Scientific Program

Day 1 :

Keynote Forum

Sangamithra Gandra

Neurologist

Keynote: THE PAINFUL TRUTH – MIGRAINE

Time : 01:30 to 02:20

Biography:

Dr.Sangamithra Gandra, a prodigious neurologist from Narayana medical college and hospital, Nellore(AP),India  has her expertise in detailed clinical evaluation of patients with Special interest in movement disorders, dementia and epilepsy. She follows her passion in improving the health and well being of patients by organizing various charity programs for patients with Stroke and Epilepsy. Her open and contextual evaluation model creates new pathways for improving health care. She has built this model after years of experience in research, evaluation, teaching and administration both in hospital and educational institutions.

Abstract:

Background: Primary headache disorders are among the most common pain syndromes affecting people worldwide. Migraine is the most common among these  primary headache disorders. The objective of this study is to analyse the clinical profile and the most common triggers of migraine in the study population in a tertiary care teaching hospital.

Methods: About 100 patients who presented with history suggestive of migraine with or without aura defined according to International classification of headache disorders 3, fulfilling the study criteria were included. Endogenous and exogenous migraine triggers were inquired using a questionnaire. Severity of migraine, associated symptoms, and functional disability were recorded. The study duration was twelve months from November 2018 to October 2019. Details were collected using a proforma.

Results: In this study, incidence of Migraine is higher in females (72%) than males (28%). Majority of migraine patients were between age group of 18-29 years constituting  about  64%  patients. Frequency of migraine more commonly observed was 3-4 per month(observed in 63%) and chronic migraine was seen in 19% patients . Migraine without aura is the most common type observed in this study. Many patients had more than one trigger. More common triggers identified were stress(38%), sun exposure (36%), sleep deprivation (36%), food habits(31%) and travel (30%).

Conclusions: Migraine is more common in females than males with majority being in between age group of 18-29 years. Many had frequency of 3-4 episodes per month. Most had more than one trigger

Keynote Forum

Samar Ghazi

Keynote: Implementation journey of international dysphagia diet standardisation initiative in kfsh- dammam

Time :

Biography:

B.Sc Rehabilitation-Speech & Hearing, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia. Postgraduate Certificate Evidence Based Therapy, College of Clinical Therapist, University College Cork, Cork, Ireland. Current Position: Senior Speech Therapist in King Fahad Specialist Hospital- Dammam, Member of the Saudi Society for Speech Language Pathology & Audiology, Irish Speech and Hearing Association and European Society for Swallowing Disorder

Abstract:

Statement of the Problem: Dysphagia is a common problem that is seen in some neurological, oncology and post-surgical cases in adults and pediatrics. Patients with dysphagia may require liquids and food that could vary in thickness and texture. Providing patients with incorrect diet will increase risk of choking, coughing, aspiration, silent aspiration, malnutrition and dehydration. King Fahad Specialist Hospital- Dammam has a Diet Manual that includes dysphagia diet based on the Manual of American Dietetic Association. However, there is no standard measure to classify this diet. The purpose of this study is to implement international updated dysphagia diet in KFSH- Dammam and to be first MOH hospital in Eastern Province Saudi Arabia using standardized dysphagia diet. It was found that in October 2012, International Dysphagia Diet Standardization Initiative was initiated at the meeting of European Society of Swallowing Disorders in Spain. Aim of IDDSI is to develop international standardized terminology and definitions for texture-modified foods and thickened liquids. Methodology & Theoretical Orientation: Lean methodology was used over a period of 8 months (April – December, 2018), project team was organized from Speech Therapy, Nutrition Therapy and Nursing Departments under the guidance of Quality Department, process map was drawn, followed by cause-and-effect analysis to understand variations. Implementation process was started by collecting data in Neuro/ Neurosurgical and Pediatric Wards to figure out the percentage of correct liquid thickness that is matching our assessment. Drinking testing method was applied to all liquids and oral supplements being served in the hospital. Food tasting method was conducted on the second year. Conclusion & Significance: By the end of 2018, the percentage of correct liquid thickness that are matching the dietitian order reached more than 90% accuracy. In 2019, the implementation was completed. Applying IDDSI, increased patient safety, improves quality of care and reduce cost

Keynote Forum

Amit Aiwale

Neurologist

Keynote: Micro-RNA expression signature pattern as additional tool for Diagnosing and grading CNS Tumors

Time : 09:30 to 10:15

Biography:

Amit B Aiwale has expertise in both Cranial and spine surgeries, has done DNB neurosurgery from CARE Hospital Hyderabad and completed Fellowship in Neuro-endoscopy under Prof. Dr. Y. R. Yadav and WFNS Fellowship under Dr. Basant K. Misra. He has done many podium paper and poster presentations in many Indian National and state level conferences. He has won many Neurosurgical Quiz as resident during training period. At very young age with interest in research work during the training period he received the Next Gen Young Neurosurgeon award in 2018 along with Abstract publication in International Neurosurgery Update 2018 held at Mumbai India. Now he is Associated with one of renowned institutes in India P.D. Hinduja National Hospital and research Centre Mahim, Mumbai

Abstract:

The current diagnostic techniques are relatively insensitive in diagnosing and grading CNS tumors, resulting in a delay in diagnosis until disease progressed or recurrence related symptoms are profound and irreversible and therapeutic options are limited or non-existent. miRNA can be useful as biomarkers for cancer detection because:(i) miRNA expression is frequently dysregulated in cancer (ii) expression patterns of miRNAs in human cancer appear to be tissue-specific and (iii) miRNAs have unusually high stability in formalin-fixed tissues. In our institute when we studied CNS tumors patients with miRNA 7,21,33,34 and 200 expressions in tumor tissue, CSF and serum we found the expression levels of miRNA 7,21,33,34 and 200 was significantly high in tissue samples in both males and females whereas no significant difference was observed gender wise in any type of sample analyzed. The expression levels of miRNA-7,34 and 200 being tumor suppressor related miRNA were found in high folds in grade1 tumors compared to high grade tumors. While the miRNA21 found in higher folds in grade4 compared to grade1 glioma. Consistent downregulation was observed for the expression of miRNA-33 in tissue and CSF samples from grade1 to grade4 CNS tumors. However, no significant variation was observed in serum. The graphical pattern of presentation of miRNA7,21,33,34 and 200 was typical in specific grade of gliomas i.e. grade1 to grade4. The fold change of presentation of miRNA may be variable but the graphical pattern remains relatively consistent in tumour tissue, CSF or blood samples from the patients with CNS tumours. We concluded that the miRNA analysis can become a future additional tool for diagnosis and follow up monitoring of patients with CNS tumors. miRNA in blood or CSF has specific graphical pattern in each individual grade of glioma and hence can be used as specific signature in prediction of conversion of low-grade glioma into high grade gliomas. Further research needs to be done with regards to role of other miRNA and the signature patterns

Keynote Forum

Radu Mutihac

Chair of Medical Physics Section,

Keynote: Human Connectome Alterations in Neurological Disorders

Time : 10:15 to 10:50

Biography:

Prof. Radu Mutihac is Chair of Medical Physics Section, University of Bucharest, and works in Neuroscience, Signal Processing, Microelectronics, and Artificial Intelligence. As postdoc/research associate/visiting professor/full professor he has run his research at the University of Bucharest, International Centre for Theoretical Physics (Italy), Ecole Polytechnique (France), Institut Henri Poincaré (France), KU Leuven (Belgium). Data mining and exploratory analysis of neuroimaging time series were addressed during two Fulbright Grants in Neuroscience (Yale University, CT, and University of New Mexico, NM, USA). His research infused biomedical imaging modalities was carried out at the Johns Hopkins University, National Institutes of Health, and Walter Reed Army Institute of Research, MD, USA.

Abstract:

Studies on the human connectome alterations using resting-state/sleep functional magnetic resonance imaging (rsfMRI), diffusion tensor imaging (DTI), and, more recently diffusion spectroscopic imaging (DSI) data have advanced and enlarged the knowledge on the organization of large-scale structural and functional brain networks, which consist of spatially distributed, but functionally linked regions that continuously share information. Brain's energy is largely consumed at rest during spontaneous neuronal activity (~20%), while task-related increases in metabolism energy are minor (<5%). Spontaneous low-frequency correlated fluctuations in blood oxygenation level dependent (BOLD) rsfMRI signals at the level of large-scale neural systems are not noise, but
orderly and organized in a series of functional networks that permanently maintain a high level of temporal coherence among brain areas that are structurally segregated and functionally linked
in resting-state networks (RSNs). Some RSNs are functionally organized as dynamically competing systems both at rest and during task-related experiments. The default mode network (DMN), the most important RSN, is involved in realization of tasks like memory retrieval, emotional process, and social cognition. Cortical connectivity at rest was reportedly altered in several forms of dementia and psychiatric disorders. Most recently, human brain function has been imaged in fMRI, and thereby accessing both sides of the mind-brain interface (subjective experience and objective observations) has simultaneously been performed. As such, functional neuroimaging moves onto new potential applications like reading the brain states, brain- computer interfaces, lie detection, aso. The present contribution aims to highlight the fundamentals and review the up-to-date findings in imaging modalities dedicated to alterations in human connectomics investigated by diffusion tensor imaging (DTI) for white matter (WM) and rsfMRI for grey matter (GM) studies, respectively, with direct impact on diagnostics and
prognostics of psychiatric and mental disorders.

Keynote Forum

Dr. Hanin Algethami

Keynote: MEG in Pre-Surgical Evaluation in Patient with Epilepsy.

Time : 11:30 to 11:50

Biography:

Epilepsy and electrophysiology fellow at King Fahad Medical City, Riyadh, KSA. Completed pediatric neurology training residency program at King Abdullah Specialized Children hospital, King Abdul-Aziz Medical city, Riyadh, KSA.

Abstract:

Background:

Epilepsy is a highly prevalent, serious neurological disease, characterized by recurrent unprovoked and often debilitating seizures. Between 30% and 40% of patients with epilepsy are resistant to antiepileptic drugs. Epilepsy surgery is the current gold standard treatment for such patients.

MEG is an advanced noninvasive neurophysiology imaging technique that is often used in the course of the presurgical evaluation of patients to estimate epileptic foci. The only MEG system in Saudi Arabia is installed in KFMC. However, no systematic analysis has been conducted yet exploring its yield, potential or clinical value in epilepsy surgeries in KFMC.

Methods:

Current project involves a retrospective study of patients with drug-resistant focal epilepsy, who underwent: (i) presurgical MEG and (ii) epilepsy surgery.  Around 50 such patients have been identified from KFMC electronic medical records over an eight-year period (2011-2019). Here we present preliminary results from 18 patients.

Objectives:

The main objective of the current study is to assess the yield, clinical utility and added value of MEG at KFMC in presurgical evaluation of patients with epilepsy, as well as clearly define its clinical indications.

Results:

Gender (Male / Female)

11 (61.1%) / 7 (38.8%)

Handedness (Right / Left / Ambidextrous)

16 (88.8%) / 1 (5.5%) / 1 (5.5%)

Age of onset (Mean / SD / Range)

10.6 / 8.04 / 1-26 

Age of evaluation (Mean / SD / Range)

24.6 / 11.1 / 4-39  

Seizure duration

14 / 9.9 / 2-29  

MRI findings

FCD: 7 (38.8%) Normal: 2 (11.1%) AVM: 1 (5.5%) MTS: 8 (44.4%)

Post-op follow-up (Mean / SD / Range)

39.6 / 30.4 / 2-93 months  

 

MEG provided positive localizing results (i.e. tight dipole clusters) in 9 patients (50%) and negative results (normal or only benign variants) in other 9 patients (50%). Positive MEG localization results were concordant with the surgical resection in 5 patients: 3 of whom (60%) became completely seizure free (Engel Ia) and 2 patients (40%) achieved worthwhile seizure reduction (Engel IIIa) with the frequency of seizures decreasing from daily to monthly. MEG localization results were discordant with the resection in 4 patients, and only 1 of these patients became seizure free (25%).

Conclusion:

Current findings demonstrate the significant clinical value of MEG in presurgical evaluation of patients with drug-resistant epilepsy. In 89% of patients with positive localizing results (8/9), MEG appropriately estimated the location of epileptogenic zone, providing clinically relevant information, which could lead to favorable post-surgical seizure outcome.

Keynote Forum

Dr Hanin Althegami

Keynote: MEG in Pre-Surgical Evaluation in Patient with Epilepsy.

Time : 11:30 to 11:50

Biography:

Epilepsy and electrophysiology fellow at King Fahad Medical City, Riyadh, KSA. Completed pediatric neurology training residency program at King Abdullah Specialized Children hospital, King Abdul-Aziz Medical city, Riyadh, KSA.

Abstract:

Background:

Epilepsy is a highly prevalent, serious neurological disease, characterized by recurrent unprovoked and often debilitating seizures. Between 30% and 40% of patients with epilepsy are resistant to antiepileptic drugs. Epilepsy surgery is the current gold standard treatment for such patients.

MEG is an advanced noninvasive neurophysiology imaging technique that is often used in the course of the presurgical evaluation of patients to estimate epileptic foci. The only MEG system in Saudi Arabia is installed in KFMC. However, no systematic analysis has been conducted yet exploring its yield, potential or clinical value in epilepsy surgeries in KFMC.

Methods:

Current project involves a retrospective study of patients with drug-resistant focal epilepsy, who underwent: (i) presurgical MEG and (ii) epilepsy surgery.  Around 50 such patients have been identified from KFMC electronic medical records over an eight-year period (2011-2019). Here we present preliminary results from 18 patients.

Objectives:

The main objective of the current study is to assess the yield, clinical utility and added value of MEG at KFMC in presurgical evaluation of patients with epilepsy, as well as clearly define its clinical indications.

MEG provided positive localizing results (i.e. tight dipole clusters) in 9 patients (50%) and negative results (normal or only benign variants) in other 9 patients (50%). Positive MEG localization results were concordant with the surgical resection in 5 patients: 3 of whom (60%) became completely seizure free (Engel Ia) and 2 patients (40%) achieved worthwhile seizure reduction (Engel IIIa) with the frequency of seizures decreasing from daily to monthly. MEG localization results were discordant with the resection in 4 patients, and only 1 of these patients became seizure free (25%).

Conclusion:

Current findings demonstrate the significant clinical value of MEG in presurgical evaluation of patients with drug-resistant epilepsy. In 89% of patients with positive localizing results (8/9), MEG appropriately estimated the location of epileptogenic zone, providing clinically relevant information, which could lead to favorable post-surgical seizure outcome.

Keynote Forum

Sangamithra Gandra

Neurologist

Keynote: THE PAINFUL TRUTH – MIGRAINE

Time : 1:00 to 1.40

Biography:

Abstract:

Background: Primary headache disorders are among the most common pain syndromes affecting people worldwide. Migraine is the most common among these  primary headache disorders. The objective of this study is to analyse the clinical profile and the most common triggers of migraine in the study population in a tertiary care teaching hospital.

Methods: About 100 patients who presented with history suggestive of migraine with or without aura defined according to International classification of headache disorders 3, fulfilling the study criteria were included. Endogenous and exogenous migraine triggers were inquired using a questionnaire. Severity of migraine,associated symptoms, and functional disability were recorded. The study duration was twelve months from November 2018 to October 2019. Details were collected using a proforma.

Results: In this study, incidence of Migraine is higher in females (72%) than males (28%). Majority of migraine patients were between age group of 18-29 years constituting  about  64%  patients. Frequency of migraine more commonly observed was 3-4 per month(observed in 63%) and chronic migraine was seen in 19% patients . Migraine without aura is the most common type observed in this study. Many patients had more than one trigger. More common triggers identified were stress(38%), sun exposure (36%), sleep deprivation (36%), food habits(31%) and travel (30%).

Conclusions: Migraine is more common in females than males with majority being in between age group of 18-29 years. Many had frequency of 3-4 episodes per month. Most had more than one trigger

  • Neurology
  • Psychology | Mental Health

Chair

Radu Muthiac

Chair

Session Introduction

Nayab Gul

Clinical Psychologist

Title: MANIFESTATION OF PSYCHIATRIC DISORDERS IN LOCAL COMMUNITY AND LEVEL OF EDUCATION AS PREDICTOR OF PSYCHIATRIC DISORDERS
Biography:

Abstract:

The purpose of the study was to unfold the manifestation of psychiatric disorders in local community and to analyse the constellation of psychiatric problems around level of education. The present study is descriptive in nature. The locale of research was Shafique Psychiatric Clinic (SPC) and the study design includes the patients visiting psychiatrist working in the facility. The sample consisted of 400 patients, both convenient and purposive sampling techniques were used for data collection. The data was collected by conducting specialized interviews for the purpose of reaching diagnosis on the bases of ICD-10 and DSM-5. The date was quantitative in nature. The analysis descriptive results revealed that both genders are equally suffering from neurotic disorders whereas  psychotic disorders were more prevalent among male as compared to female population.  Interestingly the age range varied for neurotic and psychotic disorders starting from as low as 7 years and as much as 80 years. Most of patients visiting the facility were uneducated  thus enforcing the fact that  low level of education is an important risk factor for mental health, and should be kept in mind in psychiatric prevention and mental health promotion. The  hypothesis testing revealed that level of education was negatively correlated with psychiatric disorders. Education of the masses was concluded as primary intervention for the prevention of psychiatric disorder

Day 2 :

Keynote Forum

Anirban Biswas

Clinical Neurologist

Keynote: POST BPPV SYNDROME

Time :

Biography:

Abstract:

BPPV is the commonest cause of vertigo and about 25% of balance disorder patients who attend a vertigo clinic suffer from BPPV. Fortunately, the disease is easily correctable in most cases by some physical manoeuvres called ‘liberatory manoeuvres’  or Canalolith Repositiong Manoeuvre (CRM) and patients are very soon, if not immediately relieved of symptoms if the manoeuvre is properly done.  However, quite a sizable portion (34 to 61%) of these patients are not completely symptom-free even after a very successful manoeuvre. They are of course relieved of the symptom of sudden severe head spinning on change of head posture which is the diagnostic feature of BPPV after the properly done manoeuvre; but, yet complain of a new set of symptoms viz. feeling of persistent dizziness, light headedness and unsteadiness, often a mix of all three even though there is no evidence of any positional vertigo whatsoever. This residual dizziness even after successfully repositiong the dislodged otoconia back into the otolith organs is pretty difficult to treat and causes quite a morbidity to the patient. The exact pathomechanism is not known with certainty but most published studies and clinical experience has shown that patients with high anxiety and depression as well as aged patients (in all of whom anxiety and depression are more prevalent) and patients with emotional issues are the ones who are much more likely to develop Post BPPV Syndrome and have the residual dizziness after a successful CRM. The morbidity and poor QOL induced by the residual dizziness is very high. The disease is self limiting in most cases but many patients do need medical treatment.

In our clinic we follow a protocol by which we identify which patients are more likely to have Post BPPV syndrome or the residual dizziness after a successful CRM and manage them differently. The process primarily consists of counselling and educating the patient prior to and after the repositiong manoeuvers and medicating a very select few. By this process the incidence of residual dizziness after a successful CRM is much lesser in our clinic as compared to reported international publications.