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Conference Learning Points

I am very grateful to MOHH for granting me sponsorship to the Meeting of the European Neurological Society 2009 in Italy, where we presented a poster. This opportunity is greatly appreciated. I learnt a great deal during the conference, hopefully some of which may help me take care of my patients better. Some of the learning points are described below.

1. Autoimmune paraneoplastic/non paraneoplastic encephalitis: In 2008, we published a case report on autoimmune encephalitis associated with anti-NMDA receptor antibodies (Wilder-Smith and Ng, Lancet 2008;372:344). At that time, anti NMDA receptor encephalitis was relatively rare. However, there has been, in the past year, increasing interest in this condition, and in other encephalitis related to autoimmune antibodies. Recognising the various characteristics eg. dyskinesia, autonomic dysfunction etc and treating early with immunosuppressives is important because it can restore function to normalcy while delaying treatment may result in permanent damage. Furthermore, the encephalitis may be associated with cancer, which may develop years later eg. ovarian teratoma with anti-NMDA encephalitis.

During the conference, one of the workshops was devoted to discussing the features and appropriate investigations for these conditions. Because testing various antibodies can be expensive, guidelines were discussed by doctors in Europe who had treated larger numbers of these patients. These interactive sessions were very interesting, and useful in developing evidence based and cost effective ways to treat such patients, including the ideal follow-up for a possible cancer which could occur years later.

2. Multiple Sclerosis (MS): As MS is more prevalent in the caucasian population, many lectures and presentations were devoted to this conditions. Through these, I was able to learn a lot about the latest research that was going on in this field. I was also able to find out about the various multicentre trials which I could potentially enrol patients into.

3. Neurorehabilitation: A visit to a local hospital was organised for those who were interested. The hospital had a large wing specially designated for neurorehabilitation. This was for patients with common neurological conditions eg. stroke, dementia. They had a neurogym, small swimming pool etc. In Singapore, there is increasing recognition of the need for care of patients with debilitating neurological conditions, hence the development of TTSH rehabilitation programme and NUH department of rehabilitation medicine. During the conference there were entire workshops dedicated to techniques in neurorehabilitation, some of which had many useful pointers.

4. Functional Magnetic Resonance Imagine (fMRI): Interpreting the results is not easy for doctors, who often do not have a background in physics/mathematics. The same goes for other techniques like near infrared spectroscopy and diffuse tensor imaging. However, during the conference, there were workshops which taught the basic principles of fMRI without complex mathematics/physics, so that we could use this technique more effectively in research.

5. Poster Presentation: We were given a chance to present our posters at a moderated poster walk. It was a useful experience to learn how to answer questions. In particular, people who specialised in different fields of neurology would ask unexpected questions, and we would have to think of ways to explain concepts on the spot.

6. Trade Exhibition: Personally, I found it informative to talk to sales representatives of different companies which manufactured the products we use. I learnt about: - How EEG analysis programmes worked - The manufacturing process and new uses of IVIg - The various methods of autoantibody testing - Ongoing trials for various diseases - New antibody tests for multiple sclerosis and more...

Perhaps these would not be interesting to the experienced clinician, but as an junior MO, I found them very educational and potentially useful in patient care. Once again, I am very grateful to MOHH for this opportunity, and would definitely recommend it for anyone interested in research.

Esther Ng Shu-Ting
Medical Officer Trainee
General Medicine, NUH

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