AINEP - NEUROEPIDEMIOLOGY

HISTORY OF ITALIAN NEUROEPIDEMIOLOGY

The pioneers of Italian Neuroepidemiology

The birth of neuroepidemiology in Italy dates back to the late 1970s, with the study group established at the Carlo Besta Neurological Institute in Milan under the aegis of Renato Boeri and with the support of Giulio Maccacaro. Italian epidemiology had previously emerged within the historical context of the trade union struggles for health in factories, which were pivotal to the development of occupational epidemiology in the 1960s and 1970s, driven by scientists and physicians such as Giulio Maccacaro, Renato Boeri, Benedetto Terracini, and Hrayr Terzian.

During the same historical period in which Franco Basaglia was fighting to lay the foundations of a new psychiatry that would lead to the closure of psychiatric hospitals, Maccacaro took over the editorship of the journal Sapere and the book series Medicina e Potere and Salute e Società, and later co-founded with Boeri the journal Epidemiologia e Prevenzione. An intellectual and scientific movement was developing, committed to challenging the notion of a supposed neutrality of medical science: Italian epidemiology was born as a science for prevention and the defence of health — first in the workplace and then in society at large.

Giulio Maccacaro

Renato Boeri

Benedetto Terracini

Hrayr Terzian

Studies on toxic exposures in the workplace and on occupational hazards multiplied; disease and exposure registries were developed; epidemiological surveillance systems for work-related tumours were established; and the methodological research and scientific output of Italian occupational epidemiology gained international recognition.

Following the accident at the ICMESA plant in Seveso in July 1976, which exposed the inhabitants of the surrounding areas to dioxin poisoning, a population survey was conducted to determine the effects of that exposure: the Besta group published data on the association between chloracne and peripheral neuropathies in the exposed population. Occupational exposures were subsequently the subject of an article by Boeri and Terzian in the Rivista di Patologia Nervosa e Mentale; investigations were carried out into the mechanisms of glue-induced neuropathies in shoemakers, lead and pesticide poisoning, and the effects of vinyl chloride monomer exposure among workers at the Petrolchimico plant in Porto Marghera.

The birth of Neuroepidemiology Section of the Italian Society of Neurology

On 20 May 1978, a meeting was held at the Besta under the title Neurological Epidemiology: Assessments and Proposals, promoted by Boeri, Terzian, and Amaducci and open to all neurologists potentially interested in forming a Neuroepidemiology Section of the Italian Neurological Society (SIN). The aim of the Section — officially established in November 1982 at the SIN's 6th Continuing Education Course in Sorrento — was to disseminate knowledge of epidemiological methodology in the approach to neurological diseases throughout Italy. Graziella Filippini was appointed Secretary. The establishment of the group was also fostered by the Advanced Course on Neuroepidemiology, held in San Miniato in May 1981, organised by the University of Florence under the aegis of the WHO and attended by neuroepidemologists from around the world.

AINEP as an independent association: workshops, congresses and courses

From 1982 onwards, the Section has had dedicated space at every SIN congress to develop workshops on epidemiological topics. The Section's national congresses — it became independent from the SIN in 1999 and adopted the name Associazione Italiana di Neuroepidemiologia (NEP) — are held every two to three years, the most recent in 2025 in Ferrara. The first training course organised by the Section was the Course on Epidemiological Methodology for Conducting Analytical Studies, held at the Besta in March 1983, aimed at training neurologists participating in a multicentre study — the first one entirely promoted by the Section — on risk factors for multiple sclerosis. In November 1984, a Course on Clinical Epidemiology for Neurologists was held in Rome at the Istituto Superiore di Sanità, under the scientific coordination of Pierluigi Morosini; it was based on critical appraisal modules for medical articles, subsequently published in Epidemiologia e Prevenzione. The course was taken up again by Massimo Musicco in May 1989 at the C.N.R. in Milan. Since 2004, the Introduction to Evidence-Based Neurology course has been held annually in Novara at the Università del Piemonte Orientale "Amedeo Avogadro", organised by Maurizio Leone with the coordination of Roberto D'Alessandro, with the aim of providing the foundations for applying the principles of Evidence-Based Medicine in clinical neurological practice. In 2000, the NEP launched the methodological journal Evidence Based Neurology, published biannually. Over the 30 years since its founding, the NEP has promoted and conducted numerous population studies, observational case-control and prospective studies on the major neurological diseases, and independent clinical trials. Members of the Association have made significant contributions to the drafting of diagnostic, therapeutic, and prognostic guidelines for neurological diseases, to Cochrane reviews, and to international European and non-European projects.