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.
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
The Neurology of Amnesia
Adam Zeman, Professor of Cognitive Neurology at Exeter
Advances in the Diagnosis of Neurogenetic Disorders
Julia Rankin, Consultant Clinical Geneticist at Exeter
Emerging Treatable Autoimmune Disorders of the CNS
Sarosh Irani, Associate Professor of Neurology at Oxford
Movement Disorders: A Video Presentation
Kailash Bhatia, Professor of Clinical Neurology at Queen Square
Cold Injury in the Royal Navy
Paul Hughes, Neurologist at Haywards Heath
Hepatitis E and the Nervous System
Harry Dalton, Consultant Hepatologist at Truro
The mTORopathies-What the Neurologist Needs to Know
Finbarr O’Callaghan, Reader in Paediatric Neuroscience at Great Ormond Street Hospital
Refractory Epilepsy: Hope is not a Strategy
Hannah Cock, Professor of Neurology at St George’s Hospital
Looking Back on a Career in Neurology – Some Things I Would Probably Have Done Differently
Nick Fletcher, Consultant Neurologist (rtd) at the Walton Centre
Ganglioside Antibodies and the Landscape of Immune Neuropathies
Hugh Willison, Professor of Neurology at Glasgow
Metabolic Muscle Diseases
Jon Walters, Consultant Neurologist at Swansea
MS: Emerging Treatments and Treatment of Progressive Disease
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!
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.
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.
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.
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.
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.
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.
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?
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 Squier, Magic but treatable? by Oliver Hanemann,Gratiolet’s torque and the evolution of language by Tim Crow, Effective whistle-blowing skills for neurologists by David Nicholl, and Therapeutic gardening by Richard Thompson.
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
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
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
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
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.
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 criteriaand TSC surveillance recommendations and updated neurochecklists. Phew!
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:
mTOR stands for mammalian (or mechanistic) target of rapamycin
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:
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?
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