How do we best care for people living with neurological disorders?
In this episode we discuss why prioritising neurology as a whole means truly putting the patient centre stage.
We’re joined by a panel of guests from a cross section of the neurology community as well as hearing from someone living with migraine.
http://www.oneneurology.net
How do we best care for people living with neurological disorders?
In this episode we discuss why prioritising neurology as a whole means truly putting the patient centre stage.
We’re joined by a panel of guests from a cross section of the neurology community as well as hearing from someone living with migraine.
http://www.oneneurology.net
Welcome to the One Voice for Neurology podcast, a series of seven podcasts exploring why it's time to make neurology a priority, how that can be achieved with a global and uniform response and what that could mean for the future of neurology and those living with a neurological disorder. I'm Sam Pauly, and you're listening to episode six, entitled serving and supporting. Thank you for joining us on this special series of podcasts in which we're exploring the new one Neurology initiative across seven daily episodes. In our previous episode, we discussed the endless R& D dilemma. And today we're focusing on serving and supporting people living with neurological disorders. We have a fantastic and very full lineup of guests today. Plus, we'll be hearing from neurological organizations on our one voice for neurology podcast answerphone. So let's meet our guests. Professor Paul Boon, president elect at the European Academy of Neurology, Professor David Dodick is past President of the International Headache Society and chair of the Global Patient Advocacy Coalition, Maria Brandao, Global Senior Public Affairs Manager at the global pharmaceutical company Lundbeck and Astri Arnesen– President of the European Huntington Association. A wonderful lineup, and a very warm welcome to you all. Professor Dodick and Professor Boon, I'll start by chatting with you both, but before that, I just want to remind listeners that we would love to hear your thoughts. So do make sure to join the discussion with us on Twitter. You'll find us at@OneNeurology_ and we're using the hashtag#OneNeurology. Professor Boon, let me start with you. If we only have nine neurologists or neurosurgeons per hundred thousand people in high-income countries, and that's much lower figure of 0.1 in low to middle income countries, how can we really care for people living with neurological disorders with such a limited workforce?
Prof Paul Boon:That's a good question. And the obvious thing would to be, to increase the workforce. Partially, that is actually what is taking place on, as an example, on my watch. I've seen the increase of about 50 to 60% of the number of residents being trades neurology residents in the low countries. But that takes time and that takes a lot of resources, but it's one of the logical things to do. That being said, the other option, the more immediate option is that we free the neurologists from doing all kinds of things apart from providing care. And then that's where multidisciplinary approaches, with nurses and nurses, specialists, physician, assistants, and even v olunteers. So I think that is the way to go. Now, the problem is a bit more complicated to be honest. Because on the one hand we have limited workforce. On the other hand, neurological patients in general require extra care. They require more attention. They want to still see the neurologist. They want to have personal attention, personalized care. So we are facing a troublesome situation. So I c an n ot solve that problem. I can only say that there is a couple of solutions possible, and that's what I just t ried to explain.
Sam Pauly:Is the patient doctor relationship changing, would you say?
Prof Paul Boon:You would think, yes. The patients are happy with seeing other professionals. At the same time, I still think that when explaining a difficult diagnosis, when taking care of the follow- up of patients with chronic disease, at least my patients, they still want me, they want to see the neurologist. They want to have the care and the expertise that is hard to replace. So in that sense, the classical patient-doctor relationship has not changed so much.
Sam Pauly:David what's the role currently of medical societies from specific disorders in terms of working with patient groups, would you say?
Prof David Dodick:Well, Sam, I think it varies, depending on the medical society and depending on the country. Let me just give you a recent and very specific example. I'm past president of the American headache society and past chair of the American migraine foundation. So the American migraine foundation is a public facing non-profit, that educates patients and supports patients. And they're tied to a professional society, the American headache society. So the American headache society is putting out a position paper on appropriate integration of new therapeutics coming into the space. And so they reached out to the American migraine foundation to get the patient's perspective on how they feel new therapies should be integrated into clinical practice. And that patient voice was represented in the publication that will be published in the near future. So having and integrating the patient voice both on clinical and on research matters, I think is becoming increasingly important for professional societies.
Sam Pauly:Paul, would you say that that's the same with broader neurological societies?
Prof Paul Boon:Oh, definitely yeah. If you ignore the patient perspective, I think a lot of the activities of a broader society, like the European Academy of Neurology becomes irrelevant. I mean, we all speak with one voice in terms of patient centered care being, you know, the standards that should be what we are all striving and aiming for. And that's, I think, that's correct from a structural point of view, the way it works is that the science and the content within a general neurology society like European Academy of neurology is driven by its panels. You have scientific panels for each of the subspecialty fields in neurology. Well it is our policy since a few years to have in each panel, at least one patient representative. So all the policies, everything that is tactical and strategic that is being discussed with regards to the content, the patients have a seat.
Sam Pauly:David, would you say that we're now seeing a change towards becoming more active advocates for, um, with their patient communities?
Prof David Dodick:Without a doubt in a way that I've never seen before in my career. I'll give you an example. This global patient advocacy coalition brings together over 30 different organizations, both professional societies, other foundations, regulators, and so on, and from multiple different disciplines from pain, from headache, from general neurology. So we see all of these organizations coming together with patients at the center of the table to advocate for and on their behalf. And I can tell you that this group creates globally, but acts locally. So a perfect example of that is we've collaborated with the Japanese headache society and the Japanese patient advocacy coalition to implement an employee-employer workplace initiative, to raise awareness around migraine in the workplace and begin to support those employees who have migraine in the workplace and ensure that they find appropriate care. But again, we're working with the patient community and the professional community inside of Japan to do that. And we plan to do that in countries all over the world.
Sam Pauly:Paul. Just one final question for you. How can people living with neurological disorders be better supported with regards to stigma and the issue of their disorder being invisible?
Prof Paul Boon:Well, very good question. Two aspects that I really would like to cover in my answer here. Well, one key to resolving or solving stigma is increasing public awareness. I'll give a very short and very concrete example. A kid has a seizure at school. That p rovokes stigma, in any community. What to do? But I mean the concrete initiative could be that on the local level, a person from the epilepsy league comes to the school, teaches about epilepsy, takes the class and teaches them about this. And gone is the stigma. It will increase understanding, it will not lead to problems with this kid that had the first seizure in school. Neurological diseases are very frequent. On the other hand, you mentioned the invisibility of some diseases. Well we know that many of the rare diseases, neurological ones, t here comes invisibility. And I think initiatives like the ERN's(European reference networks), I think are really key again, to remove stigma, to improve public awareness about those rare neurological diseases.
Sam Pauly:David, do you have anything to add to that? How do you think people living with neurological disorders could be better supported in terms of stigma and the issue of that disorder perhaps being invisible?
Prof David Dodick:Well, I really love what Paul just said and the examples that he used. I think it's more of a public understanding as Paul alluded to. It's not just creating awareness because the public is aware of epilepsy, but they don't have an understanding of what epilepsy is. So it's about public education to generate public understanding of the underlying nature of the disease, because, to use Paul's example, if a young kid had a seizure and someone from the epilepsy league or an expert came into educate the class and the teachers on what epilepsy is, I dare say, not only would there be more respect for that child, but we might see more young people being interested in neuroscience. They would be fascinated by this. Creating, not just awareness, but an understanding and an education around the underlying nature of these diseases is what's going to eliminate the stigma.
Sam Pauly:Wonderful. Well, thank you both so much. Please don't go away because we're going to hear from some other guests and then we'll be bringing you back in. but let's just take a moment because throughout the series, we've been asking stakeholders from across the field of neurology to leave a message on our fictitious one voice for neurology Answerphone. Now this episode, we asked our callers about caring for people living with neurological disorders and how the one neurology initiative could improve care. Let's have a listen.
Answerphone:Okay.
Maria Brandão:Hello, you've reached the voicemail of the One Voice for Neurology podcast. Please leave your message after the tone.
:Hello. My name is Anita Vatland. I'm the CEO of the Norwegian Alliance for informal carers and also a member of the board of Euro carers working for informal carers, no matter who or whom they are caring for. When somebody becomes a patient, people of all ages close to them, become their informal carers, doing everything from medical health, transportation, coordinating care, motivating, and trying to pay the bills. Informal carers are in fact, giving 50 to 80% of all the care and support sick and elderly people all across Europe. Patients should be supported from the professional healthcare system. Informal carers need support from us as a society, no matter who you're caring for. They need to be recognized. They need information and training, respite care and the possibilities to combine their caring role with working or studying. They too need to be able to take care of their mental and physical health. My hopeful One Neurology initiative is informal care support for the people that care. Now, we need to support them, which systems and possibilities to make them able to care, but also to live their lives. We did not need two patients out of one diagnosis. Thank you and have a nice day.
Prof Oertel:Hi, I'm Wolfgang Oertel from Marburg in Germany. I am a neurologist and I must tell you one word is a great initiative. Education is vital. Education of doctors and patients is extremely important and doctors have to learn to listen to patients and you should stop talking because the patient comes to you. He has been waiting for days to see you. And he wants to tell you everything, which is in his heart. That is the first point. And you have to understand the language of the patient, you have to learn to speak in real life examples. For example, if your brain is sick, you tell me, brain is a machine with a tank, with petrol, all these examples you think about. So patients understand what you say. The second problem is the classroom education, which is done by professionals alone. Patients come in as sick people. They are not coming in as partners. So the universities should actually design a new program that patients are participating in planning lectures. The third problem is stigma. Children are totally different than adults. They have no prejudice. If you ask handicapped children to come into a kindergarten with healthy children, you will be amazed. Children will never forget that there are brain disease children. And they will then know when they are adults, there are brain disease adults.
Prof Sameer Zuberi:Hello. This is Prof Sameer Zuberi, President of the European Pediatric neurologist society, otherwise known as the EPNS. We are a society for physicians from Europe and beyond with a research or clinical interest dedicated to caring for children, living with neurological disorders. Our society's goal is to promote training, clinical care and scientific research to improve care in the field of child neurology. We provide our members with a platform for networking, education and developing research collaborations, and we set the training standards for child neurology throughout Europe. The EPNS continues to work towards strengthening our partnerships and building new connections with other European level allied neurological scientific groups and patient groups. The EPNS looks forward to lobbying for high quality patient management to prevent and treat childhood neurological disorders at the European level. We see one Neurology initiative as an important tool to help us reach this goal. Child neurology is changing rapidly with technologies available for rehabilitation and new gene therapies, which will transform the lives of children with neurological disorders in the future.
Sam Pauly:Some interesting points there. Maria, let me come to you now. You are Global senior public affairs manager at Lundbeck. I wonder if you could tell us, we've been hearing about the importance of patient voice. In the past, pharma did not involve the patients so much. How has that changed?
Maria Brandão:Thank you so much for that question. I think, uh, we keep trying and you will see that increasingly pharmaceutical companies have really tried to integrate as much as possible this notion of patient centricity. But also actually make it core to their corporate values, their corporate belief, their mission statements. There are however, still improvements to be made. I think the first one is, you know, the legal compliance framework that we operate. So on the one hand, you know, we're very grateful that we have that legal compliance framework to operate within, but it's not always very easy to navigate in. And so the big question is, how do we integrate that patient voice earlier on in the value chain? So that's one thing. And then the second thing that I think professor Boon has alluded to is, is there an awareness from the patient community that they do have a role to play earlier on in the development of medication? And also is there a know-how from our end? We're really keen to hear what are the real unmet needs that people with a specific disease have and what are the most bothersome symptoms and how to best measure them? But we're really sometimes struggling how to navigate these two aspects of it. But we hope that with your help, we can get there slowly but surely.
Sam Pauly:So who would you say, Maria, values from, and what is the value of a more patient centric approach, then?
Maria Brandão:I think everyone involved in healthcare and even beyond would benefit from it. I think that, more specifically, when looking at the pharmaceutical industry, for us, it's really key to understand how the disease impacts the daily lives of the people that have been diagnosed with these diseases. And sometimes when we do some surveys and we compare the output of the surveys from the healthcare perspective, we see a difference in the answers of 20 points on average. So, you know, there is sometimes a mismatch. And so it really is important for us to hear from the people that are really impacted from that disease. So that we on the other hand can try and build a society with the best medication that will deliver on quality of life for the people who we're seeking to help.
Sam Pauly:Wonderful. Thank you, Maria. Now we'll be bringing everybody back in for one final discussion at the end of the episode, but first I wanted to remind you that you're listening to the one voice for neurology podcast. And today we're talking about serving and supporting people living with neurological disorders. Don't forget, we'd love you to join the discussion with us too on Twitter, where you'll find us at@OneNeurology_ where we're using the hashtag#OneNeurology. But now it's time for our daily audio diary from somebody living with a neurological disorder.
Elena Ruiz de la Torre:I am Elena. I am the current Executive director of the European Migraine and Headache Alliance. I suffer from migraine since I was 12 years old. Today, once more in my life, I woke up this morning, with an explosive brain, that I couldn't move. I couldn't move my head. I couldn't move my legs. I couldn't stand up. I couldn't go out of bed. That's has happened so many times in my life. I had the full agenda. I have had to ask someone to call and cancel most of my activities of the day. When I was around 30, I had a very good opportunity to have a very good place in a national organization. I went through all the examinations. When I got to the final day, I woke up like today and I couldn't go to that interview, but of course they didn't understand it. And I felt miserable, as I have felt so many other times in my life with different opportunities, with familiar moments, which I have been waiting for my children or my grandchildren to come home. And the day that they come, I have this migraine and this headache, and I cannot be with them and I need to be seated on a corner or in a dark room. That has happened so often. This condition is a neurological disease. Everyone thinks that it is just a headache, a little bit stronger, but it is a very, very complex neurological disease. It's very difficult. It has lots of triggers. It has difficult treatment. There's no way to take it through a test, to run scans, CATscan, or anything like that. Just talking to the doctor and telling the doctor what happens to you. He or she will find out and give you a good diagnosis. But to find a good doctor that could give you a good diagnosis and therefore a good treatment afterwards. It's also a challenge. It's not so easy. In a moment, I took the decision to advocate for migraine. We are the sufferers. We are the only one that can advocate for our cause. Nobody else is going to advocate for our cause. But migraine has a lot of stigma, huge stigma. And we tend to hide our condition because people doesn't know whether it is a mental problem or neurological problem. The real truth is that if you are episodic, one day, you are out of order completely. And the next day we are perfectly normal. In general, there is a lot of lack of information around the medical group of people. So we need some flexibility and we need a lot of understanding, understanding, respect, and information is what is missing in this world about migraine. Society doesn't understand what it is.
Sam Pauly:Elena Ruiz de la Torre there, talking about her experience of living with migraine. Now, let me bring Professor David Dodick and Professor Paul boon back in, and I'd like to welcome Astri Arnesen as well as. Astri, welcome you are president of the European Huntington's association. Thank you all now for joining us together. In just a few words, I'm going to come to you all, perhaps you could all say, from your own perspectives, what is key to best serving and supporting people living with neurological disorders and their families? Maria let me start with you.
Maria Brandão:We've talked a little bit about stigma and I couldn't agree more with professor Dodick and professor Boon. A couple of elements in relation to stigma, I would like to add is the importance of evidence generation. We need the evidence of the bulk of evidence to make a business case, so that policy makers understand that investing in brain health is an imperative. We cannot afford not to invest in brain health, if we are to succeed in the future. And the other element in relation to stigma and education. And I would like to talk about the power of empathy. It it really helps us to put a face to those invisible diseases that we've talked about and to create that empathy from people that maybe don't even know that they have someone in their network that is impacted by those diseases to really relate to the daily struggles, and to understand why we need to invest in brain health.
Sam Pauly:Paul, let me come to you. What would you say again, in just a few words, is key to best serving and supporting people living with neurological disorders and their families?
Prof David Dodick:From a professional perspective, and from the perspective of European Academy of Neurology, I think we need to have our voices heard much better. We need to instill public opinion about the burden of neurological disease. We need to reiterate and repeat that the brain is one of the most important organs of our body. It is the controlling organ. It is an organ that is key to what we are, to our personality, to what defines us our individuality. I think this is a very good message that we should, that we can bring and we should bring in more. So I would put the strong emphasis on public awareness and teaching and understanding of what the brain really means.
Sam Pauly:And David, let me ask you, what would you say in a few words is key to best serving and supporting people living with neurological disorders?
Prof David Dodick:The three Cs among the G7. What I mean by that is collaboration, coordination and communication among all relevant stakeholders, speaking with one voice that amplifies the message. And so the G7 to me is exactly the people, the groups that we brought together in our coalition, which are professional societies, patient advocacy organizations, corporations- because many of our patients are employed, they a re in the workplace- employers, regulators, pharma, national funding organizations, like the national institutes of health, and p olicymakers. So those are the seven organizations that should be involved in t he coalition, all coming together, all collaborating, coordinating, and communicating with one voice. And so together we can solve this problem, but only together will we be able to solve this problem.
Sam Pauly:Astri, I'd like to bring you in now. Thank you so much for joining us. Would you agree with our other guests? What is the priority from your perspective for patients and carers? Is there a disparity there with what they're saying or are you on the same page?
Astri Arnesen :No, I don't think there is any disparity, on the contrary. I really support what they are saying. And for sure, this has to be solved by a collaborative effort with the different stakeholders, developing an infrastructure that really makes the expertise needed available to each patient and family. And I think, I mean, we could start tomorrow if all people, the clinicians, understood the severity of a brain disorder or a neurological disorder and its complexity. And it's how symptoms interfere with each other. So the brain is controlling us and one symptom in the brain is really interfering with a lot of things usually. And if all clinicians could really understand that and then listen, how is this for you or your family? Then we could help a lot. So as patients and family members, we need to stop being silent, express ourselves, express our needs. And then if healthcare professionals listen to us, we can achieve a lot. And then we need to work on the systematic level, of course, and building the infrastructure.
Sam Pauly:And Astri, we've spoken quite a lot about the pace of patient centric approach, putting the patients at the center, and the patient voice. How can we empower patients to have that voice?
Astri Arnesen :I think really addressing the stigma is an important part of that, because what I experienced is that patients are reluctant in a way, or many are reluctant to come forward. We need to be there as their supporters and facilitators to bring their voice out there because it's important. And I also think that we can represent a safe Haven, so to speak, to be that bridge towards pharma, towards health authorities, because it's a bit scary to be there alone and we are much stronger together. So I think strengthening the associations and helping and supporting patients to come forward and be that voice, is a good way forward, to strengths this collaborative effort that's needed.
Prof David Dodick:If I can say, I totally agree with Astri there. Destigmatization is a big part of mobilizing the patient community and empowering them. And also I would say educating them as to what is available, that there's help out there. There's things that can be done because a lot of patients may not understand that anything can be done to improve their current situation. And there's so much that can be done. So that's part of empowering and mobilizing them and activating them to come forward. There is help and there are people who do want to help you. So I think that's important too.
Sam Pauly:Wonderful. Thank you.
Professor Vladimir Hachinski:Hi I'm Professor Vladimir Hachinski, I'm professor of neurology at Westfield university in London, Canada. You're listening to the one voice for Neurology Podcast. Thank you for doing so.
Sam Pauly:Well, let's turn to the one Neurology initiative because we've been talking about that throughout the series of podcasts. David, in our previous episode, we heard from the American brain foundation about the cure one, cure many philosophy, that making progress in one area leads to progress in another area. Some listeners may feel that patient centricity and a bundled approach are perhaps contradictory. How can they work in tandem and successfully?
Prof David Dodick:So yes, the American brain foundation's philosophy is cure one, cure many. And that's based on very tangible recent experiences. One of our scientific breakthrough awards was given to an individual who came up with the cure for spinal muscular atrophy, which is now being used to treat other neuromuscular disorders such as Duchenne muscular dystrophy. And so let me just give you another example. If we focused on neuro- inflammation or inflammation in the brain, right, we would be tackling many different diseases- from neurodegenerative diseases like Alzheimer's diseases, to multiple sclerosis, to epilepsy, to migraine, to traumatic brain injury. So that one underlying pathological process cuts across all neurological diseases. So key insights into the biology, the neurobiology of neuro- inflammation, new targets and new treatments for one disease, could have implications for treatments and other diseases. That's why I think patient centricity and this One Neurology initiative makes such perfect sense because we are dealing with one brain and we are dealing with a limited number of pathologies.
Sam Pauly:Maria, let me come to you. Lundbeck has prioritized brain health. Why and how important is it to look at the commonalities in your approach?
Maria Brandão:Well, thank you for that. Well we've talked a little bit about the burden of disease when it comes to brain health and Lundbeck has a long history in the field. And we do have that long-term commitment to a brain health. If we are to put together the number of people impacted by these different diseases, we nearly reach around half of the world's population. And I just think that's unacceptable. And I think you'll all agree with that with me to say, you know, this is unacceptable. You know, within mental health, within neurology, we need to work together to talk about the brain as the most complex organ that we know the least of, that is so fascinating because there are a lot of commonalities.
Sam Pauly:Thank you. Astri, do you see potential benefits for individuals in the service and support that they would receive from a more bundled approach?
Astri Arnesen:For sure. I think that's the only way that we can really look for it for a sustainable solution. For rare neurological disease or rare diseases, there are several thousands. So we cannot find one solution for each separate ones. We to go together, because we also share a lot, in terms of needing, you know, a multidisciplinary approach. We have long-term and progressive diseases, many of us, so the needs change as the disease progresses and evolves. And I'm sure that we can put together centres to really able to cope with a broad number of diseases because we learn from each other also. This is something I definitely learned from talking to other disease groups. We have a lot in common, even if we are also unique.
Sam Pauly:Maria, what opportunities do you see to work better in partnership with patient associations and patients?
Maria Brandão:Thank you for that question. And I think the patient association has this unique place in capturing unique insights of the patient community that they represent. And for pharma companies, it's really essential to get those insights as early as possible in the process to understand, okay, what are actually the real needs and what are patient preferences as well? So, you know, it's important that the patient groups bring us out of our ivory tower and help us as well to listen to what those those needs are. And then I think we've talked a little bit about this as well, which is at a global level- How do we find the common agendas that we all agree upon? And they're not that scarce! We share more than what we may think, initially. I think it's a question of being in good faith, having some key principles of listening and mutual respect for what each stakeholders brings to the table in terms of expertise and rolling up our sleeves so that we can together really advocate for better brain health, towards policy makers that not investing in brain health and in brain research is a non-negotiable.
Sam Pauly:Paul, what would you say is your dream for the one neurology initiative? What do you think the opportunities there in partnership and what would you like it to achieve?
Prof Paul Boon:Well, apart from obviously, having success and reach more concrete goals with all the stakeholders involved, my personal expectation would be to work much closer on the European level, much closer with the patient organizations and with the organization that basically represents the neurological patients in Europe, which is EFNA. I think we have worked together in the past alot, but I think this is a unique opportunity to intensify our collaboration and to really team up and go to all the other stakeholders that have been mentioned previously, and really make a very, very strong statement with regard to neurological disease on the European scene.
Sam Pauly:David, let me come to you. What's your hope and dream for the One Neurology initiative, perhaps particularly in terms of partnership?
Prof Paul Boon:I think we need an international G7 that includes the seven different stakeholders that I talked about- The professional societies, the patient advocacy organizations, corporations, regulators, pharma, national funding organizations, and policy makers from around the world. We need to create globally and act locally, and we need to support those societies and patient advocacy organizations on the ground, who may be in the developing world, where they have fledgling organizations. We need to be able to support them so that they can implement policy initiatives and a blueprint that we come up with locally in their own region. That's what we need. We need an international collaborative effort with all stakeholders at the table, creating globally and acting locally.
Sam Pauly:And Astri, let me give you the final word. How do you think people living with neurological disorders could be better served and what can the one Neurology initiative do to help with that? What are your dreams for the initiative?
Astri Arnesen:So my dream is it's really bringing the stakeholders together, and working on a global overall perspective and then act on the ground, simultaneously. So I think i t, I see it like a kind of a symphony where all the different stakeholders h ear some of the same messages being brought to the table by all the different stakeholders. And then we can bring in, I think, I mean, I have friends in India and in other parts of the world and they are very rarely invited to the table and they represent huge resources, both scientifically, and also definitely from a clinical perspective in how to provide services with m aybe relatively s maller means that we are in the Northern part of Europe. We can learn from each other. And we also need really to address on the ground because doing something to improve is so much better than doing nothing. And these patients are used to in general a re used to little. So for us, any progress is important.
Sam Pauly:Well, thank you all so much for joining us. That brings us to the end of our episode. So thank you for sharing your thoughts. I'd like to thank all the guests that we've heard from during the episode for such a thought provoking discussion. Don't forget, we'd love you to join the conversation on Twitter and share your voice, or even better share a video. You'll find us at@OneNeurology_ using the hashtag#OneNeurology. We look forward to chatting there. Do join us again for our final episode, episode seven: What role for policy makers, where we'll be joined by Dr Tarun Dua, the head of the World Health Organization Brain Unit, and many other guests, as we discussed the need for a global action plan and what the one Neurology initiative looks like in practice. I do hope you'll join us then! Bye-bye! Thank you for listening to the one voice for Neurology podcast, produced on behalf of the European Federation of Neurological Associations and the European Academy of neurology, the umbrella organizations, representing patient organizations and neurologists in Europe, with active contribution from the European brain council produced and hosted by Sam Pauly.