Scientific Program

Day 1 :

Keynote Forum

Anne Marie Kehres

Proserpine Hospital, Australia

Keynote: Hereditary Spastic Paraplegia

Time : 10:00AM - 10:40AM

Biography:

Mrs. Anne-Marie Kehres, a Masters in Neurorehabilitation and work as a generalist Physiotherapist at Proserpine Hospital. She has implemented a Neurorehabilitation program as well as balance and strengthening programs at Proserpine Hospital. Her position demands that she put on multiple hats as she works across all areas from inpatients, outpatients, emergency, orthopedic, pediatric, women’s health and day surgery. She works with a great interdisciplinary team focussed on wholistic treatment and discharge planning. As a private Physiotherapist, She has also worked tirelessly to keep our local nursing home open and well-funded, through funded activities and fund raising. Her passion has and always will be neurological disorders. Her aim is to spread the message that Physiotherapists not only treat symptoms and body parts but also act as advocates to better the quality of life of our patients.

Abstract:

HSP is a large group of inherited neurologic disorders in which the prominent feature is a progressive spastic paraparesis.  Also known as Familial Spastic Paraparesis it is an inherited central nervous system disorder typically characterized by gradual development of muscle weakness, spasms and stiffness of the legs, which may be first noticed in early childhood, or at any age through adulthood.

In a rural facility, physiotherapy services are offered by a generalist. As a generalist physiotherapist I can identify many gaps (additional services) that have been reported in literature as a high priority for people with HSP and other neurological conditions. Unfortunately, many of these gaps cannot be filled.  In a review of the literature conducted in Norway, the authors found that the need for professionals who understood neurological conditions was constantly revisited. Lack of local specialists was blamed on the problems of living in a rural location. In response to the lack of availability of local expertise, many people had turned to the internet for information. Others had travelled hundreds of miles to access specialist care, despite this being both onerous and inconvenient. With these issues in mind, it was clear that all the participants, both those affected by HSP and the professionals, recognised the value of the local HSP support group which was seen as central to sharing information and experience.

This presentation focuses on a case study of a young 51 year old lady with a diagnosis of HSP who moved to rural North Queensland Australia. I have presented the service gaps and challenges and how these challenges were met to provide holistic treatment for this rare and difficult condition.

Keynote Forum

Fofi Constantinidou

University of Cyprus, Cyprus

Keynote: Combating the global burden of TBI, Aging and Dementia with evidence-based research

Time : 10:40-11:20

Biography:

Dr. Fofi Constantinidou is Professor of Language Disorders and Clinical Neuropsychology, Department of Psychology and Director of the Center for Applied Neuroscience at the University of Cyprus. She is Fellow of the American Congress of Rehabilitation Medicine (ACRM) and of the American Speech-Language Hearing Association. Her research focuses in the area of acquired adult neurological disorders and their effects on intellectual and cognitive abilities, in particular learning, memory, executive systems, and categorization. Constantinidou has published extensively on brain injury and aging and her research has been funded by NIH, the European Union, the industry and the Cyprus Research and Innovation Foundation. She is Chair of the International Networking Group of ACRM and a member of the Board of Governors of ACRM. In addition, she is Deputy Chair of CPLOL, the European Association of Speech Language Therapy Professionals and President of the Cyprus Association of Registered Speech Language Pathologists. Professor Constantinidou is the 2019 recipient of the Distinguished Member Award of ACRM.

 

Abstract:

Traumatic brain injury (TBI) and Alzheimer’s Disease (AD) are the two top conditions resulting in the highest percentage of disability. TBI is no longer viewed as a single event but as a chronic disease resulting in significant challenges. Age, also results in neurocognitive changes and while higher levels of cognitive reserve result in improved neurocognitive performance, age continues to be a robust predictor of neurocognitive functioning. Age and TBI have been established as significant risk factors for the development of dementia. In fact, TBI and AD share common neuropathologic sequelae. Furthermore, moderate-severe TBI sets off a neurodegenerative cascade manifested by significant reductions in brain volume and lingering neurocognitive deficits associated with longer time since injury, placing the survivor at risk for dementia in middle/later life. The purpose of this presentation is to first, provide evidence on the chronic and progressive effects of TBI on brain volume, neurocognitive performance, and quality of life (QOL). Second, to present data supporting the use of hierarchical neurocognitive training in adults with TBI and in healthy older adults who experience neurocognitive changes associated with the normal aging process, using the Categorization Program (CP). Preliminary data on the use of the CP in patients with mild cognitive impairment will be also presented. Finally, the presentation will conclude with findings from the large-scale European project on sensory intervention and dementia, the Sense-Cog project. Conclusion & Significance: The global health burden of TBI, aging and dementia can be tackled with multidisciplinary and integrative approaches to neurorehabilitation. Recommendations are made based on recent research evidence that can contribute to personalized rehabilitation methodologies.

Session Introduction

Haijun Tu

Hunan University, China

Title: GABAergic synapse suppresses innate immunity via muscle-derived insulin signalling
Biography:

Haijun TU, Ph.D., a Professor of neuroscience, an assistant Dean of College of Biology, a director of International Science and Technology Cooperation Base of Biomedicine and Life Analytical Chemistry, Hunan University. He is He is currently a member of Society for Neuroscience and Chinese Neuroscience Society. His research interests are focusing on the molecular and cellular mechanisms of ischemia-induced Neuronal injury & Protection and Repairing and of neural regulation of innate immune response. He has published more than ten articles in the neuroscience field of journals such as Nature, Neuron, Journal of Neuroscience, EMBO Journal. He completed his postdoc training in the Bessereau laboratory of Génétique et Neurobiologie de C. elegans at University Claude Bernard Lyon1, CGphiMC UMR CNRS 5534, Lyon from July, 2013 to June, 2015 and in IBENS, INSERM U1024, Ecole Normale Supérieure, Paris, France from January, 2011 to June, 2013. Dr. Tu received his Ph.D. degree at Huazhong University of Science & Technology in 2008, received his master’s degree at Wuhan University in 2004. He received the award of Les Grandes Avancees Francaises en Biologie, Pix AXA – Academie des sciences in 2015.

Abstract:

Positioning neurotransmitter receptors in front of neurotransmitter release sites sets the excitability of neuronal networks. We previously identified an original synaptic organizer, Punctin/MADD-4, that specifies cholinergic versus GABAergic identity of post-synaptic domains at the NMJs. Punctin is secreted by the two types of motor neurons and localizes at NMJs. Alternative promoters generate different isoforms with different functions. In brief, the long Punctin isoform secreted by cholinergic motor neuron specifically localizes acetylcholine receptors at excitatory synapses, while the short Punctin isoform secreted by both cholinergic and GABAergic motoneurons is required for the proper localization of GABAA receptor at inhibitory synapse. We also showed that Punctin controls the clustering of GABAARs through the synaptic adhesion molecule neuroligin (NLG-1) and the netrin receptor UNC‑40/DCC (Deleted in Colorectal Cancer). Punctin constitutes a new ligand of NLG-1/neuroligin and UNC-40/DCC and functions as a central anterograde organizer of inhibitory synapses. Since the mammalian orthologs of these genes are expressed in the central nervous system and their mutations are implicated in neuropsychiatric diseases, this novel molecular pathway might have been evolutionarily conserved. Moreover, we found that deficiency of GABAergic synapse promotes intestinal innate immunity of C. elegans through downregulating muscular insulin like peptide INS-31, suggesting a potential target for therapy of neuropsychiatric or/and innate immunity-related diseases. The data in details will be presented at the meeting.

Ruggiero A

Catholic University of Rome, Italy

Title: Children With Low Grade Glioma And Neurofibromatosis
Biography:

Dr Ruggiero received his medical degree from the Catholic University in Rome in 1992. He holds Board of Pediatrics in 1996 and Board of Pediatric Haematology and Oncology in 1998 at the Catholic University of Rome.

Dr. Ruggiero is currently an associate professor in the Department of Pediatrics  at the Catholic University of Rome where he is responsible for teaching Pediatrics and Pediatric Hematology and Oncology. 

At present he is chief of the Pediatric Oncology Unit of the Gemelli Hospital- Catholic University of Rome.

Carrying a regular patient load as consultant in pediatric hemato-oncology allows him to maintain his clinical skills and to promote improvements in safety and quality of healthcare. Examples of activities include producing guidelines for prevention of  healthcare associated treatments and improvements in basic safe medical practices.

His research interests focus on pediatric clinical trials, clinical pharmacology of antineoplastic drugs, pain therapy and pediatric drugs.

Abstract:

Purpose: Low-grade gliomas are the most common paediatric brain tumours affecting 15 to 20% of the subjects with Neurofibromatosis type 1 (NF1).   The NF1-related gliomas appear to have a different clinical behaviour compared to the sporadic cases.

Patients and methods: 60 patients (34 boys and 26 girls) with the median age of 4 years and low-grade glioma (42 sporadic cases and 18 cases with NF1) were treated. Thirty-nine patients (28 sporadic cases and 11 cases with NF1) underwent exclusive or post-surgical chemotherapy (with Vincristine and Carboplatin). The median follow-up was 5 years and 5 months.

Results: On brain MRI, tumour reduction was achieved in 12 of 28 patients (42.8%) among sporadic cases and in 9 of 11 patients (81.8%) among those with NF1, with a statistically significant difference between the two groups (p < 0.05). The response to therapy in both patient groups was not significantly influenced by gender, age, tumour site and histopathology, although the disease reduction occurred more frequently in children under 3 years of age.

Conclusions: Our study shows that paediatric patients with low-grade glioma and NF1 are more likely to respond to chemotherapy compared to non-NF1 patients.

Zainal Muttaqin

Diponegoro University, Indonesia

Title: Urgently needed in Asia: Basic Epilepsy Surgery Center with Simple but Reliable pre-surgical investigations, based on Indonesia’s Experience
Biography:

Zainal Muttaqin is a Starting Epilepsy Surgery in Indonesia in July 1999, and since then developing Epilepsy Centers and Epilepsy Monitoring Unit at Diponegoro University/ Dr. Kariadi Hospital in Semarang, Indonesia. In cooperation with Hiroshima University, Kagoshima University, and Shizuoka National Epilepsy Center in Japan, Dr. Muttaqin’s Epilepsy Team is develops all kind of surgery for Epilepsy, from intracranial electrode placement, anterior temporal lobectomy, callosotomy, hemispherotomy to the selective amygdalo-hippocampectomy. There are about 50 epilepsy surgery cases each year for the past 19 years, and the patients comes from all over Indonesia. 

Abstract:

Background: Even with optimized medications, 30% of epilepsy patients will be refractory and this condition leads to cognitive and psychosocial decline. With 0,75% prevalence, there are more than 2.0 million epileptic in Indonesia, about 700.000 will be refractory, and half of them are potential candidates for epilepsy surgery (ES). After 19 years, number of ES increases every year reaching around 50 cases/year. By the end of 2018,  the total number reached 671 and most was temporal lobe epilepsy (TLE). Pre-surgical investigations were compared in relation to the seizure free results between the first five-year and the recent fourteen-year. Despite the excellent result shown, there are so many countries in Asia without any ES program yet while others such as Japan and Korea had a very well run ES program. To improve treatment for refractory epilepsy cases elsewhere, new centers capable of performing ES are urgently needed in many countries with limited resources in Asia.

Material and methods: Until the end of 2018, there were 671 ES cases, including 514 Temporal Lobe Epilepsies (TLEs). Pre-surgical investigations were grouped as Simple (MRI with specific protocol and routine EEG), Difficult (needs long-term ictal EEG, and/or PET CT), and Complex (needs invasive or intracranial/ subdural grid EEG, and or Electrocorticography/ ECoG during the surgery). For the first five year-period, besides seizure semiology, decision to operate were based on MRI and routine EEG (Simple) in 54 out of 56 (96,4%) TLE cases. One patient had long-term ictal EEG and another had subdural grid EEG implanted, both patients showed visually normal MRI. But for the recent fourteen-year, Simple TLEs occupy only 234 out of 458 (51%) TLE cases. Long-term ictal EEG were performed in 161 patients (35,2%), PET study in 39 patients (8,5%), subdural grid EEG in 30 patients (6,5%), and ECoG in 61 patients (13,3%).

Results: As a new ES center performing only simple TLE cases, our surgical results were Class I: 82%, Class II: 11%, and Class III: 7%. As a semi advance ES center (after more than 5 years, and only half were simple ES cases), the Class I or seizure free results were 78,7% for simple TLEs, 73,4% for Difficult TLEs, and 65,2% for Complex TLEs.            

Conclusion: For the first five year, -as a basic ES center- we relay most on good MRI besides detailed study on seizure semiology and routine EEG. The Class I or Seizure Free result was best in the Simple TLEs with MRI showing discrete unilateral temporal lesion. With 18 years experiences of structured ES program, together with those countries with advanced ES program, we should encourage countries with limited resources in Asia to initiate a new Basic ES Center, so that ES services may become available to PWEs in all part of Asia. 

 

 

Rahila Qazi

Meridian Health Services, USA

Title: Religion and mental health: A discussion of how religion impacts mental health/ Bio-PsychoSocial mode of treatment
Biography:

Abstract:

The poster presentation is based on a research of how religion impacts mental health. The positive and negative effects of Belief on emotional wellbeing.

The purpose is to share my research report and to open up a discussion of how people view religion when it comes to their emotional health. The idea is to shift the way neuropsychiatric illnesses like depression and anxiety are perceived and treated from strictly analyzing chemicals to a more holistic approach that looks at person's unique genetic makeup and life style. In the past 25 years, we have learned a tremendous amount about the mechanisms in the brain that regulate emotional behavior. We can track the effects of different medicines on the brain and then their short comings when it comes to patients who are treatment resistant. As science continues to advance, America's biopharmaceutical companies are working to develop medicines these diseases into manageable conditions. Researchers are studying biomarkers and the ways current medicines impact the pathology of the brain. Despite that progress, far too many people still suffer with mental illness in silence, while too many other seek treatment only to find insufficient remedies. It is time to think outside the box to bring the balance back in life.

Edith N. Botchway

Murdoch Children’s Research Institute, Australia

Title: Sleep Disturbances in Young Adults who Sustained Traumatic Brain Injury in Childhood: Relationship with Fatigue, Depression, and Quality of Life
Biography:

Dr. Edith Botchway is a passionate paediatric neuropsychology researcher, interested in answering critical research questions on cognitive, behavioural, and sleep outcomes in children with neurodevelopmental conditions using methods such as functional and structural MRI, actigraphy, and EEG. She completed her PhD with the University of Melbourne in September this year, where she explored sleep, fatigue, depression and quality of life outcomes in young adults who sustained traumatic brain injury in childhood.  She then worked on an industry-funded project aimed at understanding rehabilitation models of care used in survivors of childhood traumatic brain injuries and spinal cord injuries. Dr Botchway is currently a Postdoctoral Research Fellow with the Cognitive Neuroscience Unit at Deakin University, Australia, and holds honorary research positions at the Murdoch Children’s Research Institute (Australia) and Aston University in the UK.

 

Abstract:

Objective: To evaluate sleep, fatigue, depression, and quality of life (QoL) outcomes and assess the relationships among these factors in young adults who sustained TBI in childhood.

Methodology: We recruited 54 young adults with mild (n = 14), moderate (n = 27), and severe (n = 13) TBI, and 13 typically developing control (TDC) participants as part of a 20-year follow-up of a longitudinal prospective study. Sleep was assessed subjectively with the Pittsburgh Sleep Quality Index, and objectively using actigraphy sleep efficiency.  

Results: At 20 years postinjury, no significant relationship was identified between subjective sleep quality and history of childhood TBI, however, subjective sleep quality was significantly poorer in moderate TBI compared to severe TBI participants. Objective sleep disturbance, fatigue, depression, and QoL outcomes were also not significantly different between TBI and TDC or among TBI severity groups. Poor subjective sleep quality in the TBI group was also associated with increased symptoms of fatigue and depression and reduced general health. 

Conclusions: These preliminary findings indicate that while the majority of young adults with childhood TBI present with similar sleep, fatigue, depression, and QoL outcomes as their typically developing peers, some of them may be at an increased risk of poor outcomes in these domains. In addition, poor sleep outcomes in these young adults with childhood TBI may be associated with an increased risk of fatigue, depression, and reduced general health.

 

 

N. Shameer Nijam

University hospitals of Leicester, UK

Title: Saccadic Intrusions: Don’t miss toxins & drugs
Biography:

Dr Nasrul Shameer Mohamadu Nijam.

Trainee in adult neurology.

Initial part of training in Sri Lanka – Teaching hospital of Kandy and national hospital of Sri Lanka, Colombo.

Currently following the compulsory overseas training in UK – University hospitals of Leicester.

 

 

Abstract:

Saccadic intrusions are involuntary conjugate saccades (fast eye movements) that interrupt fixation. Although, some of these may be seen in normal individuals, others are pathologic. they often reflect dysfunction of the brainstem, cerebellum, superior colliculus, basal ganglia, and/or cerebral hemispheres.

We may distinguish two groups of saccadic intrusions by the presence or absence of an intersaccadic interval.

Saccadic intrusions with intersaccadic intervals such as square wave jerks, macro saccadic oscillations and saccadic pulses may be seen in neurovegetative diseases and demyelinating diseases.

Saccadic intrusions without intersaccadic intervals such as ocular flutter and opsoclonus can be seen in various conditions. This includes para infectious brainstem encephalitis, metabolic toxic states, demyelinating diseases, inherited disorders and paraneoplastic conditions (primarily neuroblastoma in children, and small cell lung carcinoma, breast carcinoma or ovarian carcinoma in adults), although in many cases, the cause remains unknown.

Ocular flutter and opsoclonus are rarely caused by drugs and toxins. This association has been reported in drugs/toxins such as cocaine, phenytoin, lithium, amitriptyline, phencyclidine and more recently venlafaxine.

The pathophysiology of saccadic intrusions has been a matter of dispute encompassing several mechanisms which include brainstem and cerebellar theories.

The options for symptomatic management of saccadic intrusions are limited to some case reports.

Although rare, possibilities of drugs and toxins as the causative agents have to be considered early in the differential diagnoses.

There is a high chance of missing the complete diagnosis if the relevant investigations are delayed.

 

Day 2 :