Event details: Monday 23 September (18.30-20.00), Hall B
Please visit www.eisaiepilepsysymposia.eu to fill in a short questionnaire which covers your personal experience in epilepsy management and also some of the issues that will be discussed during the session, you can also post questions to the faculty. Post-event, this site will host footage of the symposium.
The Eisai-sponsored symposium at the XXI World Congress of Neurology in September, entitled ‘Under the Spotlight: Epilepsy management – are we on the right track?’, will take an innovative approach to highlight the key issues in epilepsy management today.
Hosted by television health correspondent, Sue Saville, and involving an interactive panel discussion of international epilepsy experts, the symposium will address current ‘hot topics’ in the treatment and management of epilepsy.
Professor Michel Baulac (Hôpital Pitié-Salpêtrière, Paris, France) will focus on the issues involved in the management of individuals with newly diagnosed epilepsy, such as the importance of correctly diagnosing the patient’s seizure type and getting the initial treatment correct in order to ensure long-term positive outcomes, highlighting important considerations when selecting and initiating the most appropriate antiepileptic drug (AED) for monotherapy.
Professor Elinor Ben-Menachem (Sahlgrenska University Hospital, Gothenburg, Sweden) will then cover key challenges involved in the decision-making process for patients who are refractory to monotherapy and require adjunctive treatment with other AEDs, including the crucial importance of individualising treatment for each patient’s particular needs.
Dr Manny Bagary (University Hospital Birmingham NHS Trust, UK) will further expand on the need for a patient-focussed approach to epilepsy management that looks beyond just controlling seizures and addresses the overall quality of life of the patient, including the identification and management of side effects and comorbidities, such as depression and anxiety.
Professor Eugen Trinka (Paracelsus Medical University, Salzburg, Austria) will then discuss the direction of epilepsy management in the future, including the need for AEDs with unique mechanisms of action and other important issues that are likely to impact the daily clinical practice of delegates.
Covering the spectrum of epilepsy management, the interactive session promises to be stimulating, though provoking and informative for delegates, providing practical advice which they can take home and apply to their current daily practices.
Conference details: Alzheimer’s Research UK conference, Belfast, N.Ireland Report by: Alzheimer’s Research UK
March 2013 saw over 200 dementia researchers from across the UK (and beyond) gather in Belfast for the 14th annual Alzheimer’s Research UK conference. The conference is the UK’s largest annual meeting on dementia research, and each year is hosted by one of the 15 Alzheimer’s Research UK Network Centres of excellence across the country. This year marked the first completion of the cycle, with the conference hosted by the Northern Ireland Network, organised by Professor Christian Hölscher, from the University of Ulster in Coleraine.
The two-day event consisted of 4 sessions of short talks, a keynote lecture from Professor Mathias Jucker (from the University of Tübingen, Germany), a panel discussion on immunotherapy to treat Alzheimer’s disease, a poster session, and a moving and motivating address from the actor and Chancellor of the University of Ulster, James Nesbitt. In his speech Nesbitt called for more dementia research funding, “or else face a dementia catastrophe” and urged the government to commit to long term funding for research into dementia.
The short talks given at the conference covered a wide range of topics, from insulin signalling in Alzheimer’s disease to neuroimaging studies demonstrating the effect of genetic risks for Alzheimer’s on brain structure as well as studies on amyloid-beta oligomer formation, and the effects of amyloid-beta on synapse loss. Dr Oleg Anichtchik from the University of Cambridge presented a new mouse model for Dementia with Lewy bodies. The mice express a truncated form of human α-synuclein at levels lower than endogenous α-synuclein, and present abnormal aggregation of α-synuclein and memory deficits at 3 months of age. Professor Anne Stephenson, from University College London, demonstrated a potential function for the Alzheimer’s amyloid precursor protein. She showed data supporting a role for amyloid precursor protein in trafficking, showing it can control the sub-cellular location and the surface expression of neurotransmitter receptors with a role in learning and memory. A particular highlight was data presented by Professor Kevin Morgan, demonstrating the reliability of a panel of plasma and CSF biomarkers for predicting AD diagnosis, for which they have developed a high throughput surface plasmon resonance detection system.
The keynote lecture “Prion-like aspects of cerebral amyloidosis” was given by Professor Mathias Jucker, from the University of Tübingen, Germany. Professor Jucker discussed the evidence that exogenous injection of the amyloid-beta-containing brain extracts can induce amyloid pathology in a previously unaffected brain, akin to the infection spread of prion disease.
The first day concluded with an expert panel discussion on immunotherapy as a treatment for Alzheimer’s disease. Dr Eric Karran, the Director of Research at Alzheimer’s Research UK, succinctly summarized several years of research and what have been several disappointing clinical trials for both bapineuzumab and solanezumab. The panel, Professor Clive Holmes, Professor James Nicoll, Professor Hugh Perry (all from The University of Southampton) and Professor Mathias Jucker, chaired by Dr Pat Kehoe (The University of Bristol), then took questions and suggestions from the delegates. The resulting discussion addressed important issues such as why these drugs may have failed and identified potential hurdles that need to be overcome in order to develop a successful therapy. This was a very interesting session for all involved, and provided a forum in which, regardless of job title, everyone could discuss and contribute to the advance of a promising area of research. This was followed by a banquet dinner including live traditional Irish entertainment from the folk bands Sons Of Caliber and Emerald Armada.
The conference concluded with the awarding of the poster prize, which went to Claire McDonald from Trinity College Dublin, and the Jean Corsan Prize and talk. The Jean Corsan Prize is awarded to the best published paper by a PhD student, and this year went to Dr Daniel Davis from the University of Cambridge. His work showed that delirium (confusion and disruption in thinking) is a strong risk factor for dementia and cognitive decline, which was not associated with “traditional” markers for dementia such as Braak stage, amyloid or α-synuclein.
Following the main conference a PhD day was held at the University of Ulster. The event, exclusive to PhD students, allowed them to present their projects, and also included career advice in a session entitled “Life after the PhD”.
An acquired brain injury (ABI) is defined as a non-degenerative injury to the brain which has occurred after birth and includes traumatic brain injuries (TBIs), i.e. those caused by road traffic accidents, falls and assaults, and non-TBIs i.e. those caused by strokes and other vascular accidents, tumours and also infectious diseases. Approximately one million people live with the effects of an ABI in the United Kingdom (UK) and require specialist rehabilitation services and support both in hospital and the community.
There is very little accurate and reliable data on the provision of healthcare services for people with ABI in the UK. The National Institute for Clinical Excellence (NICE) estimates that the acute hospital care costs for TBI are £1 billion annually (this does not include all types of ABI) and Gustavsson et al (2011) stated that the overall cost of TBI in the UK (and again an underestimate for ABI) was approximately £4.1 billion.
In 2001, The Health Select Committee published their Third Report into Head Injury (Health Committee 2000-1) with a list of 28 conclusions and recommendations; most have not been acted upon. Although the National Service Framework for Long Term Neurological Conditions has been in place since 2005, very little progress has been made and rehabilitation services continue to vary hugely around the UK.
In July this year, the UK Acquired Brain Injury Forum (UKABIF) a membership organisation and charity that aims to promote better understanding of all aspects of ABI, launches a Campaign ‘Life after Brain Injury? Improve Services Now’ to improve rehabilitation services and support for people with ABI. UKABIF’s Manifesto ‘Life after Brain Injury – A Way Forward’ outlines the necessity of acute and early access to rehabilitation for adults with ABI to ensure optimal recovery, focusing on the need for specialist neurorehabilitation teams to manage care pathways and the cost implications of not providing adequate rehabilitation. Published studies clearly show that by providing rehabilitation, the savings made offset the costs, even when rehabilitation is not carried out immediately after injury. Over a lifetime, optimal recovery results in significant savings to health care costs.
Acute and early access to rehabilitation services
Rehabilitation after an ABI should start acutely to prevent complications, with the patient’s care pathway clearly defined, and referral to a local specialist neurorehabilitation service at the earliest opportunity; this is crucial and often overlooked. Patients who have an early referral programme in the acute stages of recovery have significantly better social integration, emotional well-being and vocational functioning (Reid-Arndt et al 2007). Turner-Stokes (2008) demonstrated the effectiveness of early intensive rehabilitation with specialist programmes for those with complex needs, and specialist vocational programmes for those with potential to return to work. Residential, social and behavioural rehabilitation programmes can all decrease the number of care hours needed, which also increases the brain injured person’s capacity for independent social activity (Wood et al 1999). In a study up to two years post-injury, patients showed a 54% reduction in the care hours required compared to pre-admission; patients between two and five years post-injury showed a 33% reduction, and patients over five years post-injury showed a 21% reduction (Wood et al 1999).
Managing the Rehabilitation Programme
If someone has been assessed as needing rehabilitation they should be referred to a ‘post-acute’ rehabilitation centre. However, in many parts of the UK there is no suitable rehabilitation facility and people with brain injuries may have to go home too early or go to inappropriate places, such as nursing homes, where insufficient rehabilitation is provided. The independent sector provides much of the high quality brain injury rehabilitation available in the UK and a number of organisations offer specialist facilities and provide services to meet the needs of a range of people with ABI including the most difficult cases.
Following a specialist rehabilitation programme, ABI patients show a significant reduction in dependency at discharge, as measured by the Functional Independence Measure (Turner-Stokes et al 2006). More intensive rehabilitation is associated with rapid functional gains once the patient is able to engage (Turner-Stokes et al 2011).
A multidisciplinary team (MDT) is required with an expertise in neurorehabilitation, comprising a core medical team and additional professionals depending on the nature of the brain injury; integrated services and an MDT rehabilitation programme promote brain recovery and enable people to recover more quickly and efficiently (Turner-Stokes et al 2011). The team should be led by Allied Health Professional specialists e.g. a physiotherapist with access to a Consultant in Neurorehabilitation over a timescale that is determined by the patients’ progress and gains.
What is the Way Forward?
UKABIF is asking for the following:
Appropriate commissioning for specialist brain injury rehabilitation should be made compulsory and each clinical commissioning group should have a named neurological lead.
Funded National Neuro Networks should be established to ensure neurological pathways are available throughout the stages of recovery (patient journey).
A National Audit of Rehabilitation should be carried out and the collection and reporting of accurate data on newly ABIs made compulsory by all providers along the patient journey, from Acute to Community services*
A review is required of The Health Select Committee Report and the National Service Framework (NSF) for Long Term Neurological Conditions.
As implemented with Stroke though Healthcare Emergency Planning and the Care Quality Commission
We need your help
To support our Campaign, please ensure that your team has a named neurological lead and if not, request one and review the information and support available for people with an ABI in your area. The full document is available to view on our website http://www.ukabif.org.uk. For further information on how to support this campaign, please contact:
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