Stroke
Session: tPA in Stroke
Capsule: tPA makes an important contribution to stroke therapy, but only a few benefit. How can we extend the value?
· Intra-arterial tPA
· Treatment beyond the 3 hours
· Treatment of stroke in evolution
· Newer agents
Session: Interventions in stroke prevention
Capsule: Data on pharmacologic and interventional means to prevent recurrent strokes are meager and
contradictory.
· Does addition of dipyridamole and clopidogrel offer significant protection in patients who failed aspirin?
Debate: Testing for right-to-left cardiac shunt
Multiple Sclerosis (MS)
Session: Multiple sclerosis (MS)
Capsule: Many people believe that MS is a syndrome rather than a single nosologic entity. The role of auto-immune processes is also still problematic, and has important implications for therapy.
Debate: MS is a single nosologic entity due to an auto-immune mechanism
· Weak points in MS diagnosis
Debate: Is MS a central or peripheral disease?
Session: Treatments strategies for MS
Capsule: Many issues regarding when and how to start treatment and what are the future avenues are not clear!
· When to start: CIS - To treat or not to treat? How to start: Induction vs. Escalation.
Session: MS- Switching between treatments
Capsule: When and based on what should we switch between treatments in MS patients?
· Role of Clinical and MRI parameters
· Role of Biomarkers and Neutralizing Antibodies
· New players: The Natalizumab/Tysabri experience: Risk vs. benefit
Session: Symptomatic Therapy
Capsule: While disease modifying therapies are widely encouraged, little evidence is available regarding symptomatic treatments.
· Anti-spasticity drugs
· Treatment of fatigue
· Therapy of pseudobulbar symptoms
Debate: Is stem cells-based therapy a realistic clinical option for MS patients?
Parkinson’s Disease (PD)
Session: Pathogenesis of PD
Capsule: In spite of much research, the pathogenesis of PD is still contested. Is there one cause that can be thought of as initiating the cascade?
· PD is a mitochondrial dysfunction disease
· PD is due to synuclein dysfunction
· Is PD a ferrinopathy?
· Olfactory dysfunction in early PD suggests that the disease is caused by a toxin
Session: PD: Motor aspects
Capsule: How can we control the motor complications in PD?
· DBS vs apomorphine infusions in complicated PD
· Is DBS ready for early PD?
· Spheramine–cell therapy for Parkinson’s disease
Session: Early PD
Capsule: Continuous dopaminergic stimulation in early PD may best prevent the development of motor complications
· Is continuous dopaminergic therapy really important in the initial stages of PD?
· L-Dopa + COMT inhibitors
· Transdermal agonists
· Are rasagiline and selegiline neuroprotective?
· Is L-Dopa still allowed as initial therapy for PD?
Session: PD: non-motor aspects
Capsule: Non dopaminergic symptoms may be more relevant than DA-responsive motor symptoms in PD
· The treatment of depression in PD patients
· Is dementia inevitable in PD?
· Compulsive behaviour is the most significant adverse event due to dopaminergics
· Daytime somnolence in PD – How to avoid and how to treat?
Neurofibromatosis
Session: Neurofibromatosis 2
Debate: Stereotactic Radiosurgery in Neurofibromatosis Type 2 (NF2)
Capsule: The relative benefits of radiosurgery and conventional operations is not yet clear
Debate: Stereotactic Radiosurgery in Neurofibromatosis Type 2 (NF2)
Neuroprotection and neuroplasticity
Session: Neuroprotection and neuroplasticity
· The role of the blood brain barrier in neuroprotection and neuroregeneration
Debate: "Neuroprotection and neuroplasticity - a dualistic vision of a continuous process"
Epilepsy
Session: Vagal Nerve Stimulation (VNS)
Capsule: VNS has been confirmed as effective therapy in resistant epilepsy
· Should VNS precede temporal lobectomy?
· Is VNS effective in resistant epilepsy?
· Other indications for VNS
Session: What to do after failure of 2 AED’s?
· Try a third drug
· Implant VNS
· Proceed to surgery
Debate: Monotherapy drug trials are unethical and should not be performed
Capsule: Many are being done, yet the ethics are often questioned
Debate: Benign Rolandic epilepsy of childhood is not a benign condition
Capsule: Some data suggests occasional serious complications, yet many do not treat patients with this condition
Dementia
Session: Mild Cognitive Impairment (MCI)
Capsule: Dementia typically develops insidiously. An intermediate stage between normal aging and dementia termed mild cognitive impairment (MCI) is still not well understood nor generally accepted.
Debate: Is MCI a useful concept?
Session: A Cure for AD
Capsule: Because beta-amyloid is a hallmark of Alzheimer disease, attempts are being made
to eliminate this protein. One of the new methods to achieve this is through anti-
amyloid immunization, while a competitive method is by inhibition of APP-cleaving enzymes.
Debate: Immunization will cure AD
Debate: Treatment of dementia with ChEI’s is appropriate
Debate: “Vascular cognitive impairment” is a misleading concept.
Session: Autoimmune dementia
Capsule: In addition to the common causes of dementia, some patients are thought to have an underlying autoimmune mechanism. When should these be considered and how should they be treated?
· Hashimoto (dysthyroid) encephalopathy
· Potassium channel antibody encephalopathy
· Anticardiolipin antibodies
Session: Cognitive Training
Capsule: Several studies demonstrate that education and involvement in intellectually demanding activities protect against dementia.
Debate: Cognitive training is useful in older people with memory impairment
Psychogenic disorders
Session: Psychogenic neurological disorders
Capsule: Clinicians are still facing frequent difficulties in differentiating “organic” from “functional” disorders.
· Is psychogenic dystonia a valid diagnosis?
· Vertigo as a psychogenic disorder
· Is Regional Sympathetic Dystrophy (RSD)–dystonia an organic disease?
· Psychogenic non-epileptic seizures – can they be diagnosed by any neurologist?
· Can they be treated by neurologists?
Pain
Session: Headache
Capsule: Migraine and tension headache are the most common types of headache, and probably the most common neurological disorders. None has a biomarker.
· Is the distinction between these two entities justified?
· Are all triptans similar?
· Is botulinum toxin effective in headache?
· Whether PFO is important to close in migraine
Session: Neurostimulation
Capsule: Deep brain stimulation is a useful treatment for movement disorders, its use for other indications is not established.
Debate: DBS can be helpful in other disorders, such as chronic pain, epilepsy and depression.
Autoimmune diseases
Session: Myasthenia Gravis
Capsule: The pathogenesis of “antibody-negative” myasthenia is still unclear. What is the role of antibodies against non-cholinergic targets? The role of thymectomy in the treatment of myasthenia is also still controversial.
· The spectrum of anti-musk antibodies
Debate: Thymectomy should be offered in late-onset MG
Movement Disorders
Session: Parkinsonian syndromes
Capsule: Movement disorders with Parkinsonian features have been diagnosed using different methods, using different criteria, but the basic question remains of the nosologic entities underlying these neurodegenerative diseases.
· SPECT imaging in the differential diagnosis of Parkinsonian syndromes
Debate: Are PSP and CBGD the same disease?
Session: Restless Legs Syndrome (RLS)
Capsule: RLS is one of the most common neurological disorders affecting quality of life.
· Is RLS very common?
· When to suspect RLS?
· Which treatments are most effective for RLS?
· Are PLMS and RLS the same disorder?
· Which treatment best avoids augmentation?
