會議議程

Lecture Abstract：
Neuromodulation and neurostimulation for the treatment of epilepsy have become increasingly popular. Since December 2020, vagus nerve stimulation (VNS) for treatment of drug-resistant epilepsy (DRE) has been enrolled into the benefit package of our National Health Insurance (NHI), and as expected the number of patients receiving this treatment has increased significantly.

Epilepsy, regarded as a network disease, is usually robust and resilient to intervention; however specific non-pharmacological non-resectional approaches like VNS and DBS have been demonstrated to modify the brain network structure and treat epilepsy to a certain extent. My presentation will illustrate the development, application, and possible future of especially VNS, as well as various other neuromodulation and neurostimulation techniques that could be applied for patients with epilepsy now and forthcoming time.

Lecture Abstract：
The decision of when and how to treat epilepsy should take into consideration the impact of seizures on the patient versus the potential positive and negative effects of medication. Treatment with AEDs may not be straightforward; there is the potential for side-effects, toxicity and pharmacological interaction with other drugs.
When considering treatment options, it is essential to adopt a personalized approach including seizure type, seizure syndrome, concomitant diseases and specific etiological risk factors. Making an evidence-based informed decision about the most appropriate first-line pharmacological therapy is essential.
The current pattern of prescribed antiepileptic drugs (AED) is unclear when the newer AEDs are available in the early 21th century. We evaluated 118,937 prevalent epileptic patients in 2016 from a comprehensive coverage health care system. We found that predominant therapy model was monotherapy. The proportion of AED monotherapy was also higher in patients with dementia and stroke. The top three antiepileptic monotherapies were valproic acid (28.7%), levetiracetam (19.1%), and phenytoin (16.9%).
We also evaluated 73,891 incident epileptic patients between 2013 and 2016 from real-world settings. We found that the top five most commonly used AEDs as monotherapy were valproic acid, phenytoin, levetiracetam, gabapentin and oxcarbazepine. Valproic acid was the first choice of all AEDs (more than 30%) while levetiracetam has replaced phenytoin as the second choice since 2015. Factors associated with whether receiving the newer AEDs in the first prescription included year of diagnosis, gender, income level, previous or coexisting comorbidities, and characteristics of care providers (level of accreditation, volume, location and urbanization).

Lecture Abstract：
Neurological recovery is the key long term outcome for cardiac arrest patient. Global ischemia reperfusion injuries, including multiple organs, during cardiac arrest and cardiopulmonary resuscitation leads to the brain damage. High quality post-resuscitation care including targeted temperature management has shown the effects of improving neurological function in these patients. Rehabilitation and recovery are proposed to bring the cardiac arrest patients to normal social life.

Lecture Abstract：
Since the application of thrombolytic therapy in acute ischemic stroke treatment and stroke unit care since 25 years ago, there is a dramatic improvement in stroke systems of care globally. Guidelines for acute stroke management, stroke quality measures and stroke center certification have emerged important clinically. The American Heart Association/American Stroke Association (AHA/ASA) advocated Get With The Guideline(GWTG)-Stroke to improve the stroke care quality; and four levels of stroke centers, including acute stroke–ready hospitals, primary stroke center, thrombectomy-capable stroke center, and comprehensive stroke center are designated in the United States. In Taiwan, several strategies have been performed to improve stroke care quality, including the Hospital Emergent Capability Accreditation by Level in Stroke since 2009, the Taiwan Clinical Performance Indicator (TCPI) in stroke since 2012, and Disease Care Quality Certification in stroke since 2017. In 2021, TCPI updated the contents, including 22 measures. The major revision are (1) the initial severity of ICH and SAH; (2) treatment for vasospasm after SAH; (3) the mortality rates of ischemic stroke, ICH and SAH, respectively; (4) intravenous thrombolysis within 4.5 hours after stroke onset; (5) antiplatelets for acute ischemic stroke within 24 hours after hospital arrival; and (6) smoking cessation.

Lecture Abstract：
台灣血栓溶解、血栓移除、雙重抗血小板藥物、口服抗凝血藥物、腦得生養腦散等治療、跨院照護急性後期照護作業、「出院準備及追蹤管理費」、長照2.0，由健康促進、出院準備到居家醫療，慢性病管理提供最佳防治。
腦中風病人：7成高血壓，5成糖尿病，5成血脂異常，5成高齡，智能、關節、眼耳感官退化，跌倒風險高。急性期後一年再住院43.3%，死亡18.8%。再住院原因：腦血管疾病(18.6%)、呼吸疾病感染(18.1%)、循環系統(10.7%)、消化系統(10.3%)、泌尿系統(9.6%)，非高齡更需整合。緊急治療90天後：30-40%恢復良好，需要緊急醫療、40-50%失能臥床，需要急性後期、長期照護、居家醫療、20%死亡需要安寧緩和醫療。
腦中風防治網需：緊急醫療、急性後期、長期照護及安寧緩和，在醫學中心、區域、地區醫院及基層醫療合作下，針對不良事件及預後跟病人及照顧者共同協商。血壓、血糖、血脂、體重、及壓力為重要指標。
研擬腦中風防治共照網結構面、過程面、並規畫成果面，供主管機關核定執行。