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www.asner.org The 11 th National Conference of ASNER, The Romanian Society of Electrodiagnostic Neurophysiology CN2019, Sibiu, Romania October 18 – October 20, 2019 Program & Abstract book
www.asner.org
The 11th National Conference of ASNER,
The Romanian Society of Electrodiagnostic Neurophysiology
CN2019, Sibiu, RomaniaOctober 18 – October 20, 2019
Program & Abstract book
ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
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Scientific partners:
.ROSocietatea Națională
de Neuroștiințe
Societatea RomânăÎmpotriva Epilepsiei
ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Dear Friends,
So here we are again, for the 11th time, and I find itreally remarkable. Every single year since 2009 wehave managed to organize a National Conference inClinical Neurophysiology, in which we tried to invitethe best experts in the field. Our goal was to spreadgood practice in clinical neurophysiologicaltechniques among those who are interested anddedicated, but also to promote research. And I daresay, we are on the right path, and we are determinedto continue. Some of you have been with us from thebeginning, many of you have attended a few times,and others are newcomers, but all of us have one thingin common, namely our passion for neurophysiology.
As always, this year we have organized practicalsessions, plenary sessions, and case presentations. Weintend thus to present some practical aspects, to hearinteresting lectures from our guests, and to share ourown experiences with each other.
So prepare for a few days of intense scientific activitywith ample opportunities for networking, and to makenew friends.
The conference has been awarded CME credits.
Welcome to the 11th edition of the ASNER NationalConference.
Tudor Lupescu M.D. Ph.D.
ASNER President
http://www.asner.org
https://www.facebook.com/asner.org/
Ioana Mindruta, M.D. Ph.D.
ASNER Vice-President
Neurology Department, “Carol Davila” University ofMedicine and Pharmacy, Bucharest, Romania
Ionela Codita, M.D.
ASNER Secretary
Neurology Department of Elias UniversityEmergency Hospital, Bucharest, Romania
Ana-Maria Cobzaru, M.D.
ASNER Treasurer
Neurology Department, “Carol Davila” University ofMedicine and Pharmacy, Bucharest, Romania
Mihai Moldovan, MD, PhD
ASNER Scientific director
Copenhagen University, Denmark and “Carol Davila”University of Medicine and Pharmacy, Bucharest,Romania
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ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Vineri, Oct 1809.00 – 18.00 Atelier EEG: Epilepsie - cazuripractice
Locatia: Hotel Golden Tulip Ana Tower (StradaScoala de Inot nr 2)
9.30 -10.00 Anomaliile interictale in EEG de veghe sisomn - sef lucr Ioana Mindruta
10.00 -10.20- Caz 1pediatric - dr Eugenia Roza,seflucr Dr Raluca Ioana Teleanu
10.20-10.40 - Caz 1 adulti - sef lucr Ioana Mindruta
10.40 - 11.00 debriefing
11.00 - 11.30 pauza
11.30 - 12.00 Cum analizam anomaliile ictale? - drAndrei Daneasa
12.00 - 12.20- Caz- dr Evelina Iachim,sef lucr DrRaluca Ioana Teleanu
12.20-12.40 - Caz - adulti - dr. Andrei Daneasa
12.40 -13.00 debriefing
13.30 - 14.30 pranz
14.30 - 15.00 cum testam crizele inregistrate EEG? -dr Irina Popa
15.00- 15.20 – Caz 3- dr Eugenia Roza, sef lucr DrRaluca Ioana Teleanu
15.20-15.40- Caz 3 adulti - dr Irina Popa
15.40 - 16.00 debriefing
16.00 - 16.30 pauza
16.30 - 17.10 caz audienta (2 caz)
17.10- 18.00 debriefing
15.00 – 18.00 Atelier EMG
Locatia: Facultatea de Medicina – Sala Senatuluidin cadrul Universitatii Lucian Blaga (StradaLucian Blaga 2A)
Workshop EMG Hessel Franssen
Sâmbătă, Oct 19 – Partea 1Locatia: Facultatea de Medicina – Sala Senatuluidin cadrul Universitatii Lucian Blaga (StradaLucian Blaga 2A)
08.30 – 09.00 Deschiderea conferintei
09.00 – 11.30 Sesiune plenara
Hessel Franssen: Neuropatii mediate imun (studii deexcitabilitate și modelare)
Pascal Proot -: Studii de conducere senzitivă înelectrodiagnosticul leziunii de plex brahial
11.30 – 12.00 Pauza
11.30 - 12.00 Simpozion “Atrofia muscularăspinală”
Tudor Lupescu – Atrofia musculară spinală -perspective terapeutice
12.00 – 12.45 Simpozion - “Manifestari clinice aleunei boli sistemice – polineuropatia amiloida de tiptranstiretina
Ana Cobzaru– polineuropatia transtiretinica
Roxana Rimbas - Amiloidoza cardiacă
12.45 – 14.00 Prânz
Comentariu: Mircea Moldovan – Neurofiziologii
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Sâmbătă, Oct 19 atelier tehnicieni EEG
Locatia: Facultatea de Medicina – Biblioteca dincadrul Universitatii Lucian Blaga (Strada LucianBlaga 2A)
Tutori: Sef Lucrari dr Ioana Mindruta, Sef Lucrari drRaluca Teleanu
9.00- 9.30 Traseul de baza in inregistrarea EEGprelungit la adult - Sef Lucrari dr Ioana Mindruta
9.30 - 10.00 Traseul de baza in inregistrarea EEGprelungit la copil - Sef Lucrari dr Raluca Teleanu
10.00 - 11.00 Variante de normalitate
11.00 - 11.30 Pauza de cafea
11.30 - 12.00 Artefactologie EEG
12.00 - 13.00 Prezentari de caz
13.00 - 14.00 Pranz
14.00 - 18.00 Sesiune de prezentari teoreticeinteractive:
1. Montaje EEG; 2. Corectia artefactelor; 3. Anomaliiepileptiforme;4. Inregistrare crizeepileptice/evenimente clinic; 5. Arhivarea
ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Sâmbătă, Oct 19 – Partea 2Locatia: Facultatea de Medicina – Sala Senatuluidin cadrul Universitatii Lucian Blaga (StradaLucian Blaga 2A)
14.00 – 16.30 Sesiune Neuromonitorizare, EEG sisomn
Dan Filip - "Colaborarea intraoperatorie întreneurofiziolog și neurochirurg - mapping cortical,subcortical și radicular”
Ionela Codita – monitorizare intraoperatorie inspondilolistezis lombosacrat
Amalia Ene, AnaMaria Cobzaru – NeurofiziologieDBS
Livia Livinț Popa, Dana Slăvoacă, Gianina MariaBalea, Ștefan Strilciuc, Dafin Mureșanu - Introductionto Quantitative EEG
Mihaela Oros: Tulburari de somn la copii
Floriana Boghez: “Effects of acute sleep deprivation”
16.30 – 17.00 Pauza
Comentariu: Mircea Moldovan Inedit- Serendipitate
17.00 – 18.30 Sesiune EMG
Tudor Lupescu –Electromiografia – studii de caz
Mihai Moldovan: Testarera excitabilității nervoase.Avem ghidul, ce urmează?
Mircea Moldovan Tetrapareza proximala, simetrica,reversibila in cadrul unei insuficiente renale cronice(IRC)
18:30- 19:30 Sesiune EMG
- Pascal Proot: Importanța recrutării, studiulnervilor cutanați antebrahiali lateral și medial,indicele Robinson în sindromul de tunel carpian.
Duminică, Oct 20Locatia: Facultatea de Medicina – Sala Senatuluidin cadrul Universitatii Lucian Blaga (StradaLucian Blaga 2A)
09.00 – 11.30 Comunicari EMG
Izabela Popa - Electrophysiologic diagnosis inradiculopathies, mononeuropathies and lumbosacralplexopathies
Moscu Bianca - "Disfonie - provocare diagnostica -prezentare de caz"
Nicu Draghici – Sindromul Eaton - Lambert inadenocarcinomul de prostata.
Florian Antonescu - Indicele split hand și alte afectăriasimetrice în SLA
Gianina Maria Balea, Livia Livinț Popa, CristinaPantelemon, Tudor Dimitrie Lupescu, Dafin Mureșan– Neuropatie motorie axonală autosomal recesivă cuneuromiotonie
Roxana Ailoaiei - “Cauze mai rare de mononeuropatieale membrului inferior-serie de cazuri”
Rotaru Bogdan – Cazuri atrofie musculara spinal tip 4și foot-drop.
11.30 – 12.00 Pauza
12.00 – 12.30 Comunicari EEG
- Partoaca Aida-Mihaela, Emil Ioachim Istrate, AnaGheorghiu, Cristian Teodorescu, Alina Popescu:EEG changes encountered in current neurologicalpractice.
- Istrate Emil Mihail, Partoaca Aida-Mihaela, AnaGheorghiu, Cristian Teodorescu, Alina Popescu:Epilepsia si migrena, coincidenta sau conexiunefiziopatologica: aspecte clinice si neurofiziologice
12.30 – 13.00 Quiz
13.00 Inchidere lucrari, diplome, feed-back
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ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Dr Pascal Proot is a neurologist based in Terneuzen,The Netherlands. He is also associated with thefoundation of the Headache Center Zeeland (TheNetherlands), University Hospital UZ Ghent(Belgium), and Kaunas University (Lithuania). He isa member of the Dutch Association of Neurology, theAmerican Academy of Neurophysiology andElectrodiagnostic Medicine, and the DutchAssociation Headache Centers.
He is involved in teaching electroneuromyography(ENMG) in various European countries. He obtainedhis degree in Medicine from Ghent University. He hasauthored several publications in peer-reviewed,international journals.
Involving sensory nerve conduction studies in EDXfor suspected brachial plexopathy"
Neurology department, Terneuzen, The Netherlands
Dr Pascal Proot
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Immune-mediated neuropathies
Department of Neurology of the University HospitalUtrecht, the Netherlands.
Hessel Franssen was born in 1951 and grew up in asmall market town to the north of Amsterdam. Heattended medical school in Leiden, the oldestuniversity in the Netherlands. He specialized inNeurology and Clinical Neurophysiology in theMunicipal Hospital in the Hague from 1977 – 1984,during which he also served as first Lieutenant in theDutch Army. He defended his PhD thesis on corticalregulation of saccadic eye movements in the CatholicUniversity Nijmegen in 1986. From 1985 – 2016 hewas staff member of the Department of Neurology ofthe University Hospital Utrecht, the Netherlands.There, he was responsible for training in ClinicalNeurophysiology as well as electroneurography andelectromyography. He was chairman of the DutchSociety of Clinical Neurophysiology for 8 years. Hehas published about 150 international peer-reviewedpapers on effects of temperature, criteria fordemyelination and excitability. Currently he isadvisor on subjects related to TranslationalElectrophysiology in disorders of peripheral andcentral motor neuron disorders.
Professor Hessel Franssen
ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
In the constantly developing field of clinicalneurophysiology, in which technology and knowledgehave made possible very precise and detaileddiagnostic findings, as in intracranial EEG recordingsor magnetoencephalography, and also therapeuticapproaches with transcranial stimulation (fordepression, migraine, neuropathic pain), EMG maylook kind of old-fashioned and obsolete. Recently, Iread an article by a Belgian author: "Pourquoil'ENMG ne disparaitra pas en 2046...", and it mademe more optimistic, because there are certain aspectsin diseases of the peripheral nervous system thatcannot be described yet by other means.
A purposeful, skilled, and logicalelectroneuromyographic examination that follows athorough clinical examination, can lead to valuableand meaningful conclusions.
This presentation will try to exemplify some clinicalsituations in which the EMG recordings are helpfuland revealing.
Surfing EMG Waveforms
Spitalul Clinic de Urgenta "Prof Dr Agrippa Ionescu"
Tudor Lupescu
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Tudor Lupescu obtained his medical degree from“Carol Davila” University of Medicine in Bucharest,in 1989. After 3 years of training at Colentina ClinicalHospital he became Specialist in Neurology in 1994.Since 2006 he is running the Neurology Departmental Agrippa Ionescu Hospital in Bucharest. 1998, hequalified as Consultant Neurologist. Since his earlyyears of training in Neurology, Tudor Lupescu hasshown a special interest in Clinical Neurophysiology.In 2000 he earned a Competence in ClinicalNeurophysiology (EEG, EMG, and EvokedPotentials). 1997 he was the first to use TranscranialMagnetic Stimulation in Romania. This was also thesubject of his PhD thesis presented in 2005. Since2008, Tudor Lupescu is President of ASNER –Romanian Society of ElectrodiagnosticNeurophysiology. He is also founding member andvicepresident of the the Romanian Society of DiabeticNeuropathy.
Dr Tudor Lupescu is Fellow of the AmericanAcademy of Neurology, and associate member of theAmerican Association of Neuromuscular andElectrodiagnostic Medicine. Between 2008 and 2014he was also member of the NeurophysiologySubcommittee of ENS, and since 2015, he is memberof the Neurophysiology Subcommittee of theEuropean Academy of Neurology.
Tudor Dimitrie Lupescu
MD, Ph.D.
ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Neurologist, with competence in electrophysiologyand special interest in epileptology, mainly invasivepresurgical exploration for epilepsy surgery,neurostimulation and brain connectivity. PhD thesison “Sleep studies in epileptic syndromes” in 2006.
Current position at the University EmergencyHospital in Bucharest in the Epilepsy and SleepMonitoring Unit and also hospital coordinator of theNational Programs for Pharmacoresistant Epilepsyand Rare Disorders.
Academic affiliation - lecturer in neurology at theUniversity of Medicine and Pharmacy “Carol Davila”of Bucharest.
Vicepresident of Romanian Association for ClinicalElectrodiagnosis (ASNER) since 2009.
Ioana Mindruta
Lecturer, MD, PhD
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The interictal spike/sharp is considered the hallmarkof epilepsy, by demonstrating the corticalhyperexcitability and hypersynchrony, which maypersists in the “normal” interictal state. The aim of thevideoEEG workshop is to show and discuss changesand sensitivity of interictal EEG in demonstrating thepathological abnormality and evaluate thesignificance of paroxysmal activity of epileptiformdischarges with clinically recorded seizure events.
Interictal findings will be interpreted in the largecontext of multimodal data of patients with drugresistant epilepsy
EEG Workshop - VideoEEG monitoring in drugrezistant epilepsy
The significance of interictal abnormalities
1 Neurology Department, University EmergencyHospital, Bucharest, Romania
Ioana Mindruta1
ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Conventional nerve conduction studies provideinformation about the number of conducting axons aswell as their conduction velocity along theinvestigated segment, a surrogate marker ofmyelination. In contrast, nerve excitability testingasses ion channel function and resting membranepotential at the site of stimulation providing an uniqueinsight into the disease mechanisms.
From the patients’s perspective, excitability testing isa simple continuation of conventional studies. Thetest is commonly performed on the median nervemotor and sensory axons stimulated at wrist. A testtakes about 15 minutes and consists of a sequence ofmeasures controlled automatically by a computer: 1)charge-duration, threshold electrotonus, current-threshold and recovery cycle. Results are given as aset of numeric excitability indices derived from themeasures. Deviations from control values isinterpreted based on a increasing number of literaturereports in different pathologies. A mathematicalmodel is available to aid the interpretation.
The presentation will focus on the recent consensusguidelines on the clinical use of axon excitabilitytesting and discuss future developments.
Measurement of axonal excitability: Consensusguidelines 2019
https://www.sciencedirect.com/science/article/pii/S1388245719311708?via%3Dihub
Mihai Moldovan obtained his medical degree from“Carol Davila” University Bucharest in 1999 and PhDdegree in neurophysiology from CopenhagenUniversity in 2004 where he continues his academiccareer.
2019 Organizer of the Nerve excitability hands oncourse at the Congress of the European Academy ofNeurology EAN2019, https://www.ean.org/oslo2019
2019 Faculty at the Master Course Electrodiagnostictechniques (University of Barcelona)https://edxneuro.com)
2019 Co-Chair of the Federation of EuropeanNeuroscience Societies (FENS) forum 2019https://www.fensfrm2019.rs
•2016, ‘P.K.Thomas’ prize of the European Academyof Neurology.
• Since 2014, elected full member in the EuropeanDana Alliance for the Brain (EDAB).
• Since 2013, serving on general council of Federationof European Neuroscience Societies (FENS) andInternational Brain Research Organization (IBRO).
• Since 2012, President of the National NeuroscienceSociety of Romania (SNN), a FENS member.
• 2012-2018, editorial board member for ClinicalNeurophysiology, the official scientific journal of theInternational Federation of Clinical Neurophysiology(IFCN).
• Since 2009, Scientific director of the Romaniansociety for electrodiagnostic neurophysiology(ASNER), an IFCN member.
• Since 2009, Invited professor and research directorassociated to the Department of Physiology andFundamental Neurosciences, "Carol Davila”University of Medicine and Pharmacy, BucharestRomania;
Nerve excitability testing. We have the guidelines.What next?
1) Copenhagen University DK;
2) Carol Davila University, Bucharest, RO
Mihai Moldovan (1,2)
Mihai Moldovan
Assoc. Prof., MD, Ph.D.
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ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
In case of chronic kidney disease (CKD), the azotateretention and the hydroelectric and acido-basicmodifications lead to multiple perturbations of thevital functions, which are difficult to explain, giventhe multitude of etho-pathogenical factors involved.
A 36yrs old female patient with progressive CKD inthe dialysis stage, presented pro-gressive,proportional tetraparesis predominantly proximally(3/5 BMRC).
The ENMG examination revealed a symmetric,predominantly demielinizating poli-neuropathy,without significant axonal loss, with proximalconduction blocks.
The muscular evaluation – the motor deficit beingpredominantly proximal – did not re-veal anypathological aspects, besides a reduced recruitinglevel.
We took under consideration – and differentiated –the length-dependant sensory-motor neuropathies(dying back), painful neuropathies (burning feet),radicular diseases (f waves), endocrine conditionsrelated to the parathormone variation,diselectrolithemia (increase of K, decrease of Na andP), medication-related neuropathies (entecavir) withacidosis and mitochondrial toxicity, and uremicmyopathies.
The symptomatology remained fluctuating from 2012until 2014, when she received a re-nal transplant.Subsequently, the neurographic and motor deficitwere significantly ame-liorated, with the resumptionof social activities.
Reevaluated at 7 years after the first examination and5 from the renal transplant, it was concluded that theremission was clinically and electrophysicallycomplete, with func-tional and locomotorindependence, The literature mentions that – posttransplant – the motor deficit is rapidly amelioratedclinically, the paresthsias disappear in 1-3 months,and the neurography reverts to normal
Dr. Mircea Moldovan, graduate of the “Carol Davila”University Bucharest, Doctor of Medical Sciences,MD is a neurologist at the Hospital “Elias” Bucharestsince 1968. Throughout his career, he had acontinuous interest for clinical neurophysiology. Inthe 80s, his main interest was the EEG and evokedpotentials under the guidance of Prof Dr VVoiculescu. In the 90s, his interest expanded to theperipheral conduction studies and EMG. During hispioneering work in Romanian clinicalneurophysiology, Mircea Moldovan advocated thediagnostic importance of clinical neurophysiology forneurological practice through talks at nationalscientific meetings and scientific publications. Mostimportantly, however, through his wealth of practicalexperience and didactic spirit, he helped initiate inclinical neurophysiology generations of youngneurologists. During the last decade, with thetransformation of “Elias” hospital neurology into auniversity department and re-formalizing his skills inEMG (2003) and EEG (2004), Dr. Mircea Moldovandeveloped his preoccupation for clinicalneurophysiology teaching. Together with Dr. IonelaCodita he carries out practical demonstrations of post-graduate courses organized by Professor Dr. PaneaEMG. In addition, Dr. Mircea Moldovan contributedto re-launch of the clinical neurophysiology society inRomania as founding member of ASNER 2009.
Mircea Moldovan
MD, PhD
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Proximal, symmetrical, reversible tetraparesis, inthe presence of chronic kidney disease
Neurology Department of Elias University EmergencyHospital, Bucharest
Mircea Moldovan*
Dr Cezar Dumitrache, Dr G Nedelcovski, Dr IonelCodita*
Commentary 1: On June 24, 1833, at a conference ofthe British Association for the Advancement ofscience, the poet Samuel Taylor Coleridge pointed tothe difference between the philosophers, with theirintellectual exercises, and the researchers, which usescientific experiments. In this context, the Cambridgestudent William Whewel proposed the use of the term"men of science" for researchers, instead of"philosophers of nature" used previously. (Blog LauraSnyder The Philosophical Breakfast Club).
Commentary 2: The term serendipity was invented byHorace Walpole in 1754. Serendipity is a commonoccurrence in the history of scientific discoveries.Other examples, besides Newton's dis-covery ofgravity mentioned above, are: Alexander Fleming'sdiscovery of penicillin in 1928, Percy Spencer'sinvention of the miowave oven in 1945, or theinvention of the sticky Post-it note by Spencer Silver1968.
ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Spondylolisthesis refers to a pathologic slippage ofone vertebra against another. Surgical treatment ofspondylolisthesis is recommended in patients withback pain refractory to conservative treatment,slippage progression, or severe slippage topresentation.
During the correction procedures lumbar rootsmay be affected, L5 root damage being often reported.
Intraoperative neuromonitoring is useful in order tominimize the risk of neurological damage duringthese interventions.
We will present some cases of surgical treatment forhigh-grade dysplastic spondylolisthesis usingintraoperative electrophysiological monitoring with :transcranial electric motor evoked potentials ,somatosensory evoked potentials , continuousspontaneous electromyography and triggeredelectromyography and the challenges of spinal rootmonitoring will be discussed.
Ionela Codita is currently working as a SeniorNeurologist in the Neurology Department of EliasUniversity Emergency Hospital and in the PonderasAcademic Hospital in Bucharest
She earned a Competence in ClinicalNeurophysiology in 2005. During her practice, dr.Codita attended many courses and teaching programsin the field of Clinical Neurophysiology such as:scholarship in Neurophysiopathology field atPoliclinical Institute of San Donato Milanese, Italy(2002-2004), “Training Course in EMG andNeurography”-Uppsala, Sweden (2009), InternationalSFEMG and QEMG Course–Kobe, Japan (2010),VIREPA distance learning courses on “EEG in thediagnosis and management of epilepsy – BasicCourse 6th edition” (September 2011- March 2012)and “EEG SCORE course-1st edition”( November2012-March 2013), the international educationalcourse “Dinalund Summer School on EEG andEpilepsy” (July 2012) , educational course:”Brainstem and Peripheral Nervous System-Neurophysiological Monitoring”- Groningen,Netherlands (Nov 2016) , educational courseorganized by International Societhy of IntraoperativeNeurophysiology , in Seoul, Korea (Nov 2017) and“Update in Neuromuscular Disorders”, London ( 24-25 May, 2018).
She manifests interest in Peripheral Neuropathies,Motor Neuron Diseases, Myopathies andIntroperative Neuromonitoring. Dr. Ionela Codita is amember of the Romanian Society of Neurology andof the International Society of IntraoperativeNeurophysiology and she is the Secretary of ASNER-The Romanian Association for ClinicalElectrodiagnosis, since 2013.
Ionela Codita
MD
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Neuromonitoring in lumbar spondylolisthesissurgery: benefits and limits
Neurology Department of Elias University EmergencyHospital, Bucharest
Ionela Codita
Alexandru Thiery, Mihai Adrian Cristescu, MihaiSabin Magurean, Raluca Ghita, Andrei Spatariu,Cristina Aura Panea
ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Senior neurologist since 2005
Certificate of complementary studies inelectromyography - Bucharest, 2013
International Course on Intraoperative Spinal Disease- Istanbul 2014
Intraoperative Neuromonitoring Course - "TheEssentials" - EANS Verona 2015
Cerebral Intraoperative Neuromonitoring Course -Groningen 2016
Physician Doctor - ULB Sibiu - 2017, with the theme"The contribution of intraoperative neurophysiologicmonitoring in neurosurgery"
Experience gained in Neurophysiologic IntraoperativeMonitoring with the Polisano Hospital Brain Team -over 100 cases since 2014 - of which 42 brain tumors,35 cases with cervicodorsal pathology, 10 cases withsubtentorial pathology and 13 cases with complexlumbosacral conditions.
Member of ASNER (Asociația Societatea deNeurofiziologie Electrodiagnostică din România) andISIN (International Society of IntraoperativeNeurophysiology)
Colaborarea intraoperatorie între neurofiziolog șineurochirurg - mapping cortical, subcortical șiradicular
Spitalul European Polisano Sibiu
Filip Dan
Filip Dan , MD, PhD
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ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Quantitative EEG (QEEG), a concept that appeared inthe 70’s along with “digital revolution”, is defined asthe mathematical processing of digitally recordedEEG.
QEEG presents a large area of applications inneuropsychiatric pathology and with each study itbrings forward new variables and methods of analysisillustrating electrophysiological brain alterations thatare invisible to the conventional EEG.
Raw EEG data is recorded and undergoes through thepreprocessing stage which contains the followingsteps: re-reference, filtering, segmentation andartefact rejection. QEEG brings new techniques ofEEG feature extraction: analysis of specific frequencybands, analyses of signal complexity, analyses ofconnectivity and network analyses. The role of QEEGis not to immediately indicate a diagnosis, but to becomplementary to other investigations, to generateadditional objective information for a precisediagnosis and to facilitate patient outcomeassessment.
As a functional neuroimaging tool relativelyinexpensive, QEEG might provide biomarkers forconnectivity pathologies or seizure detection,diagnostic criteria in neuropsychiatric disorders orpatterns in treatment response evaluation.
Although there is a vast literature on QEEG, it is notknown yet to be widely used, and there are manyscientific and controversial debates about itscontribution to the diagnosis of neurological andpsychiatric diseases.
Teaching Assistant in Neurology, Department ofClinical Neurosciences, “Iuliu Hațieganu” Universityof Medicine and Pharmacy Cluj-Napoca, Romania(September 2014 – present);
Neurologist at “RoNeuro” Institute for NeurologicalResearch and Diagnostic, Cluj-Napoca, Romania(September 2013 – present);
PhD in Neurology with the thesis “Role of functionalelectrical stimulation and of transcranial magneticstimulation in improving motor performances inParkinson’s disease”, “Gr. T. Popa” University ofMedicine and Pharmacy Iași, Romania (March 2013);
- Consultant Neurologist (June 2019);
- Neurologist (October 2012);
- Resident in Neurology (January 2006 –October 2012):
2 years of Neurology and EEG at Saint-Luc BougeClinic (1.01–30.09.2009) and at Refractory EpilepsyCenter, William Lennox Neurologic Center,Ottignies-Louvain-la-Neuve, Catholic University ofLouvain, Belgium (1.10.2007–31.12. 2008);
1 year of Psychiatry at Jolimont-Lobbes HospitalCenter, Haine-Saint-Paul, Catholic University ofLouvain, Belgium (1.10.2006–30.09.2007);
- Internship (January – December 2005);
- Medical Doctor (September 2004).
Introduction to Quantitative EEG
UMF "Iuliu Hațieganu" Cluj-Napoca, InstitutulRoNeuro - Centrul de cercetare și diagostic al bolilorneurologice, Cluj-Napoca, Romania
Livia Livinț Popa
Dana Slăvoacă, Gianina Maria Balea, Ștefan Strilciuc,Dafin Mureșanu
Livia Livinț Popa, MD, PhD
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ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Seizure severity is one of the parameters desired to bemonitored through automated detection of epilepticseizures. Previous studies have shown that ictalautonomic changes are associated with seizures, withpossible implications in sudden unexpected death inepilepsy patients (SUDEP). The current literatureholds promising results for automated seizuredetection using ictal autonomic changes. In this studywe aimed to define objective parameters that reflectseizure severity that could be implemented intowearable devices. Materials & Methods: We exploredthe peri-ictal (preictal and postictal) changes in heartrate variability (HRV), normalized to their interictalvalues. We calculated parameters reflecting theactivity of the parasympathetic nervous system: high-frequency power (HF) and root mean square ofsuccessive RR intervals that differ by more than50 ms (RMSSD). For measuring changes in thesympathetic nervous system, we used cardiacsympathetic index (CSI) and the ratio of LF-to-HFpower (LF/HF). We also determined the mean heartrate value (HR-mean), that reflects both an increase insympathetic and decrease in parasympathetic activity.For seizure severity we measured the duration of thepostictal generalized EEG suppression (PGES),seizure duration and the intensity of ictal muscleactivity, expressed as the duration of tonic bursts withfrequent exceeding the detection threshold for zero-crossings (ZC-above). We included 40 patients whohad 77 motor seizures recorded in the epilepsymonitoring unit: 61 generalized tonic seizures(GTCS) and 16 other major motor seizure types.Results and Conclusions: For all major motor seizureswe found a significant decrease in theparasympathetic activity and increase in thesympathetic activity in the postictal period. Increasein postictal sympathetic activity was significantlyhigher for GTCS compared with non-GTCS. Peri-ictaldecrease in parasympathetic activity and increase insympathetic activity were correlated with long PGES(over 20s), seizure duration and the intensity of ictalmuscle activity (ZC-above).
Heart rate variability parameters as indicators ofepileptic seizure severity
Institutul Clinic Fundeni, Bucuresti, Romania
Anca Adriana Arbune,
Jesper Jeppesen, Philippe Rivlyn, Sándor Beniczky
Insufficient sleep is a hallmark of our modern busysociety and it has becoming a public health concern.The first sleep deprivation study was published over100 years ago (1896) and since then many studieshave searched the impact of sleep deprivation onhealthy functioning. Sleep deprivation can be acute orchronic, total (sleep deprivation) or partial (sleeprestriction and sleep fragmentation) or it can intend aselective sleep stage deprivation (NREM or REMsuppression). Common repercussions to each of theminclude increased subjective and objective sleepiness,deficits of vigilance, attention, perception andcognition, mood fall and changes to glucosemetabolism, heart rate and blood pressure. Sleepfragmentation frequently arises due to sleep disorders,obstructive sleep apnea (OSA) or periodic limbmovements in sleep (PLMS), but it can also bereproduced by experimental conditions with frequentwaking or arousals episodes. There are numerousways to measure sleepiness, ranging from subjectiveself-report, EEG/PSG parameters, such as the latencyand quantity of slow wave sleep (which reflects thesleep pressure) and objective sleepiness size, such asthe Multiple Sleep Latency Test (MSLT) and theMaintenance of Wakefulness Test (MWT). Theability to sustain attention and maintain vigilance isreduced following even one night without sleep, asubstantial factor which increases the risk foraccidents or low performance and errors during shift-nights. Lapsing of attention occurs when microsleepsintrude into the waking state and may potentiallygenerate events.
Neurophysiological Overview of Acute SleepDeprivation Impact
Clinica Academica, Bucharest
Floriana Boghez
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ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Autosomal recessive axonal neuropathy withneuromyotonia is a rare disease caused by mutationsof histidine triad nucleotide binding protein 1(HINT1) gene. This distinct (clinically andgenetically) entity ranks among the most commonsubtypes of axonal, motor-predominant Charcot-Marie-Tooth (CMT) neuropathy.
We present a 13-year-old girl with progressivelower limb weakness, gait impairment, distalmuscular atrophy combined with muscle stiffness andcramps in hand and legs, beginning at age 6.
Cerebral MRI, lumbar spine MRI, voltage-gatedpotassium channel (VCKCs), acetylcholine antibody,genetic testing in spinal muscular atrophy (SMA) wasnegatives.
Nerve conduction studies was compatible withmotor axonal polyneuropathy. Concentric needleEMG show neuromyotonic discharges occurringspontaneously or provoked by needle movement ormuscle contraction and chronic neurogenic MUAP.
A homozygous, pathogenic variant was identifiedin HINT1 gene.
This case illustrates the importance of identifyingthe correct phenotype to avoid unnecessary and costlyevaluations.
Autosomal Recessive Axonal Motor Neuropathywith Neuromyotonia
INSTITUTUL RONEURO, CLUJ-NAPOCA, Romania
GIANINA MARIA BALEA
Livia Livinț Popa, Cristina Pantelemon, TudorDimitrie Lupescu, Dafin Mureșanu
Objective: Review of current knowledge regardingEEG changes associated with systemic metabolicdisorders and brain structural changes encountered inother neurological disorders other than epilepsy.
Methods: Electroencephalography, by objectifyingintercritical or ictal changes, is the most importantparaclinical investigation in supporting the diagnosisof epilepsy. Numerous disturbances of rhythm,amplitude or of graphoelements may occur, however,in the case of other pathologies with an impact on thecentral nervous system with or without a specificetiological pattern.
These can be classified into: structural abnormalitiescaused by lesions at the brain level (post-surgicalstatus, tumors, strokes, infections) and metabolic /toxic disorders (hyperammonemia, hypoglycaemia,renal failure, hypothyroidism, etc.).
We illustrate a series of cases encountered in ourclinic with electroencephalographic changes inpatients without epileptic seizures but with alteredcognitive status, which led to the request for aneurophysiological investigation.
Conclusion: Electroencephalography is a useful toolin the evaluation and monitoring of patients withother pathologies that influence brain metabolism andimplicitly electrical brain activity. The electricalchanges must always be integrated in the clinical-paraclinical picture of each patient in order toestablish a correct diagnosis.
EEG changes encountered in current neurologicalpractice
INNBN, Bucuresti, Romania
Aida-Mihaela Partoaca
Dr. Emil Ioachim Istrate, Dr. Ana Gheorghiu, Dr.Cristian Teodorescu, Dr. Alina Popescu
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ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Epilepsy and migraine are two of the most commonneurological disorders: for example in the generalpopulation, migraine has a prevalence of up to 18%.Although it is less common than migraine, epilepsy isone of the most important neurological pathologieswith a prevalence of up to 1%. Moreover, the twodisorders appear to be related. The risk of migraine istwice as high in epilepsy patients compared to thegeneral population - a risk that remains high in eachsubgroup of epilepsy (defined by the type of seizures,age of onset, etiology or family history). Thisassociation supports the existence of apathophysiological, genetic or environmental riskfactors link between the two entities, thus being ableto provide indications on the etiology of both epilepsyand migraine.
Both represent heterogeneous groups ofpathologies with a very varied natural history, clinicalpicture and therapeutic response, both of which mayhave repeated episodes of neurological dysfunction,sometimes accompanied by headaches and symptomssuch as post-ictal fatigue, cognitive or visceralphenomena, dizziness, paresthesia and aphasia ortransient hemiparesis. In typical patients, anamnesticdata usually allow the separation of the two entities.However, in the absence of convulsive phenomena orin the presence of atypical migraine symptoms,differential diagnosis can be difficult, even more soconsidering the well-known possibility of theoccurrence of EEG changes in migraine patients,which can lead to diagnostic errors.
The present paper, based on the lateststudies and articles in the field, aims to discuss theinteraction between epilepsy and migraine,integrating clinical, genetic and pathophysiologicalaspects, as well as the concept of migralepsy. Finally,some cases will be presented with the desire toexemplify the clinical principles presented, as well aspossible diagnostic pitfalls.
Epilepsy and migraine, coincidence orpathophysiological connection: clinical andneurophysiological aspects
INNBN, Bucuresti, Romania
Emil Ioachim Istrate
Dr. Aida Mihaela Partoaca, Dr. Ana Gheorghiu, Dr.Cristian Teodorescu, Dr. Alina Popescu
16
Deep brain stimulation (DBS) is a therapeuticneurosurgical procedure which consists of thestimulation of deep structures in the brain by meansof implanted electrodes, which are connected to anexternal electronic device, with the purpose ofinducing changes in electric brain activity as toimprove functions degraded by the pathologicalcondition.
Other than choosing the perfect candidate, perhaps themost determinant of success in patients undergoingDBS surgery is the optimal placement of theelectrode.
Magnetic resonance imaging and stereotactic methodsare employed to conduct preoperative localization ofthe target. Later high-precision implantation of theDBS electrodes relies on functional localization viaintraoperative microelectrode recordings.
Neurophysiology in deep brain stimulation (DBS)
Spitalul Universitar de Urgenta Bucuresti, Romania
Clinica de Neurologie
Dr Amalia Ene, Dr. Ana Maria Cobzaru
Long term video-EEG monitoring is an important stepin the presurgical evaluation for patients with focaldrug resistant epilepsy. Seizures that we record let usperform electroclinical correlations and better definethe epileptogenic network. Therefore, during this step,we must test/interact with the patient during a typicalseizure. In this workshop, we will present examples ofepileptic seizures recorded in our unit and try tounderstand the epileptogenic network through seizuresemiology.
Testing seizures that we record during video-EEG
Spitalul Universitar de Urgenta Bucuresti, Romania
Unitate de Monitorizare Epilepsie si Somn
Irina Oane MD, Ioana Mindruta MD. PhD
ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
Differential diagnosis between an L3 radiculopathiesor femoral nerve neuropathies or L4-L5radiculopathies and common peroneal nerve lesion isoften difficult or clinically impossible.
Structural or nonstructural lesions are evolving intomotor and sensory deficits which can easily mimiclumbo-sacral plexopathy.
Besides the localizing value of the electrophysiologicstudies, such investigation will enable the assessmentof severity and prognosis.
Electrophysiologic diagnosis in radiculopathies,mononeuropathies and lumbosacral plexopathies
Cabinet de Neurologie Dr Izabela Popa, Timisoara,Romania
Izabela Popa
Seizures recorded during long term video-EEGmonitoring offer a critical value towards a correctlocalization hypothesis.A thorough analysis of the electrographic ictaldischarge and its correlation with the anatomo-clinical picture often allow us to zero in on theepileptogenic network. In this workshop weexemplify such a proceeding, reviewing a trickypresurgical case.
Analysis of ictal recordings – an electrographicperspective
Spitalul Universitar de Urgenta Bucuresti, Romania
Andrei Daneasa MD, Ioana Mindruta MD. PhD
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ASNER CN2019 Bucharest, 18-20 October 2019 – Program & Abstract book11th National Conference of the Romanian Society of Electrodiagnostic Neurophysiology
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