Editorial Comment

Pediatric Neurology as a distinct discipline within the field of clinical medicine is coming of age. While it has long been considered a distinct subspecialty and credited with its own board examinations in several countries like the USA or Switzerland, other national medical councils were slower to follow these examples and adapt to the growing need for specialisation in clinical medicine. No formal recognition of this discipline exists in most European countries including, among others, Austria, England, France and Germany.

The lack of recognition might be regarded as superfluous where clinical departments of pediatric neurology have long since been set up but on the other hand this lack of recognition has hampered the development of uniform training standards, has hindered or at least slowed the institutionalised implementation of this subspecialty at the university level. Possibly still more important was the detrimental effect at the level of science management: grant applications were (and still are) reviewed by representatives of other subspecialties who find fault with the small sample sizes of the patient groups affected by orphan diseases or the “limited relevance” they see for pathogenetic mechanisms affecting only a handful of patients. It was just another unfortunate step in the same direction that the Deutsche Forschungsgemeinschaft (German Research Society which is the most powerful grant giving institution in Germany) in a recent convent decided that each subdiscipline would be allowed to name a certain number of research reviewers but “forgot” to list pediatric neurology among the disciplines of clinical neurology. It is less than likely that the field will receive a boost from systematic outside-only reviews in times when money shortage commands limited budgets for medical science.

Two recent advances which can hardly be overestimated in their long term consequences may ultimately help to improve the situation. First, the European Pediatric Neurology Society has, after long internal discussions, submitted a training syllabus that was accepted by the Confederation of European Specialists in Pediatrics (CESP), a professional platform with the task to harmonise professional education in Europe. This may in turn serve as a model for the introduction of comparable training standards in many European countries and will no doubt facilitate recognition and implementation of pediatric neurology as a discipline. In a parallel but independent development the German Medical Council is about to revise the catalogue of medical subspecialties in 2003, and pediatric neurology is almost sure to become a recognised subspecialty. Austria is to follow shortly.

Improved training standards, recognised departments with training posts and equipped with updated machinery, university teaching of this necessarily multi-disciplinary approach to the child's and adolescent's neurology are not primarily status symbols to please the pediatric neurologist's vanity or confidence but they are indispensable prerequisites for a high quality care for our patients. To name only one argument, it's precisely the fact of the small sample sizes, the rareness of the disorders under study, so often used as a negative argument, that illustrates the complexity of the task to create an evidence-based approach in our field.

In this context an international scientific journal like Neuropediatrics plays an important role in that it promotes the scientific dialogue, provides a platform for the exchange of ideas, observations and insights and offers state-of-the-art reviews on a wide range of topics for its readership. New disorders like the first description of CDG II d (Neuropediatrics 2002; 33: 27 - 32) or of a form of spastic paraplegia/cerebellar ataxia with low 5-methyltetrahydrofolate in the cerebrospinal fluid (present issue, pp. 301 - 308) stand next to communications setting the standards for the increasingly sophisticated application of botulinum toxin in a wide range of neurological disorders in childhood (Neuropediatrics 2002; 33: 221 - 223 and present issue, pp. 327 - 330).

The livelihood and quality of this forum are entirely dependent on the contributions received from clinicians and scientists around the world. Fortunately the editors are helped in their effort to manage the steadily growing influx of manuscripts by many of these colleagues who also provide expert opinions and reviews. The names of those who assisted in the year 2002 are listed below, and their support is gratefully acknowledged. My deepest appreciation and cordial thanks also go to Drs. F. Hanefeld, Göttingen, and J. M. F. Trijbels, Nijmegen, for their longstanding and devoted support of the Journal as members of the Editorial Board but also for their wise advice and friendship. We warmly welcome Drs. J. Gärtner, Göttingen, and A. Munnich, Paris, as new members of the Editorial Board.

The present issue also contains the Abstracts of the 29th Annual Meeting of the Society for Neuropediatrics. Although focussed on selected topics the diversity of themes and rich variations of methods underline the necessity to maintain an open, multi-disciplinary approach and to absorb new methodologies. Twenty-nine years is also not a bad time for coming of age, in scientific terms.

Thomas Voit