ECNP New Frontiers meeting on Neurodevelopmental disorders
The 2018 ECNP New Frontiers meeting addressed challenges in the development of CNS treatments from a neurodevelopmental perspective.
Although more than 70% of mental disorders start before the age of 24, clinical trials are typically not developed or conducted to take neurodevelopment into account. Given that many disorders, such as schizophrenia and anxiety, although diagnosed in adulthood, have their roots in early childhood and even neurodegenerative disorders such as Alzheimer’s disease are influenced by abnormal neurodevelopment, this is a significant shortcoming.
Understanding the dynamic nature of the pathophysiological mechanisms underlying psychiatric disorders is crucial for the development of effective therapies. In the last decade there has been a revolution in terms of genetic findings for neurodevelopmental disorders, with many critical discoveries in the etiopathophysiology of such conditions. These insights into the pathophysiologies of mental disorders should inform the different levels and stages of tailored interventions, including psychopharmacological approaches, to counteract early dysfunctions and prevent their future morbid consequences, especially during critical and sensitive neurodevelopmental periods.
Recent studies in different neurodevelopmental disorders (such as Rett syndrome and fragile X) have had disappointing phase III results, even when there have been very promising preclinical and early phase trial data and strong rationales based on sound mechanisms of action in known pathophysiologies. These studies were conducted with adults and adolescents. Should they have been conducted in subjects at a much younger age? It may be difficult to reverse 12-45 years of impaired function (and the resultant cascade effects) with only a few months of treatment. We have many examples in medicine beyond CNS where response outside the therapeutic window does not predict response within the window (and vice versa). It seems desirable to devote more research to identifying the developmental stages at which individuals are most likely to respond to particular treatments.
Mounting evidence suggests that our field should move toward the more ambitious goals of primary and secondary prevention. These types of interventions are easier in a neurodevelopmental frame including a staging approach to brain disorders.
The New Frontiers Meeting took place in Nice, France, on 18-19 March 2018.
You can get all the information about the programme here.