4^th Global Experts Meeting on Parkinson’s & Movement Disorders May 14-15, 2018 Singapore

Biography:

Harini Sarva is a trained fellow and movement disorders neurologist who is now the Clinical Director of the Weill Cornell Parkinson’s Disease and Movement Disorders institute. She is the Lead Neurologist for our DBS program and have collaborated with our neurosurgeon on the MRI guided focused ultrasound trial for essential tremor. She has authored and co-authored several peer-reviewed papers and presented my work at national and international conferences. She is currently working on the use of wearable devices to better enhance the evaluation of DBS patients.

Abstract:

Deep brain stimulation has revolutionized Parkinson’s disease management since its inception nearly two decades ago. Various studies have reported its efficacy in treating the motor symptoms of PD with benefits lasting for years, primarily with regards to tremor, rigidity and bradykinesia. Although non-motor symptoms and gait are not well treated with subthalamic nucleus or pallidal stimulation, DBS plays a major role in improving the quality of life of individuals with advanced PD, characterized by levodopa-induced motor fluctuations and dyskinesia. In addition, there is an impetus for earlier implantation and treatment with DBS as stimulation along with medical management has been shown to be more advantageous when compared with best medical management alone. Although, the entire mechanism of action of DBS is not understood, its potential role in treating aberrant neuronal firing is an exciting concept and has fostered research into newer technologies and continuous loop stimulation. While the risk of hemorrhage and infection are low they are not negligible and likely represent cumulative data over the last 20 years. This talk will review appropriate patient selection, current studies, newer targets and upcoming technological advances in DBS for PD.

Biography:

Jung-Eum KIM  currently working as a Senior Researcher in Kyoungpook National University Chilgok Hospital. She  has done her Master’s Degree in 2008 from Kyoungpook National University in the stream of Electrical Engineering and Computer Science. Prior to this experience she has worked as clinical research coordinator from 2005 to 2012 in Kyoungpook National University Hospital , Korea. Her research interests include: Parkinson's Disease, Dementia, Other neurology disease.

Abstract:

Background & Objective: Parkinson’s disease (PD) is a chronic progressive disease caused by loss of dopaminergic neurons in the substantia nigra, degenerating the nervous system of a patient over time. PD symptoms can cause gait disturbance such as freezing of gait (FOG) for patients. Meanwhile, a recent study shows that the gait of PD patients experiencing FOG can be significantly improved by providing the regular visual or auditory patterns for the patients.

Method: Our android based gait-aid system continuously monitors the gait of a PD patient to detect FOG with wearable sensors and upon detection of FOG, it projects the most effective visual patterns on the glasses as if the patterns were actually on the floor.

Result: We demonstrate that our system improves the gait speed and stride length of PD patients by 23% and 36%, respectively. Moreover, our system in much safer than the existing systems where the visual patterns may block the wearer’s sight.

Conclusion: Our gait-aid system based on smart glasses can be adapted for and applied to FOG of PD.

Biography:

Prof Ray-Yau Wang received her entry-level physical therapy training in National Taiwan University, master’s degree in physical therapy in Emory University, and practiced as a physical therapist in the Rehabilitation Center, Emory University Hospital, Atlanta, USA. She completed her PhD training in Physiology in National Yang-Ming University, and now is the faculty in Department of Physical Therapy and Assistive Technology, National Yang-Ming University. Prof Wang concentrates and engages in the physical therapy and medical research in the area of neurorehabilitation. One of her major research areas is to develop the treatment protocols for patients with stroke and Parkinson’s disease. She and her team have developed and provided the scientific evidence of the virtual reality training, turning-based training, backward walking, dual task training to improve patients’ balance and gait performance. They also proposed and proved that the repetitive transcranial magnetic stimulation can modulate brain activity to enhance plasticity for recovery. In addition to developing the treatment strategy, they investigate the possible brain recovery mechanisms in response to injury and rehabilitation by using the transcranial magnetic stimulation and electroencephalography.

Abstract:

Parkinson’s disease (PD) is a neurodegenerative disease that affects the brain and results in gait dysfunction due to impaired movement control, such as tremor, rigidity, bradykinesia, and postural instability. The gait dysfunction is demonstrated as decreased walking speed and difficulties in advanced walking including turning and obstacle crossing performance. Such gait dysfunction may affect the functional independence and increase the fall risks. Therefore, training to improve gait performance is essential for people with PD. Treadmill training can improve gait speed, stride length ad walking distance due to mass practice and forced use. The turning-based treadmill training has been reported to improve turning performance due to the task-specificity. The non-invasive brain stimulation, such as the repetitive transcranial magnetic stimulation (rTMS) has been proposed to prime the brain activity to enhance the following training effects. It is noted that the rTMS followed by treadmill training exerts better effects in improving walking performance paralleled modulation of corticomotor inhibition than treadmill training alone.

Biography:

Deborah Symons is currently working as Consultant Neurologist at Queensland Health in Australia.

Abstract:

Lubag disease, an X-linked dystonic parkinsonism is a rapidly progressive and disabling neurodegenerative disease affecting mainly male Filipinos with origins from Panay Island. Deep brain stimulators have been used with promising results in Parkinson’s disease. After failed medical management, a deep brain stimulator was inserted for pain management and symptom control in a patient with advanced Lubag disease. Once medically stable from the operative procedure, the patient was transferred to an intensive inpatient rehabilitation program including physiotherapy, occupational therapy upper limb therapy and speech pathology with swallow rehabilitation. Functional independence measure scores were assessed on admission to the rehabilitation unit and on discharge. There were extensive improvements in functional outcomes after intensive inpatient rehabilitation.

Biography:

Escobedo-Martinez Jorge Alberto is currently working as a Geriatrician and Dementiologist at Hospital Christus Muguerza Sur in Monterrey Area, Mexico. He has worked as High Specialty in Cognitive Aging and Dementia at National Institute of Neurology and Neurosurgery, Mexico.

Abstract:

Background & Aim: Atypical parkinsonism, accounts for 0.2 to 1.5% of all cases with probable Parkinson’s disease and its subtypes are progressive supranuclear palsy (PSP); multiple systems atrophy (MSA), dementia with Lewy bodies (DLB) and corticobasal degeneration (CBD); they share clinical presentation and have a poor response to levodopa. We aimed to investigate the main clinical and imaging characteristics of these diagnostic entities.

Method: 22 patients collected from the dementia laboratory of the National Institute of Neurology and Neurosurgery database were included, from August 2016 to June 2017; 9 PSP, 7 CBD, 3 with DLB and 3 with MSA patients. We report clinical, structural (visual scales - CGA, MTA, Fazekas, Koedam and strategic infarcts) and FDG-PET findings (18F-FDG/DTBZ).

Result: Mean ages of onset was: CBD=54.1, PSP=63.4, DLB=70.3, MSA=56 years. Mean delay on diagnosis in years were: CBD=2.1; PSP=1.2, DLB=1.3 and AMS=3.3. Initial symptoms were: Stiffness and alteration of episodic memory in CBD; postural instability with falls and stiffness on PSP; complex visual hallucinations and behavioral disorder related to REM sleep on DLB; dysarthria and falls on MSA.

Conclusion & Discussion: We must suspect an atypical parkinsonism diagnosis when disease onset is between 50-60 year, starting with falls, gait disturbances, working and episodic memory impairment, stiffness and dysarthria. Marked asymmetry and cortical thickness and metabolism are the hallmark on CBD radiological findings. Humming bird and Hot Cross Bun signs are the main characteristics found on MRI in PSP and MSA. On BLD the preserved image on MRI and the functional studies.

Biography:

Ahmed Abd El-Rahman Daoud is working as a Lecturer in Parasitology Department, Faculty of Medicine, Tanta University, Egypt. He has worked as an Assistant Lecturer, Parasitology Department, Faculty of Medicine, Tanta University, Egypt. He has completed his PhD in Microbiology, The Military Medical Academy Cairo and completed a course in Theoretical and Practical Studies in the Scanning and Transmission Electron Microscope at National Centre of Researches, Cairo. He did course in Theoretical and Practical Studies in Radio-Active Isotopes, Principles and Applications at the Regional Radio-Active Isotopes Centre, Cairo.

Abstract:

Background & Aim: Some researches have linked latent toxoplasmosis and neurological diseases, so the main interest is the probable relation between toxoplasmosis and neurological diseases such as epilepsy and parkinsonism. This study aimed to detect the incidence of Toxoplasma gondii infection in patients with idiopathic parkinsonism and correlate it to their blood level of cortisol.

Material & Method: This study was conducted on 30 idiopathic Parkinson’s patients, 30 psychiatric patients and 30 apparently healthy individuals. All subjects were given a questionnaire and anti-Toxoplasma IgM, anti-Toxoplasma IgG and cortisol level were detected by ELISA.

Result: Of the 90 cases, 41.11% and 1.11% were positive for anti-Toxoplasma IgM and IgG, respectively. The percentage of positive anti-Toxoplasma IgG cases was in healthy group (46.67%) followed by parkinsonism group (43.3%). Mean cortisol level higher in Parkinson’s group than other groups but still within normal levels. Contact to cats, drinking unfiltered water and consuming unwashed raw vegetables was significantly higher in Toxoplasma IgG seropositive Parkinson’s patients. Highest anti-Toxoplasma IgG positive cases in Parkinson’s group were detected in stage-3 of the disease.

Conclusion: A high Toxoplasma seropositivity is associated with parkinsonism. Toxoplasma gondii oocyst was the most probable main mode of transmission of Toxoplasma gondii in idiopathic Parkinson’s patients. Toxoplasma gondii may worsen idiopathic parkinsonism. Cortisol level was higher in Parkinson’s patients; still it showed no significant relationship with Toxoplasma gondii seropositivity.