Day 1 :
The University of Oklahoma Health Sciences Center, USA
Keynote: Post-traumatic headache in veterans of the Afghanistan and Iraq wars following deployment-related traumatic brain injury: long term follow-up and relation to PTSD and depression
Time : 09:30-10:00
James R Couch received his MD and PhD (Physiology) degrees from Baylor Medical School (Houston), Internship and Residency in Neurology at Washington University (St. Louis) and Fellowship in Neuropharmacology at the National Institute of Mental Health. He subsequently served on the faculties of University of Kansas and Southern Illinois University Medical School. He was chair of Neurology at University of Oklahoma Medical School from 1992-2006 and currently is Professor there. He has been interested in Headache for many years and was President of the American Headache Society (1998-2000). His current research deals with Post-traumatic Headache in war Veterans.
Traumatic brain injury (TBI) occurred in 15-20% of soldiers deployed to Afghanistan (OEF) or Iraq (OIF) wars (DTBI) with headache reported the most common post-TBI problem. In our study including 179 diffuse traumatic brain injury (DTBI) and 155 controls (deployed soldiers without DTBI [CS]), chronic daily headache (CDH) occurred in 50% of DTBI and only in 9% of CS. Of those with CDH, 80% had chronic migraine (CM). In a subset of 94 DTBI and 70 CS, using the PTSD civ questionnaire, 50% of DTBI and 17% of CS had Post-traumatic stress disorder (PTSD), and using the Beck Depression Inventory 2 (BDI 2), 48% of DTBI and 9% of CS had severe depression (BDI score ≥29 [SDep]). Further analysis of these clinical data demonstrated that PTSD was seen in DTBI with and without CM at a rate of 64-74%. However, for SDep, this was seen in 63% of DTBI with CM, in 27% of DTBI with HA ≤9/month and 9% of CS. This suggests that PTSD relates to the TBI itself, but within the syndrome of post-traumatic headache, there is a sub-syndrome of CM with a strong representation of SDep. Whether SDep is a factor in conversion of headache to CM or the reverse requires further investigation. The second component of our work was to evaluate serum of the DTBI and CS with mass spectrometry (MS) to determine if there are significant and specific differences in the MS profiles between DTBI and CS; and between DTBI with and without CM. Results will be reviewed in the presentation.
International Human Toponome project, ToposNomos Ltd. Germany
Keynote: Translation of biotechnology into clinical condensed matter physics of ALS, impact for efficient therapy
Time : 10:00-10:30
Walter Schubert is Director of the International Human Toponome Project, Munich, Germany. Based on observations on the island of KOS, Greece, in 1987 he formulated the sun light hypothesis, and derived Imaging cycler robotics for simultaneous imaging of millions of molecular signals in one and the same sample, e.g. in diseased tissues of ALS: the technology applying millions of quasi channels to reveal the toponome. He is an Emeritus Professor for toponomics of the International Faculty, CAS-MPI Partner Institute for Computational Biology, Shanghai, China, and HD in Germany. He has received many national and international awards, honors and has 150 publications, and holds many technology and therapy patents.
Molecular Unlimited Systems-Imaging Cycler (IC®) robotics, a toponome imaging system, decodes the hitherto unknown and unexpected dark space of diseases at >4.5x10 to the 481 combinatorial molecular resolution in situ/in vivo. As shown for ALS, the dark space is not a nihility or nothingness, but an almost continuous ontological contexture, a quasi-infinite parallelism of polyphony, which can be translated into efficient therapies, and in clinical condensed matter physics of ALS. An ALS patient was treated on this basis by depletion therapy of axotomy – competent cells (ACC) detected by an IC robot resulting in durable recovery. All tested ALS patients display these cells in their blood. The introduced approach is likely to be an efficient new therapeutic approach based on hypothesis-free methods of ALS-systems analysis on a large scale in topologically intact tissue structures, as required for approaches to condensed matter physics of living matter.
University of Oradea, Romania
Time : 10:30-11:00
Aurel Simion has graduated from the Institute of Medicine and Pharmacy Tg Mures in 1988 and completed his PhD thesis on the oxidative stress in acute ischaemic stroke in 2007. He is currently working as Assistant Professor of Neurology at the Faculty of Medicine and Pharmacy Oradea, and as a Senior Neurologist at the Clinical Municipal Hospital Oradea being Head of the Neurological Rehabilitation ward. His area of expertise includes cerebrovascular diseases and lumbar disc herniation.
Background: Oxidative stress in acute ischaemic stroke was extensively evaluated in the past years. Attempts to influence it in animal models of stroke showed benefit, but in human clinical trials the results were disappointing.
Material & Methods: The oxidative stress was evaluated by sequentially measuring the malondialdehyde levels in a series of 100 consecutive ischaemic stroke patients. Stroke subtype was classified according to the TOAST criteria. Patients with undetermined stroke subtype and with other causes of increased oxidative stress were excluded.
Results: Oxidative stress was significantly increased only in cardioembolic stroke. This can be explained by the fact that the embolus is not adherent to the vessel wall and often undergoes spontaneous fragmentation and lysis, reestablishing the blood flow. Spontaneous recanalisation of the vessel leads also to haemorrhagic transformation often seen in cardioembolic strokes. On the other hand, reestablishing the blood flow supplies the oxygen which is needed for oxidative stress to develop. These findings can also explain the experimental results found in animal models, in which ischaemic stroke was accomplished by temporarily clamping the carotid artery. Further developing the idea, antioxidant therapy could prove beneficial in those stroke subtypes in which blood flow is reestablished, namely embolic stroke, after thrombolysis or mechanical clot retrieval by diminishing the magnitude of reperfusion injuries.
Conclusion: It would be worth reevaluating the effect of antioxidant therapy only in cardioembolic stroke and in the context of vessel recanalisation.
D. F. Chebotarev Institute of Gerontology, National Academy of Medical Sciences of Ukraine, Ukraine
Keynote: Intermittent hypoxic training, as non-pharmacologic approaches for mild cognitive impairment treatment
Time : 11:20-11:50
Victor Kholin has completed his PhD and Postdoctoral studies at in Dmitriy F. Chebotarev Institute of Gerontology of National Academy of Medical Sciences of Ukraine. He is the CEO (Research and Development) in Institute of Gerontology of National Academy of Medical Sciences of Ukraine and Vice-Director of Ukrainian Alzheimer’s Disease Association. He has combined clinical and basic research in area of cognitive neurology, brain aging and age-related disorders. He has published more than 100 papers and has been serving as an Editorial Board Member.
Mild cognitive impairment (MCI) is early clinical stage of Alzheimer’s disease (AD). Due to now most of pharmacologic treatment of MCI and AD has predominant symptomatic approaches. Nevertheless, recent researches try to find possible non-pharmacologic approaches for treatment mild cognitive impairment and AD. It is well known that intermittent hypoxic training has shown some good clinical results as treatment strategy in several cardiovascular diseases and metabolic disorders, such as type II diabetes and pre-diabetic states. The aim of our pilot project was to estimate intervention of intermittent hypoxic trainings on subjects with mild cognitive impairment. All subjects were established of MCI diagnosis by Peterson’s criteria. The group was randomized to two subgroups for real and sham intermittent hypoxic training. The subjects have undergone a 15-hypoxic training session. The each of training session consists of intermittent hypoxic (14% O2) and hyperoxia (36% O2) periods with total time of 32 min per session. The control group has the same, but sham training session with inhalation of air with usual O2 concentration. During the trial, there were controlled several cognitive markers: MOCA-tests score, cognitive evoked potential (P300) and biomarkers; Amyloid 1-42 beta expression in platelets, APP, neutrophils extracellular traps (NETs), neutrophils microRNA (miR29-a). After 15 session of intermittent hypoxic training in main group was observed significant improvement in MOCA-test total score, the latency (P3) of cognitive evoked potentials and APP up/down index compare to sham training group. Positive trends were found in increasing of miR-29a and decreasing of native NETS markers. The results of current pilot study confirm that intermittent hypoxic training may serve as potential clinical nonpharmacological therapeutic intervention in subjects with mild cognitive impairment.
- Neurological Disorders | Neuropharmacology | Neurotherapeutics, Diagnostics and Case Studies | CNS and Brain disorders | Neurodegenerative disorders | Neurosurgery and Neural Circuits | Neuroimaging and Radiology
Location: Sylt 1
University of Oradea, Romania
Juan D Martina
Rehabilitation Centre Curacao, Curacao
Rehabilitation Centre Curacao, Curacao
Title: Hormonal and non-hormonal factors contributing to chronic fatigue after traumatic brain injury
Time : 11:50-12:10
Juan D Martina, MD Physiatrist, is currently a Senior Consultant at the Rehabilitation Centre Curacao, Dutch Caribbean. Until 1st of October 2015 he was the Chairman of the Rehabilitation Department and Director of the P&RM Residency program at Medisch Spectrum Twente Hospital and Vice-Chairman of the Medical Staff of Roessingh Rehabilitation Centre in Enschede, The Netherlands. He was the President of the Dutch Society of Physical and Rehabilitation Medicine (VRA) from March 2009 until November 2014 and was Vice-Chairman of the National Innovation Steering Committee of the association of rehabilitation hospitals (RN) until 2015. Since 2014 he also chaired the national working group for the development of clinical guidelines for spasticity treatment, published in 2017. His areas of interest are healthcare management, traumatic brain injury, spasticity and medical technology. With his experience in these fields he has contributed in numerous occasions as an Invited Lecturer across different scientific conferences worldwide.
Background: Every year, 30,000 subjects suffer a traumatic brain injury (TBI) in the Netherlands. About two thirds will develop post-TBI chronic fatigue (pTBI-CF).
Aim: The aim of this study is to identify the hormonal and non-hormonal etiological factors of pTBI-CF with a focus on those factors that may be reversible with treatment.
Patients & Methodology: To quantify fatigue severity, a validated questionnaire was sent to 332 pTBI patients, about 10 years after their trauma. A random sample of 100 patients was asked to participate in the study and 90 agreed. They underwent an extensive endocrine evaluation, and non-hormonal causes for fatigue were studied by means of questionnaires evaluating sleep, attention, emotional well being, quality of life, coping style and daily activity and dependency. Physical performance was evaluated by the Astrand biking test.
Results: Vitamin D deficiency, defined as a serum 25-hydroxyvitamin D level (25-OHD) <50 nmol/L) was found in 65%, poor sleep quality in 54% and anxiety disorders in 36%. Growth hormone deficiency (GHD) was detected in 24% and gonadal hormone deficiencies (GnHD) in 8%. Fatigue severity was correlated with serum 25-OHD levels (R -0.50, P<0.0001), the Pittsburgh sleep score (R+0.65, P<0.0001) and the anxiety score (R+0.50, P<0.0001), but not with GHD or GnHD. The first three factors together explains 57.9% of the fatigue score variance.
Conclusions: Vitamin D deficiency, poor sleep and anxiety were identified as the most important factors associated with pTBI-CF. Appropriate treatment for these disorders may help to reduce fatigue in pTBI patients
Universidad de San Martín de Porres, Peru
Title: Use of angiotensin II receptor blockers (ARBs), angiotensin I-converting enzyme (ACE) polymorphism and associations with memory performance in older people
Time : 12:10-12:30
Teodoro J Oscanoa, PhD, currently leads the Research Center of Drug Safety at the Faculty of Medicine of the University of San Martin De Porres, Lima, Peru. He is also the Head of the Department of Internal Medicine at Hospital Almenara in Lima. His research areas are geriatric pharmacology, drug safety and pharmacogenetics respectively.
Statement of the Problem: Angiotensin II is associated with poorly conditioned learning in animals, which improves with angiotensin I-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB). Recent clinical studies have provided evidence of the protective cognitive effect of ARBs, reducing the incidence of cognitive impairment of aging and progression of Alzheimer's disease and vascular dementia. Genetic studies have found an association between cognitive or memory impairment in Alzheimer’s disease and the ACE insertion (I)/deletion (D) polymorphism.
Aim: The aim of the present study is to determine the relationship between the use of ARBs, memory performance and its association with ACE polymorphisms in older adults.
Methodology: A retrospective observational case-control study was conducted. One hundred four patients over 60 years of age and without cognitive disorder were included, 52 cases (ARBs users) and 52 controls (non-users). The Wechsler Memory Scale was used to evaluate memory. ACE I/D polymorphism was determined in all patients.
Findings: The average age and years of education in cases and controls were 75.33 + 7.55 and 72.02+7.01 (p<0.05), and 11.25+ 4.09 and 12.21+3.47 (p>0.05), respectively. The genotype distribution of ACE polymorphism agreed with the Hardy–Weinberg equilibrium (p = 0.489). The frequencies of I/I, I/D and D/D alleles were 48%, 40% y 12%, respectively. No significant difference in memory performance was found between cases and controls with genotype ACE I/D and D/D. In I/I patients, memory scores were higher in cases than controls: 99.46+5.45 vs. 95.0+ 5.71 (p<0.001). A multiple linear regression predicting memory score in the total sample (predictors: age, years of education and I/I status) showed that I/I status was not an independent predictor of memory performance.
Conclusion & Significance: Older ARB users seemed to have better memory performance in the presence of the ACE I/I polymorphism.
Funding: ESSALUD - Kaelin Grant, Institute of Health Technology Assessment and Research-IETSI (Resolution No. 04-IETSI-ESSALUD-2016). Lima Peru.
University of California, Irvine, USA
Time : 12:30-12:50
Xiao-Tang Kong received her first Doctoral degree in Pediatric Medicine (1993) from Beijing Capital Medical University, China. She received her second Doctoral degree (PhD, 1996) in Molecular Biology of Cancer from University of Tokyo, Japan, and then completed her Postdoctoral research in Cancer Genetics at Memphis Children’s Research Hospital (1997-1998) and University of California, Irvine (1998-2001), USA. She was awarded her third Doctoral degree (MD, 2008) from Keck School of Medicine at University of Southern California (USC). She completed her neuro-oncology fellowship at University of California, Los Angeles (UCLA) (2013). Currently, she serves as Assistant Professor of Neurology at University of California, Irvine. Her clinical research focuses on identifying effective treatment for newly diagnosed and recurrent malignant brain tumors.
Primary malignant glioma or Glioblastoma (GBM) is the most aggressive brain tumor in adults. With maximized safe resection followed by the standard therapy consisting of radiation and chemotherapy with temozolomide, the median overall survival is only about 14 to 16 months and 5 year survival rate less than 5%. The treatment for the recurrence is more challenging. Administration of Bevacizumab, a humanized monoclonal antibody targeting vascular endothelial growth factor (VGEF) inhibitor, is an approved therapy in the US for recurrent glioma, which does improve QOL but prolongs limited survival. A latest study showed that adding medical device tumor-treating fields (NovoTTF/Optune) improves the median overall survival to 20 months and 5-year survival rate to 13%. Other new therapies are currently being investigated in variety of clinical trials for the effectiveness. Here we will review recently developed therapeutic glioma vaccines, proteasome inhibitors, gene therapy, other immunotherapy and targeted therapy for the treatment of malignant brain tumors and the challenges.
Aschwin Van Loon has worked on neurology wards and neuro surgery wards for almost two decades and after working as a registered senior nurse at a rehabilitaion centre on a ward with MS, lower and upper leg amputees and paraplegic’s patients. He has always wondered why they, as nursing staff, always use humour when they are around other nurses but almost never when they are around their patients. He has started nursing care when he was in late twenties after he had done another education in sports. Finally after much taking and debating with thesis counsellor he came up with ‘Humour as a Nursing Intervention’. In 2013 while attending the World Neuroscience Congress of the WFNN in Japan he came in contact with Vicki Evans and and she helped him to publish my thesis as an article in the Australasian Journal of Neuroscience.
Therapeutic humour is defined to be any intervention that promotes health and wellness by stimulating a playful discovery, expression or appreciation of the absurdity or incongruity of life's situations. This intervention may enhance health or be used as a complementary treatment of illness to facilitate healing or coping, whether physical, emotional, cognitive, social or psychological. Humour can be used in all kinds of ways or situations, to relativize, make tense situations less tense or it can be used to make life more pleasant. If a nurse uses humour as an intervention in complimentary care, certain patients may complain less. This paper will look at Humour as a nursing intervention. A review of the literature was done and after the review a questionnaire was undertaken and from that questionnaire and review conclusions were drawn.
Taras Shevchenko National University of Kyiv, Ukraine
Title: The activity of the parietal cortex in the reaction of choice after a traumatic brain injury compared with the anterior cingulate cortex activity in the control group
Time : 14:00-14:20
Natalia Filimonova is a Senior Scientist, ESC "Institute of biology and medicine", National Taras Shevchenko University of Kyiv, Grant of the Ministry of Education and Science “Development of methods of neurophysiologic diagnostics and correction of the consequences of traumatic brain injury, concussion and post-traumatic stress disorder in ATO participants” since 2018. During 2011-2017, she worked as a Senior Scientist in the Department "Physiology of the Brain and Psychophysiology" of the Peter Bogach Scientific Research Institute of Physiology, ESC "Institute of biology", National Taras Shevchenko University of Kyiv. She also worked as Senior Scientist in Research Laboratory of Physiological Cybernetics and Psychophysiology, Biology Faculty in National Taras Shevchenko University of Kyiv, Senior Engineer of Kiev Research Oncology Institute of the Ministry of Health, USSR, Kyiv, Scientist at Institute of Cybernetics of the National Academy of Sciences of Ukraine, Kyiv.
It is now generally accepted that the decision-making process and executive control imply involving the prefrontal cortex, which provides the selection of actions based on perceptual cues and reward values. The goal of the present study is to examine the effect of traumatic brain injury on contribution of the prefrontal cortex to the neural basis of decision making process. Integration of information processing is the fundamental principle of brain activity. We propose the method of wavelet transformation of EEG based on image recognition ideas using Krawtchouk functions as mother-wavelet. The method makes it possible to determine the temporal location of the maximum peaks of the EEG wavelet - spectrum. Thus, we search out the synchronization of brain activity in different derivations and different frequency ranges. In the group of soldiers who had traumatic brain injury (TBI) on the fighting in the East of Ukraine, during the choice reaction time task the interhemispheric synchronization was detected in the somatosensory cortex as well as in the occipital-parietal lobe. In this case, using the EEG source localization by LORETA (Low Resolution Brain Electromagnetic Tomography), the maximum activity in the subgenual gyrus was identified. While in the control group interhemispheric synchronization was detected in the prefrontal and frontal areas and occipital – frontal dynamics of signal processing were determined. Herewith the maximum activity was hold in the anterior cingulate cortex. Compared to the control group in the group of soldiers with TBI, the choice reaction was mainly based on the activity of inferior parietal lobule.
The Chinese University of Hong Kong, China
Time : 14:20-14:40
Zhi-Zhun Mo is now pursuing his PhD degree in The Chinese University of Hong Kong. He has published 13 papers in reputed journals during his Master's and PhD degree.
Uncaria rhynchophylla has been used traditionally to treat some central nervous system disorders including epilepsy and Alzheimer’s disease, it’s been reported that it might potentially provide natural treatment for Parkinson’s disease (PD). Isorhynchophylline (IRN), an oxindole alkaloid, has been identified as the main active ingredient responsible for the biological activities of Uncaria rhynchophylla. IRN has been found to possess potent neuroprotective effect against the glutamate and cerebral ischemia-induced neuronal damage, promote the degradation of α-synuclein in neuronal cells via the induction of autophagy, attenuates 1-methyl-4-phenylpyridinium ion (MPP+) induced apoptosis through endoplasmic reticulum stress and mitochondria-dependent pathways in PC12 cell, reduces the neurotoxicity induced by β-amyloid through suppressing cellular apoptosis and inhibiting oxidative stress and tau protein hyperphosphorylation. Studies mentioned above indicated that IRN possesses potent neuroprotective activity and might be a promising therapeutic agent for the treatment of PD. However, the effects of IRN on PD are still unclear. Neuroprotective effects of IRN were confirmed in experimental PD models induced by neurotoxins, including 6-hydroxydopamine (6-OHDA) and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), and studies on its action mechanisms are still on going. Our findings suggest that IRN exerting neuroprotection through regulation of α-synuclein expression, autophagy, oxidation reduction system and inhibition of neuro-inflammation.
Kocaeli University, Turkey
Time : 14:40-15:00
Kudret Esen Gumuslu has graduated from Medical School of Marmara University and completed her PhD in the field of Medical Genetics and Molecular Biology. She has experience in clinical genetics, array CGH analysis and next generation sequencing. She has research experience in genetics of CNS disorders.
FOXG1 syndrome is characterized by severe intellectual disability (ID), microcephaly, seizures, speech disorders and gait disturbance. Most affected children have brain malformations (callosal anomaly) and hyperkinetic movement disorders with polymorphic stereotypes and jerky movements. Case 1: An 18 months old girl was referred to genetics clinic with seizures, development delay and stereotypic movements in hands. She was only child of a non-consanguineous parents and she had delay on neuromotor development since birth. After 14 years follow up, she was speechless with only sounds, unable to walk and hyperkinetic movements. In whole exome sequencing heterozygous FOXG1 mutation (c.835_836delA;p.278Thr_279S erFs) expressed which was described before. Case 2: An 8 years old girl was referred to our clinic for intellectual disability, myoclonic seizures, microcephaly, development delay and stereotypes. She was third child of consanguineous parents. One of her sister with development delay was exitus at age of 2 with an unknown reason. Her inherited metabolic screening and cranial MRI was normal. In whole exome sequencing a new heterozygous FOXG1 mutation (c.147C>A) expressed which was not described in databases before. FOXG1 syndrome was previously described as congenital variant of Rett syndrome, however Rett syndrome involves period of normal early development which does not occur in FOXG1 syndrome. Also FOXG1 mutation affects both males and females. Children with severe ID, microcephaly, seizure and speech problems from birth should be suspected of FOXG1 syndrome.
Juan D Martina, MD Physiatrist, is currently senior consultant at Rehabilitation Centre Curacao, Dutch Caribbean. Until the 1st of October 2015 he was the chairman of the rehabilitation department and director of the P&RM Residency program at Medisch Spectrum Twente Hospital and vice-chairman of the Medical Staff of Roessingh Rehabilitation Centre in Enschede, The Netherlands. Dr. Juan Martina was the president of the the Dutch Society of Physical and Rehabilitation Medicine (VRA) fom March 2009 until November 2014 and was vice-chairman of the National Innovation Steering Committee of the association of rehabilitation hospitals (RN) until 2015. Since 2014 Juan Martina also chaired the National Working Groep for the development of Clinical Guidelines for Spasticity Treatment, that was be published in 2017. His areas of interest are healthcare management, traumatic brain injury, spasticity and medical technology. With his experience in these fields Dr. Martina has contributed in numerous occasions as an invited lecturer to different scientific conferences worldwide.
Long term, secondary medical complications play an important role in the chronic care for individuals with spinal cord injury (SCI). In a study published by Mc. Kinley et al almost two decades ago in Archives of Physical Medicine and Rehabilitation, pressure ulcers, autonomic dysreflexia (AD), and pneumonia/atelectasis were the most common long-term secondary medical complications found at annual follow-ups. Risk factors included complete injury, tetraplegia, older age, concomitant illness, and violent injury. Autonomic dysreflexia is a well-known clinical emergency in subjects who have had an SCI and it can be life threatening. It especially occurs in patients with an injury at level T6 or above. An episode of AD is characterized by the acute elevation of arterial blood pressure and bradycardia, although tachycardia also may occur. Objectively, an increase in systolic blood pressure greater than 20 to 30mmHg is considered a dysreflexia episode. The most important clinical signs and symptoms of AD include: 1. feeling of anxiety. 2. severe headache. 3. profuse sweating above the level of injury. 4. flushing and piloerection (body hair “stands on end”) above the injury. 5. dry and pale skin caused by vasoconstriction below the level of injury. 6. blurred vision. 7. nasal congestion. 8. bradycardia, cardiac arrhythmias, atrial fibrillation. Most common triggers of AD are from stimuli such as a full bowel and/or bladder, or sexual arousal. Untreated episodes of AD may have serious consequences, including intracranial hemorrhage, retinal detachment, seizures, and death. It has been observed that the higher the injury level, the greater the degree of clinically manifest cardiovascular dysfunction. Another important factor relating to the severity of AD is the completeness of the spinal injury; only 27% of patients with incomplete tetraplegia present with signs of AD, in comparison with 91% of patients with tetraplegia with complete lesions. While AD occurs more often in the chronic stage of SCI at or above the sixth thoracic segment, there also is clinical evidence of episodes of AD in the first days and weeks after injury. The identification and elimination of specific triggers for AD (eg, distended bladder) are considered the first line of treatment based on physiologic rationale and expert consensus, but there are virtually no controlled trials that evaluate these effects. When nonpharmacologic actions are ineffective in an acute episode, pharmacologic agents are required, and nifedipine, nitrates, and captopril are the most commonly used and recommended agents. However, only nifedipine is supported by controlled trials (level 2). More research is needed to establish the most appropriate therapeutic options.
Ben-Gurion University of the Negev, Israel
Title: Neuroprotective effects of telomerase increasing compounds in ex vivo and in vivo animal models of Alzheimer disease
Time : 15:20-15:40
Esther Priel obtained her DSc in the field of DNA repair from the Technion Institute in Haifa (Israel). She joined the Faculty of Health Sciences at the Ben Gurion University of the Negev in Beer Sheva Israel (1981) and is currently a Full Professor of Molecular Biology; served as the Director of the School of Medical Laboratory Sciences for 9 years at the same university. From 1981 till present she is the Head of the Nucleic Acid Topology Lab. She was a Visiting Scientist at the National Cancer Institute of the National Institute of Health (USA).
The telomerase reverse transcriptase protein, TERT, in addition to its role in telomere extension and maintenance, possesses non-canonical functions such as: gene transcription regulation and protection of the mitochondria from oxidative stress. TERT is expressed in the adult brain and its exogenic expression protects neurons from oxidative stress and from the cytotoxicity of amyloid beta (Aβ). Therefore we suggest that increasing the expression of TERT in neurons by pharmaceutical compounds may protect them from the Aβ-induced neurotoxic effects. We used a primary hippocampal cells culture treated with aggregated Aβ as an ex vivo model for Alzheimer`s Disease (AD) and examined the effect of telomerase increasing compounds (AGS) on the Aβ neurotoxicity and the expression of various neuronal plasticity genes in vitro and in vivo in mouse hippocampus. AGS treatment transiently increased TERT expression in hippocampal primary cell cultures in the presence or absence of Aβ and protected neurons from the Aβ induced neuronal degradation. Following AGS treatment, both in vitro and in vivo, we observed a significant increase in the expression of growth associated protein 43, and feminizing locus on X-3 genes (NeuN), in the presence or absence of Aβ, and synaptophysin in the presence of Aβ. Neurotrophic factors (NGF, BDNF) expressions were also increased in AGS treated mice and the Wnt signaling pathway was activated. This data suggest that increasing TERT by pharmaceutical compounds partially exerts its neuroprotective effect by enhancing the expression of neurotrophic factors and neuronal plasticity genes in a mechanism that involved Wnt signaling activation.
Università degli Studi della Campania “Luigi Vanvitelli”, Italy
Title: Cyclic Alternating Pattern (CAP) analysis in children affected by migraine without aura: a preliminary study
Time : 16:00-16:20
Marco Carotenuto completed his Degree in Medicine and Surgery in 2000 and Specialist degree in Child and Adolescent Neuropsychiatry in 2005. In 2008. He completed his Doctorate in Behavioural and Learning Disorders Sciences from 2008 to 2011. Presently, he is Associate Professor and the Chief of the Unit of Child and Adolescent Neuropsychiatry at Università degli Studi della Campania Luigi Vanvitelli. Areas of clinical research are child neurology, pediatric sleep disorders, polysomnography, pediatric primary headaches, and pediatric rehabilitation.
Introduction: Children with migraine headaches appear to have a range of sleep disturbances. The aim of the present study is to assess the NREM sleep instability in a population of school-aged individuals affected by migraine without aura MoA.
Materials and Methods: 33 children with MoA (20 males, 13 females, mean age 10.45 years, SD 2.06) underwent overnight PSG recordings and the Cyclic alternating pattern (CAP) was performed, according with international criteria.
Results: MoA group shows significant reduction in sleep duration parameters (TIB, SPT, TST; p≤0.001 for all) and a significant increase in awakenings per hours (AWK/h) (p=0.008) About the NREM sleep instability analysis findings, the MoA children show a reducted CAP rate% (p≤0.001), CAP rate% in S1 (p≤0.001) and in CAP rate% in SWS (p=0.004). Moreover, the A phases distribution were characterized by significant reduction in slow wave components (Total number CAP A1%, CAP A1 index) (p≤0.001) and an increasing in fast components (Total number of CAP A2% and CAP A3%) representation. MoA children show also an increased A1 and A2 mean duration (p≤0.001)
Conclusion: Poor sleep quality and NREM sleep instability are associated with MoA in children.
King Faisal Specialist Hospital & Research Center, KSA
Time : 16:20-16:40
Amal Abdullah Mokeem is a Consultant Clinical Neurophysiologist at King Faisal Specialist Hospital and Research Centre, Saudi Arabia. She has been in the Arab Board – Dec 2003 and Saudi Board – Feb 2004. She has done Pediatric Neurology Fellowship at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia during 2004-2006, at British Columbia’s Children’s Hospital, Canada during 2006-2007, Clinical Neurophysiology EEG Fellowship at British Columbia’s Children’s Hospital, Canada during 2007-2008, Clinical Neurophysiology Intraoperative Neurophysiology Monitoring (IOM) Fellowship at Vancouver General Hospital, Canada (2008-2009) and Neurophysiology and Deep Brain Stimulation Fellowship at Lahey Clinic/Tufts University, USA (2009-2010). She is having 2 Publications and gave more than 10 International Presentations.
The full potential of intra operative micro electrode recording is realized during the performance of so called functional neuro surgical procedures. During these interventions, therapeutic-lesions or stimulating electrode are stereotactically placed within deep brain structures to treat movement disorders such as PD, ET, dystonia, affective disorders, and chronic neuropathic pain. Intra-operative neurophysiology during these cases don’t monitor surgical activity, it guides it. Inter-operative recording and stimulation techniques have been developed to aid target localization. Micro-electrode recording (MER) is a neurophysiological technique that detect and amplifies the activity of individual single neural units. The Food and Drug Administration (FDA) approved deep brain stimulation (DBS) as a treatment for Parkinson’s disease in 2002. DBS does not cure PD, but it can help manage some of its symptoms and subsequently improve the patient’s quality of life. At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications, or whose medications have severe side effects. STN Anatomical Targeting by MER(Videos). Stimulation side effects during the operative procedures are important to evaluate the target. Safety of DBS greatly depends on the quality of the instruments. The method of stereotactic planning depends on the experience of the surgical and neurophysiology team. Complication of DBS can occur during placement of the electrode, infection or reaction to the electrode, and breakage of the device.
- Video Presentation
Location: Sylt 1
Elaine Wyllie, Professor, Cleveland Clinic Lerner College of Medicine, is a world renowned thought leader and epilepsy specialist who provides cutting-edge treatment for children from around the world. She is an Editor of Wyllie's Treatment of Epilepsy, now in its 6th edition, and author of The Cleveland Clinic Guide to Epilepsy, an authoritative book for the lay public. She has published over 250 scientific reports, and writes a blog on epilepsy for US News Health Care. She lectures worldwide, and her many honors include the prestigious American Epilepsy Society Research Award and Cleveland Clinic’s Master Clinician Award.
New research in pediatric epilepsy surgery is providing opportunities to help more children than ever before. Some of our most exciting results have been in children with early focal brain lesions and diffuse EEG abnormalities. The diffuse findings on EEG reflect the evolution of the epilepsy as the early focal lesion, usually cerebral infarction or malformation of cortical development interacts with the brain at different stages of development. Infants with focal lesions tend to manifest with hypsarrhythmia, and the older children tend to manifest with slow spike wave complexes and other patterns, but in both age groups the epilepsy typically disappears when the lesion is removed. Wyllie and colleagues studied 209 children with an early focal lesion who underwent epilepsy surgery, and found no significant difference in seizure outcome based on presence or abundance of generalized epileptiform discharges and EEG seizures. A second exciting new opportunity for pediatric epilepsy surgery has emerged for children with bilateral abnormalities on brain MRI. Hallbook and colleagues reviewed preoperative MRIs in 110 children who underwent hemispherectomy at Cleveland Clinic, and found abnormalities on the contralateral side in 74%. In a follow up study of 170 children who underwent hemispherectomy, Moosa and colleagues found that contralateral MRI findings had no significant impact on the frequency of seizure-free outcome among Cleveland Clinic’s highly selected cases. The contralateral MRI abnormalities in these children, although not insignificant, were always less extensive and less prominent than those on the side of hemispherectomy. Research suggests that for patients of all ages, shorter epilepsy duration may positively affect postoperative seizure outcome. By recognizing surgical opportunity and shortening the delay, we can help more children than ever before.