When Challenging Is Engaging: Videos to Educate and Fascinate Neurologists

The choice to become a neurologist may be driven by many factors. Most often, however, one is compelled to explore that last bastion that holds the secrets to human behavior. The thrilling possibility of recognizing signs and formulating syndromes, which allow drawing diagnostic conclusions on the putative topology of neural dysfunction with observation alone is a motivating force for young doctors. It also provides satisfaction even in the more advanced stages of a neurologist's career. The advent of many novel therapies during the past few decades in nearly every domain of neurology further reinforces the exciting possibilities the field has to offer.

Among the many different manifestations of neurological disease, movement disorders constitute a most challenging domain. Not only does a large number of disorders of different aetiologies fall under the “movement disorders” rubric but also a unique vocabulary has been devised to describe and thereby discern motor phenomena and movement patterns, with often overlapping features. Indeed, young neurologists (or neurologists to be) frequently feel reluctant to confidently apply this specific language when first asked whether a patient presents, for example, with chorea or myoclonus, complex tics or stereotypies, or limb rigidity or paratonia.

The question of how to scientifically approach the phenomenology of behavior, including classifying different types of movements based on observation, has a long‐standing tradition in neuroscience. ¹ , ² To quote Jean‐Martin Charcot, “Let someone say of a doctor that he really knows his physiology or anatomy, that he is dynamic—these are not real compliments; but if someone says: he is an observer, a person who knows how to see, this is perhaps the greatest compliment one can make” ³ (Fig. 1). The International Parkinson's Disease and Movement Disorder Society, which counts >9000 active members, offers a wide variety of educative activities in nearly all parts of the world, with the determined goal to improve clinical movement disorders research and patient care. The annual International Parkinson and Movement Disorder Society (MDS) International Congress is one of the main pillars of the Society to achieve this purpose.

FIG 1.

Quote from Leçons du mardi à la Salpêtrière, February 28, 1888, Malade 1.

Since its conceptual inauguration in 2008, the Video Challenge (VC; previously branded as Video Olympics and subsequently Video Games) is perhaps the most celebrated event of the annual International Congress. It provides the stage for some of the world's most intriguing movement disorders cases to be presented to select panelists—global experts with strong track records in the field—who in turn exercise their best skills in phenomenological analysis attempting to confidently reach a diagnosis. All this in real time and in the eyes of several thousand International Congress participants who in turn and from their own seats also feel challenged and attempt to “solve” the presented cases. Not uncommonly, lively discussions sprout on the phenomenology of individual cases, and it is often enlightening and comforting to witness how the opinions of experts may differ even on issues such as determining the basic type of abnormal movements. Indeed, disagreements are not unusual, and they are even politely encouraged, until the masters of ceremony, Drs. Anthony Lang and Kapil Sethi, provide decisive information in order to “move things forward.” Not to mention that when experts do not get to the right diagnosis, the audience may sigh in exasperation or even in relief, acknowledging that everybody can fail and its impossible to get the correct final diagnosis every time. It is the route of analytical thought leading to diagnosis that is celebrated in VC first and foremost.

The VC often goes quite late into the night and is perceived by many as the established rite of passage to yet another novel exciting year for the movement disorder field. Most of the thousands of attendees leave the VC invigorated by the phenomenological richness of their field and eager to apply new knowledge back to their clinics. They are also on the lookout among their own cases whether some could make the cut to the world's best, most complex, and specifically instructive presentations for the year to come. It is an incredible achievement if one considers how brief of an exposure this is: only 2 to 3 hours spent with the experts phenomenologically dissecting movement disorders presentations is enough. Although it is true that attendees to the MDS annual International Congress are usually already strongly oriented toward a movement disorders career, we are aware of many colleagues who have made their final decision to focus on abnormal movements as a consequence of the VC. Clearly the success of the VC relies on a unique combination of many ingredients, perfectly mixed by the hosts.

However, although thousands of neurologists participate live in the VC, a much higher number of colleagues are not able to take advantage of this unique once‐in‐a‐year experience. Furthermore, as the number of presented cases has increased over the years, the rhythm of presentations during the VC may have been sometimes overwhelming. Given the tremendous educational value of the session, we believed it was important to support the publication of the presented submissions along with a clinical discussion and key learning points. After many discussions with Drs. Lang and Sethi, the editors of both Movement Disorders and Movement Disorders Clinical Practice (MDCP), and the society's Publications Oversight Committee, we agreed that the cases were best suited to publish in MDCP. Drs. Marcelo Merello and Kailash Bhatia, coeditors of MDCP, worked with the team at Wiley on a plan for an annual supplement issue of the journal at no cost to the society or authors.

The availability of the cases in the online published format will now allow for global accessibility and dedicated study time; it will also complement the live discussions that arise during the event itself. Indeed, the decision to create a special supplement for MDCP every year strengthens the VC tradition and is a further step toward engaging neurologists into the fascinating world of movement disorders.

This step must be interpreted also in the new scenario of a changing and interconnected world. The recent COVID‐19 pandemic has forced the switch of the 2020 International Congress to a virtual format, which is a new challenge and a new opportunity. The VC will need to reinvent itself once again, but with the great advantage of new technologies that will allow for an even broader audience. For the first time neurologists and scientists from all over the world will be able to enjoy the VC show from their office or even from the couch in their living room. We are confident that this will leave a mark on many colleagues, because one look is worth a thousand words. If you got here, you have already read the 1000 words of this editorial. We now invite you to take a look at the instructive cases of this supplement and embrace this new endeavor.

Disclosures

Ethical Compliance Statement: We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.

Funding Sources and Conflicts of Interest: None.

Financial Disclosures for Previous 12 Months: Christos Ganos receives academic research support from the VolkswagenStiftung (Freigeist Fellowship).