Day 1 :
Keynote Forum
Allal Boutajangout
New York University Langone Medical Center,USA
Keynote: Therapy and Immunotherapy Targeting Alzheimer’s Disease
Time : 09:30-10:15
Biography:
Allal Boutajangout graduated from Free University of Brussels (ULB-Erasme Hospital), School of Medicine (PhD in Neuropathology). He completed his Postdoctoral training at New York University School of Medicine. He is a Research Associate Professor of Neurology and Neuroscience & Physiology and Psychiatry. He is also the chief of Neurodegeneration and Drug Discovery Program within Center for Cognitive Neurology at NYU. He received prestigious award Margaret M Cahn for his outstanding research in the field of Alzheimer’s and other awards from: Alzheimer association, NIH pilot grant, Toyama Company, Revalesio Company and co-investigator in 5 RO1 NIH grants. He has published more than 30 papers in reputed journals and serves as a reviewer for many scientific journals.
Abstract:
Alzheimer’s disease (AD) is an age-related progressive disorder characterized by the extracellular accumulation of amyloid β (Aβ) peptides as plaques and cerebral amyloid angiopathy (CAA), as well as intracellular neurofibrillary tangles (NFTs). AD is the most common cause of dementia globally. Care for patients with dementia accounts for ~1% of current global GDP, with this expected to rise substantially in the near future. No effective treatment is available to prevent or cure AD. Currently available treatments for AD provide largely symptomatic relief, with only minor effects on the course of the disease; hence, there is an urgent need for better therapeutic interventions. Aβ has become a major target for disease modifying treatments of AD. Unfortunately, the ongoing trials targeting amyloid Aβ failed in phase III trials. So far, the clinical benefits to the patients are limited and have no effect on tau related pathology. Previously, we reported for the first time, that active and passive immunotherapy targeting tau pathology reduces tau pathology and improves cognitive decline in two different NFT models. Recently, we developed a new monoclonal antibody against PHF-tau that reduces tau pathology and improves cognitive decline without inflammation. We have also explored the potential effects of hUCB-MSC on AD pathology. Our results suggest that use of these stem cells is associated with a reduction of amyloid burden, which correlates with improvements of cognitive function in a transgenic AD mouse model. These promising approaches using immunotherapy targeting tau or stem cells to reduce Aβ pathology in animal AD models provide critical data prior to potential clinical trials.
Keynote Forum
Giovanni Antioco Putzu
Casa di Cura Sant’Elena, Quartu Sant’Elena, Italy
Keynote: Guillain-Barré Syndrome (GBS) and GBS-like Syndrome: clinical, neuropathological and immunological correlations
Time : 10:15-11:00
Biography:
Giovanni Antioco Putzu is a Medical Doctor since 1992, with specialization in Paediatric Neurology. He achived his PhD in 1996. During PHD studies, He was a Research Fellow in Hammersmith Hospital of London, UK in 1992, then He moved in Marseille to work at INSERM (Genetics) and in Neurophathology. The Author has published more than 15 papers in the field of Neuromuscular Disorders.
Abstract:
GBS is an auto-immune life-threatening inflammatory polineuropathy that may produce severe functional disability. Vaccines, viral, fungine or bacterial infections may trigger the disease. On the basis of neuropathological and neurophysiological findings, GBS is classified in demyelinating and axonal forms. In both features, functional disability is directly correlated to axonal loss. Involvement of amyelinic axons is responsible for autonomic disturbances, which, along with bulbar spread of the disease, represent a potential cause of death in GBS. A consistent number of patients both in the early or recovery phases may complain of neuropathic pain that requires an adequate treatment. Immunological aspect of the disease, i.e auto-antibodies directed against GM1 and recently to contactin-associated protein 1 (Caspr) of the paranodal region of myelinated nerves, have already been investigated. We have demonstrated that TNF-alpha was immunolocalized in both myelinated and unmyelinated axons the sural nerve of GBS patients. We concluded that this substance may be directly responsible for axoal loss( G.A. Putzu et al, J. Neurol Sci, 2000).
Interferon-gamma, which is a stimulator of IL28A was also easily detected in the sural nerve of GBS patients. The role of adhesion molecules like ICAM in the immune process of GBS will be also discussed. The therapeutic approach of GBS is aimed to avoid death in the acute phase (respiratory failure in Landry paralysis, cardiac rhythm anomalies in disautonomia). The efficacy of plasmapheris and intravenous immunoglobulins in the treatment of GBS is nowadays clearly demostrated. The next frontier is the theoretical possibility to use monoclonal antibodies (i.e, anti-INF-gamma) as a therapeutic tool in GBS.
We also rewied the literature on GBS-like conditions that may clinically mimick GBS.
Biography:
Neurologist, Peter Silburn is a Professor of Clinical Neuroscience at The University of Queensland, Director of the Asia-Pacific Centre for Neuromodulation, and a world expert in the treatment and research of Parkinson's disease, related neurodegenerative disorders and Deep Brain Stimulation (DBS). Professor Silburn's work in DBS is changing the lives of patients with a wide range of diseases and conditions for whom standard medical therapies have not been effective, including patients with Parkinson's disease, Dystonia, Tourette's syndrome, Essential Tremor, and Post-stroke disorders.
Professor Silburn graduated from The University of Queensland in 1988 and commenced training in neurology at The Princess Alexandra Hospital, completing his training at Oxford in The United Kingdom at the Radcliffe Infirmary. He was subsequently the Clinical Lecturer in Neurology at the University of Oxford.
He then went to the Karolinska Institute, Stockholm, as a Research Fellow in the Department of Molecular Medicine. He returned to Brisbane in July 1996, commenced private practice and established affiliations with The University of Queensland.
He became full Professor in Neurobiology in 2006 and Foundation Professor of Clinical Neuroscience at the UQ School of Medicine in 2007.
Abstract:
- Neurology
Chair
Galina Mindlin
Mount Sinai, USA
Co-Chair
Ute-Christiane Meier
Queen Mary University London, UK
Session Introduction
Chia-Chun Chiang
Mayo Clinic, USA
Title: Pleural ‘drop’ metastasis 21 years after resection of a thymoma: A case report and review of the literature
Time : 12:05-12:30
Biography:
Chia-Chun Chiang is currently a neurology resident at Mayo Clinic in Arizona, USA. She received her MD degree from National Yang Ming University, Taipei, Taiwan in 2011, and completed a transitional year residency at Taipei Veterans General Hospital. She then worked as a Post-doctoral scholar at the Department of Neurosciences at University of California, San Diego, USA. She started her residency training at Mayo Clinic Arizona in 2014. He has published seven papers in reputed journals for her research in bio-photonics, neurosciences, clinical neurology and headache medicine. She has also presented at several international conferences in which she won Best Presentation Award and Best Paper Award.
Abstract:
We present an unusual case of multiple pleural drop metastasis 21 years after complete resection of an encapsulated thymoma in a Southeast Asian man with myasthenia gravis (MG). To the best of our knowledge, this is the longest reported disease-freeinterval of thymoma recurrence. A 43 year-old man with history of MG presented with a 9-month history of generalized weakness, fatigue and shortness of breath. After the initial diagnosis of MG 21 years ago, the patient underwent a complete resection of an encapsulated thymoma. His MG has reportedly been stable with cyclosporine, mycophenolate mofetil, and pyridostigmine. Due to his new symptoms, CT scan of the chest with contrast was done and revealed numerous pleural nodules surrounding the left lung
with basilar predominance and pleural thickening. The findings were concerning for “drop metastases”. CT-guided biopsy of a pleural nodule was done and the pathologic diagnosis was WHO type B1 thymoma. In the literature review, the average disease-free-interval for thymoma ranged from 68 to 86 months. Pleural and mediastinal recurrence are more common than distant hematogenous recurrence, although various presentations of thymoma recurrence have been reported. Adverse prognostic factors include an nitial higher Masaoka stage, incomplete resection, elderly age, and pleural or pericardial involvement. In patients with apparent complete resection of a thymoma, clinicians should remain vigilant for the possibility of thymoma recurrence for up to 20 years after initial management. Greater awareness
Amal Al-Hashmi
Royal Hospital Muscat, Oman
Title: Stroke is the second leading cause of mortality worldwide and is the most common cause of long term disability.
Time : 12:30-12:55
Biography:
Amal Al-Hashmi Graduated from Sultan Qaboos University(SQU) Oman , she completed her post graduate specialty in Neurology at McGill University, Montreal Neurological Institute and Hospital Montreal Canada. She currently works as Sr Consultant Neurologist and Head of Acute Stroke Unit at the the Royal Hospital Muscat . She is also Deputy Department of Neurology at the same hospital. Dr AlHashmi is a teacher for both under & post grad students and final MD examiner at SQU, in addition she is teacher and examiner at the Oman medical speciality board (OMSB ) . She is also the Vice president and the Chair Person Scientific Committee of Oman Medical Association form 2013 up to date . Dr Al-Hashmi Currently involved in multiple Stroke researchers.
Abstract:
Introduction: Stroke is the second leading cause of mortality worldwide and is the most common cause of long term disability. stroke in the young is particularly tragic because of long term disablement. More than 10% of patients with stroke are aged 55 years or younger . While specific definition of young stroke is lacking , the vast majority of authors ; stroke to pertain to individuals less than 45 years of age. However other extended it to 50. Etiologies and risk factors : Etiologies and risk factors for stroke in the young adults resemble those seen in elderly ; however the etiology is much more diverse in the young compared to old patients . Vasculopathies , cardiac, metabolic and hematological disorders are more commonly seen in ischemic stroke in the young . Whereas vascular malformation and drug abuse more commonly encountered in hemorrhagic stroke . This has therapeutical consequences and may affect outcome both in short and long term . This also may indicate separate approaches as to secondary preventive treatment. Differential diagnosis and Managements : The differential diagnosis of stroke is broad and further extended in the young because stroke may present with non specific symptoms and sings such as seizures and headache. In addition to standardized stroke management used in elderly , additional investigations, supportive and specific therapies should be considered based on the underlying etiologies. conclusion: Given the increasing incidence of stroke in the young. Stroke in the young adults are major public health and further researches are needed in order to reduce the burden and provide us with more precise epidemiologic data
Elis Eleutherio
Federal University of Rio de Janeiro, Brazil
Title: Oxidative Stress Response and Longevity: Learning from Yeast Lessons
Time : 12:55-13:20
Biography:
Elis Eleutherio has completed his PhD at the age of 32 years from UFRJ. She is the head of Laboratory of Investigation of Stress Factors (Laboratório de Investigação de Fatores de Estresse – LIFE) at Institute of Chemistry, UFRJ. She has published more than 60 papers in reputed journals and has supervised 10 PhD and 15 MSc theses.
Abstract:
Although aging is likely to be a multifactorial process, several evidences show that oxidative stress is connected to life span. Many questions remain unanswered: oxidative stress does indeed contribute to ageing; do ROS act purely as random, destructive agents or as regulators of pathways of stress response and ageing; is it the absolute level of oxidative stress or the response to oxidative stress, or a combination of both, that determines life span? Interest in the factors that determine longevity has increased since the life expectancy has increased and the world leading causes of death are age-related diseases, such as cancer and neurodegenerative diseases. The use of the yeast Saccharomyces cerevisiae as an experimental model in biochemical studies has enabled the understanding of basic cellular and molecular processes. Even taken into consideration the vast differences in complexity between yeast and humans, the study of ageing and oxidative stress response in yeast has provided key insights into pathways that modulate human longevity. The entire genome sequence of yeast has been elucidated and it is amenable to genetic modifications, which facilitates the identification of drug targeting genes or stress response pathways. A substantial portion of human protein-coding genes can actually substitute for that of the yeast. In addition, S. cerevisiae has similar antioxidant responses to mammals and 30% of known genes involved in human diseases have yeast functional homologues. So, we have using the yeast model to investigate the role of antioxidant defenses in cellular longevity and the molecular basis of neurodegeneration.
Frid Hajibonabi
Tabriz University of Medical sciences, Iran
Title: Correlation between Dysphagia and nutritional indicators in ischemic stroke patients at the time of hospital admission
Time : 14:10-14:35
Biography:
Farid Hajibonabi is a medical student at Tabriz University of Medical Sciences. He has started working on research projects since the first year of education and is still working on the projects related to neurological diseases. He is a member of student neuroscience committee of neuroscience research center in Tabriz University of medical sciences.
Abstract:
Dysphagia and poor nutritional status are common complications of stroke; however, possible associations between them are not well understood. Furthermore, it is necessary to perform a nutritional assessment of the patient in the early hours of admission, to determine both the nutritional status and the presence of dysphagia. So in this study, potential associations between dysphagia and nutritional indicators in patients with acute ischemic stroke at the time of hospital admission were evaluated. In this observational cross-sectional study, patients with ischemic stroke admitted to academic medical centers were enrolled. We studied 30 patients with stroke at the time of admission. The frequency of dysphagia and dysphasia grading score was evaluated. Nutritional indicators were assessed by knee height, mid arm circumference, triceps skin fold thickness, and calf circumference of all the admitted patients. The possible correlation between dysphagia and each parameter was evaluated. On clinical assessments 73.33% of patients demonstrated dysphagia. Dysphagia, was significantly associated with lower calf circumference (P<0.05), but not with other nutritional indicators (knee height, mid arm circumference, triceps skin fold thickness). To be concluded, Dysphasia is a prevalent problem in patients with acute ischemic stroke; however, it’s not associated with major nutritional failure at the time of hospital admission.
Paria Arfa-Fatollahkhani
Iran university of medical sciences, Iran
Title: Short-term and long-term effects of treadmill training on the balance, functional capacity and quality of life in patients with Parkinson disease- A randomized clinical trial
Time : 14:35-15:00
Biography:
Eugenia Tsoma is professor in Mansoura university Faculty of Medicine, Ukraine. He has published more than 10 papers in reputed journals and has been serving as an editorial board member of repute
Abstract:
Objectives: To evaluate the short-term and long-term effectiveness of treadmill training in improving functional capacity, balance and quality of life (QOL) for Parkinson disease (PD) patients.
Design: A prospective, randomized, single-blind clinical trial.
Methods: A total of 20 mild to moderate PD patients were randomly split in case (11) and control (9) groups. Both the groups were evaluated for 3 times; at the time of inclusion, 2 months and 4 months later. We assigned Time Up and Go test (TUG) and 6 minutes-walk test (6MW) for assessment of balance and functional capacity. Additionally, the SF-8 healthy survey was filled out in an interview conducted by the expert.
Intervention: Treadmill exercises were performed in 10 weeks (2sessions/week). The program have been applied at moderate intensity with 60% of heart rate reserved (HRR) in 30 minutes. Wilcoxon Signed Ranks test and Freidman test were applied for short-term and long-term follow up analysis, respectively.
Results: Balance and functional capacity were significantly improved in case group after the intervention (TUG P value: 0.003, 6MW P value: 0.003). Moreover, long-term analysis revealed significant results as well (TUG P value: 0.001, 6MW P value: 0.004). Mental condition scores of SF-8 in cases were not statistically different in short-term follow up. However, analysis illustrated P value: 0.016 for long-term assessment. The intervention induced significant changes in physical condition scores in both follow ups (PC P value: 0.013).
Conclusion: This study provides considerable benefits of treadmill training in balance, functional capacity and QOL for PD patients.
- Neurological Disorders & Neurosurgery
Chair
Giovanni Antioco Putzu
Casa di Cura Sant’Elena, Italy
Session Introduction
José L. Ochoa
Oregon Nerve Center, USA
Title: The IASP’s nick-“diagnosis†of CRPS-I, together with its attempted divination in Budapest, must be interred.
Time : 15:00-15:25
Biography:
José L Ochoa is a Specialized Academic Neurologist. He has written hundreds of peer reviewed articles, book chapters, and two books. He has successfully identified two syndromes of Neuropathic Pain. He has done his MD from Catholic University in 1961. He has done his PhD and DSc from University of London.
Abstract:
Our current IASP President led a distinguished group, who based on science and courage, redefined “neuropathic pain” in 2008, but were reminded that such transparency excluded CRPS-I. Current authorities who agreed on this are Past President; rejuvenated IASP taxonomists; (the AMA always agreed) and now, the E.N.S. CRPS-I hypothesis (former “RSD” and “SMP) features include that there is no structural pathology; no diagnostic test; the “objective signs” are non-specific, often reflect disuse or self-infliction; and some are willful behaviors. Pain experts admit that “for diagnosis we don’t use Evidence, we use our default criterion #4” because such perversion of the falsifiability principle (the one that allows scientific diagnosis (Popper)) is unfalsifiable (alternative diagnoses are not eliminated) i.e., it cannot be proven false and this is termed as Pseudoscience. The default position, one that cannot be proven false, also fits the null hypothesis which can never be proven correct (the data can only reject or fail to reject it (Fisher)). Topics that will be presented are: Symptoms, signs and laboratory in RSD/CRPS; S.W. Mitchell excludes the great sympathetic” from “Causalgia; The invention of “RSD” by Evans; R.Verdugo exposes placebo in faulty “diagnostic sympathetic blocks”: SMP and RSD die; M.Campero rules out sympathetic activation of C nociceptors in CRPS (microneurography); Science of abnormal human nerves as impulse generators; Neurologists sort true versus Pseudoneurological display which are Psychogenic; The nick-“diagnosis” of “CRPS-I”, as applied by non-neurologists to pseudoneurological patients: iatrogenic harm; Hysterical versus malingered CRPS; and what is wrong with the Budapests? This lecture outline will survey sensation, receptor to brain, where psyche lives.
Biography:
Mohamed ELSherif has completed his MD and PhD from Mansoura University School of Medicine, Egypt. He is the coordinator of Post-graduate and undergraduate medical students. He has published more than 17 papers in reputed journals and has been serving as a reviewer member of many neurology journals. He has received the first Best Master Thesis Mansoura University 2007, second junior travelling fellowships from the World Federation of Neurology 22/4/2009 to attend the 13th EFNS in Florence-Italy to present the poster of MD thesis.
Abstract:
Background: The GIT infection with Helicobacter pylori (HP) can inhibit levodopa (LD) in Parkinson's disease (PD) patients leading to motor fluctuation.
Objectives: To identify the incidence of HP in PD patients compared to healthy controls and its effect on motor fluctuation, response to treatment and quality of life.
Patients & Methods: Serum IgG Abs against HP urease were detected using ELISA, we monitored and compared incidence of HP infection in PD patients and controls. We compared the PD with positive HP (PD positive) and PD with negative HP infection (PD negative) regarding clinical features, the Unified PD Rating Scale (UPDRS) scores, Hoehn and Yahr Stages (H and Y) stages, PD Questionnaire for the quality of life (PD NMSQuest), and PD non-motor symptoms Questionnaire (PD-Q39).
Results: Fifty Egyptian PD patients were included. Forty-six percent were HP positive with a significant difference to control group (46% and 20% respectively, P=0.043). In PD positive, the total UPDRS and PD-Q39 scores, were significantly higher in comparison to PD negative (p<0.005 and p<0.001 respectively). The differences were not significant in the total PD NMSQuest score, and H and Y stages in both groups. The LD onset period was significantly greater in PD positive by nearly 14 minutes in comparison to PD negative. There was significantly prolonged on-duration time in PD positive in comparison to PD negative.
Conclusion: There is a high incidence of HP infection in PD and HP affects the response to LD that can deteriorate motor manifestations and the quality of life.
Giovanni Antioco Putzu
Casa di Cura Sant’Elena, Italy
Title: Palmitoylethanolamide trial on Charcot-Marie-Tooth (CMT) Neuropathy
Biography:
Giovanni Antioco Putzu is working as professor in Neurology and Clinical Neurophysiology in Casa di Cura Sant’Elena, Italy. He has published more than 40 papers in reputed journals and has been serving as an editorial board member of reputed scientific journals.
Abstract:
CMT is one of the most commonly inherited neuromuscular diseases, with prevalence of approximately 1 in 2,500 persons. Clinical complains are mainly represented by muscle pain, sensation of fatigue and painful muscle cramps. No treatment of clinical symptoms is available yet. Previous treatment with high dosage of vitamin C failed to confirm a benefit in humans. A clinical open trial has been performed in order to evaluate the efficacy of ultramicronized palmitoylethanolamide (PEA-um®). Twenty-two patients (7 male and 15 females) from four different CMT families were treated with PEA-um® at dosage of 1200 mg/day for 80 days (Normast ®, Epitech Group srl, Saccolongo, Italy). None of the patients had an add-on treatment for the clinical symptoms. Muscle pain, fatigue and muscle cramps were assessed at T0 (baseline), T1 (20thday) and T2 (80th day) using Visual Analogic Scale (VAS). Muscle strength, vibratory sensation and Motor/Sensory nerve Conduction velocities were also assessed with the same schedule. Mean values of VAS for muscle pain at T1 decreased from 5.9±2.1 to 3.9±1.7 (p<0.0001), whereas VAS for fatigue decreased from 6.3±2.4 to 3.4±1.6 (p<0.0001). VAS score for painful cramps at T1 diminished from 5.4±1.2 to 3.8±1.3 (p<0.0001). A further improvement of VAS scores for muscle pain, fatigue and painful cramps was observed at T2 evaluation. These data strongly suggest that PEA-um® is effective in improving clinical symptoms of CMT neuropathy, albeit the obvious limitation of an open study.
Chaonan Yang
China Medical University, Republic of China
Title: To assess the effectiveness of acupuncture in acute ischemic stroke patients using three neurologic function test and heart rate variability: A pilot cohort study
Biography:
Chaonan Yang has completed his Master's degree from Graduate Institute of Integrated Medicine, China Medical University, Taiwan, ROC. He is currently the attending physician of neurology, in China medical University Hospital, Taipei branch.
Abstract:
Stroke cause impairment, and also cause care burden and social cost. Patient seeking other therapy for regain their limbs weakness or spasticity, like acupuncture. Although acupuncture in post-stroke patient can relieve some function, but there is still controversial in conclusion. In acupuncture group, patients received three times a week, 2 weeks with total 6 times body acupuncture (7 sets acupoints) treatment. Data was collected by evaluation 3 neurologic deficit score or activity functional score (NIHSS, BI, mRS) before and 4, 8, 12 weeks after the intervention. HRV data were collected before and after each acupuncture interventions in acupuncture group. We enrolled 56 subjects. The results (1) In the measurement of 3 neurologic score (NIHSS, BI, mRS), there were no significant in NIHSS score in baseline, and has significant improvement in NIHSS score in control group since the 2nd day, and keep significant in the 3rd day, 7th day, 14th day and the 21th day, than back to no significant improvement in NIHSS score comparing acupuncture and control groups in the 28th day, the 56th day and the 84th day. There were no significant improvements in BI and mRS scores comparing acupuncture and control group in all comparing days. We noted the worsening of NIHSS score within 3 days in acupuncture group, and returned to no difference with control group in 4 weeks later, it is a indirect evidence that a trend of improving neurologic deficit (NIHSS score) after acupuncture treatment compare to control group.
Sarah Hasan Siddiqui
Aga Khan University Hospital, Pakistan
Title: Bilateral polyradiculitis following epidural analgesia with bupivicain
Biography:
Sarah Hasan Siddiqui completed MBBS in 2010 from Dow University of Health Sciences, one of the renowned Universities of Karachi, the largest city of Pakistan. She has joined the Aga Khan University Hospital residency program in 2012 and currently working as Chief Resident Neurology in this institution.
Abstract:
A 42 year old male developed rapid onset bilateral leg weakness following epidural analgesia which he was receiving for post-operative pain control. He had undergone partial Gastrectomy for locally advanced gastric carcinoma. On examination he had bilateral flaccid paralysis of legs, areflexia in lower limbs and variable sensory impairment up to T 9 dermatome. MRI spine did not reveal any compression initially. Nerve conduction study demonstrated abnormal motor NCS with either no response or very low amplitudes in lower limbs. Repeat MRI spine after 4 weeks demonstrated thickening and enhancement of cauda equina nerve roots representing radiculitis. Patient is currently bedbound with no significant improvement in his neurological status.
Shin-Han Tsai
Taipei Medical University, Taiwan
Title: Prehospital management of head injury patients in emergency air medical transport (EAMT)
Biography:
Shin-Han Tsai has completed his PhD from School of Medicine of Universtiy of Cincinnati, USA. He is the Director of Department of Emergency and Critlcal Care Medicine in Taipei Medical University Shuang Ho Hospital. He is also the Executive Medical Director in National Aeromedical Approval Center of Taiwan Executive Yuan, a government-funded program. He has published more than 100 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
Emergency air medical transport (EAMT) has become a major part of the modern trauma care system and is frequently used to transport patients from remote islands to a tertiary center. Data of all patients with traumatic brain injury and underwent EAMT were retrospectively retrieved from National Aeromedical Approval Center (NAAC). Patient data were analyzed by using the following parameters: age, gender, injury of severity score, and outcome within three days after air transport. Between Oct 01, 2002 to Dec 31, 2015, there were 4057 EAMS requests from the four major remote islands to Taiwan Main Island. Among them, 3520 were approved (approval rate: 86.8%). Among the 3520 patients, 458 sustained head injury. Male predominates in the head injury patient populations(M:F=2.7:1). Patients between 21 and 30 years old comprised the majority (23%). There was higher percentage of moderate to severe head injury patients compared with ground transport. Moderately injured patients comprised 25%(115 patients) and severe head injury patients comprised 27%(124 patients). Of these moderate and severe injury patients, 28% were intubated. Mannitol ( or Glycerol) was routinely used. Thirty patients expired within seven days after air medical transport. These findings demonstrated that airway maintenance is a key factor for traumatic brain injury patient transport both in air and ground