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Can MRI replace clinical neuro-ophthalmology?
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Abstracts / Journal of the Neurological Sciences 357 (2015) e457–e512
I will address then some clinical problems and namely the relationship between the mirror mechanism and autism with particular emphasis on Stern’s vitality forms, and the neural basis of “action observation” treatment in motor rehabilitation after stroke and other motor disturbances. doi:10.1016/j.jns.2015.09.257
1684 WFN15-1700 Plenary Lecture 10 - Bharucha Award Lecture Guillain-Barré Syndrome and CIDP: one disease or many? R. Hughes. Cochrane Neuromuscular Disease Group, Institute of Neurology, London, United Kingdom Guillain-Barré Syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) form a fascinating spectrum of diseases of varying severity, time course, anatomical distribution, pathology and system involvement. The most acute forms of GBS merge through subacute inflammatory demyelinating polyradiculoneuropathy with CIDP. GBS may show early recurrence after treatment but eventually recover and sometimes CIDP has an acute onset. Painstakingly constructed, but arbitrary, diagnostic criteria have served the research community for epidemiological studies and recruitment into randomised trials. Astute clinical observations have added Fisher syndrome, Lewis-Sumner syndrome and multifocal motor neuropathy to the clinical spectrum. Within GBS, detailed pathological studies, characteristic antibodies and animal experiments have largely explained the pathogenesis of acute motor axonal neuropathy and distinguished it from acute inflammatory demyelinating polyradiculoneuropathy. Other characteristic antibodies distinguish and explain Fisher syndrome. Work continues to identify biomarkers and explain the pathogenesis of the rest of the GBS and CIDP spectrum. Paraprotein associated chronic inflammatory neuropathies with antibodies to minor myelin proteins or gangliosides inform this research. Differences in treatment response of different members of the spectrum, most notably to corticosteroids, indicate different underlying mechanisms and complicate treatment of these, often very disabling, diseases. doi:10.1016/j.jns.2015.09.258
1685 WFN15-1804 Plenary Lecture 11 Can MRI replace clinical neuro-ophthalmology? C. Kennard. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom Historically clinical neuro-ophthalmology was an area of neurology, par excellence, where the history and the clinical examination, which required a detailed knowledge of neuroanatomy, would usually provide the localization of the site of the pathological lesion and some indication of its underlying aetiology. In many cases MRI can, often with even more accuracy, do as good a job of localization and pathological diagnosis. But there is far more to being a clinical neuro-ophthalmologist than merely ordering an MRI scan. Firstly, clinical assessment needs to precede scanning to ensure that the appropriate scan is requested. Secondly, there are many patients with neuro-ophthalmological disorders in whom the imaging is normal, who require a full history and detailed examination to enable the patient to be directed to other more timely and appropriate
investigations. Thirdly, the neuro-ophthalmologist is essential to correctly interpret for the patient the relevance of non-specific or benign findings, which are often reported on MRI. Finally, whatever the MRI scan may reveal a well trained neuro-ophthalmologist is then required to direct the patient to the most appropriate therapeutic procedure, be it a neurosurgical intervention, some pharmacological agent or masterly inactivity. Using a variety of neuro-ophthalmological patient histories the case will be made that despite the advent of MRI the clinical neuroophthalmologist is still essential for the provision of safe patient care and rapid diagnosis. doi:10.1016/j.jns.2015.09.259
1686 WFN15-1881 Regional North American Symposium Management of Acute Strokes – evolving approaches J. Biller. Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, USA Management of Acute Strokes – Evolving Approaches José Biller, MD, FACP, FAAN, FANA, FAHA Management of patients with acute ischemic stroke (AIS) is multifacetic. This presentation focuses on recent data, and evidencebased recommendations, on the timely restoration of blood flow using new generation mechanical thrombectomy stent retrievers for highly selected subgroup of patients with AIS due to large artery occlusive disease of the proximal anterior circulation. doi:10.1016/j.jns.2015.09.260
1687 WFN15-1780 Regional Pan-Arab Symposium Epilepsy H. Hosny, A. Ashmawi. Neurology department, Cairo University, Cairo, Egypt Prognosis of Newly Diagnosed Patients with Epilepsy Hassan S.Hosny MD Prof of Neurology , Cairo University Background: Although Epilepsy is one of the most common neurological conditions, Limited data are available on the clinical patterns of treatment response in newly diagnosed epilepsy. Objective: To identify the different clinical pattern of outcome of epilepsy in the newly diagnosed patients and the strong predictors of failure to achieve 2 years seizure remission. Methodology: In this retrospective study we collected the data of 239 patients from all ages with newly diagnosed epilepsy between the year 1994 and 2008 that were diagnosed by single senior epileptologist and followed up for at least four years at specialized epilepsy center in Egypt. The patients were divided into two groups (poor and good control) and compared for clinical characteristics. Results: A total of 239 patients with newly diagnosed epilepsy were included. Early remission was achieved in (73.6%) while (12.1%) entered late remission. Thirty four patients (14.2%) failed to achieve 2 years seizure remission. Twenty six patients (10.9%) have drug resistant epilepsy.Terminal remission uninterrupted by relapse was noted (25.1%) indicating a remitting course of epilepsy. Out of (85.5%) patients who achieved a two years remission, the events of
Abstracts / Journal of the Neurological Sciences 357 (2015) e457–e512
I will address then some clinical problems and namely the relationship between the mirror mechanism and autism with particular emphasis on Stern’s vitality forms, and the neural basis of “action observation” treatment in motor rehabilitation after stroke and other motor disturbances. doi:10.1016/j.jns.2015.09.257
1684 WFN15-1700 Plenary Lecture 10 - Bharucha Award Lecture Guillain-Barré Syndrome and CIDP: one disease or many? R. Hughes. Cochrane Neuromuscular Disease Group, Institute of Neurology, London, United Kingdom Guillain-Barré Syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) form a fascinating spectrum of diseases of varying severity, time course, anatomical distribution, pathology and system involvement. The most acute forms of GBS merge through subacute inflammatory demyelinating polyradiculoneuropathy with CIDP. GBS may show early recurrence after treatment but eventually recover and sometimes CIDP has an acute onset. Painstakingly constructed, but arbitrary, diagnostic criteria have served the research community for epidemiological studies and recruitment into randomised trials. Astute clinical observations have added Fisher syndrome, Lewis-Sumner syndrome and multifocal motor neuropathy to the clinical spectrum. Within GBS, detailed pathological studies, characteristic antibodies and animal experiments have largely explained the pathogenesis of acute motor axonal neuropathy and distinguished it from acute inflammatory demyelinating polyradiculoneuropathy. Other characteristic antibodies distinguish and explain Fisher syndrome. Work continues to identify biomarkers and explain the pathogenesis of the rest of the GBS and CIDP spectrum. Paraprotein associated chronic inflammatory neuropathies with antibodies to minor myelin proteins or gangliosides inform this research. Differences in treatment response of different members of the spectrum, most notably to corticosteroids, indicate different underlying mechanisms and complicate treatment of these, often very disabling, diseases. doi:10.1016/j.jns.2015.09.258
1685 WFN15-1804 Plenary Lecture 11 Can MRI replace clinical neuro-ophthalmology? C. Kennard. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom Historically clinical neuro-ophthalmology was an area of neurology, par excellence, where the history and the clinical examination, which required a detailed knowledge of neuroanatomy, would usually provide the localization of the site of the pathological lesion and some indication of its underlying aetiology. In many cases MRI can, often with even more accuracy, do as good a job of localization and pathological diagnosis. But there is far more to being a clinical neuro-ophthalmologist than merely ordering an MRI scan. Firstly, clinical assessment needs to precede scanning to ensure that the appropriate scan is requested. Secondly, there are many patients with neuro-ophthalmological disorders in whom the imaging is normal, who require a full history and detailed examination to enable the patient to be directed to other more timely and appropriate
investigations. Thirdly, the neuro-ophthalmologist is essential to correctly interpret for the patient the relevance of non-specific or benign findings, which are often reported on MRI. Finally, whatever the MRI scan may reveal a well trained neuro-ophthalmologist is then required to direct the patient to the most appropriate therapeutic procedure, be it a neurosurgical intervention, some pharmacological agent or masterly inactivity. Using a variety of neuro-ophthalmological patient histories the case will be made that despite the advent of MRI the clinical neuroophthalmologist is still essential for the provision of safe patient care and rapid diagnosis. doi:10.1016/j.jns.2015.09.259
1686 WFN15-1881 Regional North American Symposium Management of Acute Strokes – evolving approaches J. Biller. Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, USA Management of Acute Strokes – Evolving Approaches José Biller, MD, FACP, FAAN, FANA, FAHA Management of patients with acute ischemic stroke (AIS) is multifacetic. This presentation focuses on recent data, and evidencebased recommendations, on the timely restoration of blood flow using new generation mechanical thrombectomy stent retrievers for highly selected subgroup of patients with AIS due to large artery occlusive disease of the proximal anterior circulation. doi:10.1016/j.jns.2015.09.260
1687 WFN15-1780 Regional Pan-Arab Symposium Epilepsy H. Hosny, A. Ashmawi. Neurology department, Cairo University, Cairo, Egypt Prognosis of Newly Diagnosed Patients with Epilepsy Hassan S.Hosny MD Prof of Neurology , Cairo University Background: Although Epilepsy is one of the most common neurological conditions, Limited data are available on the clinical patterns of treatment response in newly diagnosed epilepsy. Objective: To identify the different clinical pattern of outcome of epilepsy in the newly diagnosed patients and the strong predictors of failure to achieve 2 years seizure remission. Methodology: In this retrospective study we collected the data of 239 patients from all ages with newly diagnosed epilepsy between the year 1994 and 2008 that were diagnosed by single senior epileptologist and followed up for at least four years at specialized epilepsy center in Egypt. The patients were divided into two groups (poor and good control) and compared for clinical characteristics. Results: A total of 239 patients with newly diagnosed epilepsy were included. Early remission was achieved in (73.6%) while (12.1%) entered late remission. Thirty four patients (14.2%) failed to achieve 2 years seizure remission. Twenty six patients (10.9%) have drug resistant epilepsy.Terminal remission uninterrupted by relapse was noted (25.1%) indicating a remitting course of epilepsy. Out of (85.5%) patients who achieved a two years remission, the events of