ILAE President's midterm report

Authors

Errata

This article is corrected by:

  1. Errata: ERRATUM Volume 49, Issue 8, 1486, Article first published online: 28 July 2008

The “Gray Matters” section of Epilepsia provides a forum for the Journal's owner—for almost 100 years—the International League Against Epilepsy (ILAE). As the ILAE's centenary is approaching, and as we become involved with the project of documenting the organization's and the Journal's history, we have come to regret that the modern Epilepsia provides little information about the ILAE's agenda and development. The Editors-in-Chief believe that reports from the ILAE President in the Gray Matters section would be instrumental in improving this situation in the future.

This first report, in what will hopefully be a regular series of messages, is a midterm report about the first 2 years of the present Executive Committee (EC), which was elected in 2004 and 2005 for the period 2005–2009.

The Executive Committee

According to our constitution, the EC includes three types of officers: six elected (President, two Vice Presidents, Secretary General, Treasurer, and the Immediate Past President), three ex officio (the President, Secretary General, and Treasurer of the International Bureau for Epilepsy, IBE), and two appointed (Editor-in-Chief of Epilepsia and Information Officer). As a result of the last elections, all elected officers came from either Europe or North America, a situation which seemed paradoxical at a moment when the ILAE had become a much more global organization than in the past, with 98 chapters in all regions of the world. It was also somewhat of an anomaly, since previous ECs had often included officers from Asia, Latin America or both.

At the 2005 General Assembly of the ILAE in Paris, an amendment to the Constitution was accepted which says that if after the global elections “any fully operational region of the ILAE is not present on the EC, the Chapters of this region shall elect an additional Vice President (VP). This VP will be a voting member of the EC and not be considered as a regional VP, but unrestrictedly share the global responsibilities of the EC.” The EC at its meeting in Paris, using the description of the “regions” in our by-laws, agreed that a region would be considered fully operative when it: has a Regional Commission that meets from one to three times per year and submits a budget; is proactive to develop, stimulate and coordinate the epileptological agenda in its part of the world; coordinates local education via formation of a regional academy; and organizes congresses under the direction of our International Director of Meetings. The Regional Commissions of the regions that were not present on the elected EC were invited to apply for such a VP, and Asia/Oceania was the only region that did so. Since this very active and dynamic region more than fulfils the established criteria, an election was held in the region for an additional VP.

One of the appointed officers, the Editor of Epilepsia, decided that he did not want to continue with this office beyond 2005. The position was put out for tender, and many interested and highly qualified candidates applied. At the end of a selection process that involved the EC (including the outgoing Editor), we selected a joint editorship—a basic researcher and a clinician—that also represents the two scientifically most active regions of ILAE, Europe and North America. One of the new Editors was at the time already serving as Information Officer. Therefore, there has been a midterm change in this office; again, a tender was put out, and the EC appointed a new Information Officer from the received applications.

At the end of these procedures, the EC now consists of:

  • Peter Wolf (Denmark), President

  • Emilio Perucca (Italy), First Vice President

  • Frederick Andermann (Canada), Vice President

  • Chong-Tin Tan (Malaysia), Vice President

  • Solomon Moshé (U.S.A.), Secretary General

  • Martin Brodie (U.K.), Treasurer

  • Giuliano Avanzini (Italy), Past President

  • Susanne Lund (Sweden), IBE President

  • Eric Hargis (U.S.A.), IBE Secretary General

  • Mike Glynn (Ireland), IBE Treasurer

  • Philip Schwartzkroin (U.S.A.), Co-Editor-in-Chief, Epilepsia

  • Simon Shorvon (U.K.), Co-Editor-in-Chief, Epilepsia

  • Edward Bertram (U.S.A.), Information Officer

The Priorities

The EC has set three priorities for our term of office: education, the development of epilepsy care worldwide, and translational research.

Education

It is this ECs conviction that education of all professionals who are expected to provide care for patients with epilepsy is the key to any progress, also that the provision of high-quality education attracts and binds young talent to our field. It is in education that we can make the best investment of our resources. It is our ambition to be pioneers in developing the best educational system of all medical specialities. A wide range of approaches has been taken to reach this goal. During the first half of our term of office, the focus of the EC has been on this priority.

  • 1Organization
    • • Educational Commission: The ambitious horizon we have set requires concentrated and innovative work, and a new commission has been appointed to deal with it. The Commission includes representatives of all regional commissions/academies, and has subcommissions for education in French and Portuguese languages, for basic research, and for education of professionals allied with medicine. Following a comprehensive review of the present educational landscape, the Commission is now starting to work on a global master plan.
    • • Academies: In both the European and the Asian/Oceanian regions, the establishment of epilepsy academies (Eurepa 1996 and Asepa 2003) as educational arms of the regional commissions has been a very successful approach. The two academies have developed programs that are tailored to the needs of the respective regions and have contributed much to their progress. This success has encouraged the Latin American Commission to start their own educational academy in 2007 (Academia Latino Americana de Epilepsia, Alade).
  • 2Activities
    • • Residential Courses, Summer Schools: Residential courses are held in retreat settings and extend up to 2 weeks, during which time a limited number of postgraduate students work with a group of tutors and lecturers. The courses apply a variety of methods of active learning in groups and group design of research projects.The annual Summer Schools of San Servolo in Venice, under the aegis of the ILAE, have been taking place since 2002. The Commission on European Affairs (CEA) has, since 2005, offered a biennial Summer School on antiepileptic drug clinical pharmacology and pharmacotherapy in Eilat (Israel). In 2007, CEA started an annual “Migrating Course” on epilepsy for secondary care physicians in Central and Eastern Europe. Subregional residential courses supported by the CEA include the Baltic Sea Summer School on Epilepsy for young postgraduates (started in 2007) and the Caucasus Summer School that will take place for the first time in 2008. The Latin American Summer School (LASSE), started in 2007, will become an annual course. The first LASSE, near São Paolo, Brazil, brought together young postgraduates from all over Latin America and some Portuguese speaking Africans. All who became involved in this first LASSE consider it a key event that has opened a new era for the development of epilepsy in the region.
    • • Educational seminars in underserved locations: Offerings of special seminars in underserved locations is an approach that has successfully been taken by the Asian/Oceanian Commission and Academy. Groups of senior epileptologists address primary and secondary care physicians, especially in countries without ILAE chapters. These seminars provide state-of-the-art lectures on topics relevant to issues of epilepsy care. Asepa also offers a course and board certification in EEG.
    • • Distance education: To make epileptological education accessible more widely, Eurepa has started to establish distance education modules in various fields of epileptology (Genetics, EEG, Neuroimaging, Pharmacotherapy). These modules are tutored courses that use advanced methods of interactive distance education. Their superior efficacy, compared with mere self-study using the same educational materials, has been demonstrated by a prospective evaluation with a waiting-list control group (Hézser-v.Wehrs V et al. Epilepsia 2007;48:872–879). Via Virepa (Virtual Epilepsy Academy), a section of Eurepa, this activity is constantly renewed and expanded, and is available globally.
    • • Fellowships: Fellowships for on-site training in recognized centers and institutes are an integral part of our educational approach in Asia/Oceania. The selected fellows often come from countries without established specialist care for epilepsy, and are expected to take a role in their nation's development of epilepsy care following their training. Fellowship opportunities are also being developed in North American and Latin America (to reach out to underserved subregions), and also in sub-Saharan Africa.
  • 3Resources
    • • Funding: The budgetary responsibility for educational activities is primarily with the organizers of these courses, who are expected to find multiple sources of sponsorship. For selected programs, support is given by the ILAE, typically as bursaries. For this purpose, the ILAE and some regional commissions use surpluses from the international and regional congresses.
    • • Faculty: The expanding educational agenda requires many volunteers who are willing to serve as teachers and tutors. The First VP is building up a “Faculty of 1,000” for this purpose.

Epilepsy care

This priority is highlighted by a new Commission on which all regions are represented. The main task of the Commission is to develop concrete initiatives to improve epilepsy care, especially in underserved regions. This Commission is also responsible, on behalf of the ILAE, for the Global Campaign against Epilepsy which we conduct together with the IBE and the World Health Organization (WHO). To give the Global Campaign increased momentum, more responsibility has been given to the regions. Each region is expected to establish a regional Global Campaign steering committee, to include the regional Commission Chairs and the regional Mental Health Advisors of the WHO (see below). The EC plans to focus on this priority in the second half of our term of office.

Translational research

Basic research on epilepsy has increasingly become concerned with issues that are related to prevalent clinical topics. This focus has resulted in significant progress, for example in conceptual approaches of molecular genetics and functional neuroimaging. Some of our educational programs are aimed at strengthening this development.

  • • The above-mentioned summer schools in Venice/San Servolo and Brazil (LASSE) aim at bridging basic research with clinical epileptology.
  • • Some educational seminars at ILAE congresses also address translational research. This was the case at the Latin American congress in Guatemala 2006. An ambitious educational seminar is being planned for next year's Asian/Oceanian congress in Xiamen (China).

Preliminary talks about possible cooperation have taken place with the Academy of Science of the Developing World (TWAS). It is hoped that this contact will become more substantial at the occasion of the meeting in China.

The Commissions

The work of our Commissions is an important and integral part of our activities. Commissions are appointed by the President as recommended by the EC. The ILAE has both regional and problem-oriented commissions.

Regional commissions

With almost 100 national chapters, the ILAE has reached a size that requires an organizational structure between the Chapters and the global EC. The regional commissions fulfill this need. Each regional commission has a membership that is partly elected by the Chapters of the region and partly appointed by the ILAE President. The regional commissions now include the following:

  • • Asia and Oceania
  • • Eastern Mediterranean
  • • Europe
  • • Latin America
  • • North America

The African region is the last major region with no commission of its own. The number of chapters is increasing there, and there is reason to hope that an African Commission can be established towards the end of our term of office.

The role of the regional Commissions for the further development of the Global Campaign, in cooperation with the regional structures of the IBE and the WHO, has already been mentioned above. In addition, there are joint activities of some regional Commissions that relate to our general priorities. Thus, the North American and Latin American Commissions have in 2007 initiated: an ambitious plan of exchange programs and networks for the development of underserved areas; an initiative for epilepsy care development in the Caribbean; and a specific project for the island of Hispaniola where our Chapter in the Dominican Republic will assist with developing epilepsy care in Haiti, the neighboring country.

A series of trainer courses in the Portuguese language is a joint activity of the Portuguese and Brazilian ILAE Chapters, and includes the lusophone countries of Africa. It is supported by the Commission on European Affairs and the Educational Commission, and has resulted in a bilateral fellowship program of Brazil and Mozambique.

Problem-oriented commissions

These Commissions focus on many aspects of the professional work within the ILAE's agenda. Amongst other tasks, they elaborate reports, guidelines and recommendations that become official documents of the ILAE when they have been accepted by the EC. These Commissions comprise at present:

  • • Classification and terminology
  • • Diagnostic methods
  • • Education
  • • Epilepsy care
  • • Genetics
  • • Neurobiology
  • • Neuropsychiatry
  • • Pediatrics
  • • Therapeutic strategies

Each of these commissions has a defined mission, and most of them have established subcommissions and task forces to address specific problems.

On October 19, 2007, all commission chairs met in Brussels for a long-range strategic planning meeting. The progress reports of the Commissions' activities so far provided an exciting comprehensive overview of all our activities and initiatives. What has been reported above is only a selection of highlights. The Commission reports provide exciting examples of the rich, varied, and enthusiastic activities ongoing at all levels, involving many different types of networks, which today are perhaps the most distinctive feature of our organization. We can be proud of this range of activity.

The Congresses

The ILAE was been founded at the occasion of an international congress, and for many decades, the International Epilepsy Congresses were almost the only occasions of public visibility of the League. Although this situation has changed dramatically—see above for examples of ILAE's active commission work (starting with the international classifications of seizures and syndromes), regional activities, our educational agenda, and the Global Campaign against Epilepsy—our congresses remain one of the most important parts of our activity. They provide the most important forum in epileptology for the presentation of new findings, scientific exchange and update. Global international congresses occur in odd years, and alternate with a series of regional international congresses in even years. As a consequence of the introduction of quality control measures in some of these congresses, these regional events have become increasingly attractive and economically successful. The financial surpluses which some congresses generate are at present used for two purposes: (1) to support good quality science and education at meetings of the low-budget regions; and (2) for the support of our educational programs (e.g., to provide support for young investigators to attend the future congresses, for residential courses in the region and beyond, and participation in distance education).

During the present term of office, regional congresses were held in Kuala Lumpur (Asia/Oceania) 2006, Luxor (Eastern Mediterranean) 2007, Helsinki (Europe) 2006, and Guatemala (Latin America) 2006. The traditional annual meeting of the American Epilepsy Society (AES) in San Diego was for the first time declared a joint meeting with the North American Congress of Epileptology, and will have this label every other year (and thus be in phase with the other regional congresses). The International Epilepsy Congress in 2007 took place in Singapore. The next International Congress, in 2009, will be the ILAE centenary meeting and will be held in Budapest where the ILAE was founded in 1909. Apart from the European Congress of Epileptology, all the above-mentioned congresses are joint meetings with the IBE.

Organizational Philosophy

The ILAE was founded, in 1909, primarily as an international society that soon established national committees. Today, the national organizations that constitute its membership are all legally independent entities, incorporated in their respective countries. Their individual memberships vary from a handful to over 2,000, and their resources and activities vary widely. Some are more aware than others that they are part of a global organization. Since the establishment of an intermediate organizational level between the ILAE EC and Chapters—the regional Commissions—regional identities have developed in addition, as intended and expected. The challenge we face with this structure is to ensure an optimal balance between EC, Regions, and Chapters, a balance which works best to encourage participation by all those who would like to be involved in our manifold activities. One of the ongoing issues to be addressed is the adequate participation of all regions in our global agenda and in the EC. This balance is not easy to find. It is presently under intense discussion of the EC, and was also part of our dialogue with the Regional Commission Chairs last October.

The Coming Elections

In 2008, the procedures to elect the next EC will start under the direction of an Election Committee chaired by the Immediate Past President. The first step in this process is the election of the new President from a slate of candidates who must fulfill the precondition of having served at least one term of office on the EC. This requirement is to make sure that the candidates for President have experience with our organization. It is not yet known how many of the possible candidates will actually stand for election, but they all will be given an equal chance to present themselves publically and convince our membership that their performance and accomplishments in the service of epilepsy merit their election to the highest office of our organization. In the second step of the election process, all Chapters will be invited to nominate candidates for the other offices, and the persons who receive most nominations will then be put to a general vote. We are fortunate that around the world there are now many worthy and dedicated people—men and women—who are willing to serve on the EC. The ILAE, in spite of its dynamism and ability for renewal and progress, is a slightly atavistic organization in one respect: all its officers are, and have been for decades, only men. Therefore, the next President, whoever it will be, will again be a man. I feel strongly that time has come for a change, and very much hope that the Chapters will nominate some of the excellent women who are active in our Chapters and Commissions to be strong candidates with a good chance to be elected.

Ancillary