A plethora of “Global” possibilities in Vancouver

The 68th Annual Meeting for the American Academy of Neurology in Vancouver will start next week. This year features a significant change in the structure of the meeting—access to MOST of the sessions is now entirely included in the basic registration fee. For the neurologist practicing in a resource limited setting who may be working without ready access to a large cadre of sub-specialized neurology colleagues, this means having the option of picking and choosing within the sub-specialty programs for those specific sessions most relevant to one’s own setting and situation. This year’s program also features three sessions on Teleneurology, which is a growing opportunity for expanding the reach of neurologic expertise while also providing ongoing support to colleagues working in situations with few other neurologists.Topical coverage of Neuroinfectious Diseases is also especially robust this year. Saturday, Global Health is going strong with, “Navigating your career: International Resident and Fellow Roundtable” , Global Health Session and excellent international coverage in Poster Session 1 (Global NCDs, Global capacity building, neuro-ID and neuro-HIV topics). Tuesday is the Global Health section meeting—an important opportunity to get involved in the sections leadership or simply offer your perspectives on growth priorities for the section. Wednesday from 3:30-5:30pm is “Neurocysticercosis and Globalization” and Thursday 1:00pm-5:30pm “Practical Approaches to Narrowing the Epilepsy Treatment Gap”. A new feature this year will be Experiential Learning with HEADTalks—15 minute presentations modelled from the now famous TED talk forum with select speakers presenting well-developed perspectives on timely topics. Neurology:Without Borders is clear evidence of Neurology’s (a.k.a. the green journal’s) growing interest in international research and engagement. On Monday at 5pm you have the opportunity to ask Robert Gross, Editor-in-Chief of Neurology anything global or otherwise. Hope to see you in Vancouver!

Teleneurology Sessions

Applications of Teleneurology: General 
Applications of Teleneurology: Telestroke 
Navigating Your Career: Teleneurology Panel

Availability, Affordability, and Accessibility: Unpacking Three Scary Words in Global Health

“What do you mean, you can’t get a head CT tonight? This man is having a stroke!”

My frustration must have seemed utterly naïve to the rural emergency physician on the other end of the line. It was 0100 on a Saturday, and I was taking a telephone consultation at a hospital in northern England, about a patient who appeared to have developed classic symptoms of a lateral medullary stroke. In the heat of the moment, I had forgotten that I was no longer in my familiar comfort zones of the John Radcliffe Hospital (Oxford) or the Foothills Medical Centre (Calgary, Canada), where I could always count on an emergent CT scan for an acute stroke. Fortunately for the patient in question, we could quickly arrange for the patient to be transferred to my centre for urgent neuroimaging and stroke-unit admission.

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Intra-African Ethnicity May for Be Important for Drug Choices in Epilepsy Care

Epilepsy care in African countries continues to rely largely upon older antiepileptic agents, so new findings in Acta Tropica by Motshoge and colleagues are of interest to physicians working in the region1. They evaluated the prevalence of CYP2C8*2, a slow drug metabolism allele, in San and Bantu populations in Botswana and found 17.5% amongst the San compared to 8.5% in the Bantu. The authors credit the differing evolutionary pressures on hunter-gatherers (the San). CYP2C8*2 is particularly important in the metabolism of carbamazepine and is virtually absent outside of African populations.2 Prior studies have indicated the San are also more likely to be slow acetylators3 and have lower CYP2D6 activity as well.4

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World Malaria Report 2015: Fewer Neurologically Compromised African Children in the Years to Come?

Good news. The 2015 World Malaria report recently released by the World Health Organization estimates that the number of malaria deaths fell by ~42% between 2000 and 2015. Most of the decreased mortality occurred in the WHO African region where most deaths occur and where severe disease occurs largely in children. Although the Malaria Report doesn’t capture neurological disabilities that result from malaria infections, multiple African studies have shown that 12-30% of pediatric cerebral malaria survivors experience neurologic sequelae including epilepsy, neurodevelopmental disabilities, cognitive impairment and behavioral disorders [1-9]. Assuming severe malaria infections have also decreased with mortality, many “brains” are also being saved by global reductions in malaria infections.

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Zika Virus: What the Neurologist Wants to Know

Just as Neurology: Without Borders launched last week, news coverage about the Zika virus epidemic in Latin America with Brazil at ground zero began to reach even the popular press. 1-4 Photos of devastated parents and microcephalic, dysmorphic infants have captured the public’s attention. Recent articles in the New England Journal of Medicine 5 and Lancet 6-8 among others have outlined some of what is known about the epidemiology of this arbovirus and how we believe it made its way from Africa (identified in 1947), to Southeast Asia (mid-twentieth century), to Micronesia (2007), to French Polynesia (2014) and most recently to Latin America in 2015.9

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Welcome to Without Borders!

If you have even a passing interest in the “state of global neurology”, then Neurology: Without Borders will soon become your go-to source for keeping track of the science and politics of neurology beyond the US. Without Borders will serve as a primary, centralized source for up-to-date, scholarly perspectives and academic review of developments and research relevant to the advancement of medical education, research and care in resource-limited, global settings. And US Neurology has certainly been at the forefront of mainstream American medicine’s recent expansion into the global health arena.

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