European Journal of Neurology 2012, 19 (Suppl.
1), 90457
Poster Session 1, Sunday 9 September
Ageing and dementia 1
P1001
Surrogate decision and advance
directives authorization to
institutionalization and spontaneous
refusal of cardio-pulmonary resuscitation
in dementia: a Brazilian perspective
Y. Correa-Neto1,2, G. Rego2, R. Nunes2
1Neurology Unit, Federal University of Santa Catarina,
Florianopolis, Brazil, 2Bioethics, University of Porto,
Portugal
Introduction: Institutionalization and cardio-pulmonary
resuscitation (CPR) authorization are substantial end of life
decisions in demented patients with geographical variation.
Objectives: To assess family caregivers and non-caregivers
attitudes concerning institutionalization and cardio-
pulmonary resuscitation authorization to patients and to
them if hypothetically later demented.
Patients and methods: Family caregivers of 40 consecutive
patients with Alzheimers disease assisted at an outpatient
private practice clinic in Florianpolis, Brazil, and 40
subjects without demented family members (non-caregivers)
were enrolled. After written informed consent, subjects
received a questionnaire consisting of authorizations
requests to institutionalization and CPR of demented
patients (surrogate decision) and to themselves (advanced
directive) if they hypothetically became demented later in
life.
Results: The lower institutionalization authorization rate
was observed on family caregivers early dementia stages
surrogate decisions (3%) and the greater on same group late
stages advance directives (87.9%). Institutionalization
authorization was overall greater on late versus early stages
and on advanced directives versus surrogate decisions. No
differences were observed between family caregivers and
non-caregivers. The lower spontaneous CPR refusal rate
was observed on family caregivers early dementia stages
surrogate decisions (3%) and the greater on same group late
stages advance directives (42.4%). Spontaneous CPR
refusal rate was overall greater on late versus early stages,
on advanced directives versus surrogate decisions, and on
family caregivers versus non-caregivers (this only on early
stage dementia).
Conclusions: Dementia progression improves
institutionalization authorization and CPR refusal among
Brazilians. Deciding for others decrease institutionalization
authorizations and CPR refusals. Daily interaction with
demented improves CPR refusal rates.
90 2012 EFNS
P1002
Added diagnostic value of 11C-PiB-PET in
memory clinic patients with uncertain
diagnosis
K.S. Frederiksen1, S.G. Hasselbalch1,2, A.-M. Hejl1,
I. Law3, G. Waldemar1
Memory Disorders Research Group, Dept. of Neurology,
1
Neurobiology Research Unit, 3Nuclear Medicine and PET,
2
Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark
Introduction: PIB-PET imaging measures beta-amyloid,
and may be an important diagnostic tool. We examined the
added value of PiB-PET in patients from a memory clinic
with uncertain clinical diagnosis with regards to diagnostic
classification and confidence in diagnosis.
Methods: Patients who underwent a PiB-PET study as part
of their diagnostic work-up were eligible for inclusion. The
standard diagnostic evaluation included physical and
neurological examination, cognitive and functional
assessment and a cranial CT or MRI. Additionally, most
patients had an 18F-FDG-PET and cerebrospinal fluid
sampling. Based on anonymized case reports, three
experienced clinicians reached a consensus diagnosis and
rated confidence in diagnosis before and after disclosure of
PiB-PET ratings.
Results: 57 patients (Gender, f/m: 27/30; Age: mean 65.7
years (range 44.2-82.6); MMSE: mean 24.4 (range 13-29))
were included. 27 had a positive PiB scan. 16 patients were
initially given a clinical AD diagnosis (87.5% PiB positive).
13 patients (23%) were diagnostically reclassified after
PiB-PET results were disclosed and clinicians overall
confidence in their diagnosis increased in 28 cases (49%)
and remained unchanged in 27 cases (47%). Moreover,
there was an increase in the number of patients rated as
clear AD (0% to 31.6%) and clear non-AD (12.3% to
45.6%).
Conclusion: Amyloid imaging may have a significant
impact on the diagnostic classification of patients with
uncertain diagnosis in a memory clinic as indicated by the
number of reclassifications. Increased confidence in
diagnosis may lead to more aggressive treatment.

P1003
Cell therapy with NGF in patients with
Alzheimers disease: changes in CSF
cholinergic markers
A. Karami1, H. Eyjlfsdttir1,2, S. Vijayaraghavan1,
A. Kadir1, B. Linderoth3,4, G. Lind3,4, N. Andreasen1,2,
A. Wall5, . Seiger1,6, P. Almqvist3,4, L. Wahlberg1,7,
A. Nordberg1,2, T. Darreh-Shori1, M. Eriksdotter1,2
1Dept Neurobiology, Caring Sciences and Society,
Karolinska Institutet, 2Dept Geriatric Medicine, 3Dept
Clinical Neuroscience, Karolinska Institutet, 4Dept
Neurosurgery, Karolinska University Hospital, Stockholm,
5Dept of Radiology, Oncology and Radiation Sciences,
Uppsala, 6Stockholms Sjukhem, Stockholm, Sweden, 7NsGene
A/S, Ballerup, Denmark
Background: Nerve growth factor (NGF) improves
cholinergic functions, important for cognition. Recently we
have demonstrated that the acetylcholine synthesizing
enzyme, choline acetyltransferase (ChAT) is present in
human cerebrospinal fluid (CSF).
Objectives: To investigate whether NGF treatment affects
the levels of cholinergic markers, ChAT and
acetylcholinesterase (AChE) in CSF of patients with
Alzheimers disease (AD).
Patients and methods: Samples from 6 AD patients were
included. The patients had received treatment with
encapsulated NGF releasing cells, implanted bilaterally in
the lateral basal forebrain in all 6 patients, and also in the
medial basal forebrain in 3 of the patients. The levels of
ChAT and AChE in CSF were determined by colorimetric
assays prior to and after 3 and 12 months of NGF treatment.
Results: CSF AChE activity was increased by 18% and by
37% after 3 and 12 months of NGF treatment. Patients with
double implants had a 31-61% increase, while patients with
single implants had a 5-13% non-significant increase.
Patients with no significant cognitive decline over 12
months (responders) showed a 25% significant increase in
CSF ChAT activity. The changes in CSF ChAT activity
showed high correlations with cognition, as assessed by
MMSE (r=0.79, p<0.014) and ADAS-Cog (r=-0.82,
p<0.009), as well as with nicotine-binding (r=0.941,
p<0.0003) and glucose metabolism (r=0.81, p<0.010),
assessed by positron emission tomography.
Conclusion: NGF cell therapy showed increases in the
cholinergic markers in CSF, suggestive of a positive
treatment outcome, but these findings warrant further
investigation in a larger patient sample.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 91
P1004
Subjective cognitive impairment: who are
these individuals? A review of patients
receiving a diagnosis of subjective
cognitive complaints in ordinary clinical
practice
S. Garcia-Ptacek1,2, L. Cavallin3,4, I. Kreholt5,
M. Kramberger1,6, B. Winblad1,7, V. Jelic1,7,
M. Eriksdotter1,7
1Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet, Stockholm, Sweden, 2Department of
Neurology, Hospital Clnico San Carlos, Madrid, Spain,
3Department of Clinical Science, Intervention and
Technology, Karolinska Institutet, 4Department of Radiology,
Karolinska University Hospital-Karolinska Institutet,
Stockholm University, 5Aging Research Center, Karolinska
Institutet and Stockholm University, Stockholm, Sweden,
6Department of Neurology, University Medical Centre
Ljubljana, Slovenia, 7Department of Geriatric Medicine,
Karolinska University Hospital-Karolinska Institutet,
Stockholm University, Stockholm, Sweden
Background: Subjective cognitive impairment (SCI),
defined as cognitive complaints with normal cognitive
testing, is common in clinical practice. Longitudinal studies
demonstrate increased risk of decline. We analyze this
groups characteristics at the time of diagnosis.
Patients and methods: SCIs diagnosed at Karolinska
Memory Clinic (2007-2009). Review of epidemiological,
clinical and paraclinical data, including CSF analysis and
temporal atrophy staging by a blinded rater. SCI, MCI and
AD group means were compared with logistic regression.
Results: 453 SCI patients were identified. SCIs were
significantly younger (57.7 years) than the MCI (64.2 years)
and AD (70.1 years) groups. 64.2% were women. SCIs had
more years of education and were more likely to have family
history of dementia than AD or MCI patients. SCIs scored
higher on MMSE (28.4), RAVLT delayed retention and Rey
visual memory than the other groups. 5.7% of SCI were
homozygote for ApoE4 allele, lower than AD (28.4%).
Blinded medial temporal lobe score for SCI was 1.0, lower
than MCI or AD. SCIs had higher beta-amyloid (903.7),
lower total Tau (245.1), lower p-tau (49.5) and were less
likely to have confluent white matter lesions, hypertension,
heart disease or treatment with acetyl-salicylic acid. Cornell
score of depression was higher in SCI than AD.
Conclusions: SCI is a distinct group. SCIs are more likely
to be younger, have family history of dementia, and less
likely to be homozygote ApoE4 carriers and have a
cardiovascular risk profile than others. Follow-up is
essential to investigate long-term outcome of their cognitive
function.
92 Posters, Sunday 9 September
P1005
Genetic risk score predicting accelerated
progression from mild cognitive
impairment to Alzheimers disease
E. Rodrguez-Rodrguez1,2,3, P. Sanchez-Juan1,2,3,
J.L. Vazquez-Higuera1,2,3, I. Mateo1,2,3, J. Infante1,2,3,
D. Alcolea4,5, S. Cervantes6,7, J. Clarimn4,5,
P. Martinez-Lage8, A. Lle4,5, P. Pastor6,7,
O. Combarros1,2,3
1Neurology, Hospital Universitario Marqus de Valdecilla,
2CIBERNED, 3IFIMAV, Santander, 4Neurology, Hospital Sant
Pau, 5CIBERNED, Barcelona, 6Neurology, Clnica
Universitaria de Navarra, 7CIBERNED, Pamplona,
8Neurology, Fundacin CITA-Alzheimer, San Sebastian,
Spain
Objective: The genetic factors that influence progression of
mild cognitive impairment (MCI) to AD remain largely
unknown. We assessed whether a genetic risk score (GRS),
based on 8 SNPs previously associated with AD risk in
GWA studies, is associated with either risk of conversion or
with rapid progression from MCI to AD.
Methods: Among 288 subjects with MCI, follow-up (mean
26.3 months) identified 118 MCI-converters to AD and 170
MCI-non-converters. We genotyped ABCA7rs3764650,
BIN1rs744373, CD2APrs9296559, CLUrs1113600,
CR1rs1408077, MS4A4Ers670139, MS4A6Ars610932,
and PICALMrs3851179. We calculated for each subject a
cumulative GRS, defined as the number of AD-associated
risk alleles from our list of 8 SNPs (0-16), with each allele
unit multiplied by the OR for that allele as described in
AlzGene database. Estimates of association between GRS
divided into tertiles and rapidity of conversion from MCI to
AD were calculated with logistic and Cox regression
models.
Results: GRS was not associated with risk of conversion to
AD. MCI-converters harbouring 6 or more risk alleles
progressed 2-fold more rapidly to AD when compared with
those with less than 6 risk alleles. In fact, both MCI-
converters in the second GRS tertile (mean GRS=6.9;
HazardRatio=1.89,95% CI=1.01-3.56,p=0.047) and in the
third GRS tertile (mean GRS=9.9; HR=2.06,95% CI=1.07-
3.98, p=0.031) showed a faster progression when compared
with those in the first tertile (mean GRS=4.6).
Conclusion: The combination of 8 validated non-APOE
risk SNPs for AD aggregated into a GRS predicted
accelerated progression to AD. The GRS calculation is a
first step towards development of prediction models that
incorporate aggregate genetic factors.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1006
Effect of Ginkgo biloba on cognitive
function of elderly adults over a 20-year
period
H. Amieva, C. Meillon, J.F. Dartigues
INSERM 897 Epidemiology and Biostatistics, University of
Bordeaux, France
Introduction: The study assesses the effect of Ginkgo
biloba extract (EGb761) on cognitive function of elderly
adults over a 20-year period.
Methods: The data are gathered from the prospective
community-based cohort study Paquid. Within the study
sample (n=3612), three groups were compared: 589 subjects
reporting use of EGb761 at one of the ten assessment
visits, 149 subjects reporting use of another nootropic drug
(piracetam) at one of the assessment visits and 2874 subjects
were not reporting use of either EGb761 or piracetam.
Decline on the MMSE, IST (verbal fluency) and BVRT
(visual memory) over the 20-year follow-up was analysed
with a mixed linear effects model accounting for numerous
confounding variables.
Results: A significant difference in the MMSE score
decline over the 20-year follow-up was observed in the
EGb761 and piracetam treatment groups compared to the
neither treatment group in an opposite direction: EGb761
group declined less rapidly than the neither treatment
group (clinically relevant difference of 5 points over the 20
years), whereas piracetam group declined more. Regarding
the IST and the BVRT, no difference was observed between
the EGb761 group and the neither treatment group,
whereas the piracetam group declined more. When
comparing the EGb761 and piracetam groups directly, a
significantly different decline was observed for the 3 tests.
Conclusion: MMSE decline in a non-demented elderly
population is lower in subjects who reported using EGb761
than in those who did not. This effect may be a specific
medication effect of EGb761, since it is not observed for
another nootropic medication.

P1007
Diffusion tensor changes according to
age-at-onset and apolipoprotein E
genotype in Alzheimers disease
M.-J. Kim1, S.W. Seo2, S.T. Kim3, J.-M. Lee4, D.L. Na2
1Department of Neurology, Seoul National University
Hospital Healthcare System Gangnam Center, 2Department
of Neurology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, 3Department of Radiology,
Samsung Medical Center, Sungkyunkwan University School
of Medicine, 4Department of Biomedical Engineering,
Hanyang University, Seoul, Republic of Korea
Introduction: Age-at-onset is one of the most important
factors that affect clinical course of Alzheimers disease
(AD), and apolipoprotein E (apoE) genotype may also play
an important role in determining the clinical phenotype. We
aimed to investigate the change of white matter integrity
according to age-at-onset and apoE genotype in AD using
diffusion tensor imaging (DTI).
Methods: DTI was obtained in 72 patients with AD and 66
subjects with normal cognition (NC), and apoE genotype
was available in 48 patients with AD. Multiple regression
analysis was conducted including the interaction of age-at-
onset (or current age in the NC group) and group difference
as one of the independent variables, and fractional
anisotropy (FA) and mean diffusivity (MD) values as the
dependent variables in all subjects. In order to assess the
effect of apoE, 48 AD patients whose apoE genotypes were
available were divided into two groups according to e4
allele positivity, and each group was analyzed with the NC
group using a similar method as above.
Results: Without consideration of apoE genotype, younger
age-at-onset was associated with lower FA and higher MD
in the cingulum and fronto-temporo-parietal association
fibres. When the data were analyzed individually in e4
carriers and non-carriers, the carriers showed correlation
between younger age-at-onset and both of the cingulum and
association fibres while the non-carriers showed correlation
with only association fibres.
Conclusion: Our results suggest that characteristic
topographical distribution of pathological changes in
patients with AD is determined by not only age-at-onset but
also by apoE genotype.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 93
P1008
Altered caudate morphology in
leukoaraiosis is associated with motor
dysfunction in a subset of LADIS
(leukoaraiosis and disability in the elderly
study)
M.D. Macfarlane1, M. Walterfang2, J.C.L. Looi1,3,
G. Spulber3,4, D. Velakoulis2, L.-O. Wahlund3,
LADIS Study Group
1Academic Unit of Psychological Medicine, Australian
National University Medical School, Canberra, ACT,
2Melbourne Neuropsychiatry Centre, Melbourne University,
Melbourne, VIC, Australia, 3Department of Neurobiology,
Caring Sciences and Society, Division of Clinical Geriatrics,
Karolinska Institute, Stockholm, Sweden, 4Institute of
Clinical Medicine, Unit of Neurology, University of Eastern
Finland, Kuopio, Finland
Background: Leukoaraiosis is a common finding on MRI
brain scans of the elderly and is associated with cognition,
falls and disability. Frontostriatal neural circuits are
hypothesised to be involved, with specific areas of striatal
structures linked to specific cognitive and motor circuits.
Objectives: To determine whether morphology of
neostriatal structures, as components of frontostriatal
circuits, are correlated with severity of leukoaraiosis and
motor dysfunction.
Methods: A representative subset of LADIS (n=66) was
analysed. Shapes of caudate nuclei and putamina were
determined through standardised manual tracing methods
on MRI brain scans. We assessed relationships between
leukoaraiosis and striatal volume differences, as well as
motor function, measured using the Short Physical
Performance Battery (SPPB). Analysis was controlled for
age and intracranial volume (ICV). Shape analysis was
performed using the UNC Spherical Harmonic (SPHARM)
tools, correcting for age and ICV, for correlations of striatal
shape with SPPB.
Findings: There was no association between severity of
leukoaraiosis (Fazekas score) and volumes of striatal
structures via ANOVA. On linear regression, smaller
volumes of the left caudate were associated with lower
SPPB (Beta 0.442, p=0.005). There was no association
between SPPB scores and putaminal volumes. Inward
deformation of left caudate shape was found, in regions
corresponding to the inputs of the dorsolateral prefrontal,
premotor and motor cortex, correlating with SPPB
(p=0.0017).
Conclusions: Deficits in motor functioning seen in patients
with leukoaraiosis are associated with altered morphology
of the left caudate, a potential substrate of frontostriatal
circuit dysfunction and clinical biomarker.
94 Posters, Sunday 9 September
P1009
Dementia drug treatment in clinical
practice: data on 7570 patients from
SveDem, the Swedish Dementia Registry
D. Religa1,2, K. Johnell3, M. Eriksdotter1
1NVS, Karolinska Institutet, Stockholm, Sweden,
2Mossakowski Medical Research Centre, Polish Academy of
Science, Warszawa, Poland, 3Aging Research Center,
Karolinska Institutet and Stockholm University, Stockholm,
Sweden
Background: In Alzheimers disease (AD), cholinesterase
inhibitors and NMDA receptor antagonists, such as
memantine, are used. Psychotropics are also used for
treatment of neuropsychiatric symptoms. The aim was to
study whether there are differences between dementia
disorders in the use of anti-dementia drugs and
antipsychotics (neuroleptics) in a large population of
dementia patients.
Methods: Information about dementia disorders was
obtained from the national Swedish Dementia Registry
(SveDem) (n=7,570). Multivariate logistic regression
analysis was performed to investigate the association
between dementia disorders and the use of anti-dementia
drugs and antipsychotics, after adjustment for age, sex,
residential setting, living alone, MMSE score and number
of other drugs (used as a proxy for overall co-morbidity).
Results: More than 80% of the AD and 86% of dementia
with Lewy bodies (LBD) patients used anti-dementia drugs.
Women were more likely than men to be treated with
cholinesterase inhibitors. A higher MMSE score was
positively associated with use of cholinesterase inhibitors,
but negatively associated with NMDA receptor antagonists
and antipsychotics. The use of antipsychotics in all dementia
patients was 6%, but in LBD, the use of antipsychotics was
significantly higher (16%), with an adjusted odds ratio of
4.2 compared to AD patients.
Conclusions: The use of anti-dementia drugs in AD was in
agreement with Swedish guidelines. The use of
antipsychotics in patients with LBD was high. LBD patients
suffer from psychotic symptoms early in the disease, but the
high use of antipsychotics is worrying, taking into
consideration side-effects of antipsychotics.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1010
Exploration of a composite nano-medical
device for the delivery of neuroprotectant-
nanocarriers into targeted neuronal cells
of Alzheimers disease
M.S. Mufamadi1, Y.E. Choonara1, L.C. duToit1,
G. Modi2, D. Naidoo3, P. Kumar1, V.M.K. Ndesendo4,
L. Meyer5, S.E. Iyuke6, V. Pillay1
1Department of Pharmacy and Pharmacology, 2Department
of Neurology, 3Department of Neurosurgery, University of
the Witwatersrand, Johannesburg, South Africa, 4School of
Pharmacy and Pharmaceutical Sciences, St. Johns
University of Tanzania, Dodoma, Tanzania, 5Central Animal
Services, 6School of Chemical and Metallurgical
Engineering, University of the Witwatersrand, Johannesburg,
South Africa
Purpose: The purpose of this study was to explore an
implantable composite nano-medical device that is capable
of prolonged delivery of the neuroprotectant-nanocarrier
into targeted neuronal cells of Alzheimers disease (AD).
Method: The device was fabricated by embedding
galantamine-loaded/flourescein-isothiocyanate (FITC)-
labelled functionalized nanoliposomes [f(x)NLPs]
[phosphocholine(DSPC), cholesterol, ethanolamine (DSPE-
mPEG2000)] with synthetic peptide [KVLFLS, KVLFLT
and KVLFLM] within a neuro-compliant scaffold
(glutaraldehyde crosslinked chitosan, Eudragit-RSPO, and
polyvinylalcohol or polyethyleneoxide) followed by freeze-
drying. Drug release from drug-loaded f(x)NLPs was
performed using an orbital shaker-bath (50days) and at
predetermined time intervals samples were drawn and
analyzed via UV (max=288nm). PC12-cells were seeded
on the device, ensued by air-drying/freeze-drying. Cells on
the device were examined under SEM and stereomicroscopy.
LDH release and antipoliferation were assayed using the
CytoTox-96 Non-Radioactive and CytoTox-Glu
Cytotoxicity assays, respectively, thereafter Lactate
Dehydrogenase (LDH)/dead cells was quantified employing
plate reader. At pre-determined time intervals cell uptake
was analyzed for 30 days employing plate reader and
CLSM.
Results: In vitro study demonstrated that prolonged release
of f(x)NLPs (60-100%) from the device over a period of 50
days. SEM and stereomicroscope results demonstrated that
the device was suitable for neuronal cell attachment and
proliferation. Ex vivo results exhibit less than 25% LDH
release which validate that the designed device did not
significantly induce cell injury. CSLM and plate-reader
studies revealed that f(x)NLPs facilitated the drug uptake
into PC12-cells via LDL receptor family.
Conclusions: The results revealed that the designed device
had superior cytocompatibility and was suitable to fulfil
prolonged delivery of neuroprotectants-nanocarrier into
targeted neuronal cells of AD.
 Posters, Sunday 9 September 95

P1011 P1012
A multicentre randomized clinical trial of Olfaction in frontotemporal lobar
physical exercise in Alzheimers disease degeneration
(AD): rationale and design of the ADEX H. Magerova1, M. Vyhnalek1,2, J. Laczo1,2, R. Andel3,
study A. Kadlecova1,2, M. Bojar1, J. Hort1,2
1Neurology, Charles University, 2nd Faculty of Medicine and
S.G. Hasselbalch1, K. Hoffmann1, K.S. Frederiksen1,
Motol Hospital, Prague, 2International Clinical Research
N.A. Sobol2, N. Beyer2, A. Vogel1, A.H. Simonsen1,
Center, St. Annes University Hospital Brno, Czech Republic,
G. Waldemar1 3University of South Florida, School of Aging Studies,
1Memory Disorders Research Group, The Neuroscience
Tampa, FL, USA
Centre, Rigshospitalet, 2Institute of Sports Medicine,
Bispebjerg University Hospital, Copenhagen, Denmark Introduction: Olfactory impairment is well documented in
Alzheimers disease or Parkinsons disease. On the other
Background: Physical exercise has the potential to improve
hand, only limited data are available in frontotemporal lobar
cognition, psychological symptoms, physical performance
degeneration (FTLD), however the distribution of brain
and quality of life, but evidence is scarce. Previous trials
pathology in some FTLD subtypes suggest, that olfaction
have been short, often underpowered and involving home
might be impaired even in these disorders
based light exercise programs. Most have included nursing
Methods: Following FTLD subgroups were included in the
homes residents with severe undefined dementia. The aim
study: FTLD-behaviour variant (FTD-bv, n=7), semantic
of the ADEX study is to establish whether exercise can
dementia (SD, n=4) and progressive supranuclear palsy
improve symptoms and quality of life in patients with mild
(PSP, n=8). Smell identification was assessed using a test
to moderate AD.
developed at our memory clinic - the Motol Hospital Smell
Methods: The study is a multicentre, single-blind,
Test (MHST). Results were compared with the control
randomized clinical trial. We plan to recruit 192 patients
group (n=15). In our previous study, the MHST and UPSIT
aged 55-85 years with mild to moderate AD. The participants
results correlated with each other (r=0.68, p<0.001).
will be randomly allocated into two groups: An intervention
Results: The subjects were similar in age (0.889) and
group attending 16 weeks of continuously supervised
gender (0.357), but they differed in Mini-Mental State
moderate aerobic exercise 1 hour three times a week and a
Examination (MMSE) score (p=0.002). The one-way
control group only receiving usual care. Primary outcome
analysis of covariance adjusted for MMSE score showed
measure is change in cognitive performance (Symbol Digit
impaired smell identification in the FTLD-bv group
Modalities Test) and change in quality of life (Euro-Qol-
(p<0.009) and intact in SD (p<0.405) and PSP (p<0.105)
5D-5L). Secondary outcome measures include changes in
groups.
other cognitive functions, neuropsychiatric symptoms, and
Conclusion: We have confirmed the hypothesis that smell
ADL. Blood sampling will be performed in all subjects to
identification is impaired even in specific FTLD subtypes
examine effects on biomarkers. A subgroup of the patients
reflecting the localization of neurodegenerative process.
will undergo MRI, PiB-PET and CSF studies to investigate
The atrophy in FTLD-bv involves the orbitofrontal cortex
structural changes and -amyloid accumulation.
and basis of frontal lobe that represent a part of olfactory
Discussion: This is the first controlled large study to
pathway. In SD and PSP the neurodegeneration takes place
investigate the effects of continuously supervised moderate
out of structures important for olfactory processing.
aerobic exercise. Recruitment was started in January 2012
and results will be available in late 2013. Complex
interventions of this kind present unique challenges to study
design, but may provide evidence for non-pharmacological
treatments in AD.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

96 Posters, Sunday 9 September

P1013 P1014
Localisation of attentional function in Pharmacological manipulation of
Lewy body dementia cholinergic pathways affects the duration
X. Kobeleva1,2, M. Firbank2, J.-P. Taylor2 of silent period after cortical magnetic
RWTH Aachen University Hospital, Aachen, Germany,
1
stimulation in Alzheimers disease
Institute for Ageing and Health, Newcastle General
2
C. Balla, J.L. Pepin, A. MaertensdeNoordhout
Hospital, Newcastle Upon Tyne, UK
CHR Citadelle, Lige, Belgium
Introduction: A core symptom of Lewy Body Dementia
When transcranial magnetic stimulation is applied during a
(LBD) is fluctuations in cognition and attention. However
sustained isometric contraction, the electromyographic
the aetiology of this symptom is poorly understood but may
activity ceases temporarily. This interval is called silent
relate to fronto-parietal network dysfunction. To address
period. It can be divided in two parts (SP1 and SP2) under
this issue we investigated the performance and brain
control of cortical and spinal mechanisms. As the literature
activation in LBD patients applying a modified ANT
showed changes in cortical excitability in AD, we
(attention network task) using an event-related functional
investigated if these changes are reflected in silent period
magnetic resonance (fMRI) paradigm.
and if they are under the control of cholinergic mechanisms.
Methods: 14 LBD patients and 14 age-matched healthy
The duration of silent period was studied in 11 de novo AD
controls (HC) underwent an assessment of global cognitive
patients before and after two months of treatment with
function before performing the ANT in the scanner.
10mg donepezil. As control group, we used 11 age-matched
Reaction times (RT) and error rates were compared between
normal subjects. In the control group, the mean duration of
groups. Imaging data were submitted to a GLM analysis
SP1 (SD) was 77.23ms (27.5ms). In the AD group before
using SPM (Statistical Parametric Mapping) to detect
treatment it was 103.05ms (48.7ms). In the AD group after
within and between group effects.
treatment, the mean duration of SP1 was 72.19ms
Results: The LBD group was significantly slower in RT
(28.5ms). The difference is significant between control
performance (p<0.001) and had higher error rates (p=0.02).
and AD before treatment. It is also significant between AD
However, SPM(t) analysis revealed comparable fronto-
before and AD after treatment. There is no significant
parietal network activations to the executive component of
difference between control group and AD after treatment.
the ANT between controls and LBD patients even in
For SP2, no difference was found between AD and controls
uncorrected analyses (p<0.001) and this observation held
and between AD before and after treatment.
true when co-varying for RT. In contrast using a region of
In conclusion, silent period in its first component increases
interest analysis there was an over-activation of the anterior
significantly in AD patients. Donepezil reduces the duration
cingulate and infraparietal lobule with a delay in the
of silent period (SP1 component). Functional mechanisms
hemodynamic response.
modulate probably the motor excitability in AD, at a spinal
Discussion: These findings suggest a spatially intact
or a cortical level, possibly through descending cholinergic
network with no evidence of topologically specific deficits
pathways.
in LBD. The data rather point towards poor efficiency in
neural networks associated with executive dysfunction and
increased cortical activation, which might be interpreted as
an ineffective compensation mechanism. Comparison to
other disease groups (Alzheimers) is warranted.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1015
Hippocampal GABAergic interneurons are
highly vulnerable in Alzheimers disease
E. Sanchez-Mejias1, V. Navarro2, R. Sanchez-Varo1,
L. Trujillo-Estrada1, M. Aneiros1, S. Jimenez2,
V. De Castro1, M.L. Vizuete2, J.C. Davila1, J. Vitorica2,
A. Gutierrez1
1 Cell Biology, University of Malaga/CIBERNED, Mlaga,
2 University of Seville/CIBERNED, Seville, Spain
Introduction: Alzheimers disease (AD) is characterized by
typical neuropathological changes including extracellular
amyloid-beta (Abeta) deposition and intracellular
neurofibrillary tangles. According to the amyloid cascade
hypothesis, accumulation and deposition of Abeta in the
brain are the major events in the pathology of AD. Specific
neuronal networks are preferentially affected by Abeta
pathology during disease progression. Among these the
distinct subpopulations of hippocampal inhibitory
GABAergic interneurons have been shown to be highly
vulnerable. In this sense, we have previously reported a
substantial loss of somatostatin (SOM) containing
interneurons in the hippocampus of APP-based transgenic
mouse models, with a linear correlation with the Abeta
content and glial activation.
Methods: We have analyzed the expression of SOM,
neuropeptide Y (NPY), parvalbumin (PV) and
cholecystokinin (CCK) as markers of the major inhibitory
populations in human hippocampus. Furthermore, we also
quantified the hippocampal area occupied by extracellular
Abeta immunoreactivity (plaque load) and the levels of
different Abeta forms. For this purpose, RT-PCR, Western
blots and immunostaining were performed in non-demented
controls and clinically diagnosed mild (Braak II) to severe
(Braak V-VI) AD cases.
Results: Results showed a significant declined expression
of SOM, NPY and, also PV, in severely affected AD patients
compared to the mild and control groups.
Conclusion: SOM neuropeptide regulates the metabolism
of Abeta through modulating proteolytic degradation
catalyzed by neprilysin. Thus, the high cellular vulnerability
of these GABAergic interneurons may have substantial
functional repercussions on Abeta accumulation during
disease progression as well as on hippocampal inhibitory
networks and memory processes.
FIS-PS09/00099(AG),FIS-PS09/000151(JV),CTS-
4795(JV).
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 97
P1016
Encapsulated cell biodelivery of nerve
growth factor in Alzheimers disease
M. Eriksdotter1,2, G. Lind3,4, H. Eyjolfsdottir1,2,
B. Linderoth3,4, P. Almqvist3,4, . Seiger1, L. Wahlberg1,5
1Dept Neurobiology, Caring Sciences and Society,
Karolinska Institute, 2Dept Geriatric Medicine, Karolinska
University Hospital, 3Dept Clinical Neuroscience, Karolinska
Institute, 4Dept Neurosurgery, Karolinska University
Hospital, Stockholm, Sweden, 5NsGene A/S, Ballerup,
Denmark
Background: Degeneration of cholinergic neurons in the
basal forebrain correlates with cognitive decline in
Alzheimers disease (AD). These neurons depend on nerve
growth factor (NGF) for survival. Local delivery of NGF
has emerged as a potential AD therapy due to its regenerative
effects on the forebrain cholinergic neurons. We have
developed a cell therapy technique where encapsulated cells
release NGF to the basal forebrain with the aim to halt the
degeneration of cholinergic neurons in AD.
Methods: Patients with AD have been implanted with
encapsulated NGF producing cells into the basal forebrain
bilaterally using stereotactic neurosurgery. The catheter-like
device consists of an NGF producing, genetically engineered
human cell line encapsulated behind a semipermeable fibre
membrane allowing efflux of NGF. The device can easily be
removed. Patients are monitored regarding safety,
tolerability, cognitive and biological parameters.
Results: 10 patients have hitherto successfully received
bilateral implants. The procedure in the first 6 patients was
safe, well tolerated and positive effects on cognition and
nicotine binding were found in 2 patients. However, since
the encapsulated cells, which were successfully removed
after 12 months, showed low NGF release, effort to improve
the release has been made. Recently, 4 additional AD
patients were implanted with encapsulated cells that release
5-10 times more NGF/day.
Conclusions: The first steps towards a possible therapy for
AD based on local delivery of NGF to the cholinergic
neurons in the basal forebrain have been taken. The initial
results of this novel cell therapy approach will be discussed.
98 Posters, Sunday 9 September

P1017
The determination of aggregated tau in
solution and its potential as a tool for the
diagnosis of tauopathies
S.T. ODowd1,2, P. Johansson3,4, M.T. Ardah5,
K.A. Roberts2, G. Cummins2, O. ElAgnaf5,
J. Svensson4,6, H. Zetterberg7, T. Lynch1,2, D.M. Walsh1,8
1Laboratory for Neurodegenerative Research, Conway
Institute of Biomolecular and Biomedical Research,
University College, 2Dublin Neurological Institute at the
Mater Misericordiae University Hospital, Dublin, Ireland,
3Department of Neuropsychiatry, Skaraborg Hospital,
Falkoping, 4Dept. of Endocrinology, The Sahlgrenska
Academy at University of Gothenburg, Sweden, 5Dept. of
Biochemistry, Faculty of Medicine and Health Sciences,
United Arab Emirates University, Al Ain, United Arab
Emirates, 6Dept. of Endocrinology, Skaraborg Hospital,
Skovde, 7Dept. of Psychiatry and Neurochemistry, Institute of
Neuroscience and Physiology, The Sahlgrenska Academy at
University of Gothenburg, Sweden, 8Harvard Medical School
Center for Neurologic Diseases, Brigham and Womens
Hospital, Boston, MA, USA
Introduction: Burgeoning evidence suggests soluble tau
assemblies may mediate neurotoxicity, but no specific assay
exists for their detection. The Innogenetics ELISA is the
leading commercial assay in analysis of cerebrospinal fluid
(CSF) tau, but its ability to detect different aggregation
states is undetermined.
Methods: Recombinant isoforms of human tau, and a
monoclonal antibody capable of their detection, were
expressed, purified and characterised, and tau aggregated in
vitro. A novel ELISA was devised and optimised for
detection of aggregated tau. The ability of the Innogenetics
platform to detect different aggregation states of
recombinant tau was interrogated and total-tau and phospho-
tau dosage in CSF from 53 subjects (neurodegenerative
disorders and controls) determined.
Results: Aggregated recombinant tau was detected
sensitively and specifically by the novel ELISA. The
Innogenetics assay reliably detected aggregated and
monomeric tau and evinced good recovery of both species
when spiked into human CSF. Total-tau levels were
significantly higher in AD than in controls (p<0.001) or in
patients with other neurodegenerative diseases (p<0.01).
Elevated phospho-tau levels similarly discriminated AD
from controls and other neurodegenerative diseases
(p<0.01).
Discussion: This is the first report of the capability of the
Innogenetics assay to detect different aggregation forms of
CSF tau. We also report total-tau and phospho-tau levels in
a unique cohort of patients with neurodegenerative diseases,
highlighting the variation in tau levels between groups,
despite comparable extents of neurodegeneration. This
suggests that tau dosage in CSF reflects more than merely
burden of neuronal death and suggests mechanistic
differences underlying the tauopathies.
P1018
Plasma amyloid-beta and serum amyloid-
beta auto-antibody levels in patients with
Alzheimers disease
L. Zhou1, L.W. Chu2, J.S.C. Kwan1, K.S.L. Lam1,
O.Y. Cheng1, K.H. Chan3
1University of Hong Kong, 2Medicine, University of Hong
Kong, 3Medicine, Research Center of Heart, Brain, Hormone
and Healthy Aging, University of Hong Kong, Hong Kong
S.A.R.
Introduction: Amyloid beta (A), especially A oligomers,
is important in Alzheimers disease (AD) pathogenesis.
Aim: Study plasma A40, A42, A oligomers, serum A
monomer and oligomers antibodies levels in AD patients,
and their correlation with cognitive functions.
Patients and methods: 44 AD patients and 22 non-
demented controls were studied. Cognitive functions were
assessed by Chinese version of mini-mental state
examination (MMSE), Abbreviated Metal Test (AMT),
Alzheimers Disease Assessment Scale Cognitive Subscale
(ADAS-cog). A and A antibodies levels were measured
by ELISA.
Results: Median plasma A40 and A42 levels were similar
between AD and controls. In women with AD, plasma A42
level was positively correlated with cognitive functions.
Plasma A oligomers level was higher in AD than in
controls (642.54ng/ml [range 103.33-2676.93] versus
444.18ng/ml [range 150.19-1311.18], p=0.047), and
negatively correlated with cognition. Serum A monomer
antibodies level was similar between AD and controls, but
in AD patients, serum A monomer antibodies level was
negatively correlated with cognition. Serum A oligomers
Ab level was higher in AD than in controls (42.81ng/ml
versus 24.15ng/ml, p=0.014) without significant correlation
with cognition.
Conclusion: Plasma A oligomers and serum A oligomers
antibodies levels facilitate AD diagnosis. Plasma A42 and
A oligomers levels may reflect AD severity.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1019
Nutritional intervention with Fortasyn
Connect: beneficial effects in
experimental models of Alzheimers
pathology and functional decline
N. vanWijk1, M.C. deWilde1, A.A.M. Kuipers1,
M. Balvers1, J. Sijben1, P.J. Kamphuis1,2, H. Koivisto3,4,
H. Tanila3,4, D. Jansen5,6, V. Zerbi5,6, A.J. Kiliaan5,6,
L.M. Broersen1
1Nutricia Advanced Medical Nutrition, Danone Research -
Centre for Specialised Nutrition, Wageningen, 2Utrecht
Institute for Pharmaceutical Sciences (UIPS), Utrecht
University, Utrecht, The Netherlands, 3A. I. Virtanen
Institute, University of Eastern Finland, 4Neurology, Kuopio
University Hospital, Kuopio, Finland, 5Anatomy, 6Cognitive
Neuroscience, Donders Centre for Neuroscience, RUNMC,
Nijmegen, The Netherlands
Introduction: The neurotoxic cascade of Abeta initiates at
neuronal membranes and soluble oligomers are thought to
disturb membrane properties by binding to membrane
components. As such, the precise composition of neuronal
membranes influences membrane disrupting properties of
Abeta. Moreover, membrane composition directly
influences APP-processing and the generation of Abeta. The
hypothesis that nutritional interventions that positively
affect membrane formation and composition will reduce
Abeta production, toxicity and pathology was tested in a
series of experiments using rodent models of AD.
Methods: Fortasyn Connect (FC) is a nutritional
composition containing precursors and cofactors for
neuronal membrane synthesis, viz. DHA, EPA, UMP,
choline, folate, vit.B12, vit.B6, phospholipids, vit.C, vit.E,
and selenium. We assessed the effects of dietary enrichment
with FC in the Abeta infusion model, and the APP/PS1
mouse model.
Results: In the Abeta infusion model, dietary FC protected
cholinergic neurons from Abeta-induced toxicity as
evidenced by preserved immunoreactivity for the
membrane-bound enzymes ChAT and VAChT. FC also
prevented the Abeta-induced reduction in exploratory
activity. In young APP/PS1 mice, FC decreased brain Abeta
levels, amyloid plaque burden in the hippocampus, and
neurodegeneration in the neocortex. In aged APP/PS1mice,
FC normalized hippocampal levels of the neuronal marker
N-acetylaspartate. Additionally, FC alleviated poor spatial
learning in aged mice.
Conclusion: FC intervention positively influenced the
outcome of membrane-bound processes in different rodent
models of AD. These effects on AD-like pathology and
behaviour in AD models warrant further evaluation in AD
patients. Fortasyn is a trademark of N.V. Nutricia.
Funded by EU FP7-Food project LipiDiDiet
(Grant_211696).
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 99
P1020
Psychometric properties of DQoL in
patients with Alzheimers disease and
carers
M. Gomez-Gallego1, J. Gomez-Garcia2
1Catholic University of Murcia, 2University of Murcia,
Murcia, Spain
Introduction: Quality of life is an important outcome
measure in the assessment of the interventions with
Alzheimers disease (AD) patients. DQoL is a self-rated
scale that covers the domains of sense of aesthetics, feelings
of belonging, negative effect, positive affect and self-
esteem. The aim of this study is to determine the
psychometric properties of the Spanish version of DQoL.
Methods: A sample of 102 AD patients and their 102 carers
were administered DQoL. Internal consistency of both the
whole scale and the subscales was assessed using alpha
coefficient. Agreement was assessed using the concordance
correlation coefficient (CCC). Convergent and divergent
validity were assessed by testing the relation between DQoL
scores and both demographic factors and the scores of
Minimental State Examination, Neuropsychiatric Inventory,
Geriatric Depression Scale (GDS), Barthel Index, and Zarit
Burden Inventory. Factor analysis was used to test construct
validity.
Results: The internal consistency of DQoL was excellent
for both patients and carers ratings. However, this was not
the case for some subscales (alpha< 0.7). The patient-carer
agreement was good (CCC=0.877; accuracy=0.981;
precision=0.893). Patients and carers DQoL ratings
correlated significantly with GDS scores but were not
associated with the other clinical and demographic
measures. The factorial analyses showed that all 29 items
loaded on component 1.
Conclusions: Our results indicate that DQoL functions as a
scale with good internal consistency and inter-rater
reliability. The existence of subscales is not clear. DQoL
does not relate to other constructs but depression, so it could
really measure perceived psychological well-being.
100 Posters, Sunday 9 September
P1021
Borrelia Burgdorferi: risk factor in
Alzheimers disease
R.P.W. Marquard1, A. Kurz2
1Psychiatry and Neurology, Klinikum Taufkirchen,
Taufkirchen, 2Psychiatrie, TU Mnchen, Germany
Introduction: Inflammatory factors are presumably
involved in Alzheimers disease (AD). We examined if AD
is related with non-symptomatic borreliosis.
Method: 100 patients (mean age: 72.9 years) met NINCDS-
ADRDA diagnostic criteria for probable AD after a
thorough diagnostic evaluation which comprised a
neuropsychological exam, blood tests and CT or MRI brain
imaging. The age and gender matched control group (72.8
years) scored 28 or more points on the Mini Mental State
and had no family history of dementia. All patients and
controls were Caucasian. Lyme ELISA and Western blot
test were used to examine serum samples of patients and
controls and cerebrospinal fluid of patients with positive
blood test.
Results: 28 (28%) of the AD patients but only 8 (8%) of the
controls had Lyme Borreliosis antibodies (IgG) in the serum
sample, indicating that individuals with Borrelia IgG
antibodies have an increased risk suffering Alzheimers
disease by 3.5. None of them had intrathecal antibody
production as examined in the CSF.
Discussion: We found a significantly higher rate of Borrelia
IgG antibodies in individuals with Alzheimers disease. As
several authors found similarities between the surface of
Borrelia and neuronal tissue, cross-reactivity of B.
burgdorferi antibodies with neuronal tissue or the triggering
of a non-specific inflammatory response are possible.
Further research should include investigation of the
following questions:
1. Is the frequency of Alzheimers disease in individuals
with history of non-symptomatic borrelia IgG antibodies
increased?
2. Is there any effect of early antibiotic treatment of Lyme
disease?
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1022
Cognitive-enhancing activity of thymol
and carvacrol in two rat models of
dementia
N. Majlessi, Z. Azizi, S. Ebrahimi, E. Saadatfar
Department of Physiology and Pharmacology, Pasteur
Institute of Iran, Tehran, Iran
Introduction: Alzheimers disease (AD) is known to be the
most common cause of dementia in elderly patients. The
limitations of current AD therapeutics have prompted
investigation into innovative therapeutics over the last two
decades. This study evaluated the efficacy of thymol and
carvacrol against cognitive deficits induced by amyloid
(A) or scopolamine.
Methods: Rats received bilateral intrahippocampal
injections of A (25-35) or intraperitoneal injections of
scopolamine, and the effect of different doses of thymol, or
carvacrol (0.5, 1, or 2mg/kg) on cognitive function was
determined. Animals were subjected to 5 days of training in
the Morris water maze: 4 days with an invisible platform to
test spatial learning and the 5th day with a visible platform
to test motivation and sensorimotor coordination. The acute
toxicities of thymol and carvacrol were also studied.
Results: The results showed increases in escape latency and
decreases in target quadrant entries in A or scopolamine-
treated groups. These impairments were reversed by pre-
training administration of either thymol or carvacrol. The
calculated LD50s of thymol (565.7mg/kg) and carvacrol
(471.2mg/kg) were found to be much higher than their
therapeutic doses (thymol 0.5 mg/kg, carvacrol 1mg/kg).
Conclusion: These findings provide preliminary positive
evidence for the effectiveness and safety of thymol and
carvacrol in alleviating cognitive impairments caused by
increased A levels or cholinergic hypofunction.
Anticholinesterase, antioxidant, and anti-inflammatory
activities may be the mechanisms contributing towards their
beneficial effects in these models.

P1023
A preliminary study of the association
between Cystatin C gene polymorphism
and late-onset Alzheimers disease in a
sample from Iran
Z. Azizi1, M. Noroozian2, Z. Kaini-Moghaddam3,
E. Saadatfar1, N. Majlessi1
1Department of Physiology and Pharmacology, Pasteur
Institute of Iran, 2Tehran University of Medical Sciences,
3Department of Biotechnology, Pasteur Institute of Iran,
Tehran, Iran
Introduction: Alzheimers disease (AD) is the most
common age-associated neurodegenerative disease caused
by complicated interactions between genetic and
environmental factors. Structural genomic studies
demonstrated that more than 200 genes might be involved
in AD pathogenesis regulating dysfunctional genetic
networks leading to premature neuronal death. Most genes
conferring susceptibility to AD are related to A deposition,
oxidative stress and inflammatory response. Recent studies
have shown that the endogenous protein cystatin C binds
soluble A and inhibits A oligomerization and
amyloidogenesis, protecting the brain against amyloid-
induced toxicity. Moreover, a decreased cystatin C secretion
is associated with a polymorphism found in the cystatin C
gene (CST3). Molecular epidemiological studies have
presented contradictory results concerning a potential role
of CST3 G73A polymorphism in AD.
Methods: In this study, to define a possible association of
the G73A polymorphism in CST3 gene with late-onset AD
(LOAD) in an Iranian population, we conducted a case-
control study including a clinically well-defined group of
61 LOAD patients and 63 age-matched controls. G73A
polymorphism was determined by polymerase chain
reaction-restriction fragment length polymorphisms (PCR-
PFLP) assay.
Results: Chi-square analysis showed a significantly
increased number of individuals with the G/A genotype in
AD patients compared with controls (p<0.05).
Conclusions: The results obtained from our study
demonstrate an association between G73A polymorphism
and LOAD in an Iranian sample. However, as the level of
significance is low, the G/A genotype seems to have only
minor effects in the development of AD or probably interact
with other risk factors.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 101
P1024
Systemic lipid peroxidation in mild
cognitive impairment (MCI) and
Alzheimers disease (AD)
S. Leoncini1, C. DeFelice2, C. Signorini1, A. Pecorelli1,
T. Durand3, J.-M. Galano3, C. Oger3, V. Bultel-Ponc3,
A. Guy3, S. Boschi4, L. Ciccoli1, J. Hayek5
1Department of Pathophysiology, Experimental Medicine &
Public Health, University of Siena, 2Neonatal Intensive Care
Unit, University Hospital Azienda Ospedaliera Universitaria
Senese (AOUS), Siena, Italy, 3Institut des Biomolcules Max
Mousseron (IBMM) - UMR 5247 CNRS - UM I - UM II,
Montpellier, France, 4Internal Medicine Unit, 5Child
Neuropsychiatry Unit, University Hospital, AOUS, Siena,
Italy
Introduction: Oxidative stress (OS) has been involved in
the pathogenesis of Alzheimers disease (AD) and mild
cognitive impairment (MCI). However, it is unclear whether
OS is a primary or a secondary contributor to the MCI/AD
phenotype, and whether OS markers in peripheral samples
represent reliable indicators for the presence of
neurodegenerative disease.
Methods: The study included patients with AD (n=3) and
MCI (n=6). Healthy control subjects (n=8) comparable for
age were also included. Informed consent and Institutional
Review Board were obtained. Plasma was used for
determination of free F2-Isoprostanes (F2-IsoPs),
F2-dihomo-isoprostanes (F2-Dihomo-IsoPs),
F4-neuroprostanes (F4-NeuroPs) and non-protein-bound
iron (p-NPBI) and erythrocytes were used for determination
of intra-erythrocyte NPBI (IE-NPBI). F2-IsoPs,
F2-Dihomo-IsoPs, and F4-NeuroPs were measured by gas
chromatography/negative ion chemical ionization tandem
mass spectrometry method (GC/NICI-MS/MS), while
IE-NPBI and p-NPBI were determined by HPLC.
Results: Levels of IE-NPBI [median (inter-quartile range)]
in MCI [1.14 (0.45-1.92) nmol/ml erythrocyte susp.] and
AD [1.3 (0.92-2.35) nmol/ml] were significantly higher as
compared to controls [0.67 (0.55-0.75) ] (p=0.031), as well
as those of p-NPBI [MCI: 1(0.3-1.07)nmol/ml; AD:
0.63(0.52-0.75)nmol/ml; controls: 0.25(0.1-0.4)nmol/ml]
(p=0.004). Plasma F2-IsoPs were significantly higher in
MCI [53.4(44.4-162.8)pg/ml] and AD [85(54-96)pg/ml]
compared to controls [15.35 (13.4-21.8)] (p=0.032). The
combined group of MCI and AD patients showed
significantly higher levels of plasma F2-Dihomo-IsoPs than
controls [MCI+AD: 7.5(0-25.2)pg/ml; controls: 0.85(0.5-
0.96)]. No significant differences were observed for
F4-NeuroPs (p=0.257).
Conclusions: Systemic lipid peroxidation is detectable in
peripheral blood in MCI and AD.
102 Posters, Sunday 9 September

P1025 P1026
Physicomechanical transitions of an Development of novel lysosomal
implantable nano-enabled biorobotic modulators for treating protein
intracranial device for Alzheimers disease accumulation diseases
management for validation of in vivo M.L. Wisniewski1, D.J. Hoover2, J. Hwang1,
behaviour in a simulated brain K. Viswanathan2, D. Butler3, D. Wright2,4, B.A. Bahr1,2
1William C. Friday Laboratory, University of North Carolina
environment
Pembroke, NC, 2Synaptic Dynamics Inc., Farmington, 3Dept.
M.S. Mufamadi1, Y.E. Choonara1, L.C. duToit1, of Pharmaceutical Sciences, 4Medicinal Chemistry,
G. Modi2, D. Naidoo3, P. Kumar1, V.M.K. Ndesendo4, University of Connecticut, Storrs, CT, USA
L. Meyer5, S.E. Iyuke6, V. Pillay1
Lysosomes are the primary site for removal of old and
1Department of Pharmacy and Pharmacology, 2Department
of Neurology, 3Department of Neurosurgery, University of
misfolded proteins and to maintain cellular homeostasis,
the Witwatersrand, Johannesburg, South Africa, 4School of and positive lysosomal modulation has been shown to
Pharmacy and Pharmaceutical Sciences, St. Johns enhance protein clearance to protect against protein
University of Tanzania, Dodoma, Tanzania, 5Central Animal accumulation pathology. Small-molecule lysosomal
Services, 6School of Chemical and Metallurgical modulators, for instance Z-Phe-Ala-diazomethylketone
Engineering, University of the Witwatersrand, Johannesburg, (PADK), at appropriate concentration elicit marked
South Africa up-regulation of cathepsins and other lysosomal enzymes
without any indications of synaptic compromise,
Purpose: The purpose of this study was to evaluate the
behavioural abnormalities, or major organ malfunctions.
physicomechanical transitions of an implantable nano-
Recent work designed and synthesized compounds with the
enabled Biorobotic Intracranial Device (BICD) within
objective to improve potency, selectivity, and metabolic
simulated brain environment.
stability. We utilized the PADK structure as a departure
Methods: The BICD was fabricated by embedding
point to develop a non-peptidyl lead series. Initial structures
galantamine-loaded functionalized nanoliposomes [f(x)
(SD1001, SD1002, and SD1006) demonstrated that we
NLPs] [Phosphocholine (DSPC), cholesterol, ethanolamine
could remove the internal amide linkage, eliminate the
(DSPE-mPEG2000) with synthetic peptides] within a
highly reactive diazoketone moiety, and develop highly
neuro-compliant scaffold [glutaraldehyde crosslinked
flexible, enantioselective routes for first-in-class cathepsin
chitosan, eudragit RSPO, and polyvinyl alcohol or
modulators. The resultant lead series maintained or
polyethyleneoxide] followed by freeze-drying. Rheological,
improved the modulatory profile of PADK, providing
textual and SEM studies were employed to characterize the
protection in the hippocampal slice model of protein
BICD behaviour in vitro. Hydration and degradation studies
accumulation that exhibits experimentally-induced
were conducted within artificial cerebrospinal fluid (aFCS).
phosphorylated tau deposits, ubiquitinated inclusions, and
Images were acquired using a bench-top MRI over a period
synaptic compromise. Results from animal studies include
of 50 days. Labelled-f(x) NLPs distribution within the
selective lysosomal modulation, improved synaptic integrity
BICD was examined by micro-ultrasound imaging (Vevo
and cognition, without any indications of obvious adverse
2100) and CLSM.
effects amongst major organ tissue sections. The novel
Results: SEM images validated the porous surface
compounds will be used to further design efficacious
morphology of the scaffold, with pores that are relatively
modulators for protective agents that
uniform in size and shape. Rheological and textural
i) enhance cathepsin trafficking and protein clearance,
parameters demonstrated that the crosslinked scaffold was
ii) promote synapse function, and
more firm and resilient when compared with the non-
iii) slow the progression of proteinopathies.
crosslinked scaffold. MRI images showed complete scaffold
hydrated within 30min after submergence within aFCS,
however the hydrated scaffold exhibited swelling and slight
erosion. CLSM micrographs confirmed labelled f(x)NLPs
encapsulation and distribution within the BICD.
Fluorescence patterns postulate intact vesicles after BICD
lyophilization. Ultrasound images confirmed that more
even f(x)NLPs distribution was achieved in the slightly less
viscous rather than highly viscous BICD.
Conclusions: The results validate that evaluation of BICD
physicomechanical transitions is a useful tool for further
investigation of the optimized formulation designed for
prolonged delivery of the neuroprotectant-nanocarrier into
targeted neuronal cells of Alzheimers disease.

2012 EFNS European Journal of Neurology 19 (Suppl. X), 66343


P1027
Myeloid microvesicles as potential
biomarkers of disease progression in
dementia patients
D. DallaLibera1, F. Agosta2, A. Bergami3, G. Magnani3,
V. Martinelli4, G. Comi5, C. Verderio6, M. Filippi4,
R. Furlan7
1Neurology, San Raffaele Scientific Institute, 2Neurology, San
Raffaele Scientific Institute Neuroimaging Research Unit,
3San Raffaele Scientific Institute, 4San Raffaele Scientific
Institute Neuroimaging Research Unit, 5Neurology, San
Raffaele Scientific Institute, INSPE, 61CNR Institute of
Neuroscience and Department of Medical Pharmacology,
Universit di Milano, 7San Raffaele Scientific Institute,
INSPE, Milano, Italy
Introduction: Myeloid microvesicles (MMVs) have been
indicated as important mediators of intercellular
communication and are emerging as new biomarkers of
tissue damage. MMVs, shed from reactive microglia, store
and release the IL1beta, an inflammatory cytokine increased
in AD induced by amyloid deposition. Aim of the study was
to evaluate whether MMVs reflecting microglia activation
state- may contribute to early dementia diagnosis and
predict disease rate progression.
Methods: We recruited 169 patients from the Neurological
Department of San Raffaele Hospital affected by mild
cognitive impairment (MCI), probable Alzheimers disease
(AD) according to Dubois criteria, Frontotemporal
Dementia (FTD) and other dementia. Myeloid MVs were
detected by flow cytometry in the cerebrospinal fluid of
dementia patients and healthy controls (HC) and were
correlated with clinical features, CSF data (Tau, bAmyloid)
and neuroimaging in a longitudinal study of two-year
follow-up.
Results: AD patients showed a higher amount of MMVs
than MCI and HC. An increase in MMVs was found in MCI
patients early converting to AD. MMVs correlate with
p-tau/bamiloid and with hippocampal atrophy in AD, but
not in MCI. Correlation with other neuroradiological
measures (DTI,fMRI) is ongoing. No correlation with
clinical data (MMSE, CDR, age, sex) was evident.
Conclusions: MMVs reflect the course of neuro
degeneration, thus they may represent a suitable biomarker
in monitoring disease progression and response to treatment.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 103
P1028
Different cerebrospinal fluid biomarker
patterns in dementia patients with
cerebrovascular disease and Alzheimers
disease
M. Bjerke1, M. Jonsson1, H. Zetterberg1, K. Blennow1,
R. Schmidt2, A. Wallin1
1Dep of Psychiatry & Neurochemistry, Inst of Neuroscience
& Physiology, The Sahlgrenska Academy, University of
Gothenburg, Sweden, 2Department of Neurology, Division of
Special Neurology, University Clinic of Neurology, Medical
University of Graz, Austria
Introduction: Alzheimers disease (AD) and vascular
dementia (VaD) are intertwined by mixed dementia (MD)
harbouring varying degrees of AD pathology in combination
with cerebrovascular disease (CVD) with white matter
lesions (WML). The diseases may be hard to clinically
separate due to the overlapping pathologies. A cerebrospinal
fluid (CSF) biomarker pattern representative of WML
would aid in the clinical evaluation process and provide
information about disease specific mechanisms.
Methods: Study one included 30 controls, 30 AD patients
and 26 patients with subcortical WML (9 VaD and 17 MD).
Study two included 46 normal or only slightly cognitively
impaired individuals of whom all had subcortical WML
assessed by magnetic resonance imaging. Assessment of
white matter hyperintensity (WMH) volume, atrophy and
diffusion weighted imaging (DWI) of normal appearing and
WMH matter was performed. Proteins measured in both
studies were total tau (T-tau), hyperphosphorylated tau 181
(P-tau181), amyloid b 1-42 (A1-42), neurofilament light
(NF-L), myelin basic protein (MBP), matrix
metalloproteinases (MMPs), and tissue inhibitors of
metalloproteinases (TIMPs).
Results: The biomarkers MBP, TIMP-1, NF-L, and MMP-9
were altered in patients with WML (VaD and MD) and
contributed to the separation between CVD and AD
(sensitivity 97% and specificity 81% (AUC=0.93)) in
combination with T-tau, P-tau181 and A1-42. MBP, TIMP-
1 and NF-L were related to WMH volume, the latter two to
WMH DWI and ventricular atrophy and MMP-9 to
progression of WMH.
Conclusion: The finding of different neurochemical
fingerprints of CVD with WML and pure AD speaks in
favour of different disease mechanisms of the disorders.
104 Posters, Sunday 9 September
P1029
Correlation exploration between executive
function impairment and white matter
structure in patients with subcortical
ischemic vascular disease
Y. Dong, P. Lv, L. Li, J. Wang
Department of Neurology, Hebei General Hospital,
Shijiazhuang, China
Objective: To investigate the correlation between executive
function and cerebral white matter structure change by MRI
and diffusion tensor imaging (DTI) in subcortical ischemic
cerebrovascular disease (SIVD).
Methods: 24 SIVD patients and 14 normal control subjects
(NC) were evaluated with Stroop colour words test (CWT)
and trail making test (TMT) to assess executive function.
They were divided into vascular dementia (VaD, n=12) and
vascular cognitive impairment no dementia (VCIND, n=12)
group. Age-related white matter change rating scale was
used to measure the WML. Fractional anisotropy (FA) and
mean diffusivity (MD) of normal- appearing white matter
(NAWM) were determined in the splenium of corpus
callosum (SCC), frontal (FL), parietal (PL), temporal (TL)
and occipital lobes (OL) by DTI. Correlation analysis was
used to investigate the relationship between executive
function and the imaging parameters.
Results:
(1) Compared with NC group, the scores of VaD decreased
in each test and the scores of VCIND decreased in TMT
(p<0.05).
(2) The scores of WML were (12.823.57) and (10.502.95)
in VaD and VCIND group (p<0.05). MD values of SCC
increased in two groups (p<0.05). Decreased FA values of
NAWM on FL, right TL, right OL and PL were demonstrated
in VaD, as well as of left FL and PL in VCIND patients.
They were significant compared to NC group (p<0.05)
(3) The parameters related with executive function in SIVD
patients were FA values of NAWM in left FL, right PL, TL
and MD values of SCC.
Conclusions: The executive function impairment in SIVD
patients could be associated with the degree of WML.
Microstructural white matter impairment showed by DTI
might be used for evaluating executive function decline.
P1030
Abstract cancelled
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1031
Quantitative EEG in Alzheimers disease
before and after short and long-term
treatment
A. Medvedeva, T. Vosnesenskaya
Neurological Department, First Moscow Medical University,
Moscow, Russia
Introduction: Alzheimers disease (AD) is involving
cerebral neuronal networks facilitating higher cognitive
functions.
Objective: AD is characterized by changes in spectral
power and EEG-coherence, which become stronger with the
progression of dementia. The aim was to evaluate spectral
power and EEG-coherence in AD group and healthy elderly
controls, to find their reactivity in functional tasks before
and after 3 months and 2.7 years of treatment with
galantamin, memantin and their combination, to determine
the correlations between EEG changes, cognitive and
neuropsychiatric impairments before and after the treatment.
Materials and methods: 22 patients without treatment, 23
patients on long-term treatment with mild and moderate
AD, 25 age-matched controls were examined using EEG-
recordings (spectral power and coherence), neuro
psychological investigations and neuropsychiatric inventory
(NPI).
Results: High level of apathy, depression, emotional
liability was investigated in both AD groups. We have found
significant increase of slow-wave activity in frontal, central
and temporal regions, decreased alpha rhythm in the same
regions in AD group vs. controls (p<0.05). Coherence in
same regions was lower in AD patients vs. controls (p<0.05).
After short and long-term treatment there was decrease of
slow wave activity and increase of alpha band and coherence
in the same regions (p<0.05).The combination of galantamin
and memantin was more effective than monotherapy
(p<0.05).
Conclusion: EEG changes, cognitive and neuropsychiatric
impairments have positive dynamic on short and long-term
treatment without significant difference. The study revealed
significant correlations between increased slow-wave
activity, decreased EEG-coherence, low levels of cognitive
tests and high level of apathy, depression, emotional
liability.

P1032
Caregiver preference for rivastigmine
patch in the OPtimising Transdermal
exelon In Mild-to-moderate Alzheimers
disease (OPTIMA) Study
R. Blesa1, P. Martnez-Lage2, A.U. Monsch3, P. Downs4,
C. Strohmaier5
1Hospital Sta Creu i Sant Pau, Barcelona, 2Department of
Neurology, Center for Research and Advance Therapies,
Fundacin CITA-Alzheimer, San Sebastian, Spain,
3Department of Acute Geriatrics, University Hospital Basel,
Switzerland, 4Novartis Pharmaceuticals Corporation, East
Hanover, NJ, USA, 5Novartis Pharma AG, Basel, Switzerland
Introduction: Caregivers of patients with Alzheimers
disease (AD) are often responsible for the administration
and management of medications. During the OPTIMA
Study, caregivers took part in a questionnaire to evaluate
perceived treatment compliance, satisfaction and preference.
Methods: Patients meeting pre-specified decline criteria
during a 24-48-week initial open-label (IOL) phase with
9.5mg/24 h rivastigmine patch, entered a 48-week,
randomised, double-blind phase (9.5 versus 13.3mg/24h
patch). Caregivers of patients taking oral AD medication
prior to the study completed the Caregiver Medication
Questionnaire at baseline and week 24 of the IOL phase.
The questionnaire focused on medication administration,
perceived compliance and satisfaction, and at week 24 only,
treatment preference (prior oral medication or patch).
Results: Of 1584 participating AD caregivers, 57.8% were
females [mean (SD) age; 64.0 (13.7) years]. Most caregivers
were a spouse (59.5%) or child (29.7%) of the patient and
were living with them (74.7%). Of 882 caregivers of patients
on prior AD treatment, 642 (72.8%; 95% CI 69.7, 75.7)
stated a preference for rivastigmine patch. Ease-of-use
(27.9%) and administration (10.9%) were rated as the top
two most important reasons. From baseline to week 24, the
number of caregivers reporting that they were never
concerned that the patient missed taking medication
(compliance) increased from 55.1% to 69.5% and mean
(SD) treatment satisfaction increased from 6.3 (2.7) to 7.3
(2.6) out of 10.
Conclusion: The majority (>70%) of caregivers of AD
patients preferred rivastigmine patch to oral medication,
and reported improved compliance and satisfaction
compared with previous oral medications.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 105
P1033
Memory performance is related to
functional connectivity alterations in
Alzheimers disease
A. Fukuda, F. Pereira, T. Lopes, E. da Silva, A.C. Coan,
B. Campos, B. Damasceno, F. Cendes, M.L.F. Balthazar
UNICAMP, Campinas, Brazil
Introduction: New methods in functional magnetic
resonance imaging, especially during resting state, may help
to clarify the functional organization of cognitive networks.
While their alterations have been reported in AD, especially
in the Default Mode Network (DMN), their relationship
with cognitive symptoms remains unclear. In this study, we
aimed to verify the relation between DMN connectivity and
memory performance in AD patients.
Methods: We studied 20 mild to moderate AD patients.
High-resolution Magnetic Resonance Imaging (MRI) was
performed using a 3.0T scanner (Philips - Achieva). All
patients underwent a 10 minutes task-free functional MRI
(fMRI). We used FSLs Melodic Independent Component
Analysis to study fMRI images in order to select each
patients DMN. They also underwent a cognitive evaluation,
including the Rey Auditory Verbal Learning Test (RAVLT).
We correlated RAVLTs scores (encoding, delayed recall
and recognition) with individual maps of DMN connectivity,
considering age, education and dementia severity. We also
performed VBM analysis to obtain grey matter maps to
correct these data for atrophy.
Results: We found significant areas of correlation between
DMN functional connectivity and RAVLT encoding and
delayed recall with left precuneus (MNI coordinates: -13,
-67, 34). We did not find any areas of correlation with
recognition, after correction for atrophy.
Conclusion: We report the association of changes in DMN
connectivity (atrophy corrected) with episodic amnesia in
AD, especially in left precuneus. These findings confirm
the importance of neurofunctional networks alterations in
the origin of AD symptoms.
106 Posters, Sunday 9 September
P1034
Comparing language deficits in mild
cognitive impairment and mild Alzheimers
disease
E. Tsantali1,2, D. Economidis1, S. Rigopoulou2
1Medical School, B Internal Medicine, Geriatric Unit,
Aristotle University of Thessaloniki, Hippocration Hospital,
2Neurologic Clinic, Dep. Panagia, Agios Pavlos Hospital,
Thessaloniki, Greece
Introduction: Alzheimers disease (AD) patients except of
memory loss exhibit naming impairments from mild to
moderate stages of the disease, though Mild Cognitive
Impairment (MCI) individuals tend to exhibit greater
impairments in category fluency than on naming tasks.
Aims: The aims of this study were to:
1) investigate and compare language abilities of non-
demented elderly (ND), MCIs (amnestic type) and demented
participants (AD),
2) study the diagnostic value of language deficits according
to the cognitive state of the participants.
Methods: 125 participants, 41 ND, 31 MCI and 53 mild AD
patients matched on age and education were recruited
randomly and administered clinical, laboratory,
neuropsychological and neuroimaging assessment.
Language abilities were assessed by expert
neuropsychologists using the Greek edition of the Boston
Diagnostic Aphasia Examination (BDAE).
Results: Our results indicate that verbal fluency, auditory,
reading comprehension and narrative ability are the main
language abilities to be affected in mild AD, but they are
vulnerable as well as in MCI. Six useful language subtests
of the BDAE discriminated ADs from the rest 2 groups
92.5% of the time, NDs 86.8% and MCI 67.9% of the time
in order to save time and to be accurate in clinical practice.
Conclusion: Language impairments are affected MCIs as
well as AD patients but in a slighter degree, but not elderly
without dementia. Language tests cannot distinguish MCI
from non-demented elderly and mild AD patients safely.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1035
-Aminobutyric acid type A (GABAA)
receptor activation modulates tau
phosphorylation
N.-P. Nyknen1, K. Kysenius1, P. Sakha1, P. Tammela2,
H. Huttunen1
1Neuroscience Center, 2Center for Drug Research, Faculty of
Pharmacy, University of Helsinki, Finland
Introduction: Abnormal phosphorylation and aggregation
of the microtubule-associated protein Tau are hallmarks of
various neurodegenerative diseases, such as Alzheimers
disease (AD). Tau phosphorylation regulates its functions
and is increased in AD. Molecular mechanisms that regulate
Tau phosphorylation are complex and currently incompletely
understood. Peptidyl-prolyl cis-trans-isomerase 1 (Pin1) is
a critical regulator of Tau dephosphorylation at several
disease-associated proline-directed phosphorylation sites.
Reduced Pin1 activity has been associated with Tau
hyperphosphorylation in vitro and in vivo.
Methods: We have developed a novel live-cell reporter
system based on protein-fragment complementation assay
(PCA), using split humanized Gaussia princeps luciferase
(hGLuc), to study dynamic changes in Tau phosphorylation
status. In this assay, fusion proteins of Tau and Pin1 carrying
complementary fragments of the hGLuc protein serve as a
sensor of altered protein-protein interaction between Tau
and Pin1.
Results: We identified several structurally distinct GABAA
receptor modulators as novel regulators of Tau
phosphorylation in a chemical library screen. GABAA
receptor activation promoted specific phosphorylation of
Tau at the AT8 epitope (Ser-199/Ser-202/ Thr-205) in
cultures of mature cortical neurons. Increased Tau
phosphorylation by GABAA receptor activity was
associated with reduced Tau binding to protein phosphatase
2A and was dependent on Cdk5 but not GSK3 kinase
activity.
Conclusions:
(1) GABAA receptor activity is associated with regulation
of Tau phosphorylation.
(2) hGLuc-based PCA is an efficient novel method for
studying Tau interactome dynamics and for high-throughput
screening of modulators of Tau function in live cells.

P1036
PCSK9 regulates neuronal apoptosis by
adjusting ApoER2 levels and signalling
K. Kysenius1,
P. Muggalla1, K. Mtlik2, U. Arume2,
H. Huttunen1
1Neuroscience Center, University of Helsinki, 2Insititute of
Biotechnology, University of Helsinki, Finland
Introduction: Proprotein convertase subtilisin/kexin type 9
(PCSK9) binds to low-density lipid (LDL) receptor family
members LDLR, VLDLR and ApoER2 promoting their
degradation in intracellular acidic compartments. LDLR
controls the systemic levels of circulating LDL, whereas
ApoER2 and VLDLR primarily mediate Reelin signalling
in the brain, critical for the development and plasticity of
the central nervous system. Expression level of PCSK9 is
highest in the cerebellum during perinatal development, but
is also increased in the adult brain after ischemia. The
function of PCSK9 in apoptotic context is currently poorly
understood.
Aim: To investigate the role of PCSK9 in neuronal
apoptosis.
Methods: Potassium deprivation of cerebellar granule
neurons (CGN) was used as an apoptosis model and cell
death assessed by activation of caspase-3 and c-Jun and
nuclear morphology. PCSK9, VLDLR and ApoER2 were
targeted by lentiviral RNAi to investigate their role in CGN
apoptosis.
Results: PCSK9 RNAi reduced the activation of c-Jun and
caspase-3 by 44% and 59%, respectively, at 6h post-
deprivation and the resulting cell death by 41%. Protection
was observed up to 24 hours post-deprivation. RNAi of
ApoER2 but not of VLDLR reversed the protection elicited
by PCSK9 RNAi. Pharmacological studies suggested that
PCSK9 regulates neuronal apoptosis independently of
NMDA receptor function but in concert with ERK and JNK
signalling pathways. PCSK9 RNAi also protected CGN
from staurosporine-induced apoptosis and dorsal root
ganglion neurons from NGF-deprivation.
Conclusions: Our results indicate that PCSK9 potentiates
neuronal apoptosis via downregulation of ApoER2 levels
and related anti-apoptotic signalling pathways.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 107
P1037
Early onset Alzheimers disease
N. Behrem1, A. Altinkaya2, N. Karagoz Sakall1,
P.N. Sutlas1, D. Kirbas1, B. Topcular2,3
1Department of Neurology, Bakirky Teaching and Research
Hospital for Mental Health and Neurological Disorders,
2Department of Neurology, 3Center for Research in Emotion
and Cognition, Istanbul Bilim University, Istanbul, Turkey
Introduction: Early-onset dementia is defined as dementia
before 65 years of age. The prevalence of dementia <64
years of age is approximately 54-260/100,000. Studies on
early onset Alzheimers dementia (AD) show different
clinical and sociodemographic features compared to late
onset AD. We aimed to study the clinical and
sociodemographic features of early onset AD patients in our
department.
Material and method: We included consecutive early onset
AD patients admitted to our Behavioural Neurology and
Dementia outpatient clinic between September 2011 and
January 2012 in the study.
Results: There were 48 early onset AD patients. Female/
male ratio was 0.92. Mean age at symptom onset was 53.32
(36-64) years, mean age at onset was 56.82 (41-66) years.
Mean education duration was 4.96 years. Mean follow-up
time was 2.84 years. Mean MMSE and CDR scores at first
visit were 13.34 and 1.66 respectively. The first symptom
was memory impairment in 79.16% (n=38) of patients
followed by executive dysfunction (n=6), language
impairment (n=2) and visuospatial dysfunction (n=2). The
female/male ratio is lower than in the late onset AD cohort
in our department. The duration of education and CDR at
first visit were similar to late onset AD patients. The
frequency of cognitive domains other than memory as initial
presentation was higher in early-onset AD patients. The rate
of decline in MMSE and CDR was slower in early onset AD
patients.
Conclusion: The frequency of early onset AD is increasing.
Studies show that early and late onset AD have different
characteristics in terms of clinical features.
108 Posters, Sunday 9 September
P1038
Influence of age in CSF biomarkers of
Alzheimers disease from control subjects
J.A. Monge-Argils1, C. Muoz-Ruiz2, J. Snchez-Pay3,
J. Montoya-Gutirrez1, C. Leiva-Santana1
1Service of Neurology, 2Inmunology Laboratory, 3Preventive
Medicine, General Hospital of Alicante, Alicante, Spain
Introduction: Cerebrospinal fluid (CSF) biomarkers of
Alzheimers disease (AD) are currently being assessed in
patients with cognitive impairment. In a few studies, it has
been demonstrated the influence of age in the CSF
concentration of these biomarkers. Our objective was to
confirm this influence in our cohort of control subjects.
Material: We included 55 CSF samples from control
subjects, without cognitive impairment and MMSE over 27,
with ages between 50 and 87. This population were patients
who underwent spinal anaesthesia for orthopaedic or
urological non-malignant conditions. Using xMAP
technology and INNO-BIA Alzbio-3 reagents from
Innogenetics, we quantified CSF A1-42, T-tau and
P-tau181p proteins. We analysed the results with the
Spearman p correlation. Informed consent was obtained
before the procedure.
Results: Our results showed a moderate correlation between
age and T-tau (r=0.5) or P-tau181p (r=0.4). Nevertheless, no
correlation was found with A1-42 protein CSF
concentrations. These results are very similar to those
published in the last year.
Conclusion: In our experience, as others published recently,
age has a moderate influence on T-tau and P-tau181p CSF
protein levels, but it is hardly detectable in A1-42 protein
CSF concentrations.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1039
Cognitive impairment in general paresis:
AD-like pattern?
A. Altinkaya1, M. Ozerden2, N. Behrem2, M. Colak2,
N. Karagoz Sakall2, P.N. Sutlas2, D. Kirbas2,
B. Topcular1,3
1Department of Neurology, Istanbul Bilim University,
2Department of Neurology, Bakirky Teaching and Research
Hospital for Mental Health and Neurological Disorders,
3Center for Research in Emotion and Cognition, Istanbul
Bilim University, Istanbul, Turkey
Objective: Neurosyphilis is a treatable cause of dementia.
Recent studies report an Alzheimers disease (AD)-like
pattern in general paresis patients. We retrospectively
investigated the clinical, cognitive and radiological features
of patients with general paresis of the insane (GPI) in
comparison to early onset AD patients.
Methods: GPI and early onset AD patients followed at the
Dementia and Behavioural Neurology outpatient clinic were
retrospectively compared in terms of clinical,
neuropsychological and radiological features.
Results: There were 16 patients with GPI and 44 patients
with early onset AD. The mean age of onset and mean
follow-up duration for GPI patients were 48 years and 2.12
years, respectively. The mean age of onset and mean follow-
up duration for early onset AD patients were 56.82 years
and 2.84 years, respectively. All GPI patients were male
whereas female/male ratio was 0.92 in early onset AD
group. GPI showed a similar neuropsychological pattern to
early onset AD patients. GPI and early onset AD patients
had similar performances in memory, language and
executive function tests. Attention was more severely
impaired in GPI patients whereas, visuospatial functions
were more severely impaired in AD patients. GPI patients
had more psychiatric symptoms compared to AD patients.
Both patient groups had medial temporal atrophy which was
more severe in the AD group.
Conclusion: Out results support previous studies that
demonstrate GPI that patients show AD-like pattern in
terms of clinical feature but also show that GPI and AD
might show similar radiological features, too.

P1040
Paraoxonase 1 (PON1) and anti-oxidised
LDL antibodies in a group of elderly
subjects in Poland
M. Bednarska-Makaruk1, H. Wehr1, M. Rodo1,
W. Szirkowiec1, D. Ryglewicz2
1Department of Genetics, 2First Department of Neurology,
Institute of Psychiatry and Neurology, Warsaw, Poland
Introduction: Paraoxonase 1 (PON1) is an enzyme
associated with high density lipoproteins (HDL). PON1 has
antioxidant properties and its very important role consists
of preventing low density lipoproteins (LDL) from oxidative
modification. Antibodies against oxidised LDL (anti-
oxLDL) were considered to be a good index of LDL
oxidation. The aim of the study was to investigate PON1
and anti-oxLDL in a Polish population of elderly individuals.
Methods: The investigated group consisted of 3154
individuals (1570 men and 1584 women) mean age
76.310.0 years. The subjects were participants of
multicenter PolSenior project and were recruited randomly
from the Polish population. The cognitive status of the
participants was estimated using MMSE. PON1 activity
was determined in serum basing on the method of Kitchen
[1973] using phenyloacetate as substrate. Anti-oxLDL
antibodies level was determined in serum by ELISA
method.
Results: Significant negative correlation of PON1 activity
with age and anti-ox LDL and positive correlation with
HDL-C and MMSE were stated. Correlation of anti-oxLDL
with age was significantly positive but correlation
coefficient was very low. PON1 activity and anti-oxLDL
level were significantly lower in males as compared to
females. Mean PON1 activity was also decreased in 360
subjects with MMSE<70% as compared to a group of 2667
persons with MMSE70%.
Conclusions: PON1 activity was diminishing with
advancing age which could contribute to cognitive
impairment development in the elderly. Implemented under
publicly-funded project no. PBZ-MEIN-9/2/2006, Ministry
of Science and Higher Education.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 109
P1041
Topographical disorientation (TD) in
ageing: preliminary results in healthy
subjects and MCI patients
A. Suardi1, M.L. Rusconi1, L. Rozzini2, M. Zanetti2,
M.R. Tamborrino3, L. Carelli1
1Human Sciences, University of Bergamo, 2Neurological
Clinic, University of Brescia, 3Santa Chiara Institute, Lecce,
Italy
Introduction: Some evidences have suggested TD as a
possible indicator of Mild Cognitive Impairment (MCI)
conversion into Alzheimers disease (Hort et al., 2007;
Cushman et al., 2008). The purpose of our study was to
validate a new ecological instrument for clinical practice in
order to evaluate TD in elderly healthy subjects and MCI
patients.
Materials: We built an ideal city, consisting of 14 Legos
pieces, 12 road signs, 1 toy car and 1 lay-figure, all
removable and supported on a thick sheet (180x80 cm)
where 18 roads and 4 squares are printed.
Methods: We enrolled 12 right-handed healthy participants
[10 females (F), 2 males (M); mean age =70.67, SD=4.6;
mean schooling=9.75,SD=5.3] and 12 right-handed MCI
patients (10 F, 2 M; mean age=72.25, SD=3.9; mean
schooling =7.75, SD=4). All participants were submitted to
a neuropsychological battery and to an experimental test
which included: route learning forward and backward test;
Free recall landmark; Photographs recognition and location
on the map; Map drawing; Recall and replace landmark on
the map; Replace landmark on the city; Routes description.
Results: MCI patients showed difficulties in episodic
memory, spatial planning and selective attention tasks. They
performed significantly worse in time learning forward and
backward test, map drawing and routes description; a trend
was observed in free recall landmark and photographs
location on the map.
Discussion: The interesting differences observed between
subjects and patients allow us to consider the new instrument
as a promising ecological test to study the various
components involved in TD.
110 Posters, Sunday 9 September

P1042
Monitoring brain changes in mild
cognitive impairment and a biomarker for
structural changes and correlations with
serial PET-FDG scans, PET-PIB scans, and
MMSE scores
W.R. Riddle1, S. Shokouhi2, S.C. DonLevy3
Radiology and Radiological Sciences, Vanderbilt University,
1
P1043
Nerve growth factor treatment in
Alzheimers disease: EEG changes and
relation to FDG-PET
H. Eyjolfsdottir1,2, M. Eriksdotter2,3, P. Almqvist4,5,
O. Almqvist2,3, A. Kadir3, A. Karami3, G. Lind4,5,
B. Linderoth4,5, L. Wahlberg6, . Seiger2,3,7, V. Jelic2,3
1Dept Neurobiology, Caring Sciences and Society,

Nashville, 2Radiology and Radiological Sciences, Vanderbilt Karolinska Institute, 2Dept Geriatrics, Karolinska University
University, Nasnville, 3Pediatric Nurse Practitioner, Hospital, 3Dept Neurobiology, Care Sciences and Society,
4Dept Clinical Neuroscience, Karolinska Institute, 5Dept
Nashville, TN, USA
Neurosurgery, Karolinska University Hospital, Stockholm,
Introduction: The objective of this study was to show how Sweden, 6NS Gene A/S, Ballerup, Denmark, 7Stockholms
a biomarker for structural changes generated with Sjukhem, Stockholm, Sweden
deformation-based morphometry can be used to monitor the
Background: Nerve growth factor (NGF) is important for
progression of Alzheimers disease and to correlate these
the growth and survival of central cholinergic neurons, a
changes with serial PET F-18 labelled fluorodeoxyglucose
signalling system impaired in Alzheimers disease (AD). We
(FDG) uptake scans and C-11 labelled Pittsburgh Imaging
treated 6 AD-patients with NGF by encapsulated NGF-
Compound B (PIB) retention scans.
releasing cells implanted into the forebrain. This report
Methods: 20 subjects with mild cognitive impairment and
focuses on the effects on EEG and the relation to glucose
20 normal subjects were downloaded from the Alzheimers
metabolism on PET (FDG-PET).
Disease Neuroimaging Initiative database. For each subject,
Objective: To investigate if NGF treatment improves EEG
serial Mini-Mental Status Exam (MMSE) scores, FDG
parameters and if EEG improvement correlates with
uptake volumes, PIB retention volumes, and T1-weighted
increased glucose metabolism on FDG-PET.
MR volumes were obtained. A biomarker for structural
Methods: 6 AD-patients (4 women and 2 men, mean age 62
changes was generated from the MR volumes using
years, mean MMSE at baseline 22) received treatment with
deformation-based morphometry. Binary masks for ten
encapsulated NGF-releasing cells implanted into the basal
brain regions were created for each MR image volume.
forebrain stereotactically. They were evaluated clinically,
After registering the FDG and PIB scans to the MR scans,
with quantitative EEG (qEEG) and PET at baseline, 3 and
the correlation coefficient between each subjects initial
12 months. Peak frequency (PF) (4-20 Hz) and spatial
normalized FDG vector and subsequent normalized FDG
distribution of alpha generators was analyzed from qEEG.
vector was calculated and displayed as a function of the
Cerebral metabolic ratio of glucose (CMRGlu) was
time
calculated from FDG-PET data.
Results: The normal subjects preserved their structural
Results: 3 patients had PF within normal range (8.5Hz) at
biomarkers, FDG correlation vectors, and cognitive scores.
baseline and showed significant increases in PF in the beta
In mild cognitive impaired subjects, the FDG correlation
frequency range during treatment. They had a higher MMSE
resembled the MMSE scores and the biomarker for
score at baseline, positive z-scores in Block Design, positive
structural changes identified the location of brain changes.
ADAS-cog changes and increased cortical nicotine binding
Conclusions: Our multi-modality approach may provide
at 12 months. There was a significant reduction in frontal
useful information for early detection and understanding the
shift of alpha generators during treatment which correlated
pathogenesis of Alzheimers disease.
with increased CMRGlu.
Conclusions: A more normalized EEG pattern with an
increased PF in the beta range and a reduced frontal shift of
alpha generators was found in a subset of patients suggestive
of a treatment effect with NGF.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1044
The rate of conversion to dementia in
mild cognitive impairment (MCI) patients
L. Prodan1, A. Draghici2, C. RomanFilip1
1Neurology, University Lucian Blaga Sibiu, Clinical Hospital
County, 2Universiy Lucian Blaga Sibiu, Romania
Aim: The aim of our study was to investigate the risk of
conversion to dementia for different MCI subtypes and
identify the clinical risk factors of conversion.
Methods: We recruited 365 patients, >65 years, who met
the criteria for MCI and evaluated their global cognitive
performances at baseline and annual for the next three
years. The diagnostic of dementia was established using
DSM IV TR criteria.
Results: There were 365 cases of incident MCI, 199 patients
(54%) of amnestic MCI and 1666 patients (46%) of non-
amnestic MCI. The rate of conversion in the first year was
10.4%, in the second year 17.8% and in the third year
23.3%. The mean rate of conversion during the follow-up
period was 18.9% for Alzheimers disease (AD), 11.8% for
vascular dementia (VD) and 13.2% for Alzheimers disease
with cerebrovascular disease (AD with CVD). The rate of
conversion for specific MCI subtype was 17.1%/year for
patients with amnestic MCI and 11.5%/year for non-
amnestic MCI. During the follow-up period 69 patients
converted to AD, 71% were patients with amnestic MCI; 43
patients converted to VD; 46.5% were patients with
amnestic MCI; and 48 patients converted to AD with CVD;
68.7% were patients with amnestic MCI. The mean age for
converters was 72.8 year and for non-converters 74.2 year.
The AD converters have high serum cholesterol levels, high
density lipoprotein, and the debut of hypertension before 65
year.
Conclusion: The combination of amnestic MCI subtype
with the clinical risk factors increased the risk of conversion
to dementia.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 111
P1045
Enzyme antioxidant defences are
diminished in early stages of Alzheimers
disease
M.J. Ramirez-Exposito1, M.C. Puertas1, M.P. Cobo2,
M.P. Carrera1, M.D. Mayas1, J.M. Martinez-Martos1
1Health Sciences, University of Jaen, 2Service of Neurology,
University Hospital of Jaen, Spain
Alzheimers disease (ATD) is the most common
neurodegenerative disorder worldwide. It is characterized
neuropathologically by the formation of senile plaques and
neurofibrillary tangles, and clinically by the progressive
deterioration of memory and other cognitive functions.
Senile plaques are primarily composed of a 40-42 amino
acid peptide denoted as -amyloid (A). The accumulation
and deposition of A in selective brain regions is a major
cause of neurotoxicity and is assumed to be a culprit for
inducing the pathologic process of ATD. Importantly, A is
a major source of reactive oxygen species (ROS) and other
toxic radicals. In our study, we measured the plasma levels
of the enzyme defence system glutathione peroxidase
(GPx), catalase (CAT) and superoxide dismutase (SOD) in
patients diagnosed of ATD and their age-matched controls.
We found decreased levels of catalase and GPx in ATD
patients when compared with control groups, although
changes in catalase activity were found in men but not in
women. On the contrary, we did not find changes in SOD
activity, although Western blotting analysis showed
increased protein levels of SOD-1 in both men and women
with ATD. Our results suggest that there is a defect in the
enzyme antioxidant defence system that is incapable of
responding to increased free radical production, which may
lead to oxidative damage and the development of the
pathological alterations that characterize the
neurodegenerative disorder of patients with ATD.
Furthermore, this defect could be detected early during the
development of the disease. Supported by Junta de
Andaluca, Spain.
112 Posters, Sunday 9 September
P1046
Baseline characteristics of subjects with
prodromal Alzheimers disease: the
LipiDiDiet study
Y. Freund-Levi1, P.J. Visser2,3, M. Kivipelto4,
P.J.G.H. Kamphuis5, R.L. Wieggers5, T. Hartmann6,7,
H. Soininen8
1Department of NVS, Section of Clinical Geriatrics,
Karolinska Institutet, Karolinska University Hospital,
Huddinge, Sweden, 2Department of Psychiatry and
Neuropsychology, Alzheimer Center Limburg, University of
Maastricht, 3Department of Neurology, Alzheimer Center,
VU University Medical Center, Amsterdam, The Netherlands,
4Aging Research Center, Karolinska Institutet and Stockholm
Gerontology Research Center, Stockholm, Sweden, 5Nutricia
Advanced Medical Nutrition, Danone Research - Centre for
Specialised Nutrition, Wageningen, The Netherlands,
6Deutsches Institut fr DemenzPrvention (DIDP),
Neurodegeneration and Neurobiology, 7Experimental
Neurology, Homburg, Germany, 8Department of Neurology,
University of Eastern Finland and Kuopio University
Hospital, Kuopio, Finland
Introduction: Souvenaid, containing the specific nutrient
combination Fortasyn Connect1, is designed to support
synapse formation and function in patients with Alzheimers
disease (AD). Two earlier randomised controlled clinical
trials have shown that Souvenaid improves memory
performance in drug-nave mild AD patients (MMSE 20-26;
Scheltens, 2010) (MMSE 20; Scheltens, 2011), indicating
that Souvenaid may have a promising effect in the early
phases of AD. The LipiDiDiet study2 was designed to
investigate the effects of Souvenaid on cognition in the
prodromal phase of AD.
Methods: The LipiDiDiet study is a 24-month, randomised,
controlled, double-blind parallel-group study investigating
the effects of Souvenaid in 300 prodromal AD patients
(criteria Dubois, 2007). Primary outcome measure is
cognitive functioning as assessed by a modified version of
the Neuropsychological Test Battery (Harrison, 2007).
Secondary outcome measures include progression to AD,
cognitive performance (MMSE, ADAS-cog), functional
abilities (ADCS-ADL), depression (MADRS), MRI atrophy
rate, dementia biomarkers, safety, tolerance and nutritional
parameters.
Results: The LipiDiDiet study started in 2009. Enrolment
is expected to be completed in 2012 and the first results of
the intervention are expected to be available in 2014.
Conclusion: Baseline data from the total group of
prodromal AD patients will be presented.
1Souvenaid is a registered trademark of N.V. Nutricia.
Fortasyn is a trademark of N.V. Nutricia.
2Funded by the EU FP7 project LipiDiDiet, Grant
Agreement N211696.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1047
Agitation - relation to clinical and
dementia biomarkers in cerebrospinal
fluid
V. Bloniecki1, Y. Freund-Levi2, D. Aarsland1,
K. Blennow3
1 Karolinska Institute, 2NVS, Karolinska Institute,
3 Sahlgrenska Universitetssjukhuset, Stockholm, Sweden
Introduction: Dementia leads to deterioration of patients
cognitive abilities and neuropsychiatric symptoms in
dementia (NPSD). NPSD contribute to the disease burden
of patients and care-givers, increase early hospitalization
and constitute approximately 30% of dementia associated
treatment costs. The objective of this study is to examine the
correlation between agitation and cerebrospinal fluid (CSF)
biomarkers (tau, phosphorylated tau and A1-42), clinical
and gender aspects of agitation.
Methods and material: 100 patients 45 years (mean
78.77.5), 67% female, BMI (mean 24.34.3) and MMSE
(mean 20.04.6) fulfilled diagnostic criteria of dementia
according to DSM-IV. All patients underwent a physical
exam including lumbar puncture for analysis of biomarkers
and assessment of the patients agitation level using the
Cohen Mansfield Agitation Inventory (CMAI).
Results: No statistically significant correlation was found
between agitation and all CSF-biomarkers. Men had
statistically significant higher scores on the CMAI- scale as
compared to women (F=4.0, p=0.05). Men with Alzheimers
dementia have a significant negative correlation between
BMI and agitation relating to non-aggressive physical
behaviour (r=-0.7, p=0.006).
Conclusions: The absence of correlation between agitation
and biomarkers in CSF could suggest that neurofibrillary
tangles and amyloid plaques are not involved in the cerebral
pathology causing NPSD. High levels of agitation in males
with low BMI raise the interesting question whether
agitation amongst males with low BMI can be treated by
increasing the daily calorie intake.

P1048
Short-term memory binding in mild
cognitive impairment: a preclinical marker
of Alzheimer's disease?
E. Cerea, S. Caratozzolo, M. Riva, B. Vicini Chilovi,
L. Rozzini, A. Padovani
Institute of Neurology, University of Brescia, Italy
Introduction: It is increasingly important to identify
neuropsychological measures easy to perform at low costs
that can help the clinician to predict subsequent cognitive
decline. The aim of the study is to examine two
neuropsychological tests, recently proposed in literature, the
Short Term Memory Binding Test (Parra and Della Sala,
2009) and five words of Dubois (2002), and comparing
them with neuropsychological tests regularly used during
routine neuropsychological practice.
Methods: 36 patients with a diagnosis of Mild Cognitive
Impairment (MCI) and 35 healthy controls were assessed
with a neuropsychological battery (including tests of
memory, attention, visuospatial, executive functions and
phonemics and semantic fluency), the Dubois test of five
words and a visual short-term memory task estimating the
recognition of shape, colours and shape-colour binding
(STMB).
Results: Patients with MCI performed significantly worse
than healthy controls on most parts of neuropsychological
assessment (MMSE-TMT B-Reward Rey list), on the five
words of Dubois test and on the STMB. The STMB test
correlated with episodic memory and executive functions
tests whereas the test of five words of Dubois correlates
only with memory tests.
Conclusions: The test of the five words of Dubois and
STMB test are, by their high sensitivity and specificity, tests
indicated in the diagnostic process of patients with memory
disorder. The deficit in memory domain and executive
function has been claimed to be predictive of conversion to
Alzheimers disease in patients with MCI; thus, it is possible
to assume that the STMB test might be a good predictor of
conversion to AD.
P1049
Abstract cancelled
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 113
P1050
Clinical significance of serum
inflammatory markers in patients with
subcortical ischemic vascular disease
P. Lv, Y. Dong, L. Li
Department of Neurology, Hebei General Hospital,
Shijiazhuang, China
Objectives: To evaluate the levels of soluble CD40 ligand
(sCD40L), interleukin-6 (IL-6) in the serum of patients with
SIVD and the correlation among the serum levels, cognition
and white matter lesions (WML).
Methods: 39 SIVD patients and 15 normal elderly controls
(NC) were evaluated with MMSE and MoCA to assess the
cognitive function. The patients were divided into vascular
dementia (VaD, n=19) and vascular cognitive impairment
no dementia (VCIND, n=20) group. Age-related white
matter change rating scale was used to qualitative measure
the WML. The serum levels of sCD40L and IL-6 were
detected by enzyme linked immunosorbent assay (ELISA).
The relationship was described between these inflammatory
factors and WML, cognitive impairment in patients with
SIVD.
Results:
(1) A statistically increase of sCD40L serum level of SIVD
patients versus healthy controls was detected (F=9.019
p=0.000).
(2) Compared with controls, patients with SIVD had
elevated IL-6 serum levels (F=10.605 p=0.000).
(3)There was no statistically difference in the VaD and
VCIND patients (p>0.05).
(4) There was no statistically correlation between the serum
levels of sCD40L, IL-6 and MMSE, MoCA, WML scores.
(5) Slight positive correlation between sCD40L and IL-6
was observed (r=0.318, p=0.023).
Conclusions:
(1) Increased serum levels of sCD40L and IL-6 in patients
with SIVD might indicate that inflammatory processes may
be activated in SIVD.
(2) Enhanced serum levels of sCD40L, IL-6 could not imply
the association with the severity of cognitive impairment
and WML in SIVD patients.
(3) sCD40L and IL-6 may be promoting the pathological
changes of SIVD in common.
114 Posters, Sunday 9 September

P1051
Saturated very long chain fatty acid-
induced neuronal dysfunctions playing
essential roles in Alzheimers disease:
impairment of mitochondrial activity,
induction of oxidative stress and
cytoskeleton disorganization
A. Zarrouk1,2, T. Nury1, A. Vejux1, G. Lizard1
1Laboratoire Biochimie du Peroxysome, Inflammation et
Mtabolisme Lipidique, Universit de Bourgogne, Dijon,
France, 2Laboratoire de Biochimie, Facult de Mdecine de
Monastir, Tunisia
In Alzheimers disease (AD), some lipid alterations point
towards a peroxisomal dysfunction. A cortical accumulation
of saturated very long chain fatty acids (VLCFA: C22:0,
C24:0 and C26:0), substrates for peroxisomal -oxidation,
has been found in AD patients. Human neuronal cells
(SK-NB-E) were treated with VLCFAs (5-20M; 48h). The
impact of VLCFAs on mitochondria was evaluated by the
MTT test, flow cytometric analysis (DiOC6(3), MitoSOX),
fluorescence microscopy (MitoTracker Red staining),
transmission electron microscopy. Oxidative stress was
estimated by flow cytometric analyses (DHE, DHR123, and
DAF), fluorescence microscopy (monochlorobimane), and
gas chromatography coupled with mass spectrometry.
Cytoskeleton organization (actin, tubulin and neurofilament
network) was evaluated by flow cytometry and/or
fluorescence microscopy with Rhodamine-phalloidin and
specific antibodies. Mainly with VLCFAs used at 10 and
20M, some mitochondrial changes were observed: reduced
succinate dehydrogenase activity, loss of m, increased of
the mitochondrial mass, identification of elongated
mitochondria, and overproduction of mitochondrial
superoxide anions. An overproduction of superoxide anions
and H2O2 was also revealed, no or slight overproduction of
NO was found, and a decrease of GSH associated with an
increased lipid peroxidation was detected. A more or less
pronounced disorganization of the cytosqueleton was
observed with VLCFAs at 10 and 20M. VLCFAs are able
to induce neuronal damages (mitochondrial dysfunctions,
induction of oxidative stress and disorganization of the
cytoskeleton) which can contribute to the development of
AD. Thus, increased VLCFA levels in cortical lesions of AD
patients might contribute to the development of this disease.
P1052
Acceptability, safety and feasibility of
aerobic exercise in patients with mild to
moderate Alzheimers disease: a pilot
study
K.S. Frederiksen1, N. Sobol2,3, N. Beyer2,3, K. Madsen4,
I. Law5, E. Garde6, S.G. Hasselbalch1,4, G. Waldemar1
1Memory Disorders Research Group, Dept. of Neurology,
Copenhagen University Hospital, Rigshospitalet, 2Institute of
Sports Medicine, Bispebjerg Hospital, Denmark,
3Musculoskeletal Rehabilitation Research Unit, Copenhagen,
Bispebjerg Hospital, 4Neurobiology Research Unit, 5Nuclear
Medicine and PET, Copenhagen University Hospital,
Rigshospitalet, 6Danish Research Center for Magnetic
Resonance, Copenhagen University Hospital, Hvidovre,
Copenhagen, Denmark
Introduction: Aerobic exercise may modulate
neuropathology and symptoms of Alzheimers disease
(AD). We assessed the feasibility of conducting a study of
moderate intensity aerobic exercise in patients with mild to
moderate AD, which included assessment of beta-amyloid
with PiB-PET.
Methods: Home-dwelling patients with mild to moderate
AD were recruited. An aerobic exercise program supervised
by a physiotherapist was administrated 3 times a week for 1
hour over 14 weeks. Feasibility was assessed on attendance
and retention rates, safety and a semi-structured interview.
Patients underwent PiB-PET pre- and post-intervention, for
quantification of beta-amyloid. Assessment of cognitive
function (MMSE, Symbol Digit Modalities Test (SDMT)),
Quality of Life (QoL-AD patient- and proxy-rated),
Activities of Daily Living (ADCS-ADL) and depressive
symptoms (Geriatric Depression Scale-15) were also
carried out.
Results: Results are reported as meanSD. 8 patients were
included in the study. Attendance (90%) and retention
(87.5%) was high. No serious adverse effects were observed.
Patients had fewer depressive symptoms after the
intervention (mean change on GDS: -1, (1); p=0.04).
Proxy-rated QoL (-3.4 (1.7); p=0.002) decreased whereas
patient-rated QoL did not (0.4 (2.9); p=0.7). SDMT score
(-4.4 (4.1); p=0.03)) decreased indicating poorer mental
speed and processing. PiB retention increased in all patients
(pre-test: 2.60 (0.3); post-test: 2.71 (0.31); p=0.005).
Conclusion: It is feasible and safe to carry out a study of
moderate intensity aerobic exercise in patients with AD. Our
uncontrolled study was not designed to examine the
effectiveness of aerobic exercise, which must be evaluated
in a large-scale randomized controlled trial.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1053
Caregiver burden and consumption of
social services among patients with early
onset Alzheimers disease compared to
late onset Alzheimers disease
H. Grnning1, S. Kristiansen2, D. Dyre2, A. Rahmani1,
J. Gyllenborg1, P. Hgh1
1Neurology, 2Geriatrics, Roskilde University Hospital,
Roskilde, Denmark
Introduction: Alzheimers disease (AD) is the most
common dementia disorder. For patients with early onset
AD (onset before 65 years of age, EOAD) the impact of the
disease appears to be more devastating than in late onset AD
(onset after 65 years of age, LOAD). The purpose of the
study was to analyse caregiver-burden and the consumption
of social services in a consecutive group of patients with
EOAD compared to a matching LOAD-group.
Materials and methods: Case-control study with 42
patients, 21 EOAD (mean 58.5 years) and 21 matched
LOAD patients (mean 78.2 years). Patients were matched
according to disease severity at the time of diagnosis.
Caregivers in both groups went through an interview using
the Neuro Psychiatric Inventory (NPI), Activities of Daily
Living (ADCS-ADL) and Resource Utilization in Dementia
(RUD). The quantitative results were statistically compared.
Results: The EOAD-group had a significantly higher ADL-
function compared to the LOAD-group. There was a trend
towards caregivers in the LOAD group spending more time
helping the patients, and they needed more social services
than the EOAD-group. NPI-scores were not significantly
different in regards to neuropsychiatric symptoms, but had
a tendency to a higher caregiver-burden in the EOAD-
group.
Conclusion: The higher caregiver-burden in patients with
EOAD despite a better ADL-function compared to LOAD-
patients indicates that the existing psychosocial services are
insufficient to caregivers in EOAD. Suggestible efforts are
improved information during and after diagnostic
evaluation, an extended follow-up in the clinic, strengthening
of cooperation with the primary health care sector and
psychosocial intervention.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 115
P1054
Human amniotic fluid stem cells over-
expressing choline acetyltransferase gene
restore cognitive function of kainic acid-
induced Alzheimers disease model rats
J. Kyung1, D. Kim1, D. Park1, Y.-H. Yang1, E.-K. Choi1,
H.J. Lee2, S.U. Kim3, Y.-B. Kim1
1College of Veterinary Medicine, Chungbuk National
University, Cheongju, 2Medical Research Institute, Chung-
Ang University Medical School, Seoul, Republic of Korea,
3Division of Neurology, University of British Columbia
Hospital, Vancouver, BC, Canada
We recently established an immortalized amniotic fluid
stem cell line (AF2) over-expressing human choline
acetyltransferase (ChAT) gene and transplanted these AF2.
ChAT cells to kainic acid (KA)-induced Alzheimers disease
(AD) model rats. Intrahippocampal injection of KA (0.4g/
rat) to hippocampal CA3 region caused severe neuronal
loss, resulting in profound memory deficit. Intra cere
broventricularly transplanted AF2.ChAT cells (1x 106 cells/
rat) were found to express ChAT as early as at week 2, in
parallel with the recovery of acetylcholine (ACh) levels in
cerebrospinal fluid (CSF). AF2.ChAT treatment fully
restored the impaired learning and memory function of AD
animals 4 weeks post-transplantation, in which AF.ChAT
cells were superior to their parental AF cells. The cells
migrated to the KA-induced injury site (CA3) and
differentiated into neurons, but not into astrocytes. The
present study demonstrates that human amniotic fluid cells
expressing ChAT have lesion-tropic property and improve
cognitive function of AD model rats with hippocampal
injury by increasing ACh level.
116 Posters, Sunday 9 September
P1055
Dorsal hippocampus serves as site of
action for angiotensin IV in cognitive
enhancement
L.A. Sandusky, E.C. McNay
Behavioral Neuroscience, State University of New York,
Albany, NY, USA
Introduction: Angiotensin IV (Ang IV) is an endogenous
pentapeptide inhibitor of the insulin-regulated
aminopeptidase (IRAP), and is part of the Renin-
Angiotensin System (RAS) that resides within the brain. In
adipocytes, IRAP redistributes with the glucose transporter
4 (GLUT4) to the plasma membrane in response to insulin.
In vivo Ang IVs mechanism and specific site of action
remains unknown despite having been implicated in
numerous studies investigating its memory enhancing
effects.
Methods: Male Sprague Dawley rats were given a single
microinjection cannula in the left dorsal hippocampus.
Administration of aECF, 20pM Ang IV, 40pM Ang IV, or
80pM Ang IV was administered 10 min prior to spatial
working memory testing in the spontaneous alternation
task. 24 hours later the animals were re-tested in a novel
spontaneous alternation maze to test for residual effects of
administration.
Results: Analysis of group means revealed a significant
improvement in spatial working memory when administered
40pm Ang IV compared to aECF alone (p = 0.04) on Day 1.
No group differences were detected on Day 2, demonstrating
the effects of Ang IV as acute but transient.
Conclusion: Previous research exploring the effects of Ang
IV on cognition has administered the drug via
intracerebroventricular injection. Our findings demonstrate
the dorsal hippocampus as a site of action for cognitive
enhancement by Ang IV and support the notion that this
drug might be utilized in populations where cognition is
compromised, such as ageing and dementia. Future research
will explore additional brain regions to extend current
findings.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1056
Comparison of statistical methods for
handling incomplete data in the
evaluation of clinical efficacy of
memantine in the treatment of
Alzheimers disease
O.M. Lemming1, S. Bineau2, C. Marre2, F. Marteau2
1International Clinical Research, H. Lundbeck A/S,
Copenhagen, Denmark, 2Global Outcomes Research
Division, Lundbeck SAS, Issy-Les-Moulineaux, France
Introduction: Alzheimers disease (AD) is a
neurodegenerative disease resulting in irremediable
deterioration in patient health over time. In the context of
randomized clinical trials on efficacy and safety of
antidementia drugs, the progressive nature of AD leads to
some methodological issues when handling missing data
related to patient drop-outs.
In the absence of a gold standard method for managing
missing data, this study will compare the consistency of
results from analysis on observed cases (OC) to the use of
the last observation carried forward (LOCF) method for
imputing missing data, as well as to the Mixed-Effect Model
Repeated Measures (MMRM) modelling approach.
Methods: Three approaches have been compared on the set
of pooled data from three pivotal 6-month, double-blind,
randomised, placebo-controlled trials of memantine (full
analysis set N=480 on placebo, N=488 on memantine) in
the treatment of moderately severe to severe AD (MMSE
5-14).
The data on the main clinical dimensions, i.e. cognition,
global status, activities of daily living and behaviour,
measured through standard scales, have been pooled and
analysed using OC, LOCF and MMRM approaches.
Results: The efficacy of memantine compared to placebo
was demonstrated for all clinical outcomes. These results
were comparable and consistent between the 3 statistical
approaches.
Conclusion: The consistency of the results supports the
reliability of the three statistical methods (LOCF, OC and
MMRM) and reinforces the clinical evidence of memantine
efficacy as compared to placebo in the treatment of
moderately severe to severe AD patients.

P1057
Comparison of two analytical platforms
for CSF biomarkers of Alzheimers
disease
J.A. Monge-Argils1, J. Snchez-Pay2, C. Muoz-Ruiz3,
M. Blanco-Cant1, C. Leiva-Santana1
1Service of Neurology, 2Preventive Medicine, 3Inmunology
Laboratory, General Hospital of Alicante, Spain
Introduction: Cerebrospinal fluid (CSF) biomarkers of
Alzheimers disease (AD) are currently being assessed with
two different assays. Our objective was to study if there is a
correlation between values obtained by both techniques, to
compare their validity and search for a conversion factor
between values obtained for every protein.
Material: We compared the performances of the two most
commonly used platforms, INNOTEST, an enzyme-linked
immunosorbent assay, and INNO-BIA AlzBio-3 for
measurement of CSF A1-42, total tau (T-tau) and
phosphorylated tau 181 (p-tau181p) proteins, in 30 AD
patients and 28 control subjects. The relations between the
variables of both techniques were evaluated using the
Spearman p correlation coefficient (=0.05). ROC and
AUC analyses were calculated for the variables of both
techniques.
Results: The two assay platforms yielded different absolute
values for the various analytes, always higher in INNOTEST.
We found some correction factor between values: 2.1 to 3
fold for A1-42; 4,1 to 4.6 fold for T-tau and 1.4 to 1.6 fold
for p-tau181p. In addition, those values were highly
correlated (A1-42: r=0.70, p<0.01; T-tau: r=0.90, p<0.01;
p-tau181p: r=0.85, p<0.01) and the AUC for the variables
showed very similar values.
Conclusion: The results obtained with INNOTEST and
INNO-BIA were highly correlated and its validity very
similar. Differences in absolute values point to the need for
a clear description of the technique used. However, we
found some conversion factor between values of every
protein that may be useful for transformation between both
techniques.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 117
P1058
Age features of cognitive impairment in
the early rehabilitation period of ischemic
stroke
E. Morozova, L. Pustokhanova
Department of Neurology, Academy of Medicine, Perm,
Russia
Background: One of the major risk factors for cognitive
impairment in patients after ischemic stroke is elderly age.
Methods: 156 patients (aged 38-84, 97 males and 59
females) after the first hemispheric ischemic stroke were
examined. Clinical and neuropsychological investigation
was carried out within 1 and 3 months after the stroke with
the use of NIHSS, Barthel index (BI), MMSE, FAB,
Semantic Verbal Fluency test (SVF), CES-D. The control
group consisted of 53 people without stroke.
Results: The degree of neurological deficit did not depend
on age. MMSE decline was found in 100 patients, FAB in
126 patients at the first visit. Data differences in patients
and control group were confirmed in MMSE (26.223.22
and 27.791.55, p=0.0009), FAB (12.653.29 and
15.672.25, p=0.0000), SVF (15.786.15 and 20.196.35,
p=0.0001). Significant differences between the average
CES-D in patients group and controls were not detected. At
the first visit age was associated with the tests: MMSE
(R=-0.21, p=0.0084), FAB (R=-0.25, p=0.0016), SVF
(R=-0.28, p=0.0006), CES-D (R=0.20, p=0.0143), BI
(R=-0.21, p=0.0082). Reduction of cognitive impairment
was established at the second visit: S (28.022.23,
p=0.0000), FAB (15.592.19, p=0.0000), SVF (18.026.35,
p=0.0084) increased. The average CES-D was lower than at
the first visit (11.178.41 and 8.478.01, p=0.0122).
Correlations between age and FAB (R=-0.24, p=0.0154),
SVF (R=-0.25, p=0.0185), CES-D (R=0.24, p=0.0163)
preserved.
Conclusions: Cognitive impairment in post-stroke patients
are mainly associated with frontal dysfunction. The patients
age has a negative effect on the cognitive status, degree of
depression and social activity.
118 Posters, Sunday 9 September
P1059
Patient dependence and clinical measures
of cognitive impairment, functional
disability and behaviour in Alzheimers
disease: results from dependence in AD in
England (DADE) study
R.W. Jones1, L. Lacey2, M. Knapp3, R. Romeo4, A. Sato3,
T. Niecko5, R. Trigg6, DADE Investigator Group
1Research Institute for the Care of Older People, Bath, UK,
2Janssen Alzheimer Immunotherapy, Dublin, Ireland,
3London School of Economics, 4Kings College London,
London, UK, 5Niecko Health Economics, Naples, FL, USA,
6Nottingham Trent University, Nottingham, UK
Introduction: The DADE study determined the relationship
between dependence and clinical measures of cognition,
function and behaviour in a UK population of patients with
Alzheimers disease.
Methods: A multi-centre, cross-sectional, observational
study was conducted. 249 patients with possible/probable
AD according to NINCDS/ADRDA criteria, MMSE (3-26)
participated.
Patient cognition (Mini- Mental State Examination,
MMSE), function, (Disability Assessment for Dementia,
DAD), behaviour (Neuropsychiatric inventory, NPI), global
disability (Clinical Dementia Rating Scale- Sum of Boxes,
CDR-SOB) and dependence (Dependence scale, DS) were
assessed. Higher scores indicate lower severity for MMSE
and DAD, and greater severity for DS, CDR SOB and NPI.
Associations were determined using Ordinary least squares
regression (OLS).
Results: The mean (SD) age of patients was 79 (8.5) years.
Average time since AD diagnosis was approximately 3 years
and 86% of patients lived in the community and 14% in a
nursing home or residential care home. The mean (SD)
scores for DS, MMSE, DAD, CDR SOB and NPI were 8
(3), 14.6 (6.8), 44.8 (27.7) 10.7 (4.94) and 21.9 (19.14),
respectively.
OLS analyses support statistically significant (p<0.01)
associations between DS and the other clinical severity
measures. A one point increase in MMSE and DAD was
associated with DS point decreases of 0.292 (R-squared:
0.44) and 0.089 point (R-squared=0.68). A one point
increase in NPI and CDR-SOB was associated with DS
increases of 0.046 (R-squared: 0.09) and 0.469 (R squared:
0.59).
Conclusions: Patient dependence, as assessed by the DS,
responds to changes in functional disability, cognitive
impairment and less significantly to changes in behavioural
problems.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1060
Relationship between healthcare, social
care costs, dependence on others as
illness progresses in Alzheimers disease
(AD): results from dependence in AD in
England (DADE) study
M. Knapp1, R. Romeo2, A. Sato1, R.W. Jones3,
L.A. Lacey4, DADE Investigator Group
1London School of Economics, 2Kings College London,
London, 3RICE, Bath, UK, 4Janssen Alzheimer
Immunotherapy, Dublin, Ireland
Introduction: The DADE sought to examine how
healthcare and social care costs in England change with
increasing dependence on others.
Methods: 249 patients with possible/probable AD
according to NINCDS/ADRDA criteria participated in a
multi-centre, cross-sectional, observational study. Patient
dependence (Dependence scale, DS), healthcare and social
resource utilization over the past 3 months (Client Service
Receipt Inventory (CSRI) were assessed. The costs of
services used by patients were derived by combining
medication, health and social care resource utilization data
with estimated 2009/2010 unit costs. Costs were classified
into 2 categories: direct medical costs (DMC; i.e.
medication, primary care contacts, hospital outpatient visits,
inpatient admissions, A&E attendance) and direct non-
medical costs (DNMC; i.e. accommodation, social care
services, aids and adaptation). Relationships were examined
using ordinary least squares regression.
Results: The average time since AD diagnosis was
approximately 3 years with 14% living in the nursing home
or residential care. Bivariate analysis suggested a statistically
significant association (p<0.01) between DS and total DMC
plus DNMC: a one point rise in DS is expected to increase
the total DMC plus DNMC by 760 over 3 months. The
effect is largely driven by increases in DNMC. Multivariate
analyses suggests a positive association (p<0.01, R-squared:
0.29-0.48) between DS and total DMC and DNMC with a
one point rise in DS associated with 8-21% increase in
costs.
Conclusions: Patient dependence on others, as measured by
the DS, provides information for explaining variations in
cost of care, in particular direct non medical care costs.
 Posters, Sunday 9 September 119

P1061 P1062
Hypothyroidism and cognition Pro-apoptotic function of Pin1-mediated
W.-D. Mller1, G. Brandt1, S. Sprenger1, P. Kropp2 Notch activation
1HG Creutzfeldt Institute, Kiel, 2University Medicine, S.-H. Baik, D.-G. Jo
Institute of Medical Psychology and Medical Sociology, School of Pharmacy, Sungkyunkwan University, Suwon,
Rostock, Germany Republic of Korea
Introduction: In our memory consultation a lot of
comorbidities have been observed in patients with cognitive
impairment. Besides cardiological disorders, angiopathies, P1063
and diabetes mellitus patients with thyroid dysfunction were Calsenilin contributes to neuronal cell
observed who also suffered from cognitive problems. In a death in ischemic stroke through Notch
recent study, Resta et al. (2012) point out, that in the elderly,
subclinical hypothyroidism is associated with cognitive
signalling
impairment, but its impact on specific aspects of cognition S.-H. Baik, J.-S. Park, D.-G. Jo
(long-term memory and selective attention) is less evident. School of Pharmacy, Sungkyunkwan University, Suwon,
Aim of our study is to quantify the occurrence of Republic of Korea
hypothyreodism in patients with cognitive disorders.
Methods: 750 patients were collected who consecutively
visited our memory consultation. Median age was 79 years
P1064
(female: 52%). For quantifying cognitive dysfunction all Oxidative lipid modification of -secretase
patients were tested by Mini-Mental-State-Examination in Alzheimers disease
(MMSE, Folstein, 1990) and were graded into mild, median, S.-H. Baik, A.-R. Gwon, J.-S. Park, D.-G. Jo
or severe affected. School of Pharmacy, Sungkyunkwan University, Suwon,
Results: Within the last five years 32 Patients (4,3%) Republic of Korea
suffered from hypothyroidism (70% mild). No differences
were seen in frequency of female or male patients.
Hypothyroidism was correlated with mild cognitive P1065
impairment in MMSE. After euthyroid substitution Striatal morphology as a biomarker in
cognition was improved.
Discussion: Especially in elderly patients hypothyroidism neurodegenerative disease: morphometric
may be correlated with cognitive impairment. In these methods for detecting and monitoring
patients cognitive functions can often be improved after disease impacting on corticostriatal
euthyroid substitution. Despite of the small frequency of circuits
occurrence hypothyroidism should be excluded especially
J.C.L. Looi1, M. Walterfang2
in patients with mild cognitive impairment. 1Academic Unit of Psychological Medicine, Australian
Reference: Resta F, Triggiani V, Barile G, et al. Subclinical National University Medical School, Canberra, ACT,
Hypothyroidism and Cognitive Dysfunction in the Elderly. 2Melbourne Neuropsychiatry Centre, Melbourne University,
Endocr Metab Immune Disord Drug Targets. 2012 Mar 5. Melbourne, VIC, Australia
[Epub ahead of print].

P1066
The effect of Thai traditional music on
cognitive function, psychological health
and quality of sleep among older Thai
individuals with dementia
P. Sithinamsuwan1, S. Saengwanitch1,
A. Pinidbunjerdkool1, M. Mungthin2
Department of Medicine, Phramongkutklao Hospital,
1

Department of Parasitology, Phramongkutklao College of

2

Medicine, Bangkok, Thailand

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

120 Posters, Sunday 9 September
P1067
An MEG study on the effects of medical
food on brain networks in patients with
Alzheimers disease
E.C. van Straaten1, H. de Waal1, M.M. Lansbergen2,
P. Scheltens1, R.L. Wieggers2, P.J. Kamphuis2, C.J. Stam1
1Alzheimer Centre, VU University Medical Centre,
Department of Neurology, Amsterdam, 2Nutricia Advanced
Medical Nutrition, Danone Research - Centre for Specialised
Nutrition, Wageningen, The Netherlands
P1068
Human neural stem cells over-expressing
choline acetyltransferase gene improve
cognitive and physical activities of ageing
mice
D. Kim1, J. Kyung1, D. Park1, Y.-H. Yang1, E.-K. Choi1,
H.J. Lee2, S.U. Kim3, Y.-B. Kim1
1College of Veterinary Medicine, Chungbuk National
University, Cheongju, 2Medical Research Institute, Chung-
Ang University Medical School, Seoul, Republic of Korea,
3Division of Neurology, University of British Columbia
Hospital, Vancouver, BC, Canada
P1069
Dementia and thrombolysis: a systematic
review
K. Murao, D. Leys, R. Bordet, F. Pasquier, C. Cordonnier
Departments of Neurology and Pharmacology, University
Lille North of France (EA 1046), CHU Lille, France
P1070
Disease progression in patients with mild-
to-moderate Alzheimers disease treated
with galantamine: results of a 2-year open
label study
U. Richarz1, M. Djelani2, M. Gaudig3, K. Rettig4,
B. Schauble2, E. Jedenius5
1Medical Affairs, Janssen Cilag, Baar, Switzerland, 2Medical
Affairs, 3Health Economics, Janssen Cilag, Neuss,
4Biostatistics, GEM, Meerbusch, Germany, 5Janssen Cilag
Sweden, Gteborg, Sweden
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1071
Effectiveness of galantamine in patients
with mild to moderate dementia:
12 months outcome data
U. Richarz1, M. Djelani2, K. Rettig3, B. Schauble2,
M. Gaudig4, E. Jedenius5
1Medical Affairs, Janssen Cilag, Baar, Switzerland, 2Medical
Affairs, Janssen Cilag, Neuss, 3Biostatistics, GEM,
Meerbusch, 4Health Economics, Janssen Cilag, Neuss,
Germany, 5Janssen Cilag Sweden, Gteborg, Sweden
P1072
Tooth loss and cognitive decline
S.-H. Suk1, Y.-J. Kim2, I.-S. Koh3, Y.-K. Minn4,
J.-H. Lee5, S.-H. Hwang6, J.-H. Park7
1Department of Neurology, Wonkwang University Sanbon
Medical Center and Ansan Municipal Geriatric Hospital,
Gunpo-si, 2Neurology, Sungae Hospital, 3Neurology,
National Medical Center, 4Neurology, Hallym University
Hangang Sacred Hospital, Seoul, 5Neurology, National
Health Insurance Coorperation Ilsan Hospital, Koyang,
6Neurology, Hallym University Gangnam Sacred Heart
Hospital, 7Neurology, Inje University Sangae Paik Hospital,
Seoul, Republic of Korea
P1073
Supporting synapse formation and
function in Alzheimers disease:
mechanism of action of the specific
nutrient combination Fortasyn Connect
J.W. Sijben1, P.J. Kamphuis1,2, M. deWilde1,
R.J. Hageman1, L.M. Broersen1, M. Groenendijk1
1Nutricia Advanced Medical Nutrition, Danone Research -
Centre for Specialised Nutrition, Wageningen, 2Utrecht
Institute for Pharmaceutical Sciences (UIPS), Utrecht
University, Utrecht, The Netherlands
P1074
The awareness of everyday memory
deficits in patients with Parkinsons
disease
I. Tamura1,2, S. Hamada2, S. Homma2, H. Soma2,
A. Takei2, K. Hamada2, F. Moriwaka2, K. Tashiro2
1Communication Disorders, Health Sciences University of
Hokkaido, 2Neurology, Hokuyukai Neurological Hospital,
Sapporo, Japan

P1075
Neuroprotective effect of edaravone
against hydrogen peroxide induced
neuronal cell death
J. Liu1, Z. Zhao1, S. Huang2, S. Xiao1, B. Zhang1
1Dept. of Neurology, Sun Yat-sen Memorial Hospital,
Guangzhou, 2Dept. of Neurology, Hainan Provincial Peoples
Hospital, Haikou, China
P1076
Hippocampal presynaptic alterations are
associated to amyloid plaques in young
PS1/APP Alzheimer mice
R. Sanchez-Varo1, E. Sanchez-Mejias1,
L. Trujillo-Estrada1, V. De Castro1, S. Jimenez2,
A.J. Jimenez1, J.M. Garcia-Verdugo3, M. Vizuete2,
J.C. Davila1, J. Vitorica2, A. Gutierrez1
1Cell Biology, Faculty of Sciences, University of Malaga/
CIBERNED, Mlaga, 2Biochemistry and Molecular Biology,
Faculty of Pharmacy, University of Seville/CIBERNED,
Seville, 3University of Valencia/CIBERNED, Valencia, Spain
P1077
Temporal pattern of neuritic plaques
deposition in an app751sl/ps1m146l
Alzheimer transgenic model
L. Trujillo-Estrada1, R. Sanchez-Varo1,
E. Sanchez-Mejias1, D. Baglietto-Vargas1,
I. Moreno-Gonzalez1, S. Jimenez2, M.L. Vizuete2,
J.C. Davila1, J. Vitorica2, A. Gutierrez1
Cell Biology, University of Malaga/CIBERNED, Mlaga,
1
Biochemistry and Molecular Biology, University of Seville/
2 P1082
CIBERNED, Sevilla, Spain
P1078
Clinical characteristics of Alzheimers
disease at the initial visit at the Belgrade
Memory Centre: a Serbian report
T. Stojkovic, I. Despotovic, G. MandicStojmenovic,
E. Stefanova, V.S. Kostic
Memory Centre, Neurology Clinic Clinical Center of Serbia,
Belgrade, Serbia
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 121
P1079
Hypertension: a risk factor for Alzheimers
disease?
M. BenDjebara1,2, I. Belhouane1,2, I. Kacem1,2,
I. BenArbia1,2, I. Rebai1, Y. Hizem1,2,
A. Gargouri-Berrechid1,2, R. Gouider1,2
1Department of Neurology, Razi Hospital, La Manouba,
2Research Unit of Clinical Neurophysiology and
Electrodiagnosis 03/UR/08-09, Tunis, Tunisia
P1080
Genetic genomics analysis of Ptgs2 gene
in BXD recombinant inbred mouse
hippocampus
Y. Chen, Y. Zhang, Y. Li, X. Wang, L. Lu
Nantong University, Nantong, China
P1081
Biochemical alterations of tau protein as
a healing physiological compensatory
mechanism of cytoskeleton integrity and
brain neuroplasticity in Alzheimers
disease and other types of
neurodegeneration
A. Koudinov1,2, N. Koudinova1,2, T. Berezov1,2
1Biochemistry, TT Berezov Laboratory, Russian People
Friendship University, 2Orechovich Institute of Biomedical
Chemistry, Russian Academy of Medical Sciences, Moscow,
Russia
Role of the cell adhesion molecule F3/
contactin in hippocampal synaptic
plasticity and memory in old mice
D. Puzzo1, L. Privitera1, D. Furnari1, A. Bizzoca2,
G. Gennarini2, A. Palmeri1
1Bio-Medical Sciences - Section of Physiology, University of
Catania, 2Department of Basic Medical Sciences, University
of Bari, Italy
122 Posters, Sunday 9 September

P1083 P1087
Vessel wall changes on ultrasound in Estradiol is neuroprotective against the
renal patients with intellectual decline neurotoxic effects of -amyloid (25-35)
T.J. Tegos1, G. Dimas2, C. Pitsalidis1, A. Valavanis1, in ageing female rat brains
A. Chatziapostolou1, A. Papadimitriou1, P. Kumar, R.K. Kale, N.Z. Baquer
I. Chrysogonidis3, D. Grekas2, A. Orologas1 School of Life Sciences, Jawaharlal Nehru University, New
1A Department of Neurology, AHEPA Hospital, 2First Delhi, India
Medical Propaedeutic Department, AHEPA Hospital,
3Radiology Department, AHEPA Hospital, Aristotelian

University of Thessaloniki, Greece P1088

P1084
Neuroprotective effects of
metallothionein-I against amyloid toxicity:
glial connections
J.-H. Kim1, Y.-P. Nam1, S.-M. Jeon1, J. Park1, H.-S. Han1,
K. Suk1,2
1Kyungpook National University School of Medicine, 2Brain
Science & Engineering Institute, Daegu, Republic of Korea
P1085
The validity of the MoCA-K in non-
amnestic MCI
J.-Y. Ahn1, J.-W. Cho2, J.-M. Chung3, H-T. Kim4
1Neurology, Seoul Medical Center, 2Neurology,
Sungkyunkwan University School of Medicine, 3Neurology,
Seoul Paik Hospital, Inje University College of Medicine,
4Hanyang University Hospital, Seoul, Republic of Korea
How do patients get their information?
W.-D. Mller1, G. Brandt1, S. Sprenger1, P. Kropp2
1HG Creutzfeld Institute, Kiel, 2University Medicine, Institute
of Medical Psychology and Medical Sociology, Rostock,
Germany
P1089
To determine the level of antioxidant
markers in guinea pigs exposed to
huperzine A
L. Drtinova, M. Pohanka, V. Sepsova
Faculty of Health Sciences, University of Defense, Hradec
Krlov, Czech Republic

P1086
Neuroprotective and anti-ageing roles of
dehydroepiandrosterone in aging male rat
brains
P. Kumar, R.K. Kale, N.Z. Baquer
School of Life Sciences, Jawaharlal Nehru University, New
Delhi, India

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


Autonomic nervous system disorders
P1090
Electrogastrography in pure autonomic
failure
D.A. Low1,2, E. Vichayanrat1,2, W. Seligman1,3,
Y. Yamanaka4, M. Asahina4, C.J. Mathias1,2
1Medicine, Imperial College London, 2Autonomic Unit,
University College London Hospital, London, 3Department
of Physiology, Anatomy and Genetics, University of Oxford,
Oxford, UK, 4Department of Neurology, Chiba University,
Chiba, Japan
Gastric motility is controlled, in part, by the autonomic
nervous system. Gastrointestinal symptoms can occur in
Pure Autonomic Failure (PAF), which is characterized by
postganglionic sympathetic dysfunction. No studies have
investigated gastric motility in PAF patients however.
Aim: To evaluate gastric motility by recording gastric
myoelectrical activity using cutaneous electrogastrography
(EGG) before and after standard liquid meal ingestion in
PAF.
Methods: 7 PAF patients (669 yr) and 5 healthy individuals
(665 yr) ingested a 300ml standard liquid meal (20g
glucose, 60g Complan and milk) whilst supine. Gastric
myoelectrical activity was measured using four-channel
EGG. Running spectral analysis was performed using Fast
Fourier Transformation. Dominant frequency (DF) was
defined as the frequency at which the overall power
spectrum showed peak power between 2.0-4.0 cycles per
minute (cpm). The instability coefficient of dominant
frequency (ICDF) was calculated as the ratio of the standard
deviation and mean of the peak frequencies.
Results: There was no difference between groups in
baseline pre-prandial DF (2.80.1 vs. 3.00.3 cpm) and the
minimum and maximum post-prandial DF (both P>0.05).
There was a borderline interaction effect of time and group
for ICDF (P=0.086). ICDF was higher in PAF at baseline
(10.27.9 vs. 2.30.4%) and remained unchanged early
(0-15 min, 12.55.9%) and late (30-45 min, 9.49.5%)
post-prandial. In contrast, ICDF increased in controls early
post-prandial (11.03.9%) and returned to baseline during
late post-prandial (1.90.6%).
Conclusion: Irregular gastric myoelectrical activity in PAF
patients, as suggested by high ICDF and lack of post-
prandial ICDF changes, suggest gastric dysrhythmia in PAF.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 123
P1091
Abdominal compression compensates for
compromised sympathetic superior
mesenteric artery innervation and
restores blood pressure in hypotensive
familial dysautonomia patients
E.C. Ehmann1, J. Koehn1, S. Moeller1, R. Baltadzhieva2,
F.B. Axelrod3, M.J. Hilz1,2
Department of Neurology, University of Erlangen-
1
Nuremberg, Erlangen, Germany, 2Departments of Neurology,
Medicine, Psychiatry, 3Dysautonomia Center, New York
University, New York, NY, USA
Background: Familial Dysautonomia (FD) patients have
severe orthostatic hypotension (OH) that recovers faster
upon supine-repositioning with than without abdominal-
compression. Influences of abdominal-compression on
splanchnic perfusion are unknown but may contribute to
blood pressure recovery.
Therefore we assessed superior mesenteric artery (SMA)
blood-flow changes during orthostasis, supine-repositioning
without and with abdominal-compression.
Methods: In 9 FD-patients (17.83.9 years) and 13 controls
(18.85 years) we monitored mean blood pressure (BP) and
heart rate (HR). Using real-time Doppler ultrasound, we
assessed cross-sectional SMA areas (SMA-area), time-
average velocities (SMA-TAV), SMA blood-flow (SMA-
BF), SMA-vascular resistance (SMA-VR=BP/SMA-BF),
during supine-rest, standing, supine-repositioning, another
supine-rest, second standing, and supine-repositioning with
abdominal-compression by leg elevation and flexion
towards the thorax. Differences between groups and
positions were assessed by ANOVA and post-hoc testing
(significance: p<0.05).
Results: FD-patients had pronounced OH without HR
changes during positional changes. Controls had stable BPs
and significant HR increase upon standing and HR decrease
upon supine-repositioning. Upon standing, SMA-area,
SMA-TAV, SMA-BF decreased in both groups; yet, SMA-
area decreased more in controls than in patients. SMA-VR
increased significantly in controls only. Upon repositioning,
SMA-area, SMA-TAV, SMA-BF re-increased significantly
in both groups. SMA-VR re-increased in controls and
remained unchanged in patients. With abdominal-
compression, both groups had similar SMA-TAVs and
smaller SMA-areas; but only patients had higher SMA-VRs
and lower SMA-BFs than without compression.
Conclusion: Upon standing, FD-patients cannot adequately
increase SMA-VR with subsequent SMA-constriction.
Abdominal-compression compensates def icient
sympathetic splanchnic vasoconstriction and lowers SMA-
BF in patients. The reduced blood-flow towards the
splanchnic bed contributes to accelerated BP-recovery.
124 Posters, Sunday 9 September
P1092
Direct evidence of sympathetic nervous
system hyperactivity in patients with
vasospastic angina
F. Despas, J. Van Rothem, N. Boudou, A. Vaccaro,
M. Lebrin, D. Carrie, M. Galinier, M. Elbaz, A. Pathak,
J.-M. Senard
Toulouse University Hospital, Toulouse, France
The pathogenesis of vasospastic angina remains
incompletely elucidated. Among multiple mechanisms,
vagal withdrawal can act as a trigger for spontaneous
coronary spasm, changes in sympathetic activity have also
been suggested. To date no direct assessment of sympathetic
nerve activity (MSNA) has been performed.
We evaluated haemodynamic parameters and MSNA in 31
patients: 15 having definite vasospastic angina confirmed
by ergonovine provocation test during angiography and 16
matched patients (age, gender, body mass index, risk
factors) with negative response to provocation test.
Parameters were collected during baseline and during a
mental stress known to further increase MSNA.
During baseline period, blood pressure and heart rate did
not significantly differ between groups. Baseline MSNA
was significantly increased in patients with vasospam
compared to non-vasospasm patients (56.81.3 vs. 50.31.8
burst/min; p<0.001). During mental stress period, spasm
patients presented a significant higher mean blood pressure
and MSNA in comparison to non-spasm patients (66.11.8
vs. 54.31.8 burts/min; p<0.001). For spasm patients group,
mental stress test produced a significant increase of blood
pressure, heart rate, oxygen saturation and MSNA (56.81.3
vs. 66.11.8 bursts/min, p<0.001). For non-spasm patients
group, mental stress test produced a significant increase of
heart rate, oxygen saturation and MSNA (50.31.8vs
54.31.8 bursts/min, p<0.05), but no significant
modification on blood pressure parameters.
Our results show a direct evidence of increased sympathetic
activity in patients with vasospastic angina, during mental
stress. This propensity to further increase MSNA during
stress may play a key role in the pathogenesis of coronary
spasm.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1093
Tako-Tsubo cardiomyopathy: direct
evidences of sympathetic nervous system
hyperactivity
F. Despas1, A. Vaccaro2, M. Lebrin2, C. Delmas2,
M. Galinier2, A. Pathak2, J.-M. Senard2
1Clinical Pharmacology, 2Toulouse University Hospital,
Toulouse, France
Tako-Tsubo Cardiomyopathy (TTC) is an acute reversible
condition that involves left ventricular apical ballooning
and mimics acute myocardial infarction with no detectable
coronary arterial disease. TTC typically affects aged post-
menopausal women and is usually triggered by emotional or
physical stress. The exact pathophysiology remains
unknown but data suggest a link between sympathetic
hyperactivity and TTC. Up to now, no direct evidence of
sympathetic hyperactivity has been established. The aim of
our study was to determine by microneurography if patients
with TTC present an increase of muscle sympathetic nerve
activity (MSNA) in comparison to matched heart failure
controls.
We enrolled 13 TTC patients (80.12.1 years, all female,
Body Mass Index: 23.20.8kg/m, Left Ventricular Ejection
Fraction: 402%) and 13 control patients matched for age,
sex, BMI, LVEF, renal function and haemoglobinemia.
Within 36 hours after admission, all patients underwent a
microneurography and an arterial baroreflex gain
assessment (slope of the relationship between MSNA and
diastolic blood pressure). There is no difference between
groups on haemodynamics parameters (BP and HR) and
oxygen saturation. TTC patients presented a significant
increase of sympathetic activity (66.32.7 vs. 55.62.6
bursts/min; p=0.0089). Arterial baroreflex gain is
significantly decreased compared to control patients
(1.20.3 vs. 2.50.4 % MSNA/mmHg; p=0.005).
This study showed for the first time with a direct technique,
that TTC patients present a sympathetic hyperactivity. The
increase of sympathetic nerve activity is associated to a
decrease of arterial baroreflex gain. During the acute phase,
the benefit of adrenergic antagonist has to be evaluated.

P1094
Prolonged survival in multiple system
atrophy (MSA)
P. Guaraldi1, F. Mastrolilli2, A. Cecere1,
G. Calandra-Buonaura1, L. Sambati1, G. Barletta1,
F. Provini1, F. Vernieri2, P. Cortelli1
1Dipartimento di Scienze Neurologiche, IRCSS Istituto delle
Scienze Neurologiche di Bologna, Alma Mater Studiorum -
Universit di Bologna, Bologna, 2Department of Neurology,
Campus Bio-medico University, Rome, Italy
Introduction: MSA is a sporadic neurodegenerative
disorder characterized by dysautonomia associated with
parkinsonian (MSA-P) or cerebellar (MSA-C) features with
a mean survival of 7-9 years. Few reports described patients
surviving more than 15 years (1). We retrospectively
reviewed the medical records of 108 MSA patients, assessed
in our Clinic between 1991 and 2012 in search of patients
with a disease history of >15 years.
Methods: We identified 6 patients (5 MSA-P, 1 MSA-C, 4
males). Demographic, clinical and polysomnographic data
were analyzed. Up-to date follow-up information was
obtained by telephonic interviews.
Results: MSA-P presented at 507 years (range 41-58
years) with a rigid-bradikinetic syndrome in 3 patients and
genito-urinary dysfunction in 2. MSA-C developed at 49
years with cerebellar dysfunctions. Nocturnal stridor was
present in 2 patients (1 MSA-C) that underwent
tracheostomy. All patients were bedridden at their final
assessment (145 years after onset, range 8-20). One patient
with MSA-P and stridor is still alive; mean disease duration
was 203 years (range, 16-23 years) in the whole population
and 214 years (range, 18-23 years) in the subgroup with
stridor. Causes of death were respiratory arrest (n=2) or
unknown (n=3).
Conclusions: Few previous studies reported MSA patients
with a survival >15 years, but with poor clinical description.
5.6% of our MSA had a disease history of >15 years.
Gathering clinical information regarding MSA patients with
prolonged survival may help to identify useful prognostic
and protective factors.
1. Kim et al. (2011) Survival of Korean patients with
multiple system atrophy. Movement disorders 26(5):909-
912
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 125
P1095
Quantitative cardiovascular autonomic
function in patients with primary chronic
autonomic failure
E. Vichayanrat1,2, D. Low1,2, K.B. Nilsen3,4, V. Iodice1,2,
C.J. Mathias1,2
1Autonomic & Neurovascular Medicine Unit, Imperial
College London at St. Marys Hospital, 2Autonomic Unit,
National Hospital for Neurology and Neurosurgery, London,
UK, 3Department of Neuroscience, Norwegian University of
Science and Technology, Trondheim, 4Department of
Neurology, Section for Clinical Neurophysiology, Oslo
University Hospital, Oslo, Norway
It can sometimes be difficult to differentiate the diagnosis
between Parkinsons disease with autonomic failure
(PD+AF), Pure Autonomic Failure (PAF) and Multiple
System Atrophy (MSA), owing to overlapping autonomic
features, such as orthostatic hypotension (OH).
Aim: We investigated the usefulness of a variety of
quantitative cardiovascular autonomic measures in
distinguishing these patients with primary chronic AF.
Methods: Patients underwent cardiovascular autonomic
function tests that included head-up-tilting, Valsalva
manoeuvre (VM) and deep breathing (HRDB). Blood
pressure (BP) and heart rate (HR) were continuously
recorded and analyzed off-line. The adrenergic component
of baroreflex sensitivity (BRS-a), blood pressure recovery
time during VM (PRT) and Valsalva ratio (VR) were derived
from the VM. All measures were compared between patients
and normal controls.
Results: Supine systolic BP (SBP) was not different
between groups. OH was present in patients but not in
controls (p<0.05). Absolute SBP was significantly lower
and the change in SBP was significantly greater during
tilting in PAF compared to MSA (p<0.05). Responses in
PD+AF were intermediate. BRS-a and VR were significantly
lower in all patient groups compared to controls (p<0.05)
but there was no difference between patient groups (p>0.05).
MSA patients had a significantly prolonged PRT compared
to PD+AF (p=0.035) and HRDB was significantly lower in
PAF compared to MSA (p=0.04).
Conclusion: PRT may be useful for differentiating MSA
from PD+AF and HRDB for PAF from MSA. These
findings suggest that sympathetic function is more affected
in MSA compared to PD+AF while parasympathetic
dysfunction is more prominent in PAF than in MSA.
126 Posters, Sunday 9 September
P1096
Immunohistochemical analysis reveals
sympathetic column involvement in the
SOD1 (G93A) transgenic mouse model of
amyotrophic lateral sclerosis
B. Kandinov1, A.D. Korczyn2, V.E. Drory2, D. Offen3,
N.C. Grigoriadis4, O. Olga Touloumi4
1Pharmacology and Physiology, Tel-Aviv University, 2Tel-
Aviv Sourasky Medical Center, 3Tel-Aviv University, Tel Aviv,
Israel, 4Aristotle University of Thessaloniki, Thessaloniki,
Greece
Amyotrophic lateral sclerosis (ALS) is a progressive and
fatal disorder caused by degeneration of the motor neurons
in the cerebral cortex, brain stem and spinal cord. Several
clinical reports indicated dysfunction of sympathetic and
parasympathetic innervation in ALS patients. In addition,
we have recently reported elevated heart rate and blood
pressure in transgenic (TG) mice carrying the SOD1 mutant
form of the human SOD1 transgene (SOD1G93A) even
prior to the appearance of motor symptoms. In order to
further elucidate the underlying mechanisms of autonomic
impairment in ALS we performed an immunohistochemical
study of the superior cervical ganglia (SCG) and adrenal
glands (AG) in TG and wild-type (WT) mice at the age of
75-80 days. SCG and AG sections were stained with primary
antibodies against tyrosine hydroxylase (TH) and choline
acetyltransferase (ChAT). TH expression in AG revealed a
24% decrease in the SOD1G93A group compared to WT
(p<0.0001). ChAT expression in the SCG was reduced by
28% in the SOD1G93A group compared to WT (p<0.0001).
No significant differences were found for TH in SCG or for
ChAT in AG. Since ChAT is predominantly located at pre-
ganglionic nerve terminals which innervate the AG, our
results point to a pre-ganglionic sympathetic denervation as
a potential contributor to the abnormal sympathetic
regulation in ALS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1097
Diagnostic significance of urethral
sphincter electromyography in patients
with multiple system atrophy
X. Qi1, L. Li2, W. Yao2, F. Qiu2
1 Neurology, 2Navy General Hospital, Beijing, China
Objective: To evaluate the significance of urethral sphincter
electromyography (US-EMG) for the diagnosis of multiple
system atrophy (MSA).
Methods: 15 patients who were diagnosed as MSA and 17
non-MSA patients were examined as controls were enrolled
in the study and US-EMG was performed in both groups.
Spontaneous activities during relaxation, parameters of
MUPs mean duration and amplitude, percentage of
polyphasicity, satellite potential, recruited pattern and
amplitude during strong contraction were recorded and
analyzed.
Results: US-EMG changes of various abnormalities were
found in 13 cases of the MSA group (86.7%). There was
significant difference of electromyographic findings
between the MSA group and the control group including the
mean duration and amplitude of motor unit action potentials
(MUAPs) as well as recruited pattern and amplitude during
heavy contraction.
Conclusions: US-EMG has certain values for the diagnosis
of MSA. It could be used as a routine electrophysiological
method for those suspected of MSA and could be a surrogate
of EAS-EMG.

P1098
Diagnostic significance of urethral
sphincter electromyography and external
anal sphincter electromyography in
patients with multiple system atrophy
F. Qiu1, X. Qi1, L. Li2, J. Liu2
1 Neurology, 2Navy General Hospital, Beijing, China
Objective: To assess the significance of urethral sphincter
electromyography (US-EMG) and external anal sphincter
electromyography (EAS-EMG) for the diagnosis of multiple
system atrophy (MSA).
Methods: US-EMGs and EAS-EMGs were performed in
15 patients diagnosed as MSA. Duration, motor unit action
potentials (MUAPs) amplitude, and polyphasicity, as well as
recruited pattern and amplitude during heavy contraction
were recorded and analyzed.
Results: Among 15 patients who were diagnosed as MSA,
neural injuries were shown by both US-EMG and EAS-
EMG in 13 cases. There was significant difference of
electromyographic findings between US-EMG group and
EAS-EMG group (P=0.033 and 0.011, for comparison of
means of MUAPs amplitude and medians of polyphasicity,
respectively).
Conclusions: Although US-EMG may be difficult to
perform, US-EMG may have the same specificity as EAS-
EMG for the diagnosis of MSA, especially for the diagnosis
of MSA patients with only urination disorders due to
involvement of Onufs nucleus.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 127
P1099
Sleep motor activity in parkinsonism at
disease onset: a possible biomarker
useful for differential diagnosis
M. Alessandria, G. Calandra-Buonaura, A. Cecere,
L. Sambati, R. Terlizzi, P. Guaraldi, F. Provini, P. Cortelli
IRCCS Istituto delle Scienze Neurologiche, University of
Bologna, Bologna, Italy
Introduction: Differential diagnosis of parkinsonism at
disease onset may be difficult. Aim of this study is to
describe videopolysomnographic (VPSG) motor findings in
patients with recent onset parkinsonism.
Methods: We studied 22 consecutive patients with
parkinsonian features and disease duration up to 3 years part
of the motor and non-motor prospective study on
parkinsonism at onset (BO-ProPark). Patients were
diagnosed following standard diagnostic criteria as
Parkinsons disease (PD, 12 patients), PD plus (PD with
cognitive impairment or dysautonomia, 4 patients) and as
parkinsonian syndromes (PS, 6 patients). All patients
underwent a full night VPSG, scored by a neurologist
blinded to the diagnosis.
Results: All patients showed reduced sleep efficiency with
normal sleep macrostructure. In 3/6 PS patients apnoea/
hypopnoea index was >5. A sustained muscle EMG activity
or an excessive phasic muscle activity during REM sleep
were shown in 14 patients (4/12 PD; 4/4 PD plus; 6/6 PS).
RBD episodes were recorded in 5 patients (3/4 PD plus; 2/6
PS); 6 patients showed excessive fragmentary myoclonus
(1/12 PD; 1/4 PD plus; 4/6 PS); PD plus and PS patients
showed whole body jerks during sleep; in 14 patients the
PLMS index was >15 (7/12 PD; 2/4 PD plus; 5/6 PS).
Conclusion: Our preliminary data suggest that an impaired
sleep motor control is more frequent at disease onset in
patients with PS and PD plus compared to PD patients.
More data are needed to establish if these features may have
a diagnostic value in the differential diagnosis of
parkinsonism.
128 Posters, Sunday 9 September
P1100
Quantitative electromyography of the
external anal sphincter in Huntingtons
disease patients
S. Podnar1, M. Kolenc2, J. Kobal1
University Medical Centre Ljubljana, Ljubljana, 2Novo
1
Mesto General Hospital, Novo Mesto, Slovenia
Aims: In several extrapyramidal diseases Onufs nucleus
degeneration was also demonstrated by histology and
electromyography (EMG). Although Huntingtons disease
(HD) patients also often report bladder, bowel and sexual
dysfunction Onuf s nucleus has not been systematically
studied in this population. This was the aim of the present
study.
Methods: From our registrar of patients with genetically
confirmed HD all patients willing and capable to participate
in the study using several standard questionnaires were
recruited. Those reporting bladder and/or bowel dysfunction
were also asked to undergo quantitative anal sphincter
EMG.
Results: Of 72 patients (25 men) with genetically con
firmed HD, 33 reported bladder and/or bowel dysfunction.
Anal sphincter EMG was performed in 14 of them (8 men),
33 to 67 years of age (meanSD, 4810 years). Their
disease durations were 3 to 15 years (85 years), and the
number of huntingtin CAG repeats 40 to 52 (464). In all
but 3 patients decreased tonic activity and/or decreased
voluntary activation were found in the anal sphincter.
However, in no patient quantitative EMG abnormalities
were found.
Conclusions: Our study did not demonstrate EMG signs of
the Onuf s nucleus degeneration in HD patients. Decreased
anal sphincter tonic activity and voluntary activation, as
well as bladder and bowel dysfunction could probably be
explained by basal ganglia or central autonomic structures
degeneration.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1101
Is cognitive impairment associated with
orthostatic hypotension in parkinsonism
at onset?
L. Sambati, G. Calandra-Buonaura, F. Oppi, R. Poda,
M. Stanzani Maserati, P. Guaraldi, R. Terlizzi,
M. Alessandria, L. Solieri, R. Gallassi, P. Cortelli
IRCCS Istituto delle Scienze Neurologiche, University of
Bologna, Italy
Background: Parkinsonism at onset can be associated with
cognitive impairment and autonomic dysfunctions.
Objective: To describe the cognitive features of patients
with parkinsonism at onset and to investigate their eventual
association with orthostatic hypotension (OH).
Method: We consecutively selected patients with
parkinsonism and disease duration up to three years to take
part in the Bo-ProPark Study (Bologna-motor and non
motor Prospective study on Parkinsonism at onset). Each
patient underwent, at baseline and after sixteen months,
neuropsychological assessment (Brief Mental Deterioration
Battery, Stroop Test, Semantic Fluency Task, Beck
Depression Inventory) and tilt table test (continuous
monitoring of arterial blood pressure and heart rate) to
detect the presence of OH. The clinical diagnosis was made
at the second evaluation, according to international
diagnostic criteria.
Results: We recruited 27 patients (21 Parkinsons disease
(PD); 2 Progressive Supranuclear Palsy (PSP); 1 Multiple
System Atrophy (MSA); 3 Parkinsonian Syndromes not
otherwise specified (PS)). 13 of 27 patients showed
neuropsychological impairment (NI). In these patients we
observed 3 different patterns of NI: executive functions
impairment (8 patients: 1MSA, 1PS, 6 PD); executive
function, verbal memory and fluency impairment (4
patients: 1 PSP, 3 PD); dementia, (1 PSP patient). These
patterns were not associated with the clinical diagnosis.
2 of 27 patients (1 MSA and 1 PD) fulfilled the criteria for
OH. These patients were impaired in executive functions.
The other patients with NI did not suffer from OH.
Conclusions: In parkinsonism at onset, we observed three
different patterns of NI which were neither associated with
the clinical diagnosis nor with OH.

P1102
Heart rate variability in chronic vs.
frequent migraine patients
O. Grosu1, S. Odobescu1, V. Lacusta2, L. Rotaru1,
D. Concescu1, I. Moldovanu1,2
Neurology, Institute of Neurology and Neurosurgery, 2State
1 Universiti Teknologi Petronas, Tronoh, Malaysia
Medical and Pharmaceutical University, Chisinau, Moldova
Introduction: Heart rate variability (HRV) is a marker of
autonomic activity and reduced HRV correlates with sudden
death. Data on HRV in migraine are inconclusive and
restricted to episodic type, with reports of increased HRV
especially in the young. The aim of the study was to evaluate
autonomic cardiac regulation in chronic migraine (CM)
compared with frequent migraine (FM) patients by mean of
HRV.
Methods: The study included 109 CM and 61 FM patients
corresponding to IHS criteria. In all subjects, a 5-min
electrocardiographic recording during paced breathing was
performed, and HRV was analyzed in time and frequency
domain according to international guidelines. SDNN
represents the standard deviation of the NN (R-R) interval
and reflects the total power of HRV. HRV is reduced when
SDNN <100ms.
Results: CM presented a reduced SDNN value vs. FM
group (56.584.95 vs. 99.0416.17, p<0.05) which reflect
a reduced HRV. LF (low frequency) was increased
(53.842.32 vs. 45.193.04, p<0.05) and HF (high
frequency) reduced (46.162.32 vs. 54.813.04, p<0.05) in
CM. LF/HF ratio representing an index of sympatho - vagal
balance was higher in patients with CM vs. FM (1.730.23
vs. 1.050.18, p<0.05).
Conclusion: Decreased HF suggested a reduced
parasympathetic influence, increased LF/HF ratio reflecting
a sympathetic over activity in the cardio-vascular system in
CM patients. The reduced HRV in CM found in our study
shows a strong relationship between autonomic cardiac
function and central and peripheral sensitization (as a
mechanism of migraine chronification) and may provide
some links to ischemic stroke.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 129
P1103
Association of EEG scalp potentials with
autonomic innervations of the heart
A. Subhani, L. Xia, A.S. Malik
Department of Electrical and Electronics Engineering,
Background: Cerebral activation and autonomic nervous
system have significance in studies such as mental stress.
This study aims to analyse variations in electroencephalogram
(EEG) scalp potentials that may influence autonomic
innervations during video games.
Methods: 12 healthy participants (2 females) were recruited
in this study. EEG and electrocardiogram (ECG) signals
were measured during game playing and rest condition.
Sympathetic (high heart rate (HR)) and parasympathetic
(lower normalized high frequency (HFnu)) innervations
from ECG were evaluated from heart rate variability (HRV).
Meanwhile ratio of theta at Fz to alpha at Pz power (Fz()/
Pz()) was calculated from the EEG scalp potentials to
measure workload.
Results: Results show a significant surge in both Fz()/
Pz() and HR (p<0.001, paired t-test) and a drop in HFnu
power (p<0.05, paired t-test) as evident in table 1 during
games (0.364, 0.311, 0.361) as compared to the rest
condition (0.419).
Condition Rest Game level1 Game level 2 Game level3
Averagestd 0.4190.18 0.3640.13 0.3110.12 0.3610.17
[Table 1. HFnu during rest and games]
Conclusion: It is concluded that enhanced cerebral
activation (high Fz()/Pz() ratio) is accompanied with
increment in sympathetic innervations and decrement in
parasympathetic innervations. Moreover, the results indicate
that correlation of cerebral activation and autonomic
innervations can be used to measure mental stress since they
can provide an assessment of workload.
130 Posters, Sunday 9 September
P1104
The immediate effect of paced breathing
with biofeedback and active cycling on
heart rate variability in patients in the
sub-acute post-stroke phase
P. Ginsburg1, G. Bartur2, S. Peleg2, M. Katz-Leurer1
1 Tel Aviv University, 2Reuth Medical Center, Tel Aviv, Israel
Introduction: Autonomic instability is a common
phenomenon following stroke with signs and symptoms of
hyper stimulation of the sympathetic nervous system. There
are at least two known non pharmacologic methods which
can alter autonomic balance; aerobic exercise and heart rate
variability (HRV) biofeedback, both showed success in the
rehabilitation program among cardiac or diabetic patients
with autonomic impairment.
The aim of the present study was to assess the feasibility
and the possible impact of slow abdominal breathing with
biofeedback and aerobic exercise stimuli on autonomic
regulation, by assessing HRV, among patients at the sub-
acute phase post stroke.
Methods: 15 patients up to one month post stroke underwent
measurements of HRV under three conditions while sitting
down:
(a) at rest with self-select breathing frequency,
(b) performing paced breathing with biofeedback and
(c) cycling while sitting.
Results: Patients were by mean 10 days post event with
Barthel mean score of 75/100. Patients could reduce their
breathing rate during paced breathing by mean of 6 breaths
per minute (from 15 to 9) and could tolerate for 9 (3)
minutes in constant cycling. Performing paced breathing
with biofeedback showed a significant increase in HRV
time domain parameters as compared to rest, for example;
RMSSD at rest 314.7ms, during paced breathing
41.64.5ms p<0.05. Patients exhibit significant decreased
HRV parameters during cycling, as compared to rest values
(RMSSD during cycling 21.82.5ms, p<0.05).
Conclusions: Patients post stroke may alter autonomic
balance by performing paced breathing and cycling exercise.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1105
24-hour ambulatory blood pressure
profiles in diabetic autonomic neuropathy,
amyloid neuropathy and Holmes-Adie
syndrome
E.M. Hagen1,2,3, D.A. Low2,3, E. Vichayanrat2,3,
V. Iodice2,3, A.P. Owens2, V. Ponnusamy2, M. Peche2,
K. Bleasdale-Barr3, L. Mason3, C.J. Mathias2,3
1Department of Clinical Medicine, University of Bergen,
Bergen, Norway, 2Autonomic & Neurovascular Medicine
Unit, Imperial College Faculty of Medicine, 3Autonomic
Unit, UCL Institute of Neurology, National Hospital for
Neurology and Neurosurgery, London, UK
Objective: The aim of this study was to investigate 24-hour
ambulatory blood pressure monitoring (AMBP) results in
patients with insulin-dependent diabetic autonomic
neuropathy, Amyloid neuropathy and Holmes-Adie
Syndrome.
Design: Data from 24-hour AMBP and activity diaries of 13
diabetic autonomic neuropathy, 15 Amyloid neuropathy and
12 Holmes-Adie Syndrome patients were analysed.
Diagnoses were verified by medical records.
Results: Mean age was 44.316.1 for diabetic autonomic
neuropathy, 47.811.8 for Amyloid neuropathy and
56.87.7 years for Holmes-Adie Syndrome. Male
percentages were 38.5, 73.3 and 33.3, respectively.
Orthostatic hypotension was detected on tilt-table testing in
46.0, 26.7 and 8.3% of the patient groups, respectively.
Mean daytime vs. night-time systolic/diastolic BP (SBP/
DBP) was 130/81 vs. 122/72mmHg for diabetic autonomic
neuropathy, 123/81 vs. 113/73mmHg for Amyloid
neuropathy and 127/81 vs. 118/72mmHg for Holmes-Adie
Syndrome. There was an impaired nocturnal systolic blood
pressure profile in 61.5% diabetic autonomic neuropathy,
60.0% Amyloid neuropathy and 58.3% Holmes-Adie
Syndrome patients. When assessing the AMBP and diary
activities, there was a significant SBP and DBP decrease in
diabetic autonomic neuropathy patients and a significant
SBP decrease in Amyloid neuropathy and Holmes-Adie
patients, when sitting and/or standing compared to lying (all
p<0.05). There were significant increases in heart rate when
sitting or standing versus lying in all three groups (all
p<0.01).
Conclusion: These findings indicate that 24-hour AMBP
can reveal impaired 24-hour BP profiles and autonomic
dysfunction during postural challenges in insulin-dependent
diabetic autonomic neuropathy, Amyloid neuropathy and
Holmes-Adie Syndrome patients.

P1106
Postural tachycardia syndrome (PoTS)
and 24-hour ambulatory blood pressure
and heart rate monitoring
E.M. Hagen1,2,3, D.A.
Low2,3, E.Vichayanrat2,3,
V. Iodice2,3, A.P. Owens3, K. Bleasdale-Barr2, L. Mason2,
I. Skeavington2, C.J. Mathias2,3
1Department of Clinical Medicine, University of Bergen,
Norway, 2Autonomic Unit, UCL Institute of Neurology,
National Hospital for Neurology and Neurosurgery,
3Autonomic & Neurovascular Medicine Unit, Imperial
College Faculty of Medicine, London, UK
Objective: Postural tachycardia syndrome (PoTS) is
characterized by orthostatic tachycardia (30 beats/min), in
the absence of orthostatic hypotension, with orthostatic
intolerance. We analyzed data from 24-hour ambulatory
blood pressure monitoring (AMBP) and heart rate (HR) in
patients with PoTS.
Study design: Data from 24-hour AMBP, HR and diary
activities of 15 women with PoTS were analysed. The diary
comprises a schedule of autonomically focused activities
design to provoke changes in BP and HR. All patients
underwent a 60 head-up tilt prior to the AMBP as part of
their autonomic cardiovascular investigations.
Results: Mean age was 35.47.8 years. All patients met the
criteria for PoTS on head-up tilt.
Mean (SD) daytime vs. night-time systolic/diastolic BP
(SBP/DBP) was 118(12)/77(11) vs. 100(10)/59(10)
mmHg (p<0.001). Mean (SD) daytime vs. night-time heart
rate (HR) was 94(21) vs. 74(14) beats/min (p<0.001). A
normal nocturnal systolic blood pressure fall was evident in
13/15 patients. Combining AMBP with diary activities
showing significant increases in SBP, DBP and HR during
sitting and/or standing vs. lying (p<0.001). 13 patients met
the criteria for PoTS during these manoeuvres. There was
no evidence for postprandial tachycardia or hypotension.
SBP and HR were significantly higher during post- vs. pre-
exercise standing (p<0.001 and p=0.001, respectively).
Conclusion: Except for the abnormal responses to standing,
these findings indicate normal 24-hour BP and HR profiles
in most PoTS patients. The use of 24-hour AMBP combined
with diary recording can be a supportive diagnostic tool
when evaluating patients with PoTS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 131
P1107
Parasympathetic dysfunction in ALS
patients
H. Lahrmann1, E. Toeglhofer2, W. Struhal3
1Private Practice, 2Department of Biomedical Engineering,
Technical University, Vienna, 3Autonomic Laboratory and
Department of Neurology, General Hospital, Linz, Austria
Background: Amyotrophic lateral sclerosis (ALS) is a
neurodegenerative disease with progressive loss of
motoneurones. Recent studies have shown involvement of
non-motor structures within CNS, e.g. frontotemporal
dementia, autonomic dysfunction. The correlation of
respiratory, bulbar and parasympathetic dysfunction has not
been clarified yet.
Aim of the study: We investigated the prevalence of
parasympathetic dysfunction in ALS patients compared to a
control group and its association with bulbar symptoms and
respiratory failure.
Methods: 34 ALS patients were included and divided into
four subgroups according to their bulbar status and their
lung function. The control group consisted of 11 age
matched healthy persons. All study participants underwent
the following procedures: history taking, neurological
examination, lung function test, blood gas analysis,
autonomic testing (Ewing battery).
Results: A significantly higher prevalence of
parasympathetic dysfunction was observed in ALS patients
compared to the control group. Bulbar involvement did not
correlate with the measured autonomic parameters. Patients
with respiratory failure showed significantly higher resting
heart rates (657 vs. 8527 bpm, p<0.018) and a significant
reduction of heart rate variability (e.g. coefficient of
variation 4.72.1 in control group and 1.91.0 in respiratory
failure group, p<0.034).
Discussion: The results of this study indicate a significantly
higher rate of parasympathetic dysfunction in ALS patients.
Dysautonomia correlates more with respiratory failure than
with the patients bulbar status. The autonomic dysfunction
in ALS seems to be related to the progression of the disease,
reflected by the degree of respiratory impairment.
132 Posters, Sunday 9 September
P1108
Postural tachycardia syndrome, joint
hypermobility syndrome and Chiari type I
malformation: clinical description and
autonomic evaluation
V. Iodice1, D. Low1, R. Grahame2, C. Mathias1
1Imperial College London, 2University College Hospital,
London, UK
Postural Tachycardia Syndrome (PoTS) is characterized by
an increase in heart rate of 30 beats/min on head-up tilt/
standing without orthostatic hypotension associated with
orthostatic intolerance (OI). PoTS can be associated with
Joint Hypermobility Syndrome (JHS), a heritable disorder
of connective tissue. The Chiari type I malformation (CM1)
is characterized by herniation of cerebellar tonsils 3-5 mm
below the plane of the foramen magnum and can present
with a variety of clinical symptoms, frequently including
occipital headaches, other rare presentations are OI and
syncope. An association between PoTS, CM1 and EDS III
has not been previously described.
Objective: To evaluate the clinical features and
cardiovascular autonomic function in patients with OI and
CM1.
Methods: We described 5 females with OI and CM1.
Symptoms were recorded and patients underwent autonomic
function and MRI brain assessments.
Results: Mean age was 24.28.2 years. The most frequent
presenting symptoms were: OI (palpitations, fatigue and
syncope, 60%) and headache (40%). Additional symptoms
were: bladder (60%) and gastrointestinal dysfunction
(60%). Autonomic function tests showed PoTS features in
all patients. All patients met the Brighton criteria for JHS
and MRI brain scans confirmed CM1. 4 patients underwent
surgical decompression with the following clinical
outcomes: temporary improvement of headache (1 patient),
improvement of PoTS (1 patient) and unchanged symptoms
(2 patients).
Conclusion: PoTS could be the presenting feature in
patients with CM1, the symptoms of which only partially
resolve after surgical intervention. Postural tachycardia
warrants investigation of CM1 as part of the cluster of
PoTS/JHS patients.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1109
Analysis of heart rate variability to assess
the background lead exposure in children
during orthostatic test and exercises
S. Tymchenko, E. Evstafyeva
Physiology Department, Crimea State Medical University
named after S. I. Georgievsky, Simferopol, Ukraine
Heart rate variability (HRV) method is already an established
tool in early detection of disorders of the autonomic cardiac
regulatory system. The present study was designed to
investigate whether the background lead exposure could
modify HRV during orthostatic test and exercises. Time
(SDNN, RMSSD, pNN50) and frequency (TP, VLF, LF, HF,
LF/HF, LFn and HFn) domain indexes of RR interval
variability were assessed in 30 healthy 10-11 year old
children who completed orthostatic test and exercise (step-
test).
A normal individual reaction was observed with a
characteristic HRV altered in a predictable manner in
response to orthostatic test and exercise (comprising a
significantly reduced RRNN, pNN50, HFn and elevated
LFn, LF/HF). While SDNN was significantly higher during
exercises, that can indicate changes in the state of the
sympathovagal balance.
During orthostatic test and exercises significantly higher
HRV (increased RMSSD, pNN50, HF and HFn and reduced
LF/HF, LFn) was associated with elevated lead levels
(0.31<rs<0.48; 0.01<p<0.05) measured in hair by X-ray
spectrophotometry. No correlation was present between
HRV parameters recorded at rest and lead concentration.
These data indicate that effects of background lead exposure
on HRV were found during orthostatic test and exercise and
mainly for the spectral components of HRV. Results suggest
that background lead exposure may increase vagal tone,
resulting in elevated HRV.

P1110
Effects of martial arts on heart rate
variability and hostility
S. Tymchenko, K. Zavgorodnyaya
Physiology Department, Crimea State Medical University
named after S.I. Georgievsky, Simferopol, Ukraine
Hostility has been associated with an increased risk for
cardiovascular disease. This study aims to investigate
whether this relationship could be explained by impaired
cardiac autonomic control assessed by heart rate variability
(HRV). Measures of HRV were obtained in 25 martial arts
(aikido) participants and 28 age matched (17-25 years)
healthy non-athlete control subjects from both time- and
frequency analysis of 5 minutes recordings of HRV. Time
domain indexes included mean NN (RRNN), SDNN,
RMSSD and pNN50. Total-, low- (LF) and high (HF)
frequency spectral power were calculated, as well as their
ratio (LF/HF). Results suggest that resting heart rate was
lower in Aikido athletes. Compared with control subjects
athletes had significantly increased SDNN, RMSSD,
pNN50 (p<0.05), showing evidence of increased vagal
activity. Hostility scores (Buss-Durkee Hostility Inventory)
showed significant differences between the groups
(p<0.001) with higher scores in non-athletes. Aikido
athletes have significantly higher values in the BDHI
assault subscale, while controls got significantly higher
values in verbal aggression (p<0.01). Correlation analysis
revealed that in Aikido athletes verbal aggression had a
significant negative correlation with SDNN, RMSSD, HF
and positive association with LF/HF (0.44<rs<0.50;
p<0.05). These findings suggest that HRV and hostility are
affected by exercise, especially martial arts (aikido), which
can have beneficial effects on the cardiovascular risk
profile.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 133
P1111
Reproducibility of sympathetic skin
response: within-subject consistency of
wave-form and size across different
stimulation modalities
M. Toyokura
Rehabilitation Medicine, Tokai University Oiso Hospital,
Oiso, Japan
Objective: The aim of the present study was to investigate
the specific, intra-subject consistency of the waveform type
and size of sympathetic skin response (SSR) evoked by
different modalities of stimulation. The results were
discussed based on the neurophysiological mechanism of
generating SSR.
Methods: SSRs were obtained from 38 normal subjects
using three different modalities of stimulation: auditory
(a-SSR), electrical (e-SSR), and magnetic (m-SSR). Four
stimuli of each modality were applied. The wave-forms
were classified into two types, P (positive component larger
than the negative component) and N (vice versa) (Toyokura,
1998).
Results: P-type wave-form was less frequent in the a-SSR
than the e- and m-SSRs. The maximum amplitude of a-SSR
was significantly smaller than those of e- and m-SSRs. The
size of e- and m-SSRs did not significantly differ. The
incidences of the respective waveforms and maximum
amplitude values showed intra-subject correlation among
the SSRs evoked by different types of stimulation.
Conclusions: The SSR waveform and size seemed to be
rather consistent in individuals even if the stimulation
modality was changed. The results suggested that
endogenous factors in an individual related to the
development of SSRs, e.g., the individuals emotional state,
susceptibility to the surprise effect, and anatomical
characteristics of sweat glands, were important determinants
of the SSR wave-forms and maximum amplitudes.
Difference in these factors between individuals can explain
a large inter-subject variation of the SSR parameters.
134 Posters, Sunday 9 September
P1112
Syncope due to concomitant cardiac
disease and neurogenic orthostatic
hypotension: a case report
C. Di Stefano, V. Milazzo, G. Bruno, S. Maule, F. Veglio
Autonomic Unit and Hypertension Unit, Department of
Medicine and Experimental Oncology, University of Turin,
San Giovanni Battista Hospital, Turin, Italy
Syncope may be classified into several forms, characterized
by a different prognosis.
We report a case of a 59-year-old man, referring to our Unit
in 2011. He complained of orthostatic syncope and
intolerance since 2004, when he was diagnosed with
coronary artery disease, treated with PTCA. In 2008 pauses
>3 were found during Holter ECG. After implantation of
biventricular PM, symptoms were only reduced. He
underwent ABPM (113/68 mmHg day-time, 129/78 mmHg
night-time; high BP variability; orthostatic symptoms
related to hypotension), tilt test (stopped after 15 because
of fainting and hypotension), and echocardiography (left
ventricular hypertrophy and a preserved systolic function).
During our evaluation, he also reported anhydrosis and
erectile dysfunction; we found orthostatic hypotension
(clinostatism: 117/75 mmHg; orthostatism: 90/60 mmHg
after 1; 79/57 mmHg after 3).
Ewings battery of autonomic tests could not be performed
because of PM; hand grip test was pathological; basal
plasma adrenaline (30 pg/ml) and noradrenaline (20 pg/ml)
were low and not responsive to orthostatism; cardiac SPECT
scan with 123I-MIBG showed a cardiac sympathetic
denervation. Neurological evaluation was normal.
Secondary forms of autonomic neuropathy were excluded.
Diagnosis of probable pure autonomic failure was made and
therapy with fludrocortisone and dihydroergotamine was
started; orthostatic symptoms greatly improved. At 12
months of follow-up, the patient remains asymptomatic.
Diagnosis and management of syncope may be complicated
by concomitant clinical conditions leading to syncope. In
our case, a potentially harmful arrhythmic cause was treated
and subsequent follow-up allowed the identification of an
autonomic-related non-cardiogenic cause of syncope.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1113
Autonomic nervous system reactivity in
normotensive subjects with a family
history of hypertension during Valsalva
manoeuvre
K. Cankar, Z. Melik, M. Strucl
Institute of Physiology, Medical Faculty, University of
Ljubljana, Slovenia
Introduction: This study was designed to address
alterations in autonomic nervous system activity in
normotensive subjects with a family history of hypertension.
We compared the autonomic nervous system activity in 11
normotensives with a family history of hypertension (age
23.30.4) and 14 normotensives with no family history of
hypertension (age 22.90.3).
Methods: In all of the participants their cardiovascular
parameters, including impedance cardiography, were
measured at rest. In addition, the Valsalva manoeuvre was
performed and Valsalva Index was obtained. On the basis of
the arterial blood pressure change, provoked by the Valsalva
manoeuvre, the latency of baroreflex response was
determined.
Results: Normotensive subjects with a family history of
hypertension, compared to the control group, showed
significantly higher heart rate (75.03.4 vs. 62.41.8 beats/
min), cardiac output (7.60.4 vs. 6.70.3L/min), left
ventricular weight index (4.60.3 vs. 3.90.1) and shorter
ejection time (298.94.9ms vs. 316.84.5ms) (t-test,
p<0.05). In addition, the normotensives with a family
history of hypertension have decreased latency of the
baroreflex response (7.00.5s) compared to the control
group (10.50.9s) (p<0.001).
Conclusions: Our results indicate that even normotensives
with a family history of hypertension exhibit changes of
some cardiovascular parameters at early age. The changes
in Valsalva manoeuvre response also show alteration of the
autonomic nervous system reactivity.

P1114
Juvenile migraine and the role of the
autonomic system: a preliminary clinical
study
G. Giordano1, C. Spitaleri2, F. Brighina3, I. Camarda2,
F. Consolo2, M. DAmelio3, L. Paziente2, V. Raieli2,
G. Santangelo2, E. Vanadia2, F. Vanadia2
1U.O. Di NPI Ospedale di Cristina, ARNAS Civico, 2Child
Neuropsychiatry Unit - Di Gristina Hospital - ARNAS
CIVICO, 3Neurological Department, University of Palermo,
Italy
Background and aims: Cranial Autonomic Symptoms
(CAS) are frequently reported in adult migraineurs, but the
prevalence of CAS in children affected by primary
headaches is unknown. In addition, recent studies suggest a
role of the autonomic nervous system in paediatric migraine
by the involvement of trigemino autonomic reflex.
Therefore, the aim of this study was to evaluate the
prevalence of CAS during cephalalgic attacks in a juvenile
population with primary headaches and to study the
correlation between CAS and the main symptoms of
migraine.
Methods: A total of 193 children suffering from headache
(M 86 F107, aged 4-17 years) were consecutively enrolled
in an 18-months period. A short questionnaire investigating
the presence of CAS was administered to all children. The
following CAS were included in our study: conjunctival
injection, tearing, palpebral oedema, nasal congestion,
rhinorrhoea, red ear, facial flushing, miosis, ptosis, forehead
or facial sweating.
Results: 168 children (86%) were affected by migraine, the
remaining 25 (14%) by other primary headaches. CAS were
present in 99 with migraine (59%) and only in 6 with others
type of headache (24%). Two or more CAS were found in
(75%) children suffering from migraine during their attacks.
The most common signs were flushing, red ear and
conjunctival injection. CAS were more significantly
frequent in migraineurs (p<0.5) .
Conclusion: These preliminary findings indicate that CAS
are rather common in the course of paediatric migraine
attacks. Besides, these results support the role of the
trigemino-autonomic reflex in the pathophysiology of
migraine.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 135
P1115
A case of severe orthostatic hypotension
and sensory ataxia as presenting
symptoms of Sjgrens syndrome
M. Kirbi, D. Georgiev, R. Berlot, B. Megli,
N. Zupani Krinar
Department of Neurology, University Medical Centre
Ljubljana, Slovenia
Introduction: We present a case of a 61-year-old patient
with subacute autonomic and sensory polyneuropathy
associated with Sjgrens syndrome.
Methods: The patient presented with transitory itching in
the chest and progressive symptoms of genitourinary and
later cardiovascular autonomic neuropathy, followed by
predominantly large fibre sensory neuropathy for all
modalities. Four months after the first symptoms, he was
bedridden due to severe ataxia and orthostatic hypotension.
He also developed severe urinary retention. Repeated
autonomic cardiovascular function tests confirmed
parasympathetic and sympathetic failure; nerve conduction
studies revealed severe, predominantly sensory axonal
polyneuropathy. Rheumatologic tests were negative. CSF
protein levels were mildly elevated, with normal cell counts;
tests for paraproteinemia, amyloidosis, infectious and
paraneoplastic causes were negative. Imaging studies of
spine and head were unremarkable. Empirical treatment
with intravenous immunoglobulins (IVIG) showed poor and
short-lasting effects.
Six months after presentation, he reported dry eyes and
mouth. Schirmers test was positive. Rheumatologic
screening now showed positive anti-SSB(Ro)/SSB(La)
antibodies. Sedimentation rate and plasma cryoglobulins
were elevated. Salivary gland biopsy was consistent with
Sjgrens syndrome. Infusions of corticosteroids led to a
remarkable improvement: autonomic and sensory symptoms
reduced, ataxia and orthostatic hypotension almost
disappeared. Corticosteroids were successfully tapered
down to a low maintenance dose without symptom
deterioration.
Conclusion: Severe autonomic dysfunction as presented
here is rare in Sjgrens syndrome. Disabling orthostatic
hypotension and ataxia were the first symptoms in the
presented case, followed only later by sicca symptoms and
serologic abnormalities. All symptoms were successfully
treated with corticosteroids with remarkable improvement.
Treatment with IVIG was not successful.
136 Posters, Sunday 9 September
P1116
Autonomic disorders in patients with
ischemic stroke
I. Darii1, I. Moldovanu1, M. Sangheli2, S. Plesca1
1Institute of Neurology and Neurosurgery, Institute of
2 1Neurology Department, 2Gastroenterology Department,
Neurology and Neurosurgery, State Medical and
Pharmaceutical University, Chisinau, Moldova
Background: Stroke is the most common life-threatening
neurologic disease and the leading cause of serious long-
term disability. Autonomic disorders are common in the
acute post-stroke phase, but little is known about the long
-term effects in the recovery period.
Objective: To determine the type of autonomic function
impairment during stroke recovery and their influence on
stroke rehabilitation.
Methods: The study involved 32 patients (mean age 643.2
years) with ischemic stroke and 32 healthy controls;
prospective evaluation of 12 cases in 1 month and 20 after
6 months post hemispheric stroke. The patients underwent
neurological examinations, and answered an originally
designed questionnaire assessing the autonomic
interoceptive profile.
Results: The patients who had an ischemic stroke, besides
main symptoms, presented different autonomic dysfunctions
at 1 month versus 6 months. The most common clinical
problems included abnormalities in heart rate and blood
pressure regulation (58.1% vs. 66.8%), reflecting
cardiovascular autonomic dysfunction and asymmetric
sweating with cold hemiplegic limbs (61.3% vs. 77.6%),
reflecting changes in the sudomotor and vasomotor
regulatory systems. Stroke-induced gastrointestinal, sexual
and urinary disorders are not uncommon. Most of the
patients presented vegetative dysfunctions, the most severe
ones being observed 6 months after stroke.
Conclusion: Although autonomic disturbances often are
most pronounced immediately after the stroke, they are not
limited to the acute phase only, but are long-term sequelae,
being the cause of serious long-term disability. Impaired
autonomic function may increase the risk of all-cause
mortality and cardiovascular mortality in older stroke
survivors.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1117
Chronic intestinal pseudo-obstruction
with anti-Hu antibody without neoplasia
I. Moreira1, R. Pimentel2, E. Santos1, M. Salgado2
Hospital Santo Antnio, Centro Hospitalar do Porto,
Portugal
Introduction: Chronic intestinal pseudo-obstruction
(CIPO) is characterized by mechanical obstruction of the
small/large bowel, without an anatomical lesion. Anti-Hu
syndrome is one classic, but rare, cause of CIPO, occurring
in approximately 6.5% of the cases. These antibodies are
usually associated with neoplasms, particularly small cell
lung cancer.
Case report: A 40-year-old woman, with history of one
spontaneous abortion and Raynaud phenomenon, 29 yo and
no other diseases/complaints, developed marked
constipation, with multiple dejections of liquid stools, crises
of abdominal distension and vomiting. Extensive gastro-
intestinal work-up was compatible with CIPO. When 36 yo
on set of dysphagia for solids, achalasia was diagnosed, and
improved after oesophagic dilatation. When 38 yo worsened
requiring multiple hospitalizations by intestinal occlusive
periods, without response to domperidone, erythromycin or
laxatives. Had sharp weight loss needing to escalate to
cisapride, artificial enteral nutrition and then total parenteral
nutrition. Gastrointestinal manometry was compatible with
intestinal neuropathy. Neurological examination, nerve
conduction and QST were normal. Rectal biopsy was
negative for amyloid. Anti-Hu antibodies were positive.
Wide-ranging investigation showed no evidence of
malignancy. Steroids and azathioprine were attempted, but
not maintained because of vomiting. Now shes under total
parenteral nutrition and gastrostomy is planned.
Comments: This is a case of autonomic neuropathy
involving myenteric plexus with anti-Hu antibodies with
eleven years of follow-up without evidence of malignancy.
We hypothesized that it is more likely an auto-immune
disease than paraneoplastic or an immune tumour regression
mediated by anti-Hu antibodies.

P1118
A preliminary study on blood pressure
variability assessed from left and right
arms in the elderly
M. Hsu1, J. Lin1, Y. Chang2, Y. Chou3
1Department of Physical Therapy, Koahsiung Medical
University, Kaohsiung, 2Department of Physical Therapy,
Chang Gung University, Taoyuan, 3Department and
Graduate Institute of Neurology, Koahsiung Medical
University, Koahsiung City, Taiwan R.O.C.
Introduction: Autonomic dysfunction is associated with
higher risks of cardiovascular disease. Autonomic function
can be assessed non-invasively through analyzing blood
pressure variability. There are differences in blood pressure
between the two arms, which may possibly influence
autonomic function assessment. Therefore, the purpose of
this study was to compare the autonomic function assessed
between the two arms.
Methods: 6 healthy old people were recruited from a
community recreation center. The ECG (Biopac MP100
A/D converter and Biopac ECG module) and blood pressure
(CNAP Monitor 500, CNSystems Medizintechnik AG)
were monitored continuously under three conditions:
supine, sitting, and a mental test. In each condition, the
blood pressure for both arms and the ECG were recorded,
each arm for five minutes. The order of arm tested was
randomized. Blood pressure power spectrum was analyzed
afterwards. Two-way repeated ANOVA was used to analyze
between arm differences under three conditions for low
frequency (0.04-0.15, LF), high frequency (0.15-0.40, HF),
and LF/HF ratio.
Results: Significant interactions were found between arm
and condition for LF and HF, while there was no interactions
for the LF/HF ratio. LF and HF from the right arm were
significantly higher than from the left arm in sitting
condition (p<0.0005). There are no significant differences
between arms for the LF/HF ratio under any condition.
Conclusions: Differences in blood pressure variability
between arms may exist to some extent. Further studies with
a larger sample size are needed to provide insights into
methodological considerations for autonomic function
assessment.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 137
P1119
Investigating the feasibility of using
objective motion data to assist the
diagnosis and management of
cardiovascular autonomic dysfunction
R.M. Kwasnicki, D.A. Low, C. Wong, D. Jarchi, B. Lo,
C.J. Mathias, A. Darzi, G.Z. Yang
Imperial College London, UK
Introduction: Cardiovascular autonomic dysfunction (AD)
manifests itself through various symptoms such as light-
headedness, palpitations and syncope. Stimuli for such
events include physical activity, stress, and posture changes.
Although the relationship between physical activity and
symptoms is important, activity data is currently limited to
subjective, and potentially inaccurate, patient diaries.
Our aim was to assess the feasibility of using a lightweight
motion sensor (e-AR lite, ICL) to collect an objective record
of motion for analysis alongside clinical cardiovascular
autonomic function parameters.
Methods: We recruited a patient with suspected
cardiovascular AD, who wore an e-AR sensor throughout
laboratory cardiovascular autonomic function testing and
24-hour ambulatory monitoring. Tri-axial accelerometer
data from the e-AR sensor was analysed alongside blood
pressure/heart rate data and the patients activity diary.
Results: Body orientation during head-up tilting was visible
from the e-AR sensor data. Cervical head movements were
also clearly recorded and were related to a fall in blood
pressure and heart rate with associated pre-syncopal
symptoms. Although no unusual cardiovascular events
occurred during 24-hour ambulatory monitoring, we were
able to accurately quantify both the duration and nature of
activities recorded in the patients diary using the e-AR
sensor, with corresponding physiological changes.
Conclusion: We have demonstrated the feasibility of using
a lightweight motion sensor to relate the symptoms and
objective data of cardiovascular AD to an objective account
of patient activity and posture. The true value of objective
motion capture in assisting with diagnosis and management
of AD must now be investigated in small study cohorts.
138 Posters, Sunday 9 September
P1120
The effect of levetiracetam therapy on the
autonomous nervous system in epilepsy
patients
K. Ekmeki, Y. Altun, Y. Tumay, Y. Ozkul
Neurology, Harran University, Sanliurfa, Turkey
Aim: It was aimed to research the effects of levetiracetam
on some autonomic functions by comparing autonomous
nervous system tests in epilepsy patients using levetiracetam
monotherapy with the tests of healthy volunteers who do not
use drugs.
Method: 41 patients diagnosed with partial epilepsy using
levetiracetam were included in this study. The control group
was selected from 35 healthy volunteers who do not have
epilepsy. RR interval variation (RRIV), valsalva, and tilt
tests were applied to patient and control groups in order to
assess the autonomous nerve system functions.
Findings: No statistically significant differences were
found in the results of RRIV, valsalva, and tilt tests in
patients in comparison with the control group (p>0.05). No
statistical significances were observed when the results of
upright position and the postural blood pressure changes
were compared with the control group (p>0.05).
Result: Our findings had shown that using levetiracetam
therapy had no effect on the responses of heart rate and
blood pressure in epilepsy patients.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1121
RR interval variation and the sympathetic
skin response in the assessment of
autonomic function in diabetic neuropathy
H. Ulvi, U. Avar, R. Demir, L. zel, G. zdemir,
A. Ertekin, R. Aygul
Department of Neurology and Family Medicine, Faculty of
Medicine, Atatrk University, Erzurum, Turkey
The aim of our study was to evaluate possible autonomic
nervous system (ANS) dysfunction in patients with diabetic
neuropathy (DN), and its correlation with abnormalities of
sensorimotor nerve conduction study and clinical autonomic
symptoms. We studied 44 patients with DN; the mean age
was 55.5612.92 years (range 30 yrs to 70 yrs; 24 female
and 20 male) and 35 age-matched healthy subjects (control);
mean age was 34.1912.74 years (range 24 yrs to 48 yrs; 20
female and 15 male). Mean RR interval and SSR in patients
with DN was significantly more abnormal than that of the
control subjects (p<0.05). No correlation was observed
between patient age, sex, duration of DN history,
abnormalities of sensorimotor nerve conduction and
abnormalities in RR interval, SSR. These data indicate that
patients with diabetic neuropathy show abnormalities of
ANS function. We conclude that SSR and RR interval
variation, both of which can easily be performed in the
electromyography laboratory, are helpful in combination in
the assessment of autonomic function in diabetic neuropathy.

P1122
Dispersion of ventricular repolarisation as
diagnostic tool for the assessment of
autonomic function in diabetic neuropathy
H. Ulvi, U. Avar, Z. Avar, Z. Cansever, R. Demir,
L. zel, R. Aygul
Departments of Neurology and Family Medicine and
Medical Education, Faculty of Medicine, Atatrk University,
Erzurum, Turkey
Diabetes mellitus has been shown to affect almost all
systems of the human body and abnormalities in functions
of autonomic nerves innervating various parts have been
observed in several studies. Dispersion of repolarisation has
been a proposed measure of repolarisation heterogeneity,
and increased dispersion has been found to be associated
with an increased incidence of malignant ventricular
arrhythmias. However, in literature, the assessment of the
parameters of ventricular dispersion and their correlation
with abnormalities of sensorimotor nerve conduction study
in diabetes mellitus patients have not been reported.
We studied 44 patients with diabetic neuropathy (DN) and
41 age-matched healthy subjects. In all persons 12 leads
ECG were recorded at a speed of 50mm/s and somatic nerve
conduction studies were carried out. Ventricular
repolarisation parameters (QT, QTc, JT, and JTc) and
ventricular repolarisation dispersion (d) parameters (QT-d,
QTc-d, JT-d, JTc-d) were detected. QT and JT intervals were
measured from the beginning and from the end of the QRS
complex, respectively, to the end of T-wave to baseline while
excluding the U-wave. Using Bazett formula, these intervals
were corrected for heart rate. Repolarisation dispersion
parameters were calculated the difference between minimal
and maximal values of QT, JT, QTc, and JTc among 12
leads. Mean QT-d, QTc-d, JTd, JTc-d in diabetes mellitus
patients was significantly longer than that of the normal
subjects (p<0.05). No correlation was observed between
abnormalities of sensorimotor nerve conduction and
ventricular repolarisation dispersion parameters. We
conclude that ventricular repolarisation dispersion
parameters evaluation is a helpful and cheap method in the
assessment of autonomic function in diabetic neuropathy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 139
P1123
Autonomic dysfunction: causes and
presentations. A retrospective study in a
tertiary hospital
J.J.Y. Ong, K.W.P. Ng, Y. Gao, E.P. Wilder-Smith,
Y.C. Chan
Neurology, National University Health System, Singapore,
Singapore
Introduction: Due to increasing availability, tests for
autonomic function are increasingly utilized to detect
autonomic dysfunction. We did a retrospective study to
determine the causes and presentations of patients with
autonomic dysfunction tested in our tertiary hospital.
Methods: This was a retrospective descriptive study of
patients with autonomic dysfunction tested in our
neurodiagnostic laboratory between January 2009 and
December 2011. Depending on the indication, patients
underwent one or more of the following studies: tilt-table
test, heart rate variability (HRV) during deep breathing,
Valsalva manoeuvre (VM) or sympathetic skin response
(SSR) test.
Results: A total of 219 patients (72 females, 147 males,
mean age 58.217.9) were tested. 40.2% (n=88) of patients
had abnormal findings in one or more test categories. The
most common presentations were: orthostatic hypotension
(n=21), syncope (n=19), giddiness (n=26), pre-syncope
(n=2), parkinsonism (n=11) and others (n=6). Of those who
had abnormal findings, 36.4% (n=32) had abnormal tilt-
table results. Despite normal tilt-table findings, 56 patients
still had evidence of autonomic dysfunction based on our
remaining testing battery (31 abnormal SSR, 26 abnormal
HRV, 6 abnormal VM). The most common cause of
autonomic dysfunction was diabetes mellitus. 6.8% (n=6)
had deceased.
Conclusion: Diabetes mellitus was the most common cause
of autonomic failure presenting at our neurodiagnostic
laboratory. Orthostatic hypotension by lying and standing
blood pressure measurement was present in only 9.6%
(n=21) and cannot be relied on alone to detect autonomic
dysfunction.
140 Posters, Sunday 9 September
P1124
Epidemiologic characteristics of patients
with the first episode of syncope
diagnosed by head-up tilt test with
transcranial Doppler
J.J. Lee1, S.S. Jang2
1Neurology, Daegu Fatima Hospital, Daegu, 2Neurology,
Pohang Sunlin Hospital, Pohang, Republic of Korea
Introduction: Syncope is common in the general population
and many patients visited the hospital due to a single first
episode. Most epidemiological studies have shown the
bimodal distribution of syncope incidence over a broad age
range. We evaluated epidemiologic aspects of patients with
the first episode of syncope from patients visit to hospital
due to syncope with first or multiple episodes.
Methods: We have performed head-up tilt test with
transcranial Doppler in all patients who visited the hospital
due to syncope between January 2009 and December 2011.
We evaluated retrospectively epidemiologic aspects of
patients with the first syncope from all patients.
Results: The study population included 270 patients of
whom 105 (38.9%) in the first episode and 165 (61.1%) in
multiple episodes. 105 patients of the first episode: 47
(44.8%) men and 58 (55.2%) women, average age 46.2
years (range 12-88 years), male dominant in the 2nd and 7th
decade. 165 patients of multiple episode, 74 (44.8%) men
and 91 (55.2%) women, average age 44.2 years (range
11-91years), male dominant in 2nd- 4th and 8th decade. The
positive response rate of head-up tilt test are 79 (75.2%) in
the first episode group and 122 (73.9%) in multiple episodes
group with no meaningful difference in both groups. The
same finding was made in sex ratio, average age and
positive response rate of head-up tilt test.
Conclusion: Many patients visited the hospital due to
syncope with a single first episode. The same epidemiologic
finding was made in sex ratio, average age at onset time
with same positive response rate of head-up tilt test in both
groups. Therefore we can perform a study for evaluating in
syncope even for the single first episode.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1125
Correlations between parameters of
sympathetic skin response tests and
parameters from the 24-hour ECG Holter
monitoring in patients after troponin-
positive acute coronary syndrome
M. Fila1, U. Cielik-Guerra2, M. Kamiski3,
J. Chapiski3, A. Bogucki4, J. Kasprzak2, M. Kurpesa2
1Department of Neurology, 3rd City Hospital, 2Cardiology,
Bieganski Hospital, Medical University of Lodz,
3Department of Microelectronics and Computer Science,
Technical University of Lodz, 4Departement of
Extrapyramidal Disorders, Medical University of Lodz,
Poland
Purpose: To compare the results and determine correlations
between parameters obtained in a basic neurophysiological
test of SNS - Sympathetic Skin Response Test (SSRT) and
parameters derived from 24-hour Holter ECG analysis.
Methods: The study group consisted of 52 patients aged
59.569.11 yrs (41 male) after troponin-positive acute
coronary syndrome (1-6 months before they were included).
In all of the pts direct recording of SSR potentials on both
hands and feet was performed. In standard, latency (L) and
amplitude (A) of P0 potential were evaluated. In all pts ECG
Holter monitoring was performed using DMS monitors and
analysis software CardioScan 12. Heart rate variability
(HRV) was analyzed with time and frequency domain
methods to calculate: the standard deviation of all normal
RR intervals (SDNN), the mean of all the 5-minute standard
deviations of RR (SDNN index), the standard deviation of
all the 5-minute RR interval means (SADNN index), the
root-mean-square successive difference (rMSSD), the
percentage of differences between successive RR intervals
over 24 hours that are greater than 50 ms (pNN50) and total
power spectrum (TPS), very low frequency (VLF), low
frequency (LF), high frequency (HF) of spectrum.
Premature ventricular contractions were observed and
analyzed for turbulence onset (To) and slope (Ts). We
performed also deceleration capacity (DC) analyses using
non-commercial software.
Results: Correlations have been observed between
potentials latency (L) of SSR on hand and parameters
derived from 24-hour Holter ECG analysis, but there were
not any significant correlations between these Holter
parameters and characteristics of SSR potentials recorded
from lower limbs.

P1126
Sympathetic over-reactivity as underlying
cause of recurrent syncope and
accommodation reflex loss: a report of
two cases
M.A. Sierra-Beltrn1, C.M. Hernndez-Crdenas2,
F.A. Villegas Lpez3
1CIDyT, Mdica Sur, 2Critical Care Medicine, INCMNSZ,
3CGCA, Mdica Sur, Mexico City, Mexico
Introduction: To present two clinical cases of patients
suffering both of recurrent syndromes, fixed pupils and loss
of the accommodation reflex. In both cases the underlying
cause was sympathetic over-reactivity. The first case was a
23-years-old woman who has suffered for the last 13 years
from recurrent syncopes (in 4 occasions it evolved into a
convulsive syncope) evoked after postural changes and
visual acuity defects. The second case was a 36-years-old
man who has suffered, for the last five years of recurrent
syncopes and progressive visual acuity defects.
Methods: Routine clinical and specialized rheumatological
imaging and neurophysiological tests were requested.
Results: No alterations were found on the Complete Blood
tests. Rheumatological test proved that there were not
antibodies of this sort. Images Scans discarded structural
central nervous system abnormalities. The Autonomic
Function test showed, in both cases, sympathetic over-
reactivity.
Conclusions: Sympathetic overreactivity has been observed
in upper spinal cord injuries, subarachnoid haemorrhage,
neuroleptic malignant syndrome, Guillain Barr Syndrome,
poliomyelitis and as toxin mediated diseases (botulism and
diphtheria). It is a rare circumstance that it happened in a
clinical set of no other proven etiology.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 141
P1127
Complex regional pain syndrome type I
following cervical medullary lesion: a case
report
L. Isidoro, F. Matias, C. Macrio
Neurology, Coimbra University Hospital, Coimbra, Portugal
Introduction: Complex regional pain syndrome (CRPS)
describes a variety of painful conditions following injury
that appear regionally with a distal predominance of
abnormal findings, exceeding in magnitude and duration
the expected clinical course of the inciting event. Peripheral
but also central mechanisms are involved.
Case report: Female, 56-year-old, admitted in the
emergency department with a 4-months progressive history
of right upper extremity (RUE) pain, oedema, impaired
movement, and cold skin. She denied recent trauma, surgery
or infection and reported mild relief with analgesics.
Cervical MRI performed at the beginning of the symptoms
showed C4-C5 and D1 lesions, hyperintense at T2 and
contrast enhancement. Brain image showed unspecific
white matter lesions.
Examination: RUE hyperalgesia, which was swollen,
glossy and cold. Abnormal hair and nail growth. On EMG
there was no sign of peripheral nerve lesion. Bone
scintigraphy: unilateral hyperperfusion on right joints. Plain
radiographs: severe osteoporosis of the right hand. RUE
echography revealed only mild degenerative abnormalities.
Investigation of the cervical lesion (including lumbar
puncture) was negative for an infectious or autoimmune
etiology and on the control MRI there was minor extension
of the cervical lesion and with no longer contrast
enhancement.
The analgesic treatment was optimized with analgesics,
pregabalin and antidepressives. A 3-day corticotherapy
pulse was also done and the patient started with calcitonin,
calcium and vitamin D. After pain relief, physical therapy
was started with good response.
Conclusion: We report a case of a patient who presented
with a CRPS I following a cervical inflammatory lesion.
142 Posters, Sunday 9 September

P1128 P1129
Arnold-Chiari malformation presenting Changes in cardiovascular autonomic
with recurrent syncope attacks function and peripheral nervous system in
B. Gke, A.K. Erdemolu type 2 diabetes mellitus
Neurology, Kirikkale University School of Medicine, R.K. Goit1, R. Khadka2, S.K. Sharma2, N. Limbu2,
Kirikkale, Turkey B.H. Paudel2
The Chiari type I malformation (CM1) is characterized by Physiology, Nepalgunj Medical College, Banke, 2B P
1

herniation of cerebellar tonsils to at least 3-5 mm below the Koirala Institute of Health Sciences, Dharan, Nepal
plane of foramen magnum and can present with a wide
variety of symptoms like occipital headache, vertigo
secondary to bulbar or medullary distress. Rarely syncopal P1130
episodes have also been described. Sudomotor failure with
We report a 39-year-old male patient suffering from hypogonadotrophic hypogonadism
occipital headaches and recurrent syncopes for two years.
presenting as heat stroke
The patient had a normal neurological examination;
electroencephalogram (EEG), routine blood tests, thyroid H.J. Im1, J. Oh2, D.W. Kim2
function tests and vitamin B12 levels were normal. His Neurology, 2Konkuk University Hospital, Seoul, Republic of
1

cardiological examination also showed no abnormalities. Korea

His brain magnetic resonance imaging (MRI) showed a
Chiari type I malformation with tonsillar herniation of 9mm
below the plane of foramen magnum.
P1131
Rarely, syncopal episodes have also been described and Abstract cancelled
attributed to either compression of the midbrain ascending
reticular system or vascular compromise (vertebrobasilar
artery compression, hypotension). Chiari malformation
must be thought of in the differential diagnosis in patients
suffering from recurrent syncope attacks.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


Cerebrovascular diseases 1
P1132
Point-of-care laboratory halves door-to-
therapy-decision time in acute stroke
S. Walter1, P. Kostopoulos1, A. Haass1, Y. Liu1,
P. Papanagiotou2, C. Roth2, I. Grunwald3, K. Fassbender1
1Neurology, Diagnostic and Interventional Neuroradiology,
2 Health and Primary Care, 4Gerontology and Geriatrics,
University Hospital of the Saarland, Homburg, Germany,
3Acute Vascular Imaging Centre, John Radcliffe Hospital,
Oxford, UK
Time until beginning of a causal therapy is critical for
favourable outcome of acute stroke. In ischemic stroke
treatment, application of rt-PA thrombolysis requires
information about coagulation, blood count and liver
laboratory parameters of the patient in order to reduce
bleeding complications. Currently, stroke laboratory
examinations are usually performed in the centralized
hospital laboratory, which can be time consuming.
Therefore, planned thrombolysis is often given before all
results are available as off-label use. In this study, we
examined the feasibility of gaining valuable time by
transferring the complete stroke laboratory workup required
by stroke guidelines to a point-of-care laboratory system,
that is, placed at a stroke treatment room contiguous to the
computed tomography, where the patients are admitted and
where they obtain neurological, laboratory, and imaging
examinations and treatment by the same dedicated team.
Our results showed that reconfiguration of the entire stroke
laboratory analysis to a point-of-care system were feasible
for 200 consecutively admitted patients. This strategy
reduced the door-to therapy-decision times from 8426 to
4024 min (p<0.001). Results of most laboratory tests
(except activated partial thromboplastin time and
international normalized ratio) revealed close agreement
with results from a standard centralized hospital laboratory.
These findings may offer a new solution for the integration
of laboratory workup into routine hyperacute stroke
management.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 143
P1133
High blood pressure, physical and
cognitive disability and risk of stroke in
the oldest old: the Leiden 85-plus study
B. Sabayan1, P. van Vliet2, J. Gussekloo3,
A.J.M. de Craen4, R.G.J. Westendorp4
1Gerontology and Geriatrics, Radiology, 2Neurology, 3Public
Leiden University Medical Center, Leiden, The Netherlands
Introduction: Outcomes of studies on the association
between high blood pressure and risk of stroke in very old
age have shown conflicting results. In this study we
examined whether levels of physical and cognitive disability
moderate the association between high blood pressure and
risk of stroke in the oldest old.
Methods: Study participants included 571 subjects aged 85
years from the Leiden 85-plus Study. Disability in activities
of daily living (ADL) and Mini Mental State Examination
(MMSE) were assessed at age 85 years and participants
were followed for stroke events over a period of five years.
Associations between various measures of blood pressure
and risk of stroke were estimated by Cox regression
analysis.
Results: Higher pulse pressure at age 85 years was
associated with lower risk of stroke (HR: 0.81 95% CI,
0.68-0.96). In the stratified analysis, subjects with low
disability showed an increased risk of stroke for higher
blood pressure albeit not statistically significant. Conversely,
higher blood pressure measures were associated with lower
risk of stroke in subjects with high physical and cognitive
disability (all P<0.05). The associations between various
measures of blood pressure and risk of stroke were
significantly different in subjects with low and high physical
and cognitive disability (all P for interaction <0.05)
Conclusions: In very old subjects with high physical and
cognitive disability, high blood pressure is associated with
lower risk of stroke. High blood pressure, in the presence of
advanced vascular damage, may preserve cerebral perfusion
and lower risk of low-flow infarcts.
P1134
Abstract cancelled
144 Posters, Sunday 9 September
P1135
Asymptomatic Moya-moya Registry
(AMORE) study 2012-2019 - a nation-wide,
multicenter prospective survey on
prognosis of asymptomatic Moya-moya
disease in Japan
S. Kuroda, AMORE Study Group
Neurosurgery, Hokkaido University Hospital, Sapporo,
Japan
Objective: The clinical features, prognosis, and treatment
strategy of asymptomatic Moya-moya disease are still
unclear. Therefore, we have designed the Asymptomatic
Moya-moya Registry (AMORE) Study in Japan. The
objectives of this nation-wide, multi-center prospective
study are to clarify long-term prognosis of asymptomatic
patients with Moya-moya disease and to determine the risk
factors to cause ischemic and hemorrhagic stroke in them.
Study design: AMORE Study is conducted in Japan, using
a multicenter prospective observational design. The
AMORE Study Group is composed of 16 Japanese
neurosurgery/neurology centres. In this study, all
consecutive patients diagnosed as asymptomatic Moya-
moya disease between January 2012 and December 2014
are registered. Inclusion criteria is as follows: Thus, all
patients must
(a) be between 20 and 70 years at initial diagnosis;
(b) fulfil the guidelines for the diagnosis criteria Moya-
moya disease;
(c) experience no ischemic or hemorrhagic cerebrovascular
events since they were born; and
(d) be independent in daily life.
Their clinical and radiological data are registered.
Subsequently, they are followed up at outpatient clinic for
five years after enrolment. MR imaging and angiography
are repeated every year during follow-up period. The
following items constitute the primary endpoint: TIA with
cerebral infarct, ischemic stroke or hemorrhagic stroke. The
following items constitute the secondary endpoint: TIA,
radiological occurrence of silent cerebral infarction, silent
intracranial bleeding, or silent disease progression or death.
Conclusion: We emphasize the importance to determine the
prognosis of asymptomatic Moya-moya disease, and also
present the precise protocol of AMORE Study.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1136
Early clinical implications of
microalbuminuria in patients with acute
ischemic stroke
B.-H. Cho, J.-T. Kim, H.-J. Jung, K.-H. Choi, T.-S. Nam,
S.-M. Choi, S.-H. Lee, M.-S. Park, B.-C. Kim,
M.-K. Kim
Department of Neurology, Chonnam National University
Hospital, Gwangju, Republic of Korea
Background: Microalbuminuria is considered to be
independently associated with an increased risk and
mortality of stroke. However, it has not been studied
whether microalbuminuria could be associated with the
early clinical outcomes of acute ischemic stroke. Therefore,
we sought to investigate the association between
microalbuminuria and early clinical characteristics
including outcomes at discharge in acute ischemic stroke.
Methods: We studied 361 patients with acute ischemic
stroke within 72 hours of symptom onset. Early clinical
outcomes were assessed by early neurological deterioration
(END) and modified Rankin Scale (mRS) at discharge. In
addition, early radiological outcomes were assessed by
hemorrhagic transformation (HT) and lesion changes on
follow-up diffusion-weighted imaging (FU DWI). We
categorized UACR as 30 mg albumin/g creatinine (normal)
and 30-300 (microalbuminuria).
Results: 139 of 361 patients had microalbuminuria. In 41
of 361 patients occurred END. In multivariate analysis,
urine albumin-to-creatinine ratio (UACR) was independently
associated with END (OR, 1.008; 95% CI, 1.004-1.013;
p<0.001). In addition, microalbuminuria was independently
associated with HT and lesion changes on FU DWI by
multivariate analysis.
Conclusion: In the early phase of ischemic stroke, patients
with microalbuminuria were related with worse clinical
characteristics (including END, mRS>2 at discharge, HT,
and lesions changes on FU DWI) than those without.

P1137
Knowledge of risk factors and stroke
symptoms among non-stroke patients
M. Wiszniewska1, M. Guszkiewicz2, A. Kobayashi2,
A. Czonkowska2,3
1Neurological Department, Specialist Hospital, Pila,
22nd Department of Neurology, Institute of Psychiatry and
Neurology, 3Department of Experimental and Clinical
Pharmacology, Medical University, Warszawa, Poland
Background and purpose: This study aimed to evaluate
knowledge of stroke warning signs, risk factors, treatment
and prevention among patients not suffering from stroke.
Methods: Patients admitted to one of five neurology
departments in Poland for diseases other than stroke were
asked to answer a questionnaire regarding awareness of
cerebrovascular risk factors (CVRF) and stroke. The study
was performed between November 1 and December 31
2008.
Results: 481 patients were included in the study (59.7%
women). Proper definition of stroke and TIA were given by
90.3% and 60.5% of respondents respectively. Hypertension
was reported as a risk factor by 91.1% of participants.
Approximately 70% knew that hypercholesterolemia and
smoking are risk factors of stroke, but only one-third
identified diabetes mellitus as a risk factor. Cardiac
arrhythmia was recognized as a risk factor by 8.4% . 25%
of the participants did not know any symptom of stroke.
Identification of stroke signs was worse in participants from
rural areas. 10% identified disturbances of consciousness,
numbness, and dizziness as stroke symptoms.
Conclusions: The knowledge of fundamental risk factors
was sufficiently good, but recognition of cardiac arrhythmia
and diabetes mellitus was unsatisfactory. The knowledge of
stroke symptoms was unsatisfactory particularly in rural
areas. Additional education programs are still necessary.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 145
P1138
Ischemic stroke and asymptomatic
carotid stenosis are strongly associated
with metabolic syndrome
M. Mijajlovic1, A. Jotic2, N. Lalic2,
N. Covickovic-Sternic3
1Department for Cerebrovascular Disorders, Neurology
Clinic, 2Institute of Endocrinology, 3Neurology Clinic,
Clinical Center of Serbia, Belgrade, Serbia
Background and aims: Insulin resistance (IR) plays a
crucial role in the pathogenesis of atherosclerosis, but their
role in ischemic stroke (IST) has not been elucidated. The
study was aimed to analyze IR and plasma insulin (PI)
levels, dyslipidemia pattern, obesity and plasminogen
activator inhibitor-1 in 100 patients with atherothrombotic
IST (group A), 100 patients with asymptomatic carotid
stenosis (ACAS) 50% (group B), 100 patients with lacunar
stroke (Group C) and 65 healthy controls (group D). Patients
with diabetes mellitus and ischemic heart disease were
excluded.
Methods: IR was determined by Homeostasis Assessment
Model, PI levels by Radioimmunoassay. Total-, LDL- and
HDL-cholesterol and triglyceride levels were measured in
all groups. Obesity was determined by waist circumference
and hypercoagulable state by plasminogen activator
inhibitor (PAI-1) levels.
Results: IR was significantly higher in group A compared
to group B, C and D (4.820.27 vs. 3.690.22, p<0.05;
4.820.27 vs. 2.710.21, p<0.01, 4.820.27 vs. 1.500.19,
p<0.01). PI levels were significantly higher in group A in
comparison to group B, C and D (19.001.2 vs. 15.950.88,
p<0.05; 19.001.2 vs. 11.120.19, p<0.01, 19.001.2 vs.
7.121.08). Different patterns of dyslipidemia were
observed in ACAS and IST. PAI-1 levels, and waist
circumference were significantly higher in group A, B, and
C in comparison to controls (p<0.01, respectively).
Conclusion: Our results indicate that all subtypes of
ischemic stroke as well as ACAS are strongly associated
with IR and increased PI and PAI-1 levels. Specific patterns
of dyslipidemia between ACAS and IST were observed.
146 Posters, Sunday 9 September
P1139
Therapeutic drug monitoring of
clopidogrel in neurointervention: a single
centre experience
J.J. McCabe, E. Kim, H. Villegas, W. McAuliffe
Neurological Intervention & Imaging Service of Western
Australia (NIISWA), Sir Charles Gairdener Hospital, Perth,
WA, Australia
Introduction: Clopidogrel resistance is an increasingly
concerning phenomenon in the neurointervention setting,
with an estimated incidence of 4-44%. This high incidence
is of clinical relevance as it is associated with increased
rates of thromboembolic events following carotid artery or
cerebral aneurysm stenting. Routine therapeutic drug
monitoring to identify clopidogrel resistance has been
suggested. However there is a dearth of evidence as to its
usefulness in guiding therapy in practice.
Aims: To evaluate the impact of therapeutic drug monitoring
of clopidogrel on patient management.
Methods: Point-of-care testing to identify clopidogrel
resistance using the VerifyNow assay was carried out on all
treated patients undergoing neurointerventional procedures
in a tertiary referral centre during the twelve month period
from 01/12/2010 to 01/12/2011. Clopidogrel resistance was
defined as platelet inhibition <20% with a Platelet
Reactivity Unit of >240. A retrospective review of the case
notes of all patients was carried out. Patient demographics,
co-morbidities, medications and any alteration to treatment
plan following the point-of-care test were recorded.
Results: A total of 65 patients were included in the study:
31 male and 34 female with a mean age of 57. The incidence
of Clopidogrel resistance was 20% (n=14).
Long-term treatment was altered in 89% of these cases in
light of platelet inhibition testing. Concomitant treatment
with Atorvastatin (Risk ratio 5.3, p=0.01) and age >65 (Risk
Ratio 2.8, p=0.05) was associated with resistance.
Conclusion: A high incidence of Clopidogrel resistance
was observed in our study. Routine testing is recommended
to identify non-responders and alter management
accordingly.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1140
Less complications in shunt surgery:
gravitational valves are proven to be
effective in the therapy of the idiophatic
normal pressure hydrocephalus
(SVASONA)
J. Lemcke1, U. Meier1, C. Mller2, M. Fritsch2,
U. Kehler3, N. Langer3, M. Kiefer4, R. Eymann4,
M.U. Schuhmann5, A. Speil5, F. Weber6, V. Remenez6,
V. Rohde7, H.-C. Ludwig7, D. Stengel2,8
1Neurosurgery, Unfallkrankenhaus Berlin, 2Ernst-Moritz-
Arndt-University, Greifswald, 3Asklepios Hospital Altona,
Hamburg, 4Saarland Medical University, Homburg / Saar,
5Eberhard-Karls-University, Tbingen, 6Hospital Cologne-
Merheim, Cologne, 7Georg-August-University of Gttingen,
8Center for Clinical Research, Unfallkrankenhaus Berlin,
Germany
Background: Among dementia diseases idiopathic normal
pressure hydrocephalus is the only entity susceptible to a
neurosurgical therapy. The risk of overdrainage
complications had a major influence on the indication for
surgery in the past. The aim of the SVASONA study is to
analyse in a randomised multi-center study whether the risk
of overdrainage complications can be eliminated by the use
of gravitational valves.
Methods: Patients diagnosed for iNPH by clinical
examination, radiological assessment and cerebrospinal
fluid (CSF) infusion test, CSF tap test and or continuous
ICP measurement were recruited in seven centres and
randomly assigned to either receive a ventriculoperitoneal
(vp) shunt with a programmable valve without a gravitational
unit or a programmable valve with a gravitational unit. The
patients were followed-up 3, 6 and 12 months after surgery.
The primary endpoint was the incidence of overdrainage
complications after 6 months.
Results: 150 patients were included. The study was stopped
due to a massive advantage for the patient group with
gravitational units.
Six months after surgery in the intention-to-treat population
the patients group treated with programmable valves
without a gravitational unit showed overdrainage
complications in 32.9%, and the patient group treated with
programmable valves with gravitational units showed
overdrainage complications in 2.7% (p<0.001).
Discussion: Significantly more patients had overdrainage
complications in the treatment group without gravitational
units whilst the outcome was equal in both groups. Thus, the
use of gravitational units should evolve as a new standard of
care for iNPH.

P1141
Inhibiting TLR4 signal protects against
neuronal death in transient focal ischemia
Y. Suzuki1, T. Murase2, J. Hamanaka1, K. Hattori2,
K. Tsuruma1, M. Shimazawa1, H. Nagasawa2, H. Hara1
1Molecular Pharmacology, Department of Biofunctional
Evaluation, 2Medicinal and Pharmaceutical Chemistry,
Department of Organic Chemistry, Gifu Pharmaceutical
University, Gifu, Japan
Introduction: Toll-like receptors (TLRs) are signalling
receptors in the innate immune system. Recently, we have
reported that TLR4, but not TLR3 or TLR9, contributes to
ischemic brain injury induced by middle cerebral artery
occlusion (MCAO) in mice (Hamanaka et al., Neuroscience,
171, 258-67). In the present study, we investigated whether
treatment with resatorvid, Ethyl (6R)-6-[N-(2-chloro-4-
fluorophenyl)sulfamoyl]cyclohex-1-ene-1-carboxylate, a
TLR4 signal inhibitor, exerts neuroprotective effects against
the ischemic injury.
Methods: Mice were subjected 2h MCAO followed by 22h
reperfusion. Resatorvid was intracerebroventriculary
injected immediately after reperfusion. Infarct volume and
neurological score were evaluated at 24h after MCAO. To
estimate the mechanism of neuroprotection by resatorvid,
Western blotting and immunostaining were performed.
Results: Resatorvid at 0.01g significantly reduced infarct
volume and improved neurological score compared with
vehicle treatment. The levels of p38 phosphorylation,
nuclear factor-kappa B (NF-B) activation, matrix
metalloproteinase 9 (MMP9) and NADPH oxidase 4
(NOX4) expressions were significantly suppressed in
the resatorvid-treated group. Furthermore, resatorvid
significantly reduced DNA oxidation, tyrosine nitration,
and neuronal apoptosis.
Conclusion: These data suggest that inhibiting the TLR4
signalling after ischemia shows the neuroprotective effects
against cerebral ischemia and reperfusion injury in mice.
Furthermore, resatorvid may be useful for a therapeutic
agent for stroke.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 147
P1142
The VISTA collaboration: exploratory
analysis of trial data to inform RCT design
M. Ali1,2, M. Brady2, H.-C. Diener3, D. Hanley4,
N. Wahlgren5, S. Warach6, K.R. Lees1, On behalf of the
VISTA Steering Committees
1University of Glasgow, 2Glasgow Caledonian University,
Glasgow, UK, 3University Duisburg-Essen, Essen, Germany,
4The John Hopkins Medical Institutions, Baltimore, MD,
USA, 5Karolinska Institute, Stockholm, Sweden, 6UT
Southwestern Medical Center, Austin, TX, USA
Introduction: Practical and financial barriers hinder the
pace of stroke research. Data from completed RCTs often
reside in industry or academic archives, however exploratory
analyses of these valuable data can generate hypotheses,
describe natural history patterns and pilot trial design
elements to inform future RCTs. We established the Virtual
International Stroke Trials Archive (VISTA), a collaborative
stroke trials resource.
Methods: VISTA collates data in 6 specialist archives
including acute stroke, rehabilitation, secondary prevention,
intracerebral haemorrhage, imaging, and observational
studies. Each section is governed by a Steering Committee
comprising contributing trialists. Access to VISTA has been
granted to external investigators for novel analyses.
Results: To date VISTA contains data on 49,134 patients
across 6 archives and has facilitated 40 peer-reviewed
research publications and 42 conference presentations. Data
from VISTA have been used to inform the design of the
SAINT acute stroke trials, investigate thrombolysis in the
elderly, post-stroke atrial fibrillation monitoring, prediction
of outcomes after ischaemic stroke, inclusion and attrition
of patients in RCTs, and validation of stroke outcome
measures.
Conclusion: VISTA extends the value of clinical research
at low cost, without threatening commercial or intellectual
property interests and independently delivers valuable
research output on a wide range of stroke topics. VISTA is
not a meta-analysis dataset; rather it is used to investigate
epidemiology, stroke outcomes and pilot trial design
elements. VISTA provides young researchers with access to
specialised committees for collaboration. We encourage the
contribution of further trials to the resource and collaboration
to develop new projects.
148 Posters, Sunday 9 September

P1143
A meta-analysis on the efficacy and
safety of cilostazol against aspirin
P.A.D. Canto, M.C. San Jose
Philippine General Hospital, Metro Manila, Philippines
Introduction: Stroke is a leading cause of adult disability
and death worldwide. A key aim to management of patients
with ischemic stroke is to reduce the risk of recurrent stroke
and serious fatal and non-fatal vascular events. Aspirin
remains the cornerstone antithrombotic therapy, and has
been demonstrated to have a proportional reduction in
vascular events: 19% with 500-1500mg daily, 26% with
160-325mg daily, and 32% with 75-150mg daily. Aspirin
was associated with a 22% increase in odds of symptomatic
intracranial haemorrhage and 69% increase in major
extracranial haemorrhage. In a study of 1095 patients with
recent ischemic stroke on Cilostazol, the annual relative risk
of serious vascular events was reduced by 41.7%.
Objectives: Primary objective was to determine the efficacy
and safety of Cilostazol versus Aspirin in the secondary
prevention of stroke through meta-analysis of randomized,
controlled studies. A secondary objective was to determine
if Cilostazol, compared with Aspirin, decreased the
occurrence of ischemic stroke, hemorrhagic stroke and rate
of intracranial haemorrhage.
Methodology: CASISP and CSPS2 were included in the
study. Meta-analysis was done using RevMan.
Results and analysis: Rates of overall stroke occurrence,
hemorrhagic stroke occurrence, overall hemorrhagic events
and intracranial hemorrhage were lower among those who
took Cilostazol. Although ischemic stroke occurrence was
P1144
Is CHA2DS2-VASc the best score in
predicting thrombo-embolic risk in atrial
fibrillation?
N. Diaconu1, A. Grosu1, C. Gratii1, G. Pavlic2, V. Racila1
1Institute of Cardiology, 2Institute of Neurology and
Neurosurgery, Chisinau, Moldova
Introduction: Atrial fibrillation (AF) is a risk factor for
ischemic stroke (IS) and thrombo-embolism. The stroke in
AF is associated with severe disability and high mortality,
its prevention being an important factor in management of
AF patients.
Objective: To determine the influence of atrial fibrillation
on stroke development and evolution and to compare the
stroke predictive value of several schemas published in the
last years.
Methods: Retrospective study of all ischemic stroke
patients admitted during one year in a municipal hospital.
Results: The study included 735 patients of whom 519 had
primary stroke (70.6%). AF was determined in 206 cases
(28.4%), these patients being older (70.10.65 vs. 64.30.46
years; p<0.001), majority females: 57.8% (119/206) with
more vascular risk factors. AF patients have had more
severe signs of cerebral lesion on admission (79% vs. 37%,
p<0.01), also having a higher hospital mortality rate (30.6%
vs. 13.2, p<0.001). The scores of thromboembolic risk
estimation are presented in the table below.
Scores of thromoembolic risk estimation
Low Low risk Medium Medium High risk
risk with without risk with risk without High risk without

not statistically significant, there were less ischemic stroke previous previous previous previous with previous previous

events among patients on Cilostazol compared to Aspirin. Scores stroke stroke stroke stroke stroke stroke p
Framingham 15/8.6 % 10.9% 54/30.9% 33.6% 106/60.6% 55.6% <0.01
Conclusion: There is an advantage in using Cilostazol for
CHADS2 10/4.85 % 6.8% 45/21.8% 30.6% 151/73.3% 62.6% <0.01
secondary stroke prevention due to a better risk reduction in CHA2DS2-
stroke occurrence and safety compared to Aspirin. VASc 0 0 6/2.9% 4.1% 200/97.1% 95.9% <0.01

Conclusions: Patients with AF without previous thrombo-

embolic events have a high risk of stroke with more severe
evolution and consequences. CHA2DS2-VASc is the most
sensible score in determining thrombo-embolic risk in
patients with non-valvular AF.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1145
Safety and efficacy of sonothrombolysis
using bilateral TCD monitoring by
diagnostic 2 MHz probes: a pilot study
R. Herzig1, P. Bardo1,2, M. Kuliha1,3, P. Kaovsk1,
D. koloudk1,3
1Comprehensive Stroke Center, Department of Neurology,
Faculty of Medicine and Dentistry, Palack University and
University Hospital, Olomouc, 2Department of Neurology,
Hospital Tinec-Sosna, Trinec, 3Comprehensive Stroke
Center, Department of Neurology, University Hospital and
Ostrava University, Ostrava, Czech Republic
Introduction: Sonothrombolysis is a new therapeutic
method used in patients with acute ischemic stroke (AIS).
Various frequencies and intensities of used ultrasound are
being tested. The aim was to assess the safety and efficacy
of sonothrombolysis using two diagnostic probes and
bilateral monitoring in patients with acute occlusion of the
middle cerebral artery (MCA).
Methods: 12 consecutive AIS patients (7 males; age 47-78,
average 64.19.4 years) with acute MCA occlusion and
contraindication to thrombolysis were included in the study.
60-minute bilateral Doppler monitoring of the area of
occlusion was performed in all patients (Group 1). The
control group consisted of 37 AIS patients (20 males; age
32-78, average 62.212.1 years) treated with standard
onothrombolysis and selected from the Thrombotripsy
Study database (Group 2). The differences in the number of
recanalized arteries after a 60-minute treatment, number of
independent patients (defined as a modified Rankin scale
value of 0-2) after 90 days, number of symptomatic
intracerebral haemorrhages (SICH) were statistically
evaluated.
Results: Complete recanalization was detected in 4 (30.0%)
of Group 1 and 12 (32.4%) of Group 2 patients. 7 (58.3%)
of Group 1 and 22 (59.5%) of Group 2 patients were
independent after 90 days. SICH was detected in none of
Group 1 and in 1 (2.7%) of Group 2 patients (p>0.05 in all
cases).
Conclusion: According to the presented results,
sonothrombolysis using two probes and bilateral monitoring
is safe, but not more effective than standard sonothrombolysis
in AIS patients with MCA occlusion. Acknowledgement:
Supported by IGAMHCR grants NT/11046-6/2010,
NT/11386-5/2010, NT/13498-4/2012.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 149
P1146
Are we getting better in prescribing
vitamin K antagonists for atrial fibrillation
before and after stroke?
M. Karlinski1, J.P. Bembenek1, A. Kobayashi1,2,
A. Baranowska1, A. Czlonkowska1,3
12ndDepartment of Neurology, 2Interventional Stroke
Treatment Centre, Institute of Psychiatry and Neurology,
3Department of Experimental and Clinical Pharmacology,
Medical University of Warsaw, Poland
Introduction: Effective anticoagulation with vitamin K
antagonists (VKA) is the treatment of choice for stroke
prevention in the majority of patients with atrial fibrillation
(AF). Considering growing vascular awareness, their
everyday use should be increasing.
Aim: Our aim was to evaluate changes in the use of VKA
before stroke onset in patients with pre-existing AF over the
past 15 years.
Methods: We analyzed consecutive acute stroke patients
admitted to our center between June 2006 and January
2011. Data were prospectively collected using a detailed
stroke registry. We distinguished between three periods:
1995-1999, 2000-2004 and 2005-2011.
Results: In the analyzed periods pre-stroke history of AF
was reported with similar frequency (years 1995-1999:
139/626, 22.2%; years 2000-2004: 346/1501, 23.0%; years
2005-2011: 442/1872, 23.6%). It was present on their
routine ECG after admission in 22.4%, 20.7% and 20.1%,
respectively. We observed a significant (p<0.001)
improvement in the use of VKA before stroke in patients
with pre-existing AF (8.0%, 14.3%, 27.9%), and fluctuating
prescription rate of VKA upon discharge (34.8%, 24.7%,
49.0%) in those patients. The use of subtherapeutic doses of
VKA was much higher than the doses exceeding therapeutic
window (64.7% vs. 5.9%, 72.6% vs. 5.5%, 77.4% vs.
10.3%). During the hospital stay AF was diagnosed in
additional 3.8%, 3.4%, and 6.9% of patients.
Conclusion: The number of stroke patients with AF
receiving VKA before stroke onset is systematically
growing. However, the high ratio of patients receiving
suboptimal doses points at constantly low guideline
adherence among physicians and patient non-compliance.
150 Posters, Sunday 9 September
P1147
Predictive value of routine C-reactive
protein in ischaemic stroke patients
treated with rtPA
J.P. Bembenek1, M. Karlinski1, K. Grabska1,
A. Baranowska1, A. Kobayashi1, A. Czlonkowska1,2
1 nd
2 Department of Neurology, Institute of Psychiatry and
Neurology, 2Department of Clinical and Experimental
Pharmacology, Medical University of Warsaw, Poland
Introduction: Blood biomarkers may be important
predictors of outcome after ischaemic stroke. However,
their clinical usefulness is not fully established yet,
especially in a particular group of patients treated with
intravenous rtPA. The aim of our study was to investigate
the predictive value of serum C-reactive protein (CRP) in
ischaemic stroke patients undergoing thrombolytic
treatment, adjusting for a history of infection recently
before stroke.
Methods: Consecutive patients receiving intravenous rtPA
in our stroke center (October 2003 - February 2010) were
included. Data were prospectively collected using a detailed
questionnaire including information about pre-existing
conditions, laboratory findings and medications. Routine
serum CRP was measured within 24 hours from admission.
Results: Serum CRP was measured in 197/232 patients
treated with intravenous rtPA. In 20/232 were reported signs
of infection within 7 days before stroke onset. Patients with
elevated CRP (>5 ng/ml) had more pre-existing
comorbidities, more severe strokes but a similar pre-stroke
disability, when compared to those with normal levels. In a
multivariate analysis neither elevated CRP nor recent
infection were associated with 3-month mortality. However,
elevated CRP was independently associated with increased
risk for death or dependency (OR 2.09, 95%CI: 1.03-4.26).
Patients with not elevated CRP demonstrated high
probability of not having sICH according to SITS (100%,
95%CI:97-100%) and ECASS (97%, 95%CI:92-99%)
definitions.
Conclusions: Elevated CRP may be an additional predictor
of unfavourable long-term outcome in thrombolysed
patients that could also facilitate bedside decision making
in cases with borderline eligibility for thrombolysis.
However, this should be verified in further studies.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1148
Predictors of early seizures in acute
stroke
I. Volonghi1, A. Pezzini1, E. del Zotto1, A. Giossi1,
P. Costa1, L. Poli1, M. Gamba2, L. Antonini2, M. Magoni2,
A. Padovani1
1Universit degli Studi di Brescia, 2Spedali Civili, Brescia,
Italy
Aims: To assess incidence and predictors of early seizures
(ES) in a prospective cohort of patients with acute first-ever
stroke.
Methods: Patients consecutively recruited in the setting of
the Brescia Stroke Registry were entered into the analysis.
ES (7 days) were recorded and correlated to clinical and
demographic data, disease characteristics, and risk factors,
as well as to medical complications occurring within 7 days
of symptoms onset.
Results: 516 patients [314 men; mean age 66.414.7; 436
(84.5%) cerebral infarct (IS), 80 (15.6%) intracerebral
haemorrhage (ICH)] were enrolled. ES were observed in 20
patients (3.9%), 12 with IS (2.7%), 8 with ICH (10.0%). As
expected, mean NIHSS at admission was higher in patients
with ES than in those without (13.26 vs. 8.45), while
haemorrhagic lesion (RR, 1.56, 95%CIs 1.07-2.28),
particularly with lobar location (RR, 11.7, 95%CIs 4.63-
29.30), cortical involvement (RR, 1.42, 95%CIs 1.00-2.08),
and haemorrhagic transformation of the infarct (RR, 1.51,
95%CIs 1.01-2.38) were independent predictors of ES, as
opposed to the neutral effect of vascular risk factors. The
occurrence of medical complications turned out to increase
the risk of ES in the whole group (RR, 1.16; 95%CIs 1.07-
1.26) as well as in that of patients with IS (RR, 1.17;
95%CIs, 1.06-1.28), but not in that of patients with ICH
(RR, 1.16; 95%CIs, 0.94-1.42).
Conclusion: The occurrence of medical complications in
the acute phase of stroke should be considered a further
predictor of ES in patients with brain infarction, but not in
those with ICH.

P1149
Effect of pre-treatment with statins on
ischemic stroke severity: do the doses
matter?
P. Martinez-Sanchez, B. Fuentes, G. Ruiz-Ares,
E. Correas-Callero, M. Martinez-Martinez,
L. Cullar-Gamboa, E. Dez-Tejedor
Neurology, La Paz University Hospital. IdiPAZ Health
Research Institute, Madrid, Spain
Objective: To examine the effect of pre-treatment with
statins, at high (80mg/d) and non-high (<80mg/d) doses, on
ischemic stroke (IS) severity in clinical practice.
Methods: Prospective study of IS admissions to our Stroke
Unit during a 3-year period (2008-2010). Basal data,
previous treatments (including statins), stroke severity
(NIHSS), stroke subtype, in-hospital complications, length
of stay and functional status at discharge (mRS) were
collected. Mild stroke severity was defined as NIHSS 5 on
admission. Good outcome was defined as mRS 2 at
discharge. Multivariable regression models and matched
propensity score analyses were used to quantify the
association of statins pre-treatment, at high and non-high
doses, with a mild stroke severity.
Results: Of 969 IS patients, 23% were using non-high
doses and 4.1% high doses of statins before the stroke. The
frequency of mild stroke on admission was higher in the
statin groups (57.9% for non-statins, 63.2% for non-high
doses of statins and 77.5% for high doses of statins,
p=0.026). After multivariable adjustment, pre-treatment
with statins was associated with higher odds of mild stroke
severity and this effect was greater at high doses (OR=1.637,
95% CI 1.156-2.319 for the non-high doses and OR=3.297,
95% CI 1.480-7.345, for the high doses of statins).
Conclusion: Pre-treatment with statins is associated with
lower stroke severity and this effect could be greater at
higher doses.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 151
P1150
Factors affecting blood glucose and
blood pressure level in hyperacute
ischemic stroke. Is mismatch a
contributing factor?
S. Gur-Ozmen1, B. Aksay-Koyuncu1, S. Tavukcu-Ozkan2,
R. Tolun1, Y. Krespi2
1Neurology, Istanbul Science University, 2Stroke Unit, Sisli
Florence Nightingale Hospital, Istanbul, Turkey
Background: Hyperglycaemia is detected in 30-50% and
high blood pressure (BP) is detected in 75% of acute
ischemic stroke (AIS) patients admitted to the emergency
room (ER); most of them do not have history of diabetes
mellitus (DM) or hypertension (HT). Patients with
salvageable brain tissue at admission can have higher
glycaemic and BP levels and potentially be harmed by, or
benefit the most from insulin and anti-hypertensive therapy.
Methods: The relationship between DWI/PWI mismatch,
admission blood glucose (ABGL) and blood pressure level
(ABPL) in patients admitted in the first 12 hours of AIS
onset is examined. Data of patients registered to Florence
Nightingale AS database between 2006 and 2009 were used.
Correlation between mismatch and ABGL or ABPL was
analyzed with multivariate logistic regression analysis.
Results: The sample consisted of 212 patients. The adjusted
odds of mismatch in predicting high ABPL was 2.297
(p=0.064, 95%Cl 0.953-5.536) in the whole group, and it
was 3.801 in the stress hyperglycaemia group (n: 67, %35)
(p=0.033, 95%Cl 1.110-13.015). Lower level of
consciousness, anti-DM usage, Hba1c level and
cardioembolic etiology were the other independent
predictors of high ABGL. Mismatch was not associated
with ABPL. Female gender (p=0.048) and total anterior
circulation syndrome (p=0.008) were found to be associated
with higher ABPL.
Conclusion: Hyperacute ischemic stroke patients with
mismatch which is considered as potentially harbouring
salvageable penumbral brain tissue were more likely to
present with hyperglycaemia. On the other hand, a similar
relationship with mismatch and ABPL could not be
demonstrated.
152 Posters, Sunday 9 September
P1151
The role of endothelial dysfunction in
stroke
A. Inzhutova, O. Lopatina, E. Mervaala, A. Salmina
Institute of Biomedicine, Helsinki University, Helsinki,
Finland
We investigated the role of endothelial dysfunction in
development and progression of stroke compared to
progressive angina or arterial hypertension. Known,
endothelial cells are multifunctional organ with endocrine
properties. Severe endothelial dysfunction in stroke leads to
disability of patients. Understanding of molecular
mechanisms of endothelial dysfunction and detection of
biomarkers of endothelial disorders severity is the first step
to successful prevention and treatment of stroke. In our
study endothelial dysfunction (measured by ultrasound
examination of brachial artery diameter) was more
pronounced in patients with stroke (60 women, 50 men),
than in progressive angina (50 men, 40 women). It was
associated with the increase of intracellular calcium and
reactive oxygen species levels, endothelial apoptosis and the
rise of circulating endothelial progenitor cells number in the
blood. Endothelial derived microparticles play an important
role in cell-cell communication and the development of
endothelial dysfunction. We discovered that specific antigen
composition of circulating membrane microparticles
depends on cardiovascular pathology. Moreover, membrane
microparticles contain signal proteins such as MAPK and
e-NOS and they are good biomarkers of endothelial
dysfunction severity. Stabilization of endothelial cell
membrane by cytoprotectors had a beneficial effect on
endothelial function and recovery in patients after stroke. In
opposite, without targeted treatment of endothelial
dysfunction mortality was 10% (p<0.01) and disability was
40% (p<0.001) in patients with stroke. In conclusion we
designed a method of endothelial dysfunction severity
diagnosis by detecting novel biomarkers in the blood and an
algorithm for treatment of patients with stroke by the
correction of endothelial function.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1152
Functional outcome of acute ischemic
stroke patients: association with
concentrations of thyroid hormones and
C-reactive protein
H. Kazlauskas1, A. Bunevicius2,3, N. Raskauskiene2,
A. Anskoliene1, R. Radziuviene2, V. Janusonis1,
R. Bunevicius2
1Klaipeda University Hospital, Klaipeda, 2Institute of
Psychophysiology and Rehabilitation, Lithuanian University
of Health Sciences, Palanga, Lithuania, 3Department of
Psychiatry, University of North Carolina at Chapel Hill,
USA, Chapel Hill, NC, USA
Objective: To evaluate the association of concentrations of
thyroid axis hormones and C-reactive protein (CRP) with
functional outcome of acute ischemic stroke patients.
Methods: 88 hospitalized patients (57 men and 31 women;
mean age 7211 years) within 48 hours from the onset of
ischemic stroke were included to this study. All patients
were evaluated for severity of stroke using the Scandinavian
Stroke Scale (SSS) and Glasgow Coma Scale (GCS), and
for serum concentrations of free tri-iodothyronine (T3), free
thyroxin, and thyroid stimulating hormone and C-reactive
protein (CRP). Functional outcome at discharge was
evaluated using the modified Rankin scale (mRS).
Results: In univariate regression analyses worse functional
outcome at discharge was associated with lower free T3
concentrations (=-0.230, p=0.04), with higher CRP
concentrations (=0.486, p<0.001), with female gender
(=0.281; p=0.01), with advanced age (=0.386; p=0.012),
with lower SSS score (=-0.689, p<0.001), with lower GCS
score (=-0.290, p=0.01) and with more disability prior to
stroke (=0.398, p<0.001). In multivariate analyses, after
adjustment for significant predictors in univariate analyses,
higher CRP concentrations (=0.213, p=0.02), higher SSS
score (=-0.644, p<0.001) and more disability prior to
stroke (=0.251, p=0.003) were independently associated
with worse results and together explained 57% (p<0.001) of
variance of mRS score.
Conclusions: Worse functional outcome of acute ischemic
stroke patients at discharge is associated with lower free T3
concentrations and with higher CRP concentrations on
admission. After adjustment for clinical, demographic and
neuroendocrine factors, higher CRP concentrations are
independently associated with worse functional outcome.

P1153
Effect of weekend or night compared with
daytime admission on outcome in acute
ischemic stroke patients treated with
endovascular therapy
N. Nakai1, T. Kojima2, K. Shintai2, M. Hattori1, D. Itou1,
R. Nishi1, S. Yamada1, K. Kawabata1, S. Yokoi1,
N. Mitsuma1, K. Yasui1, Y. Hasegawa1
1Neurology, 2Neurosurgery, Nagoya Daini Redcross Hospital,
Nagoya, Japan
Background and Purpose: A stroke weekend effect has
been demonstrated in many countries, but there is no report
for effect of weekend admission in acute ischemic stroke
(AIS) patients treated with endovascular therapy. We studied
AIS patients treated with endovascular therapy for weekend
effect.
Methods: We report 38 AIS patients treated with
endovascular therapy between 2005 and 2011: 11 daytime
on working days (office hours) admissions and 27 weekend
or night time (non-office hours) admissions.
We compared the following data between office hours
admission group (OH) and non-office hours admission
group (NOH); pre-treatment NIHSS, stroke onset to
admission time, admission to MRI time, admission to
puncture time, recanalisation rate, and modified Rankin
scale (mRS) at 3 months.
Results: Between OH and NOH, there was no difference in
pre-treatment NIHSS (24 vs. 19), and admission to MRI
time (34 minutes vs. 29 minutes). But there was statistical
difference in stroke onset to admission time (77 minutes vs.
56 minutes, p=0.034), admission to puncture time (105
minutes vs. 136 minutes, p=0.015) and recanalization rate
(90.9% vs. 33.3%, p=0.001). The rate of good outcome
(mRS 0-2) at 3 months in OH was similar to that of NOH
(27.2 % vs. 25.9%). Most of our cases were internal carotid
artery or proximal middle cerebral artery occlusion, as a
result higher recanalization rate in OH has no influence on
good outcome.
Conclusions: There was no weekend effect in AIS patients
treated with endovascular therapy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 153
P1154
Endovascular coil embolisation for
wide-necked unruptured intracranial
aneurysms with enterprise stent:
safety & efficacy
S.-K. Hwang1, O.-K. Kwon2
Department of Neurosurgery, Ewha Womans University,
1
College of Medicine, Mokdong Hospi, Seoul, 2Seoul National
University Bundang Hospital, Seongnam, Republic of Korea
Background: Stent assisted coil embolisation for wide-
necked unruptured intracranial aneurysms (UIA) is a
widely-accepted treatment modality. But, its technical
results and clinical outcome are not well known. The aim of
this study was to evaluate the safety and efficacy based on
result of consecutive patients in a single center.
Methods: This study included 116 patients (29 male
patients, 87 female patients, mean age; 55.4 years) with 121
UIA treated in one hospital by means of Enterprise stent
assisted coil embolisation between November 2008 and
December 2010. The clinical and radiological (magnetic
resonance angiography) results were evaluated.
Results: Successful embolisation without complications
was achieved in 94%. 6 patients had procedure related to
thromboembolic events. This resulted in neurologic
symptoms in 4 cases, and transient angiographically visible
thromboembolism without symptoms in 2 cases. Aneurysm
occlusion was complete in 30.5%, small neck remnant in
49.5%, and residual contrast filling in 19.8%. Magnetic
resonance angiography follow-up was performed at least 6
months after coiling in all patients. The mean follow-up
duration was 13.4 months (range 6-34 months). 8 patients
(6.6%) demonstrated any visible recanalization. 1 patient
(0.8%) with major recanalization was successfully recoiled
and the others with minor recanalization were conservatively
followed.
Conclusion: Enterprise stent assisted coil embolisation for
UIA appears to be effective and safe. Future studies
including controlled prospective trials and careful follow-
ups are required to assess indications and efficacy in the
long term.
154 Posters, Sunday 9 September
P1155
Outcome analysis of the randomized
multi-center study on idiopathic normal
pressure hydrocephalus (SVASONA)
J. Lemcke1, U. Meier2, C. Mller3, M. Fritsch3,
U. Kehler4, N. Langer4, M. Kiefer5, R. Eymann5,
M.U. Schuhmann6, A. Speil6, F. Weber7, V. Remenez7,
V. Rohde8, H.-C. Ludwig8, D. Stengel9
1Department of Neurosurgery, 2Unfallkrankenhaus Berlin,
Berlin, 3Ernst-Moritz-Arndt-University, Greifswald,
4Asklepios Hospital Altona, Hamburg, 5Saarland Medical
University, Homburg, 6Eberhard-Karls-University, Tbingen,
7Hospital Cologne-Merheim, Cologne, 8Georg-August-
University of Gttingen, 9Center for Clinical Research,
Unfallkrankenhaus Berlin and Ernst-Moritz-Arndt-University
of Greifswald, Berlin, Germany
Background: The aim of the prospective randomized
SVASONA study was to prove, that an excellent clinical
outcome and a low rate of overdrainage complications can
be achieved with gravitational valves.
Methods: In seven centres patients were enrolled in the
SVASONA study after passing clinical examination,
radiological assessment and CSF infusion test, CSF tap
test and or continuous ICP measurement. Patients were
randomly assigned in treatment groups with or without a
gravitational unit. The primary endpoint was the incidence
of overdrainage complications. Secondary endpoint was the
clinical outcome after 6 and 12 months.
Results: 150 patients were included in the study. Due to a
significantly lower risk of overdrainage complications in the
treatment group with gravitational units, the study was
stopped according to the protocol after the planned interim
analysis.
69% of the patients in the treatment group without a
gravitational valve and 86% of the patients in the group
with gravitational valves showed an excellent, improved or
fair outcome according to the Black grading scale after 6
months. After 12 months 75% respectively 86% were
registered. The difference was not significant.
Discussion: Whereas a significant difference between the
complication rates of the two treatment groups was evident,
there is only a tendency in the difference between the
outcomes measured by specific iNPH scores. These findings
underline that gravitational valves prevent the risk of
overdrainage but do not suppress the favourable outcomes
achieved with LPVs.
P1156
Abstract cancelled
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1157
Acute basilar artery occlusion: safety and
efficacy of different treatment strategies
and predictors of good outcome
T. Dork1, R. Herzig1, D. ak1, M. Krl1, T. Veverka1,
A. Brtkov1, P. Hlutk1, D. koloudk1, M. Heman2,
M. Roubec3, M. Kuliha3, V. Prochzka4, M. Kocher2,
P. Kaovsky1
1Neurology, Comprehensive Stroke Center, Faculty of
Medicine and Dentistry, 2Radiology, Comprehensive Stroke
Center, Faculty of Medicine and Dentistry, Palacky
University and University Hospital, Olomouc, 3Neurology,
4Radiology, Comprehensive Stroke Center, Ostrava
University and University Hospital, Ostrava, Czech Republic
Introduction: Acute ischemic stroke (AIS) caused by
basilar artery occlusion (BAO) is often associated with a
severe and persistent neurological deficit and a high
mortality rate. Various treatment concepts are being used.
The aim was 1) to assess the association between outcome
and treatment type and 2) to identify predictors of good
outcome.
Methods: The set consisted of 50 consecutive AIS patients
with radiologically confirmed BAO (37 males; mean age
64.712.4 years). Stroke severity at time of treatment was
assessed as severe (coma, locked-in state, tetraplegia) or
mild to moderate. 30-day outcome was assessed using a
modified Rankin scale (mRS) with good outcome defined
as score 0-3. The following treatments were used:
antithrombotics (AT); intravenous thrombolysis (IVT); IVT
with subsequent intra-arterial therapy (IVT+IAT); intra-
arterial therapy alone (IAT). Other observed factors were
age, mRS score before stroke onset, time to treatment,
recanalization rate.
Results: AT was used in 8, IVT in 12, IVT+IAT in 13, IAT
in 17 patients. Good outcome was found in 0 AT,2 (16.7%)
IVT,7 (53.8%) IVT+IAT, 3 (17.6%) IAT patients (p>0.05).
The following statistically significant differences were
found between patients with good vs. poor outcome: mean
age 54.2 vs. 68.0 years (p=0.0004); recanalization rate 91.7
vs. 47.4% (p=0.008); presence of severe neurological deficit
25.0 vs. 65.8% (p=0.02). Logistic regression analysis
identified age (OR=0.875; p=0.004), presence of severe
neurological deficit (OR=0.079; p=0.023), time to
treatment (OR=0.602; p=0.035) as significant independent
predictors of good outcome.
Conclusion: In the presented study, an apparent (although
statistically insignificant) trend for better outcome was
observed in the IVT+IAT group. Age, severe neurological
deficit, time to treatment were identified as significant
independent predictors of good outcome. Supported by
grants NT/11386-5/2010,NT/11046-6/2010, NT/13498-
4/2012 (IGAMHCR),CZ.1.05/2.1.00/01.0030.

P1158
Factors associated with platelet inhibition
in patients undergoing neurointerventional
procedures
J. Savic, S. Vucetic, N. Radojkovic-Gligic, M. Savic
Special Hospital for Cerebrovascular Diseases St. Sava,
Belgrade, Serbia
Introduction: Significance of antiplatelet resistance is
not well defined among patients with cerebrovascular
diseases. We tried to determine factors associated with
antiplatelet resistance in a cohort of patients undergoing
neurointerventional procedures.
Material and method: In this retrospective study, we
analyzed data of 65 consecutive patients in a one year period
that underwent neurointerventional procedure and
previously received antiplatelet therapy. We used impedance
aggregometry method to determine the level of platelet
inhibition.
Results: Indications for neurointerventional procedures
were: carotid stenosis (56.4%), vertebral stenosis (48.4%),
and symptomatic intracranial aneurysm (24.2%). Among 56
patients receiving aspirin in a median dose 700mg per week,
10.7% were resistant. Among 24 patients receiving
clopidogrel in a median dose 525mg per week, 21 of them
were on a dual antiplatelet therapy, and 60.4% of all were
resistant to clopidogrel. We found no differences between
antiplatelet-responders and non-responders regarding
gender, age, hypertension and concomitant statin therapy.
There were significantly less aspirin-responders among
patients with diabetes and hyperlipidaemia. Stenoses of
neck blood vessels were more frequent in aspirin-non-
responders.
Conclusions: Our results show that clopidogrel resistance
is very common in patients undergoing neurointerventional
procedures, and aspirin resistance is common among these
patients with diabetes and hyperlipidaemia. It emphasizes a
need for individualized approach for antiplatelet therapy in
this group of patients.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 155
P1159
Prognostic significance of hemodynamic
and hemostatic factors in the course of
different manifestations of cerebral small
vessel disease - study rationale and
protocol
J. Staszewski1, R. Piusiska-Macoch1, E. Skrobowska2,
B. Brodacki1, A. Stepien1
1Clinic of Neurology, 2Department of Radiology, Military
Institute of Medicine, Warszawa, Poland
Cerebral small vessel disease (CSVD) is one of the most
important and common vascular diseases of the brain. It is
an important cause of ischemic and hemorrhagic strokes,
dementia and vascular parkinsonism. Although main
clinical and radiological signs of CSVD are well established
its prognostic factors and course have not been well studied
so far.
The aim of the study is to evaluate hemodynamic and
hemostatic factors and to assess clinical and radiological
course of different manifestations of CSVD in long-term
observation.
Method: A prospective, observational, with 24-month
follow-up study in 150 CSVD patients (50 with lacunar
stroke, 50 with vascular dementia, 25 with vascular
parkinsonism, 25 with deep intracerebral hemorrhage) and
50 healthy subjects from control group has been planned.
The clinical and radiological course will be evaluated basing
on detailed neurological, neuropsychological and MRI
examinations. Hemodynamic (cerebral vasoreactivity, 24h
blood pressure control, MRI PWI/DWI) and hemostatic
(markers of endothelial and platelet dysfunction, brachial
artery flow-mediated dilatation test) factors will be
determined.
Discussion: The study has the potential to further unravel
the predictors and course of different manifestations of
CSVD. The scheduled trial will better define the prognosis
and prognostic factors of various clinical manifestations of
CSVD. These data may be helpful in considering the
development of preventive and therapeutic strategies in
CSVD especially in the context of individualization of the
treatment.
156 Posters, Sunday 9 September
P1160
Utility of 64-section multi-detected
cardiac CT in detection of thrombus and
circulation in left atrium appendage:
comparison with trans-oesophageal
echocardiography
F. Konoeda1,T. Dembo2, S. Yamada1, Y. Itoh1,
M. Jinzaki3, N. Suzuki1
1Neurology, School of Medicine, Keio University, 2Neurology,
School of Medicine, Kyorin University, 3Radiology, School of
Medicine, Keio University, Tokyo, Japan
Introduction: Trans-oesophageal echocardiography (TEE)
has been utilized as the assessment for the embolic source
in cardiogenic cerebral infarction with atrial fibrillation.
However there is the problem that TEE imposes a heavy
burden on the patient within the early phase of cardiogenic
stroke. Hence we assessed 64-section multi-detected cardiac
CT in place of TEE in patients with cardiogenic stroke.
Methods: We investigated 22 patients with stroke (17 men
and 5 women; mean age 69.4 years) who had undergone
both CT and TEE within the previous 1-month period. We
decided the CT and TEE grades as below and compared
each grade; CT
grade 1: no defect,
grade 2: no left atrium appendage thrombus and both defect
during early phase and clear during late phase,
grade 3: defect (+),
TEE grade 1: no thrombus,
grade 2: we can detect spontaneous echocardiographic
contrast (SEC) without thrombi,
grade 3: thrombi (+).
Result: 14 of 22 (63.6%) were good match with the findings
between the CT and TEE. Furthermore, SEC of TEE was
well accorded with the feature of CT grade 2 (Sensitivity=
72.2%, Specificity=75%, Positive Predictive Value=
92.8%).
Conclusion: We have proved a significant correlation
between enhancement patterns of multi-detected CT and
TEE findings (p=0.036). 64-section contrast enhanced
multi-detected CT of the left atrium is a useful test of the
method for evaluating thrombus and flow stasis in left
atrium appendage.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1161
The usefulness of time intensity curve
generated from MRI/PWI to predict
neurological deterioration after onset in
acute ischemic stroke patients
M. Nakazaki, T. Mori, H. Tajiri, T. Iwata, Y. Miyazaki,
K. Mizogami
Department of Stroke Treatment, Shonan Kamakura General
Hospital, Stroke Center, Kamakura, Japan
Purpose: To investigate whether or not MRI/time intensity
curve (TIC) can easily predict the neurological deterioration
of acute ischemic stroke patients.
Methods: Included for retrospective analysis were acute
stroke patients
1) who were admitted from 2008 to 2011 within 48hours
from onset,
2) with mild neurologic symptoms of NIHSS10 without
disturbance of consciousness,
3) whose emergency MRI demonstrated an ischemic lesion
in the MCA territory,
4) who were treated without reperfusion therapy, and
5) who had severe stenosis (70% or more) or occlusion of
the ICA or MCA in the affected side by DSA.
We evaluated PWI findings by time-intensity-curve (TIC)
grade, which were classified into four grades according to
the time to peak and the reduction value of the peak signal.
We investigated patients baseline features, TIC grades,
NIHSS on admission (adm_NIHSS), NIHSS on the 7th day
(7d_NIHSS) and difference between 7d_NIHSS and adm_
NIHSS (7d-adm_NIHSS). We defined neurological
deterioration as 7d-adm_NIHSS of more than 0.
Results: We analyzed 71patients, median. 2 patients had
grade 1 of TIC, 11 had grade 2, 38 had grade 3, and 20 had
grade 4. In 11 patients, 7d-adm_NIHSS was more than 0.
Among the 11 patients, 9 patients (82%) had grade 1-2 of
TIC at admission. Logistic regression analysis also
demonstrated grade 1-2 of TIC that was an independent
significant predictor of neurological deterioration (OR,62.5;
95%CI,10.0-333, p<0.001).
Conclusion: In acute ischemic stroke patients with severe
stenosis or occlusion of the IC or MCA, MRI/TIC was
useful in predicting neurological deterioration after
admission.
 Posters, Sunday 9 September 157

P1162 Documented close relationships between ANS dysfunction

(HRV/BPV/BRS) iCI onset, and its contribution to
Heart and brain. Their mutual prognosisLP-PLA2. The largest study regarding LP-PLA2.
relationships. How can we explain this Significant increase in AH, CAD, iCI groups comparing to
connection and why is it important? controls. close direct correlation with changes in carotid
arteries. New era in understanding inflammatory
D. Bartko1, P. Blazicek2, Z. Gombosova1, L. Bubelkova3,
mechanisms of atherosclerosis. Important implication for
I. Combor1, L. Danihel3, J. Fabcin4, F. Rusnak5,
clinical practice.
A. Dukat6, J. Midriak7, Z. Prieselova7, J. Kubala8,
Conclusions: AF, ectopic abnormalities, HF, HRV, BP
E. Kurca9, V. Nosal9, I. Fillip1
variability, BRS and PL-PLA2 are major predictors of onset
1Institute of Medical Sciences, Neurosciences, Military
and outcome of stroke. All are associated with increasing
Health, Central Military University Hospital, Ruzomberok,
2Divison of Clinical Biochemistry, Alpha Medical Company, age, BMI, diabetes, dyslipidemia. These findings are
Bratislava, 3Dept. of Radiology, 4MRI Center, 5Dept. of
associated with stiff blood vessels and impaired baro-
Vascular Surgery, Central Military University Hospital, receptor function. Implications of these findings for
Ruzomberok, 62nd Dept. of Internal Medicine, Comenius guidelines on prevention and practice have yet to be
University, University Hospital, Bratislava, 7Department of established. Supported by EUgrants No2622022009 &
Neurology, 8Institute of Clinical Biochemistry, Immunology 26220220153
and Allergology, Central Military University Hospital,
Ruzomberok, 9Deparment of Neurology, Comenius
University, University Hospital, Martin, Slovak Republic
Introduction: Rhythmic abnormalities, HFs, ANS
dysfunction can contribute to decreasing cardiac output and
to onset of iCI. The not are always sufficiently estimated
and implicated in practice.
Aim: To analyse an impact of AF, rhythm disturbances,
heart failures (CAD, IHD, CVD), impaired ANS functions
on iCI onset/prognosis.
Material and methods: 3064 pts with iCI, confirmed by
CT/MRI, divided in 5groups:
1. AF (n=450),
2. ectopic abnormalities (n=320),
3. CAD, IHD, CVD (n=660),
4. HRV (n=160), BPV (n=212) BRS (n=590),
5. Heart-CBF (n=192), LP-PLA 2 (n=480).
Results:
AF: Risk of iCI is 6-fold higher when AF is present.
Implantable devices discovered association with subclinical
AF and significantly increase the ascertainment of AF.
Age: Risk increases with age. 50-59yrs: 6.7%, 80-89yrs:
36.2%.
Outcome: AF is independent RF for recurrent iCI (46.5%).
Mortality: 28-day mortality: 19.1% vs. 12.0% in non-AF
group, adjusted mortality risk: 20% higher, 3-month
mortality: 32.8% vs. 19.9%.
Neurological deficit: NIHSS is significantly more severe
compared to non-AFpts.
Lesion size: iCIs significantly larger, more disabling.Silent
infarction found in 87% pts..
ECG abnormalities found in 68.1% vs. 21.3% (Holter: conv.
ECG). In improved pts: 43.0% vs. 18%. In deteriorated pts:
68.0% vs. 33.0%.
Heart and Brain: isolated arrhythmia: CBF-8.0%,
AF-12.0%, A/V tachyarrhythmia 25.0%.
CI prognosis: Five ECG abnormalities created (peaked
P-wave, T-wave, longer QT arrhythmia, ST-changes).
Combination of two/three abnormalities are associated with
higher incidence, death, complications. CAD, IHD, CVD
(HF). Close correlation between HFs with or without
congestion and NIHSS was found (n=660) HRV/BPV/BRS.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

158 Posters, Sunday 9 September
P1163
Ankle brachial index is a strong predictor
of stroke events in the general population
J. Gronewold1, M. Bauer2, N. Lehmann3, K. Krger4,
S. Moebus3, K.-H. Jckel3, R. Erbel2, D. Hermann1,
Heinz Nixdorf Recall Study Investigative Group
1Vascular Neurology and Dementia, 2Cardiology, University
Hospital Essen, 3Medical Informatics, Biometry and
Epidemiology, University of Duisburg-Essen, 4Angiology,
Helios Klinikum Krefeld, Germany
Introduction: Predictors of cerebrovascular events gain
importance in secondary stroke prevention. Herein, we
investigate the value of the ankle brachial index (ABI), a
non-invasive marker of atherosclerosis, as stroke predictor
in addition to established risk factors that are part of the
Framingham Risk Score (FRS).
Methods: 4299 subjects from the population-based Heinz-
Nixdorf-Recall Study (45-74 years; 47.3% men) without
previous stroke, coronary heart disease and myocardial
infarction, which received detailed baseline assessments,
were followed up for ischemic and hemorrhagic stroke
events over 7.91.7 years. Cox regressions were used to
evaluate FRS variables [sex, age, smoking, diabetes, LDL,
HDL, systolic blood pressure] and ABI as stroke predictors.
Results: A total of 69 strokes (61 ischemic, 8 hemorrhagic)
occurred during the observation period. Patients suffering
stroke had significantly lower ABI values at baseline (1.02
vs. 1.13, p<0.001). In multivariable regressions, ABI was a
strong independent stroke predictor (hazard ratio=0.76 per
0.1, confidence interval=0.67-0.87; p<0.001) in addition to
age (1.49 per 5 years, 1.23-1.79; p<0.001) and systolic
blood pressure (1.34 per 10mmHg, 1.22-1.48; p=0.001).
ABI similarly predicted strokes in men and women and in
subjects above and below 65 years. In subjects belonging to
the highest FRS (>13%) and lowest ABI (1.08) tertile
stroke risk was particularly elevated. In the latter, low ABI
values significantly increased stroke risk (p for trend=0.009).
Conclusion: ABI is a strong independent stroke predictor
in addition to age and blood pressure, particularly in
subjects with vascular risk profile, where ABI identifies
subjects at high stroke risk.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1164
Intra-hospital delays in stroke patients
treated with rt-PA: impact of pre-
admission notification to the emergency
medical system and to the neurologists
B. Casolla1,2, M. Bodenant1, M. Girot3, C. Cordonnier1,
J.-P. Pruvo4, E. Wiel3, D. Leys1, P. Goldstein3
1Department of Neurology, Univ Lille Nord de France, CHU
Lille, EA 1046, Lille, France, 2Dep. of Neurosciences,
Mental Health and Sensory Organs (NESMOS), SantAndrea
Hospital, University Sapienza, Rome, Italy, 3Department of
Emergency Medicine and SAMU 59, 4Department of
Neuroradiology, Univ Lille Nord de France, CHU Lille, EA
1046, Lille, France
Introduction: Pre-hospital notification enhances
thrombolysis rate and improves intra-hospital delays, but
the impact of notification to the neurologist by the
emergency medical system (EMS) call centre remains
unknown.
Our aim was to compare pre- and in-hospital delays in
stroke patients treated by intravenous (i.v.) rt-PA with and
without pre-hospital notification.
Methods: We compared baseline characteristics and
in-hospital delays in stroke patients treated by rt-PA with a
high-level notification (call to EMS and discussion EMS-
neurologist), a low-level (call to EMS without discussion
EMS-neurologist) and no pre-hospital notification.
Results: Of 302 consecutive patients (165 women, 54.6%;
median age 74 years, interquartile range [IQR] 59-83),
patients with high-level, low-level and no notification
differed for the severity at admission (median national
institutes of health stroke scale respectively of 12, IQR
7-17; 9, IQR 6-15, and 8, IQR 6-14, p=0.029). Patients with
high-level notification had shorter (i) admission-to-
completion of imaging times (27 min, IQR 14-35) than
patients with low-level notification (35 min, IQR 17-54) or
no notification (36 min, IQR 30-58) (p<0.01); (ii) door-to-
needle times (49 min, IQR 39-62 vs. 57 min, IQR 39-81 vs.
63 min, IQR 51-97; p = 0.003); and (iii) onset-to-needle
times (140 min, IQR 110-175 vs. 155 min, IQR 106-230 vs.
182 min, IQR 131-234; p < 0.001). They did not differ for
onset-to-admission time and imaging-to-needle time.
Conclusion: Pre-hospital notification by the EMS reduces
intra-hospital delays in patients eligible for rt-PA, but the
benefit is higher in case of discussion between the EMS and
the neurologist before admission.

P1165
The immune response impairment was
more pronounced in patients who
developed severe ischemic stroke
P.A. Chemrukov1, N. Goncharova2, M. Potapnev2,
U. Shabalina1, I. Petrovich1, E. Oganova3, E. Sidorovich3
1Emergency Hospital, The Belarus Research Center of
2 Hospital, 2Medical Faculty, University of Helsinki,
Transfusiology and Medical Biotechnologies, 3The Belarus
Research Center of Neurology and Neurosurgery, Minsk,
Belarus
Introduction: The association of inflammatory and
infectious processes with ischemic stroke has been
identified by so far. The aim of our study was to define the
role of immune response impairment in patients who
develop severe ischemic stroke.
Methods: In 89 patients with ischemic stroke the relative
content of T- and B-lymphocytes among peripheral blood
mononuclear cells were analyzed using the monoclonal
antibodies CD3/CD4/CD8, CD4/CD154 and CD19/CD40
(Beckman Coulter) by flow cytometry. The serum levels of
separate inflammation markers were also determined. All
patients were divided into four groups, i.e. the patients with
mild (n=29), moderate (n= 24), severe (n=24) and extremely
grave stroke (n=12). Healthy patients comprised the controls
(n=13).
Results: Decrease in CD3+ (p=0.00007),
CD3+CD4+(p=0.02), CD3+CD8+ cells (p=0.02) was found
in four groups of patients with stroke as compared to the
controls. The contents of CD3+ (54.010.4% vs. 63.68.7%,
=0.028), CD3+CD4+ (30.210.4% vs. 39.65.7%,
=0.01), CD4+CD154- (21.25.9% vs. 32.75.3%,
=0.02), CD40+CD19- cells (51.20.03% vs. 64.44.4%,
=0.01) were lower, while those of CD19+ (13.66.5% vs.
9.43.5%, =0.02), CD4+CD8+ cells (3.61.8% vs.
1.81.3%, =0.02) were higher in patients with extremely
grave stroke as compared to patients with mild stroke. The
reduction in T-helper cells correlated with the rise in hsCRP
(R=-0.34, p=0.01), while the increase in CD4+CD8+ and
CD3-CD8+ correlated with the severity of ischemic brain
lesions (R=0.049 , p=0.02).
Conclusions: Our findings suggest that stroke-induced
immune response impairment should be considered in
developing treatment strategy, especially in cases of
extremely grave stroke.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 159
P1166
Intracerebral haemorrhage (ICH) patients
as organ donors
T. Sairanen1, A. Koivisto2, A. Koivusalo3, H. Isoniemi3,
T. Tatlisumak1
1Department of Neurology, Helsinki University Central
3Department of Surgery, Division of Transplantation and
Liver Surgery, Helsinki University Central Hospital,
Helsinki, Finland
Introduction: Intracerebral haemorrhage is the most
devastating type of stroke. ICH is among the most common
reasons for brain death and thus carries the potential for
organ donation. We identified potential organ donors among
ICH patients.
Methods: A retrospective chart review of consecutive ICH
patients treated at the Helsinki University Central Hospital
(HUCH), 2005 to 2010 (n= 1 013). To assess the number of
potential organ donors we identified patients who died
within 14 days, were 75 years of age, had no cancer or
other medical conditions that would be a contraindication to
organ donation, nor did they experience severe infection
during hospitalization. The number of actual donations was
also assessed.
Results: The number of deaths was 254/1013 (25%). Of
these deceased 149 were 75 years (59%). There were 14
with cancer (3 prostate, 2 breast, 2 lung, and one of bone,
liver, maxillary, lymphoma, sigmoid, melanoma, and
bladder). Of the remaining 135 9 had a prior medical
condition (3 rheumatoid arthritis, 2 type II diabetes with
liver disease, and 1 microscopic polyangiitis, drug abuse,
Eisenmenger syndrome, and carrier of ESBL). For 1 patient
organ donation was denied by the bereaved. Among the
remaining 126 patients 8 became donors. Of the remaining
118 patients 24 had pneumonia and/or sepsis, and thus
finally 94 of 254 (37%) patients who deceased were
identified as missed potential donors. The conversion rate
(actual donors divided by potential donors) was 8.5%.
Conclusions: A considerable number of potential organ
donors exists among deceased ICH patients.
160 Posters, Sunday 9 September
P1167
Successful use of intravenous
recombinant tissue plasminogen (rtPA) in
a pregnant woman with cardio-embolic
stroke: a case report
B. Ratajczak, S.B. Sando, A.H. Aamodt
Department of Neurology, St. Olavs Hospital, Trondheim,
Norway
Introduction: Pregnancy-related ischaemic stroke is a
challenging medical problem. Historically, the use of rtPA
thrombolysis in pregnancy and early post-partum period has
been regarded relatively contraindicated. The major
concerns are the risk of bleeding and complications in both
mother and child. The safety of thrombolysis in acute stroke
in pregnancy is not clarified, as these patients are regularly
excluded from trials. Case reports that show a beneficial
effect of thrombolysis in acute ischaemic stroke in
pregnancy are scarce.
Results: The patient was a 33-year-old woman who
developed acute stroke symptoms, with right-sided
hemiparesis and expressive aphasia in the 7th gestational
week. Acute MRI of the brain showed restricted diffusion in
three different areas in the left hemisphere. An intra-venous
rtPA treatment was administered according to a standard
protocol. Her neurological symptoms improved rapidly, no
complications developed. The diagnostic work-up did not
reveal any carotid atherosclerosis, coagulopathy or
immunological disease. Echocardiography showed PFO
with right-left shunt. She was discharged with prophylactic
therapeutic enoxaparin treatment, and had no further
embolic events. At 38 weeks gestation, she delivered a
healthy boy.
Conclusion: As of now, about 200 patients are reported to
have been treated with fibrinolytics in pregnancy for various
medical conditions (thrombosed prosthetic valves,
myocardial infarction, pulmonary embolism and ischaemic
stroke). Complication rates of thrombolytic therapy in
pregnant patients are not higher than in the large randomized
trials. Careful consideration of individual risk and benefits
must be made before using thrombolysis in pregnancy. An
international registry of patients may be useful.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1168
Endoscopic removal of intraventricular
haemorrhage combined with post-
operative intraventricular thrombolysis
J. Kuzibayev
Neurosurgery, Republican Research Center of Emergency
Medicine, Tashkent, Uzbekistan
The treatment of acute intraventricular haemorrhage is still
debatable. Positioning of an external ventricular drainage is
a common procedure although with the high risk of
infection. Lately few authors have described the endoscopic
evacuation of intraventricular clots as a treatment option for
such cases. Intraventricular thrombolysis has been described
with rewarding results since more than a decade. We used
endoscopic removal of intraventricular haemorrhage
combined with postoperative intraventricular thrombolysis
in 24 patients with intraventricular haemorrhage. A rigid
endoscope (Aesculap) was inserted in the frontal horn
through, after prolonged irrigation, partially organized
haemorrhagic clots were detected and removed with the aid
of the suction tip. At the end of the procedure an external
ventricular drainage was positioned. A post-operative CT
scan was obtained in all patients to assess the organized
clots and post-operative intraventricular thrombolysis was
performed to evacuate the clots. In no patient we observed
complication related to the procedure. The results of
treatment were compared with the group of patients (21)
treated with single external ventricular drainage. All patients
in the main group survived: good recovery was in 12
patients, moderate disability in 7, severe disability - in 5. In
the group treated with single external ventricular drainage
7 patients died, good recovery was in 3, moderate disability
3, severe disability in 8. Our experience suggests that the
endoscopic removal of intraventricular haemorrhage
combined with post-operative intraventricular thrombolysis
of intraventricular clots is a useful treatment option for
patients with intraventricular haemorrhage.

P1169
The effect of a public information media
campaign on acute stroke presentation
and management in an Irish hospital
U. Moffatt1, N.A. Faheem2, D. Kelly3, P. Hickey4
1Medical 7, Sligo General Hospital, Sligo, 2Medical,
University College Hospital Galway, 3West of Ireland GP
Training Scheme, UCHG, Galway, 4Medicine, Sligo General
Hospital, Sligo, Ireland
Introduction: Stroke is the third most common cause of
death and the most common cause of acquired major
physical disability in Ireland. In people with sudden onset
of neurological symptoms a validated tool such as FAST
(Face Arm Speech Time) should be used outside the hospital
to screen for the diagnosis of stroke or TIA.
Objectives: To determine whether the FAST Campaign
increased public awareness of stroke and thus presentation
patterns of stroke/stroke-like symptoms to hospital, reduced
the time from onset of symptoms to presentation to hospital,
whether patients had CT brain within 3 hours, with view to
thrombolysis if applicable.
Methods: Retrospective audit undertaken on all patients
admitted to Sligo General Hospital with stroke/TIA, six
weeks before and after, the official launch of the FAST
campaign in Ireland, 6th May 2010 (i.e. between 25th March
and 17th June). A list of audit candidates was compiled by
the Stroke Clinical Nurse Specialist using the Stroke
Register. Data was collected between October 2010 and
January 2011 using a pro-forma. Data was analysed by the
Clinical Audit Support Team.
Results: Reduced time from onset of symptoms to hospital
presentation. Faster access to CT brain. Increased activation
of Stroke Pathway. Increased number of patients received
thrombolysis. Increased numbers received anti-platelet
within 48 hours.
Conclusion: Information media has a big influence on Irish
society and should be used as much as possible. 50%
increase in suspected stroke hospital presentation within 3
hours. 50% increase in number thrombolysed.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 161
P1170
Effect of weekday compared to weekend/
holidays admission on stroke outcome in
a comprehensive stroke unit
J.C. Portilla1, R.M. Romero1, F. Lopez1, A. Falcon1,
M. Calle1, A. Serrano1, G. Gamez-Leyva1, M. Gomez1,
P.E. Jimenez1, M.D.M. Caballero1, J.M. Ramirez2,
I. Casado1
1Hospital San Pedro de Alcntara, Caceres, 2Hospital
Infanta Cristina, Badajoz, Spain
Background: Several studies have reported disparities in
treatment and clinical outcome between stroke patients
admitted on weekend compared to a weekday because of
staffing level is reduced in those days. However, there is
evidence that protocolized care in a Comprehensive Stroke
Center should overcome this effect. Our objective is to
compare the outcome of patients admitted for stroke in a
Comprehensive Stroke Unit (CSU) according to the period
of admission.
Methods: Retrospective study. We included consecutive
patients with acute stroke admitted in our CSU for 36
months. Established protocols were applied. Two groups
were categorized: A (weekday) and B (weekend/holidays).
We compared thrombolytic use, complications and outcome
between two groups with adjustment for stroke type,
severity and other demographic factors.
Results: We included 622 patients (A:311, B:311). There
were no significant differences in demographics, type or
severity of stroke (NIHSS A: 6.9 and B: 7.1). Thrombolysis
was performed in A 8.7 % and B 7.7% (p0.05). Favourable
outcome (Rankin 2) were achieved in A: 59.5% and B:
58.8 % (p0.05). No differences in mortality were observed
(A 7.7% y B: 8%. p0.05).
Conclusions: At our CSU protocolized and continous care
to the patients by neurologists and specialized nursing
overcome the effect that the admission period may have on
thrombolytic treatment and stroke outcome.
162 Posters, Sunday 9 September
P1171
Predictive value of acute measurement of
multiple plasma neuronal and astroglial
markers on neuronal damage following
ischemic stroke
S.-H. Oh1, S.-Y. Park1, J. Kim1, Y.-K. Kim2, D.-A. Shin3,
J. Song4, O.-J. Kim1
1Department of Neurology, CHA University, 2Institute for
Clinical Research, CHA Bundang Medical Center,
3Department of Neurosurgery, CHA University, Seongnam,
4CHA Stem Cell Institute, CHA University, Seoul, Republic
of Korea
Background and aims: Prediction of extensive neuronal
damage in the acute phase of ischemic stroke is important
for prevention of secondary neuronal injury. The objective
of the present study is to investigate the predictive value of
plasma neuronal and astroglial protein levels on extent of
neuronal damage in ischemic stroke.
Methods: We measured plasma concentrations of neuronal
(neuron specific enolase (NSE), neuroglobin (Ngb) and
visinin-like protein 1 (VSNL-1)) and astroglial (glial
fibrillary acidic protein (GFAP) and S100B) markers in 175
patients with acute ischemic stroke (6-24 hours after
symptom onset). Total 109 non-stroke individuals were
included as control group. The extents of neuronal injury
were assessed by measurement of infarct volume (5 to 7
days after symptom onset).
Results: Among 5 neuronal and astroglial markers, plasma
S100B, GFAP, and NSE levels were significantly elevated
in the stroke group compared to the control group. In
Pearson correlation analysis, plasma S100B (r=0.72), GFAP
(r=0.68) and NSE (r=0.41) levels were significantly
correlated with infarct volume. In a multiple regression
model of biochemical markers (S100B, GFAP, NSE) after
adjustment of confounding factors (age, sex, systolic BP,
fasting glucose, NIHSS at admission, C-reactive protein
(CRP), white blood cell count), NIHSS at admission
(=0.41, p<0.01), plasma GFAP (=0.31, t=5.7, p<0.01),
S100B (=0.29, t=4.9, p<0.01), CRP (=0.11, t=2.6,
p=0.01) were independent predictors for infarct volume.
Conclusions: Acute measurement of plasma S100B and
GFAP levels in addition to initial clinical severity score
provides valuable information for prediction of extensive
neuronal damage following ischemic stroke.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1172
HAT score predicts hemorrhagic
transformation and functional outcome in
acute ischemic stroke patients treated
with intravenous alteplase
D.-I. Chang, S.H. Heo
Department of Neurology, Kyung Hee University, College of
Medicine, Seoul, Republic of Korea
Background: Intravenous thrombolysis with alteplase is
the most effective therapy for acute ischemic stroke, but
hemorrhagic transformation (HT) is a potentially dangerous
complication of thrombolysis. However, there was lack of
research to find predictors of HT after thrombolysis in
Korean stroke patients.
Methods: From 2003 to 2009, patients with acute ischemic
stroke who received intravenous alteplase were prospectively
enrolled into Kyung Hee University Hospital stroke registry.
CT or MRI scan with gradient echo sequences was
performed within 12-36 hours after IV thrombolysis.
Hemorrhage after thrombolysis (HAT) score of each patient
(range; 0- minimum risk, to 5- maximum risk) was
collected. We evaluated the predictability of HAT score for
HT and symptomatic intracranial haemorrhage (sICH)
using c statistics.
Results: Among 151 consecutive patients, 35 patients had
HT on follow-up brain images. In multivariate logistic
regression analysis, atrial fibrillation (OR=2.709, 95%
CI=1.118-6.567) and low density on CT scan (OR=3.419,
95%CI=1.281-9.121) increased the risk of HT after IV
thrombolysis. Patients with sICH and unfavourable (mRS
2-6) outcome at 3 months had higher HAT scores.
Conclusions: HAT score can be used for predicting the risk
of sICH in intravenous thrombolysis. In addition, it can
predict long-term clinical outcomes.

P1173
Intravenous rt-PA therapy for very old
stroke patients
C. Atsumi, H. Akiyama, H. Mizukami, K. Shimomura,
F. Maki, T. Yanagisawa, Y. Hasegawa
Department of Neurology, St. Marianna University School of
Medicine, Kawasaki, Japan
Introduction: In Japan, demographic changes will result in
a rapid increase of patients aged 90 years, but little is
known about outcomes in these patients after intravenous
recombinant tissue plasminogen activator (rt-PA) for acute
ischemic stroke. We aimed to assess safety and functional
outcome in very old stroke patients treated with rt-PA.
Methods: We analyzed retrospectively collected data of 30
consecutive acute stroke patients aged 80 years among 101
all stroke patients treated with rt-PA in our hospital from
October 2005 to September 2011. Their presenting
characteristics, favourable outcome (modified Rankin scale
0-2), mortality at discharge were compared between age 80
to 89 (octogenarians) and 90 to 99 (nonagenarians).
Results: 23 octogenarians (mean age; 83.73.0 years) and
7 nonagenarians (mean age; 910.8 years) were eligible for
our study. Gender and onset-to-needle time were similar
(60.7% women and 13441 minutes in octogenarians, and
57.1% women and 13925 minutes in nonagenarians).
Cardioembolic stroke was the most frequent stroke subtype
in both groups (19 of 23 octogenarians (82.6%) and 7 of 7
nonagenarians (100%). Median NIHSS scores at admission
and at discharge were 17 and 5 in octogenarians and 14 and
10.5 in nonagenarians. Nonagenarians less often had a
favourable outcome (14.2% vs. 30.4%, respectively) and
had a higher incidence of mortality (14.2% vs. 4.3%,
respectively) than did octogenarians.
Conclusions: Our study suggests less favourable outcomes
in nonagenarians as compared with octogenarians after
rt-PA.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 163
P1174
Complex interrelations between
inflammation and vascular risk factors
determine cognitive impairment in acute
ischemic stroke
M.P. Danovska1, B.B. Stamenov1, M.L. Alexandrova2
1Neurology, 2Physics & Biophysics, Medical University
Pleven, Pleven, Bulgaria
Introduction: Cognitive impairment following acute
ischemic stroke is common, yet its determinants are not
fully understood
Objective: This study aims to identify significant
determinants, associated with increased risk of cognitive
impairment in the acute phase of ischemic stroke.
Patients and methods: The study was carried out on 47
patients (26 males and 21 females), median age 63 years,
with no baseline dementia. All the patients were assessed
with NIHSS, MMSE and mRS. Routine biochemical
analyses and CT scan were performed within the first 24
hours of stroke onset. Serum concentrations of hs-CRP
were measured on admission.
Results: Our results showed that 57% of the patients had
cognitive impairment at discharge. We also established that
age (p=0.000), education (p=0.001), baseline systolic blood
pressure (p=0.015), hyperglycaemia (p=0.021) and serum
hs-CRP level (p=0.050) on admission were significant
determinants of early cognitive deterioration. Of all the
variables, serum hs-CRP level (OR 1.12 (1.00-1.25),
p=0.049), gender (OR 5.97 (1.05-34.00), p=0.044) and age
(OR 1.30 (1.09-1.55), p=0.004) were identified as
independent predictors of post-stroke cognitive impairment.
After baseline systolic blood pressure was entered in the
predictive model, gender lost its statistical significance of
independent predictor, which could be explained with
gender-related variations of arterial hypertension.
Conclusion: Measuring serum hs-CRP level along with
some clinical and neuroradiological predictors is a rational
approach in the complex assessment of acute ischemic
stroke in view of treatment strategies and prevention of
cognitive deterioration.
164 Posters, Sunday 9 September
P1175
Aspects of venous thrombo-embolism
prophylaxis in patients with acute stroke
I. Macavei1, I. Huza2, A. Macavei3
1Neurology, University of Medicine and Pharmacy, Tirgu
Mures, 2Neurology, Emergency Clinical County Hospital
Mures, 3General Medicine, Clinical County Hospital Mures,
Trgu-Mures, Romania
Introduction: Stroke is the leading neurological disorder
which causes prolonged motor impairment, associated with
an increased risk of venous thrombo-embolism.
Objectives: To assess the incidence of deep vein
thrombosiss (DVT) of lower limbs, appreciate the use of
thromboprophylaxis in patients admitted to hospital with
stroke with severe motor deficits and bedridden.
Patients and methods: The study included 1101 patients,
out of which 975 (81.11%) had an ischemic stroke, 132
(10.98%) had a hemorrhagic stroke and 86 (6.90%) had a
history of ischemic stroke associated with hemorrhagic
stroke and severe motor deficits. In order to diagnose DVT,
peripheral venous vascular Doppler was performed. Stroke
severity at admission was assessed using NIHSS. Work
methodology consisted of retrospective, partially
prospective, clinical study. Sources of information were
clinical observation sheets, with gathering data about
thromboprophylactic treatment, type of therapy, side effects,
duration of bedridden period.
Results: Out of the followed patients, 16 had signs of DVT
on Doppler examination, but only 6 had clinical symptoms.
According to NIHSS, 2.90% had severe neurological
impairment (>25 points), 33.60% had moderate impairment
(5-14 points) and 63.48% had mild impairment (<5 points).
277 patients (25.19%) received low molecular weight
heparin, while in 63 patients (5.72%) mechanical methods
were used. Hemorrhagic side effects were encountered in
small percentage, not exceeding the numbers from the
reference literature. Thromboprophylactic treatment was
received within 24 hours from admission in 90.5% of the
patients.
Conclusions: Thromboprophylaxis in patients with stroke
is underused or improperly used. Risk is perceived as being
smaller than in reality, because half of patients with DVT
are asymptomatic.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1176
Stroke epidemiology in Shiraz, Southern
Iran: a hospital-based single-center
retrospective longitudinal study
A. Safari1,2, R. Safari1, A. BorhaniHaghighi1,
M. Sharifian1
1Shiraz University of Medical Sciences, 2Shiraz University,
Shiraz, Iran
Background: Published data about stroke epidemiology in
Southern Iran are scarce. We tried to find the demography,
socioeconomy and mortality of patients with stroke in a
referral center in south of Iran.
Methods: This was a hospital-based single-center
retrospective longitudinal study performed in Namazi
Hospital, Shiraz, Southern Iran. Patients with the
International Classification of Diseases, 9th edition-Clinical
Modification (ICD-9-CM) codes of 160-169 were extracted
from hospital. database. Age, sex, inhabitation, coverage by
charity insurance indicating for low socioeconomic status,
length of hospitalization, discharge destination were
investigated.
Results: 16,351 patients, 8759 (53.6%) males and 7592
(46.4%) females, were recruited. Mean age of the patients
63.4 (95% CI 63.1 to 63.6) years. 2326 (14%) patients were
younger than 45 years was (young adult stroke). 428(0.026
%) of patients were in the paediatric age group (equal or
less than 18 years old. 2935 (19.95%) of the patients
inhabited rural areas and 13,416 (80.05%) were from urban
areas. 875 (5.35%) patients were from very low
socioeconomic status covered by charity insurance. Mean
hospital stay was 6.3 (95% CI 6.2 to 6.4) days. Stroke
hospital mortality rate was 20.5%, significantly higher in
females, paediatric age group, patients from low
socioeconomic status. (all P values <0.001). Mortality rate
of the stroke patients was significantly increased from 2001
till 2009. (P value <0.001).
Conclusions: Stroke is a major health issue in Iran with
higher mortality and larger proportion of young adults in
comparison to Western countries.

P1177
Evaluation of the lesions in the left
thalamus in patients with subcortical
vascular cognitive impairment using 1H
magnetic resonance spectroscopy and
diffusion tensor imaging
P. Lv, Y. Dong, L. Li
Department of Neurology, Hebei General Hospital,
Shijiazhuang, China
Objective: To investigate the lesions of the left thalamus
and the correlation with cognition in patients with SIVD by
using 1H magnetic resonance spectroscopy (1H-MRS) and
diffusion tensor imaging (DTI).
Methods: 14 patients with VaD, 14 patients with VCIND,
and 12 normal controls (NC) were recruited. The quantitative
analysis of N-acetylaspartate (NAA), myoinositol (mI),
Choline (Cho) and Creatine (Cr) resonance signals in region
of interests (ROI) located in the left thalamus were
measured. Fractional anisotropy (FA) and mean diffusivity
(MD) in the same region were measured by DTI. The
relationship was described among the MRS, DTI ratios and
cognitive impairment reflected in MMSE and trail making
test (TMT).
Results:
(1)The NAA/Cr ratio showed a gradual decrease in the left
thalamus of SIVD patients compared with controls
(F=3.656, p=0.038). No significant difference was found
between VaD and VCIND patients.
(2)Compared with controls, patients with VaD and VCIND
demonstrated increased MD value in the left thalamus
(F=3.882, p=0.030). No significant difference between VaD
and VCIND patients was observed (p>0.05).
(3)No correlation was found between MRS value and DTI
parameters in the ROI (p>0.05). (4)A significant positive
correlation was observed between TMTb time and Cho/Cr
(r=0.520, p=0.001) and also MD value in the left thalamus
(r=0.305, p=0.044).
Conclusions: The axonal loss or dysfunction and diffusion
abnormalities in the thalamus could be found in early SIVD.
The Cho/Cr value in the left thalamus and MD values in
bilateral thalamus were correlated with executive function.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 165
P1178
A case of only peripheral type facial palsy
in ponto-medullary junction area
infarction
J.H. Han, D.E. Kim
Department of Neurology, Seoul Veterans Hospital, Seoul,
Republic of Korea
Introduction: Unilateral facial palsy of the peripheral type
without other neurologic deficits is mostly diagnosed as
Bells palsy. We present an unusual case of ipsilateral
peripheral facial palsy in dorsolateral ponto-medullary
infarction without other neurologic deficits.
Case report: A 69-year-old woman was admitted with
sudden left facial weakness. She had no other neurologic
deficit, except for left peripheral type facial palsy. She had
a presumptive diagnosis of Bells palsy. Nerve conduction
study showed normal terminal latency and compound
muscle action potential (CMAP) amplitude in right and left
facial nerves. Blink reflex test showed normal R1 responses
on both sides. But, ipsilateral R2 and contralateral R2
responses were not obtained by the stimulation on the
affected side. These findings were indicative of left facial
neuropathy, due to left medullary lesion. Diffusion weighted
(DWI) brain MRI demonstrated high signal lesion in left
dorsolateral ponto-medullary junction. Apparent diffusion
coefficient (ADC) brain MRI showed low signal lesion in
the same area.
Conclusion: Occasionally, peripheral type facial palsy was
found in pontine infarction. But, isolated peripheral facial
palsy without other neurologic defects is a rare condition in
brainstem infarction. Generally, if a patient presents with
peripheral type facial palsy without other neurologic
abnormalities, brainstem lesions were not considered. This
case shows us that ponto-medullary infarction presents only
peripheral type facial palsy without other neurologic
abnormalities. So, if a patient admits with peripheral type
facial palsy, we must make up electrophysiological study
and brain image.
166 Posters, Sunday 9 September
P1179
Improving factors for patients with left
unilateral spatial neglect
M. Yamada1, Y. Nakamura1, M. Kawaguchi1, Y. Satoh1,
A. Satoh2, M. Tsujihata2
Rehabilitation, 2Neurology, Nagasaki Kita Hospital,
1
Nagasaki, Japan
Objectives: The aim of this study was to determine the
factors to ameliorate USN.
Patients and methods: 51 patients (32 male and 19 female,
ages 40-85, average educational level 11.3 years, all right-
handed) with a right hemisphere stroke who were admitted
to the hospital for rehabilitation were screened for USN. All
patients were evaluated at 1 month and 3 months using The
Behavioural Inattention Test (BIT). The cut-off value of 131
was used to determine whether USN present or not. The
patients who showed a BIT score over 131 at 3 months were
classified as the improved group (17 patients) and those
with less than 131 were the unimproved group (34 patients).
In total 17 items were studied to determine the factors
associated with the improvement of USN; ages at onset,
educational level, MMSE, KOHS block design test, Simple
test for evaluating hand function (STEF), Trail making test
(TMT-partA), Functional Independence Measure (FIM)
(total score, mobility ADL and cognition), BIT (total score,
and its subitems; line, letter and star cancellation, line
bisection, and figure and shape copying).
Results: The average scores of 12 items except for age,
education level, MMSE, TMT part 2, and FIM cognition at
1 month were significantly higher in the USN improved
group than those in the unimproved group.
Conclusions: The present study indicated that high scores
on the Bit behavioural test, shape copying, and STEF
evaluated within 1 month after the onset of stroke serve to
predict a good prognosis of USN.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1180
Real time measurement of extracellular
glutamate release in a global ischemic rat
model treated with nimodipine
H.-K. Park1,2, G.-J. Lee1,2, S.-W. Kang1,2, S. Choi1,2,
S.-K. Choi3
1Kyung Hee University, College of Medicine, 2Healthcare
Industry Research Institute, 3Kyung Hee University Hospital,
Seoul, Republic of Korea
Background and aims: It is generally thought that cerebral
ischemia is associated with extracellular concentrations of
the excitatory amino acids. It was known that nimodipine
combined with L-type voltage-gated calcium channels
prevented calcium influx inside the cell. In order to define
the effect of nimodipine on glutamate release, we monitored
extracellular glutamate release in real-time in a global
ischemia rat model with eleven vessel occlusion.
Methods: Changes in cerebral cortical blood flow (CBF)
were monitored by laser-Doppler flowmetry with cortical
glutamate levels by amperometric biosensor. A ten minute
11VO cerebral ischemia was initiated by pulling the snares
on the common carotid arteries. Nimodipine was permeated
from the burr hole beside of CBF probe during the beginning
of the ischemic period. We performed Nissl staining for a
histological assessment of neuronal cell damage.
Results: During the ischemic period, the mean maximum
change in glutamate concentration was 133.222.57M in
the ischemia group and 75.424.22M (p<0.001) in the
group treated with nimodipine. The total amount of
glutamate released was significantly different (p<0.001)
between groups during the ischemic period. The %cell
viability in hippocampus was 47.505.64 (p<0.005) in the
ischemia group, compared with the sham group. But, the
%cell viability in the nimodipine treatment group was
95.466.60 in the hippocampus (p<0.005).
Conclusion: We suggest that nimodipine treatment is
responsible for the protection of neuronal cell death through
the suppression of extracellular glutamate release in the
11-VO global ischemic model of rats.

P1181
Prevalence of combinatorial genetic
polymorphisms of CYP2C9 and VKORC1
in acute stroke patients: implications for
warfarin management
S. upe1, Z. Poljakovi2, N. Boina3, V. Matijevi2,
A. Bazina2, A. Miima2
1Department of Neurology, University Hospital Center
Zagreb, 2Department of Neurology, 3Department of
Pharmacology, University of Zagreb, School of Medicine,
Zagreb, Croatia
Background: Patients with cardioembolic stroke or stroke
due to extracranial artery dissection or cerebral sinus
thrombosis require urgent anticoagulant therapy initiation.
Among those patients, risk of embolic stroke recurrence is
5-7% within the first week with an increased risk of
bleeding into the infarct zone. Many reports confirmed that
CYP2C9 and VKORC1 genetic polymorphisms have strong
influence on interindividual warfarin sensitivity and
significantly alter the effective warfarin dose. In acute
stroke patients it is important to select initial doses based on
individual genotype in order to achieve earlier
anticoagulation and to reduce the risk of developing
warfarin side effects in early initiation of therapy,
particularly among carriers of multiple allelic variants.
Methods: We determined the frequency of alleles of
CYP2C9(*2*3) and VKORC1(-1173C>T) genes among
106 patients hospitalized for acute stroke with indications
for anticoagulant therapy. Among them were 36 previously
anticoagulated patients. The impact of CYP2C9(*2*3),
VKORC1(-1173C>T) genetic polymorphisms on warfarin
dosage was gauged using a published algorithm. We
analyzed which alleles of CYP2C9(*2,*3) and VKORC1-
1173C>T contribute to achieve earlier anticoagulant effect,
stable maintenance dose, which allelic variants spent the
longest time in therapeutic INR range and which contribute
to undercoagualtion.
Results: Target INR was firstly achieved among the patients
with polymorphism for both defective alleles (VKORC1TT,
CYP2C9*3/*3). Application of pharmacogenetic algorithm
enabled the correct assessment of dose in 81.5% patients
who required a higher or lower warfarin dose. The most
common genotype among previously under-anticoagulated
patients who developed stroke with a share of 34% was a
wild CYP2/C9 wt/wt genotype.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 167
P1182
Successful intra-arterial thrombolysis in a
patient with subarachnoid haemorrhage
developed after bridging intravenous and
intra-arterial thrombolysis
J.-H. Kwon1, W.-J. Kim1, M.-S. Kim2, S.-H. Lee2
Neurology, 2Ulsan University Hospital, Ulsan, Republic of
1
Korea
Subarachnoid haemorrhage (SAH) is a contraindication of
intravenous thrombolysis (IVT) with rt-PA. Reocclusion
after IVT is a well-known complication and intra-arterial
thrombolysis (IAT) is a relatively common procedure to
open the re-occluded vessels. We report a patient who had
recurrent acute ischemic stroke which was successfully
recanalized with IAT in spite of localized SAH developed
after IVT and IAT for acute ischemic stroke.
A 60-year-old woman with atrial fibrillation developed left
hemiparesis and gaze preference to the right side suggesting
right middle cerebral artery (MCA) territory infarction.
Brain CT at 20 minutes after symptom onset showed no
haemorrhage and IV rt-PA was administered. MR
angiography performed at 1 after IVT showed M1 occlusion
of the right MCA. The right MCA was recanalized after IAT
with urokinase and tirofiban. Her focal neurologic deficits
were fully recovered despite localized SAH in the left
parietal lobe. We treated her with anticoagulation for
prevention of recurrent ischemic stroke in spite of SAH.
However, she re-developed a right MCA territorial infarct
again at 3 days after successful thrombolysis. MR
angiography at that time revealed re-occlusion of the right
MCA. IAT with penumbra and urokinase was re-tried and
the right MCA was completely recanalized. She recovered
to 2 of modified Rankin Score at 3 months and her SAH
was not aggravated.
In conclusion, localized SAH could occur after IVT. IAT is
a considerable treatment option when a recurrent acute
ischemic stroke developed in a patient with SAH after IVT
and IAT.
168 Posters, Sunday 9 September
P1183
Ischemic stroke as a late complication of
brain radiotherapy during childhood: a
case report
C. Parmentier, Y. Vandermeeren, P. Laloux, E. Mormont
Neurology, CHU Mont-Godinne, Yvoir, Belgium
Background: Neurologists should be aware that survivors
of childhood brain cancer have an increased risk of stroke.
Stroke can occur as a delayed complication of brain
radiotherapy. We report a case that highlights the increased
risk of long-term cerebrovascular complications in such
patients.
Case-report: A 26-year-old patient presented with acute
sensory loss involving the right face, arm and leg and
clumsiness of the right arm. His previous medical history
was remarkable for smoking, alcohol abuse and a cerebellar
pilocytic astrocytoma discovered at the age of four, treated
by surgery followed by radiotherapy and chemotherapy.
Neurological examination revealed right hemihypesthesia,
right hemiataxia, right Babinski sign and a weakness of the
right arm (NIHSS=7). Head computed tomography revealed
calcifications of the left cerebellum, left temporal lobe and
of the basal ganglia. A brain MRI showed left thalamic and
parahippocampal hyperintense lesions in FLAIR and DWI
with a decrease of the apparent diffusion coefficient (ADC),
consistent with an acute ischemic stroke in the territory of
the left cerebral posterior artery. Magnetic resonance
angiography confirmed an occlusion of the left P2 segment.
Carotid and vertebral duplex-ultrasound and cardiac workup
were normal. Blood tests only showed a moderate
hyperlipemia. Thrombophilia screening was negative.
Alpha-galactosidase activity was normal.
Discussion: This case illustrates a late manifestation of
radiation-induced complication, namely intracranial steno-
occlusive disease and mineralizing microangiopathy. In
brain cancer survivors, the stroke workup should be
extensive and take into account unusual aetiologies such as
radiation-induced intracranial steno-occlusive disease.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1184
The territorial division and clinical
characteristics of anterior circulation
cerebral infarction
I. Stakena1, I. Zimaisa1, G. Enina1, I. Kikule1,
A. Platkajis2
1Department of Neurology and Neurosurgery, 2Department of
Radiology, Riga Eastern University Hospital Gailezers,
Riga, Latvia
Introduction: In the classification of anterior circulation
cerebral infarctions (ACCI) into subtypes there is not
sufficiently considered the involved artery, the territorial
area of blood supply and the size of infarction.
Patients and methods: 424 patients were examined with
ACCI who were treated at the Stroke Unit. All cases CI was
the first presentation and lacunar CI were not included. The
atherotrombotic CI were detected in 68.9%, but
cardioembolic CI - in 31.1% of patients.
Results: The vast majority of the patients were admitted
with MCA CI (98.1%) and only 1.2% had ACA and 0.7%
AChA infarcts. According to the damaged brain area MCA
and ACA CI were divided into territorial areas of
leptomeningeal (lm) and perforal (perf) arteries. The
analysis of the territorial area was only performed for the
MCA blood supply area. Most often MCA infarction was at
territory of lm arteries (73.6%) and of perf arteries only in
26.4%. Of all ACCI partial large infarction of the MCA lm
area was found significantly more often (44.1%) (p<0.005).
The incidence of other subtypes of MCA infarction (total
MCA, partial small MCA lm, large MCA perf and small
MCA perf) were similar and <15%. The clinical
characteristics of different MCA infarction subtypes differ
mainly according to the size of CI and territorial blood
supply area.
Conclusion: Elaborated supplement of ACCI classification
based on the involved arteries, territorial blood supply area
and the characteristics of infarction size is suitable for use
in neurovascular clinical practice.

P1185
Predilection for antihypertensive therapy
in patients from the stroke-risk group
E. Vereshchagina, E. Isakova, A. Kotov
Neurology, M.F.Vladimirsky Moscow Regional Clinical and
Research Institute, Moscow, Russia
Introduction: Arterial hypertension (H) is a most
investigated risk factor (RF) of cerebrovascular diseases
available for correction, but efficiency of AH therapy is low.
Materials and methods: A total of 197 AH patients were
asked to fill in questionnaires in order to study their medical
literacy and predilection to antihypertensive therapy (AHT).
Results: The patients were asked what index of arterial
blood pressure (ABP) they considered normal: 12.7% -
BP>140/80mmHg; 32.9% - 140/90-70; 23.4% - <140/90,
but >120/80; 25.4% - 120/80; and 5.6% patients could not
determine their normal ABP values. Regularly 58.4%
patients underwent AHT, not regularly - 37.1%; never -
4.7%. The causes of irregular or refuse of AHT; 58.5%
BP was not always elevated being normal sometimes
without preparations; 34.1% drugs were harmful for their
stomach, liver and kidneys, etc., 25.6% did not feel their
elevated ABP; 17.1% forgot to take preparations; 17.1%
were afraid to get accustomed to the drugs; 1.2%
complained of the unpleasant taste of the tablets; 12.2%
complained of the drug side effects; 12.2% considered
the drug cost too high; 15.9% refused to take so many
tablets; and 4.9% considered AHT ineffective.
Conclusion: The results obtained are indicative of the low
predilection to AHT, which is due to a low medical literacy
of the population. It should be noted that just the personal
attitude to the drugs (and not their high cost) was a main
cause of patients refusal of AHT.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 169
P1186
Stroke in atrial fibrillation can it be
prevented?
V. Turcanu1, A. Grosu2, N. Diaconu2, C. Gratii2,
G. Pavlic3
Clinical Military Hospital, 2Institute of Cardiology,
1
Institute of Neurology and Neurosurgery, Chisinau,
3
Moldova
Introduction: Despite the known increased stroke risk
associated with atrial fibrillation (AF) and the benefit of
oral anticoagulation (OAC) in high-risk patients, still ~20%
of all ischaemic strokes are atrial fibrillation related.
Aims: We aimed to evaluate the frequency of inappropriate
anticoagulation in all patients admitted with ischemic stroke
and AF and to calculate the theoretical number of
preventable strokes in case of proper guideline adherence
and also to assess secondary stroke prevention at discharge.
Methods: In this cross-sectional study, all patients with
ischemic stroke admitted to our hospital during January
2004 and December 2004 in which the diagnosis AF was
either known or established during hospital stay were
identified.
Results: We have included 206 patients with AF and
ischemic stroke. We have calculated the number of
preventable strokes in case AF patients would have received
adequate antithrombotic treatment on admission. On
admission, in 59% of the OAC eligible known AF patients
the drug was withheld. Improved antithrombotic guideline
adherence potentially would have prevented 54 out of the
206 (26%) ischemic strokes. At discharge at least 48% of
the patients were still insufficiently protected against
recurrent stroke.
Conclusion: Many known AF patients admitted with
ischemic stroke lack adequate antithrombotic treatment on
admission. Antithrombotic guideline adherence in these
patients could prevent a substantial number of strokes, but
secondary stroke prevention at discharge is also suboptimal.
170 Posters, Sunday 9 September
P1187
Mechanical thrombectomy with Solitaire
AB device in basilar artery occlusions
E.J. PalacioPortilla1, A. GonzlezSurez1,
J.M. Navasa Melado2, I. GonzlezAramburu1,
O. AchaSalazar3, F.J. NovoRobledo3,
M.A. RevillaGarca1, M. RebolloAlvarez-Amandi1,
A. GonzlezMandly2
Neurology, 2Radiology, 3UARH, Hospital Universitario
1
Marqus de Valdecilla, Santander, Spain
Introduction: Acute ischemic stroke (AIS) due to basilar
artery occlusion (BA) has a poor natural history. Early
recanalization of occluded brain arteries in AIS is associated
with better clinical outcome. Our aim is to describe four
patients with AIS due to BA occlusion who had been treated
with mechanical thrombectomy with Solitaire AB stent.
Methods: Description of four clinical cases of acute BA
occlusion treated with mechanical thrombectomy with
Solitaire AB stent in our hospital.
Results: Four patients (three females and one male, age
range 52-81 years) with acute BA occlusion received
treatment with mechanical thrombectomy. Intravenous
thrombolysis was previously administered in two cases.
Thrombectomy revascularization, defined as a final grade
of 2b or 3 according to the thrombolysis in cerebral
infarction (TICI) score, was successful in all cases. At 3
months, one patient had died and the other three were
functionally independent (modified Rankin scale 0-2).
Conclusion: Thrombectomy with Solitaire AB stent
achieved immediate recanalization with good clinical
outcome in most cases. Endovascular therapy with this
technique may be considered as an efficient tool for the
treatment of AIS due to BA occlusion.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1188
Clinical and ultrasonographic
characteristics in anterior ischemic optic
neuropathies (AION)
D.C. Jianu1, S.N. Jianu2, L. Petrica3, D.F. Muresanu4,
S.M. Deme5, M. Petrica1
1Neurology, Victor Babes University of Medicine and
Pharmacy, County Emergency Hospital, 2Ophthalmology,
Military Emergency Hospital, 3Internal Medicine-
Nephrology, Victor Babes University of Medicine and
Pharmacy, County Emergency Hospital, Timisoara,
4Neurology, University of Medicine and Pharmacy, Cluj-
Napoca, 5Neurology, West University, Arad, Romania
Introduction: AION represent a segmental infarction of the
optic nerve head supplied by the posterior ciliary arteries
(PCA).
Purpose: To describe characteristic clinical features and
ultrasound findings which help to differentiate newly
diagnosed arteritic AION (A-AION) from non-arteritic
AION (NA-AION).
Patients and methods: In this prospective study, 37
consecutive patients with clinical suspicion of unilateral
AION were examined following a complex protocol
including Color Doppler imaging-CDI of orbital vessels
(Logic 500, GE with 9MHz linear probe).
Results: The final diagnoses were A-AION due to GCA in
5 patients, all of them with biopsy-confirmed disease, and
32 patients with NA-AION. A combination of a history of
amaurosis fugax before an abrupt, painless, and severe loss
of vision of the involved eye, with a diffuse pale optic disc
oedema was extremely suggestive of A-AION. However,
none of these symptoms was ever found in NA-AION. The
CDI of the orbital vessels in A-AION revealed low blood
velocities, especially end-diastolic velocities, and high RI in
all retrobulbar vessels, in both orbits (with severe diminished
blood flow velocities in the PCA, especially on the affected
side). In nonarteritic AION blood velocities and RI in PCA
were relatively preserved.
Conclusions: CDI of retrobulbar vessels data supported the
evidence of involvement of the entire trunk of the PCA in
the A-AION. In contrast, in the NA-AION, the impaired
flow to the optic nerve head was distal to the PCA
themselves, possibly at the level of the paraoptic branches
(1/3 of the flow of the PCA).

P1189
Interhemispheric differences of cerebral
perfusion and brain DC potentials
influence verbal fluency in patients with
vascular encephalopathy
V. Fokin, N. Ponomareva, M. Krotenkova, R. Konovalov,
M. Tanashian, O. Lagoda
Research Center of Neurology RAMS, Moscow, Russia
Aim: In healthy subjects left frontal and temporal cortex
plays a main role in verbal fluency performance, however in
patients with chronic cerebrovascular disease there is not
much information about the brain structures participating in
this cognitive process. This study was aimed at determining
brain structures influencing verbal fluency in patients with
vascular encephalopathy (VE).
Methods: DC potentials and cerebral perfusion were
investigated in 40 patients with VE. DC potentials were
registered from head using 12 Ag/AgCl electrodes placed
according to 10-20 system with reference on right wrist. DC
potentials reflect intensity of cerebral energetic metabolism
(Fokin, Ponomareva, 2003). Standard characteristics of
computed tomography perfusion in the brain were measured
before and after word fluency test (WFT).
Results: Characteristics correlating with word production
in WFT was minimized in multiple regression model
(R=0.96; F=34.5; p<0.00001). According to this model left
frontal, right parietal DC potentials as well as
interhemispheric differences between CBF in right and left
frontal cortex, CBV in right and left thalamus, difference of
DC potentials between right and left parietal cortex
influenced the WFT performance.
Conclusion: Interhemispheric differences of brain
perfusion and energetic metabolism correlating with verbal
fluency appear to reflect the differences in activation of
right and left brain structures involved in WFT performance
in patients with VE.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 171
P1190
Clinical features of the perimesencephalic
non-aneurysmal subarachnoid
haemorrhage: a report of 35 cases
L. Yin
Department of Neurology, 2nd Hospital of Dalian Medical
University, Dalian, China
Objective: To analyse clinical manifestations and imaging
features of perimesencephalic non-aneurysmal subarachnoid
haemorrhage (PNSAH).
Materials and methods: Clinical data of 35 cases with
PNSAH were collected in this study. All cases were admitted
to the Department of Neurology, the Second Affiliated
Hospital of Dalian Medical University, from January 2001
to June 2010. The clinical manifestations, imaging features
and prognosis, were retrospectively investigated and
concluded.
Results:
1. Clinical symptoms are mild in these cases with Hunt-
Hess grade I-II, with no consciousness disturbance, focal
neurological deficits and hydrocephalus, with few (8.6%)
cerebral vasospasms which recovered quickly by
symptomatic treatment.
2. CT showed that the blood mainly distributed in
surrounding mesencephalon cisterna and anterior pontine
cisterna. The blood spread into the cerebral longitudinal
fissure and fissure of Sylvius in few cases (5.71%, 2/35).
Most CT images were classified into Fisher Grade 1~2, 2
cases were Grade 3, there was no Grade 4 case. All cases
had a negative DSA examination performed within one
week after onset, and repeated DSA showed no abnormality
after 3 months of onset.
3. Average hospitalization duration was 16 days. After a
mean 14 months follow-up, there was no re-bleeding and
permanent nerve dysfunction.
Conclusions: There is no positive finding by DSA
examination in PNSAH. The clinical symptoms are mild.
All patients recovered fast with few complications and good
prognosis. There was no obvious effect for the future quality
of life.
172 Posters, Sunday 9 September
P1191
Analysis of risk factors associated with
bleeding of AVM patients treated with
gamma knife radiosurgery (GKRS)
J.H. Yun, D.H. Kwon, B.D. Kwun
Neurological Surgery, Asan Medical Center, Ulsan
University College of Medicine, Seoul, Republic of Korea
Objectives: The two purposes of our study are comparison
of annual bleeding rate before and after GKRS and analysis
of risk factors associated with bleeding before and after
GKRS.
Materials and methods: This retrospective analysis was
performed for AVM patients treated with GKRS in single
center. Between 2001 to 2010, a total of 433 patients were
selected in this study and all charts were reviewed. We
analyzed annual bleeding rate and bleeding risk factor by
multivariate Cox proportional hazards model analysis.
Results: The 299 cases of initial bleeding presentation
before GKRS represented 69% (299 of 433). Among 35
bleeding AVM patients after GKRS, 15 patients showed
initial non-bleeding presentation and the remaining 20 were
initial bleeding ones. In analysis on factors affecting with
bleeding before GKRS, highly significant associations were
found with single feeder, deep draining vein and
periventricle location. Also we could demonstrate that AVM
patients who had a single feeder or total obliteration were at
low risk of bleeding after GKRS (62%, 56%), but one with
nidal aneurysm was high risk of bleeding after GKRS as
(4 times).
Conclusion: Annual bleeding rate of AVM was decreased
after GKRS (from 5.9% to 3.0%). AVM patients who had a
single feeder or total obliteration would have a low bleeding
risk after GKRS and on the other hand, ones with nidal
aneurysm would have a higher bleeding risk than ones
without. Meticulous clinical and radiological follow-up
study is mandatory for detection of post-radiosurgery
bleeding in AVM patients with these risk factors.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1192
Thrombolytic treatment of acute ischemic
stroke. How to harmonize logistics in the
healthcare system to meet the high-level
professional requirements of the
thrombolytic treatment protocol?
A. Folyovich, K.A. Bres-Molnr, V. Varga, E. Horvth,
K. Vadasdi, N. Kaszs
Neurology and Stroke Center, Szent Jnos Hospital,
Budapest, Hungary
Introduction: The efficacy of thrombolytic treatment (TT)
for acute ischemic stroke has been established. The number
of patients eligible for thrombolysis remains low, due to the
strict treatment protocol. This number could be increased by
highly organized logistics of the ambulance service and
hospitals. Almost all medical specialties should be available
24 hours a day. We investigated the timely distribution of
TTs during regular working hours (between 8-16 hours) and
on-call duty hours in our department, providing 24-hour
comprehensive care for patients with stroke and acute
neurological conditions.
Patients and methods: Time and date of admissions of
6076 patients treated in our Stroke Center between 2009
and 2011 were analyzed, as well as distribution between
regular working hours and on-call duty hours.
Results: Percentage of acute admissions was 86.12%.
51.15% of total patients and 66.66% of patients with TT
who were admitted during on-call duty hours. On weekends,
percentage of admissions was 20.19%, and that of patients
with TT was 17.64%. Thrombolysis was most often
performed on Thursday and Friday, and between 12 and 13
p.m. On weekends, the peak time for TT was between 17
and 18h. 23.53% of TTs were performed between 10 p.m.
and 6 a.m.
Conclusions: The rate of admissions for acute stroke was
higher during on-call duty hours, adding to the already high
workload during on-call duty. This type of high-level care,
requiring a tight interdisciplinary cooperation, can only be
safely provided in an institute, where a high-level standby
or on-call duty is available in all specialties.

P1193
Differences in changes of
interhemispheric EEG coherence in
patients after carotid ischemic stroke and
transient ischemic attack
A. Solkin, M. Bialiauski, U. Kuzniatsou, K. Bialiauskaya,
K. Pashkova, R. Santhalingam, C.S. Ilapperuma
Neurology and Neurosurgery, Vitebsk State Medical
University, Vitebsk, Belarus
Aim: To determine the dynamics of changes of
interhemispheric EEG coherence in patients after carotid
ischemic stroke (IS) and transient ischemic attack (TIA).
Patients and methods: 28 patients (18 patients with TIA
and 10 patients with IS in the region supplied by the left
carotid artery) aged 46-68 were examined by coherence
analysis of the EEG on the 2nd-14th day after TIA and on
the 60th-180th day after IS. The control group included 24
age-matched practically healthy volunteers.
Results: A decrease of EEG coherence predominantly in
the delta, theta and alpha frequency bands between different
cortical areas of hemispheres (frontal, central, parietal,
temporal and occipital) was revealed on the 2nd-4th day
after carotid TIA. Positive changes of EEG coherence in the
majority of frequency bands were revealed on the 10th-14th
day after TIA. An opposite trend of changes of EEG
coherence (increase) was observed at the same time between
some cortical areas in the beta-2 band. A relatively persistent
decrease of EEG coherence in all frequency bands with a
focus on alpha, beta-1 and beta-2 bands was revealed
between different cortical areas of hemispheres in patients
after carotid IS during the observation period.
Conclusion: The revealed changes of interhemispheric
EEG coherence give evidence of the reversible and
functional damage of central nervous system in patients
after TIA and structural and relatively persistent CNS
damage in patients after ischemic stroke.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 173
P1194
Stupefaction phenomena of peripheral
neurons in stroke patients
O. Schiopu1, M. Gavriliuc1, A. Grumeza1, A. Bodiu2
1Neurology, 2Neurosurgery, Institute of Neurology and
Neurosurgery, Chisinau, Moldova
Background and aims: Preconditioning of cerebral tissue
is a known phenomenon. Our work group suggests a new
term - stupefaction of neurons that means capacity to
recovery of neurologic functions after delayed in time
reperfusion. The aim of study derived from observation of
several post-stroke patients in which carotid endarterectomy
was performed and remarkable clinical improvement was
noticed reduction of neurological deficits.
Patients and methods: The study comprised 32 post-stroke
patients operated for carotid artery stenosis greater than
70% by carotid endarterectomy. The period between stroke
onset and surgery varied from 6 weeks to 1 year. Control
group, 21 patients, included the same population - post-
stroke patients with symptomatic carotid artery stenosis
who refused surgery. Electrophysiological exam comprising
neurography and needle EMG was performed in operated
patients by the following schedule: before surgery, 10-14
days after and 30 days after. Control group was examined
twice: 14 days after stroke onset and 3-4 months later.
Results: In all patients first exam of the paralyzed side
showed: decreased M-responses compared to the healthy
side, spontaneous activity, and unstable motor units
depending on duration from stroke onset. After surgery first
exam showed increased motor responses, bigger amount of
motor units, richer interference pattern. The evolution of
changes in peripheral nervous system was totally different
in the operated and the control group.
Conclusions: Peripheral neurons in stroke patients after
long-term carotid stenosis preserve their function in
hibernating state-stupefaction. Reperfusion, in our cases
carotid endarterectomy, leads to rapid improvement of
motor functions, based on clinical and electrophysiological
examinations, especially compared to control group.
174 Posters, Sunday 9 September
P1195
Transplantation of autologous bone
marrow stromal cells (BMSC) for ischemic
stroke: strategy and tactics for clinical
application
S. Kuroda, K. Houkin
Neurosurgery, Hokkaido University Hospital, Sapporo,
Japan
Objective: There is increasing evidence that the transplanted
bone marrow stromal cells (BMSC) significantly promote
functional recovery after central nervous system damage in
the animal models of various kinds of CNS disorders,
including cerebral infarct. However, there are several
shortages of information when considering clinical
application of BMSC transplantation for patients with
neurological disorders. Here, we discuss what we should
clarify to establish cell transplantation therapy in clinical
situation and describe our recent works for this purpose.
Methods and results: The BMSC have multiple abilities to
differentiate into the neural cells and to promote neuronal
survival and axon elongation, contributing to rebuild the
neural circuits in the injured CNS. Using optical imaging
and MRI techniques, the transplanted BMSC can non-
invasively be tracked in the living animals for at least 8
weeks after transplantation. Clinical MR apparatus can
visualize the tagged BMSC in the brain. 18F-FDG PET is
quite valuable to monitor the recovery of brain metabolism
after transplantation. The BMSC can be expanded using the
animal protein-free culture medium within a clinically
relevant period. G-CSF is useful to enhance their
proliferation when the BMSC are obtained from the aged
patients. There is optimal dose and timing of BMSC
transplantation to yield significant therapeutic benefits.
Conclusion: It is anurgent issue to develop a clinical
imaging technique to track the transplanted cells in the CNS
and evaluate the therapeutic significance of BMSC
transplantation to establish it as a definite therapeutic
strategy in clinical situation in very near future.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1196
Stroke subtypes and risk factors
associated with vascular dementia
B. Ince, G. Benbir
Neurology, Istanbul University Cerrahpasa Medical Faculty,
Istanbul, Turkey
Vascular contributions to cognitive impairment and
dementia are very important. As we know more about the
risk factors of vascular dementia (VaD), the prophylactic
managements would better help us in controlling the
morbidity of this disease. We investigated the patients
followed in stroke outpatient clinic between 1996 and 2011.
The diagnosis of VaD was made on the basis of DSM-IV
criteria and mini mental test. A total of 2798 patients were
included in the study with a mean age of 61.613.4 years;
and 53.9% of them were males. Of these, 90.5% were of
ischemic origin and 7.1% were intracerebral haemorrhages.
Among patients with ischemic stroke, the pathogenesis was
atherothrombotic in 15.8%, cardioembolic in 20.1%, small
vessel disease in 18.2%, other causes in 5.1%, and unknown
in 31.6%. A total of 127 patients (4.5%) had dementia. VaD
was present in 2.2% of patients with atherothrombotic
stroke, 4.4% of patients with cardioembolic stroke, 11.8%
of patients with small vessel disease, and 3.5% of patients
with intracerebral haemorrhage. The frequency of VaD is
significantly higher in small vessel disease (p<0.001).
Hypertension was more frequent in patients with VaD
(81.9% vs. 69.6%, p=0.001), and the use of more than one
antihypertensive drug was more common in patients with
small vessel disease and without VaD (p=0.008), suggesting
a better control for hypertension. As the studies investigated
the characteristics of VaD increased, we could better identify
the risk factors to reduce the burden of dementia, the
incidence of which seems to increase as life expectancy
advanced.

P1197
Basilar artery thrombosis in an 11-year-
old boy treated with intravenous t-PA and
endovascular mechanical thrombectomy
D. Kondziella1, J. Fink2, L. Sonneborg3, L.L. Larsen4,
A.P. Born5, M. Holtmannsptter6
1Department of Neurology, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, 2Department of Radiology,
3Department of Paediatrics, 4Department of Neurology,
Roskilde Hospital, Roskilde, 5Department of Paediatrics,
6Department of Neuroradiology, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
Basilar artery occlusion (BAO) in children is rare. BAO is
associated with a high mortality and morbidity if
recanalization of the basilar artery is not achieved before
extensive brainstem damage has occurred. An 11-year-old
boy presented with a clinical and radiological top-of-the-
basilar syndrome. Intravenous tissue plasminogen activator
(t-PA) was administered and the patient immediately
referred to the regional stroke center. Mechanical
thrombectomy using a Solitaire stent resulted in clot
removal and recanalization of the basilar artery 4 hours after
stroke onset. The patient made a full clinical recovery. To
our knowledge this is the first report on BAO in a child
treated with bridging therapy, the combination of
intravenous thrombolysis and endovascular thrombectomy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 175
P1198
Changes in plasma matrix
metalloproteinase-9 levels in patients with
acute ischemic stroke
I.M. Cojocaru1, M. Cojocaru2, V. Sapira3, G. Socoliuc3,
C. Hertea3
1Neurology, C Davila Univ of Med and Pharm, Colentina
Clinical Hospital, 2Physiology, Titu Maiorescu Univ,
Faculty of Medicine, 3Neurology, Colentina Clinical
Hospital, Bucharest, Romania
Background: Matrix metalloproteinase (MMP) have been
thought to be involved in stroke pathogenesis. MMP-9
contributes to tissue destruction.
Objective: Our aim was to analyze the MMP-9 levels in
blood within 24 hours of acute ischemic stroke onset to
observe the role of MMP-9 in the pathogenesis of
atherothrombotic stroke.
Material and methods: In this study we investigated
prospectively MMP-9 levels in serum from 106 patients (42
men and 64 women, mean age 71.526.32 years) with acute
ischemic stroke in the middle cerebral artery area in the first
24 hours from the onset (mean duration 7.84.5 hours) as
compared to 112 controls (48 men and 64 women, mean age
70.366.8 years). Exclusion criteria for patients and
controls were: atrial fibrillation, manifest ischemic
cardiopathy, infections, neoplasias, surgical interventions,
vasculitides, concurrent major renal or hepatic disorders,
major trauma in previous months. Serum samples were
collected under sterile conditions and stored in aliquots at
-700C until assay. Serum MMP-9 levels were determined by
enzyme-linked immunosorbent assay (ELISA) in blood
samples obtained on admission. Statistical analysis was
performed by Mann-Whitney and Log-Likeliwood Ratio
tests. All values reported are expressed as mean (x)SD.
Results: Mean serum MMP-9 concentrations were higher
in the group with ischemic stroke 17232.4ng/mL, range
139.6-204.4ng/mL vs. controls 579.6ng/mL, range 47.4-
66.6ng/mL (95% CI, 3.17 to 14.18; p<0.014).
Conclusion: MMP-9 activity is associated with early acute
ischemic stroke. The high levels of MMP-9 in acute
ischemic stroke document the involvement of this enzyme
in the regulation of inflammation in stroke.
176 Posters, Sunday 9 September
P1199
Off-label thrombolysis in a case of
ischemic hemiballism: a case report
A. Correnti1,2, E. Puca3, A. Pieroni3, C. Colosimo3,
D. Toni3
1 Neurologia e Psichiatria, 2UTN-Policlinico Umberto I,
3 Sapienza University of Rome, Italy
Introduction: Hemiballism is a rare hyperkinet movement
disorder. A lesion of the contralateral subthalamic nucleus,
due to a vascular etiology, is involved in more than half of
the cases. We report a case of hemiballism with an
extraluysian lesion who was treated off-label with
intravenous alteplase.
Case report: A 74-year-old man, with hypertension and
dyslipidemia, reported a left motor disorder on his arrival at
the Emergency Room. He had left-sided hemiballism
involving the face and both limbs and a cerebral CT-scan
showed only chronic signs of vascular leucoencephalopathy.
Despite having a normal NIHSS, in accordance to the
clinical signs and after exclusion of other possible causes
related to the development of this hemiballism (e.g. marked
hypoglycaemia), he was thrombolysed with alteplase iv at
4 hours from stroke onset. After this treatment, choreiform
movements were less pronounced. The following day a
brain MRI showed an ischemic lesion of the right capsula
extrema and insular cortex and the integrity of both
subthalamic nuclei. Another smaller lesion was found in the
right temporal-parietal cortex. The patient recovered
completely in three days without receiving any further
symptomatic therapy. Conclusion: Hemiballism has been
classically characterized as pathognomonic of a lesion in
the contralateral subthalamic nucleus. However, several
cases due to a lenticular or caudate lesion or even cortical,
as in the present case, have been described. Prognosis is
benign in most cases, but it seems logical to treat these cases
with thrombolysis when they are seen within an appropriate
time frame in the ER.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1200
Role of the phosphatidylinositol 3-kinase
and extracellular signal-regulated kinase
pathways in the neuroprotective effects of
cilnidipine on primary cultured cortical
neurons against hypoxia
H.-J. Yu1, S.-H. Koh2, K.-Y. Lee2, S. Kim3, H.-H. Park2,
Y. Lee2, J. Kim2
Neurology, Bundang Jesaeng Hospital, Seongnam,
1
Hanyang University College of Medicine, 3Department of
2
Neuroscience, KAEL-Gemvax Co., Ltd, Seoul, Republic of
Korea
The phosphatidylinositol 3-kinase (PI3K) and extracellular
signal-related kinase (ERK) pathways are crucial for
neuronal survival. Cilnidipine, a calcium channel blocker,
has been reported to have neuroprotective effects. We
investigated whether cilnidipine could protect neurons from
hypoxia and explored the role of the PI3K and ERK
pathways in the neuroprotection of cilnidipine. The viability
of primary cultured cortical neurons injured by hypoxia,
measured by trypan blue staining and LDH assay, was
dramatically restored with the treatment of cilnidipine.
TUNEL and DAPI staining showed that cilnidipine
significantly reduced apoptotic cell death induced by
hypoxia. Free radical stress induced by hypoxia was
markedly decreased by the treatment with cilnidipine.
Survival signalling proteins associated with the PI3K and
ERK pathways were significantly increased and death
signalling ones were markedly decreased in the primary
cultured cortical neurons simultaneously treated with
cilnidipine and hypoxia when compared with the neurons
treated with only hypoxia. These neuroprotective effects of
cilnidipine were blocked by the treatment with a PI3K
inhibitor, LY294002, or an ERK inhibitor, FR180204. These
results show that cilnidipine protects primary cultured
cortical neurons from hypoxia by reducing free radical
stress and death-related signalling proteins and by enhancing
survival-related proteins associated with the PI3K and ERK
pathways and that activation of those pathways plays
important roles in the neuroprotective effects of cilnidipine
against hypoxia. These findings suggest that cilnidipine
with neuroprotective effects against hypoxia through
various mechanisms as well as blood pressure-lowering
effect might help preventing ischemic stroke and reduce
neuronal injury caused by ischemic stroke.

P1201
Coenzyme Q10 protects neural stem cells
against hypoxia/reoxygenation by
enhancing survival signals
K.-Y. Lee1, S.-H. Koh1, H.-J. Yu2, J. Park3, Y. Lee1,
H.-T. Kim1, S. Kim1, J. Kim1
1Hanyang University College of Medicine, Seoul,
2Neurology, Bundang Jesaeng Hospital, Seongnam,
3Neurology, Inje University Paik Hospital, Pusan, Republic
of Korea
Recanalization and secondary prevention are the main
therapeutic strategies for acute ischemic stroke.
Neuroprotective therapies have also been investigated
despite unsuccessful clinical results. Coenzyme Q10
(CoQ10), which is an essential cofactor for electron
transport in mitochondria, is known to have an antioxidant
effect. We investigated the protective effects of CoQ10
against hypoxia/reoxygenation in neural stem cells (NSCs).
We measured cell viability and levels of intracellular
signalling proteins after treatment with several
concentrations of CoQ10 under hypoxia-reperfusion.
CoQ10 protected NSCs against hypoxia-reperfusion in a
concentration-dependent manner by reducing growth
inhibition and inhibiting free radical formation. It increased
the expression of a number of survival-related proteins such
as phosphorylated Akt (pAkt), phosphorylated glycogen
synthase kinase 3- (pGSK3-), and B-cell lymphoma-2
(Bcl-2) in NSCs injured by hypoxia-reperfusion and reduced
the expression of death-related proteins such as cleaved
caspase-3. We conclude that CoQ10 has effects against
hypoxia-reperfusion induced damage to NSCs by enhancing
survival signals and decreasing death signals.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 177
P1202
Inflammatory process evaluation by
serum Hs CRP and sVCAM-1 in patients
with carotid stenosis
C. Revnic1, C. Ginghina2, I.A. Popescu3, C. Popa3,
F. Revnic4
1UMF Carol Davila Bucharest, Faculty of General Medicine,
2Cardiology, C.C. Iliescu Cardiovascular Disease Institute,
3Neurology, Vlad Voiculescu Neurology Institute,
4Gerontology & Geriatrics, Ana Aslan National Institute of
Gerontology and Geriatrics, Bucharest, Romania
Objectives: Inflammation is a part of the process of
atherosclerosis; evaluation of serum Hs-CRP together with
sVCAM-1 seems to be an important predictor for stroke and
cardiovascular events in patients with atherosclerosis. The
levels of circulating inflammatory markers may express the
extent of the inflammatory response, their participation in
plaque progression and rupture needs to be evaluated.
Materials and methods: The study evaluated 86 patients
(62 men) (40 controls without carotid atherosclerosis, 22
patients with asymptomatic carotid stenosis and 24 patients
with symptomatic carotid stenosis) mean age 61.35.8
years; range 42 to 86 years. Serum Hs-CRP and sVCAM-1
levels were determined in all patients using a Dade Behring
hsCRP assay and Quantikine Human sVCAM-1
Immunoassay by ELISA method.
Results: The mean values of Hs-CRP and sVCAM-1 in
control patients were 1.38mg/ml0.63 and 636ng/dl
0.11(p=0.025); 1.780.84mg/ml and 672ng/dl0.14 in
patients with asymptomatic carotid stenosis (p=0.014);
1.820.92mg/ml and 693ng/dl 0.46 in patients with
symptomatic carotid stenosis (p=0.001). There is an
association between the higher levels of hsCRP and
sVCAM-1 with low echogenicity of carotid plaques,
suggesting a link between inflammation and potential risk
of plaque rupture.
Conclusions: The results of our study showed that highest
levels of hs-CRP and sVCAM-1 were associated with
morphological and clinical progression of the carotid
atherosclerotic disease.
178 Posters, Sunday 9 September
P1203
Intravenous thrombolysis in stroke
patients with atrial fibrillation
V. Padjen1, M. Jarakovic2, P. Stanarcevic1,
M. StefanovicBudimkic1, D. Jovanovic1, O. Savic1,
I. Berisavac1, M. Ercegovac1, L. BeslacBumbasirevic1
1Emergency Neurology Department, Neurology Clinic
Clinical Center of Serbia, School of Medicine, University of
Belgrade, 2Cardiology, Institute of Cardiovasular Diseases
of Vojvodina, Sremska Kamenica, Serbia
Background: The purpose of our study was to compare the
severity and the outcome of acute ischemic stroke among
patients with atrial fibrillation (AF) who received
intravenous thrombolysis (IVT) compared to those who did
not receive this therapy.
Methods: We performed a retrospective analysis of data
prospectively collected of stroke patients with AF that were
treated in the Stroke unit of the Emergency neurology
department. Neurological deficit was evaluated using the
NIHSS on admission while the 90-day clinical outcome was
assessed using the modified Rankin scale (mRS).
Results: There were 91 stroke patients who had AF, 47
(51.6%) were men IVT was given to 22 patients (24.2%).
Comparing the two groups there was no significant
difference between the baseline NIHSS which was
12.9+2.86 in AF patients who received IVT,and 16.2+3.11
in AF patients who did not receive IVT (p=0.053). Patients
with AF and IVT were more likely to have excellent
functional outcome (mRS 0-1) (63.6% vs. 21.7%; OR 0.16
[95% CI 0.06-0.45]; p=0.000), and favourable functional
outcome (mRS 0-2) (68.2% vs. 28.9%; OR 0.19 [95% CI
0.07-0.54]; p=0.001) than patients with AF who did not
receive IVT. Also, patients with AF and IVT were less likely
to have a fatal outcome as outcome at month 3 (13.6% in
patients with AF and IVT vs. 49.3% in patients with AF
without IVT; OR 6.15 [95% CI 1.67-22.7]; p=0.005).
Conclusion: Our study has shown that stroke patients with
AF who received IVT had significantly better outcome than
stroke patients with AF who did not receive this therapy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1204
Intra-cerebral haemorrhage in patients
warfarinized for non-valvular atrial
fibrillation
M.K. Fong, Y.P. Chu, B. Sheng, K.K. Lau
Princess Margaret Hospital, Kowloon, Hong Kong S.A.R.
Aim: To study the characteristics of intra-cerebral
haemorrhage (ICH) in warfarinized non-valvular atrial
fibrillation (wNVAF) patients.
Methods: Retrospective review on wNVAF patients who
had developed ICH and were treated at Princess Margaret
Hospital, Hong Kong from 2006-2011.
Results: 87 warfarinized patients developed ICH during the
study period, accounted for 5.34% of all ICH. Among them,
37 (24 male and 13 female) were wNVAF patients. Their
mean age was 74.8. The baseline risk for thromboembolism
and bleeding, as represented by their median CHA2DS2-
VASc and HAS-BLED score, were 4 and 2, respectively. All
patients had moderate to high bleeding risk, the lowest
HAS-BLED score was 1. 15 patients (40.5%) had both
scores in the high risk category (CHA2DS2-VASc2 &
HAS-BLED3). The volume of ICH in these 37 patients
was 19.223.0cm3. Their initial INR was 2.50.7 (range
1.1-5.0), which was corrected to 1.60.5 (range 1.1-3.1) at
12hrs. There was no correlation between ICH volume and
INR, and a majority (72.9%) developed ICH at INR 2 to 3.
3 patients required neurosurgical intervention. The mortality
was 48.6%, which was not statistically different from the
overall mortality of ICH. The ICH score showed good
correlation with mortality (c=0.75, p=0.001). All patients
with ICH score 3 died. 8 patients had good neurological
recovery at 6 months with modified Rankin scale score 3.
Conclusion: Most of our ICH-wNVAF patients had
appropriate risk/benefit balance. The clinical course of ICH
was similar to other ICH patients, and INR did not correlate
with ICH volume or clinical outcome.

P1205
25-Hydroxyvitamin D associated with
acute ischemic stroke and subtypes:
a case control study
J.R. Chaudhuri1, V.S. Bandaru1, R. Ramapriya1,
A. Anamika2, B. Balaraju1
1Neurology, 2Biochemistry, Yashoda Hospital, Hyderabad,
India
Background: Vitamin D deficiency is common in all age
groups and may contribute to cardiovascular diseases.
Recent reports have incriminated low 25-hydroxyvitmain D
levels causing ischemic stroke.
Aim: To investigate association of 25-Hydroxyvitamin D in
acute ischemic stroke.
Methods: We recruited 85 consecutive stroke patients and
85 age and sex matched control subjects attending the
department of neurology for non-vascular diseases at
Yashoda hospital Hyderabad South India, from October
2011 to February 2012. All patients under went evalution
for stroke subtypes and risk factors. We measured
25-Hydroxyvitamin D by Chemiluminiscen test, serum
calcium, phosphorus and alkaline phosphatase for case and
control subjects.
Results: Out of 85 patients there were 63 men (74.1%),
mean age 60.4 range 26-89 years. 25-Hydroxyvitamin D
deficiency was observed in 44 (51.7%) of stroke patients
and 30 (35.2%) in control subjects (p=0.01). Our data
showed hypertension in 48 (56.4%) with stroke patients and
28 (32.9%) in controls (p=0.003), diabetics in 32 (37.6%)
in stroke patients and 18 (21.7%) in controls (p=0.02).
25-Hydroxyvitamin D deficiency was found 100% (4/4) in
extracranial large artery atherosclerosis, 61.9% (13/21) in
intracranial large artery atherosclerosis, 50% (6/12) in
cardioembolic stroke, 52.9% (9/17) in small artery diseases,
27.2% (3/11) in stroke of other determined etiology and
45% (9/20) in stroke of un-determined etiology. After
adjustment, multiple logistic regression analysis showed
hypertension (Odds ratio: 3.1 95%CI 1.6-6.2), low
25-Hydroxyvitamin D (Odds ratio:3.0 95%CI 1.5-5.8) and
diabetics (Odds ratio:2.6 95%CI 2.1-4.8)
Conclusions: Low levels of 25 Hydroxyvitamin D is
significantly associated with acute ischemic stroke and it
may be an independent risk predictor for stroke.
P1206
Abstract cancelled
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 179
P1207
Post-partum stroke: a multifactorial
complication of pregnancy
M.G. Kortushvili, I.V. Verulashvili
Tbilisi State Medical University, Tbilisi, Georgia
Objectives: The aim of this study was to analyse the
influence of pregnancy on the risk of post-partum stroke
and possibilities of prevention recurrent cerebral events in
future.
Methods: Issued from a multicenter (3 centres) prospective
study, 21 women (mean age 26.9 years) with post-partum
stroke (PS), were screened from over 1200 patients of acute
cerebral stroke between January 2005 and September 2009.
PS was diagnosed clinically and by CT/MRI/angiography.
The selected patients were followed up for 2 years:
information on death, neurological status, recurrent cerebral
events were obtained from direct observation, written
questionnaire or by telephone interviews (every 6 months).
Results: Causes of post-partum stroke included cerebral
infarction (7 arterial, 8 venous) and 6 intracerebral
haemorrhage with the poorest outcome (1 maternal death
and 3 residual neurologic deficits). The median time at
onset of stroke was 6 days post- partum (range, 2-25 days).
During a mean follow-up of 2 years, 2 arterial recurrent
ischemic strokes occurred (both within the second year and
outside pregnancy); there were no cases of recurrent
cerebral venous thrombosis.
Conclusions: Post-partum stroke is a multifactorial and
non-preventable complication of pregnancy. The post-
partum period, not the pregnancy itself, is associated with
an increased risk of recurrent stroke. A previous cerebral
stroke is not a contraindication to a subsequent pregnancy.
Secondary prevention after PS is based on similar principles,
as in general population: an optimal management of
vascular risk factors and appropriate antithrombotic therapy
(at least during the first year after post-partum stroke).
180 Posters, Sunday 9 September
P1208
Intravenous thrombolytic treatment in
stroke patients with recent transient
ischemic attack: a Serbian experience
with thrombolysis in ischemic stroke -
SETIS register
M.S. Budimkic1, D.R. Jovanovic2,
L. Beslac-Bumbasirevic2, V. Padjen3, P. Stanarcevic3,
SETIS group
1Department of Emergency Neurology, Neurology Clinic,
Clinical Center of Serbia, Faculty of Medicine, University of
Belgrade, 2Department of Emergency Neurology, Faculty of
Medicine, University of Belgrade, 3Department of
Emergency Neurology, Neurology Clinic, Clinical Center of
Serbia, Belgrade, Serbia
Introduction: Patients with prior transient ischemic attack
(TIA) may have diffusion-weighted lesions on MRI imaging
despite normal CT brain findings. This raises the concern of
higher risk for post-thrombolytic intracerebral haemorrhage
in stroke patients with recent TIA. The aim of this study was
to evaluate efficacy and safety of intravenous thrombolysis
(IVT) in stroke patients with recent TIA.
Methods: We analysed 651 stroke patients treated with IVT,
from the SETIS register. Data were collected about recent
ipsilateral TIA, clinical characteristics of patients,
occurrence of symptomatic ICH (defined with SITS MOST
criteria) and 3 month outcome (using mRS).
Results: From analysed stroke patients 34 of them (5.2%)
had one or more previous TIA episodes within a month
prior to the current stroke. Most of the patients had TIA
within the first week before stroke (67%) and a majority of
those had TIA on the day of the current stroke. There was
no sex and age difference among TIA and non-TIA group
of patients (male 67.6% vs. 64.1%; mean age 57.31.6 vs.
59.60.5). Patients with prior TIA presented with less severe
stroke (mean NIHSS score 9.77.4 vs. 13.45.7), had more
frequent hyperlipidemia (84.4% vs. 55.4%, p=0.002) and
occurrence of lacunar stroke (26.4% vs. 11.6%, p=0.01).
Occurrence of sICH was equally present in both
groups-2.9% (OR 0.99, CI 0.13-7.67). The good recovery (3
month mRS 0-2) gained 76.6% of patients in TIA group and
64.6% of patients in non-TIA group (OR 1.7, CI 0.75-4.26).
Conclusion: Thrombolytic treatment in stroke patients with
recent TIA is safe.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1209
Foetal middle cerebral and arteries of
umbilical blood flow velocity in normal
and gestational diabetic pregnancies
S.-M. Fereshtehnejad1, M. ShabaniZanjani2,
R. Nasirzadeh2, S.-A.P. Alemzadeh3, S. Askari3
1Neurobiology, Care Sciences & Society (NVS), Karolinska
Institute, Stockholm, Sweden, 2Tehran University of Medical
Sciences, 3Student Scientific Research Committee, Tehran
University of Medical Sciences, Tehran, Iran
Background: Gestational diabetes mellitus (GDM) is one
of the most common complications in pregnancies.
Evaluating other conditions including intra uterine growth
restriction and pre-eclampsia, some studies have shown
significant changes in blood flow velocity of foetal middle
cerebral artery (MCA). Our study is one of the first which
has aimed to assess the effects of GDM on Doppler
parameters of the foetal MCA and umbilical artery (UI) and
to compare with normal pregnancies.
Methods: This cross-sectional study was performed in 66
pregnant women, including 33 women with GDM and the
others without it, in Akbar-Abadi University Hospital in
Tehran, Iran during 2010-2011. Peak systolic and diastolic
velocities, pulsatility index (PI), resistance index (RI) and
systolic/diastolic ratio (S/D) were recorded in UA as well as
both right and left foetal MCAs for every recruited pregnant
women by means of Doppler ultrasonography.
Results: The mean gestational age at the time of examination
was 34.45 (SD=2.62) weeks in GDM-positive group.
Although all of the measured Doppler parameters had
higher values in GDM-positives, but the differences were
not significant between the two groups of study; except for
the left foetal MCA-PI which was significantly higher in
GDM associated group [2.07 (SD=0.07) vs. 1.85 (SD=0.74),
P=0.03].
Conclusion: Our results show that gestational diabetes
could also correlate with the increased PI of the foetal
MCA. This result could be due to the brain-sparing
phenomenon; and as it was demonstrated that
hyperglycaemia affects the diabetic adult vessels, it might
also involve foetal vessels in GDM associated pregnancies.

P1210
The benefit of early Holter-ECG
monitoring for the detection of
paroxysmal atrial fibrillation in patients
with acute ischemic stroke: a pilot study
M. Kral1, D. Sanak1, M. Hutyra2, T. Veverka1,
A. Bartkova1, R. Herzig1, D. Skoloudik1, T. Dornak1,
M. Taborsky2, P. Kanovsky1
Comprehensive Stroke Center, Department of Neurology,
1 General Medicine, 2Geriatrics, UMF Carol Davila,
Department of Internal Medicine I - Cardiology, Faculty of
2
Medicine and Dentistry, Palack University and University
Hospital, Olomouc, Czech Republic
Background: Atrial fibrillation (AF) is the most common
cause of cardioemboligenic ischemic stroke (IS). Patients
with cardioemboligenic IS and AF often present with more
severe neurological deficit associated with the occlusion of
the large cerebral artery, worse clinical outcome and higher
mortality. Especially the paroxysmal form of AF is very
risky, because it is usually not being registered during a
routine electrocardiogram (ECG) examination. The aim was
to assess the benefit of early 24-hour Holter-ECG
monitoring in patients with ischemic stroke and a negative
history of AF.
Methods: In the prospective study, the set consisted of 114
consecutive IS patients (57 males, average age 75.49.8
years) with a negative history of AF and without the
presence of AF on the admission ECG exam. A standard
24-hour Holter-ECG was performed in all patients.
Results: 33 (28.9%) patients had concurrent ischemic heart
disease, 14 (12.3%) had a positive history of myocardial
infarction, and 25 (22%) a history of previous IS. Holter-
ECG was performed on average 4.12.5 days after the IS
onset. Newly detected AF was found in 10 (8.8%) patients
(paroxysmal form of AF in 90.0% out of these patients). No
acute ischemic changes were recorded on admission ECG
in all patients.
Conclusion: Holter-ECG monitoring is a non-invasive and
inexpensive method used for the early detection of AF,
particularly of its paroxysmal form. The risk of recurrent
stroke can be significantly reduced in IS patients with
diagnosed AF using the anticoagulant therapy.
Acknowledgement: Supported by the IGA MH CR grant
number NT/11046-6/2010.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 181
P1211
Evaluation of total serum MMP-9 and
their inhibitors TIMP-1 as a markers of
carotid plaque instability in elderly
patients with carotid stenosis
C.R.S. Revnic1, G.I. Prada2, C. Pena3, F. Revnic3,3,
B. Paltineanu4
1Cardiology, UMF Carol Davila Bucharest/Faculty of
3Biology of Aging, 4NIGG Ana Aslan, Bucharest, Romania
Introduction: Matrix metalloproteinases (MMPs) and their
inhibitors (TIMPs) regulate extracellular matrix (ECM)
remodelling, a key feature of atherosclerosis, and their
circulating concentrations can be assayed..
Aim: To relate circulating biomarkers of extracellular
matrix (ECM) turnover to site-specific measures of carotid
artery atherosclerosis on Echo Doppler ultrasound.
Material and methods: 110 patients admitted to the
Cerebrovascular Clinic (85 males) aged:44-89 years,
divided into three groups (44 patients with ischaemic stroke
related to carotid stenosis, 36 patients with asymptomatic
carotid stenosis and 30 controls) were included in the study.
All patients underwent carotid Echo-Doppler examination
and serum levels of total MMP-9 and TIMP-1 were
evaluated using Quantikine Human MMP-9 (total) and
TIMP-1 ELISA R&D Systems Kits with a ChemWell 2019,
Awarness,Inc. USA Autoanalyser.
Results: Serum MMP-9 and TIMP-1 levels were associated
with risk of all-cause mortality (Cox proportional hazard
ratio [HR] per standard deviation 1.10, 95% confidence
interval [CI] 1.03-1.18; and 1.11, 1.02-1.18; respectively).
TIMP-1 levels were mainly related to risks of cardiovascular
mortality and stroke (HR per standard deviation 1.20, 85%
CI 1.09-1.35; and 1.16, Carotid Echo-Doppler study showed
that in the stroke group most of plaques found were
echolucent with irregular surface compared with the
asymptomatic group where echogenic plaques with smooth
surface are found frequently (p=0.04).
Conclusions: In this community-based cohort of elderly
men, serum MMP-9 and TIMP-1 levels were related to
mortality risk. An altered extracellular matrix metabolism
may be involved in several detrimental pathways, and
circulating MMP-9 or TIMP-1 levels may be relevant
markers thereof.
182 Posters, Sunday 9 September
P1212
Post-stroke depression: predictive factors
at six months follow-up
J.M. Ramrez-Moreno1, M.J. Gmez-Baquero1,
F. LpezEspuela2, J.C. PortillaCuenca2, A. OlleroOrtiz1,
T. GavilnIglesias2, J.D. PedreraZamorano3,
P.E. JimenezCaballero2, I. Casado-Naranjo2
1Neurology, Stroke Unit, Hospital Universitario Infanta
Cristina, Badajoz, 2Neurology, Stroke Unit, Hospital San
Pedro de Alcntara, 3Nursing, Universidad de Extremadura,
Cceres, Spain
Introduction: Post-stroke depression affects approximately
one third of ischemic stroke survivors. In validation studies,
the Hamilton Rating Scale for Depression (HRSD) proved
to be an acceptable screening instrument. To identify
variables that could predict depression after stroke using
this score.
Methods: A total of 200 consecutive patients with acute
stroke, admitted to the Stroke Unit, were included in the
study. After six months follow-up, 173 survivors [71
(35.5%) females and 129 (64.5%) males; average age (SD):
71.16 (12.3) years] were evaluated, with the HRSD.
Univariate and multivariate logistic regression analyses
were conducted to determine predictive factors. Age,
gender, socioeconomic class, education, residence, social
support, Charlson index, previous depression, type and side
of stroke, National Institutes of Health Stroke Scale score
(NIHSS) at admission, Hemiparesis, Barthel index (BI) and
modified-Rankin scale (mRS) at discharge, and length of
stay were evaluated and included in the models.
Results: When a cut-off point of 13 in the HDRS was used
as the criterion, depression was rated in 42% of patients.
Univariate analysis showed that post-stroke depression was
significantly associated with: previous depression, type and
side of stroke, stroke severity assessed by the NIHSs,
hemiparesis, BI and mRS at discharge, and length of stay. A
multivariate regression model demonstrated that the most
significant factors associated with post-stroke depression
were previous depression, side of stroke, mRS at discharge,
and length of stay.
Conclusions: Post-stroke depression measured by the
HRSD is highly prevalent in the follow-up, and is associated
with previous depression, length of stay and with the degree
of disability at discharge.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1213
Correlation between white matter lesions
and neurological complication after
cardiac surgery
B. Zllami1, E. Basha2, B. Cekrezi3, J. Kruja4
1Department of Neurology, American Hospital, 2Department
of Neurology, Central Military Hospital of Tirana,
3Department of Radiology, American Hospital, 4Department
of Neurology, UHC Mother Theresa, Tirana, Albania
Background and purpose: With the advances of surgical
procedure, cardiac surgery can now be performed on older
patients with multiple chronic diseases. The white matter
lesions are hyperintensities that are located in the deep
white matter, and are often seen with small vessel disease.
We looked for the correlation between the pre-surgery white
matter lesion (MRI- T2, Flair) and the adverse neurological
outcome following the surgery.
Method and evaluation: We have seen thirty (n 30) patients
undergoing cardiac surgery (mainly valve repair and
CABG- coronary artery bypass graft surgery). Preoperative
and intraoperative variables include patient age,
comorbidities are evaluated. They are also evaluated with
neurological and cognitive examination (MMSE). Also
head MRI is performed before the surgery and after surgery
only in patients with new neurological deficits.
Results: 12 (40%) of them were presented with multiple
periventricular, subcortical white matter lesions, 18 (60%)
without cerebral lesions. After the surgery 2 patients 6.6%
with prior white matter lesion had a stroke; 6 of them 20%
had prolonged encephalopathy (3-5 day coma after surgery).
1 ischemic stroke (3.3%) happened in the group of patients
without white matter lesions patients (1-2 weeks after the
surgery).
Conclusion: White matter hyper intensities are more
common and extensive in patients with cardiovascular risk
factors and symptomatic cerebrovascular disease. White
matter lesions can be predictive for neurological
complication after cardiac surgery. The small number of our
cases does not allow us to have a statistically significant
conclusion.

P1214
Evaluation of ESSEN and SPI-II scale for
short-term prognosis of minor stroke and
TIA
J. Liu, J. Liu
The 3rd Hospital of Hebei Medical University, Shijiazhuang,
China
Background and purpose: The evaluation of stroke risk
may improve the outcome of stroke, especially for minor
stroke. We investigated the validity of ESSEN and SPI-II
scale for predicting the short-term risk of minor stroke the
clinic.
Methods: 167 patients with minor stroke or transient
ischemic attack (TIA) were enrolled in this study. The
recurrent ischemic events were recorded within 90 days
after onset and the curve of accumulative survival rate was
obtained to observe the recurrent risk. The prognostic value
of ESSEN and SPI-II scale for recurrent risk was evaluated
by calculating the area under receiver operating
characteristic curve respectively.
Results: The total recurrent rate of ischemic events within
90 days was 12.57% while the recurrent rate was 7.78% in
the first week after onset. Steep change of the cumulative
survival rate was observed in the acute phase of minor
stroke. The area under receiver operating characteristic
curve of ESSEN scale was 0.677 (95%CI: 0.557~0.797)
compared to 0.553 (95%CI: 0.413~0.694) of SPI-II scale.
Conclusions: As screening tool, both ESSEN and SPI-II
scale could evaluate the short-term risk for recurrent events
of minor stroke and TIA. The ESSEN scale was more
suitable for predicting the short-term risk at the clinic.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 183
P1215
Contribution of antiplatelet resistance to
vascular pathology in patients undergoing
neuroendovascular procedures
S. Vucetic1, N. Gligic2, J. Savic3
Special Hospital for Cerebrovascular Diseases St. Sava,
1
Neurology, 3Special Hospital for Treatment of
2
Cerebrovascular Diseases Sveti Sava, Belgrade, Serbia
Aims: Antiplatelet resistance is not sufficiently investigated
among patients undergoing neuroendovascular procedures.
Its contribution to vascular pathology is also not well
understood. The purpose of this study was to determine
contribution of antiplatelet resistance to different
cerebrovascular pathoanatomical features.
Material and method: In this retrospective study, we
analyzed data of 65 consecutive patients who underwent
neuroendovascular procedure in a one year period and
previously received antiplatelet therapy. We used impedance
aggregometry method to determine level of platelet
inhibition.
Results: Indications for neurointerventional procedures
were carotid stenosis and vertebrobasilar stenosis and
symptomatic intracranial aneurysm. Among 56 patients
receiving aspirin at a median dose 700mg per week, 10.7%
were resistant. Among 24 patients receiving clopidogrel in
a median dose 525mg per week, 21 of them were on a dual
antiplatelet therapy, and 60.4% of all were resistant to
clopidogrel. We found carotid and vertebrobasilar stenosis
and aneurysms to be significantly more often in aspirin non-
responders than in responders. However, clopidogrel
response affected neither of these vascular features.
Conclusion: These results show contribution of aspirin
response to pathomorphology of cerebral vessels. This
emphasizes a need for detailed assessment of underlying
mechanisms of vascular pathology in this group of patients.
184 Posters, Sunday 9 September
P1216
Validation of transcranial duplex
sonography as screening test for the
detection of right-to-left shunt
P. Martinez-Sanchez, E. Correas-Callero, M. Lara-Lara,
G. Ruiz-Ares, B. Fuentes, M. Martinez-Martinez,
L. Cullar-Gamboa, E. Dez-Tejedor
Neurology, La Paz University Hospital. IdiPAZ Health
Research Institute, Madrid, Spain
Objective: To evaluate the diagnostic accuracy of contrast-
enhanced transcranial colour-coded sonography (c-TCCS)
against contrast-enhanced transcranial Doppler monitoring
(c-TCD) for the detection of right-to-left shunt (RLS).
Methods: Prospective study of ischemic stroke patients
studied at our neurosonology laboratory for the presence of
RLS (March 2011-January 2012). All patients underwent
c-TCD by contrast injection (9cc of saline solution + 1cc of
air), both at rest and after Valsalva manoeuvre (VM). After
15 minutes of rest, patients underwent a c-TCCS by a
neurosonographer blinded to the results of the c-TCD, who
used the same methodology as in c-TCD. The extent of CDI
was measured according to international criteria: absent (no
HITS), small (<10 HITS), medium (>10 HITS shower
pattern) and large (>10 HITS, curtain pattern).
Results: 50 patients were enrolled, 23 men. Mean age: 43 y.
At rest, c-TCD showed 7 RLS and 6 were detected by
c-TCCS. After VM, c-TCD showed 23 RLS and 21 were
detected by c-TCCS. After VM c-TCCS showed, compared
with c-TCD: sensitivity 91.3%, specificity 92.6%, positive
predictive value (PPV) 91.3%, negative predictive value
(NPV) 92.3% and accuracy 92%. Taking into account only
medium-large RLS, c-TCCS showed, compared to c-TCD:
sensitivity 100%, specificity 100%, PPV 100%, NPV 100%
and accuracy 100%. The concordance with echocardiography
was similar in c-TCD and c-TCCS.
Conclusion: The accuracy of c-TCCS as screening test for
the detection of RLS, compared with c-TCD, is high and is
greater in case of medium or large RLS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1217
Frequency of post-stroke shoulder pain
D. Dobi1,2, M. Kapisyzi2, S. Grabova2, L. Stefanidhi2,
F. Myslimi2, S. Koci2, E. Ranxha2, J. Kruja2
1Dept. of Neurology, UHC, 2UHC Mother Theresa, Tirana,
Albania
Background and purpose: Shoulder pain is known to
retard rehabilitation after stroke. Its causes and prognosis
are uncertain. This study describes the frequency of post-
stroke shoulder pain prospectively, in an unselected stroke
population in the first 3 months after stroke.
Methods: 92 patients entered the study. 88 of them, mean
age 70.62.4 years , were examined at 2 weeks, 4, and 3
months after stroke. The data about shoulder pain, Barthel
index, anxiety and depression score were recorded. Full
neurological examination was undertaken, using the
contralateral side as a control. Pain outcome and stroke
outcome was recorded at subsequent visits. Non-steroid
anti-inflammatory drugs and physical treatment is used in
all patients, in order to treat the pain.
Results: 35 (40%) patients developed shoulder pain on the
same side of their stroke. There was a strong association
between pain and abnormal shoulder joint examination, ipsi
lateral sensory abnormalities and arm weakness. Shoulder
pain had resolved or improved at 3 months in 70 (80%) of
the patients with non-steroid anti-inflammatory drugs and
physiotherapy.
Conclusions: Shoulder pain after stroke occurred in 40% of
88 patients surviving, consenting to participate. 80% of
patients made a good recovery with pharmacological and
physical treatment. Patients with sensory and/or motor
deficits represent at risk sub-groups. Non significant
correlation was observed among male and female patients
in Barthel Index.

P1218
Intravascular perfusion of carbon black
ink allows reliable visualization of cerebral
vessels in mice
M.R. Hasan, J. Herz, D.M. Hermann, T.R. Doeppner
Department of Neurology, University of Duisburg-Essen
Medical School, Essen, Germany
Introduction: Study of the rodent cerebrovascular anatomy
provides significant insight in the experimental stroke
research. For several years, intravascular perfusion of
colored latex has been considered as a standard tool to
visualize cerebral vessels. However, this technique has
certain technical limitations, which compromise its
reproducibility. Here, we described a simple method to
visualize the cerebral vessels in mice in a reproducible
manner.
Methods: Diluted/undiluted latex mixed with carbon black
ink was injected through the left cardiac ventricle.
Alternatively, a mixture of two commercially available
carbon black inks, i.e. CB1 and CB2 at a 1:9 ratio was
injected. The minimal diameter of the stained vessels was
quantified in each method in cryosections of brains. Finally,
CB1+CB2 staining was done in combination with
triphenyltetrazolium chloride (TTC) staining in animals
subjected to transient focal cerebral ischemia.
Results: Perfusion with CB1+CB2 yielded adequate filling
of the cerebral vessels with high contrast visualization. This
technique was applied to identify the anastomotic points
between cerebral vascular territories of mice with different
genetic backgrounds and strains. Furthermore, perfusion
with combined carbon black inks allowed visualization of
significantly smaller vessel diameters at a higher vessel
density in comparison to perfusion with diluted/undiluted
latex. We finally gave evidence that this method for cerebral
vessel staining could be combined with TTC staining - a
widely used tool to observe and analyze infarct volumes in
rodents.
Conclusion: Thus, perfusion with combined carbon black
inks offers a simple, cost-effective and reproducible
technique in order to visualize cerebral vasculature in mice.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 185
P1219
Effect of anodal versus cathodal
transcranial direct current stimulation on
stroke recovery: a pilot randomized
controlled trial
E. Khedr1, O. Shawky1, A. Tohamy1, E. Darwish1,
D. El Hamady2
1Assiut University Hospital, 2Physical Medicine and
Rehabilitation, Assiut University Hospital, Assiut, Egypt
Purpose: To compare the long-term effect of anodal vs.
cathodal transcranial direct current stimulation (tDCS) on
motor recovery of subacute stroke.
Methods: 36 patients with subacute ischemic stroke
participated in the study. The patients were randomly
assigned to one of three groups; the anodal, cathodal and
sham groups. They received l tDCS at an intensity of 2mA
for 25 minutes daily for 6 consecutive days. Patients were
assessed with NIHSS, Barthel index (BI) and Medical
Research Council (MRC) muscle strength scale at baseline,
after end of sessions, and then 1, 2 and 3 months later.
Cortical excitability was measured at baseline and after the
6th sessions.
Results: By the end of the follow-up, all groups had
improved on all scales with P-values ranging from 0.01 to
0.0001. Improvement was equal in the anodal and cathodal
groups with no significant differences between them in any
of the rating scales. When these treatment groups were
combined and compared with Sham, significant time X
group interaction terms were seen for BI (p=0.002) and
NIHSS (p=0.046). Interactions were also seen in MRC
scores for all muscles. There was increased cortical
excitability of the unaffected hemisphere after the end of the
last session in all groups with the changes being more
significant in the real than sham groups.
Conclusion: Combined rehabilitation training with anodal
or tDCS may improve mobility in the upper and lower
extremities in subacute ischemic stroke.
186 Posters, Sunday 9 September
P1220
Predicting survival in haemorrhagic
stroke: the prognostic value of routine
markers
A.M.H. Young1, C.K. Weerasuriya1, A.J. Procter1,
S. Singh1, A. Rinnert1, N. Wang1, U. Rai2
1Cambridge Medical School, University of Cambridge,
Cambridge, 2Department of Stroke Medicine, Queen
Elizabeth Hospital, Kings Lynn, UK
Introduction: Serum markers of inflammation are
becoming recognised as prognostic factors in ischaemic
stroke. However, this relationship in haemorrhagic stroke is
less well defined. In this study, we examined admission
markers of inflammation and applied a logistic regression
model to predict outcome in haemorrhagic stroke.
Methods: A retrospective study was performed between
September 2009 and 2011 at a general admission stroke unit
in the UK. Over this time, approximately 1400 patients were
admitted with acute stroke; of these, 114 cases were
haemorrhagic in nature. Venous blood samples were
obtained on admission. Pre- and post-morbid (i.e. at
discharge or death) modified Rankin scores were also
recorded. Patients were controlled for age, sex, smoking
status, hypertension status and co-morbidities using the
Charles co-morbidity index (CCI). Logistic regression
models were generated using SPSS.
Results: Of the cohort examined 58 were male and 55
female. The median [quartiles] glucose values of patients
differed significantly (p=0.009) between those who survived
(n=59) at 6.5mmol/L [5.8, 8.1] compared to those who did
not (n=34) at 8.9mmol/L [6.1, 10.1]. Leukocytes
demonstrated a similar trend with a median of 9.32x109/L
[8.0,12.0] in the survival group compared to 13.4x109/L
[9.7, 17.4] those deceased (p=0.001). Using these data, our
logistic regression model predicted survival correctly on
83.9% of occasions. Separating groups by sex improved this
to 96% in females.
Conclusions: These results suggest that a logistic regression
model using plasma glucose, leukocytes, clinical outcomes
and sex might be a useful tool for prognosis in haemorrhagic
stroke.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1221
New score ABN for TIA: prediction of
short-and long-term risk of stroke
O.Y. Fartushna
Bogomolets National Medical University, Kiev, Ukraine
Transient ischemic attacks (TIA) are strong predictors of
subsequent stroke, disability and death. Thats why,
improved methods to predict risk of stroke after TIA are
very important.
Aim was to create a neurological prognostic score for stroke
risk after TIA using the clinical and neuroimaging criteria
and methodology of mathematical evaluation of the
probability of a set of independent events, and combinatorics.
Methods: The clinical, Doppler ultrasound, MRI,
transthoracic echocardiography diagnosing has been carried
out in 178 patients with TIA. Cases were reviewed by two
neurologists to establish the correlation with the diagnosis.
Results: During the 2 years observation period stroke
developed in 34 (41.5%) TIA patients. To determine the
stroke risk after TIA we have created a new score ABN
(Age, Blood pressure, Neuroimaging), which is an improved
version of the group of ABCD scales to predict short- and
long-term risk of stroke in patients with TIA. The ABN
score is calculated by summing up points for 3 independent
factors associated and optimized to predict the risk of stroke
within 2, 7, 30, 90 days after a TIA, but also to predict
stroke risk within 1 and 2 years with a sufficiently high
diagnostic accuracy, p<0.05. Total scores ranged from
0 (lowest risk) to 7 (highest risk).
Conclusions: Comparative analysis of scales ABCD2 and
ABN in the first 90 days after TIA showed a higher
sensitivity and specificity of the ABN (Se=0.83; Sp=0.69)
scale compared with the scale ABCD2(Se=0.77; Sp=0.58)
in 90 days and in the 2 years after TIA (ABN: Se=0.85,
Sp=0.75; ABCD2: Se=0.79, Sp=0.62).
P1222
Abstract cancelled

P1223
A case of Susacs syndrome
T. Kasikci, S. Bek, E. Tokgoz, S. Demirkaya, Z. Odabasi
Gulhane Medical Faculty, Ankara, Turkey
Background: Susacs syndrome is a rare angiopathy with
the triad of encephalopathy, retinal artery occlusion and
acute hearing loss. It causes retinal, cochlear and cerebral
infarcts usually in young females.
Case: A 33-year-old male patient after headache for one
week described attention deficiency, dysmnesia and acute
right hearing loss. In neurological examination his
cooperation and orientation were inadequte. He was not
able to hear with his right ear. His gait was ataxic, deep
tendon reflexes were increased. Right Babinski sign was
positive. His electroencephalography showed generalised
delta activity. In brain magnetic resonance imagings T2 and
FLAIR hyperintense, T1 iso/hypointense lesions especially
in corpus callosum were detected. Right sensorineural
hearing loss was confirmed by audiogram. Cerebrospinal
fluid analysis was normal except mild protein increase.
Recanalized vascular occlusions were shown in peripheral
retina by fundus fluorescein angiography (FFA). As a result
of laboratory findings the patient was diagnosed as Susacs
syndrome and treatment was initiated with acetylsalicylic
acid, metylprednisolon and intravenous immunoglobulin for
five days and continued with oral corticosteroid. Within the
following days encephalopathy had recovered but no
improvement was provided in hearing loss.
Conclusion: Despite the clinical and radiological similarity
with multiple sclerosis Susacs syndrome is an uncommon
microangiopathy resulting involvement of vessels.
Etiopathogenesis of the syndrome could not be clearly
defined but occlusions caused by the immune response
against precapillary endothelium may be responsible for the
pathogenesis.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 187
P1224
The influence of carotid endarterectomy
on cognitive and affective functions in
patients with atherosclerosis of carotid
arteries
N.N. Spirin1, N.N. Malyshev2, I.V. Malysheva2,
O.A. Fadeeva1
1 Neurology, Yaroslavl State Medical Academy, Yaroslavl,
2 Neurology, Regional Hospital #1, Vologda, Russia
Aim: To investigate the dynamics of neuropsychological
status in patients after carotid endarterectomy (CEA).
Methods: 52 patients were examined, 39 (75%) male and
13 (25%) female, mean age 627.5 (M). In anamnesis 21
(40.4%) patients had TIA, 14 (26.9%) had stroke, 17
(32.7%) did not have TIA or stroke. For the assessment Mini
Mental State Examination (MMSE), Hospital Anxiety and
Depression Scale (HADS), the test for remembering of 10
words and Shultz tables were used.
Results: The second assessment was performed 12.50.4
months after CEA. The positive dynamics of cognitive
status was stated based on MMSE (from 28.52.0 to
29.20.9, =0.037) and the test for remembering of 10
words (for immediate reproduction from 5.80.6 to 6.20.6
(=0.003), for postponed reproduction from 4.31.5 to
5.11.4, =0.007). Also the concentration of attention
improved based on Shultz tables (time for the first table
from 58.82 to 562 sec (=0.015), for the last table from
862 to 77.62 sec (p=0.04)). Based on HADS assessment
were decreased the level of anxiety from 9.31.8 to 8.51.5
(=0.014) and of depression from 7.12.1 to 6.381.41
(=0.031)).
Conclusion: Revascularization of carotid artery positively
influences cognitive and affective functions in patients with
atherosclerosis of carotid arteries.
P1225
Abstract Cancelled
188 Posters, Sunday 9 September

P1226
Haemorrheology of clinically silent
multifocal vascular cerebral lesions
P. Kowal1, I. Siemieniak2, A. Marcinkowska-Gapinska3
1Medical University, Strus Hospital, Rheological
2 3
Laboratory, Poznan, Poland
P1227
Intravenous and intra-arterial
thrombolysis for acute ischemic stroke:
the first experience in Cyprus
B. Kaymakamzade1, G. Akansoy1, S. Akpinar2, A. Eker3,
I. Ipekdal3, L. Erguven1, S. VudalDogruyol2,
M. Ozmenoglu3, T. Akalin1
1Neurology, 2Radiology, Dr. Burhan Nalbantoglu State
Hospital, 3Neurology, Near East University, Faculty of
Medicine, Nicosia, Cyprus
P1228
Opalski syndrome developing after
radiotherapy: a case report
S.G. zmen, B. Kocer, . Kenan, H.Z. Batur
Department of Neurology, Gazi University School of
Medicine, Ankara, Turkey
P1229
Three-year consequences of ischemic
stroke in patients with arterial
hypertension and C-reactive protein
content
O. Markulan1, T. Cherenko2
1 National Medical Academy of Post-graduate Education,
2 National Medical University, Kiev, Ukraine
P1230
Cerebral amyloid angiopathy presenting
as recurrent intracerebral haemorrhage
Z. Ozozen Ayas, D. Kotan, G. Unal, Y. Guzey Aras
Sakarya University Department of Neurology, Sakarya,
Turkey
P1231
Mortality in patients with asymptomatic
carotid atherosclerosis
I. Kolos, O. Syvakova, S. Boytsov, AMTEC Study Group
Research Center for Preventive Medicine, Moscow, Russia
P1232
Mortality in stroke patients
I.V. Pershyna
Kharkiv Medical Academy of Postgraduate Education,
Kharkiv, Ukraine
P1233
Development and validation of the Asian
stroke disability scale (ASDS)
K. Ghandehari1, K. Ghandehari2, G. Saffarian-Toosi3,
S. Masoudinezhad3, S. Yazdani3, A. Nooraddin3,
S. Ebrahimzadeh3, F. Ahmadi3, F. Abrishamchi4
Neurology, 2Neuroscience Research Center, 3Mashhad
1
University of Medical Sciences, Mashhad, 4Isfahan
University of Medical Sciences, Isfahan, Iran
P1234
The rate of disability after cerebrovascular
disease
R. Aliyev
Neurology Department, Azerbaijan State Advanced Training
Institute for Doctors named after A.Aliyev, Baku, Azerbaijan
P1235
Is malnutrition a risk factor of stroke?
M. Habib, A.N. Rizvi, M.S.I. Bhuiyan, M. Bhuiyan,
A. Haque
Neurology, Bangabandhu Sheikh Mujib Medical University,
Dhaka, Bangladesh
P1236
Influence of Cerebrolysin on white blood
cell and red blood cell aggregation,
deformability and morpho-densitometry
parameters of erythrocytes in patients
with cerebrovascular disease
A.V. Anisimova, K.V. Anisimov, T.I. Kolesnikova
Neurology, Russian State Medical University, Moscow,
Russia
P1237
Exertional periodic breathing augments
anaemia-related cerebral hemodynamic
dysfunction in patients with heart failure
J.-S. Wang
Chang Gung University, Tao-Yuan, Taiwan R.O.C.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

 Posters, Sunday 9 September 189

P1238 P1243
The difference in the biochemical indices Cerebral blood flow and head-up tilt in
of blood plasma in patients with the earlier period of acute stroke
symptomatic and asymptomatic course of L.N. Anisimova1, I.A. Voznyuk1, D.V. Polyakov2,
different degree atherosclerosis of the A.V. Polyakova3
internal carotid arteries
1Medical Military Academy, 2I. I. Mecnikov North West State
University, 3I. P. Pavlov State Medical University, St.
M.L. Pospelova1, O.D. Barnaulov2 Petersburg, Russia
1Neurology, I. P. Pavlov State Medical University,
2Pharmacology, The Bektereva Human Braun Institute, RAS,
Saint Petersburg, Russia P1244
Comparison of clinical-neuroimaging
P1239 diagnoses and cognitive profile diagnoses
Diagnostic value of Transcranial Doppler of mild cognitive impairment subtypes:
and computer tomographic angiography preliminary experience in a VAS-COG
in acute basilar artery ischemia clinic
N.G. Dadamyants1,2, A.I. Ikramov2 R. Valenti, E. Salvadori, P. Anna, F. Pescini, L. Ciolli,
Radiology, Republic Research Center of Emergency
1 S. Nannucci, D. Inzitari, L. Pantoni
Medicine, Khorezm, 2Tashkent Institute of Postgraduate Department of Neurological and Psychiatric Sciences,
Medical Education, Tashkent, Uzbekistan University of Florence, Italy

P1240 P1245
Territorial division and clinical Cerebellar haemorrhage - clinical course
characteristics of posterior circulation and prognosis
cerebral infarcts (PCCI) A.P. Bezmarevic
I. Stakena1, G. Enina1, I. Kikule1, A. Platkajis2 Special Hospital for Cerebrovascular Diseases St. Sava,
1Department of Neurology and Neurosurgery, 2Department of Belgrade, Serbia
Radiology, Riga Eastern University Hospital Gailezers,
Riga, Latvia P1246
Cardiovascular risk factors control in
P1241 patients after ischemic stroke in Western
Three-year catamnesis of survivability and Ukraine
functional outcomes in stroke patients N. Sydor1, O. Shulga1, A. Yagensky1, L. Shulga2
I. Pershyna 1 Volyn Region Hospital, 2Lutsk City Hospital, Lutsk, Ukraine
Neurology and Neurosurgery, Kharkiv Medical Academy of
Postgraduate Education, Kharkiv, Ukraine
P1247
Characteristics of stroke mimics in
P1242 intravenous thrombolysis
The implication of immediate neurological D. Leupold, M. Galovic, G. Kgi, B. Weder
improvement in acute ischemic stroke Department of Neurology, Cantonal Hospital St. Gallen,
D. Kim St. Gallen, Switzerland
Neurology, Songdohyoja Geriatric Hospital, Incheon,
Republic of Korea

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

190 Posters, Sunday 9 September

P1248 P1254
Characteristics of transient ischemic Melatonin prevents the cerebral ischemic
attacks preceding ischemic stroke brain injury-induced decrease in
O. Stojiljkovic, M. Zarkov, M. Jerkovic parvalbumin expression
Department of Neurology, Clinical Center of Vojvodina, Novi P.-O. Koh1, J.-H. Sung2, F.-A. Shah2, E.-H. Cho1,
Sad, Serbia M.-O. Kim2
1Department of Anatomy, College of Veterinary Medicine,

P1249 Institute of Agriculture and Life Science, 2Division of Life

Science and Applied Life Science, Gyeongsang National
Echocardiogram in young ischaemic University, Jinju, Republic of Korea
stroke patients: TTE versus TOE
A. Murphy1,2, J. Kinsella2, C. McGuigan2 P1255
School of Medicine and Medical Science, University
1

College Dublin, 2Department of Neurology, St Vincents Cognitive decline in patients with stroke
University Hospital, Dublin, Ireland A.K. Thacker1, N. Chaturvedi2, A.M. Verma2, M. Mishra2
1Neurology, 2Medicine, BRD Medical College, Gorakhpur,

India
P1250
Cerebral vein thrombosis and fluid
P1256
deprivation of the post-partum
N. Slimani1, R. Ghazali2, I. Eltibani2, M. Izem3,
Thrombolysis during menstruation
A. Ait-Slimane4, D. Hakem1, A. Berrah1 A. Iljicsov1, C. Ertsey1, I. Sipos1, E. Cspny1, M. Sim1,
Internal Medicine, Dr Mohammad-Lamine Debaghine,
1 S. Ilniczky1, G. Vrallyay2, I. Szl3, D. Bereczki1
University Hospital, Algiers, 2EPH Djelfa, Djelfa, 3Internal 1Neurology Department, 2Szentgothai MRI Research Center,
Medicine Emergency, 4Emergency, Dr Mohammad-Lamine Semmelweis University, 3National Institute of Rehabilitation,
Debaghine, Universitarys Hospital, Algiers, Algeria Budapest, Hungary

P1251 P1257
Depression after stroke Outcome of acute basilar artery
A. Jaoua1, S. Benamor2, S. Benammou2 occlusions followed at the intensive care
1 Neurology, 2CHU Sahloul, Sousse, Tunisia unit
N. Oztekin1, M.F. Oztekin2
P1252
1Neurology, MOH Ankara Numune Education and Research

Hospital, 2Neurology, MOH Ankara Yildirim Beyazit

CNS vasculitis associated with HCV Education and Research Hospital, Ankara, Turkey
infection
A. Castro Caldas, L. Neto, P. Canho, T. Pinho e Melo, P1258
R. Geraldes
Hospital Santa Maria, Lisbon, Portugal A retrospective analysis of cerebral vein
and dural sinus thrombosis (CVT) cases
hospitalized at our neurology service over
P1253
a two-year period
Abstract cancelled M.I. Gutirrez-Cid, B. Venegas-Prez, G. Torres-Gaona,
C. Feliz-Feliz, M.A. Aranda-Calleja, S. Bellido-Cullar
Neurology, Fundacin Jimnez Daz, Madrid, Spain

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

 Posters, Sunday 9 September 191

P1259 P1264
Post-stroke dementia syndrome Date of birth and gender as risk factors
D. Nao1, J. Kruja,2, S. Gjei,2, D. Dobi2 for ischemic stroke of middle cerebral
1Specialistic Polyclinic 2, 2Neurology, UHC Mother Theresa, artery vasculature
Tirana, Albania
A. Kutera, E. Szczepocka, K. Jastrzebski
Medical University of Lodz, Lodz, Poland
P1260
Mortality and morbidity rate in P1265
hemorrhagic stroke patients with different Management of acute ischaemic stroke in
risk factors tertiary care hospital in UAE: an audit
V. Davoudi, K. Keyhanian, M. Saadatnia, F. Haghdoost report
Neurology Department, Isfahan University of Medical
M.C. Thakre1, J.S. Inshasi2,3
Sciences, Isfahan, Iran 1Neurology, Canadian Specialist Hospital, 2Neurology,

Rashid Hospital, Dubai Health Authority, 3Medicine, Dubai

P1261 Womens Medical College, Dubai, United Arab Emirates

The assessment of carotid wall thickness

as a predictive value of risk of stroke in P1266
hypertensive diabetes and non-diabetes Verification of oversight in the
patients cancellation tests and the subscale of the
C.R.S. Revnic1, B. Paltineanu2, G.I. Prada3, F.G. Revnic4 behavioural inattention test (BIT) in
1Cardiology, UMF Carol Davila, 2Geriatrics, NIGG Ana
patients with right hemisphere stroke and
Aslan, 3Geriatrics, UMF Carol Davila Bucharest/Faculty of normal subjects
General Medicine, 4Cell and Molecular Biology of Aging,
NIGG Ana Aslan, Bucharest, Romania M. Kawaguchi1, M. Yamada1, Y. Nakamura1, K. Kawase1,
Y. Satoh1, A. Satoh2, M. Tsujihata2
Rehabilitation, 2Neurology, Nagasaki Kita Hospital,
1

P1262 Nagasaki, Japan

Cerebral venous thrombosis presenting
with subarachnoid haemorrhage: shady of P1267
3 cases study Dynamics of the quality of life in the
L. Raji, R. Ibn Moufti, H. Elotmani, M.A. Rafai, post-stroke patients restoration period
B. Elmoutawakil, I. Slassi
M. Romanova
CHU IBN Rochd, Casablanca, Morocco
Department of Neurology, M.F.Vladimirsky Moscow
Regional Clinical and Research Institute, Moscow, Russia
P1263
Correlation between high sensitive P1268
C-reactive protein (hsCRP) and infarction Predictors of stroke recurrence or cardiac
volume and brain CT-scan findings in death in non-rheumatic atrial fibrillation
patients with ischemic stroke C. Gratii1, A. Grosu1, N. Diaconu1, G. Pavlic2
P. Petramfar1, A. Shariat2, S. Mosallaei2, 1Institute of Cardiology, 2Institute of Neurology and

M. SharifianDorche2 Neurosurgery, Chisinau, Moldova

1Shiraz University, 2Shiraz University of Medical Sciences,

Shiraz, Iran

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

192 Posters, Sunday 9 September

P1269 P1275
The impact of pulmonary infections on Long-term methylphenidate treatment in
the course and outcome of stroke a young woman with ADHD and agenesia
S.T. Ristic1, D.T. Ristic2, I. Marinkovic3 of left carotid and vertebral artery without
Department of Neurology, University Clinical Centre Nis,
1
cerebrovascular complication
Institute of Pulmonary Diseases, 3Medical Faculty of Nis,
2
A. Lavillaureix1, F. Pico2
Nis, Serbia 1Neurology Department, Versailles Hospital, Versailles
Saint-Quentin-en-Yvelines University, Paris Descartes
P1270 University, Paris, 2Neurology Department, Versailles
Hospital, Versailles Saint-Quentin-en-Yvelines University,
Stroke outcomes depending on the terms Versailles, France
of hospitalization and the severity of
patientts condition P1276
V. Yavorskaya1, I. Pershyna1, A. Grebenyuk1, O. Bondar1,
A. Scoryj2, S. Kryvchun2 Abstract cancelled
1Neurology and Neurosurgery, Kharkiv Medical Academy of
Postgraduate Education, 2Kharkiv City Clinical Hospital P1277
No7, Kharkiv, Ukraine
Neurophysiological evaluation of cortical
inhibitory activity in acute stroke:
P1271 correlation with long-term functional
Sneddons syndrome observed in internal recovery
medicine practice F. Ranieri1, M. Dileone1, P. Profice1, F. Pilato1,
D. Hakem, A. Berrah F. Capone1, L. Florio1, E. Pravat2, F. Iodice1,
Internal Medicine, Bab-El-Oued Hospitaal Universitary C. Colosimo2, V. Di Lazzaro1
1Institute of Neurology, 2Institute of Radiology, Universit
Centre, Algiers, Algeria
Cattolica del Sacro Cuore, Roma, Italy

P1272
Abstract cancelled
P1278
A comprehensive functional assessment
P1273 of cerebral blood flow in ischemic brain
L. Bokeria1, I. Aslanidi1, T. Serguladze1, N. Darvish1,
Intra-arterial thrombolytic therapy with
L. Pyshkina2, M. Bekuzarova2, A. Kabanov2
streptokinase. Experience of application 1Cardiovascular Surgery, Bakoulev Scientific Center for

in Uzbekistan Cardiovascular Surgery of the Russian Academy of Medical

S. Mubarakov1, A. Zakhidov1, N. Dadamyants2 Sciences, 2Department of Neurology and Neurosurgery,
1Neurology Department, Republican Research Center of Russian State Medical University, Moscow, Russia
Emergency Medicine, 2Functional Diagnosis Department,
Republican Research Center of Emergency Medicine,
Khorezm, Tashkent, Uzbekistan
P1279
DSA analysis and etiological exploring of
P1274 stroke in 86 young adults
L. Yin
Functional outcome and quality of life in Department of Neurology, 2nd Affiliated Hospital of Dalian
patients with aneurismal subarachnoid Medical University, Dalian, China
haemorrhage
I. Gabrielyan, H. Manvelyan
Department of Neurology, Yerevan State Medical University,
Yerevan, Armenia

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

 Posters, Sunday 9 September 193

P1280
Macaroni sign, Takayasu arteritis and
stroke
S. Calado1,2, G. Matias1, C. Reizinho3, C. Jordo4,
M. Viana-Baptista1,2
1Neurology Department, Centro Hospitalar Lisboa Ocidental
(CHLO) - Egas Moniz Hospital, 2CEDOC, Medical Sciences
Faculty, New University of Lisbon, 3Neurosurgery
Department, 4Neuroradiology Department, Centro
Hospitalar Lisboa Ocidental (CHLO) - Egas Moniz
Hospital, Lisbon, Portugal
P1285
A novel hypothalamic peptide proline-rich
peptide-1 as an agent for stroke
treatment
E. Yeritsyan1, A. Galoyan2, M. Balasanyan3
1Pharmacy, Yerevan State Medical University after Mkhitar
Heratsi, 2H. Buniatian Institute of Biochemistry of the
National Academy of Sciences, 3Pharmacology, Yerevan
State Medical University after Mkhitar Heratsi, Yerevan,
Armenia

P1286
P1281
Clinical analysis of 1003 cases of
Biomarker-based test for acute stroke transient ischemic attack
diagnosis and stroke types identification W. Ju1, Y. Yang2, J. Wu2
G. Mehtiyeva, V. Yagubov, R. Shiraliyeva 1 Neurology, 2Jilin University, Changchun, China
Neurology Department, Azerbaijan State Institute of
Advanced Training for Doctors, Baku, Azerbaijan

P1287
P1282
Cerebral venous sinus thrombosis:
Tentorial dural arteriovenous fistula association with primary varicella zoster
presenting as recurrent attacks of infection in the absence of Purpura
periodic paralysis fulminans
D. Singh, A. Garg, A. Bansal, G. Goel, A. Gupta
S.A. Siddiqi1, S. Nishat2, D. Kanwar3, F. Ali3,
Neurosciences, Medanta The Medicity, Gurgaon, India
M. Azeemuddin4, M. Wasay3
1Neurology, 2Aga Khan University Hospital, 3Medicine,
P1283 4Radiology, Aga Khan University Hospital, Karachi,
Pakistan
Treatment of cerebrovascular disorders
by new hypothalamic proline-rich
PRPTIDE-1
E. Yeritsyan1, A. Galoyan2, M. Balasanyan3
1Pharmacy, Yerevan State Medical University after Mkhitar
Heratsi, 2Buniatian Institute of Biochemistry, The National
Academy of Sciences, 3Pharmacology, Yerevan State Medical
University after Mkhitar Heratsi, Yerevan, Armenia

P1284
Association of the
methylenetetrahydrofolate reductase
gene polymorphism with carotid
distensibility and intima-media thickness
in patients with cerebral infarctions
N.D. Dimitrov1, A. Savov2, E.V. Todorova-Dimitrova3,
I. Velcheva4
1Department of Neurology, Second City Hospital Sofia,
2National Genetic Laboratory, Medical University Sofia,
3Clinic of Neurology, Military Medical Academy Sofia,
4Department of Neurology, Medical University Sofia,

Bulgaria

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

194 Posters, Sunday 9 September
Child and developmental neurology
P1288
Primary cilium, NPC1 and Patched1
proteins in Niemann-Pick type C disease
C. Battisti1, M. De Santi2, P. Formichi1, B. Rossi1,
E. Radi1, S. Tripodi2, E. Tarquini2, A. Federico1
1 University of Siena, 2AOU Senese, Siena, Italy
We assessed the presence of NPC1 and Patched1 proteins
and evaluated the relative distribution and morphology of
primary cilium in fibroblasts from Niemann-Pick type C
(NPC) patients and controls. NPC1 disease is a neurovisceral
storage disorder, characterized by an abnormal intracellular
accumulation of unesterified cholesterol and glycolipids.
Two distinct disease-causing genes have been isolated,
NPC1 and NPC2, involved in the processing and utilization
of endocytosed cholesterol. The NPC1 protein functions in
the sorting and recycling of cholesterol and
glycosphingolipids in the late endosomal/lysosomal system.
This protein exhibits extensive homology with Ptc1
receptor, a transmembrane protein localized in the primary
cilium and involved in the hedgehog signalling pathway. We
evaluated morphological aspects, relative distribution and
length of primary cilia in fibroblasts from five patients
affected by NPC1 disease, using anti-acetylated--tubulin
and anti--tubulin antibodies. Moreover we evaluated the
cytoplasmic expression of the NPC1 protein and Ptc1
receptor by fluorescence microscopy in fibroblasts from the
same patients. Immunofluorescence analysis showed a
significantly decreased immunostain for both NPC1 and
Ptc1 in NPC1 patients. Moreover, the NPC1 patient
fibroblasts showed a lower percentage of primary cilia
distribution and a significant reduction in median cilia
length compared to controls. Our results confirm the
hypothesis that Ptc1 and NPC1 have a similar aminoacidic
sequence, and that they might also present a functional
convergence. Moreover, we have, for the first time,
demonstrated altered ciliogenesis in fibroblasts from NPC1
patients, suggesting an important role for the primary cilium
in the pathogenesis of the disease.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1289
Oxygen toxicity is reduced by
acetylcholinesterase inhibition in the
developing rat brain
M. Sifringer1, C. von Haefen1, S. Endesfelder2, A. Kalb1,
I. Bendix3, U. Felderhoff-Mueser3, C. Bhrer2,
C.D. Spies1
1Anaesthesiology and Intensive Care Medicine,
2Neonatology, Charit - Universittsmedizin Berlin,
3Paediatrics I - Neonatology, University Hospital Essen,
Germany
Objectives: The cholinergic anti-inflammatory pathway is
a neural mechanism that suppresses the innate inflammatory
response and controls inflammation by acetylcholine as the
key endogenous mediator. In this study, we investigated the
effects of the cholinergic agonists, physostigmine and
donepezil, on neurodegeneration, oxidative stress and
inflammation during oxygen toxicity in the developing rat
brain. The aim of this study was to investigate the level of
cell death, glutathione, lipid peroxidation and the expression
of cytokines after hyperoxia and treatment with the
acetylcholinesterase (AChE) inhibitors, physostigmine and
donepezil in the brain of neonatal rats.
Methods: Six-day-old Wistar rats were exposed to 80%
oxygen in the presence or absence of physostigmine or
donepezil and were sacrificed at defined time points (6, 12,
24 h) following treatment. Sex-matched littermates were
kept in room air, and hyperoxia-exposed pups injected with
normal saline serving as controls. Brains were examined
histologically by Fluoro-Jade B staining or were processed
for molecular studies (real-time PCR, Western blotting,
spectrophotometric analysis, HPLC) to measure IL-1 and
TNF-, malondialdehyde and glutathione.
Results and conclusions: Treatment with physostigmine
and donepezil significantly reduced hyperoxia-induced
neurodegeneration and upregulation of the pro-
inflammatory cytokines IL-1 and TNF- in the brains of
infant rats. In parallel, both AChE inhibitors reduced
hyperoxia-induced oxidized glutathione and
malondialdehyde levels, whereas reduced glutathione was
upregulated through physostigmine and donepezil treatment
in the developing rat brain.
These findings are highly relevant from a clinical aspect
because oxygen administration to neonates is often
inevitable, and AChE inhibitors may serve as an adjunctive
neuroprotective therapy.

P1290
The distribution and changes in immune
inhibitory molecule CD200 and its
receptor in the developing C57BL/6 mice
brain following hypoxia/ischemia
K. Shrivastava, M. Chertoff, G. Llovera, M. Recasens,
L. Acarin
Dept of Cell Biol. Physiol. & Immunology, Inst. of
Neuroscience, Universitat Autonoma Barcelona, Bellaterra,
Spain
Introduction: CD200-CD200R system has been widely
shown to be involved in inducing immune tolerance and in
contributing to immune privileged status of the CNS.
However, the developing brain exhibits distinct
morphological as well as physiological characteristics
determining a peculiar response to injury showing an
aggravated susceptibility to excitotoxicity and pro-
inflammatory cytokines, along with an exacerbated
inflammatory response. Hence, the aim of this study was to
characterize the expression pattern of CD200-CD200R in
the developing mice brain following Hypoxic/Ischemic
(H/I) injury by immunofluorescence.
Methods: Wild-type C57/BL6 mice post-natal day 7 were
used for H/I injury using Vannucci model modified for
neonatal mice (8% O2, 55 min) and samples were collected
3h, 12h, 24h, 48h, 72h & 7 days after hypoxia.
Results: In control neonatal brains, CD200 was expressed
on neurons, blood vessels and some astrocytes, while
CD200R was expressed on pial and perivascular
macrophages. After H/I, CD200 immunolabelling was
increased in the hippocampal fissure until 7 days post-
lesion. CD200R+ cells were a subpopulation of Iba1+
reactive microglia/macrophages, showing ameboid/
pseudopodic morphologies, and located in the damaged
hippocampus and white matter tracts, persisting until 7 days
post-lesion. Characterization of CD200R+ cells by triple
immunofluorescence showed that most CD200R+ microglia
expressed the mannose receptor CD206, characteristic of
alternatively activated phenotype M2. In addition, some
CD200R+ microglial cells showed markers of antigen
presentation such as MHCII and CD86, and in specific
survival times also expression of scavenger receptor 1
(CD204).
Conclusion: CD200-CD200R molecules are involved in
microglial response following neonatal H/I injury.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 195
P1291
Brachial plexus ultrasound in obstetric
brachial plexopathy
S. Pillen1, A. Verrips1, J. Meulstee1, B. Semmekrot1,
N. van Alfen2
Canisius Wilhelmina Ziekenhuis, 2RU Nijmegen Medical
1
Centre, Nijmegen, The Netherlands
Background: Obstetric brachial plexus injury (OBPI) is the
most common peripheral nerve injury in children. In case of
severe nerve damage surgical intervention is indicated.
However, it is difficult to decide which child needs surgery
because both reversible and irreversible nerve damage (i.e.
neurotmesis and/or root avulsion) are initially clinically
identical. Ultrasound can visualize peripheral nerves with
excellent resolution. As ultrasound is a painless bedside
technique, it can be used in even very young children.
Ultrasound of traumatic brachial plexus injury in adults
showed that root avulsion could be predicted correctly in
75%. Our study aimed to 1) assess if the neonatal brachial
plexus can be reliably visualized with ultrasound, 2)
establish reference values and 3) use them to predict root
lesions in OBPI patients. Here we present the results of a
pilot measurement and the first results in healthy neonates.
Methods: 20 healthy neonates with a gestational age of at
least 32 weeks and a negative family history for neuropathy
were included during the first week of life. Ultrasound
images were made using a Philips IU22 ultrasound device
with a linear 7-15MHz hockey stick probe. They included
the C4 to T1 nerve roots and interscalene and supraclavicular
brachial plexus. Aspects of the nerve and surrounding
tissue, continuity and cross-sectional area were evaluated.
Results and conclusion: Our pilot studies showed that the
cervical roots and brachial plexus can be visualized in
neonates. Further results are presented at the meeting.
196 Posters, Sunday 9 September
P1292
Effects of maternal infection on anxiety
and depression-like behaviours of
offspring
J. Solati, G.H. Moll, R.R. Dawirs, Y. Golub
Dept. of Child and Adolescent Mental Health, University of
Erlangen-Nrnberg, Erlangen, Germany
Introduction: LPS and some cytokines can activate the
hypothalamic-pituitary-adrenal (HPA) axis and affect brain
development in pregnant mice. Maternal infection during
pregnancy is a risk factor for several psychiatric illnesses
with neurodevelopmental origin. In this study we have
evaluated the effects of exposure of pregnant mice to the
bacterial lipopolysaccharide (LPS) on anxiety and
depression-related behaviour of male offspring.
Methods: Pregnant NMRI mice were treated with intra-
peritoneal administration of LPS (120, 240 and 480g/kg)
at the 10th gestational day. Induction of the pro-
inflammatory cytokines, TNF-, IL-1 and IL-6, was
measured in maternal serum 1.5h following maternal LPS
challenge.
Results: Consequently we investigated the serum
concentration of corticosterone in both pregnant mice and
their offspring at the age of 9 weeks. Anxiety-related
behaviour of the male offspring (at postnatal day 70) was
studied using elevated plus maze (EPM) test; and forced
swimming test was applied for evaluating the depression-
like behaviour.
Conclusion: Our results demonstrate that LPS
administration induces a significant increase in TNF-,
IL-1, IL-6 and corticosterone levels in maternal serum.
However, in offspring, prenatal LPS administration has no
significant effects on serum cytokines, corticosterone levels
and depression-like behaviour, while decreasing the anxiety
levels.
P1293
Abstract cancelled
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1294
Idiopathic optic neuritis revealing an
exceptional presentation of Parry
Romberg syndrome in a Tunisian family
A. Riahi1,2, I. Bedoui1, I. Hmida1, H. Khaled1,
M. Mansour1, J. Zaouali1, R. Mrissa1
1 Department of Neurology, Military Hospital of Tunis,
2 Facult de Mdecine de Tunis, Tunisia
Introduction: Parry-Romberg syndrome (PRS) or
progressive hemifacial atrophy is a rare neurocutaneous
syndrome of unknown etiology characterized by slowly
progressive atrophy of a hemiface, spreading occasionally
to one side of the body. Extracutaneous manifestations such
as neurologic and ocular are common.
Case report: Patient A is a 19-year-old patient born to
consanguineous parents, presented with acute blurred
vision. Examination showed left hemifacial atrophy with
limb length asymmetry. Visual acuity was impaired in both
eyes. Cerebral MRI displayed hypotrophy with some non
unequivocal white matter lesions in the right cerebral
hemisphere. VEP indicated bilateral severe optic neuritis.
Further interrogation revealed similar cases in one maternal
uncle (Patient B, 32-year-old, hypotrophy of left side of the
body) and grandmother (Patient C, 69-year-old, severe right
side hemiatrophy).
Discussion and conclusion: Usually, PRS appears to occur
randomly in sporadic cases and for unknown reasons.
Familiar cases of PRS are exceptional. All three affected
patients in our observation had extra facial extension of the
atrophy, which is uncommon, too. Ocular manifestations
associated with PRS are frequent, Patient A's optic neuritis
was partially responsive to high doses of corticoids.
The particularities of this observation highlight the
heterogeneities of the PRS spectrum.

P1295
Biopsy-proven isolated neurosarcoid in a
7-year-old: presentation, management
and follow-up
G. Anand, N. Wilkinson, M.A. McShane
Oxford University, Oxford, UK
Isolated paediatric neurosarcoid is rare and there is little
information on its management and outcome. We report on
a 7-year-old with biopsy- proven neurosarcoidosis.
Case history: A 7-year-old male presented with acute
weakness and continuous twitching of his right leg. Over
the next 48 hours he developed progressive weakness
affecting all 4 limbs. An EEG showed Right Epilepsia
Partialis Continua and T2-weighted brain MRI showed
multifocal areas of high signal changes. CSF showed mild
pleocytosis. Our preliminary diagnosis was Acute
Disseminating Encephalomyelitis and he was treated with
steroids, immunoglobulin and anticonvulsants. Though he
initially showed some improvement, he deteriorated with
further seizures that led to a brain biopsy. This showed
multinucleate giant cells positive for CD68 KP1 and CD68
PGMI but negative for factor 13a, S100 and CD1a.
Immunostaining showed CD20 and CD79a positive small
B- and CD3 positive small T-lymphocytes, none of which
expressed TDT and proliferation index was low. The
features were in keeping with sarcoid. He was treated with
intravenous cyclophosphamide followed by oral
Azathioprine Serial brain scans showing consistent
improvement and on 18 month follow-up, he could
independently walk and had made a good recovery apart
from some residual weakness of his right foot. His disease
stayed isolated to his brain.
Conclusion: Neurosarcoid though rare does occur in
children and it is important to get a tissue diagnosis as it can
mimic neoplasms. Early intensive immunotherapy can be
very beneficial and hence the urgency in diagnosis.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 197
P1296
Clinical profile and follow-up of paediatric
neurocysticercosis cases: a study from
Eastern India
S. Bhattacharjee1,2, P. Biswas3, T. Mondal4, D.S.P. Saha5
1General Medicine, Peerless Hospital, 2Toxicology,
R.G. Kar Hospital, 3Senior Resident, Pediatrics,
R.G. Kar Hospital Kolkata, , Community Medicine, R.G. Kar
Hospital, 5Consultant Neurologist,
N.R. S. Hospital, Kolkata, India
Introduction: Neurocysticercosis is the most common
parasitic central nervous infection worldwide. Our present
study attempts to evaluate the clinical profiles, treatment
outcome and 2 years of mean follow-up results of 38
paediatric neurocysticercosis patients of an Eastern Indian
hospital.
Methods: Diagnosis was mainly based on clinical features,
computed tomography (CT) / Magnetic resonance imaging
(MRI) scan and exclusion of other causes. Symptomatic,
active cyst patients were treated with albendazole for 28
days, steroids and anticonvulsants.
Results: Mean age of presentation was 8.473.19 yrs.
Patients presented with generalized seizures in 55.3%, focal
seizures, in 31.6%, headache vomiting in 63.2%, focal
neurodeficit in 10.5% and combination of symptoms in
60.5% cases. Contrast CT brain showed solitary lesion in 27
(71.1%) and multiple in the rest. Among the solitary lesions,
parietal lobe was involved in 74.1%, frontal lobe in 14.8%.
At presentation, lesions were transitional (ring enhancing)
in 58.2%, inactive in 20%, mixed in 14.6% and active in the
rest. After 2 years of mean follow-up, seizure persisted in 9,
headache in 8 cases with permanent neurodeficit in none.
44.7% lesions calcified, 31.6% disappeared, 10.5%
regressed and the rest persisted.
Conclusion: Solitary ring enhancing lesions (transitional
stage) involving the parietal lobe was the commonest CT
picture at presentation. Generalized seizure was the
commonest presentation. Calcification of the lesion was the
commonest mode of healing followed by the disappearance
of the lesions. No particular risk factor was found to be
prognostically significant (p value>0.05).
198 Posters, Sunday 9 September
P1297
Incoercible hiccups and vomiting as a
presentation of NMO in paediatric age
S. Machado1, J.P. Vieira2, C. Conceio3, R.L. Silva2,
P.R. Sousa2, M. Ramos4, G. Queiroz5, L. Ventura5,
E. Calado2
1Hospital Fernando Fonseca, Amadora, 2Pediatric
Neurology, 3Neurorradiology Department, Hospital
Peditrico Dona Estefania, CHLC, Lisboa, 4Pediatric
Rheumatology, Hospital Peditrico Dona Estefania, CHLC,
Lisbon, 5Pediatric Intensive Care Unit, Hospital Peditrico
Dona Estefania, CHLC, Lisboa, Portugal
Introduction: Neuromyelitis optica (NMO) affects
preferentially the optic nerve and spinal cord and its serum
marker, the antibody against AQP4, has completely
revolutionized the diagnosis. AQP4 is heavily expressed in
area postrema, which explains clinical presentations such as
incoercible vomiting. Nonetheless, it is also expressed in
other organs such as kidneys and stomach, and the reason
why they are spared is not understood.
Clinical Report: A previous healthy 14yo children
presented to the A&E due to a subacute onset of vomiting
and hiccups. A couple of days later she experienced
weakness in the lower limbs with further progression to the
upper limbs and urinary retention. On the examination, the
cranial nerves were spared (without RAPD), there was no
Lhermitte sign, but a tetraparesis with a pyramidal pattern
was found. Also, there was a sensory thoracic level,
hyperreflexia and bilateral Babinski sign. The aetiological
investigation disclosed: CSF with pleocytosis (PMN
predominance), extensive lesion from the postrema area
until the conus medullaris, with preferential involvement of
grey matter, a positive anti-AQPA4 ab and also both
hematuria and proteinuria. Methylprednisolone was
promptly started but due to clinical deterioration, with
necessity of invasive ventilation, cycles of cyclophosphamide
and rituximab were initiated. In spite of the aggressive
treatment strategy, she deteriorated with bilateral optic
neuritis, tetraplegia and finally fatal dysautonomia.
Conclusion: With this clinical report we intend to highlight
the potential pitfalls in the diagnosis of NMO, namely with
atypical presentations such as vomiting and renal
involvement which to our knowledge was not described
previously.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1298
Incidence of kidney stones related to
topiramate treatment in paediatric
patients
A.A.H. Mahmoud
NNI, KFMC, Riyadh, Saudi Arabia
Aim: We ran this study to assess the incidence of
nephrolithiasis in a group of children on topiramate (TPM)
therapy for at least 1 year.
Method: In this retrospective observational surveillance
study, we reviewed the medical charts of children on TPM
for at least one year seen at a paediatric neurology
department during the period from 2005 to 2010 at King
Fahad Medical City. Children with a normal baseline
ultrasound report were included. Follow-up ultrasound
reports after at least one year were collected. However,
patients with any evidence of chronic illness or medications
that may affect the kidney functions in addition to those that
are not compliant to the prescribed dose were excluded.
Family history of renal stones, symptoms suggestive of
urologic disorders, and co-morbidities were recorded.
Results: Medical charts of 96 children on TPM with mean
age of 6.9 (3.8) years were reviewed, 52 (54.2%) of the
children were males. The follow-up ultrasound showed that
5 children (5.2%) had developed kidney stone. The
occurrence of kidney stones was found in 4 females (80%)
versus (20%), 1 male (p>0.05).
Discussion: Long-term use of TPM may result in incidence
increase of asymptomatic kidney stones in the paediatric
population. Hence, routine baseline and follow-up
ultrasound of the urinary system should be recommended
during the use of TPM in children.

P1299
Neuro-osteology - a new discipline in
orthodontics
I. Kjaer
Odontology, University of Copenhagen, Denmark
Introduction: Neuro-osteology describes the inter-
relationship between neural tissue and mineralized tissue
(bone and teeth) under normal and pathological conditions
(1). Special focus areas are pituitary gland/sella turcica (2),
CNS/neurocranium (3) and PNS/jaw and teeth (4). The
prenatal interrelationship has been examined in human
foetuses in a long series of published studies now forming
the basis for analyzing malformations in postnatal jaw
regions with different neural crest origins (5).
Methods: 17 children with Single Median Maxillary
Central Incisor (SMMCI) were examined by radiography
and 2 of these by MR scan of the brain.
Results:
Dentition: One single maxillary central incisor located in
the midline.
Maxilla and cranial base: No inter-incisal suture present.
The jaw was retrognathic and the anterior cranial fossa was
significantly shorter than normally.
Brain: Midline structures of the brain, falx cerebri and the
pituitary gland were abnormal. The neuro-hypophysis was
absent and interdigitized cortex was observed in the frontal
lobes. Severe growth hormone deficiency was registered.
Conclusion: The study highlights the concurrence between
midline defects in dentition, jaw and frontal lobes and
pituitary gland. The condition may be part of the
Holoprosencephaly spectrum. The study provides guidelines
for early diagnostics in the dentition with interrelation to
CNS malformations.
References:
1. Kjr I. Crit Rev Oral Biol Med 1998;9:224-44.
2. Kjr I et al. Eur J Pediatr Surg 1999;9:354-8.
3. Kjr I et al. Neuropediatrics 2010;40:280-3.
4. Nielsen SH et al. Eur J Orthod 2006;28:529-34.
5. Kjr I. Eur J Orthod 2010;32:140-7.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 199
P1300
Early detection of minor
neurodevelopmental dysfunction at the
age of 6 months in prematurely born
neonates
M.H. Tsai1, Y.-S. Huang2, S.M. Chu2, J.F. Hsu2
Chang Gung Memorial Hospital, Yunlin, 2Chang Gung
1
Memorial Hospital, Taoyuan, Taiwan R.O.C.
Introduction: Premature infants are known to have higher
risk of minor neurodevelopmental dysfunctions (MNDs)
when 2 to 5 years old. We aimed to investigate the 6-month
neurodevelopmental outcome of prematurely born neonates
and find the determining neonatal factors of MNDs.
Methods: 151 premature infants were assessed at 6 months
corrected age with the Bayley Scales of Infant Development-
2nd Edition (BSID-II) and the Denver Developmental
Screening Test (DDST). Neonates with cerebral palsy or
major neuromotor dysfunctions at discharge were excluded
from analyses.
Results: Of 151 neonates born before 37 weeks, 20 (13.2%)
had MNDs at 6 months corrected age. These proportions
were 21.6%, 13.2%, and 8.2% for neonates born before 28
weeks, 29 weeks to 32 weeks, and 33 weeks to 36 weeks,
respectively. Half of neonates with MNDs have a birth body
weight (BBW) of less than 1000g. BSID-II and DDST are
highly correlated in assessing the MNDs of premature
neonates at 6 months corrected age. After multivariate
logistic regression analysis adjusted to gestational age and
BBW, MND was independently associated with postnatal
corticosteroid use (odds ratio [OR], 11.2; 95% confidence
interval [CI], 1.9-66.0, P= 0.008) and cholestasis (OR, 6.2;
95% CI, 1.16-33.1, P=0.033).
Conclusions: Premature neonates, even those born at 33 to
36 weeks, are found to have MNDs as early as 6 months
corrected age by BSID-II and DDST, with risk increasing as
gestation decreases. Preterm infants at risk of MNDs justify
the requirement of intervention as early as possible.
200 Posters, Sunday 9 September
P1301
West syndrome followed by juvenile
myoclonic epilepsy: a coincidental
occurrence?
G. Giordano, C. Spitaleri, A. Fontana, R. Nardello,
S. Mangano
Dipartimento Materno Infantile di Urologia e Andrologia,
Unit Operativa di Neuropsichiatria Infantile, Universit
degli Studi di Palermo, Italy
WS is an age-dependent epilepsy with onset peak in the first
year of life. According to the ILAE classification, the
etiology of WS could be symptomatic or cryptogenic. An
idiopathic etiology was considered too. In literature, there
was never previously described a transition from WS to
JME.
Methods: The proband, (male) was referred to our
Department at the age of 8 months because he showed
clusters of symmetric spasms. Interictal EEG recording
displayed an hypsarrhythmic pattern. The clinical and EEG
data suggested WS diagnosis. At 1 year of age increasing
long and thick hair in both elbow regions was observed.
This picture suggested an additional diagnosis of Hairy
Elbows Syndrome. During follow-up, the neurological
examination was normal and the EEGs showed age
appropriate background activity without abnormalities until
12 years of age, when he experienced some clusters of
bilateral, arrhythmic myoclonic jerks, synchronous with
generalized discharges of 4Hz spike-wave. This features
suggested JME diagnosis.
Results: We report a child with WS with onset at 8 months
of age followed by JME at 12 years of age. This unusual
evolution, never reported previously, suggests that both
seizure types may share some pathophysiological processes
genetically determined, which produce a susceptibility to
seizure.
Conclusion: This case documents a new transition type
from WS to JME and improves the knowledge about the
spectrum of seizure susceptibility. These findings suggest
that some genes other than those currently known and non-
conventional genetic factors can play a role in seizure
predisposition.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1302
Maternal alcohol drinking and
neurodevelopmental outcome in early
infancy
G. Jeong1, J.Y. Han2,3, H.S. Kwak4
1Pediatrics, 2Obstetrics and Gynecology, Cheil General
Hospital and Women's Healthcare Center, Kwandong
University, 3Division of Maternal Fetal Medicine, The
Korean Motherisk Program, 4Division of Endocrinology,
Department of Internal Medicine, Cheil General Hospital
and Women's Healthcare Center, Kwandong University,
Seoul, Republic of Korea
Introduction: Fetal alcohol spectrum disorder (FASD) has
been identified as significant medical and public health
problem. Many studies have reported morphologic
characteristics and long-term disabilities. However
neurodevelopment of early infancy has been rarely
described.
Methods: A prospective cohort study was conducted at
Cheil General Hospital Mother Risk Program. In total 236
pregnant women participated in the research and filled out
TWEAK questionnaire. After delivery and 12 months
postpartum, offspring5 were examined and mothers were
interviewed. Meconium was collected to measure fatty acid
ethyl ester (FAEE) in their offspring5. 106 babies being over
10 months of age were performed the physically examined
and Bayley scales of infant and Toddler Development III
(BSID-III) were performed. We compared the growth
(height, weight, and head circumference), morphological
characteristics (palpebral fissure length and philtrum grade)
and BSID-III results between maternal alcohol drinking
group and non-drinking group.
Results: The overall rate of alcohol drinking more than
once during pregnancy was 55% (66/120). In maternal
alcohol drinking group, TWEAK positive rate was 38%
(25/66) and FAEE positive rate was 24% (8/33). One child
was diagnosed as foetal alcohol syndrome. For the growth,
children in the maternal alcohol drinking group showed less
growth rate, shorter palpebral fissure length, higher
philtrum grade and lower BSID-III score than in the non-
drinking group however statistical difference was not
significant.
Conclusion: Offspring of women drinking alcohol had
tendency of delayed neurodevelopment but that was not
prominent in early infancy. Development test alone could
not be a diagnostic tool for FASD without distinctive FAS
morphology.

P1303
Paraneoplastic opsoclonus-myoclonus
syndrome in children
N. Ben Achour, I. Ben Youssef-Turki, I. Kraoua,
H. Benrhouma, A. Rouissi, H. Touaiti,
N. Gouider-Khouja
Department of Child and Adolescent Neurology, National
Institute of Neurology, Tunis, Tunisia
Introduction: Opsoclonus-myoclonus syndrome (OMS),
called Kinsbourne syndrome is the most common
paraneoplastic neurological syndrome in children associated
with neuroblastoma (NB) or more rarely with other tumours.
The objective is to study the epidemiological, clinical and
therapeutic aspects of paraneoplastic OMS (POMS)
collected in our department.
Methods: All children with POMS, followed up in our
department over 6 years (2005-2011), were reviewed.
Epidemiological data, clinical presentation and diagnostic
and therapeutic approach are discussed.
Results: 4 children (3 boys and 1 girl) with POMS were
collected. Mean age was 5.6 years. Acute ataxia was
inaugural symptom. Sleep disturbances were found in 2
patients. High rate of NSE was found in all patients.
Onconeural antibodies were negative. Screening for a
tumour, including (CT scan, Whole-Body MRI and MIBG
scintigraphy) allowed us to find the primary tumour, only in
2 patients (NB in the first case and rhabdod tumour of the
skin, in the second case). All patients received
immunomodulatory treatment (corticosteroids and
intravenous immunoglobulin). Full recovery was obtained
only in 1 patient who had etiological treatment.
Discussion and conclusion: POMS is quite a rare (4/1600
children hospitalized in our department over 6 years) or
under-diagnosed entity. Patients may present with staggering
and falling, often leading to a misdiagnosis of acute
cerebellar ataxia. Recognition of this disorder may lead to
early detection and treatment of the paediatric neoplasms
and may reduce the neurologic damage that is the major
source of morbidity in children with successfully treated
tumours.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 201
P1304
Audio-visual perception and related
memories among dyslexia disordered
students in comparison with normal
students
A. Kazemi
Psychology, Islamic Azad University Tehran Medical
Branch, Tehran, Iran
Introduction: Dyslexia is a disorder which causes some
problems in reading. Students with dyslexia suffer from
other improper functioning of the brain which is not
necessarily because of physical injuries to it. The function
of the brain in individuals with dyslexia differs from normal
people. The object of this study is to compare audio-visual
perception and related memories between a group of 2nd to
4th grade elementary students with dyslexia disorder with a
normal group.
Methods: The statistical sampling included 40 dyslexic
students chosen according to available sampling method
and 40 normal students chosen according to simple random
method. Both groups included boys and girls with equal
numbers from 2nd to 4th grades in elementary school in
Tehran city. The participants were evaluated with Frostig
developmental visual perception test, Wepman's audio
diagnosis scale, Andre-ray test and the sequence of audio
expressional memory scale. The results were analyzed using
T-Test method.
Results: Findings showed that there is a meaningful
difference between the groups in terms of visual -perception
(t=9/39) and its five sub-scales including eye-motor
coordination(t=9/12), figure grand(t=9/03), form
constancy(t=9/36), position in space(t=6/98) and spatial
relations(t=5/76); audio perception(t=9/74); visual
memory(t=3/96) and audio memory(t=5/83) .
Conclusion: The dyslexic disordered students compared to
the normal students are less capable in audio visual
perception and related memories. There is also no difference
between boys and girls in both groups.
202 Posters, Sunday 9 September
P1305
Role of glutathione redox status in the
pathophysiology of autistic disorder
A. Corejova, A. Hrabovska, J. Kyselovic
Department of Pharmacology and Toxicology, Faculty of
Pharmacy, Comenius University, Bratislava, Slovak Republic
Introduction: Oxidative stress has been suggested to be
one of the key elements in the pathophysiology of autism.
Oxidative stress is produced by high levels of free radicals,
which, in physiological conditions, are under regulation by
multiple antioxidative mechanisms. It has been proposed
that the loss of this regulation participates in the pathogenesis
of autism. The aim of our project was to examine whether
potentiated antioxidative mechanisms would affect autistic
disorder symptoms.
Methods: Patients (n=43; 2-21 years old) with autistic
disorder were enrolled. Exclusion criteria for subject
selection were as follows: Asperger syndrome, high-
functioning autism, epilepsy, selected pharmacotherapy
affecting CNS. Methylcobalamine was given daily at a dose
of 500g. Venous blood was collected at d0, d90 and d180
and redox status of glutathione as well as levels of
homocystein and cobalamine were determined. The
psychological profile was defined at d0, d90 and d180 by a
psychologist in combination with parent observations.
Results: Oral application of methylcobalamine (500g per
day) influences glutathione redox status. Based on the
combination of parent and psychologist observations,
language and social skills were improved in patients using
methylcobalamine. Social interaction was increased,
including social responsiveness and eye contact.
Conclusion: Oral application of methylcobalamine in
patients with autism seems to potentiate antioxidative
mechanisms and leads to changes in the psychological
profile of patients.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1306
Diploid/tetraploid form of cutaneous
mosaicism in a child with refractory
epilepsy and malformation of cortical
development
M.I. Sigatullina1, C. Fons2, F.V. Sanmarti3, M.I. Perez4
1Child Neurology Department, Tashkent Institute of
Postgraduate Medical Education, Tashkent, Uzbekistan,
2Child Neurology Department, 3Epilepsy Unit, , 4Genetic
Department, Hospital San Joan de Deu, Barcelona, Spain
Objective: To analyze the concordance between the
neurological symptoms and seizure semiology in a child
with a special form of cutaneous mosaicism.
Methods: The full spectrum of clinical, cytogenic,
continuous Video-EEG and MRI investigations were
performed.
Results: A 1-year-old girl was born from healthy non-
consanguineous parents. During the first 36 hours of life
she presented clonic seizures in the left hand and leg, with
tonic head and eyes deviation to the right. During the first
year she developed refractory epilepsy with generalized
tonic seizures. Family history was unremarkable for
cutaneous and epilepsy disorders. Pregnancy and delivery
were uneventful. The birth a lot of dismorphic features of
the face have been noticed, heterocroma of iris, hypo- and
hyper pigmented maculas at the skin of the right frontal area
and right leg, hypopigmented hair mixed with normal,
which followed the Blaschko lines. Clinically the girl
presented severe mental retardation and diffuse muscle
hypotonia. The EEG was characterized by focal slowing and
epileptiform activity predominant in the right centro-
parietal and centro-temporal areas. MRI of the brain
revealed extensive right parieto-occipital lysencephaly. The
routine analysis of the caryotype in the peripheral blood was
normal: 46 XX. The cytogenic investigation of the
hypopigmented parts of the skin biopsy revealed the
Chromosomal Mosaicism 92, XXXX(10)/46,XX (20).
Conclusion: There is a possible close connection between
the cutaneous mosaicism and different types of
malformations, which show us the importance of caryotype
investigation in skin fibroblasts in patients with dysmorphic
features, pigmentation changes of the skin and brain
dysplasia.

P1307
Diagnostic brain imaging in congenital
facial palsy
H. Uchikawa, K. Fujii, A. Takagi, Y. Kohno
Pediatrics, Graduate School of Medicine, Chiba University,
Chiba, Japan
Introduction: Congenital facial palsy is caused by various
disorders. But the pathogenesis of them often remains
unclear. We report three cases of congenital facial palsy
with identification of lesions by the radiological findings.
Methods: We investigated the etiology of three Japanese
patients with congenital facial palsy.
Patient 1: The 11-month-old girl presented with left facial
palsy noted at birth. During pregnancy her mother needed
insulin for diabetes mellitus.
Patient 2: The 1-year-old girl was born as second of twins.
Right facial palsy was noticed after birth.
Patient 3: The 6-year-old boy presented with bilateral facial
and abducens nerve palsy, and cleft of soft palate noted at
birth. To investigate their etiology, we performed
constructive interference in steady state (CISS) magnetic
resonance imaging (MRI) and temporal bone computed
tomography (CT).
Results: First CISS MRI were performed. In patient 1, the
left facial nerve was not observed. In patient 2, the bilateral
facial nerves were observed. In patient 3, the bilateral facial
nerves, abducens nerves and facial colliculuses were not
observed. Next, temporal bone CT was performed in patient
2. The strictured right labyrinth portion of facial canal was
observed. Therefore, patient 1 and 3 were diagnosed with
Mbius syndrome, patient 2 was diagnosed with congenital
unilateral facial palsy with strictured labyrinth portion.
Conclusion: We successfully identified the lesion causing
facial palsy using CISS MRI and temporal bone CT.
Identification of the responsible lesion is important for
diagnosis and for considering the pathogenesis of congenital
facial palsy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 203
P1308
Leigh syndrome in 13 Tunisian patients
E. Ellouz1, J. Abdelhedi2, I. Chamkha3, I. Ayadi2,
I. Hsairi2, F. Kamoun2, F. Fakhfakh4, C. Triki5
1Pediatric Neurology, 2Hedi Chaker Hospital, 3Department
of Genetics, 4Genetics, Faculte de Medecine de Sfax,
5H. Buniatian Institute of Biochemistry, Sfax, Tunisia
Introduction: Leigh syndrome is the most common clinical
phenotype of mitochondrial disorders in childhood. The
diagnostic criteria include progressive neurological disease
with psychomotor delay, symptoms of brainstem or basal
ganglia disease, raised lactate levels and characteristic
symmetric necrotic lesions in the basal ganglia or brainstem.
We try to determine clinical, radiological and genetic
features of Leigh syndrome through the evaluation of 13
Tunisian patients.
Methods: We reviewed the observations of all patients with
a clinical presentation suggestive of Leigh syndrome; we
determined the clinical and radiological features of these
patients. Respiratory chain enzymes study was not
performed. The molecular study was performed in some
patients.
Results: We collected 13 patients belonging to 9 families.
The mean age was 15 years; the mean age at onset was 2.1
years. Psychomotor delay was noted in 7 patients, gait
difficulties and movement disorders were noted in 9, spastic
paraplegia in 8, cerebellar ataxia and optic atrophy in 5,
ophthalmoplegia in 4 patients. Brain MRI showed
involvement of putamen in 9 cases, caudate nucleus and
pallidi in 3 cases, brain stem in 5 cases. Molecular study
showed a novel missense mutation in the mitochondrial
cytochrome C oxidase III gene in 2 patients, and a surf
mutation in 1 patient.
Conclusion: Leigh syndrome has a clinical and genetic
heterogeneity. The diagnosis should be considered in
children with symptoms of brain stem or basal ganglia
disease. Radiological features with bilateral and symmetric
necrotic lesions of basal ganglia and brain stem are almost
constant.
204 Posters, Sunday 9 September
P1309
Mucopolysaccharidosis VI in two siblings:
an unusual clinical presentation
E. Ellouz1, E. Chtourou2, H. Ben Othmen2, I. Hsairi2,
F. Kammoun2, A. Miled3, C. Triki2
1Pediatric Neurology, 2EPS Hedi Chaker, Sfax,
3Hopital Farhat Hached Sousse, Sousse, Tunisia
Introduction: Mucopolysaccharidosis VI or Maroteaux-
Lamy syndrome is a lysosomal storage disease characterized
by systemic clinical manifestations. Diagnosis and
management are often challenging because of the
considerable variability in symptom presentation and rate of
progression.
Methods: We report the observations of 2 siblings with
unusual clinical presentation of mucopolysaccharidosis VI.
Results: Our patients were 2 Lybian siblings (a boy and a
girl) born from consanguineous parents, aged 20 and 4
months respectively. The 2 patients presented with
psychomotor retardation. Neurological examination found
a macrocephaly and a cerebellar ataxia in the boy. He did
not have any facial dismorphy or skeletal or joint
abnormalities. The girl has a macrocephaly, flaccid
paraplegia, myelomeningocele and foot deformity. The
cerebral MRI showed a T2 hyper intensity in the midbrain
in the boy and hydrocephalus in the girl. The screening of
mucopolysaccharides in urine demonstrates an increase of
dermatan sulphate at 22mg/l suggestive of
mucopolysaccharidosis VI. The enzymatic study was in
progress. The boy died suddenly from dyspnoea.
Conclusions: Mucopolysaccharidosis VI or Maroteaux-
Lamy syndrome is a clinically heterogeneous condition.
Case studies reported in the literature have identified
subjects who presented with marked disease in the first year
of life and others who presented with slowly advancing
disease. Our patients belong to the first group. To our
knowledge cerebellar ataxia, myelomeningocele and T2
hyper intensity in the midbrain have not been reported
before.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1310
Efficient generation of functional
dopaminergic neurons from hESCs
M. LI1, Y. Zou1, N. Tang2, G. Dawe2, I. Islam2, T. Cao2
Oral Sciences, National University of Singapore, 2National
1
University Health System, Singapore, Singapore
Introduction: Years after the successful differentiation of
neurons from human embryonic stem cells (hESCs) there
are still huge limitations of current protocols that are either
difficult to replicate or unable to generate physiological
functional cells. We have created a very simple and efficient
protocol in generating functional dopaminergic neurons
from hESCs.
Methods: hESCs colonies were first digested into a single
cell suspension and subsequently seeded onto poly-L-
ornithine coated plates with Stemgent and BMP inhibitor
LDN193189 over 10 days. The cells were subsequently
passaged on Matrigel coated plates for 7 days. Rosettes
were then selected through 1 hour treatment of rosette
selection reagent followed by single cell dissociation with
accutase. Collected cells were then subjected to a stepwise
induced differentiation into dopaminergic neurons under
neural basal media supplemented with N2, B27, shh, FGF-
8, GDNF, TGF-3, dc-AMP, laminin and fibronectin.
Results: Differentiated cells gained neuron morphology
with extending neurite network were observed within 10
days of induced terminal differentiation. Immunofluorescent
staining showed positive expression of dopaminergic
markers Tuj1, TH, DAT and pan Sodium channels.
Electrophysiological studies using Patch clamp confirmed
the neurons were physiological functional in firing action
potential with clear evidence of threshold with 30pA current
injection. Dopamine release was quantified by Dopamine
ELISA kit with sensitivity of 10-100ng/ml.
Conclusion: We successfully demonstrated the efficient
generation of dopaminergic neurons from human embryonic
stem cells and confirmed them as physiological functional
cells.

P1311
Dysgraphia in children with asymmetric
bilingualism
S.M. Golubovic, N. Novakovic, Z. Kasic
Faculty of Special Education and Rehabilitation, University
of Belgrade, Serbia
Objectives: The Vlachs of Serbia are an ethnic minority of
Serbia, culturally and linguistically related to Romanians.
The Vlach languages, also called the Eastern Romance
languages, have a common origin from the Proto-Romanian
language.
Methodology: The sample consisted of 22 children (from
totally 113 tested) in early school age, from five rural
primary schools around Svilajnac and Zabar. 13 children
had dyslexic dysgraphia, and 9 had graphomotor dysgraphia.
The study was performed with the abbreviated version of
Semantic test - S. Vladisavljevic, Three-dimensional test of
reading (H. Sax) for assessment of written speech, Scale for
assessment of dysgraphia of writing (Ayiriagerra, Ozias),
and assessment of performance of graphomotor line (Lillian
Lirsa).
Results: Obtained results show that there is a statistically
significant difference ( 0.02) on the semantic test in
asymmetrically bilingual children regarding the type of
dysgraphia, which means that asymmetrically bilingual
children with graphomotor dysgraphia showing better
scores on the semantic test than asymmetrically bilingual
children with dyslexic dysgraphia. There was a statistically
significant difference ( 0.04) in the average speed of
reading between asymmetric bilingual children regarding
the type of dysgraphia. There is also statistically significant
difference ( 0.01) in the average number of errors regarding
the type of dysgraphia. Asymmetric bilingual children with
graphomotor dysgraphia make less mistakes than the
asymmetric bilingual children with dyslexic dysgraphia.
Conclusion: Asymmetric bilingual graphomotor dysgraphic
children on average remember more facts than asymmetric
bilingual children with dyslexic dysgraphia.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 205
P1312
Chronic inflammatory demyelinating
polyneuropathy in children
A. Takagi1, K. Fujii1, H. Uchikawa1, S. Misawa2,
Y. Kohno1
Department of Pediatrics, 2Department of Neurology, Chiba
1
University Graduate School of Medicine, Chiba, Japan
Background: Chronic inflammatory demyelinating
polyneuropathy (CIDP) is a slowly progressive disorder of
the peripheral nerves, causing demyelination and axonal
degeneration. In adults, the main treatments are intravenous
immune globulin (IVIg) and steroid therapy. However,
treatment for paediatric CIDP still remains to be determined.
We aimed to clarify the efficacy of IVIg and steroid
treatment in CIDP children.
Methods: We investigated the clinical course of 3 paediatric
CIDP patients. Mean age was 9.3 years (7-12), and their
gender was one male and two female. We performed
electrophysiological examinations to diagnose them as
having CIDP by using the diagnostic criteria. We basically
treated these paediatric patients firstly with IVIg (400mg/
kg/day, 5 days), and secondary methylpredonisolone (30mg/
kg/day, 3days), following oral predonisolone (1-2mg/kg/
day).
Results:
Patient 1: We treated a 7-year-old boy with IVIg, resulting
in dramatical improvement. However, we failed to change
to steroid therapy, resulting in combination therapy.
Patient 2: We treated a 9-year-old girl with IVIg and
methylpredonisolone with partial recovery. We finally could
finish the treatment.
Patient 3: We treated a 12-year-old girl with IVIg, resulting
in partial improvement. After treatment with
methylpredonisolone and oral predonisolone, she could
walk again.
Conclusion: All 3 patients showed improvement in motor
function by IVIg therapy. Subsequent steroid therapy is still
necessary for full recovery. IVIg is the most effective initial
treatment in patients with paediatric CIDP as well as adult
ones. Since IVIg has a potential risk of infection, the
transition from initial IVIg to oral predonisolone therapy
should be considered in children.
206 Posters, Sunday 9 September
P1313
Partial agenesis of corpus callosum in
Sanjad-Sakati syndrome (p-ACC): a case
report plus a review of articles)
N.S. Al Ghasab1, B. Janati2, A. Khan3
Qassim University, Hail, Saudi Arabia, 2Center for
1
Neurology, Virginia, VA, USA, 3ICU, King Khaled Hospital,
Hail, Saudi Arabia
Introduction: Sanjad-Sakati syndrome (SSS) was first
described in the Middle-East in children of consanguineous
parents. It is a rare autosomal recessive disorder known also
as Middle-East syndrome or Richadson-Kirk syndrome or
hypoparathyroidism-retardation-dysmorphism (HRD)
syndrome.
Study objective: To describe a new finding in a rare genetic
disorder where literature is meagre.
Methods: The clinical investigation was conducted at King
Khaled Hospital in Hail, Saudi Arabia in the year 2011.
Results: General physical examination showed the patient
to be short-statured with facial dysmorphic features
including a long narrow face, deep seated eyes, peaked
nose, depressed nasal bridge, micrognathia, thin lips, low
set and large floppy ears, small hands and small feet. The
patient had hypotonia, poor motor coordination, delayed
developmental milestones.
The brain MRI in our patient showed a partial agenesis of
the corpus callosum (p-ACC) characterized by absence of
the splenium and rostrum, a finding which has not
previously been reported in SSS.
Conclusion: Our patient showed partial agenesis of the
corpus callosum which could explain the patient's motor,
behavioural and developmental abnormalities. The wide
variety of MRI presentations reported in the SSS literature
may represent different gene mutations.
[SSS Figure 1]
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1314
Vestibular stimulation effect on quiet
stance balance in 3- to 7-year-old children
with cerebral palsy
S.A. Hosseini1, H.A. Haghgoo1, B. Zeinal Zadeh1,
E. Pishyareh1, S. Talebian2
1Occupational Therapy, University of Social Welfare and
Rehabilitation Sciences, 2Tehran University of Medical
Sciences, Tehran, Iran
Background and aims: Children with cerebral palsy (CP)
show a variety of neurological deficiencies such as problem
with processing tactile, somatosensory, proprioceptive,
visual and vestibular information which leads to
discoordination in bilateral movements, movement
sequencing and planning and equilibrium disorders. The
vestibular system plays an important role in the general
development and balance which is distorted severely in CP
children. We aimed to investigate the effect of vestibular
stimulation on quite stance balance in CP children.
Methods: Vestibular stimulation was performed twice
weekly with a course of 12 sessions for 20 CP children.
Using force plate, different parameters such as sideway
range, range fore-after, area and mean velocity were
measured. Data were analyzed statistically using U-Mann-
Whitney and Wilcoxon tests.
Results: Mean velocity parameter as a postural control
parameter showed significant changes but no significant
change was shown in stability postural parameters.
Conclusion: Application of vestibular stimulation for CP
children can lead to significant changes in postural control
mean velocity. Accordingly, those children who have
received vestibular stimulation in this project showed a new
balance strategy that would lead to an increase in exploratory
behaviour which would help them to maintain their balance.

P1315
Effectiveness of topiramate and
levetiracetam in infantile spasms non-
responsive to steroids
A.A.H. Mahmoud
NNI, KFMC, Riyadh, Saudi Arabia
Aim: To compare effectiveness of two novel antiepileptic
drugs, topiramate and levetiracetam as a second line
treatment for infantile spasms when oral steroids fail.
Method: 40 infants within 2 years of life with clinically-
and EEG-proven infantile spasms that did not respond to
prednisone (2mg/kg/day in two divided doses) were
recruited and randomized into two groups. They were
randomly assigned to either topiramate (group 1; 1mg/kg/
day for 3 days, then increased to 1mg/kg/day every third day
up to 6mg/kg/day) or levetiracetam, (group 2; 10mg/kg/day
for 5 days and then increased to 10mg/kg/day every 5 days
up to 60mg/kg/day).
Results: Of the 20 patients included in the final data
analysis, 11 (55%) were administered topiramate and 9
(45%) levetiracetam. 18 patients did not respond to the first
drug and subsequently to the other drug when crossed-over,
if the first drug proved ineffective. 2 patients with infantile
spasms responded to either one drug respectively without
crossover. Their EEGs improved with time.
Discussion: The present study demonstrated the
ineffectiveness of topiramate and levetiracetam suggesting
current treatment modalities are grossly inadequate
underscoring the urgent need for more research efforts to
overcome current deficiencies. 2 patients with cryptogenic
infantile spasms responded to treatment suggesting the
potential for treatment of such patients with these two
drugs, which merits further multicentre investigation.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 207
P1316
Neurophysiological perspectives of
electroencephalography in children with
attention deficit hyperactivity disorder
(ADHD)
A. Dube1, K. Yadav1, A. Gupta2, Y. Yadav3
1 Physiology, 2Pediatrics, S.M.S. Medical College,
3 Pediatrics, Sevayatan Hospital, Jaipur, India
Objective: The present study was undertaken to digitally
evaluate the electroencephalographic signature in children
with Attention Deficit Hyperactivity Disorder (ADHD).
Method: 30 children in the age range of 3-11 years were
included in the present study and power spectral analysis of
electroencephalographic (EEG) output from the central
EEG electrode pair location (preferably the Cz - Vertex pair)
was run to test the hypothesis that cortical slowing in the
prefrontal region can serve as a basis for differentiating
children with ADHD from healthy children.
Results: Quantitative electroencephalographic findings
indicated significant increased theta power and decreased
delta power seen in patients with ADHD with lack of
suppression of Mu-waves which suggested significant
maturational dysfunction in cortical arousal in the prefrontal
cortex, cortical slowing and dysfunctional mirror neuron
system in children with ADHD.
Conclusion: These findings constituted a positive initial
test of a QEEG- based neurometric test for use in the
assessment of ADHD and the significance of the mirror
neuron system in the disorders of the social mind.
208 Posters, Sunday 9 September
P1317
Treating children with epilepsy and
comorbid attention-deficit/hyperactivity
disorder (ADHD)
I. Dumitru1, A. Salan2
Pediatric Neurology, 2Pediatric Psychiatry, Country
1 1Speech and Language Pathology/Logopedics, 2Faculty of
Hospital Dr. Fogolyan Kristof, Sfantu Gheorghe, Romania
Introduction: 30-40% of children with epilepsy have
symptoms of ADHD. That causes problems at school and at
home. Despite the evidence of impairment from ADHD,
clinicians have difficulty in deciding whether to treat
children for both epilepsy and ADHD.
Methods: We treated 30 children with epilepsy and ADHD
for 3 months with anticonvulsants and then added
atomoxetine (1.2mg/kg/day), in the morning. We used
questionnaires for children, parents and teachers to evaluate
the school performance, behaviour at home and school,
relationships with friends and family every 3 months for a
year. We also performed EEG every month.
Results: 25 of these children had been seizure free before
added atomoxetine; 3 were stable, 2 experienced a reduction
in seizures. In 28 children there was no effect on seizure
frequency, or anticonvulsant drug levels the EEG findings
doesn't change after introducing atomoxetine. 2 of them
have an increased epileptic discharge. 24 children improved
compartmental and school performances. 1 no influence
was seen. 3 of them had good scores at questionnaires
completed by teachers, but no improvement in family.
Conclusion: If there is ADHD that can be diagnosed
independently of epilepsy effects, then further improvement
in inattention and hyperactive/impulsive symptoms can be
made by the addition of a specific ADHD treatment.
Although there are no recommended guidelines, we have
the opinion that if inattention and hyperactivity symptoms
persist for more than 3 months after the last epileptic
seizure, one can go for specific treatment.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1318
Semantic-pragmatic abilities in children
with graphomotor and dyslexic-dysphasic
dysgraphia
S.M. Golubovic1, G.R. Colic2
Special Education and Rehabilitation, University of
Belgrade, Serbia
Introduction: Since pragmatic deficits are often connected
with language disorders, and specific learning disabilities,
the goal of this study was to investigate the semantic-
pragmatic abilities in children with graphomotor dysphasic-
dyslexic dysgraphia, in the age from 8 to 12 years of both
genders.
Methodology: The sample consisted of 40 children of both
genders, age from 8 to 12 years, from second to fifth grade
of elementary school. The sample was divided in two
groups: the first group consisted of children with
graphomotor dysgraphia, and the second group consisted of
children with dysphasic-dyslexic dysgraphia, with IQ of 90
and above 90. For examination of semantic-pragmatic
abilities, we applied the Test of Pragmatic Language (TOPL)
and the Semantic test.
Results: In the test for assessment of pragmatics, children
with graphomotor dysgraphia have achieved, in average, 36
points (59.69%), while children with dysphasic-dyslexic
dysgraphia achieved 29 points (19.8%). There is a
statistically significant difference (p=0.000) in pragmatic
abilities between children with graphomotor and dysphasic-
dyslexic dysgraphia. In the semantic test, children with
graphomotor dysgraphia achieved on average 36 points. The
best results were achieved in the category of word
homonyms, and the worst in synonyms. Children with
dysphasic-dyslexic dysgraphia have on average achieved 29
points, best results were with the homonyms and were worst
with synonyms. The semantic ability assessed in children
with graphomotor and dysphasic-dyslexic dysgraphia was
statistically significant (p = 0.003).
Conclusion: Children with graphomotor dysgraphia differ
from children with dysphasic-dyslexic dysgraphia in all
analyzed variables, except for the subscales of synonyms
and antonyms.
P1319
Abstract cancelled

P1320
Impact of non-pharmacological treatment
on tics in children
S. Bakhtadze, N. Geladze, N. Khachapuridze
Child Neurology, Tbilisi State Medical University, Tbilisi,
Georgia
Object: Tics are involuntary, sudden, rapid, recurrent,
stereotyped motor movements or phonic productions that
involve discrete muscle groups. Pharmacological treatment
was considered as the most effective approach for
management of tics for many years. In recent periods
clinicians attempt to use behavioural methods for this
purpose. The aim of our study was to use non
pharmacological treatment like EEG biofeedback-neuro-
feedback (NF) for the treatment of tics.
Methods: We have previously examined 15 non-treated
children (9 boys and 6 girls) with simple tics (average age
10 years). All children with complex tics and with other
comorbidities were excluded from the study. Tics frequency
and severity were assessed by Yale Global Tic Severity Scale
(YGTSS). Sensorimotor rhythm (SMR) training was used
for NF therapy. 30 sessions of NF with duration of 30
minutes each was conducted in every patient. Data were
analyzed by SPSS 10.0. ANOVA was used to determine the
effect of treatment on YGTSS parameters.
Results: The ANOVA showed a significant effect of
treatment on YGTSS measures (F(1.37)=223.69,
MSE=114.735, p<0.0001). These evidences suggest that NF
significantly improves the severity and frequency of tics.
Conclusions: Thus effectiveness of SMR training in
children with tics is important, since the drugs used for the
treatment have severe side effects, compliance problems etc.
Cognitive behavioural therapy is effective not only for
reduction of tics but also for increasing self-esteem and
social competence as well.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 209
P1321
A new case of Worster-Drought syndrome
C.S. Spitaleri, F. Caramella, P. Glorioso, R. Nardello,
A. Fontana, S. Mangano
University of Palermo, Palermo, Italy
Introduction: Worster-Drought syndrome (WDS) consists
of a congenital pseudobulbar palsy and is usually associated
with spastic tetraplegia, learning impairment, behavioural
problems, and epilepsy. Congenital bilateral perisylvian
syndrome (CBPS) is characterized by bilateral perisylvian
polymicrogyria on imaging. Clark et al, have previously
proposed a WDS spectrum that includes CBPS, speculating
that it may be due to malformation of the perisylvian region
due to various perinatal or congenital causes, whether
demonstrable on imaging, or functional and not visible with
current imaging techniques. Worster-Drought suggested
that the syndrome is probably a developmental defect of the
motor tracts (corticobulbar) which run from the lower part
of the motor (Rolandic) area of the cerebral cortex to the
10th and 12th cranial nerve nuclei.
Methods: A 12-year-old boy presented with a long history
of spastic tetraplegia, learning impairment, behavioural
problems, and epilepsy. The seizures were refractive to
several antiepileptic drugs. He also had variable difficulty
in moving the tongue, soft palate and lips with weakness of
the pharynx and laryngeal muscle.
Results: Video-EEG monitoring captured paroxysms of PO
in the center-front of both hemispheres, and that project
contralaterally. Neuroimaging studies do not revealed
abnormalities.
Conclusion: Our patient presented the characteristic
symptoms of Worster-Drought syndrome (WDS) with mild
spastic tetraplegia, learning impairment, and epilepsy. MRI
did not show dysplastic cortex in the region of the sylvian
fissures, giving normal signal on T1- and T2-weighted
images. Although the white matter had a normal appearance,
an abnormality in the corticobulbar tracts cannot be
excluded.
210 Posters, Sunday 9 September
P1322
Clinical characteristics of paroxysmal
kinesigenic dyskinesia in paediatric
practice
S. Kwon, J. Suh, H.-E. Seo, S.K. Hwang
Pediatrics, Kyungpook National University School of
Medicine, Daegu, Republic of Korea
Purpose: Paroxysmal kinesigenic dyskinesia (PKD) is one
of the movement disorders in which dyskinesia occurs in a
part of the body by a sudden movement under a certain
circumstance. It is rare, but important because it mimics
epileptic seizures. This study was aimed to evaluate the
clinical features of children and adolescents with PKD in
Korea.
Methods: A total of 7 children with PKD was involved in
the study. The demographic and clinical characteristics were
retrospectively evaluated from their medical records.
Results: The age of the subjects ranged from 10 to 21 years
(mean age: 15.75.7 years). Males were predominant (M:F;
6:1). They all presented with dystonias of abrupt onset with
an average duration of 10.5 seconds (3.5-17.5 seconds),
which were triggered by various sudden movements. They
were multifocal, but mainly in limbs. No obvious
comorbidities were found. 6 of the subjects, except for a
non-compliant case, responded well to the medications and
remained symptom free. They were treated with either
oxcarbazepine (n=4, 14.95.8 mg/kg/day) or lamotrigine
(n=2, 1.50.9 mg/kg/day). There were no significant
differences between the two groups in terms of effectiveness,
adverse events, etc.
Conclusions: This study showed that clinical features of
Korean children with PKD are quite similar to those of
other Western countries. They responded well to the
medications. In addition, lamotrigine can be an alternative
treatment for PKD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1323
Clumsiness in children with ADHD
compared with normal children based on
the Lincoln Ozeretski Scale
A. Kazemi1, F. Khaledi2, M. Kazemi2
1Psychology, Islamic Azad University Tehran Medical
Branch, 2Islamic Azad University, Tehran, Iran
Introduction: Clumsiness is a syndrome that has a
pathological meaning. It is mainly concerned with the motor
activities of children. The children who are suffering from
such a problem are not able to perform normal motor skills
even if they do not show any neurological symptoms in
laboratory tests. The object of the present study is the
evaluation of clumsiness in children with ADHD compared
with normal children based on Lincoln Ozeretski Scale.
Methods: The statistical sample consisted of 30 boys with
ADHD, who were selected according to an available
sampling method and 30 boys without ADHD, selected
through random sampling, at the age of six. Measurement
tools consisted of Motor Development Lincoln-Ozeretski
Scale. Data were analyzed using T-Test.
Results: The results showed that there is a significant
difference between the kids motor skills and the dependent
variables (t=10.43).
Conclusion: Children with ADHD compared to normal
children are at a lower level of motor skills, and suffer from
clumsiness. In other words, children suffering from this
syndrome, show incompetent and abnormal motor-skills in
learning and doing an activity expected from them.

P1324
Some etiological factors of stroke in
children
S.S. Shamansurov, S.H. Saidazizova, N.M. Tulyaganova
Tashkent Institute of Postgraduate Medical Education,
Tashkent, Uzbekistan
Introduction: Today, in adults much attention is paid to
question an acute vascular pathology, but not less interest is
the problem of the sharp vascular accidents developing at
childrens age.
Aim: To investigate etiology of stroke in children.
Methods: The analysis of clinical supervision of 27
children. All children were divided at the moment of acute
stroke. Hemorrhagic Stroke in 18 patients, ischemic in 9
patients.
Results: Infections were present in 11 patients (vasculitis),
DIC in 8, hemophilia in 1, AVM in 4, Mitochondrial disease
(syndrome MELAS) in 1, Neurophakomatosis in 2 patients.
Distribution on age: 17 patients younger than till 40 days,
life (the picture of Hemorrhagic Stroke occurred 7
newborns; Ischemic stroke in at 10); on average attacks
occured on days 34-38; in all cases Hemorrhagic Stroke was
the DIC syndrome. The second group of children one year
told included 5 patients: on a share of ischemic stroke - 2
patients (trauma); hemorrhagic stroke - 3 patients (infectious
process). The third group included children up to 3 years old
(2 children): 1 child with a virus infection; 1 child with
MELAS syndrome. The fourth group included children
from 4 till 13 years (3 patients) with traumatic damage (VB
system).
Conclusions: The revealed reasons for the acute damage of
the brain blood circulation at children, have revealed a
significant divergence in etiology and are also very often
occuring in children.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 211
P1325
Neuron-specific enolase as marker of
brain lesions in children with epilepsy
C. Calcii, S. Hadjiu, I. Iliciuc
Hospital of Mother and Child Health Care, Chisinau,
Moldova
Aim: To reveal the correlation of serum NSE concentrations
with the type of epilepsy, including seizure characteristics,
frequency, age of onset, and presence of mental retardation.
Methods: To achieve the proposed objectives, the study
included 108 children with age ranging from 2 weeks to 24
months (mean age 9.21.2 months), 61(56,0%) boys and 47
(44.0%) girls. 43 patients (39.84.71%) manifested
generalized seizures, 53 (49.14.81%) had partial seizures
and 12 children (11.13.02%) had polymorph seizures.
Results: Serum NSE concentrations were elevated in 35
(32.4%) children from the study group. Out of them 12
patients (22.65.74%) had focal epilepsy, 15 children
(34.87.26%) manifested generalized type of seizures and
8 children (66.713.60%) were diagnosed with polymorph
seizures. Elevated sera NSE concentrations were identified
in following subgroups of patients: 15 out of 30 children
with several epileptic attacks per day (50%, rxy+0.43), 13
out of 41 children with several epileptic attacks per week
(32%, rxy+0.49), 4 out of 16 children with several epileptic
attacks per month (25%, rxy+0.29), and in 3 out of 21
children with two unprovoked seizure attacks (15.0%,
rxy+0.31). A moderate correlation (rxy+0.44) was observed
between the raise of the serum NSE concentration and onset
of epilepsy in the neonatal period. Strong correlation
(rxy+0.88) showed the development of mental retardation
and elevated serum NSE concentrations.
Conclusions: Increased concentrations of serum NSE were
revealed in children with epilepsy who complained daily or
weekly seizure attacks, who developed epilepsy in the first
month of life and who presented mental retardation.
212 Posters, Sunday 9 September
P1326
Neurophysiological perspectives of
electroencephalography in children with
attention deficit hyperactivity disorder
(ADHD)
A. Gupta
Paediatrics, SMS Medical College, Jaipur, India
The present study was carried out in the Department of
Pediatrics & Dept. of Physiology in collaboration with the
Departments of Neurology, SMS Medical College, Jaipur.
30 children in the age group of 3 to 11 years (median age
range of 7-10 years) with an intelligence quotient (IQ) of
more than 70, suffering from ADHD (male : female ratio
being 3:1), diagnosed as per DSM IV criteria, were included
in the study. An equal number of children matched for age
and sex acted as the control cohort.
18 to 20 epochs were selected for Power Spectral Analysis,
each lasting 2-3 seconds, the time duration representing
confocal and frequency matched neuronal pool based on the
theory of analysis of sharp changes or rapid transitional
processes (RTP) reflected in quasi-stationary segments of
local EEGs Epochs with more than 100v on the electro-
encephalogram representing artifacts were excluded from
the mean. However no significant difference could be seen
in the absolute powers of beta and alpha waves. The
increased theta/beta ratio in ADHD children and absence of
Mu-wave suppression [a characteristic feature of the mirror
neurons operational architectonics (Oberman et al, 2005)]
give an insight into the features of the disease process of
ADHD, namely cerebral dysmaturation (Monstra et al,
1996) and broken mirrors. In the present study no significant
difference could be seen in the absolute powers of alpha and
beta waves in ADHD children and the control group.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1327
Neurotrophic factors and disorders of
residual psychological development of the
child
A. Hadjiu1, S. Hadjiu2, E. Hadjiu3, C. Calcii2
1Universit de Reims Champagne-Ardenne, Reims, France,
2Neurology, 3State University of Medicine and Pharmacology
N. Testemitanu, Chisinau, Moldova
Objective: To highlight the relationship between mixed
specific psycho-developmental disorders in children and
BDNF levels.
Materials and methods: We assessed BDNF serum levels
via immunoenzymatic method in 48 children (study group)
presenting residual mixed specific psycho-developmental
disorders (aged between 2 and 5 years old) and 25 healthy
children (control group).
Results: Patients from the study group presented: language
retardation, emotional, cognitive and behavioural disorders.
An overall analysis showed that BDNF serum levels were
significantly lower in children from the study group in
comparison to controls (p< 0.05). Significantly low levels
of serum BDNF were noted in children with severe cognitive
disorders frequently associated with language disorders.
Moreover, neuroimaging data revealed abnormalities of
nerve tissue maturation. There is statistical evidence that
psychological disorders are negatively correlated with
serum BDNF levels. Thus, BDNF represents an important
marker a of child's psychological development.
Conclusions: Our data confirm the role of BDNF on the
child's psychological development (it contributes to nerve
fibre maturation, language, behaviour and emotional
centres). We suggest that low levels of BDNF influence the
synaptic plasticity and the interaction between neural and
glial cells, thereby playing a decisive role in the complex
child's behaviour including language acquisition, cognition,
affect etc. BDNF studies could have an important
implication in the comprehension of psycho-developmental
disorders, as well as in the treatment of neurodevelopmental
disorders.
 Posters, Sunday 9 September 213

P1328 P1329
BDNF in children with motor disorders Rituximab in refractory seronegative
E. Hadjiu1, S. Hadjiu1, A. Hadjiu2, C. Calcii1 juvenile myasthenia gravis with crisis
1State University of Medicine and Pharmacology R.L. Koul, A.M. AlFutaisi, R.M. Abdwani
N. Testemitanu, Chisinau, Moldova, 2Universite de Reims Childhealth, Sultan Qaboos University Hospital, Muscat,
Champagne-Ardenne, Reims, France Oman
Objective: Assessment of serum BDNF levels in children
with motor disorders
Materials and methods: We assessed serum BDNF levels P1330
via immunoenzymatic method in the blood of 54 children, Giant axonal neuropathy - first case
aged between 1 and 5 years, presenting diverse motor report in Romania
disorders and who had CNS perinatal hypoxic-ischemic
antecedents, and 25 healthy controls. I. Dumitru1, A. Salan2, L. Delne3
1Pediatric Neurology, 2Pediatric Psychiatry, 3Radiology,
Results: The results suggest that there is a relationship
Country Hospital Dr. Fogolyan Kristof, Sfantu Gheorghe,
between serum BDNF levels and motor abnormalities in
Romania
children with cerebral maturation disturbances (data was
also confirmed by neuroimaging). Furthermore, we noted
that serum BDNF levels were significantly lower in children P1331
with severe motor disorders compared to controls, but this Neurologic problems in children with
tendency was not significant in those with soft motor
disorders. The results showed an increase of BDNF levels in
autism spectrum disorder and ADHD
the study group during their first years of life, though these H.J. Park1, J.Y. Sim2, W.-S. Kim3
levels were significantly lower in comparison to the control Eulji University Hospital, Daejeon, 2Ceongju Saint Mary
1

group. Hospital, Ceongju, 3Chungbuk National University Hospital,

Conclusions: Serum BDNF levels were significantly lower Cheongju, Republic of Korea
in children with motor disorders (aged 1-5 years) in
comparison to controls. This could suggest a delayed
increase of BDNF levels during those children's
P1332
development. Thus, low BDNF levels are negatively Types of cerebral palsy, developmental
correlated with the severity of motor disorders. This could delay and epilepsy in children after
indicate the role of BDNF in plasticity of motor neurons, neonatal seizures
developmental and maintenance processes of the brain.
C. Calcii, I. Iliciuc, S. Hadjiu, A. Antohi, M. Gotonoaga
Hospital of Mother and Child Health Care, Chisinau,
Moldova

P1333
Abstract cancelled

P1334
Effectiveness of iron therapy on breath
holding spells in children
E. Bidabadi1, M. Mashouf2
1Guilan University of Medical Sciences, 2Arya Hospital,
Rasht, Iran

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

214 Posters, Sunday 9 September

P1335 P1339
Apraxia of speech in children: attempt of Comparative study of febrile or afebrile
etiological diagnostics seizures associated with mild gastro-
M.Y. Bobylova1, K. Mukhin1, I. Kirova2, enteritis
M. Ryakhovskaya2 S. Chung, E.H. Lee
Svt. Luka's Institute of Child Neurology & Epilepsy, 2Child
1
College of Medicine, Kyung Hee University, Seoul, Republic
Diagnostic Center 'Razvitie Plus', Moscow, Russia of Korea

P1336 P1340
Idiopathic unilateral isolated hypoglossal Cognitive testing and video-EEG
nerve palsy: a case report monitoring in children with consequences
I. Dumitru1, S. Paripas2 of perinatal impairment of the central
1Pediatric Neurology, Country Hospital 'Dr. Fogolyan
nervous system and epilepsy
Kristof', Sfantu Gheorhhe, 2Neurosurgery, Emergency County
Hospital Brasov, Brasov, Romania S.Y. Lavrick, S.V. Domitrak, V.V. Shprakh, L.V. Kolesova
Department of Neurology, State Medical Academy of
Postgraduate Education, Irkutsk, Russia
P1337
Possible birth injuries of the newborns at P1341
Caesarean section Dysgraphia in gypsy children with
F.N. Samadov, S.S. Shamansurov, S.H. Saidazizova semilingualism
Tashkent Institute of Postgraduate Medical Education,
Tashkent, Uzbekistan S.M. Golubovic1, V. Nestorov2, Z.N. Kasic1
1Faculty of Special Education and Rehabilitation, University

of Belgrade, 2PI 'Savski Venac', Belgrade, Serbia

P1338
Seizures in neonates
B. Medjo1, D. Nikolic2, M. Atanaskovic-Markovic3,
S. Rsovac1, J. Kalanj1, N. Vunjak1
1Neonatal Intensive Care Unit, 2Department of Neurology,
3Department of Pulmonology and Allergology, University
Children's Hospital, School of Medicine, University of
Belgrade, Serbia
P1342
Management of seizures in Bosnian
children
A. Bajraktarevic1, S. Trninic1, M. Miokovic1,
L. Kumasin1, I. Suljevic2, S. Uzicanin3, H. Niksic4
1Pediatrics Department, Public Health Institution of
Sarajevo Canton, 2Department for Biochemical Diagnostics,
Clinical Medical Center Sarajevo, 3Neuropediatrics
Department, Pediatrics Clinic Sarajevo, 4Department for
Clinical Pharmacology, Pharmacy Faculty Sarajevo, Bosnia-
Herzegovina

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


Clinical Neurophysiology
P1343
Saccade-related beta-band
desynchronization in the subthalamic
nucleus of Parkinsons disease patients
during successful antisaccades and error
trials
A. Yugeta, W.D. Hutchison, R. Chen
University of Toronto, Toronto Western Research Institute,
Toronto, ON, Canada
The basal ganglia are involved in response selection. We
have shown that the saccade-related beta-band
desynchronization (beta-SRD) in the subthalamic nucleus
(STN) may play a role in inhibition of unwanted movements
and in execution of movements. Antisaccades require an
inhibition of reflexive saccades towards the visual cue and
an initiation of voluntary saccades away from the visual cue.
If beta-SRDs are involved in voluntary saccades, we
hypothesize that beta-SRDs would be deficient during
antisaccade errors. To investigate this, we studied beta-
SRDs in the STN of Parkinsons disease (PD) patients
during successful antisaccades and error trials. 20 PD
patients performed an antisaccade task 1 to 3 days after
deep brain stimulation surgery with local field potential
recording from the STN via externalized leads. Electro-
oculography was used to measure saccades. We analyzed
the wavelet power spectrum averaged on saccade onset. The
incidence of errors was 34.5%. Latencies of saccades were
longer during successful antisaccades (426.977.4ms
[meanSD]) than during errors (312.987.2ms; p<0.01).
Beta-SRDs were observed more often during antisaccades
(27 of 34 STN) than during errors (7 of 34 STN; p<0.01).
Onsets of beta-SRDs were not significantly earlier during
antisaccades (-180.5165.9ms) than during errors
(-76.4279.1ms; p=0.25). Beta-SRDs were sustained for
longer during antisaccades (528.9205.7ms) than during
errors (374.5264.3ms; p=0.03). These results suggest that
beta-SRDs play a role in the suppression of unwanted
saccades and in the successful execution of antisaccades.
P1344
Abstract cancelled
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 215
P1345
The way how various cognitive tasks
impair the activity of subthalamic nuclei
and upper limb tremor
N. Kovacs1, I. Herndi1, G. Deli1, E. Bosnyk1, F. Nagy1,
J. Janszky1, I. Bals2
1Department of Neurology, 2Department of Neurosurgery,
University of Pecs, Hungary
Background: It is a clinically well-known phenomenon
that different cognitive tasks (e.g. counting, thinking about
the disease) may alter the tremor characteristics in idiopathic
Parkinsons disease (PD).
Objectives: To analyze the changes in the firing pattern of
subthalamic nuclei (STN) and the concomitant tremor
parameters during different cognitive tasks.
Methods: 6 patients with PD undergoing bilateral STN
deep brain stimulator implantation were enrolled into our
study. During microelectrode recording, the preamplified
and unfiltered electrical activity of subthalamic nuclei was
registered by Medtronic Leadpoint 5 system. The activity of
STN and the bilateral limb tremor were simultaneously
captured by a CED Power 1401 AD converter during three
different tasks: baseline resting condition, counting and
word-generation tasks. Raw recordings were filtered and
subsequently analyzed by Spike 2 software (CED Inc.,
version 7.08). We determined the frequency and discharge
pattern of neuronal activity by spike sorting involving both
template matching and principal component analysis
techniques. Between the tremor and STN signals cross-
correlation and coherence analyses were also performed.
Results: In the baseline resting condition the intensity and
the frequency of tremor was significantly lower than that
during counting (124 milli-g2 vs. 352 milli-g2 and 4.12Hz
vs. 4.32Hz, respectively). Meanwhile, we observed a
tendency that the firing pattern of STN became more burst-
like (bursting narrow pos skew or burst-like bimodal)
during cognitive tasks.
Discussion: Cognitive tasks may influence the firing pattern
of STN and concomitant tremor. Further studies are required
to analyze the importance and possible clinical implications
of this phenomenon.
216 Posters, Sunday 9 September
P1346
Cortical alternating generators of sleep
spindles: electrical source imaging using
high-density EEG (256-channels)
recordings
A. Del Felice, C. Arcaro, S.F. Storti, P. Manganotti
Department of Neurological, Neuropsychological,
Morphological and Motor Sciences, University of Verona,
Italy
Introduction: Sleep spindles are the hallmark of N2 sleep,
with a frequency between 10-16Hz and a duration of 0.5-
2sec, localizing over the fronto-centro-parietal cortical
areas. Anterior spindles have a relative slower frequency
compared to posterior ones, although no consensus exists
on the cortical localization of spindles generator.
Methods: 136 spindles were obtained by visual inspection
from a 256 channels EEG (Geodesic, Eugene, USA) sleep
recordings from 6 healthy volunteers. Offline analysis
filtered the marked traces at 10-12Hz (slow spindles) and
12-14Hz (fast spindles); traces of each category were
segmented, baseline-corrected, bad channels rejected by
visual inspection and replaced, and averaged. Averaged
traces were used to reconstruct on the MNI (Montreal
Neurological Institute) magnetic resonance template via an
inverse solution method (LORETA algorithm) cortical
generators of slow and fast spindles.
Results: A total of 64 slow and 70 low spindles, temporally
alternating on the EEG, were analyzed. Visual rendering of
spatial distribution of spindles by EEG-signal projection on
a cortical flat map confirmed the fronto-central distribution
of slow spindles and the centro-parietal localization of fast
ones. The source generator reconstruction localized the
generator in the anterior prefrontal cortex (middle frontal
gyri, Brodmann area 10) for the slow spindles and in the
parietal cortex (paracentral lobule, Brodmann 5; posterior
parietal cortex, 7; supramarginal gyrus, 40) for the fast
ones.
Conclusion: Sleep spindles show different, alternating
cortical generators according to their frequency and
topographical distribution on the scalp. This observation
suggests the existence of different cortical networks for
slow and fast spindles.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1347
Role of the cerebellum in the motor
control of Donders law during human
pointing tasks: an rTMS study with
kinematic analysis of the wrist
L. di Biase1, F. Giambattistelli1, F. Mastrolilli1,
F. Taffoni2, D. Formica2, P.M. Rossini3, F. Vernieri1,
J.M. Melgari1
1Department of Neurology, 2Biomedical Robotics and
Biomicrosystems Lab, Universita Campus Biomedico di
Roma, 3Universit Cattolica del Sacro Cuore, Roma, Italy
Introduction: Donders law well represents intrinsic
strategies of motor control system during pointing tasks,
executed through eye, head or arm movements [1-2]. The
central nervous system (CNS) removes the degrees of
freedom that are not essential (solution of the redundancy
problem). Aim of the present study is to identify the CNS
regions involved in the control of Donders law applied to
the motor control of human pointing tasks.
Material and methods: 11 healthy subjects underwent a
session of inhibitory rTMS (1Hz) of right cerebellar
hemisphere, while 13 control volunteers, underwent a sham
cerebellar rTMS session. Each subject executed a kinematic
analysis of the wrist during pointing tasks to evaluate
Donders law [2] before and after the rTMS session. The
orientation matrix R of the wrist was measured by means of
inertial magnetic unit.
Results: The MANOVA analysis shows significant
modifications in the curvature of Donders plans obtained
before and after rTMS cerebellar neuromodulation, in 78%
of healthy subjects that underwent to real rTMS session,
while no significative differences were found in sham
group.
Discussion: The present data suggest a cerebellar control of
Donders law applied to the redundancy problem solution in
human pointing tasks. This method could have an
application in clinical practice, particularly for functional
evaluation. Since the curvature of Donders plan is like an
individual fingerprint, these findings could be useful in
many neurodegenerative diseases, in which neuronal loss
occurs earlier than the onset of clinical symptoms and in
individually-tailored and neurophysiology-based
rehabilitation.

P1348
Left prefrontal cortex influences motor
imagery
I.M. Tarkka1, D.S. Stokic2
Health Sciences, University of Jyvskyl, Finland,
1
Mississippi Methodist Rehabilitation Center, Jackson, MS,
2 1Integrated Research and Treatment Center for Vertigo,
USA
Introduction: Our aim was to determine the role of the left
dorsolateral prefrontal cortex (PFC) in facilitation in the
primary motor cortex (M1) of the muscle involved in motor
imagery. We stimulated the left PFC during motor imagery
to induce a virtual lesion.
Methods: Transcranial magnetic stimulation to left M1
(round coil at Cz, 120% resting threshold, 8510% of
maximal output) was used to elicit responses in the right
tibialis anterior (TA) muscle during relaxation and while
imagining right ankle dorsiflexion movements cued by a
visual display. A second stimulator (figure-of-eight coil at
F3, 7510%) was used to stimulate left PFC 300ms before
M1 during relaxation and motor imagery. 5 healthy adults
(age 576 years, 4 males) were studied. Main outcome
measure was the amplitude of motor evoked potentials
(MEPs) in the right TA during relaxation and motor imagery,
without and with left PFC stimulation (8-12 traces each).
Results: Motor imagery alone significantly increased
MEPs in the right TA compared to relaxation (~400% on
average). Stimulating the left PFC 300ms before the M1
significantly reduced the facilitatory effect of motor
imagery by about one quarter (317%, p=0.0268). Paired left
PFC and M1 stimulation during relaxation, however, had no
appreciable effect on MEPs in TA (102%).
Conclusion: The results indicate that left PFC is an integral
part of the network involved in motor imagery. Impaired
output from the left PFC may hinder the potential to utilize
motor imagery for restoration of motor function after brain
injury.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 217
P1349
Multivariate gait data analysis:
comparison between older and younger
healthy adults
C. Pradhan1, M. Whr1, K. Jahn2, R. Schniepp2
Oculomotor and Balance Disorders, IFB, LMU, University
of Munich, 2Integrated Research and Treatment Center for
Vertigo, Oculomotor and Balance Disorders, IFB, LMU, &
Department of Neurology, University of Munich, Germany
Introduction: While gait analysis is a powerful non-
invasive tool, its interpretation is often hindered by large
volumes of highly correlated data. We explore Principal
Component Analysis (PCA) for dimension reduction and
linear discriminant analysis (LDA) to determine the relative
power of extracted components in separating different
clinical groups.
Methods: 224 discreet measurements using a GAITRite
sensor carpet were obtained from two groups of normal
healthy adults (Group 1: 31-40 years (34.63.32), n=20;
Group 2: 71-80 years (75.13.10), n=27). PCA was
performed to determine significant components (PC) and
loadings. Fishers LDA was used to determine the hierarchy
of discriminatory power among the components.
Results: 12 PCs explained 90% of the data variance with
the 1st explaining 28.9%. Stepwise LDA indicated that 4
PCs (PC3, PC4, PC6 and PC1 in order of discriminatory
power) were optimal for the separation of the groups. Major
contributory measures to PC3 were Base of Support (BS)
Left and Right (L&R) during self-selected, maximal-speed
and head-extended gait. In addition there were significant
contributions from BS (L&R), Stride Length (L&R) and
Functional Ambulatory Profile (FAP) scores during dual-
task gait (verbal fluency and serial 7) as well as FAP scores
during eyes-closed gait.
Conclusion: The most discriminatory gait features between
young and old healthy adults appear to be lateral
displacement variables. In addition dual-task and eyes-
closed gait appear to affect gait in elderly. PCA is useful for
gait data reduction and visualization and we intend to
explore similar methods in other clinical populations.
218 Posters, Sunday 9 September
P1350
Quantitative EEG and cognitive
impairment in Parkinsons disease
L.C. Fonseca1, G.M. Tedrus1, P.N. Carvas2,
E.C. Machado3
1Neurology, 2Medicine - FAPIC/Reitoria, 3Medicine -
FAPESP, Pontificia Universidade Catlica de Campinas,
Campinas, Brazil
Introduction: Cognitive impairment is frequent and
sometimes precocious in Parkinsons disease (PD), but
knowledge of its pathophysiology is still limited.
Quantitative EEG has provided contributions to the theme
and in the present study includes an approach to both
absolute power and coherence in different cognitive states
of PD.
Methods: 46 patients with PD and 54 normal subjects were
assessed using a neurological evaluation, CERAD
neuropsychological battery (consortium to establish a
registry for Alzheimers disease), Mini-mental Status
Examination, executive functions examination and EEG.
The mean global absolute powers at the various electrodes
for the delta, theta, alpha and beta bands were calculated, as
also the inter- and intra-hemispheric coherences. The theta/
delta global absolute ratio was also calculated. Four groups
were compared: PD with dementia (PD-D) - 12 patients; PD
with mild cognitive impairment (PD-MCI) - 12 patients; PD
with no cognitive disturbances (PD-NLCog) - 22, and the
control group (p<0.05).
Results: The global delta and theta absolute powers and the
beta frontal-occipital coherence were significantly greater
in the PD-D group than in the other groups, whereas the
theta/delta ratio was greater in the PD-D and PD-MCI
groups than in the PD-NLCog and control groups (post-hoc
analysis, ANOVA, p<0.001).
Conclusions: Significant differences were identified
between the PD-D group and other groups and between the
PD-MCI group and individuals with no cognitive
impairment using EEG absolute power and coherence. Our
findings suggest qEEG as a possible physiological tool in
the assessment of cognitive aspects in PD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1351
Diagnosis of epilepsy by means of sleep-
deprived or melatonin-induced sleep EEG
G. Gustafsson, E. Svanborg
Clinical Neurophysiology, Linkoping University Hospital,
Linoping, Sweden
Recording EEG in children may be challenging, since
reliable interpretation requires that the patient lies still.
Sleep during the recording is therefore desirable, and
parents are often instructed to keep the patient awake for at
least half the night before. However, sleep deprivation is not
easy to achieve in children. Therefore, melatonin is currently
used in a number of laboratories to induce sleep. This study
was performed to determine 1) whether melatonin is equally
efficient in inducing sleep as sleep deprivation; and 2)
whether melatonin-induced sleep is as efficient in provoking
epileptiform activity as sleep deprivation.
Method: 115 EEGs recorded between 2007 and 2008 after
sleep-deprivation and 130 EEGs recorded between 2010
and 2011 after melatonin ingestion were studied. The
children in the two groups were matched for age (1-16 y.o)
and gender. Comparisons were made concerning how many
children obtained sleep, acceptability of EEG recording and
epileptiform activity.
Results: 11 recordings in each group were not interpretable
due to movement artifacts (n.s.). Sleep was obtained in 71%
of recordings of children that got melatonin and in 60%
sleep deprived children (n.s). Epileptiform activity was
recorded in 34% of EEGs with melatonin-induced sleep and
in 39% of EEGs recorded after sleep deprivation (n.s.).
Conclusion: Melatonin had a small advantage over sleep-
deprivation in so far as sleep was obtained in a larger
number of subjects. It had no disadvantage concerning
ability to provoke epileptiform activity. Furthermore, the
procedure is much easier for the parents than to keep a
young child awake for half the night.

P1352
Polysomnographic (PSG) recordings and
clinical evaluation in patients with
prolonged disorders of consciousness
(DOCs)
M.R. Valente, S. de Biase, F. Basaldella, M. Fuccaro,
S. Lorenzut, G.L. Gigli
Neurology Clinic, Sleep Disorder Center, University of
Udine, Italy
Introduction: The aim of the study is to evaluate the
importance of sleep recordings in patients with prolonged
DOCs looking at possible correlations between clinical
evaluation, sleep patterns and evoked potentials. At our
knowledge, studies evaluating these methods altogether in
patients with prolonged disorders of consciousness are
lacking, at least with current scales.
Materials and methods: 12 patients, 10 in vegetative state
(VS) and 2 in minimally conscious state (MCS) were
evaluated from a clinical and neurophysiological point of
view. Clinical evaluation included Coma Recovery Scale-
Revised (CRS-R), Disability Rating Scale (DRS) and
Glasgow Coma Scale (GCS). Neurophysiological evaluation
included 24h PSG, SSEP, BAEP, VEP, P300 and MMN.
Results: In 4 patients 24h PSG showed the presence of a
clear sleep-wake alternation, different stages of sleep,
REM-NREM ciclicity, sleep spindles and K-complexes.
These patients had a CRS-R score of 7.251.71 while 8
patients, lacking one or more of these sleep elements, had a
CRS-R score of 3.380.91 (p<0,05). Patients with each
single sleep element (such as REM sleep) had always a
better clinical evaluation compared with those who had not.
Patients with all sleep elements and preserved BAEPs had
a better clinical evaluation, compared with patients lacking
at least one of them. No correlation was found between
presence of SSEPs and better clinical evaluation.
Conclusions: PSG recordings resulted as the best
neurophysiological tool for assessment of patients with
prolonged DOCs and may be considered a non-expensive,
non-invasive and easy to perform examination able to give
a suitable support to clinical evaluation.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 219
P1353
Feasibility of a new multichannel surface
electrode to detect neuropathy in diabetic
patients with normal results in
conventional nerve conduction studies
B.J. Kim1, K.Y. Jung1, Y.S. Koo1,2, J.H. Jang1, S.H. Lee3,
K.W. Park1
1Neurology, Korea University College of Medicine, Seoul,
2Jeju Medical Center of Jeju Special Self-Governing
Province, Jeju, 3Biomedical Engineering, Korea University
College of Health Science, Seoul, Republic of Korea
Introduction: To increase sensitivity for detecting early
neuropathy in patients with diabetes, we have recently
developed a multichannel surface electrode. This study was
performed to investigate reliability of the multichannel
(8-electrodes) surface electrode in detecting neuropathy in
diabetic patients, but with normal results from the
conventional nerve conduction study (NCS).
Methods: Age and sex matched normal healthy subjects (24
men, 32 women; mean age, 58.71 yr) and diabetic patients
with distal symmetric sensory symptoms (12 men, 12
women; mean age, 59.92 yrs) who were normal at
conventional NCS were recruited. Eight compound muscle
action potentials (CMAPs) were recorded from the abductor
pollicis brevis using the electrode by stimulation of the
median nerve at the wrist. Various latency and amplitude
related variables including minimum and maximum
latencies were obtained and analyzed to compare these
variables between the two groups using independent t-test.
We also used multiple logistic-regression analysis to find
out which variables can discriminate control and diabetic
groups.
Results: All variables related to latencies in the diabetic
patients group, especially standard deviation of CMAP
onset latencies in each subject (SDLat), showed significant
difference from control group (P<0.001). However, all
amplitude-related-variables did not show any differences.
Among all variables, minimum latency and the SDLat were
the most reliable variables to discriminate diabetic patients
from normal subjects.
Conclusions: The multichannel surface electrode is a
reliable tool to detect neuropathy in patients with diabetes
who did not have abnormality in conventional NCS.
220 Posters, Sunday 9 September
P1354
Vagus somatosensory evoked potentials
(VSEP) in subjects with multiple sclerosis
T. Polak1, F. Metzger2, D. Zeller3, A.J. Fallgatter4
1Dept. of Psychiatry, Psychosomatics and Psychotherapy,
University Clinic Wrzburg, 2Clinic of Psychiatry and
Psychotherapy, University Clinic Tbingen, 3Department of
Neurology, University Clinic Wrzburg, 4Department of
Psychiatry and Psychotherapy, University Clinic Tbingen,
Germany
Introduction: Vagus somatosensory evoked potentials
(VSEP) were proposed as an electrophysiological
contribution to the diagnosis of Alzheimers dementia (AD)
and Parkinsons disease (PD) where prolongation of
latencies as compared to healthy controls was explained by
the disease specific degeneration of brainstem nuclei. We
now searched for an independent confirmation of this
hypothesis by examining VSEP in a disease where brainstem
affection may occur but which is different from the
neurodegenerative process in AD and PD.
Method: We assessed VSEP in 15 subjects with multiple
sclerosis (37.515.1 years, 5 male; EDSS median=4,0
[range 0-7]) with brainstem affection in 8 cases and in 15
matched healthy controls. The auricular branch of the vagus
nerve was stimulated at the tragus applying electrical square
impulses (0.1msec duration, interstimulus interval 2sec,
stimulus intensity 8mA). Evoked potentials were recorded
bipolarly from the electrode positions C4-F4 and Fz-F4
(band-pass 0.1Hz to 1kHz, analysis time 10msec, averaging
of 100 artefact-free epochs).
Results: ANOVAs for repeated measurements showed
significant main effects of the factor diagnosis only for
stimulation on the right side with significant longer
latencies in patients as compared to healthy controls for
latencies P1 (p0.005) and N1 (p0.026).
Conclusions: These results further support our view of
VSEP being far field potentials generated in brainstem
nuclei and thus point to VSEP as a possible tool for the
detection of brain stem pathology in neurodegenerative as
well as inflammatory diseases.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1355
Assessing the progress of mild cognitive
impairment with the use of an ERP
electrophysiological biomarker
V. Papaliagkas
3rd Department of Neurology and Department of Physiology,
Aristotle University of Thessaloniki, Greece
Aim: To study changes in auditory event related potentials
(AERP) and their correlation with the memory status of
mild cognitive impairment (MCI) patients
Materials and methods: AERPs were recorded in 22 MCI
patients (meanSD age = 67.47.8, median (interquartile
range-IQR) MMSE score = 28 (27-29) in three consecutive
exams, and in 30 age-matched controls at baseline. During
this time period, 3 patients progressed to Alzheimers
disease (AD). Latencies and amplitudes of the late waves
(N2, P3 and Slow Wave) and N2-P3 peak-to-peak
amplitudes and latencies were measured, as well as
correlation coefficients (CC) between them and MMSE
scores.
Results: Between exams, a significant increase in P3
latency and a decrease in N2 amplitude were observed.
Only N2 latency correlated with baseline MMSE scores,
whereas P3 and Slow Wave latencies correlated with age.
Conclusions: A new index that incorporates changes in N2
and P3 latencies and amplitudes into a single
electrophysiological marker is proposed in order to describe
with high accuracy the gradual progress of MCI and its AD
conversion.

P1356
Modulatory effects on human
sensorimotor cortex activation by whole
hand vibration stimulation
A.B. Kunz1, M. Christova2, E. Gallasch2, M. Seidl1,3,
J. Bergmann4,5, Y. Krenn1, R. Nardone3,6, E. Trinka1,3,4,
S.M. Golaszewski1,3,4
1Department of Neurology, Paracelsus Medical University
Salzburg, 2Institute of Physiology, Medical University Graz,
3Spinal Cord Injury and Tissue Regeneration Center,
4Neuroscience Institute, Paracelsus Medical University
Salzburg, 5Institute of Psychology, Paris Lodron University,
Salzburg, Austria, 6Department of Neurology, F. Tappeiner
Hospital, Merano, Italy
Objective: To investigate the effect of stimulation of the
nerve afferents of the hand on cortical activity elicited by
whole-hand vibration (WHV) stimulation for sensation in
healthy human subjects.
Methods: WHV stimulation was performed in 12 healthy
subjects in separate sessions at different stimulation levels:
sub-sensory at 50Hz, sensory at 50Hz and motor at 2Hz. To
verify if stimulation at lower frequencies is less effective, an
additional experiment at sensory level with 2Hz was
performed. TMS was used to assess motor threshold (MT),
motor evoked potentials (MEP) recruitment curve (RC),
short latency intracortical inhibition (SICI) and intracortical
facilitation (ICF) to paired-pulse TMS at baseline (T0),
immediately after (T1) and one hour (T2) after 30 minutes
of WHV stimulation. F-wave studies were performed to
assess spinal motoneuron excitability.
Results: WHV stimulation at sub-sensory/50Hz and
sensory/2Hz level determines no significant cortical
excitability changes; at sensory/50Hz level and at motor/2Hz
level we found decreased MT, increased MEP RC as well as
reduced SICI and increased ICF at T1 and T2.
Conclusions: WHV stimulation at sensory/50Hz and
motor/2Hz level induces similar long-lasting modulatory
effects on motor cortical excitability. Both, the strength of
the corticospinal projections and the intracortical networks
are influenced to the same extend. The study provides
further evidence that stimulation intensity and frequency
can independently modulate motor cortical plasticity. The
selection of optimal stimulation parameters has potentially
important implications for the neurorehabilitation of
patients after brain damage (e.g. stroke, traumatic brain
injury) with hand motor deficits.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 221
P1357
Acute motor axonal neuropathy:
reversible axonal conduction block or
axonal degeneration?
Z. Arnyi1, A. brahm2
1Dept. of Neurology, Semmelweis University, 2Dept. of
Neuroinfectology, St. Lszl and Istvn Hospital, Budapest,
Hungary
Objective: Acute motor axonal neuropathy (AMAN) is a
variant of Guillain-Barr syndrome. AMAN apparently has
two distinct forms: In the Far-East, AMAN is a common
disease showing quick recovery, whereas in Europe and
North-America AMAN is rare and characterized by
complete denervation. We present 3 Hungarian patients, and
discuss the clinical and electrophysiological differences
between the two forms of AMAN.
Patients: Patient 1 and Patient 2 (32- and 61-year-old
males) acquired their disease in China and Thailand,
respectively. Both patients developed generalized weakness,
with elicitable reflexes and no sensory symptoms.
Electrophysiological assessment showed low amplitude
motor responses, with normal sensory potentials. Both
patients improved within weeks. Follow-up examination of
Patient 1 showed complete restitution of motor responses
after 2 months. Patient 3 is a 25-year-old male who
developed tetraplegia, areflexia, and respiratory
insufficiency within 2 days in Hungary. The first
electrophysiological examination was performed before
Wallerian degeneration had taken place, which showed
preserved motor responses with multiple amplitude
reductions on intermediate nerve segments, and normal
sensory responses. Follow-up examination showed complete
denervation of all limb muscles.
Conclusion: It is postulated that patients 1 and 2 with the
Far-Eastern form of AMAN had reversible axonal blocks,
as opposed to the initial axonal blocks progressing to axonal
destruction seen in the European form of AMAN in patient
3. In both forms, the immune response is elicited by
Campylobacter jejuni and directed against the axolemma,
but there appears to be a quantitative and/or qualitative
difference, perhaps related to geographical differences in
Campylobacter jejuni.
222 Posters, Sunday 9 September
P1358
Ocular vestibular evoked myogenic
potentials in patients with multiple
sclerosis
E. Gozke, Z. Ayhan, N. Erdal, N. Gurbuzer, M. Kaydan
Department of Neurology, FSM Teaching and Research
Hospital, Istanbul, Turkey
Introduction: Vestibular evoked myogenic potential
(VEMP) test is a technique based on activation of the
vestibular apparatus by acoustic stimulation. In this study
we aimed to investigate the presence of vestibulopathy in
patients with relapsing remitting multiple sclerosis (RRMS)
who have not vestibular complaints using ocular VEMP
(oVEMP) test.
Methods: 40 patients diagnosed as RRMS according to Mc
Donalds criteria and 30 healthy controls were enrolled in
the study. oVEMP tests were performed through
contralateral inferior oblique muscles. Active electrode was
placed on the lower eyelid, and the reference electrode was
attached 1cm below. The patients were requested to stare
towards a superolateral direction so as to activate inferior
oblique muscle. Meanwhile 120dB click stimulation was
delivered to the contralateral ear at 10/sec for 150 sec, and
1500 responses were averaged. The test was repeated twice
for each side and the latencies and amplitudes of the initial
negative (N1) and positive (P1) waves were measured.
Availability of any response, their latencies and amplitudes
were compared.
Results: 9 cases of RRMS (22.5%) could not yield any
response in both sides, while in the control group no
bilateral response was obtained in 4 cases (13.3%). Also in
the RRMS group no unilateral response was obtained in 5
(12.5%) cases. In the RRMS group mean latencies of N1
and P1 were significantly longer, while N1-P1 amplitudes
were found to be meaningfully lower.
Conclusion: These findings demonstrate that by using
oVEMP test subclinical vestibulopathy can be elicited in
RRMS patients without vestibular complaints.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1359
Peripheral nerve function following
24-week treatment with tanezumab,
a nerve growth factor (NGF) inhibitor
M.T. Brown1, W.J. Litchy2, D.N. Herrmann3,
M. Goldstein4, A.M. Burr1, M.D. Smith1, C.R. West1,
K.M. Verburg1, P.J. Dyck2
1Pfizer, Inc., Groton, CT, 2Mayo Clinic, Rochester, MN,
3University of Rochester, Rochester, NY, 4Medical Specialists
of the Palm Beaches, Inc., Atlantis, FL, USA
Introduction: The reported cutaneous sensory symptoms
and novel analgesic mechanism of action of tanezumab, a
monoclonal antibody NGF-specific inhibitor, raises
potential concerns regarding nerve function and safety.
Methods: This randomized, double-blind, placebo-
controlled study (NCT00863772) of neurologically normal
patients with knee or hip osteoarthritis investigated whether
tanezumab (3 administrations of 5 or 10mg IVq8w for 24
weeks) caused clinically significant changes from baseline
(cfBL) relative to placebo in a composite measure of
peroneal, sural, tibial and autonomic nerve function
(5NC+HRdb) or in intraepidermal nerve fibre density
(IENFD), assessed by distal leg skin biopsy. Efficacy
(WOMAC pain) at week 16 was also assessed.
Results: Due to an FDA-mandated clinical hold, only 219
of 369 planned patients were treated. Last observation
carried forward least squares mean and standard error (LSM
(SE)) cfBL in 5NC+HRdb scores and IEFND to week 24,
and WOMAC Pain cfBL to week 16 are shown.
Assessment Placebo Tanezumab 5 mg Tanezumab 10
(LSM (SE)) mg
5NC+HRdb -0.11 0.17 (0.30) -0.06 (0.30)
(0.29)
IENFD -0.43 0.18 (0.57) -1.12 (0.57)
(0.57)
WOMAC Pain -1.31 -2.17 (0.28) -2.48 (0.28)
(0.28)
Conclusions: The magnitude of cfBL in 5NC+HRdb and
IENFD was small and unrelated to dose; treatment
differences versus placebo were not statistically significant.
Patients reported significant pain relief with tanezumab 5
and 10mg versus placebo treatment (=-0.86, p=0.024 and
=-1.16, p=0.002, respectively). Evidence linking
tanezumab to detrimental (neurotoxic) effects on the
peripheral or autonomic nervous system was not found.

P1360
Long-term changes of visual evoked
potentials in children with insulin-
dependent diabetes mellitus
S.-S. Lee1, H.-S. Han2, H. Kim3, J.J. Lee4
1Neurology, 2Pediatrics, 3Preventive Medicine, College of
Medicine, Chungbuk National University, Cheongju-si,
4Premedical Course, College of Natural Science, Seoul
National University, Seoul, Republic of Korea
Objectives: To investigate the changes of central nerve
conduction in children with insulin-dependent diabetes
mellitus (IDDM) prospectively using the visual evoked
potentials (VEP) and to know how those results were related
to clinical risk factors and parameters of peripheral nerve
conduction studies (NCS).
Methods: A total of 76 patients (29 males and 47 females)
aged 5-26 years (mean 14.44.8) with IDDM underwent
visual evoked potentials and bilateral NCS of median, ulnar,
posterior tibial, peroneal, and sural nerves annually for 5
years. The control group was made up of 52 healthy
children.
Results: Out of 76 patients, 25 patients completed annual
studies for 5 years. Significant positive correlations were
found between the latency of P100 wave in the VEP and the
level of serum glycosylated haemoglobin. Latency and
amplitude values of P100 waves decreased progressively in
children with IDDM as the duration of the disease increased.
The values of latency and amplitude were inversely related
with the age of patients and duration of the disease. The
values of latency of P100 were not related with parameters
of NCS. However, some of the parameters of NCS were
weakly related with the amplitudes of p100.
Conclusions: Poor glycaemic control proved to be an
important risk factor over 5 years as related to the
development of subclinical central neural pathway
abnormality. VEP could be considered as a valid non-
invasive tool for detecting an early diabetic central
conduction abnormality such as retinopathy or optic
neuropathy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 223
P1361
EEG in dementia with Lewy bodies: a
diagnostic tool?
Y. Hizem1,2, M. Ben Djebara1,2, I. Abdelkefi1,2,
I. Kacem1,2, A. Gargouri-Berrechid1,2, R. Gouider1,2
1Department of Neurology, Razi Hospital, La Manouba,
2Research Unit of Clinical Neurophysiology and
Electrodiagnosis 03/UR/08-09, Tunis, Tunisia
Introduction: Frontal intermittent rhythmic delta activity
(FIRDA) is an abnormal EEG pattern found in primary and
secondary involvement of the brain in a wide variety of
diseases. The occurrence of FIRDA in degenerative
dementia could be considered as an indicator supporting the
diagnosis of dementia with Lewy Bodies (DLB).
Objective: To investigate the correlation between FIRDA
and DLB in comparison with Alzheimers disease (AD).
Methods: 88 patients with dementia were ascertained: 44
DLB and 44 AD, age and sex matched. Diagnoses were
established according to international criteria. EEGs were
performed on 47 patients as part of a routine dementia
assessment using standard techniques. Recordings were
examined blind to diagnosis following these criteria:
dominant frequency, presence of other frequencies,
asymmetry, mean amplitude and presence of focal
abnormalities including spikes, sharp waves, triphasic
waves or transient slow wave activity.
Results: A total of 18 records from the DLB group and 29
records from the AD group were examined. 8 of 18 patients
(44.5%) with DLB showed a main pattern of FIRDA. In AD
group, FIRDA occurred in 10 patients with severe dementia
(34.5%). The difference between the two groups was
significant (p: 0.03).
Conclusion: We found a significant correlation between
FIRDA and DLB. Our results are in concordance with
recent findings in literature. This pattern when found in
early stages, could be helpful for diagnosis, however this
pattern could not be considered specific for DLB.
224 Posters, Sunday 9 September
P1362
Potential mechanisms underlying the
neural effects of TDCS in post-stroke
recovery
E.M. Khedr1, O.A. Shawky1,2, A. Tohamy1, J. Rothwell3
1Assiut University Hospital, Assan University Hospital,
2
Assiut, Egypt, 3National Hospital for Neurology and
Neurosurgery, London, UK
The aim of this study was to investigate potential
mechanisms underlying the neural effects of TDCS in post
stroke recovery.
Subjects and methods: 36 patients with subacute ischemic
stroke participated in the study. The patients were randomly
assigned to one of three groups; the anodal and cathodal
groups received real tDCS at an intensity of 2mA for 25
minutes daily for 6 consecutive days. The sham group
received sham stimulation for the same duration. Patients
were assessed with the Barthel index (BI) and the Medical
Research Council (MRC) muscle strength scale at baseline,
and after end of the sessions. Cortical excitability and
transcallosal inhibition (TCI) were measured at baseline and
after sessions for both hemispheres.
Results: In all groups, resting and active motor thresholds
decreased in the affected hemisphere but were unchanged in
the unaffected hemisphere; the changes were more
significant after real tDCS than sham. The slope of the
input-output curve was steeper after real tDCS (anodal,
p=0.0001 and cathodal p=0.01) with no significant changes
in the sham group. There was a significant decrease in the
duration of TCI (pre-post tDCS) in the affected hemisphere
of all groups (p=0.0001); in the unaffected hemisphere the
duration decreased only after cathodal stimulation (p=0.01).
There was a significant correlation between improvement in
Hand grip or the BI and changes in cortical excitability.
Conclusion: Both types of real tDCS increased cortical
excitability of the affected hemisphere and these changes
correlated with the improvement in motor function.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1363
HRAS-dependent perturbation of iTBS
after-effects: a lesson from Costello
disease
M. Dileone1,2, P. Profice1, F. Ranieri1, F. Pilato1,
F. Capone1, L. Florio1, R. Di Iorio1, G. Musumeci1,
C. Leoni1, M. Tartaglia3, G. Zampino1, V. Di Lazzaro1
1Catholic University of Rome, 2San Bortolo Hospital,
Vicenza, 3Istituto Superiore di Sanit, Roma, Italy
Introduction: Costello syndrome (CS) is a rare congenital
disorder due to a G12S amino acid substitution in HRAS
protoncogene and several lines of evidence suggest a key
role of HRAS in Long Term Potentiation (LTP). Paired
Associative Stimulation (PAS) leads to an extremely
pronounced motor cortex excitability increase in CS
patients. Intermittent Theta Burst Stimulation (iTBS) is
another facilitatory repetitive Transcranial Magnetic
Stimulation (rTMS) protocol that in normal subjects induces
a similar increase in motor cortex excitability. For this
reason, we evaluated the after-effects induced by iTBS in
CS and compared them with those induced by PAS.
Methods: In two different session we evaluated iTBS and
PAS after effects in 4 CS patients and a group of 17 age
matched healthy controls. All CS patients underwent clinical
evaluation for dystonia.
Results: PAS protocol led to a 250% increase of the FDI
MEP amplitude in CS patients: surprisingly iTBS induced
no change in MEP amplitude in CS patients whereas led to
an increase of about 50% in healthy subjects. Nevertheless
all CS patients showed mild to moderate generalized
dystonia.
Conclusions: CS patients are characterized by dystonia
and, moreover, by a concomitant enhanced PAS-induced
after-effect and an impairment of iTBS-related LTP-like
phenomena. The last finding seems to suggest that HRAS-
dependent signalling pathways could differently affect
homotopic and heterotopic brain plasticity in humans.

P1364
Motor cortex excitability in patients with
vascular cognitive impairment-no
dementia: a follow-up study
M. Cantone1, G. Lanza1, M. Pennisi2, V. Puglisi1,
L. Vinciguerra1, R. Ricceri1, G. Pennisi1, R. Bella1,
M. Zappia1
1 Department GF Ingrassia, Section of Neurosciences,
2 Department of Chemistry, University of Catania, Italy
Introduction: Up to now only few studies have examined
cortex excitability in patients with cognitive decline
following vascular brain damage. Recently, a transcranial
magnetic stimulation (TMS) study showed an enhanced
motor cortex facilitation even though the absence of
changes in resting motor threshold (rMT), in patients with
vascular cognitive impairment-no dementia (VCI-ND).
Aim: To evaluate neuropsychological and neuro
physiological outcome in VCI-ND patients.
Methods: 8 VCI-ND patients (mean age 72.46.4 years)
underwent to neuropsychological assessment and to single
and paired-pulse TMS study at baseline and after two years.
Resting motor threshold (rMT), cortical silent period, short
intracortical inhibition and intracortical facilitation were
recorded bilaterally.
Results: After the follow-up period (22.13.5 months)
patients exhibited a significant worsening of Stroop
T-scores (43.4 sec16.78 vs. 66.9 sec30.98; p<0.05) and a
significant reduction in rMT over both hemispheres (left:
47.3%9.88 vs. 40.9%10.67; right: 41.9%4.88 vs.
38.4%7.11; p<0.05).
Conclusion: After two years, VCI-ND patients showed an
overall trend towards a motor cortex hyperexcitability,
although the mean rMT value was still within normal limits.
Previous studies reported that cortical excitability is stably
affected in dementing process. In this study, patients with a
significant decrease of rMT exhibited a worse performance
in cognitive evaluation even without an overt dementia,
suggesting a correlation between neuropsychological and
neurophysiological data. TMS is valuable tool in the
monitoring and early detection of neurophysiological
changes in patients at risk for vascular dementia.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 225
P1365
Ocular vestibular evoked myogenic
potentials in evaluation of patients with
multiple sclerosis
T. Gabelic1, M. Krbot2, I. Adamec2, M. Habek2,3
Neurology, 2University Hospital Centre Zagreb, 3School of
1
Medicine, University of Zagreb, Croatia
Objectives: We investigated ocular vestibular evoked
myogenic potentials (oVEMP) as supportive diagnostic toll
in assessing lesions of vestibulo-ocular pathways in patients
with relapsing remitting multiple sclerosis (RRMS).
Patients and methods: 60 patients treated at the Referral
Centre for Demyelinating Diseases with established
diagnosis of relapsing remitting multiple sclerosis were
included in the study. The control group consisted of 16
healthy subjects. oVEMP in response to acoustic clicks of
1ms duration at the intensity of 130dB SPL and the
stimulation frequency of 1Hz were studied. Signals were
divided in segments of 120ms duration (20ms before the
stimulus and 100ms after the stimulus) and averaged.
Latencies and amplitude of N10 and P13 waves of oVEMP
were evaluated.
Results: Statistically significant prolongation of latencies
was found in the group of RRMS patients (p<0.05) for N10
response on the right and left side. There was also latency
prolongation for P13 wave on right side. Statistical
significance was not reached for left P13 latency. The
difference in the amplitude between groups was not
observed. Conduction block was indentified in 18 patients
(30%).
Conclusion: Ocular vestibular evoked myogenic potentials
are useful neurophysiological methods in evaluation of
brainstem lesions in patients with relapsing remitting
multiple sclerosis.
226 Posters, Sunday 9 September
P1366
Prognostic value of neuron-specific
enolase level in patients with Parkinsons
disease
Y. Madjidova, S. Fakhargalieva
Tashkent Medical Academy, Tashkent, Uzbekistan
Aim: To study the role of neuron-specific enolase in the
forecast of Parkinsons disease (PD).
Materials and methods: We examined 35 patients, 17
(48.57%) women and 18 (51.42%) men, average age -
(7310.3) with PD. Patients were divided into 3 subgroups:
with trembling-rigidity, trembling, and akinetic-rigidity
form. NSE level was defined in the serum of patients with
the method of immune-enzyme analysis which was made
with specific test systems, on "LISA" analyzer according
to the instruction applied in a set.
Results: In 24 (68.5%) from 35 patients, NSE level was
elevated (>25ng/ml). Elevated NSE level was marked in
58.3% of men and 41.7% of women. From 3 subgroups only
in patients with the trembling form of PD fluctuation of
NSE level was within the norm (19-24.73ng/ml). More
often elevated NSE level was defined in the early period of
the disease. Depending on the rate of parkinsonism
progressing, it was revealed that more elevated NSE levels
were marked in patients with fast rate of disease progressing,
than in patients with slow and moderate rate.
Conclusions: Elevated NSE level was marked in 69% cases
of patients with parkinsonism. Elevated NSE level met in
patients with the trembling-rigidity and akinetic-rigidity
form of PD, and was more elevated in patients with fast rate
of disease progressing, also at early stages of the disease.
NSE level can be used as an additional methods of
diagnostics and the forecast of neurodestructive brain
processes, including PD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1367
Acute hyperoxia and cerebrovascular
reactivity in diabetic patients with acute
stroke: a pilot study
I. Hegedus1, I. Drenjancevic2, S. Butkovi-Soldo3,
A. Cosic2
1Neurology, University Hospital in Osijek, 2Physiology and
Immunology, 3Neurology, Faculty of Medicine University
Josip Juraj Strossmayer Osijek, Croatia
Introduction: Impaired cerebral vascular reactivity has
been described in hypertension and diabetes mellitus. Since
stroke is of vascular etiology, the aim of this study was to
determine the effects of acute hyperoxia stimulation on
cerebrovascular reactivity in diabetic patients with acute
stroke.
Methods: In this pilot study, 12 diabetic patients (DM
group) (meanSD age 656 yrs) with acute ischemic stroke
(within 72 hours) and 12 healthy subjects (613 yrs) were
included. Blood flow velocity (BFV) of middle cerebral
artery (MCA), index of pulsality (IP) and index of resistance
(IR) were determined by transcranial Doppler before,
during 15 minutes, and after 15 minutes of acute hyperoxia
(inhalation of 100% O2 over facial mask). Tromboxane B2
(TXB2) levels in blood of both groups were measured by
ELISA assay before and during acute hyperoxia.
Results: The results showed paradoxical increase in cerebral
BFV in both brain hemispheres during hyperoxia in the DM
group compared to controls, accompanied by decrease of
TXB2 during hyperoxia in the DM group and increase of
TXB2 in controls during hyperoxia. Controls exhibit
vasoconstriction in response to hyperoxia. PI and RI in the
DM group decreased during hyperoxia compared to their
basal values and compared to controls (while PI and RI of
controls increased compared to basal conditions).
Conclusion: This study demonstrated paradoxical MCA
vasodilation, accompanied by decrease in TXB2 levels in
DM patients with stroke compared to healthy controls,
suggesting the role of cyclooxygenase metabolites of
arachidonic acid mediating the change in cerebral BFV and
vasoreactivity in response to hyperoxia.

P1368
Effects of simultaneous bilateral tDCS of
the human motor cortex
L. Mordillo Mateos1, L. Turpin Fenoll2,
J. Milln Pascual2, A. Oliviero1
1FENNSI, Hospital Nacional de Parapljicos, Toledo,
2Servicio de Neurologia, Hospital La Mancha Centro,
Alcazar de San Juan, Spain
Introduction: tDCS is a non-invasive technique investigated
as a therapeutic tool for different neurologic disorders.
Neuronal excitability can be modied by application of DC
in a polarity-specic manner: anodal tDCS increases
excitability, while cathodal tDCS decreases excitability.
Objective: To determine whether simultaneous bilateral
tDCS is able to increase cortical excitability in one
hemisphere whereas cortical excitability in the contralateral
hemisphere decreases. Cortical excitability before and after
bilateral motor cortex tDCS was evaluated and compared
with unilateral motor cortex tDCS.
Methods: Cortical excitability was evaluated before and
after unilateral or bilateral tDCS using transcranial magnetic
stimulation.
Results: Simultaneous application of anodal tDCS over the
motor cortex and cathodal tDCS over the contralateral one
induces an increase in cortical excitability on the anodal-
stimulated side and a decrease in the cathodal stimulated
side. The simultaneous bilateral tDCS induced similar
effects to the unilateral montage on the cathode-stimulated
side. On the anodal side, the simultaneous bilateral tDCS
seems to be a slightly less robust electrode arrangement
compared with the unilateral montage. Intersubject
variability of the excitability changes induced by the anodal
motor cortex tDCS using the bilateral montage was lower
than that with the unilateral montage.
Conclusions: This is the rst study in which cortical
excitability before and after bilateral motor cortex tDCS
was extensively evaluated, and the effects of bilateral tDCS
were compared with unilateral motor cortex tDCS.
Simultaneous bilateral tDCS seems to be a useful tool to
obtain increases in cortical excitability of one hemisphere
whereas causing decreases of cortical excitability in the
contralateral hemisphere (e.g., to treat stroke).
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 227
P1369
Endothelial dysfunction in two patients
with posterior reversible encephalopathy
syndrome
M. Saadatnia, V. Davoudi, K. Keyhanian, S. Haghjoo
Javnmard, M. Mirmohammad Sadeghi, F. Haghdoost
Isfahan University of Medical Sciences, Isfahan, Iran
Background: We report two patients, one with eclampsia
and another one with Systemic Lupus Erythematosus
presenting posterior reversible encephalopathy. We tried to
find out whether endothelial cell dysfunction was present in
these two patients.
Case1: A 22-year-old woman who was pregnant and has
been diagnosed to have HELLP syndrome was admitted to
Al-zzahra hospital. The day after caesarean section, she had
experienced two Generalized Tonic Colonic Seizure attacks
with a consequent long time loss of consciousness. In brain
Magnetic Resonance Imaging (MRI) scan, ischemic lesions
were found in parietal lobes and basal ganglia. Serum level
of two adhesion molecules, ICAM-1 & VCAM-1 was
obtained and they were 274.5 & 102.5, respectively.
Case2: A 16-year-old girl with Systemic Lupus
Erythematosus was admitted to Al-zzhra Hospital while she
was confused and had experienced five episodes of
Generalized Tonic Clonic Seizures. Cerebral vasospasm has
been recorded through Magnetic Resonance Angiography
(MRA). Serum level of ICAM-1 and VCAM-1 were found
to be 329.3 and 75.7, respectively.
Conclusion: We found high amount of ICAM-1 and
VCAM-1 in serum of two patients with posterior reversible
encephalopathy syndrome. These adhesion molecules were
found under different circumstances within circulating
blood reflecting the endothelial damage.
228 Posters, Sunday 9 September
P1370
Relation between electrophysiological
findings and diffusion weighted magnetic
resonance imaging in ulnar neuropathy in
the elbow
Y. Altun1, S. Aygun2, M.U. Cevik3, A. Acar3, S. Varol3,
A. Arkanoglu3, H. Onder4, E. Uzar3
Neurology, 2Radiology, Siirt State Hospital, Siirt,
1 1Neurology, Mayo Clinic, Scottsdale, AZ, 2Neurology, Mayo
Neurology, 4Radiology, Faculty of Medicine, Dicle
3 Clinic, Rochester, MN, USA
University, Diyarbakir, Turkey
Diffusion weighted imaging (DWI) provides information
about tissue integration by reflecting the random movement
of water molecules within the tissue. There is a limited
number of studies regarding DWI and conventional
magnetic resonance imaging (MRI) in patients with ulnar
neuropathy in the elbow (UNE). In our study, we aimed to
investigate the diagnostic value of non-invasive DWI
technique in patients with UNE. 26 elbows in 19 healthy
controls (range 22-56 years) without any symptoms and 24
elbows in 21 patients (range 21-46 years) with cubital
tunnel syndrome underwent DWI. The electrophysiological
and clinical criteria for the diagnosis of UNE were
performed. No signal from the ulnar nerve was detected in
the healthy control group. We determined signal increase of
the ulnar nerve by DWI in all patients with UNE. T2
weighted (T2W) image showed increased signal intensity in
20 elbows, while low signal intensity was observed in 4
elbows. A positive correlation was found between disease
duration and presence of hyperintensity (p=0.044, r=0.42)
on T2W images. In addition, a positive correlation was also
found between electrophysiological severity scale score and
the largest nerve fibre diameter (p=0.017, r=0.48) and
cross-sectional area (p=0.017, r=0.48). In conclusion, DWI
might be used together with electrophysiological methods
in diagnosis of UNE. Furthermore, DWI can be preferred in
some cases since it is a non-invasive method compared to
electrophysiological methods in the diagnosis of UNE.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1371
Small fibre conduction velocity (CV) by
contact heat evoked potential stimulation
(CHEPS) is faster in peripheral than in
central spinothalamic pathways
B.E. Smith1, M.A. Ross1, B.P. Goodman1, E.P. Bosch1,
L.K. Jones Jr.2
Introduction: Nerve conduction studies (NCS) assess only
large diameter myelinated fibres. Data regarding small
diameter fibre CV are sparse. CHEPS provides objective
measures of A delta fibre pathway CV from skin to cortex.
Methods: To assess CHEPS small (A delta) fibre CV in the
periphery vs. in the CNS 13 neurologically normal controls
were recruited over 18-24 months with IRB approval. After
consenting, all subjects underwent evaluations including
CHEPS of limb and spine (L1 and C7) sites. Small fibre CV
values were calculated between skin stimulation sites and
scalp recording electrodes.
Results: CV values from distal limb sites showed means of
3.7 m/s (foot) and 2.1 m/s (hand) while spine CV values had
mean values of 1.5 m/s (L1) and 0.7 m/s (C7). CV figures
for proximal limb sites (leg and forearm) were intermediate.
Conclusions: 1) Small (A delta) fibre CV values are higher
from the distal limb than from corresponding spinal sites, 2)
since the vast majority of the conduction pathway between
spine and cerebral cortex is central and the peripheral extent
of this pathway is longer in peripheral than central segments
stimulating distal limb sites, it may be hypothesized that
peripheral small (A delta) fibre CV is greater than central
small (A delta) fibre CV, and 3) possible explanations may
include: greater peripheral axon diameter, greater peripheral
myelin thickness, and perhaps other differing physiologic
properties between Schwann cells and oligodendrocytes
such as sodium channel density or kinetics, PNS vs. CNS
axonal membrane properties, and central inhibitory
mechanisms.

P1372
Can the Mismatch negativity (MMN) be
found in the nucleus subthalamicus?
E. Minks1, P. Jurak2,3, J. Halamek2,3, J. Chladek2,
M. Bares1,4
1First Department of Neurology, St. Annes University
Hospital and School of Medicine, Masaryk University,
2Institute of Scientific Instruments of the ASCR, v.v.i., 3ICRC
- International Clinical Research Center, St. Annes
University Hospital, 4CEITEC - Central European Institute
of Technology, Brno, Czech Republic
Introduction: In the protocol of mismatch negativity
(MMN) the frequent and target auditory stimuli are
presented to the patient while unconcious. These evoked
potentials (EP) are considered to correlate with automatic
working memory and a primitive intelligence on an
unconscious level. The aim of the study was to elucidate
whether nucleus subthalamicus (STN) is involved in the
processing of audio signals.
Methods: The EEG signal was recorded from STN during
MMN protocol in 5 patients with Parkinsons disease with
9 established intracerebral electrodes. EP and event related
time-frequency analysis was performed. Protocol
parameters: 0.1-40Hz frequency band, target/frequent
stimulus 1kHz/2kHz, 100 ms, interstimulus interval 4s, 40
target stimuli.
Results: When the intracerebral electrodes were connected
with the reference electrode on the scalp - the N1 wave
(around 100ms) and MMN (peak around 200ms) dominated
at record. The most distinct N1 wave frequency was around
3Hz and this signal weakened while target motion was
presented. While intracerebral electrodes were connected in
the STN (near field potential) MMN-like potentials were
detected in 3 of 5 patients and in 4 of 9 intracerebral
electrodes. These EP were in the same latency (19625ms)
like the MMN from connection of intracerebral electrodes
to the extracranial reference electrode. In 1 patient we
observed phase reversal of MMN-like potentials.
Conclusion: The nucleus subthalamicus is involved in
processing of auditory signals on an unconscious level.
However, further verification will be needed. Supported
CZ.1.05/1.1.00/02.0068, CZ.1.05/1.1.00/02.0123 and
MUNI/A/0862/2011.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 229
P1373
Stimulus intensity and masseter volume
conduction on nerve conduction study in
facial palsy
S.J. Oh
Catholic University of Korea, Uijeongbu St. Marys Hospital,
Uijeongbu, Republic of Korea
Objectives: Electroneurography (ENoG) is used to
determine the prognosis and the outcome in the acute phase
of Bells palsy. However, we have experienced that inter-
rater and test-retest reproducibilities are relatively low. One
of the reasons is masseter volume conduction. This study is
designed to obtain pure compound motor action potential
(CMAP) of the facial nerve without activating the masseter
muscle.
Methods: 13 patients with facial palsy were enrolled.
CMAPs were measured by using the 2 channel recording
method, locating the surface electrode on nasalis muscle
and a concentric needle in the masseter muscle.
Supramaximal stimulations were done using stimulating
intensities of 20 to 60mA (sometimes over 60mA) at
intervals of 5 or 10mA. Stimulation intensities at which
masseter volume conduction arose were checked in every
patient. The values of ENoG (%) with and without
considering masseter volume conduction were assessed.
Results: Most of the masseter volume conductions arose
between a stimulating intensity of 40 and 60mA except 4 of
26 masseter muscles, which are minimally 35mA in 1
muscle, and 70mA in 2 muscles, and maximally 80mA in 1
muscle. When masseter volume conduction was neglected,
only 1 patient revealed over 90% axonal loss (ENoG< 10%).
On the contrary, when masseter volume conduction was
taken into account, 3 patients revealed over 90% axonal loss
(ENoG< 10%), which means a poor outcome.
Conclusions: Masseter volume conductions arose in all
patients. Even though the ENoG is over 10%, one should
consider masseter volume conduction all the time, especially
when 80~90% axonal loss is represented.
230 Posters, Sunday 9 September
P1374
Chronic inflammatory sensory
polyradiculopathy: a case report and
review of the literature
P. Zuberbuhler1, R. Reisin1, D. Miarro1, D. Binaghi2,
C. Marchesoni1, A. Pardal1
1Neurology Department, Hospital Britnico Buenos Aires,
2Radiology Department, Fundacin Favaloro, Buenos Aires,
Argentina
Introduction: Chronic inflammatory sensory
polyradiculopathy (CISP) is a defined entity, frequently
underdiagnosed, and potentially treatable. It must be
suspected in patients with sensory ataxia, normal nerve
conduction studies (NCS), and MRI with thickened
lumbosacral nerve roots and gadolinium enhancement.
Objective: Report of one case and review of the literature.
Case report: A 57-year-old man with marked sensory
ataxia on his left leg. Examination showed normal strength,
decreased knee and ankle jerks. Light touch and pinprick
sensations were reduced below the knees. Vibration and
joint position sense were absent in the feet. Rhomberg was
positive. NCS were normal. Tibial sensory evoked potentials
disclosed absent responses bilaterally. CSF was acellular
with elevated protein. Lumbosacral MRI showed thickening
of roots, with gadolinium enhancement. The patient was
treated with IVIg 2g/kg for 5 days, with improvement of
symptoms. Currently, he receives IVIg every month, and
remains stable.
Conclusions: The clinical course, elevated CSF protein, the
evidence of root enhancement on the MRI, good response
to immunotherapy and the exclusion of other causes of
sensory ataxia, were compatible with the diagnosis of CISP.
CISP is considered a restricted regional variant of chronic
inflammatory demyelinating polyradiculopathy (CIDP),
clinically mimicking a purely sensory variant. There are
several reports of nerve root involvement in patients with
CIDP, but there are only a few of patients with sensory
ataxia, nerve root involvement, but normal nerve conduction
studies. CISP is probably an underdiagnosed but potentially
treatable disorder that requires the identification of isolated
involvement of the sensory roots.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1375
Acoustic shear wave signalling and
calcium activation as the scientific basis
of acupuncture physiology: TRP ion-
channel experiments with fibroblast and
endothelial cells
J. Liang1, W.J. Xie2, X.Q. Yao3, P.Y.S. Cheung4,
S.K. Lam4, Q. Ma5, P.-W. Li6, X. Yang7, G. Li5,
E.S. Yang4,6,8, P. Cheng9
1EEE, University of Hong Kong, Hong Kong, Hong Kong
S.A.R., 2Health Science Center, Peking University, China,
3Chinese University of Hong Kong, Shatin, 4University of
Hong Kong, 5Time Medical Systems, Hong Kong, Hong
Kong S.A.R., 6Electrical Engineering, National Central
University, ChungLi, Taiwan R.O.C., 7Shenzhen Disease
Control Center, Shenzhen, China, 8Time Medical Systems,
Hing Kong, Hong Kong S.A.R., 9Peking University, China
A novel model of acupuncture physiology based on cellular
calcium activation by an acoustic shear wave (ASW)
generated by the mechanical movement of the needle was
reported recently and its implication on integration of
ancient Chinese medicine with modern science was
discussed. Experimental evidences were observed using
latest instrumentation in MR Elastrography, confocal
microscopy and two-photon fluorescent. To further
understand the biological nature of the ancient art, we have
developed an acoustic wave model that relates Ca2+
activation to the total acoustic energy; not time and
amplitude alone. We have made use of siRNA in knockdown
experiments in both fibroblast and endothelial cells and
found that acupuncture induced ASW activates Ca2+ influx
pathway of TRPC1, TRPV4 and TRPM7 channels in both
NIH 3T3 and H5V cells indicating the mechanosensitive
activities via the TRP channels. TRP channels, especially
TRPV4, have been implicated in the detection of acute
nociceptive and neuropathic pains. In cooperation of
TRPC1, TRPV4 was found to mediate mechanical hyper-
algesia and primary afferent nociceptor sensitization. ASW
activated Ca2+ influx pathway of TRPV4 might be the link
of the pain release observed in the large scale clinical trials
of acupuncture performed mostly in Europe in the last 10
years.
P1376
Abstract cancelled

P1377
Nucleotide interactions with K-ATP
channels in hippocampal neurons
examined with open-cell patch-clamp
method
R. Mollajew
Neuro and Sensory Physiology, Medical University of
Gttingen, Germany
ATP-sensitive K+ (KATP) channels are widely expressed in
the brain and contribute in many physiological processes.
Especially important is their protective role during hypoxia/
ischemia and epilepsy. We examined hippocampal neurons
in primary culture using open-cell (OC) patch-clamp
method. In the test experiments we monitored a loss of fura-
2 or fluo-3 from preloaded neurons and estimated that
equilibrium between cytoplasm and bath solution was
established within <1min after addition of -escin. In many
neurons we observed generation of action potentials in the
cell-attached mode indicating normal viability. The cells
were permeabilized in Ca2+- and Mg2+-free solutions by
brief exposure to 5-M -escin after which they are viable
for 5 to 60 min. The activity of KATP channels increased
within 2 min after permeabilization in ATP-free solutions.
Subsequent application of 1mM ATP inhibited KATP
channels. 1mM ADP in ATP-free solution considerably
increased their activity. Most likely it happens due to
suppression ATP sensitivity of KATP by ADP. Combined
application of 1mM AMP and 1mM ATP enhanced KATP
channel opening that might be due to disproportionate
reaction AMP + ATP < -> 2 ADP. The effects were not
observed when AMP was applied with non-hydrolyzable
ATP-PNP (1mM) and ADP-PNP (1mM). Further
complexity produced intracellular Mg2+ whose complexes
with ATP and ADP additionally increased channel openings.
The data thus reveal the multifaceted role of adenine
nucleotides in regulation of KATP channels that perhaps
cannot be reduced to a simple rationale involving ATP/ADP
ratio.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 231
P1378
Cervical vestibular evoked myogenic
potentials in cerebellar lesions
E.S. Papathanasiou, S.S. Papacostas, M. Pantzaris
Clinical Sciences, The Cyprus Institute of Neurology &
Genetics, Nicosia, Cyprus
Introduction: Cervical vestibular evoked myogenic
potentials (cVEMPs) represent a non-invasive method of
evaluating the function of the vestibular nervous system
using sound stimulation. Using air-conducted sound, the
above is thought to occur as the saccule is located close to
the oval window. Our experience in patients with cerebellar
lesions is evolving, with only a few references published,
and more illustrative cases are required. We describe two
cases with isolated cerebellar vascular lesions who had
cVEMPs and brainstem auditory evoked potentials
(BAEPs).
Methods: BAEPs were performed in the standard manner
using unilateral click stimulation at 70dB nHL with
contralateral masking noise. cVEMPs were performed
using unilateral 120dB peak SPL (pSPL) intensity 1kHz
tone air-conducted sound stimulation with contralateral
90dB pSPL masking noise. Recording was performed from
the tonically active sternocleidostoid muscle ipsilateral to
the ear receiving tone stimuli, with the active recording
electrode placed over the midpoint of the muscle, the
reference electrode on the clavicle and the ground on the
forehead.
Results: The first case (28 years old) presented with a right
middle cerebellar peduncle lesion, whereas the second case
(65 years old) presented with a lesion in the right middle
cerebellar peduncle and hemisphere. Both cases had normal
cVEMPs bilaterally. The first case revealed an abnormal
BAEP on the left and a disorganized BAEP on the right,
whereas the second case showed normal BAEPs bilaterally.
Conclusion: cVEMPs appear to be unaffected by middle
cerebellar peduncle and cerebellar hemispheric lesions.
232 Posters, Sunday 9 September

P1379 P1380
Alpha coma as unusual EEG pattern of Uncommon neurophysiological patterns
sedation induced by Propofol in Lambert Eaton syndrome
M.P. Pirovano1,2, F. Sasanelli1 E. Agazzi
1Department of Neurology, Azienda Ospedaliera di Ospedali Riuniti di Bergamo, Italy
Melegnano, Vizzolo Predabissi, 2Neurology Residency
School, University of Milano-Bicocca, Monza, Italy
Introduction: Propofol, a short acting hypnotic drug, is
P1381
usually used in intensive care units in several clinical Median compound sensory nerve action
situations, including treatment of status epilepticus by potentials (CSNAPs) recorded
continuous infusion. In these cases the EEG pattern is antidromically from the finger using a
characterized by widespread delta activity, later joined by
burst-suppression.
distant reference electrode
Case report: A woman shows up at the emergency room A.S. Wee1,2, S.J. Wilson1
presenting abdominal pain, involuntary movements and
1Neurology, University of Mississippi Medical Center,
irreducible trismus; suspecting prolonged seizure, she
2Neurology, G.V. (Sonny) Montgomery VA Medical Center,
undergoes treatment with Propofol infusion. Brain and Jackson, MS, USA
abdominal CT scans and blood tests, including extensive
toxicology, were negative. After 36 hours of sedation with
Propofol, the EEG showed a persistent and widespread
P1382
activity at 13Hz, not reactive to stimuli. After 48 hours, Acute onset multifocal motor neuropathy
infusion of Propofol was discontinued and the patient woke with conduction block (MMNCB): a case
up without seizures. An EEG performed after 12 hours report of a benign variant
showed normal awake activity, characterized by alpha
D. Tsiptsios, D. Kiourtidis, T. Tsironis, M. Krommyda,
rhythm. Subsequent investigations led to the diagnosis of
E. Ameridis, P. Petrou, A. Mastrokosta, A. Tichalas,
urosepsis, secondary to acute pyelonephritis caused by
G. Xiromerisiou, E. Koutlas, X. Fitsioris, J. Rudolf,
Pseudomonas Aeruginosa, responsive to tetracycline
treatment. The antiepileptic treatment was not necessary. G. Deretzi, I. Tsiptsios
Neurology Department, Papageorgiou General Hospital,
Conclusion: Retrospective studies showed non-epileptic
Thessalonki, Greece
events classified as seizures in about 15% of patients. In this
case the misdiagnosis allowed describing an EEG pattern of
alpha coma during Propofol infusion. Studies in children P1383
suggest that propofol induces burst-suppression as typical
EEG pattern, but data in adults are poor. In the same way, Diagnostic sensitivity of cervical
there are few reports of alpha coma, usually described in vestibular evoked myogenic potentials in
brain stem lesions. It is therefore necessary to conduct acute vertigo distinction
further studies in adults to better stratify the possible EEG M. Jolic, M. Lazarevic, S. Jolic, V. Djuric, J. Stamenovic,
patterns about duration and doses of propofol infusion. S. Djuric
Neurophysiology Department, Clinical Center of Nis, Serbia

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1384
Patients with central and peripheral
neuropathic pain: evaluation of
neuropathic pain with specific
neurophysiological reflex techniques and
clinical approach
N. Dogan1, D. Selcuki1,2
1Neurology, 2Algology-Neurophysiology, Celal Bayar
University, Manisa, Turkey
P1385
Autoimmune encephalitis associated with
Graves disease: a case report
M. Saadatnia, V. Davoudi, K. Keyhanian, M. Siavash,
B. Ansari, F. Haghdoost
Isfahan University of Medical Sciences, Isfahan, Iran
P1386
Evaluation of cutaneous silent period
parameters in patients with type-2
diabetes mellitus: effects of pregabaline
O. z1, H. Akgn1, M. Ycel1, A. Talpnar2,
. Erdoan3, .H. Ula1, Z. Odaba1
1Department of Neurology, 2Department of Endocrinology,
Glhane Medical Academy, Ankara, 3Department of
Neurology, Pamukkale University, Denizli, Turkey
P1387
Congenital hypogenesis of bilateral
abductor pollicis muscle: report of two
cases
H. Yaar1, O. z2, M. Korkmaz2, H. Akgn2, H. Tekeli3
1Department of Neurology, Ankara Mevki Military Hospital,
2Department of Neurology, Glhane Medical Academy,
3Department of Neurology, Kasimpaa Military Hospital,
Ankara, Turkey
P1388
Cervical vestibular evoked myogenic
potentials are efficacious in evaluation of
vestibulospinal pathways in patients with
multiple sclerosis
M. Krbot1, T. Gabeli1, I. Adamec1, M. Habek1,2
1University Hospital Centre Zagreb, 2University of Zagreb,
School of Medicine, Zagreb, Croatia
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 233
P1389
Neurophysiological monitoring of the
trans-procedure endovascular closure of
atrial septum defects (ASDs) in adults
M.E. Habeych Sanmiguel1, W. Anderson2, J.R. Balzer1,
D.J. Crammond1, P.D. Thirumala1
1Neurological Surgery, 2Invasive Cardiology, University of
Pittsburgh, Pittsburgh, PA, USA
P1390
Hepcidin mediates stress induced
depression
A. Nahavandi1, F. Farajdokht2, M. Solaymani2
1Department of Physiology, Tehran University of Medical
Sciences/Physiology Research Centre/Cellular and
Molecular Research Centre, 2Tehran University of Medical
Sciences, Tehran, Iran
P1391
Spastic cerebral palsy treated by anodal
transcranial direct current stimulation:
a pilot study
B. Aree-Uea1, N. Auvichayapat2, T. Janyacharoen3,
S. Iamsaard4, J. Prasertnoo5, P. Auvichayapat6
1Physiology, Faculty of Medicine, Khon Kaen University,
2Department of Pediatrics, Khon Kaen University,
3Department of Physical Therapy, Faculty of Associated
Medical Sciences, Khon Kaen University, 4Department of
Anatomy, Faculty of Medicine, Khon Kaen University,
5Physical Therapist of Srisangwal School, 6Department of
Physiology, Faculty of Medicine, Khon Kaen University,
Khon Kaen, Thailand
P1392
How to predict axonal degeneration in
carpal tunnel syndrome?
M.-H. Chang
Neurology, Taichung Veterans General Hospital, Taichung,
Taiwan R.O.C.
P1393
Hereditary neuropathy with liability to
pressure palsy presenting with brachial
plexopathy
G. Genc1, S. Bek2, T. Kasikci2, B. Kurt2, Z. Odabasi2
Maresal Cakmak Hospital, Erzurum, 2Gulhane Military
1
Medical Academy, Ankara, Turkey
234 Posters, Sunday 9 September

P1394 P1400
Prognostic value of quantative EEG prior Role of H-reflex latency in diagnosis of
to electroconvulsive therapy in psychotic diabetic neuropathy
disorders and major depression M. Budimirovi
E. Dal1, O. Kamisli1, M.E. Tagluk2, S. Kartalci3, Neurology, County Hospital Sremska Mitrovica, Sremska
Y. Kaplan1, C. Ozcan1 Mitrovica, Serbia
1 Neurology, 2Electric and Electronic Engineering,
Psychiatry, Inonu University, Malatya, Turkey
P1401
3

Movement disorder at pituitary

P1395 microadenoma
Treatment of spinocerebellar
M.G. Zhestikova1, V.A. Minenkov1, N.P. Shakhvoorost2,
degeneration with serotonin agonist E.I. Rybalko3, E.D. Vasenina4, S.D. Komissarova4,
A. Takei1, S. Hamada1, H. Soma1, S. Honma1, N.A. Korotkevich5, V.C. Van1, L.V. Van1
K. Hamada1, H. Moriwaka1, K. Tashiro1, H. Saaki2 1Neurology, State Budgetary Educational Institution of
1Hokuyukai Neurological Hospital, 2Hokkaido University Additional Education Novokuznetsk State Advanced
School of Medicine, Sapporo, Japan Medical Studies the Ministry of Health Care and Social
Development of the Russian Federation, 2Endokrinology,
Municipal Budgetary Medical Preventive Institution City
P1396 Clinical Hospital 1, 3Neurology, Municipal Budgetary
Abstract cancelled Medical Preventive Institution City Clinical Hospital 29,
4Neurology, Municipal Budgetary Medical Preventive

Institution City Clinical Hospital 2, Novokuznetsk,

P1397 5Neurology, Regional Budgetary Medical Preventive

Abstract cancelled Institution Regional Hospital, Kemerovo, Russia

P1398 P1402
Saccadic eye movements during aging in Abstract cancelled
healthy volunteers, patients with
Parkinsons disease and progressive P1403
supranuclear palsy Electromyography in obvious and
R. Bogdanov1, P. Ratmanova2, A. Litvinova2, subclinical hypothyroidism and its clinical
D. Napalkov2 correlation
1Department of Neurology, Moscow Regional Scientific
E. Oguz Akarsu1, H. Acar1, M.F. Genc1, S. Gunaydin1,
Research Clinical Institute n.a. M. F. Vladimirsky,
2Department of Higher Nervous Activity, M. V. Lomonosov S. Ozben2, F. Ozer1, M.B. Aktuglu3
1Neurology, Haseki Training and Research Hospital,
Moscow State University, Moscow, Russia
Istanbul, 2Neurology, Kafkas University, Kars, 3Internal
Medicine, Haseki Training and Research Hospital, Istanbul,
P1399 Turkey
Computerized posturographic analysis of
balance control in patients with P1404
Parkinsons disease and essential tremor Applying balance control systems in
R. Bogdanov1, D. Napalkov2, P. Ratmanova2 coordination disturbances diagnostics
1Department of Neurology, Moscow Regional Scientific N. Tarasevich, U. Lukashevich
Research Clinical Institute n.a. M.F. Vladimirsky, V&A Laboratory Limited Liability Company, Moscow,
2Department of Higher Nervous Activity, M.V. Lomonosov
Russia
Moscow State University, Moscow, Russia

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


Epilepsy 1
P1405
Localizing epileptic networks in tuberous
sclerosis using arterial spin labelling MRI
perfusion
A. Azarion1, K.A. Davis2
1Neurology, Hospital of the University of Pennsylvania,
University of Pennsylvania School of Medicine,
Philadelphia, 2Neurology, Crozer Chester Medical Center,
Chester, PA, USA
Introduction: The goal of this study is to utilize the non-
invasive technique of arterial spin labelling (ASL) magnetic
resonance imaging (MRI) to identify epileptic networks in
patients with tuberous sclerosis complex (TSC), a subtype
of neocortical epilepsy. Given that patients with TSC often
have better seizure control after surgical resection of
epileptic lesions as well as perilesional tissue, this cohort is
ideal for testing the hypothesis that ASL can accurately
identify epileptic networks. Recent studies have shown that
the quantitative ASL signal correlates with underlying
pathological changes of tubers, as well as their epileptic
potential.
Methods: In this study we plan to analyze the perfusion
patterns both within tubers and in the surrounding
perilesional regions in two populations of TSC patients,
those with epilepsy (n=6), and those with no history of
seizures (n=6). Epileptic tubers will be cross-identified with
scalp EEG, and this data will be correlated with ASL
perfusion maps.
Results: We have collected and analyzed ASL and MRI
data on 4 TSC patients with epilepsy. Thus far, it appears
that epileptic tubers and surrounding perilesional areas
show hyperperfusion in comparison with average cerebral
blood flow. Analysis of the non-epileptic tubers reveals no
significant differences in perfusion compared to average
cerebral blood flow.
Conclusion: Our preliminary data show that ASL can
accurately identify epileptic networks in TSC. Using ASL
to identify epileptic networks can potentially be applied to
all patients with neocortical epilepsy, with the ultimate goal
of improving seizure freedom rates from resective surgery.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 235
P1406
Actions of sK-channel openers in a
pharmacoresistant seizure model in-vitro
M.L. Raza, I. Papageorgiou, U. Heinemann
Institute of Neurophysiology, Charite Universittsmedizin,
CVK, Berlin, Germany
sK-channels are reported to regulate neuronal
hyperexcitability. Pharmacoresistance in epilepsy is one of
major problems; nearly 30% of patients are non-responsive
to antiepileptic drugs. To address this issue of
pharmacoresistance and role of sK-channels whether
effective or not, we tested sK-channel agonist using
pharmacosensitive/ pharmacoresistant organotypic
hippocampal slice cultures (OHSC) and human tissue from
pharmacoresistant epileptic patients. Slice cultures were
prepared from 7-8 day-old rat pups and field potential
recordings were performed from 7-14 days after incubation.
For induction of seizure-like events (SLEs) in slice cultures,
we have used 4-AP (100M) & zero magnesium ACSF. In
human tissue protocol of high K+ (8 mM) + bicuculline
(50M) & 4-AP (100M) is followed to induce epileptiform
activities. Results showed anticonvulsant actions of CyPPa,
interestingly 4-AP induced SLEs in both pharmacosensitive
and pharmacoresistant OHSCs were blocked by CyPPa at
100M in 100% slices. Whereas, zero magnesium induced
SLEs are blocked in 88% and 74% of pharmacosensitive
and pharmacoresistant OHSCs respectively. Similarly,
CyPPa at same dose blocked SLE induced by 4-AP in all
human tissues. K+ + bicuculline induced SLEs are blocked
in 3 out of 5 slices. CyPPa at 20M blocked SLEs in 100%
pharmacosensitive slices whereas, same dose of CyPPa was
ineffective against SLEs induced by 4-AP in
pharmacoresistant OHSCs. In zero magnesium model,
20M dose failed to block SLEs in both pharmacosensitive
and pharmacoresistant OHSCs. Our findings suggests
CyPPa has potential to block both pharmacosensitive &
pharmacoresistant type of seizures.
236 Posters, Sunday 9 September
P1407
Risk factors for epileptic seizure of
cavernous malformations in the central
nervous system: 52 cases
C. Huang1, D. Zhou2
1West China Clinical Medicine School of Sichuan University,
2Department of Neurology, West China Hospital of Sichuan
University, Chengdu, China
Purpose: To determine the risk factors for preoperative and
postoperative epileptic seizure in patients with cavernous
malformations (CMs).
Methods: We retrospectively studied 52 consecutive
patients diagnosed with CMs who were surgically treated
and histopathologically enrolled in West China Hospital of
Sichuan University from January 2009 to June 2010.
Clinical data, treatment procedure and follow-up
information were collected.
Results: In the univariate analysis, factors associated with
preoperative epileptic seizure were low birth weight
(p=0.017), temporal lobe involvement (p=0.003) and
cortical lesion (p=0.025). In the multivariate analysis, the
cortical lesion showed a high risk for preoperative epileptic
seizure (OR=10.48; 95% CI 1.61-68.23). In the univariate
analysis, patients with temporal lobe CMs were found more
likely to be seizure free after surgery (p=0.016). The
maximum diameter of CMs longer than 2.5cm (p=0.012)
and disease course longer than 1 year (p=0.050) predicates
an unfavourable outcome. In the multivariate analysis,
temporal lobe involvement still showed a favourable
outcome (OR=0.038; 95% CI 0.002-0.833). Application of
ECoG did not make significant difference in seizure
outcome (p=0.430).
Conclusion: Surgical treatment of patient with CMs is
satisfactory in most cases and temporal lobe involvement
usually predicts favourable postoperative seizure outcome
whether under the monitoring of ECoG or not. Thus,
epileptic patients with CMs should be considered for
surgical treatment especially when cortical brain layer or
temporal lobe is involved.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1408
Founder c.1048-1049delGA mutation in
NHLRC1 gene in Laforas disease patients
from Serbia
M. Kecmanovic1, N. Jovic2, M. Keckarevic-Markovic1,
D. Keckarevic1, G. Stevanovic2, S. Romac1
Faculty of Biology, University of Belgrade, 2Clinic of
1
Neurology and Psychiatry for Children and Youth, School of
Medicine, University of Belgrade, Belgrade, Serbia
Objectives: Lafora's disease (LD) is an autosomal recessive,
progressive metabolic disorder characterized by intractable
myoclonus and seizures, inexorable neurological
deterioration, cognitive decline, unfavourable clinical
course and poor prognosis. Despite the clinical homogeneity
there is genetic heterogeneity in LD. It is caused by
mutations either in EPM2A or in NHLRC1. There is also at
least one other gene that can be associated with LD. Here
we report a haplotype study on 11 unrelated LD
chromosomes from Serbia carrying c.1048-1049delGA
(p.E350fs) mutation in NHLRC1.
Methods: Using direct sequencing analysis, we identified 4
different mutations in NHLRC1 gene in 11 patients from 7
Serbian families. As 11 unrelated LD chromosomes from 6
patients carry c.1048-1049delGA mutation in NHLRC1, we
performed a haplotype analysis in order to estimate if this is
the founder mutation. 8 markers flanking NHLRC1:
D6S289-D6S1605-D6S274-D6S1567-NHLRC1-D6S1688-
D6S1959-D6S1643-D6S1665 were amplified by PCR and
run on 4% polyacrilamide gel along with sequenced allelic
ladder.
Results: We identified 8 different LD haplotypes carrying
p.E350fs mutation, but all analyzed chromosomes shared
same alleles for markers D6S274(166)-D6S1567(108)-
D6S1688(172). The size of common haplotype is correlated
to the number of generations from the ancestors on whose
chromosome mutation arose. So, considering those markers,
we estimated how long ago this mutation arose on an
ancestral chromosome. Shared haplotype covers 1.8cM
indicating that mutation arose 55 generations ago.
Conclusion: Mutations in NHLRC1 are the common cause
of LD in Serbia, what is mostly due to a founder effect. The
common ancestor carrier of p.E350fs mutation lived 55
generations ago.

P1409
Age- and gender related risk of
developing unprovoked seizures after
traumatic brain injury: a population-based
case-control study
B. Mahler1, C. Adelw1, T. Andersson2, A. Ahlbom2,
T. Tomson1
1Department of Clinical Neurosciences, 2Institute of
Environmental Medicine, Karolinska Institute, Stockholm,
Sweden
Purpose: To study traumatic brain injury as risk factor for
unprovoked epileptic seizures in a population-based case-
control study with incident seizure cases.
Method: In this study, 1885 patients with new onset
unprovoked seizures were included in the Stockholm
Incidence Registry of Epilepsy. 15080 controls matched for
gender, year of diagnosis, and catchment area were
randomly selected from the register of the Stockholm
County population. Exposure was defined as a hospital
discharge diagnosis of a traumatic head injury preceding the
date of seizure onset. Odds ratios (ORs) with 95%
confidence interval (95%CI) were calculated using logistic
regression to assess the risk of developing unprovoked
seizures after hospital admission for various categories of
patients and type of head trauma defined by ICD codes from
the Swedish Hospital Discharge Registry.
Results: OR for unprovoked epileptic seizures was 2.0
(1.5-2.7) after cerebral concussion (66 cases); 2.5 (1.6-3.9)
for women and 1.8 (1.3-2.5) for men. For patients older than
65 years of age OR was 2.5 (1.5-4.3) and for younger
patients 1.8 (1.3-2.5). After brain contusion or traumatic
intracranial haemorrhage (37 cases) OR was 8.9 (5.6-14.1).
OR of developing unprovoked seizures was similar for
women 9.6 (4.3-21.5) and men 8.5 (4.8-15.1). For older
patients OR was 4.7 (2.3-9.6) and 10.9 (5.8-20.4) for
younger patients.
Conclusion: We provide quantitative data on the risk of
developing unprovoked seizures after various brain
traumata. Our findings point towards a higher relative risk
for younger patients to develop epileptic seizures after
severe traumatic brain injury.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 237
P1410
Partial epilepsy with auditory features:
clinical and genetic features of 186
sporadic cases
C. Stipa1, F. Bisulli1, F. Pittau1, L. Licchetta1, I. Naldi1,
L. Di Vito1, C. Leta1, B. Mostacci1, R. Michelucci2,
S. Striano3, P. Striano4, U. Aguglia5, E. Ferlazzo5,
A.T. Giallonardo6, C. Nobile7, M. Seri8, T. Pippucci8,
P. Tinuper1
1IRCCS Institute of Neurological Sciences, University of
Bologna, 2Department of Neurological Science, Bellaria
Hospital, Bologna, 3Department of Neurological Sciences,
Federico II University, Naples, 4Department of
Neurosciences, University of Genoa, Genoa, 5Institute of
Neurology, Magna Grcia University, Catanzaro,
6Department of Neurological Sciences, Sapienza University,
Roma, 7Institute of Neurosciences, University of Padova,
Padova, 8Medical Genetics Unit, University of Bologna,
Bologna, Italy
Introduction: In 2004 we described 53 cases of partial
epilepsy with auditory features and good clinical outcome.
The syndrome was named Idiopathic Partial Epilepsy with
Auditory Features (IPEAF). Since 2004 we observed 133
additional cases and the present study summarizes clinical
features of this group of 186 patients (85 females and 101
males).
Methods: Patients were selected according to the following
criteria: partial epilepsy with auditory symptoms, negative
family history for epilepsy and absence of cerebral lesions.
All patients underwent full clinical, neuroradiological and
neurophysiological examination. The majority of patients
were screened for LGI1 mutations observed in more than
half of familial cases with autosomal dominant partial
epilepsy with auditory features (ADPEAF).
Results: Age at onset ranged from 3 to 59 years (mean 22
years). Secondarily generalized seizures were the most
common type of seizures at onset (67%). Auditory auras
occurred either in isolation (38%) or associated with visual,
psychic or aphasic symptoms (62%). Low seizure frequency
at onset and good drug response were common, with 41%
of patients seizure-free (minimum follow-up 6 months).
Seizures tended to recur after drug withdrawal. We observed
a de-novo mutation in LGI1 gene in only three patients of
the 118 tested.
Conclusions: Our data confirm the existence of a peculiar
form of non-lesional temporal lobe epilepsy, closely related
to ADPEAF, in which auditory aura could represent a
clinical marker of benign outcome in the majority of
patients. Although LGI1 mutations have been found in only
2.5%, another gene could be involved.
238 Posters, Sunday 9 September

P1411 P1412
Power spectral frequency analysis of peri- Epileptic vertigo: overview of clinical
ictal suppression by spontaneous semiology
adenosine release in hippocampus in a M. Saad, S. Zakarya, M. Abu-Hegazy
kainic acid-induced limbic status Neurology, Mansoura University, Mansoura, Egypt
epilepticus rat model Introduction: Epileptic vertigo is a rare form of partial
Y.-I. Kim1, P.A. Kwak2, Y.-M. Shon3 seizures. It is often distinctive with sudden very brief
1Department of Neurology, St Paul's Hospital, The Catholic episodes followed by rapid recovery without sequelae.
University of Korea, 2Department of Neurology, Seoul St Objective of this study was to establish the contribution of
Mary's Hospital, The Catholic University of Korea, clinical semiology of epileptic vertigo in absence of
3Department of Neurology, Yeouido St Mary's Hospital, The convulsions and loss of consciousness.
Catholic University of Korea, Seoul, Republic of Korea Patients and methods: 30 epileptic vertigo patients (19
males and 11 females) were included. Their ages ranged
Background: We performed time-frequency analysis of
from 12 to 40 years and mean age at onset was 26.7 years.
ictal EEG during spontaneous adenosine (ADO) release,
All patients were subject to neurological examination,
accompanied by a synchronous neurotransmitter recording
interictal electroencephalogram (EEG), caloric otologic
by WINICS (wireless instantaneous neurotransmitter
test, audiogram, nystagmography, carotid Doppler; brain
concentration system) in a KA-induced acute hippocampal
stem evoked potential and brain MRI.
seizure model in rats.
Results: Family history of epilepsy was reported in 20%,
Method: Young adult male Sprague-Dawley rats (n=6)
no past history of febrile convulsion, tunnel voices aura was
were implanted with four cortical electrodes, bipolar
reported in 6.7%. Dizziness was report in 8 patients
hippocampal (HC) depth electrodes and a cannula for the
(26.7%), 14 patients with true vertigo (46.6%), nausea in 6
injection of KA (1mcg 4min) in the right hippocampus
(20%) and tinnitus in 2 patients (6.7%). EEG abnormality
(CA3) under urethane anaesthesia. WINCS recording
was documented in all cases: 15 (50%) and 6 (20%) patients
electrode was inserted in left hippocampus (mirror site of
illustrated focal left and right temporal epileptiform
R HC). EEG data were analyzed by fast Fourier
discharges consecutively. In addition, there were 2 (6.7%)
transformation to obtain the power spectral density (PSD)
bitemporal, 2 (6.7%) frontotemporal and 5 cases (16.8%)
for delta to gamma frequencies (range: 1.25-100Hz), as
temporal with secondary generalization discharges. MRI of
well as local field potential (LFP) taken by both HC with a
brain was normal in 20 (66.6%), 4 cases with temporal lobe
high-frequency band (100 - 500Hz, ripple and fast ripple).
tumours, cerebral infarction was in one and small cyst.
Results: During the spontaneous, intermittent and phasic
Frontal lobe lesions were detected in 4 patients. No mesial
release of adenosine, there was a sudden disappearance of
temporal sclerosis was detected.
polyspike or spike-wave discharges in its EEG and LFP the
Conclusion: Epilepsy is an important cause of transient
EEG. PSD showed an increased power in the theta and delta
dizziness and vertigo, but misdiagnosis due to absence of
frequency band, whereas higher frequency bands (beta and
convulsions and loss of consciousness is common.
gamma) showed a decrease. Furthermore, LFP from both
HC showed bursts of population spikes (BPS) immediately
before the phasic adenosine release. BPS showed increased
power in ripple or fast ripple frequency band (100-300Hz).
Conclusion: These data strongly support the hypothesis
that adenosine might play a key role as an endogenous anti-
seizure modulator.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1413
Ictal PET F18-FDG in refractory focal
epilepsy: report of 6 cases with surgically
removed cortical hypermetabolic lesions,
with histopathological correlation and
follow-up
D. Ladron de Guevara1, S. Marca2,
G. Kuester2,
L. Rios2,
F. Solari2, M. Galvez1, M. Campos2, F. Otaiza2
1Radiology, 2Advanced Epilepsy Center, Clinica Las Condes,
Santiago, Chile
Introduction: Unlike interictal PET (Positron Emission
Tomography), ictal PET is not regularly used in focal
refractory epilepsy study, and its usefulness in pre-surgical
evaluation and prognosis value has not been established yet.
Objective: To present 6 cases of epilepsy patients whose
F18-FDG PET showed hypermetabolic cortical lesion, and
to correlate with MRI, EEG, histopathology and clinical
outcome.
Methods: Histopathology and post-surgical outcome of 6
hypermetabolic F18-FDG PET of patients with focal
epilepsy were reviewed. PET findings were correlated with
Video-EEG, MRI, and intraoperative EcoG.
Results: Ictal PET showed well-defined hypermetabolic
lesions in all patients (3 temporal and 3 extratemporal
lesions). There was coincidence between clinical, Video-
EEG, intraoperative EcoG and PET hypermetabolic foci in
all cases. MRI showed correctly the seizure onset area in 4
cases and was negative in 2 (female 38y hippocampal
sclerosis/amygdala gliosis, and male 3y frontal type IA
FCD). Both PET and MRI allowed correct localization of
foci in 4 cases: male 16 m frontal type IIB FCD, male 3 m
occipital type IIA FCD, male 7 m with temporal IIA FCD
and polymicrogyria, and female 40 y hippocampal type IIB
FCD. Post-surgical mean follow-up was 14.8 month (range
1-27 month), resulting all patients seizure free (Engel I).
Conclusion: Ictal F18-FDG PET presents a high
correlation with clinical and EEG findings, and allows a
precise localization of seizure onset area in FCD lesions.
Surgical resection of a PET hypermetabolic area predicts an
excellent post-surgical outcome.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 239
P1414
Acquired mirror writing in a patient with
complex partial seizures after surgery for
left frontal meningioma
D. Hodorog, D.I. Cuciureanu
Clinica I Neurologie, University of Medicine and Pharmacy
Gr.T. Popa, Iasi, Romania
Mirror writing can be related to a variety of focal
neurological disorders involving left parietal lobe, left basal
ganglia, and right supplementary motor area. It has also
been associated with diffuse cerebral disorders. It is nearly
always carried out with the left hand. Left-handers represent
the majority of patients. Motor, spatial-orientation, visual
word-form, involvement of thalamo-cortical circuitry
hypotheses have been advanced to explain mirror writing.
Mirror writing is rare and usually resolves over days to
weeks. Acquired mirror writing accompanied by mirror
reading have been described in some patients with extensive
visuospatial deficits and left-right disorientation.
We present the case of a right-handed women, with complex
partial seizures and acquired mirror writing after brain
surgery for a left frontal meningioma. Writing was tested for
regular and irregular words, whole sentences, numbers. She
wrote in mirror as fluidly as normal direction and preferred
mirror writing with either the right or left hand. Her
preference persisted for 4 years since her brain surgery. She
was capable of mirror reading, which was preferred to
normal reading. Oral language skills were normal. Apraxia,
visual agnosia, neglect, left-right disorientation were absent.
It is unlikely that mirror writing of our patient is the
consequence of the release of mirror motor engrams. The
engrams within the right hemisphere are not associated with
mirror reading as in our case. We presume that mirror
writing of this patient could be a consequence of mirror-
reversed visual-spatial representations.
240 Posters, Sunday 9 September
P1415
Neuropsychological profile in childhood
benign epilepsy with centrotemporal
spikes (BECTS)
P. Conde-Guzn1, M.T. Bartolom-Albistegui2, P. Quirs3
1Psychology, Universidad de Len, 2Neurology, Hospital
Nuestra Seora de Regla, Leon, 3Psychology, UNED,
Madrid, Spain
Objective: There is controversy regarding the
neuropsychological profile of children with epilepsy. The
aim of this study is to analyze the neuropsychological
profile of children with benign epilepsy with centrotemporal
spikes (BECTS).
Methods: Sample: 49 children from 7 to 12 years (25 with
BECTS treated with carbamazepine and 24 controls). We
got the neuropsychological profile by applying the WISC-R
(Wechsler Intelligence Scale for Children-Revised) and
Battery Luria-DNI (Manga and Ramos, 1991).
Results: A) We have not found any differences in IQ
between children with BECTS and controls. B) The
neuropsychological profile Luria-DNI is significantly lower
in BECTS (p<0.05) than the control group in hand motor
activity, verbal regulation, tact, spatial orientation,
articulation, naming, phonemics analysis, reading,
numerical structure and arithmetic. This is a severe
deterioration in verbal regulation, articulation, phonemics
analysis and reading. C) Nevertheless, we have not found
deterioration in the memory and the attention. In children
with crisis of absences we have found, in a previous study,
a significant memory alteration (the short-term auditory and
visual memory and logical memory) and attentional
disorder. D) The time of oxcarbazepine treatment does not
affect the neuropsychological profile, however, age at onset
of the first crisis negatively affects the ability for naming
and phonemics analysis.
Conclusions: In children, with this diagnosis and treatment,
and neuropsychological profile described, we must consider
strengthening the deficient neuropsychological and psycho-
educational areas. In addition, we must continue research in
future studies on the role of the antiepileptic drug in this
profile.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1416
Influence of anti-epileptic monotherapy
on bone mineral density and bone
metabolism biochemical markers in
children and adolescents with epilepsy
M.D. Dimic1, N.A. Dimic2
1Department of Paediatric Neurology, Clinical Center of Nis,
Nis, 2Clinic for Rheumatology, Institut for Therapy and
Rehabilitation, Niska Banja, Serbia
Introduction: Enzyme-inducing (carbamazepine) or non-
enzyme-inducing (valproate) antiepileptic drugs are
associated with bone loss and mineral metabolism
disturbances.
Methods: We evaluated effects of the carbamazepine and
valproate monotherapies on bone mineral density (BMD),
calcium and alkaline phosphatase serum levels in 29
ambulatory male epileptic patients aged 6-18 years, taking
therapy longer than 1 year and in age matched healthy male
control group (n=31). We measured BMD by Dual-energy
X-ray absorptiometry at lumbar spine (L1-L4).
Results: The mean serum levels of carbamazepine and
valproate were 7.651.46mg/ml and 78.6412.76mg/ml,
respectively, and the mean therapy duration for each drug
was 3.061.61years and 3.161.93years, respectively.
Calcium intakes in diet were similar in both the control and
study groups. Bone mineral density values of both valproate
and carbamazepine groups were lower without statistically
significant difference compared with control group
(p>0.05). The serum calcium levels were significantly
lower (p<0.01) in patients treated with carbamazepine.
Serum alkaline phosphatase levels were significantly higher
in boys treated with carbamazepine (p<0.02) and with
valproate (p<0.002), respectively. Therapy duration has
showed no effect on bone mineral density and biochemical
parameters.
Conclusion: Carbamazepine and valproate caused lumbar
bone mineral density decrease in boys with epilepsy.
Hypocalcaemia was observed in patients treated with
carbamazepine. Serum alkaline phosphatase level, as
marker of osteoblast activity, was significantly higher in
both patient groups. Therefore, there are significant benefits
of regular screening and prophylactic supplementation with
vitamin-D and calcium in patients with epilepsy receiving
long-term antiepileptic therapy.

P1417
Defective inhibition in the visual system of
photosensitive patients with idiopathic
generalized epilepsy
G. Strigaro, P. Prandi, L. Falletta, C. Varrasi, F. Monaco,
R. Cantello
Department of Neurology, Amedeo Avogadro University,
Novara, Italy
Introduction: To assess the visual system excitability of
photosensitive patients with idiopathic generalized epilepsy
(IGE) with the paired-pulse flash-evoked potential (paired
F-VEP) technique.
Methods: We studied 19 patients with IGE (16 women)
showing a photoparoxysmal electroencephalographic
response (PPR). 22 normal subjects of similar age and sex
acted as controls (17 women). We recorded F-VEPs from
occipital and central electrodes. Stimuli were single flashes,
intermingled to flash pairs at the internal frequency of 3, 8,
16, 20, 30, and 60Hz. Recordings were done both with
closed and open eyes. The single F-VEP was split into a
main complex and a late response, which were
measured separately. As to paired stimuli, the test F-VEP
emerged from electronic subtraction of the single F-VEP to
the paired F-VEP. Grouped data were analyzed by means of
nonparametric analyses of variance (ANOVA).
Results: In the eyes-closed state, the normal inhibition of
the main complex of the test F-VEP was replaced by a
paradoxical facilitation, significant at the frequency of 16,
20 and 30Hz (p<0.05). This applied to the occipital as well
as the central electrodes. The late response reacted in a
similar way, with a significant (p<0.05) enhancement at 20
and 30Hz (occipital electrodes) and at 20Hz (central
electrodes). In the eyes-open state no significant changes
in the main complex were detected.
Conclusion: The paired F-VEP technique documents a
defective inhibition in the visual system of photosensitive
patients with IGE, whose features and timing likely underlie
the PPR origin.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 241
P1418
Myoclonic Epilepsy and psychomotor
delay associated with a novel SLC2A1
gene mutation
L. Di Vito1, F. Bisulli1, D. Mei2, I. Naldi1, F. Pittau1,
L. Ferri1, C. Leta1, C. Stipa1, E. Pasini1, C. Marini2,
R. Guerrini2, P. Tinuper1
1IRCCS Istituto delle Scienze Neurologiche, University of
Bologna, Bologna, 2Pediatric Neurology Unit and
Laboratories, A Meyer Children's Hospital, Florence, Italy
Introduction: GLUT1 deficiency syndrome is caused by
mutations in SLC2A1 gene in most patients and results in
impaired glucose transport into the brain. Its clinical
spectrum is heterogeneous.
We describe a patient with a novel SLC2A1 gene mutation.
Methods: This 14-years-old patient had a family history of
febrile seizures and mental retardation in his mother. A mild
psychomotor delay was evident since childhood. At 8
months: convulsive seizures in apyrexia. At 2 years he
started an antiepileptic treatment. At 12 years he started
with diurnal episodes of myoclonic jerks at upper limbs and
drop-head without consciousness impairment. At 13 years
presented almost continuous myoclonic face and upper
limbs jerks associated with an ideo-motor delay and
increase in epileptiform EEG abnormalities. His epilepsy
was drug resistant.
Results: The neurological examination showed: facial
dysmorphism, dysarthria, slow saccadic eye movements,
hypotonus, dysdiachokinesia, upper limbs myoclonus,
weak deep tendon reflexes, mild ataxia, striae rubre.
Psychometric evaluation confirmed moderate mental
retardation.
EEG disclosed frequent discharges of irregular spike/
polyspike and waves diffuse over both hemispheres,
increased during drowsiness, inconstantly associated with
myoclonic jerks of the mouth and occasionally of neck
extensor. Brain CT and MRI were normal.
He had altered palmitoyl sulfate and aldolase blood level.
Research for SCL2A1 mutation showed a heterozygous
nucleotidic deletion (c.130-135n of TACAAC) causing the
loss of 2 aminoacids of the protein (p.Tyr44_Asn45del).
Conclusion: We present a case of myoclonic epilepsy and
cognitive delay associated with a heterozygous nucleotidic
deletion of SLC2A1 gene, not previously described.
242 Posters, Sunday 9 September
P1419
An epidemiological survey of epilepsy in
the Koung-khi department, western
Cameroon
M.S.N. Dongmo1, C. Tume2, A. Tazoacha3
1Department of Biochemistry and Molecular Biology,
University of Buea, 2Department of Biochemistry, University
of Dschang, 3Department of Lofe Sciences, University of
Yaounde 1, Cameroon
Epilepsy is a chronic and invalidating neurological disease
characterized by the repetition of seizures. The prevalence
around the world is 50.000, this is generally higher in
developed than developing countries. In Africa, some
epidemiological studies have been conducted in Mali,
Uganda with different prevalence: 13.35 and 1.3%
respectively. In Cameroon a study conducted in the Mbam
Valley, revealed a prevalence of 49 one of the highest in
the world. The koung-Khi division is one of the department
in Cameroon with a suspected prevalence of the disease, but
there is no data available. Hence the study conducted to
determine the prevalence of epilepsy and possible associated
causes. For the aim, a door to door survey was conducted in
the four villages of the department: Bandjoun, Bayangam,
Batoufam and Bandrefam The study revealed a prevalence
which differs according to each locality with an overall rate
of 7.1% in the department. Among the possible suspected to
have a link with epilepsy were the type of food consumed,
genetic factors, itching. This study revealed the existence of
the disease in the region, and the efforts made by epileptics
and their families to ameliorate their wellbeing. Further
studies are needed for a better understanding of the
management of epilepsy by populations, specially the use
of medicinal plants for the cure of the disease.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1420
Somatic co-morbidities in PWE and its
relationship with Quality of Life: the
outlook in a developing economy
P.B. Adebayo1, S.A. Ogun2, A. Ogunniyi3
1Internal Medicine, Ladoke Akintola University, Ogbomoso,
2Internal Medicine, Olabisi Onabanjo University, Ago-
Iwoye/Sagamu, 3Internal Medicine, University College
Hospital, Ibadan, Nigeria
Introduction: Evaluating co-morbidity in people living
with epilepsy (PWE) is essential and its modification might
improve their Quality of Life. We aimed to determine the
profile of self reported somatic co-morbidities and its
relationship with quality of life among PWE in Sagamu,
Nigeria.
Methods: The Quality of Life in Epilepsy-31 item (version
1.0) questionnaire was completed by 88 patients. The
presence and type of somatic co-morbidities was assessed
using a performa check list. The Statistical Package for the
Social Sciences (SPSS), version 16 was used for all
analyses.
Results: 44 males and 44 females with mean ages (SD) of
31.82(13.58) and 31.68(10.98) years respectively were
evaluated. 66 (75%) of the PWE had no somatic co-morbid
condition while 18(20.5%) had only one co-morbid
condition. Hypertension was the commonest co-morbidity
(8%). Acid peptic disease was found in 5(5.7%) patients.
Other co-morbid conditions included Asthma (1.1%),
pulmonary tuberculosis (1.1%) stroke (3.4%) and
osteoarthritis (1.1%). 4 (4.5%) had two concurrent
co-morbid conditions comprising stroke and hypertension
in three patients. There was no statistically significant
difference in the mean QoL scores between the groups with
or without concurrent co-morbid conditions.
Discussion: It appears that somatic co-morbidities have no
effect on the QoL of PWE in this study. A large comparative
study of the effect of psychological and somatic co-
morbidities on QoL of PWE in this population is desirable.

P1421
Is there any difference between awake
EEG in benign rolandic epilepsy and
continuous spike-and-waves during sleep
syndrome?
K. El Alaoui Taoussi1, A. Satte2, J. Mounach2, H. Ouhabi2
1Neurology B and Neurogenetics, Facult de Mdecine et de
Pharmacie de Rabat, 2Neurophysiology, Mohammed Vth
Military Hospital of Rabat, Rabat, Morocco
Introduction: Benign rolandic epilepsy (BRE) and
continuous spike-and-waves during sleep syndrome
(CSWS), are different entities that can have the same
awakening electrical abnormalities. Diagnosis of both is
based on sleep EEG which needs long time recording and
specialized structures. Our study aims to find a method to
set apart the two syndromes on awake EEG.
Methods: 15 awakening EEG records of 9 BRE and 6
CSWS were compared. Electrical abnormalities were
analyzed. The frequency and amplitude were calculated
through a period of 20 minutes on awake EEG recorded at
different day times.
Results: The 9 registered BRE includes 5 awake EEG
performed in morning and 4 in evening. For patients with
CSWS, 4 awake EEGs were done in morning and 2 in
evening. Biphasic abnormalities had the same appearance
in BRE and CSWS. Their average frequencies were
different between the two syndromes and during the day
with a statistically significant difference (p=0.02) between
the frequency of abnormalities recorded in the BRE in the
morning (9147 anomalies in 20 minutes) and that of
CSWS recorded the morning (19558 anomalies in 20
minutes) but there were no statistical difference between the
evening records. No statistical difference was found
between the amplitudes of the abnormalities in the various
EEG.
Conclusion: Our study suggests that diagnosis of BRE or
CSWS could be established on morning awake EEG by
calculating the frequency of the biphasic spikes. However,
the sample needs to be extended to confirm this hypothesis.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 243
P1422
Risk of obesity during treatment of
epilepsy with valproate and possible role
of Pro12Ala PPAR2 polymorphism
E.V. Krikova1, S.G. Burd2, A.S. Chukanova2,
M.A. Tushkanov3
1Clinical Genetics Laboratory, Mental Health Research
Centre of Russian Academy of Medical Sciences,
2Department of Neurology and Neurosurgery, Russian State
Medical University, 3Molecular Genetics Diagnostic
Laboratory, A.N. Sysin State Research Institute of Human
Ecology and Environmental Hygiene, Russian Academy of
Medical Sciences, Moscow, Russia
Background: Valproate (VPA), structurally analogue of
fatty acid, is one of the widely used antiepileptic drugs.
Based on the fact that several fatty acids have been
identified as PPAR-2 ligands and common Pro12Ala
PPAR-2 polymorphism has been related to obesity, insulin
resistance, and risk of type 2 diabetes we hypothesized that
obesity, often observed during VPA treatment of epilepsy,
could be associated with the presence of polymorphic
variant of PPAR-2 gene and induced via insulin resistance
mechanism.
Methods: The Pro12Ala polymorphism was genotyped in
69 subjects who fulfilled the diagnostic criteria of VPA-
treatment, taking the drug in a monotherapy mode for at
least 1 year. Insulin level and weight deviation were
analyzed respectively.
Results: Mean insulin level in patients with wild Pro(C)
allele without weight deviation was up to 2 times lower than
for Pro(C) group, exhibited weight gain (=0.00018). The
statistical difference was also shown for Pro12 and Ala12
groups with obesity - mean insulin level was up to 2.4 times
lower for Ala12 than for wild-type carriers (0.046), which
in fact may indicate the insulin-independent mechanism of
obesity in the presence of Ala12 allele.
Conclusion: Positive association was shown for insulin
level and weight gain in subjects with Pro12 allele, taking
VPA in a monotherapy mode. Clinically, these findings
could be the first prerequisite towards the rationales for the
value of combination of VPA treatment with omega-3 fatty
acids diet for patients with wild-type PPAR-2.
244 Posters, Sunday 9 September
P1423
Can a nurse intervention promote the
self-management of patients with
established epilepsy who attend
emergency departments? A nested
qualitative study
A.J. Noble1, C. Virdi1, M. Morgan2, L. Ridsdale1
1Department of Clinical Neuroscience, Institute of
Psychiatry, King's College London, 2Division of Health and
Social Care Research, King's College London, London, UK
People with epilepsy (PWE) frequently attend emergency
departments (EDs). Attendance is associated with AED
non-adherence, low knowledge of epilepsy and stigma.
Reducing unnecessary emergency hospitalisations could
help patients and reduce costs. We are conducting a trial
aimed to reduce epilepsy ED visits, by a self-management
intervention with an epilepsy nurse-specialist (ENS). We
here describe patients' perceptions of acceptability and
benefits.
Methods: N=85 adults with epilepsy were prospectively
recruited from 3 London EDs. The first 20 (age=41, SD=17;
10 males; median years since diagnosis=12) receiving the
intervention were invited for semi-structured interview.
Transcripts were analysed thematically.
Results: Participants reported not having been confident in
managing their epilepsy, but that the intervention improved
this. It did this by meeting a need for epilepsy information,
with the ENS being available in a way GPs and consultants
are not: Responses included: It was the first time someone
had sat down and really told me a huge amount; she took
the time to go through my needs, you felt you could ask
questions, not that wasting her time. Patients felt not so
frightened of seizures. One said I don't feel as if I now
need to go to hospital every time. Learning about epilepsy
prevalence helped patients not feel so alone and less
ashamed. They also felt AED adherence improved.
Conclusions: This short intervention was acceptable to
PWE who attended ED. It satisfied a perceived need for
information and in turn increased confidence. We will
report whether the intervention leads to reduced ED use
subsequently.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1424
Clinical features and seizure semiology in
children with malformations of cortical
development
M.I. Sigatullina, S.S. Shamansurov
Child Neurology Department, Tashkent Institute of
Postgraduate Medical Education, Tashkent, Uzbekistan
Objective: To analyze the clinical features and seizure
semiology of Malformations of Cortical Development
(MCD) in children.
Material and methods: 45 children age 2 months till 14
years with MCD were examined. Clinical, MRI, PET and
continuous video-EEG investigations have been performed.
The types of MCD in patients: Focal Cortical Dysplasia
(FCD)-19, Hemimegalencephaly-7, Lysencephaly-7,
Polymicrogyria (PMG)-8, Shysencephalia-4.
Results: Intractable Epilepsy was marked in patients with
FCD in 87% and hemimegalencephaly in 90%. In all
patients with Lysencephaly the muscular hypotonia and
severe mental retardation were observed, in 2 patients-
epileptic encephalopathy (West syndrome). In 6 children
with precentral and perisylvian polymicrogyria motor
deficiency in the form of a contralateral hemiparesis was
observed. All patients with Hemimegalencephaly had
severe hemiparesis on the contralateral side, mental
retardation and refractory epilepsy. All patients had the
early debut of epileptic seizures. The spectrum of epileptic
seizures was wide, from myoclonic (8), asymmetric tonic
spasms (5), clonic (4) and complex partial seizures (10) to
generalized tonic-clonic (13) and polymorphic seizures as
Lennox-Gastaut (2) and West syndrome (in 3 patients). In
all patients with Hemimegalencephaly continuous slow
activity in the involved hemisphere was registered of these
and in 3 cases - burst-suppression pattern. In 5 patients
with severe progressive epileptic encephalopathy a
functional hemispherectomy was performed with the result
of 90% of seizure reduction in these patients.
Conclusion: In most cases a clear correlation was found
between the type and location of the MCD and seizure
semiology which was also confirmed by the continuous
Video-EEG register.

P1425
Reversible homonymous hemianopia
secondary to occipital lobe seizures
R. Sawaya, S. Daouk, W. Radwan, S. Hammoud
Neurology, American University Medical Center, Beirut,
Lebanon
Introduction: We report a case of acute homonymous
hemianopia associated with simple partial seizures over the
contralateral parieto-occipital region. The hemianopsia
subsided with control of the seizures.
Material and method: A 53-year-old man, with controlled
hypertension, presented with subacute visual hallucinations
and distortion of visual perception associated with attacks
of gaze deviation and head rotation to the left. No loss of
consciousness. No focal motor symptoms. Neurological
examination revealed only a left homonymous hemianopia
which was confirmed by perimetry testing.
Results: MRI brain revealed diffuse cortical thickening and
high FLAIR signal intensity in the right parieto-temporo-
occipital region with mild restriction in diffusion-weighted
images without enhancement. No infarcts and no masses
seen. MRA showed normal carotid and cerebral arteries.
Visual perimetry revealed dense right homonymous
hemianopia. Blood studies were normal. CSF revealed
elevated protein with normal IgG index, no cells and
negative bacteriology and virology results. EEG revealed
near-status epileptic activity emanating from the right
parieto-occipital lobe. Upon treating the seizures with
antiepileptic drugs the visual disturbances subsided and the
EEG normalized, but the hemianopia and MRI findings
persisted. The patient received 1 gram IV solumedrol which
resolved the hemianopia and consequently the MRI
abnormality.
Conclusion: We report that homonymous hemianopia can
occur secondary to a seizure disorder without an underlying
infarct, tumour, or infection. It may be the result of focal
cortical oedema and reverses after the seizure is controlled
and oedema treated.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 245
P1426
The syndrome gelastic seizures -
hypothalamic hamartoma: description of
a case study
M. De Vito, L. Santulli, M. Ianniciello, S. Striano
University Federico II, Naples, Italy
Introduction: Hypothalamic hamartoma can be associated
to a wide spectrum of epileptic conditions, from a mild form
with an urge to laugh and no cognitive impairment to a
catastrophic encephalopathy with early onset gelastic
seizures, precocious puberty and mental retardation.
Surgical ablation and the use of other non-conventional
techniques seem to be useful to revert epilepsy and
encephalopathy. The goal of the study is the observation and
evaluation of the outcome of the patients followed at our
centre.
Methods: We observed 10 patients (8 males and 2 female)
with hamartoma over about a 20-year period, very
heterogeneous for length of observation. 4 patient have a
small hamartoma (< 1cm), 6 a large hamartoma (>1cm).
Among the patients with small hamartoma one has received
stereotactic implantation of radioactive I125 seeds and one
was submitted to gamma-knife surgery. Among the patients
with large hamartoma one was submitted to total resection,
one to partial resection, 2 to gamma knife surgery.
Results: All patients developed drug-resistant focal or
generalized epilepsy. Complete ablation of the hamartoma
can stop and revert the epilepsy, the partial ablation is a
temporary solution. Moreover long-term effect and efficacy
of gamma knife surgery and implantation of radioactive
I125 need a better definition.
Conclusions: Our study confirm the evolution of the
syndrome towards a drug-resistant epilepsy. The surgical
ablation of the amartoma can reverse epilepsy. The new
techniques request a long-term evaluation to establish the
real efficacy.
246 Posters, Sunday 9 September
P1427
Predicting the epileptic seizure with beta
rhythm of brain: a real time approach
R.F. Ahmad1, A.S. Malik1, N. Kamel1, J.K.J. Tharakan2
1Electrical & Electronics Engineering, Universiti Teknologi
Petronas, Tronoh, 2Department of Neuroscience, School of
Medical Sciences, Universiti Sains Malaysia, Kota Bharu,
Malaysia
Objective: Epilepsy is the brain disease that is second in
number after stroke worldwide. Around 30% patients do not
respond to anti-epileptic drugs (AEDs). Therefore, seizure
prediction can be helpful to improve the quality of life of
the patients having uncontrolled epilepsy. The study is
carried out in perspective to the real time monitoring and
prediction of the epileptic seizure.
Method: Different methods are available to predict the
seizure but still the results are not applicable for real-time
clinical application. The EEG is the major modality used for
diagnosis of epilepsy. For real-time, the method
implemented is using the pre-processing, band pass filtering
and observing its power spectrum. This method shows
different brain rhythms during the pre-ictal and ictal period.
The SVM classifier is the best option for classifying the
seizure occurrence or absence.
Results: The Physionet data set compiled by CHB and MIT
is used. The different rhythms of brain are observed for
changes and synchronization. But the beta rhythm showed
that during pre-ictal and ictal period, the beta power is
increased significantly than other frequency bands.
Conclusion: The beta rhythm has shown significant
changes during the pre-ictal period. Here, simple
combinations of methods are used as compared to other
complex methods. The implementation requires less
computational power from hardware point of view. The
EEG signals for real-time can be acquired using wireless
EEG. This approach can be adapted towards real-time
monitoring of epilepsy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1428
Religious-spiritual coping in epileptic
patients: correlation with clinical aspects
G.M. Tedrus, L.C. Fonseca, G.C. Hoehr, F.D.P. Magri,
Neuropsicofisiologia em cognio e epilepsia
Faculdade De Medicina, Pontificia Universidade Catlica
de Campinas, Campinas, Brazil
Introduction: How religiousness/ spirituality (R/S) acts on
the quality of life has been investigated, but there are few
such studies in epileptic patients. The objective was to
evaluate religious-spiritual coping and its relationship with
clinical aspects in adult epileptics.
Methods: 69 epileptic patients, (50.7% female), were
evaluated as follows: a clinical-neurological assessment and
the Brazilian version of the RCOPE scale (CRE).
Results: Mean total CRE:3.46, positive CRE:2.97, negative
CRE:2.40 and a negative/positive (N/P) ratio: 0.82 (0.16).
There was a significant negative correlation between
scholastic level and the CRE scores (positive and negative
and the factors P1, P4, P6, P7, P8, N2), less years of formal
schooling corresponding to higher CRE values. The CRE
scores were significantly greater in individuals who said
they only practiced one religion. There was negative
correlation between the age of the first epileptic seizure
(ES) and the factor N1 (Spermann Test: -0.242; p=0.047),
and between a greater ES frequency, a negative CRE
(-0.0292; p=0.034) and an N/P ratio of (-0.0292; p=0.021).
The CRE (negative and factors) were significantly smaller
in patients with generalized ES as compared to those with
focal ES. Other relationships were not significant.
Conclusions: The results showed that the majority of
patients showed high mean CRE scores (positive and
negative), which could portray aspects of the exercise of
spirituality. The R/S could be a link between health and
disease. Scholastic level correlated negatively with the R/S
scale. There was a correlation between religious-spiritual
coping and the frequency/ severity of the epilepsies.

P1429
Correlation between religiousness/
spirituality and clinical aspects of
epilepsy: WHOQOL-SRBP
G.M. Tedrus, L.C. Fonseca, G.C. Hoehr, F.D.P. Magri,
Neuropsicofisiologia em cognio e epilepsia - FAPESP
Faculdade De Medicina, Pontificia Universidade Catlica
de Campinas, Campinas, Brazil
Introduction: Despite scientific evidence, questioning
persists concerning the relationship between religiousness/
spirituality (R/S) and epilepsy. The objective of this study
was to correlate clinical aspects with R/S data in epileptic
patients.
Methods: 143 patients were evaluated as follows: a clinical-
neurological assessment, and WHOQOL-SRBP (World
Health Organization Quality of life Spirituality,
Religiousness and Personal Beliefs) total and eight
factors. Statistical tests were applied at p<0.05.
Results: Mean total score WHOQOL-SRPB: 14.39 (2.25).
The scholastic level showed a significant negative
correlation with WHOQOL-SRPB (factors 2; p=0.022 e
factors 6; p=0.02). Practicing religious individuals presented
significantly higher WHOQOL-SRPB (p=0.47). The
individuals with more than one ES type and generalized ES
showed lower WHOQOL-SRPB values (p=0.02).
Significantly lower values were observed for WHOQOL-
SRPB in idiopathic generalized epilepsy (p=0.03). The
occurrence of psychiatric co-morbidity was associated with
lower WHOQOL-SRPB (factors 2 and 6) p=0.02.
Conclusions: Scholastic level correlated negatively with
the R/S scales. There was negative correlation between R/S
and the frequency/ severity of the epilepsies. High R/S
values can portray aspects of the practice of spirituality and
confirm studies that suggest that the R/S of epileptic patients
differ in context and intensity.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 247
P1430
Clinical semiology of psychogenic non-
epileptic seizures as a subset of post-
traumatic stress related syndromes
L. Craciun1, G. Diaconu2,3, I. Mindruta4,5
1Neurology, Emergency Universitary Hospital Bucharest,
2Psychiatry, Life Memorial Hospital, Bucharest, Romania,
3McGill Group For Suicide Studies, Douglas Hospital,
Montral, QC, Canada, 4Neurology, 5Epilepsy and Sleep
Monitoring Unit, Emergency Universitary Hospital,
Bucharest, Romania
Introduction: Paroxysmal non-epileptic seizures (PNES)
among patients referred to epilepsy centres are noticeably
higher than in outpatient epilepsy population. The
differential diagnosis between epileptic/non-epileptic
seizures can be difficult, and the mean latency between
onset of PNES and adequate diagnosis is 7 years.
Method: We retrospectively analysed 12 patients
considered to suffer from pharmacoresistant, difficult to
classify epilepsy and finally diagnosed with PNES. The
patients underwent prolonged video-EEG monitoring in our
clinic and we recorded several seizure-like attacks. Patients
homemade videos displaying their habitual episodes were
also reviewed. The patients included in our study underwent
psychiatric evaluation based on a standardized approach.
Results: We finally were able to define 4 clinical patterns:
hypermotor like, tonic/tonic-clonic like, absence-like,
atonic like with sudden fall. Particular attention was
captured by a case displaying voluntary respiratory arrest
during prolonged episodes, in a context of absence-like
status.
Conclusion: The whole group showed signs of chronic
depression and had a significant history of past traumatic
events that were symbolically linked with the type of
seizure-like activity, such as a history of repeated physical
and/ or sexual abuse, loss of a close member of the family
at an early age or exposure to family separation during the
attachment-forming period (0 - 8 yrs). We inferred that the
type of ictal activity may be operationalized as trauma
re-enactment process by which the patient re-lives the initial
event. Such cases may be re-defined as subsets of post-
traumatic stress-related syndromes.
248 Posters, Sunday 9 September
P1431
Epileptic patients have an increased risk
of carbamazepine toxicity during triple
therapy for Helicobacter pylori infection:
a case presentation and review of the
literature
S. Sabetay, L. Kaplan, B. Weller
Neurology, Bnai Zion Medical Centre, Haifa, Israel
Introduction: Over 50% of the world population harbours
H.pylori in their upper gastro-intestinal tract. H.pylori
testing is recommended especially in persons suspected
with peptic ulcer disease. Triple therapy administered in
peptic ulcer disease patients with positive H.pylori tests
includes proton pump inhibitors, the antibiotics
clarithromycin and amoxicillin. When starting triple therapy
in epileptic patients the drug-drug interactions between
clarithromycin and proton pump inhibitors on one hand and
carbamazepine on the other hand are sometimes overlooked,
predisposing to carbamazepine toxicity.
Methods: Male, aged 58, with generalized tonic-clonic
epilepsy treated for two decades with carbamazepine and
phenytoin presented with acute ataxia and vertigo. No
previous adverse effects related to his antiepileptic
medications were reported and drug blood levels were
always in therapeutic range. A week prior triple therapy
(omeprazole, amoxicillin, clarithromycin) for peptic ulcer
disease and positive H.pylori testing was started. Toxic
carbamazepine blood levels in ER were obtained and the
drug was temporarily discontinued. Clarithromycin-
carbamazepine, omeprazole-carbamazepine drug
interactions were considered as causing carbamazepine
toxicity, therefore triple therapy was interrupted and, after
two days, the patient was asymptomatic and carbamazepine
levels returned to therapeutic range.
Results: Carbamazepine- clarithromycin and
carbamazepine-omeprazole interactions determined acute
carbamazepine toxicity in our patient, symptoms
disappearing following interruption of the triple therapy.
Conclusion: Carbamazepine toxicity represents a definite
risk for patients started on triple therapy for peptic ulcer
disease due to drug- drug interactions. This risk should be
known by neurologists and gastroenterologists, and dose-
reduction of carbamazepine could be considered during
triple therapy for H.pylori.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1432
Does geographic region impact the
efficacy of retigabine/ezogabine in adults
with partial-onset seizures? Analysis of
Central/Eastern Europe, Western Europe
and the rest of the world
C. Tessier1, S. McDonald2, W.-J. Lee2, S. Derossett2
1GlaxoSmithKline, Middlesex, UK, 2GlaxoSmithKline,
Research Triangle Park, NC, USA
Introduction: Retigabine/ezogabine is effective and
generally well tolerated as adjunctive therapy in adults with
partial-onset seizures. The efficacy of retigabine/ezogabine
by geographic region is reported.
Methods: A post-hoc analysis was conducted using data
from the double-blind, placebo-controlled trial, Study 302
(NCT00235755), to evaluate responder rates (50%
reduction in seizure frequency) during treatment
maintenance and percentage change in 28-day total partial-
seizure frequency from baseline to the double-blind period.
Geographic regions included Central/Eastern Europe
(Hungary/Poland/Russia/Ukraine), Western Europe
(Belgium/France/Germany/Spain/UK) and rest of the world
(ROW) (Australia/Israel/South Africa/USA).
Results: Compared with placebo, retigabine/ezogabine 600
and 900mg/day increased responder rates in patients in
Central/Eastern Europe (placebo [n=70], 19%; retigabine/
ezogabine 600mg/day [n=73], 47%; and 900mg/day [n=64],
48%), Western Europe (placebo [n=45], 16%; retigabine/
ezogabine 600mg/day [n=50], 22%; and 900mg/day [n=40],
43%) and ROW (placebo [n=49], 22%; retigabine/
ezogabine 600mg/day [n=42], 46%; and 900mg/day [n=49],
49%). Retigabine/ezogabine also reduced 28-day total
partial-seizure frequency compared with placebo in patients
in Central/Eastern Europe (median: placebo [n=74], 16.5%;
retigabine/ezogabine 600mg/day [n=79], 37.8%; and
900mg/day [n=75], 42.7%), Western Europe (median:
placebo [n=47], 10.3%; retigabine/ezogabine 600mg/day
[n=58], 21.8%; and 900mg/day [n=51], 37.2%) and ROW
(median: placebo [n=55], 15.8%; retigabine/ezogabine
600mg/day [n=42], 27.2%; and 900mg/day [n=49], 39.4%).
No significant difference on retigabine/ezogabine efficacy
by the region was observed (p-value for interaction >0.3).
Although some differences in baseline characteristics
among regions were observed, these differences did not
significantly affect retigabine/ezogabine efficacy.
Conclusion: Consistent with the overall results, retigabine/
ezogabine as adjunctive therapy demonstrated efficacy in
adults with partial-onset seizures in Central/Eastern Europe,
Western Europe and ROW.

P1433
Stereotactic radiofrequency
amygdalohippocampectomy for the
treatment of temporal lobe epilepsy: do
good neuropsychological and seizure
outcomes correlate with hippocampal
volume reduction?
H. Malikova1, L. Kramska2, R. Liscak3, Z. Vojtech2
1Radiology, Neurology, Stereotactic and Radiation
2 3
Neurosurgery, Na Homolce Hospital, Prague, Czech
Republic
Introduction: Temporal lobe surgery bears the risk of a
decline of neuropsychological functions. Stereotactic
radiofrequency amygdalohippocampectomy (SAHE)
represents an alternative to mesial temporal lobe epilepsy
(MTLE) surgery. This study compared neuropsychological
results with MRI volumetry of the residual hippocampus.
Materials and methods: We included 35 patients with
drug-resistant MTLE treated by SAHE. MRI volumetry and
neuropsychological examinations were performed before
and 1 year after SAHE. Each year after SAHE clinical
seizure outcome was assessed.
Results: One year after SAHE 77% of patients were
assessed as Engels Class I, 14% of patients were classified
as Engels II and in 9% of patients treatment failed. Two
years after SAHE 76% of subjects were classified as Engels
Class I, 15% of patients was assessed as Engels II and in
9% of patients treatment failed. The hippocampal volume
reduction was 5817% on the left and 5427% on the right
side. One year after SAHE the intelligence quotients of
treated patients increased. Patients showed slightly
significant improvement in verbal memory (p=0.039) and
semantic long-term memory subtest (LTM) (p=0.003).
Patients treated on the right side improved in verbal
memory, delayed recall and LTM. No changes in memory
were found in patients treated on the left side. There was a
trend between the larger extent of the hippocampus
reduction and the improvement in visual memory in speech-
side operated (p=0.057). No other relationships were
significant.
Conclusion: SAHE causes partial hippocampal destruction,
but seizure outcome is comparable with open surgery and
moreover SAHE does not cause neuropsychological
deficits.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 249
P1434
Therapeutic changes in patients on anti-
epileptic polytherapy: looking for the
"winner" combination
V. Hernando-Requejo, N. Huertas, N. Juarez, A. Diez
Neurology, University Hospital Severo Ochoa, Leganes,
Spain
Introduction: To analyze the clinical outcome of different
antiepileptic drugs (AED) combinations in patients taking
at least three AED.
Methods: Review of the neurological history of the last 668
patients attended in our Epilepsy Outpatient Clinic.
Results: From 42 patients on three or more AED, we
reviewed 151 AED combinations. Number of combined
AED: 3.3 (2-6).
Outcomes: Improvement (seizure frequency): 54
combinations (35.8%, the "good outcome" group, with
follow up longer of 6 months in more than 90%), in 46
(30,5%) seizure frequency didn't change, in 29 (19.2%)
increased the frequency (the "bad outcome" group), in 22
(14.6%) the treatment failed due to adverse events.
Reduction of seizure frequency ("good outcome" group):
81.2% (reduction over 50% of seizure frequency: 81.8%),
in 8 combinations (5.3%) seizure freedom was obtained. We
did not find statistical differences in the distribution of AED
in both groups (good" and "bad" outcomes): p=0.269.
Lamotrigine was present in 10.29% of the "good outcome"
and in 5.56% of "bad outcome" combinations (p=0.195),
this difference is not related to the synergy of combination
of lamotrigine and valproic acid (associated in 33% of
combinations in the "good outcome" and in 40% in the "bad
outcome" group).
Conclusion: Our data support the idea, less pessimistic than
classically accepted, that active intervention in AED
polytherapy can lead to good outcomes. Lamotrigine is
slightly more present in combinations with good outcome,
but in our series we find only a tendency.
250 Posters, Sunday 9 September
P1435
Bone health in epilepsy: are we doing
enough?
K. O'Connell, C. McGuigan
Neurology Department, St Vincent's University Hospital,
Dublin, Ireland
Background: Recent publications support an association
between epilepsy, long-term anti-epileptic drug (AED) use
and osteoporosis. Poor bone health in people with epilepsy
is multifactorial although there is evidence that AED
directly affect bone metabolism particularly enzyme
inducing drugs and sodium valproate. This study was
conducted to assess if high risk patients are being identified
and managed appropriately.
Methods: An audit of the medical records of consecutive
patients attending an outpatient department with epilepsy
was performed. Patient demographics, AED history, fracture
history, previous DXA scanning and current bone protection
medication was recorded.
Results: 79 patient records were reviewed. No fractures
were documented, 8 (10%) had been screened with a DXA
scan and 12 (15%) were on bone protection medication.
Of the female patients 10 (27%) were over 50, 4 (40%) had
a DXA scan and 5 (50%) were on bone protection. 7 were
on enzyme inducing drugs, 2 (29%) had a DXA and both
were on bone protection.
39 (50%) patients were on either enzyme inducing AED or
sodium valproate for more than 5 years and only 8 (21%)
had been screened.
Conclusion: There is no consensus with regard to screening
and treatment of AED induced osteoporosis. DXA scanning
is the gold standard screening tool. Identifying at risk
patients needs to encompass independent risk factors for
osteoporosis including age and sex in combination with
AED, duration of treatment and seizure control. The
relatively low screening rate across our patient group would
suggest a need for improved awareness of this condition.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1436
Epilepsy and Brugada syndrome
A. Velazquez1, M.P. Gil Villar2, C. Garcia Arguedas1,
C. Gonzalez Mingot2, R. Bascompte3,
T. Corbaln Sevilla1
1Neurology, Lozano Blesa Hospital, Zaragoza, 2Neurology,
Arnau De Vilanova Hospital, Lerida, 3Cardiology, Lozano
Blesa Hospital, Zaragoza, Spain
Introduction: Brugada syndrome is a cardiological
channelopathy with some typical EKG signs and high risk
of sudden death. It is put in relation with some epilepsy
syndromes in the literature. We report two patients with
both pathologies.
Material and methods:
First patient: 49-years-old male. Family history of sudden
death and personal history of febrile seizures in his
childhood. He was found unconscious with seizures while
he was sleeping. The urgent EKG showed Brugada signs
(right precordial ST segment elevation). The EEG was also
abnormal, showing right temporal spikes focus. The
flecainide test was positive, and all the other cardiological
and neurological tests were unremarkable. Since then, he
started levetiracetam treatment and no more seizures have
been reported.
Second patient: 37-years-old male, without family or
personal history of seizures or heart disease. He had a first
episode of tonic-clonic movements with post-ictal
confusion. All the neurological test were normal except the
EEG, which showed generalized spikes and waves
discharges. The urgent EKG and the ajmaline test were
positive for Brugada syndrome patterns. He started
carbamazepine and an automatic implantable cardioverter
defibrillator was placed.
Conclusions: Many ion-channel pathologies have been
described, such as heart diseases (Brugada syndrome, long
QT syndrome) and neurological disorders (including many
epilepsy syndromes). In fact, there are some mutations in
the sodium channels like SCN5A and SCN1A-B that are
linked to Brugada syndrome and generalised epilepsy with
febrile seizures. Channelopathies can coexist in the same
patient and make the differential diagnosis and the treatment
more difficult.

P1437
FET-PET visualizes increased cortical
neutral amino acid-uptake after epileptic
seizure
Y. Krenn1, S.M. Golaszewski1,2,3, A.B. Kunz1,
M. McCoy4, B. Egger5, E. Trinka1,2,3, M. Hutterer1
1Department of Neurology, 2Spinal Cord Injury and Tissue
Regeneration Center, 3Neuroscience Institute, 4Division of
Neuroradiology, 5Department of Nuclear Medicine,
Paracelsus Medical University Salzburg, Salzburg, Austria
Objective: Molecular imaging with positron emission
tomography (PET) has become essential in the management
of brain tumours. High amino acid uptake in biological
active tumour tissue allows the detection of neoplastic
growth via radiolabeled amino acid tracers. One of the most
important tracer of this group is [18F]-Fluoro-Ethyl-
Tyrosine (FET). However, little is known about the
specificity of FET-uptake.
Case report: We present two cases in which FET-PET
shows significantly increased amino acid metabolism after
epileptic events: A 44-year-old man with symptomatic
epilepsy due to a left insular secondary malignant
astrocytoma WHO grade II (in complete remission) entered
a prolonged postictal state after a complex focal seizure.
FET-PET revealed an extended and exclusively cortical
enhancement left frontal and left insular. The signal
completely resolved with symptom remission after 2
months. In a 58-year-old woman with an acute symptomatic
simple focal seizure due to a right-cerebral ischemic
infarction, FET-uptake was enhanced in the right temporal
cortex next to the white matter infarction.
Conclusion: It can be assumed that the discharge of
neurotransmitters during an epileptic event is responsible
for an increased uptake of amino acids in the postictal
phase. The latter can be visualized by FET-PET imaging.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 251
P1438
Glutamic acid decarboxylase auto-
antibodies in intractable temporal lobe
epilepsy and juvenile myoclonic epilepsy
S. Elibirlik, A. Dirican, S. Baybas, V. Sozmen,
M. Ozturk, N. Demir, E. Arslan, O. Soydemir,
H. Kucukoglu
Neurology, Bakrky Research and Training Hospital for
Neurologic and Psychiatric Diseases, Istanbul, Turkey
Purpose: High glutamic acid decarboxylase auto-antibodies
(anti-GAD) levels were reported in patients with intractable
epilepsy in some studies. In this study, we investigated the
role of anti-GAD antibodies in the etiopathogenesis of
intractable mesial temporal lobe epilepsy (MTLE) and
compared these results with juvenile myoclonic epilepsy
(JME) patients and healthy subjects.
Method: The study group consisted of 26 patients with
MTLE, 28 patients with JME and 26 healthy subjects as
control group. Anti-GAD levels were determined
quantitatively by Immunoradiodiagnostic Assay (IRMA).
Number Cruncher Statistically System (NCSS) 2007&PASS
2008 Statistical Software (Utah, USA) program was used
for statistical analysis.
Results: The serum anti-GAD levels were not different in
MTLE, JME and the control group. Anti-GAD was positive
in 3 JME cases and in one control subject. Statistical
analysis did not show any significant difference between
anti-GAD levels and demographic data, medical history,
family history, disease duration, seizure types and frequency,
antiepileptic drugs, history of status epilepticus and EEG
findings.
Conclusion: Although we did not find any statistically
significant relationship of anti-GAD levels in our study
groups, some studies reported that GAD autoimmunity may
be associated with refractory localization-related epilepsies.
Studies with higher number of patients must be performed
to determine the prevalence and the role of anti-GAD
antibodies in the etiopathogenesis of intractable epilepsy.
252 Posters, Sunday 9 September
P1439
Intravenous lacosamide in status
epilepticus and cluster seizures
Y. Handouk, S. Morresi, C. Bomprezzi, C. Minardi,
S. Malag, A.M. Mauro
U.O. Neurologia Ospedale 'Bufalini', Cesena, Italy
Introduction: Some anti-epileptic drugs (AEDs) used in
status epilepticus (SE) are associated with potential
respiratory and cardiovascular complications. Lacosamide
(LCM), a new AED, has an intravenous formulation with a
potential role in the treatment of SE.
Objective: To test the efficacy and safety of the intravenous
drug formulation in SE and cluster seizures.
Patients and methods: 11 patients with symptomatic
epilepsy (6 female and 5 male; mean age 66 (23-90); 8 with
SE and 3 with cluster seizures; were treated, after failure of
other AEDs, with simultaneous administration of
intravenous and oral LCM for two days (200mg intravenous
+ 50mg oral LCM twice daily), then switched to oral LCM
(400mg daily).
Results: EEG improvement occurred in the first 24 hours
after the beginning of LCM therapy. All patients were
responsive with no serious adverse event, except two old
patients who died for severe comorbidities.
Conclusions: LCM could be efficacious and safe in the
treatment of SE.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1440
Resting motor threshold in idiopathic
generalized epilepsies: a systematic
review with meta-analysis
F. Brigo1,2, M. Storti3, F. Rossini1, R. Nardone2,4,
F. Tezzon2, A. Fiaschi1, L.G. Bongiovanni1,
P. Manganotti1
1Department of Neurological, Neuropsychological,
Morphological and Movement Sciences, University of
Verona, Verona, 2Department of Neurology, Hospital Franz
Tappeiner, Merano, 3Department of Medicine, University of
Verona, Verona, Italy, 4Department of Neurology, Christian
Doppler Clinic, Paracelsus Medical University, Salzburg,
Austria
Introduction: Resting motor threshold (rMT) assessed by
means of Transcranial Magnetic Stimulation (TMS) is
thought to reflect trans-synaptic excitability of cortico-
spinal neurons. TMS studies reporting rMT in idiopathic
generalized epilepsies (IGEs) yielded discrepant results, so
that it is difficult to draw a definitive conclusion on cortico-
spinal excitability in IGEs by simple summation of previous
results regarding this measure. Our purpose was to carry out
a systematic review and a meta-analysis of studies
evaluating rMT values obtained during single-pulse TMS in
patients with IGEs.
Methods: Controlled studies measuring rMT by single-
pulse TMS in drug-naive patients older than 12 years
affected by IGEs were systematically searched and
reviewed. rMT values were assessed calculating mean
difference and odds ratio with 95% confidence intervals
(CI).
Results: 14 trials (255 epileptic patients and 424 controls)
were included. Patients with Juvenile Myoclonic Epilepsy
(JME) have a statistically significant lower rMT compared
with controls (mean difference: -6.78; 95% CI -10.55 to
-3.00); when considering all subtypes of IGEs, there was a
tendency toward reduced rMT values in IGEs, but the
difference did not reach statistical significance (mean
difference: -2.34; 95% CI -4.92 to -0.24).
Conclusion: Overall considered, the results are indicative
of a cortico-spinal hyper-excitability in JME, providing not
enough evidence for motor hyper-excitability when all
subtypes of IGE are considered as a whole. The considerable
variability across studies probably reflects the presence of
relevant clinical and methodological heterogeneity, and
higher temporal variability among rMT measurements over
time, related to unstable cortical excitability in these
patients.

P1441
EEG photosensitivity phenomenon among
children without epileptic seizure
I. Shchederkina
Neurology Clinic of Morozovsky Children Hospital, Moscow,
Russia
In some people, without epileptic seizure, generalized
polyspike-wave activity under photo-stimulation
(electrophysiological photosensitivity) is registered in EEG.
The frequency of such cases in population may reach 1.8%.
Aim: To evaluate the frequency of photoparoxysmal
response (PPR) in EEG for children with different
complaints.
Methods: Clinical, EEG, video-EEG-monitoring.
Results: 44 children with PPR were examined with EEG:
22 boys and 22 girls. Mean age 7.5 years. Reasons for
seeing a neurologist were: tension headache - 31.8%,
vegetative dysfunction (syncope) - 27.2%, motor tics -
22.7%, migraine - 20.4%, head trauma - 18.1%, other
(attention deficient hyperactivity disorder, logoneurosis,
retrocerebellar cyst, neuroinfection, learning disability)
were represented with identical frequency of 4.5%. Girls
were suffering under migraine twice as often, tics prevailed
among boys. Syncopes were registered more often among
females. 77% of children had neurological
microsymptomatics. Isolated PPR was registered for 42%
of children, the rest showed a combination of this EEG
phenomenon with other types of epileptiform activity
(sharp(spike)-slow wave): generalized in background
record and at hyperventilation - 16%, with frontal
localization - 6%, with temporoparietal localization, with
occipital localization - 2%. Patient surveillance period
varied from 9 months to 4 years with occasional video-
EEG. During the surveillance period none of the patients
had an epileptic seizure.
Conclusion: In order to rule out subclinical seizures, the
carrying out of video-EEG monitoring with additional trials
is necessary. Photoparoxysmal response at EEG is more
often combined with generalized epileptiform activity on
background and in case of hyperventilation. Anticonvulsant
prescription is unreasonable unless epileptic seizures occur.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 253
P1442
Retrospective clinical and
electrophysiological analysis of 33
surgically treated patients with
pharmaco-resistant epilepsy
A.R. Beatriz
Clinical Neurophysiology, Hospital General Universitario
Gregorio Maran, Ciudad Real, Spain
Objective: Analysis of clinical manifestations, ictal,
interictal and intraoperative EEG monitoring in patients
with medical treatment refractory temporal epilepsy
successfully controlled surgically.
Methods: Retrospective analysis, 33 patients. Mean age
3611.40; number of monthly seizures: 914.23 mean
duration of disease: 22 years; number of anti-epileptic
drugs: 30.93. Average monitoring duration on Intensive
video-EEG Monitoring Unit: 6.423.61 days. Scalp EEG
was recorded with surface electrodes placed according to
the 10-20 International System, plus additional 10-10
System and sphenoidal electrodes to record medial temporal
and temporobasal regions. In 12 patients, subdural
electrodes were necessary.
Results: 158 seizures were recorded, most of them focal
complex. 82% of patients presented aura (36.1% gastric).
Disturbances of consciousness appeared in almost 100%
(94.3%), being more precocious than the automatisms in the
majority of the sample. The most frequent and precocious
automatisms were oromandibular. A low percentage of
contralateral dystonic position was observed, perhaps
explained by the detection criteria that were used to.
Intercritical: epileptiform activity was observed in 87.9% of
cases; sharp waves in 93.1%., increasing with sleep in 97%.
Polyspikes during REM sleep in 21.2%. Bilateral
epileptiform activity in 21.2%. Ictal activity: Changes on
EEG activity was observed previous to clinical manifestation
in more than 69,1%. Type of ictal onset: flattening 46%,
rhythmic slow activity 41.7%. Ictal onset was focal in
48.9% (posterior lateral temporal 16.5%, frontotemporal
15.1%).
254 Posters, Sunday 9 September
P1443
Epileptogenic potential of supratentorial
brain tumours in paediatric patients
V.S. Khalilov, A.A. Kholin
Department of Neurology, Neurosurgery and Medical
Genetic, Russian State Medical University, Moscow, Russia
Purpose: Symptomatic epilepsy is common in patients with
supratentorial brain tumours. Epileptogenesis depends on
several factors including histology, location, changes in the
peritumoral parenchyma and genetic predisposition. The
aim of presented research was studying epileptogenic
potential of brain tumours of different histology in children.
Method: Among the paediatric patients investigated and
treated in the Neurosurgical Department and Psycho-
Neurological Department 2 of Russian Children Clinical
Hospital at the period 2006-2011 60 children with
supratentorial brain tumours were revealed.
Result: The group of patients (n=60) consists of 28 girls
and 23 boys (age range from 5 month till 17 years). 41
patients (68,3%) had symptomatic epilepsy. Among the
patients were revealed: fibrillary astrocytoma 8 cases (all 8
patients had epilepsy), pilocystic astrocytoma 6 (3),
pleomorphic xanthoastrocytoma 5 (4), desmoplastic
infantile astrocytoma (DIA) 1 (0), protoplasmic astrocytoma
2 (1), ganglioastrocytoma 5 (5), mixed glioma 3 (1), mixed
ganglioglioma 2 (1), anaplastic ganglioglioma 1 (0),
desmoplastic ganglioglioma 1 (1), glioblastoma multiforme
2 (2), olygodendroglioma 1 (0), anaplastic ependymoma 6
(3), choroid plexus papilloma 3 (0), atypical choroid plexus
papilloma 1 (1), choroid plexus carcinoma 1 (0),
dysembryoplastic neuroepithelial tumour (DNET) 5 (5),
primitive neuroepithelial tumour (PNET) 1 (1), atypical
meningioma 1 (1), thalamic hamartoma 3 (3),
meningioangiomatosis 2 (2).
Conclusion: Tumour types demonstrating obligate
epileptogenesis were: fibrillary astrocytoma,
ganglioastrocytoma, DNET, PNET, hamartoma,
meningioangiomatosis, desmoplastic ganglioglioma,
glioblastoma multiforme and atypical meningioma.
Pleomorphic xanthoastrocytoma was epileptogenic in 80%
of cases. Pilocystic and protoplasmic astrocytoma, mixed
ganglioglioma, anaplastic ependymoma had 50% risk of
epilepsy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1444
Clinical features and follow-up of patients
with infantile spasms
M.J. Gonzalez1, F.X. Sanmart2, I. Alonso Colmenero3,
O. Sans3, J. Campistol4
1Child Neurology Department, 2Epilepsy Unit, Barcelona
University Hospital Sant Joan de Deu, 3Neurophysiology
Unit, 4Child Neurology, Barcelona University Hospital Sant
Joan de Deu, Barcelona, Spain
Introduction: The frequency of infantile spasms (IS) is
about 2% among the epilepsy in the children and about 25%
occur in the first year of life. The incidence peak is between
4 and 7 months of age.
Objective: To describe the main clinical features, ictal and
interictal video-EEG findings in 38 patients with infantile
spasms.
Results: The mean age of beginning of the infantile spasms
was 5.1 month. In 18 patients the infantile spasms had
connection with concrete etiology and had relationship with
severe degree of delayed psychomotor development. The 8
patients with infantile spasms which did not have another
type of seizures and Hypsarrhytmia pattern during video-
EEG evaluation had better response to Vigabatrin treatment.
In 79% the interictal EEG was abnormal and in 73% of
patients were observed abnormal sleep patterns. Only in 2
patients during continuous video-EEG monitoring
hypsarrhytmic activity was registered. The improvement of
the video-EEG findings were observed during 6 months
after first record in 18 patients. In 48.5% of patients the
MRI was normal in the first examination. 27 patients were
treated with corticosteroids with a good response in 60%.
During the long follow-up 25 patients had delay of
psychomotor development and in 22 patients other type of
seizures appeared later.
Conclusion: The most important factors of the good
outcome in patients with infantile spasms are early diagnosis
and effective treatment according to the etiology of the
spasms.

P1445
The selected NR1I2 polymorphism
rs1523130 T>C and rs2472677 C>T as a
risk factor of drug resistant epilepsy
K. Jastrzebski, I. Klich, A. Klimek
Medical University of Lodz, Poland
Introduction: The NR1I2 nuclear receptor subfamily 1,
group I, member 2 (or PXR - Pregnane X Receptor) gene
product belongs to the nuclear receptor superfamily,
members of which are transcription factors characterized by
a ligand-binding domain and a DNA-binding domain. The
PXR protein is a transcriptional regulator of the cytochrome
P450 gene and ABC - transporters. PXR is expressed
mainly in the liver and intestine, where it plays important
roles in detoxification.
Methods: A total of 29 patients with drug resistant epilepsy
and 185 healthy controls from central Poland were analyzed
for the two PXR polymorphisms. The diagnosis of drug
resistant epilepsy was consistent with consensus Tasks
Force of the International League Against Epilepsy (ILAE).
The polymorphisms were detected by TaqMan RT-PCR
assay. The results were tested by Chi-square and Fisher
tests.
Results: The distribution of haplotypes between cases and
control was not important in difference and consistent with
Hardy-Weinberg equilibrium (cases: rs1523130T>C: CC -
38%, CT - 41.3%, TT - 20.7% vs. control CC - 35.2%, CT
- 46.8%, TT - 16.2%, cases: rs2472677C>T: CC - 20%, CT
- 45%, TT - 35% vs. control CC - 14.8%, CT - 48%, TT -
37.2%). The distribution of haplotypes CC/CC vs. others
haplotypes was almost statistical important - OR- 6.8519
(CI 95% 0.9262 to 50.6879).
Conclusion: Our preliminary results indicate that genetic
variability in PXR gene can play an important role in drug
resistant epilepsy but further studies are now required to
define the significance of these associations.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 255
P1446
The peculiarities of post-stroke epileptic
seizures related to post-stroke time
T. Danilova, D. Khasanova, I. Kamalov
Neurology, Kazan State Medical University, ICDC -
Interregional Clinical Diagnostic Center, Kazan, Russia
The aim of the study is to establish the clinical and
functional peculiarities of seizures-precursors (SP), early
(within the first 7 days) (ES) and late post-stroke seizures
(LS). A total of 222 patients with ischemic stroke who
experienced different types of epilepsy were under integral
medical supervision. The diagnostic complex comprised
clinical analysis, MRI, EEG, extracranial and transcranial
Doppler sonography. The simple partial seizures (45.3%,
p<0.01) developed more frequently in patients with ES, as
compared to the ones with LS and SP. The secondary
generalized seizures (35.7%, p<0.05) dominated in patients
with LS. SP (41.4%) and ES (49.5%) occurred more
frequently in patients with ischemic stroke in the left carotid
basin as compared to the right carotid one (34.5% and
36.9%, p<0.05). LS developed in the left (43.6%) and right
(47.5%) carotid basins with equal frequency. The SP often
developed in patients with lacunar stroke (34.5%, p<0.01).
The ES were more common in patients with cardioembolic
stroke (30.5%, p<0.05), the LS occurred equally in all types
of stroke. More frequent occurrence of seizures in the
dynamics in patients with SP (27.6%) and LS (24.5%) was
observed more often. Patients with ES showed decrease in
frequency of seizures over time (32.6%, p<0.05).The focal
epileptiform and slow-wave activity were more typical in
patients with ES (60.2%) as compared to the late ones
(53.6%) and SP (41.9%).
Thus, the revealed clinical manifestations of seizures
associated with different periods of stroke may indicate
their different pathogenesis.
256 Posters, Sunday 9 September
P1447
Clinical and EEG findings in idiopathic
generalized epilepsies: are there any
distinctive features to distinguish
syndromes?
A. Asadipooya, M. Emami, A. Karimpourghanadi
Shiraz University of Medical Sciences, Shiraz, Iran
Background: Epidemiologic data concerning idiopathic
generalized epilepsies (IGEs) are scarce or often unreliable.
In the current study, we specifically analyzed the syndromes
if IGE based on their demographic, clinical, and EEG
findings.
Materials and methods: In this retrospective study, all
patients with a clinical diagnosis of IGE were recruited in
the outpatient epilepsy clinic at Shiraz University of
Medical Sciences, from September 2008 through May
2011. Demographic variables and relevant clinical and EEG
variables were summarized descriptively. Statistical
analyses were performed using Chi square and Fishers
Exact tests.
Results: 2190 patients with epilepsy were registered at our
epilepsy clinic and 442 patients (20.2%) were diagnosed as
having IGE. Age of seizure onset was 127 years. Juvenile
myoclonic epilepsy was the most frequent syndrome,
followed by epilepsy with generalized tonic-clonic seizures
only and juvenile absence epilepsy. Epilepsy risk factors,
physical examination, MRI and even EEG could not
differentiate various syndromes.
Conclusion: The key element in making the correct
diagnosis of an IGE syndrome is obtaining a detailed
clinical history. However, sometimes these syndromes have
overlapping features.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1448
Impact of regular counselling on epilepsy
clinic default: the Nigerian experience
E.O. Ezunu1, M. Owolabi2
1Medicine, Federal Medical Center, Asaba, 2Medicine,
University College Hospital, Ibadan, Nigeria
Introduction: Epilepsy is one of the leading brain disorders
in the developing countries. However, the impact of
education on clinic attendance and drug compliance on
patients with epilepsy is unknown in our environment.
Methodology: This is a prospective study of subjects with
epilepsy seen at the outpatient neurology clinic, University
College Hospital, Ibadan Nigeria. A total of 184 (37 new
and 147 old) epileptic patient were recruited consecutively.
A standard questionnaire for obtaining information on their
demographic characteristics, monthly clinic attendance was
initially applied to each of the old patients without
counselling. The extent of counsel they might have received
was evaluated. The new patients were separated and
counselled monthly on the need to attend clinic regularly.
The two groups were followed up monthly for six months,
and then their clinic attendance was assessed. Informed
consent of the patients was obtained; ethical clearance from
University of Ibadan/University College Hospital Ibadan
Ethical Committee was also approved.
Results: 32 new cases (86.5%) attended the clinic as
scheduled and were compared with 21 old cases (14.3%),
Chi2= 75.14, OR=38.40, p<0.0001, 95% CI=13.44-109.70.
Conclusions: Regular counselling has a positive impact on
clinic default of epilepsy patients in our environment.
Therefore, health care providers should provide regular
counsel to their patients in the clinic.

P1449
Significance of metal content monitoring
in children with epilepsy
O. Guzeva
Neurology Department, Saint-Petersburg Paediatric Medical
Academy, Saint-Petersburg, Russia
Introduction: Metals play an important role in the
metabolism of the nervous system, including activation of
enzyme reactions.
Purpose: To study metal content in children with epilepsy
in comparison with normal parameters.
Materials and methods: The content of 11 metals (Pb, Cu,
Mn, Ca, Mg, Li, Al, Fe, Zn, Cd, Hg) in hair of 100 children
(43 girls and 57 boys) and Se in 73 children with epilepsy
(41 boys, 32 girls), age 1-14 years. 76% of children receive
valproic acid and 24% carbamazepin.
Results: There were no sex differences in metal content in
hair, except for Cu level. The difference in level of Cu was
6,3106,221ug/g (p=0.90). Contents of Zn, Cd, Mn and Hg
were below normal in all children, content of Cu - in 46%,
Se - at 34.25%, Mg - in 18%, Fe - 7%, Ca - only in 3%
children. Content of Pb and Al was overweight, and of Cu,
Ca, Mg, Li, Fe, Se below normal average. Significant
correlation (p0.95) between metal content was found in 29
(43.94%) cases: contents of Pb, Cu, Ca, Al is in correlation
with content of Cd - 6, Zn and Li - 5, Mg and Fe - 4, Hg - 3,
Mn - 2, Se with Mn.
Conclusion: The study of metal concentrations in children
with epilepsy may contribute to the discovery of new
epileptogenic pathways and justification of therapy based
on screening indicators of metals.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 257
P1450
Can vitamin B12 and folate supplements
prevent the rise of serum homocysteine in
epileptic patients receiving
carbamazepine?
M. Motamedi, S. Ahmadi Karvigh, A. Naser Moghadasi
Neurology, Tehran University of Medical Sciences, Tehran,
Iran
Objectives: To assess the level of the serum homocysteine
in epileptic patients, who are under carbamazepine
treatment and are also receiving Vitamin B12 and folate
supplements.
Methods: We studied 36 epileptic patients who were
receiving carbamazepine, folate (1mg/day) and Vitamin
B12 (1mg/month) for one year. We measured the serum
levels of Homocysteine, carbamazepine, Folate and Vitamin
B12.
Results: The meanSD of the carbamazepine therapeutic
dose was 536151.4mg/day. The folate levels were within
normal limits in all of our patients. Nine patients had low
levels of serum vitamin B12 from whom, only one had
hyperhomocysteinemia. The meanSD of homocysteine
levels was 13.38.1mol/l and 28% of our patients had
homocysteine levels above normal limits. There was no
significant association between the homocysteine and
carbamazepine, folate or vitamin B12 serum levels (pvalue=
0.61, 0.17 and 0.55, respectively).
Conclusion: This study suggests that the
hyperhomocysteinemia that was detected in some of the
epileptic patients with carbamazepine was independent of
the serum levels of folate and vitamin B12. Larger scale
controlled trials are needed to verify the possible role of
folate and Vitamin B12 or even vitamin B6 on controlling
the hyperhomocysteinemia following the treatment with
carbamazepine.
258 Posters, Sunday 9 September
P1451
Recurrent symptomatic seizure in post-
ischemic stroke prophylaxis patients
D.I. Cuciureanu1,2
1Neurology, University of Medicine and Pharmacy
'Gr. T. Popa', 2Neurology, Emergency Hospital 'Prof. Dr.
N. Oblu', Iasi, Romania
Background: To investigate the relationship between
recurrence rate of symptomatic seizures in post-ischemic
stroke patients receiving antiplatelet / anticoagulant therapy.
Method: We reviewed the clinical findings and laboratory
data of 212 patients with post-ischemic stroke symptomatic
seizures, hospitalized in our neurological service for
primary diagnoses between 2007 - 2010 and 1 year follow-
up in outpatient's service. All patient, aged 35 - 75, were
investigated by clinical examination, brain computed
tomography, vascular related blood tests, EEG studies,
cerebrovascular ultrasound and transthoracic echography
searching possible new sources of emboli for every new
seizure. All received first line antiepileptic drugs and 104
patients received antiplatelet / anticoagulant treatment.
Results: We found 46 (22 %) patients with early-onset
seizures and 166 (78%) late-onset seizures patients.
Regarding the topography and types of infarcts 98 (47%)
supratentorial infarcts, 28 (13%) watershed 48 (22%) with
subcortical involvement, 24 (11%) lacunars strokes, 14
(7%) TIA. 38 (18%) patients with recurrent stroke. Seizure
type: 72 (34%) generalized tonic clonic, 62 (29 %) simple
partial seizures, 78 (37%) partial seizures with secondary
generalization. Only 38 (18%) patients with recurrent
stroke. 22 (3 vs. 8) patients with early-onset seizures, 82 (30
vs. 52) late-onset seizures patients, 32 (10 vs. 21) simple
partial seizures, 72 (22 vs. 40) patients with primary and
secondary generalized tonic clonic seizures received
antiplatelet / anticoagulant treatment with lower rate of
seizure recurrence.
Conclusion: Rate of seizures recurrence was lower in
groups with antiplatelet treatment, maybe due to lower rate
of recurrent small silent infarcts.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1452
Blink reflex significance at estimation of
epilepsy hypersynchronous activity
V. Semashko, V. Kistsen, V. Evstigneev
Belarusian Medical Academy of Postgraduate Education,
Minsk, Belarus
Objective: The aim of our study is to estimate the self-
descriptiveness of Blink Reflex (BR) as a predictor of
epilepsy behaviour character (exacerbation or remission)
and treatment efficacy.
Methods: 37 patients (mean age 31.11.9 years) with
temporal epilepsy were studied. Latency, duration,
amplitude and configuration of R1, R2 components and R3
presences were evaluated. 21 patients were treated AED
with rTMS (1Hz, 20% of big circular coil MMI) during 10
consecutive days. Control group (n=16) took anticonvulsants
only. We observed all patients every 4 weeks for 3 months
with seizure frequency registration and
electroencephalography (EEG) control.
Results: Before anticonvulsive therapy correction in 28
(76%) patients presented hyperexcitable BR type. That BR
type is characterized by early R1 appearance, R1 and R2
duration prolongation, R2 polyphasy and high amplitude,
R3 presence. 9 patients (24%) had hypersynchronous BR
pattern with high non-polyphasic R2 amplitude. During
epilepsy exacerbation of R3 component was registered in
focus side at all cases. High seizure frequency correlated
with early R1 appearance (r=0.57, p=0.042), prolongation
of R2 duration (r=0.55, p=0.049) and R3 presence (r=0.7,
p=0.006). During anticonvulsive therapy most R2 duration
reduction was obtained in the subgroup of patients who took
AED with rTMS (r=0.74, p=0.003). BR type and its
parameter normalization correlated with seizure frequency
reduction (r=0.7, p=0.003) but had not correlations with
brain damage localization (neocortical dysplasia or mesial
temporal sclerosis) and epileptiform discharge occurrence
in EEG (p<0.05).
Conclusions: Blink reflex pattern can be used as the
criterion of estimating anticonvulsive therapy efficacy.

P1453
Non-invasive video-EEG monitoring in the
diagnosis of focal epilepsy in children
A. Bunduchi1, A. Bunduchi2, S. Hadjiu1
1Paediatrics, State Medical and Pharmaceutical University
N. Testemitanu, 2Medical Centre "Excellence", Chisinau,
Moldova
Introduction: FE (Focal Epilepsy) is met frequently in
children, clinically expressed in polymorph seizures, often
with kinematic generalized characteristics. The onset of
seizures has a maximal incidence before the age of 3, with
a higher prevalence of tonic seizures. Method of choice in
assessing the diagnosis is Video-EEG monitoring that
identifies the type of seizure, the ictal and inter-ictal
epileptiform activity and establishes the clinical-
electroencephalographic correlations.
Objective: To diagnose FE, determination of localization of
the ictal and inter-ictal epileptiform activity.
Patients and methods: Study included 89 patients, age 1
month to 18 years with admission diagnosis of ,,Epilepsy''.
The method was Video-EEG monitoring (1-12 hours), 21
channels , 10-20 system.
Results: The diagnosis of epilepsy was confirmed in 76
patients (85 %), while in 13 patients (15%) non-epileptic
paroxysms were diagnosed. Generalized epilepsy was
diagnoses in 11 patients (12%),FE in 65 patients (63%).
According to localization, distribution was following:
frontal - 30 patients (46,1%); temporal -22 (34%) ; occipital
- 9 (13,9%) ; parietal - 1 (1%) ; multifocal - 3 (5%). 35% of
patients with FE younger than 3 years had marked
generalized seizures known as infantile spasms, tonic.
Conclusions:
1. Every sixth patient with primarily diagnosed epilepsy
suffered actually a non-epileptic paroxysm.
2. 73% of patients have FE, about half of them have frontal
localization of the focus.
3. Presence of generalized types of seizures mimicking
generalized epilepsy is an important feature of FE in
patients younger than 3 years.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 259
P1454
Affective disorders and psychotic
episodes in patients with chronic active
epilepsy
L.M. Icevska
JZU ZD Zeleznicar, Skopje, FYR Macedonia
The aim of the study was to estimate frequency and types of
affective disorders and psychotic episodes in patients with
chronic active epilepsy. Evaluation of all patients with
chronic epilepsy referred for hospitalization to department
of epileptology for a period of one year, was done in this
open, prospective, observational study. 34 patients, mean
age 32.4 years, mean duration of epilepsy 19.1 years, were
included. Comprehensive interview with patients, inquiry
with family and sometimes psychological testing ( MMPI,
PIE) were used. 19 (56%) patients showed affective
symptoms. Two of them presented euphoric mood and four
irritable-explosive affect. 13 experienced depressive mood
changes (ranging from major depressive episode with
suicide attempt in one, to low-grade disorder of dysthymia
and short-term course depressive and anxiety interictal
dysphoric episodes). 5 patients with depressive mood
changes required drug treatment. 69.2% of depressive
patients had complex partial seizures (CPS), which exceeds
the total number of patients with CPS in group (55,9%).
Two-thirds of these patients had left-sided temporal foci in
EEG. Only two of our patients have psychotic episodes, in
one of them treatment related (with Topiramate). Results
showed high percentage of affective disturbances in our
group, but it must be kept in mind that these patients were
admitted to specialized clinic for severity or aggravation of
their illness. On the other hand, the importance of affective
disorder recognition and treatment must be stressed, as they
are inherent, frequent manifestations of disordered cerebral
function in epileptic patients.
260 Posters, Sunday 9 September

P1455
Seizure induction procedure during EEG
recording hot water epilepsy
B. Labovic1, R. Raicevic2, T. Lepic2, D. Veljancic2
1Clinic of Neurology, 2Military Medical Academy, Belgrade,
Serbia
Introduction: Hot water epilepsy (HWE) represents a rare
P1456
Rubella encephalitis in children:
neurological and electro-encephalographic
features
J. Abdelhedi1, I. Hsairi2, I. Kammoun3, I. Ayadi1,2,
E. Ellouz1,2, F. Kamoun1,2, N. Zouari3, C. Triki1,2
Department of Child Neurology, CHU Hedi Chaker, 2Search
1

clinical entity, classified in a group of reflex epilepsy in Unit Neuropdiatrie 01UR08_05, 3Department of
which seizures are precipitated by hot water during bathing. Neurophysiology, Sfax, Tunisia
Method: We report HWE in a 21-year-old male, with
symptoms on set appearing at the age seven years. After
initial provocative procedure when we applied a tea-pot P1457
filled with 38 C warm water and wrapped up with warm Temporal lobe epilepsy and stress
towels pressed against the back skin, with no effect; using N. Bukia1, M. Butskhrikidze2, L. Machavariani1,
the shower of wider surface of his shoulders and back with I. Bilanishvili1, N. Khizanishvili1, Z. Nanobashvili1
hot water of the same temperature 38 C which has been 1Neurophysiology, 2LEPL Center of Experimental
effective. Alongside with this, long term EEG monitoring Biomedicine, Tbilisi, Georgia
was proceeded.
Results: It is possible that stimulation of broad skin areas
involved hypersynchronisation of the parietal and P1458
frontotemporal regions that is critical to elicit seizure, not Neuron-specific enolase, a marker brain
the temperature alone.
As complex partial seizure was inducted, the EEG has inflammation, is increased in symptomatic
shown high voltage slow waves of 2.5 to 3.5/s over the left epilepsy
side, maximal over Fp1 and C3, followed by well developed N. Rashidova, K. Khalimova
spike and wave complexes over Fp1C3F3 and F7. The Tashkent Medical Academy, Tashkent, Uzbekistan
patient experienced a secondary generalized seizure in the
next 70 seconds, feeling sleepy, confused and recovered
gradually after cessation of the seizure over the following P1459
15 minutes. Status epilepticus and multiple sclerosis
Conclusion: We have special interest to present the case case overview
because of the novel method for seizure induction, which
we have applied. The importance of this observation is D. Sahovic, Z. Savic
related to the feasibility of seizure induction, in HWE cases, Neurology Clinic, Clinical Center University of Sarajevo,
under the conditions of EEG recordings. Sarajevo, Bosnia-Herzegovina

P1460
Review article: epilepsy in Ethiopia
D.K. Worku
Neurology, Addis Ababa University, Addis Ababa, Ethiopia

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

 Posters, Sunday 9 September 261

P1461 P1465
Efficacy of anti-epileptic drugs (AED): Idiopathic generalized epilepsies focal
attempts of therapy study features
A. Kotov K.V. Voronkova1, A.A. Kholin2
Neurology, Moscow Regional Research and Clinical 1Neurological Department, 2Neurological Department,

Institute, Moscow, Russia Paediatric Faculty, Russian National Research Medical

University, Moscow, Russia

P1462
Vascular epilepsy P1466
A. Hancu1, C. Pascu2, C. Mocanu1, A. Cuciureanu2 Effectiveness of the first anti-epileptic
Ovidius University Constanta, 2Neurology, Ovidius
1 drug in elderly patients with epilepsy
University Constanta, Constanta, Romania S. Lukic, M. Spasic
Epilepsy Department, Clinical Center of Nis, Nis, Serbia
P1463
Executive dysfunction in one case of P1467
juvenile myoclonic epilepsy Endothelian dysfunction and oxidating
A. Revesz1,2, L. Visu-Petra3, L. Perju-Dumbrava2 stress in epileptogenesis
1Neurology, County Hospital Satu Mare, Satu Mare, M. Pityk1, D. Delva1, O. Pityk2
2University of Medicine and Pharmacy, 3Psychology, 1Department of Child Neurology, 2Department of Psychiatry,
Babes-Bolyai University, Cluj-Napoca, Romania Ivano-Frankivsk National Medical University, Ivano-
Frankivsk, Ukraine
P1464
Abstract cancelled

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

262 Posters, Sunday 9 September
Motor neurone diseases
P1468
UNC13A influences survival in an Italian
population-based series
A. Calvo1, G. Restagno2, M. Brunetti2, I. Ossola2,
E. Majounie3, A.E. Renton4, A. Canosa1, U. Manera1,
E. Bersano1, C. Moglia1, G. Mora5, B.J. Traynor4,
A. Chi1
1ALS Center, University of Torino, S. Giovanni Battista
Hospital, 2Molecular Genetic Unit, A.S.O. O.I.R.M.-S. Anna,
Torino, Italy, 3Neuromuscular Diseases Research Unit,
4Molecular Genetics Unit, Laboratory of Neurogenetics,
NIA, Bethesda, MD, USA, 5ALS Center, Salvatore Maugeri
Foundation-IRCCS, Milano, Italy
Background: It has been recently shown that the common
variant rs12608932 in gene UNC13A is associated with
amyotrophic lateral sclerosis (ALS) susceptibility and may
be an independent modifier of ALS survival in populations
of North-European ancestry (Van Es, 2009; Diekstra, 2012).
Aim: To evaluate the effect of UNC13A on survival in a
population-based series of ALS cases of Italian ancestry.
Methods: 261 samples and 247 ethnically matched controls
were genotyped on Infinium HumanHap550 (Illumina), and
236 on Infinium HumanHap610-Quad (Illumina); 535,468
SNPs were common across both platforms, including the
rs12608932 single nucleotide polymorphism (SNP).
Survival was assessed with Kaplan-Meir curves and
compared with the logrank test.
Results: The study included 497 apparently sporadic ALS
patients (mean age 61.6 years [SD 11]) resident in Piemonte,
Italy. The minor allele frequency was similar in cases and
controls (33% vs. 32%, p=0.91). However, we found a
significant association with survival for both additive and
recessive genetic models. Patients carrying the CC (minor
allele) genotype had a 12-months shorter survival than
those carrying AA or AC genotypes (median survival time,
CC 2.5 years [95% CI, 1.5-3.4] vs. AA or AC 3.5 years [3.1-
3.8]; p=0.017). This effect was independent from patients'
age at onset, gender, site of symptom onset, phenotype and
use of NIV and PEG in a stepwise forward Cox multivariable
model (p=0.02; HR=1.42).
Comment: In the Italian population, UNC13A has a strong
independent modifier effect on ALS survival. This finding
has implications relevant to both, understanding ALS
pathogenesis and in defining therapeutic interventions.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1469
Preliminary results of the French MSA-
fluoxetine study
O. Rascol, French MSA-Fluoxetine Study Group
Clinical Pharmacology, Toulouse University Hospital,
Toulouse, France
Introduction: Multiple system atrophy (MSA) is a sporadic
neurodegenerative disorder characterized clinically by any
combination of parkinsonian, autonomic, cerebellar or
pyramidal symptoms. To date, no drug has proved sufficient
efficacy to halt the neurodegenerative process in MSA. The
therapeutic strategy relies on the control of clinical
symptoms of parkinsonism and autonomic dysfunction. Not
only a dopaminergic deficit, but also a serotoninergic one,
could be implicated in the physiopathology of MSA, as
suggested by a recent study showing an improvement of
behavioural and neuropathological deficits with fluoxetine
in a model of MSA (Ubhi, et al. Exp Neurol 2012;234:405-
16).
Objective: To test the clinical effect of fluoxetine 40mg/day
on subjects with MSA, measured by change from baseline
to month 3 in the total UMSARS (part I + part II) score.
Methods: Multi-centred, randomized, double-blind,
placebo controlled study on 81 MSA subjects. Only baseline
data and preliminary result of main outcome are presented
here.
Results: The two groups were similar at baseline concerning
age (63.5 vs. 63.1), gender (men: 58.5% vs. 65%),
UMSARS (I + II) (40.2 vs. 40.3), Beck Depression
Inventory Scale (11.8 vs. 12.3), SCOPA-AUT score (20 vs.
22.9), Epworth sleepiness scale (8.3 vs. 7.7), apathy, and
orthostatic hypotension (40% vs. 60%). No significant
difference according treatment group was found for change
from baseline in the total UMSARS score after 3 months of
fluoxetine (3.1 vs. 1.4).
Conclusion: Further analyses with adjustment and imput
for missing values are needed to confirm these preliminary
results.

P1470
TDP-43 and FUS pathology in amyotrophic
lateral sclerosis
Y. Fujita1, M. Kitani1, M. Takatama2, M. Ikeda1,
K. Okamoto1
Neurology, Gunma University Graduate School of Medicine,
1 bulbar-onset, elderly age, short diagnostic delay, FVC and
Internal Medicine, Geriatric Research Institute and Hospital,
2 small PhrenAmpl for the complete population. Small
Maebashi, Japan
Introduction: TAR DNA-binding protein of 43-kDa (TDP-
43) and fused in sarcoma (FUS), which are the key proteins
of ALS, have structural and functional similarities. However,
the relationship of these proteins have not been established.
Therefore, we examined the relationship of TDP-43 and FUS
proteins in ALS using immunohistochemical methods.
Methods: We studied the spinal cord sections from 12
common sporadic ALS (SALS) patients and 4 ALS patients
with FUS-positive cytoplasmic inclusions (including 3
familial cases and 2 patients with mutations in the FUS gene).
The sections were stained with haematoxylin and eosin (HE),
and immunostained with anti-FUS, anti-phosphorylated-
TDP-43 (pTDP-43), and anti-non-phosphorylated TDP-43
antibodies.
Results: All pTDP-43-positive inclusions except one were
negative for anti-FUS antibody in SALS. Although most of
the 42 neurons without abnormal pTDP-43 immunoreactivity
showed normal nuclear staining of FUS, 6 of 40 neurons with
fine granular pTDP-43 immunoreactivity and 13 of 22
neurons with skein-like or round inclusion did not show
nuclear staining of FUS. On the other hand, all basophilic
inclusions (BIs) and FUS-positive inclusions were not stained
with anti-pTDP-43 and anti-TDP-43 antibodies. Furthermore,
the nuclear staining of TDP-43 was well preserved in the all
neurons with BIs and FUS-positive inclusions.
Conclusion: These results suggest that the pathogenesis of
FUS proteinopathy is independent from that of TDP-43
proteinopathy; however, abnormal TDP-43 may interact with
the FUS protein in SALS pathogenesis.
P1471
Survival in amyotrophic lateral sclerosis -
prognostic factors
S. Pinto, A. Pinto, M. de Carvalho
Institute of Molecular Medicine and Faculty of Medicine,
University of Lisbon, Portugal
Introduction: Amyotrophic lateral sclerosis (ALS) is a
severe neurodegenerative disease with short survival due to
respiratory failure. We aimed to test the survival predictive
value of the classical prognostic factors in addition to the
phrenic nerve motor responses in a large ALS population.
Methods: We included 254 ALS patients followed in our
tertiary center from 1997 and 2006 in whom phrenic nerve
stimulation was performed and who fulfilled the inclusion
criteria. ALS was spinal-onset in 175 (group1- G1) and
bulbar-onset in 79 (group2- G2). Features recorded at first
visit were: gender, age at symptom onset, onset region,
diagnostic delay, forced vital capacity (FVC), ALS functional
rating scale (ALS-FRS) including the respiratory sub-score
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 263
of the reviewed ALS-FRS and mean amplitude of motor
responses by phrenic nerve stimulation (PhrenAmpl). All
patients were on riluzole.
Results: Survival analysis was evaluated by Kaplan-Meier
log-rank and multivariate Cox proportional hazards.
Independent factors negatively affecting survival were
PhrenAmpl and short diagnostic delay were also independent
factors for G1 and G2, but age at onset and FVC were also
independent predictors for G2.
Discussion: Prognostic factors in our population are in
accordance with those described by others. PhrenAmpl
showed to be an independent prognostic factor. It is non-
volitional and easily standardized and quickly performed.
FVC depends on patient co-operation and is not reliable in
patients with facial weakness. Phrenic nerve stimulation
should be included in the routine assessment of ALS patients.
P1472
Rasch analysis of the Epworth Sleepiness
Scale in patients with post-polio syndrome
C.J. Gibbons1,2, I.M. Pomeroy1, A. Tennant3, C.A. Young1
1Walton Centre Foundation NHS Trust, Liverpool,
2Collaboration for Leadership in Applied Health Research
and Care (GM CLAHRC), University of Manchester,
3Academic Department of Rehabilitation Medicine, University
of Leeds, UK
Introduction: The Epworth Sleepiness Scale (ESS) has been
widely used to assess sleepiness in clinical trials for neurology
patients. The scale has not previously been validated for use
in patients with post-polio syndrome (PPS). Data collected in
a PPS population were applied to the Rasch model to ensure
the scale was reliable, unidimensional and free from
differential item functioning (DIF) or local dependency.
Methods: A questionnaire pack containing the ESS was sent
to 282 (88% response) consecutive patients with a confirmed
diagnosis of PPS.
Results: The ESS displayed reasonable fit to the Rasch
model [2(24) =37.80, p=0.04]. Differential item functioning
was not present for either age or gender. Scale reliability was
acceptable (PSI=0.86). Mild local dependency (r=0.20) was
apparent between items 3 'Sitting inactive' and 6 'Sitting and
talking'. Collapsing items 3 and 6 into a testlet improved fit
and revealed local dependency between items 1 'Sitting and
reading' and 2 'Watching TV'. Collapsing these items into a
testlet led to a solution with excellent model fit [2(18)
=22.55, p=0.21]. The final scale was unidimensional (0.71%
T-tests significant) and free from DIF or local dependency.
Category thresholds were well ordered and item 'difficulties'
were widely distributed (-3.2 to 3 logits).
Conclusion: The Epworth Sleepiness Scale demonstrates
good psychometric and scaling properties in this population.
The scale may be used with confidence in clinics and research
with PPS patients.
264 Posters, Sunday 9 September

P1473 these conditions first-hand. By creating and validating

longitudinal models of QoL, key intervention points can be
Work in progress: quality of life (QoL) and identified to enhance care delivery.
neurological disease - trajectories of
outcome in neurological conditions P1474
(TONiC): a study protocol Familial adult spinal muscular atrophy
C.J. Gibbons1,2, R. Cousins3, I.M. Pomeroy1, H. Ando1,3, associated with VAPB gene
A. Al-Chalabi4, J. Chataway5, C. Constaninescu6,
M.R.G. de Freitas, V. Kosac, O.J.M. Nascimento
J. Ealing7, C. Hawkins8, K. Morrison9, J. Palace10,
Neurology, Federal Fluminense University, Niteri, Brazil
N. Robertson11, D. Rog7, N. Scolding12, B. Sharrack13,
P. Shaw14, K. Talbot15, T. Williams16, A. Tennant17, Introduction: Familial spinal muscular atrophy (FSMA)
C.A. Young1, on behalf of the TONiC Group associated with VAPB gene is a rare autosomic dominant
1Walton Centre Foundation NHS Trust, Liverpool, disease of late onset and slow progression. Most cases were
2Collaboration for Leadership in Applied Health Research evaluated in Brazil and they were linked to the mutation
and Care (GM CLAHRC), University of Manchester, 3Health P56S. The phenotype may vary among families. The
Sciences, Liverpool Hope University, Liverpool, 4King's objective is to report four generations of four families in Rio
College Hospital, 5National Hospital for Neurology and de Janeiro.
Neurosurgery, London, 6University of Nottingham, 7Salford Methods: We studied 41 patients of 4 families with clinical
Royal Hospital, Manchester, 8University Hospital of North history, physical exam, electrophysiological study and
Staffordshire, Stoke-on-Trent, 9University Hospital genetic test.
Birmingham NHS Foundation Trust, Birmingham, Results: All patients presented a late onset and slow
10University of Oxford, Oxford, 11University of Cardiff, progressing disease with fasciculations, proximal weakness
12University of Bristol, 13Sheffield Teaching Hospitals, and amyotrophy, hypoactive deep tendon reflex, except one
14Sheffield Institute of Translational Neuroscience (SITRaN),
patient with brisk reflex. One patient showed tongue
University of Sheffield, 15John Radcliffe Hospital, Oxford, fasciculations and respiratory insufficiency. Electro
16The Newcastle Upon Tyne Hospitals NHS Foundation
physiological studies showed patterns of lower motor
Trust, Newcastle upon Tyne, 17Academic Department of neuron disease and genetic test showed P56S mutation of
Rehabilitation Medicine, University of Leeds, UK VAPB gene.
Background: Maintaining quality of life (QoL) in Conclusion: Although it is a rare motor neuron disease,
neurological illness is a key treatment priority for clinical FSMA with this mutation could be much more prevalent in
care teams. Understanding the complex variables and Brazil than expected. Moreover many cases may be
relationships that influence QoL and the manner these underdiagnosed. Genetic test should be performed whenever
relationships develop over time are important in improving it is suspected, mainly in our country.
care and designing better services.
Aims: We aim to examine the factors influential for QoL of
individuals with multiple sclerosis (MS), and motor neurone
disease (MND). This process includes longitudinal
assessment over four time points, development of new
disease-specific scales and validation of existing scales that
measure different factors related to QoL.
Methods: The study will be run in five phases across
fourteen hospital sites
Phase One: In depth interviews and focus groups conducted
with patients, to explore QoL issues and identify potential
items for disease-specific questionnaire scales.
Phase Two: Face to face interviews and focus groups
conducted with patients to identify gross questionnaire
problems. Professionals invited to participate in Delphi
discussion to discuss factors and model design to be tested.
Phase Three: Baseline questionnaire administration.
Phase Four: Test-retest assessment (four to six weeks).
Phase Five: 6-, 12- and 24-month questionnaire
administration.
Quantitative analyses will be conducted using Rasch
analysis and Structural Equation Modelling.
Discussion: The TONiC study is a large longitudinal study
designed to explore quality of life for people living with
neurological illness. It uses quantitative models based on
qualitative investigation with the patients that experience

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1475
Effects of hypertension in ALS. Results of
a population-based study
C. Moglia1, A. Calvo1, A. Ilardi1, A. Canosa1, U. Manera1,
L. Mazzini2, G. Mora3, A. Chio'1, PARALS
1Neuroscience, University of Torino, Torino, 2Universit del
Piemonte Orientale, Novara, 3Fondazione Salvatore
Maugeri, Milano, Italy
Background: Factors related to cardiovascular risk have
been assessed in ALS with uneven findings. A recent paper
showed that a beneficial vascular risk profile is associated
with an increased risk of ALS (Sutjeda et al, 2011).
Aim: To assess the effect of arterial hypertension in a
population-based series of ALS patients.
Methods: The study population consisted of the 1260 ALS
cases incident in Piemonte and Valle d'Aosta in the period
1995-2004. Patients were affected by definite, probable or
probable laboratory-supported ALS. Arterial hypertension
was indicated as systolic pressure 160 and diastolic
pressure 100.
Results: A total of 272 patients (21.6%) were affected by
hypertension at the time of onset of ALS. Patients with
hypertension had a significantly lower age at onset of ALS
than patients without hypertension in both genders (women,
68.1 [SD 8.3] years vs. 64.2 [11.9] years, p=0.0001; men,
67.8 [8.9] years vs. 63.7 [11.5] years, p=0.0001). No
relationship between hypertension and site of onset (bulbar
vs. spinal) was found. Patients with hypertension were more
likely to have also diabetes mellitus (HR 2.9, 95% c.i. 1.8-
4.6, p=0.0001) and frontemporal dementia (FTD) (HR, 1.8,
95% c.i. 1.1-2.9, p=0.01). Hypertension did not influence
ALS outcome.
Conclusions: We have found that a preceding arterial
hypertension is associated to a delayed onset of ALS in
population-based series. This finding is in line with the
previous observation that a beneficial vascular risk profile
is associated to an increased risk of ALS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 265
P1476
Ataxin-1 and ataxin-2 intermediate-length
PolyQ expansions in ALS patients
R. Spataro1, W. Sproviero2, R. Mazzei2, F. Cavalcanti2,
F. Condino2, T. Colletti1, V. La Bella1, F.L. Conforti2
1Department of Experimental Biomedicine and Clinical
Neurosciences, University of Palermo, 2Institute of
Neurological Sciences, National Research Council, Cosenza,
Italy
Introduction: A number of studies have shown that
ataxin-2 (ATXN-2) intermediate poly-CAG expansions
with CAA interruptions are a risk factor for amyotrophic
lateral sclerosis (ALS). The present work was undertaken
with the aim to investigate the frequency of Ataxin-1
(ATXN-1) and ATXN-2 PolyQ expansions in a cohort of
sporadic and familial ALS patients from South Italy.
Methods: The PolyQ lengths of ATXN-1 and ATXN-2 in
405 sALS, 13 fALS and 296 unrelated controls without
history of neurodegenerative disorders (NC) were assessed.
Genotyping of the ataxin-1 and ataxin-2 CAG repeat
number was performed using fluorescent-labelled primer
PCR with capillary electrophoresis on an ABI3130xl
sequencer and analyzed with GeneMapper software version
4.0.
Results: We found that 57 out of the 806 ATXN-1 alleles in
the sALS cohort harboured a 32 PolyQ repeat length, as
compared to 13 out of the 544 NC alleles (p=0.0001, c2
test). For ATXN-2, a 28 PolyQ repeat length was found in
22 of the 808 sALS alleles and in only 3 of the 586 NC
alleles (p=0.0041, c2 test). Further, the analysis of ATXN-1
and ATXN-2 PolyQ repeat length expansions in fALS
revealed that ATXN-1 might be a potential risk factor also
in these patients. ATXN-1 CAT and ATXN-2 CAA
interruptions were detected in ALS patients only. Age at
onset, site of onset, and sex were not significantly related to
the ATXN-1 and/or ATXN-2 PolyQ repeat length
expansions.
Conclusion: Both ATXN-1 and ATXN-2 PolyQ
intermediate expansions are independently associated to an
increased risk for ALS.
266 Posters, Sunday 9 September
P1477
High vascular risk profile is associated
with prolonged survival in ALS
M.A. Rubio Perez, J. Pascual Calvet, J. Jimnez Conde,
A.J. Santiago Ois, E. Munteis Oliva, J. Roquer Gonzalez
Neurology Department, Parc de Salut Mar, Barcelona, Spain
Introduction: Recent studies show that a beneficial
vascular risk profile increases amyotrophic lateral sclerosis
(ALS) susceptibility. Also, low levels of vascular endothelial
growth factor (VEGF) represent a risk factor for ALS, and
correlate with shorter survival. Chronic vascular hypoxic
situations as coronary, cerebral and peripheral arterial
diseases stimulate VEGF production.
The aim of the study is to analyze the impact of the vascular
risk profile in the survival of our population of ALS patients.
Methods: Retrospective analysis of our ALS registry of
patients diagnosed between 1991 and 2011. Demographic
and clinical data like age of onset and clinical form at onset
were collected.
Patients were classified in two groups according to their
vascular risk profile. 'High Vascular Risk' profile was
defined as having suffered a clinical event (stroke, coronary
or peripheral arterial disease) or the presence of at least 3
vascular risk factors.
Results: 161 patients were analyzed (49.7% men, 50.3%
female), with median age of 64 years (IQR 55-73). 128
patients were dead (79.5%), with median survival time of
32 months (IQR 20-53). Factors associated with survival in
univariate analysis were sex, age of onset, clinical form at
onset and high vascular risk profile. Multivariate analysis
showed an independent association with survival with the
following variables: age (HR 1.028;p<0.001), clinical form
at onset (HR 1.705;p=0.009), and high vascular risk profile
(HR 0.592;p=0.014).
Conclusion: We found an association between a high
vascular risk profile and increased survival in our
population. Other prognostic markers were age of onset and
clinical form at onset.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1478
Inhibition of APP beta-cleavage site
affects survival and motor functions of
ALS transgenic mice
P. Rabinovich Toidman, M. Becker, B. Solomon
Department of Molecular Microbiology and Biotechnology,
George S. Wise Faculty of Life Sciences, Tel Aviv University,
Tel Aviv, Israel
Background: Amyotrophic lateral sclerosis (ALS) is a
progressive neurodegenerative disease defined by motor
neuron loss. Recent studies have reported an increase in
amyloid precursor protein (APP) levels and in its cleavage
products in ALS patients indicating their possible
involvement in this disease. APP is a transmembrane protein
processed either by -secretase or -secretase followed by
-secretase. The APP cleavage products mediate a reduction
in synaptic transmission, synaptic loss, neurite retraction
and programmed cell death.
Objective: Elucidation of the role of APP cleavage products
in pathology of ALS.
Methods: ALS mice models that express mutant superoxide
dismutase 1(SOD1) were treated intraventricularly with
monoclonal antibody that blocks the -secretase cleavage
site on APP. Levels of APP cleavage product called soluble
APP-, number of motor neurons, motor functions and
survival were assessed.
Results: Inhibition of APP cleavage resulted in a decrease
in the levels of soluble APP-, an increase in number of
motor neurons, delayed disease onset, improved motor
capacities of ALS affected mice and better survival.
Conclusions: APP cleavage products might contribute to
the degeneration in ALS, and early inhibition of APP
process may ameliorate disease progression.

P1479
No heart involvement in SBMA patients
G. Querin1, P.Melacini1, L.Morandi2, L. Mazzini3,
V. Silani4, A. Gaiani1, C. D'Ascenzo1, E. Pegoraro1,
G. Sorar1
1University of Padova, 2Istituto Neurologico
'C.Besta', Milan, 3University of Novara,
4University of Milan, Italy
Background: Spinal and bulbar muscular atrophy (SBMA)
is an adult-onset, X-linked, lower motor neuron disease,
characterized by slowly progressive muscle weakness and
atrophy. The disease is caused by an expansion of a CAG
repeat encoding a polyglutamine tract within the androgen
receptor (AR) gene. Nuclear accumulation of pathological
AR, which is toxic to motor neurons, has been observed in
tissues other than the nervous system including the heart.
Materials and methods: To test the hypothesis of the
presence of heart disease in SBMA we carried out a full
cardiologic evaluation (12-lead ECG, Echocardiography
and 24-hour ECG Holter) in 26 genetically defined SBMA
patients.
Results: Patients' age range was 32 - 75 yrs (mean age 54.4
yrs). 10 patients had high blood pressure and were under
antihypertensive medications. No patients displayed clinical
signs of heart disorders at the cardiologic examination. The
12-lead ECG findings were normal or consistent with left
ventricle (LV) hypertrophy in the oldest patients suffering
from high blood pressure. Similarly, echocardiography
showed no abnormalities other than mild concentric LV
hypertrophy in patients with hypertension. No patients
showed significant rhythm abnormalities at the 24-hour
ECG Holter.
Conclusions: Our findings do not support the hypothesis of
a primary heart involvement in SBMA.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 267
P1480
Rigorous control of a supervised exercise
protocol improves function and survival in
amyotrophic lateral sclerosis patients
J.P. Lopes Almeida1, A. Cardoso Pinto1, M. de Carvalho2
1Department of Physical Medicine and Rehabilitation,
University of Lisbon Medical School, Santa Maria Hospital,
2Neuromuscular Unit, Institute of Molecular Medicine,
University of Lisbon Medical School, Lisbon, Portugal
Introduction: The uncertainty about exercise in
Amyotrophic Lateral Sclerosis (ALS) is mostly derived
from paucity of randomized trials and lack of rigorous
control of exercise intensity. We hypothesized that
exercising till fatigue (as evaluated by Borg scale and
cardiopulmonary exercise test, CPET), is suitable for
ambulatory ALS patients.
Methods: Prospective, quasi-randomized, single-blinded
controlled trial. 40 consecutive ALS patients, were assigned
to the control group (G1, n=20) and the intervention group
(G2, n=20). Patients in G1 followed standard care and
exercised to fatigue with no supervision at home. G2
underwent a supervised moderate progressively resisted
exercise program 3 times/week (treadmill ramp protocol
levelled 20% lower than determined by CPET), while
compensating lower limb weakness and respiratory failure
with body-weight-supporting-systems and non-invasive-
ventilation, correspondingly. All patients performed CPET
and respiratory function tests (RFT) at 3-month interval.
Primary outcomes were ALSFRS-R scores and slopes and
RFT/CPET parameters. Secondary outcomes included
survival analysis.
Results: No clinical or laboratorial differences were
observed between groups for any variable at admission. All
ALSFRS scores improved in G2 throughout follow-up
course (p<0.05); survival from the intervention was
statistically increased in G2 (p=0.021) and when adjusted to
exercise variables. A linear decline in respiratory function
was seen in both groups, but not significant. Peak oxygen
uptake, ventilation/minute and VO2/work rate at one-year
were significantly lower in G2 (p<0.01).
Conclusion: A well-controlled exercise protocol is feasible
and should be prescribed to ALS patients since it improves
survival and respiratory efficiency, with less deconditioning.
Determinants of exercise are significant predictors of
survival.
268 Posters, Sunday 9 September
P1481
Reduced expression of BTBD10 in
anterior horn cells in amyotrophic lateral
sclerosis
N. Furuta1, Y. Fujita1, M. Takatama2, M. Matsuoka3,
K. Okamoto1
1Department of Neurology, Gunma University Graduate
School of Medicine, 2Geriatrics Research Institute and
Hospital, Maebashi, 3Department of Pharmacology, Tokyo
Medical University, Shinjuku, Japan
Background: BTBD10 was shown to activate Akt by
inhibiting protein phosphatase 2A (PP2A)-mediated
dephosphorylation. The overexpression of BTBD10
suppressed motor neuron death. However, it remains
unclear whether expression of BTBD10 is related to motor
neuron degeneration in human amyotrophic lateral sclerosis
(ALS).
Materials and methods: We examined the spinal cords of
22 patients with sporadic ALS and 5 control cases. Mirror
paraffin sections were prepared for immunohistochemistry,
which was carried out using rabbit polyclonal anti-BTBD10
antibody, anti-phosphorylation- dependent TDP-43 (pTDP-
43) antibody, and anti-TGN46 antibody, which recognizes
an intrinsic membrane protein of trans-Golgi network
(TGN). We compared the neuronal immunoreactivity
between BTBD10 and TGN46 / pTDP-43.
Results: BTBD10 was expressed in neurons in the spinal
anterior horns and only minimally expressed in astrocytes.
In control cases, BTBD10-positve small granular
cytoplasmic immunostaining was observed diffusely in the
anterior horn cells. In ALS cases, BTBD10-positive neurons
were significantly decreased in the remaining neurons, and
the reduction of BTBD10 immunoreactivity occurred more
frequently in large neurons than in small neurons. Mirror
sections disclosed that neurons with reduction of BTBD10
immunoreactivity showed more frequently fragmentation of
Golgi apparatus and pTDP-43 positive inclusions. Bunina
bodies and round inclusions showed no BTBD10
immunostaining.
Conclusion: Reduction of BTBD10 immunoreactivity was
observed in the large anterior horn neurons, and the majority
of these neurons had fragmented Golgi apparatus and
pTDP-43 positive inclusions. These results suggest that
reduced BTBD10 expression may be related to the neuronal
degeneration in ALS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1482
Novel candidate proteins for early
diagnosis in animal models and patients
of amyotrophic lateral sclerosis
H. Hara, H. Tanaka, M. Takata, K. Tsuruma,
M. Shimazawa
Molecular Pharmacology, Department of Biofunctional
Evaluation, Gifu Pharmaceutical University, Gifu, Japan
Introduction: The diagnosis of amyotrophic lateral
sclerosis (ALS) is difficult at an early stage due to lack of
definitive biomarkers. Our aim was to identify characteristic
serum protein patterns that could provide candidate
biomarkers for ALS.
Methods: We divided mutant superoxide dismutase 1
(SOD1)H46R rats into 3 groups based on disease
progression: pre-symptom (90 days), onset, and end-stage.
After separation of serum proteins using two-dimensional
electrophoresis, we selected clear protein spots and
identified 2 candidate proteins - inter-alpha-trypsin inhibitor
heavy chain H4 (ITIH4) and glutathione peroxidase 3
(GPX3).
Results: The 120-kDa ITIH4 increased at the onset of the
disease and the cleaved 85-kDa ITIH4 at the end-stage in
the sera of the SOD1H46R rats. In clinical samples,
expression of the 85-kDa ITIH4 was substantial in the sera
and in vascular endothelial cells in sporadic ALS patients,
and was not detected in controls or patients with Alzheimers
or Parkinson's disease. 100-kDa ITIH4 was specifically
increased in myelitis patients, but not in ALS. GPX3 protein
levels in the sera of SOD1H46R rats were upregulated pre-
symptom and gradually decreased as the disease progressed.
In clinical samples, GPX3 protein levels were lower in the
sera of the patients with ALS than in those of controls,
patients with Alzheimers disease, Parkinson's disease, or
myelitis.
Conclusion: These results indicate that ITIH4 and GPX3
are potential biomarkers for diagnosis of ALS and that
observing changes in these expression levels may be useful
in obtaining important clinical information on the
progression of disease in ALS patients.

P1483
Pattern of spread and survival in sporadic
ALS How does ALS progress?
F. Kimura1, C. Fujimura-Kiyono1, H. Tani2, S. Ishida1,
H. Nakajima1, T. Hirose1
1Division of Neurology, The First Department of Internal
Medicine, Takatsuki-City, 2Osaka Medical College, Osaka,
Japan
Objective: To define patterns of spread through the order of
lower motor neuron involvement (first, second or third
order), relationships between interval or sites of affected
areas from onset to involvement of a second region, and
prognosis, including 5-year survival, normal preservation of
motor function at onset of respiratory symptoms and
cumulative occurrence of each region and direction of
spread.
Method: 150 patients with sporadic amyotrophic lateral
sclerosis (ALS) underwent follow-up at 3 month intervals
until the appearance of respiratory symptoms. Symptom
appearances were determined using the revised version of
the ALS Functional Rating Scale.
Result: Median survival with combined type onset (two
regions simultaneously) was shorter (18 months) than with
bulbar onset (26 months, p1/40.01). The interval from onset
to involvement of the second region correlated significantly
with survival, independent of particular combinations. 5
year survival rate was 21% for lower limb onset, 18% for
upper limb onset and 16% for bulbar onset. Early
manifestations of bulbar symptoms within 1 year were
associated with worse survival (p<0.001) although no
significant difference in survival was seen between groups
with and without bulbar symptoms (p1/40.51). In terms of
cumulative occurrence, symptoms spread longitudinally to
adjacent regions. Bulbar function remained preserved in
27%, lower limb function in 10% and upper limb function
in 2.7%.
Conclusion: The interval between onset and involvement
of the second region is an important predictor of survival.
The data support the contiguous anatomical propagation of
lower motor neuron involvement in sporadic ALS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 269
P1484
ALS incidence and prevalence in the U.S.:
estimates from large administrative
databases
D. Perlroth1,2, R. Conrad2,3, H. Cheung2,
D. Lakdawalla2,3, L.A. White4
1Center for Primary Care and Outcomes Research, Stanford
University, Stanford, 2Precision Health Economics, 3Shaeffer
Center for Health Policy and Economics, University of
Southern California, Los Angeles, CA, 4Biogen Idec, Weston,
MA, USA
Introduction: Most ALS epidemiologic estimates are based
on samples of <1 million persons. We estimated U.S. ALS
incidence and prevalence using two large healthcare claims
databases.
Methods: We used 2005-2007 claims data from a Medicare
20% sample for patients aged 65 years and over, and
Ingenix Touchstone for patients aged 18 to 64 years. There
were 18 million person-years of data in Medicare, and 7
million person-years in Ingenix. ALS cases were included
if they had 2 medical claims with ICD-9 diagnostic code
335.20 separated by at least 90 days. We extrapolated these
findings to estimate the epidemiology of ALS in the overall
U.S. population.
Results: Annually on average, there were 477 (range 454 to
516) new ALS cases in Medicare sample and 42 (range 36
to 53) in Ingenix. Mean prevalent ALS cases were 1,670 in
Medicare and 138 in Ingenix. This resulted in an estimated
annual ALS incidence of 7.7 cases per 100,000 persons over
age 65, and 2.5 per 100,000 persons aged 18-64. The
estimated annual ALS prevalence was 26.9 cases per
100,000 over age 65 and 8.2 per 100,000 aged 18-64. The
overall U.S. adult population ALS incidence was 7,530 new
cases annually, or 3.4 per 100,000 with an annual prevalence
of 25,400 cases, or 11.3 per 100,000.
Conclusion: ALS incidence and prevalence estimates from
these data are slightly higher (7-10%) than previous
estimates based on smaller samples sizes. The number of
persons diagnosed and living with ALS may be larger than
previously thought.
270 Posters, Sunday 9 September
P1485
Potential biomarkers in the blood of ALS
patients: mitochondrial SOD and
aconitase enzymatic activities
C. Gonzlez Mingot1, P. Iaerrea2, C. Iguez1,
J.L. Capablo3, J. Costn4, F.J. Miana5, J. Garca5,
R. Osta6, P. Larrod1
1Neurology Department, University Clinical Hospital of
Zaragoza, 2Biochemical Department of Biology Faculty,
Zaragoza University, 3Neurology Service, Miguel Servet
Hospital of Zaragoza, 4Neumology Department, University
Clinical Hospital of Zaragoza, 5Physiology Department of
Medicine Faculty, 6Genetics Department of Veterinary
Faculty, Zaragoza University, Zaragoza, Spain
Background: Oxidative stress-mediated mitochondrial
degeneration plays a role in motor neuron death caused by
mutant SOD1 effects in Amyotrophic Lateral Sclerosis
(ALS). It has not yet been established whether oxidative
stress is a cause or a consequence of this neurodegeneration.
There is altered antioxidant defence enzyme (ADE) activity
in the peripheral tissues of familial and sporadic ALS
patients. This study attempts to confirm the alteration in
mitochondrial ADE activity and to try to determine whether
the altered enzyme activity in ALS is independent of a
patients condition.
Methods: We measured mitochondrial SOD1, SOD2 and
aconitase enzymatic activities in 22 controls and 26 SALS
patients at different stages of the disease. We correlated
mitochondrial antioxidant activity with clinical and
prognostic variables.
Results: Mitochondrial antioxidant enzymatic activity was
significantly lower in the 26 ALS patients than in the 22
controls (SOD 1 p<0.001, aconitase p<0.005). Cases with
lower SOD1 (p<0.05) and aconitase (p<0.005) activity
levels died before those with higher levels. Patients with
higher levels of SOD1 (p<0.05) and aconitase (p<0.05)
activity survived longer. Aconitase activity was also higher
in patients with earlier onset ages (p<0.01) and in those with
predominantly upper motor neuron (MN) signs. SOD2
activity was significantly correlated with ALSFRS scores
and nutritional parameters.
Conclusions: Mitochondrial SOD1 and aconitase activities
are independent prognostic factors for ALS, whereas SOD2
activity is influenced by the functional and nutritional status
of ALS patients.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1486
A functional variant in the PON1 gene is
associated with shorter survival in
patients with amyotrophic lateral
sclerosis
N. Ticozzi1, F. Verde1, C. Morelli1, C. Tiloca1,
D. Sangalli1, I. Fogh1,2, A. Ratti1,3, S. Messina1,
V. Silani1,3
1Department of Neurology, IRCCS Istituto Auxologico
Italiano, Milano, Italy, 2MRC Centre for Neurodegeneration
Research, Institute of Psychiatry, King's College London,
UK, 3Department of Neuroscience, University of Milan
Medical School, Milano, Italy
Introduction: The paraoxonases (PON) are a family of
enzymes involved in preventing lipid membrane
peroxidation, and in detoxification of exogenous
compounds. Several studies have suggested an association
between single nucleotide polymorphisms (SNP) in the
PON genes and increased risk of developing amyotrophic
lateral sclerosis (ALS). Our study aims to assess whether
the functional SNP rs661 in PON1, which alters the
substrate specificity of the enzyme, has an effect on disease
phenotype.
Methods: 341 Italian patients with sporadic ALS were
genotyped using the Human 660W-Quad BeadChip
(Illumina), and rs661 genotypes obtained with the
GenomeStudio software. Phenotypic traits analyzed
included: age at onset, site of onset, distribution and severity
of muscular involvement, global functional impairment,
disease duration and the time from onset to the start of non-
invasive ventilation (NIV).
Results: In comparison with patients homozygous for the
major allele (A) of rs661, individuals with at least one copy
of the G-allele presented more frequently with a bulbar
(28.8% vs. 19.3%; p=0.01) or respiratory onset (10.7% vs.
1.6%; p<0.01). Also, GG patients often showed a
symmetrical (48.1% vs. 19.8%; p<0.01) and proximal
(50.0% vs. 27.6%; p=0.04) distribution of the motor deficit.
Lastly, individuals homozygous for the G-allele had a
shorter time-to-NIV (14.3 vs. 31.2 months; p=0.01), and
reduced survival (26.8 vs. 41.4 months; p<0.01).
Conclusion: The G-allele of rs661 may increase the
susceptibility of motor neurons innervating bulbar and axial
muscles to neurodegeneration in ALS, ultimately resulting
in a faster respiratory decline and shorter survival.

P1487
The copy number of 5q13 locus genes
and the severity of spinal muscular
atrophy in Russian patients
V. Zabnenkova, E.L. Dadali, A.V. Polyakov
Research Centre for Medical Genetics, Moscow, Russia
Introduction: Proximal spinal muscular atrophy (SMA) is
an autosomal recessive disorder caused by the loss of
a-motor neurons in the spinal cord. With an incidence of 1
in 10,000 live births and a carrier frequency of 1 in 50, SMA
is the most frequent genetic cause of infantile death. SMA
patients are subdivided into types I-III according to age of
onset and achieved motor abilities. These forms of proximal
SMA are caused by mutations in SMNt gene. About 95% of
SMA cases are caused by homozygous deletion of the
SMNt gene or conversion events. The phenotype variability
of the disease with such molecular homogeneity may be
explained by presence of phenotype modifiers.
Methods: It has been developed a quantitative assay based
on Multiplex Ligation-dependent Probe Amplification
(MLPA) for this study.
Results: The SMNc and NAIP gene-copy number has been
analyzed for establishing the phenotype-genotype
correlation in 200 SMA patients (SMAI n=77, SMAII n=58,
SMAIII n=65). 77.9% of SMAI patients showed two copies
of SMNc, 60.4% of SMAII patients had three or four copies
of SMNc and 54.1% of SMAIII had four to five copies. The
NAIP gene is deleted in 36.4%, 6.9% and 4.6% affected
individuals with SMA I, II and III types, respectively.
Conclusions: The copy number of SMNc gene is a
modifying factor of severity of SMA. The absence of the
gene NAIP, indicating a considerable deletion in the locus
5q13, may be an additional criterion, modifying the severity
of the disease.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 271
P1488
Prevalence of medical comorbidity among
ALS patients in a U.S. health insurance
claims database
J.R. Williams, D.A. Kerr, W. Farwell
Biogen Idec, Cambridge, MA, USA
Introduction: Motor and respiratory decline in amyotrophic
lateral sclerosis (ALS) is well documented, but information
on medical comorbidities is limited. This study estimated
the prevalence of comorbidities among ALS patients within
a large U.S. health insurance claims database.
Methods: Subjects (n=1845) with 2 ALS medical claims
(ICD-9 code 335.20) between 2004 and 2011 were
identified, then age- and gender-matched to controls without
a claim for any motor neuron diseases (n=3690).
Comorbidity categories were defined using the Agency for
Healthcare Research and Quality's Clinical Classification
System. Prevalent comorbidity was defined as 1 medical
claim with an ICD-9 code within a particular category,
unrelated to ALS sequelae. 12-month prevalence and odds
ratios (OR) were calculated.
Results: The five most prevalent comorbidity categories
were hypertension (41.4%, OR=1.4), disease of the
heart (36.0%, OR=1.7), disorders of lipid metabolism
(28.2%, OR=0.8), diseases of arteries; arterioles; and
capillaries (19.0%, OR=2.1), and mood disorders
(17.2%, OR=3.1). The five comorbidity categories with the
greatest increased odds relative to controls were immunity
disorders (3.9%, OR=16.4), systemic lupus erythematosus
and connective tissue disorders (2.6%, OR=6.1), other
infection; including parasitic (5.1%, OR=5.8), delirium,
dementia, amnestic, and other cognitive disorders (7.4%,
OR=5.5), and epilepsy; convulsions (3.4%, OR=4.4). All
ORs were statistically significant, p<0.05. Additional
comorbidity categories with the highest prevalence and
greatest increased odds will be presented.
Conclusions: Cardiac diseases were the most prevalent
comorbidities, while immune-related disorders, cognitive
impairment, and seizures were more increased compared to
controls. Understanding the full comorbidity profile in ALS
will aid in therapeutic decision making for patients with
ALS.
272 Posters, Sunday 9 September
P1489
Ocular motor apraxia: an uncommon early
sign in amyotrophic lateral sclerosis
C. Morelli1, N. Ticozzi1, A. Doretti1,2, A. Lafronza1,
F. Verde1, D. Sangalli1, B. Poletti1, A. Ciammola1,
S. Messina1, V. Silani1,2
1Department of Neurology, IRCCS Istituto Auxologico
Italiano, 2Department of Neurosciences, University of Milan
Medical School, Milano, Italy
Introduction: Acquired ocular motor apraxia (AOMA) is
characterized by loss of voluntary control of saccades and
smooth pursuit. To our knowledge, this is the first report of
two patients with amyotrophic lateral sclerosis (ALS), also
developing AOMA.
Methods: Patient 1 developed an atypical parkinsonism at
age 62, followed three years later by slowly progressive
ALS and fronto-temporal dementia (FTD). Progressive
fixation of gaze, ocular and eyelid apraxia appeared at age
67. Patient 2 started complaining of cramps and
fasciculations in the lower limbs at age 77, and was
diagnosed with classic ALS. Six months later he developed
ocular and eyelid apraxia, and, subsequently, FTD. The
patient developed akinetic mutism and died nine months
after onset. In both cases, neuropsychological assessment
suggested a frontal and parietal dysfunction.
Neuroradiological tests showed bilateral cortical atrophy of
the frontal and parietal lobes. Genetic screening was
negative.
Results: The patients were diagnosed as having ALS-plus
syndromes (corticobasal degeneration in case 1, and FTD in
case 2). Both patients showed a prominent involvement of
fronto-parietal areas, compatible with AOMA.
Conclusion: An unrecognized bilateral involvement of
frontal and parietal lobes may underlie the impairment of
ocular movements observed in some ALS patients. Early
detection of AOMA may predict an incoming dementia,
thus assuming a negative prognostic significance.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1490
Over-representation of the L144F SOD1
mutation in Serbian ALS patients due to
founder effect
D. Keckarevic1, Z. Stevic2, M. Keckarevic-Markovic1,
M. Kecmanovic1, S. Romac1
1Faculty of Biology, University of Belgrade, 2Clinic of
Neurology, School of Medicine, University of Belgrade,
Serbia
Objectives: Approximately 5-10% of ALS cases are
familial (FALS), and the remaining ones are sporadic or
apparently sporadic (SALS). So far, more than 300 different
mutations have been identified in at least six major genes of
which mutations in the gene encoding Cu/Zn superoxide
dismutase (SOD1) are most numerous. Founder effect was
reported for A4V, G41S, I113T, and R115G SOD1
mutations. Here we present results of the haplotype analysis
in a group of Serbian ALS cases harbouring L144F mutation
confirming the existence of a founder effect.
Methods: Genomic DNA was isolated from blood samples
taken from 191 unrelated ALS patients. Coding sequence of
SOD1 gene was analyzed by direct sequencing, followed by
haplotype analysis of 8 surrounding STR loci.
Results: Sequencing analysis revealed presence of
mutations in 37 ALS cases (26/37 FALS and 11/154 SALS).
Mutation L144F was detected in 22 FALS and 4 SALS
cases. Haplotype analysis showed that all L144F
chromosomes could have common origin.
Conclusion: Results of the sequencing analysis confirmed
that SOD1 mutations are the most frequent cause in Serbian
ALS patients. Haplotype analysis suggests that over-
representation of L144F mutation could be explained by
actual Balkanian origin of L144F mutation and founder
effect.

P1491
VEGF evaluation in amyotrophic lateral
sclerosis: interplay with respiratory
function and exercise
S. Pinto1, R. Carrilho2, A. Pinto1, J. Costa2,
M. de Carvalho1
1Institute of Molecular Medicine and Faculty of Medicine,
University of Lisbon, 2Instituto de Tecnologia Qumica e
Biolgica, Lisbon, Portugal
Objectives: The role of vascular endothelial growth factor
(VEGF) in the pathogenesis of ALS is a critical point. We
have addressed this issue by evaluating VEGF expression
in a large population of patients.
Methods: We measured VEGF plasma level in 83 ALS
patients, 20 controls and 10 patients with other
neuromuscular diseases matched for age. ALS patients were
divided into 4 groups: patients with severe respiratory
insufficiency undergoing non-invasive ventilation (NIV)
(G1); patients chronically on NIV (G2); patients submitted
to exercise (G3); and ALS patients with absent respiratory
impairment.
Results: 30 ALS patients were included in G1, 14 in G2, 12
in G3 and 27 in G4. VEGF levels were similar in controls
and in all ALS groups analysed. There was no correlation
between VEGF level and gender, onset type, age, disease
duration, ALS-FRS-R and respiratory function
measurements, except for G2 in which VEGF was
negatively correlated to forced vital capacity (p=0.025).
VEGF level increased significantly in G2 after NIV
(p=0.01) and in G3 after exercise (p=0.02) but remained
stable in the rest of patients.
Discussion: VEGF is modulated in ALS by 2 relevant
interventions, NIV in patients with severe respiratory
impairment and following exercise. This observation
suggests that both NIV and exercise can drive
neuroprotective mechanisms in ALS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 273
P1492
Amyotrophic lateral sclerosis (ALS) in
Iran: focusing on functional disability and
quality of life trends
S. Nafissi1, H. Shamshiri1, E. Mir2, B. Pourmirza2,
M. Etemadifar3, R. Abolfazli1, K. Basiri3, K. Gharagozli4,
B. Zamani1, H. Ayromlou5, M.H. Harirchian1, on behalf
of Iran ALS Study Group
1Tehran University of Medical Sciences, 2Sanofi-Medical
Department, Tehran, 3Isfahan University of Medical
Sciences, Isfahan, 4Shahid Beheshti University of Medical
Sciences, Tehran, 5Tabriz University of Medical Sciences,
Tabriz, Iran
Introduction: Many studies from different parts of the
world have reported disease course, disability and quality of
life of ALS patients. Very few studies on this devastating
disease have been conducted in the Middle East. The main
goal of this study was to evaluate ALS progression,
disability and quality of life in a multicenter, prospective
study in Iran.
Methods: 358 ALS cases were registered from 24 neurology
centres all around the country. Demographic data, Manual
Muscle Test scoring (0-130), ALS Functional Rating Scale,
ALSAQ-40, ALS health scoring system, Rilutek
consumption, disease onset, presence of positive family
history and consanguinity were recorded. Follow-up visits
were performed after 6 and 12 months.
Results: Patients were 17 - 89 years old (mean=54.96),
62% were male. 22.9% of patients had bulbar onset
ALS(19.4% of males and 28.7% of females). 65.6% of
patients used Rilutek continuously. During 12 months
follow-up, 14.8% of patients died because of ALS
complication (4.2% in mild, 8.6% in moderate, 23.2 in
severe and 41.7 in terminal stages). This rate was 14.1% in
limb onset and 17.1% in bulbar onset groups. Death rate in
the Rilutek group was 13.6 vs. 17.1 in other patients.
Overall, for 0-6 and 6-12 months periods, mean score
decrements for MMT score was 13.94 and 10.93,
ALSFRS-R 4.77 and 3.66, ALSAQ score 13.85 and 14.61,
respectively. Also the scores were analyzed and compared
in all aforementioned groups and subgroups.
274 Posters, Sunday 9 September
P1493
Novel crystalloid oligodendro-gliopathy in
complex hereditary spastic paraplegia
A. Whrer1, L. Laszlo1, J. Finsterer2, C. Stllberger3,
J. Furtner1, W. Rinner1, K. Molnar1, H. Budka1,
G. Kovacs4
1Medical University of Vienna, 2Danube University Krems,
3KAR, 4Clinical Institute of Neurology, Vienna, Austria
Objectives: Hereditary spastic paraplegia (HSP), comprises
a group of so far 48 clinically and genetically heterogeneous
disorders associated with either isolated spastic paraparesis
(pure HSP) or with additional neurological or non-
neurological manifestations (complicated HSP).
Methods and results: Here we present a case of an adult-
onset, apparently autosomal dominant complicated form of
HSP. Onset of clinical symptoms was at the age of 40 years
and characterised by slowly progressive corticospinal tract
dysfunction, dysarthria, disorientation, extrapyramidal
symptoms, and bilateral ptosis. Cranial MRI revealed
hyperintensities on T2-weighted sequences mostly in the
posterior limb of the internal capsule. The proband deceased
at the age of 64 years. As morphological substrate for the
slowly progressive clinical symptoms, comprehensive
neuropathological and ultrastructural evaluation revealed a
novel oligodendrogliopathy with distinctive, partly
ubiquitinated and p62 positive fibrillar inclusions evolving
into crystalloid deposits, containing elements of the
oligodendroglial cytoskeleton (a- and b-tubulin, TPPP/p25).
In the central nervous system accumulation of crystalloid
structures has been related to histiocytes but not to glial
cells.
Conclusions: This study has implications for the
understanding on how the human central nervous system
reacts to protracted dysfunction and disruption of the
oligodendroglial cytoskeleton, including development of
crystalloid structures, which have not yet been reported in
neurodegenerative disease such as HSP.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1494
Methyl esterification of erythrocyte
membrane proteins in response to
oxidative stress in amyotrophic lateral
sclerosis: a case-control study
L. Daniele
Department of Neurological Sciences, Second University of
Naples, Italy
Objectives: Amyotrophic lateral sclerosis is a degenerative
disorder of upper and lower motor neurons. Aim of study
was to evaluate levels of methylation in erythrocyte
membrane proteins of ALS patients as possible marker of
oxidative stress
Materials and methods: Blood samples of 17 ALS patients
(10 men, 7 women, 5723years) and 13 healthy age sex
matched controls were processed to assess methylation of
intact erythrocytes membrane proteins as index of abnormal
levels of L-isoaspartyl residues and intracellular
concentrations of methyl donor S-adenosylmethionine and
AdoMet demethylated product S-adenosylhomocysteine via
high performance liquid chromatography
Results: Methyl accepting capability in erythrocyte
membrane proteins of ALS patients was lower than in
controls and abnormal L-isoaspartyl residues were
significantly higher in ALS patients (p<0.05). AdoMet
concentration was about 50% lower in ALS patients while
AdoHcy levels were equivalent measuring a lower AdoMet/
AdoHcy ratio in ALS patients (p<0.05).
Discussion and conclusions: Methyl transfer reactions
mediated by AdoMet are involved in oxidative damage
repair. Increased formation of L-isoaspartyl residues is one
of the major structural alterations occurring in erythrocyte
membrane proteins. Abnormal residues are converted into
normal L-aspartyl residues by methyltransferase (PIMT).
PIMT is ubiquitous and its repair function is crucial in
erythrocytes. Our results suggest the presence of injured
action of PIMT in ALS patients' erythrocytes with
accumulation of L-isoaspartyl residues responsible for
abnormal protein conformation. We hypothesize injured
mechanisms of DNA methylation dependent on AdoMet/
AdoHcy ratio with deregulated gene expression. DNA
hypomethylation damage epigenetic control of long-term
silencing genes expression with involvement in ALS.

P1495
Intravenous immunoglobulin for post-
polio syndrome: a randomized, double-
blind, placebo-controlled study
M. Turri1, L. Bertolasi1, E. Frasson2, M. Acler1,
M. Ferlisi1, F. Pimazzoni1, A. Gajofatto1, G. Didon2,
M. Bordignon3, S. Vicentini1, E. Dall' Ora1, F. Brigo1,
A. Fiaschi1, M. Martini4, B. Danzi4, S. Monaco1
1Clinical Neurology, University of Verona, 2Neurology,
3Management Control, Cittadella Hospital, Padova,
4Rehabilitation Medicine, Malcesine, Italy
Objective: Post-polio syndrome refers to an increase of
disabilities experienced by many polio survivors decades
after acute infection expressed by a clinical worsening or
appearance of new symptoms. Pro-inflammatory cytokines
production within the CNS indicates an underlying
inflammatory process. The aim of this paper is to describe
the effects of intravenous immunoglobulin in post-polio
syndrome.
Design: Single-center randomized, double-blind, placebo-
controlled study of efficacy of intravenous immunoglobulin
in post-polio syndrome.
Subjects : 50 patients were randomly assigned to receive
infusion of either intravenous immunoglobulin or placebo.
Methods: Primary endpoint was to demonstrate the efficacy
of immunoglobulin in improving quality of life measured
with short-form-36 (SF-36) questionnaire increasing
physical component score (PCS). Secondary endpoints
were improvement of physical performance, pain, fatigue
and muscle strength. Patients were tested before the first
infusion and two and four months thereafter.
Results: SF-36 physical component score did not
significantly improve in patients who received
immunoglobulin, but we obtained a statistically significant
improvement in SF-36 mental component score (MCS)
(p=0.015) and the subscale scores for physical and
emotional roles (p=0.05, p=0.023) two months after
treatment. No difference was found in physical performance,
pain, fatigue and muscle strength between the two groups.
None of the outcome variables tested four months after
treatment differed significantly between the groups.
Conclusions: Single treatment of intravenous
immunoglobulin improves MCS and physical and emotional
role subscales, but does not improve SF-36 PCS. Further
studies are needed to identify responding subgroups and to
test the effects of immunoglobulin after repeated treatments.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 275
P1496
Increased neurotrophin-3 of the skin of
patients with amyotrophic lateral
sclerosis
S. Ono, T. Yamano, T. Tsukie, H. Fukazawa,
K. Higashida, Y. Oketa, K. Yasui, H. Ishikawa,
M. Nomura, H. Mikami, T. Watanabe, M. Suzuki
Neurology, Teikyo University Chiba Medical Center,
Ichihara, Japan
Objectives: Recently, it was found that immunoreactivities
of ciliary neurotrophic factor (CNTF), leukaemia inhibitory
factor (LIF) and insulin-like growth factor-I (IGF-I) were
markedly increased in the skin of patients with amyotrophic
lateral sclerosis (ALS) compared with controls. These
observations serve to emphasize the potential importance of
neurotrophic factors in ALS. Neurotrophin-3 (NT-3) also
belongs to the neurotrophic factors and is known to promote
motoneuron survival. However, little is known concerning
NT-3 of skin in ALS patients.
Methods: We examined NT-3 immunoreactivity of biopsy
specimens of skin overlying the left biceps from 13 ALS
patients and 13 control subjects with other neurologic
disorders. A densitometric analysis was performed using an
image analysis program.
Results: The optical density for NT-3 immunoreactivity of
the epidermis in ALS patients (meanSD, 1.070.38) was
significantly higher (p<0.01) than in control subjects
(0.520.22). The optical density of the reticular dermis in
ALS patients (meanSD, 0.710.36) was also significantly
higher (p<0.001) than in controls (0.230.31). The above
densities of NT-3 immunoreactivity in ALS patients showed
a progressive increase in relation to duration of illness. This
positive correlation was highly significant (r=0.89, p<0.001
and r=0.73, p<0.001, respectively) in the epidermis and in
the reticular dermis.
Conclusion: These data suggest that NT-3 may have a
trophic role in skin of ALS patients and may help to explain
why decubitus formation is rare in ALS.
276 Posters, Sunday 9 September
P1497
Impaired cytoplasmic-nuclear transport
(intranuclear changes and nuclear
envelope alterations) occurs at the early
pre-symptomatic stage of amyotrophic
lateral sclerosis
Y. Nagara, T. Tateishi, S. Hayashi, R. Yamasaki,
M. Kawamura, H. Kikuchi, K.M. Iinuma, Y. Ohoyagi,
J.-I. Kira
Department of Neurology, Neurological Institute, Graduate
School of Medical Sciences, Kyushu University, Fukuoka,
Japan
The present study aimed to examine the temporal
relationship of immunohistochemical changes in the
anterior horn cells (AHCs) from mutant superoxide
dismutase 1 (mSOD1) transgenic mice related to impaired
cytoplasmicnuclear transport as a potential pathomechanism
of amyotrophic lateral sclerosis (ALS) and to examine
whether these changes occur in animal and human
specimens. We performed immunohistochemical analyses
for six autopsied patients with ALS, 6 non-neurologic
disease controls, 18 mSOD1 transgenic mice, and 18 non-
transgenic mice. Compared to non-transgenic mice aged 8
weeks, consequently, mSOD1 transgenic mice aged 12, 16,
and 18 weeks exhibited the following: 1) chronological
significant decreases in the immunostaining intensity of a
nucleoporin Nup62 in the AHC nuclear envelope; 2)
chronological significant increases in morphological
irregularities of the AHC nuclear envelope immunostained
with Nup62; and 3) chronological significant decreases in
the immunostaining intensity of karyopherin b1 in the AHC
nucleus. mSOD1 transgenic mice showed significant
decreases in the immunostaining intensity of vascular
endothelial growth factor (VEGF) and increases in hypoxia-
inducible factor 1a (HIF-a) in the AHC nucleus. Our study
indicated that impaired cytoplasmicnuclear transport
(intranuclear changes and nuclear envelope alterations)
occurred at the early presymptomatic stage (8 weeks after
birth) in the mSOD1 mice, with nuclear envelope alterations
(decreased immunostaining intensity and increased
morphological irregularities) presumably preceding
intracytoplasmic changes. These data indicate the
correlation of immunohistochemical changes in the AHCs
from ALS model animals and ALS patients. Further study
will be required to specify the cell compartment where the
changes occur first.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1498
Evaluation of autonomic dysfunction in
patients with amyotrophic lateral
sclerosis using the heart rate variability
(HRV)
K.-W. Oh, S.-H. Lee, S.-I. Oh, S.H. Kim
Neurology, Hanyang University, Seoul, Republic of Korea
Background and aims: Amyotrophic lateral sclerosis
(ALS) is a neurodegenerative disorder characterized by
progressive loss of motor neurons, however it is increasingly
recognized that non-motor manifestations may occur,
including autonomic nervous system dysfunction.
Therefore, our first objective in these studies was to evaluate
autonomic dysfunction in patients with ALS. Second
objective was to define associated clinical characteristics
and heart rate variability (HRV)
Methods: 86 patients with sporadic ALS were compared to
213 healthy controls. HRV and clinical characteristics
(duration of the disease, site of onset, ALS functional rating
scale-revised (ALSFRS-R) was collected. 40 of 86 patients
were examined twice within a month to evaluate reliability
of HRV.
Results: A decrease in HRV was found in the ALS patients,
indicating dysfunction of autonomic cardiac control
(p<0.0001). ALSFRS-R was positively associated with
HRV (p<0.05). There were no differences of HRV
parameters between first and second exam of HRV.
Conclusions: These results suggest that cardiac autonomic
dysfunction in patients with ALS has sympathetic-activated
balanced with decreasing both sympathetic and
parasympathetic components. HRV is related to disability
of the disease.

P1499
Targeting GPNMB-mediated neuronal
protection as a novel therapeutic strategy
for amyotrophic lateral sclerosis
H. Tanaka, M. Shimazawa, M. Kimura, M. Takata,
K. Tsuruma, H. Hara
Molecular Pharmacology, Department of Biofunctional
Evaluation, Gifu Pharmaceutical University, Gifu, Japan
Introduction: Amyotrophic lateral sclerosis (ALS) is an
incurable and fatal neurodegenerative disease characterized
by the loss of motor neurons. Despite substantial research,
the causes of ALS remain unclear. Understanding these
causes may be critical for the development of effective
therapies. The purpose of this study was to identify a novel
target factor involved in ALS.
Methods: Glycoprotein non-metastatic melanoma protein
B (GPNMB) was identified as an ALS-related factor using
DNA microarray analysis with mutant superoxide dismutase
(SOD1G93A) mice. The crucial roles of GPNMB were
demonstrated through in vitro and in vivo biochemical and
morphological methods, including clinical tissue sample
studies.
Results: GPNMB was greatly induced in the spinal cords
of ALS patients and a mouse model as the disease
progressed. It was especially expressed in motor neurons
and astrocytes. In an NSC34 motor neuron cell line,
glycosylation of GPNMB was inhibited by interaction with
SOD1G93A, increasing motor neuron vulnerability,
whereas extracellular fragments of GPNMB secreted from
activated astrocytes attenuated the neurotoxicity of
SOD1G93A in neural cells. Furthermore, GPNMB
expression was substantial in the sera of sporadic ALS
patients compared to that of other diseased patients.
Conclusion: This study suggests that GPNMB can be a
novel target for therapeutic intervention for suppressing
motor neuron degeneration in ALS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 277
P1500
Review of the compliance with the Awaji-
Shima criteria for the diagnosis of MND in
a clinical setting
R. Sans1, E. Villamil2
1Clinical Neurophysiology, Betsi Cadwaladr University
Health Board, Rhyl, UK, 2Clinical Neurophysiology, Somnia,
Malaga, Spain
Introduction: After the change in diagnostic criteria for
MND there has been an enhanced role of EMG in the
diagnosis of the condition.
Objective: This is an audit study to assess the compliance
with recommended guidelines in a General DGH.
Patients and methods: All patients referred to our
department to specifically exclude MND were included, in
a period of 12 months (July 2010 to July 2011). The EMG
studies were revised in order to determine the amount of
muscle studies by EMG, its locations and the findings in
each muscle. NCS were also reviewed to exclude other
causes of symptoms.
Results: 37.5% of patients referred had definitive or
probable MND according to Iwaji-Shima criteria; 37.5%
had polyneuropathies and 18.75% had normal results. Other
findings were present in 6.25% of cases. Mean number of
muscles sampled was 5, in 2 or 3 territories.
Conclusions: Most patients had no need for extensive
EMG sampling as the changes were diagnostic enough.
However, some patients might have benefited of more
extensive bulbar and thoracic regions EMG sampling.
278 Posters, Sunday 9 September
P1501
Perception of ALS patients, carers and
doctors regarding clinical management
C. Oreja-Guevara1, F.J. Rodriguez de Rivera1,
J. Mascias2, J.L. Muoz-Blanco3, J. Esteban4, L. Galan5,
J.L. Villanueva-Marcos6
1Neurology, University Hospital La Paz, Idipaz, 2Neurology,
Hospital Carlos III, 3Neurology, Hospital Gregorio
Maraon, 4Neurology, Hospital 12 de Octubre, 5Neurology,
University Hospital San Carlos, 6Advance Directives
Register, Regional Health Service, Madrid, Spain
Non-invasive positive pressure ventilation (NIPPV)
increases survival and improves patient's quality of life.
Invasive mechanical ventilation (IMV) can prolong survival
in ALS. Percutaneous endoscopic gastrostomy (PEG)
improves nutrition but also no improvement in QOL is
known. The use of these procedures has often been
controversial.
Objective: To evaluate the point of view of ALS patients,
carers and physicians about the use of NIPPV, IMV, PEG.
Methods: 30 ALS patients, 30 caregivers and 30 physicians
from four different hospitals were examined with a cross-
sectional survey. The survey consists of three groups of
questions related to accepting or refusing the procedures in
different levels.
Results: Patients: mean age: 56.5; 76% males; mean
ALSFRS 31.6; duration of disease 568.6 days (sd 354.4);
FVC 72.6. 90% of ALS patients have a carer. All doctors
agree to use NIPPV in all patients and situations and 96%
of them to use the PEG for nutrition. With respect to NIPPV
50% of patients agree with the opinion of physicians and
caregivers and 26.6% regarding PEG. IMV was the most
controversial procedure; only 20% of patients accepted
IMV, like the caregivers and doctors. Physicians showed
very different opinions: from acceptation to rejection of
IMV.
Conclusion: Our findings demonstrate that the perception
of the patients, caregivers and doctors in relation to PEG,
IMV and NIPPV is very different. This study identified
some issues to take into account in order to better meet their
needs. Decisions should be taken by all together.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1502
The association between VEGF-2578C/A
polymorphism and amyotrophic lateral
sclerosis in a Russian population
E.V. Lysogorskaia, N.Y. Abramycheva, M.N. Zakharova,
S.N. Illarioshkin
Research Center of Neurology Russia Academy of Medical
Science, Moscow, Russia
Introduction: Amyotrophic lateral sclerosis is a devastating
neurodegenerative disorder with an important genetic
contribution. Studies of association of ALS with the
2578C/A, 1154G/A and 634G/C polymorphisms in the
vascular endothelial growth factor (VEGF) gene yielded
contradictory results. We investigated the VEGF 2578/A
polymorphism in a Russian cohort of patients with ALS.
Methods: An ALS group comprised 192 patients (103/192
males and 89/192 females) aged from 20 to 83 years (52
13.4); and a control group comprised 128 age- and sex-
matched persons. All studied individuals were Slavs.
TaqMan PCR was used for the VEGF 2578/A detection.
Results: The significant difference of the allele distribution
was observed between ALS cases and controls (2=11.1;
=0.004). The 2578A/A genotype increased the disease risk
to an adjusted odd of 1.66 (95% CI 1.03-2.29). Males
carrying 2578A/A had more increased risk of ALS
(OR=2.18; 95% CI 1.90-2.47). We found significant
association of the 2578A/A genotype with earlier disease
onset (OR=1.3; 95% CI 1.21-1.40) and rapid progression
(OR=1.7; 95% CI 1.27-2.13).
Conclusions: Our data show that VEGF 2578/A genotype
can modulate the risk of ALS in a Russian population.

P1503
X-linked bulbar and spinal muscular
atrophy; experiences from a single center
J.K. Kim1, D.H. Kim1, S.H. Choi2
Dong-A University Hospital, 2Wallace Memorial Baptist
1
Hospital, Busan, Republic of Korea
Background and objectives: Bulbar and spinal muscular
atrophy (BSMA, Kennedy disease) is an X-linked
degenerative disease of the motor neuron caused by an
expansion of CAG repeat within the androgen receptor
gene. We tried to characterize the presenting manifestation
for early and easy clinical diagnosis of BSMA.
Methods: 9 clinically compatible BSMA patients were
included. All patients were from a single center during the
period 2010 to 2011. Initial clinical manifestations,
neurological examinations and laboratory findings including
genetic study were investigated.
Results: Mean age was 47.9 years and mean duration from
symptom onset to diagnosis was 45.9 months. From the
neurological manifestations, the most frequent and
consistent finding was perioral tremor (100%) typically
provoked by movements such as talking and postural hands
tremor (100%). Gynecomastia was observed in 5 patients
(62.5%) and only half of cases had bulbar symptom and
sign. Fasciculations and hypo/a-reflexia were found only in
4 patients (50%). All patients showed the pattern of chronic
motor dominant polyneuropathy with axonal involvement
in NCSs and needle electromyography. Decremental
responses in Jolly test were found in all cases from 6
patients studied. This means abnormal neuromuscular
transmission is not a rare manifestation of BSMA during a
certain stage of this disease.
Conclusion and discussion: Perioral tremor is the most
frequent and consistent finding in BSMA and it showed a
typical action induced pattern. This supports us making
clinical diagnosis of BSMA easier. The pattern and
distribution of motor weakness in tongue and limb muscle
are variable.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 279
P1504
IVIg treatment in post-polio patients;
quality of life before and after 6 months -
results from an open clinical study
G. stlund, L. Broman, L. Werhagen, K. Borg
Division of Rehabilitation Medicine Department of Clinical
Sciences Karolinska Institutet Danderyd Hospital,
Stockholm, Sweden
Introduction: Vitality (Gonzalez et al 2006) and pain
(Farbu et al 2007) were significantly improved in post-polio
(PPS) patients after IvIg treatment. Characteristics of
responders and non-responders have not been pin pointed.
Aims: To evaluate quality of life after IvIg treatment in PPS
patients before and after 6 months and to identify parameters
influencing the outcome.
Methods: Open trial, prospective follow-up study. 113 PPS
patients from a Swedish PPS outpatient-clinic who had
received one IvIg treatment were included. Quality of life,
pain and physical activity were measured by Short form 36
(SF-36), Visual Analogue Scale (VAS) and Physical Activity
Scale for the Elderly (PASE) and were answered before
treatment and after 6-month. Clinical examination of
medical records was performed before IvIg treatment.
Descriptive statistics were done for all variables before
treatment. To compare SF-36, VAS-pain and PASE before
treatment and at 6-month follow-up, Wilcoxon non-
parametric tests were performed.
Results: SF-36: Bodily pain (BP) (p=0.002), and Vitality
(VT) (p=0.008) were significantly increased after 6 month.
Increased BP and VT scores were seen in those under 65
years of age and in those with paresis only in lower
extremities. Increasing BP, was seen in those who were
working, increasing VT was seen in patients with pain.
Conclusions: SF-36: Bodily pain and vitality were
improved 6 months after IVIG treatment. Age below 65
years and pain before treatment may be indicators for future
identification of responders.
280 Posters, Sunday 9 September
P1505
The involvement of GPNMB in neuronal
cell death by endoplasmic reticulum
stress
M. Takata, H. Tanaka, K. Tsuruma, M. Shimazawa,
H. Hara
Molecular Pharmacology, Department of Biofunctional
Evaluation, Gifu Pharmaceutical University, Gifu, Japan
Introduction: Glycoprotein transmembrane non-metastatic
melanoma B (GPNMB) is a single transmembrane protein.
GPNMB is involved in the pathogenesis of several cancers
and glaucoma. However, the involvement of GPNMB in the
central nervous system is unclear. Recently, it has been
reported that GPNMB is localized in the rough endoplasmic
reticulum (ER), suggesting that GPNMB has several roles
in ER. The purpose of this study was to investigate the
effects of GPNMB against ER stress-induced neuronal cell
death.
Methods: We used mouse motor neuron (NSC34) cells and
evaluated the roles of GPNMB against ER stress by
GPNMB knockdown using siRNA and treating with
recombinant extracellular fragments of GPNMB.
Furthermore, we investigated the protein and mRNA
expressions of glucose-regulated protein 78 (GRP78/BiP)
and C/EBP homologous protein (CHOP), ER stress-related
factors.
Results: The protein expression of GPNMB was increased
by thapsigargin-induced ER stress as well as the protein and
mRNA expressions of BiP and CHOP. GPNMB knockdown
significantly increased the ER stress-induced neuronal cell
death, and suppressed the induction of BiP protein and
mRNA, but not CHOP. Moreover, the recombinant GPNMB
had protective effects against ER stress-induced neuronal
cell death with no effects on BiP expression.
Conclusion: These results suggest that intracellular
GPNMB may regulate the transcription of BiP and have
protective effects against thapsigargin-induced ER stress.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1506
Compound heterozygosity with two
mutations in the HEXB gene produces
adult Sandhoff disease presenting as a
motor neuron disease
S.-Y. Kang
Neurology, School of Medicine, Jeju National University,
Jeju, Republic of Korea
Introduction: Sandhoff disease is a rare autosomal
recessive metabolic disorder of GM2 gangliosides. It is
caused by a lack of functional N-acetyl--D-glucosminidase
A and B due to mutations in the HEXB gene. Little
information is available on molecular defects involved in
adult Sandhoff disease presenting as motor neuron disease
phenotype.
Case report: We describe a 55-year-old woman with adult
Sandhoff disease presenting as motor neuron disease. The
assay of total hexosaminidase involving A and B showed
decreased level of these activities. Analysis of HEXB gene
demonstrated two point mutations. The two mutations were
located at the exon 5 (c.619A>G) and exon 11 (c.1250C>T).
Conclusion: Compound heterozygosity of these two
mutations may trigger the development of adult Sandhoff
disease with a motor neuron disease phenotype. In patients
with motor neuron disease in the setting of a possibly
recessive disorder, Sandhoff disease should be suspected,
even when the onset age is over 50 years.

P1507
Functional gait and pulmonary function in
patients with amyotrophic lateral
sclerosis: a direct relationship
B. Heredia Camacho1, M. Castillo1, A. Hochsprung1,
G. Izquierdo Ayuso2
Biofunctional Neuropyisiotherapy, 2Neurology, University
1 Neuroscience, University of Torino, Italy
Hospital Virgen Macarena, Sevilla, Spain
Introduction: Amyotrophic lateral sclerosis (ALS) is a
neurodegenerative disease marked by progressive loss of
motor neurons, muscle wasting and respiratory dysfunction.
Hypothesis: one of the factors influencing the progressive
loss of functional gait is respiratory dysfunction.
Methods: Participants: 11 patients with suspected or
definitive diagnosis of ALS, with a functional gait, included
in a Physical Therapy programme of once-a-week
assistance. Informed consent was obtained from each
subject. Five consecutive measures of VC and FEV1 were
obtained from spirometry. Walking was documented using
an 8-meters GaitRite electronic walkway, and a Functional
Ambulance Profile (FAP) was obtained. Each measure was
observed and a graphic was made in order to compare each
parameter (FEV1, VC and FAP). A 2-way ANOVA and a
Bonferroni post-test were made.
Results: 6 patients obtained a negative progression in FAP.
Of them, 5 registered a lower FEV1 and 3 subjects, a lower
VC. 2 of them, obtained the same measure in VC. At the
same time, from 3 patients with a better FAP score, 2
obtained a better VC and also a higher FEV1. Both measures
have a significant interaction (p<0.0001).
Conclusions: FAP score is positively correlated with CV
and FEV1 measures. Furthermore, these functional
respiratory measures demonstrate a good correlation with
the functional evolution in patients with ALS. In addition, a
specific respiratory program must be included in a
Biofunctional Neurophysiotherapy program.
Because of the small number of patients included, more
studies are necessaries.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 281
P1508
A case report of a patient with ALS and
an obsessive-compulsive disorder
carrying expansion of C9ORF72
C. Moglia, A. Calvo, A. Canosa, E. Bersano, A. Ilardi,
G. Restagno, A. Chio'
It has been recently reported that a large proportion of
patients with familial ALS and frontotemporal dementia are
associated with a hexanucleotide repeat expansion in the
first intron of c9orf72. We describe a patient with a diagnosis
of ALS-FTD with psychiatric onset. At the age of 50 hour
patient developed a depressive disorder. Some months later,
muscle weakness at the right hand occurred, followed by
worsening of the mood disorder. The collection of familial
history revealed that the patient's father died after a 5-year
history of ALS. Neither cognitive nor behavioural
impairment were reported. Genetic analysis revealed a
hexanucleotide expansion in the first intron of the c9orf72
gene. MRI documented a marked hyperintensity along the
corticospinal tract; MRI fibre-tracking revealed bilateral
reduction of fractional anisotropy along the corticospinal
tract. Brain PET-CT presented reduced uptake of the
radioactive tracer in the motor cortex bilaterally, in the
fronto-mesial cortex bilaterally, between the anterior and
the middle cingulate gyrus and in the postero-lateral
occipital cortex bilaterally. The clinical and
neuropsychological assessment was consistent with a
diagnosis of FTD, associated to OCD, hallucinations and
depressive mood disorder. Later the patient developed
dysarthria, dysphagia, lower limbs weakness and
hypotrophy and worsening of spasticity at upper and lower
limbs. 14 months after the onset of the motor neuron
disease, he is still alive, wheelchair-bound.
The association of ALS, FTD, depression, psychotic
manifestations and OCD could set up a distinctive
phenotype related to c9orf72 gene expansion. Nevertheless,
this hypothesis needs to be confirmed by further
observations.
282 Posters, Sunday 9 September

P1509
Effects of neurotrophic factors on
oxidative and nitrosative stress in
amyotrophic lateral sclerosis G93A
murine model
I. Kochergin1,2, L. Brylev1,2, M. Onufriev2, I. Barskov1,
M. Zakharova1, I. Zavalishin1, N. Gulyaeva2
1Research Center of Neurology RAMS, 2Institute of Higher
P1515
Metabolomics as a tool for studying
neurodegenerative diseases
A. Wuolikainen1,2, the Erling-Persson Metabolomics
Project at Ume University
1Department of Chemistry, 2Computational Life Science
Cluster (CLiC), Ume University, Ume, Sweden

Nervous Activity and Neurophysiology, RAS, Moscow, Russia P1516

Neurolathyrism in Ethiopia
P1510 H.D. Belay, H. Demissie
Amyotrophic lateral sclerosis as a Department of Neurology, Addis Ababa University, Addis
paraneoplastic syndrome Ababa, Ethiopia
A. Riahi, M. Messelmani, H. Khaled, M. Mansour,
J. Zaouali, R. Mrissa P1517
Neurology, Military Hospital, Tunis, Tunisia
Cervical flexion myelopathy caused by a
spinal intradural cyst
P1511 D. Kondziella1, L.R. Damhave1, A. Wagner2, K. Hansen1
Neurodegenerative overlap syndrome: 1Department of Neurology, 2Department of Neuroradiology,

Copenhagen University Hospital, Rigshospitalet,

a case report
Copenhagen, Denmark
M. Minar, P. Valkovic
Second Department of Neurology, Comenius University,
Bratislava, Slovak Republic P1518
The therapeutic efficacy of herbal
P1512 medicine for olivopontocerebellar atrophy
Vestibular evoked myogenic potentials in versus genetic spinocerebellar ataxia 6
amyotrophic lateral sclerosis T. Okabe
Department of Integrated Traditional Medicine, University
N. Tarasevich, S. Likhachev, U. Lukashevich,
of Tokyo, Japan
Y. Rushkevich
Republican Research and Practical Centre of Neurology and
Neurosurgery, Minsk, Belarus P1519
The use of sulbactam treatment in ALS
P1513 patients
Hirayama disease: a report of two cases N. Polat1, H.A. Idrisoglu2, A. Sazci2
1Merd Company, 2Department of Neurology, Medical
A. Jaoua, S. Benamor, S. Benammou
CHU Sahloul, Sousse, Tunisia Faculty of Istanbul, Turkey

P1514 P1520
Cramp-fasciculation syndrome in the The controversy behind Mills syndrome
differential diagnosis of amyotrophic E. Tufanoiu, A.M. Corfu
Neurology, Fundeni Clinical Institute, Bucharest, Romania
lateral sclerosis
J. Domnguez Brtalo1, A. Hernndez Gonzlez1,
B. Miguel Martin1, C. Valencia Guadalajara1,
A. Lopez Garca1, G. Martn Palomeque2, A. Castro
Ortiz2
1Neurology, 2Neurophysiology, Hospital General Ciudad

Real, Spain

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


Movement disorders 1
P1521
Interim results from an international,
open-label study of levodopa-carbidopa
intestinal gel in patients with advanced
Parkinsons disease: efficacy results by
country
P. Odin1,2, A.J. Espay3, A.D. Vanagunas4, R.A. Hauser5,
H.H. Fernandez6, D.G. Standaert7, W.Z. Robieson8,
Y. Pritchett8, K.L. Widnell8, K. Chatamra8, J. Benesh8,
R.A. Lenz8
1Klinikum-Bremerhaven, Bremerhaven, Germany, 2Skane
University Hospital, Lund, Sweden, 3University of Cincinnati
Academic Health Center, Cincinnati, OH, 4Northwestern
University, Chicago, IL, 5University of South Florida,
Tampa, FL, 6Cleveland Clinic, Cleveland, OH, 7University of
Alabama at Birmingham, Birmingham, AL, 8Abbott, Abbott
Park, IL, USA
Introduction: Fluctuating blood levels of levodopa are
associated with motor complications in Parkinsons disease
(PD). Levodopa-carbidopa intestinal gel (LCIG) is delivered
continuously via a percutaneous endoscopic
gastrojejunostomy (PEG-J) tube.
Methods: An international, 54-week, open-label study of
LCIG in patients with advanced PD experiencing motor
fluctuations despite optimized standard therapy is ongoing
(NCT00335153). Individualized LCIG dosing was
instructed to be 16 hr/day. Efficacy outcomes included
Off time and On time with and without troublesome
dyskinesia (TD). Adverse events (AEs) were monitored.
This interim analysis included assessments performed on or
prior to the data cut-off date of Nov. 25, 2011. Efficacy and
safety endpoints were tabulated across 16 enrolling
countries.
Results: At data cut-off, 354 subjects had nasojejunal tube
insertion and 323 had received subsequent PEG-J tube.
Across countries, mean [SD] baseline values ranged from:
Age, 53.9[6.3]-70.1[6.9] yrs; PD duration, 9.2[3.9]-
16.0[6.4] yrs; Off time, 5.7[1.9]-8.4[3.3] hr/day; On
time without TD, 6.7[2.9]-8.5[2.7] hr/day; On time with
TD, 0.2[0.6]-2.3[2.2] hr/day. In each country, the change
from baseline in Off time and On time without TD was
significantly improved (p<0.05) as early as week 4, and
sustained through week 54. At week 54, mean [SD] Off
time improvements ranged from -3.4[3.9] to -5.8[2.7]hr/
day, and improvements in On time without TD ranged
from 4.1[3.8]-6.3[3.5]hr/day. Additional analyses of
baseline characteristics among countries will be included in
the presentation. AE profiles were similar across countries.
Conclusions: LCIG consistently improved motor symptoms
and resulted in similar AE profiles across countries.
Support: Abbott
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 283
P1522
A panel of five CSF biomarkers can be
used with high accuracy in the differential
diagnosis of patients with dementia
and/or parkinsonism
S. Hall1,2, A. hrfelt3, R. Constantinescu4,
U. Andreasson3, Y. Surova1,2, F. Bostrm1,5, C. Nilsson6,
H. Widner1,2, H. Decraemer7, K. Ngga1,5, L. Minthon1,5,
E. Londos1,5, E. Vanmechelen7, B. Holmberg4,
H. Zetterberg3, K. Blennow3, O. Hansson1,2,5
1Department of Clinical Sciences, Lund University,
2Department of Neurology, Skne University Hospital, Lund,
3Department of Psychiatry and Neurochemistry, Institute of
Neuroscience and Physiology, The Sahlgrenska Academy at
University of Gothenburg, 4Department of Neurology,
Sahlgrenska University Hospital, Gothenburg,
5Neuropsychiatric Clinic, Skne University Hospital, Malm,
6Department of Cognitive Medicine, Skne University
Hospital, Lund, Sweden, 7ADx NeuroSciences, Gent, Belgium
Introduction: Due to overlapping symptomatology, it can
be difficult to clinically distinguish Parkinsons disease
(PD) from atypical parkinsonism, i.e. multiple system
atrophy (MSA), progressive supranuclear palsy (PSP) and
corticobasal degeneration (CBD). There is also an overlap
in clinical symptoms and brain pathologies between
dementia disorders, including Alzheimers disease (AD),
dementia with Lewy bodies (DLB) and PD with dementia
(PDD). There is thus a need for biomarkers to improve the
diagnosis of these disorders.
Method: CSF samples (n=453) were obtained from
controls, subjects with PD, PDD, DLB, AD, PSP, MSA and
CBD. A newly developed Luminex multiplex assay was
used for simultaneous quantification of -synuclein, A42,
T-Tau and P-tau. ELISA was used to analyze NF-L.
Results: CSF -synuclein was decreased in patients with
PD, PDD, DLB and MSA, but increased in AD. CSF
-amyloid1-42 was decreased in DLB, but even further
decreased in AD. CSF T-Tau and P-Tau were increased in
AD. Multivariate analysis revealed that these four
biomarkers could differentiate AD from DLB and PDD with
an AUC of 0.90, where -synuclein and T-Tau contributed
most to the model. NF-L was substantially increased in
atypical parkinsonian disorders (PSP, MSA, and CBD).
Multivariate analysis revealed that NF-L alone could
differentiate PD from atypical parkinsonian disorders with
an AUC of 0.93.
Conclusions: CSF -synuclein improves the differential
diagnosis of AD vs. DLB and PDD, and when combined
with established AD-biomarkers the diagnostic accuracy
reaches 90%. Neurofilament light chain alone can
differentiate PD from atypical parkinsonian disorders with
an accuracy of 93%.
284 Posters, Sunday 9 September
P1523
Assessing postural stability in early
Parkinsons disease - how valid are
commonly used clinical assessment
tests?
I.M. Claesson1,2, A. Sthle1
Institution of Neurobiology, Care Sciences and Society,
1
Karolinska Institutet, 2Division of Physiotherapy, Karolinska
Universitetssjukhuset, Stockholm, Sweden
Background: Postural instability is an important symptom
of Parkinsons disease (PD) that may cause problems in
daily life. It is, therefore, important to screen for this
problem to identify those at risk for falling and to reduce
hazardous falls. The primary aim of this study was to
examine the suitability of different clinical assessment tests
for the screening of postural stability in early PD.
Methods: 28 people with idiopathic PD were assessed with
commonly used clinical assessment tests, i.e. the Berg
Balance Scale (BBS), Timed Up and Go (TuG), Timed Up
and Go-cognition (TuG-cog), the Modified Figure of Eight
(MFE), walking 30 meters at self-paced and maximum
speeds, together with disease severity rating, self-reported
fall history, the Falls Efficacy Scale-International (FES-I)
and the Freezing of Gait Questionnaire (FOG-Q). The
Bckstrand, Dahlberg, and Liljens Balance Scale (BDL),
with more complex balance demands, was also validated.
Correlations between the different assessment tests,
questionnaires, ratings of disease severity, and fall history
were calculated.
Results: Tests that included walking with a turning task
were more predictive of risk of fall and more highly
correlated to the disease severity rating scales than were the
other tests. The questionnaires FES-I and FOG-Q did not
correspond to actual falls or to disease severity.
Conclusions: To evaluate postural stability in early PD, we
suggest a battery of tests that includes the TuG, the TuG-
cog, and the MFE. For evaluating exercise intervention in
early PD the BDL is a better test than the BBS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1524
Dystonia in corticobasal degeneration:
a review of the literature on 404
pathologically proven cases
M. Stamelou, A. Alonso-Canovas, K. Bhatia
UCL Institute of Neurology, London, UK
Background: Dystonia is considered one of the classical
features of corticobasal degeneration and is reported in up
to 83% in clinical series.
Methods: We reviewed the literature on 404 pathologically
proven cases and noted the presence, age at onset,
distribution, evolution and treatment of dystonia, associated
features and final clinical diagnosis.
Results: Dystonia was present in only 37.5% of the 296
cases, with adequate information. The majority of them
presented with a corticobasal syndrome and dystonia
occurred in the first two years from disease onset, affecting
the upper limb. In phenotypes where dementia was the
cardinal feature, dystonia tended to appear later in the
disease course and to affect more cervical region and face.
54% of 374 cases, where the phenotype was available,
presented as corticobasal syndrome, 15% as frontotemporal
dementia and 10.7% as progressive supranuclear palsy.
48.8% of corticobasal syndrome cases presented with
dystonia, 51.5% with myoclonus, 86.3% with apraxia and
100% with akinetic-rigid syndrome.
Conclusion: Despite dystonia being an inclusion criterion
in all sets of clinical criteria for corticobasal degeneration,
this was present in only one third of the pathologically
proven cases presented here. Dystonia and myoclonus were
present in about half of all cases with corticobasal syndrome,
implying that these features may not be that frequent in
corticobasal syndrome as are akinetic-rigid syndrome and
apraxia. Dystonia and myoclonus almost co-occurred in our
analysis, suggesting a possible association. More accurate
characterization of dystonia in corticobasal degeneration
would be of importance for clinical diagnosis and
development of treatment strategies.

P1525
Clinical features of corticobasal syndrome
with midbrain atrophy
R. Hayashi, T. Oeda, A. Umemura, M. Kousaka,
S. Tomita, H. Nakano, H. Sawada
Clinical Research Center and Neurology, National Hospital
of Utano, Kyoto, Japan
Introduction: Mesencephalic tegmentum atrophy can be a
maker for progressive supranuclear palsy (PSP). However,
patients with corticobasal syndrome (CBS) often share
common pathological and clinical features with PSP, and
some cases show midbrain atrophy (MA). The purpose of
this study was to clarify clinical features in CBS with MA
comparing that without MA.
Methods: 34 patients with CBS (male 32%, age 72.77.6),
46 patients with PSP (male 67%, age 73.17.3), and 31
healthy controls (male 45%, age 66.712.1) were
investigated. Midbrain area was measured on planimetry
using mid-sagittal MRI. The cut-off point of midbrain area
discriminating between PSP and control was 112mm2
(sensitivity 91.3%, specificity 90.3%). We classified CBS
patients into two groups, CBS with MA (112mm2) and
without MA (>112mm2), and compared clinical features
such as age, sex, FAB, MMSE, postural instability with fall
2 years (PIF) and vertical gaze palsy (VGP) between the
groups. The clinical factors which are independently
associated with MA were identified by a general linear
model.
Results: Comparing the clinical factors in the two groups,
patients with MA were older and more often showed PIF
and VGF than patients without MA. The general linear
model analysis revealed that MA was independently
associated with PIF ( 21.3, p=0.004), VGP ( 13.8,
p=0.043) and FAB score ( 3.4, p=0.007).
Conclusion: MA in patients with CBS was associated with
PSP-like features.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 285
P1526
Characterization of gait disturbance in
patients with normal pressure
hydrocephalus
R. Schniepp1, M. Wuehr2, C. Pradhan2, K. Jahn1
1Neurology, University of Munich, 2Integrated Research and
Treatment Center for Vertigo, Oculomotor and Balance
Disorders, University Munich, Germany
In normal pressure hydrocephalus (NPH) a disturbance of
gait is typically the first symptom to appear. The most
common test for the outcome of a shunt operation is a CSF
tap test. In this study we investigated which gait parameters
positively respond to CSF tapping and at which time period
after tapping this response is most pronounced. The study
cohort comprised 41 patients (72.210.0 years, 12 females).
Gait analysis was performed on a pressure-sensitive gait
carpet (GaitRITE). Patients were tested under two different
speed-, two cognitive dual-task- and one motor dual-task-
condition. A Principal Component Analysis was performed
in order to identify relevant gait parameters. Extracted
parameters were then analyzed at different time points and
under different gait analyses. Positive effects of CSF
tapping were most pronounced during walking with
preferred walking speed. Patients did also show
improvements while walking with maximal speed and for
the motor dual-task but not for the two cognitive dual task
conditions. Velocity, stride length, stride time and double
support time were the parameters that responded most
positively (p<0.01). In nearly all cases improvements were
detectable not till 12h or even 48h after the CSF tapping.
These results indicate that in a multi-parametric analysis of
the preferred walking pattern covers a positive CSF tap test
best. In addition, gait examinations immediately after the
CSF tap test will overlook most gait improvements and
therefore gait assessments at later time points are necessary
to detect all positive effects on the walking performance.
286 Posters, Sunday 9 September
P1527
Prepulse inhibition in idiopathic REM
sleep behaviour disorder, Parkinsons
disease and multiple system atrophy
M. Zoetmulder1,2,3, H.B. Biernat1, M. Nikolic4,
L. Korbo1, P.J. Jennum2,3
1Neurological Department, Bispebjerg Hospital,
Copenhagen, 2Danish Center for Sleep Medicine,
Department of Clinical Neurophysiology, Glostrup Hospital,
Glostrup, 3Center for Healthy Aging, University of
Copenhagen, 4Department of Clinical Neurophysiology,
Glostrup Hospital, Glostrup, Denmark
Introduction: Prepulse inhibition (PPI) of the acoustic
startle response is a measure of sensorimotor gating, in
which a weaker prestimulus (prepulse) inhibits the reaction
of an organism to a subsequent strong startling stimulus
(pulse). The objective of this study was to determine
whether patients with idiopathic REM sleep behaviour
disorder (iRBD), Parkinsons disease (PD) and multiple
system atrophy (MSA) have altered PPI.
Methods: 21 PD patients with RBD, 20 PD patients without
RBD, 12 with iRBD, 10 with MSA and 20 healthy and
gender-matched controls entered and completed the study.
A passive acoustic PPI paradigm was applied with prepulses
5dB and 15dB above background noise at 30-, 60-, 120- and
300-ms intervals.
Results: Startle-response characteristics (latency and
habituation) did not differ between patients and controls
(p0.05). Non-parametric analyses showed that MSA
patients had a significantly lower PPI than the other groups
for the 60ms - 85dB and 120ms - 85dB prepulses. No
differences in PPI were found between the other groups.
Conclusion: The present study suggests that prepulse
inhibition is markedly altered in MSA. Since striatal
dopaminergic function and the pedunculopontine nucleus
(PPN) play a major role in prepulse inhibition, these results
are in line with the functional involvement of the striatum
and PPN in the pathogenesis of multiple system atrophy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1528
Hip fractures in people with idiopathic
Parkinsons disease: incidence and
outcomes
R. Rutherford1, R. Hancock1, A. Chaplin2, W. Gray3,
R. Walker3
1Medical School, Newcastle University, Newcastle Upon
Tyne, 2Medicine, Northumbria Healthcare NHS Foundation
Trust, Ashington, 3Medicine, Northumbria Healthcare NHS
Foundation Trust, North Shields, UK
Introduction: People with Parkinsons disease (PD) are
thought to be at increased risk of hip fracture compared to
the general population, with poorer outcomes post-surgery.
The aim of this audit was to establish the incidence of, and
outcomes from, hip fracture in people with and without PD
living in north-east England.
Methods: Data from two previous prevalence studies in the
same geographical area was used to estimate the number of
people with PD living in the study area. Using data collected
prospectively for the UK national hip fracture database, the
annual incidence of hip fracture in people with and without
PD was calculated. Type of fracture, time to surgery, time to
discharge and 30-day outcomes from surgery were
compared for PD and non-PD patients.
Results: The annual incidence of hip fracture was
significantly higher in people with PD across all age bands.
In those aged 60 years and over it was 2032 (95% CI 1945
to 2121) per 100.000 in people with PD and 552 (95% CI
507 to 599) per 100.000 in people without PD. The
experience of PD and non-PD patients within hospital was
remarkably similar. However, PD patients had poorer
mobility prior to hip fracture, took longer to be discharged
to the community, and were less mobile post-surgery.
Conclusions: People with PD have a significantly higher
incidence of hip fracture than people without PD and post-
surgical outcomes are poorer. Specific guidelines for
managing people with PD who sustain a hip fracture may
improve outcomes.

P1529
Cost effectiveness of Apomorphine
infusion in the treatment of advanced
Parkinsons disease in the UK
E. Walter, D. Mercsanits
Institute for Pharmaeconomic Research, Vienna, Austria
Objectives: Parkinsons disease (PD) is the second
commonest neurological disability and affects 100-180
people per 100.000 of the population and increases with
age. Continuous subcutaneous apomorphine represents an
alternative treatment option of advanced PD with motor-
fluctuation. The purpose of this analysis was to estimate the
cost-effectiveness of Apomorphine infusion (APO)
compared with Levodopa/carbidopa intestinal gel (LCIG),
Deep-Brain-Stimulation (DBS) and Standard-of-care
(SOC).
Methods: We developed a Markov-Model to simulate the
long-term consequences, disease progression (Hoehn&Yahr-
stages 3-5, percentage of waking-time in the OFF-state),
complications and adverse-events. Complications are
different for the alternatives (e.g. pump problems in case of
LCIG, temporary/permanent complications in case of
DBS). We include moderate and severe adverse-events and
death. Monte-Carlo-simulation accounted for uncertainty.
The model includes 25 health-states. Probabilities were
derived from RCT and open-label studies; direct costs
(2012 ) from published sources from the payers
perspective. QALYs, life-years and costs were projected
over a life-time horizon and discounted at 3.5%.
Results: Over a life-time horizon, costs associated with
apomorphine amounts to 46,053.42 and 2.05 QALYs (4.4
LYs). Costs associated with LCIG are 92,753.42 and 2.40
QALYs (5.3 LYs). The cost-saving amounts to 46,700 per
patient and the incremental-cost per QALY gained (ICER)
was 129,903. Costs associated with DBS are 61,893.08
and 2.16 QALYs (4.98 LYs). Apomorphine dominates DBS.
ICER amounts to 143,215.73 favourable for apomorphine.
SOC associated total-costs are 60,312.19 and 1.75 QALYs
(4.04 LYs). Apomorphine dominates SOC.
Conclusion: Apomorphine is a cost-effective alternative,
reducing OFF-time and improving quality-of-life, and is
associated with a cost-advantage.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 287
P1530
The influence of striatal dopamine on the
modulation of upper limb locomotor
synergies
I.U. Isaias1,2,3, A. Cattaneo1, J. Volkmann3, A. Marzegan1,
G. Marotta4, P. Cavallari1, G. Pezzoli2
1Dipartimento di Fisiologia Umana, L.A.M.B. P.&L.
Mariani, Universit degli Studi di Milano, 2Centro per la
Malattia di Parkinson e i Disturbi del Movimento, Istituti
Clinici di Perfezionamento, Milan, Italy, 3Neurologische
Klinik und Poliklinik, Universittsklinik Wrzburg, Germany,
4Dipartimento di Medicina Nucleare, Fondazione IRCCS Ca
Granda Ospedale Maggiore Policlinico, Milan, Italy
Introduction: Reduced arm swing while walking is a
clinical hallmark of Parkinsons disease (PD) suggesting a
direct involvement of the basal ganglia.
Aim: We investigated the role of striatal dopamine on the
modulation of upper limb synergies during walking at
different velocities.
Method: Patients were recruited according to several
inclusion criteria, including normal spatio-temporal
parameters of the stride at preferred gait speed. After 3-day
drugs-off state, 13 patients and 10 healthy controls (HC)
were asked to walk at preferred, slow and fast speed (12
trials). Kinematics were measured using an optoelectronic
system. Striatal dopaminergic innervation was measured by
FP-CIT and SPECT.
Result: At preferred gait speed, all patients showed reduced
range of motion (ROM) at one arm and four bilaterally. In
PD, ROM of the most affected arm (median: 7, range:
3.9-16.3) was significantly reduced compared to HC
(median: 25.27, range: 14.6-29.1; p<0.01). The range of
gait velocities (Km/h) was similar between patients (range:
1.93-7.81, median: 3.49) and HC (range: 1.24-8.15, median:
3.76). While walking at different velocities, patients
modulated arm swing similarly to HC (RSquare average,
PD: 0.51; HC: 0.71; p<0.001 both), although to a lesser
extent (no statistical significance). Such a modulation,
measured as linear correlation slope, as well as arm ROM
reduction at preferred gait speed, was not predicted by
contralateral striatal dopaminergic loss and clinically tested
rigidity or bradykinesia.
Conclusion: Rather than striatal dopaminergic tone per se,
mesencephalic centres (i.e. PPN and reticular system) might
be involved in the modulation of upper limb locomotor
synergies.
288 Posters, Sunday 9 September
P1531
Association between irritable bowel
syndrome and restless legs syndrome:
a comparative study with control group
R. Borji1, S.-M. Fereshtehnejad2, S. Taba Taba Vakili3,
N. Ebrahimi Daryani1, H. Ajdarkosh1
1Tehran University of Medical Sciences, Tehran, Iran,
2Neurobiology, Care Sciences & Society (NVS), Karolinska
Institutet, Stockholm, Sweden, 3Shaheed Beheshti University
of Medical Sciences, Tehran, Iran
Background: As a common gastrointestinal (GI) disorder,
irritable bowel syndrome (IBS) has been reported to be
associated with some psychological and neurological
factors. This study aimed to evaluate the prevalence rate of
restless legs syndrome (RLS) in a sample of IBS patients
and to compare this prevalence with that of matched healthy
controls.
Methods: This prospective comparative study was
conducted in Tehran, Iran during 2010 and 2011. Based on
the Rome III criteria, a total number of 225 definite IBS
patients and 262 age- and sex-matched healthy controls
were recruited in the final assessment to compare the
prevalence rate of RLS between the two groups.
Results: RLS was significantly more frequent in IBS group
(25.3% vs. 6.5%, p<0.001) which leads to an odds ratio
(OR) of 4.89 (95%CI: 2.75-8.70). IBS patients with
comorbid RLS suffered significantly more from stomach
pain [96.5% vs. 86.3%, OR=4.36 (95%CI: 1-19.12)],
nausea [40.4% vs. 21.4%, OR=2.48 (95%CI: 1.3-4.73)] and
vomiting [10.5% vs. 2.4%, OR=4.82 (95%CI: 1.31-17.76)].
Conclusion: Having enrolled a considerable number of IBS
patients and healthy controls, our study showed a
significantly higher prevalence of RLS in IBS patients.
Surprisingly, a higher prevalence rate of RLS was also
accompanied by a more severe discomfort and stomach
pain in IBS patients. It seems that screening patients with
IBS for RLS may lead to greater identification of RLS and
improved treatment of both conditions.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1532
Longstanding idiopathic dystonia
preceding Parkinsons disease
R. Modreanu, Y. Compta, M.J. Marti
Parkinsons Disease & Movement Disorders Unit, Hospital
Clnic, Barcelona, Spain
Introduction: There are few descriptions of idiopathic
dystonia preceding in years or even decades the onset of
idiopathic Parkinsons disease (PD). These reports pointed
to a possible common etiologic mechanism.
Patients and methods: We reviewed the medical records of
patients with initial focal dystonia who had been followed
in our clinic and further developed PD. Data about
demographic, clinical and genetic features, and response to
treatment of dystonia and parkinsonism were collected
retrospectively.
Results: There were 7 patients (5 men and 2 women), with
a mean age of dystonia onset of 47 (35 to 52) years and a
mean age of PD onset of 60 (55 to 63) years. The time
between dystonia and parkinsonism ranged from 3 to 28
years (median 15.3). 2 patients presented with writers
cramp, 3 with blepharospasm, 1 with cervical and 1 with
segmental (cranio-cervical) dystonia. 5 patients had a mixed
parkinsonism (with resting tremor) and 2 a rigid-akinetic
type. Genetic tests for LRKK2 and parkin mutations were
performed in 5 patients and were negative. 5 patients
received anticholinergics for dystonia without improvement.
All received levodopa and 5 of them also dopaminergic
agonists with good response of parkinsonism, but no
changes in dystonia.
Conclusions: The co-existence of dystonia with
parkinsonism suggests a possible common patho-
physiological mechanism. The previous descriptions of
dystonia preceding parkinsonism in PD antedated the
discovery of monogenetic causes of parkinsonism which
can in turn present with dystonia, but in our short series
such mutations do not appear to underlie this uncommon
association.

P1533
Unmyelinated axons are more vulnerable
to degeneration than myelinated axons of
the cardiac nerve in Parkinsons disease
S. Orimo1, T. Uchihara2, Y. Itoh3, A. Kakita4,
K. Wakabayashi5, H. Takahashi4
1Kanto Central Hospital, 2Tokyo Metropolitan Institute of
Medical Science, 3Yokufukai Geriatric Hospital, Tokyo,
4University of Niigata, Niigata, 5Hirosaki University
Graduate School of Medicine, Hirosaki, Japan
Aims: The aim of this study is to determine whether there
is a difference in the degenerative process between
unmyelinated and myelinated axons of the cardiac nerve in
Parkinsons disease (PD).
Background: We recently reported cardiac sympathetic
denervation in PD and dementia with Lewy bodies, which
accounts for the reduced cardiac meta-iodobenzylguanidine
(MIBG) uptake on MIBG myocardial scintigraphy in these
disorders. Furthermore, we demonstrated accumulation of
[alpha]-synuclein aggregates of the cardiac sympathetic
nerve in PD and a possible relationship between
degeneration of the cardiac sympathetic nerve and [alpha]-
synuclein aggregates.
Methods: We immunohistochemically examined cardiac
tissues from 4 pathologically verified PD patients, 9 patients
with incidental Lewy body disease (ILBD) and 5 control
subjects, using antibodies against neurofilament, myelin
basic protein (MBP) and -synuclein. First, we counted the
number of neurofilament-immunoreactive axons not
surrounded by MBP (unmyelinated axons) and those
surrounded by MBP (myelinated axons). Next, we counted
the number of unmyelinated and myelinated axons with
-synuclein aggregates.
Results: (i) The percentage of unmyelinated axons in PD
(77.59.14%) was significantly lower compared to that in
control subjects (92.22.40%). (ii) The ratio of unmyelinated
axons with -synuclein aggregates to total axons with
-synuclein aggregates in ILBD ranged from 94.4 to 100
(98.2 2.18%). Among axons with -synuclein aggregates,
unmyelinated axons were the overwhelming majority,
comprising 98.2%.
Conclusion: These findings suggest that in PD unmyelinated
axons are more vulnerable to degeneration than myelinated
axons of the cardiac nerve, because -synuclein aggregates
accumulate much more abundantly in unmyelinated axons.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 289
P1534
Eye movement abnormalities in essential
tremor and other neurodegenerative
diseases (Parkinsons disease, spino-
cerebellar ataxia, Huntingtons disease)
M. Wojcik-Pedziwiatr1, M. Rudzinska1, K. Zajdel2,
T. Tomaszewski1, A. Szczudlik1
Departament of Neurology, 2Departament of
1
Otolaryngology, Jagiellonian University Medical College,
Krakow, Poland
Introduction: Eye movement abnormalities are a common
sign of many neurodegenerative diseases like Parkinsons
disease (PD), spino-cerebellar ataxia (SCA) or Huntingtons
disease (HD). Even though essential tremor (ET) is the most
prevalent movement disorder, the spectrum of eye
movement abnormalities for this disease has not been
entirely explored yet.
Aim: To evaluate eye movement abnormalities in ET
patients in comparison with controls matched according to
age and gender and patients with other neurodegenerative
diseases like PD, SCA and HD and to assess the relations
between eye movement abnormalities and other signs as
well as course of ET.
Material and methods: 50 ET and 50 PD matched
according to age and gender, 42 SCA, 50 HD patients as
well as 42 healthy controls were included in the study.
Saccades were recorded using portable Saccadometer from
Ober Consulting company. EOG (Hortman) was used for
recording of smooth pursuit, OKN and fixation.
Results: The study showed that eye movement abnormalities
are considerably more common in ET patients than in
healthy subjects and their frequency in ET is similar to other
neurodegenerative diseases like PD, SCA and HD. The
most typical eye movement disturbances in ET were:
reflexive saccades dysmetria, smooth pursuit and OKN
impairment. In ET patients with concomitant cerebellar
signs volitional saccade latency prolongation was
additionally detected. The frequency of reflexive saccades
dysmetria in ET increases with disease progression.
Conclusion: Eye movement abnormalities are a common
sign of ET like other neurodegenerative diseases and their
frequency increases with disease progression.
290 Posters, Sunday 9 September
P1535
White matter damage in Parkinsons
disease patients with glucocerebrosidase
gene mutations: a study using diffusion
tensor imaging
F. Agosta1, K. Davidovic1, L. Sarro2, N. Kresojevi3,
M. Svetel3, I. Stankovi3, G. Comi4, V.S. Kostic5,
M. Filippi2
1Neuroimaging Research Unit, 2Neuroimaging Research Unit
and Department of Neurology, Vita-Salute San Raffaele
University and San Raffaele Scientific Institute, Milan, Italy,
3Clinic of Neurology, Faculty of Medicine, University of
Belgrade, Serbia, 4Department of Neurology, Vita-Salute San
Raffaele University and San Raffaele Scientific Institute,
Milan, Italy, 5Clinic of Neurology, Faculty of Medicine,
University of Belgrade, Serbia
Objective: To investigate brain white matter (WM) damage
in patients with Parkinsons disease (PD) carrying
glucocerebrosidase (GBA) gene mutations.
Methods: Among 360 PD patients screened for mutations
of the GBA gene, 19 (5.3%) heterozygous mutation carriers
were identified. 15 (mean age 64 years, mean age at onset
57 years, median Hoehn and Yahr [HY] stage score 3.0),
were found to be heterozygous for N370S (6 cases), D409H
(6 cases), D380V (1 case), E388K (1 case) and L444P
(1 case) GBA mutations, were enrolled in this study. 20 PD
patients without GBA mutations (mean age 63 years, mean
age at onset 56 years, median HY stage score 3.0) and 16
healthy controls (mean age 64 years) were also studied.
Diffusion tensor imaging (DTI) scans were obtained from
all subjects. Tract-based spatial statistics were used to
perform a brain voxel-wise analysis of mean diffusivity
(MD) and fractional anisotropy (FA).
Results: Compared to controls, GBA mutation PD carriers
showed an increased MD of the genu of the corpus callosum
and a decreased FA of the corpus callosum, cingulum,
external capsule, anterior thalamic radiations, bilaterally,
and right superior longitudinal fasciculus (p<0.05, family-
wise error corrected). PD patients without GBA mutations
did not show significant DT MRI abnormalities when
compared with healthy controls.
Conclusions: PD patients carrying GBA mutations show
WM abnormalities involving the interhemispheric, limbic
and associations tracts. Future research will clarify whether
WM damage in these patients may have an impact on the
clinical phenotype, in particular on the development of
cognitive impairment.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1536
Clinicopathological correlation of
progressive supranuclear palsy
presenting with corticobasal syndrome
H. Ling1, R. de Silva1, L. Massey1, N. Bajaj2, J. Lowe2,
J. Holton3, A. Lees1, T. Revesz3
1Reta Lila Institute of Neurological Studies, Institute of
Neurology, University College London, 2University of
Nottingham, 3Queen Square Brain Bank for Neurological
Studies, Institute of Neurology, University College London,
UK
Aim: We aimed to characterise the clinical and pathological
features of 10 progressive supranuclear palsy (PSP) cases
with a clinical presentation of corticobasal syndrome (PSP-
CBS) and to compare these with 10 PSP cases with a
classical presentation of Richardsons syndrome (PSP-RS).
Background: The clinical presentation of CBS has been
associated with PSP pathology and is clinically characterized
by asymmetric limb dystonia, rigidity, apraxia, the alien
limb phenomenon and cortical sensory loss.
Methods: Morphometry with a stereological approach was
used for tau load quantitation.
Results: Only 3.9% of PSP cases in the Queen Square Brain
Bank presented with a CBS. All PSP-CBS cases had marked
asymmetrical features with a clumsy useless limb, in
association with apraxia, hand dystonia, myoclonus and the
alien limb phenomenon, cortical sensory loss and delayed
initiation of horizontal saccades. Neuropathologically, both
PSP groups had similar total tau load (p=0.18). However,
analysis of the regional tau load revealed a shift of tau
pathology from the basal ganglia (p=0.003) towards the
cortical regions (p<0.001) in PSP-CBS when compared to
PSP-RS.
In PSP-CBS, the presence of delayed initiation of horizontal
saccades was associated with a greater parietal tau load
(r=0.6; p<0.001).
Conclusions: We conclude that PSP-CBS is a cortical
predominant subtype of PSP characterized by a shift of tau
burden from the basal ganglia towards the cortices. Early
falls and vertical supranuclear gaze palsy, when present,
might be helpful in predicting PSP pathology in patients
presenting with CBS.
 Posters, Sunday 9 September 291

P1537 P1538
Randomized, double-blind, double- Recognition of adult-onset dystonia over
dummy study of levodopa-carbidopa time (1970 to 2007): data from a
intestinal gel in patients with advanced multicenter Italian series
Parkinsons disease: efficacy analyses by A. Macerollo1, G. Abbruzzese2, A.R. Bentivoglio3,
subgroups R. Liguori4, L. Santoro5, A. Berardelli6, G. Defazio1
1Dept. of Neurosciences and Sense Organs, University of
A. Antonini1,2, K. Chatamra3, W.Z. Robieson3,
Bari, 2Department of Neuroscience, University of Genoa,
Y. Pritchett3, K.L. Widnell3, J. Benesh3, R.A. Lenz3 3Department of Neurosciences, Catholic University of Rome,
1 IRCCS San Camillo, Venice, 2University of Padua, Italy, 4Department of Neurological Sciences, University of
3 Abbott, Abbott Park, IL, USA
Bologna, 5Department of Neurological Sciences, University
Introduction: Fluctuating blood levels of levodopa are Federico II of Naples, 6Department of Neurology and
associated with motor complications in Parkinsons disease Psichiatry, Sapienza University of Rome, Italy
(PD). Levodopa-carbidopa intestinal gel (LCIG) is delivered
Introduction: A dataset of 470 Italian patients, recruited
continuously via an intrajejunal percutaneous gastrostomy
between 2007 and 2008 at 7 Italian movement disorder
tube.
centres, was checked in order to analyse the time elapsing
Methods: A double-blind, double-dummy trial evaluated
between dystonia onset and diagnosis taking into account
LCIG compared with oral levodopa-carbidopa immediate-
sex, education, place of birth and residence, year of birth,
release (IR) therapy in patients with advanced PD and
and type of dystonia.
motor fluctuations. Levodopa-responsive patients received
Methods: The dataset included 318 women and 155 men
LCIG infusion+placebo capsules or encapsulated levodopa-
with adult-onset dystonia aged 6214 years. Mean age at
carbidopa IR tablets+placebo gel infusion for 12 weeks.
dystonia onset was 5114 years. Dystonia at presentation
The primary endpoint was the change from baseline to week
was blepharospasm (BSP, n=235), cervical dystonia (CD,
12 in Off time normalized to 16 waking hours. On time
n=185) and hand dystonia (FHD, n=50) .
without troublesome dyskinesia was a key secondary
Results: The time elapsing from dystonia onset to diagnosis
outcome. Efficacy was analyzed by subgroups including
was 6 years on average. The diagnostic delay was less
gender, age (<65 or 65 years), disease duration (<10 or
marked in the patients presenting with blepharospasm than
10 years), and number of PD medications at baseline (2
in the other groups (57 vs. 88 years, p<0.05). The time
or 3).
elapsing from dystonia onset to diagnosis significantly
Results: 71 patients were randomized (n=37 LCIG; n=34
decreased by increasing the year of diagnosis, but the
IR), and 66 (93%) completed the trial. LCIG significantly
percentage of patients who had <1 year elapsing between
improved Off time (LS mean difference = -1.91hr;
dystonia onset and diagnosis did not exceed 50% in the
p=0.0015) and On time without troublesome dyskinesia
most recent time bin (> year 2000) (all patients, 47%;
(LS mean difference =1.86hr, p=0.0059) compared with IR.
cranial dystonia, 50%; extra-cranial dystonia, 43%). It was
Subgroup analyses of the change from baseline in Off
chosen one year because this is the average diagnostic
time revealed no statistically significant interaction of
delay for Parkinsons disease in western countries.
treatment group by gender (p=0.589), disease duration
Confirmation that the year of diagnosis is a significant
(p=0.135), age (p=0.935), or number of PD medications at
predictor of the percentage of patients who had <1 year
baseline (p=0.237).
elapsing between dystonia onset and diagnosis was obtained
Conclusions: These results demonstrate the robust and
by binomial regression models.
consistent efficacy of LCIG, compared with optimized oral
Conclusions: Outside movement disorder centres the
levodopa-carbidopa therapy, irrespective of differences in
recognition of dystonia in Italy remains poor even in the
gender, age, PD duration, or number of PD medications at
years 2000. We suspect that a similar situation may be
baseline.
present in other western countries.
Support: Abbott

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

292 Posters, Sunday 9 September
P1539
Nutritional status as a predictor of the
mortality in patients with Parkinsons
disease
R. Motoyama1,2, T. Oeda1,2, Y. Hari3, R. Hayashi1,2,
A. Umemura1,2, S. Tomita1,2, M. Kohsaka1,2,
K. Yamamoto1,2, T. Konishi2, H. Sawada1,2
1Clinical Research Center, 2Department of Neurology,
3Department of Nutritional Management, Utano National
Hospital, Kyoto, Japan
Purpose: It has been reported that hypoalbuminemia
increases the mortality rates in cancer or surgical operations.
To evaluate the association between the nutritional status
and mortality in patients with Parkinsons disease (PD).
Methods: The cohort of 501 consecutive PD patients
enrolled from July 2004 to March 2010 was followed until
June 15th 2010. The concentrations of serum albumin, urea
nitrogen, and creatinine, the lymphocyte counts and the
body mass index (BMI) were regarded as nutritional status,
and in addition, age, sex, disease duration, Hoehn-Yahr
stages (HY), and dementia (yes/no according to DSM-IV) )
were obtained at the study entry. The association between
the nutrition status and mortality was analyzed using Cox
proportional hazard models and the relative risk of death
was estimated as hazard ratios (HR).
Results: In the study period 22 patients died. Serum
albumin concentration was negatively associated with the
mortality in the Cox model adjusted for age, sex, disease
duration, HY and dementia (yes/no) (p=0.014). The HR was
0.38 (per 0.5g/dl, 95% CI 0.18-0.82). Patients with albumin
<3.8g/dl had a shorter lifetime than those with albumin
3.8g/dl (Log rank test p=0.010).
Conclusion: Serum albumin concentrations were a
significant prognostic factor for the mortality in patients
with PD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1540
Maintenance of constant steady state
therapeutic plasma concentrations of
levodopa following its continuous
subcutaneous administration with
carbidopa
O. Yacoby-Zeevi1, S. Oren1, P.A. LeWitt2
1Neuroderm, Ltd., Ness-Ziona, Israel, 2Neurology, Wayne
State University School of Medicine and Henry Ford
Hospital, West Bloomfield, MI, USA
Objective: To determine the pharmacokinetic (PK) profile
of levodopa (LD) following continuous subcutaneous (SC)
administration of carbidopa (CD) / LD.
Background: In PD, wearing-off between doses and
dyskinesias are often related to variable circulating
concentration of LD occurring with oral administration.
Unfortunately, with available oral LD preparations, most
patients with treatment fluctuations do not experience much
improvement and the option of administering LD
intravenously or intraduodenally (Duodopa) is costly, and
invasive. Neuroderm proposes a practical alternative for
maintaining more constant plasma concentrations of LD.
Methods: A proprietary LD/CD solution (designated
ND0612), was continuously administered SC in pigs with
PK measurements of LD and CD.
Results: Constant, dose-dependent steady-state plasma
concentrations of LD were achieved during continuous SC
administration of ND0612 for both LD and CD. By using
only 2-4ml/day of SC ND0612, constant LD plasma
concentrations could be maintained at values that are
generally effective at maintaining anti-Parkinsonian control
in humans. No safety or tolerability issues were detected.
Conclusions: The limitation of oral LD products is the
marked variability in plasma concentrations of the drug.
Using SC delivery of an LD/CD solution, we demonstrated
a promising option for achieving consistency in plasma LD
concentrations. A clinical application of this approach
should achieve improved control of motor fluctuations in
PD. Furthermore, frequent daily oral dosing with CD/LD
can be avoided. This approach is currently under
investigation in a randomized clinical trial (double-blind) of
ND0612, evaluating the plasma LD PK profile as well as
safety and tolerability.
 Posters, Sunday 9 September 293

P1541 P1542
Rapid eye movement (REM) sleep Motor learning in primary cervical
behaviour disorder (RBD): a risk factor for dystonia
cognitive impairment in Parkinsons P. Katschnig1,2, P. Schwingenschuh1,2, M. Davare1,
disease (PD)? A. Sadnicka1, R. Schmidt2, J.C. Rothwell1, K.P. Bhatia1,
R. Di Giacopo, D. Quaranta, C. Piccininni, C. Marra, M.J. Edwards1
1Sobell Department of Motor Neuroscience and Movement
A.R. Bentivoglio
Neuroscience, Catholic University of Rome, Italy Disorders, UCL Institute of Neurology, London, UK,
2Department of Neurology, Medical University of Graz,
Background: RBD is strongly associated with Austria
synucleinopathies, often heralding and later accompanying
Introduction: Motor sequence learning and motor
motor symptoms of PD and Lewy Body Dementia (DLB).
adaptation rely on overlapping circuits predominantly
The neuropsychological assessment in 24 idiopathic RBD
involving basal ganglia and cerebellum. Given the
patients revealed a cognitive impairment similar to those
importance of these neuro-anatomical structures to the
observed in patients with PD and DLB; it suggests a
pathophysiology of primary dystonia, and the previous
common pathophysiological mechanism underlying these
finding of abnormal motor sequence learning in DYT1 gene
conditions, according to Braaks hypothesis. However, this
carriers, we explored motor sequence learning and motor
theory in not confirmed in all PD cases. Our objective is to
adaptation in patients with primary cervical dystonia.
assess the relationship between the presence of RBD and
Methods: 12 patients with cervical dystonia and 11 healthy
the cognitive profile of non-demented patients with PD.
age-matched controls were included. Subjects used a
Methods: 47 patients with PD without dementia were
joystick to move a cursor from a central starting point to
evaluated by a standard neuropsychological battery
radial targets as fast and accurately as possible. Using this
assessing intelligence, episodic verbal and spatial memory,
device, we recorded baseline motor performance, motor
recall capacity, fluency, executive and visuospatial abilities.
sequence learning and a visuomotor adaptation task.
25 patients fulfilled polysomnographic criteria for RBD.
Results: Baseline motor performance with random target
Bilateral t-tests were performed to compare differences
presentation was normal except for higher peak velocity in
between RBD-PD group and non-RBD-PD group.
patients with cervical dystonia. Patients and controls had
Results: No significant differences between groups were
similar levels of motor sequence learning and motor
found regarding age, schooling, depression assessment,
adaptation.
Hoehn and Year stage (I-II), UPDRS III score, disease
Conclusion: Our patients had significantly higher peak
duration, levodopa equivalent daily doses (LEDD). Groups
velocity compared to controls, with similar movement
differed significantly for execution time in interference
times, implying a different performance strategy. The
condition of the Stroop colour word test (p=0.002).
preservation of motor sequence learning in cervical dystonia
Conclusions: Our data confirm a previous study in that
patients contrasts with the previously observed deficit seen
RBD-PD patients showed a lower cognitive performance
in patients with DYT1 gene mutations, supporting the
compared to non-RBD-PD. The cognitive involvement in
hypothesis of differing pathophysiology in different forms
executive functions is very early, because our patients
of primary dystonia. Normal motor adaptation may signify
presented a mild motor phenotype (H&Y:1,87) compared to
that previously documented cerebellar abnormalities in
literature. Thus RBD may indicate a more pervasive
cervical dystonia might simply reflect unimportant
neurodegenerative process in PD and can increase the risk
contamination of a structure directly connected to the
of cognitive impairment in patients.
basal ganglia, or might represent a compensatory response
to the primary pathophysiology within the basal ganglia.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

294 Posters, Sunday 9 September
P1543
PRRT2 mutations are a major cause of
paroxysmal kinesigenic dyskinesia in the
European population
A. Meneret, D. Grabli, C. Depienne, C. Gaudebout,
F. Picard, A. Drr, I. Lagroua, D. Bouteiller, C. Mignot,
D. Doummar, M. Anheim, C. Tranchant, P. Burbaud,
C.P. Jedynak, D. Gras, D. Steschenko, D. Devos, T.
Billette de Villemeur, M. Vidailhet, A. Brice, E. Roze
INSERM, UMRS 975 and CNRS 7225 - CRICM, Paris,
France
Introduction: Paroxysmal kinesigenic dyskinesia (PKD) is
a rare disorder characterized by recurrent attacks of
hyperkinetic movements. Mutations in the PRRT2 gene
were recently identified in PKD patients. We studied the
prevalence of PRRT2 mutations and characteristics of the
patients in a European PKD population.
Methods: 34 consecutive PKD index cases (20 sporadic
cases and 14 cases with family history) were recruited
through the 1996-2011 database of our DNA bank. Each
patient had a standardized neurological assessment.
Molecular analysis of the PRRT2 coding sequence was
performed in all index cases and their family members
when available. In addition, 3 microsatellite markers were
genotyped in the patients and their relatives.
Results: Mutations introducing premature termination
codons were identified in 22/34 patients (65%) including
13/14 families and 9/20 sporadic cases. The previously
described c.649dupC/pArg217ProfsX8 and c.629dupC/
pAla211SerfsX14 were present in 19 and 1 cases
respectively; we also report 2 novel mutations, each in one
case: c.562C>T/pGln188X and c.649C>T/pArg217X.
Segregation analysis of the mutations in the parents of 6
sporadic cases revealed 3 de novo mutations and incomplete
penetrance in a transmitting parent in the 3 other cases. No
founder effect was found for the c.649dupC mutation. The
mutated group was characterized by a younger age of onset
(9 years) compared to the negative patients (15 years;
p<0.01).
Conclusion: Mutations in PRRT2 are a major cause of PKD
in familial and sporadic cases in the European population.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1544
Peripheral selective denervation for
torticollis - long-term follow-up
T. Bergenheim1, M. Hariz2, R. Libelius3, E. Nordh3,
E. Larsson1
1Neurosurgery, Inst of Clinical Neuroscience, Ume, Sweden,
2Neurosurgery, UCL Institute of Neurology, National
Hospital for Neurology and Neurosurgery, London, UK,
3Neurophysiology, Inst of Clinical Neuroscience, Ume,
Sweden
Introduction: Spasmodic torticollis is a focal cervical
dystonia that most often responds to botulinum toxin.
However, not all patients respond to this treatment and
some develop secondary resistance. In those cases, there are
two surgical options, selective peripheral denervation
(Bertrand procedure) and pallidal Deep Brain Stimulation
(DBS). We report here on the Ume experience of selective
denervation.
Methods: 63 patients were operated. 4 patients were later
re-operated due to recurrence or change in the pattern of the
dystonia. The patients were assessed with the Tsui torticollis
scale, VAS for pain, and the Fugl-Meyer Life Satisfaction
scale before surgery, at 6 months, and long-term follow-up
(mean 42 months).
Results: 6 months follow-up was available for 57 patients
and long-term for 35. Mean score of Tsui scale was
preoperatively 10.2, early post-op 4.1 (p<0.001), 6 months
post-op 4.8 (p<0.001), and at long-term follow-up 5.3
(p<0.001). Mean VAS for pain was pre-operatively 6.2, at 6
months 4.3 (p<0.001), and at long-term follow-up 4.1
(p<0.01). Life satisfaction total score improved moderately
from a mean of 43.3 to 46.6 at 6 months (p<0.05), and to
51.4 at long-term follow-up (p<0.05). No severe or long-
lasting side effects were noted.
Conclusions: From our experience it can be concluded that
selective peripheral denervation is a satisfactory
neurosurgical option for treatment of otherwise refractory
spasmodic torticollis when the muscles involved are
surgically accessible for denervation. In patients with a
widespread muscular involvement, pallidal DBS may be
preferable.

P1545
Familial congenital mirror movements:
phenotype and neurophysiological
findings in a new family with incomplete
penetrance
M. Bologna1, A. Fasano1, E. Iezzi1, F. Di Biasio1,
L. Rocchi2, M. Srour3, A. Levert3, G. Rouleau3,
A. Berardelli1,2
1Neuromed Institute, Pozzilli, 2Sapienza University of Rome,
Italy, 3Hpital Notre Dame, Montral, QC, Canada
Introduction: Mirror movements (MMs) are involuntary
movements of one side of the body that accompany
intentional movements on the opposite side. Few families
with members presenting MMs without other neurological
disorders have been reported and mutations in DCC gene
were found to underline this condition. In the present study
we aimed to report the clinical and neurophysiological
features of a novel family with congenital MMs.
Methods: 13 members of a 4-generation family with
individuals affected with congenital MMs were clinically
evaluated using the Woods & Teuber scale. Subjects were
blood sampled for the screening of the DCC gene mutations.
5 subjects underwent neurophysiological evaluation
including recordings of voluntary and involuntary EMG
activity, motor evoked potentials (MEPs) and
interhemispheric inhibition (IHI) studied with transcranial
magnetic stimulation. The neurophysiological parameters
were recorded before and after delivering continuous theta
burst stimulation (cTBS) on the dominant primary motor
cortex.
Results: Transmission of MMs was consistent with an
autosomal dominant fashion with incomplete penetrance
and variable degree of expression. The screening of the
DCC gene mutations was negative. Among the subjects
who underwent neurophysiological evaluation, ipsilateral
MEPs were detectable in the two most severe cases. IHI did
not correlate with MMs severity; cTBS tended to reduce the
EMG mirror activity and this was clinically relevant in one
of the two most affected case.
Conclusions: Neurophysiological features suggest that
MMs in this newly reported family are mainly mediated
through uncrossed cortico-spinal tracts and that cTBS might
be a potential therapeutical tool in congenital MMs.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 295
P1546
Copper metabolism and diagnostic
problems in clinically asymptomatic
Wilsons disease patients
K. Dzieyc1, A. Czonkowska1,2
12nd Department of Neurology, Institute of Psychiatry and
Neurology, 2Department of Clinical and Experimental
Pharmacology, Medical University of Warsaw, Poland
Background: Wilsons disease (WD) is a rare autosomal
recessive inherited disorder of copper metabolism.
Diagnosis of WD is based on combination of clinical,
biochemical, genetic testing and may be problematic. The
aim of the study was the evaluation of initial copper
metabolism parameters in asymptomatic cases diagnosed
upon family history of WD.
Methods and results: We have assessed 85 WD patients
diagnosed by family screening in our center between 1964
and 2010. All of them had no history of hepatic or
neurological symptoms and were without any symptoms at
the time of diagnosis. WD diagnosis was based on copper
metabolism, DNA analysis and in uncertain cases using
radiocopper study. The initial copper metabolism test results
of asymptomatic patients were compared to their
symptomatic siblings (n=60). Serum ceruloplasmin levels
were decreased in asymptomatic patients but were
significantly higher than in symptomatic siblings
(14.37.7mg/dl vs. 10.26.2mg/dl, respectively, p=0.001),
in 11 (13%) cases were even in normal range. Urinary
copper excretion was significantly lower in asymptomatic
patients (168181.5ug/24h vs. 388.2678.6ug/24h,
p=0.003), and was normal in 11 (15%) patients. Total
copper serum concentration levels were similar in both
groups.
Conclusion: Copper metabolism test results in clinically
asymptomatic patients may cause diagnostic difficulties.
Ceruloplasmin levels and urinary copper excretion may be
less significant for diagnosis comparing with symptomatic
patients. In case of lack of genetic confirmation, further
diagnostics such as the radiocopper study may be necessary,
because missed diagnosis and delay of therapy may lead to
development of symptoms.
296 Posters, Sunday 9 September
P1547
The impact of micro-electrode recording
on selecting the most optimal trajectories
for electrode implantation
N. Kovacs, E. Gasparics, E. Bosnyk, F. Nagy, J. Janszky,
I. Bals, G. Deli
Department of Neurology, University of Pecs, Hungary
Background: Micro-electrode recording (MER) is an
electrophysiological tool for finding the most optimal
trajectory and level during implantation of chronic
stimulation electrode. Although it might be associated with
a higher risk for intra-operative intracranial bleedings, most
DBS center routinely apply it.
Objectives: To analyze the number of DBS surgeries in a
large prospective cohort where the planned trajectory was
modified by the results of MER signals.
Methods: 184 DBS electrode implantations were evaluated.
We applied Leadpoint 5 system (Medtronic Inc, MN) to
MER. Simultaneously 5 micro-electrodes were inserted
(center, anterior, posterior, medial and lateral) 2mm and the
electrophysiological activity was recorded in the level of
-10 and +5mm from the planned target level. The signals
were evaluated offline and macro-electrode stimulation was
performed subsequently.
Results: The central electrode at the level of the planned
target demonstrated pathological activity during 134
electrode placements (72.8%); however, the central
trajectory was used for chronic stimulation only in 102
(55.4%) of instances. Anterior trajectory was chosen in 53
cases (28.8%). Chronic electrodes were placed in the lateral,
medial and posterior positions less frequently (12, 15 and 6
instances, respectively).
Conclusion: Although we reached the planned target in the
vast majority of cases, we selected the central trajectory for
electrode implantation only in nearly half of the cases based
on signal quality and intra-operative stimulation.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1548
Epidemiological (cross-sectional) study to
evaluate and describe fatigue in patients
with Parkinsons disease in Italy - The
FORTE Study
F. Stocchi1, G. Abbruzzese2, R. Ceravolo3, P. Cortelli4,
M.F. De Pandis5, G. Fabbrini6, W. Liboni7, C. Pacchetti8,
G. Pezzoli9, M. Canesi9, C. Iannacone10, M. Zappia11,
FORTE Study Investigators
1Institute of Neurology, IRCCS San Raffaele Pisana, Rome,
2Department of Neurosciences, Ophthalmology,
Rehabilitation and Genetics, University of Genoa,
3Department of Neuroscience, University of Pisa,
4Department of Neurological Sciences, Alma Mater
Studiorum, IRCCS, Institute of Neurological Sciences,
University of Bologna, 5Parkinson Operative Unit, San
Raffaele Institute, Cassino, 6Department of Neurology and
Psychiatry and IRCSS Neuromed, La Sapienza University
of Rome, 7Complex Structure of Neurology, Gradenigo
Hospital, Turin, 8Parkinson Operative Unit, IRCCS
National Neurological Institute C. Mondino Foundation,
Pavia, 9Parkinson Institute, I.C.P., 10SPARC Consulting,
Milan, 11Department G. F. Ingrassia, Neurosciences Area,
University of Catania, Italy
Introduction: Fatigue is a common non-motor symptom in
patients with Parkinsons disease (PD) and one of the most
disabling symptoms of this disease, as reported by patients,
with serious impact on patients quality of life. It is generally
accepted that about 50% of PD patients will complain of
fatigue and clinical observation revealed that its severity
remained mostly unchanged during progression of the
disease. This study aims to assess, in a non-interventional
epidemiological setting, the incidence and severity of
fatigue in PD patients and its correlation with PD severity.
Methods: This is an epidemiological, cross-sectional,
multicentre study, in patients diagnosed with PD according
to the UKPDS brain bank diagnostic criteria. The primary
objectives included the evaluation of the incidence and
severity of fatigue in PD patients measured by Parkinson
Fatigue Scale (PFS-16) and assessment of its predisposing
factors (age, gender, marital status, disease duration,
presence of depression, presence of sleep disorders, PD
severity, UPDRS total score).
Results: 402 patients (mean age: 66.9 years; mean disease
duration: 7.5 years) were enrolled in 27 PD centres in Italy.
33.8% of them showed fatigue (PFS-16 score 3.3 points).
Logistic regression analysis showed that UPDRS total
score, female gender, presence of depression and presence
of sleep disorders significantly increase the odds of
occurrence of fatigue in patients with PD.
Conclusion: FORTE is the largest study ever conducted in
Italy to assess fatigue in PD patients. The large amount of
data collected will allow us to investigate in depth the
fatigue in these patients.

P1549
Usefulness of brain perfusion SPECT for
differentiation between idiopathic
Parkinsons disease and multiple system
atrophy
K.-S. Lee1, I.-U. Song1, J.-W. Park1, Y.-A. Chung2
1Department of Neurology, 2Department of Nuclear
Medicine, The Catholic University of Korea, Seoul, Republic
of Korea
Objectives: Statistical parametric mapping was performed
to investigate differences in regional cerebral blood flow
(rCBF) between patients with idiopathic Parkinsons disease
(IPD), patients with multiple system atrophy (MSA), and
healthy volunteers.
Methods: Tc-99m HMPAO SPECT was performed on 23
IPD patients (10 men, 13 women; aged 57-80 y), 9 MSA
patients (4 men, 5 women; aged 60-83 y), and 12 age-
matched healthy volunteers (5 men, 7 women; aged 56-81y).
Results: Significant hypoperfusion was observed in IPD
compared with healthy subjects in a symmetric subcortical-
cortical network including the basal ganglia, thalami,
prefrontal and lateral frontal cortex, and parietal cortex
(voxel size: 50, corrected p<0.001). For MSA, only
symmetric hypoperfusion was seen in both prefrontal
cortices with respect to healthy subjects and to IPD (voxel
size: 50, corrected p<0.001).
Conclusions: Tc-99m HMPAO perfusion SPECT shows
detailed differences between IPD and MSA, which may be
of use in the differentiation of both disease entities.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 297
P1550
Early-onset dystonia with brain
manganese accumulation due to
SLC30A10 mutations: a new treatable
disorder
M. Stamelou1, K. Tuschl2, P. Mills2, K. Chong3,
A. Burroughs4, P. Clayton2, K. Bhatia1
1UCL Institute of Neurology, 2UCL Institute of Child Health,
3Department of Radiology, 4The Wellington Hospital,
London, UK
Background: Recently, the first gene causing early-onset
generalised dystonia with brain manganese accumulation
has been identified. Mutations in the SLC30A10 gene,
encoding a manganese transporter, cause a syndrome of
hepatic cirrhosis, dystonia, polycythemia and hyper
manganesemia.
Methods: We present ten-year longitudinal clinical features,
magnetic resonance imaging data, and treatment response
to chelation therapy of the originally described patient with
proven SLC30A10 mutation.
Results: The patient presented with early-onset generalized
dystonia and jaundice accompanied by elevated whole
blood manganese levels. T1 sequences in magnetic
resonance imaging showed manganese deposition in the
basal ganglia and cerebellum. Treatment with intravenous
disodium calcium edetate, led to a slow but continuous
clinical improvement and reduction of the manganese
deposition in brain imaging.
Conclusions: We wish to highlight this rare disorder which,
together with Wilsons disease, is the only potentially
treatable inherited metal storage disorder to date, that
otherwise can be fatal due to complications of cirrhosis.
298 Posters, Sunday 9 September

P1551 P1552
Digitalised spirography and clinical Movement disorders in Ethiopia
examination based decision support D.K. Worku
system for differentiating between Addis Ababa University, Addis Ababa, Ethiopia
tremors Introduction: In a country of 80-million plus people, there
D. Georgiev1, V. Groznik2, A. Sadikov2, M. Moina2, is a shortage of physicians - only 15 neurologists serve the
M. Guid2, V. Kragelj3, I. Bratko2, S. Ribari3, Z. Pirtoek1 entire country and most are concentrated in the capital city
1Laboratory for Movement and Gait Disorders, Department - making it difficult for all who need care to see a
of Neurology, University Medical Centre Ljubljana, neurologist.
2Artifitial Intelligence Laboratory, Faculty of Computer and Methods: A review of journals was done on papers:
Information Science, University of Ljubljana, 3Institute of movement disorders in Ethiopia available until the end of
Pathophysiology, Faculty of Medicine, University of June, 2011 at the main Library of Addis Ababa University,
Ljubljana, Slovenia Department of Neurology.
Results: In one retrospective study done over a 1-year
Objective: To analyse the usefulness of computer decision
period a total of 15.1% of the neurological patients were
support system (DSS) that combines digitalised spirography
seen for movement disorders. Of these, most were
and clinical data for differentiating between essential tremor
parkinsonism (47.7%), followed by ataxia (16.5%), dystonia
(ET) and Parkinsons disease (PD), including the mixed
(8.3%), essential tremor (8.3%), chorea (7.3%), and
type tremor (MT) (comorbidity).
miscellaneous (11.9%). Data on Parkinsons disease in sub-
Introduction: ET and PD are very often misdiagnosed
Saharan Africa is limited but it appears that the age-adjusted
when standard clinical examination is applied (37-50% and
prevalence may be a little lower than in other parts of the
24%, respectively, Quinn et al., 2011). DaTSCAN can be
world. The likely explanation for this is a lack of diagnosis,
used to more precisely differentiate between ET and PD, but
and therefore treatment, leading to early fatality. Different
it is costly and not widely available. In a previous work
studies indicated that movement disorders is one of the
(sample size 69 patients), we have estimated the accuracy
neurologic disorders associated with malnutrition which is
of the argument-based machine learning (AMBL) DSS for
rampant in the country. HIV/AIDS adds more to this
tremor differentiation as 81%.
problem and makes the diagnosis and the management even
Methods: 122 (median age 69 years) patients with ET, PD
more challenging. Diagnostic evaluations are limited, but
or MT were included in the study. DSS was built using
treatment is available, although expensive. In spite of the
ABML, which combines machine learning (ML) with
limitations, patients with movement disorders require and
expert knowledge based on the clinical as well as
seek care in Ethiopia in proportions comparable to
quantitative data from digitalised spirography.
developed nations.
Results: The estimated classification accuracy of the model
Conclusion: These findings underline the need for adequate
was 91%, which shows an improvement of 10% compared
training in movement disorders for physicians and
to the previously reported model. Measured specificities of
neurologists, and community education in Ethiopia.
the model were 0.97 for ET, 0.89 for PD, and 0.98 for MT;
measured sensitivities were 0.93 for ET, 0.97 for PD, and
0.70 for MT.
Conclusions: Digitalised spirography has a potential to be
used as a stand-alone screening method for tremor analysis.
We plan to further evaluate and validate the system by
enrolling a larger number of patients and compare it to
DaTSCAN, in order to improve the diagnostic precision of
the system.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1553
Obliquus capitis inferior muscle plays an
important role in dystonic torticaput
A. Stenner, G. Reichel
Movement Disorders Department, Paracelsus Clinic,
Zwickau, Germany
Introduction: Idiopathic cervical dystonia (CD) is the most
prevalent defined dystonia in adults. The response rate to
botulinum toxin in open and double-blind studies is usually
about 60-70%. Nevertheless, there are cases of primary
treatment failure or unsatisfactory treatment outcomes. The
main reasons for this are most probably the selection of
muscles to be injected. In addition, in such cases the
problem is probably not only that not all affected muscles
are treated, but that healthy muscles are also affected by the
application of botulinum toxin.
Methods: The results of the examinations of 94 patients
with primary CD treated in our clinic, were analysed. The
cervical spine and the soft parts of the neck, including deep
neck muscles, were examined by CT in 5mm slices. For
comparison, the CT-images of 50 patients who did not
suffer from CD were analyzed.
Results: Measurement of the maximum muscle diameters
by CT revealed one distinctive feature: in 73% of the
patients the only small muscle that was asymmetrical, in
addition to the large neck muscles, was the obliquus capitis
inferior muscle. Dystonia of this muscle induced rotation to
the same side in the lower head joints.
Conclusions: Obviously, the obliquus capitis inferior
muscle plays an important role in the dystonic rotation of
the head. If treatment of the large neck muscles with Btx
does not show satisfactory results, this small muscle should
be included in the therapy plan.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 299
P1554
Dopamine therapy in primary pain
syndromes in patients with Parkinsons
disease
A. Alekseev, E. Podchufarova, M. Nodel
First Moscow Medical University, Moscow, Russia
Introduction: Many researchers discussed the role of
dopamine in the functional activity of the anti-nociceptive
system (ANS). Parkinsons disease (PD) is an example of
common dopaminergic failure, accompanied by widespread
pain syndromes.
Aim: To investigate the relationship of primary pain (pain
without peripheral sources) in patients with PD and activity
of ANS using nociceptive-flexion reflex (NFR).
Patients and methods: 12 patients with PD and primary
pain (PD+PP), mean age 63.359.04, mean duration of PD
5.680.48, 15 patients with PD and low back pain
(PD+LBP), mean age: 63.2310.11, mean duration of PD
5.424.8, and 20 patients with low back pain without PD
(LBP), mean age: 62.099.27, were enrolled in the study.
Pain intensity by visual analogue scale (VAS), NFR
thresholds (NFRTh) were determined. Patients underwent
clinical examination before and after treatment of motor
sign by dopaminergic drugs. Patients had no significant
differences in the therapy received, the stage of PD or motor
symptoms PD.
Results: Patients PD+PP had significantly (p<0.05) higher
pain intensity (7.251.76 VAS) than PD+LBP (6.731.39
VAS), not significantly different from LBP (7.381.50
VAS). Patients PD+PP had significantly (p<0.05) more
types and localizations of pain (2.751.48), than PD+LBP
(1.630.67) and LBP (1,120.38). NFRTh was significantly
(p<0.05) higher in PD+PP (19.256.21), and PD+LBP
(18.314.76), than in LBP (18.34.76). After dopaminergic
therapy all PD patients showed decreased intensity of pain.
Decreasing was more significant (p<0.05) in PD+PP
(5.11.72 VAS). NFRTh significantly (p<0.05) decreased
(14.374.78). Any correlations between pain reduction or
NFRTh increase and improvement of motor signs were not
noted.
Conclusion: Primary pain in PD may be an example of
dopaminergic-associated pain due to dopaminergic
dysfunction and incompetence of ANS.
300 Posters, Sunday 9 September
P1555
Surface electromyogram of neck extensor
and flexor muscles in Parkinsons disease
patients with antecollis and retrocollis
K. Kashihara, T. Imamura
Neurology, Okayama Kyokuto Hospital, Okayama, Japan
Objective: Patients with Parkinsons disease (PD) may
present with abnormal neck posture, including antecollis
and retrocollis. In order to study the mechanism of such
postural disorders of the neck, we evaluated the electrical
activity of the neck extensor and flexor muscles in PD
patients presenting with postural disorders.
Methods: We examined 15 PD patients without postural
disorder of the neck, 14 with antecollis, and 6 with
retrocollis. Surface electromyogram (EMG) was recorded
from the splenius capitis, trapezius, sternocleidomastoideus,
and deltoid muscles on both sides of the spine while the
subjects were at rest in the sitting position and while they
tried to lift their head in the same position.
Results: The EMG amplitude of the sternocleidomastoideus
muscles at each position was the highest. The amplitude at
the spine position was at maximum in patients with
retrocollis, followed by those with antecollis, and then by
those without neck postural disorder. In PD patients with
antecollis, the amplitude increased in the sitting position
and showed a greater increase when patients tried to lift
their head. In patients with retrocollis, changes in position
from supine to sitting hardly produced increased muscle
discharges.
Conclusion: Antecollis in PD patients may be associated
with disproportionately increased muscle tonus of both
flexor and extensor muscles, though antecollis of the
sternocleidomastoideus is the most prominent. In case of
patients with retrocollis, muscle tonus increased to the
maximum level.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1556
Xenologous transplantation of human
adipose derived mesenchymal stem cells
in an animal model of Huntingtons
disease: behavioural and micro-
anatomical outcomes
M.A. Edalatmanesh1, Z. Alizadeh2, F. Vafaee-Bagheri3,
E. Abbasi2, M. Hosseini3, H. Nikfarjam4
1Department of Physiology, Science & Research Branch,
Islamic Azad University, Shiraz, 2School of Medicine, Islamic
Azad University, Mashhad Branch, 3Neuroscience Research
Center and Department of Physiology, School of Medicine,
Mashhad University of Medical Sciences, 4Department of
Biology, Faculty of Science, Ferdowsi University of
Mashhad, Iran
Introduction: Human adipose derived mesenchymal stem
cells (hMSCs) have been proposed as alternative sources of
cells for transplantation into the brain in neurodegenerative
disorders. We tested the efficacy of hMSCs transplants to
reduce behavioural and micro-anatomical deficits in a
Quinolinic acid (QA) rat model of Huntingtons disease.
Methods: After unilateral lesion in striatum was caused by
QA, hMSCs, which were isolated and purified from
liposuction of healthy male donors, were transplanted into
the damaged striatum of rats. Animals were tested by motor
function tests at different times after cell transplantation.
The volume of striatum, lateral ventricles and atrophy
percentage of striatum and volume extension of lateral
ventricles were measured in all treated rats.
Results: MSCs survived 42 days without inducing a strong
inflammatory response from the striatum. Behavioural
amelioration was observed on tests of apomorphine induced
rotation, cylinder, beam balance and rotarod tasks for
MSCs-treated rats. Relative to QA controls, the MSCs
treated group was protected from QA-induced enlargement
of the lateral ventricles. Histological results showed
significant difference in amount of striatum atrophy
between QA controls and MSCs-treated rats.
Conclusions: These results confirm the potential of hMSCs
in treatment of behavioural and micro-anatomical defects in
Huntingtons disease. Taken together, these data demonstrate
that xenologous transplantation of hMSCs could be
considered as a good candidate for treatment of
neurodegenerative diseases, especially Huntingtons
disease.
 Posters, Sunday 9 September 301

P1557 P1558
Neuromelanin activates dendritic cells: Brain MRI apparent diffusion co-efficient
implications for Parkinsons disease (ADC) in Parkinsons disease with
U. Oberlnder1, E. Gschmack1, K. Pletinckx1, A. Dhler1, dementia
N. Mller1, M.B. Lutz1, T. Arzberger2, P. Riederer3, A. Umemura, T. Oeda, M. Kohsaka, S. Tomita,
M. Gerlach4, E. Koutsilieri1, C. Scheller1 R. Hayashi, K. Yamamoto, H. Sawada
1Institute of Virology and Immunobiology, University of Clinical Research Center and Neurology, Utano National
Wrzburg, 2Institute of Neuropathology, University of Hospital, Kyoto, Japan
Munich, 3Clinical Neurochemistry (National Parkinson
Purpose: ADC reflects pathological changes in the brain.
Foundation Center of Excellence Research Laboratory),
To evaluate ADC in the brain regions and explore which
Clinic and Policlinic of Psychiatry, Psychosomatics and
brain regions are associated with dementia in Parkinsons
Psychotherapy, 4Laboratory of Clinical Neurobiology,
Department of Child and Adolescent Psychiatry, disease.
Psychosomatics and Psychotherapy, University of Wrzburg, Methods: In 249 patients with Parkinsons disease (157
Germany without dementia and 92 with dementia), ADC was obtained
in the hippocampus, amygdala, putamen, thalamus, caudate,
Introduction: Neuromelanin (NM) is a complex polymer the superior frontal, middle frontal, superior temporal, and
pigment that is present in the dopaminergic neurons of the inferior temporal gyri, the anterior cingulate, the posterior
substantia nigra (SN). It is these neurons that degenerate in cingulate, the primary visual area and the substantia nigra.
PD. In the past decade evidence for an autoimmune By a logistic regression model using a likelihood test it was
mechanism in PD pathogenesis has accumulated. NM determined, which brain regions were associated with
represents an attractive potential target for an autoimmune dementia.
pathomechanism, as the distribution of NM in the brain Results: The ADC in the amygdala was significantly
correlates with the pattern of neurodegeneration in PD. increased in demented patients compared to the non-
Here we investigated whether NM triggers maturation of demented after adjustment for age, sex and Hoehn-Yahr
dendritic cells (DCs), the major antigen-presenting cell type (p=0.005). The odds ratio was 2.1 (>0.1 x 10-3 mm2/s, 95%
involved in adaptive (auto-) immune response. Moreover, CI 1.25-3.56).
we studied whether NM-mediated DC-activation is Conclusion: It was supposed that dementia was related to
functional in order to trigger a T-cell response. degeneration in the amygdala in Parkinsons disease.
Methods: Murine DCs were treated for 48h with NM from
human SN and synthetic dopamine melanin (DAM) in a
concentration of 50g/ml. Uptake of NM was studied by
confocal microscopy. Characterization of activation/
maturation of DCs was performed by flow cytometry and
ELISA. T-cell activation was assessed with mixed
lymphocyte reaction (MLR).
Results: DCs phagocytosed NM, leading to DC maturation
(CD86high, MHC-IIhigh), activation (release of
proinflammatory cytokines TNF- and IL-6) and T-cell
proliferation in a mixed lymphocyte reaction. DAM was
also phagocytosed, but did not cause significant DC
activation.
Conclusions: The maturation and activation of DCs
following contact with NM represents the initial step in
triggering an adaptive immune response. If operative in
vivo, this could lead to an autoimmune response directed at
NM and subsequent degradation of dopaminergic neurons
in PD. (The data has been published in BMC Neurosci.,
doi:10.1186/1471-2202-12-116.)

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

302 Posters, Sunday 9 September
P1559
Prognostic value of nocturnal stridor in
multiple system atrophy
F. Mastrolilli1, P. Guaraldi2, G. Calandra-Buonaura2,
G. Barletta2, A. Cecere2, L. Sambati2, F. Provini2,
F. Vernieri1, P. Cortelli2
1Policlinico Universitario Campus Bio-Medico, Roma,
2IRCCS, Istituto delle Scienze Neurologiche, University of
Bologna, Italy
Introduction: Multiple system atrophy (MSA) is a
neurodegenerative disease characterized by parkinsonian,
cerebellar and autonomic features. Nocturnal stridor is
frequent associating with poor prognosis. We conducted a
retrospective study to determine the survival of 111 patients
and examine the incidence and prognosis of stridor in
relation to standard therapy.
Methods: 111 patients were analyzed (68 MSA-P, 43 MSA-
C; mean age at motor onset was 589 years). 86 of 111
patients died; mean disease duration was 84 years. 80 of
111 patients underwent polysomnography.
Results: Stridor was diagnosed by polysomnography in 36
patients. Mean disease duration was 94 years in patients
with stridor; 84 years in patients without stridor. Disease
duration after stridor onset was 74 years. 28 of 36 patients
with stridor died: 14 underwent tracheostomy (62 years
after disease onset), 5 were treated with CPAP (41 years
after disease onset), 9 patients refused any treatments.
Statistical analyses showed a mean survival from disease
onset of 10 years for tracheotomised patients and 8 years for
CPAP treated patients; a mean survival after stridor therapy
of 43 years for tracheotomised patients and 22 years for
CPAP treated ones.
Conclusions: In our series stridor does not appear to be a
marker for reduced life expectancy in MSA. Despite the
treatment, the mean survival time is not significantly
different. A prospective study is needed to shed light on the
prognostic effect of the nocturnal stridor and its treatment
that is one of the most reliable clinical hallmarks of MSA.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1560
Pharmacokinetics, pharmacodynamics
and tolerability of opicapone, a novel
COMT inhibitor, during the first
administration to healthy male subjects
T. Nunes1, J.-F. Rocha1, R. Pinto1, R. Machado1,
L. Wright1, A. Falco2, L. Almeida3, P. Soares-da-Silva1,4
1Research & Development, BIAL - Portela & C S.A.,
S. Mamede Coronado, 2Faculty of Pharmacy, University of
Coimbra, 3Health Science Section, University of Aveiro,
4Dept. Pharmacology & Therapeutics, Faculty of Medicine,
University of Porto, Portugal
Introduction: Opicapone was developed to fulfil the need
for more potent, safer and longer acting catechol-O-
methyltransferase (COMT) inhibitors (1). This study was
aimed to assess the tolerability, pharmacodynamics, and
pharmacokinetics of single oral doses of opicapone in
healthy male subjects.
Methods: Single rising oral doses of 10mg to 1,200mg of
opicapone were studied under a double-blind, randomised,
placebo-controlled design. 8 sequential groups of 8 subjects
were enrolled. Within each group, 6 subjects were
randomised to receive opicapone and 2 subjects to receive
placebo. Opicapone/placebo was administered after a 10h
overnight fasting.
Results: The extent and rate of systemic exposure (AUC
and Cmax) to opicapone increased in an approximate dose-
proportional manner. Despite the relatively short half-life of
opicapone (1 to 4h), inhibition of soluble COMT (S-COMT)
activity in erythrocytes was long-lasting, ranging from 6%
(10mg) to 55% (1,200mg) at 72h post-dose. Maximum
S-COMT inhibition (Emax) occurred between 1 and 6 h
post-dose (tEmax), and was 34.5%, 71.7%, 93.8%, 96.3%,
100%, 100%, 100% and 100% with the doses of 10, 25, 50,
100, 200, 400, 800 and 1,200mg, respectively. Urine levels
of opicapone and its metabolites usually remained below
the limit of quantification, showing that the kidney is not
the primary route of excretion. Opicapone was well
tolerated at all doses tested.
Conclusion: Opicapone was well tolerated at oral single
doses of 10 to 1,200mg, presented a dose-proportional
kinetics and effectively inhibited erythrocyte soluble
COMT activity.
[1] J Med Chem 53, 3396-3411, 2010.

P1561
Effect of verbal auditory cues on cortical
motor excitability in Parkinsons disease.
Evidence from motor evoked potentials
E. Shahine1, N.A. Elsawy1, G.A. Achmawi2
1Physical Medicine and Rehabilitation, 2Neurology
Department, Faculty of Medicine, Alexandria University,
Alexandria, Egypt
Introduction: Parkinsons disease (PD) patients rely on
external sensory inputs to guide movements.
Aim: To study the effect of verbal auditory cues on cortical
motor excitability of PD patients.
Participants and methods: The study included 17 PD
patients and 15 healthy controls. Motor evoked potential
(MEP) was recorded from abductor pollicis brevis muscle
at baseline, following repetitive rhythmic thumb abduction-
adduction at preferred speed and with verbal cues. Number
of repetitive movement cycles (RMC), resting motor
threshold (RMT), central motor conduction time (CMCT),
MEP amplitude ratio and cortical silent period (CSP) mean
duration were measured.
Results: At baseline, PD patients had significantly higher
MEP amplitude ratio and shorter CSP mean duration than
controls (p=0.9, 0.01, respectively). At their preferred
speed, PD patients had significantly lower RMC compared
to controls (p=0.005); and compared to baseline, they had
significantly lower RMT, prolonged CMCT and increased
CSP mean duration (p=0.04, 0.05 and 0.01, respectively).
With verbal cues, both PD patients and controls could
increase significantly RMC (0.000, 0.028 respectively) but
still lower in patients (p=0.002). Following verbal cues,
none of the MEP parameters had changed significantly
among patients compared to controls and compared to
performance without cues. Controls had significant
shortening in CMCT and prolongation of CSP mean
duration (p=0.046, 0.001 respectively).
Conclusion: Parkinsons disease patients have significant
cortical hyperexcitability compared to healthy subjects.
Performing a repetitive motor task with or without verbal
auditory cues may normalize cortical excitability level in
PD patients.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 303
P1562
Genetic features and dopaminergic
imaging in benign hereditary chorea
T. Konishi1, S. Kono1, M. Fujimoto2, T. Terada1,3,
Y. Ouchi3, H. Miyajima1
1First Department of Medicine, Hamamatsu University
School of Medicine, Hamamatsu, 2Department of Neurology,
Iwata City Hospital, Iwata, 3Laboratory of Human Brain
Imaging Research, Molecular Imaging Frontier Research
Center, University School of Medicine, Hamamatsu, Japan
Introduction: Benign hereditary chorea (BHC) is a rare
autosomal dominant movement disorder caused by a
mutation in the TITF-1 gene, which is essential for the
development, differentiation and organization of the basal
ganglia. Previously reported TITF-1 mutations were located
in the exons or splice sites adjacent to the exons. Some
patients showed a response to levodopa therapy, suggesting
a functional impairment in the dopamine neuronal pathway
of the basal ganglia.
Methods: We investigated the clinical features in Japanese
BHC family members by genetic analyses of the TITF-1
gene and positron emission tomography (PET) imaging to
assess the integrity of the striatal dopaminergic system
using [11C]-CFT for the presynaptic dopamine transporter
function and [11C]-raclopride for the postsynaptic D2
receptor function.
Results: The BHC patients presented non-progressive
generalized choreic movements initiated in childhood and
no response to levodopa treatment. The genomic DNA
analyses showed a novel heterozygous c.464-9C>A
mutation in intron 2. A sequencing analysis of the lung
TITF-1 mRNA by a reverse transcription-PCR assay
revealed an abnormal transcript with a 7bp insertion,
identical to sequence in intron 2, at the boundary of exons 2
and 3. Dopaminergic PET studies revealed decreased
raclopride binding in the striatum compared to age-adjusted
control values, while the CFT binding was not altered.
Conclusions: The intronic mutation created a new acceptor
splice site leading to the production of an aberrant transcript
affecting the expression of TITF-1 gene. Dopaminergic
PET imaging revealed striatal D2 receptor impairment
which may be attributed to a lack of response to levodopa.
304 Posters, Sunday 9 September
P1563
Ocular application of oxybuprocaine
hydrochloride against apraxia of lid
opening: a randomized controlled trial
M. Kohsaka, T. Oeda, H. Nakano, A. Umemura,
S. Tomita, R. Hayashi, K. Yamamoto, H. Sawada
Clinical Research Center and Neurology, Utano National
Hospital, Kyoto, Japan
Introduction: Apraxia of lid opening (ALO) is often seen
in patients with Parkinsons disease. ALO is usually
aggravated by bright lights or irritants to the cornia such as
cold wind, suggesting that it could be caused by abnormal
reaction to trigeminal sensory input from the cornea. The
purpose of the study is to examine an effect of corneal
aesthetic against ALO.
Methods: A randomized placebo-controlled cross-over trial
of ocular application of oxybuprocain hydrochloride, a
short acting corneal anaesthetic, was conducted in 8
Parkinsons disease patients. Time to complete opening
after 10 minutes eye closure (complete opening time
(COT)) was measured 14 times (before and every minute
from 1 to 13 minutes after eye drops of oxybuprocain
hydrochloride or saline as placebo). Primary outcome
measure was a difference of % change of COT (%COT)
from baseline between the two arms. The data were
analyzed statistically by a two-way repeated-measure
ANOVA.
Results: In the oxybuprocaine hydrochloride arm, the mean
COT was reduced from baseline COT at every point. In
contrast, every mean COT was increased in the saline arm.
Comparing %COTs between the two arms, eye-drop of
oxybuprocaine hydrochloride improved COT significantly
compared to saline eye-drop (p<0.05). In 5 patients (63%),
the effect of oxybuprocain hydrochloride appeared within 1
minute after the eye drop.
Conclusion: Oxybuprocain hydrochloride is useful for
ALO in Parkinsons disease patients as a rescue drug.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1564
Resting state functional connectivity in
early Parkinsons disease
K. Szewczyk-Krolikowski1,2, R. Menke3,4, M. Hu1,2,
K. Talbot1,2, C. Mackay1,2,3
1Nuffield Department of Clinical Neurosciences, 2Oxford
Parkinson Disease Centre (OPDC), 3FMRIB Centre,
4Department of Psychiatry, University of Oxford, UK
Background: RS-fMRI is a promising new method for
developing an imaging biomarker in PD. It investigates
functional connectivity between different brain regions at
rest and requires minimal cooperation from the patient.
Previous resting state studies in PD used Region of Interest
(ROI) analyses which are very investigator-dependent. In
our study we employed a data driven approach of
Independent Component Analysis to look at changes in
Resting State Networks (RSN).
Methods: 19 early stage idiopathic PD patients and 19
normal controls (NC) were selected from the Oxford
Parkinson Disease Centre cohort. Patients were scanned on
two sessions: OFF and ON medication. Scans were
performed under resting conditions with eyes open in a 3T
MRI scanner. Data was analysed with Independent
Component Analysis implemented in MELODIC, FSL.
Results: We isolated 25 components. Comparing OFF state
PD patients to NC, the Basal Ganglia/Thalamic network
showed reduced connectivity in the putamen bilaterally.
The left putamen showed increased connectivity with the
Default Mode network. Dopaminergic medication
normalised all the differences. We found significant
correlations with UPDRS part III subscores in the Sensori-
Motor and Cerebellar networks.
Conclusions: Independent Component Analysis of
RS-fMRI is a sensitive method for investigation of
functional connectivity in PD. Identified connectivity
differences correspond very well to results of task-related
fMRI studies. In particular, reduced activation in the basal
ganglia has been one of the most commonly reported
findings. Our study shows additionally that this phenomenon
may be related to a stronger correlation of the putaminal
activity with the Default Mode Network.

P1565
Differences in non-motor symptoms in
patients with young-onset and late-onset
Parkinsons disease
I. Stankovic1, V. Markovic1, M. Svetel1, T. Pekmezovic2,
V. Kostic1
1Movement Disorders Department, Neurology Clinic,
Clinical Center of Serbia, 2Neuroepidemiology Unit, Institute
of Epidemiology, School of Medicine, University of
Belgrade, Serbia
Objective: To assess prevalence of different non-motor
symptoms (NMS) in young-onset Parkinsons disease
patients (YOPD) in comparison to their older counterparts
(LOPD).
Introduction: In some studies it was suggested that YOPD
patients have an increased risk of non-motor symptoms.
Methods: This cross-sectional study comprised 101
consecutive YOPD and 107 LOPD patients. All PD patients
were clinically evaluated and completed the revised NMS
Quest. The two separate backward stepwise linear
regression analyses were used to examine how the various
demographic and clinical characteristics contribute to the
total number of NMS.
Results: The mean total NMS (NMSQ-T) was 11.96.0 in
LOPD and 7.75.8 in YOPD (p<0.05). Dribbling of saliva,
loss of taste/smell, nocturia, forgetfulness, loss of interest,
hallucinations, lack of concentration, anxiety, change in
libido and difficulty in sexual activities were more prevalent
in LOPD. The only NMS more prevalent in YOPD were
restless legs and sweating. Significant positive correlations
were registered between the NMSQ-T and actual age
(r=0.480; p=0.001 and r=0.261; p=0.007), duration of PD
(r=0.499; p=0.001 and r=0.359; p=0.001) and H&Y stage
(r=0.607; p=0.001 and r=0.556; p=0.001) in both YOPD
and LOPD groups, respectively. In the multivariate linear
regression model, in the YOPD group only the H&Y stage
of the disease appeared to be a significant predictor of an
increasing number of NMS, while in the LOPD group
significant contributors were also age at onset and duration
of PD.
Conclusions: NMS were less frequent in our YOPD
patients and had different predictors than in LOPD group.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 305
P1566
Botulinum toxin therapy of cervical
dystonia (CD): duration of therapeutic
effects
D. Dressler, P. Tacik, F. Adib Saberi
Movement Disorders Section, Department of Neurology,
Hannover Medical School, Hannover, Germany
Introduction: We sought to explore the duration of
therapeutic effect of botulinum toxin (BT).
Methods: Patients with CD, receiving Xeomin, Botox or
both treatments in sequence, entered a non-interventional
study. Outcome measures included treatment duration (TD;
time between application of BT and patient-reported waning
of therapeutic effect), inter-injection interval (II) and excess
time (ET; ET=II-TD).
Results: 59 patients (male, n=22; mean age, 52.6 years;
mean Tsui score, 9.0) and 1289 treatment cycles (mean
number per patient, 21.8; standard deviation [SD], 14.0;
range, 4-66) were evaluated. Mean (SD) TD per patient
ranged from 7.8 (1.4) to 21.0 (3.9) weeks (overall mean,
11.8 [2.7]). Mean TD was 12 weeks in 83.1% of patients
and 10 weeks in 35.6%. Mean (SD) II per patient ranged
from 11.3 (1.3) to 27.8 (11.6) weeks (overall mean, 15.4
[3.4]). Overall mean (SD) ET was 3.5 (2.4) weeks (22.7%
of overall mean II). TD and II were generally stable,
although 16.9% of patients experienced treatment delays,
most frequently due to appointment difficulties. Prolonged
treatment effects, probably due to CD fluctuations, occurred
in 18.6% of patients. Singular unexplained therapy failure
(SUTF) occurred following 0.4% of injection series. No
antibody-induced therapy failure occurred.
Conclusion: TD and II were generally stable with long-
term BT application, but could be influenced by treatment
delays, CD fluctuations or SUTF. ET indicated that patients
were treated suboptimally for ~23% of their treatment
cycle, supporting a reduction of II. BT formulations
associated with low antigenicity may be useful if II is
reduced to 12 weeks.
306 Posters, Sunday 9 September
P1567
Dysautonomic dysfunction in Parkinsons
disease evaluated by SCOPA-AUT scale
V. Arnao, S. Realmuto, F. Valentino, G. Famoso,
S. Mastrilli, A. Cinturino, V. Perini, P. Aridon,
P. Ragonese, M. DAmelio, G. Savettieri
Dipartimento di Biomedicina Sperimentale e Neuroscienze
Cliniche, Universit degli Studi di Palermo, Italy
Introduction: Non-motor symptoms of PD are common,
occur across all stages of PD, and are under-reported.
Dysautonomic symptoms generally associated with more
advanced Hoehn and Yahr (H&Y) stages, further aggravate
quality of PD patients life.
Objective: To assess frequency of dysautonomic symptoms
in PD patients and to correlate to PD related characteristics.
Method: All consecutive non-demented PD patients who
underwent an extensive evaluation including UPDRS, and
Scale for Outcomes in PD for autonomic symptoms
(SCOPA-AUT) were enrolled. SCOPA-AUT evaluates the
involvement of gastro-intestinal, urinary, cardiovascular,
thermoregulatory, pupillomotor and sexual dysfunction.
Supine to standing position blood pressure and cardiac
frequency changes were measured. Orthostatic hypotension
(OH) was diagnosed according to consensus statement on
the definition of OH (Freeman, Clin Auton Res. 2011).
Results: 89 PD patients were included (mean age at
interview was 67.7). Patients were stratified according to
the medium score of SCOPA-AUT scale (17.1). Those with
higher SCOPA-AUT score had more frequently an older
age at PD onset (77%; 62.4 years), higher UPDRS IV score
(61%; 30.1) and longer disease duration (64%; 5.2 years).
Mean SCOPA-AUT score was significantly higher
(21.88.2) among those patients (5; 5.6%) who showed OH
compared to those without (16.930.2).
Conclusion: Our study remarks the role of autonomic
dysfunction in PD. In our population characterized by mild
to moderate disease severity, in most of patients the
autonomic system was involved. In these symptoms
frequency increases with duration and severity of disease,
might be present also at onset, suggesting therefore
evaluating their presence also in the earliest stage.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1568
A meta-analysis of cognitive deficits in
clinical subtypes of multiple system
atrophy
E. Lyros1,2, A. Tsapanou3, L. Messinis4,
P. Papathanasopoulos5, K. Fassbender6
1Neurology, University of Saarland, Homburg, Germany,
2Neurology, Medical School, University of Patras,
3University of Athens Medical School, Athens, 4University of
Patras, 5University of Patras Medical School, Patras,
Greece, 6University of Saarland, Homburg, Germany
Dementia and severe cognitive impairment are considered
as non-supporting features for the diagnosis of multiple
system atrophy (MSA). Several studies however suggest
that neuropsychological deficits are frequent in this
condition. It would also be interesting to see whether the
magnitude of these deficits would be any different among
MSA with predominant parkinsonism (MSA-P) and MSA
with predominant cerebellar ataxia (MSA-C). Therefore we
conducted a meta-analysis to increase power by pooling
data from individual relevant studies based on a Pubmed
database search (studies that qualified had to include both
patient groups or clearly defined only MSA-P or MSA-C
group, a control group, a battery of diverse neuro
psychological tests, statistics that were convertible to affect
size g and be written in English). Eligible studies reached
the number of 7. The overall mean effect size for each
cognitive domain was computed using a random effects
model and adjusted for sample size. Our preliminary results
indicate that significant decrements in neuropsychological
performance loading on executive functions are present in
both patients groups with their magnitude however being
greater for the MSA-P group. Reasoning, psychomotor
speed and memory recognition were less severely impaired.
It is implied that dysfunction in the frontostriatal circuits but
also of its cerebellar connections may underlie the observed
deficits.

P1569
Validation study of genetic factors
contributing to Parkinsons disease in
Spanish and Latin American populations
A. Sesar1, P. Cacheiro2,3, M. Camia-Tato3, M. Lopez4,
B. Quintns2,3, E. Alonso5, E. Cebrin6, A. Castro1,
A. Carracedo2,3, M.J. Sobrido2,3
1Neurology, Santiago de Compostela Clinical Hospital.
University of Santiago de Compostela, 2Neurogenetics
Group, Fundacion Publica Galega de Medicina Xenomica-
SERGAS, 3Genomic Medicine Group, School of Medicine-
University of Santiago de Compostela, Spain, 4Biological
Systems, Universidad Autonoma Metropolitana-Xochimilco,
5Neurogenetics, Instituto Nacional de Neurologa y
Neurociruga Manuel Velasco Surez, Mexico DF, Mexico,
6Neurology, Complexo Hospitalario Universitario de
Pontevedra, Santiago de Compostela, Spain
Introduction: In past years some genes have been
associated with predisposition to Parkinsons disease (PD)
. The aim of this study was to analyze several candidate
genes as susceptibility factors to PD in populations from
Spain and Latin America.
Methods: PD cases defined by the Gelb criteria were
compared with controls selected after family history and
clinical exam. SNPs in 12 previously reported genes and
intergenic regions were genotyped by SNPlex. After quality
control by genotyping rates, minor allele frequency and
Hardy-Weinberg equilibrium - no significant population
substructure is known in the Galician population; 71 SNPs
were analyzed in 268 patients and 257 controls. Quality
control and association tests were carried out with the R
package SNPassoc. Imputation of additional markers was
performed using HapMap panels.
Results: Nominally significant associations (P<0.05) were
found for SNPs belonging to MAPT, SNCA and SYT11
genes. Only the MAPT association remained significant
after multiple testing correction (False Discovery Rate).
These results were also checked in a Mexican cohort.
Conclusions: Genetic variation in MAPT and SNCA have
been associated with PD in independent populations. The
replication of MAPT and SNCA association confirms the
participation of these genes in susceptibility to PD while
serving as a quality indicator of our sampling protocol.
Regarding SYT11 there is only a meta-analysis of GWAS
suggesting association with PD. Our data, together with
previous results, suggest that SYT11 encoding
synaptotagmin XI, substrate for parkin may play a so far
under-recognized role in the pathogenesis of PD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 307
P1570
Leukoaraiosis as a predictor of cognitive
decline in patients with Parkinsons
disease submitted to STN-DBS
F. Sousa1, J. Rocha1, H. Costa2, C. Sousa3, J. Lima3,
R. Figueiredo4, C. Reis4, J. Massano5, M. Basto4,
P. Linhares5, R. Vaz5, M.J. Rosas5
1Neurology Department, Hospital de Braga, 2Neurology
Department, 3Neuropsychology Unit, 4Neuroradiology
Department, 5Movement Disorders Unit - Functional
Surgery, Hospital de So Joo, Porto, Portugal
Introduction: Subthalamic nucleus deep brain stimulation
surgery (STN-DBS) may lead to selective cognitive decline.
Leukoaraiosis is a cognitive decline predictor in patients
with cerebrovascular disease. The aim of the study is to
evaluate the influence of leukoaraiosis on cognitive decline
after STN-DBS in Parkinsons disease (PD).
Methods: From October 2002 and December 2010,
neuropsychological studies pre- and post-DBS (12-18
months) were prospectively registered and Fazekas
classification of leukoaraiosis in pre-DBS MR imaging was
evaluated in patients with PD undergoing STN-DBS.
Demographics, disease duration, educational level, Mini
Mental State Examination (MMSE), Frontal Assessment
Battery (FAB), categorical (Fvcat) and phonemic (Fvfon)
verbal fluency tests were compared.
Results: 91 patients were enrolled, 64 with leukoaraiosis.
In this group there was a decrease in MMSE (27.94 to 26.94
p<0.05), FAB (13.02 to 11.80 p<0.05), Fvcat (13.76 to
10.77 p<0.05) and Fvfon (18.48 to 13.86 p<0.05). In
patients without leukoaraiosis, FAB (13.62 to 13.33
p<0.05), Fvcat (14.73 to 11.81 p<0.05) and Fvfon (20.56 to
14.48 p<0.05) decreased, but not MMSE (27.74 to 27.89
p<0.05). The mean value of MMSE and FAB post-DBS was
lower in subjects with leukoaraiosis (p<0.05). There were
no differences in score variations between Fazekas 0-1 and
2-3, progression to dementia or educational level.
Conclusion: These results confirm the trend for cognitive
decline in the evaluated areas after DBS. Patients with
leukoaraiosis have lower scores on evaluated domains, but
only MMSE and FAB differences were significant.
308 Posters, Sunday 9 September
P1571
What is the diagnosis behind patients
with parkinsonian syndrome and normal
123I-Ioflupane SPECT? A clinical follow-up
study
M. Menndez1,2, F. Tavares1, M. Martnez1,
A. Lpez-Muiz2, J.A. Vega2
Hospital lvarez-Buylla, Mieres, 2Morfologa y Biologa
1 pathogenesis of Parkinsons disease (PD). Low serum uric
Celular, Universidad de Oviedo, Spain
Introduction: Making the diagnosis of Parkinsons disease
(PD) is a common clinical situation faced by neurologists,
geriatricians, and general physicians. The Food and Drug
Administration (FDA) recently approved [123I]ioflupane
([123I]-fluoropropyl CIT, DaTSCAN), a dopamine
transporter (DAT) radioligand, for SPECT to assist in the
evaluation of adult patients with suspected parkinsonian
syndromes (PS). We aimed what is the diagnosis of patients
with PS and normal DaTSCAN.
Methods: A series of 30 patients with parkinsonism and
normal 123 I-Ioflupane SPECT. They were followed up for
at least 2 years; and then a second DaTSCAN was
performed. The diagnosis was reconsidered at endpoint.
Results: The second DaTSCAN changed from normal to
abnormal only in 4 patients. Final diagnosis included cases
of essential tremor (4), SWEDD (2), FTAX (1), iatrogenic
parkinsonism (1), vascular parkinsonism (2), corticobasal
degeneration (2), multisystem atrophy (4) and PD (8). The
diagnosis remained uncertain in 6 cases.
Conclusion: DaTSCAN can help the diagnostic process in
certain situations but it should not be relied on as a substitute
for careful, experienced clinical assessment and follow up.
There is a list of alternative diagnoses to consider when a
PD patient presents with normal DaTSCAN. Following
cases of uncertain diagnosis with DaTSCAN studies does
not seem to be useful.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1572
CSF uric acid as an anti-oxidant in
Parkinsons disease
M. Pohja1, K. Murros2
Helsinki University Central Hospital, 2Helsinki University
1
Central Hospital, Jorvi Hospital, Espoo, Finland
Oxidative stress is thought to be an important factor in the
acid (UA) has been associated with faster clinical
progression of the disease. UA is an antioxidant having
interactions with another important antioxidant, ascorbic
acid (AA). We studied if UA or AA or total antioxidant
capacities in plasma and CSF are altered in PD. 16 PD
patients (52-73 yrs, 50% males, mean disease duration 4
years, mean UPDRS motor score 21) were recruited. 16
gender- and age-matched healthy subjects served as
controls. UA in CSF was statistically lower in PD patients
than in controls (19.6 umol/l vs. 25.6umol/l, p=0.03). In
plasma, the corresponding difference was trend-like
(p=0.07). The CSF/plasma ratio was the same in both
groups but strong correlation between serum and CSF UA
was seen in PD but not in the control group (0.77, p=0.01
vs. 0.42, p=0.10). In PD group, AA was higher both in
plasma (77umol/l vs. 56umol/l, p=0.03 ) and in CSF (206
umol/l vs. 156umol/l, p=0.01) suggesting higher vitamin C
intake but no difference in active transport mechanism
across BBB. Antioxidant capacities in serum and CSF
estimated by TRAP were similar in both groups. Our
novelty finding was that in PD patients CSF uric acid
concentrations are lower than in healthy, gender- and age-
matched controls. In addition, plasma and CSF uric acid
concentrations are more tightly coupled suggesting
potentially different or altered UA regulation mechanism in
PD.

P1573
Does Rivastigmine improve balance
control in Parkinsons dementia?
E. Pourcher1,2, A. Nadeau3, M. Jaime3, P. Corbeil4,5
1Clinique Sainte-Anne, 2Department of Medicine, Faculty of
Medicine, Laval University, 3Department of Kinesiology,
Laval University, 4Groupe de Recherche en Analyse du
Mouvement et Ergonomie, Faculty of Medicine, Laval
University, 5Centre de Recherche FRSQ, Centre Hospitalier
Affili Universitaire de Qubec, QC, Canada
Introduction: According to Allcock et al. (2009), impaired
attention predicts falling in Parkinsonian patients, however
the contribution of attention improvement with
cholinesterase inhibitors on balance control in Parkinsons
disease has never been formally explored.
Methods: 20 patients with idiopathic Parkinsons disease
and mild to moderate dementia (PDD) were randomized to
receive either Rivastigmine trans-dermal patches or oral
capsule for 24 weeks. Postural control using a force
platform was assessed at baseline and 24 weeks under four
conditions: eyes open/ eyes closed with static support
surface/ sway referenced to body sway form support
surface. Other outcomes included scores of the MATTIS
Dementia Rating Scale (global and attention sub-scores)
and the UPDRS motor sub-section.
Results: At 24 weeks, there was no difference in measures
of postural control at rest, with a static support surface,
however, a significant reduction was observed in sway
velocity when the support surface was sway-referenced to
body sway (p<0.01). Participants UPDRS III scores did not
differ. Better performances on the MATTIS Dementia
Rating Scale global scores were observed after 24 weeks
(p=0.052). However neither the global score, nor the
attention sub-score of the MATTIS correlated with
improvement in sway velocity. No difference was observed
in balance performance between patients on patches and
patients on oral form.
Conclusion: In PDD, Rivastigmine improves adaptive
balance control independently of an improvement on the
attention MATTIS score. This result tends to support an
improvement of balance driven by a sub-cortical cholinergic
modulation.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 309
P1574
Correlation between severity of cognitive
deficit and motor symptoms in patients
with Parkinsons disease
S. Tomic1, M. Vladetic1, K. Solic2, S. Misevic1, S. Juric1,
L. Knezevic Poljak1, S. Butkovic Soldo1
1University Hospital Center Osijek, 2Medical School
University of J.J. Strossmayer in Osijek, Croatia
Aim: To determine the existence of cognitive deficits in
patients with idiopathic Parkinsons disease (PD) compared
to a control group and to find a correlation between the
severity of cognitive deficits and motor symptoms in order
to prove influence of dopamine on cognition.
Patients and methods: Demented and depressed PD
patients were excluded from the study. Patients with PD
were scored with UPDRS III and both groups made tests of
cognitive function: Dementia Rating Scale (DRS), Raven
progressive coloured matrices (RPCM) and Mill Hill
Vocabulary (MHV) test. To analyse data we used the
methods of descriptive statistics, Student T-test, Mann-
Whitney U-test, Pearson and Spearman correlation
co-efficient with p<0.05.
Results: We found statistically significant differences in
MHV test and the frequency of pathological tests of
construction and conceptualization (DRS subscales)
between PD patients and control groups. We found no
correlation between the results of cognitive tests and
UPDRS part III in the PD patients group. There are no
connections between cognitive deficit and duration of
disease and type of PD (rigid or tremorous form). There is
a possible connection between damaged visual-spacial
perception and lesion of right side of brain.
Discussion: Patients with PD more often had cognitive
deficit (dysexecutive syndrome, synonym finding and
impaired visual-spatial perception) when compared to the
control group. There is no correlation between cognitive
deficits and severity of motor symptoms in PD patients.
Conclusion: These results suggest that cognitive deficits
are not only due to dopamine depletion, but etiology is
probably more complex.
310 Posters, Sunday 9 September
P1575
The Rome tremor scale: an easy
instrument for the evaluation of tremor
F. Puledda, L. Troilo, G. Lenzi
Neurology and Psychiatry, University of Rome Sapienza,
Rome, Italy
Background: Tremor is a movement disorder that affects
more than 10% of the general population. However, few
clinical scales are available for tremor evaluation: the
Clinical Tremor Rating Scale (CTRS) and the UPRS. The
CTRS needs 30-90 minutes, and a fully compliant patient to
be carried out. The UPRS is utilised in PD, with just a few
of the 42 evaluations concerning tremor.
Objectives: In the planning of a clinical trial on tremor, we
designed a user-friendly tremor scale, the Rome Tremor
Scale (RTS) and tested it against the CTRS.
Materials and methods: RTS consists of six items: 0=no
tremor; 1=tremor present in emotional situations, not
invalidating; 2=tremor present, affects writing; 3=tremor
present, affects daily activities; 4=tremor present, patients
require constant help; 5=disabling tremor.
Results: 40 outpatients attending our Clinic because of
neurological problems including tremor completed both
CTRS and RTS. The mean score was 15.851.33 for CTRS
and 2.0250.094 for RTS. Correlation between CTRS and
RTS shows r=0.943. By dividing patients into two cohorts,
PD and essential tremor, correlation remains highly
significant, r=0.971 and r=0.907 respectively.
Conclusions: The high correlation between RTS and CTRS
indicates that RTS appears to be a valid and easy instrument
for the clinical evaluation of tremor in an out-patient
neurological setting, both in PD patients and patients
affected by tremor due to other causes.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1576
Expanding the spectrum of chorea
associated with immune-mediated
diseases: two case reports
E. Unti1, S. Mazzucchi1, D. Martino2, F. Vanelli1,
R. Ceravolo1
Department of Neuroscience, University of Pisa,
1
Department of Neurological and Psychiatric Sciences,
2
University of Bari, Italy
Introduction: Wegener Granulomatosis (WG) and psoriasis
are diseases in which neurological involvement is quite
rare; up to our knowledge, there are no cases associated
with movement disorders in literature.
First case: A 72-year-old male, with a diagnosis of WG
since 1999. Since 2003 he presented simple verbal tics, four
limbs involuntary movements, and an amnestic mild
cognitive impairment. No steroids were given. Hyperkinetic
syndrome improved with low dosages of tetrabenazine
Second case: A 67-year-old woman presented with choreic
movements mainly in the left limbs, slight dysarthria and
painful tumefaction of left wrist. Neuropsychological
evaluation showed a mild frontal dysfunction. Within four
months diagnosis of psoriasis was made. Methylprednisolone
was given with improvement of chorea.
Methods: Genetic tests for HD, HDL2, SCA-17 and
research for acanthocytis were negative. FDG-PET showed
right caudo-putaminal hypermetabolism in the first patient
and bilateral basal ganglia hypermetabolism in the second
patient. Brain MRI did not show any significant alterations.
CSF examination, iron and copper sieric values were in the
normal range. Sieric anti-basal ganglia antibodies (ABGA)
showed auto-antigen of 45 kDa.
Conclusions: Evidence of striatal hypermetabolism on
FDG-PET with chorea associated with SLE and primary
antiphospholipid syndrome has been reported probably due
to auto-antibodies versus basal ganglia neurons. The ABGA
positivity previously reported in autoimmune movement
disorders, does not imply a pathogenetic relationship,
however along with the striatal hypermetabolism in both
and the good response to steroids in the second, one might
extend the spectrum of chorea associated with autoimmune
diseases.

P1577
Frequency distribution of orthostatic
hypotension, nocturnal hypertension and
postprandial hypotention in patients with
Parkinsons disease: a case-control study
A. Chitsaz
Neurology, Isfahan University of Medical Sciences, Isfahan,
Iran
Background: Etiology of orthostatic hypotension include
sympathetic denervation and treatment with dopaminergic
drugs.
Methods: The current study was conducted as a case-
control study in the second half of 2008 and first half of
2009. The study population included Parkinsonian patients
who received levodopa, >500mg/day for over 6 months.
Patients who had not received any levodopa until the time
of the study were in the control group. Exclusion criteria
included having a concomitant disease or taking medications
that cause orthostatic hypotension. Study variables included
demographic characteristics, severity of disease, orthostatic
hypotension, postprandial hypotension and nocturnal
hypertension. Using the mercury barometer, the presence or
absence of orthostatic hypotension was determined in all
patients. The postprandial hypotension and nocturnal
hypertension were identified using the portable device of
ambulatory blood pressure monitoring.
Findings: The frequency distribution of orthostatic
hypotension was 12% and 20% in the case and control
group, respectively. The frequency distribution of
postprandial hypotension was 12% and 24% in the case and
control group, respectively. The frequency distribution of
nocturnal hypertension was 40% and 56% in the case and
control group, respectively.
Conclusion: Although the prevalence of orthostatic
hypotension between the case and the control group was
different, the difference was not meaningful.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 311
P1578
A randomized, double-blind, placebo-
controlled trial of hydrogen water in
Parkinsons disease
A. Yoritaka1,2, M. Takanashi2, M. Hirayama3, S. Ohta4,
N. Hattori2
1Neurology, Juntendo Koshigaya Hospital, Koshiaya-shi,
2Neurology, Juntendo University School of Medicine,
Bunkyo-ku, 3Pathophysiological Laboratory Science, Nagoya
University Graduate School of Medicine, Nagoya,
4Biochemistry and Cell Biology, Development and Aging
Sciences, Graduate School of Medicine, Nippon Medical
School, Tokyo, Japan
Background: The major pathological hallmarks of
Parkinsons disease (PD) are cellular energy depletion and
oxidative stress leading to cellular dysfunction and death.
Molecular hydrogen (MH) selectively reduces the hydroxyl
radical, the most reactive oxygen species, and can thereby
effectively protect cells. MH water has been reported to
prevent dopaminergic cell loss in rat models of PD.
Method: To determine that intake of MH water is safe and
a disease-modifying treatment of PD, we conducted a
double-blind, placebo-controlled trial of MH water in
levodopa-treated patients with PD. The subjects prepared
MH water (1.6ppm) by using Aquela blue (ecomo
International) and consumed 1,000ml of MH water divided
per day for 48 weeks.The primary end-point was the change
from baseline in the total score of the Unified Parkinsons
disease Scale (UPDRS). Additional analysis is the change
of part of II and III of UPDRS and Hoehn and Yahr stage
after 8, 24, 48 weeks and 8 weeks after treatment compared
with the data at baseline.
Result: 18 subjects (7 male, 11 female) were enrolled in the
treatment protocol. The changes in the total UPDRS score
will be calculated with Mann-Whitney U-test after blinding
will be opened after all subjects have finished protocol.
Conclusion: No doubt on safety of MH water intake has
been found until now. We will demonstrate if MH may be
applicable or not for the therapy in Parkinsons disease.
312 Posters, Sunday 9 September
P1579
The prevalence of non-motor symptoms
and restless legs syndrome in Parkinsons
disease: correlation with quality of life
K.A. Abdul Manaf1, W.N.N. Wan Yahya1, H.J. Tan1,
R. Azman Ali1, H. Othman2, S. Azhar3,
N. Mohamed Ibrahim1
1Internal Medicine, 2Pathology, 3Community Health,
University Kebangsaan Malaysia Medical Centre, Kuala
Lumpur, Malaysia
Introduction: The non-motor symptoms (NMS) are
important determinants of health and quality of life (QoL)
in Parkinsons disease (PD). It occurs early and may even
predate the diagnosis of PD. NMS are not well recognized
in clinical practice despite their impact.
Aims: This study was conducted to determine the
prevalence of NMS and restless legs syndrome (RLS) in PD
and their impact on QoL.
Methods: This was a cross-sectional study involving
patients with idiopathic PD. Prevalence of NMS using the
NMS questionnaires was determined. The QoL and severity
of NMS were assessed with PDQ-39 questionnaires and
NMS Assessment Scale, respectively. Patients who met the
criteria of International RLS Study Group criteria for the
diagnosis of RLS were identified and blood samples to test
serum iron were taken.
Results: A total of 113 patients consisting of 60 males and
53 females were recruited. The mean age was 64.89.0
years. The median duration of illness was 5.0 (2.0-8.0)
years. 97.3% of patients reported the presence of NMS. The
most common symptoms were gastro-intestinal symptoms
(76.1%) followed by neuropsychiatric symptoms (72.6%)
and autonomic dysfunction (64.6%). 11 patients (9.7%) had
RLS. Patients with PD/RLS had a younger age of PD onset
(p=0.023) and lower serum ferritin levels (p=0.616). NMS
affected the QoL significantly in all dimensions of PDQ-39.
Each dimension of PDQ-39 correlated strongly with the
severity of NMS.
Conclusions: NMS was highly prevalent in our patients.
The presence and severity of NMS adversely affected the
QoL.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1580
Transcranial sonography in differential
diagnosis of restless legs syndrome
M. Budisic, Z. Trkanjec, V. Supanc, A. Lovrencic-Huzjan,
V. Bai-Kes
University Hospital Sestre Milosrdnice, Zagreb, Croatia
Background: Restless legs syndrome (RLS) has a
prevalence of around 10% in the general population. Still, it
is one of the most underdiagnosed neurological disorders.
Non-idiopathic RLS is more frequently found in patients
with anaemia. Recent transcranial sonography studies have
shown that substantia nigra (SN) hypo-echogenicity appears
to be a frequent finding in RLS, just as it is increased blood
flow velocity in a. cerebri media (ACM), measured by
TCCS, in anaemic patients. Aim of this study was to
evaluate the usage of combined TCS/TCCS imaging in
differential diagnosis of idiopathic and secondary RLS.
Patients and methods: 30 patients with RLS symptoms
(diagnosis was made according to IRLSSG criteria), 20
patients with anaemia (haemoglobin values <12g/dl) and
RLS symptoms, and 30 controls underwent neurological
and sonographic examination.
Results: Bilateral mean SN area measured on TCS was
significantly lower in idiopathic RLS patients versus
controls ( 0.090.01cm2 vs. 0.180.02 cm2; p<0.01). Values
of mean blood flow velocity measured in ACM by TCCS
were also higher in RLS patients (123.247.33 vs.
80.76.55; p<0.01) with anaemia, with normal finding of
SN area.
Conclusion: TCCS in combination with TCS is a useful
tool in diagnosing idiopathic RLS, just as it is in
differentiating idiopathic from secondary RLS due to
anaemia.

P1581
XCiDaBLE, a phase IV, prospective
observational trial evaluating
incobotulinumtoxinA (XEOMIN) for
cervical dystonia or blepharospasm:
preliminary baseline data for subjects
with blepharospasm
M.S. LeDoux1, J. Jankovic2,
K. Sethi3, A. Verma3,
E.J. Pappert3, H.H. Fernandez4
1University of Tennessee Health Science Center, Memphis,
TN, 2Baylor College of Medicine, Houston, TX, 3Merz
Pharmaceuticals, LLC, Greensboro, NC, 4Cleveland Clinic,
Cleveland, OH, USA
Introduction: While repeated injections of botulinum
toxin-A are the established treatment for blepharospasm,
there is a lack of prospectively acquired data on treatment
outcomes in real-world clinical practice.
Methods: XCiDaBLE is an open-label, prospective,
observational US study. Subjects are followed for two
cycles of incobotulinumtoxinA treatment with flexible
dosing and injection intervals determined by the investigator.
Subject-reported outcomes (recorded via Interactive Voice/
Web Response) include the Jankovic Rating Scale (JRS).
Investigators assess the baseline Clinical Global Impressions
(CGI)-Severity. An employment questionnaire, work
history and the SF-12v2 (0=worst, 100=best) are used to
evaluate work productivity and quality of life (QoL).
Results: By 01 September 2011, 184 subjects with
blepharospasm were enrolled (27.7% male, mean age 64.9
years, mean age at onset of blepharospasm 53.9 years,
97.8% previously treated with botulinum toxin). At baseline,
subjects CGI-Severity was: 32.8% normal-to-mild, 35.5%
moderate, 22.4% marked, and 9.3% severe; mean JRS
Sumscore was 5.0. Baseline mean SF-12v2 scores were
43.1 (Physical QoL) and 49.1 (Mental QoL). Most subjects
(105) were employed at onset of blepharospasm, but at
study baseline 19 subjects reported their employment status
was affected by blepharospasm and 33 subjects in
employment found that their productivity was reduced
(82.8% mean estimated productivity; normal=100%). 17
subjects received or were seeking employee disability
benefits due to blepharospasm.
Conclusions: Blepharospasm has a negative impact on
QoL, employment status and work productivity. XCiDaBLE
will provide valuable insight into the dosing and injection
frequency of incobotulinumtoxinA in subjects with
blepharospasm and treatment outcomes in real-world
clinical practice.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 313
P1582
Evaluating the efficacy of rasagiline on
depressive symptoms in Parkinsons
disease patients without dementia: the
ACCORDO study (ongoing clinical trial)
P. Barone, for the ACCORDO Study Investigators
Centro per le Malattie Neurodegenerative, University of
Salerno, Italy
Objective: In Parkinsons disease (PD), the presence of
depression is associated with worse cognitive function,
functional ability, and patients quality of life. Accumulating
evidence suggests that, in addition to its established motor
benefits, treatment with rasagiline may also be beneficial in
the management of certain non-motor symptoms of PD;
however little is known about its effects on depression. This
ongoing study aims to evaluate the efficacy of rasagiline on
depression and explore the relationship between depressive
symptoms and cognitive function in PD patients without
dementia.
Methods: This is a multicenter, randomized, double-blind,
placebo-controlled study, enrolling ~136 PD patients
(Hoehn & Yahr I-III) with depression (Beck Depression
Inventory (BDI-IA) score 15) but not dementia (MMSE
<26). Patients are randomized (1:1) to rasagiline 1mg/day
or placebo for 12 weeks; other anti-PD medications are
permitted at a stable level. The primary efficacy measure is
change from baseline to week 12 in BDI-IA total score.
Secondary measures include a neuropsychiatric cognitive
test battery, PD Quality of Life Questionnaire, Apathy Scale
and Unified Parkinsons Disease Rating Scale Parts II and
III. Safety is assessed through adverse events (AEs).
Results: As of February 2012, 121 patients have been
randomized. Mean age is 66.7 years and mean time from
diagnosis is 4.3 years. So far, 4 patients have withdrawn
early due to AEs (worsening of dyskinesia, vertigo, left
trunk flexion due to PD, nausea).
Conclusion: ACCORDO is the first prospective study to
evaluate the efficacy of rasagiline on depression. Full
results are expected in Q4 2012.
314 Posters, Sunday 9 September

P1583 P1584
Quality of life in patients with different Differentiation of parkinsonian disorders
forms of primary dystonia based on mineralization pattern of the
N.S. Basurovic1, M. Svetel2, T. Pekmezovic3, V.S. Kostic2 deep grey matter by susceptibility-
1Special Hospital for Cerebrovascular Diseases St. Sava, weighted magnetic resonance imaging
2Institute for Neurology, Clinical Centre Serbia, 3Institute for
M. Modi1, S. Thakur2
Epidemiology, Clinical Centre Serbia, Belgrade, Serbia 1 Neurology, 2Radiodiagnosis, PGIMER, Chandigarh, India
Introduction: Dystonia is frequently associated with
Objectives: There are multiple causes of
depression, anxiety, social phobia and poor quality of life.
parkinsonism;idiopathic Parkinsons disease (IPD) is most
Aim: Defining differences in quality of life in patients with
common (80-85%) and has to be differentiated from
primary focal and segmental dystonia.
atypical parkinsonian disorders (APD), i.e., progressive
Patients and methods: The study included 157 patients
supranuclear palsy (PSP), multiple system atrophy (MSA)
with primary focal dystonia (PFD) and 28 patients with
and corticobasal denegation (CBD). The aim was to study
primary segmental dystonia (PSD). Patients were treated at
mineralization pattern of the deep grey matter by
the Institute for Neurology KCS (1997-2008). All patients
susceptibility-weighted (SWI) magnetic resonance imaging
completed the Serbian translation of SF-36 which was used
to differentiate Parkinsons disease and atypical
as an outcome measure for health-related quality of life
parkinsonian disorders.
(HR-Qol).
Methods: A total of 30 subjects was enrolled for the study
Results: The mean age at onset of dystonia in patients with
of which 10 were in the control group and 20 patients
PFD was 43.211.5 years, and in patients with PSD it was
presented with features of parkinsonism. MR imaging
43.317.3 years. The mean duration of disease in patients
examinations were performed with a 18-channel 3.0T whole
with PFD was 7.3 years, and in patients with PSD it was 9.9
body imager (TIM MAGNETOM Verio; Siemens). First,
years. The ratio man/women in the group with PFD was
routine MR imaging of the brain including T1WI, T2WI
64:9, and in group with PSD was 17:11. Patients with PSD
and FLAIR sequences were done, followed by SWI. The
scored significantly worse in bodily pain (PSD 30.628.2
hypo-intensity of post lateral putamen, red nucleus,
vs. PFD 68.431.4) (p<0.01), role functioning emotional
substantia nigra, and dentate nucleus in all groups were
(PSD 38.144.2 vs. PFD 58.244.9) (p<0.01) and social
measured in comparison with SI of the CSF and vein of
functioning (PSD 50.013.6 vs. PFD 64.624.9) (p<0.05),
Galen.
while the same patient group scored significantly better in
Results: In the conventional MRI, presence of midbrain
general health (PSD 64.615.7 vs. PFD 53.918.8)
atrophy, superior cerebellar peduncle signal changes and
(p<0.05). There were no significant differences between the
atrophy differentiated PSP patients from MSA-P and PD
groups regarding physical functioning, role functioning
patients. The increased hypointensity scores of red nucleus
physical, vitality and mental health.
on SWI in PSP patients differentiated it from PD and MSA-
Conclusions: The quality of life in patients with dystonia,
P. The increased hypointensity score of substantia nigra in
has been defined by the complex interaction between
PD patients supports the site of pathology and differentiated
distribution and/or severity of disease, characteristics of
them from atypical parkinsonism patients.
patients personality and the influence of social environment.
Conclusion: Among the routine MRI techniques available
to differentiate PD and APD patients, we observed SWI as
a simple and advanced modality.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1585
Does neuro-inflammation affect
occurrence of dementia in patients with
Parkinsons disease?
I.-U. Song, J.-W. Park, K.-S. Lee, J.-S. Kim
Department of Neurology, The Catholic University of Korea,
Seoul, Republic of Korea
Background and objective: The clinical value of high
sensitivity C-reactive protein (hs-CRP) in patients with PD
is poorly defined yet. Therefore, we conducted this study to
analyze association between hs-CRP levels in PD and those
in PD with dementia. hs-CRP is an exquisitely sensitive
systemic marker of inflammation and tissue damage and
increased level of hs-CRP is strongly associated with
inflammatory reactions. Microglia-mediated neuro
inflammation has been hypothesized to play an important
role in the pathogenesis of idiopathic Parkinsons disease
(PD). Furthermore, many reports have suggested that high
concentration of hs-CRP is associated with increased risk of
cardiovascular disease, stroke, and cognitive impairment
including dementia.
Methods: We examined 60 patients with PD without
dementia and 40 patients with PD with dementia and 50
normal control subjects, and investigated differences of
hs-CRP among these 3 groups.
Result: Comparing the 3 groups, there was no significant
difference between PD and PDD groups for mean hs-CRP
values, but these two groups demonstrated significantly
higher mean hs-CRP values than the control group.
Conclusions: The pathogenesis of PD is currently unknown,
but significant microglial inflammation is observed in the
region of dopaminergic degeneration. Furthermore, it is
known that inflammation plays a role in the pathogenesis of
PD and dementia. However, we suggest in our study that,
although neuroinflammation plays a role in
neurodegenerative disease including PD and dementia,
neuroinflammation did not contribute to the pathogenesis of
PD with dementia.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 315
P1586
Prevalence and characteristics of non-
motor symptoms in Korean PD patients:
study using a non-motor symptoms
questionnaire
J.-Y. Kim
Neurology, Inje University Paik Hospital, Seoul, Republic of
Korea
We investigated the frequencies and characteristics of non-
motor symptoms (NMS) in Korean PD patients using a non-
motor symptoms questionnaire (NMSQ). We performed a
semistructured interview including NMSQ in 57 consecutive
patients who visited the movement disorder clinic of Seoul
Paik Hospital from May 2011 to October 2011. The
demographic data, Hoehn and Yahr (HY) stage, and daily
levodopa equivalent dose (LEDD) were also checked. Mean
age and duration of disease were 70.8 and 4.6 years. Mean
HY stage was 2.7 and LEDD was 793.4mg/day. We found
that the mean number of NMS per patient was 14.3 and all
patients had non-motor symptoms (range: 5-25). The most
common items were: nocturia (87.7%), anxiety (73.7%),
constipation (71.9%), remembering (70.2%), urgency
(66.7%), and insomnia (66.7%). The most common domains
were: the urinary (77.2%), depression/anxiety (65.7%), and
sleep disorders (58.3%). The total number of NMS was
correlated with HY stage but not with age and disease
duration. In women, the mean number of NMS per patient
was significantly high than in men (15.2 vs. 12.3, p=0.017).
There was a marked difference in frequencies of sleep,
depression/anxiety, and apathy/memory domains, which
were significantly higher in women. We suggest that NMS
is more prevalent in Korean PD patients compared with the
results of other previous studies. Women might be more
vulnerable to NMS than men especially in sleep, depression/
anxiety, and apathy/memory. Cultural differences might
influence the frequencies or characteristics of NMS.
316 Posters, Sunday 9 September
P1587
The examination of relationships between
voice abnormalities and the respiratory
functions in patients with Parkinsons
disease
H. Nakamura1,2, E. Sugawara1, M. Endou1, T. Takahashi1,
Y. Kuroiwa2
1Neurology, National Hospital Organization Yokohama
Medical Center, 2Neurology, Yokohama City University,
Yokohama, Japan
Introduction: Parkinsons disease (PD) is well known to
exhibit voice impairments. The aim of this study is to
evaluate objective changes in voice quality in patients with
PD.
Methods: 32 PD patients (16 male and 16 female; mean
ageSD: 70.89.01; Hoehn and Yahr: 2.340.70; Unified
Parkinsons Disease Rating Scale (UPDRS) part III:
15.038.87) and control group (14 male and 15 female;
mean ageSD: 69.87.58) were assessed. The analysed
objective voice parameters were voice volume and
maximum phonation time (MPT). All patients in the PD
group were examined by respiratory function test (vital
capacity and forced expiratory volume).
Results: There were significant differences in MPT which
was significantly shorter in the PD group than in the control
group (12.84 seconds and 17.58 seconds, respectively) and
in voice volume, which was significantly smaller in the PD
group than in the control group (91.99 and 98.60dB,
respectively). In the PD group, %VC was 96.7716.13 and
FEV1% was 80.876.49. The correlations between the
UPDRS motor score and the MPT, and between the UPDRS
motor score and the voice volume were not significant at the
0.05 level.
Conclusion: The voice of PD patients is shorter and smaller
than that of the control group. Voice abnormalities in PD
patients are not correlated with respiratory function or
motor function.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1588
The functional interhemispheric
asymmetry, clinical asymmetry and
clinico-neuropsychological features in
patients with Parkinsons disease
M.A. Bykanova, N.V. Pizova
Yaroslavl State Medical Academy, Yaroslavl, Russia
Purpose: To identify the relationship between clinical
lateralization of Parkinsons disease, individual profile of
functional interhemispheric asymmetry (IPFA) and their
influence on the neurophysiological features of patients
with Parkinsons disease (PD).
Methods and materials: To examine 70 patients (28 male
and 42 female) from 1.5 to 3 stages of PD by using the
following scales: UPDRS, HOEHN and YAHR. The IPFA
was defined using the special questionnaire with 48 jobs. 32
patients were examined using EEG study (Brain Loc).
Results: Left-sided onset was defined significantly more
frequently in patients with mixed and left IPFA than in
patients with the right IPFA (p<0.05). Right-sided onset was
observed significantly more frequently in patients with right
IPFA than in patients with mixed and left profile (p<0.05).
Slow-wave activity in the form of generalized bilaterally
synchronous bursts was observed in 27 persons (84.3%).
The lateralization of abnormal slow-wave activity with a
lack of response activation was identified in 21 (65.6%)
patients. Generator of pathological activity in right-sided
onset was detected predominantly in the left hemisphere,
while left-sided debut - on the right hemisphere mainly at
the thalamostrionigral structures. A clear lateralization EEG
activity was observed in 18 (85.7%) from 21 patients with
predominant involvement in the pathological process of the
dominant hemisphere.
Conclusions: During the EEG study (Brain Loc) generator
of pathological slow wave activity was detected on the
opposite side of the affected limb, and a clear lateralization
was observed with primary lesion of the dominant
hemisphere.

P1589
Clinical correlates of depression and
anxiety in patients with Parkinsons
disease
H. Tachibana1, T. Yamanishi1, M. Oguru1, K. Matsui1,
M. Hashimoto1, K. Matsubara1, N. Takenaka1,
S. Matsutani1, T. Oku1, D. Danno1, K. Kawabata1,
B. Okuda2, K. Toda3, N. Oka4
1Department of Internal Medicine, Hyogo College of
Medicine, Nishinomiya, 2Department of Neurology, Ehime
Prefectural Central Hospital, Matsuyama, 3Toda Internal
Medicine-Rehabilitation Clinic, Akashi, 4Department of
Rehabilitation, NHO South Kyoto Hospital, Jouyou, Japan
Introduction: Although depression and anxiety are
important determinants of quality of life (QOL) in patients
with Parkinsons disease (PD), it is unclear whether
depression and anxiety are associated with similar
demographic and clinical features.
Objective: To clarify whether depression and anxiety are
similar in terms of their associations with other clinical
variables.
Methods: 117 patients with PD participated in this study.
Patients were associated clinically using assessment
instruments comprising both neurologist-administered
rating scales and self-administered questionnaires. The
former assessments were the modified Hoehn and Yahr
Scale (HY), the Unified Parkinsons Disease Rating Scale
(UPDRS), and the Mini-Mental State Examination
(MMSE). The latter scales included State-Trait Anxiety
Inventory (STAI), Beck Depression Inventory (BDI), an
apathy scale (AS), and 2 QOL instruments: the EuroQoL
(EQ-5D) and the 39-item Parkinsons disease questionnaire
(PDQ-39).
Results: Anxiety (STAI 41 for men or 42 for women)
was diagnosed in 52% of the patients and 55% were
diagnosed to have depression (BDI 14). 14% of the total
sample had anxiety without depression, whereas 17% had
depression without anxiety. Both STAI and BDI scores were
negatively correlated with 2 QOL scales and positively
associated with AS score. BDI scores were associated with
age at onset, duration of illness, HY stage, and UPDRS
scores, whereas STAI scores were not associated with these
variables.
Conclusions: These findings suggest that anxiety and
depression may be separable in PD, although both are
common in patients with PD and are associated with QOL.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 317
P1590
Urinary and respiratory tract infections in
people with Parkinsons disease
A. Fisher1, J. English1, W. Gray2, G. Tan2, G. Idle2,
R. Walker2
1Medical School, Newcastle University, Newcastle upon
Tyne, 2Medicine, Northumbria Healthcare NHS Foundation
Trust, North Shields, UK
Background: Bacterial infections can be a common
complication in people with Parkinsons disease (PD).
Respiratory and urinary tract infections can result from non-
motor symptoms such as impaired swallowing and urinary
dysfunction. We aimed to audit patients urine and sputum
culture results to investigate how common such infections
are.
Methods: Within Northumbria Healthcare NHS Foundation
Trust, UK, microbiology archives were used to locate PD
patients with positive growth on culture during the ten year
period from June 2001-June 2011. Organism was noted and
the case notes were reviewed for clinical details.
Results: Of 643 eligible PD patients, only 12 (1.9%) had
positive sputum growths. Of those who had positive sputum
samples 75% were male and 58% were in early stage of
disease (Hoehn and Yahr stage I). In contrast, there were
101 (15.7%) positive urine cultures, although 48% were
asymptomatic. The most common urinary infections were
E. Coli (33%) and Coliforms (29%).
Conclusions: Despite the fact that pneumonia is a common
complication in people with PD, particularly in the later
stage of disease, there were remarkably few positive sputum
samples during the ten-year period. Interestingly, over half
of the samples were in people with early stage of PD; this
may reflect the difficulty of those in later stage disease to
expectorate. Positive urine cultures were much more
common, although this may reflect the relative ease of
obtaining a sample. Whether these findings reflect the
pattern of infection in people with PD is not clear.
Comparison with the general population is required.
318 Posters, Sunday 9 September
P1591
Epidemiology of restless legs syndrome in
Croatia
M. Relja1, V. Mileti2
1Department Neurology, Medical School University of
Zagreb, 2Department Neurology, Zagreb University, Zagreb,
Croatia
Introduction: Restless legs syndrome (RLS) is a common
and frequently underdiagnosed neurological disorder. RLS
may be associated with sleep disturbances and may have a
negative impact on quality of life. Reported prevalence
estimate of RLS have varied widely (from 2.5 to 29%).
Aims of study: To estimate the prevalence and to evaluate
the characteristics of RLS in Croatia.
Patients and methods: A cross-sectional survey included
1432 randomly chosen subjects aged 18 to 81 years. A
neurologist and/or family physician conducted interviews
using a questionnaire based on diagnostic criteria developed
by the International Restless Legs Syndrome Study Group
(IRLSSG).
Results: A total of 245 (17.6%) examinees answered
positively, fulfilling minimal criteria for RLS. Idiopathic
form of RLS was observed in 136 (55.5%) of 245 patients
indicating the estimated prevalence of 9.5% in the Croatian
population. Underlying conditions associated with
secondary RLS were diabetes mellitus (50%), iron
deficiency (37.5%) and use of medications (11.5% - SSRIs,
antidepressants). The prevalence was higher in women and
increased with age.
Conclusions: This is the first epidemiologic study of RLS
in Croatia showing the 9.5% prevalence of idiopathic RLS.
Only 4.5% complained of severe symptoms that needed
treatment. The results found in this study are similar to the
findings of other European countries.
Supported by the Croatian Ministry of Science
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1592
Ultrasonographic and clinical correlates
in patients with idiopathic Parkinsons
disease: a prospective study
K. Lauckaite1, D. Rastenyte1, D. Surkiene1, A. Vaitkus1,
R. Gleizniene2
Neurological, 2Radiological, Lithuanian University of
1
Health Sciences, Kaunas, Lithuania
Introduction: Among the new techniques, transcranial
sonography (TCS) has been drawing attention as an easily
accessible and inexpensive imaging method in Parkinsons
disease (PD), despite its value is still disputable.
Methods: The PD patients for prospective TCS
investigation were referred from the Neurological
Department of the Hospital of Lithuanian University of
Health Sciences in 2011. A PA2-5 transducer on the
ultrasound system Voluson 730 Expert (GE Healthcare,
Austria) was used for TCS. A total of 113 patients were
enrolled for further analysis, after excluding 19 (14.4%)
with bilateral temporal insufficiency. Diagnosis was
established according to the UK brain bank criteria. The
clinical, demographic data, UPDRS-III, HAD, HamD scale
results were collected.
Results: The mean age of PD patients (SD) was
63.512.0yrs, UPDRS-III 12.85.4 points, and stage
according to Hoehn-Yahr (H-Ys) 1.80.7. Tremor-dominant
PD was diagnosed in 39 (34.5%), postural-instability-gait-
disorder-dominant (PIGD) in 27 (23.9%), mixed type in 47
(41.6%). The subgroups did not differ according to age, sex,
H-Ys. The biggest substantia nigra (SN) plots were in PIGD
(Kruskal-Wallis Chi2=46.9, p<0.001). The significant
correlations were detected between diameter of the third
ventricle (V3) and age (Spearman r=0.5, p<0.001), V3 and
H-Ys (r=0.2, p=0.05), HamD and H-Ys (r=0.6, p=0.003),
PD subtype and SN plot (r=0.3, p=0.002), H-Ys and SN
plot (r=0.3, p=0.004), UPDRS-III and SN plot on the left
(r=-0.6, p=0.028), H-Ys and nuclei raphe changes (r=-0.2,
p=0.049), H-Ys and lateral ventricles diameter (r=0.3,
p=0.023).
Conclusions: Multiple correlates between ultrasonographic
and clinical parameters were detected in PD patients, which
add valuable clinical information.

P1593
Intravascular platelet activation in
patients with hepatolenticular
degeneration
M. Melnikova1, S. Lobzin1, T. Fedorova1, E. Panina1,
L. Vedyukova1, G. Sisoeva1, L. Tarkovskaya2,
T. Morozova2
1North-Western State Medical University named after I.I.
Mechnikov, 2Russian Research Institute of Hematology and
Transfusiology, Saint-Petersburg, Russia
Introduction: Hepatolenticular degeneration (HLD) is an
autosomal recessive inherited disorder of copper
metabolism, characterized by hepatic and neurological
dysfunction. Accumulated amounts of copper produce
angiotoxic and haemolytic effects, which can significantly
influence haemostasis. However, the platelet
morphofunctional characteristics in HLD were not
investigated before.
Methods: Platelet count and intravascular platelet activation
(IPA) were evaluated in 48 patients with HLD. 23 patients
were examined before chelating therapy and 25 on different
stages of treatment. All patients were divided into groups on
the base of the prevalence of hepatic or neurological
manifestations, and different severity of hepatic impairment.
Severity of the disease was evaluated by the Unified
Wilsons Disease Rating Scale. A control group included 25
normal individuals.
Results: All patients had thrombocytopenia and significant
increase of IPA parameters: total amount of active forms of
platelets and number of platelets, involved in aggregation.
Severity of the disease and degree of hepatic impairment
influenced only the platelet count, but not IPA. Level of
cytolysis and cholestasis did not influence IPA (p<0.05). In
patients receiving chelating therapy parameters of IPA were
reduced significantly, but remained higher than in controls.
Conclusion: In HLD patients, activation of platelet
haemostasis is observed. Parameters of IPA remain high
during the chelating therapy. Impairment of morphological
and functional properties of platelets contributes to severity
of chronic brain and liver diseases and requires treatment.
Thus, some additional factors can modify the activation and
aggregation of platelets in HLD and be the goal for further
research.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 319
P1594
Total numbers of neurons and glial cells in
the basal ganglia of brains from patients
with multiple system atrophy
B. Haugen1, K. Winge2,3, L. Salvesen1,2, T. Agander1,4,
B. Pakkenberg1
1Research Laboratory for Stereology and Neuroscience,
2Bispebjerg Movement Disorders Biobank, 3Department of
Neurology, Bispebjerg University Hospital, Copenhagen,
4Department of Pathology, Roskilde University Hospital,
Roskilde, Denmark
Introduction: MSA is a sporadic, progressive
neurodegenerative disorder characterized by varying
severity of parkinsonism, cerebellar ataxia and autonomic
failure. MSA is histopathologically characterized by glial
cytoplamic inclusions and selective neurodegeneration. The
details on the pathogenesis are still unknown.
Material and methods: The material comprises 10 brains
from patients with MSA and 10 control subjects. The total
number of neurons and glial cells in Substantia Nigra, the
Subthalamic Nucleus (StN) and the Red Nucleus (RN) of
brains from patients with MSA were estimated using design
based stereological methods providing quantitative data on
brains affected by a neuronal loss. Data were analyzed using
Sigma Stat 11.0, Systat Software Inc., San Jose, California,
USA.
Results: The MSA brains were estimated to have about
40% fewer pigmented neurons in Substantia Nigra
(40.1*104 versus 91.8*104, p0.001). In the Subthalamic
Nucleus and the Red Nucleus the total number of neurons,
oligodendrocytes and astrocytes were the same in the two
groups, whereas microglia were more abundant in the MSA
brains in both StN (20.4*104 versus 82.6*103, p=0.026)
and RN (10.2*104 versus 33, 1*104, p0.001).
Conclusion: In terms of cell numbers the Subthalamic
Nucleus and the Red Nucleus are not severely affected in
patients with MSA compared to the control subjects. The
increased microglia level could indicate inflammation in
MSA. The high loss of neurons in Substantia Nigra supports
the neurodegenerative nature of MSA.
320 Posters, Sunday 9 September
P1595
A case of orthostatic tremor associated
with Graves disease
S. Mazzucchi, D. Frosini, M. Giuntini, E. Del Prete,
R. Ceravolo
Department of Neuroscience, University of Pisa, Pisa, Italy
Introduction: Orthostatic tremor (OT) is a rare disorder
characterized by high frequency lower limbs tremor and
unsteadiness on standing with remission during sitting or
lying.
A 70-year-old woman presented with a sense of unsteadiness
and tremor in her legs mainly during standing and walking,
which gradually worsened over a year without any benefit
after clonazepam. Neurological exam showed tetra
hyperreflexia, paraparetic gait and inability to perform
tandem gait. She also reported intolerance of heat, excessive
sweating and recent loss of weight with increased appetite,
dysphagia and dysphonia.
Methods: Electromyographic recordings from vastus
medialis and tibialis anterioris performed during standing
showed a rhythmic contractile activity at about 8Hz. After
prolonged supine rest, a rhythmic contractile activity at
lower amplitude re-appeared in both lower legs. Due to
atypical clinical and EMG activity and low frequency of
tremor, a symptomatic origin was hypothized. Brain and
cervico-dorsal MRI and motor evoked potentials were
normal. Her thyroid function exams revealed severe
hyperthyroidism (thyroid stimulating hormone (TSH)
<0.004U/ml [0.400-4.000U/ml], fT3 9.25pg/ml [1.80-
4.80pg/ml], fT4 5.05ng/dl [0.80-1.80ng/dl]) and positivity
of TSH receptor antibodies. A chest and neck CT scan
revealed an increase in thyroid size involving the upper
mediastinum and affecting the left side of the oesophagus.
Result: A diagnosis of Graves disease was performed and
she was started on Carbimazole with dramatic improvement
of tremor.
Conclusion: Graves syndrome has been recently described
as a possible cause of OT, and should be taken into account
mainly when OT presents with atypical phenotype.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1596
Study of osteoprotegerin concentrations
and level of 25(OH)D in blood serum of
patients with Parkinsons disease,
ischemic stroke and other neurological
diseases
U. Fiszer1, M. Piacik-Gromada1, B. Parafinuk2,
G. Korczak-Kowalska3, K. Bocian3, T. Szatanowski1
Medical Center of Postgraduate Education, 2The Childrens
1
Memorial Health Institute, 3University of Warsaw, Poland
Osteoporosis and decrease of the level of vitamin 25(OH)D
was described in patients with PD. Concentration of
osteoprotegerin (OPG) has been associated with the risk of
osteoporosis and vascular pathology, however, it has not yet
been examined in PD patients.
Methods: The study group included 95 patients, within this
group 45 suffered from PD. A - with initial PD (20 persons),
B - with advanced PD >5 years (25 persons), C - with stroke
(30 persons), D - with other neurological disease (OND) (20
persons). Osteoprotegerin concentration measured by the
sandwich ELISA, and the level of 25(OH)D in blood serum
was obtained by the automatic chemiluminescence method.
Results: Osteoprotegerin concentration in serum was
(mean): A - 5.50pg/ml, B - 6.80pg/ml, C - 7.59pg/ml, D -
5.68pg/ml. The results demonstrate an increased
osteoprotegerin concentration in stroke patients (C v A, U
Mann Whitney test p<0.03). The mean level of 25(OH)D in
groups was: A - 15.45ng/ml, B - 13.80ng/ml, C - 11.12ng/
ml, D - 17.48ng/ml. Normal level of 25(OH)D in adults is
between 30 and 80ng/ml. Results showed decrease of level
of 25(OH)D in patients with initial and advanced PD. It was
also seen in patients with OND, and particularly with
ischemic stroke (C v D, p<0.03, t-Student test).
Conclusion: No increase of OPG in initial PD was found,
as opposed to stroke patients. The results also showed
insufficient supply of vitamin D in patients with different
neurological diseases.

P1597
Chronic pain in Parkinsons disease -
characteristics and association with bone
mineral density
H.-J. Jung1, S.-M. Choi1, E.-S. Park2, S.-Y. Lee2,
B.-H. Cho2, B.-C. Kim2, M.-K. Kim2, M.-S. Park2,
S.-H. Lee2
Neurology, Chonnam National University Hwasun Hospital,
1
Hwasun-gun, 2Neurology, Chonnam National University
Hospital, Gwangju, Republic of Korea
Background and purpose: Chronic pain and low bone
mineral density (BMD) in Parkinsons disease (PD) are
increasingly recognized as a major cause of reduced health-
related quality of life. But, there have been few studies
concerning chronic pain and relationship between
osteoporosis in PD, even though patients with PD have a
high incidence of falls. The aim of this study was to
investigate the prevalence and the characteristics of chronic
pain and its associations with BMD in patients with PD.
Patients and methods: 91 patients diagnosed with
idiopathic PD were interviewed with semi-structured pain
questionnaire. The severity of PD judged using Unified PD
Rating Scale, Hoehn and Yahr staging. BMD in the lumbar
spine and proximal femur were evaluated by dual X-ray
absorptiometry. Patients were divided into three groups
according to chronic pain, acute pain and no pain. We then
investigated the clinical correlation between severity of PD
and BMD.
Results: 73 (80.2%) out of 91 patients reported pain and 68
(74.7%) patients had chronic pain. Patients with chronic
pain were more prevalent in females (p=0.02) and old age
(p=0.042) and higher UPDRS II (p=0.016), NMSAS
(p=0.028), and the Gait and Falls questionnaire (p=0.01).
BMD in patients with chronic pain were significantly lower
femur BMD.
Conclusions: Pain is common in patients with PD and
associated with poor ADL, higher frequency of falling and
lower BMD. Patients with chronic pain should be carefully
examined and screened for osteoporosis to prevent bone
loss and associated disability due to falling.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 321
P1598
Motor phenotype of LRRK2-associated
Parkinsons disease: a longitudinal study
F. Nabli, S. Ben Sassi, E. Hentati, I. Lakhdhar, H. Nahdi,
R. Amouri, F. Hentati
National Institute of Neurology, Tunis, Tunisia
Background and aims: Mutations in the Leucine-rich
repeat kinase 2 gene (LRRK2) showed to be a significant
cause of autosomal dominant forms of Parkinsons disease
(PD). In order to determine the motor characteristics of
LRRK2-related disease, we conducted a longitudinal study
of 58 LRRK2-associated PD patients and compared them
with idiopathic PD patients.
Patients and methods: 58 patients diagnosed with
PD-related LRRK2 G2019S mutation were included in the
study and compared to 59 sporadic PD patients with
negative tests for LRRK2 G2019S, PINK1, SNCA, PRKN
et DJ1 mutations. Patients were assessed at baseline and
after a follow-up period of six years. Collected data included
the Movement Disorder Society-unified Parkinsons
Disease rating scale (MDS-UPDRS), the Hoehn and Yahr
stage and the Schwab and England scale.
Results: The LRRK2-associated PD patients had a mean
age at baseline of 68.4511.82 years, a mean age of onset
of 56.2512.05 years and in most cases (61%) a PIGD
phenotype. The mean annual decline in the UDRS motor
score and the Hoehn and Yahr staging were of 1.3% and
2%, respectively. Motor severity correlated with disease
duration and PIGD phenotype, and tremor dominant
phenotype predicted slower progression of motor
impairment. PD motor phenotype and motor scores were
similar in the LRRK2-associated PD group and in the
idiopathic PD group with no significant differences in the
progression rate of motor impairment.
Conclusion: Motor phenotype seems to be similar in
LRRK2-related PD and idiopathic PD
322 Posters, Sunday 9 September
P1599
Is the nigrostriatal dysfunction a possible
predictive marker of visual hallucinations
in Parkinsons disease? Evidence from a
123I-FP-CIT SPECT study
L. Kiferle, R. Ceravolo, V. Nicoletti, P. De Feo,
D. Volterrani, U. Bonuccelli
Department of Neuroscience, University of Pisa, Italy
Introduction: The pathogenesis of visual hallucinations
(VH) in Parkinsons disease (PD) has been considered
multifactorial. In the pathophysiology of VH, a combination
of impaired visual processing and attention was reported.
Imaging studies evidenced a role of the primary visual
system and visual association areas as well as a dysfunctional
activation of frontal areas. Moreover, longitudinal
neuropsychological studies showed an association of VH
with baseline frontal dysfunction, suggesting verbal fluency
as a potential predictor of VH within 2 years. Due to the
functional connections between basal ganglia and frontal
areas, a role of basal ganglia and of the frontostriatal circuits
in the pathogenesis of VH may be postulated.
Objective: To unveil whether a worse nigrostriatal
dysfunction at baseline may predict the development of VH
in PD.
Methods: 16 non-demented VHPD and 14 non-demented
non-VHPD patients, matched for age of onset of disease,
disease duration and severity, levodopa equivalent dose,
underwent a 123I-FP-CIT SPECT at disease onset. Striatal
uptake values in the two groups were investigated.
Results: The group of VH had a significant reduction
(p<0.05) of right caudate uptake values at baseline when
compared with non-VHPD. No significant differences were
present between groups in left caudate and putaminal uptake
values.
Conclusions: The frontal impairment reported in VHPD
may be due to a right caudate dysfunction, as it is connected
to the frontal brain areas via neuronal loops. Our data could
suggest the early caudate dysfunction as a potential
predictive marker of VH in PD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1600
Glucocerebrosidase L444P mutation
confers a genetic risk factor for
Parkinsons disease in central China
N. Xiong, Y. Wang, C. Chen, J. Huang, T. Wang
Department of Neurology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, China
Introduction: Mutations of the glucocerebrosidase (GBA)
gene have been reportedly associated with various ethnic
Parkinsons disease (PD) populations. However, whether or
not there is any association of different sequence variants of
GBA with PD in central China remains unknown. The
agriculture-related central China area should be drawn
particular attention to, as recent epidemiological studies
suggest an association of environmental toxins such as
rotenone and other pesticides with the higher incidence of
sporadic PD in rural areas.
Methods: Here, we conducted a case control study in a
cohort of 208 central Chinese PD patients and 298 control
subjects for three GBA mutations (L444P, N370S and
R120W) by Polymerase chain reaction-restriction fragment
length polymorphism and DNA sequence.
Results: Our data suggested a significant higher frequency
of L444P mutation in GBA gene of PD cases (3.4%)
compared with the controls (0.3%) (p=0.007, OR=10.34,
95% CI=1.26-84.71). As for gender, there was no significant
difference between mutation carriers and non-carriers.
Additionally, the average age at onset of PD carriers showed
no significant difference between carriers and non-carriers.
Specifically, the frequency of L444P mutation was higher in
late onset PD (LOPD) cases compared with that in control
subjects. The N370S and R120W mutations experienced no
difference between the PD group and the control group.
Conclusions: Our observations demonstrated that the GBA
L444P mutation confers a potential risk factor for PD,
especially LOPD, in the central China area.

P1601
Is the cold hands sign useful in
differentiating multiple system atrophy
from Parkinsons disease?
M. Asahina1, D.A. Low2, C.J. Mathias2, Y. Fujinuma1,
A. Katagiri1, Y. Yamanaka1, J. Shimada1, A. Poudel1,
S. Kuwabara1
1Neurology, Chiba University School of Medicine, Chiba,
Japan, 2Autonomic & Neurovascular Medicine Unit,
Imperial College London at St. Marys Hospital, London,
UK
Aim: A previous study on a small number of patients
showed that low skin temperature of the hands with skin
colour changes, the so-called "cold hands sign", may be
useful for distinguishing multiple system atrophy (MSA)
from Parkinsons disease (PD). Therefore, low skin
temperature of the hand may be a characteristic of MSA
rather than PD. We evaluated the skin colour and
temperature of the hand in a larger number of MSA and PD
patients.
Methods: Skin temperature on the centre of the palm was
measured in 50 MSA patients (age, 64.46.0 years; duration,
2.91.7 years), 50 PD patients (67.57.7 years; 8.17.6
years), and 25 healthy subjects (age, 64.711.4 years). All
participants were Japanese by ethnicity.
Results: Temperatures of <28C were observed in 3 MSA
patients (6%) and none of the PD patients and controls. We
could not find any skin colour changes on the hand, such as
dusky and violaceous, in any participants. Palm skin
temperature was significantly lower in MSA patients
(32.02.7C) than in controls (34.10.9C, p=0.0002), but
was not different compared with the PD group (32.91.8C,
p=0.06). There was no significant difference between the
PD and control groups.
Conclusions: Measurement of skin temperature is easy and
non-invasive and the cold hands (<28C) sign may be
useful for distinguishing MSA from PD. However, the
sensitivity appears to be low.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 323
P1602
Reasons for discontinuation of botulinum-
toxin treatment of focal hand dystonia
M. Balaz1,2, T. Gajda3, M. Bares1,2
1Department of Neurology, Masaryk University, St Annes
University Hospital, 2CEITEC - Central European Institute
of Technology, MU Brno, 3Medical Faculty, Masaryk
University, Brno, Czech Republic
Objective: The goal of the study was to assess the reasons
for discontinuation of long-term treatment of writers cramp
in patients treated with botulinum toxin (BTX). We also
observed the long-term BTX treatment outcomes.
Introduction: Botulinum toxin A is considered to be an
effective treatment for the patients suffering from focal
hand dystonia (such as writers cramp) but its long-term
usefulness may be limited by frequent discontinuation of
the treatment for various reasons.
Methods: We reviewed the records of 54 patients who had
more than 400 applications of BTX. We also conducted
surveys via mail or telephone interviews with the patients
who were lost to regular follow-up.
Results: Each patient had at least 2 application sessions,
median treatment duration was 82 months. 83% of treated
patients reported at least a partial improvement of their
condition. There were no serious adverse events. Most
frequent side effect was the weakness of muscles adjacent
to the injection site. Altogether 30 (55%) patients chose to
discontinue the treatment.
Conclusions: A high proportion of the patients chose to
discontinue the treatment with BTX. Main reasons for
discontinuation were side effects (33%), low efficacy
(30%), relocation (6.5%), change of writing habits (6.5%),
new symptoms and change of treatment (6.5%), other and
unknown reasons (17.5%). While BTX remains an effective
treatment, drop-out rate may be higher than in other focal
dystonias, especially due to the side effects and subjectively
assessed low efficacy in some patients.
324 Posters, Sunday 9 September
P1603
Association between falls and urinary
disturbance in Parkinsons disease
K. Sakushima1, S. Yamazaki2, Y. Hayashino2,
S. Fukuhara2, I. Yabe1, H. Sasaki1
1Department of Neurology, Hokkaido University Graduate
School of Medicine, Sapporo, 2Department of Healthcare
Epidemiology, Graduate School of Medicine and Public
Health, Kyoto, Japan
Introduction: Falling is one of the most common and
serious incidents among public health problems. It can
cause injuries such as sprains and fractures. Hospitalization
may be required when it is a serious injury. Patients with
Parkinsons disease have a higher risk of falls. Urinary
incontinence is also known as a risk factor of falls for the
elderly. However, the risk of falling associated with other
symptoms of urinary disturbance is unclear. The purpose of
this study is to identify the association between falls and
urinary disturbance in Parkinsons disease.
Methods: A prospective cohort study at a single institution
with six months observation period was conducted. Subjects
were ambulatory patients with Parkinsons disease.
Assessment included patient demographics, disease severity
measured by Hoehn and Yahr Scale, and urinary disturbance
measured by overactive bladder symptom score (OABSS).
Falls were reported by a self-documented falls record.
Results: A total of 86 patients (33 males, 53 females) were
included. Mean age was 71.07.5. Hoehn and Yahr Scale
was 2.61.1. 39 patients (45%) had at least one fall (faller)
and 28 patients (33%) had two or more falls in six months.
In OABSS, urinary urgency and urgency incontinence were
more common in fallers than in non-fallers (55% vs. 30%
and 58% vs. 35%, respectively). However, daytime
frequency and night-time frequency is not associated with
falls.
Conclusion: Falls in patients with Parkinsons disease were
not associated with urinary frequency but associate with
urinary urgency and incontinence.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1604
Pain and its clinical types in Parkinsons
disease
J. Harsany1, M. Hanakova1, P. Valkovic1,2
1Second Department of Neurology, School of Medicine,
Comenius University, 2Institute of Normal and Pathological
Physiology, Slovak Academy of Sciences, Bratislava, Slovak
Republic
Introduction: Pain is an important and distressing symptom
in Parkinsons disease (PD). A frequently overlooked
clinical feature of PD, pain may be severe enough to
overshadow the motor symptoms of the disorder. Aim of
this study was to determine frequency and types of pain in
patients with PD. Moreover, we correlated pain
characteristics with demographic data, quality of life, and
depression.
Methods: This is a single-centre cross-sectional study. 35
consecutive subjects with PD participated. Demographic
data, severity and types of pain were assessed using
structured questionnaire and Beck Depression Inventory,
respectively. Pain was divided based on Fords classification
(Mov Disord. 2010;25 Suppl 1:S98-103): musculoskeletal,
dystonic, central neuropathic, low back/radicular, and not-
classified pain. Severity of average pain during the last
week was rated on 10-point visual analogous scale.
Results: In our set of PD subjects, the presence of pain
types was as follows: musculoskeletal pain 34.3%, dystonic
pain 8.6%, central parkinsonian pain 17.1%, low back /
radicular 54.3%, and not-classified pain 14.3%. No pain
referred 20% of patients, one type 48.8%, two types 20.0%,
three types, 5.7%, and four types 5.7%. A significant
correlation was found between PD duration and number of
pain types (rho=0.53018, p=0.0011), and number of pain
types and average pain severity (rho=0.63984, p<0.0001)
Conclusion: Pain in PD is present in 80% of patients. The
most frequent type of pain is the low/back radicular pain.
Our results stress the importance of pain type determination
because of different treatment approaches.

P1605
Non-motor symptoms in Parkinsons
disease: a correlation with depression
and quality of life
M. Hanakova1, J. Harsany1, P. Valkovic1,2
1Second Department of Neurology, School of Medicine,
Comenius University, 2Institute of Normal and Pathological
Physiology, Slovak Academy of Sciences, Bratislava, Slovak
Republic
Introduction: Non-motor symptoms (NMS) of Parkinsons
disease (PD) are not well recognized in clinical practice,
and are frequently missed during routine. Aim of this study
was to determine frequency and severity of NMS in patients
with PD. Moreover, we correlated NMS scores with
demographic data, quality of life, and depression.
Methods: This is a single-centre cross-sectional study.
NMS severity was determined by using the Non-Motor
Symptom assessment scale for PD (NMSS; Chaudhuri KR,
et al. Mov Disord. 2007;22(13):1901-11.) and self-
completed NMS-Questionnaire for PD ( the NMSQuest;
Chaudhuri KR, et al. Mov Disord. 2006;21(7):916-23.).
Quality of life was assessed by PDQ-8 questionnaire, and
depression was scored by means of Beck Depression
Inventory (BDI).
Results: Data from 35 consecutive patients, mean age
65.27.8 years, duration of disease 5.54.5 years, and all
stages of PD were collected. The mean NMSS score was
39.624.6 (range: 9-110). The mean NMSQuest score was
10.54.7 (range: 2-22). We found significant correlation
between NMSS score and NMS-Quest score (rho 0.71;
p<0.0001), NMSQuest and duration of PD (rho=0.55,
p=0.0007), NMS-Quest and BDI (rho 0.69; p<0.0001),
NMSS and BDI (rho 0.56; p=0.0005), and PDQ-8 score and
BDI (rho=0.51, p=0.0017) .
Conclusion: NMS are significantly frequent across all
stages of PD. This study proves the efficiency of screening
questionnaire the NMS-Quest, as well as of NMSS. Scores
of both instruments highly correlate. Moreover, NMS
correlate with depression that correlates with quality of life
in PD. Our results stress the importance for active detection
of NMS in PD patients.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 325
P1606
Defective iron-handling and altered
cellular oxidative status in skin fibroblasts
from pantothenate kinase associated
neurodegeneration patients
S. Levi1,2, A. Campanella1, D. Privitera1, M. Guaraldo1,
C. Barzaghi3, A. Cozzi2, P. Santambrogio2, B. Garavaglia3
1Vita-Salute San Raffaele University, 2Division of
Neuroscience, San Raffaele Scientific Institute, 3Fondazione
IRCCS-Istituto Neurologico Carlo Besta, Milan, Italy
Introduction: Pantothenate Kinase Associated
Neurodegeneration (PKAN) is the most prevalent form of
neurodegeneration involving iron accumulation in the brain.
It is characterized by progressive impairments in movement,
speech and cognition. The disease is inherited in a recessive
manner due to mutations in the Pantothenate Kinase-2
(PANK2) gene that encodes a mitochondrial protein
involved in Co-enzyme A synthesis.
Aim: To elucidate the molecular mechanism leading to iron
homeostasis dysfunction in Pank2 gene defect cells.
Patients and methods: We analyzed, in primary skin
fibroblasts from three PKAN patients and three unaffected
subjects, the oxidative status and their ability to respond to
iron.
Results: In basal conditions, PKAN fibroblasts show an
increase in carbonylated proteins and altered expression of
antioxidant enzymes with respect to the controls. After iron
supplementation, the PKAN fibroblasts had a defective
response to the additional iron. Under these conditions,
ferritins were up-regulated and Transferrin Receptor 1
(TfR1) was down-regulated to a minor extent in patients
compared to the controls. Analysis of Iron Regulatory
Proteins (IRPs) reveals that, with respect to the controls,
PKAN fibroblasts have a reduced amount of membrane-
associated mRNA-bound IRP1, which responds imperfectly
to iron. This accounts for the defective expression of ferritin
and TfR1 in patients cells. The inaccurate quantity of these
proteins produced a higher bioactive labile iron pool and
consequently increased iron-dependent ROS formation.
Conclusions: Our results suggest that Pank2 deficiency
promotes an increased oxidative status that is further
enhanced by the addition of iron, potentially causing
damage in cells.
326 Posters, Sunday 9 September
P1607
Fatigue in Parkinsons disease
T. Torgan
Perm State Medical Academy, Perm, Russia
Introduction: It is not clear whether fatigue in patients with
Parkinsons disease is the primary or the secondary
symptom.
Objective: To investigate whether fatigue is associated with
depression, autonomic disturbances, the severity of
movement disorders and sleep disturbance in patients with
Parkinsons disease.
Methods: The Unified Parkinsons Disease Rating Scale,
Hoehn and Yahr scale, the Multidimensional Fatigue
Inventory (MFI-20), the Hospital Anxiety and Depression
Scale (HADS), the Epworth Sleepiness Scale (ESS), Veyn
Questionnaire for autonomic disturbances were used.
Results: 55 patients (16 males, 39 female) with Parkinsons
disease without dementia were studied. Mean age was 64
(60-70) years, the duration of the disease was 5 (2-5) years.
Patients received different dopaminergic therapy and were
examined in off period. The control group consisted of 19
persons of the same age and sex. The mean rate of fatigue
in patients with Parkinsons disease (37; 25-46 points) was
higher (=0.000) than in the control group (15; 9-19 points).
It did not depend on sex and age of the patients. 38 patients
had more than 36 points on MFI-20. The rate of fatigue in
this group did not correlate with th duration (R=-0,11,
p=0.644) and the severity of the disease (R=0.23, =0.308),
the severity of motor disorders (R=0.11, p=0.642) and
depression (R=-0.02, p=0.924). The autonomic (R=-0.41,
p=0.070) and sleep disturbances (R=0.02, p=0.093) did not
influence the fatigue.
Conclusion: Fatigue in patients with Parkinsons disease is
not the secondary symptom due to depression or sleep
disturbances, but is a primary phenomenon with its own
pathogenesis.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1608
Montreal cognitive assessment as a new
screening tool for dementia in
Huntingtons disease: a validation study
P. Moskal1, K. Banaszkiewicz2, E.M. Klimiec1,
A. Starowicz3, M. Blaz1, A. Szczudlik1
1Department of Neurology, Jagiellonian University Medical
College, 2Krakowska Akademia Neurologii, 3Department of
Medical Psychology, Jagiellonian University Medical
College, Krakow, Poland
Background and aims: Cognitive disturbances are often
the first manifestation of Huntingtons disease (HD) and are
an important factor contributing to patients disability.
Neuropsychological assessment is the most relevant, but
time consuming, method of cognitive evaluation. The
Montreal Cognitive Assessment (MoCA) is a new screening
instrument which detects early cognitive impairment.
However, MoCA has not been compared with
neuropsychological tests in HD. The aim of this study was
to find a cut-off for MoCA that sensitively screens for
dementia in HD patients.
Patients and methods: 22 HD patients were examined with
MoCA and a battery of neuropsychological tests which
assessed 5 cognitive domains: Stroop Test and Perception
and Attention Test for attention; Benton Visual Retention
Test for memory; Trail Making Test, Wisconsin Card
Sorting Test and Similarities from Wechsler Adult
Intelligence Scale (WAIS) for executive functions; Verbal
Fluency Test for language; Block Design from WAIS for
visuospatial abilities. Dementia was defined as an
impairment in at least two cognitive domains. Receiver
operating characteristics analysis was used to find a
sensitive cut-off in MoCA to diagnose dementia.
Results: According to neuropsychological assessment 15
patients had dementia. The most sensitive MoCA cut-off
score was 26, with 100% sensitivity and 71% specificity.
Another 2 patients were impaired in only one cognitive
domain and scored 26 on MoCA, the other 5 patients
without any cognitive disturbances scored >26.
Conclusion: MoCA cut-off score 26 allows for sensitive
screening for dementia in HD.

P1609
Spasticity and "spastic" gait in children
with hereditary spastic paraplegias
I.U. Isaias1,2, A. Marzegan1, E. Todeschini1, P. Cavallari1,
J. Volkmann2, P. Crenna1
1Dipartimento di Fisiologia Umana, Laboratorio per
lAnalisi del Movimento (LAMB) P. & L. Mariani, Universit
degli Studi di Milano, Italy, 2Neurologische Klinik und
Poliklinik, Universittsklinik Wrzburg, Germany
Introduction: Hereditary spastic paraplegias (HSPs) are a
clinically and genetically heterogeneous group of conditions
characterized by the presence of lower limb spasticity and
pyramidal weakness. We aimed to address spastic muscle
behaviour under dynamic conditions (unperturbed
overground walking) in children with HSP.
Patients and methods: 10 children (3 male; age range:
4-13 years) were enrolled in the study and evaluated
clinically and by means of brain MRI, BAER, SSEP and
MEP. Spastic muscle (soleus) behaviour was quantitatively
characterized by the level of current EMG activity as a
function of the muscle lengthening velocity (muscle
kinematics was estimated by geometrical models).
Results: Four different patterns of spastic muscle behaviour
were described. Pattern-I was defined by the presence of
hyper-synchronous activity in the post heel-contact phase
with equal or higher amplitude with respect to the following
push-off phase (and no activity pause between these two
phases). We classified pattern-II or -III when the hyper-
synchronous activity in the post heel-contact phase (as in
pattern-I) was paused by Post Synchronous Discharge
Silent Periods (PSDSPs) >70ms (pattern-III if PSDSPs
were >3). Pattern-IV was characterized by hyper-
synchronous activity also in the swing phase. Each child
showed a different combination of these patterns. Overall,
pattern-II was the most frequent (30%) followed by pattern-I
(14.5%) and pattern-III and -IV (< 10%).
Conclusion: A dynamic evaluation allowed a detailed
profiling of spasticity in children with HSP. This might be
useful to determine functional severity of lower limb
spasticity at follow-ups and for proper medical treatment.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 327
P1610
The impact of non-motor symptoms on
health-related quality of life in patients
with atypical parkinsonism
S.-B. Koh, C.-N. Lee
Neurology, Korea University College of Medicine, Seoul,
Republic of Korea
Background: Atypical parkinsonism is less common and
has more severe symptoms than Parkinsons disease.
Relatively little is known about the characteristics of non-
motor symptoms (NMS), which could affect to health
related quality of life (QoL) in multiple systemic atrophy
(MSA) and progressive supranuclear palsy (PSP). We report
the characteristics of NMS and the impact of NMS on
health-related QoL of MSA and PSP.
Methods: Out of 58 patients with a diagnosis of atypical
parkinsonism, 32 patients had multiple systemic atrophy
parkinsonian subtype (MSA-P), 14 patients had multiple
systemic atrophy cerebellar dysfunction subtype (MSA-C),
12 patients had PSP. We assessed the Unified Parkinsons
Disease Rating Scale part III (UPDRS-III), the modified
Hoehn & Yahr scale (H&Y), the Parkinsons Disease
Questionnaire (PDQ-39) and the non-motor symptom scale
(NMSS).
Results: There were no differences of sex ratio, disease
duration, UPDRS-III score, and H&Y stage in the three
groups. In the MSA-P, MSA-C and PSP group, PDQ-39
scores are correlated with NMSS scores, not UPDRS-III
scores. Concerning the correlations of domains in NMSS
scores and PDQ-39 scores, PDQ-39 scores of MSA-P group
are correlated with domains of mood/cognition,
cardiovascular inducing falls, and urinary dysfunction. In
MSA-C group, PDQ-39 scores are correlated with domains
of sleep/fatigue, mood/cognition, urinary dysfunction. In
PSP group, PDQ-39 scores are correlated with domain of
mood/cognition.
Conclusion: Non-motor symptoms are associated with QoL
in the three groups, and the mood/cognition domain is a
very important part of NMS. When we treat MSA, PSP
patients, we must consider non-motor symptoms, especially
mood/cognition.
328 Posters, Sunday 9 September
P1611
White matter lesions and depression in
patients with Parkinsons disease
V. Markovi1, I. Petrovi1, E. Stefanova1, D. Kozic2,
R. Semnic2, V. Kosti1
1Movement Disorders Department, Neurology Clinic Clinical
Center of Serbia, Belgrade, 2Diagnostic Imaging Center,
Institute of Oncology, Sremska Kamenica, Serbia
Introduction: The incidence of Parkinsons disease (PD)
increases with age, and white matter changes (WMHs)
present as signal hyperintesities on T2W MRI studies are
commonly observed in older adults. Severity of deep
WMHs was also correlated with depression.
Objective: To investigate whether WMHs were associated
with depression in PD patients.
Methods: We included 34 patients with (PD-D) and 25
without depression (PD-nD) with PD onset above 60yrs,
and 30 healthy controls. Diagnosis of depression was
established via Structured Clinical Interview for DSM-IV
Axis I disorders and quantified using Hamilton Depression
Rating Scale (HDRS). Patients underwent brain 1.5-T MRI.
WMHs were rated using T2W images and classified using
the semiquantitative visual rating scale of Scheltens.
Results: Comparing controls and PD patients as a group
there were no differences in WMHs in any examined region.
However, PD-D group had significantly higher WMHs
scores for total deep WM and BG regions when compared
to controls as well as for frontal deep WM and total
periventricular regions WMHs comparing with the PD-nD
group. There were no differences in WMHs between PD-nD
patients and controls in any of the examined regions. The
multivariate linear regression analysis was carried out with
HDRS score as a dependent variable and lobar (frontal,
temporal, parietal, occipital), periventricular and BG
WMHs, age, education and cerebrovascular risk factors as
independent variables. Significance was only shown for
periventricular WMHs total score (p=0.04), explaining the
39% of the variance in the HDRS.
Conclusion: Our study confirms the role of WMHs in
depression associated with PD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1612
MAPT rs242562 and GSK3 rs334558 are
associated with Parkinsons disease in a
central Chinese cohort
N. Xiong, L. Yu, J. Xiong, J. Huang, T. Wang
Department of Neurology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, China
Background: MAPT is a neuronal protein involved in the
pathogenesis of several neurodegenerative diseases
including PD. GSK3 catalyzes phosphorylation in multiple
sites of tau protein. These results have driven out a research
hotspot which is about the gene-gene interaction between
MAPT gene and GSK3 gene and their respective links in
several diseases. Previous data have indicated that the
genetic alteration of GSK3 and its interaction with MAPT
haplotype are collectively related to PD morbidity rate in a
Greek cohort. However, the association among the GSK3
gene alteration, MAPT haplotype and PD have not been
explored previously in the Chinese population.
Methods: Here, we performed a case-control association
study in a Chinese cohort of 211 PD patients and 279
matched controls from central China by Polymerase chain
reaction-restriction fragment length polymorphism.
Results: Our data showed that allele frequency of MAPT
rs242562 G/G polymorphism was significant higher in
controls than that in PD patients while G/A genotype of
MAPT rs242562 revealed higher frequency in PD subjects
compared to controls. The genotype frequency of GSK3
rs334558 C/C was over-represented in matched female
controls compared to female PD patients. Compared with
female PD patients, the genotype frequency of GSK3
rs334558 T/T polymorphism was higher in male PD
patients.
Conclusions: We conclude that G/G genotype of MAPT
rs242562 and C/C genotype of GSK3 rs334558 are
associated with PD and may serve as protective genetic
factor for PD in the central Chinese population.

P1613
The mechanisms of movement control
and time estimation in cervical dystonia
patients: a behavioural study
P. Filip1,2, I. Husrov1, M. Bare1,2
1First Department of Neurology, Faculty of Medicine
Masaryk University and St. Annes Teaching Hospital,
2Central European Institute of Technology, CEITEC MU,
Brno, Czech Republic
Introduction: The pathophysiology of cervical dystonia is
still relatively unknown. The functional imbalance of
respective muscle groups is thought to be caused by
neurochemical abnormities in basal ganglia and recently,
there has been emerging substantial evidence of considerable
cerebellar involvement. This project aims to affirm the
function of the above mentioned structures in precise
movement timing.
Methods: The participants were asked to perform a series
of simple computer tasks where the parameters of a moving
object (speed, acceleration, partially the movement
direction) were generated randomly. As the object moved
on the computer screen from left to right, the participant had
to press a button in an optimal time window to launch a
fireball from the bottom of the screen that was supposed
to hit the moving target. The fireball travelled with a
constant speed and trajectory. However, as the speed was
not sufficient to ignore the launch-interception time,
anticipatory reaction according to changing parameters of
the object was essential. We evaluated the hit ratio and
percentage of early and late errors. The results were
compared to the healthy subjects data.
Results: The overall hit ratio in the healthy subjects was
significantly higher than in the cervical dystonia group
(42.07%9.18% versus 34.91%8.23%). Also the reaction
time in cervical dystonia patients was significantly longer.
Conclusions: Our data suggest that cervical dystonia
patients have a substantial problem with predictive motor
timing. The results imply that cerebellum and basal ganglia
participate in the integration of visual information with
motor output.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 329
P1614
Predictors of quality of life of patients
with Parkinsons disease
M. Gomez-Gallego, S. Oliveira, M. Leon, C. Albert
Catholic University of Murcia, Spain
Introduction: Current treatments for Parkinsons disease
are mainly symptomatic and aimed at improving patients
quality of life (QoL). The objective of this study is to
determine which clinical factors are the most relevant for
patients QoL.
Methods: 39 PD patients were administered the QoL scale
PDQ-39. A complete neurological examination, including
the Hoehn & Yahr Scale (H-Y), the Barthel Index (BI), and
both part I and part III of Unified Parkinsons Disease
Rating Scale (UPDRS) was performed. The associations
between sociodemographic and clinical variables (years of
disease, treatment, H-Y stage, BI and UPDRS domains
scores) with PDQ-39 domains were tested using ANOVA
tests and correlational analyses. Multiple regression
analyses were carried out for each domain of PDQ-39.
Results: PDQ-39 total score was significantly associated
with marital status, UPDRS part I score, BI, postural tremor
score, axial function score, and both left and right
bradykinesia scores. BI and UPDRS part I scores explained
63% of the model variance. Higher BI scores and taking
L-DOPA predicted lower PDQ-mobility scores (R2=70.2).
The predictors of PDQ-activities of daily living were BI,
axial function score and H-Y stage (R2=66). PDQ-39-
communication was predicted only by BI (R2 =15.4); PDQ-
39-cognition by UPDRS part I score (R2=25.8); PDQ-39-
bodily comfort by rigidity score (R2 =14.4); and PDQ-39-
emotional well-being by UPDRS-part I score (R2=18.8).
Conclusions: Disability is the strongest predictor of QoL in
PD. Treatment for PD should include strategies to improve
functional independence.
330 Posters, Sunday 9 September
P1615
CSF levels of chromogranin-A in the early
stage of Parkinsons disease
M. Kaiserov1, K. Mensikova1, D. Stejskal2, P. Kanovsky1
Department of Neurology, Palack University and
1
University Hospital, Olomouc, 2Center of Laboratory
Medicine, Prostejov, Czech Republic
Background: Chromogranin-A levels in the cerebrospinal
fluid have been shown to be significantly reduced in late
stages of Parkinsons disease (PD). There are only few data
referring to its level in the early disease stage; its significance
as a potential marker in the differential diagnoses of PD
could not be established yet.
Objectives: To establish the level of chromogranin-A in a
pilot cohort of early stage, treatment-nave PD patients.
Methods: 10 patients (4 males, 6 females) and 10 gender-
and age-matched controls have been examined for the levels
of chromogranin-A in the cerebrospinal fluid; the control
subjects were those patients suffering from either low back
pain or tension-type headache.
Results: The mean CSF level of chromogranin-A in PD
patients was 74.8 (range 41.9 - 123.8) g/l, in the control
group it was 143.9 (range 116 - 181.3) g/l. The statistical
analysis showed a difference at the significance level of
p0.005.
Conclusions: Our pilot study showed that chromogranin-A
levels in CSF of early stage PD patients is significantly
reduced; it probably deserves further research with regard
to its role as a potential biomarker in the differential
diagnosis of PD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1616
Quality of life in Huntingtons disease and
its association with psychopathology
J. Fernandes1, I. Moreira1, S. Cavaco1,2, J. Damsio3,
R. Loureiro3, M. Magalhes3
1Unidade Multidisciplinar de Investigao Biomdica,
Instituto de Cincias Biomdicas da Universidade do Porto
(UMIB, ICBAS-UP), 2Unidade de Neuropsicologia, 3Servio
de Neurologia, Centro Hospitalar do Porto (CHP), Porto,
Portugal
Introduction: Huntingtons disease (HD) is a hereditary
and neurodegenerative disorder without cure or treatments
that can alter the course of disease progression. Health-
related quality of life (QoL) in HD patients is an important
target of clinical intervention.
Aim: To explore the association between HD patients QoL
and their demographic, clinical, and psychopathologic
characteristics.
Method: The Short Form Health Survey (SF-36) was used
to assess QoL in 24 HD patients (9 males, 15 females; mean
age of 48.813.3 yrs; 5.62.2 yrs of education; mean
disease duration of 6.24.5 yrs; mean CAG repeat of
43.64.7) and 24 demographically-matched healthy
subjects. The Unified Huntington Disease Rating Scale
(UHDRS), Hamilton Rating Scale for Depression (HRSD),
Beck Depression Inventory (BDI) and Dementia Rating
Scale-2 were also applied to HD patients. Mann-Whitney
and Pearsons correlations were used for data analyzes.
Results: Statistically significant reductions in HD patients
QoL were observed in all SF-36 dimensions (Physical
Functioning, p=0.008; Role Functioning-Physical, p=0.006;
General Health, p=0.001; Vitality, p=0.008; Social
Functioning, p=0.018; Role Functioning-Emotional,
p=0.002; Mental Health, p=0.018), except Bodily Pain.
Among HD patients, females had worse SF-36 Role
Functioning-Physical (p=0.014) and Vitality (p=0.003). The
decrease in QoL (all except Body Pain) was significantly
related (r>-0.42 to -0.73) to severity of psychopathological
symptoms (UHDRS Behaviour Subscale, BDI, and HRSD).
Relatively modest associations were found with other
demographic and clinical variables.
Conclusion: These results point to the importance of
depressive symptoms in HD patients QoL and reinforce the
need for an integrated and multidisciplinary clinical
approach in HD.

P1617
Cognitive functions, autonomic and
sensorial involvements in patients with
essential tremor
M. Korkmaz1, Y. Ktk1, M.A. Dikililer2, M. Ycel1,
H. Akgn1, M.T. Kak1, Z. Odaba1
1Department of Neurology, Glhane Medical Academy,
2Department of Family Medicine, rnak Military Hospital,
Ankara, Turkey
Introduction: Essential tremor (ET) is one of the most
frequent movement disorders in neurology practice. In
recent years, there are many discussions about ET being a
neurodegenerative disease.
Aim: Neurodegenerative diseases appear with an insidious
onset and are usually progressive. Their incidence increases
parallel to age. Neuronal loss frequently is seen in
pathological materials. These characteristic features are also
valid for essential tremor. Therefore ET may be accepted as
a neurodegenerative disease. To research this hypothesis we
aimed to evaluate cognitive functions, autonomic and
sensorial affects in patients with ET.
Methods: 60 patients diagnosed with essential tremor
according to Washington Heights- Inwood Genetic Study of
Essential Tremor (WHIGET) Essential Tremor Diagnose
Criteria were included in our study. Patients are separated
in two groups as severe and mild according to results of
performance subscale of Essential Tremor Rating
Assessment Scale (TETRAS).
Results: No difference was seen in Sympathetic Skin
Response and R-R intervals between groups. Lower
standard mini mental test scores, longer cortical
somatosensory evoked potentials latencies and higher
serum total copper levels were observed in the severe group
compared to the mild group.
Conclusion: We also observed cognitive and sensorial
involvement in electrophysiological tests. In addition, high
levels of serum total copper were correlated with disease
severity. Detailed investigation about copper metabolism in
more patients should be made to uncover this functional
correlation.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 331
P1618
Selegiline rescues gait deficits and
dopaminergic cells in a subacute MPTP
mouse model of Parkinsons disease
Q. Zhao1, Y. Bai1, D. Cai2
1Department of Neurology, Putuo Hospital,Shanghai
University of Traditional Chinese Medicine, 2Department of
Integrative Medicine, Zhongshan Hospital, Fudan
University, Shanghai, China
Monoamine oxidase type-B (MAO-B) inhibitors have been
often recommended as the first-line Parkinsons disease
treatment. Clinical studies showed that they had limited
symptomatic improvements which seem to be associated
with enhancement of neurotransmission. Besides selective
inhibition of MAO-B activity and elevating endogenous
dopamine concentration many experiments found that they
possessed neuroprotective effects and a potential of disease-
modification in PD. It may be one of the significant
strategies for supporting neuronal survival in PD to augment
neurotrophic factor activity, especially glial cell line-
derived neurotrophic factor (GDNF) and brain-derived
neurotrophic factor (BDNF). In this study, we investigated
the effects of selegiline on rescuing motor dysfunction and
dopaminergic function in 1-methyl-4-phenyl-1, 2, 3,
6-tetrahydropyridine (MPTP)-lesioned mice. We found that
oral administration of selegiline (1.0mg/kg/day for 14 days)
to MPTP-treated mice, commencing after impairment of the
nigrostriatal system, suppressed the reduction of nigral
dopaminergic neurons and striatal fibres of MPTP-lesioned
animals (p<0.001). At the 7th and 14th days of low dose
selegiline-treatment, the gait disorder showed obvious
improvement. Furthermore there was a significant elevation
in expression of GDNF and BDNF mRNA (2.10 and 2.75-
fold) and proteins (143.53% and 157.05%) in selegiline-
treated mice compared with saline-treated MPTP-lesioned
mice. In addition, the Bax/Bcl-2 ratio of gene and protein in
MPTP-lesioned mice obviously increased, and this effect
could be reversed by selegiline. Correlation analysis
revealed that both the gait measurement and GDNF/BDNF
were positively correlated with the number of dopaminergic
neurons. These findings demonstrate that selegiline has
neurorescue effects probably associated with induction of
NTFs and anti-apoptotics.
332 Posters, Sunday 9 September
P1619
The evolution of complexity in
transcranial magnetic stimulation induced
surface EMG: a possible illustration of
plasticity-like changes
M. Cukic1,2, A. Kalauzi3, M. Ljubisavljevic4,
N. Jorgovanovic2, V. Kostic1
1Institute for Neurology, Belgrade University, Belgrade,
2Department for Signals, Systems and Automatic Control,
University of Novi Sad, Novi Sad, 3Institute for
Multidsciplinary Studies, University of Belgrade, Serbia,
4Department of Physiology, Faculty of Medicine and Health
Sciences, UAE University, Al Ain, United Arab Emirates
Introduction: The aim of this study was to determine
whether a single-pulse TMS induces changes in complexity
of surface EMG immediately after the stimulation.
Methods: We analyzed changes in Fractal Dimension (FD)
in FDI muscle of the dominant hand in 9 healthy subjects,
while exerting three intensities of voluntary activation weak
(<30% of MVC), medium (30-60%) and strong (>60%);
control group were 5 healthy volunteers sustaining the same
three levels of contraction without presentation of TMS. FD
was calculated using Higuchis algorithm, of EMG
immediately after a TMS-induced silent period and
compared with those calculated from preceding TMS EMG
sections; FD with moving window was used to depict the
curves of complexity changes, and then we performed FFT
of the data. All analysis were performed in response to three
intensities of TMS stimulation set at 1.1 x MT, 1.2 x MT
and 1.3 x MT. Ten single TMS stimuli were delivered in
each series using a figure-of-eight coil positioned over the
optimal spot on the skull to elicit MEP from FDI muscle.
Results: The FD of the EMG after TMS fell in the majority
of examined series of recordings (in 72 out of 90 series),
and cyclic-like changes were observed in all the curves
constructed. Statistically significant changes in FD of series
before and after were more prominent for recordings
during sustaining mild and medium MVC, than in strong
MVC (p<0.05).
Conclusion: It appears that single pulse TMS of the motor
cortex induces plasticity-like changes in the voluntary EMG
signal.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1620
Does brain degeneration in Wilsons
disease involve not only copper but also
iron accumulation?
M. Skowronska1, T. Litwin1, K. Dzieyc1,
A. Wierzchowska1, A. Czlonkowska1,2
12nd Department of Neurology, Institute of Psychiatry and
Neurology, 2Department of Experimental and Clinical
Pharmacology, Medical University of Warsaw, Poland
Introduction: Wilsons disease (WD) is an autosomal
recessive inherited disorder of copper metabolism. Clinical
manifestations of WD include neurologic, hepatic and
psychiatric symptoms. Changed MR results are observed in
most WD patients with the neuropsychiatric form, and in
some with the hepatic and presymptomatic forms. In
previous studies showed that T2* and susceptibility-
weighted imaging (SWI) are highly sensitive to brain iron
accumulation, which causes decreased signal intensity.
Brain abnormalities in WD patients have been also
demonstrated with transcranial sonography (TCS).
Aim: Our aim was to investigate whether Wilsons disease
patients have MR changes typical of neurodegeneration
with brain iron accumulation, using T2* and blood
oxygenation level dependent imaging protocols. We also
investigated TCS lesions in basal ganglia in WD patients.
Methods: MRI with established protocol and TCS was
performed in admitted, clinically stable, and treated
patients.
Results: Hypo-intensity in the lenticular nucleus (LN) was
observed on T2* images of 78% neurologic, 50%
presymptomatic, and no hepatic patients (p<0.05) In SWI
images we found hypointense signal in LN in all neurologic,
83% presymptomatic, and 46% hepatic patients. No
acoustic window was found in 2 patients. Hyperechogenicity
in TCS in LN was found in 87.5% neurologic, 83%
presymptomatic and 75% hepatic patients. SWI is more
sensitive in detecting a paramagnetic signal than
conventional T2 and T2* sequences, especially for Wilsons
disease hepatic patients.
Conclusions: Magnetic resonance data suggests brain iron
accumulation in Wilsons disease. TCS is also a valid tool
for detection of basal ganglia metal accumulation in WD
patients.

P1621
Progressive supranuclear palsy-like
syndrome as a relatively common feature
of different neurodegenerations
R. Matj1, R. Rusina2,3
1Pathology and Molecular Medicine, 2Neurology, Thomayer
Hospital, 3Neurology, Institute for Postgraduate Education
in Medicine, Praha, Czech Republic
Introduction: Progressive supranuclear palsy (PSP) is
characterized by early gait disturbances and falls, axial
rigidity, vertical gaze palsy, and subcortical dementia. PSP
is considered to be a tauopathy; however, a PSP-like
syndrome has been associated with different
neurodegenerative entities. We present a series of 10
patients with a clinical presentation evoking PSP and
neuropathological findings of different neurodegenerative
entities.
Methods: Patients fulfilling the clinical and radiological
diagnostic criteria for possible or probable PSP were post
mortem neuropathologically examined. The detailed
histopathological assessment included immuno
histochemical analysis using a spectrum of antibodies
against different proteins associated with
neurodegenerations.
Results: We found in 5 patients frontotemporal lobar
degeneration (FTLD-TDP); 2 patients had a synucleino
pathy (multiple system atrophy and diffuse Lewy body
disease, respectively), 1 case was neuro pathologically
closed as a genetic form of Creutzfeldt-Jakob disease and 2
cases were Alzheimers disease.
Conclusion: Our observations support previous data
suggesting that the clinical picture of PSP-like syndrome
seems to be related to preferential localization of
pathogenetic inclusions and neuronal cell loss rather than to
specific pathological mechanisms of the disease itself.
Moreover, our observation confirms the importance of
neuropathological verification in patients clinically
diagnosed as atypical PSP.
Acknowledgement: This study was supported by grant IGA
NT12094-5/2011 from the Czech Ministry of Health.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 333
P1622
International studies on Huntingtons
diseases in Poland
D. Zielonka
Poznan University of Medical Sciences Poland, Poznan,
Poland
Introduction: Huntingtons disease (HD) is a progressive
neurodegenerative disorder where the conditioning factor is
a dynamic mutation in HTT gene. Being rare, it is difficult
to collect a large enough cohort for significant interventional
and environmental studies.
Materials and methods: Conducted in Poland, HD
research initiatives were reviewed in an archive of the HD
research Coordination Centre for Poland located at the
Department of Social Medicine of Poznan University of
Medical Sciences in Poland, Clinical Trials - a service of the
U.S. National Institutes of Health (www.clinicaltrials.gov),
EMBASE database, and the U.S. National Library of
Medicine National Institutes of Health (PubMed).
Results: Two observational and three clinical studies
regarding HD were conducted in Poland. The core study for
such research initiatives is REGISTRY; a prospective,
observational, longitudinal study on the rate of HD
progression collecting a large number of data on patients
during annual visits. Participants of the HD studies as well
as number of cross-sectional and clinical studies increased
quickly in the last years. Based on REGISTRY and other
studies, database as well as HD patients association
participants are easily and quickly collected for any other
studies. 643 participants underwent all HD studies in Poland
up to date.
Conclusions: Due to its large population Poland has
become a target country for rare diseases research.
REGISTRY was formed as a novel approach, to overcome
difficulties in patient collection for Huntingtons disease
interventional and environmental studies, to effectively
increase the number of enrolled study participants.
334 Posters, Sunday 9 September

P1623 P1624
Normal 0 21 primary episodic lingual Cerebral amyloid and hypertensive
protrusion dystonia angiopathy as the cause of diminished
R. Manso-Caldern level of consciousness and complex
Neurology, Hospital Universitario de Salamanca, movement disorders
Salamanca, Spain
R.C. Ginestal, A. Herranz, P. Garca-Ruiz, J. del Val,
Introduction: Lingual protrusion dystonia (LPD) is a S. Bellido, M.A. Aranda, I. Navas, B. Gonzalez-Giraldez
disabling form of cranial dystonia which varies from Neurology, Fundacin Jimnez Daz, Madrid, Spain
repetitive and/or episodic to sustained tongue protrusion,
Introduction: Amyloid and hypertensive angiopathies can
and can also be action-induced with speaking or eating.
infrequently cause transient focal neurological episodes.
LPD often occurs in association with oromandibular
These episodes use to be sensitive (paresthesias), motor
dystonia but can be isolated. Both idiophatic and secondary
seizure-like episodes or visual disturbances.
cases exist. Secondary causes include tardive dystonia, head
Patient: A 84-year-old woman, with a chronic respiratory
injury, electrical injury, heredodegenerative diseases (neuro-
condition and a chronic renal insufficiency due to
acanthocytosis, pantothenate kinase-associated
hypertension, previously treated with two courses of
neurodegeneration, neuroferritinopathy, Wilsons disease)
antibiotics for a respiratory infection, developed a
or varicella infection. However, primary episodic LPD is
pneumonia. She was treated with iv cefepime. 24 hours
rare.
after admission, she started to be unresponsive. 48 hours
Methods: A 17-year-old woman presented with a one-year
later, left upper limb coreic and ballistic movements,
history of episodic tightening of her tongue while speaking
together with lower limb ballistic movements and
and eating, causing difficulty in articulation and swallowing.
generalized myoclonias appeared. The CT scan showed an
Each attack lasted less than 1 minute. This symptom started
extensive chronic microangiopathic angiopathy. The CSF
after experiencing a cervical spine trauma. There was no
exam did not disclose any sign of infection or haemorrhage.
family history of neurological disorders. She did not take
The EEG exam demonstrated a diffuse encephalopathy with
neuroleptics or other medications. On examination she had
no signs of epileptic activity. We started treatment with iv
episodic speech-induced tongue protrusion associated with
valproic acid and tiapride. The antibiotic therapy was
mild dysarthria. The remainder of the neurological and
adapted to the renal insufficiency. An MRI was performed
general examination was normal.
showing an extensive and severe microangiopathic
Results: Routine haematological and biochemical
angiopathy. Several haemosiderin deposits related with past
evaluation were completely normal, as well as thyroid
microbleedings were seen both in supratentorial and
function, copper and ceruloplasmin, number of
infratentorial locations. There were no signs of acute
acanthocytes, autoimmune screen and serologies. Magnetic
haemorrhage or ischaemia. After 4 days with the new
resonance imaging of the brain and cervical spine was
antibiotic scheme and under valproic acid and tiapride, the
normal. EEG recorded during an episode of tongue spasm
patient started to improve. First, the fever and the movement
was normal. Interictal EMG of the tongue showed no
disorders disappeared. Then, the level of consciousness
evidence of denervation or myokymia. Two trials of
returned to normal. She was discharged 27 days after
treatment with clonazepam and carbamazepine were
admission with no signs of neurological impairment.
ineffective. The patient refused further trials of medication.
Discussion: We present a very infrequent case of acute
Conclusion: In contrast to most other paroxysmal
multifocal choreic, myoclonic and ballistic related to
movement disorders, episodic LPD does not appear
amyloid and hypertensive angiopathy.
responsive to anti-epileptic drugs.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1625
Improvement of tremor in a Parkinsons
case after thalamic infarction
A. Kksal1, M. ztrk1, N.H. Stpideler Kksal2,
B. Mutluay1, A. Ceyhan Dirican1, F. Aysal1, S. Bayba1
1Neurology, Bakrky Training and Research Hospital for
Mental Health and Neurological Sciences, 2Neurosurgery,
Istanbul Educational and Research Hospital, Istanbul,
Turkey
Introduction: The medical treatment of Parkinsons disease
includes dopamin agonists, enzyme inhibitors and
neuroprotective agents together with L-dopa. These drugs
are all symptomatic and do not affect the course of the
disease and motor complications may arise during medical
treatment. Thus, surgery is also performed for the
symptomatic treatment of this disease. Surgery is observed
to be more effective on tremor rather than the bradykinesia
and rigidity of Parkinsons disease.
Case report: A 76-year-old male Parkinsons patient is
followed in our outpatient clinic since 2003. He had right
side dominant bradykinesia, rigidity and resting tremor. He
was Hoehn&Yahr Stage 2 and had a UPDRS score of 16
points. His symptoms were partially under control with a
combination of L-dopa, benserazide and entacapone. The
patient was admitted to our emergency clinic in May 2007
with difficulty in speaking and right-sided weakness.
Neurological examination revealed dysarthria and slight
right-sided hemiparesis involving the face. Diffusion-
weighted cranial MRI showed an acute infarction at the
ventromedial part of the thalamus.
Results: On the 15th and 30th day, neurological examination
revealed a complete recovery of dysarthria and hemiparesis
as well as the tremor of Parkinsons disease. Bradykinesia
and rigidity were unaffected.
Conclusion: Though the possibility of recovery of tremor
in Parkinsons disease after a thalamic infarction is
theoretically known, it is a very rare clinical entity. We
aimed to present this rare case with thalamotomy-like
effects of thalamic infarction and also to discuss surgery in
Parkinsons disease in the light of this case.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 335
P1626
Effects of Nigella sativa oil on haloperidol
induced movement deficits in a rat model
T. Malik1, D.J. Haleem1, S. Pervez2, S. Hasan2, T. Fatima3
1Neurochemistry & Biochemical Neuropharmacology Unit ,
Biochemistry Department, The University of Karachi,
Karachi, 2Department of Pathology and Microbiology,
3Department of Biological Biomedical Sciences, The Aga
Khan University Hospital, Karachi, Pakistan
The neuropathological status of haloperidol (HP) induced
extrapyramidal symptoms (EPS) remains unclear, but
several lines of evidence suggest that persistent neuronal
alterations in the basal ganglia cause EPS by HP provoked
oxidative stress. The objective of this study was to evaluate
the possible protective effects of the antioxidative agent
Nigella sativa (NS) oil on HP induced neuropathological
alterations and related motor symptoms in the rodent
striatum.
Methods: HP was administered alone and with NS oil. EPS
was monitored in the HP treated groups and the animals
treated with NS only and placebo.
Results: The HP treated group displayed a high degree of
motor impairment (p<0.00) shown on rota rod experiment,
vacuous chewing movement (p<0.00) shown grossly
disturbed the large fraction of the cytoarchitectonic pattern
(p<0.05), histopathology with nerve cell depletion
concomitant shrunken cytoplasm, nuclear membrane
breakdown and chromatin disorganization. Scarring was
also a prominent feature owing profusion of astrogliosis in
the dorso- and ventrolateral regions of the caudate putamen
and in the core of nucleus accumbens. Moderate levels of
halo and pyknotic neurons were also observed in HP treated
rodents. The morphological HP induced neuronal changes
were almost absent in the HP plus NS treated groups
(p<0.00). However minor astrogliosis was observed with no
obvious indication of cell loss and 82% normal neuronal
densities were observed using a quantitative, analytic
approach in the NS plus HP treated striatum. We conclude
that NS therapy has preventive effects on HP induced
neuronal degeneration in the striatum.
336 Posters, Sunday 9 September
P1627
Cardiovascular factors in hospitalized
patients with idiopathic Parkinsons
disease: a retrospective analysis
K. Lauckaite1, G. Zemgulyte2, I. Sniokaite2, D. Surkiene1,
D. Rastenyte1, A. Vaitkus1
Neurological, 2Lithuanian University of Health Sciences,
1 Background: Parkinson patients have many difficulties in
Kaunas, Lithuania
Introduction: Evidence suggests that cardiovascular
abnormalities, co-morbid presence of white matter lesions
(WML) may exacerbate or contribute to some motor and
cognitive deficits in Parkinsons disease (PD).
Methods: A retrospective study was carried out at the
Hospital of the Lithuanian University of Health Sciences.
We have analyzed case histories of 129 (55 males, 74
females) PD patients hospitalized in 2011. Diagnosis was
established according to the UK brain bank criteria. The
clinical, demographic data, computed tomography (CT),
electrocardiogram, carotid ultrasound (ECCS), Barthel
index (BI), MMSE results were collected.
Results: The mean age of PD patients (SD) was
68.68.9yrs, and stage according to Hoehn-Yahr (H-Ys)
2.20.9. Tremor-dominant PD (TD) was diagnosed in 39
(30.2%), postural-instability-gait-disorder-dominant
(PIGD) in 58 (45%), mixed type (MT) in 25 (19.4%), 7
(5.4%) were unclassified. The most advanced H-Ys
(p=0.027) and the lowest MMSE points (p=0.099) were in
MT and PIGD groups. Mostly TP accounted for the urgent
admission (37.5%, Chi2=9.1, p=0.028). H-Ys correlated
negatively with BI (r=-0.4, p<0.001), systolic BP (r=-0.2,
p=0.03) and QRS interval (r=-0.3, p=0.014). Brain CT was
performed in 43 (33.3%), with WML detected in 22
(51.2%). The highest rate of WML was in PIGD (Chi2=8.3,
p=0.004) and in the elderly (p=0.002). Linear velocities on
ECCS (n=46, 35.7%) were lower in common or external
carotid arteries at stages 2 vs. 1 (p<0.05).
Conclusions: WML were associated with an age and PIGD
PD. The highest motor and cognitive impairment was
detected in MT and PIGD. According to cardiovascular
factors, stage 2 and later is an advanced disease.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1628
Social isolation and quality of life in
Parkinsons disease
J.Y. You
Neurology, Hanil General Hospital, Seoul, Republic of
Korea
mobility, cognition and psychiatric symptoms such as
depression, anxiety and suicidal idea. Of course many
physical problems disable patients, but recent progress
including medication and surgical methods have improved
progressively. So physical disabilities improved rapidly.
But psychosocial disabilities have been undertreated and
missed. So this study aims to find other psychosocial
support that can change the QoL of Parkinson patient.
Method: 20 Parkison patients who live alone or with an old
spouse were selected. Inclusion criteria were no regular job
and social club. So socially isolated patient were selected.
The patients QoL was measured and assessed by the
Parkinsons disease quality of life (PDQL) and the Beck
Depression inventory (BDI). We divided this group. One
group (No=12) is newly attending the day care unit or
rehabilitation center providing the physical activity and
cognitive rehabilitation. The other group (No=8) is socially
isolated, as before. Baseline, 3 months, 6 months PDQL and
BDI were checked.
Result: The first group who newly joined social activities
showed improvement in BDI and PDQL. The improvement
difference gap is increased to time.
Conclusion: Socially isolated state due to physical activity,
depression or other socio-economic state aggravated
Parkinson patients QoL. So physicians must consider the
social isolation. If physicians consider this problem, the
family and social support will be increased. Recently in
Korea, government supporting social nursing insurance is
started. And this system is expected to improve the
Parkinson patients QoL in aspects of social isolation.

P1629
Parkinsons disease (PD) epidemiology
and clinical presentation in Lugansk,
eastern Ukraine
I. Pepenina
Out-Patient, Hospital N10, Lugansk, Ukraine
PD is a common extrapyramidal disorder in Ukraine which
is vastly misdiagnosed. Low awareness of PD differential
diagnosis, as well as low access to drugs and neurosurgical
interventions seriously affect management efficiency.
Study objective: To analyze PD prevalence in Lugansk
(Eastern Ukraine).
Methods: The retrospective follow-up study of PD
prevalence in the region has been performed. Diagnosis of
PD was based on Hughes et al. criteria (1992), for staging
Hoehn-Yahr scale (1967) was used.
Results: Prevalence of PD in different age groups varies
significantly from 4.8 per 100,000 at the age below 55 to
178.0 per 100,000 in older patients. Clinical disease
peculiarities have been analyzed in 71 cases. Patients in
stages 2-4 predominated (21 males, 28 females). Tremor
prevailed in 22 patients (8 males, 14 females), akinetic-rigid
syndrome in 21 patients (13 males, 8 females), mixed
symptoms were found in 28 patients (14 males, 14 females).
Right-side onset was established in 42 cases (18 males, 24
females), left-side in 29 (17 males, 12 females). Rapid
progression was more frequent in 29 cases (16 males, 13
females), whereas moderate and slow type were detected in
19 cases (11 males, 8 females) and 18 cases (7 males, 11
females), respectively. In the disease management mostly
L-dopa, NMDA-antagonists, and dopamine-receptor
agonists are being used (in 56, 34 and 27 cases, respectively).
6 patients use MAO-B inhibitors.
Conclusion: PD in Lugansk is being mostly detected in
advanced stage seriously hampering the life quality in older
patients.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 337
P1630
High intake of folate provides anti-
parkinsonism effects: no role for plasma
level of homocysteine
H. Haghdoost-Yazdi1, N. Fraidouni2, A. Faraji1,
M. Sarookhani1
1Cellular and Molecular Research Center, Qazvin University
of Medical Sciences, Qazvin, 2Tarbiat Moalem University,
Tehran, Iran
Several lines of evidence show that homocysteine (Hcy)
levels are increased in blood and CSF of patients with
Parkinsons disease. Folate is necessary for Hcy metabolism
and there is generally an inverse relationship between
plasma folate and Hcy levels. In the present study, effect of
folate supplementation on the severity of 6-hydroxydopamine
(6-OHDA)-induced parkinsonism was investigated. Rats
were nourished with different doses of folate supplements
from 1 month before stereotaxic injection of 6-OHDA to the
end of experiments. Plasma Hcy was measured at the end of
experiments to identify its association with parkinsonism.
Our results indicate that folate supplementation attenuates
severity of parkinsonism. The best effect was seen in rats
receiving folic acid at 10-folds of normal MEM (minimum
essential medium). In this group, number of apomorphine-
induced rotations in the post-surgery tests was more than
60% lower than that in the control group. These rats also
showed significant better performances in rotarod test and
had learning patterns similar to healthy rats. 5-fold
supplementation of folate also remarkably improved the
rotarod performances but had modest effect on the rotational
behaviour. 2-fold supplementation had no effect. The levels
of Hcy in rats receiving moderate and low doses of folate
supplementations were near to that in the control group.
However, in rats treated by high dose of folate, Hcy was
significantly higher than that in the control group. Our
results indicate that folate supplementation provides anti-
parkinsonism effect, in a dose dependent manner, but this
effect is not mediated by lowering plasma Hcy.
338 Posters, Sunday 9 September
P1631
Rasagiline for the treatment of gait
disturbances in patients with Parkinsons
disease (PD): an open label study
N. Van Blercom, G. Linazasoro
Centro Investigacin Parkinson Policlnica Gipuzkoa, San
Sebastian, Spain
Background: Gait disturbances are a major cause of
disability in patients with advanced PD. Their management
is difficult and the classical dopaminergic treatment is often
unsuccessful. Rasagiline has shown some beneficial effects
against gait disorders.
Aim: To study the symptomatic effect of rasagiline 1mg/
day on gait and mobility in advanced PD.
Methodology: 15 non-demented PD patients (mean age
74.65.8 y.o; mean PD duration 9.36.1 years; mean Hoehn
& Yahr stage 3.140.8) were included in this prospective,
open study of 8 weeks duration. They showed clinically
significant gait disturbances as determined by the Timed Up
and Go test (TUaG), (TUaG >10 seconds in ON and 14 in
OFF). They were receiving a stable dose of antiparkinsonian
medications. Besides TUaG (primary variable), patients
were assessed by using the UPDRS, freezing of gait and
new freezing of gait questionnaires (FOG-Q and NFOG- Q)
and PDQ-39.
Results: 4 patients were withdrawn due to early mild side
effects. TUaG was significantly improved (basal 26.618.7,
final 2014; p<0.05). UPDRS, PDQ39, FOG and NFOG
questionnaires remained unchanged though a trend towards
improvement in the last two questionnaires was observed.
Conclusion: Rasagiline improved some parameters related
to gait performance, mainly TUaG. Rasagiline is a
therapeutic option in this clinical situation.
The study was sponsored by Lundbeck.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1632
The role of the activity of NO-system in
the development of depression in
Parkinsons disease
R.J. Matmurodov, K.M. Khalimova, M.M. Raimova
Tashkent Medical Academy, Tashkent, Uzbekistan
Some non-motorized manifestations such as disorders of
smell, constipation, depression, pain syndromes occur
before the development of the classic motor symptoms of
Parkinsons disease (PD).
Objective: To study the role of the activity of NO-system in
the development of depression in patients with PD.
Methods: A total of 58 (35 of them with depression and 23
non-depressed) patients with PD. The average age was
54.34.5 years. For the estimation of NO-system studied in
the concentration of red blood cells NOx, the activity of
NADPH-dependent NO, the level of peroxynitrite
(ONOO-), the activity of NO-synthase (NOS). The level of
depression was determined using the Zung scale.
Results: The results of this analysis showed that the NO-system
parameters in patients without depression comprise: NO
22.70.55mmol/l, eNOS 13.90.263mol/min/l, NADPH-HP
1.020.03mmol/min/l, ONOO- 0.080.005mmol/l. In patients
with mild depression up: NO-30.80.34, eNOS- 9.710.13,
NADPH-NR-1.460.02, ONOO- 0.0210.003. In patients
with depression of moderate severity parameters of NO-up:
NO-38.50.45mmol/l, eNOS 8.30.3mol/min/l , NADPH-HP
1.790.1mmol/min/l and ONOO- 0.350.02mmol/l. Our data
indicate that the degree of growth depression in PD is
accompanied by a worsening imbalance of the NO-system and
the progression of the clinical course.
Conclusion: Thus, the degree of depression in PD depends
on the activity of the NO-parameter system. In this
connection, the imbalance in the NO-system can be
considered as a factor in the progression of depression in
PD.

P1633
Parkinsons syndrome in chronic
neuroborreliosis
N.S. Baranova, M.A. Bykanova
Yaroslavl State Medical Academy, Yaroslavl, Russia
Purpose: To identify the occurrence of Parkinsons
syndrome (PS) in patients with chronic neuroborreliosis
(CNB).
Materials and methods: We explored 164 patients (115
female and 49 male) with diagnosis of CNB, average age
49.616.27 years. CNB was diagnosed by the criteria: the
presence of neurologic symptoms within 6 months from the
appearance of erythema migrans and/or a tick bite or
symptoms persisting for more than 6 months; the presence
in serum or CSF of diagnostically significant elevated titres
of antibodies to Borrelia burgdorferi; the presence of
clinical improvement from specific antibiotic therapy and/
or decrease in antibody titres to Borrelia burgdorferi in the
dynamic study of blood serum; the exclusion of other
causes, which could explain development of existing
symptoms. They also used the Diagnostic criteria UK
Parkinsons disease (PD) Society Brain Bank (1992),
Schwab and England (1969) scale, MRI.
Results: PS was diagnosed in 5 (3%) patients with CNB.
The combination of PD and CNB was observed in 3 (1.8%)
patients (1 male and 2 female). Slight deterioration was
noted (no more than 10% of Schwab and England) and the
persistence of symptoms of PD after antibiotic treatment of
neuroborreliosis. PS due to CNB was defined in 2 (1.2%)
female. Symptoms of PS due to CNB significantly
decreased after antibiotic therapy. Levodopa, dopamine
agonists were not effective.
Conclusion: PS as a manifestation of neuroborreliosis
occurred in 1 patient from 82 cases of CNB. Antibiotic
therapy significantly reduced the severity of parkinsonian
symptoms.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 339
P1634
Muscle testing and loss of ambulation in
Friedreichs ataxia
C. Mignard-Moydelacroix1, A. Boufferet2, L. Bonnet2,
D. Mignard-Moydelacroix2, Centre de Rfrence
Maladies Neurologiques Rares
1CHR de La Reunion, 2Neurologie-Maladies Rares, CHU de
La Reunion, Saint-Pierre, Reunion
Many genetic diseases are observed in Reunion Island, a
French island in the Indian Ocean. Late-onset Friedreichs
ataxias are frequent. Many adult people are walking yet in
our experience.
Aims: The neurological disorder affected mainly the
cerebellar tracts. Initially, the muscles are not weak. The
muscle testing changes over time were compared with the
walking status to clarify the cause of the loss of ambulation.
Materials and methods: 44 patients for 12 years were
classified into three categories: walkers (16), standing (11)
and non-walkers (17). 175 muscle testings were achieved
since 2008: The average score showed muscle damage for
each muscle group. Next, in six patients who lost the ability
to walk (6) since 2008: the testing done before, during and
after the loss of ambulation were reviewed .
Results: The walkers had a mean score between 4 and 5
for all muscle groups; the standing up had poorer
outcomes (between 3 and 4) with elective involvement (3/5)
on three muscle groups, (psoas, gluteus and adductors);
non-walkers scores showed the same involvement. In the
6 patients who lost ambulation since 2008, 6 months before
the loss of ambulation, no patient had a wholesome muscle
score (all<5). Three muscle groups were more impaired
than others (3/5): the gluteus, psoas and adductors.
Conclusion: The loss of ambulation in patients with
Friedreichs ataxia is correlated markedly and significantly
with muscle weakness of psoas, gluteus and adductors.
Preventive muscle strengthening on these muscles, could
delay the disease progression.
340 Posters, Sunday 9 September
P1635
Exposure of multiple system atrophy
(MSA) patients with or without orthostatic
hypotension (OH) to potentially
hypotensive drugs
S. Perez-Lloret1, M.V. Rey1, A. Pavy-Le Traon2,
W. Meissner3, F. Ory-Magne2, C. Brefel-Courbon2,
N. Fabre2, F. Tison3, O. Rascol1
1 Clinical Pharmacology, 2Neurology, CHU Toulouse,
3 Neurology, CHU Bordeaux, France
Background: OH is a hallmark of MSA.
Objective: To assess the exposure of MSA patients with or
without OH to drugs that can potentially induce OH.
Methods: Patients were assessed at the French MSA
reference Centers between 2008 and 2011. Blood pressure
(BP) was measured 5 min after lying down and every min
during 10 min after standing up. According to Gilmans
criteria, OH was defined as systolic/diastolic BP fall
30/15mmHg during the first 3min after standing. Exposure
to drugs commonly associated with OH, such as insulin,
antihypertensives of any class, peripheral vasodilators,
drugs for heart-disease, alpha1-adrenergic receptor
antagonists, dopaminergic drugs and antidepressants, was
recorded.
Results: 131 MSA patients were included in the study (age
64.70.7, 50% males, 61% MSA-P, UMSARS II score
25.30.7). OH was detected in 76 (58%) patients. 84% of
patients were exposed to at least 1 potentially hypotensive
drug. These patients were exposed to a mean of 21
potentially hypotensive drugs. Patients with OH were less
frequently exposed to antihypertensives (16% vs. 31%,
p<0.01), levodopa (58% vs. 78%, p<0.01) or dopamine
agonists (9% vs. 36%, p<0.01). Results remained significant
after adjusting for demographic or disease-related factors
by logistic regression analysis.
Conclusion: Our study showed that patients with OH were
less frequently exposed to antihypertensives, levodopa or
dopamine agonists. As it is possible that treating physicians
may have avoided exposing MSA patients to these drugs,
drug exposure may not be a major factor connected with
OH in MSA.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1636
Medication use in patients with multiple
system atrophy or Parkinsons disease
compared to a group of patients
consulting a general practitioner
S. Perez-Lloret1, M.V. Rey1, A. Pavy-Le Traon2,
W. Meissner3, F. Ory-Magne2, C. Brefel-Courbon2,
N. Fabre2, F. Tison3, O. Rascol1
1 Clinical Pharmacology, 2Neurology, CHU Toulouse,
3 Neurology, CHU Bordeaux, France
Objective: To compare drug utilization between MSA,
Parkinsons disease (PD) patients or unselected patients
consulting a general practitioner (GP).
Methods: 147 MSA patients (according to Gilman criteria)
were assessed at the MSA reference Center between 2008
and 2011. 653 PD patients (according to UKPDSBB
criteria) and 98 patients visiting a GP for reasons not related
to PD or MSA were recruited from the same geographical
area. Data were analyzed by chi-square test followed by
pair wise comparisons by bonferroni-adjusted z-test for
proportions.
Results: MSA patients were younger than PD or GP patients
(651 vs. 681 and 711 years p<0.001). Proportion of
males was similar in the 3 groups (MSA: 50% vs. PD: 49%
and 46%, p=0.9). MSA patients were more frequently
exposed to drugs for bowel disorders (MSA: 19% vs. PD:
6% and GP: 10% p<0.001), to urinary antispasmodics
(MSA: 18% vs. PD: 2% and GP: 1% p<0.001) to drugs used
for orthostatic hypotension such as midodrine or
fludrocortisone (MSA: 42% vs. PD: 3% vs. GP: 0%,
p<0.001) to antihypertensives (MSA: 22% vs. PD: 40% vs.
GP: 58% p<0.001). MSA patients were less frequently on
antiparkinsonians as compared to PD (73% vs. 88%
p<0.05). Finally, MSA patients were more frequently on
antidepressants (MSA: 48% vs. PD: 18% and GP: 10%
p<0.001).
Conclusions: Medication use patterns differ in patients
with MSA, PD and those visiting a GP.

P1637
Medication use in the patients of the
French multiple system atrophy (MSA)
reference center
M.V. Rey1, S. Perez-Lloret1, A. Pavy-Le Traon2,
W. Meissner3, F. Ory-Magne2, C. Brefel-Courbon2,
N. Fabre2, F. Tison3, O. Rascol1
1 Clinical Pharmacology, 2Neurology, CHU Toulouse,
3 Neurology, CHU Bordeaux, France
Objective: To describe medication use in MSA patients and
to relate it with different characteristics of the disease.
Methods: Patients were assessed at the French MSA
reference Center. The following variables were collected:
MSA diagnosis (probable vs. possible according to
Gilman criteria), disease duration, autonomic dysfunction
(SCOPA-Aut), disease severity (UMSARS I+II), clinical
subtype (MSA-P vs. MSA-C) and any medication use
(coded by ATC). Data were analyzed by chi-square test;
only significant differences are reported.
Results: 147 MSA patients were recruited (mean age
65.30.7; 50% males, 61% MSA-P; 82% probable MSA;
mean UMSARS-score 48.91.3; mean disease duration
5.10.2).Overall, MSA patients received 8.20.4
medications. 73% of patients received at least one
antiparkinsonian (mainly levodopa: 67%), 33% midodrine
and 10% fludrocortisone. More severely affected patients
(UMSARS>47) more frequently received antithrombotics
(27% vs. 14%; p<0.05) antidepressants (61% vs. 38%;
p<0.01,) or drugs for bowel disorders (30% vs. 10%;
p<0.01). More patients with MSA-P (versus -C) received
antiparkinsonian (90% vs. 46%; p<0.01), antihypertensive
(28% vs. 12%; p<0.05) or analgesic (19% vs. 4%; p<0.01)
medications. More patients with probable MSA (versus
possible) received midodrine (39% vs. 7%; p<0.01) and
less alpha-blockers (5% vs. 19%; p<0.02). Patients with
SCOPA-Aut score >22 were more frequently on
fludrocortisone (18% vs. 3%; p<0.01) or antidepressants
(57% vs. 41%; p<0.04). Patients with disease duration >5
years were more frequently on alpha-adrenergic blockers
for urinary problems (14% vs. 3%; p<0.01).
Conclusion: In MSA, medication use significantly differs
according to disease characteristics.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 341
P1638
Features of the basal metabolism in
patients with Parkinsons disease
R. Bogdanov1, A. Bogdanov2, E. Manannikova1,
B. Kaganov2, S. Kotov1
1Department of Neurology, Moscow Regional Scientific
Research Clinical Institute n.a. M. F. Vladimirsky, 2The
Institute of Nutrition Russian Academy of Medical Science,
Moscow, Russia
Aim: To study basal metabolic rate in patients with
Parkinsons disease.
Material and method: 30 patients with a diagnosis of
Parkinsons disease were examined and compared with 30
control subjects. None of the patients were receiving any
anti-parkinsonian treatment before the examination. We
studied basal metabolic rate and oxidation rates of
macronutrients (protein, fat and carbohydrates) by indirect
respiratory calorimetry in all patients.
Results: The average basal metabolic rate was defined. It
was increased by 33.9% in the patients with Parkinsons
disease compared to the control group. The separated
analysis of the average rate of oxidation of the
macronutrients in patients with Parkinsons disease showed
that the average rate of oxidation of the fats was increased
by 94%, average rate of oxidation of the carbohydrates was
increased by 8.6%, and there were no statistical significant
changes for proteins, compared to the control group.
Conclusion: Our results show that the increased basal
metabolic rate of patients with Parkinsons disease, in the
first place, was caused by increased basal oxidation of the
fats, and in the second place it was caused by increased
basal oxidation of the carbohydrates. This result may be
used for diet therapy optimization of patients with
Parkinsons disease.
342 Posters, Sunday 9 September

P1639 P1640
Using an endophenotype to evaluate the Drug-induced parkinsonism treated with
effect of environmental factors in disease Yokukansan in elderly patients
penetrance of adult onset primary torsion J.Y. Park, Y.H. Sim, E.C. Lee, K.H. Cho
dystonia Department of Cardiovascular & Neurologic Diseases,
College of Korean Medicine, Kyung Hee University, Seoul,
A. Molloy1, O. Kimmich1, D. Bradley1, R. Reilly2,
Republic of Korea
S. O Riordan1, M. Hutchinson1
1St Vincents University Hospital, 2Trinity Centre for Introduction: Drug-induced parkinsonism (DIP) is a
Bioengineering, Trinity College Dublin, Ireland common cause of parkinsonism in elderly people. Many
different types of medication, not only neuroepileptics, may
Objective: We aim to investigate whether significant
induce or exacerbate parkinsonism. Older people are more
differences exist in environmental exposures among
exposed to developing DIP, because they are on multiple
manifesting individuals with adult onset primary torsion
medications for chronic senile diseases. DIP is considered
dystonia (AOPTD) and their unaffected first degree
to be reversible after stopping the offending drugs within 4
relatives with abnormal temporal discrimination, indicating
months. However in some cases, it may persist. The
abnormal gene carriage, to determine reasons for the
managements with anticholinergic agents or dopaminergic
reduced penetrance of AOPTD.
drugs seemed to have additional drug side effects especially
Background: AOPTD is a poorly penetrant autosomal
in elderly people. Yokukansan (YKS) is a herbal formula
dominant disorder. Most (85-90%) gene carriers for AOPTD
used to treat Parkinsons disease in oriental medicine. We
are non-manifesting despite having reached an adequate age
introduce cases of DIP treated with Yokukansan in old
for penetrance. The temporal discrimination threshold
patients.
(TDT) is abnormal in patients with AOPTD and 50% of
Case report: We describe 4 cases of DIP possibly caused
their unaffected first degree relatives. An abnormal TDT is
by medication for common senile diseases, which were
a mediational endophenotype indicating gene carriage in
dibenzodiazepine, SSRIs for depression, flunarizine for
unaffected relatives. It is hypothesized that genetic,
vertigo, and levosulpiride for dyspepsia. All patients were
epigenetic and environmental factors may exert protective
female and above 70 years of age. They presented postural
or deleterious effects affecting penetrance of AOPTD. By
upper limb tremor and bradykinesia about 5 months after
examining environmental exposure history in both AOPTD
the initiation of offending drugs. 2 of them concurrently had
patients and their similarly aged unaffected siblings with
oral-buccal dyskinesia.
abnormal TDTs we may determine the role of the
Results: Symptoms completely improved several weeks or
environment in disease penetrance.
months after discontinuing the causative drugs and being
Methods: This is a case-control single centre prospective
treated with YKS. None of the patients suffered from any
study that will be performed using a standardised
side effects attributable to YKS.
questionnaire. The questionnaire will collect information on
Conclusions: DIP adversely affects the quality of life in
demographics and on a range of past environmental
older patients. Through careful medication history taking
exposures in patients with AOPTD and their unaffected
and avoidance of any potentially offending medication, it
siblings. A total of 60 AOPTD probands with cervical
can be often reversible. Furthermore, we propose that YKS
dystonia and one or more of their unaffected siblings with
might be helpful to the management of DIP.
abnormal TDTs will be recruited. All unaffected siblings
will be over 40 years of age, and age and gender matched to
the proband.
Results: Results of this study will be available at the
congress.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

 Posters, Sunday 9 September 343

P1641
Non-motor disturbances in patients with
Parkinsons disease
S.B. Sattarova1, Y.N. Madjidova2, D.B. Sattarova2
1Tashkent State University, Nezami, 2Tashkent Medical
Academy, Tashkent, Uzbekistan
P1647
The effect of homocystein and MTHFR
gene mutation in Parkinsons disease
treatment
P. Nurkan1, H.A. Idrisoglu2, A. Sazci2, N. Polat2
1Merd Company, 2Department of Neurology, Medical

Faculty of Istanbul, Turkey

P1642
Hemifacial spasm due to posterior fossa P1648
lipoma: a case report Association of Parkinsons disease and
S. Nazarbaghi essential tremor
Neurology Department, URMIA University of Medical V. Razdorskaya, G. Yudina, O. Voskresenskaya
Sciences, Urmia, Iran Saratov State Medical University, Saratov, Russia

P1643 P1649
Apomorphine in treatment of Parkinsons Development and validation of a quality of
disease: initiation without discontinuation life measure for carers of people with
or reduction of dopaminergic therapy Parkinsons disease
M.F. Oztekin1, N. Oztekin2, F. Ak2 C. Jenkins, S. Dummett
1Neurology, MOH Ankara Yildirim Beyazit Education and University of Oxford, Health Services Research Unit, UK
Research Hospital, 2Neurology, MOH Ankara Numune
Education and Research Hospital, Ankara, Turkey
P1650
P1644 The combination of SPECT-CT and
Subjective evaluation of emotional visual functional MR imaging in the diagnosis of
stimuli in patients with Parkinsons neuro-acanthocytosis: a case report
disease: a pilot study N. Xiong, Q. Zhu, Z. Liang, C. Liu
Department of Neurology, Union Hospital, Tongji Medical
R. Berlot, B. Dolenc, D. Georgiev, J. Bon, M. Trot, College, Huazhong University of Science and Technology,
Z. Pirtoek Wuhan, China
Department of Neurology, University Medical Centre
Ljubljana, Slovenia
P1651
P1645 Aphasia as primary symptom in
corticobasal degeneration
Life quality improvement in Parkinsons
C. Balla, J.L. Pepin
disease treated with foetal stem cells CHR Citadelle, Lige, Belgium
N. Sych, M. Klunnyk, O. Ivankova
Embryonic Tissues Center EmCell, Kiev, Ukraine
P1652
P1646 Overnight switching from pramipexole to
ropinirole CR in patients with Parkinsons
Strategy of starting levodopa treatment in
disease: an open preliminary trial in Korea
Parkinsons disease patients in Armenia
M.Y. Park, H.J. Park
Z. Tavadyan1,2, H. Bakunts1 Neurology, Yeungnam University College of Medicine,
Department of Angioneurology, Yerevan State Medical
1
Daegu, Republic of Korea
University after Mkhitar Heratsi, 2Somnus Sleep and
Movement Disorders Clinic, Yerevan, Armenia

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

344 Posters, Sunday 9 September
P1653
Treatment of patients with writers cramp
by injections of botulinum toxin-A
V. Zmachynskaya, S. Likhachev, T. Charnukha
Republican Research and Clinical Center of Neurology and
Neurosurgery, Minsk, Belarus
P1654
Comorbidities of fatigue syndrome in
patients with Parkinsons disease
V. Datieva, O. Levin
Russian Medical Academy of Postgraduate Education,
Moscow, Russia
P1655
Investigation of the prevalence of
essential tremor in individuals aged 18-60
in Erzurum
L. zel1, R. Demir1, G. zdemir1, E. zyldrm2,
U. Avar3, H. Ulvi1, R. Aygl1
1Department of Neurology, 2Department of Public Health,
3Family Medicine, Medical School of Atatrk University,
Erzurum, Turkey
P1656
The heterogenity of hypersomnia in
Parkinsons disease
M. Nodel, N.N. Yakhno
Neurology, Moscow Medical Academy, Moscow, Russia
P1657
Recently diagnosed chronic liver disease
presenting with parkinsonian symptoms
T. Kasikci1, S. Bek2, E. Tokgoz2, Y. Kutukcu2,
Z. Odabasi2
1 Neurology, 2Gulhane Medical Faculty, Ankara, Turkey
P1658
Post-infectious cerebellar atrophy
C. Silva, D. Neutel, M. Coelho, L. Albuquerque
Hospital Santa Maria, Lisbon, Portugal
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1659
Paroxistic non-kinesiogenic and
hipnogenic dyskinesia (Lugaresi disease):
a case report
M.A. Sierra-Beltrn1, C.M. Hernndez-Crdenas2,
H. Sentes-Madrid3
1CIDyT, Mdica Sur, 2Critical Care Medicine, 3Neurology
Department, INCMNSZ, Mexico City, Mexico
P1660
New approach to gait disorders therapy in
late stages of Parkinsons disease
I. Litvinenko1, I. Krasakov1,2, R. Khalimov1, A. Trufanov1
1Department and Clinic of Neurology, Military Medical
Academy named after S.M. Kirov, Saint-Petersburg, 2The
Center of Extrapyramidal Disorders, The Nikiforov Russian
Center of Emergency and Radiation Medicine, Saint
Petersburg, Russia
P1661
The effectiveness of cognitive & reflexive
saccade measures in discriminating
Huntingtons disease from healthy
controls
E.A. Toh1,2, M.R. MacAskill1,2,
J.C. Dalrymple-Alford1,2,3, D.J. Myall2, L. Livingston1,2,
J. Ross2, T.J. Anderson1,2
1Department of Medicine, University of Otago, 2New
Zealand Brain Research Institute, 3Department of
Psychology, University of Canterbury, Christchurch, New
Zealand

Multiple sclerosis 1
P1662
The relationship between age and long-
term evolution in multiple sclerosis
A. Scalfari1, A. Neuhaus2, M. Daumer2, G. Ebers3,
P. Muraro4
1Centre of Neuroscience, Division of Experimental Medicine,
Department of Medicine, Imperial College London, UK,
2Sylvia Lawry Centre, Munich, Germany, 3Oxford University,
Oxford, 4Imperial College London, UK
Background: Age has been indicated as a possible factor
influencing multiple sclerosis (MS) disease evolution.
Objectives and methods: Among 1023 patients from the
LO Ontario database, Kaplan-Meier and Cox regression
analyses investigated the impact of age at disease onset, age
at onset of progression and current age on long-term
prognosis.
Results: Growing older significantly affected disability
accumulation (HR per additional year: DSS 6=1.06; DSS
8=1.04) in relapsing remitting (RR) patients only. Age at
onset of primary progression (PP) did not influence disease
evolution. However, age at onset of RR phase, predicted
risk of conversion to secondary progression (SP) and of
attaining DSS levels. Onset at age 40 (HR=4.22) and at age
50 (HR=6.04), respectively, doubled and tripled risks of
developing SP vs. onset at age 20 (HR=2.05). Older onset
meant shorter times to disability levels but secondary to
shortened SP latency. Mean age at SP and PP onset was
similar (40.2 vs. 38.6 years; p=0.096) and the progressive
course, preceded or not by relapses was uniform, unaffected
by age at RR onset or by age at SP onset. Among PP and
RR/SP patients median ages at attainment of DSS 6 (49 vs.
48), DSS 8 (58 vs. 58) and DSS 10 (78 vs. 78) were
strikingly similar.
Conclusions: Ageing was associated with progressive
phenotypes and with shorter latency to SP, but did not affect
the progressive course. Age independently affects disability
development primarily by acting on probability and latency
of SP.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 345
P1663
Depression in multiple sclerosis patients
treated with IFN1b - who is to blame?
C. Gavan1, E. Terecoasa1, S. Gheorghevici2,
A. Poalelungi1, C. Tiu1
1University Hospital Bucharest, 2University of Medicine and
Pharmacy Carol Davila, Bucharest, Romania
Introduction: Multiple Sclerosis (MS) is a progressive,
disabling disease which affects mainly young adults.
Depression is common during the course of this disease and
has a multifactorial etiology.
Methods: We performed a cross-sectional study on 100
patients treated with IFN1b s.c. As this treatment can
favour the onset or the worsening of depression, the purpose
of our study was to analyze which factors are associated
with depression and if a longer period of treatment is linked
to a higher frequency of depression. Each patient was
clinically evaluated with a complete neurologic examination
and EDSS score was calculated. The presence of depression
was evaluated using the Hamilton Depression Rating Scale
(HDRS); cut-off point for depression 8. The patients were
divided in two subgroups according to the presence or
absence of depression. Patients with depression were further
classified as mild, medium and severe
Results: Depression was found in 41% of the patients. The
duration of treatment was not statistically significantly
associated with the presence of depression. Female sex
(OR=2.46; 95%CI=1.04-5.81) and age >40 years (OR=4.14;
95%CI=1.76-9.72) were factors associated with depression.
EDSS parameters statistically significantly associated with
depression were: sensitive (p=0.02), cerebellar (p=0.009),
and bowel and bladder (p=0.002). Impaired pyramidal
function was not associated with the presence of depression.
Conclusion: EDSS parameters associated with depression
are: sensitive, cerebellar, and bowel and bladder. Duration
of treatment is not associated with depression.
346 Posters, Sunday 9 September

P1664
Grey matter damage predicts the
accumulation of disability and cognitive
impairment 13 years later in patients with
multiple sclerosis
M. Filippi1, P. Preziosa1, M. Copetti2, G. Riccitelli3,
R. Messina1, G. Comi4, M.A. Rocca1
1Neuroimaging Research Unit and Department of Neurology,
Vita-Salute San Raffaele University and San Raffaele
Scientific Institute, Milan, 2Biostatistics Unit, IRCCS-
Ospedale Casa Sollievo della Sofferenza, San Giovanni
Rotondo, 3Neuroimaging Research Unit, 4Department of
Neurology, Vita-Salute San Raffaele University and San
Raffaele Scientific Institute, Milan, Italy
Introduction: We assessed the value of conventional and
magnetization transfer (MT) MRI quantities of normal-
appearing white matter (NAWM) and grey matter (GM)
damage and their 12-month changes in predicting the
accumulation of disability and cognitive impairment in MS.
Methods: Brain conventional and MT MRI scans were
obtained at baseline and after 12 months in 73 patients,
followed clinically for 13 years. At 13-year follow-up,
neuropsychological assessment was also performed
whenever possible. At baseline and 12 months,
T2-hyperintense and T1-hypointense lesion volume, GM,
WM, and thalamic fraction, average lesion MT ratio (MTR),
average GM MTR, average NAWM MTR and thalamic
MTR were measured. A multivariate analysis, adjusted for
follow-up duration, was performed to identify the predictors
of long-term neurological deterioration and cognitive
impairment.
Results: At 13-year follow-up, EDSS rating was performed
in 67 patients and neuropsychological evaluation was done
in 31 of them. 42 patients (63%) showed a disability
worsening (death=7 patients) and 30% were cognitively
impaired. The multivariate model included baseline GM
MTR (p=0.01, OR=0.97), GM MTR percentage change
after 12 months (p=0.005, OR=1.22), and percentage
reduction of GMF after 12 months (p=0.1, OR=0.91) as
independent predictors of disability worsening at 13 years
(r2=0.22, C-index=77%). Baseline GM MTR (p=0.06,
OR=0.83) and disease duration (p=0.04, OR=1.97) were
associated to cognitive impairment (p=0.06, OR=0.83,
r2=0.86, C-index=99%).
Conclusions: GM damage is one of the key factors
associated with long-term accumulation of disability and
cognitive impairment in MS.
This study was partially supported by a grant from
Fondazione Italiana Sclerosi Multipla (FISM2010/R/18)
P1665
Circadian rhythm genes and multiple
sclerosis (MS)
P. Lavtar1, G. Rudolf1, A. Maver1, L. Lovrei1, S. Risti2,
N. Starevi izmarevi2, M. Kapovi2, J. Sepi3,
A. Stankovi4, M. ivkovi4, E. Dini5, R. Raievi5,
S. ega Jazbec6, Z. Klemenc Keti7, K. Peterlin Potisk8,
B. Peterlin1
1Institute of Medical Genetics, Division of Obstetrics and
Gynaecology, University Medical Center Ljubljana,
Slovenia, 2Department of Biology and Medical Genetics,
3Postgraduate School, School of Medicine, University of
Rijeka, Croatia, 4Laboratory of Radiobiology and Molecular
Genetics, Institute of Nuclear Sciences Vina, 5Department
of Neurology, Military Medical Academy, Belgrade, Serbia,
6Department of Neurology, University Medical Center
Ljubljana, 7Department of Family Medicine, Medical School,
University of Ljubljana, 8University Rehabilitation Institute,
Ljubljana, Slovenia
Background: Multiple sclerosis is a chronic inflammatory
demyelinating disease of the central nervous system (CNS).
Evidence from epidemiological studies indicates that
prevalence of MS varies with geographic latitude, increasing
with distance from the equator on both hemispheres. The
circadian clock has a bidirectional relationship with diverse
physiological processes, including metabolism, CNS
functions, and immune responses. Therefore we
hypothesized that differences in epidemiology of MS
related to geographical latitude might be associated with
chronobiology. Thus, gene variability in circadian rhythms,
genes might be a risk factor for multiple sclerosis.
Methods: A total of 900 (82 familial cases) Caucasian
patients and 1024 healthy unrelated ethnically matched
controls without family history of MS, were included in the
study. Diagnosis of MS was established according to
McDonalds criteria. Altogether, 8 SNP were included in
our study, 4 in CLOCK gene: rs6811520, rs6850524,
rs11932595 and rs13124436; and 4 in ARNTL gene:
3789327, rs1481892, rs4757144 and rs12363415.
Results: Significant difference in genotype distribution in
ARNTL rs3789327 was observed in MS patients when
compared to controls (p0.000001).The same statistical
significance was reached when relapsing-remitting MS and
patients with the non-familial form of MS were separately
compared to controls. Also, in CLOCK gene rs6811520
statistically significant difference in genotype distribution
(p0.005) was found in all MS patients and non-familial
form of MS when compared with controls.
Conclusion: We provide evidence for association between
genetic variation in circadian rhythms genes and MS.
Further studies are required to substantiate the significance
of these genetic variations.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1666
Treatment of bladder dysfunctions with
sacral nerve modulation in a series of
multiple sclerosis patients
C. Zuliani1, E. Ostardo2, L. Limido3, M. Pastorello4,
E. Andretta5
1Neurology, General Hospital, Mirano, 2Urology, General
Hospital Santa Maria degli Angeli, Pordenone, 3Medtronic,
Milan, 4Urology, Sacro Cuore Hospital, Negrar, 5Urology,
General Hospital, Dolo, Italy
Introduction: Sacral nerve modulation (SNM) has been
recently used in neurogenic bladder dysfunction
unresponsive to conventional treatments; aim of our study
was to evaluate the effectiveness and safety of this treatment
in MS patients.
Methods: 17 subjects who fulfilled inclusion criteria, 13
females and 4 males (10 RR, 2 SP and 5 PP), mean age
49.810.9 years, mean MS duration 13.59.2 years, mean
EDSS score 5.81.8, underwent surgical unilateral
implantation of the InterStim System (Medtronic Inc.), with
electrical parameters individually programmed.
Demographic and MS related data were collected and each
patient filled out a questionnaire about the perceived
changes in micturition symptoms and the improvement in
QoL. The indications for SNM were voiding (24%), storage
(41%) and mixed (35%) symptoms. The mean follow-up
was 5226 months.
Results: 100% of patients with storage, 75% with voiding
and 40% with mixed symptoms reported subjective
improvements. Statistically significant changes were: in
storage and mixed symptoms a reduction in subjective
urgency level (p=0.016), in the number of micturitions/die
(p=0.012) and pads/die (p=0.033); in voiding and mixed
symptoms a reduction in number of catheterisations/die
(p=0.017), residual volumes (p=0.018) and increase in
voided volumes (p=0.016).
Conclusion: Our study indicates that SNM could be a
therapeutic option in very selected MS patients with storage
and voiding symptoms refractory to conservative treatments,
while it should be avoided in mixed symptoms. Finally
long-term efficacy of such treatment needs further research,
because MS is typically progressive and hence may have a
variable response over time.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 347
P1667
MRI findings in Ehlers Danlos syndrome
misdiagnosed as multiple sclerosis
R. Peres1, C. Hamonet2, D. Fredy3, D. Ducreux4, F. Pico1
1Neurology Department and Stroke Center, Mignot Hospital,
Versailles, 2Rehabilitation Medicine Department, Hotel-Dieu
Hospital, 3Neuroradiology Department, Sainte-Anne
Hospital, 4Neuroradiology Department, Bictre Hospital,
Paris, France
We report a case of a 38-year-old woman who presented a
complex neurological story first labelled as a primary
progressive multiple sclerosis (MS). The major event in her
medical history was a severe traumatic brain injury.
Thereafter, she reported various symptoms: a left
hemiparesis with progressive worsening over 5 years, an
episode of transient tetraplegia, sphincter dysfunctions,
vertigos, transient visual disturbance and chronic
widespread pain. Neurological examination revealed a
tetra-pyramidal syndrome and ataxia. Evoked potentials
objectified motor weakness in the left hemicorpus. Cerebral
MRI was normal but cervical spine MRI showed several
hyperintense lesions on T2 weighted sequences. Magnetic
resonance diffusion tension imaging with fibre tracking
revealed an interruption in both cervical corticospinal tracts
with no activity pattern. Methylprednisolone infusions were
inefficient. After several years of wandering diagnosis, this
case revealed to be a hypermobile Ehlers Danlos Syndrome
(EDS type III). With the appropriate symptomatic therapy,
the patient obtained a better quality of life. The clinical
presentation of EDS including pseudo paralysis due to
proprioceptive dysfunction may contribute to erroneous MS
diagnosis. This case underlines the importance to consider
an EDS when faced with an atypical MS, especially when
polyalgias are present, in order to guide patients towards
adequate treatment. In addition, the central nervous system
lesions revealed by MRI in this case are consistent with
MRI findings in other EDS cases (lesions in the corticospinal
tracts, the corpus callosum, the arcuate fasciculus...) which
suggests these lesions could be considered typical of EDS.
348 Posters, Sunday 9 September
P1668
Cerebrospinal fluid biomarkers of amyloid
-metabolism in multiple sclerosis
M. Axelsson1, K. Augutis2, E. Portelius3, G. Brinkmalm3,
U. Andreasson3, M. Gustavsson3, C. Malmestrm3,
J. Lycke3, K. Blennow3, H. Zetterberg3, N. Mattsson3
1Department of Neurosciences, Sahlgrenska Academy,
Institute of Neuroscience and Physiology, Gothenburg,
2Institute of Neuroscience and Physiology, Department of
Psychiatry and Neurochemistry, The Sahlgrenska Academy
at University of Gothenburg, Mlndal, 3Sahlgrenska
University Hospital, Gothenburg, Sweden
Background: Amyloid precursor protein (APP) and
amyloid (A) peptides are intensely studied in
neuroscience, and cerebrospinal fluid (CSF) measurements
may be used to track metabolic pathways of APP in vivo.
Reduced CSF levels of A and the soluble fragments
-sAPP and -sAPP have been reported in inflammatory
diseases, including multiple sclerosis (MS). However, the
precise pathways of APP degradation in MS are unclear, and
it is not known if they may be affected by treatment.
Objective: To characterize CSF biomarkers for APP
catabolism in MS, including the effects of disease modifying
treatment.
Methods: CSF samples from 90 MS patients and 28 healthy
controls were analyzed for -sAPP, -sAPP, AX-38/40/42
and A1-42 by immunoassays. A subset of samples was
analyzed for A isoforms by immunoprecipitation and
matrix-assisted laser desorption-ionization time-of-flight
mass spectrometry (IP-MS). CSF from relapsing remitting
(RRMS) (N=29) and progressive patients (N=12), treated
with natalizumab or mitoxantrone, respectively, were
analyzed at baseline and at follow-up after one to two years
of treatment.
Results: CSF -sAPP, -sAPP and A peptide levels were
reduced in patients compared to controls, but increased
towards normal levels after natalizumab treatment. A
multivariate model of IP-MS measured A isoforms
separated progressive patients from controls, with RRMS
patients having intermediate levels.
Conclusions: For the first time, we show that
immunomodulation by natalizumab therapy may counter-
act the altered metabolism of APP in MS. When analyzed
by mass spectrometry, the CSF A isoform distribution was
distinct in progressive patients as compared to controls with
RRMS patients showing less clear alterations.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1669
Evaluation of fampridine response by
multivariate analysis of mobility in
multiple sclerosis
T. Schulthei, S. Sobek, R. Kempcke, T. Ziemssen
Department of Neurology, Technical University Dresden,
Germany
Introduction: Walking impairment can often be found in
MS. Mobility problems are associated with negative effects
on daily and occupational life. Fampridine is approved to
improve walking in MS patients with walking disability.
The present study aimed to investigate fampridine response
on walking impairment in a setting of multivariate analysis.
Methods: 117 patients (82 women, 35 men) of the MS
centre Dresden were examined. Initial investigation (V0)
was followed by fampridine therapy for 14 days and a
second investigation (V1) for analysis of treatment effects
afterwards. Quantitative (T25FW, 2-MWT, MSWS-12,
FAP-Score of GAITRite system) and qualitative gait
parameters (SCGI) were assessed.
Results: 87 patients (74.4%) were classified as responders,
30 patients (25.6%) as non-responders. At V0 no significant
differences in all gait parameters could be found between
responders and non-responders. At V1, after two weeks on
fampridine, responders and non-responders improved non-
significantly in T25FW (10.5 vs. 15.4 sec) and 2-MWT
(108.6 vs. 90.3 meters). Responders had a marked
improvement on FAP score (V0 78.6 vs. V1 81.8; p<0.001).
MSWS-12 (54.4 vs. 73.9) and SCGI (1.21 vs. -0.14)
differed significantly between both groups (p<0.001).
Conclusion: Our results confirm positive short-term effects
of fampridine on various gait variables in a multidimensional
setting. Responders improved in all parameters compared to
non-responders. Statistical significance could be
demonstrated in two out of six outcome parameters
(MSWS-12 and SCGI).
Overall, using multivariate gait analysis revealed a high rate
of treatment responders (74.4%). Multidimensional
operationalization of mobility may help identifying a larger
proportion of fampridine responders.

P1670
Improving the sensitivity of the criteria for
the diagnosis of primary progressive
multiple sclerosis
S.B. Kelly, K. Kinsella, M. Duggan, N. Tubridy,
C. McGuigan, M. Hutchinson
Neurology, St. Vincents University Hospital, Dublin, Ireland
Background and aims: The 2010 McDonald revisions to
the diagnosis of primary progressive MS (PPMS) have
amended the criteria for dissemination in space (DIS) in the
brain and spinal cord. Either may be replaced by the
presence of CSF oligoclonal bands (CSFOBs). The aim of
this study was to evaluate the importance of CSFOBs and
to analyse the sensitivity of the diagnostic criteria for
PPMS.
Patients and methods: Retrospective review of all patients
with a diagnosis of PPMS from 1990-2010. Age and mode
of presentation, results of brain and spinal cord MRI and
CSF were documented. The sensitivities of these
investigations and of Thompsons and the McDonald
Criteria (2001, 2005, 2010) was determined.
Results: Of 95 PPMS patients with a mean age at onset of
41 years, 90% presented with progressive spastic paraparesis
or brainstem syndromes. The sensitivity of Thompsons and
2001 McDonald criteria was 64%; 74% for the 2005, 81%
for the 2010 McDonald criteria. The sensitivity was higher
for CSF and brain 16/49 than for CSF and cord 3/49 (33%
vs. 6%). When criteria requiring two of: 1 MRI brain
lesion in two areas typical for demyelination, 1 T2 spinal
lesion or CSFOBs was applied to our cohort, sensitivity
increased to 84%.
Conclusion: Altering the diagnostic criteria for PPMS so
that two of: MRI brain with 1 lesion in two areas typical
for demyelination, 1 spinal cord plaque or CSFOBs would
increase the sensitivity of the criteria for the diagnosis of
this disease.
P1671
Inbreeding of MS in the general Faroese
population
P. Joensen
National Hospital Faroe Island, Torshavn, Faeroe Islands
To estimate the inbreeding in all native Faroese diagnosed
with MS when they were residing on the islands, all patients
diagnosed with MS in the period 1943-2007 are included in
the study, after exclusion of patients of foreign origin, the
inbreed coefficients of 58 patients were estimated and for
these patients an average inbreeding coefficient of 0.0067
was revealed. For 10 control persons without any
neurological disease an average inbreed coefficient of
0.0081 was estimated. Therefore the results point to, that
the inbreeding seems not to be more common between MS
patients than in the general population, however the small
control group must be taken into account.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 349
P1672
CSF cytology in clinically isolated
syndrome may predict progression to
multiple sclerosis
Y. Motuzova1, F. Marnetto2, L. Granieri2, P. Valentino2,
A. Sala2, G. Amadore3, A. Bertolotto2
1Department of Neurology and Neurosurgery, Belorussian
State Medical University, Minsk, Belarus, 2Neurologia 2 -
Centro Riferimento Regionale Sclerosi Multipla, 3S.C.D.U.
di Radiodiagnostica, Azienda Sanitaria Ospedaliera San
Luigi, Orbassano, Italy
Introduction: The usefulness of lumbar puncture (LP) at
the time of clinically isolated syndrome (CIS) is matter of
the debate. Besides, the prognostic role of white blood cell
(WBC) count in cerebrospinal fluid (CSF) is not deeply
studied. We assessed the value of WBC count and Ig
oligoclonal bands (IgOB) in CSF of patients with CIS for
predicting conversion to clinically definite multiple
sclerosis (CDMS).
Methods: 58 patients with CIS who underwent LP between
January 2006 and January 2010 were screened. CSF
analysis included WBC count and IgOB. The diagnosis of
CIS and CDMS was made according to the McDonald
criteria 2010.
Results: During a median follow-up of 26 months, 41
(70.7%) patients converted to CDMS. CSF analysis revealed
more than 4 WBC/mm3 in 28 (48.3%) patients and CSF
IgOB in 42 (72.4%) patients. Median WBC count in patients
with CIS who developed CDMS was 5 (range, 0-45) WBC/
mm3, and in patients who did not have CDMS at the end of
follow-up was 2 (range, 1-12) WBC/mm3 (p=0.0034).
All CIS patients (n=24) with both WBC>5/mm3 and IgOB
positive developed CDMS after a median period of 9.4
months (range, 3.4-17.4) after CIS. In the group of patients
who had WBC<5/mm3 and IgOB negative (n=12) only 2
patients developed CDMS. Only 3/28 patients with
WBC>5/mm3 and 4/42 patients with positive IgOB
remained CIS patients during the follow-up period.
Conclusion: LP with assessment of WBC and IgOB at the
time of CIS may play an important role in predicting
CDMS.
350 Posters, Sunday 9 September
P1673
Visual habituation deficit in patients with
multiple sclerosis (final results)
L.S. Bir, E. Degirmenci, C. Erdogan
Neurology, Pamukkale University, Denizli, Turkey
Introduction: Visual habituation studies were performed
on neurological conditions like migraine, familial
hemiplegic migraine and photosensitive epilepsy but as far
as we know there is no study in multiple sclerosis. In this
study we aimed to investigate the habituation of pattern-
reversal visual evoked potentials (PR-VEP) in patients with
relapsing remitting multiple sclerosis (RRMS).
Methods: Ten blocks of 1024 responses were analyzed in
terms of peak latencies and peak-to-peak amplitudes of the
maximal negative and positive deflections determined by
visual inspection and habituation was analyzed as the
percentage of amplitude change between the 1st and 2nd to
10th blocks. Eyes of patients without any history of optic
neuritis and with P100 latency longer than 110ms were
classified as group 1 and the eyes of patients with history of
optic neuritis and P100 latency longer than 110ms were
classified as group 2. A third group consisted of healthy
control eyes.
Results: PR-VEP amplitudes showed a significant clear-cut
habituation after the first block in the control group but
patient groups did not show any significant decrease in the
PR-VEP amplitudes of all blocks.
Conclusion: Our electrophysiological study has confirmed
the lack of habituation in RRMS patients even if there is no
optic neuritis history before. This result would be important
for the evaluation of visual system involvement of patients
in whom standard VEP examinations are within normal
limits.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1674
Fibrinogen depleting agent batroxobin
has a beneficial effect on experimental
auto-immune encephalomyelitis
Y. Yang, S.-J. Tian, L.-F. Chen, L. Wu, D.-H. Huang,
W.-P. Wu
General Hospital of Chinese PLA, Beijing, China
Objective: Multiple sclerosis (MS) was characterized with
widespread demyelination and axonal loss. Fibrinogen
(fibrin) deposition was considered as one of the pathogenesis
of MS. In the present study, we explored the capacity of
prophylactic and therapeutic potential of fibrin depletion by
batroxobin to affect the inflammatory demyelination
process in experimental auto-immune encephalomyelitis
(EAE) mice model.
Methods: In MOG-induced EAE, batroxobin was
separately injected after immunization immediately
(prevention) and after the appearance of clinical
manifestations (suppression). At the time of
postimmunization (p.i.) day 30, 40, 60, spinal cords and
cerebellum tissue samples from EAE mice were collected
for histopathological and immunohistochemical methods.
Molecular biological methods such as Western-blot and
Real-time PCR were supplied to detect MBP, p-Akt, MHC-I
and t-PA.
Results: We observed that treatment with batroxobin
significantly ameliorated clinical severity of EAE, reduced
inflammatory cell infiltration, demyelination, axonal
damage and suppressed the activation of astrocytes and
macrophages/microglia comprising the CD11b+ population.
The expression of p-Akt appeared to reduce, while that of
MBP seemed to increase in batroxobin-treated mice as
compared to control mice. In addition, our results showed
that in vitro batroxobin reversed the dentric-like formation
of macrophages irritated by fibrinogen under inflammatory
conditions.
Conclusion: Therefore, strategy targeting fibrin as a
potential therapy for EAE may be beneficial for the
treatment of MS patients.

P1675
The influence of host genetics on Epstein-
Barr virus specific antibody levels in
multiple sclerosis patients and controls
E. Sundqvist1, P. Sundstrm2, I. Lima Bomfim1,
J. Hillert1, L. Alfredsson3, I. Kockum1, T. Olsson1
1Dept. Clinical Neuroscience, Karolinska Institutet,
Stockholm, 2Ume University Hospital, Ume, 3Institute for
Environmental Medicine, Karolinska Institutet, Stockholm,
Sweden
Introduction: We have previously analysed the association
of IgG antibodies against Epstein-Barr Nuclear Antigen 1
(EBNA1) and EBNA1 385-420 amino acid epitope with
multiple sclerosis (MS). The aim of this study was to
analyse the influence of HLA-A and HLA-DRB1 genotype
on EBNA1 IgG and EBNA1:385-420 IgG titres in incident
MS cases, and matched population based controls, recruited
throughout Sweden.
Methods: Anti-EBNA1 IgG and EBNA1: 385-420 IgG
antibodies were measured in serum, and dichotomised
based on the median among the controls. The influence of
HLA-alleles was analysed using logistic regression on 987
controls and 911 MS cases. Alleles with an allele frequency
of over 10% in EBNA IgG low individuals were grouped
into HLA-A*X and DRB1*X, respectively. A stepwise
selection was applied, adjusting for age at sampling, sex and
area of residence, and for EBNA1: 385-420 IgG for a batch-
effect in ELISA measurements.
Results: Among MS cases, DRB1*15 was associated to
EBNA IgG titres, OR 1.29 (1.0-1.6 95%CI) p=0.02. A*03
(OR 1.5, 1.1-2.1, p=0.01), A*24 (OR 1.7, 1.0-2.8, p=0.04),
and DRB1*04 (OR 0.6, 0.4-0.8, p=0.001) were associated
to EBNA1: 385-420 IgG titres. Among controls, DRB1*03
(OR 0.7, 0.6-1.0, p=0.03) and DRB1*04 (OR 0.7, 0.6-0.9,
p=0.003) were associated to EBNA1: 385-420 IgG titres.
We observed no association to EBNA1 IgG titres among the
controls.
Conclusions: We have shown that there is a genetic
influence on EBNA1 IgG and EBNA1:385-420 IgG titres.
There are also differences between MS cases and controls,
supporting a role for EBV in MS pathogenesis.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 351
P1676
Short-term evolution of spinal cord
damage in multiple sclerosis: a diffusion
tensor imaging study
M. Thaudin1,2, G. Saliou3, K. Deiva4, C. Denier1,
D. Adams1, D. Ducreux2,3
1Neurologie, CHU Bictre, 2UMR 788, Facult de Mdecine
Paris Sud, 3Neuroradiologie, 4Neurologie Pdiatrique, CHU
Bictre, Le Kremlin-Bictre, France
Introduction: The potential of DTI to detect spinal cord
abnormalities in patients with multiple sclerosis has already
been demonstrated.
Objectives: The objective of this study was to apply DTI
techniques to multiple sclerosis patients with a recently
diagnosed spinal cord lesion, in order to demonstrate a
correlation between variations of DTI parameters and
clinical outcome, and to try to identify DTI parameters
predictive of outcome.
Methods: A prospective single-centre study of patients with
spinal cord relapse treated by intravenous steroid therapy.
Patients were assessed clinically and by conventional MRI
with DTI sequences at baseline and at 3 months.
Results: 16 patients were recruited. At 3 months, 12 patients
had clinically improved. All but one patient had lower FA
values than normal subjects in either inflammatory lesions
or Normal-Appearing Spinal Cord and either at baseline or
at follow-up. Patients who improved at 3 months presented
a significant reduction in the mean ADC (p=0.002) and a
significant increase in FA values (p=0.02) in Normal-
Appearing Spinal Cord during the follow-up period.
Patients in whom the ASIA sensory score improved at 3
months showed a significantly higher FA in inflammatory
lesion at baseline (p=0.009) compared to patients with no
improvement.
Conclusion: DTI MRI detects more extensive abnormalities
than conventional T2 MRI. These abnormalities are
correlated with functional clinical outcome, especially those
observed in normal-appearing spinal cord. A less marked
decrease in FA value inside the inflammatory lesion was
associated with better outcome.
352 Posters, Sunday 9 September
P1677
Association of promoter resistin gene
polymorphism with multiple sclerosis: a
possible link to the inflammatory profile
and the age of onset
S. Emamgholipour1, A. Hossein-Nezhad2, M.A. Sahraian3
1Department of Clinical Biochemistry, Tehran University of
Medical Sciences, Faculty of Medicine Tehran, 2Tehran
University of Medical Sciences, 3Department of Neurology,
Sina MS Research Center, Sina Hospital, Tehran University
of Medical Sciences, Tehran, Iran
Introduction: The adipocytokines might participate in the
regulation of immunity and inflammation. Considering that
immune and inflammatory mechanisms have been
implicated in the pathogenesis of multiple sclerosis (MS),
resistin as an adipocytokine may provide important insights
into underlying mechanisms of the disease. Moreover,
polymorphism in the resistin promoter region, is associated
with alteration of serum resistin. This study investigates the
association between the polymorphism of RETN-420 C/G
(rs1862513) and MS susceptibility, disease behaviour and
levels of inflammatory mediators (including CRP, IL-1
and TNF-) in an Iranian population.
Patients and methods: We included a total of 282
participants, 132 of them suffering from three different
types of MS, namely relapsing remitting-MS (RR-MS)
secondary progressive-MS (SP-MS) and primary
progressive MS (PP MS). The RETN-420C/G polymorphism
and the serum levels of inflammatory mediators IL-1,
TNF, and CRP were measured.
Results: The C-allele frequency was higher among the MS
patients compared with controls, although this difference
was not significant. Also, MS patients with C/C genotype
had the lowest age of onset and the highest level of
inflammatory mediators. In addition, an increase in severity
of MS was observed in patients with C-allele, after
clustering patients with PP-MS and SP-MS as a single
group.
Conclusion: These data suggest that C-allele of RETN
rs1862513 may represent a genetic risk factor for MS in the
Iranian population. Further studies are needed to elucidate
the underlying mechanisms.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1678
Impact of OCB status and HLA-DRB1 risk
alleles on lesion load in MS patients at
age 40
V. Karrenbauer1, R. Prejs2, T. Masterman1, J. Hillert1,
A. Glaser1, K. Imrell1
Clinical Neuroscience, Karolinska Institutet, Stockholm,
1
Department of Radiology, Karolinska University Hospital,
2
Huddinge, Sweden
Approximately 95% of Nordic MS patients harbour
oligoclonal IgG bands (OCB) in the cerebrospinal fluid.
OCB-positive and OCB-negative patients have been
reported to be similar with regard to clinical characteristics
but immunogenetically different.
Objective: To address the question if being positive for
OCB, carrying HLA-DRB1*15 or carrying HLA-DRB1*04
have an impact on the risk of belonging to higher lesion
load groups in different neuro-anatomical compartments, at
a stage of disease where hypothetical entities may have
reached maximal phenotypically diversity. From a cohort of
2094 MS patients we were able to retrieve 40 OCB-negative
well characterized patients and a corresponding set of 60
OCB-positive patients, who had undergone similar magnetic
resonance (MR) examinations close to their 40th birthday.
Lesion load in different brain compartments was manually
calculated by a radioneurologist (co-author RP). Patients
were assigned to one of four or five categories regarding
juxtacortical, infratentorial and periventricular lesion load,
total amount of T2 lesions and total amount of T1 lesions.
Proportional ordinal logistic regression was used for
evaluating associations.
Results: Being positive for OCB, carrying HLA-DRB1*15
or carrying HLA-DRB1*04 did not significantly increase
the risk of belonging to higher lesion load groups. However,
a trend was seen for OCB positive patients experiencing a
double risk of belonging to infratentorial higher lesion load
categories (2.03 (0.91-4.57), uncorrected p-value 0.09).
Conclusion: In clinically active patients there seem to be
similar risks of belonging to higher lesion load categories
whether or not patients have OCBs, carry HLA-DRB1*15
or HLA-DRB1*04.

P1679
Overweight as a risk factor for multiple
sclerosis
K. Wesnes1,2, T. Riise2, M. Pugliatti3, K.-M. Myhr4
Dept. of Neurology, St Olavs Hospital, Trondheim,
1
University of Bergen, Norway, 3Institute of Clinical
2 1Division of Clinical Geriatrics, Department of
Neurology, University of Sassari, Italy, 4Neurology and the
National MS Competence Center, Haukeland University
Hospital, Bergen, Norway
Introduction: It is generally accepted that environmental
factors contribute to the risk of multiple sclerosis (MS).
Some recent studies have shown that increased body size at
age 18-20 gives a twofold risk of MS. We wanted to study
this association in a large case-control study analyzing body
size at different ages.
Methods: A population based sample of 959 cases (673
women and 286 men) and 1718 controls (1256 women and
462 men) in Norway reported their body size using body-
silhouettes from 1-9 where 9 was the largest at age 5, 10, 15,
20, 25, 30 and current age. We analyzed women and men
separately and compared the groups using T-tests and
logistic regression using body size 3 as a reference and
adjusting for smoking and education.
Results: Cases reported larger mean body size than the
controls at all ages except at current age where the opposite
trend was found. Among men we found an odds ratio (OR)
1.44 (95% CI 0.65-3.18, p-trend 0.001) for large body size
(6-9) at age 20 and OR 2.01 (95% CI 1.04-3.90, p-trend
0.005) at age 25. Among women we also found increasing
OR for increasing body size up to body size 5 where the OR
was 1.43 (95% CI 1.00-2.05, p-trend 0.02) at age 20 and OR
1.31 (95% CI 0.93-1.84, p-trend 0.01) at age 25.
Conclusion: Our data confirm that overweight in young
adults is a risk factor for MS, especially among men.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 353
P1680
Callosal atrophy in multiple sclerosis is
related to cognitive speed
G. Bergendal1, J. Martola2, L. Stawiarz3,4,
M. Kristoffersen-Wiberg2, S. Fredrikson3, O. Almkvist5,6
Neurobiology, Care Sciences and Society, Karolinska
Institutet, 2Department of Clinical Science, Intervention and
Technology at Karolinska Institutet, Division of Medical
Imaging and Technology, 3Division of Neurology,
Department of Clinical Neuroscience, Karolinska Institutet,
4SMILE Image Lab, Karolinska University Hospital-
Huddinge, Karolinska University Hospital, 5Division of
Alzheimer Neurobiology Center, Department of
Neurobiology, Care Sciences and Society, Karolinska
Institutet, 6Department of Psychology, Stockholm University,
Stockholm, Sweden
Introduction: Long-term changes regarding corpus
callosum area (CCA) and information processing speed in
cognitive and sensory-motor tasks have rarely been studied
in multiple sclerosis (MS).
Objective and methods: Information processing speed in
cognitive (Symbol Digit Modalities Test, SDMT), sensory
(Visual and Auditory Reaction Time) and motor (Finger-
Tapping speed, FT; right and left hand) tasks as well as
auditory inter-hemispheric transfer (verbal dichotic
listening, VDL) were related to CCA, measured by MRI at
baseline and at follow-up after nine years in 22 MS patients.
Possible confounding by demographic (age, gender and
education), clinical (symptom onset, duration, severity of
disease) and relative brain volume (RBV) as well as lesion
load, was taken into account.
Results: The smaller the CCA at baseline, the slower was
SDMT performance at baseline. In a similar way, CCA at
follow-up was associated with poor SDMT result at follow-
up. Furthermore, the higher the annual rate of change in
CCA the poorer was the performance in VDL on the left ear
and the more pronounced was the right ear advantage. A
positive relationship between performance in VDL right ear
and annual rate of change in RBV was also seen. Sensori-
motor tests were not significantly associated with CCA.
Lesion load at baseline was associated with FT performance
at baseline. Demographic, clinical and radiological (RBV
and lesion load) characteristics did not confound the
significant relation between CCA and SDMT.
Conclusions: CCA unlike RBV and lesion load was
associated with SDMT, which indicated a marked cognitive
rather than perceptual-motor component.
354 Posters, Sunday 9 September
P1681
Impact of fampridine on fatigue,
depression and cognition in multiple
sclerosis
S. Sobek, R. Kempcke, T. Ziemssen, T. Schulthei
Department of Neurology, Technical University Dresden,
Germany
Introduction: Fatigue and depression are independent
predictors of life quality in MS. Fatigue is a main reason for
invalidity and early retirement. Cognitive dysfunctions
cause substantial occupational and social problems in
patients with MS. The present study aimed to investigate
the influence of fampridine on fatigue, depression and
cognition in patients with MS.
Methods: 117 patients (82 women, 35 mean, median age
50.1 years) of the MS centre Dresden were examined. The
initial investigation (V0) was followed by taking fampridine
for 14 days with a second investigation (V1) for analysis of
treatment effects afterwards. Qualitative parameters for
fatigue, depression and cognition (Weimus, ADS-L,
PASAT) were collected.
Results: 87 patients (74.4%) were classified as responders,
30 patients (25.6%) as non-responders. At V0, non-
responders showed significantly higher values for physical
(p=0.009*), cognitive (p=0.048*) and total fatigue
(p=0.012*). No significant differences were evident for
ADS-L (p=0.101) and PASAT (p=0.378) at V0.
At V1, differences between responder and non-responder
groups concerning physical (p<0.001*), cognitive
(p<0.001*) and total fatigue (p<0.001*) had increased.
Depression also differed significantly between both groups
(p<0.001*), whereas no differences for PASAT (p=0.935)
emerged. Analysis of variance revealed significantly
different changes between groups over time concerning all
fatigue dimensions (p<0.001*, respectively) and depression
(p=0.001*).
Conclusion: Responders and non-responders of fampridine
therapy do not just differ regarding motor-related outcomes.
Responders additionally benefit concerning cognitive and
physical fatigue as well as depression, while non-responders
show no change in these dimensions. Cognitive function
does not seem to be influenced by fampridine.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1682
The social and economic costs of a
multiple sclerosis relapse
S. Kelly, M. Duggan, L. Buckley, K. Kinsella,
C. McGuigan, M. Hutchinson, N. Tubridy
Neurology, St. Vincents University Hospital, Dublin, Ireland
Introduction: Disease modifying therapies (DMTs)
modestly reduce relapse rates in relapsing MS at a mean
annual drug cost of 15,000. There are few data on the cost
of MS relapses.
Aim: We identified the costs and socio-economic impact
associated with mild, moderate and severe relapses.
Methods: Patients with an MS relapse from March 2011
until January 2012 completed a questionnaire detailing
length of time and earnings lost from work and other
indirect expenses. The overall direct medical costs of mild
(no treatment or oral prednisolone), moderate (outpatient
intravenous methylprednisolone) and severe (requiring
hospitalisation) relapses were calculated.
Results: Of 40 relapses in 34 patients (21 women), 4 were
mild, 27 moderate, and 9 severe. 16 (46%) were receiving
DMTs. Mean expanded disability status score was 2.8 and
increased to 3.3 during the relapse. Only 21/34 (62%) were
working prior to relapse. The median total direct costs were
5,807. The median direct and indirect cost of a mild relapse
was 760, for a moderate relapse the median cost was
1,890 and for a severe relapse, the median length of
hospital stay was 11 days at a median cost of 4,768 (mean
8,000; range 3,000 24,000). All but one patient
returned to work after a median of 9 days after the relapse.
This individual required an invalidity pension. The median
loss of earnings for those returning to work was 4,343.
Conclusion: MS relapses result in substantial direct and
socio-economic costs but a significant proportion of patients
are not working prior to having a relapse.

P1683
Clinical efficiency of high-dosage
immuno-ablative therapy with autologous
stem cell transplantation in multiple
sclerosis
A. Kartashov1, A. Kuznetsov1, D. Fedorenko2,
V. Melnichenko2, A. Novik2
1Neurology, 2Hematology, National Pirogov Center of
Therapy and Surgery, Moscow, Russia
A high-dosage immunoablative therapy with autologous
stem cell transplantation (HDIT+ASCT) is worldwide
applied as one of the new methods of treatment of a multiple
sclerosis.
Purpose: To examine the clinical efficiency of HDIT+ASCT
in patients suffering from multiple sclerosis.
Methods: 154 patients (75 (49%) men and 9 (51%) women)
have been surveyed. Average age is 313.85 years. 72
(46.8%) of patients had relapsing-remitting multiple
sclerosis, 47 (30.5%) secondary progressive, 27 (14.7%)
primary progressive and 8 (5.1%) progressive-relapsing.
Average duration of disease was 8.544.76 years. Degree of
neurologic deficiency was EDSS 3.721.8 on EDSS scale,
80.2413.5 on SCRIPPS scale. The estimation of
HDIT+ASCT efficiency was carried out on the basis of an
EDSS, SCRIPPS scales, brain RI and indicators of
immunoregulatory index prior to the beginning of
HDIT+ASCT, in 3, 6 and 12 months after HDIT+ASCT.
Results: After the HDIT+ASCT in the neurologic status
revealed positive dynamics in 35 (22.7%) patients. Clinical
stabilization is revealed in 115 (74.6%) patients. Clinical
deterioration is revealed in 4 (2.59%) patients. It is
established that positive RI dynamics is revealed in
51.6% relapsing-remitting multiple sclerosis and in 38.2%
progressive multiple sclerosis (reduction of quantity and
activity of demyelinisation focuses). Indicators of
immunoregulatory index in early terms after HDIT+ASCT
are 0.830.72, in late terms 1.460.72.
Conclusion: Positive dynamics under the HDIT+ASCT by
data of EDSS, SCRIPPS scales, brain I and the indicators
of immunoregulatory index testifies an effective treatment
for multiple sclerosis.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 355
P1684
Effect of BG-12 in subgroups of patients
with relapsing-remitting multiple
sclerosis: findings from the CONFIRM
(comparator and an oral fumarate in
relapsing-remitting multiple sclerosis)
study
M. Hutchinson1, R.J. Fox2, D. Miller3, J.T. Phillips4,
M. Kita5, E. Havrdova6, J. OGorman7, M. Yang7,
M. Novas7, V. Viglietta7, K.T. Dawson7
1St Vincents University Hospital, Dublin, Ireland, 2Mellen
Center for Multiple Sclerosis Treatment and Research,
Cleveland Clinic, Cleveland, OH, USA, 3University College
Londons Institute of Neurology, NMR Research Unit,
London, UK, 4Multiple Sclerosis Program, Baylor Institute
for Immunology Research, Dallas, TX, 5Virginia Mason
Medical Center, Seattle, WA, USA, 6Department of
Neurology, First Faculty of Medicine, Charles University in
Prague, Prague, Czech Republic, 7Biogen Idec Inc, Weston,
MA, USA
Introduction: In the Phase 3 CONFIRM study, BG-12
(dimethyl fumarate) significantly reduced relapses and MRI
activity over 2 years, versus placebo. Here we report on the
efficacy of BG-12 in subgroups of relapsing-remitting MS
(RRMS) patients from CONFIRM.
Methods: Patients were randomized 1:1:1:1 to oral BG-12
240mg BID or TID, placebo, or subcutaneous glatiramer
acetate (GA) 20mg/day (active reference comparator). The
primary endpoint was annualized relapse rate (ARR) at 2
years. The efficacy of BG-12 was evaluated in pre-specified
subgroups stratified by baseline demographic and disease
characteristics, including age, relapse history, prior MS
treatment, and Expanded Disability Status Scale score,
among others.
Results: The intent-to-treat population comprised 1,417
patients, of which 363, 359, 345, and 350 received placebo,
BG-12 BID, BG-12 TID, and GA, respectively. Both doses
of BG-12 reduced ARR over 2 years, compared with
placebo, across all subgroups. For example, treatment with
BG-12 BID and TID reduced the ARR versus placebo at
2 years by 48% (rate ratio 0.52 [95% CI 0.36-0.73]) and
63% (0.37 [0.25-0.55]), respectively, in patients who had
1 relapse in the year prior to study entry; 34% (0.66
[0.42-1.04]) and 28% (0.72 [0.47-1.11]) in patients who had
2 relapses; 53% (0.47 [0.31-0.69]) and 55% (0.45
[0.30-0.68]) in patients who had prior MS treatment; and
36% (0.64 [0.44-0.95]) and 46% (0.54 [0.36-0.81]) in
treatment-nave patients.
Conclusion: Subgroup analyses from the CONFIRM study
indicate favourable effects of either BG-12 dosages on ARR
across a wide spectrum of RRMS patients.
Supported by: Biogen Idec Inc.
356 Posters, Sunday 9 September
P1685
Effect of BG-12 on magnetic resonance
imaging activity in subgroups of patients
with relapsing-remitting multiple
sclerosis: findings from the DEFINE study
A. Bar-Or1, R. Gold2, L. Kappos3, D.L. Arnold4,
G. Giovannoni5, K. Selmaj6, J. OGorman7, M. Stephan7,
K.T. Dawson7
1Montreal Neurological Institute and Hospital, McGill
University, Montral, QC, Canada, 2St Josef Hospital, Ruhr
University, Bochum, Germany, 3Neurology, University
Hospital, Basel, Switzerland, 4NeuroRx Research Inc,
Montral, QC, Canada, 5Queen Mary University of London,
Blizard Institute, Barts and the London School of Medicine
and Dentistry, London, UK, 6Medical University of Lodz,
Lodz, Poland, 7Biogen Idec Inc, Weston, MA, USA
Introduction: In the Phase 3 DEFINE study, BG-12
significantly reduced MRI activity over 2 years vs. placebo
in relapsing-remitting MS (RRMS) patients. We assessed
the efficacy of BG-12 on MRI endpoints in patient
subgroups from DEFINE.
Methods: Patients were randomized to BG-12 240 mg BID
or TID or placebo. Effects of BG-12 on MRI endpoints at 2
years were evaluated in patient subgroups by baseline
demographic and disease characteristics, including age,
prior relapses, treatment history, T2 lesion volume, and
presence of gadolinium-enhancing (Gd+) lesions.
Results: The intent-to-treat population comprised 1,234
patients; MRI evaluations were performed in a subset of
540 patients. Both BG-12 dosages reduced numbers of T2
hyperintense and Gd+ lesions over 2 years, compared with
placebo, across all subgroups. For example, in patients who
had 1 relapse in the year prior to study entry, reductions vs.
placebo in number of new/newly-enlarging T2 lesions were
90% (95% CI 84-94%) for BG-12 BID and 80% (68-87%)
for TID, while in patients with 2 relapses, relative
reductions were 75% (49-88%) and 66% (33-83%),
respectively. In patients who had 1 relapse, there were
90% (odds ratio 0.10 [95% CI 0.04-0.24]) and 79% (0.21
[0.11-0.42]) reductions in the odds of having a greater
number of Gd+ lesions vs. placebo, with BG-12 BID and
TID, respectively, while in patients with 2 relapses,
reductions were 90% (0.10 [0.02-0.43]) and 59% (0.41
[0.15-1.13]).
Conclusion: Both BG-12 dosages demonstrated benefits on
MRI endpoints across subgroups of RRMS patients with
different disease characteristics.
Supported by: Biogen Idec Inc.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1686
Fasudil, a Rho kinase inhibitor, protects
spinal cords and vascular endothelial
cells against the inflammatory cell
infiltrations in experimental auto-immune
encephalomyelitis mice
J.-Z. Yu1, Y.-X. Li1, Y.-T. Liu1, Y.-H. Li1, C.-Y. Liu1,
H.-F. Zhang1, L. Feng1, Y. Xie1, J. Meng1, B.-G. Xiao1,2,
C.-G. Ma1,3
1Institute of Brain Science, Shanxi Datong University,
Datong, 2Institute of Neurology, Huashan Hospital, Institute
of Brain Science and State Key Laboratory of Medical
Neurobiology, Fudan University, Shanghai, 3Shanxi
University of Traditional Chines Medicine, Taiyuan, China
Purpose: To investigate the therapeutic effect of Fasudil on
expression of ROCK-II and occludin in vascular endothelial
cells of spinal cords in mice affected with EAE.
Methods: EAE was induced with MOG35-55 in C57BL/6
mice. Fasudil was intraperitoneally injected in a dosage of
50mg/kg/d from day 6 post-immunization (p.i.), and
followed by 13 consecutive days. Injection of saline into
mice was set up as control. Clinical signs were evaluated
and body weight was recorded every other day. Mice were
sacrificed on days 28-30 p.i. The expression of ROCK-II in
spinal cords was detected by immunofluorescence staining.
The extraction of spinal cords was collected for the detection
of occludin expression.
Results: The differences of incidence, body weight and
mean maximum clinical scores were statistically significant
between Fasudil-treated and control EAE mice (p<0.05).
Typical muff-like inflammatory cell infiltration and
demyelination were detected in spinal cords of control EAE
mice, but were obviously decreased after intervention with
Fasudil. After the intervention with Fasudil, the expression
of ROCK-II in vascular endothelial cells of spinal cords was
decreased. Further studies showed that Fasudil increased
the expression of occludin in spinal cords.
Conclusions: Fasudil, a Rho kinase inhibitor, decreases the
incidence rate, relieves the clinical severity in EAE mice
possibly through the inhibition of ROCK-II production on
vascular endothelial cells and the up-regulation of the
expression of tight junction protein occludin in spinal cords,
which limits infiltration of inflammatory cells into the CNS,
and ultimately prevents the development of EAE.

P1687
The glutathione and S-nitrosothiols
interaction within CNS during the acute
phase in an experimental model of
multiple sclerosis
S. Ljubisavljevic, I. Stojanovic, R. Pavlovic,
D. Sokolovic, D. Pavlovic
Faculty of Medicine, University of Nis, Serbia
Objective: Multiple sclerosis (MS) is characterized by
inflammatory processes that are associated with nitric oxide
(NO) and its related species production in CNS, which can
nitrosylate protein thiols and modulate their structure and
function, also reducing the CNS content of redox active
compounds, such as glutathione (GSH).
Method: We have evaluated the relationships between
S-nitrosothiols (RSNO) and GSH in an experimental model
of MS - experimental autoimmune encephalomyelitis
(EAE), during treatment with inhibitor of inducible NO
synthase - aminoguanidine (AG) and thiol donor molecule
- N acetyl cysteine (NAC). EAE was induced by the myelin
basic protein, dissolved in phosphate buffered saline (PBS)
emulsified in the complete Freunds adjuvant (CFA), also,
with injections of Pertussis toxin. Animals were assigned to:
control (PBS), EAE, CFA, EAE+AG, AG, EAE+ NAC and
NAC group, were scored daily for the clinical signs of EAE.
RSNO and GSH were evaluated in - whole encephalitic
mass (WEM) and cerebellums.
Results: The clinical signs of EAE were reduced in EAE
treated animals compared to the other groups (p<0.05).
RSNO concentration was increased in EAE untreated
animals compared to the EAE AG and NAC treated
(p<0.05). Also, during treatment with AG and NAC, GSH
concentration was more increased than in untreated animals
(p<0.05).
Conclusion: The finding of our work suggests a potential
role of RSNO and GSH in early clinical presentation of
experimental MS that might be also useful as predictive
parameters for MS treatment based on increased GSH and
thiol pool in CNS.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 357
P1688
Neurological deficit in patients with
multiple sclerosis and subclinical
hypothyroidism
E. Kiseleva1, N.N. Spirin2
1Neurology, 2Neurology with medical genetics and
Neurosurgery, Yaroslavl State Medical Academy, Yaroslavl,
Russia
Introduction: Thyroid pathology is frequently detected in
multiple sclerosis patients (MS). The aim of this study was
to evaluate the relationship between the neurological
features of MS and thyroid dysfunction.
Methods: 65 patients (17 males, 48 females) with clinically
definite relapsing-remitting MS were examined. All patients
had clinical remission. The mean age was 36.8 years (19 -
61 years). Severity of neurological deficit was assessed
according to the EDSS, the Functional Systems Score
(FSS). We have performed ultrasound study of the thyroid
gland, analysis of serum thyroid hormones and antithyroid
antibodies. Statistical analysis was performed using
standard statistical methods.
Results: Subclinical hypothyroidism was diagnosed in
13.8% of patients with MS, 55.5% had thyroid pathology
without dysfunction. 30.7% of patients without thyroid
pathology were the comparison group. 66% of patients
received -IFN-1b in group with subclinical hypothyroidism;
in the comparison group, only 20%. The mean FS scores for
pyramidal and sensory functions were higher in patients
with subclinical hypothyroidism, than in the comparison
group (pyramidal FSS 3.11.02 and 2.41.08, sensory FSS
2.60.71 and 1.91.12, p<0.05). 77% of patients with
subclinical hypothyroidism had polyneuropathic type of
sensory dysfunction.
Conclusion: Thus, the occurrence of the polyneuropathic
type of sensory dysfunction in patients with multiple
sclerosis can be regarded as a relative marker of subclinical
hypothyroidism. Such patients should conduct a screening
of the thyroid gland.
358 Posters, Sunday 9 September
P1689
Neuropathic pain: a disabling symptom of
neuromyelitis optica
K. Mutch, L. Elsone, A. Jacob
Neurology, Walton Centre Foundation NHS Trust, Liverpool,
UK
Background: Neuromyelitis Optica (NMO) is an
inflammatory demyelinating disorder of the central nervous
system characterised by relapses affecting optic nerves and
longitudinal extensive transverse myelitis resulting in visual
and physical disabilities and often neuropathic pain. Little
is known regarding the occurrence, type and intensity of
pain in NMO.
Objective: The aim of the study was to investigate the
frequency and features of neuropathic pain in NMO and its
impact on Quality of life.
Method: 58 patients, with a diagnosis of NMO or NMO
spectrum disorder (those with myelitis only) using
Wingerchuk Criteria, attending the National NMO clinic
over one year were assessed. 44 patients had aquaporin-4
antibodies. The Brief Pain Inventory (BPI) short form tool
was used to assess pain and its effect on quality of life.
Results: 33/58 (57%) patients reported neuropathic pain. 10
(17%) patients described pain as their worst symptom. 25
(76%) patients were in constant pain for more than 6
months. An increase in pain intensity was associated with a
new relapse in 16 patients. Descriptions of pain included
burning, pricking shooting, nagging and exhausting. Pain
interfered with activities and quality of life for 41 (71%) of
patients. Activity increased pain in 10 patients and 18
patients had no pain during sleep or lying still.
Conclusion: Neuropathic pain is a significant symptom of
NMO. It is essential to acknowledge, access and manage
patients pain in order to improve their quality of life.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1690
Olfactory dysfunction in patients with
primary progressive multiple sclerosis
F. Schmidt, O. Goektas, F. Fleiner, L. Harms
Charit Universittsmedizin Berlin, Germany
Introduction: The olfactory function is diminished in
patients with multiple sclerosis (MS). Recently we could
detect a correlation between the olfactory bulb and olfactory
brain volumes of MS patients with their lesion load. This
study focuses on the olfactory function of patients with
primary progressive MS (PPMS).
Design and methods: 14 patients with PPMS and 14
matching control persons were examined. Exclusion criteria
were olfactory dysfunction with a different genesis (post-
viral, sinunasal, post-traumatic, toxic) and age >65 years.
Olfactory testing was performed using the tripartide TDI-
test measuring olfactory threshold, the discrimination and
the identification of different odours.
Results: 13 of 14 PPMS patients (93%) and none of the
control persons showed hyposmia. The mean TDI-score of
patients with PPMS was 27.52.9, the mean Threshold-
score (T-score) 5.61.4, the mean Discrimination-score
(D-score) 9.51.9 and the mean Identification-score
(I-score) was 12.41.6. For the control persons, the mean
TDI-score was 34.02.2, the T-score 6.92.1, the D-score
12.61.6 and the I-score was 14.50.9. There was a
significant difference between the TDI-score (p<0.0001),
the D-subscore (p<0.0001) and the I-subscore (p<0.001) of
patients with PPMS compared with the control group.
Conclusions: Hyposmia appears frequently in patients with
PPMS. Odor discrimination and identification of PPMS-
patients seems to be worse than odor threshold compared to
the healthy control group. Demyelination with axon
destruction results in chronic progredient progression which
might explain the decreased olfactory function of PPMS-
patients.

P1691
Validity and reliability of Persian minimal
assessment of cognitive function in
multiple sclerosis
A. Eshaghi1, S. Riyahi-Alam1, T. Roostaei1, G. Haeri1,
A. Aghsaie1, M.R. Aidi1, H.R. Pouretemad2, M. Zarei3,4,
S. Farhang1, R. Saeedi1,2, A. Nazeri1, H. Ganjgahi3,
A.R. Azimi1, R. Benedict5, M.A. Sahraian1
1Sina MS Research Center, Tehran University of Medical
Sciences, 2Department of Psychology, Shahid Beheshti
University, 3Brain Mapping Research Center, Brain Mapping
Research Center, Tehran University of Medical Sciences,
Tehran, Iran, 4FMRIB Centre, John Radcliffe Hospital,
University of Oxford, Oxford, UK, 5Department of
Neurology, Buffalo School of Medicine, Buffalo, NY, USA
Introduction: Cognitive dysfunction is common in multiple
sclerosis and validated batteries are limited in languages
other than English.
Objective: We aimed to translate, to cross-culturally adapt,
to validate, and assess reliability of Minimal Assessment of
Cognitive Function in MS (MACFIMS) in Persian, which
is a well-constructed battery in MS literature.
Patients and methods: The battery was adapted to Persian
in accordance with available guidelines. A total of 158 MS
patients and 90 controls underwent neuropsychological
assessment. For reliability assessment, the battery was
re-administered in a subset of 41 patients after a short
interval using alternate forms to mitigate practice effects
(approximately 10 days).
Results: Patients performed significantly worse than
controls in all cognitive tests supporting discriminant
validity of our adapted battery. Approximately half of the
patients (46.2%) showed cognitive impairment as defined
by the impairment in two or more tests. Symbol Digit
Modalities Test was the most robust test by ROC analysis.
All tests were acceptable and had a good level of reliability.
Conclusions: This is the first validation of gold-standard
cognitive testing in Persian. Persian MACFIMS shows
nearly the same psychometrics as its English counterpart.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 359
P1692
Assessment of the efficacy of
rehabilitation therapy in patients with
relapsing-remitting course (RR) of
multiple sclerosis (MS) and mental
fatigue: an fMRI study
Z. Rozhkova1, O. Omelchenko1, T. Kobys2
1Radiology, Medical Clinic BORIS, 2Neurology, National
Medical Bogomolets University, Kiev, Ukraine
Objectives: We use movement tasks for assessment of the
therapy efficacy in patients with RRMS and mental fatigue
before and after rehabilitation therapy.
Methods: Two groups of patients were studied by fMRI on
1.5T SIGNA EXCITE (GE). The 1st group includes 58 right
hand patients (22-43y) with RRMSG, the 2nd group (CG)
includes 20 volunteers (23-40y). fMRI data were obtained
using block design parametric paradigm, EPI:TR/
TE=3000/60ms, matrix 64x64, FoV=24. We used complex
hand movement task, which consisted of finger tapping,
successive fingers tapping, and hand squeezing subtasks
under following scheme: 2phase DEL-7rest-7finger-7rest-
7all fingers-7rest-7hand-7rest-7finger-7rest-7all fingers-
7rest-7hand-7rest-7finger-7rest-7all fingers-7rest-7hand-
7rest. All fMRI data are obtained before (as the baseline
fMRI) and after rehabilitation therapy.
Results: From analysis of fMRI data (using FSL software
package) we found no differences between the total
MS-lesions load. In the baseline fMRI examination the
bilateral activation of the sensori-motor cortex, thalami, and
cerebellum was observed. After rehabilitation therapy we
found a statistically significant reduction of the activation
in the ipsilateral primary motor cortex area, in the
contralateral primary motor cortex area, and in the thalami
bilaterally. In the cerebellum a significant reduction of the
activation areas was observed.
Conclusion: fMRI method gives us quantitative approach
for evaluation of the cortical reorganization during complex
hand movement tasks in patients with RRMS. Although the
pathological findings in the demyelinating plaques are
diverse, the comparison fMRI data in patients with RRMS
and mental fatigue provides us very useful information for
estimation of the efficacy of rehabilitation therapy.
360 Posters, Sunday 9 September
P1693
Lactonase activity of paraoxonase-1 in
multiple sclerosis patients: a pilot study
A. Jamroz-Wisniewska1, J. Betowski2, Z. Stelmasiak1,
H. Bartosik-Psujek1
1Neurology, 2Pathophysiology, Lublin Medical University,
Lublin, Poland
Background: The lactonase activity of paraoxonase-1
(PON1), an antioxidant enzyme bound with HDL in serum,
is thought to be the most important in physiology. As the
role of oxidative stress in the pathogenesis of multiple
sclerosis (MS) is considered to be significant, we studied
this physiological activity of PON1 in MS.
Patients and methods: 57 MS patients - 21 patients with a
relapsing-remitting type of disease (in remission) and 36
patients with a secondary progressive type of disease, and
44 control subjects were involved in the study. Lactonase
and arylesterase activities of PON1 (homocysteine
thiolactone and phenyl acetate as substrates) were measured
spectrophotometrically.
Results: There were no statistically significant differences
in mean values for serum lactonase (p=0.8) and arylesterase
(p=0.6) activities of PON1 between the studied groups.
Conclusions: In groups of MS patients, compared to the
control group, no statistically significant differences in
PON1 lactonase and paraoxonase activities were detected.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1694
Factors relating to unmet needs of Irish
MS patients
R. Lonergan1, K. Kinsella1, P. Fitzpatrick2, M. Duggan1,
S. Jordan1, D. Bradley1, M. Hutchinson1, N. Tubridy1
Department of Neurology, St. Vincents University Hospital,
1
School of Public Health and Population Science, University
2
College Dublin, Dublin, Ireland
Background: Non-pharmacological MS-related needs may
be overlooked during fund allocation. Identification of
unmet needs (UN) and associated clinical/demographic
factors may inform service planning and guide resource
allocation to optimise care.
Aim: To identify unmet MS-related needs and associated
factors in Irish MS patients.
Patients and methods: Observational study in 3 regions:
South Dublin (urban), Donegal and Wexford (rural).
Patients completed a validated Needs Assessment
Questionnaire (NAQ). Univariate and multivariate analyses
were performed.
Results: 325 patients completed NAQ: 52.3% reported UN
relating to MS: 1 UN in 27%, 2 in 73%, 5 in 24%.
Univariate analysis: UN related to EDSS >6.5 (p<0.001),
progressive subtype (p<0.001), increased age (p=0.003),
MS duration (p=0.003). By multivariate analysis: increasing
EDSS and rural residence (p<0.05).
UN included: physiotherapy 57.1%, social 43.5%, financial
33.5%, employment 29.4%, occupational therapy 28.8%,
home adaptations 27.7%.
Discussion: Over 50% reported UN, suggesting that non-
pharmacological needs are suboptimally addressed,
particularly in older, more disabled patients with progressive
MS. Increasing EDSS and rural residence survived
multivariate analysis, highlighting need for increased fund
allocation, especially towards community support and
multidisciplinary service development. Identifying unmet
needs and associated factors may inform service planning
and emphasizes need for improved resources.

P1695
Bilateral horizontal gaze paralysis and
facial diplegia due to a pontine tegmental
plaque in multiple sclerosis
E. Papageorgiou, I. Markakis, V. Koukouni, G. Gekas
Neurology, General State Hospital of Piraeus, Nikaia,
Greece
Introduction: Brainstem involvement is common during
the course of multiple sclerosis (MS) and usually manifests
as internuclear ophthalmoplegia, monocular abduction
deficits, trigeminal symptoms, vestibular signs and
unilateral facial palsy. However, acute multiple cranial
nerve palsies have been rarely reported. We describe a
patient with MS who developed bilateral horizontal
ophthalmoplegia and facial diplegia due to a demyelinating
lesion in the caudal pontine tegmentum.
Case-report: A 44-year-old woman with a 6-year history of
relapsing-remitting MS, presented with complaints of
blurry vision and nausea for one week. Neurological
examination revealed complete bilateral horizontal gaze
paralysis involving saccades, pursuit and oculocephalic
reflexes, with preserved convergence and vertical eye
movements. One day following admission the patient also
developed facial diplegia. CSF had a normal cell count and
protein with positive oligoclonal bands. Brain MRI revealed
chronic demyelinating lesions in the periventicular white
matter and cerebellum and an acute lesion in the dorsal
pontine tegmentum involving both facial colliculi.
Treatment with intravenous methyl-prednisolone led to a
fast improvement of facial diplegia; the gaze deficit started
to improve gradually following subsequent trials of plasma
exchange and was completely restored within six weeks of
relapse onset.
Conclusion: To our knowledge, this is the first reported
case of complete horizontal ophthalmoplegia associated
with facial diplegia in MS. The lesion topography in our
patient suggests bilateral involvement of infranuclear and
intranuclear abducens fibres as well as of the neighbouring
inner genu of facial nerves. Thus MS should be included in
the differential diagnosis of this rare clinical syndrome.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 361
P1696
Preparation-specific genetically
determined risk of developing neutralizing
antibodies towards interferon-beta in
patients with multiple sclerosis
J. Link1, K. Fink1,2, M. Lundkvist1, B. Brynedal1,
I. Kockum1, A. Fogdell-Hahn1, J. Hillert1,2
1Centre for Molecular Medicine, Karolinska Institutet,
2Department of Neurology, Karolinska University Hospital,
Stockholm, Sweden
Introduction: A significant proportion of patients with
multiple sclerosis (MS) receiving interferon-beta (IFN-
beta) develop neutralizing antibodies (NAbs). However,
NAbs only occur in a subset of patients, which indicates
that factors such as human leukocyte antigen (HLA)
genotype could be involved in determining the risk for
NAbs.
We investigated if certain HLA class I and II alleles are
associated with the development of NAbs in a Swedish
cohort of MS patients treated with IFN-beta and whether or
not an association with clinically relevant NAb-titres exists.
Method: 419 patients with known HLA status matched the
strict criteria for NAb-positivity (n=230) or NAb-negativity
(n=189). Precise titres were measured with RT-PCR (MxA
expression). Cut-off for clinically relevant titres was defined
as an NAb-titre higher than 150TRU/ml. Statistical
dependencies were evaluated with chi square test, logistic
regression and Wilcoxon rank sum test.
Result: The risk of developing NAbs was higher when
treated with Rebif or Betaferon compared to Avonex.
Patients, treated with IFNb1-a, were more often positive for
NAbs if they were carriers of DRB1*15, whereas HLA-
A*02 influenced the risk of NAbs in patients treated with
IFNb1-b. Nevertheless, there was no allele group that
decreases the risk of NAbs lower than that of Avonex in
either Betaferon or Rebif treated groups and no allele group
increased the risk of NAbs on Avonex higher than the risk
in Betaferon or Rebif treated groups.
Conclusion: The development of NAbs is influenced by
HLA genotypes in some part, but is mainly dependent on
the choice of the IFN-beta preparation.
362 Posters, Sunday 9 September
P1697
Hiccups and vomiting in neuromyelitis
optica
S. Oumari, Y. Benmansour, A. Araqi-Houssaini,
H. Elotmani, B. Elmoutawakil, M.A. Rafai, I. Slassi
CHU IBN Rochd, Casablanca, Morocco
Introduction: In addition to optic nerve and spinal cord
pathology, neuromyelitis optica (NMO) has been reported
to have brainstem involvement resulting in intractable
hiccups with persistent nausea and vomiting.
Methods: We retrospectively studied patients who
presented vomiting and hiccups during a relapse of NMO
spectrum disorders.
Results: Among 31 patients treated for NMO, 4 (13%; 3
women and 1 man; 47 years mean age) were included. 3
patients had initially consulted a gastroenterologist because
these symptoms preceded the neurological deficit. Vomiting
lasted a median of 47 days (range: 4 days - 4 months). 3
patients were seropositive for anti-aquaporin-4 and MRI
showed area postrema involvement in all cases. These
symptoms responded favourably to corticosteroids only
because symptomatic treatments were ineffective.
Discussion: Our data confirm that the hiccups and vomiting
frequently are the initial symptoms of NMO and the
involvement of the area postrema is an important starting
point in pathophysiology of NMO spectrum disorders.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1698
Human endometrial stem cells attain
oligodendrocyte features in vitro
S. Ebrahimi Barough1, H. Mohseni Kouchesfehania2,
J. Ai3, B. Younesi1, M. Massumi4
1Biological Science, 2Tarbiat Moallem University, 3Tissue
Engineering, School of Advanced Medical Technologies,
4Department of Animal and Marine Biotechnology, National
Institute of Genetic Engineering and Biotechnology, Tehran,
Iran
Introduction: Human Endometrial-derived stem cells
(EnSCs) are the abundant and easy available source for cell
replacement therapy. Oligodendrocytes are myelinating
cells in the central nervous system (CNS) that form the
myelin sheath of axons to support rapid nerve conduction.
In CNS disorders, such as stroke, multiple sclerosis and
spinal cord injury, demyelination of axons contributes to
functional deficit.
Material and methods: The characterized cells were
coaxed to oligodendrocyte differentiation by induction of
bFGF, EGF and PDGF-AA (20ng/ml) signalling molecules
for 21 days and T3 (30ng/ml) for 8 days. Differentiated cells
were analyzed for expression of neuronal markers by
RT-PCR and Immunocytochemistry.
Results: The flow cytometric analysis showed that EnSCs
were positive for CD90, CD105, OCT4 and were negative
for CD31, CD34. The result showed the expression profile
of oligodendrocyte markers such as Nestin, Olig2, PDGFRa,
CNP in the level of mRNA. The expression of Olig2,
PDGFRa, A2B5 proteins in EnSCs were confirmed 30 days
post-treatment (PT) by Immunocytochemistry.
Conclusion: The EnSCs can response to the signalling
molecules which are usually used for oligodendrocyte
differentiation and can program to oligodendrocyte cells
and may convince to consider these cells as a unique source
for cell therapy of neurodegenerative disease.

P1699
Valproic acid induces the expression of
the EAAT3 glutamate transporter in
human oligodendroglioma cells
M.G. Bianchi, L. Reia, M. Allegri, R. Sala, M. Chiu,
R. Franchi-Gazzola, J. Uggeri, O. Bussolati
Dept. of Experimental Medicine, University of Parma, Italy
Introduction: Glutamate transport has never been studied
in human oligodendroglioma cells, although the neuronal
transporter EAAT3 is highly expressed in Oligodendrocyte
Precursor Cells. On the other hand, transcriptional
regulation of EAAT3 is still incompletely characterized and
EAAT3 role in oligodendrocytic differentiation unknown.
Conflicting evidence has been reported on the effects of
HDAC inhibitors, such as valproic acid (VPA), on
myelinating cells and glutamate transporters.
Methods: Gene expression has been studied with RT-PCR
and Western Blot. EAAT3 activity has been determined
from the initial influx of the glutamate analogue D-aspartate.
Results: EAAT3 expression and activity, barely detectable
in human oligodendroglioma Hs683 cells under control
conditions, are markedly induced by valproic acid (VPA).
EAAT3 induction is detected at both mRNA (3x) and
protein levels (10x after 72h of treatment). Under the same
conditions, VPA does not change EAAT3 expression in
human U373 glioblastoma cells. Transport activity is also
increased by VPA and exhibits typical EAAT3 features,
such as stimulation by phorbols and insensitivity to
dihydrokainate and UCPH. While no saturable glutamate
transport is detectable in control Hs683 cells, VPA-treated
cells exhibit a high affinity transport activity (Km 7M), the
Vmax of which is increased by phorbol. EAAT3 mRNA
induction is associated with a two-fold increase of PDGFRA
mRNA, a marker of early Oligodendrocyte Precursor Cells,
while CNP, TUBB3 and GFAP mRNAs remain unchanged.
Conclusions: The VPA-dependent induction of the
glutamate transporter EAAT3 in human oligodendroglioma
cells may represent an indicator of early commitment to
oligodendrocytic differentiation.
Aided by FISM, Genova, Italy
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 363
P1700
Acute psychosis masquerading Susacs
syndrome
M.G. enol1, S. Demir1, A. Ayata2
1Neurology, GATA Haydarpaa Training Hospital,
2Neurology, GATA Haydarpaa Eitim Hastanesi, Istanbul,
Turkey
Purpose: To report clinical findings and course of a patient
initially presenting acute psychosis, which was recognized
as Susacs Syndrome in further evaluation.
Methods: A 25-year-old man has been admitted to a
psychiatry clinic with acute psychotic symptoms including
memory loss and amnesia, confusion, poor co-operation
and awareness of surroundings. He had been also referred
to a neurology clinic because of difficulty in walking. He
has been initially diagnosed as multiple sclerosis due to the
suspicious MRI findings and had been referred to our
neurology department for further investigation. Detailed
neurologic and ophthalmologic examination, including
MRI, fundus fluorescein angiography (FFA) and optical
coherence tomography (OCT), were performed. According
to the ophthalmic and neurologic findings, the patient was
diagnosed as Susacs syndrome.
Results: His visual acuity and hearing level were not
evaluated at admission because of low co-operation. MRI
revealed multifocal hyperintense callosal lesions. On the
fundoscopic examination multiple peripheral arteriolar
occlusions and related retinal oedema were observed and
occlusions were confirmed with FFA. OCT imaging also
confirmed the retinal thickening and oedema. The patient
has been treated with high dose (1gr/day) methyl
prednisolone and none of the symptoms was healed. Steroid
therapy was stopped and intravenous IgG (IVIG) was
infused at a dose of 0.5mg/kg daily for five consecutive
days. The patient responded well to the IVIG infusion and
complete reversal of neurologic and psychiatric symptoms
were observed.
Conclusion: Susacs syndrome is a very rare disorder and
initial presentation may lead to misdiagnosis or cause delay
as happened in this case. Multi-disciplinary approach may
help accurate diagnosis.
364 Posters, Sunday 9 September
P1701
Optical coherence tomography (OCT) in
patients with multiple sclerosis (MS)
Z. Vladimirova, S. Cherninkova
Neurology, University Hospital Aleksandrovska, Sofia,
Bulgaria
Introduction: OCT is a non-invasive method for
examination of the retina that can be used as a tool for
assessment of the course of neurodegeneration in MS by
measurement of the retinal nerve fibre layer (RNFL) as
axonal structure (showing loss of axons), and by
determination of the macular ganglion cell layer volume
(showing loss of neurons).
Aim: To measure the thickness of RNFL and the macular
ganglion cell layer in MS patients and compare it with
healthy volunteers.
Material and methods: We have examined 15 MS patients
(age 10-54), separated in three groups - with acute optic
neuritis (ON), with ON in the past, and patients who have
never had ON. We have compared the findings with those
of 17 healthy volunteers (age 20-44) with no ocular or
system diseases.
Results: We found changes in RNFL thickness and in
macular ganglion cell volume in almost all MS patients,
with most advanced thinning in patients with ON in the past
(more than 6 months ago). The patients with long history for
MS, who have never had ON also showed changes in RNFL
thickness, but not so advanced. The most subtle changes
were found in patients with acute ON (even the most severe
cases, e.g. with only light perception), probably due to the
time needed for development of such atrophic alterations.
Conclusion: The patients with MS show thinning of RNFL
and the ganglion cell layer that are representative for the
course of neurodegeneration in the whole organism.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1702
Conus medullaris syndrome as a
complication of radio-isotope
cisternography
S.-H. Koh1, H.-J. Yu2, B.-S. Park1, J. Park3, K.-Y. Lee1,
Y. Lee1, J. Kim1
1Hanyang University College of Medicine, Seoul,
2Neurology, Bundang Jesaeng Hospital, Seongnam,
3Neurology, Inje University Paik Hospital, Pusan, Republic
of Korea
Objective: Conus medullaris syndrome (CMS) is a clinical
neurologic syndrome caused by a conus medullaris lesion.
CMS is a heterogeneous entity with various aetiologies
such as trauma or a space-occupying lesion. Multiple cases
of CMS following spinal anaesthesia have been reported,
but CMS after radioisotope (RI) cisternography has not yet
been reported.
Methods: We present four patients who developed CMS
after RI cisternography.
Results: All experienced neurological deficits such as
paraparesis, sensory loss, and urinary incontinence three to
four days after RI cisternography. Two showed abnormalities
on lumbar magnetic resonance imaging, and three had
complete symptom resolution within ten weeks.
Conclusions: The pathomechanism of CMS is unclear, but
we hypothesize that RI neurotoxicity might be responsible.
It is possible that the use of low-dose 99mTc-DTPA or an
alternative diagnostic tool such as magnetic resonance
cisternography could help to prevent this complication.
P1703
Abstract cancelled
 Posters, Sunday 9 September 365

P1704
Risk of multiple sclerosis after optic
neuritis in patients with normal baseline
MRI
I.B. Marques1, M.C. Macrio1, F. Matias1, E.D. Silva2,
L. Sousa1
1Neurology, 2Ophthalmology, Coimbra University Hospital,
P1705
Vitamin D3 supplementation in relapsing
MS: considering the safety issues
S.M. Nabavi1, S. Zari2, D. Morsali3
1Neurology, Shahed University, Tehran, 2Shahed University,
Teharn, Iran, 3UCL, London, UK

Coimbra, Portugal
Introduction: Optic Neuritis (ON) is the initial presentation
of multiple sclerosis (MS) in approximately 20% of patients.
Although abnormal baseline brain MRI is the strongest
conversion predictor, patients with normal MRI can also
develop MS. In these patients predictors of conversion are
still to be determined. Our objective is to estimate MS risk
and identify conversion predictors in ON patients with
normal baseline MRI.
Methods: Retrospective chart review of patients with
idiopathic ON and normal MRI, presenting to our hospital
between 2003 and 2010. Demographic, clinical, paraclinical
and treatment data were collected and analyzed.
Results: 42 patients were included. 10 patients converted to
MS, seven during the first 2 years and the remaining during
the next 3 years. 5-year MS conversion rate was 23.8%. A
statistically significant increase in MS conversion rate was
associated with retrobulbar ON (p=0.022), a history of
previous symptoms suggestive of demyelination (p=0.002),
positive oligoclonal bands in CSF (p=0.004) and incomplete
recovery (p=0.002). Age, sex, ON laterality, other
neurological exam abnormalities, abnormal visual evoked
P1706
Reversible therapy-related dysplastic
hematopoiesis following interferon beta
therapy in multiple sclerosis patients: 2
case reports
S.M. Nabavi1, A. Hamzehloo2, J. Shams2
1 Neurology, 2Shahed University, Teheran, Iran
P1707
Abstract cancelled
P1708
Homocysteine, vitamin B12 and folate
levels in Iranian patients with multiple
sclerosis: a case control study
M. Moghaddasi1, H. Razjouyan2, N. Mohebi1,
M. Aghaei1, M. Mamarabadi1
Tehran University of Medical Sciences, Tehran, Iran,
1

potentials, corticosteroid treatment or ON recurrence were Drexel University, Monmouth Medical Center, Long Branch,
2

not associated with a significant increase in MS conversion NJ, USA

rates.
Conclusion: A considerable proportion of patients with ON
and normal baseline brain MRI will develop MS. The risk
of conversion appears to be higher during the first 2 years,
so follow up, at least during this period, is advisable. Early
immunomodulatory treatment may be considered
individually, especially in patients with multiple factors
associated with increased MS conversion risk.
P1709
Quality of life assessment in patients with
MS receiving interferon beta-1a:
a comparative longitudinal study of
Avonex and its biosimilar cinnovex
R. Abolfazli1, A. Hosseini2, K. Gholami1, M. Javadi1,
H. Torkamandi1, S. Emami2
Tehran University of Medical Sciences, Tehran, 2Azad
1

University, Tehran, Iran

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

366 Posters, Sunday 9 September

P1710
Cognitive performance in a cohort of MS
patients in comparison to healthy
subjects: an assessment with BRB-N from
Iran
S.M. Nabavi1, S. Tahbaz2, Z. Behjati2, F. Nourbala2,
S. Sadeghi3, Z. Saeedi2, MS Research Unit, Mostafa
Center
Neurology, Shahed University, 2Tehran University, 3Shahed
1
P1714
Correlation of blink reflex abnormalities
and magnetic resonance imaging findings
in multiple sclerosis patients
E. Degirmenci, C. Erdogan, L.S. Bir
Neurology, Pamukkale University, Denizli, Turkey
P1715

University, Tehran, Iran Epidemiological and clinical

P1711
An open-label, survey-based, multicenter
study to determine patient satisfaction
with single-use prefilled AVONEX PEN
auto-injector in multiple sclerosis patients
M. Morreale1, T. Campbell2,3, V. Migounov4, E. Cass1,
S. Wong1
1Innomar Strategies Inc., AmerisourceBergen Canada,
Burlington, ON, 2Capital District Health Authority,
3Dalhousie University, Halifax, NS, 4Biogen Idec Canada
Inc., Mississauga, ON, Canada
P1712
Effects of natalizumab on global oxidative
stress in patient with multiple sclerosis
E. Aguera1,C. Bahamonde1, F. Sanchez-Lopez1,
A.I. Giraldo2, I. Tunez2
Neurology, Hospital Universitario Reina Sofa Cordoba,
1
characteristics of multiple sclerosis in the
Tomsk region, Russian Federation
M. Titova, V. Alifirova
Neurology and Neurosurgery, Siberian State Medical
University, Tomsk, Russia
P1716
Development of a T-cell vaccination (TCV)
program for chronic progressive multiple
sclerosis (CPMS). 18 years of clinical
experience
G.A. Moviglia, G. Varela, M.T. Moviglia Brandolino,
N. Blasetti, S. Piccone, G. Albanese, C. Gaeta
CIITT, Universidad Maimnides, Caba, Argentina
P1717
Using the act test for follow-up of an
attack period in clinically isolated

Biochemistry and Molecular Biology, Facultad de

2 syndrome: comparison on the basis of
Medicina, Universidad de Cordoba, Cordoba, Spain pasat in multiple sclerosis patients
B. Piri inar, S. Ozakbas
Dokuz Eylul University, Izmir, Turkey
P1713
The prevalence of neuromyelitis optica
and neuromyelitis optica-IgG
P1718
seropositivity amongst Saudis with Cluster analysis of health-related quality
central demyelinating diseases of life (HRQoL) indices in multiple
A. Al-Khathaami1,2, F. Yunus1, M. Alamgir2, S. Kojan2, sclerosis patients
M. Aljumah3 L. Sokolova, G. Gudzenko
1Department of Epidemiology and Biostatistics, College of Bogomolets National Medical University, Kyiv, Ukraine
Public Health and Health Informatics, King Saud Bin
Abdulaziz University for Health Sciences, 2Department of
Medicine, King Abdulaziz Medical City, 3King Abdullah
International Medical Research Center, King Saud Bin
Abdulaziz University for Health Sciences, Riyadh, Saudi
Arabia

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

 Posters, Sunday 9 September 367

P1719
Monitoring disease progression and
responses to disease-modifying drugs in
MS with serial MR images and a
biomarker for structural changes
W.R. Riddle1, S.C. DonLevy2, S. Shokouhi1
1 Radiology and Radiological Sciences, Vanderbilt University,
2 Pediatric Nurse Practitioner, Nashville, TN, USA
P1720
6 months follow-up after natazulimab
initiation in acute MS relapse in a
19-year-old patient
D. Taranu, S. Walter, K. Fassbender, S. Behnke
Neurology, Saarland Medical University, Homburg,
Germany
P1721
Dynamic changes of visual evoked
potentials and brainstem auditory evoked
potentials in patients with multiple
sclerosis
V. Ignatova1, L. Haralanov1, L. Todorova2
1Clinic of Neurology, MHAT-NHH, 2Institute of Biophysics
and Biomedical Engineering, BAS, Sofia, Bulgaria
P1722
Innovative management of MS patients on
natalizumab using MSDS-3D software
T. Schulthei, R. Kempcke, T. Ziemssen
Multiple Sclerosis Centre at the Department of Neurology,
Technical University Dresden, Germany
P1723
Balos concentric sclerosis:
pathognomonic MRI and MR
spectroscopy findings
M.I. Yon, A. Gulunay, S. Mungan, Z.N. Oztekin, F. Ak
Neurology, Numune Education and Research Hospital,
Ankara, Turkey
P1724
4-aminopyridine reduces cerebellar
tremor in a patient with multiple sclerosis
M. Whr, R. Schniepp
Neurology, University of Munich, Hospital Grosshadern,
Munich, Germany
P1725
Clinical and demographic determinants of
disease severity in multiple sclerosis
patients
S. Baghizadeh1, N. Beladimoghaddam2, M. Sahraian3
1Qazvin University of Medical Sciences, Qazvin, 2Shahid
Beheshti University of Medical Sciences, 3Tehran University
of Medical Sciences, Tehran, Iran
P1726
Abstract cancelled
P1727
Abstract cancelled
P1728
Early symptoms and time to the diagnosis
of multiple sclerosis
H. Nzwalo, F. S, I. Cordeiro, F. Ferreira, C. Basilio
Neurology, Faro Hospital EPE, Faro, Portugal
P1729
The effects of mindfulness-based stress
reduction (MBSR) program on physical
symptoms, quality of life and mental
health in patients with multiple sclerosis
S.M. Nabavi1, M.A. Besharat2, S. Granmayeh2, A. Imani3,
S. Sadeghi4
1Neurology, Shahed University, 2Tehran University, Tehran,
Iran, 3MBSR, Buffalo, New York, NY, USA, 4Shahed
University, Tehran, Iran

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

368 Posters, Sunday 9 September
P1730
Demyelinating disorders and visual fields:
visual field deficit due to inflammation in
the optic chiasm
N. Kale1,2, N. Kraus Warner2, S. Yedavally2,
E. Eggenberger2
Bakirkoy Training and Research Hospital, Department of
1 Dnepropetrovsk State Medical Academy, Dnepropetrovsk,
Neurology, Istanbul, Turkey, 2Michigan State University,
Department of Neuro-Ophthalmology, East Lansing, MI,
USA
P1731
Correlation between cognitive functions,
fatigue, depression and disability status in
a cohort of multiple sclerosis patients
S.M. Nabavi1, S. Tahbaz2, Z. Behjati2, F. Nourbala2,
S. Sadeghi3, Z. Saeedi2, A. Salahesh3, MS Research Unit,
Mostafa Center
1Neurology, Shahed University, 2Tehran University, 3Shahed
University, Tehran, Iran
P1732
Prevalence heterogeneity of multiple
sclerosis in the Volyn region (Ukraine)
N.V. Bobryk
Neurology, Volyn Region Hospital, Lutsk, Ukraine
P1733
Autonomic dysfunction in patients with
multiple sclerosis
H. Tutkan1, H.L. Gl2, O. Karadas3
1Neurology, Occupational Diseases Hospital, 2Neurology,
Kartal Research and Education Hospital, Istanbul,
3Neurology, Erzincan Military Hospital, Erzincan, Turkey
P1734
Importance of an intervention program for
the promotion of physical activity in the
perception of illness in people with
multiple sclerosis
L. Pedro1, J. Pais-Ribeiro2, J. Pscoa Pinheiro3
1Physiotherapy, Inst. Politecnic of Lisbon - ESTESL, Lisbon,
2Psychology, University of Porto, Porto, 3Medicine Physical
Rehabilitation, University of Coimbra, Portugal
P1735
Abstract cancelled
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1736
Prevalence of depression in patients
suffering from multiple sclerosis in the
Ukraine
O. Kalbus, V. Shkolnyk
Department of Neurology and Ophthalmology,
Ukraine
P1737
CSF findings and follow-up MRI imaging
features of acute transverse myelitis
J.H. Lee1, S.H. Hwang2, J.H. Park3
1Neurology, National Health Insurance Corporation Ilsan
Hospital, Goyang-si, 2Neurology, Kangnam Sacred Heart
Hospital, Hallym University, 3Neurology, Sanggyepaik
Hospital Inje University, Seoul, Republic of Korea
P1738
Familial cases of multiple sclerosis in the
Novosibirsk region of Russia
D.S. Korobko1, N.A. Malkova1,2, E.A. Kudryavtseva3,4,
M.L. Filipenko3
1Regional MS Centre, State Novosibirsk Regional Clinical
Hospital, 2Novosibirsk State Medical University, 3Institute of
Chemical Biology and Fundamental Medicine, Siberian
Division, Russian Academy of Sciences, 4Novosibirsk State
University, Novosibirsk, Russia
P1739
Severe alopecia associated with
interferon beta treatment in a multiple
sclerosis patient
G. Genc1, S. Demirkaya2
Maresal Cakmak Hospital, Erzurum, 2Gulhane Military
1
Medical Academy, Ankara, Turkey
P1740
3-year safety and efficacy data of
natalizumab in Cypriot patients with
relapsing-remitting multiple sclerosis
E. Kkolou, E. Gaglia, J. Toufexis, M. Pantzaris
The Cyprus Institute of Neurology and Genetics, Nicosia,
Cyprus

P1741
Treatment of the emotional-and-affective
disturbances in patients with relapsing-
remitting multiple sclerosis and a light
stage of invalidization
T. Yakushina, V. Lizhdvoy
M.F.Vladimirsky Moscow Regional Clinical and Research
Institute, Moscow, Russia
P1742
Risk of developing multiple sclerosis after
clinically isolated optic neuritis in Latvian
patients
L. Vainsteine1, D. Kozica2, G. Karelis1,2, L. Elsone2
Riga Eastern Clinical University Hospital Gailezers,
1 P1748
Neurology and Neurosurgery Department, Riga Stradins
2
University, Riga, Latvia
P1743
Assessment of optic nerve axonal
pathology in multiple sclerosis patients
using optical coherence tomography
D. Pastare1, I. ire2, G. Laganovska2, A. Millers1
1Department of Neurology, 2Department of Ophthalmology,
Pauls Stradins Clinical University Hospital, Riga, Latvia
P1744
Screening for cognitive impairment in
multiple sclerosis with MOCA test
S. Aksoy, E. Timer, M. Akgn, E. Kvrak, D. Necioglu
Orken
Sisli Etfal Education and Research Hospital, Istanbul,
Turkey
P1745
Correlation of parameters of sideropenic
anaemia and neurological disability in
patients diagnosed with multiple
sclerosis: a retrospective study
A. Alajbegovic1, N. Kukavica2, S. Alajebegovic3,
H. Resic2, J. Djelilovic-Vranic1, L. Todorovic1,
N. Jovanovic3
1Neurology Clinic, Clinical Center of Sarajevo University,
2Clinic of Haemodialysis, Clinical Center University of
Sarajevo, 3Cantonal Hospital Zenica, Bosnia-Herzegovina
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 369
P1746
The positivity rate of CSF oligoclonal
band in Turkish multiple sclerosis patients
A. Altintas, M. Nalbantoglu, B. Zeydan
Neurology, Istanbul University Cerrahpasa Medical Faculty,
Istanbul, Turkey
P1747
Complementary-alternative medicine in
multiple sclerosis
T. Basak1, V. Unver1, S. Demirkaya2
1School of Nursing, 2Neurology, Gulhane Military Medical
Academy, Ankara, Turkey
Switching and escalating therapy in long
lasting multiple sclerosis - not always
necessary
A.T. Carvalho1,2, M.J. S1,3
1Centro Hospitalar de So Joo, 2Centro Hospitalar de Vila
Nova de Gaia/Espinho, 3Health Sciences Faculty, University
Fernando Pessoa, Porto, Portugal
P1749
Antibodies to N-homocysteinylated
albumin in patients with multiple sclerosis
- preliminary results
A. Jamroz-Wisniewska1, J. Beltowski2, Z. Stelmasiak1,
H. Bartosik-Psujek1
1Neurology, 2Pathophysiology, Lublin Medical University,
Lublin, Poland
P1750
False diagnosis in multiple sclerosis
F. Khorvash1, B. Asadi2, R. Norouzi3, A. Sonbolestan4,
M. Salari3
1Isfahan University of Medical Sciences, Isfahan
Neurosciences Research Center, Isfahan, 2University of AJA,
Tehran, 3Isfahan Neuroscience Research Center (INRC),
4Isfahan University of Medical Sciences, Isfahan, Iran
P1751
Aquaporin 4 abs positive neuromyelitis
optica in Bulgaria: a clinical case
V. Grozeva, D. Georgiev
MHATNP St. Naum Sofia, Medical University Sofia, Sofia,
Bulgaria
370 Posters, Sunday 9 September
P1752
Natalizumab reduces MRI markers
suggestive of irreversible tissue damage
in relapsing-remitting multiple sclerosis
C. Oreja-Guevara1, A. Royo2, L. Rodriguez De Antonio1,
S. Noval3, B. Chamorro1, J. Moreno1, E. Diez-Tejedor1,
J. Alvarez-Linera4
1Neurology, 2Radiology, 3Ophthalmology, University Hospital
La Paz, Idipaz, 4Radiology, Hospital Ruber Internacional,
Madrid, Spain
P1753
Hypercoagulable state mimics multiple
sclerosis: a case presentation
N. Zahra1, S.M. Nabavi2, A. Saadat1
1Baghatallah University, 2Neurology, Shahed University,
Tehran, Iran
P1754
Fatigue characteristics in multiple
sclerosis patients living in the north
Khorasan province located in the northern
east of Iran, a low prevalence area
S.M. Nabavi1, R. Jajvandian2
1Neurology, Shahed University, 2North Khorasan University,
Tehran, Iran
P1755
Multiple sclerosis and ankylosing
spondylitis in an HLA-B27 negative
patient
M. Messelmani, N. Ben Ali, S. Fray, H. Khiari-Mrabet,
A. Mrabet
Neurological Department, Charles Nicolle Hospital, Tunis,
Tunisia
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1756
Alterations of the morphofunctional
parameters of the peripheral blood
lymphocytes in exacerbations of multiple
sclerosis
T. Yakushina, I. Vasilenko, V. Lizhdvoy, S. Kotov
M.F.Vladimirsky Moscow Regional Clinical and Research
Institute, Moscow, Russia
P1757
Pulmonary artery hypertension associated
with interferon beta 1a therapy in a
patient with multiple sclerosis
S. Baghizadeh1, M. Ghahari2, M. Sahraian3
1Qazvin University of Medical Sciences, Qazvin, 2Shaheed
Beheshti University of Medical Sciences, 3Tehran University
of Medical Sciences, Tehran, Iran
P1758
Can we speak about a psychiatric attack
during multiple sclerosis?
A. Ben Mahmoud, S. Hfaiedh, H. Derbali, N. Ben Ali,
M. Fraj, S. Blel
Hopital Charles Nicolle, Tunis, Tunisia
P1759
The effects of combined model of training
exercise method in function and some
biomarkers of MS patients
M.R. Kordi1, S.M. Nabavi2, S. Khodadadeh1
1Tehran University, 2Neurology, Shahed University, Tehran,
Iran
 Posters, Sunday 9 September 371

Muscle and neuromuscular junction P1761

diseases Magnetic resonance imaging evaluation
of calf hypertrophy in Becker muscular
dystrophy
P1760 M. Monforte1, G. Tasca1, E. Iannaccone1, M. Masciullo1,
Development and current status of an EU P. Ottaviani2, F. Laschena2, E. Mercuri3, E. Ricci1
patient registry for Lambert-Eaton 1Institute of Neurology, Catholic University School of

myasthenic syndrome (LEMS) Medicine, 2Department of Radiology, Istituto Dermopatico

dellImmacolata, 3Pediatric Neurology Unit, Catholic
C. Desnuelle1, F. Hanisch2, G. Le Masson3, University School of Medicine, Rome, Italy
R. Mantegazza4, A. Meisel5, J.P. Sieb6
1Centre de Rfrence Maladies Neuromusculaires, Nice, Introduction: Calf muscle hypertrophy is considered a
France, 2Martin-Luther-Universitat Halle-Wittenberg, Halle common clinical feature in dystrophinopathies, and has
(Saale), Germany, 3Centre Hospitalier Universitaires been previously attributed to deposition of fat and
Bordeaux, France, 4Istituto Neurologico C.Besta, Milan, connective tissue. Other evidences also suggested a
Italy, 5Charit Universittsmedizin Berlin, 6Hanse-Klinikum component due to true hypertrophy. The aim of our study is
Stralsund, Germany to use MR imaging to investigate the contribution of these
components to calf hypertrophy in Becker muscular
Introduction: LEMS is a rare autoimmune neuromuscular
dystrophy (BMD) patients.
disorder, frequently associated with small cell lung
Methods: 58 BMD patients aged 3511 years underwent
carcinoma or other malignancy and results in neuromuscular
lower limb MR scans. Patients were subdivided into 4
dysfunction, exertion-induced muscle weakness, and
groups, according to clinical severity (from asymptomatic
autonomic dysfunction. To better understand the natural
to non-ambulant). Cross sectional area (CSA) of lower leg
history and clinical course of LEMS, a voluntary,
posterior compartment muscles was digitally measured and
international, multi-centre, longitudinal, observational
correlated with the sum of the T1 scores (T1 scale) of the
LEMS patient registry was launched in May 2010. The
same muscles. T1 score represented a measure of fat
registry will also track long-term safety and efficacy data on
infiltration of each muscle.
medications used to treat LEMS.
Results: We found a non-significant correlation (rho=0.035
Methods: A protocol of recommended assessments is
p=0.795) between CSA and calf muscle T1 scale. We found
performed at enrolment and at routine follow-up visits to
a significant correlation between T1 scale and clinical
collect information on demographics, medical history,
severity (rho=0.901 and p<0.001), but not between CSA
treatments, signs and severity of neuromuscular dysfunction
and clinical severity (rho=0.012 p=0.927). We also found
(EMG parameters, reflexes, muscle strength, ataxia,
significant correlations between T1 scale and age
mobility/exercise), daily functioning including EQ-5D,
(rho=0.451 and p<0.001) and CSA and age (rho=0.292
autonomic dysfunction, and safety information (adverse
p=0.026).
events, ECG, spirometry, and clinical laboratory tests).
Conclusions: Based on our findings, it is likely that a major
Assessment data are entered through an internet portal
contribution to calf hypertrophy is provided by real
using a validated web-based application developed for this
hypertrophy instead of muscle fatty degeneration in BMD
program (BioMarin Pharmaceutical, USA). Recruitment
patients. Not surprisingly, T1 scale scores increase with age
and observation are planned for 5 years.
and clinical severity, while CSA only correlates with age.
Results: 43 patients (24 males, 19 females, mean age 62.2
yr, SD 12.3, range 27-84 yr) are currently enrolled in the
registry, representing 28.3 patient-years of participation
(mean length of follow-up: 8 months). Statistical summaries
will be compiled and presented annually to provide
descriptive information on the overall registry population,
current treatment practices and safety assessments, health
status and daily functioning ability, and results of
neuromuscular functioning tests.
Conclusion: The recently initiated LEMS EU patient
registry will continue to accrue and report important
information on the clinical course and treatment approaches
to this debilitating and under-recognized disorder.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

372 Posters, Sunday 9 September
P1762
Clinical impact of persistent hyperCKemia
in a Norwegian general population:
a case-control study
H. Lilleng1,2,K. Abeler1, S.H. Johnsen1,2, E. Stensland1,2,
S. Lseth1,2, S. Lindal2,3, T. Wilsgaard4, S.I. Bekkelund1,2
1Department of Neurology and Neurophysiology, University
Hospital of North Norway, 2Department of Clinical
Medicine, University of Troms, 3Department of Clinical
Pathology, University Hospital of North Norway,
4Department of community medicine, University of Troms,
Troms, Norway
Background: The purpose of this study was to assess
clinical impact of persistent hyperCKemia in a Norwegian
general population. We also investigated frequency of
neuromuscular disorders and risk factors in a group with
hyperCKemia compared with controls.
Method: In a double blind case-control study, we compared
the frequency of muscular symptoms, functions and
neuromuscular diseases between 120 individuals with
persistent hyperCKemia and 130 age- and sex-matched
individuals with normal CK values, all recruited from the
6th survey of The Troms Study. The participants underwent
a standardized interview, including questions concerning
muscle symptoms, leisure physical activity, use of statins
and presence of other CK risk factors, prior to clinical
neurological and neurophysiological examination. Knee
extensor muscle strength was assessed with a Cybex NORM
dynamometer, and a Martin Vigorimeter was used to
measure dominant hand grip strength.
Results: We found no evidence of more muscular symptoms
or impaired muscular strength in those with persistent
hyperCKemia compared to the controls. In men, weight and
Body Mass Index (BMI) were significantly higher in the
group with persistent hyperCKemia. In women, no
differences between the groups were detected.
Use of statins was similar in cases and controls. We
diagnosed 3 women with previously unknown myopathy,
all in the group with persistent hyperCKemia.
Conclusion: Only minimal clinical differences were found
between individuals with hyperCKemia and controls. Our
findings support the recently published EFNS guidelines on
diagnostic approach to pauci- or asymptomatic
hyperCKemia.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1763
Hypogonadism and erectile dysfunction in
patients with myotonic dystrophy type-1
S. Peric1, D. Lavrnic1, T. Nisic2, I. Basta1, M. Miljkovic1,
S. Popovic2, V. Rakocevic Stojanovic1
1Neurology Clinic, 2Endocrinology Clinic, Clinical Center of
Serbia, Belgrade, Serbia
Introduction: Myotonic dystrophy type-1 (DM1) is the
most common form of muscular dystrophy in adults. It
affects many organs besides muscle, including
endocrinological abnormalities (insulin resistance, thyroid
dysfunction and hypogonadism in men). Aim of this study
was to assess frequency of erectile dysfunction (ED) and
hypogonadism, the correlation between them and the impact
of ED on quality of life (QoL) in patients with DM1.
Method: This study included 25 men (22-58 years old) with
diagnosis of DM1. Severity of muscular involvement was
assessed with Muscular Impairment Rating Scale (MIRS)
and erectile function with International Index of Erectile
Function (IIEF). Levels of FSH, LH and testosterone were
analyzed. Patients completed SF-36 questionnaire as a
measure of QoL.
Results: ED was present in 18 (72%) patients. 7 (28%)
patients were euogonadic, 16 (64%) had compensated
hypogonadism and 2 (8%) had primary hypogonadism. ED
was more common in patients with hypogonadism (78% vs.
57%, p>0.05). ED was not significantly associated with age
at onset of DM1, duration of disease, age and severity of
muscular impairment at the moment of investigation
(p>0.05). SF-36 mental composite score was lower in
patients with ED (55.722.2 vs. 75.820.9, p<0.05).
Conclusion: More than two thirds of men with DM1 had
ED and hypogonadism. ED was more frequent in patients
with hypogonadism. Mental aspect of QoL was lower in
patients with ED. Development of therapeutic strategies for
ED in DM1 may have positive impact on quality of life in
these patients.
 Posters, Sunday 9 September 373

P1764 P1765
Improved methodology for obtaining large Predictive value of anti-titin antibodies in
quantities of correctly folded recombinant early and late onset myasthenia gravis
N-terminal extracellular domain of the P. Szczudlik1, B. Szyluk1, M. Lipowska1, B. Ryniewicz1,
human muscle acetylcholine receptor for J. Kubiszewska1, M. Dutkiewicz2, H. Kwieciski1,
inducing EAMG in rats A. Kostera-Pruszczyk1
1Department of Neurology, 2Department of General and
C. Sun1, X. Qi2, Z. Li3, H. Zhang4 Nutritional Biochemistry, Medical University of Warsaw,
1Department of Neurology, 2Navy General Hospital, Beijing, Poland
3Tangdu Hospital, The Fourth Military Medical University,
Xian, 4Neurology, First Hospital of Jilin University, Introduction: In 85% of myasthenia gravis (MG) patients
Changchun, China the disease is caused by acetylocholine receptor antibodies
(AChR-MG). Antibodies against other muscle antigens,
Introduction: Human myasthenia gravis (MG) is an
including titin, are also detected in MG patients, and were
autoimmune disorder of the neuromuscular system.
reported as markers of severity of MG in some populations.
Experimental autoimmune myasthenia gravis (EAMG) is a
Anti-titin antibodies are more frequent in thymoma patients.
well-established animal model for MG that can be induced
The study was conducted to estimate the role of anti-titin
by active immunization with the Torpedo Californica-
antibodies in Polish MG patients.
derived acetylcholine receptor (AChR). Due to the high cost
Methods: Anti-titin antibodies were tested in sera of 295
of purifying AChR from Torpedo Californica and the harm
MG patients aged 4-89: 164 with early- (50, EOMG) and
to the animals, the development of an easier and more
131 with late-onset MG (LOMG). Thymic pathology, MG
economical way for inducing EAMG remains critically
severity, need for immunosuppression and treatment results
needed.
at last follow-up were analyzed.
Materials and methods: Full-length cDNA of the human
Results: Thymoma were diagnosed in 17 EOMG and 10
skeletal muscle AChR 1 subunit was obtained from TE671
LOMG patients. 81 MG patients were positive for anti-titin
cells. The DNA fragment encoding the extracellular domain
antibodies, all were AChR-MG. In EOMG 6% of the
(ECD) was then amplified by PCR and inserted into pET-
patients had anti-titin antibodies; its presence had 53%
16b. The reconstructed plasmid was transformed into
positive predictive value (PPV), 99% negative predictive
BL21(DE3)pLysS, which was derived from E. coli.
value (NPV) and 90% sensitivity with 94% specificity for
Isopropyl-beta-D-thiogalacto-pyranoside (IPTG) was used
thymoma diagnosis. In LOMG, anti-titin antibodies were
to induce the expression of the N-terminal ECD. The
detected in 54% of the patients; with 47% PPV for thymoma,
produced protein was purified with immobilized Ni2+
50% NPV, 91% sensitivity and 8% specificity, respectively.
affinity chromatography and refolded by dialysis.
In neither EOMG nor LOMG anti-titin antibodies were
Results: The recombinant protein was efficiently refolded
associated with more severe course of the disease defined
to soluble active protein, which was verified by ELISA.
by maximal MGFA, the need for immunosuppression or
After immunization with the recombinant ECD, all rats
treatment outcome.
acquired clinical signs of EAMG. Importantly, the titre of
Conclusion: Detection of anti-titin antibodies in early
AchR antibodies in the serum was significantly higher in
onset-MG can serve as additional test predicting the
the EAMG group than in the control group, indicating
presence of thymoma. In Polish MG patients it does not
successful induction of EAMG.
indicate a more severe course of the disease.
Conclusion: Here we have described an improved
Study supported by the Polish-Norwegian Research Fund
procedure for refolding recombinant ECD of human muscle
PNRPNRF-204-AI-1/07.
AChR. This improvement allows for the generation of large
quantities of correctly folded recombinant ECD of human
muscle AChR, which provides an easier and more
economical way of inducing the animal model of MG.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

374 Posters, Sunday 9 September
P1766
Clinical features of anti-MuSK positive
myasthenia gravis patients
M. Bisciglia, S. Martignago, E. Albertini, C. Angelini
Neurosciences, University of Padova, Italy
Introduction: Myasthenia gravis (MG) is an autoimmune
disorder in which autoantibodies against the nicotinic
acetylcholine receptor (AChR-Ab) are pathogenetic. About
5 to 30% of MG patients have no detectable AChR-Ab
(seronegative MG), and 50% of them have antibodies
against a muscle specific tyrosine kinase (MuSK-Ab). The
aim of our study was to describe the clinical features in
MuSK-Ab positive MG patients.
Methods: A retrospective evaluation of MG patients was
performed: 207 MG patients at the Clinical Centre for
Neuromuscular diseases of Padua University (131 females,
76 males) were screened for anti-MuSK antibodies. 6 of
them (18%) were found positive. Patients were evaluated
using the MGFA (Myasthenia Gravis Foundation of
America) clinical classification.
Results: Mean age at onset was 30.5 years (range: 22 to 46
years). 1 patient was 40 years old, male, with a clinical
history of bulbar MG. 5 patients were female, 4 with oculo-
bulbar MG (66%), 1 with generalised MG. At last follow-up
4 of them (66%) improved their MGFA score. 1 patient
(16%) was asymptomatic; 2 were stable. They responded
poorly to anticholinesterases and did not benefit from
steroid treatment. They improved with immunosuppressive
agents (Cyclosporine or Azathioprine). 3 patients were
thymectomised: histological findings showed thymic
hyperplasia (2 patients) and atrophy.
Conclusions: MuSK positive patients appear to be a
different and heterogeneous subgroup of MG patients. They
are clinically more severe, requiring more aggressive
treatment. Bulbar involvement is predominant and they
respond poorly to conventional immunosuppression or
thymectomy. Cyclosporine might have a role in their
management.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1767
Exercise and cold-induced sodium
channel myotonia with the SCN4A
mutation
K. Fujii1, S. Sakota2, H. Uchikawa1, A. Takagi1, S. Anzai1,
Y. Kohno1
1Pediatrics, Chiba University Graduate School of Medicine,
Chiba, 2Neurology, Kagoshima University Schiil of
Medicine, Kagoshima, Japan
Introduction: Myotonia is characterized by a failure of
voluntary muscle to relax after contraction ceases and
divided into non-dystrophic and dystrophic types. However,
there exist indistinguishable cases not belonging to either
types, namely sodium channel myotonia. This study aimed
to elucidate the clinical manifestations of sodium channel
myotonia with heterozygous SCN4A mutation.
Methods: We investigated clinical manifestations of five
members in one sodium channel myotonia family. We also
identified the missense mutation as c.3917A (pG1306V) in
the SCN4A gene.
Results: The five members with the SCN4A mutation
exhibited diverse clinical manifestations such as muscle
cramp, muscle stiffness, fatigue, and exercise- and cold-
induced myotonia without increment of muscle volume.
They also exhibited no exacerbation by exercises, drop
attack, or muscle hypertrophy. These manifestations were
different from those of congenital myotonia and
paramyotonia in view of duration and induction. We treated
these patients with carbamazepine or mexiletine, resulting
in successful rescue of the myotonia symptoms.
Discussion: Sodium channel myotonia shows distinct
clinical features compared to those of congenital myotonia
and paramyotonia. Common clinical manifestations of
sodium channel myotonia were exercise- and cold-induced
myotonia without increment of muscle volume. The
mutated protein, p.G1306V, of this Japanese family has
been already reported as G1306E and G1306A in European
families. Although phenotypes of them were different as
myotonia permanent and myotonia fluctuans, this amino
acid substitution would be crucial for maintaining the
regular muscle function in humans.

P1768
Limb girdle muscle dystrophies. Is there a
pathological-genetic correlation?
C. Monteiro1, R. Taipa2, I. Alves3, E. Vieira4,
M. Oliveira4, M. Melo Pires2, R. Santos4, A. Guimares2
1Neurology Department, 2Neuropathology Unit, Hospital de
Santo Antnio - Centro Hospitalar do Porto, 3Neurology
Department, Hospital de So Sebastio, Santa Maria da
Feira, 4Molecular Genetics Unit, Centro de Gentica Mdica
Jacinto Magalhes - INSA, Porto, Portugal
Introduction: Limb girdle muscle dystrophies (LGMD) are
disorders characterized by progressive weakness and
atrophy, with variable age of onset. Although genetic test is
the gold standard for diagnosis, muscle biopsy may suggest
a particular disorder.
Objectives: Our aim was to verify the correlation between
suggested neuropathological diagnosis and molecular
genetics in LGMD, looking for the presence of histo-
enzymological and immunohistochemical patterns.
Methods: We selected the cases in which the
neuropathological diagnosis was LGMD (from the
neuropathology unit database). The genetic result and the
biopsy of each case were reviewed and correlated.
Results: From the 132 biopsies with LGMD diagnosis, only
77 cases have DNA analysis - 18 SGCG, 7 CAPN3, 7
DYSF, 6 SGCA and 6 SGCB; 10 cases have other less
common mutations and 23 remain without diagnosis.
Neuropathological diagnosis was confirmed by genetic test
in 15 gamma-sarcoglycanopathies (from 16 suggested, all
with immunohistochemistry for gamma-sarcoglycan absent
or markedly reduced), 6 dysferlinopathies (9 suggested), 5
alpha-sarcoglycanopathies (5 suggested) and 1 calpaino
pathy (7 suggested). In the 6 beta-sarcoglycanopathies
genetically confirmed, neuropathological diagnosis was
LGMD-non-specified. The review of those biopsies showed
that all have at least 3 sarcoglycans markedly reduced or
absent. Neuropathological suggestion of calpainopathies
(7 cases) was done based on lobulated fibres; this diagnosis
was confirmed in only one case. The other genetically
confirmed calpainopathies did not show lobulated fibres or
inflammatory infiltrates.
Conclusions: Immunohistochemistry was helpful for
diagnosing gamma-sarcoglycanopathies and it could also
have been helpful for beta-sarcoglycanopathies.
Lobulated fibres were misleading for the diagnosis of
calpainopathy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 375
P1769
New phenotype and pathology features in
MYH7-related distal myopathy
G. Tasca1, E. Ricci1, S. Penttil2, M. Monforte1,
V. Giglio3, P. Ottaviani4, G. Camastra5, G. Silvestri1,
B. Udd2
1Institute of Neurology, Catholic University School of
Medicine, Rome, Italy, 2Neuromuscular Research Center,
Tampere University and University Hospital, Tampere,
Finland, 3Centre for Neuromuscular Diseases, Uildm,
4Radiology, Istituto Dermopatico dellImmacolata,
5Cardiology Division and ICU, Ospedale Madre Giuseppina
Vannini, Rome, Italy
Introduction: Laing distal myopathy (LDM) is an
autosomal dominant disease due to mutations in the gene
encoding for the human slow-beta myosin heavy chain,
MYH7. Most reports describe it as a mild, early onset
myopathy with involvement usually restricted to foot
extensors, hand finger extensors and neck flexors, and
unspecific findings on muscle biopsy. We identified the first
two Italian families with LDM, harbouring two novel
mutations in the MYH7 gene.
Methods: Clinical, neurophysiological, pathological,
muscle MRI and cardiological investigations were
performed on affected members from the two families.
Results: Affected members from one family presented a
moderate-severe phenotype, together with distal involve
ment and even loss of ambulation at advanced age. One
patient displayed atypical muscle biopsy findings including
cytoplasmic bodies and myofibrillar myopathy-like
features. Affected members from the second family shared
a very mild phenotype, with weakness largely limited to
long toe and foot extensors and/or late onset. No patient
showed any sign of heart involvement.
Conclusion: Our study significantly broadens the clinical
and pathological spectrum of LDM. We suggest that MYH7
screening should be considered in undiagnosed late-onset
distal myopathy or cytoplasmic body myopathy patients.
376 Posters, Sunday 9 September

P1770 P1771
Exclusive presynaptic location and Protective effect of melatonin against
coupling to ACh release of the novel TNF- toxicity in the L6 muscle cell line
protein kinase C epsilon isoform in the J.G. Lim1, E.J. Chung2, J.H. Park3, D.K. Song3
adult rat neuromuscular synapse Neurology, Keimyung University Dongsan Medical Center,
1

Neurology, Daegu Medical Center, 3Physiology, Keimyung

2
N. Ortiz1, T.I. Orbis2, N. Besalduch2, N.T. Olguin2,
University Dongsan Medical Center, Daegu, Republic of
M.M. Santaf2, M. Toms2, N. Garcia2, M. Priego2,
Korea
M.A. Lanuza2, J. Toms2
1Hospital Universitari Sant Joan, 2Unitat dHistologia i Introduction: An increasing body of evidence implies that
Neurobiologia (UHN), Facultat de Medicina i Cincies de la TNF- plays a critical role in muscle cell destruction in
Salut, Universitat Rovira i Virgili, Reus, Spain inflammatory muscle diseases. We hypothesize that reactive
oxygen species (ROS) mediate TNF--induced muscle cell
Protein kinase C (PKC) regulates a variety of neural
death and destruction. Recently, melatonin has attracted
functions, including ion channel activity, neurotransmitter
attention because of their free radical scavenging and
release and kinetics of postsynaptic membrane receptors.
antioxidant properties.
Nervous tissues express different isoforms of PKC. This
Aim: The aim of this study is to evaluate the possible
diversity of isoforms and their selective location may be the
protective role of melatonin against TNF--induced cell
cause of differences in the PKCs phosphorylation activity.
death in rat L6 myocytes.
Previous studies from our group suggested that the novel
Methods: To examine the functional significance and
isoform of PKC epsilon (nPKCe) is exclusively presynaptic
detailed morphological characteristics of TNF--induced
in the neuromuscular junction (NMJ). In this study we
muscle proteolysis, L6 myocytes were subjected to
examine the distribution of nPKCe in the adult rat
increasing concentrations of recombinant TNF-, and the
neuromuscular junction and its involvement in the release
viability of myotubes was analyzed. L6 myotubes were
of acetylcholine. Immunohistochemical methods and high
incubated in serum-free, 11.1mM glucose-containing media
resolution confocal microscopy showed that PKCe is
containing TNF- with or without various concentrations of
exclusively localized in the nerve terminals of the NMJ.
melatonin, and then cell viability was evaluated using cell
Electrophysiological experiments have shown that blocking
counting assay. Intracellular ROS were measured by using
the activation of PKCe with the specific inhibitor peptide
cell permeable fluorescent dye, H2DCFDA.
eV1-2 completely prevented the enhancement of ACh
Results: TNF- at concentration of 100 ng/ml induced ROS
release induced by the phorbol ester PMA (phorbol
generation and decreased the viability of L6 myotubes.
12-myristate 13-acetate). Phorbol esters are unspecific
Further analysis of cell death showed that TNF- induced
PKCs activators. The potentiation induced by phorbol esters
apoptosis. Melatonin significantly attenuated TNF--
is a good model for presynaptic facilitation and sustained
induced ROS generation and cell death. Muscle fibre
activation of PKCs, and it is also necessary for the regulation
diameter decreased with increasing TNF- concentrations
of presynaptic neural plasticity. This clearly points to a
and was associated with attenuation of the PI3-K/Akt
relevant and specific role for nPKCe in neurotransmission
pathway as well as significant reductions in differentiation
at the NMJ. The coupling of the PKC family to the
markers. Furthermore, treatment of L6 myotubes with
stimulation of the neuromuscular transmitter release by
melatonin strongly ameliorated TNF--induced muscle
PMA could be completely mediated by the nPKCe.
atrophy and proteolysis.
Conclusion: These results suggest that ROS might be
mediated in TNF--induced muscle proteolysis and
melatonin may be useful as protecting agents for muscle
cell destruction related with inflammatory muscle diseases.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1772
Improvement in gastro-intestinal
symptoms following enzyme replacement
therapy in adult-onset Pompes disease
J. Pardo, A. Lpez-Ferreiro, E. Costa-Arpn,
M. Santamara-Cadavid, G. Fernndez-Pajarn,
M. Pardo-Parrado
Neurology, Hospital Clnico, Santiago de Compostela, Spain
Introduction: Pompes disease is a rare, autosomal
recessive glycogen storage disorder, caused by a deficiency
of acid-alpha-glucosidase (GAA). Late-onset Pompes
disease tends to present with progressive proximal weakness
and respiratory insufficiency, but other clinical features are
still emerging and have not been well documented yet.
Methods: We report a 65-year-old male diagnosed with
late-onset Pompes disease and treated with enzyme
replacement therapy (ERT) since June 2011.
Results: His symptoms began 30 years ago with proximal
bilateral lower extremity weakness. Five years later, he
presented respiratory insufficiency that required non-
invasive ventilation. During hospitalization for upper
gastro-intestinal bleeding, at the age of 51, he presented
acute respiratory failure and since then he has been on
mechanical ventilation. When seen in the Neurological
Department at the age of 64, the patient had undergone three
muscle biopsies, with normal results. At this time, the
patient complained of deteriorating muscle function, fatigue
and weight loss. During the previous twelve months,
chronic bloating, abdominal pain, with occasional diarrhoea
or intestinal subocclusion had been major complaints.
Diagnosis was made after evidence of deficient GAA
enzymatic activity on dried blood spot testing that was later
confirmed in cultured fibroblasts. Molecular studies
demonstrated mutations in the GAA gene. After four months
on ERT, his abdominal pain and bloating were resolved.
Conclusion: To the best of our knowledge, only three
patients with late-onset Pompes disease have been reported
with improvement in gastro-intestinal function following
ERT. Gastro-intestinal symptoms are unrecognized
manifestations of this rare disease and merit more attention.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 377
P1773
Muscle dystrophy due to dysferlin
deficiency: a phenotype study of 17
Moroccan families
N. Birouk1, S. Sefiani2, H. Beladi1, B. Benaaboud1,
B. Kably1, R. Ouazzani1
1Neurophysiologie Clinique, 2Neuropathologie, Facult de
Mdecine-Universit Mohamed V Souissi, Rabat, Morocco
Dysferlin deficiency is responsible for different phenotypes
of muscle dystrophies including limb girdle syndrome and
distal myopathy. This work aims to give a phenotype
description of dysferlin deficient patients belonging to 17
Moroccan families. All patients underwent clinical
evaluation for muscle impairment distribution and
orthopaedic signs, CK dosage, electroneuromyography and
muscle biopsy with immunocytochemistry for dystrophin,
sarcoglycans ( and ) and dysferlin. 18 patients aged
14 to 57 years were examined. There were 11 males and 7
females. Age at onset was 20.97.4 years (range: 12 to 35).
13 families had an established consanguinity, 9 families had
more than 1 affected member and 4 families had isolated
cases. The phenotypes were as follows: Myoshi type in 7
patients, limb girdle syndrome was found in 4, associated to
lower limbs distal muscles involvement in 4, to biceps
brachialis muscles deficit in 2 and to tibialis anterior
impairment in 1 patient. CK level was 1.5 to 6 times normal
value. All patients had dystrophic changes on muscle biopsy
with absence of dysferlin whereas dystrophin and
sarcoglycans were normal on immunocytochemistry.
Functional disability was variable, 2 patients were wheel
chair bound at the ages of 23 and 38 years, respectively.
Dysferlin deficiency was identified in 41.5% of muscle
dystrophy families with limb girdle and/or distal muscles
impairment in our series. It seems to represent the second
cause of muscle dystrophies in Morocco after
sarcoglycanopathies. A screening for the responsible
dysferlin gene mutations is necessary to identify a probable
founder mutation in our population.
378 Posters, Sunday 9 September
P1774
Botulinum toxin (BOTOX)
efficacy, safety
in blepharospasm and hemifacial spasm
M. Cabalar, V. Yayla, T. Yazar, A. Culha, O. Selcuk,
V. Guzel
Bakirkoy Training and Research Hospital, Department of
Neurology, Istanbul, Turkey
Introduction: Botulinum toxin (Botox) is most widely
used for blepharospasm (BPS) and hemifacial spasm (HFS).
We aimed to evaluate the efficacy of the drug and to present
our results of 4 years experience.
Methods: We present 15 BPS patients and 67 HFS patients
who have been treated with Botox. The average dose of
Botox performed for an optimal response was 30-35 MU
for BPS, 25-30 MU for HFS.
Results: The therapeutic effect started after 3 to 5 days and
the mean total duration of response, initial repetitive
efficacy intervals (REI) were longer in BPS (7.463.98
months) and HFS (6.333.92 months) than last REI in BPS
(5.950.17 months) and HFS (3.280.64 months). There
was a significant statistical difference between the second
REI (BPS 14.454.13 and HFS 6.824.04 months) and the
last REI (BPS 5.950.17 and HFS 3.280.64 months)
(p<0.05). The mean efficacy of treatments was 3.330.72
(0=no effect, 4=marked improvement) in BPS and HFS.
Adverse effects occurred in 7.29% of injection series.
Conclusion: Botulinum toxin is an agent effective and safe
when suitable technique and material are used in treatment
of BPS and HFS. But, long-term therapy is sometimes
associated with therapy failure following repeated injections
of the neurotoxin, presumably due to specific antibody
production. Therefore, we suggest that a shift from one
product (Botox vs. Dysport) to another should be
considered in case of failure with one product.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1775
AChR-Ab and MuSK-Ab positive
myasthenia gravis: morphological and
ultra structural findings on muscle biopsy
M. Bisciglia, S. Martignago, E. Albertini, M. Fanin,
E. Pegoraro, C. Angelini
Neurosciences, University of Padova, Italy
Introduction: Myasthenia gravis (MG) is an autoimmune
disorder: 80% of patients have antibodies against the
nicotinic acetylcholine receptor (AchRAb), 50% of
seronegative patients have antibodies against a muscle
specific receptor tyrosin kinase (MuSK-Ab). The task of
our study was to compare the histological features and
muscle fibre atrophy in muscle biopsy of AChR-Ab and
MuSK-Ab positive MG patients.
Methods: We analysed skeletal muscle biopsy of 13 MG
patients, 7 positive to AChR-Ab (AChR+) and 6 to MuSK-
Ab (MuSK+). MuSK+ patients were all females with a
mean age of 39 years, AChR+ patients were 2 females and
5 males aged 62 years on average.
Results: Mean muscle fibre atrophy factor was higher in
AChR+ MG than MuSK+ MG (normal range 0-150), in
type I fibres (494 versus 210) and particularly in type II
fibres (1023 versus 300). Morphological analysis showed
presence of type I and type II fibre grouping in AChR+
cases that demonstrate a post-synaptic action of AChR-Ab.
A correlation with corticosteroid therapy is excluded:
biopsies were done before steroid treatment. COX-negative
fibres were found in MuSK+ cases. Pycnotic nuclei and
myofibrillar disarray were found in AChR+ MG, where
mitochondria were disposed perpendicularly to the
sarcomeres. Disruption of mitochondrial cristae and
swelling of mitochondria were present in MuSK+.
Conclusion: Our findings suggest muscle atrophy of
MuSK+ and AChR+ patients to be different. AChR-Ab
cause marked muscle atrophy and neurogenic aspects.
MuSK-Ab is associated with myopathic signs and
mitochondrial abnormalities. Mitochondrial impairment
could explain the oculo-bulbar involvement in MuSK+ MG.

P1776
Investigation of HLA-DRB1 as a risk allele
for familiar auto-immune myasthenia
gravis
J. Gamez1,2, J.M. Ponseti1,3, M. Canela1,4,
M.J. Herrero-Mata5, M. Salvad-Figueras1,
E. Palou-Rivera5
1Myasthenia Gravis Unit, Hospital Universitari Vall d
Hebron, 2Institut de Recerca, VHIR, 3Surgery Department,
Clinica Teknon, 4Thoracic Surgery Department, Hospital
Universitari Vall d Hebron, 5Laboratori de Immunobiologia
per Recerca i les Aplicacions Diagnostiques, Banc de Sang i
Teixits (LIRAD-BST), Barcelona, Spain
Auto-immune myasthenia gravis (MG) is usually a sporadic
disease. After observing MG in a woman whose sister had
died of the disease, Oppenheim suggested the possible
involvement of genetic factors in 1898. We aimed to
investigate the prevalence of familiar forms in a cohort of
267 auto-immune MG patients, and the HLA-DRB1 gene
as a possible risk for familial MG. We identified 8
individuals from 5 unrelated families. The average age of
onset was 49.8 years (range 31-69). The MGFA types were
I (1), IIa (3) IIb (1), IIIa (1) and IIIb (2). Five had been
thymectomized (hyperplasia 3, thymoma 2). The type of
inheritance suggested an autosomal dominant pattern in 2
families and a recessive pattern in the other 3. The
DRB1*03:01 genotype was identified in 6 patients,
belonging to four of the families studied. The frequency of
familial forms of MG in the population studied is 2%,
similar to that observed in other studies. We found no
association with any common HLA haplotype. However,
the prevalence of DRB1*03:01 in our series was 50% for all
the genotyped alleles (9 patients). This could be a candidate
risk factor for myasthenia gravis, as the normal prevalence
of this phenotype among tissue donors in Spain ranges
between 11% and 19%. Genetic risk factors for familial
myasthenia other than the HLA-DRB1 gene may be
involved. The different inheritance patterns, phenotypes,
antibody types and histological characteristics described in
the families suggest genetic heterogeneity.
Acknowledgements: PI 10/01070 FIS-FEDER.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 379
P1777
Anti MuSK positive myasthenia gravis.
Pitfalls of diagnosis and therapy
management in the Czech Republic
M. Jakubkov, J. Piha, M. Tblov, I. Novkov
Department of Neurology and Center of Clinical
Neuroscience, Charles University in Prague, 1st Faculty of
Medicine and General University Hospital Prague, Czech
Republic
Introduction: MG is an autoimmune disease marked by
neuromuscular transmission failure at the neuromuscular
junction. Antibodies against acetylcholine receptors are
found in about 85% of all patients. In the year 2001
antibodies against muscle specific tyrosine kinase (MuSK)
have been discovered also as their pathogenetic role in
neuromuscular transmission.
Material and methods: In our center investigation of
antibodies to MuSK was introduced in the year 2007 for all
newly diagnosed seronegative patients with clinically
definite diagnosis of MG. By the method of radio
immunoassay (RIA) total of 226 serum samples were
examined.
Results: 9 patients were identified, 6 women and 3 men.
The mean age at first symptoms was 24.3 years (8-49) in
women, and 40.3 in men (20-57). In 5 patients, the first
symptom was diplopia or ptosis, bulbar weakness in 3
patients, shortness of breath in 1 patient. In 4 patients low-
frequency repetitive stimulation and single fibre EMG was
negative. The mean level of anti-MuSK was 1.167nmol/l
(0.335 to 1.89). In 5 patients more than 1 relapse (an average
of 5.4 relapses) was observed. All patients have been treated
by corticosteroids, 8 of them by immunosuppressants,
1 woman was treated by rituximab. Currently, the
quantitative myasthenia gravis score is 10.1 on average.
Conclusion: We demonstrated a low sensitivity of
electrophysiological testing and poor response to
cholinesterase inhibitors in our patients. There is no clear
correlation between levels of anti MuSK with the number
of relapses. In all patients we achieved clinical remission.
380 Posters, Sunday 9 September
P1778
Myasthenia gravis: interactions of new
acetylcholinesterase inhibitors with
nicotinic receptors
V. Sepsova1, J. Krusek2, L. Drtinova1, M. Pohanka3,
J.Z. Karasova4
1Toxicology, University of Defence, Faculty of Health
Sciences, Hradec Krlov, 2Institute of Physiology, Academy
of Sciences of the Czech Republic, Prague, 3Centre of
Advanced Studies, 4Public Health, University of Defence,
Faculty of Health Sciences, Hradec Krlov, Czech Republic
Reversible inhibitors of acetylcholinesterase (AChE) are
used in the treatment of the autoimmune disorder -
myasthenia gravis. The mechanism of action is based on the
inhibition of AChE active site that leads to an increase of
acetylcholine concentration and its prolonged presence in
the synaptic cleft compensate for the pathologic reduction
of neuromuscular receptors. Moreover, certain AChE
inhibitors are able to act directly as nicotinic receptor
modulators. In our study we have focused on the unknown
non-acetylcholinesterase effects of several AChE inhibitors.
Measurements were performed using whole-cell patch-
clamp technique. Drugs were applied using a rapid perfusion
system. Two new peripherally acting AChE inhibitors (K
298, K 524) were compared with two standards
(Edrofonium, BW284c51). All experiments were performed
on TE671 cell line expressing human embryonic muscle
acetylcholine receptor. Values of 50% inhibition (IC50)
were calculated by fitting the data to the Hill equation. All
tested compounds show a comparatively high reversible
inhibition effect (IC50). When tested compounds were pre-
applied for 5s and then co-applied with the agonist
acetylcholine (100M), responses were inhibited in
concentration dependent manner. New synthesized inhibitor
K 524 shows the lowest IC50 value 5705nM that is
approximately one or two order of magnitude lower
compared to standards. Mechanism of nicotinic receptor
inhibition is still unknown and will be discussed within our
contribution. Supported by a grant of the Ministry of
Education, Youth and sports, Czech Republic: Specific
research: Determination of biochemical and
pharmacokinetics parameters of acetylcholinesterase
inhibitors is gratefully acknowledged, AV0Z 50110509.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1779
Lack of association of toll-like receptor 9
polymorphisms with myasthenia gravis in
Han Chinese
H. Li, Y. Hong, T. Liu, X. Gao
Neurology, Affiliated Hospital of Medical College, Qingdao
University, Qingdao, China
Introduction: Toll-like receptor 9 (TLR9) is a kind of
pattern recognition receptor which can recognize bacterial
and virus genomic DNA. A recent study shows that TLR9
may play an important role in the induction and perpetuation
of autoimmune diseases. The aim of our study was to
investigate whether the polymorphisms of TLR9 variants
were associated with myasthenia gravis (MG).
Methods: A total of 132 MG patients and 212 matched
healthy control samples in a northern Han Chinese
population were included in this study. The genomic DNA
was extracted and subjected into PCR-RFLP analysis. Two
tagging SNPs (rs352140 and rs187084) that span TLR9
gene were selected by haploview software. Genotypes,
allele frequencies and haplotypes of patients and controls
were evaluated for the SNPs using the online software
SNPStats. Subgroups of MG patients were classified by
sex, age, thymoma and severity of MG.
Results: Both rs352140 and rs187084 showed
polymorphism in Han Chinese population and the
distribution of genotypes meets the Hardy-Weinberg
equilibrium. But no significant differences in the frequency
of alleles, genotypes, and haplotypes in the MG cases were
detected compared with healthy controls. There was also no
association within subgroups of MG patients.
Conclusion: We did not find an association between the
two tagging SNPs within TLR9 gene and myasthenia
gravis. TLR9 gene may not be a major genetic determinant
of MG.

P1780
Successful treatment of hypokalemic
periodic paralysis with topiramate
J. Pardo1, T. Garca-Sobrino1, F. Barros2, B. Quintns3,4,
M.J. Sobrido3,4,5, A. Lpez-Ferreiro1
1Neurology, Hospital Clnico, 2Unidad de Medicina
Molecular, Fundacin Pblica Galega de Medicina
Xenmica, 3Hospital Clnico, Santiago de Compostela,
4Center for Biomedical Network Research on Rare Diseases
(CIBERER). Institute of Health Carlos III, Madrid,
5Fundacin Pblica Galega de Medicina Xenmica,
Santiago de Compostela, Spain
Introduction: Hypokalemic Periodic Paralysis (hypoPP) is
the most common form of periodic paralysis. Most patients
have a mutation in the CACNA1S (hypoPP type I) or in the
SCN4A (hypoPP type II) gene. Preventive treatment with
carbonic anhydrase inhibitors or potassium supplementation
is usually needed. In a recent case report, treatment with
topiramate was found to be effective in two 11-year-old
twins with hypoPP.
Methods: We present a 36-year-old man diagnosed with
hypoPP type I, with episodes of transient weakness since
the age of 14.
Results: Since his first spell of generalized transient
weakness lasting several hours, the patient was treated with
daily oral potassium. In the next years, the frequency of
attacks increased and acetazolamide was added, with initial
benefit. In 2001, acetazolamide was stopped because of
increasing frequency of attacks and dichlorphenamide was
introduced, with a decrease in severity of attacks in the
following months. Two years later, because his episodes
went up again both in frequency and severity,
dichlorphenamide was stopped and the patient was put
again on acetazolamide. During the last year, the patient had
attacks every two weeks, and acetazolamide was switched
to topiramate in June 2011. Since then, he only had two
minor attacks upon initiation of the drug, and he remained
asymptomatic nine months later.
Conclusion: To our knowledge, this is the second report of
the therapeutic benefit of topiramate in cases of refractory
hypoPP. A clinical trial with this drug is warranted as an
additional treatment option for hyoPP.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 381
P1781
LGMD-2B: clinical phenotype and
diagnosis 50 years after the first
symptoms
J. Moreira Martins1,2, L. Santos2,3
1Neurology, Hospital Pedro Hispano, Matosinhos,
2Neurology, Hospital de Egas Moniz - CHLO, Lisbon,
3Neurology, Hospital Fernando Fonseca, Amadora, Portugal
Introduction: Determining the subtype and etiology of
muscle disease in patients with LGMD phenotype is
fundamental for genetic counselling, cardiac/respiratory
monitoring and further research and therapy. We report a
case whose diagnosis was made 50 years after the first
symptoms, with appropriate selection of the muscle to
biopsy.
Clinical case: A lady aged 75, who initiated proximal
paresis of lower limbs at the age of 25 years, becoming
dependent on a wheelchair at 30. At 55 proximal paresis of
upper limbs began and three years later, ventilatory
dysfunction due predominantly to diaphragmatic paresis
progressing; years later, to severe restrictive pattern needing
BiPAP. EMGs showed a myopathic pattern. Two previous
biopsies gave inconclusive results. At present she has
relatively spared extensor muscles of the wrist and fingers,
hip abductors, and toes flexors, with severe muscle atrophy
and weakness of most of the other muscles. A new muscle
biopsy was performed 50 years after the first symptoms
(forearm extensor digitorum communis) showing dystrophic
findings, absence of immunohistochemical labelling for
dysferlin, positive MHC-I, perimysium and perivascular
inflammatory infiltrates. The mutation DYSF: c.610C>T
(p.Arg204X) was found, apparently in homozygosity in
exon 6.
Discussion and conclusions: This case illustrates the
selective relative sparing of certain muscle groups even
after 50 years of clinical progression of LGMD-2B
allowing, even then, a diagnosis by muscle biopsy. The
presence of inflammatory findings is described in
dyspherlinopathies, but could pose diagnostic uncertainty
and change the treatment options.
382 Posters, Sunday 9 September
P1782
Video hand opening time (vHOT) in
myotonic dystrophy type 1 (DM1): data
from STOPP DM
A. Puwanant, J.M. Statland, K.J. Eichinger, N. Dilek,
R.T. Moxley, C.A. Thornton
Neurology, University of Rochester Medical Center,
Rochester, NY, USA
Introduction: Delayed release of the handgrip in DM1
reflects myotonia and finger extensor weakness. Previous
methods to quantify myotonia required expensive
equipments and extensive evaluator training. Video
recording is an accepted procedure to assess motor
performance in clinical trials.
Objective: To evaluate test-retest reliability and validity of
vHOT.
Methods: vHOT recordings were collected in 20 DM1
subjects on 2 consecutive days and reviewed by 2 blinded
raters. On each day 3 trials of 5-second maximal handgrips
followed by rapid full extension of the fingers were recorded
with 10 minutes rest between trials. Time for maximal hand
opening was measured separately for the thumb and long
finger. vHOT was compared to 90% to 5% handgrip
relaxation times made, using a computerized handgrip
myometer and automated software on the same day.
Results: The mean vHOT was 4.65.6 seconds. vHOT was
longer for the thumb than the long finger. The correlation of
vHOT between trials on the same day (r=0.94-0.97) was
better than for trials on separate days (r=0.88). There is no
evidence for warm-up in successive trials. The ICC for
test-retest concordance for the same rater on 2 successive
days was 0.71. The ICC for concordance between 2 raters
was 0.96. The correlation between mean vHOT and 90% to
5% handgrip relaxation times was 0.75.
Conclusions: vHOT is a simple, reliable, low-cost
alternative to computerized handgrip myometry for
assessing myotonia and finger extension in disease
progression and therapeutic trials in DM1.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1783
Early manifestations of Eaton-Lambert
myasthenic syndrome in the structure of
paraneoplastic disorders of the nervous
system
Y.G. Dubenko
Neurology, Kharkiv National Medical University, Kharkiv,
Ukraine
Introduction: Detection of early stages of paraneoplastic
disorders of the nervous system is an insufficiently explored
issue, especially as far as the pathology of neuromuscular
transmission is concerned. This causes frequent diagnostic
mistakes.
Object and method: Neurologic, immunologic and EMG
examination of 147 patients diagnosed with small cell lung
cancer was performed. A group of 39% exhibited weakness
in proximal lower limbs with the tendency towards
decreased tendon reflexes. 28% of the examined group had
started experiencing weakness 9-15 months before the
oncological pathology was diagnosed. Only 21% of the
examined patients exhibited autonomic imbalances
(decreased salivation and tear production, orthostatic
hypotension), 7% of the patients exhibited oculogyric
malfunctions. Thus, increasing, sometimes varying leg
weakness in part of the patients was the only clinical
implication of the disease, with the oncological pathology
not yet diagnosed.
Results: Only immunological tests (showing the presence
of Anti VGCC and Anti PCA-2) and EMG (at high
frequency rhythmic stimulation the test registered increased
summery potential, while during low frequency stimulation
the summary potential decreased to the myasthenic typical
low) allowed identifying the pattern of Eaton-Lambert
syndrome early manifestation.
Conclusion: Early clinical forms of Eaton-Lambert
syndrome do not always have typical clinical evidence; yet,
specific immunological tests and EMG make it possible to
diagnose right and explore the likely oncological pathology
that lacks clear manifestation.

P1784
Limb-girdle muscular dystrophies with
autosomal-dominant inheritance
T. Adyan, O. Ryzkova, A. Polyakov
Medical Genetics Research Center, Moscow, Russia
Limb-girdle muscular dystrophies (LGMD) are an example
of both clinical and genetic heterogeneity. Clinically, by the
description of non-LGMD phenotypes associated with
LGMD genes and of LGMD phenotypes associated with
originally non-LGMD disease genes; and genetically, by the
description of new LGMD genes that further increase the
diagnostic complexity. In these diseases genetic consultation
and prevention becomes complicated by this fact. By means
of direct automatic sequencing we analyzed coding
sequences and adjacent introns of the MYOT, LAMIN and
CAV3 gens, causing LGMD 1A, 1B, 1C, respectively, and
DES, CRYAB gens, causing myofibrillar myopathies,
among a sample of 18 unrelated patients with signs of
progressing limb-girdle muscular weakness (7 men, 11
women). In all subjects vertical segregation of the disease
in the family was observed. LMNA gene mutations were
identified in 4 patients (22.22%), one patient had MYOT
mutation (5.55%) and one patient had DES mutation
(5.55%). Revealed some features of the clinical picture of
patients with mutations in the analyzed genes. The data
obtained may be the basis for the algorithm of molecular
genetic diagnosis of LGMD with autosomal-dominant
inheritance.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 383
P1785
Clinical difference between myasthenia
gravis patients with an onset age of 50-64
and 65
W. Sakai1,2, N. Matsui1, Y. Izumi1, R. Kaji1
1Neurology, Tokushima University Hospital, Tokushima,
2Neurology, Nagasaki Kawatana Medical Center, Nagasaki,
Japan
Introduction: The incidence of elderly-onset myasthenia
gravis (MG) has been increasing all over the world. With an
aging population the management of elderly-onset MG is
becoming an important and challenging aspect of medical
practice.
Methods: We retrospectively analyzed 47 MG patients with
onset age at 50 years and above. We compared the clinical
characteristics of two groups, the late-onset MG (50-64
years; LOMG) and the elderly-onset MG (65years;
EOMG).
Results: 20 EOMG and 27 LOMG patients were enrolled
in our study. The EOMG group had more frequent incidence
of generalization (p<0.05) and it happened over a shorter
period. The EOMG group had a lower prevalence of anti-
acetylcholine receptor antibody and its titres. Both groups
received immunomodulatory therapy which mainly
consisted of prednisolone and calcineurin inhibitors (CNIs).
55.6% of LOMG patients and 75.0% of EOMG patients
received CNIs. The EOMG group had a better response
under the lower dose of prednisolone than the LOMG group
after one year of therapy.
Conclusions: The EOMG patients more frequently
experience generalization than the LOMG patients. The
EOMG patients should receive immunotherapy in the early
stage of the disease course.
384 Posters, Sunday 9 September
P1786
Stiff person syndrome associated with
Graves disease and thymoma
S.S. Yoon1, K.J. Hwang1, J.T. Woo2, S.S. Cho3
1Neurology, 2Endocrinology, Kyung Hee University Hospital,
Seoul, 3Pohang, Republic of Korea
Background: Stiff person syndrome (SPS) is a rare
neurologic disorder, in which muscle rigidity and cramps
result from immune-mediated inhibition of GABAergic
neuron function. SPS is associated with autoimmune
diseases and paraneoplastic conditions.
Case: A 50-year-old woman presented with progressive
stiffness of the trunk muscles and painful spasms in both
legs. She had difficulty in standing and walking. She was
diagnosed with Graves disease at an endocrine clinic and
had no other significant medical history. Her TSH-binding
inhibiting immunoglobulin, antimicrosomal, anti-glutamic
acid decarboxylase (GAD), and anti-acetylcholine receptor
antibody levels were high. On electromyography, both of
her lower extremities showed continuous motor unit
activities. A chest CT showed a thymoma, for which she
underwent an extended thymectomy. After the thymectomy,
she was treated with diazepam.
Conclusion: SPS is a rare disorder that might have various
aetiologies. Many immunological possibilities might be
considered for SPS pathogenesis.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1787
Response of refractory generalized
myasthenia gravis to treatment with
rituximab: first report from Kingdom of
Bahrain
I. Ahmed Alsharoqi
Clinical Neuroscience, Salmaniya Med Complex, Manama,
Bahrain
Objective: Myasthenia gravis (MG) is the most frequently
encountered neuromuscular disorder of an autoimmune
pathology. Current therapies available, which are mainly
immune modulators or suppressors, include acetyl
cholinesterase inhibitors, corticosteroids, azathioprine,
methotrexate, cyclophosphamide, mycophenolate mofetil,
intravenous immunoglobulin (IVIg), plasmapheresis and
thymectomy. Many of these therapies carry significant side
effects and in many instances not a satisfactory
improvement.
Methods: We report two patients with generalized MG who
presented with a rapid down spiral clinical course. Both
female patients were in a myasthenic crisis with severe
bulbar weakness and on mechanical ventilation with
quadriparesis and facial diplegia and ophthalmoplegia. Both
were seropositive, however, they were Musk negative. One
of them had malignant thymoma grade 4. Both patients
received IVIg, plasmapheresis and were on mycophenolate
mofetil in addition to corticosteroids but with poor response.
Results: We initiated rituximab with a mean follow-up of
2.5 years (375mg/m2, on days 1, 8, 15, 28 during the first
month and then one dose every 6 months). The response
was remarkable. In 3 weeks they were off ventilator and
they were then fully independent. After 2.5 years of follow-
up, both patients stopped acetyl cholinesterase inhibitors
and corticosteroids. One of the patients died from the
complication of malignant thymoma.
Conclusion: Rituximab, an anti-CD20 monoclonal
antibody is an effective therapy for refractory MG, including
patients with malignant thymoma, being well tolerated by
patients. This is the first report from Bahrain regarding the
use of Rituximab in Arab patients. We also frequently use it
for other immune related neurological disorders.

P1788
Dysferlinopathy presenting as
asymptomatic hyperCKemia
M.T. Brum, A.M. Romeiro, P. Santos, R.M. Guerreiro,
J. Pinto Marques
Department of Neurology, Centro Hospitalar de Setbal,
Portugal
Introduction: Dysferlinopathies are autosomal recessive
muscular dystrophies caused by mutations in the dysferlin
(DYSF) gene. There are 2 main phenotypes: Miyoshi
myopathy (MM) and limb-girdle muscular dystrophy type
2B (LGMD2B). Both entities show onset in young
adulthood, a slow course and massive increase in serum
creatine kinase (CK) level. Other rarer phenotypes have
been described, expanding the spectrum of clinical
manifestations and prognosis of dysferlinopathies, in
particular the form of asymptomatic hyperCKemia.
Methods: In a female, 24-year-old, Caucasian we
performed anamnesis, neurological examination and
diagnostic tests such as determination of serum CK level,
EMG, muscle biopsy and genetic study.
Results: The daughter of non-consanguineous parents with
minor thalassemia and epilepsy since being 11 years old;
mother with hyperCKemia without muscular complaints;
no family history of epilepsy. After a seizure, high CK level
in serum (>10x upper limit of normal) was detected. The
patient denied myalgia, cramps or other symptoms;
observation showed normal strength, without muscle
atrophy or hypertrophy and negative Gowers manoeuvre.
EMG was normal. Muscle biopsy showed absent labelling
for dysferlin on immunohistochemistry. The genetic study
identified two heterozygous mutations in DYSF gene:
c.4003G> A at exon 37 and exon 50 in c.5594delG,
confirming the diagnosis of LGMD2B.
Conclusion: In addition to typical MM and LGMD2B, the
dysferlinopathies are a clinically heterogeneous group,
ranging from asymptomatic to severe functional disability.
In this case only follow-up will clarify, whether this is an
asymptomatic hyperCKemia or a pre-symptomatic stage.
The dysferlinopathies must be considered in the differential
diagnosis of asymptomatic hyperCKemia.
P1789
Abstract cancelled
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 385
P1790
Stiff-person syndrome associated with
invasive thymoma, pemphigus and
myasthenia gravis: a case report
X. Gao, X. Zheng, H. Li
Neurology, Affiliated Hospital of Medical College, Qingdao
University, Qingdao, China
Case report: A 57-year-old woman has suffered from
weakness of four limbs for 1 year and stiffness and rigidity
of her lower limbs for 11 years before presenting to us. The
rigidity was relieved by sleeping, relaxation, and oral
clonazepam treatment. Repetitive nerve stimulation
revealed decrement response when she first felt weakness.
A CT scan of the thorax revealed invasive thymoma. 1
years ago, she presented with erythema and blister on her
skin, and pemphigus was diagnosed pathologically.
Pemphigus was treated and significantly improved. Before
the patient first presented with fatigability, the signs of
pemphigus had disappeared. Neurological examination
after rest revealed no ptosis or diplopia, normal motor and
sensory function. But muscle fatigue was revealed after
sustained exertion. Laboratory tests showed significantly
elevated anti-AchR antibody titre, elevated blood
sedimentation rate, positive anti-nuclear antibody,
significantly elevated anti-GAD (glutamic acid
decarboxylase) antibody level and positive anti-
amphiphysin antibody. Nerve conduction studies and needle
electromyography were normal and repetitive nerve
stimulation was consistent with MG. A positive result of
neostigmine test supported the diagnosis of MG. She was
treated with pyridostigmine bromide and prednisolone, and
the symptoms relieved. Clonazepam 2mg/d was also
administered during that time to relieve her stiffness and her
myasthenic symptoms did not worsen.
Conclusion: MG, stiff person syndrome and pemphigus in
the same patient, who presents with invasive thymoma, is
thought to be the result of generalized abnormal
immunoregulation due to thymoma.
386 Posters, Sunday 9 September
P1791
The value of systematic clinical
examinations in determining the involved
muscles and clinical classification of
myasthenia gravis patients
H. Li, P. Liu, X. Gao, T. Liu
Neurology, Affiliated Hospital of Medical College, Qingdao
University, Qingdao, China
Introduction: The roles of history-taking, fatigue test and
neostigmine test in determining muscle involvement and
clinical classification of myasthenia gravis (MG) is
unknown.
Methods: 64 MG patients were assessed by physician A
with history-taking, fatigue test, neostigmine test and
repetitive nerve stimulation (RNS) successively. The value
of each item mentioned above in determining the involved
muscles and clinical classification of MG was evaluated by
comparing each step. The results were sent to four other
physicians with diverse experience in managing MG.
Agreement among different physicians was analyzed with
the kappa test.
Results: After step 2, the determination about muscle
involvement was revised in 35 patients, and the Osserman
classification in 11 patients and MGFA classification in 21
patients. After step 3, the scope of muscle involvement was
reduced in 9 cases, and classification revised in 6 cases.
After step 4, the scope of muscle involvement was increased
in 25 cases, and classification revised in 10 cases. Kappa
values among physicians were greater than 0.5 (p<0.001 for
all comparisons) in each step. Kappa values of Osserman
classification were higher than those of MGFA classification
in all steps.
Conclusion: Fatigue test is most important in identifying
potential muscle involvement and determining clinical
classification accurately. The neostigmine test improves the
specificity for determining the involved muscles. However,
neither neostigmine test nor RNS influences the
determination of clinical classification. There is relatively
good agreement in clinical classification among physicians.
The agreement of the Osserman classification is better than
that of MGFA classification.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1792
Clinical course of late- and very-late
onset MG
B. Szyluk1, P. Szczudlik1, M. Lipowska1,
J. Kubiszewska1, M. Dutkiewicz2, A. Kostera-Pruszczyk1
1Neurology, 2General and Nutritional Biochemistry, Medical
University of Warsaw, Poland
Objectives: In aging societies the incidence of late (>50)
myasthenia gravis (MG) increases. The aim of the study
was to provide clinical characteristics of late MG in Poland.
Material and methods: Single center register of
consecutive 424 MG patients, aged 2-89. The clinical
features were compared between three groups of patients:
222 with early-onset MG (EOMG, 15-50), 79 with LOMG
(50.1-65) and 73 with very-late onset MG (VLOMG >65).
Results: The female:male ratio was 5:1 in EOMG, 1:2 in
LOMG and 3:4 in VLOMG. Acetylcholine receptor
antibody-seropositive patients constituted, respectively 81,
87 and 92% of the groups. Ocular presentation of MG was
twice more frequent in VLOMG than in EOMG (30
vs.15%). Severe disease course complicated by myasthenic
crisis was observed in 15, 18 and 7% of patients,
respectively. MG was the only disease in 68% of EOMG,
23% of LOMG and 13% VLOMG. Thymoma was
diagnosed in 8% of early-onset, 13% of late-onset and 1.5%
of very late-onset MG. History of neoplasm (other than
thymoma) had 0.4% of EOMG, 7.6% of LOMG and 12%
of VLOMG patients. Maximal MGFA severity was
significantly milder in patients older than 50.
Conclusion: In Polish MG patients older than 50 the
clinical course of the disease is more favourable than in the
early-onset group, despite high frequency of concomitant
diseases. Supported by Polish-Norwegian Research Fund
Grant PNRF-204-AI-1/07

P1793
The serum level of a proliferation inducing
ligand (APRIL) in patients with myasthenia
gravis
A. Safari, A. Borhani Haghighi, D. Niknam, M. Ghodsi,
E. Kamali Sarvestani
Shiraz University of Medical Sciences, Shiraz, Iran
Background: Myasthenia gravis is the most common
immune-mediated disorder of neuromuscular junction.
About 85% of myasthenic patients have auto antibodies
against the skeletal muscle acetylcholine receptor (AChR).
B-cell accumulation in the thymus is a hallmark of
myasthenia gravis and it seems that some B-cell stimulating
factors such as a proliferation inducing ligand (APRIL),
could be considered as a therapeutic target in Myasthenia
gravis.
Methods: The level of A-proliferation inducing ligand
(APRIL) was assessed in the study population (myasthenia
gravis patients: 35; healthy controls: 35) using ELISA
method.
Results: Mean serum level of APRIL was 9.625.77pg/mL
in patients and 2.65.58pg/mL in controls; the difference
was not statistically significant (P value: 0.28).Furthermore
the levels of APRIL in various stages of myasthenia gravis
were significantly differed (P value: 0.94) in our study
population.
Conclusion: Against some other autoimmune disorders
such as systemic lupus erythematosus and rheumatoid
arthritis, the level of APRIL in the serum of patients with
myasthenia gravis was not considerably increased and
APRIL might not be the proper treatment target of this
disorder.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 387
P1794
Collagen type-VI related myopathies
spectrum: genotype-phenotype
correlation in two patients
A.M. Carrilho1, I.M. Cordeiro2, I. Conceio3,
T. Evangelista3
1Neurology, Hospital de So Bernardo, CHS, EPE, Setbal,
2Neurology, Hospital de Faro, Faro, 3Neurology, Centro
Hospitalar de Lisboa Norte, Hospital de Santa Maria,
Lisbon, Portugal
Introduction: COL6A1, COL6A2, COL6A3 gene
mutations cause collagen type-VI (ColVI) myopathies, a
clinical spectrum at each end represented by Ullrich
congenital muscular dystrophy (UCMD) and Bethlem
myopathy. Less well-defined intermediate phenotypes are
described in between. Clinical overlap between spectrum
phenotypes makes differential diagnosis difficult.
Cases report:
Case 1: Female, 39 years, full-term born, no abnormal
findings at the time of birth. At 4 months of life she reported
scoliosis and right hemiatrophy with progressive generalized
weakness, but had no delay in motor milestones. At the age
of 33, examination revealed gait unassisted, scoliosis, right
elbow and long finger flexors, left Achilles tendons
contractures, cavus feet and proximal muscle weakness.
Normal values of CK and Aldose were found, muscle
biopsy showed signs of congenital myopathy. A new
alteration on gene COL6A1 was found (c.1352A>G (p.
Gln451Arg, exon 20, heterozygoty), with undetermined
significance.
Case 2: Female, 29 years, full-term born with neonatal
hypotonia, congenital torcicollis. No delay in motor
milestones, however, since infancy she reported
osteoarticular deformities, progressive weakness over time
with hyperlaxity of the distal fingers. At the age of 29,
examination revealed gait unassisted, right winging scapula,
scoliosis, equino-varis deformity bilaterally and proximal
weakness. Laboratorial studies were unremarkable, signs of
congenital myopathy on biopsy. DNA examination revealed
three COL6A2 gene mutations [exon 12, c.1105C>T
(p.Gln369X), exon 18, c.1466G>A (p.Arg486Gln) and an
intronic variant, c.1970-9G>A] which confirmed the
diagnosis of UCMD.
Conclusion: Genotype-phenotype correlation studies on
ColVI related myopathies reveal the presence of a
continuous spectrum of phenotypic heterogeneity and
severity, reflecting the various molecular pathogenic
mechanisms.
388 Posters, Sunday 9 September
P1795
Creatine kinase elevation, lactacidemia,
and metabolic myopathy in adult patients
with diabetes mellitus
M. Frank1, J. Finsterer2
1 KAR, Vienna, 2Danube University Krems, Austria
Objective: To determine the frequency of elevated creatine
kinase (CK) levels among patients with diabetes mellitus
and to determine how often elevated CK in these patients is
attributable to primary myopathy.
Methods: In this prospective study, we investigated how
often CK, aspartate aminotransferase, alanine amino
transferase, and resting lactate were elevated among
consecutive diabetic patients attending our clinic. Those with
elevated CK values were offered a neurologic work-up.
Results: 99 patients with diabetes mellitus, aged 19 to 87
years, were assessed between May 2008 and April 2010.
7 patients had type 1 diabetes and 92 patients had type
2 diabetes. CK, aspartate aminotransferase, alanine
aminotransferase, and resting lactate were elevated in 19 of
99, 25 of 99, 22 of 99, and 24 of 98 patients, respectively.
11 of the patients with increased CK were self-injecting
insulin. 10 of the 24 patients with elevated serum lactate
took metformin. 7 of the 19 patients with elevated CK
consented to neurologic work-up. 2 of these 7 patients had
elevated resting lactate. In all 7 patients, the findings from
neurologic investigation were indicative of a metabolic
myopathy and further diagnostic work-up was initiated.
Conclusions: In diabetic patients attending our clinic,
elevated CK levels occur in one-fifth and lactacidemia
occurs in one-quarter. Elevated CK levels are attributable to
a primary metabolic myopathy in most cases. Elevated CK
levels in the setting of diabetes mellitus require further
neurologic work-up.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1796
Pompes disease in South America:
a review
O.J. Nascimento, L. Azevedo, C. Pupe, G. Quintanilha,
F. Naylor, A. Fernandes
Federal Fluminense University, Rio de Janeiro, Brazil
Pompes disease (PD) is related to defects in the acid alpha-
glucosidase enzyme, leading to an intracellular glycogen
accumulation, mainly in muscles. Two clinical presentation
forms are described: infantile and late-onset. In both forms
the clinical presentation includes progressive proximal
weakness, muscular hypotonia, hypertrophic cardiomyopathy
and respiratory complaints. This phenotype is not completely
defined and a better knowledge of the clinical presentation
spectrum of PD is needed. The early diagnosis is crucial
facing the actual possibility of treatment. The prevalence of
this condition in some areas over the world is not well known.
To contribute to the knowledge of PD we performed a review
of all cases published in South America.
Method: A search was made in Pubmed and Lilacs.
Results: From the 64 reported cases, 30 were classified as
infantile and 34 as late-onset PD. In the infantile group, the
mean age of onset of symptoms was 1 month. 17 infants
(56%) had symptoms since birth. The mean age at diagnosis
was 5 months. Most patients had an early death, at a mean
age of 11 months. 5 patients received ERT, and were still
alive. PD diagnosis is difficulty due to the rarity of the
disease and the heterogeneity of clinical manifestations.
Conclusion: As an early diagnosis is critical to optimizing
disease management we can speculate that this number of
PD cases in South America is underestimated, and a better
phenotypic identification is needed in order to avoid
misdiagnosis of the disease.

P1797
Post-operative mortality in thymoma
associated with myasthenia gravis
L. Ionescu1, D.I. Cuciureanu2,3
Surgery, University of Medicine and Pharmacy Gr.T. Popa,
1
Neurology, University of Medicine, 3Neurology, Emergency
2 1Department for Neuromuscular Disorders, Clinical Center
Hospital Prof. Dr. N. Oblu, Iasi, Romania
Introduction: Myasthenia gravis (MG) associated with
thymoma is a real challenge for the therapeutic team as its
course is unpredictable and refractory. Aggravation of MG
post-operatively may lead to death and this can be explained
by tumour recurrence or exacerbation of extratimic
autoimmunity.
Aims: Assessment of post-operative death rate in operated
patients.
Material and methods: 21 patients with thymoma
associated with MG underwent complete thymectomy from
1990 to 2010. 6 patients died between 3 months and 16
years post-operatively.
Results: All patients who died had an invasive thymoma
associated with Osserman clinical form of MG, III and IV.
Two deaths were unrelated with the operated disease but 4
died due to aggravation of MG and acute respiratory failure.
The overall mortality rate was 24% and MG related caused
mortality rate was 18%. The 2 patients who died of unrelated
MG cause, survived 9 and 16 years post-operatively. 1
patient died due to acute cardiac failure following a tight
constrictive pericarditis presumed to be a side effect of post-
operative radiotherapy. The second patient presented at 10
years post-operatively a pleural recurrence which was
removed and survived another 6 years till he died of acute
myocardial infarction. 4 patients who died due to
aggravation of myasthenia gravis, had an Osserman clinical
stage III and IV on admission. All had an invasive thymoma.
Conclusions: Aggravation of myasthenia gravis is the first
cause of death in this series in spite of intensive anti-
autoimmunity treatment. Tumour recurrence is rare in
complete resected cases.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 389
P1798
Childhood onset myasthenia gravis with
thymoma
A. Nikolic1, D. Nikolic2,3, B. Medjo2, P. Ivanovski2,3,
I. Basta1,3, D. Lavrnic1,3
of Serbia, Clinic for Neurology, 2University Childrens
Hospital, 3University of Belgrade, School of Medicine,
Belgrade, Serbia
Introduction: Juvenile myasthenia gravis is acquired,
autoimmune myasthenia gravis occurring before 16 years of
age. Thymoma are exceedingly rare in children, especially
associated with juvenile myasthenia gravis. We report a
case of a 14-year-old boy with juvenile myasthenia gravis
and thymoma.
Case report: Our patient presented with difficulties in
chewing and swallowing, nasal speech and fluctuating
weakness of the leg muscles. Neurological examination
revealed masticatory and bulbar muscle weakness with
nasal speech, proximal muscle weakness and fatigability of
the arms and legs and distal muscle weakness of the legs,
MGFA form of the disease IIIB. Diagnosis of juvenile
myasthenia gravis was confirmed by positive neostigmine
test, decremental response on repetitive nerve stimulation
and increased titre of serum anti-acetylcholine receptor
antibodies. The patient was treated with anticholinesterases,
corticosteroids, Azathioprine and thymectomy. Patho
histological analysis of the thymus gland showed thymoma,
Masaoka grade II. After two years of unstable course of the
disease remission was achieved.
Conclusion: Since there are only ten published thymoma-
associated myasthenia gravis cases in the paediatric
population so far, this paper gives an important contribution
to better understanding of this rare association.
390 Posters, Sunday 9 September
P1799
Quality of life in myasthenia gravis
patients in Belgrade (Serbia)
I. Basta1,
T. Pekmezovic2,S. Peric1,
D. Kisic Tepavcevic3,
V. Rakocevic Stojanovic1, Z. Stevic1, A. Nikolic4,
M. Milicev4, D. Lavrnic1
1Neurology Clinic, 2Neurology Clinic, Institute of
Epidemiology, Clinical Center of Serbia, School of Medicine,
University of Belgrade, 3Institute of Epidemiology, School of
Medicine, University of Belgrade, 4Neurology Clinic,
Clinical Center of Serbia, Belgrade, Serbia
Objectives: The aim of this study was to assess factors that
might influence the health-related quality of life (HRQoL)
in patients with myasthenia gravis (MG).
Material and methods: A cross-sectional study was
performed including 230 consecutive patients with MG.
Severity of the disease was estimated according to the
MGFA classification and QMG score. HRQoL was assessed
by SF-36 questionnaire. Depressive and anxiety symptoms
were assessed using the Hamilton rating scales for
depression and anxiety, respectively. Social support was
measured by the Multidimensional Scale of Perceived
Social Support (MSPSS), while acceptance of the disease
by the Acceptance of illness scales (AIS).
Results: Our results revealed that HRQoL of MG patients
was reduced, not only in the domains related to physical
health, but also in psychosocial aspects of the HRQoL. The
significant demographic predictors of the worse HRQoL in
MG patients were older age (p=0.025) and lower education
(p=0.012). Among clinical features, significant independent
contributing factors of worse HRQoL were more severe
form of the disease according to MGFA (p=0.001) and
higher QMG score (p=0.001). Finally, psychosocial
predictors of worse quality of life were lower MSPSS score
(p=0.001), poor acceptance of the disease (p=0.001), as
well as higher levels of anxiety and depression (p=0.001).
Conclusion: Our study revealed that the HRQoL in patients
with MG is similarly reduced in its psychological and
physical aspects. These results may have a practical
implication pointing out that different aspects of
psychosocial support should be added to the regular
therapeutic protocols.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1800
Thyrotoxic periodic paralysis
J. Neumann1, J. Pouzar1, J. Kubk2, P. Jeil3
1Neurology and Neuro ICU, 2Neurology, 3Internal Medicine
and Cardiology, Regional Hospital Chomutov, Czech
Republic
Introduction: Thyrotoxic periodic paralysis (TPP) is a rare
complication associated with hyperthyroidism. TPP is more
frequent in young patients, especially males. TPP is well-
known in the Asian population compared to other ethnic and
racial groups.
Case report: We report a case of TPP in a 40-year-old
Caucasian male with a history of hyperthyroidism. The
patient presented acutely to our department with 5 hours
history of severe muscle weakness and pain. On admission
he presented with symmetric flaccid paralysis of the lower
limbs without sensory symptoms or signs. His initial
potassium level was 1.8mmol/L (3.6-5.1) with normal acid-
base status. Laboratory investigation on admission revealed
mild hypophosphatemia and hypomagnesemia. An
electrocardiogram showed sinus tachycardia and mild
depression ST in lower wall. His free T4 level 64.9pmol/L,
free T3 level 18.66pmol/L and TSH <0.005mU/L. He was
given intravenous and oral potassium supplements
(100mmol over 15 hours) and the paralysis resolved rapidly
with normalization of serum potassium. While in the
hospital he was treated with thiamazol and metoprolol. He
was discharged in good condition on day 3.
Conclusion: TPP is a rare condition in Caucasians that can
be overlooked and misdiagnosed on presentation. TPP is an
alarming and potentially fatal complication of thyrotoxicosis
characterized by progressive muscle paralysis and
hypokalemia due to a massive intracellular shift of
potassium. In TPP, hypokalemia is associated with
hypophosphatemia and mild hypomagnesemia. Early
diagnosis and immediate therapy prevent serious
cardiopulmonary complications and may hasten the
recovery of muscle paralysis.

P1801
Association between vitamin D receptor
gene polymorphism and myasthenia
gravis in Han people from northern China
H. Li1, Z. Wang2, X. Gao1, L. Tao1, H. Yu1
Neurology, Affiliated Hospital of Medical College, Qingdao
1 Neurology and Neurosurgery, Minsk, Belarus
University, 2Neurology, The Third Peoples Hospital of
Qingdao, China
Introduction: Vitamin D plays an immuno-modulating role
via vitamin D receptor (VDR), which has been shown in
many autoimmune diseases.
Methods: VDR FokI and ApaI polymorphism was
determined by PCR-RFLP method. The frequencies of
genotype and alleles were compared among different
subgroups classified by gender, age of onset, association of
thymoma, Osserman types and maximal severity in the
follow-up. The relationship between the genotype and
severity of MG and short-term (three months after treatment
initiation) therapeutic effects of glucocorticoid were also
explored.
Results: There were no significant differences in
frequencies of genotypes and a1leles between MG group
and control group, and among subgroups of MG (p>0.05).
The distribution of FokI genotypes and alleles showed no
statistical difference between the patients with better and
worse therapeutic effects of glucocorticoid (p>0.05). The
frequency of ApaI alleles in the patients with better
therapeutic effects of glucocorticoid differed from the
worse group (c2=4.400, p=0.036), while ApaI genotypes
were not associated with the therapeutic effects of
glucocorticoid. The frequency of ApaI A in the patients with
better therapeutic effects group (29.6%) was higher than in
the worse group (14.6%) (OR=2.46, 95% CI=1.04~10.43,
p=0.036). The patients with the genotype AA or Aa were
more prevalent in the better therapeutic effects group
(51.6%) than in the worse group (29.2%) (OR=2.59, 95%
CI=0.98~14.60).
Conclusion: VDR FokI and ApaI polymorphism was not
found to be related with the pathogenesis of MG. MG
patients with VDR ApaI A allele may have better short-term
efficiency of glucocorticoid.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 391
P1802
Myasthenia gravis patients quality of life
in Belarus
S. Kulikova, H. Osos, S. Likhachev, A. Astapenko
Neurology, The Republican Research and Clinical Center of
Myasthenia gravis (MG) is a chronic neuromuscular
disease. Advances in medical therapy have increased the
life expectancy of MG patients, without completely curing
the disease. To analyze quality of life (QoL), an Belarus
MG cohort was investigated.
Material and methods: 83 patients with MG and 48
healthy people were asked with questionnaire QoL SF-36.
The SF-36 consists of eight scaled categories: physical
functioning, physical role, bodily pain, general health,
emotional role, mental health, vitality and social functioning.
For the statistical analysis, Statistica 6.0, Mann-Whitney
test, Spearman correlation analysis were used.
Results: The average age of the patients was 44.216.4
years, 10.8% of them were 65 and older. In most cases
generalized MG was diagnosed (80.7%). 75.9% of the
patients had been treated with immunomodulating therapy.
In 88% of cases the disease duration was longer than one
year. 34.9% of the patients had constant disability. All the
figures of SF-36, except for bodily pain, were significantly
lower than in healthy people (p<0.001). The lowest indicator
was found in terms of physical role [25.0(0.0;75.0)] despite
the fact that physical functioning was disrupted to less
extent [60.0(37.5;85.0)]. Physical health was negatively
associated with the patients age (R=-0.29; p<0.005),
disease duration (R=-0.26; p<0.01), severity of disease
(R=-0.4; p<0.0001), therapy with immunomodulating drugs
(R=-0.21; p<0.05), disability (R=-0.34; p<0.001). Mental
health was negatively associated with severity of disease
(R=-0.23; p<0.05).
Conclusion: Low health-related QoL of patients with MG
requires further analysis to improve therapy of this disease.
392 Posters, Sunday 9 September
P1803
Conns syndrome presenting as periodic
paralysis associated with diuretics
I. Son1, M. Yi1, Y. Kim2, J. Jeong3
1Department of Neurology and Inam Neuroscience Research
Center, Sanbon Medical Center, Wonkwang University,
Gunpo-si, 2Neurology, Sungae General Hospital, 3Neurology,
Gangnam Severance Hospital, Yonsei University, Seoul,
Republic of Korea
Introduction: Primary hyperaldosteronism or Conns
syndrome featured arterial hypertension, suppressed plasma
renin activity, and increased plasma aldosterone
concentration. In most cases (>90%) primary
hyperaldosteronism attributed to bilateral adrenal
hyperplasia or aldosterone-producing adenoma.
Case: A 51-year-old man presented with bilateral limb
weakness. He had a history of hypertension medication 5
years ago, and added hydrochlorthiazide 12.5mg 2 months
ago. As a first manifestation, the patient cannot raise arms
but was not disturbed when he gripped. The symptoms
prolonged for 3~4 days and improved partially. After 1
week, bilateral limb tingling sensation and weakness
developed, so he could not go upstairs. These symptoms
improved also in 3~4 days. These transient paralyses were
repeated of improvement and aggravation. EKG showed
QT prolongation. The motor grade was proximal grade IV/
IV, distal V/V. Plasma serum K was 2.3mmol/L and CPK
was 1815U/L. EMG findings are moderate denervation
potentials but normal MUAP in bilateral FCR, FDI,
gastrocnemius (medial), tibialis anterior, vastus lateralis
muscles. Baseline plasma renin (0.14ng/ml/hr) decreased
than normal and aldosterone (531.9pg/ml) level was
elevated. Abdominal CT showed the right adrenal 1.1cm
sized mass. Oral potassium agent was taken, the patient
recovered quadriparesis approximately 10 days after.
Conclusion: Periodic hypokalemic paralysis can show a
first manifestation of primary aldosteronism and diuretics
can aggravate hypokalemia. This is a case of hypokalemic
myopathy proceed primary aldosteronism after diuretics
medication and presented bilateral limb weakness is worth
of notice. Relatively young patients with uncontrolled blood
pressure consider of secondary hypertension and should
take detailed history taking and evaluation.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1804
Tetraparesis as a form of presentation of
dermatomyositis
M. Leito Marques, J.N. Carvalho, J. Fortuna,
A. Morgadinho
Centro Hospitalar e Universitrio de Coimbra, Portugal
Objectives: To describe a case of sub-acute tetraparesis.
Methods: Monitoring and study of a patient for 20 months
and case description.
Results: A women, 82 years old, went to Neurology
department due to weakness of gradual onset within one
month and urinary incontinence. She denied pain, dysphagia
or other sensory complaints. History of flu-like syndrome
2-3 weeks before. She had a cervical spine MRI showing
degenerative changes, without compromise of the spinal
cord. Neurological examination revealed tetraparesis,
hyperreflexia, cutaneous plantar responses in flexion. The
cranial nerve and sensory exam was normal. Blood analysis
showed CPK of 11,000, increased transaminases, and
increased erythrocyte sedimentation rate. The serum
autoimmunity study showed positive ANAs.
Electromyography was consistent with an acquired
myopathy. In this context, we exhaustively researched a
neoplasia with complementary exams, which revealed no
positive findings. The patient started therapy with
metilprednisolone 1g (5 days), and was discharged with
prednisolone 60mg id. At that time, the most likely diagnosis
was polymyositis. Later, the patient came back to the
hospital with pain on muscle mass palpation, easy fatigue
and dysphagia. Muscle biopsy was compatible with
dermatomyositis.
Conclusions: The muscle diseases constitute a broad range
of diagnosis. This case describes a less typical presentation
of a (rare) disease. The rapid progression of symptoms
demanded an efficient response and diagnosis. In a patient
aged 80, female, who presents with an acute/sub-acute
muscle disease, it was mandatory to exclude a paraneoplastic
syndrome. The atypical clinical picture, like the absence of
cutaneous rash, made this an unexpected diagnosis.

P1805
MELAS syndrome: a report of two cases
and review of the literature
M. Lahmar, H. Derbali, H. Khaled, C. Ben Cheikh,
M. Mansour, J. Zaouali, R. Mrissa
Neurology, Military Hospital, Tunis, Tunisia
P1806
Internuclear ophthalmoplegia revealing
myasthenia gravis: a case report
M. Lahmar, H. Derbali, A. Baatout, C. Ben Cheikh,
J. Zaouali, R. Mrissa
Neurology, Military Hospital, Tunis, Tunisia
P1807
Different patterns of dystrophin gene
expression in an Egyptian family suffering
from muscular dystrophy
G.A. Achmawi1, N. Elsawy2, H. El Assi3, H. Kassem3,
I. Talaat4, S. El Guendi4
1Neurology Department, 2Physical Medicine, Rheumatology
and Rehabilitation Department, 3Genetics Department,
4Pathology Department, Faculty of Medicine, Alexandria
University, Alexandria, Egypt
P1808
Non-coronary myocardial infarction (MI)
caused by pyridostigmine treatment in
myasthenia gravis (MG): a case report
P. Zis1, E. Kontogeorgi1, D. Karakalos1, S. Dimopoulos2,
A. Tavernarakis1
1Department of Neurology, Evangelismos General Hospital,
21st
Critical Care Medicine Department, Evangelismos
General Hospital, National Kapodistrian University of
Athens, Greece
P1809
Cardiac assessment in boys with
Duchenne muscular dystrophy
D. Vojinovic1, V. Milic Rasic1, T. Ilisic2, A. Kosac1,
S. Todorovic1
1Clinic of Neurology and Psychiatry for Children and Youth,
Faculty of Medicine, University of Belgrade, 2University
Childrens Hospital, Belgrade, Serbia
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 393
P1810
A polymyositis case with cardiac
involvement as the first symptom
E. Matsutani1, H. Mori1, K. Goto2, K. Shindo1
1 Neurology, Kurashiki Central Hospital, Kurashiki,
2 Neurology, Omuta Hospital, Omuta, Japan
P1811
Phenotypic features in the first Greek
patient with desmin mutation
P. Manta1, G. Papadimas1, C. Papadopoulos1, S. Penttil2,
A. Areovimata1, B. Udd2,3
1Department of Neurology, Aeginition Hospital, National and
Kapodistrian University of Athens, Greece, 2Neuromuscular
Research Unit, Department of Neurology, University
Hospital and University of Tampere, 3Folkha Lsan Institute
of Genetics and Department of Medical Genetics, Haartman
Institute, University of Helsinki, Finland
P1812
A first case of oculopharyngeal muscular
dystrophy in the Slovak Republic
J. Martinkova1, P. Spalek2, V. Hancinova2, M. Cingelova1,
J. Benetin2
12nd Department of Neurology, Comenius University, 2Centre
for Neuromuscular Diseases, Department of Neurology,
Slovak Medical University, Bratislava, Slovak Republic
P1813
Two siblings with myotonic dystrophia,
one of them with tetraventricular
hydrocephalus and hyperprolactinemia
S.M. nar, L. zden Erkutlu, S. Bilge, R. Karahan
zcan, M. Beer
Taksim Training Hospital, Istanbul, Turkey
P1814
The value of psychological and
degenerative changes of vertebral column
in sympathetic intrafusal tension
syndrome
I. Andronati1, S. Plesca1, M. Sangheli2, I. Zabrian2
1Department of Back Pain, Institute of Neurology and
Neurosurgery, 2State Medical and Pharmaceutical
University, Chisinau, Moldova
394 Posters, Sunday 9 September
Neuroepidemiology
P1815
Neurology on-call coverage in a Spanish
tertiary academic hospital: a prospective
one-year study
P.M. Rodriguez Cruz, J.R. Perez Sanchez, J.P. Cuello,
G. Vicente Peracho, P. Sobrino Garcia, F. Cordido,
C. Alarcon Morcillo, B. De La Casa Fages, D. Mateo,
A. Garca Pastor, F. Diaz Otero, D. Ezpeleta
Hospital General Universitario Gregorio Maraon, Madrid,
Spain
Objectives: To analyze the features of neurological
emergency care of a tertiary hospital (referral area: 750,000
inhabitants; 1700 acute-beds) during a one-year period. To
compare this data with the whole medical emergency room
(ER).
Background: Prospective data about neurological patients
attended in ER are scarce. Its knowledge may help to
optimize resources.
Methods: Prospective and descriptive study, using a
computer database, of the patients assisted by the neurology
ER team from July 2010 to July 2011.
Results: After debugging the database, 290 days were
considered valid to analyze. 3,236 patients were included.
Average: 11.15 patients/day. Men 48%. Time distribution:
8am-3pm=30%, 3pm-10pm=46%, 10pm-8am=23%. The
neurology team evaluated at first instance 35% of patients.
The remaining 65% were initially evaluated by other
specialists. Most common pathologies were stroke 34%,
seizures 16%, headache 8%, demyelinating 5%, neuro-
ophthalmology 5%, altered level of consciousness and
dizziness 6%, neuromuscular 3%, movement disorders 3%.
We performed 58 intravenous thrombolyses. Average time
in ER: 7.17 hours/patient. Destination: admission 28%,
discharge 25%, outpatients 30%, other departments 7%,
intensive care unit 2%, death 1%. In 2009, 73,701 patients
were evaluated in the medical-ER. Our data reveal that
neurology on-call coverage represents 4.40% from the
medical-ER assistance and 5.39% from the total number of
urgent admissions.
Conclusion: Neurological disorders in ER are frequent,
wide and complex. Neurological evaluation is frequently
requested by other specialists. Stroke, seizures and headache
prevail in our area. The admission rate in the neurology
department is higher than the rest. These data support the
provision of neurology teams on-call within ER.
P1816
Abstract cancelled
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1817
Age-specific incidence, comorbidities,
and mortality in patients with alcohol
dependence syndrome in Taiwan:
a nation-wide population study
C.-J. Lu, Y. Sun
Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
R.O.C.
Introduction: Alcohol abuse is one of the main causes of
repeated admission with various medical complications. We
investigated the sex-, age-specific incidence, prevalence,
comorbidities and all-cause mortality in people with
alcoholism.
Methods: This retrospective cohort study was based on the
medical claims data of the Bureau of National Health
Insurance from 1997 to 2008, which contains 1,000,000
randomly selected beneficiaries. Patients with diagnoses of
alcohol dependence syndrome (ICD-9: 303) or alcohol
abuse (305.0) on outpatient claims and/or hospitalization
records were enrolled. We estimated the annual incidence of
alcohol dependence syndrome and related medical
complications. Cox proportional hazard model was
performed to compare the risk of comorbidities and the
survival rates for each group.
Results: A total of 4334 patients (3263 men, 75.3%)
diagnosed with alcohol dependence syndrome or alcohol
abuse were identified with mean age 40.513.1 years and
followed up for 57.037.4 months. The overall annual
incidence is 2.20 in men and 0.74 in women per thousand
person years, with prevalence highest in subjects aged
45-54 years old with (19.74 per 1000). As compared to sex-
and age-matched control group, people with alcoholism
have significantly higher risk of dementia, epilepsy, liver
cirrhosis and gastric ulcer (all p<0.001). The mortality rates
in alcoholism and control group are 46.5 and 17.4 per 1000
person-years, respectively (p<0.001).
Conclusions: People with alcohol abuse and dependence
have higher risk of dementia, epilepsy, liver cirrhosis, and
all-cause mortality, affecting predominantly subjects
younger than 55 years.

P1818
Oral antiplatelet and oral anticoagulant
drugs used in prevention of
cardiovascular diseases in the elderly in
Poland
B. Labuz-Roszak1, K. Pierzchala1, M. Skrzypek2,
A. Machowska-Majchrzak1, PolSenior Study Group
1Dept of Neurology, Medical University of Silesia, Zabrze,
2Medical University of Silesia, Katowice, Poland
Introduction: The aim of this study was to evaluate the
frequency of use of oral antiplatelet (OAP) and anticoagulant
(OAC) drugs among older people in Poland and to assess its
association with cardiovascular risk factors.
Material and methods: The study was based on data
collected during the implementation of the multicenter,
publicly funded research project PolSenior.
Results: The study group consisted of 4,979 people in the
average age of 79.358.69 years. Among them, 1,787
people (35.9%) used at least one drug for prevention of
cardiovascular diseases. OAP were used regularly by 1,648
(33.1%), OAC by 165 respondents (3.3%). Aspirin was
most often administered (32.2%). Frequency of examined
drugs use depended significantly on age, sex, place of
residence, level of education and personal income. Among
all the respondents treated with OAP, the therapy was
applied as secondary cardiovascular prevention in 717
respondents (43.5%). Aspirin as the primary prevention was
used by 705 people (42.8%). Among the respondents treated
with OAC, there were 117 (71%) with history of atrial
fibrillation. Secondary cardiovascular prevention should be
considered in further 482 respondents (15.1% of untreated
ones), primary in 1447 respondents (45.3%).
Conclusions: Aspirin was the most commonly used drug
for the prevention of cardiovascular diseases in the elderly
in Poland, but it seemed to be underutilized in high-risk
patients. Among the elderly with atrial fibrillation, OAC are
used too rarely. It is necessary to develop educational
programs among general practitioners concerning current
recommendations for the use of OAP and OAC.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 395
P1819
Prevalence of adolescence and adult
onset ataxias in the Cypriot population
K. Christodoulou1, C. Votsi1, P. Nicolaou1, A. Georghiou1,
M. Pantzaris1, S. Papacostas1, K. Kleopa1, Y.-P. Christou1,
G.A. Tanteles1, V. Anastasiadou1,2, T. Kyriakides1,
E. Zamba-Papanicolaou1
The Cyprus Institute of Neurology and Genetics, 2Makarios
1
Hospital, Nicosia, Cyprus
Introduction: The epidemiology of ataxias in Cyprus has
not been reported. A single report describing a high
frequency of Friedreichs ataxia (FRDA) in the western part
of the country was published in 1988. The Cyprus Institute
of Neurology and Genetics (CING) is the national referral
centre for ataxias and other neurological diseases.
Methods: Clinical and genetic data on adolescence and
adult onset ataxia patients were collected from the CING
registry. At the last census (01 October 2011) the total
number of inhabitants under the Cyprus Government
control area of the country was 838,897.
Results: On prevalence day (28 March 2012), 99
adolescence and adult onset ataxia patients were alive. 9 of
them were excluded as they live in the Turkish area where
the total number of inhabitants is unknown. Total prevalence
was 10.7 per 100,000 inhabitants. The prevalence rate was
1.5 for molecularly confirmed FRDA, 0.5 for molecularly
confirmed ataxia with oculomotor apraxia 2 [AOA2, 1
family], 3.0 for autosomal recessive cerebellar ataxias (both
FRDA and AOA2 excluded), 0.2 for autosomal dominant
ataxias and 5.5 for late onset sporadic ataxias.
Discussion: The prevalence of adolescence and adult onset
ataxias in our population is similar to that recorded in other
populations, but notably, autosomal dominant ataxias are
not as prevalent [2 patients in 1 family] as in other
populations.
396 Posters, Sunday 9 September
P1820
Study of the influence of depression on
the risk of stroke at men aged 25-64
during 14 years in Russia (WHO program
MONICA-psychosocial)
V. Gafarov1,2, E. Gromova1,2, A. Gafarova1,2, I. Gagulin1,2
Collaborative Laboratory of Epidemiology of
1
Cardiovascular Diseases SB RAMS, 2Institute of Internal
Medicine SB RAMS, Novosibirsk, Russia
Background and purpose: We sought to examine the
relationship between depression symptoms and the risk
development of stroke among men aged 25 to 64 years.
Methods and materials: Within the framework of program
WHO MONICA-MOPSY a representative sample of men
25-64 years old (in the year 1994) was examined. Total
sample was 657 persons. Depression symptoms were
measured at baseline with the use of the MONICA -
psychosocial Interview Depression scale. The incidence of
new strokes was ascertained under systematic surveillance
the 14-year follow-up. Cox - proportional regression model
was used for an estimation of relative risk (RR).
Results: Prevalence of depression in a cohort of men with
stroke was 70.6%. The relative risk of ischemic stroke
incident was 6.4 (95% CI=3.97-7.58) for those who showed
symptoms of depression compared with those who did not.
Within 10 years RR of developing stroke RR=5.2 (95% CI,
3.6-6.91). Within 14 years RR for stroke 1.4 (95%CI=0.01-
1.78 p>0.05).MONICA
Conclusion: Depression is a predictor of stroke in middle-
aged men.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1821
Personal anxiety and risk of development
of stroke in a population of men, 25-64
years old during 24 years in Russia
(epidemiological research of program
WHO MONICA)
V. Gafarov1,2, E. Gromova1,2, A. Gafarova1,2, I. Gagulin1,2
1Collaborative Laboratory of Epidemiology of
Cardiovascular Diseases SB RAMS, 2Institute of Internal
Medicine SB RAMS, Novosibirsk, Russia
Objective: To evaluate an influence of personal anxiety on
risk of development of stroke in men aged 25-64.
Study design and methods: Within the framework of
program WHO MONICA-MOPSY a representative sample
of men 25-64 years old (in the years 1984, 1988, 1994) was
examined. The total sample was 2149 persons. The period
of supervision was 24 years. We counted as outcome all
cases of stroke which had arisen for the first time. We used
Spielbergers scale for estimation of personal anxiety (PA).
Cox-proportional regression model was used for estimation
of relative risk (RR).
Results: 72.2% men with developed stroke had HLA (high
level anxiety) and 27.8% ALA (average level anxiety). The
relative risk of developing stroke within 5 years in a group
of men with HLA in comparison with a group of men with
ALA was 6.4 times higher (95%CI=3.088-13.308,
(p<0.0001) for stroke. Within 10 years, RR of stroke
development increased 3.8 times (95%CI=1.677-8.754,
p<0.001). Within 15 years, RR of stroke -2.9 times
(95%CI=1.07-7.952). Within 20 years the tendency to RR
decrease for development of stroke (RR=1.6) was observed.
Within 24 years (RR=1.04) p>0.05.
Conclusion: The data indicate that high level of personal
anxiety may predict higher stroke risk in middle-aged men.

P1822
The medical economic cost of patients
with alcohol dependence syndrome in
Taiwan
Y. Sun, C.-J. Lu
En Chu Kong Hospital, New Taipei City, Taiwan R.O.C.
Introduction: Alcohol abuse has been identified as an
important risk factor for chronic disease and injury. In spite
of the huge burden of their repeated admission, morbidities
and social problems, the medical cost of patients with
alcohol dependence syndrome in Taiwan has not been
thoroughly investigated.
Methods: This retrospective cohort study enrolled patients
with diagnoses of alcohol dependence syndrome (ICD-9:
303) or alcohol abuse (305.0) from 1997 to 2008 based on
the medical claims data of 1,000,000 randomly selected
beneficiaries from the Bureau of National Health Insurance.
We compared the overall medical cost of alcoholic patients
with and without medical complications of dementia,
epilepsy, liver cirrhosis or gastric ulcer, as well as the costs
of an age- and sex-matched control group.
Results: We enrolled 4334 alcoholic patients and 4334
subjects of the control group. In both groups, subjects
complicated either with dementia, epilepsy, liver cirrhosis,
gastric ulcer or gastritis have much higher monthly medical
costs than those without medical morbidities (all p<0.001).
Besides, among patients with at least one aforementioned
medical disease, those with underlying alcohol dependence
syndrome have significantly higher overall medical costs
than those not used to be alcoholics (p<0.001), with cost
differences mostly significant in women or young people
aged less than 45 years (all p<0.001).
Conclusions: People with alcohol abuse and dependence
have significantly higher overall medical costs, especially
in women or people younger than 45 years.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 397
P1823
Nutritional effects on depressive
symptoms in Parkinsons disease patients
T. Fukushima1, X. Tan2, Y. Luo3, P. Wang3, J. Song3,
H. Kanda1, T. Hayakawa1, T. Kakamu1, M. Tsuji1
1Hygiene & Preventive Medicine, Fukushima Medical
University, Fukushima, Japan, 2Wuhan University, Wuhan,
3Xiangfan No.1 Hospital, Xiangfan, China
Introduction: The factors associated with depression in
Parkinsons disease, especially lifestyle or nutrition is
poorly studied. Our study was conducted to investigate
nutritional factors associated with depression in Parkinsons
disease.
Methods: The subjects comprised 82 Parkinsons disease
patients and sex- and age-matched controls recruited from
the outpatient clinic of Xiangfan No. 1 Peoples Hospital in
Hubei, China between 2006 and 2008. The Parkinsons
disease patients were divided into two groups, 24
Parkinsons disease with depression and 58 Parkinsons
disease without depression. DSM-IV criteria were used for
the primary diagnosis of depressive disorders. The severity
of depression in patients was assessed by the criteria of the
Hamilton Depression Rating Scale (HAMD-17), and the
score of 14 was defined as depression. Eating habits and
other factors were obtained by recalling on previous state
before diagnosis of Parkinsons disease and depression.
Results: Compared with the Parkinsons disease patients
without depression and the controls, the Parkinsons disease
patients with depression showed relatively low income and
low education. Fat and vitamin B1 intake was significantly
higher in the Parkinsons disease patients with depression
than in both the Parkinsons disease patients without
depression and the controls. Bean intake was significantly
lower in the Parkinsons disease patients with depression
than in both the Parkinsons disease patients without
depression and the controls.
Conclusion: Low fat and vitamin B1, and high bean intake
might be associated with lower risk for depression in
Parkinsons disease patients with a better educational
background and income bracket.
398 Posters, Sunday 9 September
P1824
Different neurological conditions between
urban and rural samples from central
Colombia: the role of chronic diseases
M.E. Habeych Sanmiguel1, J.M. Garcia2,
R.C. Castilla-Puentes3
1Neurological Surgery, University of Pittsburgh, PA, USA,
2Internal Medicine, Fundacion Cardiovascular,
Bucaramanga, Colombia, 3Epidemiology, Temple University,
Philadelphia, PA, USA
Introduction: Despite availability of neuroepidemiological
data from developing countries including Colombia, urban-
rural differences on neurological conditions have never
been informed. In countries or places where information
cannot be collected otherwise, hospital samples from
tertiary centres are acceptable. Thus, our objective is to
identify differences in the spectra of neurological encounters
between two samples, one urban and one rural from central
Colombia.
Material and methods: We compared the relative
frequencies of neurological encounters in third level
services, from an urban sample published from Bogot
(N=2.932), to our rural sample from Tunja (N=2.664),
collected both circa to 2.000. The classification of
neurological conditions used is based on the 9th revision of
the International Classification of Diseases, clinical
modification (ICD-09-CM). A clustered sampling was used.
The information was collected in a format designed for this
specific purpose in the United Kingdom, and already tested
in Colombia.
Results: Highly significant statistical differences (df:1,1;
p<0.0001) were found for cerebrovascular disease, seizure
disorder, headache, Parkinsons disease and other movement
disorders, and, inflammatory (infectious) conditions.
Neuro-developmental disorders (df:1,1; p=0.0029),
dizziness and balance problems (df:1,1; p=0.0018), and
neuropathies (df:1,1; p=0.0007), also showed statistical
significant differences.
Discussion and conclusions: Our study showed significant
differences in all categories and diagnostics tested between
urban and rural samples. Cerebrovascular disease, although
the most frequent reason of neurological consultation in our
rural sample, could be confounded by the concomitant
presence of cardiovascular and/or pulmonary conditions in
the rural, aged population of this Colombian area.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1825
Trends and seasonal variation in stroke
hospitalization rates in Aragon (Spain)
from 1998 to 2010
A. Gimenez-Muoz1, J.R. Ara2, J.M. Abad3,
I. Campello-Morer1, J. Marta2, J.I. Lpez-Gastn2
1Department of Neurology, Royo Villanova Hospital,
2Department of Neurology, Miguel Servet Hospital,
3Department of Health and Consumer Affairs, Government
of Aragon, Zaragoza, Spain
Background: While stroke mortality in Spain has decreased
significantly in the last decade, trends in stroke
hospitalization and seasonal variation are less known.
Objectives: To evaluate seasonal variation and trends in
hospitalization for stroke in a Spanish region (Aragn) over
a period of 13 years.
Methods: We identified retrospectively all stroke patients
admitted to acute care hospitals in Aragon between January
1, 1998, and December 31, 2010, through the Minimum
Basic Data Set - Health Service of Aragon. The major
inclusion criterion was an admission with a principal
diagnosis of acute stroke as identified through the ICD-
9CM system (430, 431, 433.x1, 434.x1, and 436).
Negative binomial regression models were performed for
trends analysis. A simple moving average was used to
examine monthly variation of stroke hospitalization rates.
Results: We recorded 21,581 (77%) ischemic strokes, 5,314
(19%) intracerebral haemorrhages and 1,127 (4%)
subarachnoid haemorrhages. Age and sex standardized
hospitalization rates for ischemic stroke showed a
significant decrease (9.7% in men and 5.4% in women).
Intracerebral haemorrhage rates were highest in 2001 in
men and in 2006 in women, with a subsequent decrease till
2010. All stroke subtypes were more frequent in winter.
Conclusions:
- There has been a declining trend in stroke hospitalization
rates in Aragon in the period from 1998 to 2010.
- There was a temporal variation of stroke hospitalization
rates. These findings may help in developing strategies for
planning health care.

P1826
Is the co-operation between healthcare
participants more difficult in a poor social
environment associated with a higher risk
of stroke?
A. Folyovich1, I. Vastagh2, A. Kri2, A. Majoros1,
K.L. Kovcs2, A. Ajtay2, Z. Laki1, B. Gunda2, K. Erdei1,
L. Lenti2, Z. Dnos1, D. Bereczki2
1 Neurology and Stroke Center, Szent Jnos Hospital,
2 Neurology, Semmelweis University, Budapest, Hungary
Introduction: Low standard of living plays a crucial role in
poor morbidity and mortality rates of cerebrovascular
diseases. It is associated with a lower education level and
health awareness of the population, and a looser relationship
of people with the healthcare system. By investigating
stroke patients in two districts of Budapest with extremely
different life circumstances, our team has demonstrated that
stroke occurs at a significantly earlier age (67.1514.77 vs.
74.1211.47 years) in a poorer (VIII.) district. In this study,
we investigated the role of the quality of relationship
between stroke center, specialist outpatient department, GPs
and ambulance service.
Patients and method: Our anonymous database consisted
of residents of the two districts, who suffered a stroke in
2007. Pre-stroke history, risk factors, treatment after the
cerebrovascular accident and adherence to therapy were
also included. At the same time, data for 2010 were
evaluated. We investigated the rate of patients referred to
hospital by GPs with a diagnosis of stroke/TIA.
Result: The rate of patients with a diagnosis of cerebrovascular
disease referred to hospital by GPs or a specialist outpatient
department was significantly higher in (the wealthier)
district XII with a more favourable stroke epidemiology
(85.21 vs. 58.85%), whereas the ratio of referrals with
completed stroke vs. TIA was significantly lower (1.20 vs.
2.96).
Conclusion: At a lower standard of living, the efficacy of
cerebrovascular prevention, access to acute stroke care and
patient follow-up is decreased. There is a looser relationship
between the patient and his/her GP.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 399
P1827
Epidemiology of brain and spinal cord
tumours leading to disability in Belarus in
2006-2011
N.A. Yakushina, T.P. Dubovik, T.S. Golubeva,
A.V. Kopytok
Scientific Informational and Organizational Support,
National Science and Practice Centre of Medical Assessment
and Rehabilitation, Gorodische, Belarus
P1828
The use of electronic databases for
epidemiology of movement disorders
in the Siberian region of the Russian
Federation
M. Nikitina1, I. Zhukova1, O. Izhboldina1, N. Zhukova1,
V. Alifirova1, D. Gutorova2, O. Gileva3, M. Zhestikova4
1Neurology and Neurosurgery, Siberian State Medical
University, 2Neurology, Tomsk Regional Clinical Hospital,
Tomsk, 3Neurology, Neurosurgery and Medical Genetics,
State Educational Institution of Higher Professional
Education, Kemerovo, 4Neurology, M.G. Zhesstate
Educational Institution of Postgraduate Professional
Education, Novokuznetsk, Russia
P1829
Acute poliomyelitis: a retrospective data
analysis
L. Bertolasi1, L. Werhagen2
1F Neurological, Morphological and Motor Sciences,
University of Verona, Verona, Italy, 2Karolinska Institut at
Danderyds Hospital, Division of Clinical Sciences,
Stockholm, Sweden
P1830
The Budapest Districts 8-12 project.
Follow-up of stroke patients in two
districts of the Hungarian capital. The role
of local environmental factors in stroke
epidemiology
K.A. Bres-Molnr1, A. Folyovich1, I. Vastagh2, A. Ajtay2,
A. Kri2, A. Majoros1, Z. Laki1, K. Erdei1, K.L. Kovcs2,
B. Gunda2, L. Lenti2, K. Vadasdi1, Z. Dnos1,
D. Bereczki2
1 Neurology and Stroke Center, Szent Jnos Hospital,
2 Neurology, Semmelweis University, Budapest, Hungary
400 Posters, Sunday 9 September
Neuroimaging/ -sonology
P1831
Fronto-temporo-insula grey matter
alterations of first-episode, drug-nave
and very late-onset panic disorder
patients
C.-H. Lai1,2, Y.-T. Wu3
1Department of Psychiatry, 2Brain Image Research Unit,
Buddhist Tzu-Chi General Hospital, Taipei Branch, Taipei,
Taiwan, New Taipei City, 3Institute of Brain Science,
National Yang Ming University, Taipei, Taiwan R.O.C.
Objective: There is no voxel-based morphometry study for
first-episode, drug-nave and very late-onset panic disorder
patients. Besides, differences of onset age might represent
different clinical subgroups. Therefore we designed this
study to investigate grey matter deficits in this subgroup of
patients.
Method: 30 patients and 21 normal controls were enrolled
in our study. They all received 3 Tesla magnetic resonance
imaging acquisitions for the structural imaging of the brain.
All the structural images were processed and analyzed to
estimate the differences of grey matter volumes between
patients and controls. We utilized optimized voxel-based
morphometry function implemented in the FSL (FMRIB
Software Library) with agoraphobia, global brain volume,
age, gender and duration of illness as covariates. We also
performed the voxel-wise linear regression between clinical
rating scale scores and grey matter volumes of brain to
confirm results of optimized voxel-based morphometry and
significant region for physiopathology of very late-onset
PD.
Results: First-episode, drug-nave and very late-onset panic
disorder patients had lower grey matter volumes in the left
orbitofrontal cortex, left inferior frontal cortex, left superior
temporal gyrus and right insula when they were compared
to controls (corrected p<0.005, multiple comparisons,
cluster threshold: 30 voxels). A negative correlation
between PDSS and GMV was observed in the right insula
using general linear model voxel-wise analysis with age and
gender corrected.
Conclusion: Fronto-temporo-insula grey matter deficits
might represent the structural pathophysiology of first-
episode, drug-nave and very late-onset panic disorder.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1832
Whole brain ADC histogram in monitoring
small vessel disease: major scanner
effects in a large CADASIL cohort
B. Gunda1,2, R. Porcher3, E. Jouvent2, D. Herv2,
M. Duering4, M. Dichgans4,5, H. Chabriat2
1Neurology, Semmelweis University, Budapest, Hungary,
2Department of Neurology, Hopital Lariboisire, APHP,
University Denis Diderot, 3Hopital St Louis APHP, Paris,
France, 4Institute for Stroke and Dementia Research,
Ludwig-Maximilians-University, 5German Center for
Neurodegenerative Diseases, Munich, Germany
Objective: DTI derived histogram metrics - as global
measures of ultrastructural tissue integrity- have been
widely reported to correlate significantly with clinical
parameters in various diffuse cerebral pathologies. The aim
of our study was to evaluate whether histograms from the
widely available DWI sequence with technical updates and
without significant operator dependent post-processing, can
be used similarly to DTI histograms in follow-up studies of
CADASIL, a model of cerebral small vessel disease.
Methods: Clinical and MRI data from a large cohort of
CADASIL patients were evaluated at baseline and during 3
years of follow-up. We compared DWI-derived apparent
diffusion coefficient (ADC) histogram parameters to those
of the reference method (DTI Mean diffusivity (MD)) and
evaluated the effect of cerebrospinal fluid (CSF) suppression
and artefact removal on results. A mixed effects model was
used to evaluate the random MRI scanner effect on the
parameters.
Results: We found excellent correlation between ADC and
MD parameters especially for mean value, unchanged by
CSF suppression. Correction of image artefacts did not alter
ADC parameters significantly. In contrast, the magnitude of
the random scanner effect on ADC parameters was high and
larger than that of clinical scores, sex and age.
Conclusion: DWI derived histogram parameters without
much post-processing (CSF suppression, artefact removal)
appear promising for monitoring small vessel disease such
as CADASIL. However, given the huge scanner effect on
parameters, the use of different scanners including technical
updates may have major impact on the results and should be
evaluated in a multicentre longitudinal trial.

P1833
1H-MR spectroscopy only shows elevated
water content in adult onset autosomal
dominant leukodystrophy (ADLD) with
autonomic symptoms
J. Finnsson1, A. Melberg2, R. Raininko1
1Radiology, 2Neurology, Uppsala University, Uppsala,
Sweden
Introduction: Adult onset ADLD with autonomic
symptoms is a rare disease with a clinical course somewhat
similar to chronic progressive MS but with very different
imaging findings: extensive white matter changes in the
cerebrum and cerebellar peduncles. Patients usually present
in the fourth to sixth decade with autonomic symptoms,
later developing symptoms from the pyramidal tracts and
ataxia.
Objective: Present MRS findings in this disease.
Patients and methods: 15 members from two non-related
families affected by the disease were studied with MR
imaging and single voxel MRS and genetic tests. The MRS
results were compared to those of healthy controls.
Clinically, the family members ranged from asymptomatic
to wheelchair-bound.
Results: 14/15 family members had the genetic linkage to
the disease. 12 family members had extensive typical
pathological findings on MRI. The metabolite concentrations
of tCr, tCho and tNAA measured in mM, using internal
water as a reference, were significantly lower in family
members compared to controls and we found linear
correlations between all these metabolite levels. When tCr
was used as a reference we found no difference between the
family members and the controls. No measurable lactate
was detected.
Conclusion: The decreased metabolite concentrations
measured using internal water as a reference are most likely
due to increased water content in the tissues, diluting all
metabolites to a similar degree. This is also consistent with
the high signal intensity the patients exhibit in the white
matter on T2-weighted MR images and with the reported
histopathological findings of vacuolated myelin.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 401
P1834
3T high b-value diffusion-weighted MR
imaging in hyperacute ischemic stroke
M. Lettau1, M. Laible2,3
1Neuroradiology, 2Neurology, University of Freiburg Medical
School, Freiburg im Breisgau, 3Neurology, University of
Heidelberg Medical School, Heidelberg, Germany
Background and purpose: In patients with hyperacute
ischemic stroke, early demonstration of infarction is
essential. Diffusion-weighted imaging (DWI) is the key
method for detecting hyperacute infarction. The value of
high b-value DWI in hyperacute ischemic stroke is
controversial at 1.5T, and is unknown at 3T.
The aim of this study is to explore the value of high b-value
versus standard b-value DWI at 3T in hyperacute stroke
with quantitative and qualitative analysis.
Materials and methods: This study prospectively included
104 consecutive patients with hyperacute stroke. At 3T,
conventional MR sequences and DWI were performed. The
examination included a standard DWI (b =1,000s/mm2) and
two high b-value DWI (b=3,000s/mm2 and b=5,000s/mm2).
Qualitative and quantitative analysis was performed.
Results: With increasing b-value, DW images appeared
noisier. The number of detected lesions was significantly
higher on b=3,000 images than on the other DW images and
higher on b=5,000 images than on b=1,000 images. The
number of lesions >1cm was not significantly different.
Lesion conspicuity was higher, boundary better seen, lesion
extent bigger, and estimation of final infarct size was better
on high b-value than on standard b-value DWI. Contrast-to-
noise-ratio (CNR) and signal-to-noise-ratio (SNR)
decreased and contrast ratio (CR) increased on high b-value
DWI compared to standard b-value DWI.
Conclusions: At 3T, high b-value DWI was superior to
standard b-value DWI in detection of hyperacute infarction
and prediction of final infarct size in spite of increasing
imaging artifacts.
402 Posters, Sunday 9 September
P1835
Gray matter deficits of major depressive
disorder: a meta-analysis of voxel-based
morphometry studies
C.-H. Lai1,2
1Department of Psychiatry, 2Brain Image Research Unit,
Buddhist Tzu Chi General Hospital Taipei Branch, New
Taipei City, Taiwan R.O.C.
Objective: We designed this study to generate conclusive
grey matter deficits in major depressive disorder (MDD)
through the meta-analysis by signed differential mapping
(SDM) toolbox.
Method: The Pubmed, ScienceDirect and Scopus databases
were searched and only studies published or published
online before November 2010 would be enrolled. Twenty
voxel-based morphometry (VBM) studies of adult MDD
patients were included for the meta-analysis by SDM
toolbox with the threshold criteria as error probability less
than 0.00005 and cluster more than 50 voxels. Onset age,
patient and control number, gender ratio of both groups,
ratio of medicated patients, depression rating scores, illness
duration, co-morbidity and corrected p existence were also
meta-regressed as covariates to exclude the confounding
biases.
Results: Voxel-wise meta-analytic results of these 20 VBM
studies in MDD patients revealed that grey matter deficits
were observed in right anterior cingulate cortex [Talairach
coordinates (6, 38, 14), p<0.00005, cluster voxels >50] and
left anterior cingulate cortex [Talairach coordinates (-2, 36,
14), p<0.00005, cluster voxels >50] when the patient pool
was compared to the control pool. The findings remained
largely unchanged in jack-knife sensitivity analyses. Those
potential confounding factors had little impact on the
results.
Conclusion: The meta-analysis suggested the existence of
grey matter deficits in bilateral anterior cingulate cortices of
MDD patients.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1836
Changes in regional cerebral blood flow
during light intensity exercise of cycle
ergometery: a PET study
M. Hiura1, T. Nariai2, K. Ishii3, M. Sakata3, K. Oda3,
J. Toyohara3, K. Ishiwata3
1Faculty of Sports and Health Studies, Hosei University,
2Department of Neurosurgery, Tokyo Medical and Dental
University, 3Tokyo Metropolitan Institute of Gerontology,
Tokyo, Japan
Background and aims: During exercise cerebral blood
flow (CBF) would be affected by changes in cardiovascular
system and metabolites from working muscles, however
few investigations have elucidated the changes in CBF
during dynamic exercise. The aim of the present study is to
investigate the changes in regional CBF (rCBF) during
cycling exercise and the differences among rCBF
performing positron emission tomography (PET)
Methods: 88 healthy male volunteers were recruited (age;
231.9 yr, weight 671.9 kg). CBF was investigated by
oxygen-15-labelled H2O PET at rest and during low
intensity cycling exercise by autoradiography method in
conjunction with pulmonary oxygen uptake (VO2), cardiac
output (CO) and blood pressure. 57 regions of interest
(ROI) were defined within the whole brain by circular
shaped areas.
Results: During constant load cycling exercise, VO2 and
CO increased and had a plateau phase of 19.53.6ml/min/
kg and 8.82.1l/min, respectively. Systolic blood pressure
changed from 11410 to 12916mmHg. During exercise
rCBF changed from 62.36.6 to 76.79.6ml/min/100g on
average. There was a large increase of rCBF in vermis
(40.2%) and paracentral lobules (35.5%). In brain stem
(31.7%), basal ganglia (31.3%) and insular cortex (26.5%),
rCBF also increased apparently. These changes were reset
to the rest condition while exercise continued for 15minutes.
Conclusion: Changes in rCBF during exercise were
investigated quantitatively with PET. Exercise caused
fluctuation of rCBF in relation with regulation of the
cardiovascular system.

P1837
Sleeping habits and brain structure: the
volume of the hippocampus is smaller in
owls than larks
D. Kuperczko1, Z. Clemens1, G. Perlaki2, G. Orsi2,3,
Z. Kalmar1, A. Schwarz4, N. Kovacs1, B. Faludi1,
J. Janszky1
Department of Neurology, University of Pecs, 2Pecs
1 Spain
Diagnostic Institute, 3Department of Biology, 4Department of
Neurosurgery, University of Pecs, Hungary
Introduction: Brain morphology is supposed to be related
to several life style features. Here we investigated the
relationship between volumes of specific brain structures
and sleep duration as well as go-to-bed time which is
considered as a fairly stable trait of the personality.
Methods: 91 healthy young subjects were included in the
present study. We used semi-automatic user-independent
MR volumetry and voxel-based morphometry. We
investigated the relationship between go-to-bed time as well
as sleep duration and volumes of brain structures known to
be involved in sleep regulation (hippocampus, thalamus,
orbitofrontal cortex and brainstem).
Results: We found significant correlation between go-to-
bed time and hippocampal volume; later go-to-bed time was
associated with smaller hippocampal volume. Other
comparisons, including those with sleep duration, did not
reach significance.
Conclusion: Our results demonstrate that owls (those
who go to sleep late) are at increased risk for having smaller
hippocampi compared to larks (those who go to sleep
early) irrespective of their sleep duration. These results are
consistent with the notion of hippocampal shrinkage
associated with higher level of glucocorticoids due to the
loss of slow wave sleep mainly present during the first half
of the night.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 403
P1838
Identification of symptomatic carotid
atheroma plaques. Utility of the grey scale
median (GSM) system
G. Ruiz-Ares, B. Fuentes, P. Martnez-Snchez,
E. Dez-Tejedor
Stroke Unit, Neurology, University Hospital La Paz, Madrid,
Introduction: To date clinical and subjective
ultrasonographical criteria are used to identify the
symptomatic plaques but the standardized gray scale
median (GSM) value could be a useful objective tool for
this diagnosis. Our aim is to validate the GSM system as
tool to identify symptomatic carotid atheroma plaques.
Methods: Prospective study. Acute non-cardioembolic
anterior cerebral circulation ischemic stroke patients with
plaques in internal carotid artery ipsilateral to symptoms
were included. Echogenicity of plaques was measured by a
digital and standardized gray scale system in carotid
ultrasound B-mode (longitudinal projection) conducted
within the first week after admission by only one operator.
Intra-observer variability was measured.
Results: 52 patients were included. GSM system had better
intra-observer variability than subjective criteria.
Symptomatic plaques showed less echogenicity than
asymptomatic ones (23 vs. 37; p<0.0001). A Receiver
Operation Curve (ROC) analysis pointed to GSM value of
29 as the point associated to higher sensitivity (76%) and
specificity (82%) to identify a plaque as symptomatic
(AUC=0.874; IC 0.779-0.969; p<0.001) which was
associated with 13.93-fold increase (IC 3.66-53.01;
p<0.001) to be classified as symptomatic. A probability
model to predict the identification of a symptomatic plaque
was defined combining male sex, previous angiotensin
converting enzyme inhibitors (ACEI) treatment and GSM
<29 (ABC=0.890; IC 0.797-0.984; p<0.001).
Conclusions: GSM system is a useful tool to identify
carotid symptomatic plaques with the 29 value as cut-off
point. The combination of male sex, previous treatment
with ACEI and GSM<29 predicts probability of
symptomatic plaque.
404 Posters, Sunday 9 September

P1839
In vivo 1H-MRS and DWI for quantitative
differentiation of Parkinsons disease
(PD), multiple system atrophy (MSA), and
progressive supranuclear palsy (PSP)
Z. Rozhkova1, I. Karaban2, N. Karaban2
Radiology, Medical University Clinic BORIS,
1
P1840
Non-invasive pH-weighted magnetic
resonance imaging
Z. Dai1, G. Xiao1, Z. Shen1, L. Wang1, P.Z. Sun1,2,
R. Wu3
1Shantou University Medical College, Shantou, China,
2Department of Radiology, Athinoula A. Martinos Center for

Extrapyramidal Disorders, Institute of Gerontology, Kiev,

2 Biomedical Imaging, Massachusetts General Hospital and
Ukraine Harvard Medical School, Charlestown, MA, USA,
3Department of Medical Imaging, 2nd affiliated Hospital of
Purpose: We propose the relaxation times T2M of the main Shantou University Medical College, Shantou, China
cerebral metabolites, and the ADC coefficients in the middle
Introduction: Acid-base balance is the very important part
cerebral peduncles (MCP) for differentiating MSA from PD
of human homeostasis, which is regulated in a dynamic
and PSP.
steady state. Alteration in tissue pH can be an indicator of
Methods: Four groups of patients are studied with 1.5T
many diseases, such as stroke and tumour. Based on the
Signa Excite (GE). The PDG group includes 19 patients
theory of chemical exchange saturation transfer, we set up
with PD, the MSAG group includes 16 patients with MSA,
a new sequence that can realize pH imaging.
the PSPG group consists of 14 patients with PSP, and the
Methods: The new sequence with selective radiofrequency
CG group includes 15 healthy volunteers. For all patients
offset was used at Agilent 7T/160 animal scanner. The pulse
1H spectra are obtained in basal ganglia (BG) and in MCP.
pre-saturation offset was set at -1.87ppm and 1.87ppm. The
From the echo-time dependence of AM (where AM are the
duty cycle was maintained 50%. Other imaging parameters
peak areas of the signals from Cho, Cr and NAA) the T2M
were set as follows: TR=40ms, TE=1.5ms, slice
are calculated. ADC coefficients are determined from EPI.
thickness=2mm, single slice, field of view=6060mm,
Results: The mean T2M values (M = Cho, Cr, NAA) in BG
number of average=5 and acquisition bandwidth=50kHz.
are the following: in PDG (67.1, 40.5, 98.6ms), in MSAG
Total scan time was about 1min. The images were processed
(145.2, 59.3, 207.5ms), in PSPG (210.1, 185.3, 263.4ms),
using Matlab. Other routine MR images were acquired for
in CG (204.2, 198.0, 331.2ms). The mean T2M values in
reference. The pH phantoms were prepared with 3% agar-
MCP are the following: in PDG (63.3, 56.5, 90.2ms), in
gel and 50mmol/L creatine, in which pH value is the one
MSAG (58.2, 49.0, 101.8ms), in PSPG (134.1, 152.3,
and only difference.
233.1ms), in CG (215.0, 114.0, 320.1ms). From analysis of
Results: The intensity of signal is depending on the pH
DWI the ADC values in the BG are: (0.65x10-3), (0.54x10-3),
value, our results show that the lower the pH value is, the
(0.64x10-3), and (0.44x10-3), and in MCP: (0.82x10-3),
weaker the signal intensity is, which has statistical
(0.96x10-3), (0.79x10-3), and (0.81x10-3) in PDG, MSAG,
significance (p<0.05). In addition, the spatial resolution of
PSPG, CG, respectively.
pH imaging is excellent.
Conclusion: We detected in MCP significantly higher
Conclusion: Our pH phantoms proved that we can detect
ADC, and also lower T2M in patients with MSA in
pH value using our new sequence. This finding may provide
comparison with patients with PD and PSP are in vivo
a complement for conventional imaging, and has its
diagnostic markers of MSA.
potential advantages in detecting the acid-base metabolism.
Translated to clinic applications, this technology can be
used to acutely detect the penumbra of stroke at early stage.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1841
Botulinum toxin A related changes of
cortical activity in patients suffering from
severe hand paralysis with arm spasticity
following ischemic stroke
T. Veverka1, P. Hlutk1, Z. Tomov1, P. Hok1,
P. Otruba1, M. Krl1, Z. Tds2, J. Zapletalov3,
R. Herzig1, A. Krobot4, P. Kaovsk1
1Department of Neurology, 2Department of Radiology,
3Department of Biophysics, Biometry and Statistics,
4Department of Physiotherapy, Palack University and
University Hospital, Olomouc, Czech Republic
Aim: Investigations were performed to localize and analyze
the botulinum toxin (BoNT-A) related changes of cerebral
cortex activation in chronic stroke patients suffering from
severe hand paralysis with arm spasticity.
Methods: 14 patients (5 males, 9 females, mean age 55.3
years) suffering from upper limb post-stroke spasticity were
investigated. The change of arm spasticity was assessed
using the modified Ashworth scale (MAS). Functional MRI
(fMRI) sessions were performed before (W0), four weeks
(W4) and 11 weeks (W11) after BoNT-A application.
Patients were scanned while performing imaginary
movement with the impaired hand.
Results: BoNT-A treatment was effective in alleviation of
arm spasticity. Task-related fMRI prior to the treatment
showed extensive activation of bilateral frontoparietal
sensorimotor cortical areas, anterior cingulate gyrus,
pallidum, thalamus and cerebellum. Effective BoNT-A
treatment (W4) resulted in partial reduction of active
network volume in most of the observed areas, whereas
BoNT-free data (W11) revealed further volume reduction in
the sensorimotor network. On direct comparison, significant
activation decreases associated with BoNT-A treatment
were located in areas outside the classical sensorimotor
system, namely, ipsilesional lateral occipital cortex,
supramarginal gyrus and precuneus cortex. In comparison
to W4 and W11, no activation increases were found, instead,
activation further decreased in ipsilesional insular cortex,
contralesional superior frontal gyrus and bilateral frontal
pole.
Conclusions: Whole brain activation patterns during
treatment of post-stroke arm spasticity and further follow
up document predominantly gradual changes both within
and outside the classical sensorimotor system.
Supported by MHCR grant NS9920-4/2008.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 405
P1842
Measurement of extracellular-pH based
iopamidol chemical exchange saturation
transfer imaging at 7T
L. Wang1, Z. Shen1, Z. Dai1, G. Xiao2, Z. Sun3, R. Wu1
1Department of Medical Imaging, 2nd affiliated Hospital of
Shantou University Medical College, Shantou, 2Department
of Math and Information Technology, Hanshan Normal
University, Chaozhou, China, 3Martinos Center for
Biomedical Imaging, Department of Radiology,
Massachusetts General Hospital and Harvard Medical
School, Charlestown, MA, USA
Introduction: pHe is an indicator of many pathological
processes at biosystem. pHe of abnormal tissue, such as
tumour and stroke, is usually lower compared with normal
tissue. Iopamidol is one of the most common extracellular
contrasts possessing a high number of mobile protons (e.g.
amide), which are in exchange with water. In this work, we
aim to detect diverse pHe depending iopamidol with a new
sequence based on the theory of CEST.
Methods: A sample was made of four tubes, one containing
pure water with pH 7.0 and the others containing solutions of
iopamidol at the same concentration of 10mM with pH: 5.6,
7.3 and 7.6, respectively. All the experiments were performed
on Agilent 7T/160 scanner. The pulse pre-saturation offset of
MT-GRE sequence was set at -4.3ppm (voff) or 4.3ppm (von)
with respect to the resonance of water protons. Typical
acquisition parameters included bandwidth=50kHz, Flip
angle=120 deg, FOV=52x52mm2, TR=42ms, TE=2ms, single
slice, averages=10, matrix=128x128. A pH-weighted imaging
was obtained by subtracting the von image from the
corresponding voff one. The z-spectrum was also acquired
with pulsed labelling RF schemes.
Results: The signal intensity of each tube containing
iopamidol depends on the pH value, and the imaging SNR
is well-pleasing. The higher the signal intensity is related
with the lower pH value (p<0.05, r>0.7).
Conclusions: Our experiments proved that it is possible to
detect pHe of abnormal tissue, based iopamidol CEST
imaging with MT-GRE sequence. This finding may help the
non-invasive assessment of the extent and progression of
diseases for which pH modifications act as biomarker, as
well as provide complementary information to conventional
imaging.
406 Posters, Sunday 9 September
P1843
The role of functional MRI in diagnosing
severe chronic disorders of
consciousness
S.M. Golaszewski1,2,3, M.Seidl1,3,4,
A.B. Kunz1,4,
M. Kronbichler2,5, J. Crone2,5, R. Nardone1,3,6,
E. Trinka1,2,3, F. Gerstenbrand4,7
1Department of Neurology, 2Neuroscience Institute, 3Spinal
Cord Injury and Tissue Regeneration Center, Paracelsus
Medical University Salzburg, 4Karl Landsteiner Institute of
Neurorehabilitation and Space Neurology, Vienna, 5Institute
of Psychology, Paris Lodron University, Salzburg, Austria,
6Department of Neurology, F. Tappeiner Hospital, Merano,
Italy, 7Department of Neurology, Medical University
Innsbruck, Austria
Objective: Accurate diagnosis of severe chronic disorders
of consciousness (DOC) after TBI is essential for clinical
and rehabilitative care and decision-making.
Neurobehavioral tests, which rely on the patients
intellectual and motor ability to communicate, are the most
widely used diagnostic tools, since their advantage over
clinical assessment has been validated. However, with the
emergence of modern neuroimaging methods, especially
functional MRI, objective physiological markers for
assessing the state of consciousness are available in
specialized clinics. They are, however not fully integrated
in clinical routine, because their benefit has yet to be
determined.
Material and methods: 15 patients in apallic syndrome
(AS) and 5 patients in minimally conscious state (MCS)
after TBI and other aetiologies were examined with
somatosensory, auditory and event related paradigms in
fMRI and evoked potentials (EP). The findings were
compared to the neurobehavioural diagnosis and it was
analyzed, if additional information from fMRI and EP
confirmed or questioned the diagnosis.
Results: 3 out of 15 patients in AS showed fMRI activation
in event related paradigms, suggesting that patients are in
MCS or in beginning remission.
Conclusion: Uncertainty in diagnosis still exists even with
well-established diagnostic assessment scales. As long as
internationally accepted guidelines for assessing patients
with chronic DOC do not exist, every single diagnostic
modality available in each clinical setting should be
performed, to minimize diagnostic error and to find ways,
in terms of perceptive channels, to approach the patients.
FMRI has the potential to bring diagnostics in chronic DOC
forward to the next level.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1844
Oral somatosensory association with
visual cortex
N. Narita1, K. Kamiya2
1Neurological Dentistry, Nihon University School of
Dentistry at Matsudo, Mastudo, 2Removable Posthodontics,
Nihon University School of Dentistry at Matsudo, Japan
Introduction: Braille reading by blind individuals has been
reported to cause visual cortex activation (Fujii T, et al.
Neurosci Res. 2009, 65(2):175-86), while sighted
individuals require training to activate the visual cortex
(BMC Neuroscience 2006, 7: 79). When considering the
oral region, even though it is naturally impossible to see
inside the oral cavity by oneself or the food bolus while
chewing, proper chewing is possible without any injury to
the tongue and cheek. In this study, we attempted to clarify
the specificity between oral tactile discrimination and visual
cortex activity.
Methods: 6 healthy subjects participated in this study. For
shape discrimination, we used 6 differently shaped test
pieces, and the time duration of each discrimination trial in
the mouth was 10 seconds, with 40-second rest intervals.
F-NIRS was used to measure occipital cortex activity.
Results: Shape discrimination by the mouth activated the
primary visual cortex, association visual cortex, and
somatosensory association cortex. Furthermore, visual
cortex activity in incorrect answer was significantly
increased as compared with that in correct answer.
Conclusion: Primary and association visual cortices are
especially involved in shape discrimination in the mouth. In
addition, visual cortex activity during shape discrimination
is enhanced during the incorrect task performance, which
may conceptually coincide with the previous report
Practice makes perfect: the neural substrates of tactile
discrimination.

P1845
Structural and metabolic correlates of
neuropsychological dysfunction in
multiple system atrophy and Parkinsons
disease
C. Kobylecki1,2, K. McDonald2,3, J. Thompson2,3,
J. Anton1, R. Hinz1, A. Gerhard1,2
1Wolfson Molecular Imaging Centre, University of
Manchester, Manchester, 2Greater Manchester Neurosciences
Centre, Salford, 3University of Manchester, UK
Introduction: Cognitive impairment is known to occur in
patients with multiple system atrophy as well as Parkinsons
disease (PD). However, differences in the cognitive profile
and its underlying substrates between the two conditions are
not clearly understood. We hypothesise that functional and
structural changes in fronto-subcortical structures underlie
differences in neuropsychological performance in these
parkinsonian syndromes.
Methods: Age-matched patients with idiopathic PD (n=5)
and multiple system atrophy-parkinsonism (MSA-P; n=4)
underwent detailed neuropsychological and clinical
evaluation. In addition, volumetric T1-weighted MRI and
[18F]-fluorodeoxyglucose (FDG) positron emission
tomography (PET) in the resting state were performed.
Voxel-based analysis of both grey matter volume and FDG-
PET data was performed using SPM8.
Results: No significant differences in MMSE or Montreal
Cognitive Assessment (MoCA) scores were found between
MSA-P and PD patients. There were no significant
differences in verbal learning or verbal fluency test scores.
Patients with MSA-P had significantly poorer performance
on Stroop word (p<0.001) and colour naming (p<0.05), and
on the Trails B test (p<0.05), but not in the Stroop
interference condition. In MSA-P compared to PD, grey
matter atrophy and hypometabolism were identified in the
right anterior cingulate cortex, with additional atrophy in
the left putamen.
Conclusion: Our preliminary results indicate that structural
and metabolic changes in frontal areas, such as the anterior
cingulate cortex, are likely to contribute to poorer executive
function in patients with MSA-P compared to PD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 407
P1846
Computer assisted seizure onset zone
localization based on ictal EEG
G. Gritsch1, M. Hartmann1, H. Perko1, F. Frba1,
C. Baumgartner2, T. Kluge1
1Department Safety & Security/AIT Austrian Institute of
Technology, 22nd Neurological Department, Hospital Hietzing
with Neurological Center Rosenhgel, Vienna, Austria
Introduction: For medical refractory epilepsy patients,
neurosurgery is often the last chance to become seizure free.
In order to find the seizure onset zone (SOZ), long-term
EEG recordings are performed. Commercial source
localization software can be used to identify the SOZ based
on the recorded EEG. The disadvantage of such tools is that
they work on interictal spikes which may not stem from the
SOZ and need a lot of user interaction. Our proposed system
works on rhythmic ictal EEG without manual interaction of
the user.
Methods: The proposed system combines an automatic
seizure detection system (EpiScan) and a source localization
module. EpiScan measures the strength of rhythmic activity
within the EEG signal. If the rhythmicity measure rises
above a certain threshold, an alarm is reported. For these
time instances the rhythmic part of the signal is fed into the
source localization module. The source localization is
performed with an Eigenspace beamformer using a standard
MRI based BEM head model.
Results: 4 patients having 19 seizures were investigated.
EpiScan detected all seizures at a false alarm rate of 0.26
per hour. In most cases our localization approach was able
to reproduce clinical findings very well. Only where very
large artifacts are present, a loss of spatial concentration of
the SOZ can be observed.
Conclusion: Our proposed system is capable of
automatically detecting SOZs based on rhythmic ictal EEG.
In contrast to other commercial systems no user interaction
is necessary, thus making it a valuable approach for clinical
practice.
408 Posters, Sunday 9 September
P1847
Is quantitative assessment of cervical
nerve hypertrophy by MRI effective for the
diagnosis of chronic inflammatory
demyelinating polyradiculoneuropathy?
A single-institution, retrospective
case-control study
K. Tanaka1, N. Mori2, Y. Yokota2, T. Okunomiya1,
D. Kambe1, A. Shinde1, T. Kageyama1, T. Suenaga1
1Department of Neurology, 2Department of Radiology, Tenri
Hospital, Tenri, Japan
Introduction: Spinal nerve hypertrophy is often seen in
patients with chronic inflammatory demyelinating
polyradiculoneuropathy (CIDP). The purpose of this study
was to evaluate the effectiveness of quantitative assessment
of cervical nerve hypertrophy by MRI for the diagnosis of
CIDP.
Methods: We retrospectively enrolled 15 consecutive
patients who had been diagnosed with definite CIDP
according to the EFNS/PNS diagnostic criteria. 30 controls
matched for sex, age, and MRI systems were also included.
A radiologist reviewed the STIR images of cervical MRI
without prior knowledge of the diagnoses. The diameters of
the C5-C8 cervical nerves were measured. The mean signal
intensities in the nerves and the sternocleidomastoid muscle,
as well as background noise, were measured to calculate the
contrast-to-noise ratio (CNR) in each nerve. Receiver
operating characteristic analysis was used to determine the
cut-off values of diameter and CNR means, and the
diagnostic performance of the assessment procedure was
evaluated. Another radiologist reviewed the MR images in
the same way. The weighed kappa coefficient was calculated
to evaluate the interobserver agreement.
Results: The cut-off values of diameter and CNR means
were 5.3mm and 38.7, respectively. When the diameter or
CNR means exceeded the cut-off values, the sensitivity and
specificity were 53.3% and 93.1%, respectively. The
weighed kappa coefficient was 0.62, indicating substantial
interobserver agreement.
Conclusion: Quantitative assessment of the cervical nerve
hypertrophy by measuring nerve diameters and CNRs on
the STIR image of MRI was effective for the diagnosis of
CIDP. Moreover, the reproducibility of this assessment
procedure was acceptable.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1848
Modified CCA+jICA method for
neuroimaging data fusion
V. Youssofzadeh1, I. Faye1, A.S. Malik1, J.M. Abdullah2,
F. Reza2, N. Kamel1
1Electrical and Electronics Engineering, Universiti Teknologi
Petronas, Teronoh, 2Neuroscience, Hospital Universiti Sains
Malaysia, Kota Bharu, Malaysia
Introduction: Multi-modal data fusion may provide
improved analysis compared to that with single modality. In
this paper, EEG and fMRI data are fused to provide better
results using data fusion in order to identify functional and
dysfunctional activities in the human brain.
Method: We proposed modification to CCA+jICA
(Canonical Correlation Analysis+ Joint Independent
Component Analysis) method by incorporating Full Blind
Source Separation (FBSS). CCA maximizes inter-subject
co-variations across modalities at feature level then JICA
maximizes independency of canonical variants through
FBSS, which minimizes entropy of separated sources.
Results: Using spatiotemporal simulated data, the proposed
scheme is compared with other ICA-based data fusion
models. Table 1 shows the best correlation results for
CCA+jICA(FBSS) method. The proposed scheme is also
tested utilizing concurrent EEG-fMRI data for Auditory
Oddball task from 23 healthy subjects. ERP showed
prominent positive (300ms) and negative peaks (100 and
200ms) while fMRI images disclosed higher activity in
bilateral parietal and posterior temporal and lower activity
in mid-frontal areas. The obtained results cannot be seen in
separate analyses of EEG/fMRI.
[AVERAGE CORRELATION ANALYSIS]
Average of Joint ICA CCA + JICA CCA + JICA CCA + JICA CCA + JICA CCA + JICA
Correlation
Coefficients
(Infomax)
0.72210.84
(Infomax)
0.88270.42
(EBM)
0.78471.12
(WASOBI) (NC-FastICA)
0.85830.24 0.91170.52
(FBSS)
0.94310.425
Conclusion: The outcomes can be linked to sensory,
learning process and expectation based on activations
produced by CCA+jICA(FBSS). Applying FBSS in
CCA+jICA model demonstrates the possibilities for
exploring associations in multimodal data and can be used
for multi-task applications with improved accuracy.

P1849
Diffusion measured white matter
disintegration in cluster headache
N. Szab, T.Z. Kincses, E. Tth, G. Csete, B. Tuka,
. Prdutz, L. Vcsei
Department of Neurology, Albert Szent-Gyrgyi Clinical
Center, University of Szeged, Hungary
Objectives: In our former study we showed altered
microstructure of the white matter in migraineurs. It is not
known yet if these changes of MRI diffusion parameters
were specific for migraine, or related to the repeated pain
attacks.
Methods: 11 patients with cluster headache and 11 age-
matched healthy control subjects were recruited. Diffusion
weighted MRI images with 60 diffusion directions were
acquired on a 1.5 T GE Signa Excite scanner. Tract based
spatial statistics were used to detect the integrity of white
matter tracts in a skeleton representing the core of the fibre
bundles.
Results: Reduced fractional anisotropy was found in a right
corticospinal tract, in the corpus callosum and in the anterior
thalamic radiation bilaterally. The axial diffusivity was
bilaterally increased in the anterior thalamic radiation, in
the anterior corona radiate and in the inferior part of the
fronto-occipital fasciculus. The mean and perpendicular
diffusivity was increased almost over the whole brain with
left sided dominance.
Discussion: Since the above described white matter
microstructural alterations, however more extensive, are
similar to those found in migraine, this points to the
assumption that these findings might reflect pain related
alterations that are not specific to either of the diseases.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 409
P1850
SPG3A-linked hereditary spastic
paraplegia associated with cerebral
glucose hypometabolism
T. Terada1,2, S. Kono1, Y. Ouchi2, K. Yoshida3,
Y. Hamaya2, S. Kanaoka2, K. Shirakawa1, T. Konishi1,
M. Sakao1, H. Miyajima1
1First Department of Medicine, Hamamatsu University
School of Medicine, 2Molecular Imaging Frontier Center,
University School of Medicine, 3Department of Molecular
Diagnosis, Hamamatsu University School of Medicine,
Hamamatsu, Japan
SPG3A-linked hereditary spastic paraplegia is an autosomal
dominant hereditary spastic paraplegia (HSP) caused by a
mutation in the SPG3A gene, and is characterized by
progressive weakness and spasticity in the lower limbs
without any neurological abnormalities. We herein report
two middle-aged Japanese sisters who were heterozygous
for an R239C mutation in the SPG3A gene. They both had
experienced onset of the disease in childhood, and have a
pure phenotype of HSP. To investigate cerebral function in
these patients, [18F]-fluorodeoxyglucose (FDG) positron
emission photography (PET) with three-dimensional
stereotastic surface projection analysis was used for
measurement of the cerebral metabolism of glucose
(CMRGlc). The PET analysis revealed decreased CMRGlc
in the frontal cortex, and neuropsychological assessments
showed low scores in the Frontal Assessment Battery. HSP
caused by an R239C mutation has been reported to present
a pure phenotype confined to impairment of the corticospinal
tract. The decreased CMRGlc in the frontal cortex
associated with cognitive impairment in the frontal lobe in
these patients may indicate a more widespread
neuropathology from mutations in the SPG3A gene than
previously assumed.
410 Posters, Sunday 9 September

P1851 P1852
Magnetic resonance imaging is related to Cerebral re-organisation following
the release of neurobiochemical markers traumatic spinal cord injury
of brain damage in chronic cerebral L. Sabre1, T. Tomberg1,2, J. Krv1, J. Kepler3, K. Kepler4,
ischemia . Linnamgi1, T. Asser1
1Department of Neurology and Neurosurgery, University of
Y. Morozova
Russian State Medical University, Moscow, Russia Tartu, 2Radiology Clinic, Tartu University Hospital, Tartu,
3Prnu Hospital, Prnu, 4Institute of Physics, University of
In recent years neurobiochemical markers of brain damage Tartu, Estonia
gained particular attention.
Introduction: The aim of the study was to examine cortical
Aim of study: Correlation between MRI, protein S100 and
re-organisation after traumatic spinal cord injury (TSCI)
TNF- releasing during chronic cerebral ischemia (CCI).
using functional magnetic resonance imaging (fMRI).
108 patients with CCI aged 20 - 60 years. Control group -
Patients and methods: We studied 6 right-handed
20 healthy persons.
tetraplegic TSCI patients at 1, 3 and 12 months after the
All patients were divided in 3 groups:
injury and 12 age- and gender-matched healthy controls at
1 - initial cerebral insufficiency (ICI) - 36.1%;
a single point of time. Individuals performed simple test-
2 - 31.3% - dyscirculatory encephalopathy (DE) of grade 1 and
rest cycles of flexion/extension of the right hand fingers and
3 - 32.2% DE of grade 2. In group 1 MRI was normal in the
flexion/extension of the right ankle during fMRI. The
majority. In group 2 - light and moderate widening of
activation volumes, maximum t-values and centres of
subarachnoid spaces (SS) of convexital surface - 76%;
gravity (COG) were calculated.
moderate widening of SS - 18%. In group 3 -widening of SS
Results: During hand movements the volume of activation
and LV with focal changes of ischemic origin different aged
in the contralateral primary motor cortex (Brodmann area
period (DAP) - 88.6%; widening of LV, multiple focal
(BA) 4) was non-significantly larger in TSCI patients
changes in paraventricular areas DAP of both hemispheres
(3,991.4mm3 vs. 2,433mm3, p=0.11). During the ankle
- 8.6%. In pts with ICI, TNF- was 0.6480.003pg/l, protein
movement their BA4 volume of activation was significantly
S100 - 0.6940.001 unit of optical density (UOD); in
increased (p=0.04). TSCI patients had an increased
patients with DE of grade 1 TNF- was 0.7050.001pg/l
recruitment of associated motor cortex (BA6) during both
and protein S100 0.7400.002 UOD; in patients with DE of
tasks (p=0.01). There was no recovery of neurologic
grade 2 TNF- was 1.2200.0004pg/l and protein S 100-
function in 3 patients and the remaining recovered
0.7640.001 UOD (p<0.001). TNF- in control group
according to American Spinal Injury Association (ASIA)
0.0520.002 pg/l, protein S100- 0.540.002 (UOD),
Impairment Scale. The cortical activations were more
(p<0.001). Changes in MRI correlate with grade of CCI and
increased in the patients who recovered. The mean COGs
TNF- and protein S100 releasing. These data support the
for BA4 during hand movement in TSCI patients showed a
correlation of TNF- and protein S100 with apoptotic or
non-significant shift laterally and anteriorly. During ankle
necrotic neuronal death.
movement there was a statistically significant shift in
activation medially.
Conclusion: Our study found broadening of cortical
activation during the first year after TSCI. To our knowledge
this is the first study to show the dynamic changes of
activation in the acute phase of TSCI.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


P1853
MRI findings in Susacs syndrome: report
of three cases and review of the literature
M. Messelmani, H. Khaled, I. Bedoui, M. Mansour,
J. Zaouali, R. Mrissa
Neurology, Military Hospital, Tunis, Tunisia
Introduction: Susacs syndrome (SS) is a rare disease of
unknown pathogenesis. It is caused by a microangiopathy
affecting the arterioles of the brain, retina, and cochlea,
giving the classic clinical triad of subacute encephalopathy,
visual loss secondary to retinal branch occlusions, and
sensorineural hearing loss.
Results: We report 3 cases of SS. They were all female.
Mean age at onset was 40.3 years. Clinical symptoms at
onset were neurological in 2 cases and auditory in one case.
Neurologic symptoms included headache, memory loss,
depression, behavioural disturbance, paraesthesia and
difficulty in walking. Brain MRI showed T2 lesions in the
white matter and corpus callosum in the 3 cases. No
enhancement after the administration of gadolinium was
observed. CSF was abnormal in 2 patients showing an
elevated protein level. They were treated with
corticosteroids.
Conclusion: SS has been considered rare, but it is probably
more common than previously thought. Due to its
polymorphism, SS is difficult to diagnose when the clinical
triad is lacking. The MR scans in SS show a rather
distinctive pattern of supratentorial white matter lesions that
always involve the corpus callosum. There is often deep
grey matter, posterior fossa involvement, and frequent
parenchymal with occasional leptomeningeal enhancement.
The central callosal lesions differ from those in
demyelinating diseases, and should support the diagnosis of
SS in patients with at least two of the three features of the
clinical triad.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 411
P1854
Posterior reversible encephalopathy
syndrome (PRES): description of 25 cases
L.C.P. Marrone1, A.C.H. Marrone1, G. Gadonski2,
L.P. Diogo2, C.E. Poli-de-Figueiredo2, J.C. da Costa2
1Neurology, Pontificia Universidade Catlica do Rio Grande
do Sul, Porto Alegre, 2Neurology, Pontificia Universidade
Catlica do Rio Grande do Sul, Brazil
Posterior reversible encephalopathy syndrome (PRES) is a
clinicoradiologic entity characterized by headaches, altered
mental status, seizures, and visual loss and is associated
with white matter vasogenic oedema predominantly
affecting the occipital and parietal lobes of the brain. The
cause of PRES is not yet understood. Numerous factors can
trigger the syndrome, most commonly: acute elevation of
blood pressure, abnormal renal function and
immunosuppressive therapy. Other possible aetiologies are
eclampsia, transplantation, neoplasia and chemotherapy
treatment. The most characteristic imaging pattern in PRES
is the presence of oedema involving the white matter of the
posterior portions of both cerebral hemispheres, especially
the parieto-occipital regions, in a relatively symmetric
pattern that spares the calcarine and paramedian parts of the
occipital lobes. We performed a review of clinical data,
neuroimaging and blood basic test of 25 patients with
PRES, who were followed in Hospital So Lucas-PUCRS
in the period from March/2007 to September/2011. Our
clinical sample consisted of 25 patients (4 men and 21
women) with mean age 27.84 years (range from 2 to 74).
The most common causes of PRES reported in this series
were associated with pregnancies in 11 cases (44%),
followed by lupus in 4 cases (16%). The symptoms more
commonly reported were headache in 18 patients (72%),
visual disturbance in 17 patients (68%) and seizure in 13
patients (52%). The occipital lobe was the most common
topography of the magnetic resonance abnormality and
occurred in 23 cases (92%), followed by parietal lobe in 15
cases (60%).
412 Posters, Sunday 9 September
P1855
Bi-exponential diffusion signal decay in
normal-appearing white matter of multiple
sclerosis
S. Nagy1, P. Bogner1,2, M. Aradi3, G. Orsi4,5,6,
G. Perlaki1,4,5, H. Komaromy1, A. Schwarcz5,7,
J. Janszky4,5
1Diagnostic Centre of Pcs, 2Department of Radiography,
University of Pcs, Kaposvr, 3Department of Radiology,
County Hospital of Zala, Zalaegerszeg, 4Department of
Neurology, University of Pcs, 5MTA-PTE Clinical
Neuroscience MR Research Group, 6Department of Biology,
7Department of Neurosurgery, University of Pcs, Hungary
Aims: To characterize bi-exponential diffusion signal
changes associated with reduced white matter myelination
in multiple sclerosis (MS).
Methods: Apparent diffusion coefficients (ADC) were
generated using mono-exponential (0-1,000s/mm2) and
bi-exponential (0-5,000s/mm2) approaches from 14 patients
with relapsing-remitting type of MS and 14 age- and sex-
matched controls after acquiring diffusion-weighted images
on a 3-T MRI system. Bilateral region of interest (ROI)
measurements were performed in normal-appearing white
matter (NAWM) structures. The results were analyzed using
parametric or non-parametric tests and multiple linear
regression models.
Results: Mono-exponential ADC increases in controls but
decreases in MS as a function of age; nonetheless an
elevated ADC is observed with increasing lesion number in
patients. Bi-exponential analysis shows that the increased
ADC is the result of decreased relative volume fraction of
slow diffusing component (fs). However the fast and slow
diffusion components (ADCf, ADCs) do not change as a
function of either age in controls or lesion number and age
in MS patients.
Conclusions: Myelin content of the white matter may affect
water diffusion in multiple sclerosis patients. It is suggested
that these changes are probably due to the reduction of
myelin water fraction.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1856
Detection of CEST MRI using
magnetization transfer pre-saturation
sequence at 1.5 T scan
G. Xiao1, Z. Dai2, P.Z. Sun3, R. Wu4
1Department of Math and Information Technology, Hanshan
Normal University, Chaozhou, 2Medical College, Shantou
University, Shantou, China, 3Athinoula A. Martinos Center
for Biomedical Imaging, Department of Radiology,
Massachusetts General Hospital and Harvard Medical
School, Charlestown, MA, USA, 4Department of Radiology,
2nd affiliated Hospital of Shantou University Medical
College, Shantou, China
Introduction: Solution pH was measured using water
proton NMR via chemical exchange dependent saturation
transfer (CEST) with selected chemical exchange sites. In
this work, Magnetization Transfer pre-saturation sequence
was used to realize the CEST imaging.
Methods: The Magnetization Transfer sequence with
selective radiofrequency was used on the GE Signa HDX
1.5T Scanner. The pH samples were prepared with 3% agar-
gel and 50mmol/L creatine, in which pH value is only
difference. Magnetization Transfer pre-saturation pulse was
set at -121Hz and 121Hz. We used gradient echo to read the
MRI. Other imaging parameters were set as follows:
TR=40ms, TE=4ms, Slice thickness=5mm, single slice,
field of view=1616mm, NEX=30 and acquisition
bandwidth=31.25KHz. Total scan time was about 7.5min.
The images were processed using Matlab.
Results: The signal intensity of CEST MRI depended on
the pH value. Our result shows that the lower the pH value
is, the weaker the signal intensity is. In addition, the
diversity of the CEST MRI is approximately at 3%.
Conclusion: Our pH samples proved that we can detect pH
value using Magnetization Transfer pre-saturation sequence.
This finding has its potential advantages in detecting acid-
based metabolisms.

P1857
N4U - neuGRID for Users: a web-based
gateway to neuroimaging research
G. Spulber1,
A. Redolfi2,
L.-O. Wahlund1,
F. Barkhof3,
R. McClatchey4, C. Finochiaro5, J.-F. Mangin6,
P. Giannakopoulos7, J. Montagnan8, A. Evans9, A. Toga10,
G. Frisoni2
1Karolinska Institutet, Stockholm, Sweden, 2IRCCS,
Fatebenefratelly, Brescia, Italy, 3VU University Medical
Centre, Amsterdam, The Netherlands, 4University of West of
England, Bristol, UK, 5CFc Consulting, Milan, Italy,
6Commissariat lEnergie Atomique et aux Energies
Alternatives, Gif-sur-Yvette Cedex, France, 7Hpitaux
Universitaires de Genve, Switzerland, 8CNRS, Orsay cedex,
France, 9McGill University, Montral, QC, Canada,
10University of California, Los Angeles, CA, USA
The unprecedented growth, availability and accessibility of
sophisticated image analysis algorithms and powerful
computational resources led to the idea of developing web-
based computational infrastructures that could meet users
new requirements. On the other hand the gap between the
pace of data generation and the capability to extract
clinically or scientifically relevant information is rapidly
widening. Integration of the power of sophisticated
mathematical models, efficient computational algorithms
and advanced hardware infrastructure provides the
necessary sensitivity to detect, extract and analyze subtle,
dynamic and distributed patterns distinguishing one brain
from another, and a diseased brain from a normal brain.
neuGRID is the leading e-Infrastructure where
neuroscientists can find core services and resources for
brain image analysis. The neuGRID platform makes use of
grid services and computing, and was developed with the
final aim of overcoming the hurdles that the average
scientist meets when trying to set up advanced experiments
in computational neuroimaging, thereby empowering a
larger base of scientists. Although originally built for
neuroscientists working in the field of AD, the infrastructure
is designed to be expandable to services from other medical
fields (e.g. multiple sclerosis, psychiatric conditions).
neuGRID for Users (N4U) will provide an e-Science
environment by further developing and deploying the
neuGRID infrastructure to deliver a virtual laboratory
offering neuroscientists access to a wide range of datasets
and algorithm pipelines, access to computational resources,
services, and support. Information from this abstract is
intended to make aware researchers working with
neuroimaging of all possibilities when it comes to resources.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 413
P1858
MRI in chronic cerebral ischemia (CCI)
L. Belova1, Y. Nikitin2, V. Mashin1, N. Belova1,
V. Abramova1
Medical Faculty, Ulyanovsk State University, Ulyanovsk,
1
Scientific Center for Neurology under Russian Academy of
2
Medical Science (RAMS), Moscow, Russia
Prevention, early diagnosis and treatment of cerebrovascular
diseases, including chronic forms, are an actual problem of
modern neurology. 209 CCI I-III patients divided in two
groups: 93 with constitutional phlebopathy (CPP) and 116
without it (NP). Control group - 30 persons. MRI machine
Siemens (1.5 tesla) was used. With MR angiography sinus
sagittalis superior, sinus rectus, sinus transversus cerebri,
venae superficiales cerebri, vena cerebri magna and venae
jugulares internae were estimated. In the NP group with
CCI progression the following was defined: the increase in
linear size and body index of ventriculus lateralis cerebri,
increase of patient number with focal brain changes and
leukoaraiosis. In the CPP group the change of intensity was
the same in different CCI stages (p>0.05). Venae
superficiales cerebri in patients with CPP were wider, than
in the control group and NP in all stages; veins widening
increased in CCI II-III in comparison with CCI I. In CPP
with CCI III sinus rectus and vena magna cerebri sizes
increased. Right and left sinus transversus hypoplasty is
found in 35 CPP and in 30 NP (p>0.05) patients. One-sided
sinus transversus thrombosis in 7 CPP patients and 2 NP
(p>0.05). The MRI data proved the presence of intracranial
passive venous congestion in CPP patients: the size increase
of venae superficiales cerebri, sinus rectus and vena cerebri
magna. Intracranial sinus thrombosis was found with the
same rate in CPP and NP patients. Vein tonus and
functionality could be a reason for intracranial venous
discirculation in CCI.
414 Posters, Sunday 9 September
P1859
Cerebellar and brainstem congenital
defects in Tunisian children
I. Marouani1, I. Kraoua1, H. Benrhouma1, A. Rouissi1,
I. Turki1, E.M. Valente2, S. Nagi3, N. Gouider-Khouja1
1Department of Child and Adolescent Neurology, National
Institute of Neurology, Tunis, Tunisia, 2CSS-Mendel Institute,
Rome, Italy, 3Department of Neuroradiology, National
Institute of Neurology, Tunis, Tunisia
Introduction: Cerebellar and brainstem congenital defects
(CBCD) refer to any structural abnormality of the
cerebellum or the brainstem, present at birth, and due to
interrupted or modified development of these structures
during intra-uterine life, whatever the aetiology. Brain MRI
allows accurate description of CBCD and orientation of
genetic diagnosis.
Objective: To describe the type of CBCD observed in
Tunisian children and their clinical and radiological
features.
Patients and methods: A prospective study (2005-2012)
was conducted in 43 patients with CBCD. Malformations
were classified using a novel classification (Valente et al)
based on the determination of the primary cerebellar
diagnosis, then the associated infra- and supratentorial
abnormalities.
Results: 43 patients (28 males and 15 females) had CBCD.
The mean age of patients was 7.1 years. The most frequent
malformations were molar tooth sign (32.6%), vermian
hypoplasia (30.2%) and Dandy Walker malformation
(14%). Infratentorial and supratentorial abnormalities were
associated in 32.6% and 55.8% of cases, respectively. The
most frequent infratentorial abnormality was cerebellar
hemisphere atrophy (50%) and the most frequent
supratentorial abnormality involved the commissures
(70.8%). The most frequent clinical presentations observed
in our patients were psychomotor delay (86%), gait
disturbance (62.7%), visual abnormalities (62.7%) and
mental retardation (53.4%).
Conclusion: The use of this morphology-based
classification is practical and useful since it considers the
totality of the brain and not only the posterior fossa. Clinical
and radiological studies of CBCD allow accurate diagnosis
and orientate genetic studies in order to propose genetic
counselling.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1860
Magneto-encephalographic spike
identification in insular epilepsy
H.M. Park1, N. Nakasato2
1Neurology, Gachon University Gil Hospital, Inchon,
Republic of Korea, 2Epileptology, Tohoku University
Graduate School of Medicine, Sendai, Japan
P1861
Presynaptic dopamine transporter SPET
scanning for the differential diagnosis of
parkinsonism at the Tartu University
Hospital
H. Lindme1, K. Ulst2, P. Taba3
1University of Tartu, 2Department of Radiology, 3Department
of Neurology and Neurosurgery, University of Tartu, Estonia
P1862
CT interpretation by ASPECTS in
hyperacute ischemic stroke predicting
functional outcome
S. Tiamkao1, B. Sangpetngam2, W. Phuttharak2,
Northeastern Stroke Research Group
1Division of Neurology, Department of Medicine, 2Radiology,
Faculty of Medicine, Khon Kaen University, Khon Kaen,
Thailand
P1863
Decreased cerebral cortical NAA/Cr
correlated to prolonged periodicity of
PSD in a patient with Creutzfeldt-Jakob
disease: findings of 1H-MRS and EEG
K. Isonishi1, F. Moriwaka2, T. Kaneko3, S. Kaneko4,
T. Kashiwaba4
1Neurology, Kashiwaba Neurosurgery Hospital, 2Neurology,
Hokuyukai Neurological Hospital, 3Neurophysiology,
4Neurosurgery, Kashiwaba Neurosurgery Hospital, Sapporo,
Japan
P1864
Abstract cancelled
 Posters, Sunday 9 September 415

P1865 P1868
Radiologic characteristics of low TIA and NMR
cerebrospinal fluid pressure headache N..R. Gligic, K. Kacar
L. Mohanna1, J. Garcia1, B. Lara1, A. Paipa1, Hospital for Cerebrovascular Diseases, Belgrade, Serbia
C. Homedes1, S. Aixut2, J. Prat1, F. Rubio1
P1869
1Neurology, 2Radiology, Hospital Universitari de Bellvitge,

Barcelona, Spain
MR abnormalities after the first epileptic
fit. Which is the best attitude? Report of
P1866
two cases with different evolution
Dynamic contrast enhanced MRI for the profiles, and review of literature
evaluation of metastatic melanoma E. Ranxha1, G. Brace2, G. Fejzo2, D. Dobi3, A. Rroji4,
Z. Rozhkova, O. Dolia M. Petrela2, G. Kaloshi2
Radiology, Medical Clinic BORIS, Kiev, Ukraine 1Neurology, University Hospital Centre Mother Teresa,
2Neurosurgery, 3Neurology, 4Radiology, UHC Mother
Theresa, Tirana, Albania
P1867
Priority of clinical features in comparison
with MRI DWI of the brain in the peracute P1870
period of ischemic stroke for intravenous Imaging particularities and different
thrombolytic therapy outcomes in cerebral brain thrombosis
I.A. Khasanov1,2, E.I. Bogdanov1 caused by genetic thrombophilia:
1Neurology and Rehabilitation Department, Kazan State a case report series
Medical University, 2Stroke Unit, Republic Clinical Hospital, S. Petrescu1, A. Chirita2, G.D. Vanghelie1, C. Panea1
Kazan, Russia 1Neurology, The Emergency University Elias Hospital,
2Imaging, Regina Maria Medical Center, Bucharest,
Romania

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

416 Posters, Sunday 9 September
Neurological manifestation of systemic
diseases
P1871
The effects of oral benfotiamine on
peripheral nerve function and
inflammatory markers in type-1 diabetes:
a 24-month, double-blind, randomised,
placebo-controlled trial
D.A. Fraser1, L.M. Diep2, I.A.H. Hovden3, K.B. Nilsen3,4,
K.A. Sveen5, I. Seljeflot6,7, K.F. Hanssen7,8
1Diabetes Research Centre, 2Oslo University Hospital,
3Department of Neurology, Section for Clinical
Neurophysiology, Oslo University Hospital, Oslo,
4Department of Neurosciences, Norwegian University of
Science and Technology, Trondheim, 5Diabetes Research
Center, 6Center for Clinical Heart Research, Department of
Cardiology, Oslo University Hospital, 7Faculty of Medicine,
University of Oslo, 8Department of Endocrinology, Oslo
University Hospital, Oslo, Norway
Introduction: Short-term studies (3-6 weeks) in humans
have suggested that high-dose benfotiamine (up to 600mg/
day) can improve symptomatic scores in diabetic
polyneuropathy. To assess the efficacy of long-term
supplementation, we have carried out a 24-month,
randomised, double-blind, placebo-controlled study to
evaluate whether 300mg/day benfotiamine supplementation
can influence peripheral nerve function, soluble markers of
inflammation and other biochemical variables in patients
with type-1 diabetes.
Methods: 67 patients with type-1 diabetes of more than 15
years duration (mean 31 years) were randomly assigned to
receive 24-months benfotiamine (300mg/day) or placebo
supplementation. Peripheral nerve function and levels of
soluble inflammatory variables were assessed at baseline
and after 24 months. Tests of peripheral nerve function
included nerve conduction studies (including F-waves) of
peroneal, tibial, and sural nerves, as well as heart rate
response to deep breathing.
Results: 59 patients completed the study. Marked increases
in whole-blood concentrations of thiamine and thiamine
diphosphate were found in the benfotiamine group (both p<
0.001 as compared to placebo). However, no significant
differences in changes between the groups in either
peripheral nerve function or soluble inflammatory
biomarkers were observed.
Conclusion: Our findings suggest that high-dose
benfotiamine (300mg/day) supplementation over 24 months
has no significant effects upon peripheral nerve function or
soluble markers of inflammation in patients with type-1
diabetes.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1872
Rendu-Osler-Weber disease with hepatic
systemic shunting may lead to cerebral
manganese accumulation: clinical,
neuropsychological and radiological
findings
C.J.M. van Boheemen1, E.J.J. Habets1,
G.J. Lycklama Nijeholt2, C.J. Vecht1
Neurology, 2Radiology, Medical Centre The Hague, The
1
Hague, The Netherlands
Introduction: Rendu-Osler-Weber (ROW), or hereditary
haemorrhagic telangiectasia (HHT) is associated with
arteriovenous malformations (AVM) in various organs,
including porto-systemic shunting with neurological signs
and manganese accumulation in the basal ganglia. There are
hardly any reports on the relationship between neurological
symptoms with cognitive changes and neuroradiological
findings of manganese accumulation in ROW.
Methods: 2 patients with previously diagnosed ROW were
tested on tremor, myoclonus, dystonia, hypo- and
bradykinesia, rigidity, speech and walking difficulties.
Extensive neuropsychological testing included Stroop
colour and Word test, subtests of Wechsler Adult Intelligence
Scale-III, Number connecting test A and B, Wisconsin card-
sorting test and Rey-Osterrieth complex figure. Blood
chemistry, CT imaging of abdomen and MRI of brain were
performed.
Results:
Patient #1 showed an abdominal AVM at the inferior
mesenterical vein, and patient #2 had an intrahepatic AVM
with enlarged portal veins. Detailed neurological
examination revealed no abnormalities in #1; #2 showed a
mild postural tremor and discrete facial hypokinesia.
Neuropsychological testing showed moderate attention
dysfunction in #1 and normal values in #2. Hepatic function
was normal in both patients. MRI markedly showed
hyperintense T1 signal at the globus pallidus in both patients
suggesting manganese accumulation; the pallidal index was
140 and 166, in #1 and #2, respectively.
Conclusion: Hepatic AVM leading to cerebral accumulation
of manganese results in a hyperintense T1 signal at the basal
ganglia with a variable severity of extrapyramidal, cognitive
or behavioural abnormalities. The underlying
pathophysiological mechanism of manganese storage in the
brain and the effects on neurotransmitter function will be
discussed.

P1873
Drosophila Parkinsons mutant displays
olfactory impairment both to natural and
synthetic compounds
S. Poddighe1, M.D. Setzu2, P. Angioni3, P. Solla4,
A. Costa4, F. Marosu4, A. Liscia3
1Life and Environmental Sciences, Section of Neuroscience,
Neurological and Cardiovascular Sciences, 2Biomedical
Sciences, 3Life and Environmental Sciences, Section of
Neuroscience, 4Neurological and Cardiovascular Sciences,
University of Cagliari, Italy
Introduction: Parkinsons disease (PD) is the most
common degenerative disorder characterized by the clinical
triad: tremor, akinesia and rigidity. Recently, several studies
suggested that PD patients, at their very first onset, show
disturbance of olfaction which, since not restrained to PD,
has recently received attention in several studies.
The fruit fly is a powerful model organism for studying
neuronal dysfunction and loss that proceeds from
neurodegenerative diseases. The Drosophila genetic model
of PD (Dmel/Pink1 B9) displays the two most important
diagnostic criteria of the disease: rigidity and akinetic
behavioural.
In this study the olfactory sensitivity of the PD flies has
been investigated for the first time.
Methods: Electrophysiological recordings have been
obtained in response to natural volatiles and synthetic
compounds from groups of PD flies in their early stage of
their life cycle (3-10 days) and in a group at the end of it
(15-30 days). The results have been compared with the
same age-groups of wild type flies.
Results: In both age-groups of PD flies, a decrease in
olfactory response has been measured in respect to the wild
type flies tested to natural substances and to Hexanol and
-pinene among the synthetic volatiles. Morphological, an
analysis of neuro-anatomical correlates is in progress.
Conclusions: Our result demonstrates that PD flies show
olfactory impairment and suggest a good tool for a new
approach for studying Parkinsons disease and may greatly
contributes to better underline the development of
preclinical strategies to treat it.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 417
P1874
MRI findings and outcome of neuro-
Behets disease: the predictive factors
S. Farahangiz1, M. Mahmoodi2, S. Sarhadi1, A. Safari3,
A. Borhani Haghighi4
Department of Radiology, 2Health Policy Research Center,
1
Research Center for Traditional Medicine and History of
3
Medicine, 4Department of Neurology, Shiraz University of
Medical Sciences, Shiraz, Iran
Introduction: Initial MRI findings of patients with neuro-
Behets disease can predict unfavourable outcomes and
course of disease in these patients.
Methods: All the consecutive patients referred from 2002
to 2009 to Behet Clinic at Nemazee Hospital, Shiraz, Iran,
who fulfilled ISG criteria for Behets disease and diagnosed
as neuro-Behets disease, were enrolled in this study.
Characteristics of initial brain MRI were studied in patients
with different courses of neuro-Behets disease.
Results: Initial MRIs of 58 patients (31 women) with a
mean SD age of 38.99.7 years were reviewed. 49 (84%)
patients had parenchymal and 9 (16%) had non-parenchymal
neuro-Behets disease. Of those patients with parenchymal
neuro-Behets disease, 15 (31%) had monophasic, 13
(27%) polyphasic, and 10 (20%) had progressive courses;
11 (22%) had only headache attributed to Behets disease.
The most common sites of involvement in patients with
parenchymal neuro-Behets disease were periventricular
and superficial cerebral white matter, midbrain and pons,
respectively. Of those with parenchymal involvement, 12
(24%) had extension of lesions, 7 (14%) had contrast
enhancement, 12 (24%) had black holes and 5 (10%) had
brainstem atrophy. Patients with the progressive course had
a significantly (p=0.017; OR=18, 95% CI: 1.7-19.1) higher
rate of brainstem atrophy than those with non-progressive
course (monophasic or polyphasic).
Conclusion: Presence of brainstem atrophy in the initial
MRIs may predict a progressive course in patients with
neuro-Behets disease.
418 Posters, Sunday 9 September
P1875
Thymoma-associated cerebellitis: the
early stage of a paraneoplastic cerebellar
degeneration?
T. Teodoro1, D. Neutel1, P. Pita Lobo1, L. Neto2,
M. Coelho1, L. Albuquerque1
Neurology Department, 2Neuroradiology Department,
1 Republic, 2CNRS UMR 8194, Centre dEtude de la
Hospital de Santa Maria, Lisbon, Portugal
Background: Thymoma are infrequent causes of
paraneoplastic cerebellar degeneration (PCD). In PCD, an
initial oedematous phase has rarely been observed. We
report a case of subacute cerebellitis associated with a
thymoma.
Case report: A 34-year-old woman was admitted following
a 1-month history of mild fever, headache, dizziness,
vomiting and progressive gait imbalance.
She was confused, with a horizontal nystagmus in all gaze
positions and mild limb but severe truncal and gait ataxia.
A traumatic lumbar puncture showed 249 cells/mm3
(predominantly lymphocytes) and 117mg/dL proteins.
Brain MRI showed diffuse symmetrical swelling of the
cerebellum, with cortical-pial enhancement and
compression of the fourth ventricle. Acyclovir was
administered, but there was progressive clinical
deterioration. PCR analysis for neurotrophic virus in CSF
was negative. Serum viral serologies were unremarkable.
Body CT scan revealed an anterior mediastinal mass, which
proved to be a thymoma after biopsy. An extensive screening
for anti-neuronal antibodies was negative. The patient
underwent surgical removal of grade II thymoma, with a
striking clinical improvement in the following days. A
follow-up MRI documented radiological resolution. A
second lumbar puncture revealed 30 cells/mm3.
Discussion: We report a case of cerebellitis associated with
a thymoma. The impressive clinical and radiological
improvement immediately after tumour removal, and an
extensive investigation negative for infectious causes being
consistent with an immunological paraneoplastic response.
The aspect of oedematous cerebellitis possibly corresponds
to an early phase of PCD, previously rarely observed.
Moreover, this patient evolution suggests that this may be a
still reversible stage of PCD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1876
Consequences of an impaired cholinergic
system in the CNS and at the periphery
A. Hrabovska1, E. Krejci2
1Department of Pharmacology and Toxicology, Faculty of
Pharmacy, Comenius University, Bratislava, Slovak
Sensorimotricit, Universite Paris Descartes, Paris, France
Introduction: The cholinergic system in brain is believed
to be in control of some major physiological functions and
its dysfunction leads to severe pathologies, e.g., Alzheimers
disease, Parkinsons disease and Huntingtons chorea.
Moreover, a mechanism by which cholinesterase (ChE)
inhibitors improve cognition in dementia is explained by
enhancement of cholinergic transmission in the brain. Here
we present our recent results from genetic studies in mice
that contrast with recent views on the cholinergic system in
the brain.
Methods: Genetically modified mouse models were used in
which acetylcholinesterase is absent in the whole animal
(AChE-/-), only soluble monomer AChE is present (E5,6-/-),
or ChE are locally omitted predominantly in CNS (PRiMA-/-)
or at the neuromuscular junction (ColQ-/-). Histochemical
and biochemical analyses of cholinergic markers were
performed. Phenotype and behavioural test results were
compared with wild-type littermates.
Results: In AChE-/-, PRiMA-/- and E5,6-/- mice, we
confirmed high levels of acetylcholine in brain resulting
from similar acetylcholinesterase deficiency in the CNS.
This was accompanied with severe changes in the number
of acetylcholine receptors. AChE-/- mice developed a
dramatically changed phenotype (including motor tremor,
lower body weight, seizures and impaired thermoregulation).
E5,6-/- mice had a similar but less profound appearance.
However, PRiMA-/- mice were indistinguishable from the
wild-type littermates. On the other hand, changes in the
phenotype of ColQ-/- mice were severe and resembled the
phenotype of AChE-/- and E5,6-/- mice.
Conclusion: Our results suggest that some actions of the
cholinergic system may arise from the periphery, rather than
from the CNS as believed nowadays.

P1877
Central nervous system involvement in
primary Sjgrens syndrome
I. Moreira1, F. Teixeira2, A.M. Silva1, C. Vasconcelos3,
F. Farinha3, E. Santos1
1Neurology Department, Hospital Santo Antnio, Centro
Hospitalar do Porto, Porto, 2Rheumatology Department,
Unidade Local de Sade do Alto Minho, Ponte de Lima,
3Clinical Immunology Unit, Hospital Santo Antnio, Centro
Hospitalar do Porto, Portugal
Introduction: Primary Sjgrens syndrome (pSS) is a
systemic autoimmune disease characterized by salivary/
lacrimal glands lymphocytic infiltration and auto-antibody
secretion, excluding other disorders. The burden of central
nervous system (CNS) involvement is controversial. We
performed an observational retrospective cross-sectional
case-control study to evaluate prevalence, clinical patterns
and outcomes of CNS involvement in a cohort of pSS
patients followed in our centre.
Methods: We studied the CNS involvement in 91 pSS
patients (88 females, 3 male). Mean age was 47.6 years.
Diagnosis was established according to the criteria of the
American-European Consensus Group. Demographic,
clinical, immunological data were assessed.
Results: Nervous system involvement was detected in 24
patients (26.4%), of which 12 (13%) had CNS involvement.
All were women with mean age at disease onset and
neurological onset of 40 and 44 years, respectively.
Neurological syndromes found were: seizures in 2 patients,
motor and sensory deficits in 2, movement disorders in 2,
chronic progressive myelitis in 1, chronic progressive
myelitis and dementia in 1, aseptic meningitis in 1, and
headache and dementia in 1. From the 24 patients with
neurological involvement, 12 had headaches: 9 migraine
and 3 tension type headache. From those, only two with
magnetic resonance abnormalities compatible with
inflammatory disease were included. Neurological
involvement was the initial manifestation in 8 (75%). The
CNS involvement outcome was good in 10 (83%).
Conclusion: Our study showed great heterogeneity of CNS
involvement in pSS which managed to be frequently the
initial manifestation of pSS, as had been found in previous
studies. The prevalence was much higher than the majority
of the series in the literature.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 419
P1878
A retrospective study of neuro-Behets
disease
F. Imounan1, E.H. Ait Ben Haddou2, W. Regragui3,
A. Benomar2,4, R. Abouqal5, M. Yahyaoui2
1Neurology B and Neurogenetics, Mohammed V University
Souissi, 2Neurology B and Neurogenetics, 3Neurology and
Neurogenetics, Hpital des Spcialits, CHU Rabat Sal,
Mohammed V Souissi University, 4Facult de Mdecine et de
Pharmacie, Centre de Recherch en Epidmiologie Clinique
et Essais Thrapeutiques (CRECET), 5Facult de mdecine
et de pharmacie Rabat, Laboratoire de Biostastistiques et de
Recherche en Clinique pidmiologique (LBRCE), Rabat,
Morocco
Introduction: Neurological manifestations in Behets
disease represent between 4 to 49% of systemic
manifestations and remain the leading cause of morbidity
and mortality.
Aim of study: This report describes clinical features,
therapeutic aspects and follow-up of neuro-Behets
disease.
Methods: Retrospective series of 56 neuro-Behet cases
fulfilling the International Study Group criteria for Behets
disease were consecutively recruited over a period from
June 2004 to December 2010. All patients had clinical and
ophthalmologic examinations; they underwent laboratory
and imaging investigations. Patients with severe conditions
(parenchymal involvement and cerebral deep venous
thrombosis) received cyclophosphamide and corticosteroids.
The other patients received only corticosteroids.
Anticoagulant therapy was given to patients with cerebral
venous thrombosis. Patients follow-up and tolerance to
treatment were analyzed.
Results: The average age at diagnosis was 3412 years,
with a sex ratio of 1.15. The clinical presentation was
dominated by meningo-encephalitis (50.9%), cerebral deep
venous thrombosis (43.4%) and myelopathy (5.7%). Of the
56, 16 patients were treated by corticosteroids and 40
patients received cyclophosphamide associated with
corticosteroids. All patients, despite two aggravated cases,
evolved positively with clinical improvement and good
tolerance.
Conclusion: The demographic and clinical aspects of our
series are similar to those reported in the literature. In
contrast to previously reported cases of a poor prognosis in
severe neuro-Behets disease, our study suggests that
immediate and aggressive treatment by cyclophosphamide
may ameliorate the prognosis. However, a multicenter study
is needed to confirm the possible efficacy of
cyclophosphamide and to further assess the long-term
tolerance.
420 Posters, Sunday 9 September
P1879
Astrocytes are sensitive indicators of
hyperthermia-induced brain oedema in
normal and in Cu nanoparticles treated
rats
H.S. Sharma1, D.F. Muresanu2, M.A. Smith3,
G. Casadesus Smith3, A. Sharma1
1Surgical Sciences, Anaesthesiology & Intensive Care
Medicine, Uppsala University, Uppsala, Sweden,
2Nerosciences, University of Medicine and Pharmacy Cluj-
Napoca, Romania, 3Department of Pathology, Case Western
Reserve University Medical School, Cleveland, OH, USA
Whole body hyperthermia (WBH) induces breakdown of
the blood-brain barrier (BBB), oedema formation and brain
pathology. However, hyperthermia induced damage to glial
cells are still not well documented. The glial cells actively
regulate the brain fluid micro-environment and maintain the
BBB function. Thus, it is likely that hyperthermia will
influence astrocytic reaction in WBH. Previous studies in a
rat model of WBH exhibited profound BBB disruption,
oedema formation and brain pathology. In the present
investigation, we examined the role of astrocytic activation
following WBH in rats using glial fibrillary acidic protein
(GFAP) immunoreactivity. Furthermore, influence of
copper (Cu) nanoparticles (CuNPs 50-60nm) on WBH
induced GFAP immunoreactivity was also investigated.
Rats subjected to WBH (38C for 4h) resulted in massive
increase in GFAP immunoreactivity in the thalamus
followed by hypothalamus, pons, brain stem, cerebellum,
hippocampus, caudate nucleus and cerebral cortex. Pre-
treatment with CuNPs (50mg/kg, i.p. for 1 week)
exacerbated GFAP immunoreactivity in all the brain areas
examined. This activation of astrocytes in WBH was largely
seen in areas exhibiting BBB disruption and brain oedema
formation in normal or nanoparticle treated rats. These
observations suggest that astrocytes are sensitive indicators
of thermal brain injury, not reported earlier.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1880
Neurological status assessment in
patients after orthotopic liver
transplantation
S. Kolomiets1,2, O. Ionova1, E. Borovkova1
1Neurological and Neurosurgical Diseases Department,
Belarusian State Medical University, 2Neurological
Department, 9 City Hospital, Minsk, Belarus
Background: Neurological disorders are the commonest
reason of life quality decreasing in patients after orthotopic
liver transplantation (OLT). The actuality of the problem
depends on the increase of the amount of OLT in Belarus.
Objective: To estimate the neurological disorders intensity
in patients after OLT.
Methods: 20 patients after OLT were investigated, treated
in RSPC Organs and Tissue Transplantation, 10 men and
10 women, mean age 39.612 (20-59 years), Body mass
Index (BMI) - 23.14.2kgm2, basic disease duration 3.44.8
years; the period they were listed 49 months; the follow up
- 1211 months.
Neurophysiological testing: Mini-Mental State Examination
(MMSE), Frontal Assessment Battery (FAB), Hospital
Anxiety and Depression Scale (HADS); Paced Auditory
Serial Addition Test 3 (PASAT 3).
The neuropathy intensity was assessed by Neuropathy
Disability Score (NDS).
Results: The mean indicator on NDS was 6.43.7. The mild
cognitive disorders were revealed in 6 patients on MMSE
24.7+1.8, on FAB 14.41.5. The operative memory decrease
(PASAT 3 27.514.1) presented in 8 patients. Depression
and anxiety presented in 13 patients (HADS 10.14.5). The
correlation between neurological disorders intensity and
depression-anxiety manifestations (<0.05), aged >40 y.o.,
gender (mostly women), BMI >25kg/m2, basic disease
duration >5 years, the period they were listed >6 months,
the follow-up >5 months were registered.
Conclusions: In neurophysiological testing prominent
operative memory decreasing, depression and anxiety
presence was revealed. In neurological status the distal
symmetrical sensorimotor polyneuropathy of moderate
stage was present. The obtained results may prove the
neurological disorder progression.

P1881
Reversible injury of the corticospinal tract
with decreased perfusion-weighted
magnetic resonance imaging in a patient
with transient hypoglycaemic hemiparesis
J.-H. Kwon1, W.-J. Kim1, S.-H. Lee2, M.-S. Kim2
Neurology, 2Ulsan University Hospital, Ulsan, Republic of
1
Korea
Profound hypoglycaemia has diverse neurological
manifestations from headache to coma and death. Transient
hypoglycaemic hemiparesis (THH) is the rarely reported
complication of hypoglycaemia, usually misdiagnosed as
ischemic stroke. We report a patient with THH whose
diffusion-weighted image (DWI) and apparent diffusion
co-efficient (ADC) values showed reversible lesions in the
corticospinal tract from the internal capsule to the midbrain.
A 75-year-old man with diabetes mellitus and hypertension
was admitted to our hospital complaining of right-sided
weakness and dysarthria. He was diagnosed with type-2
diabetes 10 years ago and took metformin, voglibose and
glimepiride. He was slightly drowsy but communicable.
Other neurologic examinations showed right facial palsy
and hemiparesis. Initial blood glucose was 34mg/dl.
Intravenous dextrose was given to him. Routine laboratory
tests were all within normal range. Initial DWI performed
at 1.5 hour after symptom onset showed high signal
intensity lesions in the left internal capsule and midbrain
compatible with the corticospinal tract. ADC values reduced
in the same area. Perfusion-weighted image disclosed
delayed mean transit time in the posterior limb of the left
internal capsule. MR angiography showed no intracranial
artery stenosis. Blood sugar was increased to 155mg/dl and
his neurologic deficits were fully recovered after MRI.
DWI, ADC values and FLAIR image taken 5 days after
symptom onset revealed completely resolved lesions. In
conclusion, THH seems to be the sequela of reversible
cytotoxic oedema. Physicians should consider the possibility
of THH when MRI reveals the lesion suggesting ischemic
stroke in a patient with hypoglycaemia.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 421
P1882
Use of body-CT and PET-CT in the
investigation of paraneoplastic
neurological syndromes: retrospective
audit of practice in a regional
neuroscience unit in the UK
D.Z.J. Lee1, A. Kheder1, M. Forbes1, I. Craven2,
M. Hadjivassiliou1
1Department of Neurology, 2Department of Radiology,
Sheffield Teaching Hospitals, Sheffield, UK
Background: Paraneoplastic neurological syndromes
(PNS) are characterised by progressive neurological
dysfunction resulting from non-metastatic effects of cancer.
Positron emission tomography (PET) has emerged as an
effective tool for diagnosis of PNS. An advantage of PET
over conventional imaging modalities such as body-CT
includes demonstration of metabolically active disease in
anatomically normal appearing structures.
Aims: To analyse and improve use of whole-body CT and
PET-CT in the investigation of PNS in a regional
neuroscience unit.
Methods: Retrospective review of 42 patients with
suspected PNS referred for imaging between April 2007
and March 2008 was conducted. The data was presented
locally followed by recommendations that a consultant
neurologist with interest in PNS reviews; each case before
referral and PET-CT is considered, in cases where body-CT
is negative. We re-audited 44 patients referred between July
2008 and June 2009 and identified each patients final
diagnosis along with any additional investigations
undertaken.
Results: In the first cycle, 42 patients underwent whole-
body CT for investigation of PNS. 4 scans were positive for
malignancy and 38 were negative, of which only one was
followed up with PET-CT. In the second cycle, whole-body
CT was performed in 44 patients, of which 11 subsequently
proceeded to PET-CT. 5/44 patients had a final diagnosis of
PNS, of which only 3 had undergone PET-CT.
Conclusion: Early PET scanning in clinically suspected
PNS may prevent expensive and often unnecessary
investigations. Trust guidelines now advise use of PET-CT
rather than conventional body-CT in clinically suspected
PNS. We aim to re-audit our practice in due course.
422 Posters, Sunday 9 September
P1883
A rare case of embolic stroke due to
uterine leiomyosarcoma treated with
mechanical thrombectomy
A.J. Paipa, R. Gomez, L. Mohanna, P. Cardona, A. Lucia,
H. Quesada, L.M. Cano, F. Rubio
Hospital Universitari de Bellvitge, Barcelona, Spain
Introduction: Stroke as a direct consequence of tumoral
emboli is rare and mainly described in primary cardiac or
lung cancer.
Methods: We present the case of a 59-year-old woman with
past medical history of obesity and hypothyroidism who
presented with dysartria, left hemianopsia and left-sided
hemiparesis, (NIHSS 10). A CT scan showed no
abnormalities and the angioCT demonstrated a right distal
internal carotid artery occlusion (TICI 0). Lab test results
were normal apart from mild leucocytosis. A mechanical
thrombectomy with a Solitaire device was attempted after
unsuccessful intravenous thrombolysis. Recanalization of
the internal carotid artery was obtained while the middle
cerebral artery remained partially occluded (TICI 1).
Results: The histopathological examination of the thrombus
was compatible with a mesenchymal sarcomatous tumour.
A transoesophagic echocardiography showed a superior
right pulmonary vein mass protruding to the left atrium and
a toracoabdominal CT showed a heterogeneous, cystic and
large (13cm) uterine mass with calcified regions as well as
disseminated lung nodules compatible with a methastasic
leiomyosarcoma. The MRI showed flux absence in the right
middle cerebral artery as well as deep mild hemorrhagic
transformation. No clinical changes were seen at the time of
discharge (NIHSS 10, mRS 4).
Conclusions: Stroke due to tumour emboli is a very rare
complication of systemic cancer. To our knowledge this is
the first reported case of a leiomyosarcoma presenting as a
cerebrovascular tumoral emboli.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1884
Marchiafava-Bignami disease, Wernickes
encephalopathy or metronidazole toxicity
in a non-alcoholic patient: a diagnostic
challenge
A.L. Azevedo1, J. Marques1, J. Passos1, M. Tavares2
Neurology, 2Neuro-Radiology, Instituto Portugues de
1
Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
Introduction: Marchiafava-Bignami disease (MBD) is a
rare entity, usually associated with chronic alcoholism,
characterized by demyelination and necrosis of the corpus
callosum. It has been sporadically reported in non-alcoholic
patients, especially in the context of malnutrition or cancer,
and was also reported in patients with concomitant
Wernickes encephalopathy (WE). Metronidazole is
metabolized into an unstable analogous of thiamine, and
can induce an WE-like syndrome.
Case report: 57-year-old female patient, with mucinous
cystadenocarcinoma of the appendix previously submitted
to right hemicolectomy and small bowel resection. The
patient was under prolonged parenteral nutrition due to
surgical complications and chronically treated with high
doses of metronidazole. She presented with acute onset of
spontaneous vertical nystagmus and dysarthria followed by
rapid neurological deterioration, with somnolence, apathy,
disorientation, nystagmus in all directions of gaze, paresis
of left eye adduction, bilateral pyramidal signs, ataxia and
limb hypoaesthesia in a stocking-sleeve pattern. T2
-weighted MRI showed bilateral symmetric hyperintense
lesions in corpus callosum (mainly splenium), deep
cerebellar white matter, pons, optic chiasm and optic tracts.
EMG showed severe axonal sensory peripheral neuropathy.
Replacement therapy with thiamine and folate was started,
with prominent clinical and imagiological improvement.
Conclusions: In this case, the clinical picture and MRI
findings combine different distinctive features of WE, MBD
and Metronidazole toxicity. In selected patients with
malabsorption syndromes, WE and MBD may share similar
pathogenic pathways to metronidazole toxicity. Given the
potential dismal prognosis (especially for MBD), prompt
replacement treatment with thiamine should be initiated.

P1885
Intracranial plasmacytoma mimicking
meningioma
M. Holling1, B.R. Fischer1, T. Niederstadt2, W. Stummer1
1Department of Neurosurgery, 2Department of Clinical
Radiology, University Hospital Mnster, Germany
Objective: Meningioma is the most common dural
neoplasm. However, a variety of tumour entities may
present clinically as meningiomas. Even though a significant
number of patients with solitary plasmacytomas eventually
develop multiple myeloma, intracranial plasmacytoma is
exceptional and has been rarely described as primary
manifestation of multiple myeloma.
Methods: A 61-year-old man presented with a left occipital
skull protrusion. MRI of the head showed a lesion suggestive
for intra-osseous meningioma. Intraoperatively, the tumour
imposed as meningioma. Histologically, a tumour of high
cellularity was encountered. Based on typical findings, a
neuropathological diagnosis of plasmacytoma was
established. This diagnosis prompted complete skeletal
radiographs, which revealed an osteolytic lesion of the
eighth rib. Before chemotherapy could be initiated, the
patient died of aspergillus pneumonia.
Results: Intracranial plasmacytomas are rare and
infrequently diagnosed by imaging due to their resemblance
to meningiomas. On MRI, plasmacytomas are often
indistinguishable from meningioma, with intermediate
signal on T-weighted sequences and isointense signal to
grey matter on proton density and T2-weighted sequences.
The tumour showed typical histological and
immunohistochemical staining of plasmacytoma with
positivity for the plasma cell marker CD138 and strong
positivity for kappa light chain. Since additionally CD20-
expressing lymphocytic tumour cells were also encountered,
a diagnosis of lymphocytic plasmacytoma was
established, which is very rare.
Conclusions: In conclusion, solitary intramedullary
plasmacytoma should be considered in the differential
diagnosis of meningioma. Conversely, in dural based
plasmacytoma lymphocyte rich meningioma must also be
considered as a differential diagnosis. In some cases
differentiation may be difficult.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 423
P1886
Sjgrens syndrome and mixed connective
tissue disease: a case report and a review
of literature
M. Lahmar, M. Messelmani, H. Khaled, I. Hmida,
M. Mansour, J. Zaouali, R. Mrissa
Neurology, Military Hospital, Tunis, Tunisia
The occurrence of neurological or psychiatric disturbances
in association with rheumatic diseases has been an area of
considerable interest for many years. Mixed connective
tissue disease (MCTD) is classically considered as an
overlap of three diseases, systemic lupus erythematosus,
scleroderma, and polymyositis that typically have high
quantities of antinuclear antibodies (ANAs) and antibodies
to ribonucleoprotein (anti-RNP). Sjgrens Syndrome (SS)
is rarely reported in MCTD. We report the case of a 53-year-
old woman with no medical history who presented relapsing
remitting neurological manifestations for 20 years. The
patient presented with memory impairment, gait disorder,
paresthesias, arthralgias and worsening of general state. On
examination, the patient showed features of cognitive
impairment, frontal lobe syndrome, ataxic and spastic gait
and left hemiparesis. MRI showed multiple hyperintense
lesions of supra and infra tentorial white and grey matter
and subcortical atrophy. Cerebrospinal fluid studies showed
a mild elevation of protein level. Salivary gland biopsy,
salivary gland scintigraphy and ophthalmologic examination
showed features consistent with SS. ANAs and anti Scl 70
antibodies were increased whereas anti SSa/SSb,
rheumatoid factor and anti DNA were negative. MCTD
with predominating features of SS was diagnosed. The
patient received methylprednisone intravenously for three
days and cyclophosphamide monthly. A mild improvement
in cognitive and motor performances was noticed. MCTD
is a rare autoimmune disorder and cause of treatable
dementia. SS is rarely reported in MCTD. Neuropsychiatric
features may be the first manifestations of the disease.
Symptoms eventually evolve to become dominated by
features of one of the component illnesses.
424 Posters, Sunday 9 September
P1887
Catastrophic anti-phospholipid syndrome:
analysis of a clinical and morphological
case
M. Tviachkovskaya, M. Cvechkovskaya, O. Udina,
M.D. Ponomarev
Belarusian Medical Academy of Postgraduate Education,
Minsk, Belarus
Introduction: Catastrophic APS - a rare form of primary
anti-phospholipid syndrome (APS) is associated with
autoimmune thrombocytopathies. There are multiple
thromboses of arteries and veins of different localization.
Materials and methods: 43 patients with primary APS (26
female and 17 male, mean age 38.79.7 ) were observed at
the neurological department Hospital 5 from 2001 t
2011. Diagnosis was confirmed accordingly with universally
adopted International Criteria (Sydney, 2006). Macro- and
microscopic examination was performed in case of autopsy.
Results: The main manifestation of primary APS was acute
vascular lesions of the brain caused by thrombosis. It is
displayed as stroke (73.1%). In case of a female, 36 years
old, with an obstetric history (miscarriage) we observed
catastrophic APS, which was affected by multiple
thromboses: skin lesions (bed sores, haemorrhage), lung
(heartattacks in both lungs), heart (mitral valve vegetation
in the diffuse cardio), oesophagus (multiple erosions and
ulcers over), colon (paresis), brain (haemorrhage, and
multifocal infarcts in both hemispheres), which ended
lethally. Microvascular thrombi of varying degree of
limitation were found on microscopic examination, a part of
recanalization without inflammatory infiltration of vessel
walls.
Conclusion: Catastrophic APS develops acutely, manifests
multiple systemic thromboses and has a poor prognosis.
Macro- and microscopic results are crucial in its diagnosis.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1888
Clinical manifestations and imaging
findings in posterior reversible
encephalopathy syndrome
S.-Y. Bae, S.-J. Lee
Neurology, Yeungnam University College of Medicine,
Daegu, Republic of Korea
Objectives: Posterior reversible encephalopathy syndrome
(PRES) is typically characterized as symmetric and
reversible oedema of the posterior cerebral hemisphere with
variable symptoms. This study determines the incidence of
clinical and MRI imaging manifestations of PRES.
Materials and methods: We included 16 patients who
were diagnosed with PRES, from October 1, 2003, through
February 28, 2012, based on clinical manifestations and
MRI findings. We performed a review of clinical
information, including cause of PRES, presenting
symptoms, and imaging findings. The lesions were recorded
on the basis of FLAIR findings. As atypical imaging
findings, we included gadolinium enhancement, restricted
diffusion, haemorrhage, and unilateral or irreversible
lesions
Results: The aetiologies of PRES were hypertension,
43.8%; chronic kidney disease, 25.0%; eclampsia, 12.5%;
multiple organ dysfunction, 6.2%; and unclear cause,
12.5%. The main presenting symptoms were seizure,
43.8%; encephalopathy, 68.8%; headache, 31.2%; dizziness,
18.8%; and visual disturbance, 18.8%. The incidence of the
regions of involvement was parieto-occipital, 87.5%;
posterior frontal, 62.5%; temporal, 50.0%; brainstem,
37.5%; cerebellar, 43.8%; thalamus, 37.5%; basal ganglia,
31.2%; and corpus callosum 18.8%. The incidence of
atypical MRI manifestations were gadolinium enhancement,
50.0%; restricted diffusion, 31.3%; haemorrhage, 12.5%;
unilateral lesion, 0%; and irreversible lesion, 41.7%.
Conclusions: Even though it is somewhat hard to accept the
result of this study as an established fact because of the
small number of cases, the result suggests that atypical MRI
manifestations of PRES, contrast enhancement, were more
frequent than that commonly perceived in the previous
literature.

P1889
Neurological complications of Celiac
disease: a report on 4 patients
H. Haj Kacem, E. Turki, I. Bouchaima, M. Damak,
A. Boukhris, I. Feki, M.I. Miladi, C. Mhiri
Department of Neurology, Habib Bourguiba Hospital, Sfax,
Tunisia
Introduction: Celiac disease (CD) is an auto-immune
gastro-intestinal disorder occurring in genetically
susceptible individuals triggered by the ingestion of gluten
and characterized by the presence of anti-transglutaminase
2 and anti-gliadin antibodies. Clinical manifestations are
various. Neurological involvements of CD are rare. The
objective was to determine the clinical, para clinical,
therapeutic and the outcome of patients with CD with
neurological involvements.
Methods: A 19-year retrospective study, including all
patients followed at the neurology departments in Sfax,
Tunisia for CD with neurological involvements.
Results: We collected 4 patients with a female predominance
(sex ratio: 0.3). The average age of onset of neurological
involvements was 20 years (range 7 to 36 years).
Neurological manifestation was inaugural in one case. It
was peripheral nerve damage in one case and central
nervous system (CNS) in 3 patients (cerebellar ataxia,
seizures and cerebral venous thrombosis). All patients
received a gluten-free diet (GFD) with a favourable
outcome.
Conclusion: Neurological complications of CD are various
and can especially be revealing CD in adults. Their
pathophysiological mechanisms are still uncertain. They
may affect the CNS (often cerebellar ataxia and/or seizures).
Peripheral neuropathy is common. On brain imaging,
calcification and white matter signal abnormalities are most
often described. The introduction of a gluten-free diet often
improves clinical symptoms.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 425
P1890
A case of flaccid paraparesis caused by
intestinal Taeniasis
M. Sabau1, A. Comanescu1, L. Botnaru2
1County Clinical Emergency Hospital Oradea, University of
Oradea, 2County Clinical Emergency Hospital Oradea,
Romania
Introduction: Taeniasis is an uncommon parasitic infection
in Romania. It usually has unspecific symptoms: abdominal
colic, constipation or diarrhoea, anal itching, headache and
nervous hyper excitability.
Objective: We present a case with paraparesis diagnosed as
nutrition-related myelopathy and polyneuropathy in a
nutritional deficiency syndrome caused by intestinal Taenia
infection.
Case presentation: A 62-year-old man reports a long
standing diarrhoea of more than 1 year duration, following
a vegetarian and hypocaloric nutrition regimen. Marked
asthenia, as well as pain and numbness in the extremities
developed in the following months, while reduction of the
muscle strength and gait disturbance occurred in the last 4-5
weeks. Serial and complex medical examination gave
unremarkable findings. Pallor of the skin and of the mucous
membranes, with furfuraceous desquamation was found on
physical examination. The gait was unsteady and of
steppage type, as if walking on pillows. Impairment of all
types of sensibility, distally distributed in both upper and
lower limbs, Lhermittes sign, absence of deep tendon
reflexes and Babinski sign were found, too. Laboratory
findings disclosed a mixed type anaemia, an increased
number of eosinophiles, and decreased serum levels of iron
and B12 vitamin. Repetitive parasitological examination of
the stool was negative for several days, but showed Taenia
solium infestation after ten successive examinations.
Niclosamide, B12 vitamin, folic acid, iron and a well
balanced nutrition were started, with rapid improvement of
the symptoms.
Conclusion: Malnutrition due to taeniasis resulted in severe
anaemia, nutritional deficiency polyneuropathy and
myelopathy.
426 Posters, Sunday 9 September
P1891
Chronic inflammatory demyelinating
polyradiculoneuropathy and systemic
lupus erythematosus
M. Zouari, A. Hassine, I. Bedoui, F. Hentati
Neurology Department, National Institute of Neurology,
Tunis, Tunisia
Introduction: Chronic inflammatory demyelinating
polyradiculoneuropathy is often idiopathic. It is presumed
to be caused by an antibody-mediated immunologic reaction
and may be associated with other systemic diseases such as
systemic lupus erythematosus. A possible causal link
between these dysimmune diseases is still a matter of
debate.
Methods: A woman affected by a chronic inflammatory
demyelinating polyradiculoneuropathy associated with
systemic lupus erythematosus was selected.
Results: We report the case of a 24-year-old woman who
developed within a few days a bilateral brachial weakness
with paraesthesia in upper limbs. Neurological examination
found a bilateral weakness with distal sensory loss
predominantly in upper limbs and essentially in the
proximal region, associated to areflexia. The CSF contained
one white cell with hyperproteinorrachia (1.84g/l). Nerve
conduction studies found a demyelinating neuropathy. The
diagnosis of a CIDP was retained because the patient was
fulfilling the criteria of the American Academy of
Neurology. During her hospitalization, malar erythema
appeared with lymphopenia and positive tests for antinuclear
antibody and antinuclear anti-DNA. The diagnosis of
systemic lupus erythematosus was retained on the basis of
five criteria of the American College of Rheumatology. The
patient had full recovery under steroid therapy.
Conclusion: We should consider the diagnosis of systemic
lupus erythematosus in case of chronic polyradiculoneuropathy
and perform specific immune tests. This case report is
atypical because of the clinical presentation with brachial
weakness, which is a rare condition.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1892
Complicated pyloric stenosis with
Wernickes encephalopathy
R. Manso-Caldern1, T. Gonzlez2, M.T. Garca3
1Neurology, Hospital Universitario de Salamanca,
Salamanca, 2General Surgery, 3Neurology, Hospital Nuestra
Seora de Sonsoles, vila, Spain
Introduction: Wernickes encephalopathy (WE) is a serious
but curable neurologic disease caused by thiamine
deficiency. The classical clinical triad of ocular
abnormalities, gait ataxia and mental status changes is
present in only a subset of patients. WE is commonly
associated with alcohol consumption, but any condition
(repeated vomiting, prolonged fasting, etc) that induces
thiamine deficiency lasting 2 to 3 weeks may lead to WE.
We present a case of WE due to pyloric stenosis.
Methods: A 55-year-old man developed mental status
changes, including drowsiness, confusion and dizziness
within four days. The family denied history of alcohol use,
but he had a pyloric stenosis. In the last month, the patient
complained of gastric pain with vomiting and fasting.
Consequently, total parenteral nutrition was required. At
neurological examination, he had a vertical nystagmus, VI
cranial nerve palsy, signs of cerebellar dysfunction, lethargy
and general muscle weakness.
Results: Laboratory values were unremarkable. Brain
magnetic resonance imaging showed hyperintensive signals
in periventricular areas, thalamus and mamillary bodies.
Even though the patients initial thiamine levels were not
determined, WE was diagnosed. Thiamine 300mg daily
intravenous was started. After 7 days, his symptoms slowly
began to improve, with correction of dizziness and
alterations in consciousness. Nystagmus and
ophthalmoplegia improved but were not reversed
completely.
Conclusion: The recognition that WE can occur in non-
alcoholic patients and not always being manifested by the
classical clinical triad is sometimes forgotten. WE is a
neurological emergency and treatment should be initiated
promptly to limit morbidity and mortality.

P1893
Septo-optic dysplasia and
schizencephaly: a case report
L. Paziente, R. Nardello, S. Mangano
Dipartimento Materno Infantile di Urologia e Andrologia,
Unit Operativa di Neuropsichiatria, Palermo, Italy
Introduction: Septo-optic dysplasia (SOD) is an
uncommon developmental disorder involving variable
midline brain structures, characterized by optic nerve
hypoplasia, dysgenesis of septum pellucidum and pituitary-
hypothalamic dysfunction with consequent endocrine
deficits. The association of septo-optic dysplasia and
cortical dysplasia is described as septo-optic dysplasia-plus.
Reports on patients with septo-optic dysplasia-plus have
been rare. Other distinct features, which occur especially
when cerebral cortical abnormalities are also present (SOD-
plus), consist of significant generalized developmental
delay and/or spastic motor deficits.
Methods: We report a 10-year-old boy with septo-optic
dysplasia-plus syndrome, characterized by septo-optic
dysplasia with schizencephaly, significant generalized
developmental delay, spastic motor deficits and seizure
intractable. Extraction of DNA for gene EMX2 is in the
process of reporting
Results: Neuroimaging studies revealed schizencephaly
with enormous ex vacuo dilation of the occipital horns of
the lateral ventricles that involves medium cells up to the
vertex of the brain; the residual frontal cortex of both sides
develop a pachigiric aspect, especially in parasagittal
regions; the corpus callosum is represented in all its sections
but slightly hypoplastic at the rostrum and the splenium.
There are also dislocated left femoral head, optic atrophy,
deficiency determination and alternating exotropia
bilaterally
Conclusion: Schizencephaly is a distinct congenital
cerebral malformation presenting as transcerebral mantle
cleft between lateral ventricle and pial surface. Nearly half
of the patients with SOD have schizencephaly. When the
SOD is associated to open-lip schizencephaly, the subjects
have a poor prognosis with respect to psychomotor
development and complicating intractable epilepsy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 427
P1894
The challenges in establishing a positive
diagnosis of a seronegative Wegeners
granulomatosis with unusual clinical
presentation: a case report
O.C. Chebut1, R.I. Balasa2, Z. Bajko2, S. Mocan3
Neurology I Department, Emergency Clinical County
1
Hospital Tirgu-Mures, Tirgu Mures, 2Neurology I
Department, 3Pathology Department, Emergency Clinical
County Hospital Tirgu-Mures, Romania
Wegeners granulomatosis/GPA (granulomatosis with
polyangiitis) is a small vessel pauci-immune necrotizing
vasculitis with granulomatous inflammation that classically
involves the upper respiratory tract, lungs and kidneys and
rarely the nervous system, gastrointestinal tract and heart. A
39-year-old woman known with diabetes and obesity was
referred to our department because of a right peripheral
facial nerve palsy associated with a peripheral right
vestibular syndrome, hearing loss and acute otitis media.
After a careful assessment of her pathological history we
discovered: a pseudotumor pancreatitis two years before
(chronic pancreatic inflammation with no necrosis in the
histological exam), a complete heart block requiring a
permanent pacing eighteen months before (considered
cardiac complication of a Lyme disease after an extended
assessment with normal auto-immune serology but positive
Lyme serology) and no pulmonary or renal pathology. She
presented feverish, painful strawberry gums, saddle-nose
deformity, raised dark spots on the ankle and halux,
arthralgia and weight loss. Laboratory showed anaemia,
leukocytosis, elevated ESR and repeated negative ANCA
tests. Histological examination of the mastoid biopsy
showed a central necrotic granulomatous process with
multinucleated giant cells and necrotizing vasculitis. A final
diagnosis of GPA was retained and immunosuppressive
therapy with cyclophosphamide and steroids was started.
Three months later she developed oligoanuric acute renal
failure and died two days later. This uncommon GPA
presentation, diagnosed after cranial neuropathy, can result
in diagnostic difficulty and may allow a potentially poor
outcome. Cranial neuropathies in GPA occur later in severe
systemic forms. A negative ANCA test does not eliminate a
well-diagnosed GPA.
428 Posters, Sunday 9 September

P1895 P1897
Sensorineural hearing loss - an Acute-onset of critical illness:
auto-immune sign polyneuropathy and myopathy as a severe
C. Andrade1,2, M. Bernardes2,3, M.J. S1,4, J. Guimares1,2 complication of percutaneous
Neurology, Centro Hospitalar de So Joo, 2Faculty of
1
nephrostolithotomy: a case report
Medicine, University of Porto, 3Rheumatology, Centro
H. Zhang1, L.-M. Wu1, S.-K. Fang1, X.-B. Kong2,
Hospitalar de So Joo, Porto, 4Health Sciences Faculty,
Y. Hou2, R. Zhao2, H.-Y. Li2, H. Li2
University Fernando Pessoa, Porto, Portugal 1Department of Neurology, Jilin University, 2Department of
Introduction: Sensorineural hearing loss (SNHL) is an Urology, China-Japan Union Hospital of Jilin University,
unusual neurological symptom. An auto-immune etiology is Changchun, China
rare and its association with systemic auto-immune diseases
is neurologically relevant. We describe a patient whose
diagnosis of multiple sclerosis (MS) was reviewed after the P1898
onset of episodes of hearing loss, leading to the diagnosis of Convulsive status epilepticus due to
Sjgrens Syndrome (SS).
Case report: A 59-year-old woman who was diagnosed
hypoglycaemia as the initial presentation
with MS at 47, after an episode of vertigo/imbalance and of primary hepatic carcinoma
brain-MRI revealing supratentorial demyelinating lesions L. Wu, H. Zhang, J. Wu
with cerebral atrophy. Interferon-beta1a was started. She Jilin University, Changchun, China
remained clinically and imagiologically stable until, at 55,
relatively sudden episodes of hearing loss began, first
unilateral, then bilateral, initially with spontaneous P1899
recovery, and then only with partial response to steroids. Reversible posterior leuko-encephalopathy
Neurological examination was otherwise unremarkable. syndrome and bilateral renal
Audiogram showed a moderate SNHL. CSF study was
unremarkable (negative oligoclonal bands) and brain and
fibromuscular dysplasia
spinal MRI were unchanged. At 56, she first noticed a dry L. Mohanna1, J. Garcia1, B. Lara1, A. Paipa1,
mouth and red eyes. Schirmer test was subnormal. Retinal C. Homedes1, L.M. Cano1, S. Castaner2, J. Bruna1,
angiography was normal. Salivary gland scintigraphy P. Cardona1, F. Rubio1
showed bilateral enhancement, and minor salivary gland
1Neurology, 2Radiology, Hospital Universitari de Bellvitge,
biopsy, although atypical, showed a lymphocytic infiltrate. Barcelona, Spain
Immunological study was negative, including anti-SSa/SSb
antibodies. After exclusion of secondary causes and a P1900
rheumatologist consultation, SS was assumed, and
azathioprine plus corticosteroids initiated. Abstract cancelled
Conclusion: SNHL may be associated with auto-immune
disorders of CNS. In the presented case, the recurrent P1901
episodes of NSHL became the dominant symptom and thus,
a red-flag that led to a diagnosis review. Based on clinical Cerebral venous thrombosis as the initial
and imagiological features, SS was assumed, a known MS presentation of Behets disease: a case
mimic but with a different therapeutic approach. report
H. Ulvi, N. Aslan, R. Aygul, L. Ozel
Ataturk University, Medical Faculty, Department of
P1896 Neurology, Erzurum, Turkey
Abstract cancelled

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

 Posters, Sunday 9 September 429

P1902 P1907
Reversible hepatocerebral degeneration Neuromyelitis optica associated with
due to portovenous shunts: a case report primary Sjgrens syndrome
S. Gler1, U. Utku1, A. Tezel2, E. nl3 E. Papageorgiou, E. Papageorgiou, I.E. Markakis,
1Department of Neurology, 2Department of Gastroenterology, G. Gekas
3Department of Radiology, Trakya University, Faculty of
Neurology, General State Hospital of Nikaia, Greece
Medicine, Edirne, Turkey

P1908
P1903 Acute onset cervical myelopathy as first
Posterior reversible encephalopathy manifestation of late onset SLE (systemic
syndrome as presenting form of systemic lupus erythematosus)
sclerosis K. Tsatsou, M. Maria, P. Gouma, V. Myridaki,
M.I. Pedraza1, J. Barbado2, P. Mulero1, E. Rojo1, D. Kravaritis
L. Vega2, S. Herrero1, J. Meja1, C. de la Cruz1, Neurological Department, Evangelismos General Hospital,
A. Guerrero1, R. Fernndez1 Athens, Greece
Neurology Department, 2Internal Medicine Department,
1

University Hospital, Valladolid, Spain

P1909
P1904 Gluten sensitivity and ataxia
A. Ben Mahmoud, H. Derbali, M. Messelmeni,
Central pontine and extrapontine N. Ben Ali, H. Khiari-Mrabet, A. Mrabet
myelinolysis: a case report with Hopital Charles Nicolle, Tunis, Tunisia
assessment of cognitive function
N. Nei, S. Peji P1910
Clinical-Diagnostic Unit, Special Hospital on Addictions,
Belgrade, Serbia Abstract cancelled

P1905 P1911
Fahrs syndrome supports the Wernickes encephalopathy following total
involvement of basal ganglia in the gastrectomy for gastric neoplasm
pathogenesis of Schizophrenia: a case C. Fernandes, L. Pereira, P. Pereira, M. Rodrigues,
J. Proena
report Neurology Department, Hospital Garcia de Orta, Almada,
L. Fonseca1, D. Freitas2, S. Rocha3, . Machado3 Portugal
1 Psychiatry, Alto Ave Hospital Centre, Gumares,
2 Psychiatry, 3Neurology, Braga Hospital, Braga, Portugal
P1912
P1906 A neurological presentation of Prinzmetal
(variant) angina
Restless legs syndrome in haemodialysis
M. Hilli, L. Al Dhahir, W. Al Dhahir
patients: association with anxiety and Barking Havering and Redbridge Trust, London, UK
sexual life
S. Dikici1, A. Bahadir1, D. Baltaci1, H. Ankarali1,
N. Ercan1, M. Erdogan2
1 Duzce University, 2Duzce State Hospital, Dzce, Turkey

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

430 Posters, Sunday 9 September

P1913
The clinical significance of brain angio-
architectonic features in Alzheimers
disease
D. Izyumov
Khorezm Regional Multifield Medical Centre, Urgench,
Uzbekistan
P1914
Polyradiculoneuritis revealing Behets
disease
I. Bedoui, A. Riahi, H. Khaled, G. Garsallah,
M. Mansour, J. Zaouali, R. Mrissa
Neurology, Military Hospital, Tunis, Tunisia
P1916
Central and peripheral involvement in a
neurosarcoidosis case
S.M. Cnar1, F. Hz1, A. elik2, R. Karahan Ozcan2
1 Neurology, 2Taksim Training Hospital, Istanbul, Turkey
P1917
Intracranial vasoreactivity alterations in
portal-systemic encephalopathy
M.A. Sierra-Beltrn1, J.L. Romero-Flores2,
A. Torre-Delgadillo3, M. Uribe-Esquivel3
1CIDyT, Mdica Sur, 2The Medical School, Panamerican
University, 3Gastroenterology Department, INCMNSZ,
Mexico City, Mexico

P1915
Analytic tetraparesis
R. Tojal, J. Campillo
Professor Fernando Fonseca Hospital, Amadora, Portugal

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457


Neuro-ophthalmology/ -otology
P1918
Otolith-ocular responses in patients with
acute brainstem lesions: ocular
vestibular-evoked myogenic potentials
S.-Y. Oh1, J.S. Kim2, B.-S. Shin3, M.-W. Seo3
1Department of Neurology, School of Medicine, Research
Institute of Clinical Medicine of Chonbuk National
University, Chonbuk National University Hospital, Jeonju,
2Department of Neurology, Seoul National University
Bundang Hospital, Seongnam, 3Department of Neurology,
Chonbuk National University School of Medicine, Research
Institute of Clinical Medicine of Chonbuk National
University-Chonbuk National University Hospital, Jeonju,
Republic of Korea
Objective: The ocular vestibular-evoked myogenic
potential (oVEMP), a recently documented otolith-ocular
reflex, is considered to manifest the central projections of
the primary otolithic afferent fibres to the oculomotor
nuclei. The aim of our study is to define oVEMP abnormality
in patients with acute brainstem lesions and to determine the
brainstem structures involved in the generation of oVEMPs.
Methods: In response to air-conducted tone burst sound
(ACS), oVEMP was measured in 52 patients with acute
brainstem lesions. Individualized brainstem lesions were
projected to a standard brain mapping template for
normalization and the probabilistic lesion maps were
constructed.
Results: More than half (n=28, 53.8%) of the patients with
acute brainstem lesions showed abnormal oVEMP. The
majority of patients with abnormal oVEMPs showed lesions
in the dorsomedial brainstem that contains the medial
longitudinal fasciculus, the crossed ventral tegmental tract
and the oculomotor nuclei and nerves.
Interpretation: The otolith-ocular pathway appears to be
located in the dorsomedial brainstem. Complemented to the
cervical VEMP for the uncrossed otolith-spinal function,
oVEMP to ACS can be applied to evaluate the crossed
otolith-ocular function in the central vestibulopathy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 431
P1919
Drusen and AMD are associated with
reduced cognitive function: the Troms
study
H. Lindekleiv1, M.G. Erke1, T. Peto2, K.-A. Arntzen1,
H. Schirmer1, T. Wilsgaard1, G. Bertelsen1, E. Mathiesen1,
I. Njlstad1, Troms Eye Study Investigators
1University of Troms, Troms, Norway, 2NIHR Biomedical
Research Centre for Ophthalmology, Moorfields Eye
Hospital and University College London, UK
Introduction: Drusen are accumulations of extracellular
material found in Bruchs membrane of the eye. Drusen are
a common finding in the ageing macula and are associated
with development of age-related macular degeneration
(AMD). Studies suggest that drusen and AMD are associated
with neurodegenerative diseases and reduced cognitive
function. Population-based studies on the relationship
between AMD and cognitive functions are rare and have
only reported weak associations. Further studies are
warranted to examine the relationship between cognitive
function, drusen and AMD.
Methods: We included 2,149 stroke-free participants from
the population-based Troms Study in Norway. Retinal
photographs were graded for presence of drusen and AMD.
Cognitive function was assessed by the word memory test
(short verbal memory), digit-symbol coding test (processing
speed), and the tapping test (psychomotor tempo).
Results: We found significant decreased score on the digit-
symbol coding test for participants with soft drusen
(standardized =-0.15, 95% CI: -0.24 to -0.06) and for
participants with intermediate drusen (standardized
=-0.20, 95% CI: -0.30 to -0.10). AMD was associated with
significant decreased score on the word memory test
(standardized =-0.26, 95% CI: -0.51 to -0.01).
Conclusions: The findings suggest that drusen deposition
may share similar pathophysiology with reduced cognitive
function or that drusen deposition and reduced cognitive
function may be different symptoms of the same underlying
disease process.
432 Posters, Sunday 9 September
P1920
Selective impairment of high acceleration
vestibulo-ocular reflex in spinocerebellar
ataxia type 6
J.S. Kim1, Y.E. Huh2, Y.J. Cho3, Y.S. Lee4
1Neurology, Seoul National University College of Medicine,
Seoul National University Bundang Hospital, Seongnam-si,
2Neurology, Seoul National University Bundang Hospital,
Seongnam, 3Neurology, Ilsan Paik Hospital, Inje University
College of Medicine, Goyang, 4Neurology, Department of
Neurology, Seoul National University and Metropolitan,
Boramae Hospital, Seoul, Republic of Korea
Spinocerebellar ataxia type 6 (SCA6) may show various
patterns of abnormal eye movements, primarily due to
cerebellar dysfunction. Vestibulo-ocular reflex (VOR)
abnormalities include reduced time constants, and increased
or decreased gain of the VOR during rotation test. However,
selective impairment of high acceleration VOR has not been
reported. A 63-year-old woman with a history of dizziness
and imbalance for 15 years underwent evaluation of the
VOR using bithermal caloric and rotary chair tests, and
head impulse test (HIT) using a magnetic search coil
technique. She showed spontaneous downbeat nystagmus,
gaze-evoked nystagmus in both horizontal and vertical
directions, positional nystagmus, saccadic dysmetria,
impaired smooth pursuit, and positive bedside HIT in
addition to dysarthria, dysmetria, and hypo-active deep
tendon reflexes. The results of bithermal caloric and rotation
tests were normal, but the head impulse VOR gains were
markedly decreased for all 6 semicircular canals when
measured using a magnetic search coil technique. Brain
MRI showed diffuse cerebellar atrophy, especially in the
vermal area. She was found to have SCA6 mutation. High
acceleration. VOR may be selectively impaired in SCA6.
Patients with SCA6 should have scrutinized evaluation of
vestibular function over the broad range of acceleration
stimuli.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1921
Clinical characteristics of recurred benign
paroxysmal positional vertigo after
successful repositioning
B.K. Kim1, K.S. Hong2, J.Y. Ahn3, J. Jung1, J.H. Park4
1Eulji University Hospital, 2Ilsan Paik Hospital, 3Seoul
Medical Center, 4Paik Hospital, Seoul, Republic of Korea
Objectives: Benign paroxysmal positioning vertigo (BPPV)
is the most common cause of vertigo and usually easily
treated with repositioning manoeuvre. Although half of all
patients eventually have a recurrence, the clinical
characteristics of recurred BPPV were not studied yet.
Methods: We reviewed the records of 1305 patients with
BPPV from Eulji BPPV registry between May, 1999 and
January, 2012. Among 409 patients who experienced
recurrence during the follow-up period, typical nystagmus
and vertigo were elicited by provoking manoeuvres (Dix-
Hallpike test or roll test in the supine position) in 177
patients (34 men and 133 women, mean age was 5713
years). We compared the involved side and canals of
recurred cases with first attack.
Results: Among 177 patients, 97 were posterior canal-
BPPV and 80 were horizontal canal-BPPV (calalolithiaisis
50, cupulolithiasis 30). The same side of ears was involved
in 142 (79.8%) of 177 recurred patients. 47.2% of cases
involved same canals as first one. The severity of symptoms
of recurred cases was milder than in the first attack.
Conclusions: Most recurrences occurred on the same side
of ear, and recurred cases have less severe symptoms.
P1922
Abstract cancelled

P1923
Geotropic central positional nystagmus
with hemorrhagic infarction in the
territory of medial posterior inferior
cerebellar artery
H. Oh1, S.J. Park2, D.-S. Oh3, S.-H. Lee3
1Department of Neurology, Gwangju Veterans Hospital,
2Department of Neurology, Cheomdan Medical Center,
3Department of Neurology, Chonnam National University
Hospital, Gwangju, Republic of Korea
Background: Recurrent positional vertigo and/or
nystagmus caused by cerebrovascular disease or other brain
lesions, so called central positional paroxysmal vertigo
(CPPV), could be encountered in clinical practice even
though the most common diagnosis of recurrent positional
vertigo syndrome is benign paroxysmal positional vertigo
(BPPV). To clinicians, the differentiation CPPV from BPPV
could be a critical issue.
Case: A 55-year-old man visited our dizziness clinic with
recurrent positional vertigo and headache. Neuro-otologic
examinations including supine roll test revealed geotropic
positional nystagmus. Even though the patient had
unsteadiness, the initial diagnosis was BPPV involving the
lateral semicircular canal. Several repositioning manoeuvres
failed to remove the symptoms and signs. Unresponsiveness
to the repositioning manoeuvre, combined with unsteadiness
and headache led to check brain images. Brain MRI
revealed acute infarction with hemorrhagic transformation
in the territory of the medial posterior inferior cerebellar
artery, involving the right inferomedial cerebellum
including nodulus. The quality of vertigo and the geotropic
nystagmus had improved slightly, but those symptoms were
persistent for the 2-year follow-up period.
Conclusion: It has been known that central positional
nystagmus is mostly downbeat or apogeotropic pattern, but
geotropic nystagmus can manifest as a central positional
nystagmus. The most common cause of geotropic nystagmus
is BPPV involving the lateral canal; however, persistent
geotropic nystagmus even after proper repositioning
manoeuvre and combined neurologic signs can point to the
central etiology. In this case, the irritative hemorrhagic
cerebellar lesion involving the nodulus might be a cause of
geotropic central positional nystagmus.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 433
P1924
The prognostic value of vestibular evoked
myogenic potential in patients with lower-
brainstem strokes
S.-K. Mun
Chung-Ang University Hospital, Seoul, Republic of Korea
Objective: To find the relationship between the National
Institutes of Health Stroke Scale (NIHSS) and Vestibular
Evoked Myogenic Potential (VEMP) results in central
origin dizziness patients according to status of recovery.
Also, the usefulness of VEMP was evaluated as a tool for
predicting recovery.
Materials and methods: From September 2007 to August
2010, a prospective study was done involving 18 patients
who were admitted - and later discharged after recovery -
after being diagnosed with central origin dizziness.
Examination of neurologic deficits was performed by a
physician (a 2nd year Neurology resident) who was not
familiar with the research. The NIHSS was evaluated four
times every week, and VEMP was also performed
identically on both sternocleidomastoid muscles. Both
values were compared and analyzed.
Results: In VEMP results according to recovery stages in
central origin dizziness patients, there was a decrease in
latency and asymmetry of p13, but there was no difference
in latency and difference of latency of n23. Upon comparing
both results, p13 and the level of asymmetry decreased as
the value of the NIHSS decreased according to recovery of
symptoms. Correlation between the two groups was
statistically significant (p<0.05).
Conclusion: Compared to the NIHSS, results of VEMP
allow for objective evaluation of symptom recovery as well
as consistent results and also may be useful in clinical
practice due to its safety.
434 Posters, Sunday 9 September
P1925
Post-infectious optic neuritis associated
with scrub typhus
H.-J. Cho1, K.-D. Choi1, J.-H. Choi2, S.-H. Kim3
1Neurology, Pusan National University Hospital, Busan,
2Neurology, Pusan National University Yangsan Hospital,
Yangsan, 3Neurology, Dong-A University Hospital, Busan,
Republic of Korea
Introduction: To describe a patient who developed post-
infectious optic neuritis associated with scrub typhus.
Methods: An 8-year-old boy was hospitalized for fever,
chills, myalgia, and multiple maculopapular rashes. He was
noted to have an eschar in his body trunk. Extensive testing
for infectious etiology was negative except for scrub typhus
antibody titre of 1:5120. Fever, chills, and myalgia rapidly
resolved after doxycycline treatment. Two weeks later, the
patient developed painless visual loss in the bilateral eyes.
Results: Upon neurological examination, visual acuity was
counting fingers at 1 meter in the right eye and he was
unable to perceive the light in the left eye. Fundoscopy
revealed optic disc oedema in bilateral eyes. Gadolinium-
enhanced T1-weighted MRI of the orbit showed bilateral
enhancement of the optic nerves indicative of bilateral optic
neuritis. He was treated with intravenous methylprednisolone
800mg for 5 days, followed by a tapering course of oral
prednisolone. Two months after the onset of his visual
symptoms, visual acuity was improved completely.
Conclusion: We concluded that the patients optic neuritis
was likely associated with the scrub typhus, which has not
been reported previously. The timing of visual loss may
support an immunological mechanism of scrub typhus-
associated optic neuritis. Treatment of post-infectious optic
neuritis with high-dose corticosteroid appears effective in
our patient.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1926
Pure upbeat nystagmus in association
with bilateral internuclear
ophthalmoplegia
J.-H. Choi1, H.-J. Cho2, S.-H. Kim3, K.-D. Choi2,
J.S. Kim4
1Department of Neurology, Pusan National University
Yangsan Hospital, Yangsan, 2Department of Neurology,
Pusan National University Hospital, 3Department of
Neurology, Dong-A University Hospital, Pusan, 4Department
of Neurology, Seoul National University Bundang Hospital,
Bundang, Republic of Korea
Background and significance: Upbeat nystagmus occurs
in ventral pontine tegmental lesions affecting the ventral
tegmental tract carrying signals for upward vestibulo-ocular
reflex (VOR), and in caudal medullary lesions involving the
nucleus of Roller, one of the perihypoglossal nuclei which
might contribute to vertical oculomotor integration.
However, pure upbeat nystagmus in straight ahead position
of gaze has not been described in association with bilateral
internuclear ophthalmoplegia (INO) from pontine tegmental
lesion involving the medial longitudinal fasciculus (MLF).
We report pure upbeat nystagmus in a patient with bilateral
INO due to dorsomedial pontine tegmental lesions.
Case report: A 66-year-old man developed horizontal
diplopia and oscillopsia for three weeks. Examination
showed bilateral INO and upbeat nystagmus with fixation,
which disappeared in darkness. It was enhanced during
upgaze and convergence, and decreased in downward gaze.
Vertical head impulse tests were normal. Video-oculography
disclosed pure upbeat nystagmus with exponentially
decreasing slow phases. Brain MRI showed enhancing
lesions involving bilateral dorsomedial pons extending
from middle to upper portion. Upbeat nystagmus and
bilateral INO improved with intravenous dexamethasone
administration.
Conclusions: Upbeat nystagmus in our patient may be
attributed to damage of the cell groups of the paramedian
tracts (PMT) or the projections from the interstitial nucleus
of Cajal (INC) to PMT, or disruption of connections
between INC and the nucleus of Roller.

P1927
Vertigo and psychological distress
M. Mulazzani, C. Mller
Medical University of Vienna, Austria
Introduction: With a life time prevalence of 10.3% of the
general population, vestibular vertigo is a widespread
symptom. Furthermore psychiatric disorders are present in
nearly half of the patients presenting at specialized units for
dizziness. Therefore the importance of further elucidating
the connections between vertiginous and psychiatric
symptoms becomes clear.
Methods: 137 healthy adults completed two questionnaires:
the Symptom-Checklist-90-Revised (SCL-90-R) and the
Vestibular Symptom Scale (VSS). Additional Information
on patient history and socio-demographic factors was
gathered and assessed in a multivariate regression analysis.
Results: The global severity of psychological distress (GSI)
was positively correlated to the self-reported severeness of
vertigo and related symptoms (p<0.001), just as each of
the SCL-90-Rs subscales (p<0.001 for somatisation to
0.18 (p=0.039) for psychoticism). Subjects holding a
university degree reported lower psychological distress
compared to subjects with a lower educational level (GSI
means: 0.31 vs. 0.42; p=0.019). Women reported higher
levels of depression than men (0.59 vs. 0.41; p=0.008).
Subjects who declared any kind of disease during the last
twelve months scored higher on both vertiginous symptoms
and psychological distress (VER means: 0.21 vs. 0.14;
p=0.023; GSI means: 0.43 vs. 0.28; p<0.001).
Conclusions: These results indicate a clear connection
between psychological distress and vertigo. The existence
of psychopathological symptoms aggravates the subjective
severity of vertigo, and vice versa. This study adds to the
growing evidence of the bidirectional link between these
two symptom entities.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 435
P1928
Intact retinal ganglion cells and visual
pathways in patients with progressive
external ophthalmoplegia due to common
mtDNA deletion
E.T. Varga1, F. Naghizadeh2, B. Bereznai1, P. Balicza1,
V. Remnyi1, M.J. Molnar1, G. Holl2
1Clinical and Research Centre for Molecular Neurology,
Department of Neurology, Semmelweis University,
2Department of Ophthalmology, Semmelweis University,
Budapest, Hungary
Introduction: Mitochondrial (mt) disorders are metabolic
conditions with multi-organ involvement, often presenting
neuro-ophthalmological symptoms, too. The aim of the
study was to investigate the relation between progressive
external ophthalmoplegia (PEO), involvement of visual
pathway and mitochondrial DNA (mtDNA) mutations.
Methods: 5 female patients (age between 38 and 54 years),
suffering from progressive external ophthalmoplegia and
harbouring the common mtDNA deletion were investigated.
All eyes underwent a detailed standard clinical evaluation
via dilated pupil. Visual functions were measured with
determination of best-corrected visual acuity (BCVA),
standard automated threshold perimetry and VEP. The
quantity of the retinal ganglion cells was measured with
Fourier-domain optical coherence tomography; axonal
integrity of the retinal ganglion cells was assessed with
scanning laser polarimetry. Blood samples were screened
for the most common mtDNA mutations.
Result: Neurological investigation revealed PEO with
variable degree. In 4 of the 5 patients, normal retinal
ganglion cell thickness, retinal nerve fibre layer thickness
and distribution were found with values within the age-
related normal range, for both eyes. Visual acuity, threshold
perimetry and VEP provided results without definite
pathological changes. Genetic analysis of the mtDNA
revealed the common deletion. One patient had maculopathy
due to vitreoretinopathy unrelated to mtDNA deletion, and
decreased BSCA on both eyes.
Conclusion: In patients younger than 50 years with
progressive external ophthalmoplegia due to the common
mtDNA deletion, the retinal ganglion cells and the visual
pathway may remain intact.
436 Posters, Sunday 9 September
P1929
Vestibular function test of dizziness
patients by vestibular evoked myogenic
potential
G.-H. Lee
Neurology, Medical College, Dankook University, Cheon-An,
Republic of Korea
Background and objectives: Since the saccule is a frequent
site of hydrops formation, we evaluated whether vestibular
evoked myogenic potential (VEMP) responses can reflect
the diagnosis and the stage of Menires disease. And we
also studied other vestibular diseases such as vestibular
neuritis and benign paroxysmal positional vertigo.
Materials and methods: Retrospectively, we analyzed the
results of VEMP in 42 patients (20 men and 22 women)
with unilateral definite Menires disease, 21 patients (10
men and 11women) with vestibular neuritis, and 21 patients
(10 men and 11 women) with benign paroxysmal positional
vertigo (BPPV). All subjects underwent VEMP testing
using ipsilateral 1 KHz-tone burst sound with 105 dB nHL.
Results: VEMP was present in 85% of Menires affected
ear. The latency of p13 of affected ears in patients with
Menires disease, vestibular neuritis (VN), BPPV was not
significantly prolonged than that of normal ears in the
control group except left n23 latency in Menires disease.
In patients with Menires disease, the amplitude-ratio was
statistically (p=0.006) larger than that of the control group.
Relationship was found in amplitude ratio among groups
classified by the stage of Menires disease.
Conclusion: This study shows that amplitude ratio of
VEMP response is a useful method to determine the severity
and prognosis of Menires disease. We recommend VEMP
to quantitatively explain to the patient the severity of
Menires disease.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1930
Prevalence of migraine in low tension
glaucoma patients
M. Abu-Hegazy1, M. Saad1, W.M. Dessouky2
1Neurology, 2Ophthalmology, Mansoura University,
Mansoura, Egypt
Introduction: Some authors reported a significant
relationship between migraine and low tension glaucoma.
Objective: To investigate the prevalence of migraine in
patients with low tension glaucoma and to evaluate MRI
and EEG abnormalities in low tension glaucoma
migraineurs.
Methods: A prospective study conducted on 40 controls
and 39 patients with low tension glaucoma in Mansoura
Ophthalmology Center diagnosed by fundus examination,
tonometery, and full threshold perimetry. A standardized
questionnaire was used to indicate migraine positives. Brain
MRI and EEG were done for migraineurs in the control and
patient groups.
Results: Migraine was more common in patients with low
tension glaucoma than in the control group (p=0.03). In
patients with low tension glaucoma, females were associated
with higher prevalence of migraine than males (20.5 vs.
10.3%). Patients with age group ranging from 20 to 25 years
had a higher incidence of migraine than other age groups.
Of the low tension glaucoma migraineurs, 16.7% and 33.3%
had abnormal brain MRI and EEG, respectively.
Conclusion: Migraine is more common in low tension
glaucoma patients than in controls. It is also more prevalent
in low tension glaucoma female gender and those with age
ranging from 20 to 25.

P1931
Transient supranuclear gaze palsy
associated with persistent primitive
trigeminal artery
Y.H. Yun
Gwangmyeong Sungae General Hospital, Gwangmyeong-si,
Republic of Korea
Primitive trigeminal artery is the most frequent embryonic
communication between the carotid and vertebrobasilar
system with the estimated incidence of 0.1-1.0%. We report
a case presented with recurrent supranuclear vertical gaze
palsy related to PTA as a symptom of vertebrobasilar
insufficiency. A 57-year-old man was admitted to our
hospital because of recurrent vertical diplopia for 7 days.
On admission he was alert, but presented with conjugated
gaze palsy. In the neuro-ophthalmologic examination, the
vertical vestibulo-ocular reflex and Bells phenomenon was
preserved. There were no accompanying neurologic deficits
such as cranial nerve palsies and cerebellar dysfunction. His
ocular finding prolonged only for 5 hours then disaffeared
thereafter. We could not find any evidence of acute ischemic
lesion on the magnetic resonance (MR) imaging. MR
angiography and digital subtraction angiography, however,
showed persistent anastomosis from the cavernous segment
of right internal carotid artery (ICA) to the proximal portion
of basilar artery (BA). As expected, distal portion of BA
was hypoplastic. Vertical gaze palsy can be caused by a
lesion involving the thalamus, rostral interstitial nuclei of
medial longitudinal fasciculus, or posterior commissure.
Hypoplastic BA might cause transient ischemic symptoms.
Previous reports dealing with persistent PTA suggested that
the mechanism of ischemia in the posterior circulation be
embolism from the ICA stenosis or in-situ thrombosis in the
PTA itself. In contrast to the previous studies, our case
could show that ischemic symptoms localized to the
mesodiencephalon might be caused by hemodynamic
insufficiency from hypoplastic BA.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 437
P1932
Non-traumatic carotid-cavernous fistula
combined with acute brain stem infarction
resulting in hemiparesis
Y.H. Jung
Neurology, Chang Won Fatima Hospital, Chang Won,
Republic of Korea
Background: Carotid-cavernous fistula (CCF) is abnormal
arteriovenous communications between the carotid and
cavernous sinus. Direct CCF results from a tear in the
intracavernous carotid artery, usually due to trauma or
intervention. Indirect CCF generally occurs spontaneously
and shows more subtle signs. CCF is usually combined with
aneurysm or trauma. CCF is relatively rare, but may show
progressive, diverse symptoms such as decreased visual
acuity, exophthalmosis, ophthalmoplegia, and cerebral
ischemia due to increased venous pressure. However,
hemiparesis has been rarely reported. We report a case of
CCF combined with multiple brainstem infarctions causing
hemiparesis.
Case report: A 74-year-old woman visited our hospital
with a chief complaint of gait disturbance, headache, and
repeated vomiting during 10 days. She had a medical history
of diabetes, hypertension, and hyperlipidemia. She had no
traumatic history. A neurological examination revealed mild
dysarthria, right exophthalmos with conjunctival oedema
and ophthalmoplegia, deceased visual acuity of the right
eye, left hemiparesis (MRC Grade III) and decreased
pinprick sensation of left upper and lower limbs. Blood tests
showed elevated level of total cholesterol (343mg/dl) and
erythrocyte sedimentation rate(ESR) (30mm/hr). Random
serum glucose level was elevated to 265mg/dl. Other
studies were within normal limits. A brain MRI and MR
angiography showed a recent infarction on the right pontine
and medulla oblongata and fistula of the right carotid and
cavernous sinus.
Conclusion: CCS is usually combined with aneurysm or
trauma, and hemiparesis has rarely been reported. We report
a case of non-traumatic, no aneurysmal CCF combined with
hemiparesis.
438 Posters, Sunday 9 September
P1933
Calycopterin induces mitochondrial
biogenesis and autophagy in PC12
neuron-like cells exposed to H2O2
N. Namazi Sarvestani, F. Khodagholi
Neuroscience Research Center, Tehran, Iran
Introduction: An increase in the intracellular levels of anti-
oxidant agents, and at the same time the removal of already
damaged components, are both part of the oxidative stress
response. Flavones have been considered as one of the
antioxidants. We determine the neuroprotective effects of
calycopterin as natural flavones, on H2O2-treated PC12
neuronal cells.
Methods: PC12 cells treated with 25, 50 and 100M of
calycopterin for 3h, followed by adding H2O2 (150M).
Apoptosis was assessed by MTT test, acridine orange/
ethidium bromide and Hoescht staining and the autophagy
was determined by Mono Dansyl Cadaverin and acridine
stain. Inflammation, ER stress, mitochondrial biogenesis
and autophagy factors were measured by Western blot
method.
Results: We found that calycopterin protects differentiated
PC12 cells by inhibiting caspase-dependent pathway of
apoptosis. Calycopterin could decrease ER stress by
decreasing calpain and caspase-12 levels. These inhibitions
were along with stabilization of Nrf2, phosphorylation of
CREB and decrease of NF-KB levels. The level of
inflammatory factors such as NF-KB, TNF and COX-2
was also decreased by calycopterin. Interestingly,
calycopterin promotes mitochondrial biogenesis through
increase of PGC1, NRF1 and TFAM. We also measured
important factors involved in autophagy such as LC3B,
Atg-7, Atg-12 and P62. Calycopterin could increase
autophagy in order to protect PC12 neuronal cells from
death.
Conclusions: We provided documentation of
neuroprotective effect of a natural flavone, calycopterin,
against H2O2-induced oxidative stress in differentiated
PC12 cells by modulating the level of transcription factors,
increasing the level of antioxidant factors and promoting
biogenesis of mitochondria and autophagy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1934
Central retinal artery obstruction (CRAO) -
clinical and colour Doppler imaging (CDI)
characteristics
D.C. Jianu1, S.N. Jianu2, L. Petrica3, S.M. Deme4,
D.F. Muresanu5, S.K. Calomfirescu5, M. Petrica1
1Neurology, Victor Babes University of Medicine and
Pharmacy, County Emergency Hospital, 2Ophthalmology,
Military Emergency Hospital, 3Internal Medicine-
Nephrology, Victor Babes University of Medicine and
Pharmacy, County Emergency Hospital, Timisoara,
4Neurology, West University, Arad, 5Neurology, University of
Medicine and Pharmacy, Cluj-Napoca, Romania
Introduction: CRAO represents an abrupt diminution of
blood flow through the CRA severe enough to cause
ischemia of the inner retina.
Purpose: To assess the role of CDI in the etiological
diagnosis of CRAO.
Patients and methods: 4 patients with clinical suspicion of
unilateral CRAO were examined following a protocol
including CDI of orbital vessels.
Results: They had no emboli visible on ophthalmoscopy.
The first patient had no blood flow signal on CDI on a
surface of 2 millimetres behind the left optic disc. B-scan
ultrasound evaluation found a small round, moderate
reflective echo within the left optic nerve, 2 millimetres
behind the optic disc. Left ICA ultrasound examination
found an ulcerated ateromatous plaque, being the source of
cholesterol emboli. The second patient had no detectable
flow in the right CRA, due to multiple reverberations
determined by calcic arterial emboli, placed 5 millimetres
behind the right optic disc. The angio-CT showed an
unstable aortic plaque, considered as the source of the
emboli. The third patient had characteristic CDI findings for
Horton disease: low blood velocities, especially end-
diastolic velocities, and high RI in all retrobulbar vessels, in
both orbits (severe diminished blood flow velocities in the
CRA, especially on the affected side). The diagnosis was
sustained by temporal arteries ultrasound and biopsy. The
last patient had very low blood flow velocities in the left
CRA, due to an acute left ICA occlusion.
Conclusions: Ultrasound investigation is a valuable
diagnostic tool for identifying potential systemic conditions
associated with CRAO.
 Posters, Sunday 9 September 439

P1935
Ophthalmoplegia without ataxia: a case P1938
report Visual evoked potentials in patients with
A.C. Sarilar, M.C. Akbostanci, C. Togay Isikay diabetic neuropathy
Neurology, Ankara University, Ankara, Turkey H. Ulvi, U. Avar, Z. Canseve, Z. Avar, R. Demir,
Acute ophthalmoplegia without ataxia (AOWA) is an L. zel, R. Aygul
extremely rare disease in which acute impairment of ocular Departments of Neurology and Family Medicine and
movements is usually the sole clinical manifestation. We Medical Education, Faculty of Medicine, Atatrk University,
report a patient with isolated acute ophthalmoplegia and Erzurum, Turkey
anti-GQ1b IgG antibody in CSF whose treatment with
intravenous immunoglobulin (IVIg) led to clinical recovery P1939
within four weeks. Case was a 68-year-old woman with
diplopia, bilateral blepharoptosis and dizziness that started Acute myopia induced by administration
one week ago. She had diarrhoea just before her complaints. of 25mg/day single-dose topiramate:
Examination revealed bilateral incomplete ptosis and total a case report
ophthalmoplegia. Pupillary reaction to light was decreased
E. Vardarli1, T. Kocaoglu2, H. Kocaoglu2, D. Mete Uskay3
bilaterally. Other findings like orbital and cranial MRIs 1 Neurology, 2Ophthalmology, Ozel Tinaztepe Hastanesi,
were normal. Biochemistry, blood count, sedimentation, 3 Solo Practice, Izmir, Turkey
C-reactive protein, thyroid hormones, glycolysated
haemoglobin, and thiamine levels were normal. ANA,
ENA, ANCA, anti-dsDNA, anti-acetylcholine receptor P1940
antibodies, HIV, and VDRL was negative. CSF protein and
glucose levels were normal, and there were no cells. Anti
Abstract cancelled
GQ1b IgG antibodies were positive in CSF. Neostigmine
test was negative. Nerve conduction studies were normal. P1941
AOWA was considered and IVIg 0.4g/kg/d for five Neuro-ophthalmologic examination of
consecutive days was started. In the fourth week
examination was normal besides bilateral slight ptosis. stroke patients
AOWA has been designated as an atypical form of Miller- H.H. Bakunts, G.H. Silvanyan, L.K. Egiyan,
Fisher syndrome. The new diagnostic criteria for AOWA, K.F. Baghdasaryan
fulfilled by the presented patient, include acute or subacute Angioneurology, Yerevan State Medical University after
onset of external/internal ophthalmoplegia, absence of other Mkhitar Heratsi, Yerevan, Armenia
neurological symptoms, presence of antiGQ1b IgG
antibodies and exclusion of other identiable causes. Cases
of AOWA successfully treated with IVIg have been
P1942
reported. The disease can have a good prognosis without Abstract cancelled
treatment, though the time to complete recovery is longer.
P1943
Non-invasive alternating current
P1936 stimulation improves vision after
Isolated cranial neuritis due to paranasal traumatic injury of the optic nerve
sinusitis: two case reports A. Fedorov1, Y. Chibisova2, B.A. Sabel1, C. Gall1
C. Angelopoulou1, E. Mavraki1, S. Boutzoni1, 1Institute of Medical Psychology, Otto-von-Guericke

M. Flamouridou1, S. Stathakidou2, O. Tsirogianni2, University of Magdeburg, Germany, 2Department of

M. Riga2, M. Katotomichelakis2, D. Dardabounis3, Neurology, Mechnikov Medical Academy, Saint Petersburg,
S. Lamprakopoulos1 Russia
1Department of Neurology, 2Department of Otolaryngology,
3Department of Ophthalmology, University of Thrace,
Alexandroupolis, Greece P1944
Unusual cause of ptosis
P1937 F. Tokucoglu1, A. Ozdemir2, B. Ozer2
1Ataturk University Department of Neurology Research and
Clinical analysis of hearing loss due to Training Hospital, 2Ataturk Research and Training Hospital,
spontaneous intracranial hypotension Izmir, Turkey
S.-K. Mun
Chung-Ang University Hospital, Seoul, Republic of Korea

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

440 Posters, Sunday 9 September
Neurotoxicology / occupational
neurology
P1945
Neuroprotective profile of sesamol and
quercetin in experimental paradigm of
QA-induced neurotoxicity: inhibition of
nitrodative-inflammatory cascade
A. Kuhad, S. Singla, V. Arora, K. Chopra
University Institute of Pharmaceutical Sciences, Panjab
University, Chandigarh, India
Introduction: Quinolinic acid (QA), a well known
excitotoxin that produces a pharmacological model of
Huntingtons disease in rats and primates, has been shown
to evoke degenerative events in nerve tissue via NMDA
receptor overactivation and oxidative stress to exert its
neurotoxic actions.
Methods: Rats were intrastriatally administered quinolinic
acid and were treated with sesamol (4, 8 and 16mg/kg, i.p)
and quercetin (25, 50 and 100mg/kg, i.p) for 14 days before
and 14 days after quinolinic acid administration, with these
natural antioxidants.
Results: Intrastriatal injection of QA leads to increased
escape latency, impaired locomotor activity, as well as
significant increase in immobility time in forced swim test,
This behavioural deficit was integrated with the increased
nitrodative stress markers (increased lipid peroxidation,
raised nitrite concentration and depletion of endogenous
anti-oxidants such as catalase, superoxide dismutase and
reduced glutathione) along with the significant increase in
TNF- levels in rat brain suggesting QA mediated oxidative
and neuro-inflammatory damage. Moreover intrastriatal
administration of QA resulted in significant decrease in the
levels of dopamine, serotonin and norepinephrine in the rat
forebrain. Chronic treatment with sesamol and quercetin
attenuated these behavioural, biochemical and
neurochemical alterations in the rat brain and these effects
were attributed to their strong anti-oxidant and anti-
inflammatory potential.
Conclusions: Conclusively it is suggested that major
features of QUIN-induced neurotoxicity are mediated by
nitrodative stress induced neuro-inflammation and the
neuroprotective role of sesamol and quercetin should be
explored further as effective agents in the management of
Huntingtons disease.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1946
Age- and size-dependent neurotoxicity of
engineered nanoparticles from metals
A. Sharma1, D.F. Muresanu2, R. Patnaik3, H.S. Sharma1
1Surgical Sciences, Anaesthesiology & Intensive Care
Medicine, Uppsala University, Uppsala, Sweden,
2Neurosciences, University of Medicine and Pharmacy Cluj-
Napoca, Cluj-Napoca, Romania, 3Biomaterials, School of
Bioengineering, Banaras Hindu University, Institute of
Technology, Varanasi, India
Chronic administration of engineered nanoparticles from
metals, e.g., Cu, Ag, or Al (50-60nm, 50mg/kg, i.p. daily for
1 week) induces blood-brain barrier (BBB) disruption, brain
oedema formation and brain pathology in rats (age 18 to 22
weeks). This was most pronounced in Ag followed by Cu
and Al indicating metal specificity in neurotoxicity.
However, size and age dependent neurotoxicity of
nanoparticles are still not well known. In this investigation,
three different sizes of Cu, Ag or Al nanoparticles (20 to
30nm; 50 to 60nm, or 130 to 150nm) were administered (50
mg /kg, i.p.) in 3 different age groups of rats (9 to 10 weeks;
18 to 20 weeks or 30 to 35 weeks old). In these animals,
breakdown of the BBB to Evans blue albumin (EBA) and
radio-iodine, brain water content, neuronal injury, astrocytic
activation, myelin damages were examined using standard
procedures. We found that brain pathology caused by
different nanoparticles was inversely related to their sizes.
Thus, smaller nanoparticles from Ag, Cu or Al induced most
pronounced BBB breakdown, brain oedema formation and
neuronal injuries, glial fibrillary acidic protein (GFAP)
upregulation as well as myelin vesiculation in youngest
animals. The oldest animals also showed massive brain
pathology. The Ag and Cu exhibited greater brain damage
compared with Al nanoparticles in all age groups regardless
of their sizes. The young and elderly age groups exhibited
greater neurotoxicity to nanoparticles indicating that
perhaps children and elderly are more vulnerable to
nanoparticle-induced brain damage.
 Posters, Sunday 9 September 441

P1947 P1948
Engineered nanoparticles Ag, Cu and Al Very long chain fatty acid-induced cell
(50-60nm) induce oxidative stress, death with autophagic characteristics on
neuronal nitric oxide synthase oligodendrocytes
upregulation and brain pathology. A. Vejux, K. Ragot, M. Doria, G. Lizard
Neuroprotection by Insulin-like growth Laboratoire Bio-PeroxIL - Biochimie du Peroxysome,
factor1 Inflammation et Mtabolisme Lipidique, Universit de
Bourgogne - Facult des Sciences Gabriel, Dijon, France
A. Sharma1, D.F. Muresanu2, R. Patnaik3, J.V. Lafuente4,
X-linked adrenoleukodystrophy (X-ALD), a peroxisomal
H.S. Sharma1
1Surgical Sciences, Anaesthesiology & Intensive Care leukodystrophy characterized by ABCD1 deficiency, is
Medicine, Uppsala University, Uppsala, Sweden, associated with elevated plasmatic and tissue concentrations
2Neurosciences, University of Medicine and Pharmacy Cluj- of very long chain fatty acids (VLCFA: C24:0, C26:0). As
Napoca, Cluj-Napoca, Romania, 3Biomaterials, School of some dead cells were observed on histological tissue
Bioengineering, Banaras Hindu University, Institute of sections from the brain of X-ALD patients, we determined
Technology, Varanasi, India, 4Neurosciences, Lab Clinical & the type of cell death induced by VLCFA on oligodendrocytes
Experimental Neurosciences (LaCEN), University of Basque (myelin synthesizing cells). Murine oligodendrocytes cells
Country, Bilbao, Spain (158N) were treated for 24-48h with C24:0 or C26:0 (10-
20M) or (C24:0 + C26:0) (5M each). The impact of
The possibility that chronic exposure of nanoparticles
VLCFA on cell viability was evaluated by flow cytometry
causes blood-brain barrier (BBB) breakdown and brain
with propidium iodide (dead cell identification), DiOC6(3)
pathology by inducing oxidative stress and/or nitric oxide
(m measurement) and acridine orange (lysosomal
production was examined in a rat model. Rats treated with
integrity). No apoptotic cells were found. As some
Ag, Cu or Al nanoparticles (50mg/kg, i.p. once daily for 7
lysosomes were observed, autophagy was evaluated by
days) were tested for BBB permeability, brain oedema,
studying LC3 expression and localization by Western
neuronal nitric oxide synthase (nNOS) immunoreactivity
blotting (LC3-II identification as autophagic marker) and
and brain oxidant levels, e.g., myeloperoxidase (MP),
immunofluorescence (transfection with GFP-LC3). On
malondialdehyde (MD) and glutathione (GT) on the 8th day
158N cells, C24:0 and C26:0 alone and combined are able
as compared to saline controls. Cu and Ag but not Al
to induce cell death (loss of cell viability, decrease m,
nanoparticles increased the MP and MD levels by 2-fold in
altered lysosomal integrity) and induce an activation of
the brain, although GH showed 50% decline. At this time
autophagy (presence of LC3-II, punctuated localization of
increase in brain water content and BBB breakdown to
LC3). Thus, VLCFA are able to trigger an autophagic form
protein tracers were seen in areas exhibiting nNOS positive
of cell death in 158N cells. It remains to define whether this
neurons and cell injuries. Pre-treatment with insulin-like
autophagic process can be amplified by ABCD1 deficiency,
growth factor-1 (IGF-1) in high doses (1g/kg,i.v., but not
and whether it contributes to cell death or constitutes a
0.5g/kg daily for 7 days) together with nanoparticles
defence mechanism.
significantly reduced the oxidative stress, nNOS
upregulation, BBB breakdown, oedema formation and cell
injuries. These novel observations demonstrate that (i)
nanoparticles depending on their constitution (Cu, Ag but
not Al) induce oxidative stress and nNOS expression
leading to BBB disruption, brain oedema and cell damage,
and (ii) IGF-1 depending on its doses exerts powerful
neuroprotection against nanoneurotoxicity, not reported
earlier.

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

442 Posters, Sunday 9 September
P1949
Prevalence of alcohol use among seizure
patients admitted to the emergency room
A. Fedulau1, M. Leone2, A. Ivashynka2, D. Kuzmin1
1State Medical University, Minsk, Belarus, 2Clinica
Neurologica Maggiore della Carit Hospital, Novara,
Italy
Both epilepsy and alcohol misuse represent a frequent cause
of admission to the Emergency Room (ER). The number of
people abusing alcohol is increasing in Belarus and
represents a serious public health problem. A history of
alcohol misuse or dependence among patients with seizures
is at least twice as frequent as in the general population in
Western European countries. No information is available
for Belarus and most of other east European countries.
Objective: To study the frequency of alcohol history among
patients admitted with seizure to the emergency department
of a general hospital in Belarus.
Materials and methods: Clinical charts of all the
admissions to the ER of the 9th University Hospital in
Minsk during one year were evaluated. Data on medical
history, general and neurological examination, and
laboratory investigations were collected.
Results: Among 31,658 patients admitted to the emergency
department during 2011, a seizure was diagnosed in 1504
(4.8%). Two-hundred-fifty-one seizure patients (14%) had
a history of alcohol abuse: 35 presented with a new-onset
seizure, 74 had previous seizures and for 141 without data
of epileptic history. Associated pathology included brain
injury of varying severity (32 patients), and stroke (1). None
of the patients EEG showed focal lesions.
Conclusions: Patients with seizures and a history of alcohol
represent an important burden of neurological emergency.
The prevalence of alcohol abusers among seizure patients
was similar to Western European countries. However,
ascertainment of a history of alcohol abuse may be
challenging in the ER because patients often hide their
alcoholic history.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1950
Fatal outcome in acute Marchiafava-
Bignami in relation to pure alcohol
consumption
H. Nzwalo1, B. Banjai2, J. Drago3, F. Ferreira1, J. Soleiro1
1Neurology, 2Internal Medicine, 3Radiology, Faro Hospital
EPE, Faro, Portugal
Introduction and methods: Marchiafava-Bignami disease
(MBD) is the symmetrical demyelization of the corpus
callosum rarely seen in chronic alcoholics. There is no
specific clinical feature of MBD. The diagnosis is based on
the association of clinical and typical Brain MRI findings.
We describe a case of MBD after a relatively short period of
massive pure alcohol consumption.
Results: A 30-year-old woman, was admitted to hospital
because of acute confusional state. She had been binge
drinking for one year, but 4 weeks before admission she
started with massive daily intake (250-300ml) of
commercial pure alcohol. She was disoriented, agitated,
with generalized hypertonicity, and bilateral Babinski sign.
There were no asymmetries or meningeal signs. The
extensive laboratory tests were within normal values with
exception for mild hypochromic macrocytic anaemia. The
electro-encephalogram showed diffuse lentification of
cerebral activity. The brain MRI on T2W, DWI and FLAIR
images showed diffuse hypersignal of corpus callosum,
more intense in the splenium, without water restriction. On
T1W and on ADC images the lesion appeared hypo-intense.
On the basis of the history of alcohol abuse in association
with the imaging findings the diagnosis of MBD was made.
She started on supportive measures, corticosteroids, high-
dose intravenous vitamin B complex, including 1000mg/
day thiamine, but her condition did not improve. She died a
week later.
Conclusion: This case of MBD is atypical because of the
preceding short time of alcohol abuse and also the
association with pure alcohol consumption which has never
been described before.

P1951
Distinct molecular mechanisms are
involved in SK-N-MC cell death in
response to hydrogen peroxide and
superoxide anion
M. Moslehi, R. Yazdanparast
University of Tehran, Institute of Biochemistry and
Biophysics, Tehran, Iran
Aims: There is an increasing body of evidence indicating
that oxidative stress plays a vital role in the pathogenesis of
neurodegenerative diseases. Nerve cells are incessantly
exposed to environmental stresses leading to overproduction
of some harmful species like reactive oxygen species
(ROS). ROS including hydrogen peroxide and superoxide
anion are potent inducers of various signalling pathways
encompassing MAPKs and JAK-STAT pathways. JNK/p38
MAPKs, JAK2 and STAT3 are deemed stress-responsive
factors involved in oxidative stress-induced cell death. We
scrutinized the effects of hydrogen peroxide and superoxide
anion on SK-N-MC neuroblastoma cells to elucidate the
mechanism by which each oxidant modulated above-
mentioned pathways leading to SK-N-MC cell death.
Methods: SK-N-MC cells were exposed to hydrogen
peroxide and the superoxide anion donor, menadione.
Phosphorylation of MAPKs, JAK2 and STAT3 and cell
death were investigated.
Results: Hydrogen peroxide and superoxide anion induced
distinct responses in SK-N-MC cells as we showed that
unlike JAK2 which was activated by both oxidants, STAT3
and p38 were activated in response to hydrogen peroxide
and not superoxide radicals in SK-N-MC cells and
menadione induced JNK-dependent p53 expression and
apoptotic cell death which was not detected in H2O2-
induced JNK activation.
Conclusion: ROS type has a key role in selective instigation
of JNK/p38 MAPKs and JAK2-STAT3 pathways in SK-N-
MC cells. Identifying these differential behaviours and
mechanisms of function illuminates therapeutic targets in the
prevention or treatment of ROS-induced neurodegenerative
diseases such as Alzheimers disease.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 443
P1952
Inhibitory effect of the platelet activating
factor on the apoptosis of differentiated
PC 12 cells
D.E. Kim, J.H. Han
Neurology, Korea Veterans Hospital, Seoul, Republic of
Korea
Objective: Platelet activating factor (PAF) activation
reveals a variable effect on cell death induced by various
toxic insults. We assessed the PAF effect on MPP+ toxicity
in relation to the apoptotic process.
Methods: The effect of PAF on the MPP+ toxicity was
assessed in PC12 cells differentiated by the nerve growth
factor. To assess the MPP+ treatment-induced apoptosis and
clarify the inhibitory effect of PAF on MPP+ toxicity, we
investigated the effect of PAF on the nuclear morphological
changes observed in the MPP+-treated cells. The MPP+-
induced apoptosis was assessed by measuring change in the
apoptotic protein levels. We evaluated the effect of PAF on
the MPP+-induced cytochrome-c released and caspase-3
activation by performing the ELISA-based quantitative
analysis.
Results: PAF exhibited differential effect against MPP-
induced cell death depending on concentration. Nuclear
staining with Hoechst 33,258 demonstrated that control
PC12 cells had regular and round-shaped nuclei. In contrast,
the fragmentation of nuclei was demonstrated in cells
treated with 500M MPP+. Treatment with 0.75M PAF or
0.5M cyclosporin-A significantly attenuated the MPP+-
induced release of cytochrome-c and caspase-3 activation.
In contrast, 10M PAF induced cytochrome-c release and
caspase-3 activation, and exhibited an addictive effect
against the MPP+ toxicity.
Conclusions: The results show that PAF at low
concentrations, which does not induce a significant toxicity,
may prevent the MPP+ toxicity by suppressing the apoptotic
protein activation and mitochondrial membrane
permeability change that leads to the cytochrome-c release
and caspase-3 activation.
444 Posters, Sunday 9 September
P1953
Does oxaliplatin-induced neurotoxicity
affect peripheral small nerve fibres?
M. Buonocore1, A.M. Gatti1, A. Bodini1, G. Amato1,
A. Milani2, I.T. Lorenzetti2, V. Fregoni2, G.A. Da Prada2
1Unit of Clinical Neurophysiology, 2Unit of Clinical Medical
Oncology I, Fondazione Maugeri, Scientific Institute of
Pavia, Italy
Introduction: Efficacy of oxaliplatin in the treatment of
colorectal cancer has been largely demonstrated but its
clinical use is frequently limited by the development of
neurotoxicity. Large peripheral nerve fibres are involved in
the development of oxaliplatin induced neurotoxicity; but to
date little is known about a possible damage of peripheral
sensory small nerve fibres (SNFs). Aim of the study was to
investigate the effects of oxaliplatin treatment on the
Epidermal Nerve Fibre Density (ENFD), the study of which
is an accepted method for the assessment of small fibre
neuropathies.
Methods: 10 patients (5 males, 5 females) completed this
preliminary study. Two skin biopsies were performed in leg
and thigh before and after a chemotherapy regimen
containing oxaliplatin. In each patient the treatment was
repeated every 2 weeks until disease progression,
unacceptable toxicity or a maximum of 12 cycles.
Results: In this preliminary study no significant changes
were observed on ENFD suggesting that the standard
oxaliplatin chemotherapy for colorectal cancer does not
induce a degeneration of SNFs.
Conclusions: To the authors knowledge, this is the first
report of an investigation on the possible effect of oxaliplatin
on SNFs. This information could be useful for a better
understanding of pathophysiological mechanisms related to
the development of oxaliplatin-induced neurotoxicity and
possibly permits to assist the advancement of new
neuroprotective strategies. In order to confirm the present
findings and to explore the possibility of an oxaliplatin-
related dysfunction (without degeneration) of SNFs , more
studies on larger populations are warranted.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1954
Peroneal nerve palsy induced by
prolonged squatting: three case reports
and a review of the literature
G. Genc, A. Bakr
Maresal Cakmak Hospital, Erzurum, Turkey
Introduction: Entrapment neuropathies are common
neuropathies, and the incidence tends to increase in the last
3 decades. The reasons for this increase are technological
advances in diagnostic tools, mechanization of society and
bad working conditions. Three cases of peroneal palsy
caused by prolonged sitting in a specific position are
described and we aim to emphasize the optimization of
working conditions.
Case Reports: Peroneal nerve entrapment was diagnosed
in 3 young male patients. 2 of them were working as
building workers. They had a history of 5 or 6 hours
working in the building. The other patient was a soldier and
had a history of 2 hours squatting in military sport training.
The diagnosis was established by clinical and
electrophysiological studies. All patients had postural-
induced entrapment. Initially, all the patients were treated
conservatively with a drop-foot splint and vitamin B. 2
patients responded to treatment. Since detection of no
clinical and electrophysiological improvement after three
months of conservative treatment, surgical decompression
was performed in 1 patient, which resulted in a successful
outcome.
Conclusion: Because of nutritional deficiency, metabolic
factors, or a decrease in protective subcutaneous tissue
surrounding the nerve, thin people become more sensitive
to direct pressure and mechanical irritation. We associate
the peroneal nerve palsy induced by prolonged squatting of
our cases with this aspect. Since permanent deficits may
occur, it is very important to improve the working conditions
of workers who tend to peroneal nerve palsy.

P1955
Design, biomolecular modelling and
evaluation of surface-engineered
nanoliposomes for the management of
Alzheimers disease
M.S. Mufamadi1, Y.E. Choonara1, L.C. du Toit1,
G. Modi2, D. Naidoo3, P. Kumar1, V.M.K. Ndesendo4,
L. Meyer5, S.E. Iyuke6, V. Pillay1
1Department of Pharmacy and Pharmacology, 2Department
of Neurology, 3Department of Neurosurgery, University of
the Witwatersrand, Johannesburg, South Africa, 4School of
Pharmacy and Pharmaceutical Sciences, St. Johns
University of Tanzania, Dodoma, Tanzania, 5Central Animal
Services, University of the Witwatersrand, 6School of
Chemical and Metallurgical Engineering, University of the
Witwatersrand, Johannesburg, South Africa
Purpose: The purpose of this study was the design,
modelling and evaluation of the surface engineered
nanoliposomes (NLPs) coupled with chelating ligands
[Zinc acetate (ZnAc), Histidine (His) and
Ethylenediaminetetraacetic acid (EDTA)] for neuronal cell
protections against A aggregates.
Methods: NLPs were fabricated from
disteroylphosphatidylcholine (DSPC), Cholesterol (Chol),
and disteroylphosphatidylethanolamine (DSPE-
mPEG2000) using the reverse phase evaporation technique.
Chelating ligands were surface engineered onto the surface
NLPs. Biomolecular modelling analysis was used as
predictive approach in the design of surface-engineered
NLPs to investigate the interaction of metal ions [Cu(II) and
Zn(II)] with A(1-42) peptide resulting in CuA(1-42) or
ZnA(1-42) aggregates, and the effect of surface-modified
NLPs in preventing A aggregates. Cyto(neuro)toxicity
studies were performed on the surface-modified NLPs in
order to assess the effect on neuronal cell proliferation.
Dead cells were assayed using CytoTox-GloCytotoxicity
kit and counted employing a plate reader. The interaction of
DSPC, Chol and DSPE-mPEG2000 during NLPs
formulation and engineering of chelating ligands on the
surface of NLPs was validated by Fourier Transmission
Infrared (FITR) and Scanning Electron Microscopy (SEM).
Results: Analytico-mathematical and geometrical
configuration validated the interaction energy during
protein/metal or metal/chelating ligands complexation. Ex
vivo studies showed about 30-40% cell viability after
exposure to CuA(1-42)/ ZnA(1-42) aggregates.
Furthermore, about 60-80% cell viability was shown after
treatment with surface-modified NLPs with ZnAc, histidine
and EDTA
Conclusions: The in vitro and ex vivo experimental studies
were well corroborated by the in silico molecular
mechanistic studies, thus further confirming the potential of
NLP/chelation therapy for Alzheimers disease intervention.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 445
P1956
Potential protective roles of retinoic acid
in ethanol-induced neurotoxicity
P. Dharmasaroja, K. Grataitong
Mahidol University, Bangkok, Thailand
Introduction: Imaging studies have shown that excessive
ethanol intake can lead to abnormal reduced brain volumes
of grey and white matter across multiple regions. Exposure
to ethanol leads to a decrease in anti-apoptotic proteins and
an increase in pro-apoptotic proteins in various neuronal
cells, including Purkinje cells. Retinoic acid (RA) has been
shown to exert anti-apoptotic effects. This study aimed to
investigate the effects of all-trans RA on ethanol-induced
cell death in human dopaminergic SH-SY5Y neuroblastoma
cells.
Methods: Cell viability was revealed using an MTT assay.
Nuclear morphology was determined by DAPI staining.
Expression of tyrosine hydroxylase (TH) was analyzed
using Western blotting and real-time RT-PCR.
Results: The effect of ethanol on cell viability was dose-
dependent. In the presence of 10M RA, 200mM ethanol-
induced cell death and nuclear fragmentation were reduced
after 24 hours of exposure. Ethanol increased TH protein
expression in a dose- and time-dependent manner, with a
significant change observed at 200mM ethanol and
following 72 hours of exposure. Western blotting and real-
time RT-PCR analysis showed that 72 hours of treatment
with 200mM ethanol significantly increased TH expression
when compared to unexposed controls. In contrast, cells
cultured with 10M RA and 200mM ethanol displayed
significantly decreased TH expression when compared to
cells treated with ethanol alone.
Conclusions: RA protects against cell death and prevents
the biochemical adaptation of ethanol-treated SH-SY5Y
cells.
446 Posters, Sunday 9 September
P1957
Tacrolimus neurotoxicity heralded by
myoclonus
A. Nicodme, Y. Serroukh, F. Supiot, T. Gustot, G. Naeije
Universit Libre de Bruxelles, Belgium
Introduction: The neurological toxicity of tacrolimus is
well described, including posterior reversible
encephalopathy syndrome (PRES). Myoclonus has not been
reported earlier. We report two cases of patients treated with
tacrolimus who developed symptoms of PRES heralded by
myoclonus.
Interest: 2 patients treated with tacrolimus for liver
transplant due to alcoholic cirrhosis and hepatocarcinoma
were hospitalized in neurology. The delay between
transplant and symptoms was five months in both cases.
Case reports: A 68-year-old man presented generalized
myoclonus causing repeated falls one week before
hospitalization. Neurological examination disclosed
generalized rest and action myoclonus, dysarthria, optical
apraxia and a bipyramidal syndrome. Brain imaging and
tacrolimus blood concentration were normal. Tacrolimus
was stopped and the patient recovered. The second case is a
52-year-old man. One week before hospitalization, he
developed generalized myoclonus. Neurological
examination disclosed incoherent speech, right neglect and
severe generalized rest and action myoclonus. Tacrolimus
blood concentration was also normal. Brain magnetic
resonance imaging (MRI) showed evidence of PRES.
Clinical manifestations and MRI abnormalities disappeared
when tacrolimus was stopped.
Conclusion: Generalized myoclonus caused by tacrolimus
is a severe adverse event and unreported earlier. Myoclonus
may announce PRES symptoms in patients with normal
tacrolimus blood concentration. Clinicians should be aware
of myoclonus as first manifestation of tacrolimus toxicity.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1958
Cerebrolysin reduces exacerbation of
blood-brain barrier breakdown, oedema
formation, nitric oxide synthase
upregulation and brain pathology after
heat stroke in diabetic and hypertensive
rats
D.F. Muresanu1, R. Patnaik2, A. Sharma3, H.S. Sharma3
1Neurosciences, University of Medicine and Pharmacy Cluj-
Napoca, Cluj-Napoca, Romania, 2Biomaterials, School of
Bioengineering, Banaras Hindu University, Institute of
Technology, Varanasi, India, 3Surgical Sciences,
Anaesthesiology & Intensive Care Medicine, Uppsala
University, Uppsala, Sweden
P1959
Encephalopathy due to isotretionin
therapy
H.L. Gl1, O. Karadas2, H. Tutkan3, L. Ak1,
U. TurkBoru1
1Neurology, Kartal Research and Education Hospital,
Istanbul, 2Neurology, Erzincan Military Hospital, Erzincan,
3Neurology, Occupational Diseases Hospital, Istanbul,
Turkey
P1960
Opinion making on health status and
ability to run motor vehicles in people
after craniocerebral traumas in Poland
H. Sinczuk-Walczak
Nofer Institute of Occupational Medicine, Lodz, Poland
P1961
Protective effect of MitoQ against
Dichlorvos induced oxidative stress and
ensuing dopaminergic neuronal cell death
W.Y. Wani, K.D. Gill
Biochemistry, PGIMER, Chandigarh, India
 Posters, Sunday 9 September 447

P1962 P1967
Bortezomib induced severe peripheral Rhabdomyolysis caused by toluene
neuropathy and PRES in a patient with intoxication
multiple myeloma Z. Idrizovic1, S. Vujisic2
1Neurology, General Hospital, Bijelo Polje, 2Neurology,
A. SlassiSennou1, A. Just1, J. Amevigbe1, T. Maisonobe2,
S. Thepot3 Clinical Center Podgorica, Podgorica, Montenegro
1Neurology, Hospital of Beauvais, Beauvais, 2Neurology

Functional Explorations, Piti-Salptrire University

Hospital, 3Hematology, Avicenne Hospital, Paris, France
P1968
Garlic (S-allylcysteine) helps in treatment
of neurodegenerative disorders
P1963
A.P. Singh
GDNF-mediated protection of neurons Special Centre for Molecular Medicine, Jawaharlal Nehru
and glial cells from necrosis and University, New Delhi, India
apoptosis induced by photodynamic
treatment P1969
A. Uzdensky1, G. Fedorenko2, M. Komandirov1
Psychiatric presentation of Marchiafava-
1Biophysics, 2Institute for Neurocybernetics, Southern
Federal University, Rostov-on-Don, Russia Bignami disease: a case report with
typical radiologic findings
A. Galiana-Ivars, S. Fernndez-Menndez,
P1964 L. Redondo-Robles, R. Garca-Santiago,
Chronic methylmercury poisoning B. Cabezas-Delamare, A. Ars-Luque, J. Tejada-Garca,
manifesting as progressive myoclonic E. Rodriguez
epilepsy in a Sudanese family Complejo Asistencial Universitario de Len, Spain
M.T. Obeid, W.M. Malik, M. Homeida
Medicine, The University of Medical Science & Technology, P1970
Khartoum, Sudan
Disulfiram neuropathy: a case report
S.M. Vujisic1, Z. Idrizovic2
P1965 1Neurology, Clinical Centre of Montenegro/Medical Faculty

Autonomic nervous system dysfunction University of Montenegro, Podgorica, 2Neurology, General

Hospital of Bijelo Polje, Montenegro
related with exposure to mixed organic
solvents in shoe-makers
S. Kamisli, U. Teker, O. Kamisli, Y. Kablan, C. Ozcan P1971
Neurology, Inonu University, Malatya, Turkey Effect of Nardostachys jatamansi root
extract on haloperidol induced orofacial
P1966 dyskinesia in rats
Metronidazole-induced reversible R.A. Shaik
Pharmacology, Nizam Institute of Pharmacy, Hyderabad,
encephalopathy in a patient with India
facioscapulohumeral muscular dystrophy
A. Papathanasiou1, V. Zouvelou1, S. Kyriazi2,
M. Rentzos1, C. Moshovos1, E. Kanavakis3,
I. Evdokimidis1
1Department of Neurology, Aeginition Hospital, National and

Kapodistrian University of Athens, 2Department of

Radiology, National and Kapodistrian University of Athens,
3Department of Medical Genetics, Medical School, National

University of Athens, Greece

2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457

448 Posters, Sunday 9 September
Sleep disorders
P1972
Mortality and morbidity after sleep
disordered breathing
P. Jennum1, R. Ibsen2, J. Kjellberg3
1Danish Center for Sleep Medicine, Department of Clinical
Neurophysiology, University of Copenhagen, 2University of
Copenhagen, Glostrup Hospital, Glostrup, 3Danish Institute
for Health Services Research, Copenhagen, Denmark
The long-term prognosis of obstructive sleep apnoea (OSA)
and obesity hypoventilation syndrome (OHS), in controlled
settings are incompletely described. Using data from the
Danish National Patient Registry (NPR) (1998-2010),
30,278 individuals with a diagnosis of OSA (23,208 men
and 7,070 women) and 1,562 with a diagnosis of OHS
(1,092 men and 470 women) were identified. Four age-,
sex- and socio-economic-matched citizens were randomly
selected from the Danish Civil Registration System, in total
120,506 and 6,241 controls, respectively. Morbidity and
all-cause mortality was extracted from the NPR. The
10-year survival of treated and untreated patients with OSA
was 90.7% compared to 92.4% among controls and of
patients with OHS 63.9% compared to 85.5% amongst
controls (both: p<0.0001). Commonly significant (p<0.01)
morbidities observed in patients with OSA were related to
respiratory (1.91 (1.82-2.01)), nervous (1.65 (1.55-1.75)),
endocrine, metabolic, nutrietal (1.53 (1.54-1.75)), ENT:
1.39 (1.30-1.49), circulatory: 1.20 (1.16-1.27), muscu
loskeletal: 1.25 (1.20-1.30), digestive illnesses (1.09 (1.03-
1.14)), and injuries 1.12 (10.8-1.16). Mental disease and
neoplasm showed a lower occurrence: 0.90 (0.81-0.99) and
0.85 (0.80-0.95), respectively. OHS showed higher
morbidities to respiratory: 4.03 (3,21-5.07), nervous: 3.17
(2.43-4.15), endocrine, metabolic and nutrietal (4.65 (3.67-
5.90)), ENT:1.39 (1.30-1.49), circulatory: 1.84 (1.50-2.26),
musculosceletal: 1.25 (1.20-1.30) and digestive illnesses
(1.09 (1.03-1.14), and injuries 1.12 (10.8-1.16). Neoplasm
occurred less often: 0.70 (0.50-0.97). CPAP reduced
mortality in OSA but not in OHS patients due to major
co-morbidities. CPAP treated pts however showed
significantly higher co-morbidity. OSA and especially OHS
present significant morbidity and mortality. CPAP reduced
the excess mortality in OSA.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1973
Quality of life in patients with restless
legs syndrome; comparison of the
influence of pain versus poor sleep quality
Y.W. Cho1, H.-J. Moon1, K.Y. Jung2, W.C. Shin3
1Neurology, Keimyung University Dongsan Medical Center,
Daegu, 2Neurology, Korea University College of Medicine,
3Neurology, Kyung Hee University School of Medicine,
Seoul, Republic of Korea
Background: The patients with restless legs syndrome
(RLS) had a lower quality of life (QOL) than normal
controls. However, it is debatable which affects their QOL
more, disturbing pain or poor sleep quality. We studied the
QOL of patients with RLS and compared it to patients with
osteo-arthritis (OA) who were having similar leg discomfort.
Methods: In total, the scores of the 153 RLS patients were
compared with the scores of 153 OA patients. All subjects
completed the questionnaires, including the Korean versions
of the PSQI and SF-36, the Short-form McGill Pain
Questionnaire and VAS for their pain quantification. We
analyzed the related factors in the QOL of RLS patients
through Pearson Correlations.
Results: The patients with RLS had a higher QOL than
patients with OA, though, there were no significant
differences in pain scores between the patients with RLS
and those with OA and the subjects with RLS even had
worse sleep quality than those with OA (p<0.001).
The SF-36 Qol of RLS patients showed a significantly
negative correlation with the severity of RLS symptoms
(r=-0.472, p<0.001), the severity of depression (r=-0.569,
p<0.001), pain severity (VAS) (r=-0.394, p<0.001), and
sleep quality (r=-0.290, p<0.001). Step-wise multiple
regressions identified several factors related to SF-36 QoL:
RLS symptom severity (=-0.813, p<0.001), depression
(=-0.598, p<0.001), and female gender (=-11.983,
p<0.001).
Conclusions: We found that poor sleep quality related less
than pain severity to diminished QOL in patients with RLS.

P1974
Dynamical structure of NREM sleep
disclosed by non-linear analysis
techniques
L. Sellitti1,2,
L. Priano1, M. Bigoni1, F. Saccomandi3,
C. Guiot4, A. Mauro1,2
1Dipartimento di Neuroscienze, IRCCS Istituto Auxologico
Italiano, Universit degli Studi di Torino, Ospedale San
Giuseppe, Verbania, 2Dipartimento di Neuroscienze,
Universit degli Studi di Torino, Ospedale Molinette,
3Dipartimento di Neuroscienze, Universit di Torino, INRIM,
4Dip di Matematica Giuseppe Peano, Universit di
Torino, Italy
Introduction: Sleep is a dynamic process whose
macrostructure may be considered the result of graduations
of transient EEG activities defining the microstructure of
sleep. Among EEG activities, peculiar transient
synchronized EEG patterns (TSEP) are supposed to play a
role in organization and stabilization of NREM sleep.
Materials and methods: Sleep recordings from 10 healthy
subjects (5 males, 5 females; mean age 28.54.8 years;
normal BMI), after an adaptation night, underwent a full-
night polysomnography in the sleep laboratory. Rough data
of all EEG signals were exported into a MATLAB program
specifically written to detect TSEP onsets, and then verified
by visual inspection. The time series of TSEP sequences
were analysed according to the Recurrence Quantification
Analysis (RQA) and Recurrence Plot (RP), non-linear
analysis techniques suitable to disclose deterministic
patterns in complex and apparently chaotic behaviours.
Results: RP and RQA evidence the presence of attractors of
different "strength" towards stable sleep. TSEP form a
deterministic pseudo-periodic series with an oscillating
period which becomes progressively shorter and finally
stabilizes its recurrence rate (attractor) until steady slow
wave sleep (SWS) is reached. Both several seconds before
REM sleep onset and during the last sleep cycles of the
night, the system becomes unstable and inter-TSEP intervals
exhibit higher variability.
Discussion: We conclude that this approach is a suitable
method to describe and quantify the deterministic
neurophysiological processes during the building up of
NREM sleep, so that it may become a novel method to
detect subtle or otherwise unrecognizable conditions of
disturbed sleep.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 449
P1975
Characterizing sleep disorders in geriatric
populations
P. Seibert1,2, J. Valerio2, Y. Rafla2, F. Grimsley3,
C. Zimmerman3
1Physician Research Services, Saint Alphonsus Regional
Medical Center, 2Boise State University, 3Saint Alphonsus
Regional Medical Center, Boise, ID, USA
Sleep disorders (SD) affect approximately one-third of the
world population. The presence of SDs occurs at all ages
although the presentation and subsequent consequences for
an individuals health change in accordance with the natural
aging process. Currently, evaluation of SD is inadequate
across all age ranges as it is compromised by under reporting
and by relying on self-report rather than professional sleep
studies (i.e., nocturnal polysomnography (NP) and multiple
sleep latency tests (MSLT)). Moreover, there is a paucity of
data specific to older adults. We constructed a 111-item
questionnaire to use in conjunction with NP, MSLT, the
Epworth Sleepiness Scale (ESS), and medical chart reviews
of people referred for evaluation of SDs. We categorized
participants into two broad age groups: adult (age 19-65)
and geriatric (66-90) to illuminate a characterization of the
geriatric population. Data analysis from 682 people who
were diagnosed with SD was compared for two groups:
Adults (n=541mean age 46.22; 295 male; 246 female) and
Geriatric (n=141; mean age 71.59; 83 male; 58 female)
revealed a striking pattern of differences between the two
groups. For example, the geriatric group had significantly
greater prevalence of diagnoses of periodic limb movement,
poor sleep efficiency, hypersomnolence, and restless leg
syndrome, and nocturnal hypoxemia. Analysis also
indicated numerous mental and physical health differences
- many of which were unexpected based upon existing
literature. This investigation provides a characterization of
SD to enhance treatment approaches for geriatric
populations rather than relying on assumptions of a general
adult SD model.
450 Posters, Sunday 9 September
P1976
Obstructive sleep apnoea-hypopnoea and
acceptance of nasal CPAP in Korean
ischemic stroke patients
Y.J. Lee
Neurology, Asan Medical Center, Ulsan University College
of Medicine, Seoul, Republic of Korea
Objective: The aims of this study were to investigate the
prevalence of obstructive sleep apnoea-hypopnoea (OSA)
in patients with ischemic stroke and their acceptance rate of
nasal continuous positive airway pressure.
Design and methods: Patients with subacute ischemic
stroke were evaluated for the presence of OSA by portable
polysomnogramme (PSG) or in-lab night PSG. Berlin
questionnaire (BQ) was asked to investigate previous
history of snoring or apnoea. Patients who underwent nasal
CPAP titration for OSA were followed up for CPAP
acceptance.
Results: 94 patients with ischemic stroke were enrolled
(mean age 65.511.4yrs, 58 male). Mean BMI was
23.93.4. 57.1%; and 50% of 59 patients who answered BQ
had a history of persistent snoring and experienced apnoea,
respectively. 87.7% (50/57) of patients with ischemic stroke
who underwent PSG within a month after the onset of
stroke were diagnosed with OSA. The prevalence of mild,
moderate and severe sleep apnoea was 30%, 20%, and 50%,
respectively. Mean AHI was 30.919.5/hr. 18 patients
underwent nasal CPAP titration. 9 agreed to a trial of nasal
CPAP. 6 patients (6/9) continued nasal CPAP use with good
compliance despite of the fact that some of them remained
quadriplegic.
Conclusions: Our study showed that OSA is highly
prevalent in patients with ischemic stroke. High prevalence
of snoring history suggests that OSA might be a pre-existing
condition rather than the result of stroke. Severe neurologic
deficit does not seem to be an obstacle for nasal CPAP use.
Nasal CPAP use should be encouraged in patients with OSA
and ischemic stroke.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1977
Five Kleine-Levin syndrome cases:
a systematic report
R. Frandsen1, S. Gammeltoft2, P. Jennum3
1Danish Center of Sleep Medicine, 2Department of Clinical
Biochemistry, University of Copenhagen, Glostrup Hospital,
3Danish Institute for Health Services Research, Copenhagen
University Hospital, Glostrup, Denmark
Kleine-Levin Syndrome (KLS) is a rare form of episodic
hypersomnia with adolescent onset. About 10 cases are
reported worldwide yearly. The pathophysiology is poorly
understood. We describe five cases of KLS in a concise
form to aid data collection for further studies of this disease.
Methods: Five cases of KLS with clinical symptoms and
findings are presented with additional systematic reviews of
former cases. Hypocretine measurements, Polysomnography
and clinical evaluation.
Results: We succeeded in measuring hypocretin-1 (hcrt-1)
in patient 2 during an attack and patient 3 at the end of an
attack. Hcrt-1 was normal in both patients measured in
relation to the hypersomnia period. Patient 1 had normal
Hcrt-1 in the interval between attacks. Hcrt-1 on the last 2
patients has not been available. PSG results are not similar
to narcolepsy as sleep architecture is normal, and REM
sleep does not seem affected like in narcolepsy.
Conclusion: KLS presents a complex clinical picture. KLS
does not represent a phenotype like narcolepsy or epilepsy.
Hypocretin does not seem to be involved in the
pathophysiology of KLS.

P1978
Positional obstructive sleep apnoea:
prevalence, clinical and
polysomnographic characteristics
R.D. Marques1, T. Rodrigues2, F.G. Stelzer3
1Complexo Hospitalar Santa Casa de Porto Alegre,
2Neurology, Complexo Hospitalar Santa Casa de Porto
Alegre, Porto Alegre, 3Neurology, Complexo Hospitalar
Santa Casa de Porto Alegre, So Leopoldo, Brazil
Introduction: Body position influences the frequency of
apnoeas and hypopnoeas in 50 to 60% of obstructive sleep
apnoea (OSA) patients. This group may be treated in
different ways than non-positional OSA (NP-OSA).
Objective: To estimate prevalence, clinical and
polysomnographic factors related to positional OSA
(P-OSA).
Design: Retrospective analysis of patients undergone
polysomnography, >18 y.o., with OSA [apnoea-hypopnoea
index (AHI) >5/h]. The sample was divided in two groups
according to presence or absence of P-OSA, defined as total
AHI 5/h with reduction >50% in AHI between supine and
non-supine positions and AHI <5/h in non-supine position.
Results: In this sample of 314 individuals, P-OSA was
diagnosed in 25.2%. There was no difference related to
gender, age, daytime sleepiness, and sleep complaints, other
than higher rate of witnessed apnoea in NP-OSA (55.1 vs.
68.9%; p=0.029). BMI (27.14.6 vs. 31.26.1kg/m2;
p<0.0001) was lower in the P-OSA. Allergic rhinitis was
more prevalent in the P-OSA group (43.0 vs. 28.9; p=0.026).
Higher arousal index (29.811.9 vs. 45.719/h; p<0.0001)
and less slow wave sleep (29.214.2 vs. 25.613.5%;
p=0.050), and trend to more N1 stage (4.53.7 vs. 5.44.2%;
p=0.079) were observed in NP-OSA. AHI (17.114.6 vs.
39.122.5/h; p<0.0001) was higher in NP-OSA than in mild
OSA (62% vs. 16%; p<0.0001) predominating in P-OSA
and severe OSA (12.7% vs. 61.3%; p<0.0001) in NP-OSA.
Conclusions: The prevalence of P-OSA in this sample was
25.2%, lower than initially expected. P-OSA patients had
lower BMI and higher prevalence of allergic rhinitis.
NP-OSA patients have more severe OSA than P-OSA.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 451
P1979
Hypertension and OSAS: instrumental-
clinical correlation in a group of patients
from southern Italy
G. Gervasi1,2, I. Aric1, G. Mento1, R. Silvestri1
1Sleep Medicine Center, Messina Medical School, Messina,
2Neurorehabilitation, Centro Cardinal Ferrari, Istituto Santo
Stefano, Fontanellato, Italy
Introduction: Sleep disordered breathing has been
associated with hypertension. Obstructive sleep apnoea
(OSAS) is considered one of the secondary causes of
hypertension. Aim of this study was to evaluate the eventual
correlation between the degree of OSAS and related
hypertensive status.
Methods: We have retrospectively studied 329 patients
referred to our Sleep Medicine Center in Messina (Italy),
who were evaluated for OSAS through Holter-PSG. They
were subdivided into 4 groups according to the Apnoea/
Hypopnoea index (AHI): C (healthy patients), L (mild
OSAS), M (moderate OSAS), S (severe OSAS). Blood
pressure (BP) was detected at baseline in all patients.
Statistical significance was set at p<0.05.
Results: In group S both systolic and diastolic BP values
had a trend toward an increase. Moreover we found a trend
to a positive correlation between AHI and BP values, with
a Spearmans R-value of 0.16 and 0.14 for systolic and
diastolic values respectively. Higher BP values prevailed in
males (81.6%) over females (18.4%). However, no
correlation between AHI, mean nocturnal SaO2, BMI and
age was statistically associated with an increased risk for
hypertension.
Conclusion: Our results confirm a higher prevalence of
hypertension in elderly obese patients with the highest AHI,
especially in male subjects. This male preponderance might
be related to the overall higher prevalence of male patients
in our population, rather than to a real statistical difference
related to AHI. We were able to detect hypertension in
patients with higher AHI despite no clear association of BP
values to the OSAS severity degree.
452 Posters, Sunday 9 September
P1980
Central cholinergic neurotransmitter
system - the role in sleep disorders in
patients with Parkinsons disease
I.V. Krasakov1, I.V. Litvinenko2
1The Center of Extrapyramidal Disorders, The Nikiforov
Russian Center of Emergency and Radiation Medicine,
2Department and Clinic of Neurology, Military Medical
Academy named after S.M. Kirov, Saint Petersburg, Russia
To evaluate the potential of Galantamine therapy for EDS
and RBD in PD patients, we studied 26 patients at the age
of 66.67.8 years old with the 3rd stage of PD having
subjective complaints of sleep disorders. All the patients
were rated with the following scales: MMSE, FAB, PDSS,
ESS. 17 patients of this group underwent a complex
polysomnography (PSG) evaluating the sleep efficacy
(TST/TIB100%), sleep latency (LS); REM cycle was also
studied for behaviour disorders. Galantamine was given in
addition to previous therapy 8mg per day for 4 weeks, then
16mg per day for up to 12 weeks. EDS was revealed in 22
patients (84.5%). In 16 (93%) of 17 patients who had had
PSG done a sleep structure disruption as its fragmentation,
decrease in sleep quality as increasing the wake time during
sleeping and, therefore, reduction of its efficacy were
determined. In 12 weeks of treatment patients showed
reliable decrease in the intensity of daytime sleepiness (ESS
scale results (p=0.0006)), reduction in sleep fragmentation,
sleep quality (improving the PDSS scale results (p=0.0007)),
sleep efficacy (TST/TIB (p=0.0007)). Against background
of the given therapy there were no behaviour disorders in
REM sleep revealed. Improvement in hallucination intensity
was also noticed: PDSS7 (p=0.001) and cognitive disorders
(the MMSE (p=0.001) and FAB (p=0.001) scales).
Galantamine therapy induces a significant decrease in
daytime sleepiness intensity and behaviour disorders in
REM sleep, reduction in sleep fragmentation and
improvement in sleep quality.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1981
Issues of clinical and neurophysiological
diagnostics of narcolepsy with cataplexy
M. Tormaiov, V. Ha, E. Feketeov
Department of Neurology, Medical Faculty of P.J. afrik
University and Louis Pasteur University Hospital, Koice,
Slovak Republic
Introduction: Suggestive anamnesis of imperative
sleepiness with sudden falls is often insufficient to prove
narcolepsy with cataplexy. Diagnosis is supported by
multiple sleep latency test (MSLT), where average sleep
latency is shortened under the 8 minutes and SOREM is
present in at least 2 tests. Because of ambiguous results,
MSLT must be repeated in some cases to definitely confirm
narcolepsy.
Methods: 31 patients suspected of narcolepsy with
cataplexy were examined, which involved: all-night
polysomnography with subsequent MSLT during the next
day, HLA class II typification, MRI of the brain,
psychological as well as psychiatric examination and
laboratory screening of excessive sleepiness in order to
exclude secondary cause of narcolepsy.
Results: According to the medical history, narcolepsy with
cataplexy was presumed in 31 patients. Diagnosis was
confirmed by the first MSLT in 25 subjects (80.6%), and by
repeated MSLT in 4 subjects (12.9%). MSLT was repeated
in those cases, where REM-sleep was not present in at least
2 tests during the first MSLT. Average sleep latency was
shortened under 8 minutes in all patients during the first
MSLT. Diagnosis was reassessed to depression with
pseudocataplexy in 2 patients (6.5%) after the second
MSLT.
Conclusion: Discrepancy between clinical and
neurophysiological findings in diagnostics of narcolepsy
with cataplexy may appear. This severe diagnosis should be
clearly verified, most likely by the repeated MSLT, in case
that examination of CSL hypocretin level is not available.
Depression was the most common condition imitating the
symptoms of narcolepsy.

P1982
Decreased sleep spindle density in
patients with idiopathic REM sleep
behaviour disorder and patients with
Parkinsons disease
J.A.E. Christensen1, P. Jennum2, J. Kempfner1,
M. Zoetmulder3, H. Leonthin4, L. Arvastson5,
S.R. Christensen6, H.B.D. Srensen1
1DTU Electrical Engineering, Technical University of
Denmark, Lyngby, 2Danish Center for Sleep Medicine,
Department of Clinical Neurophysiology, University of
Copenhagen, Glostrup University Hospital, Glostrup,
3Department of Neurology, Bispebjerg Hospital,
Copenhagen, 4Department of Clinical Neurophysiology,
Glostrup University Hospital, Glostrup, 5Biostatistics,
6Clinical Pharmacology, H. Lundbeck A/S, DK- Valby,
Denmark
Introduction: The objective of this study is to determine
whether sleep spindles (SS) hold the potential of being a
biomarker for Parkinsons disease (PD).
Methods: 12 PD patients with rapid-eye movement (REM)
Sleep Behaviour Disorder (PD+RBD), 8 PD patients
without RBD (PD-RBD), 10 idiopathic RBD (iRBD)
patients and 13 age-matched controls underwent
polysomnography (PSG). SS were scored in an extract of
data from control subjects. An automatic SS detector using
Matching Pursuit (MP) and Support Vector Machine (SVM)
was developed and applied to the PSG recordings. The SS
densities in N1, N2, N3, all non-REM (NREM) combined
and REM sleep were obtained and evaluated across the
groups.
Results: The SS detector reached a sensitivity of 84.7% and
a specificity of 84.5%. On a significance level of =5%, the
PD+RBD patients had significantly lowered SS density
compared to the control group in N2, N3 and all NREM.
PD-RBD patients had significantly lowered SS density in
N2 and in all NREM. The iRBD patients had significantly
lowered SS density in all NREM stages combined. At a
significance level of =10%, iRBD had significantly
lowered SS density in N2 and N3.
Conclusion: This study suggests that the SS density has
potential of being a biomarker of PD.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 453
P1983
Sleep disorders and risk of stroke in the
general male population aged 25-64 in
Russia (the MONICA-psychosocial
study)
V. Gafarov1,2, E. Gromova1,2, A. Gafarova1,2, I. Gagulin1,2
Collaborative Laboratory of Epidemiology of
1
Cardiovascular Diseases SB RAMS, 2Institute of Internal
Medicine SB RAMS, Novosibirsk, Russia
The aim of research: To examine associations between
sleep disorders and risk of stroke in the general male
population aged 25-64.
Materials and methods: Within the framework of WHO
program MONICA-psychosocial in 1994 random
representative sample of men at the age 25-64 years,
residents in one of the Novosibirsk (Russia) districts were
investigated. The volume of sample was 657 men. Sleep
disorders have been studied by methodic MOPSY. During
the follow up period of 10 years (1995-2004) all first
incidents of stroke were investigated in the cohort. Cox
proportional regression model was used for the estimation
of relative risk.
Results: The relative risk of stroke during a follow-up
period of 5 years in subjects estimating their sleep as "bad"
or unsatisfactory was 3.9 (p<0.01) times higher than in
men estimating their sleep as good. During the follow-up
period of 10 years risk of stroke was 2.72 (p<0.05) times
higher among men estimating their sleep as bad or
unsatisfactory. The relative risk of stroke development
has increased in the group of men having sleep disorders at
the age of 55-64 years and was 8 (p<0.01) times higher than
in men estimating their sleep as satisfactory. Risk of
stroke was higher among men who had sleep disorders with
incomplete secondary-primary education in groups of
heavy-working and average-working men, among
pensioners, among divorced and widowed persons.
Conclusion: The received results show that risk of stroke is
associated with sleep disorders in male population aged
25-64.
454 Posters, Sunday 9 September
P1984
Sleep-related eating disorder secondary
to zolpidem
H. Nzwalo1, R. Peralta2, C. Bentes2
1Neurology, Faro Hospital EPE, Faro, 2Neurology, Santa
Maria Hospital, Lisboa, Portugal
Introduction and methods: Sleep-related eating disorder
(SRED) is characterized by eating episodes in the first
period of the night, accompanied by partial loss of
consciousness, and amnesia. Although considered
idiopathic, some drugs can induce SRED. We report a
video-supported case of zolpidem induced SRED.
Results: A 53-year-old woman came to consultation
because of episodes of eating, drinking, cooking, during
nocturnal sleep time with subsequent amnesia. She was
taking zolpidem for insomnia over 5 years. The history of
neurological, psychiatric, and daytime eating disorder was
negative. She reported awaking with plates and utensils in
her bed. She complained of morning nausea, anorexia,
fatigue, and gaining 6kg over the last year. Her sleep time
was regular. Her Epworth was 9. A home video showed one
episode. The EEG was normal. One episode of eating on
stage N1 of sleep was recorded in the polysomnography.
Her sleep was instable, fragmented, with frequent phase
changes, and excessive arousal index. There was no other
abnormal sleep phenomenon, apart from slightly increased
respiratory index disturbance (RDI - 14.7). Zolpidem was
stopped and the night eating episodes ceased. No abnormal
phenomenon was noted in the control polysomnography six
months later. The sleep structure improved including the
RDI (11.6). She lost 5kg.
Conclusion: There are rare cases of zolpidem induced
SRED. As a rule, SRED usually exists for longer time
before being diagnosed. Clinicians should actively ask
about symptoms suggestive of SRED to avoid the potential
deleterious consequences of this sleep disorder.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1985
Excessive daytime sleepiness (EDS):
clinical and polysomnographic findings
and relation to obstructive sleep apnoea
syndrome (OSA)
F.G. Stelzer1, T. Rodrigues1, R.D. Marques2
1Neurology, 2Pneumology, Complexo Hospitalar Santa Casa
de Porto Alegre, Brazil
Introduction: EDS is a major health issue for modern
society and it is a common complaint associated to OSA.
Objectives: To estimate clinical and polysomnographic
characteristics of EDS and the association between EDS
and OSA.
Design: In a sample of consecutive individuals that
underwent polysomnography (PSG), >18 y.o., we analysed
clinical and PSG data related to EDS (Epworth Sleepiness
Scale (ESS) score 10).
Results: In this 719 individuals sample, 53.6% had EDS.
These patients had over weight (8820 vs. 8219kg;
p<0.0001) and BMI (30.56.1 vs. 29.56.6kg/m 2;
p<0.0001). Men had more EDS (61.7% vs. 38.3%;
p=0.018). There was no difference related to age, race,
number of nocturnal sleep hours, caffeine consumption.
EDS individuals complaint more often of witnessed apnoea
(64.0 vs. 52.3%; p=0.002); memory (63.9 vs. 47.1%;
p<0.0001) and attention deficit (57.4 vs. 47.1%; p=0.006);
morning headache (39.1 vs. 28.3%; p=0.003); sexual
dysfunction (31.0 vs. 19.3%; p=0.008). EDS patients smoke
more (15.4 vs. 10.1%; p=0.040). Sleep latency was lower
(13.212.3 vs. 20.432.3min; p<0.0001) and sleep
efficiency was higher (86.710.6 vs. 83.712.1%;
p<0.0001) in the EDS group. Sleep was more fragmented in
EDS patients (arousal index: 39.821.1 vs. 36.118.7/h;
p=0.013). There was no association between OSA and EDS,
but there was a trend towards EDS in severe OSA (42.8 vs.
36%; p=0.075).
Conclusions: Men, obese and non-smokers had more EDS
in this sample. There was no significant association between
OSA and EDS. EDS patients have lower sleep latency,
higher sleep efficiency, and more sleep fragmentation.

P1986
Achondroplasia with obstructive sleep
apnoea successfully treated with nasal
CPAP therapy
K.H. Noh, S.J. Hwang, K.P. Park, J.W. Cho
Pusan National University Yangsan Hospital, Yangsan,
Republic of Korea
Case report: Achondroplasia is the most common skeletal
dysplasia in children. The patients usually have a short
cranial face, midface hypoplasia, small upper airway, which
might lead to sleep-related respiratory disturbance. We
describe a case with achondroplasia whose severe
obstructive sleep apnoea was successfully treated with nasal
CPAP (Continuous Positive Airway Pressure) therapy. A
7-year-old girl presented with snoring and sleep disturbance.
She could not sleep nearly every day due to severe
respiratory disturbance, therefore she always felt sleepy and
tired during the daytime. Her Epworth Sleepiness Scale
score was 11. She has been diagnosed as achondroplasia
several years ago. The patients height was 97 centimetre,
and she weighted 24kg. Her neck X-ray and CT showed
adenoid hyperplasia, bilateral flat condyle and narrow
foramen magnum. Split night polysomnography result
revealed severe obstructive sleep apnoea and severe snoring
with high Apnoea Hypopnoea Index (AHI) 177.8 per hour.
There was no central type apnoea. Arousal index, mostly
caused by apnoea or hypopnoea, was 178.3 per hour. There
was only stage 1 sleep and waking state on hypnogram.
Nasal CPAP therapy began at 3 oclock in the morning,
which gradually decreased apnoea and snoring. Finally,
CPAP at pressure 12mmHg dramatically eliminated apnoea
and snoring, and slow wave sleep appeared on hypnogram.
Nasal CPAP therapy is very effective with marked clinical
improvement to severe obstructive type sleep apnoea of
achondroplasia patients. CPAP therapy should be considered
regardless of adenotonsillectomy.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 455
P1987
Catathrenia - a rare but treatable
parasomnia
D. Neutel, R. Peralta, C. Bentes
Hospital de Santa Maria, CHLN, Lisbon, Portugal
Introduction: Catathrenia is a rare parasomnia that occurs
most frequently during REM sleep and consists of apnoea
during end-inspiration and expiratory groaning during
sleep. The sleep partners who hear the patient describe a
deep breath, hold breath, and exhale with a groan.
Differential diagnosis is made with other sounds during
sleep, but also with epileptic seizures.
Case report: A 32-year-old male, with a past medical
history of maxillo-facial surgery (reduction of the lower jaw
for prognathism) and epilepsy treated with valproate
1,500mg/day, presented to sleep clinic for a prolonged
groan associated with apnoea, several times a night without
snoring. MRI showed cortical perisylvian malformation -
areas of polymicrogyria in the margins of the insula and in
the central sulcus predominantly on the right. PSG revealed
fragmented and superficial sleep with increased awakenings
and arousals, a predominance of arousals associated with
respiratory effort, especially in REM sleep, RDI 7.95.
Home video identified catathrenia. CPAP was initiated with
symptom resolution.
Discussion: We describe a rare case of an epileptic patient
with catathrenia. The differential diagnosis between the two
diseases is not always easy, but essential since the treatment
with non-invasive ventilation can treat this parasomnia and
adjustment of anti-epileptic therapy is completely
ineffective. Treatment of catathrenia can improve not only
the quality of life of patients but also of their partners.
Although classified as a parasomnia, a good response to
therapies such as CPAP keeps the discussion if catathrenia
is indeed a parasomnia or sleep-disordered breathing.
456 Posters, Sunday 9 September
P1988
Clinical and polysomnographic
characteristics of obstructive sleep
apnoea (OSA) related to its severity
F.G. Stelzer1, T. Rodrigues1, R.D. Marques2
1Neurology, 2Pneumology, Complexo Hospitalar Santa Casa
de Porto Alegre, Brazil
Introduction: OSA is a very common chronic disease in
adult population. Its manifestations and treatment vary
according to severity.
Objectives: To estimate clinical and polysomnographic
factors associated to OSA severity.
Design: Retrospective study, included all patients (>18yo),
with apnoea-hypopnoea index (AHI) >5/h, submitted to
polysomnograpy. OSA was classified in mild, moderate,
and severe.
Results: In 630 patient sample, 29.3% had mild OSA;
25.2% moderate OSA, 45.6% severe OSA. Severe OSA
patients were older (47.913.3 vs. 5312.7 vs. 54.313.6
y.o.; p<0.0001), their BMI is higher (28.75.6 vs. 28.75.0
vs. 32.26.8kg/m2; p<0.0001). Mild OSA predominated in
women (46.5 vs. 37.5 vs. 35.9%; p=0.020). Severe OSA
patients complain more of witnessed apnoea, mouth
breathing and nocturia and less of morning headache.
Prevalence of hypertension was higher in severe OSA (33.5
vs. 36.9 vs. 50.5%; p<0.001). Sleep efficiency was lower
(85.911.6 vs. 85.413.3 vs. 83.811.3%; p=0.048) in
severe OSA. These patients have more N1 (4.64.1 vs.
4.94.1 vs. 6.25.2%; p<0.0001) and N2 stage (49.512.2
vs. 49.910.8 vs. 59.813.2%; p<0.0001) and less N3
(30.012.3 vs. 28.511.2 vs. 20.012.6%; p<0.0001) and
REM sleep (166.2 vs. 16.46.0 vs. 13.86.2%; p<0.0001).
Sleep was more fragmented in severe OSA patients (arousal
index=25.28.3 vs. 31.37.7 vs. 56.218.1/h; p<0.0001).
Oxygen saturation was lower in severe OSA (mean
SpO2=94.81.8 vs. 94.51.7 vs. 92.33.2%; p<0.0001).
Conclusions: Mild OSA predominates in women. Severe
OSA patients are more obese and older. Their sleep is more
fragmented, they have less slow wave and REM sleep, and
lower oxygen saturation during sleep.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
P1989
Subjective sleepiness in relation to other
sleep complaints and quantified excessive
daytime sleepiness in patients with
epilepsy
S. Khachatryan1,2, T. Stepanyan3, L. Ghahramanyan4,
I. Shadyan3, H. Amroyan3, Y. Tunyan1
1Postgraduate Department of Neurology, Yerevan State
Medical University after Mkhitar Heratsi, 2Somnus Sleep
and Movement Disorders Clinic, 3Armenian Republic
Epilepsy Center Erebouni, 4Clinical Psychology Master
Program, Department of Social Psychology, Yerevan State
University, Yerevan, Armenia
Aim: To evaluate relationship of subjective sleepiness
complaint with sleep-disordered breathing (SDB) and
insomnia complaints and measured excessive daytime
sleepiness (EDS) in patients with epilepsy.
Methods: Patients with proven diagnosis of epilepsy
attending the Armenian Republic Epilepsy Center
Erebouni were interviewed by trained staff for complaints
of sleepiness, sleep-disordered breathing and insomnia.
Epworth Sleepiness Scale (ESS) was used for assessment of
EDS. ESS score of 9 and above has been considered a cut-
off for presence of EDS in this study. Patients were in stable
condition regarding seizure frequency, with no recent
change in medication. Proportional analysis was used for
statistics.
Results: 48 patients with all-cause epilepsy aged 17-64
years participated in the study (mean age - 36.9 years), of
which 16 (34%) were females. 25 (53.2%) of all patients
had sleepiness complaint, 22 (46.8%) had SDB complaint
and insomnia was noted by 25 (53.2%). Of patients
presenting with sleepiness complaint, only 8 (36%) had
ESS score 9 and above suggestive for EDS. 12 patients
(48%) with sleepiness noted SDB and 16 (64%) of them had
insomnia complaint. SDB accompanied insomnia in 14
patients (63.6%). Mean ESS score in non-sleepy patients
was 3, in the sleepy 5.7 (p<0.03).
Conclusion: The results of our study show that different
sleep complaints are prevalent among patients with epilepsy.
They present mostly as sleepiness and insomnia in this
population. EDS seems more to be connected to disrupted
sleep and insomnia than to SDB. Sleepy patients had also
higher ESS scores.

P1990
Augmentation of restless legs syndrome
with pregabalin treatment: a case report
S. Korkmaz1, T. Bileceoglu2, M. Aksu3
1Neurology Department, Ordu University Medical Faculty,
Ordu, 2Neurology Department, Etlik Residency Education
and Research Hospital, Ankara, 3Neurology Department,
Erciyes University Medical Faculty, Kayseri, Turkey
Introduction: Augmentation is described as RLS symptoms
becoming more severe, occurring earlier and spreading to
previously unaffected body areas compared to before
treatment. Pregabalin is a treatment option of RLS and
presence of augmentation due to pregabalin has not been
reported in the literature until now.
Case report: A 30-year-old female patient admitted with
tingling and burning complaints in both legs for two years.
These complaints occurred during resting and at night and
relieved by leg movement completely or partially. The
patient was diagnosed RLS regarding to clinical findings;
then pregabalin was administered for RLS treatment. At the
beginning of therapy, patients symptoms were highly
improved. At the third month of RLS treatment, the patient
reported the reoccurrence of symptoms like initiation of
treatment. At this time, complaints were more severe and
beginning earlier at daytime, being less alleviated by legs
movement and involved not only legs but also arms. Firstly,
this condition was thought to be RLS progression, and dose
of pregabalin was increased, but worsening of symptoms
was observed by increasing the dose of pregabalin.
Secondly, the dose of pregabalin was decreased and high
relief in symptoms was observed. The condition was
diagnosed as RLS augmentation due to pregabalin
treatment.
Conclusion: This case is the first RLS augmentation due to
pregabalin usage. Pathophysiology of both RLS and RLS
augmentation are uncertain with the idea that dopaminergic
mechanism is the essential pathology. However, occurrence
of augmentation due to pregabalin that has not a known
relationship with the dopaminergic system is very
interesting.
2012 EFNS European Journal of Neurology 19 (Suppl. 1), 90457
Posters, Sunday 9 September 457
P1991
Pathological internet use and risk of sleep
disorder incidence among adolescents
E. Masoudnia
Social Sciences, Yazd Uni, Yazd, Iran
P1992
New perspectives in the treatment of
insomnia
A. Tiugan1, C. Tiugan2
1Psychiatry, University of Medicine and Pharmacy,
2Psychiatry, Emergency Clinical Military Hospital Craiova,
Romania
P1993
Sleep disorders in patients with chronic
cerebral ischemia
N. Belova1, L. Belova1, Y. Nikitin2, V. Mashin1,
V. Abramova1, O. Kolotik-Kameneva1, A. Byirina1
Medical Faculty, Ulyanovsk State University, Ulyanovsk,
1
Scientific Center for Neurology, Russian Academy of
2
Medical Science (RAMS), Moscow, Russia
P1994
Restless leg syndrome can get relief with
orgasm: a case study with review of
literature
R. Bala, Electrophysiology and Sleep Lab Team
Medical Universityshakti Neuroscience, Hisar, India