As Cardiff medical students we were privileged this year to have the Annual Meeting of the Association of British Neurologists (ABN) hosted in the spectacular Millenium Centre in Cardiff. Brilliant minds from across the country and abroad gathered to share experiences in research and clinical practice with a real focus on inspiring the younger generation to pursue neurology. The venue provided state-of-the-art lecture theatres and ample space for mingling and discussion.
The meeting began with a Student Roadshow and Specialists’ Registrar teaching programme opened by the ABN President Dr Geraint Fuller who delivered a lecture entitled “What neurologists do and Why?”. The President likened a Neurologist to Sherlock Holmes, but with added empathy and better communication skills! He used case scenarios to capture the thought processes required by a Neurologist, emphasising the importance of a good history and clinical examination to deduce the “Where?, What?, and Why?” of the clinical problem; these themes were reinforced by the virtual case scenarios (Dr Joe Anderson), and an overview (Dr Alex Foulkes) of a career in neurology.
There were also student and junior doctor presentations including a project about the expression of a mitochondrial gene as a potential biomarker for Alzheimer’s disease. Later in the afternoon Professor Huw Morris described highlights from ongoing research in neurology which included work on brain plasticity, neuropsychology, and unravelling the molecular mechanisms of neurological conditions.
Participants came together for the concluding session of the day (“How to get ahead in research”), in which the speakers (Dr Ed Fathers, Dr Masud Husain, Professor Phil Smith and Dr Will Whiteley) drew on their practical experience and knowledge of research and clinical neurology. They entertained and informed participants with simple but sound advice e.g. not more than five main points in a 40-minute talk, being clear and precise when writing, the time taken to complete a grant application (one estimate was six weeks), and keeping a balance between “play-safe” and “blue-sky” research.
The main conference began on the 7th May with the welcoming of delegates by Dr Fuller and the ABN President Elect Professor Phil Smith. There followed a feast of teaching including the neurological aspects of Intensive Care Medicine, Rheumatology and Haematology. Parallel sessions on Epilepsy and Multiple Sclerosis, and on Neuroinflammation and Movement disorders ensured that the subspecialties within neurology were covered. These teaching sessions were eye-opening and highlighted how clinical neurology is not limited to diseases originating in the brain and nervous system.
The afternoon session started with Professor Martin Samuels, from Harvard Medical School who delivered the Gordon Holmes lecture entitled “How Neurologists Think – What My Errors Taught Me”. Using case presentations as examples, he described some common diagnostic pitfalls. His candid assessment of his own errors was inspiring. This had to be the highlight of the day, having an eloquent and esteemed clinician share his experience on an issue that is relevant and applicable to clinicians at all stages of training.
New on the programme this year was the Specialist Interest Groups in which delegates were able to meet and engage with like-minded colleagues. Groups were given the opportunity to plan in advance the content of their meetings which ranged from talks to videos and case-presentations, creating an ideal platform for intellectual discourse and the building of research networks.
The day concluded with a drinks reception and the ABN Trainee dinner.
The following day started with the poster exhibition. Of note was a case study on Melkersson-Rosenthal Syndrome, a study of the proportion of posters at ABN conferences that proceed to successful publication compared to other specialties in comparable meetings, and one entitled ‘You Cannot be Sirius’; Sirius is an emerging legal-high with effects on the central nervous system.
The morning session included lectures by Professor Paul Morgan (the immunology of MS), Professor Neil Robertson (MS research within South Wales) and Professor Anne Rosser (stem cell transplantation). The lectures were of high quality and gave the audience a glimpse in to the future of the interaction between basic science and clinical neurology. They outlined the huge amount of work that goes on ‘behind the scenes’, and whetted our academic appetite.
After lunch, in the Shape of Training (SoT) debate, Dr Richard Davenport explained that the SoT plan would be detrimental to neurology, particularly because the time spent in specialty training before obtaining a certificate of specialty training would be shortened. Dr Tom Hughes concurred with this view but argued that more time spent engaged in general medicine is potentially very advantageous to specialty training. A show of hands showed overwhelming support for the view of Dr Davenport.
The final day began with the much anticipated case presentation competition. The seven cases included varicella vasculopathy and the 17 syndrome. In each case the relevant neuroanatomy was well described as was the effect of pathology on function. The winner was Dr Madhu Ramamoorthi who presented a case (entitled “It’s no laughing matter”) of myeloneuropathy secondary to nitrous oxide poisoning.
After coffee, Professor Matthew Kiernan described how good clinical observations and sound laboratory research are providing us with insights in to motor neurone disease and plausible theories for the mechanism of this disease. The lecture showed how collaborative work spearheaded by clinical observations has helped us start to understand this disease.
Professor Mary Reilly followed with an equally engrossing account of the clinical and genetic aspects of peripheral nerve disease including a useful description of algorithms to diagnose the commoner inherited neuropathies. She emphasised the central role of a detailed clinical history and examination, without which a genotype is difficult to interpret. This highlights the importance of honing history taking and examination skills which are just as important now as they were before the advances in genetics.
Throughout the conference, we were able to experience first-hand how neurologists think and approach problems; this was very well demonstrated in the clinicopathological conference during which Dr Graham Lennox gave a master class in how to think when confronted with difficult clinical cases. This is a way of thinking that should be made clear in all specialties and one that should be built upon from the early years of medical school.
The conference was an invaluable experience for students particularly because the specialists did not intimidate us but eagerly educated and inspired us. Despite the neurosciences being one of the most complex subjects, we have certainly been persuaded to enjoy this complexity and revel in its intricacies.
Useful websites and references
- http://www.sign.ac.uk 107 2008
- http://www.nice.org.uk 150 2012
- Canadian Headache Society Guideline for migraine prophylaxis. C J Neur Sci 2012;39(suppl. 2)
- Preventive Pharmacologic Treatments for Episodic Migraine in Adults. J Gen Intern Med 2013. DOI:10.1007/s11606-013-24331-1
- BMJ 2011;342:540-43. doi:10.1136/bmj.d583
- Davenport RJ The bare essentials:Headache Pract Neurol 2008;8:335-43. doi:10.1136/jnnp.2008.159095
- Pringsheim T, Davenport WJ, Dodick D. Acute treatment and prevention of menstrually related migraine headache. Neurology 2008:70:1555-63.
- Temporal arteritis. J R Coll Physicians Edinb 2012:42:341-9 (http://dx.doi.org/10.4997/JRCPE.2012.413)
ACNR 2014: V14;I3
Published online 15/7/14