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Neurology. 2013 January 22; 80(4): 406–408.
PMCID: PMC3589243

Neurology in Canada: History of the Canadian Neurological Society

T. Jock Murray, OC, ONS, MD, FRCPC, FAAN, MACP, FRCP, FCAHS,corresponding author

Scientific Advisory Boards:

  1. NON COMMERCIALMinocycline in CIS - Data Safety and Monitoring Committee(Chairman)National Population Study of Neurological conditions -Scientific Advisory CommitteeCanadian MS Monitoring Study - Scientific Advisory Board

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. Speaker and travel honorarium from Novartis;Speaker and travel honorarium from Biogen;Speaker and travel honorarium from Serono

Editorial Boards:

  1. Editorial Advisory Board of Medical Biography (UK)2002-Editorial Advisory Board of Canadian Journal of GeneralInternal Medicine 2005-

Patents:

  1. NONE

Publishing Royalties:

  1. Medicine in Quotations, American College of Physicians, 2006Multiple Sclerosis: the history of a disease. Demos Pub. 2005Multiple Sclerosis: A guide for the newly diagnosed. DemosPub. 2007

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. Non Profit Consultant to Myelin Patient Project.

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. Associated Medical Services (Ontario) and the Robert PopeFoundation provided 5 year funding for a visitingprofessorship at the Dalhousie Society for the History ofMedicine. I am the President of the DSHM and applied forthe funds, although they are for the DSHM and not to me.

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
Garth Bray, MD, FRCPC,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. Vice-President, Canadian Neurological Sciences Federation

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
Morris Freedman, MD, FRCPC,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. 1) Travel and accommodation to World Congress of Neurology as the delegate from Canada on the Council of Delegates. Funding came in part from the Canadian Neurological Society and Baycrest Centre for Geriatric Care

Editorial Boards:

  1. Brain and Cognition, Editorial Board, 2003 - present (no compensation)

Patents:

  1. Listed on provisional patent application related to methods and kits for differential diagnosis of Alzheimer's disease vs frontotemporal dementia using blood biomarkers and may be listed on the planned patent application

Publishing Royalties:

  1. Freedman M, Leach L, Kaplan E, Winocur G, Shulman K, Delis DC. Clock-drawing: A Neuropsychological Analysis. New York, Oxford University Press, 1994.

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. Advisory Board Consulting:1) Novartis Pharmaceuticals CanadaConsultancy Meeting:1)Bristol Myers Squibb

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. 1) Received financial support for a Behavioral Neurology fellow from Eli Lilly Canada2) Receives support form the Saul A. Silverman Family Foundation as a Canada International Scientific Exchange Program3) Receives support form the Morris Kerzner Memorial Fund

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. Lundbeck Canada

Research Support, Government Entities:

  1. 1) Canadian Institutes of Health Research

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. 1) Parkinson Society of Canada2) Alzheimer Society of Canada

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
and A. Jon Stoessl, CM, MD, FRCPC, FAAN, FCAHS

Scientific Advisory Boards:

  1. (1) Medgenesis, honorarium(2) Biogen Idec, honorarium(3) Member, Clinical Scientific Oversight Committee, PPMI study (Michael J. Fox Foundation)(unpaid, non-profit)

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. (1) Funding for travel and honorarium for participation in Movement Disorders Society meeting, Buenos Aires, June 2010 (from MDS)(2) Funding for travel and honorarium for participation in MDS meeting, Toronto, June 2011 (from MDS)(3) Speaker honorarium, PROBE Workshop (non-commercial entity) Toronto, June 2011(4) Honoraria for chairing sessions: (a) Teva (March 2011); (b) Allergan (May 2011); (c) Abbott (June 2011)

Editorial Boards:

  1. No compensation received. Following Ed Boards:Annals of NeurologyLancet NeurologyParkinsonism & Related DisordersTranslational Neurodegeneration

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. (1) Bioscape Imaging, commercial entity, honorarium(2) Ono Pharma, commercial entity, honorarium

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. CIHR - Team Grant (PI), 2006-2011, CIHR Team on Parkinson's - Operating Grant (PI), 2007-2012, Complications of Parkinson's disease: the dopaminergic basis for depression
    Operating Grant (co-I), 2007-2012, Positron emission tomography studies of dopamine turnover and release in bipolar disorder.
    Operating Grant (co-I), 2008-2013, Frontotemporal Lobar Degeneration with Ubiquitinated Inclusions: Genetic, Clinical, Pathological and Biomarker Studies
    Operating Grant (co-I), 2008-2011, Investigation of treatment related compulsive behaviours and impulse control disorders in Parkinson's disease
    Operating Grant (co-I), 2012-2015, Neuroimaging for Disorders of Consciousness: Charting the Canadian Ethics Landscape
    Operating Grant (co-I), 2006-2011, Role of dopamine in pain and placebo analgesia
    Operating Grant (co-), 2007-2012, Development of radiotracers based on oligonucleotide labelling
    Michael J. Fox Foundation - PI: Increased dopamine turnover as a manifestation of LRRK2 mutation, 2010-2012
    CO-I: Multi-tracer positron emission tomography (PET) functional imaging as a tool to assess the relevance of rodent LRRK2 models to the human neurochemical phenotype associated with LRRK2 mutations related Parkinsonism. 2010-2011
    Michael Smith Foundation for Health Research (PI) - Research Unit on Parkinsons and Monoaminergic Disorders of the CNS, 2006-2010
    Pacific Alzheimer Research Foundation (PI) - Centre Grant on Overlap Syndromes resulting in Dementia, 2007-2012

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. (1) Pacific Alzheimer Research Foundation (PI), Centre grant on Overlap Syndromes resulting in Dementia(2) Michael J. Fox Foundation (PI), Increased dopamine turnover as a manifestation of LRRK2 mutation

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE

Abstract

In the 19th and early 20th century, Canadian physicians interested in neurology focused on this area as part of their broader clinical practices. The most renowned was William Osler, often called Canada's first neurologist because one-third of his writing was devoted to neurology. Until the mid-20th century, most Canadian neurologists trained at the National Hospital, Queen Square, London, and in Paris. The majority returned to academic centers and after World War II every Canadian medical school and major center had consultant neurologists.

In the 19th and early 20th century, Canadian physicians interested in neurology focused on this area as part of their broader clinical practices. The most renowned was William Osler, often called Canada's first neurologist because one-third of his writing was devoted to neurology. Until the mid-20th century, most Canadian neurologists trained at the National Hospital, Queen Square, London, and in Paris. The majority returned to academic centers and after World War II every Canadian medical school and major center had consultant neurologists.

In 1947, Wilder Penfield at the Montreal Neurological Institute organized a meeting of Canadian neurologists and neurosurgeons that initiated the Canadian Neurological Society. A guiding precept was to bring neurologists, neurosurgeons, neuropathologists, and other clinicians focused on the nervous system together to exchange papers at a single conference. Subsequently, specialty associations of neurosurgeons, neurophysiologists, pediatric neurologists, and clinical neurophysiologists developed and, together with neurologists, became the Canadian Congress of Neurological Sciences. This became the Canadian Neurological Sciences Federation (CNSF) in 2006.

The CNSF is a legally constituted confederation of the Canadian Neurological Society, Canadian Neurosurgery Society, Canadian Association of Child Neurologists, and Canadian Society of Clinical Neurophysiologists. Organizations of neuroscience nurses, technologists, neuroscientists, and physiatrists are CNSF Associates, and 10 other related organizations focusing on neurologic diseases are CNSF Affiliates.

The principal CNSF mission is to enhance prevention, diagnosis, and management of nervous system disorders through professional development and advocacy. The CNSF promotes professional development by its annual Congress, which includes accredited continuing education courses, and publication of the Canadian Journal of Neurological Sciences. CNSF advocacy is channeled through Neurological Health Charities Canada.

Neurologic disease in Canada

In 2007, the CNSF sponsored a study by the Canadian Institute for Health Information (CIHI) on the Burden of Neurological Diseases, Disorders and Injuries in Canada.1 Total cost of 11 of the most common neurologic conditions was $8.8 billion, representing nearly 3% of direct and 9% of indirect health care costs. Neurologic conditions accounted for 10%–20% of hospital admissions, patient days in acute care, and inpatient rehabilitation, as well as disability-adjusted life-years.

The neurologic needs of the aging Canadian population will accelerate in coming years, as the life expectancy for Canadians has increased to 81 years (84.1, women; 78.2, men) and continues to rise.

Neurology training in Canada

During the last half century, most neurologists began their training in Canada, followed by a fellowship abroad. Initially fellowships were mostly at the National Hospital, Queen Square, in London, or in France. After 1965, this shifted mainly to the United States, and more recently to Canadian centers.

Before World War II, neurology training programs were located in a few centers, such as McGill and University of Toronto. Subsequently, training programs expanded to most Canadian medical schools. Since 1969, all training must be in university centers accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC), which also oversees the examination of candidates for specialty certification. Provincial governments regulate the number of residency positions and provide funding for all residents. There are 16 adult and 10 child neurology training programs. The RCPSC certifies 27–30 neurologists per year. The RCPSC is also responsible for a Maintenance of Certification program requiring all specialists to earn a minimum number of continuing education credits each year. The program involves a rigorous accreditation process for providers of Continued Professional Development.

Collaborative research and educational programs

The small number of medical schools in Canada (17), and centralization of many services in major centers, encourages collaborative research and education among centers. For example, the Canadian Network of Multiple Sclerosis Centers was able to enroll over 30,000 people in a genetic study. In addition, networks of clinicians and researchers dealing with multiple sclerosis, stroke, and Parkinson disease are well-established.

Canada's role in international e-learning

Canada has a pivotal role in distance education through leadership in International Videoconference Behavioral Neurology Rounds that has involved American, Argentinian, Brazilian, Canadian, Chilean, Cuban, Israeli, Jordanian, Palestinian, Russian, South African, Spanish, and Swiss (WHO) sites. Since 2009, Canada has led the Neurology International Residents Videoconferencing Exchange (NIRVE) involving resident presentations from Brazilian, Canadian, Jordanian, and Russian centers. At the national level, Canada launched National Videoconference Neurology Grand Rounds in 2011 with participation of neurology training centers across the country.

Research funding

Neuroscience research funding comes from many sources, although primarily the Canadian Institute of Health Research (CIHR), with an annual budget of over $1 billion. Unlike the NIH, CIHR funds only extramural research. Neuroscience research accounts for about 28% of CIHR funding. Other important sources for operating support include agencies related to neurologic diseases such as multiple sclerosis, heart disease and stroke, Parkinson disease, and Alzheimer disease. Infrastructure support for major equipment and renovations comes from the Canada Foundation for Innovation. Clinical trials are primarily supported by industry, and sometimes through collaborative studies cosponsored by CIHR.

Support for principal investigators comes from universities, except in the case of industry support. However, the Canada Research Chairs, funded by the federal government, supports faculty across all disciplines, with 2,000 chairs across the country, among which neuroscience is well-represented. Some provinces have programs to support investigators relatively early in their careers. The relative lack of stable salary support has aggravated the difficulty that Canada, like many other countries, has encountered in producing significant numbers of clinician–scientists. Some universities and provinces have attempted to address this problem by introducing academic practice plans.

Neurologists and clinical practice

In Canada, there are approximately 38,000 family physicians and 35,000 specialists, of which 854 are neurologists, with 28% being women. Most are in high population areas of Ontario, Quebec, Alberta, and British Columbia. There are a maximum of 26 neurologists in each of the other 6 provinces and none in the 3 territories of Northern Canada. Approximately 44% of neurologists are over age 54 years and 20% are over age 64. Thus a significant proportion of neurologists are close to retirement age.2

Many neurologists in academic centers have multiple roles and only part of their time involves clinical practice. In 2002, 31%–49% of neurologists across the 10 provinces worked in an academic setting, 76% having subspecialty interests.3

Canada has a publicly funded health care system with coverage for all citizens and freedom of choice of physician regardless of income. Fee-for-service billing is simplified, with electronic billing for all services to the provincial government and a single payment received. There is minimal paperwork, a simplified coding system, and minimal time and overhead for the neurologist.4

Challenges for the future

The Canadian health care system must find ways to maintain the values and principles of the system while improving efficiencies and managing costs. Health care is a provincial and territorial responsibility, and since each jurisdiction has different economic pressures, responses could be less consistent and uniform in the future. Even in a health care system available to all, the access may be uneven for many rural or marginalized populations.

Almost half of the neurologists currently practicing in Canada are over age 50, with many at or beyond normal retirement age; the current numbers of residents in training will not meet the increasing needs. The aging population will bring increasing requirements for neurologic services. Waiting lists for consultations and procedures require innovative approaches and the involvement of other health care professionals. There must be a greater commitment to multidisciplinary care for chronic neurologic illnesses.

Innovative approaches will be needed to deal with a future with increased costs and demands but insufficient numbers of neurologists. Linkages and collaboration with other health professionals to provide care are essential. Canada's leadership in telehealth will be important in dealing with education, consultation, and support.

STUDY FUNDING

No targeted funding reported.

DISCLOSURE

T.J. Murray is a Scientific Advisor to the Canadian Multiple Sclerosis Monitoring System supported by the Canadian Institute for Health Information; is a Scientific Advisor on the National Population Study of Neurological Conditions; has received honoraria and travel support for lectures at conferences by Biogen Idec and Serono; and is President of the Robert Pope Foundation. G. Bray receives a stipend from the Canadian Neurological Sciences Federation. M. Freedman received funding for expenses as a delegate from the Canadian Neurological Society to the Council of Delegates of the World Congress of Neurology; has received honoraria from Novartis Pharmaceuticals Canada for advisory board consulting and Bristol Myers Squibb for attending a consultancy meeting; received financial support for a Behavioral Neurology fellow from Eli Lilly Canada; is listed on a provisional patent related to methods and kits for differential diagnosis of Alzheimer's disease vs frontotemporal dementia using blood biomarkers and may be listed on the planned patent application; receives grant funding from the Canadian Institutes of Health Research and the Parkinson Society of Canada; has received grant funding from the Alzheimer Society of Canada, Lundbeck Canada, and the Canadian Institutes of Health Research; and receives support from the Saul A. Silverman Family Foundation as a Canada International Scientific Exchange Program and Morris Kerzner Memorial Fund. A.J. Stoessl's work is supported by the Canadian Institutes of Health Research, the Michael J. Fox Foundation, the Pacific Alzheimer Research Foundation, and the Canada Research Chairs program. He has served on advisory boards or committees (unpaid) for Canada Research Chairs, the Movement Disorders Society, the Parkinson Study Group, and World Federation of Neurology Association for Parkinsonism & Related Disorders; has received speaker fees from Abbott, Medscape, and Teva; and has served as a consultant for Biogen Idec, Bioscape Imaging, Medgenesis, and Ono Pharma. Go to Neurology.org for full disclosures.

REFERENCES

1. Canadian Neurological Sciences Federation The burden of neurological diseases, disorders and injuries in Canada, 2007. Available at: http://www.cnsfederation.org/advocacy.html. Accessed September 2011. [PubMed]
2. Canadian Medical Association Statistical information on Canadian physicians. Available at: http://www.cma.ca/index.php?ci_id=16959&la_id=1#1. Accessed September 2011.
3. Bailey P, Warren S, Buske L. Highlights of the Canadian Neurological Society (CNS) manpower survey. Can J Neurol Sci 2005;32:425–432. [PubMed]
4. Findlay JM. Canadian health care explained to US colleagues: the good, the bad and the ugly. Can J Neurol Sci 2010;37:310–312. [PubMed]

Articles from Neurology are provided here courtesy of American Academy of Neurology