Forward
First conceived by Dr John Rees in Brighton in 1984, the South of England Neurosciences Association (SENA) has brought together neurological centres in the South of England to provide free-to-attend, biannual educational meetings with the aim of disseminating education, offering time and opportunity for networking and developing professional relationships, and “to see how various institutions offer neurological care”. SENA’s meetings involve lectures by local leading neurologists, neuroscientists, neurosurgeons and neuroradiologists; the SpR case-presentation competition is a jewel in the crown of SENA. Each centre hosts a fun social dinner after the conference. The meetings are funded by pharmaceutical sponsorship and sponsors have stalls at our meetings. Sponsors have never had any involvement in the meeting programme and do not sponsor individual speakers.
Traditionally SENA has been a face-to-face meeting held at one of our participating centres which included Hurstwood Park Hospital, Southampton General Hospital, John Radcliffe Hospital and King’s College, St George’s and Charing Cross Hospitals in London. During the COVID pandemic when social congregation was restricted, SENA meetings became virtual; unexpectedly, demand for attendance dramatically increased. Feedback surveys indicated that SENA was now reaching individuals who previously had other commitments such as on-call, part-time, or carer commitments which prevented in-person SENA attendance. SENA has returned to face-to-face meetings but currently provide hybrid, day-long conferences which attract approximately 100 face to face attendees and over 200 virtual attendees. Our lectures are recorded and are available after each meeting for a limited period. SENA is still free to attend and attract 6-7 Royal College of Physicians (RCP) CPD credits for each meeting (half of a UK neurologist’s external CPD requirement for annual appraisal). In the past two years we have welcomed The Royal London Hospital, The National Hospital for Neurology and Neurosurgery, The Royal Free Hospital and Queen’s Hospital in Romford to our fold. In February 2022 SENA became a charitable incorporated organisation to help with governance and funding pathways. SENA meetings are extremely highly rated by attendees and sponsors, the 3.84/4 RCP score for Imperial Spring SENA 2023 is typical.
SENA is run by elected neurologists from participating centres who give up their-spare time for the benefit of all neurologists in the South of England. In times where there is little protected time (or funds) for education, a safe place to discuss neurology, meet with old colleagues, make new friends and provide an opportunity for our centres and juniors to shine, SENA provides a free forum of excellence and an oasis in which to refresh.
Dr Chris Carswell, Honorary Secretary and founding charity trustee, SENA
Conference Report
This year’s Spring SENA conference was held at London’s iconic Science Museum on the 21st of April 2023, hosted by Imperial College Hospitals. We successfully piloted the Eventleaf app this year where delegates could view the agenda, ask questions to speakers and get checked-in to register their attendance. The day kick-started with the opening address from the President of SENA, Professor Raad Shakir CBE who welcomed in-person and virtual delegates.
The first clinical talk of the day was by Dr Nicholas Davies who spoke about the different neurological infections patients can develop when either their cell-mediated, humoral or innate immunity is impaired due to congenital or acquired causes. He also gave a useful summary of neurological complications we should look out for in our patients when we prescribe immunosuppressive medications from corticosteroids to biologics.
Dr Barry Seemungal gave the next talk on traumatic vestibular disorders with a spotlight on vestibular agnosia, a condition he first discovered in 2020. Patients with vestibular agnosia may not experience vertigo but have characteristic nystagmus with dix-hallpike test, consistent with BPPV. If left untreated, it can lead to increased falls risk and mortality, and poorer employment rates.
Making strides in health-tech, Professor David Sharp presented his research on MINDER, a platform that collects data on dementia patients’ physiological observations, behaviour and environment through sensors and allows proactive healthcare to be delivered in their home. For example, infections can be detected early and treated at home, thereby improving patients’ quality of life and preventing hospital admissions.
Dr Chris Carswell then took us through the history of Normal Pressure Hydrocephalus (NPH) and presented recent meta-analysis data on how shunting improves disability, gait speed and urinary function in the short term but not cognition. Careful selection of patients is key to achieving shunt responsiveness in idiopathic NPH and this is based on brain imaging criteria, clinical symptoms, CSF tap test and lumbar drain test.
Moving on to a rapidly evolving field in neurology, Dr Harri Jenkins discussed the evidence behind thrombectomy for acute ischaemic stroke with large vessel occlusion. It is the most effective neurological treatment available with a number needed to treat of 2.6. Dr Jenkins talked about what is new on the horizon with extended window thrombolysis and thrombectomy.
Mr Christian Ulbricht, Consultant Neurosurgeon spoke next about a common presenting complaint to neurologists, low back pain. Mr Ulbricht clearly outlined the referral criteria for neurosurgery assessment: progressive neurological symptoms (especially if associated with a structural cause), progressive radicular pain, myelopathy and spinal claudication.
The next two talks by Dr Jo Girling and Dr Pooja Dassan focused on obstetric neurology. Dr Girling, Consultant Obstetrician spoke about how maternal medicine networks (regional hubs) for pregnant women with complex medical conditions can reduce morbidity and mortality. Dr Dassan then focused on epilepsy in pregnancy, highlighting lessons learnt from the MMBRACE report. Pre-pregnancy counselling, folic acid and titration of specific anti-seizure medications based on plasma drug levels, are essential.
Ms Rashmi Akshikar, Consultant Ophthalmologist delivered a highly practical talk on OCT for neurologists. She discussed papilloedema referrals from ophthalmology to neurology and how OCT scans can help distinguish neurological and non-neurological causes of disc swelling, thereby reducing the referral burden and preventing unnecessary lumbar punctures.
The next talk was the subject of much debate amongst the audience – the new shape of training curriculum for neurology trainees that was implemented from August 2022. Dr Rebecca Redwood, TPD for North West London spoke about the requirement for 1 year of general medicine and 6 months of stroke within the 5 years of neurology training, to triple CCT in neurology, internal medicine and stroke. Incorporating subspecialty exposure and research interests will become more challenging.
The next speaker Dr Luke Dixon, Consultant Neuroradiologist, gave an overview of one of the greatest masquerades in neurology, CNS lymphoma. It is often misdiagnosed as cerebral metastases, sarcoidosis or of alternative autoimmune/inflammatory aetiology. The key take home message is to not dismiss CNS lymphoma if there is a relapsing remitting course or the history is prolonged over months-years. Moreover, in immunocompromised patients necrosis and haemorrhagic foci are often present too on imaging.
Dr Angus Kennedy took the floor next and delivered an insightful talk from his years of experience in cognitive clinics. He explained how we can extract salient aspects of cognitive impairment by having a natural conversation with the patient about their life and simply observing them and their interaction with the relative they have brought with them. Neuropsychometric testing, CSF biomarkers, MRI and EEG can further add confidence to the clinical diagnosis.
We had some excellent case presentations from neurology registrars to round off the day. Dr Richard Rees won first prize speaking about a patient with childhood onset generalised dystonia (VPS16 gene mutation) and Dr Ben Loughlin won second prize for his case on a patient with chikangunya associated brainstem encephalitis and acute motor sensory axonal neuropathy.
After the meeting many retired to a local pub for a chat before the post-meeting dinner at The Ognisko restaurant in Chelsea, which offered an affordable and delectable tour of authentic Polish food.
Overall, the day was full of interesting and informative talks from clinicians in the various disciplines of neuroscience. We look forward to continuing the education journey with the next SENA autumn meeting on 6th October 2023 in Winchester.
