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European Journal of Neurology 2012, 19 (Suppl.

1), 90457

Poster Session 1, Sunday 9 September

Ageing and dementia 1


P1002
P1001 Added diagnostic value of 11C-PiB-PET in
Surrogate decision and advance memory clinic patients with uncertain
directives authorization to diagnosis
institutionalization and spontaneous K.S. Frederiksen1, S.G. Hasselbalch1,2, A.-M. Hejl1,
refusal of cardio-pulmonary resuscitation I. Law3, G. Waldemar1
Memory Disorders Research Group, Dept. of Neurology,
1
in dementia: a Brazilian perspective Neurobiology Research Unit, 3Nuclear Medicine and PET,
2
Y. Correa-Neto1,2, G. Rego2, R. Nunes2 Copenhagen University Hospital, Rigshospitalet,
1Neurology Unit, Federal University of Santa Catarina,
Copenhagen, Denmark
Florianopolis, Brazil, 2Bioethics, University of Porto,
Introduction: PIB-PET imaging measures beta-amyloid,
Portugal
and may be an important diagnostic tool. We examined the
Introduction: Institutionalization and cardio-pulmonary added value of PiB-PET in patients from a memory clinic
resuscitation (CPR) authorization are substantial end of life with uncertain clinical diagnosis with regards to diagnostic
decisions in demented patients with geographical variation. classification and confidence in diagnosis.
Objectives: To assess family caregivers and non-caregivers Methods: Patients who underwent a PiB-PET study as part
attitudes concerning institutionalization and cardio- of their diagnostic work-up were eligible for inclusion. The
pulmonary resuscitation authorization to patients and to standard diagnostic evaluation included physical and
them if hypothetically later demented. neurological examination, cognitive and functional
Patients and methods: Family caregivers of 40 consecutive assessment and a cranial CT or MRI. Additionally, most
patients with Alzheimers disease assisted at an outpatient patients had an 18F-FDG-PET and cerebrospinal fluid
private practice clinic in Florianpolis, Brazil, and 40 sampling. Based on anonymized case reports, three
subjects without demented family members (non-caregivers) experienced clinicians reached a consensus diagnosis and
were enrolled. After written informed consent, subjects rated confidence in diagnosis before and after disclosure of
received a questionnaire consisting of authorizations PiB-PET ratings.
requests to institutionalization and CPR of demented Results: 57 patients (Gender, f/m: 27/30; Age: mean 65.7
patients (surrogate decision) and to themselves (advanced years (range 44.2-82.6); MMSE: mean 24.4 (range 13-29))
directive) if they hypothetically became demented later in were included. 27 had a positive PiB scan. 16 patients were
life. initially given a clinical AD diagnosis (87.5% PiB positive).
Results: The lower institutionalization authorization rate 13 patients (23%) were diagnostically reclassified after
was observed on family caregivers early dementia stages PiB-PET results were disclosed and clinicians overall
surrogate decisions (3%) and the greater on same group late confidence in their diagnosis increased in 28 cases (49%)
stages advance directives (87.9%). Institutionalization and remained unchanged in 27 cases (47%). Moreover,
authorization was overall greater on late versus early stages there was an increase in the number of patients rated as
and on advanced directives versus surrogate decisions. No clear AD (0% to 31.6%) and clear non-AD (12.3% to
differences were observed between family caregivers and 45.6%).
non-caregivers. The lower spontaneous CPR refusal rate Conclusion: Amyloid imaging may have a significant
was observed on family caregivers early dementia stages impact on the diagnostic classification of patients with
surrogate decisions (3%) and the greater on same group late uncertain diagnosis in a memory clinic as indicated by the
stages advance directives (42.4%). Spontaneous CPR number of reclassifications. Increased confidence in
refusal rate was overall greater on late versus early stages, diagnosis may lead to more aggressive treatment.
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
Posters, Sunday 9 September 91

P1003 P1004
Cell therapy with NGF in patients with Subjective cognitive impairment: who are
Alzheimers disease: changes in CSF these individuals? A review of patients
cholinergic markers receiving a diagnosis of subjective
A. Karami1, H. Eyjlfsdttir1,2, S. Vijayaraghavan1, cognitive complaints in ordinary clinical
A. Kadir1, B. Linderoth3,4, G. Lind3,4, N. Andreasen1,2, practice
A. Wall5, . Seiger1,6, P. Almqvist3,4, L. Wahlberg1,7, S. Garcia-Ptacek1,2, L. Cavallin3,4, I. Kreholt5,
A. Nordberg1,2, T. Darreh-Shori1, M. Eriksdotter1,2 M. Kramberger1,6, B. Winblad1,7, V. Jelic1,7,
1Dept Neurobiology, Caring Sciences and Society,
M. Eriksdotter1,7
Karolinska Institutet, 2Dept Geriatric Medicine, 3Dept 1Department of Neurobiology, Care Sciences and Society,
Clinical Neuroscience, Karolinska Institutet, 4Dept Karolinska Institutet, Stockholm, Sweden, 2Department of
Neurosurgery, Karolinska University Hospital, Stockholm,
5Dept of Radiology, Oncology and Radiation Sciences,
Neurology, Hospital Clnico San Carlos, Madrid, Spain,
3Department of Clinical Science, Intervention and
Uppsala, 6Stockholms Sjukhem, Stockholm, Sweden, 7NsGene Technology, Karolinska Institutet, 4Department of Radiology,
A/S, Ballerup, Denmark Karolinska University Hospital-Karolinska Institutet,
Background: Nerve growth factor (NGF) improves Stockholm University, 5Aging Research Center, Karolinska
cholinergic functions, important for cognition. Recently we Institutet and Stockholm University, Stockholm, Sweden,
have demonstrated that the acetylcholine synthesizing 6Department of Neurology, University Medical Centre

enzyme, choline acetyltransferase (ChAT) is present in Ljubljana, Slovenia, 7Department of Geriatric Medicine,
human cerebrospinal fluid (CSF). Karolinska University Hospital-Karolinska Institutet,
Objectives: To investigate whether NGF treatment affects Stockholm University, Stockholm, Sweden
the levels of cholinergic markers, ChAT and Background: Subjective cognitive impairment (SCI),
acetylcholinesterase (AChE) in CSF of patients with defined as cognitive complaints with normal cognitive
Alzheimers disease (AD). testing, is common in clinical practice. Longitudinal studies
Patients and methods: Samples from 6 AD patients were demonstrate increased risk of decline. We analyze this
included. The patients had received treatment with groups characteristics at the time of diagnosis.
encapsulated NGF releasing cells, implanted bilaterally in Patients and methods: SCIs diagnosed at Karolinska
the lateral basal forebrain in all 6 patients, and also in the Memory Clinic (2007-2009). Review of epidemiological,
medial basal forebrain in 3 of the patients. The levels of clinical and paraclinical data, including CSF analysis and
ChAT and AChE in CSF were determined by colorimetric temporal atrophy staging by a blinded rater. SCI, MCI and
assays prior to and after 3 and 12 months of NGF treatment. AD group means were compared with logistic regression.
Results: CSF AChE activity was increased by 18% and by Results: 453 SCI patients were identified. SCIs were
37% after 3 and 12 months of NGF treatment. Patients with significantly younger (57.7 years) than the MCI (64.2 years)
double implants had a 31-61% increase, while patients with and AD (70.1 years) groups. 64.2% were women. SCIs had
single implants had a 5-13% non-significant increase. more years of education and were more likely to have family
Patients with no significant cognitive decline over 12 history of dementia than AD or MCI patients. SCIs scored
months (responders) showed a 25% significant increase in higher on MMSE (28.4), RAVLT delayed retention and Rey
CSF ChAT activity. The changes in CSF ChAT activity visual memory than the other groups. 5.7% of SCI were
showed high correlations with cognition, as assessed by homozygote for ApoE4 allele, lower than AD (28.4%).
MMSE (r=0.79, p<0.014) and ADAS-Cog (r=-0.82, Blinded medial temporal lobe score for SCI was 1.0, lower
p<0.009), as well as with nicotine-binding (r=0.941, than MCI or AD. SCIs had higher beta-amyloid (903.7),
p<0.0003) and glucose metabolism (r=0.81, p<0.010), lower total Tau (245.1), lower p-tau (49.5) and were less
assessed by positron emission tomography. likely to have confluent white matter lesions, hypertension,
Conclusion: NGF cell therapy showed increases in the heart disease or treatment with acetyl-salicylic acid. Cornell
cholinergic markers in CSF, suggestive of a positive score of depression was higher in SCI than AD.
treatment outcome, but these findings warrant further Conclusions: SCI is a distinct group. SCIs are more likely
investigation in a larger patient sample. 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.

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


92 Posters, Sunday 9 September

P1005 P1006
Genetic risk score predicting accelerated Effect of Ginkgo biloba on cognitive
progression from mild cognitive function of elderly adults over a 20-year
impairment to Alzheimers disease period
E. Rodrguez-Rodrguez1,2,3, P. Sanchez-Juan1,2,3, H. Amieva, C. Meillon, J.F. Dartigues
J.L. Vazquez-Higuera1,2,3, I. Mateo1,2,3, J. Infante1,2,3, INSERM 897 Epidemiology and Biostatistics, University of
D. Alcolea4,5, S. Cervantes6,7, J. Clarimn4,5, Bordeaux, France
P. Martinez-Lage8, A. Lle4,5, P. Pastor6,7, Introduction: The study assesses the effect of Ginkgo
O. Combarros1,2,3 biloba extract (EGb761) on cognitive function of elderly
1Neurology, Hospital Universitario Marqus de Valdecilla, adults over a 20-year period.
2CIBERNED, 3IFIMAV, Santander, 4Neurology, Hospital Sant Methods: The data are gathered from the prospective
Pau, 5CIBERNED, Barcelona, 6Neurology, Clnica community-based cohort study Paquid. Within the study
Universitaria de Navarra, 7CIBERNED, Pamplona, sample (n=3612), three groups were compared: 589 subjects
8Neurology, Fundacin CITA-Alzheimer, San Sebastian,
reporting use of EGb761 at one of the ten assessment
Spain visits, 149 subjects reporting use of another nootropic drug
Objective: The genetic factors that influence progression of (piracetam) at one of the assessment visits and 2874 subjects
mild cognitive impairment (MCI) to AD remain largely were not reporting use of either EGb761 or piracetam.
unknown. We assessed whether a genetic risk score (GRS), Decline on the MMSE, IST (verbal fluency) and BVRT
based on 8 SNPs previously associated with AD risk in (visual memory) over the 20-year follow-up was analysed
GWA studies, is associated with either risk of conversion or with a mixed linear effects model accounting for numerous
with rapid progression from MCI to AD. confounding variables.
Methods: Among 288 subjects with MCI, follow-up (mean Results: A significant difference in the MMSE score
26.3 months) identified 118 MCI-converters to AD and 170 decline over the 20-year follow-up was observed in the
MCI-non-converters. We genotyped ABCA7rs3764650, EGb761 and piracetam treatment groups compared to the
BIN1rs744373, CD2APrs9296559, CLUrs1113600, neither treatment group in an opposite direction: EGb761
CR1rs1408077, MS4A4Ers670139, MS4A6Ars610932, group declined less rapidly than the neither treatment
and PICALMrs3851179. We calculated for each subject a group (clinically relevant difference of 5 points over the 20
cumulative GRS, defined as the number of AD-associated years), whereas piracetam group declined more. Regarding
risk alleles from our list of 8 SNPs (0-16), with each allele the IST and the BVRT, no difference was observed between
unit multiplied by the OR for that allele as described in the EGb761 group and the neither treatment group,
AlzGene database. Estimates of association between GRS whereas the piracetam group declined more. When
divided into tertiles and rapidity of conversion from MCI to comparing the EGb761 and piracetam groups directly, a
AD were calculated with logistic and Cox regression significantly different decline was observed for the 3 tests.
models. Conclusion: MMSE decline in a non-demented elderly
Results: GRS was not associated with risk of conversion to population is lower in subjects who reported using EGb761
AD. MCI-converters harbouring 6 or more risk alleles than in those who did not. This effect may be a specific
progressed 2-fold more rapidly to AD when compared with medication effect of EGb761, since it is not observed for
those with less than 6 risk alleles. In fact, both MCI- another nootropic medication.
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


Posters, Sunday 9 September 93

P1007 P1008
Diffusion tensor changes according to Altered caudate morphology in
age-at-onset and apolipoprotein E leukoaraiosis is associated with motor
genotype in Alzheimers disease dysfunction in a subset of LADIS
M.-J. Kim1, S.W. Seo2, S.T. Kim3, J.-M. Lee4, D.L. Na2 (leukoaraiosis and disability in the elderly
1Department of Neurology, Seoul National University
study)
Hospital Healthcare System Gangnam Center, 2Department
M.D. Macfarlane1, M. Walterfang2, J.C.L. Looi1,3,
of Neurology, Samsung Medical Center, Sungkyunkwan
G. Spulber3,4, D. Velakoulis2, L.-O. Wahlund3,
University School of Medicine, 3Department of Radiology,
Samsung Medical Center, Sungkyunkwan University School
LADIS Study Group
1Academic Unit of Psychological Medicine, Australian
of Medicine, 4Department of Biomedical Engineering,
National University Medical School, Canberra, ACT,
Hanyang University, Seoul, Republic of Korea 2Melbourne Neuropsychiatry Centre, Melbourne University,
Introduction: Age-at-onset is one of the most important Melbourne, VIC, Australia, 3Department of Neurobiology,
factors that affect clinical course of Alzheimers disease Caring Sciences and Society, Division of Clinical Geriatrics,
(AD), and apolipoprotein E (apoE) genotype may also play Karolinska Institute, Stockholm, Sweden, 4Institute of
an important role in determining the clinical phenotype. We Clinical Medicine, Unit of Neurology, University of Eastern
aimed to investigate the change of white matter integrity Finland, Kuopio, Finland
according to age-at-onset and apoE genotype in AD using Background: Leukoaraiosis is a common finding on MRI
diffusion tensor imaging (DTI). brain scans of the elderly and is associated with cognition,
Methods: DTI was obtained in 72 patients with AD and 66 falls and disability. Frontostriatal neural circuits are
subjects with normal cognition (NC), and apoE genotype hypothesised to be involved, with specific areas of striatal
was available in 48 patients with AD. Multiple regression structures linked to specific cognitive and motor circuits.
analysis was conducted including the interaction of age-at- Objectives: To determine whether morphology of
onset (or current age in the NC group) and group difference neostriatal structures, as components of frontostriatal
as one of the independent variables, and fractional circuits, are correlated with severity of leukoaraiosis and
anisotropy (FA) and mean diffusivity (MD) values as the motor dysfunction.
dependent variables in all subjects. In order to assess the Methods: A representative subset of LADIS (n=66) was
effect of apoE, 48 AD patients whose apoE genotypes were analysed. Shapes of caudate nuclei and putamina were
available were divided into two groups according to e4 determined through standardised manual tracing methods
allele positivity, and each group was analyzed with the NC on MRI brain scans. We assessed relationships between
group using a similar method as above. leukoaraiosis and striatal volume differences, as well as
Results: Without consideration of apoE genotype, younger motor function, measured using the Short Physical
age-at-onset was associated with lower FA and higher MD Performance Battery (SPPB). Analysis was controlled for
in the cingulum and fronto-temporo-parietal association age and intracranial volume (ICV). Shape analysis was
fibres. When the data were analyzed individually in e4 performed using the UNC Spherical Harmonic (SPHARM)
carriers and non-carriers, the carriers showed correlation tools, correcting for age and ICV, for correlations of striatal
between younger age-at-onset and both of the cingulum and shape with SPPB.
association fibres while the non-carriers showed correlation Findings: There was no association between severity of
with only association fibres. leukoaraiosis (Fazekas score) and volumes of striatal
Conclusion: Our results suggest that characteristic structures via ANOVA. On linear regression, smaller
topographical distribution of pathological changes in volumes of the left caudate were associated with lower
patients with AD is determined by not only age-at-onset but SPPB (Beta 0.442, p=0.005). There was no association
also by apoE genotype. 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.

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


94 Posters, Sunday 9 September

P1009 P1010
Dementia drug treatment in clinical Exploration of a composite nano-medical
practice: data on 7570 patients from device for the delivery of neuroprotectant-
SveDem, the Swedish Dementia Registry nanocarriers into targeted neuronal cells
D. Religa1,2, K. Johnell3, M. Eriksdotter1 of Alzheimers disease
1NVS, Karolinska Institutet, Stockholm, Sweden, M.S. Mufamadi1, Y.E. Choonara1, L.C. duToit1,
2Mossakowski Medical Research Centre, Polish Academy of G. Modi2, D. Naidoo3, P. Kumar1, V.M.K. Ndesendo4,
Science, Warszawa, Poland, 3Aging Research Center, L. Meyer5, S.E. Iyuke6, V. Pillay1
Karolinska Institutet and Stockholm University, Stockholm, 1Department of Pharmacy and Pharmacology, 2Department
Sweden of Neurology, 3Department of Neurosurgery, University of
Background: In Alzheimers disease (AD), cholinesterase the Witwatersrand, Johannesburg, South Africa, 4School of
inhibitors and NMDA receptor antagonists, such as Pharmacy and Pharmaceutical Sciences, St. Johns
memantine, are used. Psychotropics are also used for University of Tanzania, Dodoma, Tanzania, 5Central Animal
treatment of neuropsychiatric symptoms. The aim was to Services, 6School of Chemical and Metallurgical
study whether there are differences between dementia Engineering, University of the Witwatersrand, Johannesburg,
disorders in the use of anti-dementia drugs and South Africa
antipsychotics (neuroleptics) in a large population of Purpose: The purpose of this study was to explore an
dementia patients. implantable composite nano-medical device that is capable
Methods: Information about dementia disorders was of prolonged delivery of the neuroprotectant-nanocarrier
obtained from the national Swedish Dementia Registry into targeted neuronal cells of Alzheimers disease (AD).
(SveDem) (n=7,570). Multivariate logistic regression Method: The device was fabricated by embedding
analysis was performed to investigate the association galantamine-loaded/flourescein-isothiocyanate (FITC)-
between dementia disorders and the use of anti-dementia labelled functionalized nanoliposomes [f(x)NLPs]
drugs and antipsychotics, after adjustment for age, sex, [phosphocholine(DSPC), cholesterol, ethanolamine (DSPE-
residential setting, living alone, MMSE score and number mPEG2000)] with synthetic peptide [KVLFLS, KVLFLT
of other drugs (used as a proxy for overall co-morbidity). and KVLFLM] within a neuro-compliant scaffold
Results: More than 80% of the AD and 86% of dementia (glutaraldehyde crosslinked chitosan, Eudragit-RSPO, and
with Lewy bodies (LBD) patients used anti-dementia drugs. polyvinylalcohol or polyethyleneoxide) followed by freeze-
Women were more likely than men to be treated with drying. Drug release from drug-loaded f(x)NLPs was
cholinesterase inhibitors. A higher MMSE score was performed using an orbital shaker-bath (50days) and at
positively associated with use of cholinesterase inhibitors, predetermined time intervals samples were drawn and
but negatively associated with NMDA receptor antagonists analyzed via UV (max=288nm). PC12-cells were seeded
and antipsychotics. The use of antipsychotics in all dementia on the device, ensued by air-drying/freeze-drying. Cells on
patients was 6%, but in LBD, the use of antipsychotics was the device were examined under SEM and stereomicroscopy.
significantly higher (16%), with an adjusted odds ratio of LDH release and antipoliferation were assayed using the
4.2 compared to AD patients. CytoTox-96 Non-Radioactive and CytoTox-Glu
Conclusions: The use of anti-dementia drugs in AD was in Cytotoxicity assays, respectively, thereafter Lactate
agreement with Swedish guidelines. The use of Dehydrogenase (LDH)/dead cells was quantified employing
antipsychotics in patients with LBD was high. LBD patients plate reader. At pre-determined time intervals cell uptake
suffer from psychotic symptoms early in the disease, but the was analyzed for 30 days employing plate reader and
high use of antipsychotics is worrying, taking into CLSM.
consideration side-effects of antipsychotics. 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.

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


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


Posters, Sunday 9 September 97

P1015 P1016
Hippocampal GABAergic interneurons are Encapsulated cell biodelivery of nerve
highly vulnerable in Alzheimers disease growth factor in Alzheimers disease
E. Sanchez-Mejias1, V. Navarro2, R. Sanchez-Varo1, M. Eriksdotter1,2, G. Lind3,4, H. Eyjolfsdottir1,2,
L. Trujillo-Estrada1, M. Aneiros1, S. Jimenez2, B. Linderoth3,4, P. Almqvist3,4, . Seiger1, L. Wahlberg1,5
V. De Castro1, M.L. Vizuete2, J.C. Davila1, J. Vitorica2, 1Dept Neurobiology, Caring Sciences and Society,

A. Gutierrez1 Karolinska Institute, 2Dept Geriatric Medicine, Karolinska


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


98 Posters, Sunday 9 September

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

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


Posters, Sunday 9 September 99

P1019 P1020
Nutritional intervention with Fortasyn Psychometric properties of DQoL in
Connect: beneficial effects in patients with Alzheimers disease and
experimental models of Alzheimers carers
pathology and functional decline M. Gomez-Gallego1, J. Gomez-Garcia2
1Catholic University of Murcia, 2University of Murcia,
N. vanWijk1, M.C. deWilde1, A.A.M. Kuipers1,
M. Balvers1, J. Sijben1, P.J. Kamphuis1,2, H. Koivisto3,4, Murcia, Spain
H. Tanila3,4, D. Jansen5,6, V. Zerbi5,6, A.J. Kiliaan5,6, Introduction: Quality of life is an important outcome
L.M. Broersen1 measure in the assessment of the interventions with
1Nutricia Advanced Medical Nutrition, Danone Research - Alzheimers disease (AD) patients. DQoL is a self-rated
Centre for Specialised Nutrition, Wageningen, 2Utrecht scale that covers the domains of sense of aesthetics, feelings
Institute for Pharmaceutical Sciences (UIPS), Utrecht of belonging, negative effect, positive affect and self-
University, Utrecht, The Netherlands, 3A. I. Virtanen esteem. The aim of this study is to determine the
Institute, University of Eastern Finland, 4Neurology, Kuopio psychometric properties of the Spanish version of DQoL.
University Hospital, Kuopio, Finland, 5Anatomy, 6Cognitive Methods: A sample of 102 AD patients and their 102 carers
Neuroscience, Donders Centre for Neuroscience, RUNMC, were administered DQoL. Internal consistency of both the
Nijmegen, The Netherlands whole scale and the subscales was assessed using alpha
Introduction: The neurotoxic cascade of Abeta initiates at coefficient. Agreement was assessed using the concordance
neuronal membranes and soluble oligomers are thought to correlation coefficient (CCC). Convergent and divergent
disturb membrane properties by binding to membrane validity were assessed by testing the relation between DQoL
components. As such, the precise composition of neuronal scores and both demographic factors and the scores of
membranes influences membrane disrupting properties of Minimental State Examination, Neuropsychiatric Inventory,
Abeta. Moreover, membrane composition directly Geriatric Depression Scale (GDS), Barthel Index, and Zarit
influences APP-processing and the generation of Abeta. The Burden Inventory. Factor analysis was used to test construct
hypothesis that nutritional interventions that positively validity.
affect membrane formation and composition will reduce Results: The internal consistency of DQoL was excellent
Abeta production, toxicity and pathology was tested in a for both patients and carers ratings. However, this was not
series of experiments using rodent models of AD. the case for some subscales (alpha< 0.7). The patient-carer
Methods: Fortasyn Connect (FC) is a nutritional agreement was good (CCC=0.877; accuracy=0.981;
composition containing precursors and cofactors for precision=0.893). Patients and carers DQoL ratings
neuronal membrane synthesis, viz. DHA, EPA, UMP, correlated significantly with GDS scores but were not
choline, folate, vit.B12, vit.B6, phospholipids, vit.C, vit.E, associated with the other clinical and demographic
and selenium. We assessed the effects of dietary enrichment measures. The factorial analyses showed that all 29 items
with FC in the Abeta infusion model, and the APP/PS1 loaded on component 1.
mouse model. Conclusions: Our results indicate that DQoL functions as a
Results: In the Abeta infusion model, dietary FC protected scale with good internal consistency and inter-rater
cholinergic neurons from Abeta-induced toxicity as reliability. The existence of subscales is not clear. DQoL
evidenced by preserved immunoreactivity for the does not relate to other constructs but depression, so it could
membrane-bound enzymes ChAT and VAChT. FC also really measure perceived psychological well-being.
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


100 Posters, Sunday 9 September

P1021 P1022
Borrelia Burgdorferi: risk factor in Cognitive-enhancing activity of thymol
Alzheimers disease and carvacrol in two rat models of
R.P.W. Marquard1, A. Kurz2 dementia
1Psychiatry and Neurology, Klinikum Taufkirchen,
N. Majlessi, Z. Azizi, S. Ebrahimi, E. Saadatfar
Taufkirchen, 2Psychiatrie, TU Mnchen, Germany Department of Physiology and Pharmacology, Pasteur
Introduction: Inflammatory factors are presumably Institute of Iran, Tehran, Iran
involved in Alzheimers disease (AD). We examined if AD Introduction: Alzheimers disease (AD) is known to be the
is related with non-symptomatic borreliosis. most common cause of dementia in elderly patients. The
Method: 100 patients (mean age: 72.9 years) met NINCDS- limitations of current AD therapeutics have prompted
ADRDA diagnostic criteria for probable AD after a investigation into innovative therapeutics over the last two
thorough diagnostic evaluation which comprised a decades. This study evaluated the efficacy of thymol and
neuropsychological exam, blood tests and CT or MRI brain carvacrol against cognitive deficits induced by amyloid
imaging. The age and gender matched control group (72.8 (A) or scopolamine.
years) scored 28 or more points on the Mini Mental State Methods: Rats received bilateral intrahippocampal
and had no family history of dementia. All patients and injections of A (25-35) or intraperitoneal injections of
controls were Caucasian. Lyme ELISA and Western blot scopolamine, and the effect of different doses of thymol, or
test were used to examine serum samples of patients and carvacrol (0.5, 1, or 2mg/kg) on cognitive function was
controls and cerebrospinal fluid of patients with positive determined. Animals were subjected to 5 days of training in
blood test. the Morris water maze: 4 days with an invisible platform to
Results: 28 (28%) of the AD patients but only 8 (8%) of the test spatial learning and the 5th day with a visible platform
controls had Lyme Borreliosis antibodies (IgG) in the serum to test motivation and sensorimotor coordination. The acute
sample, indicating that individuals with Borrelia IgG toxicities of thymol and carvacrol were also studied.
antibodies have an increased risk suffering Alzheimers Results: The results showed increases in escape latency and
disease by 3.5. None of them had intrathecal antibody decreases in target quadrant entries in A or scopolamine-
production as examined in the CSF. treated groups. These impairments were reversed by pre-
Discussion: We found a significantly higher rate of Borrelia training administration of either thymol or carvacrol. The
IgG antibodies in individuals with Alzheimers disease. As calculated LD50s of thymol (565.7mg/kg) and carvacrol
several authors found similarities between the surface of (471.2mg/kg) were found to be much higher than their
Borrelia and neuronal tissue, cross-reactivity of B. therapeutic doses (thymol 0.5 mg/kg, carvacrol 1mg/kg).
burgdorferi antibodies with neuronal tissue or the triggering Conclusion: These findings provide preliminary positive
of a non-specific inflammatory response are possible. evidence for the effectiveness and safety of thymol and
Further research should include investigation of the carvacrol in alleviating cognitive impairments caused by
following questions: increased A levels or cholinergic hypofunction.
1. Is the frequency of Alzheimers disease in individuals Anticholinesterase, antioxidant, and anti-inflammatory
with history of non-symptomatic borrelia IgG antibodies activities may be the mechanisms contributing towards their
increased? beneficial effects in these models.
2. Is there any effect of early antibiotic treatment of Lyme
disease?

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


Posters, Sunday 9 September 101

P1023 P1024
A preliminary study of the association Systemic lipid peroxidation in mild
between Cystatin C gene polymorphism cognitive impairment (MCI) and
and late-onset Alzheimers disease in a Alzheimers disease (AD)
sample from Iran S. Leoncini1, C. DeFelice2, C. Signorini1, A. Pecorelli1,
Z. Azizi1, M. Noroozian2, Z. Kaini-Moghaddam3, T. Durand3, J.-M. Galano3, C. Oger3, V. Bultel-Ponc3,
E. Saadatfar1, N. Majlessi1 A. Guy3, S. Boschi4, L. Ciccoli1, J. Hayek5
1Department of Physiology and Pharmacology, Pasteur 1Department of Pathophysiology, Experimental Medicine &

Institute of Iran, 2Tehran University of Medical Sciences, Public Health, University of Siena, 2Neonatal Intensive Care
3Department of Biotechnology, Pasteur Institute of Iran, Unit, University Hospital Azienda Ospedaliera Universitaria
Tehran, Iran Senese (AOUS), Siena, Italy, 3Institut des Biomolcules Max
Mousseron (IBMM) - UMR 5247 CNRS - UM I - UM II,
Introduction: Alzheimers disease (AD) is the most
Montpellier, France, 4Internal Medicine Unit, 5Child
common age-associated neurodegenerative disease caused
Neuropsychiatry Unit, University Hospital, AOUS, Siena,
by complicated interactions between genetic and
Italy
environmental factors. Structural genomic studies
demonstrated that more than 200 genes might be involved Introduction: Oxidative stress (OS) has been involved in
in AD pathogenesis regulating dysfunctional genetic the pathogenesis of Alzheimers disease (AD) and mild
networks leading to premature neuronal death. Most genes cognitive impairment (MCI). However, it is unclear whether
conferring susceptibility to AD are related to A deposition, OS is a primary or a secondary contributor to the MCI/AD
oxidative stress and inflammatory response. Recent studies phenotype, and whether OS markers in peripheral samples
have shown that the endogenous protein cystatin C binds represent reliable indicators for the presence of
soluble A and inhibits A oligomerization and neurodegenerative disease.
amyloidogenesis, protecting the brain against amyloid- Methods: The study included patients with AD (n=3) and
induced toxicity. Moreover, a decreased cystatin C secretion MCI (n=6). Healthy control subjects (n=8) comparable for
is associated with a polymorphism found in the cystatin C age were also included. Informed consent and Institutional
gene (CST3). Molecular epidemiological studies have Review Board were obtained. Plasma was used for
presented contradictory results concerning a potential role determination of free F2-Isoprostanes (F2-IsoPs),
of CST3 G73A polymorphism in AD. F2-dihomo-isoprostanes (F2-Dihomo-IsoPs),
Methods: In this study, to define a possible association of F4-neuroprostanes (F4-NeuroPs) and non-protein-bound
the G73A polymorphism in CST3 gene with late-onset AD iron (p-NPBI) and erythrocytes were used for determination
(LOAD) in an Iranian population, we conducted a case- of intra-erythrocyte NPBI (IE-NPBI). F2-IsoPs,
control study including a clinically well-defined group of F2-Dihomo-IsoPs, and F4-NeuroPs were measured by gas
61 LOAD patients and 63 age-matched controls. G73A chromatography/negative ion chemical ionization tandem
polymorphism was determined by polymerase chain mass spectrometry method (GC/NICI-MS/MS), while
reaction-restriction fragment length polymorphisms (PCR- IE-NPBI and p-NPBI were determined by HPLC.
PFLP) assay. Results: Levels of IE-NPBI [median (inter-quartile range)]
Results: Chi-square analysis showed a significantly in MCI [1.14 (0.45-1.92) nmol/ml erythrocyte susp.] and
increased number of individuals with the G/A genotype in AD [1.3 (0.92-2.35) nmol/ml] were significantly higher as
AD patients compared with controls (p<0.05). compared to controls [0.67 (0.55-0.75) ] (p=0.031), as well
Conclusions: The results obtained from our study as those of p-NPBI [MCI: 1(0.3-1.07)nmol/ml; AD:
demonstrate an association between G73A polymorphism 0.63(0.52-0.75)nmol/ml; controls: 0.25(0.1-0.4)nmol/ml]
and LOAD in an Iranian sample. However, as the level of (p=0.004). Plasma F2-IsoPs were significantly higher in
significance is low, the G/A genotype seems to have only MCI [53.4(44.4-162.8)pg/ml] and AD [85(54-96)pg/ml]
minor effects in the development of AD or probably interact compared to controls [15.35 (13.4-21.8)] (p=0.032). The
with other risk factors. 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.

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


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


Posters, Sunday 9 September 103

P1027 P1028
Myeloid microvesicles as potential Different cerebrospinal fluid biomarker
biomarkers of disease progression in patterns in dementia patients with
dementia patients cerebrovascular disease and Alzheimers
D. DallaLibera1, F. Agosta2, A. Bergami3, G. Magnani3, disease
V. Martinelli4, G. Comi5, C. Verderio6, M. Filippi4, M. Bjerke1, M. Jonsson1, H. Zetterberg1, K. Blennow1,
R. Furlan7 R. Schmidt2, A. Wallin1
1Neurology, San Raffaele Scientific Institute, 2Neurology, San 1Dep of Psychiatry & Neurochemistry, Inst of Neuroscience
Raffaele Scientific Institute Neuroimaging Research Unit, & Physiology, The Sahlgrenska Academy, University of
3San Raffaele Scientific Institute, 4San Raffaele Scientific
Gothenburg, Sweden, 2Department of Neurology, Division of
Institute Neuroimaging Research Unit, 5Neurology, San Special Neurology, University Clinic of Neurology, Medical
Raffaele Scientific Institute, INSPE, 61CNR Institute of University of Graz, Austria
Neuroscience and Department of Medical Pharmacology,
Introduction: Alzheimers disease (AD) and vascular
Universit di Milano, 7San Raffaele Scientific Institute,
dementia (VaD) are intertwined by mixed dementia (MD)
INSPE, Milano, Italy
harbouring varying degrees of AD pathology in combination
Introduction: Myeloid microvesicles (MMVs) have been with cerebrovascular disease (CVD) with white matter
indicated as important mediators of intercellular lesions (WML). The diseases may be hard to clinically
communication and are emerging as new biomarkers of separate due to the overlapping pathologies. A cerebrospinal
tissue damage. MMVs, shed from reactive microglia, store fluid (CSF) biomarker pattern representative of WML
and release the IL1beta, an inflammatory cytokine increased would aid in the clinical evaluation process and provide
in AD induced by amyloid deposition. Aim of the study was information about disease specific mechanisms.
to evaluate whether MMVs reflecting microglia activation Methods: Study one included 30 controls, 30 AD patients
state- may contribute to early dementia diagnosis and and 26 patients with subcortical WML (9 VaD and 17 MD).
predict disease rate progression. Study two included 46 normal or only slightly cognitively
Methods: We recruited 169 patients from the Neurological impaired individuals of whom all had subcortical WML
Department of San Raffaele Hospital affected by mild assessed by magnetic resonance imaging. Assessment of
cognitive impairment (MCI), probable Alzheimers disease white matter hyperintensity (WMH) volume, atrophy and
(AD) according to Dubois criteria, Frontotemporal diffusion weighted imaging (DWI) of normal appearing and
Dementia (FTD) and other dementia. Myeloid MVs were WMH matter was performed. Proteins measured in both
detected by flow cytometry in the cerebrospinal fluid of studies were total tau (T-tau), hyperphosphorylated tau 181
dementia patients and healthy controls (HC) and were (P-tau181), amyloid b 1-42 (A1-42), neurofilament light
correlated with clinical features, CSF data (Tau, bAmyloid) (NF-L), myelin basic protein (MBP), matrix
and neuroimaging in a longitudinal study of two-year metalloproteinases (MMPs), and tissue inhibitors of
follow-up. metalloproteinases (TIMPs).
Results: AD patients showed a higher amount of MMVs Results: The biomarkers MBP, TIMP-1, NF-L, and MMP-9
than MCI and HC. An increase in MMVs was found in MCI were altered in patients with WML (VaD and MD) and
patients early converting to AD. MMVs correlate with contributed to the separation between CVD and AD
p-tau/bamiloid and with hippocampal atrophy in AD, but (sensitivity 97% and specificity 81% (AUC=0.93)) in
not in MCI. Correlation with other neuroradiological combination with T-tau, P-tau181 and A1-42. MBP, TIMP-
measures (DTI,fMRI) is ongoing. No correlation with 1 and NF-L were related to WMH volume, the latter two to
clinical data (MMSE, CDR, age, sex) was evident. WMH DWI and ventricular atrophy and MMP-9 to
Conclusions: MMVs reflect the course of neuro progression of WMH.
degeneration, thus they may represent a suitable biomarker Conclusion: The finding of different neurochemical
in monitoring disease progression and response to treatment. fingerprints of CVD with WML and pure AD speaks in
favour of different disease mechanisms of the disorders.

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


104 Posters, Sunday 9 September

P1029 P1031
Correlation exploration between executive Quantitative EEG in Alzheimers disease
function impairment and white matter before and after short and long-term
structure in patients with subcortical treatment
ischemic vascular disease A. Medvedeva, T. Vosnesenskaya
Y. Dong, P. Lv, L. Li, J. Wang Neurological Department, First Moscow Medical University,
Department of Neurology, Hebei General Hospital, Moscow, Russia
Shijiazhuang, China Introduction: Alzheimers disease (AD) is involving
Objective: To investigate the correlation between executive cerebral neuronal networks facilitating higher cognitive
function and cerebral white matter structure change by MRI functions.
and diffusion tensor imaging (DTI) in subcortical ischemic Objective: AD is characterized by changes in spectral
cerebrovascular disease (SIVD). power and EEG-coherence, which become stronger with the
Methods: 24 SIVD patients and 14 normal control subjects progression of dementia. The aim was to evaluate spectral
(NC) were evaluated with Stroop colour words test (CWT) power and EEG-coherence in AD group and healthy elderly
and trail making test (TMT) to assess executive function. controls, to find their reactivity in functional tasks before
They were divided into vascular dementia (VaD, n=12) and and after 3 months and 2.7 years of treatment with
vascular cognitive impairment no dementia (VCIND, n=12) galantamin, memantin and their combination, to determine
group. Age-related white matter change rating scale was the correlations between EEG changes, cognitive and
used to measure the WML. Fractional anisotropy (FA) and neuropsychiatric impairments before and after the treatment.
mean diffusivity (MD) of normal- appearing white matter Materials and methods: 22 patients without treatment, 23
(NAWM) were determined in the splenium of corpus patients on long-term treatment with mild and moderate
callosum (SCC), frontal (FL), parietal (PL), temporal (TL) AD, 25 age-matched controls were examined using EEG-
and occipital lobes (OL) by DTI. Correlation analysis was recordings (spectral power and coherence), neuro
used to investigate the relationship between executive psychological investigations and neuropsychiatric inventory
function and the imaging parameters. (NPI).
Results: Results: High level of apathy, depression, emotional
(1) Compared with NC group, the scores of VaD decreased liability was investigated in both AD groups. We have found
in each test and the scores of VCIND decreased in TMT significant increase of slow-wave activity in frontal, central
(p<0.05). and temporal regions, decreased alpha rhythm in the same
(2) The scores of WML were (12.823.57) and (10.502.95) regions in AD group vs. controls (p<0.05). Coherence in
in VaD and VCIND group (p<0.05). MD values of SCC same regions was lower in AD patients vs. controls (p<0.05).
increased in two groups (p<0.05). Decreased FA values of After short and long-term treatment there was decrease of
NAWM on FL, right TL, right OL and PL were demonstrated slow wave activity and increase of alpha band and coherence
in VaD, as well as of left FL and PL in VCIND patients. in the same regions (p<0.05).The combination of galantamin
They were significant compared to NC group (p<0.05) and memantin was more effective than monotherapy
(3) The parameters related with executive function in SIVD (p<0.05).
patients were FA values of NAWM in left FL, right PL, TL Conclusion: EEG changes, cognitive and neuropsychiatric
and MD values of SCC. impairments have positive dynamic on short and long-term
Conclusions: The executive function impairment in SIVD treatment without significant difference. The study revealed
patients could be associated with the degree of WML. significant correlations between increased slow-wave
Microstructural white matter impairment showed by DTI activity, decreased EEG-coherence, low levels of cognitive
might be used for evaluating executive function decline. tests and high level of apathy, depression, emotional
liability.

P1030
Abstract cancelled

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


Posters, Sunday 9 September 105

P1032 P1033
Caregiver preference for rivastigmine Memory performance is related to
patch in the OPtimising Transdermal functional connectivity alterations in
exelon In Mild-to-moderate Alzheimers Alzheimers disease
disease (OPTIMA) Study A. Fukuda, F. Pereira, T. Lopes, E. da Silva, A.C. Coan,
R. Blesa1, P. Martnez-Lage2, A.U. Monsch3, P. Downs4, B. Campos, B. Damasceno, F. Cendes, M.L.F. Balthazar
C. Strohmaier5 UNICAMP, Campinas, Brazil
1Hospital Sta Creu i Sant Pau, Barcelona, 2Department of Introduction: New methods in functional magnetic
Neurology, Center for Research and Advance Therapies, resonance imaging, especially during resting state, may help
Fundacin CITA-Alzheimer, San Sebastian, Spain, to clarify the functional organization of cognitive networks.
3Department of Acute Geriatrics, University Hospital Basel,
While their alterations have been reported in AD, especially
Switzerland, 4Novartis Pharmaceuticals Corporation, East in the Default Mode Network (DMN), their relationship
Hanover, NJ, USA, 5Novartis Pharma AG, Basel, Switzerland with cognitive symptoms remains unclear. In this study, we
Introduction: Caregivers of patients with Alzheimers aimed to verify the relation between DMN connectivity and
disease (AD) are often responsible for the administration memory performance in AD patients.
and management of medications. During the OPTIMA Methods: We studied 20 mild to moderate AD patients.
Study, caregivers took part in a questionnaire to evaluate High-resolution Magnetic Resonance Imaging (MRI) was
perceived treatment compliance, satisfaction and preference. performed using a 3.0T scanner (Philips - Achieva). All
Methods: Patients meeting pre-specified decline criteria patients underwent a 10 minutes task-free functional MRI
during a 24-48-week initial open-label (IOL) phase with (fMRI). We used FSLs Melodic Independent Component
9.5mg/24 h rivastigmine patch, entered a 48-week, Analysis to study fMRI images in order to select each
randomised, double-blind phase (9.5 versus 13.3mg/24h patients DMN. They also underwent a cognitive evaluation,
patch). Caregivers of patients taking oral AD medication including the Rey Auditory Verbal Learning Test (RAVLT).
prior to the study completed the Caregiver Medication We correlated RAVLTs scores (encoding, delayed recall
Questionnaire at baseline and week 24 of the IOL phase. and recognition) with individual maps of DMN connectivity,
The questionnaire focused on medication administration, considering age, education and dementia severity. We also
perceived compliance and satisfaction, and at week 24 only, performed VBM analysis to obtain grey matter maps to
treatment preference (prior oral medication or patch). correct these data for atrophy.
Results: Of 1584 participating AD caregivers, 57.8% were Results: We found significant areas of correlation between
females [mean (SD) age; 64.0 (13.7) years]. Most caregivers DMN functional connectivity and RAVLT encoding and
were a spouse (59.5%) or child (29.7%) of the patient and delayed recall with left precuneus (MNI coordinates: -13,
were living with them (74.7%). Of 882 caregivers of patients -67, 34). We did not find any areas of correlation with
on prior AD treatment, 642 (72.8%; 95% CI 69.7, 75.7) recognition, after correction for atrophy.
stated a preference for rivastigmine patch. Ease-of-use Conclusion: We report the association of changes in DMN
(27.9%) and administration (10.9%) were rated as the top connectivity (atrophy corrected) with episodic amnesia in
two most important reasons. From baseline to week 24, the AD, especially in left precuneus. These findings confirm
number of caregivers reporting that they were never the importance of neurofunctional networks alterations in
concerned that the patient missed taking medication the origin of AD symptoms.
(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


106 Posters, Sunday 9 September

P1034 P1035
Comparing language deficits in mild -Aminobutyric acid type A (GABAA)
cognitive impairment and mild Alzheimers receptor activation modulates tau
disease phosphorylation
E. Tsantali1,2, D. Economidis1, S. Rigopoulou2 N.-P. Nyknen1, K. Kysenius1, P. Sakha1, P. Tammela2,
1Medical School, B Internal Medicine, Geriatric Unit, H. Huttunen1
Aristotle University of Thessaloniki, Hippocration Hospital, 1Neuroscience Center, 2Center for Drug Research, Faculty of
2Neurologic Clinic, Dep. Panagia, Agios Pavlos Hospital,
Pharmacy, University of Helsinki, Finland
Thessaloniki, Greece Introduction: Abnormal phosphorylation and aggregation
Introduction: Alzheimers disease (AD) patients except of of the microtubule-associated protein Tau are hallmarks of
memory loss exhibit naming impairments from mild to various neurodegenerative diseases, such as Alzheimers
moderate stages of the disease, though Mild Cognitive disease (AD). Tau phosphorylation regulates its functions
Impairment (MCI) individuals tend to exhibit greater and is increased in AD. Molecular mechanisms that regulate
impairments in category fluency than on naming tasks. Tau phosphorylation are complex and currently incompletely
Aims: The aims of this study were to: understood. Peptidyl-prolyl cis-trans-isomerase 1 (Pin1) is
1) investigate and compare language abilities of non- a critical regulator of Tau dephosphorylation at several
demented elderly (ND), MCIs (amnestic type) and demented disease-associated proline-directed phosphorylation sites.
participants (AD), Reduced Pin1 activity has been associated with Tau
2) study the diagnostic value of language deficits according hyperphosphorylation in vitro and in vivo.
to the cognitive state of the participants. Methods: We have developed a novel live-cell reporter
Methods: 125 participants, 41 ND, 31 MCI and 53 mild AD system based on protein-fragment complementation assay
patients matched on age and education were recruited (PCA), using split humanized Gaussia princeps luciferase
randomly and administered clinical, laboratory, (hGLuc), to study dynamic changes in Tau phosphorylation
neuropsychological and neuroimaging assessment. status. In this assay, fusion proteins of Tau and Pin1 carrying
Language abilities were assessed by expert complementary fragments of the hGLuc protein serve as a
neuropsychologists using the Greek edition of the Boston sensor of altered protein-protein interaction between Tau
Diagnostic Aphasia Examination (BDAE). and Pin1.
Results: Our results indicate that verbal fluency, auditory, Results: We identified several structurally distinct GABAA
reading comprehension and narrative ability are the main receptor modulators as novel regulators of Tau
language abilities to be affected in mild AD, but they are phosphorylation in a chemical library screen. GABAA
vulnerable as well as in MCI. Six useful language subtests receptor activation promoted specific phosphorylation of
of the BDAE discriminated ADs from the rest 2 groups Tau at the AT8 epitope (Ser-199/Ser-202/ Thr-205) in
92.5% of the time, NDs 86.8% and MCI 67.9% of the time cultures of mature cortical neurons. Increased Tau
in order to save time and to be accurate in clinical practice. phosphorylation by GABAA receptor activity was
Conclusion: Language impairments are affected MCIs as associated with reduced Tau binding to protein phosphatase
well as AD patients but in a slighter degree, but not elderly 2A and was dependent on Cdk5 but not GSK3 kinase
without dementia. Language tests cannot distinguish MCI activity.
from non-demented elderly and mild AD patients safely. 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.

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


Posters, Sunday 9 September 107

P1036 P1037
PCSK9 regulates neuronal apoptosis by Early onset Alzheimers disease
adjusting ApoER2 levels and signalling N. Behrem1, A. Altinkaya2, N. Karagoz Sakall1,
K. Kysenius1,
P. Muggalla1, K. Mtlik2, U. Arume2, P.N. Sutlas1, D. Kirbas1, B. Topcular2,3
H. Huttunen1
1Department of Neurology, Bakirky Teaching and Research
1Neuroscience Center, University of Helsinki, 2Insititute of Hospital for Mental Health and Neurological Disorders,
2Department of Neurology, 3Center for Research in Emotion
Biotechnology, University of Helsinki, Finland
and Cognition, Istanbul Bilim University, Istanbul, Turkey
Introduction: Proprotein convertase subtilisin/kexin type 9
(PCSK9) binds to low-density lipid (LDL) receptor family Introduction: Early-onset dementia is defined as dementia
members LDLR, VLDLR and ApoER2 promoting their before 65 years of age. The prevalence of dementia <64
degradation in intracellular acidic compartments. LDLR years of age is approximately 54-260/100,000. Studies on
controls the systemic levels of circulating LDL, whereas early onset Alzheimers dementia (AD) show different
ApoER2 and VLDLR primarily mediate Reelin signalling clinical and sociodemographic features compared to late
in the brain, critical for the development and plasticity of onset AD. We aimed to study the clinical and
the central nervous system. Expression level of PCSK9 is sociodemographic features of early onset AD patients in our
highest in the cerebellum during perinatal development, but department.
is also increased in the adult brain after ischemia. The Material and method: We included consecutive early onset
function of PCSK9 in apoptotic context is currently poorly AD patients admitted to our Behavioural Neurology and
understood. Dementia outpatient clinic between September 2011 and
Aim: To investigate the role of PCSK9 in neuronal January 2012 in the study.
apoptosis. Results: There were 48 early onset AD patients. Female/
Methods: Potassium deprivation of cerebellar granule male ratio was 0.92. Mean age at symptom onset was 53.32
neurons (CGN) was used as an apoptosis model and cell (36-64) years, mean age at onset was 56.82 (41-66) years.
death assessed by activation of caspase-3 and c-Jun and Mean education duration was 4.96 years. Mean follow-up
nuclear morphology. PCSK9, VLDLR and ApoER2 were time was 2.84 years. Mean MMSE and CDR scores at first
targeted by lentiviral RNAi to investigate their role in CGN visit were 13.34 and 1.66 respectively. The first symptom
apoptosis. was memory impairment in 79.16% (n=38) of patients
Results: PCSK9 RNAi reduced the activation of c-Jun and followed by executive dysfunction (n=6), language
caspase-3 by 44% and 59%, respectively, at 6h post- impairment (n=2) and visuospatial dysfunction (n=2). The
deprivation and the resulting cell death by 41%. Protection female/male ratio is lower than in the late onset AD cohort
was observed up to 24 hours post-deprivation. RNAi of in our department. The duration of education and CDR at
ApoER2 but not of VLDLR reversed the protection elicited first visit were similar to late onset AD patients. The
by PCSK9 RNAi. Pharmacological studies suggested that frequency of cognitive domains other than memory as initial
PCSK9 regulates neuronal apoptosis independently of presentation was higher in early-onset AD patients. The rate
NMDA receptor function but in concert with ERK and JNK of decline in MMSE and CDR was slower in early onset AD
signalling pathways. PCSK9 RNAi also protected CGN patients.
from staurosporine-induced apoptosis and dorsal root Conclusion: The frequency of early onset AD is increasing.
ganglion neurons from NGF-deprivation. Studies show that early and late onset AD have different
Conclusions: Our results indicate that PCSK9 potentiates characteristics in terms of clinical features.
neuronal apoptosis via downregulation of ApoER2 levels
and related anti-apoptotic signalling pathways.

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


108 Posters, Sunday 9 September

P1038 P1039
Influence of age in CSF biomarkers of Cognitive impairment in general paresis:
Alzheimers disease from control subjects AD-like pattern?
J.A. Monge-Argils1, C. Muoz-Ruiz2, J. Snchez-Pay3, A. Altinkaya1, M. Ozerden2, N. Behrem2, M. Colak2,
J. Montoya-Gutirrez1, C. Leiva-Santana1 N. Karagoz Sakall2, P.N. Sutlas2, D. Kirbas2,
1Service of Neurology, 2Inmunology Laboratory, 3Preventive
B. Topcular1,3
Medicine, General Hospital of Alicante, Alicante, Spain 1Department of Neurology, Istanbul Bilim University,
Introduction: Cerebrospinal fluid (CSF) biomarkers of
2Department of Neurology, Bakirky Teaching and Research
Alzheimers disease (AD) are currently being assessed in Hospital for Mental Health and Neurological Disorders,
3Center for Research in Emotion and Cognition, Istanbul
patients with cognitive impairment. In a few studies, it has
been demonstrated the influence of age in the CSF Bilim University, Istanbul, Turkey
concentration of these biomarkers. Our objective was to Objective: Neurosyphilis is a treatable cause of dementia.
confirm this influence in our cohort of control subjects. Recent studies report an Alzheimers disease (AD)-like
Material: We included 55 CSF samples from control pattern in general paresis patients. We retrospectively
subjects, without cognitive impairment and MMSE over 27, investigated the clinical, cognitive and radiological features
with ages between 50 and 87. This population were patients of patients with general paresis of the insane (GPI) in
who underwent spinal anaesthesia for orthopaedic or comparison to early onset AD patients.
urological non-malignant conditions. Using xMAP Methods: GPI and early onset AD patients followed at the
technology and INNO-BIA Alzbio-3 reagents from Dementia and Behavioural Neurology outpatient clinic were
Innogenetics, we quantified CSF A1-42, T-tau and retrospectively compared in terms of clinical,
P-tau181p proteins. We analysed the results with the neuropsychological and radiological features.
Spearman p correlation. Informed consent was obtained Results: There were 16 patients with GPI and 44 patients
before the procedure. with early onset AD. The mean age of onset and mean
Results: Our results showed a moderate correlation between follow-up duration for GPI patients were 48 years and 2.12
age and T-tau (r=0.5) or P-tau181p (r=0.4). Nevertheless, no years, respectively. The mean age of onset and mean follow-
correlation was found with A1-42 protein CSF up duration for early onset AD patients were 56.82 years
concentrations. These results are very similar to those and 2.84 years, respectively. All GPI patients were male
published in the last year. whereas female/male ratio was 0.92 in early onset AD
Conclusion: In our experience, as others published recently, group. GPI showed a similar neuropsychological pattern to
age has a moderate influence on T-tau and P-tau181p CSF early onset AD patients. GPI and early onset AD patients
protein levels, but it is hardly detectable in A1-42 protein had similar performances in memory, language and
CSF concentrations. 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.

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


Posters, Sunday 9 September 109

P1040 P1041
Paraoxonase 1 (PON1) and anti-oxidised Topographical disorientation (TD) in
LDL antibodies in a group of elderly ageing: preliminary results in healthy
subjects in Poland subjects and MCI patients
M. Bednarska-Makaruk1, H. Wehr1, M. Rodo1, A. Suardi1, M.L. Rusconi1, L. Rozzini2, M. Zanetti2,
W. Szirkowiec1, D. Ryglewicz2 M.R. Tamborrino3, L. Carelli1
1Department of Genetics, 2First Department of Neurology, 1Human Sciences, University of Bergamo, 2Neurological

Institute of Psychiatry and Neurology, Warsaw, Poland Clinic, University of Brescia, 3Santa Chiara Institute, Lecce,
Introduction: Paraoxonase 1 (PON1) is an enzyme Italy
associated with high density lipoproteins (HDL). PON1 has Introduction: Some evidences have suggested TD as a
antioxidant properties and its very important role consists possible indicator of Mild Cognitive Impairment (MCI)
of preventing low density lipoproteins (LDL) from oxidative conversion into Alzheimers disease (Hort et al., 2007;
modification. Antibodies against oxidised LDL (anti- Cushman et al., 2008). The purpose of our study was to
oxLDL) were considered to be a good index of LDL validate a new ecological instrument for clinical practice in
oxidation. The aim of the study was to investigate PON1 order to evaluate TD in elderly healthy subjects and MCI
and anti-oxLDL in a Polish population of elderly individuals. patients.
Methods: The investigated group consisted of 3154 Materials: We built an ideal city, consisting of 14 Legos
individuals (1570 men and 1584 women) mean age pieces, 12 road signs, 1 toy car and 1 lay-figure, all
76.310.0 years. The subjects were participants of removable and supported on a thick sheet (180x80 cm)
multicenter PolSenior project and were recruited randomly where 18 roads and 4 squares are printed.
from the Polish population. The cognitive status of the Methods: We enrolled 12 right-handed healthy participants
participants was estimated using MMSE. PON1 activity [10 females (F), 2 males (M); mean age =70.67, SD=4.6;
was determined in serum basing on the method of Kitchen mean schooling=9.75,SD=5.3] and 12 right-handed MCI
[1973] using phenyloacetate as substrate. Anti-oxLDL patients (10 F, 2 M; mean age=72.25, SD=3.9; mean
antibodies level was determined in serum by ELISA schooling =7.75, SD=4). All participants were submitted to
method. a neuropsychological battery and to an experimental test
Results: Significant negative correlation of PON1 activity which included: route learning forward and backward test;
with age and anti-ox LDL and positive correlation with Free recall landmark; Photographs recognition and location
HDL-C and MMSE were stated. Correlation of anti-oxLDL on the map; Map drawing; Recall and replace landmark on
with age was significantly positive but correlation the map; Replace landmark on the city; Routes description.
coefficient was very low. PON1 activity and anti-oxLDL Results: MCI patients showed difficulties in episodic
level were significantly lower in males as compared to memory, spatial planning and selective attention tasks. They
females. Mean PON1 activity was also decreased in 360 performed significantly worse in time learning forward and
subjects with MMSE<70% as compared to a group of 2667 backward test, map drawing and routes description; a trend
persons with MMSE70%. was observed in free recall landmark and photographs
Conclusions: PON1 activity was diminishing with location on the map.
advancing age which could contribute to cognitive Discussion: The interesting differences observed between
impairment development in the elderly. Implemented under subjects and patients allow us to consider the new instrument
publicly-funded project no. PBZ-MEIN-9/2/2006, Ministry as a promising ecological test to study the various
of Science and Higher Education. components involved in TD.

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


110 Posters, Sunday 9 September

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

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


Posters, Sunday 9 September 111

P1044 P1045
The rate of conversion to dementia in Enzyme antioxidant defences are
mild cognitive impairment (MCI) patients diminished in early stages of Alzheimers
L. Prodan1, A. Draghici2, C. RomanFilip1 disease
1Neurology, University Lucian Blaga Sibiu, Clinical Hospital
M.J. Ramirez-Exposito1, M.C. Puertas1, M.P. Cobo2,
County, 2Universiy Lucian Blaga Sibiu, Romania M.P. Carrera1, M.D. Mayas1, J.M. Martinez-Martos1
Aim: The aim of our study was to investigate the risk of 1Health Sciences, University of Jaen, 2Service of Neurology,

conversion to dementia for different MCI subtypes and University Hospital of Jaen, Spain
identify the clinical risk factors of conversion. Alzheimers disease (ATD) is the most common
Methods: We recruited 365 patients, >65 years, who met neurodegenerative disorder worldwide. It is characterized
the criteria for MCI and evaluated their global cognitive neuropathologically by the formation of senile plaques and
performances at baseline and annual for the next three neurofibrillary tangles, and clinically by the progressive
years. The diagnostic of dementia was established using deterioration of memory and other cognitive functions.
DSM IV TR criteria. Senile plaques are primarily composed of a 40-42 amino
Results: There were 365 cases of incident MCI, 199 patients acid peptide denoted as -amyloid (A). The accumulation
(54%) of amnestic MCI and 1666 patients (46%) of non- and deposition of A in selective brain regions is a major
amnestic MCI. The rate of conversion in the first year was cause of neurotoxicity and is assumed to be a culprit for
10.4%, in the second year 17.8% and in the third year inducing the pathologic process of ATD. Importantly, A is
23.3%. The mean rate of conversion during the follow-up a major source of reactive oxygen species (ROS) and other
period was 18.9% for Alzheimers disease (AD), 11.8% for toxic radicals. In our study, we measured the plasma levels
vascular dementia (VD) and 13.2% for Alzheimers disease of the enzyme defence system glutathione peroxidase
with cerebrovascular disease (AD with CVD). The rate of (GPx), catalase (CAT) and superoxide dismutase (SOD) in
conversion for specific MCI subtype was 17.1%/year for patients diagnosed of ATD and their age-matched controls.
patients with amnestic MCI and 11.5%/year for non- We found decreased levels of catalase and GPx in ATD
amnestic MCI. During the follow-up period 69 patients patients when compared with control groups, although
converted to AD, 71% were patients with amnestic MCI; 43 changes in catalase activity were found in men but not in
patients converted to VD; 46.5% were patients with women. On the contrary, we did not find changes in SOD
amnestic MCI; and 48 patients converted to AD with CVD; activity, although Western blotting analysis showed
68.7% were patients with amnestic MCI. The mean age for increased protein levels of SOD-1 in both men and women
converters was 72.8 year and for non-converters 74.2 year. with ATD. Our results suggest that there is a defect in the
The AD converters have high serum cholesterol levels, high enzyme antioxidant defence system that is incapable of
density lipoprotein, and the debut of hypertension before 65 responding to increased free radical production, which may
year. lead to oxidative damage and the development of the
Conclusion: The combination of amnestic MCI subtype pathological alterations that characterize the
with the clinical risk factors increased the risk of conversion neurodegenerative disorder of patients with ATD.
to dementia. Furthermore, this defect could be detected early during the
development of the disease. Supported by Junta de
Andaluca, Spain.

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


112 Posters, Sunday 9 September

P1046 P1047
Baseline characteristics of subjects with Agitation - relation to clinical and
prodromal Alzheimers disease: the dementia biomarkers in cerebrospinal
LipiDiDiet study fluid
Y. Freund-Levi1, P.J. Visser2,3, M. Kivipelto4, V. Bloniecki1, Y. Freund-Levi2, D. Aarsland1,
P.J.G.H. Kamphuis5, R.L. Wieggers5, T. Hartmann6,7, K. Blennow3
H. Soininen8 1 Karolinska Institute, 2NVS, Karolinska Institute,
1Department of NVS, Section of Clinical Geriatrics, 3 Sahlgrenska Universitetssjukhuset, Stockholm, Sweden
Karolinska Institutet, Karolinska University Hospital, Introduction: Dementia leads to deterioration of patients
Huddinge, Sweden, 2Department of Psychiatry and cognitive abilities and neuropsychiatric symptoms in
Neuropsychology, Alzheimer Center Limburg, University of dementia (NPSD). NPSD contribute to the disease burden
Maastricht, 3Department of Neurology, Alzheimer Center, of patients and care-givers, increase early hospitalization
VU University Medical Center, Amsterdam, The Netherlands, and constitute approximately 30% of dementia associated
4Aging Research Center, Karolinska Institutet and Stockholm
treatment costs. The objective of this study is to examine the
Gerontology Research Center, Stockholm, Sweden, 5Nutricia correlation between agitation and cerebrospinal fluid (CSF)
Advanced Medical Nutrition, Danone Research - Centre for
biomarkers (tau, phosphorylated tau and A1-42), clinical
Specialised Nutrition, Wageningen, The Netherlands,
6Deutsches Institut fr DemenzPrvention (DIDP),
and gender aspects of agitation.
Methods and material: 100 patients 45 years (mean
Neurodegeneration and Neurobiology, 7Experimental
78.77.5), 67% female, BMI (mean 24.34.3) and MMSE
Neurology, Homburg, Germany, 8Department of Neurology,
University of Eastern Finland and Kuopio University
(mean 20.04.6) fulfilled diagnostic criteria of dementia
Hospital, Kuopio, Finland according to DSM-IV. All patients underwent a physical
exam including lumbar puncture for analysis of biomarkers
Introduction: Souvenaid, containing the specific nutrient and assessment of the patients agitation level using the
combination Fortasyn Connect1, is designed to support Cohen Mansfield Agitation Inventory (CMAI).
synapse formation and function in patients with Alzheimers Results: No statistically significant correlation was found
disease (AD). Two earlier randomised controlled clinical between agitation and all CSF-biomarkers. Men had
trials have shown that Souvenaid improves memory statistically significant higher scores on the CMAI- scale as
performance in drug-nave mild AD patients (MMSE 20-26; compared to women (F=4.0, p=0.05). Men with Alzheimers
Scheltens, 2010) (MMSE 20; Scheltens, 2011), indicating dementia have a significant negative correlation between
that Souvenaid may have a promising effect in the early BMI and agitation relating to non-aggressive physical
phases of AD. The LipiDiDiet study2 was designed to behaviour (r=-0.7, p=0.006).
investigate the effects of Souvenaid on cognition in the Conclusions: The absence of correlation between agitation
prodromal phase of AD. and biomarkers in CSF could suggest that neurofibrillary
Methods: The LipiDiDiet study is a 24-month, randomised, tangles and amyloid plaques are not involved in the cerebral
controlled, double-blind parallel-group study investigating pathology causing NPSD. High levels of agitation in males
the effects of Souvenaid in 300 prodromal AD patients with low BMI raise the interesting question whether
(criteria Dubois, 2007). Primary outcome measure is agitation amongst males with low BMI can be treated by
cognitive functioning as assessed by a modified version of increasing the daily calorie intake.
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


Posters, Sunday 9 September 113

P1048 P1050
Short-term memory binding in mild Clinical significance of serum
cognitive impairment: a preclinical marker inflammatory markers in patients with
of Alzheimer's disease? subcortical ischemic vascular disease
E. Cerea, S. Caratozzolo, M. Riva, B. Vicini Chilovi, P. Lv, Y. Dong, L. Li
L. Rozzini, A. Padovani Department of Neurology, Hebei General Hospital,
Institute of Neurology, University of Brescia, Italy Shijiazhuang, China
Introduction: It is increasingly important to identify Objectives: To evaluate the levels of soluble CD40 ligand
neuropsychological measures easy to perform at low costs (sCD40L), interleukin-6 (IL-6) in the serum of patients with
that can help the clinician to predict subsequent cognitive SIVD and the correlation among the serum levels, cognition
decline. The aim of the study is to examine two and white matter lesions (WML).
neuropsychological tests, recently proposed in literature, the Methods: 39 SIVD patients and 15 normal elderly controls
Short Term Memory Binding Test (Parra and Della Sala, (NC) were evaluated with MMSE and MoCA to assess the
2009) and five words of Dubois (2002), and comparing cognitive function. The patients were divided into vascular
them with neuropsychological tests regularly used during dementia (VaD, n=19) and vascular cognitive impairment
routine neuropsychological practice. no dementia (VCIND, n=20) group. Age-related white
Methods: 36 patients with a diagnosis of Mild Cognitive matter change rating scale was used to qualitative measure
Impairment (MCI) and 35 healthy controls were assessed the WML. The serum levels of sCD40L and IL-6 were
with a neuropsychological battery (including tests of detected by enzyme linked immunosorbent assay (ELISA).
memory, attention, visuospatial, executive functions and The relationship was described between these inflammatory
phonemics and semantic fluency), the Dubois test of five factors and WML, cognitive impairment in patients with
words and a visual short-term memory task estimating the SIVD.
recognition of shape, colours and shape-colour binding Results:
(STMB). (1) A statistically increase of sCD40L serum level of SIVD
Results: Patients with MCI performed significantly worse patients versus healthy controls was detected (F=9.019
than healthy controls on most parts of neuropsychological p=0.000).
assessment (MMSE-TMT B-Reward Rey list), on the five (2) Compared with controls, patients with SIVD had
words of Dubois test and on the STMB. The STMB test elevated IL-6 serum levels (F=10.605 p=0.000).
correlated with episodic memory and executive functions (3)There was no statistically difference in the VaD and
tests whereas the test of five words of Dubois correlates VCIND patients (p>0.05).
only with memory tests. (4) There was no statistically correlation between the serum
Conclusions: The test of the five words of Dubois and levels of sCD40L, IL-6 and MMSE, MoCA, WML scores.
STMB test are, by their high sensitivity and specificity, tests (5) Slight positive correlation between sCD40L and IL-6
indicated in the diagnostic process of patients with memory was observed (r=0.318, p=0.023).
disorder. The deficit in memory domain and executive Conclusions:
function has been claimed to be predictive of conversion to (1) Increased serum levels of sCD40L and IL-6 in patients
Alzheimers disease in patients with MCI; thus, it is possible with SIVD might indicate that inflammatory processes may
to assume that the STMB test might be a good predictor of be activated in SIVD.
conversion to AD. (2) Enhanced serum levels of sCD40L, IL-6 could not imply
the association with the severity of cognitive impairment
P1049 and WML in SIVD patients.
(3) sCD40L and IL-6 may be promoting the pathological
Abstract cancelled changes of SIVD in common.

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


114 Posters, Sunday 9 September

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


Posters, Sunday 9 September 115

P1053 P1054
Caregiver burden and consumption of Human amniotic fluid stem cells over-
social services among patients with early expressing choline acetyltransferase gene
onset Alzheimers disease compared to restore cognitive function of kainic acid-
late onset Alzheimers disease induced Alzheimers disease model rats
H. Grnning1, S. Kristiansen2, D. Dyre2, A. Rahmani1, J. Kyung1, D. Kim1, D. Park1, Y.-H. Yang1, E.-K. Choi1,
J. Gyllenborg1, P. Hgh1 H.J. Lee2, S.U. Kim3, Y.-B. Kim1
1Neurology, 2Geriatrics, Roskilde University Hospital, 1College of Veterinary Medicine, Chungbuk National

Roskilde, Denmark University, Cheongju, 2Medical Research Institute, Chung-


Introduction: Alzheimers disease (AD) is the most Ang University Medical School, Seoul, Republic of Korea,
3Division of Neurology, University of British Columbia
common dementia disorder. For patients with early onset
AD (onset before 65 years of age, EOAD) the impact of the Hospital, Vancouver, BC, Canada
disease appears to be more devastating than in late onset AD We recently established an immortalized amniotic fluid
(onset after 65 years of age, LOAD). The purpose of the stem cell line (AF2) over-expressing human choline
study was to analyse caregiver-burden and the consumption acetyltransferase (ChAT) gene and transplanted these AF2.
of social services in a consecutive group of patients with ChAT cells to kainic acid (KA)-induced Alzheimers disease
EOAD compared to a matching LOAD-group. (AD) model rats. Intrahippocampal injection of KA (0.4g/
Materials and methods: Case-control study with 42 rat) to hippocampal CA3 region caused severe neuronal
patients, 21 EOAD (mean 58.5 years) and 21 matched loss, resulting in profound memory deficit. Intra cere
LOAD patients (mean 78.2 years). Patients were matched broventricularly transplanted AF2.ChAT cells (1x 106 cells/
according to disease severity at the time of diagnosis. rat) were found to express ChAT as early as at week 2, in
Caregivers in both groups went through an interview using parallel with the recovery of acetylcholine (ACh) levels in
the Neuro Psychiatric Inventory (NPI), Activities of Daily cerebrospinal fluid (CSF). AF2.ChAT treatment fully
Living (ADCS-ADL) and Resource Utilization in Dementia restored the impaired learning and memory function of AD
(RUD). The quantitative results were statistically compared. animals 4 weeks post-transplantation, in which AF.ChAT
Results: The EOAD-group had a significantly higher ADL- cells were superior to their parental AF cells. The cells
function compared to the LOAD-group. There was a trend migrated to the KA-induced injury site (CA3) and
towards caregivers in the LOAD group spending more time differentiated into neurons, but not into astrocytes. The
helping the patients, and they needed more social services present study demonstrates that human amniotic fluid cells
than the EOAD-group. NPI-scores were not significantly expressing ChAT have lesion-tropic property and improve
different in regards to neuropsychiatric symptoms, but had cognitive function of AD model rats with hippocampal
a tendency to a higher caregiver-burden in the EOAD- injury by increasing ACh level.
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


116 Posters, Sunday 9 September

P1055 P1056
Dorsal hippocampus serves as site of Comparison of statistical methods for
action for angiotensin IV in cognitive handling incomplete data in the
enhancement evaluation of clinical efficacy of
L.A. Sandusky, E.C. McNay memantine in the treatment of
Behavioral Neuroscience, State University of New York, Alzheimers disease
Albany, NY, USA
O.M. Lemming1, S. Bineau2, C. Marre2, F. Marteau2
Introduction: Angiotensin IV (Ang IV) is an endogenous 1International Clinical Research, H. Lundbeck A/S,

pentapeptide inhibitor of the insulin-regulated Copenhagen, Denmark, 2Global Outcomes Research


aminopeptidase (IRAP), and is part of the Renin- Division, Lundbeck SAS, Issy-Les-Moulineaux, France
Angiotensin System (RAS) that resides within the brain. In Introduction: Alzheimers disease (AD) is a
adipocytes, IRAP redistributes with the glucose transporter neurodegenerative disease resulting in irremediable
4 (GLUT4) to the plasma membrane in response to insulin. deterioration in patient health over time. In the context of
In vivo Ang IVs mechanism and specific site of action randomized clinical trials on efficacy and safety of
remains unknown despite having been implicated in antidementia drugs, the progressive nature of AD leads to
numerous studies investigating its memory enhancing some methodological issues when handling missing data
effects. related to patient drop-outs.
Methods: Male Sprague Dawley rats were given a single In the absence of a gold standard method for managing
microinjection cannula in the left dorsal hippocampus. missing data, this study will compare the consistency of
Administration of aECF, 20pM Ang IV, 40pM Ang IV, or results from analysis on observed cases (OC) to the use of
80pM Ang IV was administered 10 min prior to spatial the last observation carried forward (LOCF) method for
working memory testing in the spontaneous alternation imputing missing data, as well as to the Mixed-Effect Model
task. 24 hours later the animals were re-tested in a novel Repeated Measures (MMRM) modelling approach.
spontaneous alternation maze to test for residual effects of Methods: Three approaches have been compared on the set
administration. of pooled data from three pivotal 6-month, double-blind,
Results: Analysis of group means revealed a significant randomised, placebo-controlled trials of memantine (full
improvement in spatial working memory when administered analysis set N=480 on placebo, N=488 on memantine) in
40pm Ang IV compared to aECF alone (p = 0.04) on Day 1. the treatment of moderately severe to severe AD (MMSE
No group differences were detected on Day 2, demonstrating 5-14).
the effects of Ang IV as acute but transient. The data on the main clinical dimensions, i.e. cognition,
Conclusion: Previous research exploring the effects of Ang global status, activities of daily living and behaviour,
IV on cognition has administered the drug via measured through standard scales, have been pooled and
intracerebroventricular injection. Our findings demonstrate analysed using OC, LOCF and MMRM approaches.
the dorsal hippocampus as a site of action for cognitive Results: The efficacy of memantine compared to placebo
enhancement by Ang IV and support the notion that this was demonstrated for all clinical outcomes. These results
drug might be utilized in populations where cognition is were comparable and consistent between the 3 statistical
compromised, such as ageing and dementia. Future research approaches.
will explore additional brain regions to extend current Conclusion: The consistency of the results supports the
findings. 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.

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


Posters, Sunday 9 September 117

P1057 P1058
Comparison of two analytical platforms Age features of cognitive impairment in
for CSF biomarkers of Alzheimers the early rehabilitation period of ischemic
disease stroke
J.A. Monge-Argils1, J. Snchez-Pay2, C. Muoz-Ruiz3, E. Morozova, L. Pustokhanova
M. Blanco-Cant1, C. Leiva-Santana1 Department of Neurology, Academy of Medicine, Perm,
1Service of Neurology, 2Preventive Medicine, 3Inmunology Russia
Laboratory, General Hospital of Alicante, Spain Background: One of the major risk factors for cognitive
Introduction: Cerebrospinal fluid (CSF) biomarkers of impairment in patients after ischemic stroke is elderly age.
Alzheimers disease (AD) are currently being assessed with Methods: 156 patients (aged 38-84, 97 males and 59
two different assays. Our objective was to study if there is a females) after the first hemispheric ischemic stroke were
correlation between values obtained by both techniques, to examined. Clinical and neuropsychological investigation
compare their validity and search for a conversion factor was carried out within 1 and 3 months after the stroke with
between values obtained for every protein. the use of NIHSS, Barthel index (BI), MMSE, FAB,
Material: We compared the performances of the two most Semantic Verbal Fluency test (SVF), CES-D. The control
commonly used platforms, INNOTEST, an enzyme-linked group consisted of 53 people without stroke.
immunosorbent assay, and INNO-BIA AlzBio-3 for Results: The degree of neurological deficit did not depend
measurement of CSF A1-42, total tau (T-tau) and on age. MMSE decline was found in 100 patients, FAB in
phosphorylated tau 181 (p-tau181p) proteins, in 30 AD 126 patients at the first visit. Data differences in patients
patients and 28 control subjects. The relations between the and control group were confirmed in MMSE (26.223.22
variables of both techniques were evaluated using the and 27.791.55, p=0.0009), FAB (12.653.29 and
Spearman p correlation coefficient (=0.05). ROC and 15.672.25, p=0.0000), SVF (15.786.15 and 20.196.35,
AUC analyses were calculated for the variables of both p=0.0001). Significant differences between the average
techniques. CES-D in patients group and controls were not detected. At
Results: The two assay platforms yielded different absolute the first visit age was associated with the tests: MMSE
values for the various analytes, always higher in INNOTEST. (R=-0.21, p=0.0084), FAB (R=-0.25, p=0.0016), SVF
We found some correction factor between values: 2.1 to 3 (R=-0.28, p=0.0006), CES-D (R=0.20, p=0.0143), BI
fold for A1-42; 4,1 to 4.6 fold for T-tau and 1.4 to 1.6 fold (R=-0.21, p=0.0082). Reduction of cognitive impairment
for p-tau181p. In addition, those values were highly was established at the second visit: S (28.022.23,
correlated (A1-42: r=0.70, p<0.01; T-tau: r=0.90, p<0.01; p=0.0000), FAB (15.592.19, p=0.0000), SVF (18.026.35,
p-tau181p: r=0.85, p<0.01) and the AUC for the variables p=0.0084) increased. The average CES-D was lower than at
showed very similar values. the first visit (11.178.41 and 8.478.01, p=0.0122).
Conclusion: The results obtained with INNOTEST and Correlations between age and FAB (R=-0.24, p=0.0154),
INNO-BIA were highly correlated and its validity very SVF (R=-0.25, p=0.0185), CES-D (R=0.24, p=0.0163)
similar. Differences in absolute values point to the need for preserved.
a clear description of the technique used. However, we Conclusions: Cognitive impairment in post-stroke patients
found some conversion factor between values of every are mainly associated with frontal dysfunction. The patients
protein that may be useful for transformation between both age has a negative effect on the cognitive status, degree of
techniques. depression and social activity.

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


118 Posters, Sunday 9 September

P1059 P1060
Patient dependence and clinical measures Relationship between healthcare, social
of cognitive impairment, functional care costs, dependence on others as
disability and behaviour in Alzheimers illness progresses in Alzheimers disease
disease: results from dependence in AD in (AD): results from dependence in AD in
England (DADE) study England (DADE) study
R.W. Jones1, L. Lacey2, M. Knapp3, R. Romeo4, A. Sato3, M. Knapp1, R. Romeo2, A. Sato1, R.W. Jones3,
T. Niecko5, R. Trigg6, DADE Investigator Group L.A. Lacey4, DADE Investigator Group
1Research Institute for the Care of Older People, Bath, UK, 1London School of Economics, 2Kings College London,
2Janssen Alzheimer Immunotherapy, Dublin, Ireland, London, 3RICE, Bath, UK, 4Janssen Alzheimer
3London School of Economics, 4Kings College London, Immunotherapy, Dublin, Ireland
London, UK, 5Niecko Health Economics, Naples, FL, USA, Introduction: The DADE sought to examine how
6Nottingham Trent University, Nottingham, UK
healthcare and social care costs in England change with
Introduction: The DADE study determined the relationship increasing dependence on others.
between dependence and clinical measures of cognition, Methods: 249 patients with possible/probable AD
function and behaviour in a UK population of patients with according to NINCDS/ADRDA criteria participated in a
Alzheimers disease. multi-centre, cross-sectional, observational study. Patient
Methods: A multi-centre, cross-sectional, observational dependence (Dependence scale, DS), healthcare and social
study was conducted. 249 patients with possible/probable resource utilization over the past 3 months (Client Service
AD according to NINCDS/ADRDA criteria, MMSE (3-26) Receipt Inventory (CSRI) were assessed. The costs of
participated. services used by patients were derived by combining
Patient cognition (Mini- Mental State Examination, medication, health and social care resource utilization data
MMSE), function, (Disability Assessment for Dementia, with estimated 2009/2010 unit costs. Costs were classified
DAD), behaviour (Neuropsychiatric inventory, NPI), global into 2 categories: direct medical costs (DMC; i.e.
disability (Clinical Dementia Rating Scale- Sum of Boxes, medication, primary care contacts, hospital outpatient visits,
CDR-SOB) and dependence (Dependence scale, DS) were inpatient admissions, A&E attendance) and direct non-
assessed. Higher scores indicate lower severity for MMSE medical costs (DNMC; i.e. accommodation, social care
and DAD, and greater severity for DS, CDR SOB and NPI. services, aids and adaptation). Relationships were examined
Associations were determined using Ordinary least squares using ordinary least squares regression.
regression (OLS). Results: The average time since AD diagnosis was
Results: The mean (SD) age of patients was 79 (8.5) years. approximately 3 years with 14% living in the nursing home
Average time since AD diagnosis was approximately 3 years or residential care. Bivariate analysis suggested a statistically
and 86% of patients lived in the community and 14% in a significant association (p<0.01) between DS and total DMC
nursing home or residential care home. The mean (SD) plus DNMC: a one point rise in DS is expected to increase
scores for DS, MMSE, DAD, CDR SOB and NPI were 8 the total DMC plus DNMC by 760 over 3 months. The
(3), 14.6 (6.8), 44.8 (27.7) 10.7 (4.94) and 21.9 (19.14), effect is largely driven by increases in DNMC. Multivariate
respectively. analyses suggests a positive association (p<0.01, R-squared:
OLS analyses support statistically significant (p<0.01) 0.29-0.48) between DS and total DMC and DNMC with a
associations between DS and the other clinical severity one point rise in DS associated with 8-21% increase in
measures. A one point increase in MMSE and DAD was costs.
associated with DS point decreases of 0.292 (R-squared: Conclusions: Patient dependence on others, as measured by
0.44) and 0.089 point (R-squared=0.68). A one point the DS, provides information for explaining variations in
increase in NPI and CDR-SOB was associated with DS cost of care, in particular direct non medical care costs.
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


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 P1071
An MEG study on the effects of medical Effectiveness of galantamine in patients
food on brain networks in patients with with mild to moderate dementia:
Alzheimers disease 12 months outcome data
E.C. van Straaten1, H. de Waal1, M.M. Lansbergen2, U. Richarz1, M. Djelani2, K. Rettig3, B. Schauble2,
P. Scheltens1, R.L. Wieggers2, P.J. Kamphuis2, C.J. Stam1 M. Gaudig4, E. Jedenius5
1Alzheimer Centre, VU University Medical Centre, 1Medical Affairs, Janssen Cilag, Baar, Switzerland, 2Medical

Department of Neurology, Amsterdam, 2Nutricia Advanced Affairs, Janssen Cilag, Neuss, 3Biostatistics, GEM,
Medical Nutrition, Danone Research - Centre for Specialised Meerbusch, 4Health Economics, Janssen Cilag, Neuss,
Nutrition, Wageningen, The Netherlands Germany, 5Janssen Cilag Sweden, Gteborg, Sweden

P1068 P1072
Human neural stem cells over-expressing Tooth loss and cognitive decline
choline acetyltransferase gene improve S.-H. Suk1, Y.-J. Kim2, I.-S. Koh3, Y.-K. Minn4,
cognitive and physical activities of ageing J.-H. Lee5, S.-H. Hwang6, J.-H. Park7
1Department of Neurology, Wonkwang University Sanbon
mice
Medical Center and Ansan Municipal Geriatric Hospital,
D. Kim1, J. Kyung1, D. Park1, Y.-H. Yang1, E.-K. Choi1, Gunpo-si, 2Neurology, Sungae Hospital, 3Neurology,
H.J. Lee2, S.U. Kim3, Y.-B. Kim1 National Medical Center, 4Neurology, Hallym University
1College of Veterinary Medicine, Chungbuk National
Hangang Sacred Hospital, Seoul, 5Neurology, National
University, Cheongju, 2Medical Research Institute, Chung- Health Insurance Coorperation Ilsan Hospital, Koyang,
Ang University Medical School, Seoul, Republic of Korea, 6Neurology, Hallym University Gangnam Sacred Heart
3Division of Neurology, University of British Columbia
Hospital, 7Neurology, Inje University Sangae Paik Hospital,
Hospital, Vancouver, BC, Canada Seoul, Republic of Korea

P1069 P1073
Dementia and thrombolysis: a systematic
Supporting synapse formation and
review
function in Alzheimers disease:
K. Murao, D. Leys, R. Bordet, F. Pasquier, C. Cordonnier
Departments of Neurology and Pharmacology, University
mechanism of action of the specific
Lille North of France (EA 1046), CHU Lille, France nutrient combination Fortasyn Connect
J.W. Sijben1, P.J. Kamphuis1,2, M. deWilde1,
R.J. Hageman1, L.M. Broersen1, M. Groenendijk1
P1070 1Nutricia Advanced Medical Nutrition, Danone Research -
Disease progression in patients with mild- Centre for Specialised Nutrition, Wageningen, 2Utrecht
to-moderate Alzheimers disease treated Institute for Pharmaceutical Sciences (UIPS), Utrecht
University, Utrecht, The Netherlands
with galantamine: results of a 2-year open
label study
U. Richarz1, M. Djelani2, M. Gaudig3, K. Rettig4,
P1074
B. Schauble2, E. Jedenius5 The awareness of everyday memory
1Medical Affairs, Janssen Cilag, Baar, Switzerland, 2Medical deficits in patients with Parkinsons
Affairs, 3Health Economics, Janssen Cilag, Neuss,
4Biostatistics, GEM, Meerbusch, Germany, 5Janssen Cilag
disease
Sweden, Gteborg, Sweden 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

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


Posters, Sunday 9 September 121

P1075 P1079
Neuroprotective effect of edaravone Hypertension: a risk factor for Alzheimers
against hydrogen peroxide induced disease?
neuronal cell death M. BenDjebara1,2, I. Belhouane1,2, I. Kacem1,2,
J. Liu1, Z. Zhao1, S. Huang2, S. Xiao1, B. Zhang1 I. BenArbia1,2, I. Rebai1, Y. Hizem1,2,
1Dept. of Neurology, Sun Yat-sen Memorial Hospital, A. Gargouri-Berrechid1,2, R. Gouider1,2
Guangzhou, 2Dept. of Neurology, Hainan Provincial Peoples 1Department of Neurology, Razi Hospital, La Manouba,
Hospital, Haikou, China 2Research Unit of Clinical Neurophysiology and
Electrodiagnosis 03/UR/08-09, Tunis, Tunisia

P1076
Hippocampal presynaptic alterations are
P1080
associated to amyloid plaques in young Genetic genomics analysis of Ptgs2 gene
PS1/APP Alzheimer mice in BXD recombinant inbred mouse
R. Sanchez-Varo1, E. Sanchez-Mejias1,
hippocampus
L. Trujillo-Estrada1, V. De Castro1, S. Jimenez2, Y. Chen, Y. Zhang, Y. Li, X. Wang, L. Lu
A.J. Jimenez1, J.M. Garcia-Verdugo3, M. Vizuete2, Nantong University, Nantong, China
J.C. Davila1, J. Vitorica2, A. Gutierrez1
1Cell Biology, Faculty of Sciences, University of Malaga/ P1081
CIBERNED, Mlaga, 2Biochemistry and Molecular Biology,
Faculty of Pharmacy, University of Seville/CIBERNED, Biochemical alterations of tau protein as
Seville, 3University of Valencia/CIBERNED, Valencia, Spain a healing physiological compensatory
mechanism of cytoskeleton integrity and
P1077 brain neuroplasticity in Alzheimers
disease and other types of
Temporal pattern of neuritic plaques
neurodegeneration
deposition in an app751sl/ps1m146l
A. Koudinov1,2, N. Koudinova1,2, T. Berezov1,2
Alzheimer transgenic model 1Biochemistry, TT Berezov Laboratory, Russian People
L. Trujillo-Estrada1, R. Sanchez-Varo1, Friendship University, 2Orechovich Institute of Biomedical
E. Sanchez-Mejias1, D. Baglietto-Vargas1, Chemistry, Russian Academy of Medical Sciences, Moscow,
I. Moreno-Gonzalez1, S. Jimenez2, M.L. Vizuete2, Russia
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 Role of the cell adhesion molecule F3/
contactin in hippocampal synaptic
P1078 plasticity and memory in old mice
Clinical characteristics of Alzheimers D. Puzzo1, L. Privitera1, D. Furnari1, A. Bizzoca2,
disease at the initial visit at the Belgrade G. Gennarini2, A. Palmeri1
1Bio-Medical Sciences - Section of Physiology, University of
Memory Centre: a Serbian report Catania, 2Department of Basic Medical Sciences, University
T. Stojkovic, I. Despotovic, G. MandicStojmenovic, of Bari, Italy
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


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


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

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


Posters, Sunday 9 September 123

Autonomic nervous system disorders P1091


Abdominal compression compensates for
P1090 compromised sympathetic superior
Electrogastrography in pure autonomic mesenteric artery innervation and
failure restores blood pressure in hypotensive
D.A. Low1,2, E. Vichayanrat1,2, W. Seligman1,3, familial dysautonomia patients
Y. Yamanaka4, M. Asahina4, C.J. Mathias1,2 E.C. Ehmann1, J. Koehn1, S. Moeller1, R. Baltadzhieva2,
1Medicine, Imperial College London, 2Autonomic Unit, F.B. Axelrod3, M.J. Hilz1,2
University College London Hospital, London, 3Department Department of Neurology, University of Erlangen-
1
of Physiology, Anatomy and Genetics, University of Oxford, Nuremberg, Erlangen, Germany, 2Departments of Neurology,
Oxford, UK, 4Department of Neurology, Chiba University, Medicine, Psychiatry, 3Dysautonomia Center, New York
Chiba, Japan University, New York, NY, USA
Gastric motility is controlled, in part, by the autonomic Background: Familial Dysautonomia (FD) patients have
nervous system. Gastrointestinal symptoms can occur in severe orthostatic hypotension (OH) that recovers faster
Pure Autonomic Failure (PAF), which is characterized by upon supine-repositioning with than without abdominal-
postganglionic sympathetic dysfunction. No studies have compression. Influences of abdominal-compression on
investigated gastric motility in PAF patients however. splanchnic perfusion are unknown but may contribute to
Aim: To evaluate gastric motility by recording gastric blood pressure recovery.
myoelectrical activity using cutaneous electrogastrography Therefore we assessed superior mesenteric artery (SMA)
(EGG) before and after standard liquid meal ingestion in blood-flow changes during orthostasis, supine-repositioning
PAF. without and with abdominal-compression.
Methods: 7 PAF patients (669 yr) and 5 healthy individuals Methods: In 9 FD-patients (17.83.9 years) and 13 controls
(665 yr) ingested a 300ml standard liquid meal (20g (18.85 years) we monitored mean blood pressure (BP) and
glucose, 60g Complan and milk) whilst supine. Gastric heart rate (HR). Using real-time Doppler ultrasound, we
myoelectrical activity was measured using four-channel assessed cross-sectional SMA areas (SMA-area), time-
EGG. Running spectral analysis was performed using Fast average velocities (SMA-TAV), SMA blood-flow (SMA-
Fourier Transformation. Dominant frequency (DF) was BF), SMA-vascular resistance (SMA-VR=BP/SMA-BF),
defined as the frequency at which the overall power during supine-rest, standing, supine-repositioning, another
spectrum showed peak power between 2.0-4.0 cycles per supine-rest, second standing, and supine-repositioning with
minute (cpm). The instability coefficient of dominant abdominal-compression by leg elevation and flexion
frequency (ICDF) was calculated as the ratio of the standard towards the thorax. Differences between groups and
deviation and mean of the peak frequencies. positions were assessed by ANOVA and post-hoc testing
Results: There was no difference between groups in (significance: p<0.05).
baseline pre-prandial DF (2.80.1 vs. 3.00.3 cpm) and the Results: FD-patients had pronounced OH without HR
minimum and maximum post-prandial DF (both P>0.05). changes during positional changes. Controls had stable BPs
There was a borderline interaction effect of time and group and significant HR increase upon standing and HR decrease
for ICDF (P=0.086). ICDF was higher in PAF at baseline upon supine-repositioning. Upon standing, SMA-area,
(10.27.9 vs. 2.30.4%) and remained unchanged early SMA-TAV, SMA-BF decreased in both groups; yet, SMA-
(0-15 min, 12.55.9%) and late (30-45 min, 9.49.5%) area decreased more in controls than in patients. SMA-VR
post-prandial. In contrast, ICDF increased in controls early increased significantly in controls only. Upon repositioning,
post-prandial (11.03.9%) and returned to baseline during SMA-area, SMA-TAV, SMA-BF re-increased significantly
late post-prandial (1.90.6%). in both groups. SMA-VR re-increased in controls and
Conclusion: Irregular gastric myoelectrical activity in PAF remained unchanged in patients. With abdominal-
patients, as suggested by high ICDF and lack of post- compression, both groups had similar SMA-TAVs and
prandial ICDF changes, suggest gastric dysrhythmia in PAF. 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.

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


124 Posters, Sunday 9 September

P1092 P1093
Direct evidence of sympathetic nervous Tako-Tsubo cardiomyopathy: direct
system hyperactivity in patients with evidences of sympathetic nervous system
vasospastic angina hyperactivity
F. Despas, J. Van Rothem, N. Boudou, A. Vaccaro, F. Despas1, A. Vaccaro2, M. Lebrin2, C. Delmas2,
M. Lebrin, D. Carrie, M. Galinier, M. Elbaz, A. Pathak, M. Galinier2, A. Pathak2, J.-M. Senard2
J.-M. Senard 1Clinical Pharmacology, 2Toulouse University Hospital,

Toulouse University Hospital, Toulouse, France Toulouse, France


The pathogenesis of vasospastic angina remains Tako-Tsubo Cardiomyopathy (TTC) is an acute reversible
incompletely elucidated. Among multiple mechanisms, condition that involves left ventricular apical ballooning
vagal withdrawal can act as a trigger for spontaneous and mimics acute myocardial infarction with no detectable
coronary spasm, changes in sympathetic activity have also coronary arterial disease. TTC typically affects aged post-
been suggested. To date no direct assessment of sympathetic menopausal women and is usually triggered by emotional or
nerve activity (MSNA) has been performed. physical stress. The exact pathophysiology remains
We evaluated haemodynamic parameters and MSNA in 31 unknown but data suggest a link between sympathetic
patients: 15 having definite vasospastic angina confirmed hyperactivity and TTC. Up to now, no direct evidence of
by ergonovine provocation test during angiography and 16 sympathetic hyperactivity has been established. The aim of
matched patients (age, gender, body mass index, risk our study was to determine by microneurography if patients
factors) with negative response to provocation test. with TTC present an increase of muscle sympathetic nerve
Parameters were collected during baseline and during a activity (MSNA) in comparison to matched heart failure
mental stress known to further increase MSNA. controls.
During baseline period, blood pressure and heart rate did We enrolled 13 TTC patients (80.12.1 years, all female,
not significantly differ between groups. Baseline MSNA Body Mass Index: 23.20.8kg/m, Left Ventricular Ejection
was significantly increased in patients with vasospam Fraction: 402%) and 13 control patients matched for age,
compared to non-vasospasm patients (56.81.3 vs. 50.31.8 sex, BMI, LVEF, renal function and haemoglobinemia.
burst/min; p<0.001). During mental stress period, spasm Within 36 hours after admission, all patients underwent a
patients presented a significant higher mean blood pressure microneurography and an arterial baroreflex gain
and MSNA in comparison to non-spasm patients (66.11.8 assessment (slope of the relationship between MSNA and
vs. 54.31.8 burts/min; p<0.001). For spasm patients group, diastolic blood pressure). There is no difference between
mental stress test produced a significant increase of blood groups on haemodynamics parameters (BP and HR) and
pressure, heart rate, oxygen saturation and MSNA (56.81.3 oxygen saturation. TTC patients presented a significant
vs. 66.11.8 bursts/min, p<0.001). For non-spasm patients increase of sympathetic activity (66.32.7 vs. 55.62.6
group, mental stress test produced a significant increase of bursts/min; p=0.0089). Arterial baroreflex gain is
heart rate, oxygen saturation and MSNA (50.31.8vs significantly decreased compared to control patients
54.31.8 bursts/min, p<0.05), but no significant (1.20.3 vs. 2.50.4 % MSNA/mmHg; p=0.005).
modification on blood pressure parameters. This study showed for the first time with a direct technique,
Our results show a direct evidence of increased sympathetic that TTC patients present a sympathetic hyperactivity. The
activity in patients with vasospastic angina, during mental increase of sympathetic nerve activity is associated to a
stress. This propensity to further increase MSNA during decrease of arterial baroreflex gain. During the acute phase,
stress may play a key role in the pathogenesis of coronary the benefit of adrenergic antagonist has to be evaluated.
spasm.

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


Posters, Sunday 9 September 125

P1094 P1095
Prolonged survival in multiple system Quantitative cardiovascular autonomic
atrophy (MSA) function in patients with primary chronic
P. Guaraldi1, F. Mastrolilli2, A. Cecere1, autonomic failure
G. Calandra-Buonaura1, L. Sambati1, G. Barletta1, E. Vichayanrat1,2, D. Low1,2, K.B. Nilsen3,4, V. Iodice1,2,
F. Provini1, F. Vernieri2, P. Cortelli1 C.J. Mathias1,2
1Dipartimento di Scienze Neurologiche, IRCSS Istituto delle 1Autonomic & Neurovascular Medicine Unit, Imperial
Scienze Neurologiche di Bologna, Alma Mater Studiorum - College London at St. Marys Hospital, 2Autonomic Unit,
Universit di Bologna, Bologna, 2Department of Neurology, National Hospital for Neurology and Neurosurgery, London,
Campus Bio-medico University, Rome, Italy UK, 3Department of Neuroscience, Norwegian University of
Introduction: MSA is a sporadic neurodegenerative Science and Technology, Trondheim, 4Department of
disorder characterized by dysautonomia associated with Neurology, Section for Clinical Neurophysiology, Oslo
parkinsonian (MSA-P) or cerebellar (MSA-C) features with University Hospital, Oslo, Norway
a mean survival of 7-9 years. Few reports described patients It can sometimes be difficult to differentiate the diagnosis
surviving more than 15 years (1). We retrospectively between Parkinsons disease with autonomic failure
reviewed the medical records of 108 MSA patients, assessed (PD+AF), Pure Autonomic Failure (PAF) and Multiple
in our Clinic between 1991 and 2012 in search of patients System Atrophy (MSA), owing to overlapping autonomic
with a disease history of >15 years. features, such as orthostatic hypotension (OH).
Methods: We identified 6 patients (5 MSA-P, 1 MSA-C, 4 Aim: We investigated the usefulness of a variety of
males). Demographic, clinical and polysomnographic data quantitative cardiovascular autonomic measures in
were analyzed. Up-to date follow-up information was distinguishing these patients with primary chronic AF.
obtained by telephonic interviews. Methods: Patients underwent cardiovascular autonomic
Results: MSA-P presented at 507 years (range 41-58 function tests that included head-up-tilting, Valsalva
years) with a rigid-bradikinetic syndrome in 3 patients and manoeuvre (VM) and deep breathing (HRDB). Blood
genito-urinary dysfunction in 2. MSA-C developed at 49 pressure (BP) and heart rate (HR) were continuously
years with cerebellar dysfunctions. Nocturnal stridor was recorded and analyzed off-line. The adrenergic component
present in 2 patients (1 MSA-C) that underwent of baroreflex sensitivity (BRS-a), blood pressure recovery
tracheostomy. All patients were bedridden at their final time during VM (PRT) and Valsalva ratio (VR) were derived
assessment (145 years after onset, range 8-20). One patient from the VM. All measures were compared between patients
with MSA-P and stridor is still alive; mean disease duration and normal controls.
was 203 years (range, 16-23 years) in the whole population Results: Supine systolic BP (SBP) was not different
and 214 years (range, 18-23 years) in the subgroup with between groups. OH was present in patients but not in
stridor. Causes of death were respiratory arrest (n=2) or controls (p<0.05). Absolute SBP was significantly lower
unknown (n=3). and the change in SBP was significantly greater during
Conclusions: Few previous studies reported MSA patients tilting in PAF compared to MSA (p<0.05). Responses in
with a survival >15 years, but with poor clinical description. PD+AF were intermediate. BRS-a and VR were significantly
5.6% of our MSA had a disease history of >15 years. lower in all patient groups compared to controls (p<0.05)
Gathering clinical information regarding MSA patients with but there was no difference between patient groups (p>0.05).
prolonged survival may help to identify useful prognostic MSA patients had a significantly prolonged PRT compared
and protective factors. to PD+AF (p=0.035) and HRDB was significantly lower in
1. Kim et al. (2011) Survival of Korean patients with PAF compared to MSA (p=0.04).
multiple system atrophy. Movement disorders 26(5):909- Conclusion: PRT may be useful for differentiating MSA
912 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.

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


126 Posters, Sunday 9 September

P1096 P1097
Immunohistochemical analysis reveals Diagnostic significance of urethral
sympathetic column involvement in the sphincter electromyography in patients
SOD1 (G93A) transgenic mouse model of with multiple system atrophy
amyotrophic lateral sclerosis X. Qi1, L. Li2, W. Yao2, F. Qiu2
B. Kandinov1, A.D. Korczyn2, V.E. Drory2, D. Offen3,
1 Neurology, 2Navy General Hospital, Beijing, China
N.C. Grigoriadis4, O. Olga Touloumi4 Objective: To evaluate the significance of urethral sphincter
1Pharmacology and Physiology, Tel-Aviv University, 2Tel- electromyography (US-EMG) for the diagnosis of multiple
Aviv Sourasky Medical Center, 3Tel-Aviv University, Tel Aviv, system atrophy (MSA).
Israel, 4Aristotle University of Thessaloniki, Thessaloniki, Methods: 15 patients who were diagnosed as MSA and 17
Greece non-MSA patients were examined as controls were enrolled
Amyotrophic lateral sclerosis (ALS) is a progressive and in the study and US-EMG was performed in both groups.
fatal disorder caused by degeneration of the motor neurons Spontaneous activities during relaxation, parameters of
in the cerebral cortex, brain stem and spinal cord. Several MUPs mean duration and amplitude, percentage of
clinical reports indicated dysfunction of sympathetic and polyphasicity, satellite potential, recruited pattern and
parasympathetic innervation in ALS patients. In addition, amplitude during strong contraction were recorded and
we have recently reported elevated heart rate and blood analyzed.
pressure in transgenic (TG) mice carrying the SOD1 mutant Results: US-EMG changes of various abnormalities were
form of the human SOD1 transgene (SOD1G93A) even found in 13 cases of the MSA group (86.7%). There was
prior to the appearance of motor symptoms. In order to significant difference of electromyographic findings
further elucidate the underlying mechanisms of autonomic between the MSA group and the control group including the
impairment in ALS we performed an immunohistochemical mean duration and amplitude of motor unit action potentials
study of the superior cervical ganglia (SCG) and adrenal (MUAPs) as well as recruited pattern and amplitude during
glands (AG) in TG and wild-type (WT) mice at the age of heavy contraction.
75-80 days. SCG and AG sections were stained with primary Conclusions: US-EMG has certain values for the diagnosis
antibodies against tyrosine hydroxylase (TH) and choline of MSA. It could be used as a routine electrophysiological
acetyltransferase (ChAT). TH expression in AG revealed a method for those suspected of MSA and could be a surrogate
24% decrease in the SOD1G93A group compared to WT of EAS-EMG.
(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


Posters, Sunday 9 September 127

P1098 P1099
Diagnostic significance of urethral Sleep motor activity in parkinsonism at
sphincter electromyography and external disease onset: a possible biomarker
anal sphincter electromyography in useful for differential diagnosis
patients with multiple system atrophy M. Alessandria, G. Calandra-Buonaura, A. Cecere,
F. Qiu1, X. Qi1, L. Li2, J. Liu2 L. Sambati, R. Terlizzi, P. Guaraldi, F. Provini, P. Cortelli
1 Neurology, 2Navy General Hospital, Beijing, China IRCCS Istituto delle Scienze Neurologiche, University of
Bologna, Bologna, Italy
Objective: To assess the significance of urethral sphincter
electromyography (US-EMG) and external anal sphincter Introduction: Differential diagnosis of parkinsonism at
electromyography (EAS-EMG) for the diagnosis of multiple disease onset may be difficult. Aim of this study is to
system atrophy (MSA). describe videopolysomnographic (VPSG) motor findings in
Methods: US-EMGs and EAS-EMGs were performed in patients with recent onset parkinsonism.
15 patients diagnosed as MSA. Duration, motor unit action Methods: We studied 22 consecutive patients with
potentials (MUAPs) amplitude, and polyphasicity, as well as parkinsonian features and disease duration up to 3 years part
recruited pattern and amplitude during heavy contraction of the motor and non-motor prospective study on
were recorded and analyzed. parkinsonism at onset (BO-ProPark). Patients were
Results: Among 15 patients who were diagnosed as MSA, diagnosed following standard diagnostic criteria as
neural injuries were shown by both US-EMG and EAS- Parkinsons disease (PD, 12 patients), PD plus (PD with
EMG in 13 cases. There was significant difference of cognitive impairment or dysautonomia, 4 patients) and as
electromyographic findings between US-EMG group and parkinsonian syndromes (PS, 6 patients). All patients
EAS-EMG group (P=0.033 and 0.011, for comparison of underwent a full night VPSG, scored by a neurologist
means of MUAPs amplitude and medians of polyphasicity, blinded to the diagnosis.
respectively). Results: All patients showed reduced sleep efficiency with
Conclusions: Although US-EMG may be difficult to normal sleep macrostructure. In 3/6 PS patients apnoea/
perform, US-EMG may have the same specificity as EAS- hypopnoea index was >5. A sustained muscle EMG activity
EMG for the diagnosis of MSA, especially for the diagnosis or an excessive phasic muscle activity during REM sleep
of MSA patients with only urination disorders due to were shown in 14 patients (4/12 PD; 4/4 PD plus; 6/6 PS).
involvement of Onufs nucleus. 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.

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


128 Posters, Sunday 9 September

P1100 P1101
Quantitative electromyography of the Is cognitive impairment associated with
external anal sphincter in Huntingtons orthostatic hypotension in parkinsonism
disease patients at onset?
S. Podnar1, M. Kolenc2, J. Kobal1 L. Sambati, G. Calandra-Buonaura, F. Oppi, R. Poda,
University Medical Centre Ljubljana, Ljubljana, 2Novo
1
M. Stanzani Maserati, P. Guaraldi, R. Terlizzi,
Mesto General Hospital, Novo Mesto, Slovenia M. Alessandria, L. Solieri, R. Gallassi, P. Cortelli
Aims: In several extrapyramidal diseases Onufs nucleus IRCCS Istituto delle Scienze Neurologiche, University of
degeneration was also demonstrated by histology and Bologna, Italy
electromyography (EMG). Although Huntingtons disease Background: Parkinsonism at onset can be associated with
(HD) patients also often report bladder, bowel and sexual cognitive impairment and autonomic dysfunctions.
dysfunction Onuf s nucleus has not been systematically Objective: To describe the cognitive features of patients
studied in this population. This was the aim of the present with parkinsonism at onset and to investigate their eventual
study. association with orthostatic hypotension (OH).
Methods: From our registrar of patients with genetically Method: We consecutively selected patients with
confirmed HD all patients willing and capable to participate parkinsonism and disease duration up to three years to take
in the study using several standard questionnaires were part in the Bo-ProPark Study (Bologna-motor and non
recruited. Those reporting bladder and/or bowel dysfunction motor Prospective study on Parkinsonism at onset). Each
were also asked to undergo quantitative anal sphincter patient underwent, at baseline and after sixteen months,
EMG. neuropsychological assessment (Brief Mental Deterioration
Results: Of 72 patients (25 men) with genetically con Battery, Stroop Test, Semantic Fluency Task, Beck
firmed HD, 33 reported bladder and/or bowel dysfunction. Depression Inventory) and tilt table test (continuous
Anal sphincter EMG was performed in 14 of them (8 men), monitoring of arterial blood pressure and heart rate) to
33 to 67 years of age (meanSD, 4810 years). Their detect the presence of OH. The clinical diagnosis was made
disease durations were 3 to 15 years (85 years), and the at the second evaluation, according to international
number of huntingtin CAG repeats 40 to 52 (464). In all diagnostic criteria.
but 3 patients decreased tonic activity and/or decreased Results: We recruited 27 patients (21 Parkinsons disease
voluntary activation were found in the anal sphincter. (PD); 2 Progressive Supranuclear Palsy (PSP); 1 Multiple
However, in no patient quantitative EMG abnormalities System Atrophy (MSA); 3 Parkinsonian Syndromes not
were found. otherwise specified (PS)). 13 of 27 patients showed
Conclusions: Our study did not demonstrate EMG signs of neuropsychological impairment (NI). In these patients we
the Onuf s nucleus degeneration in HD patients. Decreased observed 3 different patterns of NI: executive functions
anal sphincter tonic activity and voluntary activation, as impairment (8 patients: 1MSA, 1PS, 6 PD); executive
well as bladder and bowel dysfunction could probably be function, verbal memory and fluency impairment (4
explained by basal ganglia or central autonomic structures patients: 1 PSP, 3 PD); dementia, (1 PSP patient). These
degeneration. 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.

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


Posters, Sunday 9 September 129

P1102 P1103
Heart rate variability in chronic vs. Association of EEG scalp potentials with
frequent migraine patients autonomic innervations of the heart
O. Grosu1, S. Odobescu1, V. Lacusta2, L. Rotaru1, A. Subhani, L. Xia, A.S. Malik
D. Concescu1, I. Moldovanu1,2 Department of Electrical and Electronics Engineering,
Neurology, Institute of Neurology and Neurosurgery, 2State
1 Universiti Teknologi Petronas, Tronoh, Malaysia
Medical and Pharmaceutical University, Chisinau, Moldova Background: Cerebral activation and autonomic nervous
Introduction: Heart rate variability (HRV) is a marker of system have significance in studies such as mental stress.
autonomic activity and reduced HRV correlates with sudden This study aims to analyse variations in electroencephalogram
death. Data on HRV in migraine are inconclusive and (EEG) scalp potentials that may influence autonomic
restricted to episodic type, with reports of increased HRV innervations during video games.
especially in the young. The aim of the study was to evaluate Methods: 12 healthy participants (2 females) were recruited
autonomic cardiac regulation in chronic migraine (CM) in this study. EEG and electrocardiogram (ECG) signals
compared with frequent migraine (FM) patients by mean of were measured during game playing and rest condition.
HRV. Sympathetic (high heart rate (HR)) and parasympathetic
Methods: The study included 109 CM and 61 FM patients (lower normalized high frequency (HFnu)) innervations
corresponding to IHS criteria. In all subjects, a 5-min from ECG were evaluated from heart rate variability (HRV).
electrocardiographic recording during paced breathing was Meanwhile ratio of theta at Fz to alpha at Pz power (Fz()/
performed, and HRV was analyzed in time and frequency Pz()) was calculated from the EEG scalp potentials to
domain according to international guidelines. SDNN measure workload.
represents the standard deviation of the NN (R-R) interval Results: Results show a significant surge in both Fz()/
and reflects the total power of HRV. HRV is reduced when Pz() and HR (p<0.001, paired t-test) and a drop in HFnu
SDNN <100ms. power (p<0.05, paired t-test) as evident in table 1 during
Results: CM presented a reduced SDNN value vs. FM games (0.364, 0.311, 0.361) as compared to the rest
group (56.584.95 vs. 99.0416.17, p<0.05) which reflect condition (0.419).
a reduced HRV. LF (low frequency) was increased
Condition Rest Game level1 Game level 2 Game level3
(53.842.32 vs. 45.193.04, p<0.05) and HF (high
Averagestd 0.4190.18 0.3640.13 0.3110.12 0.3610.17
frequency) reduced (46.162.32 vs. 54.813.04, p<0.05) in
CM. LF/HF ratio representing an index of sympatho - vagal [Table 1. HFnu during rest and games]
balance was higher in patients with CM vs. FM (1.730.23
vs. 1.050.18, p<0.05). Conclusion: It is concluded that enhanced cerebral
Conclusion: Decreased HF suggested a reduced activation (high Fz()/Pz() ratio) is accompanied with
parasympathetic influence, increased LF/HF ratio reflecting increment in sympathetic innervations and decrement in
a sympathetic over activity in the cardio-vascular system in parasympathetic innervations. Moreover, the results indicate
CM patients. The reduced HRV in CM found in our study that correlation of cerebral activation and autonomic
shows a strong relationship between autonomic cardiac innervations can be used to measure mental stress since they
function and central and peripheral sensitization (as a can provide an assessment of workload.
mechanism of migraine chronification) and may provide
some links to ischemic stroke.

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


130 Posters, Sunday 9 September

P1104 P1105
The immediate effect of paced breathing 24-hour ambulatory blood pressure
with biofeedback and active cycling on profiles in diabetic autonomic neuropathy,
heart rate variability in patients in the amyloid neuropathy and Holmes-Adie
sub-acute post-stroke phase syndrome
P. Ginsburg1, G. Bartur2, S. Peleg2, M. Katz-Leurer1 E.M. Hagen1,2,3, D.A. Low2,3, E. Vichayanrat2,3,
1 Tel Aviv University, 2Reuth Medical Center, Tel Aviv, Israel V. Iodice2,3, A.P. Owens2, V. Ponnusamy2, M. Peche2,
Introduction: Autonomic instability is a common K. Bleasdale-Barr3, L. Mason3, C.J. Mathias2,3
1Department of Clinical Medicine, University of Bergen,
phenomenon following stroke with signs and symptoms of
hyper stimulation of the sympathetic nervous system. There Bergen, Norway, 2Autonomic & Neurovascular Medicine
are at least two known non pharmacologic methods which Unit, Imperial College Faculty of Medicine, 3Autonomic
can alter autonomic balance; aerobic exercise and heart rate Unit, UCL Institute of Neurology, National Hospital for
variability (HRV) biofeedback, both showed success in the Neurology and Neurosurgery, London, UK
rehabilitation program among cardiac or diabetic patients Objective: The aim of this study was to investigate 24-hour
with autonomic impairment. ambulatory blood pressure monitoring (AMBP) results in
The aim of the present study was to assess the feasibility patients with insulin-dependent diabetic autonomic
and the possible impact of slow abdominal breathing with neuropathy, Amyloid neuropathy and Holmes-Adie
biofeedback and aerobic exercise stimuli on autonomic Syndrome.
regulation, by assessing HRV, among patients at the sub- Design: Data from 24-hour AMBP and activity diaries of 13
acute phase post stroke. diabetic autonomic neuropathy, 15 Amyloid neuropathy and
Methods: 15 patients up to one month post stroke underwent 12 Holmes-Adie Syndrome patients were analysed.
measurements of HRV under three conditions while sitting Diagnoses were verified by medical records.
down: Results: Mean age was 44.316.1 for diabetic autonomic
(a) at rest with self-select breathing frequency, neuropathy, 47.811.8 for Amyloid neuropathy and
(b) performing paced breathing with biofeedback and 56.87.7 years for Holmes-Adie Syndrome. Male
(c) cycling while sitting. percentages were 38.5, 73.3 and 33.3, respectively.
Results: Patients were by mean 10 days post event with Orthostatic hypotension was detected on tilt-table testing in
Barthel mean score of 75/100. Patients could reduce their 46.0, 26.7 and 8.3% of the patient groups, respectively.
breathing rate during paced breathing by mean of 6 breaths Mean daytime vs. night-time systolic/diastolic BP (SBP/
per minute (from 15 to 9) and could tolerate for 9 (3) DBP) was 130/81 vs. 122/72mmHg for diabetic autonomic
minutes in constant cycling. Performing paced breathing neuropathy, 123/81 vs. 113/73mmHg for Amyloid
with biofeedback showed a significant increase in HRV neuropathy and 127/81 vs. 118/72mmHg for Holmes-Adie
time domain parameters as compared to rest, for example; Syndrome. There was an impaired nocturnal systolic blood
RMSSD at rest 314.7ms, during paced breathing pressure profile in 61.5% diabetic autonomic neuropathy,
41.64.5ms p<0.05. Patients exhibit significant decreased 60.0% Amyloid neuropathy and 58.3% Holmes-Adie
HRV parameters during cycling, as compared to rest values Syndrome patients. When assessing the AMBP and diary
(RMSSD during cycling 21.82.5ms, p<0.05). activities, there was a significant SBP and DBP decrease in
Conclusions: Patients post stroke may alter autonomic diabetic autonomic neuropathy patients and a significant
balance by performing paced breathing and cycling exercise. 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.

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


Posters, Sunday 9 September 131

P1106 P1107
Postural tachycardia syndrome (PoTS) Parasympathetic dysfunction in ALS
and 24-hour ambulatory blood pressure patients
and heart rate monitoring H. Lahrmann1, E. Toeglhofer2, W. Struhal3
E.M. Hagen1,2,3, D.A.
Low2,3, E.Vichayanrat2,3,
1Private Practice, 2Department of Biomedical Engineering,
V. Iodice2,3, A.P. Owens3, K. Bleasdale-Barr2, L. Mason2, Technical University, Vienna, 3Autonomic Laboratory and
I. Skeavington2, C.J. Mathias2,3 Department of Neurology, General Hospital, Linz, Austria
1Department of Clinical Medicine, University of Bergen, Background: Amyotrophic lateral sclerosis (ALS) is a
Norway, 2Autonomic Unit, UCL Institute of Neurology, neurodegenerative disease with progressive loss of
National Hospital for Neurology and Neurosurgery, motoneurones. Recent studies have shown involvement of
3Autonomic & Neurovascular Medicine Unit, Imperial
non-motor structures within CNS, e.g. frontotemporal
College Faculty of Medicine, London, UK dementia, autonomic dysfunction. The correlation of
Objective: Postural tachycardia syndrome (PoTS) is respiratory, bulbar and parasympathetic dysfunction has not
characterized by orthostatic tachycardia (30 beats/min), in been clarified yet.
the absence of orthostatic hypotension, with orthostatic Aim of the study: We investigated the prevalence of
intolerance. We analyzed data from 24-hour ambulatory parasympathetic dysfunction in ALS patients compared to a
blood pressure monitoring (AMBP) and heart rate (HR) in control group and its association with bulbar symptoms and
patients with PoTS. respiratory failure.
Study design: Data from 24-hour AMBP, HR and diary Methods: 34 ALS patients were included and divided into
activities of 15 women with PoTS were analysed. The diary four subgroups according to their bulbar status and their
comprises a schedule of autonomically focused activities lung function. The control group consisted of 11 age
design to provoke changes in BP and HR. All patients matched healthy persons. All study participants underwent
underwent a 60 head-up tilt prior to the AMBP as part of the following procedures: history taking, neurological
their autonomic cardiovascular investigations. examination, lung function test, blood gas analysis,
Results: Mean age was 35.47.8 years. All patients met the autonomic testing (Ewing battery).
criteria for PoTS on head-up tilt. Results: A significantly higher prevalence of
Mean (SD) daytime vs. night-time systolic/diastolic BP parasympathetic dysfunction was observed in ALS patients
(SBP/DBP) was 118(12)/77(11) vs. 100(10)/59(10) compared to the control group. Bulbar involvement did not
mmHg (p<0.001). Mean (SD) daytime vs. night-time heart correlate with the measured autonomic parameters. Patients
rate (HR) was 94(21) vs. 74(14) beats/min (p<0.001). A with respiratory failure showed significantly higher resting
normal nocturnal systolic blood pressure fall was evident in heart rates (657 vs. 8527 bpm, p<0.018) and a significant
13/15 patients. Combining AMBP with diary activities reduction of heart rate variability (e.g. coefficient of
showing significant increases in SBP, DBP and HR during variation 4.72.1 in control group and 1.91.0 in respiratory
sitting and/or standing vs. lying (p<0.001). 13 patients met failure group, p<0.034).
the criteria for PoTS during these manoeuvres. There was Discussion: The results of this study indicate a significantly
no evidence for postprandial tachycardia or hypotension. higher rate of parasympathetic dysfunction in ALS patients.
SBP and HR were significantly higher during post- vs. pre- Dysautonomia correlates more with respiratory failure than
exercise standing (p<0.001 and p=0.001, respectively). with the patients bulbar status. The autonomic dysfunction
Conclusion: Except for the abnormal responses to standing, in ALS seems to be related to the progression of the disease,
these findings indicate normal 24-hour BP and HR profiles reflected by the degree of respiratory impairment.
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


132 Posters, Sunday 9 September

P1108 P1109
Postural tachycardia syndrome, joint Analysis of heart rate variability to assess
hypermobility syndrome and Chiari type I the background lead exposure in children
malformation: clinical description and during orthostatic test and exercises
autonomic evaluation S. Tymchenko, E. Evstafyeva
V. Iodice1, D. Low1, R. Grahame2, C. Mathias1 Physiology Department, Crimea State Medical University
1Imperial College London, 2University College Hospital, named after S. I. Georgievsky, Simferopol, Ukraine
London, UK Heart rate variability (HRV) method is already an established
Postural Tachycardia Syndrome (PoTS) is characterized by tool in early detection of disorders of the autonomic cardiac
an increase in heart rate of 30 beats/min on head-up tilt/ regulatory system. The present study was designed to
standing without orthostatic hypotension associated with investigate whether the background lead exposure could
orthostatic intolerance (OI). PoTS can be associated with modify HRV during orthostatic test and exercises. Time
Joint Hypermobility Syndrome (JHS), a heritable disorder (SDNN, RMSSD, pNN50) and frequency (TP, VLF, LF, HF,
of connective tissue. The Chiari type I malformation (CM1) LF/HF, LFn and HFn) domain indexes of RR interval
is characterized by herniation of cerebellar tonsils 3-5 mm variability were assessed in 30 healthy 10-11 year old
below the plane of the foramen magnum and can present children who completed orthostatic test and exercise (step-
with a variety of clinical symptoms, frequently including test).
occipital headaches, other rare presentations are OI and A normal individual reaction was observed with a
syncope. An association between PoTS, CM1 and EDS III characteristic HRV altered in a predictable manner in
has not been previously described. response to orthostatic test and exercise (comprising a
Objective: To evaluate the clinical features and significantly reduced RRNN, pNN50, HFn and elevated
cardiovascular autonomic function in patients with OI and LFn, LF/HF). While SDNN was significantly higher during
CM1. exercises, that can indicate changes in the state of the
Methods: We described 5 females with OI and CM1. sympathovagal balance.
Symptoms were recorded and patients underwent autonomic During orthostatic test and exercises significantly higher
function and MRI brain assessments. HRV (increased RMSSD, pNN50, HF and HFn and reduced
Results: Mean age was 24.28.2 years. The most frequent LF/HF, LFn) was associated with elevated lead levels
presenting symptoms were: OI (palpitations, fatigue and (0.31<rs<0.48; 0.01<p<0.05) measured in hair by X-ray
syncope, 60%) and headache (40%). Additional symptoms spectrophotometry. No correlation was present between
were: bladder (60%) and gastrointestinal dysfunction HRV parameters recorded at rest and lead concentration.
(60%). Autonomic function tests showed PoTS features in These data indicate that effects of background lead exposure
all patients. All patients met the Brighton criteria for JHS on HRV were found during orthostatic test and exercise and
and MRI brain scans confirmed CM1. 4 patients underwent mainly for the spectral components of HRV. Results suggest
surgical decompression with the following clinical that background lead exposure may increase vagal tone,
outcomes: temporary improvement of headache (1 patient), resulting in elevated HRV.
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


Posters, Sunday 9 September 133

P1110 P1111
Effects of martial arts on heart rate Reproducibility of sympathetic skin
variability and hostility response: within-subject consistency of
S. Tymchenko, K. Zavgorodnyaya wave-form and size across different
Physiology Department, Crimea State Medical University stimulation modalities
named after S.I. Georgievsky, Simferopol, Ukraine
M. Toyokura
Hostility has been associated with an increased risk for Rehabilitation Medicine, Tokai University Oiso Hospital,
cardiovascular disease. This study aims to investigate Oiso, Japan
whether this relationship could be explained by impaired Objective: The aim of the present study was to investigate
cardiac autonomic control assessed by heart rate variability the specific, intra-subject consistency of the waveform type
(HRV). Measures of HRV were obtained in 25 martial arts and size of sympathetic skin response (SSR) evoked by
(aikido) participants and 28 age matched (17-25 years) different modalities of stimulation. The results were
healthy non-athlete control subjects from both time- and discussed based on the neurophysiological mechanism of
frequency analysis of 5 minutes recordings of HRV. Time generating SSR.
domain indexes included mean NN (RRNN), SDNN, Methods: SSRs were obtained from 38 normal subjects
RMSSD and pNN50. Total-, low- (LF) and high (HF) using three different modalities of stimulation: auditory
frequency spectral power were calculated, as well as their (a-SSR), electrical (e-SSR), and magnetic (m-SSR). Four
ratio (LF/HF). Results suggest that resting heart rate was stimuli of each modality were applied. The wave-forms
lower in Aikido athletes. Compared with control subjects were classified into two types, P (positive component larger
athletes had significantly increased SDNN, RMSSD, than the negative component) and N (vice versa) (Toyokura,
pNN50 (p<0.05), showing evidence of increased vagal 1998).
activity. Hostility scores (Buss-Durkee Hostility Inventory) Results: P-type wave-form was less frequent in the a-SSR
showed significant differences between the groups than the e- and m-SSRs. The maximum amplitude of a-SSR
(p<0.001) with higher scores in non-athletes. Aikido was significantly smaller than those of e- and m-SSRs. The
athletes have significantly higher values in the BDHI size of e- and m-SSRs did not significantly differ. The
assault subscale, while controls got significantly higher incidences of the respective waveforms and maximum
values in verbal aggression (p<0.01). Correlation analysis amplitude values showed intra-subject correlation among
revealed that in Aikido athletes verbal aggression had a the SSRs evoked by different types of stimulation.
significant negative correlation with SDNN, RMSSD, HF Conclusions: The SSR waveform and size seemed to be
and positive association with LF/HF (0.44<rs<0.50; rather consistent in individuals even if the stimulation
p<0.05). These findings suggest that HRV and hostility are modality was changed. The results suggested that
affected by exercise, especially martial arts (aikido), which endogenous factors in an individual related to the
can have beneficial effects on the cardiovascular risk development of SSRs, e.g., the individuals emotional state,
profile. 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.

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


134 Posters, Sunday 9 September

P1112 P1113
Syncope due to concomitant cardiac Autonomic nervous system reactivity in
disease and neurogenic orthostatic normotensive subjects with a family
hypotension: a case report history of hypertension during Valsalva
C. Di Stefano, V. Milazzo, G. Bruno, S. Maule, F. Veglio manoeuvre
Autonomic Unit and Hypertension Unit, Department of K. Cankar, Z. Melik, M. Strucl
Medicine and Experimental Oncology, University of Turin, Institute of Physiology, Medical Faculty, University of
San Giovanni Battista Hospital, Turin, Italy Ljubljana, Slovenia
Syncope may be classified into several forms, characterized Introduction: This study was designed to address
by a different prognosis. alterations in autonomic nervous system activity in
We report a case of a 59-year-old man, referring to our Unit normotensive subjects with a family history of hypertension.
in 2011. He complained of orthostatic syncope and We compared the autonomic nervous system activity in 11
intolerance since 2004, when he was diagnosed with normotensives with a family history of hypertension (age
coronary artery disease, treated with PTCA. In 2008 pauses 23.30.4) and 14 normotensives with no family history of
>3 were found during Holter ECG. After implantation of hypertension (age 22.90.3).
biventricular PM, symptoms were only reduced. He Methods: In all of the participants their cardiovascular
underwent ABPM (113/68 mmHg day-time, 129/78 mmHg parameters, including impedance cardiography, were
night-time; high BP variability; orthostatic symptoms measured at rest. In addition, the Valsalva manoeuvre was
related to hypotension), tilt test (stopped after 15 because performed and Valsalva Index was obtained. On the basis of
of fainting and hypotension), and echocardiography (left the arterial blood pressure change, provoked by the Valsalva
ventricular hypertrophy and a preserved systolic function). manoeuvre, the latency of baroreflex response was
During our evaluation, he also reported anhydrosis and determined.
erectile dysfunction; we found orthostatic hypotension Results: Normotensive subjects with a family history of
(clinostatism: 117/75 mmHg; orthostatism: 90/60 mmHg hypertension, compared to the control group, showed
after 1; 79/57 mmHg after 3). significantly higher heart rate (75.03.4 vs. 62.41.8 beats/
Ewings battery of autonomic tests could not be performed min), cardiac output (7.60.4 vs. 6.70.3L/min), left
because of PM; hand grip test was pathological; basal ventricular weight index (4.60.3 vs. 3.90.1) and shorter
plasma adrenaline (30 pg/ml) and noradrenaline (20 pg/ml) ejection time (298.94.9ms vs. 316.84.5ms) (t-test,
were low and not responsive to orthostatism; cardiac SPECT p<0.05). In addition, the normotensives with a family
scan with 123I-MIBG showed a cardiac sympathetic history of hypertension have decreased latency of the
denervation. Neurological evaluation was normal. baroreflex response (7.00.5s) compared to the control
Secondary forms of autonomic neuropathy were excluded. group (10.50.9s) (p<0.001).
Diagnosis of probable pure autonomic failure was made and Conclusions: Our results indicate that even normotensives
therapy with fludrocortisone and dihydroergotamine was with a family history of hypertension exhibit changes of
started; orthostatic symptoms greatly improved. At 12 some cardiovascular parameters at early age. The changes
months of follow-up, the patient remains asymptomatic. in Valsalva manoeuvre response also show alteration of the
Diagnosis and management of syncope may be complicated autonomic nervous system reactivity.
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


Posters, Sunday 9 September 135

P1114 P1115
Juvenile migraine and the role of the A case of severe orthostatic hypotension
autonomic system: a preliminary clinical and sensory ataxia as presenting
study symptoms of Sjgrens syndrome
G. Giordano1, C. Spitaleri2, F. Brighina3, I. Camarda2, M. Kirbi, D. Georgiev, R. Berlot, B. Megli,
F. Consolo2, M. DAmelio3, L. Paziente2, V. Raieli2, N. Zupani Krinar
G. Santangelo2, E. Vanadia2, F. Vanadia2 Department of Neurology, University Medical Centre
1U.O. Di NPI Ospedale di Cristina, ARNAS Civico, 2Child Ljubljana, Slovenia
Neuropsychiatry Unit - Di Gristina Hospital - ARNAS Introduction: We present a case of a 61-year-old patient
CIVICO, 3Neurological Department, University of Palermo, with subacute autonomic and sensory polyneuropathy
Italy associated with Sjgrens syndrome.
Background and aims: Cranial Autonomic Symptoms Methods: The patient presented with transitory itching in
(CAS) are frequently reported in adult migraineurs, but the the chest and progressive symptoms of genitourinary and
prevalence of CAS in children affected by primary later cardiovascular autonomic neuropathy, followed by
headaches is unknown. In addition, recent studies suggest a predominantly large fibre sensory neuropathy for all
role of the autonomic nervous system in paediatric migraine modalities. Four months after the first symptoms, he was
by the involvement of trigemino autonomic reflex. bedridden due to severe ataxia and orthostatic hypotension.
Therefore, the aim of this study was to evaluate the He also developed severe urinary retention. Repeated
prevalence of CAS during cephalalgic attacks in a juvenile autonomic cardiovascular function tests confirmed
population with primary headaches and to study the parasympathetic and sympathetic failure; nerve conduction
correlation between CAS and the main symptoms of studies revealed severe, predominantly sensory axonal
migraine. polyneuropathy. Rheumatologic tests were negative. CSF
Methods: A total of 193 children suffering from headache protein levels were mildly elevated, with normal cell counts;
(M 86 F107, aged 4-17 years) were consecutively enrolled tests for paraproteinemia, amyloidosis, infectious and
in an 18-months period. A short questionnaire investigating paraneoplastic causes were negative. Imaging studies of
the presence of CAS was administered to all children. The spine and head were unremarkable. Empirical treatment
following CAS were included in our study: conjunctival with intravenous immunoglobulins (IVIG) showed poor and
injection, tearing, palpebral oedema, nasal congestion, short-lasting effects.
rhinorrhoea, red ear, facial flushing, miosis, ptosis, forehead Six months after presentation, he reported dry eyes and
or facial sweating. mouth. Schirmers test was positive. Rheumatologic
Results: 168 children (86%) were affected by migraine, the screening now showed positive anti-SSB(Ro)/SSB(La)
remaining 25 (14%) by other primary headaches. CAS were antibodies. Sedimentation rate and plasma cryoglobulins
present in 99 with migraine (59%) and only in 6 with others were elevated. Salivary gland biopsy was consistent with
type of headache (24%). Two or more CAS were found in Sjgrens syndrome. Infusions of corticosteroids led to a
(75%) children suffering from migraine during their attacks. remarkable improvement: autonomic and sensory symptoms
The most common signs were flushing, red ear and reduced, ataxia and orthostatic hypotension almost
conjunctival injection. CAS were more significantly disappeared. Corticosteroids were successfully tapered
frequent in migraineurs (p<0.5) . down to a low maintenance dose without symptom
Conclusion: These preliminary findings indicate that CAS deterioration.
are rather common in the course of paediatric migraine Conclusion: Severe autonomic dysfunction as presented
attacks. Besides, these results support the role of the here is rare in Sjgrens syndrome. Disabling orthostatic
trigemino-autonomic reflex in the pathophysiology of hypotension and ataxia were the first symptoms in the
migraine. 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.

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


136 Posters, Sunday 9 September

P1116 P1117
Autonomic disorders in patients with Chronic intestinal pseudo-obstruction
ischemic stroke with anti-Hu antibody without neoplasia
I. Darii1, I. Moldovanu1, M. Sangheli2, S. Plesca1 I. Moreira1, R. Pimentel2, E. Santos1, M. Salgado2
1Institute of Neurology and Neurosurgery, Institute of
2 1Neurology Department, 2Gastroenterology Department,
Neurology and Neurosurgery, State Medical and Hospital Santo Antnio, Centro Hospitalar do Porto,
Pharmaceutical University, Chisinau, Moldova Portugal
Background: Stroke is the most common life-threatening Introduction: Chronic intestinal pseudo-obstruction
neurologic disease and the leading cause of serious long- (CIPO) is characterized by mechanical obstruction of the
term disability. Autonomic disorders are common in the small/large bowel, without an anatomical lesion. Anti-Hu
acute post-stroke phase, but little is known about the long syndrome is one classic, but rare, cause of CIPO, occurring
-term effects in the recovery period. in approximately 6.5% of the cases. These antibodies are
Objective: To determine the type of autonomic function usually associated with neoplasms, particularly small cell
impairment during stroke recovery and their influence on lung cancer.
stroke rehabilitation. Case report: A 40-year-old woman, with history of one
Methods: The study involved 32 patients (mean age 643.2 spontaneous abortion and Raynaud phenomenon, 29 yo and
years) with ischemic stroke and 32 healthy controls; no other diseases/complaints, developed marked
prospective evaluation of 12 cases in 1 month and 20 after constipation, with multiple dejections of liquid stools, crises
6 months post hemispheric stroke. The patients underwent of abdominal distension and vomiting. Extensive gastro-
neurological examinations, and answered an originally intestinal work-up was compatible with CIPO. When 36 yo
designed questionnaire assessing the autonomic on set of dysphagia for solids, achalasia was diagnosed, and
interoceptive profile. improved after oesophagic dilatation. When 38 yo worsened
Results: The patients who had an ischemic stroke, besides requiring multiple hospitalizations by intestinal occlusive
main symptoms, presented different autonomic dysfunctions periods, without response to domperidone, erythromycin or
at 1 month versus 6 months. The most common clinical laxatives. Had sharp weight loss needing to escalate to
problems included abnormalities in heart rate and blood cisapride, artificial enteral nutrition and then total parenteral
pressure regulation (58.1% vs. 66.8%), reflecting nutrition. Gastrointestinal manometry was compatible with
cardiovascular autonomic dysfunction and asymmetric intestinal neuropathy. Neurological examination, nerve
sweating with cold hemiplegic limbs (61.3% vs. 77.6%), conduction and QST were normal. Rectal biopsy was
reflecting changes in the sudomotor and vasomotor negative for amyloid. Anti-Hu antibodies were positive.
regulatory systems. Stroke-induced gastrointestinal, sexual Wide-ranging investigation showed no evidence of
and urinary disorders are not uncommon. Most of the malignancy. Steroids and azathioprine were attempted, but
patients presented vegetative dysfunctions, the most severe not maintained because of vomiting. Now shes under total
ones being observed 6 months after stroke. parenteral nutrition and gastrostomy is planned.
Conclusion: Although autonomic disturbances often are Comments: This is a case of autonomic neuropathy
most pronounced immediately after the stroke, they are not involving myenteric plexus with anti-Hu antibodies with
limited to the acute phase only, but are long-term sequelae, eleven years of follow-up without evidence of malignancy.
being the cause of serious long-term disability. Impaired We hypothesized that it is more likely an auto-immune
autonomic function may increase the risk of all-cause disease than paraneoplastic or an immune tumour regression
mortality and cardiovascular mortality in older stroke mediated by anti-Hu antibodies.
survivors.

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


Posters, Sunday 9 September 137

P1118 P1119
A preliminary study on blood pressure Investigating the feasibility of using
variability assessed from left and right objective motion data to assist the
arms in the elderly diagnosis and management of
M. Hsu1, J. Lin1, Y. Chang2, Y. Chou3 cardiovascular autonomic dysfunction
1Department of Physical Therapy, Koahsiung Medical
R.M. Kwasnicki, D.A. Low, C. Wong, D. Jarchi, B. Lo,
University, Kaohsiung, 2Department of Physical Therapy, C.J. Mathias, A. Darzi, G.Z. Yang
Chang Gung University, Taoyuan, 3Department and Imperial College London, UK
Graduate Institute of Neurology, Koahsiung Medical
University, Koahsiung City, Taiwan R.O.C. Introduction: Cardiovascular autonomic dysfunction (AD)
manifests itself through various symptoms such as light-
Introduction: Autonomic dysfunction is associated with headedness, palpitations and syncope. Stimuli for such
higher risks of cardiovascular disease. Autonomic function events include physical activity, stress, and posture changes.
can be assessed non-invasively through analyzing blood Although the relationship between physical activity and
pressure variability. There are differences in blood pressure symptoms is important, activity data is currently limited to
between the two arms, which may possibly influence subjective, and potentially inaccurate, patient diaries.
autonomic function assessment. Therefore, the purpose of Our aim was to assess the feasibility of using a lightweight
this study was to compare the autonomic function assessed motion sensor (e-AR lite, ICL) to collect an objective record
between the two arms. of motion for analysis alongside clinical cardiovascular
Methods: 6 healthy old people were recruited from a autonomic function parameters.
community recreation center. The ECG (Biopac MP100 Methods: We recruited a patient with suspected
A/D converter and Biopac ECG module) and blood pressure cardiovascular AD, who wore an e-AR sensor throughout
(CNAP Monitor 500, CNSystems Medizintechnik AG) laboratory cardiovascular autonomic function testing and
were monitored continuously under three conditions: 24-hour ambulatory monitoring. Tri-axial accelerometer
supine, sitting, and a mental test. In each condition, the data from the e-AR sensor was analysed alongside blood
blood pressure for both arms and the ECG were recorded, pressure/heart rate data and the patients activity diary.
each arm for five minutes. The order of arm tested was Results: Body orientation during head-up tilting was visible
randomized. Blood pressure power spectrum was analyzed from the e-AR sensor data. Cervical head movements were
afterwards. Two-way repeated ANOVA was used to analyze also clearly recorded and were related to a fall in blood
between arm differences under three conditions for low pressure and heart rate with associated pre-syncopal
frequency (0.04-0.15, LF), high frequency (0.15-0.40, HF), symptoms. Although no unusual cardiovascular events
and LF/HF ratio. occurred during 24-hour ambulatory monitoring, we were
Results: Significant interactions were found between arm able to accurately quantify both the duration and nature of
and condition for LF and HF, while there was no interactions activities recorded in the patients diary using the e-AR
for the LF/HF ratio. LF and HF from the right arm were sensor, with corresponding physiological changes.
significantly higher than from the left arm in sitting Conclusion: We have demonstrated the feasibility of using
condition (p<0.0005). There are no significant differences a lightweight motion sensor to relate the symptoms and
between arms for the LF/HF ratio under any condition. objective data of cardiovascular AD to an objective account
Conclusions: Differences in blood pressure variability of patient activity and posture. The true value of objective
between arms may exist to some extent. Further studies with motion capture in assisting with diagnosis and management
a larger sample size are needed to provide insights into of AD must now be investigated in small study cohorts.
methodological considerations for autonomic function
assessment.

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


138 Posters, Sunday 9 September

P1120 P1121
The effect of levetiracetam therapy on the RR interval variation and the sympathetic
autonomous nervous system in epilepsy skin response in the assessment of
patients autonomic function in diabetic neuropathy
K. Ekmeki, Y. Altun, Y. Tumay, Y. Ozkul H. Ulvi, U. Avar, R. Demir, L. zel, G. zdemir,
Neurology, Harran University, Sanliurfa, Turkey A. Ertekin, R. Aygul
Aim: It was aimed to research the effects of levetiracetam Department of Neurology and Family Medicine, Faculty of
on some autonomic functions by comparing autonomous Medicine, Atatrk University, Erzurum, Turkey
nervous system tests in epilepsy patients using levetiracetam The aim of our study was to evaluate possible autonomic
monotherapy with the tests of healthy volunteers who do not nervous system (ANS) dysfunction in patients with diabetic
use drugs. neuropathy (DN), and its correlation with abnormalities of
Method: 41 patients diagnosed with partial epilepsy using sensorimotor nerve conduction study and clinical autonomic
levetiracetam were included in this study. The control group symptoms. We studied 44 patients with DN; the mean age
was selected from 35 healthy volunteers who do not have was 55.5612.92 years (range 30 yrs to 70 yrs; 24 female
epilepsy. RR interval variation (RRIV), valsalva, and tilt and 20 male) and 35 age-matched healthy subjects (control);
tests were applied to patient and control groups in order to mean age was 34.1912.74 years (range 24 yrs to 48 yrs; 20
assess the autonomous nerve system functions. female and 15 male). Mean RR interval and SSR in patients
Findings: No statistically significant differences were with DN was significantly more abnormal than that of the
found in the results of RRIV, valsalva, and tilt tests in control subjects (p<0.05). No correlation was observed
patients in comparison with the control group (p>0.05). No between patient age, sex, duration of DN history,
statistical significances were observed when the results of abnormalities of sensorimotor nerve conduction and
upright position and the postural blood pressure changes abnormalities in RR interval, SSR. These data indicate that
were compared with the control group (p>0.05). patients with diabetic neuropathy show abnormalities of
Result: Our findings had shown that using levetiracetam ANS function. We conclude that SSR and RR interval
therapy had no effect on the responses of heart rate and variation, both of which can easily be performed in the
blood pressure in epilepsy patients. electromyography laboratory, are helpful in combination in
the assessment of autonomic function in diabetic neuropathy.

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


Posters, Sunday 9 September 139

P1122 P1123
Dispersion of ventricular repolarisation as Autonomic dysfunction: causes and
diagnostic tool for the assessment of presentations. A retrospective study in a
autonomic function in diabetic neuropathy tertiary hospital
H. Ulvi, U. Avar, Z. Avar, Z. Cansever, R. Demir, J.J.Y. Ong, K.W.P. Ng, Y. Gao, E.P. Wilder-Smith,
L. zel, R. Aygul Y.C. Chan
Departments of Neurology and Family Medicine and Neurology, National University Health System, Singapore,
Medical Education, Faculty of Medicine, Atatrk University, Singapore
Erzurum, Turkey Introduction: Due to increasing availability, tests for
Diabetes mellitus has been shown to affect almost all autonomic function are increasingly utilized to detect
systems of the human body and abnormalities in functions autonomic dysfunction. We did a retrospective study to
of autonomic nerves innervating various parts have been determine the causes and presentations of patients with
observed in several studies. Dispersion of repolarisation has autonomic dysfunction tested in our tertiary hospital.
been a proposed measure of repolarisation heterogeneity, Methods: This was a retrospective descriptive study of
and increased dispersion has been found to be associated patients with autonomic dysfunction tested in our
with an increased incidence of malignant ventricular neurodiagnostic laboratory between January 2009 and
arrhythmias. However, in literature, the assessment of the December 2011. Depending on the indication, patients
parameters of ventricular dispersion and their correlation underwent one or more of the following studies: tilt-table
with abnormalities of sensorimotor nerve conduction study test, heart rate variability (HRV) during deep breathing,
in diabetes mellitus patients have not been reported. Valsalva manoeuvre (VM) or sympathetic skin response
We studied 44 patients with diabetic neuropathy (DN) and (SSR) test.
41 age-matched healthy subjects. In all persons 12 leads Results: A total of 219 patients (72 females, 147 males,
ECG were recorded at a speed of 50mm/s and somatic nerve mean age 58.217.9) were tested. 40.2% (n=88) of patients
conduction studies were carried out. Ventricular had abnormal findings in one or more test categories. The
repolarisation parameters (QT, QTc, JT, and JTc) and most common presentations were: orthostatic hypotension
ventricular repolarisation dispersion (d) parameters (QT-d, (n=21), syncope (n=19), giddiness (n=26), pre-syncope
QTc-d, JT-d, JTc-d) were detected. QT and JT intervals were (n=2), parkinsonism (n=11) and others (n=6). Of those who
measured from the beginning and from the end of the QRS had abnormal findings, 36.4% (n=32) had abnormal tilt-
complex, respectively, to the end of T-wave to baseline while table results. Despite normal tilt-table findings, 56 patients
excluding the U-wave. Using Bazett formula, these intervals still had evidence of autonomic dysfunction based on our
were corrected for heart rate. Repolarisation dispersion remaining testing battery (31 abnormal SSR, 26 abnormal
parameters were calculated the difference between minimal HRV, 6 abnormal VM). The most common cause of
and maximal values of QT, JT, QTc, and JTc among 12 autonomic dysfunction was diabetes mellitus. 6.8% (n=6)
leads. Mean QT-d, QTc-d, JTd, JTc-d in diabetes mellitus had deceased.
patients was significantly longer than that of the normal Conclusion: Diabetes mellitus was the most common cause
subjects (p<0.05). No correlation was observed between of autonomic failure presenting at our neurodiagnostic
abnormalities of sensorimotor nerve conduction and laboratory. Orthostatic hypotension by lying and standing
ventricular repolarisation dispersion parameters. We blood pressure measurement was present in only 9.6%
conclude that ventricular repolarisation dispersion (n=21) and cannot be relied on alone to detect autonomic
parameters evaluation is a helpful and cheap method in the dysfunction.
assessment of autonomic function in diabetic neuropathy.

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


140 Posters, Sunday 9 September

P1124 P1125
Epidemiologic characteristics of patients Correlations between parameters of
with the first episode of syncope sympathetic skin response tests and
diagnosed by head-up tilt test with parameters from the 24-hour ECG Holter
transcranial Doppler monitoring in patients after troponin-
J.J. Lee1, S.S. Jang2 positive acute coronary syndrome
1Neurology, Daegu Fatima Hospital, Daegu, 2Neurology, M. Fila1, U. Cielik-Guerra2, M. Kamiski3,
Pohang Sunlin Hospital, Pohang, Republic of Korea J. Chapiski3, A. Bogucki4, J. Kasprzak2, M. Kurpesa2
Introduction: Syncope is common in the general population 1Department of Neurology, 3rd City Hospital, 2Cardiology,
and many patients visited the hospital due to a single first Bieganski Hospital, Medical University of Lodz,
3Department of Microelectronics and Computer Science,
episode. Most epidemiological studies have shown the
bimodal distribution of syncope incidence over a broad age Technical University of Lodz, 4Departement of
range. We evaluated epidemiologic aspects of patients with Extrapyramidal Disorders, Medical University of Lodz,
the first episode of syncope from patients visit to hospital Poland
due to syncope with first or multiple episodes. Purpose: To compare the results and determine correlations
Methods: We have performed head-up tilt test with between parameters obtained in a basic neurophysiological
transcranial Doppler in all patients who visited the hospital test of SNS - Sympathetic Skin Response Test (SSRT) and
due to syncope between January 2009 and December 2011. parameters derived from 24-hour Holter ECG analysis.
We evaluated retrospectively epidemiologic aspects of Methods: The study group consisted of 52 patients aged
patients with the first syncope from all patients. 59.569.11 yrs (41 male) after troponin-positive acute
Results: The study population included 270 patients of coronary syndrome (1-6 months before they were included).
whom 105 (38.9%) in the first episode and 165 (61.1%) in In all of the pts direct recording of SSR potentials on both
multiple episodes. 105 patients of the first episode: 47 hands and feet was performed. In standard, latency (L) and
(44.8%) men and 58 (55.2%) women, average age 46.2 amplitude (A) of P0 potential were evaluated. In all pts ECG
years (range 12-88 years), male dominant in the 2nd and 7th Holter monitoring was performed using DMS monitors and
decade. 165 patients of multiple episode, 74 (44.8%) men analysis software CardioScan 12. Heart rate variability
and 91 (55.2%) women, average age 44.2 years (range (HRV) was analyzed with time and frequency domain
11-91years), male dominant in 2nd- 4th and 8th decade. The methods to calculate: the standard deviation of all normal
positive response rate of head-up tilt test are 79 (75.2%) in RR intervals (SDNN), the mean of all the 5-minute standard
the first episode group and 122 (73.9%) in multiple episodes deviations of RR (SDNN index), the standard deviation of
group with no meaningful difference in both groups. The all the 5-minute RR interval means (SADNN index), the
same finding was made in sex ratio, average age and root-mean-square successive difference (rMSSD), the
positive response rate of head-up tilt test. percentage of differences between successive RR intervals
Conclusion: Many patients visited the hospital due to over 24 hours that are greater than 50 ms (pNN50) and total
syncope with a single first episode. The same epidemiologic power spectrum (TPS), very low frequency (VLF), low
finding was made in sex ratio, average age at onset time frequency (LF), high frequency (HF) of spectrum.
with same positive response rate of head-up tilt test in both Premature ventricular contractions were observed and
groups. Therefore we can perform a study for evaluating in analyzed for turbulence onset (To) and slope (Ts). We
syncope even for the single first episode. 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.

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


Posters, Sunday 9 September 141

P1126 P1127
Sympathetic over-reactivity as underlying Complex regional pain syndrome type I
cause of recurrent syncope and following cervical medullary lesion: a case
accommodation reflex loss: a report of report
two cases L. Isidoro, F. Matias, C. Macrio
M.A. Sierra-Beltrn1, C.M. Hernndez-Crdenas2, Neurology, Coimbra University Hospital, Coimbra, Portugal
F.A. Villegas Lpez3 Introduction: Complex regional pain syndrome (CRPS)
1CIDyT, Mdica Sur, 2Critical Care Medicine, INCMNSZ, describes a variety of painful conditions following injury
3CGCA, Mdica Sur, Mexico City, Mexico
that appear regionally with a distal predominance of
Introduction: To present two clinical cases of patients abnormal findings, exceeding in magnitude and duration
suffering both of recurrent syndromes, fixed pupils and loss the expected clinical course of the inciting event. Peripheral
of the accommodation reflex. In both cases the underlying but also central mechanisms are involved.
cause was sympathetic over-reactivity. The first case was a Case report: Female, 56-year-old, admitted in the
23-years-old woman who has suffered for the last 13 years emergency department with a 4-months progressive history
from recurrent syncopes (in 4 occasions it evolved into a of right upper extremity (RUE) pain, oedema, impaired
convulsive syncope) evoked after postural changes and movement, and cold skin. She denied recent trauma, surgery
visual acuity defects. The second case was a 36-years-old or infection and reported mild relief with analgesics.
man who has suffered, for the last five years of recurrent Cervical MRI performed at the beginning of the symptoms
syncopes and progressive visual acuity defects. showed C4-C5 and D1 lesions, hyperintense at T2 and
Methods: Routine clinical and specialized rheumatological contrast enhancement. Brain image showed unspecific
imaging and neurophysiological tests were requested. white matter lesions.
Results: No alterations were found on the Complete Blood Examination: RUE hyperalgesia, which was swollen,
tests. Rheumatological test proved that there were not glossy and cold. Abnormal hair and nail growth. On EMG
antibodies of this sort. Images Scans discarded structural there was no sign of peripheral nerve lesion. Bone
central nervous system abnormalities. The Autonomic scintigraphy: unilateral hyperperfusion on right joints. Plain
Function test showed, in both cases, sympathetic over- radiographs: severe osteoporosis of the right hand. RUE
reactivity. echography revealed only mild degenerative abnormalities.
Conclusions: Sympathetic overreactivity has been observed Investigation of the cervical lesion (including lumbar
in upper spinal cord injuries, subarachnoid haemorrhage, puncture) was negative for an infectious or autoimmune
neuroleptic malignant syndrome, Guillain Barr Syndrome, etiology and on the control MRI there was minor extension
poliomyelitis and as toxin mediated diseases (botulism and of the cervical lesion and with no longer contrast
diphtheria). It is a rare circumstance that it happened in a enhancement.
clinical set of no other proven etiology. 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.

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


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


Posters, Sunday 9 September 143

Cerebrovascular diseases 1 P1133


High blood pressure, physical and
P1132 cognitive disability and risk of stroke in
Point-of-care laboratory halves door-to- the oldest old: the Leiden 85-plus study
therapy-decision time in acute stroke B. Sabayan1, P. van Vliet2, J. Gussekloo3,
S. Walter1, P. Kostopoulos1, A. Haass1, Y. Liu1, A.J.M. de Craen4, R.G.J. Westendorp4
P. Papanagiotou2, C. Roth2, I. Grunwald3, K. Fassbender1 1Gerontology and Geriatrics, Radiology, 2Neurology, 3Public
1Neurology, Diagnostic and Interventional Neuroradiology,
2 Health and Primary Care, 4Gerontology and Geriatrics,
University Hospital of the Saarland, Homburg, Germany, Leiden University Medical Center, Leiden, The Netherlands
3Acute Vascular Imaging Centre, John Radcliffe Hospital,
Introduction: Outcomes of studies on the association
Oxford, UK between high blood pressure and risk of stroke in very old
Time until beginning of a causal therapy is critical for age have shown conflicting results. In this study we
favourable outcome of acute stroke. In ischemic stroke examined whether levels of physical and cognitive disability
treatment, application of rt-PA thrombolysis requires moderate the association between high blood pressure and
information about coagulation, blood count and liver risk of stroke in the oldest old.
laboratory parameters of the patient in order to reduce Methods: Study participants included 571 subjects aged 85
bleeding complications. Currently, stroke laboratory years from the Leiden 85-plus Study. Disability in activities
examinations are usually performed in the centralized of daily living (ADL) and Mini Mental State Examination
hospital laboratory, which can be time consuming. (MMSE) were assessed at age 85 years and participants
Therefore, planned thrombolysis is often given before all were followed for stroke events over a period of five years.
results are available as off-label use. In this study, we Associations between various measures of blood pressure
examined the feasibility of gaining valuable time by and risk of stroke were estimated by Cox regression
transferring the complete stroke laboratory workup required analysis.
by stroke guidelines to a point-of-care laboratory system, Results: Higher pulse pressure at age 85 years was
that is, placed at a stroke treatment room contiguous to the associated with lower risk of stroke (HR: 0.81 95% CI,
computed tomography, where the patients are admitted and 0.68-0.96). In the stratified analysis, subjects with low
where they obtain neurological, laboratory, and imaging disability showed an increased risk of stroke for higher
examinations and treatment by the same dedicated team. blood pressure albeit not statistically significant. Conversely,
Our results showed that reconfiguration of the entire stroke higher blood pressure measures were associated with lower
laboratory analysis to a point-of-care system were feasible risk of stroke in subjects with high physical and cognitive
for 200 consecutively admitted patients. This strategy disability (all P<0.05). The associations between various
reduced the door-to therapy-decision times from 8426 to measures of blood pressure and risk of stroke were
4024 min (p<0.001). Results of most laboratory tests significantly different in subjects with low and high physical
(except activated partial thromboplastin time and and cognitive disability (all P for interaction <0.05)
international normalized ratio) revealed close agreement Conclusions: In very old subjects with high physical and
with results from a standard centralized hospital laboratory. cognitive disability, high blood pressure is associated with
These findings may offer a new solution for the integration lower risk of stroke. High blood pressure, in the presence of
of laboratory workup into routine hyperacute stroke advanced vascular damage, may preserve cerebral perfusion
management. and lower risk of low-flow infarcts.

P1134
Abstract cancelled

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


144 Posters, Sunday 9 September

P1135 P1136
Asymptomatic Moya-moya Registry Early clinical implications of
(AMORE) study 2012-2019 - a nation-wide, microalbuminuria in patients with acute
multicenter prospective survey on ischemic stroke
prognosis of asymptomatic Moya-moya B.-H. Cho, J.-T. Kim, H.-J. Jung, K.-H. Choi, T.-S. Nam,
disease in Japan S.-M. Choi, S.-H. Lee, M.-S. Park, B.-C. Kim,
S. Kuroda, AMORE Study Group M.-K. Kim
Neurosurgery, Hokkaido University Hospital, Sapporo, Department of Neurology, Chonnam National University
Japan Hospital, Gwangju, Republic of Korea
Objective: The clinical features, prognosis, and treatment Background: Microalbuminuria is considered to be
strategy of asymptomatic Moya-moya disease are still independently associated with an increased risk and
unclear. Therefore, we have designed the Asymptomatic mortality of stroke. However, it has not been studied
Moya-moya Registry (AMORE) Study in Japan. The whether microalbuminuria could be associated with the
objectives of this nation-wide, multi-center prospective early clinical outcomes of acute ischemic stroke. Therefore,
study are to clarify long-term prognosis of asymptomatic we sought to investigate the association between
patients with Moya-moya disease and to determine the risk microalbuminuria and early clinical characteristics
factors to cause ischemic and hemorrhagic stroke in them. including outcomes at discharge in acute ischemic stroke.
Study design: AMORE Study is conducted in Japan, using Methods: We studied 361 patients with acute ischemic
a multicenter prospective observational design. The stroke within 72 hours of symptom onset. Early clinical
AMORE Study Group is composed of 16 Japanese outcomes were assessed by early neurological deterioration
neurosurgery/neurology centres. In this study, all (END) and modified Rankin Scale (mRS) at discharge. In
consecutive patients diagnosed as asymptomatic Moya- addition, early radiological outcomes were assessed by
moya disease between January 2012 and December 2014 hemorrhagic transformation (HT) and lesion changes on
are registered. Inclusion criteria is as follows: Thus, all follow-up diffusion-weighted imaging (FU DWI). We
patients must categorized UACR as 30 mg albumin/g creatinine (normal)
(a) be between 20 and 70 years at initial diagnosis; and 30-300 (microalbuminuria).
(b) fulfil the guidelines for the diagnosis criteria Moya- Results: 139 of 361 patients had microalbuminuria. In 41
moya disease; of 361 patients occurred END. In multivariate analysis,
(c) experience no ischemic or hemorrhagic cerebrovascular urine albumin-to-creatinine ratio (UACR) was independently
events since they were born; and associated with END (OR, 1.008; 95% CI, 1.004-1.013;
(d) be independent in daily life. p<0.001). In addition, microalbuminuria was independently
Their clinical and radiological data are registered. associated with HT and lesion changes on FU DWI by
Subsequently, they are followed up at outpatient clinic for multivariate analysis.
five years after enrolment. MR imaging and angiography Conclusion: In the early phase of ischemic stroke, patients
are repeated every year during follow-up period. The with microalbuminuria were related with worse clinical
following items constitute the primary endpoint: TIA with characteristics (including END, mRS>2 at discharge, HT,
cerebral infarct, ischemic stroke or hemorrhagic stroke. The and lesions changes on FU DWI) than those without.
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


Posters, Sunday 9 September 145

P1137 P1138
Knowledge of risk factors and stroke Ischemic stroke and asymptomatic
symptoms among non-stroke patients carotid stenosis are strongly associated
M. Wiszniewska1, M. Guszkiewicz2, A. Kobayashi2, with metabolic syndrome
A. Czonkowska2,3 M. Mijajlovic1, A. Jotic2, N. Lalic2,
1Neurological Department, Specialist Hospital, Pila, N. Covickovic-Sternic3
22nd Department of Neurology, Institute of Psychiatry and 1Department for Cerebrovascular Disorders, Neurology
Neurology, 3Department of Experimental and Clinical Clinic, 2Institute of Endocrinology, 3Neurology Clinic,
Pharmacology, Medical University, Warszawa, Poland Clinical Center of Serbia, Belgrade, Serbia
Background and purpose: This study aimed to evaluate Background and aims: Insulin resistance (IR) plays a
knowledge of stroke warning signs, risk factors, treatment crucial role in the pathogenesis of atherosclerosis, but their
and prevention among patients not suffering from stroke. role in ischemic stroke (IST) has not been elucidated. The
Methods: Patients admitted to one of five neurology study was aimed to analyze IR and plasma insulin (PI)
departments in Poland for diseases other than stroke were levels, dyslipidemia pattern, obesity and plasminogen
asked to answer a questionnaire regarding awareness of activator inhibitor-1 in 100 patients with atherothrombotic
cerebrovascular risk factors (CVRF) and stroke. The study IST (group A), 100 patients with asymptomatic carotid
was performed between November 1 and December 31 stenosis (ACAS) 50% (group B), 100 patients with lacunar
2008. stroke (Group C) and 65 healthy controls (group D). Patients
Results: 481 patients were included in the study (59.7% with diabetes mellitus and ischemic heart disease were
women). Proper definition of stroke and TIA were given by excluded.
90.3% and 60.5% of respondents respectively. Hypertension Methods: IR was determined by Homeostasis Assessment
was reported as a risk factor by 91.1% of participants. Model, PI levels by Radioimmunoassay. Total-, LDL- and
Approximately 70% knew that hypercholesterolemia and HDL-cholesterol and triglyceride levels were measured in
smoking are risk factors of stroke, but only one-third all groups. Obesity was determined by waist circumference
identified diabetes mellitus as a risk factor. Cardiac and hypercoagulable state by plasminogen activator
arrhythmia was recognized as a risk factor by 8.4% . 25% inhibitor (PAI-1) levels.
of the participants did not know any symptom of stroke. Results: IR was significantly higher in group A compared
Identification of stroke signs was worse in participants from to group B, C and D (4.820.27 vs. 3.690.22, p<0.05;
rural areas. 10% identified disturbances of consciousness, 4.820.27 vs. 2.710.21, p<0.01, 4.820.27 vs. 1.500.19,
numbness, and dizziness as stroke symptoms. p<0.01). PI levels were significantly higher in group A in
Conclusions: The knowledge of fundamental risk factors comparison to group B, C and D (19.001.2 vs. 15.950.88,
was sufficiently good, but recognition of cardiac arrhythmia p<0.05; 19.001.2 vs. 11.120.19, p<0.01, 19.001.2 vs.
and diabetes mellitus was unsatisfactory. The knowledge of 7.121.08). Different patterns of dyslipidemia were
stroke symptoms was unsatisfactory particularly in rural observed in ACAS and IST. PAI-1 levels, and waist
areas. Additional education programs are still necessary. 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.

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


146 Posters, Sunday 9 September

P1139 P1140
Therapeutic drug monitoring of Less complications in shunt surgery:
clopidogrel in neurointervention: a single gravitational valves are proven to be
centre experience effective in the therapy of the idiophatic
J.J. McCabe, E. Kim, H. Villegas, W. McAuliffe normal pressure hydrocephalus
Neurological Intervention & Imaging Service of Western (SVASONA)
Australia (NIISWA), Sir Charles Gairdener Hospital, Perth,
J. Lemcke1, U. Meier1, C. Mller2, M. Fritsch2,
WA, Australia
U. Kehler3, N. Langer3, M. Kiefer4, R. Eymann4,
Introduction: Clopidogrel resistance is an increasingly M.U. Schuhmann5, A. Speil5, F. Weber6, V. Remenez6,
concerning phenomenon in the neurointervention setting, V. Rohde7, H.-C. Ludwig7, D. Stengel2,8
with an estimated incidence of 4-44%. This high incidence 1Neurosurgery, Unfallkrankenhaus Berlin, 2Ernst-Moritz-
is of clinical relevance as it is associated with increased Arndt-University, Greifswald, 3Asklepios Hospital Altona,
rates of thromboembolic events following carotid artery or Hamburg, 4Saarland Medical University, Homburg / Saar,
cerebral aneurysm stenting. Routine therapeutic drug 5Eberhard-Karls-University, Tbingen, 6Hospital Cologne-

monitoring to identify clopidogrel resistance has been Merheim, Cologne, 7Georg-August-University of Gttingen,
suggested. However there is a dearth of evidence as to its 8Center for Clinical Research, Unfallkrankenhaus Berlin,

usefulness in guiding therapy in practice. Germany


Aims: To evaluate the impact of therapeutic drug monitoring Background: Among dementia diseases idiopathic normal
of clopidogrel on patient management. pressure hydrocephalus is the only entity susceptible to a
Methods: Point-of-care testing to identify clopidogrel neurosurgical therapy. The risk of overdrainage
resistance using the VerifyNow assay was carried out on all complications had a major influence on the indication for
treated patients undergoing neurointerventional procedures surgery in the past. The aim of the SVASONA study is to
in a tertiary referral centre during the twelve month period analyse in a randomised multi-center study whether the risk
from 01/12/2010 to 01/12/2011. Clopidogrel resistance was of overdrainage complications can be eliminated by the use
defined as platelet inhibition <20% with a Platelet of gravitational valves.
Reactivity Unit of >240. A retrospective review of the case Methods: Patients diagnosed for iNPH by clinical
notes of all patients was carried out. Patient demographics, examination, radiological assessment and cerebrospinal
co-morbidities, medications and any alteration to treatment fluid (CSF) infusion test, CSF tap test and or continuous
plan following the point-of-care test were recorded. ICP measurement were recruited in seven centres and
Results: A total of 65 patients were included in the study: randomly assigned to either receive a ventriculoperitoneal
31 male and 34 female with a mean age of 57. The incidence (vp) shunt with a programmable valve without a gravitational
of Clopidogrel resistance was 20% (n=14). unit or a programmable valve with a gravitational unit. The
Long-term treatment was altered in 89% of these cases in patients were followed-up 3, 6 and 12 months after surgery.
light of platelet inhibition testing. Concomitant treatment The primary endpoint was the incidence of overdrainage
with Atorvastatin (Risk ratio 5.3, p=0.01) and age >65 (Risk complications after 6 months.
Ratio 2.8, p=0.05) was associated with resistance. Results: 150 patients were included. The study was stopped
Conclusion: A high incidence of Clopidogrel resistance due to a massive advantage for the patient group with
was observed in our study. Routine testing is recommended gravitational units.
to identify non-responders and alter management Six months after surgery in the intention-to-treat population
accordingly. 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.

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


Posters, Sunday 9 September 147

P1141 P1142
Inhibiting TLR4 signal protects against The VISTA collaboration: exploratory
neuronal death in transient focal ischemia analysis of trial data to inform RCT design
Y. Suzuki1, T. Murase2, J. Hamanaka1, K. Hattori2, M. Ali1,2, M. Brady2, H.-C. Diener3, D. Hanley4,
K. Tsuruma1, M. Shimazawa1, H. Nagasawa2, H. Hara1 N. Wahlgren5, S. Warach6, K.R. Lees1, On behalf of the
1Molecular Pharmacology, Department of Biofunctional
VISTA Steering Committees
Evaluation, 2Medicinal and Pharmaceutical Chemistry, 1University of Glasgow, 2Glasgow Caledonian University,
Department of Organic Chemistry, Gifu Pharmaceutical Glasgow, UK, 3University Duisburg-Essen, Essen, Germany,
University, Gifu, Japan 4The John Hopkins Medical Institutions, Baltimore, MD,

Introduction: Toll-like receptors (TLRs) are signalling USA, 5Karolinska Institute, Stockholm, Sweden, 6UT
receptors in the innate immune system. Recently, we have Southwestern Medical Center, Austin, TX, USA
reported that TLR4, but not TLR3 or TLR9, contributes to Introduction: Practical and financial barriers hinder the
ischemic brain injury induced by middle cerebral artery pace of stroke research. Data from completed RCTs often
occlusion (MCAO) in mice (Hamanaka et al., Neuroscience, reside in industry or academic archives, however exploratory
171, 258-67). In the present study, we investigated whether analyses of these valuable data can generate hypotheses,
treatment with resatorvid, Ethyl (6R)-6-[N-(2-chloro-4- describe natural history patterns and pilot trial design
fluorophenyl)sulfamoyl]cyclohex-1-ene-1-carboxylate, a elements to inform future RCTs. We established the Virtual
TLR4 signal inhibitor, exerts neuroprotective effects against International Stroke Trials Archive (VISTA), a collaborative
the ischemic injury. stroke trials resource.
Methods: Mice were subjected 2h MCAO followed by 22h Methods: VISTA collates data in 6 specialist archives
reperfusion. Resatorvid was intracerebroventriculary including acute stroke, rehabilitation, secondary prevention,
injected immediately after reperfusion. Infarct volume and intracerebral haemorrhage, imaging, and observational
neurological score were evaluated at 24h after MCAO. To studies. Each section is governed by a Steering Committee
estimate the mechanism of neuroprotection by resatorvid, comprising contributing trialists. Access to VISTA has been
Western blotting and immunostaining were performed. granted to external investigators for novel analyses.
Results: Resatorvid at 0.01g significantly reduced infarct Results: To date VISTA contains data on 49,134 patients
volume and improved neurological score compared with across 6 archives and has facilitated 40 peer-reviewed
vehicle treatment. The levels of p38 phosphorylation, research publications and 42 conference presentations. Data
nuclear factor-kappa B (NF-B) activation, matrix from VISTA have been used to inform the design of the
metalloproteinase 9 (MMP9) and NADPH oxidase 4 SAINT acute stroke trials, investigate thrombolysis in the
(NOX4) expressions were significantly suppressed in elderly, post-stroke atrial fibrillation monitoring, prediction
the resatorvid-treated group. Furthermore, resatorvid of outcomes after ischaemic stroke, inclusion and attrition
significantly reduced DNA oxidation, tyrosine nitration, of patients in RCTs, and validation of stroke outcome
and neuronal apoptosis. measures.
Conclusion: These data suggest that inhibiting the TLR4 Conclusion: VISTA extends the value of clinical research
signalling after ischemia shows the neuroprotective effects at low cost, without threatening commercial or intellectual
against cerebral ischemia and reperfusion injury in mice. property interests and independently delivers valuable
Furthermore, resatorvid may be useful for a therapeutic research output on a wide range of stroke topics. VISTA is
agent for stroke. 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.

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


148 Posters, Sunday 9 September

P1143 P1144
A meta-analysis on the efficacy and Is CHA2DS2-VASc the best score in
safety of cilostazol against aspirin predicting thrombo-embolic risk in atrial
P.A.D. Canto, M.C. San Jose fibrillation?
Philippine General Hospital, Metro Manila, Philippines N. Diaconu1, A. Grosu1, C. Gratii1, G. Pavlic2, V. Racila1
1Institute of Cardiology, 2Institute of Neurology and
Introduction: Stroke is a leading cause of adult disability
and death worldwide. A key aim to management of patients Neurosurgery, Chisinau, Moldova
with ischemic stroke is to reduce the risk of recurrent stroke Introduction: Atrial fibrillation (AF) is a risk factor for
and serious fatal and non-fatal vascular events. Aspirin ischemic stroke (IS) and thrombo-embolism. The stroke in
remains the cornerstone antithrombotic therapy, and has AF is associated with severe disability and high mortality,
been demonstrated to have a proportional reduction in its prevention being an important factor in management of
vascular events: 19% with 500-1500mg daily, 26% with AF patients.
160-325mg daily, and 32% with 75-150mg daily. Aspirin Objective: To determine the influence of atrial fibrillation
was associated with a 22% increase in odds of symptomatic on stroke development and evolution and to compare the
intracranial haemorrhage and 69% increase in major stroke predictive value of several schemas published in the
extracranial haemorrhage. In a study of 1095 patients with last years.
recent ischemic stroke on Cilostazol, the annual relative risk Methods: Retrospective study of all ischemic stroke
of serious vascular events was reduced by 41.7%. patients admitted during one year in a municipal hospital.
Objectives: Primary objective was to determine the efficacy Results: The study included 735 patients of whom 519 had
and safety of Cilostazol versus Aspirin in the secondary primary stroke (70.6%). AF was determined in 206 cases
prevention of stroke through meta-analysis of randomized, (28.4%), these patients being older (70.10.65 vs. 64.30.46
controlled studies. A secondary objective was to determine years; p<0.001), majority females: 57.8% (119/206) with
if Cilostazol, compared with Aspirin, decreased the more vascular risk factors. AF patients have had more
occurrence of ischemic stroke, hemorrhagic stroke and rate severe signs of cerebral lesion on admission (79% vs. 37%,
of intracranial haemorrhage. p<0.01), also having a higher hospital mortality rate (30.6%
Methodology: CASISP and CSPS2 were included in the vs. 13.2, p<0.001). The scores of thromboembolic risk
study. Meta-analysis was done using RevMan. estimation are presented in the table below.
Results and analysis: Rates of overall stroke occurrence,
hemorrhagic stroke occurrence, overall hemorrhagic events Scores of thromoembolic risk estimation
and intracranial hemorrhage were lower among those who Low Low risk Medium Medium High risk
took Cilostazol. Although ischemic stroke occurrence was 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


Posters, Sunday 9 September 149

P1145 P1146
Safety and efficacy of sonothrombolysis Are we getting better in prescribing
using bilateral TCD monitoring by vitamin K antagonists for atrial fibrillation
diagnostic 2 MHz probes: a pilot study before and after stroke?
R. Herzig1, P. Bardo1,2, M. Kuliha1,3, P. Kaovsk1, M. Karlinski1, J.P. Bembenek1, A. Kobayashi1,2,
D. koloudk1,3 A. Baranowska1, A. Czlonkowska1,3
1Comprehensive Stroke Center, Department of Neurology, 12ndDepartment of Neurology, 2Interventional Stroke
Faculty of Medicine and Dentistry, Palack University and Treatment Centre, Institute of Psychiatry and Neurology,
University Hospital, Olomouc, 2Department of Neurology, 3Department of Experimental and Clinical Pharmacology,

Hospital Tinec-Sosna, Trinec, 3Comprehensive Stroke Medical University of Warsaw, Poland


Center, Department of Neurology, University Hospital and Introduction: Effective anticoagulation with vitamin K
Ostrava University, Ostrava, Czech Republic antagonists (VKA) is the treatment of choice for stroke
Introduction: Sonothrombolysis is a new therapeutic prevention in the majority of patients with atrial fibrillation
method used in patients with acute ischemic stroke (AIS). (AF). Considering growing vascular awareness, their
Various frequencies and intensities of used ultrasound are everyday use should be increasing.
being tested. The aim was to assess the safety and efficacy Aim: Our aim was to evaluate changes in the use of VKA
of sonothrombolysis using two diagnostic probes and before stroke onset in patients with pre-existing AF over the
bilateral monitoring in patients with acute occlusion of the past 15 years.
middle cerebral artery (MCA). Methods: We analyzed consecutive acute stroke patients
Methods: 12 consecutive AIS patients (7 males; age 47-78, admitted to our center between June 2006 and January
average 64.19.4 years) with acute MCA occlusion and 2011. Data were prospectively collected using a detailed
contraindication to thrombolysis were included in the study. stroke registry. We distinguished between three periods:
60-minute bilateral Doppler monitoring of the area of 1995-1999, 2000-2004 and 2005-2011.
occlusion was performed in all patients (Group 1). The Results: In the analyzed periods pre-stroke history of AF
control group consisted of 37 AIS patients (20 males; age was reported with similar frequency (years 1995-1999:
32-78, average 62.212.1 years) treated with standard 139/626, 22.2%; years 2000-2004: 346/1501, 23.0%; years
onothrombolysis and selected from the Thrombotripsy 2005-2011: 442/1872, 23.6%). It was present on their
Study database (Group 2). The differences in the number of routine ECG after admission in 22.4%, 20.7% and 20.1%,
recanalized arteries after a 60-minute treatment, number of respectively. We observed a significant (p<0.001)
independent patients (defined as a modified Rankin scale improvement in the use of VKA before stroke in patients
value of 0-2) after 90 days, number of symptomatic with pre-existing AF (8.0%, 14.3%, 27.9%), and fluctuating
intracerebral haemorrhages (SICH) were statistically prescription rate of VKA upon discharge (34.8%, 24.7%,
evaluated. 49.0%) in those patients. The use of subtherapeutic doses of
Results: Complete recanalization was detected in 4 (30.0%) VKA was much higher than the doses exceeding therapeutic
of Group 1 and 12 (32.4%) of Group 2 patients. 7 (58.3%) window (64.7% vs. 5.9%, 72.6% vs. 5.5%, 77.4% vs.
of Group 1 and 22 (59.5%) of Group 2 patients were 10.3%). During the hospital stay AF was diagnosed in
independent after 90 days. SICH was detected in none of additional 3.8%, 3.4%, and 6.9% of patients.
Group 1 and in 1 (2.7%) of Group 2 patients (p>0.05 in all Conclusion: The number of stroke patients with AF
cases). receiving VKA before stroke onset is systematically
Conclusion: According to the presented results, growing. However, the high ratio of patients receiving
sonothrombolysis using two probes and bilateral monitoring suboptimal doses points at constantly low guideline
is safe, but not more effective than standard sonothrombolysis adherence among physicians and patient non-compliance.
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


150 Posters, Sunday 9 September

P1147 P1148
Predictive value of routine C-reactive Predictors of early seizures in acute
protein in ischaemic stroke patients stroke
treated with rtPA I. Volonghi1, A. Pezzini1, E. del Zotto1, A. Giossi1,
J.P. Bembenek1, M. Karlinski1, K. Grabska1, P. Costa1, L. Poli1, M. Gamba2, L. Antonini2, M. Magoni2,
A. Baranowska1, A. Kobayashi1, A. Czlonkowska1,2 A. Padovani1
1 nd
2 Department of Neurology, Institute of Psychiatry and 1Universit degli Studi di Brescia, 2Spedali Civili, Brescia,
Neurology, 2Department of Clinical and Experimental Italy
Pharmacology, Medical University of Warsaw, Poland Aims: To assess incidence and predictors of early seizures
Introduction: Blood biomarkers may be important (ES) in a prospective cohort of patients with acute first-ever
predictors of outcome after ischaemic stroke. However, stroke.
their clinical usefulness is not fully established yet, Methods: Patients consecutively recruited in the setting of
especially in a particular group of patients treated with the Brescia Stroke Registry were entered into the analysis.
intravenous rtPA. The aim of our study was to investigate ES (7 days) were recorded and correlated to clinical and
the predictive value of serum C-reactive protein (CRP) in demographic data, disease characteristics, and risk factors,
ischaemic stroke patients undergoing thrombolytic as well as to medical complications occurring within 7 days
treatment, adjusting for a history of infection recently of symptoms onset.
before stroke. Results: 516 patients [314 men; mean age 66.414.7; 436
Methods: Consecutive patients receiving intravenous rtPA (84.5%) cerebral infarct (IS), 80 (15.6%) intracerebral
in our stroke center (October 2003 - February 2010) were haemorrhage (ICH)] were enrolled. ES were observed in 20
included. Data were prospectively collected using a detailed patients (3.9%), 12 with IS (2.7%), 8 with ICH (10.0%). As
questionnaire including information about pre-existing expected, mean NIHSS at admission was higher in patients
conditions, laboratory findings and medications. Routine with ES than in those without (13.26 vs. 8.45), while
serum CRP was measured within 24 hours from admission. haemorrhagic lesion (RR, 1.56, 95%CIs 1.07-2.28),
Results: Serum CRP was measured in 197/232 patients particularly with lobar location (RR, 11.7, 95%CIs 4.63-
treated with intravenous rtPA. In 20/232 were reported signs 29.30), cortical involvement (RR, 1.42, 95%CIs 1.00-2.08),
of infection within 7 days before stroke onset. Patients with and haemorrhagic transformation of the infarct (RR, 1.51,
elevated CRP (>5 ng/ml) had more pre-existing 95%CIs 1.01-2.38) were independent predictors of ES, as
comorbidities, more severe strokes but a similar pre-stroke opposed to the neutral effect of vascular risk factors. The
disability, when compared to those with normal levels. In a occurrence of medical complications turned out to increase
multivariate analysis neither elevated CRP nor recent the risk of ES in the whole group (RR, 1.16; 95%CIs 1.07-
infection were associated with 3-month mortality. However, 1.26) as well as in that of patients with IS (RR, 1.17;
elevated CRP was independently associated with increased 95%CIs, 1.06-1.28), but not in that of patients with ICH
risk for death or dependency (OR 2.09, 95%CI: 1.03-4.26). (RR, 1.16; 95%CIs, 0.94-1.42).
Patients with not elevated CRP demonstrated high Conclusion: The occurrence of medical complications in
probability of not having sICH according to SITS (100%, the acute phase of stroke should be considered a further
95%CI:97-100%) and ECASS (97%, 95%CI:92-99%) predictor of ES in patients with brain infarction, but not in
definitions. those with ICH.
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


Posters, Sunday 9 September 151

P1149 P1150
Effect of pre-treatment with statins on Factors affecting blood glucose and
ischemic stroke severity: do the doses blood pressure level in hyperacute
matter? ischemic stroke. Is mismatch a
P. Martinez-Sanchez, B. Fuentes, G. Ruiz-Ares, contributing factor?
E. Correas-Callero, M. Martinez-Martinez, S. Gur-Ozmen1, B. Aksay-Koyuncu1, S. Tavukcu-Ozkan2,
L. Cullar-Gamboa, E. Dez-Tejedor R. Tolun1, Y. Krespi2
Neurology, La Paz University Hospital. IdiPAZ Health 1Neurology, Istanbul Science University, 2Stroke Unit, Sisli
Research Institute, Madrid, Spain Florence Nightingale Hospital, Istanbul, Turkey
Objective: To examine the effect of pre-treatment with Background: Hyperglycaemia is detected in 30-50% and
statins, at high (80mg/d) and non-high (<80mg/d) doses, on high blood pressure (BP) is detected in 75% of acute
ischemic stroke (IS) severity in clinical practice. ischemic stroke (AIS) patients admitted to the emergency
Methods: Prospective study of IS admissions to our Stroke room (ER); most of them do not have history of diabetes
Unit during a 3-year period (2008-2010). Basal data, mellitus (DM) or hypertension (HT). Patients with
previous treatments (including statins), stroke severity salvageable brain tissue at admission can have higher
(NIHSS), stroke subtype, in-hospital complications, length glycaemic and BP levels and potentially be harmed by, or
of stay and functional status at discharge (mRS) were benefit the most from insulin and anti-hypertensive therapy.
collected. Mild stroke severity was defined as NIHSS 5 on Methods: The relationship between DWI/PWI mismatch,
admission. Good outcome was defined as mRS 2 at admission blood glucose (ABGL) and blood pressure level
discharge. Multivariable regression models and matched (ABPL) in patients admitted in the first 12 hours of AIS
propensity score analyses were used to quantify the onset is examined. Data of patients registered to Florence
association of statins pre-treatment, at high and non-high Nightingale AS database between 2006 and 2009 were used.
doses, with a mild stroke severity. Correlation between mismatch and ABGL or ABPL was
Results: Of 969 IS patients, 23% were using non-high analyzed with multivariate logistic regression analysis.
doses and 4.1% high doses of statins before the stroke. The Results: The sample consisted of 212 patients. The adjusted
frequency of mild stroke on admission was higher in the odds of mismatch in predicting high ABPL was 2.297
statin groups (57.9% for non-statins, 63.2% for non-high (p=0.064, 95%Cl 0.953-5.536) in the whole group, and it
doses of statins and 77.5% for high doses of statins, was 3.801 in the stress hyperglycaemia group (n: 67, %35)
p=0.026). After multivariable adjustment, pre-treatment (p=0.033, 95%Cl 1.110-13.015). Lower level of
with statins was associated with higher odds of mild stroke consciousness, anti-DM usage, Hba1c level and
severity and this effect was greater at high doses (OR=1.637, cardioembolic etiology were the other independent
95% CI 1.156-2.319 for the non-high doses and OR=3.297, predictors of high ABGL. Mismatch was not associated
95% CI 1.480-7.345, for the high doses of statins). with ABPL. Female gender (p=0.048) and total anterior
Conclusion: Pre-treatment with statins is associated with circulation syndrome (p=0.008) were found to be associated
lower stroke severity and this effect could be greater at with higher ABPL.
higher doses. 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.

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


152 Posters, Sunday 9 September

P1151 P1152
The role of endothelial dysfunction in Functional outcome of acute ischemic
stroke stroke patients: association with
A. Inzhutova, O. Lopatina, E. Mervaala, A. Salmina concentrations of thyroid hormones and
Institute of Biomedicine, Helsinki University, Helsinki, C-reactive protein
Finland
H. Kazlauskas1, A. Bunevicius2,3, N. Raskauskiene2,
We investigated the role of endothelial dysfunction in A. Anskoliene1, R. Radziuviene2, V. Janusonis1,
development and progression of stroke compared to R. Bunevicius2
progressive angina or arterial hypertension. Known, 1Klaipeda University Hospital, Klaipeda, 2Institute of
endothelial cells are multifunctional organ with endocrine Psychophysiology and Rehabilitation, Lithuanian University
properties. Severe endothelial dysfunction in stroke leads to of Health Sciences, Palanga, Lithuania, 3Department of
disability of patients. Understanding of molecular Psychiatry, University of North Carolina at Chapel Hill,
mechanisms of endothelial dysfunction and detection of USA, Chapel Hill, NC, USA
biomarkers of endothelial disorders severity is the first step Objective: To evaluate the association of concentrations of
to successful prevention and treatment of stroke. In our thyroid axis hormones and C-reactive protein (CRP) with
study endothelial dysfunction (measured by ultrasound functional outcome of acute ischemic stroke patients.
examination of brachial artery diameter) was more Methods: 88 hospitalized patients (57 men and 31 women;
pronounced in patients with stroke (60 women, 50 men), mean age 7211 years) within 48 hours from the onset of
than in progressive angina (50 men, 40 women). It was ischemic stroke were included to this study. All patients
associated with the increase of intracellular calcium and were evaluated for severity of stroke using the Scandinavian
reactive oxygen species levels, endothelial apoptosis and the Stroke Scale (SSS) and Glasgow Coma Scale (GCS), and
rise of circulating endothelial progenitor cells number in the for serum concentrations of free tri-iodothyronine (T3), free
blood. Endothelial derived microparticles play an important thyroxin, and thyroid stimulating hormone and C-reactive
role in cell-cell communication and the development of protein (CRP). Functional outcome at discharge was
endothelial dysfunction. We discovered that specific antigen evaluated using the modified Rankin scale (mRS).
composition of circulating membrane microparticles Results: In univariate regression analyses worse functional
depends on cardiovascular pathology. Moreover, membrane outcome at discharge was associated with lower free T3
microparticles contain signal proteins such as MAPK and concentrations (=-0.230, p=0.04), with higher CRP
e-NOS and they are good biomarkers of endothelial concentrations (=0.486, p<0.001), with female gender
dysfunction severity. Stabilization of endothelial cell (=0.281; p=0.01), with advanced age (=0.386; p=0.012),
membrane by cytoprotectors had a beneficial effect on with lower SSS score (=-0.689, p<0.001), with lower GCS
endothelial function and recovery in patients after stroke. In score (=-0.290, p=0.01) and with more disability prior to
opposite, without targeted treatment of endothelial stroke (=0.398, p<0.001). In multivariate analyses, after
dysfunction mortality was 10% (p<0.01) and disability was adjustment for significant predictors in univariate analyses,
40% (p<0.001) in patients with stroke. In conclusion we higher CRP concentrations (=0.213, p=0.02), higher SSS
designed a method of endothelial dysfunction severity score (=-0.644, p<0.001) and more disability prior to
diagnosis by detecting novel biomarkers in the blood and an stroke (=0.251, p=0.003) were independently associated
algorithm for treatment of patients with stroke by the with worse results and together explained 57% (p<0.001) of
correction of endothelial function. 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.

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


Posters, Sunday 9 September 153

P1153 P1154
Effect of weekend or night compared with Endovascular coil embolisation for
daytime admission on outcome in acute wide-necked unruptured intracranial
ischemic stroke patients treated with aneurysms with enterprise stent:
endovascular therapy safety & efficacy
N. Nakai1, T. Kojima2, K. Shintai2, M. Hattori1, D. Itou1, S.-K. Hwang1, O.-K. Kwon2
R. Nishi1, S. Yamada1, K. Kawabata1, S. Yokoi1, Department of Neurosurgery, Ewha Womans University,
1

N. Mitsuma1, K. Yasui1, Y. Hasegawa1 College of Medicine, Mokdong Hospi, Seoul, 2Seoul National
1Neurology, 2Neurosurgery, Nagoya Daini Redcross Hospital, University Bundang Hospital, Seongnam, Republic of Korea
Nagoya, Japan Background: Stent assisted coil embolisation for wide-
Background and Purpose: A stroke weekend effect has necked unruptured intracranial aneurysms (UIA) is a
been demonstrated in many countries, but there is no report widely-accepted treatment modality. But, its technical
for effect of weekend admission in acute ischemic stroke results and clinical outcome are not well known. The aim of
(AIS) patients treated with endovascular therapy. We studied this study was to evaluate the safety and efficacy based on
AIS patients treated with endovascular therapy for weekend result of consecutive patients in a single center.
effect. Methods: This study included 116 patients (29 male
Methods: We report 38 AIS patients treated with patients, 87 female patients, mean age; 55.4 years) with 121
endovascular therapy between 2005 and 2011: 11 daytime UIA treated in one hospital by means of Enterprise stent
on working days (office hours) admissions and 27 weekend assisted coil embolisation between November 2008 and
or night time (non-office hours) admissions. December 2010. The clinical and radiological (magnetic
We compared the following data between office hours resonance angiography) results were evaluated.
admission group (OH) and non-office hours admission Results: Successful embolisation without complications
group (NOH); pre-treatment NIHSS, stroke onset to was achieved in 94%. 6 patients had procedure related to
admission time, admission to MRI time, admission to thromboembolic events. This resulted in neurologic
puncture time, recanalisation rate, and modified Rankin symptoms in 4 cases, and transient angiographically visible
scale (mRS) at 3 months. thromboembolism without symptoms in 2 cases. Aneurysm
Results: Between OH and NOH, there was no difference in occlusion was complete in 30.5%, small neck remnant in
pre-treatment NIHSS (24 vs. 19), and admission to MRI 49.5%, and residual contrast filling in 19.8%. Magnetic
time (34 minutes vs. 29 minutes). But there was statistical resonance angiography follow-up was performed at least 6
difference in stroke onset to admission time (77 minutes vs. months after coiling in all patients. The mean follow-up
56 minutes, p=0.034), admission to puncture time (105 duration was 13.4 months (range 6-34 months). 8 patients
minutes vs. 136 minutes, p=0.015) and recanalization rate (6.6%) demonstrated any visible recanalization. 1 patient
(90.9% vs. 33.3%, p=0.001). The rate of good outcome (0.8%) with major recanalization was successfully recoiled
(mRS 0-2) at 3 months in OH was similar to that of NOH and the others with minor recanalization were conservatively
(27.2 % vs. 25.9%). Most of our cases were internal carotid followed.
artery or proximal middle cerebral artery occlusion, as a Conclusion: Enterprise stent assisted coil embolisation for
result higher recanalization rate in OH has no influence on UIA appears to be effective and safe. Future studies
good outcome. including controlled prospective trials and careful follow-
Conclusions: There was no weekend effect in AIS patients ups are required to assess indications and efficacy in the
treated with endovascular therapy. long term.

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


154 Posters, Sunday 9 September

P1155 P1157
Outcome analysis of the randomized Acute basilar artery occlusion: safety and
multi-center study on idiopathic normal efficacy of different treatment strategies
pressure hydrocephalus (SVASONA) and predictors of good outcome
J. Lemcke1, U. Meier2, C. Mller3, M. Fritsch3, T. Dork1, R. Herzig1, D. ak1, M. Krl1, T. Veverka1,
U. Kehler4, N. Langer4, M. Kiefer5, R. Eymann5, A. Brtkov1, P. Hlutk1, D. koloudk1, M. Heman2,
M.U. Schuhmann6, A. Speil6, F. Weber7, V. Remenez7, M. Roubec3, M. Kuliha3, V. Prochzka4, M. Kocher2,
V. Rohde8, H.-C. Ludwig8, D. Stengel9 P. Kaovsky1
1Department of Neurosurgery, 2Unfallkrankenhaus Berlin, 1Neurology, Comprehensive Stroke Center, Faculty of
Berlin, 3Ernst-Moritz-Arndt-University, Greifswald, Medicine and Dentistry, 2Radiology, Comprehensive Stroke
4Asklepios Hospital Altona, Hamburg, 5Saarland Medical Center, Faculty of Medicine and Dentistry, Palacky
University, Homburg, 6Eberhard-Karls-University, Tbingen, University and University Hospital, Olomouc, 3Neurology,
7Hospital Cologne-Merheim, Cologne, 8Georg-August- 4Radiology, Comprehensive Stroke Center, Ostrava

University of Gttingen, 9Center for Clinical Research, University and University Hospital, Ostrava, Czech Republic
Unfallkrankenhaus Berlin and Ernst-Moritz-Arndt-University Introduction: Acute ischemic stroke (AIS) caused by
of Greifswald, Berlin, Germany basilar artery occlusion (BAO) is often associated with a
Background: The aim of the prospective randomized severe and persistent neurological deficit and a high
SVASONA study was to prove, that an excellent clinical mortality rate. Various treatment concepts are being used.
outcome and a low rate of overdrainage complications can The aim was 1) to assess the association between outcome
be achieved with gravitational valves. and treatment type and 2) to identify predictors of good
Methods: In seven centres patients were enrolled in the outcome.
SVASONA study after passing clinical examination, Methods: The set consisted of 50 consecutive AIS patients
radiological assessment and CSF infusion test, CSF tap with radiologically confirmed BAO (37 males; mean age
test and or continuous ICP measurement. Patients were 64.712.4 years). Stroke severity at time of treatment was
randomly assigned in treatment groups with or without a assessed as severe (coma, locked-in state, tetraplegia) or
gravitational unit. The primary endpoint was the incidence mild to moderate. 30-day outcome was assessed using a
of overdrainage complications. Secondary endpoint was the modified Rankin scale (mRS) with good outcome defined
clinical outcome after 6 and 12 months. as score 0-3. The following treatments were used:
Results: 150 patients were included in the study. Due to a antithrombotics (AT); intravenous thrombolysis (IVT); IVT
significantly lower risk of overdrainage complications in the with subsequent intra-arterial therapy (IVT+IAT); intra-
treatment group with gravitational units, the study was arterial therapy alone (IAT). Other observed factors were
stopped according to the protocol after the planned interim age, mRS score before stroke onset, time to treatment,
analysis. recanalization rate.
69% of the patients in the treatment group without a Results: AT was used in 8, IVT in 12, IVT+IAT in 13, IAT
gravitational valve and 86% of the patients in the group in 17 patients. Good outcome was found in 0 AT,2 (16.7%)
with gravitational valves showed an excellent, improved or IVT,7 (53.8%) IVT+IAT, 3 (17.6%) IAT patients (p>0.05).
fair outcome according to the Black grading scale after 6 The following statistically significant differences were
months. After 12 months 75% respectively 86% were found between patients with good vs. poor outcome: mean
registered. The difference was not significant. age 54.2 vs. 68.0 years (p=0.0004); recanalization rate 91.7
Discussion: Whereas a significant difference between the vs. 47.4% (p=0.008); presence of severe neurological deficit
complication rates of the two treatment groups was evident, 25.0 vs. 65.8% (p=0.02). Logistic regression analysis
there is only a tendency in the difference between the identified age (OR=0.875; p=0.004), presence of severe
outcomes measured by specific iNPH scores. These findings neurological deficit (OR=0.079; p=0.023), time to
underline that gravitational valves prevent the risk of treatment (OR=0.602; p=0.035) as significant independent
overdrainage but do not suppress the favourable outcomes predictors of good outcome.
achieved with LPVs. Conclusion: In the presented study, an apparent (although
statistically insignificant) trend for better outcome was
P1156 observed in the IVT+IAT group. Age, severe neurological
deficit, time to treatment were identified as significant
Abstract cancelled 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.

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


Posters, Sunday 9 September 155

P1158 P1159
Factors associated with platelet inhibition Prognostic significance of hemodynamic
in patients undergoing neurointerventional and hemostatic factors in the course of
procedures different manifestations of cerebral small
J. Savic, S. Vucetic, N. Radojkovic-Gligic, M. Savic vessel disease - study rationale and
Special Hospital for Cerebrovascular Diseases St. Sava, protocol
Belgrade, Serbia
J. Staszewski1, R. Piusiska-Macoch1, E. Skrobowska2,
Introduction: Significance of antiplatelet resistance is B. Brodacki1, A. Stepien1
not well defined among patients with cerebrovascular 1Clinic of Neurology, 2Department of Radiology, Military
diseases. We tried to determine factors associated with Institute of Medicine, Warszawa, Poland
antiplatelet resistance in a cohort of patients undergoing Cerebral small vessel disease (CSVD) is one of the most
neurointerventional procedures. important and common vascular diseases of the brain. It is
Material and method: In this retrospective study, we an important cause of ischemic and hemorrhagic strokes,
analyzed data of 65 consecutive patients in a one year period dementia and vascular parkinsonism. Although main
that underwent neurointerventional procedure and clinical and radiological signs of CSVD are well established
previously received antiplatelet therapy. We used impedance its prognostic factors and course have not been well studied
aggregometry method to determine the level of platelet so far.
inhibition. The aim of the study is to evaluate hemodynamic and
Results: Indications for neurointerventional procedures hemostatic factors and to assess clinical and radiological
were: carotid stenosis (56.4%), vertebral stenosis (48.4%), course of different manifestations of CSVD in long-term
and symptomatic intracranial aneurysm (24.2%). Among 56 observation.
patients receiving aspirin in a median dose 700mg per week, Method: A prospective, observational, with 24-month
10.7% were resistant. Among 24 patients receiving follow-up study in 150 CSVD patients (50 with lacunar
clopidogrel in a median dose 525mg per week, 21 of them stroke, 50 with vascular dementia, 25 with vascular
were on a dual antiplatelet therapy, and 60.4% of all were parkinsonism, 25 with deep intracerebral hemorrhage) and
resistant to clopidogrel. We found no differences between 50 healthy subjects from control group has been planned.
antiplatelet-responders and non-responders regarding The clinical and radiological course will be evaluated basing
gender, age, hypertension and concomitant statin therapy. on detailed neurological, neuropsychological and MRI
There were significantly less aspirin-responders among examinations. Hemodynamic (cerebral vasoreactivity, 24h
patients with diabetes and hyperlipidaemia. Stenoses of blood pressure control, MRI PWI/DWI) and hemostatic
neck blood vessels were more frequent in aspirin-non- (markers of endothelial and platelet dysfunction, brachial
responders. artery flow-mediated dilatation test) factors will be
Conclusions: Our results show that clopidogrel resistance determined.
is very common in patients undergoing neurointerventional Discussion: The study has the potential to further unravel
procedures, and aspirin resistance is common among these the predictors and course of different manifestations of
patients with diabetes and hyperlipidaemia. It emphasizes a CSVD. The scheduled trial will better define the prognosis
need for individualized approach for antiplatelet therapy in and prognostic factors of various clinical manifestations of
this group of patients. 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.

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


156 Posters, Sunday 9 September

P1160 P1161
Utility of 64-section multi-detected The usefulness of time intensity curve
cardiac CT in detection of thrombus and generated from MRI/PWI to predict
circulation in left atrium appendage: neurological deterioration after onset in
comparison with trans-oesophageal acute ischemic stroke patients
echocardiography M. Nakazaki, T. Mori, H. Tajiri, T. Iwata, Y. Miyazaki,
F. Konoeda1,T. Dembo2, S. Yamada1, Y. Itoh1, K. Mizogami
M. Jinzaki3, N. Suzuki1 Department of Stroke Treatment, Shonan Kamakura General
1Neurology, School of Medicine, Keio University, 2Neurology, Hospital, Stroke Center, Kamakura, Japan
School of Medicine, Kyorin University, 3Radiology, School of Purpose: To investigate whether or not MRI/time intensity
Medicine, Keio University, Tokyo, Japan curve (TIC) can easily predict the neurological deterioration
Introduction: Trans-oesophageal echocardiography (TEE) of acute ischemic stroke patients.
has been utilized as the assessment for the embolic source Methods: Included for retrospective analysis were acute
in cardiogenic cerebral infarction with atrial fibrillation. stroke patients
However there is the problem that TEE imposes a heavy 1) who were admitted from 2008 to 2011 within 48hours
burden on the patient within the early phase of cardiogenic from onset,
stroke. Hence we assessed 64-section multi-detected cardiac 2) with mild neurologic symptoms of NIHSS10 without
CT in place of TEE in patients with cardiogenic stroke. disturbance of consciousness,
Methods: We investigated 22 patients with stroke (17 men 3) whose emergency MRI demonstrated an ischemic lesion
and 5 women; mean age 69.4 years) who had undergone in the MCA territory,
both CT and TEE within the previous 1-month period. We 4) who were treated without reperfusion therapy, and
decided the CT and TEE grades as below and compared 5) who had severe stenosis (70% or more) or occlusion of
each grade; CT the ICA or MCA in the affected side by DSA.
grade 1: no defect, We evaluated PWI findings by time-intensity-curve (TIC)
grade 2: no left atrium appendage thrombus and both defect grade, which were classified into four grades according to
during early phase and clear during late phase, the time to peak and the reduction value of the peak signal.
grade 3: defect (+), We investigated patients baseline features, TIC grades,
TEE grade 1: no thrombus, NIHSS on admission (adm_NIHSS), NIHSS on the 7th day
grade 2: we can detect spontaneous echocardiographic (7d_NIHSS) and difference between 7d_NIHSS and adm_
contrast (SEC) without thrombi, NIHSS (7d-adm_NIHSS). We defined neurological
grade 3: thrombi (+). deterioration as 7d-adm_NIHSS of more than 0.
Result: 14 of 22 (63.6%) were good match with the findings Results: We analyzed 71patients, median. 2 patients had
between the CT and TEE. Furthermore, SEC of TEE was grade 1 of TIC, 11 had grade 2, 38 had grade 3, and 20 had
well accorded with the feature of CT grade 2 (Sensitivity= grade 4. In 11 patients, 7d-adm_NIHSS was more than 0.
72.2%, Specificity=75%, Positive Predictive Value= Among the 11 patients, 9 patients (82%) had grade 1-2 of
92.8%). TIC at admission. Logistic regression analysis also
Conclusion: We have proved a significant correlation demonstrated grade 1-2 of TIC that was an independent
between enhancement patterns of multi-detected CT and significant predictor of neurological deterioration (OR,62.5;
TEE findings (p=0.036). 64-section contrast enhanced 95%CI,10.0-333, p<0.001).
multi-detected CT of the left atrium is a useful test of the Conclusion: In acute ischemic stroke patients with severe
method for evaluating thrombus and flow stasis in left stenosis or occlusion of the IC or MCA, MRI/TIC was
atrium appendage. useful in predicting neurological deterioration after
admission.

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


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 P1164
Ankle brachial index is a strong predictor Intra-hospital delays in stroke patients
of stroke events in the general population treated with rt-PA: impact of pre-
J. Gronewold1, M. Bauer2, N. Lehmann3, K. Krger4, admission notification to the emergency
S. Moebus3, K.-H. Jckel3, R. Erbel2, D. Hermann1, medical system and to the neurologists
Heinz Nixdorf Recall Study Investigative Group B. Casolla1,2, M. Bodenant1, M. Girot3, C. Cordonnier1,
1Vascular Neurology and Dementia, 2Cardiology, University
J.-P. Pruvo4, E. Wiel3, D. Leys1, P. Goldstein3
Hospital Essen, 3Medical Informatics, Biometry and 1Department of Neurology, Univ Lille Nord de France, CHU
Epidemiology, University of Duisburg-Essen, 4Angiology, Lille, EA 1046, Lille, France, 2Dep. of Neurosciences,
Helios Klinikum Krefeld, Germany Mental Health and Sensory Organs (NESMOS), SantAndrea
Introduction: Predictors of cerebrovascular events gain Hospital, University Sapienza, Rome, Italy, 3Department of
importance in secondary stroke prevention. Herein, we Emergency Medicine and SAMU 59, 4Department of
investigate the value of the ankle brachial index (ABI), a Neuroradiology, Univ Lille Nord de France, CHU Lille, EA
non-invasive marker of atherosclerosis, as stroke predictor 1046, Lille, France
in addition to established risk factors that are part of the Introduction: Pre-hospital notification enhances
Framingham Risk Score (FRS). thrombolysis rate and improves intra-hospital delays, but
Methods: 4299 subjects from the population-based Heinz- the impact of notification to the neurologist by the
Nixdorf-Recall Study (45-74 years; 47.3% men) without emergency medical system (EMS) call centre remains
previous stroke, coronary heart disease and myocardial unknown.
infarction, which received detailed baseline assessments, Our aim was to compare pre- and in-hospital delays in
were followed up for ischemic and hemorrhagic stroke stroke patients treated by intravenous (i.v.) rt-PA with and
events over 7.91.7 years. Cox regressions were used to without pre-hospital notification.
evaluate FRS variables [sex, age, smoking, diabetes, LDL, Methods: We compared baseline characteristics and
HDL, systolic blood pressure] and ABI as stroke predictors. in-hospital delays in stroke patients treated by rt-PA with a
Results: A total of 69 strokes (61 ischemic, 8 hemorrhagic) high-level notification (call to EMS and discussion EMS-
occurred during the observation period. Patients suffering neurologist), a low-level (call to EMS without discussion
stroke had significantly lower ABI values at baseline (1.02 EMS-neurologist) and no pre-hospital notification.
vs. 1.13, p<0.001). In multivariable regressions, ABI was a Results: Of 302 consecutive patients (165 women, 54.6%;
strong independent stroke predictor (hazard ratio=0.76 per median age 74 years, interquartile range [IQR] 59-83),
0.1, confidence interval=0.67-0.87; p<0.001) in addition to patients with high-level, low-level and no notification
age (1.49 per 5 years, 1.23-1.79; p<0.001) and systolic differed for the severity at admission (median national
blood pressure (1.34 per 10mmHg, 1.22-1.48; p=0.001). institutes of health stroke scale respectively of 12, IQR
ABI similarly predicted strokes in men and women and in 7-17; 9, IQR 6-15, and 8, IQR 6-14, p=0.029). Patients with
subjects above and below 65 years. In subjects belonging to high-level notification had shorter (i) admission-to-
the highest FRS (>13%) and lowest ABI (1.08) tertile completion of imaging times (27 min, IQR 14-35) than
stroke risk was particularly elevated. In the latter, low ABI patients with low-level notification (35 min, IQR 17-54) or
values significantly increased stroke risk (p for trend=0.009). no notification (36 min, IQR 30-58) (p<0.01); (ii) door-to-
Conclusion: ABI is a strong independent stroke predictor needle times (49 min, IQR 39-62 vs. 57 min, IQR 39-81 vs.
in addition to age and blood pressure, particularly in 63 min, IQR 51-97; p = 0.003); and (iii) onset-to-needle
subjects with vascular risk profile, where ABI identifies times (140 min, IQR 110-175 vs. 155 min, IQR 106-230 vs.
subjects at high stroke risk. 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.

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


Posters, Sunday 9 September 159

P1165 P1166
The immune response impairment was Intracerebral haemorrhage (ICH) patients
more pronounced in patients who as organ donors
developed severe ischemic stroke T. Sairanen1, A. Koivisto2, A. Koivusalo3, H. Isoniemi3,
P.A. Chemrukov1, N. Goncharova2, M. Potapnev2, T. Tatlisumak1
1Department of Neurology, Helsinki University Central
U. Shabalina1, I. Petrovich1, E. Oganova3, E. Sidorovich3
1Emergency Hospital, The Belarus Research Center of
2 Hospital, 2Medical Faculty, University of Helsinki,
3Department of Surgery, Division of Transplantation and
Transfusiology and Medical Biotechnologies, 3The Belarus
Research Center of Neurology and Neurosurgery, Minsk, Liver Surgery, Helsinki University Central Hospital,
Belarus Helsinki, Finland
Introduction: The association of inflammatory and Introduction: Intracerebral haemorrhage is the most
infectious processes with ischemic stroke has been devastating type of stroke. ICH is among the most common
identified by so far. The aim of our study was to define the reasons for brain death and thus carries the potential for
role of immune response impairment in patients who organ donation. We identified potential organ donors among
develop severe ischemic stroke. ICH patients.
Methods: In 89 patients with ischemic stroke the relative Methods: A retrospective chart review of consecutive ICH
content of T- and B-lymphocytes among peripheral blood patients treated at the Helsinki University Central Hospital
mononuclear cells were analyzed using the monoclonal (HUCH), 2005 to 2010 (n= 1 013). To assess the number of
antibodies CD3/CD4/CD8, CD4/CD154 and CD19/CD40 potential organ donors we identified patients who died
(Beckman Coulter) by flow cytometry. The serum levels of within 14 days, were 75 years of age, had no cancer or
separate inflammation markers were also determined. All other medical conditions that would be a contraindication to
patients were divided into four groups, i.e. the patients with organ donation, nor did they experience severe infection
mild (n=29), moderate (n= 24), severe (n=24) and extremely during hospitalization. The number of actual donations was
grave stroke (n=12). Healthy patients comprised the controls also assessed.
(n=13). Results: The number of deaths was 254/1013 (25%). Of
Results: Decrease in CD3+ (p=0.00007), these deceased 149 were 75 years (59%). There were 14
CD3+CD4+(p=0.02), CD3+CD8+ cells (p=0.02) was found with cancer (3 prostate, 2 breast, 2 lung, and one of bone,
in four groups of patients with stroke as compared to the liver, maxillary, lymphoma, sigmoid, melanoma, and
controls. The contents of CD3+ (54.010.4% vs. 63.68.7%, bladder). Of the remaining 135 9 had a prior medical
=0.028), CD3+CD4+ (30.210.4% vs. 39.65.7%, condition (3 rheumatoid arthritis, 2 type II diabetes with
=0.01), CD4+CD154- (21.25.9% vs. 32.75.3%, liver disease, and 1 microscopic polyangiitis, drug abuse,
=0.02), CD40+CD19- cells (51.20.03% vs. 64.44.4%, Eisenmenger syndrome, and carrier of ESBL). For 1 patient
=0.01) were lower, while those of CD19+ (13.66.5% vs. organ donation was denied by the bereaved. Among the
9.43.5%, =0.02), CD4+CD8+ cells (3.61.8% vs. remaining 126 patients 8 became donors. Of the remaining
1.81.3%, =0.02) were higher in patients with extremely 118 patients 24 had pneumonia and/or sepsis, and thus
grave stroke as compared to patients with mild stroke. The finally 94 of 254 (37%) patients who deceased were
reduction in T-helper cells correlated with the rise in hsCRP identified as missed potential donors. The conversion rate
(R=-0.34, p=0.01), while the increase in CD4+CD8+ and (actual donors divided by potential donors) was 8.5%.
CD3-CD8+ correlated with the severity of ischemic brain Conclusions: A considerable number of potential organ
lesions (R=0.049 , p=0.02). donors exists among deceased ICH patients.
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


160 Posters, Sunday 9 September

P1167 P1168
Successful use of intravenous Endoscopic removal of intraventricular
recombinant tissue plasminogen (rtPA) in haemorrhage combined with post-
a pregnant woman with cardio-embolic operative intraventricular thrombolysis
stroke: a case report J. Kuzibayev
B. Ratajczak, S.B. Sando, A.H. Aamodt Neurosurgery, Republican Research Center of Emergency
Department of Neurology, St. Olavs Hospital, Trondheim, Medicine, Tashkent, Uzbekistan
Norway The treatment of acute intraventricular haemorrhage is still
Introduction: Pregnancy-related ischaemic stroke is a debatable. Positioning of an external ventricular drainage is
challenging medical problem. Historically, the use of rtPA a common procedure although with the high risk of
thrombolysis in pregnancy and early post-partum period has infection. Lately few authors have described the endoscopic
been regarded relatively contraindicated. The major evacuation of intraventricular clots as a treatment option for
concerns are the risk of bleeding and complications in both such cases. Intraventricular thrombolysis has been described
mother and child. The safety of thrombolysis in acute stroke with rewarding results since more than a decade. We used
in pregnancy is not clarified, as these patients are regularly endoscopic removal of intraventricular haemorrhage
excluded from trials. Case reports that show a beneficial combined with postoperative intraventricular thrombolysis
effect of thrombolysis in acute ischaemic stroke in in 24 patients with intraventricular haemorrhage. A rigid
pregnancy are scarce. endoscope (Aesculap) was inserted in the frontal horn
Results: The patient was a 33-year-old woman who through, after prolonged irrigation, partially organized
developed acute stroke symptoms, with right-sided haemorrhagic clots were detected and removed with the aid
hemiparesis and expressive aphasia in the 7th gestational of the suction tip. At the end of the procedure an external
week. Acute MRI of the brain showed restricted diffusion in ventricular drainage was positioned. A post-operative CT
three different areas in the left hemisphere. An intra-venous scan was obtained in all patients to assess the organized
rtPA treatment was administered according to a standard clots and post-operative intraventricular thrombolysis was
protocol. Her neurological symptoms improved rapidly, no performed to evacuate the clots. In no patient we observed
complications developed. The diagnostic work-up did not complication related to the procedure. The results of
reveal any carotid atherosclerosis, coagulopathy or treatment were compared with the group of patients (21)
immunological disease. Echocardiography showed PFO treated with single external ventricular drainage. All patients
with right-left shunt. She was discharged with prophylactic in the main group survived: good recovery was in 12
therapeutic enoxaparin treatment, and had no further patients, moderate disability in 7, severe disability - in 5. In
embolic events. At 38 weeks gestation, she delivered a the group treated with single external ventricular drainage
healthy boy. 7 patients died, good recovery was in 3, moderate disability
Conclusion: As of now, about 200 patients are reported to 3, severe disability in 8. Our experience suggests that the
have been treated with fibrinolytics in pregnancy for various endoscopic removal of intraventricular haemorrhage
medical conditions (thrombosed prosthetic valves, combined with post-operative intraventricular thrombolysis
myocardial infarction, pulmonary embolism and ischaemic of intraventricular clots is a useful treatment option for
stroke). Complication rates of thrombolytic therapy in patients with intraventricular haemorrhage.
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


Posters, Sunday 9 September 161

P1169 P1170
The effect of a public information media Effect of weekday compared to weekend/
campaign on acute stroke presentation holidays admission on stroke outcome in
and management in an Irish hospital a comprehensive stroke unit
U. Moffatt1, N.A. Faheem2, D. Kelly3, P. Hickey4 J.C. Portilla1, R.M. Romero1, F. Lopez1, A. Falcon1,
1Medical 7, Sligo General Hospital, Sligo, 2Medical, M. Calle1, A. Serrano1, G. Gamez-Leyva1, M. Gomez1,
University College Hospital Galway, 3West of Ireland GP P.E. Jimenez1, M.D.M. Caballero1, J.M. Ramirez2,
Training Scheme, UCHG, Galway, 4Medicine, Sligo General I. Casado1
Hospital, Sligo, Ireland 1Hospital San Pedro de Alcntara, Caceres, 2Hospital
Introduction: Stroke is the third most common cause of Infanta Cristina, Badajoz, Spain
death and the most common cause of acquired major Background: Several studies have reported disparities in
physical disability in Ireland. In people with sudden onset treatment and clinical outcome between stroke patients
of neurological symptoms a validated tool such as FAST admitted on weekend compared to a weekday because of
(Face Arm Speech Time) should be used outside the hospital staffing level is reduced in those days. However, there is
to screen for the diagnosis of stroke or TIA. evidence that protocolized care in a Comprehensive Stroke
Objectives: To determine whether the FAST Campaign Center should overcome this effect. Our objective is to
increased public awareness of stroke and thus presentation compare the outcome of patients admitted for stroke in a
patterns of stroke/stroke-like symptoms to hospital, reduced Comprehensive Stroke Unit (CSU) according to the period
the time from onset of symptoms to presentation to hospital, of admission.
whether patients had CT brain within 3 hours, with view to Methods: Retrospective study. We included consecutive
thrombolysis if applicable. patients with acute stroke admitted in our CSU for 36
Methods: Retrospective audit undertaken on all patients months. Established protocols were applied. Two groups
admitted to Sligo General Hospital with stroke/TIA, six were categorized: A (weekday) and B (weekend/holidays).
weeks before and after, the official launch of the FAST We compared thrombolytic use, complications and outcome
campaign in Ireland, 6th May 2010 (i.e. between 25th March between two groups with adjustment for stroke type,
and 17th June). A list of audit candidates was compiled by severity and other demographic factors.
the Stroke Clinical Nurse Specialist using the Stroke Results: We included 622 patients (A:311, B:311). There
Register. Data was collected between October 2010 and were no significant differences in demographics, type or
January 2011 using a pro-forma. Data was analysed by the severity of stroke (NIHSS A: 6.9 and B: 7.1). Thrombolysis
Clinical Audit Support Team. was performed in A 8.7 % and B 7.7% (p0.05). Favourable
Results: Reduced time from onset of symptoms to hospital outcome (Rankin 2) were achieved in A: 59.5% and B:
presentation. Faster access to CT brain. Increased activation 58.8 % (p0.05). No differences in mortality were observed
of Stroke Pathway. Increased number of patients received (A 7.7% y B: 8%. p0.05).
thrombolysis. Increased numbers received anti-platelet Conclusions: At our CSU protocolized and continous care
within 48 hours. to the patients by neurologists and specialized nursing
Conclusion: Information media has a big influence on Irish overcome the effect that the admission period may have on
society and should be used as much as possible. 50% thrombolytic treatment and stroke outcome.
increase in suspected stroke hospital presentation within 3
hours. 50% increase in number thrombolysed.

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


162 Posters, Sunday 9 September

P1171 P1172
Predictive value of acute measurement of HAT score predicts hemorrhagic
multiple plasma neuronal and astroglial transformation and functional outcome in
markers on neuronal damage following acute ischemic stroke patients treated
ischemic stroke with intravenous alteplase
S.-H. Oh1, S.-Y. Park1, J. Kim1, Y.-K. Kim2, D.-A. Shin3, D.-I. Chang, S.H. Heo
J. Song4, O.-J. Kim1 Department of Neurology, Kyung Hee University, College of
1Department of Neurology, CHA University, 2Institute for Medicine, Seoul, Republic of Korea
Clinical Research, CHA Bundang Medical Center, Background: Intravenous thrombolysis with alteplase is
3Department of Neurosurgery, CHA University, Seongnam,
the most effective therapy for acute ischemic stroke, but
4CHA Stem Cell Institute, CHA University, Seoul, Republic
hemorrhagic transformation (HT) is a potentially dangerous
of Korea complication of thrombolysis. However, there was lack of
Background and aims: Prediction of extensive neuronal research to find predictors of HT after thrombolysis in
damage in the acute phase of ischemic stroke is important Korean stroke patients.
for prevention of secondary neuronal injury. The objective Methods: From 2003 to 2009, patients with acute ischemic
of the present study is to investigate the predictive value of stroke who received intravenous alteplase were prospectively
plasma neuronal and astroglial protein levels on extent of enrolled into Kyung Hee University Hospital stroke registry.
neuronal damage in ischemic stroke. CT or MRI scan with gradient echo sequences was
Methods: We measured plasma concentrations of neuronal performed within 12-36 hours after IV thrombolysis.
(neuron specific enolase (NSE), neuroglobin (Ngb) and Hemorrhage after thrombolysis (HAT) score of each patient
visinin-like protein 1 (VSNL-1)) and astroglial (glial (range; 0- minimum risk, to 5- maximum risk) was
fibrillary acidic protein (GFAP) and S100B) markers in 175 collected. We evaluated the predictability of HAT score for
patients with acute ischemic stroke (6-24 hours after HT and symptomatic intracranial haemorrhage (sICH)
symptom onset). Total 109 non-stroke individuals were using c statistics.
included as control group. The extents of neuronal injury Results: Among 151 consecutive patients, 35 patients had
were assessed by measurement of infarct volume (5 to 7 HT on follow-up brain images. In multivariate logistic
days after symptom onset). regression analysis, atrial fibrillation (OR=2.709, 95%
Results: Among 5 neuronal and astroglial markers, plasma CI=1.118-6.567) and low density on CT scan (OR=3.419,
S100B, GFAP, and NSE levels were significantly elevated 95%CI=1.281-9.121) increased the risk of HT after IV
in the stroke group compared to the control group. In thrombolysis. Patients with sICH and unfavourable (mRS
Pearson correlation analysis, plasma S100B (r=0.72), GFAP 2-6) outcome at 3 months had higher HAT scores.
(r=0.68) and NSE (r=0.41) levels were significantly Conclusions: HAT score can be used for predicting the risk
correlated with infarct volume. In a multiple regression of sICH in intravenous thrombolysis. In addition, it can
model of biochemical markers (S100B, GFAP, NSE) after predict long-term clinical outcomes.
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


Posters, Sunday 9 September 163

P1173 P1174
Intravenous rt-PA therapy for very old Complex interrelations between
stroke patients inflammation and vascular risk factors
C. Atsumi, H. Akiyama, H. Mizukami, K. Shimomura, determine cognitive impairment in acute
F. Maki, T. Yanagisawa, Y. Hasegawa ischemic stroke
Department of Neurology, St. Marianna University School of M.P. Danovska1, B.B. Stamenov1, M.L. Alexandrova2
Medicine, Kawasaki, Japan 1Neurology, 2Physics & Biophysics, Medical University
Introduction: In Japan, demographic changes will result in Pleven, Pleven, Bulgaria
a rapid increase of patients aged 90 years, but little is Introduction: Cognitive impairment following acute
known about outcomes in these patients after intravenous ischemic stroke is common, yet its determinants are not
recombinant tissue plasminogen activator (rt-PA) for acute fully understood
ischemic stroke. We aimed to assess safety and functional Objective: This study aims to identify significant
outcome in very old stroke patients treated with rt-PA. determinants, associated with increased risk of cognitive
Methods: We analyzed retrospectively collected data of 30 impairment in the acute phase of ischemic stroke.
consecutive acute stroke patients aged 80 years among 101 Patients and methods: The study was carried out on 47
all stroke patients treated with rt-PA in our hospital from patients (26 males and 21 females), median age 63 years,
October 2005 to September 2011. Their presenting with no baseline dementia. All the patients were assessed
characteristics, favourable outcome (modified Rankin scale with NIHSS, MMSE and mRS. Routine biochemical
0-2), mortality at discharge were compared between age 80 analyses and CT scan were performed within the first 24
to 89 (octogenarians) and 90 to 99 (nonagenarians). hours of stroke onset. Serum concentrations of hs-CRP
Results: 23 octogenarians (mean age; 83.73.0 years) and were measured on admission.
7 nonagenarians (mean age; 910.8 years) were eligible for Results: Our results showed that 57% of the patients had
our study. Gender and onset-to-needle time were similar cognitive impairment at discharge. We also established that
(60.7% women and 13441 minutes in octogenarians, and age (p=0.000), education (p=0.001), baseline systolic blood
57.1% women and 13925 minutes in nonagenarians). pressure (p=0.015), hyperglycaemia (p=0.021) and serum
Cardioembolic stroke was the most frequent stroke subtype hs-CRP level (p=0.050) on admission were significant
in both groups (19 of 23 octogenarians (82.6%) and 7 of 7 determinants of early cognitive deterioration. Of all the
nonagenarians (100%). Median NIHSS scores at admission variables, serum hs-CRP level (OR 1.12 (1.00-1.25),
and at discharge were 17 and 5 in octogenarians and 14 and p=0.049), gender (OR 5.97 (1.05-34.00), p=0.044) and age
10.5 in nonagenarians. Nonagenarians less often had a (OR 1.30 (1.09-1.55), p=0.004) were identified as
favourable outcome (14.2% vs. 30.4%, respectively) and independent predictors of post-stroke cognitive impairment.
had a higher incidence of mortality (14.2% vs. 4.3%, After baseline systolic blood pressure was entered in the
respectively) than did octogenarians. predictive model, gender lost its statistical significance of
Conclusions: Our study suggests less favourable outcomes independent predictor, which could be explained with
in nonagenarians as compared with octogenarians after gender-related variations of arterial hypertension.
rt-PA. 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.

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


164 Posters, Sunday 9 September

P1175 P1176
Aspects of venous thrombo-embolism Stroke epidemiology in Shiraz, Southern
prophylaxis in patients with acute stroke Iran: a hospital-based single-center
I. Macavei1, I. Huza2, A. Macavei3 retrospective longitudinal study
1Neurology, University of Medicine and Pharmacy, Tirgu
A. Safari1,2, R. Safari1, A. BorhaniHaghighi1,
Mures, 2Neurology, Emergency Clinical County Hospital M. Sharifian1
Mures, 3General Medicine, Clinical County Hospital Mures, 1Shiraz University of Medical Sciences, 2Shiraz University,
Trgu-Mures, Romania Shiraz, Iran
Introduction: Stroke is the leading neurological disorder Background: Published data about stroke epidemiology in
which causes prolonged motor impairment, associated with Southern Iran are scarce. We tried to find the demography,
an increased risk of venous thrombo-embolism. socioeconomy and mortality of patients with stroke in a
Objectives: To assess the incidence of deep vein referral center in south of Iran.
thrombosiss (DVT) of lower limbs, appreciate the use of Methods: This was a hospital-based single-center
thromboprophylaxis in patients admitted to hospital with retrospective longitudinal study performed in Namazi
stroke with severe motor deficits and bedridden. Hospital, Shiraz, Southern Iran. Patients with the
Patients and methods: The study included 1101 patients, International Classification of Diseases, 9th edition-Clinical
out of which 975 (81.11%) had an ischemic stroke, 132 Modification (ICD-9-CM) codes of 160-169 were extracted
(10.98%) had a hemorrhagic stroke and 86 (6.90%) had a from hospital. database. Age, sex, inhabitation, coverage by
history of ischemic stroke associated with hemorrhagic charity insurance indicating for low socioeconomic status,
stroke and severe motor deficits. In order to diagnose DVT, length of hospitalization, discharge destination were
peripheral venous vascular Doppler was performed. Stroke investigated.
severity at admission was assessed using NIHSS. Work Results: 16,351 patients, 8759 (53.6%) males and 7592
methodology consisted of retrospective, partially (46.4%) females, were recruited. Mean age of the patients
prospective, clinical study. Sources of information were 63.4 (95% CI 63.1 to 63.6) years. 2326 (14%) patients were
clinical observation sheets, with gathering data about younger than 45 years was (young adult stroke). 428(0.026
thromboprophylactic treatment, type of therapy, side effects, %) of patients were in the paediatric age group (equal or
duration of bedridden period. less than 18 years old. 2935 (19.95%) of the patients
Results: Out of the followed patients, 16 had signs of DVT inhabited rural areas and 13,416 (80.05%) were from urban
on Doppler examination, but only 6 had clinical symptoms. areas. 875 (5.35%) patients were from very low
According to NIHSS, 2.90% had severe neurological socioeconomic status covered by charity insurance. Mean
impairment (>25 points), 33.60% had moderate impairment hospital stay was 6.3 (95% CI 6.2 to 6.4) days. Stroke
(5-14 points) and 63.48% had mild impairment (<5 points). hospital mortality rate was 20.5%, significantly higher in
277 patients (25.19%) received low molecular weight females, paediatric age group, patients from low
heparin, while in 63 patients (5.72%) mechanical methods socioeconomic status. (all P values <0.001). Mortality rate
were used. Hemorrhagic side effects were encountered in of the stroke patients was significantly increased from 2001
small percentage, not exceeding the numbers from the till 2009. (P value <0.001).
reference literature. Thromboprophylactic treatment was Conclusions: Stroke is a major health issue in Iran with
received within 24 hours from admission in 90.5% of the higher mortality and larger proportion of young adults in
patients. comparison to Western countries.
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


Posters, Sunday 9 September 165

P1177 P1178
Evaluation of the lesions in the left A case of only peripheral type facial palsy
thalamus in patients with subcortical in ponto-medullary junction area
vascular cognitive impairment using 1H infarction
magnetic resonance spectroscopy and J.H. Han, D.E. Kim
diffusion tensor imaging Department of Neurology, Seoul Veterans Hospital, Seoul,
Republic of Korea
P. Lv, Y. Dong, L. Li
Department of Neurology, Hebei General Hospital, Introduction: Unilateral facial palsy of the peripheral type
Shijiazhuang, China without other neurologic deficits is mostly diagnosed as
Objective: To investigate the lesions of the left thalamus Bells palsy. We present an unusual case of ipsilateral
and the correlation with cognition in patients with SIVD by peripheral facial palsy in dorsolateral ponto-medullary
using 1H magnetic resonance spectroscopy (1H-MRS) and infarction without other neurologic deficits.
diffusion tensor imaging (DTI). Case report: A 69-year-old woman was admitted with
Methods: 14 patients with VaD, 14 patients with VCIND, sudden left facial weakness. She had no other neurologic
and 12 normal controls (NC) were recruited. The quantitative deficit, except for left peripheral type facial palsy. She had
analysis of N-acetylaspartate (NAA), myoinositol (mI), a presumptive diagnosis of Bells palsy. Nerve conduction
Choline (Cho) and Creatine (Cr) resonance signals in region study showed normal terminal latency and compound
of interests (ROI) located in the left thalamus were muscle action potential (CMAP) amplitude in right and left
measured. Fractional anisotropy (FA) and mean diffusivity facial nerves. Blink reflex test showed normal R1 responses
(MD) in the same region were measured by DTI. The on both sides. But, ipsilateral R2 and contralateral R2
relationship was described among the MRS, DTI ratios and responses were not obtained by the stimulation on the
cognitive impairment reflected in MMSE and trail making affected side. These findings were indicative of left facial
test (TMT). neuropathy, due to left medullary lesion. Diffusion weighted
Results: (DWI) brain MRI demonstrated high signal lesion in left
(1)The NAA/Cr ratio showed a gradual decrease in the left dorsolateral ponto-medullary junction. Apparent diffusion
thalamus of SIVD patients compared with controls coefficient (ADC) brain MRI showed low signal lesion in
(F=3.656, p=0.038). No significant difference was found the same area.
between VaD and VCIND patients. Conclusion: Occasionally, peripheral type facial palsy was
(2)Compared with controls, patients with VaD and VCIND found in pontine infarction. But, isolated peripheral facial
demonstrated increased MD value in the left thalamus palsy without other neurologic defects is a rare condition in
(F=3.882, p=0.030). No significant difference between VaD brainstem infarction. Generally, if a patient presents with
and VCIND patients was observed (p>0.05). peripheral type facial palsy without other neurologic
(3)No correlation was found between MRS value and DTI abnormalities, brainstem lesions were not considered. This
parameters in the ROI (p>0.05). (4)A significant positive case shows us that ponto-medullary infarction presents only
correlation was observed between TMTb time and Cho/Cr peripheral type facial palsy without other neurologic
(r=0.520, p=0.001) and also MD value in the left thalamus abnormalities. So, if a patient admits with peripheral type
(r=0.305, p=0.044). facial palsy, we must make up electrophysiological study
Conclusions: The axonal loss or dysfunction and diffusion and brain image.
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


166 Posters, Sunday 9 September

P1179 P1180
Improving factors for patients with left Real time measurement of extracellular
unilateral spatial neglect glutamate release in a global ischemic rat
M. Yamada1, Y. Nakamura1, M. Kawaguchi1, Y. Satoh1, model treated with nimodipine
A. Satoh2, M. Tsujihata2 H.-K. Park1,2, G.-J. Lee1,2, S.-W. Kang1,2, S. Choi1,2,
Rehabilitation, 2Neurology, Nagasaki Kita Hospital,
1
S.-K. Choi3
Nagasaki, Japan 1Kyung Hee University, College of Medicine, 2Healthcare

Objectives: The aim of this study was to determine the Industry Research Institute, 3Kyung Hee University Hospital,
factors to ameliorate USN. Seoul, Republic of Korea
Patients and methods: 51 patients (32 male and 19 female, Background and aims: It is generally thought that cerebral
ages 40-85, average educational level 11.3 years, all right- ischemia is associated with extracellular concentrations of
handed) with a right hemisphere stroke who were admitted the excitatory amino acids. It was known that nimodipine
to the hospital for rehabilitation were screened for USN. All combined with L-type voltage-gated calcium channels
patients were evaluated at 1 month and 3 months using The prevented calcium influx inside the cell. In order to define
Behavioural Inattention Test (BIT). The cut-off value of 131 the effect of nimodipine on glutamate release, we monitored
was used to determine whether USN present or not. The extracellular glutamate release in real-time in a global
patients who showed a BIT score over 131 at 3 months were ischemia rat model with eleven vessel occlusion.
classified as the improved group (17 patients) and those Methods: Changes in cerebral cortical blood flow (CBF)
with less than 131 were the unimproved group (34 patients). were monitored by laser-Doppler flowmetry with cortical
In total 17 items were studied to determine the factors glutamate levels by amperometric biosensor. A ten minute
associated with the improvement of USN; ages at onset, 11VO cerebral ischemia was initiated by pulling the snares
educational level, MMSE, KOHS block design test, Simple on the common carotid arteries. Nimodipine was permeated
test for evaluating hand function (STEF), Trail making test from the burr hole beside of CBF probe during the beginning
(TMT-partA), Functional Independence Measure (FIM) of the ischemic period. We performed Nissl staining for a
(total score, mobility ADL and cognition), BIT (total score, histological assessment of neuronal cell damage.
and its subitems; line, letter and star cancellation, line Results: During the ischemic period, the mean maximum
bisection, and figure and shape copying). change in glutamate concentration was 133.222.57M in
Results: The average scores of 12 items except for age, the ischemia group and 75.424.22M (p<0.001) in the
education level, MMSE, TMT part 2, and FIM cognition at group treated with nimodipine. The total amount of
1 month were significantly higher in the USN improved glutamate released was significantly different (p<0.001)
group than those in the unimproved group. between groups during the ischemic period. The %cell
Conclusions: The present study indicated that high scores viability in hippocampus was 47.505.64 (p<0.005) in the
on the Bit behavioural test, shape copying, and STEF ischemia group, compared with the sham group. But, the
evaluated within 1 month after the onset of stroke serve to %cell viability in the nimodipine treatment group was
predict a good prognosis of USN. 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.

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


Posters, Sunday 9 September 167

P1181 P1182
Prevalence of combinatorial genetic Successful intra-arterial thrombolysis in a
polymorphisms of CYP2C9 and VKORC1 patient with subarachnoid haemorrhage
in acute stroke patients: implications for developed after bridging intravenous and
warfarin management intra-arterial thrombolysis
S. upe1, Z. Poljakovi2, N. Boina3, V. Matijevi2, J.-H. Kwon1, W.-J. Kim1, M.-S. Kim2, S.-H. Lee2
A. Bazina2, A. Miima2 Neurology, 2Ulsan University Hospital, Ulsan, Republic of
1
1Department of Neurology, University Hospital Center Korea
Zagreb, 2Department of Neurology, 3Department of Subarachnoid haemorrhage (SAH) is a contraindication of
Pharmacology, University of Zagreb, School of Medicine, intravenous thrombolysis (IVT) with rt-PA. Reocclusion
Zagreb, Croatia after IVT is a well-known complication and intra-arterial
Background: Patients with cardioembolic stroke or stroke thrombolysis (IAT) is a relatively common procedure to
due to extracranial artery dissection or cerebral sinus open the re-occluded vessels. We report a patient who had
thrombosis require urgent anticoagulant therapy initiation. recurrent acute ischemic stroke which was successfully
Among those patients, risk of embolic stroke recurrence is recanalized with IAT in spite of localized SAH developed
5-7% within the first week with an increased risk of after IVT and IAT for acute ischemic stroke.
bleeding into the infarct zone. Many reports confirmed that A 60-year-old woman with atrial fibrillation developed left
CYP2C9 and VKORC1 genetic polymorphisms have strong hemiparesis and gaze preference to the right side suggesting
influence on interindividual warfarin sensitivity and right middle cerebral artery (MCA) territory infarction.
significantly alter the effective warfarin dose. In acute Brain CT at 20 minutes after symptom onset showed no
stroke patients it is important to select initial doses based on haemorrhage and IV rt-PA was administered. MR
individual genotype in order to achieve earlier angiography performed at 1 after IVT showed M1 occlusion
anticoagulation and to reduce the risk of developing of the right MCA. The right MCA was recanalized after IAT
warfarin side effects in early initiation of therapy, with urokinase and tirofiban. Her focal neurologic deficits
particularly among carriers of multiple allelic variants. were fully recovered despite localized SAH in the left
Methods: We determined the frequency of alleles of parietal lobe. We treated her with anticoagulation for
CYP2C9(*2*3) and VKORC1(-1173C>T) genes among prevention of recurrent ischemic stroke in spite of SAH.
106 patients hospitalized for acute stroke with indications However, she re-developed a right MCA territorial infarct
for anticoagulant therapy. Among them were 36 previously again at 3 days after successful thrombolysis. MR
anticoagulated patients. The impact of CYP2C9(*2*3), angiography at that time revealed re-occlusion of the right
VKORC1(-1173C>T) genetic polymorphisms on warfarin MCA. IAT with penumbra and urokinase was re-tried and
dosage was gauged using a published algorithm. We the right MCA was completely recanalized. She recovered
analyzed which alleles of CYP2C9(*2,*3) and VKORC1- to 2 of modified Rankin Score at 3 months and her SAH
1173C>T contribute to achieve earlier anticoagulant effect, was not aggravated.
stable maintenance dose, which allelic variants spent the In conclusion, localized SAH could occur after IVT. IAT is
longest time in therapeutic INR range and which contribute a considerable treatment option when a recurrent acute
to undercoagualtion. ischemic stroke developed in a patient with SAH after IVT
Results: Target INR was firstly achieved among the patients and IAT.
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


168 Posters, Sunday 9 September

P1183 P1184
Ischemic stroke as a late complication of The territorial division and clinical
brain radiotherapy during childhood: a characteristics of anterior circulation
case report cerebral infarction
C. Parmentier, Y. Vandermeeren, P. Laloux, E. Mormont I. Stakena1, I. Zimaisa1, G. Enina1, I. Kikule1,
Neurology, CHU Mont-Godinne, Yvoir, Belgium A. Platkajis2
1Department of Neurology and Neurosurgery, 2Department of
Background: Neurologists should be aware that survivors
of childhood brain cancer have an increased risk of stroke. Radiology, Riga Eastern University Hospital Gailezers,
Stroke can occur as a delayed complication of brain Riga, Latvia
radiotherapy. We report a case that highlights the increased Introduction: In the classification of anterior circulation
risk of long-term cerebrovascular complications in such cerebral infarctions (ACCI) into subtypes there is not
patients. sufficiently considered the involved artery, the territorial
Case-report: A 26-year-old patient presented with acute area of blood supply and the size of infarction.
sensory loss involving the right face, arm and leg and Patients and methods: 424 patients were examined with
clumsiness of the right arm. His previous medical history ACCI who were treated at the Stroke Unit. All cases CI was
was remarkable for smoking, alcohol abuse and a cerebellar the first presentation and lacunar CI were not included. The
pilocytic astrocytoma discovered at the age of four, treated atherotrombotic CI were detected in 68.9%, but
by surgery followed by radiotherapy and chemotherapy. cardioembolic CI - in 31.1% of patients.
Neurological examination revealed right hemihypesthesia, Results: The vast majority of the patients were admitted
right hemiataxia, right Babinski sign and a weakness of the with MCA CI (98.1%) and only 1.2% had ACA and 0.7%
right arm (NIHSS=7). Head computed tomography revealed AChA infarcts. According to the damaged brain area MCA
calcifications of the left cerebellum, left temporal lobe and and ACA CI were divided into territorial areas of
of the basal ganglia. A brain MRI showed left thalamic and leptomeningeal (lm) and perforal (perf) arteries. The
parahippocampal hyperintense lesions in FLAIR and DWI analysis of the territorial area was only performed for the
with a decrease of the apparent diffusion coefficient (ADC), MCA blood supply area. Most often MCA infarction was at
consistent with an acute ischemic stroke in the territory of territory of lm arteries (73.6%) and of perf arteries only in
the left cerebral posterior artery. Magnetic resonance 26.4%. Of all ACCI partial large infarction of the MCA lm
angiography confirmed an occlusion of the left P2 segment. area was found significantly more often (44.1%) (p<0.005).
Carotid and vertebral duplex-ultrasound and cardiac workup The incidence of other subtypes of MCA infarction (total
were normal. Blood tests only showed a moderate MCA, partial small MCA lm, large MCA perf and small
hyperlipemia. Thrombophilia screening was negative. MCA perf) were similar and <15%. The clinical
Alpha-galactosidase activity was normal. characteristics of different MCA infarction subtypes differ
Discussion: This case illustrates a late manifestation of mainly according to the size of CI and territorial blood
radiation-induced complication, namely intracranial steno- supply area.
occlusive disease and mineralizing microangiopathy. In Conclusion: Elaborated supplement of ACCI classification
brain cancer survivors, the stroke workup should be based on the involved arteries, territorial blood supply area
extensive and take into account unusual aetiologies such as and the characteristics of infarction size is suitable for use
radiation-induced intracranial steno-occlusive disease. in neurovascular clinical practice.

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


Posters, Sunday 9 September 169

P1185 P1186
Predilection for antihypertensive therapy Stroke in atrial fibrillation can it be
in patients from the stroke-risk group prevented?
E. Vereshchagina, E. Isakova, A. Kotov V. Turcanu1, A. Grosu2, N. Diaconu2, C. Gratii2,
Neurology, M.F.Vladimirsky Moscow Regional Clinical and G. Pavlic3
Research Institute, Moscow, Russia Clinical Military Hospital, 2Institute of Cardiology,
1

Introduction: Arterial hypertension (H) is a most Institute of Neurology and Neurosurgery, Chisinau,
3

investigated risk factor (RF) of cerebrovascular diseases Moldova


available for correction, but efficiency of AH therapy is low. Introduction: Despite the known increased stroke risk
Materials and methods: A total of 197 AH patients were associated with atrial fibrillation (AF) and the benefit of
asked to fill in questionnaires in order to study their medical oral anticoagulation (OAC) in high-risk patients, still ~20%
literacy and predilection to antihypertensive therapy (AHT). of all ischaemic strokes are atrial fibrillation related.
Results: The patients were asked what index of arterial Aims: We aimed to evaluate the frequency of inappropriate
blood pressure (ABP) they considered normal: 12.7% - anticoagulation in all patients admitted with ischemic stroke
BP>140/80mmHg; 32.9% - 140/90-70; 23.4% - <140/90, and AF and to calculate the theoretical number of
but >120/80; 25.4% - 120/80; and 5.6% patients could not preventable strokes in case of proper guideline adherence
determine their normal ABP values. Regularly 58.4% and also to assess secondary stroke prevention at discharge.
patients underwent AHT, not regularly - 37.1%; never - Methods: In this cross-sectional study, all patients with
4.7%. The causes of irregular or refuse of AHT; 58.5% ischemic stroke admitted to our hospital during January
BP was not always elevated being normal sometimes 2004 and December 2004 in which the diagnosis AF was
without preparations; 34.1% drugs were harmful for their either known or established during hospital stay were
stomach, liver and kidneys, etc., 25.6% did not feel their identified.
elevated ABP; 17.1% forgot to take preparations; 17.1% Results: We have included 206 patients with AF and
were afraid to get accustomed to the drugs; 1.2% ischemic stroke. We have calculated the number of
complained of the unpleasant taste of the tablets; 12.2% preventable strokes in case AF patients would have received
complained of the drug side effects; 12.2% considered adequate antithrombotic treatment on admission. On
the drug cost too high; 15.9% refused to take so many admission, in 59% of the OAC eligible known AF patients
tablets; and 4.9% considered AHT ineffective. the drug was withheld. Improved antithrombotic guideline
Conclusion: The results obtained are indicative of the low adherence potentially would have prevented 54 out of the
predilection to AHT, which is due to a low medical literacy 206 (26%) ischemic strokes. At discharge at least 48% of
of the population. It should be noted that just the personal the patients were still insufficiently protected against
attitude to the drugs (and not their high cost) was a main recurrent stroke.
cause of patients refusal of AHT. 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.

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


170 Posters, Sunday 9 September

P1187 P1188
Mechanical thrombectomy with Solitaire Clinical and ultrasonographic
AB device in basilar artery occlusions characteristics in anterior ischemic optic
E.J. PalacioPortilla1, A. GonzlezSurez1, neuropathies (AION)
J.M. Navasa Melado2, I. GonzlezAramburu1, D.C. Jianu1, S.N. Jianu2, L. Petrica3, D.F. Muresanu4,
O. AchaSalazar3, F.J. NovoRobledo3, S.M. Deme5, M. Petrica1
M.A. RevillaGarca1, M. RebolloAlvarez-Amandi1, 1Neurology, Victor Babes University of Medicine and

A. GonzlezMandly2 Pharmacy, County Emergency Hospital, 2Ophthalmology,


Neurology, 2Radiology, 3UARH, Hospital Universitario
1
Military Emergency Hospital, 3Internal Medicine-
Marqus de Valdecilla, Santander, Spain Nephrology, Victor Babes University of Medicine and
Introduction: Acute ischemic stroke (AIS) due to basilar Pharmacy, County Emergency Hospital, Timisoara,
4Neurology, University of Medicine and Pharmacy, Cluj-
artery occlusion (BA) has a poor natural history. Early
recanalization of occluded brain arteries in AIS is associated Napoca, 5Neurology, West University, Arad, Romania
with better clinical outcome. Our aim is to describe four Introduction: AION represent a segmental infarction of the
patients with AIS due to BA occlusion who had been treated optic nerve head supplied by the posterior ciliary arteries
with mechanical thrombectomy with Solitaire AB stent. (PCA).
Methods: Description of four clinical cases of acute BA Purpose: To describe characteristic clinical features and
occlusion treated with mechanical thrombectomy with ultrasound findings which help to differentiate newly
Solitaire AB stent in our hospital. diagnosed arteritic AION (A-AION) from non-arteritic
Results: Four patients (three females and one male, age AION (NA-AION).
range 52-81 years) with acute BA occlusion received Patients and methods: In this prospective study, 37
treatment with mechanical thrombectomy. Intravenous consecutive patients with clinical suspicion of unilateral
thrombolysis was previously administered in two cases. AION were examined following a complex protocol
Thrombectomy revascularization, defined as a final grade including Color Doppler imaging-CDI of orbital vessels
of 2b or 3 according to the thrombolysis in cerebral (Logic 500, GE with 9MHz linear probe).
infarction (TICI) score, was successful in all cases. At 3 Results: The final diagnoses were A-AION due to GCA in
months, one patient had died and the other three were 5 patients, all of them with biopsy-confirmed disease, and
functionally independent (modified Rankin scale 0-2). 32 patients with NA-AION. A combination of a history of
Conclusion: Thrombectomy with Solitaire AB stent amaurosis fugax before an abrupt, painless, and severe loss
achieved immediate recanalization with good clinical of vision of the involved eye, with a diffuse pale optic disc
outcome in most cases. Endovascular therapy with this oedema was extremely suggestive of A-AION. However,
technique may be considered as an efficient tool for the none of these symptoms was ever found in NA-AION. The
treatment of AIS due to BA occlusion. 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).

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


Posters, Sunday 9 September 171

P1189 P1190
Interhemispheric differences of cerebral Clinical features of the perimesencephalic
perfusion and brain DC potentials non-aneurysmal subarachnoid
influence verbal fluency in patients with haemorrhage: a report of 35 cases
vascular encephalopathy L. Yin
V. Fokin, N. Ponomareva, M. Krotenkova, R. Konovalov, Department of Neurology, 2nd Hospital of Dalian Medical
M. Tanashian, O. Lagoda University, Dalian, China
Research Center of Neurology RAMS, Moscow, Russia Objective: To analyse clinical manifestations and imaging
Aim: In healthy subjects left frontal and temporal cortex features of perimesencephalic non-aneurysmal subarachnoid
plays a main role in verbal fluency performance, however in haemorrhage (PNSAH).
patients with chronic cerebrovascular disease there is not Materials and methods: Clinical data of 35 cases with
much information about the brain structures participating in PNSAH were collected in this study. All cases were admitted
this cognitive process. This study was aimed at determining to the Department of Neurology, the Second Affiliated
brain structures influencing verbal fluency in patients with Hospital of Dalian Medical University, from January 2001
vascular encephalopathy (VE). to June 2010. The clinical manifestations, imaging features
Methods: DC potentials and cerebral perfusion were and prognosis, were retrospectively investigated and
investigated in 40 patients with VE. DC potentials were concluded.
registered from head using 12 Ag/AgCl electrodes placed Results:
according to 10-20 system with reference on right wrist. DC 1. Clinical symptoms are mild in these cases with Hunt-
potentials reflect intensity of cerebral energetic metabolism Hess grade I-II, with no consciousness disturbance, focal
(Fokin, Ponomareva, 2003). Standard characteristics of neurological deficits and hydrocephalus, with few (8.6%)
computed tomography perfusion in the brain were measured cerebral vasospasms which recovered quickly by
before and after word fluency test (WFT). symptomatic treatment.
Results: Characteristics correlating with word production 2. CT showed that the blood mainly distributed in
in WFT was minimized in multiple regression model surrounding mesencephalon cisterna and anterior pontine
(R=0.96; F=34.5; p<0.00001). According to this model left cisterna. The blood spread into the cerebral longitudinal
frontal, right parietal DC potentials as well as fissure and fissure of Sylvius in few cases (5.71%, 2/35).
interhemispheric differences between CBF in right and left Most CT images were classified into Fisher Grade 1~2, 2
frontal cortex, CBV in right and left thalamus, difference of cases were Grade 3, there was no Grade 4 case. All cases
DC potentials between right and left parietal cortex had a negative DSA examination performed within one
influenced the WFT performance. week after onset, and repeated DSA showed no abnormality
Conclusion: Interhemispheric differences of brain after 3 months of onset.
perfusion and energetic metabolism correlating with verbal 3. Average hospitalization duration was 16 days. After a
fluency appear to reflect the differences in activation of mean 14 months follow-up, there was no re-bleeding and
right and left brain structures involved in WFT performance permanent nerve dysfunction.
in patients with VE. 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.

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


172 Posters, Sunday 9 September

P1191 P1192
Analysis of risk factors associated with Thrombolytic treatment of acute ischemic
bleeding of AVM patients treated with stroke. How to harmonize logistics in the
gamma knife radiosurgery (GKRS) healthcare system to meet the high-level
J.H. Yun, D.H. Kwon, B.D. Kwun professional requirements of the
Neurological Surgery, Asan Medical Center, Ulsan thrombolytic treatment protocol?
University College of Medicine, Seoul, Republic of Korea
A. Folyovich, K.A. Bres-Molnr, V. Varga, E. Horvth,
Objectives: The two purposes of our study are comparison K. Vadasdi, N. Kaszs
of annual bleeding rate before and after GKRS and analysis Neurology and Stroke Center, Szent Jnos Hospital,
of risk factors associated with bleeding before and after Budapest, Hungary
GKRS. Introduction: The efficacy of thrombolytic treatment (TT)
Materials and methods: This retrospective analysis was for acute ischemic stroke has been established. The number
performed for AVM patients treated with GKRS in single of patients eligible for thrombolysis remains low, due to the
center. Between 2001 to 2010, a total of 433 patients were strict treatment protocol. This number could be increased by
selected in this study and all charts were reviewed. We highly organized logistics of the ambulance service and
analyzed annual bleeding rate and bleeding risk factor by hospitals. Almost all medical specialties should be available
multivariate Cox proportional hazards model analysis. 24 hours a day. We investigated the timely distribution of
Results: The 299 cases of initial bleeding presentation TTs during regular working hours (between 8-16 hours) and
before GKRS represented 69% (299 of 433). Among 35 on-call duty hours in our department, providing 24-hour
bleeding AVM patients after GKRS, 15 patients showed comprehensive care for patients with stroke and acute
initial non-bleeding presentation and the remaining 20 were neurological conditions.
initial bleeding ones. In analysis on factors affecting with Patients and methods: Time and date of admissions of
bleeding before GKRS, highly significant associations were 6076 patients treated in our Stroke Center between 2009
found with single feeder, deep draining vein and and 2011 were analyzed, as well as distribution between
periventricle location. Also we could demonstrate that AVM regular working hours and on-call duty hours.
patients who had a single feeder or total obliteration were at Results: Percentage of acute admissions was 86.12%.
low risk of bleeding after GKRS (62%, 56%), but one with 51.15% of total patients and 66.66% of patients with TT
nidal aneurysm was high risk of bleeding after GKRS as who were admitted during on-call duty hours. On weekends,
(4 times). percentage of admissions was 20.19%, and that of patients
Conclusion: Annual bleeding rate of AVM was decreased with TT was 17.64%. Thrombolysis was most often
after GKRS (from 5.9% to 3.0%). AVM patients who had a performed on Thursday and Friday, and between 12 and 13
single feeder or total obliteration would have a low bleeding p.m. On weekends, the peak time for TT was between 17
risk after GKRS and on the other hand, ones with nidal and 18h. 23.53% of TTs were performed between 10 p.m.
aneurysm would have a higher bleeding risk than ones and 6 a.m.
without. Meticulous clinical and radiological follow-up Conclusions: The rate of admissions for acute stroke was
study is mandatory for detection of post-radiosurgery higher during on-call duty hours, adding to the already high
bleeding in AVM patients with these risk factors. 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.

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


Posters, Sunday 9 September 173

P1193 P1194
Differences in changes of Stupefaction phenomena of peripheral
interhemispheric EEG coherence in neurons in stroke patients
patients after carotid ischemic stroke and O. Schiopu1, M. Gavriliuc1, A. Grumeza1, A. Bodiu2
transient ischemic attack 1Neurology, 2Neurosurgery, Institute of Neurology and

Neurosurgery, Chisinau, Moldova


A. Solkin, M. Bialiauski, U. Kuzniatsou, K. Bialiauskaya,
K. Pashkova, R. Santhalingam, C.S. Ilapperuma Background and aims: Preconditioning of cerebral tissue
Neurology and Neurosurgery, Vitebsk State Medical is a known phenomenon. Our work group suggests a new
University, Vitebsk, Belarus term - stupefaction of neurons that means capacity to
Aim: To determine the dynamics of changes of recovery of neurologic functions after delayed in time
interhemispheric EEG coherence in patients after carotid reperfusion. The aim of study derived from observation of
ischemic stroke (IS) and transient ischemic attack (TIA). several post-stroke patients in which carotid endarterectomy
Patients and methods: 28 patients (18 patients with TIA was performed and remarkable clinical improvement was
and 10 patients with IS in the region supplied by the left noticed reduction of neurological deficits.
carotid artery) aged 46-68 were examined by coherence Patients and methods: The study comprised 32 post-stroke
analysis of the EEG on the 2nd-14th day after TIA and on patients operated for carotid artery stenosis greater than
the 60th-180th day after IS. The control group included 24 70% by carotid endarterectomy. The period between stroke
age-matched practically healthy volunteers. onset and surgery varied from 6 weeks to 1 year. Control
Results: A decrease of EEG coherence predominantly in group, 21 patients, included the same population - post-
the delta, theta and alpha frequency bands between different stroke patients with symptomatic carotid artery stenosis
cortical areas of hemispheres (frontal, central, parietal, who refused surgery. Electrophysiological exam comprising
temporal and occipital) was revealed on the 2nd-4th day neurography and needle EMG was performed in operated
after carotid TIA. Positive changes of EEG coherence in the patients by the following schedule: before surgery, 10-14
majority of frequency bands were revealed on the 10th-14th days after and 30 days after. Control group was examined
day after TIA. An opposite trend of changes of EEG twice: 14 days after stroke onset and 3-4 months later.
coherence (increase) was observed at the same time between Results: In all patients first exam of the paralyzed side
some cortical areas in the beta-2 band. A relatively persistent showed: decreased M-responses compared to the healthy
decrease of EEG coherence in all frequency bands with a side, spontaneous activity, and unstable motor units
focus on alpha, beta-1 and beta-2 bands was revealed depending on duration from stroke onset. After surgery first
between different cortical areas of hemispheres in patients exam showed increased motor responses, bigger amount of
after carotid IS during the observation period. motor units, richer interference pattern. The evolution of
Conclusion: The revealed changes of interhemispheric changes in peripheral nervous system was totally different
EEG coherence give evidence of the reversible and in the operated and the control group.
functional damage of central nervous system in patients Conclusions: Peripheral neurons in stroke patients after
after TIA and structural and relatively persistent CNS long-term carotid stenosis preserve their function in
damage in patients after ischemic stroke. 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.

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


174 Posters, Sunday 9 September

P1195 P1196
Transplantation of autologous bone Stroke subtypes and risk factors
marrow stromal cells (BMSC) for ischemic associated with vascular dementia
stroke: strategy and tactics for clinical B. Ince, G. Benbir
application Neurology, Istanbul University Cerrahpasa Medical Faculty,
Istanbul, Turkey
S. Kuroda, K. Houkin
Neurosurgery, Hokkaido University Hospital, Sapporo, Vascular contributions to cognitive impairment and
Japan dementia are very important. As we know more about the
Objective: There is increasing evidence that the transplanted risk factors of vascular dementia (VaD), the prophylactic
bone marrow stromal cells (BMSC) significantly promote managements would better help us in controlling the
functional recovery after central nervous system damage in morbidity of this disease. We investigated the patients
the animal models of various kinds of CNS disorders, followed in stroke outpatient clinic between 1996 and 2011.
including cerebral infarct. However, there are several The diagnosis of VaD was made on the basis of DSM-IV
shortages of information when considering clinical criteria and mini mental test. A total of 2798 patients were
application of BMSC transplantation for patients with included in the study with a mean age of 61.613.4 years;
neurological disorders. Here, we discuss what we should and 53.9% of them were males. Of these, 90.5% were of
clarify to establish cell transplantation therapy in clinical ischemic origin and 7.1% were intracerebral haemorrhages.
situation and describe our recent works for this purpose. Among patients with ischemic stroke, the pathogenesis was
Methods and results: The BMSC have multiple abilities to atherothrombotic in 15.8%, cardioembolic in 20.1%, small
differentiate into the neural cells and to promote neuronal vessel disease in 18.2%, other causes in 5.1%, and unknown
survival and axon elongation, contributing to rebuild the in 31.6%. A total of 127 patients (4.5%) had dementia. VaD
neural circuits in the injured CNS. Using optical imaging was present in 2.2% of patients with atherothrombotic
and MRI techniques, the transplanted BMSC can non- stroke, 4.4% of patients with cardioembolic stroke, 11.8%
invasively be tracked in the living animals for at least 8 of patients with small vessel disease, and 3.5% of patients
weeks after transplantation. Clinical MR apparatus can with intracerebral haemorrhage. The frequency of VaD is
visualize the tagged BMSC in the brain. 18F-FDG PET is significantly higher in small vessel disease (p<0.001).
quite valuable to monitor the recovery of brain metabolism Hypertension was more frequent in patients with VaD
after transplantation. The BMSC can be expanded using the (81.9% vs. 69.6%, p=0.001), and the use of more than one
animal protein-free culture medium within a clinically antihypertensive drug was more common in patients with
relevant period. G-CSF is useful to enhance their small vessel disease and without VaD (p=0.008), suggesting
proliferation when the BMSC are obtained from the aged a better control for hypertension. As the studies investigated
patients. There is optimal dose and timing of BMSC the characteristics of VaD increased, we could better identify
transplantation to yield significant therapeutic benefits. the risk factors to reduce the burden of dementia, the
Conclusion: It is anurgent issue to develop a clinical incidence of which seems to increase as life expectancy
imaging technique to track the transplanted cells in the CNS advanced.
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


Posters, Sunday 9 September 175

P1197 P1198
Basilar artery thrombosis in an 11-year- Changes in plasma matrix
old boy treated with intravenous t-PA and metalloproteinase-9 levels in patients with
endovascular mechanical thrombectomy acute ischemic stroke
D. Kondziella1, J. Fink2, L. Sonneborg3, L.L. Larsen4, I.M. Cojocaru1, M. Cojocaru2, V. Sapira3, G. Socoliuc3,
A.P. Born5, M. Holtmannsptter6 C. Hertea3
1Department of Neurology, Copenhagen University Hospital, 1Neurology, C Davila Univ of Med and Pharm, Colentina

Rigshospitalet, Copenhagen, 2Department of Radiology, Clinical Hospital, 2Physiology, Titu Maiorescu Univ,
3Department of Paediatrics, 4Department of Neurology, Faculty of Medicine, 3Neurology, Colentina Clinical
Roskilde Hospital, Roskilde, 5Department of Paediatrics, Hospital, Bucharest, Romania
6Department of Neuroradiology, Copenhagen University
Background: Matrix metalloproteinase (MMP) have been
Hospital, Rigshospitalet, Copenhagen, Denmark thought to be involved in stroke pathogenesis. MMP-9
Basilar artery occlusion (BAO) in children is rare. BAO is contributes to tissue destruction.
associated with a high mortality and morbidity if Objective: Our aim was to analyze the MMP-9 levels in
recanalization of the basilar artery is not achieved before blood within 24 hours of acute ischemic stroke onset to
extensive brainstem damage has occurred. An 11-year-old observe the role of MMP-9 in the pathogenesis of
boy presented with a clinical and radiological top-of-the- atherothrombotic stroke.
basilar syndrome. Intravenous tissue plasminogen activator Material and methods: In this study we investigated
(t-PA) was administered and the patient immediately prospectively MMP-9 levels in serum from 106 patients (42
referred to the regional stroke center. Mechanical men and 64 women, mean age 71.526.32 years) with acute
thrombectomy using a Solitaire stent resulted in clot ischemic stroke in the middle cerebral artery area in the first
removal and recanalization of the basilar artery 4 hours after 24 hours from the onset (mean duration 7.84.5 hours) as
stroke onset. The patient made a full clinical recovery. To compared to 112 controls (48 men and 64 women, mean age
our knowledge this is the first report on BAO in a child 70.366.8 years). Exclusion criteria for patients and
treated with bridging therapy, the combination of controls were: atrial fibrillation, manifest ischemic
intravenous thrombolysis and endovascular thrombectomy. 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.

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


176 Posters, Sunday 9 September

P1199 P1200
Off-label thrombolysis in a case of Role of the phosphatidylinositol 3-kinase
ischemic hemiballism: a case report and extracellular signal-regulated kinase
A. Correnti1,2, E. Puca3, A. Pieroni3, C. Colosimo3, pathways in the neuroprotective effects of
D. Toni3 cilnidipine on primary cultured cortical
1 Neurologia e Psichiatria, 2UTN-Policlinico Umberto I, neurons against hypoxia
3 Sapienza University of Rome, Italy
H.-J. Yu1, S.-H. Koh2, K.-Y. Lee2, S. Kim3, H.-H. Park2,
Introduction: Hemiballism is a rare hyperkinet movement Y. Lee2, J. Kim2
disorder. A lesion of the contralateral subthalamic nucleus, Neurology, Bundang Jesaeng Hospital, Seongnam,
1
due to a vascular etiology, is involved in more than half of Hanyang University College of Medicine, 3Department of
2
the cases. We report a case of hemiballism with an Neuroscience, KAEL-Gemvax Co., Ltd, Seoul, Republic of
extraluysian lesion who was treated off-label with Korea
intravenous alteplase.
The phosphatidylinositol 3-kinase (PI3K) and extracellular
Case report: A 74-year-old man, with hypertension and
signal-related kinase (ERK) pathways are crucial for
dyslipidemia, reported a left motor disorder on his arrival at
neuronal survival. Cilnidipine, a calcium channel blocker,
the Emergency Room. He had left-sided hemiballism
has been reported to have neuroprotective effects. We
involving the face and both limbs and a cerebral CT-scan
investigated whether cilnidipine could protect neurons from
showed only chronic signs of vascular leucoencephalopathy.
hypoxia and explored the role of the PI3K and ERK
Despite having a normal NIHSS, in accordance to the
pathways in the neuroprotection of cilnidipine. The viability
clinical signs and after exclusion of other possible causes
of primary cultured cortical neurons injured by hypoxia,
related to the development of this hemiballism (e.g. marked
measured by trypan blue staining and LDH assay, was
hypoglycaemia), he was thrombolysed with alteplase iv at
dramatically restored with the treatment of cilnidipine.
4 hours from stroke onset. After this treatment, choreiform
TUNEL and DAPI staining showed that cilnidipine
movements were less pronounced. The following day a
significantly reduced apoptotic cell death induced by
brain MRI showed an ischemic lesion of the right capsula
hypoxia. Free radical stress induced by hypoxia was
extrema and insular cortex and the integrity of both
markedly decreased by the treatment with cilnidipine.
subthalamic nuclei. Another smaller lesion was found in the
Survival signalling proteins associated with the PI3K and
right temporal-parietal cortex. The patient recovered
ERK pathways were significantly increased and death
completely in three days without receiving any further
signalling ones were markedly decreased in the primary
symptomatic therapy. Conclusion: Hemiballism has been
cultured cortical neurons simultaneously treated with
classically characterized as pathognomonic of a lesion in
cilnidipine and hypoxia when compared with the neurons
the contralateral subthalamic nucleus. However, several
treated with only hypoxia. These neuroprotective effects of
cases due to a lenticular or caudate lesion or even cortical,
cilnidipine were blocked by the treatment with a PI3K
as in the present case, have been described. Prognosis is
inhibitor, LY294002, or an ERK inhibitor, FR180204. These
benign in most cases, but it seems logical to treat these cases
results show that cilnidipine protects primary cultured
with thrombolysis when they are seen within an appropriate
cortical neurons from hypoxia by reducing free radical
time frame in the ER.
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.

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


Posters, Sunday 9 September 177

P1201 P1202
Coenzyme Q10 protects neural stem cells Inflammatory process evaluation by
against hypoxia/reoxygenation by serum Hs CRP and sVCAM-1 in patients
enhancing survival signals with carotid stenosis
K.-Y. Lee1, S.-H. Koh1, H.-J. Yu2, J. Park3, Y. Lee1, C. Revnic1, C. Ginghina2, I.A. Popescu3, C. Popa3,
H.-T. Kim1, S. Kim1, J. Kim1 F. Revnic4
1Hanyang University College of Medicine, Seoul, 1UMF Carol Davila Bucharest, Faculty of General Medicine,
2Neurology, Bundang Jesaeng Hospital, Seongnam, 2Cardiology, C.C. Iliescu Cardiovascular Disease Institute,
3Neurology, Inje University Paik Hospital, Pusan, Republic 3Neurology, Vlad Voiculescu Neurology Institute,

of Korea 4Gerontology & Geriatrics, Ana Aslan National Institute of

Recanalization and secondary prevention are the main Gerontology and Geriatrics, Bucharest, Romania
therapeutic strategies for acute ischemic stroke. Objectives: Inflammation is a part of the process of
Neuroprotective therapies have also been investigated atherosclerosis; evaluation of serum Hs-CRP together with
despite unsuccessful clinical results. Coenzyme Q10 sVCAM-1 seems to be an important predictor for stroke and
(CoQ10), which is an essential cofactor for electron cardiovascular events in patients with atherosclerosis. The
transport in mitochondria, is known to have an antioxidant levels of circulating inflammatory markers may express the
effect. We investigated the protective effects of CoQ10 extent of the inflammatory response, their participation in
against hypoxia/reoxygenation in neural stem cells (NSCs). plaque progression and rupture needs to be evaluated.
We measured cell viability and levels of intracellular Materials and methods: The study evaluated 86 patients
signalling proteins after treatment with several (62 men) (40 controls without carotid atherosclerosis, 22
concentrations of CoQ10 under hypoxia-reperfusion. patients with asymptomatic carotid stenosis and 24 patients
CoQ10 protected NSCs against hypoxia-reperfusion in a with symptomatic carotid stenosis) mean age 61.35.8
concentration-dependent manner by reducing growth years; range 42 to 86 years. Serum Hs-CRP and sVCAM-1
inhibition and inhibiting free radical formation. It increased levels were determined in all patients using a Dade Behring
the expression of a number of survival-related proteins such hsCRP assay and Quantikine Human sVCAM-1
as phosphorylated Akt (pAkt), phosphorylated glycogen Immunoassay by ELISA method.
synthase kinase 3- (pGSK3-), and B-cell lymphoma-2 Results: The mean values of Hs-CRP and sVCAM-1 in
(Bcl-2) in NSCs injured by hypoxia-reperfusion and reduced control patients were 1.38mg/ml0.63 and 636ng/dl
the expression of death-related proteins such as cleaved 0.11(p=0.025); 1.780.84mg/ml and 672ng/dl0.14 in
caspase-3. We conclude that CoQ10 has effects against patients with asymptomatic carotid stenosis (p=0.014);
hypoxia-reperfusion induced damage to NSCs by enhancing 1.820.92mg/ml and 693ng/dl 0.46 in patients with
survival signals and decreasing death signals. 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.

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


178 Posters, Sunday 9 September

P1203 P1204
Intravenous thrombolysis in stroke Intra-cerebral haemorrhage in patients
patients with atrial fibrillation warfarinized for non-valvular atrial
V. Padjen1, M. Jarakovic2, P. Stanarcevic1, fibrillation
M. StefanovicBudimkic1, D. Jovanovic1, O. Savic1, M.K. Fong, Y.P. Chu, B. Sheng, K.K. Lau
I. Berisavac1, M. Ercegovac1, L. BeslacBumbasirevic1 Princess Margaret Hospital, Kowloon, Hong Kong S.A.R.
1Emergency Neurology Department, Neurology Clinic
Aim: To study the characteristics of intra-cerebral
Clinical Center of Serbia, School of Medicine, University of
haemorrhage (ICH) in warfarinized non-valvular atrial
Belgrade, 2Cardiology, Institute of Cardiovasular Diseases
fibrillation (wNVAF) patients.
of Vojvodina, Sremska Kamenica, Serbia
Methods: Retrospective review on wNVAF patients who
Background: The purpose of our study was to compare the had developed ICH and were treated at Princess Margaret
severity and the outcome of acute ischemic stroke among Hospital, Hong Kong from 2006-2011.
patients with atrial fibrillation (AF) who received Results: 87 warfarinized patients developed ICH during the
intravenous thrombolysis (IVT) compared to those who did study period, accounted for 5.34% of all ICH. Among them,
not receive this therapy. 37 (24 male and 13 female) were wNVAF patients. Their
Methods: We performed a retrospective analysis of data mean age was 74.8. The baseline risk for thromboembolism
prospectively collected of stroke patients with AF that were and bleeding, as represented by their median CHA2DS2-
treated in the Stroke unit of the Emergency neurology VASc and HAS-BLED score, were 4 and 2, respectively. All
department. Neurological deficit was evaluated using the patients had moderate to high bleeding risk, the lowest
NIHSS on admission while the 90-day clinical outcome was HAS-BLED score was 1. 15 patients (40.5%) had both
assessed using the modified Rankin scale (mRS). scores in the high risk category (CHA2DS2-VASc2 &
Results: There were 91 stroke patients who had AF, 47 HAS-BLED3). The volume of ICH in these 37 patients
(51.6%) were men IVT was given to 22 patients (24.2%). was 19.223.0cm3. Their initial INR was 2.50.7 (range
Comparing the two groups there was no significant 1.1-5.0), which was corrected to 1.60.5 (range 1.1-3.1) at
difference between the baseline NIHSS which was 12hrs. There was no correlation between ICH volume and
12.9+2.86 in AF patients who received IVT,and 16.2+3.11 INR, and a majority (72.9%) developed ICH at INR 2 to 3.
in AF patients who did not receive IVT (p=0.053). Patients 3 patients required neurosurgical intervention. The mortality
with AF and IVT were more likely to have excellent was 48.6%, which was not statistically different from the
functional outcome (mRS 0-1) (63.6% vs. 21.7%; OR 0.16 overall mortality of ICH. The ICH score showed good
[95% CI 0.06-0.45]; p=0.000), and favourable functional correlation with mortality (c=0.75, p=0.001). All patients
outcome (mRS 0-2) (68.2% vs. 28.9%; OR 0.19 [95% CI with ICH score 3 died. 8 patients had good neurological
0.07-0.54]; p=0.001) than patients with AF who did not recovery at 6 months with modified Rankin scale score 3.
receive IVT. Also, patients with AF and IVT were less likely Conclusion: Most of our ICH-wNVAF patients had
to have a fatal outcome as outcome at month 3 (13.6% in appropriate risk/benefit balance. The clinical course of ICH
patients with AF and IVT vs. 49.3% in patients with AF was similar to other ICH patients, and INR did not correlate
without IVT; OR 6.15 [95% CI 1.67-22.7]; p=0.005). with ICH volume or clinical outcome.
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


Posters, Sunday 9 September 179

P1205 P1207
25-Hydroxyvitamin D associated with Post-partum stroke: a multifactorial
acute ischemic stroke and subtypes: complication of pregnancy
a case control study M.G. Kortushvili, I.V. Verulashvili
J.R. Chaudhuri1, V.S. Bandaru1, R. Ramapriya1, Tbilisi State Medical University, Tbilisi, Georgia
A. Anamika2, B. Balaraju1 Objectives: The aim of this study was to analyse the
1Neurology, 2Biochemistry, Yashoda Hospital, Hyderabad, influence of pregnancy on the risk of post-partum stroke
India and possibilities of prevention recurrent cerebral events in
Background: Vitamin D deficiency is common in all age future.
groups and may contribute to cardiovascular diseases. Methods: Issued from a multicenter (3 centres) prospective
Recent reports have incriminated low 25-hydroxyvitmain D study, 21 women (mean age 26.9 years) with post-partum
levels causing ischemic stroke. stroke (PS), were screened from over 1200 patients of acute
Aim: To investigate association of 25-Hydroxyvitamin D in cerebral stroke between January 2005 and September 2009.
acute ischemic stroke. PS was diagnosed clinically and by CT/MRI/angiography.
Methods: We recruited 85 consecutive stroke patients and The selected patients were followed up for 2 years:
85 age and sex matched control subjects attending the information on death, neurological status, recurrent cerebral
department of neurology for non-vascular diseases at events were obtained from direct observation, written
Yashoda hospital Hyderabad South India, from October questionnaire or by telephone interviews (every 6 months).
2011 to February 2012. All patients under went evalution Results: Causes of post-partum stroke included cerebral
for stroke subtypes and risk factors. We measured infarction (7 arterial, 8 venous) and 6 intracerebral
25-Hydroxyvitamin D by Chemiluminiscen test, serum haemorrhage with the poorest outcome (1 maternal death
calcium, phosphorus and alkaline phosphatase for case and and 3 residual neurologic deficits). The median time at
control subjects. onset of stroke was 6 days post- partum (range, 2-25 days).
Results: Out of 85 patients there were 63 men (74.1%), During a mean follow-up of 2 years, 2 arterial recurrent
mean age 60.4 range 26-89 years. 25-Hydroxyvitamin D ischemic strokes occurred (both within the second year and
deficiency was observed in 44 (51.7%) of stroke patients outside pregnancy); there were no cases of recurrent
and 30 (35.2%) in control subjects (p=0.01). Our data cerebral venous thrombosis.
showed hypertension in 48 (56.4%) with stroke patients and Conclusions: Post-partum stroke is a multifactorial and
28 (32.9%) in controls (p=0.003), diabetics in 32 (37.6%) non-preventable complication of pregnancy. The post-
in stroke patients and 18 (21.7%) in controls (p=0.02). partum period, not the pregnancy itself, is associated with
25-Hydroxyvitamin D deficiency was found 100% (4/4) in an increased risk of recurrent stroke. A previous cerebral
extracranial large artery atherosclerosis, 61.9% (13/21) in stroke is not a contraindication to a subsequent pregnancy.
intracranial large artery atherosclerosis, 50% (6/12) in Secondary prevention after PS is based on similar principles,
cardioembolic stroke, 52.9% (9/17) in small artery diseases, as in general population: an optimal management of
27.2% (3/11) in stroke of other determined etiology and vascular risk factors and appropriate antithrombotic therapy
45% (9/20) in stroke of un-determined etiology. After (at least during the first year after post-partum stroke).
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


180 Posters, Sunday 9 September

P1208 P1209
Intravenous thrombolytic treatment in Foetal middle cerebral and arteries of
stroke patients with recent transient umbilical blood flow velocity in normal
ischemic attack: a Serbian experience and gestational diabetic pregnancies
with thrombolysis in ischemic stroke - S.-M. Fereshtehnejad1, M. ShabaniZanjani2,
SETIS register R. Nasirzadeh2, S.-A.P. Alemzadeh3, S. Askari3
1Neurobiology, Care Sciences & Society (NVS), Karolinska
M.S. Budimkic1, D.R. Jovanovic2,
Institute, Stockholm, Sweden, 2Tehran University of Medical
L. Beslac-Bumbasirevic2, V. Padjen3, P. Stanarcevic3,
Sciences, 3Student Scientific Research Committee, Tehran
SETIS group
1Department of Emergency Neurology, Neurology Clinic,
University of Medical Sciences, Tehran, Iran
Clinical Center of Serbia, Faculty of Medicine, University of Background: Gestational diabetes mellitus (GDM) is one
Belgrade, 2Department of Emergency Neurology, Faculty of of the most common complications in pregnancies.
Medicine, University of Belgrade, 3Department of Evaluating other conditions including intra uterine growth
Emergency Neurology, Neurology Clinic, Clinical Center of restriction and pre-eclampsia, some studies have shown
Serbia, Belgrade, Serbia significant changes in blood flow velocity of foetal middle
Introduction: Patients with prior transient ischemic attack cerebral artery (MCA). Our study is one of the first which
(TIA) may have diffusion-weighted lesions on MRI imaging has aimed to assess the effects of GDM on Doppler
despite normal CT brain findings. This raises the concern of parameters of the foetal MCA and umbilical artery (UI) and
higher risk for post-thrombolytic intracerebral haemorrhage to compare with normal pregnancies.
in stroke patients with recent TIA. The aim of this study was Methods: This cross-sectional study was performed in 66
to evaluate efficacy and safety of intravenous thrombolysis pregnant women, including 33 women with GDM and the
(IVT) in stroke patients with recent TIA. others without it, in Akbar-Abadi University Hospital in
Methods: We analysed 651 stroke patients treated with IVT, Tehran, Iran during 2010-2011. Peak systolic and diastolic
from the SETIS register. Data were collected about recent velocities, pulsatility index (PI), resistance index (RI) and
ipsilateral TIA, clinical characteristics of patients, systolic/diastolic ratio (S/D) were recorded in UA as well as
occurrence of symptomatic ICH (defined with SITS MOST both right and left foetal MCAs for every recruited pregnant
criteria) and 3 month outcome (using mRS). women by means of Doppler ultrasonography.
Results: From analysed stroke patients 34 of them (5.2%) Results: The mean gestational age at the time of examination
had one or more previous TIA episodes within a month was 34.45 (SD=2.62) weeks in GDM-positive group.
prior to the current stroke. Most of the patients had TIA Although all of the measured Doppler parameters had
within the first week before stroke (67%) and a majority of higher values in GDM-positives, but the differences were
those had TIA on the day of the current stroke. There was not significant between the two groups of study; except for
no sex and age difference among TIA and non-TIA group the left foetal MCA-PI which was significantly higher in
of patients (male 67.6% vs. 64.1%; mean age 57.31.6 vs. GDM associated group [2.07 (SD=0.07) vs. 1.85 (SD=0.74),
59.60.5). Patients with prior TIA presented with less severe P=0.03].
stroke (mean NIHSS score 9.77.4 vs. 13.45.7), had more Conclusion: Our results show that gestational diabetes
frequent hyperlipidemia (84.4% vs. 55.4%, p=0.002) and could also correlate with the increased PI of the foetal
occurrence of lacunar stroke (26.4% vs. 11.6%, p=0.01). MCA. This result could be due to the brain-sparing
Occurrence of sICH was equally present in both phenomenon; and as it was demonstrated that
groups-2.9% (OR 0.99, CI 0.13-7.67). The good recovery (3 hyperglycaemia affects the diabetic adult vessels, it might
month mRS 0-2) gained 76.6% of patients in TIA group and also involve foetal vessels in GDM associated pregnancies.
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


Posters, Sunday 9 September 181

P1210 P1211
The benefit of early Holter-ECG Evaluation of total serum MMP-9 and
monitoring for the detection of their inhibitors TIMP-1 as a markers of
paroxysmal atrial fibrillation in patients carotid plaque instability in elderly
with acute ischemic stroke: a pilot study patients with carotid stenosis
M. Kral1, D. Sanak1, M. Hutyra2, T. Veverka1, C.R.S. Revnic1, G.I. Prada2, C. Pena3, F. Revnic3,3,
A. Bartkova1, R. Herzig1, D. Skoloudik1, T. Dornak1, B. Paltineanu4
M. Taborsky2, P. Kanovsky1 1Cardiology, UMF Carol Davila Bucharest/Faculty of

Comprehensive Stroke Center, Department of Neurology,


1 General Medicine, 2Geriatrics, UMF Carol Davila,
3Biology of Aging, 4NIGG Ana Aslan, Bucharest, Romania
Department of Internal Medicine I - Cardiology, Faculty of
2

Medicine and Dentistry, Palack University and University Introduction: Matrix metalloproteinases (MMPs) and their
Hospital, Olomouc, Czech Republic inhibitors (TIMPs) regulate extracellular matrix (ECM)
Background: Atrial fibrillation (AF) is the most common remodelling, a key feature of atherosclerosis, and their
cause of cardioemboligenic ischemic stroke (IS). Patients circulating concentrations can be assayed..
with cardioemboligenic IS and AF often present with more Aim: To relate circulating biomarkers of extracellular
severe neurological deficit associated with the occlusion of matrix (ECM) turnover to site-specific measures of carotid
the large cerebral artery, worse clinical outcome and higher artery atherosclerosis on Echo Doppler ultrasound.
mortality. Especially the paroxysmal form of AF is very Material and methods: 110 patients admitted to the
risky, because it is usually not being registered during a Cerebrovascular Clinic (85 males) aged:44-89 years,
routine electrocardiogram (ECG) examination. The aim was divided into three groups (44 patients with ischaemic stroke
to assess the benefit of early 24-hour Holter-ECG related to carotid stenosis, 36 patients with asymptomatic
monitoring in patients with ischemic stroke and a negative carotid stenosis and 30 controls) were included in the study.
history of AF. All patients underwent carotid Echo-Doppler examination
Methods: In the prospective study, the set consisted of 114 and serum levels of total MMP-9 and TIMP-1 were
consecutive IS patients (57 males, average age 75.49.8 evaluated using Quantikine Human MMP-9 (total) and
years) with a negative history of AF and without the TIMP-1 ELISA R&D Systems Kits with a ChemWell 2019,
presence of AF on the admission ECG exam. A standard Awarness,Inc. USA Autoanalyser.
24-hour Holter-ECG was performed in all patients. Results: Serum MMP-9 and TIMP-1 levels were associated
Results: 33 (28.9%) patients had concurrent ischemic heart with risk of all-cause mortality (Cox proportional hazard
disease, 14 (12.3%) had a positive history of myocardial ratio [HR] per standard deviation 1.10, 95% confidence
infarction, and 25 (22%) a history of previous IS. Holter- interval [CI] 1.03-1.18; and 1.11, 1.02-1.18; respectively).
ECG was performed on average 4.12.5 days after the IS TIMP-1 levels were mainly related to risks of cardiovascular
onset. Newly detected AF was found in 10 (8.8%) patients mortality and stroke (HR per standard deviation 1.20, 85%
(paroxysmal form of AF in 90.0% out of these patients). No CI 1.09-1.35; and 1.16, Carotid Echo-Doppler study showed
acute ischemic changes were recorded on admission ECG that in the stroke group most of plaques found were
in all patients. echolucent with irregular surface compared with the
Conclusion: Holter-ECG monitoring is a non-invasive and asymptomatic group where echogenic plaques with smooth
inexpensive method used for the early detection of AF, surface are found frequently (p=0.04).
particularly of its paroxysmal form. The risk of recurrent Conclusions: In this community-based cohort of elderly
stroke can be significantly reduced in IS patients with men, serum MMP-9 and TIMP-1 levels were related to
diagnosed AF using the anticoagulant therapy. mortality risk. An altered extracellular matrix metabolism
Acknowledgement: Supported by the IGA MH CR grant may be involved in several detrimental pathways, and
number NT/11046-6/2010. circulating MMP-9 or TIMP-1 levels may be relevant
markers thereof.

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


182 Posters, Sunday 9 September

P1212 P1213
Post-stroke depression: predictive factors Correlation between white matter lesions
at six months follow-up and neurological complication after
J.M. Ramrez-Moreno1, M.J. Gmez-Baquero1, cardiac surgery
F. LpezEspuela2, J.C. PortillaCuenca2, A. OlleroOrtiz1, B. Zllami1, E. Basha2, B. Cekrezi3, J. Kruja4
T. GavilnIglesias2, J.D. PedreraZamorano3, 1Department of Neurology, American Hospital, 2Department
P.E. JimenezCaballero2, I. Casado-Naranjo2 of Neurology, Central Military Hospital of Tirana,
1Neurology, Stroke Unit, Hospital Universitario Infanta 3Department of Radiology, American Hospital, 4Department

Cristina, Badajoz, 2Neurology, Stroke Unit, Hospital San of Neurology, UHC Mother Theresa, Tirana, Albania
Pedro de Alcntara, 3Nursing, Universidad de Extremadura, Background and purpose: With the advances of surgical
Cceres, Spain procedure, cardiac surgery can now be performed on older
Introduction: Post-stroke depression affects approximately patients with multiple chronic diseases. The white matter
one third of ischemic stroke survivors. In validation studies, lesions are hyperintensities that are located in the deep
the Hamilton Rating Scale for Depression (HRSD) proved white matter, and are often seen with small vessel disease.
to be an acceptable screening instrument. To identify We looked for the correlation between the pre-surgery white
variables that could predict depression after stroke using matter lesion (MRI- T2, Flair) and the adverse neurological
this score. outcome following the surgery.
Methods: A total of 200 consecutive patients with acute Method and evaluation: We have seen thirty (n 30) patients
stroke, admitted to the Stroke Unit, were included in the undergoing cardiac surgery (mainly valve repair and
study. After six months follow-up, 173 survivors [71 CABG- coronary artery bypass graft surgery). Preoperative
(35.5%) females and 129 (64.5%) males; average age (SD): and intraoperative variables include patient age,
71.16 (12.3) years] were evaluated, with the HRSD. comorbidities are evaluated. They are also evaluated with
Univariate and multivariate logistic regression analyses neurological and cognitive examination (MMSE). Also
were conducted to determine predictive factors. Age, head MRI is performed before the surgery and after surgery
gender, socioeconomic class, education, residence, social only in patients with new neurological deficits.
support, Charlson index, previous depression, type and side Results: 12 (40%) of them were presented with multiple
of stroke, National Institutes of Health Stroke Scale score periventricular, subcortical white matter lesions, 18 (60%)
(NIHSS) at admission, Hemiparesis, Barthel index (BI) and without cerebral lesions. After the surgery 2 patients 6.6%
modified-Rankin scale (mRS) at discharge, and length of with prior white matter lesion had a stroke; 6 of them 20%
stay were evaluated and included in the models. had prolonged encephalopathy (3-5 day coma after surgery).
Results: When a cut-off point of 13 in the HDRS was used 1 ischemic stroke (3.3%) happened in the group of patients
as the criterion, depression was rated in 42% of patients. without white matter lesions patients (1-2 weeks after the
Univariate analysis showed that post-stroke depression was surgery).
significantly associated with: previous depression, type and Conclusion: White matter hyper intensities are more
side of stroke, stroke severity assessed by the NIHSs, common and extensive in patients with cardiovascular risk
hemiparesis, BI and mRS at discharge, and length of stay. A factors and symptomatic cerebrovascular disease. White
multivariate regression model demonstrated that the most matter lesions can be predictive for neurological
significant factors associated with post-stroke depression complication after cardiac surgery. The small number of our
were previous depression, side of stroke, mRS at discharge, cases does not allow us to have a statistically significant
and length of stay. conclusion.
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


Posters, Sunday 9 September 183

P1214 P1215
Evaluation of ESSEN and SPI-II scale for Contribution of antiplatelet resistance to
short-term prognosis of minor stroke and vascular pathology in patients undergoing
TIA neuroendovascular procedures
J. Liu, J. Liu S. Vucetic1, N. Gligic2, J. Savic3
The 3rd Hospital of Hebei Medical University, Shijiazhuang, Special Hospital for Cerebrovascular Diseases St. Sava,
1

China Neurology, 3Special Hospital for Treatment of


2

Background and purpose: The evaluation of stroke risk Cerebrovascular Diseases Sveti Sava, Belgrade, Serbia
may improve the outcome of stroke, especially for minor Aims: Antiplatelet resistance is not sufficiently investigated
stroke. We investigated the validity of ESSEN and SPI-II among patients undergoing neuroendovascular procedures.
scale for predicting the short-term risk of minor stroke the Its contribution to vascular pathology is also not well
clinic. understood. The purpose of this study was to determine
Methods: 167 patients with minor stroke or transient contribution of antiplatelet resistance to different
ischemic attack (TIA) were enrolled in this study. The cerebrovascular pathoanatomical features.
recurrent ischemic events were recorded within 90 days Material and method: In this retrospective study, we
after onset and the curve of accumulative survival rate was analyzed data of 65 consecutive patients who underwent
obtained to observe the recurrent risk. The prognostic value neuroendovascular procedure in a one year period and
of ESSEN and SPI-II scale for recurrent risk was evaluated previously received antiplatelet therapy. We used impedance
by calculating the area under receiver operating aggregometry method to determine level of platelet
characteristic curve respectively. inhibition.
Results: The total recurrent rate of ischemic events within Results: Indications for neurointerventional procedures
90 days was 12.57% while the recurrent rate was 7.78% in were carotid stenosis and vertebrobasilar stenosis and
the first week after onset. Steep change of the cumulative symptomatic intracranial aneurysm. Among 56 patients
survival rate was observed in the acute phase of minor receiving aspirin at a median dose 700mg per week, 10.7%
stroke. The area under receiver operating characteristic were resistant. Among 24 patients receiving clopidogrel in
curve of ESSEN scale was 0.677 (95%CI: 0.557~0.797) a median dose 525mg per week, 21 of them were on a dual
compared to 0.553 (95%CI: 0.413~0.694) of SPI-II scale. antiplatelet therapy, and 60.4% of all were resistant to
Conclusions: As screening tool, both ESSEN and SPI-II clopidogrel. We found carotid and vertebrobasilar stenosis
scale could evaluate the short-term risk for recurrent events and aneurysms to be significantly more often in aspirin non-
of minor stroke and TIA. The ESSEN scale was more responders than in responders. However, clopidogrel
suitable for predicting the short-term risk at the clinic. 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.

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


184 Posters, Sunday 9 September

P1216 P1217
Validation of transcranial duplex Frequency of post-stroke shoulder pain
sonography as screening test for the D. Dobi1,2, M. Kapisyzi2, S. Grabova2, L. Stefanidhi2,
detection of right-to-left shunt F. Myslimi2, S. Koci2, E. Ranxha2, J. Kruja2
1Dept. of Neurology, UHC, 2UHC Mother Theresa, Tirana,
P. Martinez-Sanchez, E. Correas-Callero, M. Lara-Lara,
Albania
G. Ruiz-Ares, B. Fuentes, M. Martinez-Martinez,
L. Cullar-Gamboa, E. Dez-Tejedor Background and purpose: Shoulder pain is known to
Neurology, La Paz University Hospital. IdiPAZ Health retard rehabilitation after stroke. Its causes and prognosis
Research Institute, Madrid, Spain are uncertain. This study describes the frequency of post-
Objective: To evaluate the diagnostic accuracy of contrast- stroke shoulder pain prospectively, in an unselected stroke
enhanced transcranial colour-coded sonography (c-TCCS) population in the first 3 months after stroke.
against contrast-enhanced transcranial Doppler monitoring Methods: 92 patients entered the study. 88 of them, mean
(c-TCD) for the detection of right-to-left shunt (RLS). age 70.62.4 years , were examined at 2 weeks, 4, and 3
Methods: Prospective study of ischemic stroke patients months after stroke. The data about shoulder pain, Barthel
studied at our neurosonology laboratory for the presence of index, anxiety and depression score were recorded. Full
RLS (March 2011-January 2012). All patients underwent neurological examination was undertaken, using the
c-TCD by contrast injection (9cc of saline solution + 1cc of contralateral side as a control. Pain outcome and stroke
air), both at rest and after Valsalva manoeuvre (VM). After outcome was recorded at subsequent visits. Non-steroid
15 minutes of rest, patients underwent a c-TCCS by a anti-inflammatory drugs and physical treatment is used in
neurosonographer blinded to the results of the c-TCD, who all patients, in order to treat the pain.
used the same methodology as in c-TCD. The extent of CDI Results: 35 (40%) patients developed shoulder pain on the
was measured according to international criteria: absent (no same side of their stroke. There was a strong association
HITS), small (<10 HITS), medium (>10 HITS shower between pain and abnormal shoulder joint examination, ipsi
pattern) and large (>10 HITS, curtain pattern). lateral sensory abnormalities and arm weakness. Shoulder
Results: 50 patients were enrolled, 23 men. Mean age: 43 y. pain had resolved or improved at 3 months in 70 (80%) of
At rest, c-TCD showed 7 RLS and 6 were detected by the patients with non-steroid anti-inflammatory drugs and
c-TCCS. After VM, c-TCD showed 23 RLS and 21 were physiotherapy.
detected by c-TCCS. After VM c-TCCS showed, compared Conclusions: Shoulder pain after stroke occurred in 40% of
with c-TCD: sensitivity 91.3%, specificity 92.6%, positive 88 patients surviving, consenting to participate. 80% of
predictive value (PPV) 91.3%, negative predictive value patients made a good recovery with pharmacological and
(NPV) 92.3% and accuracy 92%. Taking into account only physical treatment. Patients with sensory and/or motor
medium-large RLS, c-TCCS showed, compared to c-TCD: deficits represent at risk sub-groups. Non significant
sensitivity 100%, specificity 100%, PPV 100%, NPV 100% correlation was observed among male and female patients
and accuracy 100%. The concordance with echocardiography in Barthel Index.
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


Posters, Sunday 9 September 185

P1218 P1219
Intravascular perfusion of carbon black Effect of anodal versus cathodal
ink allows reliable visualization of cerebral transcranial direct current stimulation on
vessels in mice stroke recovery: a pilot randomized
M.R. Hasan, J. Herz, D.M. Hermann, T.R. Doeppner controlled trial
Department of Neurology, University of Duisburg-Essen E. Khedr1, O. Shawky1, A. Tohamy1, E. Darwish1,
Medical School, Essen, Germany D. El Hamady2
Introduction: Study of the rodent cerebrovascular anatomy 1Assiut University Hospital, 2Physical Medicine and
provides significant insight in the experimental stroke Rehabilitation, Assiut University Hospital, Assiut, Egypt
research. For several years, intravascular perfusion of Purpose: To compare the long-term effect of anodal vs.
colored latex has been considered as a standard tool to cathodal transcranial direct current stimulation (tDCS) on
visualize cerebral vessels. However, this technique has motor recovery of subacute stroke.
certain technical limitations, which compromise its Methods: 36 patients with subacute ischemic stroke
reproducibility. Here, we described a simple method to participated in the study. The patients were randomly
visualize the cerebral vessels in mice in a reproducible assigned to one of three groups; the anodal, cathodal and
manner. sham groups. They received l tDCS at an intensity of 2mA
Methods: Diluted/undiluted latex mixed with carbon black for 25 minutes daily for 6 consecutive days. Patients were
ink was injected through the left cardiac ventricle. assessed with NIHSS, Barthel index (BI) and Medical
Alternatively, a mixture of two commercially available Research Council (MRC) muscle strength scale at baseline,
carbon black inks, i.e. CB1 and CB2 at a 1:9 ratio was after end of sessions, and then 1, 2 and 3 months later.
injected. The minimal diameter of the stained vessels was Cortical excitability was measured at baseline and after the
quantified in each method in cryosections of brains. Finally, 6th sessions.
CB1+CB2 staining was done in combination with Results: By the end of the follow-up, all groups had
triphenyltetrazolium chloride (TTC) staining in animals improved on all scales with P-values ranging from 0.01 to
subjected to transient focal cerebral ischemia. 0.0001. Improvement was equal in the anodal and cathodal
Results: Perfusion with CB1+CB2 yielded adequate filling groups with no significant differences between them in any
of the cerebral vessels with high contrast visualization. This of the rating scales. When these treatment groups were
technique was applied to identify the anastomotic points combined and compared with Sham, significant time X
between cerebral vascular territories of mice with different group interaction terms were seen for BI (p=0.002) and
genetic backgrounds and strains. Furthermore, perfusion NIHSS (p=0.046). Interactions were also seen in MRC
with combined carbon black inks allowed visualization of scores for all muscles. There was increased cortical
significantly smaller vessel diameters at a higher vessel excitability of the unaffected hemisphere after the end of the
density in comparison to perfusion with diluted/undiluted last session in all groups with the changes being more
latex. We finally gave evidence that this method for cerebral significant in the real than sham groups.
vessel staining could be combined with TTC staining - a Conclusion: Combined rehabilitation training with anodal
widely used tool to observe and analyze infarct volumes in or tDCS may improve mobility in the upper and lower
rodents. extremities in subacute ischemic stroke.
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


186 Posters, Sunday 9 September

P1220 P1221
Predicting survival in haemorrhagic New score ABN for TIA: prediction of
stroke: the prognostic value of routine short-and long-term risk of stroke
markers O.Y. Fartushna
A.M.H. Young1, C.K. Weerasuriya1, A.J. Procter1, Bogomolets National Medical University, Kiev, Ukraine
S. Singh1, A. Rinnert1, N. Wang1, U. Rai2 Transient ischemic attacks (TIA) are strong predictors of
1Cambridge Medical School, University of Cambridge, subsequent stroke, disability and death. Thats why,
Cambridge, 2Department of Stroke Medicine, Queen improved methods to predict risk of stroke after TIA are
Elizabeth Hospital, Kings Lynn, UK very important.
Introduction: Serum markers of inflammation are Aim was to create a neurological prognostic score for stroke
becoming recognised as prognostic factors in ischaemic risk after TIA using the clinical and neuroimaging criteria
stroke. However, this relationship in haemorrhagic stroke is and methodology of mathematical evaluation of the
less well defined. In this study, we examined admission probability of a set of independent events, and combinatorics.
markers of inflammation and applied a logistic regression Methods: The clinical, Doppler ultrasound, MRI,
model to predict outcome in haemorrhagic stroke. transthoracic echocardiography diagnosing has been carried
Methods: A retrospective study was performed between out in 178 patients with TIA. Cases were reviewed by two
September 2009 and 2011 at a general admission stroke unit neurologists to establish the correlation with the diagnosis.
in the UK. Over this time, approximately 1400 patients were Results: During the 2 years observation period stroke
admitted with acute stroke; of these, 114 cases were developed in 34 (41.5%) TIA patients. To determine the
haemorrhagic in nature. Venous blood samples were stroke risk after TIA we have created a new score ABN
obtained on admission. Pre- and post-morbid (i.e. at (Age, Blood pressure, Neuroimaging), which is an improved
discharge or death) modified Rankin scores were also version of the group of ABCD scales to predict short- and
recorded. Patients were controlled for age, sex, smoking long-term risk of stroke in patients with TIA. The ABN
status, hypertension status and co-morbidities using the score is calculated by summing up points for 3 independent
Charles co-morbidity index (CCI). Logistic regression factors associated and optimized to predict the risk of stroke
models were generated using SPSS. within 2, 7, 30, 90 days after a TIA, but also to predict
Results: Of the cohort examined 58 were male and 55 stroke risk within 1 and 2 years with a sufficiently high
female. The median [quartiles] glucose values of patients diagnostic accuracy, p<0.05. Total scores ranged from
differed significantly (p=0.009) between those who survived 0 (lowest risk) to 7 (highest risk).
(n=59) at 6.5mmol/L [5.8, 8.1] compared to those who did Conclusions: Comparative analysis of scales ABCD2 and
not (n=34) at 8.9mmol/L [6.1, 10.1]. Leukocytes ABN in the first 90 days after TIA showed a higher
demonstrated a similar trend with a median of 9.32x109/L sensitivity and specificity of the ABN (Se=0.83; Sp=0.69)
[8.0,12.0] in the survival group compared to 13.4x109/L scale compared with the scale ABCD2(Se=0.77; Sp=0.58)
[9.7, 17.4] those deceased (p=0.001). Using these data, our in 90 days and in the 2 years after TIA (ABN: Se=0.85,
logistic regression model predicted survival correctly on Sp=0.75; ABCD2: Se=0.79, Sp=0.62).
83.9% of occasions. Separating groups by sex improved this
to 96% in females. P1222
Conclusions: These results suggest that a logistic regression
model using plasma glucose, leukocytes, clinical outcomes Abstract cancelled
and sex might be a useful tool for prognosis in haemorrhagic
stroke.

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


Posters, Sunday 9 September 187

P1223 P1224
A case of Susacs syndrome The influence of carotid endarterectomy
T. Kasikci, S. Bek, E. Tokgoz, S. Demirkaya, Z. Odabasi on cognitive and affective functions in
Gulhane Medical Faculty, Ankara, Turkey patients with atherosclerosis of carotid
Background: Susacs syndrome is a rare angiopathy with arteries
the triad of encephalopathy, retinal artery occlusion and N.N. Spirin1, N.N. Malyshev2, I.V. Malysheva2,
acute hearing loss. It causes retinal, cochlear and cerebral O.A. Fadeeva1
infarcts usually in young females. 1 Neurology, Yaroslavl State Medical Academy, Yaroslavl,
Case: A 33-year-old male patient after headache for one 2 Neurology, Regional Hospital #1, Vologda, Russia
week described attention deficiency, dysmnesia and acute
right hearing loss. In neurological examination his Aim: To investigate the dynamics of neuropsychological
cooperation and orientation were inadequte. He was not status in patients after carotid endarterectomy (CEA).
able to hear with his right ear. His gait was ataxic, deep Methods: 52 patients were examined, 39 (75%) male and
tendon reflexes were increased. Right Babinski sign was 13 (25%) female, mean age 627.5 (M). In anamnesis 21
positive. His electroencephalography showed generalised (40.4%) patients had TIA, 14 (26.9%) had stroke, 17
delta activity. In brain magnetic resonance imagings T2 and (32.7%) did not have TIA or stroke. For the assessment Mini
FLAIR hyperintense, T1 iso/hypointense lesions especially Mental State Examination (MMSE), Hospital Anxiety and
in corpus callosum were detected. Right sensorineural Depression Scale (HADS), the test for remembering of 10
hearing loss was confirmed by audiogram. Cerebrospinal words and Shultz tables were used.
fluid analysis was normal except mild protein increase. Results: The second assessment was performed 12.50.4
Recanalized vascular occlusions were shown in peripheral months after CEA. The positive dynamics of cognitive
retina by fundus fluorescein angiography (FFA). As a result status was stated based on MMSE (from 28.52.0 to
of laboratory findings the patient was diagnosed as Susacs 29.20.9, =0.037) and the test for remembering of 10
syndrome and treatment was initiated with acetylsalicylic words (for immediate reproduction from 5.80.6 to 6.20.6
acid, metylprednisolon and intravenous immunoglobulin for (=0.003), for postponed reproduction from 4.31.5 to
five days and continued with oral corticosteroid. Within the 5.11.4, =0.007). Also the concentration of attention
following days encephalopathy had recovered but no improved based on Shultz tables (time for the first table
improvement was provided in hearing loss. from 58.82 to 562 sec (=0.015), for the last table from
Conclusion: Despite the clinical and radiological similarity 862 to 77.62 sec (p=0.04)). Based on HADS assessment
with multiple sclerosis Susacs syndrome is an uncommon were decreased the level of anxiety from 9.31.8 to 8.51.5
microangiopathy resulting involvement of vessels. (=0.014) and of depression from 7.12.1 to 6.381.41
Etiopathogenesis of the syndrome could not be clearly (=0.031)).
defined but occlusions caused by the immune response Conclusion: Revascularization of carotid artery positively
against precapillary endothelium may be responsible for the influences cognitive and affective functions in patients with
pathogenesis. atherosclerosis of carotid arteries.

P1225
Abstract Cancelled

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


188 Posters, Sunday 9 September

P1226 P1232
Haemorrheology of clinically silent Mortality in stroke patients
multifocal vascular cerebral lesions I.V. Pershyna
P. Kowal1, I. Siemieniak2, A. Marcinkowska-Gapinska3 Kharkiv Medical Academy of Postgraduate Education,
1Medical University, Strus Hospital, Rheological
2 3 Kharkiv, Ukraine
Laboratory, Poznan, Poland
P1233
P1227 Development and validation of the Asian
Intravenous and intra-arterial stroke disability scale (ASDS)
thrombolysis for acute ischemic stroke: K. Ghandehari1, K. Ghandehari2, G. Saffarian-Toosi3,
the first experience in Cyprus S. Masoudinezhad3, S. Yazdani3, A. Nooraddin3,
B. Kaymakamzade1, G. Akansoy1, S. Akpinar2, A. Eker3, S. Ebrahimzadeh3, F. Ahmadi3, F. Abrishamchi4
Neurology, 2Neuroscience Research Center, 3Mashhad
1
I. Ipekdal3, L. Erguven1, S. VudalDogruyol2,
University of Medical Sciences, Mashhad, 4Isfahan
M. Ozmenoglu3, T. Akalin1
1Neurology, 2Radiology, Dr. Burhan Nalbantoglu State University of Medical Sciences, Isfahan, Iran
Hospital, 3Neurology, Near East University, Faculty of
Medicine, Nicosia, Cyprus P1234
The rate of disability after cerebrovascular
P1228 disease
Opalski syndrome developing after R. Aliyev
radiotherapy: a case report Neurology Department, Azerbaijan State Advanced Training
Institute for Doctors named after A.Aliyev, Baku, Azerbaijan
S.G. zmen, B. Kocer, . Kenan, H.Z. Batur
Department of Neurology, Gazi University School of
Medicine, Ankara, Turkey P1235
Is malnutrition a risk factor of stroke?
P1229 M. Habib, A.N. Rizvi, M.S.I. Bhuiyan, M. Bhuiyan,
Three-year consequences of ischemic A. Haque
stroke in patients with arterial Neurology, Bangabandhu Sheikh Mujib Medical University,
Dhaka, Bangladesh
hypertension and C-reactive protein
content
O. Markulan1, T. Cherenko2 P1236
1 National Medical Academy of Post-graduate Education, Influence of Cerebrolysin on white blood
2 National Medical University, Kiev, Ukraine cell and red blood cell aggregation,
deformability and morpho-densitometry
P1230 parameters of erythrocytes in patients
Cerebral amyloid angiopathy presenting with cerebrovascular disease
as recurrent intracerebral haemorrhage A.V. Anisimova, K.V. Anisimov, T.I. Kolesnikova
Neurology, Russian State Medical University, Moscow,
Z. Ozozen Ayas, D. Kotan, G. Unal, Y. Guzey Aras
Sakarya University Department of Neurology, Sakarya, Russia
Turkey
P1237
P1231 Exertional periodic breathing augments
Mortality in patients with asymptomatic anaemia-related cerebral hemodynamic
carotid atherosclerosis dysfunction in patients with heart failure
I. Kolos, O. Syvakova, S. Boytsov, AMTEC Study Group J.-S. Wang
Research Center for Preventive Medicine, Moscow, Russia 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 P1285
Macaroni sign, Takayasu arteritis and A novel hypothalamic peptide proline-rich
stroke peptide-1 as an agent for stroke
S. Calado1,2, G. Matias1, C. Reizinho3, C. Jordo4, treatment
M. Viana-Baptista1,2 E. Yeritsyan1, A. Galoyan2, M. Balasanyan3
1Neurology Department, Centro Hospitalar Lisboa Ocidental 1Pharmacy, Yerevan State Medical University after Mkhitar
(CHLO) - Egas Moniz Hospital, 2CEDOC, Medical Sciences Heratsi, 2H. Buniatian Institute of Biochemistry of the
Faculty, New University of Lisbon, 3Neurosurgery National Academy of Sciences, 3Pharmacology, Yerevan
Department, 4Neuroradiology Department, Centro State Medical University after Mkhitar Heratsi, Yerevan,
Hospitalar Lisboa Ocidental (CHLO) - Egas Moniz Armenia
Hospital, Lisbon, Portugal

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 P1289


Oxygen toxicity is reduced by
P1288 acetylcholinesterase inhibition in the
Primary cilium, NPC1 and Patched1 developing rat brain
proteins in Niemann-Pick type C disease M. Sifringer1, C. von Haefen1, S. Endesfelder2, A. Kalb1,
C. Battisti1, M. De Santi2, P. Formichi1, B. Rossi1, I. Bendix3, U. Felderhoff-Mueser3, C. Bhrer2,
E. Radi1, S. Tripodi2, E. Tarquini2, A. Federico1 C.D. Spies1
1 University of Siena, 2AOU Senese, Siena, Italy 1Anaesthesiology and Intensive Care Medicine,
2Neonatology, Charit - Universittsmedizin Berlin,
We assessed the presence of NPC1 and Patched1 proteins 3Paediatrics I - Neonatology, University Hospital Essen,
and evaluated the relative distribution and morphology of
Germany
primary cilium in fibroblasts from Niemann-Pick type C
(NPC) patients and controls. NPC1 disease is a neurovisceral Objectives: The cholinergic anti-inflammatory pathway is
storage disorder, characterized by an abnormal intracellular a neural mechanism that suppresses the innate inflammatory
accumulation of unesterified cholesterol and glycolipids. response and controls inflammation by acetylcholine as the
Two distinct disease-causing genes have been isolated, key endogenous mediator. In this study, we investigated the
NPC1 and NPC2, involved in the processing and utilization effects of the cholinergic agonists, physostigmine and
of endocytosed cholesterol. The NPC1 protein functions in donepezil, on neurodegeneration, oxidative stress and
the sorting and recycling of cholesterol and inflammation during oxygen toxicity in the developing rat
glycosphingolipids in the late endosomal/lysosomal system. brain. The aim of this study was to investigate the level of
This protein exhibits extensive homology with Ptc1 cell death, glutathione, lipid peroxidation and the expression
receptor, a transmembrane protein localized in the primary of cytokines after hyperoxia and treatment with the
cilium and involved in the hedgehog signalling pathway. We acetylcholinesterase (AChE) inhibitors, physostigmine and
evaluated morphological aspects, relative distribution and donepezil in the brain of neonatal rats.
length of primary cilia in fibroblasts from five patients Methods: Six-day-old Wistar rats were exposed to 80%
affected by NPC1 disease, using anti-acetylated--tubulin oxygen in the presence or absence of physostigmine or
and anti--tubulin antibodies. Moreover we evaluated the donepezil and were sacrificed at defined time points (6, 12,
cytoplasmic expression of the NPC1 protein and Ptc1 24 h) following treatment. Sex-matched littermates were
receptor by fluorescence microscopy in fibroblasts from the kept in room air, and hyperoxia-exposed pups injected with
same patients. Immunofluorescence analysis showed a normal saline serving as controls. Brains were examined
significantly decreased immunostain for both NPC1 and histologically by Fluoro-Jade B staining or were processed
Ptc1 in NPC1 patients. Moreover, the NPC1 patient for molecular studies (real-time PCR, Western blotting,
fibroblasts showed a lower percentage of primary cilia spectrophotometric analysis, HPLC) to measure IL-1 and
distribution and a significant reduction in median cilia TNF-, malondialdehyde and glutathione.
length compared to controls. Our results confirm the Results and conclusions: Treatment with physostigmine
hypothesis that Ptc1 and NPC1 have a similar aminoacidic and donepezil significantly reduced hyperoxia-induced
sequence, and that they might also present a functional neurodegeneration and upregulation of the pro-
convergence. Moreover, we have, for the first time, inflammatory cytokines IL-1 and TNF- in the brains of
demonstrated altered ciliogenesis in fibroblasts from NPC1 infant rats. In parallel, both AChE inhibitors reduced
patients, suggesting an important role for the primary cilium hyperoxia-induced oxidized glutathione and
in the pathogenesis of the disease. 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.

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


Posters, Sunday 9 September 195

P1290 P1291
The distribution and changes in immune Brachial plexus ultrasound in obstetric
inhibitory molecule CD200 and its brachial plexopathy
receptor in the developing C57BL/6 mice S. Pillen1, A. Verrips1, J. Meulstee1, B. Semmekrot1,
brain following hypoxia/ischemia N. van Alfen2
Canisius Wilhelmina Ziekenhuis, 2RU Nijmegen Medical
1
K. Shrivastava, M. Chertoff, G. Llovera, M. Recasens,
Centre, Nijmegen, The Netherlands
L. Acarin
Dept of Cell Biol. Physiol. & Immunology, Inst. of Background: Obstetric brachial plexus injury (OBPI) is the
Neuroscience, Universitat Autonoma Barcelona, Bellaterra, most common peripheral nerve injury in children. In case of
Spain severe nerve damage surgical intervention is indicated.
Introduction: CD200-CD200R system has been widely However, it is difficult to decide which child needs surgery
shown to be involved in inducing immune tolerance and in because both reversible and irreversible nerve damage (i.e.
contributing to immune privileged status of the CNS. neurotmesis and/or root avulsion) are initially clinically
However, the developing brain exhibits distinct identical. Ultrasound can visualize peripheral nerves with
morphological as well as physiological characteristics excellent resolution. As ultrasound is a painless bedside
determining a peculiar response to injury showing an technique, it can be used in even very young children.
aggravated susceptibility to excitotoxicity and pro- Ultrasound of traumatic brachial plexus injury in adults
inflammatory cytokines, along with an exacerbated showed that root avulsion could be predicted correctly in
inflammatory response. Hence, the aim of this study was to 75%. Our study aimed to 1) assess if the neonatal brachial
characterize the expression pattern of CD200-CD200R in plexus can be reliably visualized with ultrasound, 2)
the developing mice brain following Hypoxic/Ischemic establish reference values and 3) use them to predict root
(H/I) injury by immunofluorescence. lesions in OBPI patients. Here we present the results of a
Methods: Wild-type C57/BL6 mice post-natal day 7 were pilot measurement and the first results in healthy neonates.
used for H/I injury using Vannucci model modified for Methods: 20 healthy neonates with a gestational age of at
neonatal mice (8% O2, 55 min) and samples were collected least 32 weeks and a negative family history for neuropathy
3h, 12h, 24h, 48h, 72h & 7 days after hypoxia. were included during the first week of life. Ultrasound
Results: In control neonatal brains, CD200 was expressed images were made using a Philips IU22 ultrasound device
on neurons, blood vessels and some astrocytes, while with a linear 7-15MHz hockey stick probe. They included
CD200R was expressed on pial and perivascular the C4 to T1 nerve roots and interscalene and supraclavicular
macrophages. After H/I, CD200 immunolabelling was brachial plexus. Aspects of the nerve and surrounding
increased in the hippocampal fissure until 7 days post- tissue, continuity and cross-sectional area were evaluated.
lesion. CD200R+ cells were a subpopulation of Iba1+ Results and conclusion: Our pilot studies showed that the
reactive microglia/macrophages, showing ameboid/ cervical roots and brachial plexus can be visualized in
pseudopodic morphologies, and located in the damaged neonates. Further results are presented at the meeting.
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


196 Posters, Sunday 9 September

P1292 P1294
Effects of maternal infection on anxiety Idiopathic optic neuritis revealing an
and depression-like behaviours of exceptional presentation of Parry
offspring Romberg syndrome in a Tunisian family
J. Solati, G.H. Moll, R.R. Dawirs, Y. Golub A. Riahi1,2, I. Bedoui1, I. Hmida1, H. Khaled1,
Dept. of Child and Adolescent Mental Health, University of M. Mansour1, J. Zaouali1, R. Mrissa1
Erlangen-Nrnberg, Erlangen, Germany 1 Department of Neurology, Military Hospital of Tunis,
Introduction: LPS and some cytokines can activate the
2 Facult de Mdecine de Tunis, Tunisia
hypothalamic-pituitary-adrenal (HPA) axis and affect brain Introduction: Parry-Romberg syndrome (PRS) or
development in pregnant mice. Maternal infection during progressive hemifacial atrophy is a rare neurocutaneous
pregnancy is a risk factor for several psychiatric illnesses syndrome of unknown etiology characterized by slowly
with neurodevelopmental origin. In this study we have progressive atrophy of a hemiface, spreading occasionally
evaluated the effects of exposure of pregnant mice to the to one side of the body. Extracutaneous manifestations such
bacterial lipopolysaccharide (LPS) on anxiety and as neurologic and ocular are common.
depression-related behaviour of male offspring. Case report: Patient A is a 19-year-old patient born to
Methods: Pregnant NMRI mice were treated with intra- consanguineous parents, presented with acute blurred
peritoneal administration of LPS (120, 240 and 480g/kg) vision. Examination showed left hemifacial atrophy with
at the 10th gestational day. Induction of the pro- limb length asymmetry. Visual acuity was impaired in both
inflammatory cytokines, TNF-, IL-1 and IL-6, was eyes. Cerebral MRI displayed hypotrophy with some non
measured in maternal serum 1.5h following maternal LPS unequivocal white matter lesions in the right cerebral
challenge. hemisphere. VEP indicated bilateral severe optic neuritis.
Results: Consequently we investigated the serum Further interrogation revealed similar cases in one maternal
concentration of corticosterone in both pregnant mice and uncle (Patient B, 32-year-old, hypotrophy of left side of the
their offspring at the age of 9 weeks. Anxiety-related body) and grandmother (Patient C, 69-year-old, severe right
behaviour of the male offspring (at postnatal day 70) was side hemiatrophy).
studied using elevated plus maze (EPM) test; and forced Discussion and conclusion: Usually, PRS appears to occur
swimming test was applied for evaluating the depression- randomly in sporadic cases and for unknown reasons.
like behaviour. Familiar cases of PRS are exceptional. All three affected
Conclusion: Our results demonstrate that LPS patients in our observation had extra facial extension of the
administration induces a significant increase in TNF-, atrophy, which is uncommon, too. Ocular manifestations
IL-1, IL-6 and corticosterone levels in maternal serum. associated with PRS are frequent, Patient A's optic neuritis
However, in offspring, prenatal LPS administration has no was partially responsive to high doses of corticoids.
significant effects on serum cytokines, corticosterone levels The particularities of this observation highlight the
and depression-like behaviour, while decreasing the anxiety heterogeneities of the PRS spectrum.
levels.

P1293
Abstract cancelled

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


Posters, Sunday 9 September 197

P1295 P1296
Biopsy-proven isolated neurosarcoid in a Clinical profile and follow-up of paediatric
7-year-old: presentation, management neurocysticercosis cases: a study from
and follow-up Eastern India
G. Anand, N. Wilkinson, M.A. McShane S. Bhattacharjee1,2, P. Biswas3, T. Mondal4, D.S.P. Saha5
Oxford University, Oxford, UK 1General Medicine, Peerless Hospital, 2Toxicology,

Isolated paediatric neurosarcoid is rare and there is little R.G. Kar Hospital, 3Senior Resident, Pediatrics,
information on its management and outcome. We report on R.G. Kar Hospital Kolkata, , Community Medicine, R.G. Kar
a 7-year-old with biopsy- proven neurosarcoidosis. Hospital, 5Consultant Neurologist,
Case history: A 7-year-old male presented with acute N.R. S. Hospital, Kolkata, India
weakness and continuous twitching of his right leg. Over Introduction: Neurocysticercosis is the most common
the next 48 hours he developed progressive weakness parasitic central nervous infection worldwide. Our present
affecting all 4 limbs. An EEG showed Right Epilepsia study attempts to evaluate the clinical profiles, treatment
Partialis Continua and T2-weighted brain MRI showed outcome and 2 years of mean follow-up results of 38
multifocal areas of high signal changes. CSF showed mild paediatric neurocysticercosis patients of an Eastern Indian
pleocytosis. Our preliminary diagnosis was Acute hospital.
Disseminating Encephalomyelitis and he was treated with Methods: Diagnosis was mainly based on clinical features,
steroids, immunoglobulin and anticonvulsants. Though he computed tomography (CT) / Magnetic resonance imaging
initially showed some improvement, he deteriorated with (MRI) scan and exclusion of other causes. Symptomatic,
further seizures that led to a brain biopsy. This showed active cyst patients were treated with albendazole for 28
multinucleate giant cells positive for CD68 KP1 and CD68 days, steroids and anticonvulsants.
PGMI but negative for factor 13a, S100 and CD1a. Results: Mean age of presentation was 8.473.19 yrs.
Immunostaining showed CD20 and CD79a positive small Patients presented with generalized seizures in 55.3%, focal
B- and CD3 positive small T-lymphocytes, none of which seizures, in 31.6%, headache vomiting in 63.2%, focal
expressed TDT and proliferation index was low. The neurodeficit in 10.5% and combination of symptoms in
features were in keeping with sarcoid. He was treated with 60.5% cases. Contrast CT brain showed solitary lesion in 27
intravenous cyclophosphamide followed by oral (71.1%) and multiple in the rest. Among the solitary lesions,
Azathioprine Serial brain scans showing consistent parietal lobe was involved in 74.1%, frontal lobe in 14.8%.
improvement and on 18 month follow-up, he could At presentation, lesions were transitional (ring enhancing)
independently walk and had made a good recovery apart in 58.2%, inactive in 20%, mixed in 14.6% and active in the
from some residual weakness of his right foot. His disease rest. After 2 years of mean follow-up, seizure persisted in 9,
stayed isolated to his brain. headache in 8 cases with permanent neurodeficit in none.
Conclusion: Neurosarcoid though rare does occur in 44.7% lesions calcified, 31.6% disappeared, 10.5%
children and it is important to get a tissue diagnosis as it can regressed and the rest persisted.
mimic neoplasms. Early intensive immunotherapy can be Conclusion: Solitary ring enhancing lesions (transitional
very beneficial and hence the urgency in diagnosis. 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).

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


198 Posters, Sunday 9 September

P1297 P1298
Incoercible hiccups and vomiting as a Incidence of kidney stones related to
presentation of NMO in paediatric age topiramate treatment in paediatric
S. Machado1, J.P. Vieira2, C. Conceio3, R.L. Silva2, patients
P.R. Sousa2, M. Ramos4, G. Queiroz5, L. Ventura5, A.A.H. Mahmoud
E. Calado2 NNI, KFMC, Riyadh, Saudi Arabia
1Hospital Fernando Fonseca, Amadora, 2Pediatric
Aim: We ran this study to assess the incidence of
Neurology, 3Neurorradiology Department, Hospital
nephrolithiasis in a group of children on topiramate (TPM)
Peditrico Dona Estefania, CHLC, Lisboa, 4Pediatric
therapy for at least 1 year.
Rheumatology, Hospital Peditrico Dona Estefania, CHLC,
Method: In this retrospective observational surveillance
Lisbon, 5Pediatric Intensive Care Unit, Hospital Peditrico
Dona Estefania, CHLC, Lisboa, Portugal
study, we reviewed the medical charts of children on TPM
for at least one year seen at a paediatric neurology
Introduction: Neuromyelitis optica (NMO) affects department during the period from 2005 to 2010 at King
preferentially the optic nerve and spinal cord and its serum Fahad Medical City. Children with a normal baseline
marker, the antibody against AQP4, has completely ultrasound report were included. Follow-up ultrasound
revolutionized the diagnosis. AQP4 is heavily expressed in reports after at least one year were collected. However,
area postrema, which explains clinical presentations such as patients with any evidence of chronic illness or medications
incoercible vomiting. Nonetheless, it is also expressed in that may affect the kidney functions in addition to those that
other organs such as kidneys and stomach, and the reason are not compliant to the prescribed dose were excluded.
why they are spared is not understood. Family history of renal stones, symptoms suggestive of
Clinical Report: A previous healthy 14yo children urologic disorders, and co-morbidities were recorded.
presented to the A&E due to a subacute onset of vomiting Results: Medical charts of 96 children on TPM with mean
and hiccups. A couple of days later she experienced age of 6.9 (3.8) years were reviewed, 52 (54.2%) of the
weakness in the lower limbs with further progression to the children were males. The follow-up ultrasound showed that
upper limbs and urinary retention. On the examination, the 5 children (5.2%) had developed kidney stone. The
cranial nerves were spared (without RAPD), there was no occurrence of kidney stones was found in 4 females (80%)
Lhermitte sign, but a tetraparesis with a pyramidal pattern versus (20%), 1 male (p>0.05).
was found. Also, there was a sensory thoracic level, Discussion: Long-term use of TPM may result in incidence
hyperreflexia and bilateral Babinski sign. The aetiological increase of asymptomatic kidney stones in the paediatric
investigation disclosed: CSF with pleocytosis (PMN population. Hence, routine baseline and follow-up
predominance), extensive lesion from the postrema area ultrasound of the urinary system should be recommended
until the conus medullaris, with preferential involvement of during the use of TPM in children.
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


Posters, Sunday 9 September 199

P1299 P1300
Neuro-osteology - a new discipline in Early detection of minor
orthodontics neurodevelopmental dysfunction at the
I. Kjaer age of 6 months in prematurely born
Odontology, University of Copenhagen, Denmark neonates
Introduction: Neuro-osteology describes the inter- M.H. Tsai1, Y.-S. Huang2, S.M. Chu2, J.F. Hsu2
relationship between neural tissue and mineralized tissue Chang Gung Memorial Hospital, Yunlin, 2Chang Gung
1

(bone and teeth) under normal and pathological conditions Memorial Hospital, Taoyuan, Taiwan R.O.C.
(1). Special focus areas are pituitary gland/sella turcica (2), Introduction: Premature infants are known to have higher
CNS/neurocranium (3) and PNS/jaw and teeth (4). The risk of minor neurodevelopmental dysfunctions (MNDs)
prenatal interrelationship has been examined in human when 2 to 5 years old. We aimed to investigate the 6-month
foetuses in a long series of published studies now forming neurodevelopmental outcome of prematurely born neonates
the basis for analyzing malformations in postnatal jaw and find the determining neonatal factors of MNDs.
regions with different neural crest origins (5). Methods: 151 premature infants were assessed at 6 months
Methods: 17 children with Single Median Maxillary corrected age with the Bayley Scales of Infant Development-
Central Incisor (SMMCI) were examined by radiography 2nd Edition (BSID-II) and the Denver Developmental
and 2 of these by MR scan of the brain. Screening Test (DDST). Neonates with cerebral palsy or
Results: major neuromotor dysfunctions at discharge were excluded
Dentition: One single maxillary central incisor located in from analyses.
the midline. Results: Of 151 neonates born before 37 weeks, 20 (13.2%)
Maxilla and cranial base: No inter-incisal suture present. had MNDs at 6 months corrected age. These proportions
The jaw was retrognathic and the anterior cranial fossa was were 21.6%, 13.2%, and 8.2% for neonates born before 28
significantly shorter than normally. weeks, 29 weeks to 32 weeks, and 33 weeks to 36 weeks,
Brain: Midline structures of the brain, falx cerebri and the respectively. Half of neonates with MNDs have a birth body
pituitary gland were abnormal. The neuro-hypophysis was weight (BBW) of less than 1000g. BSID-II and DDST are
absent and interdigitized cortex was observed in the frontal highly correlated in assessing the MNDs of premature
lobes. Severe growth hormone deficiency was registered. neonates at 6 months corrected age. After multivariate
Conclusion: The study highlights the concurrence between logistic regression analysis adjusted to gestational age and
midline defects in dentition, jaw and frontal lobes and BBW, MND was independently associated with postnatal
pituitary gland. The condition may be part of the corticosteroid use (odds ratio [OR], 11.2; 95% confidence
Holoprosencephaly spectrum. The study provides guidelines interval [CI], 1.9-66.0, P= 0.008) and cholestasis (OR, 6.2;
for early diagnostics in the dentition with interrelation to 95% CI, 1.16-33.1, P=0.033).
CNS malformations. Conclusions: Premature neonates, even those born at 33 to
References: 36 weeks, are found to have MNDs as early as 6 months
1. Kjr I. Crit Rev Oral Biol Med 1998;9:224-44. corrected age by BSID-II and DDST, with risk increasing as
2. Kjr I et al. Eur J Pediatr Surg 1999;9:354-8. gestation decreases. Preterm infants at risk of MNDs justify
3. Kjr I et al. Neuropediatrics 2010;40:280-3. the requirement of intervention as early as possible.
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


200 Posters, Sunday 9 September

P1301 P1302
West syndrome followed by juvenile Maternal alcohol drinking and
myoclonic epilepsy: a coincidental neurodevelopmental outcome in early
occurrence? infancy
G. Giordano, C. Spitaleri, A. Fontana, R. Nardello, G. Jeong1, J.Y. Han2,3, H.S. Kwak4
S. Mangano 1Pediatrics, 2Obstetrics and Gynecology, Cheil General
Dipartimento Materno Infantile di Urologia e Andrologia, Hospital and Women's Healthcare Center, Kwandong
Unit Operativa di Neuropsichiatria Infantile, Universit University, 3Division of Maternal Fetal Medicine, The
degli Studi di Palermo, Italy Korean Motherisk Program, 4Division of Endocrinology,
WS is an age-dependent epilepsy with onset peak in the first Department of Internal Medicine, Cheil General Hospital
year of life. According to the ILAE classification, the and Women's Healthcare Center, Kwandong University,
etiology of WS could be symptomatic or cryptogenic. An Seoul, Republic of Korea
idiopathic etiology was considered too. In literature, there Introduction: Fetal alcohol spectrum disorder (FASD) has
was never previously described a transition from WS to been identified as significant medical and public health
JME. problem. Many studies have reported morphologic
Methods: The proband, (male) was referred to our characteristics and long-term disabilities. However
Department at the age of 8 months because he showed neurodevelopment of early infancy has been rarely
clusters of symmetric spasms. Interictal EEG recording described.
displayed an hypsarrhythmic pattern. The clinical and EEG Methods: A prospective cohort study was conducted at
data suggested WS diagnosis. At 1 year of age increasing Cheil General Hospital Mother Risk Program. In total 236
long and thick hair in both elbow regions was observed. pregnant women participated in the research and filled out
This picture suggested an additional diagnosis of Hairy TWEAK questionnaire. After delivery and 12 months
Elbows Syndrome. During follow-up, the neurological postpartum, offspring5 were examined and mothers were
examination was normal and the EEGs showed age interviewed. Meconium was collected to measure fatty acid
appropriate background activity without abnormalities until ethyl ester (FAEE) in their offspring5. 106 babies being over
12 years of age, when he experienced some clusters of 10 months of age were performed the physically examined
bilateral, arrhythmic myoclonic jerks, synchronous with and Bayley scales of infant and Toddler Development III
generalized discharges of 4Hz spike-wave. This features (BSID-III) were performed. We compared the growth
suggested JME diagnosis. (height, weight, and head circumference), morphological
Results: We report a child with WS with onset at 8 months characteristics (palpebral fissure length and philtrum grade)
of age followed by JME at 12 years of age. This unusual and BSID-III results between maternal alcohol drinking
evolution, never reported previously, suggests that both group and non-drinking group.
seizure types may share some pathophysiological processes Results: The overall rate of alcohol drinking more than
genetically determined, which produce a susceptibility to once during pregnancy was 55% (66/120). In maternal
seizure. alcohol drinking group, TWEAK positive rate was 38%
Conclusion: This case documents a new transition type (25/66) and FAEE positive rate was 24% (8/33). One child
from WS to JME and improves the knowledge about the was diagnosed as foetal alcohol syndrome. For the growth,
spectrum of seizure susceptibility. These findings suggest children in the maternal alcohol drinking group showed less
that some genes other than those currently known and non- growth rate, shorter palpebral fissure length, higher
conventional genetic factors can play a role in seizure philtrum grade and lower BSID-III score than in the non-
predisposition. 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.

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


Posters, Sunday 9 September 201

P1303 P1304
Paraneoplastic opsoclonus-myoclonus Audio-visual perception and related
syndrome in children memories among dyslexia disordered
N. Ben Achour, I. Ben Youssef-Turki, I. Kraoua, students in comparison with normal
H. Benrhouma, A. Rouissi, H. Touaiti, students
N. Gouider-Khouja A. Kazemi
Department of Child and Adolescent Neurology, National Psychology, Islamic Azad University Tehran Medical
Institute of Neurology, Tunis, Tunisia Branch, Tehran, Iran
Introduction: Opsoclonus-myoclonus syndrome (OMS), Introduction: Dyslexia is a disorder which causes some
called Kinsbourne syndrome is the most common problems in reading. Students with dyslexia suffer from
paraneoplastic neurological syndrome in children associated other improper functioning of the brain which is not
with neuroblastoma (NB) or more rarely with other tumours. necessarily because of physical injuries to it. The function
The objective is to study the epidemiological, clinical and of the brain in individuals with dyslexia differs from normal
therapeutic aspects of paraneoplastic OMS (POMS) people. The object of this study is to compare audio-visual
collected in our department. perception and related memories between a group of 2nd to
Methods: All children with POMS, followed up in our 4th grade elementary students with dyslexia disorder with a
department over 6 years (2005-2011), were reviewed. normal group.
Epidemiological data, clinical presentation and diagnostic Methods: The statistical sampling included 40 dyslexic
and therapeutic approach are discussed. students chosen according to available sampling method
Results: 4 children (3 boys and 1 girl) with POMS were and 40 normal students chosen according to simple random
collected. Mean age was 5.6 years. Acute ataxia was method. Both groups included boys and girls with equal
inaugural symptom. Sleep disturbances were found in 2 numbers from 2nd to 4th grades in elementary school in
patients. High rate of NSE was found in all patients. Tehran city. The participants were evaluated with Frostig
Onconeural antibodies were negative. Screening for a developmental visual perception test, Wepman's audio
tumour, including (CT scan, Whole-Body MRI and MIBG diagnosis scale, Andre-ray test and the sequence of audio
scintigraphy) allowed us to find the primary tumour, only in expressional memory scale. The results were analyzed using
2 patients (NB in the first case and rhabdod tumour of the T-Test method.
skin, in the second case). All patients received Results: Findings showed that there is a meaningful
immunomodulatory treatment (corticosteroids and difference between the groups in terms of visual -perception
intravenous immunoglobulin). Full recovery was obtained (t=9/39) and its five sub-scales including eye-motor
only in 1 patient who had etiological treatment. coordination(t=9/12), figure grand(t=9/03), form
Discussion and conclusion: POMS is quite a rare (4/1600 constancy(t=9/36), position in space(t=6/98) and spatial
children hospitalized in our department over 6 years) or relations(t=5/76); audio perception(t=9/74); visual
under-diagnosed entity. Patients may present with staggering memory(t=3/96) and audio memory(t=5/83) .
and falling, often leading to a misdiagnosis of acute Conclusion: The dyslexic disordered students compared to
cerebellar ataxia. Recognition of this disorder may lead to the normal students are less capable in audio visual
early detection and treatment of the paediatric neoplasms perception and related memories. There is also no difference
and may reduce the neurologic damage that is the major between boys and girls in both groups.
source of morbidity in children with successfully treated
tumours.

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


202 Posters, Sunday 9 September

P1305 P1306
Role of glutathione redox status in the Diploid/tetraploid form of cutaneous
pathophysiology of autistic disorder mosaicism in a child with refractory
A. Corejova, A. Hrabovska, J. Kyselovic epilepsy and malformation of cortical
Department of Pharmacology and Toxicology, Faculty of development
Pharmacy, Comenius University, Bratislava, Slovak Republic
M.I. Sigatullina1, C. Fons2, F.V. Sanmarti3, M.I. Perez4
Introduction: Oxidative stress has been suggested to be 1Child Neurology Department, Tashkent Institute of
one of the key elements in the pathophysiology of autism. Postgraduate Medical Education, Tashkent, Uzbekistan,
Oxidative stress is produced by high levels of free radicals, 2Child Neurology Department, 3Epilepsy Unit, , 4Genetic

which, in physiological conditions, are under regulation by Department, Hospital San Joan de Deu, Barcelona, Spain
multiple antioxidative mechanisms. It has been proposed Objective: To analyze the concordance between the
that the loss of this regulation participates in the pathogenesis neurological symptoms and seizure semiology in a child
of autism. The aim of our project was to examine whether with a special form of cutaneous mosaicism.
potentiated antioxidative mechanisms would affect autistic Methods: The full spectrum of clinical, cytogenic,
disorder symptoms. continuous Video-EEG and MRI investigations were
Methods: Patients (n=43; 2-21 years old) with autistic performed.
disorder were enrolled. Exclusion criteria for subject Results: A 1-year-old girl was born from healthy non-
selection were as follows: Asperger syndrome, high- consanguineous parents. During the first 36 hours of life
functioning autism, epilepsy, selected pharmacotherapy she presented clonic seizures in the left hand and leg, with
affecting CNS. Methylcobalamine was given daily at a dose tonic head and eyes deviation to the right. During the first
of 500g. Venous blood was collected at d0, d90 and d180 year she developed refractory epilepsy with generalized
and redox status of glutathione as well as levels of tonic seizures. Family history was unremarkable for
homocystein and cobalamine were determined. The cutaneous and epilepsy disorders. Pregnancy and delivery
psychological profile was defined at d0, d90 and d180 by a were uneventful. The birth a lot of dismorphic features of
psychologist in combination with parent observations. the face have been noticed, heterocroma of iris, hypo- and
Results: Oral application of methylcobalamine (500g per hyper pigmented maculas at the skin of the right frontal area
day) influences glutathione redox status. Based on the and right leg, hypopigmented hair mixed with normal,
combination of parent and psychologist observations, which followed the Blaschko lines. Clinically the girl
language and social skills were improved in patients using presented severe mental retardation and diffuse muscle
methylcobalamine. Social interaction was increased, hypotonia. The EEG was characterized by focal slowing and
including social responsiveness and eye contact. epileptiform activity predominant in the right centro-
Conclusion: Oral application of methylcobalamine in parietal and centro-temporal areas. MRI of the brain
patients with autism seems to potentiate antioxidative revealed extensive right parieto-occipital lysencephaly. The
mechanisms and leads to changes in the psychological routine analysis of the caryotype in the peripheral blood was
profile of patients. 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.

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


Posters, Sunday 9 September 203

P1307 P1308
Diagnostic brain imaging in congenital Leigh syndrome in 13 Tunisian patients
facial palsy E. Ellouz1, J. Abdelhedi2, I. Chamkha3, I. Ayadi2,
H. Uchikawa, K. Fujii, A. Takagi, Y. Kohno I. Hsairi2, F. Kamoun2, F. Fakhfakh4, C. Triki5
Pediatrics, Graduate School of Medicine, Chiba University, 1Pediatric Neurology, 2Hedi Chaker Hospital, 3Department
Chiba, Japan of Genetics, 4Genetics, Faculte de Medecine de Sfax,
5H. Buniatian Institute of Biochemistry, Sfax, Tunisia
Introduction: Congenital facial palsy is caused by various
disorders. But the pathogenesis of them often remains Introduction: Leigh syndrome is the most common clinical
unclear. We report three cases of congenital facial palsy phenotype of mitochondrial disorders in childhood. The
with identification of lesions by the radiological findings. diagnostic criteria include progressive neurological disease
Methods: We investigated the etiology of three Japanese with psychomotor delay, symptoms of brainstem or basal
patients with congenital facial palsy. ganglia disease, raised lactate levels and characteristic
Patient 1: The 11-month-old girl presented with left facial symmetric necrotic lesions in the basal ganglia or brainstem.
palsy noted at birth. During pregnancy her mother needed We try to determine clinical, radiological and genetic
insulin for diabetes mellitus. features of Leigh syndrome through the evaluation of 13
Patient 2: The 1-year-old girl was born as second of twins. Tunisian patients.
Right facial palsy was noticed after birth. Methods: We reviewed the observations of all patients with
Patient 3: The 6-year-old boy presented with bilateral facial a clinical presentation suggestive of Leigh syndrome; we
and abducens nerve palsy, and cleft of soft palate noted at determined the clinical and radiological features of these
birth. To investigate their etiology, we performed patients. Respiratory chain enzymes study was not
constructive interference in steady state (CISS) magnetic performed. The molecular study was performed in some
resonance imaging (MRI) and temporal bone computed patients.
tomography (CT). Results: We collected 13 patients belonging to 9 families.
Results: First CISS MRI were performed. In patient 1, the The mean age was 15 years; the mean age at onset was 2.1
left facial nerve was not observed. In patient 2, the bilateral years. Psychomotor delay was noted in 7 patients, gait
facial nerves were observed. In patient 3, the bilateral facial difficulties and movement disorders were noted in 9, spastic
nerves, abducens nerves and facial colliculuses were not paraplegia in 8, cerebellar ataxia and optic atrophy in 5,
observed. Next, temporal bone CT was performed in patient ophthalmoplegia in 4 patients. Brain MRI showed
2. The strictured right labyrinth portion of facial canal was involvement of putamen in 9 cases, caudate nucleus and
observed. Therefore, patient 1 and 3 were diagnosed with pallidi in 3 cases, brain stem in 5 cases. Molecular study
Mbius syndrome, patient 2 was diagnosed with congenital showed a novel missense mutation in the mitochondrial
unilateral facial palsy with strictured labyrinth portion. cytochrome C oxidase III gene in 2 patients, and a surf
Conclusion: We successfully identified the lesion causing mutation in 1 patient.
facial palsy using CISS MRI and temporal bone CT. Conclusion: Leigh syndrome has a clinical and genetic
Identification of the responsible lesion is important for heterogeneity. The diagnosis should be considered in
diagnosis and for considering the pathogenesis of congenital children with symptoms of brain stem or basal ganglia
facial palsy. disease. Radiological features with bilateral and symmetric
necrotic lesions of basal ganglia and brain stem are almost
constant.

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


204 Posters, Sunday 9 September

P1309 P1310
Mucopolysaccharidosis VI in two siblings: Efficient generation of functional
an unusual clinical presentation dopaminergic neurons from hESCs
E. Ellouz1, E. Chtourou2, H. Ben Othmen2, I. Hsairi2, M. LI1, Y. Zou1, N. Tang2, G. Dawe2, I. Islam2, T. Cao2
F. Kammoun2, A. Miled3, C. Triki2 Oral Sciences, National University of Singapore, 2National
1
1Pediatric Neurology, 2EPS Hedi Chaker, Sfax, University Health System, Singapore, Singapore
3Hopital Farhat Hached Sousse, Sousse, Tunisia
Introduction: Years after the successful differentiation of
Introduction: Mucopolysaccharidosis VI or Maroteaux- neurons from human embryonic stem cells (hESCs) there
Lamy syndrome is a lysosomal storage disease characterized are still huge limitations of current protocols that are either
by systemic clinical manifestations. Diagnosis and difficult to replicate or unable to generate physiological
management are often challenging because of the functional cells. We have created a very simple and efficient
considerable variability in symptom presentation and rate of protocol in generating functional dopaminergic neurons
progression. from hESCs.
Methods: We report the observations of 2 siblings with Methods: hESCs colonies were first digested into a single
unusual clinical presentation of mucopolysaccharidosis VI. cell suspension and subsequently seeded onto poly-L-
Results: Our patients were 2 Lybian siblings (a boy and a ornithine coated plates with Stemgent and BMP inhibitor
girl) born from consanguineous parents, aged 20 and 4 LDN193189 over 10 days. The cells were subsequently
months respectively. The 2 patients presented with passaged on Matrigel coated plates for 7 days. Rosettes
psychomotor retardation. Neurological examination found were then selected through 1 hour treatment of rosette
a macrocephaly and a cerebellar ataxia in the boy. He did selection reagent followed by single cell dissociation with
not have any facial dismorphy or skeletal or joint accutase. Collected cells were then subjected to a stepwise
abnormalities. The girl has a macrocephaly, flaccid induced differentiation into dopaminergic neurons under
paraplegia, myelomeningocele and foot deformity. The neural basal media supplemented with N2, B27, shh, FGF-
cerebral MRI showed a T2 hyper intensity in the midbrain 8, GDNF, TGF-3, dc-AMP, laminin and fibronectin.
in the boy and hydrocephalus in the girl. The screening of Results: Differentiated cells gained neuron morphology
mucopolysaccharides in urine demonstrates an increase of with extending neurite network were observed within 10
dermatan sulphate at 22mg/l suggestive of days of induced terminal differentiation. Immunofluorescent
mucopolysaccharidosis VI. The enzymatic study was in staining showed positive expression of dopaminergic
progress. The boy died suddenly from dyspnoea. markers Tuj1, TH, DAT and pan Sodium channels.
Conclusions: Mucopolysaccharidosis VI or Maroteaux- Electrophysiological studies using Patch clamp confirmed
Lamy syndrome is a clinically heterogeneous condition. the neurons were physiological functional in firing action
Case studies reported in the literature have identified potential with clear evidence of threshold with 30pA current
subjects who presented with marked disease in the first year injection. Dopamine release was quantified by Dopamine
of life and others who presented with slowly advancing ELISA kit with sensitivity of 10-100ng/ml.
disease. Our patients belong to the first group. To our Conclusion: We successfully demonstrated the efficient
knowledge cerebellar ataxia, myelomeningocele and T2 generation of dopaminergic neurons from human embryonic
hyper intensity in the midbrain have not been reported stem cells and confirmed them as physiological functional
before. cells.

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


Posters, Sunday 9 September 205

P1311 P1312
Dysgraphia in children with asymmetric Chronic inflammatory demyelinating
bilingualism polyneuropathy in children
S.M. Golubovic, N. Novakovic, Z. Kasic A. Takagi1, K. Fujii1, H. Uchikawa1, S. Misawa2,
Faculty of Special Education and Rehabilitation, University Y. Kohno1
of Belgrade, Serbia Department of Pediatrics, 2Department of Neurology, Chiba
1

Objectives: The Vlachs of Serbia are an ethnic minority of University Graduate School of Medicine, Chiba, Japan
Serbia, culturally and linguistically related to Romanians. Background: Chronic inflammatory demyelinating
The Vlach languages, also called the Eastern Romance polyneuropathy (CIDP) is a slowly progressive disorder of
languages, have a common origin from the Proto-Romanian the peripheral nerves, causing demyelination and axonal
language. degeneration. In adults, the main treatments are intravenous
Methodology: The sample consisted of 22 children (from immune globulin (IVIg) and steroid therapy. However,
totally 113 tested) in early school age, from five rural treatment for paediatric CIDP still remains to be determined.
primary schools around Svilajnac and Zabar. 13 children We aimed to clarify the efficacy of IVIg and steroid
had dyslexic dysgraphia, and 9 had graphomotor dysgraphia. treatment in CIDP children.
The study was performed with the abbreviated version of Methods: We investigated the clinical course of 3 paediatric
Semantic test - S. Vladisavljevic, Three-dimensional test of CIDP patients. Mean age was 9.3 years (7-12), and their
reading (H. Sax) for assessment of written speech, Scale for gender was one male and two female. We performed
assessment of dysgraphia of writing (Ayiriagerra, Ozias), electrophysiological examinations to diagnose them as
and assessment of performance of graphomotor line (Lillian having CIDP by using the diagnostic criteria. We basically
Lirsa). treated these paediatric patients firstly with IVIg (400mg/
Results: Obtained results show that there is a statistically kg/day, 5 days), and secondary methylpredonisolone (30mg/
significant difference ( 0.02) on the semantic test in kg/day, 3days), following oral predonisolone (1-2mg/kg/
asymmetrically bilingual children regarding the type of day).
dysgraphia, which means that asymmetrically bilingual Results:
children with graphomotor dysgraphia showing better Patient 1: We treated a 7-year-old boy with IVIg, resulting
scores on the semantic test than asymmetrically bilingual in dramatical improvement. However, we failed to change
children with dyslexic dysgraphia. There was a statistically to steroid therapy, resulting in combination therapy.
significant difference ( 0.04) in the average speed of Patient 2: We treated a 9-year-old girl with IVIg and
reading between asymmetric bilingual children regarding methylpredonisolone with partial recovery. We finally could
the type of dysgraphia. There is also statistically significant finish the treatment.
difference ( 0.01) in the average number of errors regarding Patient 3: We treated a 12-year-old girl with IVIg, resulting
the type of dysgraphia. Asymmetric bilingual children with in partial improvement. After treatment with
graphomotor dysgraphia make less mistakes than the methylpredonisolone and oral predonisolone, she could
asymmetric bilingual children with dyslexic dysgraphia. walk again.
Conclusion: Asymmetric bilingual graphomotor dysgraphic Conclusion: All 3 patients showed improvement in motor
children on average remember more facts than asymmetric function by IVIg therapy. Subsequent steroid therapy is still
bilingual children with dyslexic dysgraphia. 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.

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


206 Posters, Sunday 9 September

P1313 P1314
Partial agenesis of corpus callosum in Vestibular stimulation effect on quiet
Sanjad-Sakati syndrome (p-ACC): a case stance balance in 3- to 7-year-old children
report plus a review of articles) with cerebral palsy
N.S. Al Ghasab1, B. Janati2, A. Khan3 S.A. Hosseini1, H.A. Haghgoo1, B. Zeinal Zadeh1,
Qassim University, Hail, Saudi Arabia, 2Center for
1
E. Pishyareh1, S. Talebian2
Neurology, Virginia, VA, USA, 3ICU, King Khaled Hospital, 1Occupational Therapy, University of Social Welfare and

Hail, Saudi Arabia Rehabilitation Sciences, 2Tehran University of Medical


Introduction: Sanjad-Sakati syndrome (SSS) was first Sciences, Tehran, Iran
described in the Middle-East in children of consanguineous Background and aims: Children with cerebral palsy (CP)
parents. It is a rare autosomal recessive disorder known also show a variety of neurological deficiencies such as problem
as Middle-East syndrome or Richadson-Kirk syndrome or with processing tactile, somatosensory, proprioceptive,
hypoparathyroidism-retardation-dysmorphism (HRD) visual and vestibular information which leads to
syndrome. discoordination in bilateral movements, movement
Study objective: To describe a new finding in a rare genetic sequencing and planning and equilibrium disorders. The
disorder where literature is meagre. vestibular system plays an important role in the general
Methods: The clinical investigation was conducted at King development and balance which is distorted severely in CP
Khaled Hospital in Hail, Saudi Arabia in the year 2011. children. We aimed to investigate the effect of vestibular
Results: General physical examination showed the patient stimulation on quite stance balance in CP children.
to be short-statured with facial dysmorphic features Methods: Vestibular stimulation was performed twice
including a long narrow face, deep seated eyes, peaked weekly with a course of 12 sessions for 20 CP children.
nose, depressed nasal bridge, micrognathia, thin lips, low Using force plate, different parameters such as sideway
set and large floppy ears, small hands and small feet. The range, range fore-after, area and mean velocity were
patient had hypotonia, poor motor coordination, delayed measured. Data were analyzed statistically using U-Mann-
developmental milestones. Whitney and Wilcoxon tests.
The brain MRI in our patient showed a partial agenesis of Results: Mean velocity parameter as a postural control
the corpus callosum (p-ACC) characterized by absence of parameter showed significant changes but no significant
the splenium and rostrum, a finding which has not change was shown in stability postural parameters.
previously been reported in SSS. Conclusion: Application of vestibular stimulation for CP
Conclusion: Our patient showed partial agenesis of the children can lead to significant changes in postural control
corpus callosum which could explain the patient's motor, mean velocity. Accordingly, those children who have
behavioural and developmental abnormalities. The wide received vestibular stimulation in this project showed a new
variety of MRI presentations reported in the SSS literature balance strategy that would lead to an increase in exploratory
may represent different gene mutations. behaviour which would help them to maintain their balance.

[SSS Figure 1]

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


Posters, Sunday 9 September 207

P1315 P1316
Effectiveness of topiramate and Neurophysiological perspectives of
levetiracetam in infantile spasms non- electroencephalography in children with
responsive to steroids attention deficit hyperactivity disorder
A.A.H. Mahmoud (ADHD)
NNI, KFMC, Riyadh, Saudi Arabia A. Dube1, K. Yadav1, A. Gupta2, Y. Yadav3
Aim: To compare effectiveness of two novel antiepileptic 1 Physiology, 2Pediatrics, S.M.S. Medical College,
drugs, topiramate and levetiracetam as a second line 3 Pediatrics, Sevayatan Hospital, Jaipur, India
treatment for infantile spasms when oral steroids fail. Objective: The present study was undertaken to digitally
Method: 40 infants within 2 years of life with clinically- evaluate the electroencephalographic signature in children
and EEG-proven infantile spasms that did not respond to with Attention Deficit Hyperactivity Disorder (ADHD).
prednisone (2mg/kg/day in two divided doses) were Method: 30 children in the age range of 3-11 years were
recruited and randomized into two groups. They were included in the present study and power spectral analysis of
randomly assigned to either topiramate (group 1; 1mg/kg/ electroencephalographic (EEG) output from the central
day for 3 days, then increased to 1mg/kg/day every third day EEG electrode pair location (preferably the Cz - Vertex pair)
up to 6mg/kg/day) or levetiracetam, (group 2; 10mg/kg/day was run to test the hypothesis that cortical slowing in the
for 5 days and then increased to 10mg/kg/day every 5 days prefrontal region can serve as a basis for differentiating
up to 60mg/kg/day). children with ADHD from healthy children.
Results: Of the 20 patients included in the final data Results: Quantitative electroencephalographic findings
analysis, 11 (55%) were administered topiramate and 9 indicated significant increased theta power and decreased
(45%) levetiracetam. 18 patients did not respond to the first delta power seen in patients with ADHD with lack of
drug and subsequently to the other drug when crossed-over, suppression of Mu-waves which suggested significant
if the first drug proved ineffective. 2 patients with infantile maturational dysfunction in cortical arousal in the prefrontal
spasms responded to either one drug respectively without cortex, cortical slowing and dysfunctional mirror neuron
crossover. Their EEGs improved with time. system in children with ADHD.
Discussion: The present study demonstrated the Conclusion: These findings constituted a positive initial
ineffectiveness of topiramate and levetiracetam suggesting test of a QEEG- based neurometric test for use in the
current treatment modalities are grossly inadequate assessment of ADHD and the significance of the mirror
underscoring the urgent need for more research efforts to neuron system in the disorders of the social mind.
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


208 Posters, Sunday 9 September

P1317 P1318
Treating children with epilepsy and Semantic-pragmatic abilities in children
comorbid attention-deficit/hyperactivity with graphomotor and dyslexic-dysphasic
disorder (ADHD) dysgraphia
I. Dumitru1, A. Salan2 S.M. Golubovic1, G.R. Colic2
Pediatric Neurology, 2Pediatric Psychiatry, Country
1 1Speech and Language Pathology/Logopedics, 2Faculty of
Hospital Dr. Fogolyan Kristof, Sfantu Gheorghe, Romania Special Education and Rehabilitation, University of
Introduction: 30-40% of children with epilepsy have Belgrade, Serbia
symptoms of ADHD. That causes problems at school and at Introduction: Since pragmatic deficits are often connected
home. Despite the evidence of impairment from ADHD, with language disorders, and specific learning disabilities,
clinicians have difficulty in deciding whether to treat the goal of this study was to investigate the semantic-
children for both epilepsy and ADHD. pragmatic abilities in children with graphomotor dysphasic-
Methods: We treated 30 children with epilepsy and ADHD dyslexic dysgraphia, in the age from 8 to 12 years of both
for 3 months with anticonvulsants and then added genders.
atomoxetine (1.2mg/kg/day), in the morning. We used Methodology: The sample consisted of 40 children of both
questionnaires for children, parents and teachers to evaluate genders, age from 8 to 12 years, from second to fifth grade
the school performance, behaviour at home and school, of elementary school. The sample was divided in two
relationships with friends and family every 3 months for a groups: the first group consisted of children with
year. We also performed EEG every month. graphomotor dysgraphia, and the second group consisted of
Results: 25 of these children had been seizure free before children with dysphasic-dyslexic dysgraphia, with IQ of 90
added atomoxetine; 3 were stable, 2 experienced a reduction and above 90. For examination of semantic-pragmatic
in seizures. In 28 children there was no effect on seizure abilities, we applied the Test of Pragmatic Language (TOPL)
frequency, or anticonvulsant drug levels the EEG findings and the Semantic test.
doesn't change after introducing atomoxetine. 2 of them Results: In the test for assessment of pragmatics, children
have an increased epileptic discharge. 24 children improved with graphomotor dysgraphia have achieved, in average, 36
compartmental and school performances. 1 no influence points (59.69%), while children with dysphasic-dyslexic
was seen. 3 of them had good scores at questionnaires dysgraphia achieved 29 points (19.8%). There is a
completed by teachers, but no improvement in family. statistically significant difference (p=0.000) in pragmatic
Conclusion: If there is ADHD that can be diagnosed abilities between children with graphomotor and dysphasic-
independently of epilepsy effects, then further improvement dyslexic dysgraphia. In the semantic test, children with
in inattention and hyperactive/impulsive symptoms can be graphomotor dysgraphia achieved on average 36 points. The
made by the addition of a specific ADHD treatment. best results were achieved in the category of word
Although there are no recommended guidelines, we have homonyms, and the worst in synonyms. Children with
the opinion that if inattention and hyperactivity symptoms dysphasic-dyslexic dysgraphia have on average achieved 29
persist for more than 3 months after the last epileptic points, best results were with the homonyms and were worst
seizure, one can go for specific treatment. 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

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


Posters, Sunday 9 September 209

P1320 P1321
Impact of non-pharmacological treatment A new case of Worster-Drought syndrome
on tics in children C.S. Spitaleri, F. Caramella, P. Glorioso, R. Nardello,
S. Bakhtadze, N. Geladze, N. Khachapuridze A. Fontana, S. Mangano
Child Neurology, Tbilisi State Medical University, Tbilisi, University of Palermo, Palermo, Italy
Georgia Introduction: Worster-Drought syndrome (WDS) consists
Object: Tics are involuntary, sudden, rapid, recurrent, of a congenital pseudobulbar palsy and is usually associated
stereotyped motor movements or phonic productions that with spastic tetraplegia, learning impairment, behavioural
involve discrete muscle groups. Pharmacological treatment problems, and epilepsy. Congenital bilateral perisylvian
was considered as the most effective approach for syndrome (CBPS) is characterized by bilateral perisylvian
management of tics for many years. In recent periods polymicrogyria on imaging. Clark et al, have previously
clinicians attempt to use behavioural methods for this proposed a WDS spectrum that includes CBPS, speculating
purpose. The aim of our study was to use non that it may be due to malformation of the perisylvian region
pharmacological treatment like EEG biofeedback-neuro- due to various perinatal or congenital causes, whether
feedback (NF) for the treatment of tics. demonstrable on imaging, or functional and not visible with
Methods: We have previously examined 15 non-treated current imaging techniques. Worster-Drought suggested
children (9 boys and 6 girls) with simple tics (average age that the syndrome is probably a developmental defect of the
10 years). All children with complex tics and with other motor tracts (corticobulbar) which run from the lower part
comorbidities were excluded from the study. Tics frequency of the motor (Rolandic) area of the cerebral cortex to the
and severity were assessed by Yale Global Tic Severity Scale 10th and 12th cranial nerve nuclei.
(YGTSS). Sensorimotor rhythm (SMR) training was used Methods: A 12-year-old boy presented with a long history
for NF therapy. 30 sessions of NF with duration of 30 of spastic tetraplegia, learning impairment, behavioural
minutes each was conducted in every patient. Data were problems, and epilepsy. The seizures were refractive to
analyzed by SPSS 10.0. ANOVA was used to determine the several antiepileptic drugs. He also had variable difficulty
effect of treatment on YGTSS parameters. in moving the tongue, soft palate and lips with weakness of
Results: The ANOVA showed a significant effect of the pharynx and laryngeal muscle.
treatment on YGTSS measures (F(1.37)=223.69, Results: Video-EEG monitoring captured paroxysms of PO
MSE=114.735, p<0.0001). These evidences suggest that NF in the center-front of both hemispheres, and that project
significantly improves the severity and frequency of tics. contralaterally. Neuroimaging studies do not revealed
Conclusions: Thus effectiveness of SMR training in abnormalities.
children with tics is important, since the drugs used for the Conclusion: Our patient presented the characteristic
treatment have severe side effects, compliance problems etc. symptoms of Worster-Drought syndrome (WDS) with mild
Cognitive behavioural therapy is effective not only for spastic tetraplegia, learning impairment, and epilepsy. MRI
reduction of tics but also for increasing self-esteem and did not show dysplastic cortex in the region of the sylvian
social competence as well. 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.

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


210 Posters, Sunday 9 September

P1322 P1323
Clinical characteristics of paroxysmal Clumsiness in children with ADHD
kinesigenic dyskinesia in paediatric compared with normal children based on
practice the Lincoln Ozeretski Scale
S. Kwon, J. Suh, H.-E. Seo, S.K. Hwang A. Kazemi1, F. Khaledi2, M. Kazemi2
Pediatrics, Kyungpook National University School of 1Psychology, Islamic Azad University Tehran Medical

Medicine, Daegu, Republic of Korea Branch, 2Islamic Azad University, Tehran, Iran
Purpose: Paroxysmal kinesigenic dyskinesia (PKD) is one Introduction: Clumsiness is a syndrome that has a
of the movement disorders in which dyskinesia occurs in a pathological meaning. It is mainly concerned with the motor
part of the body by a sudden movement under a certain activities of children. The children who are suffering from
circumstance. It is rare, but important because it mimics such a problem are not able to perform normal motor skills
epileptic seizures. This study was aimed to evaluate the even if they do not show any neurological symptoms in
clinical features of children and adolescents with PKD in laboratory tests. The object of the present study is the
Korea. evaluation of clumsiness in children with ADHD compared
Methods: A total of 7 children with PKD was involved in with normal children based on Lincoln Ozeretski Scale.
the study. The demographic and clinical characteristics were Methods: The statistical sample consisted of 30 boys with
retrospectively evaluated from their medical records. ADHD, who were selected according to an available
Results: The age of the subjects ranged from 10 to 21 years sampling method and 30 boys without ADHD, selected
(mean age: 15.75.7 years). Males were predominant (M:F; through random sampling, at the age of six. Measurement
6:1). They all presented with dystonias of abrupt onset with tools consisted of Motor Development Lincoln-Ozeretski
an average duration of 10.5 seconds (3.5-17.5 seconds), Scale. Data were analyzed using T-Test.
which were triggered by various sudden movements. They Results: The results showed that there is a significant
were multifocal, but mainly in limbs. No obvious difference between the kids motor skills and the dependent
comorbidities were found. 6 of the subjects, except for a variables (t=10.43).
non-compliant case, responded well to the medications and Conclusion: Children with ADHD compared to normal
remained symptom free. They were treated with either children are at a lower level of motor skills, and suffer from
oxcarbazepine (n=4, 14.95.8 mg/kg/day) or lamotrigine clumsiness. In other words, children suffering from this
(n=2, 1.50.9 mg/kg/day). There were no significant syndrome, show incompetent and abnormal motor-skills in
differences between the two groups in terms of effectiveness, learning and doing an activity expected from them.
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


Posters, Sunday 9 September 211

P1324 P1325
Some etiological factors of stroke in Neuron-specific enolase as marker of
children brain lesions in children with epilepsy
S.S. Shamansurov, S.H. Saidazizova, N.M. Tulyaganova C. Calcii, S. Hadjiu, I. Iliciuc
Tashkent Institute of Postgraduate Medical Education, Hospital of Mother and Child Health Care, Chisinau,
Tashkent, Uzbekistan Moldova
Introduction: Today, in adults much attention is paid to Aim: To reveal the correlation of serum NSE concentrations
question an acute vascular pathology, but not less interest is with the type of epilepsy, including seizure characteristics,
the problem of the sharp vascular accidents developing at frequency, age of onset, and presence of mental retardation.
childrens age. Methods: To achieve the proposed objectives, the study
Aim: To investigate etiology of stroke in children. included 108 children with age ranging from 2 weeks to 24
Methods: The analysis of clinical supervision of 27 months (mean age 9.21.2 months), 61(56,0%) boys and 47
children. All children were divided at the moment of acute (44.0%) girls. 43 patients (39.84.71%) manifested
stroke. Hemorrhagic Stroke in 18 patients, ischemic in 9 generalized seizures, 53 (49.14.81%) had partial seizures
patients. and 12 children (11.13.02%) had polymorph seizures.
Results: Infections were present in 11 patients (vasculitis), Results: Serum NSE concentrations were elevated in 35
DIC in 8, hemophilia in 1, AVM in 4, Mitochondrial disease (32.4%) children from the study group. Out of them 12
(syndrome MELAS) in 1, Neurophakomatosis in 2 patients. patients (22.65.74%) had focal epilepsy, 15 children
Distribution on age: 17 patients younger than till 40 days, (34.87.26%) manifested generalized type of seizures and
life (the picture of Hemorrhagic Stroke occurred 7 8 children (66.713.60%) were diagnosed with polymorph
newborns; Ischemic stroke in at 10); on average attacks seizures. Elevated sera NSE concentrations were identified
occured on days 34-38; in all cases Hemorrhagic Stroke was in following subgroups of patients: 15 out of 30 children
the DIC syndrome. The second group of children one year with several epileptic attacks per day (50%, rxy+0.43), 13
told included 5 patients: on a share of ischemic stroke - 2 out of 41 children with several epileptic attacks per week
patients (trauma); hemorrhagic stroke - 3 patients (infectious (32%, rxy+0.49), 4 out of 16 children with several epileptic
process). The third group included children up to 3 years old attacks per month (25%, rxy+0.29), and in 3 out of 21
(2 children): 1 child with a virus infection; 1 child with children with two unprovoked seizure attacks (15.0%,
MELAS syndrome. The fourth group included children rxy+0.31). A moderate correlation (rxy+0.44) was observed
from 4 till 13 years (3 patients) with traumatic damage (VB between the raise of the serum NSE concentration and onset
system). of epilepsy in the neonatal period. Strong correlation
Conclusions: The revealed reasons for the acute damage of (rxy+0.88) showed the development of mental retardation
the brain blood circulation at children, have revealed a and elevated serum NSE concentrations.
significant divergence in etiology and are also very often Conclusions: Increased concentrations of serum NSE were
occuring in children. 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.

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


212 Posters, Sunday 9 September

P1326 P1327
Neurophysiological perspectives of Neurotrophic factors and disorders of
electroencephalography in children with residual psychological development of the
attention deficit hyperactivity disorder child
(ADHD) A. Hadjiu1, S. Hadjiu2, E. Hadjiu3, C. Calcii2
A. Gupta
1Universit de Reims Champagne-Ardenne, Reims, France,
Paediatrics, SMS Medical College, Jaipur, India
2Neurology, 3State University of Medicine and Pharmacology
N. Testemitanu, Chisinau, Moldova
The present study was carried out in the Department of
Pediatrics & Dept. of Physiology in collaboration with the Objective: To highlight the relationship between mixed
Departments of Neurology, SMS Medical College, Jaipur. specific psycho-developmental disorders in children and
30 children in the age group of 3 to 11 years (median age BDNF levels.
range of 7-10 years) with an intelligence quotient (IQ) of Materials and methods: We assessed BDNF serum levels
more than 70, suffering from ADHD (male : female ratio via immunoenzymatic method in 48 children (study group)
being 3:1), diagnosed as per DSM IV criteria, were included presenting residual mixed specific psycho-developmental
in the study. An equal number of children matched for age disorders (aged between 2 and 5 years old) and 25 healthy
and sex acted as the control cohort. children (control group).
18 to 20 epochs were selected for Power Spectral Analysis, Results: Patients from the study group presented: language
each lasting 2-3 seconds, the time duration representing retardation, emotional, cognitive and behavioural disorders.
confocal and frequency matched neuronal pool based on the An overall analysis showed that BDNF serum levels were
theory of analysis of sharp changes or rapid transitional significantly lower in children from the study group in
processes (RTP) reflected in quasi-stationary segments of comparison to controls (p< 0.05). Significantly low levels
local EEGs Epochs with more than 100v on the electro- of serum BDNF were noted in children with severe cognitive
encephalogram representing artifacts were excluded from disorders frequently associated with language disorders.
the mean. However no significant difference could be seen Moreover, neuroimaging data revealed abnormalities of
in the absolute powers of beta and alpha waves. The nerve tissue maturation. There is statistical evidence that
increased theta/beta ratio in ADHD children and absence of psychological disorders are negatively correlated with
Mu-wave suppression [a characteristic feature of the mirror serum BDNF levels. Thus, BDNF represents an important
neurons operational architectonics (Oberman et al, 2005)] marker a of child's psychological development.
give an insight into the features of the disease process of Conclusions: Our data confirm the role of BDNF on the
ADHD, namely cerebral dysmaturation (Monstra et al, child's psychological development (it contributes to nerve
1996) and broken mirrors. In the present study no significant fibre maturation, language, behaviour and emotional
difference could be seen in the absolute powers of alpha and centres). We suggest that low levels of BDNF influence the
beta waves in ADHD children and the control group. 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.

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


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 P1342
B. Medjo1, D. Nikolic2, M. Atanaskovic-Markovic3, Management of seizures in Bosnian
S. Rsovac1, J. Kalanj1, N. Vunjak1
1Neonatal Intensive Care Unit, 2Department of Neurology,
children
3Department of Pulmonology and Allergology, University A. Bajraktarevic1, S. Trninic1, M. Miokovic1,
Children's Hospital, School of Medicine, University of L. Kumasin1, I. Suljevic2, S. Uzicanin3, H. Niksic4
1Pediatrics Department, Public Health Institution of
Belgrade, Serbia
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


Posters, Sunday 9 September 215

Clinical Neurophysiology P1345


The way how various cognitive tasks
P1343 impair the activity of subthalamic nuclei
and upper limb tremor
Saccade-related beta-band
N. Kovacs1, I. Herndi1, G. Deli1, E. Bosnyk1, F. Nagy1,
desynchronization in the subthalamic J. Janszky1, I. Bals2
nucleus of Parkinsons disease patients 1Department of Neurology, 2Department of Neurosurgery,

during successful antisaccades and error University of Pecs, Hungary


trials Background: It is a clinically well-known phenomenon
A. Yugeta, W.D. Hutchison, R. Chen that different cognitive tasks (e.g. counting, thinking about
University of Toronto, Toronto Western Research Institute, the disease) may alter the tremor characteristics in idiopathic
Toronto, ON, Canada Parkinsons disease (PD).
The basal ganglia are involved in response selection. We Objectives: To analyze the changes in the firing pattern of
have shown that the saccade-related beta-band subthalamic nuclei (STN) and the concomitant tremor
desynchronization (beta-SRD) in the subthalamic nucleus parameters during different cognitive tasks.
(STN) may play a role in inhibition of unwanted movements Methods: 6 patients with PD undergoing bilateral STN
and in execution of movements. Antisaccades require an deep brain stimulator implantation were enrolled into our
inhibition of reflexive saccades towards the visual cue and study. During microelectrode recording, the preamplified
an initiation of voluntary saccades away from the visual cue. and unfiltered electrical activity of subthalamic nuclei was
If beta-SRDs are involved in voluntary saccades, we registered by Medtronic Leadpoint 5 system. The activity of
hypothesize that beta-SRDs would be deficient during STN and the bilateral limb tremor were simultaneously
antisaccade errors. To investigate this, we studied beta- captured by a CED Power 1401 AD converter during three
SRDs in the STN of Parkinsons disease (PD) patients different tasks: baseline resting condition, counting and
during successful antisaccades and error trials. 20 PD word-generation tasks. Raw recordings were filtered and
patients performed an antisaccade task 1 to 3 days after subsequently analyzed by Spike 2 software (CED Inc.,
deep brain stimulation surgery with local field potential version 7.08). We determined the frequency and discharge
recording from the STN via externalized leads. Electro- pattern of neuronal activity by spike sorting involving both
oculography was used to measure saccades. We analyzed template matching and principal component analysis
the wavelet power spectrum averaged on saccade onset. The techniques. Between the tremor and STN signals cross-
incidence of errors was 34.5%. Latencies of saccades were correlation and coherence analyses were also performed.
longer during successful antisaccades (426.977.4ms Results: In the baseline resting condition the intensity and
[meanSD]) than during errors (312.987.2ms; p<0.01). the frequency of tremor was significantly lower than that
Beta-SRDs were observed more often during antisaccades during counting (124 milli-g2 vs. 352 milli-g2 and 4.12Hz
(27 of 34 STN) than during errors (7 of 34 STN; p<0.01). vs. 4.32Hz, respectively). Meanwhile, we observed a
Onsets of beta-SRDs were not significantly earlier during tendency that the firing pattern of STN became more burst-
antisaccades (-180.5165.9ms) than during errors like (bursting narrow pos skew or burst-like bimodal)
(-76.4279.1ms; p=0.25). Beta-SRDs were sustained for during cognitive tasks.
longer during antisaccades (528.9205.7ms) than during Discussion: Cognitive tasks may influence the firing pattern
errors (374.5264.3ms; p=0.03). These results suggest that of STN and concomitant tremor. Further studies are required
beta-SRDs play a role in the suppression of unwanted to analyze the importance and possible clinical implications
saccades and in the successful execution of antisaccades. of this phenomenon.

P1344
Abstract cancelled

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


216 Posters, Sunday 9 September

P1346 P1347
Cortical alternating generators of sleep Role of the cerebellum in the motor
spindles: electrical source imaging using control of Donders law during human
high-density EEG (256-channels) pointing tasks: an rTMS study with
recordings kinematic analysis of the wrist
A. Del Felice, C. Arcaro, S.F. Storti, P. Manganotti L. di Biase1, F. Giambattistelli1, F. Mastrolilli1,
Department of Neurological, Neuropsychological, F. Taffoni2, D. Formica2, P.M. Rossini3, F. Vernieri1,
Morphological and Motor Sciences, University of Verona, J.M. Melgari1
Italy 1Department of Neurology, 2Biomedical Robotics and

Introduction: Sleep spindles are the hallmark of N2 sleep, Biomicrosystems Lab, Universita Campus Biomedico di
with a frequency between 10-16Hz and a duration of 0.5- Roma, 3Universit Cattolica del Sacro Cuore, Roma, Italy
2sec, localizing over the fronto-centro-parietal cortical Introduction: Donders law well represents intrinsic
areas. Anterior spindles have a relative slower frequency strategies of motor control system during pointing tasks,
compared to posterior ones, although no consensus exists executed through eye, head or arm movements [1-2]. The
on the cortical localization of spindles generator. central nervous system (CNS) removes the degrees of
Methods: 136 spindles were obtained by visual inspection freedom that are not essential (solution of the redundancy
from a 256 channels EEG (Geodesic, Eugene, USA) sleep problem). Aim of the present study is to identify the CNS
recordings from 6 healthy volunteers. Offline analysis regions involved in the control of Donders law applied to
filtered the marked traces at 10-12Hz (slow spindles) and the motor control of human pointing tasks.
12-14Hz (fast spindles); traces of each category were Material and methods: 11 healthy subjects underwent a
segmented, baseline-corrected, bad channels rejected by session of inhibitory rTMS (1Hz) of right cerebellar
visual inspection and replaced, and averaged. Averaged hemisphere, while 13 control volunteers, underwent a sham
traces were used to reconstruct on the MNI (Montreal cerebellar rTMS session. Each subject executed a kinematic
Neurological Institute) magnetic resonance template via an analysis of the wrist during pointing tasks to evaluate
inverse solution method (LORETA algorithm) cortical Donders law [2] before and after the rTMS session. The
generators of slow and fast spindles. orientation matrix R of the wrist was measured by means of
Results: A total of 64 slow and 70 low spindles, temporally inertial magnetic unit.
alternating on the EEG, were analyzed. Visual rendering of Results: The MANOVA analysis shows significant
spatial distribution of spindles by EEG-signal projection on modifications in the curvature of Donders plans obtained
a cortical flat map confirmed the fronto-central distribution before and after rTMS cerebellar neuromodulation, in 78%
of slow spindles and the centro-parietal localization of fast of healthy subjects that underwent to real rTMS session,
ones. The source generator reconstruction localized the while no significative differences were found in sham
generator in the anterior prefrontal cortex (middle frontal group.
gyri, Brodmann area 10) for the slow spindles and in the Discussion: The present data suggest a cerebellar control of
parietal cortex (paracentral lobule, Brodmann 5; posterior Donders law applied to the redundancy problem solution in
parietal cortex, 7; supramarginal gyrus, 40) for the fast human pointing tasks. This method could have an
ones. application in clinical practice, particularly for functional
Conclusion: Sleep spindles show different, alternating evaluation. Since the curvature of Donders plan is like an
cortical generators according to their frequency and individual fingerprint, these findings could be useful in
topographical distribution on the scalp. This observation many neurodegenerative diseases, in which neuronal loss
suggests the existence of different cortical networks for occurs earlier than the onset of clinical symptoms and in
slow and fast spindles. individually-tailored and neurophysiology-based
rehabilitation.

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


Posters, Sunday 9 September 217

P1348 P1349
Left prefrontal cortex influences motor Multivariate gait data analysis:
imagery comparison between older and younger
I.M. Tarkka1, D.S. Stokic2 healthy adults
Health Sciences, University of Jyvskyl, Finland,
1
C. Pradhan1, M. Whr1, K. Jahn2, R. Schniepp2
Mississippi Methodist Rehabilitation Center, Jackson, MS,
2 1Integrated Research and Treatment Center for Vertigo,
USA Oculomotor and Balance Disorders, IFB, LMU, University
Introduction: Our aim was to determine the role of the left of Munich, 2Integrated Research and Treatment Center for
dorsolateral prefrontal cortex (PFC) in facilitation in the Vertigo, Oculomotor and Balance Disorders, IFB, LMU, &
primary motor cortex (M1) of the muscle involved in motor Department of Neurology, University of Munich, Germany
imagery. We stimulated the left PFC during motor imagery Introduction: While gait analysis is a powerful non-
to induce a virtual lesion. invasive tool, its interpretation is often hindered by large
Methods: Transcranial magnetic stimulation to left M1 volumes of highly correlated data. We explore Principal
(round coil at Cz, 120% resting threshold, 8510% of Component Analysis (PCA) for dimension reduction and
maximal output) was used to elicit responses in the right linear discriminant analysis (LDA) to determine the relative
tibialis anterior (TA) muscle during relaxation and while power of extracted components in separating different
imagining right ankle dorsiflexion movements cued by a clinical groups.
visual display. A second stimulator (figure-of-eight coil at Methods: 224 discreet measurements using a GAITRite
F3, 7510%) was used to stimulate left PFC 300ms before sensor carpet were obtained from two groups of normal
M1 during relaxation and motor imagery. 5 healthy adults healthy adults (Group 1: 31-40 years (34.63.32), n=20;
(age 576 years, 4 males) were studied. Main outcome Group 2: 71-80 years (75.13.10), n=27). PCA was
measure was the amplitude of motor evoked potentials performed to determine significant components (PC) and
(MEPs) in the right TA during relaxation and motor imagery, loadings. Fishers LDA was used to determine the hierarchy
without and with left PFC stimulation (8-12 traces each). of discriminatory power among the components.
Results: Motor imagery alone significantly increased Results: 12 PCs explained 90% of the data variance with
MEPs in the right TA compared to relaxation (~400% on the 1st explaining 28.9%. Stepwise LDA indicated that 4
average). Stimulating the left PFC 300ms before the M1 PCs (PC3, PC4, PC6 and PC1 in order of discriminatory
significantly reduced the facilitatory effect of motor power) were optimal for the separation of the groups. Major
imagery by about one quarter (317%, p=0.0268). Paired left contributory measures to PC3 were Base of Support (BS)
PFC and M1 stimulation during relaxation, however, had no Left and Right (L&R) during self-selected, maximal-speed
appreciable effect on MEPs in TA (102%). and head-extended gait. In addition there were significant
Conclusion: The results indicate that left PFC is an integral contributions from BS (L&R), Stride Length (L&R) and
part of the network involved in motor imagery. Impaired Functional Ambulatory Profile (FAP) scores during dual-
output from the left PFC may hinder the potential to utilize task gait (verbal fluency and serial 7) as well as FAP scores
motor imagery for restoration of motor function after brain during eyes-closed gait.
injury. 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.

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


218 Posters, Sunday 9 September

P1350 P1351
Quantitative EEG and cognitive Diagnosis of epilepsy by means of sleep-
impairment in Parkinsons disease deprived or melatonin-induced sleep EEG
L.C. Fonseca1, G.M. Tedrus1, P.N. Carvas2, G. Gustafsson, E. Svanborg
E.C. Machado3 Clinical Neurophysiology, Linkoping University Hospital,
1Neurology, 2Medicine - FAPIC/Reitoria, 3Medicine - Linoping, Sweden
FAPESP, Pontificia Universidade Catlica de Campinas, Recording EEG in children may be challenging, since
Campinas, Brazil reliable interpretation requires that the patient lies still.
Introduction: Cognitive impairment is frequent and Sleep during the recording is therefore desirable, and
sometimes precocious in Parkinsons disease (PD), but parents are often instructed to keep the patient awake for at
knowledge of its pathophysiology is still limited. least half the night before. However, sleep deprivation is not
Quantitative EEG has provided contributions to the theme easy to achieve in children. Therefore, melatonin is currently
and in the present study includes an approach to both used in a number of laboratories to induce sleep. This study
absolute power and coherence in different cognitive states was performed to determine 1) whether melatonin is equally
of PD. efficient in inducing sleep as sleep deprivation; and 2)
Methods: 46 patients with PD and 54 normal subjects were whether melatonin-induced sleep is as efficient in provoking
assessed using a neurological evaluation, CERAD epileptiform activity as sleep deprivation.
neuropsychological battery (consortium to establish a Method: 115 EEGs recorded between 2007 and 2008 after
registry for Alzheimers disease), Mini-mental Status sleep-deprivation and 130 EEGs recorded between 2010
Examination, executive functions examination and EEG. and 2011 after melatonin ingestion were studied. The
The mean global absolute powers at the various electrodes children in the two groups were matched for age (1-16 y.o)
for the delta, theta, alpha and beta bands were calculated, as and gender. Comparisons were made concerning how many
also the inter- and intra-hemispheric coherences. The theta/ children obtained sleep, acceptability of EEG recording and
delta global absolute ratio was also calculated. Four groups epileptiform activity.
were compared: PD with dementia (PD-D) - 12 patients; PD Results: 11 recordings in each group were not interpretable
with mild cognitive impairment (PD-MCI) - 12 patients; PD due to movement artifacts (n.s.). Sleep was obtained in 71%
with no cognitive disturbances (PD-NLCog) - 22, and the of recordings of children that got melatonin and in 60%
control group (p<0.05). sleep deprived children (n.s). Epileptiform activity was
Results: The global delta and theta absolute powers and the recorded in 34% of EEGs with melatonin-induced sleep and
beta frontal-occipital coherence were significantly greater in 39% of EEGs recorded after sleep deprivation (n.s.).
in the PD-D group than in the other groups, whereas the Conclusion: Melatonin had a small advantage over sleep-
theta/delta ratio was greater in the PD-D and PD-MCI deprivation in so far as sleep was obtained in a larger
groups than in the PD-NLCog and control groups (post-hoc number of subjects. It had no disadvantage concerning
analysis, ANOVA, p<0.001). ability to provoke epileptiform activity. Furthermore, the
Conclusions: Significant differences were identified procedure is much easier for the parents than to keep a
between the PD-D group and other groups and between the young child awake for half the night.
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


Posters, Sunday 9 September 219

P1352 P1353
Polysomnographic (PSG) recordings and Feasibility of a new multichannel surface
clinical evaluation in patients with electrode to detect neuropathy in diabetic
prolonged disorders of consciousness patients with normal results in
(DOCs) conventional nerve conduction studies
M.R. Valente, S. de Biase, F. Basaldella, M. Fuccaro, B.J. Kim1, K.Y. Jung1, Y.S. Koo1,2, J.H. Jang1, S.H. Lee3,
S. Lorenzut, G.L. Gigli K.W. Park1
Neurology Clinic, Sleep Disorder Center, University of 1Neurology, Korea University College of Medicine, Seoul,
Udine, Italy 2Jeju Medical Center of Jeju Special Self-Governing
Introduction: The aim of the study is to evaluate the Province, Jeju, 3Biomedical Engineering, Korea University
importance of sleep recordings in patients with prolonged College of Health Science, Seoul, Republic of Korea
DOCs looking at possible correlations between clinical Introduction: To increase sensitivity for detecting early
evaluation, sleep patterns and evoked potentials. At our neuropathy in patients with diabetes, we have recently
knowledge, studies evaluating these methods altogether in developed a multichannel surface electrode. This study was
patients with prolonged disorders of consciousness are performed to investigate reliability of the multichannel
lacking, at least with current scales. (8-electrodes) surface electrode in detecting neuropathy in
Materials and methods: 12 patients, 10 in vegetative state diabetic patients, but with normal results from the
(VS) and 2 in minimally conscious state (MCS) were conventional nerve conduction study (NCS).
evaluated from a clinical and neurophysiological point of Methods: Age and sex matched normal healthy subjects (24
view. Clinical evaluation included Coma Recovery Scale- men, 32 women; mean age, 58.71 yr) and diabetic patients
Revised (CRS-R), Disability Rating Scale (DRS) and with distal symmetric sensory symptoms (12 men, 12
Glasgow Coma Scale (GCS). Neurophysiological evaluation women; mean age, 59.92 yrs) who were normal at
included 24h PSG, SSEP, BAEP, VEP, P300 and MMN. conventional NCS were recruited. Eight compound muscle
Results: In 4 patients 24h PSG showed the presence of a action potentials (CMAPs) were recorded from the abductor
clear sleep-wake alternation, different stages of sleep, pollicis brevis using the electrode by stimulation of the
REM-NREM ciclicity, sleep spindles and K-complexes. median nerve at the wrist. Various latency and amplitude
These patients had a CRS-R score of 7.251.71 while 8 related variables including minimum and maximum
patients, lacking one or more of these sleep elements, had a latencies were obtained and analyzed to compare these
CRS-R score of 3.380.91 (p<0,05). Patients with each variables between the two groups using independent t-test.
single sleep element (such as REM sleep) had always a We also used multiple logistic-regression analysis to find
better clinical evaluation compared with those who had not. out which variables can discriminate control and diabetic
Patients with all sleep elements and preserved BAEPs had groups.
a better clinical evaluation, compared with patients lacking Results: All variables related to latencies in the diabetic
at least one of them. No correlation was found between patients group, especially standard deviation of CMAP
presence of SSEPs and better clinical evaluation. onset latencies in each subject (SDLat), showed significant
Conclusions: PSG recordings resulted as the best difference from control group (P<0.001). However, all
neurophysiological tool for assessment of patients with amplitude-related-variables did not show any differences.
prolonged DOCs and may be considered a non-expensive, Among all variables, minimum latency and the SDLat were
non-invasive and easy to perform examination able to give the most reliable variables to discriminate diabetic patients
a suitable support to clinical evaluation. 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.

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


220 Posters, Sunday 9 September

P1354 P1355
Vagus somatosensory evoked potentials Assessing the progress of mild cognitive
(VSEP) in subjects with multiple sclerosis impairment with the use of an ERP
T. Polak1, F. Metzger2, D. Zeller3, A.J. Fallgatter4 electrophysiological biomarker
1Dept. of Psychiatry, Psychosomatics and Psychotherapy,
V. Papaliagkas
University Clinic Wrzburg, 2Clinic of Psychiatry and 3rd Department of Neurology and Department of Physiology,
Psychotherapy, University Clinic Tbingen, 3Department of Aristotle University of Thessaloniki, Greece
Neurology, University Clinic Wrzburg, 4Department of
Aim: To study changes in auditory event related potentials
Psychiatry and Psychotherapy, University Clinic Tbingen,
Germany
(AERP) and their correlation with the memory status of
mild cognitive impairment (MCI) patients
Introduction: Vagus somatosensory evoked potentials Materials and methods: AERPs were recorded in 22 MCI
(VSEP) were proposed as an electrophysiological patients (meanSD age = 67.47.8, median (interquartile
contribution to the diagnosis of Alzheimers dementia (AD) range-IQR) MMSE score = 28 (27-29) in three consecutive
and Parkinsons disease (PD) where prolongation of exams, and in 30 age-matched controls at baseline. During
latencies as compared to healthy controls was explained by this time period, 3 patients progressed to Alzheimers
the disease specific degeneration of brainstem nuclei. We disease (AD). Latencies and amplitudes of the late waves
now searched for an independent confirmation of this (N2, P3 and Slow Wave) and N2-P3 peak-to-peak
hypothesis by examining VSEP in a disease where brainstem amplitudes and latencies were measured, as well as
affection may occur but which is different from the correlation coefficients (CC) between them and MMSE
neurodegenerative process in AD and PD. scores.
Method: We assessed VSEP in 15 subjects with multiple Results: Between exams, a significant increase in P3
sclerosis (37.515.1 years, 5 male; EDSS median=4,0 latency and a decrease in N2 amplitude were observed.
[range 0-7]) with brainstem affection in 8 cases and in 15 Only N2 latency correlated with baseline MMSE scores,
matched healthy controls. The auricular branch of the vagus whereas P3 and Slow Wave latencies correlated with age.
nerve was stimulated at the tragus applying electrical square Conclusions: A new index that incorporates changes in N2
impulses (0.1msec duration, interstimulus interval 2sec, and P3 latencies and amplitudes into a single
stimulus intensity 8mA). Evoked potentials were recorded electrophysiological marker is proposed in order to describe
bipolarly from the electrode positions C4-F4 and Fz-F4 with high accuracy the gradual progress of MCI and its AD
(band-pass 0.1Hz to 1kHz, analysis time 10msec, averaging conversion.
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


Posters, Sunday 9 September 221

P1356 P1357
Modulatory effects on human Acute motor axonal neuropathy:
sensorimotor cortex activation by whole reversible axonal conduction block or
hand vibration stimulation axonal degeneration?
A.B. Kunz1, M. Christova2, E. Gallasch2, M. Seidl1,3, Z. Arnyi1, A. brahm2
J. Bergmann4,5, Y. Krenn1, R. Nardone3,6, E. Trinka1,3,4, 1Dept. of Neurology, Semmelweis University, 2Dept. of

S.M. Golaszewski1,3,4 Neuroinfectology, St. Lszl and Istvn Hospital, Budapest,


1Department of Neurology, Paracelsus Medical University Hungary
Salzburg, 2Institute of Physiology, Medical University Graz, Objective: Acute motor axonal neuropathy (AMAN) is a
3Spinal Cord Injury and Tissue Regeneration Center,
variant of Guillain-Barr syndrome. AMAN apparently has
4Neuroscience Institute, Paracelsus Medical University
two distinct forms: In the Far-East, AMAN is a common
Salzburg, 5Institute of Psychology, Paris Lodron University, disease showing quick recovery, whereas in Europe and
Salzburg, Austria, 6Department of Neurology, F. Tappeiner North-America AMAN is rare and characterized by
Hospital, Merano, Italy complete denervation. We present 3 Hungarian patients, and
Objective: To investigate the effect of stimulation of the discuss the clinical and electrophysiological differences
nerve afferents of the hand on cortical activity elicited by between the two forms of AMAN.
whole-hand vibration (WHV) stimulation for sensation in Patients: Patient 1 and Patient 2 (32- and 61-year-old
healthy human subjects. males) acquired their disease in China and Thailand,
Methods: WHV stimulation was performed in 12 healthy respectively. Both patients developed generalized weakness,
subjects in separate sessions at different stimulation levels: with elicitable reflexes and no sensory symptoms.
sub-sensory at 50Hz, sensory at 50Hz and motor at 2Hz. To Electrophysiological assessment showed low amplitude
verify if stimulation at lower frequencies is less effective, an motor responses, with normal sensory potentials. Both
additional experiment at sensory level with 2Hz was patients improved within weeks. Follow-up examination of
performed. TMS was used to assess motor threshold (MT), Patient 1 showed complete restitution of motor responses
motor evoked potentials (MEP) recruitment curve (RC), after 2 months. Patient 3 is a 25-year-old male who
short latency intracortical inhibition (SICI) and intracortical developed tetraplegia, areflexia, and respiratory
facilitation (ICF) to paired-pulse TMS at baseline (T0), insufficiency within 2 days in Hungary. The first
immediately after (T1) and one hour (T2) after 30 minutes electrophysiological examination was performed before
of WHV stimulation. F-wave studies were performed to Wallerian degeneration had taken place, which showed
assess spinal motoneuron excitability. preserved motor responses with multiple amplitude
Results: WHV stimulation at sub-sensory/50Hz and reductions on intermediate nerve segments, and normal
sensory/2Hz level determines no significant cortical sensory responses. Follow-up examination showed complete
excitability changes; at sensory/50Hz level and at motor/2Hz denervation of all limb muscles.
level we found decreased MT, increased MEP RC as well as Conclusion: It is postulated that patients 1 and 2 with the
reduced SICI and increased ICF at T1 and T2. Far-Eastern form of AMAN had reversible axonal blocks,
Conclusions: WHV stimulation at sensory/50Hz and as opposed to the initial axonal blocks progressing to axonal
motor/2Hz level induces similar long-lasting modulatory destruction seen in the European form of AMAN in patient
effects on motor cortical excitability. Both, the strength of 3. In both forms, the immune response is elicited by
the corticospinal projections and the intracortical networks Campylobacter jejuni and directed against the axolemma,
are influenced to the same extend. The study provides but there appears to be a quantitative and/or qualitative
further evidence that stimulation intensity and frequency difference, perhaps related to geographical differences in
can independently modulate motor cortical plasticity. The Campylobacter jejuni.
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


222 Posters, Sunday 9 September

P1358 P1359
Ocular vestibular evoked myogenic Peripheral nerve function following
potentials in patients with multiple 24-week treatment with tanezumab,
sclerosis a nerve growth factor (NGF) inhibitor
E. Gozke, Z. Ayhan, N. Erdal, N. Gurbuzer, M. Kaydan M.T. Brown1, W.J. Litchy2, D.N. Herrmann3,
Department of Neurology, FSM Teaching and Research M. Goldstein4, A.M. Burr1, M.D. Smith1, C.R. West1,
Hospital, Istanbul, Turkey K.M. Verburg1, P.J. Dyck2
Introduction: Vestibular evoked myogenic potential 1Pfizer, Inc., Groton, CT, 2Mayo Clinic, Rochester, MN,
(VEMP) test is a technique based on activation of the
3University of Rochester, Rochester, NY, 4Medical Specialists
vestibular apparatus by acoustic stimulation. In this study of the Palm Beaches, Inc., Atlantis, FL, USA
we aimed to investigate the presence of vestibulopathy in Introduction: The reported cutaneous sensory symptoms
patients with relapsing remitting multiple sclerosis (RRMS) and novel analgesic mechanism of action of tanezumab, a
who have not vestibular complaints using ocular VEMP monoclonal antibody NGF-specific inhibitor, raises
(oVEMP) test. potential concerns regarding nerve function and safety.
Methods: 40 patients diagnosed as RRMS according to Mc Methods: This randomized, double-blind, placebo-
Donalds criteria and 30 healthy controls were enrolled in controlled study (NCT00863772) of neurologically normal
the study. oVEMP tests were performed through patients with knee or hip osteoarthritis investigated whether
contralateral inferior oblique muscles. Active electrode was tanezumab (3 administrations of 5 or 10mg IVq8w for 24
placed on the lower eyelid, and the reference electrode was weeks) caused clinically significant changes from baseline
attached 1cm below. The patients were requested to stare (cfBL) relative to placebo in a composite measure of
towards a superolateral direction so as to activate inferior peroneal, sural, tibial and autonomic nerve function
oblique muscle. Meanwhile 120dB click stimulation was (5NC+HRdb) or in intraepidermal nerve fibre density
delivered to the contralateral ear at 10/sec for 150 sec, and (IENFD), assessed by distal leg skin biopsy. Efficacy
1500 responses were averaged. The test was repeated twice (WOMAC pain) at week 16 was also assessed.
for each side and the latencies and amplitudes of the initial Results: Due to an FDA-mandated clinical hold, only 219
negative (N1) and positive (P1) waves were measured. of 369 planned patients were treated. Last observation
Availability of any response, their latencies and amplitudes carried forward least squares mean and standard error (LSM
were compared. (SE)) cfBL in 5NC+HRdb scores and IEFND to week 24,
Results: 9 cases of RRMS (22.5%) could not yield any and WOMAC Pain cfBL to week 16 are shown.
response in both sides, while in the control group no
bilateral response was obtained in 4 cases (13.3%). Also in Assessment Placebo Tanezumab 5 mg Tanezumab 10
the RRMS group no unilateral response was obtained in 5 (LSM (SE)) mg
(12.5%) cases. In the RRMS group mean latencies of N1
5NC+HRdb -0.11 0.17 (0.30) -0.06 (0.30)
and P1 were significantly longer, while N1-P1 amplitudes (0.29)
were found to be meaningfully lower.
IENFD -0.43 0.18 (0.57) -1.12 (0.57)
Conclusion: These findings demonstrate that by using (0.57)
oVEMP test subclinical vestibulopathy can be elicited in
RRMS patients without vestibular complaints. 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.

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


Posters, Sunday 9 September 223

P1360 P1361
Long-term changes of visual evoked EEG in dementia with Lewy bodies: a
potentials in children with insulin- diagnostic tool?
dependent diabetes mellitus Y. Hizem1,2, M. Ben Djebara1,2, I. Abdelkefi1,2,
S.-S. Lee1, H.-S. Han2, H. Kim3, J.J. Lee4 I. Kacem1,2, A. Gargouri-Berrechid1,2, R. Gouider1,2
1Neurology, 2Pediatrics, 3Preventive Medicine, College of 1Department of Neurology, Razi Hospital, La Manouba,
Medicine, Chungbuk National University, Cheongju-si, 2Research Unit of Clinical Neurophysiology and
4Premedical Course, College of Natural Science, Seoul Electrodiagnosis 03/UR/08-09, Tunis, Tunisia
National University, Seoul, Republic of Korea Introduction: Frontal intermittent rhythmic delta activity
Objectives: To investigate the changes of central nerve (FIRDA) is an abnormal EEG pattern found in primary and
conduction in children with insulin-dependent diabetes secondary involvement of the brain in a wide variety of
mellitus (IDDM) prospectively using the visual evoked diseases. The occurrence of FIRDA in degenerative
potentials (VEP) and to know how those results were related dementia could be considered as an indicator supporting the
to clinical risk factors and parameters of peripheral nerve diagnosis of dementia with Lewy Bodies (DLB).
conduction studies (NCS). Objective: To investigate the correlation between FIRDA
Methods: A total of 76 patients (29 males and 47 females) and DLB in comparison with Alzheimers disease (AD).
aged 5-26 years (mean 14.44.8) with IDDM underwent Methods: 88 patients with dementia were ascertained: 44
visual evoked potentials and bilateral NCS of median, ulnar, DLB and 44 AD, age and sex matched. Diagnoses were
posterior tibial, peroneal, and sural nerves annually for 5 established according to international criteria. EEGs were
years. The control group was made up of 52 healthy performed on 47 patients as part of a routine dementia
children. assessment using standard techniques. Recordings were
Results: Out of 76 patients, 25 patients completed annual examined blind to diagnosis following these criteria:
studies for 5 years. Significant positive correlations were dominant frequency, presence of other frequencies,
found between the latency of P100 wave in the VEP and the asymmetry, mean amplitude and presence of focal
level of serum glycosylated haemoglobin. Latency and abnormalities including spikes, sharp waves, triphasic
amplitude values of P100 waves decreased progressively in waves or transient slow wave activity.
children with IDDM as the duration of the disease increased. Results: A total of 18 records from the DLB group and 29
The values of latency and amplitude were inversely related records from the AD group were examined. 8 of 18 patients
with the age of patients and duration of the disease. The (44.5%) with DLB showed a main pattern of FIRDA. In AD
values of latency of P100 were not related with parameters group, FIRDA occurred in 10 patients with severe dementia
of NCS. However, some of the parameters of NCS were (34.5%). The difference between the two groups was
weakly related with the amplitudes of p100. significant (p: 0.03).
Conclusions: Poor glycaemic control proved to be an Conclusion: We found a significant correlation between
important risk factor over 5 years as related to the FIRDA and DLB. Our results are in concordance with
development of subclinical central neural pathway recent findings in literature. This pattern when found in
abnormality. VEP could be considered as a valid non- early stages, could be helpful for diagnosis, however this
invasive tool for detecting an early diabetic central pattern could not be considered specific for DLB.
conduction abnormality such as retinopathy or optic
neuropathy.

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


224 Posters, Sunday 9 September

P1362 P1363
Potential mechanisms underlying the HRAS-dependent perturbation of iTBS
neural effects of TDCS in post-stroke after-effects: a lesson from Costello
recovery disease
E.M. Khedr1, O.A. Shawky1,2, A. Tohamy1, J. Rothwell3 M. Dileone1,2, P. Profice1, F. Ranieri1, F. Pilato1,
1Assiut University Hospital, Assan University Hospital,
2
F. Capone1, L. Florio1, R. Di Iorio1, G. Musumeci1,
Assiut, Egypt, 3National Hospital for Neurology and C. Leoni1, M. Tartaglia3, G. Zampino1, V. Di Lazzaro1
Neurosurgery, London, UK 1Catholic University of Rome, 2San Bortolo Hospital,

The aim of this study was to investigate potential Vicenza, 3Istituto Superiore di Sanit, Roma, Italy
mechanisms underlying the neural effects of TDCS in post Introduction: Costello syndrome (CS) is a rare congenital
stroke recovery. disorder due to a G12S amino acid substitution in HRAS
Subjects and methods: 36 patients with subacute ischemic protoncogene and several lines of evidence suggest a key
stroke participated in the study. The patients were randomly role of HRAS in Long Term Potentiation (LTP). Paired
assigned to one of three groups; the anodal and cathodal Associative Stimulation (PAS) leads to an extremely
groups received real tDCS at an intensity of 2mA for 25 pronounced motor cortex excitability increase in CS
minutes daily for 6 consecutive days. The sham group patients. Intermittent Theta Burst Stimulation (iTBS) is
received sham stimulation for the same duration. Patients another facilitatory repetitive Transcranial Magnetic
were assessed with the Barthel index (BI) and the Medical Stimulation (rTMS) protocol that in normal subjects induces
Research Council (MRC) muscle strength scale at baseline, a similar increase in motor cortex excitability. For this
and after end of the sessions. Cortical excitability and reason, we evaluated the after-effects induced by iTBS in
transcallosal inhibition (TCI) were measured at baseline and CS and compared them with those induced by PAS.
after sessions for both hemispheres. Methods: In two different session we evaluated iTBS and
Results: In all groups, resting and active motor thresholds PAS after effects in 4 CS patients and a group of 17 age
decreased in the affected hemisphere but were unchanged in matched healthy controls. All CS patients underwent clinical
the unaffected hemisphere; the changes were more evaluation for dystonia.
significant after real tDCS than sham. The slope of the Results: PAS protocol led to a 250% increase of the FDI
input-output curve was steeper after real tDCS (anodal, MEP amplitude in CS patients: surprisingly iTBS induced
p=0.0001 and cathodal p=0.01) with no significant changes no change in MEP amplitude in CS patients whereas led to
in the sham group. There was a significant decrease in the an increase of about 50% in healthy subjects. Nevertheless
duration of TCI (pre-post tDCS) in the affected hemisphere all CS patients showed mild to moderate generalized
of all groups (p=0.0001); in the unaffected hemisphere the dystonia.
duration decreased only after cathodal stimulation (p=0.01). Conclusions: CS patients are characterized by dystonia
There was a significant correlation between improvement in and, moreover, by a concomitant enhanced PAS-induced
Hand grip or the BI and changes in cortical excitability. after-effect and an impairment of iTBS-related LTP-like
Conclusion: Both types of real tDCS increased cortical phenomena. The last finding seems to suggest that HRAS-
excitability of the affected hemisphere and these changes dependent signalling pathways could differently affect
correlated with the improvement in motor function. homotopic and heterotopic brain plasticity in humans.

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


Posters, Sunday 9 September 225

P1364 P1365
Motor cortex excitability in patients with Ocular vestibular evoked myogenic
vascular cognitive impairment-no potentials in evaluation of patients with
dementia: a follow-up study multiple sclerosis
M. Cantone1, G. Lanza1, M. Pennisi2, V. Puglisi1, T. Gabelic1, M. Krbot2, I. Adamec2, M. Habek2,3
L. Vinciguerra1, R. Ricceri1, G. Pennisi1, R. Bella1, Neurology, 2University Hospital Centre Zagreb, 3School of
1

M. Zappia1 Medicine, University of Zagreb, Croatia


1 Department GF Ingrassia, Section of Neurosciences, Objectives: We investigated ocular vestibular evoked
2 Department of Chemistry, University of Catania, Italy myogenic potentials (oVEMP) as supportive diagnostic toll
Introduction: Up to now only few studies have examined in assessing lesions of vestibulo-ocular pathways in patients
cortex excitability in patients with cognitive decline with relapsing remitting multiple sclerosis (RRMS).
following vascular brain damage. Recently, a transcranial Patients and methods: 60 patients treated at the Referral
magnetic stimulation (TMS) study showed an enhanced Centre for Demyelinating Diseases with established
motor cortex facilitation even though the absence of diagnosis of relapsing remitting multiple sclerosis were
changes in resting motor threshold (rMT), in patients with included in the study. The control group consisted of 16
vascular cognitive impairment-no dementia (VCI-ND). healthy subjects. oVEMP in response to acoustic clicks of
Aim: To evaluate neuropsychological and neuro 1ms duration at the intensity of 130dB SPL and the
physiological outcome in VCI-ND patients. stimulation frequency of 1Hz were studied. Signals were
Methods: 8 VCI-ND patients (mean age 72.46.4 years) divided in segments of 120ms duration (20ms before the
underwent to neuropsychological assessment and to single stimulus and 100ms after the stimulus) and averaged.
and paired-pulse TMS study at baseline and after two years. Latencies and amplitude of N10 and P13 waves of oVEMP
Resting motor threshold (rMT), cortical silent period, short were evaluated.
intracortical inhibition and intracortical facilitation were Results: Statistically significant prolongation of latencies
recorded bilaterally. was found in the group of RRMS patients (p<0.05) for N10
Results: After the follow-up period (22.13.5 months) response on the right and left side. There was also latency
patients exhibited a significant worsening of Stroop prolongation for P13 wave on right side. Statistical
T-scores (43.4 sec16.78 vs. 66.9 sec30.98; p<0.05) and a significance was not reached for left P13 latency. The
significant reduction in rMT over both hemispheres (left: difference in the amplitude between groups was not
47.3%9.88 vs. 40.9%10.67; right: 41.9%4.88 vs. observed. Conduction block was indentified in 18 patients
38.4%7.11; p<0.05). (30%).
Conclusion: After two years, VCI-ND patients showed an Conclusion: Ocular vestibular evoked myogenic potentials
overall trend towards a motor cortex hyperexcitability, are useful neurophysiological methods in evaluation of
although the mean rMT value was still within normal limits. brainstem lesions in patients with relapsing remitting
Previous studies reported that cortical excitability is stably multiple sclerosis.
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


226 Posters, Sunday 9 September

P1366 P1367
Prognostic value of neuron-specific Acute hyperoxia and cerebrovascular
enolase level in patients with Parkinsons reactivity in diabetic patients with acute
disease stroke: a pilot study
Y. Madjidova, S. Fakhargalieva I. Hegedus1, I. Drenjancevic2, S. Butkovi-Soldo3,
Tashkent Medical Academy, Tashkent, Uzbekistan A. Cosic2
Aim: To study the role of neuron-specific enolase in the
1Neurology, University Hospital in Osijek, 2Physiology and
forecast of Parkinsons disease (PD). Immunology, 3Neurology, Faculty of Medicine University
Materials and methods: We examined 35 patients, 17 Josip Juraj Strossmayer Osijek, Croatia
(48.57%) women and 18 (51.42%) men, average age - Introduction: Impaired cerebral vascular reactivity has
(7310.3) with PD. Patients were divided into 3 subgroups: been described in hypertension and diabetes mellitus. Since
with trembling-rigidity, trembling, and akinetic-rigidity stroke is of vascular etiology, the aim of this study was to
form. NSE level was defined in the serum of patients with determine the effects of acute hyperoxia stimulation on
the method of immune-enzyme analysis which was made cerebrovascular reactivity in diabetic patients with acute
with specific test systems, on "LISA" analyzer according stroke.
to the instruction applied in a set. Methods: In this pilot study, 12 diabetic patients (DM
Results: In 24 (68.5%) from 35 patients, NSE level was group) (meanSD age 656 yrs) with acute ischemic stroke
elevated (>25ng/ml). Elevated NSE level was marked in (within 72 hours) and 12 healthy subjects (613 yrs) were
58.3% of men and 41.7% of women. From 3 subgroups only included. Blood flow velocity (BFV) of middle cerebral
in patients with the trembling form of PD fluctuation of artery (MCA), index of pulsality (IP) and index of resistance
NSE level was within the norm (19-24.73ng/ml). More (IR) were determined by transcranial Doppler before,
often elevated NSE level was defined in the early period of during 15 minutes, and after 15 minutes of acute hyperoxia
the disease. Depending on the rate of parkinsonism (inhalation of 100% O2 over facial mask). Tromboxane B2
progressing, it was revealed that more elevated NSE levels (TXB2) levels in blood of both groups were measured by
were marked in patients with fast rate of disease progressing, ELISA assay before and during acute hyperoxia.
than in patients with slow and moderate rate. Results: The results showed paradoxical increase in cerebral
Conclusions: Elevated NSE level was marked in 69% cases BFV in both brain hemispheres during hyperoxia in the DM
of patients with parkinsonism. Elevated NSE level met in group compared to controls, accompanied by decrease of
patients with the trembling-rigidity and akinetic-rigidity TXB2 during hyperoxia in the DM group and increase of
form of PD, and was more elevated in patients with fast rate TXB2 in controls during hyperoxia. Controls exhibit
of disease progressing, also at early stages of the disease. vasoconstriction in response to hyperoxia. PI and RI in the
NSE level can be used as an additional methods of DM group decreased during hyperoxia compared to their
diagnostics and the forecast of neurodestructive brain basal values and compared to controls (while PI and RI of
processes, including PD. 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.

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


Posters, Sunday 9 September 227

P1368 P1369
Effects of simultaneous bilateral tDCS of Endothelial dysfunction in two patients
the human motor cortex with posterior reversible encephalopathy
L. Mordillo Mateos1, L. Turpin Fenoll2, syndrome
J. Milln Pascual2, A. Oliviero1 M. Saadatnia, V. Davoudi, K. Keyhanian, S. Haghjoo
1FENNSI, Hospital Nacional de Parapljicos, Toledo, Javnmard, M. Mirmohammad Sadeghi, F. Haghdoost
2Servicio de Neurologia, Hospital La Mancha Centro,
Isfahan University of Medical Sciences, Isfahan, Iran
Alcazar de San Juan, Spain
Background: We report two patients, one with eclampsia
Introduction: tDCS is a non-invasive technique investigated and another one with Systemic Lupus Erythematosus
as a therapeutic tool for different neurologic disorders. presenting posterior reversible encephalopathy. We tried to
Neuronal excitability can be modied by application of DC find out whether endothelial cell dysfunction was present in
in a polarity-specic manner: anodal tDCS increases these two patients.
excitability, while cathodal tDCS decreases excitability. Case1: A 22-year-old woman who was pregnant and has
Objective: To determine whether simultaneous bilateral been diagnosed to have HELLP syndrome was admitted to
tDCS is able to increase cortical excitability in one Al-zzahra hospital. The day after caesarean section, she had
hemisphere whereas cortical excitability in the contralateral experienced two Generalized Tonic Colonic Seizure attacks
hemisphere decreases. Cortical excitability before and after with a consequent long time loss of consciousness. In brain
bilateral motor cortex tDCS was evaluated and compared Magnetic Resonance Imaging (MRI) scan, ischemic lesions
with unilateral motor cortex tDCS. were found in parietal lobes and basal ganglia. Serum level
Methods: Cortical excitability was evaluated before and of two adhesion molecules, ICAM-1 & VCAM-1 was
after unilateral or bilateral tDCS using transcranial magnetic obtained and they were 274.5 & 102.5, respectively.
stimulation. Case2: A 16-year-old girl with Systemic Lupus
Results: Simultaneous application of anodal tDCS over the Erythematosus was admitted to Al-zzhra Hospital while she
motor cortex and cathodal tDCS over the contralateral one was confused and had experienced five episodes of
induces an increase in cortical excitability on the anodal- Generalized Tonic Clonic Seizures. Cerebral vasospasm has
stimulated side and a decrease in the cathodal stimulated been recorded through Magnetic Resonance Angiography
side. The simultaneous bilateral tDCS induced similar (MRA). Serum level of ICAM-1 and VCAM-1 were found
effects to the unilateral montage on the cathode-stimulated to be 329.3 and 75.7, respectively.
side. On the anodal side, the simultaneous bilateral tDCS Conclusion: We found high amount of ICAM-1 and
seems to be a slightly less robust electrode arrangement VCAM-1 in serum of two patients with posterior reversible
compared with the unilateral montage. Intersubject encephalopathy syndrome. These adhesion molecules were
variability of the excitability changes induced by the anodal found under different circumstances within circulating
motor cortex tDCS using the bilateral montage was lower blood reflecting the endothelial damage.
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


228 Posters, Sunday 9 September

P1370 P1371
Relation between electrophysiological Small fibre conduction velocity (CV) by
findings and diffusion weighted magnetic contact heat evoked potential stimulation
resonance imaging in ulnar neuropathy in (CHEPS) is faster in peripheral than in
the elbow central spinothalamic pathways
Y. Altun1, S. Aygun2, M.U. Cevik3, A. Acar3, S. Varol3, B.E. Smith1, M.A. Ross1, B.P. Goodman1, E.P. Bosch1,
A. Arkanoglu3, H. Onder4, E. Uzar3 L.K. Jones Jr.2
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 Introduction: Nerve conduction studies (NCS) assess only
Diffusion weighted imaging (DWI) provides information large diameter myelinated fibres. Data regarding small
about tissue integration by reflecting the random movement diameter fibre CV are sparse. CHEPS provides objective
of water molecules within the tissue. There is a limited measures of A delta fibre pathway CV from skin to cortex.
number of studies regarding DWI and conventional Methods: To assess CHEPS small (A delta) fibre CV in the
magnetic resonance imaging (MRI) in patients with ulnar periphery vs. in the CNS 13 neurologically normal controls
neuropathy in the elbow (UNE). In our study, we aimed to were recruited over 18-24 months with IRB approval. After
investigate the diagnostic value of non-invasive DWI consenting, all subjects underwent evaluations including
technique in patients with UNE. 26 elbows in 19 healthy CHEPS of limb and spine (L1 and C7) sites. Small fibre CV
controls (range 22-56 years) without any symptoms and 24 values were calculated between skin stimulation sites and
elbows in 21 patients (range 21-46 years) with cubital scalp recording electrodes.
tunnel syndrome underwent DWI. The electrophysiological Results: CV values from distal limb sites showed means of
and clinical criteria for the diagnosis of UNE were 3.7 m/s (foot) and 2.1 m/s (hand) while spine CV values had
performed. No signal from the ulnar nerve was detected in mean values of 1.5 m/s (L1) and 0.7 m/s (C7). CV figures
the healthy control group. We determined signal increase of for proximal limb sites (leg and forearm) were intermediate.
the ulnar nerve by DWI in all patients with UNE. T2 Conclusions: 1) Small (A delta) fibre CV values are higher
weighted (T2W) image showed increased signal intensity in from the distal limb than from corresponding spinal sites, 2)
20 elbows, while low signal intensity was observed in 4 since the vast majority of the conduction pathway between
elbows. A positive correlation was found between disease spine and cerebral cortex is central and the peripheral extent
duration and presence of hyperintensity (p=0.044, r=0.42) of this pathway is longer in peripheral than central segments
on T2W images. In addition, a positive correlation was also stimulating distal limb sites, it may be hypothesized that
found between electrophysiological severity scale score and peripheral small (A delta) fibre CV is greater than central
the largest nerve fibre diameter (p=0.017, r=0.48) and small (A delta) fibre CV, and 3) possible explanations may
cross-sectional area (p=0.017, r=0.48). In conclusion, DWI include: greater peripheral axon diameter, greater peripheral
might be used together with electrophysiological methods myelin thickness, and perhaps other differing physiologic
in diagnosis of UNE. Furthermore, DWI can be preferred in properties between Schwann cells and oligodendrocytes
some cases since it is a non-invasive method compared to such as sodium channel density or kinetics, PNS vs. CNS
electrophysiological methods in the diagnosis of UNE. axonal membrane properties, and central inhibitory
mechanisms.

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


Posters, Sunday 9 September 229

P1372 P1373
Can the Mismatch negativity (MMN) be Stimulus intensity and masseter volume
found in the nucleus subthalamicus? conduction on nerve conduction study in
E. Minks1, P. Jurak2,3, J. Halamek2,3, J. Chladek2, facial palsy
M. Bares1,4 S.J. Oh
1First Department of Neurology, St. Annes University Catholic University of Korea, Uijeongbu St. Marys Hospital,
Hospital and School of Medicine, Masaryk University, Uijeongbu, Republic of Korea
2Institute of Scientific Instruments of the ASCR, v.v.i., 3ICRC
Objectives: Electroneurography (ENoG) is used to
- International Clinical Research Center, St. Annes
determine the prognosis and the outcome in the acute phase
University Hospital, 4CEITEC - Central European Institute
of Bells palsy. However, we have experienced that inter-
of Technology, Brno, Czech Republic
rater and test-retest reproducibilities are relatively low. One
Introduction: In the protocol of mismatch negativity of the reasons is masseter volume conduction. This study is
(MMN) the frequent and target auditory stimuli are designed to obtain pure compound motor action potential
presented to the patient while unconcious. These evoked (CMAP) of the facial nerve without activating the masseter
potentials (EP) are considered to correlate with automatic muscle.
working memory and a primitive intelligence on an Methods: 13 patients with facial palsy were enrolled.
unconscious level. The aim of the study was to elucidate CMAPs were measured by using the 2 channel recording
whether nucleus subthalamicus (STN) is involved in the method, locating the surface electrode on nasalis muscle
processing of audio signals. and a concentric needle in the masseter muscle.
Methods: The EEG signal was recorded from STN during Supramaximal stimulations were done using stimulating
MMN protocol in 5 patients with Parkinsons disease with intensities of 20 to 60mA (sometimes over 60mA) at
9 established intracerebral electrodes. EP and event related intervals of 5 or 10mA. Stimulation intensities at which
time-frequency analysis was performed. Protocol masseter volume conduction arose were checked in every
parameters: 0.1-40Hz frequency band, target/frequent patient. The values of ENoG (%) with and without
stimulus 1kHz/2kHz, 100 ms, interstimulus interval 4s, 40 considering masseter volume conduction were assessed.
target stimuli. Results: Most of the masseter volume conductions arose
Results: When the intracerebral electrodes were connected between a stimulating intensity of 40 and 60mA except 4 of
with the reference electrode on the scalp - the N1 wave 26 masseter muscles, which are minimally 35mA in 1
(around 100ms) and MMN (peak around 200ms) dominated muscle, and 70mA in 2 muscles, and maximally 80mA in 1
at record. The most distinct N1 wave frequency was around muscle. When masseter volume conduction was neglected,
3Hz and this signal weakened while target motion was only 1 patient revealed over 90% axonal loss (ENoG< 10%).
presented. While intracerebral electrodes were connected in On the contrary, when masseter volume conduction was
the STN (near field potential) MMN-like potentials were taken into account, 3 patients revealed over 90% axonal loss
detected in 3 of 5 patients and in 4 of 9 intracerebral (ENoG< 10%), which means a poor outcome.
electrodes. These EP were in the same latency (19625ms) Conclusions: Masseter volume conductions arose in all
like the MMN from connection of intracerebral electrodes patients. Even though the ENoG is over 10%, one should
to the extracranial reference electrode. In 1 patient we consider masseter volume conduction all the time, especially
observed phase reversal of MMN-like potentials. when 80~90% axonal loss is represented.
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


230 Posters, Sunday 9 September

P1374 P1375
Chronic inflammatory sensory Acoustic shear wave signalling and
polyradiculopathy: a case report and calcium activation as the scientific basis
review of the literature of acupuncture physiology: TRP ion-
P. Zuberbuhler1, R. Reisin1, D. Miarro1, D. Binaghi2, channel experiments with fibroblast and
C. Marchesoni1, A. Pardal1 endothelial cells
1Neurology Department, Hospital Britnico Buenos Aires, J. Liang1, W.J. Xie2, X.Q. Yao3, P.Y.S. Cheung4,
2Radiology Department, Fundacin Favaloro, Buenos Aires,
S.K. Lam4, Q. Ma5, P.-W. Li6, X. Yang7, G. Li5,
Argentina
E.S. Yang4,6,8, P. Cheng9
Introduction: Chronic inflammatory sensory 1EEE, University of Hong Kong, Hong Kong, Hong Kong
polyradiculopathy (CISP) is a defined entity, frequently S.A.R., 2Health Science Center, Peking University, China,
underdiagnosed, and potentially treatable. It must be 3Chinese University of Hong Kong, Shatin, 4University of

suspected in patients with sensory ataxia, normal nerve Hong Kong, 5Time Medical Systems, Hong Kong, Hong
conduction studies (NCS), and MRI with thickened Kong S.A.R., 6Electrical Engineering, National Central
lumbosacral nerve roots and gadolinium enhancement. University, ChungLi, Taiwan R.O.C., 7Shenzhen Disease
Objective: Report of one case and review of the literature. Control Center, Shenzhen, China, 8Time Medical Systems,
Case report: A 57-year-old man with marked sensory Hing Kong, Hong Kong S.A.R., 9Peking University, China
ataxia on his left leg. Examination showed normal strength, A novel model of acupuncture physiology based on cellular
decreased knee and ankle jerks. Light touch and pinprick calcium activation by an acoustic shear wave (ASW)
sensations were reduced below the knees. Vibration and generated by the mechanical movement of the needle was
joint position sense were absent in the feet. Rhomberg was reported recently and its implication on integration of
positive. NCS were normal. Tibial sensory evoked potentials ancient Chinese medicine with modern science was
disclosed absent responses bilaterally. CSF was acellular discussed. Experimental evidences were observed using
with elevated protein. Lumbosacral MRI showed thickening latest instrumentation in MR Elastrography, confocal
of roots, with gadolinium enhancement. The patient was microscopy and two-photon fluorescent. To further
treated with IVIg 2g/kg for 5 days, with improvement of understand the biological nature of the ancient art, we have
symptoms. Currently, he receives IVIg every month, and developed an acoustic wave model that relates Ca2+
remains stable. activation to the total acoustic energy; not time and
Conclusions: The clinical course, elevated CSF protein, the amplitude alone. We have made use of siRNA in knockdown
evidence of root enhancement on the MRI, good response experiments in both fibroblast and endothelial cells and
to immunotherapy and the exclusion of other causes of found that acupuncture induced ASW activates Ca2+ influx
sensory ataxia, were compatible with the diagnosis of CISP. pathway of TRPC1, TRPV4 and TRPM7 channels in both
CISP is considered a restricted regional variant of chronic NIH 3T3 and H5V cells indicating the mechanosensitive
inflammatory demyelinating polyradiculopathy (CIDP), activities via the TRP channels. TRP channels, especially
clinically mimicking a purely sensory variant. There are TRPV4, have been implicated in the detection of acute
several reports of nerve root involvement in patients with nociceptive and neuropathic pains. In cooperation of
CIDP, but there are only a few of patients with sensory TRPC1, TRPV4 was found to mediate mechanical hyper-
ataxia, nerve root involvement, but normal nerve conduction algesia and primary afferent nociceptor sensitization. ASW
studies. CISP is probably an underdiagnosed but potentially activated Ca2+ influx pathway of TRPV4 might be the link
treatable disorder that requires the identification of isolated of the pain release observed in the large scale clinical trials
involvement of the sensory roots. of acupuncture performed mostly in Europe in the last 10
years.

P1376
Abstract cancelled

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


Posters, Sunday 9 September 231

P1377 P1378
Nucleotide interactions with K-ATP Cervical vestibular evoked myogenic
channels in hippocampal neurons potentials in cerebellar lesions
examined with open-cell patch-clamp E.S. Papathanasiou, S.S. Papacostas, M. Pantzaris
method Clinical Sciences, The Cyprus Institute of Neurology &
Genetics, Nicosia, Cyprus
R. Mollajew
Neuro and Sensory Physiology, Medical University of Introduction: Cervical vestibular evoked myogenic
Gttingen, Germany potentials (cVEMPs) represent a non-invasive method of
ATP-sensitive K+ (KATP) channels are widely expressed in evaluating the function of the vestibular nervous system
the brain and contribute in many physiological processes. using sound stimulation. Using air-conducted sound, the
Especially important is their protective role during hypoxia/ above is thought to occur as the saccule is located close to
ischemia and epilepsy. We examined hippocampal neurons the oval window. Our experience in patients with cerebellar
in primary culture using open-cell (OC) patch-clamp lesions is evolving, with only a few references published,
method. In the test experiments we monitored a loss of fura- and more illustrative cases are required. We describe two
2 or fluo-3 from preloaded neurons and estimated that cases with isolated cerebellar vascular lesions who had
equilibrium between cytoplasm and bath solution was cVEMPs and brainstem auditory evoked potentials
established within <1min after addition of -escin. In many (BAEPs).
neurons we observed generation of action potentials in the Methods: BAEPs were performed in the standard manner
cell-attached mode indicating normal viability. The cells using unilateral click stimulation at 70dB nHL with
were permeabilized in Ca2+- and Mg2+-free solutions by contralateral masking noise. cVEMPs were performed
brief exposure to 5-M -escin after which they are viable using unilateral 120dB peak SPL (pSPL) intensity 1kHz
for 5 to 60 min. The activity of KATP channels increased tone air-conducted sound stimulation with contralateral
within 2 min after permeabilization in ATP-free solutions. 90dB pSPL masking noise. Recording was performed from
Subsequent application of 1mM ATP inhibited KATP the tonically active sternocleidostoid muscle ipsilateral to
channels. 1mM ADP in ATP-free solution considerably the ear receiving tone stimuli, with the active recording
increased their activity. Most likely it happens due to electrode placed over the midpoint of the muscle, the
suppression ATP sensitivity of KATP by ADP. Combined reference electrode on the clavicle and the ground on the
application of 1mM AMP and 1mM ATP enhanced KATP forehead.
channel opening that might be due to disproportionate Results: The first case (28 years old) presented with a right
reaction AMP + ATP < -> 2 ADP. The effects were not middle cerebellar peduncle lesion, whereas the second case
observed when AMP was applied with non-hydrolyzable (65 years old) presented with a lesion in the right middle
ATP-PNP (1mM) and ADP-PNP (1mM). Further cerebellar peduncle and hemisphere. Both cases had normal
complexity produced intracellular Mg2+ whose complexes cVEMPs bilaterally. The first case revealed an abnormal
with ATP and ADP additionally increased channel openings. BAEP on the left and a disorganized BAEP on the right,
The data thus reveal the multifaceted role of adenine whereas the second case showed normal BAEPs bilaterally.
nucleotides in regulation of KATP channels that perhaps Conclusion: cVEMPs appear to be unaffected by middle
cannot be reduced to a simple rationale involving ATP/ADP cerebellar peduncle and cerebellar hemispheric lesions.
ratio.

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


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


Posters, Sunday 9 September 233

P1384 P1389
Patients with central and peripheral Neurophysiological monitoring of the
neuropathic pain: evaluation of trans-procedure endovascular closure of
neuropathic pain with specific atrial septum defects (ASDs) in adults
neurophysiological reflex techniques and M.E. Habeych Sanmiguel1, W. Anderson2, J.R. Balzer1,
clinical approach D.J. Crammond1, P.D. Thirumala1
1Neurological Surgery, 2Invasive Cardiology, University of
N. Dogan1, D. Selcuki1,2
1Neurology, 2Algology-Neurophysiology, Celal Bayar Pittsburgh, Pittsburgh, PA, USA
University, Manisa, Turkey
P1390
P1385 Hepcidin mediates stress induced
Autoimmune encephalitis associated with depression
Graves disease: a case report A. Nahavandi1, F. Farajdokht2, M. Solaymani2
1Department of Physiology, Tehran University of Medical
M. Saadatnia, V. Davoudi, K. Keyhanian, M. Siavash,
Sciences/Physiology Research Centre/Cellular and
B. Ansari, F. Haghdoost
Molecular Research Centre, 2Tehran University of Medical
Isfahan University of Medical Sciences, Isfahan, Iran
Sciences, Tehran, Iran

P1386 P1391
Evaluation of cutaneous silent period Spastic cerebral palsy treated by anodal
parameters in patients with type-2 transcranial direct current stimulation:
diabetes mellitus: effects of pregabaline a pilot study
O. z1, H. Akgn1, M. Ycel1, A. Talpnar2,
B. Aree-Uea1, N. Auvichayapat2, T. Janyacharoen3,
. Erdoan3, .H. Ula1, Z. Odaba1
1Department of Neurology, 2Department of Endocrinology, S. Iamsaard4, J. Prasertnoo5, P. Auvichayapat6
1Physiology, Faculty of Medicine, Khon Kaen University,
Glhane Medical Academy, Ankara, 3Department of 2Department of Pediatrics, Khon Kaen University,
Neurology, Pamukkale University, Denizli, Turkey 3Department of Physical Therapy, Faculty of Associated

Medical Sciences, Khon Kaen University, 4Department of


P1387 Anatomy, Faculty of Medicine, Khon Kaen University,
5Physical Therapist of Srisangwal School, 6Department of
Congenital hypogenesis of bilateral Physiology, Faculty of Medicine, Khon Kaen University,
abductor pollicis muscle: report of two Khon Kaen, Thailand
cases
H. Yaar1, O. z2, M. Korkmaz2, H. Akgn2, H. Tekeli3 P1392
1Department of Neurology, Ankara Mevki Military Hospital,
2Department of Neurology, Glhane Medical Academy, How to predict axonal degeneration in
3Department of Neurology, Kasimpaa Military Hospital, carpal tunnel syndrome?
Ankara, Turkey M.-H. Chang
Neurology, Taichung Veterans General Hospital, Taichung,
P1388 Taiwan R.O.C.

Cervical vestibular evoked myogenic


potentials are efficacious in evaluation of P1393
vestibulospinal pathways in patients with Hereditary neuropathy with liability to
multiple sclerosis pressure palsy presenting with brachial
M. Krbot1, T. Gabeli1, I. Adamec1, M. Habek1,2 plexopathy
1University Hospital Centre Zagreb, 2University of Zagreb,
G. Genc1, S. Bek2, T. Kasikci2, B. Kurt2, Z. Odabasi2
School of Medicine, Zagreb, Croatia Maresal Cakmak Hospital, Erzurum, 2Gulhane Military
1

Medical Academy, Ankara, Turkey

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


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


Posters, Sunday 9 September 235

Epilepsy 1 P1406
Actions of sK-channel openers in a
P1405 pharmacoresistant seizure model in-vitro
M.L. Raza, I. Papageorgiou, U. Heinemann
Localizing epileptic networks in tuberous Institute of Neurophysiology, Charite Universittsmedizin,
sclerosis using arterial spin labelling MRI CVK, Berlin, Germany
perfusion sK-channels are reported to regulate neuronal
A. Azarion1, K.A. Davis2 hyperexcitability. Pharmacoresistance in epilepsy is one of
1Neurology, Hospital of the University of Pennsylvania, major problems; nearly 30% of patients are non-responsive
University of Pennsylvania School of Medicine, to antiepileptic drugs. To address this issue of
Philadelphia, 2Neurology, Crozer Chester Medical Center, pharmacoresistance and role of sK-channels whether
Chester, PA, USA effective or not, we tested sK-channel agonist using
Introduction: The goal of this study is to utilize the non- pharmacosensitive/ pharmacoresistant organotypic
invasive technique of arterial spin labelling (ASL) magnetic hippocampal slice cultures (OHSC) and human tissue from
resonance imaging (MRI) to identify epileptic networks in pharmacoresistant epileptic patients. Slice cultures were
patients with tuberous sclerosis complex (TSC), a subtype prepared from 7-8 day-old rat pups and field potential
of neocortical epilepsy. Given that patients with TSC often recordings were performed from 7-14 days after incubation.
have better seizure control after surgical resection of For induction of seizure-like events (SLEs) in slice cultures,
epileptic lesions as well as perilesional tissue, this cohort is we have used 4-AP (100M) & zero magnesium ACSF. In
ideal for testing the hypothesis that ASL can accurately human tissue protocol of high K+ (8 mM) + bicuculline
identify epileptic networks. Recent studies have shown that (50M) & 4-AP (100M) is followed to induce epileptiform
the quantitative ASL signal correlates with underlying activities. Results showed anticonvulsant actions of CyPPa,
pathological changes of tubers, as well as their epileptic interestingly 4-AP induced SLEs in both pharmacosensitive
potential. and pharmacoresistant OHSCs were blocked by CyPPa at
Methods: In this study we plan to analyze the perfusion 100M in 100% slices. Whereas, zero magnesium induced
patterns both within tubers and in the surrounding SLEs are blocked in 88% and 74% of pharmacosensitive
perilesional regions in two populations of TSC patients, and pharmacoresistant OHSCs respectively. Similarly,
those with epilepsy (n=6), and those with no history of CyPPa at same dose blocked SLE induced by 4-AP in all
seizures (n=6). Epileptic tubers will be cross-identified with human tissues. K+ + bicuculline induced SLEs are blocked
scalp EEG, and this data will be correlated with ASL in 3 out of 5 slices. CyPPa at 20M blocked SLEs in 100%
perfusion maps. pharmacosensitive slices whereas, same dose of CyPPa was
Results: We have collected and analyzed ASL and MRI ineffective against SLEs induced by 4-AP in
data on 4 TSC patients with epilepsy. Thus far, it appears pharmacoresistant OHSCs. In zero magnesium model,
that epileptic tubers and surrounding perilesional areas 20M dose failed to block SLEs in both pharmacosensitive
show hyperperfusion in comparison with average cerebral and pharmacoresistant OHSCs. Our findings suggests
blood flow. Analysis of the non-epileptic tubers reveals no CyPPa has potential to block both pharmacosensitive &
significant differences in perfusion compared to average pharmacoresistant type of seizures.
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


236 Posters, Sunday 9 September

P1407 P1408
Risk factors for epileptic seizure of Founder c.1048-1049delGA mutation in
cavernous malformations in the central NHLRC1 gene in Laforas disease patients
nervous system: 52 cases from Serbia
C. Huang1, D. Zhou2 M. Kecmanovic1, N. Jovic2, M. Keckarevic-Markovic1,
1West China Clinical Medicine School of Sichuan University, D. Keckarevic1, G. Stevanovic2, S. Romac1
2Department of Neurology, West China Hospital of Sichuan
Faculty of Biology, University of Belgrade, 2Clinic of
1

University, Chengdu, China Neurology and Psychiatry for Children and Youth, School of
Purpose: To determine the risk factors for preoperative and Medicine, University of Belgrade, Belgrade, Serbia
postoperative epileptic seizure in patients with cavernous Objectives: Lafora's disease (LD) is an autosomal recessive,
malformations (CMs). progressive metabolic disorder characterized by intractable
Methods: We retrospectively studied 52 consecutive myoclonus and seizures, inexorable neurological
patients diagnosed with CMs who were surgically treated deterioration, cognitive decline, unfavourable clinical
and histopathologically enrolled in West China Hospital of course and poor prognosis. Despite the clinical homogeneity
Sichuan University from January 2009 to June 2010. there is genetic heterogeneity in LD. It is caused by
Clinical data, treatment procedure and follow-up mutations either in EPM2A or in NHLRC1. There is also at
information were collected. least one other gene that can be associated with LD. Here
Results: In the univariate analysis, factors associated with we report a haplotype study on 11 unrelated LD
preoperative epileptic seizure were low birth weight chromosomes from Serbia carrying c.1048-1049delGA
(p=0.017), temporal lobe involvement (p=0.003) and (p.E350fs) mutation in NHLRC1.
cortical lesion (p=0.025). In the multivariate analysis, the Methods: Using direct sequencing analysis, we identified 4
cortical lesion showed a high risk for preoperative epileptic different mutations in NHLRC1 gene in 11 patients from 7
seizure (OR=10.48; 95% CI 1.61-68.23). In the univariate Serbian families. As 11 unrelated LD chromosomes from 6
analysis, patients with temporal lobe CMs were found more patients carry c.1048-1049delGA mutation in NHLRC1, we
likely to be seizure free after surgery (p=0.016). The performed a haplotype analysis in order to estimate if this is
maximum diameter of CMs longer than 2.5cm (p=0.012) the founder mutation. 8 markers flanking NHLRC1:
and disease course longer than 1 year (p=0.050) predicates D6S289-D6S1605-D6S274-D6S1567-NHLRC1-D6S1688-
an unfavourable outcome. In the multivariate analysis, D6S1959-D6S1643-D6S1665 were amplified by PCR and
temporal lobe involvement still showed a favourable run on 4% polyacrilamide gel along with sequenced allelic
outcome (OR=0.038; 95% CI 0.002-0.833). Application of ladder.
ECoG did not make significant difference in seizure Results: We identified 8 different LD haplotypes carrying
outcome (p=0.430). p.E350fs mutation, but all analyzed chromosomes shared
Conclusion: Surgical treatment of patient with CMs is same alleles for markers D6S274(166)-D6S1567(108)-
satisfactory in most cases and temporal lobe involvement D6S1688(172). The size of common haplotype is correlated
usually predicts favourable postoperative seizure outcome to the number of generations from the ancestors on whose
whether under the monitoring of ECoG or not. Thus, chromosome mutation arose. So, considering those markers,
epileptic patients with CMs should be considered for we estimated how long ago this mutation arose on an
surgical treatment especially when cortical brain layer or ancestral chromosome. Shared haplotype covers 1.8cM
temporal lobe is involved. 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.

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


Posters, Sunday 9 September 237

P1409 P1410
Age- and gender related risk of Partial epilepsy with auditory features:
developing unprovoked seizures after clinical and genetic features of 186
traumatic brain injury: a population-based sporadic cases
case-control study C. Stipa1, F. Bisulli1, F. Pittau1, L. Licchetta1, I. Naldi1,
B. Mahler1, C. Adelw1, T. Andersson2, A. Ahlbom2, L. Di Vito1, C. Leta1, B. Mostacci1, R. Michelucci2,
T. Tomson1 S. Striano3, P. Striano4, U. Aguglia5, E. Ferlazzo5,
1Department of Clinical Neurosciences, 2Institute of A.T. Giallonardo6, C. Nobile7, M. Seri8, T. Pippucci8,
Environmental Medicine, Karolinska Institute, Stockholm, P. Tinuper1
1IRCCS Institute of Neurological Sciences, University of
Sweden
Purpose: To study traumatic brain injury as risk factor for Bologna, 2Department of Neurological Science, Bellaria
unprovoked epileptic seizures in a population-based case- Hospital, Bologna, 3Department of Neurological Sciences,
Federico II University, Naples, 4Department of
control study with incident seizure cases.
Neurosciences, University of Genoa, Genoa, 5Institute of
Method: In this study, 1885 patients with new onset
Neurology, Magna Grcia University, Catanzaro,
unprovoked seizures were included in the Stockholm 6Department of Neurological Sciences, Sapienza University,
Incidence Registry of Epilepsy. 15080 controls matched for
Roma, 7Institute of Neurosciences, University of Padova,
gender, year of diagnosis, and catchment area were Padova, 8Medical Genetics Unit, University of Bologna,
randomly selected from the register of the Stockholm Bologna, Italy
County population. Exposure was defined as a hospital
discharge diagnosis of a traumatic head injury preceding the Introduction: In 2004 we described 53 cases of partial
date of seizure onset. Odds ratios (ORs) with 95% epilepsy with auditory features and good clinical outcome.
confidence interval (95%CI) were calculated using logistic The syndrome was named Idiopathic Partial Epilepsy with
regression to assess the risk of developing unprovoked Auditory Features (IPEAF). Since 2004 we observed 133
seizures after hospital admission for various categories of additional cases and the present study summarizes clinical
patients and type of head trauma defined by ICD codes from features of this group of 186 patients (85 females and 101
the Swedish Hospital Discharge Registry. males).
Results: OR for unprovoked epileptic seizures was 2.0 Methods: Patients were selected according to the following
(1.5-2.7) after cerebral concussion (66 cases); 2.5 (1.6-3.9) criteria: partial epilepsy with auditory symptoms, negative
for women and 1.8 (1.3-2.5) for men. For patients older than family history for epilepsy and absence of cerebral lesions.
65 years of age OR was 2.5 (1.5-4.3) and for younger All patients underwent full clinical, neuroradiological and
patients 1.8 (1.3-2.5). After brain contusion or traumatic neurophysiological examination. The majority of patients
intracranial haemorrhage (37 cases) OR was 8.9 (5.6-14.1). were screened for LGI1 mutations observed in more than
OR of developing unprovoked seizures was similar for half of familial cases with autosomal dominant partial
women 9.6 (4.3-21.5) and men 8.5 (4.8-15.1). For older epilepsy with auditory features (ADPEAF).
patients OR was 4.7 (2.3-9.6) and 10.9 (5.8-20.4) for Results: Age at onset ranged from 3 to 59 years (mean 22
younger patients. years). Secondarily generalized seizures were the most
Conclusion: We provide quantitative data on the risk of common type of seizures at onset (67%). Auditory auras
developing unprovoked seizures after various brain occurred either in isolation (38%) or associated with visual,
traumata. Our findings point towards a higher relative risk psychic or aphasic symptoms (62%). Low seizure frequency
for younger patients to develop epileptic seizures after at onset and good drug response were common, with 41%
severe traumatic brain injury. 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.

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


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


Posters, Sunday 9 September 239

P1413 P1414
Ictal PET F18-FDG in refractory focal Acquired mirror writing in a patient with
epilepsy: report of 6 cases with surgically complex partial seizures after surgery for
removed cortical hypermetabolic lesions, left frontal meningioma
with histopathological correlation and D. Hodorog, D.I. Cuciureanu
follow-up Clinica I Neurologie, University of Medicine and Pharmacy
Gr.T. Popa, Iasi, Romania
D. Ladron de Guevara1, S. Marca2,
G. Kuester2,
L. Rios2,
F. Solari2, M. Galvez1, M. Campos2, F. Otaiza2 Mirror writing can be related to a variety of focal
1Radiology, 2Advanced Epilepsy Center, Clinica Las Condes, neurological disorders involving left parietal lobe, left basal
Santiago, Chile ganglia, and right supplementary motor area. It has also
Introduction: Unlike interictal PET (Positron Emission been associated with diffuse cerebral disorders. It is nearly
Tomography), ictal PET is not regularly used in focal always carried out with the left hand. Left-handers represent
refractory epilepsy study, and its usefulness in pre-surgical the majority of patients. Motor, spatial-orientation, visual
evaluation and prognosis value has not been established yet. word-form, involvement of thalamo-cortical circuitry
Objective: To present 6 cases of epilepsy patients whose hypotheses have been advanced to explain mirror writing.
F18-FDG PET showed hypermetabolic cortical lesion, and Mirror writing is rare and usually resolves over days to
to correlate with MRI, EEG, histopathology and clinical weeks. Acquired mirror writing accompanied by mirror
outcome. reading have been described in some patients with extensive
Methods: Histopathology and post-surgical outcome of 6 visuospatial deficits and left-right disorientation.
hypermetabolic F18-FDG PET of patients with focal We present the case of a right-handed women, with complex
epilepsy were reviewed. PET findings were correlated with partial seizures and acquired mirror writing after brain
Video-EEG, MRI, and intraoperative EcoG. surgery for a left frontal meningioma. Writing was tested for
Results: Ictal PET showed well-defined hypermetabolic regular and irregular words, whole sentences, numbers. She
lesions in all patients (3 temporal and 3 extratemporal wrote in mirror as fluidly as normal direction and preferred
lesions). There was coincidence between clinical, Video- mirror writing with either the right or left hand. Her
EEG, intraoperative EcoG and PET hypermetabolic foci in preference persisted for 4 years since her brain surgery. She
all cases. MRI showed correctly the seizure onset area in 4 was capable of mirror reading, which was preferred to
cases and was negative in 2 (female 38y hippocampal normal reading. Oral language skills were normal. Apraxia,
sclerosis/amygdala gliosis, and male 3y frontal type IA visual agnosia, neglect, left-right disorientation were absent.
FCD). Both PET and MRI allowed correct localization of It is unlikely that mirror writing of our patient is the
foci in 4 cases: male 16 m frontal type IIB FCD, male 3 m consequence of the release of mirror motor engrams. The
occipital type IIA FCD, male 7 m with temporal IIA FCD engrams within the right hemisphere are not associated with
and polymicrogyria, and female 40 y hippocampal type IIB mirror reading as in our case. We presume that mirror
FCD. Post-surgical mean follow-up was 14.8 month (range writing of this patient could be a consequence of mirror-
1-27 month), resulting all patients seizure free (Engel I). reversed visual-spatial representations.
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


240 Posters, Sunday 9 September

P1415 P1416
Neuropsychological profile in childhood Influence of anti-epileptic monotherapy
benign epilepsy with centrotemporal on bone mineral density and bone
spikes (BECTS) metabolism biochemical markers in
P. Conde-Guzn1, M.T. Bartolom-Albistegui2, P. Quirs3 children and adolescents with epilepsy
1Psychology, Universidad de Len, 2Neurology, Hospital
M.D. Dimic1, N.A. Dimic2
Nuestra Seora de Regla, Leon, 3Psychology, UNED, 1Department of Paediatric Neurology, Clinical Center of Nis,
Madrid, Spain Nis, 2Clinic for Rheumatology, Institut for Therapy and
Objective: There is controversy regarding the Rehabilitation, Niska Banja, Serbia
neuropsychological profile of children with epilepsy. The Introduction: Enzyme-inducing (carbamazepine) or non-
aim of this study is to analyze the neuropsychological enzyme-inducing (valproate) antiepileptic drugs are
profile of children with benign epilepsy with centrotemporal associated with bone loss and mineral metabolism
spikes (BECTS). disturbances.
Methods: Sample: 49 children from 7 to 12 years (25 with Methods: We evaluated effects of the carbamazepine and
BECTS treated with carbamazepine and 24 controls). We valproate monotherapies on bone mineral density (BMD),
got the neuropsychological profile by applying the WISC-R calcium and alkaline phosphatase serum levels in 29
(Wechsler Intelligence Scale for Children-Revised) and ambulatory male epileptic patients aged 6-18 years, taking
Battery Luria-DNI (Manga and Ramos, 1991). therapy longer than 1 year and in age matched healthy male
Results: A) We have not found any differences in IQ control group (n=31). We measured BMD by Dual-energy
between children with BECTS and controls. B) The X-ray absorptiometry at lumbar spine (L1-L4).
neuropsychological profile Luria-DNI is significantly lower Results: The mean serum levels of carbamazepine and
in BECTS (p<0.05) than the control group in hand motor valproate were 7.651.46mg/ml and 78.6412.76mg/ml,
activity, verbal regulation, tact, spatial orientation, respectively, and the mean therapy duration for each drug
articulation, naming, phonemics analysis, reading, was 3.061.61years and 3.161.93years, respectively.
numerical structure and arithmetic. This is a severe Calcium intakes in diet were similar in both the control and
deterioration in verbal regulation, articulation, phonemics study groups. Bone mineral density values of both valproate
analysis and reading. C) Nevertheless, we have not found and carbamazepine groups were lower without statistically
deterioration in the memory and the attention. In children significant difference compared with control group
with crisis of absences we have found, in a previous study, (p>0.05). The serum calcium levels were significantly
a significant memory alteration (the short-term auditory and lower (p<0.01) in patients treated with carbamazepine.
visual memory and logical memory) and attentional Serum alkaline phosphatase levels were significantly higher
disorder. D) The time of oxcarbazepine treatment does not in boys treated with carbamazepine (p<0.02) and with
affect the neuropsychological profile, however, age at onset valproate (p<0.002), respectively. Therapy duration has
of the first crisis negatively affects the ability for naming showed no effect on bone mineral density and biochemical
and phonemics analysis. parameters.
Conclusions: In children, with this diagnosis and treatment, Conclusion: Carbamazepine and valproate caused lumbar
and neuropsychological profile described, we must consider bone mineral density decrease in boys with epilepsy.
strengthening the deficient neuropsychological and psycho- Hypocalcaemia was observed in patients treated with
educational areas. In addition, we must continue research in carbamazepine. Serum alkaline phosphatase level, as
future studies on the role of the antiepileptic drug in this marker of osteoblast activity, was significantly higher in
profile. 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.

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


Posters, Sunday 9 September 241

P1417 P1418
Defective inhibition in the visual system of Myoclonic Epilepsy and psychomotor
photosensitive patients with idiopathic delay associated with a novel SLC2A1
generalized epilepsy gene mutation
G. Strigaro, P. Prandi, L. Falletta, C. Varrasi, F. Monaco, L. Di Vito1, F. Bisulli1, D. Mei2, I. Naldi1, F. Pittau1,
R. Cantello L. Ferri1, C. Leta1, C. Stipa1, E. Pasini1, C. Marini2,
Department of Neurology, Amedeo Avogadro University, R. Guerrini2, P. Tinuper1
Novara, Italy 1IRCCS Istituto delle Scienze Neurologiche, University of

Introduction: To assess the visual system excitability of Bologna, Bologna, 2Pediatric Neurology Unit and
photosensitive patients with idiopathic generalized epilepsy Laboratories, A Meyer Children's Hospital, Florence, Italy
(IGE) with the paired-pulse flash-evoked potential (paired Introduction: GLUT1 deficiency syndrome is caused by
F-VEP) technique. mutations in SLC2A1 gene in most patients and results in
Methods: We studied 19 patients with IGE (16 women) impaired glucose transport into the brain. Its clinical
showing a photoparoxysmal electroencephalographic spectrum is heterogeneous.
response (PPR). 22 normal subjects of similar age and sex We describe a patient with a novel SLC2A1 gene mutation.
acted as controls (17 women). We recorded F-VEPs from Methods: This 14-years-old patient had a family history of
occipital and central electrodes. Stimuli were single flashes, febrile seizures and mental retardation in his mother. A mild
intermingled to flash pairs at the internal frequency of 3, 8, psychomotor delay was evident since childhood. At 8
16, 20, 30, and 60Hz. Recordings were done both with months: convulsive seizures in apyrexia. At 2 years he
closed and open eyes. The single F-VEP was split into a started an antiepileptic treatment. At 12 years he started
main complex and a late response, which were with diurnal episodes of myoclonic jerks at upper limbs and
measured separately. As to paired stimuli, the test F-VEP drop-head without consciousness impairment. At 13 years
emerged from electronic subtraction of the single F-VEP to presented almost continuous myoclonic face and upper
the paired F-VEP. Grouped data were analyzed by means of limbs jerks associated with an ideo-motor delay and
nonparametric analyses of variance (ANOVA). increase in epileptiform EEG abnormalities. His epilepsy
Results: In the eyes-closed state, the normal inhibition of was drug resistant.
the main complex of the test F-VEP was replaced by a Results: The neurological examination showed: facial
paradoxical facilitation, significant at the frequency of 16, dysmorphism, dysarthria, slow saccadic eye movements,
20 and 30Hz (p<0.05). This applied to the occipital as well hypotonus, dysdiachokinesia, upper limbs myoclonus,
as the central electrodes. The late response reacted in a weak deep tendon reflexes, mild ataxia, striae rubre.
similar way, with a significant (p<0.05) enhancement at 20 Psychometric evaluation confirmed moderate mental
and 30Hz (occipital electrodes) and at 20Hz (central retardation.
electrodes). In the eyes-open state no significant changes EEG disclosed frequent discharges of irregular spike/
in the main complex were detected. polyspike and waves diffuse over both hemispheres,
Conclusion: The paired F-VEP technique documents a increased during drowsiness, inconstantly associated with
defective inhibition in the visual system of photosensitive myoclonic jerks of the mouth and occasionally of neck
patients with IGE, whose features and timing likely underlie extensor. Brain CT and MRI were normal.
the PPR origin. 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.

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


242 Posters, Sunday 9 September

P1419 P1420
An epidemiological survey of epilepsy in Somatic co-morbidities in PWE and its
the Koung-khi department, western relationship with Quality of Life: the
Cameroon outlook in a developing economy
M.S.N. Dongmo1, C. Tume2, A. Tazoacha3 P.B. Adebayo1, S.A. Ogun2, A. Ogunniyi3
1Department of Biochemistry and Molecular Biology, 1Internal Medicine, Ladoke Akintola University, Ogbomoso,
University of Buea, 2Department of Biochemistry, University 2Internal Medicine, Olabisi Onabanjo University, Ago-
of Dschang, 3Department of Lofe Sciences, University of Iwoye/Sagamu, 3Internal Medicine, University College
Yaounde 1, Cameroon Hospital, Ibadan, Nigeria
Epilepsy is a chronic and invalidating neurological disease Introduction: Evaluating co-morbidity in people living
characterized by the repetition of seizures. The prevalence with epilepsy (PWE) is essential and its modification might
around the world is 50.000, this is generally higher in improve their Quality of Life. We aimed to determine the
developed than developing countries. In Africa, some profile of self reported somatic co-morbidities and its
epidemiological studies have been conducted in Mali, relationship with quality of life among PWE in Sagamu,
Uganda with different prevalence: 13.35 and 1.3% Nigeria.
respectively. In Cameroon a study conducted in the Mbam Methods: The Quality of Life in Epilepsy-31 item (version
Valley, revealed a prevalence of 49 one of the highest in 1.0) questionnaire was completed by 88 patients. The
the world. The koung-Khi division is one of the department presence and type of somatic co-morbidities was assessed
in Cameroon with a suspected prevalence of the disease, but using a performa check list. The Statistical Package for the
there is no data available. Hence the study conducted to Social Sciences (SPSS), version 16 was used for all
determine the prevalence of epilepsy and possible associated analyses.
causes. For the aim, a door to door survey was conducted in Results: 44 males and 44 females with mean ages (SD) of
the four villages of the department: Bandjoun, Bayangam, 31.82(13.58) and 31.68(10.98) years respectively were
Batoufam and Bandrefam The study revealed a prevalence evaluated. 66 (75%) of the PWE had no somatic co-morbid
which differs according to each locality with an overall rate condition while 18(20.5%) had only one co-morbid
of 7.1% in the department. Among the possible suspected to condition. Hypertension was the commonest co-morbidity
have a link with epilepsy were the type of food consumed, (8%). Acid peptic disease was found in 5(5.7%) patients.
genetic factors, itching. This study revealed the existence of Other co-morbid conditions included Asthma (1.1%),
the disease in the region, and the efforts made by epileptics pulmonary tuberculosis (1.1%) stroke (3.4%) and
and their families to ameliorate their wellbeing. Further osteoarthritis (1.1%). 4 (4.5%) had two concurrent
studies are needed for a better understanding of the co-morbid conditions comprising stroke and hypertension
management of epilepsy by populations, specially the use in three patients. There was no statistically significant
of medicinal plants for the cure of the disease. 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.

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


Posters, Sunday 9 September 243

P1421 P1422
Is there any difference between awake Risk of obesity during treatment of
EEG in benign rolandic epilepsy and epilepsy with valproate and possible role
continuous spike-and-waves during sleep of Pro12Ala PPAR2 polymorphism
syndrome? E.V. Krikova1, S.G. Burd2, A.S. Chukanova2,
K. El Alaoui Taoussi1, A. Satte2, J. Mounach2, H. Ouhabi2 M.A. Tushkanov3
1Clinical Genetics Laboratory, Mental Health Research
1Neurology B and Neurogenetics, Facult de Mdecine et de
Pharmacie de Rabat, 2Neurophysiology, Mohammed Vth Centre of Russian Academy of Medical Sciences,
2Department of Neurology and Neurosurgery, Russian State
Military Hospital of Rabat, Rabat, Morocco
Medical University, 3Molecular Genetics Diagnostic
Introduction: Benign rolandic epilepsy (BRE) and
Laboratory, A.N. Sysin State Research Institute of Human
continuous spike-and-waves during sleep syndrome
Ecology and Environmental Hygiene, Russian Academy of
(CSWS), are different entities that can have the same
Medical Sciences, Moscow, Russia
awakening electrical abnormalities. Diagnosis of both is
based on sleep EEG which needs long time recording and Background: Valproate (VPA), structurally analogue of
specialized structures. Our study aims to find a method to fatty acid, is one of the widely used antiepileptic drugs.
set apart the two syndromes on awake EEG. Based on the fact that several fatty acids have been
Methods: 15 awakening EEG records of 9 BRE and 6 identified as PPAR-2 ligands and common Pro12Ala
CSWS were compared. Electrical abnormalities were PPAR-2 polymorphism has been related to obesity, insulin
analyzed. The frequency and amplitude were calculated resistance, and risk of type 2 diabetes we hypothesized that
through a period of 20 minutes on awake EEG recorded at obesity, often observed during VPA treatment of epilepsy,
different day times. could be associated with the presence of polymorphic
Results: The 9 registered BRE includes 5 awake EEG variant of PPAR-2 gene and induced via insulin resistance
performed in morning and 4 in evening. For patients with mechanism.
CSWS, 4 awake EEGs were done in morning and 2 in Methods: The Pro12Ala polymorphism was genotyped in
evening. Biphasic abnormalities had the same appearance 69 subjects who fulfilled the diagnostic criteria of VPA-
in BRE and CSWS. Their average frequencies were treatment, taking the drug in a monotherapy mode for at
different between the two syndromes and during the day least 1 year. Insulin level and weight deviation were
with a statistically significant difference (p=0.02) between analyzed respectively.
the frequency of abnormalities recorded in the BRE in the Results: Mean insulin level in patients with wild Pro(C)
morning (9147 anomalies in 20 minutes) and that of allele without weight deviation was up to 2 times lower than
CSWS recorded the morning (19558 anomalies in 20 for Pro(C) group, exhibited weight gain (=0.00018). The
minutes) but there were no statistical difference between the statistical difference was also shown for Pro12 and Ala12
evening records. No statistical difference was found groups with obesity - mean insulin level was up to 2.4 times
between the amplitudes of the abnormalities in the various lower for Ala12 than for wild-type carriers (0.046), which
EEG. in fact may indicate the insulin-independent mechanism of
Conclusion: Our study suggests that diagnosis of BRE or obesity in the presence of Ala12 allele.
CSWS could be established on morning awake EEG by Conclusion: Positive association was shown for insulin
calculating the frequency of the biphasic spikes. However, level and weight gain in subjects with Pro12 allele, taking
the sample needs to be extended to confirm this hypothesis. 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.

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


244 Posters, Sunday 9 September

P1423 P1424
Can a nurse intervention promote the Clinical features and seizure semiology in
self-management of patients with children with malformations of cortical
established epilepsy who attend development
emergency departments? A nested M.I. Sigatullina, S.S. Shamansurov
qualitative study Child Neurology Department, Tashkent Institute of
Postgraduate Medical Education, Tashkent, Uzbekistan
A.J. Noble1, C. Virdi1, M. Morgan2, L. Ridsdale1
1Department of Clinical Neuroscience, Institute of Objective: To analyze the clinical features and seizure
Psychiatry, King's College London, 2Division of Health and semiology of Malformations of Cortical Development
Social Care Research, King's College London, London, UK (MCD) in children.
People with epilepsy (PWE) frequently attend emergency Material and methods: 45 children age 2 months till 14
departments (EDs). Attendance is associated with AED years with MCD were examined. Clinical, MRI, PET and
non-adherence, low knowledge of epilepsy and stigma. continuous video-EEG investigations have been performed.
Reducing unnecessary emergency hospitalisations could The types of MCD in patients: Focal Cortical Dysplasia
help patients and reduce costs. We are conducting a trial (FCD)-19, Hemimegalencephaly-7, Lysencephaly-7,
aimed to reduce epilepsy ED visits, by a self-management Polymicrogyria (PMG)-8, Shysencephalia-4.
intervention with an epilepsy nurse-specialist (ENS). We Results: Intractable Epilepsy was marked in patients with
here describe patients' perceptions of acceptability and FCD in 87% and hemimegalencephaly in 90%. In all
benefits. patients with Lysencephaly the muscular hypotonia and
Methods: N=85 adults with epilepsy were prospectively severe mental retardation were observed, in 2 patients-
recruited from 3 London EDs. The first 20 (age=41, SD=17; epileptic encephalopathy (West syndrome). In 6 children
10 males; median years since diagnosis=12) receiving the with precentral and perisylvian polymicrogyria motor
intervention were invited for semi-structured interview. deficiency in the form of a contralateral hemiparesis was
Transcripts were analysed thematically. observed. All patients with Hemimegalencephaly had
Results: Participants reported not having been confident in severe hemiparesis on the contralateral side, mental
managing their epilepsy, but that the intervention improved retardation and refractory epilepsy. All patients had the
this. It did this by meeting a need for epilepsy information, early debut of epileptic seizures. The spectrum of epileptic
with the ENS being available in a way GPs and consultants seizures was wide, from myoclonic (8), asymmetric tonic
are not: Responses included: It was the first time someone spasms (5), clonic (4) and complex partial seizures (10) to
had sat down and really told me a huge amount; she took generalized tonic-clonic (13) and polymorphic seizures as
the time to go through my needs, you felt you could ask Lennox-Gastaut (2) and West syndrome (in 3 patients). In
questions, not that wasting her time. Patients felt not so all patients with Hemimegalencephaly continuous slow
frightened of seizures. One said I don't feel as if I now activity in the involved hemisphere was registered of these
need to go to hospital every time. Learning about epilepsy and in 3 cases - burst-suppression pattern. In 5 patients
prevalence helped patients not feel so alone and less with severe progressive epileptic encephalopathy a
ashamed. They also felt AED adherence improved. functional hemispherectomy was performed with the result
Conclusions: This short intervention was acceptable to of 90% of seizure reduction in these patients.
PWE who attended ED. It satisfied a perceived need for Conclusion: In most cases a clear correlation was found
information and in turn increased confidence. We will between the type and location of the MCD and seizure
report whether the intervention leads to reduced ED use semiology which was also confirmed by the continuous
subsequently. Video-EEG register.

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


Posters, Sunday 9 September 245

P1425 P1426
Reversible homonymous hemianopia The syndrome gelastic seizures -
secondary to occipital lobe seizures hypothalamic hamartoma: description of
R. Sawaya, S. Daouk, W. Radwan, S. Hammoud a case study
Neurology, American University Medical Center, Beirut, M. De Vito, L. Santulli, M. Ianniciello, S. Striano
Lebanon University Federico II, Naples, Italy
Introduction: We report a case of acute homonymous Introduction: Hypothalamic hamartoma can be associated
hemianopia associated with simple partial seizures over the to a wide spectrum of epileptic conditions, from a mild form
contralateral parieto-occipital region. The hemianopsia with an urge to laugh and no cognitive impairment to a
subsided with control of the seizures. catastrophic encephalopathy with early onset gelastic
Material and method: A 53-year-old man, with controlled seizures, precocious puberty and mental retardation.
hypertension, presented with subacute visual hallucinations Surgical ablation and the use of other non-conventional
and distortion of visual perception associated with attacks techniques seem to be useful to revert epilepsy and
of gaze deviation and head rotation to the left. No loss of encephalopathy. The goal of the study is the observation and
consciousness. No focal motor symptoms. Neurological evaluation of the outcome of the patients followed at our
examination revealed only a left homonymous hemianopia centre.
which was confirmed by perimetry testing. Methods: We observed 10 patients (8 males and 2 female)
Results: MRI brain revealed diffuse cortical thickening and with hamartoma over about a 20-year period, very
high FLAIR signal intensity in the right parieto-temporo- heterogeneous for length of observation. 4 patient have a
occipital region with mild restriction in diffusion-weighted small hamartoma (< 1cm), 6 a large hamartoma (>1cm).
images without enhancement. No infarcts and no masses Among the patients with small hamartoma one has received
seen. MRA showed normal carotid and cerebral arteries. stereotactic implantation of radioactive I125 seeds and one
Visual perimetry revealed dense right homonymous was submitted to gamma-knife surgery. Among the patients
hemianopia. Blood studies were normal. CSF revealed with large hamartoma one was submitted to total resection,
elevated protein with normal IgG index, no cells and one to partial resection, 2 to gamma knife surgery.
negative bacteriology and virology results. EEG revealed Results: All patients developed drug-resistant focal or
near-status epileptic activity emanating from the right generalized epilepsy. Complete ablation of the hamartoma
parieto-occipital lobe. Upon treating the seizures with can stop and revert the epilepsy, the partial ablation is a
antiepileptic drugs the visual disturbances subsided and the temporary solution. Moreover long-term effect and efficacy
EEG normalized, but the hemianopia and MRI findings of gamma knife surgery and implantation of radioactive
persisted. The patient received 1 gram IV solumedrol which I125 need a better definition.
resolved the hemianopia and consequently the MRI Conclusions: Our study confirm the evolution of the
abnormality. syndrome towards a drug-resistant epilepsy. The surgical
Conclusion: We report that homonymous hemianopia can ablation of the amartoma can reverse epilepsy. The new
occur secondary to a seizure disorder without an underlying techniques request a long-term evaluation to establish the
infarct, tumour, or infection. It may be the result of focal real efficacy.
cortical oedema and reverses after the seizure is controlled
and oedema treated.

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


246 Posters, Sunday 9 September

P1427 P1428
Predicting the epileptic seizure with beta Religious-spiritual coping in epileptic
rhythm of brain: a real time approach patients: correlation with clinical aspects
R.F. Ahmad1, A.S. Malik1, N. Kamel1, J.K.J. Tharakan2 G.M. Tedrus, L.C. Fonseca, G.C. Hoehr, F.D.P. Magri,
1Electrical & Electronics Engineering, Universiti Teknologi Neuropsicofisiologia em cognio e epilepsia
Petronas, Tronoh, 2Department of Neuroscience, School of Faculdade De Medicina, Pontificia Universidade Catlica
Medical Sciences, Universiti Sains Malaysia, Kota Bharu, de Campinas, Campinas, Brazil
Malaysia Introduction: How religiousness/ spirituality (R/S) acts on
Objective: Epilepsy is the brain disease that is second in the quality of life has been investigated, but there are few
number after stroke worldwide. Around 30% patients do not such studies in epileptic patients. The objective was to
respond to anti-epileptic drugs (AEDs). Therefore, seizure evaluate religious-spiritual coping and its relationship with
prediction can be helpful to improve the quality of life of clinical aspects in adult epileptics.
the patients having uncontrolled epilepsy. The study is Methods: 69 epileptic patients, (50.7% female), were
carried out in perspective to the real time monitoring and evaluated as follows: a clinical-neurological assessment and
prediction of the epileptic seizure. the Brazilian version of the RCOPE scale (CRE).
Method: Different methods are available to predict the Results: Mean total CRE:3.46, positive CRE:2.97, negative
seizure but still the results are not applicable for real-time CRE:2.40 and a negative/positive (N/P) ratio: 0.82 (0.16).
clinical application. The EEG is the major modality used for There was a significant negative correlation between
diagnosis of epilepsy. For real-time, the method scholastic level and the CRE scores (positive and negative
implemented is using the pre-processing, band pass filtering and the factors P1, P4, P6, P7, P8, N2), less years of formal
and observing its power spectrum. This method shows schooling corresponding to higher CRE values. The CRE
different brain rhythms during the pre-ictal and ictal period. scores were significantly greater in individuals who said
The SVM classifier is the best option for classifying the they only practiced one religion. There was negative
seizure occurrence or absence. correlation between the age of the first epileptic seizure
Results: The Physionet data set compiled by CHB and MIT (ES) and the factor N1 (Spermann Test: -0.242; p=0.047),
is used. The different rhythms of brain are observed for and between a greater ES frequency, a negative CRE
changes and synchronization. But the beta rhythm showed (-0.0292; p=0.034) and an N/P ratio of (-0.0292; p=0.021).
that during pre-ictal and ictal period, the beta power is The CRE (negative and factors) were significantly smaller
increased significantly than other frequency bands. in patients with generalized ES as compared to those with
Conclusion: The beta rhythm has shown significant focal ES. Other relationships were not significant.
changes during the pre-ictal period. Here, simple Conclusions: The results showed that the majority of
combinations of methods are used as compared to other patients showed high mean CRE scores (positive and
complex methods. The implementation requires less negative), which could portray aspects of the exercise of
computational power from hardware point of view. The spirituality. The R/S could be a link between health and
EEG signals for real-time can be acquired using wireless disease. Scholastic level correlated negatively with the R/S
EEG. This approach can be adapted towards real-tim