Report on the XXII World Congress of Neurology INSIDE by WILLIAM M

VOL. 31 • NO. 1 • JANUARY 2016

THE OFFICIAL NEWSLETTER OF THE WORLD FEDERATION OF NEUROLOGY Report on the XXII World Congress of Neurology INSIDE BY WILLIAM M. CARROLL, MD FEATURES he XXII World Congress of Neu- those attending Vienna rology opened Nov. 1, 2015, at the and Marrakesh. This A NOTE OF THANKS T CasaPiedra Conference Center in demographic added a Raad Shakir shares his appreciation of Santiago, Chile. youthful look to the Con- Don Silberberg’s efforts at the helm of A total of 3,500 gress. Delegates enjoyed World Neurology. delegates were the intimate Chilean PAGE 2 registered from décor of the CasaPiedra, 110 countries, comprehensive scientific PRESIDENT’S COLUMN and this Con- and teaching course pro- World Brain Alliance moves forward on gress brought a grams, and opportunities crucial brain health issues. significant rise for social, educational and PAGE 3 in the number cultural discourse. of participants Michelle Bachelet, president of Chile, addresses the Congress. NIH LEADS BRAIN DISORDERS under age 35 Opening Ceremony RESEARCH EFFORT compared to William M. Carroll The World Congress Sun- Nature supplement details Brain day evening opening was one of the most noncommunicable disease states, such as Disorders Across the Lifespan — enjoyable ceremonies for a long time. Not traumatic brain injury, Parkinson’s disease Research. only was the cultural performance infor- and multiple sclerosis. She emphasized PAGE 4 mative, lively and just the right duration, that the program was primarily preventa- but so were the preceding addresses by tive but also provided structured care. World Federation of Neurology President Raad Shakir emphasized the need for EDITOR’S UPDATED AND SELECTED ARTICLES FROM THE Raad Shakir and World Congress of Neu- both the fostering of quality neurology and JOURNAL OF THE NEUROLOGICAL SCIENCES rology President Renato Verdugo, and the equality of health care worldwide, Renato Index reorganization enhances journal. following address by Dr. Michelle Bach- Verdugo gave an illuminating and much PAGE 7 elet, president of Chile. A pediatrician appreciated background on the history of by training, Dr. Bachelet spoke firmly on Chile and the Chilean peoples. the need for global action on stroke and TEACHING COURSES EXPAND EDUCATION AT WCN dementia, leading causes of the noncom- Scientific Program Topics presented include many general municable neurological disease burden in Earlier that day, Dr. Oleg Chestnov, As- and common topics, such as stroke, the world. She also highlighted the efforts sistant Director-General of Noncommu- dementia, epilepsy and others. of the Chilean Government through its nicable Diseases and Mental Health at the PAGE 12 The XXII World Congress of Neurology opens Program of Explicit Guarantees in Health World Health Organization (WHO), led with a lively Chilean cultural performance. Care, which targets these and other see WORLD CONGRESS, page 8

Brain Health: Why Time Matters in MS Aim: maximize lifelong brain health BY GAVIN GIOVANNONI, MD, ON BEHALF OF THE MS BRAIN HEALTH STEERING COMMITTEE. disease activity (Figure 1), involving: Early referral Comprehensive Early treatment Use • Shared decision-making and diagnosis economic approach he goal of treating patients with • Early intervention Shared Monitoring Access to DMTs multiple sclerosis (MS) should be • Improved treatment access decision-making T to maximize lifelong brain health. • Proactive monitoring This is the central theme of a new inter- The report was launched during a Swift action on evidence national consensus report from a multi- symposium, “Is the MS Community Generate of disease activity Consult

disciplinary author group. Brain Health: Ready to Promote Brain Health?” on Real-world evidence Time Matters in Multiple Sclerosis calls the eve of the European Committee @MSBrainHealth Recommendation Therapeutic strategy Leads to www.msbrainhealth.org for greater urgency at every stage of for Treatment and Research in Multiple We recommend a therapeutic strategy based on regular monitoring that aims to maximize lifelong brain health while generating robust diagnosing, treating and managing MS. Sclerosis Congress Oct. 6, 2015. real-world evidence. Its recommendations aim to facilitate Professor Tim Vollmer outlined the DMTs, disease-modifying therapies. a therapeutic strategy that minimizes see BRAIN HEALTH, page 9 Figure 1. 2 WWW.WFNEUROLOGY.ORG • JANUARY 2016

contributed, or he asked a colleague FROM THE EDITOR-IN-CHIEF to contribute important articles on the WORLD FEDERATION OF NEUROLOGY Editor-in-Chief history of neurology and neurological Donald H. Silberberg his issue of World Neurology is the and her colleagues at Ascend Integrated sciences for every issue.

WFN London Office last for which I will Media, World Neurology’s As Raad Shakir notes in his gra- Chester House serve as editor. Fulfilling publishing partner, taught cious article about the transition to the Fulham Green T 81-83 Fulham High Street this role for the past three me what I needed to know, editorship of Steven Lewis, effective years has been an exciting and, in general, they helped for the March 2016 issue, generating a London SW6 3JA endeavor. I greatly appreci- to make the transition comprehensive list of email addresses United Kingdom ate that I was invited, and to electronic distribution has remained a persistent problem. I Tel.: +44 (0)20 3542 1657/1658 Fax: +44 (0)20 3 542 1301 that I accepted the challenge smooth. In addition to my am hopeful all the member organiza- [email protected] and opportunity to develop thanks to Rhonda, I am in- tions of WFN will help Steven address

WFN OFFICERS World Neurology as an online debted to Vladimir Hachin- this. President Raad Shakir (United Kingdom) publication. ski and WFN President Raad So, as I finish my three-year term, I First Vice President William Carroll (Australia) In late 2012, then WFN DONALD H. Shakir for their support and also want to thank the many other indi- Secretary-General Wolfgang Grisold (Austria) SILBERBERG Treasurer Richard Stark (Australia) President Vladimir Hachinski interesting contributions, viduals who have contributed articles,

ELECTED TRUSTEES invited me to assume the po- and also at WFN to Keith book reviews, ideas and guidance. I Gallo Diop (Senegal) sition as editor-in-chief and Newton for managing the have enjoyed my tenure, and I wish Riadh Gouider (Tunisia) Wolfgang Grisold (Austria) oversee the transition from paper to an calendar and carefully proofing galleys. Steven Lewis the best as he assumes the online newsletter. Rhonda Wickham Peter Koehler has unfailingly personally editorship. • CO-OPTED TRUSTEES Steven Lewis (USA)

REGIONAL DIRECTORS Saeed Bohlega (Saudi Arabia) Terrence L. Cascino (North America) from the WFN’s committees and officers, Günther Deuschl (Europe) but beyond this, he also targeted abstracts Riadh Gouider (Pan Africa) A Note of Thanks to Don Silberberg Marco Tulio Medina (Latin America) of articles that seemed to be the most Man Mohan Mehndiratta (Asia-Oceania) BY RAAD SHAKIR WFN website. important to global neurology. All of this ince Don took over as editor of World Part of the challenge, he said, would has been an unqualified success, for which EDITOR OF THE JOURNAL Neurolo- be to avoid all but essential redundancy the trustees and I, and indeed the WFN as OF THE NEUROLOGICAL SCIENCES John England (USA) Sgy (WN) among the three, and that has clearly a whole, are most grateful. in April 2013, been achieved through the World Neurol- World Neurology is now on sound foot- we have seen ogy Editorial Advisory Board, which was ing for his successor to take it forward to a steady im- created, and in other ways. In fact, so the next stage. There is still much work to provement successful has this been that we have been be done in developing the email database, in the quality able, during his editorship of World Neurol- as we all know, and we have begun to WORLD NEUROLOGY, an official publication of the of our news- ogy, to launch a third publication — the address that issue as well. Don will be suc- World Federation of Neurology, provides reports from the leadership of the WFN, its member letter with new open access journal, eNeurologicalSci ceeded by Prof. Steven Lewis of Chicago, societies, neurologists around the globe and news the publica- (eNS), a sister journal to WFN’s longtime Illinois, USA, as editor and Walter Struhal from the cutting-edge of clinical neurology. Con- tion of each flagship scientific journal, the Journal of of Innsbruck, Austria, as co-editor. tent for World Neurology is provided by the World RAAD Federation of Neurology and Ascend Integrated of the 16 the Neurological Sciences (JNS). No doubt, I simply wish to express our collec- SHAKIR Media. issues he has we shall begin to seamlessly blend this tive gratitude for the contribution Don Disclaimer: The ideas and opinions expressed in overseen. too into the system, as it develops and Silberberg has made and to thank him for World Neurology do not necessarily reflect those of the World Federation of Neurology or the publisher. In his first grows as part of the WFN’s publications his continuing efforts on behalf of the The World Federation of Neurology and Ascend Integrated Media will not assume responsibility for editorial, he stated that the new electronic portfolio. WFN. I hope the experience has been an damages, loss or claims of any kind arising from format would permit ready coordination Don set out his plans to publish enjoyable one and that Don has found the or related to the information contained in this publication, including any claims related to the among the two WFN publications, the important news from the WFN, reports organization to have a useful role to play products, drugs or services mentioned herein. Journal of Neurosurgery and WN, and the of WFN activities in the field and reports in neurology. • Editorial Correspondence: Send editorial correspondence to World Neurology, Dr. Donald H. Silberberg at [email protected].

World Neurology, ISSN: 0899-9465, is published bimonthly by Ascend Integrated Media 6710 W. 121st St., Suite 100 Report on the 23rd Annual Conference of the Indian Academy of Neurology Overland Park, KS, 66209 Phone +1-913-344-1300 BY GAGANDEEP SINGH, ARABINDA MUKHER- The demand on neurologists requires the and conceptual advances require that Fax: +1-913-344-1497 JEE AND PARDEEP KUMAR MAHESHWARI ability to deal with a large patient pool neurologist have the ability to provide ©2016 World Federation of Neurology with diverse neurological conditions. state-of-the-art tertiary care to patients he 23rd Annual Conference of the At the same time, recent technological see NEUROLOGY, page 11 Indian Academy of Neurology T (IAN) was held Oct. 1–4, 2015, at PUBLISHING PARTNER Agra, the city of Taj, in India. Planning Ascend Integrated Media the IAN scientific program with sizeable President and CEO professional body of clinical neurologists Barbara Kay in India is always a challenging task for Vice President of Content Rhonda Wickham two reasons. For one, India is a country Vice President of eMedia with 1.28 billion people with about 1,800 Scott Harold neurologists, which amounts to one Vice President of Sales Donna Sanford neurologist for 7,00,000.

Project Manager This entails providing each neurolo- Amanda Nevala gist with updated knowledge so as to Art Directors be able to deal with a wide range of Lorel Brown Danielle Hendrickson neurological disorders, including tropical

Editorial Offices infections and toxin-induced disorders, 6710 West 121st St., Suite 100 besides the usual neurological condi- The Taj Mahal plays as backdrop as delegates gather during the Clean India campaign held Overland Park, KS 66209 +1-913-469-1110 tions managed by Western neurologists. during the conference. WWW.WFNEUROLOGY.ORG • JANUARY 2016 3

PRESIDENT’S COLUMN

ow the 22nd World Congress of tional level. The World Health Organiza- Neurology (WCN) in Santiago, tion is going ahead on Global Coordination N Chile, is over with huge success both Mechanism on Noncommunicable Diseases scientifically and socially. There is a spe- (GCM NCDs). The place for neurology cific and enduring success story I would NCDs was not initially prominent, in spite like to mention in this column. In every of the fact that generally brain disorders WCN, the program committee makes cause major death and disability more than a specific point of bringing together all HIV, malaria and tuberculosis put together. brain health sis- The role of the WBA is to fill the gap ter disciplines to and inform, as well as educate public health be present and authorities on the devastating effects of to participate. brain health disorders, whether they are So in the Con- neurological, mental, developmental or gress, the World substance (NMDS) use issues. The short- Psychiatric As- comings of neurological health provisions sociation, World were highlighted yet again in the second Federation of edition of the Neurology Atlas 2015. This is a Neurosurgical combined effort between WHO and WFN. Societies, Inter- RAAD The Atlas was presented in a preliminary national Child SHAKIR manner at the World Congress. It will be Representatives from the World Brain Alliance and sister organization in the Global Neurology Neurology As- published in early 2016. It gives details of Network met during the World Congress of Neurology (WCN) Nov. 3, 2015 in Santiago, Chile. sociation, World the current status of manpower, service Front row (from left): Ingrid Tein, president, International Child Neurology Association; Gunther Federation of Neurorehabilitation and provisions, social support and drug avail- Deuschl, president, European Association of Neurology; Rana Karabudak, Neuroimmunol- International Brain Research Organization ability for neurological, neurosurgical, child ogy; Bill Carroll, vice-president and Global Neurology Network chair, WFN; Stephanie Clarke, were all present. neurology and rehabilitation facilities across president, World Federation of Neuro-rehabilitation, Raad Shakir, president, WFN; Yong-Kwang Tu, president, World Federation of Neurosurgical Societies; Cathy Rydell, CEO, American These organizations constitute the um- the world. Academy of Neurology; Tarun Dua, medical officer, Program for Neurological Diseases, World brella for brain health. The World Congress For the WBA to gel with our specialty Health Organization; Terrence Cascino, president, American Academy of Neurology; and Riadh of Neurology in Santiago had sessions for sister organizations in the Global Neurol- Gouider, trustee, WFN. each of these organizations, which were ogy Network, a joint meeting with the Back row (left to right): Renato Verdugo, president, WCN Santiago; Steven Lewis, WFN co- well attended and presented a showcase representatives of all organizations present opted trustee and editor continuum, American Academy of Neurology; Erik Wolters, president, International Association of Parkinsonism and Related Disorders; Riccardo Soffietti, European for each one of them. The WFN leaves the in Santiago was arranged. These global Association of Neuro-Oncology; Sam Wiebe, International League Against Epilepsy; Geoff Don- convening of the sessions and the choice neurology associations convened sessions nan, World Stroke Organization; Alan Thompson, Multiple Sclerosis International Federation; of topics to the federations. It is absolutely at the WCN and were represented at the Amadou Gallo Diop, trustee, WFN, chair, Africa Intiative; Mark Hallet, president, International correct that they should feel free to inform highest level. The World Stroke Organiza- Federation of Clinical Neurophysiology; Claudia Trenkwalder, World Association of Sleep Medi- attending neurologists on what they think tion, International League Against Epilepsy, cine; and Jes Olesen, International Headache Society. is of interest to us in their fields. International Parkinson’s and Movement The World Brain Alliance (WBA) is Disorders Society, MS International, therefore moving full steam ahead, and the Alzheimer’s International, International way to do this is for NMDS to be looked fact, which always should be at the front of collaboration is now so close that the time Headaches Society, Peripheral Nerve soci- at together. Then the combined grouping all measures carried out by health authori- has come for tackling major issues, which ety, Neuro-ophthalmology, Neuro-Otology, is big enough to compete for funding and ties. It is also true that the cost of coping can be dealt with jointly. Forming small Neuro oncology, History of Neurology all support, compared with similar big group- with NMDS conditions will be beyond working groups to tackle specific com- had sessions which were of most interest to ings such as cancer or cardiac diseases. health budgets even with high-income, let mon disorders is underway. Three topics participants. The big drive of WHO toward global alone low- and middle-income economies. already have been agreed upon, those being The issues of brain health are crucial coordinating GCM NCDs is gathering pace. The emphasis on management, in- dementia, epilepsy and traumatic brain to the major exposure we would like to Although the scope of the process is not cluding prevention, is a change in WHO injury. It is absolutely correct that working have at the highest level of international yet complete, one can see WHO trying to thinking, which we need to embrace and together, the WBA is a much more power- health care. If we are going to influence listen to all stakeholders, and the matter of welcome. WHO is receptive and recognizes ful entity rather than each of us acting public policy, we need to be at the forefront WHO dealing with disease management that advances in genetics and imaging have separately. Moreover, in many situations we of issues when decision-makers look into is now a reality. The United Nations has created a new era in early diagnosis and at are tackling the same issues at the interna- allocating budgets and resources. The only produced the declaration on NCDs and 17 times preclinical recognition, which means Sustainable Development Goals (SDGs) specialists are needed and in numbers so in 2015. In all these initiatives and targets, there shall be no difference in care between brain health should be at the forefront, and various income groups. There is no doubt we as neurologists should push hard to that recommendations to national govern- have neurological issues right in the middle ments at the GCM NCDs to train more of governmental thinking. Financial sup- doctors are commendable and welcome. port for our patients will only come if we We should also bring forward the idea that have clear publically supported initiatives although a figure of 50 percent of those in a language that makes sense and shows young doctors were recommended to be targets, which are realistic and achievable. in primary care, there is an urgent need to The WHO GCM NCDs is an excellent increase the number of specialists in brain platform to put forward our views on how diseases across the world. It is true that this to achieve early diagnosis and prevention may be a long-term policy and to a degree of neuro NCDs. The issue, which attracts wishful thinking, but if we look at the WHO and its agencies, is prevention and SDGs, many of which are long term but all coping with various disorders at the pri- of them have been approved at the highest mary care level. This is fine and commend- level of the United Nations. able, however, in our world there is a follow The way ahead is long but brain health, on to this, which is management of many when presented to decision-makers, has disorders, which are chronic, and for many so far been received with a positive and lifelong. The fact that NMDS cause major understanding attitude. We should all work disability adjusted life years is an important at every level to promote brain health. • 4 WWW.WFNEUROLOGY.ORG • JANUARY 2016 NIH-Led Effort Details Global Brain Disorders Research Agenda in November 19, 2015, Nature Supplement

Note: This National Institutes of Health press brain disorders in low- and middle-income release highlights the publication of a supple- countries (LMICs). The most strategic ment on Brain Disorders Across the Lifespan opportunities involve cross-disciplinary — Research to Achieve Nervous System Health studies of the relationship among environ- Worldwide. mental, developmental and genetic factors on brain disorders, the co-authors note. nfants are starved of oxygen during Advances in genomics provide new clues difficult births. Children’s cognitive for mental disorders research, including I function is permanently damaged due predispositions for substance abuse and to malnutrition or exposure to infections addiction, which could be harnessed to or toxins. Adults suffer from crippling improve diagnosis and identify tailored depression or dementia. The breadth and treatments. The miniaturization of complexity of these and other brain and diagnostic technologies and other mobile nervous system disorders make them health advances could improve surveil- some of the most difficult conditions lance, assessment and treatment of mental to diagnose and treat, especially in the and nervous system disorders in LMICs, developing world, where there are few where cell phones are widely used. resources. A National Institutes of Health To address infection-related nervous (NIH)-led collaboration has studied these system morbidity, scientists should pro- complex issues that occur across the lifes- duce accurate estimates of disease burden, pan and today published a supplement to develop point-of-care assays for infection the journal Nature that lays out a research diagnosis, improve assessment tools for strategy to address them. cognitive and mental health impairment “We may be at a tipping point for and study ways to improve infection research related to global brain disorders,” prevention and treatment. In addition, the according to an introductory article au- authors note that because LMIC popula- thored by co-editors Dr. Donald Silber- tions suffer exposures to toxins due to Chart shows comparison of disability associated life years (DALYs) between high-income and berg, of the University of Pennsylvania, poorly regulated mining or other indus- low- and middle-income countries. The data were derived from the World Health Organization Philadelphia, and Dr. Rajesh Kalaria, of tries, there are opportunities to advance and the Global Burden of Disease 2010 Study. Newcastle University in the United King- scientific understanding of brain responses dom. “Over the past few decades, exciting to environmental challenges. countries. To explore these many research arty International Center, grew from a basic science discoveries have been made, The authors also advocate for longi- gaps, local scientific capacity must be meeting of grantees and other scientific effective interventions have been devel- tudinal studies that would be conducted developed, as these questions are best ad- experts, convened in February 2014. oped and advances in technology have set across the lifespan in LMICs, to study the dressed by indigenous scientists who can While advances in brain imaging, the stage for a research agenda that can unique circumstances and risk factors in seek context-sensitive solutions. nanoscience and genetics hold much lead to unprecedented progress in this childhood, adolescence, adulthood and Although they cause nearly one-third promise for research discoveries, more re- field.” old age. Regional variations in the chal- of the global burden of disease, brain sources are needed, according to Fogarty More than 40 scientists collaborated lenges posed by brain disorders mean that and nervous system disorders have been Director Dr. Roger I. Glass, who contrib- to produce nine review articles that detail research priorities need to be addressed largely absent from the global health uted a foreword to the publication. “We research priorities for different aspects of country-by-country, and by regions within agenda, according to authors. As the hope this supplement inspires other sci- population ages, these disorders will entists and funding partners to join us in make up a growing proportion of illness addressing the full spectrum of research, and disability. This rise will be steeper in training, implementation and policy ques- LMICs, where early life trauma, infectious tions needed to alleviate global suffering disease and malnutrition contribute to from mental and neurological disorders the development of these disorders, the that occur across the lifespan.” co-authors of the study predict. Although The journal supplement is open-access developing countries bear a disproportion- and available at www.nature.com/brain- ately large share of these problems, they disorders. have minimal resources to cope with the The Fogarty International Center ad- challenges. dresses global health challenges through “This burden significantly affects the innovative and collaborative research and ability of children and adolescents to training programs and supports and ad- thrive and live out their true potential, vances the NIH mission through interna- and the ability of young adults to be tional partnerships. For more information, productive economically and support their visit www.fic.nih.gov. families, as well as the opportunity for About the National Institutes of older adults to age in safe and nurturing Health (NIH): NIH, the nation’s medical settings,” the co-authors observe. research agency, includes 27 Institutes and The tide is changing, the supplement’s Centers and is a component of the U.S. authors acknowledge, with mental health, Department of Health and Human Ser- substance abuse and chemical exposures vices. NIH is the primary federal agency among the priorities included in the conducting and supporting basic, clinical, new Sustainable Development Goals, and translational medical research, and is announced by the United Nations last investigating the causes, treatments, and September. cures for both common and rare diseases. Cover of supplement to journal Nature, titled Brain Disorders Across the Lifespan: Research to The project, led by the Center for For more information about NIH and its Achieve Nervous System Health Worldwide. Global Health Studies at the NIH’s Fog- programs, visit www.nih.gov. • WWW.WFNEUROLOGY.ORG • JANUARY 2016 5

Oliver Sacks: A Bright Star in the Neurological Sky Mark Your Calendars BY ORRIN DEVINSKY, MD liver Sacks is likely the world’s best- ing.” In 1965, after completing an intern- known neurologist. From the early ship at Mount Zion in San Francisco and a 2016 Oroots of a pure subspecialty in the residency in neurology and neuropathology early 19th century to now, it would be hard at the University of California-Los Angeles, 3rd International Conference on to identify another neurologist who has Sacks moved to New York, which would be Heart & Brain touched as many lives. He did it all outside his home until his death 50 years later. February 25-27, 2016 of the mainstream of traditional academic He attempted a career in neuropathol- Paris, France or private practice neurology. He forged his ogy, but clumsy hands held him back, and own path. he moved to his passion, clinical medicine Born in 1933 in London, his early life and writing. His first book, Migraine, XXV European Stroke Conference was an intellectual cauldron of family and was published in 1970. He interwove the April 13-15, 2016 friends. His mother was a surgeon and anat- neurological history of migraine with his Venice, Italy omist. His father was a general practitioner case studies and his own migrainous experi- who taught Sacks that every patient was a ences. While working at a chronic hospital Oliver Sacks (left) and Orrin Devinsky. special story. His aunts, uncles and cousins in the late 1960s, Sacks cared for patients 9th World Congress for Neurorehabilitation included inventors, chemists, United Na- with postencephalitic parkinsonism, who epilepsy — gave new insights to neurologic May 10-13, 2016 tions diplomats, Nobel laureates, celebrated had been left for custodial care. disease and brain mechanisms. His last year Philadelphia, Pennsylvania cartoonists, directors, writers, etc. His two He convinced the hospital’s administration of life was remarkably productive with the best childhood friends were Jonathan Miller to give them the chance to be treated with release of his memoir, On The Move, and and Eric Korn. Miller trained as a neurolo- L-dopa. He prevailed, and the complex sto- several extended essays in the New Yorker 5th International Conference - gist, but went on to become an acclaimed ries of triumph and defeat remain among and the New York Review of Books. In his Advances in Clinical Neuroimmunology opera director, actor, author, television pre- the most fascinating and beautifully written final months of life, he wrote his most June 17-18, 2016 senter, humorist and documentarian. Korn case studies in medicine. provocative and compelling pieces — three Warsaw, Poland was a polymath who loved science, theater, Awakenings propelled Sacks into a liter- essays in the New York Times that revealed poetry and literary criticism. He was an ary arena no neurologist had ever reached his terminal diagnosis and how he planned antique bookseller who helped recreate before. Twenty years later, Penny Marshall to live what time remained to him. These 5th European Headache and Migraine Darwin’s library at Down House. would direct the movie in which Robin essays resonated with readers around the Trust International Congress This idyllic childhood was destroyed Williams played Sacks, and Robert De Niro world. Sept. 15-18, 2016 by the blitz of London in World War II. played one of the postencephalitic patients. On a personal side, Oliver Sacks loved Glasgow, United Kingdom Sacks was sent to a boarding school in the His career continued to rise and through his patients, family and friends. He under- country, where a cruel headmaster reigned. his many books — from The Man Who Mis- stood how to love in a simple and primal He went on to college at Oxford, where he took His Wife for a Hat to Musicophilia, from way — to see all of nature as alive and sea urchins. In being himself, following his first encountered his literary mentor, W.H. An Anthropologist from Mars to Hallucina- interesting and intersecting. Jewish in heri- heart, exposing his feelings and thoughts, Auden. After medical school at Oxford tions, he created a remarkable neuroliterary tage, his religion was science. His passions he made this world richer and more special. and an internship at Middlesex Hospital in legacy. In addition, he published more than were endless — from eating fresh herring The legacy of a man is impossible for London, Sacks came to America with his 50 papers and letters in the mainstream and smoked salmon — to venerating colors, his friends and contemporaries to measure. motorcycle. Shortly after arriving, he sent academic literature. His detailed case stud- such as indigo and orange, and life’s cre- Yet for Sacks, it is a safe bet that his writings his parents a one-word telegram, “Stay- ies — from achromatopsia to temporal lobe ations, from lemurs and ferns to cycads and see OLIVER SACKS, page 13

BOOK REVIEW Palliative Care in Amyotrophic Lateral Sclerosis: From Diagnosis to Bereavement, 3rd Edition Ed. David Oliver, Gian Domenico, of patients with ALS and their families, information (“90% [of patients with ALS] Wendy Johnston from diagnosis to death. are able to die peacefully”) and detailed New York: Oxford University Press For many patients, the journey with descriptions of the variety of approaches 326 Pages, with index ALS begins at diagnosis, and this is the to deal with the problems facing this BY COLIN QUINN, MD focus of the opening chapter. As there patient population. The tone is non- is not yet a distinct biomarker for ALS, judgemental and inclusive of a variety othing we can do.” This is a exclusion of other conditions is a critical of points of view, particularly regarding commonly used phrase when part of the diagnostic approach, and is physician-assisted suicide and comple- “N discussing the management of well described here. Up-to-date informa- mentary and alternative medicines. amyotrophic lateral sclerosis with tion regarding new genes associated with The chapters are written by authors recently diagnosed patients. It is often ALS and new understandings of the pa- with a depth and breadth of experiences uttered at a time when patients are at thology behind ALS are briefly discussed. on particular topics. This is demon- Dysphagia), scopolamine is the first their most vulnerable. They have just The chapters which immediately strated by a clear understanding of the medication listed as a potential in- discovered they have a relentlessly pro- follow include an honest and data-driven variety of challenges facing patients and tervention for sialorrhea, however in gressive neurodegenerative disease and discussion covering both the purpose and the pros and pitfalls of interventions. Chapter 9 (Pain, Psychological distress simultaneously they are left with the challenges in delivering palliative care to One minor criticism of this multiple- and Other Symptoms), scopolamine is impression that they are on their own ALS patients and an approach to break- author approach is that there is often not mentioned at all. because there is “nothing we can do.” ing the news of an ALS diagnosis. overlap between chapters and, at times, This one minor critique aside, this In more than 20 concise and The subsequent chapters are devoted this means that the information in one should be required reading for anyone thoughtful chapters, Palliative Care in to a wide range of specific issues regard- portion of the book maybe somewhat involved in the management of pa- Amyotrophic Lateral Sclerosis provides ing the needs of patients, from fronto- inconsistent or incomplete when com- tients with this ALS. While there may an excellent guide for clinicians and temporal dementia to frozen shoulder. pared to another section. For example. be no cure for this disease, there is a patients regarding the particular needs All chapters provide clinically relevant in Chapter 7 (Control of Symptoms: great deal we can do. • 6 WWW.WFNEUROLOGY.ORG • JANUARY 2016 Global Neurology: Lessons Learned From Cambodia

BY SOMA SAHAI-SRIVASTAVA, MD With the help of an educational two-year ambodia is a Southeast Asian coun- grant award from the WFN, a neurology try of 15 million people with a per outreach program for Cambodian health Ccapita an- care professionals was convened July 25– nual income of Aug. 10, 2015, in Cambodia. $1,080. For 100 Our first goal was the development of years until 1953, appropriate undergraduate and residency it was a French neurology curriculum in collaboration colony, followed with the only government academic by formation medical center, the University of Health of a kingdom. Sciences (UHS), which sets the curricu- In 1970, civil lum for undergraduate and postgraduate war led to the education in Cambodia for all academic rise of Pol Pot institutions. We met with educational Soma Sahai-Srivastava and his Khmer leaders and reviewed the current curricu- Residents at the University of Health Sciences undergo a two-week hands-on session covering Rouge communist agenda, a classless lum, especially in context of a standard internal medicine, psychiatry and neurosurgery. society with no economy. Under Pol Western neurology curriculum. Chal- Pot (1975–1979), the educated class was lenges to establishing a standard neuro- Teaching rounds were held for a neu- health care professionals. targeted, and 2 million to 3 million Cam- science curriculum were identified and rology inpatient team comprising inter- Some of the lessons learned during bodians were executed. Only a handful included lack of cadaver training and neu- nal medicine residents and faculty from our trip: of doctors remained, as many died or left roanatomists in Cambodia. We decided several hospitals, including Calmette 1. Barriers to global neurology in devel- the country. to establish of two neurology teaching Hospital, Kossamak Hospital and Khmer oping countries include lack of an or- In my many trips to Cambodia in the modules for their Train-the-Trainers Soviet Friendship Hospital in Phnom ganized clinical setup for patient care. last decade as a solo volunteer, I real- program— a basic neurosciences module Penh. In addition, we visited the Chil- 2. It is important to understand the cur- ized there are no short-term volunteer and a clinical neurology module. dren’s and Adolescent Mental Health Re- rent state of neuroscience curriculum opportunities for neurology clinical Our second goal was to provide work- ferral Center at Chey Chumneas Hospital to determine the needs. care, unlike other specialties, such as shops on basic clinical neurology skills to in the Takhamu-Kandal Province, where 3. Often one needs to return to the draw- emergency medicine, pediatrics and health care professionals in all the major we held a half- day seminar and hands- ing board with basic neuroscience. surgery. No neurology outpatient clinics cities in Cambodia. We conducted a two- on teaching session on neurological 4. Initiate clinical education of existing or inpatient specialized programs existed week hands-on session for 50 residents at examination along with distribution of medical docs (our focus: psychiatry, until recently. There were only three neu- UHS in Phnom Penh, covering internal neurology tool kits. In the beautiful co- internal medicine and neurosurgery). rologists in the country reported in 2012 medicine, psychiatry and neurosurgery. lonial city of Battambang, we conducted 5. Developing many levels of peer-to-peer (Loo, 2012). Currently there is no adult or Tools used for these seminars included teaching rounds in the outpatient clinic relationships improves networking pediatric neurology residency program. PowerPoint presentations, a brain model over two consecutive days for children up and learning (e.g., resident to resident, Pediatric patients with epilepsy, autism for basic neuroanatomy, a neurological to 18 years with neurological disorders, faculty to faculty). or developmental disorders are treated examination video, neurology tool kits including epilepsy and developmental We will return to Cambodia in June in a tertiary care mental health clinic by for neurological examination, and pre- disorders. This program was held at the 2016 for two weeks with the following psychiatrists. The first internal medicine test and post-test outcome evaluations. Outpatient Free Clinic of the Battambang objectives: residency program launched in 2011. We produced a video on neurological Catholic Church. We also trained physio- 1. To provide an additional year of con- I realized that our first priority was examination and used brain models as a therapists in the department of physio- tinuity to our neurology basic train- clinical education and curriculum devel- teaching tool. Fifty neurology tool kits therapy on basic neurological skills. ing program and provide neurology opment rather than patient care, since were distributed to the residents, the We then traveled to Siem Reap, where toolkits for Cambodian health care neuroscience education at all levels — contents of which included a Snellen eye we met with the Deputy Director of the professionals. undergraduate, medical school and post- chart, penlight, dermatome chart, tongue Apsara Authority, the government agency 2. To train Cambodian neurology trainers graduate — is lacking in modern Cambo- blade, reflex hammer, tuning fork and that supervises all national monuments in two neurology modules: basic and dia. There are only four pathologists in pins. We also taught at the University of and will be setting up future workshops clinical neurosciences. the country; none are neuropathologists. Puthisastra, where 150 medical students at the 400-square-kilometer Angkor Heri- 3. To establish and deliver the first neurol- Anatomy teaching does not include 3-D received three days of neurology educa- tage Complex (one of the seven ancient ogy skill lab for international program models or cadaver or animal dissection. tion. wonders of the world) in Siem Reap for students at UHS. 4. To establish and deliver a revised curriculum and course syllabus design for a neurology module undergraduate medical students. 5. To develop curriculum for neurology residency training, with the goal of assisting in readiness in establishing the first residency program in the fall of 2016. 6. To develop culturally, geographically and medically relevant assessment exercises that include formative assessment (i.e., pre-test, post-test) and summative exams with rating scores that are consistent with learning objectives.•

Soma Sahai-Srivastava, MD, is associate professor of neurology, medical director of the neurology clinics, and director of the Headache Center at the University of Southern California, Los Angeles. At the University of Puthisastra, medical students take part in three days of neurology education. WWW.WFNEUROLOGY.ORG • JANUARY 2016 7 Fellowship Awardee from India Presents Research

udip Paul, assistant professor, analysis in the living system. department of biomedical engineer- “I was so much benefited in the form Sing, North-Eastern Hill University of exposure to my research field, which (NEHU), Shillong, India, was given the provided me with an opportunity to opportunity to present his research as learn about different aspects of brain a poster presentation. He presented signal acquisition and its interpreta- “Wavelet-Based Analysis as a Tool to tion to derive a fruitful result from the Evaluate the Degree of Neuronal Insult experimentation. This also provided me in Animal Model of Ischemic Stroke” with a platform to be exposed to the at the 45th Annual Meeting of Society cutting-edge advancement in the field of for Neuroscience Conference, held Oct. neuroscience,” he said. 17–21, 2015. He was awarded the Junior Paul, who interacted with stalwart Traveling Fellowship 2015 by the World scientists working in this area, added that Federation of Neurology (WFN) with an he was thankful to the NEHU adminis- amount of GBP 1000 toward his travel to tration and departmental faculty mem- Sudip Paul’s poster investigation looks at Sudip Paul, WFN Junior Traveling Fellowship the United States. bers for their support and especially to “Wavelet-Based Analysis as a Tool to Evalu- awardee, travels to the 45th Annual Meeting Paul works in the field of electrophys- Dr. Tapas Kumar Sinha and the constant ate the Degree of Neuronal Insult in Animal of the Society of Neuroscience in Chicago to iology and is concerned with brain signal research activity provided by him. • Model of Ischemic Stroke.” present his research.

Editor’s Update and Selected Articles from the Journal of the Neurological Sciences

BY JOHN D. ENGLAND, MD EDITOR-IN-CHIEF In our ongoing attempt to enhance Signature of circulating miR-150-5p Understanding how miRNA expres- accessibility of JNS articles to members and miR-21-5p in Myasthenia Gravis sion is altered in various diseases is ollowing the advice of the Editorial of the World Federation of Neurology, Patients,” J.Neurol.Sci. 356 (2015) an important and evolving area of Board members for the Journal of we have selected two more free-access 90-96. research. Their study should result in Fthe Neurological Sciences (JNS), we articles, which are profiled in this issue 2. In an accompanying editorial, Fredrik important new insights into disease have reorganized the contents index of World Neurology. Piehl and Maja Jagodic explain what mechanisms and perhaps lead to for each issue. This has been done to 1. Anna Rostedt Punga, et al. from microRNAs do and comment on new avenues of treatment. F. Piehl, enhance perusal of the contents by the department of neuroscience in their potential as novel biological M. Jagodic, “MicroRNAs as Promis- readers of the journal. Uppsala, Sweden, summarize data markers and drug targets for inflam- ing Novel Biomarkers and Potential The contents are now organized from 71 patients with autoimmune matory neurological diseases. This Drug Targets for Inflammatory into orderly myasthenia gravis patients, which short paper provides an excellent Neurological Diseases,” J. Neurol. section head- suggest that the immuno-microRNAs primer on microRNAs. As the Sci. 356 (2015) 3-4. • ings of miR-150-5p and miR-21-5p are a authors summarize, miRNAs are Editorials, biological marker for the disease. important regulators of biological John D. England, MD, is editor-in-chief of the Reviews, They compared sera from 71 patients processes and are the most abundant Journal of the Neurological Sciences. Original Ar- with myasthenia gravis, 23 patients class of gene regulatory molecules. ticles, Short with other autoimmune disorders Communica- and 55 healthy controls. The levels tions, Letters of miR-150-5p and miR-21-5p were to the Editor significantly elevated in the sera from and Book patients with myasthenia gravis com- John D. England Reviews. We pared to both healthy controls and still welcome unique and informative patients with other autoimmune dis- case reports, but most of these are now eases. Additionally, both of these mi- published as Letters to the Editor. croRNAs were significantly reduced Additionally, we have reserved space in the patients with myasthenia gra- for a President’s Column, which is writ- vis on immunosuppressive medica- ten by the president of the World Fed- tions compared to the patients with eration of Neurology. The inaugural myasthenia gravis who were not on President’s Column, entitled “Neurode- immunosuppressive medications. If generative Noncommunicable Diseases corroborated by additional studies, (Neurology NCDs). Where are we this report suggests that circulating now?” by President Raad Shakir, was miR-150-5p and miR-21-5p may be a published in the Sept. 15, 2015, issue disease-specific biological marker for of JNS. Of course, all of these articles autoimmune myasthenia gravis. A.R. are accessible with the online version Punga, M. Andersson, M. Alimoham- of JNS. madi, T. Punga, “Disease Specific 8 WWW.WFNEUROLOGY.ORG • JANUARY 2016

neurones in this concept. WORLD CONGRESS 2. Victor and Clara Soriano Award Lec- Prof. Kazuo Fujihara continued from page 1 ture: Prof. Mark Hallett, “The Physiol- from Sendai, Japan, reviewed ogy of Will” the current state of under- a WHO Symposium. A former gastroen- 3. The Fulton Society Symposium-Soriano standing of neuromyelitis terologist, his opening address was replete Award Lecture: Prof. Giacomo Riz- optica spectrum disorders, with illustrative and amusing anecdotes. zolatti, “The Mirror Mechanism and Its highlighted the relatively Importantly, he highlighted the lack of Clinical Relevance” uniform worldwide preva- neurologists as evidenced in the upcoming 4. Bharucha Award Lecture: Prof. Richard lence of this condition, the latest edition of the Atlas of Neurology (a Hughes, “Guillain-Barré Syndrome and recently published Consensus joint WHO and WFN initiative), and the CIDP: One disease or Many?” Diagnostic Criteria and the WHO Action Plan 2013–2017 concentrat- The World Federation of Neurology increasing role of AQP4 se- ing on noncommunicable diseases. Dr also presented medals to two distinguished ropositivity in the diagnosis. Chestnov drew attention to the following World Health Organization (WHO) Assistant Director-General recipients. The first was for Service to Neu- Prof. Alan Thompson, of points. of Noncommunicable Diseases and Mental Health Oleg rology and was presented to Dr. Michel Chestnov leads a WHO symposium. the University College Lon- 1. Epilepsy is now a WHO Assembly Dumas for services to the development of don, gave an impeccably bal- agenda item where the goals are to neurology in Africa and elsewhere. The monogenic loci for familial hemiplegic anced update on the current strengthen effective leadership, improve second was awarded to Prof. Shoji Tsuji migraine. He contrasted this with the 42 state of research and treatment, the global provisioning of care, integrate epilepsy of Japan for scientific achievements in loci identified in the International Head- initiative in progressive multiple sclerosis into primary health care services and neurology. Dr. Gallo Diop, WFN trustee, ache Genetics Consortium Genome-Wide and the recent report of the first large-scale increase access to medications. and Prof. Roger Rosenberg, University of Association Study in common migraine, phase III trial of early anti B-cell treatment 2. It is estimated that in 2015, 47 million Texas Southwestern, read the citations, nine of which also affect gastrointestinal to modify the disease course. people globally have dementia, and this respectively. tract musculature. In reviewing treatment, Prof. Thomas Südhof, 2013 Nobel figure will double every 20 years. The he lamented the lack of medications to laureate in physiology or medicine, treated global cost in 2010 was estimated at Social Event Program and WFN reduce migraine aura, especially tonaber- delegates to an enthralling lecture on $US604 billion. Business sat because of “Neurexins and 3. Finally, he acknowledged the impor- The welcome reception was held im- the high cost the Company: Towards tance of the First Ministerial Confer- mediately after the opening ceremony and effectiveness of a Molecular Logic ence on Global Action Against Demen- was well attended. The Chilean network- the angiotensin-II The scientific program was of Neural Circuits,” tia held earlier this year. ing event was held out of the city at a receptor antago- describing their This important plenary session was by all accounts one of the well-known winery and was enjoyed by nist candesartan role in the function completed by an authoritative review by the participants, after they recovered from as prophylactic, highlights of the meeting. and dysfunction of Prof. Ingrid Scheffer of Melbourne, Austra- the long bus ride inflicted by the Santiago the need for cal- neural networks lia, describing how genetics is influencing Throughout, there were superb evening traffic rush. cium gene related in schizophrenia, the management of epilepsy. At the World Federation of Neurology peptide monoclo- plenary lectures and symposia autism and intel- The scientific program was by all Council of Delegates meeting held Nov. nal antibodies for lectual disability. accounts one of the highlights of the 1, a number or reports were presented, chronic migraine on all major neurological topics, On the last day, meeting. Throughout, there were superb elections held and votes taken. Among and the develop- the final Tourna- plenary lectures and symposia on all major providing clear insight into the these was the tightest decision for a WCN ment of headache ment of the Minds neurological topics, providing clear insight venue so far. For the XXIV World Congress centers to hasten robust pursuit of knowledge of was held. The final into the robust pursuit of knowledge of of Neurology in 2019, Dubai triumphed research and its teams buzzed in for basic science and its translation to clinical basic science and its translation with the slimmest of margins over Cape translation to their first right to practice. It is only possible to mention a Town. Either would have been a fitting site clinical care. to clinical practice. answer to a ques- few of these. for the XXIV World Congress of Neurol- Profs. Michael tion with a penalty Prof. Charlotte Cordonnier of Lille, ogy, a likely reason for the closeness of the Brainin, Geoffrey for an incorrect France, addressed the vexatious issue of ce- final result. Dr. Richard Stark was elected Donnan and Nick answer. It was rebral microhemorrhages and their relation to the new position of treasurer allowing Ward gave an contested by the to amyloid angiopathy, their management Prof. Wolfgang Grisold to have more time overview of the long-term perspective in United Kingdom, Australia and Japan, and and risks with current stroke prophylaxis. for the secretary general’s role. Dr. Morris stroke, tackling early diagnosis, secondary finished in that order. Congratulations to Their investigation with the use of 7T Tesla Freidman of Canada defeated an excep- prevention and brain recovery in a high- the United Kingdom team, to define stroke risk and new prospective class exposition, respectively. which finished well ahead studies defined lesser risks from ischaemic Prof. Neil Scolding’s thoughtful and of the scheduled time for prophylaxis therapy for certain defined practical lecture on the role of cell therapy the completion of this ses- stratified groups. in central nervous system disorders was sion. The tournaments was Prof. Jes Olesen in presenting the Yahr a useful update in this much-anticipated followed by the closing cer- Award Lecture reviewed the current state therapeutic approach. Prof. John Stokes emony with the presentation of headache research and treatment, lecture on the identification and manage- of a gavel to Prof. Yoshikazu describing the new version of the Inter- ment of functional disorders also was a (Kaz) Ugawa, President of national Headache Classification, to be well-received review of the current state of the XXIII World Congress incorporated in ICD11, and then aspects this sometimes difficult to manage topic. of Neurology, from the of migraine. He drew attention to three This theme also was the basis for the excel- XXII World Congress of lent review given by Prof. Neurology President Renato Mark Hallett of the National Verdugo, in order to have Institutes of Health during the 2017 Congress called to Prof. Shoji Tsuji receives recognition for scientific the Victor and Clara Soriano order. achievements from WFN President Raad Shakir. Award Lecture. His talk combined the electrophysi- tional field of candidates for the position ological study of motor acts Summary of elected trustee. The WFN wishes these with the psychology of the A total of 272 oral lectures, and 36 teach- new members of its executive team an perception of functional and ing courses with three or four lectures enjoyable and productive term. normal movements. Prof. each were presented; 1,230 posters were An issue, which arose and caused the Giacomo Rizzolatti updated displayed from 1,668 abstracts, and there trustees and organizers considerable con- the conference on mirror were five satellite symposia. cern, was the procurement of visas for the mechanisms and their clini- There were four named lectures: Chile World Congress of Neurology. Many 2013 Nobel Laureate in Physiology and Medicine cal relevance together with 1. Yahr Award Lecture: Prof. Jes Olesen, delegates were forced to go to extreme Prof. Thomas Südhof presents a lecture on neurexins. the essential role of mirror “New Concepts in headache” see WORLD CONGRESS, page 9 WWW.WFNEUROLOGY.ORG • JANUARY 2016 9

WORLD CONGRESS BRAIN HEALTH emphasized in a joint presentation by Dr. maximize lifelong brain health — and that continued from page 1 Gisela Kobelt and Professor Helmut Butz- real-world registry data should be gener- continued from page 8 kueven, who examined MS from economic ated and used to test whether this is the lengths to obtain a visa. A number brain health perspective on MS, present- and real-world perspectives. Dr Kobelt case (see Fig. 1). were unable to complete this, and even ing recent data underpinning its scientific presented some of her own economic data Summing up, Symposium Chair some of those who did obtain a visa basis. People with relapsing–remitting MS demonstrating that the greatest effects Giovannoni stated: “I’d like every clinician, were restricted to the duration of the can lose brain volume up to seven times of the disease on employment occur at every health care professional, to think that 7 Congress. The Council of Delegates faster on average than age-matched con- relatively low levels of physical disability. someone with MS is giving us their brain recognized the difficult circumstances trols, according to a 2015 meta-analysis of Professor Butzkueven concurred, and re- to protect. It’s our responsibility to make 1 members of many national societies clinical trials. Up to a point, this damage ferred to results from a recent study show- sure that they get to old age with a healthy found themselves in as a consequence can be compensated for by neurologi- ing that people with cognitive impairment brain, so that they can withstand the rav- of the large flows of migrants in many cal reserve — the brain’s finite capacity at diagnosis were three times more likely ages of aging. As a treatment philosophy, parts of the world. In the future, the to reroute signals or adapt undamaged to reach a Kurtzke Expanded Disability it’s as simple as that.” 2,3 World Federation of Neurology hopes areas to take on new functions. Preserv- Status Scale score of 4.0 and twice as likely Health care professionals who believe not only to have those bidding for ing neurological reserve protects against to develop secondary progressive MS 10 in this treatment philosophy are invited to 4 8 future venues to declare freedom from cognitive decline and years after diagnosis. pledge their commitment to embrace the restricted access to them, but also to physical disability This underscores the recommendations of the report. Down- 5 identify and forewarn delegates of any progression in peo- importance of the re- load the full report. • practical difficulties they may encoun- ple with MS. Once port’s recommendation ter. These items will be placed on the neurological reserve of aiming to alter the References website well before each upcoming is exhausted, how- disease course through 1. Vollmer T et al. J Neurol Sci, 357 (2015):8-18. World Congress of Neurology. ever, the long-term lifestyle measures and 2. Rocca MA et al. Neuroimage, 18 (2003):847- Finally, at the Trustees Meeting progressive phase of early treatment with 55. held during the XXII World Congress the disease will be a disease-modifying 3. Rocca MA, Filippi M. J Neuroimagin;17 Suppl of Neurology, the suggestion made unmasked, Vollmer therapy. 1 (2007):s36–41. at the Kyoto site visit in September argued. Adopting a Improved treatment 4. Sumowski JF et al. Neurolog, 80 (2013):2186- 2015 to restrict the number of faculty therapeutic strategy access will ultimately 93. members to just more than 200 was that preserves neu- come from demonstra- 5. Schwartz CE et al. Arch Phys Med Rehabil, 94 endorsed with twin aims. The first was rological reserve by tions of cost-effective- (2013):1971-81. to control the cost of the World Con- minimizing disease ness. Assessing the dif- 6. Rieckmann P et al. Mult Scler Relat Disor, 4 gress of Neurology, but also to move activity therefore ference that treatment (2015):202-18. to full funding of faculty members. should be of primary makes to long-term 7. Kobelt G et al. J Neurol Neurosurg Psychiatr, The World Federation of Neurology concern when people health and economic 77 (2006):918-26. recognizes that the best calibre lectur- with MS and their clinicians make treat- burden is of vital importance in a chronic 8. Moccia M et al. Mult Scler (2015): ers are in a competitive environment ment decisions. progressive disease. To date, however, doi:10.1177/1352458515599075. and that it must make the invitation Shared decision-making relies on edu- long-term economic evaluations largely 9. Spelman T et al. Ann Clin Transl Neuro, 2 to the World Congress of Neurology cation. People with MS need to understand have been based on models owing to a lack (2015):373-87. most desirable. the potential long-term effects of the of data, explained Dr. Kobelt. disease as early as possible after diagnosis, By monitoring disease activity and Gavin Giovannoni, MD, provided this piece on be- stressed George Pepper. As co-founder of recording data in registries, health care half of the MS Brain Health Steering Committee. the patient forum Shift.ms, Pepper stated professionals can generate robust real- that engaging people with MS in their own world evidence that can be used to inform Acknowledgement health care could be “the blockbuster drug individual treatment decisions. Butzkueven Independent writing and editing assistance of the 21st century.”6 He concluded by demonstrated the power of registry data for the preparation of this article was encouraging health care professionals to to compare the effectiveness of different provided by Oxford PharmaGenesis, Ox- help people with MS to take active roles in disease-modifying therapies in propensity- ford, UK, funded by grants from AbbVie treatment decisions and disease manage- matched people with MS.9 The overall and Genzyme and by educational grants ment, starting at the time of diagnosis. conclusion was that the biggest change in from Biogen, F. Hoffmann-La Roche and Early intervention is vital, in order long-term health and economic outcomes Novartis, all of whom had no influence on to preserve cognitive function. This was could come from targeted intervention to the content.

Delegates gather to share ideas during the Congress. CALL FOR SUBMISSIONS Conclusion As the curtain closes on the XXII Special Issue on ‘Neurological Diseases in South America’ World Congress of Neurology in Santiago, Chile, we should remember his is a call for submissions of pa- peer reviewed and selected for publication of Neurology, Medical University of the spirit of giving so generously pers to a forthcoming special issue based on scientific merit, novelty, timeliness South Carolina displayed by the Chilean society, the T of eNeurologicalSci (eNS) on “Neu- and topical balance. high level of educational endeavor, rological Diseases in South America,” Before submission, authors should Special Issue Guest Editors the friendships made and renewed, which will be published in July 2016. carefully read over the journal’s Author Paulo Caramelli, Universidade Federal and the scientific, topical and cultural The guest editors of this issue welcome Guidelines. de Minas Gerais, Belo Horizonte, MG, discussions that are part of the intan- submissions of original manuscripts Prospective authors should submit Brazil gible benefits we and our colleagues and reviews that deal with basic, clinical an electronic copy of their complete Adriana Conforto, Hospital das Clini- derive from the World Congress of and epidemiological studies addressing manuscript through the journal Manuscript cas/Sao Paulo University and Hospital Is- Neurology as we look forward to the research on neurological disorders in Tracking System. raelita Albert Einstein, Sao Paulo, Brazil XXIII World Congress of Neurology South America. For more information, visit the Renato J. Verdugo, Faculty of Medi- in Kyoto in 2017. • In particular, we invite research focus- website. cine, Clinica Alemana-Universidad del ing on regional specific features related Desarrollo, Santiago, Chile William M. Carroll, MD, is WFN First to epidemiology, diagnosis, clinical Editor-in-Chief Ricardo Allegri, Neurological Vice President and Chair of the Congress manifestations, and treatment strategies Bruce Ovbiagele, MD, MSc, FRCP (Lon- Research Institute Raúl Carrea, Buenos Committee. and outcomes. All submissions will be don), FAAN, Pihl Professor and Chairman Aires, Argentina • 10 WWW.WFNEUROLOGY.ORG • JANUARY 2016 European ‘Wanderjahr’: Postgraduate Training in Nervous Diseases for Americans in the 1880s

BY PETER J. KOEHLER “Medical students constitute the only physicians, who visited German-speaking • Social Prestige class of students who in any considerable countries between 1870 and 1914. The • Ideology of Progress number follow the good old German custom American medical historian Thomas Nev- • Influence of Public, etc. of supplementing their regular course of study ille Bonner (1923–2003) stated that in this (Lehrjahre) by a season of travel (Wander- period, over 10,000 American physicians A Guide for Medical Students in jahre) for the purpose of seeing how people in studied in Vienna, where some of the Europe other places perform that work which is to oc- courses were given in English. He called it In this issue, I wish to discuss a particular cupy the remainder of their lives.” — Henry “the German magnet” and noted that “at book that was published to help American Hun, 1883 least a third and perhaps a half of the best students and physicians finding their way known men (and women) in American in Europe, notably Henry Hun’s Guide to ince 2010, we have published a medicine of this era received some part of American Medical Students in Europe (1883). number of short papers on interna- their training in a German (or Austrian) Henry Hun (1854–1924) was a lecturer on S tional relationships and exchange in university: (Bonner, p.23). diseases of the nervous system at the Al- the neurological The well-known American internist bany Medical College. His father, Thomas Theodore Meynert community. It William Henry Welch, one of the found- Hun, one of the founders of this college, is of interest to ing professors of Johns Hopkins Medical stayed in Europe for his postgraduate especially to Germany. The reason for note that the School, opined that it was “conventional studies for six years (1830s), and although this is not difficult to understand. In our leading centers Mecca of American practitioners” and ad- professor of the Institutes of Medicine, he large cities, and especially in New York, of medical edu- vised to “stick to Germany, where I find all gave lectures on the nervous system (in a there are certain clinics and opportunities cation changed the opportunities for learning pathology period before specialization in neurology of study that are probably unsurpassed over the past which I could desire.” started). Henry’s in the world. But there is, undoubtedly, centuries and It is of no surprise older brother Ed- no place where a student can attend so thereby ad- that American medi- ward (1842–1890) many excellent clinics with so little loss vanced interna- cal education was became chair of of time, or where he can so well train his tional exchange. Thomas Neville Bonner influenced by return- diseases of the eyes and hands in methods of diagnosis Italian (Padua) (1923–2003) ing physicians. Johns nervous system and treatment, as in Vienna; while, if he is and French (Paris, Montpellier) universi- Hopkins University in Albany and less anxious for clinical study, and wishes ties were popular in the 16th and 17th Medical School was was among the to train himself in laboratory work and centuries. Leiden (the Netherlands with organized accord- original members methods, he can nowhere accomplish this Boerhaave and Albinus) became popu- ing to the German of the American so well as in Germany (Hun, p.1-2). lar in the early 18th century, and later, model. In this period Neurological As- during that century, the center moved to of increasing special- sociation, Which Expenses, language and cultural Edinburgh (with Whytt, Cullen and the ization in medicine, was founded in activities Monros). Then, in the beginning of the it was important for 1875. Following The Guide offered all kind of information, 19th century, it was clearly Paris that, fol- physicians to improve graduation from including the expenses to be expected. “By lowing the revolution, became a center of their knowledge in Harvard Medical exercising the very strictest economy, a integrated medicine and surgery, attract- Europe. School, Henry medical student could study in Germany ing foreign students. As improvement Hun followed for a year (one semester being spent in Of particular interest in the second of medical practice postgraduate Vienna, the other in a smaller town) for half of the 19th century is the great was considered more courses in several between $700 and $800.” As for Berlin: number of foreign (American, Russian, important than European cities for ‘The cost of living in the best pensions Japanese, Scandinavian, etc.) students and research, smaller Henry Hun over two years. He varies from 120 to 200 marks ($30 to $50) numbers of (mostly became profes- per month” (Hun, p.35). And of course, younger) Americans visited other German sor of diseases of the nervous system at the language needed consideration. “Even universities, including Leipzig (Carl Lud- Albany in 1884. In the preface to his Guide, though the student has a fair knowledge wig), Heidelberg, Breslau and Strasburg, he noted that “Every year, a large number of the German language, and can read with the purpose to do scientific work. of Americans go to Europe to complete see WANDERJAHR, page 11 Although a minority, the latter persons their medical studies. Unfortunately the were important for the origin of medical great majority of these students have research in the U.S. The majority went for very little definite information about the postgraduate training, in particular for im- different universities or about the way in proving skills in a clinical specialty. Some which medicine is taught abroad, and on of the courses were organized to train the this account they lose much valuable time practical use of the ophthalmoscope, mi- in getting to work.” The book has 151 croscope, laryngoscope and stethoscope. pages, and, although we know he himself In April 2011, I discussed the European visited Vienna, Heidelberg, Berlin, Paris peregrination of Bernard Sachs between and London, most of the book is on Ger- 1878 and 1884. man (speaking) universities and hospitals. As he did not visit all places described in Features of Specialization in the book himself, he received information Medicine/Neurology from colleagues, acknowledging them in • Education/Medical Curriculum the preface: “For a large part of the infor- • Neurological Practice/Special Hospitals mation in the book, I am indebted to the • Instruments kindness of many friends.” He admitted • University Chairs that some American centers provide good • Societies opportunities too. • Journals/Monographs Some students go to New York or the Henry Hun’s Guide to American Medical • Success of Specialization Determined by: other large cities of America, but by far Students in Europe • Economic Reward the greater number go to Europe, and Wilhelm Erb WWW.WFNEUROLOGY.ORG • JANUARY 2016 11

WANDERJAHR of electricity in diagnosis and treatment “Prof. Friedreich used to hold an excellent Oppenheim, Edinger (Dejerine, Gowers) continued from page 10 was given by Martin Bernhardt (of the medical clinic. He visited the wards daily • Switzerland Bernhardt-Roth syndrome, a.k.a. meralgia with the students. He assigned cases to • Monakow -> Gudden it without much difficulty, he will find it paresthetica) and Ernst Julius Remak (son the students and criticized their examina- Russia greatly to his advantage to live in a Ger- of Robert Remak). Hun expressed mixed tions. He also gave systematic lectures on • Kozhevnikov -> Germany man family for a couple of months, and to feelings about the course of nervous the theory and practice of medicine. His • Korsakow -> Meynert work at the language before he commenc- disease by Carl Wernicke. They were successor, Prof. Erb, will probably conduct • Sechenov -> MD in Vienna, Helmholtz, es to attend lectures.” However, he noted “very good, but rather abstruse lectures the clinic in the same way, and will doubt- Du Bois-Reymond, Ludwig “the majority of the instructors can speak on the general principles of nervous less devote much time to the discussion of • Bekhterev -> Flechsig (Leipzig), Du Bois- English more or less perfectly.” He even diseases, without much regard to any nervous diseases’. Reymond, Meynert, Westphal, Charcot, paid attention to the cultural activities, special diseases. He does not show many French and English centers only form Wundt such as art and music. “If Munich or Dres- patients.” He also mentioned the lectures a small part of Hun’s book. Various Paris • Pavlov -> Ludwig (Leipzig), Heidenhain den be selected as the cities in which to given by Carl Westphal, demonstrating hospitals are described, but for nervous (Breslau) learn German, the spare hours of the day that psychiatric and diseases the Sweden may be devoted to the picture galleries,” nervous diseases at Salpêtrière was • Henschen -> Ludwig and Cohnheim and “the Germans are a very music-loving most German univer- mentioned not- • England people, and if the student is interested in sities were still taught Every year, a large number of ing that “Prof. • Sherrington -> Goltz music he can combine the study of that as one discipline. Americans go to Europe to Charcot was last • Head -> Ewald Hering (Prague) branch with the study of German.” On the first two complete their medical studies. year appointed Italy days, he shows insane professor of • Luciani -> Leipzig Neuroanatomy and Nervous patients. Pn the last Unfortunately the great nervous diseases, Holland Diseases day, he shows patients majority of these students have and this year he • Ariëns Kappers -> Edinger Most important of all, were his advises with nervous dis- will hold a clinic It is clear from the above that Ameri- about specialization and for the aim of ease. He devotes the very little definite information of diseases of the can neurology in the late 19th century this essay, neuroanatomy and nervous first part of each ex- about the different universities nervous system was influenced by European, in particular diseases will be discussed. With respect ercise to a systematic or about the way in which at the Salpêtrière German, knowledge in a high degree. to Vienna, he advised to go to the well- lecture, and, in the last on Thursday and Around the turn of the century, interest known neuroanatomist and psychiatrist part, he exhibits two medicine is taught abroad, Sunday.” In Lon- in American medical knowledge led to the Theodore Meynert. or three patients. Prof. and on this account they lose don, of course the start of migration in opposite direction. Prof. Meynert lectures every day, Westphal devotes him- National Hospital Several high-ranking German visitors, except Saturday, from 12 to 1. On three self rather to showing much valuable time in getting (for the paralyzed among whom neuroscientists, visited days, he gives systematic lectures on the the disease in its to work. and epileptic) was the U.S., including Ehrlich, Forel, Freud, functions of the brain and their disorders. clinical aspect than to mentioned includ- Helmholtz, These lectures are very interesting, but discussing the nature ing “Physicians, Hirschberg, Robert Koch, Carl Lud- very difficult to understand. Twice a week of the process tak- Dr. Ramskill, wig, Waldeyer, Sauerbruch and many he exhibits patients. On Saturday, from 10 ing place in the brain, and in this respect Radcliffe, Hughlings-Jackson and Buzzard; others would follow. • to 12, he demonstrates the anatomy of the the course is in decided contrast to that of physicians for outpatients, Drs. H. Charl- brain. He also allows students to work in Prof. Meynert in Vienna (Hun, p.44). ton Bastian, AY. R. Gowers, and D. Ferrier Further reading: his laboratory on the finer anatomy of the As for physiology, he, of course, Assistant Physicians, Drs. J. A. Ormerod • Bickel MH. Thomas N Bonner (1923– nervous system. His work and lectures are referred to the famous physiologist Emile and P. Horrocks.” 2003), medical historian. J Med Biogr, very interesting, but he is very irregular in du Bois-Reymond, who “gives experimen- (2014):Jul 1. his attendance (p.19). tal lectures on physiology, and he allows Well-known Scientists who Visited Bonner TN. American Doctors in “But the study of nervous diseases students to work in his physiological labo- European countries, German speaking in German Universities. Lincoln: Nebraska is not satisfactory in Vienna,” although ratory. He has a very handsome and well- particular University Press, 1963. Moriz Benedikt gave good courses on arranged lecture-room and laboratory.” • Moses Allen Starr: Erb, Meynert, Noth- • Hun H. Guide to American Medical electro-diagnosis and therapeutics. Hun Hun also referred to Hermann Munk. nagel (Charcot) Students in Europe. considered Berlin and Heidelberg (Fried- In Heidelberg Nikolaus Friedreich • James Jackson Putnam: von Rokitansky, • Lanska D. Henry Hun (1854–1924). reich, Erb) the most important universities (of the well-known hereditary ataxia) Meynert (H. Jackson) J Neurol Neurosurg Psychiatry,70 for nervous diseases. In Berlin the use and Wilhelm Erb were Hun’s favorites. • William Gibson Spiller: Obersteiner, (2001):349.

NEUROLOGY and lunch symposia, a CME, four break- continued from page 2 fast symposia, two guest lectures, four orations and 267 papers. who require such care. To cater to the tastes of trainee A unique solution to this paradox neurologists, a barbecue quiz — with an is to have neurologists who practice initial countrywide online round and a high-technology neurology provide final round during the conference — and a continuing education to neurologists clinic-pathological conference were other involved largely in community care. This hallmarks of the conference. allows the Academy to be self-sufficient Even as India needs many more neu- and caters to the educational needs of rologists, the number is increasing with all. The scientific program of IANCON 171 trained neurologists added each year. 2015 reflected the principle to ensure The scenario is certainly encouraging, as that public perception within the nation, the IAN is becoming a stronger constitu- as well as internationally, befitted. The ent of the World Federation of Neurol- distinguished guests included Shabana ogy, the support of which we gladly Azmi, a noted film actor and social acknowledge. • activist, and WFN President Prof. Raad Shakir, president, World Federation of Gagandeep Singh is IAN secretary, Arabinda Mukher- Neurology. jee is IAN president and Pardeep Kumar Maheshwari The Conference featured 14 breakfast is IANCON 2015 organizing secretary. WFN President Raad Shakir greets Shabana Azmi during the inaugural ceremony. 12 WWW.WFNEUROLOGY.ORG • JANUARY 2016 Teaching Courses Expand Education at WCN

Table 1: Teaching Courses BY WOLFGANG GRISOLD ties, are well appreciated by attendees. In Chile, 36 teaching courses were held. he WCN took place Oct. 31-Nov 5, The list (Table 1) shows the topics present- Session ID Topic 2015, at the CasaPiedra Conference ed, which helped to disseminate education- T Center in Santiago, Chile, with 3,500 al news and expert knowledge. Teaching RARE CASES IN CLINICAL PRACTICE TC 1 delegates from 112 countries participating courses offer attendees the advantage of (TOURNAMENT COMMITTEE) and creating a joint sense of neurology being in a smaller group and interacting TC 2 STROKE worldwide. The lectures from the World with renowned experts. This facilitates a Health Organization (WHO) and the climate of interaction by allowing questions TC 3 COMMON MISTAKES IN EEG READING presentation of the new WHO Atlas of Neu- and discussion of opinions. rology showed the disparity of neurological One special component of the WCN TC 4 NEUROREHABILITATION workforces around the world and docu- teaching courses are the early morning TC 5 CNS INFECTIONS mented the importance of the WFN activi- free teaching courses, a one-hour teaching ties in the work with global organizations. session presented by a single expert in the TC 6 HEADACHE One of the goals and aims of the WFN is to field. This expert has the privilege to create spread neurological development and neu- his or her talk in the form of a lecture, TC 7 EDUCATION IN NEUROLOGY YOUNG NEUROLOGIST — PROFESSIONAL TC 8 CAREER PLANNING TC 9 CHILD NEUROLOGY TC 10 CLINICAL NEUROPATHOLOGY TC 11 VIDEO SESSIONS SEIZURES SEMIOLOGY

NEUROPATHIC PAIN-ADVICE FOR CLINICAL TC 12 PRACTICE

TC 13 BOTULINUM TOXIN WORKSHOP

TC 14 NEUROIMMUNOLOGY AND MULTIPLE SCLEROSIS Cynthia L. Harden presents a morning teaching course on epilepsy. TC 15 NEUROLOGY AND PSYCHIATRIC BOUNDARIES TC 16 AUTOIMMUNE PERIPHERAL NERVES DISORDERS rological science and update participants deviating from the usually shorter teaching on current issues, but also to highlight new course lectures, and allowing the speaker TC 17 NEUROLOGY AND WOMEN neurological fields of development. to emphasize and shape the message that TC 18 AUTONOMIC NERVOUS SYSTEM Scientific sessions and topics are an he or she considers important. Despite the TC 19 DEMENTIA excellent venue and bring participants close early time of these teaching courses, the to the leading persons in the field. This number of participants was between 100 TC 20 PALATUCCI ADVOCACY concept was successfully used in plenary and 200 per course (and 339 for the topic TC 21 TRANSCRANIAL DOPPLER WORKSHOP lectures and scientific main topic sessions. of epilepsy). The topics included MS (95), TC 22 SINGLE FIBER ‘EMG’ WORKSHOP The WFN also has long kept the chronic inflammatory demyelinating poly- tradition of offering teaching courses at its neuropathy (125) and the top 10 advances in CAREERS IN NEUROLOGY IN A GLOBALIZING TC 23 Congress. This concept has been broadened neurology (95). WORLD since Marrakesh, as the WFN teaching Knowledge, skills and tutoring from MOVEMENT DISORDERS: EMERGING DIAGNOSTIC courses now are being offered on all days experienced lecturers cover many aspects TC 24 AND TREATMENT ASPECTS IN PARKINSON’S of the Congress. The teaching courses of neurology. The issue of palliative care is DISEASE AND RELATED DISORDERS were co-chaired by Sergio Castillio (local a topic with an increasing scientific basis1. TRANSCRANIAL MAGNETIC STIMULATION (TMS): committee, Chile) and Wolfgang Grisold Still palliative care is often confounded TC 25 BASIC MECHANISMS AND CLINICAL APPLICATION (teaching course committee, WFN). The with end of life care, or worse, a situation WORKSHOP 25 topics presented include many general and of helplessness. The WFN has established TC 26 PALLIATIVE CARE common topics, such as stroke, dementia, a Research Group on this topic, and the epilepsy and others. Teaching Course on palliative care was an TC 27 NEURO-ONCOLOGY Also, several courses with hands-on important step in establishing this impor- TC 28 NEURO-OPHTHALMOLOGY opportunities were offered to include and tant topic into our future curricula. TC 29 MOTOR NEURON DISEASE engage participants in practical issues, such All neurologists, working in any part of as EMG, ultrasound and botulinum toxin the world, also are aware of the importance TC 30 MUSCULAR DISORDERS treatment. Experience at the WCN in Mar- of training, lecturing and teaching, and also TC 31 NEUROLOGY IN THE EMERGENCY ROOM rakesh and Vienna has shown that these that the diversity of careers from hospital to TC 32 CURRENT MANAGEMENT OF EPILEPSY FREE types of highly interactive teaching courses, consultant level and from academic TC 33 NEUROMUSCULAR FREE despite often technical issues and difficul- see TEACHING COURSES, page 13 THE MODERN MANAGEMENT OF MULTIPLE TC 34 SCLEROSIS FREE THE TOP TEN ADVANCES IN CLINICAL NEUROLOGY TC 35 FREE TC 36 SLEEP DISORDERS

The free early morning teaching courses have remained the most visited teaching courses, despite the early hour. Teaching courses on education, advocacy and career received little attendance, yet these topics are inherent topics of the WFN. Also, palliative care received little attention as teaching courses. This shows that the topic needs promotion within the scientific sessions. All teaching courses will be available on the WFN website after the Congress. Dr. Freedman lectures on education. WWW.WFNEUROLOGY.ORG • JANUARY 2016 13

TEACHING COURSES The local flavor of Latin American patients from pediatric neurology into adult patients in the micro- and macro-environ- neurology was presented by Prof. Nitrini of neurology. Translation also has been well ment. This concept in neurology is carried continued from page 12 forward by the American Academy career to nonacademic career of Neurology (AAN) Palatucci is wide. For this reason, a courses in the United States, and the teaching course on education AAN and WFN implemented a joint in neurology covered the AAN-WFN one-day course in Chile. topics on how to establish a Topics on advocacy, press work and curriculum, as well as how to presentations were given to a small, integrate neurologic knowl- but soon to be powerful group. edge and procedures into the Also WFN President Raad Shakir national situation, politics and presented his concept of worldwide legislation. It is important to engagement of the WFN in health define new learning strate- Dr. Nitrini speaks on education in Latin America. Prof. Raad Shakir outlines the role of the WFN in the matters. gies and teaching methods, to Palatucci course. Last but not least, some of the eventually support or replace most important targets of educa- the traditional apprenticeship tion are patients and caregivers. model of neurologic educa- Despite the importance of these tion. Also the classic concept groups, patient awareness days are, of knowledge, skills and com- surprisingly, often not included in petence will need to include congresses. Since WCN 2015, the aspects of professionalism WFN implemented a patient day and attitude. Knowledge is into it congresses. This year’s topics acquired in an incremental, included stroke, epilepsy, MS and almost pyramidal way. Yet, dementia, and WFN Past President individuals and institutions Vladimir Hachinski served as conve- Several speakers and participants gather for a photo opp. A good turnout attends a day of programming. also will need to adapt to new nor and engaged in the discussion. • developments, and this pro- cedure of systemic approach to replace old Brazil, who outlined educational activities described in other fields of pediatrics and Footnote content or procedures is termed unlearning in Latin America. He discussed the rise of demonstrates a clash of concepts between 1. Oliver DJ, Borasio GD, Caraceni A, de One lecture by Dr. Freedman focused on impact factors among publications from different concepts of patient care and Visser M, Grisold W, Lorenzl S, Veronese the merging and growing possibilities of e- Latin America in the past years. involvement of careers. S, Voltz R. “A consensus review on the de- learning. He presented his own experience Within the topic of applied teaching Patient advocacy is an emerging con- velopment of palliative care for patients with video conferences worldwide and gave and education, translation was discussed by cept, which empowers physicians to not with chronic and progressive neurologi- important clues to enlarge the scope of this Prof. Camfield of Canada. This term de- only be involved in the provision of the cal disease.” Eur J Neurol. (Oct 1, 2015): project. scribes the often difficult transfer of young best medical care, but also to advocate for doi: 10.1111/ene.12889).

OLIVER SACKS with fern enthusiasts and lichen lovers, and and people and charting a course of caring. of barnacles while suffering a severe illness continued from page 5 with actors like Robin Williams, Dustin While I was in medical school research- with GI symptoms and headaches. Oliver Hoffman, and Robert De Niro. He loved ing Tourette syndrome, a pediatric neurolo- suffered migraine headaches and wrote his will instruct future generations on how to the herring mavens of Norway and Iceland gist told me I must read Awakenings — that first book precisely describing, analyzing and practice medicine, how to write honestly and Houston Street’s Russ and Daughters. it was the most informative and insightful organizing migraines. A few years later Dar- and boldly, how to see diversity and differ- Neurology owes a debt to Oliver Sacks. account of tics in the neurological litera- win published his major work, The Origin, ences as wondrous, how to live and how to He helped rudder the ship, which was ture. I was blown away. My doubts about and Oliver had his, Awakenings. Darwin was die. Ben Jonson gambled well and said that heading on a course of abstraction, of pin- what neurology could be dissolved. And my a London boy whose first major trip was to Shakespeare was “not of an age, but for all pointing the exact location of a problem understanding of what a physician could be sail around the South America on a boat; time.” Sacks was certainly not of our age in the nervous system, oft-times at the transformed. Oliver left London and flew across North — he loved fountain pens and paper, read expense of caring for patients. One of the greatest blessings in my life America on a motorcycle. Darwin loved the books and wrote letters, disliked talking on As a medical student in the 1980s, I has been my friendship with Oliver and comfort of his family and world at Down the phone, and felt that the Internet, tex- was attracted to neurology as a way to what he has taught me. His medical lessons House; Oliver had his in NYC’s west village. ting and emailing, for all they had added to study the brain and behavior. Yet neu- were many: to listen, to hear, to find the Darwin loved the Royal Botanical Gardens our world, also subtracted from the rich- rologists were the butt of endless jokes. story and to see the life; to see yourself as a at Kew; Oliver, the New York Botanical ness of experience and education. Sacks For stroke, MS, ALS, brain tumors and partner, an explorer and a healer; to doubt Garden in the Bronx. Darwin’s mind was was certainly not of our world. He was neuropathy, we could tell you where the accepted answers whenever your mind unparalleled in churning countless facts into more at home in water than on land and problem was and maybe even what caused will let you; to remember the curiosity and general theories; Oliver’s mind churned sci- preferred reading a dictionary to watch- it, but we couldn’t help the patient. At dreams that lead you to become a doctor; ence and experience into gorgeous tapestries ing television, and watching a mineral of best, it was said, we could only refer them and to hold that gift for as long and tightly of humanity. tantalum and tungsten to reading a novel. to physical or speech therapy. as you can. His life lessons were more pro- We must celebrate this man whose Sacks’ social network of friends, col- Sacks never accepted this paradigm. found. His life was infused with the joy and playful heart, sweet smile, poetic pen and leagues and correspondents had no clear Many patients ask doctors what they creativity and the simplicity and honesty magical mind will remain a bright star in the limits, including from animal people like would do if they were in the patient’s of a child, and layered on to that was an neurological sky. Jane Goodall and Katy Payne to No- situation. Oliver always observed from intensity and depth of knowledge across a Oliver connected to our world at so bel laureates in chemistry, physics, and the patient’s perspective. In doing so, he dizzying array of disciplines, and an intel- many levels, and connected to many other economics. Neuroscience and neurology gave neurology two priceless gifts. First, lectual passion that could charm and amaze worlds that escape our notice. He heard were his home, and he was close to Stan he made caring for the whole patient an in the same moment. Most of us speak and chords while we barely heard notes, and he Prusiner, Eric Kandel, Gerald Edelman, essential element of practice and showed think in single notes; Oliver thought and let us listen through his ears. He was deeply Francis Crick, D. Carleton Gajdusek and that it was essential not only for reasons wrote in chords. loved and will be missed terribly. • many others. With some, like Jun Wada, of human dignity but for its therapeutic Oliver loved Darwin, and their lives had whom he had not seen in more than 50 effect as well. Whatever special insights many parallels. Darwin honed his craft, his Orrin Devinsky, MD, is a professor of neurology, neu- years, he continued to correspond. He his education and training brought, he theory and his reputation on an eight-year rosurgery and psychiatry at the New York University loved Wada’s letters with their pressed respected the patient and family’s views as project in which he precisely dissected, School of Medicine and director of the New York maple and ginkgo leaves. He was friendly equally priceless in understanding illness classified and redefined our understanding University Comprehensive Epilepsy Center. 57th Annual Meeting of the Japanese Society of Neurology Pre-Announcement Toward Treatable Neurology

Professor, Department of Neurology, President Ryuji Kaji Institute of Biomedical Sciences, Tokushima University Graduate School

Date May 18 (wed) to 21 (sat), 2016

Venue Kobe Convention Center Kobe International Conference Center / Kobe International Exhibition Hall Kobe Portopia Hotel

[Head Quarters Office] Department of Neurology, Institute of Biomedical Sciences, Tokushima University Graduate School 13-18-15 Kuramotocho, Tokushima-shi, Tokushima, 770-8503, Japan [JSN Secretariat] The Japanese Society of Neurology Office Ichimaru Bldg., 2-3-21 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan [Congress Secretariat] c/o Congress Corporation kohsai Kaikan Bldg,. 5-1 kojimachi, Chiyoda-ku, Tokyo, 102-8481, Japan TEL: +81-3-5216-5318 FAX: +81-3-5216-5552 E-mail: [email protected]