Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 7th Global Experts Meeting on Neuropharmacology Milan, Italy.

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Day 3 :

  • Track 2:Neural Stem Cell | Track 3:Neuroethics | Track 12:Molecular Neuropharmacology | Track 13:Future Aspects of Neuropharmacology | Track 14:Case Study Reports
Speaker
Biography:

Dr. Shen Jiangang is Professor in School of Chinese Medicine, University of Hong Kong. He also serves as Associate Director (Research) and Chair of Department of Research Postgraduate Students Committee in the School. Dr. Shen’s major research interests focus on molecular regulations of oxidative stress and redox signaling in brain damage and brain repair in post-stroke and neurodegenerative diseases. He is also interested in the experimental and clinical studies on Chinese herbal medicine for cerebral and cardiovascular diseases. His studies have been supported by many prestigious research funds from Hong Kong, Mainland China and others. He has published more than 150 peer-reviewed papers in prestigious academic journals and 14 book chapters. He received many academic and research awards and appointed as honor professorship 15 universities from China and USA. He serves as the editorial board members for many international academic journals including Toxicology and Applied Pharmacology, Scientific Reports and others.

Abstract:

AIM: Tissue plasminogen activator (t-PA) is the only FDA approved drug for acute ischemic stroke, but its use is limited with the therapeutic time window within 4.5 hours and hemorrhagic transformation (HT). We aim to test the hypothesis that peroxynitrite (ONOO-), a representative of reactive nitrogen species, could be a critical therapeutic target for preventing delayed thrombolytic HT and improving outcome in ischemic stroke. We tested whether peroxynitrite decomposition catalyst (PDC) could prevent such complication. Furthermore, we investigated that baicalin, a natural antioxidant, could scavenge ONOO- and prevent HT in ischemic stroke animal model with delayed t-PA treatment.  

METHODS: Male Sprague-Dawley (SD) rats were subjected to middle cerebral artery occlusion (MCAO) with t-PA (10 mg/kg) or t-PA plus FeTMPyP (3 mg/kg, a representative PDC) or baicalin (10, 25, 50 mg/kg) at MCAO for 2 or 5 h and reperfusion for 22 or 19 h, respectively. HT was assessed with hemoglobin assay. Neurological deficit was evaluated with Modified Neurological Severity Score (mNSS). Peroxynitrite was examined by detecting 3-nitrotyrosine (3-NT) and our newly developed high selective ONOO- fluorescent probe. The expression and activity of MMP-9/MMP-2 were assessed by western blotting and gelatin zymography.

RESULTS: T-PA infusion at 2 h after cerebral ischemia did not induce HT but attenuated neurological deficit, whereas at 5 h significantly induced HT and worsened neurological outcome. Co-treatment of FeTMPyP revealed to prevent HT and improve neurological functions. Early t-PA infusion at 2 h inhibited iNOS activity, ONOO-production, MMP-9/MMP-2 expression and activity, whereas delayed t-PA infusion at 5 h up-regulated iNOS activity, increased 3-NT formation, and down-regulated MMP-9/MMP-2 expression and activity. Co-treatment of FeTMPyP revised those changes in the ischemic brain with delayed t-PA infusion 5 h. Meanwhile, Baicalin revealed strong ONOO--scavenging activity and protected the neuronal cells from ONOO--induced neurotoxicity, reduced infarct size and attenuated apoptotic cell death and HT.

CONCLUSION: Peroxynitrite could be a critical therapeutic target for preventing hemorrhagic transformation and improving neurological outcome in ischemic brains with delayed t-PA treatment.

Speaker
Biography:

Jan Ulfberg, MD, PhD, Sleep Disorders Center, Läkargruppen, Örebro, Sweden, has been dedicated to sleep research during recent thirty years, with a special interest in restless legs syndrome  ( RLS ), even named Willis Ekbom Disease ( WED ). The main focus of this research has been on the epidemiology and the pathophysiology of this disease.   

Abstract:

A highly researched area in order to find an etiology and treatment for restless legs syndrome ( RLS ) is the brain dopamine system. 
It is also claimed that hypoxia, due to decreased peripheral blood flow, might at least partially cause the characteristic unpleasant symptoms in RLS.
Selenium has a strong anti-oxidant action, and is an regulator of dopamine function as well. 
Case Presentation: Three female patients, aged 25-60, were all suffering from severe to very severe RLS since childhood. Severity was measured by using the International Restless Legs Scale (IRLS), a 10-item questionnaire. Their scores of the IRLS were between 25 and 38. All 3 patients started to take selenium yeast 100 micrograms daily. Six months later the patients presented at the clinic and were re-assessed. Their RLS symptoms were substantially reduced to “moderate”, represented by their IRLS scores of 10 to 18. All patients reported independently from each other that they did not experience any changes initially, but after 4 months of treatment, there was a steady reduction of their RLS-related symptoms. 
In the literature there is only one earlier report of selenium treatment in RLS. In a placebo-controlled trial, Rahimdel et al., showed RLS symptom-relieving benefits of selenium salt, taken orally, 50 or 200 micrograms per day.
It might be hypothesized that selenium may reduce the symptoms of RLS as  selenium may work on the function of the dopaminergic system. It is known that RLS-patients are under oxidative stress. Thus, given the fact, that selenium is a potent antioxidant, its mechanism of action could as well be related to its ability to neutralize the reactive intermediates. Another possible working mechanism could be through the positive effect selenium has on endothelial function. 
In order to explore the efficacy of selenium in RLS, future randomized clinical trials would be of great interest and value.
 

Speaker
Biography:

Mathew Nguyen, MD, MBA is board certified in Adult Psychiatry and Child/Adolescent Psychiatry. He recently retired from faculty at the University of Florida, where during his 15 years, he oversaw multiple divisions, including Child/Adolescent Psychiatry, Consultation/Liaison, Medical Psychology, and Eating Disorders. Dr. Nguyen currently runs an adult psychiatry inpatient unit at Meridian Behavioral Healthcare, Inc. in Gainesville, Florida. He continues to be involved in clinical research, lecturing, and publishing. He also recently graduated from the University of Florida with a Masters in Business Administration and plans to incorporate the MBA into improving patient care models.

Abstract:

Schizophrenia has a prevalence rate of 1% and is a complicated illness that often leads to periods of relapses. Up to a third of patients with schizophrenia are considered to be treatment-resistant. Despite the new and various antipsychotic medications that have recently come to market, the number of treatment-resistant cases continue to abound. This has led to a sub-population of patients with schizophrenia being treated with more than one antipsychotic medication concurrently. Though it has become more common in clinical practice, there is sparse literature to objectively support the combination use of antipsychotic medications. There is also little literature addressing the use of a long-acting injectable (LAI) used in combination with another atypical antipsychotic. This case report serves to highlight the concurrent use of aripiprazole LAI used in combination with oral brexpiprazole in two patients with treatment-resistant schizophrenia. The receptor binding affinity of these two antipsychotics appear complementary and perhaps even protective for extra pyramidal symptoms (EPS). We hypothesize that the use of a LAI serves as a “foundational barrier” to mitigate the potential for full psychotic relapses should patients become noncompliant with their oral medications, and that the LAI also may help with oral medication compliance in this subpopulation of treatment-resistant schizophrenia patients by increasing baseline functionality.

Speaker
Biography:

Giuseppe Scalabrino studied at the School of Medicine of the University of Milan and received his M.D. degree magna cum laude in 1968. He has held a number of academic positions in the Faculty of Medicine of the University of Milan. He was Associate Professor of General Pathology between 1971 and 1985; full Professor of General Pathology from 1986 till 2014. He has been invited speaker in various conferences, mainly dealing with the role of polyamines in oncology and subsequently with the cobalamin (vitamin B12) neurotrophism. Among his numerous honors, he received the International Award "Roentgen" from Italian Accademia dei Lincei in Rome for oncological research in 1983. He is author of more than 100 scientific papers and reviewer of numerous International  Journals.  Dr. Scalabrino's studies of cobalamin neurotrophism have been mentioned and reviewed in 12 american textbooks of neurology, biochemistry, hematology, and vitaminology.

Abstract:

Our experimental and clinical studies have highlighted the non-coenzyme functions of cobalamin (Cbl, vitamin B12). Cytokine and growth factor (GF) imbalance in the central nervous system (CNS) of Cbl-deficient (Cbl-D) rats is a key point in the pathogenesis of Cbl-D neuropathy. The increased molecules are tumor necrosis factor(TNF)-a, nerve GF, and the soluble (s) CD40:sCD40Ligand dyad; the decreased molecules are epidermal GF (EGF) and interleukin-6. The in vivo administration of the lacking myelinotrophic molecules or agents antagonizing the excess myelintoxic agent is as effective as Cbl in repairing or preventing Cbl-deficiency-induced CNS myelin lesions. Cbl deficiency morphologically affects also glial cells, which normally synthesize and release various cytokines and GFs. Therefore, Cbl deficiency triggers the rearrangements of glia gene expression, eventually leading to a changed pattern of cytokine and GF production. Such an opposite imbalance in TNF-a and EGF similar to that observed in CNS of Cbl-D rats has been found in the sera of adult patients with pernicious anemia (but not in patients with iron-deficient anemia), and it was rectified by Cbl therapy. This imbalance has been found also in the cerebrospinal fluid (CSF) of adult patients with Cbl-D neuropathy. Given that TNF-a and EGF regulate the expression of normal prions (PrPcs) and PrPcs play a crucial role in myelin maintenance, we investigated whether CNS PrPc levels are indirectly regulated by Cbl. PrPc levels had increased by the time Cbl-D-induced myelin lesions appeared. This increase was mediated by excess TNF-a and prevented by EGF. Cbl deficiency greatly reduced CNS PrPc-mRNA levels, which were subsequently increased by Cbl and EGF. Similar increases in PrPc levels also occur in the serum and CSF of adult Cbl-D patients, and the serum increase has been corrected by Cbl therapy. Therefore, Cbl may regulate the PrPc levels in the serum and CSF in humans.          

Figure 1: Cbl as a fulcrum between physiologically myelinotrophic (green) and potential myelinodamaging agents (red) in rat CNS. This is highlighted by the Cbl-mediated stimulation of EGF, the Cbl- and EGF-mediated stimulation of PrPc synthesis (green arrows), and the reduction of TNF-a and NGF levels (red arrows), eventually leading to a low NF-kB level                                                                        

Speaker
Biography:

Professor Gafarov Valery, in 1974 - MD (Novosibirsk medical university). 1980 - Phd, theme " Epidemiological studying Acute Myocardial Infarction in conditions of large industrial centre of Western Siberia". 1991 - MPH; 2003 - professor on a specialty "cardiology"; 2003 - present time – head of collaborative laboratory of epidemiology cardiovascular diseases and Laboratory of psychological, sociological aspects of therapeutic diseases of Research Institute of Internal and Preventive Medicine. The author of 758 scientific publications (articles and abstracts), from them 6 monographs

Abstract:

Objective: to study the prevalence and association of rs2412646 gene CLOCK with some components of the socio-psychological characteristics and sleep disorders in the male population 25-44 years in Russia / Siberia (Novosibirsk).

Materials and methods. In 2014-2016 GG It surveyed a random representative sample of the male population 25-44 years, one of the districts of Novosibirsk. Randomly selected 200 men had a mean age of 35.5 years, who underwent psychosocial testing. Testing conducted by questionnaire "4-item Jenkins Sleep Questionnaire». Test anxiety and depression conducted modified questionnaires of the Welsh Depression subscale of the MMPI and Bendig Anxiety subscale of the MMPI, the study of the life of exhaustion conducted questionnaires The Maastricht Questionnaire (MQ). Questionnaire "Awareness and attitude towards their health" was also proposed. The men included in the study, studied the frequency distribution of genotypes of rs2412646 CLOCK gene. Differences in the distribution of genotype frequencies CLOCK gene were evaluated by Chi square (X2) test between groups. The values of p ≤ 0,05 were considered statistically significant.

Results. It was found that the most common genotype in the population was the C / C gene CLOCK -50,3%, C / T met at 42.5% and genotype T / T all at 7.2%. Most of the men were of the opinion, that would be addressed to the doctor only when severe pain or discomfort in the heart, but would not return if the pain or discomfort would be poorly expressed, however, 10.7% of men, the carriers of the genotype C / T, I would not go to a doctor, even when a severe pain or unpleasant sensations in the heart. It is also more likely to have continued to work carriers of genotype C / T - 47,4%. Among the carriers C / T genotype often sounded that their sleep is "satisfactory" or "poor." Media C / T genotype, compared with carriers of other genotypes, most agreed with the statement that oppresses them in a bad mood, and they are much less careful and attentive to detail.

Conclusion: Our results indicate a correlation between the presence of social and psychological factors, and sleep disorders, and polymorphic markers rs2412646 CLOCK gene.

Speaker
Biography:

Kan-Yuan Cheng has his expertise in improving the functional outcomes for schizophrenia patients with severe to moderate disability. The therapeutic community, Yuli model in Taiwan which he and his colleagues established can support these persons to reintegrate into local community. His background in public health field can help us to understand about the most important outcome of health care reform. This approach is responsive to all stakeholders. 

Abstract:

Statement of problem: Mortality among patients with schizophrenia under psychiatric care reform are seldom reported in the countries without deinstitutionalization. Over the past 20 years, Taipei Veterans General Hospital Yuli Branch in Taiwan has reformed long-stay care for psychiatric patients. In the pre-early period (1998–1999), a vocational rehabilitation program was established for psychiatric patients. In the early (2000-2006) and late periods (2007-2009), the independent living skills training and the program for social reintegration were instituted in the community facilities, respectively. This study aimed to evaluate mortality among the long-stay patients with schizophrenia during the three periods. Methodology & Theoretical Orientation: In all, 2457 patients with schizophrenia who had been hospitalized for at least one year initially were retrospectively followed from Jan. 01, 1998 to Dec. 31, 2008. Compared with the general population in Taiwan, we calculated the age- and sex-specific standardized mortality ratios (SMRs) of those patients by cause of death during the three periods. Findings: Most of the patients were male (81.3%). The mean±SD age of the patients was 57.83±16.95 years. The all-, natural- and unnatural-cause mortalities of the patients were nearly two times greater than those of the general population during the whole study period. Compared with those in the pre-early and early periods, all patients in the late period had the lowest mortality gaps. In the pre-early, early and late periods, the all-cause SMR were 5.40 (95% CI=4.27-6.81), 2.90 (95% CI=2.20-3.79) and 1.17 (95% CI=0.54-2.22), respectively for the 50–69-year-old male patients. Nearly half of all the patients who participated the whole comprehensive rehabilitation program belonged to this sex and age group (N=156, 46.6%). Conclusion & Significance: With the setting-up of community facilities for the complete rehabilitation program, the mortality gaps among the 50–69-year-old male patients apparently decreased using the Yuli model. 

Table Standardized mortality ratios of all causes of deaths among 2457 long-stay patients with schizophrenia by age-and-sex groups and the three periods of the reform of psychiatric care 

Maha Nada

Ain Shams University, Egypt

Title: New sole presentation for childhood epilepsy
Speaker
Biography:

Maha Ali Nada, I am a fourty one years old assistant professor of neurology in Ain Shams University which is one of the greatest univesitiesies in Cairo. Graduated in 1999. I' ve been practicing neurology since 2001 as resident , assistant lecturer, lecturer,  and assist prof since 2014. My MD thesis was namd: Clinicoradiological localisation of language disorders in acute ischemic CVS. I joined multiple sclerosis section in our department for 7years during which, I was responsible for day therapy care for all MS patients in our department. I used to attend all neurological conferences and to participate as speaker in some. 2 years ago, I became responsible for the pediatric neurology clinic in my department, which is a specialized afternoon clinic. Being the most senior in the clinic, it was my duty to teach younger staff and to encourage them to attend this new clinic which soon became the largest of the specialized clinics in our department regarding the number of patients attending(40 patients/clinic). Trying to register this large number of patients, we find many candidates for case reports and many ideas for new research. I 've also published a case report in the BMJ (British Medical Journal) on 12/2015 with a group of medical students and I was their mentor. Many puplications in the Egyptian Journal of Neurology, psychiatry and neurosurgery.One paper in the Journal of American Science in 2012

Abstract:

Among causes of secondary enuresis, epilepsy was none of those. It was observed in 15 children with secondary enuresis whom were urologically free, that their sleep EEG showed epileptic discharge without any other manifestations of epilepsy. After receiving antiepileptics, soon they became dry. There were common manifestations between those patients and they share some EEG similarities which we will try to explain aiming to shed the light on this possible new syndrome. This can guide future research for better management of such condition.

Speaker
Biography:

Saule T.Turuspekova MD, PhD, neurologist highest category, Professor of the Department of  neurology and Neurosurgery of KazNMU. 1995- PhD Thesis -"Vegetative-vascular disorders in cerebral manifestations of diabetes mellitus." 2010 - Doctoral thesis - "The influence of small doses of ionizing radiation on the nervous system". Over 130 scientific papers which were presented at international conferences in many countries. State scholarship for talented young scientists of the Ministry of Science of the Republic of Kazakhstan. Coordinator of the Russian Youth Academy of Sciences (Samara). 2015-the personal physician of the Kazakhstan astronaut Aydin Aimbetov. Medal "Success of the Year". Badge and certificate of "Pride of the University" for outstanding contribution to the development of healthcare and medical science of the Republic of Kazakhstan and strengthening the image of the university. Patent holder The patent for invention number 31607The method of treatment patients with ischemic stroke in the early recovery period. The patent for invention number 31742The method of treatment patients with spinal cord injury in early rehabilitation period. Member of the ESO, WSO, EAN.    

Abstract:

There is an opinion that an insufficient level of external magnetic effect in terms of the degree of harm to the body can fully compete with a deficiency of minerals and vitamins, a prolonged stay in a weakened magnetic field of the Earth has a depressing effect on the central nervous system.Recently, more and more attention of researchers has been attracted to the neurostimulating effect of pulsed magnetic fields, in particular transcranial magnetic stimulation.

Objective: To evaluate effectiveness of ion-reflex induction magnetophonophoresis session using Extract of Ginkgo biloba (Tanakan (EGb 761®))    in rehabilitation of patients with ischemic stroke in the early recovery period.

Materials and methods: 72 patients were supervised with ishemic stroke. The bioelectric activity of the cerebral cortex (EEG) was studied. There were use Mini Mental State Examination (MMSE), The Montreal Cognitive Assessment Scale (MoCA), and Barthel ADL Index. Quality of life was assessed by questionnaire Rivermead. Under observation were 3 groups:  1st- 49 patients who received an extra ion-reflex induction magnetophonophoresis  sessions using Extract of Ginkgo biloba (Tanakan (EGb 761®)) by applying head’s frontooccipital longitudinal galvanization techniques were conducted; 2rd- 23 patients treated with protocol formed without sessions, 3rd -25 healthy volunteers aged 21 to 70 years.

Results: sessions of ion-reflex induction magnetophonophoresis using Extract of Ginkgo biloba (Tanakan (EGb 761®))  longitudinal methods fronto-occipital head galvanizing can achieve more significant results. There was a significant positive dynamics of cognitive functions according to the MoCA test in the intervention group (from 20,0 ± 2,3 to 26,8 ± 2,3 points) compared with controls (20,2 ± 2,1 - 23,2 ± 2,1). The MMSE was not informative. Barthel index rose by 10 points, Rivermead -15, respectively, in the 2nd - without dynamic. The EEG noted a decrease in interhemispheric asymmetry of the α-rhythm in amplitude by 30-55% in 95% of patients, reducing the severity of slow-wave shifts by 30-40%. Expression and modulation of α-rhythm improved in 90% of cases. In dynamics, the slow wave activity decreased in 85% of patients.

Conclusions: The research’s indicators’ dynamics shows positive impact of ion-reflex induction magnetophonophoresis sessions using Extract of Ginkgo biloba (Tanakan (EGb 761®)) by applying head’s frontooccipital longitudinal galvanization techniques in rehabilitation of patients with ischemic stroke in the early recovery period.

Speaker
Biography:

Juan Camilo Urazan is a psychologist and a master's degree in clinical neuropsychology, your experience is in the area of neuropsychological assessment and rehabilitation. The University has been a teacher at various institutions in Colombia; has participated as a guest lecturer at universities in Colombia and countries such as Mexico, Brazil and Ecuador. In his experience of research has addressed issues related to dementia, acquired brain injury, tumors, among others; on the other parties is the author of research articles, reviews and case studies in indexed journals of national and international.

Abstract:

It is common in the clinical evaluation the confusion between profiles associated with the Alzheimer type dementia and frontotemporal dementia. The Frontotemporal Dementia refers to a neurodegenerative clinical-pathological condition that starts in the middle and late adulthood. In the FTD is prevalent behavioral changes and alterations in the language, despite the fact that there are alterations in memory, these are more variable and are generally associated with attentional problems, or a more advanced stage of the disease. The actual case is about a subcortical variant frontotemporal dementia in a 78 years old female patient of schooling bachelor's previous occupation and technical manager of warehouse, which is sent by the area of neurology to be valued by neuropsychology, with the purpose of establishing the cognitive profile. In the neuropsychological assessment was applied sub-tests of the WAIS III, Figure Complex of King, Wisconsin Card Sorting Test, Designation of Boston, Test of Verbal Fluency and the Trail Making Test. The results show that in the DFT is a more marked of the executive functions.  However, it is important to clarify that in the qualitative analysis of the implementation of the patient are alterations in the copy of complex designs, which may be associated with deficiencies in care and organizational strategies that rely on the frontal lobes. Memory tasks that emphasize strategies of evocation also may be influenced by changes in front, because these can influence and confuse the results obtained in the valuation of other areas or cognitive domains. This profile is consistent with other studies reported.

Speaker
Biography:

Hold a Doctorate degree in Public Health and Epidemiology, Master degree in Clinical Epidemiology (MSc), Master degree in Public Health (MPH), all from The Netherlands Universities.

·         Worked in Public Health since 1999 at different levels such as:

-          Academic (Erasmus university – Rotterdam / The Netherlands, Queen Marry University – London / UK), University of East Anglia UEA / Norwich.

-          International (United Nations).

-          National Health Authority (Qatar).

-          National Health Service (NHS), UK since Feb 2007.

-          others

·         Registered as Epidemiologist Grade A with The Netherlands Epidemiological Society.

·         Has numerous publications in the UK in mental illnesses, cancer, cardiovascular diseases, diabetes, Dementia, Autism, COPD, population health, road casualties and others.

·         Has broad experience with a wide variety of statistical software programs i.e. SPSS, STATA, excel, etc.

·         Broad experience of R&D.

·         Designing, conducting, analysing, and presenting quantitative and qualitative researches.

Abstract:

Background: Autism poses a particularly large public health challenge and an inspiring lifelong challenge for many families; it is a lifelong challenge of a different kind. Purpose:

Purpose: To understand what are the key challenges and  how to improve the lives of children who are affected with autism in Dubai.

Method: In order to carry out this assessment we have used two approaches:

  • Qualitative methodology (focus groups with mental health experts working at: Al Jalila hospital (AJH), Dubai Autism Centre (DAC), Dubai Rehabilitation Centre for Disabilities, Latifa hospital, Private Sector Healthcare (PSH).)
  • Quantitative methodology. Prevalence or incidence estimates based on international research. 

Key findings:

  • Autism is the most common of the Pervasive Developmental Disorders. Dubai Autism Center estimates it affects 1 in 146 births (0.68%). If we apply these estimates to the total number of births in Dubai for 2014, it is predicted there would be approximately 199 children (of which 58 were Nationals and 141 were Non–Nationals) suffering from autism at some stage.
  • Autism spectrum disorder (ASD) is a public health concern in Dubai. Families do not consult GPs for early diagnosis for a variety of reasons including cultural reasons.

Recommendations:

  • Training of GP’s to aid early diagnosis of Autism and increase awareness.
  • There is an urgent need for an adult autism center for when the children leave the safe environment of the school at 18 years.
  • There is a need for further studies to cover the needs of people with an Autism Spectrum Disorder (ASD).

Speaker
Biography:

Mansoureh Togha received MD from shiraz university of medical sciences(1998) and graduated in course of specialty in “Neurology” in 1993 from the Tehran University of Medical Sciences(TUMS). Since then,she has been working as professor of neurology at TUMS. She is most interested in headache and facial pain researches. She has many experience of research, evaluation, and teaching in this field both in university hospital and private clinic. Also she has been the supervisor and advisor of more than 50MD, PhD and MSc theses and of a large volume of research works in collaboration with various research centers. Her main topic of research includes evaluating mechanisms involved in migraine development and progression, examining new treatment strategies and assessing the rate of comorbid disorders aimed at alleviating different types of headaches specially migraine. She has co-authored over50 international peer-reviewed publications and presented about100 papers and lectures at national or international scientific conferences. 

Abstract:

Statement of the Problem: Characterization of headaches and delineating possible relationships with Multiple Slerorosis(MS)-related determinants can ultimately circumvent headaches. Thus, in this study, we attempted to assess the prevalence of headaches during relapses and remissions of relapsing-remitting MS(RRMS)patients and denote the possible interrelations between headaches and types of MS exacerbations.Methodology & Theoretical Orientation: In a prospective case-control study, 65 RRMS patients and 65 healthy controls were recruited and asked about characteristics and co-symptoms of headaches they experienced in the preceding week and usage of disease modifying drugs and types of MS attacks were also inquired. The same questions were asked from the same patients 3 months later in a follow-up visit. Findings:A total of 57patients and 57controls were included in the final analyses. In total,26(45.6%) patients in relapse, 18(27.7%) controls, and 22(38.6%) patients in remission reported headaches and only significant difference existed between relapse patients and controls(P = 0.036). The headache prevalence was higher in patients in relapse phase having MS<3years compared to relapse patients with>3years of MS (68vs. 28.1%;P = 0.004). Other variables of interest did not differ among the three groups. Conclusion &Significance:The suggested explanation for migraine-MS interrelationship is that migraine, especially migraine with aura, switches on particular matrix metalloproteinases that in turn destruct the blood-brain barrier and render myelin autoantigens vulnerable to autoreactive T-cells present in the bloodstream and this process can ultimately culminate in MS. Furthermore, migraine episodes and MS attacks apparently share common cytokine profiles. According to our study at the earlier stages of MS, headaches were more common during attacks which may be due to active immune process in that stage. Common genetic and environmental determinants present in MS, and headaches are also on the agenda of headache-MS association. In summary, The RRMS patients in relapse phase suffer from headaches more than healthy people do.

Figure 1. Features of headache attacks during relapse and remission phases among patients with relapsing-remitting multiple sclerosis, (A) Types of headache, (B) severity of headache, (C) quality of headache, (D) location of headache