BRAIN, NEW APPROACH TO BRAIN DISEASES WORKSHOP
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1 BRAIN, NEW APPROACH TO BRAIN DISEASES WORKSHOP PROFESSOR TIMOTHY LYNCH
2 To study the phenomena of disease without books is to sail an unchartered sea, while to study books without patients is not to go to sea at all. Sir William Osler ( ) 2
3 Why bother with the Brain and Mind? Vision Smell/taste Touch Hearing - Music Memory Language and speech Imagination - Art How we see, touch, taste smell or hear the world how we live is through our brain and mind- use Diving Bell and the Butterfly quote 3
4 Brain disorders are common 1 in 5 medical admission form A&E are neurological 1 in 7 GP assessments are for neurological disorders These are common disabling expensive conditions 1. Stroke 2. Epilepsy 3. Parkinson s disease 4. Multiple Sclerosis 5. Headache including migraine 6. Dementia e.g., Alzheimer s disease 7. TBI, spinal injury etc 4
5 So what? Because many neurological disorders are treatable or can be delayed or prevented 1. TPA/thrombectomy in stroke 2. Brain surgery in intractable epilepsy 3. Stereotactic Deep Brain stimulation in Parkinson 4. Immune treatments in Multiple sclerosis 5. MAB and botulinium toxin therapy in migraine 6. New precision approaches - Gene therapy SMA 5
6 & the cost of Brain Disorders! The economic cost of brain disorders in Europe - European Journal of Neurology 2012, J Olesen et al. Fig.1. Absolute cost and type of cost of 19 brain disorders in Europe (billion PPP 2010). 6
7 Neurology can be difficult 35 yo 7 weeks pregnant Behavioural Change 6/52 headaches, nausea, dizziness, strange dreams with insomnia, psychosis - hallucinations ( dead aunt on ceiling, people going to take my baby and do experiments ) Acute urinary retention/constipation 7
8 What is the diagnosis? What test(s) would you do? Autoimmune/paraneoplastic Anti NMDA-R encephalitis 8
9 How would you treat this young pregnant woman? Initially with olanzapine, lorazepam and haloperidol prn IV Methyl Prednisolone 5 days Plasmaphoresis x5 Anti epileptic drugs Intravenous Immunoglobulin 5 days Return to plasmaphoresis and NMDA titre monitored and commenced on Azathioprine (18 th & final exchange) 9
10 Disease course 10
11 An Increasing problem and demand increases Ageing population increased number of people with neurodegenerative disease or stroke e.g., 40% get Alzheimer s disease by age 85 New treatment options New patient demands 11
12 So what should we do? Increase awareness of the brain - education 1. School teachers & children should understand memory, attention, consciousness, movement control, emotions, speech & language 2. Doctors/nurses/services allied to medicine increase knowledge of brain and mind disorders Increase research and innovation 1. Resulting in new treatments and preventative therapies to improve quality of life and offset cost longterm 12
13 How to prevent/slow brain and mind disorders A Healthy brain 1. Physical Exercise 2. Intellectual exercise/activity and novelty 3. Good sleep 4. Diet the right food at the right time 5. Laughter 13
14 New developments Consciousness Movement control and thinking Think fast think slow Precision medicine Brain imaging 2 nd renaissance? rapid spread of information and knowledge via social media, internet and development of AI and robotics 14
15 Newgrange, Boyne Valley, Co Meath 15
16 THANK YOU / health.affairs@ucd.ie 16
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