12^th Global Neurologists Meeting on Neurology and Neurosurgery September 21-22, 2018 Singapore

Biography:

Dr. Arun Oommen is the Consultant Neurosurgeon at VPS Lakeshore Global lifecare, Kochi, India. After his super specialty training and fellowship training in Neuro Endoscopy, he has worked in various super specialty centers before joining VPS Lakeshore. He is an expert in handing various neurosurgical cases and has vast surgical experience in areas like Neuro Oncology, Neuro Trauma and Neuro Critical Care, Neuro Navigation, Steriotaxic Neurosurgery, Neuro Endoscopy, and Spine problems including Spine Instrumentation. He has numerous international publications to his credit in various indexed journals. He is the editor cum advisor of the Medcrave online Journal of Neurology and Stroke. He is also the editor of the Open Access Journal of Neurology and Neurosurgery and The Neurology and Neuro Therapy Open Access Journal. He is also the peer reviewer of numerous other journals. He is one of the formost Neurosurgeons in India acquiring an MBA degree. He is a regular columnist in numerous newspapers and magazines on various health related issues.

Abstract:

PSH commonly occurs in about 15-33% of patients following severe head injury if  associated with at DAI, Brain stem Injury, preadmission hypoxia or in the younger age group. The management of PSH following severe traumatic brain injury (TBI) remains problematic, primarily due to an inadequate understanding of the pathophysiology of the condition. PSH exerts a profound negative influence on the final outcome in affected individuals.

The pathophysiological basis  by  recent evidences  support two recent hypothesis –

1. Direct injury to the  Hypothalamus

2. Functional  disconnection of the hypothalamus and diecephalon from rest of  the CNS.

PSH aggravates secondary brain injury by basically 3 mechanisms,

• Hyperthermia,

—  Rigidity and posturing

—  Elevation of circulating catecholamines

DD includes-Lethal catatonia ,Malignant hyperthermia ,Infection ,Serotonin syndrome , Delirium Tremens (DTs),Dystonias, Meningitis, Neuroleptic Malignant Syndrome, Pediatric Sepsis, Thyroid Storm

Management include -Physical Therapy, Occupational Therapy, Speech Therapy. Drugs like Alpha-adrenergic and beta-adrenergic blockers Bromocriptine Chlorpromazine, Dantrolene Morphine ,Propranolol are helpful.

While the original theories inferred an epileptogenic source, there is greater support for disconnection theories.

Biography:

MS. SUCHI is an experienced International Pre School Principal/Manager who learn't Laughter exercises from many coaches around the world. She then designed Laughter Therapy which is being used  in many places such as hospitals and Senior Activity Centres. She provides individual and group therapy in educational and home settings.

A former Manager / Trainer is now engages in building social awareness about ‘Depression & Anxiety ‘ caused by pain and the harm it brings to people, families and communities. Her aim is to encourage people to seek help early and get on the path to recovery. Her works has been featured in local press, TV and Radio and has been an invited speaker at various community clubs and educational  Institutions.  She has also been awarded by MINDS and various community clubs  in recognition of her social work.

Abstract:

Statement of the Problem: There is a lack of awareness about what happy harmones are and what can be done to get them. People tend to feel unhappy for multiple reasons and neuropathic pain adds on Stress levels of not only the patient but the caregivers as well. Being in pain leads to feeling depressed and anxious  in some cases.

Methodology & Theoretical Orientation:

Review of Books and Research shows that getting a dosage of happy harmones will not only ease the pain of the patient but  feeling happy will also have a positive impact on the recovery of the patient. Adopting  Laughter therapy and getting harmones which makes one feel good will help many to recover from Neuropathic pain  /Depression & Anxiety.

Findings: One needs to work on his/her energies using Laughter Therapy which is a  positive approach for not having Depression & Anxiety caused by Neuropathic pain . The therapy can be used as a Holistic way to  recovery. 

Conclusion & Significance: The Laughter therapy which includes ways to get the dosage of happy harmones promotes overcoming Depression & Anxiety caused by Neuropathic pain,is  a fun way to manage pain.  Repeated sessions to be conducted to remind patients that  life while having pain or during the recovery should go beyond just seeking medical and counselling help and also include rebuilding Spiritual, Physical, Emotional, Relational and Mental health. The model has been put together from for testing in many settings including hospitals ,elderly homes and senior citizen centers.  This is not a research book or paper. It is just an effort to demystify the help available for Depression & Anxiety caused by pain. It is an attempt to motivate and encourage people to seek help and take a simple approach to remember and work on all aspects of their recovery. 

Biography:

Dr. Sakshi Chopra Gupta completed her Ph.D. in Clinical Neuropsychology from the All India Institute of Medical Sciences (AIIMS), New Delhi, India. Her specialization is Neuropsychological Assessment and Rehabilitation after brain injury and neurodegenerative conditions. She has worked extensively with individuals with various neurological conditions and psychiatric disorders. Over the years, she has won various national and international awards including the Centenary Young Psychologist Award, World Congress of Neurology Bursary, International Convention of Psychological Science Bursary and Grants from the Government of India. She is a co-founder of FeelJoy, which is an online coaching platform that aims to support the overall well-being of individuals who need emotional support in a friendly and anonymous way.

Abstract:

Neuropsychological or cognitive rehabilitation has expanded in the last decade and there is growing evidence in favor of neuroplasticity in the damaged brain.  Neuroplasticity describes lasting change to the brain, even after injury. Behavioral, environmental and cognitive stimuli can cause neuroplastic change, which has significant implications for recovery after brain injury. Modulation of synaptic transmission and synaptogenesis, the staple mechanism of neuroplasticity in development, maturation and learning, is also assumed by most to underlie functional recovery in the damaged system. Functional brain mapping along with neuropsychological assessments can provide an objective evidence of the deficits, and improvements after injury to the brain. Functional Magnetic Resonance Imaging (fMRI) and connectivity data can give some information on the recovery from deficits after a Traumatic Brain Injury (TBI).

Forty seven consenting patients from a randomized controlled clinical trial within one month post Mild or Moderate TBI were randomly assigned to the control group (CG) or intervention group (IG). Patients were evaluated on neuropsychological measures and fMRI tasks. fMRI paradigm was given using a 1.5 MRI Tesla scanner using Superlab and binocular camera with eye-tracker. A 6-week literacy free cognitive rehabilitation intervention was administered on the IG which included retraining in areas of visual short term, long term memory; focussed and divided attention; planning and visuo-spatial ability and relaxation techniques.

Pre-post analysis showed improvements in both the groups; but a more significant improvement in the IG in cognitive functioning; anxiety; depression; and quality of life, immediately and at the sixth month follow-up. FMRI findings demonstrated retrieval of visual memory processing and significant working memory association post intervention.

Specific activations pre and post cognitive interventions can provide valuable information for cognitive recovery after brain injury, and may contribute to guide clinicians for specific biomarkers for rehabilitation. Functional imaging can not only provide the link between cognitive rehabilitation and plasticity in future, but also neuroplasticity after injury, in larger cohorts.

Biography:

Lissy Puno has 27 years of extensive experience practicing in the region as a Counselling Psychologist. She is the co-founder of the International Counselling & Psychology Centre in Singapore. Lissy Puno offers counselling and psychotherapy across the developmental stages as well as gives talks, trainings and workshops covering a variety of relevant topics promoting psychological wellness.  Her work that started in the United States has also covered the Philippines, Thailand, Malaysia and Singapore.

Abstract:

Relationships and Marriages have increasingly been faced with challenges of boredom, disillusionment and infidelity.  Couples are finding themselves faced with the threat of ending the relationship sooner and find themselves at a loss on how to strengthen their relationships. Extra relational and extra marital affairs have been increasingly on the rise.  Why has it gotten out of control? When is it out of control?

 An understanding of the stages of the love relationship is crucial.  The theory of how the unconscious pull of attraction can eventually lead to disillusionment that creates vulnerability towards infidelity .  What creates the attraction between two people? Why feel a pull towards one versus the other?This period of vulnerability can be setting up the stage for an affair amidst the current trend of relationships being disposable and replaceable.  Patterns of behaviour amidst emotional turmoil will be identified as one may find themselves trapped in the web of intrigues, deception, shame and betrayal that comes with affair discovery. The pain, hopelessness and helplessness during this time may also lead to ineffective behaviour. Discover ways to nurture a relationship back into trust, safety and commitment through effective relational skills versus destructive and ineffective coping actions. The 8 C's towards a mature and healthy relationship will be highlighted.  What type of support do couples need at this time to maintain a connected relationship through a longer life span? The role of a couples therapist is challenged and expanded as the relationship becomes the client and not the two individuals existing in two different worlds.  Current trends in dialogue and communication skills will be introduced.

Biography:

I am commonly known amongst my clientele as “The Happy Doctor.” For those interested in my accolades, I have both a MBA and a PhD in Metaphysical Counseling. Besides this I am internationally-acclaimed author of Happiness Reinvented – Igniting Principles of Being the Best You can Be (an Amazon bestseller), Happiness Centered Business – Igniting Principles of Growing a Sustainable Business, Happiness Centered Customers: Secrets of Creating Happy Customers for Life and my latest book, the Miserable Millionaire – From Wealth, to Depression to Self-Realization.

Abstract:

In the current volatile, uncertain, complex and ambiguous world, organisations and individuals are hard pressed and required to perform better than ever before. In the workplace, this consequently produces cumulative risks for individual health and well-being, due to the psychological and social demands on the workforce.

As the old proverbial saying goes, ‘Prevention is always better than a cure.’

Through my own extensive research and industry discussion, it is becoming increasingly clear that a single, elegant, and empiricially-supported solution has emerged that can enable individuals to be more relaxed, happier, healthier, more creative, focused, and productive. Employed by a growing list of major companies, including Google, Facebook, Target, eBay, Intel, and General Mills, this solution is known as mindfulness. Over 400 scientific studies have demonstrated the unparalleled effectiveness of mindfulness in reducing stress, lifting mood, increasing concentration, fostering creative thinking, improving decision-making, strengthening the immune system, and developing empathy and altruism.

Mindfulness is now inexpensive, simple to teach and easy to learn as top-quality mindfulness training is within the reach and budget of every business.

Biography:

Dr Fowzia Siddiqui is Professor of Clinical Neurophysiology, President of Epilepsy Foundation Pakistan, and Consultant Neurologist and Epileptologist at Aga Khan University Hospital. She has completed her MBBS from Pakistan, Fellowship training in Epilepsy with Certification in Clinical Neurophysiology from Harvard University, USA. She served as Director of Epilepsy Program at Sinai Hospital Johns Hopkins University USA before moving to Pakistan to serve her country. Her mission, to improve the care of people with epilepsy. She has published many papers in  and been serving as editorial board member, and reviewer for the Higher Education Commission of Pakistan. 

Abstract:

Introduction:

According to The World Health Organization (WHO), epilepsy is one of those serious brain disorders that affects not only the individual but has a deep impact on the family and society in general. Approximately 50 million people are affected with epilepsy around the world , it is estimated that the prevalence of epilepsy is 9.99/1000 in Pakistan and other regions of south east Asia. More than 1/3^rd of the world burden of epilepsy lies within the region.

The guidelines available in developed countries are in a setting where epilepsy care is provided by epileptologists but in South-east Asian countries the scenario is different. In Pakistan, only one neurologist for 1.4 million population, contrast to US where one neurologist for 26 thousand. This shows a desperate need to adapt to alternate guidelines with strategies to provide simplified epilepsy management at a primary care level and to standardize epilepsy care on a National level. Thus simplified guidelines are proposed.

Methods:

To form these guidelines we reviewed and adopted from many different available guidelines including the ILAE reviews and WHO recommendations.  

Results:

A complete guideline for Epilepsy management in easy to follow algorithms and tables understandable even by those not well versed in neurology. Including AED selection in special populations e.g. women, children, elderly.  A simple Status Epilepticus Protocol.  

Conclusion:

The scope of these guidelines is to walk the treating physician with keys to establish diagnosis, a then selecting AEDs. These guidelines hope to provide the physicians treating epilepsy patients with a cost effective management plan.

Biography:

Will be updated soon

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 1^st 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:

To be updated soon

Abstract:

Purpose: To analyse the clinical and angioarchitectural features of Spinal Cord Arteriovenous Shunts, their management strategies and outcome. Compare our data with that of other authors.

Materials and Method: Neurovascular disease database in our department was searched to identify patients with Spinal Cord Arteriovenous Shunts (SCAVS) documented by digital subtraction angiogram in the period between 1988 to December 2014. Retrospective analysis of their medical, imaging and angiographic records was done.

Results: We identified 150 cases of SCAVS. Among these 64 (43%) had spinal cord arteriovenous malformations (SCAVMs), 86 (57%) had spinal cord arteriovenous fistulae (SCAVFs), which comprised of 71 microfistulae and 15 macrofistulae. Overall preponderance of males (72%) was observed. Peak incidence was seen in second (26%) and third (29%) decade of life, mean age being 28 years. Macrofistulae were predominantly seen in first two decades (87%) and filar fistulae were seen mostly above forty years of age (87%). No patient with microfistulae presented in first decade of life. SCAVMs had high incidence in second (34%) and third decade (41%). Dorsal cord was most common location (37%), followed by conus (26%), cervical cord (21%), filum (11%) and radicular (5%). Cervical cord lesions were not seen above fifty years of age. Majority of cases (68%) had progressive myelopathic symptoms of motor weakness, sensory deficits and sphincter disturbances. Majority (58%) of cervical cord lesions had presented with acute onset of symptoms. Imaging evidence of haemorrhage (hematomyelia or SAH) was seen in 45% of cases with acute symptoms and in only one patient with progressive myelopathy. Out of 116 treated cases 89 received endovascular treatment and 27 underwent surgery. Higher degree of obliteration (> 80%) could be achieved in SCAVF (80%) as compared to SCAVM (58%). Improvement or stabilisation of the lesion were seen in 42 (84%) embolised patients with SCAVF and 30 (77%) embolised cases with SCAVMs. Follow-up data available for 16 surgical patients showed improvement or stabilization in eleven and detoriation in five.

Conclusion: Most of the clinical and angiographic characteristics in this series were consistent with other large series, except the fact that we had higher number of microfistulae whereas AVMs constitute higher percentage in these series. Endovascular treatment is effective in treating spinal cord arteriovenous shunts. Surgery can be reserved for selective situations like filar AVFs, lesions which are unfavourable for endovascular embolizations and in failed embolizations.

Biography:

Dr. Lee graduated from Seoul National University College of Medicine in 2001. He completed his neurology residency and fellowship at Seoul National University Hospital, and subsequently completed clinical observership at Dana-Farber Cancer Institute and Brigham & Women’s Hospital, Boston, MA, USA. He has been working for Seoul National University Hospital and Seoul National University Cancer Hospital since 2012 and now is an associate professor. His research is focused on novel treatments of autoimmune encephalitis, paraneoplastic syndrome, and neurologic complications in cancer. He published more than 220 SCI papers. He is operating the only antibody diagnostic lab for paraneoplastic and autoimmune encephalitis in Korea.

Abstract:

Autoimmune encephalitis is not only the main etiology of limbic encephalitis, presented with seizure, memory loss, and psychiatric symptom, but also the most common etiology of new-onset refractory status epilepticus. Although the pathogenesis of autoimmune encephalitis is not fully known yet, recent studies in the last decade revealed susceptible genetics, initial germinal center reaction, generation of long-lived plasma cell, and synaptic action of antibodies. The pathogenesis leaded the improvement of treatment protocols. Because the autoimmune process blocks synaptic receptors or damages inhibitory neurons, channel-modulating anti-epileptic drugs are ineffective in many cases, and only immunotherapy can control the seizure. Empirical immunotherapy is often necessary even before the definite antibody diagnosis or exclusion of viral etiologies. Immunoglobulin is relatively safe and effective in both autoimmune and viral encephalitis. More advanced immunotherapies, such as Rituximab, Tocilizumab, and cyclophosphamide, should be preserved until the infectious etiologies are excluded sufficiently. Even though immunotherapies bring a dramatic improvement in some types of autoimmune encephalitis, they are double-edged sword and should be used cautiously. Supportive treatments is also important to ameliorate patients’ intractable symptoms. Further studies are necessary to develop the optimal protocol of immunotherapy in the autoimmune epilepsy.

Biography:

To be updated soon

Abstract:

Objective To access the clinical efficacy of microvascular decompression(MVD) for spasmodic torticollis(ST).

Methods From January 2014 to Janurary 2017, a total of 117 patients with spasmodic torticollis treated with microvascular decompression at Shanghai Tongren Hospital were enrolled retrospectively. In this study, 110 cases underwent MVD with retrosigmoid approach and 7 cases underwent MVD with paramedian suboccipital approach. Intraoperative findings and follow-up results were analyzed.

Results The mean follow-up was 18.7 months. Six months after the MVD surgery, 33 cases(28.21%) were cured, 50 cases（42.74%) improved significantly, 21 cases（17.95%）improved moderately, and 13 cases（11.11%） improved minimally or unchanged. The total efficiency was 88.89%. Vertebral artery was the most common offending vessel in 104 cases（88.89%） and posterior inferior cerebellar artery (PICA) was offending vessel in 13 cases（11.11%）. In the 110 cases with retrosigmoid approach, the neurovascular conflict was spinal accessory nerve(SAN) in 78 cases(70.91%), C1C2 in 37 cases(33.64%), and the junctional area of the brainstem and spinal cord in 21 cases(19.09%). In total, 2 or 3 conflict sides were involved in 15 cases(13.64%). Of the 7 cases with paramedian suboccipital approach, the conflict site was found in bilateral SAN in 2, in the C1-C4 in 3 cases, and in the spinal cord in 2. Postoperative complications, which including shoulder numbness in 3 and hoarseness in 1, were completely relieved during the follow-up period. There was no limb weakness, cerebrospinal fluid leakage, infection, cerebral hemorrhage and other complications.

Conclusions Vascular compression may be one of the major causes of ST. MVD is a safe and effective method for the treatment of ST. With the study of etiology and pathogenesis, MVD might be one of the most effective methods to treat ST in the future.