As the new editor-in-chief of the Journal of the Neurological Sciences (JNS), I would like to introduce the readers of World Neurology Online to some new features for the journal. The first and most obvious change is a new “face” or cover for JNS. The new cover is more abstract to reflect the modern global era. The design team at Elsevier is also making the journal website more intuitive with easy links to the websites for the World Federation of Neurology (WFN) and World Neurology Online.

To fulfill its mission as the official journal of the WFN, JNS will continue to publish the best original articles in neurology and neuroscience from around the world. In addition, new areas of special interest, each with a new associate editor, have been added. These new areas and associate editors are “Best Practices” (Carmel Armon), “Global Neurology” (Donald Silberberg), “Basic and Translational Sciences” (Nicolas Bazan), “Outcomes Research” (Bruce Ovbiagele) and “Reviews, Commentaries and Editorials” (Daniel Truong). JNS also has a new editorial board, which is comprised of internationally recognized experts in neurology and neuroscience from around the world.

Working with the publishing team at Elsevier, JNS is committed to serving the members of the WFN and strengthening our ties with the World Congress of Neurology (WCN). As such, we will publish the WCN-2013 abstracts as part of the September 2013 issue. Because JNS has a tremendous global reach and readership, we believe that this issue will be an excellent vehicle to communicate the new and exciting developments that will be presented at WCN-2013 in Vienna.

Also, Vladimir Hachinski, the president of WFN, and I will be convening a teaching course, “How to Get Published in International Journals” Sept. 23 at the WCN-2013. We believe that this course, which will highlight the new priorities of JNS, will be of interest to many WFN members.

JNS is offering a new service called AudioSlides. This feature offers authors of an accepted article the opportunity to include a five-minute presentation (PowerPoint or PDF) with their publications. As the name indicates, the presentation includes audio and slides prepared by the authors and available online at ScienceDirect under an Open Access license. Authors can easily assemble the presentation by using an Elsevier-provided website. We believe that this added feature will be of great benefit to both authors and readers.

The editorial team and I also are exploring ways to provide additional educational programs through the journal. We intend to offer CME-accredited opportunities by linking the JNS website to selected educational activities. Many of these activities will contain multimedia content, including videos. We are also working toward providing CME-credits through selected articles in the journal.

All of us on the editorial team of JNS look forward to serving the WFN by increasing the prominence and circulation of the journal. We are committed to playing a vital role in addressing the challenges in global neurology and educating neuroscientists, neurologists and allied health care professionals around the world.

Jori Fleisher, MD

The past several decades have seen a groundswell of interest in the practice of neurology in low- and middle-income countries. As established clinicians, researchers and groups such as the World Federation of Neurology, American Academy of Neurology and the European Federation of Neurological Societies (EFNS) turn their attention to improving the care of neurology patients around the globe, tremendous opportunities for international collaborations have arisen. Even more recently, our specialty has seen a rise in individual efforts, or “bottom-up” approaches to global involvement, with the impetus frequently coming from trainees.

The unification of organizational interests with the growing demand for international opportunities by trainees could not come at a more opportune time. Currently, neurologic disorders account for more than 8.7 percent of premature deaths and years lived with disability worldwide.1 Stroke alone accounts for 4.1 percent of all disability-adjusted life years (DALYs), followed by Alzheimer’s disease and other

Sarah Wahlster, MD

dementias, epilepsy, migraine, Parkinson’s disease, CNS infections and neoplasms. Importantly, these estimates do not include traumatic brain injury, a major cause of premature death and disability particularly in rapidly developing nations. Such statistics take on even greater urgency in light of the dearth of neurologists in low- and middle-income countries. In one study, 23 African nations averaged one neurologist per 5 million population, with 12 countries having none.2

In parallel with growing epidemiologic recognition, neurologists and trainees have found more avenues for clinical involvement abroad. Numerous models exist, from brief visiting professorships, global brigades and mobile clinics to long-standing inter-institutional collaborations. Here, we briefly reflect on our experiences with several models and future directions.

Many opportunities are available at individual medical schools for students to spend a week or more abroad, shadowing in hospitals or freestanding clinics, or setting up makeshift clinics to provide acute, primary care to all comers. As a starry-eyed trainee, these rotations can be inspiring, yet raise concerns. In one author’s experiences (JF), during 10- to 14-day-long trips to Central America and Jamaica, such makeshift clinics were erected and provided care to hundreds of patients who might otherwise be untreated. In addition to such ubiquitous primary care concerns of headache and low back pain, countless individuals with intestinal parasites, malaria and other tropical diseases were treated. Such trips inevitably raise the question of sustainability, and whether we are instantiating a culture of “duffle bag medicine” that does more harm than good.3 For example, a day laborer and father of six in his early 40s presented to our Jamaican clinic with early-onset Parkinson’s disease. As a student, one’s initial thrill at recognizing clinical signs and making a diagnosis is quickly overshadowed by the knowledge that the one-month supply of carbidopa-levodopa available may only offer the patient 30 days of false hope.

Some of these shortcomings can be overcome with careful pre-trip collaboration with local practitioners. Arrangements can be made in advance for patient referrals, and the visiting clinicians can arrive with a working knowledge of local treatment patterns and availability. Short trips and pop-up clinics often spark a more deep-seeded commitment to global health that will shape participants’ careers. Furthermore, relationships formed between visiting trainees and local providers can be nurtured into fruitful partnerships in the future.

To that end, longer-term collaborative relationships have been formed, yielding additional opportunities for trainees. A key component to ensuring sustainability in these relationships is to work closely with local providers and carefully elicit their input about the needs at their institutions. These partnerships can be focused on building collaborative research projects as well as fostering a didactic exchange and improving medical education.

One example of such a formal collaboration is the Botswana-UPenn Partnership. Established as a means of building clinical and research capacity in Botswana in response to the HIV epidemic, this decade-long connection has fostered the growth of primary care residency programs in Botswana, countless research studies, and the Global Health Equities Residency Track at the University of Pennsylvania’s various residency programs.

While medical students and residents can apply to spend a single rotation in Botswana, the track provides U.S. trainees with in-depth training on the geo-socio-political context of the nation in which they will practice. Two four- to six-week-long rotations are spent on the medical wards in Botswana, providing clinical care and engaging in a scholarly pursuit. Working with partnership-affiliated attending physicians and local practitioners, trainees are incorporated into ward teams or able to provide specialty consultation services. Extended and repeated stays provide invaluable insight into the epidemiology of disease, team practices, as well as the challenges of providing the best possible care with the available diagnostic and therapeutic modalities. Neurologic  in-patients tend to be plentiful, comprising about 30 percent of all medical admissions, with stroke, epilepsy, meningitis, Guillain-Barre, myelopathies and CNS complications of HIV/AIDS, among the most common chief complaints.

While rotating at a partner site, there are numerous opportunities to contribute to the medical education, clinical care and research efforts in collaboration with local providers. Such collaborations have infinite future directions. Investing in the education of trainees and students at the site is a first and crucial step to improve the care of neurological patients in a sustainable fashion. At partner sites with no local neurologist, one way to support local providers is to create a targeted curriculum, based on the most commonly seen, treatable conditions and available resources. Also, participating in teaching initiatives at the local medical school and inspiring young trainees in these areas to pursue a career in neurology can potentially improve neurological care within the country.

Research initiatives may improve diagnostic and therapeutic options in countries with limited resources. Also, scholarly pursuits can be fostered through organized mentorship as well as joint authorship of case reports and research studies. New advances in technologies also lead to a wealth of opportunities for continuous interaction and collaborative efforts between sites. The Partners Neurology Residency Program has initiated a recurring series of teleconferences with their partner sites in Uganda and Mexico, during which residents and faculty at both sites discuss interesting cases, provide neurological consultation or share didactic conferences. Another advantage of telemedicine is the potential to share neuroimaging studies, EEG data files and pathology images. While difficulties with the Internet connection in developing countries remain a major challenge for videoconferencing and the transfer of larger files, continuous communications via email and emerging technology can foster a frequent exchange between sites and perpetuate sustainable connections.

Numerous other models exist for global neurology collaborations, including Medical Education Partnership Initiatives (MEPI), NIH/Fogarty program, established visiting professor programs, AAN’s Global Health Section, and WFN’s International Working Group of Young Neurologists and Trainees. Furthermore, opportunities for participation increase as students and residents advance in their training.

The most critical step in any collaboration, however, is to ensure mutual understanding and benefit, with an eye toward building capacity for neurologic care in developing nations. Barriers to such programs include funding, limited or no pre-trip training for clinicians causing misunderstandings once in country, and poor resource sharing.

In addition to international partnerships, we recognize the tremendous potential for collaborations among globally minded neurology departments and trainees in the developed world to facilitate these exchanges, share resources and foster funding opportunities. We are currently laying the groundwork for a Neurology Global Health Consortium by uniting interested and experienced neurologists from across the U.S. By gathering the collective wisdom of individuals with experience in clinical practice, education and research abroad, we hope to learn from each other and serve as a resource for other interested trainees.

To learn more about the proposed consortium, contact Wahlster at swahlster@ partners.org. To learn more about additional opportunities, contact Fleisher at jori.fleisher@uphs.upenn.edu.

Franz Gerstenbrand

Ethics in neurology are the  basis of all practical work  as well as for research  activities. In a critical analysis of  the used ethical principles, it has to  be stated that the contemporary ethical laws are missing different religious, traditional and cultural requirements. The contemporary ethics are based on the philosophy  of Socrates, Plato and Aristotle,  with the incorporation of the  Christian philosophy of Saint  Augustinus and Thomas Aquinas  and should be called Western  Ethics. But Western Ethics must  not be acceptable worldwide. The ARG Neuroethics decided to found  a task force with the aim to harmonize the ethical principles in  neurology including transcultural considerations. As members of the task force,  representatives of the Buddhism and  Hinduism, the Islamic and  Mosaic religions and the different Christian communities are invited.

As a continuous activity of  the ARG Neuroethics, the  organization of teaching courses  and informative workshops has to  be mentioned. The organizers  of neurological congresses and  symposia are asked to include  special lectures and training  courses in the program. The  great lack of ethical knowledge  in scientific reports about new  treatment programs or research  projects is shameful fact and has to  be strictly changed. A continuing ethical education is necessary.

The ARG Neuroethics is asking for more active cooperation and  for helpful support to follow the  education for a better knowledge  in ethical thinking and moral  responsibility. The aim for a  worldwide acceptable basis for  ethical principles in modern  neurology needs great knowledge and an intensive preparatory work in philosophical, moral and ethical issues.

Members of the WFN Applied Reserach Group (ARG) from many different countries are active in their regions. In 2012, we were focused mainly on Central and Eastern European countries, and we organized several meetings.

As part of these activities, members of the ARG were active in their research, related to importance of delivery of neurological services, educational activities and spreading the knowledge to our colleagues in many parts of the world. Vida Demarin was active at the Eighth Congress of the Society for the Study of Neuroregeneration and Neuroplasticity (SSNN) in March 2012 in Dubrovnik; Management of Pain in November 2012 in Moscow; Neurological Meeting on Stroke in March 2012 in Ljubljana, Slovenia; Challenges on Stroke in April 2012 in Belgrade, Serbia; and Neurological Symposium on Headache in May 2012 in Tuzla, Bosnia and Herzegovina, to mention just a few of them.

Our gorgeous city of Dubrovnik was the host of the 23rd Summer Stroke School with international participation June 4-8. For the first time, the summer school was under the auspices of Croatian Academy of Sciences and Arts. The usual and proud auspicates are Inter-University Center Dubrovnik, Croatian Stroke Society, Medical School University of Zagreb, Central and Eastern European Stroke Society and Research Group on Delivery of Neurological Services (RGODNS) of World Federation of Neurology (WFN). The joint meeting of ARG ODNS and the 23rd Summer Stroke School was organized in Interuniversity Center in June 2012 in Dubrovnik.

The aim of the course was to support the cooperation and promote exchange of knowledge and experience among participants from different countries. This meeting shed new light on epidemiology of stroke, its primary and secondary prevention, diagnostics, therapy and rehabilitation. All participants had a unique opportunity to share their national stroke data and discuss about specific stroke problems of their country. Countries of the East and West Europe had an opportunity to work together on solving problems related to stroke, whether they were medical, economical or of some other nature. We can’t skip mentioning that all the hard work was awarded by rich social program during the evenings. We look forward to 2014 course already.

The 52nd International Neuropsychiatric Pula Congress (INPC) was held June 20-23, 2012 under the auspices of the Croatian president Ivo Josipovic. The congress is traditionally held in Verudela Hotels Brioni and Histria, and organizers are: Kuratorium International Neuropsychiatric Pula Congress, Sestre Milosrnice University Hospital Center, Zagreb, and this year, the Department of Medical Sciences of the Croatian Academy of Sciences and Arts. The main sponsors of the congress were the Ministry of Science, Education and Sports of the Republic of Croatia, the city of Graz, the city of Zagreb and Istria County. This year, more than 350 international particpants attended the congress.

The main themes of the congress were recent achievements in restorative neurology, new advances in psychopathology — the interaction of biological and psychological factors. The theme of the joint meeting of the International Neuropsychiatric Pula Congress in the Section of Neuroscience Alps-Adria was discussions about different therapeutic procedures. Besides the main topic during this year’s congress, numerous symposia were also held: roundtables and workshops in collaboration with the Central and Eastern European Stroke Society (CEESS), World Federation of Neurology, Research Group on Delivery of Neurological Services (WFN RG ODNS) and one topic symposium related to dilemmas in therapies for different neurological disease (stroke, multiple sclerosis, epilepsy and Parkinson’s disease) and the Croatian branch of the Italian Cochrane Centre (CBICC) on the topic: Introduction to the Cochrane systematic review and application of evidence-based medicine in everyday practice, the meeting of the European Society of young neurologists and residents (European Association of Young Neurologists and Trainess – EAYNT), European Summer School of psychopathology in Pula, fifth Pula International Symposium on Epilepsy, neuro-otological course of vertigo, the European standards for doctoral studies in the field of neurology, a symposium on forensic psychiatry, the German Symposium on the ongoing training in neuropsychiatry (Deutschsprachiges Neuropsychiatrisches Fortbildungs Symposium), a symposium on the quality of life of psychiatric patients, a symposium on connecting providers in neurorehabilitation, a symposium on the role and experiences of nurses in the care of patients with incontinence, symposium on deep brain stimulation, interactive school about headache and symposium on palliative care.

We are proud to announce that this year’s 53rd INPC Congress in Pula June 19-22, 2013, had the endorsement of the WFN. We are grateful for all efforts related to ARG organization and its activities.

I’m deeply grateful to the WFN for awarding me the Junior Traveling Fellowship in 2013 to visit the European Stroke Conference held May 27-31, in London.

Shaily Singh

The conference was attended by more than 3,500 delegates from  around  the world. Following is the brief outline of the meeting and its structure and discussion items.

The meeting was broadly divided into different themes, with parallel symposia, teaching courses, debates and controversies, oral paper sessions, poster presentations and plenary lectures.

The various themes were acute stroke treatment both interventional and medical, intracerebral hemorrhage, translational neuroscience, arteriopathies, childhood stroke, rehabilitation, small vessel disease, imaging, neuroprotection, outcomes and quality of health services, risk factors, anticoagulation in stroke, and alternative therapies to name a few.

The plenary sessions were on the awards on stroke research and also new trial results announced, including INTERACT 2, SPS3, STITCH 2, imaging results of IST3, etc.

A huge number of research papers and posters were presented during this meeting.

There were parallel halls for oral presentations with different themes to select the area of stroke one is interested in. The timing, discipline and attendance was par excellence.

I had one abstract accepted as first author and was a co-author on one other.

Special e-poster sessions with presentations and question-and-answer sessions were undertaken for the first time for highly rated abstracts. There was a lot of interaction during my e-poster presentation and new ideas generated.

Overall, this meeting was an excellent feast of stroke academics and gave me a great opportunity to present our institutional research, to interact with other stroke researchers from around the world and to collaborate for future research.