Wednesday, November 22, 2017

Report of EAN /WSO / AAN/IBRO/WFN / EHF/LINF 9th Regional Teaching Course (RTC) on Neurology in Sub - Saharan Africa . Ougadougou, Burkina Faso 8 - 11th November 2017

The 9th Regional Teaching Course (RTC) took place in Ouagadougou Burkina Faso on November 8 – 11, 2017. The meeting was hosted by Prof. Jean Kabore, Head of the Neurological Department of the Yalgado Ouedrago Hospital of Ouagadougou together with Prof. Athanase M ilogo, Head of the Neurology Department of the Sanou Sourou hospital in Bo Bo Dialasso and Prof. Christian Napon, head of the Neurology Department of the District Hospital of Bogodogo, Ouagadougou. The RTC took place at the National Hospital “Blaise Compa ore”.

The RTC, organised by the EAN, was supported by a consortium of European and international scientific societies: 
• University of Ougadougou, Burkina Faso 
• WSO - World Stroke Organisation 
• AFAN – African Academy of Neurology 
• WFN - World Federation of Neuro logy 
• AAN - American Academy of Neurology 
• IBRO - International Brain Research Organisation 
• International PD and Movement Disorder Society 

Thanks to the funding received from the sponsoring scientific societies, 27 residents from 19 Sub - Saharan countries co uld be invited to the RTC. These residents have their flight and hotel paid for through this sponsorship. These individuals were selected by the course organisers from a larger number of neurological trainees who had been put forward by their Head of Depar tment as poten tial course participants; t hese selected participants represent some of the very best trainees from across Africa. Additional trainees from the local area attended, bring the total attendance to 75 people. 
The course was opened by Prof. Jean Kabore, Prof. Rabiou Ciss é , Dean of the University of Ouagadougou, Prof. Claudine Lougu é , Director of the Faculty of Medical Sciences of the University of Ouagadougou and Prof. Erich Schmutzhard, Director of the RTC. Prof. Ciss é we lcomed all to Burkina Faso and wa s pleased that international neurology has come to “the land of the righteous men”. He stressed the importance of the RTC and the opportunity given to the students to receive teaching of excellence from such a wide group of worldwide faculty. Pr of Schmutzhard spoke about EAN, the “home for neurology”. The pointed out that this home goes way beyond Europe. It is one of EAN’s main goals to share knowledge of excellence through its educational activities. He pointed out that in Europe and in SSA, on e out of three diseases are neurology related. It therefore is one of EAN’s main goal to get neurology on the worldwide map of medicine. Prof. Rabiou Ciss é , at the end of the speeches, declared the RTC open. 

Opening ceremony (L to R): Prof Jean Kaboure , Professor Rabiou Cissé and Professor Erich Schmutzhard

The 2017 RTC addressed four topics of major interest for Sub - Saharan Africa: 
- Stroke 
- Movement Disorders and Dementia 
- Neuromuscular diseases 
- Spinal Cord diseases 

Faculty from Africa, Europe and Amer ica attended the RTC. The core organisation of the course is led by the “Neurology and SSA” Task Force team at the European Academy of Neurology (EAN). The high international reputation for academic excellence of the course is underlined by the wide range of learned societies and institutions that support this annual course. The Faculty for the S troke section was Amadou Gallo Diop (Senegal) , Jose Ferro (Portugal), Peter Sandercock (UK) , Yomi Ogun (Nigeria), for M ovement D isorders and D ementia was Njideka Okubadejo (Nigeria), David Riley (USA), Raj Kalaria (UK), for S pinal Cord D isorders was Augustine Charway Felli, ( Ghana ) , Riadh Gouider (Tunisia), Osheik Seidi (Sudan) and f or Neuromuscular D isorders was Jean Kaboure (Burkina Faso), Wolfgang Grisold (Aust ria) Jean Michel Vallat (France). 

The topic for day one was Stroke in Sub - Saharan Africa . Prof. Amadou Gallo Diop (WFN) gave an overview of the epidemiology and classification of Stroke in Sub - Saharan Africa. He was followed by Peter Sandercock (WSO) who lectured on the clinical presentations, signs and symptoms of stroke. Prof. Jose Ferro (EAN) illustrated the state of the art in diagnostic work - up and therapeutic management of stroke while Prof. Yomi Ogun (AFAN) spoke of the state of the art and specifics of stroke diagnostics and therapeutic management of stroke in urban and rural SSA. Prof. Erich Schmutzhard (EAN) and Prof. Raj Kalaria (IBRO) moderated the Clinical Grand Round in which we discussed a case , selected by the faculty from among the many received , of possible vasculitis which was presented by Bademain Jean Fabrice Ido from Burkina Faso . The afternoon s mall group interactive workshops led by the Faculty discuss ed cases brought by the course participants and faculty. Interesting intercultural discussion followed presentation of cases with severe stroke, contrasting the different approaches to breaking ba d news taken in Europe and Africa . The case discussions were, and the preference of many families followed i n the evening by a welcome reception, offered by the local organising committee. 

RTC Faculty and the Course participants
Plenary session
 Small group discussion

Movement Disorders and Dementia in Sub - Saharan Africa .
Njideka Okubadejo gave a comprehensive overview of the epidemiology and classification of movement disorders , David Riley covered the diagnosis diagnostic work - up and management of movement disorders. Raj Kalaria (UK) gave an ove rview of the dementias in SSA. For the Grand Round Case presentations, the mode rat ors were Amadou Gallo Diop and and the discussants were David Riley, Raj Kalaria and Njideka Okubadejo. The speakers emphasised the importance of clinical assessment and observation in the diagnosis and the limited value of costly imaging studies in dia gnosis. The cases were of a case of segmental dystonia presented by Emanuel Epunge Djonga from Democratic Republic of Congo and of Dementia in young woman by Mahamadi Oudraougo from Burkina Faso. The afternoon was again given over to case discussion works hops. 

The topic for day 3 was Spinal Cord Disorders in Sub - Saharan Africa. Augustine Charway Felli reviewed the epidemiology and classification, Riadh Gouider discussed the clinical presentation, symptoms and signs of spinal cord disorders and Osheik Sei di set out the diagnostic work - up and management from an African perspective . The s peakers highlighted the lack of community - based epidemiological studies, the frequency of traumatic spinal cord injury and tuberculous spinal disease and the need for long - term management of patients with spinal cord damage . For t he Grand Round Case presentations , the moderat ors were Wolfgang Grisold and Yomi Ogun , the discussants were Augustine Charway Felli and Riadh Gouider. Dr Razafindrazata from Madagascar presented a case of tuberculosis complicated by an intramedullary tuberculoma at T6 and Potts disease at L1 - 2 . Dr Patrick Feussouo from Burkina Faso presented a case of a case of multiple sclerosis. The afternoon was again given over to cas e discussion workshops . The course dinner was a lively affair; a highlight was the 
series of short speeches on their country’s characteristics and special attributes from a representative of each country attending the course. 

The topic for day 4 was Neur omuscular Disorders in Sub - Saharan Africa . Jean Kaboure gave an overview of the epidemiology and classification, Wolfgang Grisold spoke on the clinical presentations and Jean Michel Vallat on the therapeutic management with EMG examples . For the Grand Round Case presentations, the moderators were Osheik Seidi and Erich Schmutzhard, the discussants were Jean Kabore, Wolfgang Grisold and Jean - Michel Vallat . Dr Hiba Hassan Abugabal (Sudan) presented a case of hypokalaemic periodic paralysi s and Dr Yus u f Jamnagerwal l a presented a case of juvenile dermato - mysositis . The afternoon was again given over to case discussion workshops . 

The Grand Round discussions each day provided a forum to discuss how clinical reasoning should progress in a line ar fashion from clinical history, physical examination, clinical localisation of the neurological lesion, basic investigation and finally advanced imaging if available. T he trainees brought a great many questions that arose from their daily practice; thi s unique opportunity for them to ask the Faculty questions and to network with their peers from across the continent was something they really valued. At the end of each day, participants completed a short multiple choice exam on the topic of the day. The accumulated results revealed that the learning objectives had been ach ieved to a high level. Participants also completed an on - line feedback questionnaire. 

The meeting was organised to a very high standard, and clearly meets the need to build capacity in caring for people with neurological disorders in the African continent, where the burden of disease related to both communicable and non - communicable diseases of the nervous system is high . To meet this continuing need, t he EAN - led planning group met i n Ougadougou to plan the next course . The participants to the 9 th RTC were asked to list up to three topics of interest they would like to see addressed in a future RTC. From the compilation of the topics received, three that had the highest request were identified for the 201 8 RTC. This 10 th RTC will be held in M a dagascar in October 2018 . 

Given the very large numbers of questions fielded by the Faculty about stroke over the course of the RTC, I have no doubt that the su pport fro m WSO will prove to have been an extremely cost - effective investment that will help develop a cadre of stroke neurologists in Africa to tackle the e merging epidemic of NCDs there. 

RTC Course faculty 
Peter Sandercock , Erich Schmutzhard, Eveline Sipido 
Erich Schmutzhard, MD, DTM&H(Liv.) , 
Professor of Neurology and Critical Care Medicine 
Department of Neurology , 
University Innsbruck, Austria , Chair, EAN Task Force, 
Neurology and Africa 

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