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Does Migraine Exist?

By Joost Haan, MD, PhD, BA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

Commentary: Does Migraine Exist?
by Richard Stark

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

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

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

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

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

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

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

Richard Stark is treasurer of the WFN.

Candidate Statements for WFN Secretary General, Elected Trustee

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

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

  • Marianne de Visser
  • Steven Lewis
  • Tissa Wijeratne

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

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

 


Candidates sorted alphabetically

Marianne de Visser

Marianne de Visser

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

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

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

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

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

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

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

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

 

Steven Lewis

Steven Lewis

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

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

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

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

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

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

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

 

Tissa Wijeratne

Tissa Wijeratne

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

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

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

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

 


Candidates sorted alphabetically

Chandrashekhar Meshram

Chandrashekhar Meshram

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

Services to the WFN

I am indebted to WFN for giving me the opportunity to serve as co-opted trustee and as the president of Tropical and Geographical Neurology Specialty Group (TGNSG). In these roles, I have contributed to the mission of WFN “fostering quality neurology and brain health worldwide.” Through TGNSG, I organized 16 webinar sessions on neuro infections and gave opportunity to trainees from different regions of the world to sharpen their clinical skills through interaction with the experts. Our ongoing series “Inspiring People in Neurosciences” is a step in the same direction. All of these sessions are available on the WFN website. TGNSG also provides monthly updates of COVID-19 for the WFN website. I was also instrumental in getting the teaching sessions by Indian Academy of Neurology on the WFN website. I have planned the department visit program in India for residents from poor countries.

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

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

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

Goals

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

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

 

Bo Norrving

Bo Norrving

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

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

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

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

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

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

 

Minerva López Ruis

Minerva López Ruis

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

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

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

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

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

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

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

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

 

Mohammad Wasay

Mohammad Wasay

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

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

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

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

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

Major Activities of the WFN

By Wolfgang Grisold

Wolfgang Grisold

Wolfgang Grisold

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

WFN Major Events

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

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

Geneva conference

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

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

Economic and Social Council (ECOSOC)

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

Wolfgang Grisold at the WHO

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

World Brain Day

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

Wolfgang Grisold delivering the WFN statement.

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

Council of Delegates

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

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

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

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

Education, Training Centers, and Department Visits

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

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

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

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

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

Educational Days

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

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

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

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

Webinar

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

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

Congresses and Meetings

International Congress of Neuromuscular Diseases ICNMD

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

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

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

World Congress of Neurology (WCN) 2023

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

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

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

World Congress of Neurology WCN 2025 Seoul

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

EAN Vienna, June 2022 

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

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

Summary

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

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

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

Environment, Climate, and Neurological Diseases

Webinar by the Environmental Neurology Specialty Group (ENSG).

By Safa Younis and Mohammad Wasay

Safa Younis and Mohammad Wasay

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

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

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

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

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

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

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

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

Election Announcement

In March, the Nominating Committee of the WFN invited nominations for the positions of:

Secretary General [4-year term] 

To take office from Jan. 1, 2023
Position vacated by Prof. Dr. Wolfgang Grisold


Candidates (in alphabetical order)

  • Marianne de Visser
  • Steven Lewis
  • Tissa Wijeratne


One Elected Trustee   [3-year term]

To take office immediately following the council of delegates meeting.
Position vacated by Dr. Steven Lewis upon the end of his second term of office


Candidates (in alphabetical order)

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

As in the previous two elections—2020 and 2021—voting will take place by remote online ballot. This method of voting enables all member societies to vote in the elections, regardless of whether or not they are able to attend the Council of Delegates meeting, but also reduces the impact that adverse conditions, such as differences in time zone or difficulties caused by COVID restricted travel, may have to sound decision-making when voting.

Voting will take place between Oct. 3-16, 2022, before the WFN AGM Council of Delegates meeting.

Further information on how to vote, including an instructional video, will be sent out to WFN member societies on Sept. 5 together with online registration to attend the AGM.

The results of the voting will be announced during the Council of Delegates meeting. •

 

Public Education Activities in India

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

The Indian Academy of Neurology is highly committed to public education and awareness activities regarding neurological disorders. It carries these events throughout the year. The idea is to educate general public about the disorders in order to help them for early diagnosis and better patient care. In view of the COVID pandemic, these activities were organized as virtual meetings and were well attended. The audience also got the opportunity to interact with the experts.

IAN President Nirmal Surya inaugurated the events. National coordinator for IAN public awareness programs, Chandrashekhar Meshram, had prepared and released the press notes and organized the sessions. Articles were published in leading newspapers. Some sessions were also organized in regional languages.

World Neglected Tropical Diseases Day – Jan. 30

NTDs are widespread in the world’s poorest regions, where water safety, sanitation, and access to health care are substandard. NTDs affect over 1 billion people globally and are caused mostly by a variety of pathogens including viruses, bacteria, parasites, fungi, and toxins. Gagandeep Singh, president-elect of IAN, Manish Modi, Shripad Pujari, Devashish Ruikar, Rajesh Verma, and Chandrashekhar Meshram were the expert panelists. Rahul Kulkarni, chair of Tropical Neurology subsection of IAN, was the moderator.

International Epilepsy Day – Feb 14

Epilepsy is a social stigma and the attitude of the community toward people with epilepsy is negative. Although epilepsy can be controlled by medicines in 75% of people, there is a treatment gap of 80% in those living in low middle income countries due to lack of knowledge and unavailability of medicines. Sangeeta Rawat, Chaturbhuj Rathod, Sita Jayalakshmi, and Dinesh Nayak participated in panel discussion. IAN Secretary U Meenakshisundaram moderated the session. Programs were also organized regionally by Gautam Ganguly, M A Aleem, K Ummer, and U Meenakshisundaram.

World Tuberculosis Day – March 24

Tuberculosis is the deadliest infectious disease killer and is endemic in 22 countries. The theme for the year is “invest in TB to save lives.” About one lakh cases of TB meningitis are diagnosed each year with mortality of about 30%. Sarosh Katrak, Ravindra Kumar Garg, Rohit Bhatia, and Thomas Lype interacted with moderators Rahul Kulkarni and Manish Modi to highlight different aspects of CNS TB.

Purple Day – March 26

Purple Day is an international grassroots effort dedicated to increasing awareness about epilepsy worldwide. Mamta Bhushan Singh, Ashalata, Amit Haldar, and Jayanti Mani participated in the event moderated by Sita Jayalkshmi. M A Aleem’s interview was published in the newspaper.

World Autism Awareness Day – April 2

Autism Spectrum Disorders are on the rise, and one out of 150 children may suffer from the same. A child who has difficulty in communication, difficulty in socialization, and peculiar traits like repetitive speech and behavior, usually should be suspected for autism. It is important to diagnose and intervene early. The condition is four times more common in boys as compared to girls. Environmental and genetic factors may be responsible.

There is no cure for autism but through a multidisciplinary team approach, patients can be helped to a great extent. Vrujesh Udani, Alka Subramanyam, Shefali Gulati, Koyeli Sengupta, Sonal Chitnis, Trupti Nikhalje were the panelists. Pediatric Neurology Subsection Convener K P Vinayan moderated the session. Priyadarshini Raut, parent of autistic child, narrated her experiences and triumph over the condition of her son who became an engineer and is working for a software company.

World Parkinson’s Day – April 11

This day symbolizes a time to raise awareness and advance research toward better therapies and a cure for Parkinson’s disease (PD). There are about 9 million patients with Parkinson’s Disease worldwide. With increase in life expectancy, the prevalence of this neuro-degenerative disease is on the rise.

Sanjay Pande, Rajinder Dhamija, U Meenakshisundaram, and Sumit Singh shared their views and interacted with movement disorder subsection chair Achal Shrivastava and convener Ravi Yadav.

World Multiple Sclerosis Day – May 30

Every five minutes, someone receives the life-altering diagnosis of multiple sclerosis. More than 2.8 million people of all ages live with multiple sclerosis around the world. This neurological disease impacts every aspect of a person’s life, with effects ranging from cognitive impairment to significant physical disability. Early diagnosis and access to proven disease-modifying treatments are vital to improving patient quality of life and significantly halting disease progression. Dheeraj Khurana, Lekha Pandit, R. Suresh Kumar, and Kunal Bahrani were the panellists while Manish Mahajan moderated the session.

IAN is planning to celebrate World Brain Day on July 22 in grand way with 100 activities over the week. •

Chandrashekhar is the co-opted trustee of the WFN, U Meenaksshisundaram is IAN secretary, Gagandeep Singh, is president-elect of IAN, and Nirmal Surya is IAN president.

A View From the Top

Wolfgang Grisold

Wolfgang Grisold

This is the second issue of World Neurology this year, and I will take the opportunity to update you on the activities of the WFN. I will comment on the global situation, and then describe the internal developments of the WFN also in regard to future aspects, the persistence of COVID, the important advent of the “Intersectoral Global Action Plan” (IGAP) and World Brain Day 2022, “Brain Health for All.”

Global Situation

Due to ongoing wars, conflicts, and crises worldwide, I would like to emphasize the WFN‘s statements on armed conflict and wars and also encourage donation to professional organizations.

The global situation on wars, conflicts, refugees, displaced persons, and the effects on neurology and neurological patients is severe, and the WFN is deeply concerned. The WFN condemns any conflicts of war. It cannot be stressed enough that our role is to advocate for neurology, patients and caregivers who are endangered in these situations, and the reduction of access to care and treatment. Any armed conflict will also cause new casualties and victims, many of them with neurological sequelae and also subsequent mental conditions.

The role of the WFN as a scientific society, composed of 123 member societies, is building bridges between societies, members, medical disciplines, patients, and caregivers.

The WFN encourages the support to migrants, refugees, displaced and stateless persons, and victims of conflict worldwide. As a charity, we are primarily concerned with people with neurological disorders, their access to care, and the provision of essential drugs. We have indicated organizations that are experienced in global crises, and encourage donations for the purpose to support neurological patients.

Internal Developments

The year 2022 marked the time of a new administration. The strategy is to build on established structures and evolution as well as the integration of new developments.

The WFN is working on the improvement of communication with its member societies, further developing educational tools, such as the e-learning hub and educational days, among others. The experience with the previous WFN e-learning days has been successful, and the format and time of these events has been well accepted. The possibility of short-term educational interventions has been demonstrated in a recent SNO-WFN webinar on scientific advances on neuro-oncology, which was well-attended. We want to thank our partners including AFAN, EAN, AAN, IHS-GPAC, and SNO for their support. We believe these newly added educational concepts of virtual interventions will be important.

Basic administrative structure of the WFN in London. The office presently has four staff members who administer and coordinate the WFN affairs. External IT aspects and the management of Continuum are conducted by local and experienced collaborators (IT=information technology; PCO=professional conference organizer; PR=public relations)

The WFN has several committees, which act on behalf of the trustees. For the new administrative period, we have decided to adapt some of the committees and also add several subcommittees for specific purposes such as gender and diversity, young neurologists, teaching centers as well as a patient platform, among others. Based on the virtual WFN regional meeting in January-February 2022, we have selected chairs and filled the positions with suggestions from the regions. We have also increased the ratio of females from 10% to 40%, and we are committed to continue to adapt gender balance.

At this point, I also want to thank the outgoing chairs and members of the committees for their devotion and dedication to the WFN. Rotation of positions is necessary in such a large organization, and even if the terms end, we hope that all previous members will continue working with us supporting the WFN or in other future functions. The list of the new committees will be available on the website, and we will continue to introduce committees in World Neurology.

Other current tasks include preparation for the next Council of Delegates (COD) meeting this October 2022 in Amsterdam, where a new Secretary General and and one trustee will be elected. The WFN met with the AAN in a leadership meeting, and this is also planned with the EAN and with AOAN.

The preparation of the WCN 2023 is proceeding, and the WCN program committees have started their work. A preliminary program will appear soon. The preliminary work for WCN 2025 in Korea is also ongoing.

Define the Future

The WFN has reached a critical size and has globally a wide span of activities, which make a permanent and reliable organizing, planning and administrative structure necessary. This includes long-term planning and decisions, and availability with regard to resources both personal and financial.

The WFN, being a U.K. charity, guarantees a strict and well-assessed structure, which is taken care of by the trustees with the support of the WFN staff in London and is regularly audited each year. These administrative tasks, projects, and communicative tasks, are carried out by the office staff and externally with the help of Chiu, Helen Gallagher, our professional conference organizer (PCO), Freedman (our financial consultant), and Yakkety Yak, our public relations consultant, which make the WFN a complex structure.

Congress organization is done by a PCO, and the organization of WBD and Brain Health by a PR expert company.

We appreciate that the interest and trust in the WFN is high and increasing from the standpoint of cooperations. Any project taken up by the WFN needs administration and monitoring, and increasingly, project management tools will have to be used to define capacities to the extent that projects can be supported.

For education, the projects will be based on a needs assessment, which will be the basis of future development of all educational activities. We are also supportive of the concept of CME and Continuous Professional Development, which is lifelong learning for neurologists. There are several worldwide concepts such as the AAN’s Continuum, and the European EACCME model, which offer a widespread and detailed choice of CME educational methods and models. We are happy to say that the WFN congresses (World Congress of Neurology) are always accredited with up to 40 credits from EACCME , and we have always passed the strict and thorough definitions for these meetings. They are valid for AMA and the Canadian Royal College of Physicians.

Education in neurology is needed at all levels and is a continuous process. In addition to practical and scientific content, the importance of advocacy as well as leadership will have to be implemented in the strategy of our educational programs. We are committed to our concepts of department visits and training centers, and will report on these developments in the next issue.

COVID Is Continuing

I want to remind our readers that the COVID pandemic is not over yet, and travel and communication is still at risk. This also relates to the planning of the World Health Assembly (WHA) meeting in Geneva as well as to the COD meeting in Amsterdam.

The WFN has updated the COVID website and the Specialty Group on Tropical Neurology is providing monthly updates. Also Elsevier will provide a collection of COVID papers published in ENS (and in the future, JNS) and can be found on the COVID site: https://www.sciencedirect.com/journal/eneurologicalsci/special-issue/1006JKSX5HX.

The WFN also actively works with the WHO in several working groups on the neurological effects of COVID in both acute and late effects.

The pandemic had and still has catastrophic effects on patients and caregivers, not only as limited access to care and reduced capacities, but also medical and bureaucratic hurdles. It has to be assumed that the indirect damage to acute and chronic neurological patients is high and will take considerable time to return to normal.

As neurologists, we have to take care of the so-called soft facts such as communication, personal interaction, quality of life, and that the needs of patients and caregivers are addressed.

Intersectoral Global Action Plan (IGAP)

Much energy and effort is being invested in the WHO’s International Global Action Plan (IGAP). I want to thank my predecessor William Carroll and Alla Guekht and Kimberly Karlshoej for their continuous efforts. This is a good example of a project that will have a worldwide impact, but is also a good example of worldwide cooperation.

IGAP is about to be accepted at the WHA in Geneva in May 2022. The WFN has been working with other societies such as the ILAE, the World Stroke Organization, Movement Disorders Society, and the International Headache Society on this development.

It is based on a long and fruitful cooperation with the WHO, which has several landmarks and previous books, including two editions of the Atlas and also the development of ICD 11. This IGAP will elevate the importance of neurology worldwide and will enable countries to use this WHO initiative for the establishment or development of neurology.

A brain health unit has been created by the WHO, which indicates the importance of brain health worldwide. (https://www.who.int/health-topics/brain-health#tab=tab_1).

Once the IGAP is accepted, the implementation of the IGAP will need the full attention for new projects with the WHO and with individual societies to implement this exciting program.

World Brain Day Topic

This year‘s World Brain Day (WBD) will be dedicated to “Brain Health for All.”

It is chaired and organized by our Public Awareness Committee by Tissa Wijeratne and David Dodick, with professional assistance from Yakkety Yak, which has taken care of the last WBDs. The committee consists of representatives from the WFN regions, and it is hoped that this WBD will underline the importance of brain health globally. We hope to align with the WHO in this important activity. The intent is not only to reach as many regions as possible, but also customize our WBD tools for individual use and we hope that many, if not all, WFN member societies will be able to celebrate with the WBD in their regions and use this topic to promote neurology at all levels. The topic of this year’s WBD also aligns with the upcoming IGAP, which will be approved by the WHA in May.

The view of the WFN is that brain health has a wide span from intrauterine life toward childhood, adulthood, and into aging in regard to neurological function, dysfunction, rehabilitation, and palliative care.

The selection of the topic “Brain Health for All” is based on the WFN’s 2021 brain health campaign (https://wfneurology.org/brain-health-initiative) and the cooperation with the WHO. Also regional societies including the EAN are committed to brain health, such as the European Brain Health Summit meeting in May 2022 (https://www.ean.org/ean/advocacy/brain-health). There will also be a brain health session at the EAN congress in Vienna.

This was a short update on the current proceedings of the WFN, including several cooperations and developments. Please follow us on the website and social media.

If you have comments or questions, please contact us at info@wfneurology.org. •

From the editors

Steven L. Lewis, MD, Walter Struhal, MD

We’d like to welcome all readers to the March-April 2022 issue of World Neurology.

The issue begins with the obituary of Dr. Jun Kimura (1935-2022), former WFN president and renowned electrodiagnostic neurologist, written by his colleague and former mentee, Ryuji Kaji.

In the President’s Column, WFN President Dr. Wolfgang Grisold discusses a number of items, including implications of the current global situation, internal developments and plans at the WFN, an update on COVID with regard to the WFN, the International Global Action Plan (IGAP) of the WHO, and World Brain Day 2022, devoted to Brain Health for All.

Dr. Chandrashekhar Meshram announces the important news that the Padma Shri Award, the highest civilian honor of India and conferred by the president of India in New Delhi, has been awarded to Dr. Bhimsen Singhal.

Dr. Meshram also summarizes Dr. Singhal’s remarkable accomplishments.

Drs. Marina Alpaidze, Tsotne Samadashvili, and Alex Razumovsky discuss the successful teaching course sponsored by the Neurosonology Specialty Group of the WFN held in Tbilisi, Georgia, in late 2021, which discussed the use of transcranial Doppler ultrasonography as an essential daily modality in the critical-care setting.

In this issue’s History Column, Dr. Peter Koehler discusses the early endeavors to build a CT scan, with particular reference to the Ukraine pioneers who were integral in this development.

This issue also includes a number of important announcements, including World Brain Day 2022 devoted to Brain Health for All, an announcement for the WFN’s call for applications for 2022 Grants, and an announcement of the upcoming 17th International Congress of Neuromuscular Disease, which will take place in Brussels in early July 2022.

This issue also updates us about a recent important position statement from the American Epilepsy Society about the serious risks associated with use of valproate by women of childbearing potential.

Finally, this issue also includes an obituary of Dr. Paul Kleihues, a world-renowned neuropathologist in the field of brain tumor research who was integral in the WHO classification of human tumors.

We thank all readers for their interest in World Neurology and invite you to submit ideas for contributions. Please send your ideas to stevenlewi@gmail.com. •

 

 

Neurosonology Specialty Group WFN Teaching Course

Meeting discussed use of transcranial Doppler ultrasonography as an essential daily modality in the critical-care setting.

By Marina Alpaidze, MD, PhD, Tsotne Samadashvili, MD, PhD, and Alex Razumovsky. PhD, FAHA, NVS

Conference room at Caucasus Medical Center.

The Neurosonology Specialty Group of the WFN is dedicated to the promotion of science and research as well of education and training in the field of ultrasonic techniques and its clinical utilization. Therefore, international cooperation and the dissemination of scientific information within the field of neurosonology is part of the WFN Neurosonology Specialty Group activities.

The WFN Neurosonology Specialty Group course considering clinical applications of transcranial Doppler (TCD) utilization in neurocritical care and neurosurgery was held Nov. 5, 2021, at the Caucasus Medical Centre in Tbilisi, Georgia. The meeting was conducted under the auspices of the NSG WFN, Georgian School of Anesthesia and Intensive Therapy, and Georgian Chapter of NSG WFN, and the Georgian Society of Cerebral Hemodynamics and Neurosonology.

Razumovsky (top left), L.Tsikarishvili. (bottom left), T. Samadashvili (top right), M. Alpaidze (bottom right).

Among the faculty were Drs. T. Samadashvili, MD, PhD, president of the Georgian School of Anesthesia and Intensive Therapy (NGO) and chair of the anesthesiology department at Caucasus Medical Centre; Lado Tsikarishvili, MD, PhD, chair of the neurosurgery department at Caucasus Medical Centre; M. Alpaidze, MD, PhD, professor in the department of radiology at the Tbilisi State Medical University; and Alexander Razumovsky, PhD, FAHA, NVS, secretary of the WFN Neurosonology Specialty Group.

(From left to the right) L. Tsikarishvili (neurosurgeon), T. Samadashvili (anesthesiologist), M. Alpaidze (radiologist), and A. Razumovsky (neurophysiologist).

This course was designed for different medical specialists, including neurologists, neurocritical care physicians, and neurosurgeons.  Presentations were related to the clinical yield of TCD for neurocritical care applications, specifically for patients after subarachnoid hemorrhage and traumatic brain injury. Different aspects of neurosurgical, critical care, and neurosonology were discussed in detail. Among them were management strategies of cerebral vasospasm after SAH and TBI. Some new trends in the clinical utilization of neurosonology applications were debated. Due to the COVID-19 regulations in Georgia, the meeting offered simultaneous live broadcast for a wide-ranging audience. •

Marina Alpaidze, MD, PhD, is professor in the radiology department at Tbilisi State Medical University. Tsotne Samadashvili, MD, PhD, is chair of the anesthesiology department at Caucasus Medical Center. Alex Razumovsky. PhD, FAHA, NVS, is secretary of the Neurosonology Specialty Group of the WFN.

 

 

2022 WFN Grants-In-Aid

The WFN mission is to foster quality neurology and brain health worldwide, and this year, the WFN is offering up to six grants of up to $25,000 with a maximum spend of $100,000.

Research projects that will be considered for funding include:

  • Education such as research on neurological education and patient education (Please note that grants related to the funding or creation of neurological residency or fellowship training programs will not be awarded.)Improvement of neurological services
  • Regional collaboration
  • Disease-based projects (Please note that pure laboratory or “bench research” projects are out of the scope of this grant program.)

2022 grant applications that are likely not to be adversely impacted by the COVID-19 pandemic will be preferred.

We look forward to reviewing applications for the 2022 WFN grant program.

Eligibility

Neurologists less than 10 years from graduating in neurology from WFN Member Societies.

Preference will be given to applicants residing in areas of World Bank low/lower-middle-income countries.

Aim

The WFN seeks to fund low-cost, high-impact education and outcome research projects able to be implemented locally (at source). International cooperation is encouraged.

(Please note projects to provide routine health care and ongoing research proposals are not eligible).

Criteria

Projects should be in education, improvement of services (regional or national), or scientific and require the collection of data to test a hypothesis.

Each grant will have to satisfy its terms of the agreement. (See below.)

In the application, please address the following points:

  • Relevance: How does the project directly address the mission of the WFN?
  • Value: What is the return on invested effort in funds and/or time?
  • Viability: Is this a time-limited project with a measurable outcome or is it an initiative that will grow and support the development of further research or initiatives?
  • Synergy: Within the WFN and among committees, initiatives, and task forces, with outside partners, governmental and non-governmental organisations, the WHO, fundraising agencies etc.
  • Please suggest possible partners. For example, a project on stroke would probably be interesting for the WSO, for epilepsy possibly with the ILAE, etc. (See co-sponsored grants.)
  • Evaluation: How will the outcome be measured?
  • Management: Good governance, transparent monitoring, and clear interim and financial reports are required.

Co-Sponsored Grants

The WFN encourages co-sponsored grants. These grants will be co-sponsored by the WFN and a partner organization. The partner organization can be a scientific society (e.g. ILAE, MDS, etc.), a regional society (EAN, AOAN etc.), or a national society. The partner organization will sign a sponsorship agreement with the WFN to define the shared costs and the role of the individual partners in such projects.

Project responsibility and reporting will be shared by the WFN and the partner organization.

Deadlines

  • Application due by July 1, 2022
  • Applicants will be notified of successful funding in due course after the closing date.
  • Once applicants are informed of the decision, funding will begin as soon as it can be arranged thereafter.
  • Applications are to be submitted exclusively using the online WFN grant application form and should include the following:

Application Checklist

  • The name of the lead applicant with curriculum vitae and any sponsoring group
  • Title of the project
  • Description of the project
  • Direct relevance of the project to the mission of the WFN
  • Viability of the project
  • Timeline of the project, dates, and duration
  • Detailed budget in U.S. dollars
  • Name of bank to enable electronic funds transfer and confirmation of the same by the specified bank
  • Approval by a local or institutional ethics committee

All funding must be received through an academic institution account.

Please visit the WFN website for additional information. •

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