會議議程

Lecture Abstract：
頭昏是一個非特異性的症狀，也是臨床上最常見的病患主訴之一。我們依賴周邊的感覺接收器，包括視覺系統、本體感覺系統、前庭感覺系統，中樞神經系統的統合協調以及運動輸出機制，才能保持個體的平衡。任何一個環節出了問題都會造成頭暈及步態不穩。精神上的壓力，例如焦慮症等，藉由干擾中樞神經系統的感覺統合能力而造成頭暈及不平衡等生理上的症狀。這在慢性頭暈的病人上尤其明顯。在以往，這類病患常被類為心因性(psychogenic dizziness)。不過，近年來的研究顯示，Maladaptation才是造成慢性頭暈的主要原因(functional dizziness)。此次演講將藉由幾個案例向大家介紹近30多年來，慢性頭暈從phobic postural vertigo (PPV) 一直到persistent postural perceptual dizziness (PPPD)在命名，診斷及治療上的演進。

Lecture Abstract：
The Whole Spectrum of Postural Tachycardia Syndrome (POTS)
Postural tachycardia syndrome is a complicated disorder that can show up in a
variety of ways, those with POTS may need to use several different treatment
options. At times, it can be challenging to find a treatment regime that successfully
controls all POTS symptoms. Approximately 1% of teens likely suffer from POTS, and
it is 3x more common in women than men. People of all ages can develop POTS, but
it is most common in women ages 15-45. From our and current research, POTS could
be an autoimmune condition, or a condition of overactivity of the sympathetic
nervous system or Imbalance between sympathetic and para-sympathetic activity in
some diseases with POTS phenomenon. Central effect is not uncommon with
symptoms of CBF hypoperfusion, HV and balance instability. Stress could be
important in the Pathophysiological procession of many POTS persons.

Lecture Abstract：
在2011年到2013年間台灣地區每五歲65 - 69歲、70 - 74歲、75 - 79歲、80 - 84歲、85 - 89歲、90歲以上之失智症盛行率分別為3.4%、3.5%、7.2%、13.0%、21.9%、36.9%，年紀越大盛行率就越高，且隨著每五歲之年齡差距盛行率有倍增之趨勢。推估台灣在2017年底的失智症患者已超過27萬人，並且在2031年失智人口將倍增至46萬人，2061年將超過85萬人，即每100位台灣人當中就有5位失智症患者，為完善失智症防治照護之政策，普查台灣目前社區與機構內失智症流行病學有其重要性，因此國家衛生研究院執行全台22縣市（含離島）住宿式長照服務機構流行病學研究，調查老人福利機構、一般護理之家、榮民之家機構內住民失智症和失能之盛行率。在5,751位調查個案中，排除無法確診的1,029位個案後，4,722位個案中總計有4,069位的臨床失智症患者，在不分機構類型下，住宿式長照服務機構之失智症盛行率為86.17%，且失能盛行率為97.76%。
另ㄧ針對全台全國社區失智症流行病學調查，調查區域範圍：本研究為針對全國社區65歲以上老年人口共22縣市，估計將調查12,725位。調查的結果在這個檔案送出前還在進行中，希望在明年五月能夠有結果出現，到時候在會議中再向各位報告。

Lecture Abstract：
Glymphatic system is a novel clearance mechanism in brain which is responsible for the cerebrospinal fluid (CSF) flow into the brain parenchyma along arterial perivascular space and subsequently into the brain interstitial space which facilitated by the highly polarization of aquaporin 4 (AQP4) water channels on astrocyte, then directs flow forward to venous perivascular space ultimately clearing solutes from the neuropil into meningeal and cervical lymphatic drainage vessels(1). In animal studies, Iliff et al. and other researchers had found that glymphatic system contributes to 55-65% clearance of β-amyloid protein from the mice brain(2, 3). Recently, Harrison et al. showed that glymphatic clearance related to cortical tau deposition in mouse model of tauopathy(4). The dysfunction of glymphatic system had also been proposed as the final common pathway for Alzheimer’s disease (AD) and other primary neurodegenerative disease(5). Despite that substantial knowledge regarding glymphatic system had been gained from animal studies, further study is needed to confirm if these findings could be applied to humans. Recently developed amyloid and tau position emission tomography (PET) image and DTI-ALPS method provide us an opportunity to explore the association between glymphatic activity and amyloid, tau deposition in patients with AD. Our hypothesis is glymphatic activity could be a mediator between amyloid and tau deposition on cognitive dysfunction in patients with AD.

Lecture Abstract：
Most cluster headaches occurring in Taiwan are episodic, and very few patients develop chronic cluster headaches. Treatment can be divided into acute and preventive types. Cluster headaches become extremely painful in a short period of time and are accompanied by ipsilateral autonomic symptoms; therefore, immediate treatment can bring considerable help to the patient.
Among the treatment methods currently available in Taiwan for cluster headaches, high-concentration pure oxygen inhalation has shown the best evidence level and effect in acute attacks, followed by the nasal spray form of Triptans, which is recommended as the first-line treatment. In terms of transitional preventive treatment, oral steroids and suboccipital steroid injections can be chosen. For maintenance prophylaxis, verapamil is recommended as first-line therapy. Drugs such as lithium, topiramate, and CGRP monoclonal antibody are recommended as second-line treatments. For instrumental therapy, non-invasive vagus nerve stimulation is recommended. For surgical treatment, Taiwan has no experience in its use presently, although the level of evidence and effect of sphenoid nerve stimulation are good.
Transitional prophylaxis and maintenance prophylaxis can be used simultaneously according to the individual condition of the patient, and the transitional prophylaxis can be gradually discontinued once the maintenance prophylaxis takes effect. Steroids not recommended to be used for more than 2 weeks in transitional prophylaxis. To maintain the timing of prophylaxis, the patient should wait for the end of the bout period (no attacks for 2 weeks), and then gradually tapered off the preventive medications.