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Meeting Report

The European Federation of Neurological SciencesThe European Federation of Neurological Societies (EFNS) was founded in Vienna, Austria in 1991. The EFNS is formed by all national neurological associations and societ-ies within Europe. The EFNS holds the view that all diseases in the muscle, PNS, spinal cord and the brain (with the exception of psychiatric disorders) should be diagnosed and treated by neurologists.

Scientific program of the congressSince 1995 the EFNS has organized an annual congress, which to date have been the biggest and most important in this field in Europe. The scientific program of the congress is cho-sen from the proposals of the different scien-tific panels that are the true backbone of the EFNS. These panels cover the major areas of the clinical neurosciences and are composed of eminent experts nominated by the national neurological societies, with one member per country to ensure geographical representa-tion. Therefore, the panels are asked to sug-gest topics and speakers for EFNS congresses and teaching courses. The contribution of the European section of the Movement Disorders Society and of the European Headache Society is fundamental for the final definition of the program. A discrete section is also dedicated

to the activities of European Federation of Neurological Associations (EFNA), to increase the partnership between professionals and patients.

EFNS Congress in FlorenceThe 13th Congress of the EFNS was held in Florence (Italy) from 12–15 September 2009, and was open to all neurologists and healthcare professionals interested in neurological disorders and their management.

More than 2000 scientific abstracts were sub-mitted for oral or poster presentation, and 200 bursaries were attributed to young neurologists, presenting their scientific contribution. Nearly 5500 people registered at the congress, fulfill-ing the EFNS goal of organizing in Europe something similar to the American Academy of Neurology (AAN), without the presence of Continuing Medical Education rules that facilitate American neurologists’ presence at the AAN.

Teaching coursesOne fundamental part of the scientific didactic activities of the congress is the day devoted to the teaching courses, which this time in Florence were organized with the contribu-tion of the European Section of the Movement Disorders Society and the European Headache Society.

Gian Luigi LenziDepartment of Neurosciences, 1st University of Rome ‘La Sapienza’, Rome, Italy Tel.: +39 064 454 907 Fax: +39 064 457 376 gianluigi.lenzi@uniroma1.it

13th Congress of the European Federation of Neurological SciencesFlorence, Italy, 12–15 September 2009

The 13th Congress of the European Federation of Neurological Sciences (EFNS) was held in Florence and was open to neurologists and healthcare professionals interested in neurological disorders. The congress offered teaching courses and main topics. This article summarizes the highlights of some sessions of the 13th Congress of EFNS congress that may have clinical utility.

Keywords: clinical neurophysiology • EFNS congress • small vessel disease • stem cell

13th Congress of the European Federation of Neurological SciencesExpert Rev. Neurother. 9(12), 1743–1745 (2009)

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Meeting Report Lenzi

In Florence, the teaching courses were composed of 18 theoreti-cal courses including: a very popular teaching course on ‘How do I examine…?’ (which this year included tremor, acute neurologi-cal deficit and psychosomatic presentation); hands-on courses in clinical neurophysiology; and a ‘scientific pasta dinner’ on ‘emo-tions, subconsciousness, basal ganglia’ that, owing also to the prestige of the speaker, Ives Agid (Hôpital de la Pitié-Salpêtrière, Paris, France), was completely sold-out in advance. Interaction with the attendants of the teaching course was encouraged and, accordingly, in the teaching course on ‘My most difficult cases’ the speakers interrupted their slide shows throughout their pre-sentations to seek the attendants’ opinion regarding, for example, what they would have done and how to manage the case.

Allow me to underline that the price for attending the teaching course has been kept extremely low and that the request for buying a ticket is used more to facilitate an active participation than to obtain coverage of expenses.

Main topics covered in the EFNS Florence Congress The main topics (MTs) covered at the EFNS Florence Congress were increased from the usual nine to 12, owing to the large num-ber of registrants expected in advance, which was in fact achieved. On the first day, the MTs included two on clinical neurosciences: ‘Small vessel diseases: stroke and dementia’ and ‘Monoclonal anti-bodies for multiple sclerosis (MS)’; and two on more basic aspects of neurosciences: ‘Molecular and cellular imaging of the CNS’ and ‘Clinical neurophysiology’. On the second day the MTs were ‘Advances in movement disorders’, ‘Dementias and memory dis-orders’ and two on neuroimmunology, the first mainly concering stem cells and the second concering neuroinflammation and MS. On day 3 the MTs covered headache, epilepsy, neuromuscular diseases and early MS therapy.

Highlights of the EFNS Florence CongressWe will now summarize the highlights of some of the MT sessions that may be of particular interest and clinical utility.

Small vessel disease & dementiaSpeakers outlined the condition that brings patients with lacu-nae toward a vascular cognitive impairment and then to a clear-cut dementia. It is evident from epidemiological data that these patients amount to 30% of the total number of clinically diag-nosed dementias, but this percentage increases when we consider that cognition is somehow decompensated by the occurrence of a vascular accident. The ‘pure’ forms of vascular dementia have a large genetic component, as delineated by Hansjorg Bazner (University of Heidelberg, Germany), but different types of subcoritcal vascular dementia (SVD) exist. Leonardo Pantoni (University of Florence, Italy) indicated a possible classification of SVD: age- and vascular-related SVD; amyloid angiopathy; inflammatory and immunomediated SVD; other degerative SVD; and inherited SVD. The possibility that inflammatory mechanisms could be a basis for the pathogenesis of the lacu-nae was raised by Michael Hennerici (University of Heidelberg, Germany) and then supported by Gian Luigi Lenzi (La’Sapienza

University of Rome, Italy). These issues have an important bear-ing on prognosis and therapy. Vascular cognitive impairment must be recognized as early as possible by general practitioners, and a closer collaboration with internists and cardiologists will be welcomed.

Progress in clinical neurophysiologyThe session on Progress in Clinical Neurophysiology, organized by Giorgio Cruccu (La’Sapienza University of Rome, Italy), was dedicated to illustrating recent developments in clinical neu-rophysiology that may be useful to clinicians, since some tech-niques are now being used both to understand pathophysiology and to help the diagnostic process in neurological disease. In particular, Luciano Fadiga (University of Ferrara, Italy) gave an example of translational research, showing how data col-lected in monkeys were useful to plan the appropriate experi-ment in humans and even in patients, demonstrating that the human motor cortex is strictly interrelated with sensory cortical areas in a bidirectional manner. Josep Valls-Solé (Unversity of Barcelona, Spain) offered a survey of many neurophysiological techniques (from transcranial magnetic stimulation with paired stimuli or trains of stimuli, to spinal reflexes, synchronization of the heart beat and monitoring of sphincter function) that are being successfully used to differentiate various forms of common and rare multisystem atrophies. Luis Garcia-Larrea (Inserm, France) demonstrated how, with modern ‘solid-state’ laser stimulators with optic-fiber guidance, it has become easy to record pain-related cortical signals that originate from the somatosensory areas, insular cortex and cingulated gyrus, which are the main stations of the brain ‘pain matrix’. This noninvasive method has prove very useful in patients with various forms of peripheral and central neuropathic pain.

Stem cells & neurological diseaseOrganized by Gianvito Martino (San Raffaele Scientif ic Insitute, Milan, Italy) and Nils Erik Gilhus (University of Bergen, Norway), the stem cells and neurological disease ses-sion was dedicated to clarifing the state-of-the-art in the applica-tion of stem cell therapy to neurological diseases, such as MS, de generative dementia, Parkinson’s disease and stroke. Paolo Muraro (Imperial College, London, UK) focused on bone-mar-row stem cells; Olle Lindvall (Lund, Sweden) reported on the results from trials on Parkinson’s disease and stroke patients; and Martino closed this highly interesting session with a review on the different approaches to the production of stem cells in a quantity sufficient for treatment.

Other sessions were dedicated to movement disorders, with lectures on pain in Parkinson’s disease, cortical connectivy in patients with movement disorders and the preclinical diagnosis of Parkinson’s disease; to dementias, with lectures on the molecu-lar aspects and neuroimaging of Alzheimer’s disease and memory disorders; to headache, focusing on the epidemio logically very important problem of chronic headache, trigeminal autonomic cephalalgia and treatment of the acute migraine attack; to epilepsy, with lectures on hippocampal deep-brain stimulation, genetic

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Meeting Report13th Congress of the European Federation of Neurological Sciences

engineering of adenosine-secreting fibroblasts and perspectives for therapy of refractory epilepsy; and to neuromuscular diseases, with lectures on chronic inflammatory demyelinating neuropathies and on diagnosis and treatment of myopathies.

Early active MS: treat before it is too lateIn this session, organized by Soelberg Sorensen (København University, Denmark) and Gilles Edan (Centre Hospitalier Universitaire, Rennes, France), the important problem of the ini-tiation of immunosuppressant or immunomodulating therapy in patients in the early phase of MS was approached. Luca Massacesi (Careggi Hospital, Florence, Italy) demonstrated how changes in the immune system tend to instigate early treatment of MS, in particular when the disease shows clear-cut signs of activity. Longitudinal data support this attitude, as reported by Sorensen in his lecture. Finally, Edan presented the results of induction therapy to induce early remission of MS.

Late breaking news sessionFinally, in the late breaking news session, the results of the Randomized Evaluation of Long Term Anticoagulant Therapy (RE-LY) trial on dabigatran and of the International Carotid Stenting Study (ICSS) were presented. The RE-LY trial is a clini-cal trial performed on 18,113 patients with atrial fibrillation and, therefore, at high risk for stroke, with the occurrence of stroke or systemic embolism as the primary outcome. The control arm of the trial were treated with warfarin. The results have shown a reduction of the rates of the primary outcome in the dabigatran group, as well as a reduction of bleedings and deaths. Combined with the easier method of administration and with the lack of the need for continuous control of the international normalized ratio, the feelings were of an important step forward in the treatment of patients with atrial fibrillation. Martin Brown (University College London Institute of Neurology, London, UK) reported the early results of the ICSS on the safety of treatment in patients with symptomatic carotid stenosis. In this study, comparing stenting and endarterectomy, the results have shown that so far the end-arterectomy has a minor number of acute or late complications in the patients selected with the ICSS criteria and in the centers recruited by the study.

The congress was closed by a superb lecture given by Giacomo Rizzolatti (Università di Parma, Italy), Chairman of the Department of Physiology in Parma, on the characteristics of the ‘mirror neu-rons’ and their possible relationships with fundamental aspects of the interhuman relationships, such as empathy, and therefore on clinical conditions, such as autism and cognitive decline. This lecture emphasized the potential of a closer collaboration between basic science and clinical science, the fruitful results of common research lines and the flourishing of scientific hypotheses that arise from the comparison with experimental settings.

In the final closing of the congress, the two Presidents of the major neurological organizations in Europe, Jacques De Reuck (Hospital of Gent, Belgium) for the EFNS and José Ferro (Hospital de Santa Maria, Lisbon, Portugal) for the ENS, expressed their warmest wish for a closer cooperation between their societies, establishing a joint committee to pursue the com-mon goals for the development of neurological sciences in their manifold aspects of teaching, research, patient care, prevention and interdisciplinary relationships.

The next congresses will be held in Geneva (Switzerland) in 2010 and in Budapest (Hungary) in 2011.

Financial & competing interests disclosureThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Affiliation• Gian Luigi Lenzi, MD, FRSP(Edin)

Professor of Neurology, Department of Neurosciences, 1st University of Rome ‘La Sapienza’, Rome, Italy Tel.: +39 064 454 907 Fax: +39 064 457 376 gianluigi.lenzi@uniroma1.it and Vice-President of the EFNS, Breite Gasse 4/7, 1070 Wien, Austria and Viale Università 30, 00185 Roma