1. Neurological Therapeutics - “Diagnose and Adios” No More Dr. Norman Delanty Consultant Neurologist Beaumont Hospital, Dublin Neurology Update Meeting, October 24, 2008

2. The Role of the Doctor Providing explanation Reducing uncertainty Giving reassurance Improving quality of life Reducing suffering / pain Prolonging life

3. The Past Neurologists were seen as astute diagnosticians Great at “chin-scratching” Not much good at making a real difference to people’s lives Once diagnosis made, often no treatments to offer, and often no great need or point to continue to see patients on regular and frequent follow up

4. The Present Diagnostic capability improving, e.g.,  Imaging  Neurogenetics  Video EEG monitoring Treatment modalities expanding  Advances in classical pharmacology  Biological therapies  Non-pharmacological approaches

5. The Future Further understanding of neurobiology of disease Whole genome analysis of large number of patients with well phenotyped neurological conditions  New biological pathways  Pharmacogenomics New targeted “biologicals”

6. Resources Neurology remains the Cinderella of the medical specialties Particularly so in Ireland Little central planning for advances in therapeutics  E.g., natalizumab No concept of “investing to save” in the Irish system

7. PubMed  Neurologocal therapeutics - 20,535  Treatments for neurological disease - 257,024  Treatments of Parkinson’s disease - 7,789  Antiepileptic drugs - 132,404  Natalizumab - 345  Lacosamide - 43

8. Today Alzheimer’s disease - Colin Doherty Stroke - Mark McCarron Migraine - Peter Boers Anti-epileptic drugs - Kevin Murphy Multiple sclerosis - Joan Moroney Parkinson’s disease - Tim Counihan Psychiatric disease in neurology - David Cotter Mitochondrial disease - Doug Turnbull