01_05_08_10wfn11_7.qxp 8/9/2011 10:36 AM Page 1 VOL. 26 • NO. 4 • AUGUST 2011 World Neurology THE OFFICIAL NEWSLETTER OF THE WORLD FEDERATION OF NEUROLOGY Neurological Fallout in German Epidemic INSIDE Egypt Representatives from the BY GÜNTHER DEUSCHL, EHEC contamination of World Federation of M.D., AND ROBERT sprouts. This E. coli strain is STINGELE, M.D. known to produce Shiga toxin, Neurology and Cairo which initially affects the ep- University School of uring the enterohemor- ithelium of the intestine, lead- Medicine have signed an rhagic Escherichia coli ing to hemorrhagic diarrhea, agreement to establish a D(EHEC) epidemic in north- but it subsequently also affects center for training ern Germany earlier this year, kidney epithelia, which can put neurologists from Africa. the neurological features of this the patient at risk for renal fail- PAGE 2 rare condition quickly became ure. This leads to HUS, a life- acutely apparent, and neurolo- threatening condition. Erythro- gists found themselves working cytes and thrombocytes are also Italy side by side and around the clock affected by Shiga toxin, which in Researchers gathered for MAGES with nephrologists and gas- severe cases can lead to dissem- I the International troenterologists to manage pa- inated intravascular coagulation ETTY Conference on tients with the life-threatening and multiorgan failure, which ©G Transcranial Magnetic infection. can be fatal. Infection with EHEC led to hemorrhagic uremic syndrome in one- and Direct Current However, neurologists were third of patients, half of whom developed neurological symptoms. The epidemic seems to have Stimulation in Rome. been one of the most extensive surprised to see a new and se- and deleterious in recent years. vere neurological disease mani- The symptoms were some- toseizures or even status epilep- PAGE 6 So far, 3,602 EHEC infections fest in some of the EHEC pa- times fairly mild but often dom- ticus. Some patients slipped into have been reported, including tients and we soon realized that inated the clinical syndrome. a coma and needed ventilation, Bashkortostan 838 cases of hemorrhagic ure- the nervous system could also They started with slight and which was why there was such A clinic integrates its mic syndrome (HUS). Thirty fall prey to the infection – most transient symptoms such as high demand for intensive care continuing professional patients with associated HUS likely as a result of the Shiga tox- confusion and irritability, which treatment during this epidemic. training into its existing died, and 17 without HUS died, in. About a third of the EHEC sometimes developed into a full Other patients manifested with routines and has sought according to data from the patients developed HUS, and confusional and delirious state. focal symptoms such as aphasia local and international Robert Koch Institute, a federal half of the HUS cases developed Motor symptoms with my- or apraxia. institute that oversees the pre- neurological symptoms. Very oclonus or jerky tremors were Brain stem symptoms with collaboration to bolster vention and control of disease. few of the patients who did not quite frequent, and often the loss of cranial nerve functions its impact. The institute has said that the have HUS developed the neuro- myoclonus was stimulus sensi- PAGE 14 epidemic was caused by an logical symptoms. tive. This stage sometimes led See Epidemic • page 8 Neurologists Describe Responses to Disasters in Japan BY SATOSHI TAKAHASHI, higher ground. Terrified children and who struggled during the disaster shared mitigated destruction and loss around FUMITOSHI HAMATO, MASASHI older adults panicked as many struggled their experiences, and with the attendees, them. AOKI, OKUJOU IWAMI, to evacuate their families and friends tried to come up with some solutions for One neurologist spoke of how his YOSHIKAZU UGAWA, KATSUMI from the swiftly flooding stricken areas. delivering medical care during a crisis. clinic near the northeast coastal city of NAKATA, OSAMU YAMAMURA, For days, blocked and damaged roads cut Given the overwhelming chaos, medical Kamaishi was completely destroyed by MIEKO OGINO, HIDEHIRO off medical and emergency assistance services were forced to focus less on the tsunami. The neurologist escaped to MIZUSAWA, AND GEN SOBUE access to where it was most needed, and physical examinations or medications higher ground with a number of terri- communications came to a near stand- and more on food, shelter, water, cloth- fied people, but in the chaotic retreat, he he most devastating earthquake ever still. ing, warmth, and compassion – a chal- lost his own parents. That evening, he Tto hit Japan struck on March 11. It was At this year’s annual meeting of the lenge worthy of Florence Nightingale. started administering medical care in the quickly followed by a giant tsunami that Japanese Society of Neurology, we held The afflicted remained incredibly calm, sent people frantically scrambling to a special forum in which the neurologists patient, and cooperative despite the un- See Japan • page 10 Local Organizers Gear Up for WCN 2011 Members of the Moroccan Society of Neurology have taken an active role in organizing this year’s Congress and are proud to be associated with the landmark event, which will Lebanon Jct. KY Jct. Lebanon be held in Africa for the first time. 07960 NJ Morristown, Permit No. 384 No. Permit PAID 60 Columbia Rd., Bldg. B Bldg. Rd., Columbia 60 See Page 4 Postage U.S. Presorted Standard Presorted CHANGE SERVICE REQUESTED SERVICE CHANGE N W EUROLOGY ORLD 01_05_08_10wfn11_7.qxp 8/9/2011 10:37 AM Page 2 2 • WORLD NEUROLOGY WWW.WFNEUROLOGY.ORG • AUGUST 2011 EDITOR IN CHIEF’S COLUMN T A L K B A C K We’d Like to Hear From You Catastrophic Neurology Do you have an idea for a story? Do you want to comment on eurology is often thought to be a gists have been called on to deal with cat- tients infected with enterohemorrhagic something you’ve read recently in contemplative field of medicine. astrophes. Massive events came without Escherichia coli. Neurological units have WORLD NEUROLOGY? NThe brain is complex, warning, and neurologists been filled to capacity, ad hoc intensive and patients are frequently were called into action. care units set up, and staff from hospi- Or perhaps you’d like us to share difficult. We spend a lot of Our Japanese colleagues tals in regions that were not affected by news of your research or an time thinking. Of course, are generally prepared for the epidemic were brought in tem- upcoming event with the global neurology is changing with earthquakes and tsunamis, porarily to help. neurology community ... the burgeoning fields of in- but not on the scale of the In both circumstances, cooperation terventional neurology and disaster that struck on March between neurologists and hospitals Write to us at intensive care neurology. In 11. Neurological clinics were across the countries has been critical in [email protected] the setting of acute stroke, flattened and put out of ac- coping with the crises. We have seen oth- or send a fax to for example, the patient tion, but neurologists er similar examples in recent years of +1-240-221-2548 might need tissue plasmino- worked long hours and countries helping other countries with For Letters to the Editors, please gen activator within 3 hours. BY MARK HALLETT, MD pulled together to do their similar large-scale disasters, such as the include your name and address, But this is still generally one best. The aftermath still pos- earthquake in Haiti last year. It is nice to affiliation, and conflicts of interest patient at a time. es problems as recovery continues. see such cooperation, but it would also in regard to the topic discussed In this issue of WORLD NEUROLOGY are Our German colleagues have had to be useful to have some disaster planning when you write to us. Letter may be two articles, one from Japan and one from deal with a new neurological disorder in advance. It is better to be prepared as edited for space and clarity. Germany, which describe how neurolo- that manifested in some of their pa- best as we can. ■ WFN to Collaborate With Cairo University Training Center n April, Dr. Raad Shakir, the Secretary-Treasurer set the seal on an initiative that began 2 years ago dur- certainty in the region, Dr. Shakir returned from his vis- IGeneral of the World Federation of Neurology, ing the presidency of Prof. Johan Aarli when Dr. Rag- it confident that the WFN’s perseverance in going represented the Federation at the Cairo International nar Stien of the University of Oslo, Norway, went to ahead with the program will be rewarded. ■ Neurological Congress. While he was there, he met Cairo on a fact-finding mission. As a result of that trip, with Prof. Lamees Ragab, dean of the Cairo Univer- he was able to prepare a comprehensive report on the sity School of Medicine, and the school’s vice-dean for training opportunities and facilities available in Egypt. postgraduate studies and research, Prof. Ahmed Zo- The 3-year program is intended for doctors from else- hdi, to discuss the establishment of an English-medi- where in Africa who will join the Cairo University train- HAKIR um WFN center at the Cairo University Hospital for ing program. They will train and work in the way S African neurology trainees. The initiative was made Egyptian trainees do. AAD . R R possible by the efforts of Prof. Mohamed S. El- The expenses will be met by the WFN and Cairo Uni- D Tamawy, president of the Egyptian Society of Neu- versity. The memorandum of understanding also paves rology, Psychiatry, and Neurosurgery. the way for the detailed accreditation and inspection of OURTESY They signed a memorandum of understanding for the training program.