Day 2 :
Keynote Forum
Wai Kwong Tang
Chinese University of Hong Kong
Keynote: Structural and functional MRI correlates of Post Stroke Depression
Biography:
Professor WK Tang was appointed to professor in the Department of Psychiatry, the Chinese University of Hong Kong in 2011. His main research areas are Addictions and Neuropsychiatry in Stroke. Professor Tang has published over 100 papers in renowned journals, and has also contributed to the peer review of 40 journals. He has secured over 20 major competitive research grants. He has served the editorial boards of five scientific journals. He was also a recipient of the Young Researcher Award in 2007, awarded by the Chinese University of Hong Kong.
Abstract:
Depression is common following an acute stroke. Post stroke Depression (PSD) has notable impacts on the function recovery and quality of life of stroke survivors. Incidence decreased across time after stroke, but prevalence of PSD tend to be stable. Many studies have explored the association between lesion location and the incidence of PSD. For example, lesions in frontal lobe, basal ganglia and deep white matter have been related with PSD. Furthermore, cerebral micro bleeds and functional changes in brain networks have also been implicated in the development of PSD. In this presentation, evidences of such association between the above structural and functional brain changes and PSD will be reviewed.
Keynote Forum
Rola Aatif Mahmood
Surgeon and Ultrasound specialist
Keynote: Imaging of ischemic Stroke
Biography:
Finished her High School attended: Khawla secondary girl’s school; 2003-2006. GPA= 99.3% Graduated from Medical university attended: Royal College of Surgeons in Ireland. 2006-2011 Completed internship in Salmaneya Medical Complex- Bahrain Completed Bahrain licensure exam in June 2012 Completed Saudi licensure exam in June 2012. Previous job: ultrasound specialist and patient support consultant in Abbott laboratories from September 2012 to august 2013. Current Job: Slamaniya Medical Complex- Radiology Department.
Abstract:
Stroke is the third leading cause of death and a leading cause of acquired disability. It is divided into ischemic and haemorrhagic. Ischaemic strokes are divided themselves according to territory affected or the causing mechanism. Knowledge of the pathophysiologic mechanisms of neuronal injury in stroke is essential to target treatment. The goals of an imaging evaluation for acute stroke are to establish a diagnosis as early as possible and to obtain accurate information about the intracranial vasculature and brain perfusion for guidance in selecting the appropriate therapy. A comprehensive overview including the current radiological investigations and their implications will be discussed , for example: CT angiography can depict intravascular thrombi. Diffusion-weighted MR imaging helps in detection of hyperacute ischemia. Gradient-echo MR sequences is helpful in detecting a hemorrhage. The status of neck and intracranial vessels can be evaluated with MR angiography, and a mismatch between findings on diffusion and perfusion MR images may be used to predict the presence of a penumbra.
- Neurological Disorders | Neuro Degeneration | Cerebrovascular disorders | Spine & Spinal Disorders | Stroke and its Management | Neuro Radiology & Imaging techniques | Multiple sclerosis | Neuropsychiatry and Mental health | Neuropsychology & Behavioural Sciences
Session Introduction
Turki Abualat
Imam Abdulrahman bin Faisal University, Dammam, SA
Title: Structural Neuroplastic Change nd Behavioral Motor Recovery after transcranial Direct Current Stimulation (tDCS) in Patient with Stroke: A Case Study
Biography:
Dr. Turki Abualait is a clinical researcher in neuroscience and neurorehabilitation interested in investigating the neurological disorders at Imam Abdulrahman bin Faisal University (university of Dammam formerly).
Abstract:
Fine motor and manual dexterity deficits are the main cause of functional disability that leave stroke survivors with significant impairment physically and psychosocially. transcranial direct current stimulation (tDCS) is one of the non-invasive brain stimulation (NIBS) novel techniques that can be used in modulating brain activity and improving functional and clinical outcomes. To investigate the therapeutic utility of applying tDCS in behavioral functions in patients with stroke, a 48-year- old, left-handed male who had a right-hemisphere-fronto- parietal ischemic stroke suffering from cortical sensation deficits; asterognosis and agraphesthesia was participated in 30 sessions of sham tDCS before crossover to 30 sessions of dual- hemispheric tDCS in a double-blind, sham-controlled single-case study. Six weeks of daily sessions (5 days per week) with (2 mA, 20 min). Direct current was delivered from a battery-driven, constant current stimulator (Magstim HDCStim stimulator, The Magstim Co., Whitland, UK) using saline-soaked surface sponge electrodes (5 × 5 cm) with anodal tDCS placed over ipsilesional primary motor area (M1), and cathodal over contralesional M1. Functional outcome measures were assessed with grooved pegboard, box and block test (BBT), action research arm test (ARAT), functional dexterity test (FDT) and nine-hole peg test (NHPT), in several times; prior stimulation (T0), immediately post (T1), as well as 1 month (T3) and 3 months after the end of procedure (T4). Structural and tensor diffusion imaging (DTI) data were also acquired prior (T0) and after stimulation (T1). Slight improvement in grooved pegboard, (BBT), (ARAT), (FDT) and (NHPT) in sham was noticed in (T1). However, with real dual-hemispheric stimulation all findings were clinically significant across all times (T1, T3 and T4). Higher fractional anisotropy (FA) and lower diffusivity of the corticospinal tract (CST) positively correlated with better recovery of fine motor and manual dexterity. tDCS intervention induces not only behavioral but also and structural changes in stroke.
Mohamed Hamdy Ibrahim
GMU University, United Arab Emirates
Title: Could Ambulatory Blood Pressure Monitoring Be a Routine Investigation for Patients with Mild Cognitive Impairment?
Biography:
Abstract:
To study the ambulatory measured blood pressure (ABPM) profile in normotensive patients with mild cognitive impairment (MCI). Patients and Methods: The study was designed as a case control study including 50male patients with mild cognitive impairment in the age group of 30 - 50 years old. The control group included 30 volunteers with no cognitive impairment and in the same age group (30 - 50 years old) and same gender. Mini-mental estate examination, office and ABP monitoring (ABPM) and brain MRI scans were done for cases and controls. Results: Thirty patients (60%) with MCI revealed a non-dipper blood pressure pattern. Sleeping systolic blood pressure and sleeping systolic load were significantly higher in patients with MCI than in normal volunteers (p = 0.01). MRI brain showed more white matter lesions (WMLs) in patients with MCI than in normal volunteers; however, this didn’t reach significance level (p = 0.056). Conclusion: MCI in normotensive young adult patients could reflect an abnormal circadian blood pressure rhythm. Ambulatory blood pressure monitoring could be an essential investigation in young adult MCI patients.
Biography:
Abstract:
The natural history of depression in stroke patients is complex and the mechanism of change in symptoms over time is not fully understood. We hypothesise that there are different trajectories of symptoms after stroke.
Methods: The primary analysis comprised 761 patients who completed 5 years follow up, obtained from the prospective South London Stroke Register (1998–2013). The Hospital Anxiety and Depression scale(HADs) was used to screen patients for depression symptoms at 3 months after stroke, then annually. Trajectories of depression symptoms were detected using group based trajectory modelling (GBTM).
Results: Four patterns of symptoms were identified: 6.31% of patients had severe symptoms, improved slightly in early years then worsen (predicted mean HADs score, 15.74 (se¼1.06)); 28.65% had moderate symptoms, a tendency to get worse over time, predicted mean score 7.36 (se¼0.35); 49.54% had mild symptoms and a tendency of getting worse, predicted mean 3.89 (se¼0.30), and 15.51% of the cohort, had no symptoms and remained so over time. The lowest rate of Selective serotonin reuptake inhibitors (SSRI) use, over 5 years after stroke was 1.1% for group (I) and highest was 35% for group (IV). Sensitivity analyses were used to assess the robustness of the findings using several inclusion criteria and findings agreed with the primary results.
Conclusions: The study identified 4 trajectories of depression symptoms, providing further insight into the natural history of depression. These may be used to improve the long term management of stroke patients and to implement cost effective personalized interventions.
Muhamed Al-Jarrah
Department of Rehabilitation Sciences, Jordan University
Title: Parkinson disease-induced upregulation of apoptotic mediators could be attenuated in the skeletal muscle following chronic exercise training
Biography:
Abstract:
BACKGROUND: We have shown elevated levels of p53 and active caspase-3 in gastrocnemius skeletal muscle with Parkinson’s disease (PD). The main aim of this study is to examine the impact of endurance exercise training on the expression of p53 and active caspase-3 in the skeletal muscle of mouse with induced Parkinsonism.
METHODS: Sedentary control (SC), sedentary Parkinson diseased (SPD), and exercised Parkinson diseased (EPD) groups were formed; each consisting of 10 randomly selected normal albino mice. Chronic Parkinson disease was induced in the SPD and EPD animals using 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and probenecid (MPTP/p). The expression of p53 and active caspase-3 was investigated, using immunohistochemistry, in the gastrocnemius muscle in each animal group.
RESULTS: Both p53 and active caspase-3 expression was significantly (p value < 0.05) reduced in the PD gastrocnemius skeletal muscle following endurance exercise training.
CONCLUSION: Our present data suggest that chronic exercise training reduced Parkinson disease-induced upregulation of p53 and active caspase-3 in gastrocnemius skeletal muscle. Thus, our study suggests that inhibiting p53 and/or active caspase-3 may be considered as a therapeutic approach to ameliorate PD skeletal muscle abnormalities.
Arshad Zaman
The Leeds Teaching Hospitals, Leeds, UK
Title: Can we treat what we can't see? : Neuroimaging and mental health
Biography:
Dr. Arshad Zaman is an experienced neuro specialist with over 15 years’ experience in developing and clinically applying functional Magnetic Resonance Imaging (fMRI) at international centers of excellence. Previous studies encompass a spectrum of clinical applications (epilepsy, oncology) to state-of-the-art applications (e.g. pain relief, mental health, brain training). Current commitments centre around further development and clinical utilisation of fMRI.
Abstract:
Functional magnetic resonance imaging or functional MRI (fMRI) is a state-of-the-art functional neuroimaging technique (non-invasive) that measures brain activity by detecting associated changes in blood flow. fMRI is increasingly playing a key role in providing a deeper insight into brain function and or functional brain networks. There are several novel clinical applications of clinical fMRI. Indeed, fMRI brain functional imaging, can unlock the deepest secrets of the living brain, consequently plays a key role in modern mental health treatment and psychiatric methods (clinical and research). Recently, there has been considerable consensus that modern psychiatry practices do not take full advantage of new (yet matured) powerful science, e.g. neuroimaging techniques.
The session will cover an introduction to clinical fMRI, clinical and novel applications in mental health. This session will spotlight what can and can't be done with fMRI in the context of mental health and identification and or treatment of psychiatric disorders. The session will address the key question, whether it is the correct time to inject state-of-the-art science into psychiatric practice.
- Workshop on Autism
Session Introduction
Sharmila Alam
University of Calgary
Title: Autism Spectrum Disorder from Valproic Acid
Biography:
I was a neuroscience researcher from 2006 to 2010 in University of Calgary. Before that I obtained M.Sc in Biochemical Engineering from the same university. I am a mother of two kids and now residing in saudi arabia with my family. During my research days I worked with animal models (rat and mice) of Neuorlogical diseases to look for potential treatments. I have several publications in different journals. My inquisitiveness to find out the hidden mechanism, hope to find a cause and cure that can improve the quality of life of millions of people and my passion for science keeps me going.
Abstract:
Autism spectrum disorder (ASD) is a behaviorally defined brain disorder affecting approximately 1 in 150 children [1]. Autistic children exhibit impoverished verbal and non-verbal communication skills and reduced social interactions [2]. Several studies have shown that in utero VPA (valproic acid ) exposure may link to an increased risk of ASD, where, for example, it has been reported that the rate of ASD in the children of VPA-treated mothers may be roughly eight times may be larger than that of the general population [3,4]. The purpose of the study is to observe whether VPA can influence the speed of postnatal maturation in vivo and whether this can be associated with structural and behavioral characteristics related to autism. Methodology: Although the effects of VPA have been tested in rodents for many years [5], only relatively recently it has been used to model ASD in rodents for studying ASD-like behavioural features such as social play behaviors. Findings: We found that VPA treated animals can exhibit gross cortical hypertrophy and a reduced predisposition for social play behavior. Conclusion and Significance: Structural and behavioral findings from this research suggests that alteration of the developmental time course in certain high-order cortical networks may play an important role in the neurophysiological basis of autism.
- Neuropharmacology | Brain Tumors & Neuro Oncology | Neurology and Nursing | Neurosurgery | Neurology: Research and Treatments | Therapeutic Approaches for Neurological Disorders | Clinical Trails & Case Reports
Session Introduction
Iulia Karlsson
Swedish pharmaceutical company
Title: Temodex – a novel effective local intraoperative chemotherapy treatment for patients with neuroepithelial brain tumors
Biography:
Iulia Karlsson has completed her PhD in Medical Biosciences at the age of 29 years from Swedish pharmaceutical company and works today as Regulatory Affairs Specialist and Head of Companion Diagnostics and Biomarker Development at Double Bond Pharmaceutical, an innovative pharmaceutical company founded in 2014 in Sweden. She has extensive experience in clinical studies both in human and veterinary medicine and a profound knowledge in human biology.
Abstract:
INTRODUCTION: The efficacy of the local chemotherapeutical drug Temodex, constituted of temozolomide as active pharmaceutical ingredient and dextran phosphate as carrier, was studied in a phase II clinical trial.
AIM: To assess whether Temodex improves the standard of care treatment (Stupp) for patients with operable neuroepithelial brain tumors when administered into the cavity formed after tumor resection.
METHODS: An open, controlled, comparative, retro-prospective study with overall survival (OS) as primary endpoint. Totally 95 patients with Grade II-IV glioma were included in the control group and 41 in the Temodex group.
RESULTS: Median OS of patients with highly malignant, Grade III-IV, tumors was significantly improved in the Temodex group compared to control group (14.4 vs 9.1 months, respectively, p=0.0001). Median OS for all patients (Grade II-IV) in the Temodex group was 8.5 months longer compared to control (p=0.0001). Median PFS of patients with Grade III-IV tumors was 13.6 months in the Temodex group compared to 7.8 months in control (p=0.0001). Median PFS in patients with Grade IV tumors in the Temodex group was 12.9 months compared to 7.2 months in control (p=0,0001). One-year cumulative survival ratio of patients with Grade III-IV tumors was 51.9% higher in Temodex group compared to control (p=0.0001). At the time of the latest analysis, 74.4% patients in Temodex and 94.4% patients in the control groups had died.
CONCLUSION: The current study of Temodex efficacy in combination with adjuvant chemo-radiotherapy against Grade II-IV tumors demonstrates an increase in both median OS as well as in median PFS.
Giulio Anichini
Imperial College NHS Trust, Imperial College of London, UK
Title: Real Time Intraoperative Gliomas Profiling – Preliminary Results on a Series of Patients Treated Using Intraoperative 3D US and iKnife
Biography:
I am a qualified neurosurgeon with a background of 5 years of training and 4 years of practice as a neurosurgery specialty doctor, now working as a Neuro-oncology Neurosurgery Fellow at the Imperial College of London – Imperial College NHS Trust.
Our group’s research is focused on: 1) implementation of new technologies in neurosurgery to improve both diagnosis and treatment of brain tumours; 2) molecular pathways in brain tumours; 3) improving neurological and neuro-cognitive assessment in patients with brain tumours.
Abstract:
Statement of the problem: Resection and biopsy of brain gliomas is challenging. Extent of resection has been proven to be an independent prognostic factor to predict both progression free survival and overall survival, but tumour margins are often hard to identify, and intraoperative targeting areas of suspected high grade components might be difficult only basing on pre-operative imaging. We previously explored role of intra-operative 3D US on intrinsic brain tumours resection, and the possibility of combining pre-operative spectroscopy MRI scan and PET with neuronavigation in order to target high grade areas. We have now investigated role of a new diagnostic tool, the iKnife, in combination with 3D US technology.
Methodology and theoretical orientation. Twenty-five patients diagnosed with suspected gliomas were treated with intraoperative use of 3D US and iKnife. Data were collected regarding extent of resection based on 3D US finding and targeting of the high grade components as defined by neuronavigation data, iknife results, and histological analysis according to WHO classification.
Findings. Use of 3D US was confirmed to be helpful in terms of tumour resection and verifying real-time changes. Both ultrasound and iknife data both showed areas within a transforming tumour that corresponded with a higher cell count and mitotic index on histology. iKnife use is technique and operator dependant, needing a strictly standardized protocol to obtain reproducible results.
Conclusions and significance. Intraoperative 3D US confirmed to be an extremely useful tool to both identify margins of resection and account for real time intraoperative changes. iKnife data were closely related to histological analysis, thus encouraging further data collection and studies to prove their efficacy and reliability.
Arshad Zaman
The Leeds Teaching Hospitals, Leeds, UK
Title: Paediatric Clinical fMRI: Pushing the limits
Biography:
Dr. Arshad Zaman is an experienced neuro specialist with over 15 years’ experience in developing and clinically applying functional Magnetic Resonance Imaging (fMRI) at international centers of excellence. Previous studies encompass a spectrum of clinical applications (epilepsy, oncology) to state-of-the-art applications (e.g. pain relief, mental health, brain training). Current commitments centre around further development and clinical utilisation of fMRI.
Abstract:
Functional magnetic resonance imaging (fMRI) allows non-invasive assessment of human brain function in vivo by detecting blood flow differences. From a powerful research tool actively utilised in cognitive neuroscience, clinical fMRI has evolved and matured into a robust clinical tool, implemented with a wide spectrum of patients. In this study, we further push the limits of this unique tool with paediatric patients. The purpose of this study is to present the experience of a large teaching hospital centre in the utility of clinical fMRI in a paediatric cohort and in particular focusing on the typical problems, pitfalls, solutions and benefits.
Twenty children (5 - 16 years) underwent fMRI, over a period of 2 years, as part of the regional epilepsy pre-surgical evaluation programme. fMRI was performed on a 3T Philips scanner. Some of the children additionally underwent DTI (tractography). Paediatric dedicated fMRI paradigms consisted of motor, sensorimotor, visual, auditory, memory and speech tasks. In some cases we also compared pre- and postoperative fMRI. MRI image analysis was performed using SPM12.
In all cases, fMRI successfully revealed activation of the desired eloquent cortical territories. Speech and memory fMRI was challenging for some of the younger children in our cohort. Numerous cases successfully revealed evidence of neuroplasticity.
fMRI can be successfully applied in children and holds significant promise for both research and clinical purposes. Using dedicated paediatric protocols and paradigms can result in a more effective and successful clinical fMRI investigation. fMRI allows more accurate assessment of cortical resection margins and can determine if surgery is best performed with the patient awake or asleep. Clinical fMRI has significant potential to replace Wada for this challenging age group. Fusion of fMRI and DTI yields further useful clinical information in relevant cases.
Biography:
Abstract:
Stroke is the third leading cause of death and a leading cause of acquired disability. It is divided into ischemic and haemorrhagic. Ischaemic strokes are devided themselves according to territory affected or the causing mechanism. Knowledge of the pathophysiologic mechanisms of neuronal injury in stroke is essential to target treatment.
The goals of an imaging evaluation for acute stroke are to establish a diagnosis as early as possible and to obtain accurate information about the intracranial vasculature and brain perfusion for guidance in selecting the appropriate therapy.
A comprehensive overview including the current radiological investigations and their implications will be discussed , for example: CT angiography can depict intravascular thrombi, Diffusion-weighted MR imaging helps in detection of hyperacute ischemia. Gradient-echo MR sequences is helpful in detecting a hemorrhage.
The status of neck and intracranial vessels can be evaluated with MR angiography, and a mismatch between findings on diffusion and perfusion MR images may be used to predict the presence of a penumbra.
Furhan Iqbal
Bahauddin Zakariya University Pakistan
Title: Creatine monohydrate supplementation for 10 weeks has a potential to improve learning and memory in female albino mice following neonatal hypoxia ischemia encephalopathy
Biography:
Abstract:
Currently there are no uniform standard treatments for newborn suffering from cerebral hypoxia-ischemia (HI) and to find new and effective strategies for treating the HI injury remains a key direction for future research. Present study was designed to demonstrate that optimal dose (1 or 3%) of Creatine monohydrate (Cr) for the treatment of neonatal HI in female albino mice. On postnatal day 10, animals were subjected to left carotid artery ligation followed by 8% hypoxia for 25 minutes. Following weaning on postnatal day 20, mice were divided into three treatments on the basis of diet supplementation (Normal rodent diet, 1% and 3% creatine supplemented diet) for 10 week. A battery of neurological tests (Rota rod, open field and Morris water maze) was used to demonstrate effect of Cr supplementation on neurofunction and infarct size following HI.
Open field test results indicated that Cr supplementation had significantly improved locomotory and exploratory behaviour in subjects. It was observed that Cr treated mice showed better neuromuscular coordination (rota rod) and improved spatial memory (Morris Water Maze test). A significant affect of creatine supplementation in reducing infarct size was also observed. Post hoc analysis of post hoc multiple comparisons revealed that mice supplemented with 3% Cr for 10 weeks performed better during Morris water maze test while 1% Cr supplementation improved the exploratory behaviour and gain in body weight than control group indicating that Cr supplementation has the potential to improve the neurofunction following neonatal brain damage.
Biography:
Raquel Neves. Nursing graduation in 2006 in Nursing School of Lisbon, Portugal. Completed her Master and Post-Specialization in Rehabilitation in 2013, Lisbon, Portugal. Working since 2006 with stroke patients in stroke wards. In the past she worked in Portugal (7years), KSA (2 years) and at the moment is a stroke coordinator in Amana Healthcare Hospital, Abu Dhabi, UAE.
Abstract:
Ischaemic hearth disease and stroke are the leading two cases of premature death1 and stroke continues to increase, with 16.9 million of people being affected by stroke annually.
An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive and emotional deficits and 25% to 74% of these survivors require some assistance or they need fully assistance of caregivers for activity of daily living2.
Following a stroke an individual may experience cognitive, physical and psychological deficits.
Evidence shows that the earlier rehabilitation is commenced the better the outcome for the stroke survivor and this principles should be applied in the acute and post-acute settings.
Following a stroke an individual may experience cognitive, physical and psychological deficits.
After the stroke, the first aim is to stabilize medical condition during the acute phase, and then to retrain the previously learnt tasks through actual trial and performance in the rehabilitation phase.
The main goal for stroke rehabilitation is to help stroke survivors relearning skills that are lost when part of the brain is damaged and to adjust him to this new condition.
Stroke rehabilitation is proactive, person-centered and goal-oriented process that should begin the first day after stroke. And the literature shows rehabilitation is not only related with physical recovery but also with reintegration of the person into the community and therefore the transition between hospital and community care.
A multidisciplinary team with a holistic, comprehensive and interactive approach should be in place to implement a stroke rehabilitation program as soon as possible, by setting realistic goals with the stroke survivor and family