Fourth EAN Meeting Tackles Theme of Neurogenetics

Pauline Anderson

June 15, 2018

LISBON, Portugal — New guidelines on palliative care for patients with severe multiple sclerosis, how migration affects neurologic disorders, the billion-euro plus price tag for migraines, and new insights into dementia prevention.

These are just some of the wide range of topics to be covered at the Congress of the European Academy of Neurology (EAN) 2018 here June 16 to 19, 2018.

Interwoven among the numerous presentations, workshops, and symposia will the "overarching" theme of neurogenetics — what has already been achieved in this field, the direction it's headed, and where future approaches might lie, EAN President Günther Deuschl, MD, professor emeritus of neurology at Kiel University, Germany, told Medscape Medical News.

Genetic Influences

New insights into the genetic influences on the development and function of the nervous system are coming to light every day, said Deuschl.

While neurogenetics doesn't hold the key to solving all neurologic problems, the new knowledge helps to "reclassify diseases and groups of diseases, and promises to open up new treatment approaches," he said.

For example, neurogenetics can be an important tool to identify rare neurologic disorders. All too often, symptoms of these disorders aren't immediately recognized, leaving patients uncertain about their condition for long periods.

For several of these rare disorders, therapeutic options (for example, replacement of vital enzymes, targeted medications, or a specific diet) already exist.

For more common neurologic disorders, such as epilepsy, Alzheimer's disease, and Parkinson's disease, doctors can now detect hereditary forms. This, said Deuschl, means that those affected and their loved ones can be informed of the risks earlier.

And just on the horizon is gene replacement therapy. This intervention promises to cure some of the most relentlessly progressive disorders,  including spinal muscular atrophy, and Friedreich's ataxia, an inherited disease that causes progressive damage to the nervous system.

"We would like to ensure that as many people in Europe as possible can benefit from the latest findings in this area, and our congress is a valuable information hub where the best can learn from the best," EAN President-elect Franz Fazekas, MD, head of the Department of Neurology at Graz Medical University, Austria, told Medscape Medical News.

For his part, David B. Vodušek, MD, PhD, professor emeritus, Faculty of Medicine, University of Ljubljana, Slovenia, and chair, Communication Committee, EAN, is keen to attend any conference session pertaining to neurogenetics. These are "not to be missed," he told Medscape Medical News.

Huge Hike

Also not to be missed will be discussions on the huge hike over the past 25 years in deaths due to brain disorders. In Europe, stroke, dementia, headache, multiple sclerosis, and Parkinson's disease are the primary causes of disability and the second most common cause of death.

The Global Burden of Disease study found a 36.7% worldwide increase in deaths attributable to these conditions between 1990 and 2015. This was despite the significant drop during that period in the number of deaths attributable to stroke or communicable neurologic diseases.

Deuschl called on politicians across Europe, in addition to researchers, to focus on the human and economic implications of this dramatic increase — from lost years of life to direct and indirect costs of care.  

According to the Global Burden of Disease study, in 2015, 250.7 million disability-adjusted life-years (DALYs) —  or years of healthy life lost — due to neurologic conditions were reported worldwide. This represents more than 10% of DALYs due to all illness or early death.

Brain disorders were the cause of 9.4 million deaths in 2015, which was almost 17% of all deaths during that year.

"There is no end in sight to this trend," which is due in part to population growth and demographic shifts, said Deuschl.  However, he pointed a finger at stroke and dementia disease as being the "main drivers."

Globally, stroke accounts for the most DALYs of any brain disorder (47.3%), and the most deaths  (67.3%). Alzheimer's disease and other forms of dementia are the fourth-largest cause of incapacity and the second most common cause of death.  

These and other brain disorders "have gone from being a significantly underestimated and often undertreated group of conditions to a huge challenge facing society and health policymakers today," said Deuschl.

The EAN is now trying to get a better picture of the prevalence of brain disorders in Europe. "We want to process more facts and figures and present them to national societies and politicians," said Fazekas.

"EU countries must face up to the question of whether they want to put the necessary money into preventing, curbing, and healing brain disorders in future."

The EAN is calling for more prevention strategies, along the lines of what has already been achieved for stroke. Here, research activities and political efforts have started to bear fruit, with stroke-related deaths and incapacity rates "falling all the time," said Fazekas.

"Better prevention and the introduction of specialist stroke units are starting to have an effect. But there are still huge differences within Europe, and, in many cases, within individual countries."

And it appears there's still a long way to go. The Value of Treatment study, conducted by the European Brain Council, found that as many as 8 in 10 Europeans \with a brain disorder remain untreated or inadequately treated, even though effective therapies exist.

Possible culprits for this situation include treatment plans that are inadequately mapped out, lack of specialist facilities, missed rehabilitation opportunities, or insufficient psychosocial support provided to patients and their families.

Cross-border Research

Increased funding for cross-border research projects is "an essential aspect" of getting a grip on the burden of brain disorders in Europe, said Fazekas.

He added that he and his colleagues hope that the facts and figures they're collecting "will convince politicians and decision makers to invest in the future of our society and to generate research programs for reducing the burden of neurologic disorders."  

The EAN was formed in 2014, when the European Federation of Neurological Societies (EFNS) merged with the European Neurological Society (ENS). After its inaugural meeting in Berlin, the EAN met the following year in Copenhagen and the next year in Amsterdam.

Lisbon, this year's locale, is "a great place with an excellent tradition in neurology," said Vodušek. The conference is expected to draw over 6500 delegates from across Europe.

The EAN aims to meet in various cities across continent, "from North to South and from East to West," said Vodušek. "It would be ideal to eventually visit all European countries."

However, he added, the venue selections are limited, given the sheer size of the congress and the need for large enough conference centers.

As this fourth annual congress gets under way, Vodušek reflected on the EAN roots.

"The EAN is new, but then again, it's not," he said. "It cherishes and relies on the tradition of two great previous European neurological societies — the EFNS and the ENS. I would say it combines, in a good way, the different strengths of its parents and has made good progress in the right direction since its inception. The increasing involvement of neurologists in EAN projects and events speaks favorably for the future."

Congress of the European Academy of Neurology (EAN) 2018. June 16 to 19, 2018.

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