Teaching Course 19: Controversies in Neurology

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Teaching Course 19: Controversies in Neurology by Mind Map: Teaching Course 19: Controversies in Neurology

1. Navigation

1.1. EFNS Conference overview

2. Mild Cognitive Impairment

2.1. To Treat

2.1.1. S. Knecht, Germany MCI Are you in the process of developing dementia? Treat

2.2. Not to Treat

2.2.1. J.-M. Annoni, Switzerland Not enough treatment evidence for standard treatment of MCI Why not? MCI is not a valid syndrome Specific therapies usually are unreliable Therapies have side effects There are other approaches Conclusion MCI is a mixture of many syndromes Specific trials: do not protect against conversion Therapies have side effects Interventions: Preventive and lifestyle approaches

3. Deep Brain stimulation in PD

3.1. Shall we do it early?

3.1.1. G. Deuschl. When patients cannot walk anymore Speech Studies Deep brain stimulation plus best medical therapy vs best medical therapy alone for advanced PD (studies) Pallidal vs subthalamic Deep Brain for PD (studies) A RT of Deep-Brain Stimulation for PD (studies) Risks Picture Hardware related long term effects Effects Speech improved in most studies Gait Risk due to stimulation Overall efficacy

3.2. Shall we do it late?

3.2.1. Mrs. M. Vidailhet, France The good things Despite the overall excellent outcome of neurosurgery in patients, ther is often a contrast between the improvement in motor disability and the difficulties of patients to reintegrate in normal life patients have high expectations Does STN meet expectancies problems reintegrating in normal life Neurosurgery in PD - A distressed mind in a repaired body? Schupbach M et al Neurology 2006 Examples Is the patient early in the evolution of the disease, will he/she be ready to endure some of the adverse events of STN stimulation? eyelid apraxia Weight gain Apathy Behavioral disorders Conclusion? The right timing is very important ideal candiate

4. Stroke

4.1. N.G. Wahlgren

4.1.1. Mismatch concept MR / DWI - Pro 2 million brain cells die for every minute Dilemma: treat or not to treat based on mismatch concept <4 hours 4 hour time window >4 hours some patients may benefit How to find the right patients imaging MR-Angio Cerebral blood flow MTT Conventional DWI Does mismatch represent the penumbra? Kidwell et al Not successfull yet DIAS 1 & 2: desmoteplase in acute ischemic stroke DEDAS: dose excalation study of desmoteplase in Acute ischemic Stroke EPITHET pilot / EPITHET trial to come Conclusion the mismatch concept is RIGHT There are methodological limitations that need to be solved

4.2. J. Sobesky

4.2.1. Mismatch concept MR / DWI - contra Some pictures follow Case Vignette Vignette pictures How to delineate core and hypoperfusion? DWI / false positive DWI Is DWI ischaemic core? CBF CBV MTT TTP PWI - algorhytms MRI perfusion maps Does mismatch match penumbra? Mismatch based on delayed trombolysis this presentation is not fully covered

4.2.2. The debate