2^nd International Conference on Neurological Disorders and Stroke April 28-30, 2016 The Oberoi Dubai, Dubai, UAE

Biography:

Abstract:

Introduction: Intracranial angioplasty and stenting has been used for the treatment of symptomatic intracranial stenosis. However, a recent negative major randomized trial has dampened the enthusiasm for this procedure. We present our local experience with this procedure to assess its safety, efficacy, and outcome. Patients and Methods: This is a retrospective review of all the patients with symptomatic intracranial atherosclerotic disease who underwent endovascular treatment in our tertiary center over the past ten years. Clinical, procedural, and outcome variables were gathered. Results: We identified 22 patients who were referred for stenting of symptomatic intracranial atherosclerotic stenosis. In all but three, the stents were deployed successfully (86% procedural success rate). The procedure was done under conscious sedation in 32%. Excellent flow was restored immediately in all successfully-stented cases. Post procedural strokes occurred in four patients (17.4%). One non-neurological death was identified in a patient who suffered a major post procedural stroke (4.3%). Conclusion: Intracranial atherosclerotic disease is not uncommon in our population. Angioplasty and stenting might be a valid option for the treatment of patients with recurrent symptoms despite optimal medical treatment.

Biography:

Abstract:

Background: In developed countries stroke (Stk) is a major cause of morbidity and mortality, being responsible, in Portugal, for 11.5% of all deaths. HIV infection is regarded as an independent risk factor for ischemic Stk. Methodology: We retrospectively analyzed electronic files from all patients (pts) admitted to the Hospital de Santa Maria with an ischemic Stk diagnosis, from 1993 to 2013. Data was collected using the WHO 9th Revision International Classification of Diseases (ICD-9). A subset of HIV-infected pts (G2 - ICD-9 V08, 042) was extracted from the whole Stk group (G1 - ICD-9 433, 4340), to analyze patient’s characteristics and vascular risk factors encoded in the files (hypertension - HBP, diabetes - DM, dyslipidemia - Dsl). Smoking was excluded because of unreliable information. Additionally, we analyzed data from a cohort of 1,469 sequential HIV-infected patients followed-up at the Hospital HIV Clinic. We evaluated differences between HIV-infected and non-HIV-infected patients. The mean age, the prevalence of HBP, DM and Dsl for Stk pts with and without HIV were compared using t-tests for unpaired samples. Among the HIV-infected clinic cohort we compared the same means and proportions for patients with and without Stk. These results were also confirmed using multivariate logistic regression with age, HBP, DM and Dsl as covariates, controlling the results by gender. Results: From a total of 24,399 Stk pts admitted during the study period, 115 (0.47%) were HIV-infected (G2). A difference of 20 years was found between mean ages of G1 (77.63) and G2 (57.53) pts (p<0.01%). All studied risk factors were consistently inferior in G2. G1/G2: HBP – 0.5/0.28 (p<0.01%); DM – 0.19/0.08 (p<0.01%); Dsl – 0.21/0.11 (p<0.1%). HIV-infected patients from the HIV cohort were divided into "no Stk" (G3=1350 pts) and "with Stk" (G4=119 pts - 8.1%). The prevalence of DM and Dsl was not different between G3 and G4: DM 0.05/0.08 (p=0.25%); Dsl: 0.09/0.13 (p=0.31%). But in G4 mean age (42.4/55.32 - p<0.01%) and the prevalence of HBP (0.09/0.28 - p<0.01%) were significantly higher than in G3. Conclusions: A lower prevalence of hypertension, diabetes and dyslipidemia in the HIV-infected subgroup, along with an inferior mean age, supports the assumption that HIV infection can act as an independent risk factor for stroke. This conclusion appears to be supported as well by data from the HIV clinic cohort as although hypertension and age remain relevant risk factors for stroke in HIV-infected patients, diabetes and dyslipidemia lose strength as risk factors, offering additional support for this hypothesis.

Biography:

Abstract:

Introduction: This study was conducted to review and compare the endovascular therapies for tandem occlusions of anterior cerebral circulation. Methods: Literature review was performed using PubMed. We reviewed studies that described endovascular management for patients with tandem occlusions/stenoses of extracranial and intracranial arteries in the anterior cerebral circulation. Results: 99 patients were included. The median NIHSS (for 97 patients) at the time of admission was 16 (SD ± 5.5). The mean times and ranges from onset of symptoms to recanalization (for 46 patients) and from groin to recanalization (for 54 patients) were 412 minutes (Range: 120-1574) and 83 minutes (Range: 14-180), respectively. The mean outcome mRS (for 97 patients) was 2.39 (SD ± 2.2), and 61.9% of patients had mRS of ≤2 at 90 days. 81.25% of patients who had mRS of ≤2 had groin to recanalization time of less than 90 minutes (p-value: 0.018). Despite that only 7% of patients underwent retrograde approach, 85.7% of them had outcome mRS of ≤2 compared to 60% of patients with anterograde approach (p-value: 0.016). TICI scale was described for 72 patients, 77.8% of them had scale of ≥2b. 95.8% (23 patients) who received intravenous t-PA had TICI scale of ≥2b while 75.7% (25 patients) who did not receive IV t-PA had same TICI scale (p-value: 0.041). 13.9% of patients experienced cerebral hemorrhage. Conclusion: Groin to recanalization time of less than 90 minutes and the retrograde approach were found to be favorable prognostic factors based on mRS. The use of IV t-PA was with higher TICI scales.

Biography:

WK Tang was appointed to professor in the Department of Psychiatry, the Chinese University of Hong Kong in 2011. Professor Tang completed his medical training at the Chinese University of Hong Kong. He joined the Chinese University of Hong Kong as an academic staff since 1999. His main research area is Neuropsychiatry in Stroke. Professor Tang has published over 100 papers in renowned journals, and has also contributed to the peer review of 40 journals. He has secured over 20 major competitive research grants. He has served the editorial boards of five scientific journals. He was also a recipient of the Young Researcher Award in 2007, awarded by the Chinese University of Hong Kong.

Abstract:

Stroke represents a major public health problem in the China and worldwide, but relatively little work has been directed toward identifying and treating the common neuropsychiatric disorders occurring after stroke. I will review the epidemiology, clinical and pathological correlates and treatment of depression after stroke. These disorders have been shown to inhibit physical recovery from stroke and reduced the quality of life. There are very few controlled trials examining the effectiveness of treatments for these disorders after stroke. Both pharmacological and psychological treatments, however, can alleviate symptoms of this disorder.

Biography:

Hari Priya Bandi has completed her MBBS at the age of 24 years from Adelaide University, Australia. She is currently an advanced Neurosurgical trainee of the Royal Australasian College of Surgeons. She is also currently a Master of surgery candidate at Macquarie University.

Abstract:

Aim: Arteriovenous malformations (AVMs) of the brain are a major cause of stroke in children and young adults and there are currently limited treatment modalities. Vascular targeting methods, where the AVM nidus is ‘primed’ to molecularly distinguish it from normal and in particular en passant vessels, that could then be targeted with a thrombotic agent, would be very attractive in the treatment of AVMs. Priming with radiosurgery is useful as irradiated endothelial cells over-express phosphatidylserine (PS). This can then be targeted with an antibody for PS, Annexin, which conjugated with thrombin, could effect occlusion of the AVM nidus. Methods: 30 animals were used, with 3 groups; GKS and conjugate (Annexin and thrombin); conjugate with sham GKS; and finally GKS with placebo. The model AVM was created by anastomosing the left external jugular vein to the common carotid artery in male Sprague-Dawley rats. Radiosurgery was delivered with the GammaKnife at Macquarie University Hospital (‘GammaKnife Surgery’, or ‘GKS’) with a marginal dose of 20 Gy. Results: Thrombosis rates of the AVM vessels assessed histologically were 47% in the GKS and conjugate group, 44% in the group with conjugate alone, and 63% in the GKS alone group. Conclusion: The results show that while the ligand-directed conjugate is selective, there was an unexpected decrease in thrombosis. This project is an important first step in vivo testing of vascular targeting methods for the treatment of AVMs.

Biography:

Ayodele J. Akinyemi has completed his PhD at the age of 31 years from Federal University of Technology, Akure and Lecturing in Afe Babalola University, Ado-Ekiti. He has published more than 25 papers in reputed and well indexed journals.

Abstract:

Ginger and turmeric rhizomes are used in folk medicine for the treatment of several cerebrovascular diseases with limited scientific basis for their action. Hence, in this study, we investigate the effects of two Zingiberaceae varieties (ginger and turmeric) on ectonu- cleotidases (NTPDase and 50-nucleotidase), adenosine deaminase (ADA) and acetylcholin- esterase (AChE) activities in synaptosomes of cerebral cortex from L-NAME induced hypertensive rats. The animals were divided into seven groups (n = 10): normotensive control rats; hypertensive rats; hypertensive rats treated with atenolol; normotensive and hypertensive rats treated with 4% supplementation of turmeric and ginger rhizomes, respectively. After 14 days of pre-treatment with both rhizomes the animals were induced with hypertension by oral administration of L-NAME. The results revealed an increase of ATP and AMP hydrolysis as well as ADA and AChE activities of cerebral cortex synaptosomes in induced rats when compared with the control. The supplementation of both rhizomes prevented these alterations by decreasing ATP and AMP hydrolysis and ADA and AChE activities in cerebral cortex. In conclusion, this study demonstrated that both rhizomes interfere with the purinergic and cholinergic neurotransmission in cerebral cortex of hypertensive rats. Therefore, we can suggest that both rhizomes exert neuroprotective potential under hypertensive state.

Biography:

Albert C. Ludolph, MD, Professor of Neurology and Chairman of the Department of Neurology at the University Hospital and Medical Faculty of Ulm. He is also acting Director of the Academic Neuroscience Centre of the University of Ulm. 1979 –1984 resident at the Department of Neurology and Psychiatry, University of Münster FRG, 1984 – 1985 joined Deutsche Forschungsgemeinschaft: Institute of Neurotoxicology, Albert Einstein College of Medicine. 1985 - 1989 joined the Department of Neurology at the University of Münster. 1990 - 1992 has been visiting Assoc. Professor at the Center for Research on Occupational and Environmental Toxicology, Portland (Oregon). In 1996 became C4 Professor of Neurology and Chair Department of Neurology, University of Ulm. Since 2003 became the Chair of the Academic Neuroscience Center, University of Ulm. 2005 – 2009 became the Deputy Chair of the European ALS-MND-Group. Since 2009 –became Chair of the World Federation of Neurology, ALS Research and Advisory Board of Hoffmann La-Roche,and Knopp Pharma of Drug Development in ALS. In 2015 awarded Erb-Gedenkmünze of the German Society of Neurology (DGN). He is investigator in more than 40 clinical trials with total amount of Publications of 407. He has established and currently leads the ALS-Centre at the University Hospital of Ulm and directs a multidisciplinary team for ALS care, clinical and experimental research.

Abstract:

Jean-Martin Charcot was the first to describe ALS by his revolutionary clinicoanatomical method in the middle of the 19th century. In the late 20th century, on the basis of molecular markers Heiko Braak and colleagues introduced a staging method for neurodegenerative diseases which are now the basis for innovative approaches to their pathogenesis („Braak staging“). Recently, a staging system was also proposed for amyotrophic lateral sclerosis (ALS) which showed that ALS primarily affects the frontal cortex, including the motor cortex, and then sequentially spreads into subcortical structures. This staging concept can be translated into the cinical picture and offers new insights into the disease. First, it shows that ALS is not a disease restricted to motor neurons („motor neuron disease“), but rather affects mutiple systems of the central nervous system („multisystem degeneration“). Secondly, the distribution of pareses is characteristic of the „Wernicke-Mann“ type of central pareses. Thirdly, in a characteristic sequence of events, ocular movements are part of the picture with frontal executive deficits showing up early. They are followed by deficits of the olivocerebellar system. The involvement of frontal structures in ALS has been suspected since the late 19th century; now we know that this has an anatomical basis which is reflected by sequential involvement of frontal lobe function. These deficits are temporally and spatially distinct from the deficits seen in behavioral FTD, suggesting the presence of two entities rather than a spectrum ranging from ALS to FTD. More surprisingly for the clinician, Braaks results show that the hippocampus is involved in late stages. Finally, successfull attempts have been made to translate the post mortem findings into the in vivo situation by using MRI and DTI by measuring the fractional anisotropy of corticoefferent tracts. This new concept of the disease does not have major therapeutical impact yet. It explains why a modifier of glutamate release like riluzole has a moderate influence on the disease; however, it opens avenues for new strategies of therapeutic modification and even prevention of the sporadic disease. It should be mentioned that the genetic subforms of ALS may be more easily therapeutically influenced. Following the example of spinal muscular atrophy (SMA), currently attempts are made to influence transcription of disease genes, such as the superoxide dismutase (SOD).

Biography:

Marco Pagani MD 1985; PhD in Brain Neurophysiology and Nuclear Medicine Methodology, 2000, at Karolinska Institute of Stockholm] is a Senior Researcher at the Institute of Cognitive Sciences and Technologies of the Italian National Research Council (ISTC-CNR) and is Senior Advisor of the European Neuroimaging Committee of EANM. His work focuses on the physiopathology of brain perfusion, metabolism, electrical activity and anatomy, applied to neurodegenerative, neurological and psychiatric disorders. One of the most relevant research lines he has pursued is the implementation of multivariate analysis and the relative identification of brain networking in normal and pathological conditions. He tutored PhD students investigating depression, post-traumatic stress disorder and autism and has published in Peer Reviewed Journals more than 100 full papers (mean IF > 4.36), eight of which focussed on ALS related investigations. He has presented more than 120 communications at international Conferences has given more than 40 Keynotes and Plenary Lectures at International Conferences, has taught at more than 30 CME, Workshops and Courses and has been awarded three International Prizes.

Abstract:

Functional and structural neuroimaging have highlighted in ALS the diffusion of anatomical and functional lesions beyond the classic motor areas. The value of 18F-FDG-PET as biomarker is currently gaining more importance and its possible role in supporting ALS diagnosis has been proposed. 1. Recent studies in large cohorts of ALS patients reported a very high discriminant value of 18F-FDGPET showing a clear pattern of hypometabolism in frontal and occipital cortex and hypermetabolism in midbrain being the latter the neurobiological correlate of diffuse subcortical gliosis. 2. Moreover spatially distinct networks identified ALS with an accuracy of 99%. 3. In a recent investigation we demonstrated a continuum of frontal lobe metabolic impairment reflecting the clinical and anatomic continuum ranging from pure ALS, through ALS with intermediate cognitive deficits, to ALS associated with frontal lobe dementia. 4. The finding that patients with intermediate cognitive impairment display a characteristic metabolic pattern suggests to investigate ALS by functional neuroimaging along with neuropsychological testing to disclose the early metabolic signature of a possible cognitive impairment.

Biography:

Lina Machtoub, MD, PhD University of Tokyo Japan, 2002, Director of Neuronanomed ALS Zentrum - BrünstlMedicine. In 2003, joined Max Planck Institute, Germany, after granting a research award from Alexander von Humboldt foundation. In 2006, became visiting scientist at Harvard Medical University, Boston working on several clinical research projects focusing on the development of clinical multimodal diagnostic approaches based on nanobiotechnology. In 2009, joined Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, where conducted research on developing highly sensitive, diagnostic, and targeted imaging probes with implications of in vivo imagingtargeted contrast contrast agents. Her recent work was focuced on the implication of nanotherapeutics approaches for diagnosis & treatment for neurodegenerative disorders with focus on motor neuron diseases.

Abstract:

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is the most common adult-onset motor neuron disease. It is a rapidly advancing neurodegenerative disorder, characterized by the deterioration of both upper and lower motor neurons, with a mean time of survival from onset of symptoms to death of 2–5 years. The pathophysiology of ALS remains poorly understood. The only FDA approved therapy for ALS is riluzole, a glutamatergic neurotransmission inhibitor, with modest benefits on survival. Many other agents have shown promising results in preclinical trials, but have yet to show benefit in human clinical trials. Given the limited therapeutic treatment options to date, the most important approach to improve the patient's quality of life remains symptom-based management. Recently the interest in nanoneuromedicine has grown rapidly due to the immediate need for improved biomarkers and therapies for degenerative nervous system disorders. The advent of nanomedicines can enhance the delivery of biologically active molecules for targeted therapy and imaging. In addition, nanomedical advances are leading to therapies that target CNS pathobiology and as such, can interrupt disordered protein aggregation, deliver functional neuroprotective proteins and alter the oxidant state of affected neural tissues. The work presents the latest contribution of nanomedicine with some underlying new developments in cell based delivery strategies, which could be a promising approach for the treatment of ALS.

Biography:

Ayman Alboudi MD, Tishreen university. Master in neurology, MRCP UK. Currently specialist neurologist at Rashid hospital in Dubai – UAE. Principle investigator in prospective studies on cognitive impairment in MS patients.

Abstract:

Objectives: ï‚· Highlight the different presentations of MND ï‚· Acknowledge the long survival rate in our cases Three cases has recently been diagnosed with MND and managed with the mean age of 51y. The duration of the disease is 5-19 y. each case has different presentation. 1 female and 2 males. The female presented with progressive weakness started in her 32y old, and it was mainly on the Rt side then progressed gradually to the 4 limbs and respiratory failure, with preservation of the mental and sphincters functions. The second case was a male presented with general tiredness and weakness progressed over 1y until he became on ventilator. Notably he showed no upper motor neuron signs clinically and on EMG there was clear denervation which is consistent with primary muscular atrophy Third case is a male presented in his 44y old with progressive spastic gait which within 2 y developed to Quadra paresis. The patient became on ventilator after 2y of onset and up to this moment he still has his full mental abilities. Conclusion: MND is not studied well in our region, and still the clinical course, pathology and pathogenesis still not well determined. It is possible that we have different genetic mutations and clinical progression than western and other regions, especially that we have increased percentage of consanguineous marriage. In addition, absence of the end of life policy in our country play a major role in keeping those patients

Biography:

Abstract:

Biography:

Robert Dorsett achieved his Master’s Degree in Neurological Rehabilitation from the University of Cardiff, South Wales in 2014. Robert has over 15 years of experience as a Physiotheraapist in stroke rehabilitation in South Africa and the UK. Robert currently works for Amana Healthcare Abu Dhabi treating a wide variety conditions in a post acute and long term setting

Abstract:

Stroke is the third leading cause of mortality and the second major cause of long term disability in the world. The clinical signs and symptoms as a result of stroke may have a major impact on the Quality of Life of the stroke survivor and the wider community. Their ability to participate in community activities are hampered not only as a direct result of the stroke but also due to the amount and quality of support available in the community. One of the major roles for Rehabilitation services is to provide education and information to family members and caregivers so that they can cope and deal with the long term consequences of stroke. Research has indicated that participation, particularly active participation, improves knowledge about stroke and reduces depression and anxiety in the stroke survivor and family members. How patient and family education is conducted is very much dependant on the service provided. It remains a challenge for multi-disciplinary teams to get it right particularly considering the cultural environment one works in.

Biography:

Khalid Anwar trained as a PM&R in UK and worked as a Lead Consultant in Neurorehabilitation at a University Hospital in UK for a number of years before joining Amana Hospital last year. He has worked in NHS in UK for more than twenty years. He was an Executive Committee Member of British Society of Rehabilitation Medicine for three years and sat on the education committee. He has a number of publications to his credit and has contributed to book chapters. His area of special interest includes Traumatic brain injury rehabilitation, neurorehabilitation, spasticity management including botulinum toxin therapy and prosthetic rehabilitation.

Abstract:

Multiple sclerosis is a progressive, complex, heterogeneous neurological disorder associated with long-term disability. While current treatment and drugs aim to reduce multiple sclerosis (MS) exacerbations and slow disease progression, there is a need for comprehensive rehabilitation interventions in order to reduce sequels and symptoms of the disease, improve functional ability and quality of life. An integrated team of healthcare professionals is necessary to address a myriad of problems to reduce impairments, disabilities, and handicaps and to improve participation. Inpatient and outpatient multidisciplinary rehabilitation has been shown to be beneficial in improving disability, participation and quality of life despite progression of the disease. Timing and setting of rehabilitation interventions should be selected individually depending on disease phase, functional deficits, personal requirements, as well as specific goals. The problems may be related to weakness, spasticity, mobility, balance, pain, cognition, mood, relationships, bowel, bladder, sexual function, swallowing, speech, fatigue and activities of daily living (ADL) such as dressing, eating, bathing, and household chores. Good evidence exists for different specific interventions improving physical and cognitive performance. Rehabilitation should be an integral part of the management of this disease and should be available to the patient at all stages of the disease.

Biography:

Ruairá½· has completed his Bachelor of Science (Hons) from Trinity College, University of Dublin, Ireland 9 years ago. He has also completed numerous post graduate courses related to neurological rehabilitation. He is an occupational therapist working full-time with complex neurological cases from all over The UAE. He runs a monthly spasticity and pain management clinic with specialist physicians and other members of the MDT

Abstract:

Spasticity is muscle hyperactivity associated with damage to the central nervous system. The severity of spasticity depends on a number of factors including location, age and size of injury. Harmful effects of spasticity may include pain, reduced function, and deformity. As stated in the literature, spasticity is often misunderstood, sub-optimally treated, and complex. In the rehabilitaion facility, there is a high prevalence of brain injury, including TBIs, CVAs, hypoxia, dementia as well as those related to congenital difficulties. Spasticity is prevalent across the wide spectrum of said injuries. The task was to manage many difficult cases, both adult and paediatric. This was done through a combination of education, advocacy regarding medical and surgical interventions, as well as intensive therapy. A committee of the MDT was formed to assess the management of spasticity across the hospital. A plan of action was drafted, and implemented hospital wide. A comprehensive medical review included detailed assessment of spasticity related medications. For more complex cases, referrals were sent to acute hospitals for specialist input by rehabilitaion consultants, neurologists and interventional pain specialists. A botulinum toxin treatment programme was commenced. New ITB pumps were inserted, with others reviewed. A monthly spasticity and pain management clinic was initiated with a rehabilitaion medicine consultant from our sister facility in Abu Dhabi. Education regarding the importance of MDT cooperation in managing the issue across the 24 hour cycle was provided through workshops and in-services. Standardised assessments were completed prior to, and post interventions. These included the Tardieu Scale, Modified Ashworth Scale, and the FLACC. Data collected after the commencement of our comprehensive and holisitc treatment programmes clearly indicated statistically and clinically significant differences between pre and post intervention.

Biography:

Abstract:

It is estimated that at least 10% of the worlds population lives with a disability (1). People with disabilities are among the most vulnerable and least empowered groups in the world. They often experience limited access to health care, education and livelihood opportunities. Rehabilitation can be defined as the restoration, to the maximum degree possible, of an individuals function and/or role, both mentally and physically within their family and social networks and within the workplace where appropriate. Referral to community therapy can be triggered by either post acute or chronic illness. The main objectives of community care are to improve the quality of life of people with disabilities or impairments; and working with the patient and the community to create positive attitudes towards people with disabilities, to motivate communities to support and encourage participation within the community. This workshop looks at the current community therapy situation within the UAE and discusses the challenges it is faced with. It discusses the necessity of home modifications and participation and accessibility within the community. The workshop also discusses the cultural nuances within the UAE and how they may impact community rehabilitation. It discusses the availability of support groups within the community and the availability of services which encourage those affected to return to work or productive activity. There are many international guidelines and pathways developed supporting the implementation of community rehabilitation; during the workshop such international practices are discussed and recommendations are derived from this for the UAE moving forward.

Biography:

Mansi has completed his Bachelor degrees in both Medical Technology and Medicine in Saudi Arabia at king Abdulaziz University and King Saud University for Health sciences respectively. And has done his postdoctoral studies from the University of Minnesota, department of Neurosurgery at the stem cell institution. He is a Neurosurgical Resident in Saudi Arabia, and is pursuing a career in Stereotactic and Functional Neurosurgery

Abstract:

Background data: The attempt of mouse, rat, and non-human primates transduction using retroviruses, lentiviruses and Adeno-Associated Viruses (AAV) has been utilized in the past with success seen using retrovirus and AAV in those animal species. In this study we compared AAV serotypes for expression levels of green fluorescent protein (GFP) in the cerebral cortex of adult rat, Canines, and Rhesus macaque by a developed new protocol to culture and harvest Astrocytes in vitro preceded by an in-vivo live injection into their stroke models. Followed by an in vitro experiment on human progenitor cells (HPCs) and mature human astrocytes (HA) using those same vectors. Objectives: To determine the specificity and safety profile of AAV serotypes transduction across those animal species specifically AAV serotypes AAV8, AAV9 and AAV10 on those species and human Astrocytes in vitro. Study design: this is an in-vitro and an in-vivo experimental study of direct reprograming of mature astrocytes to neurons using vector packaging specific transcription factors transduction injected into different experimental animal species. Methodology In-vitro a specific canine astrocyte culture protocol was developed using canine meningioma cells transduced with AVV free transcription factors first. After realizing that those viruses can infect canine cells. They were then used on mature canine astrocytes harvested from a live animal. Canine cortical astrocytes were cultured in an astrocyte medium on poly-l-lysine-coated flasks using an adjusted protocol. Astrocyte transductions were performed at 24 h post-plating on coated dishes. Transfected cells were cultured in human NSC medium supplemented with growth factors as per the Astro-Medium protocol. Cells were then picked for further culturing and some were fixed in 4% paraformaldehyde (PFA) for 10 min. Then they were permeabilized with 0.5% Tween-20 in PBS and then exposed to 0.1% Tween-20 with 10% horse serum. We incubated the cells with primary antibodies overnight and with secondary antibodies for 1 h when unconjugated primary antibodies were employed. Vectors were already designed and prepared in our labs and was frozen down and stored away. In-vivo a pterional craniotomy on the canine stroke model was performed. The internal carotid artery and the middle cerebral artery were then identified. Coagulation was done to the middle cerebral artery distal to the lenticulostriate vessels to preserve them. After developing a stroke in these animals a diagram model, infarct and a behavior protocol was done to determine if it’s a working model. Later, they were injected with the same vectors used in vitro. Observation is done to their neurological status and the progression in the resumption of the neurological functions lost. Euthanization is carried out later on those animals and sections of their brains were examined and fixed. Immunohistochemistry were done 3-4 weeks later after transduction. Three canine stroke models were successfully developed. The same methodology was carried out on rats/mice, and Rhesus Macaque with considerations to the distinct anatomical differences. Several rats and mice stroke models were developed with success to only one Rhesus Macaque stroke model. An in-virto experiment included the usage of AAV in transducing HPCs and HAs using three different AAVs (AAV8, AAV9 and AAV10) known from literature to be the most potent candidates for a successful robust transduction in gyrencephalic species Central Nervous Systems. Results: Cells were quantified and AAV8 were found to be a highly specific transducer in-vitro to HA (P<0.05) followed by AAV9 and AAV10 respectively, with AA10 being the least satisfactory to cause significant transduction among the AAVs on HA. AAV10 gave significant results with rats and mice in vitro (P<0.05) with mixed results in vivo (P>0.05). AAV9 gave impressive results in the Rhesus Macaque both in vivo and in vitro (P<0.05). Conclusion: AAV10 had robust results with rats and mice in vitro, with questionable results in vivo. On the contrary AAV10 were the least to react to HPCs and HA. AAV9 were abundant in the Rhesus Macaque in vitro and in vivo. AAV8 was found to be the best candidates for the transduction of canine and human astrocytes followed by AAV9. The other animal species gave mixed results when comparing in-vitro to in vivo results. Further experimentations needs to be done on those species using different transcription factors with considerable adjustment to their environmental conditions.

Biography:

Makarenko O.M. has taken PhD degree at the age of 30 at the Moscow medical stomatological institute, M.D. degree at the age of 40 at the Institute of higher nervous activity in Moscow. He carries out his post-dock researches at the Institute of higher nervous activity and T. G. Shevchenko national university of Kiev. He is a professor of the psychology department, the author of more than 100 articles in reputed journals and 5 monographs (Lambert Academic Publishing).

Abstract:

Investigation of pharmacological activity of brain Trophinotropic factors, that formed in brain cells is very actual. Receiving from female pigs after brain's hemorrhagic stroke recovery, medicine "Cerebral" is a peptide trophinotropines with brain protective, regulative, activative and modulative actions. Trophinotropine "Cerebral" was protected of the active zones of the axodendritic synapses. Destruction dendrites system of the microtubules in the pleximorph area of sensomotoric cerebrocortex are not so often registered in trophinotropine treated animals. It was shown, that "Cerebral" administrations (0,01 - 0,02 mg/kg bow., imp., twice with the interval of day) to cats with experimental model of hemorrhagic stroke was accompanied with 70% decrease of mortality, reduced symptoms of the disease: recovered of limbs movements decreases of coordination disturbances, and normalization of some reflexes. Under conditions of chronic emotional stress (15 days) "Cerebral" (0,1 mg/kg b.w., i.p., before and on the 9h day of stress exposure) prevented the decrease of rats body weight, reduced the concentration of initial and intermediate products of lipid peroxidation, normalized the activity of antioxidant enzymes (SOD and catalase) in hypothalamus and cerebrocortex zones. "Cerebral" normalized spleen cytological parameters and blood neitrophils cytochemical reactions. Trophinotropine accelerates progress of structural and functional restoration of alterative neurons (activities effect), have a cytoprotective and different pharmacological properties-trigger and contrapoptotic actions in early post stroke period. This medicine was suggested for treatment of sharp periods of stroke and decompensation phases of disease have had an original medicinal form (nasal drops), which essentially, will simplify treatment patients.

Biography:

Margherita Di Paola is currently Lecturer at LUMSA University in Rome (Italy) and Researcher at IRCCS Santa Lucia Foundation in Rome (Italy). She is Principal Investigator for a Grant of the Italian Ministry of Health on “Degenerative Disease and NeuroImaging”. NeuroImaging is indeed her field of Research, with many International publications on impacted peer-journals. She has a background as Neuropsychologist. She graduated in Psychology at University of Palermo, (Italy). She specialized in “Neuropsychology” at University of Rome “La Sapienza” (Italy). She obtained her PhD at Policlinico Agostino Gemelli Rome (Italy).

Abstract:

White matter abnormalities have been shown in the large deep fibers of Alzheimer’s disease patients (Sachdev et al., 2013; Matsuda, 2013; Liu et al., 2011). However, the late myelinating superficial white matter comprised of intracortical myelin and short-range association fibers has not received much attention. In order to investigate this area, we extracted a surface corresponding to the superficial white matter beneath the cortex, and then applied a cortical pattern-matching approach which allowed us to register and subsequently sample diffusivity along thousands of points at the interface between the gray matter and white matter in 44 patients with Alzheimer’s disease (Age: 71.02+5.84, 16M/28F) and 47 healthy controls (Age 69.23+4.45, 19M/28F). In patients we found an overall increase in the axial and radial diffusivity across most of the superficial white matter (p < 0.001) with increases in diffusivity of more than 20% in the bilateral parahippocampal regions and the temporal and frontal lobes. Furthermore, diffusivity correlated with the cognitive deficits measured by the Mini-Mental State Examination scores (p < 0.001). The superficial white matter has a unique microstructure and is critical for the integration of multimodal information and during brain maturation and aging. Here we show that there are major abnormalities in patients and the deterioration of these fibers relates to clinical symptoms in Alzheimer’s disease.

Biography:

Sofya Markdorf studies medicine in the National Research University Novosibirsk State University. She makes her scientific work in the laboratory MRT Technologies of the Institute International Tomography Center of the Russian Academy of Sciences.

Abstract:

The aim of investigation is to value the effectiveness of surgical revascularization using the functional MRI. Two groups of patients in the recovery period (> 1 year) of the stroke were investigated. Patients in the first group were after cerebral bypass surgery (10 persons), the second group included patients after conservative therapy (7 persons). MRI study was made at 1.5T system (PHILIPS). The paradigm for the functional MRI included small ball squeeze in response to a visual cue. We examined patients from group №1 before surgery, in the early postoperative and recovery periods. We tested the neurological status before and after surgery (in the recovery period). The neuronal activity from the stroke region (precentral gyrus), supplementary motor cortex and contralesional hemisphere were compared. A significant increasing neuronal activity was found in the stroke region after conservative treatment (p < 0,05). The comparing of patients with extracranial-intracranial bypass in dynamics before surgery, after revascularization and in the recovery period didn’t show any significant increasing neuronal activity in the stroke region. In the surgical group a significant decreasing neuronal activity was observed in the contralesional hemisphere in the recovery period (p < 0,05). According to the data from neurological examination the motor function recovery of the damaged upper extremity took place in the 20% of patients after surgical revascularization. The investigation was made with financial supporting of FASO Russia in theme 0333-2014-0003 in the theoretical part and clinical analysis and the RSF grant (project №14-35-00020) in the MR-tomography.

Biography:

Benjamin Chitambira completed his BSc Physiotherapy Honours degree from the University of Zimbabwe in 1995. He also completed a Postgraduate Certificate in Healthcare Leadership from the Open University in the UK in 2014. With over 19 years’ experience as a neuro-physiotherapist, he has been carrying out research on optokinetic chart stimulation as a clinical specialist physiotherapist in the Richard Stevens Stroke Unit for over 8 tears. With 11 papers published in peer reviewed journals and 4 international conference presentations, he has been a peer reviewer and guest editor for reputable journals and now serves as an editorial board member of peer reviewed journals.

Abstract:

Background: Stroke causes disability and has a huge cost to the health economy. The aim is to compare and explore recovery of movements and function in hemiplegic dense acute strokes treated by the optokinetic chart stimulation (OKCS) based OKCSIB protocol versus those treated conventionally. Methods: The A4 size optokinetic chart consists of repeated bundles of rainbow colours. The chart is placed 20 centimetres in front of a patient’s face. It is moved from side to side at approximately one cycle per second for 3 minutes then up and down for 3 minutes and finally forwards and backwards for another 3 minutes. Once patients can stand with assistance of 2 therapists, sensory interaction for balance is added. Specific active-assisted upper limb anti-gravity extensor exercises are carried out for the affected upper limb. Results: The experimental participant fully recovered affected upper and lower limb movements, at 20/20 on STREAM, by the 3 months follow up. On the other hand, the control participant did not recover voluntary movements of the affected upper and lower limb at all; remaining at 0/20. Instead, by the 3 months follow up, the control participant had developed spasticity of the affected hand and affected lower limb. The control participant’s affected lower limb was already in a flexor pattern of hip flexion and external rotation with knee flexion. The control participant was discharged to a nursing home with use of sling hoists. Conclusion: OKCS led to recovery of movements. RCTs are required to verify the evidence for its use.

Biography:

Abstract:

One major prerequisite for successful restorative therapies after stroke is a finer knowledge of how motor training reshapes the brain after injury and whether this reshaping is adaptive or maladaptive. We specifically investigated longitudinal neural changes (functional MRI, fMRI) in the primary motor cortices (M1) occurring as a function of “true” motor recovery following a motor training. Task-related fMRI measures were collected in 11 chronic patients and 12 age- and gender-matched controls immediately before and after a four-week training period (1080 repetitions per participant). Training comprised variable practice of a reach-to-grasp task executed with the impaired hand in patients and the dominant hand in controls. During practice, groups received faded (17% average) knowledge of performance about arm joint movements. Magnitude of M1 activation and anterior trunk displacement, a measure of compensatory movement strategies employed by patients to accomplish a reaching task, were analyzed. Prior training, relative to controls, patients exhibited a trend towards greater activation in M1 contralateral to the tested hand and significantly greater activation in ipsilateral M1. They also showed increased trunk movement and stronger and significant M1 activation-trunk movement correlations. After training, patients exhibited “normalization” of bilateral M1 activation, a decrease in compensatory trunk recruitment, and a trend toward “normalization” of motor activation-trunk movement relationships. We conclude that M1 is likely to play a major role in “true” recovery, suggested here by decreased use of compensatory strategies. We also suggest that combined movement kinematics-fMRI approach could help to gain a better understanding of underlying mechanisms of intervention.

Biography:

Antonio Incisa della Rocchetta has completed his PhD in 1990 at McGill University, Montreal Canada. He is the Lead Neuropsychologist at the Unit for Prolonged Disorders of Consciousness Wellington Hospital, London. He has published in international peer-reviewed journals and has been in clinical practice for over 20 years.

Abstract:

The management of patients in a Prolonged Disorder of conciousness state is complex and most recent guidelines recommend that these patients are managed in a specialised unit by a specialist multi-disciplinary team. The Prolonged Disorders of Consciousness (PdoC) Unit at the Wellington Hospital was created according to these guidelines, to diagnose and treat patients with prolonged disorders of consciousness, aiming to optimise their care and management before discharge. The assessment and therapy pathway and its implementation will be presented including the internationally recommended assessment tools used. The processes for keeping the family involved and informed about diagnosis and prognosis, with advice about possible key decisions such as long-term care and the appropriateness of life-sustaining measures including antibiotics and resuscitation will also be highlighted. Functional imaging research has indicated that a sizeable proportion of patients (17-19 percent) diagnosed as lacking awareness with behavioural diagnostic tools are in fact aware. A programme of research and clinical assessment of level of consciousness is planned, utilising functional imaging techniques (fMRI and EEG) in order to identify these patients. The ethical implications of this will be discussed.

Biography:

Abstract:

BACKGROUND: Malignant middle cerebral artery (MCA) stroke is associated with high mortality rates and high levels of morbidity among survivors. Several randomized studies have now shown that decompressive craniectomy, when performed in selected patients, can be beneficial. Here we present our initial experiences implementing decompressive craniectomy procedures in patients with brain infarcts at our hospital in Saudi Arabia. MATERIAL AND METHODS: Between October 2008 and July 2011, four out of six patients with hemispheric brain infarcts complicated by malignant edema underwent decompressive craniectomy and duraplasty within 72 hours of symptom onset. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Clinical outcome was assessed at 12 months using the modified Rankin scale (mRS). RESULTS: Two patients over 65 years old who were in poor medical condition were not treated surgically; both died within 4 days. Three females and one male, ranging in age from 38 to 57 years, underwent craniectomy. Of these, two died 7 and 21 days after stroke onset. One patient recovered with minor functional disability (mRS = 2) while the other had a residual moderately severe functional disability (mRS = 4) at final follow-up. Unexpectedly, given the small number of patients, the presence of co-morbid illness, the timeline of clinical deterioration post admission, and the lowest pre-operative GCS statistically predicted survival. CONCLUSIONS: Decompressive craniectomy rates are increasing in clinical practice, and the procedure can be life-saving. To our knowledge, our four surgical cases are among the first reported in Saudi Arabia. We call for national awareness of the management of such cases and early intervention. We also call for pre-stroke health status/co-morbidity, and both the rate and extent of neurological decline post admission to be added as potential outcome predictors in future research.

Biography:

Tamsin qualified as a Physiotherapist at Nottingham University in 2001. Following a few years working in the public sector and deciding to specialise in Neurological Rehabilitation, she started working at the Wellington Hospital in London, on the Neurological Rehabiulitation Unit. Tamsin completed a Masters in Neurological Rehabilitation and developped a keen interest in the use of Functional electrical stimulation and robotics in Neurological Rehabilitation. She has presented on this topic at the ISPRM in Berlin and in Qatar and had posters accepted at various other internatinoal conferences. Tamsin is chair of the WFNR special interest group on the “Use of Advanced Technologies in Neurological Rehabilitation

Abstract:

In recent years there has been a huge increase in the number of advanced technologies on the market aiming to maximise patient outcomes in Neurological Rehabilitation. Scientific Evidence as well as public demand are also increasing. This presentation will look at the existing evidence on the use of Technology in Stroke Rehabilitation and how this can be integrated into practise to maximise intensity and recovery. It will also use clinical examples and experience to illustrate how these devices can be integrated into the Rehabilitaion Pathway. Examples used will include various devices such as the Erigo, Lokomat, Armeo, Indego Exoskelton and various upper and lower limb FES devices.

Biography:

Yusuf Al-Bustanji is an assistant professor at United Arab Emirates University. He is a licensed and certified speech language pathologist specializing in Neurogenic Communication Disorders from The Ohio State University. He has over 20 years of experience in providing clinical evidence-based therapy services to individuals diagnosed with communication and swallowing disorders in acute care and rehabilitation centers at hospital settings.

Abstract:

Agrammatism is a language disorder characterized by morpho-syntactic impairments affecting the production and comprehension of connected speech. One characteristic of this deficit is the omission and/or substitution of grammatical morphemes in stroke survivals with Broca’s aphasia. The studies of agrammatism show that not all morpho-syntactic elements are impaired to the same degree and that some of this variation may be due to language-specific differences. This study investigated the production of morpho-syntactic elements in 15 Arabic speaking individuals with agrammatism and 15 age-matched neurologically healthy individuals. Two experiments were conducted to examine the production of complementizer, tense, agreement and negation morphology in Arabic. The results indicated that the speakers of Arabic with agrammatism had marked dissociations in producing specific morpho-syntactic elements. The observed impairment patterns overlapped, in many respects, with those observed in other linguistic groups. The findings are discussed with respect to current theories of agrammatism, including both morpho-syntactic and computational accounts.

Biography:

Kate Walker (Bachelor of Science in Human Communication Science) is a Senior Speech and Language Therapist in Acute Neurorehabilitation at the Wellington Hospital in London. Kate has worked with patients with complex stroke needs for over eight years, with her interest and expertise in alternative and augmentative communication stemming from her background in Western Australia. She continues to practice clinically as a highly regarded and advanced communication specialist.

Abstract:

Communication is a fundamental part of any human relationship – to share ideas, knowledge, feelings, needs and smiles. For patients with stroke, damage to speech and language centres in the brain can be a common and debilitating consequence, often requiring long periods of therapy. The overall objective of speech and language therapy in this context is to optimise individuals' ability to communicate, thereby improving quality of life. The role of technology in assistive communication therapies has grown over the years with the advancing skills and devices now available. Individuals with severe language or speech problems often rely on communication devices to supplement existing speech or replace speech that is not functional. These special augmentative aids help a person to express themselves by allowing the patient to interact with and control their environment. Having adequate assistive technology often means the difference between isolation and participation, and from dependence and independence. This presentation will explore the dynamic relationship between technology and communication after stroke, using patient case study examples from speech and language therapy services at the Wellington Hospital in London.

Biography:

Abstract:

Introduction: Decompressive hemicraniectomy (DH) is an emergency procedure in patients with large middle cerebral artery (MCA) infarctions. It improves survival but may not improve the overall outcome. This creates frequent disagreements between the neurosurgical on one hand and the neurological and/or the critical care teams. In the current survey, we aimed to explore the perspective on DH of each of these specialties to establish common grounds for moving forward. Methods: An electronic survey was distributed via email and social media groups to members of these specialties in Saudi Arabia and the Gulf countries. Local practices as well as common triggers for referral for DH were explored. The perceived outcomes of these procedures as well as individual impression of what constitutes good clinical outcomes were entertained. Inquiries regarding the patients’ population who are unlikely to benefit from the procedure were sought. Results: 89 physicians participated: 41 (46.1%) neurologists, 34 (38.2%) neurosurgeons and 14 (15.7%) intensivists. The majority of participants have been in practice for over 10 years (47.1%). Nine participants (10.1%) were from the Gulf Council Countries (four neurologists, and five neurosurgeons). Participants are mostly practicing in intermediate volume centers (50 to 150 stroke admissions per year; in 46.6%) or high volume centers (over 150 stroke cases per year; in 38.6%). The number of cases of DH was up to five per year in 58.6%, six to ten in 21.8%, and more than ten cases per year in 19.5%. The most frequent number of cases referred for DH was reported by the neurosurgeons to be over ten per year (in 40.6%) but the majority of neurosurgeons performed five cases or under per year (in 43.8%). Half of the neurosurgeons preferred to be consulted immediately on candidates with large MCA strokes while the rest wanted to be consulted only when radiological (28.1%) or clinical (12.5%) changes occur. The most important referral trigger for DH was clinical changes (76.9% of intensivists, 61.1% of neurologists, and 51.9% of neurosurgeons). In large MCA stroke setting, 29.3% of neurologists saw no value for ICP monitoring vs. 6.3% of neurosurgeons. All the intensivists expressed that ICP monitoring is somewhat (50%) or very valuable (50%) in this setting. The modified Rankin Scale (mRS) cutoff for good clinical outcome was 3 for 73.6% of respondents. Only 7.4% of neurosurgeons and 6.3% of neurologists (but none of the intensivists) thought that mRS-score of 5 could still be considered a good clinical outcome. There was agreement that DH only improves survival (64.4%). A third of the neurologists considered it to improve functional outcome compared to 15.4% of intensivists and 14.8% of neurosurgeons. Among intensivists, 30.8% had the impression that DH is not different from the natural history of large MCA stroke compared to 11.1% of neurosurgeons and 6.1% of the neurologists. There was agreement (66.7%) that patients older than 60 years with involvement of more than one territory should be excluded from DH. Only 7.7% of neurosurgeons excluded patients with dominant hemispheric strokes. Conclusion: There is a consensus among participants on the timing, indication and exclusions factors for patients with large MCA stroke. Guidelines issued by a committee of the three involved specialties are strongly recommended by our findings.

Biography:

Jency Thomas is an early career researcher and a teaching academic at La Trobe University. In a short career span Jency has 6 papers in A* Journals with one invited book chapter. Jency Thomas, is an early career researcher, building on from her PhD work she is developing her interest on metabolic diseases and mental health outcomes. Jency has made significant contribution and added new knowledge in the field of diabetes and cognitive impairment. She has significant experience working with range of antioxidants including omega-3 fatty acid and polyphenols. As an early career researcher she is keen to understand the effect of metabolic syndrome such as obesity, hypertension, dyslipidemia and diseases like cardiovascular and diabetes on mental health outcomes. Jency’s paper “Dietary Supplementation with resveratrol and/or docosahexaenoic acid alter hippocampal gene-expression in adult C57Bl/6 mice”. Journal of Nutrition Biochemistry was awarded the best original research paper, by University of Newcastle 2013. Her achievement is also recognised by invitation to write book chapter on “diabetes and gene expression”. Currently she is involved in number of projects, including a project on Australian Longitudinal Study on Women’s Health Data (ALSWH), Dr Thomas currently has access to database of large cohort of Australian mid-aged and Old age Women (>20,000).Dr Thomas is investigating the mental health profile of mid aged and old aged diabetic Australian women; this project is undertaken as a “Master’s Thesis Project”, for whom Dr Thomas is one of the primary supervisor

Abstract:

Diabetes is a metabolic disorder that leads to other health complications over a period of time and is the cause for considerable morbidity and mortality world-wide. The complications of diabetes in the peripheral tissues are well characterized including coronary heart disease, retinal degeneration, renal disorders, and also micro and macro vascular complications. Over the last few decades much emphasis has been placed on the complications of diabetes that occur in the central nervous system (CNS). One such neuropathology due to diabetes in CNS is cognitive impairment. The hippocampus, the limbic structure, is involved in higher brain functions and appears to be particularly vulnerable to diabetes. presents a study on the comparison of gene expression profile in the hippocampus of a streptozotocin (STZ) induced diabetic mice and a vehicle treated control animals. Here it is demonstrated that diabetes causes significant alterations in the genes that plays a crucial role in synaptic function and plasticity and also for neurogenesis, both of which are required for normal cognitive functions. Six weeks after diabetes was established in these mice, a number of genes had altered expression including genes involved in epigenetic regulation, and this included histone deacetylase (Hdac) 4, 9 and 11. Interestingly Hdac 4 and 9 are abundantly present in the hippocampus and are required for hippocampal dependent learning, memory and synaptic plasticity. Glycogen synthase kinase beta (Gsk3β) which has been shown to have a crucial role in metabolic and neurodevelopmental functions and considered to be an important regulator of synaptic functions, also exhibited significant decrease in the STZ induced diabetic mice as opposed to the buffer treated control group. The marked decrease of these genes that are crucial for higher functions in the hippocampus underscores the impact of uncontrolled diabetes on the hippocampus. Furthermore genes that have been linked to neurological disorder and cognitive dysfunction such as apolipoprotien E (ApoE) showed increased expression in diabetic mice as opposed to the non- diabetic control group. These findings implicate the abnormal transcription of genes which could disrupt normal cognitive functions in the hippocampus and also underscores epigenetic mechanisms involved in disease conditions like diabetes.

Biography:

Shi-Uk Lee has completed his PhD from Seoul National University and postdoctoral studies from Stanford University School of Medicine. He is the director of Department of Physical Medicine and Rehabilitation, Seoul National University Boramae Medical Center. He is Professor in Departtment of Rehabilitation Medicine, Seoul National University College of Medicine.

Abstract:

Asymmetry in weight distribution is the main cause of frequent fall in hemiplegic patients. Weight distribution during upright standing in early rehabilitation is important for the determination of asymmetry. Currently used upright standing training methods for stroke patients are tilt table (T/T), standing frame (S/F), and parallel bar (P/B). Among these, S/F is a relatively new training method and its exact indication and usefulness is not understood. Additionally, to our knowledge, changes of weight distribution on these methods have not been reported. Objective : Our research questions were 1) How does the weight distribution change according to T/T, S/F and P/B in subacute stroke patients? 2) Especially what does the upright posture on S/F differ from others in terms of weight distribution? Methods : Six patients (2 males and 4 females, mean age 73.7 years) in subacute stage of stroke were included in the study. Weight distribution in upright posture was assessed with the computerized wireless balanciometer (CWB) during their ‘P-bar standing try’ level of recovery. The patients were divided into two groups according to the motor power of knee extensor on the hemiplegic side. In group A (n=3), the motor power was less than ‘3’ in manual motor grade. Others (n=3) were assigned into group B (motor power > 3). Group A were provided with knee stabilizer on their hemiplegic side during standing. CWB is composed of insoles with 3 sensors located on medial and lateral side of foot front and heel region. The percentage of weight that was carried at each sensors were recorded wirelessly. The patients were asked to stand ‘comfortably still’ for more than 30 seconds for 1 trial, and the trial repeated for 3 times to obtain median value. Results : The average percentage of total body weight on hemiplegic side were calculated for tilting table, standing frame and p-bar which were 33.9% (SD 11.4), 17.8% (SD 18.0) and 14.2% (SD 23.5) each. And the average percentage of total body weight on the hemiplegic side for P-bar in group A and B were 13.7% (SD 22.7) and 31.3%(SD 26.2) each. And the value was 29.5% (SD 12.1) and 38.3% (SD 11.1) in tilting table. Conclusion : In upright posture on S/F or P/B, asymmetry of weight distribution between hemiplegic and intact side aggravated in comparison to that on T/T. This phenomenon was more evident in patients with weaker knee extensors. Therefore S/F is an upright training tool similar to P/B in terms of weight distribution and should be applied with concomitant balance training to facilitate the use of hemiplegic lower extremity for the early treatment to obtain symmetry of weight distribution.

Biography:

Hsiao-Yu Chen has completed her PhD at 2004 from University of Ulster, UK. She is the Dean of College of Health and Professor of Department of Nursing. She has published more than 35 papers in reputed journals.

Abstract:

The purpose of this study was to evaluate the effectiveness of a self-management program in prevention complications, promoting self-efficacy and health status in people with spinal cord injury. Methods: The study adopted a quasi-experimental pre-test and post-test control group design. Data was collected from October 2014 to July 2015. Qualified participants were recruited from Spinal Injury Association in Taiwan. All participants were evaluated with instruments of personal information, self-efficacy and health status, indicators at baseline and at 3 months and 6 months. The experimental group (n = 30) received self-management program in addition to teaching by the researcher, whereas the control group (n = 27) received without a self-management program. Several descriptive analysis functions were employed to explain the distribution conditions of the data. Subsequently, chi-square test and Mann-Whitney U test were performed to compare the experimental and control group. To obtain inferential statistics, generalised estimating equation (GEE) was used to compare the pre-test and post-test scores obtained from the experimental and control groups. Results: The total 57 participants were participated in this study. The average age was 40.63 years old. The results indicated that, after received the SCI self-management program, the experimental group exhibited a considerably greater improvement in self-efficacy and health status. Although, we recorded no marked differences emerged between the experimental and control groups by using a GEE. The statistics showed that the prevention of complications, the experimental group had somewhat decrease（p = .094）than the control group. Conclusion: Our study results confirmed that the SCI self-management program is an effective instrument for preventing complications, promoting self-efficacy and health status in people with SCI, and is a practical health education tool. However, monitoring these people over the long term is necessary. We plan to use the proposed SCI self-management program with a larger number of people with SCI before them discharge from hospital and to continuously monitor their improvement.

Biography:

Magda Ahmed Eldomiaty has completed his PhD at the age of 37 years from Tanta University and postdoctoral studies from Tanta University College of Medicine Egypt. She is prof. Of Anatomy and embryology in Taibah University Saudi Arabia, Tanta University Egypt. She is international reviewer in many international journals. She has published more than 25 papers in reputed journals and has been serving as an editorial board member of Edorium Journal of Anatomy and Embryology.

Abstract:

The study demonstrated the expression of muscle-derived myokines in the dentate gyrus (DG), medial frontal cortex (mFC) and cerebellum during depression and after voluntary exercise. Depression was developed by forced swimming (15 minutes/day) for 2 weeks and evaluated by automatic monitoring of the locomotor activity. Voluntary exercise was performed through accessing voluntary rat wheel for 3 weeks. Brain sections were processed and immunostained with antibodies against BDNF, MIF, VEGF and IL6. Light microscopic study and measuring the integrated optic density (IOD) of the photographs using ImajeJ software were performed to evaluate the myokines’ expression. Microscopically; BDNF was expressed in the cytoplasm and nuclei of nearly all neurons of DG, mFC and in granular and Purkinje cells of the cerebellum. MIF expression was mainly cytoplasmic in neurons of subgranular zone of DG, neurones of mFC and in Pukinje cells of cerebellum. VEGF showed cytoplasmic expression in many neurons of DG, mFC and in purkinje cells. IL6 was also cytoplasmic but expressed more in the glial cells, endothelial cells and purkinje cells. After voluntary running protocol; the IOD of BDNF increased significantly in upper and lower limbs of DG (P= 0.005 and p<0.001 respectively), mFC (P=0.001) and cerebellum (P=0.001). IOP of MIF significantly increased in both limbs of DG (p<0.001), mFC (p=0.001) but not in the cerebellum (P=0.052). IOP of VEGF and IL6 showed significant increase of in both limbs of DG (p<0.001), mFC (p<0.001) and cerebellum (p=0.001). The study could re-define the muscle derived myokines that might help in managing depression.

Biography:

Abstract:

Objectives: Stroke has been emerged as a major health problem in Libya, importing an enormous burden on the health care system. The presented study aimed to determine the pattern of stroke admissions to medical unit of Iben Sina teaching hospital, Sirte, Libya and to investigate for etiologies, risk factors and sequel in stroke patients. Materials & Methods: Data from 150 patients, who were admitted to Ibensina teaching hospital, Sirte between April 2008 and July 2009, were reviewed retrospectively. Patients age, sex, body mass Index, underlying diseases, risk factors as well as etiologies of stroke were recorded. Results: Total of 2229 patients was admitted to Medical department, IbenSina teaching hospital during the study period, 130 of them were admitted as stroked patients. The mean age was 59.83+14.17 years with male to female ratio of 1.6:1. 46.2% of the stroked patients were cerebral thrombosis, for 22.3% of stroked patients the cause was cerebral hemorrhage and for 15.4% was transient ischemic attack. Hypertension was the common underlying disease in our patients (33%), followed by combination of Diabetes Mellitus and hypertension (19.2%), ischemic heart disease (16.1%) and Diabetes mellitus alone (15.3%). Hypertension was the common risk factor (52.3%), followed by Dyslipideamia (38.4%), Obesity (36.1%), Diabetes Millitus (34.6), smoking (30.7%) and atrial fibrillation (3.8%). Hemiparesis was the commonest sequelae (42.3%) followed by hemi plegia (26.95) and no sequelae in (17.7%). Mortality rate was (13.1%), cerebral hemorrhage was associated with high mortality (8.46%). Conclusions: Our study revealed that, Cerebral thrombo-embolism was the common cause of stroke in our patients admitted to IbenSina teaching hospital.

Biography:

Makarenko O.M. has taken PhD degree at the age of 30 at the Moscow medical stomatological institute, M.D. degree at the age of 40 at the Institute of higher nervous activity in Moscow. He carries out his post-dock researches at the Institute of higher nervous activity and T. G. Shevchenko national university of Kiev. He is a professor of the psychology department, the author of more than 100 articles in reputed journals and 5 monographs (Lambert Academic Publishing).

Abstract:

The aim of this work was comparative morphological analysis of the peripheral nerve of rats after its damaging without pharmacotherapy. Studies were made on 3 groups of rats, 10 in each. 1st – group with the crossed left sciatic nerve in the field of the middle third; after 10 days these animals had some repeated surgery, crossed nerve processes were found, refreshed and sutured up by the epineural stitch. 2nd – recreated above mentioned model of the peripheral nerve damaging in the conditions of Cerebrolysin application, which was administrated 21 days. 3rd – recreated model of the peripheral nerve damage in the conditions of Cerebral appication which was introduced three days. Both drugs were used since third day after surgery. The materials for research were the central, peripheral parts and a neuroma of a sciatic nerve injury in 3,6 and 12 weeks after reproduction of a peripheral nerve damage. In the first group of animals the processes of regeneration, proceeds poorly evident and starts only after the 6th week of post-traumatic restoration. Second group showed the regeneration of nervous fibers, gradual restoration of it’s ultrastructural organizations. Was observed the increase of the quantity of blood vessels and haemomicrocirculation improvements. Third group showed most positive changes compared with the other groups. It was shown that the proximal piece of the injured nerve had only insignificant phenomena of irritation of nervous fibers. The phenomena of inflammatory infiltration, edema and destruction of the processes of damaged fibers decreased.

Biography:

Assistant Professor and consultant of Neurosurgery Consultant interventional Neuroradiology Consultant Neurocritical care Head of the surgical ICU Head of the neurovascular program King Fahad hospital of the university King Fahad specialist hospital-Dammam Section head, Saudi Neurocritical care chapter Secretary General, Saudi Arabian neurosurgical society Dammam University, Saudi Arabia

Abstract:

There is recent refinement of both endovascular and microsurgical techniques for treatment of neurovascular disorders, namely aneurysms and arteriovenous malformations. These aim at reducing morbidity and mortality of the intended procedures. Durability is a major concern facing the decision making process. Clinicians and patients alike, face this ambiguity as to the so called “best” modality of treatment. We present several cases to illustrate the intersecting rather than parallel nature of the arms of treatment, highlighting the principles behind each decision-making process.

Biography:

Abstract:

Tumefactive multiple sclerosis (TMS) is an inflammatory demyelinating disease characterized by lesions measuring more than 2 cm. TMS may occur at any age, however, it is more frequent between the second and third decades of life. Some studies state that TMS has a female gender predilection, while others deny any gender predominance. The incidence of the disease is 1 to 2 per 100 cases of MS and 3 cases per million per year in the general population. TMS commonly behaves as a mass occupying lesion. Hence, the clinical presentation varies according to the location and size of the lesion. The most prevalent symptoms at presentation are motor, cognitive (memory deficit, attention disorders and mental confusion) and sensory dysfunction respectively. Pathologically, TMS is characterized by hyper-cellular lesions with demyelination and foamy macrophages which indicate a myelin phagocytosis. Magnetic resonance imaging is considered the modality of choice to diagnose this rare demyelinating disease. However, TMS presents a diagnostic challenge as it mimics several neoplastic and inflammatory conditions. The majority of patients with TMS respond to corticosteroid therapy. Unfortunately, some may have suboptimal results with corticosteroids. Hence, other immunomodulatory modalities would be indicated. Surgical intervention might be beneficial to some patients presenting with high intracranial pressure and severe swelling. In this paper, we describe a case of tumefactive multiple sclerosis in a pregnant lady with its clinical and radiological features, with a demonstration of a new approach to steroid resistant aggressive cases.

Biography:

Abstract:

INR testing and warfarin management is one of the most fundamental components in the prevention of stroke in patients with Atrial Fibrillation and coagulation disorders. Attendance to an INR clinic can be laborious resulting in reduced compliance and achievement of targets. There is evidence to suggest that self-testing or home testing of INR has the following benefits:- • It has been seen that it Increases the time to the first primary event as it was longer in the self-testers than in the clinic-testing setting • It has similar rates of clinical outcomes • It has been seen that over the entire follow-up period, the self-testers had a small but significant improvement in the percentage of time during which the INR was within the target range • It helps patients feel better too, as self-testers also seem to have a small but significant improvement in their satisfaction levels with the anticoagulation therapy itself and their perceived quality of life Our workshop will show the ease of process which can be used to monitor INR and the subsequent control of medication with the fundamental core of quality of life maintained for the patient while adhering to international standards of evidence based practice. The workshop will allow for the exploration of the various steps that need to be taken while performing this activity. Additionally, the information materials that will be used with patients and their families will be covered in the workshop in order to complete their education process to help them self-manage their disease and maintain their functional independence.

Biography:

Shireen Qureshi, is a Consultant Neurologist/ Clinical Neurophysiologist and Head Neurologist, Subspecialty Medicine, at Johns Hopkins Aramco Healthcare Company. Shireen Qureshi is a Fellow in the Royal College of Physicians and Surgeons of Canada in the specialty of Neurology, a Member of the American Academy of Neurology, and a Member of the Canadian Society of Clinical Neurophysiologists. Graduate of King Faisal University/ Dammam University Neurology Residency at university of Toronto 2003 Qureshi is active in many organizations. She is currently the Head of the Scientific Committee and Vice President of the Saudi Stroke Association, a Member of the executive board of the Saudi Neurology Society

Abstract:

Stroke continues to have a major impact on the public health of our nation. Preventing stroke is a key to reducing its societal burden from a human and financial perspective. WHO deemed stroke as second leading cause of morbidity and mortality. Stroke (ischemic and hemorrhagic) constitutes 7% of all deaths annually in North America and Western Europe. In Saudi Arabia, accurate estimate is lacking, however, based on an older provincial population-based survey, the estimate is 30/100,000 and about one every 6 minutes. Stroke prevention is being transformed from a personal style or belief into evidence-based medicine. Ischemic stroke constitute about 70-80% of all strokes and is not a single disease; it is a system of diverse etiologies and pathogenic mechanisms. Although epidemiological realities are distressing, major advances in secondary stroke prevention and to a lesser extent, in primary prevention, has been elucidated. Despite the fact that the largely artificial distinction of primary and secondary prevention has become elusive, with the multitude of risk factors added together in different individual poses similar risk, hence, equally aggressive non-pharmacological and pharmacological intervention. Considerable research has led to a better delineation of risk factors, as well as an expanded understanding of pathophysiological subtypes. Atherosclerosis of the brain and heart vessels plays a predominant pathological role. Large artery atherosclerosis leads to hypo perfusion or atherogenic emboli, whereas micro atheroma and lipohyalinosis of small penetrating vessels cause lacunar infarcts. Approximately 20% of ischemic strokes are due to cardio embolism, commonly due to atrial fibrillation of up to 45%. 30% are cryptogenic and less than 5% due to a variety of unusual causes. Stroke research has evolved over the past decade elaborating that; different subtypes of stroke respond differently to specific interventions for stroke prevention of which cardio embolic strokes bear a big toll.