The Association of British Neurologists’ annual conference convened in Edinburgh from the 20th to 23rd of May 2024. Scotland’s capital is a terrific setting for a major conference with attendees able to explore the medieval Old Town and the Georgian New Town of the beautiful city. The conference was held in the Edinburgh International Conference Centre (EICC), a spacious and well-equipped venue just a 15-minute walk from Edinburgh Castle.
An ABN training day was held on the Monday, prior to the official conference. Sessions for registrars included: recreational drugs and brain injury, concussion and chronic traumatic encephalopathy, assessing safety for driving with neurological conditions, and viruses, vaccines, and environmental factors in multiple sclerosis.
Over the next three days, a wide variety of speakers and delegates gathered to discuss the latest research and innovations in neurology. ABN president Dr Richard Davenport, of Edinburgh, welcomed us in the expansive Pentland auditorium. This was the biggest ABN meeting ever held, with 989 delegates registered, and an exciting programme of social and academic activities was organised.
The first plenary session was entitled ‘The pathogenic mechanisms of neurological disorders’. Dr Mahinda Yogarajah presented the ‘Neurobiology of functional seizures’ and described how patients with functional seizures appear to have a loosening of brain and body mapping and that this can be objectively measured through interoceptive neuroscience. Specifically, patients with functional seizures performed poorly at tasks involving perceiving bodily signals, compared to controls. There was also a discrepancy between objective accuracy and subjective appraisal of abilities in these patients, and this correlated with the frequency and severity of seizures.
The epilepsy and cognitive/vascular parallel sessions followed. The first speaker for the epilepsy session was Dr Sophie Binks, who described a pioneering collaboration between human and veterinary neurologists, to study a naturally occurring LGI1 antibody disease in domestic cats. The study, which included cats from Belgium, Italy, the Netherlands, and the United Kingdom, demonstrated the characteristic seizure semiologies of feline LGI1 antibody positive cats. These included oro-facial automatisms, salivation, mydriasis, and circling behaviour. Immunotherapies included steroids, ciclosporin, and IVIG.
Next door, in the cognitive/vascular session was a discussion on the implementation of regular CSF biomarkers in the memory clinic, delivered by Dr Gupta Udit. We also heard about an innovative computerised test that identifies impaired cognitive function in the prodromal stages of genetic frontotemporal dementia from Dr Kerala Adams-Carr.
Following lunch was the ABN medallist lecture, ‘Three phospholipid headgroups and a neurological tale’ by Professor Lionel Ginsberg. Professor Tom Warner delivered the citation and elegantly described Ginsberg’s outstanding contributions as a clinician, academic, and teacher. He is a world expert on Fabry’s disease and other lysosomal storage disorders, and currently works on lipid biology in dementia. Professor Ginsberg’s fascinating talk reinforced this as he described his career journey and his research on the phospholipid bilayer.
The second plenary of the day covered difficult management issues. Within this session, Dr Robert Hadden delivered an excellent lecture on ‘How to treat CIDP’. He discussed the diagnosis of CIDP using a flowchart which has been devised by the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS). The diagnostic process for less straightforward situations was also discussed. Of particular interest was the discussion, citing recent research, that up to 40% of diagnoses of CIPD may be incorrect. He advocated using the ‘red flags’ in the EAN/PNS 2021 guidelines. Alternative diagnoses such as POEMs, autoimmune nodopathies, or even genetic causes may need to be considered. He also summarised the key differences between steroids and IVIG treatments including the time to respond, proportion who respond, cost, time for relapse, and adverse effects.
During breaks and in the afternoon, delegates had the opportunity to browse the 234 posters on display in Strathblane Hall. Guided poster tours were available in the categories of cognitive, general/vascular, infection/auto-immune, multiple sclerosis/inflammatory, and the peripheral nerve.
The plenary session on Wednesday, day two, was entitled ‘Expert advice for the non-expert’. Dr Luke Bennetto presented the ‘Use of optical coherence tomography (OCT) and other ophthalmology investigations’. OCT is a high-resolution technique and we can use OCT to measure the optic nerve with 1000x the resolution of MRI. It is available in optometry practices, as well as ophthalmology clinics. He discussed how OCT can be used in the diagnosis and management of neurological disease and suggested it could be used more often in practice. Importantly OCT does not come with a report and this talk covered the basics of interpretation.
There was a lecture on ‘palliative care for neurological disorders’ by Dr Jonathan Martin, a palliative care consultant who coordinates the neurology special forum of the Association for Palliative Medicine. Dr Martin explained the key elements of palliative care including management of symptoms, supporting family, advanced care planning, and decision-making with ethical and legal considerations. He advocated for a holistic approach to care and emphasised the importance of listening to the patient’s story from the start. A two-level decision-making approach was also discussed, which firstly considers whether a treatment is clinically appropriate, and then whether the patient wishes to have the treatment. Decision making should be based on the patient’s values and incorporate the principles of beneficence, non-maleficence, justice, and respect for autonomy.
During the morning tea break we could don headphones for a silent symposium on ‘The future of UK clinical practice for multiple sclerosis – Is neurofilament the answer?’. Delegates also enjoyed speaking to colleagues and browsing the exhibition.
Plenary four focused on ‘Acute neurology in practice’. Dr Adrian Parry-Jones discussed developments in intracranial haemorrhage (ICH), with four major trials published in the last month, namely the ANNEXA-1, ENRICH, INTERACT4, and SWITCH trials. The ENRICH trial suggested that minimally invasive haematoma evacuation has a functional outcome benefit in lobar haemorrhages. The concept of care bundles for intracerebral haemorrhage was also introduced. In particular, the ABC care bundle consists of rapid anticoagulation reversal, intensive blood pressure lowering, and a care pathway for neurosurgical consultation, and the combination appears to have a synergistic effect on stroke outcomes.
Plenary session five was entitled ‘Developing a new service’. Dr Simon Shields presented ‘The MDT: MS Disease Modifying Therapies (DMTs) for the non-specialist’. He described the NHS England treatment algorithm for multiple sclerosis disease modifying therapies, as well as key points for each DMT in turn. He also spoke of the advantages and challenges associated with setting up a multiple sclerosis service.
The day concluded with another poster session, with tours available in the categories of epilepsy, headache/pain, movement disorders, neuromuscular disorders, quality, service, and training. The much-anticipated Gala dinner followed this, and the evening closed with 100 neurologists stepping onto the dance floor for a traditional Ceilidh.
Thursday was the last day of the conference and we were met by a severe cold front and heavy rain. An excellent schedule lay ahead nevertheless, and commenced with the case presentation competition, with each of the six candidates delivering a 12-minute speech. The top case presentation prize went to ‘Deciphering riddles of rippling muscles’ by Dr Hiba Malik.
The Practical Neurology Lecture was given by Dr Fleur Van Dijk, who leads the National Ehlers-Danlos Syndromes (EDS) service covering the South of England. She provided a comprehensive lecture on EDS and its relevance for neurologists in clinical practice. Importantly, EDS is an umbrella term for a clinically and genetically heterogenous group of conditions and is not a diagnosis itself. Hypermobile EDS is the most described EDS type and is a clinical rather than genetic diagnosis, however there are also rare monogenic EDS types, caused by deleterious gene alterations. Monogenic EDS gene types commonly have a range of neurological features, and these are often a part of diagnostic criteria.
The Clinicopathological Conference Lecture (CPC) was delivered by Dr Ruth Dobson. She chose to approach the CPC with reference to an article from Practical Neurology, ‘How to do it: the clinicopathological conference’. This was followed by a systematic and meticulous approach which led to the correct diagnosis of systemic aspergillosis with central nervous system sequalae including acute subarachnoid haemorrhage due to fungal mycotic aneurysm.
After a successful CPC talk, Dr Richard Davenport returned to announce the prizes, and the conference was closed for another year. The next ABN conference will be held in Liverpool from the 6th to 9th of May 2025.
Visit the ABN website https://www.theabn.org/page/annualmeeting2025 for updates and further information.
