VOL. 23 NO. 3 SEPTEMBER 2008 World Neurology WFN history (A).pdf · 2017. 12. 6. · Elsevier...

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W I T H A M A D O U G A L L O

D I O P, M . D. , P H . D.

Chair man of WFN

Africa Committee

The World Federation ofNeurology’s African initia-tive has borne fruit: The

first European Federation ofNeurological Societies regionalteaching course in francophonesub-Saharan Africa took place atthe Université Cheikh Anta Diopin Dakar, Senegal, on June 26-28,2008, in collaboration with theWorld Federation of Neurology(WFN) and the InternationalBrain Research Organisation(IBRO).

The course was the direct resultof the decision made in London inDecember 2006 by Dr. Johan Aar-li, when he was elected presidentof WFN, to set up the WFNAfrica Initiative, the Task and Ad-visory Force for Neurology inAfrica (TAFNA) in 2007, and theAfrica Committee of WFN inApril 2008. Dr. Cheikh S. Boye,dean of the faculty of medicine,obtained free use of the universi-ty facilities, where a Europeanand African faculty shared theirknowledge with medical studentsand neurologists in training.

We acknowledge the dedica-tion of EFNS President JacquesDe Reuck and his Africa Project

Manager Dr. Jean-Michel Vallat,and the great help of EvelyneSipido, liaison officer of theEFNS, who spent a huge amountof time organizing, e-mailing,calling, re-calling, and followingevery step of the planning. Wealso are indebted to the authori-ties at the Université CheikhAnta Diop and the departmentof neurology for giving us theirblessing and support.

It would have been difficult tohold the course if IBRO, UN-ESCO, the Pan African Associa-tion of Neurological Societies(PAANS), and the Pan ArabUnion of Neurological Societies

NeurologyWorld

VOL. 23 • NO. 3 • SEPTEMBER 2008

Hormone Therapy May Benefit Cognition, MemoryB Y M I C H E L E G.

S U L L I VA N

Mid-Atlantic Bureau

C H I C A G O — Hormone thera-py might preserve cognition andmemory in postmenopausalwomen and attenuate some cog-nitive deficits in Alzheimer’s dis-ease, new research suggests.

Controversy exists over thepossible cognitive benefits of hor-mone therapy in older women,Mary Tierney, Ph.D., said at theInternational Conference onAlzheimer’s Disease. “While pre-clinical and observational studieshave shown a positive effect ofestradiol on the brain and cogni-tive function, randomized con-

trolled trials using conjugatedequine estrogens have shown notreatment effects in women atrisk for Alzheimer’s disease, or inwomen who have the illness.”And the oft-cited Women’s HealthInitiative Memory Study suggest-ed that hormone therapy mighteven hurt, not help, said Dr. Tier-ney of the Sunnybrook HealthSciences Centre, Toronto.

In a new 2-year trial, Dr. Tier-ney and colleagues randomized142 women aged 61-87 to eitherplacebo or to 1 mg estradiol dailyplus 0.35 mg progestin 3 days perweek. None of the women haddementia, but all had normal orbelow normal baseline memoryscores. The subjects’ mean age

was 74; mean age at menopausewas 49. Multivariate analysis con-trolled for age, years of education,apo E4 status, and prior hormonetherapy use. There was no signif-icant difference between groupson the primary end point of de-layed recall, Dr. Tierney said. Butwhen she split the group accord-ing to baseline California VerbalLearning Test (CVLT) scores, sig-nificant differences did emerge.Compared with women whoscored below the 50th percentileon baseline, those on therapy whoscored above the 50th percentileshowed significantly less declinein delayed verbal recall than didthose in the placebo group. Simi-lar, but nonsignificant, differences

(PAUNS) had not shared with ustheir generous and spontaneoushuman, financial, and materialsupport. Dr. Raad Shakir, secre-tary general of the WFN, andProf. Raj Kalaria, chair of IBRO’sAfrica Committee, took part inthe regional teaching course.

The course in Dakar was con-ducted with two themes: periph-eral neuropathies and neurode-generative disorders. Facultydelivered lectures on epidemiolo-gy, symptoms, treatment, andmanagement in the morning; cas-es were discussed in the after-noon. The course benefited fromthe expertise of Dr. Gilbert Avode

(Benin), Dr. J. L. De Reuck (Bel-gium), Dr. J. Dumas (France), Dr.M. Gonce (Belgium), Dr. R.Gouider (Tunisia), Dr. E.Grunitzky (Togo), Dr. R. Hughes(United Kingdom), Dr. R. Kalaria(United Kingdom-Kenya), Dr. B.Kouassi (Ivory Coast), Dr. M.M.Ndiaye (Senegal), Dr. A. Njamnshi(Cameroon), Dr. M. Rossor (Unit-ed Kingdom), Dr. R. Shakir (Unit-ed Kingdom), Dr. A. Thiam (Sene-gal), Dr. J.-M. Vallat (France) andDr. D. Vodušek (Slovenia). Facul-ty came from Belgium, Benin,Cameroon, Côte d’Ivoire, France,

See Dakar • page 3

T H E O F F I C I A L N E W S L E T T E R O F T H E W O R L D F E D E R A T I O N O F N E U R O L O G Y

occurred on immediate recall, in-terference recall, cued recall, andrecognition memory.

“The critical period for estrogenexposure to benefit cognition maynot be limited to the menopausetransition, since these womenwere more than 20 years post-menopausal,” but might also be

related to the state of brain func-tion when therapy is initiated, saidDr. Tierney.

In an interview with WORLD

NEUROLOGY, Victoria Luine,Ph.D., said, “Recent studies oncognition in aging animals are

Dakar Teaching Course Is a Success

See Hormone Therapy • page 8

Participants gather from the first EFNS-WFN-IBRO-UNESCO Neurology Regional Teaching Course inDakar, Senegal. The course focused on peripheral neuropathies and neurodegenerative disorders.

From Ethiopia:Addis Ababa University’sneurology departmentlooks to improve, and iswell on its way.

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From Mongolia:Did you know that 60% of Mongolia’sneurologists are located in the nation’s capital, as is more than half itstotal population?

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From Turkey:The 13th EuropeanCongress of ClinicalNeurophysiology, inIstanbul, featured 820participants from 43countries.

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WORLD FEDERATION OF NEUROLOGYEditor in Chief Dr. Mark Hallett (U.S.A.)

EDITORIAL ADVISORY BOARDDr. Pierre Bill (South Africa); Dr. William M. Carroll (Australia); Dr. Jagjit S. Chopra (India); Dr. Paula Coutinho (Portugal); Dr. Michael Finkel (U.S.A.); Dr. Osvaldo Fustinoni (Argentina); Dr. Alla Guekht (Russia); Dr. Theodore Munsat (U.S.A.); Dr. DanielTruong (U.S.A.)

WFN OFFICERSPresident: Dr. Johan Aarli (Norway)First Vice-President: Dr. Vladimir Hachinski (Canada)Secretary-Treasurer General: Dr. Raad Shakir (United Kingdom)

ELECTED TRUSTEESProf. Marianne de Visser (The Netherlands); Prof. Werner Hacke(Germany); Dr. Ryuji Kaji (Japan)

CO-OPTED TRUSTEESDr. Roger Rosenberg (U.S.A.); Dr. Niphon Poungvarin (Thailand)

REGIONAL DIRECTORSDr. Gilbert Avode (Pan Africa); Dr. Jacques De Reuck (Europe); Dr. Ashraf Kurdi (Pan Arab); Dr. Bhim Sen Singhal (Asia Oceania);Dr. Steve Sergay (North America); Dr. Mario Tolentino-Dipp (LatinAmerica)

EXECUTIVE DIRECTORKeith NewtonWorld Federation of NeurologyHill House, Heron SquareRichmond-upon-Thames, TW9 1EP, UKTel: +44 (0) 208 439 9556/9557 Fax: +44 (0) 208 439 [email protected]

EDITOR OF JOURNAL OF NEUROLOGICAL SCIENCESDr. Robert Lisak (U.S.A.)

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WORLD NEUROLOGY, an official publication of the World Federationof Neurology, provides reports from the leadership of the WFN, itsmember societies, neurologists around the globe, and news fromthe cutting edge of clinical neurology. Content for WORLD NEUROLOGY

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Disclaimer: The ideas and opinions expressed in WORLD NEUROLOGY

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©Copyright 2008, by the World Federation of Neurology

2 • WORLD NEUROLOGY WWW.WFNEUROLOGY.ORG • SEPTEMBER 2008

B Y R O G E R N.

R O S E N B E R G, M . D.

At the Annual Meeting of the AmericanAcademy of Neurology, the WFN’s

Research Committee met to re-view and discuss the 2009World Congress of Neurology(WCN).

The research committee hasbeen involved in deliberationsfor the past several world con-gresses and has worked closelywith local organizing commit-tees and WFN trustees. TheWCN 2009 Scientific Program,“Innovation in Neurology,” waspresented in detail by program cochairDr. Naraporn Prayoonwiwat, representingthe Thai Neurological Society and theWCN local organizing committee. A pro-gram was reviewed that included stroke,multiple sclerosis, epilepsy, movement dis-orders/dementia, and headache/pain.

Information about the parallel educa-

tion program lectures and sessions wasgiven by Dr. Siwaporn Chankrachang,chair of the WCN Education Committee.Dr. Prayoonwiwat and Dr. Chankrachangwere praised for their skill in developing the

WCN 2009 Scientific and Edu-cational programs.

Finally, Dr. Werner Hacke, aWFN trustee, outlined a pro-posal in which more groupsfrom the research committeeand individual research com-mittee members will be in-cluded in an organizational planstill being developed for thegovernance of future Con-gresses.

Meanwhile, the committee urges WFNmembers to become active in the researchgroups so that future World Congresseswill have renewed interest from the nextgeneration of neurologists. ■

DR. ROSENBERG is the Research CommitteeChair and a WFN trustee.

Nominations are invited from nationalneurologic societies and individuals

for the following World Federation ofNeurology posts:

�� First Vice President(to take office Jan. 1, 2010).

� Elected Trustee(to take office October 2009).

Elections will take place at the Annu-al General Meeting (AGM) of the Coun-cil of Delegates during the BangkokWorld Congress of Neurology, in Thai-land, currently scheduled for Oct. 24-30,2009.

The proposed candidates for first vicepresident will be required to formulatea full statement of their goals and ob-jectives for the organization, which will

be published. The previous deadline for receipt of

nominations is being extended. Names of those candidates who are

willing to serve must be received at theWFN London headquarters by Friday,Nov. 14, 2008, at the latest.

The proposed candidates also shouldbe sure to receive the official support oftheir respective national societies.

The names of those who are short-list-ed will be published in the March 2009issue of WORLD NEUROLOGY.

They will also be posted on the WFNWeb site at least 6 months before thedate of the election.

Any additional nominations must besubmitted jointly by five or more dele-gates at least 30 days before the AnnualGeneral Meeting. ■

Nomination Deadline Extended

World Federation ofNeurology Site Now Updated

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DR. ROGER N. ROSENBERG

The updated World Federation of Neurology Web site is now online. It featuresan inviting, easy-to-use design. Check it out at www.wfneurology.org.

WFN Headquarters Office hasmoved to more modern premis-es after 10 years in the historic

Medical Society of London building onChandos Street in London.

The new home is in Richmond-upon-Thames, easily accessible to central Londonand from Heathrow airport. In addition tobetter office facilities and electronic com-munication, the new offices also include ameeting room.

The new mailing address is Hill House,Heron Square, Richmond-upon-Thames,TW9 1EP, UK.

The telephone numbers are +44 (0)208439 9556/9557; the fax is +44 (0)208 439 9499.

The WFN’s new e-mail address [email protected]. ■

Headquarters Has Moved

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Committee Has Big Plans for 2009

SEPTEMBER 2008 • WWW.WFNEUROLOGY.ORG WORLD NEUROLOGY • 3

Another Course Planned for 2009Dakar • from page 1

Italy, Slovenia, Togo, Tunisia (representingMaghreb and Arab countries of PAUNS),the United Kingdom, and Senegal.

Over 100 neurology trainees and spe-cialists from 18 French-speaking Africancountries attended the course, held at themedical faculty site of the university. Thetrainees’ enthusiastic participation, contri-bution, and strong willingness to learnwere impressive. A highly interactive ses-sion was organized for the last day, atwhich were discussed several practical is-sues and difficulties concerning neurologypractice in the bush. Dr. Gallo Diop intro-duced the concept of the “five-star neu-rologist,” and suggested to the young neu-rologists to try to be caregiver, researcher,trainer, manager, and communicator. Rep-resentatives of WFN, PAANS, and PAUNSalso reassured the attendees that their or-ganizations are available to help Africanneurology practice, teaching, and research.E. Sipido (Italy), I. Mueller (Austria) and M.Soda (Senegal) were invaluable in provid-ing logistical help.

At the opening ceremony Dr. Boye, Dr.Shakir (secretary general/treasurer ofWFN), Dr. De Reuck (president of EFNSManagement Committee), and Dr. PierreNdiaye (chair of the Association de Neu-rologie au Senegal) agreed on that this firstregional teaching course had clear interna-tional implications.

The representative of the World HealthOrganization (WHO) in Senegal, Dr. Anto-nio Felipe, congratulated the organizers ontheir work and expressed WHO’s wish to beinvolved in future initiatives. Dr. MarinaBentivoglio, IBRO secretary-general, alsoprovided a brief but important overview ofthe work of the IBRO, and emphasized thestatement made by Dr. Kalaria, representa-tive of IBRO, at the opening ceremony.

The course followed the EFNS guide-lines for regional teaching. It consisted of2 half-days of teaching followed by 2 half-days of interactive clinical case discussions.A third half-day was added, which allowedfor open discussion with students and fac-ulty. Information about the Dakar courseis at www.efns.org/files/RTC_Dakar_final.pdf.

The World Neurology Foundation pro-vided 52 tool kits paid for by donationsfrom individual practicing neurologists;state and provincial societies in the UnitedStates, Canada, and Europe (via EFNS);and private individuals, who, although notinvolved in medicine, nonetheless under-stood the need for these neurology tools.Dr. Pierre Ndiaye, former chair of the de-partment of neurology at UniversitéCheikh Anta Diop, recalled during the clos-ing ceremony that it was the contents ofsuch kits—the reflex hammer, the tuningfork, and other tools—with which the mostfamous neurologists, such as Charcot, de-scribed the syndromes and signs that arethe basis of clinical neurology. The neuro-logic tool kits were distributed as equitablyas possible among the countries that wererepresented in Dakar. Dr. Beugre Kouassi,chair of the education commission of theAfrica Committe of WFN, conducted thedistribution with the assistance of EvelynSipido, Dr. Avode, and Dr. Mansour Ndi-aye, head of the department of neurologyat the university. Information on the WorldNeurology Foundation can be found athttp://worldneurology.org/aboutUs.asp.

The participants look forward to futurecollaboration with the WFN, EFNS, IBRO,UNESCO, and WHO in Africa. There areplans already for the second EFNS region-al teaching course, to be held in anglo-phone sub-Saharan Africa in 2009. ■

B Y G E O R G E K . YO R K I I I , M . D.

The WFN Research Group on the His-tory of the Neurosciences aims to

support original research in the historyof the basic and clinical neurosciencesand to foster international collaborationin original studies on the history of theneurosciences in non-Western cultures.The group’s published sym-posia are widely respectedthroughout the world.

The research group com-pleted its work on the SydneySymposium on the Historyof Cerebral Localization,which took place at the 2005World Congress of Neurolo-gy in Sydney. It will be pub-lished in the Journal of theHistory of the Neurosciences sometimethis year. It is likely to become an au-thoritative source on the history of cere-bral localization.

In Sydney, the contributors to thework, myself included, presented orig-inal research on selected topics in thehistory of localization. The symposiumincludes the following chapters:� The Sydney Symposium on the His-tory of Cerebral Localization: An In-troduction, by G.K. York and D.A.Steinberg.� Cerebral Localization in Antiquity, byF. Clifford Rose.� Cerebral Localization in the 18th Cen-tury: An Overview, by A. Karenberg.� Cerebral Localization in the 19thCentury—The Birth of a Science andits Modern Consequences, by D.A.Steinberg.� The Role of Focal Epilepsy in the De-

velopment of Jacksonian Localization,by M.J. Eadie.� Localization of Language Function inthe 20th Century, by G.K. York.

The research group does not plan topresent a symposium at the upcoming2009 World Congress of Neurology inBangkok; however, it has tentative plansto present a symposium on the history of

epilepsy at a subsequentworld congress. Provisionaltopics include:� Epilepsy in Babylonia.� The Sacred Disease.� Epilepsy in Galenic Med-icine.� Electricity and Chemistry:Robert Bentley Todd andJohn Hughlings Jackson.� The Synthesis of Pheno-

barbital.� Hans Berger and the Use of the Elec-troencephalogram in the Diagnosis ofEpilepsy.� Social Constructs in the Care of Peo-ple with Epilepsy.

The group will follow tradition andpublish this symposium in its journal.The research group maintains closeworking contacts with other organiza-tions devoted to the history of neurolo-gy, neuroscience, and medicine, includ-ing the International Society for theHistory of the Neurosciences and the his-tory section of the American Academyof Neurology. It aims for closer links withsuch organizations; inquiries may be di-rected to [email protected]. ■

DR. YORK is the chair of the WFNresearch group on the history of theneurosciences.

History of the Neurosciences:Research Group Update

THE PRESIDENT’S COLUMN

B Y J O H A N A . A A R L I , M . D.

President, WFN

As seen on the cover of this issue, the first internationalteaching course in neurology in Africa took place inDakar, Senegal, June 26-28, 2008. Both the course and

the subsequent neuroscience seminar given at the Univer-sité Cheikh Anta Diop were successes.

There are many excellent training coursesin neurology every year. Why did the Dakarcourse receive such attention? First of all, theprogram was excellent. Discussion of the se-lected topics—peripheral neuropathies anddementia—was led by prominent speakersfrom Belgium, Benin, Cameroon, Coted’Ivoire, France, Italy, Senegal, Slovenia, Togo,Tunisia, and the United Kingdom. The courseaddressed many of the practical difficulties ofpracticing in rural areas, of particular importance to theaudience of nearly 150 trainees and specialists fromcountries throughout Africa.

There are two other important reasons for this success.One is that the meeting so clearly reflected the basic ideaof the Africa initiative: With Africa—For Africa. The oth-er is that it was a joint venture among several internation-al organizations that worked hand in hand to make thiscourse just the first of a series to be held on African soil.

This African initiative had many roots. The Univer-sité Cheikh Anta Diop, in Dakar, was instrumental inpreparing the ground for the meeting, which wasopened by Prof. Cheikh S. Boye, dean of the faculty ofmedicine.

It had been decided at the 2007 meeting of the Pan-African Society of Neuroscientists in Kinshasa to organize

an international teaching course in clinicalneurology in sub-Saharan Africa in 2008. TheAfrica Committee of the World Federation ofNeurology, chaired by Amadou Gallo Diop,worked hard to realize the meeting. In a re-gion where neurology is underdeveloped, thePan-African Association of Neurological Sci-ences (PAANS), the umbrella organizationthat brings together African neurosurgeonsand neurologists, supported the initiative.That organization has increasingly stronger in-

fluence on health authorities.The International Brain Research Organisation

(IBRO), in partnership with UNESCO’s International Ba-sic Sciences Programme, has been a powerful force todevelop and sustain brain research across the African con-tinent. IBRO and the International Basic Sciences Pro-gramme (IBSP) of UNESCO have formed a partnershipto create an initiative called Building Brain Sciences inAfrica. Over the last 2 years, it has developed close links

with the WFN and the European Federation of Neuro-logical Societies (EFNS) to promote clinical neuro-sciences in Africa. This new collaboration strengthens thelong-standing association of UNESCO and IBRO as thecore of a broad-based partnership with other interna-tional and African organizations such as the EFNS andthe WFN.

The EFNS had a central role in the conception and con-tent of the teaching course. The organization has longencouraged strong collaboration in Africa, initially withNorth African (Francophone) countries and then with themany Anglophone African countries. It remains a force-ful partner with the WFN in the Africa initiative. The Pan-Arab Union of Neurological Societies (PAUNS) also hasa strong basis in the North African countries and alwayshas been available to support African clinical neurology,teaching, and research.

The World Neurology Foundation (WNF), the chari-table arm of WFN in North America, also was involved.They provided tool kits that contained neurologic equip-ment necessary for clinical examination that were dis-tributed among meeting participants.

The Dakar course represented a primarily African ini-tiative with many international organizations collabo-rating in a smooth and effective manner. It has paved theway for the Teaching Course in Neurology in Africa2009. ■

Dakar 2008—Collaboration for the Future

DR. JOHAN A. AARLI

DR. GEORGE K. YORK III


REPORT FROM THE EDUCATION COMMITTEE:

B Y T H E O D O R E

M U N S AT, M . D.

T wo recently completed ex-ternal reviews of the neu-rology department and

residents at Addis Ababa Univer-sity in Ethiopia have already re-sulted in correcting significantdepartment needs and confirm-ing the expertise of young neu-rologists in that country.

In December 2007,at the request of Dr.Guta Zenebe, neurol-ogy department chair-man, and members ofthe Association ofNeurologic Sciencesof Ethiopia, the neu-rology department—founded in 1973 by Dr.Zenebe—was visitedby WFN EducationCommittee members Dr.Gretchen Birbeck, associate pro-fessor and director of the Inter-national Neurologic and Psychi-atric Epidemiology program atMichigan State University, EastLansing (U.S.A.); Dr. Amadou Gal-lo Diop, professor and chairmanof neurology at Dakar (Senegal)University; and myself. Our goalwas to carry out an external pro-gram review and to make recom-mendations for development.

Upon arrival, we met with theEthiopian minister of health, thedean of the medical school at Ad-dis Ababa University, and thechairs of all the relevant depart-ments at the school. We visitedboth inpatient and outpatient fa-cilities, and discussed them withfaculty and residents. Upon leav-

ing, we drew up a report of ourfindings that was felt to be ofgreat value to the department ofneurology at the medical school,and we were told that several ofthe needs outlined in it have al-ready been corrected.

One cannot underestimate theenormous difficulty in providingadequate education for healthproviders in this country that isso lacking in resources, or the re-

markable results thathave been obtainedby the neurologistswho work there.

Then, in April ofthis year, at the re-quest of the depart-ment of neurology atAddis Ababa Univer-sity, several other af-filiates of the Educa-tion Committee of

the WFN (Dr. James Johnson,consultant neurologist, Aukland,New Zealand; Prof. Pierre Bill,professor emeritus of neurology,University of Kwazulu-Natal,Durban, South Africa; and Dr.Redda Tekle-Haimanot, profes-sor of neurology, Addis AbabaUniversity) carried out an exter-nal evaluation of the first groupof neurology resident graduatesin that country.

All neurology residents at Ad-dis Ababa University have had 2-3 years of internal medicine train-ing, which is very appropriate forneurology practice in their coun-try. Each resident is required tocarry out a research project anddefend a thesis. Dr. Zenebe andhis associate Dr. Mehila Zebeni-gus have established a laudable

training program with specificobjectives for each year of train-ing, subspecialty training whereavailable, and effective evaluationand feedback mechanisms.

The WFN external evaluationconsisted of a multiple choice andessay written examination, an Ob-jectively Structured Clinical Ex-amination, and a bedside evalua-tion of cases. In the examiner’swords, “The candidates were re-markably knowledgeable and con-fident, considering the lack of ex-posure to certain facilities” such asimaging and electrophysiology.

Because experience suggeststhat residents receiving trainingin their home country are muchless likely to emigrate than arethose who receive their trainingelsewhere, these results were es-pecially welcomed, and they re-inforced the WFN EducationCommittee’s view that residenttraining is best carried out inone’s own country. The six grad-uates will join the eight neurolo-gists currently in practice.

The results of these two exter-nal reviews reinforced our viewthat carefully targeted WFN edu-cation efforts, in conjunction withother resources, can produce im-portant results with modest re-source input. In one example,neurologic care in Ethiopia hasbeen assisted for many years by aremarkable organization of expa-triate Ethiopian physicians andneuroscientists led by Dr. Enaw-gaw Mehari, a neurologist in pri-vate practice in Morehead, Ken-tucky (U.S.A.) and an honoraryconsultant at Addis Ababa Uni-versity. The nonprofit organiza-

tion that he has established, Peo-ple to People, has provided majoreducational and resource assis-tance to the neurology depart-ment at the university, includingelectronic communication equip-ment, books, organization of con-ferences, and so on.

The department also receivessupport from the Mayo Clinic,Rochester, Minnesota (U.S.A.), inan effort led by Dr. James Bowerto provide a cadre of visiting pro-fessors who are actively involvedwith resident, medical school,and nonphysician neurologic ed-ucation. Additionally, Dr. JosephBerger, chair of the departmentof neurology at the University ofKentucky, Lexington (U.S.A.), hasbeen involved with a neuro-AIDSprogram. Finally, the departmentof neurology at McGill Universi-ty, Montreal, Canada, has been anactive participant in educationalsupport for Ethiopia over manyyears.

No doubt as a result of all thisoutreach, the department of neu-

rology at Addis Ababa has a planto establish a neuroscience insti-tute at the university to house theneurology, neurosurgery, and psy-chiatry departments. The Ethiopi-an Ministry of Health has desig-nated Zewditu Hospital, thecurrent home of the department,for this purpose. Ethiopia is alsoa new but important participantin the WFN continuing educa-tion program. With approxi-mately 80,000,000 people in sub-Saharan east Africa, Ethiopia hasmore than its share of health, re-source, and political problems.But despite many hurdles, neu-rologists in Ethiopia have thewill, insight, skills, and persis-tence to provide better care forthe citizens of their country. I amcertain that, with help from theirmany friends, their future isbright. ■

DR. MUNSAT, emeritus professor ofneurology at Tufts University,Boston, U.S.A., is chair of theWFN’s Education Committee.

Ethiopia Makes Good on WFN Outreach Efforts

DR. THEODORE MUNSAT

B Y H A N S F O R S S B E R G, M . D. ,

A N D Å S A H E D B E R G, P H . D.

At the Stockholm Brain Institute, clinicalresearchers from several neurologic dis-

ciplines work together with basic neuro-scientists and computational scientists togain better understanding of cognitivebrain functions in health and disease.

The Stockholm Brain Institute (SBI) is aresearch center for cognitive and compu-tational neuroscience based on 10 researchgroups from the three universities in Stock-holm: Karolinska Institute, Royal Instituteof Technology, and Stockholm University.The groups represent key scientific areasfrom life and medical sciences, behavioralsciences, and mathematical sciences.

SBI is located on the premises of the Uni-versity Hospital, which allows interactionwith clinicians from disciplines such as psy-chiatry, neurology, and neuropediatrics.The clinicians’ strong influence on the cen-ter results in clinically relevant projects.

Research is mainly focused on three cog-

nitive functions: learn-ing/memory, emotion,and action/perception.These areas are ap-proached from three per-spectives: normal devel-opment and aging; sexdifferences; and patho-physiology, with a focuson neurodevelopmentaldisorders (autism, atten-tion-deficit/hyperactivi-ty disorder, cerebral pal-sy); psychiatric disorders(schizophrenia); and neu-rodegenerative disorders(Alzheimer’s, Parkinson’s, Huntington’s dis-ease). The goal is to explore the pathologi-cal processes underlying these disorders todevelop new principles for prevention andintervention, as well as new biomarkers.

The research has a systems neurobiolo-gy approach; that is, from genes, cells, andneural networks to cognitive functionsand behavior. SBI is also unique in its

strong computational group. Mathemati-cal modeling is used to achieve a coherentunderstanding of the multilevel systemsthat underlie cognitive functions, in whichnumerous factors vary independently.Based on empirical data, the work of thecomputational neuroscience group buildsmathematical models of neural networksby means of single neurons with specific

properties (such as ion channels and in-tracellular pathways). These models cantest various hypotheses and disease path-ways.

SBI has developed strong alliances withpartners from the biomedical and biotech-nology industries, including AstraZeneca,IBM, Neurosearch, and Karolinska Inno-vation, with whom SBI researchers initi-ated Cogmed, a small biotech company.The collaboration includes the building ofcommon infrastructure, collaborative re-search projects, and a research school, al-lowing SBI to build up a top-of-the-linePET facility with high-resolution researchtomography combined with a BlueGene/L computer for image reconstruc-tion and analysis. The ultrafast computeralso is used for mathematical modelingand real-time simulation of neural net-works with several hundred thousandneurons. ■

DR. FORSSBERG is the director of SBI. DR.HEDBERG is the scientific coordinator.

At Stockholm Brain Institute, Collaboration Is Key

Dr. Forssberg is director of SBI, where clinicians andbasic scientists drive neurologic research.

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Dr. Munsat participated in rounds on a recent trip to thedepartment of neurology at Addis Ababa University in Ethiopia.


B Y D E N I S E N A P O L I

Associate Editor

Dr. Robert Lisak, an American, hasbeen elected as a fellow “by distinc-tion” of the Royal College of Physi-

cians in London, one of the highest hon-ors the United Kingdom–based societycan bestow.

Of 13 such fellowships awarded thisyear, only 5 went to Americans.

Dr. Lisak, editor of the Journal of theNeurological Sciences (the official journalof the World Federation of Neurology),has been conducting research and takinga leadership role within the field of neu-rology for nearly half a century.

“I was involved in some of the earlieststudies examining the role of T cells, Bcells, and antibodies in the pathogenesis”of multiple sclerosis, he said.

He cited, for example, a study of an-timyelin antibodies in neurologic diseases(Arch. Neurol. 1974;32:163-7).

He also has conducted important re-search into the in vitro cell-mediated im-munity of cerebrospinal fluid lympho-

cytes to myelin basic protein in primarydemyelinating diseases (N. Engl. J. Med1977;297:850-3), as well as studies con-cerning the animal model of experimen-tal autoimmune encephalomyelitis.

In the field of myasthenia research, Dr.Lisak’s work “has focused on immuneregulatory mechanisms and cellular inter-actions that allow for the development ofthis autoimmune disease. Since I have alsobeen involved in therapeutic trials andstudies, I guess I have been doing what isnow called translational research for 42years.”

Dr. Richard Lewis, professor and asso-ciate chair of neurology with Dr. Lisak atWayne State University, Detroit, said in aninterview that he has known Dr. Lisak formore than 30 years.

A resident at the University of Pennsyl-vania, Philadelphia, when Dr. Lisak was onthe faculty, Dr. Lewis recounted that Dr.Lisak’s passion for research “bordered onthe obsessive.”

“I was impressed at that time by his en-cyclopedic knowledge, his enthusiasm forneurology—particularly for the immuno-

logic disorders—and his incredible energyand drive.

“[Dr. Lisak] was doing translational re-search before the term was coined. I re-member drawing extra tubes of [cere-brospinal fluid] on every patient I did alumbar puncture on, so thatDr. Lisak could investigate im-munologic markers of dis-ease,” commented Dr. Lewis.

Dr. Lisak earned his MD atthe College of Physicians andSurgeons, Columbia Universi-ty, New York.

He also trained in medicineat Montefiore Medical Centerand the Bronx Municipal Hos-pital, both in New York.

His neurology and immunology train-ing took place at the University of Penn-sylvania, Philadelphia, and at the Nation-al Institute of Mental Health.

Additionally, Dr. Lisak also completed aFulbright fellowship at the University ofLondon.

Some of Dr. Lisak’s upcoming projectsinclude combining the use of molecularbiologic techniques with cell biology, andimmunologic approaches to study in fur-ther detail the effect of cytokines on glialcells and neurons, work done in collabo-

ration with Joyce Benjamins, Ph.D., andothers.

“In myasthenia gravis, Samia Ragheb, I,and other members of our neuromuscu-lar group are looking at how a B-cell fac-tor called BAFF may be involved in the

evolution of the autoimmuneprocess. And as in the pastwhen I was at Penn and Lon-don, I have had the benefit offantastic collaborators.”

Dr. Lisak said that his re-search over the years has beensupported by many institu-tions, including the NationalInstitutes of Health, the Na-tional MS Society, the Muscu-

lar Dystrophy Association, the Guillain-Barré Syndrome/Chronic InflammatoryDemyelinating Polyneuropathy Founda-tion, the Myasthenia Gravis Foundation ofAmerica, the Fulbright-Hays grant, andseveral pharmaceutical companies. Healso thanked the department of neurolo-gy at Wayne State, his current researchhome.

“The honor also reflects on the depart-ment of neurology at Wayne State Uni-versity, and its accomplishments, as well asthe continued improvement in the Journalof the Neurological Sciences. ■

His research helped to define immune processes inthe pathogenesis of neurologic disorders.

Lisak Is Fellow by Distinction of Royal College of Physicians

DR. ROBERT LISAK


B Y M I C H E L E G. S U L L I VA N

Mid-Atlantic Bureau

C H I C A G O — Keeping fit may help reduce brain atro-phy in patients with early Alzheimer’s, researchers saidat the International Conference on Alzheimer’s Disease.

An exercise-tolerance study confirmed that the hip-pocampus was significantly larger in patientswho had higher fitness levels, Dr. Jeffrey Burnssaid at the meeting, which was sponsored bythe Alzheimer’s Association. The associationwith fitness level also was found with whole-brain volume during a previous study in thesame cohort, he added in an interview.

“Those in the lower half of fitness level havefour times more brain atrophy than [do] thosein the higher fitness group,” compared withnormal aging, said Dr. Burns, director of theHoglund Brain Imaging Center at the University of Kansas,Kansas City (U.S.A.).

In an interview with WORLD NEUROLOGY, Dr. Yves Rol-land of Hôpital La Grave-Casselardit in Toulouse, France,who was not involved in the current study, said it addedneuroimaging evidence to the available epidemiologicaland basic research. “However, no randomized controlledtrials have yet demonstrated that regular physical activi-ty, a modifiable lifestyle factor, prevents dementia.”

In the current study, Dr. Burns and his colleague, Robyn

Honea, Ph.D., evaluated cardiorespiratory fitness in 119subjects older than 60; 56 had no dementia, and 63 had ear-ly-stage Alzheimer’s. All undertook a treadmill test, whichmeasured peak oxygen consumption during the moststrenuous part of the test. They also underwent MRI.

All of the AD patients showed disease-related atrophyin the hippocampus, temporal cortex, and parietal cortices.

But patients with higher fitness levels had sig-nificantly greater white matter volume in thehippocampus, inferior temporal gyrus, andprecentral gyrus.

“We found that the level of fitness wasstrongly related to volume in the parietalarea, and also in the hippocampus,” Dr. Burnssaid.

“That’s affected early in Alzheimer’s, andthe brain undergoes a lot of atrophy in that re-gion as the disease progresses.”

He noted that it is not possible to characterize thepercentage of volume preserved in the more fit sub-jects, because the measurement tool—voxel-basedmorphometry—provides only a linear correlation. “Buton the whole, people who were more fit had largerbrains.”

In another interview with WORLD NEUROLOGY, LauraEggermont, Ph.D., of Vrije Universiteit, Amsterdam, whowas also not involved in the study, said that the findingswere timely and relevant, but it was unfortunate that the

level of cognitive functioning was not also mentioned.“The literature on healthy cognitive aging also shows astrong relationship between level of physical activity andbrain volume, and some randomized controlled trialshave shown that aerobic physical activity interventions ben-efit cognitive function, specifically higher order executivecontrol processes.”

Reduced atrophy in both grey and white matter couldalso have implications for cognitive and independentfunctioning. However, a previous study showed that, al-though more active AD patients had reduced brain atro-phy, they did not show better cognitive functioning aftercontrolling for age (Neurology 2008;71:210-6).

As understanding of the relationship grows, exerciseprescriptions could become part of an Alzheimer’s treat-ment program, Dr. Burns suggested. Dr. Rolland addedthat physical activity is an especially appealing low-cost,low-risk alternative treatment for this major public healthpriority.

“In addition to the multiple reasons for engaging inphysical activity, preserving brain health could be a strongand convincing argument to promote activity in thepopulation and one which could have a major impact onmedical practice and public health education.”

However, Dr. Eggermont advised caution regarding ex-ercise in the elderly, whose ability is often hampered bydisease or disability.

Neither of the researchers disclosed any conflicts. ■

Fitness May Slow Brain Atrophy in Alzheimer’s

B Y PAT R I C E W E N D L I N G

Chicago Bureau

C H I C A G O — Pardoprunox, apartial dopamine D2- and D3-re-ceptor agonist and full serotonin 5-HT1A–receptor agonist, signifi-cantly improvedsymptoms in patientswith early Parkinson’sdisease in a multicenterphase II clinical trial.

Investigators ran-domized 139 patientswith idiopathic PD toplacebo or pardoprunoxtitrated from 9 mg/dayto 45 mg/day. Mean agewas 59; the majority were Hoehnand Yahr stage 1.5 or 2 (66% par-doprunox, 70% placebo).

The mean change from baselinein Unified Parkinson’s Disease Rat-ing Scale (UPDRS) motor scoreswas significantly greater with par-doprunox than placebo at the endof a flexible 2- to 6-week titrationphase (–6.1 vs. –3.1) and after afixed 3-week maintenance period(–7.3 vs. –3.0).

After the maintenance period,there were significantly more re-sponders in the pardoprunoxgroup (51%) than in the placebogroup (16%).

UPDRS activities of daily livingand Clinical Global Impressionscale were also significantly moreimproved in the pardoprunoxgroup, said Dr. Juliana Bronzova,reporting on behalf of theBruegel Study Group at the 12th

International Congress of Parkin-son’s Disease and Movement Dis-orders.

Of the 69 patients on pardo-prunox, 22 discontinued becauseof adverse events (15) or consentwithdrawal (7). Of the 70 patients

randomized to placebo,7 discontinued becauseof adverse events (1) orconsent withdrawal (6).

The most commonevents in the pardo-prunox and placebogroups included nau-sea (32 vs. 3), asthenia(10 vs. 0), increasedblood pressure (5 vs. 3),

somnolence (17 vs. 4), andheadache (13 vs. 5), said Dr. Bron-zova of Solvay Pharmaceuticals,which makes pardoprunox andsponsored the study.

In an interview with WORLD

NEUROLOGY, Dr. William J. Wein-er, director of the MarylandParkinson’s Disease and Move-ment Disorders Center at the Uni-versity of Maryland, Baltimore,who was not involved with thestudy, said that the absolutechange between the groups, –4.3points, is not only statistically sig-nificant, but also “falls within therange of a clinically meaningfulchange” but still “similar to thatseen with traditional agonists.Whether or not partial dopamineagonist treatment in PD is better inthe short or long term than a tra-ditional dopamine agonist or lev-odopa remains to be seen.” ■

Partial Dopa AgonistGives Benefit in Early PD

B Y PAT R I C E W E N D L I N G

Chicago Bureau

C H I C A G O — Deep brain stimulation of limbicrelays within the basal ganglia circuitry reducedtic severity in patients with Tourette syndrome.

In three patients with severe and medically re-fractory TS, researchers applied high-frequencybilateral deep brain stimulation to the centro-median-parafascicular complex (CM-Pf ) of thethalamus and the ventromedial part of the globuspallidus interna (GPi).

The greatest improvement of tics was seen withventromedial GPi stimulation, Dr. Luc Malletsaid at the 12th International Congress of Parkin-son’s Disease and Move-ment Disorders. The totalYale Global Tic SeverityScale score was reduced65%, 96%, and 74% frombaseline in patients 1, 2,and 3, respectively.

CM-Pf stimulation re-duced tic severity by 64%,30%, and 40%, respective-ly. Combining thalamicand pallidal stimulation did not improve tic re-duction (Arch. Neurol. 2008;65:952-7).

In patient No. 2, the best result was obtainedafter 1 month, but the effects decreased after 2months, even with increased voltage, said Dr.Mallet of Pitié-Salpêtrière Hospital, Paris. Verygood long-term effects were observed in patientNo. 1, who was identified with borderline per-sonality disorder before surgery. The decrease intic severity was accompanied by a dramatic re-duction in self-injurious behaviors and impul-siveness, allowing the patient to start psy-chotherapy, to improve autonomy and socialrelationships, and to return to full-time work 2years after surgery.

In patient No. 2, a stable reduction in tic sever-

ity was achieved 27 months after surgery using 20hours of pallidal stimulation followed by 4 hoursoff. In patient 3, tic severity was reduced by 74%at 20 months without medication under pallidaland thalamic stimulation.

DBS is not without risks, said Dr. Mallet in aninterview with WORLD NEUROLOGY. “DBSshould be reserved to the refractory forms of thedisease or for patients who are intolerant topharmacological treatments. Aside from theseconsiderations, there are few drawbacks be-cause DBS is reversible and adjustable throughfour available contact localizations and throughadjustment of electrical parameters, includingfrequency, pulse width, and voltage.”

In another interviewwith WORLD NEUROLOGY,Dr. Joseph Jankovic, di-rector of the Parkinson’sDisease Center and Move-ment Disorders Clinic atthe Baylor College ofMedicine, Houston, whowas not involved with thestudy, said, “It confirmsthe findings of our initial

report of effectiveness and safety of GPi DBS[Neurology 2007;68:159-60] in a 15-year-old boywith malignant Tourette syndrome [Mov. Disord.2007;22:1743-50]. Since this report of theyoungest case of TS treated with DBS, we havestudied five other patients with similar improve-ments in their tics as well as their obsessive-com-pulsive and self-injurious behavior.”

Dr. Jankovic has helped form guidelines forthe evaluation of potential candidates for DBSin Tourette (Mov. Disord. 2006;21:1831-8). “Onlythose patients whose tics are so troublesome thatthey interfere with normal physical activity, re-sult in self-injury, or are otherwise disabling de-spite optimal medical therapy should be con-sidered,” he said. ■

Targeted Deep Brain StimulationImproved Tic Severity in Tourette

DR. LUC MALLET

DR. YVES ROLLAND

DR. WILLIAM J. WEINER

DR. JOSEPH JANKOVIC

The focus of the journal will be on psychiatricresearch pertinent to Asia produced either within or from outside the continent. This may include preclinical, clinical, service system and policy development research relevant to psychiatry and will highlight the socio-cultural diversity of the region as it pertains to mental health.

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congruent with these findings on women who were nev-er users, past users, and current users, and suggest that bet-ter outcomes of [HT] occur when therapy is begun aroundthe menopause or in rats when estradiol levels have begunto decline.” Dr. Tierney “raises the intriguing possibilitythat ‘menopausal age’ may not be as critical as ‘brain age.’”But it will be difficult to model that hypothesis in animals,noted Dr. Luine, professor of psychology at Hunter Col-lege of the City University of New York.

In another study, Kara Bottiggi Dassel, Ph.D., of the Bar-row Neurological Institute, Phoenix (U.S.A.), examined theeffect of past hormone use on the cognitive deficits ofAlzheimer’s patients. The study included 49 women (av-erage age, 75) categorized as current hormone therapyusers (20), past users (18), or never-users (11). All had a di-agnosis of Alzheimer’s; there were no differences in func-

tional levels or Clinical Dementia Rating scores. Whilethere were no significant differences in memory, pastusers scored significantly better than never-users on the de-mentia rating scale, with a clinically meaningful mean scoredifference of 31 points. Past users also scored significant-ly better than never-users on the Controlled Oral WordAssociation Test and the clock drawing test, both mea-sures of executive function. She then examined hormoneuse by baseline dementia ratings. Women were split into“higher functioning” (mean dementia rating score 68) or“lower functioning” (mean dementia rating score 120).Among the higher-functioning group, 45% were past hor-mone therapy users, 45% were current users, and 10%were never-users. Among the lower group, 25% were pastusers, 35% were current users, and 40% were never-users.

“The length of illness was similar among women in thehigher group, suggesting that there is less of a decline incognitive functioning in the hormone therapy users,” Dr.Dassel said.

Dr. Luine commented: “Some earlier RCTs with pos-

itive outcomes on both memory function in women andin Alzheimer’s dementia also used natural hormones likethis newest study by Tierney and colleagues. However,it is important to note that there is a difference betweencognitive loss with ‘normal’ aging and the severe cogni-tive losses that occur with Alzheimer’s disease. Thus far,no drug or hormone has been able to have a major im-pact on the progression of Alzheimer’s disease. Thus, itis probably still optimistic to posit that estradiol might be‘a magic bullet’ for this disease.” She added that while“positive results of [HT] in young and aging populationshave been seen in Europe, Japan, and China,” in additionto the United States, all observational or longitudinal tri-als suffer from a bias in which HT users “tend to beyounger, healthier, and better educated—all traits whichpredict positive brain/cognitive aging and thus con-tribute to a positive outcome” for those on HT therapy.

The researchers said they had no conflicts. ■

Senior Writer Jeff Evans contributed to this report.

HT May Aid CognitionHormone Therapy • from page 1

B Y R I C A R D O F. A L L E G R I , M . D. ,

P H . D. , A N D C E C I L I A M .

S E R R A N O, M . D.

The history of neurology in SouthAmerica has its roots in 1885, whenthe Hospital San Roque de Buenos

Aires initiated its Nervous Diseases Ser-vice. Its first director was Dr. José MaríaRamos Mejía, a writer, sociologist, scien-tist, and outstanding public citizen. In1887, only 5 years after Dr. Jean-MartinCharcot was awarded the chief of neu-rology position at the famous Hôpital dela Salpêtrière in Paris, Dr. Ramos Mejía be-came the first professor of neurology inSouth America, at the Universidad deBuenos Aires.

Three others—Dr. Christofredo Jakob, aGerman neuropathologist; Dr. José A. Es-tévez, a skilled clinician; and Dr. José Inge-nieros, a sociologist—collaborated withhim to develop the field in Argentina.

In 1892, Dr. Augusto Orrego Luco,who was trained in France by Dr. Char-cot, took over as professor of nervous dis-eases at the Universidad de Chile, Santi-ago. He was the most prominent figurein Chilean neurology during the secondhalf of the 19th century, and was nick-named the Charcot of America. In 1907the department of neurology was takenover by his disciple, Dr. Joaquín Luco Ar-riagada (who was trained by Dr. JosephBabinski).

In Brazil, the discipline emerged in 1912when the school of medicine at the Uni-versidade do Rio de Janeiro created its firstdepartment of neurology. Its first full pro-fessor, Dr. Antõnio Austregésilo Rodríguesde Lima, was a politician, writer, andskilled physician; he is considered the fa-ther of Brazilian neurology.

The São Paulo School of Neurologywas founded in 1925, when Dr. EnjolrasVampré was appointed head of the de-partment of psychiatry and neurology.Dr. Vampré, who also was trained atSalpêtrière, is considered the founder ofthe neurology in São Paulo.

In 1925, Chilean doctor Luco Arriagadacreated the Hospital del Salvador Serviciode Neurología in Santiago. In 1932 the So-ciedad de Neurología, Psiquiatría y Neu-

rocirugía de Chile was founded. When Dr.Arriagada retired, Dr. Lea Plaza was madechair of neurology at the University ofChile, and Dr. Jorge Oyarzun became chiefof neurology at the Hospital del Salvador.

In 1925, Uruguay also took an impor-tant step with the creation of the depart-ment of neurologic diseases at the Schoolof Medicine of Montevideo, with Dr.Américo Ricaldoni as its chairman. In1927, the Uruguayan government createdthe Instituto de Neurología de Montev-ideo (the first neurologic institute in LatinAmerica), with Dr. Ricaldoni as its desig-nated director.

Peru’s nascent field of neurology beganin 1935 with Dr. Julio Oscar Trelles Montes,who was trained in Paris by Dr. Jean Lher-mitte. Dr. Trelles is considered the father ofPeruvian neurology. In 1937, he foundedthe Revista de Neuropsiquiatría, and 1 yearlater, the Sociedad de Neuropsiquiatría yMedicina Legal. In 1940, he was made pro-fessor of neuropathology at the school ofmedicine at Universidad Nacional Mayor deSan Marcos. By this time, Dr. Trelles wasalso tending to the Refugio de Incurablesin Lima, which was later renamed Hospi-tal Santo Toribio de Mogrovejo. Almostevery neurologist in Peru studied at thishospital in some capacity under Dr.Trelles’s 30-year directorship.

In Uruguay at the beginning of 1937, Dr.Alejandro Schroeder, who was trained inGermany, was appointed director of the In-stitute of Neurology in Montevideo. After

Dr. Schroeder’s tenurethere, the institute, whichwas renamed Instituto deNeurología Prof. Dr.Américo Ricaldoni, hasbeen ranked among thetop in South America. In1939 the Sociedad de Neu-rología y Neurocirugia deMontevideo opened withDr. Schroeder as its firstpresident.

In Venezuela, neurolo-gy began when Dr. PedroB. Castro returned fromParis in 1936, where hehad been trained by Prof.Georges Charles Guillain

at Salpêtrière. In 1938, Dr. Castro tookover as a neurology consultant at HospitalVargas, Caracas. In 1940, the UniversidadCentral de Venezuela created its first de-partment of neurology and psychiatry andnamed Dr. Castro its chairman.

Chilean neurology was invigorated in1939 when Dr. Alfonso Asenjo Gómez,who was trained in the United States byDr. Walter Dandy and in Germany by Dr.Wilhelm Tönnis, created the Hospital delSalvador’s service of neurosurgery.

In Buenos Aires in 1941, Dr. VicenteDimitri was designated professor of neu-rology at the University of Buenos Aires.With Dr. Dimitri, neurology in Argentinacame into its own.

In 1943, Dr. Adherbal Tolosa, Dr. Pauli-no Longo, and Dr. Oswaldo Lange createdthe Arquivos de Neuropsiquiatria in SãoPaulo under the direction of Dr. Lange.This journal remains foremost in neuro-sciences in Latin America; its articles are ac-cessible in Index Medicus, World HealthOrganizaton, Bireme, Lilacs, and Latindex.

In 1944, Dr. Deolindo Augusto deNunes Couto took over as chairman of thedepartment of neurology at UniversidadeFederal do Rio de Janeiro and consolidat-ed activity in neurology in Brazil. In 1946,he founded the Instituto de Neurología daUniversidade Federal do Rio de Janeiro,which carried out extensive research inneurology, neurophysiology, and neuro-surgery. This institute, later renamed In-stituto de Neurología Deolindo Couto da

Universidade Federal do Rio de Janeiro, be-came the international face of Brazilianneurology.

In Argentina, Dr. Jose Pereyra-Kafer be-came chairman of the Hospital RamosMejía Neurology Service (formerly Hos-pital San Roque) in Buenos Aires, andthen took over as professor of neurologyat the University of Buenos Aires. The So-ciedad Neurológica Argentina (SNA) wasfounded in 1957. In 1953, the Instituto deNeurocirugía e Investigaciones Cerebralesof Chile opened, and for the following 34years it was directed by Dr. Asenjo.

Dr. Andrés Rosselli Quijano, whotrained in the United States with Dr. Ray-mond Adams, Dr. Maurice Victor, andDr. C. Miller Fisher, founded a neurolo-gy unit in 1956 that was annexed to theneurosurgery department at HospitalMilitar Central de Bogotá. The SociedadNeurológica de Colombia was formed in1963.

In 1953 the Archivos Venezolanos dePsiquiatria y Neurologia was created.Neurology and psychiatry became inde-pendent specialties in 1959 under Dr. Cas-tro, the first chairman and founder of thenew department of neurology at the Uni-versidad de Venezuela. The quarterly Pan-American Congress was conceived withinthe framework of the WFN. The first openconference was held in October 1963, inLima, Peru, chaired by Dr. J. Oscar Trelles,the country’s prime minister.

In conclusion, neurology in SouthAmerica emerged toward the end of the19th century, following the origin of thespecialty in Europe and its official baptismwith Charcot at Salpêtrière in Paris. Thefirst steps took place almost simultane-ously in five countries: Argentina, Brazil,Uruguay, Chile, and Peru. In the othercountries, the development of neurologytook place later in the 20th century. ■

DR. ALLEGRI and DR. SERRANO work atServicios de Neurología & Neuropsicologíaand Centro de Estudios Médicos eInvestigaciones Clínicas, Buenos Aires.Adapted from a journal article published byDr. Allegri in the Journal of the NeurologicalSciences (J. Neurol. Sci. 2008 Aug 15;271:29-33).

The Pioneers of Neurology in South America

Dr. Allegri and Dr. Serrano say neurology was born onthe continent toward the end of the 19th century.

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NEWS FROM THE NATIONAL SOCIETIES


NEUROLOGIC PEARL

B Y M A R T I N A . S A M U E L S, M . D.

Although the heart normally autoregu-lates using Starling’s law and its own

endogenous nervous system, it is poten-tially under the influence of the rest of thenervous system. In an autonomic storm,for example, dramatic alterations in car-diac rhythm and function may occur.

As long as the ECG has beenin use, clinicians have recog-nized that catastrophic neuro-logic or psychiatric events mayalter the appearance of theECG. This observation wasmade by Dr. Harold Levine atthe old Peter Bent BrighamHospital, Boston, and wasprobably named “cerebral Twaves” by the renowned andcreative cardiologist Dr.George Burch of Tulane University inNew Orleans.

However, the cause was presaged by Dr.Walter Bradford Cannon, the distinguishedHarvard Medical School physiologist. In1942, he wrote his memorable paper,“ ‘Voodoo’ Death,” in which he recountedmany descriptions of the phenomenon ofbeing literally frightened to death that hehad gathered from the anthropological lit-erature. Dr. Cannon hypothesized thatthese deaths were caused by an intense ac-tion of the sympathetic-adrenal system.

Subsequent studies have confirmed thatthe major mechanism of neurocardiac dys-regulation is the release of catecholaminesdirectly into the myocardium by sympa-thetic nerves. The central nervous systemis represented in the heart in the insula,with efferent connections—via the amyg-dala and hypothalamus—to the intermedi-olateral cell column and the stellate ganglia.

Balance between the right and left sidesand the sympathetic and parasympatheticnervous systems is also important in main-taining normal neurocardiac control. Thisnetwork—the anatomical basis of the“fight or flight” hypothesis—may be acti-vated by life-threatening stress with littlechance of escape or control, or by physio-logical perturbations.

Causes of neurocardiac dys-regulation are subarachnoidhemorrhage, seizures from theinsulae, and intense psycholog-ical stress. The most typicalECG alterations involve repo-larization, with deeply invertedT waves seen prominently inthe anterior, inferior, and later-al precordial leads; but manyother ECG abnormalities havebeen recorded, including heart

block, bradycardia, asystole, ventriculartachycardia, alteration in the shape andwidth of the QRS complex, and U waves.

In recent years, thanks to the availabil-ity of echocardiography, it has been rec-ognized that in extreme circumstances ofacute stress, an acute cardiomyopathy—characterized by a disproportionate hy-pokinesia of the left ventricular apex—may develop. This pattern of leftventricular apical ballooning, as seen byechocardiography or contrast ventricu-lography, has been likened to the shape ofa Japanese octopus trapping pot called thetakotsubo; hence, the name takotsubo-like cardiomyopathy.

Patients with the takotsubo-like car-diomyopathy (usually older women) havesuffered a recent psychological stressor, re-sulting in acute heart failure and chest pain;they demonstrate the typical left ventricu-lar apical ballooning pattern seen on the

echocardiogram. Such patients usually havea cardiac enzyme leak (for example, tro-ponin), indicating that this process causesauthentic cardiocyte damage.

The cardiac pathology is characteristicand known as contraction band necrosis.(See left figure.) This process is probablycaused by Cannon’s sympathetic stormwith release of catecholamines directlyinto the endocardium. The pattern of dys-function reflects the density of cate-cholamine receptors in the various parts ofthe heart. At a cellular level, the cate-cholamines, released from sympatheticnerve terminals, open a receptor-operatedcalcium channel, which leads to the ECGchanges, followed by calcium-mediatedfree radical damage to cardiomyocytes.

Takotsubo-like cardiomyopathy is po-tentially completely reversible, provided amalignant arrhythmia does not intervene.The appearance of ventricular tachycardiain one patient, induced by discussing astressful event, is illustrated above, atright.

It is likely that neurocardiac damage fallson a continuum, with benign alterationsof the ECG on the mild end of the spec-

trum and takotsubo-like cardiomyopathyon the severe. Similar mechanisms maywell play an important role in many re-lated phenomena, such as sudden unex-pected death in epilepsy; sudden unex-pected nocturnal death syndrome; suddeninfant death syndrome; cardiac arrhyth-mias associated with epileptic seizures;insular infarcts and intracerebral hemor-rhages; sudden death associated with nat-ural catastrophes (such as earthquake);death and cardiac problems after man-made disasters (the Sept. 11 attacks inNew York); and cardiac events in associa-tion with emotional excitement (the in-creased rate of cardiac events in Germanyduring the World Cup matches on dayswhen the German team was playing).

It is important for neurologists to beaware of the neurocardiac connection. Itmay be possible to prevent such problemsin high risk patients with the use of ben-zodiazepines, β-blockers, calcium channelblockers, and free radical scavengers. ■

DR. SAMUELS is the neurologist-in-chief andchairman of the department of neurology atBrigham and Women’s Hospital, Boston.

Cerebral T Waves and Takotsubo-Like Cardiomyopathy

(L) Myocardiac contraction band necrosis is typical of the neurocardiac lesion. (R) ECG shows a healthy man’s emotional distress during recollection of events.

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HIGHLIGHTS FROM THE JOURNAL OF THE NEUROLOGICAL SCIENCES

B Y A L E X T S E L I S, M . D. P H . D.

Most patients with acute neurologic infectionssurvive, but residual problems are common andusually manifest as incomplete resolution of the

acute deficits. It is not uncommon, however,to develop new complications several monthsor even years later. Examples include seizuresand the parkinsonian syndrome following en-cephalitis lethargica.

It has been known that polio patients oc-casionally experienced a return of their orig-inal symptoms decades after an apparentlycomplete resolution; a case report by Ray-mond and Charcot first appeared in 1875. Spo-radic observations of the problem continueduntil the number of patients became large enough to callattention to this newly recognized clinical entity, post-poliomyelitis syndrome (PPS). Clinical criteria were es-tablished in the mid-1980s, and research efforts intensi-fied.

While a number of hypotheses were advanced to ex-plain this late-developing weakness, with concomitant fa-tigue and pain, none is universally accepted. The com-parison with multiple sclerosis (MS), another chronicneurologic disease (with a relapsing and eventually chron-

ic progressive course) in which fatigue is prominent, sug-gests itself.

The effects of the chronic immune activation in the cen-tral nervous system in MS likely manifest themselves inpart with fatigue, a well-known and often disabling symp-

tom. Recent studies have looked at specificmarkers of inflammation and correlated themwith symptoms in MS. Various measures of fa-tigue and pain were catalogued and inflam-matory markers in the blood investigated.These included tumor necrosis factor–α (TNF-α), interleukin 1-β, and interleukin 6 (IL-6).Leptin, a recently identified molecule involvedin inflammatory processes, body weight, andsleep, also was elevated in PPS. The expectationwas that MS, with abundant evidence for a role

of active inflammation in causing these symptoms, wouldbe associated with considerably elevated inflammatorymarkers, compared with PPS and normal controls.

The results of these studies were quite unexpected. Theinflammatory markers were elevated in both MS and PPSpatients, compared with normal controls.

In a recent paper by a group of investigators fromMcGill University, Montreal, some of these intriguing re-sults are explained in more detail ( J. Neurol. Sci.2008;271:80-6).

The authors examined 51 postpoliomyelitis syndromepatients and a control group of 31 normal, age-matched,local volunteers. The participants had measurementstaken of their serum levels of inflammatory markers, fa-tigue, muscle pain, and strength, as well as disease dura-tion and joint pain.

The authors found that levels of TNF-α, IL-6 and lep-tin, specifically, were elevated in the patients with PPS,compared with the normal controls.

Additionally, TNF-α was correlated with muscle pain. Dr. Daria A. Trojan, one of the senior authors of this

study, is a physiatrist who first began seeing PPS patientsduring her fellowship under Dr. Neal Cashman and hascontinued as a staff physician in the PPS clinic at the Mon-treal Neurological Institute. Dr. Trojan pointed out thata prospective study is needed to confirm and extend theseresults and that they may provide support for a trial ofimmunomodulating agents in this disease.

While it is too early to state whether these findings haveimplications for amyotrophic lateral sclerosis, these resultsdocument an inflammatory state in one form of motor neu-ron disease, albeit a much more slowly progressive one. ■

DR. TSELIS is an associate professor of neurology at WayneState University, Detroit. He is the book reviews editor forthe Journal of the Neurological Sciences.

Three Inflammatory Markers Elevated in PPS

DR. ALEX TSELIS

DR. MARTIN A.SAMUELS

Site visit to be carried out.


PROFILES IN NEUROLOGY

B Y S A R A N G E R E L J A M B A L , M . D.

Iam glad to have the great opportunityto write about the practice of neurol-ogy in my country, Mongolia. Let’s be-

gin with its interesting history. The practice of neurology

got its start in Mongolia in 1939with the establishment of 10neurologic beds in the CentralHospital by the Russian neu-rologist Dr. N.Ya. Semyonova.

In 1947, a neurologist whowas a faculty member ofLeningrad Medical HighSchool, Dr. G.Ya. Liberson,founded the neurology de-partment in the medical fac-ulty of Mongolian State University.

Dr. G. Ya. Liberson’s work was takenover by the first Mongolian neurologists,Dr. G. Lodon and Dr. L. Dagzmaa.

In the 1950s and 1960s, the first scien-tific research works were done in thefield of neuroinfections (neurolues, epi-demic encephalitis, polymyelitis) ac-cording to the social and ecological re-quirements of the country at that time(G. Lodon, D. Rawdandorj). At this time,

the second adult neurology ward and thefirst one for children were launched, thefirst department of neurosurgery wasfounded, and the use of new diagnosticmethods such as EEG and pneumoen-cephalography (PEG) was adopted(Tsagaankhuu G et al. 2007).

In the 1970s and 1980s, the neurologicservice in the country expanded to be-come an independent medical branchand improved the quality of neurologiccare by increasing the number of neu-rologists (about 100) and founding neu-rologic wards in all province hospitals(each with about 20 beds and two neu-rologists).

At that time, the Mongolian neurologistswere supported mostly from Ukrainianneurologists (E.P. Zagorowsky), and in-herited their methods (Tsagaankhuu G etal. 2007).

The political changes in the late 1980sand early 1990s with the end of the ColdWar smashed completely the old social-ist social system in the country.

While the loss of contact with Russianneurologists was keenly felt, one benefitwas that Mongolian neurology was of-

fered new chances to develop profes-sional relationships with neurologistsfrom other countries.

In 2002, the Mongolian neurologic as-sociation “Monneurology” was founded,and it became a member of the WFN.

Also in 2002 the first inter-national epilepsy seminar-workshop was held with thesupport of the ASEAN Epilep-sy Society. In 2006, the first in-ternational neurologic INFO-Seminar was held inUlaanbaatar, with the initia-tion of WFN and internation-al participation opening newopportunities in foreign rela-tions.

Today, the neurologic service in Mon-golia consists of more than 20 medical doc-tors with PhDs and about 200 neurologists.

The number of neurologists in Mongo-lia is 7.8 per 100,000 people, which is a veryhigh proportion compared to most othercountries of the world.

About 60% of all Mongolian neurologistsare working in the capital Ulaanbaatar,where more than a half of the populationis concentrated (1.5 million of Mongolia’sentire population of 2.5 million people livein the capital city).

The number of neurologic beds is about900 in the whole country, about 3.7 per10,000 (Baasanjaw D et al, 2006).

In recent years, neurologic research hasfocused on the epidemiology of most com-mon neurologic disorders such as stroke,epilepsy, neurodegenerative and neuroin-flammatory diseases.

The stroke epidemiology study revealedthat there is a high percentage of the he-morrhagic type (about 50% vs. about 40%ischemic stroke and 10% subarachnoid he-morrhage), which requires special atten-tion to prevention (Baasanjaw D et al,1999).

Also, several research studies were doneon epilepsy, which is a significant cause ofdisability in Mongolia. But because offlaws in the design of these studies, theirfindings do not distinguish various exacttypes of epilepsy, limiting the studies’usefulness.

From 1997 to 2000, the neurogeneticgroup from the U.S. National Institutes ofHealth, which was led by Dr. Lev Gold-farb, collaborated with the MongolianMedical Research Institute to undertakeresearch on neurohereditary diseases inMongolia.

The investigators found a high preva-lence of certain neurogenetic disordersassociated with certain regions of thecountry.

For example, Charcot Marie Tooth[CMT] type 2 disease was prevalent inArkhangai province, where there wereabout 100 cases in the population of97,000.

Other disorders with a geographic

prevalence included the observations ofCMT type 1 disease in Khulunbuir,Dornod province; hereditary spasticspinal paralysis in the Khowd and Uwsprovinces; and familial oligophrenia inDornod province

Cases of myotonic dystrophy were reg-istered in nearly all provinces.

Not all provinces were involved in theepidemiologic research, but the fact thathereditary neurologic disorders occur inhigh prevalence within a country that hassmall population deserves special clinicalattention.

Despite the high number of specialistsand neurology beds in Mongolia, there aremany problems resulting from the difficult

current socioeconomic situation in thecountry.

There is insufficient medical and socialinsurance, both of which were newlyfounded in Mongolia only 10 years ago.

The low level of knowledge and outdat-ed training methods of some neurologistsare leading to misdiagnosis and treatmentfailures in many cases.

Neurologic residency training lasted for2 years during the period from 1997 to2001 and included psychiatry training.Since 2002, the training program has beenshortened to 1 year.

The quality of clinical training is limit-ed by numerous problems: Neurologyresidents must often pay for part or all oftheir training costs; they lack proper work-places; and they are unsalaried.

In most respects, neurology residencytraining in Mongolia lacks standards, ade-quate supervision, and standardized ex-aminations.

Established neurologists require butusually do not receive training in order tobring them up to date with the massive in-crease in new diagnostic methods in recentyears.

Without such training they risk misin-terpreting test results.

Pharmaceutical companies are not in-clined to introduce their new drugs inMongolia because our small populationmeans fewer sales for them.

Some important medical branches inneurology, such as neurorehabilitation,are still nonexistent in the country. Instead,this type of treatment has been replacedby minimally effective traditional treat-ment methods.

To become familiar with the latest ver-sions of diagnostic and treatment research,the neurologic consultant of the Ministryof Health began to implement a CME pro-gram for neurologists.

The younger generation of neurolo-gists eagerly participates in these CME op-portunities. All recent information mustbe translated into Mongolian becauseknowledge of the English language is notwidespread.

We are also working on setting and re-newing the special standards and guide-lines for neurologic diseases which can begenerally diagnosed and treated.

Mongolia is located in the center of theAsian continent, is bordered by Russiaand China, and, belongs neither amongthe Southeast, Pacific, nor Middle Eastcountries.

The climate is dry and cold. Mongolia hasits own culture and language, and a popu-lation with a nomadic style of life that hasexisted for thousands of years.

We hope our geographical, cultural,and climatic conditions will not be a bar-rier for expanding our foreign relation-ships, and we continue to makes stridesto improve our neurologic services inMongolia. ■

SARANGEREL JAMBAL, M.D., known to herfriends as Saraa, is a neurologist at the“Reflex” Neurological Clinic in Ulaanbaatar,Mongolia.

The Practice of Neurology in Mongolia

DR. SARANGERELJAMBAL

Dr. Sarangerel Jambal assesses blood flow using Doppler ultrasound on a patient atthe “Reflex” Neurological Clinic in Ulaanbaatar, Mongolia.

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Training has been cut from 2 years to 1 year;residents are unsalaried;

exams are not standardized.

ABOUT 60% OF ALL MONGOLIAN NEUROLOGISTS

ARE WORKING IN THE CAPITAL ULAANBAATAR,

WHICH HAS MORE THAN HALF OF

THE POPULATION.

MONGOLIA HAS 7.8NEUROLOGISTS PER 100,000PEOPLE, A VERY HIGH RATE

FOR THAT PART OF THE WORLD, AND

900 NEUROLOGIC BEDS.

www.clinicalneurologynews.com

— We Write Medicine’s First Draft — Clinical Neurology News

THE LEADER

IN NEWS

AND

MEETING

COVERAGE

Before the drugis approved...

Before the guidelineis issued...

Before the researchis published...

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You read it first in

20089th International Conference onAlzheimer’s Disease Drug DiscoveryOctober 6-7, 2008 New York, USA www.worldeventsforum.com/addf/9thaddd/index.html

36th Annual Meeting of the Interna-tional Society for Paediatric Neuro-surgery (ISPN) October 12-16, 2008 Cape Town, South Africa www.ispn2008.org

6th International Congress on MentalDysfunctions & Other Nonmotor Fea-tures in Disease October 16-19, 2008 Dresden, Germany www.kenes.com/pdment2008

Dystonia Europe 2008 October 17-19, 2008 Hamburg, Germany www.dystonia-europe-2008.org

46th Annual Meeting of the Academyof Aphasia October 19-21, 2008Turku, Finland www.academyofaphasia.org

2nd World Congress on Controversiesin Neurology (CONy)October 23-26, 2008 Athens, Greece www.comtecmed.com/cony/2008

12th Asian Oceanian Congress of Neu-rology (AOCN 2008) & 16th AnnualConference of the Indian Academy ofNeurology (IANCON 2008)October 23-26, 2008New Delhi, India www.aocn2008.com

9th International Congress ofNeuroimmunology October 26-30, 2008 Forth Worth, Tex., USAwww.isni2008.org

19th International Symposium onALS/MND November 3-5, 2008 Birmingham, Englandwww.mndassociation.org/research/ for_researchers/international_ symposium/index.html

European Charcot Foundation Symposium 2008: Multiple Sclerosisand GenderNovember 13-15, 2008 Taormina, Italy www.charcot-ms.eu/Symposium_ 2008-pages-id-197-sid-128.htm

1st International Headache Summit November 14-17, 2008Tel-Aviv, Israelwww.headache-summit.com

Neuroscience 2008 November 15-19, 2008Washington, D.C., USA www.sfn.org/am2008


200937th Annual International Neuropsy-chological Society Meeting February 11-14, 2009 Atlanta, Ga., USA www.the-ins.org/meetings

2nd Asian and Oceanian ParkinsonDisease and Movement Disorder Congress February 15-17, 2009 New Delhi, India www.aopmcindia.com

5th Annual Update Symposium Serieson Clinical Neurology &NeurophysiologyFebruary 16-17, 2009Tel Aviv, Israelwww.neurophysiology-symposium.com

2nd European Brain Policy Forum February 25-26, 2009Brussels, Belgium www.kenes.com/ebpf2009

9th International Conference onAlzheimer’s and Parkinson’s Diseases:Advances, Concepts andNew Challenges March 11-15, 2009 Prague, Czech Republic www.kenes.com/adpd

5th World Congress of the World Institute of Pain March 13-16, 2009 New York, USA www.kenes.com/wip

24th Conference of Alzheimer’sDisease International March 25-28, 2009 Singapore www.adi2009.org

2nd International Symposium onPsychogenic Movement Disorders andOther Conversion DisordersApril 2-4, 2009Washington, D.C., USAwww.movementdisorders.org/education/pmd

61st Annual Meeting of the AmericanAcademy of Neurology April 25-May 2, 2009 Seattle, Wash., USA www.aan.com

19th World Congress of NeurologyOctober 24-30, 2009 Bangkok, Thailandwww.wcn2009bangkok.com

Calendar of International Events


BOOKS TO CONSIDER

B Y J O H N WA LT O N, M . D.

Seizing Opportunities: The Reminis-cences of a Physician” (Weardale,England: Memoir Club, 2008) is a

charming and well-written memoir fromDr. Richard Godwin-Austen, former Sec-retary-Treasurer General of the WFN.

Richard came from a distinguished, if insome ways eccentric, family. Among hisforbearers were knights, generals, and oth-er individuals of distinction. Not least washis great uncle, Henry Haversham God-win-Austen, who discovered the second-highest mountain of the world, which inmy childhood was known as Mount God-win-Austen, though it is now generally re-ferred to as K-2. The name Godwin-Austen still identifies a glacier in theHimalayas.

After Dr. Godwin-Austen’s schooling,training, and subsequent career in Londonand Devon, he eventually arrived in Not-tingham (England), as a consultant neu-rologist. He served as president of the As-sociation of British Neurologists inaddition to his 8-year-long post at theWFN, which he served with distinction.

Among the anecdotes that enliven thetext is the story of how the now famousBritish film actor Hugh Grant, in his ear-lier, formative years, was a lodger in theGodwin-Austen household. Another high-light is the author’s experiences during a3-month stay in Bagdad, when he wascalled to consult with the then-presidentof Iraq, shortly before Saddam Hussein as-sumed that office.

More personal episodes from Dr. God-win-Austen’s life are also faithfully re-counted, including his early courtship ofSusan Toller. That relationship endedwhen they realized that the demands ofhis early career made it impossible for him

to marry. She left for the United States.Subsequently, Richard and his first wifeJane enjoyed an exceptionally happy mar-riage, which ended with Jane’s tragic deathin a motor accident in which Richard suf-fered only minor injuries; Dr. Godwin-Austen’s description of the accident isquite poignant. His advances, through amutual friend, toward the woman whowas to become his second wife led to an-other happy marriage, which also is re-counted in great detail. Touchingly, Dr.Godwin-Austen has dedicated this vol-ume to both of his wives.

Medical autobiography is a specializedart form, but this book will be read withpleasure by many of Dr. Godwin-Austen’sfriends, admirers, and others as well, andis a delightful example of the genre.

John Walton (Lord Walton of Detchant) isthe author of several books and a pastpresident of the WFN.

Memoir: ‘Seizing Opportunities’

Dr. Richard Godwin-Austen, formerSecretary-Treasurer General of the WFN.

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B A S E D O N A N I N T E R V I E W W I T H

R A A D S H A K I R , M . D.

Secretary-Treasurer, WFN

It is almost 40 years since Dr. Raad Shakir, the WFN’ssecretary-treasurer general, received his medical de-

gree from the University of Baghdad. Sincethen, his postgraduate pursuits and his manyclinical, research, and academic endeavorshave taken him to the United Kingdom, theMiddle East, South East Asia, Africa, and theUnited States.

Members are familiar with Dr. Shakir’sdecades of service to the WFN. What theymay not know are the years of training and re-search that prepared him for that task.

Over his career, his chief research area hasbeen tropical neurology. One of his earlier WFN postswas as secretary and then chairman of its tropical neu-rology research group, then as secretary of the researchgroup’s Asian division.

Building on his experience with Asia, Dr. Shakir workedwith Dr. Johan Aarli, WFN president, to bring the Chi-

nese Neurological Society to the membership of theWFN. Soon after he was instrumental in establishing theAfrica Committee at a stakeholders’ meeting in Stellen-bosch, South Africa. With the committee in place, theWFN can now work with African entities to provide themwith support and training.

Dr. Shakir’s close work with these and oth-er international organizations, together with hisestablished expertise in central nervous systeminfections, culminated in his selection as chair-man of the neurology working group for the11th edition of the World Health Organiza-tion’s International Classification of Diseases.

The excellence of Dr. Shakir’s medical ed-ucation and neurology training prepared himwell for the leadership role he has played sowell for WFN and other organizations. After

receiving his medical degree in Baghdad, Dr. Shakirtrained in neurology at the Institute of Neurological Sci-ences in Glasgow, Scotland. In 1980, he moved to Kuwait,where he was a consultant neurologist and associate pro-fessor then academic dean at the University of KuwaitMedical School in Kuwait City. During that time, he spent

a year at Harvard Medical School in Boston as a lecturerin the department of neurology.

In 1991, Dr. Shakir became consultant neurologist andclinical lecturer at the University of Newcastle UponTyne. Since 1995, he has been a consulting neurologistat London’s Charing Cross Hospital and Central Mid-dlesex Hospital and is currently head of the departmentand chief of service of the neurosciences/head and neckdirectorate at Imperial College, also in London.

Dr. Shakir is a member of the Royal Colleges of Physi-cians and a fellow of the Royal Society of Medicine andthe Royal Society of Tropical Medicine and Hygiene. Hehas served as the editor for three journals—Medical Prin-ciples and Practice, Journal of Tropical and GeographicalNeurology, and Neurological Infections and Epidemiolo-gy—and as author of numerous papers and book chap-ters, as well Tropical Neurology (published by W.B. Saun-ders; first edition, 1999, and second edition, 2003).

In addition to the WFN, Dr. Shakir has also maintaineda longtime association with the International LeagueAgainst Epilepsy, with stints as treasurer of the league’scommission on tropical diseases and as a member of itseducation and public relations committees. ■

A Track Record of Extending, Connecting, Exchanging

Text: ‘Cancer NeurologyIn Clinical Practice’

B Y M A C I E J M . M R U G A L A ,

M . D. , P H . D.

Iwelcomed the second edition of“Cancer Neurology in Clinical Prac-

tice” with great joy and expectation.This volume is already a classic inneuro-oncology literature.

This book covers a broad spectrumof neuro-oncology topics that were or-ganized in an easy-to-follow manner,and many of the authors are experts intheir respective fields.

This book will be wel-comed by neuro-oncologyfellows who, in the past,lacked a single compendi-um that would guide themin their studies of the field.Although we do have nu-merous excellent resourcesin neuro-oncology, many ofthem focus on intracranialdisease and primary brain tumors.Only a few address neurologic com-plications of cancer and give adviceon day-to-day management of neuro-oncology patients. “Cancer Neurolo-gy in Clinical Practice”(New York:Humana Press, 2008) fills that void; itis a comprehensive, highly special-ized yet practical textbook. Its stylecould be compared with “Office Prac-tice of Neurology” from Samuels andFeske that many of you have on yourbookshelves.

Who else will embrace this book?Most certainly savvy neurology resi-dents and medical oncology fellows,because this tome is saturated withuseful clinical information. It also be-longs on the shelf of the general neu-rologist who frequently takes care ofcancer patients and needs a quick,

readable, and practical reference.Even well-seasoned neuro-oncologistswill likely refer to this text for prob-lems less frequently encountered.

The first half covers diagnostic toolsand symptoms of cancer neurology, in-cluding chapters on seizures, headache,mental status changes, cancer pain,and steroid therapy. These chaptersshould be required reading for all physi-cians who care for cancer patients.There are dedicated chapters dealing

with complications ofcancer therapy, includingthose associated withnewer treatments as wellas older and rarer ones.The book closes with 13chapters on neurologiccomplications tied to spe-cific malignancies.

One would like to readthis volume cover to cov-

er. It might be a challenge, though, formost of us who carry a significant clin-ical workload. But even reading it“chunk by chunk,” highlighting im-portant information and frequently re-turning to it, would be immenselyuseful. The layout of each chapter isvery clear and intuitive, and one canfind the information one needs in afew turns of the page. Tables are clearand not overcrowded (kudos to thegraphics editors!), images are of su-perb quality, and references are easy toread. Overall, this book is a great ad-dition to any professional library.

DR. MRUGALA is assistant professor inthe division of neuro-oncology in thedepartment of neurology andneurosurgery at the University ofWashington, Seattle.

DR. MACIEJ M. MRUGALA

DR. RAAD SHAKIR


A. Martin Halliday, M.D., 1926-2008B Y S. J. J O N E S, M . D.

Dr. Martin Halliday died March 18, 2008,at the age of 81.

Dr. Halliday’s outstanding career in neu-rology and clinical neurophysiologyspanned the exciting decades from 1950 to1990, when advances in thespecialty came frequently.

His pioneering enthusiasmfor computer technologyplaced him at the forefront ofresearch into sensory evokedpotentials (EPs), arguably thefirst noninvasive “window”onto specific processes of thehuman brain.

While deeply interested inall aspects of brain function, Dr. Hallidaynever forgot that the chief virtue of EPsconsisted in what they could contribute toclinical neurology.

Dr. Halliday showed academic promisefrom an early age. He passed the entranceexaminations for both Oxford and Cam-bridge universities at 15 years old but wasdeemed too young to attend.

By the age of 20, he had graduated withfirst-class honors from the University ofGlasgow.

His subsequent medical training wasfollowed by an obligatory period of mili-tary service, during which his aptitude forresearch became apparent. His work on

the effect of sleep deprivationon hand tremor was promptedby the need to quantify andminimize the risks of pilot fa-tigue during the Berlin airlift.

This led to an invitationfrom Dr. Arnold Carmichaelto join the newly establishedMedical Research Council unitat the National Hospital forNervous Diseases in London.

Dr. Halliday’s subsequent espousal ofEP research followed the lead of his col-league Dr. George Dawson, who hadshown that consistent stimulus-related po-tentials could be extracted from the elec-troencephalogram (EEG) by means ofanalogue signal-averaging. In 1961, withthe inestimable technical assistance ofDawson’s electronic wizard, Jack Pitman,

Dr. Halliday introduced the first genera-tion of digital signal-averaging devices toclinical neurophysiology. The nucleus ofhis team was completed by his research as-sistant and wife, Lisl.

Dr. Halliday’s most significant clinicalbreakthrough came in the early 1970s,when his work with Dr. Ian McDonaldand Dr. Joan Mushin showed for the firsttime that visual EPs could be used as ahighly sensitive diagnostic test in patientssuspected of having optic neuritis or mul-tiple sclerosis (MS).

It was this discovery that led directly tothe adoption of similar methods in neu-rodiagnostic departments all over theworld, and to an explosion of visual EP(VEP) research. Subsequent papers fromDr. Halliday’s lab refined the methodand quantified the diagnostic power ofVEPs in MS and other demyelinating dis-eases, demonstrating the complementar-ity of VEP methodology with imagingtechniques such as magnetic resonanceimaging.

It is essentially the same method that re-mains in use today, and is still regarded as

the benchmark test for pathophysiologicalstudies of optic nerve demyelination. Pub-lished at the end of his career, the secondedition of Dr. Halliday’s largely self-penned reference work, “Evoked Poten-tials in Clinical Medicine,” seems unlikelyever to be superseded.

One of Dr. Halliday’s many virtueswas his insistence on due credit being ac-corded all his collaborators, including themost junior. A kind friend as well as aninspiring chief, Dr. Halliday was a cul-tured and humane man whose extra-mural interests extended to the arts (es-pecially music) and philosophy.

Perhaps his least-known contributionwas in the promotion of Advaita, a Hin-du philosophical school that addressesthe ultimate truth underlying the reli-gions of the world.

His third book in this area, “The Spir-itual Awakening of Science,” is soon to bepublished posthumously. ■

DR. JONES is Honorary Consultant,National Hospital for Neurology andNeurosurgery, London.

DR. MARTIN HALLIDAY

B Y PA O L O M . R O S S I N I , M . D.

Atotal of 820 participants from 43 coun-tries (including non-European coun-

tries such as Thailand, Korea, Australia,Egypt, and New Zealand) attended the13th European Congress of Clinical Neu-rophysiology, which took place from May4 to May 8, 2008 in the Istanbul (Turkey)Convention Centre.

The congress was convened by Prof.Onder Us of the city’s Institute of Neu-rological Sciences at Marmara University,and featured more than 400 scientific pre-sentations in the field of clinical neuro-physiology, including studies on epilepsy,movement disorders, Alzheimer’s disease,stroke, sleep disorders, peripheral neu-ropathies, and myopathies.

Data also were shared on some of thefuture therapies of interest to this impor-tant medical specialty, including deep andsurface brain stimulation, transcranialmagnetic stimulation, robots for rehabili-tation, the brain-computer interface, psy-chophysiology and brain cognition, andbrain imaging.

The congress was enriched by the par-ticipation of the executive committee ofthe International Federation of ClinicalNeurophysiology (IFCN), which is led byProf. Hiroshi Shibasaki, its president, andalso by the active involvement of severalprominent neuroscientists who are in-terested in and deal with electromagnet-ic brain function in Europe.

One major highlight of the congress wasthe attendance of a large number of youngcontributors, 60 of whom benefited fromthe Young Travel Fellowships awarded bythe IFCN and the European Chapter. Thenumber of fellowships awarded was thegreatest in the congress’s history.

Besides the scientific activity, the con-

gress offered an exciting social program.The faculty dinner and gala dinner wereheld in enchanting historic buildings in oldIstanbul, amid terrific views of theBosphorus.

The General Assembly of the Euro-pean Chapter also chose the site of thenext congress.

Presentations were made by the Austri-an Society, in support of Innsbruck, andalso by the Italian Society, in support ofRome.

Ultimately, the delegates expressed theirvotes (22 to 15) in favor of having the nextcongress in Rome in 2011.

We’ll see you in Rome! ■

DR. ROSSINI, of the department ofneurological sciences, La SapienzaUniversity, Rome, is the chairman of theEuropean Chapter of ClinicalNeurophysiology.

The 13th European Congress of Clinical NeurophysiologyMEETING HIGHLIGHTS

Sympathetic Skin Response Re-flects Degree of Spine Injury in

Patients,” a paper by young investiga-tor Dr. Hatice Kumru and colleagues,was recognized at the 13th EuropeanCongress of Clinical Neu-rophysiology in Turkeywith an award that isnamed for Prof. KorkutYaltkaya, a highly respectedTurkish neuroscientist.

The study’s findings mayeventually help neurologistsand other providers developan index of recovery of sym-pathetic function in patientswho sustain spinal cord injury, by con-firming the importance of supraspinalcenters and the sympathetic descendingpathways for the generation of thesympathetic skin response.

Dr. Kumru, of L’Institut GuttmannHospital Clinic, in Barcelona, withcolleagues Dr. Joan Vidal, Dr. PedroSchestatsky, Dr. Jesus Benito, Dr.Maria Perez, and Dr. Josep Valls-Sole,characterized the dysfunction in thecircuit responsible for the sympatheticskin response (SSR) in patients withspinal cord injury (SCI) and, specifi-cally, whether the dysfunction was inthe afferent or efferent arm of the re-sponse to somatic inputs.

The researchers analyzed the sym-pathetic skin response of the handsand feet in patients with spinal cord in-jury at various levels and of varyingseverity. Subjects were 16 complete

and 34 incomplete spinal cord injurypatients.

The lesions were above T4 in 18 pa-tients, between T4 and T10 in 20 pa-tients, and below T10 in 12 patients.

Control subjects were 15healthy volunteers matchedfor gender and age.

The sympathetic skin re-sponse was recorded dur-ing deep breathing, unex-pected acoustic stimuli,single electrical stimuli tothe median and peronealnerves, and brisk hand mus-cle contraction.

However, the response was absent inhands and feet in three patients withcomplete spinal cord injury above T4.

It was present in the hands and ab-sent in the feet in 10 complete spinalcord injury patients and in 3 patientswith incompete spinal cord injury atvarious levels.

In patients who had responses inboth the hands and feet, the mean la-tency difference between them was sig-nificantly longer than in control sub-jects, regardless of stimulus modality (Pless than .0001 for all comparisons).

The amplitude of the sympatheticskin response was bigger in controlsubjects than in patients in hands andfeet, but the differences were only sig-nificant for brisk hand muscle contrac-tion in the foot.

Dr. Kumru’s paper was selected forthe honor over 10 other finalists.

Sympathetic Skin Response ReflectsDegree of Spine Injury

Dr. Rossini said one highlight was themany young investigators in attendance.

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VOL. 23 NO. 3 SEPTEMBER 2008 World Neurology WFN history (A).pdf · 2017. 12. 6. · Elsevier...

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Transcript of VOL. 23 NO. 3 SEPTEMBER 2008 World Neurology WFN history (A).pdf · 2017. 12. 6. · Elsevier...