inside front cover ssp mission visionwarmest greetings to the stroke society of the philippines...

INSIDE FRONT COVERSSP MISSION VISION

My warmest greetings to the Stroke Society of the Philippines (SSP) as you hold your 16th SSP Annual Convention.

Research advancements have enabled the medical field to delve deeper into the cause, diagnosis, prevention, and care of diseases that affect humanity. We in government note the significance of learning platforms that allow our professionals to recalibrate treatment regimens and adapt more conscientious practices at par with international standards. Highlighting the prevalence of stroke in Filipino families, this convention is framed all the more important as it empowers your members to respond more efficiently to the needs of our citizemy. May the discourse engendered by this gathering lead to crafting a more comprehensive, updated healthcare framework that will succor and protect our countrymen from various ailments.

We are galvanized by our duty to uphold and serve the public welfare. I am confident that, with integrity, excellence, and transparency as our guideposts, we can rid our society from the ills that hinder us from optimizing our full potential and build the inclusive, equitably progressive Philippines we have long aspired to.

MESSAGE

MALACAÑAN PALACEManila

The President of the PhilippinesBENIGNO S. AQUINO III

Republic of the PhilippinesDepartment of Health

OFFICE OF THE SECRETARY

Secretary of HealthJANETTE P. LORETO-GARIN, MD, MBA-H

Warmest greetings to the Stroke Society of the Philippines (SSP) on the occasion of its 20th Anniversary and 16th Annual Convention with the theme “FIGHT STROKE: Global Perspective, Local Initiatives, Collective Action.”

The Department of Health notes the comprehensive scope and diverse programming of this convention, which includes postgraduate courses and symposia. We hope that participating physicians and allied medical professionals will be able to enthusiastically engage in information exchanges and in the discussion of challenges, opportunities and initiatives in acute stroke treatment and prevention in the Philippines.

May this event contribute to enhancing capacities of our medical and health workers in stroke management and rehabilitation as part of achieving Universal Health Care for all Filipinos. Congratulations and more power to SSP! Mabuhay!

MESSAGE

PHILIPPINE MEDICALASSOCIATION

PMA President, 2014-2016MARIA MINERVA P. CALIMAG, M.D., PhD, FPBA, FPSECP

I convey my heartfelt greetings and congratulations to the organizers of the 16th Annual Convention of the Stroke Society of the Philippines (SSP) themed: “FIGHT STROKE: Global Perspective, Local Initiatives, Collective Action’’

The efforts of the SSP to work towards the goal of advancing the field of stroke medicine through one encompassing gathering, is truly admirable. The unity displayed by members of your organization speaks of how even in the most complex of issues in the global health milieu such as in the field of diagnostics, we can discover our respective niches and contribute significantly in creating effective, lasting solutions.

The Philippine Medical Association (PMA) is honored to be a part of your distinguished work, and as president, I urge you to continue harnessing, along with your knowledge and capabilities, your diligence and passion in building healing and comforting environs for your patients. As the umbrella organization of all medical organizations in the Philippines, the PMA shares your aspirations for the consummate Filipino medical professional who is equipped with not only the needed wisdom or skills to heal and ease the patient’s pain, but also of a relentless yearning to push the boundaries of science and of oneself.

May this event inspire excellence in all of you, and strengthen your core as an organization that constantly strive for advancement and the highest standards of our profession.

I send my fondest wish for a fruitful and memorable Convention for all the delegates. Mabuhay and Cheers!

MESSAGE

PHILIPPINE COLLEGE OFPHYSICIANS

PCP PresidentMARIANO B. LOPEZ, MD, FPCP

Warmest Greetings!

In behalf of the Board of Regents of the Philippine College of Physicians (PCP), I would like to express our deepest gratitude for the sustained enthusiasm and hard work of your society for providing an avenue of learning. It is with great optimism that the delegates will take advantage of this great opportunity to have a meaningful learning experience worth cherishing and sharing.

Stroke has been one of the top ten causes of deaths and disabilities in the country. It has been plaguing people’s lives with financial and health burden from out of pocket costs and premature deaths, and to add further insult is the emotional grief from the sudden attack of a killer disease. It is timely that Stroke Society of the Philippines meticulously organized a scientific gathering of physicians and allied medical professionals to participate in its16th Annual Convention aptly titled, “FIGHT STROKE: Global Perspectives, Local initiatives, Collective Action.”This occasion offers a venue for empowerment and friendship in developing strategies on how to fight stroke as an organized team. Stroke care and management is not the sole responsibility of those who specializes in it or even those who advocates for it. There should be concerted efforts engaging all stakeholders to compassionately heal behaviours predisposing people to stroke and to lead with integrity to change the unhealthy norms that halts the progress of curbing the disease and the burden that accompanies.

I hope that the delegates will continue to be inspired and become an inspiration in advancing the status of our nation’s health.I wish you all success in your endeavours.

I.M. Healing and Leading with Integrity.

MESSAGE

PHILIPPINE ACADEMY OF FAMILY PHYSICIANS

PAFP National President 2014ALEX J.B. ALIP JR., MD, FPAFP

On behalf of the Philippine Academy of Family Physicians, we send our warmest regards to the Stroke Society of the Philippines on the occasion of the 16th Annual Convention with the theme “FIGHT STROKE: Global Perspective, Local Initiatives, Collective Action.” We find your topics quite relevant, given our modern-day society which predisposes to a myriad of illnesses, including nervous system conditions. Likewise, we absolutely agree with you in stressing that stroke management requires a good and organized team approach. Many family physicians in the frontlines of health care delivery constantly encounter such cases, and your commitment to collaborative work is indeed most welcome.

We are hopeful for more opportunities at cooperation between our two organizations -towards our common vision of quality medical attention and patient welfare.

Again, our congratulations and wishing the best in your future undertakings!

MESSAGE

PHILIPPINE NEUROLOGICALASSOCIATION

PNA PresidentPAUL PASCO, MD

Warm greetings from the Philippine Neurological Association! As you reach the start of your third decade as an organization, I congratulate you for consistently keeping a global perspective on stroke while always starting and maintaining local initiatives. In your annual conventions pride of place is always given to our homegrown speakers from a wide range of specialties, including nurses and other paramedical personnel. Your meetings are in a wide range of places, the better to reach our people wherever they are. In fact this year’s convention at the Manila Hotel is more an exception than the rule.

In your outreach programs you always strive for collective action in the form of innovative activities that aim to educate and inspire our people to reduce stroke disease burden.

I can only wish you more success as you continue to FIGHT STROKE!

MESSAGE

THE STROKE SOCIETYOF THE

PHILIPPINES

SSP PresidentMARIA CRISTINA Z. SAN JOSE, MD, FPNA

We welcome everyone to the 16th Annual convention of the Stroke Society of the Philippines. This is a special year as we celebrate the 20th year of the organization.

The mantra and the theme of the first annual SSP convention ,“Thinking Globally, Acting Locally” remains to be true and is revisited in this year’s convention. We continue the fight against stroke, in unity with the global community, using approach and strategies applicable to the local setting and emphasizing the vital role of individuals, societies, sectors, physicians of varied specialties, and allied health professionals. Similar to a mosaic where each single piece is important to complete the picture, the success of our fight can only be achieved through the collected and concerted efforts of all. Achievements and progress have been made but much more remains to be done in order to halt the projected increase of stroke prevalence and burden, especially in the developing countries.

The Scientific Program, divided into postgraduate courses and sessions, has been carefully crafted to cater to the specific needs and interest of various groups managing stroke patients. The program covers a wide range of topics from the basics and the must know’s and must do’s, to the latest evidence, guidelines & technology, from the pearls to pitfalls, simple diagnostics to complex management issues. The Opening Ceremonies is made extraordinary this year with messages & lectures to be delivered by Past Presidents of the Stroke Society of the Philippines.

On behalf of Officers and Members of the SSP Board of Trustees, we would like to thank all the members of the organizing committee, invited faculty for sharing their generous time and expertise and pharmaceutical partners for their unending support to make this convention possible.

Let us revisit in order to appreciate & learn from past experiences, look at the present with awareness and responsiveness and together face the future and the challenges of Stroke prevention, treatment and rehabilitation with firm commitment and enthusiasm.

Truly yours:

MESSAGE

THE STROKE SOCIETY OF THE

PHILIPPINES

Overall Convention ChairMARIA EPIFANIA VASQUEZ COLLANTES,MD

Despite the advancement of science and research on stroke management, the global stroke burden is still rising.In our country, stroke is still the second leading cause of death with a prevalence of 0·9%.As Filipinos, we need to have a collective action focused towards fighting this malady. The challenges include inadequate training of health workers and inadequate delivery ofsupport system to the rural communities and to the underprivileged sectors. The greatest obstacle is the out of pocket cost of health care.

To address the challenges, the Stroke Society of the Philippines conducts its stroke awareness and management programs, educating health workers and front liners.

The Scientific Committee of SSP has created a comprehensive series of lectures on stroke management, prevention and recovery. A Basic Stroke Management Postgraduate Course for Physicians will precede the main convention. There will also be two separate workshops on Physical and Occupational Therapists and a Case Based Neurosonology Workshop.

One of the highlights of the convention is the Presidential Plenary during the Opening Ceremonies where past presidents of the society will deliver their visions and accomplishments of the SSP.

The Main Convention is filled with out of the box topics starting with Acute Stroke Management, Risk Factors, Nouveau Entities, Complex management and difficult decision making in Stroke. There will also be a Neurosurgical, Rehabilitation and Pediatric Symposia to complete the comprehensive approach to stroke care.

Join us as we intensify our fight against Stroke.

MESSAGE

THE STROKE SOCIETY OF THE

PHILIPPINES

ChairmanScientific Committee

JOHNNY K. LOKIN, MD

My warm felicitations to the members of the Stroke Society of the Philippines and to the participants of the 16th Annual SSP convention !

Holistic care of stroke victims will undoubtedly be of paramount importance in an era when the burden of stroke will not only impact significantly on the patients but more so on their families and the community in general. “Fight Stroke: Global Perspective, Local Initiatives, Collective Action” is this year’s leitmotif that has been crafted by the scientific committee in addressing this issue. It has been the commitment and advocacy of the Stroke Society of the Philippines to offer it’s services and resources to promote continuing stroke education for our colleagues in the country for two decades now. We have always believed that in creating a scholarly venue for physicians, nurses, physical therapists, occupational therapists as well as speech therapists will help broaden one’s perspective of stroke management in their community. Better ways in recognizing, managing as well as delivering the needs that truly define and represent stroke care can also be achieved via this network.

It is the ardent hope of the national scientific committee that this educational venture would serve as an affirmation of the SSP’s role in imparting knowledge, skills and updates to help improve awareness and eventually outcomes of stroke victims.

Congratulations to the Members of the Scientific Committee and the Stroke Society of the Philippines for 20 years of “stroke-busting” !

MESSAGE

SCIENTIFIC PROGRAMME

ACTIVITY

Pipes, Penumbra & Perfusion : A Review of the Basics of Stroke- Dr. Jose Leonard R. Pascual V

Helpful Scoring Systems in Stroke: What, How and Why?- Dr. Belinda Mesina-Nepomuceno

BREAKDiagnostic Investigations in Stroke: The Must Know’s & Must Do’s- Dr. Nino Emerico F. Porciuncula

Neuroimaging Simplified: CT and MRI in Stroke- Dr. Pedro Danilo J. Lagamayo

Mid Day CME (Unrestricted CME Grant c/o Natrapharm-Patriot)

Acute Stroke Mgt: Manage it as a Brain Attack!- Dr. Cristina Z. Macrohon-Valdez

Blood Pressure Management in Acute Stroke Infarct & ICH: How low & how high?- Dr. Marc Conrad C. Molina

Increase Intracranial Pressure: How to Recognize & Resuscitate?- Dr. Lina C. Laxamana

TIME

09:00-09:30 AM

09:30-10:00 AM

10:00-10:30 AM 10:30-11:00 AM

11:00-11:30 AM

11:30-01:00 PM

01:00-01:30 PM

01:30-02:00 PM

02:00-02:30 PM

DAY 1: August 13, 2015 (Thursday)

Stroke Management: Your Questions Answered… Pandanggo-Polkabal Ballroom

Moderator: Dr. Maricar P. Yumul

Moderator: Dr. Rodolfo F. Germinal Jr.

ACTIVITY

BREAK

Antiplatelets or Anticoagulants for Stroke Prevention:Choosing what is Good, Better or Best for the Patient?- Dr. Jorge L. Padilla

Management of Hypertensive ICH: What’s in, what’s out?- Dr. Allan A. Belen

What’s New, What’s Next?: Updates on Stroke Prevention Guidelines- Dr. Loreto T. Talabucon

Sunset CME (Unrectricted CME Grant c/o Hi-Eisai)Maximizing Dementia Management- Dr. Simeon M. Marasigan

PPI Genes and Clopidogrel Response...It’s Complicated- Dr. Maria Cristina Z. San Jose

Opening Ceremonies and Past Presidents Plenary- Dr. Joven C. Cuanang- Dr. Abdias V. Aquino- Dr. Ester S. Bitanga- Dr. Jose C. Navarro- Dr. Carlos L. Chua- Dr. Artemio A. Roxas Jr.

TIME

02:30-03:00 PM

03:00-03:30 PM

03:30-04:00 PM

04:00-04:30 PM

04:30-07:00 PM

07:00 PM


Moderator: Dr. Alvin Joseph D. Mercado



Trends in Stroke Rehabilitation Roma Salon

Neurosonology Case-Based Teaching Course Roma Salon

ACTIVITY

Seminar Overview- Dr. Jose Alvin P. Mojica

Updates in Stroke Rehabilitation- Dr. Joycie Eulah Abiera

Trends in Stroke Rehabilitation Part I: Internet Delivered Applications (IDA)for Aphasia and Depression- Ms. Andrea Monique Dargantes BSSLP- Mr. Ivan Tapawan MA Psych

BREAK / SNACKSTrends in Stroke Rehabilitation Part II: Virtual Reality, Treadmill TrainingCircuit Training- Ms. Cressilda Bulalacao OTRP- Mr. Jess Christopher C. Daet PTRP

OPEN FORUM/CLOSING CEREMONIES

TCD report analysis - Dr. Romulo U. EsagundeIntracranial stenosis - Dr. Annabelle Lao-ReyesSubarachnoid Hemorrhage & Vasospasm - Dr. Johny K. LokinCryptogenic Stroke - Dr. Anna Sage-NolidoExtracranial Carotid Stenosis - Dr. Maria Cristina Z. San JoseAcute Ischemic Stroke SonoThrombolysis - Dr. Jose C. Navarro

TIME

08:00-08:10 AM

08:10-08:30 AM

08:30-09:30 AM

09:30-10:00 AM

10:00-11:30 AM

11:30-12:00 NN

01:00-01:30 PM01:30-02:00 PM02:00-02:30 PM02:30-03:00 PM03:00-03:30 PM03:30-04:00 PM

Moderator: Dr. Jose Alvin P. Mojica

Moderator: Dr. Romulo J. Esagunde


DAY 2: August 14, 2015 (Friday)

Acute Stroke Treatment & Prevention in the Philippines: Challenges, Opportunities, Initiatives

Pandanggo-Polkabal Ballroom

TIME

09:00-09:30 AM

09:30-10:00 AM

10:00-10:30 AM 10:30-11:00 AM

11:00-11:30 AM

11:00-01:00 PM

01:30-02:00 PM

02:00-02:30 PM

02:30-03:00 PM

ACTIVITY

IV rTPA in Diverse Settings- Dr. Arturo F. Surdilla

Endovascular Therapy in Acute Ischemic Stroke: From Evidence to Practice- Dr. Peter Paul P. Rivera

Break/Visit to the Booth

The Empowered Nurse in the Team- Maria Isabelita C. Rogado, RN, MAN

How Close are we on Hitting our Targets for Stroke Prevention?- Dr. Dante D. Morales

Mid Day CME (Unrestricted CME Grant c/o Natrapharm-Patriot)

Lipids and Stroke: Treatment to Target and Time to Treatment- Dr. Johnny K. Lokin

Updates on Carotid Disease- Dr. Maria Cristina Z. San Jose

Snoring and Stroke- Dr. Rosalina B. Espiritu- Picar

Risk Factor Plenary Roma Salon

Moderator: Dr. Orlino A. Pacioles

Moderator: Dr. Maria Socorro F. Sarfati


DAY 2: August 14, 2015 (Friday)TIME

03:00-03:30 PM

03:30-04:00 PM

04:00-04:30 PM

07:00 PM

ACTIVITY

BREAK / VISIT to the BOOTH

Gender Issues in Stroke- Dr. Raquel A. Alvarez

A Closer look on Cryptogenic Strokes- Dr. Artemio A. Roxas Jr.

FELLOWSHIP NIGHTTheme : Senti sa 90’s

Nouveau Entities Moderator: Dr. Cymbeline Perez-Santiago


DAY 3: August 15, 2015 (Saturday)TIME

09:00-09:30 AM

09:30-10:00 AM

10:00-10:30 AM

11:00-12:00 NN

12:00-01:30 PM

01:30-02:00 PM

02:00-02:30 PM

02:30-03:00 PM

03:30 PM

ACTIVITY

Strokes sec to Infective Endocarditis- Dr. Romulo U. EsagundeCerebral Venous Thrombosis- Dr. Alejandro A. BaroqueResuming Antithrombotics after Intracranial Hemorrhage- Dr. Maria Epifania V. Collantes

Intraventricular Hemorrhage- Dr. Manuel Mariano

Mid Day CME (Unrestricted CME Grant c/o Pfizer)Apixaban: From Innovation to Clinical Practice- Dr. Rosalina B. Espiritu-Picar

Early Rehabilitation in Stroke: How early is early- Dr. Jose Alvin P. MojicaRehabilitation & Devices: What is the Evidence?- Dr. Reynaldo Rey-Matias

Strokes in Children: Focus on Acute Management- Dr. Marilyn A. TanBusiness Meeting

Complex Management & Difficult Decision Making

Neurosurgical Symposium

Stroke Rehabilitation Symposium

Pediatric Strokes Symposium

Pandanggo-Polkabal Ballroom

Moderator: Dr. Geraldine Sienna L. Mariano

Moderator: Dr. Rhoderick M. Casis

Moderator: Dr. Maria Mercedes L. Barba

Moderator: Dr. Carlos L. Chua


Carpet CarpetCarpet

Plenary Lectures

54 6 732 11 12HS 14

15

13Registration

Floor plan for hospitality suite and booths

8 91 10

HS – 3x4 metersBooths – 2v3 meters, frontage is 2 meters

PHOTOBOOTH

Legend:HS= Boehringer1.Natra 2.Natra 3. Hi Eisai4. Otsuka 5. LRI-Thera 6. Ever Neuro7. Astellas 8. Pharma-3 9. E-Chimes10. Pfizer 11. Bayer 12. Pfizer13. Medichem 14. Torrent 15. Innogen16. RYB Pharma /Philcare Pharma 17. SSP A=Metrobank B= MSN Lifestyle

AB

16

17

FLOOR PLAN

SPEAKERS

and

ABSTRACT

JOSE LEONARD R. PASCUAL V, MD

PIPES, PENUMBRA & PERFUSION: A REVIEW OF THE BASICS OF STROKE

The brain depends on continuous delivery of glucose and oxygen via the cerebral vasculature. Disruption in the arterial supply or the venous drainage results in damage to the affected brain. Depending on which portion of the brain is deprived of oxygen, a stroke patient may present with motor, sensory, or cognitive neurologic deficits.

The continuous blood supply of the brain is crucial, and maintained by ensuring adequate perfusion via autoregulation of arterial pressure and opening of collateral circulation. The degree of damage to the brain in acute stroke is a function of the time deprived of oxygen and the cerebral perfusion pressure.

Education and Training: • 1999, Doctor of Medicine, University of the Philippines, College

of Medicine • 2003, Residency in Adult Neurology, UP-PGH • 2005, Clinical Research Fellowship in Stroke Neurology, UP-PGH • 2006, Clinical Research Fellowship in Stroke Neurology,

Singapore General Hospital, Postgraduate Institute of Medicine • 2007, Clinical Research Fellowship in Stroke Neurology, National

Neuroscience Institute, Singapore General Hospital

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurologica; Association • Associate Professor II, UP College of Medicine, Department of

Anatomy • Project Head, St. Luke’s Medical Center Stroke Databank • Active Consultant, UP-PGH, Manila Doctors Hospital • Visiting Consultant, St Luke’s Medical Center, The Medical City

Awards and Citations: • UPMASA Most Outstanding Teacher in Basic Sciences in 2010,

2013, and 2014 • Dr. August D. Camara Most Outstanding Teacher in 2012 and 2014 • UPMASA Illinois Chapter Most Outstanding Teacher in Basic

Sciences, 2014 • Dr. Patricio F. Reyes Professorial Chair Award, February 4, 2015

DAY 1: STROKE MANAGEMENT Aug. 13, 2015

BELINDA LIOBA L. MESINA-NEPOMUCENO, MD

HELPFUL SCORING SYSTEMS IN STROKE: WHAT, HOW AND WHY?

In stroke, scoring systems have been used to define disease severity, determine the course of treatment, predict clinical outcomes, recovery and disability, as well as assess risk factors and stroke occurrence and recurrence. Several of these stroke scales have proven reliability and validity in the various stroke trials, as well as their utility in the clinics, for stroke in general, while others are specific for a stroke subtype or mechanism. Nonetheless, familiarity with these scales guide clinicians in their decision-making and management of stroke patients

Education and Training: • 2007, Doctor of Medicine, UERMMMC College of

Medicine • 2012, Residency in Adult Neurology, UERM Memorial

Hospital • 2014, Fellowship in Stroke and Cerebrovascular Disease, St. Luke’s Medical Center

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurological Association • Active Staff, Providence Hospital, Quezon City • Visiting Staff, Rizal Medical Center and Capitol Medical

Center


NINO EMERICO S. PROCIUNCULA, MD

DIAGNOSTIC INVESTIGATIONS IN STROKE: THE “MUST KNOWS” AND “MUST DOS”

The decision to investigate and the choice of investigations, is primarily driven by the need to answer a specific question relevant to the diagnosis or management of the patient. However, it is also based on the patient’s symptoms, age, pre- and post- stroke condition, willingness to accept any risks, costs or inconvenience associated with the investigations, and the cost- effectiveness of the investigations. (Hankey’s 2014)

All patients with TIA or stroke in whom active management is being considered should undergo at least the following first-line/”must do” investigations:

Brain Imaging (CT or MRI)Complete Blood CountBiochemistry Profile (Glucose, lipid Profile, electrolytes, crea)ElectrocardiographyChest X-ray

Further investigations may be required to address questions that have arisen from the initial assessment. There are certain scenarios wherein the options or second-line diagnostic tests will be a “must do”. The role of angiography, echocardiography, ultrasound -- transcranial & carotid, coagulation profile and other tests will be highlighted on the different scenarios presented in this lecture.

Education and Training: • 2009, Residency in Neurology and Psychiatry,

University of Santo Tomas Hospital • 2011, Fellowship in Stroke and Vascular Neurology,

University of Santo Tomas Hospital

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurological Association • Visiting Staff, Brain and Spine Institute, Cardinal Santos

Medical Center


DIAGNOSTIC INVESTIGATIONS IN STROKE: THE “MUST KNOWS” AND “MUST DOS”

Education and Training: • 1977, Doctor of Medicine, UST Faculty of Medicine and

Surgery

• 1983, Residency in Diagnostic Radiology and Ultrasound, Division of Radiological Sciences, Santo Tomas University Hospital

Affiliations; Academic and Administrative Positions: • Head, Section of Ultrasound, Philippine Heart Center

up to the present.

• Board Member – The Stroke Society of the Philippines

• Chair, Department of Radiological Sciences and Medical Imaging at the MCU-Filemon D. Tanchoco Medical Foundation and Hospital

• Associate Professor 2, UST Faculty of Medicine and Surgery

• Visiting Professor, MCU College of Medicine

• Active Medical Staff (Rotating) in Diagnostic Radiology, Ultrasound, CT Scan and MRI and held different administrative positions at the following: Sto Tomas University Hospital (UST), Philippine Heart Center, Manila Central University – Filemon D. Tanchoco.

PEDRO DANILO J. LAGAMAYO, MD


MA. CRISTINA Z. MACROHON-VALDEZ, MD

ACUTE STROKE MANAGEMENT: MANAGE IT AS A BRAIN ATTACK!

The goal of “Brain Attack” is to salvage the ischemic penumbra or to limit the mortality and morbidity associated with stroke. The brain attack system follows in detail the standard guidelines dominating the whole concept of stroke systems of care from patient recognition at the outset to administration of thrombolytic therapy.

The brain attack system involves early stroke evaluation and general medical management in acute phase of ischemic stroke, specific reperfusion strategies, such as intravenous thrombolytic therapy and endovascular treatment. It also includes strategies to provide physiologic neuroprotection as well as proper monitoring and nursing care in the acute stroke unit.

Education and Training: • 2001, Doctor of Medicine, Ateneo de Zamboanga

University College of Medicine • 2002, Masters in Public Health, Ateneo de Zamboanga

University College of Medicine • 2007, Residency in Adult Neurology, St. Luke’s Medical

Center • 2009, Clinical Research Fellowship in Stroke/

Cerebrovascular Disease, St. Luke’s Medical Center • Visiting Clinical Stroke Fellow – Massachusetts General

Hospital, June 2009 and University of Cincinnati, July-August 2009

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurological Association • Board of Trustees, Stroke Society of the Philippines • Head, Acute Stroke Unit, St. Luke’s Medical Center,

Quezon City • General Neurology and Stroke Consultant, St. Luke’s

Medical Center


MARC CONRAD C. MOLINA, MD

BLOOD PRESSURE MANAGEMENT IN ACUTE STROKE INFARCT & ICH: HOW LOW & HOW HIGH?

There is a persistent controversy that exists if there are worthwhile beneficial effects of early and rapid blood pressure lowering in stroke. Elevations in blood pressure are common in stroke, especially in patients with pre-existing hypertension and large strokes, due to issues of variable ‘autonomic stress’ and elevated intracranial pressure. Though there are positive associations between blood pressure levels and poor outcomes evident across a range of studies. Very low blood pressure levels and large reductions in blood pressure have also been shown to predict death and dependence. This is demonstrated more so in ischemic strokes than hemorrhagic strokes. Latest evidence indicates that early blood pressure lowering can reduce hematoma expansion in hemorrhagic strokes but there is uncertainty whether this translates into improved clinical outcomes. Guidelines generally recommend control of high systolic BP (>180 mmHg), but recent evidence indicates that even more modest elevation (>140 mmHg) increases risks of cerebral edema and hemorrhagic transformation following thrombolysis in Ischemic strokes. Any potential benefits of rapid blood pressure lowering in acute strokes must be balanced against the potential risks of worsening cerebral ischemia from altered autoregulation/perfusion. This lecture will explore the current knowledge regarding the management of blood pressure in acute ischemic and hemorrhagic strokes and introduce clinical trials aimed at resolving this critical and controversial issue in the care of acute stroke patients

Education and Training: • 2007, Doctor of Medicine, UERMMMC College of

Medicine • 2012, Residency in Adult Neurology, UERM Memorial

Hospital • 2014, Fellowship in Stroke/Cerebrovascular Disease, St. Luke’s Medical Center

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurological Association


LINA C. LAXAMANA, MD

INCREASED INTRACRANIAL PRESSURE: HOW TO RECOGNIZE AND RESUSCITATE?

Specialized care for patients with intracranial hypertension

has evolved over the years. How to recognize this problem

entails knowledge of the anatomy and physiology of

cerebral disorders in particular those affecting changes in the

intracranial contents - brain tissue, blood and cerebrospinal

fluid. Clinical changes will require constant neurological

checks as a normal examination may turn bad in a minute or

so. Performing a brief but concise neurologic examination

in a specialized area like the stroke or neurocritical care unit

with a well trained, knowledgeable and efficient nurse and

physician may outdo other tests like radiographic exam or

an ICP monitoring (when indicated). However, performing

all these tests will certainly herald good outcome especially

when treatment is done right away. Time is brain. No single

treatment is right for everyone. A goal or a program to tailor

treatment the NEEDS of each patient faced with intracranial

hypertension should be set.

Education and Training: • Residency in Internal Medicine and Neurology, St.

Luke’s Medical Center • Fellowship in Neurocritical Care, University of

Cincinnati, Ohio, USA

Affiliations; Academic and Administrative Positions: • Fellow, Philippine College of Physicians • Fellow, Philippine Neurological Association • Member, Neurocritical Care Society • Assistant Professor I, St. Luke’s College of Medicine,

William H. Quasha Memorial • Head, Section of Neurology, St. Luke’s Medical Center,

Global City • Head, Neurocritical Care Unit, St. Luke’s Medical Center,

Global City • Member, Stroke Service, St. Luke’s Medical Center,

Global City • Active Consultant, St. Luke’s Medical Center, Quezon

City and Global City


JORGE L. PADILLA, MD

Education and Training: • Doctor of Medicine, University of the Philippines

College of Medicine • Residency in Adult Neurology, Department of

Neurosciences, UP-PGH • Fellowship in Stroke, National Neuroscience Institute - Tan Tock Seng Hospital, Singapore • Fellowship in Stroke and Neurointervention in Delhi, India

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurological Association • Medical specialist, Cotabato Regional and Medical Center • Visiting Consultant, Manila Doctors Hospital


ANTIPLATELETS OR ANTICOAGULANTS FOR STROKE PREVENTION: CHOOSING WHAT IS GOOD, BETTER OR BEST FOR THE PATIENT

Apart from lifestyle modification and non pharmacologic

therapy, antithrombotic treatment plays a vital role in

secondary stroke prevention after an initial event. Categorizing

patients into possible or known pathologic cause like large

vessel atherosclerosis, small vessel occlusion, cardioembolism,

dissection, and even blood disorders leading to ischemic

stroke will prove to be beneficial for clinicians to decide the

appropriate antithrombotic treatment for them. The lecture

will present this approach to more appropriate choice of

agent based on recent literature.

ALLAN A. BELEN, MD

MANAGEMENT OF HYPERTENSIVE ICH: WHAT’S IN, WHAT’S OUT?

Intracerebral hemorrhage (ICH) is the bleeding into the brain parenchyma due to the rupture of a cerebral artery. This type of stroke comprises about 10 to 15% of strokes and is associated with a high mortality rate with an increased possibility of developing disability in the survivors. Hypertension appears to be one of the leading risk factors and is estimated to occur in about 72 to 81% of all ICH patients. Management of patients with hypertensive intracerebral hemorrhage should be individualized according to the location and size of the hematoma, age of the patient, blood pressure, and the presence of any complications.

The lecture will explore on the most common clinical scenarios and questions asked about the management of spontaneous intracerebral hemorrhage in adults, in particular, those related to hypertensive ICH. Discussion will focus on issues regarding diagnosis, management of blood pressure, prevention of secondary brain injury and complications related to intracranial pressure, the role of surgery, predictions of outcome, and secondary prevention. Answers are based on the current treatment guidelines set by the Stroke Society of the Philippines and the 2015 updated guidelines by the American Heart Association/American Stroke Association


Surgery • 2012, Residency in Adult Neurology and Psychiatry,

University of Santo Tomas Hospital • 2014, Fellowship in Stroke and Neurovascular

Ultrasound, University of Santo Tomas Hospital

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurological Association • Coordinator, Neurology and Psychiatry Group, San

Pablo City Medical Society • Head, Stroke Services, Community General Hospital of

San Pablo City


LORETO P. TALABUCON, JR., MD

WHAT’S NEW, WHAT’S NEXT? : UPDATES ON STROKE PREVENTION GUIDELINES

Stroke is the 2nd most common cause of death and is a

leading cause of adult disability. Healthcare costs associated

with the treatment of stroke are high and burdensome

especially in lower income countries such as our country.

Keeping our population healthy is one of the most effective

ways in reducing the healthcare burden of our government

and its people.

This lecture will focus on the primary prevention of stroke

by mainly identifying and controlling stroke risk factors.

Stratifying our patients whether they are at high risk of stroke

can be done by use of a risk assessment tool. Evidence-based

recommendations will be presented and discussed in the

lecture. By preventing stroke before it happens, we hope for a

healthier and wealthier Philippines.

Education and Training: • 2002, Doctor of Medicine, Xavier University-Ateneo de

Cagayan • 2008, Residency in Adult Neurology, UP-PGH • 2013, Clinical and Research Fellowship in Stroke,

National Neuroscience Institute, Singapore General Hospital

Affiliations; Academic and Administrative Positions: • Active Consultant, Madonna and Child Hospital,

Cagayan de Oro City • Medical Staff Member, AKBAY-PMG Stroke and

Rehabilitation Center, Cagayan de Oro • Part-time Clinical Faculty Member, Dr. Jose P. Rizal

College of Medicine, Xavier University, Cagayan de Oro


JOYCIE EULAH ABIERA, MD

UPDATES IN STROKE REHABILITATION

The most advanced clinical and robotic treatments nowadays

are customized therapy that will help reach patient’s goals.

The treatment approach may be in the form of communication

and understanding which utilize a computer assisted therapy

that enhance speaking, listening and reading. The mobility and

training with the aid of a treadmill system and measurement

tools that enable patients to begin walking earlier.

The coordination and strength is another treatment that

avails of the interactive device in gaming technology that is

focused on the hand and arm function. The combination of

non-invasive navigated transcranial stimulation (nTMS), along

with occupational therapy yielded better results in the Upper

Extremity Fugl-Mayer Assessment (UEFM) score. Stroke

rehabilitation through new combination of technology and

therapy has greater gains in patient’s motor function.

Education and Training: • 2009, Residency in Rehabilitation Medicine, UP-PGH • 2011, Prosthetics and Orthotics, Up-PGH • 2011, Honorary Fellowship in Pediatric Prosthetics and

Orthotics, Rehabilitation Institute of Chicago 2011, Visiting /Research Scholar, Department of Physical

Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine

Affiliations; Academic and Administrative Positions: • Clinical Associate Professor University of the Philippines

College of Medicine, Department of Rehabilitation Medicine

• Adjunct Associate Professor, Orthopaedic Rehabilitation Engineering Center (OREC) Marquette University, Academic Support Facility

• Co-Director, Motion Analysis Program Department of Orthopedics, UP-PGH

Awards and Citations: • Recipient of the Nancy Hylton, Mentor-Mentee Program

at Children’s Center at Kent, Seattle, Washington, 2010 • Recipient of the Hand Rehabilitation Foundation

Educational Program at Philadelphia Hand Center, 2010 • InterAcademy Young Physician Leader Awardee for 2012

DAY 1: STROKE REHABILITATION Aug. 13, 2015

MS. ANDREA MONIQUE DARGANTES

MR. IVAN TAPAWAN

MS. CRESSILDA BULALACAO, OTRP

MR. JESS CHRISTOPHER DAET, PTRP, RPT

SEMINAR WORKSHOP IN TRENDS IN OCCUPATIONAL AND PHYSICAL THERAPY INTERVENTION TECHNIQUES IN STROKE REHABILITATION

Stroke is a neurological condition caused by insufficient blood supply which severely impairs movement and function. Given this, restoration and relearning of motor function is vital part in the rehabilitation process. Physical therapy offers recent trends of enhancing motor recovery in addition to conventional strengthening and range of motion exercises. These recent trends include treadmill training, circuit training and virtual reality.

Treadmill training is a mobility supervised training that allows a person to generate repetitive steps to regain and enhance patient’s ambulation. It can be used with body weight support or harness to allow patients to practice repeatedly even in the early phase of rehabilitation.

Circuit training is an approach which incorporates task-oriented practice of different activities as well as repetitions of these actions to facilitate acquisition of functional skills. Circuit training for neurological conditions should include activities that are significant to a person.

Virtual reality is a simulated physical rehabilitation program that uses technology as platform to augment patient’s training. According to studies, this new approach was found to provide improvement in arm function, as well as, patient’s functional balance after stroke.

Although these concepts are already known to enhance patient’s strength and endurance for well population and person with musculoskeletal condition, little information exists with regards to its utilization and effectiveness in neurorehabilitation. The purpose of the discussion are: (1) to explore the use and evaluate the effectiveness of virtual reality, treadmill training and circuit training when used as treatment options in stroke rehabilitation; (2) to identify indications, contraindications and precautions for each technique, and lastly (3) to develop a training program which will utilize the abovementioned intervention for patients with stroke.


ROMULO U.ESAGUNDE, MD

ANNABELLE LAO-REYES, MD

JOHNNY K. LOKIN, MD

TCD REPORT ANALYSIS CRYPTOGENIC STROKE

ANNA SAGE-NOLIDO, MD

MARIA CRISTINA Z. SAN JOSE, MD

JOSE C. NAVARRO, MD

INTRACRANIAL STENOSIS EXTRACRANIAL CAROTID STENOSIS

SUBARACHNOID HEMORRHAGE ANDVASOSPASM

ACUTE ISCHEMIC STROKE SONOTHROMBOLYSIS

Various imaging modalities are available to study the extra-intracranial vasculature. The advantage of ultrasound lies in its repeatability, low cost, safety, portability, non-invasiveness, physiologic /hemodynamic information and real-time applications.

Transcranial Doppler has proven value in the detection of intracranial stenosis, right to left shunt, microembolism and assessment of collateral circulation which aids clinicians ascertain mechanisms that led to the stroke, plan and monitor treatment and determine prognosis. In acute stroke, several studies have demonstrated enhanced thrombolysis using ultrasound. Other clinical settings where TCD has established indication include monitoring for vasospasm and confirming cerebro-circulator arrest (ICP and brain death).

Carotid duplex ultrasonography is an established method for screening patients with suspected stenosis of the carotid bifurcation and extracranial vertebral arteries. In addition to stenosis and occlusions, duplex scanning allows for characterization of plaques. detection of arterial dissection and assessment of mild atherosclerosis through IMT measurement.

The goal of this teaching course is to demonstrate the spectrum of clinical applications of ultrasonography using illustrative cases & assist clinicians and conference participants on how to interpret and understand results.

Neurosonology Cased Based Teaching Course

Overview

DAY 1: NEUROSONOLOGY WORKSHOP Aug. 13, 2015

ARTURO F. SURDILLA, MD

IV RTPA IN DIVERSE SETTINGS

Down south of the National Capital Region, in Northern

Mindanao, we have a vision:

“Every stroke patient deserves the best functional outcome.”

Working towards this end, we started intravenous thrombolysis

in acute ischemic stroke in 2010. This is a presentation of our

local experiences in “getting started, just doing it, and going

farther” in rTPA therapy.

Education and Training: • 1989, Doctor of Medicine, Dr. Jose P. Rizal School of

Medicine, Ateneo de Cagayan • 1996, Residency in Adult Neurology, UP-PGH • 1997, Fellowship in Electromyography, UP-PGH • 2012, European Master in Stroke Medicine, Danube

University, Austria

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurological Association • President, Stroke Society of the Philippines-Northern

Mindanao Chapter • Vice-President, PNA Northern Mindanao Chapter • Director, AKBAY Stroke Care and Neurological

Rehabilitation Center, Cagayan de Oro • Board of Trustees, Philippine Society for

Neurorehabilitation • Head, Acute Stroke Unit-Neuro ICU, Nothern Mindanao

Medical Center • Assitant Professor, Dr. Jose P. Rizal School of Medicine,

Xavier (Ateneo de Cagayan) University • Member, Local Health Board, Cagayan de Oro City

DAY 2: ACUTE STROKE Aug. 13, 2015

PETER PAUL P. RIVERA, MD

ENDOVASCULAR THERAPY IN ACUTE ISCHEMIC STROKE: FROM EVIDENCE TO PRACTICE

Education and Training: • 1994, Doctor of Medicine, UP College of Medicine

• 1999, Residency in Neurosurgery, UP-PGH

• 2001, Cerebrovascular Fellowship, Division of Neurosurgery, University of Toronto, Canada

• 2003, Diagnostic and Interventional Neuroradiology Fellowship, University of Western Ontario, Canada

Affiliations; Academic and Administrative Positions: • Fellow, Academy of Filipino Neurosurgeons

• Director, Stroke Center, St. Luke’s Medical Center, Global City

• Training Officer, UP-PGH Neurosurgery Residency Training Program

• Training Committee Member, Neurosurgery Training Program, St. Luke’s Medical Center

• Board of Trustees, Philippine Board of Neurosurgery • Board of Trustees, Stroke Society of the Philippines


MARIA ISABELITA C. ROGADO, RN, MAN

THE EMPOWERED NURSE IN THE TEAM

Education and Training: • 1977, Bachelor of Science in Nursing, San Juan de Dios

College

• 2003, Master of Arts in Nursing, Major in Medical-Surgical Nursing, La Concordia College, Manila

• Doctor of Nursing (candidate), St. Paul University Philippines, Tuguegarao

• Certified Nurse Specialist and Certified Faculty of the Americal Heart Association for BLS and ACLS

Affiliations; Academic and Administrative Positions: • Secretary, World Federation of Critical Care Nurses

• Professor, Arellano Graduate School

• Past Vice President, St. Luke’s Medical Center, Division of Nursing

• Former Chief, Division of Nursing Education, Philippine Heart Center

• Former Head, Department of Critical Care, Philippine Heart Center


DANTE D. MORALES, MD

HOW CLOSE ARE WE ON HITTING OUR TARGETS FOR STROKE PREVENTION?HOW CAN WE BE CLOSER?

The National Nutrition and Health Surveys (NNHeS) I: 2003 and II:2008 of the National Nutrition Surveys of the Food and Nutrition Research Institute, Department of Science and Technology showed that among Filipinos 20 years and above, the age-adjusted prevalence of stroke were 1.4% and 0.9% respectively or a remarkable decrease of 36%. (The 2013 stroke data are still forthcoming.) These figures are lower than the age-adjusted prevalence average of 2.6% in the United States affecting the same age population and conducted with similar survey protocols from 2009 to 2012 as reported by the National Health and Nutrition Evaluation Survey (NHANES). But inspite of the stroke reduction in the Philippines, mortality due to cardiovascular(CV) diseases has been rising.

The targets of stroke prevention are measured by the reduction in mortality and morbidity and the preservation of quality of life. In the US, CV mortality went down from 2001 to 2011 by 15.5% but it still accounted for 31% of all deaths in 2011 including 5% mortality due to stroke. The reduction in CV mortality was due to achieving the goals on the seven metrics of CV health in the American Heart Association (AHA) 2020 goals among US adults 20 years and above. These were on smoking, body mass index, total cholesterol, blood pressure, fasting plasma glucose and physical activity(PA). The decline in stroke mortality resulted from reduced stroke incidence and lower case fatality rate and interventions that controlled CV risk factors such as hypertension(HTN), high cholesterol, diabetes(DM) and smoking.

The World Health Organization (WHO) reported 56 million deaths worldwide in 2012, of which 38 million(68%) were due to non-communicable diseases (NCDs) which consist of CV diseases, cancer, diabetes and chronic respiratory diseases. With these staggering statistics, member states have agreed on a set of nine voluntary global targets to be attained by 2025. These include alcohol, physical activity(PA), salt/sodium intake, tobacco use, HTN, DM, obesity, treatment for prevention of heart attacks and strokes and availability and affordability of technologies and essential medicines to manage NCDs. The overarching target is a 25% reduction of premature mortality from the four major NCDs by 2025. Although individual behaviour change is important, attacking NCDs needs leadership, policy development and strong effort towards universal health coverage at the highest levels and all departments of government.

To achieve implementation, the intervational strategies should be cost-effective and feasible. The WHO Report in 2011 and 2014 identified several interventions which have been shown to be effective with reasonable implementation cost, impact and feasibility in countries with varying income levels and thus are considered “best buys”. They are very challenging but achievable especially through national legislation, local government laws and ordinances and company policies. As proof of this is the Sin Tax Law in the Philippines implemented in January 2013 which resulted in the reduced prevalence of smoking from 31% in 2008 to 25.4% in 2013 with 3.2 million less smokers.

On the main question at hand, it’s only when we succeed in significant reduction of the prevalence of behavioural and biologic risk factors and reduction in mortality and morbidity of stroke, can we truly claim that we are close to the set targets of stroke prevention.

Education and Training: • Doctor of Medicine, UP College of Medicine • Residency in Internal Medicine, The Washington Hospital Center,

Georgetown University, Washington, DC, USA • Clinical Fellowship in Medicine and Clinical and Research

Fellowship in Cardiology, Harvard Medical School and Boston City Hospital Thorndike Memorial Laboratory, Boston, Massachusetts, USA

Affiliations; Academic and Administrative Positions: • Diplomate & Fellow, Philippine College of Physicians, Philippine

College of Cardiology, American College of Physicians, American College of Cardiology

• Clinical Associate Professor, College of Medicine, University of the Philippines

• Consultant, Internist & Cardiologist, Dept. of Medicine & Section of Cardiology, UP-Philippine

• General Hospital (PGH), Manila Doctors Hospital (MDH), Makati Medical Center (MMC), Philippine Heart Center (PHC)

• Cardiologist, Philippine Airlines & UNICEF, UN Dev’t Program, World Health Organization

• Member, Board of Directors, Manila Medical Services, Inc. • Member, Board of Trustees, Tytana Colleges (formerly Manila

Doctors College) • Past President, Philippine Lipid & Atherosclerosis Society, 2002-

2003 & 2012-2013; UP Medical Alumni Society, 1991; Philippine College of Physicians, 1994; Philippine Heart Association, 1985

• Past Vice-President, Stroke Society of the Philippines, 2002-2003 • Former Medical Director, Manila Doctors Hospital, 1994-2010


JOHNNY K. LOKIN, MD

LIPIDS AND STROKE: TREATMENT TO TARGET AND TIME TO TREATMENT Affiliations; Academic and Administrative Positions:

• Member, Board of Trustees , Stroke Society of the Philippines

• Chief of Neurology Section, Delos Santos Medical Center

• President of the Philippine Neurological Association in 2008

• President of the Philippine College of Psychopharmacology

• Head, Neuro-Intensive Care and Stroke Unit, Chinese General Hospital & Medical Center

• Member, Stroke Services, University of Santo Tomas Hospital

• Vice Chair for Clinical Training, Department of Neurology and Psychiatry, University of Santo Tomas Hospital

• Member, Adult Neurology Specialty Board, Philippine Neurological Association

• Honorary Fellow, Korean Neurocritical Care Society

DAY 2: RISK FACTOR PLENARY Aug. 13, 2015

MARIA CRISTINA Z. SAN JOSE, MD

UPDATES ON CAROTID DISEASE

Carotid stenosis is an important cause of Transient Ischemic Attacks and stroke. Thromboembolism and hypoperfusion are the pathophysiologic mechanisms of ischemic stroke distal to a carotid stenosis.

Risk assessment based on symptomatology and degree of stenosis helps guide management. Medical therapy for carotid stenosis has improved with aggressive risk factor modification, use of statins and antiplatelet agents. Carotid endarterectomy (CEA) in addition to best medical management is proven among patients with symptomatic severe carotid stenosis and is moderately useful for patients with moderate stenosis of at least 50%. While carotid artery stenting (CAS) is considered to be an alternative to CEA, patient’s age and other co-morbidities may influence choice of intervention based on recent trials.

The annual stroke risk with asymptomatic carotid stenosis has declined from 2-2.5% in the 1990’s to 0.5-1%. Most patients will benefit with best medical management alone. Revascularization techniques are not routinely recommended as their benefit may be lower than previously reported.

Education and Training: • 1994, Doctor of Medicine, UST Faculty of Medicine and Surgery • 1999, Residency in Adult Neurology (Chief Resident), UP-PGH • 2001, Fellowship in Stroke/Cerebrovascular Disease (Chief

Fellow), St. Luke’s Medical Center • Clinical Rotations at the University of Pittsburgh Medical Center

(UPMC) Stroke Institute, 2001 and Columbia-Presbyterian Medical Center Stroke Institute & Neurovascular Laboratory, 2002

Affiliations; Academic and Administrative Positions: • President, Stroke Society of the Philippines • Fellow, Philippine Neurological Association • Head, Stroke Service, St. Luke’s Medical Center, QC • Head, Health Service Outcomes Research (HSOR) under the

Research and Biotechnology Group of St. Luke’s Medical Center • Vice Chair for Services, Department of Neurosciences UP-PGH • Clinical Associate Professor, UP College of Medicine • Member: Stroke Council; Research Committee, Neurosonology

Group of the Philippine Neurological Association and Member of the Editorial Board of the Philippine Journal of Neurology (PJN)

• Founding Member, Phiippine Society of Vascular Medicine

Awards and Citations: • Research Chair Holder at St. Luke’s Medical Center QC for 2

consecutive years (2012, 2013) for commitment to research excellence in the field of Neurology.

• Young Researcher Award for 2015, St. Luke’s Medical Center, QC


ROSALINA B. ESPIRITU-PICAR, MD

Education and Training: • 1992, Doctor of Medicine, cum laude, UST Faculty of Medicine

and Surgery • 1997, Residency in Neurology, Makati Medical Center • 1998, Fellowship in Sleep Medicine, Columbia Presbyterian

Medical Center, New York, USA

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurological Association • Vice Chairperson, Department of Neurosciences, Makati Medical

Center • Section Chief and Associate Professor in Clinical Neurology, Dr.

Jose G. Tamayo Medical University, Binan, Laguna • Section Chief, Neurophysiology, University of Perpetual Help

Medical Center, Binan, Laguna • Co-Director, Sleep Laboratory, Makati Medical Center • Attending Neurologist at the Makati Medical Center, Mt. Sinai

Medical Center and Sta. Rosa Medical Center


STROKE RISK AND SLEEP APNEA

As humans, we spend roughly a third of our lives asleep. Sleep health is an issue for the current times given our overwhelming rates of chronic sleep deprivation, circadian rhythm disorders and the societal impact of shift work.

A brief discussion on these important health issues will be given as it pertains to the perpetuation of risk factors for cardiovascular and cerebrovascular diseases.

Sleep disordered breathing is currently considered an emerging risk factor for cerebrovascular disease. The impact of SDB is mainly due to it being a major driver for the progression of atherosclerosis. It has been correlated with BP fluctuations during the evenings, increased risk for cardiac arrhythmias and shunting through PFOs.

Methods for diagnosing SDB will be discussed from the most simple, cost-effective means to the most sophisticated and gold standard, polysomnography. The impact on overall health and risk reductions with the use of SDB treatments will complete the lecture.

RAQUEL A. ALVAREZ, MD

GENDER DIFFERENCES IN STROKE

Cerebrovascular disease is the second leading cause of death worldwide. Stroke is generally characterized by increased endothelial damage of the blood brain vessels leading to inflammation and accumulation of fatty deposits in the damaged arterial wall, thus inducing atherosclerosis. Stroke contributes significantly to the global burden of disease, mandating high interest in stroke prevention.

In epidemiologic studies, pathophysiology, treatments, and outcomes, sex differences in stroke have been observed. These differences are multifactorial including anatomic, genetic and hormonal factors. Perimenopausal women appear less vulnerable to stroke than similarly aged men. However there is an increase in stroke among in postmenopausal women and in combination with living longer, women are older at stroke onset and suffer more severe stroke. Loss of sex steroid hormone dependent protection, after menopause may potentially be the cause of excess stroke in older women. These women tend to have poorer quality of life, more discharges to nursing homes and more vulnerable to post stroke depression.


Surgery • 1993, Residency in Neurology, Makati Medical Center • 2001, Preceptorial on Stroke, New York Presbyterian

Hospital, Columbia Medical Center

Affiliations; Academic and Administrative Positions: • Fellow and Past President, Philippine Neurological

Association • PRO, Stroke Society of the Philippines • Chief, Section of Neurology, Makati Medical Center • Chief, Section of Neurology, Department of Internal

Medicine, San Juan De Dios Educational Foundation

DAY 2: NOUVEAU ENTITIES Aug. 13, 2015

ARTEMIO A. ROXAS, JR., MD

A CLOSER LOOK ON CRYPTOGENIC STROKE

The search for Patent Foramen Ovale is becoming more common in young subjects suffering from migraine, transient ischemic attack, or cryptogenic stroke. Autopsies have revealed that the prevalence rate of Patent Foramen Ovale is 26%, and may be incidental and not the direct cause of stroke. What is known is that PFO is more prevalent among young patients with cryptogenic stroke, and that it’s importance as the etiology increases if the size if the defect is >4 mm, if there is an AtrialSeptal Defect or a venous thrombus detected, and if there is evidence of a hypercoaguable state. These risk factors play a major role in management decisions, whether to treat medically with antiplateletsor anticoagulants, or invasively through surgery or percutaneous closure.

The Transcranial Doppler (TCD) Bubble Test is simple. Air-mixed saline is injected into the right antecubital vein three times whiledoppler signal is recorded in the Right Middle Cerebral Artery for 25 seconds after the Valsalva maneuver. The higher the number of microbubbles shunting through a PFO, the higher the probability of correctly diagnosing the interatrial communication. The shunt is classified as small (1-10 microembolic signals), medium (>10 microembolic signals) and large (>10 microembolic signals with “curtain”).

Transcranial Doppler and Transesophageal Echocardiography (TEE) are complementary diagnostic tests for PFO, but TCD should be recommended as first choice for screening because of its simplicity, non-invasive character and low cost. Recent studies show great concordance between TCD and TEE with sensitivity ranging from 70% to 100% and specificity >95%


Association • Immediate Past President, Stroke Society of the

Philippines • Associate Professor, University of the Philippines-

College of Medicine for Department of Neurosciences • Head, Section of Neurology and Director of Acute

Stroke Unit and Neuro-ICU, The Medical City Hospital • Chairman, Stroke Council, Philippine Neurological

Association • Secretary, Brain Foundation of the Philippines • Past Editor in Chief, Philippine Journal of Neurology • Clinical Epidemiologist-Investigator for stroke related

studies: HOPE-3, ENGAGE, INTERSTROKE, RELY, RELY-Able, ON-TARGET, TRANSCEND, REACH Registry, STROKE-OP, APOLLO, PICASSO and SOCRATES

DAY 2: NOUVEAU ENTITIES Aug. 13, 2015

ROMULO U. ESAGUNDE, MD

STROKE SECONDARY TO INFECTIVE ENDOCARDITIS

Stroke occurs in 10-25% of patients with Infective Endocarditis (IE). Cerebral embolism can herald the diagnosis of IE. The risk of stroke begins to increase approximately 4 months before the diagnosis of IE and peaks in the 1-month period after the diagnosis of IE, with an absolute risk increase of 9.5% and an odds ratio 96.5 (95% CI 60.1-166.0). A 0.5% risk of stroke occurrence per day exists among patients with IE. Stroke in IE patients can be subtle or subclinical. Cranial MRI findings showed clinically silent embolic lesions in up to 80% of IE patients.

The overall prevalence of cerebral hemorrhage in CNS involvement of IE is 3-7%, usually due to rupture of mycotic aneurysms, vascular wall necrosis and hemorrhagic transformation of infarct. Intraventricular hemorrhage as well as perisylvian and perirolandic subarachnoid hemorrhages are fairly common to IE patients.

Management of IE patients with embolic stroke is directed towards minimizing the risk for subsequent embolization and prevention of hemorrhagic complication. Anticoagulation can be considered in cases of mechanical prosthetic valves, atrial fibrillation and hypercoagulable state. Antiplatelet therapy may decrease the rate of embolization. Thrombolytic therapy is contraindicated in acute stroke patients diagnosed with IE due to increase hemorrhagic risk. Patients with mycotic aneurysms may benefit from surgical of endovascular interventions.

Education and Training: • Doctor of Medicine, University of Santo Tomas • Residency in Neurology, Jose R. Reyes Memorial

Medical Center • Research Fellowship in Stroke/Neurosonology,

Singapore General Hospital

Affiliations; Academic and Administrative Positions: • Fellow and Treasurer, Philippine Neurological

Association • Secretary, Stroke Society of the Philippines • Medical Specialist I, Department of Neurology, JRRMMC • Assistant Professor 2, Department of Medicine, DLSU-HIS • Neurology lecturer, San Beda College of Medicine • Consultant, Our Lady of Pillar Medical Center, Imus,

Cavite

DAY 3: COMPLEX MANAGEMENT Aug. 13, 2015

ALEJANDRO A. BAROQUE II, MD

CEREBRAL VENOUS THROMBOSIS Education and Training:

• 1984, Doctor of Medicine, University of Santo Tomas

• 1989, Residency in Neurology and Psychiatry, UST Hospital


Association

• Fellow, Philippine Psychiatric Association

• 1st Vice President, Stroke Society of the Philippines

• Professor I, Department of Neurology and Psychiatry, UST Faculty of Medicine and Surgery

• Past Chairman, ASEAN Neurological Association

• Secretary General, Asia-Pacific Congress Against Stroke, 2008

• Secretary, Department of Neurology and Psychiatry, UST Faculty of Medicine and Surgery

• Active Medical Staff, UST Hospital

DAY 3: COMPLEX MANAGEMENT Aug. 13, 2015Ublica;

MARIA EPIFANIA V. COLLANTES, MD

RESUMING ANTITHROMBOTICS AFTER INTRACRANIAL HEMORRHAGE

The use of antithrombotic therapies to prevent thromboembolism in patients with an acute or prior intracerebralhemorrhage (ICH) presents a clinical dilemma with competing risks and benefits.

Particularly vexing issue after a patient has had an ICH is whether to begin or re-initiate antiplatelet agents and anticoagulants—. Patients with a compelling indication for an antiplatelet agent should restart an antiplatelet agent several weeks after the ICH, but use the lowest dose possible. Patients with suspected CAA or brain microbleeds should have the most compelling indication because of their increased risk for recurrent ICH and should, therefore, be exposed to the lowest possible dose. Patients with a deep ICH seem to have a lower recurrence risk.

ICH is the most feared and devastating complication of anticoagulant treatment, leading to death or disability in two thirds of cases. Once ICH occurs, the decision of whether to resume anticoagulation is a true therapeutic dilemma that requires balancing the competing risks of hematoma growth or recurrent ICH and disabling thromboembolic events.Among all factors associated with an increased risk of recurrent ICH on warfarin, ICH location and documented history of thromboembolism seem to be the key factors that tilt the risk/benefit balance of restarting anticoagulation after ICH

Risk factors such as hypertension, diabetes and smoking must be treated aggressively. If the patient does not have a compelling indication, perhaps omitting further antiplatelet therapy would be the most prudent approach.

Education and Training: • Residency in Internal Medicine, Manila Doctors Hospital • Residency in Adult Neurology, UP-PGH • Visiting Fellowship in Neurocritical care, Critical Care

Neurology, Barnes Jewish Hospital, St. Louis, MO, USA • Master of Science in Clinical Epidemiology, UP College

of Medicine

Affiliations; Academic and Administrative Positions: • Fellow, Philippine Neurological Association • 2nd Vice President, Stroke Society of the Philippines • Clinical Associate Professor, UP College of Medicine • Coordinator, Neuro ICU, UP-PGH • Research Coordinator, Department of Neurosciences,

UP-PGH • Member, Ethics Review Board, Manila Doctors Hospital • Attending Neurologist, UP-PGH and Manila Doctors

Hospital

DAY 3: COMPLEX MANAGEMENT Aug. 13, 2015

MANUEL M. MARIANO, MD

INTRAVENTRICULAR HEMORRHAGE Affiliations; Academic and Administrative Positions:

• Fellow, Academy of Filipino Neurosurgeons

• Head, Institute for Neurosciences, St. Luke’s Medical Center, Global City

• Member of the Board of Trustees and Past 2nd Vice President, Stroke Society of the Philippines

DAY 3: NEUROSURGICAL SYMPOSIUM Aug. 13, 2015

JOSE ALVIN P. MOJICA, MD

EARLY REHABILITATION IN STROKE: HOW EARLY IS EARLY?

Does early mobilization after stroke, i.e. within 24-48 hours, affect functional outcome?

The Stroke Society of the Philippines recommends that stroke patients be mobilized early as soon as medically stable, preferably within 24 hours unless contraindicated. The advocates for early mobilization cite the negative effects of bed rest on various organ systems which might slow recovery and the immobility related complications which occur soon after stroke. However, early mobilization may also be potentially harmful to the stroke patient by damaging to the ischemic penumbra associated with reduced blood flow when the head is raised or increase the blood pressure with activity. Also there are concerns about the increased risk of bleeding with mobilization among patients with intracerebral hemorrhage or those with ischemic stroke treated with thrombolysis.

This talk will look at the safety and efficacy of early mobilization after a stroke.

Education and Training: • Doctor of Medicine, University of the Philippines

College of Medicine • Residency in Rehabilitation Medicine, UP-PGH • Subspecialty training in Stroke Rehabilitation, University

School of Medicine in Miyagi, Japan • Subspecialty training in Cardiovascular Rehabilitation,

University of Sydney Cumberland College of Health Sciences and Lidcombe Hospital in New South Wales, Australia

• Master in Health Professions Education, National Teacher Training Center for the Health Professions, UP Manila

• WHO Fellow in Problem Based Learning at the Universities of Maastricht, Nijmegen and Groningen in The Netherlands

Affiliations; Academic and Administrative Positions: • Professor and Chairman of the Department of

Rehabilitation Medicine, College of Medicine and Philippine General Hospital, UP Manila

• Former Dean, National Teacher Training Center for the Health Professions, UP Manila


REYNALDO REY-MATIAS, MD

REHABILITATION AND DEVICES: WHAT IS THE EVIDENCE?

This presentation reviews the literature and describes a variety of evidence-based reviews about devices in Physical and Rehabilitation Medicine like Rehabilitation Robotics and Repetitive Brain Stimulation in Stroke.

Researches into these fields have grown rapidly and the number of therapeutic rehabilitation robots has expanded dramatically during the last two decades. Robotic Rehabilitation devices used for motor rehabilitation include Therapeutic end-effector and Assistive exoskeleton types.

We will review the clinical uses of both types In Lower extremity functions as gait and for the Upper extremities.

Both therapeutic end-effector and assistive exoskeleton devices have proven to be effective complements to conventional physiotherapy in patients with sub acute stroke, but there is no clear evidence that robotic gait training is superior to conventional physiotherapy in patients with chronic stroke or when delivered alone. Upper limb motor function training in patients recovering from stroke, robot-assisted therapy was comparable or superior to conventional therapy in patients with sub acute stroke.

Evidence also shows that rTMS has a positive effect on motor recovery in patients with stroke, especially for those with subcortical stroke. Low-frequency rTMS over the unaffected hemisphere may be more beneficial than high-frequency rTMS over the affected hemisphere.

The positions of the American Heart Association and the US Veterans Administration with regards to the use of Rehabilitation Robotics in Stroke will also be included.

Education and Training: • 1988, Doctor of Medicine, University of Santo Tomas • 1992, Residency in Physical Medicine and Rehabilitation, UP-PGH • 1994, Fellowship in Adult Brain Injury Rehabilitation, Rancho Los

Amigos Medical Center, California, USA • 2006, Masters in Human Movement Science, UP College of

Human Kinetics • 2007, Certificate Course in Swallowing Rehabilitation,

Northwestern University, Chicago, Illinois, USA

Affiliations; Academic and Administrative Positions: • Chairperson, Department of Rehabilitation Medicine – St. Luke’s

Medical Center • Chairperson, Philippine Board of Physical and Occupational

Therapy, Professional Regulation Commission • President, Philippine Academy of Rehabilitation Medicine • Secretary, Asia Oceania Society of Physical Medicine and

Rehabilitation • Clinical Associate Professor, Department of Rehabilitation

Medicine- UP College of Medicine • Board Member, Pain Society of the Philippines • Board of Trustees, Philippine Society of Neurorehabilitation • International Member, World Federation of NeuroRehabilitation • International Member, International Society of Physical and

Rehabilitation Medicine


MARILYN A. TAN, MD

STROKES IN CHILDREN: FOCUS ON ACUTE MANAGEMENT

Stroke is increasingly recognized as an important cause of neurologic morbidity and mortality in children. However, clinical trials in pediatric stroke are lacking. The diversity of stroke risk factors and the lower frequency of stroke in children compared to adults pose challenges in the conduct of clinical trials. Thus, current treatment recommendations for arterial ischemic stroke (AIS) in children have mainly been adapted from adult stroke studies, case series or expert opinion of pediatric stroke neurologists. Successful thrombolytic therapy using tissue plasminogen activator (tPA) for acute ischemic stroke in children have been reported in literature but there is insufficient data to recommend its routine use.

The American Heart Association (AHA) guidelines in 2008 state that tPA generally is not recommended for children with AIS outside of a clinical trial. On the other hand, the administration of low molecular weight heparin (LMWH) or unfractionated heparin (UFH) may be considered in children for up to 1 week after an ischemic stroke pending further evaluation to determine its cause. Long term secondary stroke prophylaxis includes anticoagulation using heparin or warfarin, or use of antiplatelet agents such as aspirin or clopidogrel.

Education and Training: • Doctor of Medicine, University of the Philippines,

College of Medicine • Residency in Pediatrics, UP-PGH • Fellowship in Child Neurology, UP-PGH • Fellowship in Pediatric Stroke: The Hospital for Sick

Children

Affiliations; Academic and Administrative Positions: • Diplomate, Philippine Pediatric Society • Fellow, Child Neurology Society of the Philippines • Fellow, Philippine Neurological Association • Associate Professor 3 in Pediatrics – UP College of

Medicine • Pediatric neurologist – Philippine General Hospital,

Manila Doctors Hospital • Training officer – Section of Pediatric Neurology, UP-

PGH

DAY 3: PEDIATRIC STROKES Aug. 13, 2015

Boehringer Ingelheim

Ever Neuro

Hi-Eisai

LRI-Therapharma

Natrapharm Patriot

Otsuka

Astellas

Bayer

Cathay YSS

Conjug8

E*Chimes

Innogen

Metrobank

MSN Lifestyle

Pfizer

Pharma3

Torrent Pharma

CORPORATE SPONSORS

SPONSORS

16th Annual SSP ConventionOrganizing Committee

August 13 - August 15, 2015Manila Hotel

Dr. Maria Cristina Z. San JosePresident

Scientific: Dr. Johnny K. Lokin Dr. Romulo U. Esagunde Dr. Manuel M. Mariano Postgraduate Course for MD : Dr. Maria Cristina Z. Macrohon-Valdez Postgraduate Course for PT/OT/ Allied Health Professionals: Dr. Jose Alvin P. Mojica Neurosonology Course : Dr. Jose C. Navarro Stroke Nursing Course : Louie Paul P. Eugenio, RN and Dianna Jean F. Serondo, RN

Publicity/Flyers/Posters: Dr. Artemio A. Roxas, Jr. Dr. Arturo F. Surdilla Dr. Orlino A. Pacioles

Physicals: Dr. Carlos L. Chua Dr. Eric P. Capulong Dr. Gerard Saranza

Registration: Dr. Juvy M. Asuncion Dr. Ciela V. Balagtas Dr. Charisma T. Evangelista Dr. Ruth T. Villanueva

Hotel Accommodation: Dr. Cristina Z. Macrohon-Valdez

Ways and Means: Dr. Alejandro C. Baroque Dr. Betty D. Mancao

Documentation: Dr. Pedro Danilo J. Lagamayo Dr. Roland C. Perez Dr. Randolf John R. Fangonilo Dr. Robert Francis G. Luzod

Audiovisuals: Dr. Jose Leonard R. Pascual V Dr. Allan A. Belen Dr. Loreto P. Talabucon Dr. Novito M. Magsino

Socials: Dr. Ma. Socorro F. Sarfati Dr. Julette F. Batara

Opening Ceremonies: Dr. Raquel A. Alvarez Dr. Godfrey T. Robeniol Dr. Artemio A. Roxas, Jr. Dr. Jose Leonard R. Pascual V

Souvenir Program: Dr. Belinda Mesina-Nepomuceno Dr. Maria Cristina Z. San Jose

Dr. Maria Epifania V. CollantesOverall Convention Chair

Dr. Alejandro C. BaroqueSenior Adviser

SSP ANNUAL CONVENTIONS

1st Philippine Congress on Brain AttackTheme: Thinking Globally, Acting LocallyOctober 1-2, 1999, Manila Midtown Hotel

2nd Philippine Congress in Brain AttackTheme: Organizing Stroke ServicesYear 2001

3rd Philippine Congress on Brain AttackTheme: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH)August 2002

4th SSP Biennial ConventionTheme: Ugaliing Tingnan, Ating Kalusugan, Upang Brain Attack ay MaiwasanAugust 20-22, 2003Bethel Guest House, Dumaguete City

5th SSP Annual ConventionTheme: Emerging Diagnostic Modalities & Therapeutic Interventions in Acute Brain AttackAugust 19-21, 2004Taal Vista Hotel, Tagaytay City

6th SSP Annual ConventionTheme: SSP Goes to the CommunityAusgust 18-20, 2005Fort Ilocandia Hotel, Laoag City

7th SSP Annual ConventionTheme: SSP Goes to Mindanao: Empowering the Community for Optimal Stroke CareAugust 21-23, 2006The Marco Polo Hotel, Davao City

8th SSP Annual ConventionTheme: SSP Goes to Central LuzonAugust 16-18, 2007Legenda Hotel, Subic Bay Freeport Zone, Zambales

9th SSP Annual ConventionTheme: Stop Stroke before it Stops YouAugust 22-24, 2008Baguio Country Club, Baguio City

10th SSP Annual ConventionTheme: The Philippine Stroke Agenda: Tackling Knowledge, Issues, Concerns and Awareness in StrokeAugust 20-23, 2009Holiday Inn, Clarkfield, Pampanga

11th SSP Annual ConventionTheme: Harmonizing Strategies in Stroke: From Bench to Bedside to BackyardAugust 18-20,2010Marco Polo Hotel, Davao City

12th SSP Annual ConventionTheme: Strengthening the Weaker Links in Philippine Stroke CareAugust 11-13, 2011Sarabia Manor Hotel, Iloilo City

13th SSP Annual ConventionTheme: From Thinking Globally, Acting Locally to Individualized TherapyAugust 9-11, 2012Malberry Suites, Cagayan De Oro City

14th SSP Annual ConventionTheme: H.I.T. Stroke: Hitting Ideal Targets Against STROKEAugust 8-10, 2013Oriental Hotel, Palo, Leyte

15th SSP Annual ConventionTheme: Basics in Bicol: Best Practices in Community- Based Stroke CareJuly 31-August 2, 2014Avenue Plaza Hotel, Naga City Bicol

SSP ANNUAL CONVENTIONS

MALACAÑANGManila

BY THE PRESIDENT OF THE PHILIPPINES

PROCLAMATION NO. 92

DECLARING THIRD WEEK OF AUGUST OF EVERY YEAR ASBRAIN ATTACK AWARENESS WEEK

Whereas, the Stroke Society of the Philippines was organized in 1995 composed of multi-disciplin-ary professionals to help address the different concerns in the prevention, treatment and rehabilitation of brain attack victims;

Whereas, the problem of stroke or “Brain Attack” continues to grow as one of the country’s seri-ous health problems due to the growing prevalence of certain types of lifestyle and diet, which puts the Filipino people at high risk for the disease and eventually will affect our national socio-economic development;

Whereas, the different strategies in the prevention, treatment and rehabilitation of brain attack should be vigorously pursued to reduce stroke related deaths and disability, and to reduce the risk fac-tors for said disease;

NOW, THEREFORE I, GLORIA MACAPAGAL ARROYO, President of the Philippines, by virtue of the powers vested in me by law, do hereby declare the Third Week of every August as Brain Attack Aware-ness Week.

IN WITNESS WHEREOF, I have hereunto set my hand and caused the seal of the Republic of the Philippines to be affixed.

Done in the City of Manila, this 28th day of August, in the year of Our Lord, Two Thousand and One.

By the President:

ALBERTO ROMULOExecutive Secretary

BOARD OF TRUSTEESOfficers 2015-2016

The STROKE SOCIETY of the PHILIPPINESRoom 1403 14th Flr. North Tower

Cathedral Heights Bldg. Complex Inc.St. Luke’s Medical Center, 279 E. Rodriguez Sr.Blvd, Quezon City

Telefax (632) 722-5877 Tel. No.723-0103 loc. 5143E-mail: [email protected]

Dr. Maria Cristina Z. San Jose President

MEMBERS PAST PRESIDENTS

Dr. Raquel M. Alvarez P.R.O.

Dr. Alejandro C. Baroque II 1st Vice-Pres.

Dr. Pedro Danilo J. LagamayoDr. Betty D. Mancao

Dr. Manuel M. MarianoDr. Jose Alvin P. MojicaDr. Orlino A. Pacioles

Dr. Jose Leonard R. Pascual VDr. Peter P. Rivera

Dr. Maria Socorro F. SarfatiDr. Maria Cristina M. Valdez

Dr. Artemio A. Roxas, Jr.(2013-2014)

Dr. Carlos L. Chua(2011-2012)

Dr. Jose C. Navarro(2009-2010)

Dr. Ester S. Bitanga(2007-2008)

Dr. Abdias V. Aquino(2005-2006)

Dr. Joven R. Cuanang(Founding President 1995-2004)

Dr. Romulo U. Esagunde Secretary

Dr. Maria Epifania V. Collantes 2nd Vice-Pres.

Dr. Johnny K. Lokin Treasurer

inside front cover ssp mission visionwarmest greetings to the stroke society of the philippines...

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