The International Child Neurology Association: the first 25 years
Birth of child neurology in different parts of the world
In the late 1960s, a child neurologist from the Free Uni-versity of Brussels, Belgium, Dr. Sabine Pelc (1921–1989), (Fig. 1) perceived the need for a world-wide forum for neurologists whose focus was the care of children with neu-rologic conditions. In order to fill this need, she set about visiting various European and American countries in order to identify other child neurologists. I met her in 1969 when she visited the Neurological Institute of Columbia Presby-terian Medical Center in New York, where the National Institute of Neurologic Diseases and Blindness of the National Institutes of Health (NIH) had supported a training program for child neurologists since 1956 under the direc-torship of Dr. Sidney Carter. She had already identified a number of fully trained child neurologists in Europe, Japan and Latin America before coming to the USA.
In the United States, the NIH had recognized the need for physicians specially trained in the neurology of childhood in the mid-1950s, a decade after neurology had become a spe-cialty, independent from both psychiatry and internal medicine, and after neurology residency training programs had been established in major medical schools. Up to the mid-1950s there were no official training programs in child neurology in the USA. Most children with neurologic diseases were cared for by pediatricians or orthopedists interested in cerebral palsy, by adult neurologists interested in epilepsy, or by neurosurgeons who, besides children with brain tumors, hydrocephalus, or cranio-cerebral injuries, often treated those with medical neurologic problems. The level of care was uneven and there was little research on the neurologic diseases of children.
In 1956 there were less than a dozen full-time professors of child neurology and training was haphazard. For example, when the need for specialized care for children with neurologic conditions became evident in the early fifties, Dr. H. Houston Merritt, director of the Neurological Institute of New York, put Dr. Sidney Carter, an adult neurologist, in charge of the chil-dren’s service which had been started in 1934 by Dr. Ber-nard Sachs. Besides Dr. Carter, some of the pioneers in child neurology in the United States included Drs. Frank R. Ford and David B. Clark at Johns Hopkins Medical School in Baltimore.
In 1937 Dr. Ford had written a classic textbook of child neurology that went through six editions. At Boston Children’s Hospital Dr. Bronson Crothers founded child neurology in 1920 and was soon joined by Dr. Randolph Byers. The 1959 Crothers and Paine’s mono-graph on cerebral palsy remains a classic to this day. At the Massachusetts General Hospital in Boston, Dr. Philip R. Dodge assisted Dr. Raymond D Adams, celebrated professor of neurology and neuropathology, in running the child neu-rology service until he moved to St Louis in 1967 to spawn another school of child neurologists. At the University of Chicago, Dr. Douglas Buchanan, a Scot, joined the neuro-surgeon Paul Bucy in 1931.
As a medical student in Switzer-land in 1948 I devoured their 1939 book, written in collaboration with the neurosurgeon and neuropathologist Dr. Percival Bailey, which provides case histories of 100 consecutive intracranial tumors in children; this exciting book made me aware of the attractions of child neurology and contributed to my unswerving decision to become a child neurologist after I attended Dr. Ste´phane Thieffry’s teaching consultations in child neurology at the Hoˆpital des Enfants Malades in Paris in 1951.
By 1954, when I became a resident in neurology at the Neurological Institute, Dr. Carter had already trained one child neurologist, Dr. Marvin Lewis, who unfortunately had just died of a malignancy. Dr. Niels Low, then a pediatrician and a future president of ICNA, came to the Neurological Institute in January 1955. He spent a year of training with Dr. Carter, went to Salt Lake City as child neurologist (where in 1956 he showed me a ward of untreated adoles-cents with phenylketonuria) and returned to New York in July 1958 to complete his training in neurology and become eligible for the Board Examination in Neurology, which he and I (3 days from delivering my second daughter) took together in a major snow storm in December 1960.
From 1956 on, support from the NIH enabled Dr. Carter to train two child neurologists every year, and other medical schools with major neurology services to develop their training pro-grams in child neurology. By 1967 the American Board of Psychiatry and Neurology and American Board of Pedia-trics established criteria for eligibility for the dual Board Examinations in Pediatrics and in Neurology with Special Competence in Child Neurology. The criteria were 2 years of pediatrics, 1 year of adult neurology, and 2 years of child neurology to include a year of clinical hospital in- and out-patient work and a year combining further clinical work with such electives as EEG, neuroimaging, neuropathology, or research.
By 1970 the number of fully trained and qualified child neurologists in the USA and Canada was large enough for them to feel the need for their own society. The Child Neu-rology Society (CNS) was founded at its first meeting in Hamilton, Ontario in 1972 under the presidency of Dr. Ken-neth Swaiman, also one of the founding members of the ICNA. At its inception the CNS had 223 members; it cele-brated its 25th anniversary in 1997 and its membership in 1998 is 1290.
In Canada Dr. J Preston Robb was in charge of neurol-ogy at the Children’s Hospital of Montreal and collaborated with Dr. Wilder Penfield in epilepsy surgery. His service was the nidus for training a large number of child neurolo-gists particularly interested in epilepsy and genetic disorders. Dr. John Stobo Prichard (1914–1986), who was born in Wales but emigrated to Toronto in 1950, was the founding president of ICNA. He trained many child neurologists for underdeveloped and commonwealth coun-tries, many of whom developed child neurology services of their own. Another emigrant from the UK, Dr. Henry Dunn, is described as the father of child neurology in British Columbia.
Child neurology was also developing in a number of European countries. In the United Kingdom, Dr. Ronald C. Mac Keith, a pediatrician whose focus was the multi-disciplinary care of children with cerebral palsy, from 1958 on organized bi-yearly meetings of the Spastics Soci-ety’s Little Club in Oxford; the meetings were kept rela-tively small, though international, so as to foster meaningful discussion. These were a first European venue for the meet-ing of European and American child neurologists; they led to the founding of the European Federation of Child Neu-rology Societies in 1970, which held the first of its bi-yearly meetings in Sweden in 1973. It was supplanted by the Eur-opean Pediatric Neurology Society which had its first meeting in Eilat, Israel in 1995. Other pioneers of child neurology in the UK were Dr. Thomas T.S. Ingham of Edin-burgh and Dr. Neil Gordon of Cheshire.
In 1958 Dr. Mac Keith started the publication of the Little Club Clinics in Cerebral Palsy, a monograph series that, with volume 61 in 1976, became the Clinics in Developmental Medicine. One of their most recent (1998) books is the second edition of ICNA’s Dr. Jean Aicardi’s textbook Diseases of the Ner-vous System in Childhood. Also in 1958, Dr. Mac Keith had launched the first volume of the Cerebral Palsy Bulletin which, in 1962, became Developmental Medicine and Child Neurology, one of the major international journals devoted to our specialty.
In Holland Dr. Hans Prechtl, in Germany Dr. Albrecht Peiper, and in France, Dr. Andre´ -Thomas had spearheaded the neurologic examination of neonates, studies that Drs. Claude Dreyfus-Brisac and S Saint-Anne Dargassies were to extend to premature and high risk infants. Besides Dr. Ste´phane Thieffry, and Dr. Gilles Lyon who was to move to Brussels, Dr. Jean Aicardi, another future president of ICNA, was a young child neurologist in Paris in the 1950s; he was to direct the child neurology service at the Hoˆpital des Enfants Malades in Paris for many years and to train scores of child neurologists from around the world.
In Belgium Dr. Ludo van Bogaert had been conducting clinical/pathological studies of CNS diseases of childhood in the Bunge Research Institute in Antwerp. In Brussels Drs. Sabine Pelc and Gilles Lyon practiced and taught clinical child neurology. Dr. Lyon cre-ated with his young colleague Dr. Philippe Evrard one of the premier academic child neurology services of Europe at the Cliniques Universitaires St. Luc.
In The Netherlands, the pioneers were, besides Dr. Prechtl, Dr. Jacobus Will-emse in Utrecht, Dr. Paul Fleury in Amsterdam and Dr. Ritske LeCoultre in Groningen, the future second president of ICNA whose father-in-law was the famous Swiss–Dutch composer Frank Martin.
In Germany, Dr. F J Schulte was the founding editor of Neuropa¨diatrie in 1969 (which became Neuropediatrics in 1980) to which Drs. Wilhelm Mortier and H. Doose, as well as Dr. Kurt Jellinger from Austria, were early contributors. Other early German child neurologists were Drs. Dieter Schaeffer, Folkar Hanefeld and Gert Jacobi.
In Italy Drs. Giovanni Cavazutti and Maurizio De Negri and in Spain the young Drs. Emilio Fernandez Alvarez and Ignacio Pascual Castroviejo were among the pioneers in our field, as were in Scandinavia Dr. Sven Brandt of Denmark, and Drs. Ingrid Gamstorp and Bengt Hagberg of Sweden. Drs. Hagberg and Aicardi will be remembered, among their many other contributions, for putting Rett syndrome on the map.
In Asia and Oceania Dr. Yukio Fukuyama of Japan, another future president of ICNA, was the chief mover in the development of child neurology. His early interest in the infantile and childhood epilepsies and his description in 1960 of the congenital muscular dystrophy that bears his name led to his appointment as Professor and Chief of the Division of Neurology at the National Children’s Hospital in Tokyo in 1965. Two years later he became Professor and Chairman of the Department of Pediatrics of the Tokyo Women’s Medical College where he trained dozens of future child neurologists for Japan and other Asian coun-tries.
The Tokyo Child Neurology Study Group had been meeting for several years when the Japanese Society of Child Neurology held its first meeting in 1961, with over 1000 members. He spearheaded the founding of the Asian and Oceanian Association of Child Neurology in 1983 in Taipei, organized by one of his former students, Dr. Yu-Zen Shen of Taiwan. Dr. Fukuyama was president of the first two International Symposia on Developmental Disabilities in Tokyo in 1977 and 1979, and founded the Japanese child neurology journal No to Hattatsu in 1969 and the interna-tional journal Brain and Development in 1979. Like Dr. Aicardi, Dr. Fukuyama traveled widely throughout the world and played a major role in the development of the international pediatric neurology community. In China, Drs. Zuo Chi-Hua and Wu Xi-Ru organized a training sym-posium on child neurology in Beijing in 1988.
Dr. Ian Hop-kins of Australia, trained by Dr. David Clark, brought child neurology to Australia in the 1960s, as did the late Dr. S.K. Hendarto and Dr. S.M. Lumbantobing to Indonesia and Dr.Pongsakdi Visudhiphan to Thailand. A pediatrician in Bombay, India, Dr. Prabhakar Udani, was a long term student of tuberculosis of the central nervous system and of the consequences of prenatal and postnatal malnutrition on brain development. The founder of child neurology in Israel was the late Dr. Naomi Amir. She created modern in-and out-patient services in the venerable Bikur Cholim Hospital, which later moved to the Shaare Zedek Hospital, both in Jerusalem. She organized satellite neurology clinics in several Arab villages, and started a preschool in the hospital for children with a variety of neurologic handicaps which provided her and her trainees the opportunity for intensive and long-term evaluation of the efficacy of various interventions.
In Latin America, some of the pioneers of child neurology were Drs. Antonio Lefe`vre and Olavo Nery and the younger Drs. Aron Diament and Saul Cypel in Brazil, Dr. Maria Antonietta Rebollo in Uruguay, and Drs. Hector Vazquez and Bernabe Cantlon in Argentina where Dr. Aquiles Gar-eiso had started to practice child neurology in the Hospital de Nin˜os in the 1920s. These pioneers founded child neu-rology societies in each of their countries, as well as a Latin American Society in 1978, which indicates that they had succeeded in training a core of younger colleagues, together with others who returned from training in Europe, the USA or Canada. In Monterrey, Mexico Dr. Rau´l Caldero´ n Gonza´lez, who had trained with Dr. David Clark in Balti-more in the 1960s, founded a modern neurologic multidis-ciplinary consultation and rehabilitation center for children with cerebral palsy, learning disabilities, epilepsies and other neurologic problems.