01_7_12wfn11_4.qxp 4/1/2011 10:43 AM Page 1 VOL. 26 • NO. 2 • APRIL 2011 World Neurology THE OFFICIAL NEWSLETTER OF THE WORLD FEDERATION OF NEUROLOGY South Africa Battles HIV-Related Disease INSIDE United Kingdom London’s National BY AHMED I. BHIGJEE, M.D. ture, and a lack of commitment to Hospital for Neurology addressing the crisis. As a result, outh Africa is made up of nine most patients who were depen- and Neurosurgery marks provinces, one of which is KwaZulu- dent on the state for care were 150 years of excellence in SNatal (KZN). As of July 2010, Statistics ARV naive. In turn, many patients clinical care, research, South Africa has put the estimated popula- presented with advanced disease. and training. tion of the country at 49.9 million, of which At IALCH, as with other inter- HIGJEE PAGE 2 10.6 million reside in KZN. The 30-bed neu- nal medicine units in South I. B rology unit at the Inkosi Albert Luthuli Africa’s public sector, 50%-60% of Afghanistan/Pakistan Central Hospital (IALCH) in Mayville, KZN, the neurological inpatient work- HMED . A R Physicians from and a smaller 12-bed unit at Grey’s Hospital load in the state hospitals is HIV D in Pietermaritzburg, about 90 km away, are related. The range of neurological Afghanistan will train in the only neurological facilities in the public manifestation of HIV-related dis- neurology at neighboring OURTESY sector serving KZN and the northern part ease at IALCH is similar to that in C Pakistan’s Aga Khan of the Eastern Cape, a neighboring province the rest of the country. The fol- Dr. Ahmed I. Bhigjee says HIV accounts for about 55% University under a to the south of KZN with a population of lowing is a discussion of some of of neurological workload in South African hospitals. program initiated by the 6.7 million people. Only about 20% of the the more common or serious neu- 2 American Academy of population can afford private health insur- rological complications seen at our hospital. culous lymphadenopathy is more common in Neurology. ance, which means that most patients have HIV-positive patients, who also suffer com- to be managed in public sector facilities. Neurotuberculosis plications such as strokes and hydrocephalus. PAGE 8 Against the above scenario, one should also The HIV epidemic has made the tubercu- However, HIV-positive patients requiring ven- note that South Africa probably has the high- losis (TB) problem catastrophic. In 2007, triculoperitoneal shunting have poorer out- Child Neurology est infection rate of the human immunode- there were about 315,000 cases of new or comes. No patient with Medical Research The International Child ficiency virus (HIV) in the world. About 5.7 recurrent TB in South Africa.3 There has Council grade 3 or 4 has survived shunting.4 Neurology Association million individuals of the total population been a corresponding increase in extrapul- The common difficulty of confirming a di- says global cooperation is 1 (11.4%) are infected. Until recently, the man- monary tuberculosis (EPTB). agnosis of TBM in the HIV-negative setting crucial in its efforts to agement of this epidemic was bedeviled by Ǡ Tuberculous meningitis (TBM) is the is compounded when there is HIV coinfec- train more pediatric the inadequate roll-out of antiretroviral drugs most serious of the EPTB conditions. In tion. Cerebrospinal fluid (CSF) smears (about (ARVs). Some of the reasons for the tardy re- HIV-positive patients, it presents in a manner 0% positive) and cultures (about 20% positive) neurologists in sponse by the state included the prevailing de- similar to that in HIV-negative patients – have low sensitivity in Southern Africa,5,6 developing countries. nialist attitudes about HIV/AIDS, the lack of fever, headaches, and a change in mental PAGE 11 funding, inadequate staffing, poor infrastruc- state are common but not invariable. Tuber- See South Africa • page 12 Premortem Transferrin Level May Flag Creutzfeldt-Jakob BY MATTHEW STENGER formance of diagnostic testing curs in patients in the absence of the observation that brain iron CJD-positive vs. CJD-negative Elsevier Global Medical News was improved when measure- any known risk factors. It is the dyshomeostasis is accompanied cases than was T-tau. T-tau ment of total transferrin (T-TF) most common of the three by increased TF in sCJD cases, showed a significant correlation ow CSF total transferrin lev- was combined with measure- types of CJD, the others being they measured levels of T-TF and with duration of sampling prior Lel is a reliable premortem ment of the established sporadic hereditary and acquired. TF isoforms (TF-1 and TF-beta- to death in CJD-positive but not marker for sporadic Creutzfeldt- Creutzfeldt-Jakob disease (sCJD) In the current study, the re- 2) in CSF from the two groups. CJD-negative cases, whereas no Jakob disease, according to a biomarker, total-tau (T-tau). searchers obtained human pre- Compared with CJD-negative correlations were observed for study by researchers at Case Sporadic Creutzfeldt-Jakob mortem CSF autopsy-confirmed cases, CJD-positive cases had the TF markers in either group. Western Reserve University in disease (sCJD) is a rare, fatal samples from 99 sCJD-positive lower median CSF T-TF and This indicates that “T-tau Cleveland, Ohio, USA. prion disorder that typically cases and 75 sCJD-negative cases higher median T-tau values. T- changes as sCJD progresses, Dr. Ajay Singh and her col- goes undetected until biopsy or collected about 10 days to 36 TF and both TF isoforms were leagues also reported that per- autopsy. This form of CJD oc- months before death. Following more sensitive differentiators of See Creutzfeldt-Jakob • page 4 WCN 2011: Meeting of Minds in Marrakesh Interested in participating in the Tournament of the Minds at this year’s Congress? Find out what you have to do to join in on the fun and test your neurological prowess. See Page 2 01_7_12wfn11_4.qxp 4/1/2011 10:33 AM Page 2 2 • WORLD NEUROLOGY WWW.WFNEUROLOGY.ORG • APRIL 2011 EDITOR IN CHIEF’S COLUMN WCN 2011 The Future of Books Team Up for Marrakesh his issue of WORLD NEUROLOGY features learn by reviewing cases and to acquire knowl- ducation and entertainment tions on a range of neurological three book reviews, two on practical mat- edge about how to use modern methods such Ewill again share a platform at topics based on clinical cases Tters of peripheral neuropathies and one as MRI. John D. Stewart’s Focal Peripheral Neu- this year’s World Congress of from around the world. The on neurological history. Do books matter these ropathies can be read cover to cover, but it will Neurology in Marrakesh, Mo- questions will focus on visual ma- days? Does anyone still read them? Should have a long shelf life as a source for quickly rocco, when participants “exer- terial, videos, and stills, with a anyone read them? There is plenty of materi- checking up on those critical, but easily for- cise their brains” in the Tourna- minimum of text. The winning al available in journals, there are lots gotten details. Justin A. Zivin and ment of the Minds. team will receive a prize. of review articles, and the Internet is John Galbraith Simmons’ tPA for The popular Tournament of All of the teams will participate overflowing with information. There Stroke: The Story of a Controversial the Minds offers a unique in a qualifying round. are really two issues here; one is the Drug is a modern history of the opportunity for com- The eight teams that intellectual content of the book, and new therapy, detailing its devel- peting national teams achieve the highest the other is the format. opment. It is at once educational to interact with their scores will advance to As to the content, books have sig- and entertaining. These are all colleagues from other a semifinal round and nificant value for different types of valuable as books. countries and test compete in two readers. The value comes from the fact But what about the format? their clinical prowess groups of four teams, that they can harbor an extended Some readers must hold the print- and intellectual with the winners of overview of a field as a single entity. ed book in hand; easy to read af- tenacity. This is the each group advancing It is difficult to get an easily accessible BY MARK HALLETT, M.D. ter many years of use, and easy to fourth time the to the final. overview by looking at a series of ar- navigate, it allows the reader to World Federation In general, there ticles, even review articles. A book can be a valu- shift rapidly from one part of the book to an- of Neurology will be one able source for someone learning about a new other. Others, mainly younger readers, are hap- has held the team per area because the information often is organized py with electronic media such as the Kindle and tourna- coun- for ease of learning – start with the basics in the iPad. Once a reader is used to these reading de- ment at one of its congresses. try, but for countries where there front of the book and gradually build up to the vices, they are easy to use, and in addition, they “I am thrilled that the Tourna- are a limited number of neurol- more complex details toward the end. This is the can store many books in a single package about ment of the Minds will be in- ogists, a team may consist of na- textbook.