The “gross neurological product” of Europe is high and increasing — that was the conclusion from an analysis of neurological publications that was presented by Giorgio Cruccu at the third Congress of the European Academy of Neurology (EAN) in Amsterdam in June. This strength in European neurology research was reflected in the array of presentations enjoyed by over 6,000 delegates at the meeting.

On the first day of the congress, the European Medicines Agency Committee for Medicinal Products for Human Use issued a positive opinion for approval of cladribine tablets for treatment of highly active relapsing–remitting multiple sclerosis (MS), and the decision was the talk of the MS community in Amsterdam. At the congress, Per Soelberg Sørensen presented further data on the safety and efficacy of cladribine tablets. The integrated findings from the CLARITY, CLARITY Extension and ORACLE-MS trials support the hypothesis that cladribine works via an immune-resetting mechanism, and showed that unexpected adverse events were minimal. The therapy is set to be approved by the European Commission later this year.

Another major development in neurology that had preceded the congress and created a buzz among attendees was the reclassification of stroke as a neurological condition in the ICD-11, the current revision of the WHO International Classification of Diseases and Related Health Problems: the new classification can be seen in the ICD-11 Beta Draft. Raad Shakir, who is President of the World Federation of Neurology and was a central figure in bringing about the reclassification, was awarded honorary membership of the EAN at the opening address.

Discussion of these major developments was accompanied throughout the congress by presentation of many notable studies that reflect the breadth of neurology research across Europe, with highlights in migraine and Parkinson disease (PD). Following reports earlier in the year of successful trials of the human monoclonal antibody erenumab in the treatment of migraine, a subgroup analysis from the same trials was presented at the EAN Congress. This analysis showed that erenumab was also effective for migraine patients with medication overuse. Another study that was presented showed that cannabinoids are as effective for migraine prevention as currently used therapies, and can reduce pain in cluster headaches in patients who had migraines in childhood.

In the field of PD, results of the TOLEDO study were presented, and showed that subcutaneous infusion of apomorphine for 12 weeks reduced off-time and the associated dyskinesia when compared with infusion of saline. No unexpected adverse events were observed, and the results indicate that this approach should be considered for patients with severe motor fluctuations. A preliminary study that was also presented indicated that hypertension is associated with more-severe symptoms of PD, warranting further investigation of the link to determine how blood pressure should be managed in PD.