T he Association of British Neurologists Autumn Meeting had an array of amazing speakers who were specialists in their respective fields. These included not only neurologists, but also representations from neurosurgery, neuro-radiology and even obstetric physicians.
The programme was thoughtful and comprehensive, covering a range of pertinent topics in neurology.
Neurology commissioning in the new NHS
Niran Nirmalananthan, St George’s, London, UK
The conference started with an interesting lecture on commissioning for neurology in the NHS – mainly the challenges faced and strategies to overcome them. I found this to be very enlightening – it really brought to light the issues faced when trying to fund care and how to distribute funding and services amongst secondary and tertiary centres. It also discussed the concept of “Integrated Care Boards” and how these are relevant to neurology commissioning. It was very informative and made me think about the logistics of care for patients with neurological disease – including thinking of the geographical and socio-economic factors.
Advances in neurosurgery for movement disorders
Ludvic Zrinzo, Consultant Neurosurgeon, UCLH, London, UK
This was a very exciting lecture with several videos which showed the tangible response of neurosurgical interventions. Mr Zrinzo explained what structural versus functional neurosurgery involves, and how the evolution of imaging techniques and advances in technology have impacted the course of neurosurgery. He discussed the current treatments for tremors (Parkinsonian tremor as well as essential tremor) including the use of MR-guided focus ultrasound. This can also be used in focal dystonia, pain and even psychiatric conditions. The lecture had amazing graphics and radiological imaging showing the precise targets and the underlying neuro-physics. He emphasised the need for neurologists and neurosurgeons to collaborate when treating patients with movement disorders and highlighted when to seek neurosurgical input, which I found to be very useful.
[Further reading…Update on MR guided focused ultrasound for tremor | ACNR]
Myasthenia: treatment beyond the 2015 guidelines
Dr. Saiju Jacob, Birmingham, UK
I really enjoyed this lecture and thought it was very well planned out and concise yet very detailed. Dr Jacob discussed the 2015 Practical Neurology guidelines for Myasthenia gravis and how these have evolved over the past few years. He discussed the investigations, including the role of specialist investigations (i.e. imaging and small fibre EMG) and when to refer to specialist clinics. He also discussed treatment from the basics to the more complex cases and went through the exciting treatments on the horizon. He discussed the new treatments through analysis of the current evidence from trials, which seems to be focusing on new immune-modulatory targets including the use of other B cell therapies and complement inhibitors.
[Further reading…Overview of new developments in myasthenia gravis therapy | ACNR]
Practice updates: SIH guidelines
Professor Manjit Matharu, UCLH, UK
This was an excellent lecture given by Professor Matharu, who is indeed a “legend” in the field of headaches. He discussed the incidence of spontaneous intracranial hypotension (SIH), how it presents, necessary investigations and then the management. He went through important trials and evidence which aid in the diagnosis of this condition which can often be missed, and he also discussed key aspects of treatment including when to repeat using blood patches versus when to seek alternative options. I found it interesting that he explained that the imaging can be normal in up to 20% and moreover, that lumbar puncture is not always the most useful diagnostic tool with a low pick-up rate – thus emphasising the diagnostic difficulty in many cases. Important differentials were discussed which I also found very useful and I will certainly use this information when I see patients with a headache, an extremely common occurrence.
Climate change and neurology
Professor Sanjay Sisodiya, UCLH, UK
This was an informative but also harrowing lecture in many ways. It was enlightening to consider a different perspective of approaching how we take care of our health – and that is indeed through taking care of our planet. It was fascinating but not entirely surprising to learn about how high temperatures affect us at a biochemical or molecular level, as evidenced by trials with rising CSF temperatures. He discussed the detrimental effect of high temperatures on patients with various forms of complex epilepsy including Dravet’s. No matter how much we invest in pharmacological treatment strategies, the rising temperature of the earth will negate all this progress. It was quite heartbreaking to hear the measures parents go through to keep their children “cool”. I took away a lot of learning points from this and will strive to make positive changes to help the planet and also to encourage others that the effect of climate change is tangible and will only worsen with time with no action. I think it will become more and more relevant in clinical practice in the future, and all physicians needs to be aware of how they can make an impact to improve the situation and also to consider how it affects their patients.
ABN Practical Neurology Lecture: What does data science and AI have to do with neurology?
Prof James Teo, Kings College London, UK
This was a very interesting lecture that highlighted the expanding role of artificial intelligence (AI) in healthcare, including in neurological diseases. Professor Teo broke down what AI actually is and how it works. Its use was highlighted in stroke care, where AI is used to analyse radiological images and to help determine acute stroke treatment. He discussed the use of AI to gather massive data within the NHS and the need to establish “a language in AI for the NHS” going forward. My major take home was that I need to brush up on medical statistics and also learn coding and R. Moreover, I feel that my days of painless data collection as a medical student and as a junior doctor may not pass on to future junior doctors, and the focus would be more on analysing the wealth of easily obtainable data.
ABN John Walton lecture
Professor Joanna Wardlaw, Edinburgh, UK
Professor Wardlaw has a lengthy list of accolades and is an expert neuroradiologist, to say the least, with a wealth of experience. Her lecture was thorough and very interesting – she focused on small vessel disease and its clinical significance. She also discussed how the presence of small vessel disease and white matter hyperintensity contributes to cognitive symptoms and can predict future disease risk. The trials discussed highlighted that reducing or “shrinking” white matter hyperintensity can in fact result in improved motor and cognitive function. She discussed the risk factors and management strategies. She also discussed the trial she has been involved with looking at the use of re-fashioning isosorbide mononitrate in lacunar strokes specifically, which has had very promising and exciting results thus far.
BIASP Session: Advances in thrombectomy
Soma Banerjee, Consultant Stroke Physician, Imperial College, UK
I really enjoyed this lecture by Dr Banerjee, who is the lead for the stroke and thrombectomy service at Imperial College London. The lecture provided a concise and structured summary of the important thrombectomy trials to date, and future horizons to look out for. The lecture in essence honed in on how beneficial thrombectomy is as a treatment for stroke and the need to find ways to incorporate this more into stroke care. Controversies and challenges were also discussed as well as ways to try to overcome these in the near and longer term future. Perhaps more neurologists even performing thrombectomy in the way cardiologists perform PCI for STEMI – it is exciting to see how this will evolve as it is rapidly advancing.
[Further reading… The frontiers of acute stroke management | ACNR]
Neurology on the maternity unit
Catherine Nelson-Piercy, Consultant Obstetric Physician, Guys & St Thomas, UK
Dr Catherine Nelson-Piercy delivered an amazing lecture on common neurological complications in pregnancy – including seizures and stroke. It was very informative and will certainly guide my management of pregnant patients with neurological presentations. The reassurance to use imaging and assess on a risk versus benefit basis, as well as to treat pregnant women with stroke as any other patient, was especially resonant for me. I also really enjoyed learning more about the strategy for seizure treatment in pregnancy and how imperative it is to have careful drug-level monitoring and involvement of the multi-disciplinary team, i.e. obstetricians working closely with the neurologists.
Antiseizure medication: patient choice vs. regulation
Charlotte Lawthom, Royal Gwent Hospital, Wales vs Fergus Rugg-Gunn, UCLH, UK
The conference closed with an exciting debate between two prominent epileptologists regarding “Patient choice vs regulation” in relation to sodium valproate. Both sides were very convincing and discussed highly relevant points. I do however personally agree with regulation over choice, but I know this might be a controversial statement and it is certainly not straightforward.
[Further reading…Epilepsy Archives | ACNR]