35^th European Neurology Congress June 14-15, 2021 London, UK

Biography:

Roopa K.G is a graduate in Neurology with qualified skills in diagnosis management and prognosis of diseases related to brain, spine, nerves and muscles .I have undergone an efficient training in subspecialities such as stroke, neuromuscular disorders, demyelinating disorder electrophysiology and epilepsy. I am also trained in general medicine from reputed government collage (BMC &RI ) Bengaluru. I have an experience working as general physician for few years with good reviews .

Abstract:

Background and objectives: Acute encephalopathy is common in a broad spectrum of critically ill patients and is strongly associated with hospital mortality and short and long term cognitive impairment in survivors. There are many risk factors including hypoxia, dysglycemia, hypotension, sepsis and metabolic derangements along with preexisting cognitive impairment and severity of their primary illness which contribute to poor neuropsychological and functional outcome in these patients. Objective is to study the clinical features and outcome of acute encephalopathy in 75 critically ill patients admitted with various primary illnesses other than primary CNS illness, admitted as inpatients with regular follow up over a period of at least 3 months. Materials and Methods: 75 critically ill patients admitted in manipal tertiary care center, old airport road Bengaluru, were involved in this study after applying inclusion and exclusion criteria. The duration of the study was from June 2015 to December 2016. It was a prospective study where in clinical features and various risk factors contributing to neuropsychological and functional outcome of these patients were studied in detail, with follow up period of about 3 months. Results: It was observed that 60% of them were males and 40% were females. Mean age of our patients was 60 years. Out of 75 patients, 34 (45.3%) had second visit or early mortality. Among the sample studied 35 (46.6%) had septic encephalopathy where as 9.3% had viral encephalopathy, hepatic encephalopathy, uremic encephalopathy each. During the second visit among survivors of 41 patients, 33(80.4%) of them had impaired MMSE and 26.9% had features of depression .33.3% of patients in the age group above 80yrs had features of depression compared to other younger age groups. During the third visit (after 3months) majority of older age group had poor functional outcome as measured by MRS grading compared to the younger age with statistical significance (P<0.001).And also during this visit it was observed that older age groups had cognitive dysfunction (with ACE below 82) with statistical significance (P <0.001) in other words 65% of those surviving patients with cognitive dysfunction (ACE below 82) were in the age group 61-80years.Conclusion: There is an increasing prevalence of acute encephalopathy in critically ill patients. Risk factors like hypotension, older age groups and sepsis and prolonged hypoxia, dysglycemia are associated with poor neuropsychological and functional outcome. Early recognition of these risk factors and necessary timely measures to avoid them may help to reduce global burden associated with this illness.

Biography:

Bashir A Sanaie (DM, Neurology) is working as Assistant Professor and Head, Department of Neurology, Superspeciality Hospital of Govt. Medical College, Srinagar (J&K) India. Has expertise in dealing with patients of neuroinfections and is founder of Multiple Sclerosis Support Group of Kashmir. He has keen interest in patients’ awareness programs in addition to my own work as a consultant neurologist. Has been recently conferred Medical Excellence Award and Gold Medal by Indian Solidarity Council, International Award for Rising Talent in Nepal.

Abstract:

Longitudinal extensive transverse myelitis (LETM) is defined as a spinal cord lesion that extends over three or more vertebrae, as seen on MRI of the spine. Our case is a 50 year gentleman who presented with history of severe radicular pain in the upper back followed by weakness of all four limbs for two months associated with paresthesias, urinary retention and constipation. Neurological examination revealed quadriparesis with sensory level at T1, hyperreflexia and extensor plantar response. MRI of the spinal cord showed longitudinally extensive T2 lesions /hyperintensities extending from C1 to the conus medullaris. Cerebrospinal fluid examination revealed mild lymphocytic pleocytosis (20 cells) with normal sugar (53mg/dl) and raised protein (61mg/dl). CSF staining, MTB-PCR, VDRL were negative. MRI Brain was normal. Anti NMO panel (anti-Aquaporin 4 antibody and anti- MOG antibody) was negative. ANA, anti- Ro/anti- SSA and anti-La/anti-SSB were positive and anti-ds DNA was negative. Schirmer test was positive in both eyes and lip biopsy revealed focal lymphocytic sialoadenitis. A final diagnosis of LETM secondary to Sjogren’s syndrome was made. The patient was treated with intravenous methylprednisolone 1gm daily for five days. As there was no clinical improvement patient was initiated on plasmapheresis @ 250ml/kg in five sessions over a period of 10 days. Following this patient showed partial recovery in symptoms. LETM is a characteristic feature of neuromyelitis optica (NMO) but such spinal lesions can also occur in systemic autoimmune diseases like Sjogren’s syndrome.

Biography:

Jidhin Raj has completed his Neuroloy training from the prestigious Government Medical College Kottayam. He is presently the Senior resident in Neurology in the same college. He has won various prizes in Quizes and is an avid reader. His special interests include Neuropthalmology and Movement disorders. He is one of the reviewers of Neurology Journal pulished by American Academy of Neurology.

Abstract:

Introduction:- Frontal lobe dysfunction is a predominant feature of progressive supranuclear palsy however it can be present in other parkinsonism syndromes also. The frontal assessment battery (FAB) is a brief tool developed to assess frontal lobe functioning at bedside. Objective: To assess the frontal lobe functions in patients with Parkinsonism syndromes. Methods: 110 study subjects who fulfilled the inclusion and exclusion criteria were included in the study over a period of 10 months They were clinically evaluated for frontal lobe dysfunction using the FAB battery during the ON and OFF period. Collected data was coded and entered in Microsoft Excel and data was analyzed using SPSS software version 20. Results : The mean MMSE score of the population during the ON and OFF period was 25.09 +/-1.8 and 25.05+/- 0.8. In terms of FAB scores, the mean value of the study population during ON and OFF periods were 11.18+/- 2.9 and 10.95+/- 2.8 respectively. The mean difference between the FAB scores during the ON and OFF period was 0.24 which was statistically significant (p=0.018). There was significant difference between the frontal lobe dysfunction during the ON and OFF period (p <0.05). Conclusion: Frontal lobe dysfunction during the ON period was found in 54.5% of the total study population In the OFF period 60% of the total study population had frontal lobe dysfunction. The maximum dysfunction was found in PSP and minimum in CBD during both ON and OFF period.

Biography:

Jidhin Raj has completed his Neurology training from the prestigious Government Medical College Kottayam. He is presently the senior resident in Neurology in the same college. He has won various prizes in Quizes and is an avid reader. His special interests include Neuropthalmology and Movement disorders. He is one of the reviewers of Neurology Journal published by American Academy of Neurology.

Abstract:

Women with epilepsy (WWE) face specific challenges throughout their lifespan due to the effects of seizures and antiepileptic drugs on hormonal function, potentially affecting both sexual and reproductive health, awareness of these gender-specific issues and implementation/adaptation of effective interventions for WWE results in significantly improved health-related quality of life in this patient population. Although sex ratios in the epidemiology of epilepsy are not fully established, there appears to be a slight gender difference in the prevalence of different epilepsy types, such as idiopathic generalized epilepsy and childhood absence epilepsy (2–5 times more common in girls than boys) and juvenile myoclonic epilepsy (1.5 times more common in girls than boys). In a study conducted in India, more than half of WWE concealed their history of epilepsy prior to their wedding, fearing social stigma and breakdown of the marriage negotiations. Management of epilepsy in women requires not only knowledge of epilepsy, but also recognition of the various roles and priorities women have in their lives (education, career development, child rearing, the role as carer within the extended family), and attention to gender-specific issues and their impact on patients’ wellbeing throughout life catamenial epilepsy refers to exacerbation of seizures during different phases of the menstrual cycle in women with pre-existing epilepsy. Catamenial epilepsy can affect one third to one half of WWE and it is reported that up to one third of female patients with intractable complex partial seizures may have this condition. There exist complex, multidirectional interactions between female hormones, seizures and AEDs. Most hormones act as neurosteroids and can thus modulate brain excitability via direct binding sites. Any changes in endogenous or exogenous hormone levels can affect the occurrence of seizures, either directly or via pharmacokinetic interactions that modify the plasma levels of AEDs. The most common reproductive endocrine disorder in WWE is PCOS, a condition characterized by hyperandrogenism, multiple ovarian cysts, anovulatory cycles, hirsutism and obesity. The prevalence of PCOS in WWE has been estimated at between 4% and 19%. Most studies suggest an increased incidence of PCOS in women taking valproate as opposed to carbamazepine or lamotrigine. Although WWE often express concerns about worsening seizure control during pregnancy, converging evidence from multiple studies shows that seizure activity during gestation is unchanged from pre-pregnancy baseline in more than half of cases. In the European and International Registry of Antiepileptic Drugs in Pregnancy, 64% of WWE reported no change in seizure control from the first trimester to the following two trimesters, with 93% of these women being seizure free. It is reported that in the menopause, 40% of WWE can experience a worsening of seizure frequency, whereas up to 27% may go into remission.Psychiatric comorbidity is high in patients with epilepsy often as a result of AED treatment. The overall prevalence rate of psychiatric conditions in epilepsy ranges between 20–30% and 50–60%, according to different estimates.

Biography:

Iftach Dolev is a Neuroscientist and an entrepreneur. He completed his PhD and Post-Doctoral fellowship at the Tel-Aviv University in the field of Neuroscience during which he specialized in electrophysiology and non-invasive brain stimulation at Harvard Medical School. Iftach is the co-founder and CEO of QuantalX Neuroscience developing the DELPHI technology, the first bed-side tool for the evaluation and monitoring of brain function in health and disease using direct, non-Invasive, patient independent brain Network Electrophysiology.

Abstract:

The disruption of normal patterns of structural brain connectivity is believed to play a central role in the pathophysiology of many neurological and psychiatric disorders, such as, dementia, movement disorders, stroke, traumatic brain injury (TBI) etc., particularly, white matter changes lay in the heart of the onset of many pathologies. Traditional brain imaging technologies are expensive, inaccessible, and fail to provide actionable insights regarding brain network health. Therefore, there is a huge need, for a simple, precise and accessible tool that objectively evaluates brain functional status. DELPHITM is an active system for the visualization of brain health. It is a proprietary acquisition and analysis AI based algorithm that interfaces with available ‘Off-the-Shelf’ hardware to enable direct stimulation and monitoring of the brain (TMS-EEG). DELPHI’s output measures, which are indicative for several electrophysiological features were significantly different between, age defined groups as well as mild Dementia patients and age matched healthy controls. In a multidimensional approach the DELPHI output measures ability in identification of brain white matter fibres connectivity damage in stroke and traumatic brain injury (TBI) was tested. DELPHI output measures were able to classify healthy from unhealthy with a balanced accuracy of 0.81±0.02 and AUC of 0.88±0.01. additionally, DELPHI output measures, differentiated successfully, between cerebral small vessle disease (cSVD) diagnosed subjects and age matched healthy controls, with AUC of 0.88 (p<0.0001), sensitivity of 0.83 and specificity of 0.75. These results indicate DELPHI as a possible aid for early detection of white matter integrity and pathologies.

Biography:

Abstract:

Introduction: The respiratory manifestations of coronavirus disease 2019 (COVID-19) are well-reported, but recent evidence implicates the nervous system in the pathogenesis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This study aims to summarise the clinical characteristics associated with patients whose cerebrospinal fluid (CSF) tested positive for SARS-CoV-2, to provide clinicians with a better understanding of the neurological involvement of COVID-19 from a clinical and diagnostic perspective. Methods: A comprehensive search of PubMed, EMBASE, Scopus, WHO Coronavirus database, bioRxiv, medRxiv, and Web of Science databases was carried out. Original studies reporting positive RT-PCR SARS-CoV-2 tests on CSF samples were included. Key search terms encompassed all variations of “COVID-19” AND “cerebrospinal fluid”.

Results: 525 studies were identified through the systematic search. 56 full-text articles were included and assessed for eligibility post abstract screening and deduplication, of which 13 were qualitatively analysed. A total of 14 patients were reported to test positive for SARS-CoV-2 in their CSF samples. In 21.4% (3/14) of cases, nasopharyngeal (NP) swabs tested negative despite a positive CSF sample. 14.2% (2/14) of positive cases as per NP swab tested negative after supposed recovery, but progressed to neurological deterioration and positive CSF tests. Most commonly reported symptoms included headache (6/14), fever (5/14), vomiting (4/14), cough (4/14), visual disturbances (4/14), diarrhea (3/14), and seizure (3/14). 28.6% (4/14) of patients were admitted to ICU, and 14.2% (2/14) expired.

Conclusion: It is important to consider the neurological manifestations of COVID-19 even in the absence of a positive NP swab test. Additionally, SARS-CoV-2 RT-PCR tests of CSF samples may prove to be a beneficial diagnostic modality in the case of COVID-19 nervous system involvement. In order to establish informed guidelines, further evidence is needed to understand the clinical implications of CSF tests in COVID-19 patients.

Biography:

Abstract:

It has been long established that inflammation plays a role in the pathophysiology of cerebrovascular diseases. Colchicine is a low-cost anti-inflammatory drug used commonly in clinical practice for gout and pericarditis. Recent clinical trials have demonstrated that colchicine has a beneficial effect in reducing composite cardiovascular outcomes. These composite outcomes include stroke incidence in the study populations. We conducted a systematic review and meta-analysis to study the effect of colchicine in preventing stroke in patients with coronary artery disease. We systematically reviewed 8 RCTs, and meta-analysed 7 RCTs, including a total of 12270 patients (colchicine group: 6152, control group: 6118; mean age in colchicine group=60.9±9.6, control group=63.3±9.6) with a following up ranging from 31 days to 36 months. There is a statistically significant reduction in risk of incident stroke in patients with a history of symptomatic CAD in the colchicine compared to the control group (placebo or no treatment) (risk ratio 0.5 (95% CI 0.31-0.81); p = 0.005) without heterogeneity across the analysis (I2 = 0%; P for Cochran Q = 0.48). Colchicine treatment in addition to standard therapy in patients diagnosed with ACS (≤30 days) was statistically significant in reducing stroke incidence compared to control groups (risk ratio 0.37, (95% CI 0.17-0.80); I2 = 0%; p = 0.01). There was no statistical significance in risk of stroke in patients with CCS in the colchicine compared to the control group (risk ratio 0.61, (95% CI 0.45 0.33-1.12); I2 = 0%; p = 0.11). Colchicine prevents stroke in patients with coronary artery disease, with a larger effect in acute coronary syndrome compared to chronic coronary syndrome. 227 and 193 patients with CAD and ACS respectively, need to be treated with colchicine to prevent 1 event of stroke over a follow-up timeline of 24.2 months. Timing of treatment, history of previous stroke, PCI incidence, dosing and follow up duration are factors worth evaluating in future studies to determine suitability of colchicine for clinical use.

Biography:

Raffaele Pilla, Pharm.D., Ph.D., Doctor Europaeus, received his Master’s degree in Pharmacy at G. d’Annunzio University in Chieti-Pescara, Italy in 2005, where he also served internships at the Cell Physiology Laboratory and Molecular Biology Laboratory. Prior, he was an Erasmus Student at Faculté de Pharmacie de Reims in Reims, France. He received his Doctor Europaeus in 2010 from Pitié-Salpétrière Institute in Paris, France. Also in 2010, he received his Ph.D. in Biochemistry, Physiology, and Pathology of Muscle at G. d’Annunzio University in Chieti- Pescara, Italy. He was hired as a Postdoctoral Scholar in the Department of Pharmacology and Physiology at the University of South Florida in Tampa, on two research grants funded by the Office of Naval Research (US Navy) and Divers’ Alert Network. He has written and lectured widely worldwide. He has been involved in ongoing research at the University of South Florida with the use of ketone esters.

Abstract:

Nutritional ketosis is effective to contrast seizure disorders and other acute and chronic neurological disorders. Glucose is the primary metabolic fuel for cells, however many neurodegenerative disorders have been recently associated with impaired glucose transport and metabolism causing energy deficits, such as in Alzheimer’s disease, Parkinson’s disease, general seizure disorders, and traumatic brain injury. Ketone bodies and tricarboxylic acid cycle intermediates can bypass the rate-limiting steps associated with impaired neuronal glucose metabolism. After prolonged periods of fasting or ketogenic diet (KD), the body utilizes energy obtained from free fatty acids (FFAs) released from adipose tissue. Hepatic ketogenesis converts FFAs into ketone bodieshydroxybutyrate and acetoacetate, while a percentage of acetoacetate spontaneously decarboxylates to acetone. This represents a state of normal physiological ketosis and can be therapeutic. Therapeutic ketosis leads to metabolic adaptations that may improve brain metabolism, restore mitochondrial ATP production, decrease reactive oxygen species production, reduce inflammation, and increase neurotrophic factors’ function. It has been shown that KD mimics the effects of fasting and the lack of glucose/insulin signaling, which promotes a metabolic shift towards fatty acid utilization. KD can only induce a modest blood ketone level elevation and requires extreme dietary carbohydrate restriction for maintaining sustained levels of ketosis. Prior to the advent of exogenous insulin for the treatment of diabetes mellitus in the 1920’s, general guidelines for therapy were represented only by dietary modifications. For example, Dr. Elliot Joslin’s Diabetic Diet in 1923 consisted of “meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, tea” and contained approximately 5% of energy from carbohydrates, 20% from protein, and 75% from fat. A similar diet was advocated by Dr. Frederick Allen. The aim of this work is to analyze the current literature on therapeutic ketosis and its successful clinical applications in diabetes type I and II.