From the editors

We’d like to welcome all readers to the April 2024 issue of World Neurology. The issue begins with the President’s Column, where World Federation of Neurology (WFN) President Dr. Wolfgang Grisold provides an update on a number of initiatives, including the Global Burden of Disease study, Brain Health, WFN educational initiatives, and World Brain Day (WBD) 2024 plans. Also in this issue you will find additional details about the upcoming Digital Neurology Updates (WNU) 2024, an exciting online educational initiative planned for September 2024. Registration is now open.

Drs. M. S. Damian and P. Laforet provide a report on the use of telemedicine devices and telehealth in neuromuscular disease, promising to provide state-of-the-art care to remote regions. Drs. Vladimir Hachinski and Ryosuke Takahashi provide an opinion piece (reprinted with permission from the 2023 Hiroshima Summit) about the future of prevention of neurologic disease, particular with the aging of the population.

Drs. Tissa Wijeratne, David Dodick, Steven Lewis, Alla Guekht, and Wolfgang Grisold report on exciting plans for World Brain Day 2024, which is devoted to Brain Health and Prevention. In this issue’s History column, Dr. Peter Koehler provides biographical details about a ship’s surgeon (Abraham Titsingh) and cranial injuries, among other interesting historical and medical details.

Drs. Chandrashekhar Meshram, Surat Tanprawate, and Serefnur Ozturk provide a summary of the many activities of the e-Communications & e-Learning Committee and Migrant Neurology Specialty Group. Dr. Salsabil Abdulrahim Mady Abulazayem details her four-week department visit at the university hospital in Giessen, Germany, as a recipient of the Department Visit Program from the German Neurological Society and the WFN. The WFN also wants to sincerely thank the German Neurological Society for its longstanding and continued support of this important and successful program.

Drs. Chandrashekhar Meshram, Gagandeep Singh, Nirmal Surya, and U. Meenakshisundaram report on the multitude of activities from WBD 2023 in India and their plans for WBD 2024.

In closing, we continue to thank all readers for their interest in the WFN and World Neurology, and we look forward to sharing more details about the many upcoming activities for neurologists worldwide in upcoming issues. We encourage contributions about neurology and neurologists from all regions of the world. We look forward to hearing from you. •

World Brain Day 2024: Promoting Brain Health and Prevention Globally

Tissa Wijeratne, David Dodick, Steven Lewis, Alla Guekht, Wolfgang Grisold

Neurological disorders represent a significant global health concern, impacting individuals and societies across the globe. With billions of people affected and millions of lives lost each year, the burden of neurological disorders cannot be overstated. Despite advances in medical science, disparities in access to quality care persist, underscoring the urgent need for comprehensive prevention strategies.

World Brain Day (WBD), an initiative launched by the World Federation of Neurology (WFN) in 2014, serves as a platform to raise awareness and advocate for improved neurological care worldwide. In collaboration with six global regions, WBD 2024 focuses on Brain Health and Prevention, aligning with the global agenda to combat disability and promote well-being.

The latest findings from the Global Burden of Disease Study highlight the preventable nature of many neurological conditions, emphasizing the importance of targeted interventions. Stroke, Alzheimer’s disease, and other dementias are among the most extensively studied conditions, with identifiable risk factors that offer opportunities for prevention.

Regional neurological societies, including the American Academy of Neurology, African Academy of Neurology, Asian and Oceanian Association of Neurology, European Academy of Neurology, Pan-American Federation of Neurological Societies, and Pan Arab Union of Neurological Societies, play a pivotal role in leading preventive efforts within their respective regions.

By disseminating educational materials and advocating for policy changes, these societies contribute to the global effort to promote brain health and prevent neurological disorders.

WBD 2024 represents a call to action for stakeholders across all sectors to prioritize brain health and prevention. Through advocacy, education, and community engagement, we can empower individuals and communities to adopt healthy lifestyles and reduce the burden of neurological disorders worldwide. By joining forces with regional neurological societies and leveraging the power of digital communication, we can amplify our message and effect positive change.

Together, let us work toward a future in which neurological disorders are preventable, and all individuals have access to the care and support they need to thrive.

Please visit https://wfneurology.org/world-brain-day-2024 for more information and a toolkit and join us in our ambitious mission on preventable brain health campaign today. •

Key Message

• World Brain Day (WBD) 2024, in collaboration with six global regions, emphasizes Brain Health and Prevention.

• Promote the WBD 2024 campaign in communities, hospitals, villages, and city-regions.

• Follow updates on the WFN website and social media platforms.

• Six regional societies to lead activities on brain health and prevention.

Preventing Neurological Disorders: Are We Being Far-Sighted Enough?

If we do not slow the pandemic of neurological disorders, we face an even greater pandemic driven by aging populations – but still too few health professionals deal in prevention.

Vladimir Hachinski and Ryosuke Takahashi

Ryosuke Takahashi

Vladimir Hachinski

Health professionals are trained to deal with diseases. Few engage in prevention, which remains underestimated, underfunded, and underused, but is pivotal in stemming the rising tide of neurological disorders. For dementia, billions spent on finding a drug to counter cognitive deterioration have yielded two drugs of efficacy still to be fully determined and unquestionable complications and high costs. Moreover, an effective drug to slow cognitive deterioration in symptomatic patients would only address the symptomatic late phase of the disease. It would do nothing to prevent increasing waves of cognitive impairment, driven by aging populations compounded by an open-scissors crisis of upward aging trends and downward birth rates.

In 1960, global life expectancy was 51 years; now it is 72 years. The global fertility rate was five births per woman; now it is 2.4. In Japan’s super-aged and declining birth rate society, life expectancy has changed from 68 years to 85 years, while the total fertility rate has declined from 2 to 1.3 per woman. This poses mounting social, economic, and health challenges.

One approach is keeping older adults healthy and working past their current retirement ages. Another is educating people to optimize their cerebral, mental, and social health so that they can contribute to the increasingly knowledge-based economy. Integral brain health is key to health, productivity, and well-being throughout life.

Promoting brain health includes preventing risk factors and enhancing protective factors. Neurological disorders inflict the largest proportion of disability adjusted life years. Stroke and dementia account for 62%. Stroke, ischemic heart disease, and most dementias share modifiable risks and protective factors, and also to a lesser degree, with Parkinson’s disease and bipolar disorders.

Risk factors differ in other neurological disorders, but promoting integral brain health might mitigate their consequences and prevent complications from the triple threat of stroke, ischemic heart disease, and dementia.

Integrating and scaling up prevention by promoting integral brain health through multiple approaches can promise a quantifiable difference. The World Health Organization is acting at the global level, and several countries have national brain health plans that must be complemented by community initiatives that can more easily integrate population-focused and individual approaches.

Integral Brain Health: An Urgent Action Plan

An abyss exists between what is done and what needs to be done. An abyss cannot be crossed in small steps, so we need an Integral Brain Health Urgent Action Plan to:

Consider integral brain health – cerebral, mental, and social – in all individual, community, and governmental decisions.

Create a compendium of actionable knowledge on what is known and what needs to be and can be known by experts and users, and strategies of motivation and implementation.

Fund new approaches to promoting and scaling up integral brain health in different-sized populations, with variable measures and reflecting different cultures.

Empower existing leaders, organizations, and communities to implement their highest impact measures based on cost effectiveness.

Create a new integral brain culture through public campaigns featuring highly accomplished brain users, such as sports champions, innovators, artists, writers, media personalities, scientists, and scholars.

One slogan could be “Integral brain health now.” The campaign could promote a basic ABC of “Activity and rest, Balanced diet, and Connecting with others” to help people think better, feel better, and perform better. It would emphasize the simplest, most effective individual actions. For example, walking 4,000 steps a day decreases mortality and provides significant health benefits. Doing it with someone else adds the benefit of socializing and doubles the chance that the person will continue to walk. Walking in greenery adds yet another benefit – long recognized in Japan as shinrin-yoku (forest bathing).

But how can health professionals expand their horizons when they are trained to focus on individual patients? The pandemic taught acute care doctors the importance of prevention so that they would not be overwhelmed by cases. It also fostered unprecedented collaboration between public health officers and acute care professionals. Similar cooperation is needed to prevent brain disorders before the painful lessons of the pandemic fade.

Integral brain health concerns everyone. Small efforts by many produce big changes overall. If about 10% of the population adopts a new view, change follows rapidly. The pandemic is still transforming lifestyles, work, and education – now is a propitious time to introduce fundamental changes.

Exhausted by the pandemic and crises, we may ask if this is the best time to ramp up prevention. But there seldom is an ideal time to innovate. If we do not begin to slow the pandemic of neurological disorders, we face an even greater, more relentless pandemic driven by aging populations. Infectious pandemics subside, aging epidemics do not. If we do not act now, then when? If not us, then who? It is for us, and it is now that we need to act. •

Vladimir Hachinski is a Distinguished University Professor in the Department of Clinical Neurological Sciences at the Robarts Research Institute of Canada’s Western University and former president of the World Federation of Neurology. He has made major contributions to the understanding, diagnosis, treatment, and prevention of stroke and dementia, and leads a dementia prevention/brain health initiative.

Ryosuke Takahashi is chair of the Department of Neurology at the Kyoto University Graduate School of Medicine. He is the past president of the Japanese Society of Neurology and the vice president of the Asian-Oceanian Association of Neurology. His major research interests are in the diagnosis and treatment of Parkinson’s disease and its related disorders.

Editors’ Note: This article was originally published in G7 Japan: The 2023 Hiroshima Summit, edited by John Kirton and Madeline Koch, published by GT Media. It is available at https://bit.ly/g7hiroshima. Reprinted with permission. This article represents the opinion of the authors and is not the official opinion of the WFN.

On Ship’s Surgeons and Cranial Injury

The history of Abraham Titsingh (1684-1776) as a surgeon.

Peter J. Koehler

“In the year 1709, A van D, sailor on the country’s warship Catwijck, commanded by the Lord Captain De Veth, was in the Sloop, while it was put out, and when the rear hoist broke, he fell with the right side of his head on the barrel of the cannon: I found him as a Sufferer, who was lying stricken, in a deep Sleep, Motionless and Feelingless, which Accidents usually accompany those who have so fallen, because the Brain, being shaken by the Fall, or Stroke; its Fluids in its Movements, and the Vessels in its Workings, are hindered, especially that, by which the stirring and feeling is working on our muscles, and that alone is powerful to kill us. It also happens, when only the Shaking of the blow is the Cause of this, that these Accidents do not last long; for after bloodletting, which in all, who have fallen on the Head, or have been severely beaten, is duly applied as the first Means, it frequently disappears, and then I saw them as awakening, and looking about with astonishment.” 2p.54-5 (See Figure 1.)

It occasionally happened that the surgeon diagnosed temporary paralysis.

Sometimes, during one or more minutes, an arm or leg would remain blocked, on the bruised side, or on the opposite side, and this immediately gave me the impression, as if they were broken; but while I was examining this, the forces resumed, and then they looked, like someone stricken with a violent fever. As soon as they consume any liquid, they gag and vomit. If one touches the head, one finds the place where the blow came, impression …1,p.54-5

Figure 1. Frontispice of Titsingh’s book De verdonkerde heelkonst der Amsterdammers uit hunne eigen Handvesten, 1730.

Abraham Titsingh (1684-1776), the ship’s surgeon who wrote this in 1730, had observed this picture more often. See Figure 2. He not only felt an impression, but soon often a swelling would start. The injured persons often continued vomiting from time to time. He felt it was important to write this down because surgeons often did not see these patients until after this episode was over. The patient would be put in bed, the hair should be shaven, and “the hairy scalp was to be stewed with wool rags boiled in wine containing warming herbs.” Others would use brandy for this purpose.

Bed Rest

Bed rest should be continued for several days, in combination with “a cooling lifestyle.” He compared the case with a squire, identified as JVK, who had fallen from a moving carriage and was apparently dead, but recovered after a bloodletting. He had a big bump on the forehead and had to keep to bed for a month. For the first 14 days, he swooned every time he stood up.1,p.55

Trepan

Titsingh criticized the ship’s surgeons who did not bring the trepan on board because it would be useless due to the ship’s movements. He was aware of which locations one should not trephine.

“It should also be noted that one should not trephine on the sutures too lightly, and never on the Sutura Sagittalis, because there the Sinus Longitudinalis runs under it; for if one were to drill into it, one would obtain such a great blood discharge that death must necessarily follow.”1p,53 Moreover, he knew of the danger of skull fractures. In some cases, but not all, it was necessary to trephine to make room, “lest the deposited blood, or its decay, or the departed bone splinters, damage the brain.”1,p.53-4

Figure 2. Portrait of Abraham Titsingh, by Jacob Houbraken, after Jan Maurits Quinkhard, 1742-1780, engraving, 18.5 x 13.1 cm, Amsterdam, Rijksmuseum (object number RP-P-OB-48.331; public domain).

Drunken Sailor

Another case he described was of a drunken sailor who fell in the cable hole with his head on the tip of a grapnel. He had a large wound on the side of the back of his head, where Titsingh could feel the injury of the skull with his finger. The wound was bleeding unusually heavily and prevented him from continuing. He was unable to stop the bleeding, and the man died the same evening. The next morning, he and a colleague dissected the skull and diagnosed a fracture with impression, as well as bone chips that reached to the meninges. Moreover, he suspected that the transverse sinus was damaged, “which we did not investigate, but let him rest with the dead.”1,p.60

Son of Ship’s Surgeon

Abraham Titsingh was the son of an Amsterdam ship’s surgeon who worked for the Dutch fleet. The latter died during the Nine Year War (1688-1697) against the French, when Abraham was only 10 years old. After his father’s death, he was taught the healing arts by a Swedish ship’s surgeon, who was an excellent teacher. Abraham’s two brothers Gerard and Isaak also became surgeons in Amsterdam. At least one of them, Isaak, was partly trained by Abraham. In 1702, Abraham was promoted to second ship’s surgeon.1 He was a rough ship’s lump and had little respect for his superiors, but was beloved among the ship’s people. 2, p.134 He remained in the country’s service until 1710, when he settled in Amsterdam as a surgeon, having taken his master’s examination in 1711.

He became surgeon of the admiralty and guild master. In the surgeon’s guild, he later brought about considerable change in the administration that was unprecedented in its history. He brought to light that the incumbent overlords had defrauded the surgeon’s diplomas and the guild treasury. The result was that the entire corrupt guild board was deposed in 1732. Titsingh himself stayed on after the guild board was purged.3 In the same year, the new guild board under leadership of Titsingh was depicted in a group portrait by the painter Jan Maurits Quinkhard (1688-1772). See Figure 3.

Figure 3. Overlords of the surgeon’s guild of Amsterdam (1732) with Titsingh on the far right; made by Jan Maurits Quinkhard, oil on canvas, 176.5 x 273 cm, Amsterdam Museum (object number SA 454; public domain).

Spina Bifida

Titsingh was critical of guild exams and was hated by his fellow surgeons. He believed practice was more important than theory, and that experience at the bedside was “the safest and surest way.”2,p.136 In particular, he criticized theorists. “The reflective pedants misled the young through unproven feelings. They wrote medicinal novels, emblems with sharp acid, salt, oily grease, and other blanket particles”.1,p.792 However, he published several books himself, including Heelkundige verhandeling over de tegennatuurlijke splijtinge der ruggegraad [Surgical Treatise on the Unnatural Splitting of the Spine]. See Figure 4.5 The subtitle was “Geschreven aan den uitmuntende chirurgyn Hendrik Ulhoorn” [Written to the excellent surgeon Hendrik Ulhoorn]. In fact, he was writing against an earlier treatise on the same subject by his fellow surgeon and citizen Hendrik Ulhoorn (c. 1687-1746), who sought the cause of the defect largely in an unnatural bending of the fetus in the womb. Titsingh, however, ruled that it consisted of defective development of the vertebrae of the spine, caused by dropsy and often accompanied by hydrocephalus, and also did not exonerate the woman’s imagination in some cases.

Figure 4. From Titsingh’s Heelkundige verhandeling over de tegennatuurlijke splijtinge der ruggegraad [Surgical Treatise on the Unnatural Splitting of the Spine] (1736).

Titsingh’s point of contention was mainly directed against Ulhoorn’s idea that the surgical training, especially in Leiden, was inadequate, and that it was better to go to Paris. Ulhoorn had indeed studied at Leiden University, but later traveled to Brussels and Paris. In the latter city, he trained in surgery under Joseph Guichard Duverney (1649-1730), after which he settled in Amsterdam and inscribed at the Guild in 1715. Titsingh did not agree at all about Ulhoorn’s ideas on training.5,p.2011 On the contrary, he believed it was excellent in Leiden. In the book, he referred to several authors who had written on spina bifida, including his fellow citizen medicinae doctor Nicolaas Tulp (1593-1674).6

In 1750, Titsingh published Diana, ontdekkende het geheim der dwazen, die zich vroedmeesters noemen [Diana: Discovering the Secret of Fools Who Call Themselves Midwives], in which he criticized the attitude of some midwives who were interested in money, rather than a humane and considerate manner to assist and help the woman in childbed.1,p.793 In mythology, Diana was not only the goddess of hunting, but also of chastity and pregnant women.

His last book was Geneeskonst der Heelmeesters tot dienst der Zeevaart [Medicine of Surgeons to the Service of Seafaring].7 On the title page, he mentioned that he was “surgeon of the country’s fleet.” In this book, one finds some reports from ship’s surgeons about various diseases treated by them on their voyages, both on board and on land, in foreign places. He wrote on their medical treatment, about which he widely communicates his reflections, remarks, and clarifications.

Not Only Surgical Cases

Ship’s surgeons did not only treat surgical cases. The surgeon’s chest they brought on board contained instruments as well as medicines. The contents of the ship’s pharmacy were subject to precise regulations. The Dutch United East India Company made a list of no less than 144 substances in 1704.

Figure 5. Ship of the Dutch United East India Company by Gerrit Groenewegen, 1786, engraving, 13.1 x 15 cm, Amsterdam, Rijksmuseum (object number RP-P-1910-3459, public domain).

Before each voyage, the chest was subjected to a careful inspection in front of the ship’s surgeon by a physician
and surgeons appointed for that purpose.9,p. 26-7 Ship’s journals from the late 17th and early 18th century show that scurvy was the leading cause of death during longer outward voyages to the Cape of Good Hope, in particular if changes in weather and wind caused delays. See Figure 5. As can be expected, there was a relation with the duration of the voyage. None of the voyages with high scurvy mortality during that period lasted less than 19 weeks.8, p. 52 A Treatise of the Scurvy by James Lind (1716-1794), who had been employed by the Royal Navy between 1738 and 1748, appeared in 1753.9 However, the proposed treatment was not immediately adopted by all doctors and surgeons. The lack of a generally accepted theoretical explanation for his observations played an important role here.10

In his book Harde Heelmeesters [Tough Surgeons], physician Arnold E. Leuftink described the backgrounds of illness and death among 18th century sailors and soldiers, as well as the medical care of the ship’s surgeons, using ship’s journals as sources. Infectious diseases were common already upon leaving Europe. Respiratory diseases with coughing and rheumatic complaints were also common. Rain and storms sometimes led to the crew being constantly at work, wearing wet clothes, and often falling ill due to lack of sleep. And then, of course, there were the seasick soldiers.9,p.69-70

Quarrelsome Person

According to his biographer, the physician Jelle Banga (1786-1877), all of Titsingh’s writings have something unpleasant, something pugnacious, because of the repeated broad enumeration of his grievances, and something cumbersome because of the elaborate and embellished surgical considerations. The language is flat, uncivilized, and generally prickly and snappy. The style is confused, without coherence, broken up by all kinds of inappropriate ideas, idle thoughts, and short-tempered pranks, which according to his own confession he could not avoid writing. Banga believed it was due to the fact that he had not been properly educated in his early youth and only trained to follow his father’s example.

For eight years, he worked as a ship surgeon with rough sailors, roaming everywhere. He was enterprising by nature, but he seems to have applied himself to his craft only with zeal. Only when he established himself as a surgeon in Amsterdam did he realize his flaws. In the exercise of his art, he showed himself to be a gentle and experienced surgeon.1,p.795 •

References

  1. Banga JJ. Geschiedenis van de Geneeskunde en van hare beoefenaren in Nederland. Part II. Leeuwarden, Eekhoff, 1868.
  2. Snelders S. Vrijbuiters van de heelkunde. Op zoek naar medische kennis in de tropen 1600-1800.  Amsterdam/Antwerpen, Atlas, 2012.
  3. IJpma FF, Teulings C, van Gulik TM. Gildepenningen van de Amsterdamse chirurgijns [Guild medals from the Surgeons’ Guild of Amsterdam]. Ned Tijdschr Geneeskd. 2015;159:A8647.
  4. Titsingh A. Heelkundige verhandeling over de tegennatuurlijke splijtinge der rugge-graat. 2nd edition. Amsterdam, Graal, 1736.
  5. Lindeboom GA. Dutch Medical Biography. Amsterdam, Rodopi, 1984.
  6. Koehler PJ. Neurology in Tulp’s Observationes medicae. J Hist Neurosci. 1996 Aug;5(2):143-51.
  7. Titsingh A. Geneeskonst der Heelmeesters tot dienst der Zeevaart. Amsteldam, Wor, 1752.
  8. Leuftink AE (1991). Harde heelmeesters. Zeelieden en hun dokters in de 18e eeuw. Zutphen, Walburg.
  9. Milne I. Who was James Lind, and what exactly did he achieve. J R Soc Med. 2012 Dec;105(12):503-8
  10. Lind J. A Treatise of the Scurvy. Edinburgh: Sandi, Murray and Cochrane; 1753.

e-Communications & e-Learning Committee and Migrant Neurology Specialty Group

This column highlights the WFN committees and specialty groups that raise awareness and carry information on the important contribution of these groups for the functioning of the WFN.

By Chandrashekhar Meshram, Surat Tanprawate, and Serefnur Ozturk

Chandrashekhar Meshram, Serefnur Ozturk, and Surat Tanprawate.

The committees of the WFN contribute immensely to the functioning of the WFN. The chairs are appointed by the trustees. The present composition and membership can be seen on the WFN website.

The committees work on specific issues while the specialty groups focus on specific neurological conditions.

Information about the Publication Committee and the history of Neurosciences Specialty Group was published in the last issue of World Neurology.

In this issue, Information about the e-Communications & e-Learning Committee and the Migrant Neurology Specialty Group is published. Dr. Surat Tanprawate, who is the chair of e-Communications & e-Learning Committee, which comes under the broad category of education, has summarized the information about this committee. Dr. Serefnur Ozturk, the chair of the Migrant Neurology Specialty Group, has provided the information about this group.

e-Communications & e-Learning Committee

The e-Communications & e-Learning Committee occupies a critical position in advancing neurology education and communication worldwide. Through strategic consolidation of three subcommittees and targeted efforts, the committee has become a driving force in streamlining activities to enhance visibility, disseminate knowledge, and foster collaboration across electronic media platforms. Initiatives such as website enhancements, social media management, and the establishment of an e-Learning Hub have significantly extended the WFN’s reach and influence within the neurology community. Past-Chair Walter Struhal spent a lot of effort to streamline this committee.

The official website of the WFN serves as a central repository for neurology professionals and the general public worldwide. It offers a comprehensive array of resources, including educational materials, networking opportunities, advocacy initiatives, information on WFN programs, and multilingual support. This platform facilitates collaboration and drives the advancement of neurological care across borders.

In today’s digital landscape, the role of an e-Communications Committee dedicated to managing social media cannot be overstated. In conjunction with website enhancements, the WFN has harnessed the potential of social media platforms such as X (previously Twitter), Facebook, and LinkedIn to broaden its reach and deepen engagement. This proactive approach has made the organization’s initiatives and resources more accessible to stakeholders worldwide.

At the heart of the committee’s mission lies the e-Learning Hub, conceived by Morris Freedman, a distinguished committee member. The e-Learning Hub serves as a centralized repository of high-quality educational activities, including rounds, seminars, webinars, master classes, conferences, and special lectures. Leveraging the internet’s capabilities, the hub ensures convenient access to educational resources for neurologists worldwide, irrespective of their career stage.

Through close collaboration with regional societies, the committee coordinates Educational Days and e-Learning events tailored to specific neurology subfields and regional contexts. A recent milestone in this collaborative effort is the fourth WFN-AFAN E-Learning Day, focusing on neuropathies. This online event also offers on-demand videos for participants, ensuring accessibility and flexibility in learning.

World Brain Day 2024, scheduled for July 22, 2024, underscores the importance of brain health and prevention, spearheaded by WFN. The e-Communication Committee plays a pivotal role in raising awareness and fostering engagement through digital platforms. By leveraging these channels, the committee ensures global outreach and impact, amplifying the message of brain health and prevention to diverse audiences worldwide.

Through strategic initiatives, collaborative efforts, and innovative approaches, the committee continues to play a pivotal role in advancing neurological care and shaping the future of the field.

Migrant Neurology Specialty Group

Migration is a historically old and increasing social, economic, and beyond that, public health problem. The Migrant Neurology Specialty Group was formed Dec. 18, 2018, in Marrakech, Morocco, during the 12th Maghreb Congress of Neurology. Its aim was to attract the attention of neurologists worldwide and health policymakers in the host countries, on the particularity of the neurological disorders in the migrant population. Most human migration is in search of better opportunities, reflecting the desire for an improved quality of life. The current international migration is a reflection of the world, resulting from the dynamics generated by changes in political, economic, and cultural and environmental climate-related structures. Refugees are at significantly higher risk of experiencing disability associated with neurological conditions. Services and care pathways, including access to quality emergency care, should be responsive to the needs of all people with neurological disorders, not least those who are already vulnerable, such as refugees.

Studies on the health of migrants show that migrants have more health problems than the hosting populations. They are more vulnerable to communicable diseases, but also to some non-communicable diseases, such as stroke, hypertension, diabetes mellitus, or obesity. The high prevalence of neurological diseases in low- and middle-income countries, where the majority of migrants are originating, a high frequency of diseases of the nervous system should be expected among migrants. However, the incidence, prevalence, and clinical presentation of neurological diseases may differ in migrant people depending on the epidemiology, geography, and genetic background of the native country.

Stroke is a major public health problem among migrants given the high prevalence of vascular risk factors such as hypertension, diabetes mellitus, obesity, and smoking. Dementia, multiple sclerosis, neuroinfectious diseases, and functional disorders are common and important problems among migrants. The WFN Migrant Neurology Specialty Group plans more meetings dedicated to other neurological diseases in migrant people, such as cognitive disorders in elderly migrants, epilepsy, neurogenetics, migraines and headaches, neuromuscular diseases, movement disorders, anxiety, and depression.

The group has a strong collaboration with WFN for refugees as “Brain Health for All on World Refugee Day” to ensure the equitable access to resources, treatment, and rehabilitation that is essential for brain health to all refugees. The interesting book “Neurology in Migrants and Refugees” book was published in 2021. The charter of the global alliance was adopted by the U.N. General Assembly on Dec. 19, 2018, and this constitutes real progress for the cause of migrant people. Past-Chairs Mustapha El Alaoui Faris and Antonio Federico made significant efforts to establish and streamline the activities of this group. •

Chandrashekhar Meshram is co-opted trustee of the WFN. Dr. Surat Tanprawate is the chair of e-Communications & e-Learning Committee. Dr. Serefnur Ozturk is the chair of the Migrant Neurology Specialty Group.

Embracing the Future of Neurology

The launch of World Federation of Neurology Digital Neurology Updates (WNU) 2024.

In an era where digital transformation is revolutionizing every aspect of our lives, the World Federation of Neurology (WFN) is proud to announce a significant leap forward in global medical education with the inaugural World Federation of Neurology Digital Neurology Updates (WNU 2024) 2-day online event. Scheduled for Sept. 26-27, 2024, this event is a testament to our unwavering commitment to fostering global collaboration and education in the field of neurology.

A New Era for Global Neurology Education

The decision to host WNU 2024 as a fully online event was born out of WFN’s core goal: to overcome geographical, economic, and logistical limitations, thereby creating a more inclusive and far-reaching educational platform. This initiative allows neurologists, researchers, health care professionals, and interested parties from across the globe to come together in an interactive digital space. By doing so, WNU 2024 not only democratizes access to the latest neurological knowledge but also significantly reduces the environmental impact typically associated with traditional conferences, underscoring our dedication to sustainability.

A Rich Tapestry of Neurological Knowledge

WNU 2024 is poised to offer an enriching and diverse educational program. The agenda is meticulously designed to cater to the needs of both seasoned professionals and those in the early stages of their neurology careers. Participants can look forward to keynote lectures delivered by distinguished experts in the field, promising insightful discussions that are sure to inspire new ideas and propel the practice of neurology into new frontiers.

WNU 2024 demonstrates WFN’s adaptability and unwavering commitment to advancing neurological care and education across the globe, regardless of the obstacles we may encounter.

As we look forward to this exciting event, WFN extends its heartfelt gratitude to all those dedicated to the field of neurology. Your passion and commitment are the driving force behind our efforts. Join us for WNU 2024, Sept. 26-27, 2024, and be a part of an engaging, stimulating online gathering that promises not only to educate but also to inspire.

wnu-neurology.com •

Election of One Trustee for the Council of Delegates Meeting 2024

Review the list of candidates for WFN trustee.

Prof. Raad Shakir, CBE, FRCP

For the upcoming election of a trustee at the virtual Council of Delegates (COD) meeting in September, WFN’s Nomination Committee, chaired by Prof. Raad Shakir, has reviewed all applications and has the following recommendations (in alphabetical order):

  • Fernando Cendes, Brazil
  • Valery Feigin, New Zealand         
  • Miguel Osorno, Mexico
  • Brian Sweeney, Ireland
  • Barbara Tettenborn, Switzerland
  • Tissa Wijeratne, Sri Lanka

The statements of these individuals will be published in an upcoming issue of World Neurology, and will be available on the WFN website.

The voting process will be announced in due course, and will be accompanied with detailed instructions.

The deadline for nominations was March 15, 2024. Nominations made after this deadline are still possible. Additional nominees must be a member of a WFN member society and must present the supporting signatures of five or more authorized WFN delegates, a CV, and a letter of agreement to stand.This must be submitted to the Secretary General, c/o the WFN Headquarters at info@wfneurology.org no later than 30 days prior to the start of electronic voting. Deadline for additional nominations will be Friday, July 26, 2024. Electronic voting will occur over three weeks starting Aug. 26, 2024. •

Prof. Raad Shakir, CBE, FRCP, is chair of the WFN Nomination Committee, and a past president of the WFN.

WFN Clinical Fellowship

Four weeks of learning at the university hospital in Giessen, Germany.

By Salsabil Abdulrahim Mady Abulazayem

I completed my WFN clinical fellowship at the department of neurology at the University Hospital Gießen in Giessen, Germany, for a period of four weeks under the supervision of Prof. H. B. Huttner. I was welcomed by Dr. M. Jünemann. He showed me the department and introduced me to the entire team. I appreciate the warm and kind welcome. I always felt fully integrated into the department’s daily routine, which allowed me to participate in all of the available activities.

During my first week, I regularly attended the movement disorders clinic with Prof. Reuter, where I had the opportunity to evaluate patients with all types of movement disorders and to discuss the cases, the diagnostic work-up, and therapeutic options. I also had the opportunity to witness complex therapies not present back home, such as subcutaneous apomorphine infusion and deep brain stimulation.

In the second week, I attended the neurocritical unit with Prof. Schramm, Dr. Alhaj Omar and Dr. Khilan, where I had the opportunity to evaluate patients with acute neurological conditions such as Guillain-Barre Syndrome (GBS), acute stroke patients, and post-thrombectomy care, and their diagnostic work-up and management plans. I was truly impressed by the perfect care from all of the medical staff.

During my third and fourth weeks, I attended the stroke unit rounds where cases were assessed and discussed, usually patients presenting with acute ischemic stroke, acute hemorrhagic stroke, acute lower motor neuron lesions such as GBS or myositis, and meningitis.

I had the opportunity to attend an epilepsy clinic with Dr. Mück, an MS clinic, and discuss diagnostic work-up and therapeutic options in different patients. In addition, I had the opportunity to attend the weekly Journal Club during my month. Also, I attended daily morning staff rounds where clinical cases were presented and interactively discussed to reach a final diagnosis.

I was able to increase my knowledge base and to learn therapeutic and diagnostic approaches that I could use in my daily clinical practice thanks to this clinical fellowship.

To conclude, I would like to thank Prof. Huttner and his team, Dr. M. Jünemann, Prof. Reuter, Prof. Schramm, Dr. Alhaj Omar, Dr. Mück, Dr. Wolff, Dr. Ebert, Dr. Genau, and Dr. Khilan for all of their kindness. Of course, I would like to thank the World Federation of Neurology for granting me the opportunity to do this clinical fellowship and the German neurological Society for their wonderful ongoing help with the WFN Department visit program. I highly recommend it to young neurologists. •

Salsabil Abdulrahim Mady Abulazayemi is Lecturer of Neurology, Cairo University.

World Brain Day 2023 in India

images of newspapers covering world brain day in india

A sampling of the media coverage of WBD in India 2023.

Unique activities enhanced World Brain Day in India.

Chandrashekhar Meshram, Gagandeep Singh, Nirmal Surya, and U. Meenakshisundaram

World Brain Day 2023 was celebrated with great enthusiasm and commitment in India by the Indian Academy of Neurology. The campaign extended over several days.

The 2023 theme was Brain Health and Disability, Leave No One Behind, and  generated a lot of interest. The activities were focused toward increasing awareness among common people and students about brain health and disability. Chandrashekhar Meshram issued a press release.

This year, we at the Indian Academy of Neurology changed the approach and focused on reaching a few hundred thousand people through the most popular TV channel in the country. The activity was in the form of panel discussions on brain health and disability. WFN President Prof. Wolfgang Grisold was one of the panelists. Other panelists were IAN President Dr. Gagandeep Singh, WFN Trustee Dr. Chandrashekhar Meshram, IAN Past President Dr. Nirmal Surya, IAN Secretary Dr. U. Meenakshisundaram, and IAN Treasurer Dr. Lakshmi Narsimhan.

The panelists discussed the importance of World Brain Day, dementia and disability, epilepsy, stroke and disability, and the role of rehabilitation in disability. People could watch the telecast twice on July 22. The session is also available on YouTube. 

Articles were published in newspapers to educate people about brain health and disability, the importance of exercise for brain health, information about Guillain-Barre Syndrome and its outbreak in Peru, stroke and disability, and brain health as a human right.

Walk for Your Brain was organized and held July 23 in Nagpur. People from various walks of life participated in the activity. The event was led off by Ravindra Thakare, tribal commissioner. People carried placards that displayed messages such as “Our brain, our future,” “It is your brain, use it or lose it,” “Proper diet for healthy brain,” “Epilepsy is treatable, don’t hide it,” “Clean city, healthy brain,” “Exercise, diet, and sleep. Three pillars of brain health,” and “Avoid air pollution for a healthy brain.” Chandrashekhar Meshram explained the importance of World Brain Day and provided tips for preserving brain health and preventing neurological diseases.

The Indian Federation of Rehabilitation (IFNR) conducted several activities on World Brain Day. Dr. Nirmal Surya, president of IFNR, presented on family- and community-based rehabilitation in which he emphasized the role of family participation in delivering rehabilitation in developing countries.  He said this model would be a way forward in providing affordable rehabilitation for all in developing countries. Dr. Abhishek Srivastava, secretary and director of the IFNR, explained prevention and rehabilitation of poliomyelitis and how we win with community-based rehabilitation. The talk was elaborate on the various rehabilitative aspects that were undertaken to uplift the daily living of patients with poliomyelitis.

IFNR organized an awareness drive with a video contest, in which participants submitted videos on the theme of World Brain Day: Prevention, Awareness, Education, Advocacy to uplift the brain health. Over 80 submissions were received. The top five submissions were showcased on the World Brain Day Webinar Platform and given prizes.

Epilepsy Foundation India organized a public awareness program for people with epilepsy. The program kicked off with a painting competition and a welcome address by Dr. Nirmal Surya. He talked about the importance of brain health and the theme of leaving no one behind and how to keep the brain healthy and disease-free.

Prof. Tissa Wijeratne, co-chair of WBD and WFN, talked about brain health and disability and why it is important to have awareness in developing countries. Dr. Chandrashekhar Meshram, trustee of the WFN, emphasised the need of brain health in epilepsy as well as other diseases such as stroke, Parkinson’s, and dementia. A dance and lecture session by members of the Epilepsy Foundation was also organized.

The World Brain Day campaign will certainly contribute toward promotion of brain health, awareness and prevention of disability, early diagnosis, treatment and prevention of neurological disorders, and in turn improving the patient care.

The IAN’s Plans for World Brain Day 2024

In continuation of the campaign Brain Health for All, the WFN has decided the theme for WBD 2024 is Brain Health and Prevention. The Indian Academy of Neurology will participate in the 2024 campaign in a big way. India has a high incidence of young strokes. With the increase in life expectancy, the problems of diseases such as dementia and Parkinson’s disease are on the rise. Lifestyle medication, diet, and air pollution are important issues that need to be addressed. Public awareness for causes and prevention of neurological diseases will be the top priority during the 2024 WBD activity in India. •

WFN Neurological Community Update

WFN president reviews neurology development around the world, IGAP, World Brain Day, WCN, and other key topics.

Wolfgang Grisold

A 2023 WFN survey of WFN member societies assessing knowledge and content of the IGAP, revealed a disconcerting low level and awareness. Activities and publications of the WFN are aimed to increase the awareness and practical implementation of IGAP (Displayed Q 4-8) (London Office: C. Hunte)

Welcome to the first issue of World Neurology in 2024. We hope you had a relaxing, festive holiday season, and we look forward to the new year. 2024 will be another positive year for neurology, and we as the neurological community of the WFN will have many opportunities to foster and support neurology.

Globally, neurology is developing well. This statement can be supported by developments in neuroscience and global developments. General neurology as well as the subspecialties are thriving; examples are stroke and worldwide stroke services, epilepsy, and new drugs for epilepsy, movement disorders, and MS. The new possibilities not only to diagnose, but also to treat some of the genetic diseases is an incredible advance, and breaks previous dogmas on therapy limitations and prognosis of some neurological diseases.

Regarding global development, important are the activities of the WHO. Worldwide, the WHO has 194 member states. Several WHO departments take care of present and emerging health problems of the world. The classification of neurological disorders still needs separation from mental disorders and requires a universal and globally accepted classification, which can be the basis for universally applied stable and more devoted structures.

A positive example for the development of classification is stroke and ICD-11, where the WHO ICD-11 classification will allow further implementation of stroke services worldwide. Despite this amazing success story, we must continue to develop the prevention as well as chronic care, disability, and palliative care in stroke patients on the other side of the spectrum.

The WHO has implemented a “brain health unit” that fosters and supports the implementation and development of neurology. One key development is the IGAP, which is based on policy and advocacy, therapy, prevention, innovation, research, and public health. This concept was accepted by all member states at the World Health Assembly in 2022. Despite its strong support for neurology and ultimately persons with neurological diseases, the echo and acceptance at the regional and country level still needs more powerful inputs.

Presently, the WHO is developing a tool kit for the implementation of IGAP, addressing all stakeholders. The WFN uses its channels of distribution to member societies, uses information at talks and presentations, has information on IGAP on its website, and has emphasized the IGAP and cooperation with the WHO at the World Congress of Neurology (WCN) 2023 and will continue to do so.

We want to emphasize this important IGAP activity for several reasons:

  1. It promotes neurology at all levels and everywhere (“Semper et unique“).
  2. It provides a well-structured concept on the establishment and needs of neurology, which can be adapted and used according to the individual local needs. This may differ according to the income status of countries.

The call to all member societies is to familiarize members and health systems with the IGAP, put it on the agenda of your society meetings, and try to promote it within your networks, including health authorities and other stakeholders.

The mission of IGAP and the role for the development of neurology is enormous. We want to remind readers of the important role of the ILAE and the WFN in its development. We share this common effort, and as stakeholders, we have to avoid competitive altruism. The common goal is implementation of neurology and improvement of the large number of persons affected with acute and chronicneurologic disorders, disability, and be on the forefront to prevent disease.

From the other tasks and programs of the WHO, such as brain health, fight meningitis and tuberculosis, and implementation of rehabilitation, we would like to remind readers of the WHO essential medicine list (EML), which we covered in the last issue of World Neurology in 2023. Successfully, more medications, one for epilepsy and two for MS, were added to the EML list. The EML is a dedicated WHO effort to make drugs available in all countries of the world. In some countries, there is a lack of registered drugs, deficits in registration, procurement, distribution, and affordability.

World Brain Day (WBD)

The WBD has become an annual event for the WFN community. It celebrates the day of WFN’s founding in 1957, chooses a yearly topic, and collaborates with topic-related societies and regions.

This year, we will continue supporting the important topic of brain health, and focus on brain health and prevention. The activities will be chaired by D. Dodick and T. Wijeratne, the WFN regions, and will receive professional help from the marketing firm Yakkety Yak.

Prevention in neurology is a powerful and often underestimated tool to prevent neurological diseases and has a wide range of interventions, from vaccination, to pharmacology, nutrition, and lifestyle modifications. As with diagnosis and treatment, all types of prevention need to be added to neurological curricula.

Communication: Meetings/Congresses and Education

Communication with the WFN‘s member societies is important. Please follow our website and social media. We also have a new medium called the WFN Service Page, which will be published every three months in the Journal of the Neurological Sciences (JNS). This will increase the reach of the WFN. We also encourage you to publish material from your society and your regions in World Neurology. If you consider publishing in a journal, please consider the JNS and eNS as official journals of the WFN.

Congresses such as the WCN 2023 always leave impressions and produce new insights, either at the meeting or in discussions and informal gatherings. We are happy to report we had a large number of persons participating virtually at this congress. This served two main purposes: to reach countries worldwide, who are unable to travel for financial and other reasons, and to increase the worldwide spread of neurology. One hundred and thirty two countries participated.

There is material on the WFN website from the WCN 2023 in Montreal. Also, please note the summary of the plenary sessions, the coffee talks, and all abstracts are now published in the JNS.

Meeting with the Korean Committee in Seoul.

The next WCN will be in Seoul in 2025. The program committee has started its work. It is a generous venue and and a vibrant city. The Korean Neurological Society is putting much effort into this important congress, and it will provide strong input for neurology in the region.

For September 2024, we are planning a virtual educational update meeting: World Federation of Neurology Digital Update 2024 (WNU2024) Sept. 26-27. Eminent speakers will provide an update on the most frequent diseases, and the meeting will offer online teaching courses on these topics.

It will be a useful update instrument between the WCN congresses. Updates, education, and CME will be the strategy. The meeting will be virtual only.

WFN educational days will be continued, with the AFAN WFN educational day on neuropathies on Feb. 17, 2024, followed by a joint headache day with AFAN and GPAC/IHS. Another educational day with the AOAN is planned. This format has been successful, attracting  many attendees, not only from the regions, but worldwide. Recordings of the meeting can be seen in the WFN e-learning hub.

The WFN president high above Seoul.

We need to encourage and increase our efforts for CME and continuous professional development (CPD) worldwide. This is an essential part of professional practice in neurology, and needs constant update and development. Worldwide, many countries have established CME programs, belonging to the portfolio of practicing neurologists and are often linked with recertification. Usually the time of participation in a meeting or an activity is converted into a system of credits. This works well for individual countries but, for many reasons, in most circumstances cannot be exchanged or compared.

For large international congresses such as the WCN, the UEMS EACCME system is used, which has a detailed and strict separation of industry and other possible influences on the scientific program. This system is acknowledged by most European countries, and it also has an agreement with the American Medical Association and the Canadian Royal College of Physicians.

The WFN has a Standards and Evaluation Committee (chaired by Prof. Laszlo Vescey) in place that receives applications for meetings and events which fulfil the criteria of the WFN . This committee endorses international meetings according to the requirements of the WFN. The endorsed meeting is allowed to use the WFN logo for its event.

This was a short update on important WFN activities. Please follow us on our website and social media as well as the new WFN service page in JNS for more information. •

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