Day 1 :
Keynote Forum
Vinod Metta
Imperial College Hospitals, UK
Keynote: Triple ‘P’ for ‘P’: Fast facts, CDS regimes in Parkinson’s disease
Time : 10:00-10:40
Biography:
Vinod Metta has got trained at Kings College Hospital, London and higher specialist training in neurology and movement disorders at Imperial College, University College London, Queen Square Hospitals, London. He was awarded with prestigious Doctorate award for his research exploring pathophysiology and treatment options of disabling non-motor symptoms fatigue and sleep in patients with Parkinson’s disease, in collaboration with Kings and Imperial College London. He is also a Recipient of prestigious Joint British Neurology and Australian and New Zealand Association of Neurologists 2016 Fellowship award. He has authored and co-authored several papers published in high impact factor journals like prestigious Brain Journal and several book chapters in iconic Oxford textbook of Clinical Medicine (5th and 6th editions) and his recent book on hidden face of Parkinson’s disease reached celestial heights. He has special interest in exploring and pioneering biomarkers to investigate pathophysiology and treatment models in neurodegenerative disorders.
Abstract:
James Parkinson described Parkinson’s disease (PD) in 1817 which is now recognized as one of the commonest chronic neurodegenerative disorders in the world with an annual incidence of 20 per 100,000 and up to 2% of population aged over 80. Typically, the condition leads to depletion of dopamine containing and other (serotonergic, noradrenergic) neurons leading to the clinical expression of the classic motor symptoms of bradykinesia, tremor and rigidity while non-motor symptoms such as olfactory loss, depression and dysautonomia also dominate. Dopaminergic neurons in the basal ganglia normally fire in a random but continuous manner, so that striatal dopamine concentrations are maintained at a relatively constant level. In the dopamine-depleted state, however, intermittent oral doses of levodopa induce discontinuous stimulation of striatal dopamine receptors. This pulsatile stimulation leads to molecular and physiologic changes in basal ganglia neurons and the development of motor complications. These effects are reduced or avoided when dopaminergic therapies are delivered in a more continuous and physiologic manner. Studies in primate models and patients with Parkinson’s disease have shown that continuous or long-acting dopaminergic agents are associated with a decreased risk of motor complications compared with short-acting dopamine agonists or levodopa formulations. Continuous dopaminergic stimulation is a novel therapeutic strategy for the management of Parkinson’s disease, which proposes that dopaminergic agents that provide continuous stimulation of striatal dopamine receptors will delay or prevent the onset of levodopa-related motor complications. Most innovative, neoteric treatment strategies that provide continuous dopaminergic stimulation can be achieved with triple ‘P’ treatment in the form of transdermal patch, pump and continuous infusion therapies helps to combat this debilitating and denervating illness.
Keynote Forum
Quincy J Almeida
Wilfrid Laurier University, Canada
Keynote: A ‘Look’ into the Underlying Mechanisms and Rehabilitation Interventions for Gait Impairment in Parkinson’s disease.
Time : 10:40-11:20
Biography:
Dr. Quincy Almeida is the Director of the Movement Disorders Research & Rehabilitation Centre (MDRC) at Wilfrid Laurier University. With 100+ published articles. He is an expert in motor control, balance and gait assessment and exercise rehabilitation for Parkinson’s disease. His research has been funded by the Canadian Institutes for Health Research, the Natural Science and Engineering Research Council of Canada, the Canadian Foundation for Innovation, and the Brazilian National Council for Scientific and Technological Development. He has been awarded the Queen Elizabeth II Diamond Jubilee Medal, the Franklin Henry Young Scientist Award for motor control in Canada, and the Early Career Distinguished Scholar Award from the North American Society for the Psychology of Sport & Physical Activity.
Abstract:
Gait and balance deficits are arguably the most debilitating symptoms associated with Parkinson’s disease (PD), as well as the leading cause of loss of independence and quality of life in PD. One example is the so-called ‘freezing phenomena’, in which patients report feeling like their feet are glued to the ground leaving them unable to make their next step. This motor symptom is argued by many to dopa-resistant, and often leads to an increased risk of trips and falls. Thus, it is considered one of the most severe gait disorder associated with advanced PD.
This presentation will utilize a series of experiments to systematically disentangle the sensory, perceptual, cognitive and emotional processes involved in the planning and control of human walking, In order to enhance our understanding of the underlying mechanisms of the typical motor symptoms seen in PD. Subsequently, these basic science discoveries will be translated into therapeutic interventions that target these mechanisms, with the goal of identifying the most novel and effective rehabilitation strategies recommended for PD.
Keynote Forum
Raymond Chong
Augusta University, USA
Keynote: The dimensionality of fatigue in parkinson's disease
Time : 11:40-12:20
Biography:
Dr. Raymond Chong completed his PhD in 1997 from the University of Oregon. He is the director of the Augusta University's Applied Health Sciences graduate program. He is the lead author in over 70% of his papers. Dr. Chong is a regular reviewer for the US Veteran Affairs Research department and also serves on the editorial board of several journals including Gait & Posture.
Abstract:
Fatigue is commonly reported among individuals with Parkinson’s disease (PD). It may occur before the overt symptoms of bradykinesia, rigidity and tremor. As very little is understood about how to measure it, we determined the dimensionality of fatigue in PD using four recommended scales, the Fatigue Severity Scale (FSS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Parkinson Fatigue Scale (PFS) and Visual Analog Fatigue Scale (VAFS). Quality of life measures including cognition, depression, sleep, life orientation, physical activity and PD symptoms were tested for their correlations with fatigue. The results showed that fatigue was associated with many quality of life variables, with the PDQ-39 summary index showing the strongest association. PD subjects agreed more strongly than caregivers that they experienced higher levels of fatigue. 27% of PD subjects rated fatigue as one of their top three most bothersome symptoms. The constructs of fatigue were captured within one dimension by the VAFS which explained 67% of the total variance. The highest likelihood ratio gave a cut-off score of < 5.5 on the VAFS. The change in scores required to produce a perceptible difference or is grossly observable ranged between 1.4 and 2.2 points respectively. The potential utility of a single measure such as the VAFS in PD that is reliably correlated with quality of life is consistent with the pursuit to develop clinical tests and measurements that are accessible, easy to use and universally interpretable across health science disciplines. It is hoped that the simplified method of quantifying fatigue may be useful in studying movement disorders in PD.
Keynote Forum
Surya Pratap Singh
Banaras Hindu University, India
Keynote: Neuroprotective and anti-inflammatory role of Tinospora cordifolia in MPTP induced parkinsonian mouse model
Time : 12:20-13:00
Biography:
Surya Pratap Singh is currently working as a Professor in the Department of Biochemistry in Banaras Hindu University. He has done his Post-doctoral training from 2000 to 2008 from University of Illinois at Chicago and Johns Hopkins, USA and 1995-1996 from National Institute of Neuroscience, Tokyo. Japan. He received his PhD degree from IMS, Banaras Hindu University in 1994 and completed his MSc from Faculty of Science, Banaras Hindu University in 1986 and BSc in 1984 Faculty of Science, Banaras Hindu University.
Abstract:
Parkinson’s disease, an age related neurodegenerative disorder, is characterized by progressive loss of dopaminergic neurons in substantia nigra pars compacta of the mid brain and projecting neurons in striatum. Recently, several studies regarding Parkinson’s disease have proven the role of oxidative stress in neurodegeneration and neuroinflammation. In this context, our study evaluates the neuroprotective effect of Tinospora cordifolia aqueous extract (TCAE) in parkinsonian mice. From the immunohistochemistry and western blot analysis, it is evident that TCAE inhibits the MPTP-induced activation of NF-κB and its associated pro-inflammatory cytokines. Through, Real time PCR analysis it was revealed that pro-inflammatory cytokines were found to be up regulated in MPTP intoxicated mice while TCAE treatment significantly restored their levels. In addition, the expression level of IL-10 was found decreased in diseased condition which was further restored by TCAE treatment. Tyrosine hydroxylase, an important enzyme which is used as marker in Parkinson’s disease, its expression was found to be reduced in MPTP mice while on giving TCAE, its level was significantly restored. Our result clearly indicates that Tinospora cordifolia provides neuroprotection against MPTP induced nigrostriatal dopaminergic neurodegeneration and shows potent anti-inflammatory activity.
- Parkinson’s Disorders | Epidemiology of Parkinson’s disease | Diagnosis for Parkinson’s Disease | Managing life with Parkinson’s Disease | Advanced therapies in Parkinson’s Disease
Location: Singapore
Session Introduction
Harini Sarva
Weill Cornell Medicine, USA
Title: Deep brain stimulation in Parkinson’s disease: Review and update
Time : 14:00-14:30
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.
Jung-Eun Kim
Kyungpook National University, South Korea
Title: Usefulness of gait-aid system using smart glasses for freezing gait of Parkinson’s disease
Time : 13:50-14:20
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.
Ray-Yau Wang
National Yang-Ming University, Taiwan
Title: Exercise to improve walking abilities in individuals with Parkinson’s disease
Time : 14:30-15:00
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.
Deborah Symons
Queensland Health, Australia
Title: Rehabilitation outcomes with deep drain stimulator in a patient with Lubag’s disease: A case study
Time : 15:00-15:30
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.
Escobedo-MartÃnez Jorge Alberto
The National Neurology an Neurosurgery Institute of Mexico , Mexico
Title: Clinical and imaging characteristics of atypical parkinsonism; Case series
Time : 16:00-16:30
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.
Ahmed Abd El Rahman Daoud
Tanta University, Egypt
Title: Is there relationship between Toxoplasma gondii IgG seropositivity and idiopathic parkinsonism and does it have correlation with cortisol blood level ?
Time : 16:30-17:00
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.