Day 2 :
Paracelsus Medical University Salzburg, Austria
Time : 10:00-10:40
Stefan Golaszewski was born 1964 in Vienna where he studied Technical Physics and Medicine. From 1995 to 2001 he worked as Neurologist at the University Innsbruck where he focused on clinical applications of functional Magnetic Resonance Imaging (fMRI). From 2001 to 2002 he worked at the Medical University Graz. Since 2005 he works as associate Professor at the Department of Neurology at the Paracelsus Medical University (PMU) Salzburg in Austria and focuses on the investigation of cortical reorganization after stroke. Since 2010 he is medical head of the Neuroscience Institute of the PMU. He published 120 papers in international peer-reviewed journals.
Restoring sensorimotor, neuropsychological or cognitive functions after a stroke is usually unsatisfactory. At the same time increases the stroke frequency, and the number of those who survive such an event and therefore have high hopes for the rehabilitation treatment increases considerably in recent years. The talk provides an overview of new approaches in stroke rehabilitation that are currently in the experimental stage or at the edge of daily clinical neurorehabilitation including also pharmacologic agents for neuroenhancement.\\r\\nFirstly, the lecture gives a comprehensive overview about the methods of peripheral electrical stimulation for enhancing corticospinal excitability in stroke patients to improve sensorimotor function of the upper and the lower extremity. Different levels of stimulation and different stimulation protocols in combination with motor training are discussed. A special method for peripheral electrical stimulation with a mesh glove is presented. Results of single and paired-pulse transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) are presented to follow corticospinal excitability changes and to assess cortical brain reorganization changes after a treatment period with the mesh glove. Effects of mesh glove stimulation are compared to a control group receiving sham stimulation. A program with mesh glove stimulation to raise sensorimotor cortical excitability in the lesioned cortex applied before a physiotherapeutic training to raise effectiveness of a subsequent motor training is presented. In addition, peripheral vibration for enhancing corticospinal excitability and its neuromodulatory potential in stroke patients will be discussed.\\r\\nThe talk will further concern methods for central sensorimotor, neuropsychological and cognitive stimulation by transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) for inhibition and facilitation of lesioned and unlesioned brain structures for promoting cortical reorganisation after stroke.\\r\\nAnother topic of the talk will be functional electrical stimulation (FES)-assisted active cycling in comparison with active cycling without FES concerning walking and balance in stroke patients. The results of a randomized controlled trail that was recently published in the Archives of Physical Medicine and Rehabilitation will be summarized and potential applications of FES in stroke rehabilitation will be discussed.\\r\\nFinally, the talk will deal with targets of a neuropharmacologic enhancement of sensorimotor, neuropsychological and cognitive functions in stroke patients to promote recovery and will present pharmacologic agents that hold promise for a future application in daily neurorehabilitation and will discuss its side effects and potential risks.\\r\\n
Lund University, Sweden
Time : 10:40-11:10
Saema Ansar has completed her PhD at Lund University, Sweden in 2007. After her two post-doctoral trainings at Department of Neurology at Heidelberg University,\\r\\nGermany and at Glostrup Research Institute, Copenhagen University, Denmark, she has been working as senior researcher at Department of Clinical Science of Lund\\r\\nUniversity. She has well-recognized expertise in the fi eld of stroke, vascular research, pharmacology, drug delivery and advanced imaging technology such as MRI. She\\r\\nhas supervised more than 15 graduate and undergraduate students and has published more than 20 papers in reputed journals.
Substantial eff orts have been made over the last three decades to understand the biochemical mechanisms involved in\\r\\nischemic brain damage and to develop potential remedies to protect the brain aft er stroke. However, although more than\\r\\n1,000 experimental neuroprotective agents and procedures have been tried, they have all failed in major clinical trials. Th us, it\\r\\nis necessary to reconsider the premises upon which these failed treatments were developed and fi nd novel ways to understand\\r\\nand treat acute cerebral ischemia. Stroke is primarily a vascular disease, with devastating consequences for brain tissue/neurons.\\r\\nHowever, the primary focus for much of stroke research has hitherto been on the protection of neurons. Our research group has\\r\\ntaken a diff erent approach: we have focused instead on the cerebral vasculature and the changes that occur in this tissue in the days\\r\\nfollowing a stroke. Th is work is driven by the basic consideration that without properly regulated blood circulation in the brain,\\r\\nany attempt at neuroprotection will have a low chance of success. Our research group is the fi rst to discover the inherent capability\\r\\nof cerebral vessels to increase the expression and function of vasoconstrictor receptors in the smooth muscle cells as a response to\\r\\ncerebral ischemia. We recently discovered that inhibition of the MEK signaling pathway in the cerebral vasculature improves acute\\r\\noutcome in all types of experimental stroke. Th ese exciting initial fi ndings are propelling our current research program.
- Imaging and Diognosis and Acute Stroke Management
University of Leeds, UK
Time : 11:30-12:00
Dr Sikha Saha is a Biomedical Scientist with a background in Physiology and Biochemistry. Her research interests include drug delivery, metabolic profiling and toxicity testing using a novel 3D in vitro BBB model and preclinical testing of novel drugs and diagnostic devices using in vivo models of stroke and neurodegenerative diseases. Her work has led to more than 80 publications in peer review journals and international conferences. She is a lead inventor of a biomaker patent and a co-inventor of a patent with the formation of a spin-off company.
Stroke remains the world’s leading cause of death and disability for which no early diagnosis or effective therapies are available. The increasing prevalence of ischemic stroke and related health risks, combined with the lack of early diagnosis and effective therapies, highlight the desperate need for continued preclinical research to understand the pathological mechanisms of this devastating disease which may enable the development of novel therapeutic targets. However, stroke induced early events and pathological mechanisms remain poorly understood. This is primarily due to lack of clinically relevant models that are highly reproducible as the pathophysiology of cerebral ischemia in animal models is modulated by numerous indirect or secondary factors including the species, type of blood vessels occluded, occlusion period and reperfusion time. We have now optimised murine models of stroke and examined neuronal degeneration and neurochemical changes in these models. These models show consistent pathological and neurochemical changes. In collaboration with the engineering team at the Leeds University, we have also developed bio photonic technologies using lasers with skin safe wavelengths for detection of biomarkers in stroke.
Alexandria University, Egypt
Title: Evaluation of the role of ischemia modifi ed albumin as a new biochemical marker for differentiation between ischemic and hemorrhagic stroke
Time : 12:00-12:30
Nany Hassan Abu Al-Makarim is Lecturer of Internal Medicine, Geriatrics Department at Alexandria University, Egypt. She has done her MS in Rheumatology and MD in Geriatrics.
Objective: To evaluate the role of the detection of ischemia modifi ed albumin (IMA) level in the diff erentiation between ischemic and hemorrhagic cerebrovascular stroke. Materials & Methods: Sixty elderly persons classifi ed into three groups, 25 patients diagnosed with cerebral infarction, 15 patients diagnosed with cerebral hemorrhage and 20 elderly healthy persons with matched age as control were enrolled in the study. IMA was measured using the available chemical method and computerized tomography (CT) was done for diagnosis of brain lesions. Results: IMA was signifi cantly higher in patient group than control group. Th ere was positive signifi cant correlation between age, albumin with IMA, (P=0.000 and 0.037 respectively). However there was no statistical signifi cant diff erence between sex and diagnosis cross tabulation (0.51). It was found that, IMA was statistically higher in infarction group than hemorrhage group (P=0.000) and IMD index was statistically higher in infarction group than hemorrhage group (P=0.013). Our investigation in elderly patients suggests that IMA assay is a sensitive marker for early detection ischemic and hemorrhagic stroke.
Paracelsus Medical University Salzburg, Austria
Title: Functional improvement in stroke patients in the subacute stage after treatment with whole-hand electrical stimulation
Time : 12:30-13:00
Stefan Golaszewski worked as a Neurologist at the University Innsbruck from 1995 to 2001, where he focused on clinical applications for functional Magnetic Resonance Imaging. From 2001 to 2002, he has worked at the Medical University. He has worked as Associate Professor at the Department of Neurology at the Paracelsus Medical University (PMU) Salzburg in Austria since 2005 and focuses on the investigation of cortical reorganization after stroke. Since 2010, he is Medical Head of the Neuroscience Institute of the PMU. He has published 120 papers in international peer-reviewed journals.
Introduction: Th e present study examines the eff ect of whole-hand electrical stimulation on motor recovery in stroke patients at the subacute stage. Peripheral electrical stimulation has been proved to modulate cortical plasticity in healthy and in patients. Such neuromodulatory eff ects have been also found aft er application of electrical hand mesh-glove stimulation (MGS) in our previous studies on healthy subjects. Materials & Methods: Patients with cortico-subcortical ischemic stroke and predominantly motor hemiparesis of the upper extremity were recruited for the study. MGS was applied on the paretic hand daily for 60 min before the standard rehabilitation training over three weeks. Th e hand motor and sensory functions were evaluated with Wolf Motor Function Test, Fugl-Meyer Assessment score, Nine Hole Peg Test and Semmes-Weinstein monofi laments. Single and paired-pulse transcranial magnetic stimulation (TMS) was applied to follow the corticospinal excitability changes over the treatment period. Further, functional magnetic resonance imaging (fMRI) was conducted to assess the cortical brain reorganization changes aft er the treatment. Eff ects of MGS were compared to control group receiving sham stimulation. Results: Patients form both groups showed signifi cant functional improvement as assessed with the motor functional tests. However the improvement degree for the MGS group was increased compared to the control group. Th ese functional eff ects correlated with neuroplastic changes within the sensorimotor area as revealed by TMS and fMRI. Discussion: Electrical stimulation applied before a physiotherapeutic training raise the motor cortical excitability in the lessoned cortex so that the subsequent training becomes more eff ective. Th e obtained results provide better understanding how modulation of central motor controlling structures by somatosensory stimulation correlates with the functional motor recovery.
Neuro Center, India
Title: The 10,000 fold effect of retrograde neurotransmission, a new concept for stroke revival: Use of intracarotid sodium nitroprusside
Time : 14:00-14:30
Background: rTPA showed level-1 benefi t in AIS. Intracarotid-sodium-nitroprusside (ICSNP)studied here for widetreatment- window and fast-recovery. 1. Retrograde-Neurotransmission-RNT (acute); Normal-impulse: At synaptic-level, glutamate-activates NMDA-receptors having nitric-oxide-synthetase (NOS) on post synaptic-neuron, for further propagation by calcium-calmodulin complex. Nitric-oxide (NO-produced-by-NOS) travels-backward across chemical-synapse (CS), binds NO-receptor/sGC of presynaptic-neuron, regulating anterograde-neurotransmission (ANT). Heme (ligand-binding-site) exhibits >10,000-fold higher affi nity for NO than for oxygen (10,000-fold-eff ect). Stroke: Normal synaptic-activity, ANT and RNT are absent. NO-donor (SNP) releases NO from NOS. NO travels backward across CS to bind heme of NO-receptor/sGC, generates Electrical-Impulse as in normal-ANT. Vasospasm (acute): Juxtrapenumbra- perforators show vasospastic activity. NO vasodilates the perforators via the NO-cAMP-pathway. Long-Term Potentiation (LTP) chronic: Via NO–cGMP-pathway. Aims/Study design: To treat acute-stroke by RNT/vasodilatation and chronic-stroke by LTP. Case control prospective study. Materials & Methods: 200-patients (100-control and 100 patients ICSNP group). Mean time for superfusion was 9.5 days poststroke. Status was monitored by NIHSS, MRI and TCD. Results: Aft er 90-seconds in ICSNP group, mean change in NIHSS score decreased by 1.44-points/6.55%; aft er 2 hour, decreased by 1.16-points; aft er 24 hour, increased by 0.66-points/2.25%, compared to control-group increase of 0.7 points or 3.53%; at 7 days, 8.61-point decrease, 44.58%, compared to the control-group increase of 2.55 points or 22.37%; at 2 months 6.94-points decrease, 62.80%, compared to the control-group decrease of 2.77 points or 8.78%. Conclusions: ICSNP is a swift -acting drug in the treatment of stroke, acting within 90 seconds on 9.5 post-stroke days with a small decrease aft er 24 hours then to normal in due course.
Neuro Gen Brain & Spine Institute, India
Time : 14:30-15:00
Alok Sharma is a Neurosurgeon and presently Professor & Head of Department of Neurosurgery at the LTMG Hospital & LTM Medical College, Director of the NeuroGen Brain & Spine Institute and Consultant Neurosurgeon at the Fortis Hospital in Mumbai , India. He has authored 12 books, edited 2 books, contributed chapters to 8 other books and has 83 scientifi c publications in medical journals. He has made 146 scientifi c presentations all over the world & has conducted several national and international trials and has been conferred with numerous honors and awards in his distinguished career. He has organized many international and national conferences and regularly conducts handson training workshops on Microvascular Surgery, Neuroendoscopy and Spinal fi xations. He has been committed to both basic as well as clinical research in attempting to fi nd an answer to the problems of paralysis and neurological defi cits that occur following injury and diseases of the nervous system. Is the pioneer of Stem cell therapy in India and has setup the Stem cell and Genetic research laboratory at the LTMG hospital & LTM Medical College. He has also created the NeuroGen Brain and Spine institute which is India’s fi rst dedicated Stem Cell Therapy and Neurorehabilitation Hospital. He has published pathbreaking results of Stem Cell therapy in Pediatric Neurodevelopmental disorders such as Autism and Cerebral palsy as well as in other conditions such as Muscular dystrophy and Spinal cord injury. He is the founder of the “Indian Journal of Stem Cell Therapy” and on the editorial board of 4 other journals. He is the Founding President of the “Stem Cell Society of India” and the Vice President of the “International Association of Neurorestoratology”. His other special interests include Revascularization surgery for cerebral ischemia, Psychosurgery, Stereotactic surgery, Neuroendoscopy, Spinal surgery and Neurotrauma.
Cellular therapy is being widely explored in the management of stroke and has demonstrated great potential. It has shown to help the repair of the central nervous system by promoting angiogenesis, neurogenesis, and reduction of glial scar formation. In this study, we have analyzed the eff ect of intrathecal administration of autologous bone marrow mononuclear cells (BMMNCs) on 24 patients diagnosed with chronic stroke. Th ese patients were also advised a personalized multidisciplinary neurorehabilitation program. Th ese patients were followed up for minimum of 6 months to maximum of 4.5 years.Th ey were assessed on functional independence measure (FIM) objectively, along with assessment of standing and walking balance, ambulation, and hand functions. On comparison of the PET CT scans performed before and aft er the therapy, Increased FDG uptake was recorded in 3 patients. Out of 24 patients, 12 improved in ambulation, 10 in hand functions, 6 in standing balance, and 9 in walking balance. It was found that, patients of the younger groups showed higher percentage of improvement in all the areas. Also, patients who underwent cell therapy within 2 years aft er the stroke showed better changes as compared to the other group. We also found that ischemic type of stroke had better recovery than the hemorrhagic stroke. Th ere were no major adverse events recorded on follow up. Th is study demonstrates the potential of intrathecal autologous cell therapy in improving the prognosis of functional recovery in chronic stroke.