38^th European Neurology Congress 2025

Movement disorders are a group of conditions that affect the ability to produce and control movement. These disorders are primarily caused by abnormalities in the brain regions involved in motor control, particularly the basal ganglia, cerebellum, and motor cortex. Movement disorders can result in either excessive or diminished movement, affecting a person's quality of life.

Types of Movement Disorders

1. Parkinson’s Disease

• Overview: Parkinson’s disease (PD) is the most common movement disorder, characterized by the progressive degeneration of dopamine-producing neurons in the brain.
• Symptoms:
  • Tremors: Involuntary shaking, often starting in one hand.
  • Bradykinesia (slowness of movement): Difficulty initiating and performing movements.
  • Muscle Rigidity: Stiffness in the limbs and trunk.
  • Postural Instability: Difficulty maintaining balance and coordination.
• Treatment: Medication like levodopa (dopamine precursor), dopamine agonists, deep brain stimulation (DBS) surgery, and physical therapy.

2. Essential Tremor

• Overview: Essential tremor is a common movement disorder that causes rhythmic shaking, particularly in the hands, head, or voice.
• Symptoms:
  • Shaking: Often worsens with purposeful movements like writing or holding an object.
  • Location: Commonly affects the hands, but can also affect the head, voice, or legs.
  • Progression: Typically worsens over time, but can be manageable with treatment.
• Treatment: Medications (beta-blockers like propranolol, anticonvulsants), deep brain stimulation, and lifestyle modifications.

Cognitive neuroscience is an interdisciplinary field that studies the neural mechanisms underlying cognition, including mental processes such as perception, memory, attention, decision-making, language, and problem-solving. It seeks to understand how the brain enables these complex behaviors and how various brain regions work together to support mental functions. Cognitive neuroscience merges concepts from psychology, neuroscience, and neurobiology to uncover how the brain processes information and produces thoughts and actions.

Key Areas of Study in Cognitive Neuroscience

1. Perception:

   • Overview: Perception involves the processing of sensory input (sight, sound, touch, taste, and smell) to form a mental representation of the world.
   • Key Questions: How do sensory systems translate physical stimuli into mental experiences? How does the brain integrate sensory information from different modalities?
   • Neural Basis: Areas like the occipital lobe (vision), temporal lobe (auditory processing), and parietal lobe (somatosensation) are involved.

2. Memory:

   • Overview: Memory refers to the processes of encoding, storing, and retrieving information.
   • Key Questions: How is information encoded in the brain? What mechanisms underlie the formation of short-term and long-term memories? How do memories get consolidated or forgotten?
   • Neural Basis: The hippocampus, amygdala, and prefrontal cortex are critically involved in memory processes, particularly in long-term memory and working memory.

Neuropsychiatry is a specialized branch of medicine that combines elements of neurology and psychiatry to understand, diagnose, and treat mental disorders that have a neurological basis. It focuses on the interplay between the brain's physical structure and function and its influence on behavior, mood, cognition, and mental health. Neuropsychiatry is concerned with how damage or dysfunction in the brain can lead to psychiatric symptoms, and how psychiatric disorders may also have neurological underpinnings.

Traumatic Brain Injury (TBI) is a disruption in normal brain function caused by a sudden external force. It can result from direct trauma, acceleration-deceleration forces, or penetration of the skull. The severity of TBI ranges from mild (concussion) to severe, with varying degrees of impact on physical, cognitive, and emotional well-being.

Causes

1. Falls (common in young children and older adults).
2. Motor Vehicle Accidents (leading cause in young adults).
3. Sports Injuries (contact sports like football, soccer, and boxing).
4. Violence or Assault (e.g., gunshot wounds, domestic violence).
5. Explosive Blasts (common in military personnel).

Types of TBI

1. Concussion

   • Temporary loss of brain function.
   • May or may not involve loss of consciousness.
   • Common symptoms: headache, dizziness, confusion, and nausea.

2. Contusion

   • Bruising of brain tissue.
   • Often localized to the site of impact.

3. Diffuse Axonal Injury (DAI)

   • Damage to brain cells due to rotational forces or rapid deceleration.
   • Common in high-speed accidents.

4. Penetrating Injury

   • Objects pierce the skull, damaging brain tissue.

5. Hematomas and Hemorrhages

   • Subdural Hematoma: Blood collection between the dura and brain.
   • Epidural Hematoma: Blood between the skull and dura mater.
   • Intracerebral Hemorrhage: Bleeding within brain tissue.

Neuro-oncology focuses on the diagnosis and treatment of tumors affecting the nervous system, including the brain, spinal cord, and peripheral nerves. Tumors can be primary (originating in the nervous system, e.g., gliomas, meningiomas) or secondary (metastatic, spreading from other organs like the lung or breast).

Common Symptoms

• Headaches, seizures, cognitive changes, vision problems, and nausea.
• Symptoms vary based on tumor size, location, and type.

Diagnosis

• Imaging (MRI, CT scans), neurological exams, biopsies, and lumbar punctures are used to identify and classify tumors.

Treatment

1. Surgery: To remove tumors safely.
2. Radiation Therapy: Kills residual tumor cells.
3. Chemotherapy: Stops cancer growth (e.g., temozolomide for glioblastoma).
4. Targeted Therapy and Immunotherapy: Advances in personalized medicine.
5. Palliative Care: Manages symptoms and improves quality of life.

Neurodegenerative diseases are a group of progressive conditions characterized by the gradual degeneration and death of nerve cells, leading to irreversible cognitive, motor, and functional impairments. The most common diseases in this group include Alzheimer’s Disease (AD), Parkinson’s Disease (PD), Amyotrophic Lateral Sclerosis (ALS), Huntington’s Disease (HD), Multiple Sclerosis (MS), and Frontotemporal Dementia (FTD).

Key Features

1. Progressive Nature: Symptoms worsen over time, with no current cures.
2. Diverse Impacts: Affects cognition (e.g., memory, language), motor skills (e.g., tremors, weakness), and emotional states (e.g., depression, mood swings).
3. Complex Causes: Linked to genetic mutations, protein misfolding, oxidative stress, inflammation, and environmental triggers.

Long-Term Challenges

Patient Impact

• Cognitive Decline: Memory loss, difficulty thinking, and confusion affect daily life.
• Physical Impairments: Progressive loss of motor function leads to dependence on caregivers.
• Emotional Strain: Anxiety, depression, and frustration are common.

Caregiver Burden

• The progressive nature of these diseases often places immense physical, emotional, and financial strain on caregivers over years.

Healthcare System Strain

• Long-term care requires significant medical resources, including therapy, medications, and rehabilitation.

Pediatric neurology focuses on diagnosing and treating neurological disorders in children, including conditions affecting the brain, spinal cord, peripheral nerves, and muscles. Common disorders include developmental delays, epilepsy, cerebral palsy, muscular dystrophy, autism spectrum disorders, and neurogenetic or neurocutaneous syndromes like tuberous sclerosis. Symptoms vary widely and may include seizures, developmental regression, motor or sensory deficits, or cognitive and behavioral challenges. Diagnosing these conditions involves a range of tools such as clinical evaluations, imaging (MRI, CT scans), EEG for seizures, genetic testing, and metabolic or inflammatory markers. Treatment combines medications (e.g., antiepileptic drugs), therapies like physical, occupational, and speech therapy, and sometimes surgical interventions. Advances in genetic medicine, neuroimaging, and neurostimulation have greatly improved diagnostic and treatment options. However, challenges remain, including managing chronic conditions and addressing the emotional and social impacts on children and families. Early diagnosis, multidisciplinary care, and continued research are critical for enhancing outcomes and quality of life for affected children.

Neurotechnologies and brain-machine interfaces (BMIs) represent cutting-edge advancements in the field of neuroscience, aiming to bridge the gap between the brain and external devices. Neurotechnologies involve the development of tools and techniques to monitor, manipulate, or augment brain function, often with the goal of improving or restoring cognitive, sensory, or motor functions in individuals with neurological disorders or injuries. BMIs, a key subset of neurotechnologies, enable direct communication between the brain and machines, such as prosthetics or computer interfaces, by interpreting neural signals. These interfaces can assist in restoring movement for individuals with paralysis, offering new possibilities for rehabilitation, and providing alternative communication methods for patients with severe motor impairments. Techniques like electroencephalography (EEG), functional magnetic resonance imaging (fMRI), and invasive brain implants allow for increasingly sophisticated brain interaction, although challenges such as signal accuracy, long-term stability, and ethical considerations remain. As research progresses, the potential of neurotechnologies and BMIs to enhance human abilities, treat neurological conditions, and even augment human cognition is vast, promising groundbreaking transformations in medicine and human-computer interaction.

Neuromuscular disorders are a group of diseases that affect the muscles and the nerves that control them, leading to muscle weakness, wasting, and loss of motor function. These disorders can be caused by issues in the motor neurons, peripheral nerves, neuromuscular junction, or muscles themselves. Some common types of neuromuscular disorders include muscular dystrophies, amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA), myasthenia gravis, peripheral neuropathies, and Charcot-Marie-Tooth disease.

Muscular dystrophies, such as Duchenne muscular dystrophy, are genetic conditions that cause progressive muscle degeneration, leading to severe disability. ALS, also known as Lou Gehrig's disease, involves the degeneration of motor neurons, causing muscle weakness and eventual paralysis. SMA is a genetic disorder that leads to the progressive loss of motor neurons in the spinal cord, affecting muscle movement. Myasthenia gravis is an autoimmune condition where the immune system attacks the neuromuscular junction, leading to muscle weakness, particularly with prolonged activity.

Symptoms of neuromuscular disorders often include progressive muscle weakness, difficulty walking, muscle cramps, and fatigue. Depending on the condition, patients may also experience difficulty breathing or swallowing. Diagnosis typically involves a combination of clinical evaluation, genetic testing, electromyography (EMG), muscle biopsy, and imaging studies.

Artificial intelligence (AI) is increasingly playing a transformative role in neurology by enhancing diagnosis, treatment planning, and patient care. AI systems, including machine learning algorithms and deep learning models, are being used to analyze large amounts of medical data, such as imaging, genetic information, and clinical records, to identify patterns that may be difficult for humans to detect. In neurology, AI is particularly impactful in areas such as neurological imaging, neurological disorders diagnosis, and personalized treatment strategies.

AI-powered tools are significantly improving neuroimaging by automating the analysis of MRI, CT, and PET scans to detect early signs of neurological conditions like Alzheimer’s disease, Parkinson’s disease, brain tumors, and multiple sclerosis. These systems can help identify subtle changes in brain structure and function, potentially allowing for earlier diagnosis and intervention. In addition to imaging, AI is aiding in the analysis of electrophysiological data, such as EEG, to identify abnormal brain activity in patients with epilepsy or other seizure disorders.

Behavioral neurology is a specialized branch of neurology that focuses on understanding how the brain's structure and function affect behavior, cognition, and emotional processing. It bridges the fields of neurology and psychiatry by studying disorders that involve cognitive functions (such as memory, attention, and decision-making) and emotional regulation, and how these are influenced by brain damage, dysfunction, or diseases. Behavioral neurologists are trained to diagnose and manage a variety of conditions where neurological and psychiatric symptoms overlap.

Common disorders encountered in behavioral neurology include dementia, Alzheimer's disease, frontotemporal dementia (FTD), Parkinson's disease with cognitive impairment, stroke-related cognitive impairments, mood disorders, traumatic brain injury (TBI), seizure disorders, and psychosis associated with neurological conditions. These disorders can manifest as memory loss, personality changes, impaired judgment, executive dysfunction, and changes in mood or behavior, often due to lesions in specific regions of the brain, such as the frontal lobes, temporal lobes, and hippocampus.

Epilepsy and seizure disorders are neurological conditions characterized by abnormal electrical activity in the brain, which can lead to recurrent, unpredictable seizures. A seizure is a sudden surge of electrical activity in the brain that can affect motor skills, sensation, behavior, and consciousness. When these seizures occur repeatedly without an identifiable cause, the condition is termed epilepsy.

Types of Seizures

There are two main categories of seizures:

1. Focal Seizures (also called partial seizures): These originate in one specific area of the brain. They can either affect one part of the body or cause unusual sensations or emotions.

   • Focal aware seizures: The person remains conscious during the seizure.
   • Focal impaired awareness seizures: The person may lose awareness and have impaired consciousness during the seizure.

2. Generalized Seizures: These affect both sides of the brain and typically lead to a loss of consciousness.

   • Tonic-clonic seizures (formerly known as grand mal seizures): These involve a stiffening of the body (tonic phase) followed by violent shaking or jerking (clonic phase).
   • Absence seizures (formerly known as petit mal seizures): These involve brief episodes of staring or a loss of awareness, often without physical convulsions.
   • Atonic seizures: These cause a sudden loss of muscle tone, leading to falls.
   • Myoclonic seizures: These involve sudden, brief jerks or twitches of muscles.

Causes of Epilepsy and Seizures

Epilepsy can result from a variety of causes:

• Genetic factors: Certain forms of epilepsy, such as juvenile myoclonic epilepsy, have a genetic basis.
• Brain injury: Trauma, infections (e.g., meningitis), strokes, or tumors can lead to seizures.
• Neurological diseases: Conditions like Alzheimer’s disease, multiple sclerosis, and brain malformations can cause epilepsy.
• Metabolic or systemic disturbances: Low blood sugar, electrolyte imbalances, or high fever (febrile seizures in children) can provoke seizures.
• Drug use or withdrawal: Certain drugs, alcohol, or medication withdrawal can trigger seizures.

Neuropathic pain is a type of chronic pain that occurs due to damage or dysfunction in the nervous system, either in the peripheral nerves (outside the brain and spinal cord) or the central nervous system (brain and spinal cord). It is often described as burning, shooting, stabbing, or tingling and can be caused by various conditions, including diabetes (diabetic neuropathy), shingles (postherpetic neuralgia), multiple sclerosis, spinal cord injury, trauma, and chemotherapy-induced neuropathy.

Managing neuropathic pain can be challenging, as it often does not respond well to traditional pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids. Effective treatment typically requires a multimodal approach that targets the underlying cause, the pain pathways, and the specific symptoms experienced by the patient. The following are key strategies in neuropathic pain management.

Neurorehabilitation is a multidisciplinary approach aimed at helping individuals with neurological disorders or injuries recover lost function, improve quality of life, and adapt to changes in cognitive, physical, or emotional capabilities. It is typically used in the treatment of conditions such as stroke, traumatic brain injury (TBI), spinal cord injury, neurodegenerative diseases (e.g., Parkinson’s disease, multiple sclerosis), cerebral palsy, and other neurological conditions that impair brain and nervous system function. The goal of neurorehabilitation is not only to restore as much lost function as possible but also to help individuals adapt to disabilities and optimize their independence and daily functioning.

Neuroimmunology is the study of the interactions between the immune system and the nervous system. It is a relatively recent and rapidly growing field of research that focuses on how immune responses influence brain function, the development of neurological diseases, and the repair mechanisms following nervous system injury. Neuroimmunology is vital for understanding both autoimmune neurological diseases and the role of inflammation in various neurological disorders.

Future Directions in Neuroimmunology

Advances in neuroimmunology are expected to lead to improved treatments for autoimmune neurological disorders and neurodegenerative diseases. New research is focusing on understanding how the immune system can be harnessed to promote repair and recovery in neurological conditions. Additionally, the exploration of immunotherapies, biologic agents, stem cells, and gene therapy is likely to provide innovative approaches to treating a wide range of neurological diseases.

In summary, neuroimmunology is a rapidly evolving field that seeks to understand the intricate relationship between the immune system and the nervous system. Its discoveries have the potential to transform the way we treat autoimmune diseases, neurodegenerative disorders, and brain injuries, offering hope for more effective treatments and, ultimately, improved outcomes for patients with neurological conditions.

Neurovascular disorders are a group of conditions that affect the blood vessels in the brain and spinal cord, leading to neurological symptoms. These disorders result from disruptions in the normal blood flow to the brain, causing damage to brain tissue. Neurovascular disorders include conditions such as stroke, transient ischemic attacks (TIAs), aneurysms, and vascular malformations. These conditions are among the leading causes of disability and death worldwide, making early detection, treatment, and prevention critical for improving patient outcomes.

Sleep disorders and disruptions in the circadian rhythm are common issues that affect individuals' health, well-being, and daily functioning. The circadian rhythm refers to the body's internal clock, which regulates sleep-wake cycles, body temperature, hormone release, and other physiological processes over a 24-hour period. Sleep disorders encompass a wide range of conditions that impact the quality, timing, or duration of sleep, and they can often be closely tied to disruptions in the circadian rhythm.

Neurotics refer to individuals who experience neuroticism, a personality trait characterized by emotional instability, anxiety, mood swings, and a tendency to experience negative emotions more intensely than others. Neuroticism is one of the five major personality traits in the Five-Factor Model (FFM) of personality, often referred to as the "Big Five" personality traits. While neuroticism itself is not classified as a clinical disorder, people with high levels of neuroticism are more prone to various emotional and psychological difficulties, such as anxiety disorders, depression, and stress-related conditions.

Neuroplasticity refers to the brain's remarkable ability to reorganize and adapt by forming new neural connections throughout life in response to learning, experience, or injury. This process allows the brain to recover from damage, compensate for lost functions, and enhance its ability to process information. Neuroplasticity plays a critical role in brain repair, particularly in the aftermath of brain injuries or neurological conditions. It is an ongoing process that can be harnessed through rehabilitation strategies to promote recovery and improve neurological function.

Nutrigenomics and precision medicine are emerging fields in healthcare that focus on the interplay between genetics, nutrition, and personalized treatment strategies. These fields aim to optimize individual health by tailoring interventions based on genetic makeup, lifestyle factors, and environmental influences. Here's an overview of both concepts and how they work together to offer more targeted and effective healthcare solutions.

Nutrigenomics

Nutrigenomics is the study of how genetic variations influence an individual’s response to nutrients and other bioactive components in food. It explores the relationship between diet, genetic factors, and the development or prevention of diseases. Nutrigenomics seeks to understand how genetic differences affect how individuals metabolize, absorb, and utilize nutrients, which in turn influences their health, susceptibility to diseases, and the efficacy of dietary interventions.