The anatomy, physiology and normal developmental changes of brainstem auditory pathways will be discussed. The brainstem auditory evoked potentials (BAEPs) will be described in details, the BAEPs waveforms and their associated physiological genetrators. The methodology including stimulation and recording technique, patient-related variables affectinf recordings and the basis of interpretation will be presented. The use of wave V threshold determinations or latency-intensity measurements in the evaluation of the peripheral auditory system will also be introduced. The clinical use of brainstem auditory evoked potentials (BAEPs) will be further illustrated in the evaluation of the central auditory system and in different peripheral nervous system diseases. Furthermore the application of BAEPs in intraoperative monitoring in infratentorial lesions to monitor the auditory pathway from the periphery to auditory cortex will be showed. Finally the Vestibular evoked myogenic potentials (VEMPS) will be discuss in details from the anatomy and physiology to the techniques of recordings and peculiar pattern in diseases. Some illustrative clinical cases will be presented.
The Quantitative Sensory Testing is a widely diffuse tool to investigate somatosensory thresholds in pain and sensory dysfunctions. The lesson will focus on the basis of psycophysical test and the stimulus-response ranges for sensory function. The different techniques that explore and quantifying the sensory thresholds from tactile, pressure, vibratory, thermal and painful stimuli, will be presented. Different operative protocols will be presented in details with clinical case. These sensory thresholds will be described in details: thermal and pain thresholds, vibration detection threshold, mechanical detection and mechanical pain thresholds including stimulus/response functions; wind-up ratio and pressure pain thresholds. Finally, the construction of the sensory profile will be showed and QST’s strengths and limitations.
Several illustrative cases will be presented with discussion using the televoting system.
Finally there will be a focus on different paradigms exploring the conditioned pain stimulation (CPM) applied to the neuropathic pain diseases.
The autonomic function tests exploring the sudomotor, vasomotor and pupils functions will be discussed from the bedside evaluation to the quantification. For sudomotor functions the anatomo-physiological basis will be explored and several tests will be presented including iodine and starch test (thermoregulatory sweat test), or iontophoretic stimulation and quantification of sweating with different devices, the Quantitative Sudomotor Axon Reflex Test (QSART) technology and the determination of electrochemical skin conduction. The vasomotor axonal reflex responses will be described in details from the physiological basis to the clinical application in peripheral neuropathies. The different stimuli and recordings device will be described including laser doppler system and scan. Then clinical cases will be discussed using televoting systems.
Finally the anatomy and physiology of the pupil motricity will be described, and the pharmacological tests using dilute parasympathetic and sympathetic agonists to assess the supersensitivity of denervated pupils. The clinical application in focal and generalised autonomic neuropathy with different clinical cases will be presented.
The treatment of neuropathic pain (NP) is often changeling. There will be described the recent evidence-based recommendations for the pharmacotherapy of NP based on randomized controlled trials. The current knowledgment regarding efficacy, side effects and indication for the classical drugs including, in particular, tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitor antidepressants, pregabalin, gabapentin, opioids, and local drugs.
Furthermore, different reasons of modest efficacy in NP and negative clinical trials will be described including the heterogeneity of diagnostic criteria for NP and the placebo response. Then different strategy of phenotyping subgroup for future personalized therapeutic algorithms. Several cases will be presented.
tel.+ 39 040 368 343