Day 3 :
Keynote Forum
Salvatore Polizzi
Medicina Occupazionale e Ambientale, Italy
Keynote: Neurotoxic Effects of Aluminium and Alzheimer’s Disease: Single Photon Emission Computed Tomography (SPECT) imaging among retired foundry workers with mild cognitive impairment (MCI)
Biography:
Salvatore Polizzi has completed his School of Medicine in 1981, at the age of 24 years, from Turin University School of Medicine. He completed his Occupational Medicine residency program from Turin University School of Medicine in 1988. He is the director Occupational and Environmental Medicine since 1984 and of Oncological Screening Program since 2000. He has published more than 60 papers in reputed journals both national and international.
Abstract:
Introduction: Aluminium is a well known neurotoxic metal and in a previous study (Neurotoxicology 2002; 23:761-774) we found a probable relationship between inhalation of aluminium dusts and MCI. The present study examined SPECT in a small subgroup that accepted to perform the test.
Methods :In a cross sectional study we enrolled 29 subjects: 20 professionally exposed to Aluminium, 9 control without any known occupational exposure to the toxic metal.
We determined SPECT imaging, serum levels of Aluminium (Al-s) and Iron, blood levels of Manganese and different neurocognitive tests: Mini Mental State Examination score (MMSE-score), the time to execute the test (MMSE-Time), Clock Drawing test (CDT) and auditory event related evoked potential ERP-P300 (P300).
Results - Al-s levels in the controls were lower than 10 µg/L. (8,6 ± 1,5 µg/L) and none showed SPECT hypoperfusion.
In foundry workers, Al-s levels were significantly higher (p < 0,02) (12,9 ± 1,5 µg/L) and SPECT imaging was normal in two subjects (10%), while 18 (90%) showed some degree of cerebral hypoperfusion: 14 (70%) revealed hypoperfusion in the temporo mesial hippocampus, para hippocampal region, and frontal cortex and 4 (20%) showed hypoperfusion in the cerebral cortex.
Conclusions: Even if the small size of the studied population imposes prudence in the interpretation of the results, SPECT hypoperfusion seems to be compatible with aluminium exposure; this could be controlled implementing lifestyle/diet (physical activity, curcuma, silica enriched water) to slow the brain ageing, to reduce body burden and to chelate the metal.
Keynote Forum
David Rowell
Queensland Brain Institute, Australia
Keynote: An economic evaluation of deep brain stimulation for patients with Tourette’s syndrome: An initial exploration
Biography:
David Rowell is Post-doctoral Research Fellow in Asia-Pacific Centre for Neuro-modulation at Queensland Brain Institute. He has published more than 20 papers in reputed journals.
Abstract:
Background: Tourette’s syndrome (TS) is a neuropsychiatric movement disorder. Symptoms of severe TS include involuntary tics, vocalizations and coprolalia, which can progress to affect adversely health related quality of life. Co-morbidities include attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and affective disorders. Typically, treatment may involve pharmacotherapy and supportive counseling. For a small number of patients, deep brain stimulation (DBS) is now being used to treat intractable TS. The clinical outcomes have generally been positive. To date, no economic evaluation of treating TS with DBS has been published. A well-designed economic evaluation has become a pivotal ingredient to ensure that the necessary resources are directed towards the healthcare services, which offer the best patient outcomes. The aim of this research is to present an initial exploration of an economic evaluation of DBS to treat severe TS.
Methods: We conduct a cost utility analysis (CUA), which compares the direct medical costs reported as $US and outcomes reported as quality-adjusted life years (QALYs) of DBS with best medical treatment (BMT). Our sample consists of 17 patients who received DBS for severe TS at St Andrews War Memorial Hospital, Brisbane, Australia from September 2008 to February 2012. Clinical indices for (i) tic severity (Yale Global Tic Severity Score) and (ii) depression (Hamilton Depression rating Scale) and (iii) age were collected pre and post DBS. These clinical data were converted QALYs using standardized coefficients derived from a multivariate regression published by Müller-Vahl et al (2010) for a sample 200 German outpatients (R 2 = 54%). The direct costs for DBS included hardware, surgical implantation, inpatient stay, neuro-stimulator programming and adverse events. For BMT direct costs included estimates for rehabilitation, inpatient stay, outpatient treatment, pharmaceuticals and ancillary treatments. All costs were reported in $US2016. TreeAge® software was used to estimate an Incremental Cost Effectiveness Ratio (ICER) using a Markov model, with a 10-year time horizon and 3.5% discount rate.
Results: The direct costs of DBS and BMT were estimated to be $USD 124,400 and $USD 34,180, respectively. DBS was estimated to increase health utility. The ICER was estimated to be lower than the $USD 50,000 per QALY threshold used by the Federal Drug Administration (FDA).
Conclusions: Our initial exploration suggests DBS is a cost-effective treatment for patients with severe TS. However, our economic evaluation contains several limitations. Firstly, indirect costs were not included. Secondly, health utilities pre and post DBS were imputed from clinical data rather than measured directly. Thirdly, long-term costs and benefits are uncertain; an average age of 28 years at implant implies a further 50 years of life post DBS. The ICER was sensitive to estimates of adverse events. Finally, our results were derived from a small sample. Future research will administer a survey of healthcare costs and QALYs to an international database of TS patients treated with DBS maintained by the University of Florida, with the aim of developing a more robust economic evaluation.
- Neurophysiology & Neuropsychiatry
Session Introduction
Galina Mindlin
Director at Brain Music Treatment Center, USA
Title: This uncontrolled pilot study assessed short-term effectiveness and acceptability of “brain music therapy†(BMT), a self-guided neurofeedback intervention for anxious insomniacs.
Biography:
Galina Mindlin is an Assistant clinical professor of psychiatry at Icahn School of Medicine, Mount Sinai Health System and Clinical/Executive Director at Brain Music Treatment Center in New York City. She is board certified in Psychiatry/Neurology and holds a PhD in Neuroscience. Dr. Mindlin co-authored the book Your Playlist Can Change Your Life (Sourcebooks, 2012). She provides direct clinical care for diverse patient population, including patients suffering from addiction, personality, mood, anxiety disorders and supervises clinical teams, residents, psychology interns, medical students. She is trained in psychodynamic psychotherapy at Columbia University, completed her training in DBT and is thought mindfulness by Thich Nhat Hanh.
Abstract:
Objective: This uncontrolled pilot study assessed short-term effectiveness and acceptability of “brain music therapy” (BMT), a self-guided neurofeedback intervention for anxious insomniacs. Methods: Following baseline assessment, volunteers (n=15) with clinically significant insomnia and anxiety underwent EEG. Slow and fast wave brain patterns were converted to piano music tacks and transferred to CD’s. Participants were instructed to use their personalized CDs to facilitate sleep and anxiety reduction (relaxing track) or to stimulate focus and alertness (activating track) on a daily basis. Repeated measures of sleep (PIRS), anxiety (STAI), daytime functioning (DFT) and quality of life (QOL) were taken at Weeks 0, 3, and 6. Results: Participants were middle-aged (43.9/11.4), Caucasian (60.0%) females (66.7%) who were college educated (100%) and employed (93.4%). ANOVA showed significant changes on measures of sleep, anxiety, and DFT (i.e., fewer negative effects); no changes were found for DTF (i.e., more positive effects) or for QOL. Intervention acceptance was high, with participants reporting easy use, helpfulness, and willingness to refer friends with similar problems. Conclusions: Results provide preliminary support for BMT as a treatment for anxious insomnia. The intervention is user friendly, while eliminating the need for potentially dangerous hypnotics and repeat visits to psychotherapists.
- Neurology treatment
Session Introduction
William S Baek
Parkside Medical Group, USA
Title: Diagnosis and Management of Neurogenetic Disorders: a Practical Approach
Biography:
William S Baek is a triple board-certified neurologist. Born in NYC, he graduated from Seoul National University College of Medicine in 1999 and completed his Neurology residency at the University of Chicago and a fellowship in Clinical Neurophysiology at UC San Diego in 2006. He completed an NIH postdoctorate research fellowship at the Children’s Hospital of Philadelphia. He has served on UM at Beaver Medical Group, and as the Primary Stroke Center Medical Director, Internal Medical Residency Program Faculty Member, Neurology Clerkship Director, EMR champion, and QI/Peer Review Committee member at Kaiser Fontana Medical Center. He was a member of the Donald M. Palatucci Advocacy Leadership Forum, Class 2014. He also serves on the Clerkship Directors Consortium, Ethics Section of the AAN and is a member of the AANEM. He was the official bilingual moderator for the 2009 AOCCN, IFCN, in Seoul, Korea. He is on the Editorial Board for the Journal of Neurology and Neuroscience and JSM Alzheimer's Disease and Related Dementia. He has over 25 publications, almost all as sole author. He is a certified medical interpreter for Korean and Spanish he has done TV shows in Korean, English and Spanish. He studied German at Harvard University. He also a professional medical translator for Japanese
Abstract:
Since the beginning of the 21st century the field of Neurogenetics has exploded, generating novel concepts, unveiling mechanisms, and creating the basis for innovative molecule-targeted specific therapies for neurological disorders. Establishing a genetic diagnosis for any neurological condition is critical for understanding the natural course of the disease and managing accordingly; it shall no longer be viewed as medically unnecessary. This has created a paradigm shift towards reclassifying diseases based on the molecular features rather than signs and symptoms. Down syndrome, 22q11.2 deletion syndrome, Angelman syndrome, Prader Willi syndrome, Klinefelter syndrome, Turner syndrome, cri-du-chat (5p deletion), phenylketonuria, neurocutaneous disorders, Duchenne’s muscular dystrophy, Friedreich’s ataxia (1/50,000), myotonic dystrophy, Huntington’s disease(1/10,000), and Charcot-Marie-Tooth disease(1/3000) are among the most common hereditary neurological disorders I would like to present several genetically confirmed cases seen in our outpatient clinic, including practical management of these conditions. This consists of a myriad of cases I have personally diagnosed and treated in an omnibus fashion, such as Fragile X syndrome, horizontal gaze palsy with progressive sclerosis(HGPPS), Smith-Magenis syndrome(SMS), Huntington’s disease, spinocerebellar ataxia(SCA), oculopharyngeal muscular dystrophy(OPMD), and fascioscapulohumeral muscular dystrophy(FSHMD) with review of the literature.
Gloria BenÃtez-King
Casa di Cura Sant’Elena Italy
Title: PC-ONE- Primary Cilia is not Developed in Olfactory Neuronal Precursors Obtained from Schizophrenia and Bipolar Disease Patients
Biography:
Gloria Benítez-King is professor in department of Neurology and Clinical Neurophysiology in Casa di Cura Sant’Elena, Italy
Abstract:
CMT is one of the most commonly inherited neuromuscular diseases, with prevalence of approximately 1 in 2,500 persons. Clinical complains are mainly represented by muscle pain, sensation of fatigue and painful muscle cramps. No treatment of clinical symptoms is available yet. Previous treatment with high dosage of vitamin C failed to confirm a benefit in humans. A clinical open trial has been performed in order to evaluate the efficacy of ultramicronized palmitoylethanolamide (PEA-um®). Twenty-two patients (7 male and 15 females) from four different CMT families were treated with PEA-um® at dosage of 1200 mg/day for 80 days (Normast ®, Epitech Group srl, Saccolongo, Italy). None of the patients had an add-on treatment for the clinical symptoms. Muscle pain, fatigue and muscle cramps were assessed at T0 (baseline), T1 (20th day) and T2 (80th day) using Visual Analogic Scale (VAS). Muscle strength, vibratory sensation and Motor/Sensory nerve Conduction velocities were also assessed with the same schedule. Mean values of VAS for muscle pain at T1decreased from 5.9 ± 2.1 to 3.9 ± 1.7 (p<0.0001), whereas VAS for fatigue decreased form 6.3 ± 2.4 to 3.4 ± 1.6 (p <0.0001). VAS score for painful cramps at T1diminished from 5.4 ± 1.2 to 3.8 ± 1.3 (p<0.0001). A further improvement of VAS scores for muscle pain, fatigue and painful cramps was observed at T2 evaluation. These data strongly suggest that PEA-um® is effective in improving clinical symptoms of CMT neuropathy, albeit the obvious limitation of an open study.
Aliaksandr Haretski
The Body Regeneration Center of EAFM, Poland
Title: The Method of Nervous System Regeneration
Biography:
Aliaksandr Haretski is the rector of the European Academy of Folk Medicine, Professor of the department of Neurology of the International University of Science in Hannover, Germany, Doctor of naturopathy /complementary medicine of the Institute for Interdisciplinary Studies in Hannover, Germany. He is the director of the Body Regeneration Center of EAFM, Poland. He published more than 20 articles in reputed journals. He is the author of the book „A PRACTICAL GUIDE TO REJUVENATION AND COMPLETE HEALING OF DISEASES and cancer”.
Abstract:
The Method of Nervous System Regeneration. It is a universal integrated method based on the use of more than 40 our developments know-how. It is able to mobilize human abilities and make the human body restore itself. The unique advantage of the method is the absence of contraindications and adverse side effects. This method helps us not only halt the disease progression but restore lost body functions. Many patients with various chronic incurable and even genetic diseases, such as cancer, Parkinson’s disease, MS, ALS, ICP, fibromyalgia, CFS, all types of myopathy, atrophy and muscle dystrophy, undergo their treatment successfully in our center. The use of this method allow us to have an integrated impact on the whole body at once rather than on its separate damaged parts, cleanse the body of toxins, eliminate the main causes of a disease, boost immunity, provide the body with nutrients to fight against diseases, launch the mechanisms of body regeneration and self-healing in patients with various diseases practically at any age. When stimulating the immune system, the body starts to produce a large number of its own stem cells. Old damaged cells will be completely replaced with new ones in organs in a very short time. Scar tissue cells will be transformed into new healthy cells in damaged organs. As a result all organs will be completely revived again without any surgery. The unique results of treatment achieved by our patients many times are the best proof of the efficiency of this method.