26^th European Neurology Congress August 06-08, 2018 Madrid, Spain

Dimitar Maslarov PhD, DSC is a professor of neurology at the Medical University of Sofia. In the nineties, he was a research fellow at the Brain Research Institute, where he worked on the stress disorders. In 2017, he defended Doctor of Science thesis on "Cerebrovascular Diseases - Current Assessments and Ideas for Improving Public Health". Author of monographs, textbooks on neurology and a manual on nursing care. Have over 200 scientific publications and more than 150 congresses and conferences participations. He is a member of the Scientific Panels of Neurocritical Care and Palliative care at the European Academy of Neurology and Member of the International Scientific Committee of the SSNN. He is on the Management Board of the Bulgarian Society of Neurology and Chairman of the Sofia Branch. Member of the Editorial Board of Bulgarian Neurology and Deputy Director Editor-in-Chief of the Editorial board of the Health and Science Magazine.

Parkinson's disease (PD) is a disease, which encompasses the central nervous system. Symptoms start gradually, sometimes in just one hand. Th is condition usually is the reason for rigidity and tremor. Even though PD is not curable, some medicines could considerably improve the symptoms.

 

Medications: PD patients possess low levels of dopamine in their brains. The idea of medication is to increase or substitute for dopamine.

 

Levodopa-carbidopa: Th e drug that goes through the human brain barrier and turns into dopamine is levodopa which is combined with carbidopa.

 

Levodopa-carbidopa infusions: Patients with advanced PD disorder can still be influenced by Carbidopa-levodopa, however their response is variable. Yet, it's administered through a feeding tube that delivers the medication in a gel form directly to the small intestine. Dopamine agonists imitate the consequences of the dopamine on the brain. They consist pramipexole, rotigotine and

ropinirole. For fast alleviation can be used the Apomorphine, which is a short-acting injectable dopamine agonist. Monoamine oxidase B (MAO-B) Inhibitors contain selegiline, rasagiline and safi namide. Their function is to avoid the failure of the dopamine in the brain via constraining the MAO B enzyme of the brain. Catechol-O-methyl transferase (COMT) inhibitors – entacapone slightly extends the outcome of levodopa treatment through interlocking the enzyme which demolishes dopamine. One more COMT inhibitor is the Tolcapone, which can hardly be given to patients because of a danger of severe liver harm and liver failure.

 

Anticholinergics: Medicines used for decades to assist the tremor related with PD.

 

Amantadine: Amantadine alone provide short-term relief of symptoms of early PD. It could be combined with Carbidopalevodopa treatment throughout the advanced phases of PD to regulate the dyskinesias.

 

Surgical Procedures: In deep brain stimulation (DBS), are implant electrodes into the subthalamic nucleus or the globus pallidus

interna. DBS may steady the medicine variations, to decrease or stop dyskinesias, to diminish tremor and the rigidity. Also, can prevent slowing down patients’ actions. Treatment of PD should be personalized.

 

Avathvadi Venkatesan Srinivasan, driven by his quest for excellence joined Madras Medical College (MMC) and received MD (General Medicine) in 1978. Later he pursued and received DM in Neurology from his alma mater. His thirst for research, skills and the latest development in Neurology made him fi nd his way to the National

Institute of Neurology and Neurosurgery, his pioneering research work on Neuroleptic Malignant Syndrome got him bestowed with the PhD degree in 2002. It made him the first ever recipient in Neurology from the Tamil Nadu Dr. M.G.R. Medical University, since its inception in 1988. His path breaking research (6 papers) in Phantom limbs, Stroke etc., with Padma Bhusan Dr. V S Ramachandran, Director, Center of Brain and Cognition, University of San Diego remain acclamatory to his undisputed authority in Behavioral Neurology and Movement disorders. He authored more than 100 scientifi c papers; dozens of his other work have found places in reputed medical journals and has published 12 chapters. His research papers presented, won acclaims in 60 National conferences and in 25 International conferences held in UK, USA, Japan, Australia, China, Europe and other countries. He is the only one from India to collaborate with Dr V S Ramachandran, who is the first recipient of Padma Bhusan for his contribution to Neurosciences.

Statement of the Study: The research question is whether the understanding of clinical conundrum of neuroleptic malignant syndrome (NMS) would become clearer when schizophrenia and affective disorders are studied separately.

 

Methods: Twenty schizophrenics and thirty aff ected disorder cases who developed NMS were studied between 1990 and 2001 prospectively. Modified criteria of Keck was used for the diagnosis of NMS. Only patients who developed fever, altered sensorium, extrapyramidal and autonomic symptoms are included, standard statistical analysis of the data which included factor analysis,

correlation analysis and discriminate analysis were performed.

 

Summary of Results: Mean age of onset in schizophrenia was 32 years (18-58 yrs.) and in aff ective disorders was 43 years

(15-73 yrs.). NMS developed within nine hours of starting therapy and lasted for a mean duration of 23 days. In the affective disorder group, NMS developed over a period 17 hours and lasted for a mean duration of 11 days. Fever occurred in all the cases and earlier is schizophrenia (11.9 hrs.) compared to aff ective disorders (16.8 hrs.). The altered sensorium occurred within 9.6 hours in schizophrenia and 25.69 hours in aff ective disorder. The  rigidity occurred in 38.8 hours in schizophrenia and 84.9 hours in aff ective disorder. Rigidity followed fever and altered sensorium in both the conditions. Autonomic symptoms occurred within 48 hours in schizophrenia and 107 hours in aff ective disorder. Th e correlation analysis showed signifi cant correlation between NMS onset with fever and altered sensorium. Cluster analysis indicated that autonomic and extrapyramidal symptoms cause for the evolution of NMS. The factor analysis of the parameter responsible for MNS in schizophrenics are extrapyramidal symptoms 0.913, autonomic symptoms 0.858, fever 0.779, altered sensorium 0.497, whereas in aff ective disorders extrapyramidal symptoms 0.931, autonomous symptoms 0.955, fever 0.200, altered sensorium 0.181. Four patients died in schizophrenic group.Our discriminant analysis clearly showed the importance of the parameters with the associated probability of discrimination; autonomic symptoms (0.9), extrapyramidal symptoms (0.7), altered sensorium (0.6) and fever (0.3). Th e misclassifi cation rate in the case of schizophrenia is 15% and aff ective disorder is around 7%. AVS-CUV criterion can be used confi dently in NMS. AVSCUV criterion; clinically defi ne autonomic symptoms and signs, extrapyramidal symptoms, altered sensorium, fever. Clinically probable: autonomic symptoms and signs, extrapyramidal symptoms. Clinically possible: altered sensorium with autonomic symptoms or extrapyramidal symptoms.

 

Conclusion: NMS developed earlier and look a longer time to resolve in schizophrenics compared with aff ective disorders. Mortality occurred only in schizophrenics. New AVS-CUV criteria have been added to the world literature.