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Humanitarian crises and the use of teleneurology
Gretchen L. Birbeck, MD, MPH, Without Borders Editor, Rochester, NY
For an interesting read, check out this report on Teleneurology from Saadi and Mateen detailing neurology referrals from Doctors without Borders delivered via a Collegium Telemedicus platform. As is so often the case with relatively new healthcare services, the report raises as many questions as it answers. If anyone reading this has utilized this system for MSF neurology consultation requests, it would be fascinating to better understand what the barriers are to referral given the relatively low numbers received. So few referrals were requested, I was reminded of the Peanuts cartoon with Lucy sitting all alone in her consultation booth awaiting the opportunity to give Psychiatry consultations for ¢5. Having provided these asynchronous telemedicine consultations myself, I must say my comfort level when offering advice to physicians located in regions where I have professional experience working and am very familiar with local clinical epidemiology, disease burden and health services capacity is quite high. In contrast, I am frankly uncomfortable when asked for my opinion on cases from regions where I lack these basic insights.
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Acute symptomatic seizures in the tropics—The need to improve outcomes
Gretchen L. Birbeck, MD, MPH, Without Borders Editor, Rochester, NY
Regarding1 acute symptomatic seizure associated with tropical conditions such as cerebral malaria2 and Japanese encephalitis virus3 as being well-recognized to frequently result in neurologic sequelae including epilepsy, neurodevelopmental abnormalities and behavioral disorders, in the June issue of Seizure, Soni et al1 working in Chandigarh, India detail neurologic outcomes in a cohort of 604 children with acute symptomatic seizures due to a number of conditions. The acute mortality rate was 1% and all those who died had seizures as a result of CNS infections. Neurodevelopmental disabilities were seen in 16% and risk factors for this included requiring more than one antiepileptic drug during the index admission, sequelae at discharge, abnormal neuroimaging and an abnormal EEG. Even in the relatively short 6-month follow-up period, almost 6% of survivors developed epilepsy following their acute symptomatic seizure with risk factors for epilepsy development including CNS infection as the etiology for the index seizures, presenting with status epilepticus, abnormal EEG findings and abnormal imaging. Longer term outcomes and behavioral outcomes were not available. Unlike in the US with viral gastroenteritis is the commonest precursor of acute symptomatic seizures in children, in this region of India and many other tropical regions CNS infections predominate. NIH-funded clinical trials aimed at identifying targets for neuroprotection from cerebral malaria sequelae are underway now (NCT01660672; NCT01982812; NIHR01NS102176). Given the similarities in the incidence and type of sequelae seen in this larger India-based cohort, if neuroprotective trials for malaria are successful, expansion to this more heterogenous group might be warranted.
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Looking at risk factors for peripheral neuropathy in Uganda
Gretchen L. Birbeck, MD, MPH, Without Borders Editor, Rochester, NY
In this week’s Neurology, Saylor et al. report findings from Uganda looking at risk factors for peripheral neuropathy (PN) among 800 adults in the Rakai Community Cohort Study. Based upon the requirement for at least one symptom AND least one sign on physical examination, 13% of adults assessed had evidence of neuropathy. HIV was certainly a risk factor for PN, but 7% of HIV negative participants also had PN. Risk factors included age, neurotoxic medications and tobacco use. As the authors point out, these rates of PN warrant further investigations into possible causes, especially environmental exposures and nutritional vulnerabilities especially since the presence of PN was associated with impaired function.
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Standard operating procedures improve neurological emergency management in a resource-poor sub-Saharan African setting
Gretchen L. Birbeck, MD, MPH, Without Borders Editor, Rochester, NY


In this innovative intervention study in Gambia, Jaiteh et al. developed standard operative procedures (SOPs) for the care of common neurologic emergencies based upon syndromic diagnoses for stroke, fever with headache and seizure and found that in both rural and urban settings the availability of SOPs led to more appropriate evaluations and care. Larger studies with longitudinal assessments are likely needed to evaluate the impact on outcomes, but these findings suggest that a key role for the neurologist working in resource limited settings should be developing SOPs of this nature and assisting with implementation nationally.


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Disclaimer: Blogs constitute the opinion of the author and do not reflect the views of the AAN or of Neurology ®



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Latest in Global Neurology

  • HIV-associated motor neuron disease HERV-K activation and response to antiretroviral therapy In this small case series Bowen and colleagues report activation of human endogenous retrovirus-K (HERV-K) in people with HIV who developed motor neuron disease that subsequently improved with antiretroviral therapy. For neurologists caring for HIV patients in HIV endemic areas, this may be the silver lining on a heavy cloud. ​
    Lauren N. Bowen, MD, Richa Tyagi, MS, Wenxue Li, PhD, Tariq Alfahad, MD, Bryan Smith, MD, Mary Wright, MD, MPH, Elyse J. Singer, MD and Avindra Nath, MD  Published September 24, 2016
  • Moderate alcohol intake reduces risk of ischemic stroke in Korea A population-based, case-control study to examine a dose-response relationship between alcohol intake and risk of ischemic stroke in Koreans who had different alcoholic beverage type preferences
    Soo Joo Lee, MD, PhD, Yong-Jin Cho, MD, PhD, Jae Guk Kim, MD, et al. on behalf of the CRCS-5 Investigators | Published December 1, 2015

Extra! Extra! Read all about it!

Four-year training position for African neurologists in Dakar, Sengal - Call for candidates - The Department of Neurology of Cheikh Anta Dio in partnership with The World Federation of Neurology is offering an excellent opportunity for French speaking African physicians to train in a WFN accredited training site. Submission deadline July 28, 2017.
Département de neurologie de Cheikh Anta Dio en partenariat avec The World Federation of Neurology offre une excellente occasion pour les Français parlant des médecins africains s’entraîner dans un site de formation accrédité de WFN. Date limite de soumission 28 July, 2017.

US Immigration Policy Update - An update to the original letter of January 2017 has been published on the American Academy of Neurology website, regarding a recent decision by the Supreme Court and announcements by the U.S. Department of Homeland Security.

The May issue of the American Academy of Neurology's Global Health Section has posted: 
This issue inclues interviews of neurologists working in Bermuda and Nigeria, as well as a report from the
1st African Academy of Neurology Congress.

Neurology®: Clinical Practice has just launched their next Practice Current survey on a very globally relevant topic—How do you treat epilepsy in pregnancy? Given the broad range of approaches to managing this problem in diverse settings with varying resources, this survey promises to provide interesting insights. If you care for epilepsy patients, please consider completing the survey to add your own perspective.

Check out Dr. Omar Siddiqi’s most recent blog on his work in Zambia. Read about “The Broken File” effect. Quite an insightful commentary on what we need to do to improve patient care wherever we work.

Funding opportunity to facilitate developing partnerships  The American Neurological Association International Outreach Committee (ANA IOC) is pleased to announce the first international outreach scholarship program, designed for residents, fellows and junior faculty in neurology who are members of the ANA. This year, we will be offering up to two (2) scholarships to facilitate a person in training in neurology to work in low to lower-middle income countries (as defined by the World Bank) for a minimum of six (6) weeks in the upcoming academic year. This application will require the support of an in-country host as well as an ANA mentor in the resident, fellow or junior faculty member's location of training. All applicants must be in good standing in their current training program. Please see guidelines for full information on this new opportunity: IOC Scholarship Guidelines.

The American Academy of Neurology elects an international stroke expert to be their president - Dr. Ralph L. Sacco, MD, MS, FAHA, FAAN, has been elected President of the American Academy of Neurology. He is the principal investigator of the Northern Manhattan Study, the Florida Puerto Rico Collaboration to Reduce Stroke Disparities and he’s been a recipient of the WSO Global Stroke Leadership Award.

New Zika Care Connect website launched by CDC in collaboration with the March of Dimes - The site contains links to information, services and resources for pregnant women with Zika as well as their families. 

2017 ANA Meeting features Global Neurology - This year the ANA has included a Presidential Symposium dedicated to Global Neurology titled, Translational Neuroscience Research to Improve Outcomes for the "Bottom Billion" as part of the 2017 Annual Meeting. The Scientific Program Advisory Committee has also added a special interest group dedicated to Global Neurology, which will enable those in the global neurology community an ideal opportunity to showcase their research.
     The upcoming American Neurological Association (ANA) annual meeting will be held in San Diego, CA from October 15-17, 2017.  In addition to opportunities for travel awards, poster prizes, and to give data blitz presentations, this is a meeting at which you can meet and network with experienced and successful neurologist investigators from academic medical centers around the US, senior leadership from NIH and other neuroscience research sponsors, and peers/colleagues at every career stage. It will be a valuable and worthwhile experience. Hope to see you there. ~ Gretchen Birbeck


Global Stuff you should know

On The Road


 The 9th Biennial Latin American Epilepsy Congress in Cancun, Mexico

José E. Cavazos, MD, PhD 
Assistant Dean for the MD/PhD Program SOM/GSBS CTSA KL2 Program Director IIMS Professor of Neurology and Physiology University of Texas Health Science Center San Antonio

 On August 20 – 23, I was able to attend the 9th Biennial Latin American Epilepsy Congress in Cancun, Mexico. This Epilepsy Congress has an attendance of about 900 Epileptologists from every Latin American country as well as a substantial number of North American Epileptologists. It is the Regional Congress of the International League Against Epilepsy. There were 3 Pre-Congress Symposia the preceding day, August 19, with a Basic Science workshop focus upon Pharmacoresistance, a Clinical Review course on Epileptology, and a Patient/Family based activity sponsored by the International Bureau of Epilepsy, the international patient advocacy organization. The Epilepsy Congress has a healthy mixture of case based practical workshops, new advances in every aspect of epilepsy care, and didactic lectures by experts.

The Congress was well organized as usual. Lodging and transportation services can be arranged by the organizing committee. Tourism packages are also available. In prior years, I have attended this Epilepsy Congress in Santiago, Chile (2000), Cartagena, Colombia (2010), Quito, Ecuador (2012) and Buenos Aires, Argentina (2014). Many of our leading North American Epilepsy Centers are well represented among the speakers of the meeting. Although the official language of the Congress is Spanish, at least a dozen of the lectures I attended were presented in English.

Photos of the event are available at the 9th Latin American Congress on Epilepsy website About page

Full program of the event is available at the 9th Latin American Congress on Epilepsy website Programme page

The International League Against Epilepsy (ILAE) and International Bureau for Epilepsy (IBE) organize regional biennial congresses around the world. The 10th Biennial Latin American Epilepsy Congress will be in San Jose, Costa Rica in 2018. The 32nd International Epilepsy Congress (IEC), the World’s Epilepsy Meeting will take place in Barcelona, Spain from September 2nd to 6th of 2017 with an expected attendance of about 5000 Epileptologists.


Neurology Podcasts

March 27, 2017: Dr. Kiran T. Thakur interviews Dr. Tarun Dua, Medical Officer at the World Health Organization working on the Program for Neurological Diseases and Neuroscience, Management of Mental and Brain Disorders in the Department of Mental Health and Substance Abuse, Geneva, Switzerland Find it here.

February 6, 2017: Dr. Omar Siddiqi interviews Dr. Victor Valcour, Associate Professor of Geriatric Medicine and Neurology at the UCSF Memory and Aging Center and Deputy Director of the Global Brain Health Institute. Find it here.

Without Borders Podcast Archive

Current Neurology Podcast
Dr. Stephen Donahue interviews Dr. Aaron Berkowitz

Dr. Stephen Donahue interviews Dr. Aaron Berkowitz about his paper on Zika virus-associated Guillain-Barre syndrome variant in Haiti. Dr. Ilena George is reading our e-Pearl of the week about juvenile Huntington disease. Dr. Alberto Espay interviews Dr. Alireza Atri about his Clinical Trials Plenary Session at the AAN meeting about 5-HT6 antagonist as adjunctive therapy to cholinesterase inhibitors in patients with mild-to-moderate Alzheimer disease.