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What is Epilepsy ?; Bangkok Post: Dr. Yotin’s interview

What is Epilepsy ?; Bangkok Post: Dr. Yotin’s interview

Epilepsy – a common neurological disorder characterised by recurrent seizures that generally last from a few second to a few minutes – is not a new illness. in fact, it may be one of mankind’s oldest diseases, said Dr Yotin Chinvarun, an epileptologist.

Yet, it can make those having it feel discriminated against, he added.

However, Dr Yotin insisted if given proper medical treatment, people with epilepsy can lead a normal life.

According to the expert, the seizures involve abnormal electrical function in the brain, normally caused by damages to certain area of the brain.

“Not everyone with a seizure has epilepsy,” he said. Seizures that are not related to epilepsy may result in different conditions such as facial twitching, hemifacial spasms and periodic limb movement. some people just have a muscle tic that may look or feel like a kind of seizure. but epileptic seizure is a chronic disorder that occurs repeatedly over weeks, months or years.

A 2007 file photo shows Mike Seman console his 2 1/2-year-old son, Alex, as doctors sedated him prior to brain surgery at the Children’s Hospital in Pittsburgh. Alex suffered from seizures since he was four months old. the bandages cover previously implanted sensors that guide surgeons as they remove the piece of abnormal brain tissue causing the seizures.

It is mostly found in young children and old people, Dr Yotin said, but seizures can start at any age.

There is a wide variety of epilepsy which can be categorised many ways. the most common classification of the epilepsies is determined by the syndromes related to the location where the seizure originates. the seizures may occur either in particular or general parts of body.

Seizures affect patients in many different ways – some may fall to the ground, others may experience body stiffness, muscle contraction or clonic spasm.

Other seizures may be more difficult to notice because they don’t develop reactions. Patients may have visual disturbance or experience deja vu or a certain illusion known as jami vu. some may have temporary speech problems. there are also difficult-to-notice symptoms like mild muscle twitches, unresponsive staring, lip movements like smiling or chewing and eye blinking.

“Patients with epilepsy may be conscious or unconscious during a seizure. It occurs without warning.

“My patient was caught stealing in a convenience store. in fact, he had seizure and couldn’t remember what had happened during the seizure and didn’t recall he was stuck with seizure.”

People with epilepsy need to avoid water sports, sleep deprivation and stay away from high places. Driving can be possible, should they be free of seizure for one year, he said, adding epilepsy is not a kind of mental illness. while symptoms may look scary, but they don’t make a patient violent or dangerous.

Children with epilepsy may have movement disorders, sleep disturbance, problems with growth and development.

Epileptic seizures are especially prevalent in autistic people – among 40% of them, said the doctor, adding that a number of people with Down’s syndrome experience myoclonic seizure – abnormal movements on both sides of the body at the same time – that can be fatal.

Children who suffer from autism and Down’s syndrome usually have abnormal cortical development, which is a common cause of epilepsy. Uncontrolled seizures will cause damage to the brain. they can often develop complications such as infections.

The type of seizures a patient has depends on many factors such as the part of the brain affected and the underlying cause of the seizure. Symptoms can be mild to severe.

WHAT TRIGGERS THE SYNDROME?

People with history of head injuries or brain infections have a high risk of developing epileptic seizures. Brain tumours or brain lesions where there is a scar tissue or abnormal mass of tissue damaged in a specific area of the brain can cause seizures. Genetic disorders may also be a cause for concern. in addition, stroke victims are susceptible to the development of epileptic seizures.

“People don’t have to have a family history to develop epilepsy. and the condition may develop although they don’t have any risk factors,” Dr Yotin said.

What’s more, complications during pregnancy through a difficult delivery are attributable to the syndrome. An infant who had premature birth complications and was born with head and brain injuries face a higher risk of developing epilepsy.

“Children may develop seizures after having vaccinations but there is no evidence for this claim. It may have a connection between seizures and the lymphatic system,” the doctor said.

Most common causes of epilepsy among older adults and the elderly may be dementia, strokes, metabolic disorders, underlying chronic kidney diseases, liver failure and degenerative diseases.

Numerous studies indicate high mortality in old people who have prolonged epilepsy, said Dr Yotin.

TACKLING THE SYNDROME

After physical and neurological examinations, if epilepsy is suspected, a doctor may do some tests. A routine EEG or electroencephalogram is normal for diagnosis. Dr Yotin said EEG is a test that measures and records the electrical activity of the brain. It is used to diagnose epilepsy and detect what types of seizures are happening.

“Special sensors will be attached to a patient’s head and hooked by wires to a computer, which is used to record the brain’s electrical activity on screen. So, seizures can be seen by the changes in the normal pattern of the brain’s electrical activity,” the doctor explained.

Also, additional tests may be performed to investigate and evaluate the condition. they are 24-hour video EEG monitoring and neuro-imaging MRI. Neuropsychological assessment and WADA testing may also be used to figure out brain function such as memory, language and attention.

Non-invasive tests including single photon emission computed tomography (SPECT) scanning, positron emission tomography (PET) scanning may be implemented to identify the epileptogenic zone if the initial evaluations are not conclusive. Brain functional mapping may be used in some cases.

KEEPING CONTROL

Medications may be common to treat epileptic seizures. they are used to prevent seizures and may reduce the number of seizures. according to Dr Yotin, patients may need to take seizure medicines for about 2-5 years.

“About 60% of those receiving medication achieve zero seizures. some may be able to reduce or completely stop their seizure medicine after having no seizures for several years. Seizures may persist in many cases so that medication treatment may be lifelong,” the doctor said.

Gamma Knife is radiosurgery, a non-invasive neurosurgical procedure that uses powerful doses of radiation to target and treat diseased brain tissue while leaving surrounding tissue intact.

Some patients with certain types of epilepsy may require brain surgery to remove the abnormal brain cells that cause the seizures.

“Surgery can be palliative, decreasing the frequency or severity of seizures in patients who are unresponsive to medicine . in some cases, it can be curative,” he said.

Meanwhile, others may be treated by vagal nerve stimulation that can help reduce the number of seizures.

A special ketogenic diet featuring high-fat, low-carb food is another treatment option. This non-drug treatment is ideal for difficult-to-control epilepsy in children. but it’s not recommended in the elderly.

WHAT TO DO IF A PERSON CLOSE TO YOU HAS A SEIZURE?

Be calm, Dr Yotin said. and remove things that could cause injury if the person falls down or bumps into them. Gently roll the person on his or her left side.

“Don’t move the person to another place. and never try to force the person’ mouth open or put anything in it because it can be dangerous for both patient and helper. the action may cause injuries to the patient such as chipped teeth or a fractured jaw, meanwhile the helper may get bitten.

“If a seizure lasts longer than 10 minutes, call for emergency medical service,” he said.

HOW TO WARD OFF THE CONDITION

In addition to a regimen of healthy diet and regular exercise, avoid sleep deprivation, alcohol and narcotics, the doctor advised. Also skip using sleeping pills for a long period. Avoiding head injuries may reduce the chance of developing epilepsy.

“If a person has such signs as slow response, cognitive impairment, chronic depression and clumsiness, consult a doctor. Epilepsy may be possible,” the doctor said.

He added several studies have found that there was misperception about epilepsy among the public and those suffering from it are deprived of medical benefits or compensation.

“As a result, patients don’t receive sufficient care, leading to poor living and premature death.

“It’s a formidable disease. Treatment usually works to control and reduce seizures. Without treatment, seizures may continue and even become worse and more frequent. One of the most dangerous complications of the condition is a prolonged seizure condition that can result in brain damage or death. People should learn about it as it can be useful to yourself and people near you.”

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PRINCIPLES OF AUTONOMOUS NEURODYNAMICS 2014 Paris, France July 7-9, 2014

PRINCIPLES OF AUTONOMOUS NEURODYNAMICS 2014 Paris, France (download)
July 7-9, 2014

SAND XI
11th Annual Meeting of the Society for Autonomous Neurodynamics (SAND)

Location:

Institut Pasteur
28 Rue Du Docteur Roux, 75015 Paris, France

Supporting Institutes and Programs:

Human Genetics & Cognitive Functions Lab, Pasteur Institute The Green Neuroscience Laboratory, Neurolinx Research Institute The University of Toronto Epilepsy Research Program (UTERP) Hack Your PhD
Stichting Epilepsie Instellingen Nederland (SEIN)
Institute of Experimental Physics, Warsaw University Greenspiration Foundation, Canada

www.utoronto.ca/sand/PAND2014/

SAND XI – PRINCIPLES OF AUTONOMOUS NEURODYNAMICS 2014 Paris, France – July 7-9, 2014

DAY 1 – Monday, July 7

Registration
Opening & Orientation

Welcome & Opening Remarks (G. Dumas, C. Gruson-Daniel, A. Lam) Introduction & Welcome to Institut Pasteur (Thomas Bourgeron)
An Orientation to SAND (A. Lam)
A Brief Primer on Autonomous Neurodynamics (E. Ohayon)

Session 1 – Epilepsy I: Transitions in Space, Time and Modulation Chair:

9:00 – 10:00

10:00 – 10:10 10:10 – 10:25 10:25 – 10:30 10:30 – 10:50

P. Carlen
11:10 – 11:30 p.x

Piotr Suffczynski

Suzie Dufour

Marc Koppert

Berj Bardakjian

Modeling of Seizure Transitions with Ion Concentration Dynamics

Revisiting Extracellular and Intracellular K+ Accumulation and Buffering during Epilepsy: A Spatiotemporal Study

Seizure Control in Autonomous Computational Models of Epilepsy Estimation of Regions of Interest in the Epileptic Brain from Intracranial Group Discussion over Lunch

10:50 – 11:10 p.x

11:30 – 11:50 11:50 – 12:10 12:10 – 13:30

p.x

Session 2 – Dynamics I: Harmonics, Looping & Grooving

EEG Chair: S. Kalitzin

Maciej Labecki

David Colliaux

Julien Laroche

Nature of Fundamental and Harmonic Components of Steady State Visual Evoked Potentials
Une Boucle Sensorimotrice Minimale:
Modeles Subjectifs et Voies Biochimiques /

Minimal Sensorimotor loop: Subjective Models and Biochemical Pathways The Autonomous Groove of Relational Dynamics
Group Discussion
Coffee break

13:30 – 13:50 p.x p.x

13:50 – 14:10

14:10 – 14:30 14:30 – 14:40 14:40 – 14:50

p.x p.x

Session 3 – Epilepsy II: Molecules & Metabolism (Fatty Acids ̧ Hormones, Metals)

Chair: A. Lam

Paul Hwang

Melanie Jeffrey

Laura Frutos

A Double Blind Placebo Controlled Trial of
Docosahexaenoic Acid (DHA) in Epilepsy – A Preliminary Report Electrophysiological Studies of Progesterone and its Metabolites: Open to Whom?
A Working Chapter in the Hidden Story of Metals and Epilepsy

14:50 – 15:10 p.x 15:10 – 15:20 p.x

15:20 – 15:50 p.x 15:50 – 16:00

16:00 – 16:20 p.x 16:20 – 16:40 p.x

16:40 – 16:50 16:50 – 17:00 Evening

i

Group Discussion

Session 4 – Imaging Across Scales, Conditions and Stages of Treatment

Chair: J. Hwang

Ann Lam

Yotin Chinvarun

How do you Translate Particle Accelerator Images to
Post-Surgical Treatment?
Ictal PET in Status Epilepticus:
A Valuable Presurgical Tool in Selected Patients with Status Epilepticus (SE) Group Discussion

Close of Day 1 Announcements & planning for retreat

SAND Social & Dinner Principles of Autonomous Neurodynamics 2014

SAND XI – PRINCIPLES OF AUTONOMOUS NEURODYNAMICS 2014 Paris, France – July 7-9, 2014

DAY 2 – Tuesday, July 8

Introduction to Day 2, Updates & Announcements 09:30 – 09:35 Session 5 – Epilepsy III: Start, Stop and See Chair: P. Suffczynski

Robert Helling

Prisca Bauer

Stiliyan Kalitzin

Gap-Junctions as Common Cause of High-Frequency Oscillations and Epileptic Seizures: A Computational Cascade of Neural Mass and Compartmental Modelling
Post-Ictal Generalised EEG Suppression (PGES) – the “Neuronal brake”?

In and Out United: Whole Body Motion Detection and its Electrographic Correlates in Cases of Major Motor Seizures

09:35 – 09:55 p.x

09:55 – 10:15 p.x

10:15 – 10:35 p.x

10:35 – 10:45

10:45 – 10:55

10:55 – 11:15 p.x

11:15 – 11:35 p.x

11:35 – 11:55 p.x

11:55 – 12:05

12:05 – 13:30

13:30 – 13:40

13:40 – 14:00 p.x

14:00 – 14:20 p.x

14:20 – 14:40 p.x

14:40 – 14:50

14:50 – 15:10 p.x

15:10 – 15:30 p.x

15:30 – 15:50 p.x

15:50 – 16:00

Group Discussion Coffee break

The Open Future I: Technology & Medicine in Autonomy, Cognition & Health

Session 6 –

Jie Mei

Julie Hwang

Paul Hwang

Session 7 –

Chair: M. Labecki

Transitioning to a New Era: How will Future Technologies Revolutionize Cognition, Autonomy and Social Thinking
Naturopathic Medicine and Neurology:
a Glance into the Philosophy and Science of Treatments of People and their Neurologic Conditions from a Naturopathic Perspective

A Common Platform for Neurophysiological Database: EEG, ERP, MEG and PSG
Group discussion
Lunch & leisurely deep discussions

Neural Networks and Artificial Life: Structures, Embodiment & Surprise Returns

Chair: S. Dufour

Stiliyan Kalitzin

Gueorgui Petkov

Remi Sussan

Elan Ohayon

Post-Lunch Reawakening: The SANDS of Time

A Computational Modelling Approach to the Critical Role for Network Structure and Spread of Information in Seizure Onset Grandeur et Misère de la “Vie Artificielle” /
The Grandeur and Misery of “Artificial Life”

Wait, did that just move? Strange embodied behavior in naive spatial networks

Coffee break

Session 8 – The Open Future II – Nouveaux Ports Vers L’autonomie: Chair: E. Ohayon Neural, Social, Cultural

Guillaume Dumas

Martin Fortier

Bronwyn Sekulovich

Probing the Complementary Nature of Autonomy and Coupling Across Neural, Behavioral, and Social Scales
Importing Bayesianism into Anthropology?
An Ethnobiological Look at Probabilistic Models of Categorization Triple E: Environmentally Engaged Education

Group discussion

Principles of Autonomous Neurodynamics 2014

ii

SAND XI – PRINCIPLES OF AUTONOMOUS NEURODYNAMICS 2014 Paris, France – July 7-9, 2014

DAY 2 – Tuesday, July 8 (Continued)

Session 9 – Reports from the Frontiers of Open Science: Principles & Practice

Chair: L. Frutos

Célya Gruson-Daniel

Ann Lam

Tales from the Open Science Tour
Challenges, New Approaches and Opportunities in Green and Open Neuroscience
Group discussion

Close of Day 2 Announcements &
Coordinate for Paris Open Laboratory Space Tour

Paris Open Community Laboratory Space Tour & Potluck Apéro
@ La Paillasse
226 rue Saint Denis, 75002 Paris http://lapaillasse.org/

With our Guide: Célya Gruson-Daniel Evening (18:30 – 21:00)

16:00 – 16:20 p.x

16:20 – 16:40 p.x

16:40 – 16:50 16:50 – 17:00

Principles of Autonomous Neurodynamics 2014

iii

SAND XI – PRINCIPLES OF AUTONOMOUS NEURODYNAMICS 2013 Paris, France- July 7-9, 2013

DAY 3 – Wednesday, July 9

Introduction to Day 3, Updates & Announcements

Session 10 – Dynamics II: Brain Oscillations

Peter Carlen Potassium and Seizures: an Oscillatory Relationship

Uziel Awret Brain Oscillations and Sparse Predictive Coding

Coffee break

ROUNDTABLE DISCUSSIONS:

09:30 – 09:35 Chair: Y. Chinvarun

09:35 – 09:55 p.x

09:55 – 10:15 p.x

10:15 – 10:25

Chairs: Lam & Dumas
10:25 – 11:25 p.x

11:25 – 11:40 11:40 – 11:45 p.x 11:45 – 12:00

Round Table

What are the Relations of Open Science & Autonomy: Necessary Bedfellows or Risky Business?

SAND Next Stops & Steps
Closing of Day 3 Remarks and Announcements Retreat coordination

SAND SCIENTIFIC RETREAT
July 9 -12
CÉVENNES AND STEVENSON TRAIL Post-Presentation Events Begin the Afternoon of July 9th, 2014 Depart from Gare de Lyon with TGV 2pm

Principles of Autonomous Neurodynamics 2014

iv

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Art as Therapy—Can Creative Expression Soothe Dementia Symptoms?

With a final stroke of the brush, Laura Baxter puts finishing touches on her painting, a piece of abstract art others deem a masterpiece. Baxter was diagnosed with Alzheimer’s disease at age 62. Now 77, she cannot remember how to sign her name without assistance. When she is done with her painting, she needs help finding her way to the bathroom down the hall and back to the art room, where several other people are creating their own works. “Are you Laura?” a woman asks, pointing to Baxter’s freshly signed painting. “It looks like you were sitting here.” Baxter smiles as she seems to recognize her own work, still glistening red with wet paint, and reclaims her spot at the table.

A woman with dementia displays her painting at Amber Grove Place in Chico, California. Caregivers at the assisted living community notice residents benefit in many ways from the creative arts.Image courtesy of Lorrie Badour, Amber Grove Place.

Scenes like this one at Amber Grove Place, an assisted living community for people with Alzheimer’s disease and other dementias in Chico, California, are emerging from a growing appreciation that the creative arts can help people with dementia in myriad ways. Art improves mood, reduces depression and anxiety, deepens connections with other people. In some cases, art even boosts cognition, claim some caregivers and clinicians who work with people engaged in this form of therapy. The evidence is largely qualitative and anecdotal, but some small placebo-controlled studies hint that the effects—which are inherently difficult to measure—may be real

Figuring out whether art therapy interventions benefit people with dementia is important. It’s also a tall order, said Anjan Chatterjee of the University of Pennsylvania in Philadelphia. With the dearth of pharmacological treatments for the burgeoning population of people with dementia, it is high time to explore artistic engagement for the relief of neuropsychiatric symptoms, Chatterjee told Alzforum. While there are drugs in the pipeline, none are imminent or expected to be a cure (see Alzforum Therapeutics database). “We are forced to think about what else can be done,” he said. Having recently published the book “The Aesthetic Brain: How We Evolved to Desire Beauty and Enjoy Art,” Chatterjee thinks the time is ripe for more research in the area. “There is an increased interest in art and the brain,” he said. “The zeitgeist seems ready for this.”

Excitement about art as therapy grew after the 2009 documentary “I Remember Better When I Paint.” Directed by Eric Ellena and Berna Huebner, whose mother painted prolifically before dying of Alzheimer’s disease, the film showcases initiatives around the world to engage people with dementia in art, whether by doing art projects inside assisted living facilities, by bringing people to museums, or by immersing them in other creative experiences. The movie draws upon the expertise of clinicians, caregivers, and art therapists, all of whom have witnessed the power of art in reaching those with dementia.

Berna Huebner drew upon her mother’s experiences with art therapy for the documentary and the book “I Remember Better When I Paint.” Courtesy of the Hilgos Foundation.

Huebner’s mother, Hilda Gorenstein, was a professional painter, but put her brushes aside after being diagnosed with AD in her 80s. She moved into a nursing home at age 90, and there she became anxious, apathetic, and aggressive—sometimes to the point of needing to be restrained. One day, when Huebner asked her mother if she’d like to paint, Gorenstein responded enthusiastically, “Yes, I remember better when I paint!” In response, Huebner invited students from the School of the Art Institute of Chicago to help her mother regain her skill and zest for the craft. After months of visits from one dedicated student, Jenny Graf Sheppard, Gorenstein gradually came out of her shell and started to paint. With the help of Sheppard and other students, Gorenstein produced around 300 paintings in the final years of her life. Doctors, caregivers, and family members noticed that the art sessions calmed Gorenstein, increased her focus, and made her receptive to communication.

“She was regaining the quality of life that she lost when she entered the nursing home,” recalled Sheppard in the film. According to Sheppard, the nursing home staff had subscribed to the idea that the “lights were off” for Gorenstein, and that she was no longer capable of engaging meaningfully. Huebner described her mother’s resurgence as a breakthrough, and hopes to share the same experience with others. She founded the Hilgos Foundation, which awards scholarships to students at the School of the Art Institute of Chicago to involve people with dementia in the arts.

Buoyed by dedicated students, artist Hilda Gorenstein painted prolifically in the final years of her life before succumbing to Alzheimer’s. From “I Remember Better When I Paint,” courtesy of the Hilgos Foundation.

While Gorenstein’s comeback is but one anecdotal account, other caregivers and researchers claim to have witnessed similar transformations. Judy Holstein, who is featured in the film and previously directed art programs at the Council for the Jewish Elderly in Chicago, told Alzforum that art engagement leads to closer connection with others, better attention, and greater mental and physical well-being. People tend to focus deeply during creative activities, become more present, and forget about aches, pains, and other things that would otherwise cause agitation, Holstein said. She recalled one instance when a woman who used a walker left it behind to participate in a drama session. Art can serve as a healthy outlet for people to express their fears, she said. “When you engage in art, you know your sense of well-being and inner and outer health is improved, not just during it, but afterwards,” she said.

Others extol the benefits of bringing people to art, rather than bringing art to people. Sean Caulfield is the co-founder and creative director of ARTZ: Artists for Alzheimer’s. This Boston-based nonprofit, also featured in Huebner’s documentary, creates guided, interactive programs at museums, parks, theaters, and other stimulating environments where people with dementia and their caregivers can engage. ARTZ focuses on getting people with dementia out into the community. Last year its museum program, “Meet Me at the Museum,” drew 800 people from 48 different care facilities, Caulfield said. “Consciousness is being raised about the idea that ‘getting out’ is therapy for all of us, and when people are deprived of that, their condition can worsen,” he said.

Like Holstein, Caulfield speaks of improvements in mood and communication. By acknowledging nonverbal forms of communication among the participants, such as a smile or thoughtful glance at a painting, program leaders sometimes find that people who had stopped speaking will suddenly pipe up. “Once the person’s anxiety about speaking is removed, and they feel accepted, that person will then speak. It just comes right out,” Caulfield said. While these momentary breakthroughs may not happen directly because of the art, Caulfield said it works as a catalyst. “That’s what makes art the great equalizer. By removing some of the physical, environmental, and social barriers, we’re left with the person.”

Where is the Proof?

While firsthand accounts of the transformative power of art in dementia abound, controlled trials do not. Chatterjee, who believes that engagement in the arts benefits people with dementia, readily concedes that solid research is lacking. “People have intuition but what is the evidence?” he asked. Chatterjee and colleagues recently reviewed the literature  (see Chancellor et al., 2014), uncovering a dozen case studies and four randomized controlled trials. Together they point to neuropsychiatric benefits of art engagement for people with dementia, but most were methodologically weak, Chatterjee said. “The problems with the studies are typically that they are anecdotal, or lack proper control groups. Also, they haven’t looked at basic questions of how many sessions there should be, or whether the effects generalize beyond the sessions, ” he said.

One study led by Diane Waller of the University of London, U.K., compared cognitive and psychological changes in people with dementia who had weekly art therapy sessions to those in people who took up other recreational activities for 40 weeks (see Rusted et al., 2006). The people in the art group became mentally sharper, calmer, and more social compared to those in the recreational group. After the study, participants in the art therapy group became more depressed for a while. Conclusions were hard to draw, however, because only 21 of the 45 people enrolled in the trial completed it, and had been diagnosed with several different kinds of dementia to begin with.

Another study, led by Toru Mase at the National Center for Geriatrics and Gerontology in Obu, Aichi, Japan, enrolled 39 people with mild Alzheimer’s disease in a 12-week trial that compared the cognitive and psychological effects of weekly art therapy to those of sessions where participants tried to solve math problems. Quality of life reportedly improved modestly for those in the art therapy sessions (seeHattori et al., 2011).

Chatterjee said future studies should parse out which kinds of art therapy most benefit people with dementia. The ideal study would start with people in similar stages of the same disease, intervene several times per week over the course of months, and incorporate appropriate control therapies based on social activity. He also suggested tracking whether benefits to patients persist beyond the art sessions, and whether the mental health of caregivers improves. Such studies would be time-intensive and costly, he said. “Funding would have to come from the government, but there’s more of a push towards biologically oriented interventions,” he said.

Does Art Defy Dementia?

Many reports on art’s effects on people with dementia are case studies. Luis Fornazzari of the University of Toronto has published a handful over the past decade, documenting that artistic or musical ability is relatively preserved in people with dementia (see Fornazzari, 2005Fornazzari et al., 2006). Most recently he published a collection of sketches the sculptor Mary Hecht made as she struggled with severe vascular dementia in the last years of her life (see Fornazzari et al., 2013). While Hecht scored low on cognitive tests such as the mini-mental state exam and, oddly enough, the clock drawing test, she produced detailed drawings of other things from memory, such as one of a reclining Buddha, and one of a famous cellist she had seen years before. “She proved the point that art, regardless of progressive dementia, is more resistant to neurodegenerative pathologies,” Fornazzari claimed. He also noted that Hecht came alive whenever art came up in conversation. “She couldn’t recall my name or who I was, but everything in the realm of art was there and fresh and ready to be discovered,” he told Alzforum. “The art was preserved, but the mundane, day-to-day things were impaired.” Fornazzari claims to have witnessed a similar preservation with other artists and musicians with Alzheimer’s disease.

In some cases, particularly in people with frontotemporal dementia (FTD), new artistic abilities emerge as the disease progresses. Bruce Miller of the University of California, San Francisco, recalled a businessman who had never painted before entering a period of “artistic brilliance” (see Miller et al., 1996). Miller observed similar episodes in other FTD patients, including, most famously, the scientist Anne Adams, who painted renderings of musical compositions while sliding into progressive aphasia (Seeley et al., 2008; see also New Scientist story). Although most patients with dementia never become renowned artists, the observation that their artistic expression remains intact while other faculties deteriorate could indicate that art poses a unique avenue of expression for those with dementia, said Miller. “These observations have taught me that despite the degenerative process, there’s a human being inside. There are things that give dementia patients great pleasure, and they still have potential,” he said.

Other clinicians make similar observations treating a disease that, like Alzheimer’s, devastates some parts of the brain and leaves others relatively spared. “Although verbal memory is almost always affected early, the disease is different in everyone,” said Brad Hyman of Massachusetts General Hospital. “I frequently ask our families to try nonverbal communication and skills, and in some cases this can be art. One of my patients recently won a local art contest despite struggling with our ‘standardized’ tests. Others respond well to music. Not every patient benefits. Even so, I concur with the idea that even in advanced dementia there is a person alive inside, and am committed to finding ways to help get them out,” he said.

In 2007, Miller compared art by people with FTD or AD to that made by healthy controls using raters blinded to each person’s diagnosis. People with FTD tended to produce disorganized yet vivid art, whereas people with AD tended to paint with muted colors and produce slightly distorted images (seeRankin et al., 2007). Miller thinks these artistic differences reflect the parts of the brain respectively ravaged by the each disease. When the frontal lobes degenerate, as in FTD, executive function and language suffer but visual processing may get a boost. In contrast, because Alzheimer’s progresses to the back of the brain where visuospatial processing occurs, this disease could lead to less vibrant or distorted drawing, Miller said. Overall, he believes that when certain parts of the brain degenerate, others become more active. “There’s this constant back and forth of one circuit turning off and the other turning on,” he said. This would explain why a subset of people with FTD may suddenly experience intense visual perception and hence be drawn to producing art, he said.

Even so, Miller doubts that creating or enjoying art can improve cognitive function or slow neurodegeneration in dementia. “I don’t think it changes the course of the disease, but it’s symptomatic therapy,” he said. Not all patients enjoy producing art, he added, and the type of creative activity to which people gravitate—including dancing or music—varies from person to person.

Miller champions the biological focus at the nation’s funding agencies, because finding cures for dementia should be the ultimate goal, he said. In the meantime, other interventions are sorely needed. “People live a long time with these diseases, so these other therapies are also important and their study should be funded,” he said.

Other leading Alzheimer’s researchers agree that rigorous data on art therapy may be hard to get. “A key challenge with dietary or lifestyle interventions is reducing things to a prescription.  We can now do that with physical exercise (three 30-minute sessions per week of weight training or brisk walking), but factors such as mental and social engagement cannot yet be reduced to a randomized, controlled trial. As a result we do not have an evidence-based regimen we can prescribe. The same is true of art therapy,” said Sam Gandy of Mount Sinai School of Medicine in New York. “Still, art may improve quality of life for patients and caregivers, even if temporarily. Anything that brings respite and joy into their lives is worth a shot while we are chasing down the science.”

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Researchers reveal new cause of epilepsy

Researchers reveal new cause of epilepsy

epileptic-seizures

A team of researchers from Sanford-Burnham and SUNY Downstate Medical Center has found that deficiencies in hyaluronan, also known as hyaluronic acid or HA, can lead to spontaneous epileptic seizures. HA is a polysaccharide molecule widely distributed throughout connective, epithelial, and neural tissues, including the brain’s extracellular space (ECS). Their findings, published on April 30 in The Journal of Neuroscience, equip scientists with key information that may lead to new therapeutic approaches to epilepsy. The multicenter study used mice to provide the first evidence of a physiological role for HA in the maintenance of brain ECS volume. It also suggests a potential role in human epilepsy for HA and genes that are involved in hyaluraonan synthesis and degradation. While epilepsy is one of the most common neurological disorders—affecting approximately 1 percent of the population worldwide—it is one of the least understood. It is characterized by recurrent spontaneous seizures caused by the abnormal firing of neurons. Although epilepsy treatment is available and effective for about 70 percent of cases, a substantial number of patients could benefit from a new therapeutic approach. “Hyaluronan is widely known as a key structural component of cartilage and important for maintaining healthy cartilage. Curiously, it has been recognized that the adult brain also contains a lot of hyaluronan, but little is known about what hyaluronan does in the brain,” said Yu Yamaguchi, M.D., Ph.D., professor in our Human Genetics Program. “This is the first study that demonstrates the important role of this unique molecule for normal functioning of the brain, and that its deficiency may be a cause of epileptic disorders. A better understanding of how hyaluronan regulates brain function could lead to new treatment approaches for epilepsy,” Yamaguchi added. The extracellular matrix of the brain has a unique molecular composition. Earlier studies focused on the role of matrix molecules in cell adhesion and axon pathfinding during neural development. In recent years, increasing attention has been focused on the roles of these molecules in the regulation of physiological functions in the adult brain. In this study, the investigators examined the role of HA using mutant mice deficient in each of the three hyaluronan synthase genes (Has1, Has2, Has3). “We showed that Has-mutant mice develop spontaneous epileptic seizures, indicating that HA is functionally involved in the regulation of neuronal excitability. Our study revealed that deficiency of HA results in a reduction in the volume of the brain’s ECS, leading to spontaneous epileptiform activity in hippocampal CA1 pyramidal neurons,” said Sabina Hrabetova, M.D., Ph.D., associate professor in the Department of Cell Biology at SUNY. “We believe that this study not only addresses one of the longstanding questions concerning the in-vivo role of matrix molecules in the brain, but also has broad appeal to epilepsy research in general,” said Katherine Perkins, Ph.D., associate professor in the Department of Physiology and Pharmacology at SUNY. “More specifically, it should stimulate researchers in the epilepsy field because our study reveals a novel, non-synaptic mechanism of epileptogenesis. The fact that our research can lead to new anti-epileptic therapies based on the preservation of hyaluronan adds further significance for the broader biomedical community and the public,” the authors added.

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APRC Associate School of Neuroscience, Bangkok

APRC Associate School of Neuroscience, Bangkok

 

 

Dates: July 28 – August 1, 2013

School Web Site URL: http://www.tnsthai.com/

Organizer: Kanokwan Tilokskulchai

Purpose of the School : To provide basic knowledge of electroencephalography from basic research to clinical research and clinical application.

The Faculty of Medicine Siriraj Hospital, Mahidol University and the Thai Neuroscience Society, in cooperation with the International Brain Research Organization (IBRO), is pleased to announce the opening of the IBRO-APRC Associate School 2013 with financial support from the IBRO Asian/Pacific Regional Committee (IBRO-APRC). The Associate School will take place at the Faculty of Medicine Siriraj Hospital, Mahidol University and will consist of five days of intensive basic and advanced lectures with demonstrations, discussion by lecturers from Canada, the US, Japan and Thailand.

Deadline for applications: April 28, 2013 (Midnight GMT)

You must register to apply:  http://ibro.info/register/

Please log-in if you’ve already registered: http://abc.yt/z

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Epilepsy Masterclass

 

Epilepsy Masterclass (Download program_pdf file)

 

   14th June – Programme

   15th June – Programme

Registration closes on 7th June 2013.

www.agoralive.com/UCB/event8

    14th June – Programme

Session 1: Diagnosis and classification of epilepsy: challenges and unmet needs in the Asia Pacific region. Chair: Mark Cook, Australia

08:00-08:10 Chair’s welcome and introduction Mark Cook, Australia

08:10-09:00 Epilepsy syndromes classification: academic versus practical advantages.

Part 1: Classification

Eugen Trinka, Austria

09:00-09:50 Epilepsy syndromes classification: academic versus practical advantages.

Part 2: Differential diagnosis in epilepsy

Mohamed Armin, Australia

09:50–10:05 Q & A

10:10-10:30 Coffee break

Workshops: (delegates to attend A or B)

10:30-12:30 A. EEG course in Mandarin (Delegates from China) Xiao Rong Liu, China

B. EEG course in English (Delegates from India, Australia & Japan) Udaya Seneviratne, Australia

12:30-13:30 Lunch

Session 2: Treatment of epilepsy: the need for comprehensive care. Chair: Mark Cook

13:30-14:10 Antiepileptic treatments: when, how and for how long? Patrick Kwan, Australia

14:10-14:50 What are the alternatives when drugs don’t work? Mark Cook, Australia

14:50–15:50 Debate: Does mechanism of action really matter?

Chair: Udaya Seneviratne, Australia

Terry O’Brien, Australia & Patrick Kwan, Australia

15:50-16:05 Coffee break

16:05-16:45 Comprehensive care in epilepsy Yushi Inoue, Japan

16:45–17:00 Q & A

Workshops: (delegates to attend C, D or E)

17:00-18:30 C. Using AEDs in women with epilepsy Terry O’Brian, Australia

D. What to do when the first monotherapy fails? Yotin Chinvarun, Thailand

E. Acute management of seizures across the age divide Anna Berroya, the Philippines

 

15th June – Programme

Session 3: New horizons in epilepsy. Chair: Peter Bergin, New Zealand

8:00-08:10 Chair’s introduction to Day 2 Peter Bergin, New Zealand

8:10-08:40 EpiNet: Connecting to better help patients Peter Bergin, New Zealand

8:40-09:35 Immunology-mediated seizures Wendyl D’Souza, Australia

09:35-10:30 Non-convulsive status epilepticus Mohamed Armin, Australia

10:30-10:45 Coffee break

10:45–11:40 Research horizons in epilepsy Weiping Liao, China

11:40–11:55 Q & A

Workshops: (delegates to attend F, G or H)

12:00-13:30 F. Treating epilepsy: do doctors and patients have the same expectations? Candan Gürses, Turkey

G. SUDEP in epilepsy Eugen Trinka, Austria

H. Managing quality of life of patients with epilepsy Manjari Tripathi, India

13:30-14:30 Lunch

14:30-15:30 Debate: Is it worth retrying an AED which failed to control a patient previously?

Chair: Udaya Seneviratne, Australia

Wendyl D’Souza, Australia & Manjari Tripathi, India

15:30-15:40 Meeting close and departure

 

We kindly invite you to register to this Regional Epilepsy Masterclass. This will give you exclusive access to the live event and/or recorded webcast & presentation kit after the masterclass. Registration closes on 7th June 2013.

www.agoralive.com/UCB/event8

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Sleep: “Update in Sleep Disorder Breathing management”

Sleep_dreams_v11

 

 

 

 

 

“Update in Sleep Disorder Breathing management” (download)

18th March 2013 At Dr.Pongsak Viddayakorn Conference Room

(7th Floor, Rehabilitation Building) Bangkok Hospital Medical Center

Limited seating. Please Contact

ลงทะเบียนผ่าน Contact center Tel: 1719

11:30-12:30 LUNCH

12:30-12:45 Opening Remarks : Dr. Yotin Chinvarun M.D., PhD

12:45-13.30 “Sleep-Disordered Breathing and Acute Ischemic Stroke” Dr. Yotin Chinvarun M.D., PhD

13:30-14:15 Metabolic consequences of SDB

-Can we make the difference. Prof. McEvoy

14:15-14:45 Q & A, BREAK

14:45-15:30 How to diagnose & treat difference types of SDB Prof. McEvoy

15:30-16:30 WORKSHOP: Dr.Tripat Singh

-Scrolling & Demonstration.

-Titration, CPAP & ASV algorithms-Philips Respironics.

Professor Douglas McEvoy is a respiratory/sleep physician-scientist and NHMRC (National Health Medical Research

Council) Practitioner Fellow. His skills in respiratory and sleep physiology and clinical trials in Sleep Disorders

are internationally recognized.

Prof McEvoy’s key roles:

 Director of the Adelaide Institute for Sleep Health

 Board Member of the Sleep Health Foundation

 Executive Committee member of the Australasian Sleep Trials Network.

Prof McEvoy is Principal Investigator of the ongoing Sleep Apnea CardioVascular Endpoints (SAVE) Study- a large international

multi-centre, randomized controlled trial to determine whether CPAP treatment reduces the incidence of

stroke and othercardiovascular events.

Dr. Yotin Chinvarun M.D. Ph.D. is a senior Neurologist/Epileptologist/Sleep medicine at the Pramongkutklao

hospital and Bangkok hospital. He had been trained as epilepsy fellow at the Austin hospital, Melbourne University

(1995-1999) and achieved the Ph.D. (Neurology) degree from there. He had set up the sleep lab and the EMU at the

Pramongkutklao hospital and at the Bangkok hospital for 16 years. He is a pioneer of epilepsy surgery in Thailand and

has an experienced in sleep medicine

He is now working as:

President of the Sleep club, Neurological society of Thailand

Board committee of the Snoring society of Thailand, Epilepsy society of Thailand and Thailand

Neurological society of Thailand

Consultant Neurologist at the Pramongkutklao hospital and Bangkok hospital

 Director of Comprehensive Epilepsy and Sleep disorder Program at the Pramongkutklao hospital

and Bang kok hospital

 Associate director of PET center, Wattanosoth Hospital

Invited speaker.

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EEG Workshop 2013

PMK EEG WORKSHOP 2013

26-27 February 2013, Fi 5, Marusuwan Room, PMK hospital

 

PMK

EEG Teaching Course

Bangkok, Thailand

Day 1: 26th February 2013, Tuesday

Time

Topics

Speakers

08.00 –08.45          Registration
08.45 –09.00          Opening Addresses Yotin
09.00 –09.30

09.30 –10.30

         Technical 1 – The BasicBreakout Session 1 Yotin
10.30 –11.00          Coffee/Tea Break
11.00 –11.30

11.30 –12.30

         Normal EEG 1 – Awake and SleepBreakout

Session 2

Pasiri
12.30 –13.30          Lunch
13.30 –14.00

14.00 –15.00

         Technical 2 – Localization and Artifacts

Breakout Session 3

Suthida
15.00 – 15.30          Coffee/Tea Break
15.30 –16.00

16.00 –17.00

         Normal EEG 2 – Normal VariantsBreakout

Session 4

Montri
17.00 –17.10          Closing Remarks

 Proposed Teaching Faculty

 Dr. Montri Saengpattrachai M.D.

 Dr. Pasiri  Sithinamsuwan M.D.

 Dr. Suthida Yenjun   M.D.

 Dr. Yotin Chinvarun M.D. Ph.D.

 Day 2: 27th February 2013, Wednesday

Time

Topics

Speakers

09.00 –09.30

09.30 –10.30

      Non-Epileptiform PatternsBreakout Session 5 Pasiri
10.30 –11.00       Coffee/Tea Break
11.00 –11.30

11.30 –12.30

      “How to Read and How to Report an EEG?” Yotin
12.30 –13.30        Lunch
13.30 –14.00

14.00 –15.00

      Focal Epileptiform PatternsBreakout Session7 Montri
15.00 –15.30       Coffee/Tea Break
15.30 –16.00

16.00 –17.00

      Generalized Epileptiform PatternBreakout

Session 6

Suthida

 

 

 

 

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