Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 3rd International Conference on Neurological Disorders and Brain Injury London, UK.

Day 1 :

Keynote Forum

Suresh Kumar

Headaches, TBI and Memory Research Institute, USA

Keynote: Functional and cerebral metabolites evaluation of single episode mTBI with MRS and DTI
Euro Brain Injury 2017 International Conference Keynote Speaker Suresh Kumar photo
Biography:

Suresh Kumar is a Triple Board Certified Brain Injury Specialist, Neurologist and Director of Headaches, TBI and Memory Research Institute in Southern USA. He completed his Residency training in Neurology from Louisiana State University and later board certification in Headaches Medicine & Traumatic Brain Injury Medicine. He is User Interface Software Architect; Neuro Scientist & Clinician operating research based clinical practice. He has helped more than 50 patients with memory impairment after TBI and mild to moderate dementia under Regain Memory 360 protocol approach. He has published and presented many abstracts and papers on diagnosis, treatment of mild traumatic brain injury and cognitive deficit.

Abstract:

Background: Traumatic brain injuries (TBI) are widespread and well documented. However, impact of a single episode mTBI has been under-diagnosed with symptoms and underlying microscopic injuries being ignored. Studies with functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI) and reconstruction software are becoming more popular in mTBI diagnoses. These methods have proven problematic and their use as a diagnostic tool for mTBI has been called into question.

Methods: Retrospective study on 250 mTBI patients was conducted in TBI clinic over last four years. 160 patients were given WMS-IV standardized test after scoring <26 on MoCA cognitive screening. Functional magnetic resonance imaging (fMRI)/diffusion tensor imaging (DTI) tests were performed within average of 22 months after initial mTBI. 31 patients were further tested with fMRI, Swan, Flair and DTI with fractional anisotropy (FA) on white matter (WM), and the cortical thickness was measured in grey matter (GM) with color representation. Magnetic resonance spectroscopy (MRS) was done on bilateral frontal lobe and posterior cingulate consistently in all patients, if decreased cortical thickness was observed with neuronal loss. We identified subject-specific regions of abnormally high and low FA, axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) across all white matter voxels and several WM regions.

Results: The decrease cortical thickness in left frontal lobe (LFL) and RFL 89% (26/29) patients had MRS with decreased NAA, increased choline and myo-inositol were compared WM tract low FA. Corpus callosum (CC) WM DTI with decrease FA is 83.33% correlated with LFL, GM and MRS. Similarly, CC is 95% related with RFL with p value<0.05. 23/29 79% of lesions in the CC, hippocampus and SLF are well published in DTI literature as characteristic of mTBI. Immediate and delayed memory index is 36.79% related with Rt. temporal lesion. Decrease probability of attention score is 61.25% related with RLF and 64.51% with CC with P value<0.039. Executive functioning probability of low score is 100% related with LFL and 82.6% with RFL with P value<0.05.

Conclusion: There is no statistical difference between the areas tested by MRS in GM and DTI on WM, but they complement each other by detecting the lesions in the same patients in two different places. These tests can be used simultaneously to increase the predictive value. The MRS study with cerebral metabolites changes were seen at an average of 22 months, which was a longer interval than prior studies. WMS-IV findings of delayed recall and executive functioning are hallmarks of TBI and confirm disruptions in the memory circuit pathway. Functional magnetic resonance imaging (fMRI)/diffusion tensor imaging (DTI) study further support the memory loss in patients with cognitive deficits on WMS IV battery. There is a direct correlation between single-incident mTBI to underlying cerebral lesions and cognitive deficits. Strong correlations are seen secondary to patient selection, after low WMS-IV scores.  

Euro Brain Injury 2017 International Conference Keynote Speaker Fontaine H Guy photo
Biography:

Fontaine H Guy has made 15 original contributions at the inception of pacemakers since early 60s. He has serendipitously identified Arrhythmogenic Right Ventricular Dysplasia in the late 70s. He has published more than 900 scientific papers including 201 book chapters. He was the Reviewer of 17 journals in Clinical and Basic Science. He served during five years as a Member of the Editorial Board of Circulation. He has been invited to give 11 master lectures of 90 minutes each during three weeks in the top universities of China (2014).

Abstract:

Therapeutic hypothermia produced by evaporation of per fluorocarbon in the fossa nasalis in a flow of oxygen reported in a prospective multicenter study has demonstrated a tendency to improve outcome in out of hospital cardiac arrest. When I saw the experiments on pigs at the Weil Institute of Cardiac Care Medicine (WICCM), I was immediately convinced that another approach of cooling could be abrupt decompression of gas. After multiple experiments, I demonstrated that it was possible to obtain on the same model a drop of brain temperature similar to the work previously reported at the WICCM. However, the simultaneous work on infrared images on severed pig heads suggested that it was possible to cool the brain by the decompression of gas inside the mouth instead of the nose which looks to be an even less invasive and faster method on the field. The second major interest of this new technique seems to be its application in stroke also suggested by animal models. It was during these experiments that my wife watching TV beside me experienced an episode of cardiac arrest that I was able to diagnose immediately. I started cardio pulmonary resuscitation followed by defibrillation performed by an old but still working defibrillator that I kept in the basement of my house when the original study of the method of fulguration was completed. Before arrival of fire brigade, I used a bottle of compressed gas also available in the basement of my house and delivered the cooling gas at that time in the fossa nasalis. Despite a period of 6 minutes of no-flow, she was able to recover after five days of coma with absolutely no neurologic deficit. This fortuitous resuscitation using for the first time brain cooling by decompressed gas will be used for the first pilot study supported by the Schiller Company (Switzerland). It will start soon in the city of Lugano which is already famous for its highest success rate of resuscitation (50%). 

Keynote Forum

Aguinaldo Pereira Catanoce

Pontifi cia Catholica University of Campinas, Brazil

Keynote: Development and improvement of multidisciplinary work in the treatment of major vascular lesions of the nervous system

Time : 11:20-12:05

Euro Brain Injury 2017 International Conference Keynote Speaker Aguinaldo Pereira Catanoce photo
Biography:

Aguinaldo Pereira Catanoce completed his Graduation and Post-graduation in Medicine and Neurosurgery at Catholic University of Campinas in Brazil in 2007. He is a member of Brazilian Society of Neurosurgery since 2009. He has eight years of experience in “Neurosurgery and video endoscopes for brain tumors at the base of skull and intra-ventricular area in addition to the improvement of microsurgical treatment of vascular lesions”. He is a Neurosurgeon and Professor in Department of Neurosurgery at University of Campinas, Brazil; Manager; Medical and Technical Director at University Hospital, São Paulo, Brazil with seven years of experience in Hospital Management.

Abstract:

Development and improvement of multidisciplinary work in the treatment of major vascular lesions of the nervous system. Implemented a corporative hospital management system and clinical care aimed at the fast and efficient service in cases of hemorrhagic stroke, especially of the cerebral aneurysm and feasibility of endovascular or surgical treatment. Described and documented the efficiency and the good results through the organization of medical and multidisciplinary team associated with the corporate organization focused on innovation in the management model.

Keynote Forum

Esther M Remeta

Chiropractic Research Institute, USA

Keynote: Chiropractic cranial treatment model and neuroplasticity in a post stroke 72-year-old male: A case report

Time : 12:05-12:50

Euro Brain Injury 2017 International Conference Keynote Speaker Esther M Remeta photo
Biography:

Esther M Remeta is a practicing Chiropractor and Clinical Researcher. She is currently the Executive Director at Chiropractic Research Institute (CRI) in Clemmons. She completed her Doctor of Chiropractic Degree at National College of Chiropractic in Illinois. She is a SOTO-USA Board Certified Sacro Occipital Technique and Craniopathy Practitioner and a Diplomat with the American Academy of Pain Management.

 

Abstract:

Stroke is often associated with paralysis, leading to poor outcomes and quality of life as well as reduced activities-of-daily-living (ADL). The purpose of this presentation is to illustrate how chiropractic care can be used to facilitate neuroplasticity of the brain as a means to reduce/reverse any secondary stroke paralysis. This novel manner of multidisciplinary care incorporates the fields of allopathy, chiropractic, psychology, neurorehabilitation and nutrition. Care was measured with videotaping of progress, monitoring of ADLs and work capacity levels along with standard biomechanical orthopedic, neurological and chiropractic evaluation studies. Treatment included sacro occipital technique (SOT) which incorporated cranial manipulative care while simultaneously performing normal side extremity specific range of motion and then immediately following with performing the same range of motion activities on the abnormal side. Pre/post-videotaping of patient found continued progress over years, with showing walking 18-years later even though CT-scan illustrated the same area of initial brain tissue damage. Generally treatment of similar cases requires a minimum of six-month treatment followed-up with life-long wellness treatment, for the once compromised areas. Finding low risk therapeutic options to help a patient recover from brain trauma is a challenging endeavor. This presentation addresses the success of SOT chiropractic care and suggests that neuroplasticity may have a biomechanical-neurological connection pathway. Further studies are needed to identify if a subset of stroke patients might be responsive to chiropractic cranial manipulation to help facilitate biomechanical neuroplasticity. This may offer a low-risk, low-cost option for successful care of a post-stroke patient

  • Brain Injury | Brain Injury Treatment | Neurological Disorders
Location: Chambers Suite
Speaker

Chair

Fontaine H Guy

Piti-Salptrire Hospital, France

Session Introduction

Androulis Antonios

National and Kapodistrian University of Athens, Greece

Title: Hypothermia for intracranial hypertension after Traumatic Brain Injury: A randomized clinical study

Time : 12:50-13:20

Biography:

A Androulis is a qualifi ed Neurosurgeon operating as Complex Spine Fellow at the 2nd Neurosurgical department of Attikon University Hospital and Director of Neurosurgery at IASO General Private Hospital. He is currently pursuing his PhD at National and Kapodistrian University of Athens, Greece. His research work focuses on issues of cerebrospinal surgery and in vitro models for studying neurodegenerative and immunosuppressive neuropathies.

Abstract:

Background: Most patients with heavy traumatic brain injury (TBI) are nursed in ICUs. Clinical trials indicate significant mortality and morbidity in cases with sustained increases in intracranial pressure (ICP). A current way of controlling intracranial pressure in ICU is therapeutic hypothermia. The benefit of hypothermia on functional outcome is unclear.

Methods: 26 patients were randomly enrolled in the experimental group and 26 patients in the control group. Patients in the experimental group (n=26) were subjected to therapeutic hypothermia and monitored by 24 hour-recording of temperature and intracranial pressure. In control group (n=26), 24 hours recording of body temperature ​​and intracranial pressure was also performed but without the use of therapeutic hypothermia. Patient recording ranged from 1 to 6 days.

Results: There were 1638 hourly measurements of intracranial pressure in the control patient group. ICP exceeded ≥ 15 mmHg in 1192 of these hourly measurements while in remaining 446 values ranged from 8-14 mmHg. In experimental group, 2.208 hourly ICP measurements were performed. ICP values exceeded ≥15 mmHg in 685 and ranged from 5-14 mmHg in 1523 hourly measurements. The effect of therapeutic hypothermia was found significant (F=14.34, p=0.000).

Conclusions: Our investigation showed that therapeutic hypothermia can be used as an additional form of treatment of intracranial hypertension although the benefit in secondary injuries when patient intracranial pressure was ≥ 20 mmHg remains unclear. In particular, in patients with ICP>20 mmHg after TBI, therapeutic hypothermia does not improve results than the traditional form of care.

Biography:

Junzo Nakao has completed his PhD at University of Tsukuba, Japan. He has his expertise in Neurotrauma and Neurointensive Care. He has published more than five papers in reputed journals

Abstract:

Aim: Acute hyperthermia of severe brain injury causes secondary brain injury and aggravate outcome of patients. Therefore, maintenance of normothermia is recommended for severe brain injury in the acute phase. Therefore, we use cooling blanket (CB) for maintenance of normothermia in Japan. Aim of this study is to report that maintenance of normothermia by intravascular cooling system (ICS) for severe brain injury in the acute phase and compare the effect of ICS with CB. Method: Six patients with severe brain injury were given normothermia after soon surgery from January 2016 to November 2016. Result: Two cases were maintained by CB and four cases were maintained by ICS. All cases were given craniotomy for removal intracranial hematoma. Average GCS in-hospital of CB group was five and that of ICS group was 6.25. Average time-to-target temperature of CB group was 305 minutes and that of ICS group was 103.5 minutes (p<0.01). Patient’s temperature of ICS group was more comfortable than that of CG group. GOS was not significantly different between groups (GOS of CB group was 3.5 and that of ICS group was 2.5). Discussion: ICS has the potential of effective temperature control system because it is able to get target temperature quickly and effectively. On the other hand, it has the risk of complication; for example, infection and clot formation and so on. We need to accumulate more cases to find ICS to be effective.

Biography:

Getachew Desta completed his Doctor of Medicine at Gondar University and has one and half years of working experience as a Lecturer at Bahir Dar University, Ethiopia. Currently, he is a fourth year Resident in Surgery at Bahir Dar University.

Abstract:

Background: Craniopagus parasiticus is a rare medical case and it is unique unlike other cases reported from different literature. The head of parasitic twins is protruding from the temporal area of cranium. Parasitic head has two deformed lower limbs; one is too rudimentary attached to the mass; long bones of bilateral lower limbs and some pelvic bones. After dissection of the mass, the intestine was seen but no chest organs and other abdominal organs. There is also rudimentary labium but no vaginal opening.
Case Presentation: A 38-years-old multigravida (gravida V para IV) women from Amhara ethnicity referred from rural health center to referral hospital due to prolonged second state of labor at 42+1 weeks. Upon arrival, she had contraction, term sized gravid uterus and fetal heart beat was 112. On digital pelvic examination, the cervix was fully diluted; station of the head was high and the pulsating umbilical cord coming in front of the presenting part with ruptured membrane but yet in the vaginal canal. The team decided emergency cesarean section and then a live female infant weighing 4200 g was delivered. The placenta was single and normal. The APGAR scores were seven and nine at 1 and 5 min, respectively. The infant appeared to be grossly normal except the parasitic co-twin attached at the cranium. The neonate was investigated with the available investigations (CBC, X-ray, Doppler ultrasound) and pediatric side consultation was made. After a week of counseling and investigations, successful separation operation was done. During post-operative time, the neonate comfortably suckled on breasts without neurological deficit. The details of the surgery, post-operative condition & subsequent follow up will be discussed during the conference.
Conclusion: The possible etiologies of craniopagus parasiticus are still unknown due to a rarity of cases. Doctors, Genetic Scientists, Epidemiologists and Researchers continue to investigate this case as the reasons that could give clue to birth defect and to provide answer for better prognosis of cases and improved the life chances of the twins. This case will have some input in the effort to know the etiology and pathogenesis of this new borns.

 

  • Workshop
Location: Chambers Suite

Session Introduction

Suresh Kumar

Headache, Tbi & Memory Research Institute, USA

Title: Late seizures in mTBI: A prospective study
Biography:

Suresh Kumar is a Triple Board Certified Brain Injury Specialist, Neurologist and Director of Headaches, TBI and Memory Research Institute in Southern USA. He completed his Residency training in Neurology from Louisiana State University and later board certification in Headaches Medicine & Traumatic Brain Injury Medicine. He is User Interface Software Architect; Neuro Scientist & Clinician operating research based clinical practice. He has helped more than 50 patients with memory impairment after TBI and mild to moderate dementia under Regain Memory 360 protocol approach. He has published and presented many abstracts and papers on diagnosis, treatment of mild traumatic brain injury and cognitive deficit.

Abstract:

Objective: Persistent symptomatic mild traumatic brain injury (mTBI) is a focal disease process. Almost 80% of the patients have spontaneous resolution after mTBI, but 5 to 10% who have persistent mTBI disease presented to our clinic with persistent symptoms. The study was conducted on this group of patients with symptoms after mTBI for more than one month. Abnormal EEG results increase with persistent symptoms as the focal abnormalities increase due underlying focal shear brain cell injury. Aim of this study is to study predictor of late complications of seizure after episodes mTBI.
Method: A perspective study of patients presented to a TBI clinic for five years was conducted. On initial visit after neurological evaluation and detail questioning about the history of the mTBI and possible seizure semiology with strict inclusion criteria, a montreal cognitive assessment (MoCA) was administered to patients. Following neurological evaluation, a one-hour routine EEG as a standard protocol was performed after four weeks of the mTBI.
Results: 202 patients (105 females and 97 males with an average age of 42 years) presented and followed over three years after mTBI. Total 14 patients (6.9%) had seizures and 12 (5.9%) late seizures with average time of 22 months. 8/14 (57%) patients experienced complex-partial seizures and 6/14 (42%) encountered partial seizures episodes. 11/14 (78%) had recurrent seizure episodes while three patients had single episodes. 111/202 (55%) experienced transient LOC and 35/202 (12.4%) patients had abnormal focal EEG reports. 24/35 (68.6%) patients had an abnormal EEG and LOC. 12/14 (85.7%) patients had abnormal EEG results in predominantly frontal and temporal lobes, but only 10/14 (71.4%) of those also had LOC. On further analysis, LOC has a relative risk of 81.8% for future seizure episodes. Abnormal EEG is 37.14% directly correlated with seizures and 20.12% related with memory loss (P<0.0392). LOC is 5.35% related with memory loss (P<0.0412). The relative risk was 6.15, the patients who experienced seizures after the mTBI were six times more likely to have an abnormal EEG than those who did not experience any seizures. The sensitivity of the EEG at discovering abnormal brain wave-like activity was 85.7% with LOC group.
Conclusion: We do not have any standard protocol for recommendation and follow up after mTBI and to determine the late risk of seizure. From our study, loss of consciousness, abnormal EEG and memory loss are directly correlated with each other after mTBI and the abnormal EEG will increase the risk of late seizure in mTBI patients. Persistent symptomatic mTBI needs further testing with EEG to define future risk of seizure or increase risk of memory loss. The late risk of seizure after mTBI from this study was 6.9% and had an onset up to six years.

  • Traumatic Brain Injury | Case Reports and Case Management of Brain Injuries
Location: Chambers Suite
Speaker

Chair

Suresh Kumar

Headache, Tbi & Memory Research Institute, USA

Biography:

Esther M Remeta is a practicing Chiropractor and Clinical Researcher. She is currently the Executive Director at Chiropractic Research Institute (CRI) in Clemmons. She completed her Doctor of Chiropractic Degree at National College of Chiropractic in Illinois. She is a SOTO-USA Board Certified Sacro Occipital Technique and Craniopathy Practitioner and a Diplomat with the American Academy of Pain Management.

 

Abstract:

Introduction & Aim: This article seeks to share a novel manner of multidisciplinary care which incorporates allopathy, chiropractic, psychology, acupuncture, neurorehabilitation and nutrition for the treatment of TBI. Case 1: A 28-year-old female suffered TBI from a violent attack resulting with severe debilitating headaches requiring daily bed rest for two years with her condition consistently devolving prior to initial office visit. She was diagnosed with chronic migraines and informed that she would need prescription medication the rest of her life. Case 2: A 30 year old female sustained a TBI from a motor vehicle accident. PET scans noted decreased bilateral occipital lobe metabolic activity. She had chronic headaches of two year duration with transient paralysis of her left extremities and short term memory loss. She was informed by her neurologist that due to the duration of her post-concussion syndrome that no recovery could be expected. Case 3: A 70 year old male suffered a TBI from a stroke causing complete paralysis of the right upper and lower extremity. He also suffered from swallowing difficulty and speech problems. His neurologist had informed him that he would never work again, would need to walk with assistance, and have compromised use of his right hand.
Treatment/Intervention: A focal point of this multidisciplinary care at this clinic is sacro occipital technique (SOT) cranial manipulation protocols along with specific neurological rehabilitation training and home exercises. Home therapy focuses on physical, mental and emotional balance which increases efficacy of treatment. The care model is implemented for a minimum of one year with most patients remaining in the model for five years.
 
Results: Case 1: When treatment began, there was a significant initial improvement along with a gradual increase in function so that two years later (one treatment per week) headaches occur only once every two weeks lasting 12 hours. She is off all 10 of her prescription medications except for one and is currently tapering off of it under medical supervision. She is now able to live a more normal life with her young eight year old daughter taking part in her life activities as well. Case 2: After five years of treatment (one time per week), she is headache free, has neither short term memory loss nor any paralysis episodes. Case 3: After nine months of care, he was back at work full time and without paralysis, speech or swallow problems. After five years of care (one treatment per week), there were no obvious symptoms associated with the left parietal lobe infarct despite brain MRI scans showing damage was still present.
Interventions/Outcomes: A focal point of this multidisciplinary care at this clinic is sacro occipital technique (SOT) cranial manipulation protocols along with specific neurological rehabilitation training and home exercises over a five-year period. Significant improvement was noted in all cases with length of care varying from eight months to five years.
Conclusion: This care model gives greater hope for those suffering from TBI as well as gives the health care profession at large more options to create treatment plans resulting in better prognosis.

Biography:

Arun Kumar Prasad is a student of Department of Neurology at Taishan Medical University, China. He has published more than three papers in reputed journals and conferences in the field of Brain Injury.

Abstract:

Recent studies suggest that central nervous system (CNS) lymphatic drainage pathway to extracranial lymph compartments may play an important role in the removal of substances in the brain and cerebrospinal fluid (CSF). After the onset of subarachnoid hemorrhage (SAH), large amount of macromolecular substances, such as cellular lysates, proteins, peptides were accumulated in the brain tissue and CSF, which contribute to cerebral vasospasm and cerebral injury. The present experiment was carried out to investigate the possible role of cerebral lymphatic drainage pathway in the development of cerebral vasospasm and related cerebral injury and the influence of Ginkgo biloba extract. Wistar rats were used in the experiment and animals were divided into different groups. SAH models were replicated by double cisternal injection of autologous arterial hemolysate. In some animals, the main cerebral lymphatic drainage way out being blocked (cerebral lymphatic blockade, CLB). Two different constituents, ginkgolides and ginkgo flavone, were given as interventions. It was found that SAH reduced the drainage of Evans blue-labeled albumin (EBA) from the brain to the olfactory bulbs, cervical lymph nodes and abdominal paraaortic lymph nodes. A kinetic analysis of 125I-labeled human serum albumin (125I-HSA), a cerebrospinal fluid (CSF) tracer, showed that the clearance rate of macromolecules in the CSF was significantly reduced after SAH. Furthermore, SAH reduced the diameters of basilar artery (BA) and increased thickness of BA. Prominent cerebral injury was found after induction of SAH. The spasm of BA and cerebral injury were partially antagonized by ginkgolides and ginkgo flavone. It was concluded that cerebral lymphatic drainage pathway exerts intrinsic protective effects against cerebral vasospasm and cerebral injury by removal of macromolecular substances in the brain and subarachnoid spaces. Ginkgolides and ginkgo flavone may alleviate the exacerbated cerebral vasospasm and cerebral injury following SAH by CLB.