Day 1 :
Keynote Forum
James Montgomery Barber
The Royal London Hospital, UK
Keynote: Neuromodulation techniques for disorders of cognition and behaviour
Biography:
James Barber qualified with MB BS from University College London in 1999. He has been working in Neurosurgery since 2005, having been a Consultant in The Royal London Hospital for the past 2 years. His main areas of practice are: Neurotrauma (specifically the management of patients with prolonged post-traumatic disorders of consciousness), Neuromodulation (Epilepsy and Affective Disorder), Complex CSF-Flow Disorders and Craniofacial Reconstruction. He has published the first case series in the U.K. of the implantation of a wireless intracranial pressure monitor and is setting up a trial to look at the potential benefits of VNS in minimally conscious subjects.
Abstract:
Neurosurgery to modify behavior is known to have been in practice for thousands of years. It was more than likely that for the majority of this timespan the success of any such interventions were those for either space-occupying tumours or blood clots. In the 20th Century, the disastrous forays into disconnecting ‘aberrant circuits’ in the brain, although initially performed with the best of intentions, set back surgical modification of behaviour back to its neolithic roots. With the more recent advent of advanced imaging modalities, connectomics and methods for stimulating brain structures, neuromodulation has seen a resurgence in efficacy for treating cognitive disturbance, heralding a new era of highly specific therapies for refractory neuropsychological conditions. In this talk, we will be looking at the various treatments currently available and discuss potential techniques that could prove to be revolutionary in the decades to come.
Keynote Forum
Philip Anthony McMillan
Hull and East Yorkshire Hospitals NHS Trust, UK
Keynote: Dementia is a disease of the ependymal layer: Novel theory from looking at cognitive impairment in multiple sclerosis.
Time : 10:40-11:20
Biography:
Dr Philip McMillan is a Consultant in the NHS with over 23 years of medical expertise. His primary focus has been around Geriatrics and Neurological Rehabilitation and has developed unique perspectives on the capacity of the brain to recover from injuries and disease. Through international collaboration he has proposed a nutritional protocol for dementia reversal and has recently had a breakthrough theory on the pathology of dementia. His current aim is to lead the field of dementia to a new direction of research and treatment of this devastating disease.
Abstract:
The intricacies of dementia are explored in relation to varied studies on brain atrophy in multiple sclerosis and used to delineate the primary pathology of the latter.
The theory examines the high frequency of cognitive impairment (Jongen 2012) in Multiple Sclerosis and its early manifestation during the disease. The fact that there is associated brain atrophy cannot be explained by the degree of damage to neurons. (Carlos 2015) noted a 5 to 10 times greater rate of atrophy in Multiple Sclerosis.
The cognitive changes with Multiple Sclerosis are then correlated embryologically to the subependymal zone (Kazanis 2009) explaining the pathology of brain atrophy and why we have not made more progress through research.
Our understanding of the blood CSF barrier and the brain CSF interaction is poorly understood and probably holds the key to the symptoms of dementia (Erikson 2013). This interaction between the CSF and brain interstitial space is coordinated by the ependymal and subependymal zone of the brain.
This is a novel concept that will aim to explain the links of all forms of dementia, as well as directing fertile areas for research.
- Neuropsychiatry | Neurological Disorders | Neuro Oncology
Location: Tokyo, Japan
Session Introduction
Amani Osman Hassan
Cardiff University, UK
Title: The overlap and co-occurrence of Neurodevelopmental and psychiatric disorders in children with mild intellectual disability: A UK study
Biography:
Abstract:
Biography:
Dr. Pawan Rajpal completed his bachelor’s in medicine from Mumbai in India and followed this by a Post Grad diploma in Psychological Medicine. He further trained in London finishing his Membership of the Royal college Of Psychiatrists and further specialized in Psychiatry of Intellectual disability. He has been practicing for last decade in prestigious Harley Street in London and at Priory group, working with people with Neuro developmental disorders, specializing in diagnosing and managing complex cases.
Abstract:
Prevalence of ADHD in childhood and persistence of symptoms in Adulthood. The history of the diagnosis, ADHD through the life cycle, the myths that surround ADHD will be discussed. The treatments available options available, the protocols used in UK, the NICE Guidelines, and the research discussed.
75% of children diagnosed with ADHD in childhood have symptoms that continue to cause morbidity in adulthood. How the symptom profile can change as the person grows and the brain matures. The characteristic problems seen in Adults, who have ADHD.
The impact on health systems and society in terms of financial implications will presented. What is different in treatment protocols in children and in adults. Stimulants, non-stimulant medications. The effects, side effects and compliance issues. Drugs used in past to treat ADHD and potential side effects and monitoring requirements.
Comorbidity is frequently seen with Alcohol and drugs. Mental illness can also co occur in forms of depression and anxiety. The causes and probable treatment options of these comorbidities will be presented.
The executive function deficits associated with the diagnosis and the day-to-day difficulties that present themselves. The adaptations that might help with these issue so as to empower patients to take control of their diagnosis.
Treatment options available and expected outcomes. Discussion of different stimulants, the pharmacology and side effect profile. We will discuss the basis of choosing a specific subgroup of medications and what to expect.
Psychological aspects of treatment and how they need to be presented differently for somebody with ADHD will be presented.
James Montgomery Barber
The Royal London Hospital, UK
Title: Normal pressure hydrocephalus: A treatable form of dementia
Biography:
James Barber qualified with MB BS from University College London in 1999. He has been working in Neurosurgery since 2005, having been a Consultant in The Royal London Hospital for the past 2 years. His main areas of practice are: Neurotrauma (specifically the management of patients with prolonged post-traumatic disorders of consciousness), Neuromodulation (Epilepsy and Affective Disorder), Complex CSF-Flow Disorders and Craniofacial Reconstruction. He has published the first case series in the U.K. of the implantation of a wireless intracranial pressure monitor and is setting up a trial to look at the potential benefits of VNS in minimally conscious subjects.
Abstract:
The World’s population is aging at a dramatic rate. The number of persons aged 60 or above is expected to more than double by 2050 and more than triple by 2100. As a result, the proportion of humans with age-related cognitive decline will literally ‘explode’, creating a massive financial and productivity burden that could be catastrophic to global economies. Whilst the underlying mechanisms aetiological in precipitating such decline are poorly understood, there are a subset of patients who respond favourably to a neurosurgical intervention that shunts cerebrospinal fluid from the brain into the abdomen. In this talk we will look at some of the theories behind how this condition develops, current techniques to treat it and potential future therapeutic directions that may have applications across the whole spectrum of cognitive disorders in the elderly.
Biography:
Dr Karanikas Evangelos, is a military psychiatrist servicing in 424 General Military Hospital of Thessaloniki, Greece. Head of the Research and Education Department of the Psychiatric Clinic. Scientific Associate of 2nd University Psychiatric Department, Aristotle University Thessaloniki, Greece. Research Fellow of Melbourne Neuropsychiatry Center, Australia and Lecturer in Rural Medical School, Toowoomba, University of Queensland, Australia. His research interests focus on neuro-endocrine and immunological mechanisms in Psychosis.
Abstract:
The aim of the presentation is to report on our laboratory’s work regarding neuro-endocrine, neurotrophin and immune parameters especially focusing on early psychosis. Thus, 4 study groups were involved, the Ultra High Risk for Psychosis (UHR), First Episode Psychosis (FEP), Healthy controls (HC), and Chronic Schizophrenia patients (CHRON). We measured serum cytokines, Interleukin, (IL),-1a, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17A, Tumor Necrosis Factor-a (TNF-a) and Interferon-γ (IFN-γ), as well as the neurotrophin Insulin Growth Factor (IGF)-1. We also measured serum cortisol levels at 3 time points and performed the Dexamethasone Suppression Test (DST) plus psychometric evaluations. Our first study involved the direct comparison between FEP and UHR groups. The results showed higher levels of both pro-inflammatory (TNF-a,IL-2,IL-12,IFN-γ) and anti-inflammatory (IL-10) cytokines in the FEP group without significant alteration regarding the HPA axis function. Subsequently, in a 2nd study, we implicated an additional third group (HC). The results suggest that the FEP group presented increased both pro-inflammatory cytokines (TNF-a, IFN-g, TNF-b) the anti-inflammatory cytokine (IL-4) compared with HC. The UHR showed increased IL-4 against only the HC. Finally, in a third study we additionally recruited a CHRON group. UHR group presented increased IL-4 levels compared with the rest groups. The findings favor a hypothesis of an increased mobilization of both the pro-and anti-inflammatory cytokine networks, in full blown psychosis compared with both normality and the pre-psychotic stage. IL-4 appears to play a significant role at prodrome. Cytokines rather than endocrine and neurotrophin markers represent a promising field in early psychosis.
Rumi Suzuki
Brain Spa Co. Ltd, Japan
Title: Introduction of NeurOptimal® nonlinear dynamical Neurofeedback™ system
Biography:
Rumi Suzuki was Born in Tokyo, Japan in 1961. After graduating from Japanese high school, Rumi Suzuki lived in Sri Lanka for 10 years to help her father’s business. She suffered from severe mental disorder for 25 years, when she met across Neurofeedback in the U.S. She brought the Neurofeedback technology into Japan. Since then, she has been managing Brain Spa Co., Ltd. in Tokyo, which is a company practicing neurofeedback training for 10 years. She is a Representative of Zengar Institute Inc.(Canada) and an Instructor who is certified to teach NeurOptimal® in Japanese.
Abstract:
Introduction of NeurOptimal® nonlinear Dynamical Neurofeedback™ system, which was developed by Dr. Valdeane W. Brown & Dr. Susan Dermit Brown of Zengar Institute Inc.(Canada). NeurOptimal® is a neurofeedback technology which harnesses the dynamical properties of the brain. NeurOptimal® Dynamical Neurofeedback™ is the only neurofeedback system which uses the technology of nonlinear mathematics, all the other neurofeedback systems are linear. Instead of pushing the brain in a particular direction as is done by linear neurofeedback systems, NeurOptimal® mirrors back what CNS has just done, which information is then mirrored back to NeurOptimal®, then mirroring back again between CNS and NeurOptimal®. NeurOptimal® is not a treatment but a training, which enhances the resilience and flexibility of CNS by way of its self-regulating ability. As the NeurOptimal® training goes on, the initial problems seamlessly fade away regardless of what diagnosis clients had. NeurOptimal® does not need a diagnosis: NeurOptimal® process is the same for migraines, irritable bowl, anxiety, ADHD, Autism, or sleep disturbances, the same for a 100-year-old, a newborn baby, someone in coma or at peak health. The NeurOptimal® mirroring back system made this possible. In addition to the characteristics of NeurOptimal®, a couple of success stories are mentioned: Alzheimer disease (Mr. Craig Walker’s office), real moms from Zengar website, and myself. NeurOprimal® perfectly mirrored back the minute feel of my depression of 20 years, which was too subtle to be understood exactly by anyone. NeurOptimal® will definitely be one of the essential tools for world-wide mental care.
Mustafa Ender Taner
Gazi University Faculty of Medicine, Turkey
Title: Quality of life and pain perception in alcohol dependence: A comparative examination of patients, their relatives and healthy controls
Biography:
Mustafa Ender Taner graduated from Hacettepe Faculty of Medicine in 1994 and completed his residency in Gazi University Faculty of Medicine, Department of Psychiatry. He became Associate Professor in 2008 and Professor in 2013. He is currently lecturer in Gazi University Department of Psychiatry and Head of Consultation Liaison Psychiatry Department. Serving as Deputy Chief Physician in Gazi University Health Applications and Research Center since July 2014, Prof. Dr. Taner has many national and international studies on many subjects including general psychiatry, psycho-pharmacy, mental state disturbances, consultation liaison psychiatry.
Abstract:
Alcohol dependence, quality of life and pain are frequent and clinically important three terms that both coexist and interact with each other. According to a review in 2005; quality of life in persons with alcohol use disorders is lower than the general population, used amount of alcohol was inversely proportional with quality of life, quality of life in alcohol dependence is getting better with treatment and the association of alcohol dependence and quality of life is related with sociodemographic features and comorbidities (1). Dependence is a social disease that affect not only the dependent person but also his/her family and social environment. For this reason, the quality of life is also affected in the family of the dependent person (2). Another situation accompanying to alcohol dependence is pain and related conditions. Alcohol dependents are showed to more likely experience painful situations and be more sensitive to painful stimulus (3). In this study, we aimed to compare quality of life and pain perception in alcohol dependents, their first-degree relatives and healthy controls. Hereby; the possible effect of the difference in quality of life and pain perception on alcohol dependence can be examined.
Yi Wah Eva Cheung
Tung Wah College, Hong Kong
Title: The role of structural MRI and functional MRI in brain tumor characterization
Biography:
Eva Cheung has completed her MSc in Biomedical Engineering from Chinese University of Hong Kong and MSc in Medical Engineering & Physics from King’s College London, UK. Currently, she is pursuing her PhD in University of Hong Kong. She is a Senior Clinical Associate in Tung Wah College, teaching BSc in Radiation Therapy at Tung Wah College, Hong Kong.
Abstract:
Purpose: to evaluate the effectiveness of using functional MRI in differentiation of brain tumors, using Apparent Diffusion Coefficient (ADC) values.
Material and method: 3T brain MR images were reviewed retrospectively in 66 patients with 73 brain tumors comprised of different types of malignant tumors. The MR protocol included T1w, T2w, T1w + C, and DW-MRI was performed using single-shot echoplanar (EPI) sequence with b gradient factor value of 0, 500 and 1000 s/mm2 in the three orthogonal axes. Five regions of interest (ROI) with volume of 5 ± 1.5 mm3 were placed on tumor areas and the minimum Apparent Diffusion Coefficient (ADC MIN) values were obtained, necrotic and vasogenic edema area and correlated with the histopathology results. ADC MIN values between Lymphoma vs GBM, Atypical Meningioma vs Meningioma, Lymphoma vs Demyelination, GBM vs metastatic tumor, Low grade Glioma vs High grade Glioma, were compared using Mann-Whitney test . The ADC MIN values in different types of gliomas were assessed using Kruskal-Wallis test with pairwise multiple comparison.
Results: The mean ADC MIN is significant lower in patients with Lymphoma (0.716 x10-3 mm2/sec) than GBM (1.052 x10-3 mm2/sec) (p=0.001); the mean ADC MIN of Atypical Meningioma (0.755 x10-3 mm2/sec) is significantly lower than Meningioma (1.114 x10-3 mm2/sec) (p=0.012); the mean ADC MIN of Lymphoma (0.716 x10-3mm2/sec) is significantly lower than Demyelination (1.832 x10-3 mm2/sec) (p=0.057). The mean ADC MIN values between GBM (1.052 x10-3 mm2/sec) and metastatic tumor (0.8-1.1 x10-3 mm2/sec) were similar, which cannot be used to differentiated (p=0.910). Regarding gliomas, the mean ADC MIN of high grade gliomas (1.064 x10-3 mm2/sec) is significant lower than that of low grade gliomas (1.455 x10-3 mm2/sec) (p=0.001).The mean ADC MIN of Necrotic tumors is 2.234mm2/sec and the mean ADC MIN vasogenic edema is 1.319 mm2/sec.
Conclusion: The ADC MIN values provide practical information which can be used for the differentiation of specific brain tumor histology as well as glioma types. DWI can improve imaging diagnosis in the clinical setting, compared to using structural MRI scans alone.
Violeta Kateva
St. Naum Hospital, Bulgaria
Title: The effects of high frequency repetitive Transcranial Magnetic Stimulation in patients with Multiple Sclerosis
Biography:
Violeta Kateva currently working as a neurologist at University Hospital for Neurology and Psychiatry “St. Naum”- Sofia, Bulgaria. She is an experienced Clinician with a demonstrated history of working in the medical practice industry. Skilled in Microsoft Excel, Clinical Research, Customer Service, Microsoft Word, and Strategic Planning. Strong education professional graduated from National Hospital for Neurology and Neurosurgery, Queen Square, London.
Abstract:
We studied the effect and safety of 10day treatment with high frequency (15 Hz) repetitive transcranial magnetic stimulation (rTMS) applied bilaterally over the primary motor cortex in patients with multiple sclerosis (MS) in clinical settings. We investigated a heterogeneous group of 35 patients with MS-31 with spasticity, 32 with decreased muscle strength, 14 with mood disturbances, 23 with bladder control impairment, 11 with bowel control impairment and 13 with fatigue.
Methods: We used the Modified Ashworth Spasticity Scale; the five-point scale for muscle strength; Timed 25foot walk test; Beck's Depression Inventory; Bladder and Bowel Control Scales from the Multiple Sclerosis Quality of Life Inventory and Fatigue Severity Scale. The patients were evaluated on the first and on the last day of treatment. For statistical comparison of the results before and after treatment we used Wilcoxon Signed Rank Test.
Results: All the symptoms, excluding fatigue, were significantly improved. Twenty-four patients did the Timed 25 Foot Walk Test and 16 (67%) had clinically significant improvement. None of the patients had any serious adverse events.
Conclusions: Repetitive TMS is beneficial in the management of motor, affective, bladder and bowel symptoms in patients with MS. The procedure has excellent safety profile.
Ng Kah Wee
Singapore General Hospital, Singapore
Title: A Singapore eating disorders treatment program: What is available and what has worked?
Biography:
Kah Wee is currently a Consultant with the Singapore General Hospital, Department of Psychiatry. She is also the director of the eating disorders programme. She is also actively involved in planning the annual eating disorder awareness week for previous years. She is a facilitator and speaker for the Support for Eating Disorders Singapore (SEDS). Kah Wee was awarded the SingHealth HMDP Fellowship in Eating Disorder at the Institute of Psychiatry, London, United Kingdom.
Abstract:
We are the only dedicated treatment programme in Singapore. We are a multi-disciplinary team which offers inpatient and outpatient treatment for patients with eating disorders. The number of patients presenting to us has risen significantly over time. Our clinical services have expanded, with addition of family based therapy in 2012. Majority of our patients are diagnosed with Anorexia Nervosa (AN), followed by Bulimia Nervosa (BN) and Eating Disorders Not Otherwise Specified (EDNOS). From 2013, diagnoses include Other Specified Feeding/Eating Disorder (OSFED) and Avoidant/Restrictive Food Intake Disorder (ARFID). Clinical profile of our patients with AN has changed over time with lower presenting body weight and body mass index. Patients with BN scored higher in eating disorder psychopathology subscales than those with AN and EDNOS. Malay patients remain under-represented over the years. Treating patients with eating disorders in our programme is challenging, in view of our multi-racial population. Cultural factors influence the eating disorder psychopathology, eating disorder literacy and willingness for treatment. There are significant ethnicity differences between the diagnoses of eating disorders. Outcome measures such as weight restoration and return of menstruation are the established markers, however psychopathology such fat phobia may not be measured adequately in an Asian population.
Khurram Sadiq
The Greater Manchester Mental Health NHS Foundation Trust, UK
Title: Social media and addiction
Biography:
Dr. Khurram Sadiq is a Consultant Psychiatrist in a Complex Community Mental Health Team (CMHT) working in central Manchester, United Kingdom Dr. Sadiq completed his basic medical degree from Khyber medical College Peshawar Pakistan and went to United Kingdom to complete his training in Psychiatry. He did his core psychiatric training in Lincoln, Lincolnshire UK before moving to Leeds for a non-training Registrar post in Crisis Resolution and Home Treatment Team. He then completed his specialist qualification of MRCPsych (Member of Royal College of Psychiatrist) from Royal College of Psychiatrist, United Kingdom in 2011. He then completed his Specialist Registrar training from Liverpool where he worked in Inpatients Psychiatry, CMHT, Neuropsychiatry and Brain injury, Psychology, ADHD teams and Recovery team. He also gained some Forensic Psychiatry during his early days as a Consultant Psychiatrist.is a medical doctor specializing in the care of mental health patients. As a psychiatrist, Dr. Sadiq diagnoses, manages and treat treats mental illnesses/ disorders at the same time providing Clinical and Administrative Leadership to his team. Dr. Sadiq may treat patients through a variety of methods including medications, psychotherapy or talk therapy, psycho-social interventions and more, depending on each individual case. Different medications that a psychiatrist might prescribe include antidepressants, anti-psychotics mediations, mood stabilizers, stimulants, anxiolytics and hypnotics. Dr. Sadiq treats conditions like depression, anxiety spectrum disorders, Mood disorders including depression and Bipolar Affective disorder eating disorders, Psychotic disorders including Schizophrenia, & drug induced psychosis insomnia, ADHD (Attention deficit Hyperactivity disorders, Autistic Spectrum disorders including Asperger's disorder. Dr Sadiq has a niche interest in ADHD, Asperger's, Psych-oncology and Personality disorders. His other non-clinical niche area is Leadership and Bullying and Harassment; during his training he attained a Fellowship in Clinical Leadership from Mersey Deanery and has been in different Leadership roles representing trainees at the highest podium like General medical Council, Royal College of Psychiatrist as well as the Local Education bodies. He was the Psychiatric Trainee Committee elect for 2 terms from the North west of England representing his fellow trainees at the Royal College of Psychiatry. He also worked with the General Medical Council in formulating National survey for the trainees with specific focus at Undermining at workplace.
Abstract:
Well we live in a dynamic world of Social Media. The world is divided into two Parrodoxes, Real world and Online which is now declared a domain. We know the advantages of Social Media, how connected we are, how easy it is to communicate however what we disregard is the unknown dark realm of the Social Media with a dynamic interface which is very engaging and addictive in nature.
With the expansion of Social Media and advent of Smart phones, our universe is in our hands and just a touch away. Screen time has increased considerably, real time has decreased substantiality, there is a false perception of anonymity, closeness, proximity and security. This leads to a lot of deviant behaviors.
Outdoor activities have been replaced with Gaming consoles, VR Gismos and ever engaging Social Media. Social isolation is on the rise, there has been an increase in the mental health disorders amongst children, adolescents and adults.
Social Media is now deemed as an addiction. There is a significant withdrawal, craving and dependence on Social Media, working on Rewards, surges, highs and pleasure system. The conundrum is to counter this addiction which impacts the young, impacting not only the social values but institutions affecting skill sets and endangers the societal fabric.
Mohamed Hasan Mansour
Al-azhar University, Eygpt
Title: Microsurgical resection versus stereotactic guided ommaya reservoir drainage of cystic craniopharyngioma
Biography:
To be updated soon
Abstract:
Background: Craniopharyngioma is often associated with cystic components. Although these tumors are histologically benign, recurrence rates up to 57% have been reported even after surgical gross total resections, due to their invasiveness.
Objective: To compare the outcome of invasive and less invasive surgeries of cystic craniopharyngioma.
Methods: This study included 20 patients diagnosed and managed in Al-azhar university hospitals and Al-Mansoura university hospital between May 2015 and April 2017. 10 patients were treated by surgical modalities, 10 Patients were treated by a less invasive maneuver by superior fenestration and insertion of ommaya reservoir. The craniopharyngioma was predominately cystic.
Results: Ommaya reservoir insertion and drainage of cystic craniopharyngiomas is safe and effective for symptom relief and might be associated with a better outcome than microsurgical treatment.
Elixena Lopez Savon
Juan Manuel Marquez Hospital, Cuba
Title: Intraspinal ependymomas and their association with metastasis/ disseminations in patients over a period of 22 years.
Biography:
Elixena López Savón is graduated as a doctor in June 2006, working in primary care in rural areas of her country, in 2008. She graduated as a specialist general practitioner of I degree, and also attended a medical emergency in the same year, after two years, from 2009 to 2011 in Bolivia as intensivist doctor in the town of Villa Tunari, as part of a medical collaboration agreement between her country and the Bolivian government.
Later she received a master’s degree in Emergency and Medical Emergencies and started the specialty of Neurosurgery, surgical branch of which she graduated in 2015, after four years and means of studies, with good teaching and care results at the Institute of Neurology and Neurosurgery (INN) of Havana.
She started working as a neurosurgeon three years ago in the pediatric hospital "Juan Manuel Márquez" in Havana city where she has been living since 2013, she had certified courses of spinal surgery, carotid doppler, trans fontanel ultrasound, she also had an interventional imaging research course, she is a member of AOSPINE since 2013, and she participated in five congresses of this organization held in Havana.
Abstract:
Introduction: Ependymomas are neuroepithelial tumors of variable morphological appearance whose treatment of choice is surgical. They represent 13% of intraspinal tumors and constitute 40% of spinal tumors in adults. In Cuba there are few studies about this pathology, hence the main objective is to evaluate the behavior of intraspinal ependymomas in the Neurology and Neurosurgery Institute.
Patients and Methods: A retrospective descriptive study of 47 patients operated on with a histological diagnosis of intraspinal ependymomas in a period of 22 years was carried out.
Results: In the patients studied, 51% started with a radicular syndrome. In ependymomas, the most frequent histology was myxopapillary (34%) and the terminal filum was the location that prevailed (48.9%). A total resection was achieved in 51.1%, postoperative complications were not frequent, being the cerebrospinal fluid fistula (19.1%) the most frequent. Half of the subjects evolved favorably. 40.4% of the intraspinal ependymomas studied were from intracranial tumors, and of these 73.7% recurred. Primary spinal tumors did not disseminate in 92.9% of cases.
Conclusions: Intraspinal ependymomas may be primary of the spine or disseminations / metastases of other locations of the neuraxis. The disseminations do not depend on the degree or histological type. Spinal ependymomas have a high rate of tumor recurrence. The adequate postoperative functional recovery depends on an early diagnosis of intratracheal ependymomas and the degree of surgical resection.
Sergio Kosac
Hospital San Miguel, Argentina
Title: Neurophysiological monitoring during epilepsy in surgeries
Biography:
Dr. Kosac Sergio, born on September 04, 1952. He is a Neurologist, (Universiry of Buenos Aires), Neurophysiologist, working intesively in the Intraoperative Monitoring field.
Abstract:
Epilepsy Surgery originates in the early XX Century since the discovery of functional areas, by Broca, Hitzog, and many others, one the one hand. On the other hand, Jackson’s findings, describing the irritative cortical foci, and proposing their excision, until the experiencies of W. Penfield, who generated a most complete functional cortical map, until that time, specifying motor and sensitive/sensorial areas, allowed surgical techniques to advance significantly.
Nowadays, surgeries for reduction or elimination of cortical irritative foci, are carried out in cases of: cortical dysplasia, cortical tumors, vascular malformations, etc. Although more and more accurate and satisfactoy surgical techniques were developed, in same cases it is imperative to preserve fucntional areas, whenever they are near or over the surgical area.
To prevent or minimaze damages to such functional areas, it is necessary to perform Intraoperative Neurophysiologic techniques. In cases of epilepsy surgeries, there area two ways: one is the electroencephalogram over the cortex, named electrocorticogram. I will not speak about this matter. The other one is the neurophysiologic Intra-Operative Monitoring. (IOM) perform this method, we can do, depending on the type of pathology, localion, which method will be applied: One technique is to locate, over the dura, motor and sensory areas: it is possible through a technique that applies Somatosensory Evoke Potentials, recorded with a strip of electrodes. Through this technique, we can map out cortex areas, allowing the surgeon to know, before opening the dura, where those functional areas are.
Another technique is, once motor and sensory areas are located, to find some fuctions over and into the motor area more accurately. This is made with a stimulator given to the surgeon, connected to the neurophisiologist’s equipment, through which, we can map out more accurate areas: i.e., hand area, leg area, etc,.. applying the stimulator over some points, and the neurophysiologist delivering stimuli to activate cortical motor neurons, and recording in the corresponding muscles.
Those techniques will be showed, with case presentations, graphics and videos. The goal is to show to the audience some methods that could improve life quality for those patients who traveled or undergo epilepsy surgeries with some funcional damage risk.
- Behavioral Neurology
Session Introduction
Philip Anthony McMillan
Hull and East Yorkshire Hospitals NHS Trust, UK
Title: Integrated biochemical theory of delirium and experience with Pharmacological reversal
Biography:
Dr Philip McMillan is a Consultant in the NHS with over 23 years of medical expertise. His primary focus has been around Geriatrics and Neurological Rehabilitation and has developed unique perspectives on the capacity of the brain to recover from injuries and disease. Through international collaboration he has proposed a nutritional protocol for dementia reversal and has recently had a breakthrough theory on the pathology of dementia. His current aim is to lead the field of dementia to a new direction of research and treatment of this devastating disease.
Abstract:
Delirium is a significant problem in older hospital admissions, with worse clinical outcomes, prolonged hospital stay and functional disability. This presentation will cover the clinical experience of managing these complex patients during their hospital stay. The basis of this theory is with hepatic encephalopathy and the fact that all forms of delirium are clinically consistent. Looking to explain the integrated theory of delirium based on brain glutamate and ammonia management. This will demonstrate the biochemical aspects of delirium and how it is related to other conditions and most significantly how there is a higher incidence of delirium in dementia. Anecdotal experience of reversing delirium using this biochemical framework and use of simple medication in hospital has been very successful with up to 70% of patients demonstrating clinical improvement. This theory has the potential to revolutionize our care of older patients and give insight into the links between delirium and dementia.
Amani Osman Hassan
CWM Taf University Health Board, UK
Title: The STOMP in children and adolescents with learning disabilities in South Wales, UK
Biography:
Abstract:
Fawad Kaiser
Shifa Tameer–e-Millat University, Pakistan
Title: Relationship between violence and mental health in the Afghan Refugees; Plight of the Internally Displaced Person (IDP)
Biography:
Fawad Kaiser is an Associate Professor Psychiatry and Head of Department of Behavioural Sciences Shifa Tameer–e-Millat University Islamabad Pakistan. Also Director Quality Enhancement Cell, STMU and Consultant Forensic /Adult General Psychiatrist at Shifa International Hospital. Visiting Consultant Forensic Psychiatrist Jeesal Group UK. Also Managing Editor Journal of STMU and Member Scientific Advisory Board and Reviewer for Rawal Medical Journal and EC Forensic Science journal E Cronicon. As a hobby He is a Columnist with newspaper Daily Times Pakistan, Hilal, Turkey Tribune, The Morning Mail and have also published widely in research e.g. medical education, genetics, law, stress disorders, politics, economics, crime, psychology and terrorism.
Abstract:
Statement of the Problem: Inside Afghanistan, tens of thousands have become internally displaced1. Internally Displaced Person IDP are at a greater risk for physical and mental health problems. Pakistan, home to 1.3 million registered Afghan refugees and some 700,000 undocumented Afghans, resulting in significant personal, social and economic cost and the impact of all three may have on their mental health.
Additionally, and importantly, studies have investigated relationship factors between mental health of displaced person and refugee person2, 3, 4, 5, 6.. Relationships might include relationships between individuals, groups and communities. In a study7 with a 30-month follow-up, PTSD, depression, and somatic complaints reduced with time in internally displaced and non-displaced children, but psychosocial adaptation did not improve in displaced children and remained worst with time. The relationships between violence and health need further investigation, might it be the impact of war on mental health8 or the impact of family relationships, physical abuse and early adversities. The purpose of this study is to describe the experience of IDP Afghan Refugees seeking help for mental health disorders. Methodology: A review of individual, family, community, and societal risk and protective factors for mental health among Afghan refugees who are settled as Internally Displaced Person in Pakistan. Findings: Exposure to violence was found to be a key risk factor, whereas stable settlement and social support in the host country have a positive effect on the mental health and well-being. Conclusion & Significance: Timely, but fair and thorough, assessment and resolution of refugee status had positive effect on mental health. Early intervention access for mental and physical health, and provision to good housing and schooling were central to adjusting and positive mental health. Further research is needed to enquire into the effects of prolonged uncertainty about refugee status which seems to have a negative effect on mental health. Since mental health problems originating among refugees in forced migration are often long lasting, recommendations are made that host countries must implement immigration, health-care, and social policies that support IDP family units and keep deleterious consequences for mental health to a minimum.