Neurology, priorities for the future between technology and system sustainability

Technology can become a key factor in both acute and chronic care. Telemedicine should not be considered an emergency remedy or a 'minor' mode of care. Instead, it can become a strategic tool. In stroke, for example, not all facilities may have a 24-hour neurologist, in which case remote connection between peripheral facilities and specialist centres can facilitate rapid decisions and interventions that the sooner they are carried out, the better the outcome for the patient, reducing possible long-term consequences such as disability. In chronic diseases, follow-up visits, renewal of treatment plans, remote monitoring and comparison between professionals can reduce unnecessary travel, improve adherence to treatment and shorten waiting lists.

Of course, technology is not enough. We need interoperable infrastructures, shared information systems, clear protocols and trained professionals. If each actor in the pathway uses separate tools, digitisation risks multiplying complexity instead of reducing it. The real innovation is not to have multiple platforms, but to build an ecosystem in which hospital, territory and general practice can read and use consistent clinical information.

Another priority concerns appropriateness and sustainability. Neurology today is criss-crossed by important innovations, but often at high cost: think of new therapies for certain rare diseases, advanced treatments for neuroimmunological pathologies, the scenarios opening up in Alzheimer's with anti-amyloid drugs, or diagnostic and interventional technologies. Embracing innovation is necessary, but it cannot mean renouncing responsibility in the management of resources. The physician today must also be a professional capable of contributing to appropriate, evidence-based choices oriented towards real clinical value.

The issue is particularly relevant in rare neurological diseases. In recent years, many conditions that once lacked therapeutic options are finding concrete pharmacological answers. But in order for these opportunities to reach patients, specialist expertise makes all the difference: the disease must be suspected, diagnosed early, the patient must be directed into the correct pathway, and efficacy and safety must be monitored over time. The availability of an innovative drug alone does not guarantee equity if there is no network capable of intercepting needs.

The same applies to dementias. In the case of Alzheimer's, the difference in the coming years will increasingly come down to early diagnosis: identifying patients early, distinguishing between the different forms of cognitive impairment, making appropriate use of biomarkers, neuroimaging and neuropsychological assessments, and building pathways that ensure equal access to new treatment options. Prevention and early diagnosis will become central not only to symptom management, but to the entire organisational structure of neurology.

These issues will also be addressed at the 65th SNO National Congress - Hospital Neurological Sciences, which will be held in Reggio Calabria from 3 to 6 June, bringing together over a thousand physicians and neuroscience professionals. The congress represents the main annual appointment of our scientific society and will address, through plenary sessions, thematic tables and working groups, many of today's most pressing issues: the clinical network for Alzheimer's and access to new treatments, artificial intelligence in neuroscience, the relationship between sleep and the brain, the management of acute stroke, multiple sclerosis, rare diseases, neurorehabilitation, neurosurgery and neuroradiology. These moments of confrontation between professionals in the field are fundamental for spreading best practices and finding new solutions together for increasingly urgent problems.

The Congress will also be an opportunity to reiterate a point: Italian neurology already has a very high-level professional network. In many areas, from stroke pathways to neuroradiology, from neurosurgery to the management of chronic pathologies, our country has developed skills, specialised teams and shared procedures that represent an asset of the National Health Service. The challenge is to make these excellences more homogeneous throughout Italy.

Alongside the critical issues, there is a positive note that should not be overlooked. The demand for health is changing: citizens are paying more attention to prevention, quality of life, and early diagnosis. This is an important cultural transformation, which neurology must be able to embrace. To do so requires investment, organisation and technology, but also a new vision of the role of the specialist: no longer just the doctor who intervenes when the disease is overt, but a professional capable of accompanying the patient throughout his or her life, both in the absence of symptoms for preventive purposes, as well as in cases of urgency or accompaniment in chronic pathologies.

The priorities of neurology all converge in one direction: to build a stronger, more integrated neuroscience network that is closer to the people. It is an ambitious, but possible goal, and the clinical, scientific and human heritage of Italian neurology tells us that we already have many of the skills needed to achieve it.

* President SNO-Hospital Neurological Sciences and Director of the Department of Medical Specialisations and Neurology - Prato