At the end of June, the European Academy of Neurology (EAN) held its congress in Vienna, Austria. The WFN had a leadership meeting with the EAN, a joint session on brain health, and hosted a mixed live/virtual WFN trustee meeting. In addition to the Regional Teaching Course and the participation of the WFN in the Brain Health Summit, further cooperation was discussed.

We will continue to participate in meetings of each of the six regional associations and have joint sessions to discuss present issues and provide visions for the future.

Summary

The past months have been a success for neurology worldwide, with the WFN actively involved. Special thanks to the previous administration, Prof. Bill Carroll, who was supported by Prof. Alla Guekht and WFN Strategy and Program Director Kimberly Karlshoej, who proceeded with the important activity of relations with the WHO and IGAP and also laid the foundations of this continuing development.

Yet celebration needs to be followed by action, and the IGAP will need further work and implementation, which consists of awareness and advocacy for political action, treatment and therapy, rehabilitation, prevention, innovation, and research. All WFN Member Societies are invited to be involved in this global mission.

The implementation of IGAP is a vast worldwide advocacy project, which demands effort — both bottom-up and top-down approaches are needed. •

Environment, Climate, and Neurological Diseases

Webinar by the Environmental Neurology Specialty Group (ENSG).

By Safa Younis and Mohammad Wasay

Safa Younis and Mohammad Wasay

In honor of World Environment Day celebrated annually on June 5, the World Federation of Neurology (WFN) hosted a webinar to raise awareness and explore the relationship between environmental factors and the brain. This webinar unpacked variables such as climate change and chemical pollutants as risk factors for neurological disorders.

Esteemed neurologists from around the world spoke at this event, including Dr. Mohammad Wasay, who moderated the webinar, Dr. Wolfgang Grisold (WFN president), Dr. Gustavo Roman (ENSG president), Dr. Jacques Reis, Dr. Anna Ranta, Dr. Peter Spencer, Dr. Philip Landrigan, Dr. Serefenur Ozturk, Dr. Augustina Charway Felli, Dr. Hidehiro Mizusawa, Dr. Teresa Corona, and Dr. Alla Guekht.

Of the many themes discussed, Dr. Reis elaborated on environmental challenges that society faces and the neurologists’ role as the climate changes. He specifically examined the correlation between climate change and an increase in neurological diseases. He said that according to the World Economic Forum Davos: The Global Risks Report 2022 — climate action failure, extreme weather events, and biodiversity losses will likely be the most concerning global risks over the next decade. Further, Dr. Anna Ranta conferred the benefits of green spaces on vascular brain health. There is evidence that exposure to green spaces has a positive impact on stroke prevention, severity, and mortality. Dr. Peter Spencer discussed the climate-relevant neurotoxic botanicals linked with human motor-neuron diseases such as Lathyrus sativus, Cycas micronesica, Manihot esculenta, and Gyromitra esculenta. He demonstrated that these botanicals can be linked to certain neurological diseases such as Lathyrism, Cassavism, and Amyotrophic Lateral Sclerosis-Parkinsonism-Dementia Complex.

Dr. Philip Landrigan spoke about climate change, chemical pollution and the developing human brain. There is growing evidence that toxic chemicals can cause neurodevelopmental disorders in children, since they are more sensitive to chemicals in the environment compared to adults. Dr. Landrigan also expressed that there may be countless unrecognized chemicals causing neurotoxicity in children. He stated a great example of how lead was removed from gasoline, which was known to cause neurotoxicity. The benefits for this action included a 2- to 5-point gain in population mean IQ and a $200 billion annual economic benefit to the U.S. through increased economic productivity of more intelligent and creative children, simply by removing one neurotoxic chemical from the environment. Dr. Gustavo Roman shared lessons learned from COVID-19 from an environmental point of view.

Dr. Wolfgang Grisold concluded the program by emphasizing the importance of this discussion in our everyday lives. This enlightening webinar encourages future research that assesses the correlation between environmental factors and neurological conditions.

Dr. Serefnur Ozturk (ENSG vice president) emphasized policy changes to improve air pollution and brain health. Dr. Augustina Charway (African Academy of Neurology president) discussed brain health challenges in Africa. •

Mohammad Wasay is Alicharan Endowed Professor of Neurology, Department of Medicine, Aga

Khan University, Karachi, and Secretary General, Environmental Neurology Specialty group, WFN.

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