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Letter from the Editors

Steven L. Lewis, MD, Walter Struhal, MD

We would like to welcome all neurologists worldwide to the September/October 2021 issue of World Neurology. The issue begins with the President’s column, where WFN President Prof. Bill Carroll discusses the upcoming WCN, opening within days of the publication, and the important role of the WCN in the WFN.

Next, Kimberly Karlshoej, WFN strategy and program director, and on behalf of multiple contributors, updates us on the Intersectoral Global Action Plan (IGAP) on Epilepsy and Other Neurological Disorders of the WHO.

Prof. Wolfgang Grisold provides another informative report on the WFN Committees and Specialty Groups, with this issue’s report providing us with an update on the Constitution & Bylaws Committee and the Neurosonology Specialty Group. Prof. Gagandeep Singh and colleagues then discuss their recent publication of the India State-Level Disease Burden Initiative, reporting on the trends of the burden of neurological diseases across the states of India from 1990 to 2019.

Dr. Imane Hajjaj, from Morocco, provides us with a report of her successful and informative (pre-COVID-19) visit to Istanbul, Turkey, as part of the WFN Department Visit program. In this issue’s History column, Prof. JMS Pearce discusses the development of the concept of the extrapyramidal system. Next, María Jimena Alemán, a medical student from Guatemala, reviews the book One by One by One, by Dr. Aaron Berkowitz, about the author’s experience providing much-needed neurologic care in Haiti.

Finally, Dr. David Steinberg provides a heartfelt obituary, reprinted with permission from the Journal of the Neurological Sciences, on the life of Dr. George K. York III, neurologist and historian of neurology.

Thank you for your interest in World Neurology, and we look forward to “seeing” so many of you at the WCN2021, starting Oct. 3! •

From the Editors

Steven L. Lewis, MD, Walter Struhal, MD

We would like to welcome all neurologists worldwide to the July-August issue of World Neurology. This issue begins with the important and sobering update by Dr. Chandrashekhar Meshram about the epidemic of rhino-orbito-cerebral mucormycosis occurring within the COVID-19 pandemic, including its current treatment recommendations.

On a more uplifting note, WFN President Prof. William M. Carroll provides us a number of important updates in his President’s Column, including the ongoing festivities for this year’s World Brain Day, the exciting plans for the World Congress of Neurology just a few short months away, and the Annual General Meeting of the Council of Delegates of the WFN.

WFN First Vice President, Prof. Ryuji Kaji also provides an update on the four candidate cities for World Congress of Neurology 2025. This is followed by the statements from each of these candidate cities: Beijing, Brisbane, Istanbul, and Seoul. Following these proposals are the statements from each of the candidates for WFN elected trustee, first vice president, and president.

In this issue’s history column, Prof. Peter Koehler provides a detailed analysis of the likely migraine occurring in the renowned scientist, Christiaan Huygens. And in his ongoing column, WFN Secretary General Prof. Wolfgang Grisold updates us on the activities of the WFN Finance Committee and the Specialty Group on Neuroepidemiology.

Profs. Satish Khadilkar and Sarosh Katrak describe the history and evolution of the highly successful AAN-WFN Continuum Program in Mumbai, and its recent conversion to a digital format. Prof. Mustapha El Alaoui-Faris details his look back on eight years of experience successfully training Sub-Saharan African Neurologists at the WFN Training Center in Rabat, and provides his thoughts for further optimization of these educational efforts. Dr. Lawrence Robbins provides a personal view of setting up a neurology clinic in Central America, and advice for others considering such volunteer opportunities.

Finally, Prof. Aida Kondybayeva updates us on the details of the recent and highly successful neurology Online Update meeting held in Kazakhstan.

Thank you for your interest in World Neurology and the many activities detailed in these issues. We look forward to seeing so many of you attending the upcoming World Congress of Neurology this October. As always, we look forward to your contributions to this publication, including updates on the many recent and ongoing activities of this year’s World Brain Day. •

WCN 2025 List of Candidate Cities Finalized

By Ryuji Kaji MD, PhD

Ryuji Kaji MD, PhD

Ryuji Kaji MD, PhD

The World Congress of Neurology will be held virtually Oct 3-7, 2021, in Rome. Thank you for submitting more than 2,000 abstracts, which are very high in quality scientifically and clinically. WCN 2023 is scheduled from Oct 13-19 in Montreal, Canada.

The venue of WCN 2025 will be selected from Asian-Oceanian cities by electronic voting by the council of delegates this year. The winner will be announced at the online Annual General Meeting just before WCN 2021.

Since the conventional site visits by the committee members were not possible because of the pandemic, we had to carefully scrutinize the documents and information provided by the host societies to determine the finalists with the help of Kenes, our Professional Congress Organizer (PCO).

I am now respectfully reporting four cities as finalists: Brisbane, Australia; Seoul, South Korea; Beijing, China; and Istanbul, Turkey. Congratulations to all! Evaluation of these cities will be announced later by Kenes.

Each candidate society produced a statement detailing and promoting the bid, which is published in this issue of World Neurology, as well as a five-minute video version of the bid which is displayed on the WFN website in the period before the WFN member societies vote on the 2025 venue.

I wish good luck for all the candidates! •

Ryuji Kaji, MD, PhD, is chair of the Congress Committee and is first vice president of the WFN.

 

XXVII WORLD CONGRESS OF NEUROLOGY CANDIDATE COUNTRY

Beijing, China

Members of the Chinese Society of Neurology (CSN) are keen to host the XXVII World Congress of Neurology (WCN) in 2025 in Beijing. It will give the CSN great honor to welcome their colleagues worldwide to participate this prestigious event, for the first time, in China.

Chinese Society of Neurology: A Brief Introduction

With 14 branch societies and 700,000 members, CSN is a non-profit national social organization established in 1910 and has the institutional aim of promoting scientific research, clinical prevention, diagnosis, and treatment of neurological diseases. CSN is now the largest and most well-known society with a focus on neurology in China. CSN plays a leading and active role in the nation’s medical education, training, and professional exchanges in the area of neurology and brain health.

Outlook to World Congress of Neurology 2025

CSN will strive to deliver a high-level XXVII WCN for neurologists, scientists, practitioners, and experts to share academic achievements, participate various education and training activities, and translate scientific advances into action all over the world. By closely collaborating with World Federation of Neurology (WFN), national and international academic organizations and media, CSN will also be committed to distribute updated knowledge from WCN 2025 to various countries around the world.

During the XXVII WCN, we are going to address a wide range of new global neurological challenges, highlighting the challenges of diagnosis and treatment for neurological diseases in developing countries and potential solutions. We would also like to provide opportunities for members of the community to have immersive and personalized experience of scientific research and clinical practice in China by visiting our hospitals and research institutes in Beijing. We aim to bridge global resources and build international clinical and scientific networks to facilitate local and international collaborations, and, ultimately, accelerate neurological research and therapy.

Positive Impact on Chinese Neurological Community

China is the most populous and the largest developing country in the world, with a population of 1.4 billion. While they have made some impressive progress, more efforts are needed to meet the challenges posed by an aging population—the most vulnerable group to neurological diseases. XXVII WCN in 2025 will provide an extraordinary opportunity to bring together both local and international scientists, clinicians, public health experts, and policy makers to promote health and address the urging need to alleviate the epidemic of neurological diseases in China.

Extensive Experience in Organizing Conferences

CSN holds more than 20 academic conferences each year, the largest of which is an annual neurological meeting that attracted about 8,000 participants nationwide in 2019. Prof. Yongjun Wang, the president of CSN and president of Beijing Tiantan Hospital, and his team are also experienced in organizing international congresses. The most well-known is Tiantan International Stroke Conference, which has been held annually since 2000 with about 10,000 delegates attending.

Fantastic Venue and City

China National Convention Center (CNCC), the proposed conference venue, covers an area of 270,000 square meters, with a construction area of 530,000 square meters, and has enough capacity to hold large-scale conferences. CNCC is right next to the Bird Nest Stadium (China National Stadium for the 2008 Olympics opening and closing ceremony) and is suitable for viewing the beautiful scenery of Beijing. Around CNCC, there are plenty of luxury and comfortable hotels to accommodate enough attendees. CNCC is 25 km away from the Bejing Capital Airport, which is convenient to travel to and from most countries.

Beijing is China’s capital city, with over 21 million residents with an administrative area of 16,410 km2. With its history of more than 3,000 years, combining both modern and traditional style, Beijing has become a global city and one of the world’s leading centers for culture, education, and science and technology. By the end of 2019, there are 11,311 medical and health institutions, including 733 hospitals and about 100,000 practicing (assistant) physicians.

This bid has received overwhelming support from the entire CSN. We pledge to make sure the conference is successful, and the stay of doctors, researchers, and guests in Beijing an enjoyable and memorable experience. •

 

XXVII WORLD CONGRESS OF NEUROLOGY CANDIDATE COUNTRY

Brisbane, Australia

It is with great anticipation and excitement that the Australian New Zealand Association of Neurologists (ANZAN) submits this bid for the 2025 World Congress of Neurology (WCN) to be awarded to Brisbane.

Australia and New Zealand are proud multicultural nations. Approximately 50% of our populations are born overseas or born to parents of overseas origin, many from the Asian and Oceanic region. This gives us a unique understanding of and ability to cater to the needs of the regional and international neurological community.

Australia and New Zealand have a tradition of excellence in neurology and have contributed to major advances in understanding of neurological disease through strong national and international collaborations, in both basic and clinical research.

Education is the most important aim of the conference. Our members are well placed to help design and deliver a high-quality program that is diverse and inclusive of both local and international experts and registrants, and of young speakers. We would advocate for topics that are of relevance and interest to our region and also of global relevance. These are sessions on indigenous health, led by indigenous members of the scientific community, and climate change. Climate change is a critical issue in Oceania, whose islands are predicted to suffer catastrophic effects from rising sea levels. We will highlight the importance of this issue by ensuring and advertising that the meeting is carbon neutral.

Australia is experienced in holding large-scale international scientific meetings and will offer our unique antipodean hospitality. We will contribute a strong local flavour to the meeting by drawing on our unique indigenous cultures and our vibrant local music and entertainment.

Brisbane is a superb place for a conference. It receives direct flights from the Americas, Europe, and Asia. The Brisbane Convention and Entertainment Centre (BCEC) is in the heart of the city, with hotels of all grades within easy walking distance. The BCEC is modern and well-designed, with beautiful theatres and spaces, and a collection of superb Australian aboriginal art. The BCEC was voted the World’s Best Convention Centre in 2016-2018. In 2014, it was selected to host the G20 summit (the “best ever”). It has a dedicated “dietary requirements” kitchen that can satisfy all cultures and needs.

The BCEC is close to parks, museums, theatres and restaurants, and the riverside district. delegates can easily walk or cycle along the river. WCN will ‘own Brisbane’ for the week – signs in the airport, banners in the streets and lit-up buildings will welcome delegates to our city, and also highlight to the public the importance and value of neurological sciences. We have identified a range of striking locations for the official dinners and, to showcase Australia and New Zealand cuisine and culture, we are already planning a spectacular event for all delegates.

The bid, if successful, will be supported by nearly $1 million in funding from city, state, and federal government, mitigating the risk of hosting the WCN.

The World Federation of Neurology has a goal of increasing access to neurological services, and the congress regularly offers support to neurologists from low-income countries. In addition, to advance neurology in our region, ANZAN will invite, as our sponsored guests, the physicians who care for neurological patients in Oceania. We anticipate this will lead to significantly increased personal connections among our nations, and provide pathways for neurology training.

Furthermore, as a legacy, any profits from the Congress will be used for education in our region. ANZAN already has a category of membership for neurologists from low-income countries and though our Asia-Pacific committee has a diverse programme of teaching, that will be extended to become a lasting benefit of holding the WCN in Brisbane.

Australia and New Zealand are a unique pair of countries that are worth exploring. The Australian aboriginal people have the world’s oldest living culture, and the indigenous peoples of New Zealand and the Oceanian region have a rich Polynesian culture. Visitors can also explore our cities, beaches, deserts, reefs and rainforests. All the important sites can be reached easily from Brisbane.

As additional arguments in favor of our bid, we point out that the ability of Brisbane to host major events is recognized by its listing as the preferred host for the 2032 Olympic games. Furthermore, the WCN has been held in the Southern hemisphere on only three previous occasions. The ability to highlight and advocate for neurological sciences would provide benefit to our region by locating the Congress once again in the southern hemisphere. •

 

XXVII WORLD CONGRESS OF NEUROLOGY CANDIDATE COUNTRY

Istanbul, Turkey

On the behalf of the Turkish Neurological Society, it is a great pleasure and honor for us to submit this letter of intent to the World Federation of Neurology (WFN) to host the World Congress of Neurology in 2025, in Istanbul.

The Turkish Neurological Society was established on May 12, 1992, as a separate society. The aim of our society is to increase awareness of neurological diseases in Turkey, to investigate the impact of neurological diseases on public health, to make preventive studies, and to improve education and research facilities of professionals related to neurology. Moreover, increasing the recognition of neurological diseases, improving the diagnostic and therapeutic interventions with the collaboration of related fields including child neurology, neurosurgery, psychiatry, radiology, cardiology, physical treatment and rehabilitation, ophthalmology, and otology are accepted as the main goals. In addition to neurologists acting as our full members, we have psychologists, physiotherapists, nurses, and medical students acting as associated members who work together to catch the target. The overall number of members is around 2,600 at the time being who will be looking forward to attending the World Congress of Neurology, which will be held in their country.

Istanbul, as Turkey’s most populous city a cultural and financial center, bridges Europe and Asia both physically and culturally. From this point of view, one may easily recognize its unique location in connection with the opportunities it presents regarding international events and organizations. The city is offering an outstanding infrastructure in the framework of the conference and exhibition venues, best accommodation alternatives with almost 112,000-bed capacity and over 222 five- and four-star hotels, Istanbul offers a variety of options, including top international and domestic hotel brands, at a variety of price points. In the widest price range, and most enjoyable social event opportunities together with cultural and historical aspects belonging to the times where Istanbul used to be the capital of three ancient empires: Roman, Byzantine, and Ottoman Empires. Istanbul is an ideal city to convene congresses with 100 to 30,000 or more participants.

The city is home to seven convention centers and three exhibition centers, each capable of hosting major events with thousands of delegates. Istanbul has four independent meeting clusters spread around the city—The Congress Valley, the Golden Horn, the Airport Area, and the Asian side.

Istanbul Congress Center is located in the city center and covers an area of 120,000 m2 on a total of eight floors, which includes a 3,705-pax auditorium, meeting halls, and exhibition areas. It is only at a walking distance from a wide range of hotels, restaurants, and attractions.

Istanbul is considered one of the main air traffic hubs connecting many international airlines from Europe to Middle East, Asia and Africa and served by more than 50 airlines from all parts of the world. Travel time to Istanbul from all major cities of Europe is between two and three hours. The national carrier of Turkey, Turkish Airlines (THY) has branches in almost all of the European countries also member of Star Alliance. Most of the countries’ citizens may obtain their visa at the airport upon arrival.

As a strong verification to its prestigious ranking Istanbul hosted conferences in recent years that received praise from all sides. Some of the main congresses are World Dental Congress FDI, with 15,000, International Congress of the European Academy of Dermatology and Venereology EADV hosting 8,100 delegates, EFNS-ENS Joint Congress of Neurology with 5,000, Ninth World Stroke Congress WCS with 2,500 can be counted within the prestigious meetings that Istanbul hosted.

We believe that the World Congress of Neurology will be an excellent opportunity for academic and scientific exchange among neurologists from all over the world, with the reasonable and attractive costs that will be committed. It will be a great facility for thousands of neurologists not only from Turkey but also from the region to attend this organization at the southeastern part of our continent. With your great support and our experience, our goal is to make the World Neurology Congress 2025 a glorious, unforgettable event.

We look forward to welcoming you to Turkey. We would be honored to receive your support to organize this event in Istanbul in 2025.

Let us meet where the continents meet. •

 

XXVII WORLD CONGRESS OF NEUROLOGY CANDIDATE COUNTRY

Seoul, South Korea

Seoul, the capital of South Korea, is a city where both modern and traditional cultures coexist. Remnants of history are seen among modern architecture in this mega-city. Whether for business or leisure, travelers can enjoy this global city steeped in tradition and history. Traveling to Seoul is convenient with visa-free entry for 112 countries and direct flights to and from 108 cities and 54 countries. In addition, the city is considered to be one of the safest in the world, with the highest safety and lowest crime index in 2016. Furthermore, because Seoul is accessible and safe for locals and tourists, the Union of International Associations has recognized it as one of the top three convention cities for five consecutive years. Coupled with Korea’s highly successful response to the COVID-19 pandemic and its continuous efforts to safeguard its citizens and tourists, Seoul is the perfect place for people to come together for mutual exchanges of ideas through international conventions.

We propose to hold the 2025 World Congress Neurology (WCN 2025) at COEX, a global convention center located in Gangnam, the heart of modern Seoul, where major technological hubs are clustered. COEX has a subterranean design that combines vibrant spaces with state-of-the-art facilities, and we anticipate using approximately half of the venue for the event. The venue’s design and layout will provide ample space for academic and scientific activities, including lectures and sessions as well as social events. Numerous international conferences, such as the G20 Seoul Summit and the Asia-Europe Summit (ASEM), have been successfully held at this venue. COEX is surrounded by hotels, Duty-Free shops, banks, a large department store, and emergency facilities, such as hospitals and police and fire stations. In addition, COEX has Asia’s largest underground mall with over 300 stores and restaurants, a movie theater, a library, and even an aquarium. The variety of activities COEX offers allows participants to unwind after a day of scientific pursuit and networking. They may opt to go shopping, take a stroll in nearby parks, visit a spa, or enjoy their entertainment of choice.

Additionally, traveling to and from the venue and airport—anywhere within Seoul—is convenient thanks to an abundance of taxis and mass transportation, including the subway and bus. Participants can quickly get around the city and fully enjoy its culture, history, aesthetics, and architectural design. Therefore, we anticipate that hosting the event at COEX will provide an overall unforgettable experience for all.

Inspired by the World Federation of Neurology’s steadfast drive despite the many difficulties the COVID-19 pandemic posed, the Korean Neurological Association (KNA) is more committed than ever to support the growth, knowledge, and innovation of the neurological society by ensuring the successful organization of this premier educational event.

We believe that this could take place in the heart of Seoul and wish to extend our support and enthusiasm moving forward. Furthermore, we hope that by hosting this event, we will pave the way for a more robust network among the various international neurological societies, including the KNA, to achieve high-quality neurologic care. Although the association is a relatively new society founded in 1982, we have extensive experience hosting major scientific meetings over the last decade. Specifically, we have successfully hosted 2,600 participants at the World Stroke Congress 2010 and 1,600 participants during the 2018 AOCN (the most attended AOCN meeting), both in Seoul. Thus, the KNA is more than capable of organizing and hosting such a big conference while ensuring that participants enjoy both the Congress’s scientific programs and social events, as well as any leisure activities.

In Seoul, our fellow World Federation of Neurology members will surely enjoy furthering themselves in pursuing the skills and knowledge needed in neuroscience. Moreover, they will also enjoy socializing with locals and fellow convention attendees; enjoy authentic Korean cuisine; explore the country’s culture, local activities, shopping, and everything in between. We believe that Seoul is suitable for the WCN 2025 and hope you will strongly consider our capital for the future conference. •

Candidate Statement for Elected WFN Trustee

Alla GuekhtAlla Guekht

It has been a tremendous privilege to serve as Elected Trustee of the World Federation of Neurology with the rich tapestry of more than 120 national societies and hard work of the most talented professionals in neurology in the world. It was a great honor to be able, especially at the challenging times of COVID-19 pandemic, to contribute to achieving the WFN mission to foster quality neurology and brain health.

As the trustee of the WFN, I have become integrated into its outstanding multifaceted work. I have learned so much from our president, esteemed colleagues in the Board of Trustees, WFN committees, regional and national organizations, neurologists from many countries of the world, and the WFN staff members.

In my role as the WFN trustee, I contributed to the successful development of the collaboration with the WHO. Adoption of the Resolution WHA 73_R10: Global Actions on Epilepsy and Other Neurological Disorders was the landmark event and unprecedented recognition of the global importance of these conditions; the WHO made a commitment to develop a 10-year Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and to include in this plan “ambitious, but achievable, global targets on reducing preventable cases of, and avoidable deaths …, strengthening service coverage and access to essential medicines, improving surveillance and critical research and addressing discrimination and stigma.” The WFN, in collaboration with the International League Against Epilepsy, the International Bureau for Epilepsy, the International Child Neurology Association and European Federation of Neurological Associations, powerfully advocated for this resolution, actively participating in the 71st and 72nd WHA and the 146th WHO executive board meeting, where the historical decision to discuss a possible draft resolution on further action on epilepsy and other neurological disorders had been made.

Notably, WFN actively supported the WHO actions aimed on prevention and treatment of non-communicable disorders, and, indeed, productive collaboration with the WHO strengthened the Global Neurological Alliance.

As the WFN trustee, I have been deeply involved in the WHO COVID-19 NeuroForum and NeuroResearch Coalition, co-chairing the WHO NeuroForum follow-up and long-term impact working group, which meaningfully contributed to the creation of the WHO Case Report Form for Post-COVID conditions and is working on several important projects on prevention and care of patients with its neurological manifestations.

I worked in the WFN Membership Committee, communicating with several neurological societies, and bringing them closer to the WFN as the potential new members. I was privileged to contribute actively to the WCN.

I feel very much honored to be nominated for the re-election. During my term as WFN trustee, I have become aware of both the exciting opportunities as well as the significant challenges facing the global neurological community. If re-elected, I will continue to serve faithfully to the WFN, working diligently, fostering partnership with national, regional, and international neurologic societies and disease-based organizations, further developing collaboration with the WHO in order to assist the WFN to achieve its mission to improve neurological care, education, and research worldwide. •

Candidate Statements for First Vice President

Riadh GouiderRiadh Gouider

I trained at the Charles Nicolle Hospital in Tunis, and in La Pitié Salpêtrière Hospital in Paris. This mixture of learning and training encouraged me to explore global neurology.

My journey with the World Federation of Neurology (WFN) began in 1993 during the 15th World Congress of Neurology (WCN) in Vancouver. Since then, my enthusiasm and commitment to WFN has never wavered.

Being the national delegate of the Tunisian Society of Neurology for almost a decade (2005-2015) showed me how important a delegate can be as a crucial link between his national society and the international neurology community.

Appointed as a regional director for Pan-Arab region from 2008-2010 and regional director Africa from 2012-2015 taught me the crucial role of the six regions in WFN strategy and actions, especially when the neurology resources are scarce.

To support the WFN in its mission to promote global neurological education and training, I participated in the accreditation of three teaching centers : Rabat, Dakar, and Cairo.

Lately, I had the honor to be designated as the convenor of the first WFN/AFAN e-Learning Day, which took place in October 2020, the second will be held in November 2021.

My involvement on several committees of WFN: as a co-chair of the e-Learning Task Force, the Education Committee, the specialty groups, and the e-Communication Committee, provided me with invaluable insight into those committees’ functions, the development of their activities, and their positions within WFN.

The most important influence was my election for two terms as an elected trustee from 2014 to 2020. This position filled me with a strong sense of pride and gave me the chance to significantly contribute to the challenges the WFN has faced and the opportunities to participate in the activities of the WCN meetings.

I have had the honor of serving the WFN through a variety of roles.

I feel that I am experienced and honored to stand for the role of first vice president.

If elected, I pledge to support the mission of the WFN to contribute to the advancement of teaching and practice of neurology throughout the world.

I will focus on:

– Provision of access to quality training programs and teaching materials to neurologists, trainees, and health care professionals from all over the world through the e-learning capabilities.

-Creation of more teaching centers all over the world, especially Africa, Central and Southeast Asia, Latin America, parts of Eastern Europe, providing equal educational opportunities in regions with fewer neurologists.

-Strengthening relations among south and north countries and be an active contributor to the dissemination of information and scientific progress.

To further empower and strengthen the links of communications between WFN and regional organizations.

Enhance the cooperation of WFN with international organizations such as the WHO and neurological NGOs.

My fellow delegates, I am asking for your vote to be elected as first vice president. Regardless the results of the election, I promise to continue working for the WFN with the same enthusiasm and commitment. •

 

Gustavo Román

I was honored by my nomination as candidate for vice president of the World Federation of Neurology (WFN) from the American Academy of Neurology and neurologists from Colombia, my homeland, Brazil, Chile, Honduras, Panama, Uruguay, Spain, and France.

My mentor, Prof. Charles Poser, who served as editor of World Neurology in 1960 instilled in me the importance of the WFN in a globalized world. Over four decades, I served two terms as elected trustee of the WFN and participated in numerous activities.

I was born in Colombia and as an intern encountered the challenges of neurologists working in tropical countries: confronting formidable diseases with minimal diagnostic tools and a limited therapeutic arsenal. With a scholarship, I studied at the Salpêtrière in France and learned the enduring value of clinical neurology and neuropathology. Back in Colombia, I was appointed neurology faculty and wrote two textbooks: Practical Neurology and Tropical Neurology.

I joined Texas Tech University as professor of neurology and interim chair of neurology. In 1990, I was appointed chief of neuroepidemiology at the National Institutes of Health (NIH). I published HTLV-1 and the Nervous System; contributed to the diagnostic criteria for vascular dementia and guidelines for epidemiological studies on epilepsy; I co-authored Neurocysticercosis: A Clinical Handbook and participated in a multinational study of epidemic neuropathy in Cuba. I chronicled this experience in the book Cuban Blindness: Diary of a Mysterious Epidemic Neuropathy.

I returned to teaching at the University of Texas San Antonio as professor of neurology, medicine (geriatrics), and geriatric psychiatry and established the Alzheimer Disease Clinic. In 2010, I was selected the “Jack Blanton Endowed Chair” to organize a new memory center at Methodist Neurological Institute where I currently serve as professor of neurology, Weill Cornell Medical College, New York, and Texas A&M College of Medicine.

At the beginning of the pandemic, in early 2020, as chair of the environmental neurology specialty group of the WFN, I proposed creating international neurological registries of COVID-19 among neurological societies worldwide (Lancet Neurology 2020;19:484). With the group, I wrote the first comprehensive review on the neurology of COVID-19 (J Neurol Sci 414 (2020) 116884). These efforts resulted in the formation of scientific groups, such as the global COVID-19 Neuro Research Coalition (Ann Neurol 2021;89:1059).

As vice president of the WFN, I pledge to continue addressing the needs of neurologists worldwide during this pandemic, with emphasis on education and accessibility to scientific information to better serve neurological patients. Nontraditional methods and creative solutions such as telemedicine that have proven effective during the pandemic may have myriad applications in regions of the world with few neurologists.

We must be ready for future challenges, and the WFN is the only institution capable of serving as link of union and coordinating core for neurologists around the world. As vice president, I pledge to advance the goals and mission of the WFN in forging the future of neurology around the world. •

 

Guy Rouleau

I am honored that the Canadian Neurological Society (CNS) has nominated me for the position of WFN first vice president.

Following medical school at the University of Ottawa, I did neurology training at McGill University and research training at Harvard (PhD 1989). I then began my career as a clinician-scientist at McGill. In 2004, I moved to the University of Montreal as director of research at Ste‐Justine Hospital. I returned to McGill in 2013 as chair of the department of neurology and neurosurgery, and director of the Montreal Neurological Institute-Hospital (MNI). My work focuses on genetic diseases of the brain, and I have published over 800 articles in peer‐reviewed journals and have been cited over 85,000 times.

I collaborate with neurologists from every continent. Among many other international activities, I co-organized two Congrès de Neuroscience du Mali à Bamako, and I lead a project in Shenzhen, China, assisting the development of advanced therapies for epilepsy and movement disorders. I initiated the WFN-Neurological Institute-Canadian Neurological Society Departmental Visit program for young South American neurologists. The MNI funds these visits and provides the training. We are organizing a similar program for young African neurologists. As Canadian delegate to the WFN for six years, I know the organization well. In that role, I helped the CNS make a successful bid to host the 2023 WCN in Montreal. As WFN first vice president, I would be ideally positioned to contribute to the success of this upcoming congress.

I hope to increase the WFN’s impact on the practice of international neurology. The advent of the internet, social networks as well as accelerated medical discoveries, bring rapid, constant change requiring that organizations regularly reassess their structures and modes of operation.

As first vice president, I would recommend establishing a task force to make recommendations about how to:

Modernize: Currently, the president is elected quadrennially. The past president has no official role, leading to a loss of experience and talent. To ensure continuity, most professional organizations have a president-elect, president, and past-president. This structure could be explored.

Democratize: We need to find ways to ensure that younger people are more engaged and better represented within the WFN. The WFN must be relevant to neurologists of all ages and professional stages. The gender balance and diversity in the WFN’s leadership must also be improved.

Open: The impact of the open sharing of information is growing and has been accelerated by the COVID-19 pandemic. Sharing of information in medicine must become the norm. The WFN should adopt the open science ethos to allow equal access to information, ensure transparency, reproducibility, and equity. Under my leadership, the MNI has become a world leader in open science. Experience and methods developed there can help the WFN facilitate the spread of open science in the world of neurology.

On a personal level, I have spent nearly 40 years practicing neurology. I remain fascinated by the work we do, and I feel I still have much to contribute to our field. •

Tour Through the WFN Continues

The Finance Committee and the Specialty Group on Neuroepidemiology

By Wolfgang Grisold

Wolfgang Grisold

Wolfgang Grisold

In this issue of World Neurology, we would like to continue to introduce you to one committee and one specialty group. The committee/specialty group is introduced by the respective chairs, who were asked to explain their tasks and activities to our membership. Further details, such as the list of committee/specialty group members can be found on the WFN website, as well as email addresses of the chairs and members, which will be helpful if you want additional information.

The Finance Committee

Bo Norrving

Bo Norrving

The Finance Committee is chaired by Prof. Bo Norrving. He is senior professor in neurology and a consultant neurologist at Lund University Hospital in Sweden. He has been active in several functions in the WFN oven many years. He has a long experience in governance and leadership of scientific societies, including being president of the World Stroke Organization.

The Finance Committee has several experienced members with a global representation. The task of the WFN Finance Committee is to regularly review the economic strategies and financial situation of the WFN, functioning as an independent body from the WFN executives. The Finance Committee identifies strengths, weaknesses, opportunities, and threats for the WFN, and tries to look into the future taking the global economic situation, and environmental and political issues into account.

The committee also considers the need for adaptations of WFN educational and training activities related to information technology issues, educational tools, and practical issues. The committee helps to ensure that the WFN has a strategy to maintain an economic corpus that is a sufficient reserve for any upcoming disruptions and other threats. In particular, it is essential to have a sustainable balance to support future core projects (fostering best neurological practices, education, and research) and maintaining reserves in case of a downturn in congress income in the future. For this purpose, the assets are composed of short- to medium-term working capital and a longer-term reserve fund. WFN finances and corporate structure are regularly audited.

Over the years, the views of the Finance Committee and those of the trustees have been in excellent agreement. The committee acknowledges the careful strategic planning that has been in constant function at the WFN leadership over the past decades and continues into the future.

Specialty Group on Neuroepidemiology

Carlos N. Ketzoian

Carlos N. Ketzoian

The Specialty Group on Neuroepidemiology is chaired by Prof. Carlos N. Ketzoian, neurologist, epidemiologist, and neurophysiologist from the Neuroepidemiology Section, Institute of Neurology, University Hospital, School of Medicine, Montevideo, Uruguay. (carlosk@mednet.org.uy). He has been chairing and researching in several neuroepidemiology activities, is the past-president of the Pan American Society of Neuroepidemiology, and participates in national and international scientific activities. He is also a member of the editorial board of neuroepidemiology.

The Specialty Group on Neuroepidemiology has a long history in the WFN. The proceedings of the group are oriented toward activities of teaching, research, and presentation of neuroepidemiologic results in academic activities, either in the congresses of the WFN or in congresses in different regions such as the Pan American Congresses of Neurology and Pre-Congress Symposia organized by the Pan American Society of Neuroepidemiology.

At the WCN 2021, a scientific session on neuroepidemiology will take place themed “The impact of socio-demographic, economic, and cultural factors on the epidemiology of neurological disorders (WFN Specialty Group on Neuroepidemiology)” on Oct. 6, 2021, in Rome, which is now a virtual meeting.

Research courses and projects have been developed for low- and middle-income as well as high-income countries, favoring a North-South interaction and collaboration. This has had a positive impact on the training of human resources in the area of neuroepidemiology.

Future projects will offer neuroepidemiology training activities in low-income countries. The II Latin American Neuroepidemiology Course scheduled for March 2020 has been postponed without a still-confirmed date of completion given the COVID-19 pandemic global situation. The current situation will need adaptation and virtual as well as hybrid courses will need to be implemented. •

Neurology Update in Kazakhstan 2021

By Aida Kondybayeva, MD, PhD

Aida Kondybayeva

Aida Kondybayeva

The International Educational Online Forum: Neurology Update in Kazakhstan was held April 23-24, 2021. Forums of this scale in Kazakhstan are held every two years, and this forum was being held online for the first time. The event was attended by 985 doctors, including neurologists, internists, GPs, rehabilitation specialists, and intensive care specialists from Kazakhstan, Kyrgyzstan, Uzbekistan, Belarus, and Ukraine.

At the first day within the framework of the International Educational Online Forum: Neurology Update in Kazakhstan, the EAN-Day in Kazakhstan was held. This event was held with the joint work of the European Academy of Neurology, Kazakh National Association of Neurologist Neuroscience, and al-Farabi Kazazakh National University.

Welcoming speeches to the participants were given by Prof. Saltanat Kamenova, president of KNANN; Nadezhda Petuhova, chair of the Public Council of the Ministry of Health of the Republic of Kazakhstan; Prof. Raushan Isayeva, director of High School of Medicine, Faculty of Medicine and Health, al-Farabi Kazazakh National University; and Mikhail Mazurchak, vice president of KNANN. They noted the special significance of the EAN-Day in Kazakhstan for all practicing doctors who took part in this event.

The speakers of the EAN-Day in Kazakhstan were Prof. Aksel Siva from the Department of Neurology of Istanbul University, Cerrahpaşa School of Medicine (Istanbul Turkey); Prof. Erik Taubøll from the Department of Neurology Oslo University Hospital (Oslo, Norway); and Prof. Maxwell Simon Damian, Department of Medicine, Cambridge University (Cambridge, UK).

The professors presented reports on the situation with MS, epilepsy, and neuromuscular diseases before and during the COVID-19 pandemic; these presentations aroused great interest among all participants of the event.

Luca Caffaro, the youngest speaker of this event, presented an interesting report on the work of the Residents and Research Fellows Section (RRFS) of the EAN, and on professional development opportunities for young neurologists and residents. EAN-Day in Kazakhstan received positive feedback from all registered participants of the event.

In the second half of the event, workshops were held, in which speakers presented analyses of difficult clinical cases and the possibilities of their resolution. The second day, the forum was no less eventful, and included reports of doctors from Spain (Jerzy Krupinski-Bilecki), Afghanistan (Ayesha Khaideri), Ukraine (Sergey Moskovko), Russia (Dmitry Kasatkin, Evgeny Evdoshenko, and Natalia Khachanova), and Kazakhstan (Gulsum Duschanova, Saltanat Kamenova, Gulnar Kabdrakhmanova, Mikhail Mazurchak, Maksharip Martazanov, Karlygash Kuzhibaeva, Aida Kondybayeva, and Asel Aralbayeva). Topics including MS, pain, neuromuscular diseases, and epilepsy were discussed. •

Aida Kondybayeva, MD, PhD, is a neurologist and chair of the Educational Committee at Kazakhstan National Association of Neurologist “Neuroscience” Institutional Delegate of the European Academy of Neurology from Kazakhstan.

 

Cerebral Venous Thrombosis After Vaccination Against SARS-CoV-2

With Information on the International Consortium on CVT Registry

By José M. Ferro, MD, PhD

The public and the global medical community have been exposed since early March 2021, both from the media, the official agencies, and the medical literature, to multiple and often contradictory information, concerning the risk of “uncommon” thrombosis occurring after vaccination against SARS-CoV-2. Most of the news concerned the vaccine manufactured by AstraZeneca and more recently the vaccine from Johnson and Johnson/Janssen. The uncommon thromboses were splanchnic and cerebral venous thrombosis (CVT), mostly the latter.

Mass vaccination is currently humanity’s great hope to control the pandemic. Vaccines were developed, tested, and approved in an incredibly fast pace, about one year since the onset of the pandemic. Administration of a vaccine simultaneously to millions of persons in multiple locations of the world was never done before in human history. Not surprisingly, extremely uncommon side effects of the vaccine, which were not detected in randomized trials of hundreds or thousands of subjects, can emerge when a much larger sample of millions is exposed to the vaccine.

COVID-19 Infection and CVT

CVT was known to occur as a rare complication (0.08%) of COVID-19, accounting for 4.2% of all acute cerebrovascular disease occurring during COVID-19 infection. Several case reports, case series, and systematic reviews of CVT associated with COVID-19 infection have been reported since the beginning of the pandemic 1,2. Both a systematic review2 and a large study based on administrative data from a hospital network3 indicate than the incidence of CVT increased with COVID-19 infection.

CVT can be the initial clinical manifestation of the infection, but the majority of CVTs develop within 13 days of onset of COVID-19 symptoms. Recognized risk factors for CVT are present in only one third of the patients. The main pathophysiological mechanism is related to the hypercoagulable state seen in moderate/severe COVID-19 disease. In fact, CVT patients often have very high D-Dimers, low fibrinogen levels, and low platelet counts. The prognosis is less favorable; namely case fatality (40%) is higher than the non-COVID-19 CVT (5-10%). Management is similar, namely on what concerns the use of parenteral heparin in the acute phase of CVT.

Case Reports and Case Series of CVT Occurring After Vaccination Against SARS-CoV-2

The European Medicines Agency (EMA) approved four vaccines against SARS-CoV-2: two mRNA vaccines from Pfizer and Moderna and two adenovirus vector DAN vaccines from AstraZeneca (AZ) and Johnson & Johnson/Janssen (JJ). The AZ vaccine is not yet approved for use in the United States.

Shortly after the onset of mass vaccination with those vaccines in Europe and in several other countries around the world, there were signals and thereafter publications of case reports and small case series of severe CVT occurring in young women within days of vaccination with the AZ vaccine 4-8. The growing number of those events led several countries to contraindicate the AZ vaccine in young and middle-aged adults, despite the total number of signaled cases being low (<200) as well as the estimated absolute risk of CVT (5 per million vaccinated individuals). In April, a small number of similar cases were reported in the U.S. after the JJ vaccine 9, leading the authorities to temporarily pause the use of that vaccine. A few individuals developed immune thrombocytopenia (ITP) 10 without thrombosis after receiving the mRNA vaccines. There are a few CVTs also reported, but the percentage of CVT occurring after mRNA vaccination is much smaller than for the adenovirus vector DNA vaccines

A striking feature of those cases was the high frequency of thrombocytopenia, which is uncommon in pre-COVID-19 CVT (<10% of the cases). Some other patients had only thrombocytopenia, splanchnic venous thrombosis, or hemorrhagic phenomena, or a combination of those, eventually with CVT. Although most of the emphasis has been placed in the thrombocytopenia, the most serious event, which may be fatal, is CVT. CVT is obviously also the most relevant event to the neurology community.

From the published cases and those signaled to the EMA’s Pharmacovigilance Risk Assessment Committee (PRAC), a clinical profile of CVT associated with the AZ vaccine can be extracted:

  • CVTs occur almost exclusively in women below age 60.
  • Only about one third has traditional risk factors for CVT, such as thrombophilia or use of estrogenic contraceptives.
  • CVT occurs up to 20 days after the administration of the first dose of the vaccine.
  • A high percentage (up to two thirds) has thrombocytopenia; some have high D-Dimers and low fibrinogen.
  • The clinical picture is often of a malignant CVT, with multiple sinus and veins thrombosis, cerebral hemorrhages and oedema, causing herniation, often requiring decompressive craniectomy, as a live-saving intervention.
  • The mortality is high (~25%).
  • Patients with traditional risk factors for CVT do not appear to have an increased risk of CVT after vaccination.

Possible Pathophysiological Mechanisms

Chance association or undetected recent COVID-19 infection are possible, but unlikely, explanations for CVT occurring after AZ and JJ vaccines. They cannot account for the different risk of CVT after each type of vaccine, not for the distinct clinical laboratory profile, as described in the previous section. Moreover, SARS-CoV-2 PCR nasopharyngeal swabs were negative in all the patients, in whom that test was performed (or reported to be performed), and patients only displayed antibodies against the virus spike protein antigen (most probably a vaccine effect) and not against other antiviral antibodies, as expected if they were recently infected.

Shortly after the notice of the first cases of venous thromboses with thrombocytopenia, a group of researchers from Germany, Ontario, and Vienna under the leadership of Andreas Greinacher identified the mechanism of the thrombotic complications of AZ vaccine, which they called “thrombotic thrombocytopenia.” Unfortunately, this label underscores the fact that the main feature of the syndrome is CVT, with the consequent risk of death and disability. Their patients tested positive on a screening platelet factor 4 (PF4)-heparin immunoassay. None of the patients had received heparin before blood for the tests was drawn. Patients also tested positive on a platelet-activation assay in the presence of PF4 independent of heparin. Platelet activation was inhibited by high levels of heparin and immunoglobulin4. They concluded that the vaccine resulted in a rare thrombotic thrombocytopenia mediated by platelet-activating antibodies against PF4, which clinically mimics autoimmune heparin-induced thrombocytopenia (HIT). In recent years, it has been recognized that triggers other than heparin (polyanionic medications, infections, surgery) can also cause a HIT-like coagulopathy, which can also be spontaneous. The pivotal observations of Greinacher et al 4 were confirmed by other researchers11. This post-vaccinial entity is now named vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) or vaccine immune thrombotic thrombocytopenia (VITT).

A similar laboratory observation was found in the cases reported after the JJ vaccine. This finding raises the suspicion that the adenovirus vector could be the initial trigger of antibody production. The adenovirus vector carries negatively charged DNA, which binds to the positively charged PF4. An alternative explanation is the strong inflammatory stimulus of the vaccination or cross-reaction of antibodies produced by the vaccine and PF44. RNA is charged positively, so this immune response is unlikely to occur after mRNA vaccines.

Management of Cerebral Venous Thrombosis Occurring After Vaccination Against SARS-CoV-2

The risk of CVT following AZ vaccine being estimated as only five cases per million vaccinated people, it is evident that no randomized trials are possible to inform management decisions. Evidence comes from case series, analogy with HIT management, and expert consensus statements, and therefore is of low quality. Strong recommendations are not possible and the most sensible option is to produce guidance documents that will be periodically updated, as new evidence is produced.

Vaccinated persons should be informed that they may experience a transient headache a few days after vaccination. If the headache persists or is unusually severe, or they have any other neurological symptom, they should seek urgent medical advice. These patients should be examined by a neurologist.

If the clinical picture is suspicious of CVT, cerebral CT with venography or MR with MR venography should be performed to confirm, or not, the diagnosis of CVT. Meanwhile, a complete blood cell count and film, coagulation tests (INR, APTT, fibrinogen, D-Dimers) and COVID antibodies are obtained.

If CVT is confirmed and platelet count is below 150×109/L, VITT is a possibility. However, if the results of coagulation tests, fibrinogen, and D-Dimers are normal, VITT is unlikely, and the patient can be managed accordingly to the current CVT Guidelines12, namely be treated with low molecular or unfractionated heparin in the acute phase.

On the contrary, if any of those tests is abnormal, VITT is suspected and a HIT Elisa test (capable of detecting PF4 antibodies) should be performed. Consultation with a hematologist is advisable to guide on further testing (e.g., functional HIT assays) and discuss management. Meanwhile, platelet transfusions should be avoided, IV immunoglobulin (e.g., 1 mg/kg for 2 days) be administered, and a non-heparin anticoagulant (argatroban, danaparoid, or direct oral anticoagulants) be used instead of heparin4,11. Endovascular treatment of CVT can also be an option.

The International Consortium on CVT Initiative

From the available evidence so far, it is apparent that CVT after SARS-CoV-2 vaccines can be a heterogeneous group of patients. While most appear to have an immune mechanism (VITT), a few other cases may be coincidental, related to the usual CVT risk factors or even to recent COVID-19 infection. Therefore, a detailed analysis of non-selected CVT cases who developed after any COVID-19 vaccination needs to be performed.

The International Cerebral Venous Thrombosis Consortium (ICVTC) is an existing, global collaboration by academic researchers with the primary aim to perform investigator-initiated research on the epidemiology, manifestations, and outcome of patients with CVT.

Currently, 32 hospitals are participating in the consortium and have already collected data of 1,308 patients with CVT, prior to the COVID pandemic. ICVTC recently launched a prospective registry to report clinical manifestations, laboratory findings, management and outcome of patients with CVT after any COVID-19 vaccination. The registry will include CVT patients with radiologically confirmed CVT, with onset of CVT symptoms within four weeks of COVID-19 vaccination, and informed consent. Principal investigator is Jonathan Coutinho from the Amsterdam University Medical Centers (j.coutinho@amsterdamumc.nl).

Conclusion

Medicine should follow the ethical principle of “Primum non nocere” (first do not harm). However, ethics should also be applied with justice. We must consider that the individual risk of CVT following COVID infection is much higher (6x) than that following any anti-SARS-CoV-2 vaccine3, even without considering the indirect effect of the infection through contagium. Therefore, the fundamental message for the public should focus on the urgent need, safety, and confidence on vaccines.

Epidemiological, clinical, and laboratory research will unveil the multiple remaining unanswered questions on the occurrence of CVT after anti-SARS-CoV-2 vaccines. Meanwhile, neurologists and other health care workers must be aware of this very rare complication of the AZ and JJ vaccines. Management of the occasional CVT patient occurring after those vaccines should follow the most recent guidance statements from national13 and international official agencies and from scientific societies14, which are likely to be updated as evidence grows. Inclusion of those cases in the ongoing International Consortium on Cerebral Vein Thrombosis registry is welcome. •

From the Serviço de Neurologia, Centro Hospitalar Lisboa Norte; J Ferro Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa; Lisboa, Portugal. jmferro@medicina.ulisboa.pt

Inclusion Criteria for the International Consortium on CVT Registry

Patients with cerebral venous thrombosis with:

  • Radiologically confirmed CVT
  • Onset of CVT symptoms within 4 weeks of any COVID-19 vaccination
  • Informed consent, according to local law

For more information, contact Dr. Jonathan Coutinho at j.coutinho@amsterdamumc.nl.

 

References

  1. Dakay K, Cooper J, Bloomfield J, Overby P, Mayer SA, Nuoman R, Sahni R, Gulko E, Kaur G, Santarelli J, Gandhi CD, Al-Mufti F. Cerebral Venous Sinus Thrombosis in COVID-19 Infection: A Case Series and Review of The Literature. J Stroke Cerebrovasc Dis. 2021 Jan;30(1):105434. doi: 10.1016/j.jstrokecerebrovasdis.2020.105434
  2. Baldini T, Asioli GM, Romoli M, Carvalho Dias M, Schulte EC, Hauer L, Aguiar De Sousa D, Sellner J, Zini A. Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis. Eur J Neurol. 2021 Jan 11:10.1111/ene.14727. doi: 10.1111/ene.14727
  3. Taquet M, Husain M, Geddes JR, Luciano S, Harrison PJ. Cerebral venous thrombosis: a retrospective cohort study of 513,284 confirmed COVID cases and a comparison with 489,871 people receiving a COVID-19 mRNA vaccine. In press
  4. Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. N Engl J Med. 2021 Apr 9. doi: 10.1056/NEJMoa2104840
  5. Castelli GP, Pognani C, Sozzi C, Franchini M, Vivona L. Cerebral venous sinus thrombosis associated with thrombocytopenia post-vaccination for COVID-19. Crit Care. 2021 Apr 12;25(1):137. doi: 10.1186/s13054-021-03572-y
  6. Schultz NH, Sørvoll IH, Michelsen AE, Munthe LA, Lund-Johansen F, Ahlen MT, Wiedmann M, Aamodt AH, Skattør TH, Tjønnfjord GE, Holme PA. Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021 Apr 9. doi: 10.1056/NEJMoa2104882
  7. Mehta PR, Mangion SA, Benger M, Stanton BR, Czuprynska J, Arya R, Sztriha LK. Cerebral venous sinus thrombosis and thrombocytopenia after COVID-19 vaccination – a report of two UK cases. Brain Behav Immun. 2021 Apr 12:S0889-1591(21)00163-X. doi: 10.1016/j.bbi.2021.04.006
  8. Muir K-L, Kallam A, Koepsell SA, Gundabolu K. Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination. N Engl J Med. 2021 Apr 14. doi: 10.1056/NEJMc2105869.
  9. Franchini M, Testa S, Pezzo M, Glingani C, Caruso B, Terenziani I, Pognani C, Bellometti SA, Castelli G. Cerebral venous thrombosis and thrombocytopenia post-COVID-19 vaccination. Thrombosis Research (2021), https://doi.org/10.1016/j.thromres.2021.04.001
  10. Lee EJ, Liu X, Hou M, Bussel JB. Immune thrombocytopenia during the COVID-19 pandemic. Br J Haematol. 2021 Apr 14. doi: 10.1111/bjh.17457
  11. Scully M, Singh D, Lown R, Poles A, Solomon T, Levi M, Goldblatt D, Kotoucek P, Thomas W, Lester W. Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021 Apr 16. doi: 10.1056/NEJMoa2105385.
  12. Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, di Minno M, Maino A, Martinelli I, Masuhr F, Aguiar de Sousa D, Stam J; European Stroke Organization European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of Neurology. Eur J Neurol. 2017 Oct;24(10):1203-1213. doi: 10.1111/ene.13381
  13. Pai M, Grill A, Ivers N, et al. Vaccine-induced prothrombotic immune thrombocytopenia VIPIT following AstraZeneca COVID-19 vaccination: lay summary. Science Briefs of the Ontario COVID-19 Science Advisory Table. 2021;1(16). https://doi.org/10.47326/ocsat.2021.02.16.1.0
  14. Oldenburg J, Klamroth R, Langer F, Albisetti M, von Auer C, Ay C, Korte W, Scharf RE, Pötzsch B, Greinacher A. Diagnosis and Management of Vaccine-Related Thrombosis following AstraZeneca COVID-19 Vaccination: Guidance Statement from the GTH. Hamostaseologie. 2021 Apr 1. doi: 10.1055/a-1469-7481

President Praises WFN Performance During the Pandemic

By Prof. William Carroll, WFN President

William Carroll, MD

Against the backdrop of what is without a doubt medical history – the vaccination of the world against SARS-Cov-2 virus (COVID-19) – it is appropriate to review our performance. That the vaccination rollout is bumpy is to be expected. That the world has developed a multitude of vaccines and that the process is under way in just over a year is outstanding.

What about the WFN? This assessment of the WFN is focused on the component parts of our organization rather than by overall achievement. In so doing, I hope to illustrate the effort and output of each.

  • Member Societies
  • Regional Organizations
  • Individuals
  • Related Organizations
  • London Office
  • Trustees

It is my personal perspective, and any errors or omissions are mine.

Member Societies

The member societies are the neurological bodies representing neurologists in each jurisdiction and are the core of the WFN. All have had to deal with the impact of the pandemic on their organization, function, and educational activities. In most instances, they have been successful. Members have continued to serve and care for neurological disorders, be involved in educational activities and training, and in many cases supported the World Brain Day campaign of 2020 and the first electronic Annual General Meeting of the Council of Delegates. Collectively, these efforts have assisted the WFN’s mission to foster brain health and quality neurology worldwide.

Member societies are the neurological bodies representing neurologists in each jurisdiction and are the core of the WFN.

117 of 122 member societies responded to the Needs Registry.

In addition, member societies have participated in the program to update communicability with the London Office, an essential element for our global organization. During this program, they have engaged in Zoom conversations to communicate their views on WFN activities and how they might be further engaged.

A pleasing 117 societies responded to the Needs Registry, which will provide data for the development of targeted campaigns to improve services and resources in all socioeconomic strata. Member societies in Africa and Mexico have, where possible, maintained WFN Training Programs.

Some member societies have seized the opportunity presented by the pandemic to upgrade their electronic educational program. Especially notable has been the efforts of the Indian Academy of Neurology in its highly regarded neuroinfections series of 2020, where it partnered with the Tropical and Geographical Neurology Specialty Group.

More recently, the IAN has begun a series highlighting the contribution made by inspiring leaders in neurology. (Please see WFN website.)

Regional Organizations

These six organizations through their presidents have attended the biennial WFN Strategy Meeting in 2020 at the time of the onset of the pandemic. Most of the six have continued their regular congresses.

Most of the six regional organizations have continued their regular congresses.

The EAN and AAN held successful virtual congresses in 2020 and plan to do so again in 2021. Both have also maintained close organizational ties through regular leadership meetings with the WFN.

The AOAN had to defer its 17th Congress from August 2020. It held a successful, highly regarded meeting in early April 2021, which was the first regional hybrid meeting. AFAN has deferred its scheduled biennial meeting from 2021 to October 2022 to be held in Cameroon.

With the WFN, AFAN held a valuable e-Learning Day on stroke in 2020, which included two parallel sessions in French. A similar e-Learning Day will be held in November 2021 on epilepsy.

PAUNS held its biennial Congress in February 2020 (at the onset of the pandemic) and will do the same in 2022.

PAFNS held its Congress in conjunction with the Brazilian Academy of Neurology in 2019 and plans its next congress for 2023.

Regional organizations are supporting efforts by a subgroup of trustees and office staff to improve communications.

Individuals

Neurologists are the core of each member society and the advocates and supporters for them and the WFN. They continue to participate in all regular activities of diagnosis, treatment, and care. In a number of instances, neurologists and neurological infrastructure have been drafted to COVID duties.

Many individuals have made, and are continuing to make, important contributions to national, regional, global, and disease-specific COVID-19 data collection efforts on topics ranging from the impact of COVID-19 on the provision of neurological services generally, the documentation of neuro-COVID phenotypes, and contributed to the development of the WHO Case Report Form to provide more uniform data collection. Many have also participated in activities overseen by the WHO Neuro-COVID Global Forum, the COVID-19 Neuroresearch Coalition, the EAN ENERGY Registry, the NINDS NeuroCOVID project, and the WFN Environmental Neurology Specialty Group’s list of registries.

Many neurologists continue to make important contributions to COVID-19 data collection and maintain neurological services.

Related Organizations

Members of the Global Neurology Alliance (GNA) have supported the WFN World Brain Day campaigns, especially the International Parkinson’s Disease and Movement Disorder Society (2020) and the Multiple Sclerosis International Federation (2021). Recently, GNA members have played a major role in the constructive assessment and advice to the WHO on its discussion plan for the preparation of the Intersectoral Global Action Plan for Epilepsy and Neurological Disorders. Notable here were the International League Against Epilepsy (ILAE,) International Bureau for Epilepsy (IBE), International Child Neurology Association (ICNA), World Stroke Organization (WSO), International Headache Society (IHS), the International Parkinson’s Disease and Movement Disorder Society (IPD&MDS), Alzheimer’s Disease International (ADI), the World Federation of Neuro-Rehabilitation (WFNR), World Psychiatry Association (WPA), and Multiple Sclerosis International Federation (MSIF).

A number of WFN Specialty Groups have also made valuable contributions to the WFN goals. I have already mentioned the Tropical and Geographical Neurology Specialty Group’s series on neuroinfections where they partnered with the Indian Academy of Neurology. The Migrant Neurology Specialty Group has produced an excellent comprehensive reference book on “Neurology for Migrants.”

The Rare Neurological Diseases Specialty Group is conducting a survey on these and their resourcing around the world. The new ALS/MND Diagnostic Criteria were published by the ALS/MND Specialty Group, and the Neuromuscular Disease Specialty Group held its 2020 Congress virtually.

London Office

If member societies are the core of the WFN, the London office is the heart. The WFN employed a second senior manager, Kimberly Karlshoej, in February 2020 with the primary role of overseeing new WFN initiatives, such as the Needs Registry and enhancing the relationship between the WFN and the WHO.

Within weeks, she joined the other London staff in lockdown. Despite the tribulations of the pandemic on London residents, the office staff have exceeded everyone’s expectations, including their own. They have maintained the routine day-to-day management of the federation, such as receiving and responding to email from member societies, calendar organization, financial, and membership records.

Where necessary, they have joined conference calls and provided audio recording for the production of accurate minutes despite an array of different time zones through countless Zoom, GoTo, Teams, and Webex meetings.

They guided a flawless Council of Delegates Annual General Meeting, including the inaugural electronic trustee election. They have orchestrated improved electronic communicability with member societies, specialty groups, WFN committees, and the Global Neurology Alliance, increased the social media posts, and assisted the regular website updates, including the COVID-19 and World Neurology page. These tasks, and there are many that I may have omitted, have all been performed with a cheerful professional disposition which has facilitated business operations in this unprecedented environment. I am sure I speak for all the trustees when I say that we are indebted to our office.

The London Office guided a flawless 2020 Council of Delegates Annual General Meeting, including the inaugural electronic trustee election.

The most important initiative they have been engaged in is the updating of member society contacts and the development of its enduring continuity.

Trustees

The pandemic began one month after the 2020 Trustees and Regional Presidents’ Strategy Meeting. At this time, Jean Marc Leger stepped down as co-opted trustee, and his place was taken soon after by Marianne de Visser. Both Leger and de Visser added invaluable depth to trustee discussions and decisions.

The expiration of Riadh Gouider’s stellar term as trustee at the 2020 AGM was also marked by the election of Morris Freedman. Freedman has begun to develop a WFN e-learning pilot program. Gouider continues to oversee the WFN/AFAN e-learning Day. Throughout 2020 and to date, each and every one of the trustees have combined energetically in the collective effort of the WFN. All have recognized the importance that they represent all member societies, and that decisions made by them, as trustees, are all gauged by their worth for the whole federation.

Trustees all recognize that they represent all member societies and that decisions made by them are gauged by their worth for the whole federation

It has been a pleasure to witness the careful consideration given by all in discussing a matter of weight before arriving at the most optimal decision. I have no doubt that the present composition of four officers, three elected trustees, and two co-opted trustees is the most efficient for a number of reasons.

First, a nine-person group is simply workable. Each can contribute readily both in discussion and in the preparation of papers for specific proposals. Second, the ability to co-opt two trustees provides flexibility for particular skillsets and diversity. Third, the staggered rotation of the elected trustees provides additional corporate memory to that of the executive officers. Fourth, a board of nine persons is a number that the London office can support efficiently. An increased number would likely require an increase in staff. Leanness and flexibility are two desirable virtues on which the WFN depends.

Current trustee structure is fit for purpose.

  • A nine-person group is simply workable. Each can contribute readily both in discussion and in the preparation of papers for specific proposals.
  • The ability to co-opt two trustees provides flexibility for particular skillsets and diversity.
  • The staggered rotation of the elected trustees provides additional corporate memory to that of the executive officers.
  • A board of nine persons is a number that the London office can support efficiently.

Conclusion

I am then unashamedly proud of the WFN and its robust advancement on all fronts despite the COVID-19 pandemic. As I have tried to illustrate above, every part of the organization, its governance, and the processes have performed admirably. I, as the president, and we all as the WFN, know that from individual neurologists, who have continued to function as neurologists in the care of people with neurological illness, through to the London office should share a sense of achievement for what has been done.

There is still some way to go to a post-COVID normal but we can appreciate that we will continue to prosecute our mission to foster brain health and quality neurology through and beyond the end of this pandemic. •

The Format of World Congress of Neurology 2021 in Rome Finalized

By Ryuji Kaji, Chair Congress Committee, First Vice President of the WFN

Ryuji Kaji

The Congress Committee met on April 19, and the format of WCN2021 was finalized. Considering the global outlook of the COVID-19 pandemic and the decisions of other international meetings, we had to conclude that WCN2021 shall be held all online.

Despite being fully virtual, we will try our best for all of the participants to amply experience the atmosphere of Rome using state-of-the-art technology. The registration fee was revised and discounted to a large extent to facilitate attendance of many delegates, young neurologists, and medical students (see box at right), and the contents will be held available on the web for three months after the meeting for the registered participants.

The deadline of abstract submission was May 3, and we received over 2,000 abstracts. More bursaries than usual (200) will be provided to encourage young neurologists in the form of waiving registration fees. The early registration fees will apply until July 13, and we sincerely ask more neurologists than ever to make our virtual meeting one of the best WCNs in the new style of holding an academic meeting during the pandemic.

We are also soliciting nominations of the names for WFN medals for 2021 ( https://wfneurology.org/activities/education-grants-and-awards/wfn-awards ).

See you all virtually in Rome! •

Registration Fees Euros
Full Participants Int’l – Early 300
Full Participants Int’l – Late 350
Full Participants – Italians Early 200
Full Participants – Italians Late 250
Low/Lower Middle Income Countries – Early* 150
Low/Lower Middle Income Countries – Late* 200
Allied Health Professionals – Early + Late ** 100
Undergraduate Medical Students – Early + Late ** Waived
*Low/Lower Middle Income countries are defined according to the World Bank Country Classification. Participants from Low/Low Middle Income Countries must submit a copy of their passport

**Allied Health Professionals include Residents, Fellows, Nurses, Physical Therapist, Occupational Therapist, and Speech Therapist. Status must be certified by an official letter from the institution signed by the head of the department
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