Full Programme

Full programme

( updated as per 7 May 2019 )



Wednesday, June 5

07.30-09.00

Educational courses
EC01 | Single-Fiber EMG (Part 1)
EC02 | EEG processing and analysis
EC03 | Conventional neurophysiology options for the study of small fibers
ECL1 | Hands-on Teaching Course on Nerve and Muscle Excitability Studies, including MScan MUNE (Part 1)
ECL2 | Implementing Neuromuscular Ultrasound in clinical neurophysiologic everyday practice (Part 1)

09.00-09.30

Break

09.30-11.30

Educational courses
EC01 | Single-Fiber EMG (Part 2)
EC05 | Challenges of EEG Interpretation in Critically-ill Patients: Case-based Course
ECL1 | Hands-on Teaching Course on Nerve and Muscle Excitability Studies, including MScan MUNE (Part 2)
ECL2 | Implementing Neuromuscular Ultrasound in clinical neurophysiologic everyday practice (Part 2)

10.00-11.30

Oral session 1

Section of assistants/technicians 1
How to perform NCS correctly?
Marta Banach ( Poland ) and Magdalena Koszewicz ( Poland )

11.30-12.30

Lunch break

12.30-14.00

Symposium 4
Evoked potentials and their clinical implications in CNS diseases
Organiser-Chair: Anna Pokryszko-Dragan

Evoked potentials as a monitoring tool in CNS diseases.
Beata Zakrzewska-Pniewska and Monika Nojszewska
P300 potential in the assessment of cognitive performance in CNS diseases.
Anna Pokryszko-Dragan

The first presentation concerns evoked potentials (EP) as a monitoring tool in CNS diseases. EP reveal normal or altered conduction in selected tracts of the central nervous system in a quantifiable way. Since alteration of signal conduction is the main mechanism of symptoms and signs in many CNS disorders, especially in multiple sclerosis (MS), multimodal EP may serve as a representative measure of the functional impairment in such diseases. Moreover, EP have been shown to be predictive for diseases course, and thus might help to select patient groups at high risk of progression for clinical trials. EP can detect deterioration, as well as improvement of impulse propagation, independently from the mechanism causing the change. Therefore, they might be candidates for biomarkers in many CNS disorders. In the second presentation the role of event-related potentials  will be  highlighted in the assessment of cognitive performance, with a special regard to P300 component. The examples will be shown of  P300 evaluation , complementary to neuropsychological tests, in the patients with primary CNS disorders as well as with CNS involvement in the course of systemic diseases. The pros and cons of the method and its potential future applications will be discussed.

Symposium 2
Brainstem SIG Symposium – State of the art in intraoperative monitoring of the brainstem
Organiser-Chair: Satu Jääskeläinen

Monitoring trigeminal, facial, and acoustic nerves during posterior fossa surgery.
Gemma Pérez-Fajardo ( Barcelona, Spain ) 
Monitoring and predicting efficacy of hemifacial spasm surgery
Pepijn van den Munckhof ( Amsterdam, Netherlands )
Novel techniques for intraoperative monitoring of the lower brainstem
Vedran Deletis ( Split, Croatia )

This first Brainstem SIG symposium gathers novel and standard neurophysiologic techniques available for intraoperative monitoring of the brainstem and most of the cranial nerves during different types of intracranial neurosurgery. It covers less often used methods for monitoring hemifacial spasm surgery, in addition to commonly used ENMG and evoked potential techniques for posterior fossa surgery as well as novel and innovative methods utilizing e.g. laryngeal ENMG and reflex recordings techniques to prevent nerve damage at the lower brainstem level in the operating room.

Educational courses
ECL1 | Hands-on Teaching Course on Nerve and Muscle Excitability Studies, including MScan MUNE (Part 3)
ECL2 | Implementing Neuromuscular Ultrasound in clinical neurophysiologic everyday practice (Part 3)

Section of assistants/technicians 2
Clinical and technical aspects of evoked potentials.

Justyna Pigonska ( Poland ) and Jolanta Galecka ( Poland )

14.00-16.00

Educational courses
EC07 | From interictal and ictal EEG to syndrome diagnosis and etiology
EC08 | Mastering semi-quantitative motor unit potential analysis skills

14.00-14.30

Break

14.30-16.00

Symposium 1
Neurodegenerative Dementing Disorders, Brain Over-excitation, and EEG
Signatures: Preclinical and Clinical Evidence
Organiser-Chair: Claudio Babiloni ( Sapienza University of Rome, Italy )

Characterization of epileptic spiking associated with brain amyloidosis in APP/PS1 mice as new readouts in preclinical treatment trials.
Heikki Tanila ( University of Eastern Finland, Kuopio, Finland )
Effects of Ab42 in the brain and abnormal cortical excitability as revealed by cortical EEG biomarkers in patients with preclinical and prodromal Alzheimer’s disease.
Claudio Del Percio ( Sapienza University of Rome, Italy )
Effects of dopamine depletion in the brain and abnormal cortical excitability as revealed by cortical EEG biomarkers in patients with Lewy Body diseases.
Laura Bonanni, ( University of Chieti-Pescara “G. D’Annunzio”, Italy )

Background: 1) Temporal lobe Epilepsy and Alzheimer’s disease (AD) show similarities of high clinical interest. In AD patients, the incidence of convulsive seizures is 10 times higher than healthy controls and 87 times more frequent with “early-onset” disease manifestation; 2) cognitive decline starts 5.5 years earlier in AD patients with epilepsy than AD controls; and 3) hippocampus hyperactivity is a risk factor for mild cognitive impairment (MCI) and rationalized an antiepileptic preventive treatment trial in MCI using Levetiracetam (NCT01044758). Aims: show new evidence about the prevalence of EEG signatures of over-excitation of cerebral cortex and abnormal functional connectivity networks in AD and Lewy body diseases.

Symposium 3
Spontaneous and stimulation dependent markers of the effectiveness of Anterior Nucleus of Thalamus-DBS treatment
Organiser-Chair: Daniel Fabo ( NICN, Budapest, Hungary )

Epileptiform activities in the Anterior Nucleus of Thalamus (ANT).
Daniel Fabo ( NICN, Budapest, Hungary )
Detailed analysis and high frequency activities of the Anterior Nucleus of Thalamus (ANT).
Ivan Rektor ( CEITEC, Brno, Czech Republic )
Stimulation biomarkers for Anterior Nucleus of Thalamus-DBS.
Emilia Toth ( UAB, Birmingham, AL, USA )

Anterior Nucleus of Thalamus (ANT) DBS treatment is an emerging invasive neurostimulation option for drug resistant epilepsy. The efficacy is variable and the identification of the responsive patient group is highly needed based on the invasive nature and high costs of the intervention. In this symposium we review the available data for invasive and non-invasive markers for DBS efficacy, and present our own results based on invasive recordings from the human Anterior Nucleus of Thalamus (ANT).

Educational courses
ECL1 | Hands-on Teaching Course on Nerve and Muscle Excitability Studies, including MScan MUNE (Part 4)
ECL2 | Implementing Neuromuscular Ultrasound in clinical neurophysiologic everyday practice (Part 4)

16.00-16.30

Coffee-break

16.30-18.00

Plenary lectures 1 and 2
Modern EEG diagnostics
Margitt Seeck ( Switzerland )
Brain-state-dependent stimulation: a new era of therapeutic clinical neurophysiology.
Ulf Ziemann ( Germany )

18.00-19.00

Opening ceremony

19.00

Welcome reception  

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Thursday, June 6

07.30-09.00

Educational courses
EC09 | Needle EMG testing: how to solve problems when interpretation becomes difficult…
EC10 | How and when to test the autonomic nervous system?
EC14 | Seizure types: An interactive video-EEG session

08.00-09.00

Section of assistants/technicians 3
cEEG in the neuro-intensive care unit.

Martin Ejler Fabricius ( Denmark )
Home video and ambulatory EEG in a district hospital setting.
Jonathan Cole ( United Kingdom )

Oral session 2 and 3

09.00-10.30

Plenary lectures 3 and 4
Nerve excitability testing: from threshold electrotonus to CMAP scans.
Hugh Bostock ( United Kingdom )
Early diagnosis of ALS: can we improve on the Awaji criteria?
David Burke ( Australia )

10.30-11.00

Coffee-break

11.00-12.30

Symposium 5
The Construction of Pain
Organiser-Chair: Luis Garcia-Larrea

The Symposium will discuss how the aversive experience we call “pain” emerges from the coordinated activation of multiple brain areas.

Luis Garcia-Larrea will describe the so-called “pain matrix” as a fluid system of several interacting networks. Initial processing in a ‘nociceptive matrix’ receiving ascending input leads to activation of second-order structures supporting ‘salience’  attributes , passage  from  pre-conscious  nociception  to  conscious  pain, and encoding in memory systems.
Hélène Bastuji will discuss data from intracortical EEG, illustrating  that nociceptive processing is initiated in parallel in sensory and limbic areas, to converge in the anterior insula in less than one second, and underscoring the role of this region in integrating limbic with sensory input to initiate a perceptual decision on the stimulus ‘painfulness’.
Markus Ploner will discuss approaches to cortical nociceptive processing via the study of brain oscillations. Conscious pain depends on integration of brain activity across different areas, and functional connectivity between sensory and high-level networks should determinant for access to consciousness. Interactions between neural oscillations, together with the implementation of graph theory methods are likely solutions to gain access to local and global levels of processing, thus allowing the study of normal and abnormal pain with non-invasive measures.

Symposium 6
Diagnosing amyotrophic lateral sclerosis
Organiser-Chair: Birger Johnsen

Diagnostic criteria in ALS, a review.
Birger Johnsen
Application of diagnostic criteria in individual cases: practical problems.
Mamede De Carvalho
New techniques to support the diagnosis of ALS.
Hatice Tankisi

The diagnosis of amyotrophic lateral sclerosis (ALS) is clinical and relies on the presence of progressing disease with both upper motor neuron (UMN) and lower motor neuron (LMN) involvement, and the exclusion of other diseases. The «revised El Escorial criteria» (rEEC) has proposed an electrophysiological algorithm for supporting diagnosis, which was refined in the recent «Awaji criteria» (AC) with the intention of facilitate earlier diagnosis. The criteria have a high specificity, lack sensitivity although most studies show a higher sensitivity of the AC than the rEEC, and have a rather large inter-rater variation when used by untrained physicians indicating that their use may require training. Development of a reliable objective method for detection of UMN involvement is the most critical item for improvement of diagnostic sensitivity. This symposium will review current criteria, encompass their potentialities and limitations including their correct application and incorporation with clinical findings, and finally review promising new techniques for diagnosing and monitoring of ALS as transcranial magnetic stimulation, the novel motor unit number estimation (MUNE) method, MScanFit MUNE, ultrasound and neuroimaging. The session will be interactive with the presentation of a number of clinical vignettes regarding diagnostic categorization, underlying difficulties, and strategies to overcome practical problems.

Symposium 7
Advanced Technologies in Clinical Neurophysiology
Organiser-Chair: A. Suppa ( Sapienza University of Rome, Italy )

Wearable sensors in Parkinson’s disease.
A. Suppa ( Sapienza University of Rome, Italy )
Adaptive and closed-loop DBS in Parkinson’s disease.
R. Eleopra ( Foundation of the Carlo Besta Neurological Institute, Milan, Italy )
A wearable robotic sixth finger for grasping recovery in hand paresis.
S. Rossi ( University of Siena, Italy )

Symposium description: Dr Antonio Suppa will introduce and discuss the more advanced wireless technologies currently available for objective long-term monitoring of motor symptoms in PD. Dr Roberto Eleopra will discuss the more advanced technologies for possible closed-loop or adaptive DBS  strategies in patients with PD. Dr Simone Rossi will discuss the emerging technologies for robotic-assisted neurorehabilitation in order to promote motor recovery in patients with stroke.

Tips for trainees 2
Jitter analysis with concentric needle electrode
, by Erik STÅLBERG ( Sweden )
When and how to test NM junction
, by Yann PEREON ( France )
Diagnosis and treatment of Lambert-Eaton Myasthenia, by Donald SANDERS (USA)

Educational course
EC11 | EMG approach to acute and chronic polyneuropathy (Part 1)

12.30-13.30

Lunch break

13.30-15.00

Elsevier Author Workshop
The Journal Publishing Cycle
Peter Bakker, Publisher Neurology at Elsevier
How submitted papers are handled?
Ulf Ziemann, Editor-in-Chief, Clinical Neurophysiology
How to write and revise a paper?
David Burke, Editor-In-Chief, Clinical Neurophysiology Practice

Symposium 8
Quantified Measures for Motor Unit’s Bioelectrical Activity
Organiszer-Chair: M.B. Baslo ( Istanbul University, Istanbul Medical Faculty, Department of Neurology, Turkey )

Extracting quantified information from MUP configuration: Quantitative MUP analysis macro and scanning EMG.
M.B. Baslo ( Istanbul University, Istanbul Medical Faculty, Department of Neurology, Turkey )
Activation of motor units: Recruitment and interference pattern analysis.
E. Stalberg ( Uppsala University, Department of Neuroscience, Sweden )
Towards estimating the numbers of motor units: from configuration to quantity.
A. E. Oge (Istanbul University, Istanbul Medical Faculty, Department of Neurology, Turkey)
MUNIX.
S. Nandedkar ( Natus Medical Incorporated, Department of Neurology, USA )

Description:  This lecture aims to depict the principles of motor unit electrophysiology in health and disease by stating the pros and cons of both basic and advanced methods. The temporal and spatial features of motor unit action potential revealed by quantitative MUP analysis, macro EMG and scanning EMG will be discussed. Along with, recruitment properties of motor units to voluntary contraction and interference pattern analysis will be reviewed. Methods for counting the number of motor units by means of both estimation methods and MUNIX will be presented.

Symposium 9
Can salience mask the genuine nociceptive brain activity?
Organiser-Chair: Massimiliano Valeriani (Neurology, Ospedale Pediatrico Bambino Gesú, Rome, Italy)

Physiology of the so-called “Pain Matrix”
Ulf Baumgaertner ( Department of Neurophysiology, Heidelberg University, Germany )
Is the cerebral cortex stimulation painful?
Laura Mazzola ( Service épilepsie, sommeil et explorations fonctionnelles neuropédiatriques, HFME, Lyon, France )
“Pain Matrix” or “Salience Matrix”? That is the question.
Marina de Tommaso ( Applied Neurophysiology and Pain Unit,  Bari University, Italy )

The network of the cortical areas processing the nociceptive input is commonly known as “Pain Matrix”. In the last decades, new neuroimaging and neurophysiological techniques have increased our knowledge about the physiology of these brain regions. However, the concept itself of “Pain Matrix” has been recently challenged by studies which showed that the cortical activities following a painful stimulation can be evoked by salient non-painful stimuli. The hypothesis has been made that the pattern of cerebral activation, traditionally considered as a marker of pain perception, is a mere expression of the salience of the incoming input, independently of its nociceptive quality. The major aim of this symposium will be to compare the elements in favour of the existence of a specific pain representation within the brain with those which are against this view.

Tips for Trainees 1
Controversies on EEG and NCS, by Sándor BENICZKY ( Denmark )
What is the best montage to browse your EEG in?
Double banana, by Ioana MINDRUTA ( Romania )
Common average, by Sándor BENICZKY ( Denmark )
What is the most accurate and clinically useful method for sensory NCS: near-nerve needle technique or surface recordings?
Surface recordings are suitable for accurately investigating the vast majority of nerves, by Björn FALCK ( Sweden )
Why you should be able to use the near-nerve technique, by Birger JOHNSEN ( Denmark )

Educational course
EC11 | EMG approach to acute and chronic polyneuropathy (Part 2)

15.00-16.00

Poster session 1

16.00-16.30

Break

16.30-18.00

Symposium 11
Changes in Axonal Excitability in Neurological Disease
Co-organisers-Co-Chairs: David Burke, Christian Krarup

Introduction to threshold tracking
David Burke
Axonal properties in peripheral nerve disease
Hessel Franssen
Axonal changes in motor hyper-excitability syndromes
Dirk Czesnik
Altered Na+ channel expression in mouse models of CMT
Christian Krarup

This symposium will address the clinical application of threshold tracking techniques to diseases of the peripheral and central nervous system. The Introduction to threshold tracking will provide essential information about the techniques used to study axonal excitability in human subjects in vivo, data essential for the understanding of subsequent talks. Professor Franssen will focus on the changes in axonal excitability in common polyneuropathies, and Dr Czesnik will address changes in motor axon excitability that are presumably the result of plastic changes in the properties of the innervating motoneurons. Professor Krarup will focus on disordered Na+ channel function in a validated mouse model of Charcot-Marie-Tooth disease, showing how blocking Na+ channel function can ameliorate the deficit in this model.

Symposium 12
Human brain networks in physiological and pathological aging: graph theory application
Organiser-Chair: Fabrizio Vecchio

Brain plasticity and connectivity: methods and applications to EEG data
Francesca Miraglia ( Brain Connectivity Laboratory, IRCCS San Raffaele Pisana, Roma, Italy )
Brain networks connectivity in physiological and pathological aging during rest and task
Fabrizio Vecchio ( Brain Connectivity Laboratory, IRCCS San Raffaele Pisana, Roma, Italy )
Connectivity in neurodegeneration
Paolo Maria Rossini ( IRCCS Gemelli, Roma, Italy )

Human behavior and cognition are characterized by engagement of functional distributed networks within the brain. Such networks organization is especially significant in physiological and pathological aging and requires a high degree of intra-modal and inter-modal integration of information flow arriving from several, different and often remote brain sources. These networks dynamically connect adjacent and/or remote cortical neuronal assemblies via cortico-cortical connections. A novel approach, applying concepts from graph theory to neurophysiological data, is a promising new way to characterize brain activity, providing a method to evaluate whether functional connectivity patterns between brain areas resemble the organization of theoretically efficient, flexible or robust networks, based on strength of synchronization of different brain regions. The present proposed symposium is structured in three communication that summarize the possible aspect of connectivity analyses, including EEG graph theory, in both physiological and pathological aging. Specifically, the symposium will be opened by a brief exploration of the modern techniques for the study of brain connectivity. It will be investigated brain connectivity in physiological aging by graph theoretical analysis of resting-state EEG recordings.  Furthermore, it will be illustrated possible way to investigate and diagnosticate neurodegeneration such as Alzheimer’s disease through the study of the brain connectivity modulation

Symposium 13
Entrapment neuropathies, updated diagnostic electrophysiological techniques
Organiser-Chair: Ann Hanafy

Clinical and Electrophysiological tips in entrapment neuropathies.
Ann Hanafy
Combination of clinical provocative techniques  with the electrophysiological study, an attempt to increase the diagnostic yield in diagnosis of early CTS.
Ayat Allah Farouk Hussein
Value of stimulated SFEMG in diagnosis of early CTS.
Ayat Allah Farouk Hussein
Therapeutic role of repetitive peripheral magnetic stimulation in Carpal Tunnel Syndrome.
Amira M. El Gohary

The symposium considers the value of neurophysiological, clinical and provocative tests in the diagnosis of entrapment neuropathies. In the first lecture, experience in combining neurophysiological and clinical techniques will be related. The remaining three talks focus on Carpal Tunnel Syndrome. The first of these compares the value of neurophysiology and provocative tests while the second considers the utility of single fibre EMG in the diagnosis of early CTS. The last lecture will give data on the usefulness of repetitive magnetic stimulation for the alleviation of pain in CTS.

Tips for trainees 3
Artefact recognition in EEG, by Piotr OLEJNICZAK ( USA )
Tips on pain neurophysiology: taking advantage of the little we have, by Luis GARCIA-LARREA ( Spain )
Evoked potentials, by Walter PAULUS ( Germany )

Section of assistants/technicians 4
A beginners guide to TMS.
Verity McClelland ( UK )
Polysomnographic findings in health and diseased aging.
Poul Jørgen Jennum ( Denmark )
Electroencephalography basics.
Daniel Fabo (​ ​​Hungary )

18.15-20.15

Industry Satellite Symposium 

20.30

Young night event ( Not included in the registration fee ) 

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Friday, June 7

07.30-10.30

Educational courses
EC12 | Conventional and threshold tracking TMS
EC13 | Quantitative electromyography

08.00-09.30

Symposium 14
Myths and truths of high frequency oscillations (HFO) as markers of epileptogenic tissue
Organiser-Chair: Milan Brazdil ( Brno Epilepsy Center, Brno, Czech Rep.)

Options in physiology.
Premysl Jiruska ( The Czech Acad. of Sciences, Dept. of Develop. Epileptology, Prague, Czech Rep. )
Interictal very high frequency oscillations.
Milan Brazdil ( Brno Epilepsy Center, Brno, Czech Rep.)
Neuronal action potentials in HFO that predict seizure outcome.
Johannes Sarnthein ( Neurosurgery Department, University of Zurich, Switzerland )
HFO to guide epilepsy surgery in a prospective trial.
Maeike Zijlmans ( Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands )

The quest for high frequency oscillations (HFO) as biomarkers of epileptogenic tissue has led to ever-increasing frequencies but has cast doubt on their physiological plausibility and their clinical applicability. In this symposium, we will first present controversial physiological recordings to elucidate the physiological origin of HFO and discuss their role in epileptogenicity. Are HFO related to neuronal action potentials or mere effects of signal filtering? To address clinical relevance, we will then ask whether and how HFO can be defined prospectively to predict post-surgical seizure outcome. Is the experts’ agreement on HFO detection sufficient to warrant a more widespread interest in HFO? Here we plan four short presentations (Jiruska, Brazdil, Sarnthein, Zijlmans) followed by a debate between speakers and audience.

Symposium 15
Brain Stimulation – Networks, Semiology, Clinical Value
Organiser-Chair: Ioana Mindruta ( University Emergency Hospital of Bucharest, Neurology Department, Bucharest, Romania )

Brain networks activated while performing high-frequency intracranial stimulation for functional cortical mapping.
Andrei Barborica ( Univ. of Bucharest, Physics Dept., Bucharest, Romania )
Networks associated with clinical responses evoked by high-frequency intracranial stimulation.
Ioana Mindruta ( Univ. Emergency Hospital of Bucharest, Neurology Dept., Bucharest, Romania )
Networks of ictal symptoms evoked by intracranial stimulation in patients with drug-resistant epilepsy explored through stereo-EEG method
Irina Popa ( Univ. Emergency Hospital of Bucharest, Neurology Dept., Bucharest, Romania )

Session description: High-frequency intracranial stimulation is an essential method for mapping brain function. It is commonly considered that clinical effects result from tissue activation near the stimulation site. However, it may be possible that certain symptoms are the result from activation of broader networks. By using alternating stimulation polarity, we show that it is possible to overcome the stimulation artifact and identify brain networks activated during ~50Hz stimulation in 10 patients undergoing presurgical evaluation for drug-resistant epilepsy using stereo-EEG method. The activation of the networks at stimulation levels evoking a clinical symptom was compared with the below-threshold stimulation, that did not elicit any clinical effects, allowing to evidence a selective recruitment of pathways associated with a particular symptom. The method allowed identification of physiologic networks associated with various somatosensory, motor or language-related symptoms, among others. In addition, we selected patients in which typical ictal symptoms were elicited during stimulation using alternating polarity in several brain regions. Thus, networks underlying ictal symptoms in each patient were identified and then compared to ictal onset activation in order to determine the overlap between epileptogenic and symptomatogenic zone. As early clinical symptoms are the main indicators of the epileptogenic network, this work might play an important role in tailoring depth electrode implantation charts and surgical resections.

Tips for trainees 4
Reducing noise and interference in nerve conduction studies, by Sanjeev NANDEDKAR ( USA )
EMG: Which muscle to sample in radiculopathies?, by Ali EMRE OGE ( Turkey )
EMG: Don’t forget the blood vessels!, by Mehmet BARIS BASLO ( Turkey )

Oral session 4

09.30-10.00

Coffee-break

10.00-11.30

Plenary lecture 5 and 6
Mozart effect in epilepsy: Why is Mozart better than Haydn? A SEEG study
Ivan Rektor ( Czech Republic )
Recipes for dealing with the reproducibility crisis in transcranial stimulation
Walter Paulus ( Germany )

11.30-12.30

General Assembly

12.30-13.30

Lunch break

13.30-15.00

Symposium 16
Muscle and Nerve Damage in Intensive Care: electrophysiological studies
Organiser-Chair: Mamede De Carvalho ( Portugal )

Speakers:
Neurophysiology of the respiratory muscles

Mamede De Carvalho ( Faculty of Medicine-Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal )
Axonal and muscle fiber excitability in intensive care neuromuscular dysfunction
Werner Z’Graggen ( Inselspital, University Hospital of Bern, Bern, Switzerland )
Strategies for investigating patients in ICU
Jean-Philippe Camdessanche ( Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France )

Neuromuscular dysfunction is increasingly recognized as a complication in patients cared in the intensive care unit (ICU). This condition is a predictor of mortality risk and is the most frequent cause of prolonged ventilator dependency. Risk factors for both intensive care myopathy and neuropathy are use of steroids, clinical severity, sepsis and multi-organ failure. Muscle lesion spectrum varies from sarcolema inexcitability and myofibrilhar destruction to muscle fibre necrosis. Axonal lesion is a less frequent cause of weakness in the intensive care setting, but can aggravate the manifestations derived from muscle fibre lesion damage. Diagnosis require clinical and laboratory evaluation. Electro- diagnostic testing is essential to evaluate the cause and severity of the intensive care neuromuscular dysfunction. In addition to conventional techniques to assess conduction velocity, spontaneous activity and morphology of motor unit potentials, novel techniques should be considered to investigate these patients. In this session, we aim to stress the importance of threshold technique to address muscle fibre and axonal membrane excitability, and to discuss the relevance of performing neurophysiological tests to investigate diaphragm function. In addition we intend to discuss the strategies to investigate these patients using the available neurophysiological armamentarium.

Symposium 17
Facial Reinnervation and Function
Organiser-Chair: Hilmi Uysal ( Akdeniz Univ., Fac. of Medicine, Dept. of Neurology, Antalya, Turkey )

What we have learned from full face transplantation?
Hilmi Uysal ( Akdeniz University Faculty of Medicine, Department of Neurology, Antalya, Turkey )
Neurophysiological approach to rehabilitation after full face transplants
Cagdas Topcu ( Research Assistant, Faculty of Electronics, Telecommunications and Informatics, Gdansk University of Technology, Gdansk, Poland )
Scientific outlook on the advanced techniques for assessing the re-innervation after muscle transplantation.
Both speakers, Hilmi Uysal and Cagdas Topcu.

Following up the reinnervation is a remarkable topic in full-face transplantation which usually completes within nine months. On the other hand, reinnervation does not mean to regain the complete function. Recovery of facial expressions improves the nonverbal communication, but reinnervation of muscle and skin is complex. Moreover,  it is predictable to have plastic changes in primary and secondary association cortices following total loss of innervation. Face transplantation patients generally have different backgrounds and exhibit different degrees of sensorymotor improvement. Therefore, each case needs to be treated individually. The complexity of facial nerves and randomness of reinnervation may be responsible for unexpected observations of aberrant reinnervation and synkinesis after facial transplantation. In this symposium, we will present and discuss neurophysiological approach to individualized rehabilitation strategies after full-face transplantation.

Symposium 18
Neurophysiological evaluation in sleep disorders and neurodegeneration
Organiser-Chair: Poul Jørgen Jennum ( Danish Center of Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark )

RBD – Marker for Parkinsonisme. Importance of imaging techniques and pain perception
Marit Otto ( Department of Clinical Neurophysiology, Århus University Hospital. Århus. Denmark )
Electrophysiologic markers for Narcolepsy
Fabio Pizza ( Department of Neurology. University of Bologna. Bologna. Italy )
Neurophysiologic markers for sleep disorders. Implication of data-driven methods.
Poul Jørgen Jennum (Danish Center of Sleep Med., Clinical Neurophysiology, Copenhagen, Denmark)

Sleep disorder are common affecting a significant part of the population. Central for the diagnose is the polysomnographic (PSG) evaluation which is considered as the gold standard. The technology rely decades of experiments, which however also have proven limitations primary due to the initial definition and manual scoring of the physiological measures. During latest decades significant advances have improved. In this symposium we focus on the medical and technical advantages which have appeared in 1) REM sleep Behavior Disorders (RBD) which are strongly associated with narcolepsy and alfasynucleinopathies, primarily Parkinson’s Disease PD, and 2) narcolepsy with cataplexy which have associated with loss of hypocretinergic neurons in hypothalamus. We will discuss the current neurophysiological findings and evaluation for diagnosing these disorders. We will discuss both the use of traditional electrophysiological methods but also the use of advance diagnostic methods taking the basic disease pathophysiological understanding into consideration.

Tips for trainees 5
Testing reflex epilepsies: what should be done?, by António MARTINS DA SILVA ( Portugal )
Electrophysiology of syncope, by Mario HABEK ( Croatia )
Surface EMG in Tremor and Myoclonus, by Josep VALLS-SOLE ( Spain )

15.00-16.00

Poster session 2

16.00-16.30

Break

16.30-18.00

Plenary lectures 7 and 8
Cortical EEG rhythms in neurodegenerative dementing disorders.
Claudio Babiloni ( Italy )
Challenges of measurable signal and artifact identification in clinical neurophysiology.
Piotr Olejniczak  ( USA )

19.30

Congress closing dinner ( Not included in the registration fee )

_________________________________________________________________________________________________________________________________________

Saturday, June 8

08.00-09.00

Poster session 3

09.00-10.30

Symposium 10
Applications of novel therapeutic transcranial magnetic stimulation techniques
Organiser-Chair: Letizia Leocani ( Hospital San Raffaele. Milano. Italy )

Deep transcranial magnetic stimulation. Advantages and disadvantages.
Letizia Leocani ( Hospital San Raffaele. Milano. Italy )
Transcranial static magnetic stimulation. Mode of action and future perspectives.
Antonio Oliviero ( Hospital de Parapléjicos. Toledo. Spain )
Single pulse transcranial magnetic and other forms of stimulation for migraine.
Francesca Puledda ( Institute of Neuroscience. King’s College. London. UK )

Transcranial magnetic stimulation has been used as a therapeutic method for more than 30 years. New forms of stimulation have appeared in the recent past that have been selectively used, or have shown the potential for use, in certain disorders. The H-coil produces stimulation centered in the depth of the brain. Letizia Leocani will present and discuss the advantages and disadvantages of it and the disorders in which the deep H-coil may be more suitable. A magnet over the scalp has shown to induce a change in brain excitability. Antonio Oliviero will comment on mode of action and future perspectives for clinical application. Finally, many non-pharmacological types of therapy have been proposed for migraine, including a single-pulse portable TMS. Francesca Puledda will review these therapeutic options.

Tips for trainees 6
Pitfalls in electromyography, by Christian KRARUP ( Denmark )
Tips on motor neuron disease EMG, by Mamede DE CARVALHO ( Portugal )
Short and long exercise test. When? How?, by Hatice TANKISI ( Denmark )

Oral sessions 5 and 6

10.30-11.00

Coffee break

11.00-12.30

Plenary lectures 9 and 10
The neuroscience and experience of severe sensory loss.
Jonathan Cole ( United Kingdom )
The role of clinical  neurophysiology in diagnosing neuromuscular diseases in children.
Anna Kostera-Pruszczyk ( Poland )

12.30-13.00

Closing Ceremony