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    Report on the First IBRO-UCT African Advanced School on Epilepsy

    The first school in the IBRO African Centers for Advanced Training in Neuroscience Program enjoyed great success, establishing an important foundation for the future of advanced neuroscience training and research in Africa. The IBRO-UCT African Advanced School on Epilepsy took place at the University of Cape Town, South Africa, between 2-16 December 2015. Participants included 24 students from 10 different African countries and 24 instructors from 3 African countries, the UK and Canada. This group produced a diverse but regionally-focused school that was tailored to the needs and concerns of African neuroscience and provided the highest quality teaching and training. IBRO thanks the local organizers, faculty and students for their commitment, expertise and enthusiasm. Please find the full report from the school organizers below.

    The next IBRO African Centers for Advanced Training in Neuroscience School will be at the Mohammed V University in Rabat, Morocco. Applications open until 14 February 2016!

    REPORT ON THE FIRST IBRO-UCT AFRICAN ADVANCED SCHOOL ON EPILEPSY

    The first IBRO-UCT Advanced School on Epilepsy provided an ideal opportunity for junior researchers, postdoctoral fellows and postgraduate students in Africa to gain knowledge and experience in the use of advanced neuroscience techniques in the clinical diagnosis of epilepsy and electrophysiology. It succeeded in promoting collaboration across the continent of Africa and enhancing the level of expertise in the neurosciences by encouraging interaction in daily group tutorial sessions, creating a common website for exchange of information, and a WhatsApp group for frequent informal communication.

    A total of twenty-four students from Nigeria, Cameroon, Democratic Republic of Congo, Senegal, Ethiopia, Egypt, Burkina Faso, Kenya, Malawi and South Africa and an equal number of instructors from South Africa, Uganda, the United Kingdom, Canada and the Democratic Republic of Congo participated in the school.

     

    Several IBRO alumni contributed as instructors sharing their clinical and research expertise with the students. These included Angelina Kakooza, a current member of the African Regional Committee of IBRO, Alfred Okpanachi, Vinogran Naidoo, Hayley Tomes and Toni-Lee Sterley.

    The clinical paediatric neurology component was led by Jo Wilmshurst, Head of Paediatric Neurology at UCT, along with Alvin Ndondo, Angelina Kakooza, Veena Kander and Tando Quvile. Graham Fieggen, Head of Neurosurgery, coordinated clinical sessions at UCT. Lectures aimed at providing a deeper understanding of the pathogenesis of epilepsy, the role of surgery in epilepsy, and the effect of antiepileptic drugs on behaviour and cognitive function in patients with epilepsy. Students gained practical experience by attending clinics and ward-rounds. Videos and practical demonstrations provided insight into state-of-the-art techniques, such as MRI, EEG, and deep brain stimulation. 

    CLINICAL EPILEPSY AND RELATED TOPICS

    The majority of the first 5 days of the course was allocated to clinical epilepsy and related topics. Presentations were delivered at the Red Cross War Memorial Children’s Hospital. The initial presentations built a foundation of information relating to terminology, clinical presentations, epidemiology and aetiologies. This was at a fairly basic level to allow the non-clinicians time to understand concepts. However there was time allocated to encourage questions and discussion from the group. As the sessions progressed more complex concepts were introduced including novel, research-based and state of the art interventions for epilepsy. The students especially gained from the video examples of seizures and asked for more exposure to this type of teaching.

    Key targeted topics were also addressed relating to the co-morbidities of epilepsy, stigma of suffering from epilepsy, and to illustrate transition from basic sciences to clinical practice, the effect of epilepsy, underlying aetiologies and antiepileptic drugs on brain maturation was also covered. On the last clinical day the students spent all day in the clinical setting, attending a clinical presentation where the children (and their carers) came into a seminar teaching room and their clinical case and examination signs were demonstrated. The group were encouraged to interact with the children and this session was found to be very positive for students and the children, who enjoyed the attention.

     

    The group was then divided into smaller groups and rotated between an epilepsy clinic (sitting in on the consultations) and the neurophysiology unit where they were taken through the process of recording electroencephalograms, the potential information attained and the potential pitfalls. At the end of the day the group reconvened to sit in on a working meeting coordinated by the epilepsy surgical team at Red Cross which reviewed past and future epilepsy surgical patients. Clinical histories and management options were discussed, the neuroimaging illustrated in detail and the pros and cons of surgical interventions addressed.

    BASIC ELECTROPHYSIOLOGY AND IMMUNOHISTOCHEMISTRY

    The basic electrophysiology/immunohistochemistry component was run by Joe Raimondo and his team, Andy Trevelyan, Neela Codadu, Dirk Lang, Vinogran Naidoo, Laurie Kellaway, Alfred Okpanachi, Hayley Tomes, Richard Burman, Toni-Lee Sterley, Susan Cooper, Morea Petersen and Simone le Roux. The first day of the basic neuroscience component included introductory lectures on the principles of neurophysiology which established the conceptual grounding for much of the advanced material presented in the remainder of the course. Topics included the basis of membrane potential, action potentials, the intrinsic properties of neurons and neurotransmission.

     

    This was followed by a hands-on workshop where students were taught the NEURON simulation environment. This allowed them to consolidate the material learned earlier in the day and also be introduced to the premier technology and programming environment for creating neural simulations. Each student generated their own complex morphological simulation of a single neuron. The day was ended with some entertainment by one of South Africa’s premier slight-of-hand artists and illusionists – Stuart Lightbody. The students enjoyed this and were amazed by his ability to ‘manipulate our brains.'

    On the second day, students received a lecture on advanced brain imaging, which was followed by a practical session where they prepared brain slices for immunohistochemistry. In the afternoon, students were introduced to electronics and soldering. In groups of 2 they spent the afternoon building their own bioamplifiers (Backyard Brains Spikerboxes). This was a challenging task as electronics was unfamiliar to many of the students. This was an empowering exercise however as after 3 hours of burnt fingers and many destroyed components we had seven working amplifiers!

     

    The following day students received a world-class introduction to advanced topics in the basic neuroscience of epilepsy delivered by Andrew Trevelyan of Newcastle University, UK. They continued their immunohistochemistry practical by staining their brain slices. The afternoon was spent using the amplifiers built the previous day to record action potentials from the cockroach leg preparation. Students learned the concepts and techniques necessary to make extracellular recordings from neurons.  Students worked in groups of two, where they had access to their own amplifier, laptop computer recording station. They used this experiment to explore rate coding in sensory systems.

    As a fun addition, students performed microstimulation of their cockroach legs using pop music.  The following three days saw students receiving two lectures in the morning followed by a daily rotation through one of three advanced practical sessions. The lecture topics included the anatomy of brain circuitry, models of seizure activity, network mechanisms in seizures, infectious causes of epilepsy, drosophila in the laboratory and ion dynamics in seizures. The practical sessions included hands on experience:

    1) patch-clamping single neurons and making intracellular recordings during epileptiform activity

    2) performing interface chamber experiments to record field potentials during in vitro seizures

    3) performing confocal imaging of the immunohistochemistry tissue that they had prepared during the earlier days of the school

     

    In addition to lectures and practical sessions, students met for at least one hour each day to work on group assignments in which they were required to address a specified topic which they presented on the last day of the school:

    Group 1Design a research program to develop and test new treatments for epilepsy secondary to neurocysticercosis

    Group 2Write a protocol to assess whether phenobarbital causes brain damage when used in the infantile period,” which is particularly relevant to Africa where phenobarbital is widely used to treat epilepsy

    Group 3Design an ideal antiepileptic drug to manage neonatal seizures

    Group 4How far down the animal kingdom can we go and still learn about epilepsy? Primates, rodents, c elegans, zebrafish, and slime mould have all been used in recent epilepsy publications – is this appropriate?

    The small working groups which were made up of trainees from different disciplines worked extremely well, with some exceptional projects generated out of this interaction. Of most benefit, however, was the time spent with these smaller groups discussing study methodology and relevance.

    CONCLUDING REVIEWS

    In general, the feedback from the students was very positive with many stating that this was the “best ever.” They appreciated the depth of lectures, hands-on experience, integration of basic and clinical aspects of epilepsy bridging the gap between basic and clinical neuroscience. Instructors were impressed by the enthusiasm and commitment of the students. They were engaging and positive even when faced with techniques and settings that were advanced and unfamiliar to them, beyond their prior training experiences.

    Further, the students contributed in unique areas, for example suggesting unusual pathologies for a child admitted to the ward with a motor disorder. The child in question originated from the Congo and a doctor from the same country was one of the students, she suggested exclusion of a condition more prevalent in her region and not seen in South Africa. In another presentation Angelina Kakooza noted the diversity of novel information which arose from her presentation on stigma, concepts which she had not been aware of before, came to light as they were specific to the geographical locations of the students.

    There did not seem to be any major language barriers – a number of the group had French as their first language but there were enough bilingual speakers to ensure fluency in the course.

    Some of the clinicians requested more video seizure examples and electrophysiology sessions. Some 4 hours were already allocated to this alone and it was emphasised to the group that the clinical aspects of the course were to illustrate the need for clinical relevance in research areas. That these sessions could not, in the time span permitted, equip the students with adequate knowledge to practice. If they were interested in expanding their knowledge in these clinical skills then they would need to enter a formal training program or a dedicated course with far more hours dedicated to these specific areas. At least, they now know what is possible and how these techniques can be used to answer important questions in epilepsy research. The school seemed to achieve its aim which was to open the minds of the students to what is available, providing the seed, the beginnings, the foundations upon which the students can continue to build their research careers.

    For more information on the IBRO African Centers for Advanced Training in Neuroscience, please click here.

     

    The IBRO-African Centers for Advanced Training in Neuroscience

    an IBRO initiative in partnership with the IBRO African Regional Committee,
    Mohammed V University of Rabat, and the University of Cape Town