Research and Diagnostic RoNeuro TH EUROPEAN TEACHING...

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JUNE 1-3, 2016 | GRAND HOTEL ITALIA | CLUJ-NAPOCA | ROMANIA

6TH EUROPEAN TEACHING COURSE on NEUROREHABILITATION

RoNeuro BRAIN DAYS

FOUNDATION OF THESOCIETY FOR THE STUDY OFNEUROPROTECTION AND

NEUROPLASTICITY

FOUNDATION

OF TH

E SOC

IETY FOR THE STUDY OF NEUROPR

OTE

CTI

ON

AN

D N

EU

ROPLASTICITY •

Institute for Neurological Research and Diagnostic

www.roneuro.ro | www.ssnn.ro BOOK OF ABSTRACTS | ISSUE 2/2016 ISSN 2501-7039 ISSN-L 2501-7039

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VOLKER HÖMBERGProgram ChairmanEFNRS Secretary GeneralWFNR Secretary General

HEINRICH BINDERProgram Co-Chairman EFNRS Past President

DAFIN F. MUREȘANUCourse Director President of the Romanian Society of Neurology

SSNN President

WELCOME ADDRESS

This event is organized by the Foundation of the Society for the Study of Neuroprotection and Neuroplasticity, together with the Romanian Society of Neurology and “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, and is endorsed, as the previous ones, by the World Federation of Neurorehabilitation (WFNR) and European Federation of Neurorehabilitation Societies (EFNRS).

After fifth successful past events, the meeting in Cluj will again present a platform for exchange of newest scientific information as well as providing space for teaching oriented workshops. We try to reach an audience of all colleagues with an interest in this steadily expanding and exciting field (physicians, nurses, therapists, basic scientists etc.)

A major topic will be to come to a resume where neurorehabilitation in Europe stands today and where future perspectives in science and education as well as in optimizing services shall go. The formats used in the meeting as well as the selected main thematic areas will certainly have a chance to be of interest to a wide audience.

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SCIENTIFIC COMMITTEE & FACULTY

LOCAL COMMITTEE

Ioana Alexa / RomaniaOvidiu Băjenaru / RomaniaHeinrich Binder / AustriaDana Boering / GermanyNatan Bornstein / IsraelDumitru Cernobrov / Republic of MoldovaNatalia Ciobanu / Republic of MoldovaDumitru Ciolac / Republic of MoldovaCristian Falup-Pecurariu / RomaniaAntonio Federico / ItalyMarc Fisher / USA Ștefan Florian / RomaniaAlexandru Gasnaș / Republic of MoldovaStanislav Groppa / Republic of MoldovaAlla Guekht / RussiaVolker Hömberg / GermanyKurt Jellinger / Austria Matthias Kienle / GermanyAxel Kohlmetz / AustriaVitalie Lisnic / Republic of MoldovaTudor Lupescu / RomaniaDafin F. Mureșanu / RomaniaAdriana Sarah Nica / RomaniaLăcrămioara Perju-Dumbravă / RomaniaDaniel Pirici / Romania Gabriel Prada / Romania Sorin Plotnicu / Republic of MoldovaAlessandra Rufa / ItalyStephen Skaper / ItalyCristina Tiu / RomaniaChristel Vanroy / BelgiumGregory del Zoppo / USA

Silviu Albu /RomaniaMihaela Băciuț /RomaniaGrigore Băciuț /RomaniaMaria Balea /RomaniaAnca Buzoianu /RomaniaNicu Drăghici /RomaniaLăcrămioara Perju Dumbravă /RomaniaŞtefan Florian /RomaniaIuliana Găinariu /RomaniaIoan Mărginean /RomaniaAlina Nagy /RomaniaLivia Popa /RomaniaOvidiu Selejan /RomaniaAdina Stan /RomaniaDana Slavoacă /Romania

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ORGANIZERS

FOUNDATION OF THESOCIETY FOR THE STUDY OFNEUROPROTECTION AND

NEUROPLASTICITY

FOUNDATION

OF TH

E SOC

IETY FOR THE STUDY OF NEUROPR

OTE

CTI

ON

AN

D N

EU

ROPLASTICITY •

Institute for Neurological Research and Diagnostic

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MEDIA PARTNERS

ZIAR VERTICAL

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GENERAL INFORMATION

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COURSE VENUE

GRAND HOTEL ITALIA2 Trifoiului StreetCluj Napoca, Romania

www.grandhotelitaliacluj.ro

Scientific Secretariat

Foundation of theSociety for the Study of Neuroprotection and Neuroplasticity37 Mircea Eliade Street, 400364, Cluj-Napoca, RomaniaOffice phone: +40745255311E-mail:[email protected]

Contact Details

Mrs. Doria Constantinescu, mobile: [email protected]

Mrs. Diana Biris, mobile: [email protected]

Registration Desk

All materials and documentation will be available at the registration desk located at SSNN booth.The staff will be pleased to help you with all enquiries regarding registration, materials and program. Please do not hesitate to contact the staff members if there is something they can do to make your stay more enjoyable.

Global Travel & More

21 Rapsodiei Street, Ap 15Cluj Napoca, [email protected]

GENERAL INFORMATION

LOGISTIC PARTNER:

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LANGUAGE

The official language is English. Simultaneous translation will not be provided.

CHANGES IN PROGRAM

The organizers cannot assume liability for any changes in the program due to external or unforeseen circumstances.

NAME BADGES

Participants are kindly requested to wear their name badge at all times. The badge enables admission to the scientific sessions and dinners.

FINAL PROGRAM & ABSTRACT BOOK

The participants documents include the program and abstract book which will be handed out at the registration counter.

COFFEE BREAKS

Coffee, tea and water are served during morning coffee breaks and are free of charge to all registered participants.

MOBILE PHONES

Participants are kindly requested to keep their mobile phones turned off while attending the scientific sessions in the meeting rooms.

CURRENCY

The official currency in Romania is RON.

ELECTRICITY

Electrical power is 220 volts, 50 Hz.Two-prong plugs are standard.

TIME

The time in Romania isEastern European Time (GMT+2).

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SCIENTIFIC PROGRAM

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WEDNESDAy - JUNE 1ST, 2016

08:40 – 09:00 WELCOME ADDRESS:

Dafin F. Mureșanu (Romania), Volker Hömberg (Germany), Irinel Popescu (Romania), Anca Buzoianu (Romania), Natan Bornstein (Israel), Ștefan Florian (Romania) Dafin,

WFNR and EFNRS activities update Volker Hömberg (Germany)

European Curriculum for Residency Training in Neurorehabilitation Volker Hömberg (Germany)

SESSION 1 - ChAIRPERSONS: Volker Hömberg (Germany), Heinrich Binder (Austria)

09:00 – 09:30 Volker Hömberg (Germany)

Neurorehabilitation 2016: Where are we? Where to go?

09:30 – 10:00 Dafin F. Mureșanu (Romania)

Key concepts in neurorehabilitation: evidence based medicine, external validity and individualized treatment. How to match them?


Shifting the paradigm in brain protection and recovery

10:30 – 10:40 Discussions

10:40 – 11:10 COFFEE BREAk

6TH EUROPEAN TEACHING COURSE on NEUROREHABILITATION

RoNeuro BRAIN DAYS

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SESSION 2 - ChAIRPERSONS: Dafin F. Mureșanu (Romania), . Stanislav Groppa (Rep. Moldova)


Neurorehabilitation: Restoration vs Compensation


Motor Learning

12:10 – 12:40 Heinrich Binder (Austria)

Biomarkers for guiding rehabilitation


12:50 – 14:00 LUNCh

SESSION 3 - ChAIRPERSONS: Alessandra Rufa (Italy), Ștefan Florian (Romania)


Individualized rehabilitation: what does it mean?


The more the better – is it true?

15:00 – 15:30 Alessandra Rufa (Italy)

What the study of saccades can tell us in movement disorders?

15:30 – 16:00 Ștefan Florian (Romania)

Surgical approaches for posterior fossa



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SESSION 4 - ChAIRPERSONS: Vitalie Lisnic (Rep. Moldova), Dana Boering (Germany)

16:40 – 17:10 Dana Boering (Germany)

Neuromodulation in neurorehabilitation

17:10 – 17:40 Dana Boering (Germany)

Assessment of diminished states of consciousness

17:40 – 18:10 Ciolac Dumitru (Rep. Moldova)

Epilepsy as a dynamic disorder of neural networks


ThURSDAy - JUNE 2ND, 2016

SESSION 5 - ChAIRPERSONS: Antonio Federico (Italy), Gregory del Zoppo (USA)

09:00 – 09:30 Kurt Jellinger (Austria)

Pathology and pathogenesis of vascular cognitive disorder

09:30 – 10:00 Antonio Federico (Italy)

Update of inherited small vessel diseases

10:00 – 10:30 Gregory del Zoppo (USA)

Modulation of cerebral microvessel structure and permeability in vascular cognitive impairment

10:30 – 11:00 Stephen Skaper (Italy)

Co-ultramicronized palmitoylethanolamide/luteolin promotes oligodendrocyte maturation, precursor cell survival and improves outcome in experimental autoimmune encephalomyelitis



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SESSION 6 - ChAIRPERSONS: Kurt Jellinger (Austria), Stephen Skaper (Italy)

11:40 – 12:10 Gabriel Prada (Romania)

Alpha Lipoic Acid- the role of an ideal antioxidant in neurorehabilitation

12:10 – 12:40 Alexa Ioana (Romania)

Benfotiamine – multifaceted therapeutic potential in neurorehabilitation

12:40 – 13:10 Tudor Lupescu (Romania)

Electroneuromyography in the evaluation of peripheral nerve lesions outcome


13:20 – 14:30 LUNCh

SESSION 7 - ChAIRPERSONS: Lăcrămioara Perju-Dumbravă (Romania), . Cristian Falup Pecurariu (Romania)

14:30 – 15:00 Vitalie Lisnic (Rep. Moldova)

Current concepts on Guillain-Barré syndrome

15:00 – 15:30 Lăcrămioara Perju-Dumbravă (Romania)

Orthostatic hypotension in Parkinson’s disease

15:30 – 16:00 Cristian Falup Pecurariu (Romania)

Gait disturbances in Parkinson’s disease



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SESSION 8 - ChAIRPERSONS: Gabriel Prada (Romania), Tudor Lupescu (Romania)

16:40 – 17:10 Matthias Kienle (Germany)

Functional Magnetic Stimulation a valuable tool in neurorehabilitation

17:10 – 17:40 Christel Vanroy (Belgium)

Effects of aerobic training after stroke

17:40 – 18:10 Daniel Pirici (Romania)

Modulation of water buffering as a treatment option for oedema in ischemic stroke


FRIDAy - JUNE 3RD, 2016

SESSION 9 - ChAIRPERSONS: Stanislav Groppa (Rep Moldova), . Vitalie Lisnic (Rep. Moldova)

09:00 – 09:30 Gasnaș Alexandru (Rep. Moldova)

Brain neuroplasticity in acute ischemic stroke

09:30 – 10:00 Cernobrov Dumitru (Rep. Moldova)

Safety and efficacy profile in patients with acute ischemic stroke treated with intravenous thrombolysis in first 4,5 hours

10:00 – 10:30 Plotnicu Sorin (Rep. Moldova)

Neurovisualization and effectiveness of treatment of patients with ischemic stroke by systemic intravenous thrombolysis

10:30 – 11:00 Ciobanu Natalia (Rep. Moldova)

Pathogenic aspects of ischemic stroke in patients with metabolic syndrome



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SESSION 10 - ChAIRPERSONS: Ovidiu Băjenaru (Romania), Natan Bornstein (Israel)

11:40 – 12:10 Ovidiu Băjenaru (Romania)

Secondary post-stroke prevention and neurorehabilitation - a unique and complex medical activity

12:10 – 12:40 Cristina Tiu (Romania)

Modern interventional treatment in acute stroke in Romania

12:40 – 13:10 Adriana Sarah Nica (Romania)

Management of osteoporosis and fracture in neurological pathology


13:20 – 14:20 LUNCh

ESO EAST SESSION

ChAIRPERSONS: Natan Bornstein (Israel), Cristina Tiu (Romania)

14:20 – 14:30 INTRODUCTION TO ThE ESO EAST PROGRAM

Natan Bornstein (Israel)

14:30 – 15:00 Natan Bornstein (Israel)

National stroke registries: what can we learn from them

15:00 – 15:15 Cristina Tiu (Romania)

Romanian stroke registry: current status and future developments

15:15 – 15:45 Stanislav Groppa (Rep Moldova)

Stroke peculiarities in Moldova’s population: prevalence, incidence and risk factors

15:45 – 16:00 Vitalie Lisnic (Rep. Moldova)

Moldavian Republic stroke registry: current status and future developments


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SESSION 12 - ChAIRPERSONS: Alla Guekht (Russia), Marc Fisher (USA)


Pharmacological support in early rehabilitation The CARS Trial results

17:10 – 17:40 Alla Guekht (Russia)

Cognitive decline after stroke: current concepts and preventive strategies

17:40 – 18:10 Axel Kohlmetz (Austria)

Rigorous evaluation combined with real life studies The CREGS-S trial

18:10 – 18:40 Marc Fisher (USA)

Future directions of acute stroke therapy


18:50 – 19:00 CLOSING REMARkS

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ABSTRACTS

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BENFOTIAMINE – MULTIFACETED THERAPEUTIC POTENTIAL IN NEUROREHABILITATION

IOANA ALExA Department of Internal Medicine, University of Medicine and Pharmacy „Gr.T. Popa” Iași, Romania

Benfotiamine is a lipid-soluble thiamine precursor having much higher bioavailability than genuine thiamine. Growing body of evidence revealed that benfotiamine alleviates the severity of diabetic complications such as neuropathy, nephropathy and retinopathy by inhibiting the formation of advanced glycation end products (AGEs). Benfotiamine prevents the progression of diabetic complications by increasing tissue levels of thiamine diphosphate, which enhances the transketolase activity that directs the precursors of AGEs to pentose phosphate pathway, resulting in the reduction of tissue levels of AGEs. Other beneficial effects of benfotiamine include improvement in cardiomyocyte contractile dysfunction in experimental diabetes mellitus, reduction in neuropathic pain and improvement in experimental postischaemic healing. Moreover, benfotiamine has been shown to reduce oxidative stress in a mechanism unrelated to its anti-AGE property. In addition to its beneficial effects in preventing the progression of diabetic complications, benfotiamine has been demonstrated to prevent the induction of vascular endothelial dysfunction, which suggests the novel role of benfotiamine in improving the vascular functional regulation.

Numerous studies revealed few more additional therapeutic benefits of benfotiamine. Administration of benfotiamine reduced vibration perception, motor function and overall scores of alcoholic polyneuropathy that were significantly improved in an 8-week randomized controlled study.

Throught its high bioavalability compared with classical thiamine, benfotiamine efficiently compensates vitamin B1 deficiencies caused by alcoholism, nutritional deficiencies, chronic diseases, intoxications.

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SECONDARY POST-STROKE PREVENTION AND NEUROREHABILITATION – A UNIQUE AND COMPLEx MEDICAL ACTIVITY

OVIDIU BăjENARU University of Medicine and Pharmacy “Carol Davila”, Bucharest, RomaniaDirector of the Department of Neurology, Neurosurgery and PsychiatryChairman and Head of Dept. Neurology - University Emergency Hospital, Bucharest, Romania Secondary prevention and post-stroke neurorehabilitation are not two

separate medical aspects in the same patient, but they must be concieved and applied as a unitary personalized medical activity in complex protocols, as they interfere in many components and are reciprocally conditioned. The drug administration reccomendations, according to the actual guideliness target both the risk factors of stroke and stroke recurrence, but also the potential delayed post-stroke complications and neurological deterioration, as deep venous thrombosis and pulmonary thrombembolism, the development of increased insulin resistance due to deconditioned muscle activity with subsequent metabolic syndrome and increased risk for recurrent cardio- and cerebrovascular events, the development of post-stroke depression and neurocognitive impairment leading to dementia, increased risk of cardiovascular events including myocardial infarction and vascular death, increased risk for severe local and/ or systemic infections, increased risk for secondary epileptic seizures. On the other side a complex neurorehabilitation personalized program has to take into account all these particular aspects of the cardio-and cerebrovascular disease of the patient and comorbidities, and in particular the biological features of the brain of the patient which are best understood only by the treating neurolgists, together with the psychological and social particularities of the patient and not only the features of the physical deficits. So, a complete and coherent program of neurorehabilitation of these patients must be accomplished by a medical team lead and coordinated by the neurologist who has to evaluate and integrate the particular aspects of medical treatment of hypertension, dyslipidemia, increased insulin resistance, antithrombotic therapy, and all other risk factors and medical conditions, with the degree of cardiovascular and metabolic tolerance of the patient, and with the particular needs for motor, cognitive, psychosocial rehabilitation and the prevention of all other possible complications and comorbidities. The role of all other specialists ( including physiatricians, kinesitherapists, ergotherapists, psycologists, dieteticians, etc. ) has to be well defined in this medical team in order to be integrated in a coherent manner in the neurorehabilitation and personalized secondary prevention program - conceived, monitored and periodically reevaluated by the team lead by the neurologist, as the specialist who has the most unitary and integrative vision of the neurological background disease.

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BIOMARKERS FOR GUIDING REHABILITATION

HEINRICH BINDER Landsteiner Institute for Neurorehabilitation and Space Medicine Vienna, Austria

After initial harmful event a cascade of pathophysiological but also repair processes start running. To launch, to accelerate, to guide these repair its necessary to know where we are on the road, not at all how to prevent a wrong branch line. Until now decisions regarding initiation and art of manner doing specific neurorehabilitation depends mostly on empirical basis. In the meantime a number of so called biomarkers exist as proteomics, transcriptomics, metabolomics wich mirrors admittedly as surrogate marker the different advanced pathways. Not only they gave a hint on different stadia of pathophysiologic as well as reapir processes. They can help to judge appropriate treatment.

INDIVIDUALIZED REHABILITATION: wHAT DOES IT MEAN?


During the past ten years an increasing number of publications dealing with characterization of an individual person, their physiological as well as pathological condition based on biological traits. Phrases are coined like individualized medicine, personalized medicine and patient-centered medicine. More and more novel terms with the suffix “omic” have gained ground like genomics, proteomics, metabomics concerning to the field of genome, proteome a.s.o. It is a matter of increasing concentration on individual subcellular conditions of pathways right up to genetics. It is the attempt to understand varying reactions to equivalent loads, injuries but also treatments, particularly pharmacological. This is particularly important concerning the crucial outcome question. But its necessary to beware taking far too drastic measures and to forget renowned biologic measures like blood pressure, also imaging techniques and not at least environmental factors and barriers depicted in the frame of ICF.

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THE MORE THE BETTER – IS IT TRUE?


Duration and frequency of inpatient rehabilitation interventions is much discussed. This regards to best practice as well as to be economical.

Best practice depends on two factors: first of all the actual but mutative mental and physical inventory, to come second on the rehabilitation process with aligned tools. which is a more qualitative question and not at least the rehabilitation process. The mental and physical inventory concerns paramount neurological and specific neuropsychological deficits but at the same time attention span, concentration, memory, cardiopulmonary and musculoskeletal capacity. All of this are determining factors for aligned tools on the one side as well as for onset, chronology, strength, duration of separate workloads, frequency and relation of exposure and recovery phase. The literature provide no really viable information with exception of such statements like “as early as possible” and “intense”. But this is neither workable nor mindful for the individual situation.

ASSESSMENT OF DIMINISHED STATES OF CONSCIOUSNESS

DANA BOERINGMedical Director, Gesundheitszentrum, Bad wimpfen, Germany

Over the last two decades there has been a capacious development of consciousness science, from the implementation and international acceptance of standardized neurobehavioral assessment tools of disorders of consciousness, especially the Coma Recovery Scale Revised, which uncovered a high rate of misdiagnosis, to sophisticated ancillary techniques as brain imaging and electrophysiological examinations. These have enhanced our scientific understanding of recovery of consciousness in the human brain following severe brain damage and demonstrated that patients with little or no behavioral evidence of conscious awareness may retain critical cognitive capacities and harbor latent potential for further recovery.

This raises questions regarding the phenomenon of ‘minimal’ consciousness: When is minimal consciousness enough to call a patient conscious? What is the moment of no consciousness and how can we objectively measure this in another human being? This problem is emphasized in the renaming of the vegetative state into unresponsive wakefulness syndrome, reminding physicians to remain

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careful when making inferences regarding consciousness based on behavioral assessment. Furthermore, there is a need to give a name to those patients who are behaviorally unresponsive but follow commands like motor imagery tasks as demonstrated by recent brain imaging paradigms.

The talk will encompass an overview of actual behavioral and ancillary assessment methods available for scientific use and everyday work in early neurorehabilitation, their respective pros and cons as well as the challenge all of them represent in our effort to deal with DSC patients and enhance their recovery. It concludes that in the recent years it has become ever clearer that the separate sub conditions: coma, unresponsive wakefulness syndrome, minimally conscious state fit into the percept of gradually recuperating consciousness.

NEUROMODULATION IN NEUROREHABILITATION

DANA BOERINGMedical Director, Gesundheitszentrum, Bad wimpfen, Germany

Over the last two decades there was a substantial advance in our understanding of the intrinsic ability of the CNS to reorganize its networks and reconfigure its activity in response to environmental changes or lesions, due to advances in noninvasive brain evaluation techniques, refined basic science investigations, progress in computational power and analytical approaches as well as in genetic science. The study of neuroplasticity engages nowadays scientists of a multitude of disciplines.

In this context, neurorehabilitation takes advantage of the immense increase in neuroscience knowledge about mechanisms of postlesional plasticity, its different temporal scales, and sets its main emphasis on the application and refined assessment of a broad repertoire of neuromodulation forms to enhance training induced cognitive and motor learning.

The talk will give an overview of current neuromodulation strategies like pharmacological neuromodulation, noninvasive brain stimulation, brain computer interfaces, real time fMRI neurofeedback, as well as behavioral neuromodulation techniques, somatosensory input reduction/augmentation, combined cortical/peripheral stimulation, robotics. It will address the complex open questions and future challenges in the application of these promising therapeutic manipulations of brain plasticity.

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NATIONAL STROKE REGISTRIES: wHAT CAN wE LEARN FROM THEM

NATAN BORNSTEIN Tel-Aviv University, Sackler Faculty of Medicine, IsraelStroke Unit at Tel-Aviv Medical Center, Israel

Clinical registries play an important role in measuring healthcare delivery and supporting quality improvement for individuals with cardiovascular disease and stroke. Well-designed clinical registry programs provide important mechanisms to monitor patterns of care, evaluate healthcare effectiveness and safety, and improve clinical outcomes. The use of clinical registries is likely to grow given the increasing focus on measuring and improving healthcare delivery and patient outcomes by stakeholders in both the private and public sectors.

The focus of clinical registries is to capture data that reflect “real-world” clinical practice in large patient populations. The data from clinical registries do not replace the need for traditional randomized controlled trials. Rather, registries and trials are complementary approaches, each with unique advantages and imperfections.2 Such clinical registries do not solely contain claims or administrative data yet may be linked to such data sources.

Clinical registries also provide the opportunity to identify and evaluate healthcare disparities within a broad patient population in community practice outside of the structured research protocol setting. This promotes the ability to examine important issues involving patient access and outcomes in subpopulations, including racial and ethnic minorities, women, the elderly, individuals with multiple comorbidities, and individuals with congenital heart conditions.

National Acute Stroke Israeli Survey (NASIS) ia a tri-annual prospective national registry conducted over a period of two consecutive months in order to assess trends in incidence, characteristics, management, and outcome of hospitalized patients with acute stroke and TIA. Includes all stroke patients admitted to hospitals nationwide, thus avoiding institution and patient selection bias. NASIS registry in- total over 8,000 patients (2004-2013)

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MESSAGE TO TAKE HOME:• Surveysprovidedataandallowfutureplanning• Surveysindicatedeficienciesinongoingtherapy• Surveysallowcomparisonsbetweenhospitalsandencourage improvement• Educationbenefit• Resultscandirectnationalhealthpolicies

SAFETY AND EFFICACY PROFILE IN PATIENTS wITH ACUTE ISCHEMIC STROKE TREATED wITH INTRAVENOUS THROMBOLYSIS IN FIRST 4,5 HOURS

DUMITRU CERNOBROV1,2 STANISLAV GROPPA1,2, EREMEI ZOTA1,2, IGOR CRIVORUCICA2, PAVEL LEAHU1,2, ALExANDRU MATEI1,2

1. “N. Testemitanu” State Medical and Pharmaceutical University, 2. Institute of Emergency Medicine

Introduction: Stroke is a major medical and social problem both worldwide and in the Republic of Moldova. According to the National Centre of Health Management during the years 2000-2014 there was a continuous elevation of incidence and prevalence of cerebrovascular diseases per 10.000 population. The general incidence raised from 20,4 in 2000 to 26,82 in 2014; the prevalence index

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in the general population reached 199,08 in 2014 compared to 67,0 in 2000; this dynamic led to an increase in the number of deaths due to stroke in recent years, cerebrovascular diseases ranking second place in the total number of deaths per year. Starting with 2005, our clinic has used intravenous thrombolysis as treatment of eligible patients with acute ischemic stroke. Our aim was to assess the efficacy and safety of intravenous thrombolysis with rtPA in treatment of patients with acute ischemic stroke and compare the results to those provided by the international community.

Methods: 40 patients diagnosed with acute ischemic stroke treated at the Institute of Emergency Medicine during the period November 10, 2015 - April 30, 2016 and followed up for one month after hospital discharge. Analyzed data included: time from onset of symptoms; time till arrival to the emergency department; time till brain CT; till rtPA administration (door to needle time); presence of intracerebral arteries occlusion before and after rtPA administration and its correlation to NIHSS score; recanalization rate after rtPA; presence of symptomatic or asymptomatic intracerebral hemorrhage after treatment with rtPA at 24h and hospital discharge; number of days in the ICU; total inpatient treatment duration; mRS at admission and hospital discharge. Other registered parameters were: demographic profile, stroke risk factors, blood pressure values and basic observations found at brain CT. Patients with medical history of decompensated cardiac, renal, hepatic pathologies were excluded. The solution of rtPA was administered at a dose of 0.9 mg / kg.

Results: All 40 patients diagnosed with acute ischemic stroke were classified according to TOAST criteria (atherosclerosis of a major artery - 7; cardioembolic - 8; lacunar - 12; other determined etiology - 0; unclear etiology - 13). Among them 21 were men and 19 women; average age - 62 years old. Average time of arrival to the emergency department was - 90 min (max - 195; min - 9); average time required to perform CT - 47.45 min (max - 129; min - 20); time to rtPA infusion - 114.6 min (max - 233; min - 75). NIHSS score at admission ranged from 6 to 18 points. Associated diseases: Arterial hypertension - 36 patients (90%), Diabetes mellitus - 6 patients (15%), Hypercholesterolemia - 21 patients (52.5%), Atrial fibrillation - 21 patients (52.5%), History of stroke - 3 patients (7.5%), Heart failure - 17 patients (42.5%), Ischemic heart disease - 13 patients (32.5%), Smoking - 3 patients (7.5%). Signs of cerebral artery occlusion were found in 20 cases (50%), average NIHSS score at admission in these patients being 14p. Signs of recanalization after the administration of rtPA were observed in 12 patients (60% of those with occlusion) average NIHSS score at last day of follow up was 7 points. Patients with poor recanalization rate had an average NIHSS score of 6 points at last day of follow up. More detailed results are provided in the publication paper.

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Conclusion: Intravenous thrombolytic therapy within the first 3-4,5 hours of ischemic stroke onset offers substantial net benefits for almost all patients with potentially disabling deficits, nevertheless detailed inclusion/exclusion criteria should be analyzed and an individualized decision is ought to be made. Further investigations are needed in order to determine the correlations between recanalization rate and patient’s outcome after intravenous rtPA treatment.

PATHOGENIC ASPECTS OF ISCHEMIC STROKE IN PATIENTS wITH METABOLIC SYNDROME

NATALIA CIOBANU1,2 STANISLAV GROPPA1,2


The metabolic syndrome is a major and escalating public-health and clinical challenge worldwide in the wake of urbanization, surplus energy intake, sedentary life habits, and increasing obesity. It is characterized by a group of risk factors clustered in one individual, known to promote or increase the risk for development of diabetes mellitus, cardio and cerebrovascular disease. The vascular risk is amplified as compared with the effect of a risk factor alone. The risk for incident ischemic stroke seems to augment with the increasing number of components of the metabolic syndrome, all of which have been individually associated with an increased risk for future cerebral ischemic events. The metabolic syndrome confers a 5-fold increase in the risk of type 2 diabetes mellitus and 2-fold the risk of developing vascular disease over the next 5 to 10 years. Further, patients with the metabolic syndrome are at 2- to 4-fold increased risk of stroke, a 3- to 4-fold increased risk of myocardial infarction, and 2-fold the risk of dying from such an event compared with those without the syndrome. The prevalence of the metabolic syndrome in high-risk populations is obviously high, but it is also important to note that in a healthy population it was found a prevalence of 24%-36% and in patients with stroke it was found a prevalence of 46–64%. Therefore, identifying the metabolic syndrome in patients may enable the clinician to better assess the vascular risk. Current international guidelines recommend metabolic syndrome screening for the identification of persons at high long-term risk of vascular disease. Lifestyle modification remains the initial intervention of choice for such population. Pharmacological treatment should be considered for those whose risk factors are not adequately reduced with lifestyle changes.

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EPILEPSY AS A DYNAMIC DISORDER OF NEURAL NETwORKS

DUMITRU CIOLAC1,2 CHIOSA VITALIE1,2, STANISLAV GROPPA1,2


Actual paradigm postulates that the brain functioning is emerging from a complex interplay of different brain areas and relies on the integrity of structural and functional networks. The application of network analysis in modern epilepsy research has provided valuable information on seizure onset, propagation and termination, on the interictal state of functional networks and on alterations in structural networks. Ictal studies have repeatedly identified a more regular network topology and changes in modularity when the epileptic brain goes into a seizure. Resulting disruptions in structural and functional connectivity may be associated with cognitive and behavioral impairments, often seen in patients with pharmacoresistant epilepsy.

Development of functional network biomarkers is a possible clinical application of network analysis to predict the risk of seizure recurrence (outcome) after epilepsy surgery. Resection of hub nodes that were active during a seizure is associated with seizure freedom in patients with neocortical epilepsy. Studies indicate the potential use of network analysis to improve the outcome of epilepsy surgery.

Characterization of epileptogenic networks in the dynamic process of seizure generation and in the interictal state will advance our understanding of epilepsy as a network disease. Early identification of network alterations may lead to an improved intervention in pharmacoresistant epilepsy to reduce future burdens associated with the disease.

GAIT DISTURBANCES IN PARKINSON’S DISEASE

CRISTIAN FALUP-PECURARIU Department of Neurology, County Emergency Clinic Hospital, Faculty of Medicine, Transilvania University Brașov, Romania

Gait abnormalities could appear early or late in Parkinson’s diseases (PD) patients and is one of the most bothersome symptoms. The most important gait abnormalities encountered in PD are freezing of gait, festination and falls. Freezing of gait (FOG) defined as a brief absence or reduction of forward progression is found especially in patients with disease duration longer than 5 years. It could lead

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to falls and consequent injuries. It has several provoking factors and can be related to rigid – akinetic phenotype, severity of the disease and insufficient response to antiparkinsonian drugs. The key pathophysiological element in FOG is gait pattern generation disturbances.

There are subjective methods to assess freezing of gait (scales and questionnaires) and objective methods (video recording and lower limb accelerometry).

Falls are associated with increased age, cognitive impairment, severity and duration of the disease and have important consequences regarding quality of life. Injuries resulting from falls represent the 6th leading cause of death in elderly population. There are several causes of falls, including impairment of postural reflexes, freezing of gait, severe dyskinesia, and medication and associated cardiovascular and neurological diseases.

Therapeutic options of gait abnormalities in Parkinson’s disease include levodopa medication, dopamine agonists, MAO inhibitors, apomorphine and deep brain stimulation of the subthalamic nucleus. Physiotherapy, cueing, musculoskeletal exercises and cognitive therapies represent some standard strategies for rehabilitation of gait disturbances and falls.

UPDATE OF INHERITED SMALL VESSEL DISEASES

ANTONIO FEDERICO Unit of Clinical Neurology and Neurometabolic Disease, University of Siena, Siena, Italy

Cerebral microangiopathies are responsible of a great number of strokes. In the recent years advances in molecular genetics identified several monogenic conditions involving cerebral small vessels and predisposing to ischemic and/or hemorrhagic stroke and diffuse white matter disease leading to vascular dementia. Clinical features and diagnostic clues of these conditions, [cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), COL4A1-related cerebral small vessel diseases, autosomal dominant retinal vasculopathy with cerebral leukodystrophy (AD-RVLC), and Fabry’s disease] are here reviewed. Albeit with variable phenotypes and with different defective genes, all these disorders produce arteriopathy and microvascular disintegration with changes in brain functions. Specific diagnostic

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tools are recommended, genetic analysis being the gold standard for the diagnosis. We will also discuss on some pathogenetic mechanism responsible for brain abnormalities evident in an early stage of the diaseses.

FUTURE DIRECTIONS OF ACUTE STROKE THERAPY

MARC FISHER Senior Lecturer in Neurology, Harvard Medical School Emeritus Professor of Neurology, University of Massachusetts Medical School, USA

Currently, AIS has entered a golden age brought about by a confluence of factors including an enhanced understanding of the basic pathophysiology of focal ischemic brain injury, improved acute stroke imaging, the proven efficacy of both intravenous and intra-arterial therapies to restore blood flow and improving care delivery systems to allow for the expeditious treatment of AIS patients. The results of the 5 endovascular trials published in 2015 provide conclusive evidence that intra-arterial therapy with devices to restore blood flow improves outcomes. The trials however have left many unanswered questions that will require additional trials to be performed. They also lead the way for reconsideration of neuroprotection as an adjunctive therapy with device recanalization. One approach is to use early neuroprotection to try to preserve the ischemic core so that patients requiring a long time for transport to an endovascular center remain good candidates for treatment. After successful reperfusion, secondary injury may occur and worsen clinical outcome. Neuroprotection may reduce the effects of so-called reperfusion injury. Another consideration for the future of acute stroke therapy is to develop thrombolytic drugs that have superior recanalization efficacy as compared to i.v. tPA or to use other molecules with tPA to enhance its thrombolytic effects.

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BRAIN NEUROPLASTICITY IN ACUTE ISCHEMIC STROKE

ALExANDRU GASNAȘ1,2 STANISLAV GROPPA1,2 1. “N. Testemitanu” State Medical and Pharmaceutical University, 2. Institute of Emergency Medicine

Following stroke, the brain undergoes various stages of recovery where the central nervous system can reorganize neural circuitry (neuroplasticity) both spontaneously and with the aid of behavioral rehabilitation and non-invasive brain stimulation. Transcranial magnetic stimulation (TMS) work reveals changes in ipsilesional and contralesional cortical excitability in the sensorimotor cortices. The severity of motor deficits indexed using TMS has been linked to the magnitude of activity imbalance between the sensorimotor cortices. Procedure of transcranial magnetic stimulation (TMS) has been used for over 30 years to investigate the recovery of motor function in patients with stroke. In particular, it has been used to quantify the extent of damage to the corticospinal tract, reorganization of cortical representation of body parts affected and intracortical excitability and cortico-cortical in both hemispheres. Since rTMS is known to modulate cortical excitability in local and remote regions to the areas stimulated, it has been suggested to be a viable therapeutic approach to aid in the recovery of motor function after stroke , yet there is accumulating evidence that the response to rTMS is inconsistent and variable . When targeting stimulation over M1, rTMS has been delivered in isolation and in combination with rehabilitation training in individuals with stroke. Since the effects of rTMS can outlast the period of stimulation itself , the prevailing thought is that the aftereffects may be capitalized on by pairing it with skilled motor practice and/or rehabilitation training to promote neuroplastic change .

Theoretically, rTMS can be used to increase cortical excitability in the ipsilesional cortex by directly applying excitatory rTMS over the ipsilesional hemisphere or by applying inhibitory rTMS over the contralesional to potentially decrease abnormally increased inhibition to the lesioned M1 . This manipulation of cortical excitability is supported by observations of imbalanced IHI after stroke . Impaired motor performance following stroke is often attributed to a disruption in IHI where an overactive contralesional area suppresses the activity of the lesioned hemisphere.

In summary, functional recovery might be obtained either when rTMS is applied at low-frequency (around 1 Hz) over the disinhibited, unaffected hemisphere in order to restore defective inhibition or when rTMS is applied at high-frequency (5 Hz or more) over the affected hemisphere in order to reactivate hypoactive regions. Decreased ipsilesional cortical excitability may contribute to decreased corticospinal transmission resulting in diminished motor function of the paretic

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upper limb. Ipsilesional excitatory rTMS may increase the excitability of the damaged cortex, thereby contributing to enhanced corticospinal transmission potentially leading to better motor function of the paretic upper limb. Increased interhemispheric inhibition (IHI) from the contralesional to ipsilesional cortex via the corpus callosum may contribute to decreased ipsilesional corticospinal excitability and diminished motor function of the paretic upper limb. Contralesional inhibitory rTMS may suppress contralesional to ipsilesional IHI and assist in improving ipsilesional corticospinal transmission, potentially leading to better motor function of the paretic upper limb.

STROKE PECULIARITIES IN MOLDOVA’S POPULATION: PREVALENCE, INCIDENCE AND RISK FACTORS

STANISLAV GROPPA1,2 EFREMOVA DANIELA1,2 1. “N. Testemitanu” State Medical and Pharmaceutical University, 2. Institute of Emergency Medicine

Stroke remains the most common life-threatening neurological disease globally and impacts individuals, their families and society. It is the leading cause of disability among elderly and the second leading cause of mortality worldwide. Every year 16 million people worldwide suffer a stroke, of which 5,7 million die and 5 million remain disabled.

The incidence of stroke in Europe varies from 101.1 to 239.3 per 100,000 among men and from 63.0 to 158.7 per 100,000 among women, being the highest in Eastern Europe. In the Republic of Moldova during the years 2000-2014 there is a progressive increase of incidence and prevalence of cerebrovascular diseases reported per 10,000 population, the incidence increased from 20.4 in 2000 to 26.82 in 2014, and the prevalence from 67.0 in 2000 to 199.08 in 2014. The death rate from stroke in Republic of Moldova remains one of the highest in Europe. But a good knowledge of risk factors for stroke should help to implement relevant strategies and policies, and reduce stroke incidence, mortality and sequels. In this context we performed an epidemiological study to collect data and it had covered the period from Octomber to December 2015. The aim of the study was to identify the prevalence of the risk factors for stroke in the Republic of Moldova.

Thus, prevention is the primary treatment strategy, aimed to reduce morbidity and mortality related to stroke. Knowledge about specific risk factors for stroke in the population of Republic of Moldova will contribute to developing a national

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strategy for primary prevention of stroke.

Keywords: Epidemiology, incidence, risk factors, stroke.

COGNITIVE DECLINE AFTER STROKE: CURRENT CONCEPTS AND PREVENTIVE STRATEGIES

ALLA GUEKHT Russian National Research Medical University Moscow Research and Clinical Center for Neuropsychiatry, Russia

Global burden of stroke is increasing worldwide; post-stroke cognitive impairment contributes substantially to the burden of the disease. Incidence and prevalence of post-stroke cognitive impairment are being extensively investigated over the last years; however, the results of the studies vary for the difference between the countries, diagnostic criteria, time elapsed from stroke and other methodological issues. Three months after stroke the majority of studies reveal cognitive impairment in 30-60% of stroke survivors, though the range is from 17 to 92%.

In the routine clinical practice cognitive consequences of stroke are sometimes underestimated compared to obviously disabling motor and/or sensory deficit. Patients could be considered as fully recuperated after TIA or minor stroke, but cognitive impairment and may persist beyond resolution of focal symptoms.

Importantly, after stroke the progression rate from mild cognitive impairment to dementia increases. There is a huge variability in terms of manifestation or acceleration of cognitive decline after stroke; however, often there is a delay that could provide unique opportunities for disease modifying strategies to be applied to preserve cognition following stroke.

In terms of risk factors, biomarkers and mechanisms, there is an extensive overlap between vascular and degenerative mechanisms, when the tissue damage produced by vascular factors aggravates the damage produced by neurodegeneration and vice versa. These common pathways include excitotoxicity, neuroinflammation, oxidative stress, apoptosis, proteinopathies and neurotrophic alterations, leading to neurovascular damage and degeneration A number of the cellular and molecular processes involved in dysfunction of neuro-vascular unit have been extensively studied over the last decade in terms of their role in the mechanisms of post-stroke cognitive decline.

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Better understanding of the risk factors and estimation of the risk scores for post-stroke cognitive impairment are important for development and assessment of preventive strategies (lifestyle modification, neuroprotective agents, cognitive rehabilitation, other interventions).

NEUROREHABILITATION 2016: wHERE ARE wE? wHERE TO GO?

VOLKER HÖMBERG Heinrich Heine University of Duesseldorf SRH Health Center, Bad wimpfen, Germany

Within the last 10 years the number of survivors after stroke and TBI has dramatically increased due to advances in acute medical care.

In parallel the need for intensive neurorehabilitation to combat resulting impairment and handicap has increased. Fortunately also over the last 20 years neurologic rehabilita-tion is more and more conceived as appplied neuroscience:

Dramatic progress has been made in the application of evidence based medical prin-ciples and the number of well designed randomized controlled trials in the field is in-creasing. Nevertheless there is a remaining epistemological problem in how far the rationales of EBM originally designed for pharmaceutical studies are really suited to as a source of beat evidence :Due to heterogeneity of populations ,usually comparably small sample sizes and hence also difficult to interpret metaanalyses the EBM ra-tionale my sometimes be misleading.

Nevertheless a reasonable approach to design efficient treatment strategies is to follow elementary rules derived from behavioural and neurosciences concerning neu-roplasticity and learning mechanisms. This has resulted in the invention of better scien-tifically founded procedures for neurological treatment of motor ,cognitive and language problems. A good example is the very successful application of the principle of forced use and avoidance of learned non use in constrained in used movement therapy. This concept now also spreads to non motor fields as language , cognitive and perceptual rehabilitation.

Furthermore the use of intelligent mechanical training devices (often loosely called “robots” a has open news therapeutic windows especially in the early stage of treat-ment in severely impaired patients.

On the other hand pharmaceutical concepts for neuroprotection have more or less failed so fare possibly due to the selection of the wrong mostly monomodal drugs not properly addressing the complexity of the brain´s endogenous defense mechanisms at an early stage after injury.

There is however a growing selection of neuromodulatory techniques

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such as pe-ripheral nerve stimulation , non-invasive brain stimulation and also pharmaceutical interventions with monaminergic drugs and especially antidepressants to facilitate brain recovery within a limited time-window after stroke with the aim to reduce im-pairment.

In future it will be extremely important to differentiate more clearly treatment elements addressing compensation and task specific learning from those elements addressing impairment reduction especially in the early sensitive period after an insult.

As treatment intensity is likely to be the key element for impairment reduction we cer-tainly have to find clever and affordable ways: to increase the daily treatment time of our patients. To day even during inpatient rehabilitation treatment times hardly exceed three hours a day i.e. that we use only a small percentage of waking hours leaving long “idling” time not field by any treatment. In this sense we have to “reinvent” neurorehabili-tation within this sensitive post injury period to combat impairment with high frequency treatments combined with neuromodulatory techniques (robot use, peripheral and central stimulation , pharmaceuticals) .

We have to think how our rehabilitation environments should look like and can be “enriched” and how we can generate a high level of motivation and fun in patients to let them successfully participate in such high frequency treatments.

Furthermore prognostic criteria have to be worked out to enable decisions when to switch from impairment oriented (e.g. massed non goal directed activities) to compen-satory (task specific) learning strategies.

Another important issue is to work out salient biomarkers to describe the patients´s course and prognosis beyond scores and clinical observation such as neuroimaging and neurophysiology datasets or combinations of them.

Finally we have to understand better individual genetic trait variables ( (e.g. BDNF pol-ymorphisms) as ultimate biomarkers to understand interindividual differences in re-sponse to certain treatments.

NEUROREHABILITATION: RESTORATION VS COMPENSATION


Over the last two decades there has been a remarkable change in our thinking in the invention, design and efficacy evaluation of motor therapies in neuro-rehabilitation which can be described by three paradigmatic changes:

First there is a change from confession to profession i.e. more and more evidence based approaches rather than intuitively driven procedures have come into use. This was accompanied by a change from “hands on” treating to “hands

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off” coaching approaches, which now dominate most of the evidence procedures. This change in treatment philosophy has had a marked impact also on the self-understanding of the therapists in their relation to the patient mutating from treaters to teachers .

Thirdly these developments were accompanied by a transition from intuitevely marshaled individual one to one treatments to quality proven group treatments.

In neurological rehabilitation the distinction between treatment strategies targetted

to restore function and thereby decrese impairments contrasted to approaches to compensate function in order to improve activities is becoming more and more important.

Especially in the early postacute stage within a limited therapeutic time window ( e.g. ca 3 months in stroke) restorative approaches are aimed to decrease impairment .This approach probably implies very time intensive ( e.g. up to 8 hours a day multifacetted treatments. We must admit that the repertoire for impairment oriented treatment approaches still is rather limited.

So far only three major strategies have been shown to help decrease impairment in the subacute stage e.g. after stroke: The forced use or constraint induced movement therapy approach has been proven to be effectve in the multicenter prospective EXCITE trial ( Wolf et al 2008) ). Also the use of antidepressant agents was shown to be effective in the FLAME trial (Chollet et al 2011 ) . Very recently the CARS trial (Mureșanu et al 2016) documented for the first time after decades of frustrane attempts to achieve some sort of neuroprotective and/or neurorestorative effects that a mutimodal drug can improve impairment after stroke .

Possible additional candidates for a true „impairment“ oriented treatment approach are neuromodulatory techniques such as peripheral neuromuscular and/ or sensory stimulation ( eg. whole hand subliminal „mesh-glove“ stimulation )and more and more also non invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation and transcranial DC stimulation. Also the use of non fatiguable robotic devices to enable a high intensity massed movement treatment appear promising.

Probably the most important impact in facilitating impairment reduction will however have clever ,economically feasible, approches to increase the net number of therapy or activity hours per day by creating true „ enriched environment“ for severely impaired patients . They should enable 6-8 hours of daytime treatment to avoid leaving our patients „inactive and alone“ in future.

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MOTOR LEARNING


The classical physiotherapy school such as the Bobath concept , the Vojta and the Kabat concepts and many more have been challenged very much.recently Also their claim to be based on “Neurophysiological bases” has been critisized . A recent meta- analysis of the Bobath concept for instance (Collen et al 2009 stated that “the Bobath Concept ist not superior to other approaches. Based on best evidence synthesis, no evidence is available for the superiority of any approach.Evidence-based guidelines rather than therapist preference should serve as a framework from which therapists should derive the most effective treatment..“

Most of these classical concepts failed to include recent knowledge about brain pasticity and learning processes.

Within the last two decades we have made tremendous progress in applying elementary rules of motor learning ( see table below in bringing forward strategies for motor improvements ( for a review see Hömberg 2013).

Table

Rules for learning-oriented motor therapy• Repetition • Task orientation • Active behavior• Ecological validity • Shaping • Knowledge of results • Motivation

In the talk these elementary rules will be illustrated and made understandable.Furthermore a clear distiction between task- oriented learning ( which is

preserved in most neurological conditions)aand massed activity- non goal directed approaches which may help to facilitate recovery in limited time windows after brain injury is proposed.

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PATHOLOGY AND PATHOGENESIS OF VASCULAR COGNITIVE DISORDER

KURT jELLINGER Institute of Clinical Neurobiology, Vienna, Austria

Vascular dementia / vascular cognitive disorder (VaD/VCD) is not a single entity, but a group of conditions characterized by various pathophysiologic correlations and clinical findings. Classification, prevalence, and pathophysiology are a matter of discussion. Cinical diagnostic criteria show moderate sensitivity (~50%) and variable specificity (range 64-98%). In clinical series, VCD is suggested in 8-10% of cognitively impaired elderly subjects. Its prevalence in autopsy series varies from 0.03 to 58%, with means of 8 to 15%. Major types are multi-infarct encephalopathy, small vessel and strategic infarct type dementia, subcortical arteriosclerotic leukoencephalopathy (Binswanger), multilacunar state, mixed cortico-subcortical type, granular cortical atrophy, and postischemic encephalopathy. They result from systemic, cardial, and local large or small vessel disease; pathogenesis is multifactorial. Vascular pathology often coexists with AD and other disorders; 25-80% of dementia cases show both AD and cerebrovascular lesions (CVL). Cognitive decline is commonly associated with widespread small vascular lesions involving subcortical brain areas affecting systems involved in cognition, memory, and behavior (thalamo-cortical, cortico-subcortical, limbic). Lesion pattern of “pure” VCD, differs from that in mixed dementia (AD+VCD), more often showing large infarcts, which suggests different pathogenesis of both disorders. Due to the high variability of cerebrovascular pathology no validated neuropathologic criteria exist for VCD, but recent UK multi-center guidelines assessing of 14 vessel and parenchymal pathologies in 13 brain regions showed up to 95% predicted probability for combinations of 3 pathologies. Further clinico-pathologic studies and harmonization of neuropathologic procedures are needed to validate diagnostic criteria for VCD to clarify the impact of CVLs on cognitive impairment.

FUNCTIONAL MAGNETIC STIMULATION A VALUABLE TOOL IN NEUROREHABILITATION

MATTHIAS KIENLE International Application Specialist, Magventure

rTMS is already an accepted tool in brain research and early stroke treatment. The results found are temporary limited. A group of rehab centers in Germany are using functional peripheral magnetic stimulation combined with transcranial

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stimulation in combination with conventional physiotherapy in patient with chronic stroke (> 3years after stroke). This complex procedure has resulted in surprising results of hand/arm and leg movement. The shown cases are presenting exemplary the procedure and its results.

RIGOROUS EVALUATION COMBINED wITH REAL LIFE STUDIES - THE CREGS-S TRIAL

AxEL KOHLMETZ Austria

Randomized clinical trials are the gold standard to determine efficacy but are not practical in every circumstance. Registries can be invaluable to measure effectiveness and for studying routinely used treatments. However, result differences are potentially subject to bias but most of the major sources can be managed through a rigorous approach of selection, matching and independent, blinded assessment of outcome. Methods include the use of propensity scores and propensity score matching. One example where this approach is being used is the CREGS-S Trial in stroke recovery. The trial design and methodology will be discussed in detail as a relevant example about the level of sophistication applied in modern clinical research.

CURRENT CONCEPTS ON GUILLAIN-BARRé SYNDROME

VITALIE LISNIC GAVRILIUC EUGENIU, ODAINIC OLESEA, CHETRARI LARISA, SANGHELI MARINA, PLESCA SVETLANA “Nicolae Testemitanu” State University of Medicine and Pharmacy Chisinau, Republic of Moldova

This year we mark the centenary since the description of Guillain-Barré syndrome (GBS). At the same time the recognition of its numerous variants and subtypes is part of its continuously evolving and fascinating history. GBS is the most frequent cause of a subacute neuromuscular palsy. Its incidence is 1,2-1,8/100.000. In the countries of the EU there are about 7000 cases annually. In spite of the relative low lethality – 3-5%, the most of the patients are severely affected, 25% require artificial ventilation and 20% are not able to walk at half a year after onset. Most of the patients (two thirds) die due to complications at the rehabilitation stage. In about 10% cases GBS have a recurrent course. Additional

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IVIG course is under investigation for these patients. In other 5% cases chronic inflammatory demyelinating polyneuropathy could start as GBS. Antiganglioside antibodies are associated with a more severe course; their concentration is higher at the onset of weakness. Pain is persistent during the whole disease evolution; in 40% patients is manifested before motor involvement. In 2011 were published the new Brighton diagnostic criteria (Sejvar et al.), validated in the Netherlands, India. IVIG and plasma exchange remain the main treatment in GBS, but as well the general treatment play an essential role. A special attention should be paid to the management of pain and fatigability. There are proposed systems to establish prognosis in GBS as EGRIS (Erasmus GBS Respiratory Insufficiency Score) and IGOS (International GBS Outcome Study). Ongoing trial of Eculizumab could bring promising results.

ELECTRONEUROMYOGRAPHY IN THE EVALUATION OF PERIPHERAL NERVE LESIONS OUTCOME

TUDOR LUPESCU Head of Neurology Department, “Agrippa Ionescu” Hospital, Bucharest, Romania

Electroneuromyography is an important diagnostic tool in the evaluation of peripheral nerve lesions. Knowledge regarding the nature of nerve injury (mechanism, localization) combined with the electrodiagnostic changes in evolution, can bring important information regarding the prognosis, the efficacy of the treatment, and of the neurorehabilitation outcome.

Thus, the factors taken into consideration are the type of nerve lesion, the extent of demyelination or axonal loss, the recruitment pattern in muscle supplied by the nerve, and the distance from the nerve injury to the muscle.

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KEY CONCEPTS IN NEUROREHABILITATION: EVIDENCE BASED MEDICINE, ExTERNAL VALIDITY AND INDIVIDUALIZED TREATMENT. HOw TO MATCH THEM?

DAFIN F. MUREȘANU Chairman Department of Clinical Neurosciences, University of Medicine and Pharmacy “Iuliu Hațieganu”, Cluj-Napoca, Romania

The last decade has been very fertile in the development of both neurosciences and evidence based medicine (EBM), even if sometimes they did not go hand in hand.

Evidence based medicine is a concept that tries to build clinical decisions based on empirical knowledge collected from randomized control trials (RCTs). RCTs were designed in order to avoid systematic sampling errors.

As we can see from the genomic, transcriptomic and proteomic studies of post lesional regulations, the biological reality of the nervous system is extremely complex and rather individualistic (neurotrophicity, neuroplasticity and neurogenesis responses).

Therefore, due to patients’ heterogeneous responsivity in clinical practice, the approach of neurorehabilitation should be more individualistic, with better chances to manage complex situations.

This presentation will analyze why RCTs concept is difficult to be applied to neurorehabilitation studies.

SHIFTING THE PARADIGM IN BRAIN PROTECTION AND RECOVERY


Nowadays, it is still difficult to find the correct therapeutic approach for brain protection and recovery in stroke, especially because we do not fully understand all of the endogenous neurobiological processes, the complete nature of the pathophysiological mechanisms and the links between these two categories.

Endogenous neurobiological processes, such as neurotrophicity, neuroprotection, neuroplasticity and neurogenesis, are central to protection and recovery and represent the background of endogenous defense activity (EDA).

Stroke pathological cascades contain a limited number of pathophysiological processes. It is characterized mainly by excitotoxicity, oxidative stress, inflammation, apoptotic-like processes and and important metabolic disturbances.

Pathophysiological processes share some common mechanisms with EDA (e.g.

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excitotoxicity and neurotrophicity together with neuroplasticity have, as a common important driver, the NMDAR activity; inflammation has an important contribution for neuroregeneration, stimulating neuroplasticity, via trophic factors).

Postlesional brain regulation is currently better understood. Every lesion in the nervous system triggers in the first minute an endogenous neuroprotective reaction. An endogenous repair process, combining neuroplasticity and neurogenesis follow this as a second answer. All these processes are initiated and regulated by endogenous biological molecules.

The biological reality of the nervous system is far more complex. In fact, there is an endogenous holistic process of neuroprotection and neurorecovery that should be approached therapeutically in an integrated way.

The current tendency to exclusively frame drug activity in terms of single mechanisms and single focus effect might distract from other paradigms with greater explanatory power and hinder the development of more effective treatment strategies.

A change of concept is required in pharmacological brain protection and recovery in stroke therapy.

This presentation briefly reviews the current and future considerations in this therapeutic strategy, including an integrated pharmacological approach, focusing on drugs with multimodal activity rather than single mechanism drugs, which usually are chemical drugs.

In line with this strategy the current presentation will also highlight the result of CARS Trial, one of the latest double blind placebo randomized controlled trial in the filed.

PHARMACOLOGICAL SUPPORT IN EARLY REHABILITATION THE CARS TRIAL RESULTS


BACKGROUND AND PURPOSE: The aim of this early neurorehabilitation trial was to investigate whether patients randomized to Cerebrolysin showed improved motor function of the upper extremities over 90 days in comparison with patients randomized to placebo.

METHODS: This study was designed as a prospective, randomized, double-blind, placebo-controlled, multicenter and parallel-group study. Patients were treated with Cerebrolysin (30ml/day) or placebo (saline) once daily over 21 days starting the treatment 24-72 hours after stroke onset. In addition, patients participated in a standardized rehabilitation program over 21 days starting within 72 hours after stroke onset. Primary endpoint was the action research arm test (ARAT) score on

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day 90. Safety assessment was based on adverse events, vital signs and laboratory parameters.

RESULTS: The nonparametric effect size on the ARAT score on Day 90 indicated a large superiority of Cerebrolysin as compared to placebo (MW=0.71, 95%CI 0.63-0.79). The multivariate effect size on the global status, as assessed by twelve different outcome scales, showed a small superiority (MW 0.60, P <0.0001). The rate of premature discontinuations was below 5% (3.8%). Cerebrolysin was safe and well tolerated.

CONCLUSIONS: Cerebrolysin had a beneficial effect on function and global outcome in early rehabilitation patients after stroke. The safety aspects of Cerebrolysin were comparable to placebo, thus suggesting a favorable benefit-risk ratio. Due to the size of the study the results should be confirmed by a high precision, large-scale randomized clinical trial.

MANAGEMENT OF OSTEOPOROSIS AND FRACTURE IN NEUROLOGICAL PATHOLOGY

ADRIANA SARAH NICA ”Carol Davila” University of Medicine and Pharmacy Bucharest National Institute of Rehabilitation, Physical Medicine and Balneology, Bucharest, Romania

The vulnerability of the neurological patient with disabilities has multiple faces. One of the sub- evaluated and underdiagnosed aspects refers to osteoporosis and secondary somatic complications of osteoporosis.

Especially after the age of 50, osteoporosis increases in the general population, and especially in the context of the developed neurological disabilities on the background of stroke, head injuries, vertebro-medullary trauma, multiple sclerosis and other neurodegenerative diseases. These categories of pathology, and especially stroke and VMT are high risk groups for the development of osteoporosis and fracture.

In case of VMT sequela, the osteoporosis process preferentially affects the trabecular bone, and the process accentuates after 16-24 months post trauma. The demineralization appears in the sub-lesion areas, predominantly on the antigravity stressed areas (distal femur, proximal tibia), and can be followed by the appearance of fracture (1-34%).

These patients, through prolonged rest and lack of physical solicitation develop a marked deconditioning syndrome with important echo over the osteoarticular somatic structures. The neurological lesions and the hormonal changes of these

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severe conditions can determine insulin resistance, increase of renal clearance, reduction of the intestinal absorption of calcium, vitamin D deficiency, gonadic function disturbance through the inhibition of the osteo-anabolic action of the sexual steroids, hyperleptinemia ( leptin representing a hormone with major role in the control of energetic intake and energy loss), pituitary suppression of TSH.

The evaluation of the neurological patient with disabilities, that can present hemiplegia, para or tetraparesis, or mixed clinical and functional aspects are evaluated from general clinical and functional point of view, neurological and locomotory, and paraclinical through radiological examination, bone mineral density evaluation, blood and urine analysis.

In this context, osteopenia is a critical point, frequently debated for its importance in the therapeutic decision. Possible microtrauma or recent trauma can be identified, frequently neglected, and also there can be recorded general state modifications: sweating, appetite, weight loss and the appearance of deformations of the limbs and spine.

The anamnesis records the situations with potential risk of falling, depending on the different daily activities (transfers, mobilization, dressing), and controls the presence of the pharmacological interaction over the vigilance state of the patient and the risk regarding balance affections.

The research over the last 15 years regarding mobilization and management of osteoporosis have brought therapeutic solutions for the general population. Although results are encouraging, a consensus doesn’t exist over the anti-osteoporotic therapy, and long term therapeutic algorithm is unclear. These circumstances justify the association between pharmacological therapy and non-pharmacological therapy that will include a correct training for transfers, orthesis and wheelchair utilization, use of electro-stimulation procedures, and also multiple categories of physical exercise programs.

In this therapeutic program, rearrangement of the patients establishment is imposed, with facilities according to the needs of the patient, in order to prevent the lack of physical solicitation due to fear and also risk of fracture. The importance of the patient’s education must not be neglected, through the initialize of preventive programs for falling, which impose the development of individual or group kinetotherapy programs with periodic evaluation.

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ORTHOSTATIC HYPOTENSION IN PARKINSON’S DISEASE

Lăcrămioara PERjU-DUMBRAVă University of Medicine and Pharmacy “Iuliu Hațieganu” , Cluj-Napoca, Romania

Besides the well-known motor symptoms, Parkinson’s disease (PD) patients show a large series of non-motor issues, including cardiovascular autonomic dysfunction (CAD). CAD occurs in almost all PD patients, and is reported even in the very early stages. They may represent a combination of peripheral sympathetic denervation (as documented with cardiac neuroimaging), and central mechanisms.

One of the most frequent symptoms of CAD is orthostatic hypotension (OH). It occurs in 30-60% of all patients with PD, with or without symptoms. In some patients OH can precede motor symptoms manifest and sometimes even PD diagnosis. OH is associated with older age, male sex, longer disease duration, posture and gait instability phenotype, low mini-mental state examination scores, visual hallucinations. It also increases the probability of falls and is an independent risk factor for mortality.

It must be considered that some PD patients might have the underlying pathology of OH but no apparent symptoms. Therefore CAD should be extensively evaluated by physical examination (Heart rate variability, Valsalva ratio, Blood Pressure responses to Valsalva Maneuver, Head-up tilt table testing) imaging techniques (cardiac uptake of MIBG and 6-[18F] fluorodopamine) and plasma norepinephrine concentration.

Treating OH in PD patients currently relies on non pharmacological approaches, such as reducing BP lowering drugs, ensuring adequate fluids, and salt supplementation.

Pharmacological treatments are effective, but often exacerbate supine hypertension.

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MODULATION OF wATER BUFFERING AS A TREATMENT OPTION FOR OEDEMA IN ISCHEMIC STROKE

DANIEL PIRICI1

MUREȘANU D.F.2, PIRICI I.3, TUDORICA V.4, BALSANU A.5, BOGDAN C.5 1. Department of Research Methodology and Immunohistochemistry, University of Medicine and Pharmacy of Craiova, Romania 2. Department of Clinical Neurosciences, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania 3. Department of Anatomy, University of Medicine and Pharmacy of Craiova 4. Department of Neurology, University of Medicine and Pharmacy of Craiova 5. Department of Physiology, University of Medicine and Pharmacy of Craiova

Formation of cerebral edema is a common pathological denominator in ischemic stroke. The only currently accepted non-surgical approach in the treatment of brain oedema is represented by parenteral administration of hypertonic solutions. Aquaporin-4 (AQP4) is an astrocytic membrane associated protein, representing the primary water channel in the mammalian brain, and controlling the bidirectional flux of water towards and from the brain parenchyma. Although its deletion has been showed to be protective against cerebral oedema on knock-out animal models, and a specific inhibitor (TGN-020) has been developed that showed on brain imaging reduced oedema on an animal model of stroke, there is yet no histopathological characterisation of its effects.

On a rat model of ischemic stroke, we have tested here the utility of the AQP4 inhibitor, as a treatment option aiming to reduce brain oedema. We have utilised 24 Sprague Dawley male rats with ages between 4-5 months, on which we induced a permanent occlusion of the middle cerebral artery by electrocauterisation. Half of the animals received a single intraperitoneal injection of the inhibitor at 15 minutes after inducing ischemia (100mg/kg), while the other half received an equivalent volume of saline. After three days the animals were sacrificed, perfused with saline and 10% neutral buffered formalin, and brains harvested. All tissue was processed for paraffin embedding, classic histopathology, single and multiple immunohistochemistry and in depth image analysis.

Treated animals showed compared to control cases significantly lesser haemorrhagic transformation events, lower neuropil density expansion, lower infiltration with endogenous albumin into the adjacent brain parenchyma, lower density of apoptotic cells, and reduced glial scar formation. We have moreover characterised the precise perivascular compartment where serum plasma influx seems to be blocked on during its passage towards the parenchyma as a result of the treatment.

This is the first histopathological report of the changes induced by systemic administration of an aquaporin-4 inhibitor, as a treatment option for oedema in

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ischemic stroke. The data presented here offers a histopathological substrate for its mechanism of action, further in depth characterisation opening the road for a future treatment option in ischemic stroke.

Acknowledgement: This work was supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNCS – UEFISCDI, project number PN-II-RU-TE-2014-4-0582, contract number 160/01.10.2015

ALPHA LIPOIC ACID - THE ROLE OF AN IDEAL ANTIOxIDANT IN NEUROREHABILITATION

GABRIEL PRADA Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Alpha-lipoic acid (ALA), also named Thioctic Acid, is a compound produced enzymatically in the mitochondria in small quantities from octanoic acid. It functions naturally as a co-enzyme for mitochondrial α-ketoglutarate dehydrogenase and pyruvate dehydrogenase, and thus serves a critical role in mitochondrial energy metabolism. ALA is an ideal antioxidant since it has both direct and indirect antioxidant effects and has both lipophilic and hydrophilic properties (thus considered universal antioxidant). It acts as a regenerator for other antioxidants (glutathione, alpha-tocopherol, vitamin C), scavenger for reactive oxygen species, and as a chelator of free metal ions.

Being both water and fat soluble, ALA readily crosses biological membranes, consequently reaching all compartments of the cell. Other effects are: inhibition of advanced glycation end-products, improvement of axonal transport and stimulation of nerve growth factor.

Since beneficial effects are achieved with low micromolar levels of ALA, it is possible that some of its therapeutic potential extends beyond the strict definition of an antioxidant. Current trials are investigating whether these beneficial properties of ALA make it an appropriate treatment not just for diabetes mellitus, but also for neuropathy, neurodegenerative diseases, ischemia reperfusion injury, atherosclerosis and insulin resistance. In addition, ALA represents a potential therapeutic agent for the vascular endothelium.

There are some evidences that emphasize the potential for ALA to maintain or improve neurological disorders (e.g. Alzheimer’s disease, multiple sclerosis), limit progression of cardiovascular disease, reduce chronic inflammatory conditions, as well as improve or maintain antioxidant/detoxification defences

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that otherwise decline with age. It is apparent that ALA is clinically effective in mitigating complications of diabetes and potentially, other vascular diseases. Thioctic Acid could also have an effect in acute and post-acute stroke due to its direct and indirect anti-oxidant properties.

NEUROVISUALIZATION AND EFFECTIVENESS OF TREATMENT OF PATIENTS wITH ISCHEMIC STROKE BY SYSTEMIC INTRAVENOUS THROMBOLYSIS

SORIN PLOTNICU1,2

EREMEI ZOTA1,2, DIANA ZAGADAILOV2, STANISLAV GROPPA1,2


Contemporary treatment of patients with acute ischemic stroke include: reperfusion strategies, basic treatment, secondary prevention and early rehabilitation.

Reperfusion strategies involve removal or dissolution of thrombus which caused cerebral vessel occlusion, and it should be performed in the first minutes / hours after the onset of clinical signs of a stroke, and the reversible brain changes could be assessed by neurovisualization methods.

Currently there are proposed several methods of reperfusion achieved by systemic intravenous thrombolysis, selective intra-arterial thrombolysis, mechanical thrombolysis and various combinations of these methods.

Intravenous rt-PA within the first 4.5 hours of acute ischemic stroke received the highest level of evidence (Class 1, Level A) and is recommended for use in the treatment of both acute ischemic stroke European guidelines, as well as from the US.

The study included 40 patients with acute ischemic stroke treated by systemic intravenous thrombolysis with rt-PA within the first 4.5 hours after the onset. Neurovisualization was achieved by performing CTNC (computed tomography non-contrast) and CTA (computed tomography angiography) at the onset, after 24 hours after thrombolytic therapy and CTNC after 30 days after the treatment . Were appreciated the initial brain changes, cases of occlusion recanalization and types of hemorrhagic transformation, when sings were present.

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wHAT THE STUDY OF SACCADES CAN TELL US IN MOVEMENT DISORDERS?

ALESSANDRA RUFA Unit Neurometabolic Disease and Dep. Neurological and Behavioural Sciences, Medical School, University of Siena, Italy

Saccades, antisaccades and fixation characteristics delineate specific oculomotor findings in movement disorders.

Saccadic eye movements are fast movements of repositioning of the fovea in a new point of interest in space. They can be made in response to an unattended visual target: the reflexive and visually guided saccades (VGS), or internally defined and self placed: the antisaccades. Fixational changes are involuntary movements that interrupt fixation causing visual instability and oscillations. They include various forms of nystagmus, and saccadic intrusions or oscillations. Structures in brainstem, cerebellum, and basal ganglia are recruited during the control of saccade starting, saccade dynamics and gaze holding. Therefore changes in VGS, antisaccade and various kind of nystagmus or saccadic intrusions and oscillations, determine peculiar oculomotor findings in specific movement disorders. Cerebellar ataxias are often associated with nystagmus, such as downbeat nystagmus, gaze evoked or rebound nystagmus, saccadic intrusions, oscillations (opsoclonus or flutter) and saccade dysmetria. Saccade speed is also abnormal in cerebellar ataxias. Saccadic intrusions, multistep saccades and hypometria are the hallmark of Parkinson’s disease. Slow vertical saccades and limitation of the range of vertical eye movements associated with saccadic intrusions are typically observed in PSP. In Huntington’s diseases there is a difficulty in saccade initiation, abnormal antisaccade execution, associated with a complete inability to suppress reflexive saccade to novel stimuli.

Here I report the principal abnormalities of saccades, antisaccades and fixations that may delineate peculiar oculomotor profiles in movement disorders.

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CO-ULTRAMICRONIZED PALMITOYLETHANOLAMIDE/LUTEOLIN PROMOTES OLIGODENDROCYTE MATURATION, PRECURSOR CELL SURVIVAL AND IMPROVES OUTCOME IN ExPERIMENTAL

AUTOIMMUNE ENCEPHALOMYELITIS

STEPHEN D. SKAPER MASSIMO BARBIERATO, LAURA FACCI, GABRIELLA CONTARINI, CARLA MARINELLI PIETRO GIUSTI Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy

Oligodendrocytes are the myelin-producing cells of the central nervous system responsible for ensheathment of axons. Oligodendrocytes have limited ability to repair the damage to themselves or to other nerve cells, as seen in multiple sclerosis (MS), a chronic neuroinflammatory demyelinating disorder of the central nervous system with a strong neurodegenerative component. MS lesions are characterized by the presence of undifferentiated oligodendrocyte precursor cells (OPCs), highlighting their inability to mature into myelin-producing oligodendrocytes. Thus, an important strategy may be to replace the lost oligodendrocytes and/or promote their maturation or proliferation. N-palmitoylethanolamine (PEA), an endogenous fatty acid amide belonging to the N-acylethanolamines family possesses analgesic, anti-inflammatory, and neuroprotective actions. Several recent studies show that a composite of co-ultramicronized PEA and the flavonoid luteolin (co-ultraPEALut, 10:1 by mass) to be more efficacious that PEA alone in improving outcome in experimental models of spinal cord and traumatic brain injuries. We examined the ability of co-ultraPEALut to promote the progression of OPCs into a differentiated phenotype. OPCs isolated from newborn rat cortical glial cell cultures were maintained under conditions which favor either differentiation (Sato’s medium) or proliferation (serum-free medium with fibroblast growth factor-2 and platelet-derived growth factor-AA (‘SFM’)). Co-ultraPEALut (10 μM) treatment of OPCs in Sato’s medium stimulated the morphological development, total protein content and gene expression (RT-PCR) for the major structural myelin proteins myelin basic protein (MBP) and proteolipid protein, the enzyme 2’,3’-cyclic nucleotide 3’-phosphodiesterase (thought to mediate process outgrowth in oligodendrocytes and play a critical role in the events leading up to myelination), together with genes coding for enzymes involved in cholesterol and fatty acid synthesis and antioxidant defense (catalase). Co-ultraPEALut also increased the content of MBP (Western blot) in OPCs in Sato’s medium. OPCs, maintained in an undifferentiated state (SFM) displayed improved survival capability in the presence of co-ultraPEALut and down-regulation of Apoe, whose deletion reportedly leads to a later time of

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peak symptoms/disease severity and less severe demyelination/axonal damage in myelin oligodendrocyte glycoprotein (MOG35-55)-induced experimental autoimmune encephalomyelitis (EAE). Importantly, co-ultraPEALut improved the clinical score in this EAE model in C57BL/6 mice, often used as a chronic monophasic model of MS. Hence, strategies intended to promote endogenous remyelination in MS patients should focus on both enhancing the long-term survival of OPCs and on stimulating these cells to proliferate and differentiate into remyelinating oligodendrocytes. Within this context, co-ultraPEALut may represent a novel pharmacological strategy.

Supported in part by MIUR, PON ‘Ricerca e Competitività 2007 - 2013’ project PON01_02512, and by Regione Veneto project protocol 103173COF/14/LR52001C2/000051.

MODERN INTERVENTIONAL TREATMENT IN ACUTE STROKE IN ROMANIA

CRISTINA TIU FLORINA ANTOCHI, BOGDAN DOROBAT, ELENA TERECOASA, OVIDIU BăjENARU University of Medicine and Pharmacy „Carol Davila”, University Hospital Bucharest, Romania

Stroke is the leading cause of morbidity and mortality in Romania. Primary and secondary prevention of stroke are insufficiently used by general practitioners or even by neurologists, and interventional treatment in acute stroke is available in only few centers. Remarcable efforts have been done in order to improve acute stroke care, the main result being the organization of the Priority Action of the Ministry of Health for Interventional treatment in acute stroke. The program is growing constantly and is inccluding intravenous thrombolysis and thrombectomy in acute ischemic stroke and endovascular treatment of subarachnoid hemorhage due to ruptured aneurysms. Sepparately there is a large experience of carotid stenting in over 10 years of endovascular treatment of internal carotid artery stenosis. The results of the Priority Action are registered in the Romanian National Registry of Interventional Treatment of the Acute Stroke, created by and belonging to the Romanian Society of Neurology from Romania. The annalysis of the results from the registry demonstrate a constant improvement of the specific timing for iv thrombolysis, and an annual increase in the number of acute stroke patients treated by interventional methods.

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EFFECTS OF AEROBIC TRAINING AFTER STROKE

CHRISTEL VANROY Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences at the University of Antwerp, Belgium

Background and purpose Several studies have investigated the immediate effects of aerobic training (AT) after stroke. In these studies, often less disabled patients were included and they were not coached to integrate exercises into daily living. This study aimed to examine long-term effects of AT followed by an coaching approach on aerobic capacity, strength and gait in subacute patients.

Methods Sixty consecutive stroke patients were randomly allocated to a 12-week Motomed training (MG) combined with educational sessions or to a control group (KG). Then MG was divided into a coaching and non-coaching group for 9 months. Assessments were made before and after training and at follow-up at six and 12 months. The aerobic capacity was determined with a maximal graded exercise test, isometric knee extension strength by a handheld dynamometer and gait with the Functional Ambulation Classification and the 10-meter walk.

Results Throughout the study significant within time interactions (p<0.0001) were found in peak oxygen consumption, peak work load, paretic leg strength and gait. Borderline significance was found for peak oxygen consumption (p=0.16) and peak work load (p=0.08) between MG and KG, whereby more disabled patients seemed to have more benefit from MG. The coaching approach revealed less deterioration of the nonparetic leg.

Conclusion MG combined with information sessions seem to become evident on peak oxygen consumption and workload, whereby more severe disabled patients appear to have more benefit from the MG. Coaching the patients after AT caused less deterioration in the strength of the nonparetic leg and peak work load at 12 months. Further research should focus on other coaching modalities and follow-up research to increase or preserve aerobic capacity, strength and gait speed.

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MODULATION OF CEREBRAL MICROVESSEL STRUCTURE AND PERMEABILITY IN VASCULAR COGNITIVE IMPAIRMENT

GREGORY DEL ZOPPO Department of Medicine, Department of Neurology, University of washington School of Medicine Seattle, washington USA

Vascular cognitive impairment (VCID) and vascular dementias are associated with changes in cerebral tissue structure and function that appear in relation to alterations to cerebral microvessels. Vascular abnormalities include microhemorrhages, other markers of increased permeability, matrix and protein deposits, and vascular involution. The latter is a common accompaniment of ageing. However, little is known about the molecular and structural events that occur within arterioles (small vessel disease), vessels <100 μm diameter, and capillaries. Cerebral capillaries consist of the endothelium, the extracellular matrix (ECM) of the basal lamina, and the astrocyte end-feet that communicate with the neurons they serve (the “neurovascular unit”). Pericytes and ancillary cells contribute to these cerebral vascular structures. All microvessel components participate in distinct and interacting networks. Changes in the neuropil accompanying VCID are reminiscent of vessel responses to focal ischemia.

Acute processes in the evolution of cerebral vascular injury caused by focal ischemia (ischemic stroke) can be seen in the cerebral capillary compartment within the neurovascular unit. Events within the capillary and the microvascular endothelium-matrix-astrocyte complex contribute to injury within the neuropil that lies below the resolution of clinical detection systems. Chronic and degenerative disorders of the neuropil (e.g. β-amyloid deposition in Alzheimer-type dementia, and ageing) are likely to have their origins in acute processes of VCID. Considered here are the possible acute processes that involve the cerebral microvasculature, in relation to the evolving understanding of acute alterations in microvessel structure/function following focal ischemia.

Focal ischemia causes loss of patency within the dependent microvasculature (focal “no-reflow”), restoration of which is possible and can rescue injury extent. The loss of patency coincides with rapid alterations in the relationships within the endothelium-matrix-astrocyte complex. This includes coincident i) decreases in endothelial cell β1-integrin and astrocyte β4-integrin expression, ii) increases in integrin αvβ3 expression, iii) decreases in astrocyte αβ-dystroglycan, iv) alterations in matrix composition by degradation, and v) changes in permeability that are reproducible in in vitro systems. Changes in microvessel cell function

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accompany these alterations in adhesion, which do not involve cell demise. Recent studies emphasize that β1-integrin receptor changes and alterations in ECM can significantly affect the permeability barrier. Ischemia can modulate the ultrastructural characteristics of both endothelial cells and astrocytes in regions of neuron injury. These changes have implications for intra- and inter-cellular signaling processes within the microvasculature and within the neurovascular unit. During focal ischemia loss of basal lamina ECM components and loss of heparan sulfates (HS) from perlecan characterizes structural distortion of microvessels. Accompanying these events are the acute generation and release of ECM proteinases and heparanase. Their impact on the neuropil is not yet understood. A number of similarities can be observed in the neural degenerative disorders of the CNS, characterized by cerebral amyloid angiopathy (CAA).

For instance, generation or deposition of β-amyloid (Aβ), perlecan, and HS in the parenchymal tissues and the blood vessels of the brain accompany some forms of cognitive impairment. In the blood vessels β-amyloid deposits are found predominantly in the walls of arterioles and arteries in the cortex and deep brain structures. This location explains the frequent lobar distribution of the amyloid-associated microhemorrhages. β-amyloid precursor protein (AβPP) is found less often in capillaries and veins, but when it is the AβPP infiltrates the basal lamina ECM, as well as the surrounding tissue. Aβ peptides could change cell-matrix interactions within brain microvessels and cause their instability, thereby promoting hemorrhage when the vessels are injured (e.g. microinfarctions, ageing). The notion that Aβ peptides themselves might directly promote hemorrhage by inhibiting thrombosis is suggested by AβPP structure and the potential role(s) of the Kunitz domain. Two isoforms of AβPP have Kunitz protein inhibitor (KPI) domains. One isoform of AβPP found in cerebral blood vessels and in brain deposits in Alzheimers patients has a KPI domain identical to protease nexin-2 (PN-2), a protein known to regulate hemostasis. The ability of AβPP/PN-2 to increase the size of the hemorrhage in one murine model suggests that some portion of the molecule has an anticoagulant effect. Mice lacking AβPP/PN-2 had decreased hemorrhage volume in another model study. The impacts of β-amyloid deposition or clearance within the microvasculature on its structural integrity and on hemostasis in gray matter and white matter integrity and function are still poorly understand.

Increased microvessel permeability may lead to local microglial activation, contributing to both tissue and further microvessel injury. The impact of innate inflammation within the neuropil on microvessel structure involves the participation of activated microglia, which release (pro-)MMP-9 and cathepsin L, both capable of modulating matrix structure. Containing these processes to the bed of injury is the focus of experimental treatment approaches.

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In concept, all of these events can be initiated by reduction in perfusion to the microvessel beds, which, without intervention, can lead to persistent low perfusion and chronic injury of the dependent tissue via secondary mechanisms suggested here. How ageing contributes to such injury is an important consideration.

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CURRICULUM VITAE

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IOANA ALExA

ROMANIA

PROFESSIONAL EXPERIENCEFeb 2015 – Professor Internal Medicine, Department of Internal Medicine, University of Medicine and Pharmacy „Gr.T. Popa” Iasi, Romania2007 – 2015 Assoc Professor2000 - 2007 Lecturer1990 - 2000 Assist Professor

Activities and main responsabilities: Academic activity with students and residents Research activity, mainly in the field of Internal medicine and GeriatricsPlace of work: University of Medicine and Pharmacy „Gr.T. Popa” Iasi, Romania

2008-present time Senior Specialist Geriatry-Gerontology2002-2008 Specialist Geriatry-Gerontology1998-present time Senior Specialist Internal Medicine1994-1998 Specialist Internal Medicine1991-1994 Resident doctor Internal Medicine

Activities and main responsabilities: Medical Doctor in Internal Medicine and GeriatricsPlace of work: University of Medicine and Pharmacy „Gr.T. Popa” Iasi, Romania

1989-1991 General Practitioner1986-1989 InternActivities and main responsabilities: Medical doctor/ Trainee

EDUCATION1980-1986 Diploma of Medical Doctor Curricula of the Faculty of Medicine University of Medicine and Pharmacy „Gr.T. Popa” Iasi, Romania

1994-1997 Ph D Diploma (confirmed by OM 5374/20.11.1997) In Medicine; the thesis with the title „Pregnancy-induced hypertension – new insights concerning pathophysiology and clinico-biological aspects”, scientific advisor prof. dr. V. Tacu

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PUBLICATIONS9 Books, 4 Chapters in books, 62 Papers

AFILLIATION TO PROFESSIONAL SOCIETIESThe Romanian Society of Internal MedicineThe European Society of Internal MedicineThe Romanian Society of Geriatrics and GerontologyThe European Society of GerontologyThe Balkanic Medical UnionThe Society of Physicians and Naturalists, Iasi, Romania

OVIDIU BăjENARU

ROMANIA

1983 : M.D. at the Faculty of Medecine of University of Medecine and Pharmacy “Carol Davila” Bucharest1983-1985 : post graduate hospital stagium in University Hospital of Emergency Bucharest1985- 1989 : resident of neurology 1985 : assistant professor – University of Medicine and Pharmacy “Carol Davila” Bucharest - Department of Neurology of the University Hospital of Emergency Bucharest1989 : specialist in neurology, confirmed by the Ministery of Health of Romania1993 : Ph.D. at the University of Medecine and Pharmacy “Carol Davila” Bucharest - senior lecturer of neurology - Head of Department and Medical Chief (University Hospital of Emergency, Bucharest1994 - 1999 : Associate Professor of Neurology 1999 (since) : Professor of Neurology at the University of Medicine and Pharmacy ” Carol Davila” Bucharest and Chairman of the Neurology Department of the University Hospital of Emergency Bucharest2006: : Doctor Honoris Causa - University „Ovidius” – Constanta ( Romania )

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2011 : Director of Department of Clinical Neurosciences - University of Medicine and Pharmacy ” Carol Davila” Bucharest2013 ( since) : Corresponding member of the Romanian Academy of Medical Sciences

Other professional activities :

2000-2004 : Vice-Dean of the Faculty of Medecine - University of Medecine and Pharmacy “Carol Davila” Bucharest2001-2013 : President(founder) of the Romanian Society of Neurology2013(since) : Honorary President ad vitam of the Romanian Society of Neurology2003-2009 : member of the Scientific Committee of ECTRIMS 2005-2009 : member of the Executive Committee of the European Society of Neurology2011 (since) : member of the National Committee of Habilitation of the Romanian Ministery of Education for PhD accreditation and high academic degrees

Post graduate training :

1992 - 1994 : post graduate training in clinical neurology and functional investigations of the nervous system at University “ Rene Descartes”(Paris) : C.H.U. Sainte-Anne (Neurology) and C.H.U. Cochin – Port Royal (Functional Investigations of the Nervous System) and training in neuroendocrinology 1996 : second medical competence (confirmed by the Ministery of Health of Romania) in “Diagnosis in Neurological Diseases by MRI”.1997 : assistant of clinical research in pharmaco-clinical trials (Paris)2009, 2011 : International training for methodology in clinical research

Fields of interest for the scientific research

• dementiaandneurodegenerativediseases(inparticularParkinson’sdisease)• multiplesclerosis• stroke• experimentalandclinicalstudyofsleepdisturbancesintheneurologicaland neuroendocrinologic diseases- more than 450 scientific papers published and reported in different national and international scientific meetings• ISIWebofScience: h-index:8 - 5 medical books and monographies ( published in Romania ) - co-author ( 1 chapter ) to the “International Neurology - A Clinical Approach” ( eds. ROBERT P. LISAK, DANIEL D. TRUONG, WILLIAM CARROLL, ROONGROJ BHIDAYASIRI ), Wiley-Blackwell , 2009- Country Principal Investigator – in more than 20 international, multicentric clinical trials- Principal Investigator of the research site – in more than 30 international and

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national multicentic trials- Member of the Steering Committee of PRECISE trial

Other activities:

- coordinator of the Continuous Medical Education ( EMC ) national program of the Romanian Society of Neurology for neurologists in Romania- coordinator and author of the Guidelines for diagnosis and treatment of neurological diseases ( agreed by the College of Medecins of Romania ) main author of the national guidelines for Parkinson’s disease, Multiple Sclerosis and Dementia- coordinator of the National Program of the National House of Insurance and Ministery of Health, for treatment of patients with neurological diseases (2000 - 2015)- coordinator of the first medical team in Romania for DBS in Parkinson’s disease. - chief-editor of Romanian Journal of Neurology ( the official journal of the Romanian Society of Neurology )

Scientific affiliation :• RomanianSocietyofNeurology(HonorayPresidentadvitam)• UEMS–EuropeanBoardofNeurology(SecretaryGeneral–electedin2010)• EuropeanNeurologicalSociety(ENS)–memberoftheExecutiveCommittee between 2005 – 2009• EuropeanStrokeOrganization• EuropeanFederationofNeurologicalSocieties(EFNS)andEuropeanAcademyof Neurolgy (since 2014)• AmericanAcademyofNeurology(coorespondingmember)• DanubeNeurologicalAssociation(Vice-SecretaryGeneral–electedin2011)• ECTRIMS(memberoftheScientificCouncil2003-2009)• NewYorkAcademyofSciences• AmericanAcademyforAdvancementinScience• MovementDisordersSociety• RomanianAssociationfortheStudyofPain• RomanianSocietyfortheStudyofNeuroplasticity(founderpresidentofhonour)

2005, 2006, 2010, 2011: awarded by the Prize of Excelence in Neurology for the scientific activity in Romania ( decided by a National Jury organized by the Health Chamber of the Romanian Parliament )2008: awarded by the Romanian Society of Internal Medicine for the best scientific activity in a related medical speciality2014: awarded by the International Brain Foundation and Romanian Academy of Medical Sciences, for excellency in the development of management of patients with multiple sclerosis in RomaniaInvestigator in an International Program of Research for genetic factors in stroke patients; Country Principal Investigator – in more than 30 international, multicentric clinical trials; Principal Investigator of the research site – in more than 30 international and national multicentic trials

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HEINRICH BINDER

AUSTRIA

EDUCATION:

1965 - 1972 Faculty of Medicine at the University Vienna MD since (promotion on) 1972, June 6th

1972 - 1978 University Hospital for Neurology, graduated in Medical Specialist for Neurology and Psychiatry

9/1982 Docent for neurology, a title corresponding to PhD

since 1988 Professor for Neurology, University Vienna founding member of the Austrian Society for Neurorehabilitation

5/1989 Head of the Neurological Hospital “Maria Theresien-Schlössel”

1994-2007 Head of Ludwig Boltzmann Insitute for Restorative Neurology and NeuromodulationSince 2008 Deputy Head of Landsteiner Institute for Neurorehabilitation and Space Medicinesince 2002 Head of the Neurological Center, Otto Wagner Hospital, Vienna. Main focus: Patients with severe neurological/ neuropsychological deficits and invasive neurorehabilitation methodscurrently President of • AustrianSocietyforNeurorehabilitation(OEGNR)• EuropeanFederationNeuroRehabilitationSocieties(EFNRS)Member of • ManagementCommitteeoftheWorldFederationNeuroRehabilitation(WFNR)• ManagingBoardoftheInternationalDanubeSymposium

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• EditorialBoardof”JournalofMedicineandLife”:Chairman of • SpecialInterestGroup/WFNR“SpinalCordInjury”• SpecialInterestGroup/WFNR“EarlyRehabilitation”• Scientificpanel/EFNS“BrainrecoveryandRehabilitation”• SpecialBranch/InternationalDanubeSymposium:“NeuroRehabilitation”

Main topic of research: Neurorehabilitation, brain injury, spinal cord injury, vegetative state/ apallic syndrome (more than 140 publications)

DANA BOERING

GERMANY

After graduation in medicine at the University of Cluj Napoca clinical training in internal medicine at the University Hospital Cluj, then, after resettlement in Germany, achievement of clinical training in neurology and neurorehabilitation in Kettwig and of neurophysiology at the Alfried Krupp Hospiltal Essen.

Between 2002 and 2016 head of the early rehabilitation department at the St Mauritius Therapieklinik Meerbusch with focus on disorders of consciousness in severe brain injured patients.

Since 2016 assistant medical director at the Gesundheitszentrum Bad Wimpfen

1994-2002 Collaboration with the University of Essen in the field of plasticity after stroke, with an emphasis on the role of the cerebellum in motoric learning tasks

Since 2002 Collaboration with the University of Düsseldorf in the field of plasticity after stroke

Since 2009 Collaboration with the Coma Science Group Liege Belgium

Member of the DOC special interest group of the IBIA.

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NATAN BORNSTEIN

ISRAEL

EDUCATION1970-73 University of Sienna, Medicine, Sienna, Italy1973-79 Technion Medical School, Hifa, Medicine, MD, 1979Date of receiving specialixation certificate: 11 September, 1984Title of Doctoral dissertation: Dextran 40 in acute ischemic strokeName of Supervisor: Dr. Jacob Vardi

FURTHER EDUCATION1978-83 Tel-Aviv University, Sackler Faculty of Medicine, neurology (residence), Israeli Board certified in Neurology, 19831979-83 Tel-Aviv University, Sackler Faculty of Medicine, Post graduate studies in Neurology1984-87 Sunnybrook Medical Center, University of Toronto, M.R.C stroke, Fellowship

ACADEMIC AND PROFESSIONAL EXPERIENCE1982-1995 Tel-Aviv University, Neurology, instructor1991-present European stroke Conference (ESC), Executive committee1995-1999 Tel-Aviv University, Neurology, Senior lecturer1995 Eliprodil CVD 715 clinical trial, Steering Committee1995-1997 International Stroke Study (IST), Steering Committee1995-1999 American Academy of Neurology, Member of the International Affairs Committee1996 Asymptomatic Carotid Stenosis and Risk of Stroke(ACSRS), Advisory Committee1996-present The Mediterranean Stroke Society (MSS), President1996-2002 EFNS, Management Committee1997-2009 Israeli Neurological Association, Secretary1999-present Tel-Aviv University, Neurology, Associated Professor2001- present European Society Neurosonology and Cerebral Hemodynamics (ESNCH) Executive committee2005-present Neurosonolgy Research Group, Executive committee2006-present European Master in Stroke Medicine, Member of faculty

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2006-2008 NEST II clinical Trial, Steering Committee2006-present SENTIS clinical Trial, Steering Committee2006-present CASTA Trial, Steering Committee2006-present Brainsgate clinical Trial, Steering Committee2008- present World Stroke Association (WSO), Vice president2009-present Israeli Neurological Association, Chairman2009-present European Stroke Organization (ESO), Member on the board of directors2010- NEST III clinical Trial, Steering Committee

PROFESSIONAL ACHIEVEMENTS- EDITORIAL BOARD1991-present Neurological Research Journal, Guest Editor1991-present STROKE, Member of the editorial board1998-present European Journal of Neurology, Member of the editorial board1999-present Journal of Cerebrovascular disease, Member of the editorial board2000-present Journal of Annals of Medical Science, Consulting Editor2001-present Journal of Neurological Science (Turkish), Member of the editorial board2001-present Acta Clinica Croatica, Member of the editorial Counsil2003-present Italian Heart Journal, International Scientific Board2003-present Journal of Neurological Sciences, Guest Editor2004-present Turkish Journal of Neurology, International Advisory Board2005-present Archives of Medical Sciences (AMS) , Member of the Editorial Board2006-present Journal of Cardiovascular Medicine, International Scientific Board2006-present International Journal of Stroke, Editorial Board2006-present Acta Neurologica Scandinavica, Editorial Board2009-present American Journal of Neuroprotection& Neurogeneration (AJNN) Member of the Editorial Board2010 Neurosonology, International Editorial Board2010 Frontiers in Stroke, Review Editor

PROFESSIONAL ACHIEVEMENTS- REVIEWER1998-present Lancet, Ad Hoc reviewer1998-present Diabetes and its complications, Ad Hoc reviewer1999-present Journal of Neuroimaging, Reviewer1999-present Journal of Neurology, Ad Hoc reviewer2000-present Neurology, Ad Hoc reviewer2003-present Israeli Medical Association Journal (IMAJ), Reviewer2003-present Acta Neurologica Scandinavica, Ad Hoc reviewer2006-present Journal of Neurology, Neurosurgery & Psychiatry, Reviewer2010- European Neurology, Ad Hoc reviewer

MEMBERSHIP IN PROFESSIONAL SOCIETIES1977-present Israeli Medical Association

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1983-present The Israeli Neurological Association1985-present Stroke Council of the American Heart Association (Fellow)1986-present American Academy of Neurology1986-present Neurosonology Research Group of the World Federation of Neurology1987-present Stroke Research Group of the World Federation of Neurology1990-2008 International Stroke Society1995-2008 European Stroke Council1995-present Mediterranean Stroke Society (MSS)1998-present European Neurosonology Society2005-present World Stroke Organization (WSO)2008-present Fellow of the European Stroke organization (FESO)

DUMITRU CERNOBROV REPUBLIC OF MOLDOVA

EDUCATION 1990 - 2000 General school # 26 (Chisinau) - Graduate1998 – 2000 Slavonic University, Courses of Foreign Language (English) Graduate2000 – 2006 State Medical and Pharmaceutical University “ N. Testemitanu”, General Medicine Department Medical Doctor, General Medicine2006 – 2009 State Medical and Pharmaceutical University “ N. Testemitanu”, Postgraduate Education Department, Neurology - Neurology2007 - 2010 Deutscher Lesesaal, German language course Graduate, B2 level2009 – 2011 State Medical and Pharmaceutical University “ N. Testemitanu”, Postgraduate Education Department, Neurology Neurorehabilitation

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PROFESSIONAL EXPERIENCE:May 2013 – present time Institute of Emergency Medicine; Neurologist, Neurological Intensive Care Unit mun. Chişinău, R. Moldova

August 2011 – May 2013 National Scientific Practical Center of Emergency Medicine; Neurologist, Stroke Unit; Neurological Intensive Care Unit mun. Chişinău, R. Moldova

July 2010 – December 2011 Municipality Hospital ” Sf Treime ” Neurologist mun. Chişinău, R. Moldova

November 2008 Clinical trials in Multiple Sclerosis– present time Study coordinator, treating neurologist mun. Chişinău, R. Moldova

June 2008 – present time State Medical and Pharmaceutical University “ N. Testemitanu” Scientific researcher mun. Chişinău, R. Moldova January 2008 Moldavian League Against Epilepsy– present time Treasurer mun. Chişinău, R. Moldova

May 2004 – June 2007 National Scientific Practical Center of Medical Emergencies; Nurse , Intensive Care Unit; mun. Chisinau, R. Moldova;

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NATALIA CIOBANU

REPUBLIC OF MOLDOVA

Occupational field Department of Neurology PhD student Work experience Period April 2015 – presentOccupation or position held ResearcherName and address of employer Neurology Departament. Institute of Emergency Medicine, Chisinau, Republic of MoldovaType of business or sector Within the project of the State Program “Systematization of risk factors, optimizing health care service, sustainable assessment and mathematical modeling of stroke’’ within the project:’’ Pecularities of pathogenic mechanisms, noninvasive and neurosurgical management of ischemic stroke in population of Republic of Moldova ‘’ Period November 2015 – presentOccupation or position held ResearcherName and address of employer Neurology Departament. Institute of Emergency Medicine, Chisinau, Republic of MoldovaType of business or sector Within the project: „Systematization of risk factors, pecularities, pathogenic mechanisms and developing treatment strategies of stroke in population of Republic of Moldova‘’ Period 2014 – presentOccupation or position held NeurologistName and address of employer Clinical Hospital of Traumatology and Orthopaedics, Chisinau, Republic of MoldovaType of business or sector Curative activity in neurology Period 2012 – 2015Occupation or position held NeurologistName and address of employer Institute of Emergency Medicine, Chisinau, Republic of Moldova

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Type of business or sector Curative activity in neurology Education and Training Period 2014 – presentQualification / diploma obtained PhD studentPrincipal subjects covered or skills acquired „Clinical Neurology”Education or training organisation’s name and locality Department of Neurology State University of Medicine and Pharmacy „Nicolae Testemiţanu” from the Republic of Moldova Period 2009 – 2012Qualification / diploma obtained Diploma of License DegreePrincipal subjects covered or skills acquired Postgraduate studies in residency - specialization of Neurology

Education or training organisation’s name and locality State University of Medicine and Pharmacy „Nicolae Testemiţanu” from Republic of Moldova Period 2002 – 2009Qualification / diploma obtained Diploma of Higher Education in the field of Medicine, Principal subjects covered or skills acquired In the field of MedicineSpeciality: General MedicineEducation or training organisation’s name and locality State University of Medicine and Pharmacy „Nicolae Testemiţanu” from the Republic of Moldova Period 1991 – 2002Qualification / diploma obtained Graduation DiplomaEducation or training organisation’s name and locality Theoretical Lyceum „M. Eminescu” Chisinau, Republic of Moldova

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DUMITRU CIOLAC

REPUBLIC OF MOLDOVA

Work experience 2014 –today Neurologist in National Center of Epileptology2014 – today Neurologist in Stroke Intensive Care Unit2013 – today Trainee scientist in Laboratory of Neurobiology and Medical Genetics2012 –today Lecturer at Histology, Cytology and Embryology Department Education and training 2015, October 1 - 3 5th National Congress of Neurologists of the Republic of Moldova 14th Symposium of Neurologists and Neurosurgeons Chisinau – Iasi Talk: “Importance of Dense Array EEG in localization of epileptogenic foci”

2015 April – 2016 April Grant Project: “Improovement of performances in neuroscince through scientific colaboration and acces to European Centres of Excellence” performer

2015 - 2018 Institutional Project: “Drug resistant epilepsy: risk factors, aspects of clinical, neuroimaging, neurophysiological polymorphism and their role in presurgical evaluation” performer

2015, June 1 - 5 5th European Teaching Course on Neurorehabilitation and 14th Congress of European Society for Clinical Neuropharmacology, Cluj Napoca, Romania Talk: “The Importance of High-Density EEG in The Detection of Epileptiform Interictal Changes And Location of The Epileptogenic Foci”

2015, 19 – 25 April Salzburg Medical Seminars on “Applied Clinical Research”

2014, November 28 – 29 “Teaching Course on Movement Disorders”, Chisinau, Moldova

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2014,11-13 June “Est-European Course of Epilepsy”, Cheile Grădiștei, România.

2014, March 23-26 Educational course held by Jorg Welmer -„MRI in Epilepsy”, Chisinau, Moldova

2014 - today National Transplantation Program, the diagnosis of brain death by Electroencephalography

2013, September 22 - 24 Listener at„The XIX-th Session of the Balkan Medical Days and the second Congress of Emergency Medicine of the Republic of Moldova”

2012, September 24-28 „1st International Course on Neuroepidemiology in Eastern Europe endorsed by the European Federation of Neurological Societies”, Chisinau, Moldova

2011-present Member of Neurology Society from Moldova

2011- 2014 Resident in Neurology at the Deparment of Neurology and Neurosurgery, State University of Medicine and Pharmacy „Nicolae Testemitanu”.

2004-2010 University degree at State University of Medicine and Pharmacy „Nicolae Testemitanu”, General Medicine faculty.

2000-2005 High school in Moldavian-Turkish Lycee, Chadir-Lunga city.

1993-2000 Primary russian school, Cantemir city. Additional Information - List of Publications

1. Groppa St., Duca V., Ciolac D. Correlative clinical, electroencephalography and neuroimaging patterns in Herpes Simplex Virus – type 1 encephalitis. Archives of the Balkan Medical Union. 2013; 48: 36-39. ISSN 1857-00112. Ciolac D., Covanțev S. The role of mast cells in inflammatory reaction in burn injury and post burn regeneration. Scientific Annals of SUMF “N. Testemițanu” 2013;4:143-1453. Ciolac D., Covanțev S. The role of mast cells in type 1 diabetes mellitus. Scientific Annals of SUMF “N. Testemițanu” 2013;4:167-1704. Duca V., Groppa St., Cobilețchi S., Onufrei I., Ciolac D. Multiple ischemic events caused by recurrent thromboembolism. Scientific Annals IEM 2012;1:17-215. Ciolac D., Groppa St. Integrating TMS and High Density EEG: a deeper insight into brain excitability and connectivity. Archives of the Balkan Medical Union. 2015; 50, 2(supl.1): 196-201 (ISSN 0041-6940)

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6. Ciolac D., Groppa St. Transcranial Magnetic Stimulation in newly diagnosed epilepsy. Bulletin of the Moldova Science Academy. Medical Sciences. 2015; 2 (47): 208-211. ISSN 1857-0011.7. Groppa St., Chiosa V., Munteanu C., Mișina L., Vataman A., Ciolac D., Gorincioi N. The importance of high-density EEG in detection of interictal epileptiform changes and localization of epileptogenic foci. Bulletin of the Moldova Science Academy. Medical Sciences. 2015; 2 (47): 201-2018.ISSN 1857-0011.8. Chiosa V., Ciolac D., Vataman A., Groppa St. Features of presurgical assesement of patients with pharmacoresistant epilepsy. Archives of the Balkan Medical Union. 2016; 51, 1(supl.1):195-199 (ISSN 0041-6940)

Personal skills and competences

Mother tongue RomanianOther languages Russian – C2, English – C1, Turkish – B, German – B 1.1Computer skills and competences: Good working knowledge of Windows and Microsoft Office

CRISTIAN FALUP-PECURARIU

ROMANIA

Cristian Falup-Pecurariu is Head of the Department of Neurology, County Emergency Clinic Hospital from Brasov, and is Lecturer of Neurology at the Transilvania University from Braşov, Romania. He received his medical degree from the University of Medicine and Pharmacy “Iuliu Haţieganu” from Cluj-Napoca.

He hold a 1 year fellowship of the European Neurological Society in movement disorders and sleep medicine at Hospital Clinic, University of Barcelona, Spain.

During his career Cristian Falup-Pecurariu was President of the European Association of Young Neurologists and Trainees (EAYNT), EAYNT Liasion Officer with World Federation of Neurological Society, co-representative of Europe on the International Working Group for Young Neurologists and Trainees (World Federation of Neurology). He was also Secretary of the EFNS/MDS-ES Panel on Movement Disorders, member of the Educational Committee of MDS-ES and currently is member of the MDS Leadership Task Force and European

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Academy of Neurology Scientific Panel Movement Disorders. He is member of EUROPAR (European Parkinson’s Group) and International Parkinson and Movement Disorders Society Non motor study group.

He is the initiator and Course Director of the Movement Disorders Teaching Course held in Brasov.

His research focuses on non-motor aspects of Parkinson’s diseases and restless legs syndrome.

ANTONIO FEDERICO

ITALY

Prof. Antonio Federico, born in Polla (Sa) on the 25.08.48, from 1990 is full professor of Neurology at the University of Siena , Director of the Unit Clinical Neurology and Neurometabolic Disease.

He was Director of the Department of Neurological, Neurosurgical and Behavioural Sciences, University of Siena ( 2002-2008).

He received the degree in Medicine and specialization in Nervous and Mental Diseases, summa cum laude, at the University of Naples in 1972 and 1975 respectively. He received the Lepetit Award for the best degree dissertation in 1972. His biological training was in the Institute of Biochemistry as student and after in Physiology of the University of Naples, and in the Centre de Neurochimie of CNRS, in Strasbourg, directed by prof. Mandel where he worked in the years 1973-75. He also collaborated with many international research groups, in different countries where he spent in the past years some times: in Montreal (Prof. Andermann, Karpati and Shoudgbridge), in London (dr A. Harding and prof. Morgan-Hughes), in Toronto (dr.Robinson), in Bonn (prof. von Bergmann) , in Paris (dr.Baumann), in Baltimore (proff. Moser and Naidu), in Oxford (prof. Matthews), etc.His clinical formation was made at the Medical School of the University of Naples, in the Dept, Neurology, and after in Siena, where he moved on 1980 with his mentor, prof. G.C. Guazzi. Associated professor in Neurology in 1982, since 1990 he is full professor of Neurology, Medical School, University of Siena.

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In 2013, he received honoris causa degree in Medicine at University Carol Davila, Bucharest, Rumania.

In the years 1990-96 he was Secretary of the Italian Society of Neurology. In the years 2006-08 was President of the Italian Society of Neurology.

He coordinated the Study Group on Clinical Neurogenetics of the Italian Society of Neurology.

He has been referee for projects evaluation in the area of Orphan drugs and Orphan diseases for Biomed Projects from EU, for MURST, CNR and Istituto Superiore di Sanità, and other national and international funding agencies, etc.

He is member of the Second Opinion Group of the American Leucodistrophy Association. Associated editor of Neurological Sciences in the past 3 years. From 2012, he is Editor-in Chief.

He is author of more than 500 article quoted by Pubmed. He is author of a chapter on Cerebrotendinous Xanthomatosis, Vinken and Bruyn Edts, Handbook of Clincal Neurology, vol 49, Neurodystrophies and Neurolipidoses. On the book McKusick’s Mendelian Inheritance in Man,. Ed.1992, Catalog of Autosomal Dominant and Recessive Phenotypes he is cited for 3 different diseases. He was editor of the book Late Onset Neurometabolic diseases (A.Federico, K. Suzuki and N.Baumann Edts), Karger 1991, and many other books from Italian and international Publishing Companies.Recently he published (2015) Manuale di Neurologia Pratica and Neurologia and Assistenza infermieristica, for students.

His main field of interest is related to neurometabolic, neurodegenerative and rare diseases, investigated from a genetic, metabolic, neuroimaging and clinical point of vue.

Summary of the academic involvements:- Director of the Section Neurological Sciences, Dept Neurological , Neurosurgical and Behavioural Sciences (2000-2012)- Director of the Research Center for the Diagnosis, Therapy and Prevention of the Neurohandicap and Rare Neurological Diseases, until the 2010- Vice-Dine of the Medical School, University of Siena (2003-2006)- Director of the Postgraduate School of Neurology, University of Siena, from 2006 up to 2014.- Director of the PhD School in Cognitive and Neurological Sciences, University of Siena (from 2000 up to date)- Coordinator of the Section of the Univ. Siena of the PhD Program Neurosciences, Univ. Florence.- Research delegate for the Dept Medicine, Surgery and Neurosciences (2013- )- Vice-Rector of the University of Siena, from 1st april 2016.

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Medical Involvements- Director of the OU Clinical Neurology and Neurometabolic Diseases, University Hospital of Siena Medical School.- Director of the Regional Reference Center for Rare Diseases- Regional Coordinator of the Network for Rare Neurological Diseases, Tuscany Region.- Member of several Ministry of Health and Regional Committees National and International Commitments- President of the Italian Society of Neurology (2009-11)- Italian delegate to the World Federation of Neurology- Italian Delegate to the European Union of Medical Specialists ( Section Neurology)- Italian Delegate and Chairman of the Neuromediterraneum Forum and President- Consultive Member of the European Brain Council- Editor – in – Chief of Neurological Sciences, Springer Verlag Editor. He is in the Editorial Board of many national and international journals.- Member of the American Panel United Leucodystrophies.- Member of the Scientific Committee of AISM (Associazione Italiana Sclerosi Multipla)- Chairman of the Scientific Committee of the European Academy of Neurology- Chairman of Neuromediterraneum Forum- Co-Chairman of Research group of WFN Migration Neurology

Member of the Scientific Societies:- Società Italiana di Neurologia (Past Secretary, President, Past-President and Member of the Committee)- Society for the Inborn Errors of Metabolism- Italian Association of Neuropathology- SINDEM (Italian Association of Dementias)- Italian Association for Parkinson’s disease- Italian Association of Neurogeriatrics ( Member of the Scientific Committee)- Italian Stroke Forum- European Academy of Neurology (Member of the Board and Chairman of the Scientific Committee)- American Academy of Neurology- World Federation of Neurology (Co-Chair Section of Migration Neurology)- Neuromediterraneum Forum ( President)

His present positions are:full professor of Neurology, University of Siena, Medical School- Director of Unit Clinical Neurology and Neurometabolic Diseases, Siena Hospital.- Past-Director of the Section Neurological Diseases of the Department of Neurological and Behavioural Sciences of the University of Siena since the 2012, at the fusion of this Department in the Dept Medicine, Surgery and Neurosciences.

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- Italian Delegate to the World Federation of Neurology and to European Academy of Neurology Council.- Past- President of the Italian Society of Neurology ( President years 2009-2011) - From 1995 he is Director of a PhD Programme on Applied Neurological Sciences at University of Siena, from 2004 of the European PhD Programme and European School of Doctorate of Applied Neurological Sciences. Since 2011 he is director of the PhD Programme on Cognitive and Neurological Sciences at University of Siena.- He is Italian member of the Committee of European Union of Medical Specialists, in the section Neurology.- Delegate for Research in the Dept. Medicine, Surgery and Neurosciences.- Coordinator for the Tuscany Region of the Network on Rare Neurological Diseases.- On 2013, he received Honoris Causa degree from the University Carol Davila, Bucharest- Chairman of the Neuromediterraneum Forum- Editor in Chief of Neurological Sciences, Springer-Verlag Editor.- Co-Editor of many international journals.- On the 2014 was nominate WHO consultant for Rare Neurological Diseases.- From june 2014, he is Chairman of the Scientific Committee and Member of the Board of the European Academy of Neurology- From February 2015 Co-Chairman of the Research Group Migration Neurology of the World Federation of Neurology.- From the 1st april 2016, vice-Rector of the University of Siena.

MARC FISHER

USA

Dr. Fisher was affiliated with the University of Massachusetts Medical School for 35 years and is currently an emeritus Professor of Neurology. He began work part-time at Beth Israel Deaconess Medical Center in Boston with an appointment at Harvard Medical School in August, 2014. He has a long track record in performing MRI-based experiments in rat stroke models to evaluate the presence and evolution of the ischemic penumbra. Using diffusion/perfusion MRI his experimental group has evaluated the effects of therapies on the progression of the diffusion/perfusion mismatch. Dr. Fisher has extensive experience in organizing and implementing clinical acute stroke therapy trials with a particular interest

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in imaging-based trials. He has performed these trials with co-investigators at multiple sites around the world. He has maintained an active clinical practice for many years with an emphasis on patients with cerebrovascular disorders as well as broad range of other neurological illnesses. He has published extensively and has published over 260 peer-reviewed articles with an h-index of 72 and has edited or co-edited 13 books. He currently serves as editor-in-chief of Stroke and will continue in that position until 2020.

ALExANDRU GASNAȘ

REPUBLIC OF MOLDOVA

WORK EXPERIENCE 2012 – today Neurologist in IH Medpark 2014 – today Consultant in the Department of Neurology of Institute of Emergency Medicine2009 – today Scientist in Laboratory of Neurobiology and Medical Genetics 2015 – today Performer in the State Program :Peculiarities of pathogenic mechanisms, noninvasive and neurosurgical management of ischemic stroke in the population of Moldova.2014 – today Lecturer at Neurology and Neurosurgery department at State University of Medicine and Pharmacy “Nicolae Testemitanu2015 – today Scientific Secretary of Neurology Society from Moldova EDUCATION AND TRAINING 2016, April 21-24 Neurology internship, Polisano Clinic, Sibiu, Romania

2016, April 7-8 2nd International Conference “Imaging in Congenital Heart Interventions”, Lund, Sweden.2015, October 1 - 3 5th National Congress of Neurologists of the Republic of Moldova 14th Symposium of Neurologists and Neurosurgeons Chisinau – Iasi Talk: “Brain neuroplasticity and connectivity studies” 2015 April – 2016 April Grant Project: “Improovement of performances in neuroscince

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through scientific colaboration and acces to European Centres of Excellence” performer

2015 - 2018 Institutional Project: “Drug resistant epilepsy: risk factors, aspects of clinical, neuroimaging, neurophysiological polymorphism and their role in presurgical evaluation” performer

2015, June 1 - 5 5th European Teaching Course on Neurorehabilitation and 14th Congress of European Society for Clinical Neuropharmacology, Cluj Napoca, Romania Talk: “Transcranial Magnetic Stimulation (TMS) and results of connectivity studies in acute ischemic stroke ”

2015, 1 – 8 March Salzburg Medical Seminars on “Weill Cornell Seminar in Neurology”

2014, November 28 – 29 “Teaching Course on Movement Disorders”, Chisinau, Moldova

2012 - today Transcranial Magnetic Stimulation Program, neuroreabilitation after stroke by TMS

2013, September 22 - 24 Speaker at„The XIX-th Session of the Balkan Medical Days and the second Congress of Emergency Medicine of the Republic of Moldova”

2012, September 24-28 „1st International Course on Neuroepidemiology in Eastern Europe endorsed by the European Federation of Neurological Societies”, Chisinau, Moldova

2011-present Member of Neurology Society from Moldova

2011-till present PhD candidate- Transcranial magnetic stimulation in aute phase of ischemic stroke

2008- 2011 Resident in Neurology at the Deparment of Neurology and Neurosurgery, State University of Medicine and Pharmacy „Nicolae Testemitanu”.

2002-2008 University degree at State University of Medicine and Pharmacy „Nicolae Testemitanu”, General Medicine faculty.

1991-2002 Academic Romanian-English Lyceum Mircea Eliade

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Additional Information - List of Publications

1. GROPPA,Stanislav.;Gasnaș, A.; Transcranial Magnetic Stimulation And Results of connectivity studies of acute ischemic stroke.Archives of the Balkan Medical Union 03/2013; 48(3):215-2172. GROPPA, St.,Gasnaș, AL.,ZOTA, E., CERNOBROV, D. Strategii actuale de recanalizare in AVC ischemic acut. Conferinţa Ştiinţifică Anuală a Colaboratorilor şi Studenţilor USMF “Nicolae Testemiţanu” 0ctombrie 17-19 ,20123. GROPPA ST. ZOTA E. PLOTNICU S Gasnaș A. CHIOSA V. CERNOBROV D.; Protocol de evaluare a pacientului cu accident vascular cerebral acut. „ACTUALITĂŢI ÎN NEUROURGENŢE”, Institutul de Medicina Urgenta, 2013, 15 noiembrie 2013 F/C4. GROPPA ST. ZOTA E. PLOTNICU S Gasnaș A. CHIOSA V.; Conferinţa Ştiinţifică Anuală a Colaboratorilor şi Studenţilor USMF “Nicolae Testemiţanu”. Moldova, Octombrie 20135. GROPPA ST. ZOTA E. CHIOSA V. Gasnaș A.; Conferinţa ştiinţifico-practică „Actualităţi în neuroştiinţe” în cadrul Expoziţiei internaţionale specializate MoldMedizin & MoldDent. Stimularea magnetică transcorticală: indicaţii diagnostice şi tratament. Moldova ,Chisinau,2013, Moldexpo.)6. Gasnaș,ALEXANDRU.;“Stimularea magnetică transcraniană şi rezultatele studiilor de conectivitate în AVC ischemic acut. Caz clinic.”. Conferinta anuala a colaboratorilor si studentilor USMF consacrata “Zilelor Universitatii”. Chisinau, Moldova, Institutul de Neurologie si Neurochirurgie,15-17 octombrie, 20147. Gasnaș,ALEXANDRU.;“Stimularea magnetică transcraniană şi rezultatele studiilor de conectivitate în AVC ischemic acut. Caz clinic.”. Conferinta Anuala a Tinerilor Specialisti. Chisinau, Moldova, Institutul de Medicina Urgenta, 20148. Gasnaș A., BARBARII C., AFTENE D. Manifestările clinice şi managementul farmacologic al tulburărilor de mişcare după accident vascular cerebral. Caz clinic. Simpozionul al XIV-lea al Neurologilor şi Neurochirurgilor Chişinău-Iaşi, 1-3 octombrie 20159. Stanislav Groppa, Vitalie Chiosa, Bălănuță Tatiana, Gasnaș Alexandru, Ciolac Dumitru.; Aprecierea stării funcționale a structurilor neuronale și de transmitere aferente și eferente ale sistemului nervos central și periferic prin metoda examenului complexa XIV-a ediție a Expoziției internaționale specializate „INFOINVENT” Moldova, 25 - 28 noiembrie10. Georghe Ciobanu, Vitalie Chiosa, Alexandru Gasnaş , Implementarea stimulării magnetice transcraniene în practica neurologică în republica moldova. XII-a ediție a Expoziției internaționale specializate „INFOINVENT” Moldova,19-20 noiembrie 2013

Fields of special interests Transcranial magnetic stimulation, Neuroplasticity, Ischemic tolerance of the nervouse system and vascular cerebral diseases

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STANISLAV GROPPA

REPUBLIC OF MOLDOVA

Stanislav Groppa, MD, PhD, Professor, Academician of Academy of Science of Moldova,

Neurologist, Head of Department of Neurology of continue postgraduate training of State University of Medicine and Pharmacy “N. Testemițanu”, director of the Clinic of Neurology and Neurosurgery of Emergency Medicine Institute, Head of the Laboratory of Neurobiology and Medical Genetics.

Graduated the State University of Medicine and Pharmacy “N. Testemițanu “ and at the age of 29 years submitted the doctoral thesis in Health Sciences and was deputy-rector, at the age of 35 -submitted the PhD thesis and at 39 was conferred the title of professor. In 2007, he became member of the Academy of Sciences, and elected academician- coordinator of the Health Sciences Section of the Academy of Sciences and in 2012- member of ASM. He is vice president of the Academy of Sciences. Honorary member of the Academy of Medical Sciences of Romania.

He went on internships abroad (Russia, USA, Germany, China, Australia, Italy and other) , worked and continues to work with scientists and scientific institutions from several countries.

Under his direction it was submitted 16 doctoral theses of medical sciences, including 3 PhD. Is the holder of several patents and inventions. He is concerned within 3 main areas: stroke, epilepsy and pain management. He is also a member of several international societies, including the National Council of cerebrovascular diseases in the US; Professor of European Academy of Epileptology ; member of European Academy of Neurology.

Professor S. Groppa is the president of the League Against Epilepsy from Moldova, President of the Society for the fight against cerebrovascular disease, Vice President of the Society of Neurology of Moldova. He is a member of the editorial board of several national and international journals.

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ALLA GUEKHT

RUSSIA

Professor, Department of Neurology and Neurosurgery, Russian National Research Medical University and Director, Moscow Research and Clinical Center for Neuropsychiatry, Russia

Professor Guekht’s research interests are in epilepsy, neuroepidemiology and vascular dementia.

She received her MD degree from the 2nd Moscow Medical Institute and held a residency in Neurology at the same medical school where she completed PhD on EEG monitoring in carotid surgery and subsequently - doctoral dissertation on Brain plasticity and restoration after stroke.

She received several prestigious International Awards, including Bruce S. Schoenberg International Award in Neuroepidemiology for her research in post-stroke epilepsy.

Professor Guekht has authored more than150 Pubmed-listed publications and 11 books on Neurology and Epileptology, including the National guidelines and Manual in Neurology; she serves on the Editorial Boards of several international journals.

She is the member of several Committees of the World Federation of Neurology and the European Federation of Neurological Societies, Secretary of the Commission on European Affairs of the International League against Epilepsy. Professor Guekht serves in the International Organizing / Program Committees for the several International and European Congress on neurology, epileptology, vascular dementia; she is the invited speaker at many International and European Congresses.

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VOLKER HÖMBERG

GERMANY

MEDICAL DIRECTOR St. Mauritius Therapy Hospital Meerbusch

Personal Data Born 25 July 1954

Business phone (Secrs Mrs Reinhard, Mrs Teschner) 0049 7063 522234Email:[email protected]

Medical Career

1973 - 1980 Medical School, Universities of Düsseldorf and Freiburg; Electives in Neurology at Boston City Hospital, Boston, Mass.; National Hospital for Nervous Diseases, London

1975-1980 Junior researcher in the Department of Neuropsychology at the C. & O. Vogt Institute for Brain Research, Düsseldorf and the Department of Neurology, Freiburg (Prof. R. Jung)

1980 - 1981 Research fellow in the Department of Neuropsychology (Prof. G. Grünewald) at the C. & O. Vogt Institute for Brain Research, Düsseldorf

1981-1986 Clinical training in the Department of Neurology (Prof. H.-J. Freund), Heinrich-Heine-University Düsseldorf

since 1985 Senior registrar in the Department of Neurology, Heinrich-Heine- University Düsseldorf

1987-1996 Senior investigator for the German Research Council Special Task Force in Neurology at Heinrich-Heine-University (SFB 200 and SFB 194)

1987-2005 Medical director of the Neurological Therapy Center (NTC), Heinrich- Heine-University Düsseldorf

Since 1988 Board examiner for Neurology at the local examination board (Ärztekammer Nordrhein)

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1989-1997 Vice president of the German Society for Neurological Rehabilitation

1993 Habilitation in Neurology, Heinrich-Heine-University Düsseldorf

Since 1995 Board examiner for physical medicine and rehabilitation (Ärztekammer Nordrhein)

1997-2005 Medical director of the Neurological Therapy Center, Cologne

1998-2004 President of the German Society for Neurological Rehabilitation

2000 to 2010 Medical director and head of Neurology, St. Mauritius Therapy Hospital, Meerbusch

Since 10/2011 Head of Neurology SRH Gesundheitszentrum Bad Wimpfen

10/2004 to 12/2010 Vice president of the German Society for Neurological Rehabilitation

2005 to 2010 Panel-Chairman Neurorehabilitation for European Federation Neurological Societies (EFNS)

Since 12/2010 Member of the board (DGNR)

Since 2003 Secretary General World Federation for NeuroRehabilitation (WFNR)

Since 2011 Secretary General European Federation of Neurorehabilitation Societies (EFNR)

Since 2015 Vice President of EFNR

Areas of scientific interest Motor control Neuropsychology, Brain plasticity Epistemology of rehabilitation sciences Pharmacology in neurorehablitation

Publications more than 200 original articles in peer reviewed journals

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KURT jELLINGER

AUSTRIA

Born in Vienna on May 28, 1931, MD study Univ. of Vienna School of Medicine; specialist in neurology, neuropathology and psychiatry; Ass. Prof. Institute of Neurology Vienna (1966), Full Professor of neuropathology Med. Univ. Vienna (1973), director Dept. of Neurology, Lainz-Hospital, Vienna (1976-30 September 1997); Director, Ludwig Boltzmann Institute of Clinical Neurobiology, Vienna (1977-2002); Guest Professor Univ.of Graz & Innsbruck School of Medicine (1998-2000); since May 2002 Chief, Institute of Clinical Neurobiology, Vienna, Austria.

Member of many national and international societies, honorary member of German and Austrian Societies of Neurology, Neuropathology, Alzheimer and Parkinson disease societies, French and Hungarian societies of Neurology, Intl. Soc. of Neuropathology. Honorary foreign member of the Romanian Academy of Medical Sciences. Several national and international awards (for Med. Science, City of Vienna, Alzheimer-Obelisk, Senator Burda and Lundbeck awards for Parkinson research, A.M.Jakob medal of German Soc. of Neuropathology, Meritorial Service award Amer. Ass. Neuropathol., G. Cotzias Award of the Spanish Soc. of Neurology.Executive editor Acta Neuropathologica (1978-2005), member of editorial boards of many international journals. 564 papers in international refereed journals and 329 reviews and chapters in handbooks, editor and co-editor of 10 books. Reviewer for many international scientific journals.

Expertise / research interests:Neuropathology, brain aging, Parkinson’s disease, Alzheimer’s disease, non-Alzheimer dementias, movement disorders, CNS aging, neurodegenerative disorders and vascular dementia, multiple system atrophy.

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MATTHIAS KIENLE

GERMANY

PROFESSIONAL EXPERIENCE:

January 2011- present

•MagVentureA/SFarumDenmark,InternationalApplicationSpecialist •Mydutiesincludeusertrainingondevicehandlingandclinicalapplication in Neurology, Psychiatry, Brain Research, Neurorehabilitation •Furthermore,I’mresponsibleinestablishingreferencesitesforMagnetic Stimulation in Diagnostic, Research and Treatment

August 2007 – December 2010

•AlpineBiomedGmbHLangenfeldGermany,ProductManager/ Specialist for NeuroDiagnostic •Iwasresponsibleforusertrainingondevicehandlingandclinicalapplication in Neurology, NeuroSurgery and Neurorehabilitation (EMG, NCV, EP, ERP, IOM, EEG, Sleep)

September 1998 – August 2007

•MedtronicGmbHDusseldorfGermany,ProductManager/ Specialist for NeuroDiagnostic •Iwasresponsibleforusertrainingondevicehandlingandclinicalapplication in Neurology, NeuroSurgery and Neurorehabilitation (EMG, NCV, EP, ERP, IOM, EEG, Sleep)

September 1996 – August 1998

• Schwamedico GmbH Giessen Germany, Product Specialist for Acupuncture,TENS

January 1993 – August 1996

•ProScienceResearchCenterLindenGermany,Assistantfor Neuropharmacological Research

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March 1987 – December 1992

•UniversityHospitalGiessen,NurseNeurosurgeryIntensiveCareUnit

EDUCATION/ QUALIFICATION

2002 – Physiotherapy: Basic Education Munich School of Physioterapy1993 – Graduation: Diplom – Ingenieur FH Biomedizinische Technik, Fachochschule Gieβen-Friedberg

VITALIE LISNIC

REPUBLIC OF MOLDOVA

Dr. Vitalie Lisnic is a Professor of Neurology at Department of Neurology of the State University of Medicine and Pharmacy „Nicolae Testemitanu”, Chisinau, Republic of Moldova. He is a consultant in the Department of Vertebroneurology and Neuropathies, responsible for electromyographic examinations at the Institute of Neurology and Neurosurgery in Chisinau.

Dr. Lisnic graduated the Faculty of General Medicine of the Chisinau State Medical Institute in 1989. He passed internships in Neurology and Neurophysiology in Moscow (Russian Federation) in 1993, Charles University, Pilsen (Czech Republic) in 1994, Landesnervenklinik of Salzburg (Austria) in 1999, Emory University, Atlanta (USA) in 2002 and 2003, Vienna University (Austria) in 2008. In 2003 obtained a clinical attachment in neuropathies at the National Institute of Neurology, Queen’s Square, London, UK. In 2003-2004 he was the Principal Investigator of the Moldovan team of the grant of the Moldovan Research and Development Association and U.S. Civilian Research and Development Foundation.

Dr. Lisnic other important responsibilities include the following:• PresidentoftheMoldovanNeurologicalAssociation• MemberoftheEducationCommitteeoftheEuropeanAcademyofNeurology• DelegateoftheRepublicofMoldovainWorldFederationofNeurologyand European Academy of Neurology• MemberoftheAmericanAcademyofNeurology• MemberofMovementDisordersSociety

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• Memberofeditorialboardof2MoldovanandoneUkrainianmedicaljournals

Dr. Vitalie Lisnic is the author of more than 150 scientific publications in Moldovan and International biomedical journals. Under his guidance were defended 4 Ph.D theses.

TUDOR LUPESCU

ROMANIA

Tudor Lupescu obtained his medical degree from “Carol Davila” University of Medicine in Bucharest, in 1989. After 3 years of training at Colentina Clinical Hospital he became Specialist in Neurology in 1994. Since 2006 he is running the Neurology Department al Agrippa Ionescu Hospital in Bucharest. 1998, he qualified as Consultant Neurologist. Since his early years of training in Neurology, Tudor Lupescu has shown a special interest in Clinical Neurophysiology. In 2000 he earned a Competence in Clinical Neurophysiology (EEG, EMG, and Evoked Potentials). 1997 he was the first to use Transcranial Magnetic Stimulation in Romania. This was also the subject of his PhD thesis presented in 2005. Since 2008, Tudor Lupescu is President of ASNER – Romanian Society of Electrodiagnostic Neurophysiology. He is also founding member and vicepresident of the the Romanian Society of Diabetic Neuropathy.

Dr Tudor Lupescu is associate member of the American Academy of Neurology, and associate member of the American Association of Neuromuscular and Electrodiagnostic Medicine. Between 2008 and 2013 he was also member of the Neurophysiology Subcommittee of ENS.

Since 2016 member of the EAN, and member of the Clinical Neurophysiology Scientific Panel of the EAN.

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DAFIN F. MUREȘANU

ROMANIA

Dafin F. Mureșanu, MD, PhD, MBA, FANA Professor of Neurology, Senior Neurologist, Chairman of the Neurosciences Department, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, President of the Romanian Society of Neurology, President of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN), member of the Academy of Medical Sciences, Romania, secretary of its Cluj Branch. He is also member of 13 scientific international societies (being member of the American Neurological Association (ANA) - Fellow of ANA (FANA) since 2012) and 7 national ones, being part of the executive board of most of these societies. Professor Dafin F. Mureșanu is a specialist in Leadership and Management of Research and Health Care Systems (specialization in Management and Leadership, Arthur Anderson Institute, Illinois, USA, 1998 and several international courses and training stages in Neurology, research, management and leadership). Professor Dafin F. Mureșanu is coordinator in international educational programs of European Master (i.e. European Master in Stroke Medicine, University of Krems), organizer and co-organizer of many educational projects: European and international schools and courses (International School of Neurology, European Stroke Organisation summer School, Danubian Neurological Society Teaching Courses, Seminars - Department of Neurosciences, European Teaching Courses on Neurorehabilitation) and scientific events: congresses, conferences, symposia (International Congresses of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN), International Association of Neurorestoratology (IANR) & Global College for Neuroprotection and Neuroregeneration (GCNN) Conferences, Vascular Dementia Congresses (VaD), World Congresses on Controversies in Neurology (CONy), Danube Society Neurology Congresses, World Academy for Multidisciplinary Neurotraumatolgy (AMN) Congresses, Congresses of European Society for Clinical Neuropharmacology, European Congresses of Neurorehabilitation). His activity includes involvement in many national and international clinical studies and research projects, over 350 scientific participations as “invited speaker” in national and international scientific events, a significant portfolio of scientific articles (134 papers indexed on Web of Science-ISI, H-index: 15) as well as contributions in monographs and books published by prestigious international publishing houses. Prof. Dr. Dafin F. Mureșanu has been honoured with: the Academy of Romanian Scientists, “Carol Davila Award for Medical Sciences / 2011”, for the contribution to the Neurosurgery book “Tratat de Neurochirurgie” (vol.2), Editura Medicala, Bucuresti, 2011; the Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca “Octavian Fodor Award” for the best scientific activity of the year 2010 and the 2009 Romanian Academy “Gheorghe Marinescu Award” for advanced contributions in Neuroprotection and Neuroplasticity

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ADRIANA SARAH NICA

ROMANIA

CURRENT POSITION- Professor in Physical Medicine, Rehabilitation and Balneoclimatology at the University of Medicine “Carol Davila”, Bucharest- Head of Rehabilitation Department - University of Medicine “Carol Davila”, Bucharest - PhD- Chief of University Rehabilitation Department III – National Institute of Rehabilitation, Physical Medicine and Balneoclimatology- European Board certified in PRM- EFIC Councilor for Romania- Senior consultant in Physical Medicine and Rehabilitation

MEDICAL CAREER1978 – MD at the Faculty of Medicine – University of Medicine “Carol Davila”, Bucharest 1982 – University assistant and resident doctor – Balneoclimatology, Sport Medicine and Physical Medicine – University of Medicine “Carol Davila”, Bucharest 1985 – Specialist in Balneoclimatology, Sport Medicine and Physical Medicine – University of Medicine “Carol Davila”, Bucharest, confirmed by the Ministery of Health of Romania1992 – Lecturer – Balneoclimatology, Sport Medicine and Physical Medicine – University of Medicine “Carol Davila”, Bucharest1997 – PhD at the University of Medicine “Carol Davila”, Bucharest1998 – Ass. Professor of Balneoclimatology, Sport Medicine and Physical Medicine – University of Medicine “Carol Davila”, Bucharest 2002 – 2004 – Medical Director of National Institute of Rehabilitation, Physical Medicine, Balneoclimatology, Bucharest, Romania2003 – Professor of Rehabilitation, Physical Medicine and Balneoclimatology

SCIENTIFIC ACTIVITYAuthor of 4 booksChapters in published books - 9 chapters Author or coauthor of more than 200 papers published in national and international issuesResearch: project manager in 6 national projects, partner in 1 international projectKeynote speaker in international congresses and conferences: Verona (1995), Florence (2008), Bucharest (2007, 2008)

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Delegate of ISPRM WRD Commitee for ICF, 2011

AFFILIATION- Romanian Association of Physical Medicine and Rehabilitation ISPRM (International Society of Physical & Rehabilitation Medicine (Board member since 2010)- Romanian Association for the Study of Pain (Past President) - Romanian Rheumatological Association- Romanian Association for Osteoporosis- Romanian Association for Laser- Romanian Association for Psycho-neuro-endocrinology- Romanian Association for Geriatry- I.A.S.P. - Fellow of Seminar Salzburg Society- EFIC (Councellar of the Board of European Federation International Corner Committee for Romania – 2006 - 2012)- Romanian Termography Medical Association (President)- Member of the PRM Commision in the Ministry of Healt.

LăCRăMIOARA PERjU-DUMBRAVă

ROMANIA

Lăcrămioara Perju-Dumbravă, MD, PhD is Professor of Neurology within the Neurosciences Department, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Chairman of the First Neurology University Clinic, Cluj-Napoca, Romania. Her academic status includes her position as member of the Board of the Faculty of Medicine and of the University’s Senate, as well as Doctorate coordinator in the field of MEDICINE. Her prestigious activity includes: publishing of 3 monographs, co-authorship in other 7 speciality books, 192 scientific papers published in medical journals, chairman and speaker at annual national congresses and conferences, international conferences and membership in editing committees and professional societies, involvement in several clinical studies, her expertise being sought by national medical councils and committees.

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DANIEL PIRICI

ROMANIA

Daniel Pirici is a pathologist, and currently Associate Professor in the Department of Research Methodology and Immunohistochemistry at the University of Medicine and Pharmacy of Craiova, Romania. His research focus currently involves the mechanisms by which an inhibitor of the most ubiquituous water channel in the brain (aquaporin 4) protects the CNS against edema during the ischemic insult. Hist team is involved in the fisrt histopathological characterisation of the changes following an ischemic insult, in what it regards water buffering along the vascular and perivascular basement membranes in the CNS; and in assessing the mechanisms driving the perivascular drainage of Aβ peptide along the perivascular spaces.The groups’ technical competences revolve around simple and multiple immunohistochemistry, deconvolution, three dimensional renderings and morphometry, as well as multispectral image analysis on a unique microscopy setup in Romania.Dr Pirici holds a PhD in biomedical sciences, neuropathology and molecular biology of animal models of Alzheimer’s disease at the University of Antwerp, Belgium. He has participated in two national grants as a project director, and has been involved in eight other national projects as a team member, authoring /participating in more than 60 articles and presentations visible in the ISI system, with a cumulated h index of 14.

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GABRIEL PRADA

ROMANIA

Gabriel-Ioan Prada, MD, PhD, graduated medical school at “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania in 1984 and after two years of internship at “Fundeni” Clinical Hospital in Bucharest, started his activity at “Ana Aslan” National Institute of Gerontology and Geriatrics in Bucharest since 1986. He is senior specialist in Geriatric Medicine and Gerontology and also in Internal Medicine. Dr.Prada has a Diploma in Gerontology at International Institute on Ageing - United Nations and a Master of Science Degree in the Faculty of Medicine, Department of Geriatric Medicine, “Victoria” University of Manchester, United Kingdom under the supervision of Prof.Raymond Tallis, editor of Brocklehurst’s Textbook of Geriatric Medicine and Gerontology. Dr.Prada also has a PhD degree in medical sciences at “Carol Davila” University of Medicine and Pharmacy, Bucharest. Currently, Dr.Prada is Medical Director at “Ana Aslan” National Institute of Gerontology and Geriatrics and also Professor of Geriatrics and Gerontology, head of the Chair of Geriatrics and Gerontology, Department 5, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest. He is author of 13 books and book-chapters, national and international editions, and over 350 papers published or presented at national and international scientific meetings. Dr.Prada has been involved in several international and national research projects, including HYVET (Hypertension in the Very Elderly Trial), PREDICT (Increasing the PaRticipation of the ElDerly in Clinical Trials), ERA-AGE 2 (European Research Area in Ageing) and FUTURAGE - A Roadmap for Ageing. He is also full member of the Boards of UEMS-Geriatric Medicine Section (European Union of Medical Specialists), EUGMS (European Union of Geriatric Medicine Societies), IAGG (International Association of Gerontology and Geriatrics) and IAGG-ER Clinical Section.

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SORIN PLOTNICU

REPUBLIC OF MOLDOVA

Full Name and Title Sorin Plotnicu, MD, professor assistant Year of Birth 18.09.1969Country of Residence Republic of Moldova

Specialized in(including year of qualification)Neurology – 26.06.1994Radiology – 1999Computed Tomography - 2000

Current PositionState Medical University “N. Testemitanu”, Chisinau, Department of Postgraduate Education, Neurology Department; professor assistant, since 2001PMSI Institute for Emergency Medicine, Imaging Department, Chisinau; since 1999Starting Date in this Position

Education Including Acquired Degree and Time PeriodState Medical University “N. Testemitanu”, Chisinau, Medical Doctor1988 – 1994

Relevant Professional Qualifications (Post-Graduate Education and GCP Training)GCP compliance course, NIDA Clinical Trials Network16.03.2015

Russian Medical Academy of Postgraduate Studies, Computed Tomography training course2000

State Medical University “N. Testemitanu”, Chisinau, Neurology1994 - 1995

Relevant Experience / Positions (Responsibility/ Years)Medical territorial association, Centre, neurologist1995 - 2000

Previous Experience in Clinical Trials

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Phase II/III2012 – present time

Phase I2002 - 2003

Membership to Medical and Scientific SocietiesNational Society of Neurologists, MoldovaNational Society of Radiologists, MoldovaSociety of Radiologists of Moscow city, Moscow, RussiaMoldavian League Against Epilepsy, Moldova

ALESSANDRA RUFA

ITALY

Academic Medical School:University of Siena, Italy,Summa cum laude (1989) Master’s degree Program I: Ophthalmology, Univ. of Siena, Italy, Summa cum laude (1994). Master’s degree Program II: Neurology Univ. Siena, Italy Summa con laude (2005) Fellowships: CNR (1995-97)- Univ. of Siena (1997-98) Ph.D. program: Neurometabolic Disease, University of Florence, Italy(1998-2000)Fellowship John’s Hopkins Hospital (lab eye movements. Prof. David Zee) 2000-2001-2003

Professorship NEI, NIH (2015)Research interestsNeuro-ophthalmology Neurometabolic Diseases, Eye movements, Vision, Sensory Motor integration, Neurodegeneration

Scientific Collaborations: June-July 2000 Visiting Scientist, Neuro-Ophthalmology service (Prof. J.G. Odel) Department of Ophthalmology and Electro-oculography (multifocal electroretinography-multifocal visual evoked potential) (Prof. D. Hood) Department of Psychology. Columbia University New-York.April-June 2002 Visiting Scientist, Ocular Motor-Vestibular Testing and Research Laboratory (Prof. D.S. Zee), Neurology Department, Johns Hopkins Hospital, Baltimore, USA;

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April-June 2005 Visiting Scientist, Ocular Motor-Vestibular Testing and Research Laboratory (Prof. D.S. Zee), Neurology Department, Johns Hopkins Hospital, Baltimore, USA1995-up to date: Unit Neurometabolic Disease and Dep. Neurological and Behavioural Sciences (Prof. A. Federico), Medical School, University of Siena. Italy 2002: Centro Sistemi Complessi and Dep. of Information Engineering. University of Siena Italy2008 up to date Collaboration with Prof J R Leigh Eye movement research lab Cleveland2008 up to date Prof Alessandro Innocenti School of Echonomy University of Siena2010 up to date Prof Stefano Ramat Ing Pavia2010 up to date Prof Paolo Bartolomeo Sal Petrier Parigi2010 up to date Prof Dorina Creanga institute of Phisics Isa Romania

2012-present : Lance M. Optican, PhD, biomedical engineer, Senior Scientist at NIH. Chief of the Section on Neural Modeling, Laboratory of Sensorimotor Research, National Eye Institute, NIH. In the frame of CERVISO project

2012-present : Dr Susana Martinez Conde MD PhD and her group at the Laboratory of Visual Neuroscience (Martinez-Conde Laboratory), Barrow Neurological Institute (USA) in the frame of the CERVISO project

Membership Society for Neurosciences (SfN), Italian Society of Neurosciences, Italian Society for Neurology, Italian Society for Ophthalmology, Italian Society of pediatric Ophthalmology, American Academy of Neurology (AAN).She took part to Regional, National and European programs of research. She is the IP of a European program CORDIS FP7 PEOPLE

STEPHEN SKAPER

ITALY

STUDIES: B.S. (chemistry) Illinois Institute of Technology (1969); Ph.D. (biochemistry) University of South Dakota (1973); Laurea in chemistry, University of Padua (1990)

CAREER: NIH Postdoctoral Fellow, Department of Medicine, University of California, San Diego (1973-1976); Fellow in Human Genetics, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio (1977); Postgraduate Research Biologist, Department of

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Biology, University of California, San Diego (1978); Assistant Research Biologist, Department of Biology, University of California, San Diego (1979-1982); Associate Research Biologist, Department of Biology, University of California, San Diego (1983-1987); Head, Laboratory of Neuropharmacology, Neuroscience Research Laboratories, Fidia S.p.A. - Abano Terme, Italy (1987-1993); Principal Scientist and Head, Laboratory of Cell Biology, Researchlife S.c.p.A. (a Lifegroup Company), Biomedical Research Center, St. Thomas Hospital, Castelfranco Veneto (TV), Italy (1993-1996); Visiting Professor, Department of Pharmacology, University of Padua, Padua, Italy (1997); Assistant Director, Molecular Neurobiology Research, SmithKline Beecham Pharmaceuticals, New Frontiers Science Park, Harlow, United Kingdom (1998-2001); Senior Group Leader, Migraine and Stroke Research, Neurology & GI Centre of Excellence for Drug Discovery, GlaxoSmithKline R & D Limited, Harlow, United Kingdom (2002-2003); Senior Group Leader, Neurodegeneration Research, Neurology & GI Centre of Excellence for Drug Discovery, GlaxoSmithKline R & D Limited, Harlow, United Kingdom (2004-2007); Senior Group Leader, Target Validation (Cognition and Pain), Centre of Excellence for Drug Discovery, GlaxoSmithKline R&D Limited, Harlow, United Kingdom (2008); Adjunct Professor, Department of Pharmacology and Anesthesiology, University of Padua, Faculty of Medicine, Padua, Italy (2009-present).

PROFESSIONAL MEMBERSHIPS: Sigma CI (The Scientific Research Society); Phi Lambda Upsilon (honorary chemistry society); Alpha Chi Sigma (professional society in chemistry/chemical engineering); Society for Neuroscience; International Society for Cerebral Blood Flow and Metabolism

JOURNALS EDITED: Editor-in-Chief, CNS & Neurological Disorders – Drug Targets; Associate Editor, American Journal of Neuroprotection and Neuroregeneration; Editorial Board Member, Scientific Reports (Neuroscience); Councilor, International Association of NeurorestoratologyREVIEW PANELS: The Wellcome Trust (UK), Biotechnology and Biological Sciences Research Council (BBSRC) (UK), Austrian Science Fund (ad hoc review panel to evaluate interdisciplinary doctoral programmes in neuroscience)

RESEARCH INTERESTS: Molecular biology and cellular mechanisms of cell death in CNS ageing, neurodegenerative disorders and neuroinflammation, astrocyte-microglia interactions, pharmacological modulation of oligodendrocyte precursor maturation and demyelinating diseases. Track record of drug discovery project leadership in kinases, ion channels, G-protein-coupled receptors, DNA repair enzymes, growth factors, identification and optimization of tools for target validation studies, utilising RNAi, conditional and viral knockdown\outs\ins, transcriptomics, proteomics and in vitro cell-based disease or mechanism relevant assays in rodent systems.

PUBLICATIONS: OVER 300 publications in the neurosciences, including book chapters and symposia proceedings.PATENTS: Pharmaceutical compositions containing monosialoganglioside GM1 or derivative thereof suitable for the treatment of Parkinson’s disease (Patent No.: US 6,620,792 B1), use of CRF receptor agonists for the treatment or prophylaxis of diseases, for example

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neurodegenerative diseases (US 2003/0186867 A1), treatment of conditions with a need of GSK-3 inhibition (PCT WO 02/062387 A1), use of CRF receptor agonists for the treatment or prophylaxis of diseases, for example neurodegenerative diseases (PCT WO 01/72326 A1), use of monosialoganglioside GM1 or N-dichloro-acetyl-lyso-GM1 for preventing or reversing neuronal degeneration induced by long term treatment with L-DOPA in the therapy of Parkinson’s disease (EP 0 770 389 A1)

REVIEWER FOR JOURNALS: Journal of Neuroscience, PNAS, Nature Reviews, The FASEB Journal, Journal of Neurochemistry, Journal of Neuroinflammation, Neurobiology of Disease, Neurobiology of Aging, Glia, Neuroscience, Apoptosis, PLoS One Biology, Journal of Pharmacology and Experimental Therapeutics, British Journal of Pharmacology, European Journal of Pharmacology, Journal of Neurological Sciences.

CRISTINA TIU

ROMANIA

I always considered myself an optimistic person but still there are certain things which I find depressing, and a CV is one of those things. Suddenly it is not about you anymore, but about a person who had a number of achievements which are rarely the things you find interesting about yourself, and all your life is compressed in half a page.

I have graduated the University of Medicine and Pharmacy “Carol Davila” in Bucharest in 1987 and I started my career in neurology in 1991, as a resident in the Department of Neurology of the University Hospital Bucharest, the same place where now I am Associated Professor and Head of the Stroke Unit. I have two favorite domains: vascular pathology and multiple sclerosis. My main interest is in cerebrovascular diseases, I am coordinating a teaching course for cervical and cerebral ultrasonography and I followed the European Master in Stroke Medicine Programme in Austria.

My involvement in MS field started in year 2000, when the first patients in Romania were treated with DMTs due to a constant effort (read fight) of three people: Prof. Ioan Pascu, Prof. Alexandru Serbanescu and Prof. Ovidiu Băjenaru. Since then, I have followed-up hundreds of patients with MS, and I am now the coordinator of the University Hospital Bucharest Center for the National Programme for treating the Patients with Multiple Sclerosis. I have

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participated, together with my colleagues in the majority of the main International Clinical Trials in MS in the last decade and we had also several original scientific work related to clinical aspects of MS patients. I am one of the two representatives of the Romanian Society of Neurology in the Board of ECTRIMS.In the end of my half page, I am looking forward to future goals: development of basic research in MS in Romania, a National MS Registry, better drugs, a better education for patients and doctors, a better me…

CHRISTEL VANROY

BELGIUM

Christel Vanroy is a physiotherapist and clinical stroke researcher currently undertaking her PhD in Biomedical Sciences at the University of Antwerp and the University of Leuven.

After completing her specialty training in Sport Rehabilitation at the University of Leuven in 1996, she started clinical work in stroke patients and in patients with sport injuries. In 2005, she continued her academic career as an assistant professor at the Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences at the University of Antwerp, Belgium. Christel Vanroy’s clinical and research focus is in the area of stroke rehabilitation, in particular on how to evaluate and increase physical activity and aerobic capacity after stroke. She recently finished an RCT-study of 6 years, in which the immediate and long term-effects of an aerobic training program combined with coaching were explored. She is also involved in developing telerehabilitation techniques to objectively quantify training outcomes. She is recently publishing in this field.

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GREGORY DEL ZOPPO

USA

Dr. del Zoppo has contributed to the science of acute treatment strategies for ischemic stroke and of the impact of ischemia on the cerebral microvasculature. He was a pioneer of the acute clinical use of plasminogen activators for the treatment of thrombotic/thromboembolic stroke in the early 1980s. In consequence his group has focused on microvessel/neuron responses in the acute evolution of post-ischemic cerebral injury in experimental systems including non-human primate models to murine in vitro systems, and in clinical trial design. Contributions of the experimental work on cerebral microvessel responses in focal ischemia (ischemic stroke) include the focal “no-reflow” phenomenon, the role of peripheral inflammatory responses to microvessel events, acute alterations in microvessel structure, acute endothelial- and astrocyte-matrix adhesion receptor and matrix alterations in edema and hemorrhagic transformation, and related glial events associated with neuron injury. Current attention is on the relationships and interactions among endothelial cell and astrocyte adhesion to the matrix, the tight junction and adherens complexes, and their management of the permeability barrier under nromoxia and injury. Those studies support the concept of the “neurovascular unit.” Dr. del Zoppo has also designed and conducted clinical trials in acute interventions in ischemic stroke, and problems of hemostasis and thrombosis. Currently, he serves on both DSMBs and Advisory Boards for clinical trials in ischemic stroke.

Following research work at the California Institute of Technology, Dr. del Zoppo trained in internal medicine and hematology, and at the Institute of Neurology, Queen Square (London). Experimental and clinical programs were undertaken at The Scripps Research Institute, the Klinikum RWTH Aachen (Gastprofessur der DFG), and the University of Washington. For this work Dr. del Zoppo received the Javits Neuroscience Investigator Award, election to the AAP, the ANA, and the Japanese Society of Neurology, and the 2012 Willis Lecture Award of the AHA/ASA. He is currently Professor of Medicine (in the Division of Hematology) and Adjunct Professor of Neurology at the University of Washington.

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SPONSORS

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www.ssnn.ro‘‘RoNeuro’’

Institute for Neurological Research and Diagnostic,Cluj-Napoca, Romania

Phone: 0374 46.22.22

Mircea Eliade street, no. 37, 400364 | Cluj-Napoca | RomaniaFax: 0374.461.674 | Email: [email protected]

www.roneuro.ro

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