A review of the history and development of neurology in Hungary.

By Prof. László Csiba

László Csiba

The development of neurology in Hungary dates back more than 150 years. In 1882, the first Department of Neurology and Psychiatry was established at the Medical Faculty of the University of Budapest, laying the foundation for the independent evolution of the discipline.

Following this, the growth of neurology accelerated, with internationally renowned neurologists working in Hungary. These include Prof. Károly Schaffer (associated with Tay-Sachs-Schaffer disease) and Prof. József Mátyás Baló (associated with Baló concentric sclerosis).

Several other outstanding neurologists of Hungarian origin also contributed significantly to the field. These include Nobel laureate Róbert Bárány, who worked in Vienna, and György Békési, who conducted groundbreaking research on hearing in the United States and was also awarded the Nobel Prize.

The complete separation of neurology and psychiatry in Hungary took place only in the second half of the 20th century. Prior to that, the Hungarian Society of Neurology and Psychiatry had united the scientific and postgraduate activities of neurologists and psychiatrists in the early 20th century. After the formal split in 1992, this work was continued by the Hungarian Neurological Society. Neurological training in Hungary consists of a 60-month program.

The Hungarian Neurological Society currently has 562 members and includes 17 affiliated societies focusing on specific subfields of neurology. These are:

• Béla Horányi Clinical Neuroscience Society
• Hungarian Epilepsy League
• Hungarian Headache Society
• Hungarian Neuroimmunological Society
• Hungarian Neuropathological Society
• Hungarian Neuroradiological Society
• Hungarian Neuroscience Society
• Hungarian Neurosonological Society
• Hungarian Neurosurgical Society
• Hungarian Pain Society
• Hungarian Scientific Parkinson Society
• Hungarian Society of Clinical Neurogenetics
• Hungarian Society of Clinical Neurophysiology
• Hungarian Society of Pediatric Neurology
• Hungarian Society of Sleep Diagnostics and Therapy
• Hungarian Stroke Society
• Neuro-Ophthalmology Section of the Hungarian Ophthalmology Society

As an umbrella organization, the main task of the Hungarian Neurological Society is to provide a platform for continuing medical education and professional exchange of information. The society also seeks to foster cooperation between the specialties and member societies within the field of neurology.

The society maintains its own website, which serves both as a platform for the dissemination of guidelines and for postgraduate education. In 2024, we organized the 39th National Neurological Conference, with more than 400 participants.

In Hungary (population: 9.8 million), there are 56 neurology departments with a total of 2,680 neurological beds. Stroke patients are treated in 39 dedicated stroke units, where more than 3,500 intravenous thrombolysis and more than 1,000 mechanical thrombectomies are performed annually.

Competency examinations are available in electrophysiology, neurointervention, and vascular neurology.

Continuing medical education is conducted both in person and online. Fifty credit points must be earned over a five-year period from accredited courses to maintain board certification.

Every two years, the Hungarian Neurological Society organizes an international conference where all affiliated societies host their own sessions to present developments in diagnostics and therapy in their respective fields.

The society is also committed to educating the public and advocating for appropriate funding for neurological diseases with health care policymakers.

The Hungarian Neurological Society maintains intensive international relations. Thanks to these efforts, Budapest hosted the European Academy of Neurology (EAN) Congress in 2023, which attracted more than 8,000 participants.

The society has vibrant relations with the neurological societies of Central European countries, including the Czech Republic, Romania, Serbia, and Slovakia. Every year, we organize a three-day neurology training conference in Romania specifically for Hungarian neurologists living beyond Hungary’s borders.

In Hungary, neuroimmunological patients (including approximately 6,000–7,000 people with multiple sclerosis) receive immunomodulatory treatment at dedicated multiple sclerosis centers. The treatment of extrapyramidal disorders and epilepsy is also concentrated in specialty centers, which benefit from priority funding for both pharmaceutical and instrumental therapies. •

Prof. László Csiba is a neurologist and professor in the department of neurology at the University of Debrecen in Hungary.

A neurologist’s perspective and experience with the DREAM program.

By Prof. Massimo Leone

Integrating epilepsy in primary care in sub-Saharan Africa. Some activities and events in 2023 and 2024.

In 2022, the World Health Organization (WHO) released the Intersectoral Global Action Plan (IGAP) on epilepsy and other neurologic disorders.¹ One of its main goals is improving access to care for people living with epilepsy (PLWE), particularly in low- and middle-income countries where about 80% of these patients live.

Sub-Saharan Africa has 1.3 billion inhabitants. The estimated number of PLWE in the region exceeds 20 million, but there is only one neurologist for every 2 million people.

The majority of PLWE in Sub-Saharan Africa are managed in primary care facilities by nonphysician clinicians (NPCs) whose education on the disease is insufficient. More than 75% of PLWE have little or no access to treatment. The Sub-Saharan African population is expected to double by 2050, as is the number of PLWE.

IGAP calls for improved access to care for PLWE, particularly at the primary care level. Actions to meet this need are urgently needed. Increasing (and improving) the number of primary care services for PLWE and improving education to NPCs² are two key steps toward addressing this issue.

In 2020, an epilepsy program in Sub-Saharan Africa was started in primary care centers through the Disease Relief Through Excellent and Advanced Means (DREAM) program. This was in partnership with the C. Besta Neurological Institute, Instituto de Ricovero e Cura a Carattere Scientifico (IRCCS) Milan, the Italian Society of Neurology, and Global Health Telemedicine (GHT).

Since 2002, the DREAM program has delivered care for HIV/AIDS patients in Sub-Saharan Africa. It is now active in 10 Sub-Saharan African countries with 50 primary care centers. This includes 28 laboratories with molecular biology. DREAM is part of the national public health systems in these countries.

Integrating epilepsy in primary care in sub-Saharan Africa and partnership for IGAP. The map shows DREAM centers integrating treatment for epilepsy, HIV and other diseases. Different levels and strategies for the intervention of the partnership in 2023, 2024, and 2025 are shown in the pictures.

Among the main achievements of DREAM is a long-term suppressed viral load in 95% of HIV patients in the program.³ All health care personnel are local, and the involvement of community health workers greatly contributes to the high retention rate. In all DREAM centers, HIV management is integrated with noncommunicable diseases. This is in accordance with the UN-WHO 2011 directive to fight the double burden of the diseases.⁴

Italian neurologists considered DREAM a reliable platform to deliver care to PLWE in Sub-Saharan Africa, and an education and training program for local NPCs was started. So far, 20 in-person teaching and training courses on epilepsy and other highly prevalent neurologic diseases such as stroke and headache have been delivered to more than 300 primary health care workers. Each course is followed by periods of shared work on the ground and training on the job in Malawi, Central African Republic, Mozambique, and the Democratic Republic of Congo.⁵

Three video electroencephalograms have been installed. More than 1,100 EEG recordings have been sent to epilepsy specialists in Italy through the GHT telemedicine platform. Sub-Saharan African clinicians have sent more than 3,400 teleconsultation requests to Italian neurologists. More than 2,600 PLWE are regularly treated at the 14 DREAM centers where epilepsy care is now delivered.

In addition, the Italian Society of Neurology started a teaching and training program for neurology residents. It includes periods of work at primary care centers in Sub-Saharan Africa under the mentorship of senior expert neurologists.

In conclusion, our long-term epilepsy program and partnership is enhancing cooperation between neurologists and primary health care NPCs. This approach contributes to increased and improved access to care for PLWE in Sub-Saharan Africa. •

Prof. Massimo Leone works in International Affairs for the Global Neurology Program at The Foundation of the Carlo Besta Neurologic Institute, IRCCS, in Milan, Italy.