European Federation of Neurological Societies: parent to the European Academy of Neurology

Abstract

Background and purpose

The European Academy of Neurology (EAN) is a vigorous organization of great importance for all neurologists and for our patients. But how did neurology get organized at the European level? That is the topic of this article.

Methods

Most important sources are memories and documents of the author, who was a moving force in developing the European Federation of Neurological Societies (EFNS), one of the two parents of the EAN.

Results

All European national neurological societies and the World Federation of Neurology were involved in a difficult political interaction resulting in the EFNS. Organizational and administrative development was the initial task. Scientific panels led by a scientific committee, teaching courses for young neurologists, teaching courses in middle and eastern Europe and successful congresses were developed. The purchase of headquarters as well as the creation of a fully owned scientific journal (European Journal of Neurology) were important and financially beneficial. The EFNS also promoted the formation of the European Brain Council and of the patient organization European Federation of Neurological Associations. All these elements have continued after fusion with the European Neurological Society to form the EAN.

Conclusion

The very successful development of the EFNS has largely been carried on into the EAN.

INTRODUCTION

The European Federation of Neurological Societies (EFNS) was one of two parents of the European Academy of Neurology (EAN). The early history of the EFNS is probably of interest to present day neurologists as it illustrates how neurology was organized at the European level. I was involved from the beginning of this process and a kind of ‘last witness’. The history is also described in different sections of the EAN archives, https://www.ean.org/home/organisation/efns‐archive‐new/history.

In the 1980s the World Federation of Neurology (WFN) supported regional organizations such as the South American, South Asian etc. There was no European neurological organization and the WFN naturally wanted to support its creation but under the umbrella of the WFN, not a totally independent organization. Professor Franz Gerstenbrand of Innsbruck, Austria, who was extremely politically adept, picked up these signals at a very early point in time and entrusted Professor Daniel Bartko of Bratislava, Czechoslovakia, then a communist country, to organize a pan‐European meeting with the aim of forming a regional organization of WFN for Europe. During the meeting the so‐called Pan‐European Society of Neurology was formed as an organization based on individual membership in close alliance with the WFN. This was at the time of the Soviet Union and there was a communist regime in all the middle European countries including Czechoslovakia. The group that was elected to lead this society consisted of a good number of leaders from communist countries and it is probably fair to say that the level of neurology and neuroscience in the former communist block was not impressive. In many quarters in Europe the formation of this society was regarded as premature. The influence of the communist block and the dependence on the WFN were unacceptable. The Pan‐European Society of Neurology had been accepted by the president of the WFN, Richard Masland, an American with little feeling for European neurology. The presidency changed, however, to Lord Walton of Detchant, one of the most highly respected neurologists in Europe. He had a clear feeling for the level of neurology in different European countries and could understand the problems with the newly formed organization.

The next meeting of the Pan‐European Society of Neurology was planned for Vienna in 1991 under the leadership of Professor Gerstenbrand. Before that meeting there was hectic activity including a meeting in Marseille for all presidents of national neurological societies summoned by Professor Serratrice. I represented Denmark. Several of us suggested that the future organization should be a federation of national neurological societies and Gerstenbrand was not directly against this proposal. The meeting ended with plans for the further process but, much to our disappointment, nothing happened after the meeting. In April 1991 the leadership of the Scandinavian neurological societies met in Copenhagen and reconfirmed their desire for a European federation. I was given the task to draw a preliminary constitution and bye‐laws for such a federation and my proposal was agreed with some changes. It was sent on behalf of all the societies to Lord Walton who undertook further negotiations with Gerstenbrand. He accepted to convert the Pan‐European Society of Neurology into a new society called the European Federation of Neurological Societies (EFNS). That happened during the congress in Vienna 1991 and Gerstenbrand was elected president while the present author was elected vice‐president. The EFNS was formally incorporated in Austria the same year (Figure 1).

FIGURE 1.

Key players in forming the EFNS. From right to left Gerstenbrand, Serratrice, Walton, Mr Henry Roux‐Alezais and Olesen.

DEVELOPING THE EFNS

The EFNS was formed but stood on very shaky ground. It had no finance, no national neurological societies were formally members and nobody paid dues. It was planned that it should have a congress only every 4 years and its management committee consisted for the most part of fairly old and/or old‐fashioned neurologists who were not prepared to put in a lot of work. At the same time, the EFNS was faced with highly efficient competition from the European Neurological Society (ENS). That society was formed in 1989 as a society of individual members, but it was created by relatively young neurologists with a high scientific standing. It had already held two very successful and profitable congresses in 1989 and 1991, but it had a bit of an elitist and closed appearance. We wanted a much broader organization that reached out to all corners of Europe, including the former communist countries which we wanted very much to help in their transition scientifically and clinically. The ENS on the other hand paid no attention to lesser developed countries. One of the first tasks for the EFNS was to seek collaboration with the ENS rather than competition. The EFNS therefore proposed to the ENS that one organization could have meetings on even years and the other on odd years. That would mean friendly competition and room for both organizations to develop. Unfortunately, the ENS never answered the letter but a year later the EFNS received a kind of answer because the ENS singlehandedly decided to hold annual meetings. It was a kind of declaration of war, but healthy in the sense that it became clear to everybody on the management committee of the EFNS that the choice was between success or death.

Our president Franz Gerstenbrand was politically and administratively incredibly efficient. During only 10 years he had built up the neurological department in Innsbruck from a sleepy provincial department to one of Europe's biggest and best neurological departments with its own advanced neuroimaging, neuro intensive care and neurorehabilitation. Like most of the other members of the management committee he did not have a lot of time to put into the development of the new organization. His method of developing his department had been to find the right young people and let them have a free hand. He used this approach again and selected me to do the hard work developing the EFNS.

First and foremost, we had to make sure that all national neurological societies in Europe became members of the EFNS and paid dues. We revised the constitution so that members of a national neurological society that was itself a member of the EFNS were personally members of the EFNS. Since we did not have much to offer at this early point in time, we decided to charge each national society a symbolic membership fee of 1 Euro per member. We contacted all societies and soon had most countries as members. Unfortunately, it was primarily the smaller countries and the countries in middle and eastern Europe who became members. Germany, France and Great Britain were missing. UK and Germany were ‘ENS territories’ while France was undecided. At a meeting with leaders of the French Neurological Society and with valuable support from Jean‐Marc Léger, secretary of the French Society, we secured French membership. It was not easy, and it included exercising my primitive French. It must have sounded ridiculous, but it was a token of goodwill which seemed to be appreciated. Later Germany with the help of many esteemed colleagues joined and at last Great Britain.

Finances were a big problem. The organization had very little money. There were two possibilities, and both depended on the pharmaceutical industry. The first aim was to obtain unrestricted grants directly to the organization. It was in the heyday of the novel migraine treatments called the triptans and I was at that time president of the International Headache Society and known by companies from many drug trials. Unrestricted grants were obtained from several companies with an interest in migraine. Later companies with other interests followed suit. The other funding possibility was through congresses. Because the ENS had decided annual congresses we did the same, but we were behind schedule. It is only possible to plan a big congress years ahead. One had already been planned for 1995 in Marseilles under the leadership of Professor Serratrice, but until then we could only have somewhat smaller interim congresses, the first of which was in Berlin in 1993 brilliantly organized by Professor Einhaupel and then Poznan in 1994 organized successfully by Professor Wender. The congress in Marseilles in 1995 was well organized and attended but generated no surplus to the EFNS. This made it clear that the EFNS had to have full insight into and control over future congress budgets. We achieved that in collaboration with Professor Fieschi who organized the next congress in Rome in 1996. The surplus from that congress eliminated worries about finances. The full congresses scheduled every year after that all provided a handsome surplus to the society. Thus, it became wealthy before the fusion with ENS.

How could we involve European neurological talent covering all the many neurological diseases? Experts were needed when the EFNS was asked for a position regarding health policy issues and for committee work and guidelines. Even more so, they were needed to make congress programmes as varied as possible avoiding having the same people to speak repeatedly. Considering the very loose membership of the EFNS via national societies, how could we find active people with good scientific standing? The answer to all these questions proved to be the creation of a scientific committee which I had the privilege to head. Under this committee scientist panels were created, one for each of the major neurological diseases and each panel consisting of a member from each country of Europe nominated by their national neurological society. In a very short time, we had a database of approximately 1000 neurologists from all European countries, representing all neurological diseases. Until the present day they have provided valuable input to congresses, to guideline papers and to the website. They have also spurred collaborative research.

In order to make our congresses attractive for the pharma and device industry we decided that there would be nine major themes at each congress. Headache, epilepsy, Parkinson's disease, multiple sclerosis, stroke and dementia would each be a major theme at every congress and the three remaining themes would alternate between other diseases. This proved successful and EFNS congresses obtained excellent support from the industry. They soon reached the same size and quality as the congresses of the ENS. Later they even surpassed them.

The EFNS needed association with a scientific journal. One model was to give an existing journal the opportunity to call itself the official journal of the EFNS. This was the model that had been followed by the ENS, but I had more ambitious plans. I wanted the EFNS to be the owner or at least part owner of its journal. Therefore, I proposed to Acta Neurologica Scandinavica that they should be the official journal of the EFNS. They should change their name to be European and at the same time sell half of their stock to the EFNS for 1 Euro. My argument was that the future belonged to journals affiliated with major societies. This offer was refused, and I tried to repeat it with the journal called European Neurology published by Karger. They also turned the offer down. I did not lose faith, however, in my idea that organizational affiliation was crucial and in future would be even more so for scientific journals. I decided that EFNS would start its own journal. I wrote a proposal, sent it to several publishers and got some positive responses. Anthony Gresford, editor of a relatively young company specialized in fast publication, Rapid Communications of Oxford, was known by me from book publishing. It sounds incredible, but we agreed that they should start the journal with no payment from the EFNS. They only requested the right to publish the journal for the first 5 years with EFNS as the sole owner. EFNS got the right to switch to another publisher every 5 years and that happened, I think after 10 years. The next task was to find an editor of the new journal. I contacted a Belgian professor who had an excellent track record as an editor. I corresponded with him and met him during the World Congress of Neurology in Vancouver, but somehow he was not keen on the idea, being used to editing well‐established journals. In contrast, the right entrepreneurial spirit was clearly present in another candidate, Francois Boller, but we did not know him very well and he did not have a track record as an editor. My friend and colleague Professor Per Soelberg Sørensen was extremely busy as an international top scientist in the field of multiple sclerosis but he accepted to share editorship. After long discussions about the name of the new journal, the European Journal of Neurology was launched with success in 1993, a success that has continued and increased ever since. The EJN has further profited from becoming the official and fully owned journal of the EAN.

After a few years everything worked well for the EFNS. It had solid finances, successful congresses, big involvement of neurologists all over Europe and a growing and extremely dedicated and competent staff headed by Uschi Tsabitscher assisted by Lisa Müller, Anja Sander and others (Figure 2).

FIGURE 2.

Frederikke “Uschi” Tsabitscher at first volunteered as administrator for EFNS. Later she became fully employed and she led the organizational development of the EFNS with a firm but gentle hand. Her untimely death was a major loss but fortunately she had recruited young assistants who were so excellent that one of them, Anja Sander, is still the CEO of the EAN. Here Uschi is with the author, then president of EFNS.

The EFNS had been lucky in its infancy to have free office space at the Hospital Rosenhügel, and later an inexpensive office at the university campus in the old Vienna City Hospital. The creation of a branch office in Florence with Mrs Eveline Sipido and another in Prague led by Professor Pavel Kalvach assisted by Mrs Magdalena Danalova was not enough. We needed space of our own and much larger. Professor Eberhard Deisenhammer, who had been a pillar of support of the EFNS since its inception, investigated the possibility of acquiring a suitable apartment or building. He came up with a marvellous new building in the centre of Vienna next to several art museums. We decided to buy rather than rent it, partly because it would be a good investment and partly because it would reduce our liquidity which threatened to be so big that it would make the EFNS liable to pay tax in Austria. Unfortunately, we did not buy the whole house, perhaps something for the EAN to do. It was clear to me that without support from patient organizations it would be difficult. During my last years as president of the EFNS I therefore contacted Mrs Mary Baker of the European Parkinson's Disease Association who accepted to unite the neurological patients in Europe and we assigned Mrs Eveline Sipido to assist her with logistical support. Thus the European Federation of Neurological Associations was formed. It remains a highly valued partner for the EAN.

Hand in hand with the European Federation of Neurological Associations we then used EFNS logistical resources to form the European Brain Council. It united all players with an interest in brain diseases and brain research and became an important force in Bruxelles which multiplied the financial support to brain research. It remains an important partner for the EAN in the continued lobbying for neurological and brain research. The history of the European Brain Council is the subject of another article in this special issue.

As soon as the EFNS was at par with the ENS we started to wonder about the wisdom of having two neurological organizations in Europe. We approached the ENS and a negotiation committee was formed with three members from each organization. Agreement about a fusion was reached by the committee, but it was voted down by the ENS council. This happened twice more. Whether later success was because EFNS had become much stronger than ENS or whether it was because other persons took leadership of the two organizations is not easy to say. Perhaps it was a combination of both. But long after my presidency Jacques De Reuck, president of the EFNS, and Gustave Moonen, president of the ENS, both Belgians, succeeded (Figure 3).

FIGURE 3.

Professor Deisenhammer, left, with four presidents of the EFNS. From right to left Heiss, DeReuck, Gerstenbrand and Olesen.

Each supported by their committee they managed to fuse EFNS and ENS and the EAN was born. This was a major achievement of great importance for European neurology. Every neurologist in Europe is now behind the EAN and its many activities benefit neurology immensely.

Today I wonder about new horizons to reach. European neurology was fragmented but is now united. In many but not all respects it can now measure up to American neurology. In the past dementia, stroke, headache and equilibrium disorders were not really part of neurology. Now that they are, the burden of neurological diseases is enormous. That burden is not yet reflected in undergraduate teaching, research funding or care facilities. It is comforting to see that the EAN has the power needed and the will to address this situation. The World Health Organization has finally understood the importance of brain diseases and the EAN is ready as a strong partner.

AUTHOR CONTRIBUTIONS

Jes Olesen: Writing – original draft.

CONFLICT OF INTEREST

No conflict of interest.

Olesen J. European Federation of Neurological Societies: parent to the European Academy of Neurology. Eur J Neurol. 2024;31:e15680. doi: 10.1111/ene.15680

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.