Agenda

Date

November 18-19, 2019

Location

Madrid, Spain

Conference Agenda

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Keynote Session:

Meetings International -  Conference Keynote Speaker Steven Benvenisti Esq photo

Steven Benvenisti Esq

Brain Injury Alliance of New Jersey, USA

Title: Spring break: A true story of hope and determination

Biography:

Steven Benvenisti Esq earned his Juris Doctorate in Law at the age of 25 from Bridgeport University after graduating with High Honors from college. He is a Partner at Davis, Saperstein & Salomon P.C., one of the leading law firms in the U.S.A. His practice is devoted to representing individuals who sustained traumatic neurological disorders. He has been named by the National (U.S.A.) Trial Lawyers as the Top 100 Trial Lawyers.

He is the President of the “Brain Injury Alliance of NJ” and on the Board of Directors of “Mothers against Drunk Driving.” He has been an international keynote speaker at hundreds of Neurology, Rehabilitation and Educational Conferences. All honorariums are donated to charities. Authored Spring break: A true story of hope and determination, regarding a severely brain injured college student who received long-term inpatient, outpatient care and rehabilitation.

Abstract:

This program is presented by an Attorney from the U.S.A., who is a partner at one of the leading law firms in America. His law practice is devoted entirely to representing victims who sustained traumatic neurological disorders. He has worked on thousands of cases and provides insight on the remarkable power of rehabilitation.

He will discuss the powerful impact comprehensive rehabilitation has on patients who sustained neurological disorders. The specific case featured involves the true story of an “All American” college student who, while on vacation, was walking and struck by a drunk driver’s vehicle traveling at over 80 kmph (50 mph). His parents were asked to consent to his organ donation due to the CT Scans revealing their son’s severe brain damage (T.B.I.), for which there is no cure. The family declined to consent to organ donation and instead got a room in the hospital to be with their son 24/7.

The audience will witness powerful before and after photographs of this student. The “after” photographs depict the student in a coma and on full life-support. The program educates the audience about neurological disorders through an attorney from the perspective of the survivor and their family, while also providing them with needed tools to help them in their own professional and personal capacities.

Traumatic brain injury is the silent epidemic of our time. Despite the tens of millions who sustain a T.B.I. every year, very few medical professionals, employers, educators and people understand the reality of what the survivor and family experience. The most effective way to get an understanding of traumatic brain injury and how to deal with it is directly from the perspective of a survivor. Steven Benvenisti, Esq., has presented this program on TV, through the news media and to hundreds of audiences worldwide.

Meetings International -  Conference Keynote Speaker Arturo Solis Herrera photo

Arturo Solis Herrera

Human Photosynthesis Research Centre, Mexico

Title: Neuromelanin and stroke

Biography:

Arturo Solis Herrera is MD, Ophthalmologist, with subspecialty in Neuro-ophthalmology, also has a M.Sc. and Ph.D. in pharmacology. After his finding of bioenergetic role of Neuromelanin, he started Human Photosynthesis ® Research Centre; in 2007, in Aguascalientes, Mexico. 

Abstract:

Stroke, a multifactorial disease; is the fifth leading cause of death in USA. Its diagnosis and treatment are particularly complex, and it focused mainly on vascular and bloodstream alterations since it is thought that blood carries the elements necessary for the proper functioning of CNS and all tissues in general. In spite the intensive study of blood vessels, the prevention and treatment of cerebral vascular events is limited as the multiple chronic sequelae that are commonly generated are a heavy burden on the patient and family. The discovery in 2002 of the unsuspected bioenergy role of neuromelanin represents the beginning of a new era in stroke physiopathology; because now is possible to discern that the sacrosanct double role of glucose as a source of energy and biomass is a source of carbon chains only, glucose cannot provide the energy that its own metabolism requires. If glucose were a source of energy, diabetic sufferers would fly. Therefore, our finding that neuromelanin possesses the intrinsic ability to transform light into chemical energy by dissociating the molecule of water, such as chlorophyll in plants; constitutes a conceptual revolution that allows us to understand that our organism takes energy from the light and the elements it needs to implement biomass are taking from food. In stroke, the separation between energy and biomass is particularly useful, as it turns out that the dissolution of the clot is not as urgent or useful, as the tissues tolerate surprisingly well the interruption of the blood supply while the source of energy is kept in good condition, which can achieved by pharmacologic treatment.

Meetings International -  Conference Keynote Speaker Igor N Pronin photo

Igor N Pronin

Burdenko National Medical Research Center for Neurosurgery, Russia

Title: Surgical revascularization as an option in treatment of Moyamoya disease

Biography:

Igor N Pronin has completed his MD in 1987 at Moscow Sechenov Medical Academy, Russia. Derek Harwood-Nash Paediatric Neuroradiology scholarship, Toronto, Hospital of Sick Children, 2001 PhD, Burdenko Neurosurgery Institute RAMS, Moscow, Russia, 1998. Residency in Neurosurgery, Burdenko Neurosurgery Institute RAMS, Moscow, USSR, 1987 – 1989. Since 1989 – 2015 Igor Pronin held positions:  Neuroradiologist, then   Senior Research Associate, Leading Research Associate.  He is the Deputy Director of Science of N.N. Burdenko NMRCN, Head of neuroradiology (inc. PET-CT center) department, since 2015. He has published more than 100 papers (including 18 monographs: 4 Springer); He is also an Editional Board Member of 7 medical Journals in Russia.

Abstract:

Moyamoya disease (MMD) is a rare cerebrovascular pathology with severe consequences and prognosis. Treatment options are differ from site to site (1, 2). Burdenko Neurosurgical Center has the largest series of observations of MMD in Russia. Between 2008 to 2017 in our center 64 patients with MMD were observed. There were 14 adults (aged 19-37 years, mean age 29) and 50 children (aged 1, 2-17, mean age 7,4). Male/female ratio was 1:1, 8. The clinical manifestations included: transient ischemic attacks (74%), ischemic strokes (50%), epilepsy (24%), intracranial hemorrhage (8%), hyperkinesis (5%) and cephalgia (55%). Final diagnosis was confirmed with subtraction angiography, MR- CT-angiography and CT-perfusion (PCT). During the diagnostics we decided follows tasks: the definition of the stage of the disease, the assessment of angiographic characteristics of the “donor” and “recipient” vessels, the state of collateral circulation and the degree of Cerebrovascular insufficiency.

METHODS: Surgical treatment was performed in 13 adults (17 sides) and 33 children (52 sides). Total number of surgical interventions was 69. Indirect revascularization was performed in 12 patients (22 sides), direct revascularization was performed in 11 patients (15 sides), and combined revascularization was performed in 23 patients (32 sides). Indirect revascularization was performed only in children of younger age (up to 10 ages). Among them there were 10 bilateral revascularizations. Direct revascularization was performed in 11 adults, 4 – bilateral revascularizations. Combined revascularization was performed in 21 children (2 – 18 age) and 2 adults (19 and 35 age), 9 – bilateral revascularization. Follow-up period was up to 9 years.

RESULTS: In group of patients with indirect revascularization clinical improvement was reached in 77% of cases, in group of patients with direct revascularization – in 91%, and in group with combined revascularization there was the improvement in 100% of cases. Postop. PCT showed good correlation with clinical improvement demonstrating restoration of blood flow in revascularization area. The complications were seen more often in patients with indirect revascularization and were associated with the perioperative ischemic disorders.

CONCLUSION: According of our experience the decision about the variant of the surgical revascularization in patients with MMD should be made on the base of different factors such as the age of the patient, the clinical severity of the disease, angiographic characteristics of the donor and recipient vessels, the state of collateral circulation and the degree of cerebrovascular insufficiency.

Meetings International -  Conference Keynote Speaker Tayseer Mohamed Zainelabdin Ali photo

Tayseer Mohamed Zainelabdin Ali

Al Qassimi Hospital, UAE

Title: Total and LDL cholesterol as risk factors of ischemic stroke in Emirati patients

Biography:

Tayseer Mohamed Zainelabdin Ali is senior consultant neurologist at Ministry of Health - UAE has more than 15 year experience working department of health and prevention in AL Qasimi hospital sharjah. She is the in charge of Neurology department in Al Qasimi Hospital in sharjah. She has several research papers in neurology segments.

Abstract:

The role of total and LDL-cholesterol as independent risk factors of ischemic stroke remains uncertain. The aim of this hospital based prospective observational study is to investigate the association between total and LDL cholesterol levels and ischaemic stroke in Emirates patients admitted to hospital between June 2007 and June 2009 with atherothrombotic stroke. One hundred and seventy one Emirati patients, 89 males and 82 females with acute ischemic stroke were diagnosed and investigated for risk factors, including hypertension, diabetes mellitus, cardiac diseases, cigarettes smoking and past history of transient ischemic attack (TIA) and past history of stroke. Exclusion criteria were patients with acute or chronic atrial fibrillation and patients receiving "statins". Brain CT scan, echocardiogram and carotid ultrasound were done on hospital admission. One hundred and twelve patients (65.5%) had hypercholesterolemia (total cholesterol level ≥ 5.2 mmole/L, LDL cholesterol ≥ 4.2 mmole/L). One hundred and thirty patients (76.0%) were hypertensive. Ninety patients (52.8%) were diabetic. Twenty two (12.9%) were heavy smokers. Fifty patients (29.2%) had past history of cardiac disease. Twenty eight patients (16.4%) had previous stroke Twelve patients (12%) had TIA. Out of the one hundred and twelve patients with hypercholesterolemia nine patients (5%) only had isolated hypercholesterolemia. The commonest risk factor associated with hypercholesterolemia is hypertension (78.8%). In conclusion, the results of this study do not support the association between isolated hypercholesterolemia and atherothrombotic stroke. Hypercholesterolemia is not an independent risk factor for ischaemic stroke but it can interact with other risk factors mainly hypertension to promote atherosclerosis.

Oral Session 1:

  • Stroke | Neurological Disorders and Neuroprotection | Stroke Rehabilitation and Brain Haemorrhage
Speaker

Chair

Igor N Pronin

Burdenko National Medical Research Center for Neurosurgery, Russia

Meetings International - Stroke 2019 Conference Keynote Speaker Denise O Dwyer photo

Denise O Dwyer

Rehab Group, Ireland

Title: Exploring self-management 21st century recovery systems, including Wellness Recovery Action Planning (WRAP), with mental health and acquired brain injury cohorts

Biography:

Denise O Dwyer is a Chartered Psychologist and has been working with Rehab Group for over ten years. Based in the West of Ireland, Denise works in Quest Brain Injury Services, Galway, and also covers Adult Mental Health as well as Generalised and Specific Learning Disabilities with The National Learning Network, Mayo. She has completed her Doctorate in 2015 on Twenty First Century Recovery and Wellness Recovery Action Planning (WRAP), within the contexts of Acquired Brain Injury (ABI) and Adult Mental Health.  She is a proponent of the application of simple, daily and functional activity, to improve and maintain mental health and wellbeing. Her research, involving 105 service users of The Rehab Group, showed the depression and anxiety levels of participants in a WRAP programme, significantly lowered, by comparison with their respective wait list counterparts. Her research has been widely received, most recently at Neuro Rehabilitation Conferences in Saudi Arabia, and Prague.  Denise is currently in the process of writing her first book, rooted mainly in the area of Humanistic Psychology, as well as drawing from other relevant fields in making Psychology applicable for everyone.

Abstract:

The concept of Recovery has taken on new meanings in recent years. Traditional emphasis on diagnosis and repair, has been steadily replaced with the notion of developing and maintaining psychological wellness. This study examined Wellness Recovery Action Planning (WRAP), as a possible intervention in mental health management.  A between groups case cohort design was employed to examine the effects of WRAP with Mental Health and ABI populations, as well as their respective wait list control counterparts. Cohen’s d observed medium effect sizes in the reduction of Anxiety and Depression for both the ABI (Cohen’s d for Anxiety  -0.5; Cohen’s d for Depression  -0.7) and Mental Health cohorts ( Cohen’s d for Anxiety -0.7; Cohen’s d  for Depression -0.6). Results demonstrate the potential of WRAP in offering a fresh, twenty-first century perspective, in the functional management of mental health.  Prior to this study, there was no evidence of WRAP having been trialled within the context of ABI, and based on the results indicated, it is indeed a worthy contender in the everyday management of mental health across populations.

Meetings International - Stroke 2019 Conference Keynote Speaker Sara Moya Millan photo

Sara Moya Millan

DACER Foundation, Spain

Title: Intervention in the acute patient hospitalized with stroke–DACER MODEL

Biography:

Sara Moya Millan, degree in Psychology from the University of Granada (Spain) and Master in Neuropsychology at Complutense University of Madrid. Nowadays, she is coordinator of the Neuropsychology department in DACER Foundation. She brings 15 years of experience in the Neuropsychological treatment of people with brain damage. Alongside she complements clinical activity with training healthcare staff in the specialization on the management of the acute patient hospitalized by stroke. She is also assisting in the ongoing practical training of postgraduate students from different universities in Spain.    She currently coordinates three ongoing research projects in Dacer Foundation.

Abstract:

The next article presents a type of intervention in patients who, after suffering stroke, are hospitalized. DACER MODEL. This model is the result of scientific evidence and clinical experience. The patient should experience as soon as possible, motor, sensory, cognitive and behavioral patterns, suitable to promote as normalized brain reorganization as possible. The model is structured in three fundamental premises: 1 early intervention, work the sooner the better with the patient; 2 global, unifying the entire environment (family and health workers) in the specific intervention of each affected person; and 3 intensive, creating a stimulating environment for the patient to receive adequate care throughout the day.

DACER MODEL consist of implementing performances in the phase in which the patient is hospitalized, to minimize future neurological and organic sequelae. To achieve this objective, the model includes three key actions: 1) Training and support for relatives and environment of the affected through the School of Families, a training action aimed at families, which is carried out in the hospital itself. 2) Training and support to health personnel who directly care for the patient with stroke and 3) Early intervention of a multidisciplinary team specialized in neurorehabilitation, including medical professionals, neuropsychology, speech therapy, occupational therapy and physical therapy.

Meetings International - Stroke 2019 Conference Keynote Speaker Mervyn Lim Jun Rui photo

Mervyn Lim Jun Rui

National University of Singapore, Singapore

Title: Acceptance of disability in stroke survivors: A systematic review

Biography:

Mervyn Lim Jun Rui is a neurosurgical resident practicing in the National University Hospital of Singapore, and is a part-time Masters in Public Health student of the Saw Swee Hock School of Public Health. His research interests lie in stroke, end-of-life care, and the application of technology for improving functional outcomes in patients with neurological impairment.

Abstract:

Purpose: To identify measures of acceptance of chronic disability used in post-stroke rehabilitation.

Background: Stroke is the second leading cause of morbidity worldwide. Acceptance of disability is an illness cognition where patients recognises the need to adapt to a chronic illness and perceives the ability to tolerate the unpredictability of the disease. It has been shown to increase ability to cope with the consequences of chronic diseases; thus, it is important to identify tools for measuring acceptance of disability and understand its role in post- stroke rehabilitation.

Methods: This was a systematic review of acceptance of disability in stroke survivors. We identified studies from five electronic databases. Three researchers screened and extracted data from all studies independently using the following inclusion criteria: participants diagnosed with stroke, aged 16 years and above, studies measured acceptance of disability, published in English, and published in a peer-reviewed scientific journal. Methodological quality was assessed using the NIH Quality Assessment Tool.

Results: We identified 6379 records and included five studies (published from 2008 to 2015) in our review. The studies had sample sizes ranging from 89 to 344. One study was graded poor quality, while the rest were fair to good. We identified four measurement tools used in stroke survivors: stages of acceptance based on Fink’s Theory of acceptance, the Acceptance of Illness Questionnaire, the Acceptance Subscale of Illness Cognition Questionnaire, and the Revised Acceptance of Disability Scale. Factors significantly correlated with acceptance of disability measured using these tools included disease duration, religious beliefs, first stroke, understanding of stroke, confrontational coping mode, capacity for functional activities, family support, and post-stroke depressive symptoms.

Conclusion: Existing tools for measuring acceptance of disability identified in our review appear to be useful in post-stroke rehabilitation to identify patients requiring psychological support to improve coping with the challenges related to stroke.

Meetings International - Stroke 2019 Conference Keynote Speaker Silvia Gilibets Parcerisa  photo

Silvia Gilibets Parcerisa

Althaia Foundation, Spain

Title: Cerebrall autosomal dominant artheriopathy with subcortical infarcts and leukoencephalophaty

Biography:

Silvia Gilibets Parcerisa has completed his PsyD at the age of 23 years from Autonomous University of Barcelona and postdoctoral studies (Master Degree) from Autonomous University of Barcelona. She is a clinical neuropsychologist of the Neurorehabilitation Uni of Solsona. President of GIGA association (integral treatment of neurological illnes).

Abstract:

The present case study describes the clinical and neuropsychological characteristics of a patient diagnosed with CADASIL. The neuropsychological assessment practiced and the participation of a neurocognitive rehabilitation program are indicated. CADASIL is a dominant autosomal hereditary disease, characterized by the presence of multiple strokes during young adulthood, with a progressive worsening of stroke-dependent functionality and localization. The expected cognitive pattern is an alteration mainly at the level of executive functions, with greater disinhibition and including serious behavioral disorders, with loss of insight and important functional, social and labor repercussion. Once the neuropsychological profile has been established, the patient is included to participate in a platform for computerized cognitive rehabilitation, lasting approximately 4 months. During this time, he also conducts follow-up visits with the psychotherapist for behavioral work. Subsequently, a neuropsychological evaluation is carried out to assess the patient's evolution during rehabilitation. During this process, the difficulties encountered during the evaluation are also working with the family, in order to facilitate the integration of the patient. With this case study we intend to give shape to the neurorehabilitation unit of our center, considering the importance of having these types of units for stroke-affected patients.

Meetings International - Stroke 2019 Conference Keynote Speaker Igor N Pronin photo

Igor N Pronin

Burdenko National Medical Research Center for Neurosurgery, Russia

Title: Special Session: CT and MRI in diagnosis of acute stroke

Biography:

Igor N Pronin has completed his MD in 1987 at Moscow Sechenov Medical Academy, Russia. Derek Harwood-Nash Paediatric Neuroradiology scholarship, Toronto, Hospital of Sick Children, 2001 PhD, Burdenko Neurosurgery Institute RAMS, Moscow, Russia, 1998. Residency in Neurosurgery, Burdenko Neurosurgery Institute RAMS, Moscow, USSR, 1987 – 1989. Since 1989 – 2015 Igor Pronin held positions:  Neuroradiologist, then   Senior Research Associate, Leading Research Associate.  He is the Deputy Director of Science of N.N. Burdenko NMRCN, Head of neuroradiology (inc. PET-CT center) department, since 2015. He has published more than 100 papers (including 18 monographs: 4 Springer); He is also an Editional Board Member of 7 medical Journals in Russia.

Abstract:

Early evaluation of patients with suspected stroke is crucial to prevent irreversible damage to ischemic brain tissue. It consists of a rapid neurological examination and immediate brain imaging to confirm the diagnosis and to guide treatment decisions. The European Stroke Organization guidelines recommend brain imaging with computed tomography (CT) or magnetic resonance imaging (MRI) in all suspected stroke or transient ischemic attack patients. Non-contrast CT scans (NCCT) are used for initial acute diagnostic imaging in the early management of suspected stroke because they are accessible and quick to acquire. However, NCCT scans are insensitive to subtle early ischemic change and can not differentiate tissues with different degree of ischemic damage. MRI, especially DWI, has a superior sensitivity in the detection of acute stroke compared to NCCT  and shows areas of cytotoxic edema even in superacute stage of ischemia. It is possible to visualize very small ischemic foci. According of common opinion MRI is superior to CT in the detection of stroke mimics.

Perfusion CT (PCT) and MRI (MR-PWI) provides important diagnostic and prognostic information that cannot be derived from clinical or other CT and MRI modalities. Perfusion techniques are minimal invasive, short time consuming, clinically available methods with quantitative assessment of hemodynamics parameters that can be easily incorporated into imaging protocol of stroke diagnosis.

Nowadays novel CT techniques make it possible to overcome three-dimensional limitations of the first CT PWI studies and to investigate practically the whole brain (“whole brain perfusion”).

The main key applications of perfusion techniques in stroke are the measurement of the extent of ischemic tissue and the differentiation of infarct core from potentially salvageable brain tissue, assisting in patient selection for acute reperfusion therapy, to predict of the clinical outcome after revascularization treatment and haemorrhagic transformation of ischemic stroke.

Conclusion: 

CT and MRI are the main methods of choice in detection of acute stoke with different sensitivity and specificity. PCT and MR-PWI are very informative in assessment of infarct core extent and penumbra/infarct core ratio. PW-DWI mismatch can help more precisely select patient for thrombolytic therapy. But more randomized trails with standardized software and techniques are necessary to validate CT and MR-perfusion usage in stroke diagnosis.