The ABN annual meeting 2019 was in Edinburgh this year and featured a bagpipe-accompanied reception, excellent Scottish hospitality and speakers from across the UK, as well as that rarest of clinical entities – Scottish sunshine. Whilst the Gala dinner, with accompanying auction of rare books and ceilidh were fantastic – and they were – the entire programme showcased the best of UK neurology.
Over 3 days plus 1 day pre-meeting with separate sessions for neurology registrars, GP and acute medical physicians and pre-ST3 doctors, the audience was treated to a series of stellar talks. There was so much on offer that we will focus on a few highlights.
An era of new treatments
Professor Matthew Walker discussed the rapidly-evolving area epilepsy treatments, which include virus-derived vectors for focal delivery of specific ion channel DNA that can integrate and potently reduce focal seizures. He discussed the potential for this to be used in an epilepsy surgery pathway with recourse to resection of the dysfunctional and vector-treated tissue if refractory, thereby containing the potential treatment risks. Building on excitement about antisense oligonucleotide treatment in spinal muscular atrophy, Professor Charles Thornton from Rochester gave the Gordon Holmes lecture on developing treatments for myotonic dystrophy. Although not truly a neurological treatment, CAR-T therapies for acute leukaemias and lymphomas have been licensed for use in seven specific Haematology units across England (www.england.nhs.uk). They can cause prominent, usually self-limiting neurological symptoms as a direct toxicity related to their anti-CD19 properties, but have the potential to transform outcomes in acute leukaemias (as recently featured in BBC documentary War in the Blood – available until 6/8/19). These centres will need dedicated neurologists as a named member of the team, to help guide management and investigation of these critically unwell patients and presents an interesting growth area for collaboration.
Motor neurone disease
MND featured prominently this year. In Professor Dame Pamela Shaw’s ABN medallist lecture, she demonstrated the huge value of involving the public and patients in neurological research. She cited examples of the sizeable financial donations made by prominent individuals towards establishing SiTRAN, Sheffield translational neuroscience. These collaborations have also driven therapeutic innovations such as the HeadUp Collar, a supportive technology meeting a common patient-identified need in MND. Professor Siddhartan Chandran’s talk on inducible pluripotent stem cells in human disease modelling highlighted the particular utility of this technology for diseases affecting cells of the brain and spine. There were also several talks on current research, including by Dr Jonathan Cooper-Knock and data from the Scottish CARE-MND platform on genotype-phenotype correlations of long-survivors with MND, giving opportunity for optimism about this challenging disease.
The case presentations are always of exceptional quality, and this year was no exception with a range of challenging and thought-provoking cases, with a neuroimmunological flavour overall. For us, take-home messages were (i) the growing utility of paranodal antibody assays from Dr Simon Rinaldi’s lab in Oxford (research domain at present); (ii) rare but potentially under-recognised paraneoplastic myelitis mimicking neuromyelitis optica; (iii) an ongoing note of caution of the potential risks of immunosuppression with a case of EBV-associated lymphoproliferative disorder leading to vasculitis of multiple organs and ultimately death.
The clinico-pathological case always fills me with delight, not least because I am glad not to be the discussant! This year Ed Newman was the brave person to discuss the case, and kept the audience riveted as he worked through the problem with elegant ease. Seeing the diagnostic process laid bare is always impressive, even more so when accompanied by Scottish neurovocabulary (Bonkle,Tyndrum, Kells anyone?) and the correct diagnosis.
We also want to mention a debate that has been initiated (but by no means concluded) regarding whether or not the ABN should adopt a formal position on medical assisted dying. Jaquie Palace and Uma Nath clearly and dispassionately summarised the current state of affairs. They focused on the various definitions and legal nuances of the debate as well as the recent change in position of the Royal College of Physicians (London) from a state of opposition to neutrality. They also presented data on the voting patterns of different physician groups in the RCP survey. This was followed by a brief but lively discussion from the floor. The ABN will be drawing more attention to the work that they are doing surrounding this important topic in the coming months.
Congratulations and thank you to Jon Sussman and committee who organised the meeting.
The next ABN meeting is in Bournemouth, 13-15th May 2020. So why go? The calibre and breadth of talks is high, and they are consistently practical, relevant and inspirational in equal measure. There are always plenty of opportunities to catch up with old friends and colleagues and to make new ones. Finally, the opportunity to appreciate the neurology Zeitgeist is, we think, unparalleled: to hear and contribute to discussions on Assisted Dying, Shape of Training, and neurological services is as important as the exciting new science and treatments discussed in sessions on either side.