“roneuro” research and diagnostic 12 amn th congress · gelu onose /romania wai poon /hong kong...

CONGRESS12 AMNTH

“RoNeuro” Institute for Neurological Research and Diagnostic

FOUNDATION OF THESOCIETY FOR THE STUDY OFNEUROPROTECTION AND

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13-16 NOVEMBER 2014 | HOTEL JA OCEAN VIEWDUBAI | UNITED ARAB EMIRATES

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Dafin F. Muresanu

President of the Romanian Society of Neurology

Professor of Neurology, Chairman Department of ClinicalNeurosciences, University of Medicine and Pharmacy “Iuliu Haţieganu”, Cluj-Napoca, Romania

President of the Society for the Study ofNeuroprotection and Neuroplasticity (SSNN)

CONGRESS CHAIRMAN

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AMN PRESIDIUM

Klaus von Wild / Founding & Honorary President

CEO KvW Neuroscience Consulting GmbH, Münster, Germany

Professor of neurological surgery Medical Faculty Universityof Münster, Germany

Dr.h.c. Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Haţieganu”, Cluj-Napoca, Romania

Professor h.c. for physical rehabilitation Medical Faculty AlAzhar University, Cairo, Egypt

Wai S. Poon / President

Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China

Minoru Shigemori / AMN Past President

Director, Yanagawa Rehabilitation HospitalProf. Emeritus, Kurume University School of Medicine113-2, Kamimiyanaga-cho, Yanagawa City, Fukuoka, 832-0058, Japan

Nicole von Steinbüchel / Vice President

Annette Groenefeldt, Holger Schmidt, Joy Backhaus

Institute of Medical Psychology and Medical Sociology, University Medical Center, Georg-August University, Göttingen, Germany

Anton Alvarez / Treasurer

Medinova Institute of Neurosciences, Clínica RehaSalud, A Coruña, Spain

Department of Neurosciences, University of Medicine & Pharmacy ‘Iuliu Hatieganu’, Cluj-Napoca, Romania

Volker Hömberg / Chairman of the scientific program committee

Dept of Neurology, Heinrich Heine UniversityDüsseldorf, Germany

Dafin F. Muresanu / Secretary General

President of the Romanian Society of Neurology

Professor of Neurology, Chairman Department of Clinical Neurosciences, University of Medicine and Pharmacy “Iuliu Haţieganu”, Cluj-Napoca, Romania

President of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN)

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FACULTY/in alphabetical order

Anton Alvarez /SpainRussell Andrews /USAKarin Diserens /Switzerland Volker Hömberg /Germany Jan-Peter Jantzen /GermanyChristian Matula /AustriaDafin Muresanu /RomaniaGelu Onose /RomaniaWai Poon /Hong KongIgnacio Previgliano /ArgentinaDorel Sandesc /RomaniaAndreas Schwartz /GermanyJohann Sellner /AustriaNicole von Steinbüchel /GermanyJohannes Vester /Germany Pieter Vos /NetherlandsKevin Wang /USAKlaus von Wild /GermanyWise Young /USA

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Fundation of the Society for the Study of Neuroprotection and Neuroplasticitywww.ssnn.ro

Romanian Academy of Medical Scienceswww.adsm.ro

“Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, Romaniawww.umfcluj.ro

ORGANIZERS

“RoNeuro” Institute for Neurological Research and Diagnosticwww.roneuro.ro


NEUROPLASTICITY

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Academy for Multidisciplinary Neurotraumatologywww.brain-amn.org

Academy forMultidisciplinaryNeurotraumatology

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SCIENTIFIC PROGRAM

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14TH NOVEMBER, 2014

09:20 – 09:30 Welcome Address Dafin Muresanu (Romania), Wai Poon (Hong Kong), Volker Hömberg (Germany), Suhail Abdulla Al-Rukn (UAE) Session 1 Chairpersons Klaus von Wild (Germany), Volker Hömberg (Germany), A.V. Ciurea (Romania)

09:30 – 10:00 Dafin Muresanu (Romania) Advances in brain protection and recovery in traumatic brain injury

10:00 – 10:30 Wai Poon (Hong Kong) Surgical treatment for intracerebral haematoma: where we are after STICH I&II and in the era of minimally invasive surgery

10:30 – 11:20 DEBATE SESSION Chairpersons Pieter Vos (Netherlands), Ignacio Previgliano (Argentina)

PRO: ICU-Management of Traumatic Brain Injury • Therapeutic Coma: Pro Jan-Peter Jantzen (Germany)

CONS: Therapeutic coma in traumatic severe head injury: Cons Andreas Schwartz (Germany)

COMMENT Volker Hömberg (Germany)

11:20 – 11:30 Discussions

11:30– 11:50 Coffee Break

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Session 2 Chairpersons Kevin Wang (USA), Christian Matula (Austria)

11:50 – 12:10 Pieter Vos (Netherlands) Traumatic brain injury impact of depression and posttraumatic stress disorder on outcome and quality of life

12:10 – 12:30 Anton Alvarez (Spain) Cognitive deficits and the risk of dementia after traumatic brain injury

12:30 – 12:50 Ignacio Previgliano (Argentina) Transcranial Doppler in traumatic brain injury: From de emergency room to rehabilitation

12:50 – 13:10 Nicole von Steinbüchel (Germany) Outcome in persons after mild traumatic brain injury


13:30 – 14:30 Lunch

Session 3 Chairpersons Nicole von Steinbüchel (Germany), Anton Alvarez (Spain)

14:30 – 14:50 Johannes Vester (Germany) The multidimensional approach in clinical neuroscience research - advances and challenges

14:50 – 15:10 Kevin Wang (USA) Recent advances in acute and chronic TBI biomarker research

15:10 – 15:30 Dorel Sandesc (Romania) What is death? From brain death concept to organ transplantation

15:30 – 15:50 Christian Matula (Austria) The CAPTAIN GCS training tool - or how to decrease inter-rater variability in a multicenter, multinational TBI trial


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Session 4 Chairpersons Wise Young (USA), Wai Poon (Hong Kong)

16:00 – 16:20 Russell Andrews (USA) Disaster response: an opportunity to improve global healthcare in the 21st century

16:20 – 16:40 Karin Diserens (Switzerland) Disorders of consciousness in early neurorehabilitation

16:40 – 17:00 Gelu Onose (Romania) Our experience on neuroprotection – with the use of some main related molecules – in patients with subacute/ subchronic conditions following severe central nervous system lesions


17:10– 17:30 Coffee Break Session 5 Chairpersons Russell Andrews (USA), Karin Diserens (Switzerland)

17:30 – 17:50 Johann Sellner (Austria) Strategies to improve the outcome of spinal cord ischemia

17:50 – 18:10 Wise Young (USA) Umbilical cord blood mononuclear cell therapy of chronic complete spinal cord injury

18:10 – 18:30 Volker Hömberg (Germany) The future of scientific meetings: what new formats do we need?


18:40 – 18:50 Closing remarks

18:50 – 19:50 AMN Board Meeting

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ABSTRACTS

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ANTON ALVAREZ1,3

Jesus Figueroa1,2

Dafin Muresanu3

1. Medinova Institute of Neurosciences, Clínica RehaSalud, A Coruña, Spain

2. Rehabilitation Department, University Hospital, Santiago de Compostela, Spain

3. Department of Neurosciences, University of Medicine & Pharmacy ‘Iuliu Hatieganu’, Cluj-Napoca, Romania

COGNITIVE DEFICITS AND THE RISK OF DEMENTIA AFTER TRAUMATIC BRAIN INJURY

Traumatic brain injury (TBI) is a medical condition with an enormous socioeconomic impact because it affects more than ten million people annually worldwide, constitutes the first cause of injury-related death in young adults, and is associated to high rates of lifelong impairments in physical, cognitive and psychosocial functioning.

Neurocognitive deficits are the most common complaints after TBI. Subjects with mild TBI (mTBI) usually experience transient cognitive symptoms, particularly confusion and impairments of verbal and visual memory and attention, and recover cognitive functioning completely within 1-3 months. However, up to 10-15% of the individuals with mTBI show persistent cognitive complaints and difficulties in executive functions such as decreases in cognitive flexibility and in the abilities to maintain attention and to inhibit incorrect responses. Cognitive deficits are also present in almost all patients shortly after moderate and severe TBI (m-sTBI) and include impaired arousal, information processing speed, attention, learning and memory, language, executive functions, and fine motor speed. Cognitive functioning improves during, at least, the first two years after m-sTBI, but more than 50% of these patients endure long-term injury-related disabilities. The investigation of cognitive impairment in TBI patients is a challenging topic because it varies depending on multiple factors such as the severity, type and location of the injury, the age of the patient, or the time elapsed since TBI occurred.

In spite of an initial (complete or partial) recovery in most of the cases, some TBI patients show late decline in cognitive functioning, particularly those with advance age and/or with increased levels of depression; and subjects undergoing TBI earlier in life have an increased risk of developing dementia. Several studies showed that a history of m-sTBI anticipates the onset of Alzheimer’s disease (AD) at younger ages and that the risk of having AD increases with increasing TBI severity. Similarly, a history of repetitive mTBI was found to be associated with the development of chronic traumatic encephalopathy (CTE), a neurodegenerative condition resembling dementia pugilistica. According to epidemiological studies, the relative risk of dementia in individuals who had a TBI of sufficient severity as to require hospitalization ranges from 1.5- to 3-fold, and the risk of dementia attributable to TBI is in the range of 5% to 15%.

Treatment of neurocognitive deficits and the prevention of TBI-related dementia were overlooked until very recently, and even nowadays remain priority issues waiting for an effective drug management. Taking into account that the pathogenesis of TBI involves multiple cellular and molecular mechanisms influencing cognitive functioning,

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recent investigations indicate that multimodal drugs, able to promote brain repair and regeneration by modulating several pathophysiological pathways, constitute the most promising therapeutic option to improve the acute outcome and the long-term recovery of cognitive functions after injury. Several clinical trials demonstrated improvements in cognitive performance after treatment with multimodal peptidergic drugs such as Cerebrolysin in TBI patients. However, large controlled trials and long-term efficacy studies are still needed.

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RUSSELL ANDREWS1

Leonidas Quintana2

1. Nanotechnology & Smart Systems, NASA Ames Research Center, Moffett Field, CA, USA

2. Department of Neurosurgery, Valparaiso University Medical School, Valparaiso, Chile

DISASTER RESPONSE: AN OPPORTUNITY TO IMPROVE

GLOBAL HEALTHCARE IN THE 21ST CENTURY

Objectives:Earthquakes alone often kill more than 200,000 people annually, and the universal humanitarian and medical response to disasters removes political, cultural, and socioeconomic barriers that often hinder the response to other global medical issues. Improved disaster response requires resources be “on-site” within 24 hrs - not the days to weeks of current disaster response.

Methods:Trauma and stroke centers (TSC) evolved when evidence showed that immediate “24/7” treatment resulted in dramatic improvements in morbidity/mortality. TSCs (e.g. academic medical centers - university hospitals - in the US) are part of the “mainstream” ongoing healthcare system - not a separate system. All physicians, nurses, and allied health personnel (both senior and in-training) are part of the TSC team - seamlessly integrated into the overall healthcare system. Equipment is presently available (e.g. military portable operating rooms) for a mobile trauma center to be in full operation anywhere worldwide less than 24 hours after a disaster strikes.

Results: To date disaster response has remained separate from the ongoing healthcare system, e.g. UNOCHA (United Nations Office for the Coordination of Humanitarian Affairs) and the Red Cross. We propose that disaster response - like TSCs - be integrated into ongoing healthcare systems worldwide (governmental/nongovernmental, national/international). This global “mega trauma center system” would improve disaster response and also be a platform for establishing universal training, certification, and research standards.

Conclusions:There are substantial political, cultural, and socioeconomic benefits - in addition to healthcare benefits - of integrating disaster response globally into the ongoing healthcare system.

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KARIN DISERENS1

Klaus R.H. von Wild2

1. Head Unit for acute Neurorehabilitation, Service de Neurologie, Département Neurosciences Cliniques, Lausanne, Switzerland

2. Med. Faculty University Münster; CEO kvw neuroscience consulting GmbH; Muenster, Germany

EVALUATION AND TREATMENT IN ACUTE PHASE OF DISORDERS OF CONSCIOUSNESS

The evaluation of consciousness in the acute phase is important in order to establish definite diagnosis, predictability, and to make treatment decisions i.e. to define an acute neurorehabilitation approach. In spite of advances in neuro-imagery and neurophysiology, 40% of patients having no motor response are erroneously diagnosed as “vegetative state”(VS) even when perception is still preserved. This is one of the reasons, why we replaced the “VS” as a clinical diagnose by the term “unresponsive wakefulness syndrome” (“UWS”). The integration of new clinical signs into validated scales evaluating disorders of consciousness (for example: the coma recovery scale), is required to accurately describe spontaneous motor behaviour in order to differentiate motor output blocked responsiveness from “ true” disorders of consciousness.

Definitions of disorders of consciousness are reviewed. The neurosurgeon will also draw attention to the Emergency Coma Scale, a hybrid scale composed of elements from Glasgow coma scale and the Japan Coma Scale designed and published by the AMN member Tomio Ohta.

The challenge of implementing acute neurorehabilitation in intensive and intermediate care in a University Hospital will be demonstrated using the results of a transversal Acute Neurorehabilitation Unit in Lausanne, Switzerland. This approach will be compared with the neurosurgeon´s view on prolonged coma and UWS following traumatic brain injury. This concept is based on many years of personal experience in early neurorehabilitation as part posttraumatic neurosurgical treatment in Germany. The main principles of acute neurorehabilitation will be presented, including neurosensory stimulation, verticalisation, facilitation by robotic training and brain computer interfaces as well as music therapy.

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JAN-PETER JANTZEN

Johannes-Gutenberg-University Medical School at Mainz

University of Texas Southwestern Medical School at Dallas

Head, Department of Anaesthesiology, Intensive Care Medicine and Pain Management

Academic Teaching Hospital Hannover Nordstadt Germany

ICU-MANAGEMENT OF TRAUMATIC BRAIN INJURY •

THERAPEUTIC COMA: PRO

Traumatic Brain Injury (TBI) imposes significant burden on individuals, families and society. Management aims at limiting consequences of secondary brain injury, focusing on the “lethal duo”: Hypoxemia and Hypotension. Rational strategies are based on cerebral physiology: “Function drives metabolism, metabolism drives flow”. Pathophysiology proceeds in reverse: If flow becomes too low to meet metabolic needs, function eventually ceases. Rationale of treatment by means of inducing pharmacological coma is establishing a new balance: reducing function, thus lowering metabolic needs, thus rendering perfusion adequate. This is achieved by controlled administration of sedatives or anesthetics – with or without mild hypothermia. Effect on function is monitored by EEG, therapeutic goal is abolition of cortical electrical activity - isoelectricity or burst-suppression-pattern.

The relation between depth of anesthesia, EEG activity and CMRO2 was established

more than 30 years ago in dogs:

CMRO2 (left) and EEG activity (right) as function of Isoflurane concentration [from 1].

Almost as old is conventional wisdom, that prophylactic barbiturate coma does not improve outcome of TBI2. Current guidelines3 state: “In the acute phase of intensive treatment deep-sedation (RASS score of –5) should generally be targeted, especially if intracranial hypertension (ICP >15–20 mmHg) is present.” That recommendation unveils an underlying dilemma: Uncertainty about the goal of sedation, in particular vs. induced coma. Shall it “shield” the patient, improve nursing conditions, facilitate ventilation, reduce CMRO

2, lower ICP - or improve survival..? That ambiguity blurs

interpretation of scientific data. Consequently, there is no Level-1-Recommendation-based Class-1-Evidence to support therapeutic coma, simply because a credible control group would hardly achieve a RASS score of -5 - and thus receive “substandard care”!

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This being accepted, management should still be based on best available evidence3 – or at least common sense - which supports therapeutic coma. This notwithstanding, drugs and strategy must be selected carefully, the practitioner must be aware of complications and side effects and the recovery phase – emergence - needs meticulous attention.

Nobody in his right mind would treat a broken bone without some means of immobilization - or?

References:

1 Newberg LA et al. (1983) The cerebral metabolic effects of Isoflurane at and above concentrations that suppress cortical electrical activity. Anesthesiology, 59:23-82 Ward JD et al. (1985) Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg 62:383-83 Martin, J et al. (2010) Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version. Ger Med Sci 8:1-154 Hertle D et al. (2012) Effect of analgesics and sedatives on the occurrence of spreading depolarizations accompanying acute brain injury. Brain 135:2390-8

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CHRISTIAN MATULA

Neurosurgical Department, Medical University of Vienna, Austria

THE CAPTAIN GCS TRAINING TOOL - OR HOW TO DECREASE INTER-RATER VARIABILITY IN A

MULTICENTER, MULTINATIONAL TBI TRIAL

One of the most important challenges completing a study like the CAPTAIN trial is to reduce the inter-rater variability to an absolute minimum. The inter-rater variability, or better known in the literature as reliability of a study, indicates (among other explanations) how or how much the result of a trial depends on the people who are doing the clinical examinations by using a clinical scale (e.g. The Glasgow Coma Scale, GCS). For that reason, from the beginning of the CAPTAIN trial, there has been a GCS Training Tool developed to achieve this goal. In the scientific literature about variability, the main approach to improve reliability seems to be the increase in the number of observers and improving the instrument used. Especially when running TBI trials, an inappropriate reliability of grading scales used can cause severe problems in analyzing the results of such a study. Most studies in moderate to severe TBI use GCS ≤ 12 for inclusion but GCS assessment is rarely standardized. Recent studies show identical GCS assessments in only 32% of the cases and deviations were up to 7GCS points. This is mostly because of a lack of clear operational rules and GCS training. On average, although many types of diagnostic scores are effective, improving the GCS seems to be the most important. To solve this problem of heterogeneity in GCS assessment for the Captain Trial, we developed a special module in the form of an interactive video to train the rater and synchronized them in a high level. The tool is available as a stand-alone version but also via internet in different languages. A multicenter, multinational GCS Validation Study recently started for validation of the instrument used. Preliminary first results proofs the efficacy of the training tool in a high range among other interesting findings presented. Because instrumental variables constitute a major source of error, improving the instrument is an important approach and one of the crucial needs achieving reliable results of such a trial.

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ADVANCES IN BRAIN PROTECTION AND RECOVERY IN TRAUMATIC BRAIN INJURY

In the last decade, we have seen an increase in efforts to establish evidence based parameters for the practice of brain protection and recovery. This effort has been placed in a broader context involving the role of theory in advancing brain protection and recovery science, particularly in relation to specifying the active components and mechanisms of action of interventions.

Rehabilitation is defined as a process through which each disabled person reaches the maximum physical, functional, cognitive and psychosocial recovery possible within the limits of their disability. Endogenous defense activity (EDA) of the nervous system is a the continuous process that simultaneously performs activities of neurotrophicity, neuroprotection, neuroplasticity and neurogenesis. Neuroregeneration (neurorepair) is the morphological outcome of the interactions between these basic neurobiological processes developed in a particular biological individual context. Neurorecovery is the positive outcome producing clinically relevant results, with immediate functional and late structural effects.

Restitution is an intrinsic process involving biochemically and genetically induced events, such as reduction of edema, absorption of heme, and restoration of axonal transport and ionic currents.

Substitution depends on external stimuli, such as practice, that, through learning, drives activity-dependant plasticity.

Compensation is targeted to improve the mismatch between patients’ impaired skills and the demand of the patient or the environment.

All basic biological processes can be naturally activated endogenously or exogenouslyIn order to successfully compete with pathophysiological processes and support recovery, EDA effects must be enhanced by:

• pharmacological • complex neurophyscological mood and cognitive support • physical means • electromagnetic stimulation • environmental stimulation • stem cell transplantation • any demonstrated combinations of these factors capable of improving patient condition after TBI

This presentation will give an overview on latest advances in brain protection and recovery in TBI.

DAFIN F. MURESANU

Chairman Department of Clinical Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy,Cluj-Napoca, Romania

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GELU ONOSE

Head of the P(neural-muscular)RM Discipline/ Clinic Division - the National Reference Centre for Neurorehabilitation,

Emergency Hospital “Bagdasar-Arseni”, Bucharest, Romania

OUR EXPERIENCE ON NEUROPROTECTION – WITH THE USE OF SOME MAIN RELATED MOLECULES

– IN PATIENTS WITH SUBACUTE/ SUBCHRONIC CONDITIONS FOLLOWING SEVERE CENTRAL NERVOUS

SYSTEM LESIONS (WITH FOCUS, BUT NOT EXCLUSIVELY, ON TRAUMATIC, BRAIN AND SPINAL CORD – INJURIES)

It is a contemporary reality the dialectic antagonism between, on one hand, the results of the general human progress (including in the health domain – due to which survival ensuring, even in desperate situations, became frequently possible), with its consequent elevation of the standards/ strivings for improvements of the peoples’ quality of life (QoL) and on the other – thus – the anachronic co-existence of severe disabilities/ handicaps, providing ”veterans of the contemporary medicine”: an actual, inappropriate, painful truth and global burden. Additionally, there is another growing challenge – quantitatively and as complexity, too – including for NeuroRehabilitation: the significant and fast augmenting of the mean life duration (the alert ”demographic ageing”), a population process generating more elderly, who’s bio-/medico-social characteristic is poly-pathology, with consequent multiple disabilities.

The complex modern management of patients with subacute/ subchronic conditions following severe central nervous system (CNS) lesions, involves – in addition to neurosurgical and/or of intensive care type intervention(s), if necessary – endeavors for: balanced pharmacological – and not only – stimulation of: neuroprotection, neurotrophicity (and even, to some limited extent), neuro-/synapto-genesis and modulation of neuroplasticity – all, together and in judicious synergy, with physical-kinesiological (including rehabilitation nursing) speech and/or cognitive-behavioral, therapies, for obtaining as consistent as possible neurorehabilitative and neurorestorative outcomes.

In this work, I first make an up-to-date general overview on the subject matter, detailing the path-physiological lesional mechanisms consequent to CNS injuries – including as intimate targets for neuroprotection – and then, a synthetic presentation of mine and colleagues’ expertise, on neuroprotection, mainly through using four modern related: drugs, respectively nutritional supplements.

Key words: neuroprotection, neurotrophicity, neuroplasticity, neuro-/synapto-genesis, neurorestoratology, endogenous defense activity (EDA)

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IGNACIO J. PREVIGLIANO

Head Division of Intensive Care, Hospital Fernandez, Argentina

Prof. of Neurology, Neurology Chair, Universidad Maimonides,Argentina

TRANSCRANIAL DOPPLER IN TRAUMATIC BRAIN INJURY: FROM DE EMERGENCY ROOM TO REHABILITATION

Traumatic Brain Injury´s (TBI) clinical classifications allows for severity evaluation as well as study and treatment regimens. The target in TBI is to avoid secondary injuries that can cause or worst intracranial hypertension. Although brain images are the cornerstone for pathophysiology evaluation, there are a group of patients that presents initially with an increase in intracranial pressure (ICP) in which early treatment can make a difference. These are patients with moderate and severe head injury. Ract, Tazarourte and we found that Transcranial Doppler (TCD) examination of cerebral flow velocities, pulsatile index and cerebral perfusion pressure (CPP) enables early treatment of high ICP. Our results showed that patients with high ICP that responded to fluids and norepinephrine treatment had better outcomes that the ones that does not.

Inside the ICU TCD has demonstrated utility in CPP and ICP estimation and showed some patterns that are useful in the setting of absence of ICP devices for monitoring. Some TCD patterns are useful to establish prognosis, ie normal values correlates with good outcomes. A special group of patients in which TCD is particularly helpful are those with decompressive craniectomy, in them the study emends evaluate the changes and identify trephination syndrome.

There are few studies that evaluate flow velocities during recovery and rehabilitation. Our experience in posttraumatic dementia evaluation and treatment with cognitive rehabilitation plus neurotrophic factors showed an improvement in mean flow velocities, cerebral perfusion pressure and cerebrovascular resistance.

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WAI S. POON

Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China

SURGICAL TREATMENT FOR INTRACEREBRAL HAEMATOMA: WHERE WE ARE AFTER STICH I&II AND IN THE ERA OF

MINIMALLY INVASIVE SURGERY

Although STICH I and II for spontaneous ICH did not show an advantage of early surgical treatment over the best medical treatment, referral frequency has increased and operation number remaining the same after these clinical trials. The story for STICH [trauma] is quite different: early surgery has a reduced mortality and an improved functional outcome. In all these trials, the surgical methods of evacuating these haematomas were not standarised: opening surgery, microsurgery or endoscopic surgery. For clinical trials in the future, a matured surgical modality has to be selected and appropriate training organized before it should be open up for a multi-centre clinical trials.

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ANDREAS SCHWARTZ

Director of the Neurological Dpt., Klinikum Hannover

Associate Professor of Neurology, Univ. of Heidelberg, Germany

THERAPEUTIC COMA IN TRAUMATIC SEVERE HEAD INJURY: CONS

The use of barbiturates in cases with traumatic brain injury with uncontrollable intracranial pressure was broadly recommended, but is not adequately supported by the literature. The negative inotropic effect, the possible drop in blood pressure, and impaired neurological evaluability during barbiturate sedation must be respected.

The maintenance of CPP (target 50-70 mmHg) is recommended so far, but the superiority of a CPP-oriented versus ICP-oriented protocol is not demonstrated. The high-dose barbiturate sedation reduces ICP, but does not increase the result and the EEG monitoring of the sedation encounters considerable practical problems.in the ICU, which means further risks to the patient. However, deep sedation or therapeutic coma can be attempted at elevated ICP, when refractory to treatment.

Further on propofol is recommended for the control of ICP, but not for improvement in mortality or 6 month outcome either, but it can produce significant morbitiy when used in high dosages.

Hyperventilation during therapeutic coma with ventilation, particularly as a prophylactic measure is potentially dangerous and should be avoided. The short-term use in acute ICP crises is permitted only during the first 24 hours.

Longer lasting sedation/analgesia is producing significant problems with ventilation, secondary infections, reduced capability of the immune system, organ demage and severe problems in the coagulation system.

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JOHANN SELLNER

Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria

STRATEGIES TO IMPROVE THE OUTCOME OF SPINAL CORD ISCHEMIA

Spinal cord infarction syndrome (ASCIS) is a rare but often devastating disorder caused by a wide array of pathologic conditions. According to recent estimates, ASCIS accounts for 5-8% of all acute myelopathies and 1-2% of all vascular neurological emergencies. Among the main causes are aortic pathologies and interventions, as well as any etiology of cerebral ischemia.

The diagnosis is generally made clinically, with neuroimaging to confirm the diagnosis and exclude other conditions. Patients typically present with acute paraparesis or quadriparesis, depending on the level of the spinal cord involved. The outcome depends on the severity of the initial deficits, mostly motor function. The frequency of recovery varies, only 20% show improvement of their ASIA Impairment Scale (AIS) when examined 12 months post discharge. Strategies to improve the outcome are therefore essential.

In this talk, I will present key steps and pitfalls in the management of patients with ASCIS. These include, one the one hand, primary and secondary preventive measures. On the other hand, early recognition is essential and requires adequate knowledge of clinical presentation and prompt MRI of the spinal cord. I will cover current treatment options in the acute phase and provide prospects of emerging neuroregenerative treatments aimed at improving the unfavorable outcome.

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NICOLE VON STEINBÜCHEL

Annette Groenefeldt, Holger Schmidt,Joy Backhaus

Institute of Medical Psychology and Medical Sociology, University Medical Center, Georg-August University, Göttingen, Germany

OUTCOME IN PERSONS AFTER MILD TRAUMATIC BRAIN INJURY

Little is known with respect to generic health-related Quality of Life (HRQOL) of individuals after mild traumatic brain injury (mTBI) and the association with cognitive functioning. No investigations have yet been conducted concerning disease-specific HRQOL and the relation with possible medical symptoms, cognitive and emotional deficits in mTBI.

This study compared 60 individuals after mTBI with 30 matched brain healthy controls in a cross-sectional retrospective design. Applying inclusion, exclusion and matching criteria resulted in equal groups concerning demographic characteristics and variables such as depression, anxiety or alcohol abuse.

Although at least three months had to have passed since the mTBI was diagnosed, all patients suffered from post concussive symptoms. Only two significant group differences were found for all 12 administered neuropsychological tests. This implies that the patient either did not develop any noticeable cognitive deficits or that the tests were not sensitive enough to detect them. However the HRQOL instruments in contrast were most sensitive in identifying impairments related to mTBI. Analyses revealed significant differences for the SF-36 and for the QOLIBRI. Assessing the cognitive dimension of HRQOL in detail with the COGQOL resulted in most significant differences for all subscales. Besides these findings analysis of variance and latent class analysis underlined the fact that mTBI is a very heterogeneous population, which can suffer from long-term consequences.

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JOHANNES VESTER

Department of Biometry and Clinical Research, IDV Data Analysis and Study Planning, Krailling, Germany

THE MULTIDIMENSIONAL APPROACH IN CLINICAL NEUROSCIENCE RESEARCH -

ADVANCES AND CHALLENGES

The multivariate strategy is expected to become a key development in Neurosciences clinical research, opening up new horizons for treatment concepts and disease management.

In the past, many confirmatory trials in neurosciences failed due to adherence to a single outcome approach. Multidimensional analysis opens a completely new direction for clinical and statistical thought in neurosciences, which is perhaps much closer to the complicated reality of recovery from a nervous system injury than the previous “one-criterion paradigm” of clinical trials. It is thus fortunate that adequate multivariate data analysis procedures are now available that are appropriate for the multidimensional concept. These procedures are robust with respect to every data situation and highly efficient with multiple target criteria. Furthermore, these procedures produce easily interpretable results (global test as well as global treatment effect).

Examples from the literature and current multivariate study designs in neurosciences are discussed and their implications related to future developments.

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PIETER VOS

Department of Neurology Slingeland Hospital, Doetinchem, The Netherlands

TRAUMATIC BRAIN INJURYIMPACT OF DEPRESSION AND POSTTRAUMATIC STRESS

DISORDER ON OUTCOME AND QUALITY OF LIFE

Traumatic Brain Injury (TBI) encompasses the functional disturbances and structural damage of the brain caused by direct impact, by external acceleration, deceleration and/or rotation forces to the head. Mild TBI comprises 90% of all TBI’s. In general outcome from mild TBI is considered good and disability rare. However a minority of MTBI patients may experience long term posttraumatic complaints. The purpose of this study was to study the impact of depression and posttraumatic stress disorder on outcome and quality of life following TBI. The prevalence, predictors, and impact of depression and post traumatic stress disorder (PTSD) on functional outcome and Health Related Quality of Life were assessed 6 and 12 months following TBI.

A sample of 1919 TBI patients who attended the Emergency Department received postal questionnaires after 6 and 12 months. The questionnaires included items regarding socio-demographics, and measures of Health Related Quality of Life including the SF-36, the Perceived Quality of Life Scale, the Beck Depression Inventory and the Impact of Event Scale.

TBI prevalence rates at 6 and 12 months follow-up for depression were 7% and for posttraumatic stress disorder 9%. Living alone was an independent predictor of depression and/or PTSD at follow-up.

Depression and PTSD were associated with a significantly decreased functional outcome as measured with the Glasgow Outcome Scale Extended and health related quality of life as measured with the SF-36 and the Perceived Quality of Life Scale.

Depression and/or PTSD are relatively common in our sample of TBI patients and may be responsible for the observed decrease in functional outcome and Health Related Quality of Life in TBI patients.

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KEVIN K.W. WANG

Center for Neuropro-teomics & Biomarkers Research, Department of Psychiatry, McK-night Brain Institute, University of Florida,

Gainesville, USA

RECENT ADVANCES IN ACUTE AND CHRONIC TBI BIOMARKER RESEARCH

There are about 1.7 million incidents of civilian TBI in the United Sates annually. In addition, the Armed Forces Health Surveillance Center has documented that over 300,000 service members sustained a confirmed TBI between 2000 and 2014 (2ndQ). While 80-85% TBI’s are categorized as mild (mTBI), predicting outcomes from mTBI is problematic, as some individuals (approximately 30%) are more susceptible to develop a range of persistent multi-factorial postconcussion syndrome and/or central nervous system (CNS)-mediated disorders including cognitive impairment, neurological symptoms, neuropsychiatric disorders and/or neuro-endocrine dysregulation. TBI sufferers are also more prone to develop neurodegenerative diseases such as Alzheimer’s disease (AD), Parkinsonism and Chronic Traumatic Encephalopathy (CTE) - which may not manifest until years after the initial injury event(s).

For the acute phase of TBI, a number of biomarkers are now documented, including neuronal proteins [neuron specific enolase (NSE), neurofilament-H, αII-spectrin breakdown products (SBDPs) and dendritic protein MAP2 and Ubiquitin-C-terminal hydrolase-L1 (UCH-L1)], glial proteins [glial fibrillary acidic protein (GFAP), S100α] and oligodendrocyte protein [myelin basic protein (MBP]). Emerging data also suggest that UCH-L1 and GFAP form a promising neuron-glia biomarker tandem for the acute diagnosis of mild and moderate TBI. Yet, importantly, blood levels of these acute biomarkers will return to baseline concentrations within days after TBI. We hypothesize that a continuum of TBI “Systems Biomarkers” are released or elevated through different pathways at different time points post-TBI and might reflect certain chronic conditions of TBI. Example of such chronic TBI biomarkers include (i) Neurodegeneration/CTE-linked total Tau protein (T-Tau), phospho-Tau (P-Tau), amyloid beta peptides (Aα1-40, Aα1-42) markers, (ii) Autoantibody and neuroinflammatory proteins and mRNA markers, and (iii) Neuroendocrine and pituitary dysfunction biomarkers.

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WISE YOUNG

Richard H. Shindell Chair in NeuroscienceFounding Director,

W.M. Keck Center for Collaborative Neuroscience Rutgers, The State University of New Jersey

Distinguished Visiting Professor, The University of Hong Kong

UMBILICAL CORD BLOOD MONONUCLEAR CELL THERAPY OF CHRONIC COMPLETE SPINAL CORD INJURY

Umbilical cord blood (UCB) contains stem/precursor cells, including mesenchymal, hematopoietic, endothelial, and neural cells, as well monocytes or macrophage precursor cells. Many laboratories have reported that umbilical cord blood mononuclear cells (UCBMC) improve walking recovery when transplanted into animal spinal cords as late as a week after injury. We treated 28 people with chronic spinal cord injury (SCI): 5 at the Chinese University of Hong Kong (CUHK), 3 at Hong Kong University (HKU), and 20 at the Chengdu People’s Liberation Army General Hospital in Kunming. All but one subject had chronic complete SCI with C5 through T11 neurological levels. Chronic indicates more than one year after SCI and neurologically stable for >6 months. Complete is defined as American Spinal Injury Association (ASIA) Impairment Scale (AIS) A with absent anal sensation and sphincter contraction. One subject in Kunming was motor incomplete (AIS C) with a C3 neurological level. The 8 subjects in Hong Kong received four injections of 4 or 8 microliters of 100,000 > cells/microliter into dorsal root entry zones above and below the injury site. Groups of 4 subjects in Kunming received four injections 4, 8, or 16 microliters of cells, then four 16-microliter injections plus an intravenous 30 mg/kg dose of methylprednisolone (MP), or four 16-microliter injections plus MP and a 6-week course of oral lithium titrated to 0.6-1.0 mM serum levels. In Hong Kong, the subjects did not receive systematic walking training after treatment whereas subjects in Kunming received 3-6 months of intensive locomotor training, as much as 6 hours a day for 6 days a week. At 3 months in Kunming, if the subjects showed evidence of continuing locomotor recovery, they stayed for an additional 3 months training. At 11-16 months after treatments, the subjects came back to hospital or a team of nurses or doctors went to their homes to assess them. Outcome measures included AIS classification and ASIA motor and sensory scores, the Walking Index of Spinal Cord Injury (WISCI), the Spinal Cord Independence Measure (SCIM), the Visual Analog Scale (VAS) for pain, the Modified Ashworth Scale (MAS) for spasticity, and severe adverse events (SEA). In Hong Kong, five subjects received magnetic resonance diffusion tensor imaging (MR-DTI) of their spinal cords. The Hong Kong trial showed that the surgery and transplantation are safe. No subject had neurological loss after the therapy. While some showed improved sensory scores, none had significant motor score, WISCI, SCIM, VAS, or MAS changes. MR-DTI revealed narrowing of white matter gaps at the injury site and two subjects showed bundles of fibers growing many centimeters across the injury site. The Kunming trial showed sensory score improvement but no significant motor score changes. However, by 11-16 months after treatment, 15 of 20 subjects had WISCI scores indicating ability to walk 10 meters, 40% with assistance and 35% without assistance. SCIM scores confirmed that 75% walked indoors (up to 10m), 40% with assistance and 35% without assistance. Similarly, 35% walked moderate distances (up to 100m) without assistance but only 10% walked long distances (>100m) and none could walk up stairs. Before treatment,

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90% required assistance for bladder and bowel care. By discharge from hospital, 80% catheterized themselves but almost all still required assistance for bowel routines. At 11-16 months after treatment, over 50% no longer catheterized and did not require help for their bowel routines with only rare (<1/month) or no accidents. Five of 19 subjects converted from complete (AIS A) to sensory incomplete (AIS B, n=3) or motor incomplete (AIS C, n=2). The C3 incomplete patient showed some sensory improvement but no significant motor change. Two subjects stopped locomotor training due to tibial fractures present before treatment. One subject had delayed locomotor training due to swelling of one knee and possible new tibial fracture. One subject had poor wound healing and cerebrospinal fluid leak due to low serum protein, resolved with a high protein diet. Several subjects had postoperative pain and swelling at the surgery site, resolved with routine therapies. No subject had loss of neurological function. Two patients that received lithium had severe neuropathic pain before treatment and showed significant reductions of VAS at 6-12 months. In conclusion, UCBMC can be safely transplanted into spinal cord of subjects with chronic complete SCI, allowed 35% of the subjects to ambulate unassisted with four-point walkers for 10 or more meters, and restored independence for bladder and bowel care in over half of the subjects. The implications of these findings will be discussed.

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CURRICULUM VITAE

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Current position(s): Director, Medinova Institute of Neuroscienes Clinical Research Director, QPS-JSW Life Sciences Spain

Academic Training- Main Positions:1987 Medical Doctor (M.D.) Degree, Santiago de Compostela University1987 MD Grade Thesis, Dep. Psychiatry, Santiago de Compostela University1988 Neuroendocrinology Specialist Master Course, Santiago de Compostela Univ1988 Graduate in Psychology, Santiago de Compostela University1988-1990 Doctorate in Psychiatry, Dep. Psychiatry, Santiago de Compostela University1988-1992 Resident-Research Fellow of the Ministry of Education and Science (PNFPI): Dep. Psychiatry, Santiago University & Madrid Complutense University1992-1997 Postgraduate Associated Researcher, Department of Psychiatry, Madrid Complutense University1997 Psychiatry Doctor, Academic Thesis, Ph.D., Department of Psychiatry, Madrid Complutense University1997-1999 Post-doctoral Grant (National Plan of Scientific Res. & Tec. Development) Basic and Clinical Research, CIBE, A Coruña1999-2012 EuroEspes Biomedical Research Centre, A Coruña, Spain2009- now Associated Researcher, Granada University (SICA INVS59201) Clinical Research Director, QPS-JSW Life Sciences Spain, A Coruña, Spain2010- now Head of the Research Directorate, Fundación Antidemencia Al-Andalus, Spain2012- now Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain2013- now Visiting Professor, Department of Neurosciences, Faculty of Medicine, Iuliu Hatieganu University, Cluj Napoca (Romania))

Antón Alvarez has more than 25 years experience in Basic and Clinical Research on Alzheimer’s disease. He was involved in a number of research projects, including projects funded by Public Institutions, pharmaceutical R&D studies, industrial and R+D+I projects, epidemiological studies and two projects funded by the European Comunity: (1) MimoVax: Alzheimer’s disease treatment targeting truncated AB40/42 by active immunisation (an STREP -Specific Targeted Research Projects- Project approved through the Six Framework Programme of the European Community to develop and test a vaccine for Alzheimer’s disease). Period: 2006-2010. (2) BIOMED-PL-950523-European Concerted Action on Pick’s Disease. Period: 1995-1998. As a result of his research activity, Antón Alvarez published more than 100 scientific papers and book chapters.

ANTON ALVAREZ /SPAIN

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Appointment: Ames Associate (Smart Systems & Nanotechnology), National Aeronautics and Space Administration (NASA) Ames Research Center, Moffett Field, California, USA 94035

Education: Undergraduate & medical school – Dartmouth College/Medical School, Hanover, NH Graduate school - Harvard University, Cambridge, MA

Residency: Surgical Internship – Walter Reed Army Medical Center, Washington, DC Neurosurgery Residency – Stanford University Medical Center, Palo Alto, CA

Professional: Faculty member (Neurosurgery) at the following (1986-2001): University of California, Davis, Medical Center Stanford University Medical Center State University of New York Upstate Medical Center Texas Tech University Medical Center (Chief, Neurosurgery) Currently: Since 1998: Ames Associate (Smart Systems & Nanotechnology) at NASA Ames Research Center, Moffett Field, CA, USA. Since 2001: Private practice neurosurgery in Silicon Valley/San Jose, CA.

Major Committees/Memberships: Aerospace Medical Association American Association of Neurological Surgeons: Past Chair, International Committee Asian Congress of Neurological Surgeons – Executive Committee Bioluminate, Inc. (NASA patent licensee): Scientific Advisory Board Computer Assisted Radiology and Surgery (CARS): Program Committee Congress of Neurological Surgeons Epilepsy Foundation of Northern California: Board Member European Association of Neurosurgical Societies European Association for Predictive, Preventive and Personalised Medicine International Association of Neurorestoratology: VP Neuromodulation International Conference on Neuroprotective Agents: Co-Director New York Academy of Sciences (Life Member) World Federation of Neurosurgical Societies: Education Committee Member

Publications: Editor, Intraoperative Neuroprotection. Williams & Wilkins, 1996 Author: Too Big to Succeed: Profiteering in American Medicine. iUniverse, 2013 Author/co-author of over 35 book chapters Author/co-author of over 75 peer-reviewed research articles Presenter/co-presenter of over 200 presentations at major national/international scientific meetings (many as invited speaker)

Patents: “Multimodality Instrument for Tissue Characterization” US Patent #6,718,196 (April 6, 2004) to NASA on behalf of RW Mah and RJ Andrews. “Carbon Nanotube-based Nanoelectrode Array for Deep Brain Stimulation” Patent Application by NASA on behalf of J Li, M Meyyappan, R Andrews, March, 2003.

RUSSELL ANDREWS /USA

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KARIN DISERENS /SWITZERLAND

Médecin adjoint, MER I, head of the Unit of Acute Neurorehabilitation, Department of Clinical Neurosciences, CHUV, University Hosptital, Lausanne, Switzerland. As a spécialist in neurology and in physical medecine and rehabilitation was on the head of the post acute neurorehabiliation clinics (1996-2005), than mobile team of neurorehabilitation in the University Hospital (2006-2009) before getting the responsability of the Acute Neurorehabilitation Unit of the Department of Clinical Neurosciences of the Universitiy Hospital in Lausanne. After contributing to the quality criterias of the acute and post acute neurorehabilitaiton in Switzerland, the main research domain concerns now, the evaluation of the diagnosis of the disorders of consciousness and of the effect of neurosensorial stimulation during the acute phase reinforced by robotic mobilisation and brain computer interface.

Acute Neurorehabilitation Unit of the Department of Clinical Neurosciences of the Universitiy Hospital in Lausanne. After contributing to the quality criterias of the acute and post acute neurorehabilitaiton in Switzerland, the main research domain concerns now, the evaluation of the diagnosis of the disorders of consciousness and of the effect of neurosensorial stimulation during the acute phase reinforced by robotic mobilisation and brain computer interface.

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CHRISTIAN MATULA /AUSTRIA

Christian W. Matula, MD, PhD is Professor of Neurosurgery at the Neurosurgical Department at the Medical University of Vienna, Austria. He serves as a Director of Skull Base Division and Head of the Neurotrauma subdivision. Furthermore, he is founding member and Neurosurgical Head of AONeuro – a pilot initiative of the AO Foundation-, Chairman of the AONeuro TK Expert Group and permanent member of the AONeuro Steering Committee. He is also the medical director of two private health care centers in Vienna and Lower Austria.

Dr. Matula received his MD degree in 1986 from the University of Vienna, his PhD in Neuroendoscopy in 1996 from the same University, and was appointed Professor in 1997. He completed a fellowship in Neuroanatomy in Würzburg, Germany, a fellowship in skull base surgery in Washington and one in vascular surgery in Phoenix.

Dr. Matula has developed an international reputation in the area of skull base surgery with special focus on new surgical technologies, endoscopic skull base surgery, orbital surgery, but also in Neurotrauma with special focus on skull base trauma, reconstruction and clinical trials. He has been active in many workshops, courses, webinars, and webcasts and has given a high number of invited lectures as visiting professor at numberless congress all over the world. He is the author of more than 250 publications mostly on skull base surgery, microsurgical techniques, neurotrauma, neuroendoscopy and has written several textbooks and atlases. As director of the educational program for neurosurgery at the Medical University of Vienna, he has initiated a variety of well-known seminars and played a major role in developing and enhancing the neurosurgical educational program in Austria in particular at the Department of Neurosurgery, Medical University of Vienna. He is member of several Neurosurgical Societies all over the world and the recipient of countless awards and honors.

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DAFIN F. MURESANU /ROMANIA

Dafin F. Muresanu, MD, PhD, MBA, is Professor of Neurology, Senior Neurologist, Chairman of the Neurosciences Department, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, President of the Romanian Society of Neurology, President of the Society for the Study of Neuroprotection and Neuro-plasticity (SSNN), member of the Academy of Medical Sciences, Romania, secretary of its Cluj Branch. He is also member of 13 scientific international societies (being member of the American Neurological Association (ANA) - Fellow of ANA (FANA) since 2012) and 7 national ones, being part of the executive board of most. Professor Dafin F. Muresanu is specialist in Leadership and Management of Research and Health Care Systems (specialization in Management and Leadership, Arthur Anderson Institute, Illinois, USA, 1998 and several international courses and training stages in Neurology, research, management and leadership). Professor Dafin F. Muresanu is coordinator in international educational programs of European Master (i.e. European Master in Stroke Medicine, University of Krems), organizer and co-organizer of many educational projects: European and international schools and courses (International School of Neurology, European Stroke Organisation summer School, Danubian Neurological Society Teaching Courses, Seminars - Department of Neurosciences, European Teaching Courses on Neurorehabilitation) and scientific events: congresses, conferences, symposia (International Congresses of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN), International Association of Neurorestoratology (IANR) & Global College for Neuroprotection and Neuroregeneration (GCNN) Conferences, Vascular Dementia Congresses (VaD), World Congresses on Controversies in Neurology (CONy), Danube Society Neurology Congresses, World Academy for Multidisciplinary Neurotraumatolgy (AMN) Congresses, Congresses of European Society for Clinical Neuro-pharmacology, European Congresses of Neurorehabilitation). His activity includes involvement in many national and international clinical studies and research projects, over 200 scientific participations in the last 7 years as “invited speaker” in national and international scientific events, a significant portfolio of scientific articles (107 papers indexed on Web of Science-ISI) as well as contributions in monographs and books published by prestigious international publishing houses. Prof. Dr. Dafin F. Muresanu has been honoured with: the Academy of Romanian Scientists, “Carol Davila Award for Medical Sciences / 2011”, for the contribution to the Neurosurgery book “Tra-tat de Neurochirurgie” (vol.2), Editura Medicala, Bucuresti, 2011; the Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca “Octavian Fodor Award” for the best scientific activity of the year 2010 and the 2009 Romanian Academy of Medical Sciences “Gheorghe Marinescu Award” for advanced contribu-tions in Neuroprotection and Neuroplasticity.

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GELU ONOSE /ROMANIA

Dr. Gelu Onose - 55 years; graduated, in 1982, from the Faculty of General Medicine, within the Inatitute of Medicine and Pharmacy, in Bucharest, Romania

- Professor at the (State) University of Medicine and Pharmacy (UMP) “Carol Davila”, in Bucharest- Doctoral/ Post-Graduate Tutor - at the (State) University of Medicine and Pharmacy ”Carol Davila” (UMPCD), in Bucharest- MD; - PhD; - MSc- Senior Physician of : - Physical & Rehabilitation Medicine (PRM) and- Gerontology & Geriatrics (G-G)

Competences in :

- General Echograpy - Management of sanitary services

- Chief of the of the UMPCD PRM Discipline and of the (neural-muscular) Clinic Division - the National Reference Center for NeuroRehabilitation - and of its RDI Nucleus, of theTeaching Emergency Hospital“Bagdasar-Arseni” (TEHBA), in Bucharest

- President Co-Founder of the Romanian Society for Neurorehabilitation (RoSNeRa) - affiliated to the World Federation for NeuroRehabilitation (WFNR) - member of the Management Committee - and respectively, of the Romanian Society for Spinal Cord Pathology, Therapy and Rehabilitation (RoSCoS) - affiliated to the International Spinal Cord Society (ISCoS) and to European Spinal Cord Injury Federation (ESCIF)

- A member of the Scientific Committee, afferent to the Prezidium of the world Academy for Multidisciplinary Neurotraumatology (AMN)

- Selected and invited - as among ”Highly-specialized scholars” - by Thomson Reuters to participate in the invitation-only ”Academic Reputation Survey”, within its related partnership with Times Higher Education’s influential World University Rankings: 2010, 2011, 2012

- Invitated Peer-Reviewer (March 2010) by the “Journal of Molecular Histology” and (March, 2012) by the ”Spinal Cord” journal (both ISI Thomson Reuters rated)

- A member of the Board of the Romanian Society of Physical and Rehabilitation Medicine

- Gest Editor within the Special Issue, Second Edition, Vol. 4 of the Journal of Medicine and Life, 2011

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- 8 published medical books - one of them : “The Spondyloarthropathies”, and received, in 2002, the “Iuliu Hatieganu” Award of The Romanian Academy)

- 2 chapters within medical books

- About 200 scientific works and papers - communicated within national and international scientific meetings and/or published in peer-reviewed or non peer-reviewed medical journals - and professional interviews/ articles, in mass-media- 3 Patents/ Invention Certificates (plus an Utility Model), appointed by the State Office for Inventions and Marks (SOIM/ OSIM)- Main awards: the “Iuliu Hatieganu” Award of The Romanian Academy (2002); the Award of the (Romanian) National Authority for Scientific Research for the RDI project acronymed ”ACTUAT” (2006); the Gold Medal at the International Saloon of Inventions, Geneve/ Switzerland for the RDI project acronymed ”MOD” (2008)- A member of the Scientific Council/ Editorial Board of medical journals:- ”Journal of Medicine and Life” (rated in Index Medicus, Medline)- “Infomedica”- (Romanian) “Rehabilitation, Physical Medicine and Balneology“- “Romanian Neurosurgery”- ”Industria Textila” (ISI Thomson rated journal)

A member of the :- Romanian Medical Association (RMA)- Romanian Society of Physical and Rehabilitation Medicine (PRM) - including of its Board- Romanian Society of Neurosurgery (RSN)- Romanian Society of Biomaterials (RSB)- Balkan Medical Union (BMU),- International Society of Hydrothermal Technique (SITH - the National Council of the Romanian Section SITH - RS),- British Society of Gerontology (BSG)- The International Spinal Cord Society (ISCoS)- The European Spinal Cord Injury Federation (ESCIF)- World Academy for Multidisciplinary Neurotraumatology (AMN) - a member of the Scientific Committee, afferent to the Prezidium- World Federation For Neurorehabiliation (WFNR) - a member of the Council, Management Committee- (International) Association for the Study of Medical Education (ASME, UK)

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WAI S. POON /HONG KONG

Dr Poon Wai Sang is currently the Chair Professor and Chief of the Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong. He is active in undergraduate and postgraduate surgical education, as head of the Division of Surgery for Graduate Studies (taking care of M. Phil. and Ph.D. students), and specialist training in neurosurgery, as Chairman of the Specialty Board in Neurosurgery.

He received his undergraduate medical education at Glasgow University (1973-8), general surgical training at the City and University Hospitals, Nottingham, U.K. (1980-1982), neurosurgical training at Glasgow’s Institute of Neurological Sciences with Bryant Jennett, Graham Teasdale, David Mendelow, Sam Galbraith, John Turner and Rab Hide (1983-6), experimental cerebral ischaemia at Glasgow University’s Wellcome Surgical Institute with Jim McCulloch (1986) and experimental neuro-oncology at Harvard Medical School’s Massachusetts General Hospital with Bob Martuza(1990-1).

His clinical interests include pituitary surgery and surgical management of Parkinson’s disease; research interests include clinical and experimental head injury, hyponatraemia, telemedicine, neurorehabilitation and neuro-oncology.

He is an active participant of college and society activities locally and internationally: Second Vice-President at Large of the World Federation of Neurosurgical Societies [2005-9], Council Member of the Chinese Neurosurgical Society and Past-President of the Hong Kong Neurosurgical Society [1996-2000], member of the Board of Governors of the International Brain Injury Association. He was the Honorary Secretary of the College of Surgeons, Hong Kong [2005-2011].

He has served the Editorial Boards of Acta Neurochirugica [2001-2006], British Journal of Neurosurgery, Neurosurgery, Korean Journal of Neurosurgery, World Neurosurgery and Surgical Practice, and is author and co-author of >200 peer-reviewed articles. In January 2011, he received the State Scientific and Technological Progress Award (SSTPA) 2010 second-class for the research study entitled “Technology for the early diagnosis and prevention of secondary brain injury in the management of traumatic brain injury” jointly conducted by the Fourth Military Medical University of Xi’an and the Chinese University of Hong Kong.

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IGNACIO J. PREVIGLIANO /ARGENTINA

Date of Birth: 28/11/57 - Place of Birth: Argentina

University Studies: Buenos Aires University School of Medicine (1975 - 1980).Degree: Medical degree. Graduated with Honor Diploma Board certificate in Neurology and Critical Care Medicine

Actual positions: - Head Intensive Care Unit – Hospital Fernandez – Buenos Aires – Argentina- Prof. of Neurology – Maimonides University- Asoc. Prof. of Internal Medicine – Maimonides University - Director Superior Course of Intensive Care Medicine – Maimonides University and Argentinean Critical Care Society- Director Neurocritical Care Committee – Critical and Intensive Care Medicine’s Ibero Panamerican Federation

Awards1992- Dr. Juan Demonte Award: Best Scientific Presentation. Argentine Critical Care Society “Arteriovenous oxygen and lactate difference during extra corporeal circulation its relationship with the brain neurological injury “.1995- Buenos Aires Neurosurgical Society XXXVII Annual Journeys “CT Scan in head injury: diagnostic and prognostic value”.1998- II South American Broncology Meeting Award. “Brain hemodynamics during fiber bronchoscopy”2000: -Argentine Medical Association 25th Neurosciences Meeting Award “Stroke Unit Usefulness: a cohort study” 2002: Argentinean Trauma Meeting Mention Award “Deep venous thrombosis and pulmonary edema prophylaxis in severe burn patients: Sodic Heparin o Low molecular weight heparin?2005: Argentinean Critical Care Society Award. 9th Congress of the World Federation of Societies of Intensive and Critical Care Medicine Glasgow 7 Surveillance Program: Epidemiology and Outcome in Argentinean Intensive Care Units 2005: 3rd Argentinean Congress of Organ and Tissue Procuration for Transplantation Award Evidence Based Medicine: Transcranial Doppler usefulness for brain death diagnosis in patients in barbiturate coma.2007: 5th Argentinean Congress of Organ and Tissue Procuration for Transplantation Especial Mention for Oral Presentation Apnea test: usefulness and complications2011: International Internal Medicine Meeting – Neurology Award Cerebral Hemodynamic Changes in Cocaine Abusers

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Research: 148 investigation papers presented in national and international meetings.

Publications 48 papers in national and international peer review journals. Chapter author’s in 21 Intensive Care, Neurology, Neurosurgery, Anesthesia and Obstetrics books.

Editor Intensive Care Medicine Textbook – Argentinean Critical Care Society, Buenos Aires, 2007 and 2013 Evidence Based Neurocritical Care – Corpus Editorial, Rosario, 2007

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DOREL SANDESC /ROMANIA

Present Position - Secretary of State, Ministry of Health - Care, Romania - President, Romanian Society of Anesthesia and Intensive Care - Member, Executive Committee, World Federation of Societies of Anesthetists (WFSA) - Professor of Anesthesia and Intensive Care, “V. Babes” University of Medicine and Pharmacy Timisoara, Romania

Medical education, training 1. University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Training in Anesthesia and Intensive Care , “V. Babes” University of Medicine and Pharmacy, Timisoara, Romania 3. Fellowships in Anesthesia and Intensive Care: England, Holland, France 4. Diploma of In-Depth Training in Anesthesia and Intensive Care, Academy of Lyon, France

Scientific activity 1. Publications in extenso: - 9 (nine) articles in ISI or Pubmed cited journals - 47 (forty seven) articles in scientific journals

2. Monographies, textbooks - Coauthor: 16 (sixteen) - First author: 8 (eight) 3. Research activity: - Research grants accessed by national competition: 7(seven) - Principal Investigator in International Clinical Trials: 22(twenty-two) trials 4. PhD in Anaesthesiology and Intensive Care 5. A patent for Invention No. A00783/6th of October 2006, as co-author for “Artificial breathing for small lab animals with a new respiratory valve”. 6. Director/Organizer of 14 national scientific meetings with international participation 7. Member in the board of seven romanian medical journals 9. Member of eight scientific medical societies, romanian and international

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ANDREAS SCHWARTZ /GERMANY

Born on 8.th of October 1955 in Stolzenau (Germany). Medical student from 1974-1980 at the University of Düsseldorf. 1980 medical degree by a thesis in tropical medicine under the auspices of Prof. H. Schlipköter.

Residency and fellowship in neurology until 1985 and in diagnostic radiology, branch neuroradiology, until 1989 at the Department of Neurology (Director: Prof. H.-J. Freund) of the University of Düsseldorf, interrupted by research fellowships at the universities of Hannover (1982) and Tübingen (1986).

1989 habilitation and Assistant Professor in Neurology with special interest in neuroradiology.

Since 1990 Professor of Neurology at the University of Heidelberg and head of the MR division . From 1992 to 2000 vice chairman of the department of neurology (Director: Prof. M. Hennerici) at the University Clinic Mannheim.

Since August 2000 Chairman of the Department of Neurology at the Klinikum Hannover and since December 2000 Associate Professor of Neurology of the University of Heidelberg. Since October 2006 Medical Director of Klinikum Region Hannover Nordstadt hospital.

Main research interests: cerebrovascular diseases, neuroradiology with special interests in MRI and angiography, multiple sclerosis, and parkinsonism. More than 180 publications in international journals and handbooks. Editor of a textbook in neurology. The scientific research has been continuously supported by the Deutsche Forschungsgemeinschaft and German Minister of Health as well as major grants since 1985.

Professor Schwartz is a full member of a number of national and international societies (ENS, AAN, RSNA,ANSR, ESNR) in the neurological field and serves since 1996 as a regional representative of the German Stroke Foundation.

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JOHANN SELLNER /AUSTRIA

Johann Sellner is a neurologist who specializes in CNS inflammation, cerebrovascular disorders and non-compressive myelopathies. He graduated from the Medical University Graz in 2001and received post-graduate training in Heidelberg, DE (Prof. W. Hacke, 2001-2004), Bern, CH (Prof. Ch. Hess, 2005-2007) and Munich, DE (Prof. B. Hemmer, 2008-2010). He held fellowship positions in Bern, CH (2004-2005), San Francisco, USA (2006) and London, UK (2009). In 2013 he moved to the Paracelsus Medical University where he heads the centers for Multiple Sclerosis and Primary Stroke Prevention at the Department of Neurology.

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NICOLE VON STEINBÜCHEL /GERMANY

Biography

Since Director of the Department of Medical Psychology and Medical2004/2005 Sociology, University Medical Center, Georg-August-University of Göttingen

2001-2004 Associate Professor (C4) of Gerontopsychology at Geneva University and Head of the Neurogerontopsychology Unit, Department of Psychogeriatrics, Geneva University Hospital1999-2000 C3-Research Professor of the Dorothea-Erxleben Foundation, Magdeburg University1993-1997 C3-Professor of Medical Psychology, Institute of Medical Psychology (IMP), Munich University (LMU) 1997 Postdoctoral thesis (“Habilitation”) in „Clinical Psychology and Neuropsychology“, Leopold- Franzens University, Innsbruck 1987-1993 Graduation (Dr. rer. biol. hum.) and scientific researcher at the IMP, LMU1985 Diploma in psychology at the Institute of Psychology, Munich University, studies in philosophy and history of art

Editorship

1998-2012 Editor of the section „Quality of life and disease coping“ of the „Zeitschrift für Medizinische Psychologie“Since 2004 Editor of the series „Psychomed Compact“, UTB textbooks series

Main areas of work (Selection)Neuropsychology, cognition, (intercultural) health-related quality of life research, currently outcome work package leader of the CENTER-TBI-Study.

Offices (Selection)

1998-2002 Vice-chairperson of the German Society of Medical Psychology2001-2005 Member of the board of the Swiss Society of PsychologySince 2003 Member of the board, vice-treasurer of the Academia, currently Vice President of the Multidisciplinaria Neurotraumatologica (AMN)2007-2010 Member of the board of the European Brain and Behaviour Society (Scientific Committee)2008 Founding member of the International Society for Clinical Neuromusicology2008-2011 President of the QOLIBRI Society

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Born, 1952, he specialized in Veterinary Medicine between 1971 and 1974 at the University in Munich, then changed to the University in Cologne in 1974 and specialized in Human Medicine from 1974 to 1980. In 1976 to 1979, he also studied biometric methods for pharmacology and clinical research at the institute for Data Analysis and Study Planning in Munich.

While studying human medicine, he completed research work on pattern recognition in the visual brain and de-veloped a pharmacodynamic Neuron Simulation Model at the Institute for Medical Documentation and Statistics of the University at Cologne.

From 1985 to 1995, he was member of the Ultrahigh Dexamethasone Head Injury Study Group and leading bio-metrician of the German GUDHIS Study in Traumatic Brain Injury.

Since 1982 has been holding advanced training courses on biometry for professionals in clinical research and university establishments.

Since 1995 he is Senior Consultant for Biometry & Clinical Research. He planned and evaluated about 150 ran-domized clinical studies worldwide and is member of various international Advisory Boards and Steering Com-mittees including participation as biometric expert in regulatory authority panels and in FDA, EMEA, and BfArM hearings. He is head of the multidimensional section at the institute for Data Analysis and Study Planning and statistical peer reviewer for leading medical journals.

JOHANNES VESTER/GERMANY

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PIETER VOS /NETHERLANDS

Pieter Vos has joined the department of Neurology at the Slingeland Hospital in Doetinchem in the Netherlands recently. Research activities over the last 15 years carried out in a university medical centre were dedicated to traumatic brain injury. Focus of the research activities is to unravel the clinical, biochemical and genetic determinants of neuroplasticity and recovery after mild, moderate and severe traumatic brain injury. Pieter Vos is founder of the Dutch working group on Neurotraumatology. Current international activities: chairman of the scientist panel on neurotraumatology and head of the task force mild traumatic brain injury, both residing under the European Federation of Neurological Societies. He is a member of the editorial board of the European Journal of Neurology and treasurer for the Academia Multidisciplinaria Neurotraumatologica.

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KEVIN K.W. WANG /USA

Dr. Wang He is internationally recognized for his original contributions to the fields of CNS disorders-linked proteolytic enzymes, neuroproteomics and disease biomarker discovery and validation. He obtained his Ph.D. in Pharmaceutical Sciences with Distinction from the University of British Columbia in Vancouver in 1989. He joined Parke-Davis Pharmaceutical Research (Ann Arbor, MI) in 1991, and following the company’s merger with Pfizer Inc. (2000), he became Group Leader of CNS Therapeutics/CNS new targets team and co-chaired the Far East Scientific Opportunity Team. In 2002, he moved back to academia to become Associate Professor of Psychiatry at the University of Florida (Gainesville, FL), Associate Director of the Center for Traumatic Brain Injury Studies and Director of the Center of Neuroproteomics and Biomarkers Research. One year after, he co-founded Banyan Biomarkers Inc. (Alachua, Florida). In 2007, he transitioned to Banyan as full-time Chief Scientific & Operations Officer and Director of its Center of Innovative Research. In 2011, he rejoined the University of Florida McKnight Brain Institute as Executive Director of the Center for Neuroproteomics and Biomarkers Research / Chief - Translational Research & Associate Professor of Psychiatry and Neuroscience and continues his basic, applied and translational research. He is also Chair Professor of the Taipei Medical University.

Dr. Wang published more than 250 peer-reviewed papers, reviews and book chapters and co-authored eight US patents. He co-edited four books on proteases, neuroproteomics and biomarkers for CNS disorders. He is Associate Editor of the journals Translational Proteomics and Frontier in Neurotrauma. He also serves on five international journal’s Editorial Board. Dr. Wang was Past President and current Council member of the National Neurotrauma Society (USA).

His research interests include neuro-Proteomics, CNS Injury, neurodegeneration, substance abuse research, post-translational modification research, biomarkers, diagnostics and therapeutic development.

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WISE YOUNG /USA

Dr. Wise Young, founding director of the W.M. Keck Center for Collaborative Neuroscience and a professor at Rutgers, The State University of New Jersey, is recognized as one of the world’s outstanding neuroscientists. He obtained a Bachelor of Arts degree from Reed College, a Doctorate from the University of Iowa and a medical degree from Stanford University. After a surgery internship at New York University and Bellevue Medical Center, he was invited to join the neurosurgery department at NYU. In 1984, he became director of neurosurgery research. In 1997, as part of Rutgers’ commitment to the future, Dr. Young was recruited to establish and direct a world-class center for collaborative neuroscience.

Dr. Young led the team that discovered and established high-dose methylprednisolone (MP) as the first effective therapy for spinal cord injuries. This 1990 work upended concepts that spinal cord injuries were permanent, refocused research, and opened new vistas of hope. This team also played a major role in Dr. Andrew Blight’s signal work on 4-aminopyridine (4-AP), which shows significant promise for increasing nerve conductivity. Dr. Young developed the first standardized rat spinal cord injury model used worldwide for testing therapies, formed the first consortium funded by the National Institutes of Health (NIH) to test promising therapies, and helped establish several widely accepted clinical outcome measures in spinal cord injury research. Dr. Young founded and served as editor-in-chief of the Journal of Neurotrauma. He organized the National and International Neurotrauma Societies as forums for scientists to share discoveries and collaborate on spinal cord injury and brain research. He has served on advisory committees for the NIH, the National Academy of Sciences, and NICHD, and on advisory boards for many spinal cord injury organizations.

Dr. Young is committed to bringing treatments to people with chronic spinal cord Injuries. He has built and trained a twenty-five center clinical trial network in China, Taiwan, and Hong Kong where human clinical trials using umbilical cord blood mononuclear cells and lithium to treat people with chronic spinal cord injuries are now underway. In the initial results from the Phase II trial in Kunming, China, 75% of the participants (15 out of 20) recovered the ability to walk with a rolling walker. He now is establishing clinical trial networks in the United States, Norway, and India where he plans to initiate Phase III trials in 2014.

Well-known as a leader in spinal cord injury research, Dr. Young is in high demand as a speaker at scientific conferences throughout the world and when media are in need of expert knowledge. He has appeared on ‘20/20’ with Barbara Walters and Christopher Reeve, ‘Today’, with Katie Couric, ‘48 Hours,’ ‘Eye-to-Eye,’ Fox News, and CNN with Jeff Greenfield. His work has been featured in a Life magazine special edition, USA Today, and innumerable national and international news, talk, and print publications. A few of his many honors include: NIH Jacob Javits Neuroscience Award (1985-1992), Wakeman Award (1991), Tall Texan of the Year Award (1997), “Cure” Award (1998), Trustees Award for Excellence in Research (2001), Asian American Achievement Award (2002), Douglass Medal for work with the advancement of young women in the sciences (2003), and Elizabeth M. Boggs Award for service to the disability community (2004). In 2005 he was the first researcher elected to the Spinal Cord Injury Hall of Fame. In 2006, Dr. Young received The Hope Award – A Salute to Research Innovation, the New Jersey Educator of the Year Award, and the Caring Heart Award. Also in 2006, the Richard H. Shindell Chair in Neuroscience was established at Rutgers University and Dr. Young was named as the first person to hold that chair. In 2007 the Motolinsky Foundation named Wise Young as the recipient of their Distinguished Citizen Award. In 2011 he was selected as the McGowen Distinguished Lecturer. In August 2001, TIME Magazine named Dr. Young as ‘America’s Best’ in the field of spinal cord injury research. Recently BioNJ recognized Dr. Young’s unique contributions by presenting him with their Patient Advocacy Award.

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JA OCEAN VIEW HOTEL PO Box 26500 Dubai, United Arab Emirates Tel: +971 4 814 5599 Fax: +971 4 814 5999 www.jaresorts.com

CONGRESS VENUE

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Scientific Secretariat

Society for the Study of Neuroprotection and Neuroplasticity37 Mircea Eliade Street, 400364, Cluj-Napoca, RomaniaOffice phone: +40745255311E-mail:[email protected]

Contact Details

Mrs. Doria Constantinescu, mobile: [email protected]

Mrs. Diana Biris, mobile: [email protected]

Registration Desk

All materials and documentation will be available at the registration desk located at SSNN booth.The staff will be pleased to help you with all enquiries regarding registration, materials and program. Please do not hesitate to contact the staff members if there is something they can do to make your stay more enjoyable.

General Information

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LANGUAGE

The official language is English. Simultaneous translation will not be provided.

CHANGES IN PROGRAM

The organizers cannot assume liability for any changes in the program due to external or unforeseen circumstances.

NAME BADGES

Participants are kindly requested to wear their name badge at all times. The badge enables admission to the scientific sessions and dinners.

FINAL PROGRAM & ABSTRACT BOOK

The participants documents include the program and abstract book which will be handed out at the registration counter.

COFFEE BREAKS

Coffee, tea and mineral water are served during morning coffee breaks and are free of charge to all registered participants.

MOBILE PHONES

Participants are kindly requested to keep their mobile phones turned off while attending the scientific sessions in the meeting rooms.

CURRENCY

The official currency in Dubai is Dirham.

ELECTRICITY

Electrical power is 220 volts, 50 Hz.Plug Type G (UK) are standard.

TIME

The time in Dubai isUAE standard time (UTC+4).

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SPONSORS

www.ssnn.ro


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“roneuro” research and diagnostic 12 amn th congress · gelu onose /romania wai poon /hong kong...

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