The 9th Regional Teaching Course (RTC) in Sub-Saharan Africa 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 Milogo, 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 Compaore”.
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 Neurology
- 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 could 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 Department as potential course participants; these 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 Cissé, Dean of the University of Ouagadougou, Prof. Claudine Lougué, Director of the Faculty of Medical Sciences of the University of Ouagadougou and Prof. Erich Schmutzhard, Director of the RTC. Prof. Cissé welcomed all to Burkina Faso and was 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. Prof 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, one 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 Cissé, 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:
– Movement Disorders and Dementia
– Neuromuscular diseases
– Spinal Cord diseases
Faculty from Africa, Europe and America 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 Stroke section was Amadou Gallo Diop (Senegal), Jose Ferro (Portugal), Peter Sandercock (UK), Yomi Ogun (Nigeria), for Movement Disorders and Dementia was Njideka Okubadejo (Nigeria), David Riley (USA), Raj Kalaria (UK), for Spinal Cord Disorders was Augustine Charway Felli, (Ghana), Riadh Gouider (Tunisia), Osheik Seidi (Sudan) and for Neuromuscular Disorders was Jean Kaboure (Burkina Faso), Wolfgang Grisold (Austria) 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 small group interactive workshops led by the Faculty discussed cases brought by the course participants and faculty. Interesting intercultural discussion followed presentation of cases with severe stroke, contrasting the different approaches to breaking bad news taken in Europe and Africa. The case discussions were, and the preference of many families followed in the evening by a welcome reception, offered by the local organising committee.
RTC Faculty and the Course participants
The topic for day 2 was 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 overview of the dementias in SSA. For the Grand Round Case presentations, the moderators 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 diagnosis. 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 workshops.
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 Seidi set out the diagnostic work-up and management from an African perspective. The speakers 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 the Grand Round Case presentations, the moderators 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 case 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 Neuromuscular 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 paralysis and Dr Yusuf Jamnagerwalla 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 linear fashion from clinical history, physical examination, clinical localisation of the neurological lesion, basic investigation and finally advanced imaging if available. The trainees brought a great many questions that arose from their daily practice; this 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 achieved to a high level. Participants also completed an on-line feedback questionnaire.
RTC Course faculty
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, the EAN-led planning group met in Ougadougou to plan the next course. The participants to the 9th 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 2018 RTC. This 10th RTC will be held in Madagascar in November 2018.