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Focus on the Asian brain
It is all about that powerful and complex organ, the amazing brain, that an eminent group will discuss and debate next weekend in Colombo.
What can ail the brain and how can these ailments be prevented and treated, will be on the minds of nearly 300 delegates, both local and foreign, as they meet from November 14 to 16 at the Cinnamon Grand Hotel.
With the theme ‘Challenge of the ageing brain: Asia’s burden’ the tightly-packed three-day programme will not only see one but two 
organisations, joining forces to get the best outcome.
The comprehensive scientific programme of the 8th Annual Academic Sessions of the Association of Sri Lankan Neurologists (ASN) and the 8th Annual Congress of the Asian Society Against Dementia (ASAD) will include the latest developments with regard to general neurology as well as dementia.“These sessions are unique because we will be taking a very close look at the challenges that are typical to Asia, while coming up with strategies suitable for the region,” said Prof. Asita de Silva, the Conference Co-Chair for ASN-ASAD, adding that the brain is a jigsaw. In diseases such as dementia, can we find the missing pieces and lock them back up? This is the challenge.
The other Conference Co-Chair is ASN President Dr. Arjuna Fernando.
While the sessions will cover “a nice mix” of dementia and general neurology including epilepsy and stroke, distinguished are the speakers on the latest developments in disease diagnosis and management. They include Dr. Mary Ganguli from the University of Pittsburgh, USA, and Prof. Christopher Chen from the University of Boston, USA.
The prestigious J.B. Peiris Oration on ‘Pre-clinical interventions for the prevention of Alzheimer’s Disease’ will be delivered by world expert Prof. Colin Masters from the University of Melbourne, Australia.
The chief guest is First Lady Shiranthi Rajapaksa while Dr. Ra’ad Shakir, President of the World Federation of Neurology, and Prof. Akira Homma, President of ASAD, will also address the gathering.
Prof. de Silva, attached to the Ragama Medical Faculty of the University of Kelaniya, creates in the mind’s eye the plight of Asia with its massive populations and rapid demographic changes including an ageing population. This would create the “biggest burden” of dementia in this region. The high incidence of non-communicable diseases (NCDs) would aggravate the issues because NCDs are risk factors for dementia.
“We will be facing a massive disease-load,” he says, pointing out that so far there is no cure, but dementia has to be treated aggressively to delay its progression. However, medicines are expensive.
Prof. de Silva explains that at the same time, Asia has its own “unique structures – extended family care” to look after victims of dementia. The extended family networks care for such patients, for it is 99% informal care.
It would be hospital and mainly home but no institutionalised care (nursing home placement), according to him. This is also why the burden including stress of the care-givers is an important factor that needs to be looked at. “In severe cases of dementia it would be like tending a three-month-old baby. The bed-wetting and tube-feeding all being part of the care needed,” adds Prof. de Silva.
While discussing cutting-edge science and research, he says that the sessions will also focus on “our very own” (Asian) remedies such as non-drug interventions and traditional treatment options.
| Sri Lanka part of massive hypertension clinical trial
A person who has suffered a stroke is rushed to hospital. While Neurologists along with a multi-disciplinary team get into action to save the patient’s life, they also grapple with a conundrum. Knowing that hypertension (high blood pressure) is a major cause of stroke, Neurologists have to ask themselves: Should we administer blood pressure lowering medication to the patient during the acute phase of the illness? If the patient has been on such medications, should we continue them? “This has been the biggest challenge, an unending debate, in the management of stroke,” says Prof. Asita de Silva, underscoring that it was an “unknown area”.  Prof. Asita de Silva These were the perennial questions that a global clinical trial across five continents and 23 countries including Sri Lanka attempted to get evidence-based answers for, studying more than 4,000 stroke patients, the Sunday Times learns. ‘Efficacy of Nitric Oxide in Stroke (ENOS) Clinical Trial’ over a lengthy 12 years from 2001 to 2013 was funded by the Medical Research Council (MRC) of the United Kingdom and BUPA Foundation. Sri Lanka’s participation and contribution to this clinical trial were coordinated by the Clinical Trials Unit of the Ragama Faculty of Medicine, Kelaniya University under the supervision of Prof. de Silva who was the National Coordinator and member of the International Advisory Committee. The investigators from Sri Lanka were Prof. Saman Gunatilake of the Colombo South (Kalubowila) Teaching Hospital and Dr. Udaya Ranawaka and Dr. Nirmala Wijekoon of the Colombo North (Ragama) Teaching Hospital. Setting the backdrop of the ENOS clinical trial, Prof. de Silva said that high blood pressure is present in 70% or more of patients with acute stroke. Whether blood pressure should be lowered early after stroke or whether to continue or temporarily withdraw existing anti-hypertensive drugs are important questions in day-to-day clinical practice. Several large trials in the past have tested the safety and efficacy of individual drugs or management strategies that lower blood pressure after stroke, with investigators reporting negative or neutral results, he said. Considering the importance of the questions that were being evaluated, the ENOS trial was adopted by the Australian, Canadian and United Kingdom National Institutes for Health Research and Stroke Research Networks while the trial results have been recently published in ‘The Lancet’, the prestigious medical journal, the Sunday Times learns. So, what have been the findings of the ENOS clinical trial? “The investigators found no benefit in lowering of blood pressure with glyceryl trinitrate in patients with acute stroke and raised blood pressure. The trial also provided no evidence for the strategy of immediately continuing pre-stroke blood pressure-lowering drugs after admission to hospital. In fact, the investigators report that such a policy might have a deleterious effect,” said Prof. de Silva. Overall, the main implication for practice from this large clinical trial is that it seems reasonable to withhold blood pressure-lowering drugs until patients with an acute stroke are medically and neurologically stable, and have suitable oral or enteral access to allow safe drug re-introduction, it is learnt. The ENOS trial clearly demonstrated that large collaborative clinical trials through research collaborations are possible. They are just as important and relevant to medical practice as they ever were, said Prof. de Silva, adding that Sri Lanka has fortified the thinking that the country has the capacity to collaborate and contribute to science. |