In the name of research

Prof. Dr. Wolfgang Grisold will be the first Austrian to become President of the World Federation of Neurology on 1 January 2022. The renowned neurologist has been a long-time companion of neuroregeneration research at the Ludwig Boltzmann Institute of Traumatology, the research centre in cooperation with AUVA. Conny Schneider, science communicator at the LBI Trauma, meets Dr Grisold in virtual space for an interview.

Dr Grisold, you have a long history with our institute. How did it come about?

The story is that Professor Redl (note: head of LBI Trauma from 1998 to 2018) and I have known each other for a long time, namely from our school days. We have always stayed in touch after that. His scientific work started in technology, with the scanning electron microscope. I was working in pathology at the time and had a lot of understanding for structures in the body, especially in neurology. That’s when common interests arose. It was a very fruitful collaboration for me to look at things with Heinz’s technical background. Especially when Dr. Robert Schmidhammer joined us, who was very interested in peripheral nerves and nerve surgery. This is a highly relevant topic for AUVA and for us neurologists, where there is still a lot to do.

It is now 27 years ago, in 1994, that the first scientific publication appeared together with the LBI Trauma. It described how peripheral nerve defects can be bridged with a laminin-fibrin matrix and silicone tubes. Just one year later, the next study followed: the non-invasive evaluation of nerve regeneration using electromyography. Can you tell us something about this technique?

With pleasure. We examined two techniques at that time, the measurement of nerve conduction velocity and electromyography. These are now standard examinations of the peripheral nervous system.

Measuring nerve conduction velocity is a fairly simple method. You stimulate the nerve and then observe either the resulting muscle twitch or, if you measure it with high sensitivity, a potential, an electrical representation of the stimulus. This way I can see if the nerve is OK or if the stimulus conduction is slowed down.

Electromyography measures the naturally occurring voltage in a muscle. Simply put, you stick a needle into the muscle and get electrical signals. These signals tell us if the muscle is normal or denervated, or if there are other diseases of the muscles. Sometimes you have to use both methods to get to the target.

Another area you have done research on is polyneuropathies. Can you tell us about that?

Polyneuropathies are manifestations of a symmetrical disturbance of sensory perception and sensitivity. According to the length of the nerve fibres, they usually affect the legs – ranging from persistent tingling to complete loss of sensation in the feet.

In our latitudes, polyneuropathies are mainly associated with diabetes, but some forms of chemotherapy can also cause them. Alcohol is not to be neglected either. Sometimes, however, they occur without any apparent cause, mostly in old age. I see patients who run from practice to practice, from finding to finding, with no result. My advice is not to despair, to keep watching and to take good care of your feet.

I can fully subscribe to that. In the course of my research for the Ludwig Boltzmann Research Group on Ageing and Wound Healing, which is housed at the LBI Trauma, I often see injuries as a result of polyneuropathies because people can no longer feel their feet. This goes as far as nails that have gone in unnoticed. You have to take extra good care of yourself and your body, even if it’s not easy without “feeling”.

In addition to the classic polyneuropathies in the feet, there are others that play a role in the care of accident patients: namely polyneuropathies in the intensive care unit.

Yes, the so-called critical illness neuropathies, we have also dealt with those. It is the case that those who are ventilated for a long time can develop a polyneuropathy. Sepsis also plays a role. Patients develop paralysis in all extremities, and the frenal nerve, which gives impulses to the diaphragm, can also be damaged. This makes it difficult to get away from ventilation.

There is no definitive therapy yet. It is important to treat the underlying disease, improve general health, and then take your time. The Criticall Illness Neuropathies can regenerate again.

Are we now switching from looking back to looking forward? As President of the World Federation of Neurology, which has 123 national associations worldwide, you now occupy a particularly prominent position. What are your plans for the coming years?

The Federation is global, so of course we have a very different range of issues and needs. I will focus my plans strongly on the educational activities. The association currently runs 5 so-called teaching centres worldwide. The idea is not to always go there to teach, but to empower local trainers who then pass on their knowledge. We have been doing this for several years in Rabat (Morocco), Dakar (Senegal), Cairo and Cape Town. Recently we also started in Mexico, but there the needs are different again, the neurological centres are much better developed, they are interested in other things. We have to respond to that. In the future, we also want to expand the offer to Asia.

It is important to me that the regions of the World Federation all have their say. At the moment, everything is not always completely symmetrical. In the future, everyone should meet at eye level, everyone should be heard. I would also like to introduce regional conferences, so that this works better.

Dr Grisold, thank you very much for the interview. In conclusion, is there anything else you would like to leave our readers with?

Yes, namely that our health care system here in Austria, despite all the criticism, is really one of the best in the world, and we can consider ourselves lucky to live in Austria. We are exemplary in traumatology, and the research at the LBI Trauma also contributes significantly to this, which is so closely related to clinical needs due to its proximity to AUVA.