ICNA President-Elect Elections 2016

Elections for the ICNA President-Elect 2016 will be held soon. Below are the candidates for 2016 ICNA President-Elect in no particular order. 

	Michael V. Johnston, M.D. Executive Vice President and Chief Medical Officer, Kennedy Krieger Institute Kennedy Krieger Institute 707 N. Broadway Baltimore, MD 21205 Bio & Candidate Statement
	Professor Joanne M. Wilmshurst MD Senior Specialist in Paediatric Neurology, Head of Paediatric Neurology and Neurophysiology, Senior Lecturer, School of Child and Adolescent Health, Red Cross Children’s Hospital, University of Cape Town South Africa Bio & Candidate Statement

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Michael V. Johnston, M.D Executive Vice President and Chief Medical Officer, Kennedy Krieger Institute Kennedy Krieger Institute 707 N. Broadway Baltimore, MD 21205

Mike is the Chief Medical Officer and Executive Vice President of the Kennedy Krieger Institute in Baltimore, Maryland, USA where he holds the Blum Moser Endowed Chair of Pediatric Neurology, and he is a Professor of Neurology and Pediatrics at the Johns Hopkins University School of Medicine. He is a member of the ICNA Executive Board, and head of the research committee, and he has been actively involved in numerous ICNA meetings as a presenter, invited speaker and/or member of scientific selection committee since 1990. He received the John Stobo Pritchard Research Award from ICNA at the 1990 meeting in Tokyo and he has been selected to receive the Frank Ford Lecture Award from ICNA at its meeting in 2016 in Amsterdam. He has also received the Javits Neuroscience Investigator Award from the NIH, the Bernard Sachs Award from the Child Neurology Society and he served as the Associate Editor for Child Neurology for the Annals of Neurology from 1999-2005.

After undergraduate study at Franklin and Marshall College and medical school at the University of Pittsburgh, he trained as a resident in pediatrics and pediatric neurology at Johns Hopkins Hospital and he completed two years of basic neuroscience and neuropharmacology at Hopkins. At the completion of his training, he became an Assistant Professor of Pediatrics and Neurology at the University of Michigan Medical School where he practiced inpatient and outpatient child neurology and started a laboratory to focus on mechanisms of injury and neuroprotection in the developing brain.

His group was one of the first to use the term “neuroprotection” in the context of perinatal hypoxic-ischemic brain injuries, which were widely considered to be untreatable at the time. His research in collaboration with Faye Silverstein and John McDonald discovered that the NMDA glutamate channel blocker MK-801 could completely block hypoxic-ischemic brain injury in neonatal rats when given prior to injury. This was one of the discoveries that led to the development of therapeutic hypothermia for infants with asphyxia. He was promoted to the rank of full Professor at Michigan in 1987 and the next year he returned to Hopkins as a Professor and in his current roles at Kennedy Krieger.

He is clinically very active seeing inpatients and outpatients at Kennedy Krieger and in the Johns Hopkins Bloomberg Children’s Center. He is one of the founding members of the Neuroscience Intensive Care Nursery (NICN) directed by Dr. Frances Northington in the Bloomberg Center at Hopkins. His group in collaboration with the Kannan Laboratory group at Hopkins recently received funding from the Cerebral Palsy Foundation in the US to scale up the use of dendrimer nanoparticles to deliver targeted anti-inflammatory therapy for infants with periventricular leukomalacia.

Mike has also collaborated with Dr. Sakku Naidu at Kennedy Krieger and Johns Hopkins on the role of abnormal glutamate metabolism in the pathogenesis of Rett syndrome. His group was the first to report that NMDA glutamate receptors are elevated in postmortem cerebral cortex from young girls with Rett syndrome less than 8 years of age but are reduced in brain tissue from older girls. Drs. Raili Riikonen and Sakku Naidu also showed that levels of glutamate are paradoxically elevated in CSF and brain tissue of girls with Rett syndrome. Based on these data, the US Food and Drug Administration awarded Dr. Naidu a grant to carry out a clinical trial of the effect of dextromethorphan as a competitive antagonist of NMDA receptors on verbal and cognitive function in girls with Rett syndrome. Additional trials are being planned by other groups using more powerful NMDA glutamate receptor antagonists such as ketamine.

Mike’s research has been funded by NIH grants and non-federal awards since 1982 and he has published more than 290 peer reviewed papers in journals and more than a 100 reviews and other educational articles. He is the Editor-in-Chief of Neurobiology of Disease, 2nd edition published by Oxford University Press and he is a Co-Editor of Aicardi’s Diseases of the Nervous System, 4th edition, both of which will be published in 2016.

He is one of the primary teachers and mentors for the Neurodevelopmental Disabilities and Child Neurology residents at Kennedy Krieger Institute and Johns Hopkins Hospital. Mike is excited about the potential for new treatments for pediatric neurological disorders and the impact these treatments could have throughout the world. To learn about new developments in global clinical research, he recently completed the Harvard Medical School Global Clinical Scholars Research Training Program (GCSRTP) in the 2013-2014 academic year.

President-Elect statement: 

Overall Mission statement

The mission of ICNA is to promote excellence in clinical care, education and research in child neurology internationally. One of our special goals should be to hasten the translation of new knowledge in developmental neuroscience into therapies that can reduce neurological disability in low and middle income countries.
The vision of ICNA should be to become the pre-eminent global medical organization for translational neuroscience in infants and children over the next decade.

My qualifications for the role of President-Elect of ICNA

It would be a great honor for me to be elected as the President-Elect of ICNA, and I feel that my experiences in academic medicine, administration and research in pediatric neurology make me well qualified for this role. My research on brain injury and neuroplasticity, cerebral palsy and related neurological disorders are very relevant to disorders in the developing world, and I feel that I can effectively lead the expansion of the educational and clinical research missions for ICNA .

My executive skills as a senior executive officer at the Kennedy Krieger Institute and running a research program, and as a Professor at Johns Hopkins are strong qualifications for the ICNA presidency. These roles have made it necessary for me to apply successfully for numerous grants from NIH and private grants as well as to manage funds, which will also be important for my role in ICNA. I also have extensive experience as a speaker and advocate for pediatric neurology, especially for research, in many countries of the world, and this ability will be important to approach potential donors and organizational funders for ICNA projects.

Past experiences and contributions to clinical, educational and research goals of ICNA

ICNA has demonstrated its ability to hold well attended high quality scientific meetings as well as regional teaching meetings that highlight innovative neuroscience that is relevant to reducing the impact of neurological disorders on children. I have attended most of the ICNA meetings since 1990 and I have been a speaker at several ICNA educational meetings including recent visits to Mexico, Sri Lanka and India. In addition to my involvement with ICNA I have spoken about child neurology scientific topics in many countries as an invited speaker throughout the world including five visits to various regions of India. My research on neuroprotection for asphyxia, cerebral palsy, and brain plasticity after injury are very relevant to childhood disorders in the developing world.

Current initiatives and advocacy to Expand ICNA’s global networks

ICNA has also created many innovations over the past decade including an outstanding website that highlights new knowledge and the Journal of ICNA (JICNA) which has great potential. The initiative of Drs. Ken Mack and   Harry Chugani to eliminate dues has resulted in strong growth of the membership to more than 2000. Dr. Ingrid Tein’s innovative program of Seed Grants for Global Burden of Disease Research Trainee Fellowships has also been very successful. The book series on topics in child neurology published by Mac Keith Press have also been very useful. All these programs are important and should be expanded, and it will be important to expand fund raising to support these programs over the next decade.

Proposed future directions: The ICNA Global Pediatric Brain Network

I believe that ICNA is mature enough to create its own “ICNA Global Pediatric Brain Network.” A recent special issue of Nature published in November 2015 entitled “Brain Disorders Across the Lifespan” highlighted support from the Fogarty International Center at NIH for global research for Low and Middle Income Countries (LMICs) and the role of their Global Brain Program. The Fogarty Center has also connected with several other similar organizations from Canada (Grand Challenges Canada-Saving Brains), the EU Tropical Diseases Program, the UK Welcome Trust, the UK Medical Research Council, the US Agency for Overseas Development and the Bill and Melinda Gates Foundation.

The report highlights several pediatric neurological disorders including neonatal encephalopathy and cerebral palsy, malaria, epilepsy, encephalitis, meningitis, traumatic brain injury, fetal alcohol syndromes and genetic encephalopathies that have a greater burden in LMICs compared to high resource countries. The series of articles also emphasized that a new metric called “age-standardized estimated disability adjusted life years (DALYs)” provides a better way of measuring the enhanced impact of neurological disorders on children in LMICs.

ICNA would be well equipped to establish such a program and the range of organizations that support these programs indicate they could also be a source of financial support for ICNA . Several members of ICNA including Charles Newton from Oxford-Kenya (malaria, epilepsy), Pratibha Singhi (CNS infections) from Chandigarh, India, Helen Cross (epilepsy) from London, as well as others have published extensively and in high profile journals such as the New England Journal on pediatric neurological disorders in LMICs.

At a personal level, I am interested in a global research network that could support a clinical trial for a cost-effective therapeutic hypothermia treatment device that we developed with an undergraduate bioengineering team at Johns Hopkins (Kim et al, Medical Devices: Evidence and Research 2013:6 1-10). It is clear that a much greater proportion of cerebral palsy in LMIC countries is due to asphyxia compared to high resource countries, and our device, which does not use any electricity, could play a role in reducing the burden of CP in these countries.

Nevertheless, this proposal is not focused on my personal project but on organizing a network of centers around the world dedicated to pediatric neurology translational research with ICNA being the catalyst. Accordingly I envision the ICNA Global Pediatric Brain Network as a new initiative that expands current links established by ICNA, capitalizes on the current intellectual and organizational assets of ICNA and could result in great benefits for children and enhanced financial support for ICNA’s programs.

Summary statement

In summary, it is a great honor to be nominated for the post of President-Elect of ICNA, and I am enthusiastic about this possibility if I am elected. I feel that I am well qualified through experience and professional interest to take on the responsibilities of leading this outstanding organization, and if elected I would work with the Executive Committee and membership to strengthen and expand its existing successful programs.

If there is support for the idea, I would also propose that we organize the “ICNA Global Pediatric Brain Network” and aggressively seek funding from international organizations to support new global clinical research initiatives proposed by our membership.

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Professor Joanne M. Wimshurst MD Senior Specialist in Paediatric Neurology, Head of Paediatric Neurology and Neurophysiology, Senior Lecturer, School of Child and Adolescent Health, Red Cross Children’s Hospital, University of Cape Town South Africa

Executive Summary

• Current Officer position: Secretary of the ICNA (2014-2018)
• Clinical / University position: Head of Paediatric Neurology and Neurophysiology, Red Cross Children’s Hospital, Cape Town, South Africa
• Key areas of interest for the position of President of the ICNA
  • Expanding and supporting the membership, especially trainees and newly qualified child neurologists.
  • Offering more to the membership
  • Promoting new and established Educational programs
  • Developing training program initiatives
  • Collaborating with other societies and associations to the mutual benefit of the members of both
  • Acting as a conduit to promote research capacity between different groups, e.g. cohorts of children with rare conditions, linking centres with advanced investigative capacity to centres with large collections of undefined cases.
  • Promoting the benefits of the information resources available through ICNApedia, enabling members to readily access up-to-date resources in child neurology.
  • Making all of the biennial congresses a huge success and a focal point to raise the international recognition of the ICNA.

Biosketch

Qualifications

I am Head of Paediatric Neurology at the Red Cross War Memorial Children’s Hospital, University of Cape Town, in South Africa. This is the largest children’s hospital in sub-Saharan Africa and is a university affiliated, tertiary hospital, which also runs an accredited training program in paediatric neurology. A wide spectrum of the neurological diseases which occur in children from resource poor countries (RPC) are managed here.

I have trained and worked in 3 continents (Europe, Australia and Africa). This has provided me with insight into the needs of diverse population groups. In my centre, we aim to provide optimal care but due to limited resources must justify our practice based on evidence-based data and international guidelines. RPC often lack the capacity to follow international guidelines. I am part of a number of working groups devising epilepsy guidelines and am specifically ensuring these are either relevant to RPC or reflect essential clinical practice. Introducing and adapting guidelines, which may not yet be viable in many centres with limited resources, allows the centre to use them to lobby for the development of tools deemed essential to child health care.

My research areas of interest, and peer reviewed publications (n=65), include epilepsy in childhood, the neurophysiology of childhood disorders, neuromuscular disorders of childhood, demyelinating diseases in childhood, neurocutaneous disorders, neuro-infectious diseases (e.g. HIV, tuberculosis) and access to services and training in Africa. I completed my MD thesis on peripheral neuropathies in children and retain a particular interest in this area.

My activities within Africa include positions on the executive boards of the Paediatric Neurology and Development Association of Southern Africa (PANDA-SA), the African Child Neurology Association (ACNA) and the Commission of African Affairs (education officer), which is the African branch of the International League Against Epilepsy (ILAE). My global activities are related to my position as Secretary of the International Child Neurology Association (2014-2018). Also, I am chair of the Commission on Paediatrics for the International League Against Epilepsy (ILAE). Within this group, I oversee various Task Forces addressing the co-morbidities of epilepsy, advocacy for children with epilepsy and adapting existing guidelines for neonates, infants and children with epilepsy to make them relevant at a local level.

In addition to my position as Head of Paediatric Neurology at Red Cross War Memorial Children’s Hospital, I am chair of a training program for doctors in Africa, the African Paediatric Fellowship Program (APFP) http://www.scah.uct.ac.za/scah/apfp. Limited funding is available to train doctors in specific skills identified by the referring centres. These specialists return to their centres and have continued to build services based on their training. Through this work and my involvement with other African associations, I have built up a network of contacts across Africa who are involved in the management of children with neurological disease. This group is working towards improving training across the continent, identifying functional and possible training units to complement the one I currently run.

Statement of intent for the position of President of the ICNA

During my time serving a second term as secretary of the ICNA (2014-2018), I have promoted the membership by looking at new angles to make becoming a member beneficial and by simplifying the joining process. The free membership has been a great success, expanding the currently membership from around 200 to 2000 over the last 4 years. I would encourage free membership to continue and would reinforce revenue generation through the successful outcomes of the biennial ICNA Congresses.

The ICNA should be an inclusive organisation which reaches as many doctors as possible who are working in the field of child neurology. The association needs to listen to its members and to remain aware of and enhance ways it can help practitioners attain excellence.

If elected president of ICNA, my agenda would include the promotion of education and training, building research collaborations and the promotion of working with other associations and societies who have complementary interests to the ICNA. These are not separate items, there is and should be inevitable overlapping.

The ICNA has a strong history of supporting educational programs across the globe. It is most well known for the congresses (the ICNCs) which now occur every 2 years. I have been part of a sub-committee on the board to devise guidelines to enhance equity in the bids to hold future ICNCs. I have been part of the ICNA support committees for the 4 most recent congresses. Beyond the major congresses, the whole board meet once to twice a year typically in centres where educational input from the EB would be beneficial – since joining the EB, I have organized the EB meetings and lectured at these in Europe, Asia, Oceania, Central and South America, namely in Kiev, Prague, Bali, Brisbane, Kaunas, Iguazu Falls and Mexico City.

Networking with large groups of health care works and understanding practice in different regions is very useful. Smaller targeted educational support activities should also continue and I would support selected members of the board being funded to attend other national meetings as invited speakers. Over the same time period, I have been part of meetings in North America, Uganda, Kenya, South Africa, Morocco, Vienna, Brussels, Ghana, China, Japan, Sudan and Tunisia. Invited speakers need not be restricted to board members – if an association / society notifies the ICNA that it would benefit from the input of a particular ICNA member, then the association could be approached to fund the travel of that member.

Through the ICNA, I have helped to organize 3 focus group meetings. The first was in February 2012 in Kampala, Uganda on the topic of epilepsy in children. Key representatives from 19 African countries attended. This resulted in 2 further such meetings in Cape Town, South Africa (2013), which focused on cerebral palsy, and in Ghana (2014) which focused on autism. Each meeting resulted in peer reviewed publications, as well as further collaborative research and educational projects between the working group and with the international colleagues the group are networking with. We did not use a conference management team and the speakers funded their own travel. Various members of the ICNA board contributed to the program as well as non-board ICNA members. These meetings are exciting not just for achievement of the expected outcomes but also for the co-support from other organizations.

The World Federation of Neurology provided significant funding to the first meeting, as did the NIH. Other organizations have provided top-up funds: eg. the Child Neurology Society, the Japanese Child Neurology Society and there were also a number of personal donations. Speakers from the International League Against Epilepsy have also been part of the programs. There is no reason that these working group templates cannot be adapted for centres outside Africa and I would encourage this to continue.

There is huge variation in the training schedules undertaken internationally. Consensus in the ideal aspects of training and identification of how the ICNA can promote this are areas which I will advance, by specifically identifying training posts, through to short term attachments and by supporting “visiting experts”. In my centre, we operate an African Paediatric Fellowship Program whereby doctors from different parts of Africa are trained either as fully accredited child neurologists or in the specific skills they need to function in their centres (e.g. EEG interpretation). These doctors return home and continue to build capacity in their own institutes.

Research is an essential tool to gain knowledge as to how to optimise best practice. Too often devising guidelines cannot be consolidated due to lack of class 1 data. This is often because of the lack of large study populations. Using the ICNA as a conduit to pull interested groups together should be developed further. Rare conditions can be pooled. Regions without the capacity to fully study conditions should be able to collaborate with international centres which have these resources i.e. one site provides the material while the other provides the analysis in a mutually beneficial study.

Clinicians often lack the resources to undertake or complete research projects. I would encourage expansion of the support in this area for ICNA members. There are members of the association with huge knowledge and skill in this area who would be willing to facilitate support of clinicians who are eager to develop research in their setting. I would like to promote the role of the Journal of the ICNA (JICNA) and to encourage submissions. This open access on-line resource will soon be available as a Medline resource with the intent that uploaded data will be openly available to all practitioners. 

I strongly support interlinking and collaborating with other major organizations. It is is important to complement what other associations do and to avoid duplication, while looking for joint projects and ways of supporting dual activities – especially in the areas of training, education and research. World Neurology Federation has invited the ICNA to be part of a neurosummit group of associations focused on neurological diseases. 

Following on from the concept of using the internet to stay up to date, it is clear that Web-based learning is becoming an essential and effective part of improving skills across the world and especially so in Africa. This constant updating of technology and access to the technology is an important part of “moving with the times”. Current trainees in neurology are a different breed to those of previous years. This new breed are “technosavvy” and require resources to keep up with the demands of current practice. They expect ready and immediate answers to diagnostic and management challenges. A constant challenge is how to sift through the multitude of data one is overloaded with, how to be sure it is truly evidence-based and represents good clinical practice, whether the recommendations reflect what is real practice in most parts of the world and so on.

By creating a new committee, I would propose that the ICNA undertakes a role to fulfill this need for child neurologists to help them to sift through the huge amount of internet data to find the truly useful resources and publications. To address the current guidelines already well devised by many associations e.g. the International League Against Epilepsy, and to put this information in an accessible format for the speedy access that today’s doctors require. As such ICNApedia has become one of the most valuable resources for the association.

The trainees in child neurology and junior consultants are the future leaders of the association and the speciality. It is essential for the ICNA to listen to their needs and requests and to adapt the association accordingly. In 2015 the concept of ICNA future leaders was broached at the board meeting and subsequently a formal working group will meet at the ICNC 2016 in Amsterdam. This group will be tasked with identifying areas in need of facilitation inclusive of keeping up to date, examinations skills, publishing and career development options.

The pooled skills and knowledge of a typical EB is a phenomenal resource and in the position of President I would aim to bring the board together with clear targets and analysis of outcomes to promote child health at an international level. Especially I aim to inspire young training / newly qualified child neurologists to want to be involved with the ICNA.

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