President’s Column

By Raad Shakir

Raad Shakir

Raad Shakir

Now the 22nd World Congress of Neurology (WCN) in Santiago, Chile, is over with huge success both scientifically and socially. There is a specific and enduring success story I would like to mention in this column. In every WCN, the program committee makes a specific point of bringing together all brain health sister disciplines to be present and to participate. So in the Congress, the World Psychiatric Association, World Federation of Neurosurgical Societies, International Child Neurology Association, World Federation of Neurorehabilitation and International Brain Research Organization were all present.

These organizations constitute the umbrella for brain health. The World Congress of Neurology in Santiago had sessions for each of these organizations, which were well attended and presented a showcase for each one of them. The WFN leaves the convening of the sessions and the choice of topics to the federations. It is absolutely correct that they should feel free to inform attending neurologists on what they think is of interest to us in their fields.

Representatives from the World Brain Alliance and sister organization in the Global Neurology Network met during the World Congress of Neurology (WCN) Nov. 3, 2015 in Santiago, Chile.

Representatives from the World Brain Alliance and sister organization in the Global Neurology Network met during the World Congress of Neurology (WCN) Nov. 3, 2015 in Santiago, Chile.
Front row (from left): Ingrid Tein, president, International Child Neurology Association; Gunther Deuschl, president, European Association of Neurology; Rana Karabudak, Neuroimmunology; Bill Carroll, vice-president and Global Neurology Network chair, WFN; Stephanie Clarke, president, World Federation of Neuro-rehabilitation, Raad Shakir, president, WFN; Yong-Kwang Tu, president, World Federation of Neurosurgical Societies; Cathy Rydell, CEO, American Academy of Neurology; Tarun Dua, medical officer, Program for Neurological Diseases, World Health Organization; Terrence Cascino, president, American Academy of Neurology; and Riadh Gouider, trustee, WFN.
Back row (left to right): Renato Verdugo, president, WCN Santiago; Steven Lewis, WFN co-opted trustee and editor continuum, American Academy of Neurology; Erik Wolters, president, International Association of Parkinsonism and Related Disorders; Riccardo Soffietti, European Association of Neuro-Oncology; Sam Wiebe, International League Against Epilepsy; Geoff Donnan, World Stroke Organization; Alan Thompson, Multiple Sclerosis International Federation; Amadou Gallo Diop, trustee, WFN, chair, Africa Intiative; Mark Hallet, president, International Federation of Clinical Neurophysiology; Claudia Trenkwalder, World Association of Sleep Medicine; and Jes Olesen, International Headache Society.

The World Brain Alliance (WBA) is therefore moving full steam ahead, and the collaboration is now so close that the time has come for tackling major issues, which can be dealt with jointly. Forming small working groups to tackle specific common disorders is underway. Three topics already have been agreed upon, those being dementia, epilepsy and traumatic brain injury. It is absolutely correct that working together, the WBA is a much more powerful entity rather than each of us acting separately. Moreover, in many situations we are tackling the same issues at the international level. The World Health Organization is going ahead on Global Coordination Mechanism on Noncommunicable Diseases (GCM NCDs). The place for neurology NCDs was not initially prominent, in spite of the fact that generally brain disorders cause major death and disability more than HIV, malaria and tuberculosis put together.

The role of the WBA is to fill the gap and inform, as well as educate public health authorities on the devastating effects of brain health disorders, whether they are neurological, mental, developmental or substance (NMDS) use issues. The shortcomings of neurological health provisions were highlighted yet again in the second edition of the Neurology Atlas 2015. This is a combined effort between WHO and WFN. The Atlas was presented in a preliminary manner at the World Congress. It will be published in early 2016. It gives details of the current status of manpower, service provisions, social support and drug availability for neurological, neurosurgical, child neurology and rehabilitation facilities across the world.

For the WBA to gel with our specialty sister organizations in the Global Neurology Network, a joint meeting with the representatives of all organizations present in Santiago was arranged. These global neurology associations convened sessions at the WCN and were represented at the highest level. The World Stroke Organization, International League Against Epilepsy, International Parkinson’s and Movement Disorders Society, MS International, Alzheimer’s International, International Headaches Society, Peripheral Nerve society, Neuro-ophthalmology, Neuro-Otology, Neuro oncology, History of Neurology all had sessions which were of most interest to participants.

The issues of brain health are crucial to the major exposure we would like to have at the highest level of international health care. If we are going to influence public policy, we need to be at the forefront of issues when decision-makers look into allocating budgets and resources. The only way to do this is for NMDS to be looked at together. Then the combined grouping is big enough to compete for funding and support, compared with similar big groupings such as cancer or cardiac diseases.

PC_AtlasThe big drive of WHO toward global coordinating GCM NCDs is gathering pace. Although the scope of the process is not yet complete, one can see WHO trying to listen to all stakeholders, and the matter of WHO dealing with disease management is now a reality. The United Nations has produced the declaration on NCDs and 17 Sustainable Development Goals (SDGs) in 2015. In all these initiatives and targets, brain health should be at the forefront, and we as neurologists should push hard to have neurological issues right in the middle of governmental thinking. Financial support for our patients will only come if we have clear publically supported initiatives in a language that makes sense and shows targets, which are realistic and achievable.

The WHO GCM NCDs is an excellent platform to put forward our views on how to achieve early diagnosis and prevention of neuro NCDs. The issue, which attracts WHO and its agencies, is prevention and coping with various disorders at the primary care level. This is fine and commendable, however, in our world there is a follow on to this, which is management of many disorders, which are chronic, and for many lifelong. The fact that NMDS cause major disability adjusted life years is an important fact, which always should be at the front of all measures carried out by health authorities. It is also true that the cost of coping with NMDS conditions will be beyond health budgets even with high-income, let alone low- and middle-income economies.

The emphasis on management, including prevention, is a change in WHO thinking, which we need to embrace and welcome. WHO is receptive and recognizes that advances in genetics and imaging have created a new era in early diagnosis and at times preclinical recognition, which means specialists are needed and in numbers so there shall be no difference in care between various income groups. There is no doubt that recommendations to national governments at the GCM NCDs to train more doctors are commendable and welcome. We should also bring forward the idea that although a figure of 50 percent of those young doctors were recommended to be in primary care, there is an urgent need to increase the number of specialists in brain diseases across the world. It is true that this may be a long-term policy and to a degree wishful thinking, but if we look at the SDGs, many of which are long term but all of them have been approved at the highest level of the United Nations.

The way ahead is long but brain health, when presented to decision-makers, has so far been received with a positive and understanding attitude. We should all work at every level to promote brain health.