European Journal of Neurology 2014, 21: 809–813

doi:10.1111/ene.12454

EDITORIAL

The European Academy of Neurology is founded: a fundamental step linking the glorious past with our future challenges

This issue of the European Journal of Neurology heralds the first and only joint congress of the European Federation of Neurological Societies (EFNS) and European Neurological Society (ENS), the only panEuropean general neurology organizations: the EFNSENS Joint Congress of European Neurology, Istanbul 2014. It marks the long-awaited union of the EFNS and ENS to form a single new organization, the European Academy of Neurology (EAN).

European neurology: where do we come from? Neurology first arose as an independent medical specialty in the second half of the 19th century in Europe (UK, France, Germany and Russia). National neurological societies were soon founded in the USA (1875), Belgium (1896), France (1899), and throughout Europe (Table 1). The separation from internal medicine and psychiatry remained difficult in many other European countries, where national societies were born only much later (Table 1). The need and interest for international meetings was soon discussed. After a few unsuccessful attempts (starting as early as 1900) the first International Neurological Congress finally took place in 1931 in Bern (Fig. 1) [1]. The welcome address was given by the vice-president of the meeting and local host Robert Bing, a multilingual French neurologist of GermanJewish descent, who became the Chair of Neurology in Basel and was pivotal in founding the Swiss Neurological Society [2]. Forty-two countries from four continents were represented [1]. The meeting was then

Table 1 Foundation of national neurological societies Country

Full name of society (English)

Founded in

Austria Denmark Finland Germany Italy Portugal Romania Spain Sweden Switzerland United Kingdom

Austrian Society of Neurology Danish Neurological Society Finnish Neurological Society German Society of Neurology Italian Society of Neurology Portuguese Society of Neurology Romanian Society of Neurology Spanish Society of Neurology Swedish Neurological Society Swiss Society of Neurology Association of British Neurologists

2000 1900 1961 1907 1907 1982 2001 (1921) 1949 1938 1908 1907

© 2014 The Author(s) European Journal of Neurology © 2014 EAN

held every 4 years, but only when it came to Brussels in 1957 was the World Federation of Neurology founded following a proposal from the Belgian Ludo van Bogaert. The need for a continental society devoted to the entire field of neurology arose in the 1980s, in part triggered by the great advances in clinical and translational research, in part to counteract the tendency towards fragmentation caused by the birth of different subspecialties including clinical neurophysiology, epileptology, stroke and movement disorders. The European Neurological Society (ENS) was founded in 1986 on the initiative of Gerard Said and P.K. Thomas with the significant support of Anita Harding, Klaus Toyka, Andreas Steck, George Franck and Pierre Rondot. The ENS was modelled on the American Academy of Neurology, using as driving force the initiative and inventiveness of motivated individual members and focusing on congresses with a strong scientific and educational programme. The first meeting of the ENS took place in Nice in 1988 (Fig. 2) and after 1994 conferences were held annually. In 1989, Daniel Bartko, President of the then Czech-Slovakian Neurological Society, organized a pan-European congress for neurology, a first attempt to link the national neurological societies across the Iron Curtain. At the second congress in 1991 in Vienna, the European Federation of Neurological Societies (EFNS) was founded with a council of 44 national delegates. Franz Gerstenbrand from Austria acted as its first president (Fig. 3). The EFNS undertook political representations on behalf of its members and became a founding member of the European Brain Council, which lobbied the European Parliament for a major increase in annual funding for research.

Why a new society? As the years went by it became obvious that the ENS and the EFNS were pursuing very similar aims, targeting the same group of trainee and qualified neurologists in Europe and involving the same expert speakers. Both organizations offered fellowships for trainee neurologists to spend time in other centres, both supported subspecialty panels, both published a journal and both were very successful in running larger and larger

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Figure 1 Participants at the first International Neurological Congress in Bern in 1931. Bernard Sachs from the USA, president of the conference (seated fourth from the left), and Otto Marburg from Germany (standing third from the left) were the initiators of this meeting. Local host and vice-president of the conference was Robert Bing, standing second from the left.

Figure 2 P.K. Thomas, the first president of the ENS, and Gerard Said, its secretary for 20 years, at the first meeting in Nice in 1988.

conferences. Last but not least the fall of the Iron Curtain had changed also the political panorama in which single neurologists and organizations in Europe could act. Most neurologists not involved directly in the activities of the two societies and ignorant of the historical backgrounds did not recognize the reason for having separate neurological societies and European meetings. Early attempts to bring the two organizations together failed to overcome the technical and (to some extent also) emotional difficulties of welding a vigorous society of individual members with a more complex federation of national neurological societies. By chance two long-standing Belgian friends held senior office in the two organizations at the same time Jacques De

Reuck, as President of the EFNS, and Gustave Moonen, as Secretary-General of the ENS. We owe it to them to have had the will and political skill to insist that unification could and should take place and to launch a transition task force to make sure it did. The formal agreement to found the new societies was signed in Budapest in 2011 [3].

The Transition Task Force prepares the birth of the new society The Task Force was established at the EFNS Congress in Florence in 2009 with six members, three from each organization: Jacques De Reuck, Belgium, © 2014 The Author(s) European Journal of Neurology © 2014 EAN

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missing awareness of the underlying needs and great potential. The last meeting of the Transition Task Force took place in Vienna on 4 March 2014 (Fig. 4). Lisa M€ uller and Sabine Adam of the EFNS and ENS offices and many other people were involved in the challenging procedure and should be thanked here.

The European Academy of Neurology (EAN)

Figure 3 Franz Gerstenbrand, the first president of the EFNS.

Detlef K€ ompf, Germany, and Gunhild Waldemar, Denmark, for the EFNS and Gustave Moonen, Belgium, Claudio Bassetti, Switzerland, Jose Ferro, Portugal, for the ENS. The Task Force drafted a process for the unification and a constitution for the EAN which was debated and agreed at every stage by the EFNS Council of delegates and the ENS General Assembly of members. The creation of the bylaws, the definition of the bodies of the new society, financial and legal matters, practical and particular issues to be solved made many meetings of the Transition Task Force necessary. The challenging goal of bringing the two societies together was pursued in an atmosphere of friendship and mutual respect and with the never

Figure 4 The six members of the EFNSENS Transition Task Force (2009–2014) depicted at their last meeting in Vienna on March 2014 (in the back row from the left: Detlef K€ ompf from Germany, Gustave Moonen from Belgium, Jacques De Reuck from Belgium; in the front row from the left: Gunhild Waldemar from Denmark, Jose Ferro from Portugal and Claudio Bassetti from Switzerland).

© 2014 The Author(s) European Journal of Neurology © 2014 EAN

The constitution proposed for the EAN describes its aim as to promote excellence in neurology in Europe, the aim shared by both its parent organizations. The constitution lists the following objectives: 1 to increase the availability and standards of neurological services; 2 to advance the development of neurology as the major medical specialty caring for patients with neurological disorders; 3 to encourage collaboration between European national neurological societies; 4 to strengthen collaboration between clinical neurology and related professional and lay organizations; 5 to support neurological research, encourage research collaboration and promote dissemination of research results; 6 to strengthen the standard, availability and equality of neurological education for neurologists and affiliated/related health professionals; 7 to raise awareness among the lay public, media, healthcare providers and other stakeholders as well as law and policy makers about the burden and cost of neurological disorders and the benefits which clinical neurology can bring; 8 to collaborate with international, national and regional neurological associations and related international health organizations.

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The structure of the EAN was created in order to guarantee a balanced representation of the national societies (reflecting the ‘EFNS spirit’) and that of individual members (reflecting the ‘ENS spirit’). Hence, the EFNS council of 45 delegates has been supplemented by 45 delegates elected by the ENS in an on-line election to form the General Assembly, or parliament, of the EAN. The last stage of this process is the election by the General Assembly of the EAN Board which will take place at the EFNS-ENS Joint Congress of European Neurology in Istanbul.

European neurological journals Neurology as a new specialty needed for its development its own journals. In the USA the Journal of Nervous and Mental Diseases (1874) and in Europe Brain (1878), Neurologisches Zentralblatt (1891), Zeitschrift f€ ur Nervenheilkunde (1891, becoming the Journal of Neurology in 1973) and Revue Neurologique (1893) were founded. After their birth, the ENS and EFNS needed their own publications. The ENS formed an affiliation with the Journal of Neurology. In a strange quirk of history Richard Hughes, the current president of the EFNS, joined Marco Mumenthaler (from Bern, Switzerland) as co-chief editor of the Journal of Neurology from 1981 to 1989. The EFNS founded the European Journal of Neurology (EJN) in 1997 with Franc¸ois Boller 1997–2005 and Per Soelberg Sørensen 1997–2002 as its first chief editors followed by Matti Hillbom 2004–2012, ably abetted during the past 10 years by Managing Editor Sirkka-Liisa Leinonen. The journal published traditional research articles but has also been the vehicle for publishing other important outputs including guidelines, consensus reviews and CME articles. It became readily available online to EFNS members and others including free of charge access to neurologists in the poorest HINARI group countries. Choosing between two prestigious journals would have been difficult but the issue was decided by the facts that the EJN was owned by the EFNS and the Journal of Neurology by its publishers. The EJN now becomes the official journal of the EAN. It retains its name but gains the subtitle of the Journal of the European Academy of Neurology. Those negotiating the union of the two organizations would have preferred the subtitle to be the actual title but changing the title would have meant losing the prestige and impact factor >4.0 built up by the current chief editor of the EJN (Anthony Schapira, 2006 ) and his predecessors. The contract for publishing the EJN for the next 4 years was put out to tender and, against strong

competition, the existing publishers Wiley were successful in retaining the contract. The new journal will be a flexible platform for the EAN, capable of reacting confidently to the latest developments in the publishing world and interacting with other outputs of the organization including eBrain and NEUROPENEWS.

The future: Istanbul 2014, Berlin 2015, and beyond The meeting in Istanbul (31 May to 3 June 2014) will be the last for the ENS and EFNS and will see the birth of the EAN. The programme is rich with 25 teaching courses, 8 symposia, 23 focused workshops, 5 special sessions, 3 practical sessions, 3 interactive sessions and many satellite symposia. More than 2000 oral and poster communications will be presented. Every subfield of neurology will be covered. At the meeting the first EAN board will be elected and the life of the new society will begin. Activities developed by the joint efforts of the ENS and EFNS will need to be continued, such as • the creation of European Guidelines in Neurology, a longstanding success story of the EFNS, which under the skilled coordination of Michael Brainin became recently a joint activity of both the EFNS and the ENS [4]; • the further organization with the European Board of Neurology (EBN) of an annual European final examination for residents in neurology (an initiative that was started by both societies at the ENS meeting in Milano in 2009) [5]; • the further development and support of the world’s largest neuroscience e-learning resource called eBrain (which was started initially by the British Joint Neuroscience Council, soon supported by the EFNS and then the ENS; it was launched in fall 2011 and made available free to all members of ENS and EFNS); • the support of the activities of the European Brain Council. Several challenges which concern the entire field of neurology will need to be addressed, including the following: • the discussion of the role of general neurology and neurologists in training as well as academic/nonacademic centres [6]; • more effective integration of translational research approaches in training and hospital activities/careers (‘clinical neuroscientists’); • better standardization/harmonization of training in neurology across Europe (currently the duration of training varies from 3 to 6 years) [5];

© 2014 The Author(s) European Journal of Neurology © 2014 EAN

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more coordinated support for the further development of new areas which are at risk of being lost to neurology because they lie at the borderland with other medical specialties, such as neurorehabilitation, intensive care and emergency neurology, sleep and dementia; • stronger lobbying for support for research in neuroscience including clinical neurology at a European level; • strengthening the attractiveness of and justification for a continental general neurology conference in the context of decreasing financial resources and an increasing number of subspecialty conferences. We expect the EAN to be open to membership and welcome colleagues from all over the world at its meetings and to collaborate with other organizations, including the World Federation of Neurology, American Academy of Neurology, other international societies and subspecialty organizations.

C. L. Bassettia and R. Hughesb (President of the ENS, President of the EFNS) a

Neurology Department, Inselspital, Bern University Hospital, Bern, Switzerland; and bDepartment of Clinical Neuroscience, King’s College London, London, UK

(e-mail: [email protected])

© 2014 The Author(s) European Journal of Neurology © 2014 EAN

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References 1. Louis ED. The conceptualization and organization of the first International Neurological Congress (1931): the coming of age of neurology. Brain 2010; 133: 2160– 2166. 2. Bassetti C, Valko PO. History of the Swiss Neurological Society in the context of the national and international development of neurology. Schweiz Arch Neurol Psychiatr 2009; 160: 52–65. 3. Argov Z, Hughes R. Creation of the European Academy of Neurology. Neurology 2012; 78: 137–138. 4. Sorbi S, Hort J, Erkinjuntti T, et al. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol 2012; 19: 1159–1179. 5. Struhal W, Mellgren SI, Grisold W. Three important steps to European neurology harmonization: core curriculum, visitation program, European board examination. Eur J Neurol 2013; 20: 101–104. 6. Bassetti C, Hughes R. Academic general neurology: any future? Yes! Schweiz Arch Neurol Psychiatr 2014; 165: 40–41.

The European Academy of Neurology is founded: a fundamental step linking the glorious past with our future challenges.

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