Prof. (emeritus) Klaus V. Toyka, FEAN, EAN Honorary Member, Würzburg, Germany
As a co-founder and former president of the European Neurological Society (ENS*) I had the pleasure of being invited by the EFNS* (Prof. Detlev Kömpf) in 2011 for a Regional Teaching Course (RTC) in Yekaterinburg, Russia. Prof. Kömpf served on the board as the representative for RTCs of the sister society EFNS. I learned that RTCs constitute a very efficient format for communication and advancing knowledge in Eastern European countries. In Yekaterinburg, located at the border between Europe and Asia, over 250 junior and more senior neurologists joined the RTC sessions. Some of the participants had travelled up to 1200 kilometres to the west from as far east as Novosibirsk. Dr Elena Lebedeva was our local host back then, and she is still very active in the EAN.
The newly formed EAN kept this very attractive course format, and in 2016, another RTC, was organised in Kutaisi, Georgia by Prof. Zaza Katsarava, a native of Georgia who had moved to the University of Essen, Germany and was then Chief of the Neurology Department at a Hospital in Unna, Germany. His late mother, Prof. Dodo Shubladze, was a famous neurologist and one of the admired academic teachers of Madona Sekhniashvili. The RTC was planned in collaboration with the EVEX-Hospital in Kutaisi, Georgia. Besides the lectures and presentations in the morning about headache, stroke and MS, epilepsy and mental health, we organised the three-day afternoon special hands-on workshops in neuromuscular disorders and clinical electrophysiology with Prof. Katsarava and Dr Sekhniashvilki. The morning sessions were attended by almost 200 participants, and the afternoon workshops by about 100 neurologists from Georgia and Azerbaijan. Two Georgian neurologists specialised in this field agreed to assist in this course: Madona Sekhniashvili and Gvantsa Giorgadze. The RTC was appreciated by the participants at large and so was the special course on EMG.
This EAN RTC was followed by a separately organised Teaching Course by invitation from Evex Hospital Group, Georgia in 2018, again with support from Prof. Katsarava. The electrophysiology course was organised by Prof. Karlheinz Reiners and Prof. Toyka, both at the Department of Neurology, University of Würzburg. Prof. Stephan Zierz, University of Halle, Germany joined the faculty as an expert in myology. This time Madona Sekhniashvili, Gvantsa Giorgadze, and Khatia Gvantseladze, participated as faculty supporting the teaching and examination of patients. This course had 22 participants from Georgia.
In 2019 the same faculty and Dr Gvantseladze were invited by the State Medical University of Baku, Azerbaijan, to hold another teaching course organised by Dr. Marziyya Mammadova, hosting about 45 participants in their country.
The outstanding contributions by Dr Sekhniashvili to the RTC in 2016 led to the invitation to the Neurology Department, University Hospital in Würzburg in 2017. Dr Sekhniashvili applied for an EAN Clinical Fellowship which was granted, allowing her to attend advanced courses in Neuromuscular Disorders and Clinical Electrophysiology.
In her Fellowship Report to the EAN, Dr Sekhniashvili stated about her visit to Würzburg, “I could extend my knowledge in my field of interest during the six-week EAN Fellowship. It meant a great chance for me to observe numerous aspects of electrophysiology, for gaining experience in making the diagnosis in rare disease and in learning about general management of patients with neuromuscular disorders…. It was the best opportunity I have ever had before to learn how the full spectrum of neurophysiologic tests is performed, interpreted and integrated in the clinical point of view. This fellowship definitely increased my interest in pursuing an academic career in NMD in my home country.”
Following the EAN fellowship and the further two courses Dr Sekhniashvili decided to engage in a research project investigating sepsis-associated critical illness neuromyopathy (CIPNM) and to apply for a binational (Georgian-German) advanced career PhD programme at the Tbilisi State Medical University in Tiflis, Georgia. The application for a one-year research fellowship in Germany was granted by the German Academic Exchange Service (DAAD) at the Leipzig University Medical Center (EAN members Docent Petra Baum and Prof. Joseph Classen). Research work could not be started before October 2021 due to the pandemic-related delay. The Comprehensive Sepsis Center, Dresden-Kreischa, cooperated in the project. Prof. Toyka was the German academic mentor.
In her research work Dr Sekhniashvili discovered and described a novel electrophysiological abnormality in patients with CIPNM. In essence she had noticed that even completely missing nerve and muscle compound action potentials are mostly not due to nerve-muscle degeneration but rather implicate a functional defect. After eleven months at the Intensive Care Units in Leipzig and Kreischa a first publication in the international journal Clinical Neurophysiology was published in September 2022, titled Temporary reversal of nerve and muscle dysfunction by serial electrical stimulation in critical illness neuromyopathy. A second publication in the journal Clinical Neurophysiology Practice is under review, titled Temporary reversal of nerve and muscle dysfunction in critical illness neuromyopathy: reproducibility and variability. Two further sub-studies are in preparation.
After returning home in the autumn of 2022, Dr Sekhniashvili received a university docent post at the New Vision University and continues her advanced studies within the PhD programme at the Tbilisi State Medical University, both in Tiflis, Georgia. The advanced doctorate degree mentors Prof. M. Janelidze, Tbilisi, and Prof. Toyka join efforts to finish the binational PhD programme by 2023.
Moreover, during the SARS-CoV-2 pandemic, Dr Sekhniashvili translated the 4th edition of the e-book Neurological Examination for Neurologists in Training into Georgian. It includes new movies and was inaugurated and licensed to Georgian neurologists in 2021.
With our report we would like to show how stimulating such exchange activities can be part of our ongoing effort to harmonise neurology teaching and knowledge across Europe and beyond. We encourage other EAN member societies to organise such a regional teaching course (RTC) in their country with the help of EAN and the Head Office team. In Georgia, for sure, application papers for a new RTC in 2023 are in preparation.
Prof. Klaus V. Toyka, FEAN
EAN Honorary Member and EAN Archivist
2016 EAN RCT stroke faculty: M Jauss, K Toyka, M Pezzella, Z Katsarava, M Vosko 
2016 EMG Course, Kutaisi 
2016 RTC faculty and local hosts, Katsarava, Jauss, Straube, Mayer, Toyka, Janelidze, Siva, Ashina, Vosko 
2018 Tbilisi EMG Course, Drs Giorgadze, Gvantseladze, Toyka, Sekhniashvili 
2018 Tbilisi EMG Course, Profs Reiners and Zierz 
2019 Baku EMG Course, Drs Sekhniashvili, Zierz, Gvantseladze, Toyka, Giorgadze 
2019 Baku EMG Course, M Sekhniashvili 
MS Research, M Sekhniashvili, Leipzig 2022 
Temporary facilitation phenomenon after slow electrical stimulation of the tibial nerve with rising CMAP amplitudes 
Leipzig 2022, K Toyka, M Sekhniashvili, and Docent Baum
*More about ENS, EFNS and the foundation of the EAN can be found in the Archive
