Scientific Program

Day 1 :

Keynote Forum

Kita Sallabanda Diaz

President of Spanish Society of Radiosurgery Associate Professor of Neurosurgery, University Complutense of Madrid Spain

Keynote: Combined treatment of Spine tumors

Time :

Biography:

Dr. Kita Sallabanda Diaz has more than 25 years of experience in the field of Neurosurgery. He currently works in this specialty at the Genesiscare Madrid - Arturo Soria, while he is an external medical consultant at the San Carlos University Clinical Hospital in Madrid. Author of Treaty of Radiosurgery (2012) and Guide of Brain Metastases (2015), has published in numerous scientific media of the Spanish and world scene. He is the current President of the Spanish Society of Radiosurgery and the Neuro-Oncology Committee of the Clinical Hospital of Madrid. In the field of teaching, he is an associate professor at the Complutense University of Madrid, a tutor for residents of the San Carlos Clinical Hospital in Madrid and is a professor of the International Master's Degree in Advanced Technological Applications in Radiation Oncology. Dr. Kita has given more than 100 oral and poster presentations at the National and International Congresses and also an active invited professor. His area of expertise mailnly lies in Cyberknife SRS, Epilepsy, Cognitive functions and brain metastases.

Abstract:

  • Every year in the U.S., 180,000 new cases are diagnosed and 20,000 of them with medular compression. 5-14% of patients with cancer develop Spine metastases, from tham 33% Bone 4% Leptomeningeal 0.1-0.4 Intramedullary
  • 60% of Spinal Metastases appear in patients with: Breast Cancer Lung Cancer

 Prostate Cancer (7.4%)

The treatment basicaly is based on: SURGERY, RADIOTHERAPHY COMBINED TREATMENT, RADIOSURGERY

Until 1990 the first treatment was Radiotheraphy, later we come back to surgery, Patchel trial demostrate the superority of surgery (Lancet 2005), Clase I evidence

From these time we take in considerstion NOMS and SINS criteria-

The developmant of techonlogy in radiotheraphy make us to chamge the paradigm.

Radiosurgery take a very important role in the treatment of sipne tumors

The combine treatment is our first option, surgery + radiosurgery.

 

The principal indication of Spine Radiosurgery as a primary treatment are: residual tumors after surgery, recurrent tumours, multiple lesión, unfarable localization, high risk for open surgery.

We present our seria, experience and biblography revisión about the combine treatment in spine pathology

 

Keynote Forum

Salil Uppal

Medical Director Uppal Neuro Hospital India

Keynote: Prevalence of Migraine in Epilepsy

Time :

Biography:

Dr. Uppal is a Doctor of Medicine in Neurology. He is the Medical Director of Uppal Neuro Hospital in Amritsar. His area of interests lies in Stroke, Epilepsy, Neuro Critical Care, and Movement Disorders. His research works include Non- motor symptoms in Parkinson’s Disease, Transcranial Doppler in Acute Ischemic Stroke, Epilepsy and Migraine.

Abstract:

Headache is commonly associated with seizures as an inter-ictal, preictal, ictal, or postictal phenomenon, it is often neglected because of the dramatic neurological manifestations of the seizure. A prospective study was designed to identify epidemiological association between headache and epilepsy and  to evaluate the types and frequency of seizure-associated headaches in patients with epilepsy on anti-epileptics

 AIMS AND OBJECTIVES  To  evaluate the type and frequency of  headache in people with epilepsy and risk factors with special attention to the anatomic localization of the epileptogenic focus, seizure classification (focal versus generalized) while on antiepileptic drugs over a period of 3 months.

  STUDY DESIGN   Study conducted at  Outdoor Patient Department, of Department of Neurology, DMC&H, Ludhiana. Patients ³17 years  with a diagnosis of epilepsy more than 2 years on single antiepileptic agent  - with new onset headache ,increase in frequency and severity of headache in epilepsy were taken . Headache data  analyzed according to IHS criteria, Epilepsy classified  according to the 2010  (ILAE) Commission report.

Results  73 cases (29 female, males 44) on antiepileptic monotherapy  were taken .Mean age was 26years,  median age at epilepsy onset  was 15 years  ,median epilepsy duration  was  8years.Generalized epilepsy seen in  48 (66%),  focal epilepsy  25 (33%) . 23 (30%) reported  headache , inter-IH in 15 (40%)and  peri- IH occurred in 12 ( 50%) of these  5 (18.3 %) had an associated inter-IH,  7  had headache related to the seizures,  Carbamazepine, levetricetam ,valproate, oxcarbamazepine ,lamictal  given in 17,18,29, 6, 2, patients 7,5 ,10,2 1had headache

 

  • Neurology | Neuromuscular Diseases | Neurodegenerative Diseases | Neuroimmunology
Location: madrid

Session Introduction

Richa Kulshrestha

Consultant, Robert Jones and Agnes Hunt Orthopaedic Hospital, United Kingdom

Title: Rapid subjective improvement of learning in a patient on Ataluren
Speaker
Biography:

Dr Kulshrestha works at a centre of excellence for neuromuscular disorders in the UK. She and her team of doctors, physiotherapists and sports scientist are committed to provide innovative methods of rehabilitation of untreatable conditions. This project has the backing of patients and well received by FSHD charity, UK.

Abstract:

Statement of problem: Dystrophinopathy is a rare, severe muscle disorder, and nonsense mutations are found in 13% of cases. Ataluren was developed to enable ribosomal read through of premature stop codons in nonsense mutation genetic disorders. Effectiveness of this drug has been assessed by National Institute of Clinical Excellence in the UK and the drug is available by managed access agreement for patients after 5 years of age. Methodology and theoretical orientation: we describe a patient with Duchenne muscular dystrophy (DMD) commenced on treatment with Ataluren at 5 years and 7 months. Physiotherapy assessments pre and post treatment are compared. Findings: this young boy had global developmental delay and was diagnosed with DMD at two and half years. He started walking at three and half years. He has significant learning difficulties and attends special school. He has point mutation in exon 65 (c.9461T>A; p.Leu3154X) inherited from mother. This is amenable for read through by Ataluren. His muscle biopsy had classic features of dystrophy. Dystrophin was absent with labelling of rod domains and only a rare revertant-like fibres are seen with a C terminal antibody. Mutations towards the C terminus affect all isoforms of dystrophin, including those in the brain. Pre-treatment timed rise from floor was 34.8 seconds, 10 meters run was 11.2 seconds and North Star Ambulatory assessment was 7/34. These responded with 5 months of treatment on Ataluren to timed rise from floor to 11 seconds, 10m run to 8 seconds and North Star Ambulatory assessment to 15/34.  According to assessors this difference was related to improvement in understanding of instructions. Conclusion and significance: Effectiveness of Ataluren is proved for motor abilities in patients with DMD. This is the first case subjectively showing that Ataluren can positively impact the learning difficulties.

 

Vasyl Babenko

Neurologist, Heart Institute, Ministry of Health of Ukraine, Ukraine

Title: Metabolic syndrome and acute ischemic stroke: predictors of functional outcome
Speaker
Biography:

Abstract:

INTRODUCTION: The aim of study was to establish predictors of functional outcomes of acute ischemic stroke (IS) in patients with metabolic syndrome(MS). METHODS: 202 patients with MS and clinical manifestations of IS were perfomed. The functional outcome after acuit IS was assessed by the modified Rankin scale: 0-1 point –favorable functional outcome (FFO), 2-6 points–unfavorable outcome (UnFO). RESULTS:After IS, the ratio of patients experiencing FFO comprised 48% and UnFO–52%. Statistically significant (p<0,001) main predictors and clinical indicators of AFO after acute IS in patients with MS: NIHSS scale ≥10 points (relative risk (RR) 3.61; p<0,0001),and Bartel index ≤40 points (RR 2.76; р<0,0001); level Glasgow Coma Scale ≤13 points (RR 3.61; р<0,0001); complex intima-media (RR 2.37; р<0,0001); infarct zone≥25,3cm3(RR 3.09; р<0,0001);level of fasting blood glucose ≥7,6mmol/L (RR 2.4; р<0,006); reduction level of HDL lipoproteins (RR 2.37; р<0,0001);occurrence of atherothrombotic(RR 2.21) and cardioembolic subtype(RR 2.41; р<0,0001); ischemic heart disease(RR 1.69; р<0,045); total number components of MS (RR 1.5; р<0,05). SUMMARY:The most important significant predictors of UnFO after acute IS of patients with MS were definded.

Richa Kulshrestha

Consultant, Robert Jones and Agnes Hunt Orthopaedic Hospital, United Kingdom

Title: Upper Limb rehabilitation in Facioscapulohumeral Dystrophy (FSHD) patients
Speaker
Biography:

Dr Kulshrestha works at a centre of excellence for neuromuscular disorders in the UK. She and her team of doctors, physiotherapists and sports scientist are committed to provide innovative methods of rehabilitation of untreatable conditions. This project has the backing of patients and well received by FSHD charity, UK.

Abstract:

Statement of problem: FSHD sufferers live a long life with disability. Symptoms may develop in early childhood and weakness usually noticeable in the teenage years with 95% of affected individuals manifesting disease by age 20 years. The disorder impacts on the upper extremity and torso, impacting negatively on the muscle mass, shoulder mobility and functional tasks.  Consequently chronic disuse of the shoulder negatively impacts independence of sufferers, prospects of employment and staying at work. At present there is no known cure and knowledge regarding the mechanisms underpinning FSHD is not sufficient to halt the progression of the disease via pharmacological interventions or gene therapy. Surgical interventions are used to improve scapular stabilisation but long term effect on disease progression is limited. Methodology and theoretical orientation: The aim of this exercise was to understand views of patients for compliance with exercise programmes and understand the barriers for regular exercise. This is followed by a pilot of testing arm cycling as potential rehabilitation method. Findings: We received 232 responses from the online survey. 92.6% responders are in agreement that upper limb exercise is necessary as upper limb dysfunction impacts daily living in 86.9% patients. Arm cycling was considered to be a feasible exercise by 57.1%. The focus group session echoed the need for home based exercise programme as attending a regular gymnasium was not entertained by patients. In this particular group of patients pain, fatigue and lack of motivation were additional barriers identified for compliance with exercise programmes. Pilot study of arm cycling showed that patients with different level of function were able to perform cycling at cadence and resistance to improve muscle function. Conclusion and significance: There is need for upper limb rehabilitation and arm cycling offers a potential method to enhance muscle function but its effectiveness is yet to be shown.

 

Biography:

Abstract:

Background: Stroke is the second leading cause of death worldwide. Stroke mortality has been shown to be higher in blacks in multiracial studies; it is also a very important cause of disability with its attendant deterioration in the quality of life in survivors. The profile of stroke in North-central Nigeria has been sparsely described despite the fact that it constitutes about 50 to 60% of neurological admission in this part of the world.

Objectives: To determine the risk factors associated with stroke, assess the case fatality 90 days post stroke, determine the bad prognostic factors of stroke and assess the sensitivity and specificity of clinical sub-typing of stroke using the WHO and Siriraj stroke scoring tools.

 

Method:  A longitudinal cohort study with a 90 day follow up for secondary outcome was carried out on Stroke patients admitted into the neurology unit of Jos University teaching Hospital over a 2-year period, September 1st 2016 to August, 2018.

Results: A total of 246 stroke patients were admitted during the study period. Males were 131 (53.3%) and females 115 (46.6%) with an age range of 59.5 ± 13.1 for males and 56.7 ± 14.2 for females. Hypertension (81.7%), Obesity (80.9%), dyslipidemia (54.5%), Alcohol consumption (24.8%), carotid plaques (19.5%), cardiac disease (19.1%) and Diabetes mellitus (18.5%) were the commonest risk factors for stroke.

The 90 days fatality for stroke was 22%; however, 37% became disabled and unable to carry out activities of daily living without support. Significant predictors of mortality and morbidity were; coma, elevated glycated hemoglobin, cardiac disease, HIV infection and high National institute of health stroke score (NIHSS)

WHO clinical stroke sub typing showed a sensitivity of 54.3% and a specificity of 86.3% while Siriraj has a sensitivity of 87.9% and specificity of 84.9% for ischemic stroke, however, for hemorrhagic stroke, WHO sub typing revealed a sensitivity of 86.3% and a specificity of 54.3% while Siriraj was found to have a sensitivity of 84.9% and specificity of 87.9%, showing that Siriraj is a better tool for stroke categorization for appropriate management in areas where neuroimaging are either not readily available or not affordable.

Conclusion: stroke is a major cause of mortality and morbidity in North Central Nigeria. Community screening for risk factors should be pursued aggressively and identified risk factors managed promptly in order to reduce the burden of this pandemic. Siriraj stroke sub-typing can be used in resource limited setting like ours where neuroimaging facilities are either not available or are too expensive.

 

Biography:

Deepti pathak is currently pursuing her Ph.D degree in Biochemistry department of All India Institute of Medical Sciences. Her thesis work is based on the blood based biomarker discovery in a neurodegenerative disorder called Friedreich's ataxia

 

Abstract:

Friedreich's ataxia is characterised by the high iron and copper deposits in the brain and cardiac cells which triggers the cellular and axonal death causing increased plasma levels of the circulating nucleic acids in the patients. A quantitative study was done and the plasma levels of cell free Nucleic acids, and trace elements iron and copper were assessed and correlated with the GAA repeat numbers and frataxin levels in patients. 25 FRDA patients and 25 controls from Northern India were included. Iron and Copper level assessment were done by Nitro PAPS and Dibrom PAESA method, respectively. Fluroscent dye based Qubit 3.0 Fluorometer was used for cfNAs quantifications.  Iron (Fe2+) and Copper (Cu2+) levels were found to be significantly decreased in patients (Cu; mean ± SD(range) 8±5(2-16) ; Fe mean ± SD(range) 5±3(15-13) compared to controls(Cu; mean ± SD(range) 13±8(12-29) ; Fe mean ± SD(range) 16±7(4-26)   whereas free cfDNA levels were found to be higher in patients (mean ± SD(range) 73±35(2-16))  compared to controls (mean ± SD(range) 34±0.3(9-6)). There was a significant positive correlation between GAA repeat numbers and cfDNA & frataxin level and and Fe and Cu levels. Significant inverse correlation was established between GAA repeat numbers and Fe and Cu levels & frataxin and cfNA.