Who are on the line-up of the WESAN Exeter Neurology course in 2017?

The West of England Seminars in Advanced Neurology (WESAN) is an annual course convened by Neurologists at the Royal Devon and Exeter Hospital. You may check out the previous programmes listed in the blog post tilted What has the Exeter Neurology Course accomplished in the last decade. You may also learn more about WESAN in the blog post titled A short history of WESAN. 

Exeter Cathedral timelapse. Joe Dunckley on Flikr. https://www.flickr.com/photos/steinsky/894007623

The WESAN programme this year, as usual, is an exquisite balance of topics covering the spectrum of neurological specialisms. The agenda is a fine blend of new and old topics, delivered by experts at the cutting edge of their fields.

 

The Rougement Hotel Exeter. Robert Cutts on Flikr. https://www.flickr.com/photos/panr/5542700403

So what has WESAN lined up for 2017? Here are the topics and speakers

 

 Functional Neurological Disorders-The Assessment as Treatment

Jon Stone, Professor of Functional Neurology at Edinburgh

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The Neurology of Amnesia

Adam Zeman, Professor of Cognitive Neurology at Exeter 

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Advances in the Diagnosis of Neurogenetic Disorders

Julia Rankin, Consultant Clinical Geneticist at Exeter 

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Emerging Treatable Autoimmune Disorders of the CNS

Sarosh Irani, Associate Professor of Neurology at Oxford 

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Movement Disorders: A Video Presentation

Kailash Bhatia, Professor of Clinical Neurology at Queen Square 

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Cold Injury in the Royal Navy

Paul Hughes, Neurologist at Haywards Heath 

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Hepatitis E and the Nervous System

Harry Dalton, Consultant Hepatologist at Truro

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The mTORopathies-What the Neurologist Needs to Know

Finbarr O’Callaghan, Reader in Paediatric Neuroscience at Great Ormond Street Hospital  

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Refractory Epilepsy: Hope is not a Strategy

Hannah Cock, Professor of Neurology at St George’s Hospital 

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Looking Back on a Career in Neurology – Some Things I Would Probably Have Done Differently

Nick Fletcher, Consultant Neurologist (rtd) at the Walton Centre 

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Ganglioside Antibodies and the Landscape of Immune Neuropathies

Hugh Willison, Professor of Neurology at Glasgow 

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Metabolic Muscle Diseases

Jon Walters, Consultant Neurologist at Swansea 

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MS: Emerging Treatments and Treatment of Progressive Disease

Claire Rice, Consultant Neurologist at Bristol  

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You may register for WESAN Exeter now

Follow WESAN on twitter: @wesanexeter

By FranzfotoOwn work, CC BY-SA 3.0, Link

A short history of WESAN

This is a follow up to my last blog post titled What has the Exeter neurology course accomplished in the last decade? There I discussed the achievements of the West of England Seminars in Advanced Neurology (WESAN). In this post, the focus is on the history of WESAN, and who better to tell the story than Christopher Gardner-Thorpe, who spent the bulk of his neurology career at the Royal Devon and Exeter Hospital, where I now work. His own story needs a different blog post to relate. For now, here is Chris’s brief look-back at the history of WESAN. In a way, this also happens to be the first Neurology Lounge guest blog!

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A Short History of WESAN

By Christopher Gardner-Thorpe

The Bath Course that David Bateman started in 1993/4 was very successful and the first general neurology course in the south of the country (the Edinburgh Course which had started before 1993 was a little different but equally enjoyable and useful), concentrating on everyday issues. The participants were drawn from consultant and trainee doctors who enjoyed a couple of days in Bath with accommodation and good fraternity intermingled with significant learning opportunities. The slide projection apparatus in those days left a lot to be desired and often the slide projector would jam or the laptop computer would not recognise the projector or vice versa. It usually took up to half a dozen persons clustered round the apparatus in order to get it going again.

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Pharmaceutical sponsorship was available and widespread in those days and the Course rightly counted for study leave. Audit had barely started and discussions between colleagues enabled us all to keep roughly in-line with current practice throughout the country.

David Bateman moved from Bath to Carlisle to start a new neurology unit, in the north of England where he knew the territory well, having trained partly in Newcastle. This provided a good opportunity for Exeter to take over the course. Colleagues in Bath did not wish to run the course nor was there a competitive venue to continue the course there. So we set up West of England Seminars in Advanced Neurology and the acronym WESAN was the obvious shortcut term. Nick Gutowski and Christopher Gardner-Thorpe were pleased to take on the course.

By Equestenebrarum - File:Topographic Map of the UK - Blank.png, CC BY 3.0, Link
By EquestenebrarumFile:Topographic Map of the UK – Blank.png, CC BY 3.0, Link

In order to continue to ensure the conviviality that surrounded the Bath meetings, a clear choice of venue was Bovey Castle in Moretonhampstead. This hotel, previously a British Railway hotel of mediocre reputation, had been greatly improved and was a fine venue. We were made most welcome and the course content went from strength to strength. The one drawback was that the hotel was a taxi ride across half of Dartmoor from Exeter, but this did not deter participants – and the isolation might have been an advantage. Again, pharmaceutical support allowed the cost for participants to be kept reasonable. This continued for a few years until the squeeze came – three golf courses was the nail in the coffin.

Bovey Castle. © Copyright Martin Bodman http://www.geograph.org.uk/photo/2475196
Bovey Castle. © Copyright Martin Bodman http://www.geograph.org.uk/photo/2475196

A new venue had to be found. This took the form of the Rougemont Hotel in Exeter, the old hotel opposite the Southern Railway Station of Exeter Central, the name reflecting the red earth of Devon and the mound upon which in 1068 the castle had been built nearby. The venue was not exactly the similar to Bovey Castle but access within Exeter was much easier. Furthermore, just before Christmas (for we had changed the timing from June to November) the hotel was within easy walking distance of the High Street shops. The dinner has been held at one of two sites, the Cathedral Chapter House and the Guildhall. The latter has become the venue of preference and is only a couple of hundred yards from the hotel. The hotel became the Thistle and is now the (second) Mercure in Exeter.

The Rougemont Hotel, Exeter. Robert Cutts on Flikr https://www.flickr.com/photos/panr/5542700403
The Rougemont Hotel, Exeter. Robert Cutts on Flikr https://www.flickr.com/photos/panr/5542700403

We have enjoyed running the course and the speakers have increased from about ten to a regular and lucky number of thirteen, over the two days, Thursday and Friday, with the option of staying to enjoy Devon over the ensuing weekend. Joe Gormley and Ibrahim Imam have joined the team to provide new stimulus, continuity and a long future for this Course.

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 Why not click to register for WESAN now!

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What has the Exeter neurology course accomplished in the last decade?

The West of England Seminars in Advanced Neurology (WESAN) is a neurology course which holds annually in Exeter, the historic English city in the scenic county of Devon. It is a highly-regarded, even if a little bit unassuming, neurology meeting. Over the last decade I have attended several WESAN conferences, always going back to base buzzing with neurological enthusiasm, and brimming with fresh insights into knotty problems. I was therefore very pleased when, along with my colleague Joe Gormley, I was invited to join the long-running conveners of this distinguished course, Christopher Gardner-Thorpe and Nick Gutowski.  And I am talking about this now because the next WESAN is on the 24-25 November 2016.

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What has WESAN achieved over the last ten years to earn the accolades I have poured all over it? Who are the neurology masters who have graced the WESAN podium over the years? Who are the unsung but bright stars who have cast their spell on generations of neurology consultants and trainees? Which subjects did WESAN tackle, and what topics did the speakers conjure up to regale and enthuse? And what will delegates be served this year?

By Dietmar Rabich - Own work, CC BY-SA 4.0, Link
By Dietmar RabichOwn work, CC BY-SA 4.0, Link

To find out, I collated all WESAN programmes since 2005, and I have reproduced them below. The range of topics addresses all the core neurology subspecialties, but keep an eye out for sprinkling of intriguing titles such as Quoi de neuf? Rien de neuf! by Alan Emery, The neuropathologist in court by Waney SquierMagic but treatable? by Oliver Hanemann, Gratiolet’s torque and the evolution of language by Tim CrowEffective whistle-blowing skills for neurologists by David Nicholl, and Therapeutic gardening by Richard Thompson.

Reunion of neurologists at the Salpêtrière hospital. Photograph, 1926 http://wellcomeimages.org/indexplus/obf_images/03/de/5ebbbcfa56d021dda69b21761b96.jpgGallery: http://wellcomeimages.org/indexplus/image/M0005197.html, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=36322408
Reunion of neurologists at the Salpêtrière hospital, 1926. http://wellcomeimages.org/indexplus/obf_images/03/de/5ebbbcfa56d021dda69b21761b96.jpgGallery: http://wellcomeimages.org/indexplus/image/M0005197.html, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=36322408

WESAN 2005

  • Jeremy Hobart (Plymouth) Who rates scales? How to sell yourself short
  • Vaughan Pearce (Exeter) On being a medical director
  • Waney Squier (Oxford) The neuropathologist in court
  • Jonathan Schott (London) Limbic encephalitis-the autoimmune connection
  • Chris Clough (London) The JCHMT
  • Alan Emery (Exeter) Quoi de neuf? Rien de neuf!
  • Stephen Brown (Bodmin) Epilepsy and psychiatry
  • Adam Zeman (Exeter) Syndromes of global amnesia
  • Roger Barker (Cambridge) Huntington’s disease
  • Peter Newman (Middlesborough) IVIG in neurology
  • Pam Shaw (Sheffield) Diseases of the motor neurone
  • Giles Elrington (London) Commercial neurology

WESAN 2006

  • Christopher Weatherley (Exeter) Understanding spinal surgery
  • Mike Boggild (Liverpool) Multiple sclerosis
  • Brendan Davis (Stoke-on-Trent) Headache
  • David Nicholl (Birmingham) Ethics for neurologists
  • Graham Hughes (London) Lupus
  • Peter Harper (Cardiff) Neurology and the beginnings of genetics
  • Adrian Wills (Nottingham) Ventilatory failure for the neurologist
  • David Hilton-Jones (Oxford) Muscles
  • John Winer (Birmingham) Peripheral nerves
  • Tim Lewis  (Bristol)Neuroradiology
  • Pam Crawford (York) Epilepsy-do the facts fit?
  • Geraint Fuller (Gloucester) Training

WESAN 2007

  • Brendan McLean (Truro) Epilepsy
  • Nick Kane (Bristol) Problems and pitfalls in clinical use of EEG
  • Mark Wiles (Cardiff) Education in neurology
  • Mark Edwards (Queen Square) Movement disorders
  • Michael Hutchinson (Dublin) Multiple sclerosis and pregnancy
  • Richard Thompson (Royal College of Physicians) Therapeutic Gardening
  • Vik Devaraj (Exeter) Peripheral nerve surgery for neurologists
  • Oliver Hanemann (Plymouth) Magic but treatable? Tumours due to the loss of merlin
  • Peter Nestor (Cambridge) Mild cognitive impairment-use and abuse of a new construct
  • Rustam Al-Shahi Salman (Edinburgh) Dilemmas in the management of cavernous malformations
  • Paul Davies (Northampton) Headache
  • Peter Bliss (Exeter) Neuro-oncology
Exeter High Street, GuildhallBy Franzfoto - Own work, CC BY-SA 3.0, Link
Exeter High Street, GuildhallBy FranzfotoOwn work, CC BY-SA 3.0, Link

WESAN 2008

  • Neil Scolding (Bristol) Stem cell therapy and MS
  • Robin Howard (Queen Square) Neuromuscular complications on the ITU
  • Russell Lane (Queen Square) Understanding headache
  • Andrew Larner (Liverpool) Practical cognitive neurology
  • Mark Manford (Cambridge) When is a fit not a fit?
  • Ian Barker (Medical Defence Union) Medicolegal matters
  • Hadi Manji (Queen Square) Tropical neurology in central London
  • Tim Crow (Oxford) Gratiolet’s torque and the evolution of language
  • Hardev Pall (Birmingham) Tremor – changes in classification and treatment
  • Malcolm Hilton (Exeter) BPPV: Five-minute miracle cure guaranteed
  • Charles Clarke (Queen Square) The neurology of high altitude, the problems of chronic hypoxia
  • Peter Whitfield (Plymouth) Question time with a neurosurgeon (in the hot seat)

WESAN 2009

  • Marguerite Hill (Swansea) Myasthenia
  • Simon Hammans (Southampton) Muscle disorders and their genetics
  • Graham Venables (Sheffield) Stroke
  • Kirstie Anderson (Newcastle) Sleep
  • Angus Kennedy (Charring Cross) Cognitive problems
  • Caroline Hahn (Edinburgh) Veterinary neurology
  • Susan Duncan (Edinburgh) Epilepsy
  • Peter Harvey (London)
  • Siobhan Leary (Queen Square) Multiple sclerosis
  • Karen Morrison (Birmingham) Motor neurone disease
  • Guy Sawle (Nottingham) Movement disorders
  • Nick Silver (Liverpool) Headache

WESAN 2010

  • Mark Roberts (Manchester) Muscle disorders
  • Peter Simcock (Exeter) Neuro-ophthalmology and optic nerve disorders
  • Bridget MacDonald (St George’s) Epilepsy-practical points in the ordinary neurology clinic
  • Mike Lunn (Queen Square) The diagnosis, pathogenesis and therapy of inflammatory peripheral neuropathies
  • Fady Joseph (Gwent) Behcet’s disease
  • Ian Gilmore (Liverpool) Alcohol-the good, the bad and the ugly
  • Richard White (Liverpool) Headache and stroke in clinical practice
  • Stanley Hawkins (Belfast) Multiple sclerosis
  • Mike Alexander (Dublin) Neurophysiology
  • Ralph Gregory (Poole)
    • When the Parkinson Disease honeymoon is over
  • Gerry Saldanha (London) On Education
  • Kathryn Peall (Cardiff) Myoclonus-dystonia syndromes and familial tremor

exeter-267163

WESAN 2011

  • Lionel Ginsberg (Royal Free) Fabry Disease and peripheral neuropathies
  • Ray Murphy (Dublin) Interesting clinical cases
  • Lina Nashef (Kings) SUDEP-an update
  • Markus Reuber (Sheffield) Managing patients with non-epileptic attacks
  • Chris Turner (UCL) Which is the most important organ involved in myotonic dystrophy?
  • David Bates (Newcastle) The Future of treatments in multiple sclerosis
  • Alastair Compston (Cambridge) Brain: a journal of neurology, 133 years on
  • Ed Fathers (Taunton) How to give a talk
  • Paul Maddison (Nottingham) Paraneoplastic disorders and related antibodies
  • Mark Jackson (Exeter) 1922: stress and the origins of neuro-endocrinology
  • Richard Davenport (Edinburgh) The cervical spine
  • Sam Chong (Medway and Kings) Neuropathic pain-just amitriptyline deficiency?
  • Paul Worth (Norwich) Movement disorders

WESAN 2012

  • Luke Bennetto (Bristol) Intracranial tension-highs and lows
  • Manish Gandhi (Exeter) When the heart rules the brain
  • Richard Jacoby (Exeter) Rheumatology for neurologists
  • David Gow (Manchester) Peripheral nerves
  • Desmond Kidd (Royal Free) Neurosarcoidosis
  • Yvonne Hart (Newcastle) Epilepsy
  • David Nicholl (Birmingham) Effective Whistle-blowing skills for neurologists
  • Tom Hughes (Cardiff) Stroke: trials and tribulations
  • Nigel Leigh (Brighton) Motor neurone disease as a syndrome-lumping, splitting or just mixed up?
  • Simon Mead (Queen Square) Prions and dementia: an update, new diagnostic techniques and clinical trials
  • Philip Buttery (Cambridge) Gene therapy and Parkinsonism
  • Nick Davies (Hereford and Birmingham) Metabolic muscle disorders
  • Diane Playford (Queen Square) Vocational rehabilitation and MS

WESAN 2013

  • Simon Hickman (Sheffield) Optic neuritis and multiple sclerosis
  • Paul Hughes (Brighton) Medicine in the Armed Forces
  • Anu Jacob (Liverpool) What’s new in neuromyelitis optica?
  • Mark McCarron (Derry) Have advances in our understanding of cerebral amyloid angiopathy helped the patient?
  • Stuart Weatherby (Plymouth) Rare headache syndromes
  • Andrea E Cavanna (Birmingham) Crossroads in neurology and psychiatry: Tourette syndrome
  • Tim Lewis (Bristol) Neuroradiology
  • Martin Prevett (Southampton) Chronic neurological disease in Africa
  • Angus Kennedy (Chelsea and Westminster) An approach to neurology in the Intensive Care Unit and in obstetrics
  • Nick Davies (Chelsea and Westminster) The neurology of HIV in the combined anti-retroviral era
  • David Bennett (Oxford) Advances in understanding sensory neuropathies and channelopathies
  • John Duncan (Queen Square) Imaging the brain in epilepsy
  • Romi A Saha (Brighton) Movement disorders

WESAN 2014

  • Jonathan Knibb (Brighton) Progressive aphasia
  • Graham Flint (Birmingham) Syringomyelia
  • Tony Warner (Queen Square) Dystonia and dystonia Parkinsonism syndromes
  • Robin Lachman (Queen Square) Metabolic encephalopathy
  • Martin Turner (Oxford) Making a diagnosis of motor neurone disease
  • Tim Lynch (Dublin) I have learned from my patients
  • Michael Pelly (Chelsea and Westminster) Managing a humanitarian disaster
  • Tony Marson (Liverpool) Seizures, epilepsy and driving
  • Peter Brex (King’s College, London) A NICE update of multiple sclerosis
  • Raanan Gillon (Queen Square) Minimally conscious state, medical ethics and English Law
  • Robert Guiloff (Queen Square) Recent developments in neuropathic pain
  • Barry Seemungal (Charring Cross) A clinical and scientific approach to acute dizziness
  • Andrew Larner (Liverpool) Which screening tool should I use in a patient complaining of poor memory

WESAN 2015

  • Kerry Mills (King’s College, London) EMG and NCV-use and misuse in neurology
  • Melissa Maguire (Leeds) Music and its associations with epileptic disorders
  • Guy Leschziner (London) Differential diagnosis of parasomnias
  • Matt Craner (Oxford) Neuroprotection in MS-old drugs, new tricks
  • Gareth Llewelyn (Cardiff) Recognising and treating peripheral nervous system vasculitis
  • Steve Sturman (Birmingham) Assessment of consciousness and prognosis after acute brain injury
  • Paul Lewis (London) Brain tumour history
  • Justin Pearson (Bristol) Hyperacute stroke units
  • James Miller(Newcastle) Myositis-rashes, inclusions and drugs
  • Raanan Gillon (London) Minimally conscious state, medical ethics and English Law
  • Heather Angus-Leppan (London) Migraine and headache
  • Jeff Kimber (London) Autonomic disorders
  • Alan Whone (Bristol) Current and future advanced treatments for Parkinsonism

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And this year, WESAN 2016 offers:

  • Charlotte Dougan (Liverpool) Muscle disorders
  • Hadi Manji (London) Drug-related neuropathies
  • Simon Farmer (London) Superficial siderosis
  • Martin Sadler (Plymouth)  Epilepsy
  • Kate Petheram (Sunderland) Multiple sclerosis
  • David Werring (London) Microbleeds and cerbral amyloid
  • Chris Allen (Cambridge) A Lifetime in neurology
  • John Stein Dyslexia
  • Andrew Brown (DVLA) Neurologists and driving
  • Thomasin Andrews(London) Huntington’s Disease and movement disorders
  • Mark Wardle (Cambridge) Ataxias: an overview and diagnostic strategy
  • Diego Kaski (London) Diagnosis and management of acute vertigo-central or peripheral?
  • Ibrahim Imam (Exeter) Neurology in Nigeria

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Was WESAN really called The Bath Course, in the distance past? Was David Bateman associated with WESAN in any way? Keep an eye out for the answers in follow-up post on A Short History of WESAN by Chris Gardener-Thorpe.

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mTORopathy: an emerging buzzword for neurology

I was recently perplexed with my first case of tuberous sclerosis complex (TSC). I had no idea what treatment, monitoring and surveillance I needed to institute. I quickly checked things up in neurochecklists; I found excellent checklists on the pathology and clinical features, but was disappointed that there were no treatment or monitoring checklists. I quickly hunted down TSC diagnostic criteria and TSC surveillance recommendations and updated neurochecklists. Phew!

By Herbert L. Fred, MD and Hendrik A. van Dijk - http://cnx.org/content/m14895/latest/, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11892420
By Herbert L. Fred, MD and Hendrik A. van Dijk – http://cnx.org/content/m14895/latest/, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11892420

In the process I discovered that TSC features may improve on treatment with a class of drugs called mTOR inhibitors. Highfalutin stuff I said to myself, and thought nothing more of it. I had to reassess my opinion very shortly afterwards when I came across the Association of British Neurologists (ABN) SoundCloud page with ABN President Phil Smith interviewing Ingrid Scheffer on epilepsy genetics.

We have all experienced that disquieting feeling of just learning something new, and then seeing it crop up all over the place. This is what I felt when Ingrid Scheffer casually stated that Tuberous Sclerosis is an mTORopathy. mTOR is big enough to be an ‘opathy‘, and I was completely ignorant of it! And how come I haven’t heard of Ingrid Scheffer before now-serves me right for missing the last ABN conference in Brighton.

I decided to dig a bit deeper and here are 9 things about mTOR I discovered:

1

mTOR stands for mammalian (or mechanistic) target of rapamycin

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mTOR is a kinase

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The mTOR pathway is important in regulating cell growth and cell death

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mTOR has an important role in many disorders (mTORopathies). These include tuberous sclerosis, epilepsy, autism, traumatic brain injury, brain tumours, and dementia

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Mutations in TSC1 or TSC2 genes cause hyperactivation of the mTOR pathway

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mTOR inhibitors are under investigation for the treatment of these diverse diseases

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Sirolimus is the major mTOR inhibitor

By Fvasconcellos - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1549073
By FvasconcellosOwn work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1549073

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The DEPDC5 gene regulates mTOR inhibition.

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The DEPDC5 gene is mutated in many neurological disorders such as familial focal epilepsies, focal cortical dysplasia, and epileptic spasms. These constitute DEPDC5 motoropathies.

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Enough information to tickle the little grey cells but if you want to dig deeper than you may follow these links:

What are the most controversial questions in neurology?

Uncertainty and doubt abound in Neurology. There are many evidence-free areas where experts rub each other the wrong way. These controversies are big and occur in all neurology subspecialties. Controversy-busters have tried for about a decade to iron out these wrinkles on neurology’s face, but the unanswered questions remain. This is why there is a 10th World Congress of Controversies in Neurology (CONy) holding in Lisbon this year.

I want to assure you I have no conflict of interest to declare in this blog. My interest is to explore  which questions have plagued this conference over the last 10 years to pick out the most controversial topics in neurology. To do this I reviewed all previous conference programs and focused on the items that were slated for debate. I looked for practical topics that have remained unresolved, or are just emerging. Here are my top controversial neurological questions:

Raccoon argument II. Tambako The Jaguar on Flikr. https://www.flickr.com/photos/tambako/7460999402
Raccoon argument II. Tambako The Jaguar on Flikr. https://www.flickr.com/photos/tambako/7460999402

 

1st CONy 2007 (Berlin, Germany)

  • Clinically isolated syndromes (CIS): To treat or not to treat
  • Is stem cell therapy an imminent treatment in advanced multiple sclerosis (MS)?
  • Vascular cognitive impairment is a misleading concept?
  • Is mild cognitive impairment a misleading concept?

 

2nd CONy 2008 (Athens, Greece)

  • Can physical trauma precipitate multiple sclerosis?
  • Should patients with Parkinson’s disease (PD) be treated in the pre-motor phase?
  • What is the first line therapy for chronic inflammatory demyelinating polyneuropathy (CIDP)?
  • Is intravenous immunoglobulin (IVIg) effective in chronic myasthenia gravis (MG)?
  • Tau or ß-amyloid immunotherapy in Alzheimer’s disease (AD)?
  • Chronic fatigue syndrome is an organic disease and should be treated by neurologists?

 

3rd CONy 2009 (Prague, Czech Republic)

  • Should cerebrospinal fluid (CSF) be tested in every clinically isolated syndrome?
  • Can we prevent multiple sclerosis (MS) by early vitamin D supplementation and EBV vaccination?
  • Does Parkinson’s disease (PD) have a prion-like pathogenesis?
  • Patients with medication overuse headache should be treated only after analgesic withdrawal?

 

 

4th CONy 2010 (Barcelona, Spain)

  • Camptocormia in parkinson’s disease (PD): Is this dystonia or myopathy?
  • Does chronic venous insufficiency play a role in the pathogenesis of multiple sclerosis (MS)?
  • IVIg or immunosuppression for long-term treatment of CIDP?

 

5th CONy 2011 (Beijing, China)

  • Is sporadic Parkinson’s disease etiology predominantly environmental or genetic?
  • Is multiple sclerosis (MS) an inflammatory or a primarily neurodegenerative disease?
  • Are the new multiple sclerosis oral medications superior to conventional therapies?
  • Is bilateral transverse venous sinus stenosis a critical finding in idiopathic intracranial hypertension (IIH)?

 

6th CONy 2012 (Vienna, Austria)

  • Will there ever be a valid biomarker for Alzheimer’s disease (AD)?
  • Is amyloid imaging clinically useful in Alzheimer’s disease (AD)?
  • Do functional syndromes have a neurological substrate?
  • Should blood pressure be lowered immediately after stroke?
  • Migraine is primarily a vascular disorder?

 

 

7th CONy 2013 (Istanbul, Turkey)

  • Is intravenous thrombolysis the definitive treatment for acute large artery stroke?
  • Atrial fibrillation related stroke should be treated only with the new anticoagulants?
  • Is the best treatment for chronic migraine botulinum toxin?
  • IS CGRP the key molecule in migraine?
  • Is chronic cluster headache best treated with sphenopalatine ganglion (SPG) stimulation?
  • When should deep brain stimulation (DBS) be initiated for Parkinson’s disease?
  • Do interferons prevent secondary progressive multiple sclerosis (SPMS)?
  • Is deep brain stimulation (DBS) better than botulinum toxin in primary dystonia?
  • Are present outcome measures relevant for assessing efficacy of disease modifying therapies in multiple sclerosis (MS)?
  • Should radiologically isolated syndromes (RIS) be treated?
  • Does genetic testing have a role in epilepsy management?
  • Should cortical strokes be treated prophylactically against seizures?
  • Should enzyme-inducing antiepileptic drugs (AEDs) be avoided?
  • EEG is usually necessary when diagnosing epilepsy

 

8th CONy 2014 (Berlin, Germany)

  • Is late-onset depression prodromal neurodegeneration?
  • Does Parkinson’s disease begin in the peripheral nervous system?
  • What is the best treatment in advanced Parkinson’s disease?
  • Are most cryptogenic epilepsies immune mediated?
  • Should epilepsy be diagnosed after the first unprovoked seizure?
  • Do anti-epileptic drugs (AEDs) contribute to suicide risk?
  • Should the ketogenic diet be prescribed in adults with epilepsy?
  • Do patients with idiopathic generalized epilepsies require lifelong treatment?
  • Cryptogenic stroke: Immediate anticoagulation or long-term ECG recording?
Southern Chivalry: Argument Vs Clubs. elycefeliz on Flikr. https://www.flickr.com/photos/elycefeliz/6271932825
Southern Chivalry: Argument Vs Clubs. elycefeliz on Flikr. https://www.flickr.com/photos/elycefeliz/6271932825

 

9th CONy 2015 (Budapest, Hungary)

  • Is discontinuation of disease-modifying therapies safe in  long-term stable multiple sclerosis?
  • Is behavioral therapy necessary for the treatment of migraine?
  • Which is the first-line therapy in cases of IIH with bilateral papilledema?
  • Should patients with unruptured arterio-venous malformations (AVM) be referred for intervention?
  • Should survivors of hemorrhagic strokes be restarted on oral anticoagulants?
  • Will stem cell therapy become important in stroke rehabilitation?
  • Do statins cause cognitive impairment?

 

10th CONy 2016 (Lisbon, Portugal)

  • Which should be the first-line therapy for CIDP? Steroids vs. IVIg
  • Should disease-modifying treatment be changed if only imaging findings worsen in multiple sclerosis?
  • Should disease-modifying therapies be stopped when secondary progressive MS develops?
  • Should non-convulsive status epilepsy be treated aggressively?
  • Does traumatic chronic encephalopathy (CTE) exist?
  • Does corticobasal degeneration (CBD) exist as a clinico-pathological entity?
  • Is ß-amyloid still a relevant target in AD therapy?
  • Will electrical stimulation replace medications for the treatment of cluster headache?
  • Carotid dissection: Should anticoagulants be used?
  • Is the ABCD2 grading useful for clinical management of TIA patients?
  • Do COMT inhibitors have a future in treatment of Parkinson’s disease?

 

Debate Energetico. Jumanji Solar on Flikr. https://www.flickr.com/photos/jumanjisolar/5371921203
Debate Energetico. Jumanji Solar on Flikr. https://www.flickr.com/photos/jumanjisolar/5371921203

 

Going through this list, I feel reassured that the experts differ in their answers to these questions? The acknowledgement of uncertainty allows us novices to avoid searching for non-existent black and white answers. It is however also unsettling that I thought some of these questions had been settled long ago. It goes to show that apparently established assumptions are not unshakable?

Do you have the definitive answers to resolve these controversies? Are there important controversies that are missing here? Please leave a comment