21^st World Congress on Neurology and Therapeutics March 15-17, 2018 London, UK

Biography:

Hardeep Sahota is a NHS Doctor in the UK currently working at Chelsea and Westminster NHS Foundation Trust. His long-term ambition is to follow a path in neurosurgery. He is also a fully qualified Pharmacist in Great Britain. He completed his medical degree at Bristol Medical School.

Peggy Fooks is a NHS Doctor in the UK currently working at Chelsea and Westminster NHS Foundation Trust. She graduated from Oxford Medical School. She has passion for singing and has travelled the world with her choral music. She also enjoys long distance running.

Abstract:

A 19-year-old year university student was brought to the Emergency Department by his mother. He had been non-specifically unwell for about nine days, but his peers had called his parents when he began to become confused, disoriented and drowsy. On admission, he was complaining of headache and photophobia; his family had noticed right eyelid drooping. He had Glasgow Coma Scale/Score (GCS) 13 to 14 and generally weak, but no focal neurology on examination. He was febrile-spiking 38.8℃. An urgent CT head scan was performed, followed up with an MRI, which together showed marked oedema in the right temporal lobe and, to a lesser degree, in the medial right frontal lobe. Significantly, 7 mm of midline shift and effacement of the ventricles was noted. He was commenced immediately on IV aciclovir treating for likely HSV encephalitis with empirical ceftriaxone cover. Although the diagnosis was uncertain, a lumbar puncture was not performed as his imaging showed raised intracranial pressure. His case was discussed with Neurosurgical Registrar at our tertiary referral center, and the local Neurology Consultant. Neither of them felt that an immediate transfer to a neurosurgical unit was necessary given his GCS was relatively stable and he had been commenced on treatment for the most likely diagnosis. He was reviewed by ITU on site who did not find an indication to admit him to HDU while he remained stable. After 48 hours of antimicrobials and supportive therapy, his GCS deteriorated fluctuating between 8 and 13. There was still no focal neurology observed. A repeat CT showed new hypodense regions in the left hemisphere and increased midline shift at 12 mm. the condition was discussed with neurosurgeon who recommended urgent decompression surgery. They asked that the patient be intubated immediately and transferred as urgently as possible to the theatre for decompressive craniotomy. Audiences will gain knowledge on the following topics after the presentation: herpes simplex encephalitis is associated with 70% mortality if untreated; delay in treatment leads to higher morbidity and mortality; clinicians should aim for MRI to correlate images with the clinical presentation; aciclovir must be started immediately and only stopped once lumbar puncture definitely rules out diagnosis which can take up to ten days from having the initial investigation; and a combination gold standard for diagnosis are MRI, CSF, PCR for viral DNA.

Biography:

Caroline Attwell graduated with a Master’s in Physiotherapy in 2004 from de University of Buenos Aires, Argentina. She started her career in a high-performance athletic training facility then left for the United States and Europe where she worked and did research for a polo organization. Since 2008, she has been in the acute neurorehabilitation team at the CHUV (University Hospital of Lausanne) as Physiotherapist and Researcher. She occasionally lectures for the HESAV (University of Applied Sciences and Arts, Western Switzerland). Her domains of preference are the new developments in neurorehabilitation, acute neurorehabilitation, new technologies and respiratory care for acute neurological patients

Abstract:

Introduction: The use of natural environments to promote health and prevent illness is widely recognized. However, in the case of individuals experiencing disorders of consciousness (DOC), little is understood about the use of contact with nature in treatment and rehabilitation. The aim of this study is to investigate the effects of outdoor therapy in relation to the awareness and wakefulness levels of this population.

Patients & Methods: This study is a non-randomized cross-over pilot trial. It is set within the Acute Neuro-Rehabilitation Unit (University Hospital, Lausanne). Twenty adults diagnosed with DOC were included in the study. They participated in an indoor-outdoor neurosensory interdisciplinary therapy program. As the primary outcome awareness and wakefulness were measured by an adapted behavioral grid. Functioning and disability were recorded as secondary outcomes.

Results: The difference in scores between indoor and outdoor therapy was computed. Preliminary results show a solid positive trend in favor of the outdoor therapy. We can clearly detect the improvement of several points such as, visual fixation, exploration, intentional movements and communication. It is noteworthy that these clinical items are involved in in the determination of DOC diagnosis.

Conclusion: Outdoor therapy may provide a beneficial complementary treatment option for DOC. The promising preliminary results of the study show the need to develop further interdisciplinary research in this field.

Biography:

Tania Alexandra Couto is a Portuguese neuroscience researcher currently based in Macau, SAR, China. Her work is developed in the neuroimaging department in Faculty of Health Sciences at the University of Macau. The research aims are focused on neuroimaging fusion projects, integrating NIRS-ERP simultaneous measurements, applied to neuropsychiatric disorders. She has participated in different conferences, symposiums and Congress as speaker on a subject of Neurofeedback; haemodynamic approach with NIRS tool; NIRS-ERP studies: multimodal approach applied to neuropsychiatric disorders. She combines clinic experience in neurofeedback -EEG, cognitive rehabilitation and clinic psychology in several hospitals and Portuguese clinics between 2009-2016 and also, a valuable internship in Stroke Unit in King´s Hospital College (London), where she had the opportunity to develop her clinical practice with stroke acute patients, her major area of interest in cognitive rehabilitation. In parallel, the neurofeedback /EEG-Q clinic experience allowed to develop a deep interest in neuro creativity applied to the neuropsychiatric and healthy population.  As PhD student, she has been worked on the neurofeedback application in a multimodal approach (NIRS-ERP studies), focused on working memory and visual creativity.

Abstract:

The present study investigated the neural correlates of prefrontal dysfunction in food addiction disorder activated by a n-back task in undergraduate and graduate students. We used a neuro-vascular coupling measure captured by near-infrared spectroscopy recordings with n-back paradigm in 2-back and 3-back conditions. We found that middle frontal gyrus (dorsolateral PFC – BA46) and frontopolar (orbitofrontal cortex BA 10) areas were activated, highlighting significant differences in three channels. Furthermore, to support the main hypothesis, in the behavioral performance students with low results in food addiction scale (less than three symptoms) were related with health conditions activated by n-back task, specifically the 2-back health condition. These results suggest that undergraduate and graduate students are sensitive to highly palatable food and the activation of BA 46 and BA 10 may correlate with unhealthy food pattern, which highlight the possibility of biomarker for food addiction disorder related to the dysfunction of working memory in PFC captured by nirs recordings. Even that the record of junk items has been presented higher activations during a 3-back task, junk conditions are not always related with inefficient emotional regulation underlying the binge eating events referred to in the YSAS and traditionally expected by the literature. This evidence could reflect that other patterns of eating behaviour and strategies of emotional regulation related should be more explored and redefined among students populations exposed to risky eating behaviors

Biography:

Abstract:

Electro diagnostic (EDX) studies play an essential role in the evaluation and disorders localization of the peripheral nervous system such as disorders of the primary motor neurons (anterior horn cells), primary sensory neurons (dorsal root ganglia), nerve roots, brachial and lumbosacral plexuses, peripheral nerves, neuromuscular junctions, and muscles. These studies include variety of tests such as nerve conduction studies (NCSs), repetitive nerve stimulation, late responses, blink reflexes, and needle electromyography (EMG). It is an extension of the clinical history and examination. Therefore, a directed history and examination prior to the study is important and it helps to formulate a study based on the differential diagnosis. Nerve conduction studies are tests of the peripheral sensory and motor nerves assess pre and post ganglionic lesions, identify lesions of the plexus or the relevant peripheral nerves. EMG helps further to localize the lesion by assessing the presence of active denervation in the muscles supplied by the affected nerve, the presence of re-enervating potentials, it also analyzes whether the underlying process is neuropathic or myopathic in origin as well as helps in predicting the prognosis. Patients with suspected neuromuscular junction disorders undergo repetitive nerve stimulation to assess for abnormalities in neuromuscular transmission and identify the presence of pre or post synaptic defect. A specific test for the single muscle fiber (single fiber EMG) assesses the presence of jitter. The use of the various EDX studies summarized

Biography:

Abstract:

Biography:

Vahe Poghosyan received his MSc in Mathematics (1997) from Yerevan State University and PhD in Neurophysiology (2000) from National Academy of Sciences of Armenia. He held positions of Research Scientist in RIKEN Brain Science Institute in Japan (2000-2007), and Senior Scientist (2007-2016) and Director of Research Training Program (2011-2016) at AAI Scientific Cultural Services Ltd. in Cyprus. Currently, he is the Head of MEG Laboratory and Consultant of Neuronavigation at King Fahad Medical City in Riyadh, KSA. He has published more than 20 research papers in the high-impact journals in the field of Neuroscience

Abstract:

Magnetoencephalography (MEG) is a state-of-the-art functional neuroimaging and neurophysiology technique, whose primary clinical application is in the diagnostic evaluation of patients with epilepsy. MEG’s value in epilepsy and in functional neuroimaging in general, stems from its high spatiotemporal accuracy and resolution: MEG is the only currently available non-invasive technique to offer both, high spatial (of the order of few millimeters) and excellent temporal (sub-milliseconds) resolution. Numerous studies have shown the clinical usefulness and added value of MEG in epilepsy. In a prospective blinded study (considered class 1 evidence by American Academy of Neurology), MEG yielded non-redundant information in 33% of patients, where it suggested to cover additional areas in 13% of patients and modifications of the surgical decision in 20% of patients. This information would not have been available from other techniques, although patients underwent video/EEG, imaging, and PET and SPECT when indicated. In general, recent incorporation of MEG in the clinical practice has been a valuable advancement in the field. MEG’s role in the pre-surgical evaluation of patients with epilepsy is threefold. First, it is used to localize the epileptic foci, estimating the epileptogenic zone. Second, MEG is used to determine the language-dominant hemisphere. Third, it is used to map the eloquent cortex of language, motor and sensory (visual, auditory and somatosensory) functions

Biography:

Elamir H Elsherif is a Neurophysiologist Physician. He has completed his Medical degree in 2002 at Ain Shams University in Cairo. He had his training in Neurophysiology in Kings County and Downstate Hospitals in Brooklyn New York. In 2008, he completed the American Board of Neurophysiologic Monitoring in Chicago. Currently, he is working as a Consultant of Intra-operative Neuromonitoring and the Director of Neurosonology Lab at King Fahd Medical City. He is interested in Cortical Mapping, Neuromodulation and Brain Computer Interfaces.

Abstract:

Electrocorticography (ECoG) is the direct recording of electrical potentials associated with brain activity from the cerebral cortex, ECoG is comprehensive to reading electrical activity whether its spontaneous similar to Electroencephalogram (EEG) or evoked as in case of central sulcus mapping technique. The grid electrodes used for recording can be used as stimulators as well; this invasive stimulation and recording from the human brain can provide unique opportunities to study fundamental processes at fine temporal and spatial resolution. ECoG vs. EEG; while ECoG is useful in temporal and spatial localization, EEG is useful to look for diffusion of the seizure, either in the same or the contralateral hemisphere. The circumstances during which ECoG is employed vary among hospitals, at some institutions, recordings are made during all epilepsy surgeries, and the intraoperative findings are used to tailor the surgical resection to each patient. At other centers, ECoG is used selectively (e.g. only in extratemporal procedures). On the other hand, it may be performed universally for research purposes but the findings then are not used in determining the volume of brain tissue to be resected. EEG and ECoG recordings are important during the entire duration of the procedure because they allow monitoring for the occurrence of after-discharges, electrical seizures, and even clinical seizures. The occurrence of after-discharges is quite common during these procedures, and the main objective of monitoring is to recognize those that occur in response to stimulation. Technical limitations of recording and keeping the electrode in place during the surgery should be considered. Controversy also exists concerning the use of ECoG to guide the extent of resection of adjacent or distant seizure foci associated with brain tumors.

Biography:

Abstract:

Introduction: Recent decades have shown substantial progresses in the development of adjunctive tools in epilepsy surgery, specifically, image-based neuronavigation and electrophysiological neuromonitoring. For many patients, surgery for intractable epilepsy provides freedom or significant relief from seizures, offering functional improvement that ameliorates their quality of life. The aim of this paper is to show how neuronavigation helps to improve the precision and safety of epilepsy surgery.

Methods: Despite the availability of noninvasive structural and functional neuroimaging techniques, invasive monitoring with depth electrodes, strips and grids is still often indicated in the management of intractable epilepsy. Neuronavigation is used as a common platform to merge complementary information obtained from the correlation of anatomic and structural details with functional information. During surgery, neuronavigation is a valuable tool in planning the best trajectory for inserting recording electrodes in the brain. Also, it will enhance the precision and accuracy of the surgery during the removal of the epileptogenic area without damaging any vital structures. Precise identification of the epileptogenic area in medically refractory epilepsy is of vital importance. The main benefits of neuronavigation in epilepsy surgery is the effective precision of targeting even in small and deeply seated lesions, safe manipulation in critical brain areas, accurate placement of electrodes, and correlation of electro-clinical information modalities with underlying structures. Furthermore, navigation provides individual tailoring of the craniotomy and reaches the target in the planned trajectory. Additionally, minimally invasive procedures are performed rather than traditional surgeries, which require more invasive craniotomies. The whole procedure is achieved, through a small incision, to remove the seizure-producing regions deep within the brain.

Conclusion: The neuronavigation concept proved its value in epilepsy surgery by linking anatomic and functional data of a specific patient. Enhanced by the integration of multimodal information, neuronavigation significantly improved the available treatment options. Neuronavigational imaging data combined with functional investigations can greatly help discussion within the multidisciplinary epilepsy surgery team helping in the shared decision making process. Finally, during surgery, an intraoperative acquisition can be acquired to refresh the navigation data. These intraoperative acquisitions allow the assessment of surgical results within the operating room while the patient still on the surgical table and before closing the craniotomy.

Biography:

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