One Europe, one neurologist?

World Federation of Neurology

BACKGROUND AND PURPOSE

To acknowledge the occasion of the 10th anniversary of the formation of the European Academy of Neurology (EAN), the World Federation of Neurology was invited to contribute its perspective on the formation of the EAN and its activities over the past decade.

METHODS

This article is based on the experiences of the author in several functions with the European Union of Medical Specialists, the European Federation of Neurology and the European Neurological Society and with the World Federation of Neurology as a trustee since 2009. This article is supported by the author's own archive as well as by several publications.

RESULTS

The formation of the EAN was influenced by the activities of the two main predecessor societies, the European Neurological Society and European Federation of Neurology, which left an imprint on the structure of the EAN. The newly formed EAN underwent rigorous structural and organizational changes and has been acting as a successful and independent regional society, expanding increasingly in worldwide activities.

CONCLUSION

The EAN, with its 47 member countries, strong democratic leadership and structure, is an excellent example of a regional society with expanding global influence that uses its advocacy skills to influence and improve the structure of neurology in Europe.

The Intersectoral Global Action Plan (IGAP): A unique opportunity for neurology across the globe

The World Health Assembly (WHA) approved the Intersectoral Global Action Plan (IGAP) in 2022. This ambitious project, formally called the Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders, is a 10-year plan to enhance neurology implementation worldwide and to raise the status of brain health and neurology services for patients with neurological diseases. The IGAP has 5 important components: relation with policy makers, therapy, prophylaxis, research, and public health. The implementation of IGAP is a challenge, not only for the specialty of neurology but for the whole neurological community, encompassing patients, carers, healthcare providers, and the public. The lack of a unified definition of neurology and the great variety of health systems, as well as the dependency on socioeconomic status, will necessitate custom-made solutions in all regions.

Awakening to sleep disorders in Europe: Survey on education, knowledge and treatment competence of European residents and neurologists

OBJECTIVES

Sleep-wake disorders are common in the general population and in most neurological disorders but are often poorly recognized. With the hypothesis that neurologists do not get sufficient training during their residency, the Young European Sleep Neurologist Association (YESNA) of the European Academy of Neurology (EAN) performed a survey on postgraduate sleep education.

METHODS

A 16-item questionnaire was developed and distributed among neurologists and residents across European countries. Questions assessed demographic, training and learning preferences in sleep disorders, as well as a self-evaluation of knowledge based on five basic multiple-choice questions (MCQs) on sleep-wake disorders.

RESULTS

The questionnaire was completed by 568 participants from 20 European countries. The mean age of participants was 31.9 years (SD 7.4 years) and was composed mostly of residents (73%). Three-quarters of the participants reported undergraduate training in sleep medicine, while fewer than 60% did not receive any training on sleep disorders during their residencies. Almost half of the participants (45%) did not feel prepared to treat neurological patients with sleep problems. Only one-third of the participants correctly answered at least three MCQs. Notably, 80% of participants favoured more education on sleep-wake disorders during the neurology residency.

CONCLUSIONS

Education and knowledge on disorders in European neurological residents is generally insufficient, despite a strong interest in the topic. The results of our study may be useful for improving the European neurology curriculum and other postgraduate educational programmes.

European Clinical Neuropsychology: Role in Healthcare and Access to Neuropsychological Services

This study analyzed aspects of the work of clinical neuropsychologists across Europe. There are no published comparisons between European countries regarding the nature of clinical neuropsychologists' work. Forty-one national psychological and neuropsychological societies were approached, of which 31 (76%) responded. Data from seven countries with less than 10 neuropsychologists were excluded. A license is required to practice clinical neuropsychology in 50% of the countries. Clinical neuropsychologists work independently in 62.5%. Diagnostic/assessment work is the most frequently reported activity (54%). Most neuropsychologists work in public hospitals, followed by health centers. Adult neuropsychology was the most frequent area of activity. Services in public institutions are covered by public entities (45.8%), or by a combination of patient funds and public entities (29.2%) and only 4.2% by the patient; whereas services in private institutions are covered by the patient (26.1%) and the combination of patient, public entities (21.7%) or patient and private entities (17.4%). The data suggest that the number of neuropsychologists working across European countries is considerably low in comparison to other medical professionals. The results of the survey identified similar aspects of neuropsychologists' work, despite variations in terms of reimbursement and mechanisms, reflecting economic and healthcare differences. Estimates on the number of clinical neuropsychologists suggest insufficient access to neuropsychological services.

Routinely collected patient data in neurology research: a systematic mapping review

BACKGROUND

This review focuses on neurology research which uses routinely collected data. The number of such studies is growing alongside the expansion of data collection. We aim to gain a broad picture of the scope of how routine healthcare data have been utilised.

METHODS

This study follows a systematic mapping review approach which does not make a judgement on the quality of the papers included in the review, thereby enabling a complete overview of the field.

RESULTS

Of 4481 publications retrieved, 386 met the eligibility criteria for this study. These publications covered a wide range of conditions, but the majority were based on one or only a small number of neurological conditions. In particular, publications concerned with three discrete areas of neurological practice - multiple sclerosis (MS), epilepsy/seizure and Parkinson's disease - accounted for 60% of the total. MS was the focus of the highest proportion of eligible studies (35%), yet in the recent Global Burden of Neurological Disease study it ranks only 14th out of 15 neurological disorders for DALY rates. In contrast, migraine is the neurological disorder with the highest ranking of DALYs globally (after stroke) and yet it was represented by only 4% of eligible studies.

CONCLUSION

This review shows that there is a disproportionately large body of literature pertaining to relatively rare disorders, and a correspondingly small body of literature describing more common conditions. Therefore, there is potential for future research to redress this balance.

Ixcellence Network®: an international educational network to improve current practice in the management of cervical dystonia or spastic paresis by botulinum toxin injection

Botulinum toxin is a well-established treatment for a number of conditions involving muscle hyperactivity, such as focal dystonia and spastic paresis. However, current injection practice is not standardized and there is a clear need for structured training. An international group of experts in the management of patients with cervical dystonia (CD) and spastic paresis created a steering committee (SC). For each therapeutic area, the SC developed a core slide set on best practice, based on the literature. International sites of expertise were identified for training and courses were designed to include lectures and casebased learning. Where possible, courses received accreditation from the European Union of Medical Specialists (UEMS). Each course was peer reviewed by the SC, the UEMS accreditation board and the attendees themselves (through evaluation questionnaires). Attendees' feedback was shared with the SC and the trainers to tailor future training sessions. From the program launch in 2012 to December 2014, 328 physicians from 34 countries were trained in a total of 58 courses; 67% of the courses focused on spastic paresis and 33% on CD. Of the 225 (69%) physicians who completed feedback forms, 95% rated their course as 'above average/excellent' in meeting the preset learning objectives. Most (90%) physicians declared that attending a course would lead them to change their practice. The development of the 'Ixcellence Network' for continuous medical education in the fields of spastic paresis and CD has provided a novel and interactive way of training physicians with previous experience in botulinum toxin injection.

Insufficient global health education in European neurological post-graduate training: a European Association of Young Neurologists and Trainees survey

BACKGROUND AND PURPOSE

The awareness of and demand for neurological expertise in global health (GH) have emerged over recent years and have become more relevant due to the increasing numbers of refugees from developing countries arriving in Europe. This study aimed to assess the provision of GH education and opportunities for international exchange during neurology post-graduate training with a focus on Europe.

METHODS

We developed a questionnaire covering different aspects of and interest in GH education on behalf of the European Association of Young Neurologists and Trainees. Residents in neurology and junior neurologists (RJN) were approached to complete this survey.

RESULTS

Completed questionnaires were returned by 131 RJNs, of whom 65.7% were women and 84.0% were between 26 and 35 years old. In total, almost one-third (29.0%) of RJNs reported that their residency programs offered training in GH. Limited education was reported for women's or children's health and neurological disorders of immigrants and refugees, as only 22.1%, 25.2% and 22.1% of RJNs reported that such training was offered, respectively. The curriculum rarely included coverage of the global impact of neurological disorders. Definite plans to volunteer in a developing country were reported by 7.6%. The majority of the participants acknowledged the importance of GH training and international exchange during post-graduate education.

CONCLUSION

This survey corroborates the interest in and appreciation of GH education by European RJNs. However, there are shortcomings in training and opportunities for international exchange. Academic neurology and international bodies, including the European Academy of Neurology, are requested to address this.

Are the French neurology residents satisfied with their training?

BACKGROUND

There have been dramatic changes in neurology over the past decade; these advances require a constant adaptation of residents' theoretical and practical training. The French Association of Neurology Residents and the College of Neurology Teachers conducted a national survey to assess the French neurology residents' satisfaction about their training.

METHODS

A 16-item questionnaire was sent via e-mail to French neurology residents completing training in 2014. Data were collected and processed anonymously.

RESULTS

Of eligible respondents, 126 returned the survey, representing approximately 40% of all the French neurology residents. Most residents (78%) rated their clinical training favorably. Seventy-two percent reported good to excellent quality teaching of neurology courses from their faculty. However, many residents (40%) felt insufficient their doctoral thesis supervision. All residents intended to enter fellowship training after their residency, and most of them (68%) planned to practice in a medical center.

CONCLUSION

French neurology residents seemed satisfied with the structure and quality of their training program. However, efforts are required to improve management of the doctoral thesis and make private practice more attractive and accessible during the residency. In the future, similar surveys should be scheduled to regularly assess neurology residents' satisfaction and the impact of the forthcoming national and European reforms.

The European Association of Young Neurologists and Trainees in 2013: striking a blow for European junior neurologists

BACKGROUND AND PURPOSE

The main objective of the European Association of Young Neurologists and Trainees (EAYNT), an independent Brussels-based association of junior neurologists, is to represent and promote the interests of European junior neurologists.

METHODS AND RESULTS

A wide variety of projects and activities are ongoing, carried out by members of the organization in close collaboration with major European and National Neurology bodies. Most recently, we surveyed European junior neurologists about their views on the European Board of Neurology Examination, the status of e-learning in postgraduate neurology training and migration patterns of young neurologists.

CONCLUSIONS

The aim of this paper is to outline the current and future activities of the EAYNT. We run a series of lectures ('EAYNT special sessions') at the major European conferences and disseminate information to young neurologists at the EAYNT booth. We provide information about travel grants, fellowships as well as sharing personal experiences of working abroad. EAYNT members have the opportunity to sit on the scientific subcommittees of the European Federation of Neurological Societies (EFNS) and European Neurological Society (ENS), to chair poster sessions and review abstracts. Furthermore, we continue to provide a forum for young neurologists from all over Europe to network and socialize by means of get-together events and hospital visits.

Partnership and cooperation is necessary to improve and expand neurology

BACKGROUND

Brain disorders have a large impact on society, representing one third of the total burden of disease. Neurology is more than before divided into fields of highly specialized branches.

OBJECTIVE

To assess the need for co-operation in neuromedicine to achieve optimal results for patient treatment, diagnosis and care.

DISCUSSION

Co-operation regarding patients with disorders in the brain and nervous system should involve medical specialists, general practitioners, other professionals, patients and carers. Optimal co-operation represents both an institutional and personal challenge. The principle of joint action between several subspecialists should also have consequences for educational systems and requirements. Formalised co-operation is well established in medical research, and principles for good practice in neuroscience have relevance also for clinical medicine. How to organise the optimal treatment is therefore not only a challenge for neurologists, but also for the total health system within hospitals and in society.

CONCLUSION

Open-handedness and a willingness to co-operate should be a hallmark for neurologists.