History of Neurology in Hong Kong

In Hong Kong prior to the 1970's specialization within the discipline of internal medicine was not encouraged. In those days, patients with neurological diseases were taken care of by doctors who had to, or felt confident to, do so. There were few neurologists, if any, in the sense that we understand today.

In 1973, the Hong Kong Neurological Society (HKNS) was founded. The founding members were mainly neurosurgeons whose specialty had by then gained a foothold in the territory. No record of their activities has remained.

Specialisation began in the latter half of the 1970's. Both the Government and The University of Hong Kong began to send local graduates to the United Kingdom for training in neurology. Among the early trainees were Drs. S.H. Ng and J.K.C. Tsui who both went to the University of Newcastle-upon-Tyne where the then Sir John Walton was Professor of Neurology and Dean of the Medical School. Dr. Ng returned in 1979 and became, in 1982, the first neurologist to serve as president of HKNS.

In 1981, Dr. C.Y. Huang, then a senior consultant neurologist at Lidcombe Hospital, Australia, was appointed as senior lecturer to the Department of Medicine, University of Hong Kong. His appointment is still remembered as the first sign of recognition of neurology by the establishment. Two years later, Dr. Robert Teoh, a Newcastle graduate trained in neurology at Hammersmith, Guy's and Hopkins, was likewise appointed as senior lecturer at the new Faculty of Medicine in the Chinese University of Hong Kong.

In 1983, a separate neurosurgical society was formed and the constitution of HKNS was amended to restrict full membership to physicians who have received formal training in neurology. Neurologists-in-training were offered provisional membership, and other physicians welcome as associate members. Two years later, through the efforts of Dr. C.Y. Huang, HKNS became a members of the World Federation of Neurology.

Throughout the 1980's, the development of neurology gathered pace. Many medical officers returned after overseas training to become neurologists in their respective medical units. The largest concentration of them was found in Queen Elizabeth Hosptial, where, at one time, was said to have half-a-dozen neurologists. Unfortunately, not every hospital was so well endowed any many hospitals outside the "Big Three" had no neurologist at all until well into this decade.

The climax of the 1980's was undoubtedly the visit of Sir John Walton in 1986 at the invitation of The University of Hong Kong to review the development of neurology in the territory. Sir John clearly saw the lack of dedicated space and staff as the major impediment and recommended the establishment of 'a dedicated clinical unit for the combined care ofneurological and neurosurgical patients.... with five academic neurologists and three neurosurgeons, plus consultants in neurophysiology, neuropsychology, neuropathology,...' In the 11 years that have since passed, the University has never had more than three neurologist and two neurosurgeons, although a dedicated floor for neurology and neurosurgery did come into being at Queen Mary Hospital recently.

In 1987, the Government set up a Working Party on Postgraduate Medical Education and Training which was chaired by Dr. Keith Halnan. In giving evidence on behalf of HKNS, the then president, Dr. Y.L.Yu, pointed out the HKNS was already applying a strict set of criteria for election to its full membership. As a result, virtually all full members of HKNS are now neurologists accredited by the Hong Kong College of Physicians and Hong Kong Academy of Medicine.

Since 1988 and ahead of many other bodies that now provide "CMEs", HKNS has been organizing annual scientific meetings to provide members with updates on the management of common neurological conditions (see Table). Overseas speakers are always invited to compliment local experts. In addition, HKNS hosts about half-a-dozen other scientific meetings or workshops each year, the latter covering such skills as EEG and EMG, muscle biopsy interpretation and Botulinum toxin injection. In recent years, quarterly lunchtime clinical meetings have been introduced. These are very popular as they allow neurologists from the private public sectors to talk about their interesting cases.

An independent Hong Kong Brain Foundation was founded in 1988 by neurologists and neurosurgeons to promote research, education and public awareness of neurologicaldiseases. Today, the Foundation has many members beside clinicians, including scientists, healthcare professionals and individual members of the public. Its scholarships are highly valued by the trainees.

Facilities for the care of patients with neurological diseases have improved somewhat since the inception of the Hospital Authority in 1990. Magnetic resonance imaging was brought in, neurosurgical departments have multiplied, stroke units are being introduced, and, finally, a few neurologists are elevated to positions of responsibility. There are, as yet, no plans to set up any department of neurology, and for the foreseeable future neurological patients will continue to be looked after by general physician/neurologists working in large departments of medicine. However, a working group on "neurology service development" under the aegis of the Hospital Authority was convened in 1997 under the chairmanship of Dr. Patrick Li.

Before the mid-1980's, Hong Kong had hardly any publication of a neurological nature that reached an international journal. (There were two notable exceptions: 'Familial occurrence of thyrotoxic periodic paralysis' by A.J.S. McFadzean & Rosie Yeung - BMJ 1969, and 'Moyamoya disease as a cause of subarachnoid haemorrhage in Chinese' by Michael Lee & Edmund Cheung - Brain 1973.) With the injection of trained academic neurologists to the two universities, neurological research began to progress. Initially, information on the local pattern of nervous diseases was not available, and much of the earlier efforts were epidemiological. Major studies on stroke, multiple sclerosis, masthenia gravis and tuberculous meningitis were undertaken. The successful publication of these studies in journals such as Stroke, Brain, ActaNeurologica Scandinavica and The Lancet has helped to generate more quality research. In recent years, neurological research in Hong Kong has clearly entered the international arena. Papers from Hong Kong are to be found in virtually all major neurological and general medical journals, including, in addition to those mentioned, Neurology, Journal of Neurology, Neurosurgery, and Paychiatry, Archives of Neurology, Journal of the Neurological Sciences, Journal of Neurology, Epilepsia, Electroencephalography and Clinical Neurophysiology, Neuromuscular Disorders, Quarterly Journal of Medicine and The New England Journal of Medicine.

Publications

  1. Newsletter (for Members only) Quarterly Free
  2. 20 Years of Neurology in Hong Kong
    Editor: Richard Kay Year of Publication: 1997
  3. 腦有所醫
  4. Case book of neurology

Relationship with overseas organizations

An affiliate of World Federation of Neurology.