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Background and purpose: In the coming decades, the world will face an increasing burden of neurological disorders (ND) and an urgent need to promote brain health. These challenges contrast with an insufficient neurological workforce in most countries, as well as decreasing numbers of general neurologists and neurologists attracted to work in general neurology (GN). This white paper aims to review the current situation of GN and reflect on its future. Methods: The European Academy of Neurology (EAN) task force (TF) met nine times between November 2021 and June 2023. During the 2023 EAN annual meeting, attendees were asked to answer five questions concerning the future of GN. The document was sent for suggestions and eventually approval to the board and the presidents of the 47 national societies of the EAN. Results: The TF first identified four relevant current and future challenges related to GN: (i) definition, (ii) practice, (iii) education, and (iv) research. The TF then identified seven initiatives to further develop GN at both the academic and community level. Finally, the TF formulated 16 recommendations to promote GN in the future. Conclusions: GN will remain essential in the coming decades to provide rapid, accessible, and comprehensive management of patients with ND that is affordable and cost‐effective. There is also a need for research, education, and other initiatives aiming to facilitate improved working conditions, recognition, and prestige for those pursuing a career in GN. [ABSTRACT FROM AUTHOR]

Despite representing a significant proportion of the U.S. population, there is a paucity of population-based research on the health status and health needs of sexual and gender minority (SGM) individuals in neurology. Compared with heterosexual peers, some SGM populations have a higher burden of chronic health conditions. In parallel, SGM individuals are more likely to experience stigma and discrimination producing psychological distress, which may contribute to and be compounded by reduced health care access and utilization. In this narrative review, we summarize the existing literature on common neurological health conditions such as stroke, headache, epilepsy, movement disorders, and traumatic brain injury through the lens of intersection of SGM identity. Special focus is attuned to social determinants of health and gender-affirming hormonal therapy. Given the limitations in the available literature, there is an urgent unmet need for datasets that include sexual orientation and gender identity information, as well as funding for research that will characterize the prevalence of neurological conditions, unique risk factors, and health outcomes in SGM populations. In the health care community, providers should address deficiencies in their professional training and integrate inclusive language into their clinical skillset to build trust with SGM patients. There is an opportunity in neurology to proactively engage SGM communities, collaborate to remove barriers to care, promote resilience, and develop targeted interventions to ensure high-quality, culturally competent care for SGM populations to improve neurological health for all. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to assess emergency neurology management in Italy by comparing patients admitted to the hub and spoke hospitals. Methods: Data obtained from the annual Italian national survey (NEUDay) investigating the activity and facilities of neurology in the emergency room conducted in November 2021 were considered. Information for each patient who received a neurologic consultation after accessing the emergency room was acquired. Data on facilities were also gathered, including hospital classification (hub vs spoke), number of consultations, presence of neurology and stroke unit, number of beds, availability of neurologist, radiologist, neuroradiologist, and instrumental diagnostic accessibility. Results: Overall, 1,111 patients were admitted to the emergency room and had neurological consultation across 153 facilities (out of the 260 Italian ones). Hub hospitals had significantly more beds, availability of neurological staff, and instrumental diagnostic accessibility. Patients admitted to hub hospital had a greater need for assistance (higher number of yellow/red codes at neurologist triage). A higher propensity to be admitted to hub centers for cerebrovascular problems and to receive a diagnosis of stroke was observed. Conclusions: The identification of hub and spoke hospitals is strongly characterized by the presence of beds and instrumentation mainly dedicated to acute cerebrovascular pathologies. Moreover, the similarity in the number and type of accesses between hub and spoke hospitals suggests the need to look for adequate identification of all the neurological pathologies requiring urgent treatment. [ABSTRACT FROM AUTHOR]

Recent insights into the frequency of occurrence and the genetic and mechanistic basis of nervous system disease have demonstrated that neurologic disorders occur as a spectrum across all ages. To meet future needs of patients with neurologic disease of all ages and prepare for increasing implementaton of precision therapies, greater integration of child and adult neurology residency training is needed. ANN NEUROL 2023;94:1005–1007 [ABSTRACT FROM AUTHOR]

Treating neurological patients during the pandemic period has become extremely challenging. At the same time, responding properly to these challenges has been diverse around the world, with varying levels of readiness, discipline, and approach. Additionally, there are significant differences in healthcare resources and processes between nations, and even within a nation, and these have significantly influenced the treatment procedure throughout the pandemic. However, neurologists have been called to care for patients with neurological symptoms who have COVID-19, and to continue managing COVID-19-affected neurological comorbidities in patients as before. This study highlights how the treatment procedures for neurological diseases are rapidly changing due to the spread of the SARS-CoV-2 virus. It also focuses on the challenges healthcare professionals are facing while providing proper treatment to neurological patients during the pandemic situation. Lastly, it offers some useful recommendations regarding the effective management of neurological diseases during the COVID-19 pandemic period. [ABSTRACT FROM AUTHOR]

Background: The ongoing COVID-19 pandemic has resulted in significant changes in the delivery of neurological disease care and in neurology training in academic departments. Objective: We aimed to investigate how neurology residents viewed the future of neurology after the COVID-19 pandemic with regard to three main aspects: (i) organization of neurological activity, (ii) patient care, and (iii) funding availability for neurological diseases. Methods: We surveyed Italian neurology residents in order to investigate how they viewed the future of neurology after the COVID-19 pandemic. Results: Responses were collected from 254 residents who reported: a high risk of reduction of hospital neurological beds, of worsening of the quality of neurological patient management, and of lack of funding for neurological care and research. Conclusion: The survey results demonstrate the views of future neurologists regarding the direction of neurology after the COVID-19 emergency. It is important to focus on these aspects in order to adapt neurology training to the societal changes introduced by the pandemic, and to safeguard the essential role of neurology in the management and prevention of chronic degenerative illnesses and emergencies. [ABSTRACT FROM AUTHOR]

Background and purpose: Brain health is essential for health, well‐being, productivity and creativity across the entire life. Its definition goes beyond the absence of disease embracing all cognitive, emotional, behavioural and social functions which are necessary to cope with life situations. Methods: The European Academy of Neurology (EAN) Brain Health Strategy responds to the high and increasing burden of neurological disorders. It aims to develop a non‐disease‐, non‐age‐centred holistic and positive approach ('one brain, one life, one approach') to prevent neurological disorders (e.g., Alzheimer's disease and other dementias, stroke, epilepsy, headache/migraine, Parkinson's disease, multiple sclerosis, sleep disorders, brain cancer) but also to preserve brain health and promote recovery after brain damage. Results: The pillars of the EAN Brain Health Strategy are (1) to contribute to a global and international brain health approach (together with national and subspecialty societies, other medical societies, the World Health Organization, the World Federation of Neurology, patients' organizations, industry and other stakeholders); (2) to support the 47 European national neurological societies, healthcare and policymakers in the implementation of integrated and people‐centred campaigns; (3) to foster research (e.g., on prevention of neurological disorders, determinants and assessments of brain health); (4) to promote education of students, neurologists, general practitioners, other medical specialists and health professionals, patients, caregivers and the general public; (5) to raise public awareness of neurological disorders and brain health. Conclusions: By adopting this 'one brain, one life, one approach' strategy in cooperation with partner societies, international organizations and policymakers, a significant number of neurological disorders may be prevented whilst the overall well‐being of individuals is enhanced by maintaining brain health through the life course. [ABSTRACT FROM AUTHOR]

The United Nations' Sustainable Development Goals (SDGs) were set forth in 2015 as a blueprint for all nations to create a more sustainable future together. These 17 social, environmental, and economic goals have established targets to meet globally by the year 2030, with a focus on pro-poor initiatives, gender equality, and ending hunger. The relationship of the SDGs with neurological disorders and how the achievement of the SDGs intersects with the future of neurological practice have not been comprehensively examined. However, the incidence of neurological disorders, the outcomes of people living with neurological disorders, and the training of future neurologists can be interlinked, directly or indirectly, with programming for the SDGs and their eventual achievement. Each SDG is reviewed in the context of neurology. This lens can inform programming and policy, enhance research and training, and improve inter-sectoral action for neurological disorders worldwide. [ABSTRACT FROM AUTHOR]

This article, published in Seminars in Neurology, discusses the disparities in access to neurologic care for underserved and marginalized populations. The authors highlight the challenges faced in improving neurologic care, education, and research in different regions around the world. They also address the unique challenges faced by neurologists caring for patients in countries at war or patients who have been forcibly displaced. The article provides hope and inspiration by describing ongoing efforts to improve care, educate future neurologists, and increase research in order to serve all patients with neurologic disease. The authors hope that their work will increase awareness and lead to collaborations that improve the care of underserved and marginalized populations. [Extracted from the article]

With the exponential growth of literature on coronavirus disease 2019 (COVID-19), we aimed to identify and characterize the 100 most cited COVID-19–related articles in neurology and neurosurgery. In March 2021, we performed a title-specific search of the Scopus database using ("neurology" or "neurologic" or "neurosurgery" or "neurosurgical") and "COVID" as our search query term without date restrictions. The top 100 most cited English-language articles were obtained and reviewed. Our search yielded 9648 articles published from December 2019 to March 2021. Bibliometric analysis of the top 100 articles found that the most cited article had a citation count of 1741 and was the first to report on the detailed neurologic manifestations of the disease; Neurology had the most number of publications; the majority of the primary authors were neurologists, but 35% were from nonneuroscience specialties; the United States, Italy, the United Kingdom, China, and Germany were the top contributors, with a combined total of 77%; most of the publications were correspondence or editorial articles; and most articles discussed the neurologic manifestations and complications of patients with COVID-19. This study identified the top 100 most cited neurologic or neurosurgical COVID-19–related articles published to date. This list can be used to identify high-impact studies that will help health care practitioners in clinical decision making and researchers in navigating key areas of study and guiding future research. [ABSTRACT FROM AUTHOR]

Background: Neurology is a field of increasing subspecialization. There is no published data regarding the proportion of neurology subspecialists in the Baltic States. The aim of this cross‐sectional study was to identify factors associated with neurology subspecialty choice, to examine possible differences between neurology residents' and junior neurologists' view of subspecialty, and to assess perceived subspecialty acquisition opportunities and subspecialty attractiveness. Methods: The research was conducted as an anonymous online survey between December 28, 2020, and January 24, 2021 of neurology residents and neurologists who completed their residency during the last 5 years in the Baltic States. Results: In total, 72 residents and 65 neurologists participated. "Cerebrovascular diseases" and "multiple sclerosis and autoimmune diseases of the nervous system" were rated as the two most attractive subspecialties by residents, whereas "headache" and "clinical neurophysiology" were the most attractive among junior neurologists. "Vertigo and dizziness" and "dementia" were ranked the least attractive among both groups. "Cerebrovascular diseases" were perceived as having the most acquisition opportunities. The two most common determinants of subspecialty choice were "medical content of the subspecialty" and "influence of mentor during undergraduate studies or residency". Conclusions: Two‐thirds of junior neurologists subspecialize in at least one subspecialty, and one‐third of residents are already determined to pursue subspecialty training. Junior neurologists rated most outpatient‐related subspecialties as more attractive than neurology residents. Between the Baltic States' universities, there was a significant difference in the number of residents who were determined to pursue subspecialty training. [ABSTRACT FROM AUTHOR]

The article presents an interview with Claudio Bassetti currently serving as Professor of Neurology. Topics include studies showing that sleep loss and sleep apnea, increase the risk of stroke and dementia; and promoting sleep for fostering the health and by this having better lives, better body, brain and mental functions.

As an internist, Wilhelm Erb (1840–1921) developed neurology (he also used the term "neuropathology" synonymously) in the tradition of his teacher, Nikolaus Friedreich, in Heidelberg. He left behind a huge corpus of semiological and nosological elements that now constitute our current knowledge of neurology, much more than just the eponyms associated with his name. In 1891, he founded the journal Zeitschrift für Nervenheilkunde [Journal of Neurology] together with internist-neurologist colleagues, thus creating the counterpart to the Archiv für Psychiatrie und Nervenkrankheiten [Archive for Psychiatry and Neurology], which was founded by Berlin neuropsychiatrists Wilhelm Griesinger and Carl Westphal. Despite his reservations about the Gesellschaft Deutscher Nervenärzte [Society of German Nerve Doctors], he was elected its first president in 1907. Erb was also one of the most important representatives of electrodiagnosis and therapy in Europe. He had many disciples who were part of the Heidelberg School of Neurology. His anti-Semitism—a widespread Zeitgeist phenomenon—was documented in several letters to his friend, neurologist Adolf von Strümpell, in which he expressed his contempt for the growing role of Jewish neurologists. Erb's retirement years were marked by illnesses, depression, and grief over the death of three of his sons. [ABSTRACT FROM AUTHOR]

1. Evaluate the state of advance care planning procedure codes in neurological disease. 2. Investigate healthcare and palliative outcomes associated with use of advance care planning codes. Neuropalliative care emphasizes the need to reduce suffering and improve quality of life for the 1 billion people living with neurological disease worldwide. Advance care planning (ACP) procedure codes (CPT 99497 and 99498) have been established to reimburse meaningful care-goal discussions, but these codes are underutilized in neurological patients. Using the TrinetX database, real-world electronic health data was collected from over 800,000 individuals across 92 institutions with one of four neurological diseases: Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis (ALS), and ischemic stroke. The findings were similar across these illnesses. ACP procedure codes were documented in 2.5% of patients, commonly at 2-years disease duration. Twenty percent of individuals had multiple ACP discussions noted. Furthermore, except in ALS, individuals who were white were 3% more likely to have the ACP codes documented than nonwhite individuals (p<0.015). After matching for demographic and health variables, usage of the ACP codes was associated with fewer hospitalizations and emergency visits and more palliative services (p<0.05). Multiple instances of ACP codes are further associated with more palliative encounters (p<0.05). Despite medical progress in neurology, many neurological diseases remain incurable. ACP procedure codes may represent meaningful conversations that help avoid burdensome care and increase symptom-focused management. Based on the positive associations identified in our study, we encourage more providers to have these conversations and document appropriately for reimbursement. Future work should investigate on a more granular scale how these codes are used in clinical practice to identify aspects of the care-delivery system that are most associated with healthcare and palliative outcomes. [ABSTRACT FROM AUTHOR]

Education, medical education, medical residency, medical school, neurology, translational medicine, translational science Keywords: education; medical education; medical residency; medical school; neurology; translational medicine; translational science EN education medical education medical residency medical school neurology translational medicine translational science 555 556 2 01/09/23 20230201 NES 230201 Dear Editor, From 26 to 29 March 2022 occurred the first edition of the European Academy of Neurology (EAN)'s Science School in Salzburg, Austria. [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

Given widespread use of glucocorticoid therapy in neurologic disease, understanding glucocorticoid pharmacology and risk is paramount for the practicing neurologist. While dosing and tapering regimens vary depending on the neurological disease and indication being treated, there are important general principles of glucocorticoid prescribing and monitoring that can guide clinical decision-making. Glucocorticoid-related toxicities can occur across multiple organ systems, including hypertension; dyslipidemia; weight gain; hyperglycemia; osteoporosis and avascular necrosis; myopathy; gastrointestinal bleeding; infection; and neuropsychiatric effects with sleep, mood disturbance and cognition. This narrative review provides a practical framework for safe and responsible prescribing of this therapeutic class of medications, including appreciation of immunosuppressive consequences, risk mitigation strategies, dosing and tapering, and recognition of adrenal insufficiency and glucocorticoid withdrawal. • Glucocorticoids have widespread anti-inflammatory and non-inflammatory effects. • Glucocorticoids carry risk of toxicities with opportunities for risk mitigation. • Surveillance is needed to minimize risk of steroid-associated adrenal suppression. • Glucocorticoid taper benefits from stable and predictable dose reduction over time. [ABSTRACT FROM AUTHOR]