Articles – Page 54

World Brain Day 2017 Topic Announced

Wolfgang Grisold
and Mohammed Wasay

World Brain Day 2017 will be centered on stroke, and will be jointly prepared and celebrated with the World Stroke Organization. This topic emphasizes the importance of stroke and should alert towards prevention and introduce advances in treatment.

We hope that many national societies will be able to join us again this year. Material for the campaign, as well as suggestions for press releases, will follow.

World Brain Day 2017 will also have an international press conference centered on the important topic of stroke.

For the status of ongoing preparation please follow our website and social media.

There is also a WFN website dedicated for this event, where you can communicate with us. •

Gazi University of Ankara

Dr. Maouly Fall
Fann Teaching Hospital, Neurology Department of Cheikh Anta Diop University

Residents at Gazi University of Ankara.

Many thanks to the Turkish Neurological Society and World Federation of Neurology (WFN) for allowing me to perform this visit to the neurology department of the Gazi University of Ankara from Nov. 15 to Dec. 15, 2016.

My first day in Ankara was devoted to a visit to the city and the headquarters of the Turkish Neurology Society with Burak Tokdemir, manager of the Turkish Neurological Society. The next day was effectively my first day in the neurological department, with Tokdemir, where we first met Prof. Ayşe Bora Tokçaer, the head of the neurology department. After welcoming me, she give me my program, which began with a visit to different parts of the department with Dr. Serhat, a resident in neurology.

Gazi University staff from left: Prof. Reha Kuruoglu, Prof. Ayşe Bora Tokçaer, Dr. Maouly Fall, Prof. Bulent Cengiz, Dr. Hale Zeynep Caglayan, Prof. Bijen Nazliel, and Prof. Yahya Karaman.

We went to the offices of different professors and associate professors, the outpatient clinic, the inpatient clinic with the intensive unit care, and the EEG and EMG laboratories.

During my visit to the neurology department of Gazi University, I attended several activities, which were important for me and for my practice in Senegal. I participated in the activities of the EMG laboratory observing the basic techniques of nerve conduction, needle EMG with several muscles, which I never seen evaluated before, and single-fiber EMG, which is not available in Senegal. Also, I went to both a standard EEG laboratory and to long-term monitoring video EEG and interpretation, where I acquired many experiences.

In the EMG laboratory with the EMG team.

I spent each week in the outpatient clinic with different specialties to learn and perform several situations in clinical neurology: headache disorders management, neuromuscular diseases, epilepsy management, multiple sclerosis, Parkinson’s diseases and other movement disorders, and neuro-ophthalmological diseases. I saw many cases of epilepsy, movement disorders, headache, MS, pseudotumor cerebri, as well as many videos and photos. I also participated in some sessions of botulinum toxin injections and apomorphine test, which are not available in Senegal. These activities were helpful and useful to me because since I returned to Senegal my approach and management of patients have improved considerably.

In the EEG laboratory with the EEG team.

I also spent two days of the week in the intensive care unit and inpatient area to see how to manage some rare neurological disorders and emergency cases.

My best experience was the morning of Dec. 7, when I joined the neurosurgery team of Prof. Ayşe Bora Tokçaer and Prof. Tylan Altiparmak to see the operation on a female patient with generalized dystonia. She was operated on for globus pallidus interna DBS. During the operation, I saw how they target the globus pallidus (GPi) and microrecording. I was lucky to attend this surgery session all the more because it was something I had only read about before. It was a great experience.

I also had the opportunity to visit the school of physiotherapy and rehabilitation and talk with physicians about the management of patients in the outpatient and inpatient clinics.

During the last day of my visit, I was invited to talk about neurology in Senegal. I talked about my country, the academic neurological team, the different hospitals and their specialities, the neurological diseases in our setting, how neurology is being practiced, which neurological disorders are common and how we manage them, and with what means. The audience was attentive, and the discussion after was essential.

My experience during this visit was well above my expectations and gave me a broader understanding of the management of neurological disease in our conditions of work in Senegal.

Once again, I thank the Turkish Neurological Society, the WFN, and all the teachers, all the doctors, and all the staff of the neurology department of Gazi University of Ankara. •

Germany’s University Hospital Ulm

Samy Mohamed Lemine, dadah
Nouakchott- Mauritania

It was my great pleasure to be accepted for a department visit at University Hospital Ulm in Germany.

I arrived there on Oct. 3, 2016. I started the next day in the neurology department. Prof. Kasubek, who is the vice head of department, introduced me and showed me around the neurological department.

For three weeks, I stayed in the emergency room. It was an opportunity for me to see how they receive patients and how they manage them. When the emergency room was empty, I had the opportunity to assist senior physicians in the stroke unit. I also spent time visiting hospitalized patients.

During my time there, I assisted in a thrombectomy procedure with a radiologist. It was a wonderful and interesting experience.

I spent my last week there in the neuro-inflammatory part of the neurology department. I discovered many things there, such as immunoadsorption, plasmapheresis, and immunoglobulin administration.

Every time a patient was examined by a German physician, I received a translation in English. I asked questions and received responses. My stay was enjoyable, and I was happy to discover another way to practice medicine.

At the end of my stay, I realized that there was great benefit for me to discover the German neurological model.

I thank the World Federation of Neurology and the Deutsch Neurological Association for having invited me to this department visit program in Germany. •

Norway’s Riks, Ullevål and National Epilepsy Center

Marieme Soda Diop-Sene
Neurologist, Fann University Hospital
Dakar/Senegal

Marième Soda Diop-Sene with Professor Espen Dietrichs, the Head of the Department of Neurology, Oslo University Hospital

From Oct. 22 to Nov. 19, 2016, we had a study trip in Oslo. We arrived on Saturday, Oct. 22, and stayed in the researcher house in Blindern. It was a comfortable house with all of the amenities, located between Riks Hospital and Ullevål Hospital.

We spent the first two weeks at Riks Hospital, the third week at Ullevål Hospital, and the last week at the National Epilepsy Center.

At Riks Hospital, we met Prof. Espen Dietrich and all of the teaching staff of the neurology department. We participated in morning staff meetings at the neurology ward and at the radiology ward, where we learned a lot about neuroradiology. We also visited patients.

At the clinical ward, we participated in the consultation of movement disorders with Prof. Inger Marie Skogseid, whose patients had severe dystonia and Parkinson’s disease. Some of them had deep brain stimulation (DBS), and others received botulinum toxin injections. It was the first time we saw patients who had DBS and botulinum toxin for movement disorders.

We attended headache consultation and neurovascular disease consultation with Prof. Anne Hege Aamodt. We saw patients with vascular disease (classical stroke) as well as a rare case of middle cerebral artery vasospasm in a young woman.

With Prof. Aamodt, we attended headache consultations and saw patients with migraines and occipital headaches. We also witnessed the administration of botulinum toxin and local anaesthetic injections for headaches.

Even if sometimes such cases are found in our daily practice, the management (exploration and treatment) is totally different. The main fact we learned is to use alternative treatment, such as botulinum toxin or local anaesthetic injection, for the treatment of headache and movement disorders.

We also had a great interest in attending neurophysiology interventions. We performed EEGs and EMGs, and we had really interesting cases, including diabetic amyotrophy and severe peripheral polyneuropathies of different etiologies.

The third week, we visited Ullevål Hospital, where the daily routine is different from Riks Hospital; indeed it’s mostly an emergency hospital. We met Prof. Sigrud Kierulf Braekken and her team. We witnessed some cases of refractory epilepsy, myasthenia gravis, and trigeminal neuralgia at the emergency unit, but no cases of acute stroke and thrombolysis.

We also met Dr. Angelina Maniaol, whose principal interest is myasthenia gravis, and discussed juvenile myasthenia gravis, which is one of our main research subjects.

The last week, we visited the National Epilepsy Center, a really amazing experience. We met Prof. Rune Markhus and Prof. Ellen Molteberg, and their teams.

We had some rich exchanges about research topics we could do together. We discussed research methodology with Prof. Morten Lossius and Prof. Cecilie Johanssen Landmark.

At the morning staff meeting, we discussed polysomnography recordings in a patient with a parasomnia; we read and discussed EEG recordings of children with epilepsy.

With Prof. Anette Ramm Pettersen, we also exchanged information about neurophysiology and neuropsychological comorbidities in children with epilepsy.

We shared our daily experience in Senegal through two talks: “Neurology in Senegal” and “Two Clinical Cases of Tropical Neurology.” The first one was about a stroke in a patient with HIV-1 and HIV-2 co-infection, and the second case was about Pott’s disease in an HIV-1 patient.

We attended a meeting on deep brain stimulation at the congress center with Prof. Skogseid, organized by the Norwegian Neurological Association.

We focused on movement disorders, neurophysiology and epileptology, and myasthenia gravis because those topics are our main interests.

On the social part of the stay, we visited Oslo with Prof. Geir Slapø and his wife. We had a social evening at Prof. Aamodt’s House, where we met the members of the Norwegian Neurological Association.

We saw snow for the first time, and all of this made our trip unforgettable.

We acknowledge all of the members of the Norwegian Neurological Association and the WFN for having made this trip possible.

We are thankful for the precious moments we shared at work and in their family lives. •

Norwegian Neurological Association Oslo University

Yohannes Debebe Gelan, MD
Neurologist and Assistant Professor at Addis Ababa University, Department of Neurology
Ethiopia.

Yohannes Debebe Gelan, MD, (center) together with the chairman of the Norwegian Brain Council and the chief physician at Oslo University Hospital during a social event.

I am Yohannes D. Gelan, a final-year neurology resident at Addis Ababa University, Ethiopia, at the time of the visit. I was very lucky to be selected to the prestigious WFN Department Visit program. I knew ahead of my visit that I would have a once-in-a-lifetime experience in Oslo. I visited the neurology units of Oslo University Hospitals (OUH) with a fellow African neurologist from Senegal named Marième Diop Sene.

My visit surpassed all my expectations. I was thrilled by the amount of attention and respect I received from the people I met in OUH. The visit took place from Oct. 21 to Nov. 18, 2016.

The first person I met in Oslo was Prof. Kari Anne Bjørnarå who took care of everything that I needed to survive the first few days in cold Oslo. On Saturday, Oct. 22, we toured the beautiful city of Oslo with Prof. Geir Slapø and his wife, Prof. Andrea Slapø. They were very welcoming. They took us to the Holmenkollbakken. I can’t imagine how people are brave enough to do skiing from that height. I rode on the zipline, which was fun.

We spent the first two weeks in Rikshospitalet, which is a highly specialized national referral center for Norway. We were introduced by Prof. Anne Hege Aamodt and Prof. Espen Dietrichs to all of the staffs of the OUH neurology department on the first day in their morning meeting. We were quite surprised that the method of communication was changed to English not only for the first days but also for most of the month we stayed with the department. The majority of the patients also were willing to speak to us in English. That helped to make my visit productive.

I was a little bit scared when we were asked to do a mandatory methicillin-resistant Staphylococcus aureus (MRSA) test before getting access to the wards. We were told that Norway has the lowest MRSA prevalence rate. Fortunately, the tests were negative, and we were given keys, IDs, and all the other things required to wander around the hospital.

A typical day in OUH starts with a morning meeting followed by radiology sessions. I was impressed by the level of communication between radiologists and neurologists. I have taken a lesson on the importance of working in tandem with radiologists for all neurologists. I hope we will start a similar system in our department as well. There were short presentations on Monday morning and Tuesday at lunch time.

The first week, I followed Prof. Aamodt in the vascular neurology and headache units. She was enthusiastic to show me everything despite her busy schedule at both the stroke and the headache units. I saw patients with rare causes of stroke. I observed how extracranial and transcranial Doppler ultrasound is useful in the evaluation of patients with acute stroke. Even though I wasn’t lucky enough to watch a thrombectomy being done, I saw how it may bring dramatic changes in a patient with vertebral artery thrombosis. I also witnessed occipital and supraorbital nerve blocks while Prof. Aamodt was working with her headache patients.

On the second week, I joined the movement disorder team. Prof. Inger Marie Skogseid showed us two cases of Wilson’s Disease and many more interesting cases. I was able to accompany her to the operating room when she was called to adjust the intraoperative deep brain stimulation (DBS) current setup for a patient with essential tremor. She also shared with us her vast experience on the use of DBS in dystonic patients. I also saw botulinium toxin injections for various movement disorders and chronic pain disorders. At the end of the second week, I visited the electrophysiology unit. Apart from the routine nerve conduction studies and EMG, I was able to observe quantitative sensory testing for the first time in my clinical experience.

During the third week, we went to Ullevål Hospital, which is the center for most of the neurological emergencies for the Oslo region. They also have a specialized center for multiple sclerosis. We were introduced by Prof. Sigrun Kierulf Braekken, the head of the neurology unit. The neurology staff in Ullevål hospital also made English their primary method of communication for us. The first days in Ullevål hospital were a bit difficult as the hospital architecture was so complicated, unlike the Rikshospitalet. I accompanied neurologists on the general neurology ward, and I observed the sophisticated care delivered at the center. It was interesting to see the long list of tests that are done from CSF samples. On the second day, I accompanied the neurologist in the emergency room. It was fascinating to see how the emergency multidisciplinary team works with such coherence and speed. The infrastructure and the equipment in the ER are quite astonishing. I had a chance to visit the stroke unit and neurology ICU.

I attended the neurological physical examination session on the third day of my stay in Ullevål hospital. It was good to see how the basics are done even in the high-tech setup. Finally, I joined the electrophysiology unit, and I got a great lesson in EEG interpretation from an electrophysiology fellow.

On the last week of my stay, I visited the Sunnaas Rehabilitation Hospital. The hospital is built on the hillside with an amazing view of the fjords. Prof. Frank Becker briefed me on the hospital. It is the highest rehabilitation center for Norway. It was interesting to hear about their experience with lifelong rehabilitation follow-up of some neurologic disorders. It is also a national center for locked-in-patients and rare neuromuscular disorders. I attended case discussions held between Prof. Tor Haugstad, the head of traumatic brain injury rehabilitation, and his colleague. Afterward, he showed me around the individual patients’ rooms, the gymnasium, the swimming pool, and the workshop for occupational rehabilitation. The meticulousness of their approach in rehabilitation of patients is something I should dream of establishing in my home country.

At last, I went to visit Spesialsykehuset for Epilepsy (SSE). Prof. Ellen Molteberg showed us around the adult and pediatric wards, epilepsy monitoring unit, the center for mentally handicapped children, and the special school for children and adolescents with epilepsy. I visited the kitchen for ketogenic diet preparation. I also was able to observe when ambulatory EEG is applied and the results are read. I learned a lot from morning discussions on peculiar EEGs on new admissions. We were really impressed by the clinical work as well as by the dedication for research activities in epilepsy. Prof. Cecilie Landmark showed us the sophisticated antiepileptic pharmacologic laboratory. She also briefed us about ongoing trials in their laboratory.

I believe this kind of visit to advanced neurological units is a source of inspiration for young neurologists like me from a developing country. I have acquired new clinical skills. I have gotten ideas on how to implement some of the things I observed in accordance with our available resources in Ethiopia. I would like to thank all members of the neurology department. I would like to thank Andrea and Geir Slapø. They are amazing people who made our weekends exciting. My special gratitude goes to Anne Hege Aamodt for inviting us to the Halloween and the neurology staff dinner party and for all of the support she provided during my entire stay. •

An Update on WFN Educational Activities

Wolfgang Grisold
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and
Steven Lewis
World Federation of Neurology

Dr. Stefan Meng demonstrates nerve ultrasound at a peripheral nerve meeting in Vienna.

One of the most important and fascinating tasks of the WFN is education. This is an implicit task of a scientific society. Scientific societies have many other tasks, such as promoting science, exchange of knowledge, development, and cooperation. However, their most prudent and important task is to keep preparing for the coming generation and maintaining the present generation with education and knowledge to make them the best in their specialty. This ensures the optimal care for patients with neurological diseases.

Wolfgang Griswold

Neurology presence and workforce varies considerably around the world (Steck, Struhal et al. 2013) and also medical systems and educational systems. The WFN has had a number of educational programs throughout its history. Notably, the World Congress of Neurology (WCN) has served the purpose of fostering new development as well as educating neurologists in the field with the development of teaching courses to promote knowledge on a practical level. The World Congresses of Neurology has been doing this for a long time. As a whole, the WCN has been considered a primarily educational effort (Munsat, Aarli et al. 2009).

The WFN also provides Applied Research Groups, which serve to promote their subspecialty, for example motor neuron disease, neuromuscular diseases, neurosonology, and who, in addition to their scientific work, also engage in congresses and teaching courses. The Applied Research Groups are invited to engage on the structure and content of WFN teaching courses at each WCN.

WCN 2017
This year, the XVIII WCN will take place in Kyoto. It will be jointly hosted with the Japanese Society of Neurology. The congress will offer many educational components and disseminate the latest news and developments, as well as deliver many scientific sessions, teaching courses, and presentations and poster sessions, which all contribute to education in neurology. The WCN is a live event and is accredited by the EACCME for 8 CME hours a day, which is mutually recognized by the AMA and the Royal College of Physicians and Surgeons of Canada, thus being evaluated by high international standards.

Several attractive opportunities are implemented at WCN 2017. There will be congress bursaries, which in addition to the waiving of the congress fee will offer travel grants. This is aimed at young neurologists and is supported by the congress and, also in part, by the professional conference organizer Kenes. This year, travel grants for 80-90 persons are planned.

For the first time, the Munsat¹ prize on education will be rewarded, named after Theodore Munsat (Medina 2014), who was very active in education and chaired the WFN education committee for several years. This prize will be awarded for the first time in Kyoto and will be an acknowledgement for persons involved in the promotion of education in neurology, and in particular educational activities within the WFN.

In addition to the scientific program, the WFN organizes teaching courses at several levels, hands-on courses, and educational sessions. The joint AAN-WFN Advocacy Palatucci workshop is a good example of a session teaching the skills of advocacy and leadership.

From the World Congress to Enduring Materials
Increasingly, the WFN also produces enduring materials, which are journal-published Congress abstracts, the Journal of Neurological Sciences (JNS) and eNS, the dissemination and organization of Continuum with the AAN for use in Continuum user groups, and, increasingly, the WFN website and social media.

Educationalists distinguish between live events and enduring materials. Enduring materials can be anything from printed, written material or media available as educational audio or video.

The WFN is in the good position to be able to use several publication materials, such as the website and social media, including Facebook, which among other activities also spread news and developments in timely ways and reach the groups of both young and middle-aged neurologists, and possibly also other health-related groups.

The JNS is the official journal of the WFN, and publishes material from studies, reviews, and cases, and has a large international participation. Two editor-selected CME articles appear on the website each month and can be downloaded free. The JNS is a continued success and is now edited by Prof. John England.

The journal eNS has been founded as an electronic open access journal, also serving as a platform for articles and cases, and has published several local features. It is meant to work in conjunction with the JNS. As it is an open access journal, fees for publication for open access articles are necessary, and this may be a hindrance in low-income areas; However, eNS is increasingly picking up momentum.

Continuum: Lifelong Learning in Neurology is a product of the AAN and published by Wolters Kluwer . Graciously over the years, the AAN has donated print copies of the journal to countries in need, on the condition that workgroups are constituted, that articles will be read and discussed, and these conferences will be reported back to the WFN. The logistics of the dissemination of this program is done by the WFN, which includes the mailing, sending, receiving, and accumulating the reports. This is an ongoing success story and the WFN and the AAN are happy to provide this service. For an example of a Continuum program, see the recent article on the Moroccan Continuum program.

Books: In the recent past, the WFN also produced a book series, Seminars in Neurology, which was aimed at countries with low education standards and limited resources of health care. Despite being a success, they became outdated and have been replaced by the other educational materials and endeavors discussed in this article.

Video conferences are presently launched on the WFN website and it is expected that video conferences on cases or diseases held between several departments will provide a useful academic support for training. Increasingly, video-type seminars will be used for educational purposes

The public: One of our main aims is the promotion of neurology, which is much wider that any training and education we do specifically for the specialty. Individual health groups, committed nongovernment organizations (NGOs), and patients need to be aware
of neurologic symptoms, diseases, and emergencies, and be encouraged to seek help for neurological conditions for themselves or others.

The aim of public education is to spread information on neurology, raise awareness and understanding, and improve the fate of patients with neurological diseases. All in all, this could be called advocacy work for neurology. Indeed, this is the greatest gap we need to fill. At present, a good example of educational aspects are the Days of the Brain, which are topic-focused and try to improve awareness with regard to specific neurological diseases.

World Brain Day: Education of the Public on a Larger Scale
A major initiative from the WFN is World Brain Day which had its origins at the WCN 2013 in Vienna, and will take place for the fourth time this year at the WCN in Kyoto, presented jointly with the World Stroke Organization.

The previous World Brain Day topics were epilepsy (with the International League Against Epilepsy [ILAE]) and dementia. The day commemorates the founding day of the WFN and is July 22.

Members are encouraged to celebrate this World Brain Day and receive educational matter, suggestions for press mailings, and printout material. Last year, a virtual press conference was added for the first time. Press mailings, articles, and local activities are considered as measures for success and were observed and counted.

Patient Day
The WFN has introduced the concept of a Patient Day at the World Congress of Neurology, which is a day and a session devoted to patients, careers, and health groups for the purpose of spreading news and interest of the Congress. This was successful in Vienna and in Santiago, and will need to be continued at further congresses. Common diseases such as stroke, epilepsy, and movement disorders are usually selected, and speakers from the Congress give talks in an understandable format.

Other Efforts
Public Relations and Press Conferences also serve to promote the content of neurology and serve the purpose of reaching out.

Junior Traveling Fellowships
Junior traveling fellowships (JTFs) provide support for individuals to attend meetings and congresses. The applications can be made worldwide, and applications from low- and middle-income countries are preferred. The participation in the meeting needs to be “active,” which means a presentation or a poster should be in the program. A final report is requested, which might be used for publication in World Neurology. In the last years, an average of 30 JTFs could be granted per year. Applications are announced on the WFN website.

WCN Congress Bursaries
The WFN also offers congress bursaries to attend the World Congresses. The bursaries are devoted to younger neurologists, with preference to applicants from low- and middle-income countries, and include a travel grant and free attendance to the Congress. The number grantees allowed depends on the Congress budget. Over the last several years, 55 bursaries were given in Marrakech, 120 in Vienna, and 30 in Santiago. This year, we are planning for 100 in Japan. In part, this is also supported by the professional conference organizer, Kenes.

IFMSA
The International Federation of Medical Students’ Associations is an international association of medical students. The WFN has cooperated with regard to students‘ medical curricula concerning neurology, and also provides free entrance for two students at the World Congresses.

Courses, Caravans and Regional Teaching Courses
The needs for education differ worldwide, and they are not limited to live events and enduring materials. Courses with nurses, paramedical professionals and other health groups can be necessary, as well as small standalone meetings. Some of these meetings have been funded by the WFN with grants.

A good example of a continuing joint activity by the EAN and WFN is to hold teaching/training courses in Subsaharan Africa each year. Last year the course took place in Maputo, Mozambique in November, and this year it will be in Ouagadougou, Burkina Faso. These EAN regional teaching courses usually attract 70-80 persons, have a lean teaching staff of 10-15 persons, and attract trainees from Africa to offer scientifically valuable and highly interactive courses. This education of trainees and young neurologists is important, as they will act as multipliers for the future development of neurology in Africa.

WFN Grants are Available Each Year
The idea of WFN grants was first introduced in 2011. Grants allocate a sum of money for a purpose and a project, which in many instances are projects related to neurologic education. The website shows details about the grant application. The WFN is also eager to share and participate in grants with other scientific societies such as the International League Against Epilepsy, the World Stroke Organization, and the Movement Disorder Society.

WFN grants are awarded once a year, and applications are scrutinized and selected by a grant committee.

Department Visits
In past years, the WFN, jointly with partner members, has developed a program of Department Visits, where young neurologists from low-income countries can go and stay for four to six weeks to study the procedures, techniques, and observe the neurologic work at a major neurological center. This program was introduced for African countries.

Turkey started this initiative with us, and it has now been followed by department visits in Austria, Germany, and Norway, and soon Italy. Names of fellows and reports can be seen in World Neurology articles.

Both the participants and the sponsors have been enthusiastic about this initiative, which not only introduces the participants to recent developments and up-to-date procedures, but also introduces new insights into other medical and social systems.

This year, North America is joining, and the Canadian Neurological Society is introducing a department program dedicated to countries in South America. This will expand this successful educational tools in the Americas.

WFN Teaching Centers
The development of WFN Teaching Centers was successfully introduced with the first WFN Teaching Center in Rabat Morocco in 2013. The idea is to train neurologists locally with high standards, and also acknowledge the high standard of the training center. The first Teaching Centers were successively established in Africa in Rabat, Cairo, and Dakar, and offer both “full training” and fellowship opportunities, which include electrophysiology and epileptology.

WFN Teaching Centers undergo a process of evaluation, a site visit, and re-evaluation after four years. The Teaching Centers also need to be embedded in a publicly accessible university, along with facilities and services that include internal medicine, radiology, neurosurgery, neuropathology, and rehabilitation.

At present, Rabat has had one fellow each year for the past three years, and will start to train a second fellow this year. Cairo is now starting with one fellow and Dakar will start with both a complete training position and one fellow on epileptology.

The WFN organizes the Teaching Centers with regard to administration, and also supports the WFN fellows. The applications for these training positions are announced via the WFN website and media. A committee, consisting of members of the WFN education committee, the local university, and the regional society, scrutinizes and selects the candidates.

The Applied Research Group on neuromuscular diseases held a very successful congress in Toronto in 2016. This Congress, ICNMD 2016 (icnmd2016.org/), also yielded a share of profit to the WFN, and the WFN has decided to use this money for additional funding of two successive training fellowships in neurophysiology, which will take place in Rabat, and possible cooperation with the international society of electrophysiology is planned.

In the Americas, Mexico has excellent neurological training programs, several of which were visited by the WFN in 2016 and received the status of WFN Teaching Centers. In 2017, attempts will be made by the WFN to sponsor one trainee from South America to train in a Mexican Teaching Center, and the preparations for this department visit are ongoing.

A further potential development for the WFN Teaching Centers could be regular visits from an international professor, who would stay a few days, give lectures, and make rounds in the department for a short time (e.g, a week). This would also help the WFN to identify the needs of the Teaching Centers more clearly.

The concept of the WFN Teaching Centers is expanding, to potentially include a Teaching Center in South Africa, and already for Rabat a re-evaluation process will be needed. The WFN is also aware that a Teaching Center should be available in Asia, which, while having very highly developed and scientifically active countries, still has several countries with significant needs with regard to neurology training. This will be an upcoming project.

Vision
Education is an ongoing process of innovation and renewal, and the prediction of the future is not easy.

There is a need for research into the most efficient and best educational methods. Apart from practical learning, training curricula and the apprenticeship type models prevail. In addition, much time now seems potentially spent (and perhaps wasted) on routine work, and some training curricula, too.

There is no doubt that time and experience count, but could we not improve in the efficiency of knowledge transfer? It will be an important effort and task for the WFN to stimulate research in the field of education.

With the rapidly expanding developments in neurology, training curricula and teaching concepts have an increasingly shorter half-life. In addition to the need for trainees and practicing neurologists to accumulate new knowledge at a fast pace, we must also invest in mechanisms to investigate and assess which skills and knowledge trainees need to acquire (e.g., the milestones that were developed by the Accreditation Council for graduate Medical Education [ACGME] and American Board of Medical Specialties [ABMS] in the U.S. [Lewis et al, 2014), and also mechanisms to replace “old knowledge” with new (unlearning).

There are, however more tangible projects currently in our sights, such as the expansion of the WFN Teaching Centers, development of education on electronic WFN platforms, and the development of a global curriculum for training of neurology, aiming for suggestions with regard to the teaching and training methods, taking into consideration differences in local needs and resources.

Most important is the vision to increase efforts on public education and involvement of patients and patient groups. Awareness, prevention, understanding, and care for patients with neurological diseases need to be one of our major tasks.

References

Theodore L. Munsat (1930-2013). US neurologist, long term chair of the WFN education committee and also founding director of “Continuum.” See: http://worldneurologyonline.com/article/theodore-l-munsat-1930-2013-an-outstanding-legacy-with-the-wfn/
JA, A. “The History of the World Federation of Neurology: The First 50 Years von Johan A. Aarli.” OUP Book: 2014
Medina, M. T. (2014). “In memoriam of Professor Theodore L. Munsat (1930-2013): his outstanding legacy with the WFN.” J Neurol Sci 339(1-2): 1-2.
Munsat, T., J. Aarli, M. Medina, G. Birbeck and A. Weiss (2009). “International Issues: educational programs of the World Federation of Neurology.” Neurology 72(10): e46-49.
Steck, A., W. Struhal, S. M. Sergay, W. Grisold and N. Education Committee of the World Federation of Neurology (2013). “The global perspective on neurology training: the World Federation of Neurology survey.” J Neurol Sci 334(1-2): 30-47.
Lewis SL, Józefowicz RF, Kilgore S, Dhand A, Edgar L. Introducing the neurology milestones. J Grad Med Educ. 2014; 6(1 Suppl 1):102-4.

Call for Applications for 2017 WFN Junior Traveling Fellowships

By Steven L. Lewis, MD,
and Wolfgang Grisold, MD

This year, the WFN is again able to offer Junior Traveling Fellowships for young neurologists from countries classified by the World Bank as Low or Lower Middle Income, to attend approved international meetings.

Applications for 2017 would be most welcome.

There will be 30 awards; applicants should be neurologists in training or early in their careers, have an MD degree or equivalent medical degree, hold a post not above that of associate professor, and be no older than 45 years of age.

Candidates are asked to apply online via www.wfneurology.org/junior-travelling-fellowship-grants-form.

You will be asked to provide:

The name and dates of the meeting for which you wish to register
A CV and bibliography
A letter of recommendation from the Head of your Department
An estimate of expenses, to a maximum of £1,000, no excess will be granted

It is expected that applicants participate actively in the meeting (e.g. presentation, poster) that they attend. The submission of an abstract is encouraged. A copy of the abstract also should be included. Preference will be given to candidates who have not previously received an award and to candidates who intend to attend the 2017 World Congress of Neurology in Kyoto, Japan.

Applications must be received at the WFN office no later than Wednesday, March 15. All applications will be reviewed by the education committee, and the awards will be announced as soon as possible thereafter.

Seven New African Professors of Neurology Announced

By Gallo Diop, MD

Seven new neurology professors and four psychiatry professors in Africa were chosen from the candidates for the positions. Photo by Gallo Diop, MD.

Seven new neurology professors and four psychiatry professors in Africa were chosen by juries from French-speaking universities. Photo by Gallo Diop, MD.

From Nov. 7 to 15, 2016, the 18th biannual African contest for selecting new university professors was organized in Dakar, Senegal. After a tough competition, the assistant professors are upgraded to the grade of professor by different juries whose members come from all French-speaking universities and, depending on the needs, from other countries such as Belgium, France, and Canada. All the Francophone universities of the African Council for Higher Education (www.lecames.org), use this exam for enriching their faculty. They submit the candidacy of their assistant professors several years after they have received their doctorates. All the specialties of medical, pharmaceutical, dental, and veterinary sciences are involved.

This year, there were 172 successful candidates out of a total of 201 candidates from 24 universities. For neurology, seven candidates competed, and all succeeded. The awardees, in order of merit, are: Dieudonne Gnonlonfoun (Benin), Yacouba Mapoure (Cameroon), Paul Ossou (Congo), Thierry Adoukonou (Benin), Komi Assogba (Togo), Fode Cisse (Guinea), and Moustapha Sarr (Senegal).

This is a great achievement for local neurology training because six of them were entirely trained for four years, 15 years ago, at the University of Dakar, and one (Dr. Adoukonou) from the University of Abidjan (Ivory Coast). They also benefitted from one to two years of complementary focused training in France.

Gallo Diop, MD is a professor of neurology at the University Hospital of Dakar, Senegal, and co-opted trustee of the WFN.

International Conference Tackles Air Pollution, Emerging Medical Issues

By Peter Spencer and Jacques Reis

Speaking at the welcome at the Council of Europe were (from left) Professor Christman of the Faculty of Medecine, Professor de Seze of the Department of Neurology, Dr. Mengus of the COE and Professor Sandner of the University of Strasbourg.

Air pollution is an increasing concern for humanity. The subject urgently needs more attention from medical scientists and society alike. It has long been recognized as a major health threat with multiple impacts, increasing mortality, and morbidity. Pulmonary and cardiovascular diseases are well known outcomes. Brain impacts are an emergent challenge, as are related epigenetic changes and developmental issues.

For the first time, a conference tackled these issues in an inter-professional and translational approach. Basic researchers, epidemiologists, public health specialists, and neurologists assessed current knowledge and identified key gaps that mandate further research.

The conference, which took place in a pleasant Christmas atmosphere in Strasbourg, Germany, was organized by the Club de Neurologie de l’Environnement, NEUREX, and the Environmental Neurology Applied Research Group of the World Federation of Neurology

Prof. Grisold and Mrs. Reis, a local organizer, at the International Conference.

While compelling data are lacking, there is growing concern that continuous exposure to heavily polluted air might perturb brain development, increase the risk of ischemic stroke in adults, and even contribute to the development of neuro-degenerative and behavioral disorders.

The historical correlation between childhood exposure to lead from gasoline, population IQ attainment, and violent behavior during adulthood, coupled with experimental evidence of persistent epigenetic changes in the brains of lead-exposed primates, serves as an early warning of the dire potential effects of neuropollution.

That fine particles suspended in breathable air enter the brain is certain, whether directly via the sensory innervation of the olfactory epithelium or through pulmonary transfer to the circulation, the lymphatic system or other peripheral route. How the brain responds to neuropollution is the subject of debate. Is the particulate garbage removed without incident by normal physiological processes? Does its presence trigger a neuroinflammatory response? Is this a short-term event or can this lead to temporary or persistent brain cell dysfunction and damage? Can this initiate or exacerbate a neurodegenerative process related to amyotrophic lateral sclerosis, Parkinson’s disease or Alzheimer’s disease?

Attendees enjoy the Alsatian atmosphere.

Given the extraordinary levels of ambient air pollution in many population centers around the globe, the ever-increasing trend of human urbanization, the rapid projected growth of some of the most populous cities in Africa and Asia, and the growing evidence for adverse health consequences of neuropollution, the Strasbourg conferees urged immediate action to curb air pollution and greater investment in research to establish the health effects and their underlying mechanisms.

The organizers thank La Région Grand Est, the Council of Europe, and the municipality of Oberhausbergen for their kind support.

Peter Spencer, PhD, FANA, FRC, is a professor of neurology at the School of Medicine and senior scientist at the Oregon Institute of Occupational Health Sciences, both at the Oregon Health & Science University, Portland. Jacques Reis, MD, is with University Hospitals, Strasbourg, France, and is chair of the WFN Environmental Neurology Research Group.

The Profile of Neurology Has to Grow for Greater Recognition

By Raad Shakir, MD

Raad Shakir, MD

With the publication of Global Burden of Disease (Lancet Oct. 8, 2016), it is now clear that brain health is at the forefront of diseases leading to morbidity and mortality. Moreover, if we combine neurological, mental, developmental, and substance-use disorders (NMDS), then the group is the leading cause of mortality and morbidity, surpassing cancer and cardiac disease.

These facts, in my opinion, have not trickled to the policymakers, let alone the public. If this does not happen, then desperately required funding and support would not follow soon. Neurologists have to be more proactive in “promoting” the discipline across the world. In many parts of the world, our numbers are so small that the sheer number of patients overwhelms us, and our specialty is not recognized as a priority by governments. At times, we have to explain our discipline to the lay public, as the neurology profession is not instantly recognizable. In the eyes of many, being a heart specialist is easy to comprehend while a neurologist may not be. We may have to use the word “brain” more liberally, and stating that we are a “brain specialist” could be an option, which may perhaps be more recognizable. Although this does not cover those of us who look after the disorders of the peripheral nervous system, in my opinion, the issue of recognition of our specialty is much more important.

In this context, we have to understand that many other interest groups and those responsible for statistics come into play. As glaring examples, I will mention two. The first and most obvious is the issue of cerebrovascular diseases. Sixty years ago, International Classification of Diseases (ICD) 7 decided that anatomically all strokes are diseases of vessels, and classified them under cardiovascular diseases! This served the interests of some groups, but not those who suffer a stroke or those who look after them. This will hopefully change with the World Health Organization (WHO) modernizing its International Classification of Diseases next year. This has led to the lumping together of the two most prevalent causes of death and disability, i.e. heart attacks and strokes. Both cardiologists and neurologists have clearly stated their opinion to the WHO that the two have different physiology, etiology, pathology, epidemiology, and clinical outcomes, and fall under different types of physicians. Both recommended rectifying this erroneous state back in 2011. We are now working closely with the WHO statisticians to remedy this anomaly while at the same time keeping statistical continuity when previous data are compared to new ones.

The second issue in the Global Burden of Disease is that it had to utilize diagnoses based on ICD10 that are flawed and rather outdated, and therefore attribution is totally dependent on the original etiology. Let me explain. When including statistics on epilepsy as an example, the Global Burden of Disease only included primary generalized seizure disorders and not any other forms of epilepsy! This means that perinatal injuries as well as all post-traumatic epilepsy in general are classed under injuries, post-meningitis/encephalitis epilepsy under infections, and so on. This may sound bizarre, but this is how the situation is in the world we live in. Moreover, neurologists deal with complications of general medical and toxic conditions, but the burden lies outside neurology. All neurological complications of diabetes, alcohol abuse, and toxic etiologies, as examples, are classed as due to the original issue, however remote. This leaves us with a major deficiency in our statistics and makes the majority of our work attributed to some other specialty.

One can understand the dilemma of statisticians producing classifications and the major pressures they experience. However, this rather rigid procedure may “simplify” various matters but it does not serve the accurate reporting of specialty-specific complications. Moreover, it will not help epidemiologists who are interested in ensuring that clinicians seeing such complications report and categorize them accurately.

Dementias are the leading cause of death and disability, and the incidence is increasing exponentially. The matter is beyond the health finances of most countries. Again, neurology is short-changed here. I do not think that it is recognized by many health providers that dementia is an organic disease of the brain. However, traditionally our psychiatrist colleagues deal with many aspects of the condition, and hence it is a joint endeavor between both disciplines. This is yet another reason why talking about brain health is in many ways a better description of all the disorders that we deal with on a daily basis.

When this logic is followed, there is no doubt that brain disorders are by far the leading cause of mortality and morbidity. We, as those responsible for looking after millions of affected individuals, must make our voices heard and be advocates for our patients. Some of these issues may sound obvious to some practicing in the more developed world, but it certainly is not the case in most parts of the world. Even if we look at the more developed sections of the world, we will find a huge discrepancy between various geographic locations, sometimes within the same country. Care provision is certainly not uniform, and it is our duty to inform the public of what is available and feasible in their localities so that the correct provisions can be made.

Globally, the number of neurologists is woefully low. It is most important to emphasize that our numbers are increasing, but so is the need for our services. This puts a huge pressure on us to perform efficiently with meager resources. Training is the way ahead, and perhaps as important is for us to emphasize that it is not enough to have neurological training programs without the support of the most essential specialties for proper service provision. Along with neurologists, health care providers will need neurosurgeons, neurophysiologists, neuroradiologists, reliable laboratory services, physiotherapists, geneticists, psychiatrists, immunologists, and nurse specialists. I could go on, but the point is made that we cannot work in isolation. When addressing these facts to governments, we have to clearly state the benefits of such integrated systems, and only then can neurological health provisions make inroads into the death and disabilities related to brain diseases.

I have so far stayed away from research, which is the cornerstone of our progress. This is performed now at varying levels in all parts of the world. Encouraging collaboration between regions and institutions is a core responsibility of the WFN, which we diligently pursue.

The profile of neurology has to increase, and our role in global health is being more recognized. The road is long, but the obstacles are not insurmountable. Most of this is in our hands.