Doctors Corner

ICNA Executive Board

Executive board meeting of the International Child Neurology Association (14-15th Feb) and Neurology Satellite meeting (16th Feb). Jo Wilmshurst

Front row:
Guillermo Agosta (Argentina);Raili Riikonen (Finland);Ian Wilkinson (Australia);AhmedRaouf Ibrahim (Eygpt);Lieven Lagae (Belgium);Banu Anlar (Turkey); Virginia Wong (Hong Kong);Milivoj Velickovic Perat (Slovenia)
middle row:
Robert Ouvrier (Australia - President);Hugo Arroyo (Argentina);Sergio Rosenberg (Brazil);William Logan (Canada)
back row:
Peter Baxter (UK);Jo Wilmshurst (SA);Marilisa Guerreiro (Brazil);Paolo Curatolo (Italy);Orvar Eeg-Olofsson (Sweden - Treasurer); Biju Hameed (UK - invited to discuss ICNApedia website) Charles Newton;(Kenya) Ken Mack (USA - Secretary)

Twenty out of 25 members of the ICNA executive board managed to travel from diverse areas of the globe to South Africa to attend the above meeting. The EB meeting was held at Red Cross Children’s Hospital and many topics were discussed including how to improve education in the filed of child neurology, how to increase membership of the association and promotion of international training initiatives. Collaboration of research projects across multicentre sites was targeted as a key area to develop. The web page for ICNA has been dramatically revamped and linked to ICNApedia and now has numerous useful links. The scientific program of the next International Child Neurology Congress will be in Cairo, Egypt May 2nd-7th 2010 The program is already fairly organised and it looks to be an excellent meeting to plan to attend with something for every special interest area.

The group seemed genuinely impressed by the hospitality of South Africa as a whole. Many spent extra time in other parts of the country, not just the Cape. A bid for a future ICNC would be met favourably. Six of the group stayed on to give talks on their key areas of interest for the Neurology Symposium held at the Sports Science Institute, in Newlands. Several other members also attended and gave input for the case presentations. It was attended by around 100 delegates from general paediatrics, paediatric neurology, neurodevelopment and neurosurgery. Dr Peter Baxter from Sheffield Children’s Hospital in the UK, presented an approach to movement disorders - this was extremely useful for the detailed video examples he was able to include. He described primary movement disorders - kinesigenic and non-kinesigenic and their investigation and response to treatment. He addressed secondary movement disorders. He also covered the long list of differentials.

Dr Ken Mack (secretary of ICNA), from the Mayo Clinic in Cleveland, USA, followed him with a clear and concise summary of an approach to headaches, He covered the nature of headache, the differentiation from migraine (migraine actually makes you encephalopathic, even after the headache, nausea is common, as is the hyperacusis), how to target therapy - pointing out the need to address the many environmental issues compounding success in treatment (eg the behavioural phenotype of the typical adolescent is not geared to complying with most recommended interventions of regular meals, early to bed, avoiding stress etc). He worked through the various medical interventions from the acute care, emergency care and prophylaxis. He also covered features of a headache which would be considered pathological.

Professor William Logan, from The Hospital for Sick Children Toronto, Canada followed him with a fascinating talk on the role of functional MRI. His visuals were excellent and demonstrated the potential for this technique in screening children for localisation of motor, sensory, cognitive, emotional, vascular and epileptic disorders. He discussed methods used to ensure even young children cooperated - with videos and voice projection into the scanner giving the children instructions but also allowing distraction if they were becoming bored. He discussed various research applications of fMRI in children including cognition (Memory, Working Memory, Attention, Executive Function), specific disorders (dyslexia, ADHD, autism), reorganization and plasticity, development (neonate, children versus adult). Professor Robert Ouvrier (President of ICNA), from The Children’s Hospital at Westmead, Institute for Neuromuscular Research, Sydney, Australia, talked on aged related peripheral neuropathies. He updated the audience with the very latest now understood in the differentiation of this complex group of disorders and put the conditions into logical groupings of those presenting in infancy and early childhood. For example the early onset neuronal HMSN group previously without genetic markers are linked to mitofusin mutations on 50% of cases. Sadly none of the genetic mutations described can be screening for in SA except the 17p duplication causing CMT1A.

Professor Virginia Wong from Hong Kong gave a dynamic presentation on the topic of autism. She covered a vast amount of information in the time allotted. She discussed various screening tools and presented simplified versions her group had defined and tested. She showed some fascinating videos of children (some very young) with early features suggestive of autism. One of her key markers was the “point and show” skill - children with normal development acquire the ability to draw a carer’s attention to an object by pointing and looking at the carer to ensure they had gained their attention - children with autism don’t do this. She also talked about the interventions which can be helpful and the monitoring she provides. Professor Orvar Eeg-Olofsson, Department of Women’s and Children’s Health/Neuropediatrics, University Hospital, Uppsala, Sweden, presented a talk on epidemiological markers, mainly viral infections and their link to epilepsy. This was a complex talk but the message was fascinating for helping us understand why some children develop catastrophic epilepsy. He discussed in particular the role of human herpes virus type 6 (HHV6) and how its direct invasion on the CNS could result in encephalitis and epilepsy. This virus has been identified in 8-40% of children with febrile convulsions. The association with herpes simplex virus type 1 and temporal lobe epilepsy is logical. Other viruses mentioned were live measles vaccination and Lennox Gastaut syndrome, CMV and neonatal seizures, West syndrome and Rasmussen encephalitis, and Influenza A and B, adeno, parainfluenza, RSV and rotavirus in febrile seizures. He then went on to a complex explanation of immunological markers also potentially involved in epilepsies. This understanding should lead to future treatment innovations so was infact very exciting.

The day was competed with a series of case presentations - this was probably the most fun and interactive part of the meeting. Dr Tiziana Aduc presented a 5½ yr old boy with an unusual MRI showing extensive symmetrical white matter demyelination/dysmyelination detected after an MVA lead to further investigations. She also presented a 9 year old boy with dyskinetic CP which had evolved into bizarre abnormal movements. Dr Lorna Jacklin presented a child with a rare metabolic disorder. Dr van Toorn presented a child with a clinical phenotype of Huntingtons chorea but negative genetic testing. Dr Riegen Solomons presented a boy with an unusual ocular movement disorder. Dr Ndondo presented a series of cases with severe neurocysticercosis (this completely flawed the panel who were still discussing it at the speakers dinner that night and felt it most unfair to ask them on condition so out of their fields of expertise!) and Dr Donald presented a girl with an acquired ataxic movement disorder which developed after the removal of a benign teratoma.

The EB meeting and symposium was generously supported by various companies especially Jansen-Cilag, Sanofi-Aventis and UCB who between them managed to feed, assist with transport and accommodate the board members. The support from members of PANDA SA was huge with almost complete attendance of the PANDA executive board who all under took various host roles over the meetings.