Flash Posters. Saturday, June

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1 European Journal of Neurology 205, 22 (Suppl. ), Flash Posters EUROPEAN JOURNAL OF NEUROLOGY Saturday, June Child neurology; Education in neurology; Neuroethics; History of neurology; Neurology and arts F00 Urinary tract manifestations in children with cerebral palsy I. Grigore, H. Abou Ainain, A. Ulinici, C. Prazaru, G. Diaconu Sf. Maria Hospital, Pediatric Neurology, Iasi, Romania Introduction: The aim of this study was to evaluate the urinary problems associated with cerebral palsy (CP) in children and how these affect daily and social life of them. Methods: We enrolled in this study 29 children diagnosed with different types of CP (89.37% with spastic CP, 6.2% with dyskinetic CP, 3.87% with ataxic CP, 0.56% with mixed CP). The study protocol included: physical and neurological examination; biochemical tests; urine analysis; renal ultrasound, questionnaires completed by parents about child sphincter control, presence of fever >38 C, which persists >24h in the absence of other infections, the existence of urinary symptoms. The diagnosis of urinary infection was based on the presence of a significant bacteriuria. The diagnosed enuresis was made according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Results: Urinary incontinence was diagnosed in 98 cases (52.04% had severe motor deficit), urinary infections in 7 cases (over half of them had severe CP and a history of more than two urinary-tract infections). Other urinary symptoms were urinary emergency (45 cases) and painful urination (30 cases) % of children with CP have fulfilled the diagnostic criteria for enuresis. Conclusion: Urinary-tract manifestations are common in children with CP and the most frequent are urinary incontinence and infections. The presence of these problems interfered with patient s comfort and negatively influenced the quality of life and should be considered at the end of a correct neurological assessment. F002 Spinal dysraphism pathogenesis, clinical picture and clinical cases V. Stoyanova, V. Bojinova-Tchamova, N. Topalov, I. Aleksandrova Clinic of Child Neurology, University Hospital of Neurology and Psychiatry St. Naum, Sofia, Bulgaria Background and aims: Congenital malformations of the central nervous system are present in about 3% of neonates as isolated or multisystem disorder. These conditions are serious medical and social problems because of high frequency and variety of clinical manifestations. We present 5 patients from our clinic with spinal dysraphism. We further discuss the importance of etiology and risk factors. Methods: We have used detailed neurological examination, blood tests, CT scan with 3D reconstruction, MRI, transfontanellar ultrasound, EMG and genetic testing. Results: Patient was a 9-month-old boy with Patau syndrome with sacral dysgenesis and spina bifida occulta. Patient 2 was a 2-year-old boy from a pregnancy during which the mother had systemic intake of non-steroidal antiinflammatory drugs, who had Arnold Chiari type 2 syndrome. Patient 3 was a -year-old girl who had increased phenylalanine levels during the neonatal period and had spina bifida occulta. Patient 4 was a 4-year-old girl from normal pregnancy with spina bifida aperta. Patient 5 was a 4-year-old girl who was diagnosed with diastematomyelia, tethered spinal cord syndrome and spina bifida aperta. All patients had some degree of weakness in the lower extremities. Patient 2 and 4 had incontinence. Patients 2, 3 and 5 had foot deformities. Conclusion: Spinal dysraphism must be considered in patients with weakness and decreased muscle tone in the lower extremities, incontinence and foot deformities. The imaging investigations are of prime importance. Knowledge of risk factors is central for prevention EAN

2 Flash Posters 485 F003 Moral brain I. Ben Hamouda, M.N. Tougourti 2, S. Belal 3 Charles Nicolle Hospital, Neurology, Tunis, Tunisia, 2 Razi Hospital, Internal Medicine, Manouba, Tunisia, 3 Charles Nicolle Hospital, Neurology, Tunis, Tunisia Background and aims: The demonstration of a moral brain may have important consequences in terms of individual freedoms and legal liability. Our goal is to contribute to understanding neural structures and bimolecular mechanisms involved in altruism, empathy and the defense of moral rules. Materials: The authors conducted an analysis of major research contribution in cognitive neuroscience, neurobiochemistry and neurogenetics, the purpose of which was to elucidate the links between the moral behavior of the human being and the activation of a complex set of neural structures. They also studied the alterations that such a system can undergo under the effect of various exogenous manipulation neurobiochemical or neuro-biophysical Results: The moral brain is a reality, even though its organic structures and functions are only partially demonstrated. Human brain has a great plasticity and is highly adaptable to a variety of environmental changes, including cultural ones. Neuroscience by delimiting moral neural circuits would help to better understand some immoral behavior, neurophysiological dysfunctions involved and ways to treat them. The excesses of such advance are possible: development of a moral treatment, which would force the person to comply, without his knowledge, and by biochemical or physical means, with repressive rules and restrictions, wrongly considered moral ; emergence of new standards of conduct with unknown consequences on the survival conditions of the human species. Conclusion: The next discoveries are sure to cause disruptions in our current conceptions of moral values. Neuroscience should enable humanity a smooth transition without brutal cultural shock. F004 Epidemiology of dysgraphia in Kosovska Mitrovica S.M. Golubovic, J. Milisavljevic University of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia Background and aims: Goal of this research was to determine frequency of appearance of dysgraphia, and types of dysgraphia in children of third and fourth grades in primary schools in the territory of city Kosovska Mitrovica. Methods: Sample consisted of 436 children of third and fourth grades in all primary schools in city Kosovska Mitrovica (Serbia). Children were examined with test for assessment of dysgraphia in handwriting (Cordic A, Bojanin S, 992). Results: Frequency of appearance of dysgraphia in a total of 436 children was.7% (5 children), of which there were 37 boys (72.55%) and 4 girls (27.45%). In third grade 27 children had dysgraphia, of which there were 9 boys (70.3%) and 8 girls (29.6%). From total 27 dysgraphia, there were 9 (70.3%) graphomotor dysgraphia, in 3 boys (68.42%) and 6 girls (29.6%), while language dysgraphia was present in 8 children (20.62%), i.e. 6 boys (75%) and 2 girls (25%). In fourth grade 24 children had dysgraphia, of which there were 9 boys (75%) and 6 girls (25%). From those 24 dysgraphic handwritings, 8 were graphomotor (75%), 3 boys (72.22%) and 5 girls (27.7%), and 6 were language (33.3%), 5 boys (83.35%) and girl (6.66%). Conclusion: Ability of drawing in children with dysgraphia is significantly above expected for their calendar age. Frequency of appearance of dysgraphia is much higher in boys than in girls (ratio 3:), and graphomotor dysgraphias are much more frequent in comparison to language European Journal of Neurology, 22 (Suppl. ),

3 486 Flash Posters F005 In search of discrete neuropsychological profiles in multiple sclerosis M. Katsari, D. Kasselimis 2, G. Gasparinatos, R. Antonellou, K. Voumvourakis National and Kapodistrian University of Athens, 2 nd Neurology Department, Attikon Hospital, Athens, Greece, 2 National and Kapodistrian University of Athens, st Neurology Department, Aeginition Hospital, Athens, Greece Background and aims: Several studies have shown that multiple sclerosis patients often demonstrate specific cognitive deficits affecting cognition, mainly processing speed. In this context, the present study investigates potential discrete neuropsychological profiles in different MS subtypes. Methods or Materials or Case Report: 28 MS patients (3 men), 9-45 years old (mean: 3.93; SD: 7.20), with 9-8 years of formal schooling (mean: 4.39; SD: 2.22) were recruited. Patients were classified by a neurologist in MS subtypes and Clinical Isolated Syndrome on the basis of the McDonald criteria (200). An extended battery of neuropsychological tests was used. This battery included Montreal Cognitive Assessment, Brief Repeatable Neuropsychological Battery, Trail Making Test A. B, Stroop Neuropsychological Screening, Rey Complex Figure - Copy, Hospital Anxiety Depression Scale. Depression and anxiety signs were also recorded. Results: Wilcoxon Signed Rank Tests revealed significantly low performance on a range of neuropsychological tests only for the SPMS group. Scores of the CIS and RRMS groups were found to be within normal limits. Results from neuropsychiatric measures indicated the presence of depression in the CIS and SPMS group. Conclusion: Even though our findings are preliminary and thus they should be interpreted with caution, they indicate a clear-cut neuropsychological pattern, by discriminating SPMS patients form the other two subtypes on the basis of generalized cognitive impairment with prominent executive deficits. We therefore stress the importance of neuropsychological assessment of MS patients, as part of a comprehensive interdisciplinary approach to the disease. Possible implications with regard to depression signs in SPMS and CIS patients are also discussed. F006 Zinaida Suslina, Russian pioneer of haemorheology in cerebrovascular neurology in the end of the 20 th and beginning of 2 st century. D. Labunskiy Santa Rosa CA, USA Background and aims: Zinaida Suslina ( ) was a director of the Research Center (formerly Institute) of neurology in Moscow, Russia. She was also an Academicran- Secretary of the Department of Clinical Medicine of Medical Sciences, Head. Department of Nervous Diseases Faculty of Dentistry MSMSU course and Nervous Diseases Department of Basic Medicine of the Lomonosov Moscow State University, President of the Research Council on the Research Center of Neurology, editor and member of editorian stuff of four neurology journals. Methods: We analysed an official biography of Zinaida Suslina, interviewed her coworkers and read her main published books and articles devoted to haemorheology in cerebrovascular disesases. Results: Zinaida Suslina the creator of a new scientific field associated with the study of haemostasis and haemorheology in cerebrovascular diseases. Priority studies performed by her under the concept of heterogeneity of ischemic stroke, neurological aspects of hypertension and problems cardiac neurology, significantly expanded understanding of pathogenesis of cerebral blood flow. Implementation of the results on the role of cardiac disorders in the pathogenesis and progression of ischemic stroke significantly improved immediate outcome and prognosis of patient s live and stroke prevention across the country. She was a recognized authority in the development of the science of clinical trials of medicinal products, an active participant in a number of new domestic drugs, used widely in Russia, which are widely used in neurological practice. Conclusion: Combination of too many tasks and responsibilities made her life unbearable. She died at 65 from hemorrhagic stroke, which was her main research subject during her entire life. 205 European Journal of Neurology, 22 (Suppl. ),

4 Flash Posters 487 F007 On an integrative neurology Part I: clinical and experimental interdisciplinary fundamentals M.C. Michailov, E. Neu, G. Weber 2, T. Senn 3, G.-E. Schulz, U. Welscher, E. Duehmke, E.-R. Weissenbacher, N. Willich 4, R. Wilkowski Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Munich, Germany, 2 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad., Vienna, Austria, 3 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Innsbruck, Austria, 4 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Muenster, Germany Introduction: Angio-cardiology (=AC) & neurology (=N) are central clinical disciplines in bio-medicine, because regulation in multi-cellular animal-organisms (metazoa) belongs to cardio-vascular/nervous systems. Ultraspecialization needs new models for holistic & multidimensional consideration of organisms, beginning with clinical-medicine. Examples for long-term observations in this interdisciplinary context ( ) are demonstrated. Methods: Given in part-ii: electrical & motor activities, psychological items, etc. Results: Examples about neurological-approaches to interdisciplinary research are given. A-Philosophy according to scientific theory & ethics are considered conceptions about anthropology & medicine incl. integrative biophysics, physiology, pharmacology, also psychology, angiocardiology, radio-oncology,etc. (B-E). B-Psychology Psychosomatics Psychiatry. Probands-Patients (n=30): Cardiac&respiratory-frequency=CRF, blood-pressure=bp: Hypothermia 37-0 C/climate-mountains m/music-respiratory-sport-therapy induce decreased CRF-BP 0-20% & positive psychic-item changes: relaxed/open/clear/ etc. upto 50%. Hyperkinesis-tremor, depression can be antagonized by Chinese-Indian-European physical-exercises/ respiratory-therapy/meditation/etc. C-Angio-Cardiology. Bronchial&tocolytic therapy use ß-sympathomimetics accompanied by blood-pressure disturbances. Buphenin/ fenoterol increase CRF, synchronize EEG-patterns (cats: stereotaxically-implanted-electrodes: hippocampus/hypothalamus-posterior/nucleus-tractus-solitarii): propranololantagonization also of adrenolytic-buphenine-effect on rat portal-vein. Further neuropharmacological research could help counteract pathological CRF-EEG-effects. D- Genito-Urology. Probands-Patients (cystotonometry/ctm, n=50): Genitourological-neurological-patients have increased vesical-pressure/prolonged micturition/decreased urothelial-electropotentials after radiotherapy (radiocystitis Gamma-/X-irradiation-70Gy)/spinal-cord injury (neurogenic-bladder). Pharmaco-&adjuvant psychosomatic therapy support recovery. Further research about patho-neurophysiological mechanisms could support more effective vesical therapy of neurogenic bladder, radiocystitis (incontinence, others). E-Radio-Oncology. Patient-observations (see A&D). Enormous vascular radiosensitivity-variation is demonstrated: Threshold-doses of human-preparations (surgical-tissue) for epigastrial-ovarial-renal-uterine arteries varied from 5-00 cgy to Gy! X-rays strongly potentiate arterial-contractions to neuro-hormones (nor-&adrenaline/pg-f2alpha/5-ht). Radiogenic vasoconstriction can cause decreased oxygenation, i.e. low effectivity of radio-oncotherapy. Conclusion: Realization of future practical models for integrative neurology (A-E) needs paradigm-changes in interdisciplinary research supported by new administrative-scientific fundamentals (see Neu-Michailov-et-al. EAN- 205). 205 European Journal of Neurology, 22 (Suppl. ),

5 488 Flash Posters F008 On philosophical neurology and UNO-Agenda 2 M.C. Michailov, E. Neu, C. Lütge, M.-L. Gräfin von Brockdorff, P.N. Srivastava 2, C. Gibault-Martin 3, T. Bilbili, R. Neu, G. Weber 4 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Munich, Germany, 2 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., New Delhi, India, 3 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., St. Malo, France, 4 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Vienna, Austria Background and aims: Philosophy is science of science acc. to Immanuel-Kant considering all disciplines reflected by epistemology-ethics-aesthetics. Caused by central-position of neurology in medicine is recommendable creation of philosophical neurology (independently from medical-phil.) considering not only ethics, but also scientific-theoretical&aesthetical fundamentals, possible by regular interdisciplinary co-operation&discussions (see- Neu-et-al. incl.ref.ean-205). Methods: CONCEPTION for discussion incl.: Results: A. EPISTEMOLOGY. Creation of integrative neurology can include enlarged information in normal&pathological neurophysiology/-morphology/-genetics, also psycho-neurology (e.g.psycho-neuro-immunomodulation). Integrative neuro-therapy incl. Chinese- Indian&other traditional-medicine in education&treatment has to be discussed. Clarification of notions acc. to axiology-logic-semantic is necessary. B. MORAL PHILOSO- PHY. Independently from various modern ethical-theories (deontology,etc.) has to be considered Kant conc. human obligations to himself (patients) (a), other humans (medical personnel) (b), sub-human, e.g. reduction of animal-experiments (c) suprahuman beings: moral limits about&applications of theological-practices of great-religions (Buddhist/Taoist/Yoga-meditation/etc.) for therapy. C. AESTHETICS. In relation to A-B interdisciplinary consideration is necessary to destine volume of paradigmchanges in neurology by non-&surgical-therapies, e.g. radiochemotherapy,etc., leading to pathophysiological & psychopathological effects (primum non nocere). Conclusion: Establishment of regular common congresssessions of European Acad. of Neurology (EAN) with philosophical (FISP-ISB-EACME,etc.), psychological (IUPsyS,etc.), physiological (IUPS,etc.), medical societies (ISIM-ICC-FIGO-SIU) could open new scientific&political dimension in medicine, leading to humanization, higher efficacy, internationalization of science-medicine-ecology in context of UNO-Agenda2 for better health-education-etc. on global level. DEDICATION: to moral-support : Austria: K- Lorenz*, France: J-Dausset*, J-M-Lehn*, Germany: O- Hug, H-Müller-Mohnssen, R-Wittenzellner/GSF-Muenchen, M-Eigen*, H-Michel*, Japan: K-Fukui*, Y-Ikemi, T-Sugahara, UK: B-Josephson*, Lord-A-Todd*, USA-India: H-G-Khorana*, D-Hubel* (Nobel-Laureates*). F009 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

6 Flash Posters 489 F00 Prevention of child neurological disorders in Uganda J. Nakibirango Rise and Shine Dyslexic Organization (RASDO), Kampala, Uganda Background and aims: The most challenging issue in Uganda is data collection and neurological disorders have become inevitable phenomenon in the country to all categories of children from affluent or non-affluent families yet the public has little knowledge about the causes and handling of children with neurological disorders. Rise and Shine Dyslexic Organisation (RASDO) was started in Munyonyo to cater for Dyslexic children and experience shows that Neurological disorders are increasingly prevalent in Uganda; the factors that are producing this increased burden include malnutrition, perinatal conditions, diseases, accidents and complications before and after birth. Methods: RASDO offers psychosocial support to both parents and teachers for proper management of children with neurological disorders. Our staff addresses issues through checklists, interviews and observation; findings show that malnutrition, adverse perinatal conditions, malaria, meningitis, demographic transitions, increased vehicular traffic, persistent regional conflicts, trauma, and alcohol abuse lead to neurological disorders such as cerebral palsy, dyslexia, mental retardation, epilepsy, peripheral neuropathy, and other developmental disorders. Results: Special educationist and a part time nurse give attention to dyslexic children to address their issues. As there is a big increase in numbers who need help of our services, RASDO needs good working relationship and networking with Neurological organizations worldwide for excellent services. Conclusion: Child neurology being a crucial issue in the development of the nervous system, RASDO needs to collaborate with International organizations on the prevention of increasing number of child neurological disorders. Lastly, training for many numerological specialists in Uganda is still lacking and should be addressed. Disclosure: RASDO F0 On education and research in neurology Part I: necessity of regular implication of physiology E. Neu, M.C. Michailov, U. Welscher, J. Foltinova 2, V. Foltin 2, D. Martin, E. Gornik 3, G. Govil 4, S. Gupta 4, M. Sharma-Kaune 4, S. Kuznetsov 5, D.G. Weiss 5 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Munich, Germany, 2 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Bratislava, Slovakia, 3 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Vienna, Austria, 4 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., New Delhi, India, 5 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Rostock, Germany Background and aims: Future integrative neurology (education-research) needs enlarged philosophical&(psycho-) physiological fundamentals: On example of neuroregulatory mechanisms in cardiovascular(=cvs)&urogenital systems(=ugs) are given recent-results to summarized long-term investigations (A-D ): see-neu- Michailov-et-al.,Part-II. Methods: Electro-&motor-activity in CVS-UGS on cellular/b., organ-system-levels/c-d, human-rat-guineapig=gp. Results: A-Philosophy-Psychophysiology. Consideration about scientific&ethical limits of observations on patients&human-relevancy/surgical-tissue of animal-experiments, positive influence of psychosomatic (Th.von Uexküll)&somatopsychic (Y.Ikemi) therapies on CVS- UGS is reported: e.g. psychic-items-increase relaxed/ tranquil upto 50% correlated with cardiac&respiratoryfrequency-decrease after music&respiratory-therapy (probands/patients:n=70). B-CYTOPHYSIOLOGY. Vascular myocytes (GP-portal-vein, n=20): Complex electricalreactions after neurohormones (noradrenaline-etc.), anaesthetics (pentobarbital-procaine-etc.) incl. inhibition of electrical activity/spikes-bursts, leading to vasodilation/ antagonizing hypotension by Ca. Neurotropic xenobiotics - chlorophenols-pyrethroids-hgcl2-mncl2 induce irreversible effects in spike-activity/burst-plateaus (63.2/.5/ min) (neuro-effector disturbances) of GP-Detrusor-myocytes (n=50). C-CARDIO-VASCULAR SYSTEM. Observations about high complex pressor-depressor-biphasic reactions of rat blood-pressure (n=65) to neurohormones (acetylcholine/vasopressin/5-ht), non-&nicotine-like ganglion-stimulating agents (AHR-602/MCN-A-342/DMPP/ nicotine), central-vagal-electrostimulation (55Hz,5s,5V) after anaesthetics, mercaptoethylguanidine (MEG:NOsynthase-inhibitor) suggest hypothesis about 3 mechanisms of pathogenesis from hypertonia-idiopathica: Sensitization of CNS (formatio-reticularis/hypothalamus), spinal sympathetic neurons (cholinergic-nicotinic)&vascular effector/ myocytes-endothel. This opens new possibilities for antihypertensive pharmaco-therapy. D-UROGENITAL-SYS- TEM (guinea-pig:n=25): Generation of spontaneous-phasic-contractions/spc 4.04/min&slow-tonic-contractions/ STC in-vivo (isovolumetric-cystotonometry) after critical pressure (>20mmHg)&in-vitro (stretch>3-5mn) from vesi- 205 European Journal of Neurology, 22 (Suppl. ),

7 490 Flash Posters cal-trigone (0.28/min) suggest new hypothesis for micturition: STC mediates transition from collecting (sympathetic) to expulsion (parasympathetic) phase by transformation of electrical spike-activity into burst-plateaus after criticalstretch leading to detrusor-excitation (see B), opening new approaches to vesical pathogenesis-therapy. Conclusion: Enlarged implication of physiology in an integrative neurology could support more effective education/therapy-prophylaxis, esp. of hypertension, vesical-incontinency, neurogenic-bladder in context of better health&science in all countries acc. to UNO-Agenda2. F02 On education and research in neurology Part II: regular congress reports on example of physiology E. Neu, M.C. Michailov, U. Welscher, G. Werner 2, A. Werner-Srivastava 3, G. Govil 4, S. Gupta 4, M. Sharma-Kaune 4, S. Kuznetsov 5, G.-R. Stainov 6, D.G. Weiss 5 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Munich, Germany, 2 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Dortmund, Germany, 3 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Offenbach, Germany, 4 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., New Delhi, India, 5 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Rostock, Germany, 6 Inst. Eco- Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., Fulda, Germany Background and aims: Systematic physiological investigations ( ) related to an integrative neurology, esp. A-philosophical-fundamentals&psycho-physiology as well as electro-&motor-activities incl. neuroregulation of B-myocytes C-cardio-vascular D-urogenital-systems [-7] are summarized (no internet info) reflecting also regular congressparticipation in Methods: Congress-RESULTS (recent related to earlier) see Neu et al EAN-205 (part I). Results: PHILOSOPHY [a]-fisp-203-athens (World- CongrPhilos) Proc464-5&503-4; -2008/0-Seoul Proc. DVD/ISBN-3, Istanbul: [A]. PSY- CHOLOGY [b]-iupsys-2008-berlin Int.J.Psychol.43/3-4,p.54/248/65/799[A]. PSYCHOSOMATICS [c]- ICPM-2005-Kobe J.Psychosom.Res. 58,85-86[A]. PHYSIOLOGY [2]-CongrProcIUPS (IntUnPhysiolSci) 23 Birmingham-203:AbsBook LB44&83&37[BCD] 22:Kyoto-2009:JPhysiolSci 59/S:68&24&447-8[ABCD] 2:San-Diego-2005:Faseb-J 9/4:39.4/35.2, 9/5:772.4/772.5[ABCD] 20:Christchurch-200:CD:ID334&29[CD] 9:StPetersburg- 997:P036.03& P058.38& P036.02& [BC] 8:Glasgow-993:40.3&40.32&2.2[BCD] 7:Helsinki-989:529&529[BD] 6:Vancouver- 986:P70.2&P70.[CD] 5:Sydney-983:Spl[CD] 4:Budapest-980:2428&2429&2430[ABC] 3:Paris-977:497-9[CD] :New-Delhi- 974:273&378&33[ACD] IndianJ.Physiol.Pharm 979: [C] Jerusalem-984 RegMeet:285[D]. [3]-ISP (IntSocPathophysiol): 2006-Beijing: ChinJPathophysiol 22/S3:228[D] 2002-Budapest: ActaPhysiolHung 89//3:77[C] 998-Lahti: Pathophysiol 5/ S:245&246[BCD]. [4]-IUBS (IntUnBiolSci): 99-Tokyo 38&62[CD]. [5]-FEPS (FedEurPhysiolSci) ActaPhysiol: 204-Budapest 2/s697:62-64[ABCD] 20-Istanbul PC28[BD] 2007-Bratislava 9/S658:49&52&9[ABCD] 2006-München 86/S:OT06-36&PM09A-7[AD] Nice Press FEPS London 2&23[BD] 999-Prague PhysiolRes 48/S:S96&S38[BD] 995-Maastricht EurJPhysiol 430/4/S:52&6&604[CD]. [6]-DPG (GermanSocPhysiol) EurJPhysiol 2002-Tübingen 443/S[BD] 997-Rostock 433/6:R65[BD] 992-Düsseldorf 420/:R99[AB] 99-Freiburg 49/:R98[BD] 984-Dortmund 402:R5&R48[BCD] 983-Mainz 398:R25[BC] 982-Giessen 392/S:R36&R37[BD]. BIOPHYSICS [7a]- IUPAB-204 IUPAB Proc. 7,3-32, Beijing Protein&Cell Springer S9-03:3-4[ABCD]. [7b]- Experientia :62-2[C]. PHARMACOLOGY [7c]-IUPHAR-204 Cape Town Basic&ClinPharm&Tox 5/S,77-8,32-3[BCD]. Conclusion: Clarification of observations A-D, esp: neuroregulation could lead to new approaches of pathogenesistherapy of cardiovascular/hypertension,etc&urogenitalincontinency/neuogenic-bladder,etc: diseases supporting better health in all countries acc: to UNO-Agenda2. Reports about long-term research-projects, similar to journals eg Physiol-Rev. are necessary also to scientific-congresses eg for neurology,etc:, initiating discussions about future research-strategy. Dedicated to moral-scientific-support of Nobel- Laureates: Austria-K-LORENZ, Australia-Sir-J-Eccles, France-J-M-Lehn, Germany-M-Eigen/K-von-Klitzing/H- Michel/E-Neher, GB-Sir-J-Kendrew/Lord-A-Todd, USA- J-Deisenhofer-FRG/H-B-Khorana-India/B-Richter/R-Wilson F03 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

8 Flash Posters 49 F04 Antiepileptic drugs duotherapy in children with epilepsy G. Pilina Izhevsk, Russian Federation Background and aims: It is well known that about 30% of epileptic seizures are not well controlled. The purpose of this research was to study the efficacy of different combination of two antiepileptic drugs (AED) in children with uncontrolled epileptic seizures in monotherapy. Methods: Patients with frequent epileptic seizures (more than 2 per month), 3-8 years of age, treated by AED duotherapy in follow combination: valproate and carbamazepine (N = 6), lamotrigine and valproate (N = 0), lamotrigine and topiramate (N = 2), topiramate and valproate (N = 2), topiramate and levetiracetam (N = 8). Duotherapy was started after ineffective second line AED monotherapy during 6 months. Performance of treatment was evaluated after 6 months duotherapy. Results: 48 children (20 boys and 28 girls), mean age 9.7±3.2; types of seizure: generalized tonic-clonic seizures (n=8), generalized myoclonic (n=2), partial (n=24), absence (n=4). Therapeutic effect was achieved (seizures frequency reduced) in all patients; seizures stopping: in 2/6 (33%) children treated by valproate and carbamazepine, in 6/0 (60%) children treated by lamotrigine and valproate, in 7/2 (58%) children treated by lamotrigine and topiramate, in 0/2 (83%) children treated by topiramate and valproate, in 8/8 (00%) children treated by topiramate and levetiracetam. Side-effects were detected in 5/8 (28%) cases (weight gain and tremor) during treatment by combination valproate with lamotrigine or carbamazepine. Conclusion: The results let us to suggest higher efficacy of duotherapy uncontrolled seizures in monotherapy combination topiramate with levetiracetam or topiramate with lamotrigine. F06 Designing an information resource to explain diagnostic lumbar puncture and promote best practice A. Thomson, A. Davis, A. Paterson 2, G. Giovannoni, K. Schmierer Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Neuroscience and Trauma, 2 Agency of Design, London, United Kingdom Background and aims: The lumbar puncture (LP) procedure is an important test in neurological practice. It is also being used to assess outcome indices in clinical trials. Appropriate information is key to both preparing patients for this invasive procedure and facilitating use of atraumatic LP needle systems by clinicians in order to minimize adverse effects such as local pain and post-lumbar puncture headache. Methods : A cross-disciplinary team (designers, clinicians and people with multiple sclerosis (pwms)) developed a website to explain the LP procedure at The Royal London Hospital (Barts Health NHS Trust, UK). The information resource was designed as a fully responsive website to work across multiple technology platforms. User testing was carried out to review both the visual design and functionality of the resource for people who commonly suffer from visual and cognitive limitations. Results: After successful testing, our website peak.com/lumbarpuncture is now being used in the informed consent process for clinical trials involving pwms. Currently we are piloting the tool in our day unit and A&E departments. The information presented includes how to prepare for the procedure, how to deal with adverse effects, the purpose of examining cerebrospinal fluid and information on the atraumatic needle. Illustrations and animations present information in an engaging format. F05 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

9 492 Flash Posters Website home page What happens during the procedure F07 Endothelial dysfunction in the metabolic syndrome and its correction D. Tursunov Tashkent medical academy, Tashkent, Uzbekistan Background and aims: To study role of endothelium in pathogenesis of various diseases such as neurological and cardio - vascular systems and possibility of pharmacological and non-pharmacological effects on their function and its represent a significantare interest in experimental Neurology. Methods: Experiments were performed on 60 rabbits, weighing up to 3400g to create a model of metabolic syndrome in animal drinking bowl was added 5% sugar solution - sand, and mixed in a daily feed crystalline cholesterol of 250mg/kg body weight. Animals were subcutaneously injected insulin dose of 0. units./00g, a day. Results: Increasing of concentration of von Willebrand factor, homocysteine, endothelin- in.8; 3.4 and 2. times, respectively, on day 60 compared to control group. Study showed that reduction of vwf serum Glyukofazh under the action does not occur. Glucophage moderately reduces the content of this factor by.4% compared to the untreated group (P<0.05). Treatment of chitosan sulfate reduces the content of this factor by 2.7 and.6% (P<0.05), Nanoforms chitosan sulfate reduces the factor Villenbranda, and chitosan at - 2. and 0.7%, respectively. Nano form of chitosan sulfate has a stronger corrective action. Conclusion: The results will help to understand the pathogenesis of various neurological and cardio - vascular diseases at on experimental level. Nanoforms of chitosan sulfate has a stronger corrective effect on the performance of endothelial dysfunction compared with chitosan sulfate and Glucophage. Information on the atraumatic needle Conclusion: The resource provides an appropriate way of communicating sensitive, yet important information to patients. It also demonstrates an innovative way of spreading best practice and encourages widespread adoption of atraumatic needles for LP in both clinical and research settings. The resource will be demonstrated at the meeting. 205 European Journal of Neurology, 22 (Suppl. ),

10 Flash Posters 493 F08 Comparing the effect of Phenytoin on inflammatory mediator s production by gingival fibroblast in children and adults S. Vahabi Teheran, Iran Background and aims: About 30 to 50% of patients taking Phenytoin develop significant gingival alternations especially in buccal anterior part of oral cavity. This study was done to compare the synthesis of its inflammatory mediators and related gingival overgrowth in different ages. Methods: Samples were collected from biopsy of a healthy gingival of four adults years old through crown lengthening surgery and four children 4- years old through impact tooth surgery, after local anesthesia and from the keratinized soft tissues around the teeth. Gingival biopsies were transferred to a medium which containing DMEM and cultured on specific plates 25 cm2 and put on incubator containing CO2 with temperature of 37ºc. MTT was used to compare the proliferation rate of fibroblasts. Supernatant of culture medium of test and control sinks were collected by sampler and concentration of ILβ, PGE2, IL6, TGFβ, TNFα and IL8 were analyzed by ELISA. Results: Different proliferation rate of Phenytoin induced gingival fibroblasts in adults (0.073±0.77) as compared to children (0.056±0.028) was not significant. Production of PGE2, TGFβ and IL6 by Phenytoin induced gingival fibroblasts in children was increased as compared to adults (p<0.05). Production of IL8 by Phenytoin induced gingival fibroblasts in children was decreased compared to adults (P=0.02). Conclusion: Phenytoin induced gingival fibroblasts of children produce more amounts of ILβ, PGE2, IL6, TGFβ and IL8 as compared to adults fibroblasts. More comprehensive studies with well-documented designs using other methods are recommended to verify these results. F09 Developing history of neurology in Kyiv O. Yuryk State Institution Institute of traumatology and orthopaedics of NAMS of Ukraine, Laboratory of neuroorthopaedics and pain problems, Kiev, Ukraine Background and aims: Study of particular features of establishment and development of neurology in Kyiv. Methods: Worked out records of archival depositories of Kyiv. Results: The first hospitals in Kyiv were opened under rule of princess Olha ( ). In 874 city Oleksandrivska hospital with neurological inpatient department was opened. In 904 here neurologic consultation room was opened. In 884 at Medical Faculty of Kyiv St Volodymyr Univesity the Chair of Diseases of Nervous System and Mental Disorders headed by professor Sikorskyi was established. In 903 from this Chair originated and became freestanding the Chair of Diseases of Nervous System headed by professor Lapinskyi. In 906 German baron von Steingel granted to the city his palace on Bulvano-Kudriavska Street, 25 (today Institute of Traumatology and Orthopedics is situated here). In this building a hospital for treatment of poor Kyiv citizen was established. In 907 professor Lapinskyi created here a hydropathic out-patient clinic with electrical therapy room, since 92 hospital «Bulvarno-Kudriavskyi health resort» with 75 beds. Here mainly patients with neurological diseases were treated. In 98 health resort was passed to Russian Red Cross and «The third Kyiv hospital R.K.K.» was created. In 920 it became «The forth Soviet Sanatoria», from in this building Kyiv Psychoneurological Institute with five departments was functioning which was headed by academician Mankivskyi. In July 950 the Institute was reorganized into Kyiv Research Neurosurgical Institute. Conclusion: All scientific-and-clinical work on neurology began to be conducted by Chairs of Neurology of Kyiv Medical Institute and Kyiv Postgraduate Institute of Medical Education. 205 European Journal of Neurology, 22 (Suppl. ),

11 494 Flash Posters Cognitive neurology/neuropsychology F020 Association between education and mini mental state examination score: an Albanian population-based study I. Alimehmeti, M. Rakacolli 2, D. Dobi 3, A. Kuqo 4, J. Kruja 2 Maastricht University, International Health, Maastricht, Netherlands, 2 University of Medicine, Tirana, Neurology, 3 UHC Mother Teresa, Neurology, 4 UHC Mother Teresa, Service of Neurology, Tirana, Albania Background and aims: Dementia, currently a major public health concern, is often being diagnosed using the mini mental state examination (MMSE) score. Nevertheless, such a score may be biased in developing countries because of their inherently high health illiteracy which is strongly related to education level. Therefore our aim is to assess the association between education and MMSE score in the Albanian population. Methods: As of 2008, all residents (n=4955) living in one district in Tirana were interviewed and clinically examined by neurologists to assess prevalence of neurological disorders in such a population. Among others, the MMSE was performed in all individuals 50 years or older. Education was classified in low (no education and elementary education), middle (secondary and high school) and high education (university and post-university degree). One-way Anova and linear regression analysis were used to assess the association. Results: 635 individuals (5.7% males) aged 62.2±9.39 years old were included in the final analysis. In the oneway Anova analysis education was associated with MMSE score (p<0.00). Moreover, the linear regression analysis confirmed the association when adjusted for age and sex (β 0.350, 95% CI , p 0.00). The association did not change after further adjusting for marital status (β 0.37, 95% CI , p 0.003). In a sensitivity analysis, 93 cases with diagnosed dementia were excluded but the association diluted but remained significant (β 0.279, 95% CI , p 0.002). Conclusion: Education is associated with MMSE score, therefore it should be taken into account when screening for dementia in developing countries. F022 Depression and cognitive decline in diabetic patients in Târgu Mures, Romania A.R. Balogh, R. Gál 2, S. Páll 3, B.-M. Iuhos 2, S. Szatmári 2 Targu-Mures, Romania, 2 Spitalul Clinic Judetean de Urgenta Mures, Department of Neurology, Târgu Mures, Romania, 3 Spitalul Clinic Judetean de Urgenta Mures, Department of Internal Medicine, Târgu Mures, Romania Background and aims: Diabetes and depression frequently appear as comorbidities. Different researches confirm the hypothesis that diabetes and depression have common elements in their pathophysiology like: the hypothalamushypophysis-adrenal axis or some inflammatory mediators. Both diseases are risk factors of cognitive decline. Several studies show that depressed diabetics perform significantly worse in cognitive tasks than non-depressed diabetics. Methods: We made a prospective study at the Diabetology Clinic from Târgu-Mures, Romania, during a period of 8 months, between 202 December and 204 June. We recruited 62 patients, the cognitive state was assessed with different screening batteries including: Beck Depression Inventory (BDI), Mini-mental state examination (MMSE), Trail-Making A,B, clock drawing test, verbal fluency tests (semantic, phonetic). In addition, we collected information about their medical history and living conditions. Results: 72 patients were depressed according to the BDI. Older patients (>65 years), the unemployed or those with lower educational level were significantly more depressed (p=0.00). We got statistically significant correlations between BDI test results and: MMSE, Trail Making A, B, phonetic verbal fluency, Ranschburg-Ziehen test results, (for all p 0.0), showing the associations between cognitive impairment and depression among the diabetic patients. Conclusion: Depression was more frequent in our diabetic patients than in general population. Older, unemployed patients and those with lower educational level were at higher risk for depression. According to the study results the emphasis on the emotional status of the patients would be important in order to increase their compliance and the treatment efficiency. F02 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

12 Flash Posters 495 F023 Physical exercising is reducing anxiety, depression and memory deficits associated with a MPTP-induced rat model of Parkinson s disease A. Ciobica, R. Lefter 2, D. Timofte 3 Iasi, Romania, 2 Romanian Academy, SOP HRD/59/.5/S/33675 Project, Iasi, Romania, 3 Gr. T. Popa University, Iasi, Romania Background and aims: It is well known that in Parkinson s disease (PD), individuals have greater reduction in physical activity levels. Also, inactivity is considered an important factor in accelerating the degenerative process of PD. In addition, PD is known for its cognitive impairments, as well as for depression and anxiety disorders, which may be important causes of morbidity (40% prevalence in PD). Also, one of the most used animal models of PD is generated by the administration of -methyl-4-phenyl-,2,3,6- tetrahydropyridine (MPTP). Methods: We want it to see if induced physical exercising in an MPTP-induced rat model of PD (20 mg/kg i.p.), will result in any changes in memory (as tested in Y maze), anxiety (as tested in elevated-plus-maze) and depressionlike behaviour (forced-swim-test), as compared to a nonexercised control group of rats which also received MPTP. The exercising was performed on an adapted treadmill, for 2 weeks (3 series of 5 minutes/day). Results: In the group of exercised MPTP group we could observe an increased time spent by the rats in the open arms of the elevated-plus-maze, together with a significant decrease of stretching behaviour and increased head dipping, as compared to non-exercised MPTP group, factors which are suggesting an anxiolytic-like manifestation. In addition, spontaneous alternation in Y maze (index for immediate memory), and swim time (anti-depressive index) in forced swim test were increased in the exercised rats with an MPTP-induced model of PD. Conclusion: Physical exercising seems to reduce anxiety, depression and memory deficits associated with a MPTPinduced rat model of PD. F024 Mild cognitive impairment: a retrospective study E.I. Davidescu, M.E. Ispas, B.O. Popescu University of medicine and Pharmacy Carol Davila, Neurology, Bucharest, Romania Background and aims: Worldwide, the growing number of elderly people leads to a population of over 60 years estimated at two bilion by Identification of people with mild cognitive impairment (MCI) is a general goal since it is considered that treating vascular risk factors and other future early intervention might reduce the rate of progression. In this study we searched for any statistically significant correlations between the severity of cognitive dysfunction and a number of individual parameters as age, comorbidities and social risk factors. Methods: A retrospective study, which evaluated a group of 04 subjects with cognitive impairment admitted to our Department of Neurology. Data collection was performed by a standardized questionnaire covering demographic and clinical (cardiovascular, thyroid pathology,cognitive tests) data.we identified two groups: group A (67 patients with MCI) and group B (37 patients with early Alzheimer s Disease (AD). Results: Patients with MCI (single domain) are significantly younger, residing in urban areas.there was a considerable higher prevalence of cardiovascular risk factors in group B comparative to group A. Conclusion: There was a higher incidence of cardiovascular risk factors (diabetes, dyslipidemia, hypertension, coronary disease) in patients with early AD compared to those with MCI. Dyslipidemia is a marker of progression of MCI to AD that can be easily monitored.our study found an increased frequency of thyroid hormone axis disorders (especially hypothyroidism) in group A. Also, we found a higher percentage of depressive disorders in group B, most likely of organic substrate(patients being aware of cognitive deficits). 205 European Journal of Neurology, 22 (Suppl. ),

13 496 Flash Posters F025 Validation studies of the Clock Drawing Test in mild cognitive impairment D. Duro, D. Carneiro 2, S. Freitas 3, M. Pereira 4, B. Santiago 5, I. Santana 6 Coimbra, Portugal, 2 Faculty of Medicine, University of Coimbra, 3 Center for Neuroscience and Cell Biology, 4 Centro Hospitalar e Universitário de Coimbra, Neurology Department, 5 CHUC, Neurology, 6 Centro Hospitalar e Universitário de Coimbra, Neurology, Coimbra, Portugal Background and aims: Mild Cognitive Impairment (MCI) is a transitional entity between normal aging and Alzheimer s disease. The early screening of this situation has been one area of evolving research and several neuropsychological tests have been proposed to achieve this aim. The Clock Drawing Test (CDT) is a widely used instrument in this field; however, its application needs further validation in specific clinical populations, mainly in milder forms of cognitive decline and in the distinction between MCI subtypes. We conducted a validation study of three CDT scoring systems in a cohort of MCI patients previously classified in amnestic single-domain (amci) and amnestic multidomain (mdmci). Methods: 90 amci, 90 mdmci and 90 community-dwelling controls matched according to gender, age and education were assessed with Mini-Mental State Examination, Montreal Cognitive Assessment and the CDT (Rouleau, Cahn and Babins systems). Clock drawings of MCI patients were scored by a neuropsychologist and an inexperienced rater. Results: There was high inter-rater reliability in all CDT scoring systems (p<0.00). Significant correlations were found between the cognitive screening instruments and the CDT. CDT total scores had only sufficient discriminative capacity (60%) between control and MCI subjects. Conclusion: The selected CDT scoring systems had high inter-rater reliability to screen for MCI and can be applied in large scale studies and primary health care. In this context, CDT revealed only sufficient discriminatory capacity and should therefore be used with other cognitive screening tests in order to increase the diagnostic accuracy. F026 Regional metabolite difference in early stage AD, amnestic MCA and healty control using mr spectrocopy H.S. Han, D.S. Shin, H.G. Kang 2 St carollo hospital, Neurology, 2 Asan hospital, Neurology, Suncheon, Korea, Republic of Background and aims: Magnetic resonance spectroscopy (MRS) is a non-invasive examination for measuring intracerebral metabolites.in patients with incipient dementia, N-acetylaspartate (NAA) decreases but myoinositol (MI) increases.the decrease of NAA reflects the hypometabolism of neuronal mitochondria, and the increase of MI reflects the increase of gliosis caused by inflammations. This study is to figure out the ratio of each metabolite to creatine in the hippocampus and The posterior cingulate gyrus in early stage of Alzheimer s dementia (AD), amnestic Mild cognitive impairment(amci) patients and healthy controls (HC). Methods: 0 subjects meeting the criteria for AD, 9 for amci and 0 HC were enrolled. We measured ratio of N-acetylaspartate (NAA), myo-inositol (mi) and choline (cho) to creatine(cr) in the left hippocampus, left posterior cingulate gyrus by using H MR spectroscopy Results: NAA/Cr ratio in hippocampus was significantly lower in early AD than amci and HC. (P<0.05) There were no significant difference of NAA/Cr ratio and cho/cr ratio in hippocampus between amnestic MCI and healthy control. There was no significant difference of NAA/Cr ratio, mi/cr ratio and cho/cr ratio in posterior cingulate gyrus between AD, amci and HC. mi/cr ratio were significantly higher in AD and amnestic MCI than healthy control in hippocampus (P<0.05). Conclusion: In this study, neuronal damage in hippocampus was prominent in AD than amci and healthy control. And glial change caused by inflammation was prominent in AD and amci than healthy control.but this study has some limitation(ex.single hospital study, small in size). Further investigation with large population study and multicenter studies are needed. 205 European Journal of Neurology, 22 (Suppl. ),

14 Flash Posters 497 F027 Frequency of dementia diagnosis in multidisciplinary memory clinics P. Johannsen, E. Bjerregaard 2, S.B. List 3, G. Waldemar Rigshospitalet, Memory Clinic, Copenhangen, Denmark, 2 Glostrup Hospital, Memory Clinic, Glostrup, Denmark, 3 Bispebjerg Hospital, Department of geriatrics, Copenhagen, Denmark Background and aims: The Capital Region of Denmark s clinical quality database for dementia in showed large variation in the frequency of vascular dementia inbetween different memory clinics. In clinics merged into 6 multi-specialty units. Methods: The frequencies of specific dementia diagnoses were assessed for the hospital based memory clinics. Patients with normal-pressure hydrocephalus and Huntington s disease were excluded. The frequency was based on all new patients referred, for whom a specific etiological diagnosis was assigned. Clinics with less than 20 evaluations per year were excluded. Results: Number of patients, the frequency of dementia and etiological dementia diagnosis plus lowest and highest frequency in-between memory clinics for Alzheimer s disease, vascular and mixed dementia are listed in the table. The frequency of demented amongst referred patients has been stable around 60%. Conclusion: Multispecialty memory clinics with a focus on diagnostic criteria seem to harmonize the frequency of dementia diagnoses in-between clinics. The frequency of vascular dementia is still variable between clinics. F028 Assessing incidental memory in cognitively intact individuals versus patients with Mild Cognitive Disorder (MCI). D. Kontaxopoulou, I. Beratis, S. Fragkiadaki 2, N. Andronas, P. Papantoniou 3, S. Vardaki 4, J. Papatriantafyllou 5, A. Economou 6 Athens University Medical School, 2 nd Neurology Clinic, Attikon Hospital, Athens, Greece, 2 Athens, Greece, 3 National Technical University of Athens, School of Civil Engineering, Department of Transportation Planning and Engineering, Athens, Greece, 4 National Technical University of Athens, Department of Transportation Planning and Engineering, Athens, Greece, 5 General Hospital of Athens G. Gennimatas, Department of Psychiatry, Athens, Greece, 6 National University of Athens, Department of Psychology, Athens, Greece Background and aims: Incidental memory refers to a situation where the individual memorizes automatically information without any explicit intention. This mnemonic process appears to be important in everyday life situations, however only a limited number of studies have explored this issue in clinical populations. In this study we investigate the patterns of incidental memory performance and intentional memory performance in cognitively intact individuals and in patients with MCI. Methods: 35 healthy participants (57.8±SD=2.8 years) and 3 neuropsychologically confirmed amnestic-mci patients (67.7±SD=9.years), underwent a comprehensive neurological/neuropsychological assessment in which intentional memory was assessed by Hopkins Verbal Learning Test-Revised (HVLT). They also carried out a driving simulator experiment right after which incidental memory was assessed with a questionnaire regarding elements from their driving task, without previous notice. Results: The MCI group had a significantly poorer performance in incidental memory than the cognitively intact group (t(64)=2.9, p=0.032, d=0.54) as well as in intentional memory (t(64)=7.25, p<0.00, d=.82). Conclusion: Incidental memory appears to follow a similar pattern of decline with the one observed in the case of effortful episodic memory, as assessed by classical neuropsychological tests. Nonetheless, the effect size (d values) indicates that incidental memory is less impaired than intentional memory in patients with MCI. 205 European Journal of Neurology, 22 (Suppl. ),

15 498 Flash Posters F029 Cognitive screening instruments: speed versus accuracy for dementia diagnosis A.J. Larner Walton Centre for Neurology and Neurosurgery, Cognitive Function Clinic, Liverpool, United Kingdom Background and aims: To examine the relationship between diagnostic accuracy for dementia and surrogate measures of test duration of commonly used brief cognitive screening instruments (CSI). Methods: For several CSI examined in pragmatic diagnostic test accuracy studies (ACE, ACE-R, DemTect, m- ACE, MMP, MMSE, MoCA, 6CIT, TYM), diagnostic accuracy for dementia (either overall correct classification or area under the ROC curve) was correlated with measures of test duration (either total test score or total number of test items/questions). Results: Overall correct classification was positively correlated with total test score (r=0.58) and total number of test items/questions (r=0.66), both moderate correlations, which respectively did not reach statistical significance (t=.89, df=7, p>0.) or showed a trend towards significance (t=2.33, df=7, 0. > p>0.05). Area under the ROC curve was positively correlated with total test score (r=0.83) and total number of test items/questions (r=0.79), both high correlations which reached statistical significance (t=3.86, df=7, p<0.0; and t=3.46, df=7, p<0.02). Conclusion: These data suggest that there is a trade-off for CSI between test accuracy, measured by two different parameters, and test duration, as measured by two different surrogate measures, such that longer tests are more accurate for dementia diagnosis. F030 Abstract cancelled. F03 Impulse control disorder in very early Parkinson s disease V. Marković, I. Petrović, T. Stojkovic, I. Stanković, M. Svetel, E. Stefanova 2, V. Kostic 3 Belgrade, Serbia, 2 Neurology Clinic, Clinical Centre of Serbia, Centre for memory disorders, Belgrade, Serbia, 3 Clinic of Neurology, Neurodegenerative diseases, Belgrade, Serbia Background and aims: About 5-5% of Parkinson s disease (PD) patients develop impulse control disorder (ICD) in the course of the disease. Aim was to assess frequency of ICDs in early stage of PD and its relation to other psychiatric and cognitive disorders. Methods: We included 2 patients with unilateral PD. Demographic and clinical data were obtained, disease severity was assessed with UPDRS scale, presence of psychiatric disorders was screened for with Hamilton depression and anxiety scale, Beck depression inventory, and Apathy scale. Comprehensive cognitive tests battery was applied. Diagnosis of ICDs was made according to previously published criteria. Results: ICDs was detected in 2 (8.7%) patients. LEDD was 208mg in non ICD group and 230mg in ICD group (p=0.553), and there was 37.8% drug naive patients in non ICD group and 8.2% in ICD group (p=0.082). Pathological gambling was found in 2 patients, same as pathological eating and hypersexuality, while one patient had pathological shopping. None had DDS. Punding was detected in 2.6% of patients and hobbysm in 9.6% of patients. There were 4 drug naive patients with hobbysm and all other ICD patients received dopaminergic treatment, dopamine agonists more often (p=0.02). ICD patients had higher scores on Hamilton scale od depression (p=0.03), while no difference in other examined parameters was detected. Conclusion: ICDs can complicate PD very early in the disease course, more often in the context of dopamine agonists treatment. Depressive symptoms are more common in this subgroup of PD patients. Disclosure: Ministry of Science, Serbia, project No European Journal of Neurology, 22 (Suppl. ),

16 Flash Posters 499 F032 Effects of Norharmane on memory retention in passive avoidance learning in rats M. Najafi, M.H. Esmaeili 2 Karaj, Iran, 2 Qazvin University of Medical Sciences, qazvin, Iran Background and aims: Although benzodiazepine drugs, notably have anxiolytic and amnesic properties, but some of β-carbolines as their inverse agonists, have a stimulating effect on the dopaminergic system and also increase dopamine levels in hippocampus, and could exert anxiogenic and learning-enhancing actions. The goal of present study was to investigate the effects of benzodiazepine receptor inverse agonist Norharmane on memory retention of passive avoidance learning in rats. Materials and Methods: 40 male Wistar rats were divided into: control, alcohol and norharmane groups. All rats were trained in a passive avoidance task (50Hz, ma, for 3sec). Alcohol (0.2ml) or Norharmane (0.5,, 2mg/kg, i.p.) were injected immediately after training. Retention test was done 48h later. Memory retention of each animal was measured as latency takes to enter the dark chamber of the task. Results: After-training injection of Norharmane improves memory retention in a dose-dependent manner, so that the time spent in the light chamber area before entering to the dark area and total time spent in the light chamber in the norharmane groups were more than control group. These times in the norharmane (2mg/kg) group was significantly higher than control group(p<0.00) Conclusion: According to the findings, Norharmane, as inverse agonists of benzodiazepine receptors in the low doses, through GABA receptors stimulation improves memory retention and so may be useful for memory improvement. F033 High prevalence of cognitive-dysphasic symptoms in frontotemporal dementia, behavioral variant (FTDbv), and progressive supranuclear palsy (PSP) G. Ransmayr, S. Ransmayr-Tepser 2, A. Fuchs 3, D. Bauer 3, R. Lehner 2, M. Stefelbauer 2, M. Guger 4, D. Pohn 2, P. Schwingenschuh 5, C. Eggers 2, E. Laich 6, W. Struhal 2, F. Fellner 7, L. Ransmayr 8 Department of Neurology and Psychiatry, Linz, Austria, 2 Abteilung für Neurologie, Linz, Austria, 3 Abteilung für klinsche und Gesundheitspsychologie, Linz, Austria, 4 Abteil+, Linz, Austria, 5 Medizinische Universität Graz, Klinische Abteilung für Neurogeriatrie, Graz, Austria, 6 Abteilung für Neurologie, Steyr, Austria, 7 Institut für Radiologie, Linz, Austria, 8 Institut für Sprachen und Literaturen, Innsbruck, Austria Background and aims: Reduced word fluency occurs in PSP and FTDbv, aphasia, however, is not included in the diagnostic criteria (Litvan996, Raskovsky20). The Aachen Aphasia Test (AAT; Huber, Poeck; Verlag Hogrefe) analyses spontaneous speech, verbal repetition, written language, naming, language comprehension and includes the Token Test. Little is known about AAT in FTDbv and PSP. Methods: Each twenty patients with FTDbv, PSP (Richardson-type9, pure akinesia gait freezing type pat.) and Alzheimer s disease (AD; McKhann20) were examined. Age was 7.2±8.7, 73.8±6.2, and 79±0.9 years, respectively (AD>FTDbv; Kruskal-Wallis-ANOVA, Mann- Whitney-U-Test; p.023), Minimental State Examination (MMSE) z-scores -3.2±2.9, -.5±., -3.5±2.2 (p>.05), symptom duration median 36, 42 and 48 months. Results: 30-7% of FTDbv, 25-74% of PSP and 60-85% of AD patients showed deficits in ST of the AAT (beyond the.28-fold standard deviation of the means of controls). Deficits without differences between groups were found in the ST naming (recognition, naming and description of objects, colors, situations and actions, 68-85%) and language comprehension (6-74%). In FTDbv, AAT revealed amnesic aphasia in 43%, global and Broca aphasia in each 6% of the patients, in PSP amnesic in 35%, in AD amnesic in 23% and Wernicke aphasia in 7%. CERAD+ revealed word fluency deficits in FTDbv and PSP. In FTDbv, AAT global score tended to correlate with cognitive decline (MMSE; Spearman rank correl., p.06). Conclusion: Cognitive-dysphasic deficits were found in FTDbv and PSP, mainly for naming and description of objects, colors, situations and actions, and language comprehension. 205 European Journal of Neurology, 22 (Suppl. ),

17 500 Flash Posters F034 The postural response time and the speed of the fine hand coordination in the patients with Vascular Mild Cognitive Impairment S. Likchachev, E. Sidorovich 2, T. Pavlovskaya National Research and Clinical Center Of Neurology and Neurosurgery, neurological, Minsk, Belarus, 2 Minsk, Belarus Background and aims: Early diagnostic markers for vascular mild cognitive impairment (VaMCI) are becoming increasingly important. Methods: The study subjects were 65 patients with VaMCI and 35 patients without cognitive impairment. Cognitive performance tests included MoCA and Shulte s tables. Postural function was assessed by the computerized dynamic stabiloplatform (Belarus) in the mode without visual and acoustic control. Nine Hole Peg Test (NHPT) and 0 sequential finger tapping (all fingers on thumb) were used. Results: In the dynamic stabilographic examination the average time of postural response (ATPR) as the time of one attempt to restore posture while standing on the dynamic platform (.5±0.9 vs 0.8±0.2 sec., p= ), the NHPT time (26.±4.2 vs 2.5±2.3 and 28.0±3.8 vs 22.6±.4 for the right and the left hand) as well as the finger tapping time (9.7±6.4 sec vs 4.2±.2sec, P=0.008 and 9.2±4.3 vs 4.3±.4 for the right and the left hand, P=0.007) were higher in VaMCI patients compared to the controls. ATPR correlated with MoCA test scale scores (R=-0.64, P<0.000), with the Shulte s tables time (R=0.5, P<0.000). The NHPT and the finger tapping time also correlated with MoCA test scale scores (R=-0.79, P<0.000 and R=-0.82, P<0.000) and with Shulte s tables time (R=0.74, P<0.000 and R=0.69, P<0.000). In its turn ATPR correlated with the NHPT and the finger tapping time (R=0.55, P<0.000 and R=0.89, P<0.000). Conclusion: The increase of the postural response time as well as NHPT time and the finger tapping time may be suggested as an early marker of psychomotor slowing in patients with VaMCI. 205 European Journal of Neurology, 22 (Suppl. ),

18 Flash Posters 50 Epilepsy F035 Cosmetic effects of Anti-Epileptic Drugs among adult Sudanese epilepsy patients, Omdurman M.A. Abdelrahim, M.D. Dafaalla, M.M. Alfaki, R.A. Alsherif, M.I. Alfaki, M.S. Abd Elmotalib, M.A. Taha, A.S. Ahmed, M.A. Alnor, D.N. Osman, A.M. Hussein 2 Daoud Research Group, 2 Faculty of medicine, University of Khartoum, Department of Neurology, Khartoum, Sudan Background and aims: Adverse effects are a leading cause of treatment failure with antiepileptic drugs(aeds). We studied the cosmetic effects of AEDs and their association with medications adherence, and quality of life. Methods: The study was performed on Sudanese epilepsy patients attending Daoud charity neurological clinic from June to September 204. Five main variables were used in data collection: ()Cosmetic effects profile; (2)Morisky Medication Adherence Scale(MMAS-8); (3)WHO Quality of Life Brief-26; (4)socio-demographic data, and (5)Epilepsy related data. A senior neurologist assessed the cosmetic effects through clinical examination of the patients. Results: There were 42 patients (3% females); mean age 34.±0.4 years. Hair loss was the most commonly reported cosmetic effect by female patients(75%) who were taking sodium valproate. (26.2%) of patients had weight gain and none of them thought weight gain is an adverse effect. Neither quality of life score, nor adherence score were correlated with any of the cosmetic effects of AEDs (P>0.05). A significant positive correlation was found between the duration from the last attack and the quality of life score (P=0.03). The gum overgrowth was correlated with the Hirsutism and Acne (P<0.05). Also the skin rash was correlated with the weight loss and Acne (P<0.05). Conclusion: We concluded that our patients prioritize medication intake in spite of the presence of cosmetic effect, and this together with the absence of association between quality of life and the cosmetic effect may be attributed to different Sudanese patients perception to these cosmetic effects from other populations in addition to the unique Sudanese culture. F036 Familial Dravet syndrome in 3 male siblings and normal sisters and parents A. Alboudi, A. Alboudi 2, S. Geblawi 3, S. Abdool 4 Dubai, United Arab Emirates, 2 Tishreen university, internal medicine, Lattakia, Syrian Arab Republic, 3 I care clinic, pediatrics, Dubai, United Arab Emirates, 4 Rashid hospital, Neurology, Dubai, United Arab Emirates Background and aims: Dravet syndrome is a rare epileptic disorder, usually autosomal dominant inheritance. the majority of cases are de novo point mutations at different parts of sodiume channel SCNA gene Case Report: We studied 3 brothers who had symptoms of Dravet syndrome. All the patients started to have seizures at age 3 months old, as febrile seizures, then evolved to full blown Dravet syndrome by the age of 2 months. The first case is the first child of the family and he is 8y old now with uncontrolled recurrent seizures up to 3 per day, mainly partial motor seizures on the right side of the body. The other 2 patients are 5y old twins had the same scenario. It is worth noting that the all 3 patients had the first seizure just after the DTaP vaccination. The family has also 3 unaffected daughters. Results: Genetic testing was done for the all 3 patients, and came positive for the mutation R886X C5656T at SCNA gene. both parents and the 3 sisters were tested negative for the mutation Conclusion: Even both parents don t have the mutation, but the possibilty to have mosaicism at the level of the gonadal cells is raised here. and it is interesting that all the male siblings are affected while non of the female. This is the first report from the Middle east about familial Dravet syndrome, which most probably underdiagnosed F037 Abstract cancelled F038 Abstract cancelled F039 Abstract cancelled F040 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

19 502 Flash Posters F04 The incidence, treatment and outcome of posttraumatic epilepsy in one Croatian general hospital in a period of 20 years A. Bujan Kovac, S. Hajnsek, L. Sapina 2, Z. Petelin Gadze, S. Nankovic, I. Cajic, V. Sulentic University Hospital Centre Zagreb, Department of Neurology, Zagreb, Croatia, 2 General Hospital Dr. Josip Benčević, Department of Neurology, Slavonski Brod, Croatia Background and aims: Posttraumatic epilepsy, as frequent complication of traumatic brain injury (TBI) requires careful diagnosis, proper selection of antiepileptic drugs (AEDs) and follow-up. Prognosis is usually favorable but some patients develop pharmacoresistant epilepsy. Methods and Materials: The study included 3 patients with post-traumatic epilepsy (PTE), 46 females and 67 males in period from % of the patients had mild TBI, 5% moderate, and 43% severe. Most of the patients (50%) had complex partial seizures (CPS) with secondary generalized tonic-clonic seizures (GTCS), 28% had GTCS, 8% CPS, 4% elementary partial seizures (EPS) with GTCS, 2% had isolated EPS and 8% had combination of partial and generalized seizures. Neuroimaging (brain MRI and CT) showed gliosis in 57% patients, localized atrophy in %, in 6% gliosis with atrophy and 27% of the patients had normal neuroimaging findings. 60.2% of the patient were treated with one or more conventional AEDs and 39.8% with at least one of the new AEDs. Results: Patients treated with conventional AEDs achieved remission in 73% of cases and those treated with at least one of the new AEDs in 77%, and in this group remission was attained earlier (.6 months compared to.85 months). Diagnozed psychiatric comorbidity lengthened the average time to remission in both groups months. Conclusion: Therapy with AEDs of the new generation leads to earlier and more complete remission of post-traumatic epilepsy. F042 Bilateral periventricular nodular heterotopia in an adult patient with partial seizures with autonomic manifestations A. Buture, D. Anghel, E. Solomon, A. Dulamea Fundeni Clinical Institute, Neurology, Bucharest, Romania Background and aims: We present the case of an adult patient diagnosed with partial seizures with autonomic manifestations and secondary generalized tonic seizures mistreated as biliary dyskinesia for three years. Case Report: The patient is a 39-year-old right-handed woman, with the onset of the disease at the age of 34 with autonomic seizures consisting of episodes of nausea, vomiting and urinary urgency with secondary generalized tonic seizures. The frequency of episodes was 3-4 per year. She was mistreated for biliary dyskinesia for 3 years when the final diagnosis of epilepsy was established. Differential diagnosis was made between organic diseases of abdominal structures (carcinoid, pheochromocytoma), hypoglycemia, panic attacks, primary autonomic system diseases. The patient has a history of repeated loss of consciousness between the age of 7 and 2 years and chronic headache, considered as syncope. Currently the patient is under antiepileptic treatment and the patient is seizure free. However, the patient presents weekly episodes of right migraine with partial remission at NSAIDs administration Results: MRI showed bilateral nodular heterotopia with identical gray matter signal on all sequences at occipital periventricular regions of the occipital lobes. Wakeful interictal EEG recordings revealed spikes and sharp waves in temporal parietal-occipital channels. The 24-hour ECG monitoring, echocardiography and abdominal ultrasound were normal. Conclusion: Partial seizures with autonomic manifestations can be easily misdiagnosed and treated as cardiogenic syncope,organic or functional disturbances of abdominal viscera, atypical migraine. In our case the secondary generalized seizures and interictal EEG led to a rare cause of epilepsy in adults-periventricular nodular heterotopia. 205 European Journal of Neurology, 22 (Suppl. ),

20 Flash Posters 503 F043 Oculomotor disturbance after aortic surgery A. Caetano, R. Pelejão, J. Costa 2, M. Viana-Baptista Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Neurology, Lisbon, Portugal, 2 Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Ophtalmology, Lisbon, Portugal Background and aims: The risk for cerebral ischemic insults accompanies aortic surgeries. There have been reports of oculomotor disturbances developing after surgical interventions, usually without a clear etiology being determined. Case Report: A 70-year-old Portuguese female, submitted to surgical implantation of an aortic valve replacement (due to severe aortic insufficiency) and an ascending aortic conduct (due to an aortic aneurysm), developed, immediately after surgery, gait disturbance and unspecific visual disturbance, with episodic (and stereotyped) bouts of conjugated horizontal nystagmus. These were brief episodes (0 minutes duration), with spontaneous recovery, sometimes triggered by head position changes or Valsalva maneuvers (but also occurring during rest). She presented to the emergency room after one such episode accompanied by left hemifacial paresthesias. Her neurological examination was unremarkable, her brain imaging showed severe small vessel disease, chronic cerebellar infarcts and slight basilar artery stenosis. Inter-ictal EEG showed occasional left temporal waves. The episodes reduced their frequency gradually over a few months. After the introduction of anti-epileptic treatment with carbamazepine the episodes reduced dramatically. Conclusion: There is a clear temporal relation between the aortic surgery and the stereotyped ocular nystagmus episodes. There have been reports of strategic ischemic cortical lesions affecting oculomotor areas, where patients develop epileptic paroxysmal nystagmus episodes. Although there is uncertainty regarding their etiology, we propose an epileptic origin for this disturbance, although we don t reject that other surgical factors may be involved (such as hypothermia or time of surgery). F044 Abstract cancelled F045 The link between Ramadan-related activities and seizure frequency during Ramadan in epileptic patients attending Banat Charity Clinic in July and August 204 M. Dafaalla, M. Abd-Elmotalib, M. Taha, M.A. Abdelrahim 2, M. Alfaki 3, M.I. Alfaki, R.A. Alsherif, A.M. Hussein 4 Daoud Research Group, 2 Khartoum, Sudan, 3 daoud research group, 4 Faculty of medicine, University of Khartoum, Department of Neurology, Khartoum, Sudan Background and aims: To assess the effect of fasting and other Ramadan-related activities on the seizure frequency of epileptic patients. Methods: A series of 80 epileptic patients was conducted from patients attending Daoud charity clinic in Banat, Khartoum, Sudan. Data related to the fasting status, seizure frequency before and during Ramadan, and the adherence to late night prayers were documented using preformed pro-formats. Patient s approval was obtained as necessary. Results: 44.7% of patients fasted the whole Ramadan, whereas 5.5% of these chose to fast without or against the physician consultation. The remainder either stopped or never tried to fast. The change in seizure frequency is not affected by the fasting status (P=0.625). Moreover, there is higher incidence of seizure during Ramadan in the non-fasting population. There is no correlation between the duration of sleep and the change in seizure frequency, but increasing the duration of sleep by 2 hours decreases the frequency of seizures, but the difference is not significant (R=0., P=0.56). There is no relationship between the change in the sleep duration at night and the seizure frequency (P=0.22). In fact, patients who slept less than 2 hours have lower seizure frequency (seizure frequency is 40% lower in Ramadan). The change in seizure frequency is not related to neither the adherence to early nor late night prayers (P=0.76, 0.27). Conclusion: The epileptic patients can fast and practice the Ramadan related ceremonies, and this will not affect their seizure frequency. However, further studies are recommended before applying these results. 205 European Journal of Neurology, 22 (Suppl. ),

21 504 Flash Posters F046 The effect of melatonin in patients with intractable epilepsy F. Faraji, A. Rezaie Ashtiani 2, M. Ebrahimi Lagha 3, S. Amjadi 3, B. Sadeghi 4, A. Talaie 5 Arak University of Medical Sciences, Neurology, 2 Arak University Of Medical Sciences, Neurology, 3 Arak University Of Medical Sciences, Students Research Committee, Medicine Faculty, 4 University Of Medical Sciences, Social medicine, 5 Islamic Azad university, Health Department, Arak, Iran Background and aims: Approximately 5-0% of epileptic patients do not respond to antiepileptic drugs and many of them have psychological disorders such as sleep disturbance. The aim of the present study was to determine the effect of Melatonin on sleep quality and seizure attacks in patients with intractable epilepsy Methods: A semi clinical trial was carried out on 30 patients with intractable seizure. Samples were selected from neurologic clinics of Arak city. After physical and neurologic exam the demographic and Pittsburgh questionnaire fulfilled and all patients received melatonin 3 mg at bedtime for 2 months. Finally patients were reexamined and for a second time completed the demographic and Pittsburgh questionnaire. Results: The sleep quality in 80% of patients was undesirable. After intervention mean of seizure attacks during a month decreased and sleep quality improved significantly (P<0.05). Number of seizure attacks decreased significantly during study period (mean±sd of 5.50±2.7 before vs. 3.06±.68 after intervention). Also a significant correlation was observed between sleep quality and number of seizure attacks. Conclusion: Melatonin without significant complications was effective on control of seizure and improves sleep quality. Disclosure: This study was supported by a grant from Office of Vice Chancellor for Research of Arak university of Medical Sciences F047 External validation of the STESS scale for predicting status epilepticus mortality in Polish population. M. Godek, S. Szklener, K. Rejdak Medical University of Lublin, Neurology, Lublin, Poland Background and aims: The Status Epilepticus Severity Score (STESS) is a prediction tool developed to estimate the risk of mortality in status epilepticus (SE). Our aim was to determine the accuracy and universality of the STESS scale based on adult patients population in Poland. Methods: Total of 69 patients diagnosed with SE were prospectively evaluated with the STESS tool. The primary outcome measure was mortality assessed after 30 days of observation. Areas under the curve were calculated to quantify the prognostic value. Calibration was assessed as the measure of how closely predicted outcomes agree with the actual outcomes with using Hosmer-Lemeshow test. Results: Among 69 status epilepticus patients with a mean age of 58.0 years (± 8.2), mortality was 29%. The receiver operating characteristic curve for prediction of death by the STESS had an area under the curve of with an optimal cutoff point greater than 3. Hosmer-Lemeshow statistics revealed good calibration of the Status Epilepticus Severity Score (chi-square goodness-of-fit test =.52; p = 0.67). Conclusion: STESS scale is a reliable tool to predict poor outcome for patients suffering SE in the Polish population. The clinical value of the scale has been confirmed and can be readily applied in everyday practice to risk-stratify of mortality. 205 European Journal of Neurology, 22 (Suppl. ),

22 Flash Posters 505 F048 Cardio-vascular risk factors evaluation in patients with epilepsy. V. Grymailo Kharkiv, Ukraine Background and aims: Epilepsy and antiepileptic drugs have certain impact on cardio-vascular system. The aim of our study was to evaluate cardio-vascular risk in patients with epilepsy. Methods: We observed 50 patients with epilepsy aged 9-35 years without cardio-vascular diseases who have started treatment with carbamazepine (CMZ) 25%, valproic acid (VPA) 26%, lamotrigine (LTG) 24% and levetiracetam (LEV) 25% in monotherapy of average therapeutic doses. Each of them had clinical neurological examination, ECG, lipid spectrum of the blood evaluation, body weight index (BWI), waist- hip ratio (WHR) evaluation, carotid arteries dopplerography. Results: Rise of total cholesterol and low density lipoprotein were reliably more often in patients on CMZ than in patients on VPA, LTG and LEV (p<0.0) after 2 years of antiepileptic treatment. In patients on VPA rise of triglycerides, increase of intimamedia thickness more than 0,7 mm, BWI more than 25 and WHR more than 0.9 were reliably more often than in patients on CMZ (p<0.05), LTG and LEV (p<0.0). Systolic blood pressure (SBP) more than 40mmHg was observed in 7% of patients on KMZ, 4% on VPA and % on LTG but the difference was not reliable (p=0.059). Cardio-vascular diseases (CVD) developed in 3% of patients on VPA and in 5% on CMZ (p=0.027). Conclusion: Patients on CMZ had more significant lipid spectrum changes, but patients on VPA had worse results of carotid arteries dopplerography, higher levels of BWI and abdominal obesity. However, the amount of CVD was reliably higher in patients on CMZ. F049 Epilepsy in patients with stroke Z. Ibodullayev, N. Nurmetov, O. Kurbanov 2 Tashkent Medical Academy, Neurology department, Tashkent, Uzbekistan, 2 Tashkent Medical Academy, Neurology, Tashkent, Uzbekistan Background and aims: One of the main causes of epileptic seizures in the elderly is a stroke. Stroke and epilepsy are the most common neurological diseases. Epileptic seizures after stroke significantly complicate the recovery period. The purpose of the study was to examine the state of nitric oxide (NO) in the cerebrospinal fluid of patients with stroke. Methods: 36 patients with acute stage of ischemic stroke were observed. 26 (8.2%) of them (20 males and 6 females) had convulsions (mean age 62.3). Results: In the cerebrospinal fluid of stroke patients with and without early seizures differences in metabolites NO were observed. In patients with acute ischemic stroke accumulation of cerebrospinal fluid nitrite during the first day is marked. This phenomenon has been observed neither in patients with early seizures after stroke nor in hemorrhagic stroke. A defect in endothelial nitric oxide synthesis is a feature of stroke patients with epileptic seizures. This may be one of the mechanisms of epileptic seizures in stroke. Conclusion: Stroke (hemorrhagic) is a major cause of seizures and epilepsy in the elderly. Accumulation in ischemic stroke NO has a protective and vasodilatation effect in relatively small hearth, while the production of NO in the later periods is accompanied by an increase of neurological deficit. 205 European Journal of Neurology, 22 (Suppl. ),

23 506 Flash Posters Infection and AIDS F050 Posterior reversible leukoencephalopathy syndrome in an 8-year-old puerperal HIV patient on antiretroviral therapy R. Araújo, S.R.M. Batista, M. Sousa, B. Santiago 2 Centro Hospitalar e Universitário de Coimbra, Neurology, Coimbra, Portugal, 2 CHUC, Neurology, Coimbra, Portugal Background and aims: Posterior reversible leukoencephalopathy syndrome (RPLS) is an uncommon condition characterized by predominantly posterior subcortical lesions of a transient nature in most cases. It is classically related to hypertension and renal disease, preeclampsia or immunosupressive therapy. Methods: An 8-year-old patient who had her first baby 4 days earlier develops severe headache suggestive of intracranial hypotension. Previous to this her husband reported a period of unresponsiveness that lasted about two minutes, without any other evidence of seizure. She was diagnosed with HIV during the course of the pregnancy which was otherwise uneventful, and had been on ARVT with atazanavir, ritonavir and emtricitabine/tenofovir for 8 months. She had had epidural anesthesia with a iatrogenic tear of the dura-mater, treated with an autologous blood patch. Her CD4 count was over 600/mL and HIV RNA was undetectable. Results: She was normotensive; she had no alteration on mental status and neurological examination was normal. Transcranial Doppler showed normal posterior circulation vasorreativity. Her MRA showed lesions compatible with RPLS, with no vasoconstriction. Protein S was slightly reduced, interpreted in light of her post-partum status. Her headaches subsided on day 3 after admission. Protease inhibitors were consequently suspended. MRA with posterior symmetrical and frontal right lesion, compatible with RPLS MRA with posterior lesion, of similar characteristics Conclusion: We present an unusual case of RPLS in which the absence of hypertension, renal disease, eclampsia and normal vasoreactivity of intracranial arteries suggest ARV influence. This would be, to our best knowledge, the youngest patient with the shortest time of ARV exposure to display ARV-related RPLS. 205 European Journal of Neurology, 22 (Suppl. ),

24 Flash Posters 507 F05 Neurocysticercosis with additional widespread systemic compromise with both skeletal and cardiac involvement F.M. Branco Germiniani, V.F. Zetola, S. Almeida, D. Brighente Bertholdo 2, G. Lenci Marques 3 Hospital de Clínicas - Universidade Federal do Paraná, Internal Medicine Department, Neurology Service, Curitiba, Brazil, 2 Hospital de Clínicas - Universidade Federal do Paraná, Radiology Service, Curitiba, Brazil, 3 Hospital de Clínicas - Universidade Federal do Paraná, Internal Medicine Department, Cardiology Service, Curitiba, Brazil Background and aims: Neurocysticercosis is a worldwide disease that can present in varied forms. Although patients may present with multiple cysts, generalized systemic compromise is rare. We present the case of a patient with neurocysticercosis, skeletal muscle and cardiac involvement. Case Report: A 70-year-old male patient was admitted to the ER with a history of cognitive decline that started a few years before, worsening over the past 6 months to the point that he wouldn t recognize his relatives. A couple of days before admission he developed symptoms of delirium. He had been diagnosed in 202 with Neurocysticercosis and had undergone a treatment regimen with Albendazole 400mg once a week for two weeks. On physical examination he had several nodular lesions in the skeletal musculature with a widespread distribution, compromising muscles of the scalp, face, neck, trunk, arms and legs. Apart from fluctuating confusion, neurological exam was otherwise normal, safe for mild gait ataxia. Whole body MRI showcased multiple cysts with visible scolex not only in his brain, but also in the extrinsic ocular muscles, tongue, neck muscles, arms, hands, and lumbar muscles. A transthoracic echocardiogram revealed two myocardial cysts located in the interventricular septum, measuring 0.5 cm and another one in the right ventricle, with no compromise of systolic function. Treatment with antihelmintic drugs was contraindicated due to the risk of severe anaphylaxis and death. Lumbar muscles with multiple cysts Hand muscles with multiple cysts Conclusion: Neurocysticercosis may present with varied forms, but systemic compromise, i.e. widespread cysts in skeletal and cardiac muscles is a rare presentation. Echocardiac image of myocardial cyst 205 European Journal of Neurology, 22 (Suppl. ),

25 508 Flash Posters F052 Frontal lobe syndrome and bone involvement in a patient with syphilis G. Cação, S. Pina 2, S. Cavaco 3, M. Correia 4, J. Damasio Porto, Portugal, 2 Centro Hospitalar do Porto, Neurorradiology, Porto, Portugal, 3 Centro Hospitalar do Porto - Hospital de Santo António, Neuropsychology Unit, Porto, Portugal, 4 Centro Hospitalar do Porto, Neurology, Porto, Portugal Background and aims: Patients with neurosyphilis may present a broad range of neurological symptoms, some with severe neuropsychiatric syndromes. Bone involvement may occur in syphilis, being less frequent in post-penicillin era. Case Report: We describe a 45-year-old man, bank manager, highly self-disciplined, with rigid character and obsessive-compulsive traits since youth. By the age of 42 he developed mood fluctuations, hyperactivity, insomnia, increased impulsiveness and aggressiveness. The following two years were characterized by clinical deterioration. By the age of 44, he also presented disorganized speech, difficulties in daily planning, and major calculi problems. At this time, and over two weeks, he developed intense lumbar pain and fever. When observed he presented inattention, lack of initiative, childish behavior, language errors and no insight of his difficulties. Neuropsychological tests revealed major deficits affecting attention, language and executive functions. MRI disclosed global cortico-subcortical atrophy and, a T2 hyperintense lesion with contrast enhancement at L4 vertebra. CSF analysis revealed 62 leukocytes (56monocytes), increased proteins and positive VDRL (4dilutions). Treated with penicillin G for 2 days, he presented immediate improvement on lumbar pain, fever and sleep. A progressive improvement of attention, language and executive functions was observed. The clinical progress is continuous and sustained eighteen months after diagnosis. Conclusion: In the XXI century, syphilis still is the great imitator. Here, we highlight the clinical presentation as a frontal lobe syndrome, in a patient with a peculiar premorbid personality. We also emphasize the presence of bone involvement, increasingly rare nowadays. The continuous improvement reinforces the importance of early diagnosis. F053 Transverse myelitis caused by enterovirus G. Cação, J. Martins, J.P. Pereira 2, A.P. Correia, J. Damasio Porto, Portugal, 2 Centro Hospitalar do Porto, Neurorradiology, Porto, Portugal Background and aims: Infectious causes of transverse myelitis are frequently suspected, but the pathogenic agent rarely identified. Enteroviruses are associated with different neurological syndromes, being transverse myelitis a rare presentation. Case Report: We describe a 23-year-old female who presented low back pain, associated with inferior limbs (IL) numbness, urinary incontinence and constipation. Two days later she developed IL weakness. When observed, she presented an asymmetric flaccid paraparesis, brisk deep tendon reflexes, right Babinski sign, loss of pain sensation below D4 on left/ D8 on right, decreased proprioception and vibration sense on halluxes, with loss of ambulation. Brain MRI was normal, spinal cord MRI revealed a long medullar hyperintensity that affected more than 2/3 of the cord diameter between C2-C7, the right antero-lateral portion between D-D2 with contrast enhacement and the anterior half between D3-D. CSF analysis revealed 2 leukocytes (08 monocytes), increased proteins, normal glucose and positive polymerase chain reaction for enterovirus. Anti-aquaporin antibodies were negative. She was treated with iv methylprednisolone for 5 days, followed by immunoglobulins, and presented immediate improvement. Control MRI, nine months afterwards, revealed a slight hyperintensity between D-D3 with minor cord atrophy. She had progressive improvement, regaining independent gait few months later. Conclusion: Tropism of enterovirus for the spinal cord is well established, although pathophysiological mechanisms remain incompletely understood. Some authors suggest a direct role of the virus causing tissue destruction, while others propose an indirect mechanism caused by a cytokine-mediated small-vessel vasculitis. In this case, improvement after corticosteroids and immunoglobulins supports an immuno-mediated mechanism. 205 European Journal of Neurology, 22 (Suppl. ),

26 Flash Posters 509 F054 Neuroinfectious diseases in Brunei Darussalam A major impact on health care in the region E.M. Craemer, S. Diah 2, H. Muharram 2, J. Lim 2, U. Meyding-Lamadé Krankenhaus Nordwest, Klinik für Neurologie, Frankfurt am Main, Germany, 2 Universiti Brunei Darussalam, Negara, Brunei Darussalam Background and aims: Infectious diseases are worldwide a major killer of human beings. The treatment of neuroinfectious diseases is still one of the major unsolved problems in neurology today. It is known that many infectious diseases may cause a severe dysregulation on inflammatory parameters and also may cause a severe disruption and dysregulation of the coagulation cascade. The ROTEM ( thrombelastography)allows to measure the impairment of funtion of various coagulation parameters, thus enabling us to stay that, e.g. a normal thrombocyte cell count does not signal a normal thrombocyte function or vice versa a reducted thrombocyte count does not necessarily indicate a severe impairment of thrombocytic function, i.e. coagulation capacity. The information will help to investigate the functional coagulation behaviour in the long term by means of the detailed analysis of coagulation parameters using ROTEM during the acute stage of disease. Methods: During the acute phase of the disease 3ml citrated blood will be taken from the participant at up to a total of 8 visits. Results: Patient a: Low MCF in EXTEM analysis signifies that Patient a has a bleeding risk. In INTEM analysis this signifies a increasing bleeding risk. Increased CTF in EXTEM analysis signifies a intact haemostasis with a low auxilary. F055 Perilesional edema around calcified neurocysticercosis lesions after 8 years S. Dias, P. Brás, J. Morgado, R. Relvas, R. Pedrosa Centro Hospitalar Lisboa Central, Neurology, Lisbon, Portugal Background and aims: Neurocysticercosis is a major cause of acquired epilepsy in endemic countries. Residual calcifications are the most frequent imaging finding, and have been implicated as likely epileptic foci. Transient episodes of perilesional edema are known to occur in some patients in association with seizures, but their pathophysiology is unclear. Case report: A 42-year-old patient from Cape Verde with a known history of neurocysticercosis was brought to our hospital due to sudden headache and a focal motor seizure with secondary generalization. She had been treated for neurocysticercosis and seizures 8 years earlier, and was since asymptomatic. Brain magnetic resonance imaging (MRI) revealed several small inactive calcified lesions, and a nodular, ring-enhancing left occipital lesion with surrounding edema. She was treated with prednisolone, albendazole and antiepileptic drugs and experienced no further seizures. Imaging studies performed in the following months, however, revealed the appearance of more lesions with surrounding edema. A biopsy was performed, showing an involuting cysticercus with an intense surrounding inflammatory response. She was treated with a longer course of steroids, with improvement of imaging features. Conclusion: Calcified neurocysticercosis lesions should not be regarded as inert, as they may present with new acute symptoms in association with perilesional edema, even after many years. Little is known about the nature of this process, and there are very few published reports of histopathological findings of calcified lesions during an episode of perilesional edema. Our case, like the others reported in the literature, support an inflammatory nature, but further studies are required to better characterize this entity. preliminary results ROTEM analysis for four selected patients Conclusion: Neuroinfectionology is highly important infections of the brain and meninges may cause severe disability in patients of any age. Increasingly, comparable to stroke, in neuroinfectious diseases the gold standard for survival is rapid diagnosis as basis for rapid treatment. Therefore: Time is brain! 205 European Journal of Neurology, 22 (Suppl. ),

27 50 Flash Posters F056 Neuro-Behcet s disease: a case report I. Gabrielyan, K. Harutyunyan, G. Avagyan, H. Amirjanyan, S. Khachaturyan, H. Hambardzumyan, H.M. Manvelyan Yerevan state medical university, Neurology, Yerevan, Armenia Background and aims: One of the most devastating manifestations of the Behcet s disease is the involvement of the nervous system, also known as neuro-behcet s disease (NBD), which usually occurs -0 years after the first symptoms. There are 2 types of NBD: Parenchymal (75%) and Non-Parenchymal (7.7%), and in 7.3% it s not possible to categorize. Methods: A 43-year-old male with more than 5 years of history of Behcet s disease presented in out-patient department with headache, progressive memory loss and executive dysfunction. His history is significant for neurosensory hearing loss for about 4 years and a panretinal coagulation procedure in right eye a year ago. Shortly after that sudden speech difficulty and weakness in left extremities were developed. Brain MRI was performed, which did not reveal any changes. Neurological examination revealed slurred speech, mild weakness in left extremities, increased muscle tone in both arms, bradykinesia, affective disturbances, and mild cognitive impairment (MMSE - 20). Laboratory tests showed non-specific inflammatory changes, neuroimaging studies showed no abnormalities. Results: Considering neurological involvement treatment plan was modified including increase of steroid dosage. 3 months later patient s neurological symptoms have greatly diminished and MMSE score was 24. Follow-up MRI showed non-specific white-matter abnormalities. Conclusion: Even without typical early changes on MRI, development of neurological symptoms in Behcet patient requires high suspicion for NBD. F057 Aseptic meningitis in adult patients in a secondary hospital in Spain: epidemiological study between 2006 and 204. D.A. García-Estévez Spain Background: Acute aseptic meningitis is characterized by a clinical syndrome of meningeal inflammation in which CSF has a lymphocytic pleocytosis ( 5 cells) and the CSF bacterial culture is negative. Viral etiology is the main cause of the lymphocytic meningitis. Nucleic acids amplification techniques are the methods of choice to diagnose viral meningitis from CSF samples and viral pathogens can be identified in nearly 70%. Aim: To investigate the epidemiology and the etiology of aseptic meningitis in an adult population using real-time polymerase chain reaction (PCR) method. Patients and methods: This retrospective study was conducted in a secondary hospital in Spain. Cases of aseptic meningitis were collected between 2006 and 204 in immunocompetent adult patients (ages 4 years-old). Several microbiologic and serologic tests were performed. Enteroviruses and herpes viruses were determined using CSF PCR test. Results: A total of 39 cases of aseptic meningitis were included. The median age was 49 years (range 4-87 years). Seven cases had no viral etiology. 29 of the 36 cases were diagnosed as confirmed or possible viral meningitis. The annual incidence was 6.4 cases / persons-year. In 2 of 29 cases (4.4%) an etiological agent was identified: VZV (4), HSV-2 (), HIV (2), mumps virus (2), enteroviruses (2) and influenza A virus (). The outcome was good in all patients. Conclusion: An etiologic diagnosis was achieved by PCR and/or virus-specific antibodies in 4.4% of the lymphocytic meningitis. In our adult population herpes viruses were the main etiological agent (4.6%) and entero viruses only accounted for 6.6%. 205 European Journal of Neurology, 22 (Suppl. ),

28 Flash Posters 5 F058 Cerebral and cerebellar tuberculomas in a 78-year-old woman: a case report A. Parralo, A. Lopez, N. Giraldo 2, J.J. Bravo 3, C. Valencia 3, A. Hernandez 2 Ciudad real, Spain, 2 University General Hospital of Ciudad Real, Neurology, Ciudad Real, Spain, 3 Ciudad Real, Spain Background and aims: Central nervous system tuberculosis is a rare manifestation of mycobacterium tuberculosis infection. The wide spectrum of the disease includes subacute or chronic neurological lesions associated to fever of unknown origin and immunosuppression. Case Report: We present a case of a 78-year-old woman under empiric treatment with corticosteroids from one month ago, due to fever of unknown origin. Neurological examination showed right spastic hemiparesis, as well as ataxia and dysmetria of the limbs. A left frontoparietal lesion was seen on computed tomography (CT). Magnetic resonance imaging was performed revealing the left frontoparietal lesion with perilesional edema, and multiple ring enhancing images in both cerebellar hemispheres, which suggested tuberculomas (Figure). Results: Systematic hematological, biochemical, microbiological and serological tests, ecocardiographic exam and body-ct did not reveal relevant information. Cerebrospinal fluid study showed high adenosine deaminase activity levels, low glucose levels and normal levels of blood cells. Loewenstein culture was positive for mycobacterium tuberculosis six weeks after the initial examination. Pyrazinamide, isoniazid, rifampicin, ethambutol and corticosteroids were empirically given from the onset with favourable evolution. Conclusion: Tuberculomas are sometimes seen in neuroimaging studies, especially among rural population. Tuberculomas must be considered in the differential diagnosis of people with neurologic expansive lesions, more if they are immunocompromised, even without the typical underlying meningeal process. Our case highlights the need for an early suspicion of the diagnosis, so that timely treatment can be initiated to prevent severe brain damage and a fatal outcome. F060 CSF escape in an HIV-infected patient receiving antiretroviral therapy J. Martins, P. Salgado, E. Santos, M. Marta 2, M. França 3 Centro Hospitalar do Porto - Hospital Santo António, Neurology, Porto, Portugal, 2 Blizard Institute - Barts and The London School of Medicine and Dentistry, Neuroimmunology Unit - Neurosciences & Trauma, London, United Kingdom, 3 Centro Hospitalar do Porto - Hospital Santo António, Immunology, Porto, Portugal Background and aims: CSF escape is seldomly described in HIV infected patients receiving antiretroviral therapy (ART) and recognized as a severe complication. Case Report: We present a 35-year-old man with HIVinfection diagnosed in 2007, during primary infection. He started ART in 2009 with a good immunovirological response. In the course of disease he was admitted twice for encephalitis. Clinical presentations were similar and characterized by neuropsychiatric symptoms (disorientation, recent memory deficits, aphasia, seizures and behavior changes). MRI revealed diffuse hyperintensities, in T2 and FLAIR, involving diffuse white matter substance and temporal, medial frontal and insular lobes cortex, without gadolinium enhancement. CSF analysis showed mildly elevated protein, lymphocytic pleocytosis with >78% CD8 cells, and high viral load. He had undetectable plasma viraemia and high CD4 cell count. The first episode (200) had full recovery without neurological disability. He was treated with a short course of steroids and ARV changed for better CNS penetration. In 204, disease similar presentation was unresponsive to IV steroids or immunoglobulin therapy, with worsening of cognitive function and the appearance of psychotic symptoms. Lacking therapeutic alternatives, ART was intensified with RAL and MRV (CPE score=6). After four months follow-up the patient presents a favorable course, persisting cognitive impairment. Steroids are being tappered. Conclusion: We describe a patient with CSF/plasma HIV dissociation, high CD4 cell count and undetectable plasma viraemia. A better understanding of this disease is needed in order to achieve the best therapeutic strategy. F059 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

29 52 Flash Posters F06 Bartonella Henselae presenting as acute encephalitis A. Merwick, G. Ingle National Hospital for Neurology and Neurosurgery, London, United Kingdom Background and aims: Encephalopathy with associated fever has a broad differential including infectious, immune, paraneoplastic and metabolic causes. Case Report: A 9-year-old woman presented with headache, ataxia following return from holiday in Majorca. She had a prodromal rash over her forehead, with facial swelling. She vomited, and was noted to be febrile, agitated with slurred speech and became febrile. On initial examination she was drowsy GCS 0/5 (E3, V2, M5). Upper limb examination showed increased tone on the left, with brisk reflexes. Results: CSF showed WBC/cm 3, 2 RBC/cm 3, glucose 6.0mmol/L, protein 0.42g/L, gram stain, culture, viral PCR were negative and oligoclonal bands positive in CSF and serum. Routine bloods were normal, except for elevated LFTs. MRI brain showed abnormal signal in pons and right thalamus, left external capsule, rostrum of the corpus callosum, left insula and anterior temporal lobe and in both superior parietal lobe white matter. The juxtacortical white matter of the right superior frontal gyrus was also involved, with areas of restricted diffusion in the left insula white matter and rostrum corpus callosum. Serum testing was positive for Bartonella Henselae IgM 20 IgG titre 52 and serology 6 months later showed a fall in IgM titre to <20 and IgG titre to 28. She verified she kept pet cats. Conclusion: This case of encephalitis demonstrates the importance of obtaining a complete history of environmental exposures in patients presenting with encephalitis. In acute progressive encephalitis atypical bacterial infections should be considered. Disclosure: Salary funding from the Health Service Executive (HSE)/Dr Richard Steevens scholarship and UCC Ainsworth prize F062 Simultaneous existance of ANTI-GABA B and ANTI-NMDA receptor antibodies in patient wiith HSV encephalitis D. Naoumis, M. Antonopoulou, C. Rentzos, E. Kouremenos, A. Codounis 25 Hellenic Air-Force Hospital, Neurology, Athens, Greece Background and aims: HSV encephalitis is the most common form of acute encephalitis. It appears sporadically throughout the year, at all ages. Except classic symptoms of encephalitis (fever, headache, mental confusion), another symptom is seizures, usually controlled by the administration of conventional antiepileptic treatment. We describe a case of a female patient, where HSV infection was identified, which triggered autoimmune encephalitis. Case Report: 33-year-old female patient was hospitalised for persistent seizures for 30 days period, after plastic surgery for anisomastia. After 3 consecutive brain MRIs, a temporal right lobe lesion identified, as well as 5 cells in CSF and HSV IgM antibodies in peripheral blood. Seizures persisted, despite the aggressive medication and further investigation revealed co-existence of GABA B and NMDR receptor antibodies in peripheral blood and GABA B receptor antibodies in CSF. Results: Initially, the patient was treated with iv corticosteroids for 3 days (gr/day) and after the confirmation of autoimmune aitiology a five-day IVIG shema (total 00gr) was administrated. After IVIG, seizures became well controlled with moderate medication. After month MRI lessions disapperared. Conclusion: It is known that seizures can be caused by immune responses to both excitatory and inhibitory preor post-synaptic receptors, such as NMDA-R, AMPA-R, GABA BR KAI CASPR 2. Seizures caused by such disorders are usually resistant to antiepileptics, unless the immune mechanism is simultaneously identified and addressed. Possible association between seemingly different clinical entities raises the question wether the pathogenetic mechanism by which an HSV infection affects the nerve cells can trigger autoimmune response. 205 European Journal of Neurology, 22 (Suppl. ),

30 Flash Posters 53 F063 A case of paraplegia in a 9-year-old pregnant I. Popa, A.M. Cobzaru, I. Mindruta, A. Marinescu 2, C.I. Coclitu 3 Emergency University Hospital Bucharest, Neurology, Bucharest, Romania, 2 Emergency University Hospital Bucharest, Radiology, Bucharest, Romania, 3 Bucharest, Romania Background and aims: The syndrome of transverse myelitis can have multiple etiologies. Case Report: We present the case of a 9-year-old female, in the 30th week of pregnancy who is admitted to our department with paraplegia and total loss of sensitivity up to T6 level. The symptomatology has installed in a period of 4 weeks. General clinical examination: dullness to percussion in the right inferior thorax. Neurologic examination: paraplegia, loss of all types of sensibility up to T6 level, bilateral Babinski sign, bilateral clonus. Blood work: inflammatory syndrome (ESR=04mm/h, CRP=54mg/L). Antibodies anti HCV, antigens HBV, HIV, TPHA, VDRL and RPR all negative. Mycobacterium tuberculosis IgG positive. Lumbar puncture: normoglycorrachia, hyperproteinorrachia, negative Ziehl-Neelsen stain. Chest X Ray: right pleural effusion. Pleural effusion: low glucose, high LDH, low protein and albumin, negative Ziehl-Neelsen stain, negative culture for aerobe and anaerobe bacterias. MRI: focal intramedullary TWI hypointensity expending the spinal cord at T6 level and diffuse T2WI hyperintensity spreading from C4 to L2 vertebrae. Results: At this point we started treatment with Methylprednisolone g/day and she developed a meningeal syndrome. The second lumbar puncture revealed: hypoglycorachia (30mg/dL), hyperproteinorrachia (80mg/dL), CSF-leukocyte count 62/uL and positive PCR Mycobacterium Tuberculosis. Positive diagnosis was that of intramedullary tuberculosis and we started her on tuberculostatic drugs with the regression of lower limbs hypoesthesia and the ability of initiating movement with left toes at the time of discharge. Conclusion: Even though intramedullary tuberculosis is a rare condition one should always have that in mind. F064 An unusual etiology of cerebral cystic tumor: brain tuberculoma, a case report A. Riahi, A. Arous, C. Drissi, M. Ben Mahmoud, R. Sebai, N. Hammami, S. Nagi, M. Ben Hammouda National Institute of Neurology, Neuroradiology department, Tunis, Tunisia Background and aims: Cystic tumors in adult patients can lead to a troublesome differential diagnosis. Primary brain tumors (pilocytic astrocytomas, gangliogliomas, oligodendroglyomas ), metastases or brain abscesses are the more frequent. We report herein an exceptional cause of cystic brain tumor. Case Report: A 22-year-old man presented with headache and vomiting. Neurologic examination did not reveal any localizing signs but funduscopic exam showed a papilledema. Brain MRI revealed a right temporal parenchymatous cystic mass, with thin walls and content identical to the signal of CSF. This mass has a nodule of 25mm in contact of its posterior wall, taking intense and homogenous contrast after Gadolinium injection, and associated with perilesionel edema. In diffusion-weighted images, nodule was in hyposignal with elevated Apparent Diffusion Coefficient, while the cystic part was identical to CSF. Perfusion sequence showed a decreased relative cerebral brain volume (rcbv). The patient was operated on for tumor removal. Results: Operative findings denoted that cystic component of the tumor was in fact the temporal horn of the lateral ventricle that was excluded by the nodular lesion. Pathological study of the lesion revealed giant cells granuloma with focal caseous necrosis. The diagnosis of brain tuberculoma mimicking a cystic tumor was made and the patient was put on tuberculosis treatment. Conclusion: In endemic areas, tuberculosis must be ruled out first in patients with brain tumors since it may simulate any type of lesion. 205 European Journal of Neurology, 22 (Suppl. ),

31 54 Flash Posters F065 Guillain-Barré syndrome in HIV infection a case report E.C.I. Rosca, O. Rosca 2, M. Simu University of Medicine and Pharmacy Victor Babes, Department of Neurology II, Timisoara, Romania, 2 University of Medicine and Pharmacy Victor Babes, Department of Infectious Diseases I, Timisoara, Romania Background and aims: The acute inflammatory demyelinating polyradiculoneuropathy or the Guillain-Barré syndrome (GBS) was rarely described in HIV-infected patients. Recent studies suggest that the treatment with Immunoglobulin (IVIG) not only improves the neurologic symptoms, but in addition to ART therapy, it reduces the HIV reservoir. Case Report: We report the case of a 2-year-old man, with generalized motor deficit that interrupted his ART therapy 3 months ago. Five days before admission, he noted paresthesias in his limbs, followed by pain and progressive weakness. On neurological examination, he had /5 strength in the lower extremities, 3/5 strength in the upper extremities, diminished tendon reflexes, decreased sensation in the lower limbs and dysphagia. Examination of the CSF revealed increased protein level and pleocytosis. Electromyographic findings suggested an acute demyelinating process with conduction block. A diagnosis of GBS was made and the patient received treatment with a 5-day course of 0.4 g/kg/d IVIG. He refused the ART therapy Results: After the treatment, the neurological status improved (3/5 strength in lower extremities, 4/5 in upper extremities, swallowing problems remitted). Interestingly, his CD4 and CD8 cell count increased and the plasma viral load decreased. Conclusion: IVIG has several effects on the immune system but the mechanism of action in HIV infection is unknown; recent studies suggest its utility as adjuvant therapy in HIV infection. The present case brings further evidence in favor of this hypothesis. Furthermore, the patient s immune status improved and the viral load decreased without any ART therapy. F066 A case of concurrent detection of Prototheca zopfii and intracranial germinoma N. Rusche, J. Hench 2, S. Frank 2, U. Rösler 3, P. Lyrer, N. Peters USB, Neurology, Basel, Switzerland, 2 USB, Neuropathology, Basel, Switzerland, 3 Freie Universität, Veterinärmedizin, Berlin, Germany Background and aims: Germinoma and other germ cell tumors (GCTs) of the central nervous system are rare, especially affecting children and young adults. GCTs constitute an important differentialdiagnosis to inflammatory brain disease. Concurrent intracerebral protothecosis has not been described. Case Report: A 2-year-old male Caucasian presented with Parinaud s syndrome. He reported several holiday trips to Thailand, including diving. MRI showed bilateral subependymal contrast enhancing lesions periventricular to the anterior lateral ventricles, anterior commissure, di- and mesencephalon and the caudate. CSF showed mononuclear pleocytosis and positive oligoclonal bands. Periventricular stereotactic biopsy exhibited granulomatous inflammation, favoring differentialdiagnosis of cerebral sarcoidosis. Under guideline therapy, clinical course and follow-up MRI were initially stable. Yet, after four months, MRI revealed disease progression with beginning hydrocephalus. A consecutive biopsy of the contralateral periventricular lesion showed particles suggestive of Prototheca associated with granulomatours changes. Presence of Prototheca zopfii (genotype 2) was confirmed by PCR and DNA sequencing from brain-tissue, CSF and urine. Again, under treatment (amphotericin, voriconazole) the clinical course initially remained stable, but MRI showed progressive disease again, enforcing biopsy of the progressive mesencephalic lesion, which revealed germinoma. Chemotherapy was initiated, leading to lesion regression. By retrospective immunohistochemical analysis, no tumor was detected in the protothecosis biopsy site. Results: Intracranial germinoma is a rare but important differentialdiagnosis to inflammatory brain processes, especially in young adults. Here, diagnosis of germinoma was confounded by initial diagnosis of protothecosis with positive PCR in several tissues, including brain tissue. Conclusion: The potential causal link between the two disease entities remains elusive. 205 European Journal of Neurology, 22 (Suppl. ),

32 Flash Posters 55 F067 Acute ischaemic stroke and lyme neuroborreliosis: a case report J. Sequeira, S. Dias, J. Morgado, C.M.C. Capela, A. Calado, M. Dias, R.M.G. Pedrosa Centro Hospitalar Lisboa Central, Neurology, Lisbon, Portugal Background and aims: Lyme neuroborreliosis (LNB) is an infectious disorder of the nervous system caused by the spirochaete Borrelia burgdorferi (Bb), occurring in 0 to 5% of patients with Lyme disease. Central nervous system involvement is rare, but can occasionally pose a challenge in the differential diagnosis of cerebrovascular disease. The authors describe a patient with cerebral vasculitis and stroke due to LNB. Case Report: A 38-year-old previously healthy Portuguese woman presented with acute binocular diplopia and gait imbalance. Examination demonstrated a wide-based gait, paresis of left eye adduction, right hemiataxia and a cutaneous rash resembling erythema migrans. The patient s history was positive for a tick bite and subsequent flu-like syndrome one month before admission. Results: Brain magnetic resonance imaging showed a left paramedian mesencephalic ischaemic infarction. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis and absence of oligoclonal bands. Serological tests for Bb were positive in the serum (anti-bb IgM) but negative in the CSF. Further investigation was normal or negative, excluding other infectious, autoimmune or prothrombotic disorders. A diagnosis of LNB was made and the patient was treated with a 2-day course of intravenous ceftriaxone (2 g/day). Complete neurological recovery was observed during the first week of treatment and she was asymptomatic at discharge. Conclusion: LNB is an uncommon cause of ischaemic stroke and should be considered in its differential diagnosis when an evocative epidemiological context is present. Precocious detection is essential to provide appropriate treatment and prevent further events. 205 European Journal of Neurology, 22 (Suppl. ),

33 56 Flash Posters Movement disorders F068 High-frequency repetitive transcranial magnetic stimulation can improve quality of life and depression in Parkinson s disease A. Makkos, E. Pál, Z. Aschermann, J. Janszky 2, S. Komoly, N. Kovacs 2 University of Pécs, Pécs, Hungary, 2 MTA-PTE Clinical Neuroimaging MR Research Group, Pécs, Hungary Background and aims: The efficacy of repetitive transcranial magnetic stimulation (rtms) on health-related quality of life has not been evaluated in depressive Parkinson s disease (PD) patients. Therefore, we conducted a randomized, double-blind, placebo-controlled study to evaluate the efficacy of rtms over bilateral motor cortex. Methods: 46 patients with PD an mild-moderate depression randomly assigned to active (n=23) and sham (n=23) rtms. 2 patients in the sham group did not complete the protocol because of reasons unrelated to the study. High frequency rtms was applied over the primary motor cortex for 0 days. An investigator blinded to the treatment performed three video-taped examinations on each patient: before stimulation (baseline), day (short term), and 30 days after treatment session ended (long-term effect). Primary endpoint was the changes in quality of life measurement (PDQ- 39) while secondary endpoints included depression scales and Movement Disorders Society Unified Parkinson s Disease Rating Scale (MDS-UPDRS). Results: In the actively-treated group not only the quality of life improved (from 25.4 to 9.6 points, PDQ-39 summary index, median values, p<0.00), but also the severity of depression (from 7 to 7 points, Montgomery-Asberg Depression Rating Scale, p<0.00). We could also demonstrate an insignificant improvement in MDS-UPDRS Motor Examination by 6 points (p=0.229). In the sham-treated group none of the examined tests and scales improved significantly after sham stimulation. Conclusion: Our results demonstrate the beneficial effects of rtms over the motor cortex on health-related quality of life and depression in PD. Disclosure: Our study was supported by Bolyai Scholarship of Hungarian Academy of Sciences, OTKA PD03964, TÁMOP A-//KONV , and Hungarian Brain Research Program - Grant No. KTIA_3_NAP-A- II/0 government-based funds. The present scientific contribution is dedicated to the 650th anniversary of the foundation of the University of Pécs, Hungary. Montgomery-Asberg Depression Scale 205 European Journal of Neurology, 22 (Suppl. ),

34 Flash Posters 57 F069 Bilateral subthalamic deep brain stimulation improves sleep-quality G. Deli, Z. Aschermann, P. Ács, J. Janszky 2, B. Faludi, S. Komoly, I. Balás, T. Dóczi 2, N. Kovacs 2 University of Pécs, Pécs, Hungary, 2 MTA-PTE Clinical Neuroimaging MR Research Group, Pécs, Hungary Background and aims: Sleep problems are one of the most common non-motor symptoms of Parkinson s disease (PD). There are inconsistent data available on the beneficial effect of subthalamic deep brain stimulation (DBS) on sleep quality. In the present study we aimed to evaluate how DBS can change the sleep-related problems. Methods: In this prospective study, 25 consecutive patients underwent DBS implantation were enrolled. Patients were examined twice: week prior the DBS implantation (baseline) and 2 months postoperatively. Severity of PD symptoms were assessed by Movement Disorders Society Unified PD Rating Scale (MDS-UPDRS) and Non-Motor Symptoms Scale (NMSS). Presence and severity sleep disturbances were specifically measured by PD Sleep Scale (PDSS-2). Results: Total score of MDS-UPDRS improved from 8 (median, interquartile-range: 63-03) to 55 points (median, IQR: 46-75, p<0.00). Health-related quality of life also improved from 29 (IQR: 8-40) points to 5 (IQR: 9-28) points (p=0.002) measured by PDQ-39. With the exception of hallucinatory symptoms and sexual dysfunction, all domains of NMSS improved. At baseline 3 patients reported sleep problems, but year after DBS implantation only 3 did (p=0.02). Simultaneously, the total score of PDSS-2 decreased from 24 (IQR: 7-32) to 0 (IQR: 7-8) points (P<0.00). Although all domains of the PDSS-2 significantly improved, only 6 items had significant decrease after DBS implantation. Conclusion: Not only the number of patients reporting the presence of clinically relevant sleep problems improved, but also the general sleep quality became better. Disclosure: Our study was supported by the Bolyai Scholarship of Hungarian Academy of Sciences, OTKA PD03964, TÁMOP A-//KONV and Hungarian Brain Research Program - Grant No. KTIA_3_ NAP-A-II/0 government-based funds. The present scientific contribution is dedicated to the 650th anniversary of the foundation of the University of Pécs, Hungary. F070 Study of the spinocerebellar ataxias in Belarus I. Pliashko, S.A. Likhachev Minsk, Belarus Background and aims: The spinocerebellar ataxias (SCA) are the group of neurological diseases characterized by phenotypic and genetic heterogenity, cerebellar dysfunction and various noncerebellar symptoms. Methods: We created and studied the republic database which included 343 patients with SCA. 83 (24%) patients were examined in our center. Ataxia severity measured using the scale for assessment and rating of ataxia (SARA). 23 (7%) patients were genetically tested for the SCA types, 2. Results: The prevalence of SCA in Belarus is 3.5 cases per 00, (58%) patients live in cities, 45 (42%) in villages; 53.6% were female and 46.4% were male. The age of the patients was 8-7 (49±.7) years. Among 83 (24%) patients clinically examined in our center, 39 were male, 44 female. Age of the patients was 8-66 (39±8.) years old; the age of onset was 5-64 (33.5±6.7). 4 (49.4%) patients have positive family history. All the patients had slowly progressive cerebellar ataxia. SARA score was 6-37 (2±4.). Extrapyramidal symptoms were observed in 2 (25%) cases, pyramidal tract involvement in 39 (47%), peripheral neuropathy in 20 (24%), cognitive impairment in 27 (33%). Molecular-genetic test of 23(28%) patients detected 2 SCA- and 4 SCA-2 cases. Conclusion: Our results suggest phenotypic heterogeneity of SCA. The clinical examination of patients with genetically confirmed SCA-, 2 conforms with known reverse correlation between the size of CAG expansion and the age of the onset of disease. F07 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

35 58 Flash Posters F072 Compound heterozygosity for Niemann- Pick type C disease presenting as sporadic adult-onset cerebellar ataxia, dystonia and supranuclear ocular paresis without psychiatric symptoms or visceral signs A.D. Magalhães, L. Correia Guedes, M. Coelho Hospital de Santa Maria, Neurology Department, Lisbon, Portugal Background and aims: Niemann-Pick type C (NPC) disease is a rare autosomal recessive, probably underdiagnosed disorder, in which the lysosomal accumulation of lipids causes a wide variety of symptoms that make difficult and delay its diagnosis for about 5-0 years after symptom onset. Adult-onset NPC is uncommon and its main clinical features are cognitive decline, psychosis, cataplexy, epilepsy, and cerebellar, basal ganglia and brainstem dysfunction. Case Report: A 4-year-old woman visited the department for imbalance and difficulty swallowing, slurred speech and impairment in memory and attention. On neurological examination there was executive dysfunction, mild short-term memory deficit, hypermetric saccades and slowing of vertical ocular movements, facial dystonia, scanning speech, limb and truncal ataxia, intention tremor, inability to stand unaided with multidirectional oscillations, widened base, unstable gait and inability to tandem walk. No evidence of parkinsonism or proprioceptive loss. Results: Brain MRI showed pancerebellar atrophy. Inflammatory, vascular, toxic, endocrine and nutritional, infectious and structural causes were excluded. Genetic testing for SCA,2,3,6,7 and 7, DRPLA and ataxia with oculomotor apraxia type and 2 was negative. Filipin test on skin biopsy was positive and genetic testing for NPC showed compound heterozygosity for c.352_353delag (p.q9fs*8) and c.357a>g (p.r73g) mutations, the latter not previously reported. Conclusion: NPC is a treatable disease in which the delay in diagnosis can significantly impact patients quality of life. We report a case of a compound heterozygosity and a new mutation not yet described presenting as sporadic cerebellar ataxia, dystonia, supranuclear ocular paresis and cognitive decline. F073 Oxydative stress: implications for Parkinson s disease B.H. Manel, B.A. Sana, G. Hajer 2, F. Selima 2, M. Abdelhedi 2, H.M. Salah, B.A. Sofien 3 University Hospital of Sahloul, neurology, Sousse, Tunisia, 2 University of Farhat Hached, Biochemistry,, Sousse, Tunisia, 3 University Hospital of Sahloul, neurology, sousse, Tunisia Background and aims: The pathogenesis of PD is not completely understood. Oxidative stress seems to be one of the main etiological factors that has been proposed. The aim was to evaluate peripheral blood markers of oxydative stress in PD patients, to compare results with a control population and to deduce it s therapeutic consequence. Methods: A case control study including 52 PD patients and 52 control subjects from the Department of Neurology at the University Hospital of SAHLOUL, Sousse Tunisia. Idiopathic PD patients were diagnosed. The control group included subjects without neurodegenerative, somatic or psychiatric diseases. Blood samples were analyzed in the laboratory of biochemistry at the University Hospital of Farhat Hached, Sousse Tunisia. Peripheral blood markers of oxidative stress (ceruloplasmin, ferritin, transferrin, albumin, Copper, Zinc, Iron, catalase, TBARS, homocystein, lipids, liver and renal functions, fasting plasma glucose level) were evaluated Results: A total of 04 individuals were enrolled, the mean age was respectively 6.8 and 57.2 years. The mean age of onset of the disease was PD group had plasma glucose, urea, homocystein, TBARS levels higher than in the control group. Total cholesterol, HDL-cholesterol and uric acid levels were lower in the control group. Plasma Iron and ferritin concentrations were significantly higher in PD patients and it was a positive correlation with age. Transferrin was negatively correlated to age and âge of onset of the disease Conclusion: Our results suggest a pathogenetic role of systemic oxidative stress in PD. Many studies demonstrated that treatments aimed at decreasing oxidative damage may be beneficial. 205 European Journal of Neurology, 22 (Suppl. ),

36 Flash Posters 59 F074 Diagnosis of subclinical postural disorders in patients with Parkinson s disease I. Maryenko, A. Buniak, S. Likhachev Republican Research and Clinical Center of Neurology and Neurosurgery, Department of Neurology, Minsk, Belarus Background and aims: Introduction: The main symptoms of Parkinson s disease (PD) are locomotor and postural disorders. Objective: Detection of latent postural disorders in patients with PD -2 stages on the Hoehn and Yahr scale. Methods: Material and Methods: We examined 30 patients with PD (4 male and 6 female, with mean group age 38,2±5,6 years). There are 8 patients with st stage, 2 patients with 2nd stage. At the moment of examination patients didn t complain of dizziness, falling, unsteadiness and instability. The dynamic stabilometry was performed using the stabiloanalyzer Stabilan with biofeedback (JSC Rhythm, Russia). The patients were given instruction to hold the moving marker by deviation of the body. The results were presented as a diagram of the testing directions and stabilogram parameters. Stability parameters assessed included: the average speed of movement of the center of pressure (ASMSP, mm/s), ellipse area (EA, mm2). Subclinical postural disorders were diagnosed when magnitudes of all the values in this test were not greater than 35% of the same indicators in the Romberg test. Results: Dynamic stabilometry in the patients with PD had revealed an insufficient deviation of the pressure center in all directions in 5 (50%) cases. Mean ratio of EA in dynamic and Romberg tests was 20±4.9%. Conclusion: Subclinical postural disorders identified in 50% of cases. In patients with early PD dynamic stabilometry allows to reveal dissociation between disease stage and degree postural instability. F075 Unusual phenotype of pathologically confirmed progressive supranuclear palsy K. Mensikova, L. Tuckova 2, J. Ehrmann 2, P. Kanovsky Faculty of Medicine and Dentistry, Palacky University and University Hospital, Department of Neurology, Olomouc, Czech Republic, 2 Faculty of Medicine and Dentistry, Palacky University in Olomouc, Department of Clinical and Molecular Pathology, Olomouc, Czech Republic Background and aims: Based on the results of recent clinico-pathological studies it seems that the clinical heterogeneity of progressive supranuclear palsy is much more broader than it has so far seemed. Here we report two cases of patients with unusual manifestation of pathologically confirmed PSP. Methods: Detailed clinical and laboratory examinations and post mortem neuropathological examinations were done in both patients. Results: The first case was a 60-year-old woman with progressive micrografia and stuttering speech from the age of 53. Bilateral horizontal nystagmus, pyramidal syndrome, postural instability, asymmetric parkinsonian syndrome, severe dysarthria, gaze palsy and bulbar syndrome were present after 6 years. There were no signs of cognitive deterioration. The patient died due to the cardiac arrest; at autopsy, the brain pathology matched to the diagnosis of 4R tauopathy. The second case was a 67-year-old woman with progressive cerebellar syndrome, increased urinary frequency and orthostatic hypotension from the age of 60 years; followed by parkinsonian and pyramidal syndrome, speech impairment, dystonia of the limbs and anterocollis. There were no signs of cognitive deficits. The patient died due to bronchopneumonia; at autopsy, the brain pathology Conclusion: The combination of clinical symptoms was such diverse and the symptoms which are classified as exclusion criteria for PSP were present, so they were both clinically diagnosed as MSA-P. The brain pathology meeting Williams diagnostic criteria of PSP raises the question about the next possible clinical phenotype of PSP, PSP- MSA. Supported by the grant IGA UP LF European Journal of Neurology, 22 (Suppl. ),

37 520 Flash Posters F076 Cerebral folate deficiency syndrome with adolescence onset I. Moreira, E. Lourenço 2, M. Rodrigues 2, M. Magalhães Hospital Santo António, Centro Hospitalar do Porto, Neurology, Porto, Portugal, 2 Hospital de Braga, Neurology, Braga, Portugal Background and aims: Cerebral folate deficiency (CFD) syndrome is a clinically heterogeneous neurological syndrome with multiple etiologies, characterized by CSF folate deficiency with normal serum folate level. Case Report: A 2-year-old boy, with two cousins with phenylketonuria, developed at age of 0 a progressive generalized tremor associated with gait difficulties. At age of 6, when he was first observed, had cognitive regression with frontal behavioral traits, intrusive eye movements during pursuit and saccadic gaze, multisegmental dystonia, generalized tremor, pyramidal syndrome and gait ataxia. Neuropsychological assessment showed frontal dysfunction. Electroencephalogram exhibited basal slow activity (6 Hz). Levodopa was started with virtually disappearance of movement disorder symptomatology. Blood count, biochemistry, thyroid function, copper, ceruloplasmin and non-volatile and very long chain fatty acids were normal. CSF folate was low (<20 nmol/l, normal range is nmol/l); neurotransmitters and pterines were normal. Serum folate was normal. Lactate and pyruvate were slightly increased. Brain MRI had small nonspecific white matter lesions with normal spectroscopy. Diagnosis of CFD syndrome was established. Electromyography, muscle biopsy, POLG gene and complete mitochondrial DNA sequencing were normal. Blocking anti-folate receptor A antibodies were positive. He has a mutation in heterozygous to PAH gene. With the folinic acid supplementation cognitive and extra-pyramidal syndrome improved, but since age of 8 pyramidal syndrome worsening. Results: This patient had CFD syndrome with high anti-folate receptor antibodies level but a mitochondrial cytopathy could not be totally excluded. Conclusion: CFD phenotypic expression seems to be determined by age of onset. Family history and levodopa response makes this a peculiar case. F078 Assessment of severity and therapeutical response in 70 patients with idiopathic and symptomatic form of restless legs syndrome N. Neykov, I. Staikov 2, A. Simeonova 2 Sofia, Bulgaria, 2 MHAT Tokuda Hospital Sofia, Neurology, Sofia, Bulgaria Background and aims: To evaluate the clinical form and severity of the condition, the degree of sleep disorders, the effects of the therapy, electroneurographic and electromyographic findings in 70 patients with symptomatic or idiopathic form of RLS Methods: Somatic and neurological status, laboratory tests, electromyography, electroneurography and evaluation of complaints and sleep disorders by PSQI and by RLS- RS before the start of therapy and on the third month after the therapy. Results: Cases of idiopathic restless legs syndrome: Before starting the treatment with a dopamine agonist and magnesium, patients were on average 32 RLSRS and 3 PSQI scale. None of the group of patients with idiopathic form of RLS had any EMG and ENG data for damage to the peripheral nerves and muscles before or after treatment. After three months of treatment, patients were assessed on average 5 RLSRS and 3 PSQI scale. Symptomatic patients with restless legs syndrome: Before the start of treatment RLSRS averaged 26 and PSQI 2. Patients with symptomatic restless legs syndrome were divided into groups according to their concomitant conditions. Most patients had ENG data for varying levels and types of damage to the peripheral nerves. On the third month of therapy with dopamine agonists and magnesium a moderate improvement was found in complaints, with RLSRS 9 and PSQI 6. Conclusion: Patients with restless legs syndrome both idiopathic and symptomatic form have a significant improvement during treatment with dopamine agonists and magnesium, and in those with idiopathic RLS form the therapeutic response is higher F077 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

38 Flash Posters 52 F079 The prevalence and risk factors of impulsive control disorders in Parkinson s disease patients A. Nikitina, N. Fedorova Russian Medical Academy for Post-Graduate Education, Neurology, Moscow, Russian Federation Background and aims: Impulsive control disorders (ICD) in Parkinson s disease (PD) patient develop as a result dopaminergic replacement therapy (DRT). ICD in PD patient include pathological gambling, hypersexuality, compulsive buying, and binge eating, punding, dopamine dysregulation syndrome (DDS). Aim: To determine the prevalence clinical spectrum of ICD in PD patients Methods: Material and methods: 340 PD patients were screened by Questionnaire for Impulsive-Compulsive Disorders in Parkinson s Disease (Weintraub D, 2009). ICD revealed in 60 patients (7%). Mean age was 64,86±9,59. Average disease duration was 0,76±5,66. Average age of onset disease was 54,48±0,5. Mean duration dopamine replacement therapy was 9,64±5,39. Prevalence men and women in this survey was equally (m=3; w=29). L-dopa equivalent dose (00mg of L-dopa = 3- mg of L-dopa in controlled-release form = 70mg of L-dopa if also using entacapone = mg of pramipexole = 5mg of ropinirole) was 226,47±734,96. Results: The most frequent ICD was occurance of punding (0.3%), dopamine disregulation syndrome (DDS) was found in 7.9%, binge eating 6.2%, hypersexuality 5.0%, compulsive shopping 4.%, pathological gambling,%. Different ICDs combined in one patient in 55% case. Of these 60 patients, 2 of the ICDs was 28.3%, 3 of the ICDs was 5%, 4 of the ICDs was 6.7%, 5 of the ICDs was 5%. More often occured the combination by punding and binge eating (n=2); DDS and punding (n=). Conclusion: The most frequent ICD was punding and DDS, and gambling occured rarely. F080 Influence of different motor subtypes of Parkinson s disease (PD) on expression of non-motor symptoms (NMS). M.A. Nikitina, I.A. Zhukova, V.M. Alifirova, N.G. Zhukova, O.P. Izhboldina, A.E. Agasheva 2, L.M. Glotova 2, M.A. Titova, E.V. Terskikh, M.N. Azhermacheva Siberian State Medical University, Department of neurology and neurosurgery, Tomsk, Russian Federation, 2 Hospital 2, Tomsk, Russian Federation Background and aims: Background. NMS are important determinants of life quality (QoL). It is increasingly evident that PD is not a single entity but rather a heterogeneous neurodegenerative disorder. Aim. Studying variation of NMS depending on motor subtypes in patients with PD (PwPD) without dementia. Methods and Materials: 3 PwPD (mean age: 66.5±5.8 years; mean duration of PD: 7.2±5.6 years; H&Y stages 4) were screened in the Siberian region to reveal of NMS. Two groups of motor phenotypes were studied (homogeneous by gender, age, stage): I 52 tremor dominant (TD) PwPD, II 8 rigidity dominant (RD). Clinical assessments were carried out using the UPDRS (III part), H&Y Scale, Beck depression inventory, PD Sleep Scale, Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale, Apathy Scale, Parkinson s Disease Questionnaire-39. Results: Significant differences were found between groups in the NMS expression: II group were about twice as likely to have clinically-significant depressive symptoms (33.3%, while 3.4% in I), apathy (40.7% in group II, 30.7% in I), excessive daytime sleepiness (67.9% in II, 53.8% in I), anxiety (48.% and 38.4% relatively). The RD subtype correlates with a worse NMS score than the TD subtype does. Conclusion: Observations show NMS variation depending on the PD motor subtype. Thus, further research is needed regarding PD subtypes in order to determine diagnostic and prognostic biomarkers to reveal mechanisms of neurodegenerative processes, to improve therapeutic clinical trial designs and QoL of PwPD. 205 European Journal of Neurology, 22 (Suppl. ),

39 522 Flash Posters F08 Patients with degenerative cerebellar ataxia do not benefit from a short-term treatment with acetyl-dl-leucine: a case series J. Pelz, C. Fricke, D. Saur, J. Claßen University of Leipzig, Department of Neurology, Leipzig, Germany Background and aims: Recently, acetyl-dl-leucine was shown to significantly improve motor function in degenerative cerebellar ataxia regardless of underlying etiology, symptom duration or severity. Aim of this case series was to revisit this observation. Methods: 0 patients with degenerative cerebellar ataxia (six female; median age 54 years, range 43 to 80 years; median symptom duration 4 years, range to 33 year) were treated with 5 g liquid acetyl-dl-leucine daily for 7 days. Concomitantly, all patients received altogether 5 sessions of physiotherapy à 45 minutes and also 5 sessions of occupational therapy à 30 minutes, each individually matched to the patient s symptoms. For blinded endpoint assessment, changes on the Scale for the Assessment and Rating of Ataxia (SARA) were assessed by three examiners (CF, DS, JC) from videos recorded at baseline and on day 7 of active treatment. Results: There was an excellent interrater reliability for the assessment of SARA scores from the video recordings with an intraclass correlation coefficient (absolute mode) of 0.97 to 0.98 between each pair of raters. While 7 of 0 patients reported subjective improvement, no significant change in mean SARA score could be detected (Wilcoxon test; p = 0.7). During in-hospital treatment no side effects were observed. Conclusion: We failed to confirm beneficial effects of acetyl-dl-leucine in combination with an intensive short-term physio- and occupational therapy in degenerative cerebellar ataxia. At this time, acetyl-dl-leucine cannot be recommended for treatment of patients with cerebellar ataxia and further (pre-) clinical studies are warranted. F082 Plasma concentration of apoptotic bodies in Parkinson s disease A.-B. Perona-Moratalla, E. Palazón García, S. Arteaga 2, G. Serrano-de las Heras 2, T. Segura Martín Hospital General de Albacete, Neurology, Albacete, Spain, 2 Hospital General de Albacete, Research Unit, Albacete, Spain Background and aims: Apoptosis appears to be one of the molecular mechanisms involved in the pathogenesis of Parkinson s disease (PD). Analyzing in vivo pathological samples to confirm it is not feasible. However, it is possible to detect and quantify in plasma apoptotic bodies (AB), small vesicles, originating from cells that have undergone apoptotic cell death. Pilot study aimed at assessing whether there is a correlation between the plasma concentration of AB and the Hoehn and Yahr (H&Y) stage in patients with PD. Methods: 4 PD patients were enrolled in the project and demographic variables, evolution time, clinical phenotype and H&Y stage were recorded. Furthermore, peripheral blood samples were collected from each patient in order to purify circulating apoptotic bodies and, subsequently, to determine the concentration (number/ml plasma) of these vesicles using flow cytometry techniques. Results: 9 men and 5 women, mean age 68.9 years (range 49-8); Stage, n=3; stage 2, n=7; stage 3, n=3 and stage 4, n=, were studied. Our results showed that patients at advanced stages (3,4) displayed significantly lower apoptotic bodies levels ( ± SD), than that detected in less severely affected subjects ( ±26,337 SD) p<0.05. Differences between evolution time, demographics data or clinical phenotype and AB plasma concentration were not found. Conclusion: The high plasma levels of apoptotic bodies determined in PD patients at early stage strongly suggests that apoptosis is involved in the progression of PD. Further studies are required to confirm this hypothesis. 205 European Journal of Neurology, 22 (Suppl. ),

40 Flash Posters 523 Neuroimmunology F083 Autoantibodies against glutamate receptor delta2 in a Caucasian patient after allogenic stem cell transplantation R. Miske, T. Rosenkranz 2, M. Müller 2, S. Hahn, I. Blöcker, S. Mindorf, Y. Denno, W. Schlumberger, W. Stöcker 3, C. Probst, C. Terborg 2, L. Komorowski Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany, 2 Asklepios Klinik St. Georg, Hamburg, Germany, 3 Institute of Experimental Immunology, Affiliated to EUROIMMUN AG, Lübeck, Germany Background and aims: Autoantibodies against neuronal receptors have become important markers for several treatable neuroimmunological disorders. Here we report autoantibodies against glutamate receptor delta2 (GluRδ2) in a patient who developed graft-versus-host disease affecting the gut and steroid-responsive neurological symptoms including myoclonic jerks, gait problems and a tendency of falling following stem cell transplantation. Methods: Histo-immunoprecipitation (HIP) with the patient s serum and cryosections of rat and porcine cerebellum followed by mass spectrometry was used to identify the autoantigen. Correct identification was verified by indirect immunofluorescence using recombinant GluRδ2 expressed in HEK293. Results: The patient s serum produced a granular staining of the cerebellar molecular layer (IgG and IgG3; endpoint titer: :,000) but did not react with other CNS tissues or 28 established recombinant neural autoantigens. HIP revealed a unique protein band at ~0 kda that was identified as GluRδ2. The patient s serum also stained HEK293-GluRδ2 but not mock-transfected cells. Control sera from 30 patients with other anti-neural autoantibodies (anti-nmdar, anti-hu, anti-yo, anti-ri, anti-aquaporin 4, anti-lgi, anti- CASPR2) and from 37 healthy blood donors were negative for anti-glurd2. Preadsorption with lysate from HEK293- GluRδ2 neutralized the patient s tissue reaction whereas control lysate had no effect. In addition to anti-glurδ2, the serum contained autoantibodies against the pancreatic glycoprotein CUZD. Conclusion: Both autoreactivities, antibodies against GluRδ2 and CUZD, seem to be connected to the patient s disorder supposedly triggered by the transplantation. Anti- GluRδ2 has so far been described in few Japanese patients with steroid-responsive cerebellar ataxia whereas anti- CUZD is a marker for Crohn s disease. Disclosure: RM, SH, IB, SM, YD, CP, and LK are employees of EUROIMMUN AG, a company that develops, manufactures and sells serological immunoassays. WSch are Wst Members of the Board. F084 Successful symptomatic therapy with intrathecal baclofen and great improvement after cancer treatment in a woman with anti amphiphysin positive stiff person syndrome N. Manhalter, E. Boros 2, M. Bokor, F. Fazekas 3, Z. Dénes 2, D. Fabo 4, A. Kamondi 4, L. Erőss 5 Nyírő Gyula Hospital-National Institute of Psychiatry and Addictions, Department of Neurology, Budapest, Hungary, 2 National Institute for Medical Rehabilitation, Department of Neurology, Budapest, Hungary, 3 Hungarian Military Hospital, Department of Neurology, Budapest, Hungary, 4 National Institute of Clinical Neuroscience, Department of Neurology, Budapest, Hungary, 5 National Institute of Clinical Neurosciences, Department of Functional Neurosurgery, Budapest, Hungary Background and aims: Stiff person syndrome is a rare neuroimmunological disease, characterized by severe, involuntary stiffness with superimposed painful muscle spasms, which are worsened by external stimuli. The classical form is associated with high levels of antibodies against glutamic acid decarboxylase. One of the variant forms is associated with antibodies against amphiphysin. This entity is a paraneoplastic syndrome, caused primarily by breast cancer, secondarily by lung cancer. Symptomatic therapy of anti amphiphysin positive stiff person syndrome includes treatment with benzodiazepines and baclofen (including intrathecal baclofen therapy). The effect of immunological therapies is controversial. Treatment of the underlying cancer may be very effective. Case Report: In this report, we describe a 68-year-old female presenting with an unusally rapidly developing anti amphiphysin positive stiff person syndrome, which was associated with breast cancer. Results: Her painful spasms abolished after intrathecal baclofen treatment was initiated. Her condition improved spontaneously and significantly after cancer treatment, which enabled to start her complex rehabilitation and the simultaneous dose reduction of the intrathecal baclofen. The bedridden patient improved to using a rollator walker and the baclofen pump could be removed 8 monthes after breast surgery. Conclusion: This highlights the importance of cancer screening and treatment in anti amphiphysin positive stiff person syndrome cases. 205 European Journal of Neurology, 22 (Suppl. ),

41 524 Flash Posters F085 Recurrent IgG4-related hypertrophic pachymeningitis J. Martins, N. Vila Cha 2 Centro Hospitalar do Porto - Hospital Santo António, Department of Neurology, Porto, Portugal, 2 ICBAS- Universidade do Porto, Biomedical Investigation Multidisciplinary Centre, Porto, Portugal Background and aims: CNS involvement in IgG4-related disease is rare and hypertrophic pachymeningitis (HP) represents the most common neurological presentation. These patients exhibit moderate-to-severe blood-csf barrier damage, oligoclonal IgG bands and high CSF IgG4 concentrations. Both IgG4 Index and IgG4loc are strong indicators of intrathecal IgG4 synthesis. Case Report: In 2008 a 63-year-old woman was admitted with a 2-month history of isolated high dorsal pain. CSF analysis showed lymphocytic pleocytosis, with normal protein and glucose ratio. MRI revealed pachymeningeal thickening and enhancement from C5 to D2, inducing slight medular compression. She was treated with steroids with clinical improvement and progressive regression of pachymeningeal lesion in control MRI. In 204 the patient was admitted for isolated lumbar pain over a period of 3 months. MRI revealed lumbar pachymeningeal thickening and intense enhancement from D7 to L5. CSF analysis showed mild lymphocytic pleocytosis, proteins 23 mg/ dl (<45), IgG concentration 48.4 mg/dl ( ), IgG Index 3.5 (<0.7) and evidence of oliglonal bands synthesis (3). CSF-IgG4 concentration was 4.7 mg/dl ( ), IgG4 Index was 7.09 ( ) and IgG4loc >0. Albumin quotient was.7 (<0.7). Both serum IgG and IgG4 were normal. Investigation including autoimmunity study, angiotensin converting enzyme, microbiological analyses and body CT scan were negative in both episodes. Meningeal biopsy was not performed. Conclusion: This case illustrates an IgG4-Related HP with a recurrent pattern in 6 years, which has not been previously described in literature. Despite being a rare disorder, the responsiveness to steroids treatment justifies the prompt investigation towards this etiology. F086 The effect of biogenic amines on Th7- cells in multiple sclerosis. M. Melnikov, V. Murugin 2, M. Pashenkov 2, A. Boyko Russian Research and Science Medical University named by Pirogov, MMSC, Moscow, Russian Federation, 2 Institute of Immunology, Laboratory of Clinical Immunology, Moscow, Russian Federation Introduction: Multiple sclerosis (MS) - chronic autoimmune disease of the CNS predominantly mediated by T- cells. Biogenic amines can participate in MS pathogenesis modulating immune cells activity and cytokine production. Objective: to study the effects of norepinephrine, dopamine and serotonin on the Th7-cells activity in MS. Methods and Materials : Data from 39 patients with relapsing-remitting MS and 30 healthy controls were included. Circulating Th7-cells was determined by flow cytometry (CD4+CD26+CD6+CD96+). The level of IL-7 was studied by ELISA in supernatants of short-term cells culture of peripheral blood mononuclear cells (PBMC) stimulated with anti-cd3cd28 antibodies. Samples were cultured also in the presence of exogenously added norepinephrine, dopamine and serotonin in different concentrations. Results: CD4+CD26+CD6+CD96+-cells ratio was comparable in patients and controls while IL-7 - significantly higher in MS (especially in relapses). Biogenic amines suppress IL-7: norepinephrine 0^-4 M (p<0.0) - both in controls and MS, dopamine 0^-5 M (p<0.05) and serotonin 0^-4 M (p<0.05) - only in MS, but not significant in controls. Conclusion: Effects of norepinephrine, dopamine and serotonin on IL-7 production can be considered as additional mechanism of immunoregulation in MS. 205 European Journal of Neurology, 22 (Suppl. ),

42 Flash Posters 525 F087 Practical management of stiff person syndrome in a limited resource setting report of experiences in a two year follow-up N. Siddi Ganie, R. Nichol 2, E. Janse Van Rensberg 2, L. Smit 2, A. Kruger 2, M. Nel 3, E. Lecuona 4 Durban, South Africa, 2 University of Free State, Neurology, Bloemfontein, South Africa, 3 University of Free State, Psychiatry, Bloemfontein, South Africa, 4 University of Free State, Occupational Therapy, Bloemfontein, South Africa Background and aims: Stiff person syndrome (SPS) is a severe, debilitating disease that is characterised by fluctuating degrees of rigidity and stiffness of the axial and lower limb muscles as well as positive serology for either the anti- GAD antibody, anti-ampiphysin antibody or the anti-islet pancreatic cell antibody. It has a prevalence estimated to be one in one million persons. Because of the rarity of this condition, no randomised controlled trials have been done to ascertain the effectiveness of the various treatment options currently available for the treatment of Stiff person syndrome as well as how they compare to each other. There have only been two reported cases of SPS in South Africa until 203. Since then more patients have met the DALA- KAS criteria for the diagnosis of typical SPS. Case Reports: We aim to describe the treatment of three SPS patients over a two year period. We will include a comparative analysis of their current treatment modalities including those for co-morbid psychiatric illnesses as well as patient preferences. Results: All three patients improved significantly with immunoglobulin therapy at 3-4 month intervals to alleviate stiffness and rigidity. Oral medication alone was ineffective for complete management. Conclusion: In a limited resource setting, the holistic management of stiff person syndrome becomes very difficult because of reduced availability of drugs prescribed for symptom control or immunological agents for disease modification. Despite the high cost, we also advocate the routine use of intravenous immunoglobulin every three to four months because of improved functional ability that is sustainable for that period F088 Steroid-responsive encephalopathy associated with thyreoid antibodies (SREAT) and limbic encephalitis P. Sommer, M. Krichmayr, T. Schlager, E. Fertl Vienna, Austria Background and aims: SREAT is a rare neurological syndrome consisting of encephalopathy in presence of thyreoid antibodies. Clinical presentation includes an altered mental state accompanied by epileptic seizures, cognitive impairment or psychiatric symptoms. SREAT has been classified as an immune-mediated disorder. Evidence concerning typical MRI lesions is scarce, so far case reports and small series reported mostly nonspecific white matter abnormalities. Results: A 38-year-old woman with a history of depression was admitted due to a severe generalized epileptic seizure without reorientation. At admission our patient presented with prolonged stupor. Laboratory studies were normal except mild hyponatriemia and the presence of antithyroid antibodies. CSF exhibited a slight pleocytosis, PCR for herpes virus, however, was negative. EEG was severely abnormal with generalized, but frontally predominant slow waves without spikes. cmri showed considerable enhancement of both amygdalae and bitemporal cortex, predominately right-sided. In the clinical course the patient developed typical Klüver-Bucy syndrome compatible with the radiological abnormalities. No tumor could be identified, antineuronal antibodies were not detected. Treatment with intravenous immunglobuline remained without effect, but consecutively we observed a rapid response to steroid treatment with full recovery after six weeks. Conclusion: We report a case of SREAT with MRI features of limbic encephalitis and beneficial clinical outcome. Evidence on typical MRI in patients with SREAT is scarce, further studies are warranted. 205 European Journal of Neurology, 22 (Suppl. ),

43 526 Flash Posters F089 Anti-LGI encephalitis: presentation with pure psychiatric symptoms S. Sousa, M. Faria 2, C. Carmona, F. Pita Hospital de Cascais, Neurology, Cascais, Portugal, 2 Hospital de Cascais, Medicine, Cascais, Portugal Background and aims: The anti-lgi encephalitis can present by classic limbic encephalitis, hyponatremia and faciobrachial tonic seizures. The anti-lgi synthesis rarely is intrathecal. Case Report: A 43-year-old woman with a past history of hysterectomy and oophorectomy for uterine cancer in 2007 and recurrent depressive episodes, initiate depressive symptoms with thoughts of suicide, in March 204. Various antidepressives were prescribed without improvement and she was admitted in psychiatric hospital. The treatment was escalated but she went on to develop memory dysfunction and auditory hallucination. Electroconvulsive therapy was done with impairment of cognitive function. In June 204, she was evaluated by neurologist; examination revealed a confusional state and memory loss. Blood tests and brain MRI were unremarkable; EEG showed diffuse slow activity. Cytochemical CSF was normal, but oligoclonal bands were positive. CSF and serum samples were sent for neuronal antibodies analysis. On day 20 after admission, she had dystonic posture of right upper limb that resolved with antiepileptic drug and later, she developed cognitive fluctuations, gait instability and tachycardia. She began sequential treatment with metilprednisone, intravenous immunoglobulin and rituximab (600mg/week, 4 weeks) for presumed autoimmune encephalitis, with gradual improvement. Days after treatment, anti-lgi antibodies were reported positive in CSF only. No occult neoplasm was detected. Conclusion: This case exemplifies the clinical and paraclinical variability of anti-lgi encephalitis. Our patient had unusual features in the described case, namely a pure psychiatric symptoms for a long period, the absence of hyponatremia, the brachial dystonic postures remission with antiepileptic drugs and the exclusive intrathecal production of anti-lgi antibodies. F09 Anti-NMDA receptor encephalitis with cancer of unknown primary origin E. Tüzün, A. Coban, R. Türkoglu 2, B. Bilgic, H.A. Hanağası, H. Gürvit İstanbul University, Neurology, İstanbul, Turkey, 2 Haydarpasa Numune Research Hospital, İstanbul, Turkey Background and aims: Paraneoplastic neurological syndromes (PNS) constitute a rare group of disorders caused by the remote effects of cancer. N-methyl-D-aspartate receptor (NMDAR) encephalitis associated with ovarian teratoma is a common cause of paraneoplastic encephalitis. Tumors related with NMDAR encephalitis generally have a relatively benign nature. Methods: We herein report two NMDAR encephalitis cases (62- and 64-year-old men) presenting with metastatic cancer of unknown primary origin. Results: Patients showed cognitive dysfunction, seizures and autonomic symptoms, slow waves on EEG, medial temporal lobe hyperintensity on cranial MRI and NMDAR antibodies in sera and CSF. Symptoms were effectively treated by pulse steroid and intravenous immunoglobulin treatment. Sixteen months after the neurological episode, 62-year-old patient developed a right parotid gland mass which was diagnosed as metastatic small cell neuroendocrine carcinoma. Three months later, a repeat PET scan showed a lung mass, which was diagnosed as small cell lung cancer. PET examination revealed a left inguinal mass in 64-year-old male patient, which was diagnosed as carcinoma of the metastatic squamous cell histological subtype. Repeat PET examinations failed to show the primary tumor in a follow-up period of 5 years. Conclusion: Both of our cases presented with metastatic lesions with unknown primary origin, which to our knowledge, has never been reported in NMDAR encephalitis. The rare occurrence of parotid gland small cell cancer metastasis from the lung is also reported for the first time in NMDAR encephalitis. Our cases imply that NMDAR encephalitis may occur with metastatic malignant cancer and the underlying cancer may show a very insidious course. F090 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

44 Flash Posters 527 F092 Impact of intracerebral neuro-behcet s disease immunoglobulin injection to brain parenchyma histology and behavioral tests E. Erdağ, C. Şahin 2, F. Arıcıoğlu 2, R. Türkoglu 3, E. Tüzün Istanbul University, Neuroscience, Istanbul, Turkey, 2 Marmara University, Pharmacology, Istanbul, Turkey, 3 Haydarpasa Numune S, İstanbul, Turkey Background and aims: Behcet s disease (BD) is a recurrent, multisystem inflammatory disease characterized with aphtous, genital ulcerations and uveitis with unknown etiology and pathogenesis. Neuro-Behcet s disease (NBD) is a neurological syndrome seen in 5-5% of the BD patients, mostly known as parenchymal form. There are no adequate animal models identified for NBD, so developing an animal model is purposed in this study. Methods: Immunoglobulins (IgG) were isolated from sera pool consisting of 5 cases and 5 health subjects samples with highest antibody levels. 20 Sprague Dawley rats were grouped for intracerebral injections as isolated antibody, serum physiologic, complete Freund adjuvant (CFA). 8 injections were performed every other day. As behavioral tests; open field, locomotor activity, elevated plus maze and passive avoidance were also performed at first, middle and end of the injection period. Animals then perfused and brain tissues were collected for immunohistochemistry staining. Results: For all groups, the time spent in the central area in the maze decreased while NBD group had shorter time. Correspondingly to the open field test s result, increase of anxiety was detected in fact of supporting the time spent in open arms in elevated plus maze test. Passive avoidance test showed memory impairment in NBD group. Immunohistochemistry results displayed neuronal changes in CDb, 8a and GFAP stainings. Conclusion: Comparing to NBD group with healthy subjects, NBD sera and/or IgG injected group showed significant proinflammatory and neuronal damaging changes. However, to confirm these findings it has to be studied in larger groups and more subjects. F093 Pathogenic role of proinflammatory cytokines in the development of chronic cerebral ischemia D. Usmanova, Y. Madjidova, K. Rasulova Tashkent Pediatric Medical Institute, Neurology, Tashkent, Uzbekistan Background and aims: Cerebral ischemia is the most frequent cause of the brain functions disorders accompanied by immune changes. The multiple studies show participation of the inflammation process in the atherogenesis and development of the chronic cerebral ischemia (CCI). Purpose was to study characteristics of the proinflammatory cytokines (TNF-α, IL-β, IL-6) in the patients with CCI with regard to the genesis of the development. Methods: There were studied 33 patients who were divided into 2 groups in relation to the pathogenesis of the CCI development. Group included 65 (42,5%) patients with CCI developed predominantly on the basis of arterial hypertension (AH). Group 2 consisted of 68 (44,5%) patients with CCI, developed mainly in cerebral atherosclerosis. The control group of 20 (3,0%) healthy subjects was made for comparison of immunological examinations. The measurement of the cytokine contents (TNF- α, IL-β, IL- 6) in the peripheral blood serum was performed with IFA method with use of commercial tests systems Vector Best, Novosibirsk, RF,203. Results: The level of TNF-α in the blood serum in the patients of group and 2 was increased 2,9 (6,3±0,76 pg/ ml) and 2,2 times (4,6±0,48 pg/ml), respectively, in the control group only 2,5±0,23 pg/ml. In group IL-β was increased,8 times (,4±,0 pg/ml), in group 2,4 times (8,9±0,64 pg/ml).il-6 in group was 7,4±0,86 pg/ ml, while in group 2 was 6,5±0,62 pg/ml. Conclusion: In the pathogenesis of CCI of the hypertonic and atherosclerotic genesis the proinflammatory cytokines have important role. F094 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

45 528 Flash Posters Neuro-oncology F095 Differential gene methylation in paired glioblatomas suggests a role of microenvironment in tumor progression A. Alentorn, A. Duran 2, A. Malousi 3, Y. Marie 4, M. Sanson 5, K. Hoang-Xuan, J.-Y. Delattre, A. Idbaih 5, C. Vecht 6 -APHP, Groupe Hospitalier Pitié-Salpêtrière,Paris, France. 2-2Institut du Cerveau et de la Moelle épinière (ICM), IN- SERM U 27, CNRS, UMR 7225, Paris, France. 3-UPMC University Paris 6, UM 75, Paris, France., Service de Neurologie 2, Paris, France, 2-APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France., Service de Neurologie 2, Paris, France, 3 Institut-Hospitalo-Universitaire Institut du Cerveau et de la Moelle épinière (IHU-ICM), Paris, France, Plateforme de Bioinformatique / Biostatistique, Paris, France, 4 Institut du Cerveau et de la Moelle épinière (ICM), INSERM U 27, CNRS, UMR 7225, Paris, France, Plateforme de séquençage et génotypage, Paris, France, 5 AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris 7503, France, Paris, France, 6 -APHP, Groupe Hospitalier Pitié-Salpêtrière,Paris, France. 2-2Institut du Cerveau et de la Moelle épinière (ICM), INSERM U 27, CNRS, UMR 7225, Paris, France. 3-UPMC University Paris 6, UM 75, Paris, France., Service de Neurologie 2, Paris, France Background and aims: DNA and histone methylation are post-transcriptional modifications that have been recently described in gliomas. Indeed, glioma CpG island hypermethylated phenotype (G-CIMP) has been identified as prognostic biomarker and as a surrogate marker of IDH/2 mutations. However, the role of DNA methylation in glioblastoma progression is unknown. We sought to analyze DNA methylation levels in paired (initial and recurrence) primary glioblastoma samples to identify candidate pathways that may prone to glioblastoma progression. Methods: We have analyzed 2 samples (5 paired samples, two of them with three surgeries) using Illumina 450K Bead arrays. We have analyzed differential methylation at probe and at gene region level. Finally, pathway analysis has been performed using differentially methylated regions. All analysis has been performed with R and Bioconductor packages. Results: Mean methylation level at initial sample compared to recurrence was strongly positively correlated (R2 = 0.98). There was no differentially methylation at probe level. However, at gene level 3080 genes were differentially methylated. Interestingly, pathway analysis showed that most of the differentially methylated genes are involved in immunity and inflammation response (i.e. GO: , GO: and GO: ). Conclusion: Methylation levels were strongly conserved when comparing initial to recurrence. Interestingly, such findings, as shown by pathway analysis, suggest that a modulation of methylation in glioblastoma microenvironment may play a role in glioblastoma progression. Further studies are needed to validate the role of methylation of glioblastoma microenvironment in tumor progression. F096 Paraneoplastic cerebellar degeneration in a patient with ovarian cancer - a case report T. Bourinaris, G. Deretzi, T. Kalantzakou, P. Petrou, I. Tsiptsios Thessaloniki, Greece Background and aims: Paraneoplastic cerebellar degeneration (PCD) is an uncommon non-metastatic neurological complication of malignancies. The neurological symptoms usually develop within weeks, progressing rapidly, before stabilizing and often leaving the patient disabled. We present a case of PCD as the initial manifestation of an ovarian adenocarcinoma in a 59-years-old female patient. Methods: A 59-year-old patient was presented the emergency department complaining of dizziness with subacute onset since 3 weeks with concomitant nausea and vomiting. On presentation she had cerebellar ataxia, mainly truncal, with nystagmus and dysarthria, which was rapidly deteriorated on following days. Initial laboratory and imaging evaluation was normal. On suspicion of paraneoplastic syndrome an abdomen CT showed a cystic mass at the anatomical position of right ovary. Further evaluation confirmed the diagnosis of PCD with positive anti-yo antibodies while a diagnostic laparoscopy revealed a low grade ovarian adenocarcinoma. Results: The patient was treated with abdominal hysterectomy with bilateral salpingo-oophorectomy and epiploectomy due to omental metastases, followed by plasmapheresis. Although the neurological symptoms were improved after the surgery, she eventually died on 6th postoperative day due to complications. Conclusion: PCD can precede the diagnosis of ovarian cancer in many cases. As our case shows the early diagnosis and treatment of the underlying cancer could be critical for the successful management of the paraneoplastic syndrome. 205 European Journal of Neurology, 22 (Suppl. ),

46 Flash Posters 529 F097 Leptomeningeal carcinomatosis from gastric cancer relapse A. Caetano, F. Gouveia 2, L. Alves Hospital Egas Moniz, Centro Hospitalr Lisboa Ocidental, Neurology Department, Lisbon, Portugal, 2 Centro Hospitalar do Barreiro Montijo, Internal Medicine, Lisbon, Portugal Background and aims: Leptomeningeal carcinomatosis (LMC) from gastric cancers (GC) is rare, with an incidence of up to 0.69%. The time lag between GC diagnosis and LC detection can be as high as 6 years. Cytopathological examination of the CSF is the gold standard test for diagnosis. Prognosis is very poor despite advances in chemotherapy and radiotherapy techniques. Case Report: A 66-year-old male with history of cervical spondylotic myelopathy and cured gastric adenocarcinoma (surgical resection 5 years earlier), with a recent normal endoscopy presented to the emergency room with increasingly frequent paroxysms of cervical pain with head and upper limb irradiation, accompanied by profuse sweating, vomiting and tachycardia. These episodes were worse during decubitus. His neurological examination revealed left eye papilledema. His brain CT was normal. On lumbar puncture (LP) opening pressure was increased (37cmH2O), there was hyperproteinorrachia (80 mg/dl), hypoglycorrachia (33% of blood glucose) and no pleocytosis (3 white cells/ul of CSF). Microscopy of the CSF cells was positive for neoplastic mucocellular cells (later confirmed on a second LP). His brain MRI showed no changes, namely no meningeal contrast enhancement. After extensive investigation, a biopsy of the esophagogastric anastomosis was positive for gastric malignancy. He died month later. Conclusion: This patient had a cured GC for 5 years, and presented with a nonspecific clinical picture. We performed a LP and despite the low number of cells, CSF microscopic evaluation was positive for malignancy thus diagnosing LMC. We reinforce the need for CSF examination even when LMC seems an improbable diagnosis. F098 Cystic radionecrosis of the temporal lobe as a late complication in patients with nasopharyngeal carcinoma: presentation of four cases and review of the literature A. Diaz-Alba, M. Sierra del Rio, E. Pappa, L. Feuvret, D. Ricard, D. Leclercq, K. Mokhtari 2, D. Psimaras 3, J.-Y. Delattre 4 Paris, France, 2 AP-HP, Groupe Hospitalier Pitié Salpêtrière, Laboratoire de Neuropathologie R Escourolle, Paris 7503, France., Paris, France, 3 University René Descartes, Department of Neurology Mazarin, Hôpital Pitié-Salpêtrière, Paris, France, 4 -APHP, Groupe Hospitalier Pitié-Salpêtrière,Paris, France. 2-2Institut du Cerveau et de la Moelle épinière (ICM), INSERM U 27, CNRS, UMR 7225, Paris, France. 3-UPMC University Paris 6, UM 75, Paris, France., Service de Neurologie 2, Paris, France Background and aims: Nasopharyngeal carcinoma (NPC) is a common malignant tumor in the Chinese population but is rare in the Western countries (incidence below / ). Radiotherapy is the standard radical treatment with excellent long term results, nevertheless, due to the close proximity to the skull base and the medial temporal lobe local radionecrosis is a well-known late complication. Cystic radionecrosis is a very rare condition and only a few cases have been described in the literature. Methodst: We present 4 cases with emphasis in radiological differential diagnosis with tumor and symptomatic treatment of radionecrosis. All of our patients were irradiated with 70 Gy. Results: The clinical presentation was multiple cranial involvement in 3/4, and memory impairment and seizures in. Two out of 4 patients were treated with steroids; none of them had clinical or radiological response. Conclusion: Similar to the literature the periods between the last irradiation and the diagnosis of radionecrosis ranged from 59 to 69 months. This entity must be searched in patients with NPC previously irradiated; the differential diagnosis of radionecrosis versus tumor recurrence or infection processes may be difficult but newer imaging techniques in radiology are helpful for the early diagnosis. 205 European Journal of Neurology, 22 (Suppl. ),

47 530 Flash Posters F099 Subependymoma presenting in family adenomatous polyposis: random association or Turcot syndrome? N. Dubuisson, P. Bosschaert 2, X. De Koninck 3, C. Verellen Dumoulin 4, M.J. Dupuis Clinique Saint-Pierre Ottignies, Neurology, Ottignies, Belgium, 2 Clinique Saint-Pierre Ottignies, Radiology, Ottignies, Belgium, 3 Clinique Saint-Pierre Ottignies, Gastroenterology, Ottignies, Belgium, 4 IPG Gosselies, Genetics, Gosselies, Belgium Background and aims: We report the case of a 38-year-old male patient with history of familial adenomatous polyposis (FAP) who presented a subependymoma. An atypical presentation of Turcot syndrome was suspected. The syndrome described by Turcot associates primary brain tumors with multiple colorectal polyps. It is classified in two types based on the clinical aspects and genetic abnormalities. Type associates glioblastoma or high grade astrocytoma to hereditary non polyposis colorectal cancer. Type 2 associates medulloblastoma with FAP in 80% of cases but high grade astrocytoma and ependymoma have also been described. Case Report: Six members of this patient s family were followed in gastroenterology for FAP. After genetic investigations a deletion of four pairs in exon 5 of the APC gene was detected. Furthermore, the patient s uncle suffered both polyposis and cerebellar medulloblastoma. MRI screening of the family members to prevent future brain tumors was conducted. Our patient presented a lesion under the floor of the fourth ventricle; subependymoma was suspected and histological examination confirmed the diagnosis. Results: We present a case of subependymoma associated with FAP. Subependymoma represents % of intracranial tumors and many of the cases are detected incidentally. Taking into account this data and the existence of medulloblastoma by the patient s uncle, we believe the hypothesis could be a true association and not only a coincidence. Conclusion: We report the first described case of subependymoma associated with FAP. Awareness of this association is recommended but systematic brain screening in FAP is a matter of debate. F00 Malignant transformation of benign meningioma: case report and review of literature. A. Innocenti, G. Simonetti, P. Gaviani, A. Botturi, E. Lamperti, A. Silvani IRCCS Neurologico Carlo Besta, Milan, Italy Background and aims: Meningioma is a common intracranial tumor originated from meningothelial cells. Most meningiomas are benign, associated with a good outcome. However, malignant behavior as metastatic disease has been described. In this report we present a case of non-cns metastases of meningioma and discuss predictors of tumor evolution. Case Report: In 990 a young female underwent a surgical exeresis of a grade I meningioma. 20 years later, for a local recurrence, a new resection was performed, followed by radiotherapy and radiosurgery. In 203 a chest x-ray showed the incidental discovery of a pulmonary consolidation: a lung biopsy revealed a lesion compatible with anaplastic meningioma. Subsequent analysis revealed renal involvement. Despite three lines of chemotherapy, neurological status progressively deteriorated, and in 204 the patient died. Conclusion: Although meningiomas are usually slow growing, aggressive behavior is occasionally described. Extracranial metastases are very rare, but may be present even with a grade I meningioma: WHO grade does not strictly fit with the prognosis. For this reason, it is important to discover what criteria can predict a malignant behavior. The most important predictors are histological features but they can not explain all aggressive behaviors. Several evidences are currently showing the relevance of some molecular pathways and gene (dys)regulation, as mutations in NF2 gene or loss of p. An aggressive behavior could depend on the accumulation of mutations, but the order of mutations is far from being understood. Understanding the pathogenesis of a malignant attitude may allow to predict an aggressive evolution and to identify therapeutic molecular targets. 205 European Journal of Neurology, 22 (Suppl. ),

48 Flash Posters 53 F0 Extraocular muscles thickening: the hidden rarity M. Lopes, L. Fontao, C. Santos, J.E. Alves 2, A. Coelho 3, C. Peixoto 3, F. Pimentel 4, A. Luís 4, C. Monteiro 4, L. Ruano Centro Hospitalar de Entre o Douro e Vouga, Neurology, Santa Maria da Feira, Portugal, 2 Centro Hospitalar do Porto, Neuroradiology, Porto, Portugal, 3 Centro Hospitalar do Porto, Anatomical Pathology, Porto, Portugal, 4 Centro Hospitalar do Porto, Maxillofacial Surgery, Porto, Portugal Background and aims: Microcystic adnexal carcinoma is a rare malignant neoplasm, presumably originating from sweat gland cells. The primary tumour is usually on the facial skin and has an aggressive behaviour, with high risk of subcutaneous and perineural dissemination. Methods: We observed a patient with microcystic adnexal carcinoma and reviewed the scientific literature on this topic. Results: A 53-year-old previously healthy woman was subjected to total thyroidectomy in April.203 and radioactive iodine on June.203 to treat a thyroid papillary carcinoma. A few weeks after the end of treatments, she started complaints of ocular discomfort, eyelid ptosis, blurred vision and dyschromatopsia on the right eye, and diplopia. A neurological evaluation revealed optic neuropathy, incomplete eyelid ptosis and discrete proptosis of the right eye, and diplopia on the right and left-and-up gazes. An orbital MRI revealed a non-specific thickening of right medial and inferior rectus muscles. She started on oral corticotherapy, with mild clinical improvement. MRI was repeated in January 204, with de novo abnormalities of the surrounding fat tissue, and March 204, with a contrast enhanced soft tissue mass invading retrobulbar fat tissue, orbital apex, pterygopalatine fossa, masticator space, foramen rotundum and vidian canal. Pathological examination diagnosed a microcystic adnexal carcinoma. Conclusion: There are four described cases of microcystic adnexal carcinoma with intraorbital clinical presentation, but only one of these is a primary orbital carcinoma. Our case was challenging, because of the temporal relation with the thyroid neoplasm treatment, non-specificity of imaging findings, initial clinical improvement and extreme rarity of this entity. F02 Extradural compressive myelopathy associated with B-cell chronic lymphocytic leukemia: A rare complication of a common malignancy A. Matas, R. Almendra, A. Veiga, A. Costa, J.P. Gabriel, M.R. da Silva Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal Background and aims: Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults in western countries. Is it associated with a low overall neurologic complication rate and the finding of extradural compressive myelopathy due to this entity is extremely rare, with only a few reports available in the literature. Case Report: A 69-year-old female diagnosed as a case of B-CLL two years before presented to our neurology department with complaints of low back pain and non-traumatic rapidly progressive lower limbs weakness. On general examination her vitals were normal, but neurological examination revealed flaccid paraparesis, predominant proximal, with areflexia, bilateral Babinski sign and hypoestesia bellow T6. Investigation revealed monoclonal gammopathy IgM-κ, macrocytosis and hypochromia without evidence of any other hematological abnormality. MRI of the spine showed an enhancing extradural mass extending from T2 to T6 with a left paravertebral component, causing cord compression. Results: A T2-T5 decompressive hemilaminectomy with lesion excision was performed within 24 hours and histopathology confirmed the diagnosis of B-CLL. Patient was managed with combined treatment with rituximab, cyclophosphamide, vincristine and prednisolone, with only modest neurologic recovery. Conclusion: It is distinctly rare for CLL to cause epidural compression, especially in a stable phase of the disease. This uncommon complication of CLL should be promptly recognised and urgently managed in order to prevent permanent disability. 205 European Journal of Neurology, 22 (Suppl. ),

49 532 Flash Posters F03 Parotid adenocarcinoma with paraneoplastic opsoclonus myoclonus ataxia (POMA) syndrome B. Özkara, A. Kutlu 2, S. Mulayim 3 Kocaeli, Turkey, 2 Kocaeli University, Neurology, Kocaeli, Turkey, 3 Kocaeli Univesity, Neurology, Kocaeli, Turkey Background and aims: Opsoclonus is a rare disorder characterized by involuntary, repetitive and rapid conjugate saccades occurring in all directions of gaze. Opsoclonus is more common in childrens than adults. Nearly 50% of child cases with OMS are associated with the presence of a neuroblastoma, although only 2% of children with this tumor actually develop the syndrome.in contrast, up to 50% of adult cases tend to be idiopathic.small cell lung and breast cancer account for approximately 70% of all adult cases. We present a POMA syndrome with parotid adenocarcinoma. Case Report: A 4-year-old male patient had started behavioral symptoms and 3 weeks after the onset he experienced bilateral eyeball tremor, staggering gait and frequent falls. Opsoclonus, truncal and extremity ataxia was observed. Results: Routine blood and urine tests, tumor markers, imaging tests were normal. Protein was increased in CSF. PET-CT scan showed no pathological involvement. As the symptoms persisted; 000mg/day intravenous methylprednisolone pulse steroid therapy was applied for 7 day dramatic improvement occured in symptoms. During clinical follow-ups a mass lesion was detected under the left ear and a biopsy procedure was performed and the results showed presence of a polymorphous low-grade adenocarcinoma. Conclusion: POMA is most commonly associated with breast and ovarian cancers, and when coincident with lung cancer it is typically associated with small-cell lung carcinoma. So far, POMA syndrome with parotid adenocarcinoma has not been reported in the literature. We establish a diagnosis of a POMA syndrome with parotid adenocarcinoma. F04 Is there a difference in paraneoplastic sensor neuropathy in cases of lung small cell carcinoma and renal cell carcinoma? Y. Raduta, V. Khodulev 2, V. Ponomarev Belarusian Medical Academy of Postgraduate Education, Head of Department of Neurology and Neurosurgery of Bel- MAPGE, Minsk, Belarus, 2 Repablic Centre of Neurology and Neurosurgery, Minsk, Belarus Background and aims: Lung squamous cell carcinoma (LSCC) and Renal cell carcinoma (RCC) are the most common causes of paraneoplastic sensor neuropathy (PSP).The development mechanism of the PSP in LSCC is related to parathormone-like substance. RCC is related to erythropoietin-like substance. Aim: exploration the clinical and EMG differences of PSP depending on the type of carcinoma. Methods: 32 patients with PSP were examined (9 women and 3 men), average age 52.7±0.7,among those 8 patients with LSCC with LSCC and 4 patients with RCC. Vibrational, tactile and thermal sensitivity were assessed according to the scale of Neuropathy Dysfunctional Score (NDS). Sensor nerves of the limbs were investigated using EMG: n.suralis and n.peroneus superficialis on both sides. Results: all patients had a decline or absence of ankle jerk reflex, 6 patients with LSCC and 2 patients with RCC had a decline of tactile sensations (P=0.05). Sensory disorders in the legs on a scale of NDS estimated on the average (.9±5. among patients with LSCC and 2.2±5,2 with RCC) score (P=0.05). The amplitude decline of n.suralis and n.peroneus superficialis in the LSCC group 5.2 (2,6-6.3) and 2.2 (.8-2.7) µv and in patients group with RCC 5. ( ) and 2.3 (.8-2.8) µv accordingly (P=0.05). Conclusion: the PSP patients with LSCC and RCC was caused by the sensitivity owing to the axon affection of limb nerves and demonstrated no difference results in clinical and EMG results. 205 European Journal of Neurology, 22 (Suppl. ),

50 Flash Posters 533 F05 Epstein-Barr virus role in primary central nervous system lymphoma in a non-hiv infected patient: an autopsy case report C. Rosado Coelho, R. Matos, J. Pimentel 2, A.F. Valadas Hospital de São Bernardo, Department of Neurology, Setúbal, Portugal, 2 Hospital de Santa Maria do Centro Hospitalar de Lisboa Norte, Laboratory of Neuropathology (department of Neurology), Lisbon, Portugal Background and aims: Introduction: Primary central nervous system lymphoma (PCNSL) is a non-hodgkin lymphoma that arises within and is confined to the CNS. In immunocompetent patients the EBV role in the pathogenesis of PCNSL is not well established. Case Report: Methods: Case report. Results: A 57-year-old man with diabetes mellitus type 2 was admitted to the emergency department due to a 2-weeks history of progressive diplopia, dysphagia, right arm paresis and unsteady gait. A brain-mri showed multifocal lesions (several T2-hyperintense and one T2-hypointense), contrast-enhanced, in the cerebral white matter and brainstem with mild oedema. CSF revealed lymphocytic pleocytosis (monocytoid and small lymphocytoid cells) and elevated protein content. CSF flow cytometry did not support neoplastic disease and Epstein-Barr virus (EBV) genome was detected in CSF. HIV and systemic autoimmunity analyses were negative. A whole body CT-scan excluded pathology outside CNS. Few days after admission, the patient had respiratory failure, starting methylprednisolone followed by plasmapheresis without clinical benefit. The patient died.5 months after admission. Although planned, a brain biopsy was not performed in due time. The brain autopsy revealed B-cell non-hodgkin PCNSL with parenchymal and leptomeningeal involvement. Conclusion: This case illustrates the difficulties of PCNSL differential diagnosis despite a thorough diagnostic workup. Moreover, in this non-hiv patient, the EBV infection has further impeded the PCNSL diagnosis due to the imaging and CSF cytochemical variability of these two pathologies. This case emphasizes the importance of an early brain biopsy in all patients with EBV infections and CNS lesions that do not respond to the established treatment. F06 The assessment of brain metastases risk in breast cancer patients: the role of hormone receptor status and other tumor characteristics (a retrospective observational descriptive study) F. Scarlatescu Bucharest, Romania Background and aims: Objectives: to identify the breast cancer patients with a high risk of brain metastases, thus facilitating potential prophylactic treatment and diagnostic screening strategies. Methods: Retrospective observational descriptive study on 74 patients (all females) with breast cancer admitted in our hospital in 204. A clinical neurological exam was performed in all patients followed by brain MRI in selected cases. Data regarding the estrogen, progesterone receptors (ER,PR) and human epidermal growth factor receptor-2 (HER-2) were obtained by immunohistochemical methods from tumor samples at diagnosis and collected from the medical records. Statistical analysis was performed using SPSS Statistics v.9.. For all statistical tests significance was assumed at p<0.05. Results: Mean (±SD) age at diagnosis was (±.96) years. In our study group 4 patients had brain metastases (8,9%). There was a statistically significant correlation between the negative status of ER and PR and the development of brain metastases (p=0.003 for ER and 0.02 for PR) as well as for the triple negative status (ER, PR and HER-2) and brain metastases (p=0.037). Neither age and disease stage at diagnosis were correlated with brain metastases (p=0.79 respective p=0.4). Conclusion: The group of women with negative hormone receptor status are at higher risk for brain metastases and might represent the target for future prophylactic strategies. 205 European Journal of Neurology, 22 (Suppl. ),

51 534 Flash Posters F07 Heat shock protein 70 as a novel immunotherapeutic anti-cancer agent in neurooncology: preclinical and clinical studies M. Shevtsov Saint Petersburg, Russian Federation Background and aims: Immunotherapeutic anti-tumor activity of Hsp70 was assessed in the series of preclinical and clinical studies. Methods: Therapeutic capacity of intratumoral delivery of Hsp70 was analyzed in the model of intracranial glioma in rats. Hsp70-treated animals were explored for viability, tumor size, IFN-gamma production and cytotoxicity of lymphocytes. Intratumoral delivery of Hsp70 was assessed in patients with newly diagnosed brain tumors (n=2). Following tumor resection Hsp70 was administered into the resection cavity. Before administration of Hsp70 and after the last injection, specific immune responses to the autologous tumor lysate were evaluated using the delayed-type hypersensitivity test. Peripheral blood was monitored to identify changes in lymphocyte subpopulations, cytokine levels. Results: Targeted intratumoral injection of Hsp70 resulted in significant inhibition of tumor progression (as confirmed by MRI) and the prolonged survival of tumor-bearing animals. Therapeutic efficacy was associated with infiltration to glioblastoma of NK-cells (Ly-6c+) and T-lymphocytes (CD3+, CD4+, and CD8+) as well as with an increase in the activity of NK-cells (granzyme B production) and CD8+ T-lymphocytes as shown by IFN-gamma ELISPOT assay. Subsequent clinical study demonstrated that one patient had a complete clinical response documented by MRI findings and one patient had a partial response. A positive delayedtype hypersensitivity test was observed in three patients. In peripheral blood, there was a shift from cytokines provided by Th2 cells toward cytokines of a Th-cell-mediated response. These data corresponded to changes in lymphocyte subpopulations. Conclusion: Hsp70 shows a great promise in treatment of brain tumors and further randomized clinical trials are indicated. F08 Safety and efficacy of primary central nervous system lymphoma management in elderly population: our institutional experience. G. Simonetti, P. Gaviani, A. Innocenti, A. Botturi, E. Lamperti, A. Silvani IRCCS Neurologico Carlo Besta, Milan, Italy Background and aims: Primary central nervous system lymphoma (PCNLS) represents about 3% of all brain tumours. Median age at diagnosis is 65 years, with median survival (m-os) ranging from 0 to 20 months. High-dose methotrexate (HD-MTX) and radiotherapy improved m-os, representing now the standard treatment for PCNSL. Age is the most influential prognostic factor; moreover this particular subset of patients is still understudied and medical care is not standardized. The aim was to assess toxicity/ efficacy of HD-MTX in elderly population ( 75 years). Methods: 7 consecutive elderly-patients, treated with HD-MTX between 2007 and 204, were retrospectively evaluated.toxicities were evaluated according to National- Cancer-Institute s Common Terminology Criteria for Adverse Event (CTCAE), efficacy was evaluated by MRI performed after cycles of HD-MTX. Results: No evidence of haematological toxicity was recorded in 47% of patients. No episode of febrile neutropenia, no mucositis/infections nor gastrointestinal toxicity were recorded; only one episode of grade nephrotoxicity was noted. A deep-vein-thrombosis with a pulmonary involvement was detected. M-OS from diagnosis was 20.9 months (range months), with OS-2 of 58.8% and a OS-24 of 45.4%. A positive trend between the correlation with OS and KPS 70 was found (P=0.0023; correlation coefficient r ). The average time to progression was 5.2 months ( months). After 7 years of follow-up, four patients are still alive. Conclusion: Toxicity assessment can be considered mild, confirming that not only this therapeutic regimen is quite safe, but also reinforcing the concept that elderly in good general health condition, can be treated with the schedule generally reserved for younger population. F09 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

52 Flash Posters 535 F0 Outcome of patients with recurrent glioblastoma after hospitalization: Data review from 200 to 204 at the M.D. Anderson Cancer Center I. Tremont-Lukats, P. Barata 2, C. Kamiya-Matsuoka, S.-H. Lee-Kim 3, M. Loghin 3, B. O Brien 3 Houston, USA, 2 Lisbon, Portugal, 3 M.D. Anderson Cancer Center, Neuro-Oncology, Houston, USA Background and aims: We know little about the impact of hospitalization on patients with recurrent glioblastoma (rgb). Our aims were to determine reasons for admission, discharge outcome including survival, and whether patients had updated advance care planning (ACP) and end-of-life (EoL) discussions in clinic before admission. Methods: Retrospective review of electronic records of patients with glioblastoma admitted from January 200 to August 204. Results: 27 patients were admitted and found to have rgb. The median stay was 5 days (-37d). Neurologic decline was the first cause for admission (n=32, 25%); in other 49 patients (38%) rgb was detected by neuroimaging. Of 76 patients (60%) discharged to continue treatment, 9(25%) could not because they never improved. 6 (5%) patients died and 45 (35%) were sent to hospice care. Median survival was 0 mo, but only 4 mo after hospitalization. Only 20 (6%) patients had evidence of prognosis/eol discussions before admission, and 5 (4%) had an updated, complete ACP. After admission, 52 (4%) had DNR orders on file. There was no relation between selected variables and time to admission or survival. Poor survival was related to <3 mo from rgb diagnosis to admission and to a Karnofsky score <70 (P<0.000 for each). Conclusion: Short survival was associated with <3mo from rgb to admission and KPS<70. Two thirds of patients never resumed treatment after hospitalization. EoL/ACP discussions were rare before admission. Hospitalization of patients with rgb could be a sign of terminal illness for many, and it should prompt EoL discussions because treatment benefit is unlikely. F Case Report: Pulmonary metastasis of atypical meningioma L.W. van der Linden, O. Schijns 2, S. Basunaid 3 MUMC+, neurology, Maastricht, Netherlands, 2 MUMC+, neurosurgery, Maastricht, Netherlands, 3 MUMC+, lung medicine, Maastricht, Netherlands Background and aims: Meningiomas are usually benign tumors, but infrequently metastasize outside of the central nervous system. We present a case of a 63-year-old-man with pleural metastases of an intracranial meningioma. Although rare, the possibility of metastases in patients with recurrent meningiomas may not be neglected. It s prevalence may be underestimated. Case Report: A 6-year-old man presented in April 200 with a grade II meningioma with invasion of the brain parenchyma, dura and the roof of the skull. Fractioned radiotherapy followed after resection. A resection of recurrent meningioma took place in 20 with histopathologic findings consistent with a grade III meningioma. Despite post-surgery radiotherapy a MRI in march 202 showed re-growth of the meningioma at the base of the superior sagittal sinus and at the border of the left occipital resection cavity. Meanwhile a thoracotomy revealed large collections of necrotic tissue. The histopathologic findings demonstrated a metastasis of atypical meningioma. An additional colouring showed an increased level of Mib, indicative of increased proliferation. The patient refused other treatments and died one week later. Results: figure 2 histology Conclusion: Meningioma is usually regarded as a benign neoplasm. Extracranial metastasis of meningioma is rare (0.%).The most frequent sites are the lungs. The histological tumor grade of the meningioma was not correlated with the metastatic spread in recent literature. Invasion of the venous sinuses, previous craniotomy, local recurrence and nuclear protein-related cell proliferation markers are being regarded as risk factors for metastasis. This case shows that, although rare, the possibility of metastases in patients with recurrent meningiomas may not be neglected. 205 European Journal of Neurology, 22 (Suppl. ),

53 536 Flash Posters Clinical neurophysiology F2 Pectoral spasm after expander-based breast reconstruction. A. Doretti, S. Gerevini 2, B. Riccardi, F. Gregorini, V. Silani, L. Maderna Istituto Auxologico Italiano, Neurology, Milan, Italy, 2 Ospedale San Raffaele, Neuroradiology, Milan, Italy Background and aims: Tissue expander-based breast reconstruction is the most commonly utilized technique for mammal reconstruction after radical mastectomy for mammal neoplasia. This modality, however, may be associated with significant pain related to pectoralis spasms. Breast reconstruction integrated with fat grafting (lipofilling) is a technique widely used in current practice. Report: 62 years old female presented with pectoral spasm after reconstructive surgery of the breast. She underwent a tissue expander-based breast reconstruction, keeping the expander for 0 month. After that she was subjected to positioning of the mammal prosthesis, but in 3-4 weeks she developed subcontinuos spasms of major pectoral muscles. This lead to a persistent spasm also after the prosthesis removal (one year later) for a self fulfilling system, without any pain. She had never been subjected to chemotherapy or radiotherapy. The electromyography showed repetitive involuntary contraction with burst of msec, 2 Hz in frequency. We also studied the brachial plexus and the course of the pectoral nerve with Magnetic Resonance (DTI sequences) and with Echography of the mammal region. Results: The spasm reduced/stopped after onabotulinumtoxina infiltration of the pectoralis major under electromyographic and echographic guidance. She is replicating the infiltration every three month with benefit. Conclusion: Spasms of the pectoralis is not due to compressive trauma to the pectoral nerves by the mammal prosthesis but it should be due to the irritative activity of the prosthesis on the pectoral nerve course. Indeed the spasm started after the prosthesis positioning. F3 Neurophysiological tools of neurorehabilitation of patients with cerebral insult S. Huseynova, A. Musayev Research Institute of Medical Rahabilitation, no department, Baku, Azerbaijan Background: The study on the condition of neuromotor apparatus carried out by neurophysiological researches in the patients with cerebral insult (CI) allows to define the functional condition of corticospinal tract and peripheral neuromotor apparatus. Aim: To study the opportunities of transcranial magnetic stimulation (TMS) and electroneuromyography (ENMG) in the analysis of the results of neurorehabilitation in 85 patients with CI. Methods: TMS was carried out in the process of rehabilitation with the registration of evoked motor potential (EMP) and evaluation of its parameters, definition of the time of central motor conduction (TCMC). By ENMG studies the conduction velocity (CV), also M-potential parameters were defined. Amplitude ratio (AR) was also estimated. Results: In the study of functional condition of corticospinal tract decrease of EMP amplitude (in severe cases its absence), increase of EMP latency and TCMC was observed. In the evaluation of condition of peripheral neuromotor apparatus decrease of CV, change of M-potential parameters was observed on the side of hemiparesis. The course of MS conducted contributed to the positive dynamics of clinical symptoms, improving of functional condition of the central neuromotor apparatus. This is evidenced by increased EMP, improved temporary indicators and increased AR. The influence of MS on the condition of segmented peripheral neuromotor apparatus was less evident and was observed only by the tendency of increased M-potential amplitude. Conclusion: TMS and ENMG bear high information value and great significance in the diagnostics and rehabilitation of patients with CI. More characteristic parameters here are EMP, peripheral М-potential. 205 European Journal of Neurology, 22 (Suppl. ),

54 Flash Posters 537 F4 A new method for performing vibratory evoked potentials M. Krbot Skoric, M. Habek, I. Adamec, T. Gabelic, A.B. Jerbic 2, M. Cifrek 3, I. Krois 3, V. Isgum 3 University Hospital Center Zagreb, Neurology, Zagreb, Croatia, 2 University of Zagreb, Zagreb, Croatia, 3 University of Zagreb, Faculty of Electrical Engineering and Computing, Zagreb, Croatia Background and aims: Sense of vibration is affected in many neurological conditions; never the less it is often overlooked in everyday practice. Currently used method for detection of vibratory evoked potentials enables detection of late cortical response (around 50 ms), and it offers no information about early sensory components. The aim of this research was to establish reliable and objective methods, which will enable objective examination of functional integrity of the entire sensory vibratory pathway (from receptors in the skin (Pacinian corpuscles, Meissner s corpuscles) to the primary sensory cortex). Methods: Specially designed vibratory stimulator with well-defined parameters of stimulation (frequency and duration of stimulation) with constant displacement of vibratory applicator was designed and used for vibratory stimulation. The stimulation area was at wrist on the right and on the left hand. Somatosensory evoked potentials (SSEP) of ulnar nerve were performed for the purpose of known comparison. Results: Stimulation with frequency of 20 Hz and 200 Hz showed recognizable and repeatable morphology of the waveform, with two significant peaks around 20 (N20) and 30 ms (P30). N20 and P30 appear earlier than any other known components related with vibratory evoked potentials. Achieved results are in concordance with widely used and established method, SSEP. F5 EEG findings in hospitalized psychiatric patients S. Mijo, S. Grabova, M. Rakacolli 2, F. Elezi 3, A. Shehu, T. Kamberi, J. Kruja 2 UHC Mother Teresa, Neurology, Tirana, Albania, 2 University of Medicine, Tirana, Neurology, Tirana, Albania, 3 UHC Mother Teresa, Psychiatry, Tirana, Albania Background and aims: The EEG is not a commonly requested test on patients attending psychiatric services. It is usually requested to investigate for a possible organic brain syndrome causing behavioral changes or to exclude epilepsy. Aims: The aim of this study was to describe the outcomes of electroencephalography and determine the clinical factors associated with an abnormal EEG in patients with psychiatric problem Methods: We reviewed and analyzed the data of standard EEG recordings requested for patients hospitalized in the Service of Psychiatry over a 2 months period from January to December 204. The EEG recordings were performed in the EEG laboratory at the Service of Neurology reviewed by an experienced neurophysiologist. The referral reasons for EEG of psychiatric patients were evaluated. Results: We reviewed ninety eight standard interictal EEG recordings of hospitalized psychiatric patients. 6 patients (62%) were females, 37 were males (38%). The total rate of abnormal EEG in psychiatry patients were 56% (n=55 pts). The specific epileptiform activity were found in patients with previous history of seizures 4 patients (4.2%), being on treatment with Clozapine 5 patients (6.7%) or in patients where were suspected de novo seizures 0 patients (0%). Non diagnostic abnormalities such as diffuse slowing, and diffuse fast activities were found in 2 patients. Patients with primary psychiatric disorders did not have any specific epileptiform activity (n=69). Conclusion: EEG is not a commonly requested test on patients attending psychiatric services but all suspected seizure disorder or confusional patient presenting to psychiatry should be evaluated with EEG recordings. Vibratory evoked potentials elicited with stimulation of the right hand with frequency of 20 Hz Conclusion: Our methodology enables detection of early cortical activation, which is necessary for quantitative assessment of whole vibratory pathway. Further experiments with larger number of healthy participants and patients with decreased vibration due to different pathologies are necessary to further confirm the usefulness of this method. 205 European Journal of Neurology, 22 (Suppl. ),

55 538 Flash Posters F6 Electroencephalogram in uremic encephalopathy D. Milikic, S. Vujisic 2, L. Radulovic 2, S. Vodopić 2 Clinical Centre of Montenegro, Neurology, Podgorica, Montenegro, 2 Podgorica, Montenegro Background and aims: The problem of metabolic enecphalopathies is insufficiently treated in modern neurological science. Therefore explorations in this field are scanty. The aim of our investigation was to evaluate the results of clinical, laboratory, neuropsychologycal and neurophysiologic investigations and their connection in a sample of 36 patients undergoing chronic dialysis programme. According to this aim, patients were divided into two groups. The first group of patients had normal electroencephalogram (EEG), and they represented control group, and the other group had abnormal EEG findings Methods: During our investigation, patients underwent following diagnostic procedures: biochemical analyses, physical and neurological examinations, neuropsychological testing (mini-mental state examination- MMSE) and EEG. Statistical data evaluation was made in order to estimate the degree of correlation and the significance of between- group differences. Results: After performing all examination found that the level of urea was significantly correlated with pathological EEG findings, as well as with raw score on the MMSE test. Neurological findings did not show any significant correlation with EEG changes. Polyneuropathy was the most frequent neurological disorder. Based on the results of visual EEG analysis, we concluded that the most common abnormalities were non-epileptiform changes with focal distribution. Conclusion: The results of this work reaffirm the importance of EEG recording and EEG analysis aiming to provide a precise and continuing insight into the functioning of nervous system during the haemodialysis, as well as follow-up, diagnostics and prevention of possible complications. F7 Neuromyotonia: an unusual presentation in inflammatory myopathy R. Dal-Prá Ducci, R. Scola, P. Lorenzoni, C. Kay, L.C. Werneck Hospital de Clínicas - UFPR, Neuromuscular, Curitiba, Brazil Background and aims: Neuromyotonia is a rare condition with spontaneous and continuous muscle fiber activity of peripheral nerve origin. Clinically is characterized by visible myokymia, cramps and pseudomyotonia. Neuromyotonia can be immune mediated or not, as well as, occurs isolated or in association with other disorders, as neoplasia, auto-immune, anterior horn cell degeneration, Schwartz- Jampel syndrome. Neuromyotonia associated to inflammatory myopathy has rarely been documented. Demonstrate the association between neuromyotonia and inflammatory myopathy in a case report. Results: A 60-year-old woman presented with dysphagia and weakness in lower limbs a year ago. Neurologic examination revealed proximal weakness in lower limbs (grade 4-). Laboratorial tests showed: CK 4,63U/L (Normal:30-200), erythrocyte sedimentation rate 72mm/h (Normal:<30). Neurophysiologic study showed motor axonal/ demyelinating polyneuropathy, myopathic potentials and neuromyotonia discharges. Muscle biopsy revealed inflammatory myopathy. Extensive research was negative for malignancy. The diagnosis of inflammatory myopathy with neuromyotonia was made and immunosuppressive therapy was done. Conclusion: Neuromyotonia and inflammatory myopathy is a very rare association and in our case the patient had atypical clinical manifestations and the diagnosis of neuromyotonia was made with neurophysiologic study. Neuromyotonia is an unusual presentation in inflammatory myopathy. 205 European Journal of Neurology, 22 (Suppl. ),

56 Flash Posters 539 F8 Inclusion body myositis as differential diagnosis of post-poliomyelitis syndrome R. Dal-Prá Ducci, R. Scola, C. Kay, P. Lorenzoni, L.C. Werneck Hospital de Clínicas - UFPR, Neuromuscular, Curitiba, Brazil Background and aims: The presence of progressive weakness that occurring years after acute poliomyelitis is usually due to post-poliomyelitis syndrome, although, this is not the unique etiology of weakness. Inclusion body myositis (IBM) is the most common inflammatory myopathy after age 50. To our knowledge, this is the first case of IBM in a patient with sequelae of poliomyelitis. Methods: Case report of IBM in a patient with sequelae of poliomyelitis. Results: A 63-year-old man presented proximal weakness in the left lower limb since 53 years. He had weakness and atrophy in the right lower limb due to acute poliomyelitis in childhood. Neurological examination revealed proximal lower limbs atrophy and weakness (grade 3). Infectious, inflammatory, toxic and malignancy workup was negative. Highest CK was 534U/L (Normal:30-200U/L). Neurophysiological study showed myopathic pattern and signs of motor neuron involvement with acute and chronic bilateral denervation. Muscle biopsy showed endomysial inflammation, myofibers with rimmed vacuoles and inclusions, ragged red and COX-negative fibers. The diagnosis of IBM was made and immunoglobulin was done. The patient had a slight improvement of weakness (grade 4-). Conclusion: In patients with sequelae of acute poliomyelitis which presenting weakness, IBM should be differentiated from post-poliomyelitis syndrome. F9 Necrotizing myopathy associated with HIV: a case report. R. Dal-Prá Ducci, R. Scola, C. Kay, P. Lorenzoni, F. Magalhães 2, M. Gomes 2, M. Carvalho 3, L.C. Werneck Hospital de Clínicas - UFPR, Neuromuscular, Curitiba, Brazil, 2 Hospital de Clinicas, Infectologia, Curitiba, Brazil, 3 Hospital de Clinicas, Clinica Medica, Curitiba, Brazil Background and aims: Necrotizing myopathy (NM) is an inflammatory myopathy, which diagnosis is performed by histopathologic analysis, showing myocyte necrosis without significant inflammation. NM can occur after drug abuse, use of toxic agents, due to autoimmune mechanisms and may be associated with neoplasia. NM associated to HIV has rarely been documented. Methods: Case report of NM associated with HIV Results: A 20-year-old man presented with proximal progressive muscle weakness and intense and diffuse myalgia. On examination: lymphadenopathy, diffuse edema and proximal weakness (grade 3). Laboratorial tests showed: CK 26,67U/L (Normal:30-200U/L), positive HIV serology, CD4 count: 300/UL, viral load: 50,027 copies. Conduction velocity was normal and needle electromyography with myopathic pattern. Muscle biopsy revealed necrotizing myopathy. The diagnosis of NM with HIV was made and management with antiretroviral and immunosuppressive therapy was done. Follow-up after one month showed: CK 39U/L, CD4 count,79/ul and viral load was undetectable Conclusion: Myalgia and weakness are common in HIV. The critical test for the diagnosis in this case was the muscle biopsy. Treatment of NM associated to HIV remains empirical with no randomized controlled trial and there is little information about the importance of HIV therapy and about the prognosis. 205 European Journal of Neurology, 22 (Suppl. ),

57 540 Flash Posters F20 Pronator teres syndrome added on carpal tunnel syndrome: a case report A. Çetiz, S. Tasdemir 2, H. Akgun, S. Alay, O. Oz, Ü.H. Ulas, S. Demirkaya Gulhane Military Medical Academy, Department of Neurology, Ankara, Turkey, 2 Beytepe Military Hospital, Neurology, Ankara, Turkey Background and aims: Pronator syndrome is characterized by median nerve compression at the elbow and presents with pain and muscle weakness of the forearm. It has very similar clinical signs with carpal tunnel syndrome. In this case report we present a patient with pronator teres syndrome added on carpal tunnel syndrome. Case Report: A 50-year-old male was referred to our clinic with right hand weakness, numbness and pain in the palmar face of the hand for nearly.5 months. Neurological examination revealed, 3/5 muscle strength on right abductor pollicis brevis with thenar atrophy, flexor digitorum profundus and flexor pollicis longus muscle strength were also 3/5. When he prompted to punch the right hand he was unable to full flexion of the phalanges and 2. Electromyography indicated acute phase of pronator teres syndrome and chronic period carpal tunnel syndrome on the right upper extremity. Results: emg table sensory nerve conduction studies motor nerve conduction studies F2 Significance of electromyoneurographic findings in the evaluation of quality of life in diabetic polyneuropathy Z. Vukojevic Banja Luka, Bosnia and Herzegovina Background and aims: Electromyoneurography (EMNG) is the most important method for establishing diagnosis of diabetic polyneuropathy (DPN), but can be a useful method to assess the patients quality of life. We wanted to determine the correlation between each domain of quality of life at the Medical outcomes study SF-36 scale with EMNG parameters in order to assess the quality of life in DPN. Methods: The study included 80 patients with diabetes mellitus type 2 and distal, sensorimotor polyneuropathy, mean age of years with an average duration of diabetes of 2.2 years. All examinees were determined the quality of life by the SF-36 scale, underwent EMNG examination, and subsequently the relationship of individual EMNG parameters with certain domains of quality of life was inquired. EMNG examination included nervus peroneus, tibialis, medianus, ulnaris (motor nerve conduction velocity MCV, compound muscle action potential CMAP), nervus suralis, medianus and ulnaris (sensory nerve conduciton velocity SCV, compound nerve action potential CNAP). Results: MCV of nervus peroneus was statistically significantly associated with a domain of physical functioning, and CNAP of nervus suralis was statistically significantly associated with domain of vitality at the SF-36 scale. SCV of nervus medianus was significantly associated with the domains of social and emotional functioning. Conclusion: Some parameters of the EMNG examinations are statistically significantly associated with some specific domains quality of life at the SF-36 scale. The most important parameters are MCV of nervus peroneus, CNAP of nervus suralis and SCV of nervus medianus. F22 Abstract cancelled needle EMG Conclusion: Proximal neuropathy of the median nerve occurs infrequently and some of the symptoms are similar to carpal tunnel syndrome or radiculopathy so can be out of the attention of physicians. In this case report a pronator teres syndrome together with CTS patient has been discussed with neurological examination and electrophysiological findings. During performing median nerve conduction studies importance of proximal portion has been demonstrated. 205 European Journal of Neurology, 22 (Suppl. ),

58 Flash Posters 54 Epilepsy 2 F23 Abstract cancelled F24 Right-brain epileptic syndrome, the clinical features A. Jusupova Bishkek, Kyrgyzstan Background and aims: To study the cognitive and autonomic changes in patients with right-brain symptomatic and idiopathic epilepsy in the interictal period. Methods: The study involved 46 patients, of which 29 patients had idiopathic epilepsy and 7 with symptomatic hemispheric accent. The age of patients with idiopathic form ranged from 0 years to 37 years, and in symptomatic 6 to 44 years. Methods of investigation: measurement of blood pressure, pulse, breath rate, EEG, examination of ophthalmologist including description of fundus, MRI brain, examination of psychiatrist, psychological examination. Results: Among idiopathic epilepsy patients 23 (80%) had rare generalized tonic-clonic seizures. Almost all patients 20 (70%) with idiopathic epilepsy had cognitive impairment to the level of mild dementia and mental disorders such as viscosity of thinking, thoroughness, irritability, obsessions. Further, these mental disorders formed an epileptic type of organic personality disorder, which was confirmed by psychiatrist. There were (67%) secondarily generalized and 6 (33%) partial seizures cases among hemispheric symptomatic patients. 4 (83%) patients had frequent seizures. Autonomic aura combines both cardiovascular and hyperventilation manifestations. There were not present cognitive changes in these patients. Behavior and emotional background was characterized by depression, anxiety, thoroughness, interpersonal difficulties, problems paralinguistic communication, impaired visuospatial skills. Conclusion: Right-brain symptomatic epilepsy is accompanied by depression, apathy, increased personal anxiety, combined with cardiovascular and hyperventilation syndrome, with a reduction of adaptation functions. Idiopathic epilepsy without a clear accentuation often accompanied by behavioral responses such as irritability, aggression, affective instability, reduced tolerance to psychological factors, along with the pronounced autonomic and cognitive changes observed. F25 Malian cultural conceptions about epilepsy Z. Kone, D.B. Coulibaly 2, M. Camara 2, Z. Traore 3 Dakar, Senegal, 2 University of Bamako, Neurology/Gabriel Toure Hospital, Bamako, Mali, 3 University of Bamako, Neurosciences, Point G Teaching Hospital, Bamako, Mali Background and aims: Epilepsy, or popularly termed out of the shadow, is the slogan chosen by the International League against epilepsy. This policy, in an attempt to bring epilepsy out of the shadows, is based on information, education and communication, and must be led by realities including, but not limited to cultural values of a diverse background of people. Goal: with this background, the study aimed at, investigating the conceptions in Malian culture about epilepsy, assessing the ways in which people with epilepsy are perceived through the prism of Malian beliefs, and finally, based on these findings, articulate the policies most appropriate, with an ultimate goal of ensuring that people with epilepsy can flourish in their life without any taboo. Methods: A review of the historical and socio-anthropological literature, correlated with interviews of resource persons about the local culture, was conducted and data were analyzed. Results: Tonic-clonic seizures (70%), atonic seizures (30%) were the only seizures considered as epilepsy. Beliefs about the etiology and mechanisms were misconceived (00%) with a strong attribution of epilepsy etiology to the supernatural (45%). Treatments were ineffective and culturally bound. Epileptic patients were found to be stigmatized but not excluded and were living in their community. Conclusion: In the Malian cultural context, the disease was in the shade and the patient were excluded from some community activities like work with fire for example, but were found to be living in full light with the rest of the society. 205 European Journal of Neurology, 22 (Suppl. ),

59 542 Flash Posters F26 Genealogical tree in case of rare epileptic syndromes among Georgian population with epilepsy M. Lazariashvili, N. Maziashvili 2, S. Kasradze 3 Tbilisi, Georgia, 2 Institute of Neurology and Neuropsychology, Department of Neurology, Tbilisi, Georgia, 3 Institute of Neurology and Neurophsychology, neurology, Tbilisi, Georgia Background and aims: There are more than 350 million people affected by rare/orphan diseases in the world. Most of them (80%) are genetic pathologies characterized by chronic occurrence and poor prognosis. Some epileptic syndromes themselves belong to the rare genetic diseases group and severe of them characterized by deficit of cognitive functions,pharmacoresistance and high rate of mortality. The aim of this study was to assess of Genealogical tree heritage features of rare epileptic syndromes in Georgian population. Methods: The study was carried from st March to 30th December 204 on the base of Institute of Neurology, family members st and 2 nd order relatives of patients diagnosed as a rare epilepsy syndromes were surveyed through the adapted Georgian version of «Questionnaire for Assessment of the Subjective Handicap of Epilepsy» (SHE). Results: 22 people were assessed in total. 8 (male) and 4 (female). Among them Rett Syndrome, Dravet Syndrome, Neurofibromatosis type- were diagnosed in single cases. Five children were with West syndrome, Ten patients were with JME and in four children CAE were diagnosed. In overall 70 family members were studied and among them 7 (0%) cases with epilepsy were reveald: In four cases focal epilepsy were diagnosed in family members st and 2nd order relatives and JME and CAE were diagnosed in family members st order relatives. Conclusion: On the basis of our studies we explored the genetic peculiarity of the rare epileptic diseases in their family members and reveald quite high frequency of epilepsy which requires further research conduct in future. Disclosure: The study was conducted within the President s grant for young scientists of the Shota Rustaveli National Science Foundation (N52/44) F27 Palinacousis as a rare manifestation of temporal lobe dysfunction L. Leitão, A. Martins, C. Reizinho 2, A. Ribeiro 3, P. Pita Lobo Hospital Prof. Doutor Fernando da Fonseca, Neurology, Amadora, Portugal, 2 Hospital Egas Moniz, Neurossurgery, Lisbon, Portugal, 3 Hospital Egas Moniz, Pathology, Lisbon, Portugal Background and aims: Palinacousis is a paroxysmal auditory illusion consisting of perseveration of an external auditory stimulus after it has stopped. May be caused by lesions involving the medial geniculate body or the temporal lobe. Results: A 64-year-old right-handed man, was admitted at the emergency department by generalized tonic-clonic seizures treated with sodium valproate (VPA). In the intercritical period the neurological examination revealed: left central facial palsy, left tactile hemihypoesthesia and absent left cutaneous plantar reflex. Brain CT-scan showed a right temporal subcortical lesion. During hospitalization, patient had sensitive focal seizures on the left hemibody, which ceased after increasing VPA dose. He also complained of left palinacousis triggered by several environmental sounds and hyperacusis. The audiogram revealed left hyperacusis. Brain auditory-evoked potentials were normal. Electroencephalograms were performed, during palinacousis phenomena, which showed theta-delta waves in the right fronto-temporal region. Brain MRI disclosed a right temporo-insular lesion with gadolinium enhancement and oedema. These symptoms didn t stop after levetiracetam addition, and ceased only after treatment with dexamethasone. Lesion s neuropathological examination showed a glioblastoma. Conclusion: Palinacousis can occur as an aura, seizure or as a postictal event. In this case we considered it could be an interictal phenomenon (no epileptic electroencephalographic evidence and no response to anti-epileptic treatment), although the improvement with corticotherapy didn t exclude the possibility of an ictal source, namely seizures with insular origin. This could also support the fact that corticosteroids may be a more frequent and early treatment option in some epileptic conditions like structural epilepsy related with cerebral tumors. 205 European Journal of Neurology, 22 (Suppl. ),

60 Flash Posters 543 F28 Eslicarbazepine acetate as add-on treatment to antiepileptic monotherapy in adults with partial-onset seizures: German data of the EPOS study F. Losch, M. Holtkamp, R. McMurray 2, R. Sousa 3, E. Kockelmann 4 Charité - Universitätsmedizin Berlin, Berlin, Germany, 2 Eisai Europe Ltd, Hatfield, United Kingdom, 3 Bial -Portela & Cª, S.A., S. Mamede do Coronado, Portugal, 4 Eisai GmbH, Frankfurt am Main, Germany Background and aims: Eslicarbazepine acetate (ESL) is approved as a once daily adjunctive therapy in adults with partial onset seizures (POS), with or without secondary generalization. The non-interventional study EPOS (Eslicarbazepine acetate in Partial-Onset Seizures) aimed to assess retention rate, efficacy and tolerability of ESL as add-on to monotherapy in everyday clinical practice across eight European countries. Here we present results obtained in the subpopulation of patients enrolled in Germany. Methods: Adult patients with uncontrolled POS under antiepileptic monotherapy for whom the physician had previously and independently decided to initiate ESL add-on therapy were offered participation upon providing informed consent. Patients were seen at baseline and at visits after 3 and 6 months after commencing ESL add-on therapy. 04 German patients were included in this post-hoc analysis. Results: The mean age was 46.5±5.6 years. The median time since first diagnosis of epilepsy was 8.7 years. The median seizure frequency over 3 months prior to baseline was 7.0. Levetiracetam (37.5%) and lamotrigine (30.8%) were the most frequently reported monotherapies at baseline. At six-months, retention rate was 86.5%. For the terminal 3 months, 44.7% of patients reported seizure freedom. Adverse events (AE, n= 32) occurred in 20 patients; two serious AE (hyponatremia and convulsion) were reported for 2 patients. Most frequently reported AEs were dizziness (3.8%), headache (3.8%), hyponatremia (2.9%) and fatigue (2.9%). Conclusion: ESL as add-on to antiepileptic monotherapy is retained and well-tolerated by the majority of adult patients in a real-life German population. Disclosure: This study was supported by Eisai Ltd. F29 Prognostic factors for recurrence after AED withdrawal. M. Maione, M. Impellizzeri, G. Fanelli, E. Leopizzi, G. Comi, F. Minicucci Scientific Institute Vita-Salute University San Raffaele, Neurology, Milan, Italy Background and aims: About 70% of epileptic patients achieve seizure control with antiepileptic medications. Currently, after patients achieve complete control for a minimum period of 2 years, antiepileptic drug (AED) discontinuation may be considered. However, there is no common agreement on what factors can predict the likelihood of recurrence of seizures. The objective of our study is to identify factors that can predict such a recurrence. Methods: Medical records of 23 patients, with a seizurefree period of a minimum of 2 years and age of onset of seizures 4 years, have been reviewed. All patients were evaluated for a minimum period of 2 years after AED withdrawal. Results: At the end of the observation period 68.3% of patients remained seizure-free after a 2 year follow up. Recurrence rates between various types of epilepsy were similar. On the contrary, significant differences were found referring to different types of seizure: focal without secondary generalization (recurrence rate of 9.2%), primary generalized (35.3%) and focal with secondary generalization (45.9%). Other variables we took into account (e.g. family history of epilepsy, neuroimaging and electroencephalography) provided interesting data but did not meet any statistical significance. Conclusion: The percentage of patients who relapsed after drug discontinuation was significantly lower than data reported in literature. This mismatch is probably due to the shorter follow-up period we considered. Although data emerging from the study are interesting, these variables should be analyzed in a larger cohort of patients to increase validity. 205 European Journal of Neurology, 22 (Suppl. ),

61 544 Flash Posters F30 The quality of life in Albanian adolescents suffering of epilepsy J. Naska, S. Mijo, S. Grabova, A. Bushati 2, J. Kruja 3 UHC Mother Teresa, Neurology, Tirana, Albania, 2 University of Medicine, Tirana, Neuropediatrics, Tirana, Albania, 3 University of Medicine, Tirana, Neurology, Tirana, Albania Background and aims: The aim of this one year study was to assess the quality of life in adolescents with epilepsy. Methods: The QOLIE-AD-48 Questionnaire was administrated in University Hospital Centre Mother Teresa Service of Neurology, Tirana, Albania. We randomly selected a total of 52 patients with epilepsy 20 female and 32 male (aged -8 years) subdivided into four categories: primary generalized (n=26), partial seizures (n=8) (complex partial seizures n=0; partial seizures with secondary generalization n=8), Pharmacoresistant epilepsy (n=4), Epilepsy with mental disability (n=6). Results: There are significant differences in QOLIE scores (range 0-00) between primary generalized seizures (QO- LIE average =36 points) and partial seizures categories (QOLIE average =48 points) indicating that quality of life was affected by the seizures severity. The weighted subscales values of QOLIE includes: Epilepsy impact =.8 (average 38.2 points), Memory concentration = 6.7 (39.7), attitudes toward epilepsy =.9 (20.8), physical functioning= 4.4 (49.), stigma = 6.7 (5.2), social support=.2 (59.2), school behaviour = 2.9 (47.8), health perceptions = 5.4 (44.9). Conclusion: Patients with epilepsy reported low rate of the overall quality of life (range 0-00) measured at 43.9 points. The major constrains for patients with epilepsy was related with social support and attitudes toward epilepsy. This study shows a direct correlation between the overall severity of neurological disability and low rates of Quality of life in patients with epilepsy. F3 Memory disturbances among adult Sudanese epileptic patients in neurologic and psychiatric outpatient clinics in Khartoum State in the duration from June to September 204 D.N. Osman, M.A. Alnor, A.S. Ahmed, M. Dafaallah, M. Taha, M.A. Abdelrahim, M.M. Alfaki, A.M. Hussein 2, M.I. Alfaki, R.A. Alsherif Daoud Research Group, 2 Faculty of medicine, University of Khartoum, Department of Neurology, Khartoum, Sudan Background and aims: The aim of this study is to identify the factor(s) associated with memory disturbances among adult Sudanese epileptic patients. Methods: A case series study of 47 consecutive epileptic patients was done in different neurologic and psychiatric outpatient clinics in Khartoum State. Patients in the postictal phase and with memory disturbances from different etiologies were excluded. Patients were interviewed by three psychiatrists and trained doctors using the memory component of the mental state examination to objectively assess memory disturbances. The subjective component of memory was assessed by a validated questionnaire (The Questionnaire of Memory Efficacy). Anxiety and depression were assessed by the validated Hospital Anxiety and Depression Scale (HADS). Results: Short and long term memory disturbances were objectively detected in 68.% and 3.9% of patients respectively. There was no significant association in the mean long term memory score among patients with idiopathic generalized epilepsy and temporal lobe epilepsy (P=0.72). However, there was a significant difference in the mean short term memory score among patients with temporal lobe epilepsy compared to idiopathic generalized epilepsy (p=0.02). There was no significant association between the mean memory score and the duration of epilepsy, use of sodium valproate, carbamazepine and polytherapy (P=0.34, 0.07, 0.43, 0.93) respectively.there was a correlation between memory disturbances and both anxiety and depression (R=0.72, R2=0.5, P=0.00) and (R=0.35, R2=0.2, P=0.025) Conclusion: Epilepsy causes significant memory disturbances that may be attributable to the disease itself, drug therapy and associated anxiety and depression. 205 European Journal of Neurology, 22 (Suppl. ),

62 Flash Posters 545 F32 Single seizure increases the evoked response by deep brain electrical stimulation L. Raspante, D. Medeiros, M. Morais 2 Universidade Federal de Minas Gerais, Department of Fisiology and Biophysic, Belo Horizonte, Brazil, 2 Universidade Federal de Minas Gerais, Department of Physiology and Biophysic, Belo Hoizonte, Brazil Background and aims: Analyze the cortical evoked response by deep brain electrical stimulation (ES) after a single induced pentylenetetrazole seizure. Methods: Male Wistar rats were surgically implanted with bipolar electrodes in the anterior thalamus for ES and two microscrews in parietal cortex for EEG acquisition. After a recover period (5-days) animals underwent tail vein cannulation and divided in three groups: PTZ-noES (PTZ infusion 4mg/ml/min until myoclonic seizure manifestation and no ES), ES-noPTZ (0.5 Hz, 00µs pulse width and of 0.8mA for 460s and saline infusion) and PTZ+ES (simultaneously PTZ infusion and ES until myoclonic seizure). The protocol was separated in three sequential periods: baseline EEG (20s spontaneous activity), ES (20s ES) and testing period (accordingly with experimental group). One (D) and seven days (D7) later, the baseline EEG and ES periods were repeated in all animals. The normalized EEG energy (mean EEG energy-v2 250ms after ES normalized by mean V2 of the previous 250ms) was calculated for all experimental days and periods. The normalized energy of baseline and ES periods of days and 7 was compared among groups. Results: At D, PTZ+ES group showed a significant increase in normalized energy of the ES period, compared with PTZ-noES and ES-noPTZ groups. There was no significant difference in D7 ES period. The baseline period normalized energy demonstrated no difference among groups in neither D nor D7. Experiment Experiment 2 Conclusion: The cortex evoked response was enhanced when one single seizure episode was paired with thalamus ES. Disclosure: Research supported by CAPES, FAPEMIG, CNPq and NNC. 205 European Journal of Neurology, 22 (Suppl. ),

63 546 Flash Posters F33 Midwakh induced seizures: cases from UAE M. Shakra, T. Alsaadi 2, L. Turkawi SKMC, Neurology, Abu Dhabi, United Arab Emirates, 2 SKMC, Neurology, Abu Dhabi, United Arab Emirates Background and aims: Drug induced seizures are rare causes of hospital admissions. Various classes of drugs are reported to induce seizures, either directly, due to their epileptogenic potential, or due to drug withdrawal effect, or indirectly due to systemic and CNS related side effects. Midwakh is commonly used among young Emiratis. However, its CNS related adverse effects are not well studied Methods: we reviewd the charts of twelve consecutive patients with history of seizures provoked by smoking midwak Results: all patients had completely negative work up for epilepsy. Nine of the twelve patients had no further seizures when they discontinued smoking midwakh. Conclusion: We propose that Midwakh smoking can be considered as one of the drugs that can induce seizures and a careful drug history is important for any patient presenting with history of new onset seizures of unclear etiology F34 How accurate can we distinguish seizures from syncope based on history data? A. Stojanov, M. Spasic, Z. Peric, S. Lukic Clinic of Neurology, Clinical Center Nis, Nice, Serbia Background and aims: To access accuracy of historical data for discrimination seizure from syncope in adult patients with first episode of transient loss of consciousness (TLOC). Methods: Consecutive sample of adult patients evaluated at our tertiary epilepsy clinic, during the 204, due to first episode of TLOC. Alongside to the standard clinical observation, screening questionnaire with historical questions was performed in all patients. Score results were compared to final diagnosis based on detailed neurology, electrophysiology, and cardiology assessment. Clinical predictors were analyzed for their relationship with the outcome using two-way tables with Mann-Whitney test for continuous or ordinal variables, while Fisher exact test or Pearson c2 tests were used for other variables. Discrimination values were tested with classification tables and receiver-operator characteristic (ROC) analysis. Results: The analyses included 87 patients (44M, 43 F). Final diagnosis of epileptic seizures has made in 7 patients (33M, 38F) and syncope in 6 patients (M, 5F). Patients with epileptic seizures have been significantly younger (median 32 years, IQR 2-56) than patients with syncope (median 53.5, IQR 42-63). In multivariate model screening questionnaire overall score has significant predictive values (OR 73.75). Screening questionnaire correctly classified 85.06% patients with sensitivity 83.% and specificity 93.75%. Area under ROC curve was Conclusion: Screening questionnaire based on historical criteria could be a useful additional tool for differentiate seizure from syncope. Regarding the pretest probability, questionnaire s overall gain in diagnostic accuracy is moderate. Potential improvement for the use in the tertiary academic centers could be considered in future studies. 205 European Journal of Neurology, 22 (Suppl. ),

64 Flash Posters 547 F35 The features of epilepsy in adults: impact on quality of life. M. Tadjenov, G. Rakhimbaeva, J. Toshev Tashkent Medical Academy, Neurology department, Tashkent, Uzbekistan Background and aims: Because of demographic change and high frequency of epilepsy in adults, the amount of elderly with epilepsies is rising. However, only few studies investigated the impact of epilepsy on quality of life (QoL). We investigated the influence of epilepsy to different aspects of QoL dependent on the age of the patients and the age of onset of epilepsy. Methods: In our study, three patient groups were recruited from two centers: Group : 39 elderly ( 65 years.) with late onset of epilepsy ( 65 years), group 2: 43 elderly ( 65 years.) with early-onset, long-lasting epilepsy ( 50 years), group 3: 40 young adults ( 50 years) with epilepsy. Statistical analysis of differences between groups was performed by generalized linear models. Results: Adults with late-onset epilepsy (group ) had a significantly lower seizure frequency, were treated with less anti-epileptic drugs (AEDs), and reported a better tolerability of AED treatment, but had more comorbidities compared with groups 2 and 3. After adjusting for seizure frequency, tolerability of AEDs and comorbidity, young adults (group 3) reported the highest overall QoL, despite patients of group and 2 did not have significance. Epilepsy-related fears, especially fears of stigmatization, were significantly higher in elderly with long-lasting epilepsy compared with groups and 3. Conclusion: Seizure-related variables, tolerability of AEDs and comorbidity have a stronger influence on QoL and on restrictions due to epilepsy than age, age at onset of epilepsy or duration of epilepsy. However, some results indicate group-specific patterns of impairment and epilepsyrelated fears. F36 Array CGH for the investigation of epilepsy B. Tumiene, Z. Ciuladaite 2, E. Preiksaitiene 2, A. Utkus 2, V. Kucinskas 2 Vilnius, Lithuania, 2 Vilnius University Hospital Santariskiu Clinics, Centre for Medical Genetics, Vilnius, Lithuania Background and aims: Molecular karyotyping methods enabled huge progress in epilepsy diagnostics and genetic etiology uncovering. According to ISCA consensus statement 200, it is an established first-tier diagnostics for patients with developmental disabilities or congenital anomalies, giving a 7-20% additional diagnostic yield in epilepsy patients depending on epilepsy forms and comorbidities. Tens of genes were affirmed as being a single cause or giving a predisposition to epilepsy by thorough investigation of genomic imbalances found in these patients. Methods: We present four cases with genomic imbalances found by acgh in patients with epilepsy. First one is a 7-years-old female with severe intellectual disability, dysmorphic features, corpus callosum hypoplasia, congenital heart defect, bilateral clubfoot, dolichosigma and pyelectasy. Molecular karyotyping revealed a terminal chromosome deletion [del()(q43)]. Second patient, a 3-years-old female, presented with congenital heart defect, severe developmental retardation, dysmorphic features and stridor, an interstitial deletion of chromosome 6 [del(6)(q6.q22.3)] was diagnosed. Third patient is a female of 2.5-years with lissencephaly, severe developmental retardation and mild dysmorphism. A balanced translocation t(5;9)(p0;q0) inherited from a healthy father was found by conventional karyotyping while array-cgh disclosed an interstitial deletion of chromosome 7 [del(7)(p3.2p3.3]. Fourth female patient presented at the age of 35 years with a profound intellectual disability, dysmorphism and diabetes mellitus. Unbalanced translocation [der(9)t(9;9) (q34.3;q3.43)] was revealed by array-cgh. These genomic imbalances were inherited from a healthy father who is a balanced translocation carrier. Conclusion: Molecular karyotyping has a high practical and scientific value in the investigation of epilepsy patients. 205 European Journal of Neurology, 22 (Suppl. ),

65 548 Flash Posters F37 Influence of epilepsy on patients quality of life: focusing on seizure frequency, disease duration and medication count G. Zemgulyte, G. Jurkeviciene, D. Mickeviciene, E. Sukockiene 2, G. Rutkauskaite 3 Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Neurology, Kaunas, Lithuania, 2 Kaunas, Lithuania, 3 Hospital of Lithuanian University of Health Sciences, student, Kaunas, Lithuania Background and aims: The aim of the study was to evaluate quality of life (QoL) of patients with epilepsy and it s connections with disease characteristics and pharmacotherapy. Methods: In total, 74 patients participated in the survey. QoL, physical (PhWB) and psychological (PsWB) wellbeing were evaluated by SF-36v2 questionnaire. Patients were subgrouped by seizure frequency ((i) /week, (ii) </week- /month, (iii) </month- /6 months, (iv) </6 months- /y), disease duration in years: (i) -<5, (ii) 5- <0, (iii) 0-<20, (iv) 20 and medication count: mono or polytherapy. Results: Median of patients age was 33 years. The frequency of most patients seizures was </6 months- /y (40.5%). The disease duration of most patients was 20y (29.7%). Overall, 56.8% of patients were on monotherapy and 43.2% - polytherapy for epilepsy. Totally, 4.9% of patients indicated their health state as poor, 37.8% - fair, 3,% - good, 2.3% - very good and 4.% as excellent. PhWB in seizure groups varied between points and PsWB varied between 52.8 and 6.3. PhWB in monotherapy group was 55.69±29.5 and in polytherapy group it was 68.2±22.7 points. Accordingly, PsWB in these groups was 55.9±3.9 and 59.9±22.2 points (p>0,05). Conclusion: No connection was found between seizure frequency, disease duration, medication count and QoL indices. Disease associated factors had no major effect on subjects s lives. Evaluation of QoL in clinical practice is important, because treating a patient with epilepsy has to aim not only of controlling seizures, but also at the disease or it s treatment not interfering with QoL or well-being. Disclosure: Nothing to disclos 205 European Journal of Neurology, 22 (Suppl. ),

66 Flash Posters 549 Neurogenetics F38 An Algerian family with autosomal recessive Charcot-Marie-Tooth (ARCMT) disease related to c.3-g>a homozygous mutation in the GDAPgene W. Amer el Khedoud, F. Ferrat, N. Mezghiche, A. Belamri 2, C. Magdelaine 3, A. Chaouch 2, M. Chaouch Department of Neurology, Algiers, Algeria, 2 Department of Neuromuscular Explorations, Algiers, Algeria, 3 UF de génétique moléculaire, Limoges, France Background and aims: Autosomal recessive Charcot- Marie-Tooth (ARCMT) is a heterogeneous group of inherited motor and sensory neuropathies. The gene encoding the ganglioside-induced-differentiation-associated protein (GDAP) has been associated with both demyelinating and axonal phenotypes. Case Report: We report a detailed clinical, electrophysiological, and genetic study of three siblings from an Algerian ARCMT family who are homozygous for the c.3- G> mutation in the GDAP gene. They had an early age of onset with delayed walking associated with atrophy and motor weakness of the lower limbs that has spread to the upper limbs at the end of the first decade causing severe functional disability. The phenotype included hoarse voice and paralysis of the diaphragm. We notice a variability of the severity of the disease in the sibship. The electrophysiological data are compatible with an axonal form of the disease. Results: 40 mutations in the GDAP gene have been reported in patients with CMT. The mutation c.3-g> For the GDAP gene has already been described but in a compound heterozygotes in both Spanish and Polish family, whereas in our patients this mutation is in a compound homozygote which has not been reported before. Conclusion: In addition to the severity of motor weakness in our patients, there were several particular clinical features as hoarse voice and involvement of the diaphragm responsible for restrictive respiratory insufficiency that appeared in the third decade. In GDAP neuropathy, respiratory and laryngeal function should be thoroughly investigated because life expectancy can be compromised due to respiratory failure. F39 A patient with 4q3-q22 chromosomal deletion and Incontientia Pigmenti skin lesion. Diagnostic problems and therapeutic options G.J. Braathen, V. Haugan, A.K. Eek, Ø.L. Busk, K. Tveten Telemark Hospital, Department of Laboratory Medicine, Section of Medical Genetics, Skien, Norway Background and aims: Deletions of the 4q3-q22 chromosomal region have infrequently been reported. The patients may be short, microcephalic and severely retarded with multiple minor anomalies. Two of the three patients reported died before months of age. Incontinentia pigmenti (IP) is a genodermatosis that segregates as an X-linked dominant disorder and is usually lethal prenatally in males. In affected females it causes highly variable abnormalities of the skin, hair, nails, teeth, eyes, and central nervous system. Exome sequencing is a technique for sequencing all the protein-coding genes in a genome. Case Report: A new born girl with some dysmorphic features developed a skin rash, cephalic hematoma and seizures. She was treated with antiepileptic drugs. MRI and EEG were done as well as chromosomal analysis, Array comparative genomic hybridization (ACGH) and exome sequencing. Results: Chromosomal analysis revealed the 4q3.-22 deletion while ACGH defined the breakpoints. The skin lesion was compatible with IP. Exome sequencing was done to look for variants in the remaining allele of the deleted genes at 4q looking for variants of importance for her phenotype and thus hopefully give possible therapeutic options. The exome results are pending. Conclusion: 4q3-q22 deletion and Incontinentia pigmenti (IP) have never been described in the same patient and it is the first large 4q3-q22 deletion case with identified breakpoints. To our knowledge this is the first case with a defined chromosomal deletion where exome sequencing was done to investigate the remaining allele of the deleted genes looking for possible therapeutic options. F40 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

67 550 Flash Posters F4 Leukodystrophies: clinical and paraclinical diagnostic approach in the absence of genetic analysis S. Hatteb, S. Daoudi 2 Universitary hospital, neurology, Tizi Ouzou, Algeria, 2 Tizi-Ouzou, Algeria Background and aims: Leukodystrophies are characterized by abnormalities of brain white matter. We present clinical cases where coexistence of extraneurological signs and radiological specificities guided the diagnosis. Case Report: Case: 24-year-old girl with secondary amenorrhea, presented after an appendectomy, balance disorder with weakness in the lower limbs. examination showed a cerebellar ataxia with pyramidal syndrom. The magnetic resonance imaging (MRI) revealed, high signal intensity of cerebellar and hemispheric white matter on FLAIR and T2, with cavitations in frontal regions. Case2: 34-year-old man, presented with progressive ataxia. the examination found a hairless aspect of the skin with testicular atrophy. A yellowish coloration of teeth with abnormality of their arrangement was noted. The MRI showed high signal of periventricular white mater. Case3: 0-year-old girl with albinism, presented with progressive ataxia, poor school performance and character disorders. MRI showed T2 and Flair high signal lesions in periventricular regions and dentate nucleus. Results: All MRI aspect was suggestive of leukodystrophy. All enzymatic dosages were normal. case, The clinical presentation associated with the MRI aspect of leukodystrophy with cavitations evoked a vanishing white matter (VWM) disease. amenorrhea was suggestive of ovarioleukodystrophie. case2. The hormonal dosage showed low rates of FSH / LH and testosterone. We evoked the diagnosis of syndrome 4H (hypomyelination, hypogonadotropic hypogonadism, hypodontie). case3, the dosage of the cholestanol was elevated. This associated with the clinical presentation, and high signal of the dentate nucleus evoked a cerebrotendinous xanthomatosis. Conclusion: Establishing algorithms for each clinical entity by combinating symptoms with specific MRI abnormalities allowed us to reach a diagnosis. F42 DYT sequencing in patients with cervical dystonia in the Moscow region S. Kotov, K. Ostapchuk, O. Sidorova, V. Misikov, A. Polyakov 2, N. Galeeva 2 M.F. Vladimirsky Moscow Regional Clinical and Research Institute (MONIKI), Department of Neurology, Moscow, Russian Federation, 2 Medical Genetics Research Center, DNAdiagnostics laboratory, Moscow, Russian Federation Background and aims: Cervical dystonia (CD) is one of the most common motor disorders. It was revealed at least 25 different loci and/or genes, linked with the disease (DYT - DYT25). It is well known that the role of genetic disorder in CD and other types of focal dystonia is lower than in generalized dystonia. The aim of our work was investigating of CD in Moscow region. Methods: Genetic testing of 20 patients for the presence of the DYT gene mutation was performed using sequencing method, 6 ones had isolate CD, 4 - CD as a part of generalized dystonia (CD was a single clinical manifestation in the first 2-3 years of the disease). All the patients received treatment with botulinum toxin type А (BTA). Results: From 20 patients only one had C /del GAG mutation in 5th exon of DYT gene (generalized dystonia with main manifestation as CD). Single nucleotide polymorphism (SNP) rs80968 of DYT gene was revealed in 3 patients. Mean Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score after the BTA treatment course decreased by 29.3%, wherein patients with generalized dystonia - 3.8%, and patients with isolated CD %. Positive dynamics as a decrease or cessation of pain syndrome was noted in all the patients. Conclusion: In Moscow regional East-Slav patients with CD the prevalence of mutation C /del GAG in DYT gene was 5%. Our data confirm significance of SNP presence in patients with CD. 205 European Journal of Neurology, 22 (Suppl. ),

68 Flash Posters 55 F43 Analysis of gene expression TRIM35 in patients with temporal lobe epilepsy with acgh microarray DNA methods L. Kotula, J. Kocki 2, M. Grabek-Gawłowicz 2, P. Gil-Kulik 2, A. Petniak 2, J. Karwat 2 Lublin, Poland, 2 Medical University of Lublin, Department of Clinical Genetics, Lublin, Poland Background and aims: Temporal lobe epilepsy (TLE) was defined in 985 by the International League Against Epilepsy (ILAE) as a condition characterized by recurrent, unprovoked seizures originating from the medial or lateral temporal lobe. TLE is the most common single form causing refractory epilepsy. The protein encoded by TRIM35 gene is a member of the tripartite motif (TRIM) family. The TRIM motif includes three zinc-binding domains, a RING, a B-box type and a B-box type 2, and a coiled-coil region. Methods or Materials or Case Report: Work includes comparing the level of gene expression TRIM35 in patients with temporal lobe epilepsy N=4 and control group (patients with no clinical history of seizures) N=4. The method, that head been used was cdna microarrays type Human Whole Genome DNA Microarray by Biote2 AGILENT ALL HUMAN FEATURES. Using the method of TR-PCR we have confirmed the result for the genes with the largest increase or decrease of the transcript in the study group versus control group. Results: We received increased expression.942 times in the studied group, FDR=0.5846, P= Conclusion: The group of patients was too small to significantly extend conclusions. In further should be ersearch on the role of the TRIM35 gene in other types of epilepsy. F44 x-linked adrenoleucodistrophy an unpredictable phenotype? M. Marques, C. Duque, S.M.P. Carvalho 2, C. Januário Centro hospitalar e universitario de coimbra, Neurology, Coimbra, Portugal, 2 Centro Hospitalar e Universitário de Coimbra, Neuroradiology, Coimbra, Portugal Background and aims: X-linked adrenoleukodystrophy (X-ALD) is the most common peroxysomal disease. Its clinical spectrum is very variable, affecting mainly men but also heterozygous women. In the last case, phenotypes are variable and unspecific and, in the absence of endocrine dysfunction, the clinical diagnosis can be difficult. Case Report: We report the case of a three generations family with different neurological manifestations, and with a positive genetic test for X-ALD in some of its elements. Only one of those is male and has a typical form of X-ALD, beginning in childhood. The others, two women, mother and daughter, were presented at the neurology clinic at different times, with totally distinct phenotypes from each other. The mother had a spastic paraparesis and the daughter revealed a clinical picture of involuntary movements of the upper limbs, characterized by multifocal myoclonus. Results: The family connection between the three elements, which was not clear at the beginning, allowed genetic diagnosis for mutation in the ABCD gene and so, restrict the complementary investigation.however, unlike the presentation with spastic paraparesis, sensory ataxia, polyneuropathy or sphincter dysfunction, wich is is relatively well known, the clinical frame of involuntary movements and multifocal myoclonus is unusual. Conclusion: With this family want to do a brief review of the different manifestations of X-ALD; remember this diagnosis in the investigation of a familial spastic paraparesis and discuss if the clinical presentation with tremor/ multifocal myoclonus is acceptable in this disease. F45 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

69 552 Flash Posters F46 Neurodegeneration with brain iron accumulation type 2 : A single gene, two very different clinical presentations. P. Pérez Torre, M. Kawiorsky, A. Escobar Villalba, E. Bazán, A.S. Herranz, R. Gonzalo-Gobernado, A. Jimenez-Escrig Hospital Ramón y Cajal, Madrid, Spain Background and aims: Neurodegeneration with brain iron accumulation type 2 (NBIA2) is a rare disease caused by a mutation in the PLA2G6 gene which produces a wide spectrum of clinical manifestations and can occur at different ages, causing delayed diagnosis. We report two siblings affected of NBIA2 with a striking disparity presentation (typical/atypical),in which we discovered in a whole-exome study a PLA2G6 gene mutation. Case Report: A 32-year-old woman, born after a normal pregnancy. In her first months she had weak cry and frequently adopted opisthotonus posture, with normal additional test. She never walked independently and slowly deteriorate in motor and cognition. A 20-year-old woman had normal development up to the age of nine when she begun with subtle difficulties in school and social withdrawn. Several MRI showed hypointensity in the substantia nigra and globus pallidus. Image. MR imaging showing hypointensity related to iron accumulation in substantia nigra. Image 2.MR imaging showing hypointensity related to iron accumulation in basal ganglia. Results: We identified two mutations in PLA2G6 gene, an already reported (c.c222t:p.r74w /c.c435g:p. H479D), confirmed by Sanger method. Both mutations had a frequency of 0 in the.000 Genomes database and a SIFT/Polyphen score of 0,0/0,96. With the confirmation of NBIA2 molecular diagnostics in both sisters we started treatment with iron chelators. Conclusion: We report an exceptional case of two different clinical presentations of NBIA2 in two sisters and a mutation in gene PLA2G6 previously undescribed. F47 Adult onset leukodystrophy a possible Alexander s disease S. Varanda, A.F. Santos, T.G. Oliveira 2, M. Gonçalves-Rocha 3, J. Pereira, J. Fernandes 2, J. Rocha Braga, Portugal, 2 Hospital of Braga, Neuroradiology, Braga, Portugal, 3 Hospital of Braga, Genetics, Braga, Portugal Background and aims: Alexander s disease (AD) is a disorder of astrocytes resulting from mutations in GFAP gene, which encodes the glial fibrillary acidic protein, important in long-term maintenance of central nervous system myelination. More than 50 different mutations have been described, mostly de novo. Though mainly an infancy/childhood disease, it can start in adulthood with slowly progressive bulbar, pyramidal and cerebellar signs, seizures and dysautonomia. Discuss clinic-radiological spectrum of AD. Case Report: 7-year-old woman admitted after sudden onset of left-limb weakness, with progressive aggravation. She also reported recent urinary incontinence. Past medical history of arterial hypertension and dyslipidemia, unremarkable family history. Neurological examination revealed rhinolalia, left hemiparesis, hyperreflexia, bilateral Babinski sign and left hemi-hypoesthesia. Brain MRI showed ventral medullary hyperintensity on T2-weighted images and atrophy, without recent vascular lesions. No signs of neuropathy motor neuron disease on electromyogram, normal vascular investigation. A year later, she experienced strength worsening and slurred speech, also complaining of effortful breathing. Progression of bilateral hemiparesis and dysarthria were observed. Spirometry showed small airways obstruction. Brain MRI with overlapping lesions. Molecular testing of GFAP revealed c.602_604del (p.arg20del) variant, not previously described, of unknown significance. Remaining investigation was unremarkable. Conclusion: Adult-onset AD has a broad clinical spectrum, including stroke-like episodes. This patient presents clinicradiological findings suggestive of AD. However, functional assessment of genetic variants of unknown significance is difficult in the clinical setting and usually relies on bioinformatics analysis. In this case, the deleted amino acid is evolutionarily preserved, thus in favor of variant causality. Genetic characterization is, nevertheless, still incomplete. F48 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

70 Flash Posters 553 Neurological manifestations of systemic diseases F49 Rare association of prostatic adenocarcinoma and IgM-monoclonal gammopathy of undetermined significance in patient with chronic inflammatory demyelinating polyneuropathy: who is the culprit? D. Bazadona, V. Miletić University Hospital Centre Zagreb, Neurology, Zagreb, Croatia Background and aims: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired, chronically progressive or relapsing, sensor and motor neuropathy which advances for more than two months. CIDP usually occurs as an idiopathic disorder, but can be associated with numerous conditions. Paraneoplastic CIDP-like neuropathies have also been described, although, paraneoplastic syndromes from urologic malignancies, especially those associated with prostatic cancer, represent clinical rarity. So far, there is insufficient evidence regarding clinical and electrophysiological features, to consider CIDP associated with systemic diseases different from idiopathic CIDP. Having heterogeneous clinical presentation, and a variety of possible underlying etiologies, CIDP can cause many difficulties in everyday clinical practice. Case Report: We describe rare co-occurrence of prostatic adenocarcinoma and IgM-MGUS in a patient with CIDPlike neuropathy, presenting with tremor and gait ataxia, with excellent response to surgical treatment of underlying malignancy. Our patient fulfilled clinical and electrodiagnostic criteria for CIDP, and undertaken investigations revealed two above mentioned conditions, that could either separately or mutually explain clinical picture. Results: Complete resolution of resting tremor, and improvement of postural tremor after surgical treatment of prostatic adenocarcinoma has not previously been reported, and certainly points to paraneoplastic origin of our patient s condition. Conclusion: Rare co-occurrence of prostatic adenocarcinoma and IgM-MGUS highlights the importance of broad investigation in patients with CIDP. Determining the etiology is paramount, and treating the underlying disorder is the mainstay of treatment, especially when having in mind that paraneoplastic CIDP can precede diagnosis of primary tumor. F50 Neurological complications of nephropathic cystinosis in a young female adult Case report E. Dongo, M. Magyar, G. Aradi, I. Szőcs, A. Csillik,, M. Resch 3, E. Rimely 4, G. Varallyay 4, D. Bereczki, I. Vastagh Semmelweis University Medical School, Department of Neurology, Budapest, Hungary, 2 Semmelweis University, 3 Department of Genomic Medicine and Rare Disorders, Budapest, Hungary, 3 Semmelweis University Medical School, Department of Ophtalmology, Budapest, Hungary, 4 Semmelweis University Medical School, MR Research Centre, Budapest, Hungary Background and aims: Cystinosis is an autosomal recessive genetic disorder, with lysosomal accumulation of the amino acid cystine. In the nephropathic form, leading symptoms are end-stage kidney disease in childhood, and corneal deposits of cystine. Renal transplantation provides longer lifespan to the patients, so other symptoms, like neurological complications can occur in adulthood. We report a 32-year-old woman with neurological manifestation of nephropathic cystinosis. Methods and Case Report: The patient had renal transplantation at the age of 0 years. After transplantation cysteamin treatment was introduced, suspended temporarily during her pregnancy. She was referred to our department with progressive severe visual loss, anisocoria, horizontal and vertical nystagmus, distal paresis of the upper limbs, gait ataxia and mild cognitive impairment. Brain MRI, electroneurography, electromyography, muscle biopsy, detailed ophthalmological examination were performed. Results: Brain MRI scan showed several white matter lesions in the periventricular area and in both hemispheres with faint contrast enhancement. Electrophysiological examination revealed signs of chronic myopathy, and muscle biopsy proved vacuolar myopathy. Detailed viral serological tests were negative, only EBV and VZV antigens showed prior infections. Crystal deposits in all layers of the cornea was seen by ophthalmological examination. Conclusion: In this young adult patient with neurological manifestation of nephropathic cystinosis we found vacuolar myopathy and corneal crystal deposits, which are wellknown complications of cystine deposition. According to the literature, the multiple white matter lesions seen on the MRI are very likely to represent intracranial complications of the systemic storage disease, possibly caused by the temporary interruption of cysteamine treatment during her pregnancy. 205 European Journal of Neurology, 22 (Suppl. ),

71 554 Flash Posters F5 Thrombotic thrombocytopenic purpura in neurocritical care: a case report S. El Jaafary, M. Badr 2, M. El-Shamy 3 Cairo, Egypt, 2 Theodor Bilharz research center, Critical Care, Cairo, Egypt, 3 Theodor Bilharz Research Institute, Crtical care, Cairo, Egypt Background and aims: Thrombotic thrombocytopenic purpura TTP is a rare blood disorder. In its full-blown form, the disease consists of: consumptive thrombocytopenia, microangiopathic haemolytic anaemia,intravascular thrombus formation and organ dysfunction. It remains a potentially life-threatening disorder even after introduction of plasmapheresis, which reduced the mortality rate. Moschcowitz syndrome is TTP with predominant central nervous system involvement. Case Report: A 26-year-old female patient, developed high grade fever and fluctuating weakness week following caesarian section, then repeated attacks of generalized tonic clonic convulsions with disturbed conscious level upon which she was admitted to the intensive care unit, where her temperature was 38C0, Glasgow coma scale equals 5/5 with status epilepticus. Examination showed hypertension and tachycardia, bilateral papilloedema grade I, lateralization on the right side. Phenytoin in loading dose was given with little effect controlling seizures then midazolam infusion started with recurrence of seizures upon any attempt to reduce its dose. Urgent CT brain showed brain oedema. Venous sinus thrombosis was suspected but MR venograghy was negative. CBC showed severe anemia and thrombocytopenia.mildly elevated liver enzymes, elevated levels of LDH, reticulocytosis, with normal kidney functions, and blood film was positive for schistocytes. Results: Based on clinical and laboratory finding, the diagnosis of TTP was established plasma pheresis with fresh frozen plasma was initiated, upon which patient showed dramatic response following the second session with marked improvement of the conscious level & cessation of seizures. Conclusion: Neurologic involvement is a prominent component of TTP, with impaired consciousness and focal cerebral manifestations that are reversible with treatment. F52 Abernethy malformation type 2 - complicated by portosystemic encephalopathy T. Göksungur Istanbul University, Faculty of Medicine of Istanbul, Department of Neurology, Capa, Turkey Background and aims: Congenital extrahepatic portosystemic shunts (CEPS; Abernethy malformation) are rare conditions presenting with clinical manifestations due to hepatic shunting resulted in encephalopathy, pulmonary hypertension, hepatopulmonary syndrome and hypoglycemia. Here, we present a patient where the main findings were neurological. Case Report: A 32-year-old male patient with episodes of syncope, nausea, vomiting and aggressive and psychotic behavior, once or twice a month for about four years was admitted to hospital. He was apathetic and had tremor in his hands and his speech and gait was disturbed on admission. Hyperammonemia with normal liver functions was detected and abdominal ultrasonography revealed a congenital extrahepatic portosystemic shunt with normal hepatic image. He was diagnosed as Abernethy malformation type 2 complicated by portosystemic encephalopathy. Results: The patient responded very well to surgical ligation of the shunt and no further episodes have been reported after the surgery. Conclusion: CEPS should be considered in the differential diagnosis of hepatic encephalopathy in patient with hyperammoneia. 205 European Journal of Neurology, 22 (Suppl. ),

72 Flash Posters 555 F53 Subacute cognitive decline and stroke-like episodes in late-onset mitochondropathy K. Jessen, M. Meier-Cillien, J. Unser, S. Hopf-Jensen 2, H. Stolze, B. Vatankhah Diako, Neurology, Flensburg, Germany, 2 Diako, Radiology and Neuroradiology, Flensburg, Germany Case Report: A 5-year-old man with subacute aphasia, apraxia and cognitive deficits developing within two weeks was admitted. He also reported on an increasing hypacusis during the last months and a diabetes mellitus for several years. The computer tomography and magnetic resonance imaging (MRI) of the brain revealed temporal edemas in both hemispheres. The findings were also conformable to a viral encephalitis. Nevertheless, the lumbar puncture did not support this hypothesis. The cell count was normal, but the lactate was highly raised in the spinal fluid (7.4mmol/l, normal: <.9) and in the blood (4.4 mmol/l). No hints for an autonomic or paraneoplastic encephalopathy were found. The condition increasingly worsened especially regarding his cognitive state. A further MRI revealed a massive increase showing stroke-like areas in both hemispheres including diffusion deficits of the cortex. The areas did not obey the arterial supply territories. A possible mitochondropathy was assumed and a therapy with L-arginine was started. A preexisting metformine medication was discontinued due to a possible enhancement of the now upcoming lactic acidosis. A muscle biopsy proved a mitochondrial DNA mutation with heteroplasmic 3243 A>G mutation. The state of the patient finally improved but relevant deficits especially regarding speech and cognition remained. He was later transferred to a rehabilitation unit. Later on it turned out, that a niece of the patient suffered from the same disease. Summary: We report about a late and subacute onset of mitochondrial encephalomyopathy, lactic acidosis and strokelike episodes (MELAS syndrome) and demonstrate neuroradiological findings. F54 Peripheral neuropathy as presenting feature in Sjögren Syndrome: a case report. F. Kalligerou, V. Zisimopoulou, S. Katsavos, A. Tsagkaropoulos, E. Kouremenos, A. Kodounis 25 Hellenic Airforce General Hospital, Department of Neurology, Athens, Greece Background and aims: Sjögren Syndrome (SS) is an autoimmune inflammatory disorder characterized by chronic lymphocytic and plasmacellular infiltration of exocrine glands and extraglandular features including peripheral nervous system involvement. Peripheral neuropathy may manifest as sensory ataxic neuropathy, trigeminal neuropathy, multiple mononeuropathy, radiculoneuropathy, painful sensory neuropathy without sensory ataxia, autonomic neuropathy with anhidrosis and multiple cranial neuropathy. Case Report: A 42-year-old woman presented with a 5-year-history of recurring facial numbness and patchy dysesthesia of the upper and lower extremities. The patient described 2 previous episodes which were successfully treated with oral corticosteroids. She also complained of long-standing dry mouth and occasionally foreign body sensation in the eyes. Neurological exam revealed numbness of skin and mucosal membranes in the distribution of V3 nerve and significantly decreased proprioception in lower limbs. All serum laboratory and hormonal values were within normal ranges except for a positive diffuse staining of antinuclear antibodies (ANA) at :80. EMG and NCS revealed normal values. Somatosensory evoked potentials were substantially prolonged. Gadolinium enhanced brain MRI revealed unilateral enhancement of the V3 nerve. MRI of the cervical and thoracic cord was normal and CSF values were unremarkable. Results: Histopathology of minor salivary glands was consistent with a diagnosis of SS. The patient was treated with corticosteroids and her condition gradually improved. Conclusion: Neurologic involvement occurs in approximately 0 to 30% of patients with primary SS and may precede the diagnosis. Screening for SS should be considered in the differential diagnosis of unexplained peripheral neuropathy. Our case demonstrates a successful diagnosis and treatment of neurologic complications of SS. 205 European Journal of Neurology, 22 (Suppl. ),

73 556 Flash Posters F55 Neuropathy revealing primary systemic amyloidosis: case report S. Makhlouf, M. Messelmani, E. Mabrouk, H. Derbali, J. Zaouali, R. Mrissa Military hospital, Tunis, Tunisia, Department of neurology,, Tunis, Tunisia Background and aims: The expression of AL Amyloidosis is often systemic. Peripheral neuropathies are present in 20% of primary Amyloidosis. Case Report: We report the case of a patient with amyloidosis revealed by peripheral neuropathy. Results: A 63-year-old man was examinated due to painful paresthesia, motor weakness of the feet, diarrhea, anal incontinence and orthostatic hypotension. Neurological examination showed cortical functions and cranial nerve pairs to be normal. The tendon reflexes were low in the lower limbs. Spinal MRI did not show medullar or radicular compression. The electromyogram showed a severe peripheral axonal neuropathy. Salivary gland biopsy showed positive Congo red stains. Immunofixation showed kappa light chains. The treatment was based on the association of melphalan and dexamethasone. Conclusion: Amyloidoses are classified as rare diseases. Primary systemic, or light chain amyloidosis (AL) is characterized by a clonal population of plasma cells in the bone marrow that produce monoclonal light chain of kappa or lambda type.in addition to neuropathy or myopathy, primary systemic amyloidosis is usually presents with systemic or generalized symptoms, cardiac or renal insufficiency or multiple organ involvement. Musculosketal pain, purpura, hepatomegaly, macroglossia, orthostatic hypotension, and edema are most common. The presence of an autonomic disorder supports a suspected diagnosis of polyneuropathy due to amyloid deposition. The treatment is based on high dose of melphalan and autologous stem cell transplantation. Diagnosis of AL amyloidosis should be considered in the presence of a mild peripheral neuropathy. The two key diagnostic procedures are serum protein electrophoresis and nerve biopsy. Delay in treatment worsens the prognosis F56 Spastic paraplegia: Have a think to hepatic myelopathy (Report of 3 cases) O. Hdiji, N. Bouzidi, E. Turki, I. Bouchhima, M. Damak, M.I. Miladi, C. Mhiri Habib bourguiba hospital, Sfax, Tunisia Background and aims: Hepatic myelopathy (HM) is a rare neurological complication of chronic liver disease with portal hypertension. There is no special diagnostic tool for hepatic myelopathy. In this study, we described three patients who presented with spastic paraparesis and diagnosed as HM when all other possible diagnoses were ruled out. Methods: This retrospective study was carried on all patients followed for HM at the Neurology s department, Habib Bourguiba Hospital during 2 years. All data were collected from their medical records. Results: We have collected 3 patients with MH. The mean age was 24.6 years with sex-ratio (M/F) 0.5.Only one had a history of previous encephalopathy. Two patients had hepatitis B cirrhosis and one had cirrhosis of unknown origin. All of them had portal hypertension with porto-cave shunt. All cases were presented with progressive weakness in lower limbs with walk difficulty. Sphincter disturbances and sensory symptoms were noted on 3 and 2 cases respectively. Their examination revealed spastic paraparesis. Vitamin B2 and Folate values were normal. Anti-nuclear antibody and HIV antibodies were negative on all cases. Cerebrospinal fluid contained normal glucose, protein, and cell counts. Spinal cord and brain MRI were normal on all cases. Nobody had liver transplantation and they gradually worsened. Conclusion: HM must be considered in patients with chronic liver disease presenting with spastic paraplegia after excluding other etiologies of myelopathy and this even on association to sphincter disturbances and sensory symptoms and without any prior episodes of encephalopathy. 205 European Journal of Neurology, 22 (Suppl. ),

74 Flash Posters 557 F57 Antiphospholipid antibodies - a cause or a consequence of epileptic seizures or antiepileptic treatment? G. Mihailescu, I. Buraga, S. Nica, C. Baetu 2, R. Ciurea 3, B. Margineanu 3 UMF CAROL DAVILA, Colentina Hospital, Neurology, Bucharest, Romania, 2 Colentintina clinical hospital, Neurology, Bucharest, Romania, 3 Colentina Clinical Hospital, Neurology, Bucharest, Romania Background and aims: Partial or generalized seizures can precede the diagnosis of antiphospholipid syndrome (APS) or be neurological associated symptoms. Are antiphospholipid antibodies (AFLA) a cause or a consequence of epileptic seizures or antiepileptic treatment? Methods: 58 patients with APS (89% women, % men) were studied, (72%) of them with neurological symptoms (headache, amaurosis fugax, repeated strokes), and 9 of them (8%) with epileptic seizures. AFLA, lupus anticoagulant antibody, Anti-dsDNA (Double-Stranded Antibodies), antibodies anti Ro, anti Sm, anti RNP were measured. EEG and cerebral MRI and CT scan were performed. Results: 5 patients of 9 had seizures at ages under of 9 patients had seizures before APS diagnosis or suggested it. All 9 patients had high levels of anticardiolipinic antibodies, lupus anticoagulant antibody was present in 6 patients, 7 patients were positive for Anti-dsDNA (Double- Stranded Antibodies) and 6 for antibodies anti Ro, anti Sm, anti RNP. Seizures were generalized (5 patients), partial (4 patients). Multiple ischemic lesions (88.88% more than 2 lesions) and/or cerebral atrophy were identified. Conclusion: High levels of AFLA in patients with seizures, even prior to APS diagnosis. 66% of them showed high values for lupus anticoagulant antibodies. These antibodies are a risk factor for ischemic vascular diseases, especially neurologic ones. Cerebral lesions appear early in the course of the disease and seizures can precede or suggest the diagnosis of APS. Three patients received antiepileptic drugs prior to the APS diagnosis so it could also be an iatrogenic lupus-like syndrome. Could anticoagulant therapy be helpful? F58 Stroke and multiple-site arterial infarcts with deep venous thrombosis secondary to probable ovarian mucinous cystadenocarcinoma G. Papadimitropoulos, M. Chondrogianni, C. Zompola, A. Roussopoulou 2, G. Dervenoulas, C. Liantinioti, S. Papageorgiou, N. Economopoulos 3, K. Voumvourakis, G. Tsivgoulis National and Kapodistrian University of Athens, 2 nd Neurology Department, Attikon Hospital, Athens, Greece, 2 Athens, Greece, 3 General University Hospital ATTIKON, 2 nd Department of Radiology, Athens, Greece Background and aims: Multiple infarcts in cancer patients have been well documented, as a result of either systemic complications like disseminated intravascular coagulation or more directly malignancy-related hypercoagulable states such as mucin-related thrombosis. We present the case of a 49-year-old Caucasian woman with stroke, visceral infarcts and pulmonary embolism as first presentation of ovarian malignancy. Case Report: The patient was admitted to the ER with speech disorders and shortness of breath whereupon aphasia with right hemianopia and ataxia of the right upper limb was found, with markedly elevated D-dimers titre (> 8000 ng/ml). Brain CT revealed multiple left temporal and parietooccipital cortex hypodensities, confirmed with emergency brain MRI to be areas of true diffusion restriction corresponding to acute infarcts of the left middle cerebral artery. Moreover, pulmonary CT arteriography showed massive bilateral pulmonary infarction. Results: In the course of investigation the patient proved seronegative for autoimmune disorders of coagulation while many neoplastic markers (namely Ca 9.9, Ca 5.3, Ca 25, HE4) were elevated, with Ca 9.9 measured at more than 0,000 U/mL. Abdomen CT was ordered and a large infiltrating left ovary mass was revealed with mixed features including hyperintensities and lobules, indicating probable cystadenocarcinoma of the ovary. Multiple infarcts of the spleen and both kidneys were also observed. Conclusion: Although the patient passed away due to multiorgan failure before resection and biopsy of the tumor could be performed, little doubt exists as to the cause of the infarcts, indicating among other things, a probable role for D-dimers as biomarker for occult neoplasms. 205 European Journal of Neurology, 22 (Suppl. ),

75 558 Flash Posters F59 Bing-Neel syndrome in a patient with Waldenstrom s macroglobulinemia. R. Pasmans, T. Schreuder Heerlen, Netherlands Background and aims: Waldenstrom s macroglobulinemia (WM) is a rare chronic lymphoproliferative disorder, characterized by the presence of large amounts of circulating monoclonal immunoglobulin M (IgM) and lymphoplasmocytoid bone marrow infiltration. Neurological complications include polyneuropathy (5-0%), diffuse encephalopathy and focal deficits related to hyperviscosity or bleeding. Bing-Neel syndrome is an extremely rare neurologic complication associated with central nervous system (CNS) infiltration by lymphoplasmacytoid and plasma cells. We present a patient with leptomeningeal infiltration. Case Report: A 55-year-old man with WM presented with a progressively numb chin since a year and a half. It occurred specifically in prone or supine position. Furthermore he reported a dull headache on awakening and since two years he experienced right-sided tinnitus and autophonia. Neurological examination revealed right-sided conductive hearing loss but was otherwise normal. Based on magnetic resonance imaging (MRI) he was diagnosed with Bing- Neel syndrome. Results: Laboratory results showed IgM paraproteinemia, 27.4 g/l. Gadolinium-enhanced MRI brain showed right temporal and left frontal dural enhancement and thickening involving the right temporal lobe, compatible with leptomeningeal infiltration by lymphoplasmacytic cells: Bing-Neel syndrome. Contrast-enhanced CT skull showed mastoiditis and a pathological mass in the epitympanum on the right. Figure 3: contrast-enhanced CT skull Conclusion: Radiologic findings of Bing-Neel syndrome have been infrequently reported due to extreme rarity of the case. However rare, it may be necessary to consider this diagnosis in WM because it can mimic many diagnoses. In addition to differentiating true WM lesions in the CNS from hyperviscosity events, evaluation of the brain with gadolinium-enhanced MRI has the potential to guide management. Figure : transverse gadolinium-enhanced MRI brain Figure 2: coronal gadolinium-enhanced MRI brain 205 European Journal of Neurology, 22 (Suppl. ),

76 Flash Posters 559 F60 A case report study of late-onset adrenoleukodystrophy associated with psychiatric symptoms. G. Radevski, I. Milanov University Neurological Hospital Saint Naum Sofia, Neurology, Sofia, Bulgaria Background and aims: X-linked adrenoleukodystrophy is a rare genetic disease affecting paroxisomal metabolism of very long chain fatty acids due to mutations in the gene ABCD. It is not commonly appreciated that patients with adrenoleukodystrophy (ALD) can first present in adulthood with psychiatric symptoms. Our aim is to increase awareness of metabolic diseases such as adrenoleukodystrophy, which are probably underrecognized as a cause of psychiatric illness. Case Report: We describe the case of a 33-year-old man affected by ALD whose symptoms first appeared a few years earlier in the form of worsening the psychiatric signs present as treatment-resistant mania. They were followed by the onset of spastic paraparesis and amyotrophy indicative of the concomitant presence of adrenomyeloneuropathy. We made neurologic examination, magnetic resonance imaging and metabolic screening revealed abnormalities of very long chain fatty acids. Results: Our patient manifests signs of mania. Neurologic examination reveals spasticity, marked hyperreflexia with clonus, and bilateral Babinski signs. Neuroimaging presents diffuse, confluent white matter lesions that typically originate in the parieto-occipital region. Both neuroleptic and anticholinergic medications may result with little resolution of the underlying psychiatric symptoms. Metabolic screening revealed abnormalities of plasma very long chain fatty acids. This case study illustrate the importance of performing neurologic and radiological examinations on all psychiatric patients with chronic illnesses. We emphasize the importance of reexamining and reimaging patients who are not responding to standard treatment. The clinical problem of treatment resistance should be seen as an indication that other diagnoses, such as an underlying metabolic disorder, need to be considered. F6 Takayasu arteritis with bilateral occlusion of subclavian artery and stenosis of left internal carotid artery E.A. Solomon, A. Buture, A. Dulamea 2 Bucharest, Romania, 2 Fundeni Clinical Institute, Neurology, Bucharest, Romania Background and aims: Takayasu arteritis is a chronic, idiopathic inflammatory disease that primarily affects large vessels such as aorta and its branches. Affected arteries become stenotic or occluded. It is a disease with different clinical presentation, depending on the different groups of blood vessels involved. Case Report: We report a case of a 26-year-old woman diagnosed with Takayasu arteritis since 200. At age 3 the patient had a double aorto-coronary by-pass secondary to a bilateral occlusion of subclavian artery, she had hypertension and dyslipidemia. The patient was admitted for headache, nausea and vertigo after a myocardial infarction with angioplasty and stenting on anterior descending artery Results: CT angiography showed 80-90% stenosis of left internal carotid artery, 50% of right internal carotid and stenosis of bilateral common carotid stent Conclusion: Takayasu arteritis is a disease with high risk of stroke in young adults. 205 European Journal of Neurology, 22 (Suppl. ),

77 560 Flash Posters F62 Prosopagnosia as the presenting symptom of Whipple s Disease M. Tábuas-Pereira, M. Vicente 2, C. Filomena 3, M.I.J. Santana Coimbra, Portugal, 2 CHUC, Neurology, Coimbra, Portugal, 3 CHUC, Infectious Disorders, Coimbra, Portugal Background and aims: Whipple s disease is a rare multisystemic chronic infectious disease. Central Nervous System is secondarily involved in 43% of the patients and in 5% there is an isolated or primary involvement of CNS. The most frequent CNS symptoms are headaches and cognitive changes. Prosopagnosia is as relatively rare condition, usually related to vascular lesions, consisting in an inability to recognize familiar faces, despite the absence of low-level visual impairments or cognitive alterations. Case Report: Here we report a 54-year-old woman who presented sub-acutely with fever, headache and seizures, leading to the diagnosis of an infectious meningoencephalitis, treated with broad-spectrum antibiotherapy with a temporary improvement. She then developed a chronically-evolving cognitive impairment with associative prosopagnosia as the major complaint. Retrospectively she had complaints of sporadic abdominal pain and mild sacroiliac arthralgia. Although the duodenum biopsy was negative, the diagnosis of a primary CNS WD was weighted and confirmed by PCR and brain biopsy. She was treated with ceftriaxone 5 days followed by co-trimoxazole for 2 years with no further impairments. Conclusion: To our knowledge, prosopagnosia in the context of primary CNS Whipple s Disease was only described once in a context of a more complex clinical case. Acute clinical awareness is necessary as CNS Whipple s disease is a rare treatable disease that can lead to serious irreversible lesions if not promptly treated. A long term follow-up is mandatory. F63 Paraneoplastic neurogical syndromes: rare but more common than expected: literature review with ten cases H. Uluğut Erkoyun, S. Gündoğan, Y. Secil, T. Kurt İncesu, Y. Beckmann, H.S. Türe, G. Akhan Izmir katip çelebi university atatürk education and research hospital, neurology department, Izmir, Turkey Background and aims: Paraneoplastic neurological syndromes (PNS) are rare disorders which are remote effects of cancer that are not caused by the tumor, its metastasis or side effects. Whereas some syndromes affect only certain parts of the nervous system, other syndromes involve both central and peripheral neurons, resulting in complex clinical manifestations. We present ten different cases of PNS who were followed in our neurology clinic in last two years and we review the findings with the literature. Methods: 3 of our patients were stiff-person syndrome, 2 were limbic encephalitis, 3 were subacute cerebellar degeneration, one was Lambert-Eaton myasthenic syndrome, and was subacute sensory neuronopathy. Primary malignancy was lung cancer in 4, breast cancer in 2, ovarian cancer in, and thyroid cancer in of the patients. In 2 cases malignancy could not be detected at the time of presentation. Autoantibody testing was achieved in 7 of the patients where all were positive to targeting intracellular antigens. of the patients died. Results: PNS are more common than expected and neurologist should be aware of the variety of the clinical presentations of these syndromes. Conclusion: PNS are rare but important entity in clinical practice. Antibody testing is diagnostic tool in PNS but sometimes it can be negative. Type of auto-antibody and primary cancer are major determinants of prognosis of diseases. PNS are more common than expected and neurologist should be aware of the variety of the clinical presentations of these syndromes. 205 European Journal of Neurology, 22 (Suppl. ),

78 Flash Posters 56 Neuro-ophthalmology/-otology F64 Prevalence of parkinsonian symptoms among patients with peripheral vestibular disorders S. Becker-Bense, C. Wittmann, B. Bloem 2, M. Dieterich University Munich, Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), Munich, Germany, 2 3Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmengen, Netherlands Background and aims: After an epidemilogic study found increased prevalences of benign paroxysmal positional vertigo (BPPV) in Parkinson s disease (PD) (overall 5.3%; % in self-reported dizziness) [], two questions arise: A) wether the prevalence of PD is increased in BPPV either, and B) if the prevalence of parkinson symptoms differs compared to other peripheral vestibular syndromes. Methods: All patients with carefully diagnosed BPPV (n=2347), Menière s disease (MD; n=48), and vestibular neuritis (VN; n=73) in the Department of Neurology and German Dizziness Center between 2004 and 203 were retrospecitvely classified according to the modified Hoehn and Jahr scale [2]. Results: The prevalence for parkinson symptoms in the total BPPV group (mean 59years) was.%. In BPPV patients > 65years of age it rises to 2.6%, > 70 to 3.5%, and > 80 to 4.5%. The symptoms were only mild in the majority of patients ( 2). In VN and MD the prevalences lay within the range of the normal population ( 0.% resp. 0.3%). Conclusion: Among patients with peripheral vestibular disorders only the BPPV patients showed a slightly increased prevalence of parkinson symptoms compared to the general population (2.6% vs..8% > 65years). However, the prevalence for PD in BPPV patients (3.5% > 70years) seems to be lower than the prevalence for BPPV in PD (5.3% at a mean age of 72 years) at least in less severly affected patients that can visit an outpatient clinic.. Wensen et al., Parkinsonism Relat Disord Goetz et al., Movement Disorders 2004 Disclosure: The study is funded by the German Federal Ministry of Education and Research (grant code 0 EO 40,IFB LMU). F65 No evidence for an impairment of horizontal canal or otolithic organ function in patients with progressive supranuclear palsy N. Böttcher, T. Bremova, S. Bardins, N. Dinca, K. Feil 2, S. Krafczyk 2, S. Lorenzl 2, M. Strupp 2 University of Munich, German Center for Vertigo and Balance Disorders, Munich, Germany, 2 University Munich, Department of Neurology, Munich, Germany Background and aims: Since conflicting findings on vestibular function in progressive supranuclear palsy (PSP) were published we systematically investigated semicircular canal, saccular and utricular function and correlated this with the impairment of the oculomotor system, postural imbalance, PSP rating score (PSPRS), frequency of falls, Falls Efficacy Scale (FES) and Dizziness Handicap Inventory (DHI). Methods: 7 patients with probable PSP (0 females, age 64-79yrs, mean 72yrs, mean disease duration 3.4yrs, mean PSPRS 3.8) and 5 age-matched controls were examined with cervical vestibular evoked myogenic potentials (cvemp for saccular function) and ocular VEMP (ovemp for utricular function), video Head Impulse Test (vhit), calorics, videooculography of saccades, posturography and the above mentioned scales. Results: All subjects except one control had reproducible o/ cvemp. There was no significant difference of the peak-topeak amplitude of ovemp (3.5±7.2µV vs. 2.7±5.5µV) and cvemp (63.4±40.4 µv vs. 57.2±33.9µV) between PSP patients and controls. In PSP patients the mean VOR gain was.0±0.2 and caloric testing also normal. The mean velocity of saccades in PSP patients was 233±89 / sec horizontal, 5±75 /sec downward and 23±07 /sec upward (controls 426±69 /sec; 44±69 /sec; 433±63 /sec; all p<0.0). Total root mean square (RMS) in PSP patients was significantly increased (eyes open/head straight/stable ground.22±8.05 vs 7.03±2.5, p=0.05) but not total sway. There was no significant correlation between vestibular/oculomotor function and the scales mentioned above. Conclusion: Using a systematic approach we neither found evidence for an impaired semicircular or otolith function in patients with PSP nor a correlation between vestibular, oculomotor, postural function and disability scores. 205 European Journal of Neurology, 22 (Suppl. ),

79 562 Flash Posters F66 Correlation between nitric oxide synthesis and transcranial doppler ultrasonography in ophthalmic migraine patients A.E. Bulboaca, A. Bulboaca, C.L. Ursu 2 Cluj, Romania, 2 Clinical Rehabilitaion Hospital, Neurology, Cluj, Romania Background and aims: Hemodynamic changes of the cerebral arteries in ophthalmic migraine may be an important pathophysiological mechanism of the disease. The nitric oxide (NO) synthesis plays a significant role in hemodynamic changes due to vasodilatation effect. The purpose of this study is to evaluate the possible hemodynamic changes by Doppler measurements and their correlation with NO synthesis in ophthalmic migraine. Methods: 37 ophthalmic migraine patients were compared with 35 healthy volunteers. Other cerebral and ophthalmic diseases were excluded by ophthalmological, neurological, and cranial MRI examinations. The migraine assessment scale (MIDAS) was used for clinical evaluation. Transcranial Doppler ultrasonography (TCD) was performed using 2 and 4 MHz frequencies transducers. The flow velocities of the internal carotid artery, middle cerebral artery, posterior cerebral artery, and NO plasma concentration were assessed 2 hours after migraine attacks. Results: The NO synthesis was significantly increased compared to the control group. The flow velocities decreased in internal carotid artery, middle cerebral artery, and posterior cerebral artery. The correlation between decreased flow velocities and NO plasma concentration was significant. Conclusion: Autonomic nervous system dysfunction in ophthalmic migraine is an important pathophysiological mechanism. The flow velocity status may reflect the vasomotor response and endothelial reactivity induced by NO synthesis. Further studies on the vasomotor response are necessary for evaluation of this pathophysiological mechanism implication in ophthalmic migraine. F67 Establishing a Vestibular Migraine Diagnosis Questionnaire and testing it for reliability: a preliminary study N. Celebisoy, H. Karapolat 2, F. Gokcay 3, C. Bilgen 4, T. Kirazli 4 Izmir, Turkey, 2 Ege University Medical School, Physical Medicine and Rehabilitation, Izmir, Turkey, 3 Ege University Medical School, Neurology, Izmir, Turkey, 4 Ege University Medical School, Otorhinolaryngology, Head and Neck Surgery, Izmir, Turkey Background and aims: To establish a Vestibular Migraine Diagnosis Questionnaire which may distinguish patients with vestibular migraine in a group of patients defining vertigo and to determine its reliability. Methods: A questoinnaire consisting of ten questions was prepared by 5 specialist physicians and was given to thirty consecutive patients referred to our dizziness clinic with a pre-diagnosis of vestibular migraine. Results: When all items of the questionnaire were evaluated, the content validity ratio ranged from 0.6 to 0.87, and the content validty index was The confirmity observed between the real diagnosis (based on vestibular migraine diagnostic criteria of the International Classification of Headache Disorders-3 beta version and clinical examination)and the diagnosis based on the questionnaire was 73.3%, and the kappa coefficient was (moderate). Sensitivity of the questionnaire was 86.7% (3/5) and the specifity was 60% (9/5) with a positive predictive value of 68.4% (3/9) and a negative predictive value of 8.8% (9/). There was no significant difference in question conformity (conformity between the first and second responses) or diagnostic conformity (conformity between the real diagnosis and the diagnosis based on the questionnaire (p>0.05). Conclusion: The questions of our questionnaire had moderate reliability It was decided that it would be better to make a diagnosis of vestibular migraine in Turkish population after a face-to-face interview and neuro-otological examination than based on a questionnaire. Administering our preliminary study to a larger patient group would contribute to our results. 205 European Journal of Neurology, 22 (Suppl. ),

80 Flash Posters 563 F68 Transitory episodes of tilted visual perception disorder in a patient with left lateral ventricle dilatation due to foramen of Monro stenosis S. Cherninkova, R. Petkov 2 University Alexandrovska Hospital, Neurology, Sofia, Bulgaria, 2 University Sofiamed Hospital, Radiology, Sofia, Bulgaria Background and aims: Transitory tilted or inverted visual perception disorder is a relatively rare anomaly related to variable brain pathology. The duration of these transitory episodes is variable from seconds to several hours. In almost all patients described in the literature the rotation of the visual images is in the frontal plane. In the literature is proposed that the region involved in cases with this phenomenon is the parieto-occipital zone or there is a dysfunction of the multisensory parieto-insular vestibular cortex or its associative cortical areas. Material and Methods: We present a 6-year-old boy who informed his parents about three episodes of rotation of the images in front of him in the last 5 days, lasting -2 minutes and abruptly disappearing. According to his description, the tilt of vision is approximately 900 and is in the frontal (coronal) plane. A full neurological and neuroophthalmological status, electro-encephalography and MRT of the brain were performed. Results: Except of tilted vision episodes, no other neurological or neuro-ophthalmological abnormalities were found. Electro-encephalography was normal. MRT of the brain revealed the only pathologic finding mild unilateral (left) lateral ventricular dilatation due to left foramen of Monroi stenosis, interpreted as congenital. Right lateral ventricle, third ventricle and fourth ventricles were normal in size. No other brain or brain vessels anomalies were disclosed. Conclusion: We did not find in the literature reported patients with tilted perception disorder associated with hydrocephalus. There is no obvious explanation of tilted perception disorder in this case. F69 Predictive capability of an ipad based medical device (MedX) for the diagnosis of vertigo and dizziness K. Feil, R. Feuerecker 2, T. Brandt 3, R. Strobl 4, E. Grill 5, A. von Mueller 6, M. Strupp 2 Munich, Germany, 2 University Munich, Department of Neurology and Department of German Center for Vertigo and Balance Disorders (DSGZ), Munich, Germany, 3 University of Munich, German Center for Vertigo and Balance Disorders, Munich, Germany, 4 University Hospital, 4 Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), Munich, Germany, 5 University Hospital, 4 Institute for Medical Information Processing, Biometrics and Epidemiology (IBE) and German Center for Vertigo and Balance Disorders, Munich, Germany, 6 Parmenides Foundation, Pullach/Munich, Munich, Germany Background and aims: Making correct diagnosis of patients presenting with dizziness and vertigo can be challenging. In this study we present a new approach using an ipad based program named MedX to systematically compare the prediction of clinical diagnoses and determine the power of this system to distinguish between different diagnoses. Methods: The data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders. All patients were seen by a specialist receiving a complete standardized history and a systematic clinical examination. We compared the final diagnosis with the suggested diagnosis by the system and further analyzed to predictive value of the system. Surface of ipad-based program MedX. Production of diagnosis in constellary diagnosis (CD), putting information of patient s history. Results: 60 patients (mean age 58.±6.3, 5.2%female) were included. The most common diagnoses were as follows: phobic postural dizziness (9.3%), Meniere s disease (7.7%), vestibular migraine (VM) (6.6%) and benign paroxysmal positioning vertigo (5.4%) followed by bilateral vestibulopathy (BVP) (8.0%) and downbeat nystagmus (7.5%). The accuracy of the suggested diagnosis ranged from 82 to 99% having a specificity from 92-99%. The sensitivity differed: in vestibular neuritis (VN) or VM the sensitivity was quite lower (42.3% for VN and 43.7% for VM) than in psychogenic vertigo (80.5%), Menière s disease (77.8%)or BVP (8.6%). Conclusion: These results demonstrate the possibilities of MedX, which can guide for the diagnosis based on the collected data. The resulting predictive model correctly matched a patient to his ultimate clinical diagnosis in 95.5% of the time over all different diagnosis. All in all MedX is a new way to screen for different vertigo diagnosis. Disclosure: This study was supported by the BMBF to the IFB (grant code 0 EO 090). F70 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

81 564 Flash Posters F7 Isolated optic tract acute inflammation R. García-Rodríguez, M. Gonzalez Delgado, J. Fernández-Domínguez, V. Mateos Marcos Oviedo, Spain Background and aims: Optic neuritis (ON) is an acute inflammatory demyelinating disorder of the optic nerve that occurs most often in young adults. It can be associated with a more widespread demyelinating disorder of the central nervous system such as multiple sclerosis (MS). In fact, up to half of MS patients can present with optic neuritis as a clinically isolated syndrome. However, inflammation of the optic tract is a much more rare entity. Case Report: A 24-year-old woman presented with a 0- day history of visual disturbance with sudden onset. Ophtalmologic examination showed a campimetric deficit (left homonymus inferior quadrantanopsia) with normal visual acuity. The rest of the neurological exploration showed no other deficits. Magnetic Resonance Imaging (MRI) revealed enhancement of the right optic tract (figure ). There were no other cerebral or medullar lesions. Optic coherence tomography, as well as visual and somatosensory evoked potentials were normal. Cerebrospinal fluid oligoclonal bands and serum anti-aquaporin 4 antibody were absent. F72 Repeatability of the ice test in the evaluation of ptosis in myasthenia gravis J.-M. Hwang Seoul National University College of Medicine, Department of Ophthalmology, Gyeonggi-do, Korea, Democratic People s Republic of Background and aims: The ice test is known to be the most sensitive test in diagnosing ptosis related to myasthenia gravis. However, little is known of the repeatability of the ice test in myasthenic ptosis and controls. To determine the repeatability of the ice test in the evaluation of ptosis in myasthenia gravis. Methods: In 36 patients with myasthenia gravis and 39 patients with nonmyasthenic ptosis, the ice test was repeated 2 times on separate days in the afternoon. Results: The ice test demonstrated poor repeatability in myasthenia gravis compared to nonmyasthenic ptosis. Repeated ice tests increased the positive predictive value by 2.5% and the negative predictive value by 7.4% compared to a single test. Conclusion: The ice test displayed poor repeatability in myasthenic ptosis. Repeated tests enhanced the validity of the test. The ice test demonstrated poor repeatability in myasthenia gravis (72.7%) compared to nonmyasthenic ptosis (97.4%). Repeated ice tests increased the positive predictive value by 2.5% and the negative predictive value by 7.4% compared to a single test. Figure. MRI images showing selective enhancement of the right optic tract Results: After a 5-day pulse steroid therapy of intravenous methylprednisolone ( g/day) the patient recovered completely. A new MRI performed three months later showed resolution of the optic tract enhancement. Conclusion: Acute focal lesions of the optic tract are infrequent either isolated or associated with MS. Visual recovery in this patient was excellent, as it usually occurs in ON, and an expectant management was elected in absence of any other alterations in the rest of the studies performed. 205 European Journal of Neurology, 22 (Suppl. ),

82 Flash Posters 565 F73 Neuro-ophthalmologic findings in neurodegeneration with brain iron accumulation type I J. Jesus Ribeiro, C. Farinha 2, M. Sousa, F.V. Moreira, M. Amorim 3, J.M.G. Lemos, C. Januário Centro Hospitalar e Universitário de Coimbra, Neurology, Coimbra, Portugal, 2 Centro Hospitalar e Universitário de Coimbra, Ophtalmology, Coimbra, Portugal, 3 Centro Hospitalar e Universitário de Coimbra, Otorhinolaryngology, Coimbra, Portugal Background and aims: Neurodegeneration with brain iron accumulation (NBIA) type I is characterized by basal ganglia iron deposition. Neuro-ophthalmic involvement includes pigmentary retinal degeneration, optic neuropathy and slow saccades; however a characteristic neuro-ophthalmic phenotype has not been delineated so far. Methods: Five patients with disease onset between 9 and 23 years old and genetic confirmed NBIA type I underwent ophthalmologic examination with color fundus photography (CFP), spectral domain-optical coherence tomography Spectralis (SD-OCT), fundus autofluorescence (FAF) and videonystagmography. Results: Median distant visual acuity was 20/20. Two patients presented with mild optic disc pallor and retinal pigment epithelium (RPE) mottling/atrophy in CFP; mild thinning of the outer nuclear layer (ONL) in SD-OCT; FAF was normal. Another two patients presented with bilateral signs of more advanced retinopathy: RPE mottling/atrophy outside the macula and optic disc pallor in CFP;SD-OCT revealed loss of the photoreceptors inner-outer segment junction (IS OS) and external limiting membrane (ELM), and profound ONL thinning outside the central macula; FAF revealed a parafoveal hyper-autofluorescent ring. Videonystagmography was available in 2 patients, showing low gain vertical pursuit (0.45Hz) in both (patient mean gain: 0.28; patient2 mean gain: 0.35) and slow upward saccades (peak velocity 225º/s) in one patient. Conclusion: In spite of normal central vision, the majority of patients showed outer retinal changes, similar to retinitis pigmentosa. Lower vertical pursuit gain and slow upward vertical saccades were detected in a subset of patients. A peripheral retinopathy in conjunction with abnormal vertical saccades and/or pursuit in a patient with a movement disorder may suggest a NBIA type I. F74 Retinal nerve fibre layer thickness in progressive onset multiple sclerosis patients B. Kaymakamzade, A. Tuncer 2, S. Kadayifcilar 3, R. Karabudak 4 Near East University, Neurology, Nicosia, Cyprus, 2 Hacettepe university, Neurology, Ankara, Turkey, 3 Hacettepe University, Opthalmology, Ankara, Turkey, 4 Hacettepe University, Neurology, Ankara, Turkey Background and aims: Multiple Sclerosis (MS) is classified into various sub-groups. Primary Progressive MS (PPMS) and Progressive Relapsing MS (PRMS) are the least common forms of MS and they are characterized with progression from disease onset. Patients with PRMS experience one or more relapses. There is limited information about it s clinical and laboratorial features and ongoing neuropathologic process in PRMS patients. Optical coherence tomography is a non-invasive method used to assess retinal nerve fiber layer (RNFL)thickness, which can be a reliable tool used to monitor axonal loss in MS. Methods: In this study, MS patients with progressive disease from onset who are followed-up in Hacettepe University, Neurology Department were evaluated. Demographic, clinical characteristics were detailed and RNFL thickness measurements were evaluated as a neuroaxonal damage marker. Patients with progressive onset (PPMS and PRMS) compared with the other sub-groups of MS. RNFL assessment by optical coherence tomography (OCT) was performed in 2 MS patients (PPMS(n=8), PRMS (n=5), RRMS (n=8)) and 0 healty controls. Results: Progressive patients (PPMS, PRMS) had significantly lower RNFL values than RRMS patients and control groups (p=0.008). No significant difference was detected between PPMS and PRMS groups (p=0.97). Correlation was detected significantlly between the RNFL thinning and the EDSS score (p=0.045). No correlation was found between disease duration and RNFL thinning (p=0.202). Conclusion: As a result, progressive onset patients have retinal nerve fiber thinning. No significant difference was detected between PPMS and PRMS groups. These findings suggest that ongoing neuropathological process in PPMS and PRMS diseases are similar. 205 European Journal of Neurology, 22 (Suppl. ),

83 566 Flash Posters F75 Diagnostic accuracy of vestibular neuritis in Emergency Department P. Brown, E. Watson, S. Mossman Wellington Hospital, Neurology, Wellington, New Zealand Background and aims: Vertigo and dizziness admissions to USA Emergency Departments costs $US 4 billion/year. Differentiating benign vestibular syndromes from cerebrovascular causes is important. The aim of our study was to assess the accuracy of the diagnosis of vestibular neuritis in the Emergency Department at Wellington Hospital, New Zealand, pre and post increased input by the Neurology service. We hypothesised that Neurology input and objective recording of the vestibular ocular reflex (VOR) gain of the head impulse test by EyeSee Cam video-oculography would improve diagnostic accuracy of vestibular neuritis, rationalise neuroimaging and reduce hospital stay. Methods: Acute admissions with a primary diagnosis of vestibular neuritis were identified using ICD-0 codes. Clinical records were reviewed for 8 month time intervals pre and post Neurology service involvement. Results: 35 admissions over 3 years were identified with vestibular neuritis. Diagnostic accuracy of vestibular neuritis was best in patients assessed by the Neurology service with recording of the VOR gain of the head impulse test by video-oculography. Conclusion: A more accurate diagnosis of vestibular neuritis likely reflected improved access to the Neurology service, utilisation of the clinical head impulse test, and objective recording of the VOR gain of the head impulse test by video-oculography. Increased neurological input did not demonstrate a decreased hospital stay, and saw an increase in neuro-imaging requests, although these seemed appropriate on case review and risk factors..tehrani A et al. Rising annual costs of dizziness presentation to US emergency departments. Academic Emergency Medicine, 203,Vol.20(7), p.689 F76 Psychogenic convergence spasm mimicking bilateral abducens palsy C. Papastergios, I. Markakis 2, N. Fragkos 3, V. Spinaris 3, G. Gekas 2 Nikaia, Piraeus, Greece, 2 St. Panteleimon General State Hospital of Piraeus, Neurology, Piraeus, Greece, 3 St. Panteleimon General State Hospital of Piraeus, Psychiatry, Athens, Greece Background and aims: Convergence spasm is characterized by episodes of transient ocular convergence that present either alone or in association with accommodative spasm and miosis. It may be secondary to brainstem pathology, intracranial hypertension, myasthenia gravis, Wernicke s encephalopathy, Miller-Fisher syndrome, Graves disease and bilateral thalamic infarcts. However, it has also been reported as a manifestation of psychogenic disorders. Case Report: We present a case of sustained psychogenic convergence spasm mimicking bilateral abducens palsy. Results: A 49-year-old female was admitted to our department with a two month history of diplopia, vertigo and vomiting. Neurological examination revealed sustained horizontal diplopia due to bilateral lateral rectus movement restriction that was interrupted during monocular vision. Magnetic resonance imaging and angiography of the brain were normal. Routine blood testing was normal. Thorough auto-antibody testing, including anti-achr, anti-musk and anti-gqb, was also negative. Lumbar puncture revealed normal cell count, biochemistry and cerebrospinal fluid (CSF) pressure. Further ophthalmological and thyroid control did not revealed any pathology whatsoever. The patient was referred to the psychiatric department. She was prescribed antidepressant treatment along with psychotherapy. On her weekly assessments the patient showed gradual clinical improvement. She was diagnosed with conversion disorder and discharged after a month with complete regression of her symptoms. Conclusion: Convergence spasm may be associated with a wide spectrum of neurological disorders. However, when thorough diagnostic investigation is negative, a psychogenic etiology should be strongly suspected. In these cases an appropriate pharmacological and psychotherapeutic intervention may lead to full symptom recovery. 205 European Journal of Neurology, 22 (Suppl. ),

84 Flash Posters 567 F77 Differential diagnosis of Atypical Parkinsonian Disorders through the analysis of oculomotor profile in MSA, PSP and CBD patients F. Rosini, G. Lucii, P. Federighi, E. Pretagiani, C. Vinciguerra, F. Giannini 2, R. Rocchi 2, A. Federico 3, A. Rufa University of Siena, Eye-tracking and Visual Application Lab, Unit of Neurology and Neurometabolic disorders, Department of Medical, Surgical and Neurological Sciences, Sienna, Italy, 2 University of Siena, Neurology and Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, Sienna, Italy, 3 University of Siena, Neurology and Neurometabolic Diseases Unit, Department of Medicine, Surgery and Neuroscience, Sienna, Italy Background and aims: Atypical parkinsonian disorders (APDs) are a group of progressive and levodopa-refractory parkinsonisms with distinctive and often overlapping atypical features. Differential diagnosis is challenging. We aimed to determine peculiar changes in oculomotor profile that may help in distinguishing Multiple System Atrophy (MSA C and P), Progressive Supranuclear Palsy (PSP) and Corticobasal Degeneration (CBD). Methods : We recorded the eye movements of eight patients with MSA-C (mean age 57.5±6.3 years-old), four with MSA-P (58.5±6.2), five with PSP (72±6.7) and three with CBD (62±4). Horizontal (±0 and 8 ) and vertical (up/ down 8 ) visually-guided saccades and antisaccades were tested and compared with EVAlab s normative data. Three minutes of steady fixation were recorded. Standard saccadic parameters, antisaccade errors with corrections and fixation changes were evaluated. Results: MSA-C showed fast and dysmetric (often hypermetric) horizontal saccades. MSA-P exhibited horizontal and vertical saccadic hypometria. Very slow and fragmented horizontal and, mostly, vertical saccades were typical in PSP. CBD showed increase of latency, slowness and hypometria of eye movements. PSP and CBD exhibited the higher number of antisaccade errors, with the lowest percentage of spontaneous error corrections in CBD. Steady fixation was interrupted by sporadic saccadic intrusions in all groups, with the lowest frequency in CBD. Conclusion: Our findings testify the presence of peculiar oculomotor abnormalities in APDs. Slowing of all ocular movements is the hallmark in PSP patients; loss of accuracy with preserved velocity is typical in MSA, particularly MSA-C. Latency and voluntary saccades are more impaired in CBD group than MSA, suggesting a greater cortical impairment. F78 Painful ophthalmoplegia with cryptococcosis and varicella zoster infections M. Santos, A.D. Magalhães, M. Costa, R. Peralta, L. Albuquerque Hospital de Santa Maria, Neurology Department, Lisbon, Portugal Background and aims: Cryptococcosis is a fatal fungal infection characteristic of immunocompromised patients. In contrast to cryptococcal meningitis, orbital involvement and cranial neuropathies are very rare. Case Report: A 83-year-old woman was admitted due to sub-acute painful left ophthalmoplegia, that developed in one month. Neurological examination showed on the left eye: mild proptosis, conjunctival hyperemia, decreased visual acuity, papillary pallor, complete ptosis and external ophthalmoplegia. Three days later she further presented nonreactive mydriasis and cutaneous eruption suggestive of herpes-zoster ophthalmicus, associated with anterior uveitis and probable chorioretinitis. Her past medical history included myasthenia gravis (pyridostigmine 60 mg 4id plus prednisolone 5 mg daily), diabetes mellitus, arterial hypertension and moderate chronic renal disease. Brain and orbital MRI scan confirmed T2 hyperintensity in the left periorbital tissues, extra-ocular muscles and cavernous sinus. Cerebral spinal fluid (CSF) analysis was compatible with lymphocytic meningitis and both cryptococcus neoformans (CN) and varicella zoster virus (VZV) were isolated. Blood serological exams were positive for VZV, but negative for CN and human immunodeficiency virus (HIV). Intravenous acyclovir was administered (2 days) concomitantly with fluconazole 600mg daily (one month) and subsequently reduced to 200mg daily (6 months). Results: Complete clinical remission was achieved within 3 months. Conclusion: We report an immunocompromised HIVnegative patient, who presented with painful complete ophthalmoplegia, orbital involvement and asymptomatic meningitis, associated with CN infection and VZV reactivation. In immunosuppressed patients, a clinically evident herpes-zoster ophthalmic should not delay the active search of concomitant rare situations, like CN. 205 European Journal of Neurology, 22 (Suppl. ),

85 568 Flash Posters F79 Clinical manifestations and influence factors of ocular ischemic syndrome. F. Yunusov, K. Abdukhalimova, A. Kadirova, G. Rakhimbaeva Tashkent Medical Academy, Neurology department, Tashkent, Uzbekistan Background and aims: Ocular ischemic syndrome (OIS) is a disturbance with arterial perfusion decline to the eye, where atherosclerosis of ipsilateral carotid artery (CA) is the main cause. The primary aim of the study was to establish the clinical characteristics and treatment of ocular ischemic syndrome (OIS) and impact factors its development. Methods: We investigated 32 patients with OIS at angioneurology department of Tashkent Medical Academy during the latest 3 years. All patients were undergone to the next procedures: detailed medical and ocular histories, ophthalmic assessment with fluorescein angiography, CA duplex scanning with following treatment. Results: Average age of the 32 patients (38 eyes) with OIS was 64 +/- 6 years. Ocular signs were amaurosis fugax (20%) and/or gradual (25%) or sudden (43%) visual loss. At first visit, eyes with OIS had visual acuity less than or equal to 20/400 in 62%, iris neovascularization (NV) in 84%, angle NV in 52%, intraocular pressure from 6 to 50 mmhg (median 9 mmhg), optic disc pale (38%) and/or cupped (7%) or edematous (8%). Associated systemic diseases in these patients included diabetes mellitus (52%), arterial hypertension (63%), coronary artery disease (4%), and previous stroke or transient ischemic attack (33%); Occlusion or severe stenosis (80%-99%) of the internal carotid artery was seen in 67% on the side of OIS. Conclusion: Ocular ischemic syndrome has a bad visual prediction. Nevertheless, timely diagnosis may be decisive to the health of these patients because OIS may be the presenting sign of serious cerebrovascular and ischemic heart diseases. 205 European Journal of Neurology, 22 (Suppl. ),

86 Flash Posters 569 Neurotraumatology; Critical care F80 Cytarabine-induced posterior reversible leukoencephalopathy syndrome (PRESS) case report F.M. Branco Germiniani, J.C. Kristochik, H.A.G. Teive, S.K. Nabhan 2 Hospital de Clínicas - Universidade Federal do Paraná, Internal Medicine Department, Neurology Service, Curitiba, Brazil, 2 Hospital de Clínicas - Universidade Federal do Paraná, Internal Medicine, Bone Marrow Transplant Service, Curitiba, Brazil Background and aims: Posterior reversible leukoencephalopathy syndrome (PRESS) is an endovascular dysfunction that occurs in the setting of chemotherapy, as well as in other conditions. However, only a handful of cases due to Cytarabine have been reported. The aim of our study is to report a case of Cytarabine induced PRESS. Case Report: A 44-year-old female patient diagnosed with acute myeloid leukemia underwent a chemotherapeutic cycle for bone marrow suppression with HYDAC, which included Cytarabine. Following that she developed vomiting and headache, with an initial investigation with normal brain CAT scan and abdominal ultrasonography. A lumbar puncture with CSF was performed, which was also normal and she was discharged. She returned in a couple of days with a confusional state and with severe visual loss, without any other compromise of cranial nerves, motor or sensory deficit. Coordination and gait were also preserved. She had hypertension, which prompted the use of intravenous nitroglycerin. A new lumbar punctured was unremarkable, except for the presence of only one immature cell. A brain MRI disclosed hyperintensities of subcortical white matter on both occipital regions on T2-weighted images, without any signs of restriction of diffusion images. After successful management of hypertension, her visual deficit reversed completely. She underwent three other chemotherapy cycles with HYDAC, without any further neurological symptoms, but she eventually died due to leukostasis. Conclusion: Posterior reversible leukoencephalopathy syndrome is an endothelial dysfunction associated with transitional hypertension states associated with chemotherapy, among other causes. However, Cytarabine-induced PRESS is a rare iatrogenic effect. F8 Impaired consciousness due to spontaneous intracranial hypotension with subdural haematomas S. Dias, J. Sequeira, J. Morgado, D. Forte 2, A. Irañeta 2, A. Calado Centro Hospitalar Lisboa Central, Neurology, Lisbon, Portugal, 2 Centro Hospitalar Lisboa Central, Neurosurgery, Lisbon, Portugal Background and aims: Spontaneous intracranial hypotension (SIH) is an important cause of new-onset daily headaches caused by spontaneous spinal cerebrospinal fluid leaks, with a broad spectrum of clinical manifestations. Development of subdural haematomas is an important complication, but impaired consciousness is rarely seen. Case report: A 47-year-old man presented with new-onset daily orthostatic headaches that were relieved by recumbency, accompanied by nausea, vomiting and echoed hearing. Cranial computed tomography and magnetic resonance imaging (MRI) revealed descent of the cerebellar tonsils, effacement of the suprasellar and perimesencephalic cisterns, ventricular collapse, and bilateral subdural haematomas, and the patient was admitted with the diagnosis of SIH. During his stay, he developed increasing psychomotor agitation and confusion, and later became unconscious with no eye opening response, uttering only incomprehensible sounds and showing a localizing response to pain. Repeat cranial MRI showed further downward displacement of the cerebellar tonsils and brainstem, and he was admitted in an intensive care unit. He was initially treated conservatively, with minor improvement. An epidural blood patch was later performed with progressive clinical and imaging recovery. No cerebrospinal fluid leak was found. Cranial MRI performed one year later was completely normal and the patient reported no recurrence of symptoms. Axial FLAIR image showing bilateral subdural haematomas and ventricular collapse. 205 European Journal of Neurology, 22 (Suppl. ),

87 570 Flash Posters Conclusion: Stupor and coma are rare but known complications of SIH, thought to result from diencephalic herniation. They can be the form of presentation of this disorder, and this entity should be considered in the differential diagnosis of patients presenting with impaired consciousness in the appropriate clinical context. F82 Basal cortisol relationship with the appearance of postoperative delirium I. Fuentes Fernandez, A. Moreno Flores, C. Albacete Moreno, R. Jara Rubio Virgen de la Arrixaca Hospital, Intensive Care Unit, Murcia, Spain Background and aims: Analyze the basal blood cortisol levels in undergoing cardiac surgery patients and the relationship of these with the appearance of hyperactive delirium. Methods: Prospective study with patients undergoing cardiac surgery and subsequently admitted to Intensive Care Unit at our center. Demographic, pre, intra and postoperative data were collected. Patients remained sedated with remifentanil until the extubation. Cortisol plasma levels were determined at 8 am, the morning following surgery. Delirium was diagnosed by the Nursing Delirium Screening Scale for the first 5 days after surgery. Results: 40 patients blood samples (39% women) were extracted (8 were excluded due to loss of the sample). The study subjects had an average age of 65.5±. The hyperactive delirium appeared in 4 patients (30.8%). We found no significant differences between patients without delirium (ND) and Delirium (D) in terms of age, basal cortisol, age over 75 years, cardiopulmonary bypass time and hours of mechanical ventilation. Patients who developed hyperactive delirium had higher EuroSCORE additive scale, higher ICU stay and had received higher dose of Diazepam in anesthesia induction. 47 patients (35.3%) with Euroscore >5 received more than 0 mg of Diazepam. A linear regression was performed and his combination was associated with hyperactive delirium (OR 3.5, 95% CI.5 to 8., p 0.03). Conclusion: In our study, postoperative basal cortisol is not related to the appearance of hyperactive delirium. However Diazepam doses greater than 0 mg in patients with major Euroscore of 5 was associated with hyperactive delirium. F83 Effect of neurometabolic therapy on quality of life in patients with consequences of traumatic brain injury V. Grymailo, I. Iakubenko 2, T. Litovchenko 2, V. Florikyan 2, I. Pasiura 3 Kharkiv, Ukraine, 2 Kharkiv Medical Academy of Postgraduate Education, Neurology, Kharkiv, Ukraine, 3 Central Clinical Hospital Ukrzaliznytsi, Neurology, Kharkiv, Ukraine Background and aims: Сhronic post-traumatic headache is often evident and significantly reduces the quality of life in patients with mild TBI. Methods: We examined 70 patients with consequences of mild TBI. All patients were treated with neuroprotective therapy. Quality of life was evaluated by using the questionnaire MOS SF-36. Results: According to the scale of physical functioning the quality of life was in average 64.±3.2 points and as to role functioning, it was 65.4±.5 points before the treatment. After the neurometabolic treatment, the level of physical functioning was 83.8±2.2 and as to role functioning, it was 78.5±. points. The impact of pain decreased daily activity to 65.3±.8 points. After the neurometabolic treatment, daily activity was 73.7±.5 points, respectively. Social functioning and emotional functioning before the treatment was 63.5±.5 and 68.±.6 points, respectively. After the neurometabolic treatment it was 79.9±2.5 and 85.5±2. points, respectively. The mental health of patients with mild traumatic brain injuries were 65.2±.7 points before the treatment and 80.9±2.5 after treatment. Conclusion: Integral evaluation of quality of life according to the questionnaire SF- 36 showed the decrease of quality of life according to the scales of pain intensity, social functioning and mental health. The treatment of patients with consequences of mild traumatic brain injuries with neurometabolic therapy improves quality of their life. 205 European Journal of Neurology, 22 (Suppl. ),

88 Flash Posters 57 F84 Clinical and diagnostical features of mild traumatic brain injury N. Kufterina, S. Grygorov 2 Kharkiv, Ukraine, 2 Kharkiv National Medical University, Kharkiv, Ukraine Background and aims: Traumatic brain injury is one of the most common reasons of hospitalization in the world, the frequency of which yearly grows up. Clinical-diagnostical features studying in young patients after mild traumatic brain injury. Methods: We have inspected 90 patients after mild traumatic brain injury (TBI), which were treated in the Kharkiv emergency unit hospital named by Prof. A.I. Meshaninov. Also there were inspected 25 almost healthy people. Were used clinical-neurological, neuro-physiological, neuropsychological, biochemical, statistical methods. Results: In the acute period patients complained on headache (9.6%), vertigo (35.4%), general weakness (83.3%), worsening in memory (87.4%), in attention (75.0%); reduction in sight (77.%), rumor (64.6%), convulsive assaults (37.5%), apathy and sleepiness (22.9%). Accordantly to the neuropsychological investigation, were found reduction of number of words for 0 words test memorizing (in comparison with control group), the lower total volume of reproduction (p<0.05), increasing time for working by Shulte s tables, more amount mistakes. Studying BDNF in the blood serum has shown, that in the acute period, the changes are not such significant, as in distant. But not the same fact was observed by studying S00. It was shown, that S00 in the acute period of TBI increases more than twice in comparison with the control group. All changes correlated with complaints and neurological symptoms. Conclusion: Even mild traumatic brain injury occurs the disturbance of neuropsychological indices and its biochemical markers. This changes is necessary to take into account providing the treatment tactics in TBI patients. F85 Abstract cancelled F86 Abstract cancelled F87 Acute disseminated encephalomyelitis associated with mycoplasma pneumonia infection: diagnostic challenge in the ICU setting A. Matas, R. Almendra, A. Veiga, A. Costa, J.P. Gabriel, M.R. da Silva Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal Background and aims: Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory demyelinating condition that usually presents as an acuteonset encephalopathy associated with polyfocal neurologic deficits. Diagnosing this entity in the ICU setting, in patients with other causes for consciousness impairment, is not straightforward. Case Report: A 35-year-old previously healthy female was brought to medical attention because of acute of a febrile disease, asthenia, myalgia, nonproductive cough and dyspnea progressing in the previous week. She was admitted to the ICU because of acute respiratory failure requiring mechanical ventilation. Her neurological examination was then normal. The patient s condition gradually improved, allowing her exemption from the ventilator and sedation withdrawal nineteen days later, but she failed to regain full consciousness. On the neurologic examination there was also noticeable an anisocoria, divergent strabismus and areflexic tetraparesis. Brain MRI disclosed diffused expanded cerebral lesions involving the subcortical white matter of both hemispheres and within the both thalami. Cerebrospinal fluid showed a mild lymphocytic pleocytosis; oligoclonal bands were absent but with serologic tests were positive for M. pneumonia. Treatment with intravenous immunoglobulins (0.4g/kg/day) for five days with almost full neurologic recovery. Two years later she remains with only mild neurocognitive sequelae and she has not suffered any other demyelination attack. Conclusion: The case presented highlights the challenge that is diagnosing ADEM in the presence of impaired consciousness prior to neurological manifestations of the disease. Clinicians should be aware of this entity in ICU patients, promptly recognize and treat it. 205 European Journal of Neurology, 22 (Suppl. ),

89 572 Flash Posters F88 Post hypoxic myoclonus & Lance Adams syndrome: analysis of 2 patients M. Oztekin, N. Öztekin 2, E. Kahya 3 MOH Ankara Diskapi Teaching and Research Hospital, Neurology, Ankara, Turkey, 2 Ankara, Turkey, 3 SB Ankara Diskapı Teaching andresearch Hospital, Neurology, Ankara, Turkey Background and aims: In recent years the number of patients surviving cardiac arrest increased due to developments in emergency medicine. Post-hypoxic myoclonic status and Lance Adams syndrome are difficult complications following cardiac arrest or prolonged hypoxic brain injury besides dystonia, chorea, tremor and parkinsonism.analysis of 2 patients developed post hypoxic myoclonus including two patient with Lance Adams syndrome following resucitation is presented. Methods: Patients who were brought to emergency wards or already on treatment with various reason of two education hospitals with cardiac arrest or prolonged hypoxia who developed extensive myoclonic jerks or prolonged myoclonic seizures were included in the study. Patients were admitted to intensive care units for the treatment Results: There were 3 male patients and 8 female patients. Only 8 patients survived through the post-hypoxic state. One patient showed fullrecovery,two patients developed Lance Adams syndrome. Five other patients discharged with neurological morbidity other than movement disorders.patients were treated with levetiracetam, valproic acid, clonazepam and phenobarbital. Conclusion: Patients with post hypoxic encephalopathy showed diverse clinical symptoms and variabilities depending on duration of hypoxia, patients premorbid cerebral vascular status and comorbidities. It is still unknown which patient will respond to medical tratment and who will developed Lance Adams syndrome. Further studies are needed to clarify the physiopathology F89 Amelioration of vibration syndrome using automated myofascial release massage M. Politis USA Background and aims: Hand and Arm Vibration Syndrome (HAVS) is a peripheral neuropathy that usually results from using vibrating hand tools. Therapeutic deep tissue myofascial release massage (DTMRM) is routinely used to stem its progression, but self-massage or regularly visiting a therapist is inefficient or impractical. To increase efficacy, an automated device (called HVAS Massage) was developed and its effectiveness is reported. Methods: Patients (26 male, female) were diagnosed with HAVS in the prior 2-24 months. Each completed a survey ( Baseline ) based on the Michigan Hand Outcomes Questionnaire (MHOQ). Each was instructed to use the HVAS Massage for 0 minutes, four times daily. All continued with their daily activities and were surveyed again at 30 days ( Completion ), and all data were analyzed. Results: Overall mean disability at baseline was 28.8% in males and 9.7% in females compared with 24.6% and.5%, respectively, at completion. All but 2 male and 2 female patients reported heightened fingertip sensitivities at Completion. All patients reported their hands and fingers felt better and believed the device was beneficial. Conclusion: It is concluded that the HVAS Massage device is beneficial to patients with Hand and Arm Vibration Syndrome. Notably, males and females experienced beneficial results; with a greater benefit in females. The likely reason for the results is that the device performs DTMRM several times daily. These data support the use of HVAS Massage therapy as a prevention against the progression of Hand and Arm Vibration Syndrome, and even suggest symptoms can be reversed. 205 European Journal of Neurology, 22 (Suppl. ),

90 Flash Posters 573 F90 Direct carotid-cavernous fistula - ultrasonographic follow-up for direct shunt and treatment decision O. Rusu, A.C. Mergeani, C.I. Coclitu, A. Ciobotaru, S. Frangu, B. Dorobat 2, O.A. Bajenaru, F. Antochi University Emergency Hospital Bucharest, Neurology, Bucharest, Romania, 2 University Emergency Hospital Bucharest, Interventional Neuroradiology, Bucharest, Romania Background and aims: Carotid-cavernous fistula (CCF) is an abnormal communication between the internal or external carotid artery and the cavernous sinus. Commonly, the direct CCF is secondary to craniofacial trauma, but it can also be spontaneous, in association with other diseases. The aim of our case presentation is to highlight one of the methods used for complete occlusion of a direct, high-flow velocity CCF by endovascular therapy. Case Report: We report a case of a 29-year-old female, with recent history of head trauma, who progressively developed diplopia, headache and left ear tinnitus. The neurologic exam showed exophthalmia, proptosis, chemosis and complete ophthalmoplegia. The cerebral CT scan raised the suspicion of a left CCF (dilated left ophtalmic vein) confirmed by digital substraction angiography (DSA) a highflow CCF. Results: We performed percutaneous angioplasty with stent-graft of the left internal carotid artery but the followup ultrasonographic exam of the cervico-cerebral arteries achieved 0 days later revealed increased velocities at the level of the carotidian siphon due to incomplete occlusion of the CCF, although the DSA control showed complete occlusion short after stent displacement. So we proceeded to transarterial occlusion of the abnormal communication using another covered stent while preserving the patency of carotid artery. Three months later the patient was free of symptoms and the cervico-cerebral Doppler exam was normal. Conclusion: Endovascular therapy of direct CCF which includes a diversity of transarterial and transvenous embolization techniques, permits occlusion of the shunt. In the case of our patient, the treatment was achieved successfully using two covered stents. F9 New risk factor for traumatic spinal cord injury L. Sabre, J. Harro 2, D. Eensoo 3, M. Vaht 2, V. Kabel 4, M. Pakkanen 4, T. Asser, J. Kõrv University of Tartu, Department of Neurology and Neurosurgery, Tartu, Estonia, 2 University of Tartu, Department of Psychology, Tartu, Estonia, 3 University of Tartu, Department of Social Studies, Tartu, Estonia, 4 Haapsalu Neurological Rehabilitation Centre, Haapsalu, Estonia Background and aims: Several behavioural factors like violence, impulsivity and alcohol related problems are associated with traumatic spinal cord injury (TSCI). Such factors have been related to inherently low neuronal serotonergic capacity that in turn is reflected in low activity of monoamine oxidase (MAO) as measured in platelets. The aim of the study was to characterise platelet MAO activity and impulsivity in individuals with TSCI. Methods: Data were collected from 92 patients with TSCI and 92 age- and gender-matched control subjects. Platelet MAO activity was measured radioenzymatically and expressed as nanomoles of beta-phenylethylamine oxidized per 0 to the tenth power platelets per minute. Facets of impulsivity were self-reported using the Adaptive and Maladaptive Scale (AMIS) and Barratt Impulsiveness Scale (BIS-). Results: Most of the patients were men (87%). Mean time from TSCI was 4.2±3.7 years. Twenty-one patients (24%) reported social problems connected with alcohol and 30 (32%) patients had consumed alcohol before the trauma. Platelet MAO activity was significantly lower among the patients with TSCI (6.4±3.2 vs 8.8±3., p<0.000). The difference also remained significant when smoking status was taken into account (p<0.000). Women had significantly higher BIS impulsivity compared to the controls (6.6±8.8 vs 52.3±9.4, p=0.09). Conclusion: Individuals with TSCI have lower platelet MAO activity and women with TSCI are more impulsive compared to the healthy controls. Since personality traits will not change after the injury, our results indicate that low platelet MAO activity is an important risk factor for TSCI that can have predictive value and aid in undertaking preventive measures. 205 European Journal of Neurology, 22 (Suppl. ),

91 574 Flash Posters F92 Infectious complications in neurocritical care D. Sergeev, D. Gorbatyuk 2, P. Prokazova, J. Ryabinkina, M.A. Piradov Research Center of Neurology, Intensive Care Unit, Moscow, Russian Federation, 2 Moscow State University, Faculty of Basic Medicine, Moscow, Russian Federation Background and aims: Nosocomial infections are considered as major problem in neuroicu setting. Methods and Materials: We assessed infectious complications in patients admitted to our neurocritical care unit with severe vascular and neuromuscular disorders (n=67, 30 males, 37 females, median age 4 year). Results: The population consisted of patients with Guillain-Barré syndrome (GBS; 49%), stroke (43%), and myasthenia gravis (8%). Infectious complications were identified in 53% cases: pneumonia (96%), urinary tract infections (50%), catheter-associated bloodstream infections (50%), and sinusitis (27%). Patients with stroke were most susceptible to nosocomial infections (e.g., 00% patients with ischemic stroke had pneumonia), while in GBS patients the rate of all types of infections was the lowest. In 65% cases patients had concurrent infections, that increased the lenght of ICU stay from median 0 days in patients without infection to 30 days in patients with at least one infection and duration of ventilation from 8 days in to 50 days, respectively. Mortality rate did not differ in patients with no or one or two types of infections (4% vs. 22% and 8%, respectively, p>0.05), while all patients with 3 types of infection survived and among patients with 4 infections 50% died. However, infectious complication was never considered as an immediate cause of death. Multidrug resistant pathogenes were isolated in up to 25% cases. Conclusion: a significant proportion of neuroicu patients may have infectious complications, that is associated with increase of duration of ICU stay and need for mechanical ventilation, especially when 2 or more types of infection is present. F93 Therapeutic craniocerebral hypothermia in management of acute ischemic stroke patients I. Sharinova, O. Shevelev 2, V. Shmirev 3, M. Tardov 4, I. Kalenova 5, N. Litvinov 5 Moscow, Russian Federation, 2 Peoples` Friendship University of Russia, Pathophysiology, Moscow, Russian Federation, 3 Scientific Medical Centre of Presidential Administrative Department, Neurology, Moscow, Russian Federation, 4 Moscow Otolaryngological Centre, Ultrasound Laboratory, Moscow, Russian Federation, 5 Presidential Hospital No., Stroke Unit, Moscow, Russian Federation Background and aims: Craniocerebral hypothermia (CCH) is the mild therapeutic hypothermia variant with primary brain cooling. Specific features of CCH is the possibility to use this method without any sedation of patients. We study the impact of therapeutic CCH on neurological status, cerebral blood flow, hemodynamic parameters and body temperature. Methods: This prospective study conducted in patients admitted to stroke unit between January 202 and December 204. Including criteria was acute ischemic stroke first 72 hours. Excluding criteria was bradycardia. We used the therapeutic hypothermia helmet device for CCH induction. The ultrasound Doppler analyzer used for recording of the cerebral blood flow velocity. Neurological status (NIHSS), hemodynamic parameters, and tympanic temperature were studied before and after CCH. Results: The total number of patients ware 5 stroke patients. 85 patients (mean age 68±2.2, men 4, women 27) consists therapeutic hypothermia group; control group included 30 similar patients (mean age 68.8±2.3, men 3, women 7). Neurological deficit degree decreased in CCH group (35.2%). There was not any significant difference in neurological status of control group patients. MCA mean blood flow velocity increased in hypothermia group (6%). Tympanic temperature significantly declined from 37.±0.72 C to 34.6±0.8 C. Hemodynamic parameters did not statistically differ in hypothermia and control group. We calculate decrease of the mortality in CCH patients. Conclusion: Craniocerebral hypothermia promotes regression of the neurological deficit, increasing of the cerebral blood flow velocity. Hemodynamic parameters remained stable during all craniocerebral hypothermia procedure. F94 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

92 Flash Posters 575 F95 Haemorrhagic stroke during pregnancy may be successfully treated a case study of two cases M. Wiszniewska Specialist Hospital Piloa, Neurological Department, Pila, Poland Background and aims: Stroke in pregnancy and puerperium occurs in 0-34/00,000 maternal patients. The greatest risk factor of stroke in pregnancy is eclampsia with HELLP syndrome. Hemorrhagic stroke is associated mainly with eclampsia, probably due to heavy hypertension. Urgent cesarean section, antihypertensive and antiepileptic treatment, and magnesium sulfate infusions should be administered. Case Report: Case : 38-year-old patient in 32 nd week of pregnancy (gravidity 7) was admithed to hospital due to right hemiplegy with aphasia and epileptic seizure. Eclampsia and HELLP syndrome was recognised, and in CT were observed haemorrhacic and ischemic cerebral lesions. Cesarean section h5 min. after arrival was performed. She received: MgSO4 iv, antihypertensive, antiepilepctic drugs, and rehabilitation. Hemiparesis disappeared and in the 5 th day she was released home. Case 2: 23-year-old patient in 37 th week of pregnancy (gravidity I) was admited to hospital by cause of hemiplegy with aphasia an epileptic sezures. Eclampsia and HELLP syndrome was recognised. Cesarean section was performed 35 minutes after admission. She received: MgSO4 iv, antihypertensive, antiepilepctic drugs, and rehabilitation. In the 23 rd day she was released to Rehabilitation department. Results: In the presented cases, prompt and correct diagnosis as well as appropriate treatment brought a positive result: neonates were born healthy and the patients improved. Conclusion: Eclampsia, HELLP syndrome, and stroke during pregnancy are major causes of maternal and neonatal death. Prompt treatment and delivery of the baby by cesarean section are indispensable. Pregnant women with eclampsia, HELLP syndrome, and stroke should appear in such center where it is possible to create comprehensive treatment. 205 European Journal of Neurology, 22 (Suppl. ),

93 576 Flash Posters Sleep disorders F96 Sleep apnea and depression in patients with Parkinson s disease I.T. Burduladze, R. Shakarishvili 2 Research Institute of Clinical Medicine., Department of Neurology, Tbilisi, Georgia, 2 P. Sarajishvili Institute of Neurology, Tbilisi, Georgia Background and aims: Depression is a frequent complication of Parkinson s disease (PD). Selective therapy of depression is very essential for improvement psychoneurological state in those patients especially in cases of accompanied pathologies, such as sleep related breathing disturbances, particular central sleep apnea syndrome (CSAS). Purpose of the present study was to research some possible positive therapeutic effects of selective serotoninnoradrenalin reuptake inhibitors (SSNRI) in PD patients complicated by depression and CSAS. Methods: 25 male patients (mean age 69.0 years) were examined retrospectively. All of them were treated by SSNRI (maximum dose 50 mg daily) during 6 month. In all cases the Hamilton Depression Scale (HADS), Mini-Mental State Examination (MMSE) and Epworth Sleep Questionnaires (ESQ) were completed. Results: We found out, that moderate stages of PD were correlated with high HADS, ESQ and low MMSE scores. After 6 month treatment, trustworthy changes in HADS and ESQ scores were in evidence. HADS scores were reduced by 3% (p<0.00) and ESQ scores by 8% (p<0.05). In all cases, improvement of morning-time mood and reduction of wake-up headaches severity were revealed. Conclusion: Treatment of depression in PD patients is very important for their recovery. The drugs of choice should include pharmacotherapy with SSNRI. According from the previous researches, considering CSAS as an independent risk-factor of ischemic stroke as well as depression, our study speculates, that adequate therapy of depression in above mentioned patients may play an important role in prevention of brain ischemic events. F97 Predictive value of Berlin questionnaire (BQ), Epworth Sleepiness Scale (ESS) and some anthropometric measurements in patients with obstructive sleep apnea (OSA) M. Dimitrova, A. Pavlov 2, K. Prinova, K. Genov, K. Kostov 2 Military Medical Academy, Clinic of Neurological diseases, Sofia, Bulgaria, 2 Military Medical Academy, Clinic of Pulmonology and Sleep Medicine, Sofia, Bulgaria Background and aims: The Berlin questionnaire and Epworth Sleepiness Scale are widely used instruments for screening at-risk patients for OSA. Some anthropometric measurements such as body mass index(bmi), neck circumference, age and gender also correlate with the severity of OSA. Methods: This study included 84 patient who were admitted in the Department of SLeep Medicine for evaluation of suspected OSA. The patients were diagnosed by using polygraphic monitoring system STARDUSTTM II RES- PIRONICS. Apnea-hypopnea index was evaluated. Ten of our patients did not meet the criteria for OSA. The other 74 patients were divided into three groups according to AHI: patients with mild OSA ( AHI>5 but <5)-6 patients; with moderate OSA(AHI>5 but <30)- ; with severe OSA (AHI>30)- 57. All patients were examined with BQ, ESS and BMI, neck circumference, age and gender were analysed additionally. Results: The mean age of our patients was 54 years with prevalance of male gender (79.8% of patients). BMI>30 had 9.9% of all patients, neck circumference>40cm. had 86.5%. ESS<9 points had 27 patients but >9points had 47 patients. All patients diagnosed with mild OSA had ESS<9 points, 0 patients with moderate OSA had ESS<9 points. 9 of all patients were evaluated at low risk with Berlin qestionnaire. Conclusion: We concluded that BQ is an useful tool for finding patients who are at-risk for OSA. ESS is useful in patients with severe OSA but in patients with mild and moderate OSA is not sensitive and not appropriate for screening. BMI and neck circumference are other useful markers for screnning risk population. 205 European Journal of Neurology, 22 (Suppl. ),

94 Flash Posters 577 F98 Incidence of sleep disorders in the Slovenian adult population S. Gak, M. Rakusa 2, M. Cokolic 3, L. Dolenc Groselj University Medical Centre Ljubljana, Division of Neurology, Institute of Clinical Neurophysiology, Ljubljana, Slovenia, 2 University Medical Centre, Neurology, Maribor, Slovenia, 3 University Medical Centre Maribor, Division of Internal Medicine, Endocrinology and Diabetology, Maribor, Slovenia Background and aims: Sleep disorders are commonly neglected. With our study we tried to evaluate incidence and variables which influence excessive daytime sleepiness and insomnia in Slovenian population. Methods: We included 27 (62 women) volunteers. Sleep disorders were evaluated with Epworth scale (ES) and Insomnia Severity Index (ISI). Volunteers who scored >0 on ES were considered to have excessive daytime sleepiness. For insomnia evaluation, we divided volunteers according to the ISI score (0-7 no insomnia; 8-4 subthreshold insomnia; 5-2 moderate and severe clinical insomnia). Descriptive statistic, t-test (ES) and ANOVA (ISI) and logistic regression (variables: age, gender, education) were done. Results: The 85% of volunteers scored 0 or less on Epworth scale. They had significantly lower ES (5.2±2.8 vs. 3.8±2.8) and ISI (6.5±5.4 vs.0.3±7.6) score. Pearson correlation was significant between ES and ISI in patients with excessive daytime sleepiness (r=0.5). The 57.5% of volunteers didn t have any clinically significant insomnia. Subthreshold insomnia was found in 35.4% of volunteers, 4.7% had moderate and 2.4% had clinically severe insomnia. Mean ISI score and standard deviation were 2.8±2.2;.3±2.2; 7.8±2.6 and 2±5.6 respectively. Volunteers with significant insomnia had also significantly higher Epworth scale score (.6±6.4 vs. 6.±3.7). ES and ISI score were not influenced by age, gender or education. Conclusion: Excessive daytime sleepiness and clinically significant insomnia were relatively rare. However, it is concerning that more than one third suffered from the subthreshold insomnia. For daily practice it is important that ES and ISI score are not influenced by age, gender or education and may be used without further adjustments. F99 Determining parental depression-anxiety and sleep quality of asthmatic children H. Jahangiri Tehran, Iran Background and aims: Having a child with a chronic disease may cause anxiety and depression and impair the sleep quality in the mothers. Taking care of the sick child by the parent-which are usually the main care taker- can be associated with high loads of stress and result in behavioral problems like anxiety, depression and disturbance in sleep quality. This study aimed at determining parental depression-anxiety and sleep quality of asthmatic children. Materials and Methods: Present study was an analytical descriptive cross-sectional study performed on 50 parents of asthmatic children between the ages of 4-3 yrs hospitalized in Emergency Department of Mofid and Markaz Tebbi Hospitals. Data were collected using 3 questionnaires include of demographic characteristics, Hospital Anxiety and Depression Scale (HADS) and Pittsburgh sleep quality index questionnaire (PQSI). Results: Results indicate that high levels of depression and anxiety and poor sleep quality requiring clinical intervention were seen in 29.2%, 37.3% and 39.% of parents, respectively. A significant association was detected between depression-anxiety and sleep quality (P value<0.005). Also, depression-anxiety was significantly correlated with smoking and number of children (P value <0.005).A total of 20.2% of parents were depressed and 4.4% of parents with anxiety disorder had a history of cigarette smoking (P value<0.005).susceptibility was only correlated with anxiety (P value<0.005). Conclusion: Present study showed a significant association between depression-anxiety and sleep quality in parents with asthmatic children. Therefore, children with and their parents need to be assessed for the requirement of support regarding sleep quality and anxiety-depression status. 205 European Journal of Neurology, 22 (Suppl. ),

95 578 Flash Posters F200 Insomnia, depression and their comorbidity in a single sleep center population: an epidemiological study A. Karamyan, L. Ghahramanyan, S. Khachatryan Somnus Sleep and Movement Disorders Clinic, Yerevan, Armenia Background and aims: Insomnia and depression appear to go hand-in-hand. Current study aimed to estimate prevalences of insomnia, depression, and their overlap in a single sleep center population in Armenia. Methods: Data were collected from Somnus Sleep and Movement Disorders Clinic in Armenia based on retrospective clinical records review. Patients reporting either insomnia, depression or both were enrolled in the study encompassing the period of last three years. Insomnia and depression were diagnosed according to ICSD-2 and ICD- 0 criteria, respectively. Hamilton Depression Rating Scale was used for standard assessment of depression severity. Results: A total of 28 clinical records were reviewed, of those 02 were diagnosed with insomnia, mean age-49. (9-9), 49 with depression, mean age-40.7 (6-76), wherein 4 patients had both of the diagnoses. The estimated prevalence of insomnia was 8.4%, depression-2%, and comorbidity of both-3.4%. In all age groups both insomnia and depression were more frequent in women, being significantly predictable by sex. OR for women compared with men of having insomnia was.58, 95% CI. Prevalence of depression was twice as higher in women than in men (66.2% vs 33.8%). Among insomnia patients 40.2% were diagnosed with comorbid depression, whereas 27.5% of patients with depression had comorbid insomnia. Conclusion: We found lower than expected prevalences of both insomnia and depression in sleep clinic population. In both conditions taken separately there is a high level of comorbidity, which should alert clinicians to reveal one of these disorders while examining for the other. F20 Polysomnography in patients with ALS V. Merkul, Y. Rushkevich, N. Chechik 2, S.A. Likhachev, I. Abelskaia 2 Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus, Minsk, Belarus, 2 Presidents Hospital, Minsk, Belarus Background and aims: One of the most common complications of ALS is a breathing problem leading to respiratory failure. Aim: Examination sleep patterns in ALS patients without breathing disorder related complaints using full-night polysomnagraphy. Methods: We examined 25 patients with ALS (the average age was 59 (52; 64) years, 2 men and 3 women; disease duration - 8 (2-28) months). The control group consisted of 30 сerebrovascular disease (СVD) patients without breathing-related problems. Results: Me AHI indicators and quantity of desaturation (D) in groups were in the normal range (AHI was 2, (0.5; 5.5); D 39.5 (9; 57)), in control group - AHI was 3.5 (0.7; 25.6), D 35 (27; 229.5), but АНI and D max values in СVD patients were higher. Min oxygen saturation was lower in patients in both groups (ALS: 78 (75; 84) min/max 57/90; СVD: 78.5 (75;8) min/max 66/88). A trend in increasing number of sleep apnea events was discovered in СVD patients (22 (; 99)/0.5(2; 63)) (p=0.09). Discovered a significant increase of respiratory rate during sleep in patients with ALS (ALS: 8.(5.5; 8.9); СVD: 3.5 (3.4; 5.7)) (p=0.00). Detected significant reductions in S2 and S3 phases in ALS patients in comparison with СVD patients: S2-40.7(24.5; 49.5)/49.9(38.7/57.3), (p=0.02) and S3 2.7(0.75; 6.4)/5.(4.2/7.7), (p=0.04). Conclusion: Our study has revealed a respiratory impairment and determined paroxysmal nocturnal hypoventilation, a lower number of minimal saturation, the reduction of sleep stages S2 and S3 in ALS patients. F202 Abstract cancelled F203 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

96 Flash Posters 579 F204 STOP-Bang: screening for obstructive sleep apnoea in a cognitive clinic B. Stagg, A.J. Larner 2 Alzheimer s Society, Liverpool, United Kingdom, 2 Walton Centre for Neurology and Neurosurgery, Cognitive Function Clinic, Liverpool, United Kingdom Background and aims: To report the use of the 8-item STOP-Bang screening questionnaire for obstructive sleep apnoea (OSA) in new referrals to a dedicated cognitive clinic to ascertain whether OSA may contribute to cognitive problems. Methods: Prospective observational study, Cognitive Function Clinic. Results: Of 92 consecutive patients seen over a 3-month period (October-December 204), 6 had a pre-existing OSA so were excluded, as were patients with an established dementia/amnesia diagnosis (0), needing a translator (3), or without cognitive complaints (). Five patients declined or were unable to complete the questionnaire, leaving a total of 67 (F:M = 26:4; age range years, median 60). There was no correlation between STOP-Bang score and cognitive performance judged by MMSE or m-ace scores (r = -0.7, -0.3 respectively). 33 patients scored 3 or more, the STOP-Bang criterion for suspected high risk of OSA. However, in only one case did the clinician think it very likely that OSA contributed to the presenting cognitive problems, and possibly in another five. 4 had clear alternative explanations for cognitive complaint (underlying neurodegenerative disorder, depression). Conclusion: STOP-Bang is simple to administer and score, and acceptable to patients. It is very sensitive, probably identifying large numbers of false positives (e.g. any tired male over 50 years). F205 Relationship between subjective sleep disturbances, anxiety and depression in adult epilepsy patients E. Sukockiene, G. Jurkeviciene 2, D. Mickeviciene 2, G. Zemgulyte 2, G. Rutkauskaite 3 Kaunas, Lithuania, 2 Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Neurology, Kaunas, Lithuania, 3 Hospital of Lithuanian University of Health Sciences, student, Kaunas, Lithuania Background and aims: The aim of the study was to evaluate the frequency and characteristics of sleep disturbances, anxiety and depression, to characterise relationship between these parameters and demographic, as well as pharmacotherapy data in adult epilepsy patients. Methods: In total, 74 patients participated in the survey. The structured questionnaire consisted of three parts: (i) demographic data; (ii) evaluation of sleep disturbances (SD), using digital analogue scale (DAS, 0 points no disturbance, 0 worst possible): daytime sleepiness (DS) or night sleep disturbances (NSD); and (iii) the Hospital Anxiety and Depression (HAD) scale. In addition, pharmacotherapy data was collected. Results: The median age of patients was 33 years, 70.3% were women. The proportion of subjects who received anticonvulsive medication was 56.8%, and who received %. SD were indicated by 89.2% participants: 47.3% - DS and 87.8% - NSD. 88.% patients who received anticonvulsive medication and 90.6% who received 2 medications indicated SD. Anxiety was reported by 40.5%, depression by 27.7%, both by 20.3% patients. Anxiety was connected with SD (r=-0.6, p<0.00), DS (r=-0.03, p<0.009) and NSD (r=-0.7, p<0.00); depression was connected with SD (r=-0.6, p<0.00). Conclusion: The quality of sleep in most adult patients with epilepsy was not sufficient. The majority of them suffered from NSD. The count of the medications did not affect sleep quality, while anxiety and depression were common and they markedly worsened sleep quality. 205 European Journal of Neurology, 22 (Suppl. ),

97 580 Flash Posters Sunday, June Ageing and dementia F200 Impact of donepezil and memantine on behavioral and psychological symptoms in patients with Alzheimer s disease P. Bago Rozankovic, J. Badzak Zagreb, Croatia Background and aims: Behavioral and psychological symptoms of dementia (BPSD) are common in Alzheimer s disease (AD). Donepezil and memantine are both used for the treatment of moderate AD. This study evaluated the efficacy of donepezil and memantine on BPSD in patients with moderate AD. Methods: A prospective, longitudinal, randomized, 6-month clinical trial included 57 patients with moderate AD. The Neuropsychiatric Inventory (NPI) was performed to assess the prevalence and severity of BPSD at baseline and after 6-month treatment with memantine (n=29) and donepezil (n=28). Results: Baseline characteristics of participants including age, sex, mean length of education and disease duration were comparable. There was also no difference considering baseline Mini-Mental State Examination (MMSE) and Hachinski Ischemic Score (HIS) scores The NPI total scores improved from baseline to month 6 in both groups, with greater change in memantine group (p<0.00) comparing to donepezil group (p=0.008). Patients treated with memantine had significantly lower NPI final scores than patients treated with donepezil (p=0.029). Analysis of the NPI domains revealed statistically significant improvement in delusions (p=0.046), agitation/aggression (p=0.00), depression (p=0.004) and anxiety (p=0.003) with memantine treatment, while donepezil produced significant improvement only in depression (p=0.027) and anxiety (p=0.042). Conclusion: The data suggest that specific drugs for AD, especially memantine, may be effective in treating BPSD in patients with moderate AD. The major benefits were observed on the symptoms of delusions, agitation/aggression, depression and anxiety in memantine group and depression and anxiety in donepezil group. F2002 Dementia and Alzheimer s disease (AD). Experience of the Memory Center of Rabat. M. Benabdeljlil, F. Boutbibe, M. Rahmani, F. Benbelaïd, M. Bennani, S. Aïdi, M. El Alaoui Faris Hôpital des Spécialités - Mohamed V University, Department of Neurology A and Neuropsychology, Rabat, Morocco Background and aims: Memory clinics are not very common in the developing world. The purpose of the study is to investigate demographic profile and etiologies of dementia in the Memory Center of Rabat. Methods: We studied all dementia cases presenting between January 2000 and May 203. Diagnosis of dementia was based on complete neurologic and somatic clinical examination, and neuropsychological assessment. All patients had cerebral imaging (CT Scan or MRI). Routine laboratory tests were performed in all cases and sometimes more analysis for specific etiologies. We used the usual criteria for diagnosis of AD and other degenerative dementias. Results: We found 56 cases, of which 283 males and 278 females. The mean age was years (SD 3.28; range 8 to 95 years). The mechanism of dementia was degenerative in 328 cases (58.5%) including 287 AD, vascular in 95 cases (6.9%), mixed in 42 cases, infectious in 33 cases and inflammatory in 8. Other etiologies were found in 35 cases, and dementia was of undetermined cause in 0 cases. Early-onset dementia (EOD), defined by an age-onset before 65 years, represented 44.7% of our dementia cases. Conclusion: Our study shows a large diversity of etiologies in dementia. As in developed countries, AD is the first cause of dementia, followed by vascular dementia. Other etiologies, like infectious and inflammatory diseases, are less frequent and mainly diagnosed in EOD. The percentage of EOD is high in our series, perhaps due to selection bias, and shows that dementia needs careful investigations in order to detect the potentially reversible conditions. 205 European Journal of Neurology, 22 (Suppl. ),

98 Flash Posters 58 F2003 The role of sleeping abnormalities on the driving performance of individuals with Mild Cognitive Impairment (MCI) I. Beratis, N. Andronas, E. Papadimitriou 2, D. Kontaxopoulou, S. Fragkiadaki, C. Koros, A. Bonakis, A. Economou 3, S. Papageorgiou Athens University Medical School, 2 nd Neurology Clinic, Attikon Hospital, Athens, Greece, 2 National Technical University of Athens, Department of Transportation Planning and Engineering, Athens, Greece, 3 National University of Athens, Department of Psychology, Athens, Greece Background and aims: According to recent research the driving fitness of individuals with MCI is an open issue without the presence of clear difficulties as compared to cognitively intact individuals of similar age. Goal of the present study was to explore for the first time the role of sleeping abnormalities on the driving performance of individuals with MCI. Methods: 27 cognitively intact individuals (Age: 63.4±7.2 years) and 33 individuals with MCI (Age: 66.4±7.4 years) were included in the analysis. A CDR score of 0.5 was required for the diagnosis of MCI. Inclusion criteria were the presence of a valid driver s license and regular car driving. Data collection included a comprehensive neurological/ neuropsychological assessment and a driving simulation experiment. The Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS) were applied for assessing sleeping abnormalities. Outcome measures were average speed, lateral position, lateral position variation, average headway distance, wheel average position and reaction time in unexpected incidents. Results: The analysis did not reveal significant correlations between sleeping abnormalities and indexes of driving performance in the cognitively intact group. In the drivers with MCI the analysis revealed the following significant correlations: AIS with lateral position variation, r=-.502, p=.003; AIS with wheel average position r=-.374, p=.032; ESS with lateral position variation, r=.355, p=.042; ESS with average speed, r=.345, p=.049; and ESS with average headway distance, r=-.373, p=.032. Conclusion: Sleeping abnormalities appear to be significantly related with the driving behavior of individuals with MCI. F2004 Inappropriate central nervous system drug usage in geriatric patients O. Kara, G. Arik, M.C. Kizilarslanoglu, M.K. Kilic, H.D. Varan, M.E. Kuyumcu, Y. Yesil, B.B. Yavuz, M. Halil, M. Cankurtaran Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey Background and aims: Geriatric people are particularly vulnerable to inappropriate medication for several reasons. STOPP criteria comprise 65 clinically significant indicators for potentially inappropriate prescribing in geriatric patients, while START criteria comprise 22 evidence-based indicators for prescription omissions. The aim of this study is to demonstrate the inappropriate medication of central nervous system drugs in geriatric patients. Methods: Consecutive 374 geriatric patients were enrolled. General characteristics, comorbid diseases, laboratory results, and medications were noted. STOPP/START criteria were used for assessing inappropriate medication for central nervous system. SPSS (Statistical Package for Social Sciences) for Windows 5.0 programme was used for statistical analysis. Results: One hundred forty (37.4%) male, 234 (62.6%) female geriatric patients with mean age of 74.57±6.74 were enrolled. Two hundred fifty (66.8%) outpatients and 24 (33.2%) hospitalized patients. The most common comorbidities; 32 (83.4%) hypertension, 60 (42.8%) diabetes mellitus, 60 (42.8%) hyperlipidemia, 22 (32.6%) osteoporosis, 36 (9.6%) dementia, 49 (3.%) were chronic obstructive pulmonary disease. Drugs of patients were evaluated; inappropriate medication use rates in the central nervous system drugs was 3.8% according to the STOPP criteria, 8.6% according to the START criteria (drug details will be shared during the presentation). Conclusion: Avoiding the use of inappropriate medication and prescription omissions are an important, simple, and effective strategy in reducing medication-related problems and in older adults. 205 European Journal of Neurology, 22 (Suppl. ),

99 582 Flash Posters F2005 Induction of cortical microbleeds and microinfarcts in wide type mice Y. Chen, S. Gautier 2, L. Ravasi 3, C. Potey 2, F. Auger 3, R. Bordet 2 U7 - CMRR - Hôpital Roger Salengro, Lille, France, 2 U7 - Laboratoire de pharmacologie médicale, Lille, France, 3 IMPRT, Plateforme d imagerie du vivant, Université de Lille 2, Lille, France Background and aims: Brain microbleeds (BMB) and micro-infarctus (BMI) are the expression of vascular damage, they may also reflect amyloid related pathology. The objectives of our study were to develop cortical BMB and BMI in a wild type mouse model, and to identify impact on occurrence of amyloid deposits. Methods: 6 C57BL/6J male mice received stereotaxic injection of Collagenase to induce a BMB, concentrated at: 0.2; 0.8; or 2 UI/µL (COL2); or of Endothelin to induce a BMI, concentrated at 0.4 or µg/µl (ET), or of saline (Sham). During the follow-up, we collected in vivo data by 7-T-MRI and [8F] FDG PET at 24 hours, 6 weeks, and 3 months after surgery. At 3 months, mice were sacrificed to obtain histology. Results: In haemorrhagic model, lesion was important for COL2 compared to others. The ratio of T2 relaxation time target/control was lower in COL 2 (0.53) than in Sham (0.8) (p=0.006). Metabolism significantly decreased at 3 months compared to 6 weeks in bilateral dentate gyrus, midbrain, and thalamus in COL2. In ischemic model, lesion was distinct in ET compared to others. The radio of apparent diffusion coefficient target/control was higher in ET (.03) than in Sham (0.82) (p=0.00). Whatever the lesion, we did not observe any brain amyloid deposit at 3 months. F2006 One single administration of MPTP is enough to produce memory deficits in a rat model of Parkinson s disease A. Ciobica, R. Lefter 2, M. Luca 2 Iasi, Romania, 2 Romanian Academy, SOP HRD/59/.5/S/33675 Project, Iasi, Romania Background and aims: Besides the well known locomotory aspects, the various neuropsychological investigations of patients with Parkinson s disease (PD) have shown specific cognitive impairments, ranging from minor disturbances in memory to intellectual function or even dementia. Also, one of the most used animal models of PD in rats in referring to the administration of -methyl-4-phenyl-,2,3,6-tetrahydropyridine (MPTP). Methods: In this way, while most of the administration patterns are including several different intraperitoneally (i.p.) injections of MPTP (e.g. 4 injections X 20mg/kg, 2 h apart; 2 daily injections of MPTP, 20 30mg/kg, 5 days), here we were interested, for the first time in our best of knowledge, to see if just one acute administration of a single injection of MPTP 20mg/kg i.p. will result in any cognitive deficits in rats, as studies in the Y maze task. The behavioral testing was performed one week after the MPTP administration, while the control group received saline. Results: In this way, the administration of single i.p. MPTP dose resulted in a significant decrease of the spontaneous alternation percentage in the Y maze task (77.5±6.2% in controls vs. 52.2±4.% in MPTP group), suggesting deficits in the immediate working memory. Moreover, these results were not generated by some locomotor deficiencies, considering that there was no significant difference in the number of arm entries between the two groups of rats. Conclusion: One single i.p. administration of MPTP 20mg/kg is enough to produce memory deficits in a rat model of PD, as studies in the Y-maze task. ratio of relaxation time target area/control in haemorrhagic lesion Conclusion: Stereotaxic injection is reliable and reproducible. The concentration of Collagenase is 2UI/µL and of Endothelin is µg/µl for a visible lesion, and are respectively 0.8UI/µL and 0.4 µg/µl for modelling micro-lesions. 205 European Journal of Neurology, 22 (Suppl. ),

100 Flash Posters 583 F2007 Creutzfeldt-Jacob and Alzheimer s diseases: one brain, two diseases H.M. Delgado, F. Ladeira, F. Sá, S. Carpenter 2, I. Carmo CHLO, Neurology, Lisbon, Portugal, 2 HSJ, Neuropathology, Porto, Portugal Background and aims: Prevalence of dementia among the population of over 80-year-olds is around 5%, and Alzheimer s disease is the most common cause. Creutzfeldt-Jacob disease is a rare cause of dementia, that causes a faster deterioration of cognitive functions, but in initial phases might be similar to other causes of dementia. We present a patient with these two causes of dementia proved in pathologic analysis. Case Report: We evaluated a man, 83 years old, with a history of hypertension, prostatic cancer and cognitive deterioration with memory impairment for the last 3 years. The family reported a sharp decline of his cognitive functions in the last 2 months with language and orientation loss, walking impairment and sphincter incontinence followed by insomnia, visual hallucinations and generalized myoclonus. His CSF analysis revealed pleocytosis (7 PMN), elevation of Tau and and a decrease of beta amyloid protein. The electroencephalogram revealed a pattern of encephalopathy with paroxystic periodic activity. The MRI showed increased diffusion weighted imaging (DWI) in caudate nucleus and cerebral cortex. The pathologic study was made 3 months after the first evaluation. Conclusion: Clinical, laboratorial, imagiologic and pathologic data corroborate the clinical impression of a rapid progressive dementia superimposed on a previous Alzheimer s disease. This case shows the need to consider the differential diagnosis of rapid progressive dementia even in patients with other previous types of dementia. F2008 A new model of individual cognitive therapy (cst) for dementia: a pilot study in five cases. G. Dore, M. d Onofrio 2 freelance professional, Ittiri, Italy, 2 AOU SASSARI, Sassari, Italy Background and aims: Cognitive stimulation therapy for dementia is gaining increasing importance and a recent Cochrane review suggested consistent mental functions benefit associated with CST, although improvement seems transient and does not exceed a three months follow up. We present 5 patients in whom a new model of long term CST was associated with long term increase of cognitive performance lasting 7 years. Methods: Five patients with mild to moderate dementia underwent clinical, cognitive, daily living and brain imaging (SPECT) evaluation pre- and post-cognitive rehabilitation. The patients attended an individual setting for 8-24 months, twice a week.cst involved a wide range of activities to stimulate thinking, reasoning, memory and epicritic hand gestures. A 7 years follow up post-treatment carried out. Results: The daily living improvement registered by the caregivers at the end of treatment was confirmed in the cognitive assessment concerning most of the cognitive functions. The hypo-perfusion revealed by 99mTc-HMPAO SPECT strikingly changed after treatment. Substantial stabilization in the cognitive tests was recognized at 7 years follow-up. Conclusion: The results obtained seem very encouraging in that: a wide cognitive reserve seems available in demented patients if properly stimulated. Stimulation training efficacy seems related to quality of the material used and length of treatment; a correlation between length of training and prolongation of the benefit seems plausible. Although the present results needs confirmation in a wider sample of patients, they strongly suggest that in this patients, targeted complex psichoneurocognitive therapies may led to a longlasting benefit of cognition and quality of life. 205 European Journal of Neurology, 22 (Suppl. ),

101 584 Flash Posters F2009 Abstract cancelled F200 Dementia with Dermatologic manifestations A. Nasri, M. Ben Djebara, F. Laatar, I. Kacem, Y. Hizem, A. Gargouri, R. Gouider Razi Hospital, Tunis, Department of Neurology/ Research Unit UR 2 SP 2, tunis, Tunisia Background and aims: Cutaneous manifestations are seldomly looked for in demented patients and association between dementia and dermatitis, have been fewly reported. Case Reports: We report two cases with this rare association, and discuss relationships between the neurological and dermatological features. Results: Case report : N.H., a 6-year-old woman with epilepsy since the age of 5 years treated with phenobarbitone, carbamazepine and valproic acid. At the age of 59 years, she developed memory troubles, ataxia, diarrhea and finally photosensitive erythema than dark discoloration on the dorsal surfaces of her hands and legs. Her examination showed dementia, pyramidal and cerebellar syndrome, and pellagroid lesions. Brain MRI showed diffuse atrophy. The diagnosis of Pellagra was considered. Phenobarbitone was discontinued and she received oral niacine treatment with a dramatical recovery. The diagnosis of drug-induced pellagra secondary to phenobarbital was established. Case report 2: M.B., a 32-year-old man diagnosed with xeroderma pigmentosum (XP) at the age of 7 months. Since the age of 27 years, he developed ataxia, myoclonus than cognitive decline. On examination, he had dementia, pyramidal syndrome, peripheral neuropathy, cerebellar ataxia, dystonia and myoclonus. Brain MRI showed a marked diffuse atrophy. The diagnosis of neurological manifestations of XP was considered. Conclusion: In the first case, the association of the 3 Ds (Dementia, Dermatitis and Diarrhea) led to the diagnosis of Pellagra. The constellation of central and peripheral neurological features, led to consider XP as a cause in the second one. Attention should be given to dermatological examination, especially in patients with early onset dementia. 205 European Journal of Neurology, 22 (Suppl. ),

102 Flash Posters 585 F20 Predictability of shunt effectiveness based on gait improvement at tap test in idiopathic normal pressure hydrocephalus M. Ishikawa Kyoto, Japan Background and aims: Improvement of gait disturbance after shunt surgery is well known in idiopathic normal pressure hydrocephalus (inph). The cerebrospinal fluid tap test (TT) is a diagnostic tool used to select shunt-responsive inph patients. However, assessment results of TT and shunt surgery vary depending on measures, observers and timing. In this study, we investigate correlations between gait improvement at TT and after surgery in our 57 suspected inph patients to predict shunt effectiveness. Methods: Assessment measures at TT were timed up and go test (TUG) and 0-meter walk (0M; sec, step). Postoperative gait improvement was assessed using gait domain of the inph grading scale (GSg) and motor domain of the functional independence measure (FIMm) by different examiners at discharge (mean:.8 postoperative days). Values of the area under the curve (AUC) from receiver operating characteristic curve were calculated between data of TUG or 0M(sec, step) and the gait improvement by different assessment measures. Results: Mean age was 77.6 years and male-female ratio was 38:9. Ventriculoperitoneal (VP) and lumboperitoneal (LP) shunts were done in 39 and 8 patients. Gait improvements on GSg by a neurosurgeon and therapists, FIMm and FIMm 3 were 80.7%, 9.2%, 75.4%, and 66.6%, respectively. A combination of 0M(sec) and FIMm showed a highest AUC value of The sensitivity and specificity were 60.4% and 85.7%, respectively, at a cutoff level of 4.4%. Conclusion: Gait improvement after surgery is most reliably predicted with 0-meter walk (sec) at TT, where the cutoff level was4.4% of gait improvement. Disclosure: I got lecture fees from the Medtronic Japan, Co.. F202 Side effects of pharmacotherapy on cognitive functions in Parkinson s disease: P300 generators study O. Ivanenko, S. Kryzhanovskyi, A. Cherninskyi, I. Zyma, I. Karaban 2 Taras Shevchenko National University of Kyiv, Department of Human and Animal Physiology, Kiev, Ukraine, 2 Institute of Gerontology National Academy of Medical Sciences of Ukraine, Kiev, Ukraine Background and aims: Parkinson s disease (PD) neurodegenerative disorder with dopamine deficit as major pathology. There are 5 main ways to correct functional activity of dopamine synapse: levodopa, dopamine agonists, amantadine, monoamine oxidase inhibitors, anticholinergic drugs. We aimed to assess the possible side effects of this medication on cognitive functions in PD patients without dementia. Cognitive potential P300 is associated with information processing, memory, attention, and it s objective electroencephalography-based approach for our goal. Methods: 92 PD patients (age 46-74, Hoehn-Yahr stage 2-3) and 26 healthy volunteers participated in present study. Patients were divided into groups based on type of medication, levodopa dosage and level of cognitive impairment (higher or lower). P300 was recorded in oddball paradigm task with auditory stimuli. We applied sloreta (standardized low resolution brain electromagnetic tomography) to identify the sources of P300 activity. Results: We have found increased activity of P300 sources in right middle frontal gyrus in patients with higher level of cognitive impairment. Similar differences in this area also were revealed in PD patients who didn t take dopamine agonist. Highest levodopa dosage leads to decreasing of P300 source s activity in same frontal region. In addition, PD subjects with greater doses of levodopa (more 400mg/ day) demonstrated enhanced P300 generators in right parietal area. There were no significant differences in all other cases. Conclusion: High levodopa dosage and absence of dopamine agonists were associated with deviations in cognitive processes. These changes in P300 generators may serve as possible harbingers of future dementia in PD patients. 205 European Journal of Neurology, 22 (Suppl. ),

103 586 Flash Posters F203 Major neuropsychiatric disorders frequency in a cohort of older adults with cognitive dysfunction P. Simos, S. Kapetanaki 2, M. Basta, I. Koutentaki, S. Panagiotakis 3, S. Tziraki, N. Fountoulakis 3, A. Bertsias 4, G. Duijker 4, C. Lionis 4, C. Manassaki, D. Boumpas 5, A. Plaitakis 2, A. Vgontzas, I. Zaganas 2 University of Crete, Psychiatry, Heraklion, Crete, Greece, 2 University of Crete, Neurology, Heraklion, Crete, Greece, 3 University of Crete, Internal Medicine, Heraklion, Crete, Greece, 4 University of Crete, Clinic of Social and Family Medicine, Heraklion, Crete, Greece, 5 University of Athens, Internal Medicine, Athens, Greece Background and aims: Neuropsychiatric disorders increase in prevalence with advancing age and are often associated with or are the cause of cognitive dysfunction. Aim of this study, as part of an ongoing multidisciplinary project, was to describe the frequency of neuropsychiatric disorders in a cohort of aged adults with low cognitive function, as judged by their Mini Mental State Examination (MMSE) scores. Methods: Eligible participants were those aged 60 years, attending selected primary health care facilities on the island of Crete, Greece, irrespectively of cause of visit, and showing potential cognitive impairment as defined by a MMSE score of 24. Upon meeting this criterion, patients were referred for a thorough neuropsychiatric and neuropsychological assessment, in order to establish a final diagnosis. Results: Among the 344 participants with a low MMSE score, the frequency of neurocognitive disorders (primary or secondary) was: mild cognitive impairment (MCI) 48.3% (2.7%, 5.2%, and 27.%, pure amnesic, amnesic multidomain, and non-amnesic, respectively), probable Alzheimer s disease (AD) 27.0%, depression 24.4%, anxiety disorder 8.3%, vascular dementia 2.9%, Parkinson s disease 2.6%, Lewy body dementia.7% and frontotemporal lobar degeneration 2.3%. Conclusion: In this cohort of older adults with low cognitive function, MCI, AD, depression and anxiety were the most frequent disorders. These data suggest that a large percentage of patients with low cognitive function in a community-dwelling sample are diagnosed with either treatable disorders, such as depression and anxiety, or disorders such as MCI that their early detection and treatment may potentially influence favorably their course. F204 Cognitive and behavioral symptoms of behavioral variant frontotemporal dementia. Does gender matter? C. Koros, I. Beratis, S. Fragkiadaki, D. Kontaxopoulou, S. Matsi, N. Andronas, L. Stefanis, S. Papageorgiou Athens University Medical School, 2 nd Neurology Clinic, Attikon Hospital, Athens, Greece Background and aims: The aim of the present study was to assess gender differences in behavioral variant frontotemporal dementia (bv-ftd) patients. Although there are numerous reports addressing the effect of gender on cognitive and behavioral features of Alzheimer s disease patients, this is the first study focused on bv-ftd. Methods: 26 age-matched patients (3 men/ 3 women) with predominant frontal lobe atrophy meeting clinical criteria for bv-ftld. We evaluated the role of gender differences concerning 6 different cognitive and 8 behavioral symptoms based on data from the patient history, neuropsychological testing and behavioral scales (e.g. NeuroPsychiatric Inventory-NPI and Frontal Behavioral Inventory-FBI). Categorical parameters were analyzed using chi-square test and continuous data using Student s T-test. Results: The prevalence of cognitive symptoms as well as neuropsychological testing scores (including episodic memory, executive functions and speech) showed no difference between sexes. As far as behavioral symptoms are concerned, both the overall NPI and FBI scores were significantly higher in men. Men were more likely than women to exhibit disinhibition and aggressiveness (p=0.030 and respectively), dietary changes including overeating and sweet craving (p=0.006). In contrast, neglect in personal care was reported in women more often than in men (p=0.05). Apathy, social withdrawal, obsessive-compulsive and psychiatric symptoms (including depression) were equally recorded in both groups. Conclusion: Despite the fact that the cognitive clinical profile is substantially similar between sexes, our data suggest a male preponderance in the disinhibition/aggressiveness spectrum of symptoms in bv-ftd. F205 Absence of effect of renal impairment on rivastigmine pharmacokinetics in patients with Alzheimer s disease G. Lefevre, F. Callegari, Y. Xiong 2 Novartis Pharma AG, Basel, Switzerland, 2 Novartis Pharmaceuticals Corporation, East Hanover, USA Background and aims: Alzheimer s disease (AD) affects people mostly in older age (>65 years). People in this age group tend to develop renal impairment. Using a retrospective pharmacokinetic modelling analysis, we studied the effects of renal impairment on steady state concentrations of rivastigmine and its metabolite NAP226-90, following transdermal patch (5, 0, 5 and 20 cm^2) or rivastigmine capsule (3, 6, 9, and 2 mg) administration. 205 European Journal of Neurology, 22 (Suppl. ),

104 Flash Posters 587 Methods: Pharmacokinetic data were collected from IDE- AL (Investigation of transdermal Exelon in ALzheimer s disease) study, a 24-week, multi-centre, randomised, double-blind, placebo and active-controlled (rivastigmine capsule), phase III trial conducted in patients with probable AD. Boxplots were constructed for the observed steadystate plasma concentrations of rivastigmine and NAP stratified by baseline renal-impairment (quantified by creatinine clearance [CLcr] and estimated glomerular filtration rate [egfr]).analyses were repeated with modelbased estimates of plasma concentrations adjusted for bodyweight. Results: When stratified by renal function, the two groups (mild or no renal impairment, versus moderate, severe, and end-stage renal impairment) were comparable for demographic covariates for all patient groups. There was no correlation between CLcr or egfr and plasma concentrations of rivastigmine or NAP226-90, and boxplots of concentrations of both largely overlapped within each dose level between the two groups (Figures and 2). Comparable results for both patch and capsule were observed for bodyweightadjusted concentrations versus unadjusted concentrations. F206 Abstract cancelled F207 An unusual case of dizziness: early onset of sporadic Creutzfeldt-Jakob disease M. Margoni, D.M. Bonifati 2, G. Zanusso 3, M. Bongianni 3, M.C. Malaguti 2, D. Orrico 2 University of Padova, Department of Neurosciences, Padua, Italy, 2 Santa Chiara Hospital, Trento, Department of Neurological Disorders, Trent, Italy, 3 University of Verona, Department of Neurological and Movement Sciences, Verona, Italy Background and aims: Diagnosis of sporadic Creutzfeldt- Jakob disease (scjd) in living patients remains a challenge mainly when ataxia is the only symptom at onset. Nasal brushings analyzed by real-time quaking-induced conversion (RT-QuIC) allow intravital diagnosis with a specificity of 00% and sensitivity of 97%. Case Report: We present a 56-year-old woman who complained acute dizziness. Results: Neurological examination showed a wide-based and unsteady gait. Routine blood and immunologic screening were normal as well as a brain MRI. One month later ataxia worsened, hallucinations and short term memory impairment appeared. Cerebrospinal fluid (CSF) was normal. Microbiological tests and onconeural antibodies were negative protein was positive with tau levels of 493 pg/ml. Both nasal brushing and CSF resulted RT-QuIC negative. Brain MRI was normal. Over the next three months, patient progressively deteriorated, till overt dementia. A second CSF analysis revealed a positivity and an increased tau levels >300 pg/ml, while RT-QuIC assay resulted negative. Thus, nasal brushing was repeated and resulted positive to RT-QuIC assay. A brain MRI performed at nine months from onset showed the typical hyperintense signal at cortical ribbon and basal ganglia. PRPN analysis showed no mutation and MV at codon 29. The patient died after one year and scjd was confirmed. Discussion: The present case shows that scjd diagnosis might be difficult when ataxia is the only symptom at onset and supportive tests might be negative, including RT-QuIC on nasal brushing. However, nasal brushing was RT-QuIC positive but not CSF confirming the higher diagnostic value of this procedure. Conclusion: Rivastigmine can be safely administered to patients with renal impairment and does not require dose-adjustment as there is no impact on steady-state plasma concentrations of either rivastigmine or its metabolite NAP Disclosure: Study supported by: Novartis Pharma AG Gilbert Lefèvre and Francesca Callegari are employees of Novartis Pharma AG, Basel Switzerland, and Yuan Xiong is employee of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. 205 European Journal of Neurology, 22 (Suppl. ),

105 588 Flash Posters F208 Correlation between cerebrospinal fluid and neuroimaging biomarkers in Alzheimer s disease R. Miguel, J. Barreira 2, I. Baldeiras 3, C. Oliveira 3, I. Carmo, L. Alves 4 Hospital de Egas Moniz (CHLO), Lisboa, Neurology Department, Lisbon, Portugal, 2 Hospital de Egas Moniz (CHLO), Lisboa, Portugal, Neurorradiology department, Lisbon, Portugal, 3 Centro Hospitalar e Universitário de Coimbra, Laboratório de Neuroquímica, Coimbra, Portugal, 4 Hospital de Egas Moniz (CHLO), Centro de Estudos de Doenças Crónicas, Faculdade de Ciências Médicas, Universidade de Lisboa;, Neurology Department, Lisbon, Portugal Background and aims: Structural MRI and cerebrospinal fluid biomarkers (CSF) seem to increase specificity to the clinical diagnosis of Alzheimer s disease (AD). Few studies have investigated the concordance between these two biomarkers. Objective: To retrospectively determine the concordance between neuroimaging and CSF profile in cognitively impaired patients whose clinical picture was ambiguous, imposing differential diagnosis between AD and non-ad dementia, thereby trying to understand if the performance of lumbar puncture (LP) in patients who have undergone neuroimaging is redundant. Methods: CSF and neuroimaging were evaluated retrospectively in 24 patients with an ambiguous clinical diagnosis. CSF and neuroimaging results were dichotomized between AD and nonad-suggestive. A final diagnosis of probable AD versus probable non-ad dementia was made at the end of a follow-up period of 27.3 months. Results: 58.3% of patients were males. Mean age of symptoms onset was years. 56% of patients had a final diagnosis of a probable non-ad dementia: frontotemporal (n=5), semantic (n=2), Creutzfeldt-Jakob (n=2), progressive non-fluent aphasia (n=) and Lewy body dementia (n=), vascular mild cognitive impairment (n=), depressive syndrome (n=) and dementia secondary to space-occupying-lesion (n=). An association between neuroimaging and CSF biomarkers profiles was not found (p>0.05). Conclusion: Taking into account that the two types of biomarkers were not concordant, and considering that CSF biomarkers are more specific than neuroimaging, the performance of LP in the patients with ambiguous clinical presentation seems to be useful, in order to increase the diagnostic confidence. 205 European Journal of Neurology, 22 (Suppl. ),

106 Flash Posters 589 Cerebrovascular diseases F209 Relationship between insular cortex infarction and newly diagnosed atrial fibrilation E.M. Alba Suarez, P. Martínez Sánchez, B.E. Sanz Cuesta, C. Calle De Miguel, J. Rodríguez Pardo De Donlenbún, J. Pérez Lucas, I. Illán Gala, J. Díaz De Terán, B. Fuentes, E. Díez Tejedor Hospital Universitario La Paz, Neurology, Madrid, Spain Background and aims: Newly diagnosed atrial fibrillation (NDAF) after a cerebral infarction (CI) could be a consequence of the insular injury and not previous to the CI. Target: to analyse whether the insula is affected more frequently when the atrial fibrillation (AF) is diagnosed after the CI than when it is previously known. Methods: Observational study of stroke patients admitted to a Stroke Centre ( ). Variables: basal and clinical data, prior or newly diagnosed AF, stroke severity (NIHSS), CI with insular involvement in neuroimaging and stroke subtypes. Multivariate models were performed to evaluate the association between AF and insular involvement Results: 004 patients were included, 58.2% male, mean age years. The involvement of the insula was similar in patients with prior AF vs. NDAF (34.8 vs. 33.5%) and greater than in those without AF (7.6%) (P<0.000). Left atrial enlargement was more frequent in patients with known AF and NDAF than in those without AF (74.6%, 60.6% and 38.6%, P <0.000). Multivariate analysis showed that AF (both, known and newly) was associated with insular infarction (OR.472; 95% CI ) as well as diabetes mellitus (OR.863; 95% CI ), and NIHSS on admission (OR.2; 95% CI ). Conclusion: The insular involvement in patients with CI is similar in those with known and newly diagnosed AF. This suggests that NDAF is probably previous and not a consequence of CI. F2020 Comparative analysis of risk faktors of stroke among population and patients with stroke R. Aliyev, R. Shiraliyeva, A. Mammadbayli, R. Hasanov Baku, Azerbaijan Background and aims: Stroke is the second cause of death and first cause of disability among elderly people. The purpose of our study is the comparative analysis of risk factors of stroke among patients with stroke and among population. Methods: The study was held in the northwestern region of Azerbaijan. The study involved 73 patients with stroke and 82 residents in age group ( years). The study carried out with the use of a special questionnaire and survey form. The reliability of the risk factors was assessed when necessary with the use of laboratory and instrumental methods, as well as based on medical documents. Results: Comparative analysis showed that the majority of risk factors (hypertension, coronary heart disease, diabetes, transient ischemic attack or stroke in the history, atrial fibrillation and alcohol abuse) were common among patients suffering from stroke, compared to the population. The interesting thing is that emotional stress is more prevalent in the population than patients suffering from stroke. There were no significant differences in smoking between population and patients suffering from stroke. Conclusion: Based on these results it can be noted that the number of smokers is most common among men. From this point of view, the comparison of the prevalence of smoking among patients suffering from stroke did not give any statistical difference. Thus, the results proved once again the importance of expanding coverage of preventive measures, as well as holding information works to raise awareness on elimination of bad habits that lead to stroke. 205 European Journal of Neurology, 22 (Suppl. ),

107 590 Flash Posters F202 Intravenous thrombolysis in grey areas J.N. Alves, A.F. Santos, L. Oliveira 2, J. Mota 3, C. Machado, J. Pinho, C. Ferreira 4 Braga, Portugal, 2 Centro Hospitalar do Médio Ave - Famalicão, Internal Medicine, Famalicão, Portugal, 3 Hospital de Santa Maria Maior - Barcelos, Internal Medicine, Barcelos, Portugal, 4 Hospital de Braga, Neurology, Braga, Portugal Background and aims: The decision of performing intravenous thrombolysis is especially challenging in patients with relative contraindications or conditions in which benefit and risks are not well established. With this study, we intend to compare risks and benefit of thrombolysis in patients with relative contra-indications with historical controls with no contra-indications. Methods: Case-control study, with data collected from the prospective registry of patients with ischemic stroke who underwent IV thrombolysis between 2007 and 204. Patients who had any relative-contraindication and in which thrombolysis was performed were included and compared with a randomly selected group of 40 patients, who were also treated with thrombolysis but had no known contraindication. Results: Thrombolysis was performed in 37 patients with relative contra-indications between 2007 and 204 (RC group). 59.5% were female with a median age of 75. No demographic variable was statistically different between groups. Contra-indications were: malignancy, dementia, chronic liver disease, hyperglycemia, recent myocardial infarction and recent gastrointestinal hemorrhage. No statistically significant differences were found between groups regarding safety profile (symptomatic intracranial hemorrhage: RC group=3.5%; control group=5%, p=0.452) and good outcome (mrs 2: RC group=43.2%, control group=44.8%, p=0.898). No major extracranial hemorrhages were reported in either group. Conclusion: This study suggests that selected patients with relative contra-indications may also benefit from thrombolysis and have a similar safety profile as patients with no contra-indications. F2022 Posterior cerebral artery infarction: still an understudied vascular topography of ischemic stroke K. Antonenko, L. Sokolova Bogomolets National Medical University, Neurology, Kiev, Ukraine Background and aims: Ischemic stroke caused by infarction in the territory of posterior cerebral artery (PCA) has not been studied as extensively as infarctions in other vascular territories. Objective: To investigate peculiarities of clinical picture, cognitive deficit and dynamics of neurological deficit recovery during -year period of follow-up in patients with ischemic PCA strokes. Methods: 74 consecutive patients after acute ischemic PCA stroke were examined by neurological scales (NIHSS, modified Rankin scale, Barthel index, MMSE) on admission, at -month, 3-month, -year period of follow-up; brain MRI. Results: Infarcts were located predominantly in the cortical territory of PCA 44 patients (59.5%), combined cortical and deep 26 (35.%), bilateral infarcts of PCA 4 (5.4%). Atherotrombotic infarction was the most frequent stroke subtype (45.9%), followed by cardioembolic (33.8%), and lacunar subtypes (2.%). In clinical picture prevailed vertigo (87.8%), hemianopsia (88.6%), visual agnosia (6.8%), visual neglectus (3.5%), headache (48.6%), sensory (2.3%) and motor disturbances (6.2%). In patients with combined PCA lesions cognitive disorders were more evident 25.4±.9 compared to pure-cortical lesions 28.±2.3 (р<0.00). Combined PCA infarcts were characterized by higher background neurological deficit in comparison with isolated cortical lesions (0.±.3 versus 6.3±2.; р<0.00). At 3 months number of patients with unfavorable functional outcome was 63.3% in group of combined infarctions compared to 22.7% pure cortical-only (p=0.00), at -month 30.0% compared to 9.% (p=0.029), after -year 4.3% compared to 4.5%, accordingly. Conclusion: Combined cortical and deep PCA infarcts were characterized by higher level of neurological deficit and worse clinical outcome, more evident cognitive disorders. 205 European Journal of Neurology, 22 (Suppl. ),

108 Flash Posters 59 F2023 Cardiovascular comorbidity in adult patients with acute ischemic stroke D. Tomov, D. Arabadzhieva 2, A. Kaprelyan 3, Z. Georgieva 4, Z. Slavov 5, V. Zlateva 6 Department of Health Economics and Management, Varna, Bulgaria, 2 St. Marina University Hospital of Varna, Department of Neurology, Varna, Bulgaria, 3 Medical Unviersity of Varna, Department of Propedeutics of Internal Medicine, Varna, Bulgaria, 4 Medical University of Varna, Department of Propedeutics of Internal Medicine, Varna, Bulgaria, 5 Chernorizets Hrabar Varna Free University, Department of Informatics, Varna, Bulgaria, 6 Medical University of Varna, Department of Health Economics and Management, Varna, Bulgaria Background and aims: Ischemic stroke (IS) is the most common cerebrovascular disease worldwide and in Bulgaria. There is a considerable risk for IS in adult patients with cardiovascular diseases (CVDs). The objective of the present communication is to analyze the correlations between some common CVDs and acute IS. Methods: We examined 258 patients with acute IS, 29 males and 29 females, at a mean age of 7 years hospitalized in the First Clinic of Neurology, St. Marina University Hospital of Varna, Bulgaria, in The co-occurrences of arterial hypertension, ischemic heart disease, myocardial infarction, effort angina pectoris, ventricular tachyarrhythmia, atrial fibrillation, and heart failure were assessed by means of ANOVA, correlation and cluster analysis. Results: There were 58 IS patients (in 22,48%) with four accompanying diseases, 52 IS patients (in 20,6% of the cases) with two accompanying diseases, etc. Arterial hypertension co-occurred in 246 IS patients (in 95,35%), ischemic heart disease - in 54 IS patients (in 59,69%), effort angina pectoris - in 0 IS patients (in 39,5% of the cases), heart failure - in 63 IS patients (in 24,42%), atrial fibrillation - in 4 IS patients (in 5,89% of the cases), etc. The correlation between atrial fibrillation and ventricular tachyarrythmia presented with the highest Pearson s coefficient (r=0,567) followed by that between atrial fibrillation and effort angina pectoris (r=-0,492), that between ventricular tachyarrythmia and effort angina pectoris (r=-0,40), etc. Conclusion: A regular control and adequate treatment of CVDs in adult individuals and keeping-up the healthy lifestyle could ensure a successful IS prevention. F2024 Diagnostic potential of microwave techniques in neurology: new insight into beta-adrenergic activity testing K. Arkhypova, F. Volokh, A. Nosatov 2, V. Malakhov Kharkiv Medical Academy of Postgraduate Education, Department of rehabilitation, sport medicine and exercise therapy, Kharkiv, Ukraine, 2 Kharkiv City Clinical Hospital No. 7, Department of Neurology, Kharkiv, Ukraine Background and aims: Being the major component of the interaction between the sympathetic nervous and the cardiovascular systems, beta-adrenergic receptor (beta-ar) function often plays an important role in cerebrovascular incidents too. Because activated sympathetic tone is associated with poorer outcome in certain neurological cases (for instance, after stroke), we investigated whether beta- AR activity is associated with lesser disease severity and improved outcome after treatment. In this work, we have focused on the comparison study of beta-ar activity in patients with hypertensive encephalopathy as well as in health individuals. Methods: Label-free microwave dielectrometry and the osmotic fragility methods. Both techniques monitor variation of the study parameters in response to the beta-blocker propranolol in vitro. Results: We studied 8 patients with hypertensive encephalopathy, depending on disease severity they were subdivided into 2 groups, as well as 26 health individuals (control). Initial levels of the beta-ar activity (numerically expressed by the beta-arm index) were significantly different between all groups exceeding in 2 (p<0.03) and 2.8 (p<0.0) times compared to control. On the 0th day of the study, we revealed normalization of index in the studied groups: it fell by 7.6% (p<0.03) in group and to 30.% (p <0.00) in group 2. The results of dielectric observation also revealed the change in beta-ar activity, which increased by 2.7% (p<0.00) and by 4.4% (p<0.04), respectively. Conclusion: Beta-AR activity testing we propose may be useful for diagnostics, assessment of severity of hypertensive encephalopathy, and evaluation of individual sensitivity to beta-blockers. 205 European Journal of Neurology, 22 (Suppl. ),

109 592 Flash Posters F2025 The role of vertebral artery hypoplasia in vertebro-basilar insufficiency A. Azimov, F. Yunusov, G. Rakhimbaeva 2 Tashkent, Uzbekistan, 2 Tashkent Medical Academy, Neurology department, Tashkent, Uzbekistan Background and aims: In patients with posterior inferior cerebellar artery infarction (PICAI) or lateral medullary infarction (LMI), the ipsilateral vertebral artery is often hypoplastic. The aim of investigation was to establish the role of hypoplastic vertebral artery (HVA) in vertebro-basilar insufficiency. Methods: 79 patients with ischaemic stroke, including vertebral artery territory infarction (LMI or PICAI), were classified according to their stroke location (49 anterior circulation strokes (ACS) and 30 posterior circulation strokes (PCS)) by MRI. The frequency of HVA was measured in comparison with 86 normal healthy people. Results: 27 patients (34.9%) had HVA (3.4%, bilaterally). Patients with PCS showed a higher rate of HVA than those with ACS (42.3% vs 28.9%, p<0.00). The HVA frequency of those with ACS was similar to that of the normal group (24.5%). Of the 30 patients with vertebral artery territory stroke, 4 (46.6%) had HVA (bilateral HVA in 2), and all of 28 showed ipsilateral HVA territory stroke. In 2 patients with vertebral artery territory stroke, classification of the ipsilateral vertebral artery as hypoplastic (vs dominant or symmetric) predetermined the neurological deficite on hypoplasia side, and a higher incidence of steno occlusion (p<0.00). Conclusion: HVA is not uncommon in the normal population, and is frequent in patients with PCS. People with HVA may have a high probability of PCS with symptoms of vertebro-basilar insufficiency. F2026 A classical syndrome and a revisited etiology: a patient with Foix-Chavany- Marie Syndrome and radiotherapy induced vasculopathy R. Barbosa, I. Gil 2, F. Ladeira, S. Calado, M. Viana-Baptista Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Neurology Department, Lisbon, Portugal, 2 Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Neuroradiology Department, Lisbon, Portugal Background and aims: Bifacial diplegia, dysarthria, and central voluntary paresis of the lower cranial nerves with preserved emocional movements is known as Foix-Chavany-Marie Syndrome (FCMS). Although FCMS is classically considered the result of bilateral opercular lesions some cases of unilateral opercular lesions in patientes with clinical and imagiological evidence of old contralateral lesions have been described. Methods: We report a case of a 42-year-old male, who has been diagnosed a pinealoma at 7 years old and underwent hole brain radiotherapy and ventriculo-peritoneal shunting. He was admitted with a sudden left body hemiparesis, with left gaze palsy and anarthria. He coud not follow comands to open mouth, protude the tongue, close the eyes or show the teeth. However he could do so spontaeously when yawning or blinking. Head CT scan didn t show acute changes but cerebral MRI revealed acute ischemic right corona radiata and lenticulo-capsular stroke and multiple old, cavitated bilateral lesions. Conventional cerebral angiography showed diffuse vasculopathy characterized by multiple stenosis in all cerebral territories. Blood and cardiac exams were normal. We admitted acute ischemic stroke caused by radiotherapy-induced vasculopathy and a FCMS. He started Aspirin 50 mg. month later, anarthria and dysphagia didn t improve and he was nourished by a nasogastic feeding tube. Conclusion: In our patient, the presence of old lesons, sequelae of cerebral radionecrosis associated with an acute ischemic lesion may explain the clinical picture of FCMS. Symptomatic radiation induced cerebral vasculopathy has a latency periodo of 2-25 years and there is no specific treatment. 205 European Journal of Neurology, 22 (Suppl. ),

110 Flash Posters 593 F2027 Ischemic tolerance in the brain after prodromal TIA I. Barbov, I. Petrov, S. Lazarova, A. Georgievska University Clinic of Neurology, Skopje, Macedonia Background and aims: Ischemic tolerance has been extensively studied in experimental models of heart and brain ischemia. While there is some clinical evidence of ischemic tolerance in the heart, it is not known whether the same is true for the human brain. Methods: We conducted a retrospective case-control study in 00 stroke patients with and without antecedent TIA. Results: Despite no significant differences in baseline characteristics, independence (Rankin scale score of 0 to ) and favorable outcome (Glasgow Coma Scale score of 5) were significantly associated with prior TIA in univariate analysis. After correction for other cardiovascular risk factors, TIA before stroke also was an independent predictor of mild stroke (Canadian Neurological Scale score of 6.2) in multivariate models (absolute difference 20.8%; P=0.0). Conclusion: Assuming that a TIA represents an adequate stimulus to elicit ischemic tolerance, our results suggest that ischemic tolerance might occur in the human brain. F2028 Implication of C4d in progression of ischemic stroke on patients with lupus erythematosus. S. Bebitov, G. Rakhimbaeva, K. Mirzaeva Tashkent Medical Academy, Neurology department, Tashkent, Uzbekistan Background and aims: Systemic lupus erythematosus (SLE) is one of the uncommon causes of ischemic stroke. According to literature, protein s concentrate of complement system (PCS) can be decreased in blood of SLE patients, but the role of PCS C4d has not been studied completely in ischemic stroke. Aim of our study was to define the role of PCS C4d in patients with ischemic stroke, caused by SLE. Methods: We studied 42 SLE patients during five years (middle age 45.56±4.23). As an indicator of SLE, all patients, which observed ischemic stroke, underwent to magnetic resonance image (MRI). In addition, Enzyme Linked Immuno Sorbent Assay (ELISA) was used for determination of concentrate of PCS C4d in blood. Results: Concentration of PCS C4d was g/l in 54.76% SLE patients with multifocal ischemic stroke on MRI. 35.7% of SLE patients had g/l PCS C4d concentration with lacunar ischemic stroke on MRI. 9.5% SLE patients had g/l PCS C4d level without ischemic stroke signs on MRI. Conclusion: It should be noted that relatively high concentration of PCS C4d during a long time might be used as a prognostic marker for ischemic stroke in patients with SLE. 205 European Journal of Neurology, 22 (Suppl. ),

111 594 Flash Posters F2029 The outcome of acute stroke depends on either occluded artery or atrial fibrillation I. Berisavac, P.D. Stanarcevic, D. Jovanovic, M. Ercegovac, V. Padjen, M.S. Budimkic, L. Beslać-Bumbaširević Belgrade, Serbia Background and aims: Neurologic deficit severity in stroke patients depends on occluded artery and co-morbidities. We compared survival, co-morbidity frequencies, complications and length of stay in neurology intensive care unit (NICU) between patients with acute stroke in either basilar artery (BA) or medial cerebral artery (MCA) area. Methods: Prospective, observational, single-center study included 69 acute stroke patients allocated in two groups: -BA (N=30); 2-MCA (N=39). Age, Glasgow coma scale (GCS), The National Institute of Health Stroke Scale (NIHSS), complications as mechanical ventilation (MV), infections, acute kidney injury (AKI), acute myocardial infarction (AMI), length of stay in NICU and survival were compared and co-morbidities frequency: atrial fibrillation (AF), diabetes mellitus (DM), hypertension (HTN), hyperlipidemia. Results: Age was similar and women were older in group (7. vs. 57.2, p=0.0046). At the admission into NICU, GCS was lower in group (8.6±3.92 vs. 0.85±5.37, p=0.025) and NIHSS was greater (28.79±.38 vs. 9.7±9.88, p=0.0006). In each group 6 patients were on MV (p=0.44). Complications occurred similarly: infections, AMI, AKI (all p>0.05). Group had longer length of stay in NICU, hospitalization duration and greater NIHSS at dismissal from hospital (all p>0.05). Survival was similar in both groups (53% vs. 46%). Atrial fibrillation was more frequent in group 2 (P=0.044), unlike DM, HTN and hyperlypidemia. Conclusion: Acute stroke in region of BA was more severe. Patients with stroke in MCA area had more frequent AF than patients with stroke in BA area. F2030 Hypoxıc corpus callosum lesıon after cardiac arrest with 3 prognosis E. Eruyar, Y. Sücüllü-Karadag, S. Bilen 2, N. Öztekin 2, F. Ak ANH Traning and Research Hospital, Neurology, Ankara, Turkey, 2 Ankara, Turkey Background and aims: Hypoxic ischemic damage of corpus callosum (CC) after cardiac arrest is a rare condition. Lesions of the splenium of the corpus callosum after hypoxia are bilateral and lead to poor prognosis. Herein, we present a case with good prognosis after cardiac arrest with bilateral lesions of the splenium of corpus callosum. Methods: 46-year-old dyspneic female patient was admitted to the emergency room and cardiac arrest developed soon after. In initial neurological examination she was unconscious and unresponsive to verbal and painfull stimuli with intact reflexes. Brain tomography was normal. The patient was diagnosed as allergic asthma and anaphlaxisrelated to respiratory and cardiac arrest Results: She was extubated upon improvement of respiration spontaneously and the recovery of consciousness on the 7 th day of hospitalization. She was dysphasic and had blurred vision. MRI which was performed 3 days after, revealed diffuse diffusion the splenium of corpus callosi bilaterally, in occipital lobes and in cortical gray matter on vertex level. The present lesions were thought to be associated with hypoxia. The patient s neurological findings and lesions had completely disappeared on control imaging after 3 months Conclusion: Reversible MRI lesions with transiently restricted diffusion in the SCC have been reported in various conditions. Hypoxic SCC lesions are usually bilateral and have poor neurological prognosis. Only the prognosis of a patient with unilateral lesion was good. Our case had have good prognosis and lesions were localized in the central part. 205 European Journal of Neurology, 22 (Suppl. ),

112 Flash Posters 595 F203 Pulvinar sign in a female: not just in Fabry disease A. Caetano, J. Barreira 2, R. Pelejão, P. Freire 3, C. Conceição 4, L. Campos 5, M. Viana-Baptista Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Neurology, Lisbon, Portugal, 2 Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Neurorradiology, Lisbon, Portugal, 3 Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Intensive Medicine, Lisbon, Portugal, 4 Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Internal Medicine, Lisbon, Portugal, 5 Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Internal Medicine, Lisbon, Portugal Background and aims: Fabry disease is an X-linked lysosomal disease, and is an important diagnosis to consider when faced with acute cerebral vascular events in young patients. Isolated pulvinar sign is a recognized sign of Fabry disease, even considered by some authors as pathognomonic, however, the first case of T-weighted MRI findings of isolated pulvinar hyperintensities not related to Fabry has been recently reported. Case Report: A 52-year-old woman, with a previous history of uncontrolled type diabetes, hypertension, and psychyatric disease was admitted to the emergency room in a comatose state, presumed to be of hypoglycemic etiology (iatrogenic, following insulin subcutaneous injection). After metabolic control and recovery, her neurological examination disclosed no relevant changes. Her brain CT revealed isolated bilateral pulvinar hyperdensities compatible with calcifications, which were hyperintense on T- weighted MRI imaging. She had ocular abnormalities from her diabetic disease and uncontrolled hypertension, but no Fabry disease signs. Similarly, there were no neuropathic symptoms, no cardiac or skin changes suggestive of Fabry disease. There was slight impaired kidney function attributed to her long-standing arterial hypertension and type diabetes. Her alpha galactosidase activity was normal, as was PCR sequencing for Fabry associated gene mutations. Conclusion: The pulvinar sign has been correlated with severity of clinical disease in Fabry disease but not with ischemic stroke. It is believed that increased cerebral blood flow in the posterior circulation may be involved. Other mineralizing systemic changes may result in calcification of thalamic and deep gray nuclei, but usually not restricted to the pulvinar nuclei. F2032 A case of leukoencephalopathy, cerebral calcifications and cysts Labrune Syndrome J. Coelho, C. Nunes 2, O. Rebelo 3, G.A.P.R.C. Santo 4, M. Pereira 3 Coimbra, Portugal, 2 CHUC, Neuroradiology, Coimbra, Portugal, 3 Centro Hospitalar Universitário de Coimbra, Neurology, Coimbra, Portugal, 4 COIMBRA, Portugal Background and aims: In 996, Labrune et al. described a new clinical entity in three children with leukoencephalopathy, multiple cysts in the brain parenchyma and calcifications in the deep gray matter. In subsequent years, 20 similar cases were reported, half of them adults. Case Report: A woman (52 years old) observed in neurology clinic by insidious headache with growing intensity, associated with nausea, vomiting and cognitive decline. A brain CT-scan and MRI were performed and disclosed multiple cystic formations, nodular calcification and leukoencephalopathy. The parasitological serological study proved negative. She was submitted to surgical remotion of one of the cysts and histopathological examination was done. This showed no epithelial lining that aims to epithelial or parasitic cysts, the presence of multiple microcalcifications, gliosis, hemosiderin deposits, thickening of the arterial walls without amyloid deposition. Over the next two years there was a gradual deterioration of the clinical condition, with the emergence of tetraparesis and aphasia and the development of epilepsy. CT images showed increased size of the cystic lesions and calcifications. The combination of clinical, imaging and pathological features allowed diagnosing Labrune Syndrome. A neuro-ophthalmologic evaluation was performed and excluded retinal findings consistent with Coats syndrome. Conclusion: Labrune syndrome is a rare disorder characterized by extensive brain calcifications, leukodystrophy and parenchymal cysts. Here we described an adult-onset one, which is the first portuguese case. 205 European Journal of Neurology, 22 (Suppl. ),

113 596 Flash Posters F2033 Ischemic cerebrovascular events related to a hairdresser visit ( beauty parlour strokes ): a 0-year case series P. Correia, I. Meyer, A. Eskandari 2, P. Michel CHUV, Neurology, Lausanne, Switzerland, 2 Stroke Centre, Neurology Service, Lausanne, Switzerland Background and aims: Ischemic cerebrovascular events (ICE) related to hairdresser visits are usually attributed to positional hypoperfusion in compressed vertebral arteries or cervical artery dissections. We determined the frequency, mechanisms, localisation, outcome of a consecutive sample of hairdresser ICE. Methods: We prospectively collected ICE during or in relation to a hairdresser visit (0/2002 to 2/202). All ischemic strokes after 0/2003 are documented in Acute STroke Registry and Analysis of Lausanne (ASTRAL). Hairdresser strokes were compared to ASTRAL (0/2003 to 2/202). Results: We identified 0 hairdresser ICE (9 strokes and TIA). When compared with 2,36 non-hairdresser strokes, they had similar age, anterior-posterior distribution, more females (odds ratio [OR].87, confidence interval [CI] ) and lower admission NIHSS(median 3 vs. 6, p=0.7). Hairdresser ICE had less hypertension (OR 0.28, CI ), diabetes (0% vs. 23.8%), hyperlipidemia (OR 0.5 CI ). ICE mechanisms varied: dissection, cardiac, lacunar, atherosclerotic stenosis, unknown (n=2 each), comparable with ASTRAL. Two cases (M stenosis, V4 occlusion) were possibly related to systemic hypotension during hot air hair drying. Unadjusted clinical outcome at 2 months was better (OR 6.34, CI ) in the hairdresser group. Conclusion: Patients with hairdresser strokes were more often female and had more benign risk factor profiles. No predilection for posterior circulation was seen and multiple mechanisms seen including dissection, systemic hypotension, and likely chance occurrence. A lower initial NIHSS may account for better outcome. Available data are insufficient for preventive recommendations. F2034 Clinical evaluation and laboratory data assessment for hemorrhagic transformation prediction in ischemic stroke patients: a retrospective study E. Costru-Tasnic, M. Gavriliuc, O. Odainic, E. Manole Chisinau, Moldova Background and aims: Older age, male gender, high blood pressure (HBP), admission hyperglycaemia, low platelet count, and low serum lipids are considered independent risk factors for hemorrhagic transformation (HT) in ischemic stroke (IS), with or without thrombolytic therapy. The aim of our study was to evaluate clinical and laboratory data of IS patients to verify their predictive importance for HT. Methods: We retrospectively analyzed data of 45 consecutive patients with IS, hospitalized in a tertiary Neurological Centre from Republic of Moldova in 203. We identified the patients with HT (group A) and without this complication (group B). We selected information on the age, gender, thrombolytic treatment, mortality rate, HBP, atrial fibrillation, diabetes mellitus, risk factors, and laboratory findings. The obtained data were compared by t-student test, CI 95%. Results: The TH incidence was 4.%, 58.82% of patients were male. None of the patients with TH receive thrombolytic therapy. 94.% of the group A patients were diagnosed with IS attributed to atherothrombosis and 5.89% attributed to cardioembolism. The main age of TH patients was 64.94±3.2 versus 67.58±0.7 in non-th patients. The mortality rate in group A was 35.29% vs 5.07% in B group. Patients from group A presented with higher incidence of HBP, obesity, smoking, admission hyperglycaemia, higher platelet count versus B group patients. Conclusion: The obtained results confirm that the male gender, HBP, obesity, and high level of serum glucose at admission correlate with HT, and may act like predictive factors for this complication. 205 European Journal of Neurology, 22 (Suppl. ),

114 Flash Posters 597 F2035 Clinical, neuroimaging and oxidative stress markers in predicting outcome of spontaneous intracerebral hemorrhage M. Danovska, M. Alexandrova Pleven, Bulgaria Background and aims: Although spontaneous intracerebral hemorrhage (sich) is associated with the highest mortality rate, it still remains an unresolved medical problem. Objective: To assess the prognostic value of some clinical, neuroradiological and oxidative stress parameters on the clinical outcome of patients with sich. Methods: Of the 337 patients with sich, only 0 were selected on the grounds of strict exclusion and inclusion criteria. Risk factors, neurological status, neuroradiological and blood biochemical parameters were evaluated. Results: Initial assessment of primary stroke severity and neurological deficit by GCS and NIHSS were found strongly correlated with the clinical outcome after sich. Age and vascular risk factors did not correlate with the clinical outcome. Male patients had better survival on the 30-th day compared with the female ones. The serum hs-crp level (p=0.027) and the hematoma volume (p=0.005) were found independent predictors of lethal outcome, while the lipid hydroperoxides concentration (ROOH) (p=0.0) was significantly associated with the functional outcome on the 7 th day after sich. Hyperglycemia (p=0.034), hs-crp (p=0.004) and total antioxidant status (TAS) (p=0.036) were significant indicators for lethal outcome over a 3-month period. Patients with hs-crp more than 4.5 times above normal showed a lower survival rate within a 3-month period. Conclusion: Neurological deficit on admission and hematoma volume are reliable predictors of the clinical outcome after sich while oxidative stress markers oxidative stress markers should be considered additional prognostic criteria that could serve for early stratification of patients and optimal choice of therapeutic approach. 205 European Journal of Neurology, 22 (Suppl. ),

115 598 Flash Posters Cerebrovascular diseases 2 F2036 Intracranial hemorrhage after non-urgent carotid recanalization: a hyperperfusion syndrome with devastating consequences M. González Delgado, E. Murias, P. Vega, E. Morales, M. Alonso, L. Camblor, A. Ceilan, S. Calleja Hospital Universitario Central de Asturias, Oviedo, Spain Background and aims: Hyperperfusion syndrome has been described as the triad of headache, neurological deficit and seizures developing after carotid revascularization associated with hypertension and in the absence of cerebral ischemia. Intracranial hemorrhage is the most serious manifestation of cerebral hyperperfusion. Methods: Consecutive patients who needed non-urgent internal carotid artery (ICA) recanalization, carotid stenting (CAS) or carotidendarterectomy (CEA) were studied from February 2005 to November 204. Results: 957 patients were studied. 6 of them (5 males and female) presented ICH after ICA recanalization (CAS). Mean age was 7.6 (54-84) years. 4 patients presented as clinically symptomatic carotid pathology and 2 as asymptomatic. Cranial CT at admission showed leukaraiosis in 2 patients, was normal in 2. A borderline ischemic stroke was seen in a further 2 patients. At the time of the procedure, 4 patients were under ASA. Another 2 were under Clopidogrel and LMWH (nadroparin 0.8 /24 h). One was under nadroparin 0.6 /24 h and another under nadroparin 0.4 /24 h. A further 2 patients were under ASA and clopidogrel. After the procedure, 4 patients presented with neurological worsening, one patient with a slight headache and another with transient neurological deficit prior to a decrease in the level of consciousness. Cranial CT showed an ipsilateral ICH in all cases. Half of the patients died. Conclusion: ICH after non-urgent carotid recanalization had a poor prognosis. Neurological symptomatology related with such may be trivial, namely, a slight headache. A careful antithrombotic treatment should be recommended, and high LMWH doses should be avoided. F2037 The frequency of epileptic seizures in the first 24h of stroke onset I. Grkic, V. Paunovic, A. Zecevic, V. Miletic, V. Mileusnic, L. Pekic, P. Nikic Special hospital for cerebrovascular diseases Sveti Sava, Belgrade, Serbia Background and aims: Epileptic attack is paroxysmal, short and stereotypical amendment motor activity, sensibility, behavior or consciousness caused by abnormal electrical, hyperactivity of the brain. The frequency of seizures in the first 24h of stroke onset is 3-6% in most studies. The goal of of this research is observation of the relationship between localization and type of stroke (ischemic/hemorrhagic) in relation to the frequency of epileptic seizures in the first 24 h. Methods: This research encompassed 65 patients (male and female) who are in the first 24 h of the beginning stroke had convulsive epileptic seizures. The study was conducted from January 203 to January 204. Patients who previously had epilepsy were not recorded. They also recorded and relapses of attacks in the first 24 h. Results: In the study was included 65 patients of which 36 (55.4%) men and 29 (44.6%) women. 35 patients (53.8%) of all the treated patients had ischemic stroke and 30 (46.2%) had hemorrhagic stroke. Infarction in the right hemisphere is represented at 3 (48%) while 34 (52%) patients had a stroke in the left hemisphere. One patient had an AVM. Conclusion: Our research has shown that patients with ischemic stroke have a higher incidence of seizures than those with hemorrhagic stroke. The survey also showed a higher incidence of seizures in myocardial localized in the left hemisphere. 205 European Journal of Neurology, 22 (Suppl. ),

116 Flash Posters 599 F2038 Cerebrolysin and recovery after stroke (CARS): a meta-analysis of two randomized, controlled, double-blind trials assessing the combination of Cerebrolysin and standardized rehabilitation on motor recovery A. Guekht, W.-D. Heiss 2, O.A. Bajenaru 3, C. Popescu 4, E. Gusev 5, J.C. Vester 6, D. Muresanu 7 Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation, 2 Max Planck Institute for Neurological Research, Colonge, Germany, 3 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, 4 Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania, 5 Russian National Research Medical University, Moscow, Russian Federation, 6 IDV Data Analysis and Study Planning, Krailling, Germany, 7 Iuliu Hatieganu University of Medicine and Pharmacy, Cluj -Napoca, Romania Background and aims: This meta-analysis combines the results of two multicenter stroke studies of identical design (CARS and CARS2) assessing efficacy of Cerebrolysin on motor recovery in early rehabilitation. Cerebrolysin is a parenterally administered neuropeptide preparation approved for the treatment of stroke. Methods: Both studies had a prospective, randomized, double-blind, placebo-controlled design. Treatment with 30ml Cerebrolysin once daily for three weeks was started hours after stroke onset. In addition, patients participated in a standardized rehabilitation program over 2 days starting <72 hours after stroke onset. Primary endpoint was the Action Research Arm Test (ARAT) score on day 90. For both studies individual patient data were available. Results: The nonparametric effect size of the two studies on ARAT score indicated a clear superiority of Cerebrolysin as compared to placebo (MW 0.62, P<0.000, Lachin pooling, Day 90, LOCF; N=442). The multivariate effect size on the composite outcome, as assessed by twelve different outcome scales, confirmed this superiority (MW 0.56, P<0.000). The OC analysis resulted in similar overall effect sizes. Premature discontinuation was 3.8% (CARS) and 4.2% (CARS2). The less severe baseline level in CARS2 may have caused the substantial ceiling effects in the placebo group of CARS2. Negligible differences in safety aspects were found. Conclusion: Cerebrolysin had a beneficial effect on function and overall outcome in early rehabilitation patients after stroke. The safety aspects suggest a favorable benefitrisk ratio. Due to the exploratory character and heterogeneity of both studies the results should be confirmed by a high precision, large-scale randomized trial. Disclosure: The study has been supported by EVER Neuro Pharma F2039 Effect of decompressive craniectomy for malignant middle cerebral artery infarction especially in elderly patients: a Single center experience for 3 patients A. Güler, S. Ciftci, H. Sirin, N. Celebisoy, E. Kumral, T. Turhan 2, E. Ozgiray 2 Ege University Medical School Hospital, Neurology, Izmir, Turkey, 2 Ege University, Neurosurgery, Izmir, Turkey Background and aims: Patients with massive hemispheric infarction are at risk for developing life-threatening cerebral edema during clinical follow-up. Decompressive surgery for large hemispheric infarction involves removing a large frontotemporal-parietal bone flap and opening the dura ipsilateral to the side of infarction to allow outward herniation of the brain, thus lowering intracerebral pressure (ICP) and alleviating or preventing downward herniation. In this study, we want to evaluate its effects on mortality and morbidity of malignant infarction. Methods: Patients with massive cerebral who needed decompressive surgery due to brain edema were evaluated in our study retrospectively. We took in consideration age, pre-operational and post-operational Glasgow Coma Scale score (GCS), time of the surgery, size of midline shift. Patients status in terms of morbidity was evaluated by Modified Rankin Score (mrs) at the hospital discharge. Results: Decompressive surgery was performed in 3 patients (44 female/69 male). The mean age of patients was 70 (min 3, max 85). All had large middle cerebral artery infarction. Patients GCS ranged between 3-5 before surgery. Modified Rankin Score was 6 in 55 patients and in others it was between 3-5. We evaluated which factor (in terms of age, GCS, time of surgery, size of midline shift) could be the most effective on mrs in our patients. Conclusion: Decompressive surgery is a life saver method in severe brain edema and it is also a good theraupatic option in malignant infarction. To benefit from it effectively, patients characteristics should be defined carefully. F2040 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

117 600 Flash Posters F204 Hypertension in admission is associated with lower risk of early seizures after stroke F. Jashari, Z. Hundozi 2, A. Shala 3, G. Lila 2, D. Boshnjaku 2, J. Rrustemi 2 University clinical centre of Kosovo, Neurology, Prishtina, Kosovo, 2 University Clinical Center of Kosovo, Neurology, Prishtina, Kosovo, 3 University Clinical Center of Kosovo, Prishtina, Kosovo Background and aims: Stroke is the most common cause of seizures among elderly. Despite the common occurrence of early seizures (ES) after stroke, relationship between risk factors and this dramatic complication is not well known. We have determined the relationship between clinical measures in admission and ES after stroke. Methods: In this study we have included 037 patients (mean age 69±2, 5.6% females) with ischemic and hemorrhagic stroke. Frequency of seizure occurrence within two weeks after stroke was determined. In addition, in a logistic regression model we have analyzed the effect of blood pressure (BP) in admission and other patients risk factors (age, gender, diabetes, atrial fibrillation (AF) and dyslipidemia on the ES after stroke. Results: ES frequency was 4% and 3.6% for ischemic and hemorrhagic stroke respectively. Compared to patients with high BP in admission, those with low BP had higher risk of ES (7.5% vs. 2.9%, p=0.00). Mean age of patients with ES was lower (62.5 vs. 69.3, p<0.00). In a logistic regression outcome analyses of relevant confounders and potential predictors, including BP, age, gender, diabetes, AF and dyslipidemia, BP and age (<65 years) remained independent predictors of ES with OR of 0.4 (95% CI , p=0.006) and 0.96 (95% CI , p=0.003). Conclusion: ES after stroke are equally frequent in patients with ischemic and hemorrhagic stroke. Hypotension in admission and younger age patients are at higher risk of ES after stroke. F2042 Common carotid intima-media measurements determine distal disease structure and vulnerability F. Jashari, P. Ibrahimi 2, M. Henein 3 University Clinical Center of Kosovo, Neurology, Prishtina, Kosovo, 2 Umeå University, Public Health and Clinical Medicine, Umea, Sweden, 3 Umea University, Public Health and Clinical Medicine, Umea, Sweden Background and aims: In patients with carotid atherosclerosis the future risk of stroke is mainly related to the degree of stenosis. Plaque echogenecity could have additional diagnostic value. The aim of this study was to assess the relationship between common carotid artery (CCA) ultrasound markers of atherosclerosis and distal plaque features, at bifurcation and internal carotid artery (ICA). Methods: We analyzed 74 carotid arteries in 87 patients with known carotid disease (mean age 69±6 year, 36% females). Intima media thickness (IMT) and grey scale median (IM-GSM) were measured at the CCA. Plaque textural features: gray scale median (GSM), juxtaluminal black area (JBA-mm2), and plaque coarseness, at bifurcation and ICA were also determined. CCA measurements were correlated with those of the distal plaques. Figure. Measurements of intimal-media complex echogenicity in CCA and plaque echogenicity in bifurcation and ICA. Results: An increased IMT in CCA correlated with plaque irregularities in the bifurcation and ICA (r=0.53, p<0.00), while IM-GSM was closely related to plaque GSM (r=0.78, p<0.00) and the% echolucent components (<25GSM area) (r=-0.74, p<0.00), but to a lesser extent with plaque coarseness (r=0.66, p<0.00), JBA area (r=-0.56, p<0.00), and GSM of the JBA (r=0.49, p=0.00). Both, IMT and IM- GSM correlated with severity of stenosis (r=0.27, p=0.00 and r=0.2, p=0.003) respectively. 205 European Journal of Neurology, 22 (Suppl. ),

118 Flash Posters 60 Table. Relationship between IM-GSM in the CCA and plaque features in the bifurcation and ICA. Figure 2. Correlation between CCA intima-media GSM and GSM of the plaques located in bifurcation and ICA (left). Correlation between conventional IMT in the CCA and degree of stenosis in the ICA (right). Conclusion: Measurements of CCA reflect distal disease at bifurcation and internal carotid branch with IMT reflecting the plaque irregularities and IM-GSM as a marker of textural plaque vulnerability. IM-GSM has additional value over and above IMT in determining distal plaque nature, known to reflect its vulnerability. F2043 Cerebral venous thrombosis - an evaluation of 62 cases D.C. Jianu, M.P.S.N. Jianu 2 University of Medicine and Pharmacy, Neurology, Timisoara, Romania, 2 Military Emergency Hospital, Ophthalmology, Timisoara, Romania Background: Cerebral vein and dural sinus thrombosis (CVT) generally manifest in various non-specific clinical forms. Aims: To identify CVT causes and risk factors, to describe the demographic, clinical, laboratory, and neuroimaging data, and to evaluate the treatment and outcome. Methods: We analysed 62 CVT consecutive patients, which were examined at admission and after three months, using the mrs scores. Results: Mean age was 38.4 years (SD 7.9); 42 were women, 80.95% of them being fertile. The most frequent neurological syndrome was intracranial hypertension. CT showed direct signs of dural sinuses thrombosis in 0 pts, and venous cerebral infarcts in 23 cases. MRI identified thrombosis of SSS in 42 pts, transverse sinus in 23 cases, cavernous sinus in 4 pts. Emissary vein thrombosis was identified in five cases. 3 out of 62 MRI had a normal prior CT. DSA revealed isolated cortical veins occlusion, without sinus occlusion in 4 cases. Risk factors were identified in 45 pts (72.6%); congenital thrombophilia being the most common (2 cases). All pts received anticoagulant therapy. After 90 days from admission, functional outcome was good, with a mrs score 2 in 36 pts, moderate/ severe disability in 9 cases, the death rate being.3% (7 pts). Severity of CVST was found to be associated with presence of rapidly worsening symptoms (p=0.00), and occlusion of 4 or more sinuses (p=0.005). Conclusion: CVT was common in women of fertile age. The outcome was favorable if the pts were promptly diagnosed and adequately treated. F2044 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

119 602 Flash Posters F2045 Hospital-initiated prevention of recurrent ischemic stroke: changes from 995 to 203 M. Karlinski, J. Bembenek, A. Kobayashi, A. Czlonkowska Warsaw, Poland Background and aims: Secondary prophylaxis of stroke should never be delayed. Our aim was to investigate changes in approach to pharmaco-prevention of recurrent ischemic stroke initiated during hospital stay from 995 to 203. Methods: This is a retrospective registry-based analysis of consecutive acute ischemic stroke patients from a highly urbanized area (Warsaw, Poland) admitted to a single stroke centre between 995 and 203. A total of 4234 patients were divided to four time periods: (n=554), (n=329), (n=397) and (n=954). Results: The proportion of patients receiving antiplatelets during hospital stay increased from 82% in years to 88-90% in years , particularly due to change that occurred in the subgroup with atrial fibrillation (increase from 69% to 80-85%, respectively). In patients discharged with diagnosis of atrial fibrillation the use of anticoagulation decreased from 38% in years to 3-32% in years , and then increased to 48% in years Antihypertensive drugs were given to 97-00% of patients diagnosed with hypertension across all evaluated time periods. The use of statins was recorded since 2003 and it increased quickly in patients with total cholesterol level >200 mg/dl (6%, 94% and 9%, respectively) whilst more gradually in those with total cholesterol <200 mg/dl (36%, 77% and 85%). Conclusion: Over the last 20 years the approach to hospital-initiated prevention of recurrent stroke in our centre has significantly improved in terms of atrial fibrillation management and use of statins, which may reflect uptake of contemporary guidelines. However, it still remains suboptimal. F2046 Acute infarction of corpus callosum due to transient obstructive hydrocephalus B. Kaymakamzade, A. Eker Near East University, Neurology, Nicosia, Cyprus Background and aims: Infarcts of corpus callosum (CC) are not common. Acute ischemia of CC is not a well-known feature in patients with hydrocephalus. Herein, we describe a case with acute CC infarction due to another rare entity; transient obstructive hydrocephalus. Case report: A 66-year-old man was admitted with sudden onset right-sided hemiparesia. He was alert with full cooperation and orientation, he had right-sided central facial palsy, hemiparesia, hemihypoestesia and Babinski sign. CT showed left sided basal ganglion hematoma with extension to all ventricles. 20th. hour of the bleeding, he became stuporous. MRI demonstrated acute obstructive hydrocephalus and acute diffuse patchy infarction with elevation of corpus callosum. The neurological status progressed to coma in a couple of hours and he had extensor response to noxious stimulus and had bilateral Babinski sign. Then neurological detoriation stopped suddenly and after a few hours he begun to localize painfully stimulus. The CT showed significant decrease in ventricular size and complete resolution of the clot in the third ventricle. Results: The mechanism of signal abnormalities is probably related with the neural compression of CC against the falx. The other interesting entity of our case is transient obstructive hydrocephalus. Presumably, the clot caused obstruction of third ventricle dissolved or decayed by the help of fibrinolytic activity of CSF, which was raised after IVH. The addition of ipsilateral pyramidal findings in the period of hydrocephalus suggest the presence of diffuse axonal injury. Since bilateral neurological symptoms are disproportionate to imaging findings, the degree of axonal injury is considered to be microscopic. 205 European Journal of Neurology, 22 (Suppl. ),

120 Flash Posters 603 F2047 Chasing delirium in stroke units E. Klimiec, P. Moskal 2, K. Kowalska, P. Potoczek, A. Srednicka 3, K. Ochyra 3, M. Kornas 4, A. Słowik 5, A. Klimkowicz-Mrowiec 5 Department of Neurology, University Hospital in Krakow, Cracow, Poland, 2 University Hospital in Cracow, Cracow, Poland, 3 Jagiellonian University Medical College, Cracow, Poland, 4 The Institute of Applied Psychology, Jagiellonian University, Cracow, Poland, 5 Department of Neurology, Jagiellonian University Medical College, ul. Botaniczna 3, Krakow, Poland, Cracow, Poland Background and aims: Delirium is a common complication of stroke associated with worse outcomes. Diagnosing delirium is challenging in busy stroke settings. DSM-V criteria are proposed as diagnostic standard but should be performed by trained psychiatrist or neurologist. Confusion Assessment Method (CAM) takes only few minutes and can be done by every doctor or nurse. We aimed to find the most effective schedule of assessment for both instruments and to compare their sensitivity in identifying post-stroke delirium. Methods: The study was performed in Stroke Unit, Department of Neurology, University Hospital, Krakow. Patients were screened for delirium with CAM and independently assessed with DSM-V criteria on daily basis during the first week of hospitalization. We analysed effectiveness of assessment strategies separately for DSM-V and CAM. Results: 267 consecutive patients were included: 29 with ischemic, 26 with haemorrhagic stroke and 22 with TIA. Delirium was observed in 2% of patients. Assessment with DSM-5 on day, 3, 7 allowed detecting 94.7% of delirium cases. When CAM was used, over 5% of delirious patients were missed because they could not be assessed due to neurologic deficit. In CAM-applicable patients, the most effective approach was to screen patients daily during the first week of hospitalization. It enabled detection of 83.3% delirious CAM-applicable patients, which corresponds to 70.% of all cases. Conclusion: The effectiveness of post-stroke delirium detection depends on diagnostic strategy. Diagnostic sensitivity is higher with DSM-V and assessment on day, 3 and 7. When CAM is used, everyday screening seems to be the most effective strategy. F2049 Pyogenic brain abscess mimicking ischaemic stroke M. Krommyda, A. Chaudhuri, S. Chawda 2, S. Andole Department of Neurology, Essex Centre for Neurological Sciences, Queen s Hospital, Romford, UK, Neurology, London, United Kingdom, 2 Department of Radiology, Essex Centre for Neurological Sciences, Queen s Hospital, Romford, UK, Radiology, London, United Kingdom Background and aims: We report a case of pyogenic brain abscess mimicking, and initially treated as, an acute ischaemic stroke. Case Report: A 54-year-old male patient presented with rapidly evolving left-sided weakness complicated by secondary generalized tonic-clonic seizures. The CT Head scan on admission revealed a right temporal lobe low attenuation area with loss of the grey-white matter differentiation, reported as an acute right middle cerebral artery (MCA) ischemic infarct. His past medical history was unremarkable apart from recently diagnosed left sinusitis treated with ceftriaxone and metronidazole. Results: Due to the absence of recognised vascular risk factors, he underwent MR scan of brain and MR angiogram of cerebral vessels. His brain scan showed acute cortical ischaemia in right temporal lobe supported by restricted diffusion on DWI; there was possible suspicion of narrowing and elevation of the right MCA with no signal from the temporal branch. The patient continued to be treated for an acute cerebral ischemic infarct. However, due to persistent frontal headache, CT scan of head with contrast was requested, which revealed a ring enhancing lesion in the right temporal lobe with mass effect and moderate midline shift, suggestive of a brain abscess probably from the extension of an incompletely treated paranasal sinusitis. Neurosurgical intervention became necessary and aspiration of pus from the temporal lobe lesion grew Streptococcus constellatus in culture. The patient was treated with intravenous antibiotics and made a gradual recovery. Conclusion: Clinical awareness of focal pyogenic brain abscess presenting as stroke-mimic is important to avoid delays in diagnostic intervention and appropriate treatment. F2048 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

121 604 Flash Posters F2050 Antiplatelet and anticoagulant therapy in elderly people with diabetes mellitus in Poland B. Labuz-Roszak, K. Pierzchala 2, A. Machowska-Majchrzak 3, M. Skrzypek 4, M. Mossakowska 5, J. Chudek 6, A. Wiecek 7 Medical University of Silesia in Katowice, Chair and Clinical Department of Neurology, Zabrze, Poland, 2 Medical University of Silesia in Katowice, Chair and Clinical Department of Neurology in Zabrze, Zabrze, Poland, 3 Medical University of Silesia, Chair and Clinical Department of Neurology, Zabrze, Poland, 4 Medical University of Silesia, 2 Department of Biostatistics, Faculty of Public Health, Katowice, Poland, 53 International Institute of Molecular and Cell Biology, Warsaw, Poland, 6 Medical University of Silesia, Department of Pathophysiology, Katowice, Poland, 7 Medical University of Silesia, Department of Nephrology, Endocrinology and Metabolic Diseases, Katowice, Poland Background and aims: Diabetes mellitus (DM) is an important and common cardiovascular risk factor. The purpose of the study was to evaluate the frequency of use of oral antiplatelet drugs (OAPs) and oral anticoagulant drugs (OACs) among elderly with DM in Poland. Methods: The study was based on data collected during the implementation of a multicentre publicly funded research project called PolSenior. Results: Among PolSenior participants aged 65 and older (n=4979), 085 people (2.8%) had pharmacologically treated DM. Among them, 502 people (46.3%) used at least one drug in pharmacological cardiovascular prevention. OAPs were used by 462 (42.6%), while OACs - by 44 subjects (4.%). Aspirin was used by 4.%. Use of drugs significantly depended on age (p=0.02) and personal income (p<0.0). Sex, place of residence and level of education did not affect the prevalence of pharmacological prevention. Previous stroke and previous myocardial infarct were mostly associated with OAPs, while history of atrial fibrillation (AF) with OACs treatment. Among respondents treated with OAPs, therapy was applied as secondary cardiovascular prevention in 238 (5.52%), as primary - in 224 people (48.48%). Among respondents treated with OACs, 29 persons (67.44%) had a history of AF. Secondary cardiovascular pharmacological prevention should be considered in 6 untreated respondents (2.5%), and primary - (SCORE 0 and/or AF) in 242 respondents (48.2%). Conclusion: Our study was the first to determine the frequency of use of OAPs and OACs among elderly diabetics in Poland. Educational programs should be developed among general practitioners concerning current recommendations for pharmacological cardiovascular prevention. Disclosure: Implemented under publicly-funded project No. PBZ-MEIN-9/2/2006, Ministry of Science and Higher Education. 205 European Journal of Neurology, 22 (Suppl. ),

122 Flash Posters 605 Movement disorders 2 F205 Benefits of safinamide as add-on to a DA-agonist in patients with early PD are clinically meaningful R. Anand, R.D. Hartman 2, V. Lucini 3, E. Forrest 3, R. Giuliani 3, M. Mcbride 4 St Moritz, Switzerland, 2 Neurwritte LLC, Morristown, USA, 3 Newron pharmaceuticals SPA, Bresso, Italy, 4 Instat consulting inc, Chatham, USA Background and aims: Analyses were performed to determine if the significant improvement in motor symptoms of each individual study with safinamide (Xadago, Zambon SpA, Italy) as add-on to a DA-agonist in early-stage PD (ESPD) for the primary efficacy endpoint (mean change from baseline in UPDRSIII) is clinically meaningful. Methods: Pooled studies 009, 05 and MOTION were analysed using a modified Intent-to-Treat Population (mitt) based on randomized targeted doses (placebo; safinamide 50 mg/day; safinamide 00 mg/day). Clinically relevant change for the UPDRSIII is considered as 30%; improvements of 30%, 40% and 50% in UPDRS III, 20% and 30% in UPDRSII+III, and improvement in CGIChange (CGI-C) were analysed. The differences in responder rates between treatments were compared using a logistic regression model (chi-square test). Results: The mitt population included 08 patients (safinamide 50mg/day, 280; safinamide 00mg/day, 369; placebo, 369). Significantly (p<0.05) greater proportions of patients in the safinamide 50 and 00mg/day groups, compared to placebo (Pbo), met each of the responder criteria defined above. The percentages of patients meeting the most stringent criteria were as follows: 50% in UPDRS III [50mg:.4% (p=0.027), 00 mg:4.4% (p=0.003), Pbo:7.6%]; 30% in UPDRS II+III [50mg: 25.4% (p=0.005), 00mg: 29.3% (p=0.003), Pbo:20.%]; and any improvement in CGIC [50mg: 45.5% (p=0.08), 00mg: 48.2% (p=0.06), Pbo:39.6%]. Conclusion: Significantly higher proportion of ESPD patients treated with safinamide as add-on to a DA-agonist improved by a clinically relevant magnitude, compared to treatment with a DA-agonist alone. F2052 A hypomorphic CAMTA2 mutation is associated with a syndromic familial essential tremor S. Bohlega, D. Monies 2, E. Shosha 3, B. Meyer 2 Riyadh, Saudi Arabia, 2 KFSH & RC, Genetics, Riyadh, Saudi Arabia, 3 Al Majmaa University, Academic Affairs, Riyadh, Saudi Arabia Background and aims: To identify the genetic basis of an autosomal recessive syndrome characterized by juvenile onset tremor, dystonia and myoclonus. Methods: A positional cloning approach utilizing genomewide linkage, homozygozity mapping and whole exome sequencing was used. The impact of a CAMTA2 hypomorphic mutation on transcription and translation was studied by cloning of wild type and mutant alleles into a GFP expression cassette transfected into HEK cells. Results: Linkage analysis and homozygozity mapping localized the disease allele to a 2. Mb interval on chromosome 7 with a LOD score of Whole exome sequencing identified a C>T change in the isoform 4 5 UTR (chr7: ) of CAMTA2 (NC_00007.) that was only 6 bases upstream of the translation start site and segregated with disease in an autosomal recessive manner. Cloning of wild type and mutant alleles in a GFP expression system showed no impact upon transcription but a significant reduction in translation. In situ hybridisation showed CAMTA2 to be strongly expressed in Purkinje cells. Screening of a cohort of Parkinson s disease patients failed to identify additional pathogenic alleles of CAMTA2 that may have further linked it to ET. Conclusion: Mutation of CAMTA2 likely underlies Familial Essential Tremor (FET). The genetic basis of Essential Tremor has this far been elusive. We report the strongest genetic linkage (LOD 4.8) to date for Essential Tremor (ET), albeit in a syndromic presentation, and the first instance of a clear autosomal recessive pattern of inheritance related to this phenotype. The role of CAMTA2 deserves further study in syndromic and pure forms of ET. 205 European Journal of Neurology, 22 (Suppl. ),

123 606 Flash Posters F2053 Can tablet computer be a solution for patients with writer s cramp? The first evidential explanation on a cortical level M. Braschinsky, T. Tomberg 2, P. Taba Taru University Clinics, Neurology Clinic, Tartu, Estonia, 2 Taru University Clinics, Radiology Clinic, Tartu, Estonia Background and aims: Writer s cramp (WC) is a form of task-specific focal dystonia. Its mechanisms are not fully understood. Here we report a case of clinically, neurophysiologically and radiologically proved WC, in which a 63-year-old man, despite of severe difficulties writing on paper, was able to do it on tablet computer using a digital pen. The aim of this study was to prove the hypothesis of differences in cortical activation during a specific task writing between conventional and digital. Methods: Functional magnetic resonance imaging (fmri) was performed, to compare two series of tasks. During the first series the patient was instructed to imagine himself writing conventionally on paper, using a common pen. During the second series the instructions were to imagine himself writing on a tablet computer, using a digital pen. Results: Standard MRI using FLAIR and T-3D sequences was normal. During performing the series different cortical activation patterns appeared. When imagining writing on paper using a conventional pen there was a broader bilateral premotor activation along with right-sided activation laterally to the primary motor cortex in precentral gyrus. Upon imagining a digital writing there was a more localized premotor activation on the left without any activation in the primary motor cortex (BA4). Conclusion: There are distinct cortical activation patterns during performing seemingly similar tasks - writing on paper versus on tablet computer. This phenomenon supports the cortical involvement in pathogenesis of writer s cramp and suggests that tablet computers may be used as an alternative therapeutic tool in WC. F2054 The impact of Paeoniflorin on α-nuclein degradation pathway Z.-L. Cai, X. Li Affiliated Lianyungang Hospital of Xuzhou Medical College, Lianyungang, China Background and aims: Paeoniflorin (PF) is major pharmaceutical active ingredients of traditional Chinese medicine Radix, which plays a neuroprotective role by regulating autophagy and ubiquitin-proteasome degradation pathway. Methods: PC2 cell treated with or without MPP+ (0.5mM) for 24h, then Paeoniflorin50 um, Rapamycin (0.2µg/ml) were administered to cells respectively for 24h. We detected proliferative activity of cells with MTT method, and Western Blot was used to detect the expression levels of α-synuclein, microtubule-associated protein light chain 3(LC3-II) and E. Confocal microscopy was used to observe the expression of α-synuclein and LC3. Results: () Paeoniflorin can significantly reduce the damage of MPP+, and the cells returned to normal (Figure). (2)The cell viability was significantly increased after 24h exposure to RAPA and PF in the MPP group (all P>0.0). (3) After the PF and RAPA treatment, CAT and SOD activities of the cells were distinctly decreased (compare with MPP+, P<0.00). (4) MPP+ activated both LC3-Ⅱ and E. RAPA increase LC3-Ⅱ, while inhibiting the E. PF upregulated both LC3-Ⅱ (autophagy) and E expression (ubiquitin-proteasome pathway) significantly (P<0.00), promoting the degradation of α-synuclein, reducing cell damage (Figure2). (5) MPP+ leads to an enhanced immunofluorescence signal of intracellular α-synuclein and LC3, and after PF treatment, the fluorescence intensity of α-synuclein decreased (Figure3). Figure Figure2 205 European Journal of Neurology, 22 (Suppl. ),

124 Flash Posters 607 Figure3 Conclusion: In this study, we demonstrated that PF upregulated both autophagy and ubiquitin proteasome pathways significantly, promoting the degradation of α-synuclein and reducing cell damage. Paeoniflorin may be a potential therapeutic medicine for neurodegenerative diseases. Disclosure: This project was supported by the China Postdoctoral Science Foundation (NO: 630), the natural science foundation of Jiangsu Province (NO: BK20402), the Ji-angsu Province Postdoctoral Research Funding (NO: 3074C), Jiangsu Province Health Department Funding (NO: H2036). F2055 Methodology of data quality review in istradefylline phase 3 Parkinson s disease trial M. Cantillon, B. Novak, J. Montero 2, G. Wilson 3, R. Smith 4 Kyowa, Princeton, USA, 2 Inventiv, Miami, USA, 3 Prostrakan, Galashiels, United Kingdom, 4 Inventiv, Carne D Aude, France Background and aims: PD patient diaries have been used as a clinical outcome measure, contributing to regulatory approval of PD medications. However, estimation of ON and OFF times relies heavily on accurate completion of patient diaries. Rater training and central data review was investigated of ON and OFF Patient Diary data in the istep Phase III istradefylline trial. Methods: A total of 240 raters from 8 countries participated in the ON and OFF Patient Diary rater training program. This included in-person training at Investigator s Meetings (IM) and online training for absentee and new raters. Only trained raters were permitted to conduct diary training and concordance testing with subjects. Findings were categorized and documented by type (e.g. Invalid Diaries, Batched Data Entry, Concordance Error, etc.). Raters received additional training and were asked to retrain subjects on appropriate diary completion conventions. Results: Of the visits centrally reviewed diaries to date, 64% contained findings, some significant. Findings included batched data entry (57%) defined by more than 5 hours of data entered at one time (excluding Asleep time), followed by prospective data entry (27%). Additionally, invalid diaries were identified, defined as diaries containing more than 4 invalid entries, concordance errors, and missing data findings; these accounted for 6% of all findings. Further analysis ongoing now will be complete by time of presentation. Conclusion: These results support the use of a stringent training and centralized data review program to monitors diary completion. Such continuous training of users and feedback is effective in ensuring quality data. Disclosure: Kyowa Hakko Kirin Pharma supports the trial and the analyses 205 European Journal of Neurology, 22 (Suppl. ),

125 608 Flash Posters F2056 Management of advanced Parkinson s disease R. Checiches Cluj Napoca, Romania Background and aims: Parkinson s disease is the second most common neurodegenerative disorder with a great variety of motor and non motor symptoms, which have an important impact in the deterioration of the quality of life. Methods: For this retrospective observational study 5 patients with Parkinson s disease in stage 3, 4 and 5 on the Hoehn and Yahr scale were included. An evaluation form was completed with comparative and descriptive studies being made afterwards. Results: There were 3 women and 20 men, with the median age of The median age of onset was 57.72, the median duration of the disease until an advanced stage was reached was 0.0 years. There were 20 patients with 3 Hoehn and Yahr stage disease and 3 with 4 stage disease. Median MMSE score was 26.25, 6 patients also had dementia. Polyneuropathy was present in 28 patiens, depression in 8, psychotic episodes in 6. Monotherapy was present in 22 patients while combination therapy in 29. Ten patients were on levodopa with direct duodenal delivery (Duodopa). The levodopa equivalent dose was higher in patients on monotherapy. The UPDRS II, III and IV scores were statistically significant better on patients using direct duodenal delivery therapy. Conclusion: The management of advanced Parkinson s disease poses a real challenge for the clinician, due to the multitude of motor and non motor complications. One alternative that led to a better control of the symptomatology in this study was the use of levodopa with direct duodenal delivery (Duodopa). F2057 Wide intrafamilial phenotypic variability in a Huntington s disease family. Y. Christou, E. Zamba-Papanicolaou, A. Georgiou 2, L. Koutsou 2, M. Pantzaris, K. Christodoulou 2 The Cyprus Institute of Neurology and Genetics, Neurology Clinic, Nicosia, Cyprus, 2 The Cyprus Institute of Neurology and Genetics, Neurogenetics, Nicosia, Cyprus Background and aims: Huntington s disease (HD) is an autosomal dominant neurodegenerative disease characterized by involuntary movement (mainly chorea), cognitive decline and psychiatric disturbances. It is the result of a CAG repeats expansion (>36 repeats) in the gene encoding the protein huntingtin on chromosome 4. In few cases atypical motor symptoms other that chorea have been reported including parkinsonism, spinocerebellar ataxia, spastic paraparesis and motor neuron disease. We would like to report a HD family with unusually different phenotypic presentation. Methods: To describe the intrafamilial variability of clinical manifestation in a Huntington s disease family. Results: Four of nine siblings developed movement disturbances. The index patient presented mild involuntary movements of the limbs at the age of 68 years old, with no cognitive decline. She was tested positive for HD mutation (8/4 CAG repeat expansion). Her older sister presented progressive spastic paraplegia at the age of 56 years. Following the index patient diagnosis she was also tested positive for HD mutation (23/45 repeats). One of their brothers reportedly presented movement disturbances with gait difficulty and even though he was not tested, his children were found to be HD mutation carriers. A youngest brother, with intermediate CAG expansion (8/32), developed asymmetrical Parkinsonisms at the age of 52 years old. Conclusion: The presence of intrafamilial phenotypic variation in HD has significant impact on genetic counseling. Furthermore intermediate CAG repeats (27-35) could be associated with subtle but relevant motor manifestations. 205 European Journal of Neurology, 22 (Suppl. ),

126 Flash Posters 609 F2058 Neuropsychological profiles of Parkinson-plus patients in a Greek cohort V. Constantinides, G. Paraskevas, E. Kapaki National and Kapodistrian University of Athens. Athens, Greece, st Department of Neurology, Medical School, Athens, Greece Background and aims: Parkinson-plus syndromes are extrapyramidal disorders that commonly affect cognition. The aim of this study was to report on the neuropsychological profile of patients with progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal degeneration (CBD). Methods: All patients fulfilled the most recent criteria for possible or probable PSP, MSA or CBD. Clinical data (age, sex, disease duration, education) were recorded. A battery of neuropsychological tests was administered, consisting of the Mini Mental State Examination (MMSE), Frontal Assessment Battery (FAB), the 5-point Clox and Clox2 drawing tests, the Category Fluency test (animals) and the 5-word Immediate and Delayed Recall Test (without and with a clue). Results: A total of 48 patients were included in the study (9 CBD, MSA and 8 PSP). Mean age was 66.3±8.2, mean disease duration 3.0±.4 and mean education was 0.9±4.8 years, with no differences between the three groups. MSA patients performed better than PSP and CBD patients in the MMSE Figure (p=0.08) and the Category Fluency test (p=0.007). MSA patients performed better than CBD patients in the MMSE (p=0.025) and Clox2 (p=0.03). CBD patients had lower FAB scores than MSA and PSP patients (p=0.008). Conclusion: Neuropsychological test performance is helpful in differentiating Parkinson-plus syndromes. F2059 The Goldenberg Apraxia Test is a useful tool to differentiate corticobasal degeneration from progressive supranuclear palsy and multiple system atrophy V. Constantinides, G. Paraskevas, E. Kapaki National and Kapodistrian University of Athens. Athens, Greece, st Department of Neurology, Medical School, Athens, Greece Background and aims: Parkinson-plus syndromes are a heterogenous group of extrapyramidal disorders, consisting of corticobasal degeneration (CBD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). One of the clinical hallmarks of CBD is apraxia. We administered the Goldenberg Apraxia Test in parkinson-plus patients to assess its usefuleness in differentiating Parkinson-plus syndromes. Methods: All patients fulfilled current criteria for probable PSP, MSA and CBD. Clinical data (age, disease duration, education, sex) were recorded and the Goldenberg Apraxia Test was administered to all patients. Results: A total of 38 patients were included in the study ( CBD, 9 MSA, 8 PSP). Mean age was 64.4±8.7, mean disease duration was 2.7±.8 and mean education was 0.6±4.7 years. The three groups did not differ in their age, disease duration or education. CBD patients scored significantly lower than MSA or PSP patients in the Total Goldenberg Apraxia Test Score (82.8±27.5 vs. 3.6±4.2 vs. 25.3±4.2 respectively) (p=0.00). All subscores of the test were also significantly lower in the CBD patients (Hand Imitation, Finger Imitation and Pantomime) (p=0.00 for all subscores). Conclusion: The Goldenberg Apraxia Test is a useful test to quantify apraxia and helps to differentiate CBD from PSP and MSA patients. 205 European Journal of Neurology, 22 (Suppl. ),

127 60 Flash Posters F2060 Neuropsychiatric symptoms in a Greek cohort of Parkinson-plus patients V. Constantinides, G. Paraskevas, E. Kapaki National and Kapodistrian University of Athens. Athens, Greece, st Department of Neurology, Medical School, Athens, Greece Background and aims: Parkinson-plus syndromes, although considered primarily movement disorders, are complex diseases that affect both cognition and behaviour. The aim of the study was to determine the neuropsychiatric profiles of supranuclear palsy (PSP), corticobasal degeneration (CBD) and multiple system atrophy (MSA). Methods: All patients met the latest criteria for possible or probable PSP, CBD or MSA. We recorded clinical data (age, disease duration, education), and also delivered the 2-point neuropsychiatric inventory (NPI) to all patients. Results: A total of 47 patients were included (8 CBD, 9 PSP, 0 MSA). Mean age was 65.2±8. years, mean education was 0.2±4.7 years, mean disease duration was 32.9±7.2 months and mean NPI score was 4.4±5.. The 3 groups did not differ in their age, disease duration, or years of education. However, they differed significantly in the mean NPI score (CBD: 7.2±8.6, PSP: 6.6±3.2, MSA: 5.3±6.3, p=0.04). MSA patients had significantly less apathy and appetite changes compared to PSP and CBD patients. Conclusion: MSA patients exhibit significantly less neuropsychiatric symptoms, compared to PSP and CBD patients, particularly apathy and appetite changes. F206 Expanding the spectrum of Parkinson s Disease Psychosis: a case series of patients with forms of Cotard s syndrome. G. Dervenoulas, R. Gournellis 2, C. Christodoulou 2, A. Karavia 2, F. Georgousopoulou 2, C. Zompola, D. Margaritis 2, C. Papazahos 2, C. Arvaniti, S. Papageorgiou, L. Stefanis University of Athens, Attikon University Hospital, Second Department of Neurology, Athens, Greece, 2 University of Athens, Attikon University Hospital, Second Department of Psychiatry, Athens, Greece Background and aims: Psychosis in Parkinson s Disease (PD-P) is rather common and is classically characterized by visual hallucinations, delusional ideas and paranoid ideation. The existence of Cotard s Syndrome (CS), whose cardinal feature is nihilistic delusion concerning ones own body, has only scarcely been reported in patients with PD-P. Methods: A case series describing clinical features and disease course of three patients with Parkinson s Disease (PD) and CS-like symptomatology. All patients were followed at the Movement Disorders Clinic and the Departments of Psychiatry and Neurology. Results: The mean age of our patients was 73.3 years, whereas the mean duration of PD before the onset of CS-like symptomatology was 7.0 years. None of the three patients had signs of visual or auditory hallucinations. Their psychiatric features were not associated with alterations in dopaminergic treatment or a systemic medical condition. Two out of three patients had a characteristic nihilist delusion concerning the negation of internal organs in the context of a depressive episode. One patient had an incomplete form of CS, with persistent severe hypochondriasis and cenestopathy. All 3 patients eventually responded well to clozapine. Conclusion: Delusions are less common than hallucinations in patients with PD-P. Delusions of jealously and misidentification syndromes are more often reported. Our observation contributes to the further expansion of PD-P spectrum. Early diagnosis and treatment of depression, which usually coexists or precedes CS, can result in amelioration of psychiatric symptoms. Furthermore, clozapine seems to be a beneficial therapeutic option for PD patients with CS-like symptomatology. 205 European Journal of Neurology, 22 (Suppl. ),

128 Flash Posters 6 F2062 Cognitive impairment, parkinsonism and cerebellar ataxia resulting from extensive cerebral calcinosis in a patient with Systemic Lupus Erithematosus J. Dias Ferreira, T. Teodoro, M.V.S. Coelho, M.M.C.D.S. Rosa, J. Ferreira, R. Geraldes 2, L. Guedes Hospital de Santa Maria, Lisboa, Neurology Department, Lisbon, Portugal, 2 Oxford University Hospital, Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom Background and aims: Systemic lupus erythematosus (SLE) and anti-phospholipid antibody syndrome can present with several movement disorders, namely parkinsonism, chorea or ataxia. Imagiologic exams can disclose associated vascular disease, often no abnormalities are observed. Reported cases showing calcium deposition are scarce and those cases etiology is not fully understood. Methods or Materials or Case Report: 70 year-old woman, history of arterial hypertension and depression, presented with 5 day symptomatology of emotional lability, difficulty in verbal articulation and gait instability, recent worsening. Neurological examination: hypomimia, decomposition of saccadic ocular movements, scandid dysarthria, intentional and postural tremor and gait ataxia. Brain CT displayed multiple symmetrical calcium deposits in cerebellar dentate nucleus, pulvinar, lenticular and caudade nucleus, corona radiata, parietal and occipital cortex. Blood analysis disclosed anemia (Hb.4g/dL), renal failure (CrCl 55mL/min/.73m 2 ), hyperparathyroidism (PTH 47pg/mL), cholecalciferol deficiency (27.3ng/mL), normal calcium and phosphorus, positive anti-phospholipid and antinuclear antibodies with dsdna 53UI/mL and hypocomplementemia. Normal parathyroid gammagraphy. Diagnosis of lupus nephritis associated renal failure and secondary hyperparathyroidism were made; hydroxychloroquine and cholecalciferol were started. It was later documented a behavioral and cerebellar worsening, insidious cognitive impairment, upper limb rigidity and gait and limb bradykinesia appearance. Levodopa was initiated with slight clinical improvement. Brain CT (image 2) Brain CT (image 3) Conclusion: Association between SLE and cerebral calcifications is rare and, generally, extrapyramidal symptoms do not predominate. Reported cases associating SLE and movement disorders usually show nonspecific changes in imagiologic exams. We report a rare case of cognitive behavioral abnormalities, ataxia and extrapyramidal symptoms as presentation of SLE associated with cerebral calcium deposits and an enlightened etiology - secondary hyperparathyroidism. Brain CT (image ) 205 European Journal of Neurology, 22 (Suppl. ),

129 62 Flash Posters F2063 Pyramidal involvement in a series of Huntington s Disease patients. E. Gatto, A. Sanguinetti, J.L. Etcheverry 2, V. Parisi 3, M. Cesarini, G. Persi 4, L. Bevacqua 5, P. Lopez 6, A. Bertotti 6 INEBA, Buenos aires, Argentina, 2 BUENOS AIRES, Argentina, 3 Buenos Aires, Argentina, 4 Sanatorio de la Trinidad Mitre, Neurology, Buenos Aires, Argentina, 5 INEBA, Imagenes, Buenos aires, Argentina, 6 Hospital Aleman, Neurofisiología, Buenos aires, Argentina Background: Pyramidal involvement has sporadically, mentioned in Huntington s disease (HD). Recently, the loss of cortical pyramidal neurons in HD has been related with cognitive and motor impairments. Aims: To describe pyramidal impairment in a series of HD patients Methods: This study was approved by Institutional Review Board. Pyramidal signs, DTI tractography and motor evoked potentials (MEPs) elicet by TMS were explored in HD patients from our Institution. Parametric and non-parametric tests were used as appropriate. Results: 32 consecutives, unrelated HD patients were evaluated, mean age years, mean age at onset years, mean disease duration 8.42 years and mean CAG repeats 45. Pyramidal signs were identified in 23 patients (7.85%). The mean age in HD with pyramidal signs (HDP) was years vs years in HD patients without pyramidal signs (HDp) (p: 0.08); mean disease duration 9.25 years in HDP vs years HDp (p: 0.30); mean age at onset 32.0 years HDP vs years HDp (p: 0.03) and mean CAG repeats in HDP vs HDp (p: 0.03). In HDP, DTI was normal and MEPs showed at least one of the following abnormalities: decreased MEP amplitudes, increased latencies and/or central motor conduction times, reduced cortical silent periods. Conclusion: Our findings contribute to support a pyramidal involvement in HD. The occurrence of pyramidal signs suggests younger age, younger age at onset, longer disease duration, longer CAG repeats and electrophysiological impairment. A more extensive study is required to determine if pyramidal involvement could be a useful HD biomarker. F2064 Abstract cancelled F2065 Evaluation of the safety and tolerability of opicapone in the treatment of Parkinson s disease and motor fluctuations: analysis of pooled phase III studies H. Gama, J. Ferreira 2, A. Lees 3, N. Lopes, A. Santos, R. Costa, C. Oliveira, R. Pinto, T. Nunes, J.F. Rocha, P. Soares-da-Silva BIAL Portela & Cª S.A., Dept. R&D, S. Mamede do Coronado, Portugal, 2 Instituto de Medicina Molecular, Neurological Clinical Research Unit, Lisbon, Portugal, 3 National Hospital for Neurology and Neurosurgery, London, United Kingdom Background and aims: The aim of this analysis was to evaluate the safety and tolerability of opicapone (OPC) in patients with Parkinson s disease (PD) and motor fluctuations across phase III studies. Methods : Patient-level data of matching treatment arms of two multicentre, 4 to 5-week, double-blind, randomised, placebo- and active-controlled studies (BIPARK I and II) was integrated (placebo, 25mg-OPC and 50mg-OPC). The studies had similar designs and measurement instruments. Safety was assessed by incidence of treatment-emergent adverse events (TEAEs), changes in laboratory values, ECGs and vital signs. Results: 766 patients were included in the pooled safety set (N=257, 244 and 265 for placebo, 25mg- and 50mg- OPC, respectively). The most commonly reported TEAEs were dyskinesia (8.3% OPC vs. 6.2% placebo), constipation (5.7% vs..9%), insomnia (5.% vs..6%) and dry mouth (4.7% vs..2%). No dose relationship was observed for the majority of TEAEs. Serious AEs were reported for few patients: 4.3% placebo and 3.5% OPC. One death (pneumonia) occurred in placebo. There were no reports of severe diarrhea, myocardial infarction, prostate cancer, melanoma or any serious hepatic event in OPC groups. Impulse control disorders were reported by <% of OPC-treated patients. No relevant differences compared to placebo were observed for laboratory parameters, vital signs or ECG readings. Conclusion: Treatment with OPC was safe and well tolerated with no apparent association to known safety concerns of other anti-pd drugs, particularly other COMT inhibitors. 205 European Journal of Neurology, 22 (Suppl. ),

130 Flash Posters 63 MS and related disorders F2066 Neuromyelitis optica and neuromyelitis optica spectrum disorders: the evaluation of 86 patients followed by Istanbul Bilim University, Department of Neurology B. Altunrende, A. Altinkaya, B. Topcular, M. Kocaslan, S. Server 2, S. Firtina 3, S. Yenice 3, G. Akman Demir Istanbul Bilim University, Faculty of Medicine, Neurology, Istanbul, Turkey, 2 Istanbul Bilim University, Faculty of Medicine, Radiology, Istanbul, Turkey, 3 Istanbul Bilim University, Faculty of Medicine, Biochemistry, Istanbul, Turkey Background and aims: Background and objectives: Neuromyelitis optica (NMO) and its spectrum disorders (NMOSD) are relatively rare disorders. We aimed to evaluate clinical characteristics and disease course of the NMOSD patients followed at our department. Patients and methods: All the patients with the diagnosis of NMO/NMOSD followed since the establishment of our multiple sclerosis clinic in April 20, were evaluated. Results: There were 86 patients (66 female, 20 male) with NMO/NMOSD followed at our MS unit; 24 had NMO, 42 had recurrent optic neuritis (RON); and 20 had longitudinally extensive transverse myelitis (LETM). The disease course was relapsing in 70 patients (8%). The first attack was bilateral ON (BON) and TM in 3 patients, ON and TM in patient, ON in 50 patients (bilateral in 6) and TM in 26 patients. NMO IgG was positive in 2 patients with NMO (55%), 4 patients with LETM (25%), and 8 patients with RON (25%). Oligoclonal band was positive in 5 out of 44 patients (34%). In NMO/NMOSD patients, cranial magnetic resonance imaging (MRI) showed no abnormality in 48; nonspecific lesions in 37; and patient had hypothalamic lesion. In spinal MRIs, 4 patients had LETM; six had suspected hyperintense T2 lesion in C5. Conclusion: This is one of the largest single center series collected over 4 years. NMO/NMOSD seems to be overrepresented in our center since it is one of the few where NMO IgG testing is available. In NMO/NMOSD, early diagnosis and treatment is important to prevent the patient from the permanent disability. F2067 Quantitative magnetization transfer imaging of newly occurring MS lesions: a longitudinal MRI study M. Andelova, M. Garcia Alzamora 2, L. Gaetano, M. Gloor 3, M. Amann, C. Stippich 2, E.-W. Radue 4, L. Kappos, O. Bieri 3, T. Sprenger University Hospital Basel, Neurology, Basel, Switzerland, 2 University Hospital Basel, Neuroradiology, Basel, Switzerland, 3 University Hopsital Basel, Physics, Basel, Switzerland, 4 Basel, Switzerland Background and aims: Magnetization transfer (MT) MRI is based on the interaction of free and macromolecular protons and reflects tissue integrity. Beyond simple MT ratio (MTR) imaging, quantitative MT (qmt) allows a more comprehensive assessment of lesion characteristics by quantifying the ratio (F) of restricted to free proton pool size, exchange rate (kf) between proton pools, and T-/T2- relaxation times. We studied the suitability of a rapid qmt technique for assessing MS lesion formation and recovery. Methods: 8 relapsing-remitting MS patients were followed over 2 months with bimonthly MRI scans at.5t. MT imaging was performed using balanced steady-state free precession. New lesions were segmented on PD/T2w sequences and superimposed on MT images to track lesional parameters longitudinally. Lesional qmt values were normalized to the corresponding mean intensities of normal appearing white matter. Results: 8 of 8 participants (m:f=2:6, mean age=39.8y(27-55), disease duration=9.8y(-22), median EDSS=2.25(-4.5)) developed 30 new lesions. We observed consistent lesional MT changes at the time, but not before lesion occurrence on conventional MRI with reductions of F and kf being much more pronounced than MTR reductions (average changes -39%, -37%, +25%, +48%, -6% for F, kf, T, T2, MTR). There was a gradual recovery of all parameters (0%, 4%, -9%, -24%, 4%, for F, kf, T, T2, MTR after 2 months). Conclusion: While qmt appears to have no clear added value over conventional MTR for determining the first appearance of new lesions, it seems to be more sensitive to tissue alterations, as indicated by stronger changes of absolute values. Disclosure: TS: Novartis, ATI, Actelion, Electrocore, Genzyme, Biogen Idec, SNF, Swiss MS Society, Novartis Pharma. OB/MG: Swiss MS Society. LK: Actelion, Advancell, Allozyne, BaroFold, Bayer HealthCare Pharmaceuticals, Bayer Schering Pharma, Bayhill Therapeutics, Biogen Idec, BioMarin Pharmaceutical, CSL Behring, Élan, Genmab, GenMark Diagnostics, GeNeuro SA, GlaxoSmith- Kline, Lilly, Merck Serono, MediciNova, Novartis, Novo Nordisk, Peptimmune, Sanofi-Aventis, Santhera Pharmaceuticals, Roche, Teva, UCB, Wyeth. Other authors: nothing to disclose. 205 European Journal of Neurology, 22 (Suppl. ),

131 64 Flash Posters F2068 Abstract cancelled F2069 Effects of peginterferon Beta-a on brain magnetisation transfer ratio and atrophy in patients with relapsing-remitting multiple sclerosis: 2-year ADVANCE results D. Arnold, B. Kieseier 2, X. You 3, S. Liu 3, B. Sperling 3, S. Hung 3 Montreal Neurological Institute, McGill University, Montreal, Canada, 2 Heinrich-Heine University, Department of Neurology, Düsseldorf, Germany, 3 Biogen Idec Inc., Cambridge, USA Background and aims: Magnetisation transfer ratio (MTR) imaging provides an indirect measurement of myelin density. MTR and brain atrophy are complementary markers of neuroprotection. We report the effects of subcutaneous peginterferon beta-a (PEG-IFN) every 2 weeks on MTR and atrophy in patients with RRMS in the AD- VANCE study. Methods: ADVANCE was a 2-year, phase III, double-blind PEG-IFN dosed every 2 or 4 weeks study with a -year placebo-control, followed by re-randomisation of placebo patients to PEG-IFN every 2 or 4 weeks. Patients were evaluated for changes in the MTR of normal-appearing brain tissue (NABT) and overall brain volume. Results: From baseline to week 48, the mean MTR of NABT declined significantly less with PEG-IFN every 2 weeks vs placebo (-0.29% vs %, p=0.04). From baseline to week 48, there was no significant difference in mean whole brain volume reduction for PEG-IFN every 2 weeks vs placebo (-0.72% vs -0.62%, p=0.08). From baseline to week 96, there was a numerically reduced percentage of both MTR of NABT and whole brain volume decrease with continuous PEG-IFN every 2 weeks vs delayed treatment every 4 weeks, chosen as a control in lack of a true placebo arm over 2 years. Conclusion: PEG-IFN every 2 weeks preserved myelin density in NABT compared with placebo (Year ). Brain atrophy did not differ, likely due to the development of pseudoatrophy after the initiation of interferon treatment. Disclosure: This study has been sponsored by Biogen Idec Inc. (Cambridge, MA, USA). F2070 Alemtuzumab improves quality of life in relapsing-remitting multiple sclerosis patients with inadequate efficacy response to prior therapy: 4-year follow-up of CARE-MS II R. Arroyo González, T. Moreau 2, J.A. Cohen 3, G. Giovannoni 4, D.H. Margolin 5, L. Kasten 6, E. Havrdova 7 Hospital Clinico San Carlos, Madrid, Spain, 2 Burgundy University, Dijon University Hospital, Dijon, France, 3 Cleveland Clinic, Cleveland, Cleveland, USA, 4 Queen Mary University of London, Barts and The London School of Medicine, London, United Kingdom, 5 Genzyme, a Sanofi company, Cambridge, USA, 6 PROMETRIKA LLC, Cambridge, USA, 7 First Medical Faculty, Charles University in Prague, Prague, Czech Republic Background and aims: In the 2-year CARE-MS II study (NCT ), alemtuzumab demonstrated superior quality of life (QoL) improvements versus subcutaneous interferon beta-a in relapsing-remitting multiple sclerosis (MS) patients who had inadequate efficacy response to prior therapy. QoL improvements with alemtuzumab were maintained at Year 3 and were associated with sustained reductions in preexisting disability (SRD). Methods: Patients with relapse after 6 months of prior MS therapy received 2 annual treatment courses of alemtuzumab 2 mg (baseline and Month 2). In an extension study (NCT ), patients could receive as-needed alemtuzumab retreatments year apart. QoL endpoints included Functional Assessment of Multiple Sclerosis (FAMS), EuroQol 5-dimensions (EQ-5D) visual analogue scale (VAS), Short-Form 36-Item survey (SF-36; mental component summary [MCS] and physical component summary [PCS]), and QoL change by SRD ( -point EDSS decrease from baseline over 6 months [with baseline score 2.0]). Results: The extension study enrolled 393 (93%) CARE- MS II alemtuzumab-treated patients. Over 4 years, 68% received only the initial 2 courses. Mean FAMS and EQ-5D VAS scores improved from baseline to Year 4 (P<0.000 and P=0.0034, respectively). Over 4 years, 32.6% and 33.% of patients had improved MCS and PCS scores, respectively. Patients achieving 6-month SRD benefited from significantly greater improvements from baseline to Year 4 in FAMS, PCS, and EQ-5D VAS scores than patients who did not (P<0.05). Conclusion: Sustained improvements in physical, mental, and emotional aspects of QoL were observed through 4 years in alemtuzumab-treated patients and were likely related to improvements in preexisting disability, despite most patients receiving only 2 alemtuzumab courses. Disclosure: Study supported by Genzyme, a Sanofi company, and Bayer Healthcare Pharmaceuticals. 205 European Journal of Neurology, 22 (Suppl. ),

132 Flash Posters 65 F207 Relapse rate in pregnant multiple sclerosis women from our experience C. Baetu, I. Buraga, M. Buraga 2 Colentintina clinical hospital, Neurology, Bucharest, Romania, 2 University of Medicine and Pharmacy Carol Davila Bucharest, Physiology, Bucharest, Romania Background and aims: MS has a higher incidence in women with childbearing potential than in any other group. Generally, the rate of relapse is thought to decrease during pregnancy and increase in the postpartum period. These relapses do not appear to contribute to an increased disability. Methods: We observed 20 women with multiple sclerosis from Colentina clinical hospital, department of neurology over a period of 3 years; all women were under immunomodulatory treatment before pregnancy.the patients were examined in month 3, 6 and 9 of gestation as well as 3 and 6 months in postpartum period. The relapse rate was compared with the one before pregnancy. Kurtzke Expanded Disability Status Scale was used to determine the disability progression. Results: The relapse rate was higher during the first 3 months but not as much as in the first 3 months in postpartum period and the EDSS score increased in the first 9 months after gestation. There was a decrease of about 80 percent in the rate of relapse during the third trimester of pregnancy, followed by an increase of 65 percent in the first three months post partum. The increase of the relapse rate in patients with multiple sclerosis after delivery has importance for management of the disease. Conclusion: Pregnancy did not lead to increased disability. we observed thet post partum increase in relapse rate is the main event related to pregnancy in MS. F2072 Switching from Natalizumab to Fingolimod: a crumbling bridge. D. Baroncini, P. Annovazzi, S. Baldini, M. Zaffaroni, G. Minonzio 2, A. Bianchi, G. Comi 3, A. Ghezzi Multiple Sclerosis Study Center, Neurology Department, Gallarate, Italy, 2 Sant Antonio Abate Hospital, Neuroradiology Department, Gallarate, Italy, 3 Institute of Experimental Neurology-University Hospital IRCSS San Raffaele, Neurology Department, Milan, Italy Background and aims: Natalizumab (NAT) is a strong treatment for relapsing remitting multiple sclerosis (RRMS), but it s use is limited by the risk of progressive multifocal leukoencephalopathy (PML). In patients at high risk of PML the dilemma is whether to continue NAT with closer monitoring or to move to other treatments. Fingolimod (FTY) is a good candidate. The aim of this study is to contribute to define the best strategy for switching from NAT to FTY. Methods: Consecutive RRMS patients who switched from NAT to FTY were included if fulfilling the following criteria: NAT treatment 2 months (m), washout period (WP) 2 m, FTY treatment 6 m, absence of neutralizing antibodies against NAT. Clinical and radiological evaluations were performed periodically. Patients were defined active by the presence of: relapse and/or new T2 and/ or gd+ lesion at brain MRI and/or point worsening in the last EDSS score. Results: Thirty-nine RRMS patients were included. The first relapse after NAT withdrawal occurred after a median of 7.6 weeks (w). The cohort was splitted in terciles (WT) according to WP duration: w for first group (WT, 2 pts), w for the second (WT2, 4 pts) and w for the third (WT3, 3 pts). ARR, EDSS score and number of active patients were significantly higher in WT3 respect to WT both during WP and FTY treatment period (p<0.05). Conclusion: Early initiation of FTY after NAT withdrawal reduce the risk of MS reactivation and consequently of EDSS progression. 205 European Journal of Neurology, 22 (Suppl. ),

133 66 Flash Posters F2073 Fingolimod and antidepressants in MS no evidence of a relevant interaction (REGAIN study) S. Vormfelde, K. Schuh, M. Baier 2, A. Bayas 3 Novartis Pharma GmbH, TA Neuroscience, Nuremberg, Germany, 2 Novartis Pharma GmbH, Medical Information Processing & Statistics, Nuremberg, Germany, 3 Klinikum Augsburg, Neurology, Augsburg, Germany Background and aims: Nearly half of all Multiple Sclerosis (MS) patients also suffer from depression, often treated with antidepressants. We evaluated the safety and tolerability of the combination of oral fingolimod with antidepressants. Methods: REGAIN is a 2-week, 25-center, open label study in MS patients with concurrent mild to moderate depression. Patients were treated with fingolimod for at least two weeks before they started treatment with citalopram, fluoxetine or venlafaxine for 6 weeks, selected at the discretion of their treating physician. Results: The study was terminated early due to unsatisfactory recruitment. 54 (44 female, mean age 42 years) of 250 planned patients were enrolled. No new safety signal became evident. Serious adverse events were reported in 3/54 patients resulting in one study drug discontinuation. 43 patients experienced adverse events. Quality of life (QoL) improved by 2.2 (SD=3.7) points on the Patient Reported Impact of Multiple Sclerosis (PRIMUS) QoL questionnaire from a baseline mean of 9.7 (SD=4.7) points. Fatigue, measured by the Modified Fatigue Impact Scale (MFIS) improved by 8.2 (SD=7.3) points from 44.9 (SD=7) points at baseline. Disability as measured by the Extended Disability Status Score (EDSS) remained stable with a change of -0., SD=0.7 (baseline 3.5, SD=.4 points) over this relatively short period. Depression improved by 6.3 (SD=7.4) points on the Hamilton Depression Scale (HAM-D2) from a baseline of 5.7 (SD=5.9) points. Conclusion: Patients remained stable or improved with the combination of fingolimod and any of the three antidepressants. We observed no unexpected safety signals. Disclosure: The REGAIN study was supported by Novartis Pharma GmbH, Nuremberg, Germany; Stefan Vormfelde, Katrin Schuh and Monika Baier are emploees of Novartis; Antonios Bayas has received honoraria for serving on advisory boards and as speaker from Merck Serono, Biogen Idec, Bayer Vital, Novartis and Sanofi / Genzyme; for advisory board activities from TEVA; for trial activities from Biogen Idec, Merck Serono and Novartis; and received grants for congress trips and participation from Sanofi / Genzyme, Biogen Idec and Merck Serono. F2074 Bat-wing view of the pons associated with chronic alcoholism E. Eruyar, S. Bilen, N. Öztekin 2, F. Ak ANH Traning and Research Hospital, Neurology, Ankara, Turkey, 2 Ankara, Turkey Background and aims: Central pontine myelinolysis (SPM) is a neurological disorder characterized by loss of myelin in pons tegmentum. SPM is an osmotic demyelination syndrome may often occur with rapid correction of hyponatremia as the hyponatremia is not necessarily in all cases. Clinical presentation in SPM is highly variable and neurologic signs may change from severe vary from mild. Typical symptoms are confusion, mutism, dysarthria, dysphagia, bulbar and pseudobulbar palsy, hyperreflexia, guadriplejia and seizures. Rarely asymptomatic patients were reported too. Many medical conditions can cause as half of the cases are chronic alcoholics. Here, in chronic alcoholics who have not hyponatremia we can see a rare condition: the bat-wing views in MRI. This sign is rare and shows central pontine myelinolysis. Methods: A 43-year-old male patient was evaluated with gait disturbance and diplopia for year. He was a chronic alcoholic for approximately 27 years and was hospitalized for alcohol withdrawal by psychiatry. At neurological examination bilaterally cerebellar tests minimal impairment and ataxia was observed. Results: Routine biochemical tests including sodium were normal. TA hypointense, T2A hyperintense lesion was detected in the central pontine which was similar bat-wing views ( images,2,3). This sign was central pontine myelinolysis sequale due to alcoholism. Conclusion: Central pontine myelinolysis and extrapontine miyelinolizis are accepted as the iatrogenic disease problems resulting with rapid correction of hyponatremia. This clinical picture was more easily recognizable with the widespread use of cranial MRI. In this case without hyponatremia etilogy is only alcoholism. 205 European Journal of Neurology, 22 (Suppl. ),

134 Flash Posters 67 F2075 Alemtuzumab administration on nonconsecutive days does not impact lymphocyte depletion, infusionassociated reactions, or efficacy A.N. Boyko, S. Wray 2, T.J. Braley 3, D.H. Margollin 4, L. Kasten 5 Russian Science and Research Medical University named after N. I. Pirogov and Moscow Multiple Sclerosis Center, Moscow, Russian Federation, 2 Hope Neurology, Knoxville, USA, 3 University of Michigan Multiple Sclerosis and Sleep Disorders Centers, Ann Arbor, USA, 4 Genzyme, a Sanofi company, Cambridge, USA, 5 PROMETRIKA LLC, Cambridge, USA Background and aims: For the treatment of relapsingremitting multiple sclerosis (RRMS), the recommendation is that alemtuzumab be administered intravenously on 5 consecutive days (Course ) and on 3 consecutive days 2 months later (Course 2). As adherence to this schedule may not always be feasible in clinical practice, we assessed infusion-associated reaction (IAR) frequency, efficacy, and lymphocyte pharmacodynamics of alemtuzumab administered on nonconsecutive days in the CARE-MS I (NCT ) and II (NCT ) studies. Methods: IARs (adverse events occurring during infusion or up to 24 hours post-infusion) were assessed following nonconsecutive infusions (Course : >5 days; Course 2: >3 days). Assessments included lymphocyte counts month post-treatment; relapses and 6-month sustained accumulation of disability over 2 years (SAD, per Expanded Disability Status Scale [EDSS] score); gadolinium (Gd)-enhancing and new/enlarging T2-hyperintense lesions within year of treatment, in subjects completing Course or 2 over 6 0 or 4 8 nonconsecutive days, respectively. Results: Mean CD4+, CD8+, or CD9+ cell counts ( 09/L) month after treatment were similar with nonconsecutive (Month : 0.04, 0.07, 0.02; Month 3: 0.06, 0.06, 0.03) versus consecutive infusions (Month : 0.04, 0.07, 0.02; Month 3: 0.06, 0.06, 0.05). IAR incidence was similar with nonconsecutive infusions (Course : 39/40; Course 2: 5/9) compared with the overall CARE-MS population (90%). Most subjects completing Course or 2 on nonconsecutive days remained free of relapse, SAD, Gd-enhancing lesions, or T2 lesions. Conclusion: Administering alemtuzumab on nonconsecutive days, prolonging the treatment courses by up to 5 additional days, does not appear to impact lymphocyte pharmacodynamics, safety, or efficacy. Disclosure: Study supported by Genzyme, a Sanofi company, and Bayer Healthcare Pharmaceuticals. 205 European Journal of Neurology, 22 (Suppl. ),

135 68 Flash Posters F2076 The safety of IFNbeta in children and adolescents with relapsing-remitting multiple sclerosis O. Bykova, A. Boyko 2, T. Batysheva 3 Moscow, Russian Federation, 2 Russian Research and Science Medical University named by Pirogov, MMSC, Moscow, Russian Federation, 3 RESEARCH and CLINICAL CENTRE of PEDIATRIC PSYCHONEUROLOGY, Moscow, Russian Federation Background and aims: To assess the safety of IFN beta in children and adolescents with multiple sclerosis, prospective evaluation of 66 and retrospective evaluation of 72 pediatric patients with RRMS was made. Methods: Among 35 IFNbeta b patients 26 AEs in 20 patients was described: flu-like syndrome in 7 and local reactions in 7 patients, only three were classified as serious % of adverse reactions occurred after each injection, 30.82% were recorded periodically, and only 3.85% were observed continuously, which led to the ending of treatment. The spectrum of AEs in the prospective group of sc IFNbeta a 22 (20 patients) included flu-like symptoms in 8 patients, local changes in 5 and epilepsy in one. Adverse events during im IFNbeta a therapy in pediatric patients have been presented only by flu-like syndrome. The frequency of flu-like syndrome tended to the reduction in time, none of the patients did not discontinue therapy due to it. Results: We retrospectively analyzed the results of sc IFNbeta a (22 and 44) in 72 pediatric RRMS patients who were receiving IFNbeta a at least 6 months. All retrospective patients were divided into 30 6 years old, and 42 ranged from 6 to 5 years. Conclusion: The study showed that local reactions in the older age subgroup met 2 times more often, which could be due to the fact that in the oldest age subgroup injections performed by the patients themselves, while in the younger age subgroup, the administration of the drug is fully implemented by parents. F2077 Patient related outcome in everyday practice beyond the EDSS P. Calabrese Basel, Switzerland Background: In clinical studies, most patient-related outcome measures (PROM) in multiple sclerosis (MS) are generally measured by neurological impairment scales such as the Kurtzke Expanded Disability Status Scale (EDSS). However, it becomes evident that most scales do not cover the spectrum of dimensions which might be of everyday relevance to the patients. Hence some additional information, such as cognition, fatigue, affective status and psychosocial adjustment, is needed to provide information about healthrelated quality of life (HRQoL). Methods: Neurological impairment (EDSS) and PROM were measured in a group of n = 40 MS patients using the EMS (Exploration Module for Multiple Sclerosis), based on a 2-item self-rating-questionnaire representing cognition, affective status, fatigue and psychosocial adjustment at baseline and after 2 months. The participants were on a stable Glatiramer acetate medication. Based on repeated measurement statistics, a transition analysis was performed in order to trace the annual, dimension-specific changes in EDSS and PROM, respectively. Results: Though a significant proportion of the patients remained stable, we were able to detect some subtle transitions in a number of neurological as well as HRQoL-related measures. Moreover, some dimensions of physical disability as quantified by the EDSS were only loosely correlated with the everyday functioning domains as represented in the EMS. Conclusion: While the cohort remained stable in a number of neurological characteristics, these measures were not suited to reflect HRQoL-related dimensions. Hence, it is argued that some additional measures beyond the EDSS are needed to monitor MS-related disease burden in everyday practice. Disclosure: This study was partly funded by TEVA 205 European Journal of Neurology, 22 (Suppl. ),

136 Flash Posters 69 F2078 JCV serology in time: 3 years of follow-up M. Cambron, N. Hadhoum, E. Duhin, A. Lacour, A. Chouraki, O. Outteryck, P. Vermersch CHRU Lille, Neurology, Lille Cedex, France Background and aims: Although a lot of neurologists are reluctant to use natalizumab in MS (multiple sclerosis) given the increased risk for PML (progressive multifocal leukoencephalopathy), trust was regained with the introduction of JCV antibody titers as a potent disease modifying therapy. Literature shows that in patients with a negative JCV serology, the risk of PML is virtually non-existent. Unfortunately seroconversion causes concern amongst many neurologists. Furthermore when patients seroconvert, it remains unclear what the risk is of passing the important threshold of.5. Methods: JCV serology data of 6 patients were analyzed, upon treatment with natalizumab at the University Hospital in Lille, France between May 202 and November 204. Results: Out of 8 patients who tested negative for JCV antibody at baseline, 23 (28.3%) seroconverted but only 7 (8.6%) passed the threshold of.5. Out of 80 patients testing positive for JCV antibody at baseline, 23 had an initial level of JCV antibody of.5 or lower. Out of these 23 patients 9 passed the.5 threshold during the following 3 years. When focusing on the group of patients that had an initial JCV antibody titer lower than or equal to 0.9, only out of 8 patients passed the threshold of.5. 8 out of 5 patients passed this threshold if the initial serology was higher than 0.9. Conclusion: JCV-negative patients and JCV positive patients with antibody levels lower than or equal to 0.9 both have a low risk of passing the.5 threshold. F2079 Multiple sclerosis patients have increased stress-induced Heat Shock Protein 70 expression M. Mycko, H. Cwiklinska, C.F. Brosnan 2, C.S. Raine 2, K. Selmaj Medical University of Lodz, Department of Neurology, Laboratory of Neuroimmunology, Lodz, Poland, 2 Albert Einstein Collge of Medicine, Bronx, USA Background and aims: The aim of our project was to globally assess the changes of heat shock proteins (HSPs), stress-responsive proteins, in multiple sclerosis (MS) patients. Methods and Materials: We performed a global analysis of HSP gene expression within chronic active MS plaques using microarrays. Furthermore, to understand the mechanism of HSP regulation we analyzed HSPs expression in peripheral blood mononuclear cells (PBMCs) from MS patients, healthy controls and patients with rheumatoid arthritis (RA). HSP levels were detected by Western blot and quantified by ELISA. Results: We were able to retrieve expression data for 45 individual HSP genes from the CNS of the MS patients. These genes represented all 8 major families of HSPs. Out of these 45 genes, 6 were found to be more then 2 fold upregulated at the margins of chronic active lesions versus normal appearing white matter (NAWM). HSPAA (encoding Hsp70) was jointly upregulated in both centers and margins, whereas other HSP genes were different between these two areas. We have also found that following heat shock Hsp70 was significantly more upregulated in MS patients compared to healthy controls. Hsp70 over-expression was preceded by increased nuclear presence of heat shock factor (HSF). Conclusion: Our results indicate that immune cells from MS patients are more prone to Hsp70 induction in stress conditions suggesting a possible link between Hsp70 overexpression and development of autoimmunity. Disclosure: Supported by NCN OPUS UMO-203//B/ NZ6/02055 grant to HC and PSPB Grant to MPM 205 European Journal of Neurology, 22 (Suppl. ),

137 620 Flash Posters F2080 Frequent early relapses and severe cortical damage characterize patients at high risk of early developing progressive multiple sclerosis A. Scalfari, G. Ebers 2, R. Nicholas, P. Muraro 3, M. Calabrese 4 Imperial College, London, United Kingdom, 2 Oxford University, Oxford, United Kingdom, 3 Imperial College, London, United Kingdom, 4 University of Verona, Verona, Italy Background and aims: Relapsing remitting (RR) Multiple Sclerosis (MS) patients with a large number of early attacks are at higher risk of developing a progressive disease. In this subgroup, we aimed at elucidating pathological changes in the grey matter. Methods: By using 3D Double Inversion Recovery and 3DT weighted imaging we compared the number of cortical lesions and the cortical thinning between RR MS patients with (n=42) and 3 (n=4) relapses during the first 2 years, matched by similar disease duration (7. vs 7.2 mean years). Results: Patients with 3 early attacks where distinguished by a larger number (4.9 vs 2.4 mean lesions; p<0.00) and volume (37 vs 205mm 3 ; p<0.00) of cortical lesions at disease onset. By the end of the observation period, they had entered the progressive phase in larger percentage (4.4% vs 2.4%; p=0.08) and in significantly shorter time (6. vs 8.3 mean months; p<0.00). In addition, they accrued a significantly higher number (4.5 vs 5.; p<0.00) and volume (409 vs. 368 mm 3 ; p<0.00) of cortical lesions, and a significantly more severe global (2.28 vs 2.44mm; p<0.00) and cerebellar cortical thinning (05 vs 0mm; p<0.00), which accounted for their aggressive disease course. Conclusion: Frequent early relapses associate with a more prominent focal and diffuse cortical damage in the long term. These data provide initial evidence for risk stratification of subgroups, potentially benefitting from early aggressive treatment, and highlight the grey matter pathology as important target for future therapies. Disclosure: This research was granted by MS UK Society F208 PANGAEA: The average German fingolimod patient. Demographics and baseline characteristics from a 5 year non-interventional study of RRMS patients treated with fingolimod. T. Ziemssen, H. Albrecht 2, L. Klotz 3, S. Schmidt 4, H.-J. Schwarz 5, B. Tackenberg 6, C. Cornelissen 7 Carl Gustav Carus University Hospital, Center for Clinical Neurosciences, Dresden, Germany, 2 Dr. med. Holger Albrecht, Praxis für Neurologie, Munich, Germany, 3 Unilkinik Münster, Klinik für allgemeine Neurologie, Münster, Germany, 4 Neurologiesche Gemsinschaftspraxis Schmidt, Neudecker & Viebahn, Bonn, Germany, 5 Kantar Health GmbH, Munich, Germany, 6 Philipps-Universität und Universitätsklinikum Gießen und Marburg, Klinik für Neurologie, Marburg, Germany, 7 Novartis Pharma GmbH, Nuremberg, Germany Background and aims: Fingolimod is a sphingosine -phosphate-receptor modulator approved for the treatment of RRMS. The non-interventional study PANGAEA (Post-Authorization Non-interventional German safety of GilEnyA in RRMS patients) is conducted in Germany, to investigate long-term safety, tolerability and effectiveness of fingolimod patients in daily clinical practice. Here we present the baseline characteristics of the average German fingolimod patient. Methods: Recruitment into the study finished in December ,229 patients were enrolled. In this analysis we present the demographics and baseline characteristics of this German fingolimod cohort. Results: The proportion of female patients was 7.6% and the mean age was 39.4(±0.0) years. 48.0% of all patients were switching to fingolimod from interferons, 23.0% from glatiramer acetate and 8.4% from natalizumab. 5.9% of the patients were treatment naïve. The mean annualized relapse rate at baseline was.5(±0.3) and the mean EDSS at baseline was 3.0(±0.03). 8.4% of the patients started with the fingolimod treatment in PANGAEA. 8.6% of the patients participated in other fingolimod clinical trials before PANGAEA with a mean treatment duration of 209.3(±9.8) days at baseline. Over the study inclusion-period the time since diagnosis, number of relapses in the past 24 months and the mean EDSS at baseline decreased. Conclusion: By December 203 approximately patients were on treatment with fingolimod in Germany. PANGAEA included patients and therefore represents the average German fingolimod patient. Over time since approval, physicians included patients at an earlier time point since diagnosis. Disclosure: This study is supported by Novartis Pharma GmbH, Nuremberg, Germany 205 European Journal of Neurology, 22 (Suppl. ),

138 Flash Posters 62 F2082 Long-term efficacy and safety of prolonged-release fampridine treatment in patients with multiple sclerosis: design of the multicentre, randomised, double-blind, placebo-controlled ENHANCE study T. Ziemssen, J. Hobart 2, P. Feys 3, M. Linnebank 4, A. Goodman 5, M. McNeill 6, J. Zhong 7, L. Mehta 7 University Clinic Dresden, Dresden, Germany, 2 Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom, 3 University of Hasselt, Diepenbeek, Belgium, 4 University Hospital Zurich, Zurich, Switzerland, 5 University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA, 6 Biogen Idec, Maidenhead, United Kingdom, 7 Biogen Idec, Cambridge, MA, USA Background and aims: Walking difficulties are a common cause of disability in multiple sclerosis (MS). Prolongedrelease fampridine tablets (PR-fampridine; dalfampridine extended release in the US) were shown to improve walking speed in MS patients in two Phase 3 trials. The recently completed exploratory Phase 2 MOBILE study showed benefits of PR-fampridine versus placebo on balance and patient-perceived walking ability and physical impact of MS. The Phase 3 ENHANCE study was designed to evaluate whether PR-fampridine 0 mg twice daily provides clinically meaningful benefits versus placebo on patient-reported walking ability and physical impact of MS, balance, and upper extremity function. Methods: Patients (N 590) with a diagnosis of MS and walking impairment are being recruited at 02 study sites worldwide and will be randomised (:) to PR-fampridine 0mg or placebo twice daily for 24 weeks (Figure). The primary efficacy endpoint is the proportion of patients achieving a mean improvement of 8 points from baseline on the Multiple Sclerosis Walking Scale-2 over 24 weeks. Secondary endpoints are proportion of patients achieving a mean improvement of 5% in Timed Up and Go speed and changes from baseline in Multiple Sclerosis Impact Scale-29 physical score, Berg Balance Scale, and ABIL- HAND questionnaire over 24 weeks. Safety will also be assessed. Figure. ENHANCE Study Design Results: Enrolment began in September 204. Study completion is expected in July 206. Conclusion: ENHANCE is designed to further evaluate the clinical meaningfulness of PR-fampridine treatment on patient-reported walking ability, physical impact of MS, upper extremity function, and objectively measured balance in MS patients with walking impairment. Disclosure: This study is funded by Biogen Idec (Cambridge, MA, USA). Writing and editorial support for the preparation of this abstract was provided by Excel Scientific Solutions (Southport, CT, USA); funding was provided by Biogen Idec. F2083 Development of a screening tool to support identification of patients with secondary progressive multiple sclerosis (SPMS) T. Ziemssen, D. Simsek 2, R. Lahoz 2, E. Verdun 2 Dresden, Germany, 2 Novartis Pharma AG, Basel, Switzerland Background and aims: Transition from RRMS to SPMS is difficult to diagnose. Here, we describe methodology for developing a screening tool that can help physicians to diagnose SPMS early. Methods: Tool will be developed along 3 steps: Quantitative research: A retrospective cross-sectional study to describe differentiating characteristics between SPMS and late RRMS patients using Adelphi Real World database. 279 MS patient record forms from 25 neurologists (US) are available. Key variables will include demographics, MS history, treatment history, daily activities, symptoms and clinical characteristics including MRI activity. Patients will be stratified based on EDSS and disease duration into: Early RRMS (control group), Late RRMS and Early SPMS. A multivariate regression analysis will identify the significant predictors of patient classification as Late RRMS or Early SPMS by physician. Qualitative research: () Openended qualitative interviews of patients (6 each in the US and Germany 8 RRMS and 8 SPMS/country) and treating clinicians (8/country) to identify and characterize key differentiating features of these two MS phenotypes. (2) Integrating interviews with quantitative research to draft the tool. (3) Use of draft version by physicians treating SPMS patients. (4) Cognitive debriefing with physician to validate and finalize the tool. Tool validation: Sensitivity and specificity will be validated against reference tests in a 2-Month prospective observational study in patients with late RRMS and SPMS after the implementation of the tool. Results: Details of SPMS screening tool will be presented. Conclusion: Such a validated tool is expected to support physicians in more accurate and timely identification of SPMS patients to provide optimized clinical intervention. Disclosure: Study supported by: Novartis Pharma AG. T. Ziemssen has received speaking honoraria and travel expenses for scientific meetings; has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past years with Bayer Schering Pharma, Biogen Idec, EMD Merck Serono, Genentech, Genzyme, Novartis, Sanofi-Aventis, Teva Pharmaceuticals and Almirall. D. Simsek, E. Verdun, and R. Lahoz are paid employees of Novartis Pharma AG, Basel, Switzerland. 205 European Journal of Neurology, 22 (Suppl. ),

139 622 Flash Posters F2084 Multicenter open-label non-interventional study (NIS) assessing change of activity in ambulatory patients with CIS or RRMS treated with glatiramer acetate (GA): COPTIVITY study design. T. Ziemssen, R. Kern 2, A. Müller-Schubert 3 Dresden, Germany, 2 Universitätsklinikum Carl Gustav Carus, Zentrum für Klinische Neurowissenschaften, Dresden, Germany, 3 Teva Pharma Germany, Berlin, Berlin, Germany Background and aims: With more than 20 years of clinical use and and 2 million patient-years of exposure, glatiramer acetate (GA) is one of the first treatments for relapsing-remitting multiple sclerosis (RRMS). Over the years, measuring quality of life (QoL) like participation in social life and work has gained in importance. As real world data supporting the effect of GA on these parameters are missing the objective of the COPTIVITY study is to determine the efficacy of daily treatment with GA 20mg/ml on QoL. Methods: COPTIVITY is a two-year, open-label, multicenter NIS assessing physical and mental activity in ambulatory GA-treated patients. In addition to tolerability, relapses and disability, fatigue (FSMC), work (WPAI-MS), QoL (EQ-5d-5L) and information processing (SDMT) are assessed in this study. Patients (n=500) diagnosed with MS or clinically isolated syndrome (CIS), who are treatment-naïve or switching from other DMTs (Disease Modifying Therapies) will be followed for 2 years. Primary endpoint: UK-NDS, (user-friendly clinical disability scale). Secondary endpoints: tolerability, EDSS, relapses, fatigue (FSMC), work (WPAI-MS), QoL (EQ-5d-5L) and information processing (SDMT). Results: COPTIVITY began in January 205. Study design and first baseline data will be presented at st EAN Congress in Berlin, Germany. Conclusion: The COPTIVITY study will provide the opportunity to measure GA s effect on various QoL measures in a real world setting on a large group of patients. Disclosure: This study is funded by TEVA Pharma Germany, Berlin. 205 European Journal of Neurology, 22 (Suppl. ),

140 Flash Posters 623 Muscle and neuromuscular junction disease F2085 The incidence of Pompe disease in patients with vacuolar myopathy: a pilot study of a tertiary care center C.E. Bekircan-Kurt, H.N. Günes 2, S. Erdem-Özdamar, E. Tan Hacettepe University, Neurology, Ankara, Turkey, 2 Ankara Training Hospital, Neurology, Ankara, Turkey Background and aims: Pompe disease is a rare autosomal recessive, lysosomal storage disorder due to acid α-glucosidase deficiency. The disease is classified into two forms: infantile- and late-onset. Late-onset form is slowly progressive with substantial impairment in muscle strength and respiratory function. The diagnosis of late-onset Pompe disease is challenging due to clinical variability and generally misdiagnosed as limb-girdle muscular dystrophy. Therefore clinical clues such as rigid spine, early involvement of respiratory muscles and diaphragm weakness as well as muscle biopsy and enzyme activity are crucial for the diagnosis. Here we report the incidence of Pompe disease among our vacuolar myopathy patients. Methods: The patients who were evaluated between 2004 and 203 and who had limb-girdle type muscle weakness and muscle biopsy compatible with vacuolar myopathy were included. The muscle and/or dry blood samples were analysed for acid α-glucosidase enzyme activity and the diagnosis was verified by genetic analysis. Results: The muscle biopsy of 50 patients was compatible with vacuolar myopathy. 6 of them were diagnosed as Pompe disease. The incidence of Pompe disease in our vacuolar myopathy series was 2%. The mean age of Pompe patients was 33.5 and 3 of them were male. All patients had proximal myopathy; 2 had also distal myopathy. The enzyme replacement treatment (ERT) was initiated in all patients. 2 patients lost ambulation during follow-up and one patient died. Conclusion: Pompe disease diagnosis is vital as the disease can be treated by ERT. Although its incidence in our country is not known, our study suggests a high frequency in patients with vacuolar myopathy. F2087 Admission to intensive and intermediate care units may not influence one-year Guillain-Barré disability score A. Costa, T. Gomes, F. Silveira, G. Nadais, P. Abreu Centro Hospitalar S. João, Neurology, Porto, Portugal Background and aims: Admission to Intensive or Intermediate Care Units (ICU/IMC) is commonly required in patients with Guillain-Barré Syndrome (GBS) being associated with increased acute mortality, morbidity and incomplete recovery. Our aim was to analyse the relationship between ICU/IMC admission and disability at one-year of follow-up. Methods : We performed a retrospective analysis of patients charts diagnosed with GBS in our university hospital between 2003 and 203. We compared patients admitted to ICU/ICM with those admitted to a general ward concerning GBS disability scale (GBSDS) at discharge and at one-year of follow-up. Categorical data were evaluated with Kruskal-Wallis one-way analysis of variance (p<0.05). Results: Forty-nine patients (33 male) were included with a median age of 57 years (range: 8-64). Twentyfive patients were admitted to ICU (n=9) and ICM (n=6). GBSDS scores at discharge (median inpatient length: 35 days; 5-48) were significantly associated with ICU/ICM admission (p=0.00) as ICU/ICM admitted patients scored significantly higher. On the contrary, no statistically significant associations were found with GBSDS scores at oneyear (median follow-up: 0 months; -38). Nevertheless, we found a significant association between GBSDS at discharge and after one-year of follow-up (p=0.036). Age significantly influenced GBSDS scores at discharge, but not time-length between onset of symptoms and either first observation in the Emergency Department or inpatient admission. No statistically significant associations were obtained for GBSDS at one-year. Conclusion: GBS patients admitted to ICU/ICM seem to have acutely worse disability scores. Nonetheless, despite the higher disease severity and frequent complications, their long-term functional recovery may not be significantly compromised. F2086 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

141 624 Flash Posters F2088 Chronic progressive external ophthalmoplegia with a large novel deletion of mitochondrial DNA confirmed by MLPA assay S.-Y. Kang, H.J. Kim, J.-H. Oh Jeju National University Hospital, Jeju, Korea, Republic of Background and aims: Chronic progressive external ophthalmoplegia (CPEO) is a mitochondrial myopathy commonly caused by deleterious changes in the mitochondrial DNA (mtdna). We report a Korean CPEO patient with a large novel deletion in the mtdna, which was genetically confirmed by a multiplex probe amplication (MLPA) assay. Case Report: A 38-year-old man presented with a 20-year history of bilateral ptosis. He complained of mild dysphagia and general weakness, but had not suffered from diplopia since ptosis had developed. He was noted to have short stature. Past medical and family history was unremarkable. Neurological examination showed bilateral ptosis and complete ophthalmoplegia. Cataract or retinal pigmentary degeneration was not observed upon ophthalmologic examination. Electrocardiography and echocardiography were normal. Brain MRI, nerve conduction, and repetitive nerve stimulation tests were normal, but electromyography demonstrated myopathic potentials. Muscle biopsy showed ragged-red fiber and cytochrome oxidase-negative fiber consistent with mitochondrial myopathy. We performed MLPA assay of mtdna from muscle tissue and peripheral blood leukocytes, and followed up with polymerase chain reaction and direct sequence analysis. The MLPA analysis showed a deletion of a 4,407 base pairs (bp) segment in the mtdna region. Results: We report a novel 4,407 bp deletion in the mtdna of a Korean patient with CPEO. Conclusion: To the best of our knowledge, this is the first report on the successful use of MLPA to detect large deletions of mtdna in a patient with CPEO. MLPA can be a useful platform for diagnosis to detect large deletion mutation in the mtdna. F2089 Atypical chronic progressive external ophthalmoplegia with unilateral involvement and without evidence of mitochondrial dysfunction of the limb muscles I. Karin, C. Catarino, B.G. Schoser, T. Klopstock Munich, Germany Background and aims: Chronic progressive external ophthalmoplegia (CPEO) is a mitochondrial disorder characterized by bilateral ophthalmoparesis and ptosis. It is often accompanied by neck and limb muscle weakness and other neurological and non-neurological symptoms. CPEO is most often caused by mitochondrial DNA (mtdna) deletions or point mutations. Case Report: We describe a 70-year-old patient, who presented with a 0-year history of progressive left-sided ptosis and ophthalmoparesis. No other neurological symptoms were reported. There were no other signs in the neurological examination. The patient underwent ptosis correction surgery twice. Laboratory assessment, cranial MRI, neurophysiology and muscle biopsy of the right biceps brachii and left orbicularis oculi muscles were performed. Genetic testing included long-range PCR and Southern Blot from muscle DNA of biceps brachii. Results: Neurophysiology examinations did not show any pathology. MRI of the brain was normal. Repeated serum CK levels were increased once out of three measurements (67 U/l). Muscle histology and respiratory chain enzymes biochemistry, both done on tissue from biceps muscle, did not show any pathological findings. Histology of the orbicularis oculi muscle showed fibrotic changes and subsarcolemmal mitochondrial aggregation, with COX-negative, SDH-positive ragged red fibers. Genetic testing showed a single 0 kb mtdna deletion with 0% heteroplasmy. Conclusion: CPEO may have an atypical presentation with unilateral involvement only. In such cases, with no further symptoms, the histologic assessment of non-ocular muscles may be insufficient to confirm mitochondrial disease. F2090 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

142 Flash Posters 625 F209 Short term and long term postoperative outcome; videoscopic versus transsternal thymectomy in myasthenia gravis patients H.S. Lee, H.E. Lee, H.Y. Shin, S.M. Kim Severance hospital, neurology, Seoul, Republic of Korea Background and aims: Thymectomy may benefit patients with myasthenia gravis (MG). Although transsternal thymectomy is a widespread, traditional surgical technique, videoscopic thymectomy recently became popular with its minimally invasive and superior cosmetic advantages. So far, little is known about short-term and long-term outcomes according to surgical methods. Methods: 236 patients who underwent thymectomy were analyzed retrospectively. 90 patients received transsternal thymectomy and 46 patients were operated on videoscopic thymectomy. We collected data about preoperative demographics, operative, and post-operative factors which may influence short or long-term outcomes. Results: The length of operation time, intubation time, chest tube duration, ICU stay, and hospital stay were significantly shorter in videoscopic thymectomy. Also, lower amount of blood loss during operation and amount of chest tube drainage in videoscopic group were confirmed by our data. Postoperative vital capacity was higher, rate of MG crisis after thymectomy was lower in videoscopic thymectomy. In our data, group of transsternal thymectomy had longer follow up duration. (5.05±2.32 year; transsternal VS. 3.30±.74 year; videoscopic) At the last clinical review, 70% (63/90, transsternal) and 43.8% (63/46, videoscopic) had achieved complete stable remission or pharmacological remission. Conclusion: Videoscopic thymectomy demonstrated safe, excellent prognosis regarding operative, short-term outcome variables. Although long-term outcome of videoscopic thymectomy might be inferior to transsternal thymectomy in our data, the shorter follow up duration of this group might influence to remission rate. F2092 Association of myasthenia gravis autoantibodies to clinical features and response to therapy Y. Malik, A. Almadani, J. Dar, J. Inshasi, M. Junaidi Rashid Hospital, Neurology, Dubai, United Arab Emirates Background and aims: Myasthenia gravis (MG) is a rare disorder of neuromuscular junction mediated by autoantibodies like acetylcholine receptor (AChR-Ab), Anti MuSK-Ab, etc. Our objective is to determine association of auto-antibodies to clinical features and therapeutic response of MG. Methods: We collected 35 patients with MG from Rashid Hospital, Dubai. It was a retrospective observational study in which patient s >5years follow-up was reviewed. Clinic visits and admissions (mysthenic crisis) were evaluated in terms of Osserman s classification and MG American Federation (MGFA) severity scale. Results: We recruited 35 patients, out of which 59% were female. Age of our patients was 5 to 76 years (mean=38.5). We encountered mainly general MG (84.5%) out of which 90% patients were seropositive and in Ocular myasthenia group 45.5% were seropositive. Immunologically AchR- Ab were seen in 76% cases, Anti MuSK-Ab in 7% and 6% were seronegative. Onset occurred before 35 years of age in 92% seronegative and 63% seropisitve patients. Motor complaints were almost equal in both groups and bulbar features predominated in seropositive group 63% vs 25% (p=0.06). Seronegative patients had milder disease (Osserman s classes or2) whereas seropositive patients had comparatively severe disease (Osserman s class 3or4). Amongst seropositive patients those with Anti MuSK-Ab displayed severe disease than AchR-Ab patients. Response to Acetylecholineestearse inhibitors was better in seronegative patients (p=0.876). Conclusion: Myasthenia is a postsynaptic neuromuscular disorder, mediated by autoantibodies. Seropositive MG display severe form of disease in comparison to seronegative patients. Seronegative patients mainly have ocular myasthenia, less incidence of myasthenic crisis and respond better to Acetylecholineest earse inhibitors. 205 European Journal of Neurology, 22 (Suppl. ),

143 626 Flash Posters F2093 Clinical features of LGMD2A in a cohort of Czech patients from Motol University Hospital Prague R. Mazanec, V. Potockova, K. Stehlíková 2, L. Fajkusová 2 Motol University Hospital, Department of Neurology, Prague, 2 Brno University Hospital, Molecular biology and gene therapy center, Brno, Czech Republic Background and aims: Limb girdle muscular dystrophies (LGMD) are relatively common cause of myopathic syndrome in children and adults. The causal mutations of CAPN3 gene locus 5q5. (LGMD2A) are most common in recessive types. Methods: In a group of 8 patients (0F + 8M) with genetically confirmed causal mutations in CAPN3 gene, we evaluated the basic clinical symptoms of age at onset, rate of progression, contractures, the distribution of muscle weakness, spinal deformity and basic laboratory tests (muscle enzymes, spirometry, ECG). Results: We found significant variability of the onset of symptoms (from 4 to 35 years), the progression of myopathic syndrome (light-medium-heavy), in failing to squat (3-50 years) and wheelchair (first 8 years - in 63 years still walking). Conversely uniform finding was weakness UL+LL (00%), scapula alata, Achilles tendon contracture and lumbar hyperlordosis (00%). We found no difference in phenotype between males and females. We found CK and myoglobin elevation (00%). In 4 cases the first symptom of muscular dystrophy was CK elevation.most cases manifests itself later between 0-25 years of age and are confined to a wheelchair between years of age with the exception of light forms. No cardiomyopathy or heart conduction abnormalities were found. Spirometry was normal except in two patients. Conclusion: LGMD2A is phenotypically variable disease with mild, moderate and severe course. Manifestation usually in first or second decade, latest at the end of the 4.decade. The cardiopulmonary functions were not affected. We found no effect of gender on the severity and course of the disease. F2094 Non-melanoma skin cancer risk in azathioprine-treated people with myasthenia gravis I. McGurgan, C. McGuigan St Vincent s University Hospital, Department of Neurology, Dublin, Ireland Background and aims: Increased rates of non-melanoma skin cancer (NMSC) have recently been reported in people with myasthenia gravis (MG) receiving azathioprine treatment. Guidelines for patients with dermatological and gastrointestinal disorders on azathioprine stress the importance of awareness of this risk. The aim of this study is to assess whether MG patients are being informed of these guidelines. Methods: Clinical records of patients with MG attending a university hospital neurology clinic were reviewed. Data on patient demographics, clinical presentation, diagnosis, azathioprine treatment, development of NMSC and counselling regarding NMSC risk were recorded. Results: 69 MG cases were identified, median age 57 years (range 20-70). 42 (60.9%) had received azathioprine at some point with a mean cumulative dose of 225.3g (range g) and treatment duration of 6. years (range years). Skin cancer risk and prevention advice provision was documented in 3 (7.%) azathioprine-treated patients. 4 patients developed histologically-confirmed NMSC (2 SCC, 5 BCC); all were treated with azathioprine (incidence rate of 23.4 per 000, 5 times higher than expected). Documented advice on other safety issues such as regular blood test monitoring was found in 30 (7.4%) azathioprine-treated cases. Conclusion: Preventative measures such as daily sunscreen use have been shown to reduce the incidence of NMSC in the general population. The results of this study demonstrate a very low rate of advice provision about NMSC risk in azathioprine-treated MG patients and the need for increased awareness among treating neurologists and patients. 205 European Journal of Neurology, 22 (Suppl. ),

144 Flash Posters 627 F2095 Elevated serum cardiac troponin T (ctnt) in patients with myotonic dystrophy G. Meola, R. Valaperta 2, R. Cardani 3, F. Lombardi 2, B. Rampoldi 4, R. Pannella 5, B. Fossati 6, E. Brigonzi 7, S. Gallo Cassarino 7, I. Merli 7, M. Piccoli 7, G. Cuomo 7, R. Rigolini 7, P. Gaia 7, E. Pusineri 7, E. Costa 7 San Donato Milanese (MI), Italy, 2 Research Laboratories -IRCCS Policlinico San Donato, Milan, Italy, 3 Laboratory of Muscle Histopathology and Molecular Biology, Neurology, San Donato Milanese (MI), Italy, 4 Service of Laboratory Medicine, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy, 5 service of Laboratory Medicine, IRCCS Policlinico San Donato, san Donato Milanese (MI), Italy, 6 IRCCS Policlinico San Donato, Neurology, San Donato Milanese (MI), Italy, 7 IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy, Background and aims: Myotonic dystrophy type (DM) and type 2 (DM2) are autosomal dominant multisystemic disorders characterized by skeletal muscle and cardiac involvement. Recently, an elevation of circulating cardiac troponin T (ctnt) in patients with neuromuscular diseases, including DM, was reported in absence of myocardial injury. The aim of the study was to determine the clinical and biological significance of elevated ctnt in patients with DM. Methods: 60 DM patients (46 DM and 4 DM2) were analysed. Each patient underwent full clinical and cardiac assessment and routine blood tests. Cardiac investigations comprised ECG, 24h ECG-Holter and 2D-echocardiogram. Serum levels of ctnt, ctni, and other cardiac biomarkers were performed. ctnt protein expression was analysed by Western blot on skeletal muscle biopsies using the two antibodies from the high-sensitivity ctnt assay. Results: 53/60 DM patients showed elevated serum levels of ctnt not accompanied by an increase of ctni values. ECGs and echocardiograms revealed little or no cardiac involvement in both DM and DM2 patients. WB showed a positive immunoreaction by one antibody in DM but not in healthy skeletal muscle. Conclusion: No correlation is found between increased levels of ctnt and cardiac manifestations. Moreover, the serum increase of ctnt does not seem to be caused by the release of ctnt from injured skeletal muscle. It is possible that a cardiac involvement might be present in DM patients with more accurate and reproducible investigation such as MRI. F2096 Late-onset mitochondrial disease with diffuse leptomeningeal enhancement A. Merlini, M. Romeo, M. J. Messina, M. Rodegher, S. Previtali, G. Comi, V. Martinelli San Raffaele Scientific Institute, Department of Neurology and INSPE, Milan, Italy Background and aims: We describe an unusual adult-onset presentation of mitochondrial disease characterized at MRI by diffuse leptomeningeal enhancement Methods: Observational case report. Results: A 59-year-old male presented to our Neurology department with a three-year history of progressive cognitive decline, bradykinesia, dysarthria and hearing loss. He suffered from ankylosing spondylitis, for which he had been treated with sulfasalazine and adalimumab. Brain MRI showed a diffuse leptomeningeal enhancement and gadolinium-enhancing T2 lesions in both caudate nuclei and in the left putamen. Spinal cord MRI was normal. Lumbar puncture revealed increased protein content (39mg/dl) with cell/ul and oligoclonal bands. Comprehensive bacterial, micobacterial and fungal tests were all negative. Autoimmune screening revealed only antinuclear antibody positivity (:60). PET imaging showed hypometabolism in the temporo-mesial left regions, left caudate nucleus and cerebellar hemispheres, while EEG was normal. At first, suspecting either iatrogenic or autoimmune meningoencephalitis, both sulfasalazine and adalimumab were discontinued and prednisone was started ex-juvantibus, with no neurological improvement. Family history revealed that the patient had a 64-year-old sister with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). Suspecting a rare presentation of mitochondrial disease also in our patient, muscular biopsy was performed, which revealed mitochondrial abnormalities. Conclusion: CNS involvement, mitochondrial abnormalities at muscle biopsy and CNS feature suggest atypical presentation of mitochondrial encephalomyopathy. The unusual presentation of our patient highlights the significant phenotypic variability of mitochondrial diseases, also within the same family. 205 European Journal of Neurology, 22 (Suppl. ),

145 628 Flash Posters Neuroimaging F2097 Neural correlates of the Lee Silverman Voice Treatment in Parkinson s disease A. Baumann, G. Hartwigsen 2, A. Nebel, S. Wolff, O. Granert, G. Deuschl, K. Zeuner, T. van Eimeren 3 Kiel University, Department of Neurology, Kiel, 2 Kiel University, Department of Psychology, Kiel, 3 Köln University, Department of Neurology, Cologne, Germany Introduction: Hypophonia is extremely frequent is Parkinson s disease (PD). Although pharmacological and neurosurgical interventions improve other symptoms, hypophonia often remains unaffected. During Lee Silverman Voice Treatment (LSVT), PD patients learn to use a highpitch voice for normal conversations. Even though this treatment is clinically effective, neural mechanisms are largely unclear. In this current fmri study, we investigate the effect of LSVT on neural correlates of covert high- and normal-pitch voice in comparison to healthy controls. Methods: During fmri, subjects covertly spoke 80 short sentences (5 per block), which were visually presented. Before every block, subjects were told by a visual cue to either use a covert normal- or high-pitch voice. In PD patients, the whole procedure was done -2 weeks before and after LSVT. Results: Preliminary results of 6 experiments in 4 healthy controls and 7 PD patients robustly show increased activation of the supplementary motor area, bilateral putamen, bilateral operculum and left supramarginal gyrus during high- vs. normal-pitch covert speech. Relative to controls, pre-lsvt PD patients showed relatively reduced activation of the VTA-SNr region during high- vs. normal-pitch covert speech. Conclusion: Preliminary results show activation in effortrelated speech areas in high- vs. normal pitch in a covert speech task. Interestingly, PD patients showed reduced effort-related activation increase in the VTA-SNr region. Until presentation at the congress, we will be able to see if this finding is counteracted by LSVT, since we will have completed post-lsvt and control measurements. F2098 Quantitative analysis of the velocity characteristics of cerebrospinal fluid flow in patients with communicating hydrocephalus using phase-contrast MRI O. Bogomyakova, N. Mesropyan, Y. Stankevich, A. Tulupov Novosibirsk, Russian Federation Background and aims: To evaluate velocity characteristics of cerebrospinal fluid (CSF) flow in patients with communicating hydrocephalus (CH) (dilatation of the ventricular system in unknown causes). Method: The study involved 23 patients with CH (0 patients with an average index of the anterior horn 0.45; 3 patients with an average index - 0.3). All patients underwent routine MR imaging and CSF velocity MR imaging (phase-contrast MRI). The calculated mean velocity, mean flux and peak velocity of CSF flow were compared with the control group (60 healthy volunteers). We observed velocity values of CSF flow in the basal cisterns of brain, subarachnoid space of foramen occipital magnum and C2- C3 cervical level. Student s paired t-test was performed to indicate significant differences between mean values at the patient and volunteer groups. Results: Analysis of differences has shown that CSF flow characteristics in patients with moderate CH had significantly lower values of mean velocity and mean flux, than in the group of healthy volunteers mainly at the level of the prepontine cistern and anterior subarachnoid space of foramen magnum (p <0.05). In patients with severe CH a decrease of velocity parameters is defined at the level of the all basal cisterns and subarachnoid spaces of foramen magnum and cervical level (p <0.05). Conclusion: The data suggests a progressive disorder of outflow of CSF from the cranial cavity, depending on the degree of expansion of the ventricular system and is probably related to a breach of its reabsorption. Disclosure: This work was financially supported by the Russian Science Foundation (project N ). 205 European Journal of Neurology, 22 (Suppl. ),

146 Flash Posters 629 F2099 Three-way interaction of 5-HTTLPR, BDNF Vall66Met and COMT Val58Met polymorphisms and its effect on regional gray matter volume in patients with major depressive disorder E. Canu, M. Kostic 2, A. Munjiza 2, F. Agosta, I. Novakovic 3, V. Dobricic 3, V. Miler Jerkovic 4, T. Pekmezovic 5, D. Lecic Tosevski 2, M. Filippi San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Neuroimaging Research Unit, Milan, Italy, 2 University of Belgrade, Institute of Mental Health, Belgrade, Serbia, 3 Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia, 4 University of Belgrade, School of Elecrical Engineering, Belgrade, Serbia, 5 Clinic of neurology, Neuroepidemiology, Belgrade, Serbia Background and aims: To assess the complex three-way interaction between SERT, BDNF and COMT genes functional polymorphisms in patients with major depressive disorder (MDD) and whether its effect on brain structure. Methods: 78 MDD patients and 66 healthy controls underwent genetic testing for 5-HTTLPR, BDNF Val66Met and COMT Val58Met polymorphisms, T-weighted MRI, and clinical assessment. Compared with controls, patients were more BDNF-Val homozygotes (MDD=53; controls=32; p=0.03), COMT Met carriers (MDD=63; controls=47; p=0.058) and SERT L carriers (MDD=65; controls=47; p=0.056). Based on these results, all patients and controls were separated into three groups:. High risk group, i.e., patients or controls with all three susceptibility polymorphisms (SP); 2. Intermediate risk group (two SPs); and 3. Low risk group (one or none SPs). Regional gray matter (GM) volumes between patients and controls taking into account their genetic background were assessed. Results: The High risk group was significantly larger among the patients than the controls (MDD=40; controls=7; p=0.00). Compared to the Low risk control group, the High risk patient group showed reduced GM volume in the right middle and inferior orbitofrontal cortex bilaterally, and left superior frontal, inferior temporal and lingual gyri. Conclusion: The accumulation of SPs in MDD patients and controls is associated with volume alterations of brain regions known to be vulnerable in MDD that are not visible when comparing each SP separately. Observing differences among patients based on the accumulation or interaction of genetic risk factors is necessary to obtain greater understanding of MDD pathological mechanisms. F200 Superficial siderosis and xanthochromia S. Fernández Menéndez, R. Garcia Santiago, N. González, L.B. Lara Lezama, L. Redondo Robles, A. Álvarez Noval, B. Cabezas Delamare, B. Clavera de la Gándara Complejo asistencial universitario de León, León, Spain Background and aims: Diagnosis of late-onset ataxia is challenging. Superficial siderosis is a rare condition. Patients present with slowly progressive gait ataxia and sensorineural hearing impairment. Case Report: We report a case of superficial siderosis with its characteristic magnetic resonance imaging (MRI) and xanthochromia. We discuss this uncommon condition. Results: A 66-year-old man presented with progressive gait imbalance with bilateral hearing loss for 2 years. He had a prior cervical trauma 6 years ago and the patient was treated with cervical disc surgery. The clinical examination revealed truncal ataxia and risk reflexes throughout with bilateral Babinski sign. The bilateral hearing loss was revealed as sensorineural. MRI showed hemosiderin deposition along cerebral convesity, cerebellum, brainstem and spinal cord (Figure ). Cerebrospinal fluid (CSF) revealed xanthochromia in the 4 tubes of CSF obtained with a lumbar puncture (Figure 2), red blood cells of 400 mm3. MRI angiography and cerebrospinal angiography was performed, but the bleeding source was not detected. Figure Figure 2 Conclusion: Superficial siderosis is in the differential diagnosis of late-onset ataxia. Neurosensorial hearing loss and a prior history of trauma is usually present. It is caused by constant slow hemorrhage into the subarachnoid space with central nervous system hemosiderin deposition. Brain MRI is the investigation of choice. Surgical treatment depends on the identification of the bleeding source, so MRI angiography and cerebrospinal angiography might be necessary 205 European Journal of Neurology, 22 (Suppl. ),

147 630 Flash Posters F20 Cerebral venous sinus thrombosis: a rare cause of non-aneurismal subarachnoid hemorrhage I. Fuentes-Fernandez, R. Hernandez Clares 2, R. Carrasco Torres 2, C. Sanchez-Vizcaino 2, J. Martín Fernandez 2 Virgen de la Arrixaca Hospital, Intensive Care Unit, Murcia, Spain, 2 Virgen de la Arrixaca Hospital, Neurology, Murcia, Spain Background and aims: Cerebral venous thrombosis (CVT) is an entity with a broad spectrum of clinical manifestations. Subarachnoid hemorrhage (SAH) is a very rare initial presentation of a CVT, with only 35 cases reported, and significant radiological and therapeutic differences with aneurismal SAH. Radiologically, SAH secondary to CVT tends to be located and circumscribed along the cranial convexity, with sparing of the basal cisterns. Heparin remains the treatment of choice as in other CVT. Case Reports: A 70-year-old woman was referred to our hospital after a sudden onset intense headache followed by progressive right side hemiparesis and repetition seizures refractory to medical treatment with antiepileptic drugs. This was associated with meningism, including neck stiffness and photophobia. Results: An urgent plain computerized tomography (CT) demonstrated a left frontoparietal SAH along the cranial convexity, without involvement of the basal cisterns. The presence of intracranial aneurysms was ruled out by arterial phase CT-angiography. The venous phase of the study showed changed suggestive of superior sagittal and right lateral sinus thrombosis. Brain Magnetic Resonance and Magnetic Resonance-Angiography confirmed the CVT. Treatment with low molecular weight heparin was started immediately, and in the next hours the patient started to gradually improve. A CT-angiography revealed patency of the cerebral venous system Conclusion: CVT may rarely present as acute SAH and clinically may mimic an aneurismal bleed. Location of blood along the cranial convexity with sparing of the basal cisterns can be the key to diagnosis. Presence of intracranial aneurysms or other vascular malformations must be ruled out by angiographic studies. F202 Relationship between brain temperature and white matter damage in subacute carbon monoxide poisoned patients S. Fujiwara, Y. Yoshioka 2, T. Matsuda 3, H. Nishimoto, T. Murakami, T. Nanba, A. Ogawa, K. Ogasawara, T. Beppu 4 Iwate Medical University, Department of Neurosurgery, Morioka, Japan, 2 Osaka University, Laboratory of Biofunctional Imaging, WPI Immunology Frontier Research Center, Osaka, Japan, 3 GE Healthcare Japan, MR Applications and Workflow Asia Pacific, Tokyo, Japan, 4 Iwate Medical University, Department of Neurosurgery, Department of Hyperbaric Medicine, Morioka, Japan Background and aims: Carbon monoxide (CO) poisoned patients have shown the imbalance between the cerebral perfusion and metabolism after CO exposure and brain temperatures in these patients may change abnormally as a result of the imbalance. In these patients, it has been reported that cerebral white matter (WM) was damaged in the early phase, BT may thus depend on the extent of damage in which brain metabolism should be reduced. Here, we investigated whether BT correlates with WM damage in the subacute CO-poisoned patients. Methods: In 3 CO-poisoned patients, proton magnetic resonance spectroscopy and diffusion tensor imaging (DTI) were performed on 3 Tesla magnetic resonance imaging system in the subacute phase after CO exposure. BT was estimated from the chemical shift difference from water (H2O) to N-acetylaspartate (NAA) signals with the following formula: T [ C] = Δ(H2O-NAA). WM damage was assessed by fractional anisotropy (FA) value, which is calculated from DTI dataset. Correlation was examined by Pearson correlation coefficient with p<0.05. We defined mean±.96 standard deviations of BT and FA value from the age-matched controls as the normal cut-off values (p<0.05). Results: Significant correlation was observed between BT and FA (rho=0.68, p=0.0244). One of 3 patients showed delayed neuropsychiatric sequelae on Day 27 after CO exposure. DNS patient showed normal BT and significant low FA value, whereas the other 2 patients showed significant high BT and normal FA value (Fig. ). Conclusion: BT might associate with degree of WM damage in the subacute CO-poisoned patient. Disclosure: This study was supported in part by Grant-in- Aid for Scientific Research C (No , ) and grants for the Strategic Medical Science Research Center for Advanced Medical Science Research from the Ministry of Science, Education, Sports and Culture, Japan. 205 European Journal of Neurology, 22 (Suppl. ),

148 Flash Posters 63 F203 Cranial MRI findings in patients with hemifacial spasm E. Gozke, Z. Aktan, S.S. Tasdemir, H. Tastekin Toz, P. Doğan Ak, B.S. Anil 2 FSM Teaching and Research Hospital, Neurology, Istanbul, 2 FSM Teaching and Research Hospital, Radiology, Istanbul, Turkey Background and aims: Clonic hemifacial spasm (HFS) is a disorder characterized by involuntary contractions of muscles innervated by facial nerve one side of face and it negatively affects daily life. The aim of this study was to investigate cranial MRI findings in patients with HFS. Methods: Cranial MRI findings of 92 patients (53 female, 39 male) who have HFS were evaluated as radiologically. Results: Age range and mean age of cases was 23-8 and 55.5±3., respectively. Cranial MRI was normal in 40 (43.4%) patients. We detected small vessel disease in 46 (50%), dolicoectasic basilar artery in 7 (7.6%), cerebral atrophy in 6 (6.5%), benign tonsillar ectopi in 2 (2.%), arachnoid cyst in pontocerebellar angle in (.08%), pontocerebellar angle tumor in (.08%), and periventricular demyelinating plaque in (.08%) of the patients. Conclusion: Clonic HFS can occur due to any pathology in the course of facial nerve. In our patients cranial MRI showed direct irritation of facial nerve in only 9 (9.7%) cases (dolicoectasic basilar artery, arachnoid cyst and tumor in pontocerebellar angle). The presence of small vessel disease in half of the patients suggests relationship between atherosclerotic process and occurrence of clonic HFS. F204 Diagnosis of carotid body paragangliomas by various imaging techniques and treatment D.C. Jianu, M.P.S.N. Jianu 2 University of Medicine and Pharmacy, Neurology, Timisoara, 2 Military Emergency Hospital, Ophthalmology, Timisoara, Romania Introduction: Carotid body paragangliomas are rare hypervascular lesions arising from neural crest paraganglia cells, with a tendency of slow, but progressive growth, giving rise to external compression, or/and involvement of the carotid arteries, craniofacial nerves and other neighbouring structures. Methods: We analysed demographics, mode of presentation, imaging features, Shamblin classification, treatment modalities, and neurological complications (stroke, cranial nerve injuries), of 7 patients (pts) with carotid body paragangliomas, in order to find specific signs and to elaborate a strategy for diagnosis and treatment. Results: All lesions were paragangliomas of the carotid bifurcation, represented by painless lateral neck mass. There was no evidence of functional tumor. One pt had two localisations (the second was a glomus tumor of the left prelacrimal sac) and another one had a family history for carotid body tumor. The tumors were confirmed during ultrasonography (all pts), MRI with MRA (all cases) and DSA (2 pts). No preoperative embolisation was performed before complete resection of paragangliomas. Postoperatively, stroke occurred in one case, and 4 other pts had a transient twelth cranial nerve deficit. Conclusion: Early diagnosis of carotid body paragangliomas is possible now with MRI+MRA and color Doppler sonography. Early surgery for them minimizes the risk of complications associated with large tumours. 205 European Journal of Neurology, 22 (Suppl. ),

149 632 Flash Posters F205 Functional neuroimaging using the method H MRS in epilepsy L. Lipatova, T. Kapustina 2 Saint Petersburg, Russian Federation, 2 St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, Epilepsy Dept, St. Petersburg, Russian Federation Background and aims: Modern structural and functional studies of the brain have a huge impact on the diagnosis and treatment of epilepsy. The use of new imaging techniques has led to a better understanding of the pathophysiology underlying symptomatic epilepsy. In clinical practice, the use of neuroimaging reveals various changes of the brain, such as granulomas, malformations, vascular or traumatic injuries, tumors, etc., which allows accurate syndromic and etiologic diagnosis and determine the tactics of special treatment. Functional neuroimaging is used for localizing the brain dysfunction, primarily through the breach in the metabolism of the brain. Methods: MRI of brain and proton magnetic resonance spectroscopy (H MRS) was performed in 60 patients with epilepsy (PE) and 40 healthy volunteers (HV). Method H MRS was used to analyze the metabolism of N-acetyl aspartate (NAA), choline (Cho) and creatine (Cr) by calculating its concentration peaks, and to determine the ratio of these metabolites. Results: All investigated parameters in PE were significantly reduced relative to the norm, and the ratio of these metabolites were as follows: NAA/Cho =.48±0.2 and.78±0.22; Cho/Cr = 0.95±0.3 and.00±0.4; NAA/Cr =.45±0.20 and.50±0.22ppm, respectively. We determined decrease of three main brain metabolites in PE using method Н МРС that allows non-invasive biochemical study of brain metabolism: Cho, marker of neuron s membranes, component of phospholipid metabolism; Cr, marker of aerobic brain processes and NAA- marker of neurodegeneration. Conclusion: These finding are particularly important in MRI-negative form of epilepsy for a more accurate diagnosis, choice of treatment strategy and prognosis of the disease. F206 Neuroimaging characteristics of the recurrent vestibular dysfunction I. Maryenko, A. Antonenco, D. Naumenko, S. Likhachev Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus Background and aims: It was recently found that the certain role in the development of the paroxysmal vestibular dysfunction (VD) is played by the vascular compression of the cochleovestibular nerve (CVN). To evaluate the relation between the vessels and CVN in the patients with paroxysmal VD using magnetic resonance tomography (MRI). Methods: 39 patients (39 male and 00 female, with mean age 4.2±8.9 years) with vertigo had been examined. All the patients underwent vestibular testing and brain MRI with isotropic pulse sequence FIESTA-C and angiographic sequence (TOF) («DISCOVERY MR750W 3.0T» (GE, USA)). Results: Brain MRI revealed adherence of vessel to CVN in 30 (2.6%) patients. All the cases of neurovascular conflict (NVC) are represented by anterior inferior cerebellar artery (AICA). NVC on the right was found in 2 (40%) cases, on the left in 0 (33.3%) cases, bilateral NVC in 8 (26.6%). NVC classification (Sirikci, 2005). AICA loop surrounds CVN in 9 (30%), local NVC in the distal third of CVN in 7 (23.3%), local NVC in the proximal third of CVN in 0 (33.3%), longitudinal compression in the distal third of CVN in 5(6.7%), longitudinal compression in the proximal and the middle thirds of CVN in 4 (3.3%), compression and deformation of CVN in the middle third in 2 (6.75%) cases. Conclusion: Recurrent VD in 2.6% cases is caused by NVC. NVC may be depicted in detail by MRI. Application of NVC variants classification will help to standardise description of the revealed cases. 205 European Journal of Neurology, 22 (Suppl. ),

150 Flash Posters 633 F207 The 2D-MTA is a feasible method for assessing atrophy of the the medial temporal lobe in daily clinical practice M. Menendez Gonzalez, A. Fernández Oliveira, F. Conejo Bayón, J. Maese, T. Mesas Uzal Universidad de Oviedo, Oviedo, Spain Background and aims: Despite a strong correlation to severity of AD pathology, the measurement of medial temporal lobe atrophy (MTA) is not being widely used in daily clinical practice as a criterion in the diagnosis of prodromal and probable AD. This is mainly because the methods available to date are sophisticated and difficult to implement (volumetric methods) or lack objectivity (visual rating scales). In this pilot study we aim to describe a new method for measuring MTA and then assess its reproductibility. Methods: The 2D-MTA is a planimetric method consisting in measuring the area of 2 brain regions on one single MRI coronal slide and then use these data for calculating a simple substraction. The two areas are: () the MTL region (A); and (2) the parenchima within the medial temporal region (B) (Figure ). Therefrom, we can compute the 2D- MTA=(A B) 0. A series of 290.5T-MRI studies from 230 subjects ranging years, who had been studied for cognitive impairment were used in this study. 6 inexperienced tracers (IT) plus one experienced tracer (ET) traced the two areas needed to compute the 2D-MTA. The reproducibility was assessed using the Intraclass Correlation Coefficient (ICC)-Model 2. F208 MRI biomarkers in ALS patients V. Merkul, Y. Rushkevich, S. Likhachev, S. Antonenko Republican Research and Clinical Center of Neurology and Neurosurgery, Department of Neurology, Minsk, Belarus Background and aims: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease where motor neurons within the brain and spinal cord are lost, leading to paralysis and death. Reliable biomarkers for ALS are needed, given the clinical heterogeneity of the disease. Definition of neuroimaging features of degenerative process in ALS patients using multimodal magnetic resonance imaging (MRI). Methods: We examined 47 patients with ALS, the control group consisted of 35 patients without neurologic symptoms. The groups were matched by sex and age. Diagnosis of ALS was made by revised El Escorial criteria. Our research was made using the MRI Discovery MR750w 3.0T, General Electric (USA). Results: We revealed T2-weigted hyperintensities in medulla: the main group - 2 (24%) and control - 2 (5.7%) (p=0.028). We found similar changes on Flair T2-weigted in internal capsule - 48% in the main group and 25 (7.4%) in control (p=0.04); in medulla - (22%)/ (2.8%) (p=0.0), in precentral gyrus - 3 (26%) only in ALS patients (p=0,002). When using SWAN we found a reduced MRI signal from the precentral gyrus cortex, which is associated with the iron deposition, more often in ALS patients (33 (66%)/6 (7.%)) ( p=0.000). No significant changes in extramotor regions were found. Conclusion: We revealed MRI changes in medulla, precentral gyrus and internal capsule in ALS patients. Flair sequence is more sensitive in comparison to T2-WI in MRI in ALS patients. Our study revealed significant MRI abnormalities in ALS patients that can provide a noninvasive biomarker for ALS. The two areas needed for calculating the 2D-MTAi have been drawn in different colors: the medial temporal lobe region (A, red) and the parenchyma within the medial temporal region, that includes the hippocampus and the parahippocampal girus (B, blue) Results: Results show a intrarater ICC of 0.87 ( ) and a interrater ICC of 0.85 ( ). Conclusion: The 2D-MTA is a simple, objetive method for measuring MTA that has good to very good intrarater and interrater reproducibility and may be easily implemented in clinical practice even if new users have no experience tracing the area of regions of interest. 205 European Journal of Neurology, 22 (Suppl. ),

151 634 Flash Posters Cerebrovascular diseases 3 F209 Effects of nicergoline on vascular depression rat and the expressions of cerebral monoamine neurotransmitter receptors and apolipoprotein E4 L. Li, Y. Li Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine, Neurology, Lianyungang, China Background and aims: To explore the effects of nicergoline on vascular depression (VD) rats and the expressions of cerebral monoamine neurotransmitter receptors and apolipoprotein E4 (ApoE4). Methods: 48 rats were randomly divided into model group, fluoxetine group, nicergoline low-dose group, nicergoline mid-dose group, nicergoline high dose group and normal group. VD model rats were established by high-fat feeding and chronic unpredictable mild stress. The corresponding drugs or distilled water were given to each group for 2 days. Sucrose consumption test, open-field test were taken before and after the treatment. The expressions of 5-hydroxytryptamine A receptor (5-HTAR), Dopamine D2 receptor D2DR adrenaline α2a receptor α2aar) in hippocampus were detected by immunohistochemical staining and Western blot (WB), the ApoE4 was detected by Enzyme linked immunosorbent assay (ELISA). Results: Compare with the rats in normal group, the scores of open field and sugar consumption were significantly reduced in model rats (P<0.0). Except nicergoline low-dose group, treatment group exceeded significantly model group in those indices after the treatment (P<0.05~0.0) the differences between treatment groups have no statistical significance. The expression levels of 5-HTAR, D2DR, α2aar, ApoE4 in model groups was significantly higher than that in normal group, but except nicergoline low-dose group, the expression levels of these indices in each treatment group were significantly lower than that of model group (P<0.0),the differences between treatment groups have no statistical significance. Conclusion: Nicergoline showed the reverse effect on vascular depression model rats, the mechanism may be related to the decreased of 5-HTAR, D2DR, α2aar and ApoE4 in brain. F20 Systematic cardiovascular assessment in transient global amnesia B. Louise, E. Magnin, E. Medeiros de Bustos, C. Billon Grand 2, T. Moulin CHRU J. Minjoz, Neurology, Besançon, 2 CHRU J. Minjoz, Neuroradiology, Besançon, France Background and aims: Transient global amnesia (TGA) is a syndrome defined by the sudden onset of an isolated anterograde and retrograde amnesia, spontaneously resolved within less than 24 hours. Its aetiological mechanisms are still open to question. The aim of this study was to describe the MRI characteristics and the vascular assessment of a prospective cohort of patients presenting with TGA at the Besançon emergency services. Methods: This analysis included patients who presented with TGA between December 200 and November 20 at the Besançon emergency services and were given an emergency brain MRI. The TGA diagnosis was given on the basis of the clinical criteria proposed by Hodges and Warlow. The parameters studied were the demographic and clinical data, the brain MRI and the vascular assessment. Results: This analysis involved prospectively included patients with a mean age of 63 (50 76) and a sex ratio of :0. The TGA diagnosis was given on the basis of the clinical criteria proposed by Hodges and Warlow. The parameters studied were the demographic and clinical data, the brain MRI and the vascular assessment. Conclusion: If age, ictal onset and MRI anomalies during the TGA s acute phase are arguments in favour of a vascular mechanism, then there is no such evidence today. Despite its small population size, this study challenges the relevance of the completion of a systematic cardiovascular assessment after a TGA. It is no longer acknowledged as purely functional. It should perhaps be considered as a sign whose vascular aetiology must be urgently explored. 205 European Journal of Neurology, 22 (Suppl. ),

152 Flash Posters 635 F2 Epidemiology of stroke risk factors in Belarus H. Lushchyk, S.A. Likhachev The Republican Research and Clinical Center Of Neurology and Neurology, Neurology, Minsk, Belarus Background and aims: Stroke is one of the leading causes of death. Death rate from stroke in people of working age is particularly alarming. Studying the prevalence of stroke risk factors will help develop an optimal system for prophylaxis thus reducing morbidity and mortality from stroke. Objective: Study prevalence of stroke risk factors among people of working age. Methods: Using a specially developed standardized questionnaire card, the screening of open population was carried out. 277 people aged between 40 and 62 (mean age - 53 years), including 206 women (74%) and 7 men (26%) who lived in one district of Minsk were examined. Results: The following risk factors were revealed: Overweight - 89 people (68%), including 95 people with a BMI of and 94 people with a BMI 30. Family history of hypertension before the age of people (49%). Arterial hypertension 30 people (47%), including 5 people with hypertensive crisis in medical history. Hypodynamia 99 people (36%). Smoking 58 people (2%). Coronary heart disease 46 people (7%). Family history of stroke/ heart attack before the age of people (7%). Diabetes mellitus - 5 people (5%). Alcohol abuse 2 people (4%). Conclusion: The most common modifiable stroke risk factors in the studied population are overweight, hypertension and hypodynamia. Particularly disturbing is the fact that only 5% of patient with hypertension (68 people) regularly take antihypertensive medication. F22 The dynamics of neurological parameters in the most acute period of ischemic stroke in young patients of Kyrgyzstan. I. Lutsenko Bishkek, Kyrgyzstan Background and aims: Stroke in young patients has a variety of clinical manifestations. We aimed to evaluate young patients in the acute phase of different subtypes of ischemic stroke for prediction of its course and outcomes depending on etiology. Methods: An analysis of neurological status dynamics of acute ischemic stroke (IS) in 5 young patients, treated at 3 clinics in Bishkek, was done. For IS subtype classification we used TOAST criteria and etiological classification. Inclusion criteria were: age 8-45 years, IS within 36 hours from onset, supported with MRI or CT scan; 2-20 score on National Institutes of Health stroke scale (NIHSS). Patients were tested on Day and 0 according to NIHSS, Glasgow Outcome Scale, Barthel index, Mini-Mental State Examination, and complaints of headache, weakness in the limbs, imbalance, etc. noted. Results: We enrolled 30 men (58.8%) and 2 women (4.2%), 9 to 45 (34.9±.2) years. The distribution according to TOAST criteria was; large artery atherosclerosis 7 (3.7%), cardiogenic embolism 0 (9.6%), small artery occlusion 2 (3.9%), other known etiology 28 (3.9%) and unknown etiology 4 (7.8%). The patients with cardioembolic stroke on Day had moderate and severe strokes with level of consciousness from stupor to coma, while hemorheological, hemodynamic strokes, sinus thrombosis and stroke after brain vasculitis, had mild to moderate severity (p<0.05). Conclusion: Cardiac embolism and cerebral vessels vasculitis are the leading cause of IS in young patients. By the end of acute period of IS there is better outcome and recovery in hemorheological strokes, sinus thrombosis and vasculitis than in cardioembolic strokes. 205 European Journal of Neurology, 22 (Suppl. ),

153 636 Flash Posters F23 When a stroke is not just a stroke: MELAS syndrome presenting at the age of forty-nine C. Marques-Matos, J. Reis, C. Reis 2, L.M.C.A. Castro 3, M. Carvalho Hospital de São João, Neurology, Porto, Portugal, 2 Centro Hospitalar S. João, Neuroradiology, Porto, Portugal, 3 Hospital de São João, Pathology, Porto, Portugal Background: Mitochondrial encephalomyopathy lactacidemia and stroke-like episodes (MELAS) syndrome is one of the most common maternally-inherited mitochondrial diseases. However, its pleomorphic clinical manifestations and variable family history make the diagnosis sometimes elusive. The original diagnostic criteria for MELAS syndrome required stroke-like episodes before 40 years of age, encephalopathy characterized by seizures or dementia, and either blood lactic acidosis or the presence of ragged-red fibres in skeletal muscle biopsy. However, these criteria have recently been subject of much debate. Case Report: We report the case of a 54-year-old male presenting with progressive cognitive impairment from the age of 49 and a clear step-wise loss of function in relation to what seemed to be two previous cryptogenic ischemic strokes. He had no vascular risk factors apart from mild dyslipidemia and a past history of smoking. We excluded reversible causes of dementia and pursued the investigation for rare causes of stroke. Careful neuroimaging interpretation of evanescent lesions was highly suggestive of a metabolic disorder. Results: MELAS syndrome was finally diagnosed through typical pathological findings on muscle biopsy and genetic detection of the typical mtdna mutation 3242 A>G. Conclusion: This case highlights the need for a high level of suspicion in face of cryptogenic stroke in adult patients with few vascular risk factors, particularly when evanescent lesions are apparent, and the need for a revision of the MELAS syndrome diagnostic criteria to include presentations at an older age. F24 Case series and review of current practice of management of cerebral venous thrombosis in a tertiary neurology service in the United Kingdom J. McMinn, T. Lavin 2, M. Punter 2, M.W. Kellett 3 Pennine Acute NHS trust, Medicine, Manchester, United Kingdom, 2 Greater Manchester Neurosciences Centre, Neurology, Salford, United Kingdom, 3 United Kingdom Background and aims: We have recently expanded our service provision for patients with cerebral venous thrombosis and to review our current practice performed a retrospective analysis of patients admitted to our neurology unit. Methods: We performed a retrospective analysis of consecutive patients with CVT admitted to a tertiary adult neurology unit between January 202 to December 204. Demographics, time from symptoms to presentation and diagnosis, clinical features, aetiological factors, treatment and outcome are described. Results: 27 patients, 48.% female, had a mean age of 39. years (range 6-69). Mean time to presentation was 3 days (range 0-20) and from presentation to diagnosis (by computed tomography or magnetic resonance venography) was.9 days (range 0-8). The most common features were headache (92%), nausea/ vomiting (59%), seizure (44%), visual disturbance (30%), encephalopathy (22%), focal weakness (22%), papilloedema (9%), focal sensory changes (5%), cranial neuropathy (%) photophobia (%), hemi-neglect (7%), dysphasia (7%), and dyspraxia (7%). 67% had an identifiable risk factor, most commonly infection (26%), oral contraceptive pill (22%) and dehydration (9%). 26 out of 27 patients received anticoagulation in the form of heparin or warfarin; three patients required surgical intervention. At discharge 48.% of patients had no symptoms, 25.9% patients had minor residual symptoms (modified Ranking Scale (mrs) ), 8.5% mild disability (mrs 2) and 7.4% severe disability (mrs 4). Results Table Results Table 2 Results Table 3 Conclusion: These results reflect the variety of clinical features of CVT. A slightly higher level of morbidity was observed, perhaps reflecting bias of transfer to the centre. There were no deaths. 205 European Journal of Neurology, 22 (Suppl. ),

154 Flash Posters 637 F25 How can models of cost-effectiveness in TeleStroke be established? The five scenarios in the Franche-Comté experiment E. Medeiros De Bustos, B. Bouamra, M. Le Goff-Pronost 2, F. Vuillier 3, L. Bonnet, T. Moulin 4 CHU Besancon, Neurology, Besançon, France, 2 Institut Telecom, Bretagne, Département Logiques des Usages, Sciences Sociales et Sciences de l Information, Brest, France, 3 CHU Besancon, Neuro, Besançon, France, 4 Besançon, France Background and aims: While the scientific basis of telestroke is demonstrated, the development of telemedicine in stroke is still limited by medico-economic aspects. Our objective was to construct an operational model in telestroke based on our experience in the Franche-Comté region. Methods: Medico-economic evaluation of 5 different organisational scenarios for telestroke: the current model, comprised of 3 stroke units and 8 emergency services, all equipped with telemedicine tools; the model with alternating hubs; the stroke ward model (local units dedicated to stroke care and equipped with telemedicine tools); the model without telemedicine; and the model with 8 stroke units. Establishment of a model that takes into account patient management costs during the initial phase (from onset of clinical signs to hospital discharge) according to different financial sectors (transport, hospital personnel time, telemedicine tools, etc.). Comparison of the different models according to three criteria: economic, thrombolysis rates, and hospitalisation in a dedicated unit. Results: The main distribution of the 5 scenarios varied as follows: global costs by patient (acute phase) between 3,720 and 4,596 ; rate of thrombolysis between -32% and +0%; and hospitalisation between 62% and 90%. The three scenarios with telemedicine were all cheaper than those without, with savings of 350 to 850 per stroke patient. For a region with a population of million, the annual gain would be between 660,000 and,700,000. Conclusion: The scenarios with telemedicine, in particular those with the stroke ward model, reduce management costs whilst promoting care quality for all patients, including non-thrombolysed patients. F26 Pure thalamic infarcts: what s new? E. Medeiros de Bustos, E. Medeiros de Bustos CHRU J. Minjoz, Neurology, Besançon, France Background and aims: The aim was to compare a cohort of thalamic infarct confirmed by MRI to the first ever historical cohort described in 988 focusing specially on the long-term outcome. Methods: We studied retrospectively 55 patients with MRI proven thalamic infarcts (without involvement of superficial territory of posterior cerebral artery) hospitalised from 2003 to 2009 and registered prospectively in a hospitalar registry. The infarcts were classified in to 4 classic territories: inferolateral, tuberothalamic, posterior choroidal artery (PChoA) and paramedian territory. Risk factors, clinical presentation, etiology and long term outcome were collected and compared to the historical cohort. Results: Population s mean age was 70 years and 30 women were listed. The main risk factors were high blood pressure (56%) and hypercholesterolemia (3%). 35 patients suffered inferolateral infarcts, 2 tuberothalamic infarcts, 3 PChoA and 5 paramedian infarcts. As expected, clinical presentation did not differ from historical cohort. The most common etiologies listed were cardio embolism, large arteries atherosclerosis and microangiopathic infarcts. Only one death occurred at the acute phase. After an average of 4 months of follow-up, 0 patients died, one suffered a recurrence of stroke, another suffered myocardial infarct. The main complication of thalamic stroke was depression which occurred in 4 cases. Dementia is classic but finally occurred only in 6 cases. Dejerine Syndrome which is also classic was reported only in 3 cases. Conclusion: Thalamic infarcts are rare. Their clinical presentation has not changed significantly through the last 20 years. The outcome remains rather good and has not improved since European Journal of Neurology, 22 (Suppl. ),

155 638 Flash Posters F27 Epidemiology of stroke, subtypes and risk factors in northwestern Iran: a five year retrospective study K. Mehrvar, M. Aboutalebi, M. Rezaei, M. Farhoudi NSRC, Tabriz, Iran Background: Cerebrovascular accidents (CVAs) are the leading cause of disability and third leading cause of mortality in Iran. Approximately 80% of all stroke deaths occur in developing countries. Data on stroke epidemiology have so for been limited in Iran. To fill this gap, this study was designed to focus on stroke demographic data, risk factors, types and mortality. Methods: A retrospective study was done at Imam-Reza and Raazi hospitals, two university tertiary referral hospitals in northwestern Iran, from March 2008 to April 203. Demographic data, type of stroke, length of hospitalisation, stroke risk factors and hospital mortality were recorded for all the stroke suffering patients. Results: A total number of 5355 patients enrolled in the present study. Mean stroke age was 67.59±3.8 years old with 50.6% male gender dominancy. Among stroke-diagnosed patients 76.5% were ischemic stroke cases, 9.2% were subarachnoid hemorrhage (SAH) and 4.3% were intracerebral and intra ventricular stroke (ICH + IVH). Considering risk factors for stroke in this study include hypertension (68.8%), diabetes mellitus (23.9%), smoking (2.7%), hyperlipidemia (.4%), atrial fibrillation (4.8%), ischemic heart diseases (7.9%) and family history of CVA (.5%). Moreover, hospital mortality rate remains 20.5%. Conclusion: The epidemiologic study reveals ischemic stroke as the most prevalent stroke subtype. Actually like most of similar studies hypertension was included as the main risk factor for stroke related casualties. Considering high mortality rate and predominant role of hypertension among Iranian patients suffering stroke, preventive measures to control hypertension seems necessary. F28 Actovegin effect on cognitive outcome following forebrain ischemia in diabetic rats S. Meilin, Y. Berkovich, A. Rechstein 2, I. Woelfel 2 MD Bio Sciences, Ness Ziona, Israel, 2 Takeda, Tel Aviv, Israel Background and aims: The consequences of stroke with co-morbidity (diabetes) continues to place a significant socioeconomic and clinical burden worldwide, but effective neuroprotective treatments have so far eluded the medical community. This study was designed for testing the effect of Actovegin on cognitive impairment following global brain ischemia in diabetes rats. Methods: 40 young adult male Sprague Dawley rats had injection with 60mg/kg streptozotocin to induce diabetes. 4 days later, 25 rats underwent four-vessel occlusion (4VO), for a period of 5 minutes, to induce global cerebral ischaemia. 5 rats did not undergo vessel occlusion (Sham). Following surgery, rats were assigned to one of three groups: sham-operated, placebo or Actovegin treatment. Actovegin (200 mg/kg) and placebo (saline) were administered intraperitoneally once daily starting at six hours after ischemia. Learning and memory were evaluated using the Morris water maze tests at days post-ischemia. Results: A difference between the survival rate following Actovegin treatment and the placebo treated animals was reported (Sham group 73% survival. Placebo group: only 33% survival. Actovegin group: 52% survival). The main feature of 4VO is injury to the hippocampus leading to disabilities in special learning and memory. Learning test at days post-ischemia showed no effect of Actovegin. Memory test showed beneficial activity of actovegin (Time spent by the animals looking for the missing platform: sham group 3.0±2.0 sec. Placebo group: 5.8±.8 sec. Actovegin group: 9.69±.23 seconds; p<0.05 vs. placebo). Conclusion: Actovegin treatment led to increase in survival rate, and improvement of memory. Disclosure: Takeda 205 European Journal of Neurology, 22 (Suppl. ),

156 Flash Posters 639 F29 Painless paraplegia: a rare manifestation of acute aortic dissection O. Hdiji, E. Turki, I. Bouchhima, N. Bouzidi, M. Damak, M.I. Miladi, C. Mhiri Habib Bourguiba Hospital, Neurology, Sfax, Tunisia Background and aims: Acute aortic dissection is an extreme emergency that is generally manifested by violent chest pain irradiating to back and to abdomen. It can be rarely associated with neurological manifestations. We report a case of one patient with neurological signs revealing acute aortic dissection and discuss some particularities. Case Report: A 70-year-old man, with no previous known medical or chirurgical conditions, was hospitalised for brutal heaviness of the lower limbs associated to urinary retention. Neurological exam revealed flaccid paraplegia without sensory disorder. Acute spinal cord compression was initially suspected. Spinal magnetic resonance imaging (MRI), realized in emergency, was normal. The patient presented one day after his hospitalization a cardiopulmonary arrest. The autopsy report concluded to a cardiac tamponade related to an aortic dissection. Results: Acute aortic dissection can be associated with extra-thoracic complications. Neurological signs represent one of these complications, consisting on paraplegia, which are typically painful. Rare cases with painless paraplegia are described. The pathophysiologic mechanism is ischemic by thrombosis of intercostal, radicular or Adam- Kiewicz s arteries. Spinal MRI can be normal or showed spinal ischemia. Computed tomography (CT) or magnetic resonance (MR) angiography is the gold exam that confirmed the diagnosis. Conclusion: Acute aortic dissection is one of spinal cord ischemia s causes. It is an extreme emergency that can lead to death unless an early diagnosis. It must be suspected in any patient with paraplegia even painless, imposing the practice of CT or MR angiography. F220 Influence of the carotid atherosclerosis on the cerebral vasoreactivity M. Mijajlovic, M. Stojanovic 2, T. Pekmezovic 2, N. Sternic 2 Belgrade, Serbia, 2 Institute of Neurology, Belgrade, Serbia Background and aims: Many factors influence cerebral vasomotor reactivity (VMR), which reflects cerebral small vessels functional status, including morphological and functional parameters of large and small brain blood vessels. The aim of our study was to investigate correlation between VMR, and morphological and hemodynamic parameters of carotid arteries. Methods: In a retrospective cross sectional study we included 285 patients. Cerebral VMR was evaluated measuring breath holding test (BHI), while morphological and hemodynamic parameters of carotid arteries were measured using ultrasonic methods (intima-media thickness-imk, peak systolic velocity-psv, end diastolic velocity-edv). We also noted middle cerebral artery (MCA) hemodinamic parameters: mean flow velocity (MFV) and pulsatility index (PI). From medical records we collected information about age, gender, and vascular risk factors: hypertension, diabetes melitus, atrial fibrilation, cardyomyopathy, dyslipidemia, smoking. Results: Patients mean age was (25 males, 60 females). We found correlation between BHI and some vascular risk factors: age (r=-0.242, p<0.0), dyslipidemia (p<0.05) and hypertension (p<0.05). We also found negative correlation between BHI and presence of carotid plaques, and BHI and IMK (r=-0.203, p<0.0). Positive correlation between BHI left ACM and EDV left ACI (r=0.2, p<0.05) was registered. We also found negative correlation between BHI and PI ACM on both sides (r=-0.268, p<0.0). Conclusion: Our investigation shows correlation between cerebral VMR, and morphological as well as hemodynamic parameters in carotid arteries. Our results also show higher influence of morphological then hemodinamic parameters on VMR. 205 European Journal of Neurology, 22 (Suppl. ),

157 640 Flash Posters F22 Evaluation of cerebral hemodynamic changes using TCD and cerebral CT perfusion in patients with high grade internal carotid stenosis M. Militaru, A.G. Militaru 2, D. Lighezan, M. Simu 3 Municipal Emergency Hospital Timisoara, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, 2 Institute of Cardiovascular Diseases Timisoara, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, 3 University of Medicine and Pharmacy Victor Babes, Department of Neurology II, Timisoara, Romania Background and aims: This study aimed to evaluate the significance of cerebral hemodynamics parameters using cerebral CT perfusion (CTP) and Transcranian-Doppler (TCD) in asymptomatic/symptomatic patients with severe carotid stenosis (over 70%) candidates for (percutaneous (CAS) or surgical (CEA)) intervention. Methods: 0 patients with severe carotid stenosis with/ without signs of clinical organ damage were studied, versus 3 otherwise matched patients except carotid stenosis. We measured: Cerebral blood flow (CBF), cerebral blood volume (CBV), pulsatility index (PI), mean flow velocity (MFV), the calculated mean transit time (MTT), cerebrovascular reactivity to hypercapnia with the breath-holding-index (CVR), in the middle cerebral artery (MCA) with CTP, TCD. These values were correlated with the neurological symptoms and severity of carotid stenosis. Results: 7 (70%) of the study patients were symptomatic, 5 (50%) with ischemic stroke (Rankin>2), 4 (40%) had coronary disease, 6(60%) had CEA and 4 (40%) CAS. There were significantly lower values in patients with carotid stenosis comparet to controls - CBF, MFV(cm/s) (32.4±6.4) (p<0.00), CVR (%/s) (0.67±0.2) (p<0.05) and higher MTT (0.4±0.5 s values). CVR(%/s) (0.62±0.) and CBF (ml/00g/min) (0.78±0.2) were lower in symptomatic versus asymptomatic patients and also when carotid stenosis is over 90% (CVR 0.59±0.08) and CBF (0.77±0.3 respectively). Conclusion: Cerebral hemodynamic parameters using ultrasound and imaging of MCA correlate, both to the severity of carotid stenosis and to the association of coronary and peripheral artery involvement. These parameters can therefore decide the type intervention (CAS/CEA) and/or association of coronary or peripheral intervention. F222 Giant pseudoaneurysm of external carotid artery: a case report M. Milosevic, H. Budincevic Department of Neurology, Zagreb, Croatia Background: An 85-year-old male patient presented to our department with sudden onset of dysarthria, accompanied with confusion. During somatic status examination, a large palpabile pulsatile mass on the right side of the neck was found. The dimensions were about 5cm. Initially the otolaryngologist diagnosed it as a tumorous mass in parapharyngeal space, that should be punctured, but due to patients current condition we have postponed it until he becomes stabile. Computed tomography of the brain showed hypodensity in the right parietooccipital part of the brain. Ultrasound of carotid arteries showed an occlusion of the right internal carotid artery, which was probably caused by compression with a tumorous mass, that was diagnosed as giant pseudoaneurysm of the right external carotid artery, bacause of the arterial blood flow into the pseudoaneurysm. CT angiography and magnetic resonance of neck vessels also showed compressed right internal carotid artery with large pseudoaneurysm of the external carotid artery. Methods: During treatment the neurological deficit regressed, and surgical treatment was suggested, but the patient refused any further treatment. Results: Surprisingly 7 months later the same patient was admitted to our department, with left hemiplegia and ipsilateral central facial palsy. CT of the brain showed large zone of hypodensity in the right parietooccipital and temporal part of the brain. His condition was complicated with uroinfection and right sided pneumonia. Conclusion: Suitable antibiotics according to the antibiogram were given along with antihypertensive and antithrombotic therapy, with intravenous solutions. Despite the therapy and given healthcare, the patient passed away. 205 European Journal of Neurology, 22 (Suppl. ),

158 Flash Posters 64 F223 Clinical-pathophysiological mechanisms of formation of post-stroke pain T.S. Mishchenko, O. Kutikov, N. Balkova Kharkiv, Ukraine Introduction: Post-stroke pain (PSP) occurs during the st year after stroke in up to 20% of patients. This pain is a significant burden for the patients, as it decreases their quality of life and results in problems of rehabilitation. So, the aim of this study was to investigate a prevalence, risk factors, clinical peculiarities, and pathophysiological mechanisms of PSP. Methods: 32 patients with PSP were assessed with clinical and neuroimaging methods and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, Visual Analogue Scale, Mini-Mental State Examination (MMSE) scale, Frontal Assessment Battery (FAB), and Hamilton Rating Scale for Depression (HRSD). Results: In the examined patients 4 PSP types were determined: central PSP (6.7%), pain associated with joint and locomotor impairments (73.3%), headache (3.3%), and pain spasticity (56.7%). Patients with PSP demonstrated cognitive impairments in 76.6% with mild to moderate level in 73.3%. These patients also had a significantly depressed mood. A combination of chronic pain and depressed mood in the post-stroke period resulted in a formation of specific conditions basing on a vicious circle where pain and depression reinforced one another. In patients with PSP MRI showed a localization of stroke predominantly in thalamic and right middle cerebral artery territories. Conclusion: Formation of PSP did not depended on a size of nidus, but it depended on the stroke localization, levels of cognitive impairments and depression. 205 European Journal of Neurology, 22 (Suppl. ),

159 642 Flash Posters Headache and pain F224 Effect of manipulative therapy in combination with kinesio taping on low back pain and dynamic changes of somatosensory-evoked potentials L. Anatskaia, T. Svinkovskaya, V. Zabarovski The Republican Research and Practical Center of Neurology and Neurosurgery, Department of Neurology, Minsk, Belarus Background and aims: This study was conducted in order to evaluate the response of pain and dynamic changes of somatosensory-evoked potentials (SEPs) to manipulative therapy (MT) in combination with kinesio taping (KIT) in patients with subacute low back pain. Methods: The N9, N3, N20 latency and N9-N3, N3- N20, N9-N20 interpeak SEPs values, obtained during median nerves stimulation, and N22, N30, N38 latency and N22-N30, N30-N38, N22-N38 interpeak SEPs values, obtained during tibial nerves stimulation and amplitude of the N20-P23, P38-N46 were evaluated in 7 patients between years of age with subacute low back pain before the first and after the last session of MT with KIT. Results: Significant decrease of low back pain severity was determined after course of treatment, p<0.05. The decrease in the N3 latency values (p<0.05), N9-N20, N3-N20 interpeak values (p<0.05), in the N30, N38 latency values (p<0.05) and in the N22-N30, N30-N38, N22-N38 (p<0.05) interpeak values after treatment compared to pre-treatment course SEPs values was revealed. Significant increase in the amplitude of the cortical SEPs N20-P23 and P38-N46 during median and tibial nerves stimulation (p<0.05) was also obtained. Conclusion: Our study demonstrated that nociceptive afferent impulses produced by combined application of MT and KIT in low back pain lead not only to a significant decrease of pain intensity but also significantly increase speed of sensory pulses conduction from lumbar spinal cord to the primary sensory cortex; from cervical spinal cord to cortical levels and amplitude of the cortical SEPs, improving the brain neuroplasticity and preventing chronicity of pain. F225 Prevalence of pain in patients with multiple sclerosis and its association with anxiety, depressive symptoms and quality of life B. Labuz-Roszak, K. Kubicka-Baczyk, K. Pierzchala, A. Majewska, A. Matejczyk, M. Roszak 2 Medical University of Silesia in Katowice, Clinical Department of Neurology, Zabrze, Poland, 2 Silesian University of Technology, Gliwice, Poland Background and aims: Pain is one of the most frequently reported symptoms of multiple sclerosis (MS). It affects the daily functioning of patients, limiting the ability to work, and reduces the joy of life. Aim: Analysis of the impact of pain on quality of life and symptoms of anxiety and depression in patients with MS. Methods: The study included 44 patients with diagnosed MS (mean age 4±2 years, mean disease duration 7.4±7.2 years). The study was conducted on the basis of the author s survey on current and previous pain, EuroQol 5D quality of life self-esteem questionnaire and the Hospital Anxiety and Depression Scale (HADS). Results: Among all respondents, 7 people (8.3%) reported current pain, and 20 patients (83.3%) declared the occurrence of pain in the past. Currently, patients have reported: pain in one or more extremities-79 people (54.9%), headache and facial pain-72 (50%), back pain-72 (50%), painful muscle spasms-54 (38.6%), pain in eyeball-37 (25.7%), Lhermitte s sign-32 (22.2%). Patients who reported pain significantly more frequently experienced symptoms of anxiety (p<0.0) and depression (p<0.0), and had significantly worse quality of life (p<0.0). An association between presence of pain and gender (p<0.0), age (p<0.05), disease duration (p<0.00), the degree of disability (p<0.05), and the presence of a job (p<0.0) was found. Conclusion: Pain in MS patients is associated with anxiety and depression, and worse quality of life. Female sex, older age, longer disease duration, greater disability, and lack of occupational work predispose to the occurrence of pain in MS patients. 205 European Journal of Neurology, 22 (Suppl. ),

160 Flash Posters 643 F226 Greater occipital nerve anesthetic blockade as transitional preventive therapy in cluster headache E. Martínez Velasco, M. Ruiz, M. de Lera, P. Mulero, L. López-Mesonero, M.S. Hernández 2, J. Barón 3, C. de la Cruz, A.L. Guerrero Valladolid Hospital, Neurology, Valladolid, Spain, 2 Clinic Hospital, Psychiatry, Valladolid, 3 Clinic Hospital, Neurophysiology, Valladolid, Spain Background and aims: A short-term prophylactic treatment including oral corticosteroids should suppress attacks in cluster headache (CH) patients, but they are limited by potential side effects. Greater occipital nerve (GON) blockade has been proposed as an alternative for transitional preventive therapy in CH. Methods: We prospectively assessed consecutive patients diagnosed with episodic CH attending during a cluster period (January January 205). Occipital blockades were carried out at one-third of the distance between external occipital protuberance and mastoid process, always bilaterally. We injected 2cc of a local anesthetic, and added in some cases triamcinolone. Short-time efficacy was assessed one week after the procedure and was rated as complete (immediate end of cluster period), partial (decrease of at least 50% of attacks) or null (no improvement or decrease of attacks less than 50%). Results: We included 5 cluster periods in 33 patients (3 females, 30 males). Mean cluster period order was 7.3±4.9 (range: -20) with a mean of painful days of 22.3±6.2 (5-90). Procedure was well tolerated in all cases. In 0 blockades (9.6%) the patient was previously receiving oral corticosteroids and triamcinolone was added in 8 procedures (5.7%). After 22 blockades (43.%) a total relief was achieved and partial response was observed with 7 procedures (33.3%). We did not find any correlation between response to blockade and cluster period order, number of painful days, previous oral corticosteroids or triamcinolone adding. Conclusion: GON blockade is a fast and safe technique that should be considered as a transitional preventive therapy in CH. F227 Opioids for chronic non-cancer pain: the other side of the pond. S. Montella, M. Allegri 2, M. Baciarello 2, C. Compagnone 2, M. Marchesini 2, C. Dagostino 3, W. Raffaeli 2, C. Vellucci 2, G. Fanelli 2 Federico II University, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Naples, 2 University of Parma, Anesthesia, Critical Care and Pain Medicine Unit, Department of Surgical Sciences, Parma, 3 Magna Graecia University, Interregional Research Center for Food Safety & Health (IRC FSH), Catanzaro, Italy Background and aims: Opioids are important therapeutic options for pain. Their use and abuse are topics of intense controversy. Recent statement of the American Academy of Neurology (AAN) about the use of opioids in USA expresses growing concerns and alerts clinicians worldwide on their prescription. Alarming estimates of the AAN, however, may not be representative of the European countries. Methods: We reviewed recent literature about opioids misuse in USA and Europe. Results: Average consumption of opioids is higher in the USA than in Europe: 39,487 defined daily doses/million inhabitants/day in the USA, 9,000 in Germany, 3,000 in Denmark. In USA, prevalence of non-medical use of prescription opioids was 4.5%. USA alone represents 83% of the world oxycodone s consumption and 99% of hydrocodone s. Conversely, European Drug Report confirms that average annual prevalence of opioids misuse is around 0.4% in Europe and illicit heroin use remains the major cause for opioid-related morbidity and mortality. Conclusion: The recent AAN statement describes the opioid epidemic as a worldwide situation. It suggests to adopt restrictive behaviors in their prescription. The situation, however, is different in Europe, where allowed but controlled prescriptions do not correspond to increased illicit use. The AAN position paper opens a huge challenge in finding the balance between minimizing opioids risks and reducing pain treatment. The only effect of the AAN statement could be a reduced access to pain medication against the WHO indications for chronic pain patients. 205 European Journal of Neurology, 22 (Suppl. ),

161 644 Flash Posters F228 Personality assessment in chronic migraine: MMPI-2 results in a series of 24 patients I. Muñoz, M.S. Hernández, E. Dominguez, E.M. Sotelo, M. Ruiz Piñero 2, G. Isidro, E. Mayor, V. Molina, A.L. Guerrero 2, F. Uribe Clinical Hospital, Psychiatry, VALLADOLID, 2 Valladolid Hospital, Neurology, Valladolid, Spain Background and aims: Pathogenic role of personality characteristics in migraine is still under discussion. A higher neuroticism score in migraineurs comparing with control subjects has been described. We aim to identify personality profiles of chronic migraine (CM) patients. Methods: Patients consecutively attended in an outpatient headache office. CM diagnosed accordingly to ICHD-III. We administered six-item Headache Impact Test (HIT-6) and Hospital Anxiety and Depression Scale (HADS). Personality was assessed using the revised Minnesota Multiphasic Personality Inventory (MMPI-2), a 567-item, truefalse questionnaire that evaluates personality on 3 validity scales and 0 clinical scales. All subjects were migrainefree on the day of evaluation. Results: 24 patients (2 male, 22 females). Age at inclusion 39.±9.3 years (range: 23-6). Time from CM onset 39.4±46.8 months (6-80). Mean HIT-6 score 63.5±6 (49-76); in 20 patients (83.3%) severe headache-related impact (HIT-6 60). Scores of 6.9±3.5 (0-4) in HADS-Anxiety and 2.3±2.4 (0-8) in HADS-Depression. No patient met criteria for depression and 3 (2.5%) for anxiety. Scores for validity scales of the MMPI-2 were within the norm for all patients. 2 cases (50%) met criteria for hypochondriasis, 4 (6.7%) for depression and 8 (33.3%) for hysteria. In 8 patients (33.3%) two or more profiles of this classic neurotic triad were present. Finally 9 migraineurs (37.5%) were concerned about their physical health. Conclusion: Alterations in classic dimensions of personality in CM patients assessed with MMPI-2 are not uncommon. Correlation with headache severity and CM duration should be assessed on larger series. F229 The number of active trigger points is associated with physical aspects of health-related quality of life in tension type headache M. Palacios-Ceña, S. Ambite-Quesada, A.L. Guerrero 2, C. Ordás-Bandera 3, A. Guillem-Mesado 4, A.B. Caminero 5, J. Baron Sanchez 2, L. Arendt-Nielsen 6, C. Fernández-de-las-Peñas Rey Juan Carlos University, Phisioterapy, Madrid, Spain, 2 Clinical Hospital of Valladolid, Neurology, Valladolid, Spain, 3 Rey Juan Carlos Hospital, Neurology, Mostoles, Spain, 4 Gregorio Marañon Hospital, Neurology, Madrid, Spain, 5 Complejo Asistencial de Avila, Neurology, Avila, Spain, 6 Aalborg University, Center for Sensory Motor Interaction, Aalborg, Denmark Background and aims: Some evidence supports that referred pain elicited by active trigger point (TrPs) reproduces features of tension type headache (TTH). No study has investigated the association of active TrPs with health-related quality of life in TTH. Our aim was to investigate the association between the number of active TrPs and healthrelated quality of life in TTH. Methods: Women with TTH diagnosed by experienced neurologists according to International Headache Classification (ICHD-III) were included. Exclusion criteria included other primary headaches, medication overuse headache, whiplash or fibromyalgia. TrPs were bilaterally explored within the masseter, temporalis, trapezius, sternocleidomastoid, splenius capitis, and suboccipital. Health-related quality of life was assessed with the SF-36 questionnaire including 8 domains: physical functioning, physical role, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Higher scores represent better quality of life. Spearman correlation coefficients were used to determine correlations between the number of active TrPs and domains of the SF-36. Results: 52 women (age: 49, SD: 3) with a frequency of 6 days/month (SD: 8) participated. Each women with TTH exhibited 3.8±2.3 active TrPs. The number of active TrPs showed moderate negative associations with physical functioning (rs: -0.39; P=0.025), physical role (rs: ; P=0.046), and bodily pain (rs: -0.33; P=0.029), but not with the remaining domains: the higher the number of active TrPs, the worse the physical function, physical role and pain. Conclusion: The number of active TrPs was associated with physical aspects of quality of life in a cohort of women with frequent episodic or chronic TTH. 205 European Journal of Neurology, 22 (Suppl. ),

162 Flash Posters 645 F230 Pathophysiology of idiopathic intracranial hypertension E. Predtechenskaya, N. Mesropyan, O. Bogomyakova, A. Tulupov Novosibirsk, Russian Federation Background and aims: To evaluate effect of hyperprolactinemia on velocity characteristics of cerebrospinal fluid (CSF) flow by data of phase contrast MRI. Methods: 5 patients with hyperprolactinemia underwent routine MR imaging and CSF velocity phase-contrast MRI. This method allows to visualise the liquor flow without contrast inception. Average prolactin level for females (within the follicular phase of the menstrual cycle) is 250mkME/ ml, for males 800mkME/ml. 5 patients appeared to have pituitary microadenomas, without ventricular system compression. Were observed velocity value of CSF flow on interventricular foramina, foramen magnum levels. The calculated mean velocities, mean flux were compared with control group (60 healthy volunteers) Results: Analysis of differences between respective mean values of CSF flow has shown that CSF flow characteristics in patients with hyperprolactinemia had significantly lower values of mean velocity and mean flux, than in the group of healthy volunteers at the foramen magnum level. Mean flux is 2 times lower, mean velocity indicators are 5 times lower. At the level of interventricular foramina mean flux is 2 times higher; mean velocity indicators are 3 times higher. Conclusion: In patients with moderate hyperprolactinemia have a changed velocity on interventricular foramina, significantly higher, which is an evidence of hypersecretion of CSF. The rate of CSF flow is significantly reduced at the level of foramen magnum, which is an indirect evidence of reduced outflow and CSF volume expansion. These changes may explain the influence of prolactin on the development of idiopathic intracranial hypertension and on data from the significance of prolactin as an osmoregulator. F23 Molecular genetic polymorphism of MMP 3 in patients with migraine. G. Rakhmatullaeva, K. Khalimova, R. Matmurodov 2 Tashkent Medical Academy, Neurology, Tashkent, 2 Tashkent, Uzbekistan Background and aims: To identify the molecular genetic polymorphism of MMP 3 in patients with migraine. Methods: The analysis of the results of the genetic polymorphism of MMP 3, in patients with migraine. Results: 30 patients with migraine frolicking in the background anomalies of cerebral vessels were produced molecular genetic survey identifying gene polymorphisms MMP 3 Mean age 36.±.02 years: men -, women - 9. Of these, 7 (20%) of the patients with uncomplicated form of migraine, the remaining 23 (80%) patients with migraine complicated with chronic cerebral ischemia. Examinees normal 6a/6a genotype was found in 5 (50%) patients, adverse 5a/5 a homozygous genotype in 7 (23.3%) and heterozygous 5a/genotype 6a in 8 (26.6%) patients. When comparing the genotypes of patients with migraine showed that adverse homozygous 5a/5a genotype occurs mostly in patients with complicated chronic cerebral ischemia, whereas heterozygous 5a/6a genotype with uncomplicated forms. Analysis of the genotypes of MMP depending on the anomalies revealed that the deformation of cerebral vessels by type coiling found heterozygous 5a / genotype 6a in (26.6%) cases, with kinking adverse 5a/5a homozygous (23.3%) cases. In this case, the normal 6a/6a genotype was present in half of patients with vascular anomalies of the vertebral arteries, but the strain of the vertebral arteries frolic on the background of osteochondrosis of the cervical spine. Conclusion: The homozygous unfavorable 5a/5a genotype characteristic of migraine on the background of cerebral vascular anomalies, complicated with chronic cerebral ischemia. 205 European Journal of Neurology, 22 (Suppl. ),

163 646 Flash Posters F232 Molecular genetic polymorphism of MMP 9 with and without a cephalalgia background anomaly, as well as without it. G. Rakhmatullaeva, K. Khalimova, R. Matmurodov 2 Tashkent Medical Academy, Neurology, Tashkent, 2 Tashkent, Uzbekistan Background and aims: To identify the molecular genetic polymorphic variant A8202G metalloproteinase MMP9 gene. Methods: The analysis of the results of the genetic polymorphism of MMP 9 To date, we have carried out the molecular genetic study of 46 (00%) in patients with cephalalgic syndrome on the background of anomalies and without abnormalities of cerebral vessels, as well as 20 healthy individuals of Uzbek nationality. At the same time, male patients was 5 (32.6%), mean age 48.2±.5 years. 3 women (67.4%), mean age 40.9±.0 years. Results: The analysis of the data of molecular genetic studies of polymorphism 562 C/Tw matrix metalloproteinase 9 gene identified in 8 (39.%) cases had normal, 20 (43.5%) heterozygous mutation in 8 (7.4%) homozygous. Thus, patients with cephalgic syndrome but without cerebrovascular abnormalities detected in normal type 6 (50%) of cases, while in 4 (33.3%) heterozygote, 2 (6,6%) mutation. In patients with secondary headaches, namely circulatory encephalopathy, even in the presence of anomalies in 5 (3.2%) cases revealed normal type, 9 (56.2%) heterozygous and 2 (2.5%) mutation. In patients with migraine amid cerebrovascular abnormalities found in 7 (46.7%) cases, the normal type of three (20%), and mutation in 5 (33.3%) heterozygous type, while in the group of patients without cephalalgia, but with abnormalities of cerebral vessels in 2 (66.7%) heterozygous mutation in one or 33.3% cases mutational variant. Conclusion: The absence of deformation in the vessels of the brain does not exclude the possibility of mutations in the gene MMP9, conversely the mutation is a risk factor for CVD. F233 Flexion relaxation ratio, neck posture, joint position error, and pressure-pain thresholds following computerized mobilization of the cervical spine for the treatment of chronic neck pain Y. River Israel Background and aims: Two previous studies showed that computerized mobilization of the cervical spine, a novel therapy, is safe and potentially effective treatment of chronic neck pain and associated headache (River et al. Clin. J. of Pain 202; River et al. Pain Medicine 204). Objective: Investigate several physiological measures following individualized, computerized mobilization of the cervical spine in a three dimensional space for the treatment of chronic neck pain. Methods: Pilot, open trial. Participants: 9 patients with chronic neck pain. A control group without neck pain for the assessment of flexion relaxation ratio, Intervention: A computerized cradle capable of 3-dimensional neck mobilization was utilized. Treatment sessions lasted 20min, biweekly, for 6 weeks. Main outcome measures: Pain visual analog scale (VAS), cervical range of motion (CROM), neck disability index (NDI), joint position error (JPE), Pressure pain thresholds (PPT), Forward neck tilt (FNT), and flexion relaxation ratio (FRR) measured by surface EMG. Results: Comparing baseline at week with week 6 and week 2, the VAS scores dropped by 2.3 points (p=0.040). CROM increased by % (p=0.06). NDI decreased from 5.42 to 9.42 (p=0.086); JPE decreased from 2.88 to.4 (p<0.0); PPT increased from.27kg/cm 2 to 2.44Kg/cm 2 (p=0.043); FNT decreased from 20.36cm to 9.02cm (p=0.04). Left sided FRR significantly increased (P=0.07). Conclusion: Preliminary physiological evidence suggests that individualised computerised, 3-dimensional cervical mobilization positively changes neck posture, cervical neuromuscular control, and the processing of nociceptive and proprioceptive information. Disclosure: I am a share holder of Headway company that developed the Occiflex device 205 European Journal of Neurology, 22 (Suppl. ),

164 Flash Posters 647 F234 Chronic migraine with or without medication overuse headache: prevalence, preventive treatments and efficacy. H. Santos-Canelles Coaña, Spain Background and aims: Chronic migraine (CM) is a very common reason for medical consultation in neurology outpatient clinics. Many of those patients also meet criteria for medication overuse headache (MOH) according to ICHD- 3beta criteria. Methods: A 24-month retrospective study of patients with chronic daily headache (CDH) from the hospital outpatient clinic was performed. The frequency of chronic migraine (CM) with or without MOH was determined. Demographic data were also analysed as well as concomitant diseases, analgesics intake associated to MOH, medical preventive treatments prescribed and their effectiveness. Results: Over the length of the study, 34 patients were diagnosed with CDH, most frequently CM (53.73%). 50% of patients with CM accomplished criteria for MOH. Mean age at first visit was 45 years and the male/female ratio was /6. Most frequent concomitant diseases were: hypertension, deppresion, dyslipidemia, thyroid diseases and asthma. Frequently consumed analgesics in MOH were: combinations (50%), acetaminophen and NSAIDs (37.5%), ergotics (2.5%) and triptans (9.4%). All patients were prescribed preventive treatments, most commonly antiepileptics (44%, mainly topiramate), amytriptiline (3,9%), beta-blockers (6.7%) and flunarizine (6.7%). Preventive treatment was effective in 53.9% and failed in 39.7% (48% of them had MOH and 52% did not). Conclusion: CM shows to be a common cause of CHD as in previous studies. A high percentage of patients also accomplish criteria for MOH. In this study both groups (with and without MOH) responded to preventive treatment in a similar percentage. Follow-up studies with a higher number of patients should be performed to reach more conclusive results. F235 Intracranial hypertension in Gorlin Syndrome S. Sousa, C. Carmona, F. Pita Hospital de Cascais, Neurology, Cascais, Portugal Background and aims: Gorlin syndrome (GS) is a rare inherited multisystem disorder due to germline mutations in the human homolog of the patched (PTCH) gene. The diagnosis is a clinical one, molecular findings are used to support it. Case Report: A 37-year-old woman come to our department in February 204, with complaint of headache sometimes with vomits with no postural association, terminal insomnia, and concentration problems, initiated one month ago. She gave a medical history of odontogenic keratocysts, palmar pits, and bilateral ovarian fibromas. Neurological examination was normal, include ocular fundus examination. A tension headache and depressive syndrome were admitted. Cerebral CT showed exuberant calcification of falx cerebri and tentorium cerebelli. Calcium metabolism study was normal. The presence of intracranial ectopic calcification in association with odontogenic keratocysts, palmar pits, bilateral ovarian fibromas support criteria for diagnosis of GS. To exclude brain tumors or cysts reported in GS or cerebral venous thrombosis, she realized a brain MRI that was normal. She initiated treatment with SSRI, mexazolam and trazodone. Months later, the patient maintains the symptoms. Lumbar puncture was performed; CSF opening pressure was 30 cmh2o without cytological abnormalities. A complete ocular exam was normal. No causes of intracranial hypertension were evident. She began treatment with topiramate with improvement. Conclusion: The intracranial hypertension is common in GS by association with brain tumors or hydrocephalus. This is the first described case of idiopathic intracranial hypertension like syndrome in GS, taking on the possible role of GS on cerebral fluid dynamics. 205 European Journal of Neurology, 22 (Suppl. ),

165 648 Flash Posters F236 Frontal intermittent rhythmic delta activity as diagnostic method in migraine headaches E. Suljic, N. Polimac 2, A. Mehicevic Clinical Center University of Sarajevo, Department of Neurology, Sarajevo, 2 General Hospital Sarajevo, Neurology Department, Sarajevo, Bosnia and Herzegovina Background and aims: EEG is still a very useful method to diagnose not only epilepsy, but also headaches. Discovery of frontal intermittent rhythmic delta activity (FIRDA) gave new opportunities in terms of differential diagnostic distinction of primary headache. To determine it theta and frontal intermittent rhythmic (Delta) Activity (FIRDA) is encountered significantly more in migraine headaches and if they correlate with the clinical manifestations of migraine. Methods: Research was conducted at Department of Neurology EEG Cabinet from to The study included 50 patients with migraine and 50 patients who have a headache, which does not have the character of migraine in the control group. Results: In the group of migraine headaches relationship between women and men is 2.57:, the average age of the respondents was Significantly more frequent were unmarried (27%) and respondents with a university degree (20%). Theta activity and FIRDA were significantly more frequent in migraine group (Theta 22%, FIRDA 7%) as well as in all clinical forms of migraine, while in patients who have migraine headaches for more than five years FIR- DA significantly more represented with 24%. Conclusion: EEG analysis showed significantly more frequent Theta activity and FIRDA in patients with migraine headaches with the FIRDA highly specific for migraine because it does not appear in the non migraine primary headaches. Disclosure: This research has not been granted any commercial or institutional support F237 Simplification of the migraine diagnostic criteria devised from its characteristics in the international classification of headache disorder III beta (ICHD III beta) K. Takagi, R. Hishida, S. Nojima, H. Kobayashi, K.Y. Yamazaki Tokyo Medical University Ibaraki Medical Center, Department of Neurology, Inashiki-gun, Japan Background and aims: The migraine diagnostic criteria are not easy for general practitioners and patients in the international classification of headache disorder III beta (ICHD III beta). We devised simplification of the migraine diagnostic criteria from its characteristics and tension-type headaches criteria s one in ICHD III beta. Patients and Methods: Our method diagnoses a headache as a migraine, when the headache correspond four items of all eight items in C and D parts in diagnostic criteria for migraine in ICHD III beta; unilateral location, pulsating quality, moderate or sever pain intensity, aggravation by or causing avoidance of routine physical activity, nausea, vomiting, photophobia and phonophobia.we studied the accuracy of our method retrospectively for already diagnosed 0 outpatients based on ICHD III beta from April 2007 to December 2007 (30 males, 7 females, with an average age of 43.9 years, including suspicious patients). In this study the results of accuracy of our method are under conditions that we should be able to diagnose precisely about A, B and E parts. Results: Of 0 patient cases, 55 had migraine, 4 had tension type headaches and 32 had other headaches based on ICHD III beta. Using our simplified diagnostic method, we could diagnose 4 tension type headache patients and 48 migraine patients correctly, but we misdiagnosed 7 migraine patients as tension type patients (the specificity was 00% and the sensitivity was 87%). Conclusion: We think our simplified diagnostic method is useful for general practitioners and patients. 205 European Journal of Neurology, 22 (Suppl. ),

166 Flash Posters 649 F238 Headache and EEG, hype-hope and hazard K. Tawfik Cairo, Egypt Background and aims: Headache disorders are clinical syndromes defined by historical criteria. The EEG is not included in the diagnostic criteria of the International Headache Society for migraine or other major headache categories. Objective: Studies designed to determine whether headache patients have an increased prevalence of EEG abnormalities report conflicting results. By this study we are trying to spot light and solve this dilemma, knowing that the only well-matched controlled studies to address this question found that there was no increased prevalence of EEG abnormalities in patients with headache. Methods: This is a retrospective observational study upon our database of routine EEG recorded between Sept.204 and Dec EEG records have been screened of which only 29 records with a primary complaint of headache were analysed. Results: Headache as a primary complain represents 3% of the total causes for which the EEG to be ordered. The reported numbers of definitely abnormal EEG rhythms in patient suffering from headache have been consistently low (3.4%) in routine EEG. Conclusion: Similar to other studies; EEG did not improve the diagnostic accuracy for the headache patient in our study. F239 Frontal thermography in healthy individuals and headache patients: reliability of the method C. Voiticovschi Iosob, F. Antonaci 2, E. Rossi 3, A. Costa 2, G. Sances 2, G. Dalla Volta 4 State Medical and Pharmaceutical University Nicolae Testemitanu, Chisinau, Moldova, and University of Pavia, Italy, Pavia, Italy, 2 Pavia Headache Centre, C. Mondino National Institute of Neurology Foundation, IRCCS, Dept. of Brain and Behavioral Sciences University of Pavia, Pavia, Italy, 3 Politecnico di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Milan, Italy, 4 Istituto Clinico Città di Brescia, Centro Cefalee, Brescia, Italy Background: Infrared thermography detects infrared lights emitted by the body to visualise changes in temperature due to abnormalities in the surface blood flow of affected areas. This method may aid in the diagnostic process in pain medicine. Aim: To assess the reliability of human body temperature measurement by means of Frontal Infrared Thermography (FIT). Methods: 35 right handed volunteers (26 F and 9 M) with a mean age of 35±.6 years were evaluated. 5 out of 35 subjects were headache patients. FIT has been assessed with an infrared thermal camera (model LT3, Zhejiang Dali Technology Co. Ldt). The image analysis evaluated the temperature in two target points in the frontal polar sites. The measurements were performed in two separate sessions (T and T2), and each session was the mean of three separate measurements. The Asymmetry Index, ANOVA way, intra-class correlation coefficient and Pearson s correlation coefficient for the T were calculated. ANOVA 2 way was used to compare the measurements between T and T2. Results: The analysis of variance did not show statistically significant difference between three consecutive measurements during the T and T2. The best reliability was found between the second and the third measurement. The statistical test ANOVA 2 way did not revealed intra-individual test-retest variations. No correlation was found between FIT and other variables. Thermography.JPG Conclusion: FIT can be considered an effective method for the temperature evaluation in controls and headache patients. 205 European Journal of Neurology, 22 (Suppl. ),

167 650 Flash Posters Movement disorders 3 F240 Abstract cancelled F24 Abstract cancelled F242 On the basis of slow pursuit eye movements (POM) responses machine learning (ML) predicts UPDRS and symptoms development in individual Parkinson s disease (PD) patients A. Przybyszewski, S. Szlufik 2, J. Dutkiewicz 2, P. Habela, D. Koziorowski 2 Polish-Japanese Academy of Information Technology, Informatics, Warsaw, Poland, 2 Medical University Warsaw, Neurology, Warsaw, Poland Background and aims: L-DOPA as well as DBS has been shown to improve peripheral motor abnormalities in PD measured as UPDRS. We propose to measure POM in order to find if their parameter correlate with UPDRS and can predict effects of different treatments. Methods: We conducted horizontal POM measurements in response to light spot moving sinusoidally (with frequencies: 0.25, 0.25, 0.5Hz) for 0 patients with Parkinson s disease (PD) in four sessions: S=MedOffDBSOff, S2=MedOffDBSOn, S3=MedOnDBSOff, S4=MedOnDBSOn. Changes of motor performance, behavioral dysfunction, cognitive impairment and functional disability were evaluated in each session according to UPDRS. POM were recorded by head-mounted saccadometer (Ober-Consulting, Poland). ML method was based on RSES_2.2 (Rough-System-Exploration-Program). Results: The mean age was 58.3±9.3 (SD) years, mean disease duration was 0.9±.6 years, mean UPDRS/UPDRS III: S: 59.4±6.2/43.5±2.7; S2: 29.9±3.3/20.4±7.9;S3: 5.2±4.4/35.3±.; S4: 8.2±.4/9.6±5.9; differences S-S2, and S-S4 were statistically significant (p<0.00) and S-S3 - not stat-sig. POM measurements were not stat-sig.: gain - for slow/medium/fast sinusoids: S:.06±0./0.96±0.2/0.83±0.2; S2:.03±0./0.97±0.2/0.86±0.; S3:.05±0./0.99±0./0.94±0. S4:.00±0./0.96±0./ 0.87±0.. Accuracy as sum of normalised differences between stimulus and eye position - for slow/medium/fast sinusoids were: S: 0.70±0.3/0.62±0.6/0.54±0.8; S2: 0.67±0.8/ 0.68±0.6/0.6±0.20; S3: 0.73±0.3/0.70±0.8/0.63±0.8; S4: 0.78±0.3/0.76±0.5/0.66±0.8. Prediction of individual UPDRS III values from POM parameters gave global accuracy of 77.4% (ML: cross-validation-method). Effects of different treatments (session numbers) based on neurological data can be predicted in 53%, adding POM measurements increased prediction to 79.5% (global accuracy). Conclusion: ML approach is more precise and powerful than popular statistical methods. Eye movement measurements (POM) significantly increase estimations of different treatments effects. Disclosure: This work was partly supported by Grant 20/03/B/ST6/0386 from the National Centre of Science, Poland. No conflict of interest exists. POM MedOffDBSOn POM MedOnDBSOn 205 European Journal of Neurology, 22 (Suppl. ),

168 Flash Posters 65 F243 Are there any clinical and epidemiological features of Parkinson s disease in the south of Russia (by example of Rostovon-Don city)? E. Rabadanova, Z. Goncharova Rostov-on-Don, Russian Federation Background and aims: The prevalence of Parkinson s disease (PD) in the world varies widely as determined, apparently, by genetic factors, environmental influences, research methodology. The epidemiological study of PD in Rostov-on-Don is being conducted for the first time since 203. Methods: Dynamic descriptive clinical and epidemiological research with the creation of the population register. The study is based on data from medical institutions of Rostov-on-Don. Prevalence of PD is estimated: number of cases per 00,000 population on st of December 204. Determination of morbidity and mortality now is impossible due to the lack of territorial population register. Results: A total of 622 patients with PD meet the eligibility criteria and are included into the study. The predominance of women (F:M=,74:) was revealed. The prevalence is estimated as 56.4 patients per 00,000, which is lower than world values. Prevalence varies widely in different age groups: from 0. in group years, to 6.3 in group years per 00,000. Mean age of the onset is 67.2 (SD 6.5) years, that is consistent with the results of other research. Mean Hoehn and Yahr was 2.5 (SD 0.7). V and I Hoehn and Yahr is less often observed, 2.3% and 8.% respectively. Such low rates of I stage of PD is associated, apparently, with insufficient diagnostics of PD at the early stage. Conclusion: Revealed clinical and epidemiological features of PD in Rostov-on-Don require further continuation of our research. F244 Validity and realiability of the Bulgarian version of the essential tremor embarassment assessement (ETEA) G. Radevski, I. Milanov University Neurological Hospital Saint Naum Sofia, Neurology, Sofia, Bulgaria Background and aims: The aim of the study was to evaluate the psychometric properties of the Essential Tremor Rating Assessment Scale (TETRASv3.) for patients with this chronic disease. Methods: To assess the psychometric properties of the scale we examined 40 essential tremor patients. To assess the test-retest reliability patient filled the scale twice in a twoweek interval. Results: Cronbach s alpha coefficient exceeds Pearson test-retest reliability coefficient ranged from 0.92 to 0.96 for all subscales. The questionnaire demonstrates good convergent validity with significant correlations between two subscales. Тhe results showed high reliability and applicability for the Bulgarian population. Conclusion: TETRASv3. - Bg is a reliable and valid tool. Тhis scale can be used in everyday practice, in clinical trials and for evaluation of a certain treatment. 205 European Journal of Neurology, 22 (Suppl. ),

169 652 Flash Posters F year experience in the treatment of hemifacial spasm with onabotulinum toxin A A. Rodríguez-Sanz, I. Ybot Gorrín, F. Vivancos Matellano La Paz University Hospital, Neurology, Madrid, Spain Background and aims: Hemifacial spasm (HS) is a neuromuscular movement disorder characterized by involuntary contraction of the muscles innervated by the facial nerve. The botulinum toxin (BT) is a more effective therapeutic alternative than oral drugs. The aim of this study is to analyse the response to BT and its adverse effects (AE) in 85 patients with HS in the long term. Methods: Consecutive patients with HS, who have attended in the Movement Disorders Unit for treatment with BT for 20 years, were prospectively included. Following variables were analysed: demographic data, aetiology, duration of treatment, BT dose, response to the treatment, degree of patients satisfaction, need for association of oral drugs and AE. A multivariate analysis that included onset age, aetiology, BT dose, response to BT and degree of patients satisfaction, was performed to identify those factors associated with HS according to sex. Results: 85 patients were included, 56 (66%) women. Age: 52 (SD4). Duration of HS: 2 years. In 24 (28%) HS was secondary. They were treated during 9 years (SD6), range: The minimum and maximum BT doses were IU (SD3.7) and 22IU (.6) respectively. 82 (96%) responded adequately. Degree of patients satisfaction was high in 53 (62%). 6 (9%) needed oral drugs. 50 (59%) presented infrequent, mild and reversible AE at some time during follow-up. Descriptive analysis showed the degree of patient s satisfaction is significantly higher in men. Conclusion: To our knowledge, the sample size of our study is one of the biggest ever published. Our results confirm that BT treatment maintains its efficacy and safety during the long-term follow-up. Degree of patient s satisfaction to BT treatment is higher in men. Disclosure: This study was supported by an unconditional investigational grant from Allergan F246 Using typing cadence to detect and monitor Parkinson s disease J. Samzelius Habit DX Inc., San Francisco, California, USA Background and aims: Can typing cadence be used to detect and monitor Parkinson s disease (PD)? This study says: Yes, it can. The statistical qualities of typing cadence are superb and at a level neither the patient nor the doctor would be able to detect, picking up differences as small as /00th of a second. Inconsistency is the key measurement thus, speed of typing is not relevant, making age also have low relevance (since speed and age are highly correlated). Thus, 20-year olds can be compared to older subjects. The hypothesis to be tested in this study is that Typing Cadence data can discriminate between patients with PD and healthy controls. Methods: A total of about 50 patients were recruited. A separate sample of 55 college students was used as controls. A small software application measured typing cadence and intermittently sent data to our server. Results: Each person was measured for 90 days. In total, we collected about 30M data points across upwards of 800 variables. No one reported any difficulties in using the measurement system. To date, we have analysed data for 6 variables. The likelihood that a patient or control would be misclassified is 4.8x0-36. We have also noted a certain grouping pattern within the 6 variables, indicating that we later can develop a disease fingerprint. Conclusion: Typing cadence can discriminate between PD patients and controls. 205 European Journal of Neurology, 22 (Suppl. ),

170 Flash Posters 653 F247 Ataxia with vitamin E deficiency with unique neuro-imaging findings C. Silva, D. Neutel 2, S. Reimão 3, J. Ferreira 3, M. Coelho Hospital de Santa Maria, Neurology Department, Lisbon, Portugal, 2 Hospital do Espírito Santo de Évora, Neurology, Évora, Portugal, 3 Instituto de Medicina Molecular, Neurological Clinical Research Unit, Lisbon, Portugal Background and aims: Ataxia with isolated vitamin E deficiency (AIVED) is a rare autosomal recessive neurodegenerative disease, due to mutations in the α-tocopherol transfer protein (TTPA) gene, located on chromosome 8q3. Clinical features include progressive cerebellar ataxia, dysarthria, limb areflexia, loss of proprioception and vibration sense and bilateral extensor plantar reflexes. Case Report: A 33-year-old woman was observed due to gait imbalance with progressive worsening since childhood. No history of co-sanguineous parents. Family history of unclear choreiform involuntary movements of the maternal grandmother. The neurological examination disclosed mild cognitive impairment, retinal dystrophy, hypometric saccades, dysarthria, tetraparesis (MRC 4/5), absence of deep tendon reflexes, bilateral extensor plantar reflexes, reduced proprioception and vibration sense, limb and gait ataxia with worsening with eyes closed. Brain and spine MRI showed diffuse cortico-subcortical atrophy, T2 and T2* hypointensity in the head and body of caudate nuclei consistent with increased ferromagnetic deposition, bi-parietal subcortical white matter changes, and central hyperintense signal within the cervical cord. The serum analysis revealed a low level of vitamin E (mg/l). Genetic testing confirmed the diagnosis of ataxia with vitamin E deficiency homozygous mutation for TTPA gene [c.227_229delinsatt(p.trp76_gln278delinstyr)-exon 2]. She was started with high doses of vitamin E (900mg/ day) therapy with neurological stabilization after 3 years of follow-up. Conclusion: AIVED is a rare disorder among all the autosomal recessive ataxias. The Brain MRI is normal in most of the report cases. Our patient has a typical clinical presentation of ataxia with vitamin E deficiency, but with a unique neuro-imagiological picture. F248 Correlation of findings on SPECT datscan and transcranial sonography in Parkinson s disease S. Skutilova Masaryk University, Neurologic Clinic, Brno, Czech Republic Background and aims: Diagnosis of Parkinson s disease is based on clinical symptoms (UK Brain Bank criteria) and response to L-dopa treatment. The authors compare data of neuroimaging methods such as SPECT datscan and transcranial sonography in the diagnostic of Parkinson s disease. Methods: All of the 29 patients were examined by two methods:. TCS was realised in 25 patients (86.3%), in 4 patients was not done because of insufficient transtemporal bone window. 2. SPECT datscan was realised in all patients (00%) Results:. SPECT Datscan - pathological finding in 29 patients (00%) 2. TCS - pathological finding in 6 patients (55.2%) - normal finding in 9 patients (3.%) - not done in 4 patients (3.7%) Conclusion:. SPECT datscan is much more exact, reliable method, but is expensive, invasive and not widely accessible 2. TCS is safe, quick, non-invasive and inexpensive method, but the sensitivty is much more lower. 3. We suggest starting with TCS and in the case of absence transtemporal window or physiological finding continuing with SPECT Datscan. 205 European Journal of Neurology, 22 (Suppl. ),

171 654 Flash Posters F249 Hyperechogenicity of the substantia nigra for diagnosis of Parkinson s disease K. Smilowska, M. Smilowski, Z. Mandrela 2, L. Szczechowski, M. Grechuta Multiklinika Salute, Neurology, Katowice, 2 Medical University of Silesia, Departament of Radiodiagnostics and Interventional Radiology, Katowice, Poland Background and aims: A hyperechogenicity of the substantia nigra (SN) is a common finding in transcranial sonography (TCS) of Parkinson`s disease (PD) patients. Imaging by TCS has been recommended by European guidelines (EFNS/MDS-ES/ENS) for the differential diagnosis of PD from atypical or secondary parkinsonism, also for early PD diagnosis and also for detection of subjects at risk for PD. Methods: We examined 25 PD patients and 25 controls. Controls were recruited from the patients who were referred for carotid ultrasound and who had other neurological diseases, but not including movement disorders. All PD patients were also evaluated in UPDRS Part III tool and correlation between echogenicity and UPDRS Part III score was compared. Results: The enlargement of SN (margin over 0.2cm 2 ) was observed in 2 PD patients (84%) and in 2 controls (8%) (p<0.005). The sensitivity of the method was 84% and specificity was 92%. No correlation between UDRS Part III and SN echogenicity was observed (r=0.). Conclusion: TCS is a reliable and highly sensitive tool for differentiation of PD patients from individuals without CNS disorders. TCS shows the hyperechogenicity of substantia nigra in a percentage of controls patients, which indicates careful observation. It is very helpful in ambulatory diagnosing of PD patients but it can`t be helpful to evaluate the PD severity. F250 Causes of death in patients with Parkinson s disease I. Smolentseva, O. Krivonos, A. Ayrapetyan, N. Amosova State Scientific Research Center n.a. A.I. Burnasyan, neurology, Moscow, Russian Federation Background and aims: Mortality among patients with Parkinson s disease (PD) is.2 to 3.4 times higher then in people of the same age in general population. Death rate due to Parkinson s disease in Russia in 202 was 0.3 per The most common causes of death in patients with Parkinson s disease are concomitant disorders and complications of the disease due to immobility in the late stage of PD. Methods: 36 patients with Parkinson s disease were enrolled in a prospective 3-year study ( ). 50 (36,8%) subjects with PD had I-II stage according to Hoehn and Yahr scale, 67 (49,3%) - III stage, and 9 (3,9%) people - IV-V stage. To collect and process data we devised a unified computer-based Register of Patients with Parkinson s Disease. Causes of death were analysed according to the death certificates and postmortem summaries. Results: During 3 years of follow-up 7 (5,%) patients out of 36 died (5 men and 2 women). Median age among deceased patients was years. In 3 patients with advanced stages of PD death was caused by complications of the disease (pneumonia and urinary infection), 4 patients with early stages died from concomitant disorders (myocardial infarction, malignancies). Conclusion: Thus, cause-of-death analysis in patients with Parkinson s disease reveals that dynamic patient observation and early detection of complications are needed for well-timed correction, which may increase life span. F25 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

172 Flash Posters 655 F252 The evaluation of neutrophil-lymphocyte ratio in idiopathic Parkinson s disease V. Solmaz, E. Perktas 2, D. Aksoy 3, B. Cevık 2, S. Kurt 3 Turkey, Turkey, 2 Gazıosmanpasa Unıversty Medical Faculty, Neurology, Tokat, Turkey, 3 Tokat, Turkey Background and aims: Idiopathic Parkinson s disease (IPH) is one of the most common neurodegenerative diseases in the world. There is loss of nigrostriatal dopaminergic neurons in the pathogenesis of the disease; but is unknown exactly what caused the loss of neurons. The purpose of this study is, by examining the ratio of neutrophil-lymphocyte (N/L) in the blood of the people with idiopathic Parkinson s disease to contribute to the literature. Methods: In this study we included 0 patients with idiopathic Parkinson s disease between the years of in our clinic, and 75 healthy subjects. Sociodemographic data of patients, duration of disease, drugs used and Hoehn- Yahr stages were recorded. Neutrophil and lymphocyte counts in the blood of patients, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels were determined. Exclusion criteria of the participants were identified as history of active or chronic infection, malignancy, inflammatory and rheumatic diseases. Results: There was no significant difference between patient and control groups in terms of age and sex (p=0.33, p=0.54). There were statistically significant differences between the patient and control groups in terms of N / L ratios (p=0.000). There was a strong positive correlation between N / L ratios and Hoehn-Yahr stages (p=0.038). In addition there was no significant difference between the groups regarding ESR and CRP (p=0.095, p=0.5). Conclusion: We found that in idiopathic Parkinson s disease N/L ratios were higher than healthy subjects. Elevated N/L ratios are usually considered as an inflammatory marker. The results of this study suggested that inflammation plays a role in the pathogenesis IPH F253 Clinical presentation of diabetic basal ganglia disease S. Sousa, L.O. Gouveia, R. Guerreiro, F. Pita Hospital de Cascais, Neurology, Cascais, Portugal Background and aims: Hemichorea-hemiballismus is a rare but classical complication of non-ketotic hyperglycemia. Parkinsonism and dystonia are less described. Case Report: A 77-year-old female, presented to our emergency department following a 24h history of sudden onset of involuntary left limb movements. Neurological examination revealed ballistic movements involving the left upper and lower limbs. She had history of hypertension, type 2 diabetes mellitus and dyslipidemia. There was no previous history of neuroleptic use. On admission, blood glucose concentration was 442mg/dL and hemoglobin Ac was 2.2%, urinalysis was negative for ketones. CT-scan revealed leukoencephalopathy. Brain MRI performed, on day 7 after admission, shows T hyperintensity and T2 slightly hyperintensity of the right caudate and lenticular nuclei without diffusion-restriction. Cytochemical cerebrospinal fluid was normal. We treated the patient with glycemic control and tiapride 00mg bid with resolution of ballistic movement within one week. At 4 weeks follow-up, hypomimia and bradykinesia were noted, attributed to the tiapride which was discontinued but without improvement. Later, she develops a dystonic posture of left upper limb. Repeated brain MRI shows hyperintensity attenuation of the basal ganglia. Conclusion: We describe a patient with hemiballismus as a complication of a non-ketotic hyperglycemia, which resolves after normalization of blood glucose. However, bilateral parkinsonism and unilateral dystonia were triggered in later stage, and after metabolic control and remain with neuroleptic withdrawal. These facts suggest that movement disorders induced by hyperglycemia are not always a benign phenomenon and they can persist, probably because of irreversible neurotoxic damage of hyperglycemic crisis. 205 European Journal of Neurology, 22 (Suppl. ),

173 656 Flash Posters MS and related disorders 2 F254 Vascular alterations in multiple sclerosis and amyotrophic lateral sclerosis : preliminary analysis of susceptibility factors R. Lanzillo, C. Criscuolo, A. Cianflone, E. Postiglione, R. Liuzzi 2, M. Mancini 2, E. Tedeschi 3, M. Vastola, M. Incoronato 4, F. Capasso 5, T. Mancino 5, A. Passannanti 5, R. Mormile 5, M. Salvatore 3, V. Brescia Morra Federico II University, Neurosciences, Reproductive and Odontostomatological Sciences, Naples, 2 Institute of Biostructure and Bioimaging, National Research Council, Naples, 3 Federico II University, Advanced Biomedical Sciences, Naples, 4 IRCSS SDN Foundation, Naples, 5 Federico II University, Laboratorio Emostasi etrombosi DAI di Medicina di Laboratorio, Naples, Italy Background and aims: To study the association among multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and vascular changes at genetic, anatomic and functional level. Methods: 300 MS, 50 ALS patients, and 300 healthy subjects (HS) will be recruited. To assess the endothelial dysfunction development risk and/or a genetic susceptibility, serum levels and single nucleotide polymorphisms of homocysteine, VEGF-A, Endothelin (ET-) and HIFA will be analysed and correlated to micro and macro vascular abnormalities detected by Magnetic Resonance (MR) and Ultrasound imaging (US). Project will end in 206. Results: Homocysteine levels (HL) were performed in 56 MS, 5 ALS patients and 45 HS, VEGF-A in 50 MS patients vs 25 HS. Median HL were 3.4μmol/L in MS, 2.82μmol/L in ALS patients and 2.6μmol/L in HS. At Kruskal-Wallis test median HL values were significantly different in the three groups (p=0.002). Median HL were significantly higher in MS and ALS patients vs HS (p<0.05). In MS women median HL were significantly higher compared to HS (2 vs 9.94μmol/L, p<0.0000), and HL correlated to disease duration (p=0.007). Median VEGF-A values tended to be higher in patients vs HS (9.68 vs 0, p=0.96). 0 patients (78 RR, 2 PP, SP and 0 ALS) underwent contrast enhanced brain MR, and 68 patients (54 RR, PP, 0 SP and 3 ALS) US evaluation. Conclusion: Combining different molecular analysis and imaging modalities may provide new insights into the vascular aspects of MS pathogenesis. These preliminary results support an altered vascular profile in MS, especially in females. F255 Multiple sclerosis prevalence rates and selected exogenous variables: a global ecological analysis K.J. Lauer Griesheim, Germany Background and aims: An association of multiple sclerosis (MS) with the preservation method of meat by smoking had been shown in 4 regions. In the present study, data on MS prevalence compiled by the Multiple Sclerosis International Federation (MSIF) were compared with the preservation method of meat smoking, climatic data, and 25-OH vitamin D in plasma or serum. Methods: The MS prevalence rates 203 in 89 countries were derived from the MSIF 203, and rates published for 6 additional countries were included. Selected geographic and climatic (temperature; precipitation; sunshine) variables, vitamin D (Wahl et al. 202) and habit of smoking for preservation were evaluated. Rank correlation analysis according to Spearman and multiple linear regression were applied. Results: The MS prevalence rate was highly correlated with the original epidemiological data (r=0.934; p<0.000), whereas concentration of 25-OH vitamin D in serum, or plasma, was unrelated to MS. Latitude, lower temperature, less precipitation, and less sunshine duration were bivariately associated with MS, but not in multivariate analysis (data not shown). In contrast, meat preservation by smoking also correlated with MS prevalence in the backward stepwise variant of multiple linear regression (beta=+0.863; standard deviation of beta=0.073; p<0.000). Conclusion: Data by MSIF 203 on MS prevalence have a high validity when compared with the original epidemiological data. Meat preservation by smoking was associated with the MS prevalence in multivariate analysis, whereas vitamin D was unrelated. Possible immunological mechanisms are discussed. 205 European Journal of Neurology, 22 (Suppl. ),

174 Flash Posters 657 F256 The plasma values of matrix metalloproteinase 3 and 9 correlate with biological activity of initial and relapsed neuroinflammation acute attacks S. Ljubisavljevic, I. Stojanovic 2, J. Basic 2, S. Vojinovic, V. Djuric, D. Stojanov 3 University Clinical Center of Nis, Clinic for Neurology, Nis, Serbia, 2 University of Nis, Faculty of Medicine, Institute for Biochemistry, Nis, Serbia, 3 University Clinical Center of Nis, Center for Radiology, Nis, Serbia Background and aims: Matrix metalloproteinases (MMPs) are proteolytic enzymes that are involved in a variety of physiological and pathological processes, including those in CNS. Methods: In this study, plasma values of MMP-3 and -9 have been compared in clinically isolated syndrome (CIS) and relapsing remitting multiples sclerosis (RRMS) patients during their acute attacks, in relation to the biological activity of disease. Therefore, we compared the MMPs plasma values regarding EDSS, progression index of disease (PID), acute brain lesion volume seen on magnetic resonance imaging (MRI) and index of brain blood barrier (BBB) permeability destruction. Results: The obtained results demonstrated the higher plasma values of MMPs in both study groups, than to control values (p<0.05). No statistical significances have been detected comparing the obtained values of both enzymes between CIS and RRMS group (p>0.05). In both, CIS and RRMS, groups, the patients with higher EDSS showed higher MMPs plasma values (p<0.05). The MMPs values were also significantly higher in both study patients with higher total number comparing to those with lower number of MRI brain lesion p<0.05, p>0.05 (only for MMP-3 in RRMS). All obtained correlations, between MMPs and EDSS, PID, volume of MRI Gd-enhancement brain lesions and index of BBB permeability, were positive (p<0.05). Conclusion: This study demonstrates alterations of both tested MMPs with closed correlation with disease biological activity. Although MMPs are being implicated in the pathogenesis of acute neuroinflammation the MMPs inhibitors might be useful in the future design of disease modifying therapy with the specific target profile. F257 Differences in clinical and imaging measures for PPMS patients vs RRMS patients in the USA E. Loefroth, E. Verdun, M. Merschhemke, R. Lahoz, J. Pike 2, E. Jones 2 Novartis Pharma AG, Basel, Switzerland, 2 Adelphi Real World, Macclesfield, United Kingdom Background and aims: Primary progressive multiple sclerosis (PPMS) is a phenotype of MS that represents approximately 0% of the MS population at onset and the lack of treatment options represents a significant unmet clinical need. Here we describe real world data, differentiating the sociodemographic, clinical and imaging features of PPMS and relapsing-remitting multiple sclerosis (RRMS) patients. Such studies can contribute to optimize the design of future studies in PPMS. Methods: Data were drawn from the Adelphi Multiple Sclerosis Disease Specific Programme ( ), a cross-sectional study of US-based neurologists managing MS patients, MS patients and their informal carers. 789 patients were defined as RRMS (physician designation and Expanded Disability Status Scale [EDSS<6]) and 335 as PPMS (physician designation; excluded patients with no T2 lesions). Fisher s Exact test and Mann-Whitney test were applied for categorical and continuous outcomes, respectively. Results: PPMS patients were older with higher EDSS score at diagnosis, exhibited a higher number of current T2 lesions and lower number of relapses prior to initial MS diagnosis and in the last 2 months vs RRMS patients. RRMS was predominant in females whereas PPMS had nearly equal gender distribution. A higher proportion of patients with PPMS vs RRMS had new/enlarging T2 lesions in the last 2 months (Table). Furthermore, PPMS patients were less likely to be employed; the majority required assistance with walking and had a higher number of concomitant conditions. Details will be presented. Table: Sociodemographics and clinical characteristics of RRMS and PPMS patients Conclusion: There are distinct differences in clinical and imaging features as well as burden of disease between RRMS and PPMS populations. Disclosure: Study supported by: Novartis Pharma AG. E. Loefroth, E. Verdun, M. Merschhemke and R. Lahoz are paid employees of Novartis Pharma AG, Basel, Switzerland. J. Pike and E. Jones are paid employees of Adelphi Real World, Macclesfield, UK 205 European Journal of Neurology, 22 (Suppl. ),

175 658 Flash Posters F258 Infections in alemtuzumab patients previously treated with subcutaneous interferon beta-a J. Lycke, J.A. Cohen 2, E.J. Fox 3, H.-P. Hartung 4, E. Havrdova 5, K.W. Selmaj 6, D.H. Margolin 7, L. Kasten 8, D.A.S. Compston 9 University of Gothenburg, Gothenburg, Sweden, 2 Cleveland Clinic, Cleveland, USA, 3 Central Texas Neurology Consultants, Round Rock, USA, 4 Heinrich-Heine-University, Düsseldorf, Germany, 5 First Medical Faculty, Charles University in Prague, Prague, Czech Republic, 6 Medical University of Łódź, Łódź, Poland, 7 Genzyme, a Sanofi company, Cambridge, USA, 8 PROMETRIKA LLC, Cambridge, USA, 9 University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom Background and aims: In phase 3 studies of patients with active relapsing-remitting multiple sclerosis, infections were more common with alemtuzumab than with subcutaneous interferon beta-a (SC IFNB-a). This analysis evaluates infection incidence in patients who received SC IFNB-a in the core CARE-MS studies and then switched to alemtuzumab in the first 2 years of the extension study. Methods: In the 2-year core CARE-MS I (NCT ) and II (NCT ) studies, SC IFNB-a treated patients received 44μg 3 times/week, and then could enter an extension study (NCT ) and receive 2 courses of alemtuzumab 2mg at extension Months 0 and 2. Results: The extension enrolled 282 SC IFNB-a treated patients; 93.3% received 2 courses of alemtuzumab. Infection incidence over 2 years was 56.8% during core study SC IFNB-a treatment and 68.% after switching to alemtuzumab (extension Year : 52.%; Year 2: 49.6%). Infections were predominantly mild to moderate; nasopharyngitis, urinary tract infection, upper respiratory tract infection, and sinusitis were most common. Over 2 years, serious infections occurred in 5.7% of patients. 47.2% of patients had infections on both treatments. No deaths or withdrawals linked to infection occurred after switching to alemtuzumab. Conclusion: Alemtuzumab-treated patients with prior SC IFNB-a treatment in the CARE-MS core studies had a similar risk of infection as the patients who received alemtuzumab in the core studies. These findings support the consistent safety profile of alemtuzumab across clinical trials. Disclosure: Study supported by Genzyme, a Sanofi company, and Bayer Healthcare Pharmaceuticals. F259 Identification of gene expression profile associated with the clinical response to Sativex in multiple sclerosis patients F. Martinelli Boneschi, L. Ferrè, M. Sorosina, E. Mascia, G. Pavan, A. Nuara, V. Martinelli, F. Clarelli, F. Esposito, G. Comi Scientific Institute San Raffaele, Department of Neurology, Milan, Italy Background and aims: Nabiximols (Sativex) treatment is effective in reducing muscle spasticity and pain in MS patients. The aim of the study is to identify gene networks and signaling pathways induced by Nabiximols treatment by analyzing the transcriptional profiling of whole blood (WB) in MS patients and to identify signature of response to treatment. Methods: We collected WB at baseline and 4-week (4-wk) follow-up of 0 Nabiximols-treated MS patients, and of 53 at 4-week (4-wk) follow-up. We are performing a whole-genome microarray-based transcriptome profiling using Illumina technology on extreme phenotypes of response. Functional enrichment analysis will be done using WebGestalt and Cytoscape 3.0 software among others. Results: About two thirds of treated patients were deemed as responders at 4-wk. We selected 5 patients who were super-responders (R) (>20% improvement in the spasticity numerical rating scale (NRS) at 4-week, and >30% at 4- week; mean change: -2.9 and -3.6 score respectively) and compared to 5 non-responders (NR) (<20% improvement in the NRS at 4-week; mean change: +0.). After qualitycontrol steps, we will select differentially expressed genes (DEGs) in the following contrasts: 4-week vs baseline and 4-week vs baseline, and change between 4-week and baseline in R compared to NR. Conclusion: As far as we know, this is the first study that specifically tests the impact on WB of nabiximols treatment and look for signature of treatment response. Novel insight into the mechanism of action of the drug at peripheral level and biomarkers of response to treatment are expected. 205 European Journal of Neurology, 22 (Suppl. ),

176 Flash Posters 659 F260 CSF and serum levels of interleukin-6, interleukin-8, interleukin-0, beta-2-microglobulin and orosomucoid at the time of first clinical symptoms in MS patients Z. Matejcikova, J. Mares, V. Sladkova, J. Klosova, S. Skalska, T. Svrcinova, J. Zapletalova 2, P. Kanovsky University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, Neurology, Olomouc, Czech Republic, 2 Faculty of Medicine and Dentistry, Palacky University and University Hospital, Department of Medical Biophysics, Olomouc, Czech Republic Background and aims: We hypothesized that the levels of some markers could be changed in MS in comparison with controls. We studied five inflammatory markers (interleukin-6, interleukin-8, interleukin-0, beta-2-microglobulin, orosomucoid). Methods: The study was based on CSF and serum examination in patients with MS and control group (patients with non-inflammatory disease). In the MS patients, the lumbar puncture was indicated and performed at the time of the first clinical symptoms compatible with MS. None of our patients had been treated by corticosteroids before lumbar puncture. The aim of the study was to assess CSF and serum levels of inflammatory markers and compare these levels between MS group and control group. We tried to find inflammatory changes in early stage of MS. Results: CSF and serum examination was performed in 02 patients with newly diagnosed MS meeting McDonald s revised diagnostic criteria (70 females; median 40 years) and 02 control group patients (79 females; median 37.5 years). No statistically significant differences in demographic data between MS patients and control group were found. Significantly higher CSF levels of IL-8 (median 59.; p<0.000, Mann-Whitney U test) and beta-2-microglobulin (median.27; p<0.000, Mann-Whitney U test) in MS patients group were found. Significantly lower serum levels of IL-8 (median 8.00, p=0.08, Mann-Whitney U test) were found. Conclusion: The levels of two studied inflammatory markers were found to be increased at the time of first clinical symptoms of MS. As the etiology of MS is still unknown, research on inflammatory and neurodegenerative markers in MS should continue. F26 Individualized patient counseling can improve adherence by efficient management of avoidable adverse events M. Mäurer, R. Voltz 2, Y. Begus-Nahrmann 3, G. Niemczyk 4, B. Schmid 5, B.C. Kieseier 6 Caritas Krankenhaus, Bad Mergentheim, Germany, 2 Uniklinikum Köln, Cologne, Germany, 3 Konzept Pharma Service GmbH, Freden, Germany, 4 Biogen Idec GmbH, Patient and Nurse Liaison, Ismaning, Germany, 5 Biogen Idec GmbH, Medical Neurology, Ismaning, Germany, 6 Universitätsklinikum Düsseldorf, Düsseldorf, Germany Background and aims: Discontinuation of therapy in multiple sclerosis (MS) patients occurs frequently, although beneficial effects of the disease-modifying therapy occur only in the long term. Patient counseling programs (PCP) should not only help patients understand the rational basis of the disease and therapy, but also improve adherence to the chosen medication. This study evaluates whether an individualized PCP identifying and addressing individual adherence barriers can improve adherence and provide effective support. Methods: In February 204, a PCP for patients receiving delayed-release dimethyl fumarate (DMF) started which included amongst other elements differentiated information for 3 patient subtypes and a smart phone application. DMF patients not included in the PCP served as controls. Results: To date, 5686 DMF patients have registered in the PCP. 49% of patients had experience of only one therapy while 2% were newly diagnosed. The main reason for changing therapy to DMF in the PCP and control group was lack of perceived efficacy of prior therapy. Therapy discontinuation for patients included in the PCP is 4.9% (n=299). The main reason for therapy discontinuation was ongoing gastrointestinal problems. Close contact between PCP and patients led to effective AE management, and most symptoms could be handled and improved. Therapy discontinuation in the control group (not coached with PCP) constituted by 823 DMF-patients. To date 24% (98) reported discontinued therapy. Conclusion: Adherence could be highly improved by the individualized PCP. Qualitative and quantitative measurements of adverse effects reduction and therapy continuation show that the individualized approach of the PCP can increase adherence. Disclosure: Supported by Biogen Idec GmbH, Ismaning 205 European Journal of Neurology, 22 (Suppl. ),

177 660 Flash Posters F262 Prolonged-release fampridine treatment improved patient-perceived physical health impact of multiple sclerosis L. Mehta, J. Lycke 2, C. Gasperini 3, M. McNeill 4, J. Zhong, J. Elkins Biogen Idec, Cambridge, MA, USA, 2 The Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden, 3 San Camillo-Forlanini, Rome, Italy, 4 Biogen Idec, Maidenhead, United Kingdom Background and aims: Mobility impairment reduces quality of life in patients with multiple sclerosis (MS). The objective of this analysis was to evaluate the effect of prolonged-release (PR) fampridine tablets (dalfampridine extended-release in the United States) on patient-perceived physical health impact of MS. Methods: Patients were enrolled in Europe and Canada and randomised to PR-fampridine 0mg tablets (n=68) or placebo (n=64) twice daily in the 24-week, randomised, double-blind, phase 2 MOBILE study. The 29-item MS Impact Scale (MSIS-29), a patient-reported measure of the impact of MS on physical and psychological health, was assessed at baseline and each study visit. Mean changes from baseline for each of the 20 items of the MSIS-29 physical impact subscale were calculated using all post-baseline visits up to 24 weeks; the proportion of patients with any mean improvement is reported. Treatment differences were assessed using logistic regression adjusting for mean baseline item score. Results: Higher proportions of patients treated with PRfampridine demonstrated benefits in 6 of the 20 items compared with placebo over 24 weeks (Figure ). A post hoc analysis demonstrated statistically significant improvements for PR-fampridine versus placebo in four items: difficulties moving around indoors (p=0.03), difficulty doing things spontaneously (p=0.02), having to depend on others to do things (p=0.07), and taking longer to do things (p=0.04; Figure ). Percentage of patients with any mean improvement in MSIS-29 physical impact subscale individual items over 24 weeks Conclusion: Treatment with PR-fampridine improved patient-perceived impact of MS on several physical health domains versus placebo. These results suggest the benefits of PR-fampridine extend beyond improved walking speed Disclosure: This study was funded by Biogen Idec (Cambridge, MA, USA). Writing and editorial support for the preparation of this abstract was provided by Excel Scientific Solutions (Southport, CT, USA); funding was provided by Biogen Idec. 205 European Journal of Neurology, 22 (Suppl. ),

178 Flash Posters 66 F263 Factors associated with positive Restless legs syndrome screening in a multiple sclerosis cohort: an analysis from the inms study M. Mendonça, P. Viana 2, E. Rodrigues 3, C. Fernandes 4, A. Matas 5, R. Barreto 6, R. Peralta 2, R. Geraldes 2 Centro Hospitalar de Lisboa Ocidental - Hospital Egas Moniz, Neurology Department, Lisbon, Portugal, 2 Centro Hospitalar de Lisboa Norte - Hospital de Santa Maria, Neurology Department, Lisbon, Portugal, 3 Centro Hospitalar do Funchal, Neurology Department, Funchal, Portugal, 4 Hospital Garcia de Orta, Neurology Department, Almada, Portugal, 5 Centro Hospitalar de Trás-os-Montes e Alto Douro, Neurology Department, Vila Real, Portugal, 6 Centro Hospitalar de Entre o Douro e Vouga, Neurology Department, Santa Maria da Feira, Portugal Background and aims: Restless legs syndrome (RLS) is a sleep-related movement disorder characterized by an uncomfortable () sensation in legs causing an urge to move that (2) worsens at rest and (3) evening and (4) improves with movement. It has with an estimated prevalence of 5% in the general population but a reported prevalence in Multiple Sclerosis (MS) as high as 65.%. RLS diagnosis is based on clinical criteria, however, mimics and confounders are frequent. We aimed to disclose the factors associated with a positive RLS screening in MS patients. Methods: The inms study is a hospital-based multicenter, observational, cross-sectional study of patients with MS designed to assess chronic insomnia prevalence and its comorbidities. It included 206 patients. Data regarding demographic and clinical features was collected. A positive- RLS screening was defined by a positive answer to () plus either (2), (3) or (4). Results: RLS screening was positive in 52 patients (25.2%). Their mean age was 42.8 years, with 9.9 years of mean disease duration and median EDSS score of 2. Sensory disability, presence of nocturnal pain, spasms or immobility were significantly more common in patients with positive RLS-screening. Conclusion: Using a screening tool we found a lower prevalence of RLS than previously reported. A positive RLS-screening was more common in patients with sensory dysfunction and nocturnal symptoms as pain, spasms or immobility, suggesting a secondary aetiology for RLS in these patients. Further studies are necessary to understand if there is a real sensory dysfunction associated with RLS in MS or if mimics can indeed confound this diagnosis Disclosure: The inms study was performed within the programme Esclerose Múltipla para Internos de Neurologia (EMIN), under support of Biogen Idec. F264 Fingolimod every-other-day: a possible strategy to prevent fingolimod-induced severe lymphopenia in multiple sclerosis patients. A. Merlini, F. Patti 2, M. Rodegher, M.J. Messina, M. Romeo, G. Comi, V. Martinelli San Raffaele Scientific Institute, Department of Neurology and INSPE, Milan, Italy, 2 University of Catania, Dept. of Neurosciences, Catania, Italy Background and aims: A rare side-effect of fingolimod (FTY), a recently approved treatment for relapsingremitting multiple sclerosis (MS), is severe lymphopenia (<0,2*0^9/L). In that case FTY discontinuation is recommended, depriving patients of an effective treatment option. FTY administered every-other-day (FTY-EOD) might prevent FTY-induced severe lymphopenia. Methods: Multicentre retrospective consecutive case series. Results: So far we have collected 0 patients (age 40±8.8), who underwent off-label FTY-EOD due to severe lymphopenia, from two Italian MS centres. All patients were female. Mean disease duration was 6,5 months (IQR=222), mean EDSS was 3.0±.9. All patients had undergone immunomodulatory treatment; seven patients had also undergone immunosuppressive or natalizumab treatment. Mean BMI was 2.0±2.5. Lymphopenia occurred variedly after FTY start (IQR=2.8 months), with mean value of lymphocyte count of 0.20*0^9/L±0.02. No correlation could be observed between BMI and lymphocyte counts (R^2=0.33, p=0.08). Expanded disability status scale (EDSS) at FTY- EOD start was 2.9±2.0. Three months after FTY-EOD start lymphocyte values increased in all patients (0.44*0^9/ L±0.2), while EDSS remained stable (2.9±.9). Eight patients continued FTY-EOD for further 3 months with mean lymphocyte count of 0.43*0^9/L±0.0. Importantly, among them two patients had had clinical relapses (one and two relapses, respectively) at the 6-month follow-up. Conclusion: In our small case series FTY-EOD was able to prevent FTY-induced severe lymphopenia. Further studies are warranted to assess FTY-EOD long-term safety and efficacy in controlling clinical and neuroradiological disease activity. 205 European Journal of Neurology, 22 (Suppl. ),

179 662 Flash Posters F265 Analysis of relationship between lesion of functional systems of the nervous system and symptoms of fatigue O. Mialovytska, Y. Khyzhniak 2, T. Kobys National Medical University, Neurology, Kiev, 2 Kiev, Ukraine Background and aims: Fatigue in multiple sclerosis (MS) is a highly disabling symptom, which is reported to affect 53-92% of persons with MS. Methods: 96 patients (34 male and 62 female) with definite relapsing-remitting MS (McDonald s criteria 200) were included in the study. Krupp s Fatigue Severity Scale (FSS) was used for detecting fatigue. Disease severity was evaluated using the Kurtzke s expanded disability status scale (EDSS). The risk of fatigue development was defined in terms of the odds ratio - OR and 95% confidence interval. Results: According to the results of clinical and neurological examination, using structured questionnaire scales, fatigue symptom was found in 73 of the examined patients (88%). The lesion of the pyramidal system, coordination system and cranial nerves for the time of observation has statistically significant prognostic meaning for assessment of possibility of moderate and severe fatigue development (more than 4 points), pyramidal system lesion - OR=7,43 ( ), coordination disorders - OR=4.60 ( ), lesions of cranial nerves - OR=4.33 ( )), (p<0.05). The presence of pyramidal coordination disorders in the onset of the disease may increase the risk of fatigue detection higher than 4 points during the following observation (lesion of pyramidal system - OR=.62 ( ), coordination disorders OR=.4 ( )). Conclusion: The study detected a relationship between functional lesions of the nervous system and development of fatigue in MS patients. F266 Comparison of relapse rates after switching from low dose interferon to other disease modifying treatments in patients with multiple sclerosis S. Mira, A. Coban, M. Kürtüncü Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey Background and aims: Almost half of relapsing remitting multiple sclerosis (RRMS) patients, who start interferon (IFN) beta-a im., switch to another disease modifying treatment (DMT) in 3 years. In this real-life study, we tried to assess the effect of the treatment change in RRMS patients. Methods: We included RRMS patients who used IFN beta- a 30mcg im. at least for one year and switched to higher doses of IFNs, GA or fingolimod. We collected data such as EDSS at treatment onset, annualized relapse rates (ARR) in the last year before and first year after switching to another DMT, duration of treatments, and last EDSS. Results: A total of 59 patients (8 female and 4 male) were evaluated. 53 patients switched to IFN beta-a sc., 26 to IFN beta-b sc., 3 to GA, and 49 to fingolimod. The mean age of patients, EDSS, and ARR in the last year before the treatment change did not differ among groups (p>0.05, p=0.0, and p=0.6 respectively). ARRs (±standard deviations) in the first year according to DMTs were as follows: IFN beta-a sc.: 0.92±0.70, IFN beta-b: 0.73±0,72, GA: 0.87±0.80, and fingolimod: 0.3±0.55. Patients who switched to fingolimod had the least ARR compared to patients who switched to other DMTs (p<0.00). Conclusion: This real-life study may suggest that the patients with a similar disease activity may benefit more from switching to fingolimod in terms of ARR in the first year. 205 European Journal of Neurology, 22 (Suppl. ),

180 Flash Posters 663 F267 Psoriasis co-morbidity attenuates transcriptional activity in patients with multiple sclerosis G. Miron, M. Gurevich, A. Barzilai 2, A. Achiron Sheba Medical Center, Multiple Sclerosis Center, Ramat Gan, Israel, 2 Sheba Medical Center, Dermatology Department, Ramat Gan, Israel Background and aims: Epidemiological studies have demonstrated an association between multiple sclerosis (MS) and psoriasis, showing a higher risk of psoriasis amongst MS patients. To gain insight into the properties of the genes involved in disease co-morbidity we have investigated the gene expression signature of peripheral blood mononuclear cells (PBMC) in patients with co-morbidity of MS and psoriasis and in patients with either disease, in comparison to healthy subjects. Methods: PBMC gene expression was analysed in 6 patients with relapsing-remitting MS and psoriasis co-morbidity (MS/P, age 40.2±2.0 years, disease duration (DD) 4.8±.0 years, EDSS=2.6±0.5), 7 patients with RRMS only (MSO, age 35.9±2.6, DD 5.5±2.0, EDSS=2.0±0.3), 2 patients with psoriasis only (PSO, age 43.8±5.0,) and 0 healthy controls (age 34.4±2.3 years). Differentially expressed genes (DEG s, p<0.05 after false discovery rate correction) were determined and biological functional analysis performed. Results: The gene expression signature of MS/P patients (20 DEGs) was characterized by decreased expression of inflammatory and proliferative pathways as compared to MSO patients (503 DEGs). This was demonstrated by significantly lower activity of proliferative EiF2 (p=7.63e-06 vs. 7.97E-6), eif4 regulation (p=.2e-03 vs. 5.36E-0) and mtor (p=3.62e-03 vs..5e-9) signaling pathways. The suppression of these proliferative pathways could be explained by the PSO signature (923 DEG s) suppressing pro-inflammatory pathways of NFAT (p-value=5.30e-06) and TREM (p= p-value=4.6e-04), inhibiting MS related T-cell proliferation and cytokine production. Conclusion: Comorbidity of MS and psoriasis is associated with decreased inflammatory transcriptional activity in MS patients. F268 Multiple sclerosis and psoriasis comorbidity a better long-term outcome? G. Miron, M. Gurevich, A. Barzilai 2, A. Achiron Sheba Medical Center, Multiple Sclerosis Center, Ramat Gan, Israel, 2 Sheba Medical Center, Dermatology Departmen, Ramat Gan, Israel Background and aims: Epidemiological studies have demonstrated an association between multiple sclerosis (MS) and psoriasis, showing a higher risk of psoriasis amongst MS patients. Autoimmune, vascular, and neurological comorbidity in MS have been previously shown to affect clinical characteristics of the disease. The aim of this study is to assess if psoriasis comorbidity in MS affects clinical outcome measures. Methods: The Sheba Hospital Multiple Sclerosis Center Database was queried to identify MS patients that at time of diagnosis had psoriasis comorbidity. Clinical outcome measures were examined in 26 MS patients with psoriasis (MS/P, age of MS diagnosis 35.6±2.2 years, age of psoriasis diagnosis 26.3±2.8 years, 20 females) compared to age, gender and treatment matched 00 MS only patients (MSO, age of diagnosis 36.8±0.9 years, 75 females). Patients had documented follow up for a mean duration of 2.5±0.6 years. Results: Both groups had similar extended disability score (EDSS) at onset (2.5±0. vs. 2.4±0). MS/P group had significantly higher proportion of primary progressive patients (23% vs. 8%, p<0.05). Relapsing remitting (RR) MS/P patients showed slower disease progression than RR MSO patients as demonstrated by time to second relapse (3.4±0.8 vs..7±0.2 years, p<0.0), time to EDSS=4.0 (8.3±3.0 vs. 5.2±0.7 years, p<0.05) and time to EDSS=6.0 (2.4±.8 vs. 6.9±0.7 years, p<0.05). Additionally, in the RR MS/P group a smaller percentage of patients had ever received immunomodulatory treatment compared to MSO (70% vs. 87%, p=0.06). Conclusion: Psoriasis comorbidity is associated with decreased progression of disability in MS patients. 205 European Journal of Neurology, 22 (Suppl. ),

181 664 Flash Posters F269 Neurovascular reactivity in patients with primary progressive multiple sclerosis G. Tekgöl Uzuner, N. Uzuner Eskisehir, Turkey Background and aims: The occipital regions of the brain have hyperactive neurons in patients with relapsing remitting multiple sclerosis (RRMS) during attack period. However, it is not known whether the same phenomena is present in patients with primary progressive multiple sclerosis (PPMS) or not. The objective of this study is to assess the neurovascular activation of patients with PPMS during the progression period. Methods: 23 patients with PPMS and 5 healthy subjects were screened for this study during the last 5 years in our Neurosonology laboratory. We performed transtemporal transcranial Doppler recordings from the P2-segments of both posterior cerebral arteries simultaneously during complex visual stimulation. The individual reactivity was defined with a relative increase of the blood flow velocities as a percentage change of the baseline values. Results: Since there is no significant side difference, the Doppler data of the left and right sides were pooled both in patients (23 patients and 46 vessels) and controls (5 controls and 30 vessels). The complex visual reactivity was significantly higher in the patients (44.2%) from those of the controls (34.6%) (p=0.09). Conclusion: Our results support the theory of the occipital region have hyperactive neurons in PPMS patients during the attack period as in the case in RRMS patients. F270 Specificity of serum and CSF chitinase-3 like protein (CHI3L) for MS diagnosis R. Boitet, S. Finge 2, G. Hinsinger 3, P. Corbeau 2, P. Marin 3, E. Thouvenot CHU de Nîmes, Neurology Department, Nîmes, 2 CHU de Nîmes, Laboratory of Immunology, Nîmes, 3 Institut de Génomique Fonctionnelle, Functional Proteomics Platform, Montpellier, France Background and aims: Chitinase-3 like protein (CHI3L) is an inflammatory protein identified as sensitive biomarker of multiple sclerosis (MS) in cerebrospinal fluid (CSF) and serum but its specificity has not been tested. Our study aims at evaluating the interest of CSF and serum CHI3L for diagnostic of different inflammatory and non inflammatory neurological conditions, in comparison with classical CSF immunological parameters. Methods: We performed a monocentric retrospective cohort study of patients tested for oligoclonal bands (OCB) in Nîmes Hospital. Patients were categorized into clinically isolated syndromes (CIS), MS, inflammatory neurological disease controls (INDC), peripheral inflammatory neurological disease controls (PINDC), non-inflammatory neurological disease controls (NINDC) and symptomatic controls (SC). CSF and serum CHI3L concentrations were determined by ELISA. Results: 202 patients, including 35 CIS, 7 MS, 7 INDC, 2 PINDC, 62 NINDC and 59 SC, were analysed. We observed a significant elevation of CSF CHI3L in all groups compared to SC (p<0.05), except for PINDC. In serum, CHI3L levels were significantly lower in SC than in CIS, MS and and INDC (p<0.05). OCB were significantly more frequent in CIS and MS patients than in other groups (p<0.0). Conclusion: In our study, CSF and serum CHI3L concentrations have a low specificity to discriminate CIS or MS from other inflammatory or non-inflammatory neurological diseases, while OCB are more specific for demyelinating conditions. However, we show that CSF CHI3L has a strong sensitivity for any neurological pathological condition compared to SC, while OCB were present in only 2% of INDC, and 25% of PINDC and NINDC. 205 European Journal of Neurology, 22 (Suppl. ),

182 Flash Posters 665 F27 Genetic susceptibility markers have no effect on multiple sclerosis disability outcomes. D. Vecchio, N. Barizzone 2, A. Lucenti 2, P. Naldi, G. Predebon 2, R. Cantello, S. d Alfonso 2, M. Leone 3 University of Eastern Piedmont, Neurology Unit, Department of Translational Medicine, Novara, 2 University of Eastern Piedmont, Department of Health Science, Novara, 3 IRCCS Casa Sollievo della Sofferenza, Neurology Unit, San Giovanni Rotondo, Italy Background and aims: We analysed the association of genetic markers of disease susceptibility and the development of disability in an Italian cohort of 307 multiple sclerosis (MS) patients. Methods: Patients were enrolled from January 200 in two MS Centers and followed till the occurrence of an expanded disability status score (EDSS) of 3 maintained for at least 6 months, or by June 30, 204, whichever came first (mean follow-up:.±6.9 years). We genotyped all the patients for 5 HLA loci (A*02:0, DRB*03:0, DRB*04:05, DRB*3:03, DRB*5:0) and a subset of 24 patients for the 02 non-hla SNPs associated with MS susceptibility. A weighted Genetic Risk Score (wgrs) according to De Jager was calculated for the latter. Results: 2 patients reached a maintained EDSS of 3. None of the single HLA markers influenced the probability of attaining and maintaining EDSS 3 in 307 patients. The cumulative probability of reaching EDSS 3 ten years after onset was similar for the three tertiles of the wgrs: 23.0% (±0.08) for the lowest, 9.8 (±0.05) for the intermediate, and 20.3 (±0.08) for the highest for EDSS 3. Conclusion: The 07 established genetic markers for MS susceptibility to have probably poor influence in the development of disability after 0 years of disease. F272 Brain parenchymal fraction is significantly reduced in early multiple sclerosis: a quantitative MRI study C. Atac Ucar, A.N. Yuceyar, O. Kitis 2, O. Ekmekci, A. Sagduyu Kocaman Ege University Medical School of Hospital, Department of Neurology, Izmir, Turkey, 2 Ege University Medical School of Hospital, Department of Radiology, Izmir, Turkey Background and aims: Brain atrophy is a manifestation of tissue damage in multiple sclerosis (MS). We aimed to determine the magnitude and clinical relevance of brain volume dynamics using quantitative MRI in the early MS. Methods: 20 MS patients with the mean age of years and 20 matched healthy volunteers were included. The mean duration of the disease was 2.38 years. Brain morphometric measures were performed with Java Image Manipulator (JIM) 4.0 software with the use of brain finder tools, using axially orientated images. By using the ROI (region of interest) technique, tissue volumes were quantified automatically. We determined the brain parenchymal fraction (BPF), brain volume, grey (GM) and white matter (WM) volume and brain+csf volume. Results: MS patients had significantly lower BPF compared with control subjects. Average GM, WM, brain and brain +CSF volumes of MS patients were also lower than the controls. Significant correlation was detected between disease duration and BPF value. We didn t find significant correlation between EDSS, 25 foot walk, 9Hole Peg Test scores and BPF values. However, the patients who have lower Paced Auditory Serial Addition Test-3scores had significantly lower WM and brain volume. 27.3% of patients had some deficits on neurophysiological test battery. We did nt find significant correlation between neurophysiological test scores and BPF. Conclusion: MS patients in the early phase have measurable amounts of whole brain atrophy determined with BPF without significant correlation with neurophysiological tests. Cognitive impairment in multiple sclerosis may not be the result of tissue destruction, but rather a balance between tissue destruction, tissue repair, and adaptive functional reorganisation. 205 European Journal of Neurology, 22 (Suppl. ),

183 666 Flash Posters F273 Tumefactive lesions in multiple sclerosis: MRI findings from phase 2 and 3 clinical trials of fingolimod L. Zhang-Auberson, N. Mueller-Lenke 2, G. Pearce 3, D. Bischof, N. Putzki Novartis Pharma AG, Basel, 2 University Hospital Basel, Basel, Switzerland, 3 Novartis Pharmaceuticals Corporation, East Hanover, USA Background and aims: Tumefactive lesions are typically defined as large demyelinating plaques (size>2cm) by MRI, mass effect, accompanying oedema, and ring enhancement with gadolinium contrast. The exact frequency of tumefactive demyelinating lesions (TDL) is unknown, but they appear to affect approximately 2% MS patients. Based on heterogeneous individual reports, there was speculation if fingolimod treatment could be associated with increased risk of TDLs. Methods: As lesion diameter was not assessed during the trials, clinical database was searched for MRI T2-lesion volume increase >5000mm 3 to identify potential TDLs in patients in the fingolimod phase 2 and 3 core studies (FREEDOMS, FREEDOMS II, and TRANSFORMS). The selected MRIs were subsequently reviewed by 2 treatment blinded independent neuroradiologists for presence of TDL based on lesion diameter 2cm and other radiological characteristics. Correlated clinical courses were also evaluated. Results: MRI scans available from 3439 patients were screened, of which 0.7% (7 in 237 patients) and.9% (2 in 22 patients) met the 2 cm lesion size criteria in fingolimod and in control groups (3 interferon-beta, 8 placebo), respectively. The data did not show increased risk of patients treated with fingolimod vs. comparator (OR=0.77;CI=0.3,.9; p=0.56) to experience large T2- lesions. Clinical and radiological features, as well as final diagnosis of TDL of these patients will be provided in the poster. Conclusion: Compared with interferon-beta and placebo, fingolimod did not increase the risk of TDL in phase 2 and 3 core studies. This study provides valuable insights into frequency of TDL during placebo and interferon treatment. Disclosure: Study supported by: Novartis Pharma AG. The following authors have received compensation for serving as consultants or speakers; they or the institutions they work for, have received research support/travel grants from the companies indicated N Mueller-Lenke (Biogen Idec, Merck Serono, Novartis) L. Zhang-Auberson, D. Bischof and N. Putzki are employees of Novartis Pharma AG, Basel G. Pearce is an employee of Novartis Pharmaceuticals Corporation, East Hanover, US 205 European Journal of Neurology, 22 (Suppl. ),

184 Flash Posters 667 Neurorehabilitation F274 Comparison of the effectiveness of three rehabilitation therapies in post-stroke elderly patients A. Capisizu, A.S. Nica 2, A. Zamfirescu 3, A. Mirsu-Paun 4, A.A. Capisizu 5, S.M. Aurelian University of Medicine and Pharmacy Carol Davila, Clinic of Geriatric, Bucharest, 2 National Institute of Rehabilitation Filantropia, Rehabilitation, Bucharest, Romania, 3 Bucharest, Romania, 4 University of Medicine and Pharmacy Carol Davila, Bucharest, 5 University of Medicine and Pharmacy Carol Davila Bucharest, Pediatric Neurology, Bucharest, Romania Background and aims: Rehabilitation at the elderly in post-stroke is a long process. Which is the key of a good recovery: neuroprotection, programs of exercise or all together? Methods: A cross-sectional prospective study for year in Geriatric Department St.Luca Bucharest. 9 from 500 inpatients (62.2% female, mean-age 79.03±7.3) with one first unilateral stroke and no severe cognitive impairment were enrolled. Patients were divided into three relatively equal groups who received different neurorehabilitation therapies: neuroroprotection (NT), kinetotherapy (KT) or together (NT+KT). Functionality was measured by Barthel- Index, Tinetti-dynamic-Scale and Reisberg-Scale. Data was collected twice, at inclusion (T) and after month (T2) from each recovery treatment and made comparison data. Statistical multivariate analyses were made by SPSS Results: Barthel-Index scores differed significantly Tvs. T2 [F(.2)=93.08, p<0.000, partial h2=0.45]; post-hoc tests were not significant. Reisberg-scale, F (.2)=66.08, p<0.000, partial h2=0.37; KT group decreased less than the NT and the NT+KT groups (0.84 and 0.99 respectively, p<0.05). Tinetti-scale, both time and the interaction time by treatment were significant[f(,2)=70,0, p<0.000, partial h2=0.60 and F (2.2)=4.82, p<0.05, partial h2=0.08, respectively]; the mean for the KT group decreased less than for the NT and NT+KT groups (by 2.87 and 3.36 respectively, p<0.0). Time by Treatment Effects- Barthel Index Time by Treatment Effects- Reisberg Scale Time by Treatment Effects- Tinetti Scale Conclusion: All three neurorehabilitation methods (NT, KT and NT+KT) had a positive impact on functional capacity in all three groups (based on pre- versus post-overall mean scores), after one month of treatment. Patients with KT+NT and NT improved on Reisberg and Tinetti scales statistically significant compared with KT only. For Barthel Index the improvement had no statistical significance in any of treatment groups. 205 European Journal of Neurology, 22 (Suppl. ),

185 668 Flash Posters F275 Is customized vestibular rehabilitation effective in patients with Parkinson s disease? N. Celebisoy, H. Karapolat 2, A. Acarer, G. Ozgen 2, Z. Colakoglu Ege University Medical School, Neurology, Izmir, 2 Ege University Medical School, Physical Medicine and Rehabilitation, Izmir, Turkey Background and aims: Patients with Parkinson s disease complain about restrictions in their daily life activities and impairment in mobility and balance. The aim of this study was to compare the effects of vestibular rehabilitation on functioning, quality of life, balance, and postural stability in patients with Parkinson s disease. Methods: The study included patients with Parkinson s disease, divided into a rehabilitation group (Group, n:29) and a control group (Group 2, n:). All patients were evaluated before and after 8 weeks of customized vestibular rehabilitation for motor score (Unified Parkinson s Disease Rating Scale); quality of life (Parkinson s Disease Questionnaire-39 [PDQ-39] ); balance (Activities-Specific Balance Confidence Scale [ABC], Timed Up and Go Test [TUG], Dynamic Gait Index [DGI], and Berg Balance Scale [BBS]); and postural stability (Modified Clinical Test for Sensory Interaction on Balance [mctsib]. Results: There were no significant differences between the two groups in terms of variables considered at the onset of the study (p>0.05). In Group ; a significant improvement in TUG, ABC, BBS, and DGI scores was noted after rehabilitation (p<0.05). In the control group; a statistically significant impairment was observed in mctsib (firm and foam eyes closed [EC]) at the end of the study (p<0.05). The other parameters evaluated at the beginning and at the end of the study did not show statistically significant changes in either group (p>0.05). Conclusion: Vestibular rehabilitation was found to be effective in improving balance in patients with Parkinson s disease. F277 Explicit anosognosia (the patient s selfevaluation) after right hemisphere stroke, the impact in early physical rehabilitation S. Deme, D.S. Ioncu, N.C. Hreniuc, D.C. Jianu 2, A. Docu Axelerad 3, S. Docu Axelerad 3 Western Vasile Goldis University of Arad, Neurology, Arad, 2 Timisoara, 3 Ovidius University, Faculty of Medicine, Neurology, Constanta, Romania Background and aims: Anosognosia or the unawareness of one s own motor deficits, is a heterogeneous syndrome associated with denial of motor deficits. Anosognosia for left hemiplegia occurs usually after right brain damage. Some patients may have anosognosia even when their motor deficits severely restrict daily activities. The most common method to explore anosognosia is a structured interview regarding patients motor impairment. Methods: The study included 56 ischemic patients with right-brain damage (RBD). All patients presented unilateral vascular lesions in parieto-temporal right brain demonstrated by MRI scan and left hemiplegia. A physical program was performed weekly in order to improve their motor impairment. The patient s self-evaluation was performed using Visual-Analogue Test assessing Anosognosia for motor impairment (VATAm) and was correlated with NIHSS scale and MMSE test. Results: 60.74% (34 patients) were male and the mean age for the lot was 62±4. The NIHSS score at admission was 24.3 and improved after 8 weeks to 3.8 (p<.00, CI95%). The MMSE scores ranged from 6 to % of the subjects had MMSE scores of and only 0.3% had an MMSE of 29, or 30. The total VATAm score at admission was 4.6 (range 2 to 6), and improved after 8 weeks to 8.5 (p<.00, CI95%). Conclusion: We found that only 3 (23.2%) of the patients studied developed severe anosognosia, whereas 35% showed different degrees of unawareness after 8 weeks, from mild to moderate, proving that early mobilization may well be beneficial to these patients. F276 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

186 Flash Posters 669 F278 Action observation and mirror neuron system recruitment: effect of type of task on motor facilitation S. Fumagalli, M.A. Rocca, R. Gatti 2, M. Filippi San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Neuroimaging Research Unit, Milan, Italy, 2 San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Laboratory of Movement Analysis, Milan, Italy Background and aims: We assessed whether the effect of Action Observation (AO) on motor facilitation during the performance of a motor task with the dominant upper limb varies according to the type of executed movement (simple, complex and finalistic). Methods: fmri scans during the execution (E) of a motor task, the observation (O) of a video showing the same task performed by another person and the simultaneous execution and observation (EO) of the task were obtained from three groups of healthy subjects (5 subjects x group) randomised to perform: a simple motor task (SM) (flexion-extension of the last four fingers of the right hand), a complex motor task (CM) (flexion-extension alternated to abduction-adduction of the last four fingers of the right hand) and a finalistic motor task (FM) (use of an object with the right hand). Results: During O task, SM and FM groups had an increased activation of the bilateral inferior frontal gyrus compared to CM. During O and OE tasks, FT group experienced a higher activation of the left inferior parietal lobe compared to ST and CT; whereas the CT group had higher activation of the superior parietal gyrus than the FT and ST ones. Conclusion: Both the modality of administration (observation vs observation and execution) and the type of task (simple, complex or finalistic) modulate mirror neuron system recruitment during AO. This has important practical implications for the use of this strategy in rehabilitation studies. Disclosure: Partially supported by grants from FISM (FISM202R5) and Italian Ministry of Health (RF ). F279 A theoretical approach of resilience in stroke patients E. Gertje, U. Koglin 2, A. Zieger 2, G. Schulze 2, A. Engelhardt University of Oldenburg, Department of Neurology, Oldenburg, Germany, 2 University of Oldenburg, Faculty of Education and Social Sciences, Oldenburg, Germany Introduction: Stroke is an acute-onset disease frequently followed by physical, psychological and social long-term consequences for patients. Interestingly, during acute care as well as during rehabilitation, patients with similar prognoses recover differently, some of them being more resistant. The maintenance of psychological and physical factors despite significant adversity is defined as resilience. So far, resilience in stroke patients has not been investigated much. The aim of this study is to define a theoretical model of resilience in stroke patients based on recent literature on different concepts and factors of resilience and resilience measurements in patients with stroke or other neurological diseases. Methods: Manual search of literature in PubMed about concepts and factors of resilience and resilience and stroke has been done. In addition a systematic review of literature with the search string Resilience AND Nervous System Diseases has been performed. Articles have been selected based on systematic review criteria; resilience measurement outcomes have been compared. Results: Multiple factors influencing resilience are summarized in figure. Furthermore, 59 research articles have been reviewed and finally 20 articles about resilience and neurological diseases have been included into the study. The systematic review showed that the Connor Davidson Resilience Scale and the Resilience Scale have been used most, measuring mainly patients personal traits characteristics. Figure : Model of resilience in stroke patients Conclusion: Resilience is a complex interdisciplinary construct, still difficult to measure. It is influenced not only by personality but also by multiple social and biological factors, which can change over time and situation depending on specific risk factors. 205 European Journal of Neurology, 22 (Suppl. ),

187 670 Flash Posters F280 A non-supervised classification neural network reveals temporal patterns of kinematic strategies in children s gait cycle D. Gómez Andrés, I. Pulido-Valdeolivas 2, A. Cinza-González 2, I. Rodríguez-Andonaegui 3, J.A. Martín-Gonzalo 3, J. López-López 4, E. Rausell 2 Hospital Universitario La Paz, P, Madrid, Spain, 2 Universidad Autónoma de Madrid, Anatomy, Histology and Neuroscience, Madrid, Spain, 3 Physiotherapy School. ONCE-UAM, Madrid, Spain, 4 Hospital Universitario Infanta Sofía, Physical Medicine and Rehabilitation, San Sebastián de los Reyes, Spain Background and aims: The gait cycle (GC) is one of the main outputs of the central nervous system (CNS). It is described as a sequence of observational events (OE) such as heel-strike or toe-off. After instrumental gait analysis technologies,the foundations have been laid for distinguishing GC phases on the basis of other criteria, such as the onset of CNS-commanded kinematic configurations for the lower limb to manage weight support and translation across the GC. Methods: 4-5 left and 4-5 right GCs from 29 school-aged children were measured at 20 time epochs (Codamotion ). Each GC was representedby 20 kinematic vectors (one-per-epoch) of 3X5 elements each (frontal, sagittal and rotational angular parameters from pelvis, hip, knee, ankle and midfoot), which were classified by means of a trained unsupervised 0x0 neurons SOM neural network. Hierarchical clustering of neurons was used to reduce the number of groups and to solve arbitrary selection of network dimension. Results: The heatmap shows the classification of 280 GCs (rows) and 20 epochs (columns) between two heel-strikes of the same foot. Left to right black epochs tag contralateral toe-off, contralateral heel-strike and ipsilateral toe-off. Colours differentiate groups of SOM-neurons (kinematic configurations). Notice 5 types of GCs with different combinations of kinematic patterns whose onsets are not coincident with OE timing. F28 Heart rate variability changes during complex auditory stimulation in patients with disorders of consciousness and healthy subjects: preliminary results P. Guaraldi, C. Di Stefano 2, V. Petrone 2, R. Bolelli 2, A. Cortesi 2, L. Simoncini 2, P. Cortelli 3, R. Piperno 2 Local Health Council, Modena, Italy, 2 Neurorehabilitation Unit Casa dei Risvegli Luca De Nigris, Bellaria Hospital,, Bologna, Italy, 3 University of Bologna, Department of Biomedical and Neuromotor Sciences, Bologna, Italy Background and aims: Autonomic changes can be induced by different stimuli and provide clues on subjects responsiveness. We aimed to assess the changes in heart rate variability (HRV) induced by auditory/musical stimuli in patients with disorders of consciousness (DOC) and in healthy subjects (CNT). Methods: We assessed the HRV of 5 DOC (3 males, age 35.8±5, LCF=2.4±0.55) 9±2 months after brain injury and of 5 CNT. Subjects were assessed while they rested listening to a neutral story (NN), a series of autobiographical data read with neutral tone (NA), the story of an episode emotionally important for them (EE), him/her favorite song (CdC) and the description of the patient written by his/her relatives (DDL) with musical enrichment. The stimulation was preceded by a baseline of 0 minutes during which the subject heard only the sound of a stream (baseline). Each subject was assessed twice: the first time, the order of stimuli followed an increasing emotional level and complexity; the second time, the order of stimuli was random. HRV was derived by a 3 lead ECG using autoregressive algorithm. Results: Both in DOC and CNT LFnu, HFnu and LF/HF ratio did not differ during baseline, NN, NA, EE, CdC, irrespectively of the order of stimuli administration. The LF/HF ratio tended to rise during increasing emotional level and complexity stimuli, but was statistically different only during DDL compared to baseline (DOC p=0.028; CNT p=0.022). Conclusion: Enriched stimulation in an immersive environment increased the sympatho-vagal balance in DOC and CNT suggesting undisclosed awareness in DOC. Conclusion: Healthy children s CNS commands a small number of kinematic configurations to manage events associated with the gait cycle whose onsets are not coincident with OE. These configurations and their timing should be should be taken into account when designing therapies for gait disorders. 205 European Journal of Neurology, 22 (Suppl. ),

188 Flash Posters 67 F282 Dual electrical stimulation improved upper limb paresis of patients with stroke I. Jun-Ichi Oita, Japan Background and aims: We recently developed a dual electrical stimulation system, that stimulates synergistic muscles during shoulder flexion, elbow extension, wrist extension, and finger extension to improve motor functions of hemiparetic upper limbs. Here we investigated the effectiveness of this system in chronic stroke patients. Participants: The 8 patients (male: female, 5:3; mean age: 68.9) with chronic stroke received dual electrical stimulation. Interventions: The patients undergoing dual electrical stimulation underwent upper limb training for 60min per day, 5 days per week for 3 weeks. Main Outcome Measure: Outcomes were assessed using the upper extremity component of Fugl-Meyer assessment (FMA), Wolf Motor Function Test (WMFT), Modified Ashwarth Scales (MAS), Motor Activity Log (MAL) before and after intervention. The dependent t-test for paired samples was used to perform pre- vs post-treatment comparisons of the FMA, WMFT, MAS, and MAL. Results: All patients completed the training successfully using this system without any incidents or complications. The mean FMA score increased from 23.9 to (p<0.05), WMFT time decreased from050.9 sec to sec (p<0.05). The mean MAS did not show the difference, and MAL was increased from 8.7 to 2.7 (p<0.05). Conclusion: In this study, our new dual electrical stimulation system may be effective for upper limb paresis of patients with chronic stroke. F283 Combined repetitive transcranial and peripheral magnetic stimulation modulates functional state of the brain in stroke patients S. Kuznetsova, V. Kuznietsov, N. Skachkova Institute of Gerontology of the NAMS of Ukraine, Neurology, Kiev, Ukraine Background and aims: Repetitive transcranial magnetic stimulation (rtms) can enhance motor skill learning in stroke patients. However, the mechanisms of action of rtms are not completely understood. It was also recently shown that repetitive peripheral magnetic stimulation (rpms) promotes a functional cortical reorganization in healthy subjects. In this sham-controlled randomized trial we investigated the effect of combined rtms and rpms against the background of fosfocreatine therapy on functional state of the brain in stroke patients. Methods: 77 patients with ischemic stroke were randomized to receive Hz real or sham rtms and rpms against the background of fosfocreatine therapy. We evaluated the Motor Club Assessment Scale (MCAS), cortical excitability and electroencephalography (EEG) before and after the intervention. Results: The improvement of motor function was greater in the real stimulation group (RSG) (40.4% in MCAS) when compared to the sham group (7.% in MCAS). RSG showed statistically significant increase of motor evoked potential amplitude (before 0.82±0.29, after.36±0.23) and reduce resting motor threshold (before 8.00±3.29, after 73.67±3.72) of the affected hemisphere. No significant changes were observed of cortical excitability of both affected and intact hemispheres of sham group, as well as the intact hemisphere of RSG. The power spectral EEG analysis revealed a significant increase in alpha band power and decrease in theta band power in the RSG. Conclusion: Combined rtms and rpms against the background of fosfocreatine therapy improved motor functions, increased cortical excitability of the affected hemisphere and harmonized electrical activity of the brain in stroke patients. 205 European Journal of Neurology, 22 (Suppl. ),

189 672 Flash Posters F284 Facilitated communication in severe traumatic brain injury patients M.-A. Bruno, S. Laureys Liege, Belgium Background and aims: Facilitated communication (FC) describes the process by which a disabled person is physically assisted by another person ( facilitator ) to communicate using a communication board, modified typewriter or computer. The majority of controlled experimental studies have shown its invalidity in children with severe developmental disabilities. Nevertheless, proponents of FC propose the technique in communicatively impaired or noncommunicative patients with acquired acute brain injury. Methods: We assessed the efficacy of FC in 4 patients with severe chronic traumatic brain injury following coma. Following auditory or visual presentation of a word or picture to the patient in the absence of the facilitator, the latter reentered the room and was requested to assist the patient to communicate the presented word or picture. Results: In the 3 patients in MCS, none of the presented words could be correctly communicated via FC (see table ). In patient 4, however, who had emerged from MCS but only showed a functional yes-no communication to closed questions using reproducible head movements, all of the presented words could be correctly communicated via FC by the trained facilitator and also by clinicians or lay persons without any prior training. F285 Abstract cancelled F286 Early neurological improvement of patients with acute stroke C.-C. Mutu Sibiu, Romania Background: NIHSS scale is the tool by which to measure the severity of neurological impairment in acute stroke in both at the initial time of stroke and subsequent stages. Objective: The study of the short-term evolution of patients in the Neurology Clinic of Sibiu by analysing the dynamics of the NIHSS scale in the two key moments of hospitalisation (admission and discharge). Methods: We conducted an analytical study, observational, prospective type on a number of 85 patients with acute ischemic stroke, hospitalized within two months period. NIHSS scale has been evaluated at all patients on the first day of the admission and at discharge date, aiming to the possible correlation between the degree of recovery of patients and TOAST subtypes of stroke. Results: Those 85 patients with ischemic stroke (average age 7,42 years), according to TOAST classification, were divided as follows: 34.% LAA, 20% CE, 3.76% SAA,.7% OE and 2.94% EU. To them, the mean value of NIHSS scale at admission and at discharge (A/D) has varied as follows: 2.65/7.72 points for the LAA subtype, 0.4/5.8 points for SAA suptype, 2.82/7.23 points for CE subtype, 8/3 points for OE subtype, 4.63/7.09 points for EU subtype of stroke and 2.7/6.02 points for the whole study group. Conclusion: During hospitalisation (average-9.9 days) the degree of early recovery for the whole study group was 45.2%. The degree of early recovery has been maximum (5.54%) for EU stroke subtype and minimum (38.98%) for the LAA stroke subtype. Table : Demographic and clinical data of patients. MCS- : Minimally conscious state minus ; patients showing non-reflex behavior such as visual pursuit, localization to pain or to objects or contingent behavior to emotional stimuli. MCS+: Minimally co Conclusion: Despite the demonstrated usefulness of FC in one of the 4 presented cases, the use of FC in traumatic brain injury patients should prompt controlled verification of the facilitator prior to its clinical use. 205 European Journal of Neurology, 22 (Suppl. ),

190 Flash Posters 673 F287 Comparison of the effects of mat Pilates and reformer Pilates on balance, strength, mobility, fatique and quality of life in patients with multiple sclerosis I. Bulguroglu, A. Guclu-Gunduz, Y. Gokhan, C. Ozkul, C. Irkec 2, H.Z. Batur-Caglayan 2, B. Nazliel 2 Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey, 2 Gazi University, Faculty of Medicine, Department of Neurology, Ankara, Turkey Background and aims: The aim of our study was to investigate the effects of mat Pilates and reformer Pilates on balance, strength, mobility, fatigue and quality of life in patients with multiple sclerosis (MS). Methods: Study planned randomized, controlled, singleblind. Patients (EDSS 4) are divided into 3 groups; Mat Pilates (n=2), Reformer Pilates (n=3) and control group (n=3). Patients were evaluated with Berg Balance Scale, static balance tests, Timed Up and Go test, Activity Specific Balance Confidence Scale, Fatigue Severity Scale, Fatigue Impact Scale (FIS), Multiple Sclerosis Quality of Life Questionnaire (MSQOL-54). Additionally extremities muscle strength and core endurance-power were evaluated. Results: As a result of mat Pilates and reformer Pilates applications, in both groups balance, mobility, upper lower extremity muscle strength, core of stability and quality of life was increased (p<0.05), fatigue was observed as reduced (p<0.05). There was no difference in the control group (except for physical and psychosocial dimensions of FIS and physical dimensions of MSQOL-54) (p>0.05). When the amount of change was compared in two Pilates groups, in the development of left hip flexion, right hip extension, right shoulder flexion and right elbow flexion muscle strength was higher in the Reformer Pilates group (p<0.05) in the other parameters was observed that the gain was similar (p>0.05). Conclusion: In light of these results mat Pilates or reformer Pilates in patients with MS seems to be effective in improving balance, strength, mobility, fatigue and quality of life, and there is no significant difference between the two methods. Disclosure: Our research has not been granted. F288 Prolonged-release fampridine as adjunct therapy to active enabled motor training in multiple sclerosis patients: a pilot, double-blind, placebo-controlled study F. Jacques, A. Schembri 2, A. Nativ 3, C. Paquette, P. Kalinowski 2 Clinique Neuro-Outaouais, Gatineau, 2 Cogstate, Melbourne, Australia, 3 Clinique NeuroGym, Gatineau, Canada Background and aims: The study aim is to investigate if multiple sclerosis (MS) subjects treated with PRF 0mg BID will show a greater benefit from active enabled motor training as compared with subjects treated with placebo. Methods: Single center, phase 4, pilot, placebo-controlled, double-blind 8 weeks study. 30 MS patients of all types were recruited. 5 patients were randomized to receive PRF 0mg BID and 5 to received placebo BID. All patients participated in active enabled motor training consisting of 3 sessions of hour per week for a period of 6 weeks. Patients were evaluated at times -4, 0, 6 and 4 weeks using the timed 8 meters walk (8MW), the 6 minute walk (6MW) and the timed sit to stand (STS). Results: Both groups were balanced at baseline. The PRF treated group achieved a higher mean percent improvement from baseline in all three tasks at both the 6 and 4 week time points. The difference reached statistical significance (mean difference of 4.29, p=0.046) for the 8MW at the 4 week time point. A higher incidence of responders (>20% improvement from baseline) was seen in the PRF treated group at 6 weeks on the 8MW (odds ratio [OR] of 2.3) and the 6MW (OR of.63), and at 4 weeks on the 8MW and the STS (OR of 2.0). Conclusion: PRF in MS patients appears to enhance the benefit of active enabled motor training and to better sustain it over the following 8 weeks. Further studies are warranted. Disclosure: The research has been financed by an unrestricted grant from Biogen Idec. F289 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

191 674 Flash Posters F290 Computer asisted cognitive rehabilitation in stroke and Alzheimer s disease. P. Ressner, P. Nilius 2, D. Berankova, P. Bartova, P. Krulova, H. Srovnalova-Zakopcanova, M. Bar University Hospital in Ostrava, Neurology, Ostrava, Czech Republic, 2 Ostrava, Czech Republic Background and aims: Cognitive functions are impaired in neurodegenerative diseases of the brain, stroke, brain trauma and others diseases. Cognitive rehabilitation (CR) should be a part of complex therapy. Neural plasticity for the cognitive rehablitation is needed. Methods: We tested the hypothesis that computer assisted CR is more effective in acute structural brain lesions as stroke than in neurodegenerative diffuse brain disease as Alzheimer s disease (AD). We tested age- and sex-matched 72 patients post-stroke patients with mild cognitive impairment (32 patients with the left hemispere lesion, 2 patients with the both hemispheres lesions and 28 with the right hemisphere lesion) and 58 patients with mild AD. We administered WAIS-III, MMSE, Adenbrook Cognitive Test, and also Hospital Anxiety and Depression Scale to exclude patients with significant anxiety or depression. Battery of the tests was administered before and after computer asisted CR. For computer asisted CR we used software NEUROP-4 for the therapy twice a week for the 3 monts (2weeks). Results: In the stroke patients effect of the computer asisted CR was significanty higher effective than in AD. Conclusion: Results in our study correlate with the hypothesis, that for the cognitive rehabilitation is crucial brain plasticity which we expect higher in acute demarcated brain lesions with spared rest of the brain tissue than in diffuse neurodegenerative disorder. These results correlate with the data in the literature. We need higher number of the patients to further analysis. Disclosure: Our resarch has been granted by institutional support RVO-FNOs/202-. F29 Abstract cancelled F292 Possibilities of the robot-assisted kinesitherapy in complex rehabilitation of post-stroke patients K. Sklyannaya, V. Bronnikov Centre of Complex Rehabilitation, Perm, Russian Federation Background and aims: Lokomotor training is an integral part of post-stroke rehabilitation. New methods of robotic kinesitherapy are widely used in the process of rehabilitation of post-stroke patients, however, the efficiency of their application is not adequately explored. The purpose of our study was to estimate effects of Lokomat in patients after stroke. Methods: We analysed the complex rehabilitation efficiency results of 35 patients after stroke, who underwent course of 5 sessions of conventional physical therapy and 5 sessions of robot-assisted therapy using Lokomat in Complex Rehabilitation Centre in 204. We compared obtained data with results of the control group of 20 patients who recieved only 5 sessions of conventional kinesitherapy. Evaluation measures for both groups were muscle strength grading scale, modified Ashworth scale, visual analogue pain scale, Rivermead mobility scale, Barthel scale. Patients coordination and balance were evaluated with stabilometric platform. Main parameters obtained were the position of the body centre of gravity and the surface of statokinesiogram. Results: The most significant improvement in the Lokomat group was observed in muscle strength scale and mobility scale. Patients in the control group also showed improvements, but only the index of physical possibilities was significantly increased. Patients in the main group showed better stabilometry results. Reduction of frontal asymmetry of the body gravity centre and decrease of statokinesiogram surface were observed. Conclusion: We established the positive clinical effect of the complex rehabilitation course in patients after stroke, and the efficiency is higher in patients in the Lokomat group. F293 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

192 Flash Posters 675 Peripheral nerve disorders F294 Clinical and neurophysiologic characterization of a population with HNPP J. Afonso Ribeiro, A. Matos, J. Parra, L. Almendra, A.P. Geraldo, L.J.M.P. Negrão Centro Hospitalar e Universitário de Coimbra, Neurology, Coimbra, Portugal Background and aims: Hereditary neuropathy with liability to pressure palsy (HNPP) is usually characterised by painless recurrent neuropathies in usual areas of entrapment. Nowadays atypical forms are described, with greater prevalence than originally documented. Neurophysiologic studies play a major role in diagnosis of HNPP. Methods: We reviewed clinical and electrophysiological data of patients with genetic diagnosis of HNPP consulted in a tertiary hospital. Results: We studied 7 patients, 9 (52.9%) of them male. Current mean age is 42.6 years (SD 2.8), and the mean age at st manifestation of the disease was 25.0 years (SD 2.8). The mean difference between the st manifestation and clinical observation was 9.3 years. 6 patients (35.3%) had a typical presentation (with recurrent painless neuropathies), being peronal nerve palsy the most common. The remaining patients (64.7%) had atypical forms of the disease. Generalised changes in motor and/or sensitive conduction studies, with decrease in CMAP amplitudes and focal demyelination in common entrapment sites, were found in 5 patients (88.2%); patient had a severe sensory-motor axonal neuropathy; and other patient had changes restricted to median and cubital nerves. No clinical-electrophysiological correlation was found. Genetic studies revealed PMP22 delection in 5 patients and point mutations in 2 (members of the same family). Conclusion: Current literature emphasises the atypical forms of HNPP. The related absence of clinical-electrophysiological correlation highlights the importance of nerve conduction and genetic studies for the diagnosis of the disease. Gravity scores are still lacking in its clinical characterization F296 Epidemiology of Guillain-Barré syndrome in Emirate of Dubai A. Alboudi, J. Inshasi 2, S. Abdulla Mohammad Alrukn 2, P. Sarathchandran 2, A. Abdul Rahman Shaffi Al Madani 2 Dubai, United Arab Emirates, 2 Rashid Hospital, Neurology, Dubai, United Arab Emirates Background and aims: Guillain-Barré syndrome is the most common cause of flaccid paralysis, after the near eradication of polio. This is critical a disease with high disability outcome. There is no Data from UAE about this disease. Methods: We had data collected from 4 major hospitals in Dubai, for all patients during We used NINDS criteria. Evaluation discharge was by Hugh s scale for disability. Results: We encountered 98 patients, with annual incidence of about.3/00, % of patients were male, with median age 38y. The peak incidence of the disease was at the 3 rd decade. Tow thirds of patients had preceding precipitating factor, with prodromal period ranging from 2 days to 4 weeks. There were two main subtypes of the disease, 0 patients (0.2%) had Miller-Fisher syndrome, and the rest had full Guillain-Barré syndrome. 2 patients had preserved deep tendon reflexes, and 79% had cranial nerves involvement. Autonomic signs were found in 3 patients (3.2%). And 2 (2,2%) patients needed ICU admission. The median hospital stay was 6.5 days. 65.4% of the patient had good prognosis with Hugh s scale at discharge 3 or less, with death in 2 patients only (2%) Conclusion: In our study we found some differences from the global studies in regard to the male:female ratio with mild increase in male where the peak of incidence is at younger age. Also with less mortality rate. F295 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

193 676 Flash Posters F297 Multiple cranial neuropathy: a rare presentation of mixed cryoglobulinemia associated with hepatitis C virus. P. Brás, S. Dias, A. De Sousa Lisbon, Portugal Background and aims: The presence of mixed cryoglobulinemia associated with hepatitis C virus infection is found in about 50% of patients. Among its clinical manifestations stands out a peripheral neuropathy presenting, most commonly, as a distal sensory-motor polyneuropathy. However, in this case report we present a rare manifestation of cryoglobulinemic neuropathy: multiple cranial nerve involvement. Case Report: A 66-year-old Caucasian woman was admitted to the neurology department with acute paresis of the left oculomotor nerve (diplopia, ptosis and paresis in adduction and supraversion of the left eye). Two months before, she had a similar clinical episode in the right eye, not investigated. Her medical history revealed a longstanding, untreated infection with hepatitis C virus, type 2 diabetes mellitus and arterial hypertension. On the sixth day of hospitalisation, she presented a right-sided peripheral facial nerve palsy. The imaging study disclosed no abnormalities. Analytically, she had a polyclonal cryoglobulinemia. The neurophysiological study revealed a sensorimotor axonal polyneuropathy in all four limbs and a subacute, severe neuropathy in the right facial nerve. The patient was treated with prednisolone 60mg/day without significant improvement. Subsequently, she was oriented for antiviral therapeutic management. Results: Case Report Conclusion: This case is unique because multiple cranial neuropathy is a rare presentation of cryoglobulinemia associated with hepatitis C. Since its effective therapy remains unclear, further studies will be needed to clarify this problem. F298 Retrospective assessment of evolution in chronic inflammatory demyelinating polyneuropathy E.I. Davidescu, M.L. Geambasu 2, I. Buraga 2 Bucharest, 2 University of Medicine and Pharmacy Carol Davila, Neurology, Bucharest, Romania Background and aims: Performing an analysis based on epidemiological, clinical, laboratory and therapeutic data of patients with chronic inflammatory demyelinating polyneuropathy (CIDP) treated with monthly sessions of intravenous human immune globulin. Methods: We performed a retrospective study on a group of 32 patients with CIDP admitted in our department during 203. There were 2 men and women, aged between 28 and 82 years; although it can occur at any age but more common in young adults. In our study, 40.7% of patients were years old. The mean period of evolution of the disease was.6 years. Therapy consisted of monthly administration of intravenous human immune globulin (in average 7 sessions in this lot). Results: 59% of the group had a symmetrical evolution of polyneuropathy and the onset was in 57% of the cases in lower limbs, proximal. Only 9% of patients had impaired cranial nerves and 66% had associated comorbidities. Therapy was generally well tolerated, only 6% presented adverse events as chills, unusual tiredness or wekness, or burning sensation in the head. Only 9% of patients benefited of plasmapheresis association, because of costs. Conclusion: Usual presentation of CIDP is a sensorimotor polyneuropathy. Most patients respond to treatment with Iv Ig, used now as a first-line therapy with short-term benefit. Studies are needed to investigate the long-term benefits of these therapies and all efforts must be done at an early diagnosis of the disease, as initiation of early treatment is essential to prevent loss of nerve axons. F299 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

194 Flash Posters 677 F2200 Acute onset of chronic demyelinating polyradiculoneuropathy E. Ehler, I. Stetkarová 2 University Pardubice, Neurology, Pardubice, 2 University Hospital FNKV Prague, Neurology, Prague, Czech Republic Introduction: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired, immune mediated neuropathy with a prevalence of 2-7.9/ inhabitants. Approximately 6-20% of CIDP patients have an acute onset with progressive muscle weakness during the first 6-8 weeks followed by a subsequent chronic course. It can be mistaken for an acute polyradiculoneuritis; however, it has significant differences in course, longer progression, more serious prognosis and distinct therapy. Abnormalities typical for subacute or chronic demyelinization are presented by EMG. The aim of the study was to define in detail the subgroup of patients with acute onset of CIDP. Methods: We retrospectively analysed clinical data and neurophysiological findings in the group of 42 patients with CIDP which were registered and treated in a neuromuscular centre (22 males, age 3-84 years). Results: An acute onset of CIDP was found in 8 patients (5 males, age 3-7 years). In all of these patients the first diagnosis was determined as an acute polyradiculoneuritis. Multiple motor conduction blocks, time dispersion, and slow conduction velocities in motor and sensory fibers, prolonged F-wave latency, prolonged distal motor latency and prolonged duration of the distal compound motor action potentials were presented on the first EMG investigation. Conclusion: Diagnostics of CIDP has its defined clinical, electrophysiological and supportive criteria according to EFNS/PNS from 200. An acute onset of CIDP is not so rare an entity and has to be differentiated from acute polyradiculoneuritis because of significant differences in therapy and prognosis. Supported by Research Projects of Charles University PRVOUK P34. F220 A difficult differential diagnosis in a case of small fiber neuropathy T. Geraldes, M. Melo Pires 2, T. Coelho 3 Hospital Garcia de Orta, Department of Neurology, Almada, 2 Centro Hospitalar do Porto, Hospital de Santo António, Neuropathology Unit, Porto, 3 Centro Hospitalar do Porto, Hospital de Santo António, Department of Neurophysiology, Porto, Portugal Background and aims: Small fiber neuropathy is defined pathologically by selective degeneration of small diameter sensory and/or autonomic axons. Often idiopathic these neuropathies may be due to genetic causes such as transthyretin amyloidosis (A-TTR) or secondary to common diseases such as diabetes mellitus (DM). Pain is the main complaint. Diagnosis is based on clinical features, normal nerve conduction studies, and abnormal results of smallnerve fiber tests. Some patients may evolve to a large fiber sensory neuropathy. We describe a clinical case of a patient with two simultaneous causes of small fiber neuropathy. Case Report: A 64-year-old female patient, with type II DM diagnosed since 997 is also a known carrier of the genetic mutation Val30Met for A-TTR. She was referred to our clinic complaining of dysesthesia in the extremities and alternating diarrhea and constipation. Nerve conduction studies were normal apart from the presence of bilateral carpal tunnel syndrome. Quantitative sensory testing showed abnormal cold and heat pain sensation. The patient was submitted to a nerve biopsy, in 2007, which revealed an axonal neuropathy without amyloid deposits. In 200 a salivary gland biopsy was negative for amyloid deposits. Since then, the patient maintained a relapse and remitting pattern of sensory and gastrointestinal complaints. Results: This case report intends to alert to the existence of several potential causes of small fiber neuropathy and remember that not all diagnoses are static. Conclusion: In this particular case, we considered a diabetic neuropathy and not amyloidosis but the diagnosis may change in the near future. 205 European Journal of Neurology, 22 (Suppl. ),

195 678 Flash Posters F2202 Evaluation of quality of life and disability in 22 cases achieved a Guillain-Barré syndrome (GBS) and treated by immunoglobulins: a prospective study B. Houria Algiers, Algeria Background and aims: Emphasize the interest of immunoglobulins in the GBS treatment by accelerating functional recovery. Assess the impact of the disability on the socio-familial and professional and the quality of life. Methods: 22 patients with GBS, supported and monitored in service of neurology at the Central Hospital of the Army of Algiers, were identified in a retrospective manner in our registry between January 2009 and January 204. Functional evaluation was made before treatment and at months/ 6 months/ year/ 2 years, with the ONLS scales (overal neuropathy limitation scale), Barthel and Rankin. The patients were reviewed in consultation or contacted by telephone to fill a quality of life questionnaire SF-36. Results: The poor prognosis of elements found in our series were the need for mechanical ventilation in 2 cases, a period of less than 7 days extension phase in 8 patients and early axonal damage the EMG in 5 cases. Patients had a mean score ONLS 9, SF-36 physical median score of 75 [59-89] and a median score of 7 mental [65-89].The median Rankin score was 2 [-4], and the median Barthel score of 00 (87.5 to 00) with a criterion of improvement of at least point. Conclusion: Functional recovery in GBS can be accelerated through early and effective treatment with immunoglobulins which allowed a significant improvement in the quality of life of patients on all levels. F2203 Outcome of Guillain-Barré syndrome in Thailand P. Sukphulloprat, K. Kulkantrakorn Thammasat University, Internal Medicine, Pathumthani, Thailand Background and aims: Guillain-Barré syndrome (GBS), the most common acute polyneuropathy, is commonly seen worldwide with significant morbidity and mortality. This study was to identify clinical characteristics, electrophysiologic changes, clinical course, treatment, outcome and prognostic factors of GBS in Thailand Methods: A retrospective study of GBS patients who were 5 years of age or older, admitted to Thammasat University Hospital and Bangkok Hospital between st January 2009 and 30 th November 204 Results: 30 patients were recruited. Demographic characteristics were collected and described as follows; 60% male gender; average age 54 years; Asian 60%, European 20%, others 0%. Disease subtype consists of AIDP 66.7%, AMAN 0%, AMSAN 3.3%, MFS 6.7%, PCB 6.7%, bifacial weakness with paresthesia 6.7%. Average GBS disability score at admission was 2.9. Immunotherapy was IVIg 83.3%, plasma exchange 3.3%, steroid 3.3%. Average length of stay was 4.2 days, assisted ventilation rate was 3.3%. After the average of one year-follow up, average GBS disability score was 2, good outcome (score <3) was 63.3% and no death. Predictors of inability to walk unaided (GBS disability score 3) were older age, previous diarrhoea, autonomic disturbances, weakness of facial, bulbar, distal upper limbs and lower limbs muscles, higher disability score at admission or onset of treatment. Conclusion: Most GBS patients in Thailand are AIDP subtype and have good outcome. Predictors of severe disability are older age, previous diarrhoea, autonomic disturbances, severe weakness at admission or onset of treatment. 205 European Journal of Neurology, 22 (Suppl. ),

196 Flash Posters 679 F2204 Hereditary neuropathy with liability to pressure palsies (HNPP) with deletion in PMP22 gene: characteristics in a Brazilian series P. Lorenzoni, R. Scola 2, C. Kay, C. Cavalet 2, R. Arndt 2, L.C. Werneck Curitiba, 2 UFPR, Neurology, Curitiba, Brazil Background and aims: Hereditary neuropathy with liability to pressure pal sies (HNPP) is an autosomal dominant peripheral neurop athy characterised by acute episodes of focal neuropathies mainly at common sites of entrapment. HNPP has specific clinical, electromyography and genetic characteristics, but there are few studies to describe their characteristics in Brazil. Methods: A retrospective analysis of 3554 patients disclosed 0 patients with a diagnosis of HNPP. Correlations between clinical manifestations, laboratory features, electrophysiological features, histological and molecular findings are analysed. Results: The sample consisted of 0 patients, aged 23 to 53 years, from seven unrelated families. Acute nerve palsy was present in 7 cases and the number of different acute nerve palsy range from to 3 episodes. The sites of first nerve palsy episode were peroneal, ulnar, radial and suprascapular nerves. The identified sites of focal neuropathy were carpal tunnel at the wrist, ulnar groove at the elbow, head of the fibula at the knee, radial at the arm and suprascapular at the shoulder. Nerve conduction studies showed focal neuropathy in all patients and generalised symmetrical neuropathy in 8 patients. In nerve biopsy, tomacula was found in one case. The molecular analysis detected a deletion mutation of.5-mb in PMP22 gene in all patients. Conclusion: The clinical and electrophysiological pictures of our patients were similar to those previously described in HNPP. Although, clinical and electrophysiological phenotype was not homogeneous, our study contributes to the idea that deletion in PMP22 gene is the most frequent mutation in Brazilian HNPP patients. F2205 Central nervous system involvement in a patient with chronic inflammatory demyelinating polyneuropathy (CIDP) Y. Malik, H. Hashim, A. Almadani, Z.-U. Nisa Rashid Hospital, Neurology, Dubai, United Arab Emirates Background and aims: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disorder of the peripheral nervous system (PNS) which progresses in either chronic progressive or relapsing form. It bears a range of clinical varieties and rarely involves the central nervous system such as cranial variant of CIDP which encovers cranial nerve palsies along with flaccid paralysis. Someties it may present with demyelination of central nervous system such as optic neuropathy, which is not well known clinical manifestations in CIDP with CNS involvement. Case Report: We are presenting a case of a middle aged male of Arab ethnic origin, who presented with chronic progressive course of the disease suggestive of CIDP. He had progressive sensory and motor complaints in all extremities for last 3 years. In Germany he was diagnosed as a case of CIDP on clinical and electrophysiological grounds and was treated with IVIG initially and later with prednisolone plus Azathioprine.His response to mentioned immune modulaters was not sufficiently good. Recently he presented to our department with right frontal headache and reduced vision in right eye for few days. Clinical assessment and investigations confirmed the diagnosis of optic neuritis which was treated with Methylprednisolon. Optic neuritis with CIDP is not a well known entity, although both are likely to have similar pathologic mechanism. Results: No results in a case report. Conclusion: A simultaneous presentation of peripheral and central demylination is a highly rare experience. Though immune mechanism seems to play significant role in such clinical scenarios, still these are needed to be investigated further. 205 European Journal of Neurology, 22 (Suppl. ),

197 680 Flash Posters F2206 Denervation hypertrophy: an unusual consequence of an L5 motor radiculopathy E. Mc Govern, S. Connolly, R. Killeen, M. Farrell 2, C. Mc Guigan St Vincent s University Hospital, Department of Neurology, Dublin, 2 Beaumont University Hospital, Dublin, Ireland, Department of Neuropathology, Dublin, Ireland Background and aims: Extensive denervation usually leads to muscle atrophy. Neurogenic muscle hypertrophy is rare. We report the case of hypertrophy of tibialis anterior muscle as a chronic complication of L5 motor radiculopathy. Case Report: A 62-year-old, right-handed man presented with a 3-year history of painful swelling and stiffness of the right anterior leg approximately 3 years following lumbar discectomy. Pain was most marked at rest and ambulation was also affected. The symptoms had persisted despite anterior tibial fasciotomy. Examination revealed marked hypertrophy of the right anterior tibial musculature resulting in a 3cm increase in leg circumference. The remainder of the neurological examination was normal. Results: Routine laboratory investigations were normal with the exception of an elevated creatine kinase level (400 IU/L, normal <70 IU/L). Needle electromyography (EMG) of the resting right lower limb revealed complex repetitive discharges (CRDs) continuously in tibialis anterior (TA), and intermittently in tibialis posterior, extensor digitorum brevis & tensor fasciae latae muscles. Chronic reinnervation in the right L5 myotome was evident on EMG during voluntary activation. Lumbosacral magnetic resonance imaging (MRI) demonstrated neural foraminal stenosis at L4-L5 with compromise of the exiting right L5 nerve root. Muscle biopsy of TA demonstrated fibre hypertrophy and splitting. Conclusion: Denervation hypertrophy is a rare chronic complication of a motor radiculopathy and can cause significant morbidity. 205 European Journal of Neurology, 22 (Suppl. ),

198 Flash Posters 68 Monday, June Ageing and dementia 2 F300 Presbyphagia in the Greek population: clinical characteristics and the influence of gender G. Nasios TEI of Epirus, Speech and Language Therapy, Ioannina, Greece Background and aims: The swallowing mechanism changes significantly as people age, even in the absence of chronic diseases, a phenomenon called presbyphagia. Several studies have pointed out the varied age-related changes in swallowing physiology. This study sought to determine the relationship between swallowing performance, age and gender. Methods: A total of 98 healthy participants were recruited and divided into 3 age groups: 3 (22 female, 9 male) comprised the younger group (ages 20-30), 33 the mid-age (2 female, 2 male) (ages 55-65) and 34 (2 female, 3 male) the older group (age 75+). A 25ml Water Swallowing Test (WST) was administered and the total time of completion as well as the number of required swallows, were recorded. Results: Results revealed that the older group required more time and more swallows to complete the 25mL-water test. There was statistically significant correlation between age and time of completion (p=0.00, <0.05), as well as between age and total number of swallows (p=0.00, <0.05). No statistically significant relationship was found between performance on the water swallow test and gender although women required longer time and more swallows than men in each age group. Conclusion: The swallowing capacity is clearly affected by age and shows important decline in the elderly, a condition called presbyphagia. The study points out the growing need for assessing swallowing parameters and aspiration pneumonia risk in the elderly. F3002 Clinical and therapeutic profile of dementia with Lewy bodies: findings from a Tunisian cohort of 28 patients A. Nasri, M. Ben Djebara, L. Sellami, Y. Sidhom, Y. Hizem, R. Gouider Razi Hospital, Tunis, Department of Neurology/ Research Unit UR2SP2, Tunis, Tunisia Background and aims: Dementia with Lewy bodies (DLB) is the second major cause of degenerative dementia. However, it remains underdiagnosed. We aimed to establish the characteristic profile of DLB in a Tunisian cohort and to compare it to western countries Methods: A 2 years retrospective study ( ) includig all the patients diagnosed with probable or possible DLB according to revised McKeith criteria. Demographic, clinical neuropsychological, paraclinical and therapeutic features were analyzed. Results: We included 28 patients (6%of all dementias). Sex-ratio was.7 and mean age of onset at 73.5 years. Mean time to diagnosis was 3.3 years. Major clinical features were: visual hallucinations (92%), apraxia (90%), memory troubles (86%) and parkinsonian syndrome (84%). Fluctuations were found in 70% and RBD in 7.%. Neuropsychological assessment found mainly dysexecutive (97%), memory (96%) and visuospatial/constructive (44.5%) disorders. Electroencephalography found FIR- DA pattern in 6%. Brain imaging showed diffuse atrophy (50%). Main used drugs were hypnotics (53%), anticholinestrasics (30%), levodopa (26%, with response in 25% cases). Intolerance was noted in a quarter of the patients that used neuroleptics before diagnosis. Conclusion: Male predominance and age of onset between 50 and 83 years were noted as classically described. However, clinically, we found a higher frequency of memory troubles and a lower frequency of visuospatial/constructive disorders and RBD than previously reported. FIRDA pattern and diffuse atrophy with preservation of hippocampus were considered as additional criteria for DLB. Dopa-responsiveness was found in 25% especially at early stages. The cholinergic deficit in DLB may explain the responsiveness to anticholinesterasics in hallucinations and memory troubles. 205 European Journal of Neurology, 22 (Suppl. ),

199 682 Flash Posters F3003 Accident risk of drivers with cognitive impairments E. Papadimitriou, D. Pavlou, D. Kontaxopoulou 2, S. Fragkiadaki 3, C. Antoniou 4, G. Yannis, I. Golias National Technical University of Athens, Department of Transportation Planning and Engineering, 2 Athens University Medical School, 2 nd Neurology Clinic, Attikon Hospital, 3 Athens, Greece, 4 National Technical University of Athens, Athens, Greece Background and aims: The objective of this paper is to estimate and explain the accident risk of drivers with cognitive impairments in a driving simulator task. Methods: The accident risk of drivers cognitively impaired due to specific pathologies (MCI, AD or PD) is calculated as the rate of the number of accidents to the number of unexpected incidents, both occurring during a driving simulator task in a rural road environment. The accident risk rates of impaired drivers are compared to those of healthy drivers of similar age groups. Results: More than 20 drivers have completed the driving simulator experiment. More than 80 drivers had some brain pathology and more than 40 were the control group. Each participant had to deal with 4 unexpected incidents during their driving task, i.e. the sudden appearance of an animal (deer or donkey) on the road. The impaired drivers group had systematically higher accident probability than the control group. More specifically, accident risk of AD and MCI drivers was 35% and 30% higher respectively than the accident risk of the control group. Conclusion: Impaired drivers have higher accident probability than the control ones. Even when they drive slower, they are more likely to crash the incident that unexpectedly happens in front of them. F3004 Grand Total EEG analysis in frontotemporal dementia and Alzheimer s disease P. Ioannidis, G. Papadopoulos, C. Mpakirtzis, E. Koufou, T. Afrantou, D. Karakostas AHEPA University Hospital, 2 nd Neurology Department, Thessaloniki, Greece Background and aims: The Grand Total EEG (GTE) is a qualitive EEG analysis method whose diagnostic value has proven in Alzheimer s disease (AD). Frontotemporal dementia (FTD) is the pathological description of a group of neurodegenerative disorders. From the current data the EEG in FTD is not diagnostic. Methods: EEGs from 29 FTD (mean age 64.3, mean disease duration.8, s.d.:.29 years, mean MMSE: 2) and 2 AD (mean age 68., mean disease duration.66, s.d.:.47 years, mean MMSE: 2) patients were evaluated according to the GTE score. These results were compared in order to investigate possible differences in EEG findings between the two diseases. Results: Median GTE scores were compared between FTD and AD (7.7 vs 6.2, p: 0.24). The individual items of the score: FTD and AD median scores were almost the same in rhythmic background activity (p: 0.87), in reactivity (p: 0.32), in slow wave activity (p: 0.39), in sharp wave activity (p: 0.26) and in paroxysmal activity (p: 0.87). Conclusion: GTE analysis cannot provide additional information in the differential diagnosis of AD from FTD. Furthermore none of the individual items of GTE showed any statistically significant difference between the two groups. Our findings agree with the bibliography. Further investigation is needed in order to clarify a possible role of EEG in differentiating FTD from AD. 205 European Journal of Neurology, 22 (Suppl. ),

200 Flash Posters 683 F3005 Grand total EEG analysis in primary progressive aphasia and Alzheimer s disease T. Afrantou, E. Koufou, G. Papadopoulos, C. Mpakirtzis, P. Ioannidis, D. Karakostas AHEPA University Hospital, 2 nd Neurology Department, Thessaloniki, Greece Background and aims: The Grand Total EEG (GTE) is a qualitive EEG analysis method whose diagnostic value has proven in Alzheimer s disease (AD). Primary progressive aphasia (PPA) is a neurodegenerative disease which falls in the spectrum of fronto-temporal lobar degeneration (FTLD). The recent literature shows that the characteristics of EEG have not been studied enough in PPA. Methods: EEGs from 5 PPA (mean age 63., mean disease duration 2.8, s.d.:.69 years, mean MMSE: 7) and 2 AD (mean age 68., mean disease duration.66, s.d.:.47 years, mean MMSE: 2) patients were evaluated according to the GTE score. These results were compared in order to investigate possible differences in EEG findings between the two diseases. Results: Median GTE scores were compared between PPA and AD (2 vs 6.2, p: 0.006). The individual items of the score: PPA median scores were higher than AD in sharp wave activity (p: 0.0) but not statistically significant in rhythmic background activity (p: 0.76), in reactivity (p: 0.07), in slow wave activity (p: 0.06) and in paroxysmal activity (p: 0.). Mean disease duration was higher and MMSE worse in the PPA group, probably because of the late attendance to the Neurologist when the first symptom was progressive disorder of language. Conclusion: The total score as also sharp wave activity show reliable differences between the two diseases. Due to the heterogeneity of the sample, as mentioned before, further research is needed to clarify the role of the EEG in PPA compared to AD. F3006 Disorders in empathy related to dementia syndromes from a Greek outpatient Memory Clinic E. Lykou, V. Kamtsadeli 2, N. Tsinia 3, E. Chatziantoniou 3, O. Papatriantafyllou, C. Mpoulas 4, C. Karageorgiou, J. Papatriantafyllou 2 G.Gennimatas, Athens, Greece, 2 G.Gennimatas-IASIS Center, Athens, Greece, 3 G.Gennimatas-Aeginitio Hosp., Athens, Greece, 4 G.Gennimatas-Chios Hosp., Athens, Greece Background and aims: The aim of the study is to estimate changes in empathy in the most frequent neurodegenerative diseases. Methods: In the study participated 82 patients and 46 normal controls. Diagnosis has set through international criteria The participants got a battery of tests: MiniMentaLStatE- Examination, Addenbrook scognitiveexamination, GeriatricDepressionScale or ZungDepressionScale.The caregivers answered the Neuro-Psychiatric Inventory. We used the Interpersonal Reactivity Index (IRI) about the patient s current level of empathy. The IRI is a measure of both cognitive and emotional components of empathy that is administered in questionnaire form. The caregivers (relatives for controls) answered the questions of Perspective Taking and Empathic Concern sub-scales. These subscales seem to correlate better with the underlying atrophy. Results: We used ANCOVA test and as covariates age and years of education. ) Perspective Taking (PTS) Normal controls differ statistically from all types of dementia except LBD/PDD patients. MCI patients differ from bvftd. AD patients do not differ from other disorders. LBD/PDD differs only from bvftd. PnFA, sv-ftd, CBD/PSP patients do not differ from other disorders. ) Empathic Concern (ECS) Normal controls differ from all types of dementia except LBD/PDD, PnFA, sv-ftd. bv-ftd patients differ from MCI, AD, LBD/PDD and sv- FTD. PnFA and CBD/PSP patients do not differ from other disorders. Conclusion: There is a loss of empathy in many of dementia syndromes. There is a differential loss about Perspective Taking and Empathic Concern. The sub-scales of IRI are suitable to examine these changes in many dementia syndromes. 205 European Journal of Neurology, 22 (Suppl. ),

201 684 Flash Posters F3007 Assessment of driving performance of drivers with cognitive impairments: which are the critical measures? D. Pavlou, S. Fragkiadaki 2, D. Kontaxopoulou 2, A. Economou 3, I. Beratis 3, E. Papadimitriou, G. Yannis, S. Papageorgiou 2 National Technical University of Athens, Department of Transportation Planning and Engineering, Athens, Greece, 2 Athens University Medical School, 2 nd Neurology Clinic, Attikon Hospital, Athens, Greece, 3 Athens, Greece Background and aims: This paper aims to identify driving performance measures in which drivers with cognitive impairments significantly deviate from the general population. Methods: The driving performance of more than 75 drivers with cognitive impairments (MCI, AD or PD) is compared to the driving performance of more than 50 healthy drivers of similar age (all drivers are over 55 y.o.), through a driving simulator experiment. For each driver, the following driving performance measures are calculated: speed, speed variability, lateral position, lateral position variability, headway, steering angle, steering angle variability, reaction time at incidents, number of traffic violations and number of accidents. These are compared to the range of typical values of the respective distribution of healthy drivers, and significant deviations from the typical distribution are identified. Results: More than 60% of the impaired drivers have extremely low mean speeds, compared to the control group and they often have lower speed variability (in around 50% of the cases) than controls. Regarding the vehicle lateral position, the impaired drivers tend to have difficulty in positioning the vehicle on the lane, and out of 4 has very high lateral position variability. Half of the impaired drivers have very large mean headways from the vehicle ahead and around 20% of them have very high steering angle variability. Moreover, they get outside road lines and cause accidents more often. Finally, 50% of drivers with cognitive impairments have very slow reaction times in unexpected incidents. Conclusion: Impaired group has various difficulties in driving performance compared with the control drivers. F3008 Cognitive impairment in Slovenian patients after ischemic stroke or transient ischaemic attack (TIA) J. Potocnik, K. Ovcar, L. Mumelj, M. Menih 2, M. Rakusa 2 Faculty of Medicine University of Maribor, Maribor, Slovenia, 2 University Medical Centre, Neurology, Maribor, Slovenia Background and aims: Montreal cognitive assessment scale (MoCA) is one of the most sensitive and specific tests for detecting and evaluating cognitive impairment. Aims of our study were to standardize MoCA test for the Slovenian population and to validate it for detection of cognitive impairment in patients after stroke or TIA. Methods: We included 60 patients and 52 healthy adults older than 50 years. Both groups were age matched (72±9 years). Patients were further divided into two subgroups in regard to their history of memory complaint. All, control and both study groups had to take the MoCA scale test. After statistical analysis of their results we determined cutoff values, sensitivity, specificity and likelihood ratio of the MoCA test. Results: Cut-off value between all patients and controls was 25 points, with the sensitivity of 90% and specificity of 65% (like-hood ratio 2.59). If patients had memory complaint, cut-off value was lover at 22 points. Sensitivity was 90% and specificity was 94% (like-hood ratio 9). Significant correlation was found between MoCA score and education (ρ=0.40; p<0.0). Conclusion: Our results show that MoCA scale can be used as a sensitive screening tool for early detection of cognitive impairment in patients after stroke or TIA. We should be alert for the patients, who score less than 22 points. However, if patients do not express memory complains, we might use more rigorous criteria (25 points). 205 European Journal of Neurology, 22 (Suppl. ),

202 Flash Posters 685 F3009 Dementia caused by inflammatory and autoimmune disorders M. Rahmani, M. Benabdeljlil, F. Alamouri, S. Aïdi, F. Boutbibe, M. El Alaoui Faris Hôpital des Spécialités - Mohamed V University, Department of Neurology A and Neuropsychology, Rabat, Morocco Background and aims: Dementia has many forms and a variety of causes. Many of them are treatable. The aim of this study is to analyze secondary inflammatory causes of dementia and to compare them to the others etiologies. Methods or Materials or Case Report: To identify dementia caused by inflammatory and immune disorders, we reviewed all the 56 cases of dementia collected between January 2000 and May 203 in the Memory Center of Rabat. All individuals underwent CT scan and/or cerebral MRI with biological testing and lumbar puncture. Results: There were 20 patients, representing 3,53% of all subjects, aged between 7 and 74 years with a mean age of 43. years. All patients were under 65 years except one who was 74. There were 0 men and 0 women. Neurobehcet s disease was the most frequent etiology (6 cases) followed by multiple sclerosis (5 cases), lupus erythematosus disease (2 cases) and Goujerot-Sjogren disease (2 cases). These conditions were noted in the younger subjects. Other etiologies were also noted: Hashimoto s disease (one case), limbic encephalitis (one case), Rasmussen s encephalitis (one case), anti-nmda s encephalitis (one case) and cerebral angeitis (one case). Dementia was severe in 2 cases and moderate in the others. Conclusion: Immune disorders resulting in dementia are rare. They are usually responsible of an early onset dementia. This dementia may be reversible if caught early enough and if appropriate treatment is administered. F300 Can MRI visual rating scales discriminate different types of dementia? R. Samoes, T. Rodrigues 2, C. Pinto 3, S. Cavaco 3, P. Pinto 2, R. Taipa 4 Centro Hospitalar do Porto - Hospital de Santo António, Neurology Department, Porto, Portugal, 2 Centro Hospitalar do Porto - Hospital de Santo António, Neuroradiology Department, Porto, Portugal, 3 Centro Hospitalar do Porto - Hospital de Santo António, Neuropsychology Unit, Porto, Portugal, 4 Centro Hospitalar do Porto - Hospital de Santo António, Neurology Department and Neuropathology Unit, Porto, Portugal Background and aims: Medial temporal lobe atrophy (MTA) and posterior atrophy (PA) scales are visual rating scales used to evaluate MRI of patients with cognitive impairment. We aimed to analyze the usefulness of these scales in the distinction of different types of dementia. Methods: From a cohort of patients with cognitive impairment followed in our outpatient clinic, we identified patients fulfilling the established clinical criteria for probable Alzheimer s disease (AD), frontotemporal dementia (FTD), Lewy body dementia (LBD) and mild cognitive impairment (MCI), with available MRI studies and contemporary neuropsychological evaluation. We retrospectively revised patients clinical registries; MTA and PA were classified by a blinded neuroradiologist. Results: We included 43 patients (53AD, 3FTD, 9LBD, 50MCI comparable groups). Significantly higher MTA scores were associated with AD and FTD compared to MCI patients (p<0.00; p=0.04, respectively). There were no significant differences of MTA scores between the other groups, namely between AD and FTD patients. Ratings for PA scale were significantly higher in AD group comparing with FTD and MCI patients (p=0.003; p<0.00, respectively). There were no differences of PA scores between the remaining groups. Discriminating AD from FTD patients, PA was more accurate than MTA (ROC curve area 0.68 p=0.005 vs p=0.4, respectively). Conclusion: Our results showed that MTA is a good scale for differentiating AD and FTD from MCI patients but not in differentiating AD from FTD patients. PA was also frequently found in AD patients and it was more accurate than MTA in discriminating AD and FTD patients. 205 European Journal of Neurology, 22 (Suppl. ),

203 686 Flash Posters F30 Cerebrospinal fluid routine parameters and biomarkers as potential indicators of clinical progression in mild cognitive impairment M. Schjønning Nielsen, P. Høgh 2, S. Hasselbalch 3, A. Hviid Simonsen 4 Roskilde, Denmark, 2 Roskilde Hospital, Denmark, Roskilde, Denmark, 3 Rigshospitalet, Danish Dementia Research Centre, Copenhagen, Denmark, 4 Rigshospitalet, Memory Disorders Research Group, Copenhagen, Denmark Background and aims: Neuroinflammation may have an important role in the pathophysiology and clinical progression of Alzheimer s disease (AD). Cerebrospinal fluid (CSF) proteinconcentration, white cell count and intrathecal IgG syntesis are potential markers of such processes. Objective: To investigate whether an elevated CSF proteinconcentration, CSF white cell count or increased IgG synthesis at baseline can predict clinical progression from Mild Cognitive Impairment(MCI) to AD. Furthermore, to investigate the role of these markers as risk factors for progression, comparied to AB42, Tau and P-tau levels. Methods: Routine CSF parameters and CSF-AB42, CSF- T-Tau, CSF-P-Tau and IgG index measured at baseline lumbarpuncture, were retrospectively registered in a consecutive referred cohort diagnosed with MCI. Clinical progression was determined by clinical history and cognitive tests(mmse) at baseline and during follow-up Results: 52 MCI subjects were included, mean age 70.3 (range 56 to 80 ), mean MMSEscore 27 (range 24 to 30). The patients had a mean follow-up-period of 28.5 months (range 5 to 48). 27 patients remained stable (non-progressive MCI), whereas twenty-five patients progressed from MCI to AD (progressive MCI). Neither CSF white cell count nor proteinconcentration differed significantly between the groups. None had an elevated IgG index. No significant difference was found in CSF- T-Tau or CSF-AB42 concentrations between the groups. The CSF-P-Tau mean concentration was significantly higher in the group of progressive MCI (p = 0.04), although within laboratory reference range Conclusion: In this retrospective study of CSF parameters as potential baseline predictors of clinical progression in MCI, we found only CSF-P-Tau to be a risk factor for progression. F302 The neuroprotective effect of exenatide on experimental Alzheimer s model in rats V. Solmaz, B. Piri Çınar 2, G. Yigittürk 3, D. Aksoy 4, O. Erbas 5 turkey, Turkey, 2 Giresun state hospital, neurulogy, giresun, Turkey, 3 ege unıversty medcal faculty, histology, embryology, Izmir, Turkey, 4 Tokat, Turkey, 5 gazıosmanpasa unıversty medical faculty, neurology, tokat, Turkey Background and aims: Alzheimer is a progressive neurodegenerative disease with systemic affect as well as the cognitive functions. Mainly in the pathogenesis of the disease the amyloid plaques, oxidative stress, neuroinflammation and the cholinergic losses has role. In addition, the presence of insulin resistance in Alzheimer s disease (AD) is also accepted. Exenatide is a new antidiabetic agent known for reducing the insulin resistance specifically. In this study, the effects of exenatide were evaluated Alzheimer s model in rats based on clinical, histopathologic and laboratory findings. Methods or Materials or Case Report: In 4 rats giving intracerebroventricular streptozosin created Alzheimer s model, and 7 rats were taken for sham-operated group by giving intracerebroventricular NaCl with the same method. The half of the first group was administered saline and the other half was administered Exanatide (20 µgr/kg/day i.p). In the groups the brain tumor necrosis factor alpha (TNFalpha) levels, choline acetyl transpherase (ChAT) activity, hippocampal CA and CA3 neuron counting and the memory functions were clinically evaluated. Results: While the brain TNF-alpha levels were significantly low in exenatide-treated group, the ChAT activity significantly increased. The hippocampal CA and CA3 neuron numbers are significantly higher in Exenatide treated groups compared to the STZ-saline-treated group. Conclusion: In conclusion our study showed that Exenatide has neuroprotective and anti-inflammatory effects in STZ induced experimental Alzheimer s rat model. 205 European Journal of Neurology, 22 (Suppl. ),

204 Flash Posters 687 F303 Apathy in Alzheimer s disease at initial presentation: evaluation by the Neuropsychiatric Inventory Y. Uchiyama, S. Shimizu 2, M. Iwata, H. Hashida 3, S. Uchiyama, K. Kitagawa Tokyo Women s Medical University, Department of Neurology, Tokyo, Japan, 2 Medical Research Institute, Tokyo Women s Medical University, Tokyo, Japan, 3 Japanese Red Cross Medical Center, Department of Neurology, Tokyo, Japan Background and aims: The purpose of this study was to determine whether apathy is associated with clinical features at initial presentation and to investigate the relationship between apathy and regional cerebral blood flow (CBF). Methods: We retrospectively selected 68 patients diagnosed with AD based on the National Institute on Aging- Alzheimer s and Association workgroups on diagnostic guidelines for Alzheimer s disease for probable AD. We analyzed their clinical features including age, duration of disease, the Mini Mental State Examination (MMSE), the Self-Rating Depression Scale (SDS), apathy scale, Neuropsychiatric Inventory (NPI), everyday memory checklist (EMC) judged by caregivers and self-evaluation and N- isopropyl-p-(23) I-iodoamphetamine (23I-IMP) SPECT findings. The SPECT data were analyzed using three-dimensional stereotactic surface projections. Results: When defined as NPI apathy scores, 43 patients (62.7%) already had apathy at the time of initial presentation. Duration of disease was significantly longer and SDS scores were significantly higher for the patients with apathy. Using multivariate analysis, caregiver EMC (OR,.6; 95% CI,.06-.3; p=0.00), duration of disease (OR,.64; 95% CI,.-2.6; p=0.0) and apathy scale score (OR,.8; 95% CI,.06-.8; p=0.002) were correlated to the NPI apathy scores. In the patients with apathy CBF was significantly decreased in the ventromedial prefrontal cortex and anterior temporal lobe. Conclusion: Apathy was not associated with cognitive function and depression. The functions in the ventromedial prefrontal cortex might correlate with apathy. F304 Standardization and validation of a specialized examination for the assessment of testamentary capacity in patients with dementia: Preliminary results P. Voskou, A. Douzenis 2, A. Economou 3, S. Papageorgiou 4, I. Beratis University of Athens, st Department of Neurology, Athens, Greece, 2 University of Athens, 2 nd Department of Psychiatry, Athens, Greece, 3 University of Athens, Department of Psychology, Athens, Greece, 4 University of Athens, 2 nd Department of Neurology, Athens, Greece Background and aims: Testamentary capacity (TC) is evaluated according to the time of the will making. The will s validity depends on whether the testator/testatrix was -at that time- conscious of his/her actions or was suffering from a disorder affecting his/her judgement or/and intention. The number of challenged wills, based on lack of TC, is increasing. There are few studies targeted at the specialized evaluation of TC of demented patients. The purpose of this study was to develop a structured instrument, specialized for the assessment of TC in patients with dementia. Methods: We developed a tool, constisting of four subtests, assessing the patient s characteristics, which are usually examined for TC: memory (focusing on orientation, autobiographical memory and realistic perception of beneficiaries), existence or not of psychopathology, financial parameters (value of assets, everyday life products, bills) and intention (vignettes and theory of mind). For its validation, we examine the patients visiting the 2 nd Department of Behavioral Neurology and Neuropsychology. Results: Preliminary results are presented, showing a high sensitivity of this clinically applicable instrument, which demends about 5 min for its administration. Conclusion: The characterization of a person as incapable of will making, due to deficits in recall memory, is dangerous, because his/her intention of how and to whom he/ she desires to dispose his/her assets may remain intact. The evaluation of TC is a complicated process, requiring many cognitive, functional and emotional parameters to be taken into consideration. The development of a specialized instrument aims at the protection and autonomy of this vulnerable category of patients. 205 European Journal of Neurology, 22 (Suppl. ),

205 688 Flash Posters F305 Effects of skinfold thickness to Alzheimer s disease patients treated with Exelon (4.6mg/24h, 5cm 2 ) transdermal patch Y.-H. Yang, M.-C. Chou, K.-M. Chang 2, W.-F. Wang 2 Kaohsiung Municipal Ta-Tung Hospital, Neurology, Kaohsiung, Taiwan, Chinese Taipei, 2 Changhua Christian Hospital, Neurology, Changhua, Taiwan, Chinese Taipei Background and aims: Exelon (4.6mg/24h, 5cm 2 ) transdermal patch has been used extensively for Alzheimer s disease. The transdermal patch can provide more stable plasma concentration of rivastigmine with less clinical side effects. However, little is known about the effects of skinfold thickness to plasma concentration of rivastigmine when AD patients applying transdermal patch. Methods: Clinically diagnosed AD patients according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer s Disease and Related Disorders Association (NINCDS/ADRDA) criteria who have continuously used Exelon patches (4.6mg/24h (5cm 2 )) for more than six months were recruited. Plasma concentrations of rivastigmine and its metabolite, NAP , were measured by capillary electrophoresis. The skinfold thickness was examined at four sites (biceps, triceps, subscapular and suprailiac area) by Lange Skinfold Calipers (Beta Technology, Santa Cruz, California, USA). Results: The mean plasma concentrations of rivastigmine and NAP for the 26 recruited patients were.24±0.63ng/ml and 4.6±3.3ng/mL, respectively, The plasma concentration of NAP was moderately inversely correlated with the skinfold thickness at the subscapular region (Spearman s rank correlation coefficient= , p=0.038), but height, body weight, body mass index, and skinfold of biceps, triceps, and suprailiac areas (p>0.05). Conclusion: Subscapular skinfold thickness was inversely correlated with the plasma concentration of NAP Skinfold thickness should be considered for the clinical application of Exelon (4.6mg/24h, 5cm2) transdermal patch. F306 Cerebral diseases and distractibility while driving G. Yannis, N. Andronas 2, I. Beratis 2, P. Papantoniou 3, E. Papadimitriou, D. Pavlou, C. Antoniou 4, I. Golias 3, S. Papageorgiou 5 National Technical University of Athens, Department of Transportation Planning and Engineering, Athens, Greece, 2 Athens, Greece, 3 National Technical University of Athens, School of Civil Engineering, Department of Transportation Planning and Engineering, Athens, Greece, 4 National Technical University of Athens, Athens, Greece, 5 Chaidari - Athens, Greece Background and aims: This paper aims to assess the degree to which cerebral diseases affect the distractibility of drivers through a driving simulator task. Methods: The driving performance of drivers with cognitive impairments (MCI, AD or PD) is examined under three driving conditions: undistracted driving, driving while conversing with a passenger, and driving while conversing on a handheld mobile phone. For each driver, the following driving performance measures are calculated: speed, speed variability, lateral position, lateral position variability, headway, steering angle, steering angle variability, reaction time at incidents, number of traffic violations and number of accidents, for the three conditions. Results: Conversing with passenger appears to have no significant effect on speed in all examined groups. However, mobile phone use leads to reducing speed in the AD and MCI groups. On the other hand, PD drivers seem to have higher vehicle lateral position variability when using the mobile phone while driving. Another interesting finding is that although all examined groups increase their headways when using the mobile phone, PD drives tend to drive closer to the vehicle ahead. Moreover, PD drivers have higher steering angle variability during the mobile phone conversation. Finally, mobile phone use while driving significantly increases reaction times at unexpected incidents for all examined groups by at least 30%, and especially for the impaired groups. Conclusion: Conversation with passenger don t seem to significantly affect driving behaviour in any examined group. Mobile phone use, though, deteriorate driving performance, especially for PD patients, in several ways. 205 European Journal of Neurology, 22 (Suppl. ),

206 Flash Posters 689 F307 Frequency of neuropsychiatric disorders in a large cohort of older adults on the island of Crete, Greece I. Zaganas, C. Lionis 2, G. Duijker 2, A. Bertsias 2, S. Kapetanaki, M. Basta 3, S. Tziraki 3, S. panagiotakis 4, I. Koutentaki 3, N. Fountoulakis 4, C. Tziraki 5, C. Manassaki 3, A. Plaitakis, P. Simos 3, D. Boumpas 6, A. Vgontzas 3 University of Crete, Neurology, Heraklion, Crete, Greece, 2 University of Crete, Clinic of Social and Family Medicine, Heraklion, Crete, Greece, 3 University of Crete, Psychiatry, Heraklion, Crete, Greece, 4 University of Crete, Internal Medicine, Heraklion, Crete, Greece, 5 MELABEV elders clubs, Research Department, Jerusalem, Israel, 6 University of Athens, Internal Medicine, Athens, Greece Background and aims: In the aging population, neuropsychiatric disorders are increasingly confronted by primary health care (PHC) physicians. The aim of this analysis is to examine the association of literacy level and cognitive decline and explore the frequency of neuropsychiatric disorders in a large community-dwelling rural cohort. Methods: Eligible participants were those aged 60 years, visiting PHC facilities in the rural areas of the island of Crete, Greece who were administered the mini mental status examination (MMSE). The presence of neuropsychiatric and medical disorders was ascertained on the basis of a structured interview and review of PHC medical records. Results: The mean age of the 3225 participants in this study (57.9% females) was 73.6 (±7.9) years. The incidence of low MMSE score ( 24) among persons without neuropsychiatric diagnosis (total 26.4%) varied significantly (p<0.000) with education level: 55.%, 24.6%, and 5.5% for those who did not attend school, persons with -6 years of schooling, and persons with 7 years of education, respectively. In the entire cohort, neuropsychiatric disorder frequencies were: depression 2.5%, hypothyroidism 9.4%, dementia of any cause 4.2%, anxiety disorder 4.%, traumatic brain injury 2.7%, stroke 2.0%, B2 deficiency.5%, Parkinson s disease.5%, epilepsy 0.7%, and multiple sclerosis 0.%. Conclusion: In this rural cohort of older adults, cognitive dysfunction, as detected by MMSE, was frequent and strongly associated with low education. The most frequent neuropsychiatric disorders were depression, hypothyroidism, dementia, and anxiety disorder. PHC physician training focusing on the diagnosis and management of these common conditions may contribute to better patient care. 205 European Journal of Neurology, 22 (Suppl. ),

207 690 Flash Posters Cerebrovascular diseases 4 F308 The pattern of neurological damage in patients with different subtypes of ischemic stroke and their early recovery C.-C. Mutu Sibiu, Romania Background: Ischemic stroke is a heterogeneous disease with distinct subtypes, each of them presenting specific etiological, pathogenesis and clinical aspects. Objective: The study of neurological impairment and short-term evolution of patients in the Neurology Clinic of Sibiu by analyzing the dynamics of all items of the NIHSS scale in the two key moments of hospitalization (admission and discharge). Methods: We conducted an observational, prospective study on a number of 85 patients with acute ischemic stroke, hospitalized in the range of two months in the Neurology Clinic of Sibiu. NIHSS scale has been evaluated at all patients on the first day of the admission and at the discharge date, aiming to achieve correlations between the extent of neurological damage and the recovery of patients and TOAST subtypes of stroke. Results: Distribution of patients according to TOAST classification, were as follows: 34.% LAA, 20% CE, 3.76% SAA,.7% OE and 2.94% EU. Motor and language functions were more affected compared with cognitive and sensory functions independently of the subtypes of stroke. Recovery of the upper limbs motor deficit was significantly greater in patients with SAA and EU stroke subtypes compared with LAA and CE subtypes. Recovery of cognitive and language deficits has not varied depending on the stroke subtypes. Conclusion: The pattern of neurological impairment is specific for each TOAST subtype of ischemic stroke. Early recovery of motor deficits depends on the subtype of stroke while recovering of cognitive deficits and language is independent of this issue. F309 Transient neurological deficits: discrimination of vascular and migrainous etiologies with occipital transcranial magnetic stimulation G. Naeije, N. Ligot ulb, hôpital erasme, neurology, Brussels, Belgium Background and aims: Focal transient neurological symptoms (TND) are generally assumed to be TIA until proven otherwise. Prevalence of TND may reach 30% of individuals. A proportionate stroke occurrence is not associated, suggesting that many TND are benign. Migraine aura without headache (MAWH) is an important differential. MAWH patients have higher cortical excitability on occipital transcranial magnetic stimulation (otms). We compared cortical excitability in patients with MAWH and ischemic TND with otms to determine if otms could be discriminative. Methods: Patients with TND fulfilling either International Headache Classification (ICDH-3ß) or Fisher s criteria for MAWH and patients with TND of brutal onset lasting less than 24 hours/minor stroke were prospectively included. All patients had neuro-vascular work-up including brain MRI and underwent otms within 48 hours of onset Results: 9 subjects with MAWH and 8 subjects with TIA or minor stroke were included. In the MAWH group, median age was 53. Symptoms were visual in two, visual and phasic in two. Lateralized paresis was associated with hemi-sensory deficit in two, aphasia in one, visual in one and vertigo in one. Diffusion weighting imaging (DWI) was normal in all subjects. In the TIA/ minor stroke group median age was 67. Symptoms were visual in one, phasic in three, right hemiparesis with aphasia in two, lateralized sensory-motor deficit in two. DWI disclosed acute ischemic lesion in 7/8 subjects. otms showed cortical hyperexcitability with phosphenes induction in 8/9 subjects with MAWH and none of the subjects with TIA/minor stroke. Conclusion: otms is a promising tool to discriminate between MAWH and TIA 205 European Journal of Neurology, 22 (Suppl. ),

208 Flash Posters 69 F3020 Herpes simplex virus (HSV)-associated vasculitis presenting as a stroke in a young patient N. Nazarova, K. Fedorov Moscow, Russian Federation Background and aims: HSV infection is a rare case of cerebral vasculitis. Case Report: A 34-year-old female presented to the stroke unit in June 203 with a severe headache, vomiting, depressed consciousness and left sided focal deficit. Brain magnetic resonance tomography (MRI) revealed multiple cortical and subcortical strokes of the right hemisphere. On admission no stenosis of cerebral arteries were found. Wight blood cell count was increased. Cerebrospinal fluid (CSF) was normal. Extended examination excluded connective tissue diseases and primary antiphospholipid syndrome. Thrombophylia genes showed heterozygote mutations. Patient was treated with anticoagulant, dexamethasone, aspirin and statin. She recovered well within two weeks to a mild hemiparesis. In July 203, brain magnetic resonance angiography MRA showed absence of the blood flow in right anterior and middle cerebral arteries. MRI revealed thickening and contrast enhancement of the right internal carotid and the proximal part of middle cerebral arteries walls. There was anti-hsv immunoglobulin M plasma increase, CSF was positive for HSV DNA. Intravenous acyclovir was started. After treatment HSV was eliminated from CSF but MRA showed no improvement. Oral prednisolone and rivaroxaban were administered. In August 203, MRA revealed cerebral arteries recanalization with a slight residual extra- and intracerebral arteries narrowing. Prednisolone was tapered off. In September 204, she was symptom free. MRI upon admission to the hospital MRA before treatment MRA after treatment Results: Acyclovir administration led to elimination of HSV from CSF but recanalization of cerebral arteries was achieved after steroid treatment only. Conclusion: MRI of the vessel wall in conjunction with CSF investigation for viral DNA should be performed for the evaluation of unexplained stroke in young individuals. 205 European Journal of Neurology, 22 (Suppl. ),

209 692 Flash Posters F302 Spontaneous carotid cavernous fistula masquerading as chronic cavernous sinus thrombosis. Diagnostic and therapeutic challenges. A case report K. Notas, M. Spilioti, T. Tegos, T. Kalatha, K. Kouskouras 2, S. Finitsis 2, V. Katsaridis 3, A. Orologas Aristotle University of Thessaloniki, AHEPA General Hospital, st Neurological Department, Thessaloniki, Greece, 2 Aristotle University of Thessaloniki, AHEPA General Hospital, Department of Radiology, Thessaloniki, Greece, 3 European Interbalkan Medical Center, Endovascular Neurosurgery Department, Thessaloniki, Greece Background and aims: Carotid cavernous fistula (CCF) (communication between the cavernous sinus and the carotid arterial system) can be classified on the basis of angiographic features (high vs. low flow), angioarchitecture (direct vs. dural) and mechanisms of onset (traumatic vs. spontaneous).its usual cause is a head trauma, but sometimes it occurs spontaneously, leading to diagnostic difficulties between cavernous sinus thrombosis (CST) and CCF. Case Report: A 60-year-old female with a medical history of hypertension, diabetes mellitus and dyslipidemia, presented with a 3-months history of left-sided retro-orbital pain, headache and vomiting, developing firstly left exophthalmos and visual loss, which gradually expanded bilaterally, and was treated for CST. Neurological examination revealed bilateral proptosis, eyelid edema and conjunctival chemosis, left III and VI cranial nerves palsy, left mydriasis, lack of left pupillary light reflex, a decrease in left corneal and facial sensation and right partial VI cranial nerve palsy. Further examination of the left eye revealed counting fingers visual acuity, optic disc swelling, retinal hemorrhages and left central retinal artery occlusion. Repeated brain MRI-MRA-MRV exams suggested cavernous sinus thrombosis. Results: Lack of response in the anticoagulation treatment and carotid CTA plus triplex examination led to a possible CCF diagnosis, which was confirmed by carotid digital subtraction angiography. Embolization with balloon-assisted coiling and liquid embolic agents was subsequently performed, with good outcome. Conclusion: Differentiating between CST and CCF can be clinically difficult. Use of radiologic and angiographic studies helps in diagnosis, with cerebral angiography to be the criterion standard. Prompt diagnosis and management can lead to lifesaving interventions. F3022 Cognitive impairments in acute period of primary and recurrent cerebral hemispheric ischemic stroke L. Novikova, O. Kozyolkin ZSMU, Neurology, Zaporizzha, Ukraine Background and aims: To study features and dynamics of cognitive disorders (CD) in patients with primary and reсurrent cerebral hemispheric ischemic stroke (CHIS) in the acute stage of the disease. Methods: The study included 4 patients (26 men and 5 women, average age 66.4±.4 years) with ischemic stroke. The main group amounted to 3 patients (7 men and 6 women, age 68.±2.5 year) with acute recurrent CHIS. The control group consisted of 28 patients (9 men and 9 women, age 65.6±.6 year) with primary CHIS. All patients were performing neurological examination using the following scales: Montreal Cognitive Assessment (MoCA), Mini-Menthal State Examination (MMSE) and Frontal Assessment Battery (FAB) FAB on the st -3 rd and 0 th -3 th day of the acute period of the disease. Outcome of the acute period of stroke was assessed by the modified Rankin scale. Results: Statistical analyses showed that the structure of cognitive disorders in patients with primary stroke characterized pre-demential cognitive disorders and for patients who suffered from recurrent CHIS was typically dementia from mild to moderate degree (p<0.05). Significantly higher rates of cognitive decline in patients with recurrent CHIS against the primary CHIS following domains by MoCA scale: «naming (45% vs. 7%, p<0.05 ), a series of subtractions (72.3% vs. 26.9%, p<0.05) are defined. Conclusion: The patients with recurrent CHIS characterized by more severe cognitive impairment in the acute period of the disease. 205 European Journal of Neurology, 22 (Suppl. ),

210 Flash Posters 693 F3023 The features and dynamics of cognitive disorders in patients with cerebral hemispheric ischemic stroke in acute phase of disease L. Novikova, O. Kozyolkin ZSMU, Neurology, Zaporizzha, Ukraine Background and aims: To study cognitive impairments in patients with acute cerebral hemispheric ischemic stroke (CHIS) Methods: The study included 62 patients (4men and 2 women, average age 65.53±2. years) with ischemic stroke. The main group amounted 30 (48.4%) patients with acute recurrent CHIS. The control group consisted of 32 (5.6%) patients with acute primary CHIS. All patients were performing physical and neurological examination using scales: National Institutes of Health Stroke (NIHS), Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) on the st -3 rd and 0-3 th day of the acute period of the disease. Outcome of the acute period of disease was assessed by the modified Rankin scale. Results were examined with a statistical analysis. Results: It was detected that patients with recurrent CHIS are characterized with lower summary score by MMSE, MoCA and FAB scales than those with first stroke episode. It was revealed that moderate cognitive disturbances are prevailed in the structure of cognitive disorders in primary stroke, while in recurrent brain ischemia mild and moderate dementia is dominated. Transitory type of perceptiongnostic field violations in primary ischemic supratentorial stroke was established and realised by orientation, attention and numeracy, memory, optical-spatial activities domains. Conclusion: The leading cognitive domains which are associated with expressed cognitive disfunction in patients with recurrent brain ischemia are detected. F3024 Retrospective analysis of patients with transient global amnesia (TGA) to identify risk factors M. Nowakowska-Kotas, M. Waliszewska-Prosół, I. Lis 2, P. Papier 2, A. Szczerbaniewicz 2, M. Mende 2, D. Wiącek 2, R. Podemski Wroclaw Medical University, Department of Neurology, Wroclaw, Poland, 2 Wroclaw Medical University, Student Association of Neurology, Wroclaw, Poland Background and aims: Transient global amnesia (TGA) is a sudden short-term memory loss that lasts no longer than 24 hours. Migraine, epilepsy and cerebral ischemia are frequently disputed possible causes. The seasonal occurrence of TGA was not yet evaluated in the literature. The aim of the study was to analyze TGA patients taking into account clinical characteristics and risk factors. Methods: The retrospective analysis of 43 patients with TGA (33 women and 0 men) of mean age 67 years (ranging from 50 to 84 years) hospitalized between 2008 and 204 were conducted. The presence of chronic diseases and potentially conducive situations, blood test results, radiological examinations and additional studies were investigated. Results: Majority of patients (93%) underwent first-ever episode of TGA. 9 patients noted specific triggers prior to the onset of TGA. Chronic diseases were present in 90.7% patients: hypertension (58%), hyperlipidemia (6%), coronary heart disease (4%) and diabetes (9%). None of our patients suffered from migraine or epilepsy. Brain imaging abnormalities were reported in 62.8% of patients, the most common were vascular lesions. Doppler ultrasonography of carotid arteries showed atherosclerotic lesions in 58% of patients and the pathology of EEG was observed in 50%. Most patients had TGA episodes in the summer months (4.9%). Conclusion: TGA risk factors are similar to those typical for ischemic stroke (hypertension, hyperlipidemia, atherosclerosis of carotid arteries, diabetes). The obtained data do not confirm the reports of other authors on the subject in which the main risk factors are migraine and epilepsy. 205 European Journal of Neurology, 22 (Suppl. ),

211 694 Flash Posters F3025 Recurrent ischemic stroke based on meningovascular syphilis P. Orosz, I. Vastagh, I. Szőcs, G. Tamas, G. Varallyay 2, I. Kalina 2, D. Bereczki Semmelweis University, Department of Neurology, Budapest, Hungary, 2 Semmelweis University, MR Research Center, Budapest, Hungary Background and aims: Cerebrovascular ischemia caused by meningovascular syphilis is a rare, infectious disease presenting predominantly in young patients and seems to be the most frequent manifestation of neurosyphilis in HIVnegative individuals. The central nervous system might be involved at any stage of the disease. Middle cerebral artery (MCA) and vessels of the anterior circulation are most commonly affected. Case Report: We report the case of a 38-year-old male patient presenting with acute right sided hemiparesis and aphasia with unknown onset. Smoking, hypercholesterinaemia and complete recovery from a previous ischaemic stroke with right sided symptoms were present in his medical history. Results: Magnetic resonance (MR) and angiography (MRA) imaging revealed significant stenosis of the distal internal carotid artery (ICA), the proximal segment of MCA and anterior cerebral artery (ACA) with acute multiple infarction signs in the left hemisphere. Computed tomography angiography (CTA) showed a thrombus in the aforementioned localisation. In 24 hours, recanalization was detected in the left ACA and MCA with transcracnial Doppler ultrasound and later by CTA and MRA. Detailed examination excluded cardioembolism, thrombophilia, autoimmune and HIV tests were negative. Serum Treponema pallidum IgM and IgG proved to be positive, but normal findings were detected in the routine and treponemal-specific antibody tests in the cerebrospinal fluid (CSF). Young age, multiple stenoses and outcome despite of seronegative CSF findings most likely refered to the diagnosis of meningovascular syphilis. Conclusion: Meningovascular syphilis is a rare entity, but needs to be considered in the differential diagnosis of ischaemic stroke when risk factors are present. F3026 Arterial stiffness in patients with vascular dementia D. Ovcharov, S. Andonova, G. Angov, L.D. Traykov 2, J. Petrova Alexandrovska hospital, Sofia, Bulgaria, 2 Sofia, Bulgaria Background and aims: The purpose of this study was to determine the change of the arterial stiffness in patients with vascular dementia with and without risk factors. Methods: A total of 39 patients (59 to 82 years of age) were recruited for this study. Several indicators were assessed, including age, gender, arterial stiffness, arterial hypertension, BMI and cognitive function in 3 patients with vascular dementia and hyperlipidemia, 2 patients with vascular dementia without hyperlipidemia, 4 healthy people in a control group. The cognitive function was evaluated using a battery of cognitive disorder tests. Functional parameters of arterial stiffness (ACC evaluation) were assessed using computer software (Echo Tracking). Results: Bearing in mind the limitations due to sample size, these result show that the leading risk factor for increased arterial stiffness is increased BMI followed by hyperlipidemia and arterial hypertension. Conclusion: These preliminary results are from a study assessing arterial stiffness changes in patients with vascular dementia with and without hyperlipidemia, arterial hypertension and increased BMI. The evaluation of arterial stiffness may be used as a reliable criteria for early diagnosis of vascular dementia. 205 European Journal of Neurology, 22 (Suppl. ),

212 Flash Posters 695 F3027 Alternating mood in extensive pontine infarctus M. Oztekin, N. Öztekin 2, E. Kahya 3, D. Mermi 3 MOH Ankara Diskapi Teaching and Research Hospital, Neurology, Ankara, Turkey, 2 Ankara, Turkey, 3 SB Ankara Diskapı Teaching andresearch Hospital, Neurology, Ankara, Turkey Background and aims: Bilateral ischemic lesions of pons leading to locked-in state generally results with coma yielding loss of all communication. During the recovery phase after gaining consciousness patients can regain their communication abilities partially with spared voluntary control of eye muscles. Although ischemic lesions stabilize in time communication may fail due to various reasons. We present a case with fluctuating communication abilities leading to alternating mood disorder after several years following extensive pontine infarctus that resulted in locked- in state. Case Report: 34-year-old female patient diagnosed as locked in state due to basilar artery dissection at 26 years of age. Following long lasting coma she was quadriplegic and communication was possible only through eye movements. In the eighth year of her illness she developed alternating mood behaviour being unresponsive for a week and then started cooperating. Her neurological examination showed no additional deficit Results: Magnetic resonance imaging (MRI) showed extensive destruction in ventral pons (Fig-3). Her blood tests and electroencephalography were within normal limits. She was treated with serotonin reuptake inhibitors with partial recovery. Conclusion: Patients with chronic neurological illness are prone to depression but fluctuating unresponsiveness is rare. The fluctuating character of depression in this patient needs an explanation. We can only speculate that the impact of the chronic disease on the patients mood or ischemia of raphe nucleus and serotoninergic system may explain the fluctuating character of the mood disorder of the patient. 205 European Journal of Neurology, 22 (Suppl. ),

213 696 Flash Posters F3028 A case of massive spinal epidural hematoma related to anticoagulant usage A. Topal, Y. Sücüllü-Karadag, S. Bilen 2, E. Eruyar, N. Öztekin 2, F. Ak ANH Traning and Research Hospital, Neurology, Ankara, Turkey, 2 Ankara, Turkey Background and aims: Spontaneous spinal epidural hematoma must be suspected in patients with sudden onset back and neck pain especially who are under anticoagulant or antiplatelet treatment. A delay in diagnosis and management may cause to progressive severe limb weakness or may be the cause of death. Magnetic resonance imaging(mri) is one of the most valuable imaging methods for the diagnosis. Surgical decompression might be lifesaving. Here we report a case of massive spinal epidural hematoma Case Report: A 66-year-old female patient was admitted with complaints of acute onset severe neck and back pain which were followed by paraplegia. She had no history of trauma. She had hypertension,valvular heart disease and she was taking warfarin and digoxin.in neurological examination she was paraplegic and had sensory impairment till T4 level. INR value was Results: On MRI images of cervical, thoracal and lumbalspinal cord massive epidural hematoma from craniocervical junction extending to lumbosacral level was observed. Since a surgical decompression could not be managed because of the patient s medical problems corticosteroid treatment was administered. But she could not be rescued and she died. Conclusion: In a patient coming with neck or back pain and who is under anticoagulant treatment spontaneous spinal epidural hematoma mustbe considered. Becaus eearly surgical decompression might be lifesaving and a delay in diagnosis and treatment maycause severe morbidity and mortality. F3029 Intravenous thrombolysis for branch atheromatous disease: is it really effective? M.-G. Park, Y. Yim 2, K.-P. Park Pusan National University Yangsan Hospital, Neurology, Yangsan, Korea, Republic of, 2 Bonseng memorial hospital, Neurology, Busan, Korea, Republic of Background and aims: The effectiveness of intravenous thrombolysis (IVT) using tissue plasminogen activator (tpa) is not established in branch atheromatous disease (BAD). We evaluate the effectiveness of IVT in BAD by comparing with conventional treatment in BAD. Methods: We retrospectively reviewed the data of 8 BAD patients who have been admitted between January 20 and July 204. Among these patients, we enrolled only the ones who arrived at the hospital within 24 hours from onset, and divided those into two groups depending on whether or nor tpa was given. Early neurological deterioration and good outcome (modified Rankin score: 0-) at 3 months were examined between two groups. Results: 38 patients with BAD were enrolled in the study: 0 patients in tpa group and 26 patients in non- tpa group. Patients in tpa group showed no symptomatic hemorrhage. Early neurological deterioration occurred in 70% (7 of 0 patients) of tpa group and 50% (3 of 26 patients) of nontpa group (p=0.846). The frequencies of good outcome at 3 months were 20% (2 of 0 patients) in tpa group and 34.6% (9 of 26 patients) in non- tpa (p=0.394). Conclusion: In our small series study, intravenous tpa did not adequately prevent the early neurological deterioration, and show any benefit in terms of functional outcome in BAD patients. More effective treatments are desperately needed for prevention of the early neurological deterioration and good outcome in BAD patients. 205 European Journal of Neurology, 22 (Suppl. ),

214 Flash Posters 697 F3030 Influence of Cytoflavin on the dynamics of cerebral blood flow in the patients with cerebrovascular disease A. Payenok, V. Shevaga, B. Zadorozhna 2, O. Kukhlenko Danylo Halytsky Lviv National Medical University, Department of Neurology and Neurosurgery, Lviv, Ukraine, 2 Danylo Halytsky Lviv National Medical University, Department of Rehabilitation and alternative medicine, Lviv, Ukraine Background and aims: The aim of the study was to investigate the influence of medicinal preparation Cytoflavin on the dynamics of cerebral blood flow in patients with cerebrovascular disease. Methods: 22 patients at the age of 38.27±.40 years with initial cerebrovascular disease were examined by the method of transcranial Dopplerography (TCD) before and after 25-day treatment cycle with Cytoflavin ( tablet, two times per day). The mean duration of the disease according to the questioned data was 4.08±0.58 years. Control group was formed of 22 healthy volunteers of the age of 38.27±.8 years. Results: The main complaints of the observed patients were headache most prominent in the afternoon which most frequently was localized at parieto-occipital region and frontal region, feeling of heaviness in the head, which disturbed the ability of patients concentration. Neurological examination revealed subtle focal neurological deficit. TCD data revealed that observed patients had reliable (P<0.05) decrease of cerebral blood flow both in the carotid (at 5.7%) and vertebrobasilar (at 25.68%) basins while compared to the control group. The quantity of vessels where the decrease of mean blood flow velocity was registered fluctuated from to 7 (mean number was 3.5±0.37). Conclusion: The treatment with Cytoflavin promoted increase of the mean blood flow velocity in carotid basin at 33.88% and in vertebrobasilar basin at 25.9%. At the same time the intensity of headache in the group of treated patients significantly decreased. F303 The integration between blood pressure and lipids: new insights into stroke risk, questions and concerns E. Pello, T. Kouznetsova 2, E. Verevkin, Y. Nikitin, J. Staessen 2 FSBI Institute of Internal Medicine and Preventive Medicine SB RAMS, Department of Ethiopathogeneses and Clinics of Internal Diseases, Novosibirsk, Russian Federation, 2 University of Leuven, Department of Cardiovascular Diseases, Division of Hypertension and Cardiovascular Rehabilitation, Leuven, Belgium Background and aims: Albeit cardio- and cerebrovascular disease are leading causes of death, have heterogeneous pathophysiology, similar mechanisms of tough outcomes development are based on atherosclerosis. We were minded to admit worst-case contingencies in patients at highest risk/ composite diseases/complications. Methods: We executed EPOGH follow-up (5 years, n=94), evaluated lipids/diary card/blood pressure (BP, mean)/variability (Var, weighted SD) for 24-hour (24h)/day (D)/night (N) systolic (S)/diastolic (Di) BP. Results: Gender disparities in stroke development dwindling in accordance with age changes are well-known. In partial correlation analyses with gender inclusion we guessed a riddle of association of TC with 24hSBP (r=0.270), 24hDiBP (r=0.27), DSBP (r=0.286), DDiBP (r=0.28), NSBP (r=0.73), NDiBP (r=0.75), Var24hSBP (r=0.276), Var24hDiBP (r=0.73), VarDSBP (r=0.232), VarNS- BP (r=0.253), VarNDiBP (r=0.75); TG with 24hSBP (r=0.292), DSBP (r=0.302), DDiBP (r=0.6), NSBP (r=0.28), Var24hSBP (r=0.283), Var24hDiBP (r=0.242), VarDSBP (r=0.264), VarDDiBP (r=0.93), VarNSBP (r=0.77), VarNDiBP (r=0.6); HDL-C with 24hSBP (r=- 0.84), DSBP (r=-0.54), NSBP (r=-0.20), Var24hSBP (r=-0.48), VarDSBP (r=-0.200), VarDDiBP (r=-0.82); LDL-C with 24hSBP (r=0.274), 24hDiBP (r=0.29), DSBP (r=0.285), DDiBP (r=0.29), NSBP (r=0.85), NDiBP (r=0.20), Var24hSBP (r=0.299), Var24hDiBP (r=0.86), VarDSBP (r=0.27), VarDDiBP (r=0.70), VarNSBP (r=0.234), VarNDiBP (r=0.80), P<0.05 for all. We promoted notes about risk of ischemic/hemorrhagic/unclassified stroke, TIA, asymptomatic cerebral ischemia, migraine with aura, self-reported symptoms, etc, visibly shaken. Higher risk of recurrent stroke asserted among patients with egfr below 60 ml/min. Hyperuricemia independently serviced uplifting risk of stroke. We also lashed out at links between inflammation/heart failure/stroke severity to ensure scientific outlet. Conclusion: We retained resemblance of reached scenery of vying risks contribution to proof possibility of coerced coherent woeful events appearance. 205 European Journal of Neurology, 22 (Suppl. ),

215 698 Flash Posters F3032 Stent-based thrombectomy: Are there gender differences in the outcome? F. Perren, V. Pereira Mendes 2 Geneva, Switzerland, 2 Toronto University Health Network, Interventional Neuroradiology, Toronto, Canada Background and aims: The natural course of stroke has been shown to be worse in women than in men. Several recent studies suggested no gender differences in the outcome among patients treated with systemic thrombolysis. Because the latter achieves recanalization in only about one-third of patients with MCA occlusion, endovascular therapy with stent-based thrombectomy is an alternative for these cases. Methods: Retrospective analysis of patients with major ischemic stroke due to acute proximal MCA occlusion ineligible for systemic thrombolysis who had been treated with stent retrievers thrombectomy. We studied whether gender differences in the efficacy and safety outcomes of stent based mechanical thrombectomy were present. Results: 8 patients (9 women, mean age of 63.0±6.6 years; 9 men 67.2±6.6 years (t=0.449; p>0.05) were studied. NIHSS at admission was 6.89±3.95 in women, 5.0±5.45 in men (t=0.84; p>0.05). Recanalization was complete in 8/9 women and 8/9 men. NIHSS after recanalisation in women was 4.78±4.87 in men 6.33±8.4 (t=0.494; p>0.05). NIHSS improvement before and after recanalization was significant in women (t=5.3947; p=0.0007) and in men (t=4.4; p=0.0043). Improvements did not differ significantly between women and men (t=.230; p>0.05). Good functional outcome at 90 days (mrs 0 2) showed no gender difference (Fisher exact p>0.05). Hemorrhagic transformation ocurred in 4/9 women (/9 symptomatic) and in 5/9 men (/9 symptomatic). Conclusion: Stent-based thrombectomy for acute MCA occlusions seems relatively safe, recanalyzes very efficiently, and improve neurological outcome. This small study shows no gender differences in the outcome among patients treated with stent retrievers thrombectomy thus nullifying the usual gender differences in functional outcomes after stroke. 205 European Journal of Neurology, 22 (Suppl. ),

216 Flash Posters 699 Headache and pain 2 F3033 Types of headache accompanying slight and moderate astma and their relationship with smoking U. Akin, G. Bilgin 2, C.S. Demircan, T.K. Yoldas ankara traning and research hospital, neurology, Ankara, Turkey, 2 ankara traning and research hospital, chest diseases, Ankara, Turkey Background and aims: Asthma together with headache impact life quality more. In this study, headache types, frequency and relationship with smoking were analyzed in asthmatic patients with no other known disease. Methods: Totally 200 (02 female and 98 male) patients with mild and moderate asthma who were monitored by chest diseases policlinic were involved. Severity of asthma evaluated according to GINA 204. Headache types were evaluated according to International Classification of Headache Disorders Results: A significant difference is present among headache types in asthmatic patients (p<0.05). Headache was detected in 38% mild, and 64% moderate asthma. These results were consecutively 20% and 35% for migraine; 8% and 29% for tension type headache (TTH). Difference between asthma and headache types were statistically significant (p<0.05) due to gender. Headache was present in 62.75% of females and 45.92% of males. Migraine was detected in 36.3% of females and 22.4% of males. These percentages were 26.47% and 23.47% consecutively for TTH. Difference between smoking and headache types were statistically significant (p<0.05). Headache was present 78.05% in smokers, 38.4% in nonsmokers. A significant difference was present between smoking-migraine and smoking-tth (p<0.05) % of smokers had migraine and 34.5% of smokers had TTH. Conclusion: In smoker asthmatic patients, especially in females migraine (more frequent) and TTH (less frequent) are significantly prevalent. Since life quality is negatively affected in these patients, proper treatment and psychological support is very important. Number of studies are inadequate and more research is necessary. F3034 Association of fibromyalgia with migraine G. Al Gawwam, M. Kashmoola 2, A. Al Mahdawi, A. Al Mahdawi Baghdad, Iraq, 2 Al Mustansiryah university, Neurology, Baghdad, Iraq Background and aims: Fibromyalgia and migraine share the same pathophysiology in disturbance of neurotransmitters and hypothalamic endocrine dysfunction so this draws of researchers and clinician to look for possible relation between two conditions. The aim is to determine the percentage of fibromyalgia in migrainous individuals and the association between the migraine patient characteristics and development of fibromyalgia. Methods: 00 patients meeting the criteria for the diagnosis of migraine with aura and without aura according to the international classification of headache society (ICHII), and according to the questionnaire of migraine to assess the type and severity of migraine. The patients were examined in the neurological department of medicine, in Mosul city and Baghdad city. This study included 00 healthy controls who had no features of migraine or any type of headache and both patients and control groups checked for features of fibromyalgia according to American college of Rheumatology (ACR) 990 criteria for fibromyalgia, after exclusion other causes. Results: 37 migraineous patients (37%), 4 of them (4%) had migraine with aura, while the remaining (33%) were without aura. The severe migraine, migraine without aura, female gender, those are more commonly to develop features of fibromyalgia and there was significant relationship between migraine and fibromyalgia. results tables &2 205 European Journal of Neurology, 22 (Suppl. ),

217 700 Flash Posters result table 3 Conclusion: 37 migrainous patients (37%), four of them (4%) had migraine with aura, while the remaining ( 33%) were without aura. The severe migraine, migraine without aura, female gender, those are more commonly to develop features of fibromyalgia and there was significant relationship between migraine and fibromyalgia F3035 Pressure pain sensitivity maps of the head are similar in chronic and episodic migraine patients J. Baron Sanchez, M. Ruiz Piñero, M. de Lera, M. Pedraza, C. de la Cruz, C. Rodríguez, A.L. Guerrero, P. Madeleine 2, M.L. Cuadrado 3, C. Fernández-de-las-Peñas 4 Hospital clinico de Valladolid, Neurology, Valladolid, Spain, 2 Aalborg University, Department of Health Science and Technology, Aalborg, Denmark, 3 Hospital Clínico San Carlos, Neurology, Madrid, Spain, 4 Rey Juan Carlos University, Phisioterapy, Madrid, Spain Background and aims: The fronto-temporal scalp seems to be the most sensitized part of the head in migraine patients. No current data exist related to pressure pain sensitivity (PPS) maps of the head in Chronic Migraine (CM) patients. We aim to investigate differences in PPS maps between patients with CM and Episodic Migraine (EM). Methods: 6 patients with CM and 6 with EM were included. Pressure pain thresholds (PPT) were measured in 2 points distributed over the scalp. Locations and nomenclature of these points were based on the 0/20 and 0/0 systems for electroencephalogram recordings: 8 points on the right side (Fp2, F4, F8, C4, T4, P4, T6 and O2), 8 points on the left (Fp, F3, F7, C3, T3, P3, T5 and O) and 5 points along the mid-sagittal line (Fpz, Fz, Cz, Pz, and Oz). PPS topographical maps were constructed. All subjects were migraine-free on the day of evaluation. Results: Time from migraine onset was increased in CM cases (26±5.6 years) compared to EM (.± years). PPTs were decreased in frontal part of the scalp (FP2, FP, F4, F3), and fronto-temporal junction (F8, F7) was more sensitive than all other parts of the head in both patients with CM and EM. Neither PPT values nor PPS maps revealed significant differences between patients with CM and EM. Conclusion: Our results suggest that PPS maps of the head are similar in CM and EM patients. Fronto-temporal scalp is the most sensitized part of the head in this series, in accordance with previous studies. 205 European Journal of Neurology, 22 (Suppl. ),

218 Flash Posters 70 F3036 Melatonin 4mg as preventive therapy for primary headaches A. Bougea, N. Spantideas 2, V. Lyras 3, T. Avramidis 4, T. Thomaidis 5 Athens, Greece, 2 Athens Speech and Language Institute, Athens, Greece, 3 Athens Benakion and Korgialenion Red Cross Hospital, Head of Neurology Department,, Athens, Greece, 4 Head of Neurology Department, Athens Benakion and Korgialenion Red Cross Hospital, Athens, Greece, 5 Head of Neurology Department, Head of Neurology Department, Athens, Greece Background and aims: Α growing body of research shows pineal hormone melatonin as possible candidate for primary headache prevention. Methods: We performed an open-label single arm study at the outpatient Headache Clinic at the Korgialenio Benakio Hospital of Athens. 49 patients (37 with migraine and 2 with tension-type headache) received oral melatonin, 4mg, 30 minutes before bedtime for 6 months. Primary outcomes were attack frequency (AF) and headache impact on daily activities assessed by the Headache Impact Test (HIT). Secondary endpoints included. mean melatonin levels both during a pain-free period and during a headache attack and 2. mean Hamilton Depression Rating Scale scores and Epworth scale for sleepiness were performed to see if there was any difference between the two main primary headaches (migraine and TTH) in the beginning of the study. Results: A statistically significant reduction in headache frequency was found between baseline headache frequency and after 6 months of treatment. The HIT score was statistically significantly reduced in both group of headache patients. Melatonin levels both during a headache attack and pain-free period did not differ among the two groups. No statistically significant differences were found in HAD Depression scores as well as in Epworth scale for sleepiness between migraineurs and TTH patients. Conclusion: This pilot trial shows very promising results in frequency reduction of both primary headaches, migraine and TTH and in daily quality of life improvement. Further well organized double blind placebo-control studies are needed in order to conclude whether melatonin has a role in primary headaches prevention. F3038 Combined concordant peripheral neurostimulation for chronic migraine headaches: a retrospective analysis of 88 consecutive patients K. Reed, F. Conidi 2, K. Will, R. Bulger, S. Datta Reed Migraine, Dallas, USA, 2 Stuart, USA Background and aims: Occipital nerve stimulation (ONS) is an approved headache treatment in Europe. We hypothesized the addition of supraorbital stimulation (SONS) may improve the results for chronic migraine, In 200 we reported positive results in a series of 7 patients treated by combined ON-SON stim. To date we have implanted combined systems in over 500 patients suffering from chronic/ refractory migraine. Methods: 88 patients received combined occipital and supraorbital leads. Follow which the patient received a Migraine Disability Assessment (MIDAS) and survey including headache frequency/severity, medication usage, overall satisfaction, and preference for either combined or single modality therapy (ON-SONS vs. ONS). Results: 93% of patients received SON and ON leads, 5% ONS only, 2% frontal only. 63 patients (29 F; 34 M) responded to the survey. All suffered from chronic/refractory migraine and failed conservative management/onabotulinum toxin. The average duration since implant was 4 mo. 85% of patients reported over 50% improvement in HA frequency (HA days/mo) and/or severity (VAS 0-0). Average HA days/mo decreased by 73% (27 to 7), average severity improved by 59% (9 to 4). 50% had complete resolution of headaches (0-/mo). 7% of patients decreased medication usage by >50%, 38% discontinued all routine headache medications. MIDAS scores improved by 76% (avg 208->50). 87% felt the treatment to have been successful, and 93% would recommend it to others. Conclusion: Combined SONS-ONS neurostimulation provides effective therapy for some patients with intractable chronic migraine headaches. The degree of responsiveness reported here was markedly improved over that reported by most studies evaluating ONS alone. F3037 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

219 702 Flash Posters F3039 Chronic cluster headache and the pituitary gland A. De Pue, B. Lutin 2, P. A. Boon, K. Paemeleire Ghent University Hospital, Neurology, Ghent, Belgium, 2 Ghent University Hospital, Radiology, Ghent, Belgium Background and aims: Cluster headache is classified as a primary headache by definition not caused by an underlying pathology. However, numerous symptomatic cases of otherwise typical cluster headache have been reported. Methods: Case report and review of the literature. Results: A 45-year-old male suffered from primary chronic cluster headache (CCH, ICHD-3 beta criteria fulfilled) since the age of 35 years. A magnetic resonance imaging (MRI) study of the brain in 2006 was reported normal. He tried several prophylactic treatments but was never longer than month without attacks. He was under chronic treatment with verapamil with only a mild effect on attack frequency. By February 204 the patient developed a continuous interictal pain ipsilateral to the right-sided cluster headache attacks. An indomethacin test (up to 225mg/day) was negative. Because of the change in headache pattern we performed a new brain MRI which showed a cystic structure in the pituitary gland. The differential diagnosis was between a Rathke cleft cyst or a cystic adenoma. Pituitary function tests (PFTs) showed an elevated prolactin level. This could be due to verapamil-induced hyperprolactinemia or a prolactin-producing tumour. A dopamine agonist (cabergoline) was started and the headache subsided completely. Potential pathophysiological mechanisms of pituitary tumor-associated headache will be discussed. Pituitary gland F3040 Headache in a patient with a spinal cord lesion A. De Pue, P.A. Boon, K. Paemeleire Ghent University Hospital, Department of Neurology, Ghent, Belgium Background and aims: Headache attributed to autonomic dysreflexia after spinal cord injury (SCI) is underrecognized. Methods: Case report and review of the literature. Results: A 48-year-old male had suffered a SCI at the level of D3-D4 with paraplegia, due to a car accident at the age of 28 years. Since two years he complained about sudden onset nighttime headaches that awoke him from sleep. Associated symptoms included nasal blockage and flushing of the cheeks. As a potential triggering factor he mentioned a full bladder. After bladder catheterization the headache seemed too subside. Similar headache attacks could be provoked by physical exercise. Magnetic resonance imaging of the brain showed an external bifrontal hydrocephalus but was otherwise unremarkable. A diagnosis of headache attributed to autonomic dysreflexia was eventually made. The headache associated with autonomic dysreflexia is often severe and accompanied by altered heart rate, increased blood pressure, diaphoresis and facial flushing. Autonomic dysreflexia can occur with cervical or high thoracic spinal cord transection ( D6). The onset of symptoms ranges from within a week up to 5 years after the acute lesion. Multiple alterations following disruption of the descending cardiovascular pathways have been described. Provoking stimuli include bladder distention and bowel impaction. This clinical entity is potentially dangerous and can result in intracranial haemorrhage, seizures, coma and/or myocardial infarction. The initial management of an acute episode includes assuming a sitting position, trigger removal and monitoring of blood pressure and heart rate. Conclusion: Awareness of this potentially dangerous and frequently overlooked clinical entity is crucial. Conclusion: Neuroimaging should be considered in all patients with CCH, especially those with an atypical presentation or evolution. Response to acute treatment does not exclude a secondary form of cluster headache. There may be shared pathophysiological mechanisms of primary and secondary cluster headache. 205 European Journal of Neurology, 22 (Suppl. ),

220 Flash Posters 703 F304 Assessment of Convulex efficacy in the treatment of status migrainosus Y. Didkova, O. Mialovytska 2 the Hospital Railway Station Kiev 2, neurological, Kiev, Ukraine, 2 the О. О. Bohomolets, National Medical University, Kiev, Ukraine Background and aims: Frequent migraine attacks can cause such complications as status migrainosus and migrainous stroke. Methods: 50 patients with migraine have been examined over the period A group of patients with status migrainosus (25 patients) was selected among them. Severity of headache was assessed by 0 scores on the VAS scale in all patients of this group and headache lasted more than 72 hours. In all 25 cases the Migraine Disability Assessment test was performed with the indices corresponding to III and IV degree. All 25 patients were infused Convulex 500mg during 2 hours. Results: Three hours after Convulex administration dynamic intensity of headache on the VAS scale was assessed. 7 patients demonstrated complete reduction of headache (0 points on the VAS scale). In 4 patients headache decreased to 3 4 points on the VAS scale (p<0.05). And 4 patients stopped taking Convulex because of side effects. 2 patients who had been infused with Convulex completed Migraine Disability Assessment questionnaire after a year. The following results were obtained: 5 patients noted a low level of disability due to a significant decrease in migraine attacks during last three months of observation, that corresponds to I degree of Migraine Disability Assessment test and 6 patients noted changes corresponding to II degree (p<0.05). Conclusion: The use of Convulex for reduction of status migrainosus is an effective method that outlines future prospects for studying the efficacy of anticonvulsants in the treatment of migraine and prevention of its complications. F3042 Videomotion analysis of lumbar spine movements in lower back pain I. Goursky, S. Likhachev, V. Vashchylin, S. Elenskaya 2 Republican Research and Clinical Center of Neurology and Neurosurgery, Department of Neurology, Minsk, Belarus, 2 Hospital of the Ministry of Internal Affairs of the Republic of Belarus, Minsk, Belarus Introduction: It is necessary to constantly control range of lumbar spine (LS) movements in the course of lower back pain (LBP) treatment, which implies simple and informative tool for vertebral biomechanics assessment. Objective: To developed method for LS biomechanics assessment by means of videomotion analysis. Methods: 0 patients with LBP without vertebral instability or severe spondylosis were examined before and after routine treatment course. We recorded patients spine movements (leftward and rightward bending) using digital video camera. To facilitate anatomical landmarks tracking we placed spherical markers over the lumbar spinous processes. The retrieved data was used to calculate angles, which characterize movements of LS. These angles include ones formed by three neighbor vertebrae, and one formed by the intersection of Th2-L and L5-S lines. Range of motion was defined as the difference between angle in the neutral and in the extreme positions. Markers coordinates and angles were calculated using the computer program developed by us. Results: Before treatment median range of leftward bending was [7.025; ] (median [25%; 75%]), and the rightward 7.95 [6.45; 25.5] ; block at one or more levels (motion range less then 2.5 ) was revealed in 9 cases. After the treatment leftward bending range changed to [6.90; 33.45], and the rightward to [7.55; 36.70], with the difference being statistically significant (Wilcoxon signed rank test, one-sided alternative hypothesis, p<0.05); block at one or more levels was revealed in 7 cases. Conclusion: Thus, the developed videomotion analysis method allows to detect lumbar spine motility impairment. 205 European Journal of Neurology, 22 (Suppl. ),

221 704 Flash Posters F3043 Cluster headache presentation. Is it the same in different countries? V. Grozeva, A. Garcia-Casado 2, I. Milanov, J.M. Lainez 2 MHATNP St. Naum Sofia, Neurology, Sofia, Bulgaria, 2 Hospital Clinico Universitario, Valencia, Neurology, Valencia, Spain Background and aims: Despite all the descriptions of cluster headache (CH), still little is known about differences in clinical presentation between forms, genders, and geographical distribution. We aim to show results from 56 patients with CH, regarding demographics, presentation, triggers, diagnostic delay and treatment response. Methods: We performed 2 observational studies: one prospective cross-sectional in Valencia, Spain; and one retrospective in Ruse district, Bulgaria. We used the ICHD-III with a slight modification for collecting the data. We focused on demographics, presentation, comorbid conditions, family history, triggers, smoking, diagnosis delay, treatment (pharmacological and neuromodulatory), and some specific female issues. Results: We estimated that chronic CH is more common in the Spanish cohort. Family history of migraine is significantly higher in the Spanish cohort, while cardiovascular diseases - in the Bulgarian cohort. They are also the most common concomitant diseases among the Bulgarian CH patients. The two groups with CH differ slightly in clinical presentation. Spanish patients are treated with oxygen, triptans, occipital blockade and neuromodultation, while the Bulgarians are treated mainly with Flunarizine. Diagnosis delay is long in both groups, but it is much shorter in the Spanish cohort comparing with the Bulgarian. Conclusion: Presentation of CH does not differ significantly regarding geographical distribution. The main differences come when considering setting the diagnosis, and treatment. They may be explained by differences in medical care and education between countries. Raising the awareness of CH is essential in Eastern European countries because nowadays this devastating headache can be treated successfully with drugs and some alternative neuromodulatory methods. Disclosure: The study has been performed by the support of the European Headache Federation. The main author won their 2nd EHF award for 202. F3044 Impulsivity among migraine patients: analyzing subscales of Plutchik scale in a series of 239 cases M.S. Hernández, I. Muñoz, E. Dominguez, M. de Lera Alfonso 2, E. Martínez Velasco 2, M. Ruiz Piñero 2, V. Molina, A.L. Guerrero 2, F. Uribe Clinical Hospital, Psychiatry, 2 Clinical Hospital, Neurology, Valladoid, Spain Background and aims: Impulsivity may be related to an anxious anticipation of pain. It might explain an increased consumption of symptomatic treatments in migraine patients, one of main risk factors for Chronic Migraine (CM). Plutchik Scale (PS) is a screening test designed to assess impulsive behaviours grouped in four subscales: ability to plan, control of emotional states, control of basic behaviours, and control of other behaviours. We aim to analyze influence of impulsivity on CM or Medication Overuse (MO). Methods: Patients attended in an outpatient headache office in a tertiary hospital (January 203-January 205). Episodic migraine (EM), CM and MO diagnosed accordingly to International Classification of Headache Disorders, III edition. Patients answered PS (5 multiple choice items, positive if score >20). We analyzed results including four subscales. Results: 239 patients (34 males, 205 females), age 38.± years (range: 8-70). 6 cases (67.4%) CM and, among them, 5 (7.4%) with MO. Plutchik score 3.±6.8 (-40); 36 patients (5.%) met criteria for impulsivity. Considering subscales 2.6% of patients were over the cutpoint regarding ability to plan, 20.5% for emotional states, 4.6% for common behaviours and 26.4% for other behaviours. We found no differences in Plutchik or subscales scores or presence of impulsivity when comparing EM and CM groups and CM patients with or without MO. Conclusion: In our migraine population, impulsivity assessed by Plutchik scale is frequent, mainly when considering emotional states or common behaviours. However, neither Plutchik nor subscales scores correlated with CM or MO. 205 European Journal of Neurology, 22 (Suppl. ),

222 Flash Posters 705 F3045 The role of psychosocial factors in chronicitation and disability in chronic low back pain patients O. Jugurt, M. Sangheli, S. Plesca, R. Ciobanu 2 INN, Neurology, Chisinau, Moldova, 2 University of Medecine and Pharmacy Nicolae Testemitanu, Neurology, Chisinau, Moldova Background and aims: Chronic low back pain (CLBP) is a major health problem, often accompanied by disability. The purpose of our study was to determine the relationship between socio-occupational factors, emotional distress and pain syndrome, the impact on the quality of life in patients with CLBP. Methods: The study consisted of 62 subjects, divided in 3 groups: group A (30 patients with CLBP), group B (8 patients with acute back pain), group C (4 healthy subjects). Patients were evaluated with socio-demographic questionnaire, Visual Analog Scale, Beck Depression Inventory, Test Anxiety Inventory, SPF-36 Health Survey, Back Performance Scale, Rolland-Morris Disability Questionnaire. Results: The socio-demographic questionnaire demonstrated that in group A, more than half of patients are not employed, indicated the presence of poor financial condition and job disatisfaction (73%) and lower educational level. Responses to Beck Depression Inventory showed that group A reported a high level of depression (94%). The value of reactive anxiety is statistically relevant, it is increased in patients with CLBP in comparison with group B and C. Results to SP-36 Health Survey suggests a lower score for physical functioning, general health perception, vitality in patients with CLBP. Higher score of anxiety, depression leads to higher level of disability. Conclusion: Psychosocial factors are presumed to have a substantial impact on pain disability, with worsening clinical course of CLBP. The results of this study support the approach of early indentification and management of psychosocial risk factors (,,yellow flags ) in the prevention of pain chronicitation and in the development of disability. F3047 Alcohol induced headache in patients with migraine and tension-type headache: a hospital based study in Korea B. Kim Seoul, Korea, Republic of Background and aims: Alcohol is frequently regarded as the principle trigger of headache. However, scientific researchs about its impact on different headache disorders are inconclusive. Until now, there is no study on alcohol induced headache in the Korean population. Methods: We consecutively recruited patients with migraine and tensoin type headache. We analyzed the percetage of non-alcohol consumers and alcohol induced headache in migraine and tension-type headache. Characteristics of alcohol induced headaches were also investigated. Results: Total 456 patients were analyzed (388 with migraine without aura, 3 with migraine with aura, and 37 with tension type headache). There was a significantly higher percentage of nonconsumers of alcohol in migraineurs (43%) than patients with tension type headache (32%). The frequency of alcohol as a trigger was higher in migraine without aura (6%) than either of tension type headache (44%) and migraine with aura (42%). Hang-over headaches (8%) were more common than immediate alcohol induced headaches. Alcohol induced headaches were milder than usual headaches. Conclusion: Alcohol induced headaches are usually tension-type and more frequently occur in patients with migraine without aura. F3048 Abstract cancelled F3046 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

223 706 Flash Posters MS and related disorders 3 F3049 Baseline Demographics and Disease Characteristics from ORATORIO, a Phase III Trial Evaluating Ocrelizumab in Patients with Primary Progressive Multiple Sclerosis X. Montalban, B. Hemmer 2, K. Rammohan 3, G. Giovannoni 4, J. de Seze 5, A. Bar-Or 6, D. Arnold 6, A. Sauter 7, D. Leppert 8, P. Chin 9, H. Garren 8, M. Messier 8, J. Wolinski 0, A. Kakarieka 8, D. Masterman 9 Department of Neurology-Neuroimmunology, Vall d Hebron University Hospital, Barcelona, Spain, 2 Technische Universität München, Neurology, Munich, Germany, 3 University of Miami Health System, MS center of excellence, Miami, USA, 4 Barts and the London School of Medicine, Neuroscience, London, United Kingdom, 5 University Hospital Strasbourg, Neurology, Strasbourg, France, 6 Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada, 7 F.Hoffmann La Roche, Biometrics, Basel, Switzerland, 8 F.Hoffmann La-Roche, Neuroscience, Basel, Switzerland, 9 Genentech-Roche, Neuroscience, San Francisco, USA, 0 University Texas Medical School, Neuroscience, Houston, USA Background and aims: To present demographic and baseline disease characteristics of patients in the ORATORIO study. Evidence implicates B-cells in the pathophysiology of MS including primary progressive MS (PPMS). Ocrelizumab (OCR), a recombinant humanized monoclonal antibody that selectively targets CD20+ B-cells, is being investigated in a phase III study in PPMS. Methods: ORATORIO is a parallel-group, double-blinded, randomized controlled study examining the efficacy and safety of 600 mg OCR or placebo (2:) every 24 weeks until the last patient has reached at least 20 weeks. Entry criteria included a diagnosis of PPMS (McDonald criteria, 2005), CSF oligoclonal bands or elevated IgG index, age of 8-55 years, and Expanded Disability Status Scale (EDSS) score of 3.0 to 6.5 at screening. The primary outcome measure is the time to onset of confirmed disability progression, defined as an increase in EDSS score sustained for at least 2 weeks. Results: A total of 732 patients were randomized by 83 sites in 29 countries. Baseline mean age was 44.6; 49.3% female, 94.% Caucasian. Mean duration of MS symptoms was 6.48 years (range years), and the mean EDSS score was The mean number of gadolinium enhancing (Gd+) lesions on brain MRI was.0, 73.6% of patients presenting no Gd+ lesions. The mean normalized brain volume was cm3. Conclusion: The ORATORIO baseline data are consistent with a PPMS population. The results of the ORATORIO study will provide information on the efficacy and safety of ocrelizumab in PPMS. Disclosure: Study Supported by: F.Hoffmann La-Roche F3050 The role of microperimetry in multiple sclerosis: correlation with OCT S. Montella, G. Cennamo, A. Carotenuto, I. Cerillo, L. Bilo, M. Romano, C. Minervino, M. Allegri 2, C. Della Guardia, E. Chiariello Vecchio, G. Cennamo, G. Orefice Federico II University, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Naples, Italy, 2 University of Parma, Anesthesia, Critical Care and Pain Medicine Unit, Department of Surgical Sciences, Parma, Italy Introduction: Spectral optical coherence tomography (SD- OCT) measures the loss of retinal ganglion cells secondary to neurodegeneration and changes of optic disc morphology. Fundus-controlled microperimetry (MP) assesses retinal sensitivity. Our aim is investigate, in multiple sclerosis (MS), the correlation between retinal structural changes, evaluated through SD-OCT, and functional changes, evaluated through MP. Methods: Our prospective comparative study included 05 eyes of 53 consecutive patients, divided in two groups. Group A included 56 eyes of 28 MS patients; group B involved 49 eyes of 25 healthy patients. The anatomical examination included GCC examination, circumpapillary RNFL (cprnfl) and macular volume evaluated through the SD-OCT. Functional tests included the measurement of visual best-corrected visual acuity (BCVA), of visual field and the assessment of macular sensitivity through the MP. Results: MS group showed a significative reduced GCC, cprnfl, macular volume, BCVA, visual field and macular sensitivity compared with the control group (P<0.00). In MS group, we found a strong correlation between macular sensitivity, evaluated through the MP, and macular volume reduction, evaluated through the SD-OCT (r2=0.25, P<0.00). Conclusion: The significative statistical evidence and the strong correlation between anatomical and functional parameters, support the use of OCT and MP in MS patients. The MP allows a more precise evaluation of the macular and peripapillary region. In MS, the presence of a subclinical form of optic nerve involvement can be demonstrated in a very early stage, and well followed by the introduction of MP in the standard examination protocol. 205 European Journal of Neurology, 22 (Suppl. ),

224 Flash Posters 707 F305 Anatomical and functional retinal changes in multiple sclerosis S. Montella, G. Cennamo 2, A. Carotenuto, I. Cerillo 3, M. Romano 3, E. Chiariello Vecchio 4, C. Minervino 5, G. Cennamo 3, G. Orefice 3 Naples, Italy, 2 Eye clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Naples, Italy, 3 Federico II University, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Naples, Italy, 4 F., Naples, Italy, 5 Federico II University, Naples, Italy Background and aims: Neurodegeneration, including that of retinal layers and eye s inner structures, plays an important role in disability in multiple sclerosis (MS). We describe anatomical and functional retinal changes in MS patients versus controls and determine the degree of neurodegeneration in MS eyes. Methods: Our prospective comparative study included 53 patients (28 MS patients and 25 controls). Anatomical examination included Goldmann tonometry, biomicroscopic and fundus oculi examination, retinography, GCC examination, circumpapillary RNFL (cprnfl) and macular volume, evaluated through the SD-OCT. Functional tests included: measurement of visual best-corrected visual acuity (BCVA), visual field and microperimetry (MP). Results: MS group showed a significative reduced GCC, cprnfl, macular volume, BCVA, visual field and macular sensitivity compared with controls (P<0.00), more evident in patients with previous optic neuritis (ON). In MS we found a strong correlation between GCC thickness and macular volume (r2=0.59, P<0.00); between GCC and RNFL thickness (r2=0.48, P<0.00); between macular sensitivity and macular volume reduction (r2=0.25, P<0.00); between RNFL and macular volume (r2=0.43, p<0.00). Conclusion: We documented a significative reduction of GCC thickness, RNFL thickness and macular volume in MS patients vs controls and a significative reduction of macular sensibility in MS patients; a strong correlation between macular sensibility and macular volume but also between macular sensibility and GCC and RNFL thickness was evidenced. Our results support the use of OCT and MP in MS patients and raise expections about the validity of SD-OCT and MP as a biomonitoring tool for neurodegenerative diseases. F3052 Multiple sclerosis and environmental risk factors: a case-control study in Iran S.M. Nabavi, M. Abbasi 2, N. Zerafatjou 3, S.M. Fereshtenejad 4 Shahed university, Neurology, Tehran, Iran, 2 Shaeh university, Student research group, Tehran, Iran, 3 Shahed university, Student rsearch group, Tehran, Iran, 4 Karolinska Institute, Neurobiology, Stockholm, Sweden Background and aims: Studies have shown a rapidly increase in the incidence and prevalence of MS in Iran. The aim of our study was to evaluate the relationship between probable environmental exposure and MS by using a casecontrol design in Iran. Methods: This case-control study was conducted on ageand sex-matched; 660 MS patients and 42 healthy controls from different parts of Iran. In addition to the baseline variables, list of many potential environmental risk factors were recorded and compared between the two groups. Results: Our findings demonstrated that prematurity ([OR=4.99, P=0.07]), positive history of Measles and Mumps ( [OR=.60, P=0.029; OR=.85, P=0.003 respectively]) breast feeding, [OR=2.90, P=0.002] head trauma in childhood ([OR=8.2, P=0.03]), vaccination in childhood and adulthood, ([OR=.89, P=0.050; OR=4.57, P=0.032 respectively].) positive history of Migraine, Positive family history of MS [OR=2.73, P<0.00] and IBD and Migraine and collagen vascular diseases ([OR=3.4, P=0.004; OR=3.8, P<0.00; OR=.8, P=0.040 respectively]), stressful life events ([OR=32.57, P<0.00]) and microwave exposure ([OR=3.55, P 0.00]) were statistically significant more in patients with MS in comparison with control group in adjusted model. Moreover, sun exposure ([OR=0.09, P=0.00]), dairy and calcium supplement consumption ([OR=0.44, P=0.00]) and positive history of diabetic mellitus appeared to be relation with decreased risk of MS [(OR=0., P= Furthermore, our results showed the influence of climate on MS risk in adjusted model. Conclusion: Sun exposure (Protective) and stressful life events (Predisposing) are among the most flexible environmental factors in MS pathogenesis in Iran. It seems that more studies need to assess other potential environmental risk factors. 205 European Journal of Neurology, 22 (Suppl. ),

225 708 Flash Posters F3053 Translation and validation of the COOP/ WONCA functional health status charts in Farsi speaking Iranians with multiple sclerosis M. Taghipour, M. Salavati, S.M. Nabavi 2, F. Rajabzadeh University of Social Welfare and Rehabilitation Sciences, Department of Physical Therapy, Tehran, 2 Shahed university, Neurology, Tehran, Iran Background and aims: Dartmouth COOP Functional Health Assessment/World Organization of National Colleges, Academies and Academic Association of General Practitioners (COOP/WONCA) functional health assessment charts demonstrate levels of function/well-being along 5-point ordinal scales in 9 domains. Responses, illustrated by drawings, make above-mentioned scale an appropriate tool for those with literacy difficulties. The purpose of the present study was to translation, reliability assessment and construct validityof the COOP/WONCA charts for Farsi speaking Iranians with multiple sclerosis (MS). Methods: A total of 97 participants in this cross-sectional study completed COOP/WONCA charts and Short Form of Health Survey (SF-36). With an interval of 4 weeks, 50 participants were asked to complete the charts in the retest session. The construct validity was evaluated by use of SF-36, Expanded Disability Status Scale (EDSS) score and duration of disease Results: More floor effects but less ceiling effects were observed for all items. All Intraclass Correlation Coefficient (ICCs) were equal or above 0.50 with the highest reliability obtained for the condition where the social support was used in both test and retest sessions. The correlation of COOP/WONCA Charts with the SF-36 subscales of physical components was higher than subscales of mental components. Most of the COOP WONCA Charts items have more correlation with related items of SF-36 questionnaire. Conclusion: In conclusion, Persian version of the COOP/ WONCA charts was shown to be psychometrically appropriate to evaluate the functional level and quality of life in Iranian subjects with Multiple Sclerosis and this is the first time that we apply this assessment method in MS. F3054 Slow titration improves tolerability of dimethyl fumarate in multiple sclerosis A. Orviz, I. González-Suárez, V. Lopez de Velasco, J. Matias-Guiu, C. Oreja-Guevara Hospital Clinico San Carlos, Neurology, Madrid, Spain Background and aims: Dimethyl fumarate (DMF) was approved in Europe in 204 as first-line treatment for relapsing-remitting multiple sclerosis (RRMS). Methods: Observational prospective study included patients with RRMS who started DMF May-December 204 by expanded access programme. The eligibility criteria were injectable-administration adverse events (AEs) on previous disease modified treatment (DMT) and needle phobia. Neurological examination (EDSS, MSFC) was performed at baseline and every three months. The follow-up involved first month tolerability visit, quarterly laboratory assessment, half-year cognitive evaluation (SDMT, PASAT) and annual OCT and 3-Teslas MRI. Results: 38 RRMS-patients: mean age 37 median disease duration of 5 years. Baseline EDSS scored 2.0 and median DMF-treatment period was 4.5 months. 24% were naïve and 53% came from another first-line treatment. Despite administration with fat diet, gastrointestinal (GI) events occurred in 58% and flushing in 76%, mostly mild and transient. In the fast titration group (full-dose reached in 7 days), the incidence of GI events was higher than in the slow titration one (full-dose in 5 weeks), 72% versus 45% (p=0.09), but no differences about flushing. The lymphocyte average count decreased 33.3% and 47.4% at third and sixth month respectively. 2 patients stopped DMF due to GI events and lymphopenia. 3% of cases (all switching from another DMT) experimented one relapse, everyone during DMF slow titration period. Conclusion: Almost two thirds of GI events on DMF could be avoided using a slow titration. Relapses during the incomplete dose period have to be considered to define washout periods between different treatments. 205 European Journal of Neurology, 22 (Suppl. ),

226 Flash Posters 709 F3055 Long-term follow-up of the safety of delayed-release dimethyl fumarate in RRMS: interim results from the ENDORSE extension study C. Pozzilli, J.T. Phillips 2, R.J. Fox 3, K. Selmaj 4, R. Zhang 5, M. Novas 5, M.T. Sweetser 5, R. Gold 6 Faculty of Medicine, Sapienza University of Rome, Rome, Italy, 2 Multiple Sclerosis Program, Baylor Institute for Immunology Research, Dallas, USA, 3 Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, USA, 4 Medical University of Lodz, Lodz, Poland, 5 Biogen Idec, Inc., Cambridge, USA, 6 St. Josef Hospital, Ruhr University, Bochum, Germany Background and aims: Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) demonstrated efficacy and an acceptable safety profile in patients with relapsing-remitting multiple sclerosis (RRMS) in the Phase 3 DEFINE and CONFIRM studies. We report safety outcomes from ENDORSE, an 8-year extension of DEFINE/ CONFIRM investigating long-term effects of DMF. Methods: Patients randomised to DMF 240 mg twice (BID) or three times daily (TID) in DEFINE/CONFIRM continued the same dosage in ENDORSE. Patients randomised to placebo (PBO; DEFINE/CONFIRM) or glatiramer acetate (GA; CONFIRM) were re-randomised : to DMF 240 mg BID or TID. Adverse events (AEs) were analysed according to treatment received in the parent/extension study: BID/BID, TID/TID, PBO/BID, PBO/TID, GA/ BID, and GA/TID. Results: As of 4 May 204, total follow-up in ENDOR- SE was 4,98 patient-years. Incidence of AEs, serious AEs, and AEs leading to discontinuation by group are listed in the Table. Incidence of serious infections was 4% in all groups, with no confirmed opportunistic infections.* There were no new findings in haematologic outcomes compared with DEFINE/CONFIRM. Hepatic AEs occurred in 3% of patients in any group; there was no evidence of increased risk of renal or urinary events. There were five deaths; none were considered related to study drug. F3056 Sex steroids and remyelination: an experimental study E. Predtechenskaya, A. Korablev Novosibirsk State University, Dept of Medicine, Novosibirsk, Russian Federation Background and aims: We study a protective effect of synthetic analogues of sex steroids, particularly of estrogens and testosterone, on myelin, and evaluate their possible involvement in the process of remyelination. We use cuprizone--induced murine model of demyelination, and inject mice with either hexestrol - a synthetic analogue of estrone - or nandrolone - a synthetic analogue of testosterone. Methods: Mice have been divided into four groups: [] control group, [2] mice that are administered only cuprizone, [3] mice that are administered hexestrol and cuprizone, and [4] mice that are administered nandrolone and cuprizone. Each group consists of 6 male and 6 female animals. In all mice MRI (.5T) of the brain has been taken and the area of corpus callosum has been measured (in pixels, pu). Results: The area of corpus callosum has been found to be in group [] 96pu (males), 9pu (females) group [2] 06pu (males), 9pu (females) group [3] 35pu (males), 67pu (females) group [4] 43pu (males), 70pu (females) Conclusion: Our results indicate that female brain is more resistant to toxic demyelination. Moreover, the effect of neurosteroids differs in female and male brain. The protective effect of both estrogen and testosterone steroids is stronger in the female brain than in the male brain. Remyelination is almost two times stronger in females than in males. Conclusion: Sustained treatment with DMF continues to demonstrate a favourable benefit: risk profile. *Note: after the May 204 data cut, a case of progressive multifocal leukoencephalopathy was reported in the setting of severe, prolonged lymphopenia (approximately <0.5x09/L of 3.5 years duration). Disclosure: Study supported by: Biogen Idec 205 European Journal of Neurology, 22 (Suppl. ),

227 70 Flash Posters F3057 Prolactin and remyelination: an experimental study E. Predtechenskaya, A. Khodakov Novosibirsk State University, Dept of Medicine, Novosibirsk, Russian Federation Background and aims: Remission of multiple sclerosis (MS) during pregnancy is documented by a number of studies. It suggests that sex hormones are involved in an endogenous mechanism of protection against MS. Our main focus is on the following question: Is prolactin increase an independent factor of hormonal defense during pregnancy, or is it itself a consequence of increase in placental steroids? Methods: Pure hyperprolactinemia is induced by administering metoclopramide (cerucal). Mice have been divided into three groups: [] control group, [2] mice that are administered cuprizone, and [3] mice that are administered metoclopramide and cuprizone. In all mice MRI of the brain has been taken (.5T) and the area of corpus callosum has been measured (in pixels, pu). Results: We find that the average area of the corpus callosum in the control group is 25±4 pu, in group [2] is 89±7 pu, and in group [3] is 48±29 pu. Thus in the animals of the second group the demyelinated area is nearly two times bigger than in the animals of the third group. Conclusion: The results suggest that prolactin offers a potent protection to brain tracts subjected to cuprizon-induced demyelination. The present model can be extrapolated to physiological hyperprolactinemia during pregnancy. Considering a recently discovered effect of prolactin on cell growth we conjecture that the protective effect of prolactin is related to accelerated remyelination, histologically manifested through accelerated growth of oligodendrocytes precursor cells. We do not exclude that the direct effect of prolactin is strengthened by the effect of placental steroids. F3058 A demyelinating disorder characterized by repeated episodes of optic neuritis and brainstem dysfuntions in a girl with anti-mog positivity L. Moiola, F. Sangalli 2, P. Preziosa, M. Radaelli 2, L. Leocani 3, G. Di Maggio 4, C. Baldoli 5, V. Martinellli 6, G. Comi 3 Milan, Italy, 2 San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Department of Neurology, Milan, Italy, 3 san Raffaele Hospital, neurology, Milan, Italy, 4 San Raffaele Hospital, Neurology, Milan, Italy, 5 san Raffaele Hospital, neuroradiology, Milan, Italy, 6 san Raffaele Hospital, Neurology, Milan, Italy Background and aims: The spectrum of demyelinating diseases is expanding because of the discovery of new biomarkers. In NMO and NMOSD diagnostic criteria AQP4- Abs are included. AntiMOG-Abs have been reported in childhood ADEM, but recently also in some patients with NMO/NMOSDB, AQP4-negative. These patients have some clinical and neuroradiological differences and a more favourable outcome Methods: Case report Results: A 6-year-old girl complained a brainstem dysfunction (BD) in August and December 200. Both times MRI showed T2 lesions in brainstem. Oligoclonal bands were absent. AQP4-Abs were negative. Both times clinical and radiological abnormalities disappeared after iv-steroids. Moreover in October 200, April and October 20 she had three times optic neuritis (ON) with recovery after steroids. A diagnosis of multiple sclerosis was made and she started glatiramer acetate. She did well till September 203 when she had severe ON. In November 203 she presented another BD episode. MRI showed new T2 lesions involving the right cerebral peduncle and hypothalamus. Anti- MOG-Abs were positive twice. High dose-steroid had no benefits. She was then treated with both intravenous cyclophosphamide (3,700mg) and rituximab (RTX; 2,200mg). MRIs showed a progressive reduction of lesions and she recovered. She repeated at 6-months regular interval RTX (2,000mg) without new events. Conclusion: Pediatric patients presenting with clinical and MRI findings highly suggestive of NMO but with AQP4- Abs-negative and MOG-Abs-positive represent a clinical variant in spectrum of demyelinating disease. We described a case of a MOG-Abs-positive patient who has been treating with RTX. MOG-Abs could be pathogenetic and therefore we tailored therapy choosing drug targeting B-cells Disclosure: I received honoraria for speaking from Sanofi- Aventis, Biogen-Idec and Merck-Serono 205 European Journal of Neurology, 22 (Suppl. ),

228 Flash Posters 7 F3059 Hirsutism and the risk of multiple sclerosis among Italian women: The EnvIMS Study G. Ragnedda, I. Casetta 2, S. Leoni 3, K.-M. Myhr 4, T. Riise 5, C. Wolfson 6, A.G. Masala 7, M. Pugliatti 8 University of Sassari, Department of Biomedical Sciences, Department of Clinical and Experimental Medicine, Sassari, Italy, 2 University of Ferrara, Department of Biomedical and Surgical Sciences, Section of Clinical Neurology, Ferrara, Italy, 3 University of Sassari, University Hospital, Department of Biomedical Sciences, Department of Clinical and Experimental Medicine, Sassari, Italy, 4 University of Bergen, The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway and The KG Jebsen Centre for MS-Research, Department of Clinical Medicine, Bergen, Norway, 5 University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway, 6 McGill University, Research Institute of the McGill University Health Centre, Montreal, QC Canada and Department of Epidemiology and Biostatistics and Occupational Health, Montreal, Canada, 7 University of Sassari, Department of Surgical, microsurgical and medical sciences, Sassari, Italy, 8 University of sassari, Department Clinical and Experimental Medicine, Sassari, Italy Background and aims: Androgens appear to have a protective effect on the risk of developing multiple sclerosis (MS), both in animal models and in humans. However, other evidence suggests that hyperandrogenism and related clinical signs (e.g. hirsutism) are more frequent in women with MS. In addition, the androgenic effects of new several oral contraceptives have recently been suggested to be an emergent risk factor for MS. Using data from a large case-control study, we investigated the association between hirsutism, as a marker of hyperandrogenism, and the risk of MS in the Italian female population. Methods: A self-administered postal questionnaire (EnvIMS-Q) which included a set of questions about the presence of, and treatment for, hirsutism was sent to individuals with MS and frequency age and sex-matched controls from Italy. The association was examined using odds ratios (ORs) and 95% confidence intervals (95%CIs), adjusting for covariates using logistic regression. Results: A total of 80 women (95% of the females in the sample), 390 cases and 790 controls gave information about hirsutism. 4 (0.5%) cases and 86 (0.9%) controls reported having hirsutism. In the regression model, with index age, smoking habit and body mass index as covariates, no evidence of an association was found between MS and hirsutism (ORadj=.8; 95% CI: ). Conclusion: Hirsutism and hence hirsutism-related hyperandrogenism are not associated to MS among Italian women. Disclosure: The study was supported by grants from Fondazione Italiana Sclerosi Multipla (2007/R/4, 2008/R/9), Regione Autonoma Sardegna, Assessorato Igiene/Sanità, Italy; no other disclosures in relation to the study F3060 Efficacy and safety of a 3 times weekly dosing regimen of glatiramer acetate in relapsing-remitting multiple sclerosis patients: 3-year results of the Glatiramer Acetate Low-frequency Administration (GALA) open-label extension study O. Khan, P. Rieckmann 2, A.N. Boyko 3, K.W. Selmaj 4, N. Ashtamker 5, M.D. Davis 6, S. Kolodny 7, R. Zivadinov 8 Wayne State University School of Medicine, Detroit, USA, 2 Bamberg, Germany, 3 Moscow, Russian Federation, 4 Medical University of Łódź, Łódź, Poland, 5 Netanya, Israel, 6 Frazer, PA, USA, 7 Teva Pharmaceuticals, Cleveland, USA, 8 Buffalo, NY, USA Background and aims: To evaluate the efficacy and safety of glatiramer acetate 40 mg/ml three-times weekly (GA40) over 36 months during the open-label (OL) extension phase of the GALA study. Methods: 97.2% of PC phase completers consented to enter the OL extension. Early start (ES) patients (n=834) received GA40 for 36 months. Delayed start (DS) patients (n=49) switched from placebo to GA40 at Month 2. Results: 76 ES (85.9%) and 325 DS (77.6%) patients completed 36 months of treatment. The adjusted mean ARR was lower for ES versus DS patients over 36 months (0.23 vs 0.30, risk ratio [RR]=0.770; P=0.0052). Fewer cumulative gadolinium-enhancing T and new/enlarging T2 lesions were observed in ES versus DS patients over 36 months (RR=0.660, P= for T; RR=0.680, P<0.000 for T2). The number of active lesions at month 6 converting to T hypointense lesions by Month 36 was lower for ES patients (RR=0.685; P=0.0260). Rates of adverse events (AEs) and serious AEs were lower in the OL extension compared with the PC phase. No new common AEs were identified. AEs were consistent with the GA safety profile. Conclusion: Early treatment with GA40 resulted in sustained reductions in ARR, lesion activity, and evolution of active lesions to chronic black holes over 36 months. Disclosure: Study sponsored by Teva Pharmaceutical Industries to evaluate the efficacy and safety of glatiramer acetate 40 mg/ml three times weekly. 205 European Journal of Neurology, 22 (Suppl. ),

229 72 Flash Posters F306 Neuroinflammation drives anxiety and depression in relapsing-remitting multiple sclerosis S. Rossi, V. Studer, C. Motta, S. Polidoro, E. Chiarello, S. Gelibter, A. Calò, I. Colonna, D. Centonze Tor Vergata University, Rome, Italy Background and aims: Mood disorders have long been considered as a consequence of diagnosis and disability in multiple sclerosis (MS). Inflammation has recently emerged as contributing factor in psychiatric disorders. We aimed to investigate the inflammatory pathogenetic mechanisms and the prognostic relevance of MS psychiatric symptoms. Methods: 405 relapsing-remitting (RR)MS patients underwent psychiatric assessment by means of Beck Depression Inventory (BDI) and State/Trait Anxiety Inventory (STAI- Y/Y2). Cerebrospinal fluid (CSF) sample collected on the same day was available for patients. Central levels of proinflammatory cytokines Ilβ, IL2, IL8, TNF, and IFN were determined and their effects on synapses were tested by patch-clamp recordings in vitro. Results: Active patients had higher values of STAI-Y and BDI respect to remitting patients, but similar trait-anxiety scores. No differences were observed in psychometric variables between relapsing and asymptomatic MRI-active patients, underlying the effect of subclinical inflammation on mood symptoms. STAI-Y and BDI scores were significantly reduced in parallel to resolution of brain inflammation. IL2 CSF levels correlated with STAI-Y, whereas TNF and ILβ correlated with BDI. IL2 altered the sensitivity of striatal GABAergic synapses to cannabinoid modulation, whereas depression-related cytokines increased striatal glutamatergic synaptic trasmission. As emotional disturbances were associated with subclinical inflammation, an alteration of psychometric profile could early detect subclinical reactivation. High STAI-Y scores significantly predicted the risk of disease reactivation (OR.06, p<0.0). Time to first relapse was lower among patients with clinically significant state anxiety. Conclusion: Mood symptoms are driven by intrathecal inflammation, even subclinical, and can predict disease reactivation in RRMS. F3062 Sensing the rhythm of MS S. Rutledge, B. Greene 2, I. McGurgan, K. O Connell, C. McGuigan, N. Tubridy St Vincent s University Hospital, Department of Neurology, Dublin, Ireland, 2 UCD, Biomedical Engineering, Dublin, Ireland Background and aims: To quantitatively assess the mobility of people with early-stage multiple sclerosis (MS) using inertial sensors and, to determine if people with early-stage MS could be automatically distinguished from healthy controls, on the basis of gait. Methods: A cross-sectional study on mobility of people with relapsing-remitting MS not on disease-modifying therapy. Participants performed a Timed Up and Go (TUG) test, instrumented with inertial sensors, and compared to healthy controls. The impact of MS and disability level were assessed using the Multiple Sclerosis Impact Scale physical score (MSIS-20) and Expanded Disability Status Scale (EDSS). Both measures were correlated with sensor data from the TUG test. Angular velocity signals for MS patient during TUG test Results: 38 MS patients (aged 45.9±9.8; 24F), 33 controls (aged 59.8±2.7 years; 9F). In the MS group (mean TUG time 7.9±.7s, range s), mean EDSS was.3±.2, range Mean MSIS-20 was 3.6±2.5, range Mean disease duration was 7.3±7.5years. Reliability analysis (ICC(2,k)), showed that 36/52 inertial sensors parameters obtained during the TUG showed excellent intra-session reliability; 9/52 showed moderate reliability. This compared favourably with controls results. A cross validated elastic net regularized regression model of MSIS-20 yielded an MSE of 2. with 37 DoF. Similarly, a model of EDSS yielded an MSE of.5 with 6 DoF. Classification using logistic regression showed that participants with early-stage MS can be distinguished from controls, even with minimal disability levels with 96.9% accuracy. 205 European Journal of Neurology, 22 (Suppl. ),

230 Flash Posters 73 Cross-validated MSE of Elastic Net fit for MSIS-20 and EDSS MSIS-20 and EDSS scores compared to predicted MSIS-20 and EDSS scores from regression model Conclusion: Inertial sensor parameters detect early gait abnormalities in people with MS and may have longitudinal value in disability assessment but further studies are required to confirm this. F3063 Cortical variants of multiple sclerosis: demographic, genetic, and clinical features J. Domingos, R. Samoes, I. Moreira 2, E. Santos, C. Pinto 2, A. Gonçalves 2, A. Bettencourt 3, S. Cavaco 2, A.A.D.M. Silva Centro Hospitalar do Porto - Hospital de Santo António, Neurology Department, Porto, Portugal, 2 Centro Hospitalar do Porto - Hospital de Santo António, Neuropshychology Unit, Porto, Portugal, 3 Autoimmu and NeuroScien, Unidade Multidisciplinar Invest Biomed, Inst Ciencias Biomed Abel Salazar, UPorto, Porto, Portugal Background and aims: In recent years, the Cortical Variants of Multiple Sclerosis (MS-cv) have been progressively recognized, mainly through case reports or small series. We aimed to characterize the demographic, genetic and clinical features of MS-cv in the context of a large cohort of MS patients. Methods: In a consecutive series of 420 MS patients, 9 were classified as MS-cv (cognitive/behavior, cortical presentations or forms with predominant cognitive impairment). APOEε4 and HLA-DRB*5:0 were searched. A comprehensive battery of neuropsychological tests was applied. Chi-square and Mann-Whitney tests were used for the statistical analysis. Results: MS-cv patients characteristics were: 6 (84%) women; mean age=43±2, mean education=8±5; 2 (74%) relapsing-remitting MS; mean age at disease onset=32±; mean disease duration= years±9; and mean EDSS=3±2. Only one patient had APOEε4 and two had HLA- DRB*5:0. Eleven (58%) scored below the 5th percentile on >25% of cognitive measures. 6 of these patients had dementia according to the MMSE. The frequency of pathological anxiety and depression, according to HADS, was respectively 65% and 29%. In comparison to the remaining 40 MS patients, MS-cv patients had lower education, more cognitive impairment, and higher psychopathology (p<0.05). There were no statistical significant differences concerning age at disease onset, disease duration, disease course or EDSS between the two groups (p>0.05). Conclusion: In our cohort of MS-cv patients, cognitive impairment and psychopathology were frequent clinical features. These results are consistent with other published case series. The association between MS-cv and low education suggests a critical role for cognitive reserve in the clinical presentation of MS. 205 European Journal of Neurology, 22 (Suppl. ),

231 74 Flash Posters F3064 The effect of fingolimod on new T-hypointense lesions and evolution of pre-existing Gd+ lesions, stratified by lesion size: Post-hoc analysis of the FREEDOMS study T. Sprenger, E.-W. Radue, N. Mueller-Lenke, G. Francis 2, D. Haering 3, D. Tomic 3, L. Kappos University Hospital Basel, Basel, Switzerland, 2 Novartis Pharmaceuticals Corporation, East Hanover, USA, 3 Novartis Pharma AG, Basel, Switzerland Background and aims: In the FREEDOMS study, fingolimod 0.5mg significantly reduced the proportion of baseline gadolinium-enhancing (Gd+) lesions evolving into T-hypointense lesions (THL) and the proportion of patients developing THL. This study evaluates the effects of fingolimod on: ) new THL developed on-study and 2) evolution of baseline Gd+-lesions, stratified by average size into new THL. Methods: ) New THL developed on-study were counted in all patients (irrespective of baseline Gd+-lesion status) and analyzed in a negative-binomial model. 2) Transition of baseline Gd+-lesions into THL was followed at months (M) 6, 2 and 24. Gd+-patients were stratified by average baseline Gd+-lesion volume into subgroups: low-volume (LV;n=236) and high-volume (HV;n=246) with means below or above the median (74.4mm3). A logistic-regression model, adjusted for treatment and number of Gd+-lesions at screening, analyzed evolution of Gd+-lesions into THL, for fingolimod vs. placebo. Results: Overall, the mean numbers of newly-developed THL over 2 and 24 months were lower in fingolimod vs. placebo-treated patients (Table ). The same was true for the HV- and LV-subgroups (Table ). Gd+-lesions in fingolimod-treated patients in the HV-subgroup were less likely to evolve into THL compared with placebo [(M6:46% vs. 62%; p=0.07); (M2:33% vs. 55%; p=0.005); (M24:32% vs. 48%; p=0.0)]. In the LV-subgroup, fewer Gd+-lesions evolved into THL, with no clear treatment effect. Conclusion: Lesions in the HV-group were more likely to evolve into THL than lesions in the LV-group. Fingolimod decreased the overall number of THL developed on-study and reduced the risk of Gd+-lesions evolving into THL in the HV-group. Disclosure: Study supported by: Novartis Pharma AG T Sprenger (Novartis, Eli Lilly, Allergan, Genzyme, ATI, Mitsubishi Pharma Europe, Biogen Idec) E-W Radue (Actelion, Biogen Idec, Merck Serono, Novartis) N Mueller- Lenke (Biogen Idec, Merck Serono, Novartis) G Francis, retired, was an employee of Novartis Inc, East Hanover, USA at the time this work was performed D Haering and D Tomic are employees of Novartis Pharma AG, Basel L Kappos Institution, University Hospital Basel (Actelion, Addex, Bayer Health Care, Biogen Idec, Biotica, Genzyme, Eli Lilly, Merck Serono, Mitsubishi, Novartis, Ono Pharma, Pfizer, Receptos, Sanofi-aventis, Santhera, Siemens, Teva, UCB, Xenoport) Table : Newly developed THL over 2 or 24 months 205 European Journal of Neurology, 22 (Suppl. ),

232 Flash Posters 75 F3065 Safety of autologous bone marrow mesenchymal stem cells intrathecal transplantation in patients with progressive multiple sclerosis M. Swiderek-Matysiak, J. Wojtkiewicz 2, A. Habich 2, I. Selmaj, W. Maksymowicz 2, K. Selmaj Medical University of Lodz, Neurology, Lodz, Poland, 2 UWM University Olsztyn, Neurology and Neurosurgery, Olsztyn, Poland Background and aims: To assess safety and tolerability of intrathecal administration of autologous mesenchymal stem cells (MSCs) in patients with progressive multiple sclerosis (MS) who failed on previous therapies. Methods: 0 MS patients with disability progression min.0 point in the EDSS (Expanded Disability Status Scale) in past year were included in the study. Mean EDSS score at baseline was 7.25 point and mean patients age was 46.5 years. MSCs were isolated from bone marrow and cultured for 4-5 weeks. After four passages mln of fresh MSCs, were suspended in autologous spinal fluid and injected intrathecally in single infusion. The main outcome measures were recording of side effects and tolerability. We analyzed systemic and injection-related adverse effects as well as adverse events during study follow-up. Results: 5 patients had injection-related adverse events consisting of headache for 2-3 days and patient suffered from backache. No fever and no any other signs of infections were recorded. Intensity of all adverse effects were characterized as mild. No major adverse effects were reported during 2 months of study follow-up. No major abnormalities were recorded in laboratory tests after MSCs injection and during follow-up. Conclusion: Intrathecal administration of autologous MSCs in patients with progressive multiple sclerosis is safe and well tolerated procedure. F3066 Multiple sclerosis with idiopathic alopecia areata K. Takahashi, K. Komai, C. Ishida, Y. Motozaki, T. Ikeda, Y. Ikeda Iou hospital, Neurology, Kanazawa, Japan Background and aims: The use of immunosuppressants such as cyclophosphamide for the treatment of patients with multiple sclerosis (MS) may induce alopecia as an adverse reaction; however, case reports of the MS patients with idiopathic alopecia areata (AA) is rare. Methods: We analysed the clinical features of two cases of MS with AA in Japan. Results: Both patients were male and MS onset occurred prior to AA onset. Clinically, the MS in both cases was the opticospinal type without both longitudinally extensive cord lesions and anti-aquapolin-4 antibodies. After AA onset, there was no relapse of MS in both cases. AA was of the severe systemic form in both cases and both patients suffered from chronic urticaria. Conclusion: Both MS and AA are considered autoimmune diseases; however, CD4 T-cells play an important role in MS whereas CD8 T-cells are pivotal in AA pathology. Moreover, MS often develops in young adult women, whereas AA frequently occurs in children less than 5 years old. Thus, since the clinical and immunological features of MS are significantly different from that of AA, the occurrence of MS concurrently with AA might be rare. Because the Japanese opticospinal form of MS differs pathologically from the typical western type of MS, it is likely that it might occur concurrently with AA in this population. 205 European Journal of Neurology, 22 (Suppl. ),

233 76 Flash Posters Muscle and neuromuscular junction diseases 2 F3067 Sporadic late-onset nemaline myopathy (SLONM): a single centre experience. M. Monforte, G.A. Primiano, G. Silvestri, M. Mirabella, M. Luigetti, S. Servidei, E. Ricci, G. Tasca Catholic University School of Medicine, Neurology, Rome, Italy Background and aims: Sporadic late-onset nemaline myopathy (SLONM) is a rare acquired myopathy characterized by a subacute adult onset proximal weakness. The pathological hallmark of the disease is the presence of nemaline bodies on muscle biopsy. The general outcome is poor especially in patients with associated monoclonal gammopathy. In recent years therapeutic interventions, such as intravenous immunoglobulins (IVIg), chemotherapy and autologous stem cell transplantation, have shown some degree of efficacy in SLONM associated with monoclonal gammopathy. Methods: We present clinical, histopathological, muscle imaging, laboratory, and follow-up data after treatment of 6 SLONM patients from a single centre. Results: Clinical severity was variable, but all patients had a rapid worsening of weakness during the first months of disease. Besides proximal upper and/or lower limb weakness, neck extensors and respiratory involvement were frequent. Imaging was consistent in all patients, characterized by gluteal, paraspinal, posterior thigh and soleus muscles involvement. Five patients had a detectable monoclonal gammopathy. Clinical stabilization was reached for the majority of the patients who received periodic infusion of IVIg. One patient was unsuccessfully treated with IVIg, Melphalan and Bortezomib. Conclusion: Common clinical and imaging elements were found in our cohort of SLONM patients. In our experience periodic IVIg administration seems able to stabilize the disease progression in the majority of the cases. Awareness of SLONM as a nosological entity is essential to establish an early and correct diagnosis and a prompt therapy. F3068 Contribution of a and a2 adenosine receptors on ACh release in the adult neuromuscular junction N. Ortiz, T. Obis 2, N. Garcia 3, M.M. Santafe 3, M. Priego 4, M. Tomas 3, N. Besalduch 3, M. A. Lanuza 3, J. Tomas 3 Hospital Universitari Sant Joan, Department of Neurology, Reus, Spain, 2 Facultat de Medicina i Ciències de la Salut. Universitat Rovira i Virgili, Unitat d Histologia i Neurobiologia (UHN), reus, Spain, 3 Facultat de Medicina i Ciències de la Salut. Universitat Rovira i Virgili, Unitat d Histologia i Neurobiologia (UHN), Reus, Spain, 4 u, Reus, Spain Background and aims: Adenosine receptors (PRs) are a class of purinergic receptors, G-protein-coupled receptors with adenosine as endogenous ligand. The subtypes A and A2A have been involved in the regulation of neurotransmission in muscle. High resolution immunohistochemistry and confocal microscopy show that both receptors are present and differentially localized in the three cells (muscle, nerve and glia) that configure de Levator auris longus (LAL) mouse neuromuscular junctions (NMJs). Results: Electrophysiological study shows that in resting conditions, the presence of selective modulators of the PRs does not result in any change of the evoked release. This finding confirms the previous observation that PRs are not tonically coupled to neurotransmission in the NMJ and that the unbalance per se of the A and A2A mechanisms by using selective blockers and stimulators does not reveal or unmask any involvement of the endogenous adenosine in resting conditions.we assayed PRs role during synaptic activity. Adenosine (0µM) increases facilitation of the firsts EPPs and protects for depression during repetitive stimulation. Conclusion: These points to a specific involvement of the PRs molecules in the modulation of ACh release during activity. Disclosure: This work was supported by a grant from MEC (SAF20-237) and a grant from the Catalan Government (Generalitat) (2009SGR European Journal of Neurology, 22 (Suppl. ),

234 Flash Posters 77 F3069 Myotonic dystrophy type 2 and metabolic syndrome M. Vujnic, S. Z. Peric 2, D. Savic-Pavicevic 3, J. Pesovic 3, V. Rakocevic-Stojanovic 4 Banja Luka, Serbia, 2 Belgrade, Serbia, 3 Center for Human Molecular Genetics, Faculty of Biology, University of Belgrade, Belgrade, Serbia, Belgrade, Serbia, 4 Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia, Belgrade, Serbia Background and aims: Metabolic syndrome (MetS) seems to be more common in patients with muscular disorders than in general population. The aim of this study was to investigate frequency and features of MetS in patients with myotonic dystrophy type 2 (DM2) since this topic has not been investigated so far. Methods: Study comprised 44 genetically confirmed DM2 patients (30% males, 5± years old, with mean disease duration of 5±3 years). New worldwide consensus criteria for MetS from 2009 were used. Results: Components of MetS were present with following frequencies in DM2 patients: central obesity 6%, arterial hypertension 57%, hypertriglyceridaemia 46%, low HDL cholesterol 27%, and hyperglycemia 27%. MetS was diagnosed in 20 (46%) patients 30% of patients had three MetS components, 4% had four and 2% had all five components. Patients with MetS compared to those without it had around 40-time increased risk of hypertriglyceridemia (p<0.0), -time increased risk of hypertension and hyperglycemia (p<0.0), and five-time increased risk of central obesity (p<0.05), while frequency of low HDL level did not differ between groups (p>0.05). Presence of MetS was not in association with patients gender and age, duration of disease and severity of muscular impairment (p>0.05). Conclusion: MetS was found in almost half of our DM2 patients. Identification of this harmfull but potentially treatable condition is of major importance in diseases (such as DM2) that still lack causal therapy. F3070 Mc Ardle disease (glycogenosis type 5): clinical progression from diagnosis and new basis for follow-up in a small cohort of Italian patients V. Ponzalino, L. Vercelli, T. Mongini University of Torino, Italy, Department of Neurosciences Rita Levi Montalcini, Turin, Italy Background and aims: Glycogen storage disease type V is a disorder of carbohydrate metabolism, inherited in an autosomal recessive manner and produced by mutations in the gene (PYGM) encoding the muscle isoform of glycogen phosphorylase (myophosphorylase), which cause an impaired ATP generation. Patients typically complain exercise intolerance, the so called second wind phenomenon and episodic myoglobinuria. The level of serum CK is high even at rest. Methods: We enrolled 9 patients with bioptical and/or genetically confirmed diagnosis referring to our center and reviewed the medical history from diagnosis to the present. Then we performed a clinical and functional evaluation by using the North Star Ambulatory Assessment (NSAA), MRC scale, 6MWT and GSGC score. We also assessed pulmonary and cardiac function and CK blood level Results: At diagnosis our patients reported almost the same typical symptoms; the first clinical evaluation was normal in five patients, three patients showed lumbar hyperlordosis with mild waddling gait and only one patient had mild scapular girdle weakness. Conclusion: The disease appears to have a benign course: our patients do not show a significant worsening in motor and respiratory functions, but keep on complaining the same early symptoms. From now, our patients will be inserted in a clinical database and periodically submitted to a standard evaluation in order to assess the clinical progression on the basis of standard criteria. 205 European Journal of Neurology, 22 (Suppl. ),

235 78 Flash Posters F307 Clinico-serologic predictors of positive repetitive nerve stimulation study in newly diagnosed generalized myasthenia gravis D. Reyes, R. Govindarajan 2, N. Galvez-Jimenez, V. Salanga Cleveland Clinic Florida, Pauline Braathen Neurological Center, Weston, USA, 2 University of Missouri Health System, Neurology, Columbia, USA Background and aims: Myasthenia gravis (MG) is a neuromuscular junction autoimmune disorder with acetylcholine receptors (AchR) antibodies, and repetitive nerve stimulation (RNS) demonstrating decremental response in 80-90% in patients with generalized (g) MG. Few studies have analyzed the clinical and serological markers affecting the RNS response. To analyze the clinical and serological markers affecting RNS response in newly diagnosed gmg patients. Methods: Retrospective study of newly diagnosed adult gmg with available RNS study and serological markers and at least one year follow-up between 200 and 20. Myasthenic symptoms were classified into one of the five: general, severe, axial, bulbar and ocular. Chi Square/Fisher was used for categorical variables; and Student t-test/ano- VA, for continuous variables. Results: 44 patients included (Mean age: 64, Females: 27, Caucasians: 68%, Hispanics: 6%). Facial weakness in 98% of patients followed by gaze paresis 93%. Positive RNS (Pos-RNS) in 75%. AchR antibodies positive in 70%. Older patients showed more probability to develop diplopia, (χ2=7.669, p<0.0), decreased odds of proximal limb weakness (χ2=0.7, p<0.0) and decreased odds of Pos-RNS (χ2=7.4, p<0.0). Proximal limb weakness showed association with thymus hyperplasia/thymoma (p=0.053) and Caucasian (χ2=4.74, p<0.0). Generalized weakness was associated with AchR binding antibodies (p<0.05). Yield of Pos-RNS was highest in the trapezius, 46%. Lower limb weakness correlates with Pos-RNS in tibialis anterior. Conclusion: Age, appendicular and generalized weakness are the best predictor of RNS decrements. Thymus involvement increases the probability of having proximal weakness. Trapezius carries the highest yield for RNSP for non specific symptoms such as generalized weakness and fatigue. F3072 Paraneoplastic, thymoma associated myasthenia gravis (TMG): improvement of long-term survival in primary inoperable thymoma patients B. Schalke, L. Kirzinger, M. Ried 2, R. Neu 3, R. Kollanur 4, J. Marienhagen 5, A. Götz 6, O. Hamer 6, A. Marx 7 University of Regensburg, Neurology, Regensburg, Germany, 2 University of Regensburg, Medical Centre, Department Thoracic Surgery, Regensburg, Germany, 3 Inst. Eco-Med. (=Inst. Umweltmed.) c/o ICSD/Int. Acad. Sci., POB 34036, 8000 Muenchen, Germany (Berlin-Bratislava- Innsbruck-Muenchen-New Delhi-Paris-Sofia-Vienna), Munich, Germany, 4 University of Regensburg, Medical Centre, Department of Neurology - Integrated myasthenia Gravis Centre at medbo, Regensburg, Germany, 5 University of Regensburg, Medical Centre, Department of Nuclear Medicine, Regensburg, Germany, 6 University of Regensburg, Medical Centre, Radiology, Regensburg, Germany, 7 University of Mannheim-Heidelberg, Department of Pathology, Mannheim, Germany Background and aims: TMG is a paraneoplastic autoimmune disease treated according to standard protocols the same way as other subtypes of MG. Long-term survival in TMG is limited by tumor progression. Methods: We included new diagnostic and therapeutic procedures for TMG patient care. Standard CT with contrast enhancement of mediastinum was the first diagnostic step for primary visualization of the thymoma and measuring the tumor volume by volumetry. To differentiate whether the boundary between tumor and surrounding tissue is infiltrated or not we used cine-mri, when akinesia was present the patient was not operated. Octreoscan for functional imaging was performed to detect somatostatin receptor (SR) expression on tumor cells. Results: If positive neoadjuvant treatment with Octreotide (Sandostatin ) plus Prednisolon was started to reduce tumor volume. Therapy goes along with repeated volumetry. If volume reduction was successful, tumor infiltration in the Cine-MRI was diminished, thymomectomy was performed with the aim of macroscopic complete resection accompanied by radical pleurectomy or extrapleural pneumonectomy followed by hyperthermic intrathoracic chemotherapy perfusion(hithoc). Subsequent adjuvant chemotherapy and/ or radiation was conducted. Conclusion: Survival in TMG is predominantly determinated by tumor disease. Careful preoperative clinical investigation, neoadjuvant therapy, radical thymomectomy with extended surgical resection of advanced thymic tumors infiltrating adjacent structures (stage III) or with pleural metastases (stage IVa) is safe and feasible, if necessary with pleurectomy and/or pneumectomy, followed by intrapleural chemotherapy for disseminated pleural metastasis seems to offer a better local tumor control. In our hands this approach provides a low recurrence rate and an acceptable survival. Disclosure: Part of this study was supported by Novartis/ Germany 205 European Journal of Neurology, 22 (Suppl. ),

236 Flash Posters 79 F3073 Congenital generalized lipodystrophy family with myopathic involvement M. Sohtaoglu Sevindik, M.A. Akalin 2, A. Tunckale 3 Istanbul, Turkey, 2 Cerrahpaşa Faculty of Medicine, Istanbul University, Neurology Department, Istanbul, Turkey, 3 Cerrahpaşa Faculty of Medicine, Istanbul University, Internal Medicine, Istanbul, Turkey Background and aims: Congenital generalized lipodystrophy (CGL) is defined as a rare autosomal recessive genetic disorder characterized by absence of metabolically active adipose tissue, muscular appearance, and severe insulin resistance. Homozygous or compound heterozygous mutations in four genes (AGPAT2, BSCL2, CAV and PTRF) are uptodate associated with four clinical subtypes. The CGL was originally described by Berardinelli and Seip, and since then, approximately 300 cases have been reported. Methods: We report two female Turkish siblings who presented with proximal muscle weakness, fatigue, hypermasculinity, generalized loss of subcutaneous fat, acanthosis nigricans, acromegaloid appearance, umbilical hernia, dyslipidemia, insulin resistance, coronary heart disease and infertility. Family history revealed that the patients mother and two aunts had similar conditions and deceased due to myocardial infarction at forties. The patients and all their female relatives with the same phenotype were unable to concieve male children, the pregnancies with a male fetus ended up in miscarriage or in stillborns. Results: Neurological examination was normal except proximal weakness (muscle strength: 4/5), easy fatigability and loss of deep tendon reflexes. Creatine kinase levels were normal but electromyography showed myopathic involvement at proximally located muscles. Muscle biopsy revealed intracytoplasmic inclusions of lipid and muscle fiber disproportion. The metabolic syndrome was severe with one patient with coronary heart disease having a triglycerid level of 2700 mg/dl. Conclusion: The presented patients and their family tree suggest an X-linked inheritance, which may be considered as a novel mutation for CGL. Whether the leptin replacement therapy for CGL is a cure for myopathic involvement needs further investigations. F3075 Novel OPA mutation in syndromic mitochondrial dominant optic atrophy (DOA+): a case report V. Thavapalan, T.-W. Liang, G. Rakocevic Thomas Jefferson University Hospitals, Neurology, Philadelphia, USA Background and aims: OPA gene mutation rarely causes syndromic Dominant Optic Atrophy (DOA+), where mitochondrial DNA destabilization results in multi-organ deterioration in a progressive fashion. We present a unique patient with novel OPA gene mutation manifesting with severe optic atrophy, progressive hearing and pan-sensory loss, hyperkinetic movements and cognitive decline. Case Report: Now a 43-year-old man developed progressive visual and sensorineural hearing loss in early childhood, leading to becoming legally blind and deaf by age 6. He also developed progressive ptosis, external ophthalmoplegia, chronic headache and cognitive regression. He has also developed a progressive distal sensory and motor neuropathy with worsening ataxia. His smell and taste have also deteriorated. However, swallowing and bowel/bladder functions remain intact. When attempting ambulation, he exhibits severely discoordinated, staggering gait with ballistic, pseuodoathetoid limb movements leading to falls and injuries. Consequently, he requires continuing safety parameters and supervision, and a wheelchair since age 22. He lost spontaneous and intelligible speech in his early twenties, with communication reduced to reading sign-language via finger-tapping on his palms. Results: Serial MRIs demonstrate symmetric T2/FLAIR hyperintensity below the inferior head of the caudate, increasingly prominent cerebellar volume loss and a small optic chiasm. MR Spectroscopy showed increased lactate/ creatinine ratio in the cerebellum. Genetic testing revealed OPA mutation at c.208 T>C, p.ile403thr. Muscle biopsy showed cytochrome c deficient fibers and ragged-red fibers. Conclusion: Unlike previous cases of DOA+, our patient s pan-sensory deprivation, hyperkinetic movements and cognitive regression related to progressive central and peripheral nervous system deterioration is unique, requiring further study into OPA gene expression. F3074 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

237 720 Flash Posters F3076 Reduced muscle mitochondrial enzyme activity in MuSK-immunized mice H. Durmuş, E. Ozkok, B. Yetimler, E. Tüzün Istanbul University, İstanbul, Turkey Background and aims: Muscle specific kinase (MuSK)- antibody positive myasthenia gravis (MG) patients might present with clinical and electrophysiological signs of muscle atrophy. Methods: To investigate the potential contribution of mitochondrial dysfunction in muscle atrophy induced by MuSK immunity, mitochondrial enzyme expression and activity were investigated in muscle samples of recombinant human MuSK-immunized C57BL/6 (B6) mice using histochemical and biochemical methods. Results: 6 of 7 (85.7%) MuSK-CFA-immunized mice and none of the CFA-immunized mice showed muscle weakness. Clinical grades were 0, 2 and 3 in, 3 and 3 mice, respectively. OD values for anti-musk IgG (mean±standard deviation, range) in MuSK-CFA and CFA-immunized mice were 0.9±0.2 (0.7-.2) and 0.2±0. (0-0.4), respectively. On histochemical analysis, atrophy was observed in 9.2±2.8% (4-25%) and.4±0.8% (-3%) of muscle fibers of MuSK-CFA and CFA-immunized mice, respectively. On SDH and COX staining, atrophy was seen almost exclusively in darkly stained type fibers. Type fiber atrophy was confirmed with H&E and ATPase stains. On MGT staining, MuSK-CFA-immunized mice showed considerably increased RRF percentages (7.4±.5%, 6-0%) as compared to CFA-immunized mice (0.8±0.5%, 0-2%). Although all muscle samples showed normal intensity on SDH and COX stains, MuSK-CFA-immunized mice had significantly reduced citrate synthase, SDH and NADH-cytochrome c-reductase enzyme activity than CFA-immunized mice. Pearson test did not show significant correlation between clinical grades and any of the histochemical or biochemical parameters. However, the single grade 0 MuSK-CFAimmunized mouse had the lowest atrophy (4%) and RRF (6%) ratios. Conclusion: Our results suggest that MuSK-immunity might induce severe muscle atrophy through mitochondrial dysfunction. F3077 Ocular myasthenia gravis T. Uyar, H. Durmuş, Y. Parman, P. Serdaroglu-Oflazer, G. Saruhan-Direskeneli 2, F. Deymeer Istanbul University, Istanbul Medical Faculty, Neurology, Istanbul, Turkey, 2 Istanbul University, Istanbul Medical Faculty, Physiology, Istanbul, Turkey Background and aims: The objectives of this study are to explore clinical, serological and therapeutic characteristics, to evaluate treatment strategies, and to search for prognostic factors in ocular myasthenia gravis (OMG). Methods: In our MG database, there were 0 OMG patients whose symptoms started between 200 and 200 and who had symptoms for 2 years. Demographic, clinical and serological characteristics as well as treatments used were extracted from the charts. MG-Composite and MG-QOL scales were performed on 58 patients who were examined for the study. The effect of prognostic factors was evaluted. Median follow-up was 8 years. Results: Median onset age was 40 years. Males predominated (female/male ratio: 0.8), particularly in the juvenile and late-onset periods. The most frequent onset as well as the predominant symptom was ptosis. The disease was severe in most of patients. Anti-AChR antibodies were present in 55% of the patients whose onset age was later and the disease was more severe as compared to seronegative patients (both significant). None had anti-musk antibodies. Two patients had thymoma. Thyroid disease was the most frequently associated disorder. Half of the patients had favorable outcome (complete stable remission, pharmacological remission) and another third had improved at the last follow-up visit. Conclusion: There was no significant difference between those who used immunospressives (IS) and those who did not, suggesting that the use of IS, though necessary in many patients in the initial phases, possibly had little influence on the longterm outcome. Presence of severe symptoms and concomitant thyroid disease appeared to be unfavorable prognostic factors. 205 European Journal of Neurology, 22 (Suppl. ),

238 Flash Posters 72 F3078 Thymoma-associated myasthenia gravis: clinical features and surgical results A.N. Yuceyar, A. Uluakay, G. Uncu, O. Ekmekci, H. Karasoy Ege University Medical School of Hospital, Department of Neurology, Izmir, Turkey Background and aims: The aim of the study was to determine the clinical and pathological characteristics of thymoma- associated myasthenia gravis (T-MG) patients and to evaluate the independent predictors of clinical outcomes (gender, age of onset, first symptom, MG clinical stage, tumor staging) Methods: A retrospective study was conducted among 26 T-MG patients (7.02% of our total MG patients) who underwent thymectomy in our department over a 22-year period ( ).The surgical approach was sternotomy or anterolateral thoracotomy Results: Median age was 43.70±9.88 years. Ocular onset MG was recorded in 72.3% of patients. Before thymomectomy, disease severity was graded as mild generalized (I, IIa/b), moderate generalized (IIIa/b, severe generalized (IVa/b) in 32%, 3.98%, 29.% 7.02%, respectively. After surgery 6.7% of patients achieved complete stable remission while 83.3% of them were classified as in pharmacological remission. During follow-up, 50% of patients had a clinical relapse and 2% of patients had a thymoma relapse. Neither clinical nor pathological variables (tumor stage, tumor invasion) were correlated with the chance of achieving complete stable remission (CSR). However CSR was never recorded in bulbar onset MG patients. Immunosuppressive drugs were required for controlling the symptoms Conclusion: TG may have a worse prognosis than MG without thymoma. As no clinical and pathological predictors for outcome were identified, T-MG patients must be followed carefully for a clinical relapse and tumor recurrence. Long-term immunosuppressive drugs are also required. 205 European Journal of Neurology, 22 (Suppl. ),

239 722 Flash Posters Neuroepidemiology; neurotoxicology; Autonomic nervous system disorders F3079 Abstract cancelled F3080 Abstract cancelled F308 Brain MRI findings of welders G. Celiker, T. Akturk, E. Tutkun 2, H. Yılmaz 2 Ankara Meslek Hastalıkları Hastanesi, Neurology, Ankara, Turkey, 2 Ankara Meslek Hastalıkları Hastanesi, Ankara, Turkey Background and aims: Elevated serum manganese level is associated with T hyperintesity in the basal ganglia at MRI as a biological marker of manganese accumulation. But at the same time T hyperintensity in basal ganglia without high serum manganese level has been known as a sign of chronic manganese exposure especially in welders. Methods: 20 welders were evaluated in our Occupational Diseases Hospital in Ankara. All patients had blood and urine test (including iron studies, heavy metals, solvents, thyroid, liver and kidney function tests), brain MRI, EEG, neuropsychologic assessment, other necessary tests and consultations corresponding to the complaints. Results: None of them had elevated serum manganese level and all of other chemical tests are normal. 5 of them had increased T MRI signal in the basal ganglia. All of the EEGs were normal. No one had parkinsonism. 2 of 5 had postural tremor, one of them had anxiety, irritability and slight forgetfulness and the other 2 had just intermittant headache. MOCA test was used for neurocognitif assesment and all of the patients scored normally for their ages, educations and for Turkish population. Following images are sample MRIs of one of the welders. Axial T hyperintensity of welder Sagittal T hyperintensity of welder Normal axial T2 Flair of welder Conclusion: Welding and parkinsonism association has been known for a long time. But welding without proper protection could be associated with non-specific symptoms and only T MRI hyperintensities in the basal ganglia. Sometimes chronic manganese exposure may cause irreversible neurologic deficits. So before this happens we should warn welders and their employers about risks and importance of protection. 205 European Journal of Neurology, 22 (Suppl. ),

240 Flash Posters 723 F3082 Quality of referral from primary care physicians to a Portuguese Neurology outpatient clinic: a review of 50 cases S. Dias, P.M.F.L. Esperança Lisbon, Portugal Background and aims: Referral is an essential part of the general practitioner s (GP) role. Complete clinical history and appropriate investigations performed prior to referral can help minimize time lost collecting this information and avoid delay in workup and treatment. Methods: We reviewed the GP referral letters and clinical files of 50 consecutive outpatients evaluated by the first author in a Neurology clinic from January to December 204. We assessed whether forms contained adequate information regarding previous medical and drug history, if suitable studies were performed prior to referral, and whether referral was appropriate. Results: 52% of forms (n=26) had no information regarding previous medical history, with 26% (n=3) having a thorough history and 22% (n=) only partial information. Only 4% of letters (n=7) had a complete list of medications, the remainder having either absent or insufficient data. Of the 72% of patients (n=36) that would have benefited from having basic investigations performed prior to referral, only 66.% (n=24) had any workup performed. After evaluation, referral was deemed inappropriate in 20% of patients (n=0), the majority of which (90%, n=9) had non-neurological symptoms. These were either incorrectly diagnosed as neurological (n=3) or referred to the wrong specialty (n=6) despite correct identification. Conclusion: The majority of referral letters lacked essential clinical information. Many patients were not adequately investigated before referral, and in a significant portion of cases patients were inadequately referred. Education and training interventions may improve diagnostic accuracy, and requesting advice from specialists prior to referral may help avoid unnecessary referral and expedite management. F3083 Infectious antecedents of Guillain-Barré syndrome in 0 years of Neurology practice T. Gomes, A. Costa, G. Nadais, F. Silveira, P. Abreu Centro Hospitalar S. João, Neurology, Porto, Portugal Background and aims: Some form of infection precedes around two-thirds of the Guillain-Barré syndrome (GBS) cases. Campylobacter jejuni (CJ) is the commonest, with one-third of the cases. Nevertheless, other agents have been implicated. We aimed to characterize the unusual infections preceding GBS in a 0-years case-series. Methods: We performed a retrospective analysis based on charts of GBS cases from our university hospital between 2003 and 203. Statistical analysis was performed using IBM SPSS 2. Results: 52 cases (55±7 year-old, 65% males) were included, with available etiological studies in 22 (53±8 year-old, 64% males). Recent CJ infection was confirmed in eleven (46%) cases and other rarer agents in 0 (36%). Symptoms and agents shown no statically significant association. Rare agents were found in 25% and 3% and CJ in 64% and 33% of gastrointestinal and respiratory symptoms, respectively. Only gastrointestinal symptoms associated with EMG patterns, preceding 80% of acute motor axonal neuropathy (AMAN) and 60% of acute motor-sensory axonal neuropathy (AMSAN), but only 28% of acute inflammatory demyelinating polyradiculoneuropathy (AIDP) cases (p=0.046), [70% of axonal variants (p=0.027)]. Rare agents were detected in 27% of AIDP and 40% of AMSAN, and CJ in 00% of AMAN, 33% of AMSAN and 56% of AIDP, without statistical significance. Preceding symptoms and agents did not affect GBS disability scale scores. Conclusion: GBS aetiology is diverse and our work reveals how, even in clinical settings, several rare pathogenic antecedents can be identified in association with GBS. Furthermore, we suggest that preceding symptoms may be associated with particular EMG patterns. F3084 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

241 724 Flash Posters F3085 Transient Horner s syndrome after epidural anesthesia: a rare complication J. Leempoel, F. Evrard 2 Brussels, Belgium, 2 Ottignies, Belgium Background and aims: We report a case of a 34-year-old woman who presented a transient Horner s syndrome after epidural anesthesia. Case Report: The patient was hospitalised in our clinic for labour as she was 40 weeks pregnant. After an infusion of oxytocin, an epidural anesthesia was administered at L3-L4 level, in sitting position, without any early complication. Six hours after the beginning of the procedure, she benefited of an urgent cesarean section because of fetal bradycardia during labour. She was placed in left lateral decubitus position. Soon after the successful delivery, she described a left-sided weakness and numbness. Left-sided ptosis and myosis were directly noted with slight left facial and brachial hypoesthesia and slight left arm weakness. There was no asymmetry of the limb reflex and no Babinski sign. A cerebral CT scan did not show any lesion. Antiplatelet treatment with aspirin was started. The next day, a brain MRI was performed and was normal. She had previously totally recovered of her deficit. Results: Horner s syndrome is a recognized but rare and little known complication of epidural anesthesia with spontaneous resolution. It has been described especially in obstetrical conditions (0.4 to 4%) because of cephalad spread of local anesthesia due to low epidural space, high intraabdominal pressure and supine position. In these situations, the cause of the Horner s syndrome might not be clear and create stress for the patient and the medical staff, leading to unnecessary and costly investigations. Conclusion: We report a case of transient and benign Horner s syndrome after epidural anesthesia. F3086 Head-up tilt test in diagnosis and follow-up of patients with trimetazidine induced orthostatic hypotension and extrapyramidal symptoms A. Mišmaš, M. Legac 2, A. Bazina 3, I. Adamec 3, M. Habek 3 Zagreb University Hospital Centre,, Neurology, Zagreb, Croatia, 2 General Hospital Zadar, Neurology, Zadar, Croatia, 3 Zagreb University Hospital Centre, Neurology, Zagreb, Croatia Background and aims: Orthostatic hypotension (OH) in older patients is often iatrogenic and antihypertensive drugs are usually suspected for causing it. Besides antihypertensives, trimetazidine; orally administered antianginal agent; is also know for causing OH and extrapyramidal symptomes. We have used head-up tilt (HUT) test for diagnosis and follow-up of three patients with OH and extrapyramidal symptoms. They were all taking antihypertensives and trimetazidine. Methods: 3 male patients underwent 700 HUT test for OH and extrapyramidal syndrome suspected on a basis of anamnesis and neurological examination. patient was diagnosed with Lewy-body dementia, other 2 had normal cognitive functions. Results: All patients reported feeling of dizzines when tilted with blood pressure drop that met the criteria for OH and a heart rate that showed chronotropic incompetence. Polypragmasy was evident. Patients were taking 4-5 medications, mostly antihypertensives, with bisoprolol and trimetazidine present in the therapy of all three. After trimetazidine discontinuation and antihypertensives dosage correction follow-up HUT in all 3 patients showed improvement. 2 patients no more met the criteria for OH. Further antihypertensive drug reduction was required only in a patient with Lewy-body dementia. They also had fewer extrapyramidal symptomes and did not complain of dizzines. Conclusion: Besides its usefullness for iatrogenic OH diagnosis HUT is also usefull to follow the effect of the medication therapy corection. 205 European Journal of Neurology, 22 (Suppl. ),

242 Flash Posters 725 F3087 A longitudinal study of neurologic complications of chronic alcohol abuse associated with bone deficiency, immunodeficiency and oxidative stress S. Shkrobot, L. Milevska Ternopil, Ukraine Introduction: Alcohol abuse is a major health problem worldwide. It contributes to over 200 diseases and injuryrelated health conditions. Methods: Multivariative analysis was performed using Dual Energy X-ray Absorptiometry, immunological (CD3, CD4, CD8, CD6, CD22) and biochemical (assessment of lipid peroxidation) methods to assess factors predicting disability and neurologic complications in chronic alcohol abuse patients. Results: A total of 6 male alcoholic patients with neurologic complications were evaluated. 4.6% had chronic encephalopathy; 30.2% - chronic polyneuropathy; 37.% - chronic encephalopolyneuropathy; 8.% - chronic encephalomyelopolyneuropathy. Duration of alcohol abuse and bone mineral density had significant associations (r=-0.265) (Table ). Increasing of the neurologic complications due to alcohol abuse had also strong correlation with bone mineral density (r=-0.497). The level of lipid peroxidation was significantly increased in all alcoholic patients (p<0.05) and had correlation with duration of alcohol abuse (r=0.29) and level of bone deficit (r=-0.42). About 86.4% of chronic alcohol abuse patients with neurologic complications were diagnosed secondary immunodeficiency of cytotoxic type that had significant association with the level of bone deficiency (p<0.05). F3088 Correlation of non-motor symptoms in patients with Parkinson s disease with different H&Y Stage in the Siberian region, Russian Federation M.A. Nikitina, I.A. Zhukova, N.G. Zhukova, V.M. Alifirova, O.P. Izhboldina, A.E. Agasheva 2, E.V. Terskikh, M.A. Titova, L.M. Glotova 2, M.N. Azhermacheva Siberian State Medical University, Department of neurology and neurosurgery, Tomsk, Russian Federation, 2 Hospital 2, Tomsk, Russian Federation Background and aims: There is insufficient information regarding what are the most important neuropsychiatric symptoms in patients with Parkinson s disease (PwPD) without dementia in different PD stage. Methods and Materials: 225 PwPD (mean age: 67.8±6.4 years; mean PD duration: 6.8±4.6 years; H&Y stages 4) were screened to reveal of non-motor symptoms (NMS). Clinical assessments were studied using the UPDRS(III part), Hospital Anxiety and Depression Scale, Beck depression inventory, PD Sleep Scale, Epworth Sleepiness Scale, Apathy Scale, Questionnaire for Impulsive-Compulsive Disorders, Parkinson s Disease Questionnaire-39. Odors identification studied using Sniffing Stix Test. Four groups of H&Y Stage were studied (homogeneous by gender, age): I 2 PwPD (UPDRS 9.5±8.6), II 78 (UPDRS 28.5±6.4), III 96 (UPDRS 35.9±8.9), IV 39 (UPDRS 52.2±33.6). Results: Significant differences were found between groups in the expression of NMS: anxiety, impulsive behaviors depression prevailed in PwPD in I and II stages; depression, apathy, pathological gambling in the III; sleepiness and cognitive impairment was expressed more in the IV than at early stages. Olfactory dysfunction is the early, specific PD symptom. QoL correlated with the amount of newly appeared NMS and it s expression (p<0.0), rather than to the PD stage in cognitively intact PwPD. Conclusion: Observations show NMS variation depends on the H&Y stage in PwPD. Also revealed that the NMS have more influence on QoL in PwPD than motor deficit. This should be considered in PwPD management to correct motor and NMS. Conclusion: Key findings were that significant neurologic complications and duration of alcohol abuse play a considerable role in the development of bone deficiency, immunodeficiency and oxidative stress. Thus, this study offers insight into numerous factors for clinicians caring for alcoholic patients with neurologic complications. 205 European Journal of Neurology, 22 (Suppl. ),

243 726 Flash Posters F3089 Interaction between autonomic nervous system and pain perception in migraine population A. Popescul, O. Grosu, G. Corcea, S. Odobescu, I. Moldovanu National Institute of Neurology and Neurosurgery, Chisinau, Moldova Background and aims: The role of autonomic nervous system in acute and chronic pain states are well known. The interaction is thought to be due to baroreflex arch. It is known that pain thresholds (PT) could be modified in different conditions: migraine, hypertension, stress but are they influenced by circadian modification of blood pressure, which could be a marker of autonomic imbalance? Methods: The study sample consists of 07 patients with migraine which underwent ambulatory blood pressure monitoring (ABPM) and evaluation of mechanical PT with pressure algometry. According to European Society of Hypertension guidelines (203) the day-to-night blood pressure ratio was calculated and patients stratified in dipping categories: dipping, non-dipping and over dipping. From the analyses subjects with hypertension, obesity, sleep apnea, and diabetes mellitus were excluded. The data was analyzed with SPSS package for Windows. Results: According to ABPM results sample was divided in groups by circadian modification of blood pressure: Gr. I dipping, Gr. II non-dipping and Gr. III over dipping subjects. The PT were compared between groups. In the Gr. I PT were 407.8±90.68 kpa/cm², Gr. II 409.0± kpa/cm² and Gr. III ±04.58 kpa/cm² ( p <0.05, Gr. I/III, Gr. II/III). The results were adjusted for age, body index and mean blood pressure. Conclusion: This study shows never described results that pain thresholds are different between different dipping groups and circadian modification of blood pressure could influence pain perception system. These results should be addressed in further studies. F3090 Postural orthostatic tachycardia syndrome and spontaneous internal carotid artery dissection A. Mišmaš, B. Sitaš 2, A. Bazina, D. Ozretić 3, Z. Poljaković, M. Habek Zagreb University Hospital Centre, Neurology, Zagreb, Croatia, 2 General Hospital Našice, Neurology, Našice, Croatia, 3 Zagreb University Hospital Centre, Department of Diagnostic and Interventional Radiology, Zagreb, Croatia Background and aims: Postural orthostatic tachycardia syndrome (POTS) is a common manifestation of orthostatic intolerance. It is defined by a heart rate increment of 30 beats/min or more within 0 minutes of standing or headup tilt (HUT) in the absence of orthostatic hypotension. We present a secondary POTS caused by spontaneous internal carotid artery (ICA) dissection. Methods: The male patient with no trauma history presented with sudden onset headache, nausea, lightheadedness, right Horner syndrome and mild left arm paresis. Brain magnetic resonance (MR) imaging with MR angiography showed small acute ischaemic lesion in right parietal region with distal C and proximal C2 right ICA segment dissection and pseudoaneurysm formation. In order to occlude the pseudoaneurysm the patient was endovascularly treated with stent assisted coil placement. After one day bed rest the patient regained full ambulation still complaining of lightheadedness. Evaluation by HUT was proposed. Results: A marked increase in heart rate for more than 30 beats/min without blood pressure drop on 70 HUT confirmed POTS. Dietary measures with mobilisation resulted in complete resolution of orthostatic symptoms. The 3 months follow-up HUT showed normal findings while cerebral DSA showed persistent pseudoaneurysm filling. Conclusion: Lightheadedness is not a common symptom of anterior circulation stroke. In patients with stroke due to spontaneous ICA dissection who have orthostatic symptoms one should also consider autonomic nervous system dysfunction. 205 European Journal of Neurology, 22 (Suppl. ),

244 Flash Posters 727 F309 Epidemiology of post-traumatic epilepsy in Uzbekistan N. Tolibova, A. Prokhorova 2, S. Gazieva Tashkent, Uzbekistan, 2 Tashkent Medical Academy, Neurology, Tashkent, Uzbekistan Background and aims: The frequency of symptomatic epilepsy appears to be steadily increasing in Uzbekistan; due mainly to traumatic brain injury(tbi). The objective of the study is to assess the epidemiological and clinical characteristics of patients with post-traumatic epilepsy among Uzbek population. Methods: The study was conducted in three main hospitals in Tashkent, namely: Tashkent Medical Academy, Republican Clinical Hospital and Central Railway Hospital. Cases of active epilepsy were ascertained from medical outpatient records in those health-care institutions, and registration cards of the calls of the ambulance station. Clinical and neurological examinations were conducted by a neurologist. Electroencephalography (EEG), and in addition MRI and CT were performed in newly diagnosed cases to assist in confirming the diagnosis. Results: The results have shown that there were 228 cases of symptomatic epilepsy between 203 and 204. The most common one was TBI (26.5%), notably in males-20.8%, on average three times more frequently than in females 5.67%. TBI was most commonly seen in the age group years. More than 2 attacks per year were registered in 23.7% of patients with post-traumatic epilepsy, in 72,3% -2 attacks per year; 3% of patients were in medical remission. Monotherapy was received by 83.6% of patients. The most commonly prescribed medications were carbamazepine, benzonal, valproic acid salt, both given as monotherapy and as part of polytherapy. Conclusion: The studies have concluded that the rate of post-traumatic epilepsy among Uzbek population is still high, because international standards of examination and treatment for patients with symptomatic epilepsy are not met correctly. F3092 Risk factors of cerebral stroke among Uzbek population N. Tolibova, S. Gazieva, D. Rasulova 2 Tashkent, Uzbekistan, 2 Tashkent Medical Academy, neurology, Tashkent, Uzbekistan Background and aims: Stroke is the second most common cause of death worldwide and a leading cause of disability in adults. In Uzbekistan the incidences of cerebral strokes vary between 0.9 to.4 cases per 000 people. The mortality rate during the acute phase of stroke goes up to 35-40% ( Asadullaev M.M., 20). The objective of the study is aimed at exploring risk factors of stroke among Uzbek population. Methods: The study was conducted in three main hospitals in Tashkent, namely: Tashkent Medical Academy, Republican Clinical Hospital and Republican Emergency Care Research Center. Prestroke risk factors were obtained from patient s medical history and hospital records. Results: The results have shown that between 20 and 203 there were 2,608 cases of stroke, 53.4% of which were male, and 46.6% female. The most frequent risk factors are hypertension 72%, hypercholesterolaemia 8.4%, diabetes mellitus 7.5, past history of stroke 3.5%, TIA 7.3%, alcohol 6.%, smoking 5.4%, heart failure 3.4% and 24.7% having more than one risk factor. Hypertension and hypercholesterolaemia were common among the middle age group, while past history of stroke and multiple risk factors were more common among the elderly. Conclusion: Hypertension was found to be the most important risk factor for stroke among our study population. Public enlightenment on the importance of early detection of hypertension and adherence to antihypertensive medications will go a long way in reducing the morbidity and mortality associated with stroke in our environment. 205 European Journal of Neurology, 22 (Suppl. ),

245 728 Flash Posters Cerebrovascular diseases 5 F3093 Cognitive profile of patients with cognitive impairment due to small vessel disease P. Radić, B. Radić 2, N. Klepec 2, L. Unusic 2, J.M. Poje 3 University of Zagreb, School of Medicine, Zagreb, Croatia, 2 University Hospital Center Zagreb, Department of Neurology, Zagreb, Croatia, 3 General Hospital Koprivnica, Department of Neurology, Koprivnica, Croatia Background and aims: Cerebral small vessel disease (SVD) is one of the major causes for cognitive impairment. Unlike typical vascular dementia, the majority of mild cognitive impairment (MCI) due to SVD exhibits a relatively insidious onset, with gradual cognitive deterioration that mimics MCI due to Alzheimer s disease (AD). However due to pathophysiology of SVD it is supposed that this group of patients display predominantly frontal-subcortical cognitive features with poor performance on executive functions and mental processing speed. Methods: 5 patients with the diagnosis of SVD MCI (9 males and 6 women) and 8 patients with MCI AD ( females, 7 males) were included in the study. Battery of computerized cognitive tests assessing attention, frontal functions (rivers naming), memory (Word list learning) and working memory (Stenbeerg test) was performed. Results: Patients with the diagnosis of MCI due to SVD performed significantly better than patients with MCI due to AD on tests of visual and verbal memory (p<0.05). In test of attention, working memory and frontal functions patients with MCI duo to SVD performed worse than patients with MCI duo to AD Conclusion: Our results revealed extensive cognitive deficits in patients with MCI due to SVD. This was most prominent in the domain of executive functions and mental processing speed while verbal memory was relatively preserved. Cognitive profile differs between AD and small vessel disease and cognitive testing should be performed to distinguish these two groups of patients. F3094 The role of depression and anxiety - neurotic disorders during ischemic stroke N. Rashidova, K. Khalimova, N. Mukhamedov 2 Tashkent Medical Academy, Neurology, Tashkent, Uzbekistan, 2 Tashknt medical academy, Neurology, Tashkent, Uzbekistan Background and aims: Known that combined stroke and depression increases the risk of death in patients compared with patients without depression. Purpose: Study the role of antidepressants in the treatment of depression and anxiety and neurotic disorders in ischemic stroke. Methods or Materials or Case Report: We observed 95 patients with stroke with mild and moderate form of depression. Age of patients ranged from 55 to 70 years (average 60.5±3.5 years). Among them, were 44 male (46.3%), 5 female patients (53.6%). All patients were assigned pathogenetic therapy depending on the etiology of stroke and paroxetin (Rexetin) 20mg 2 times a day. The course of treatment was 3 months. To assess the level of anxiety and depression were conducted neuropsychological tests. Results: As a result of treatment rexetin significantly improved the condition of patients in the first week of treatment. There was a decrease in feelings of lump in the throat, anxiety, attacks of breathlessness, shortness of breath, normal sleep, increase of intellectual activity and performance. Before treatment, the average score on the Hamilton scale was 9.0±3.0, after treatment showed a significant improvement-0.0±3.0. The scale of Spielberg-Khanin showed that patients treated with rexetin after 3 months of treatment decreased personal and reactive anxiety by 22% and 3%, respectively. Conclusion:. Depression and anxiety-neurotic disorders worsen during ischemic stroke. 2. Rexetin is a drug of choice in the treatment of patients with ischemic stroke with anxiety and neurotic disorders, which reduces these symptoms of anxiety at 74.2% and give positive effect on cognitive function in patients. 205 European Journal of Neurology, 22 (Suppl. ),

246 Flash Posters 729 F3095 Vascular endothelial growth factor as marker of angiogenesis in ischemic stroke K. Rasulova, F. Inoyatova 2, Y. Madjidova, B. Daminov Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan, 2 Tashkent Medical Academy, Tashkent, Uzbekistan Background and aims: Controlled vascular growth is critical for successful tissue regeneration and wound healing, as well as for treating ischemic diseases such as stroke, heart attack or peripheral arterial diseases. Direct delivery of angiogenic growth factors has the potential to stimulate new blood vessel growth, but is often associated with limitations such as lack of targeting and short half-life in vivo. The purpose of study was to identify features of angiogenic mediator vascular endothelial growth factor (VEGF) expression in blood serum of patients with ischemic stroke. Methods: The study was based on analysis of blood serum from 35 patients with ischemic stroke (26 women and 6 men) and 20 volunteers (control group, 0 men and 0 women) aged from 3 to 80 years old (mean age 58.6±6.2 years). For immunohistochemical studies were used monoclonal mice antibodies to vascular endothelial growth factor (VEGF; Novostra, the titer of :00). Results: Immunological study has revealed positive reaction with antibodies to VEGF in all specimens of patients in the control group. In patients with ischemic stroke VEGF level reduced on 53.6%. Conclusion: Thus, the analysis of our data shows that reduction of growth factor VEGF is the important factor in the pathogenesis of ischemic stroke and could be the underlying mechanism for relapses of the disease. F3096 Analysis of proteinuria as a method of prognostication of stroke outcome K. Rasulova, B. Daminov, Y. Madjidova Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan Background and aims: To study proteinuria in stroke patients in dynamics to predict poor outcomes. Methods: The study included 200 patients with acute stroke (50 with ischemic stroke, 50 with hemorrhagic stroke). We carried out standard methods of diagnosis (neurological examination, CT and/or MRI). The level of consciousness was evaluatted on Glasgow scale, severity of neurological deficit by Original and Scandinavian scales. To assess kidney function was conducted urinalysis, determined glomerular filtration rate using MDRD. However, to predict the outcome of stroke we investigated proteinuria by qualitative (using a 20% solution of sulfosalicylic acid) and quantitative (50% solution of nitric acid) method. Urinalysis performed on admission of the patient to the clinic, in the dynamics at 7, 4, 2 days and 3 months after stroke onset. Results: In allowable values of proteinuria (0.033g/l) or mild proteinuria (0.5g/l) without any marked changes of urea and creatinine in blood in mild to moderate functional deficit we marked favorable prognosis, at moderate to vigorous proteinuria ( g/l) in moderate or severe functional deficit was the risk of early and late complications, and at massive proteinuria (>0g/L) we observed poor prognosis for life. Conclusion: Thus, study the level of protein in the urine of patient after the stroke in dynamics is a simple, non-invasive and cheap method for predicting the outcome of stroke and could be able to predict poor functional outcome, taking into account the severity of neurological deficit. 205 European Journal of Neurology, 22 (Suppl. ),

247 730 Flash Posters F3097 Cerebro-cardio-renal dysfunction in ischemic stroke patients K. Rasulova, B. Daminov, Y. Madjidova Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan Background and aims: In this study, we analyzed frequency and predictors for impaired renal function and its impact on functional outcome in cardioembolic stroke patients with cardioembolic stroke. Methods: We prospectively analyzed 27 patients with acute first-ever ischemic stroke of cardioembolism genesis aged 63.82±4.68 years (48.% men and 5.8% women). In anamnesis, myocardial infarction was in 4 patients, atrial fibrillation was in 2 patients (of them, constant form in 7 patients), dilatatory cardiomyopathy was in 4 patients. Estimated glomerular filtration rate (egfr) was calculated on admission and during hospitalization from the equation of the Modification Diet for Renal Disease. Outcome measures included mortality and functional outcomes at 3 months after stroke, assessed as modified Rankin Scale (mrs) score. Results: On admission, cerebro-renal dysfunction was found in 40.7% (n=) and was associated with worse 3-month outcome (mrs score 2: 25.9% versus 44.4%, P=0.00) and a higher mortality rate (22.2% versus 4.8%, P=0.043). Multivariate logistic regression identified older age and history of myocardial infarction as independent predictors of renal dysfunction on admission (P<0.05), especially in women. Normalization of egfr during hospitalization was achieved in 55.6%. Conclusion: In patients with cerebro-renal dysfunction due to acute cardioembolic ischemic stroke on admission is frequent and associated with worse outcome. Normalization of egfr can often be achieved during hospitalization, but in everyday life, fluctuations of renal function because of infection or dehydration have to be considered. Careful monitoring of cerebro-renal status is indispensable and should influence drug treatment decisions. F3098 Cerebrovascular diseases in Lyme neuroborreliosis S. Richard, B. Wittwer, S. Pelletier 2, K. Lavandier 2, J.-C. Lacour, G. Mione, L. Maillard, X. Ducrocq CHU Nancy, Neurology, Nancy, France, 2 CH Bar-le-Duc, Stroke Unit, Bar-le-Duc, France Background and aims: Cerebrovascular diseases in neuroborreliosis are a rare condition described only in isolated or small case series. No specific clinical or radiological features have been identified and diagnosis is based on very different criteria. Methods: We retrospectively describe cases diagnosed in the stroke unit of Nancy Hospital, located in the endemic area of the north-east of France. We also reviewed other cases found in the literature. Results: We identified five cases in our centre and 44 other reported cases. Mean age was 4 years (range 5 to 77). Possible previous contact with Borrelia burgdorferi (Bb) was found in about half of cases. Additional neurological symptoms (headache, cognitive impairment, and/or gait disturbance) were found in 40% of cases. Cerebral imaging revealed both ischemic (86%) and hemorrhagic lesions (4%) with a multiterritorial aspect in 26% of infarctions, and signs of vasculitis in 57%. Analysis of cerebrospinal fluid (CSF) revealed lymphocytic meningitis in 88% of cases and elevated protein level in 84%. CSF/serum anti-bb antibody index (AI) was positive in 74% of cases. Outcome was favourable after appropriate antibiotic treatment. Our 5 patients presented a modified Rankin score scale 0-, without any stroke recurrence, after a median follow-up of 2.8 years. Figure : Brain magnetic resonance imaging showing multiple ischemic lesions in both thalami, right lentiform nucleus and right caudate nucleus on fluid-attenuated inversion recovery imaging (a), and T images 3-mm thick axial with gadolinium Figure 2: Brain magnetic resonance imaging with axial T sequence with gadolinium showing diffuse meningeal and perivascular enhancement (a) vanished 3 weeks after antibiotherapy by ceftriaxone (b). Figure 3: T2*-weighted gradient-recalled echo resonance imaging showing multiple micro-bleeds in the mid-brain (a), medulla oblongata and anterior cervical spinal cord regarding C2-C3-C4 (b). Conclusion: For patients with cerebrovascular events without obvious cause living in endemic area, diagnosis should be considered in presence of repeat multiterritorial strokes at short intervals, other neurological symptoms, history of Bb infection and radiological aspect of vasculitis. Diagnosis can be confirmed by CSF analysis with AI but with incomplete sensitivity. 205 European Journal of Neurology, 22 (Suppl. ),

248 Flash Posters 73 F3099 Nontyroidal illness syndrome (NTIS) in acute ischemic stroke F. Ros Forteza, L. Cacho Gutiérrez University of Salamanca, Stroke Unit, Guarda, Portugal Background and aims: The Nontyroidal illness syndrome (NTIS) or low T3 low T4 syndrome is a state of adaptation or dysregulation of thyrotropic feedback control. There are few studies that relationship the NTIS in the Acute Ischemic Stroke (AIS). Methods: 354 patients with AIS were included to our Stroke Unit in the last 2 years. It was selected two subgroups: 98 normothyroid patients and 75 NTIS patients. To analyze the differences for the studied variables among two subgroups of stroke: normothyroid and NTIS. The following variables were analyzed: gender, age, vascular risk factors, NIHSS scale, OCSP classification, previous TIA, global thyroid profile, lipid profile, uric acid, NT pro-bnp, CRP, ESR (erythrocyte sedimentation rate), and mortality. There were excluded factors that interfere with thyroid function. Statistical analysis: Chi-square, ANOVA and Tukey. Results: The NTIS was observed in a 2,2% of patients with acute ischemic stroke. Statistically significant differences were found between the two subgroups of stroke for the following variables favoring NTIS subgroup: gender (man), age (older), scale NIHSS, TACI territory, previous TIA, LDL-cholesterol, NT pro-bnp (higher values) and mortality (higher rate). Conclusion: The routine global thyroid profile determination in the first week of acute ischemic stroke can provide information on the course and prognosis of stroke. NTIS can be considered a marker of bad prognosis in the AIS. Then, it can be created a model of prognostic stratification dependent of free T3 values at admission. Further studies, namely cohort studies, will be needed to elucidate the role of thyroid function in AIS. F300 Prior statin use was associated with less favorable 3-months outcome in patients treated with intravenous thrombolysis after acute ischemic stroke M. Rubinic Majdak, V. Vuletic, S. Basic University Hospital Dubrava, Neurology, Zagreb, Croatia Background and aims: Intravenous thrombolysis has been shown efficacious and safe for acute stroke treatment. The aim of our research was to determine the influence of prior statin use on 3-month outcome after acute ischemic stroke treated with intravenous thrombolysis (IVT). Methods: 72 patients with ischemic stroke who were treated with intravenous thrombolysis between December 2008 and June 204 were included in our study. 3-month outcome was assessed by the modified Rankin Scale (mrs) Score. Favorable outcome at 3 months was defined as a modified Rankin scale score 2. 3-month global outcome, age and risk factors of statin users were compared to statin non users. Results: Of 72 thrombolized patients, 33 (9%) patients were statin users and 39 (8%) were non users. Statin users were on average 6 years older. History of hypertension, diabetes mellitus, atrial fibrillation and prior stroke were more often in statin users. History of smoking, alcholism and carotid stenosis were more often in non users. These differences were statistically significant only for diabetes mellitus (39% vs. 9%, p=0.0) and prior stroke (27% vs 9%, p=0.05). Favorable outcome at 3 months had fewer statin users than non users (30% vs. 48%, p=0.0). Conclusion: Thrombolysed patients which were prior statin users have less favorable outcome. The prognostic meanings of several baseline variables may contribute to this findings. F30 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

249 732 Flash Posters F302 A follow-up pilot study of the clinical and imaging pattern in patients with cryptogenic stroke N. Salari, E. Manole State University of Medicine and Pharmacy N. Testemitanu, Neurology, Chisinau, Moldova Background and aims: To initiate the first follow-up pilot institutional study in Moldova of the clinical and imaging pattern in patients with ischemic stroke with undetermined cause. Methods: A prospective follow-up study was started in 203. From 684 patients (mean age 67.7 years) with ischemic stroke there were 33 patients selected with ischemic stroke with unidentified cause (7 women and 6 men) mean age 44 years. At admission the work-up included neurological examination, cerebral CT/MRI, blood investigations, coagulation tests, Holter-ECG, Doppler ultrasound examination of the precerebral arteries, transthoracic echocardiography. Epi Info statistical package was used. Results: From 33 patients, 5 patients had a recurrent ischemic stroke. Imaging findings showed infarct within the posterior circulation (33.3%), superficial infarcts - 9 (27.3%), deep brain ischemia 7 (2.2%), infarct larger than one half of the cerebral hemisphere - 6 (8.2%). Risk factors found: hypertension 4,, non-stenotic carotid atherosclerosis 2, obesity 2, smoking (>5 years) 7, diabetes 6, paroxysmal atrial fibrillation (>30 seconds) - 2, migraine 2, hyperhomocysteinemia 2, deep vein thrombosis 2, antiphospholipid antibody syndrome, interatrial aneurism -, connective tissue disorder -. Patients with no risk factor 4. Conclusion: The percentage of patients with cryptogenic stroke was 4.82%. It was noticed the prevalence of young age between patients with ischemic stroke with undetermined cause. The most frequent imaging findings were infarct within the posterior circulation (33.3%) and superficial infarcts (27.3%). F303 Clinical case presentation of a young patient with cerebral amyloid angiopathy N. Salari, E. Manole State University of Medicine and Pharmacy N. Testemitanu, Neurology, Chisinau, Moldova Background and aims: Cerebral amyloid angiopathy is responsible for 0% of non-traumatic cerebral haemorrhages, but still remains in the shadow when the etiological factors of the cerebral haemorrhages are being searched. In terms of imaging, the disease is presented by limited microhemorrhages in the cortical or cortico-subcortical areas. Case Report: A male patient, aged 43, with 2 years history of high blood pressure and year history of diabetes mellitus was examined. Ocular-motility disorders, bilateral pyramidal failure, mild cerebellar disorders, mild cognitive disorders and neuroimaging changes were noticed. The patient refused brain biopsy. Results: The imaging examination (cerebral MRI 3T) of the patient revealed cerebral microhaemorrhages with different localizations, characteristic for cerebral amyloid angiopathy and hemorrhages caused by high blood pressure and diabetes mellitus. In behalf of cerebral amyloid angiopathy plead the lobar cerebral and cerebellar localisation of the microhemorrhages, the temporal cerebral hematoma, the cognitive disorders and the e2/e2 genotype of apolipoprotein E. The Boston criteria delineates a greater age than 55 years, but the literature data describe cases of CAA at younger people, morphologically confirmed. Conclusion: In case of parenchymal hemorrhages in young adults, one of the risk factors that needs to be looked for is the cerebral amyloid angiopathy. The cerebral amyloid angiopathy needs to be taken into consideration in each patient presenting with lobar parenchymal hemorrhages, regardless age. 205 European Journal of Neurology, 22 (Suppl. ),

250 Flash Posters 733 F304 Posterior variant of alien hand syndrome as a manifestation of a dominant hemisphere stroke P. Salgado, J.M.M. Chaves, M. Magalhães, C. Correia Hospital Santo António, Centro Hospitalar do Porto, Neurology, Porto, Portugal Background and aims: Posterior variant of alien hand syndrome (AHS) is a rare entity caused by temporal disorders that usually affects the non-dominant hemisphere. Although the anterior variant of AHS may be dependent on acute focal lesions such as stroke, the posterior variant is mainly associated with neurodegenerative disorders such as corticobasal syndrome. Here we present a case of posterior variant of AHS as a stroke manifestation. Case Report: A 74-year-old right-handed man, with known vascular risk factors, suddenly developed, after a sneeze, a subjective sensation that his right hand looked strange, like it wasn t his own, and also felt some difficulty in controlling its movements. No additional symptoms, namely weakness or involuntary movements were present, and these changes were noted only in the hand. The symptoms lasted less than twelve hours. His neurological exam was normal. Results: Cerebral magnetic resonance imaging (MRI) showed multiple cortical areas of abnormal hyperintensity on diffusion-weighted imaging (DWI) located on the left pre- and mainly postcentral gyrus, superior parietal lobe and posterior side of cuneus, corresponding to acute infarction in the distal territory of the left middle and posterior cerebral arteries. Paroxysmal atrial fibrillation was confirmed by 24h ECG and oral anticoagulants were introduced. The patient remains asymptomatic. Conclusion: AHS can occur with lesions of the dominant hemisphere and can also be the first and only manifestation of stroke. In this case, DWI- MRI was essential to identify the posterior variant of AHS, its cause and also the probable stroke etiology, thus directing the etiological investigation. F305 Intraventricular hemorrhage and recurrent superficial siderosis in a patient previously submitted to neurosurgical intervention A.F. Santos, J. Mota 2, R.J.P. Maré, J. Pinho, R. Almeida 3, C. Ferreira Hospital de Braga, Neurology, Braga, Portugal, 2 Hospital de Santa Maria Maior - Barcelos, Internal Medicine, Barcelos, Portugal, 3 Hospital de Braga, Neurosurgery, Braga, Portugal Background and aims: Superficial siderosis (SS) is an uncommon slowly progressive disease, characterized by hemosiderin deposition from repeated bleeding in subarachnoid space. The underlying causes have been reported in about 65% of the disease. Current/previous CNS tumors are the most common cause (2%). Post surgical changes related to neurosurgeries are other reported cause (7%). Case Report: A 67-year-old woman, with previous meningioma surgery (2000) and hypertension, was admitted in 2005 with drowsiness, motor dysphasia and right abducens nerve palsy. Brain MRI: dilated lateral ventricles (left predominance) with liquid content. Cerebral angiography: no fistulas, arteriovenous malformations, aneurysms. Laboratory studies (including infectious serology, immunologic studies, tumor markers): negative. Lumbar puncture: opening pressure>50 cmh2o, 62 cells, erythrocytes, normal proteins and glucose, virological and microbiological negative. Ceftazidime, acyclovir and corticotherapy had been started with rapid clinical improvement, so treatment was continued although intraventricular liquid was identified as blood. At discharge neurological examination was normal. In 202 admitted with transient dysphasia, right quadrantanopsia and right hemiparesis. MRI: supra and infratentorial SS. EEG: paroxysmal activity (left frontotemporal). Phenytoin was started. In 204 admitted with dysphasia, left abducens nerve palsy and right hemiparesis. Brain CT: left hemispheric edema and intraventricular hemorrhage. Corticosteroids were started with rapid clinical improvement. Control MRI maintained evidence of hemosiderin deposition. Conclusion: Clinical presentation may be determined by SS. This may have been initially secondary to neurosurgery and perpetuated by intraventricular hemorrhages. We speculate that there might be a form of positive feedback by which siderosis causes choroid plexus congestion and intraventricular repeated bleeding. 205 European Journal of Neurology, 22 (Suppl. ),

251 734 Flash Posters F306 Cerebral venous sinus thrombosis revealing hypercoagulability related to hyperhomocysteinemia in a patient with marfanoid phenotype M. Santos, J.R.L.D.M. Marques 2, M.C.M. Costa Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal, Department of Neurology, Amadora, Portugal, 2 Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Portugal, Department of Neurology, Lisbon, Portugal Background and aims: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke which can be related to hypercoagulability states or infections. Homocystinuria is an hereditary disorder of methionine metabolism that can present with cognitive defect, ectopia lentis, marfanoid features and premature thrombotic events. Case Report: A 44-year-old man with a previous history of ectopia lentis and glaucoma was admitted to the hospital with depression of consciousness and seizures. MRI (with venogram) revealed an acute thrombosis in the right lateral and superior saggital sinus, subacute thrombosis in the right sigmoid sinus, bilateral frontal parasaggital venous infarcts and bilateral mastoiditis. White blood cell count was 0.9x03/μL and C-reactive protein 2.20mg/dL. Cerebrospinal fluid analysis disclosed pleocytosis (40/uL), elevated protein concentration (84.9mg/dL), with negative bacteriological examination. Hypocoagulation, sodium vaproate and ceftriaxone were started. Clinical examination revealed baldness, pectus excavatum, kyphosis, scoliosis, long limbs, a multimodal cognitive impairment and left hemiparesis. Prothrombotic screening showed hyperhomocysteinemia (>50μmol/L), not reduced by a pyridoxine loading test. There was resolution of focal signs. Genetic analysis confirmed a mutation in the cystathionine betasynthetase gene (compound heterozygosity: p.i278t [c.833 T>C] and p.g35r [c.05 G>C]). Despite treatment with pyridoxine, cyanocobalamin, folic acid and dietary recommendations, the patient died two years later of an acute myocardial infarction. Homocystinuria phenotype Conclusion: The authors present a case of CVST revealing hyperhomocysteinemia, which had not been diagnosed despite the patient s phenotype and treated ocular disorder. Recommended therapy consists of a specific diet and vitamin supplementation, which are not always effective in controlling homocysteine levels. CVST and homocystinuria - MRI 205 European Journal of Neurology, 22 (Suppl. ),

252 Flash Posters 735 F307 Primary angiitis of the central nervous system presenting with a single focal hemorrhagic lesion M. Santos, J. Pimentel 2, M.C.M. Costa Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Department of Neurology, Amadora, Portugal, 2 Hospital de Santa Maria do Centro Hospitalar de Lisboa Norte, Laboratory of Neuropathology (department of Neurology), Lisbon, Portugal Background and aims: Primary angiitis of the central nervous system (CNS) is a rare disorder which can present with headache, cognitive impairment, focal deficits, transient ischaemic attacks (TIA) or stroke and brain parenchymal hemorrhage (% of cases). A positive angiography or biopsy and the exclusion of systemic vasculitis are required for the diagnosis. Case Report: A 37-year-old African woman was admitted to the hospital with focal motor seizures (right hemisphere) which started six hours after waking up with a left lower limb sensory-motor deficit. She referred loss of appetite, generalised myalgias and pulsatile holocranial headache of two months duration. Brain CT disclosed a right intra-axial fronto-parietal hemorrhagic lesion. Sedimentation rate was 78mm and hemoglobin 8.7g/dL (without leukocytosis or elevated C-reactive protein). MRI showed the hemorrhagic lesion, surrounded by vasogenic edema, with heterogeneous contrast enhancement. After pharmacological control of seizures, neurological examination disclosed flaccid left hemiparesis (grade 2), apalesthesia and agrafestesia in the left limbs. Cerebrospinal fluid cytochemical and cytology analysis were normal. Screening for infectious diseases (blood, CSF, echocardiogram) or primary neoplasm outside the nervous system were negative. After another inconclusive MRI (with spectroscopy), a brain biopsy showed a non-granulomatous, non-necrotic vasculitis associated with hemorrhage. Digital brain angiography and investigation for systemic vasculitis were negative. Under corticoid treatment there was complete clinical resolution. After 8 months, the patient is under azathioprine and the neurological examination is normal. CT and MR imaging Brain biopsy Digital angiography Conclusion: The authors describe a case of primary CNS vasculitis presenting as a single brain hemorrhage, which, by its rarity, constituted a particular diagnostic difficulty. 205 European Journal of Neurology, 22 (Suppl. ),

253 736 Flash Posters F308 Limb-shaking transient ischemic attacks treatment pitfalls T. Santos, J. Nunes 2, H. Felgueiras, A. Martins-Campos, H. Morais, P. Barros Centro Hospitalar Vila Nova de Gaia/Espinho, Neurology, Vila Nova de Gaia, Portugal, 2 Centro Hospitalar Vila Nova de Gaia/Espinho, Imaging, Vila Nova de Gaia, Portugal Background and aims: Limb-shaking transient ischemic attacks (TIAs) are a hallmark of hemodynamic compromise underlying a severe internal carotid artery (ICA) stenosis/ occlusion. Although it is estimated to increase significantly the stroke risk, the best treatment is unknown. Case Report: 79-year-old male, refers multiple transient episodes of involuntary and irregular wavering movements involving right limbs simultaneously that started three months ago and became more frequent in the last week. These episodes are invariably triggered by rising from sitting/lying position, usually lasting 5 minutes and are often accompained by ipsilateral weakness. Medical history of arterial hypertension, diabetes, stroke and coronary/peripheral arterial diseases. Neurologic examination: right spastic hemiparesis (grade 4+) and osteotendinous hyperreflexia. Results: Brain CT-scan: left-hemispheric borderzoneshapped recent parietal and frontal infarcts. Doppler ultrassonography: left post-bulbar ICA occlusion and <50% right ICA stenosis. CT-angiography confirms the occlusion, revealing patency of the distal ICA upstream the ophthalmic segment; suggests the absence of anterior and left posterior communicating arteries and defines a 65-70% right proximal ICA stenosis. MRI-perfusion study discloses reduced cerebral blood flow and increased mean transit time in left hemisphere, suggesting inadequate collateral compensation. Conclusion: Limb-shaking TIAs/ICA occlusion increases the stroke risk. The recent Carotid Occlusion Surgery Study failed to prove superiority of ECA-ICA (superficial temporal-middle cerebral arteries) bypass surgery over medical therapy on stroke recurrence. So, in a patient with ICA occlusion and signs of perfusion failure, the medical treatment remains our only weapon, despite a dreadful stroke recurrence rate of 22%. ICA occlusion is a serious condition with limited/ineffective treatment options, demanding for new clinical research. 205 European Journal of Neurology, 22 (Suppl. ),

254 Flash Posters 737 Motor neurone diseases F309 Extrapyramidal and cognitive signs in amyotrophic lateral sclerosis E. Beghi & EURALS Consortium IRCCS - Istituto Mario Negri, Neuroscience, Milan, Italy Background and aims: While clinical, pathological and genetic overlap between amyotrophic lateral sclerosis (ALS) and fronto-temporal dementia (FTD) is well-known, the association with Parkinson s disease (PD) is based on case reports or small series, and data are inconsistent for Alzheimer s disease (AD). In this study, we aimed to assess the association between ALS and AD, FTD and PD. Methods: We investigated 46 patients with newly diagnosed ALS and 46 age and sex-matched controls (affiliates of local general practitioners). Each individual was screened for extrapyramidal signs and cognitive dysfunction (Minimental State Examination, MMSE and Frontal Assessment Battery, FAB). Results: Rigidity was present in 8.2% of cases and 2.0% of controls (adjusted Odds Ratio, adjor 5.7; 95% confidence interval, 95%CI ). The percentages for bradykinesia and postural instability were 8.2 vs. 2.7% (adjor 4.8; 95%CI.4-6.5) and 2.7 vs. 9.6% (p=0.03; adjor 0.3; 95% CI ). FAB 2 was recorded in 24.8 vs. 9.6%; adjor 2.9; 95%CI.5-5.7). Tremor and abnormal FAB score were predicted by an older age at onset while an abnormal FAB score was associated with cramps and family history of AD. Conclusion: Newly diagnosed ALS carries a higher than expected risk of extrapyramidal signs and FTD. EURALS Consortium: Pupillo E, Bianchi E, Messina P, Chiveri L, Lunetta C, Corbo M, Filosto M, Lorusso L, Marin B, Mandrioli J, Riva N, Sasanelli F, Tremolizzo L, Vitelli E, Leali N, Maestri E, Perini M, Cotelli MS, Comi M, Tavernelli F, Perrone P, Ceroni M, Alvisi E, Cereda C, Buzzi P, Galbussera A, Vertuè GL, Monticelli ML. Disclosure: Study supported by the Italian Ministry of Health (grant RFPS ) and the European Community s Health 7th Framework Programme (grant agreement ) F30 Epidemiology and clinical features of ALS in Iran R. Boostani, B. Khazaee Masshad University of Medical Sciences, MASHHAD, Iran Background and aims: Few studies could be found in the literature on the epidemiology and clinical description of ALS in Middle East hitherto, with one from central Iran (Isfahan ). Methods: MND and ALS out/inpatients-according to EL Escorial criteria-of Khorasan province s sole neurologic center which is also the neurologic referral center of northeastern Iran were identified. Results: Among 7 identified patients, 59 had definitive diagnosis and entered the study. 64.4% male vs. 35.6% female with a significant distribution (ratio:.8- p: 0.027). 86.2% lived in urban areas. Mean age was 5.2y (SD: 3.25); mean age of onset: 47.7y (SD: 4.4) and mean symptom onset to diagnosis:.7m (SD: 8.4). 0 patients (6 alive and 4 dead) had tracheostomy with mean symptom onset-tracheostomy interval of 39.8m and mean total duration of 5.3(among the dead). Merely symptomatic sensory, cognitive and sphincteric involvement non-attributable to other causes were present in 0%, 0% and 4.5%. 9 patients were dead and their mean disease duration was 53.m (SD: 84.6). There was a significant difference in disease duration among the dead (p:.042) between 2 age of onset groups whereas none were found in gender, presentation type and onset UMN/LMN pattern. Conclusion: Mean age in our study was less than and clinical pattern was similar to most previous studies. Sex distribution was significant and there was a significant difference between disease duration among the dead and age group, symptom onset- diagnosis interval and symptom onsettracheostomy interval. 205 European Journal of Neurology, 22 (Suppl. ),

255 738 Flash Posters F3 Picc line as an alternative to gastrostomy in amyotrophic lateral sclerosis patients at advanced stages R. Juntas-Morales, N. Pageot 2, W. Camu 3 CHU Gui de Chauliac, ALS center, Montpellier, France, 2 CHU Gui de Chauliac, ALS center, Montpellier, France, 3 Montpellier, France Background and aims: Gastrostomy is performed in ALS when dysphagia is severe or when weight loss is significant but in some cases it cannot be performed or may raise some concerns mainly when respiratory insufficiency is severe. Peripherally inserted central venous catheter (Picc line) is a potential alternative for patients nutritional support and it s use has not been described to date in ALS patients. Methods: All patients files from our ALS center since 202 were reviewed and the outcome of those patients with gastrostomy or with Picc line catheters were compared. Results: 25 ALS patients with Picc line and 42 with gastrostomy (mainly radiologically inserted) were identified. Picc line was performed because of: failure of gastrostomy procedure (two cases), severe respiratory insufficiency (23 cases). At the time of the procedures, ALS duration was 32 months with Picc line vs 24 for gastrostomy, p=0.03. Mean delay to death was 4 months for picc line and 9 months for gastrostomy (p=0.002). In the Picc line group, 2 patients had venous thrombosis and 3 had sepsis. In the gastrostomy group, 23 had at least one complication (peristomal infection, bowel obstruction, diarrhea, nausea, inadvertent tube removal). Conclusion: Both procedures appeared safe and no immediate complication was noted. Nethertheless although less severe, complications were more frequent with gastrostomy (23 out of 42, vs 5 out of 25 for Picc line). Delay to death is shorter with Picc line as patients who underwent this technique have a much more advanced stage with severe respiratory insufficiency. F32 Mesenchymal stem cell (MSC) transplantation in patients with amyotrophic lateral sclerosis: phase I/II clinical trial A. Czaplinski, J. Wojtkiewicz 2, T. Siwek 2, A. Habich 2, M. Barczewska 2, W. Maksymowicz 2 Neurozentrum Bellevue, Neurology, Zurich, Switzerland, 2 UWM University Olsztyn, Neurology and Neurosurgery, Olsztyn, Poland Background and aims: To evaluate the safety, tolerability and therapeutic effects of transplanting mesenchymal stem cells (MSC) cells into ALS patients. Methods: patients affected by early stage or progressive ALS were transplanted intrathecally with MSC cells. In order to estimate the individual disease progression rate in ALSFRS score for each study participant before transplantation, the patients had a six months period of natural history observation. After transplantation each patient have been examined every two months using ALSFRS. The individual mean rate of change in ALS-FRS pre- and posttransplant has been calculated. Results: No serious side effects of the procedure and no detrimental effects on neurological function were reported. For the entire group (n=) no difference in the mean rate of change in ALSFRS has been observed (p=0.2). While there was no functional improvement over-time following MSC transplantation for the entire group, in a responders group (n=7) a statistically significant decrease in the mean rate of change in ALSFRS has been found (p<0.05). Conclusion: Intrathecal administration of autologous bone marrow- derived MSCs into ALS patients is feasible and safe. No clinical benefits were evident for the entire patients group (n=). However, there was a significant decrease in a mean rate of change in ALSFRS score following intrathecal treatment with MSCs in a responders group (n=7). There were no obvious clinical or demographic differences between responders and non- responders groups. In most patients from the responders group the beneficial effect was evident only during the first 4-6 months after transplantation suggesting a need for a repeated transplantation. 205 European Journal of Neurology, 22 (Suppl. ),

256 Flash Posters 739 F33 A case of facial onset sensory and motor neuronopathy (FOSMN) associated with TDP-43 proteinopathy S. Jaiser, J. Attems 2, T. Williams Royal Victoria Infirmary, Department of Neurology, Newcastle upon Tyne, United Kingdom, 2 Royal Victoria Infirmary, Department of Pathology, Newcastle upon Tyne, United Kingdom Background and aims: FOSMN involves a generalised sensori-motor neuronopathy of caudally decreasing severity. Following the recent description of a case with prominent TDP-43 pathology, we describe a further case with TDP-43 positive inclusions and discuss inferences regarding aetiology. Case Report: A 62-year-old man presented with diminished perioral sensation as well as weakness, fasciculation and cramps in his arms, which had developed over three years. For one year, he had also noted progressive dysarthria, dysphagia and weight loss of 7kg. Examination demonstrated decreased sensation in all divisions of the trigeminal nerve bilaterally, with absent corneal reflexes. The tongue was atrophic, fasciculating and weak. Periscapular muscles were bilaterally wasted and fasciculation was evident throughout the upper limbs. Power was normal throughout, reflexes were briskly preserved and plantar responses were flexor. Blood tests (including anti-ganglioside antibodies and genetics for Kennedy s disease), cerebrospinal fluid analysis, motor evoked potentials, and MRI of brain and cervical spine were normal or negative. Serial EMG showed increasingly widespread neurogenic changes; no neuropathy was detectable on conduction studies. The patient died three years after presentation. Post-mortem revealed loss of anterior horn cells (AHCs) throughout the spinal cord with remaining AHCs showing prominent TDP-43 positive inclusions but no Bunina bodies. Less prominent TDP-43 pathology was seen in the trigeminal sensory and hypoglossal nuclei. The corticospinal tract was normal. Conclusion: Our finding of TDP-43 pathology in a case with clinical FOSMN adds weight to the suggestion that it is part of the spectrum of motor neuron disease-like TDP- 43 proteinopathy syndromes. F34 Abstract cancelled F35 Serum Irisin levels and metabolic state in amyotrophic lateral sclerosis C. Lunetta, A. Lizio, L. Tremolizzo 2, P. Magni 3, M. Ruscica 3, C. Macchi 3, E. Maestri, B. Morlotti 4, V. Sansone Fondazione Serena Onlus, NEuroMuscular Omnicentre, Milan, Italy, 2 Monza (MI), Italy, 3 University of Milan, Department of Pharmacological and Biomolecular Sciences, Milan, Italy, 4 Ospedale Niguarda Ca Granda, Centro Dislipidemie, Milan, Italy Background and aims: Amyotrophic Lateral Sclerosis (ALS) is often associated to a decline in nutritional status that appears to be an independent prognostic factor of survival. Muscle tissue is able to release a variety of cytokines (or myokine) among which Irisin that seems to be implicated with regulation of body weight, metabolism, and development of the nervous system. Up to now none has ever investigated the relationship between metabolism in ALS patients and Irisin. Objectives: To evaluate serum Irisin level in ALS patients compared with healthy subjects (HS); to compare serum Irisin level with metabolic state and other clinical and biochemical features of ALS patients. Methods: We performed an observational, cross-sectional study in 50 ALS patients and 32 HS matched for age and gender. ALS patients underwent complete neurological, nutritional and pulmonary evaluations. Serum Irisin concentration was measured using an Enzyme Immunoassay Kit. Results: ALS patients showed a higher serum Irisin level compared to HS (5.03±37.84 vs 3.4±2.24, p<0.000). Patients with both hypometabolic and hypermetabolic states were associated with higher Irisin level compared to HS and patients with normometabolic state (p<0.000 and p<0.000, respectively) (Figure). Irisin were significantly correlated with ALSFRS-R,% of FVC, CO2 and HCO3 arterial blood level, and% albumin serum level. Serum Irisin Levels in ALS patients according their metabolic state Conclusion: ALS patients with impaired metabolic state showed higher serum Irisin levels compared to HS. Moreover Irisin was negatively correlated with disability and respiratory function of patients. Our data suggest to consider Irisin as a new biomarker of metabolic state and prognosis of ALS. 205 European Journal of Neurology, 22 (Suppl. ),

257 740 Flash Posters F36 Epidemiological and clinical features of amyotrophic lateral sclerosis in Uzbekistan D. Mirzaeva, A. Prokhorova, K. Daminova Tashkent Medical Academy, Nervous disease, Tashkent, Uzbekistan Background and aims: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by multifactorial aetiology, affections of central and peripheral motor neurons, progressive course and onset of terminal respiratory insufficiency. The amount of patients including ones in Uzbekistan that is suffering and dying from ALS is increasing. The development of a familial ALS (FALS) shows the role of mutations of the gene producing the superoxide dismutase. Methods: Data on morbidity on base of register for the period of was studied. Special attention was paid to geographic epidemiology of ALS in different regions of Uzbekistan and to features of clinical manifestations of this disease in Uzbek nationality. Results: During the analyzed period there were 3.4 cases of ALS per 00,000 per year registered. 70% were patients from Andijan valley, 30% from other regions. Gender analysis determined that 60% of patients were women (mean age 43±4.2 years), 40% men (mean age 48±3.4 years). Most patients associated the debut of ALS with virus disease. Disease of 80% of patients debuted by bulbar form, of 20% by spinal form. The FALS is absence in our country. The average life expectancy was 2.5±0.45 years in the bulbar form, 3±0.86 in the spinal form. The onset of decompensation on the average 6 months later after debut. Conclusion: The analysis of the register of ALS in Uzbekistan demonstrated that ALS was the most common disease in Andijan valley, primary occurred in women, is not of a personal nature and mainly declares itself by bulbar form. F37 Evaluation of cardiac neural regulation in patients with Amyotrophic Lateral Sclerosis G. Mora, L. Dalla Vecchia 2 Fondazione Maugeri, Neurorehabilitation, Milan, Italy, 2 Fondazione Maugeri, Cardiology, Milan, Italy Background and aims: There is increasing evidence that the autonomic nervous system (ANS) is also affected in amyotrophic lateral sclerosis (ALS) as part of the complex degenerative process. Aim of this study was to better characterize the cardiac neural regulation in ALS using heart rate (HR) variability analysis. Methods: We enrolled 32 ALS patients (5 women, age 62±2 years). Electrocardiogram and respiration activity were continuously recorded at rest and during a 75 headup tilt. Spectral analysis provided indices of the cardiac sympathetic (LFRR) and vagal (HFRR) activity. Data are expressed as mean±se. Results: Patients showed low RR variance (7±02 msec2) and an altered response to orthostasis, as reflected by the absence of increase in HR, LFRR and LF/HF ratio during tilt. At rest 4 patients (Group ) were characterized by signs of low sympathetic cardiac activity (LFRR 29±7, HFRR 63±6, LF/HR.3±0.6) while the remaining 8 patients (Group 2) by signs of elevated sympathetic activity (LFRR 75±3, HFRR 20±3, LF/HR 5.9±.2). Both groups did not increase LFRR and LF/HF during tilt, although in Group 2 HR increased. Age and disease severity were similar in the two groups. Disease duration was shorter in Group 2. Conclusion: ALS presents altered cardiac neural regulation. We found either a lower or a higher sympathetic activity at rest, and an abnormal response to orthostasis. Patients with basal sympathetic hyperactivity showed a preserved capability to increase HR during tilt. In perspective, a comprehensive ANS evaluation is needed for a better understanding of the pathophysiology of ALS. 205 European Journal of Neurology, 22 (Suppl. ),

258 Flash Posters 74 F38 Elevated creatine kinase is associated with a better prognosis in patients with amyotrophic lateral sclerosis M. Rafiq, E. Lee 2, M. Bradburn 2, C. McDermott, P. Shaw University of Sheffield, Neuroscience, Sheffield, United Kingdom, 2 University of Sheffield, Clinical Trials Unit, Sheffield, United Kingdom Background and aims: Creatine kinase (CK) isoenzymes are crucial to energy metabolism and the genes for the various CK isoenzymes are up-regulated in individuals involved in activities that require muscular and cardiorespiratory endurance. These facts suggest that CK may be up-regulated in ALS to combat metabolic stress and hence may influence prognosis. This study aims to explore the potential of CK as a prognostic factor in ALS. Methods: This is an observational cohort study, using the clinical database from the Olesoxime (TRO9622) investigational medicinal product trial. Results: The CK level was strongly co-related with the lean body mass (LBM) of the affected individual. Also, the mean CK was significantly higher in males then in females and was higher in the participants with limb onset disease compared to bulbar onset disease. In order to account for the influence of LBM on the CK level, LBM was added in the Cox proportional hazard model as a covariate, along with other known prognostic confounders. The hazard ratio was statistically significant and suggest that the logck was an independent factor for survival; one unit increase in logck results in an individual being 0.74 times as likely to die at any given time point (p=0.009). The CK levels did not co-relate strongly with the manual muscle scores at any time point. Conclusion: This study highlights the potential usefulness of CK as a prognostic marker in ALS. F39 A single intraperitoneal lipopolysaccharide injection successfully induced Parkinson s disease in mice A. Rashed, A.P.K. Abou-Aisha 2, P.L. Mahran The German university in Cairo, Department of Pharmacology & Toxicology, Cairo, Egypt, 2 The German university in Cairo, Department of Microbiology and Immunology, Cairo, Egypt Background and aims: Parkinson s disease (PD) is a complex chronic progressive neurodegenerative disorder. The prominent neuropathological hallmark is the loss of dopaminergic neurons in substantia nigra (SN). Mounting evidence in PD brains and animal models show that neuroinflammation played a role in pathophysiology of the disease. Lipopolysaccharide (LPS, 5mg/kg, i.p) in mice was shown to induce reduction of tyrosine hydroxylase (TH) 3h post injection, and hypothesized to initiate inflammatory response that persisted to cause further damage 2h later. This study aims to assess the long term implications of single LPS (5mg/kg,i.p) on dopaminergic neurons in SN, motor and non-motor functions. Methods and Materials: Male Swiss albino mice (20-25g, 5-6 weeks old) were divided into two groups of 9-0 animals each. The mice received single i.p LPS from E. coli, strain 0:B4 (5mg/kg) or saline (0.9%). Behavioral characterization of working memory, anxiety and motor functions were assessed by modified Y maze, elevated plus maze and ladder rung respectively on days 7 and 8 after injection. The mice were then sacrificed and the brains were extracted. The SN was examined by histological analysis and immunofluorescent staining of TH. Results: The LPS group displayed reduction of melatonin containing neurons and TH immunoreactivity in SN, suggesting dopaminergic neuronal loss. Moreover, the LPS group showed significant cognitive impairment, increase in anxiety and motor impairment compared to the control group. Characterization of SN. (A-B) LPS treatment induced marked degeneration of neurons compared to control mice. (C-D) LPS treatment showed a significant reduction in dopaminergic neurons seen by the decrease of TH immunoreactivity. 205 European Journal of Neurology, 22 (Suppl. ),

259 742 Flash Posters Behavioral assessment after LPS injection. (A-B)LPS treatment showed significant decrease of working memory. (C-D)LPS treatment showed increase of anxious behavior. (E)LPS treatment induced motor deficit. Mean±SEM, n=9-0,**p<0.0 and***p<0.00 vs control Conclusion: Taken together, the results demonstrated that the LPS injected mice can be a model for PD to explore future therapeutic approaches considering both motor and non-motor symptoms. F320 Marital status is a prognostic factor In amyotrophic lateral sclerosis R. Spataro, V. La Bella Palermo, Italy Background: Amyotrophic Lateral Sclerosis (ALS) is a progressive motor neuron disorder leading to paralysis and death in a few years. Several variables have been linked to a short survival: female sex, older age at onset, bulbar site of onset, rapid progression, low FVC%, low BMI and rapid ALSFRS-R decline (Haverkamp LJ et al, 995; Wolf et al, 204). With regard to marital status, early studies suggested that being married is associated to a more frequent access to tracheostomy and longer survival (del Aguila et al, 2003; Chiò et al, 200). Aims: To study the role of marital status on survival in ALS patients Methods: We performed a retrospective analysis on 92 consecutive ALS patients followed-up at our Center (40% with bulbar onset, M/F=.44, median survival=29 months). At diagnosis, 67 patients were married and 25 were single/widowed. A Kaplan-Meyer survival analysis was performed in married and single/widowed patients. Furthermore, a multivariate logistic regression analysis assessed which variables are likely to be associated with the marital status. Results: In our ALS cohort, being married was associated with a longer survival (married, median 3 months vs single/widowed, median 9 months; p<0.00). A multivariate logistic regression analysis confirmed that a longer survival is independently associated with a married status. Education, working activity and respiratory status were not significantly different among married and single/widowed patients. Conclusion: Marital status is an independent prognostic factor in ALS and it significantly affects survival. 205 European Journal of Neurology, 22 (Suppl. ),

260 Flash Posters 743 Movement disorders 4 F32 Neuregulin- SNP8NRG22533 polymorphism in Parkinson s disease E. Giza, S. Veletza 2, A. Mestidou 2, V. Tsipropoulou, Z. Katsarou 3, S. Bostantjopoulou Aristotle University of Thessaloniki, 3 rd Neurology, Thessaloniki, Greece, 2 Democritus University of Thrace, Biology, Alexandroupoli, Greece, 3 Hippocratio General Hospital, Neurology, Thessaloniki, Greece Background and aims: Neuregulin- (NRG) belongs to a family of neurotrophic and differentiation factors involved in numerous functions ranging from neurodevelopment to neurotransmission and synaptic plasticity. Many studies have identified the genetic association between NRG and schizophrenia and specific single nucleotide polymorphisms (SNPs) were correlated with the disease. In this study, we examined for the first time the potential association of the multi-functional NRG gene with Parkinson s disease (PD) with an emphasis on the appearance of psychotic symptoms in PD patients. Methods: In this study NRG- SNP8NRG22533 (rs ) polymorphism, one of the most commonly reported SNP in schizophrenia, was screened in 98 consecutive Greek PD patients (mean age 62.2±0.4 yrs, mean age at disease onset 5.4±0 yrs, mean disease duration 0.8±5.95 yrs) and in 98 normal controls matched for age. PD patients and controls were genotyped using Taqman assay and real time PCR. The detection of psychotic phenomenology in PD patients was based on Parkinson Psychosis Rating Scale (PPRS) score. Results: The allele and genotype frequencies did not differ significantly between PD patients and controls. There were no significant differences on age at onset between the three possible genotypes or the alleles. The PPRS score did not also differ significantly between these groups of patients. Conclusion: Our results do not provide evidence that the NRG- SNP8NRG22533 polymorphism is associated with the appearance of PD in Greek population and the disease age of onset. Finally, it seems that it does not influence the presence of psychotic symptoms in PD patients. F322 Peripheral neuropathy in Parkinson s disease Z. Grambalova, P. Kanovsky, P. Otruba 2 Olomouc, Czech Republic, 2 University Hospital Olomouc, Neurology, Olomouc, Czech Republic Background and aims: The recent studies suggest increased frequency of peripheral neuropathy (PN) in Parkinson s disease patients (PD). The aim of our study is to verify the increases frequency of PN in our group of PD patients compare to the age matched group of controls. And the patients with IPD we sorted out according to the duration of L-Dopa treatment, dose of L-Dopa and age below and over fifty. Methods: We examined using electromyography (using conduction studies and needle electromyography) 49 PD patients with asymptomatic polyneuropathy and 40 healthy controls. Patients without risk factors for PN were included (fasting blood was analyzed to rule out possible causes of PN). And relatively healthy controls without risk factors for PN. PN was defined using The American Academy of Neurology and Electrodiagnostic Medicine criteria for PN (e.g. nerve conduction studies and needle electromyography) Results: Frequency of polyneuropathy in PD patients was significantly higher then in controls (45% versus 2%, p<0.000). Conclusion: Frequency of polyneuropathy in PD patients was significantly higher than in controls (45% versus 2%, p<0.000). We did not established the relationship between the group with long term using L-Dopa, with the duration of PD and with the age too. It should be assumed that the neurodegenerative process might underlie the involvement of the central as well as the peripheral nervous system in Parkinson s patients. 205 European Journal of Neurology, 22 (Suppl. ),

261 744 Flash Posters F323 Tetrahydrobiopterin deficiency one deficiency, multiple outcomes C. Tiu, N. Grecu, E. Terecoasa, S. Gheorghevici, O. Bajenaru University Emergency Hospital, Neurology, Bucharest, Romania Background and aims: Dopa-responsive dystonia is a rare condition characterized by childhood-onset dystonia, with marked diurnal fluctuation, and sustained response to levodopa therapy, without its specific adverse effects. Deficiencies in all enzymes involved in the dopamine synthesis pathway have been described with similar, but yet different phenotypes. Case Report: We present the case of a 34-year-old female with prominent parkinsonian features (severe axial rigidity, marked bradikinesia and hypokinesia), with onset at 29 years of age, and rapid progression over two years. She had previously been extensively investigated and had received levodopa therapy, being misinterpreted as Parkinson s disease, therapy which she however stopped due to the worsening of a preexisting depression. In our department we noticed marked fluctuation of her symptoms throughout the day, and a slight dystonic posture of the inferior limbs. She recounts abnormal posturing of her right limbs beginning in late childhood and recurrent ankle sprains. Levodopa testing led to a spectacular clinical improvement. Results: Cerebrospinal fluid (CSF) analysis showed markedly decreased levels of tetrahydrobiopterin, with normal neopterin and biopterin, while serum phenylalanine levels were mildly elevated. Dopamine substitution was reinstated, with 25 mg of levodopa 4 times/day and catechol-omethyl transferase inhibitors. Conclusion: Although the clinical aspects of dopa-responsive dystonias are similar, the genetic and enzymatic defects differ. Dosing CSF pteridin levels and serum phenylalanine levels can contribute to a better classification and an improved treatment scheme, by allowing the addition of suplemental tetrahydrobiopterin. The particularity of the case is the late clinical onset at 29 years of age. F324 Contribution of quantitative EEG (QEEG) to early diagnosis of cognitive deficits in idiopathic Parkinson s disease D. Guner, B. I. Tiftikcioglu, N. Tuncay, I. F. Uludag, Y. Zorlu İzmir Tepecik Education and Research hospital, Neurology, Izmir, Turkey Background and aims: Deficits in frontal executive, attention span, memory and visiospatial functions could be seen in early stages during the clinical course of Parkinson s disease. There is need for rapid, feasible and practical tests in clinical practice, to early diagnose and monitor the patients, without causing any discomfort. The aim of this study is to compare patients with Parkinson s disease whom do not have cognitivite complaints, with healthy control subjects using neurophyschological tests and qeeg analysis Methods: A total of 45 patients with Parkinson s disease, registered in Movement Disorders Outpatient Clinic at our Institute, whom not diagnosed with dementia according to DSM-IV criteria and not diagnosed with depression according to Beck Depression Scale, whose clinical Hoehn-Yahr scale is 2 and MMSE score is 26, has completed at least primary education, and age, gender and duration of education matched 39 healthy control subjects, were enrolled in the study. Demographical features, neuropsychological test scores and qeeg data were compared in both groups. Results: There was no significant difference between the patients and healthy controls according to age, gender and duration of education and MMSE test results (p>0.05). Scores of tests for frontal executive functions, verbal memory processes, attention span and visiospatial functions were significantly lower compared with healthy controls (p<0.0). Analysis of qeeg revealed generalized slowing in bioelectrical activity in patient group (p<0.00). These were moderately correlated with MMSE test scores (r= ; p<0.0). Conclusion: QEEG could be beneficial in the early diagnosis and monitoring of cognitive dysfunction in patients with Parkinson s disease 205 European Journal of Neurology, 22 (Suppl. ),

262 Flash Posters 745 F325 Intra- and inter-subject variability of gait velocity and temporospatial gait parameters from slow to fast walking C. Heinze, C. Pradhan, M. Wuehr, K. Jahn, R. Schniepp DSGZ, Munich, Germany Background and aims: Locomotion as a self-organizing system seeks maximal stability of the subject. Recent studies give evidence for a speed dependent development of gait variability and stability. As unnatural walking conditions, walking with slow or maximum speed might hold intrinsic gait fluctuations. Our study aimed to investigate the intrinsic intra- and intersubject variability of gait parameters in different speeds. Methods: 4 healthy subjects performed a gait analysis (GAITRite sensor carpet, 6.7 m) walking ten times in three different conditions (slow (SWS), preferred (PWS) and maximum walking speed (MWS)). The coefficient of variance (CV) served as a measure for variability for velocity and temporospatial gait parameters. Results: Inter-subject CV is speed-dependent (F=26.47; p<0.00). A post-hoc Bonferroni test reveals a significantly higher CV for velocity in SWS and MWS compared to PWS (p<0.00). Likewise the inter-subject CV of cadence and various longitudinal gait parameters are speed dependent, e.g. CV of Cadence (F=6.6; p<0.00). Conclusion: Shifting away from the resonant frequency of the oscillatory system of locomotion i.e. preferred walking speed leads to higher intrinsic fluctuations of the walking velocity. This is accompanied by likewise changes of temporal and spatial gait parameters. When performing gait analysis outside the preferred walking mode, scientists and clinicians should be aware of the intrinsic variation of the data. This finding is of important relevance for patients with cerebellar and vestibular gait disorders, since gait observations and analyses often contains gait measurements outside the preferred walking mode. F326 Genetic, radiological and neurophysiological biomarkers of cognitive impairment in Parkinson s disease M. Hussein, O. Serafy 2, R. Hassan 3, S. Al Shafie 4, R. Edward 5, A.M. Ali 6, G. Ezzat 7 banisuef unuiversity, neurology, banisuef, Egypt, 2 cairo university, neurology, Cairo, Egypt, 3 banisuef university, neurology, Banisuef, Egypt, 4 Al Fayoum University, Clinical pathology, Al Fayoum, Egypt, 5 Cairo university, Radiology, Cairo, Egypt, 6 Cairo university, neurology, Cairo, Egypt, 7 Al fayoum university, Clinical pathology, Al Fayoum, Egypt Introduction: Cognitive impairment in Parkinson s disease (PD) has been clearly reported in the medical literature. The exact pattern of this impairment and its biomarkers are still subjects of considerable controversy. Aim: To explore the cognitive profile of patients with PD, study the role of the genetic factor in the development of cognitive impairment in PD, correlate such impairment with the microstructural changes in the brain, and evaluate the role of P300 in assessment of cognitive function in PD. Methods: The study was conducted on 40 patients with PD and 20 controls. Selected PD patients were submitted to assessment of cognitive function using PD-Cognitive Rating Scale (PD-CRS), genotyping for glucocerebrosidase (GBA) mutation and bone derived neurotrophic factor (BDNF) polymorphism, assessment of microstructural changes in basal ganglia, thalamus, hippocampus and prefrontal white matter using diffusion tensor imaging (DTI), and measurement of P300 latency. Results: The cognitive impairment in PD patients starts with executive dysfunction followed by impairment in attention, memory, and visuospatial skills. Naming is the last cognitive domain to be affected. The cognitive impairment in PD patients can be attributed to the genetic factor (BDNF polymorphism and GBA mutation) and the microstructural changes in basal ganglia, thalamus, hippocampus and prefrontal white matter. The cognitive impairment in PD patients leads to prolongation of P300 latency. Conclusion: Cognitive impairment in PD is present even in the earlier stages of the disease and it can be correlated with certain genetic, radiological and neurophysiological, biomarkers. 205 European Journal of Neurology, 22 (Suppl. ),

263 746 Flash Posters F327 Study of olfaction in relatives of patients with Parkinson s disease (PwPD) O. Izhboldina, I. Zhukova, M.A. Nikitina, N. Zhukova, V. Alifirova, M. Azhermacheva Siberian State Medical University, Department of neurology and neurosurgery, Tomsk, Russian Federation Background and aims: Number of family forms of Parkinson s disease (PD) increased in recent years. Olfactory dysfunction observed in almost a quarter of clinically healthy relatives of PwPD [Marras J., 2005]. Immediate family of patients with olfactory dysfunction risk of developing disease increases by 0-20% in average over next 2 years [Ponse M.M., 2004]. Aims to research olfactory function in immediate family of PwPD by using Sniffing Stix Test. Methods: The research included 45 immediate family: group I: children of PwPD aged 9 to 57 years. group II: included 45 people with no signs of PD who did not have relatives with diseases of extrapyramidal system. Groups were homogeneous by gender, age. Olfactory function of all participants was researched using Sniffing Stix Test. Results: Normosmiya was recorded in all subjects according to results of the test. However, the results for sub-tests threshold (group I: 5.3±.8; group II: 7.8±.6 points) and discrimination (3.6±4.; 4.3±.9 relatively) were slightly lower in first group than in the second, but it was in the range of statistical norms. Subtest of identify odorants showed greatest differences between groups (group I 0.3±3.6; group II 3.5±2.). Also the result of I group was lower than normal values (see Table ). Parameters of olfactory function F328 One-year follow-up study of the effectivness of continuous dopaminergic stimulation in movement disorders J. Jansa, N. Zupancic Kriznar, M. Kramberger Gregoric, R. Koritnik, Z. Pirtošek, R. Rajner, M. Trost University medical centre Ljubljana, Neurologic clinic, Ljubljana, Slovenia Background and aims: Movement disorders could be treated by Deep brain stimulation (DBS) (Parkinson s disease (PD), essential tremor, dystonia) and levodopa/carbidopa intestinal gel (LCIG/Duodopa) (PD). We were exploring their effect in terms of the quality of activities of daily living (ADL) motor and ADL process skills, as measured by Assessment of Motor and Process Skills (AMPS) within first year post treatment. Methods: 7 patients with movement disorders, 2 with PD, 3 with dystonia and 2 with essential tremor were included in the study; 7 male, 0 female with average age of 65±0 years. 7 were included into Duodopa and 0 into DBS treatment. They were assessed with AMPS. AMPS has no ceiling or floor effect and is a valid and reliable measure of ADL. The range of AMPS scores is within 3 to 4. Patients were assessed prior the treatment (PD in best-on) and followed at month 3, 6 and 2 post treatment. Results: Initial average AMPS-Motor score was 0.4±.04, at month three 0.65±0.82, at month six 0.6±0.85, at year 0.72±0.73. The differences were not significant for month three and six (p=0.; p=0.0) but at year p=0.05 post treatment. Initial average AMPS-Process score was 0.49±0.48, at month three 0.63±0.4, at month six 0.58±0.43, at year 0.65±0.5 respectively. The differences were not significant for month three, six and year (p=0.04; p=0.2; p=0.4) post treatment. Conclusion: CDS improves/sustain the quality of ADL performance in patients with movement disorders. Conclusion: Research has shown that rates of identification of odors are primarily reduced in children of PwPD. However, other parameters of smell may change later and finally leading to hyposmia. Thus, the dynamic evaluation of smell is necessary for relatives of PwPD. 205 European Journal of Neurology, 22 (Suppl. ),

264 Flash Posters 747 F329 The relationship between results of computerised cognitive testing and medications in early-stage Parkinson s disease R. Kaladyte Lokominiene, V. Budrys Vilnius University Hospital Santariskiu Clinics, Neurology, Vilnius, Lithuania Background and aims: It is reported that patients with advanced Parkinson s disease (PD) on dopaminergic medication express improvement in mental flexibility, tonic alertness and working memory but there are reports that dopamine agonists worsen temporal functions. Objective: to investigate the association of cognitive functions of patients with the usage of medications for early-stage PD. Methods: 5 patients with clinically probable early-stage PD (Hoehn-Yahr.0-2.0) and 42 controls have undergone cognitive testing with Cambridge Neuropsychological Automated Battery (CANTABeclipse3.0.0). Results: 48 (4.7%) patients were treated. Correct latency of choice reaction time (CRTMecolat) on dopaminergic medication (DM) was 359.9±87.76ms (untreated (UN) ±50.6ms, p=0.000), number of correct trials 99.46±0.68 (UN 99.8±0.72,p=0.038), span lenght 4.92±.58 (UN 4.04±.08, p=0.00). CRTMecolat was lower in amantadine subgroup compared to DM (307.5±38.44ms, p=0.000). Span length did not differ in subgroups on amantadine and rasagiline. All outcomes of One-touch-Stockings and Cambridge Gambling test (CGT) risk adjustment were better in DM. CGToverall-proportionbet in amantadine group differed from dopaminergic monotherapy (0.46±0.0 and 0.57±0.53, p=0.006). DM made less mistakes and had lower latency in Spatial Working Memory, between and total errors correlated with LDE (r=0.462, p=0.00; r=0.388, p=0.007). DM group reached higher Paired Associates Learning stage (7.87±0.68 and 7.42±0.86, p=0.020). The results of graded naming did not differ in treatment groups. Conclusion: The medications for early-stage PD have heterogenic impact on cognitive functions. Dopaminergic treatment is assocated with better visuospatial function, planning and decision-making but relationship with working memory is contraversial. Amantadine is associated with better sustained and focused attention and decrease of reaction time. There is no association between the results of semantic memory and medications for early-stage PD. Disclosure: This work was performed as a part of a clinical research study KRANEPARK supported by Lithuanian Research Council under the contract No.MIP077/20. F330 Greater improvement of motor symptoms of Parkinson s disease by slow body swaying with an automatic rocking chair than by simple repose on the chair K. Kannari, I. Ozaki, T. Kurosawa 2 Aomori University of Health and Welfare, Department of Physical Therapy, Aomori, Japan, 2 Hachinohe National College of Technology, Department of Mechanical Engineering, Hachinohe, Japan Background and aims: We have previously demonstrated that slow body swaying with an automatic rocking chair improves motor symptoms of Parkinson s disease (PD). However, simple repose on the chair without body swaying may also have some beneficial effect on the motor symptoms of PD. Methods: 8 patients with Parkinson s disease (modified H-Y score: 2.6±0.4) received a gentle body swaying for 0 min on the automatic rocking chair developed by us under the condition of 0.3 Hz in frequency and 5 cm in amplitude. On the other day, the patients undertook simple repose for 0 min on the automatic rocking chair. Before and after the intervention, UPDRS Part III, Timed Up and Go Test (TUGT), and changes in posture were estimated. Results: Rocking stimulation significantly reduced (improved) an UPDRS Part III score (from 26.4±.6 to 20.6±.5, p<0.05). No significant changes were found in TUGT and posture. Simple repose also significantly reduced an UP- DRS Part III score (from 22.8±.7 to 9.9±.8, p<0.05). No significant changes were found in TUGT and posture. The degree of improvement in UPDRS Part III under rocking stimulation was greater than that under simple repose (5.5±0.8 vs 2.9±0.9, p<0.05). Conclusion: Both slow rocking and simple repose significantly improve motor symptoms of PD. However, rocking stimulation has much greater ability to improve motor symptoms of PD. 205 European Journal of Neurology, 22 (Suppl. ),

265 748 Flash Posters F33 Treatment of camptocormia by the continuous subcutaneous infusions of apomorphine P. Kanovsky, K. Mensikova 2, M. Kaiserova, M. Vaštík, S. Kurcova 3 Olomouc, Czech Republic, 2 Faculty of Medicine and Dentistry, Palacky University and University Hospital, Department of Neurology, Olomouc, Czech Republic, 3 Palacky Univerzity, Olomouc, Czech Republic Background and aims: Camptocormia may be present as a rare idiopatic dystonic disorder, or much more frequently as a symptom of the complicated stage of Parkinson s disease (PD). Reported prevalence rates range from 3% to 7% in PD. Camptocormia poorly respond to both manipulation with dopaminergic treatment or deep brain stimulation. Methods: In the last four years, we had to manage five patients suffering from Parkinson s disease who developed camptocormia. All five patients were treated with L-DOPA and dopaminergic agonists at the time when camptocormia appeared. None of the patients improved following the manipulation of dopaminergic treatment; application of botulinum toxin injections into affected trunk muscles also did not alleviated their disorder. The diagnostic apomorphine challenge test was performed in all five patients. In case of a positive response apomorphine test (i.e. with a substantial improvement of camptocormia) was the treatment by the continuous subcutaneous infusions of apomorphine initiated. Apomorphine dose was gradually titrated, according to the clinical response and tolerance, up to the daily dose ranging from 40 to 70mg. Results: The camptocormia improved in all patients at the four week of continuous apomorphine treatment, and this effect remained stable. One patient died after 3 years of the initiation of apomorphine treatment; in other 4 patients is the mean duration of stable response.8 years. Conclusion: Apomorphine hydrochloride in the form of continuous subcutaneous infusions can be successfuly used for the treatment of camptocormia in the late stage od Parkinson s disease. F332 Botuloxin-therapy for the pain correction in patients with spasmodic torticollis Y. Karakulova, N. Loginova, N. Demchuk Perm State Medical University, Neurology, Perm, Russian Federation Background and aims: Spasmodic torticollis (ST) is a painful condition that affects the movement of the neck muscles. Pain is one of the most significant complaints that disturbs the quality of life of the patients. Aim was to determine the pain level, psychoautonomic status and quality of life of the patients with ST before and after Botuloxintherapy. Methods: 35 patients suffering of ST (23 women and 2 men) were examined, using VAS, III part of a Toronto Western spasmodic torticollis rating scale (TWSTRS), scale of quantitative assessment of chronic pain (Brief Pain Inventory, BPI) before and after treatment with botulinum toxin. Results: Before the treatment with Botulotoxin average level of pain according to VAS was 6.4±.8 points. The average total score according the pain intensity subscale of TWSTRS was 0.2 points. On BPI scale average score was 30.7 points. At the next examination (in one month of botulinum toxin treatment) values were follows: TWSTRS pain intensity subscale mean score was 8.4 points. On BPI scale average score was 2.4. After the treatment average level of pain on VAS was 4.±0.8 points. Conclusion: In patients with ST pain is one of the leading complaints. Its intensity varies from moderate to high. Botuloxin-therapy significantly reduces not only the severity of involuntary movements, but also the severity of pain, improves psychoemotional and autonomic status and life quality level. 205 European Journal of Neurology, 22 (Suppl. ),

266 Flash Posters 749 F333 Periaqueductal lesion in the mesencephalon due to neurosarcoidosis causing severe resting tremor. Case report A. Kelemen, G. Tamas, A. Toth, D. Milanovich, G. Varallyay 2, A. Takats Semmelweis University, Department of Neurology, Budapest, Hungary, 2 Semmelweis University, MR Research Centre, Budapest, Hungary Background and aims: Sarcoidosis may affect different parts of the nervous system in 5% of the cases, causing various symptoms such as tremor and parkinsonism. Early diagnosis is crucial for its successful therapy. Case Report: A 5-year-old woman was admitted to our Department. She was treated with steroid for systemic sarcoidosis ten years ago; the therapy was stopped after three years because of clinical remission. Before her admission, a ventriculo-peritoneal shunt was implanted because of hydrocephalus due to the occlusion of the aqueductus cerebri. Although liquor pressure was normalized, she suffered from progressive headache, fatigue, then tremor of all of the extremities, head and jaw. Vertical gaze palsy had developed, with a tendency to fall backward; she was unable to sit or stand alone. Later, she became somnolent. Cranial MRI showed T2 hyperintensity in the periaqueductal area of the mesencephalon with the occlusion of the aqueductus cerebri. Liquor analysis showed elevated total protein. Tremorometry showed pure resting tremor of the extremities with high rhythmicity between 4.4-5Hz suggesting nigrostriatal dysfunction. Results: We adjusted methylprednisolon (intravenous 5mg/kg for four days; then oral 0.6mg/kg/day long-lasting) and levodopa (3x00mg). The patient became awake after a few days; she was able to sit and walk. Her resting tremor was markedly reduced. Conclusion: The symptoms could be explained by the mesencephalon lesion. Although a histological test was not possible from the brainstem, the efficacy of steroid therapy supports the diagnosis of neurosarcoidosis. F334 Vegetative manifestations of Parkinson s disease after strong psychoemotional stress M. Khanova Tashkent, Uzbekistan Objective: To study sympathetic activity in patients with Parkinson s disease (PD) developed after strong psychoemotional stress. Patients and Methods: The study included 35 patients with PD (Hoehn and Yahr stage I-IV) who had suffered strong psychoemotional stress. 25 healthy matched controls were control group. Vegetative function was evaluated in both groups using sympathetic skin response (SSR) and Guillaume-Vane vegetative Scale (GVS). In SSR was elicited by electrical stimulation of the right median nerve and simultaneously recorded on the palms of both hands. In GVS scores more than 5 testified to the presence of vegetative dysfunction syndrome. Results: There were no significant differences in the SSR and its means of latency and amplitude between main and control groups. SSR parameters were depended on disease duration, UPDRS score, and disease stage. We observed significant correlations with rigidity and bradykinesia, but not with tremor. Mental stress had no effect on SSR parameters in any group. But in GVS we noted different autonomic dysfunctions. According to this scale data, 20 patients with tremor had 40 score, 3 patients with rigidity and bradykinesia - 43 score and 2 patients with mixed forms - 48 score. Conclusion: The GVS as a method of evaluation of sympathetic activity is more sufficient for exploration of autonomic dysfunctions in PD after strong psychoemotional stress than SSR, which could demonstrate various deviations in the vegetative system. PD patients are sensitive to mental stress, but the arithmetic task had no effect on SSR parameters 205 European Journal of Neurology, 22 (Suppl. ),

267 750 Flash Posters F335 Korean patients with spinocerebellar ataxia type 6 presenting with unusual manifestations H.J. Kim, S.-Y. Kang Jeju, Korea, Republic of Background and aims: Spinocerebellar ataxia type 6 (SCA6) is a dominantly inherited form of spinocerebellar ataxia, which usually manifests as a syndrome of progressive pure cerebellar ataxia with a late onset, and caused by a small expansion of CAG repeats in the CACNAA gene. We describe two unrelated Korean SCA6 patients presenting with dystonia and apraxia of eyelid opening, respectively, aiming to extend the clinical heterogeneity of SCA6. Methods: Case : A 5-year-old man presented with a 3-year history of progressive gait disturbance. He had complained stiffening of the right leg. Neurological examination showed gait ataxia, dysarthria, downbeat nystagmus, gaze evoked nystagmus (GEN), hypermetric horizontal saccade and saccadic pursuit. He also had right foot dystonia elicited by walking. Case 2: A 58-year-old woman visited our clinic with a -year history of progressive gait difficulty, clumsy hand, slurring of speech, and difficulty in eye opening. Neurological examination showed apraxia of eyelid opening, horizontal GEN, dysmetric saccades and mild dysarthria. There were mild bilateral intention tremor, bradykinesia and rigidity. Gait was normal based, but arm swing and walking speed were decreased. She was treated with levodopa, but the symptoms were not alleviated. Results: Genetic testing was positive for SCA6 in both cases. Conclusion: SCA6 is clinically characterized by a severe form of late onset slowly progressive pure cerebellar ataxia with nystagmus. These two cases expanded the clinical phenotypes of SCA6 and emphasized the existence of dystonia, eyelid apraxia, and parkinsonism in SCA6 patients. 205 European Journal of Neurology, 22 (Suppl. ),

268 Flash Posters 75 MS and related disorders 4 F336 Gait abnormalities in patients with primary progressive multiple sclerosis are not related with domains evaluated by expanded disability status scale I. González-Suárez, I. Pulido-Valdeolivas 2, D. Gómez Andrés 2, I. Rodríguez-Andonaegui 3, J.A. Martín-Gonzalo 3, A. Orviz, E. Rausell 2, C. Oreja-Guevara Hospital Universitario Clínico San Carlos, Neurology, Madrid, Spain, 2 Universidad Autónoma de Madrid, Anatomy, Histology and Neuroscience, Madrid, Spain, 3 Physiotherapy School. ONCE-UAM, Madrid, Spain Background and aims: Poor control of weight support and translation during gait in patients with primary progressive multiple sclerosis (PPMS) is a reflection of lesions in different parts of the central nervous system (CNS). The Expanded Disability Status Scale (EDSS) scores the degree and gross location of CNS affection in those patients. Our aim is to explore which gait parameters could predict the impairment of EDSS cerebellar, pyramidal, brainstem and sensory system items. Methods: 72 averaged kinematic and spatiotemporal parameters (36left/36right) of 5 joints were acquired from 4-5 gait cycles of 0 PPMS patients by means of instrumented gait analysis (IGA). Four Random forests were trained with the scores of cerebellar, pyramidal, brainstem and sensory items of the EDSS as dependent variables and gait parameters as predictors. Goodness-of-fit was assessed by -OOB error rate, and influence of each predictor was estimated by mean percentage of decrease in model accuracy when variable is out-of-the-bag. Results: The heatmap shows the importance of each gait parameter (rows) in the prediction of EDSS items (columns). The greener the square, the more important is the parameter. Model prediction analysis gives a low goodness-of-fit, meaning that EDSS scores are poorly correlated with gait performance. In spite of that, range of pelvic tilt seems to be important (2.3left, 2.37right) to predict EDSS pyramidal items. The importance of other parameters needs to be discussed. F337 Fampyra also improves manual skills in PPMS patients I. González-Suárez, A. Orviz, V. Lopez de Velasco, J. Matias-Guiu Guia, C. Oreja-Guevara Hospital clinico san carlos, neurology, Madrid, Spain Background and aims: Primary progressive multiple sclerosis (PPMS) is a MS variant in which no treatment have proven efficacy. Recently, fampridine has demonstrated to improve walking speed in patients with MS. Our objective is to describe the clinical response of different systems in patients with PPMS treated with Fampridine. Methods: Patients with PPMS were studied for a follow up of 6 months. Neurological examination, 25 foot walk test (25FWT), ambulation index (AI), 9 hole-peg test (9HPT) and symbol digit modality test (SDMT) was done at baseline, in the 5th day and 6th month after Fampyra administration. Results: 0 patients with PPMMS diangosis, 70% women. Mean age (SD 8.02). 60% responders. EDSS median, [range]; baseline 6.0 [Range ], 5 th day 5.5 [ ] (p=0.06); 25FWT baseline 8.03 seconds [ ], 5 th day 7.7 [ ] (p=0.); AI at baseline 4.0 [ ], 5 th day 3.5 [ ] (p=0.23); MSWS2 Median points baseline [ ], 5 th day 27.0 [ ] (p=0.02); 9HPT dominant hand median time baseline [ ], 5 th day [ ] (p=0.03); non dominant hand baseline [ ], 5 th day 24.2 [ ] (p=0.73); SDMT median points baseline 34.0 [20-4], 5th day 35 [26-53] (p=0.7). Conclusion: Fampridine is an effective drug that improves walking speed and manual skills in patients with PPMS. No effects on cognitive function have been demonstrated Heatmap Conclusion: Gait is a global emergent property of the CNS that cannot be adequately evaluated with the EDSS. It should be evaluated separately as an additional domain. 205 European Journal of Neurology, 22 (Suppl. ),

269 752 Flash Posters F338 Impact of melatonin on motor, cognitive and neuroimaging indices in patients with multiple sclerosis M.H. Harirchian, T. Roostaei 2, M. Sahraian 3, T. Gholipour 4, M. Togha 5, B. Siroos Iranian Center of Neurological Researches, Tehran University of Medical Sciences, Neurology, Tehran, Iran, 2 Iranian Center of Neurological Researches, Tehran University of Medical Sciences, Tehran, Iran, 3 Sina MS research Center, Tehran, Iran, 4 Harvard medical center, Tehran, Iran, 5 Tehran, Iran Background: A series of preclinical and clinical studies have shown that melatonin could modulate the immune system response, especially in the state of chronic inflammation. Recent studies showed that circulating level of melatonin decreases in Multiple Sclerosis (MS) patients. Methods: A double-blind, randomized, parallel-group, placebo-controlled clinical trial was designed to study the tolerability and efficacy of supplemental therapy with melatonin (3 mg/day) in comparison to placebo in relapsingremitting MS (RRMS) patients receiving once weekly interferon beta. Patients were followed up for 2 months. Primary outcomes consisted of the number of relapses, change in Extended Disability Status Scale (EDSS), and the number and volume of new T2 and gadolinium-enhancing brain lesions. Secondary outcomes included change in performance on Multiple Sclerosis Functional Composite (MSFC) as well as change in fatigue and depression. Results: 26 patients (3 in each group) were recruited in the study. All the participants, except for one patient in the placebo group, completed the study. There was no significant difference either in primary or secondary outcomes between melatonin and placebo arm during and after 2 months follow up. However, a trend for beneficial effect was observed for melatonin on change in MSFC performance and the cognitive subscore of the Modified Fatigue Impact Scale (P=0.05 and 0.006, respectively). Conclusion: This study showed that supplemental therapy with melatonin in RRMS patients receiving once weekly interferon beta is well tolerated. However, we found no significant effect for treatment with melatonin on measures of clinical and functional disability and development of brain lesions F339 Baseline demographics and disease characteristics from OPERA I and II, two phase III trials evaluating ocrelizumab in patients with relapsing multiple sclerosis S. Hauser, G. Comi 2, H.-P. Hartung 3, K. Selmaj 4, A. Traboulsee 5, A. Bar-Or 6, D. Arnold 6, G. Klingelschmitt 7, D. Leppert 8, A. Kakarieka 8, F. Lublin 9, H. Garren 8, L. Kappos 0 UCSF, Neuroscience, San Francisco, USA, 2 Scientific Institute H.S. Raffaele, neurology, Milan, Italy, 3 University Dusseldorf, Neuroscience, Düsseldorf, Germany, 4 Medical University in Lodz, Neurology, Lodz, Poland, 5 University of British Columbia, Multiple Sclerosis Clinic, Vancouver, Canada, 6 Montreal Neurological Institute and Hospital, Mc- Gill University, Montreal, Canada, 7 F.Hoffmann La-Roche, Biometrics, Basel, Switzerland, 8 F.Hoffmann La-Roche, Neuroscience, Basel, Switzerland, 9 Mount Sinai Hospital, Neurology, New York, USA, 0 University Hospital Basel, Basel, Switzerland Background and aims: To present demographic and baseline disease characteristics of patients in the OPERA I and II studies. Ocrelizumab (OCR) is a recombinant humanized monoclonal antibody that selectively targets CD20+ B-cells. Two Phase III trials, OPERA I and II, are investigating the efficacy and safety of OCR compared with INFβ in patients with relapsing MS (RMS). Methods: The OPERA trials are randomized (:), doubleblinded, double-dummy, parallel-group studies investigating the efficacy and safety of 600 mg OCR administered by intravenous infusion every 24 weeks compared with highdose, high-frequency IFNβa (44 µg 3x per week). Entry criteria included a diagnosis of RMS (McDonald criteria, 200), Expanded Disability Status Scale (EDSS) score of 0-5.5, and age of 8-55 years, and at least 2 documented relapses within the last 2 years or one in the year prior to screening. The primary endpoint is annualized relapse rate at 2 years. Results: For OPERA I/OPERA II respectively: 82/835 patients were randomized with mean ages 37.0/37.3 years; 66.0% female. Mean duration since first symptom was 6.5/6.7 years, EDSS scores were 2.80/2.82. The mean number of gadolinium enhancing (Gd+) lesions on brain MRI was.79, with 59.7% of patients with no Gd+ lesions in OPERA I, and.87 and 59.8% respectively in OPERA II. Conclusion: The OPERA I and II baseline data are consistent with a RMS population. The results of the OPERA studies will provide information on the efficacy and safety of ocrelizumab compared with IFNβ in RMS. Disclosure: Study Supported by: F.Hoffmann-La Roche 205 European Journal of Neurology, 22 (Suppl. ),

270 Flash Posters 753 F340 Effect of delayed-release dimethyl fumarate on total disability burden in relapsing-remitting multiple sclerosis: area under the curve analysis of changes from baseline in EDSS scores E. Havrdova, R.J. Fox 2, R. Gold 3, J. Xiao 4, A. Zhang 4, N.C. Kurukulasuriya 4, A. Bar-Or 5 Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic, 2 Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, USA, 3 St. Josef Hospital, Bochum, Germany, 4 Biogen Idec, Cambridge, USA, 5 Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada Background and aims: Compared with traditional disability progression analysis, AUC analysis contains more information about the cumulative extent of disability over time because it considers all Expanded Disability Status Scale (EDSS) scores over the study period. Here we quantify the effect of delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) on total disability burden in the Phase 3 DEFINE and CONFIRM studies using area under the EDSS-time curve (AUC) to integrate all measured EDSS progression and improvement over the 2-year study period. Methods: RRMS patients were randomized to receive placebo or DMF 240mg BID or TID in DEFINE, or placebo, DMF 240mg BID or TID, or glatiramer acetate (GA; reference comparator) in CONFIRM, for up to 2 years. EDSS scores were assessed at 2-week intervals. For AUC analysis, EDSS change scores were computed relative to baseline (week 0). AUC of EDSS change scores was calculated for all patients, with imputation applied for missing scores; treatment groups were compared in mean EDSS AUC change, adjusted for covariates, using ANCOVA ranked data. Positive AUC change indicates net worsening in EDSS from baseline; negative AUC change indicates net improvement in EDSS from baseline. Results: Compared with placebo, mean difference in AUC change in EDSS scores was lower with DMF BID in both DEFINE (P=0.0036) and CONFIRM (P=0.0375) but was not significantly different with GA (P=0.5523; Table ). F34 MS-like illness as an initial manifestation of primary antiphospholipid syndrome C. Irkec, İ. Yildirim Çapraz, H.Z. Batur Caglayan, M. Mutlucan, E. Gomleksiz, B. Cengiz Gazi University Faculty of Medicine, Neurology, Ankara, Turkey Background and aims: Antiphospholipid syndrome (APS) is an autoimmune disease, characterized by recurrent thrombotic events, miscarriages and thrombocytopenia, and is associated with the presence of antiphospholipid antibodies (apl). Howewer, neurologic disorders are among the most common and important clinical manifestations associated with the APS, ocular symptoms and multiple sclerosis-like illness are rare initial manifestations of primary APS. Case Report: We report a case of a 4-year-old woman who admitted to the our department with blurred vision on the left eye. The patient was diagnosed with optic neuritis. The brain MRI showed multiple white matter lesions in periventricular area. Her complaints improved after pulse steroid treatment. 0 days later, she presented right hemiparesis and generalized tonic-clonic seizures. The new MRI revealed left frontal ischemic lesion. Results: Anticardiolipin and anti-beta 2-glycoprotein I (b2gpi) antibodies were present. Conclusion: In this case report, we aim to emphasize the significance of recognizing an unusual initial presentation of antiphospholipid syndrome. Especially when the clinical profile is associated with apl, APS can mimic MS. Conclusion: AUC analysis suggests a positive benefit of DMF on a measure of total disability burden. Patients receiving DMF had a better overall experience with respect to disability compared with placebo. Disclosure: Study supported by Biogen Idec, Inc. 205 European Journal of Neurology, 22 (Suppl. ),

271 754 Flash Posters F342 Evaluation of the efficacy and safety of mitoxantrone in Polish patients with multiple sclerosis A. Jamroz-Wisniewska, K. Rejdak, H. Bartosik-Psujek, M. Baczek, M. Zaganczyk, A. Czukiewska Medical University of Lublin, Neurology, Lublin, Poland Background and aims: Mitoxantrone (MX), an anthracenedione immunosuppressant drug, remains the only approved drug in the treatment of progressive type of multiple sclerosis (MS). The aim of the study was to evaluate the efficacy and safety of MX treatment in patients with MS. Methods: Adult patients with secondary-progressive and primary-progressive MS were enrolled, with worsening of the neurological state in the previous 8 months. MX was given i.v. every 3 months. Patients were assessed clinically and additional tests were performed. Efficacy of the treatment was assessed on the basis of the EDSS. Results were evaluated statistically using descriptive statistics. Results: The total number of 3 patients were enrolled (F/M 80/33, mean age=4.6 years, mean disease duration=9.7 years). The mean dose which patients received was 43 mg. The mean value of EDSS at baseline was 6.0, at the end of the treatment 6.7. Stabilization of neurological status was observed in 44% patients, improvement - in 8%, deterioration in 38%. The following side effects were observed: urinary tract infection (in 36% of cases), leukopenia (in 8%), menstrual disorders (in 4%), decrease in ejection fraction (in 2%). Therapy was interrupted in 8 patients because of lack of efficacy, intolerance of treatment or death (in one case). Conclusion: MX treatment was effective and prevented neurological impairment in most of the enrolled patients, and even caused an improvement in 8% of the studied group. Except one fatal case, no other serious side effects were observed, and the treatment was generally well tolerated. F343 Patient-reported physical functioning in relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients in Europe E. Jones, S. Naoshy 2, J. Pike, C. Watson 2 Adelphi Real World, Manchester, United Kingdom, 2 Biogen Idec, Cambridge, USA Background and aims: Multiple sclerosis (MS) is a chronic inflammatory disease that can lead to increased physical impairment and diminished health-related quality of life (HRQoL). The objective of this study is to evaluate patient-reported physical functioning and HRQoL impact for RRMS and SPMS patients in Europe. Methods: Adelphi MS Disease Specific Programme, a cross-sectional study in Europe (France, Germany, Italy, Spain and the UK), was used to identify patient-reported data for 88 RRMS and 42 SPMS patients. Physical aspects of HRQoL were assessed using the Hamburg Quality of Life Questionnaire in MS (HAQUAMS) physical subscales, in which higher scores indicate more disability. Fisher s Exact or Chi-Squared (for categorical outcomes) and Wilcoxon rank-sum test (for numerical outcomes) were used to determine differences between RRMS and SPMS patients. Results: Physical impairment reported by a higher proportion of SPMS patients than RRMS patients were motor (92.25% vs. 6.52%; p<0.000) and coordination (65.49% vs. 34.7%; p<0.000). Mean scores for the HAQUAMS lower limb subscale and upper limb subscale were higher for SPMS than RRMS patients (3.29 vs.83; p<0.000) and (2.44 vs.44; p<0.000) respectively. Conclusion: There is a high burden on physical functioning experienced by MS patients, with SPMS patients reporting a greater burden as well as significantly higher levels of disability in upper and lower limb physical subscales than RRMS patients. As SPMS patients are more impacted in their physical functioning than RRMS patients, there is a need to prevent patients from progressing to SPMS. Disclosure: Study sponsored by Biogen Idec Inc. F344 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

272 Flash Posters 755 F345 A clinical comparative study of multiple sclerosis and neuro-behcet s syndrome M. Kchaou, N. Ben Ali, H. Jamoussi, S. Fray, S. Echebbi, S. Belal Departement of neurology, tunis, Tunisia Background and aims: NB disease, the most frequent vasculitis in our country, shows a clinical and radiological presentation simulating MS in some case. So, we are often confronted to diagnosis dilemma at the early stages. we would like to compare the clinical,mri,and laboratory findings in the tow conditions. Methods: Retrospective study including 2 groups: 30 MS (Mc Donald criteria), 40 NB (Behcet disease: ISG 999 criteria with neurological signs before or after systemic symptoms) Results: Compared with MS, we have noted a male predominance and a more advanced age at onset in NB. Both showed encephalomyelopathy disseminated in time and space. Patients with MS, showed a more polyphasic course, whilst those with NB showed a more progressive one. In MS optic neuritis, motor and sensitive signs were common. On the other hand, in NB the main neurological manifestation was motor signs, mental disturbance and progressive pseudo bulbar palsy. Neuromaging findings showed that inflammatory lesions do not enhanced after Gado in NB. There is more global brain atrophy in MS and more brain stem atrophy in NB. Green matter was more involved in NB disease. Intrathecal synthesis (OCB, Index Ig G) were present in 65% against 7.5% in NB disease. After immunoelectrophoresis, we noted Profile 2 in 70% of MS and Profile (80%), 3and4 in NB disease. Conclusion: An overdiagnosis of MS is made essentially if we are white matter abnormalities on MRI responding to the McDonalds criteria and in the absence of systemic manifestations. Comparative studies are useful to avoid the maximum of missdiagnosis. F346 Evaluation of an exercise-based patient education workshop in people with multiple sclerosis S. Kersten, C. Lutz 2, P. Schubert, M. Liebherr, S. Cavus 3, S. Becker 3, C. Damm 3, C. Haas Hochschule Fresenius, University of Applied Sciences, Institute for complex Health Research, Idstein, Germany, 2 Saarland University, Sports Science Institute, Saarbrücken, Germany, 3 Hochschule Fresenius, University of Applied Sciences, Faculty of Health & Social Sciences, Idstein, Germany Background and aims: Physical exercise shows numerous positive effects in people with chronic diseases. For People with Multiple Sclerosis (PwMS) physical exercise has a potential benefit in quality of life, physical and mental health. To transfer regular physical exercise in PwMS everyday life a patient education seems to be a key strategy. This study aimed at evaluating PwMS ability to regulate their own exercises for 2 weeks. Within this period, PwMS were instructed by supervisors in an exercise-based Patient Education Workshop (epew) on two weekends. Methods or Materials or Case Report: 27 PwMS participated in pretests (T0), an epew (weekend and weekend 4) and posttests (T) 2 weeks after T0. PwMS were encouraged to work out self-controlled for the whole study duration (2 weeks) and were measured in 6-Minute-Walk-Test (6MWT), Timed-Up-And-Go-Test (TUG) and Functional- Gait-Assessment (FGA) (Figure ). Figure : Study design. Results: Results were homogenous (Table ) and showed significant improvements (Figure 2). The epew was welltolerated by all participants. Furthermore, they were able to transfer physical exercise in daily routine. Table : Spearman correlation coefficients between T0 and T. The values show homogeneous effects. 205 European Journal of Neurology, 22 (Suppl. ),

273 756 Flash Posters Figure 2: Absolute percentage of change in [%] defined as the difference from the results in T0 (set as 00%) to the results in T. TUG: 4.73%; 6MWT: 0.7% (n.s.); FGA: 2.5%. Significant differences (Wilcoxon) are denoted by *. Conclusion: Patient education for PwMS often focuses on disease or symptom management without regarding exercise behaviour. An epew has the potential to support PwMS individually in order to integrate physical exercise in everyday life with a low amount of time and money. Considering the results in 6MWT, clinical relevance of a change of 0.7% has to be discussed despite non-significance (Figure 2). It is important to educate PwMS theoretically and practically in physical exercise to enable an autonomous exercise management regarding pre-conditions, training barriers and motivation factors. Disclosure: The patient education programme was financed and supported by the German Multiple Sclerosis Society (department Saarland and Rheinland-Pfalz) and the IKK Südwest. F347 Economic activity and employment of Portuguese patients with multiple sclerosis in results of the national cross-sectional PORT-MS study R. Samoes, S. Varanda 2, M. Grilo 3, J. Sequeira 4, J. Tomás 5, J. Ferreira 6, M.D.C.R.R.M. Macário 5, C.M.C. Capela 4, E. Santos 7, L.M.A.F.D. Sousa 5, R.M.G. Pedrosa 4, J. de Sa 6, M.J. Sá 3, J.M. Vale Santos 8, J.J.F.C.A. Cerqueira 2, A.A.D.M. Silva, P. Alegria 8 Centro Hospitalar do Porto Hospital de Santo António, Neurology, Porto, Portugal, 2 Hospital de Braga, Neurology, Braga, Portugal, 3 Centro Hospitalar de São João, Neurology, Porto, Portugal, 4 Centro Hospitalar de Lisboa Central Hospital de Santo António dos Capuchos, Neurology, Lisbon, Portugal, 5 Centro Hospitalar Universitário de Coimbra, Neurology, Coimbra, Portugal, 6 Centro Hospitalar de Lisboa Norte Hospital de Santa Maria, Neurology, Lisbon, Portugal, 7 Centro Hospitalar do Porto - Hospital Santo António, Neurology, Porto, Portugal, 8 Hospital Beatriz Ângelo, Neurology, Loures, Portugal Background and aims: In Portugal, there existed no a multicentric study on the general characteristics (demography, disease milestones, treatment, socioeconomic status) of Multiple Sclerosis (MS) patients. Methods: Patients fulfilling McDonald 200 criteria were sequentially recruited in 204 in 7 centers and data systematically collected (PORT-MS study). Here we present data on employment. Results: 56 patients included: time since diagnosis 9.4±7.2 years (Relapsing-Remitting (RR) and Primary-Progressive (PP) similar, Secondary-Progressive (SP) 6 years longer), current age 42.9±2.4 years-old (RRMS 40.7±.6, SPMS , PPMS 52.5±.3); median EDSS 2.5 (RRMS 2.0, SPMS 6.5, PPMS 6.0); 2.5 females to male; current disease type 82% RRMS, 9.4% SPMS, 8.6% PPMS; years of education 2±4,5 (equal between genders, RRMS 2.6±4.2, SPMS 9.2±4.7, PPMS 9.8±5.4). Proportion economically active (unemployment rate): global 6.5% (3.5%); RRMS 7% (2.7%), SPMS 7% (44.4%), PPMS 7.8% (2.%); RRMS females (age 4.2±2. years-old, EDSS 2.0) 67.4% (5.7%), RRMS males (age 39.2±0. years-old, EDSS 2.0) 80.2% (9.3%); all EDSS % (2.5%), EDSS ,7% (2.%), EDSS % (45.5%). RRMS economically active vs non active: current age 38±9.2 vs 47.2±4; EDSS,5 vs 3,5; females 67,8% vs 80.5%; years of education 3.6±3.6 vs 0.±4.5. RRMS non active population: 69.5% retired due to disease, 3.7% student,.5% retired due to age, 5.3% other. See table for other data. 205 European Journal of Neurology, 22 (Suppl. ),

274 Flash Posters 757 Table: Data on employed vs unemployed patients with RRMS. Conclusion: 0% of national MS population collected. Mildly incapacitated patients have rates of activity and employment similar to general population; these are much reduced in relatively young patients with moderate and high incapacity, essentially due to retirement due to disease. Disclosure: This research had institutional support from Biogen Idec and the GEEM (Grupo de Estudos de Esclerose Múltipla, the Portuguese medical society for MS. F348 First impressions on dimethyl fumarate in an Italian cohort of multiple sclerosis patients F. Sangalli, M. Radaelli, M. Rodegher, B. Colombo, V. Martinelli, G. Comi, L. Moiola San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Department of Neurology, Milan, Italy Background: Pivotal studies demonstrated the promising efficacy and tolerability profile of dimethyl fumarate (DMF) in Multiple Sclerosis (MS) patients. However there are still few reports of its use in real life setting. Aims: To prospectively evaluate safety and efficacy of DMF in MS patients. Methods: Till now 27 patients started DMF at San Raffaele Hospital. We performed periodic clinical and radiological evaluation, recording data on efficacy (relapses, disability, active brain lesions) and safety (grade and frequency of adverse events). Results: Mean follow-up was 8 months. All patients received a previous disease modifying therapy. Annualized relapse rate (ARR) in the year before DMF start was 0.56 and 48% of patients had an active brain MRI in the six months before starting therapy. At baseline median EDSS was.5. ARR after DMF start was 0.3 (p>0.05). Median EDSS at last follow-up was 2. 40% of patients showed active brain lesions (i.e. new or enlarging T2 lesions and/or gadoliniumenhancing lesions). Half of patients presented gastrointestinal side effects and/or flushing; the first subsided after the one month of treatment while the latter was more persistent. We observed grade 3 lymphopenia in two patients (8%) and treatment was interrupted with normalization of values. 2 patients (8%) referred transient mild arthralgies. Conclusion: Our data confirm that DMF is generally well tolerated, but a longer follow-up and a wider sample size are needed to draw conclusions about efficacy. 205 European Journal of Neurology, 22 (Suppl. ),

275 758 Flash Posters F349 Central nervous system vasculitis with selective involvement of the left hemisphere F. Sangalli, M. Radaelli, L. Moiola, M. Rodegher, E. Agordati 2, G. Comi, V. Martinelli San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Department of Neurology, Milan, Italy, 2 San Raffaele Hospital, neurlogy, Milan, Italy Background and aims: Isolated Central Nervous System (CNS) Vasculitis diagnosis is challenging, being it limited to the CNS. Methods: To report 3 cases of persistent hemilateralized Isolated CNS Vasculitis Results: ) 43-year-old female with occipital seizures. A brain MRI showed cortical-subcortical lesions in the left frontal and occipital lobes with Gd-enhancement. The cerebrospinal fluid (CSF) was normal. She developed gait disturbances. She was treated with steroids and Cyclophosphamide with benefits. The following MRIs showed a moderately increased number of lesions, involving only the left cerebral-infratentorial structures. 2) 33-year-old female with memory and language difficulties. A brain MRI showed moderate atrophy of the left cerebral hemisphere and multiple (mostly white matter) lesions in the left cerebral-infratentorial structures. CSF analysis detected oligoclonal bands. Her cognitive impairment worsened. The brain MRI showed an increased number of white matter enhancing lesions and left hemiatrophy of the brain. She was treated with Alemtuzumab with benefits. 3) 64-year-old female with a pseudotumoral hyperintense lesion in the left hemisphere. The CSF was normal. She was treated with steroids with partial benefit. During steroid tapering the lesion worsened causing seizures. She was treated with Cyclophosphamide with partial control of the disease and then with Rituximab. Their brain biopsies showed perivascular lymphomononuclear infiltrates, mostly T lymphocytes and macrophages. Few CD20+ B cells were present. The neuropathologic features were consistent with Isolated CNS vasculitis. Conclusion: few patients with a selective and persistent Isolated hemilateralized CNS vasculitis were described so far. Brain biopsy is the gold standard for a definitive diagnosis. F350 Disability progression and recovery from relapses with peginterferon beta-a: interim analysis from ATTAIN, extension of the phase III study - ADVANCE T. Scott, B. Kieseier 2, S. Newsome 3, X. You 4, S. Shang 4, S. Liu 4, S. Hung 4, V. Evilevitch 4, B. Sperling 4 Allegheny General Hospital, Department of Neurology, Pittsburgh, USA, 2 Heinrich-Heine University, Department of Neurology, Düsseldorf, Germany, 3 Johns Hopkins University, Department of Neurology, Baltimore, USA, 4 Biogen Idec Inc., Cambridge, USA Background and aims: ATTAIN is an extension study of ADVANCE, examining long-term safety, tolerability, and disease outcomes of subcutaneous peginterferon beta-a (PEG-IFN) 25 mcg in patients with relapsing-remitting multiple sclerosis (RRMS). This analysis examined 24- week confirmed disability progression (CDP) and recovery from relapse in RRMS patients treated with PEG-IFN over 3 years. Methods: Patients aged 8 65 received PEG-IFN every 2 or 4 weeks or delayed treatment (placebo for Year followed by PEG-IFN for subsequent years). Estimated 24-week CDP (measured by the expanded disability status scale) and rates of CDP due to incomplete recovery from relapse (observed relapses) were compared at Year 3 between patients dosed continuously every 2 or 4 weeks. The estimated proportion of patients with progression was based on the Kaplan-Meier product limit method. Results: The proportion of patients with CDP was significantly smaller in patients treated continuously every 2 weeks with PEG-IFN (8.9%) than patients treated continuously every 4 weeks (5.5%) (HR 0.57, 95% CI 0.37, 0.87; p=0.0098). At the data cut date, among patients experiencing relapses, those treated every 2 weeks had significantly lower rates of CDP due to incomplete recovery from relapse compared with those treated every 4 weeks (9.8% vs 2.0%; 53.2% relative reduction in percentage of patients; p=0.06). Conclusion: In RRMS patients followed long term beyond the phase III stage, continuous treatment with PEG-IFN 25 mcg every 2 weeks reduced the risk of 24-week CDP and the risk of CDP due to incomplete recovery from relapse, compared with continuous treatment every 4 weeks. Disclosure: This study has been sponsored by Biogen Idec Inc. (Cambridge, MA, USA). 205 European Journal of Neurology, 22 (Suppl. ),

276 Flash Posters 759 F35 Lymphocyte pharmacodynamics and safety of fingolimod in patients previously treated with alemtuzumab K. Selmaj, A.D. Bass 2, K.R. Edwards 3, P.S. Sørensen 4, D.H. Margolin 5, L. Kasten 6, J.A. Cohen 7 Medical University of Łódź, Łódź, Poland, 2 Neurology Center of San Antonio, San Antonio, USA, 3 Multiple Sclerosis Center of Northeastern New York, Latham, USA, 4 Danish Multiple Sclerosis Center, Rigshospitalet, Copenhagen, Denmark, 5 Genzyme, a Sanofi company, Cambridge, USA, 6 PROMETRIKA LLC, Cambridge, USA, 7 Cleveland Clinic, Cleveland, Cleveland, USA Background and aims: Alemtuzumab had superior efficacy versus subcutaneous interferon beta-a (SC IFNB-a) in phase 2 (CAMMS223 [NCT ]) and 3 (CARE- MS I [NCT ]; CARE-MS II [NCT ]) studies in relapsing-remitting multiple sclerosis. We assessed lymphocyte pharmacodynamics and safety in patients who initiated fingolimod after alemtuzumab in extension (NCT ) of these trials. Methods: In core studies, patients who were treatmentnaïve or had inadequate efficacy response to prior diseasemodifying therapy ( relapse after 6 months) received 2 annual courses of alemtuzumab 2 or 24mg, or SC IFNB- a 44µg 3 times/week. In extension, alemtuzumab-treated patients could receive as-needed retreatment; SC IFNB- a treated patients switched to alemtuzumab. Other therapies, including fingolimod, were permitted in the extension. Lymphocyte counts were obtained every 3 or 6 months and in the month after each alemtuzumab course. Results: Of 3 patients receiving fingolimod after alemtuzumab,, 6, 5, and patients had, 2, 3, and 4 alemtuzumab courses, respectively. Mean (SD) time from last alemtuzumab dose to fingolimod initiation was 2.0 (.54) years; mean follow-up after fingolimod initiation was.4 (0.70) years. T- and B-lymphocyte counts increased following the last dose of alemtuzumab, and decreased following initiation of fingolimod, consistent with known effects. No adverse event (AE) types predominated during fingolimod treatment. Two patients experienced serious AEs after fingolimod initiation (syncope in patient and subacute pericarditis, basal cell carcinoma, and papillary thyroid cancer in another). Conclusion: Lymphocyte counts in patients who switched from alemtuzumab to fingolimod were consistent with known pharmacodynamic effects of each drug. No consistent AE trends were observed. Disclosure: Study supported by Genzyme, a Sanofi company, and Bayer Healthcare Pharmaceuticals. F352 Influence of fatigue on sexual function of the multiple sclerosis patients N. Radzikhovska, L. Sokolova Bogomolets National Medical University, Neurology, Kiev, Ukraine Background and aims: The sexual function (SF) disorders in patients with multiple sclerosis (MS) and the contributing factors are still pressing issues. The objective - discovering influence of fatigue on SF in MS patients. Methods and Materials: There were 23 MS patients (63 female and 60 male) examined and partners of 63 female patients interviewed. The average age of patients was 32.9±6.6 years. The patients were tested with anonymous questionnaires by scale in order to measure the SF (MFSQ, IIEF, SEAR by counting the total number of points - TNP) and fatigue (MFIS). Results: 74.8% of patients had a SF disorder. Deterioration of sexual relationships were observed in 35.7% of MS patients. 96.7% of patients showed signs of fatigue. All patients with fatigue symptoms had SF disorder. Male patients with fatigue symptoms demonstrated statistically significant decrease of SF by all factors. Female patients experienced SF deterioration influenced by fatigue. Deterioration in relations between partners in more evident level of fatigue is described (males: minor fatigue 0-2 points - TNP is 78.8±.2; moderate ±5.3; evident ±9.6; severe - 3.2±24.0, p 0.05; females: minor fatigue 0-2 points - TNP is 77.6±0.8; moderate ±9.0; evident ±0.7; severe ±9.5, p 0,05). Conclusion: Male and female MS patients demonstrated deterioration of SF with escalating fatigue. The sexual relations between partners with tendency to deterioration are significantly effected by fatigue. 205 European Journal of Neurology, 22 (Suppl. ),

277 760 Flash Posters F353 Mesenteric lymph nodes (MLN) T-cell subpopulations changes in the model of experimental autoimmune encephalomyelitis (EAE) under the influence of immunomodulatory therapy D. Kiselev, N. Spirin, T. Rumyantseva 2, D. Pozhilov 2 YSMU, Neurology, Yaroslavl, Russian Federation, 2 YSMU, Anatomy, Yaroslavl, Russian Federation Background and aims: In view of modern hypotheses about the possible role of intestinal microbiota and intestinal lymphoid tissue (ILT) in the pathogenesis of multiple sclerosis, it is actual for the study the condition of MLN T-cell subpopulations during EAE development including under the influence of immunomodulatory therapy. Methods: We studied 40 mice C57BI / 6 EAE (00ug/kg MOG 35-55) of three groups: control, EAE untreated and EAE treated by Fingolimod (0,3 mg / kg one time a day th to 25th day per os). Immunohistochemically typed CD4 and CD8 + in MLN on the 0 th, 5 th, 20 th, 30 th and 50 th days. Neurological symptoms were assessed using clinical index. Results: Compared with the control group the development of EAE accompanied by an increase density of both studied MLN T-cell subsets. During the first two weeks there was a predominant increase in the density of CD4 and later till the last (50 th ) day СD8 cells. Fingolimod therapy during the entire period of observation was accompanied by the development of less severe neurological symptoms and higher levels of CD4 and CD8 versus to the group without treatment, but CD8 increase was more prominent and prolonged. Conclusion: The CD4, CD8-cells density phasic changes, observed in MLN, indirectly support the theory of ILT involvement in autoimmune demyelination pathogenesis. Fingolimod therapy led to the accumulation of CD4 and especially CD8 cells in MLN and therefore to their exclusion from the pathological process, which in combination with neurological symptoms reduction indicates on treatment efficacy. 205 European Journal of Neurology, 22 (Suppl. ),

278 Flash Posters 76 Neuroimaging 2 F354 Unusual periprocedural complication during aneurysm embolization A.C. Mergeani, O. Rusu, A. Ciobotaru, B. Dorobat 2, A. Dimitriade, O.A. Bajenaru, F. Antochi University Emergency Hospital Bucharest, Neurology, Bucharest, Romania, 2 University Emergency Hospital Bucharest, Interventional Neuroradiology, Bucharest, Romania Background and aims: Endovascular treatment of intracranial aneurysms still has risks although a lot of technological improvements have been made and a lot of experience has been earned. The aim of our study is to present a case where the middle cerebral artery(mca) was occluded during angiography before starting the aneurysm embolization for the anterior comunicating artery(acoa) Case Report: A 60-year-old female was admitted to our hospital with severe headache and vomiting. The neurological exam revealed neck stiffness. The CT scan showed subarachnoid hemorrhage(sah). Cerebral angiography with four vessel study demonstrated a 5 mm, narrow neck ACoA aneurysm. We decided to perform embolization with coils but before beginning the procedure she developed right hemiparesis and aphasia and the left MCA-M was occluded. Results: We started the administration of intra-arterial nimodipine and heparine at the site of the occlusion with improvement of neurologic symptoms and repermeabilization of MCA. The embolization was performed with 3 coils without any complications, with complete occlusion of the aneurysm. Repeated CT scan showed a similar aspect. The patient was discharged without neurological deficits. Conclusion: We choose to present this case to underline that although during the latest years, the endovascular treatment of intracranial aneurysms with detachable coils has rapidly evolved, the vasospasm secondary to SAH may be responsible for severe ischemic complications during angiography and administration of intra-arterial nimodipine seems to be effective in reducing these risks. It is important to highlight that endovascular treatment still has risks of morbidity and mortality despite increasing clinical experience and technological improvements. F355 Moyamoya-like vasculopathy different clinical presentations A.C. Mergeani, O. Rusu, A. Ciobotaru, A. Dimitriade, B. Dorobat 2, O.A. Bajenaru, F. Antochi University Emergency Hospital Bucharest, Neurology, Bucharest, Romania, 2 University Emergency Hospital Bucharest, Interventional Neuroradiology, Bucharest, Romania Background and aims: Moyamoya syndrome refers to radiological features that resembles idiopathic moyamoya disease and coexist with other conditions that can explain the vasculopathy. The aim of our study is to present two cases of moyamoya-like vasculopathy, manifested as ischemic or hemorrhagic stroke, rarely described in the literature. Case Report: We present a case of a 55-years-old female with known history of tuberculous meningitis and B virus hepatitis, admitted to our clinic for intraventricular hemorrhage. The digital substraction angiography (DSA) of the cervico-cerebral arteries showed occlusive lesions and abnormal collateral vessels similar to those observed in moyamoya disease. During hospitalization she developed secondary hydrocephalus. Our second case is a 53-year-old male, heavy smoker, with prior tonsillopharyngitis three weeks before, admitted to our clinic for suspicion of acute encephalomyelitis (ADEM). The initial cerebral MRI was suggestive for inflammatory lesions, but the second MRI combined with MR spectroscopy and MR angiography suggested a vascular pathology of the larger lesions and also raised the suspicion of moyamoya-like vasculopathy confirmed by DSA. High levels of TPO antibodies and lupus anticoagulant were found. Results: The female patient was transferred to the neurosurgery clinic for ventriculo-peritoneal shunt and was discharged without hemorrhage or hydrocephalus. The second patient received treatment with intravenous immunoglobulins, antiplatelet therapy and corticoids followed by immunosuppressants with almost complete symptoms remission. Conclusion: These cases highlight the importance and usefulness of DSA in diagnosing rare cases of moyamoyalike vasculopathy secondary to tuberculous meningitis or immune conditions even in patients with elevated thyroid autoantibodies. 205 European Journal of Neurology, 22 (Suppl. ),

279 762 Flash Posters F356 Quantification of corpus callosum regional atrophy in multiple sclerosis M. Pawlak, J. Wencel, A. Kalinowska-Łyszczarz 2, E. Kotecka 3, D. Gulczynska 3, R. Kaźmierski 4 Poznan, Poland, 2 Poznan University of Medical Sciences, Department of Neurology, Poznan, Poland, 3 L. Bierkowski Hospital, Department of Radiology, Poznan, Poland, 4 Poznan University of Medical Sciences, Department of Neurology and Cerebrovascular Disorders, Poznan, Poland Background and aims: Inflammatory lesions localized in white matter contribute to axonal loss and in consequence gradually lead to atrophy of corpus callosum (CC) that develops over time. We aim to identify the CC subregions capable of discriminating patients with multiple sclerosis (MS) from age and gender matched normal controls. Methods: We analyzed T-weighted MRI data from 204 MS patients (65% female) and 204 age and gender matched controls from Brain-Development database. Median age for both groups was 32 years (IQR 26-39, Range 9-53). Automatic measurement of CC cross-sectional area was performed in mid-sagittal plane using Yuki from Automatic Registration Toolbox. Statistical analysis was performed using R-CRAN and Receiver Operator Characteristic. Total cross sectional area and subsections based on Hampel and Witelson were assessed as predictors. Results: Total CC cross sectional area was characterized by area under the curve (AUC) 0.73 with maximal accuracy 68%, sensitivity and specificity 68%. Subsections of the corpus callosum based on Hampel indicated that splenium (AUC 0.75) and mid-section (AUC 0.73) were good predictors for MS. Remaining regions had lower discrimination ability (W=0.50, W2=0.70, W3=0.64, W4=0.73, W5=0.70, W6=0.7, W7=0.75). Analysis based on Witelson subsections identified genu and splenium as good predictors (C=0.74, C2=0.66, C3=0.62, C4=0.63, C5=0.78). There was a difference in AUC for total CC area between female (AUC0.75) and male patients (AUC0.72). Conclusion: The most affected regions discriminating MS patients from normal controls include mid anterior region and splenium of the corpus callosum. Disclosure: Grant support: Polish National Science Centre grant 20/0/D/NZ4/0580(MAP) F357 Clinical and radiological features in non-inflammatory acquired disorders of the corpus callosum. 8 case studies A. Riahi, I. Bedoui, H. Derbali, M. Messelmani, M. Mansour, J. Zaouali, R. Mrissa Military Hospital of Tunis, Neurology department, Tunis, Tunisia Background and aims: The corpus callosum (CC) represents a large cerebral white matter structure. It connects the left and right cerebral hemispheres and facilitates interhemispheric communication. Thus, its isolated non-inflammatory disorders remain rare. We report herein a series study of patients with isolated CC lesions. Methods: Patients with isolated CC acquired disorder were included. Multiple sclerosis and other inflammatory diseases were excluded. We discuss the clinical signs, the radiological features on brain imaging (CT scan and brain MRI for all patients, angioscanner, angio-mr or Spectroscopy depending to the etiology) and the short term outcome after an appropriate treatment. Results: Eight patients (5 male, 3 female) were recruited. Mean age was 47 years (28 76 years). Diagnosis were isolated CC infraction (2 patients), hemorrhage (4 patients), encephalitis ( patient) and lymphoma ( patient). Clinical manifestations were intracranial hypertension in hemorrhagic patients, consciousness impairment in encephalitis and lymphoma patients. Dysarthria and apraxia in the stroke cases. Brain imaging (CT scans and MRI) were conducted in all cases. In the hemorrhage group, three patients presented anterior communicant artery aneurysm and one presented an arteriovenous malformation. Short-term prognosis was depending on the etiology and treatment of each patient. Conclusion: Clinical correlation in CC lesion is poor, since our patients presented mostly with non-specific signs. Control examinations with advanced neuropsychological assessment are needed to study the long-term outcome of these lesions. 205 European Journal of Neurology, 22 (Suppl. ),

280 Flash Posters 763 F358 Postpartum cerebral angiopathy - a challenging diagnosis O. Rusu, A. Ciobotaru, A.C. Mergeani, C.I. Coclitu, S. Frangu, B. Dorobat 2, O.A. Bajenaru, F. Antochi University Emergency Hospital Bucharest, Neurology, Bucharest, Romania, 2 University Emergency Hospital Bucharest, Interventional Neuroradiology, Bucharest, Romania Background and aims: Postpartum cerebral angiopathy is considered a part of the spectrum of reversible cerebral vasoconstriction syndromes. It commonly presents with thunderclap headache, encephalopathy, seizures and/or neurologic deficits. The syndrome may be precipitated by many factors and the pathophysiology is unclear, different hypotheses being discussed. Case Report: We report a case of a 28-year-old patient, with medical history of uninvestigated spontaneous abortion, with 40 weeks pregnancy, who presented with occipital headache, visual disturbances, temporo-spatial disorientation within the context of high blood pressure values, for which cesarean section was performed. Neurological examination showed right homonymous hemianopia and mild ataxia of the right arm and of the bilateral lower limbs. The cerebral MRI showed many hyperintensity in T2 and FLAIR, discrete hypointensity in T in vertebro-basilar territory, some of them with diffusion restriction. The cerebral digital substraction angiography revealed multiple stenoses at the level of the ponto-mesencephalic part of the basilar artery and of the left posterior cerebral artery. We performed a screening for procoagulant status, vasculitis, with detection of heterozygous gene MTHFR mutation and and positive anticardiolipin antibodies, the last being negative at repeated blood tests at six months. Results: We administred orally and intra-arterial nimodipine, antiplatelet and symptomatic treatment with partial dilatation of stenoses on further angiographic re-evaluations and partial symptoms recovery. Conclusion: All these findings are suggestive for postpartum cerebral angiopathy and with this case presentation we tried to increase the awareness for rare disorders such as this one, because the delay in diagnosis and treatment may lead to permanent neurological sequelae. F359 Relationship between neuroradiological parameters and morphological abnormalities in experimental hydrocephalus in rabbits K. Senkevich, M. Shevtsov 2 Saint-Petersburg, Russian Federation, 2 Saint Petersburg, Russian Federation Background and aims: Analysis of the correlation between neuroradiological parameters and morphological abnormalities was performed in the model of acute obstructive hydrocephalus. Methods: Two groups of New Zealand rabbits were analyzed as follows (0 animals each): () experimental group with hydrocephalus; (2) control group (sham-operation). For induction of hydrocephalus kaolin was stereotactically injected into the lateral ventricle. Phosphate-buffer solution was used in control rabbits. Following 2 and 4 weeks after the operation MR brain scans were obtained. Regional fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured in regions of interest before and after injection of kaolin. At the end of observation period the brains were assessed histologically with Hematoxylin- Eosin and Kluver-Barrera s methods. Additionally the morphology of blood-brain barrier and myelinated nerve fibers was assessed with the help of transmission electron microscopy (TEM). Results: As measured by MRI ventricles were significantly enlarged. Dilatated ventricles compressed the basal cisterns and caused brain shift and periventricular edema. FA values were significantly reduced in the periventricular areas. The values of ADC in the periventricular and periaqueductal areas were significantly elevated in the experimental group (P<0.05). Subsequent histological analysis established the impairment of white matter and necrobiotic changes in the cortex. TEM demonstrated damage of the myelin sheaths and blood-brain barrier in all animals. Conclusion: The study revealed the correlation of the neuroradiological parameters with morphological abnormalities in the white matter and blood-brain barrier thus indicating the clinical application of these parameters for the diagnostics and management of hydrocephalus. 205 European Journal of Neurology, 22 (Suppl. ),

281 764 Flash Posters F360 The blood flow rate dynamics through the internal carotid arteries in patients with chronic cerebral ischemia using magnetic resonance imaging Y. Stankevich, O. Bogomyakova, L. Shraibman, A. Tulupov The Institute International Tomography Center of the Russian Academy of Sciences, Laboratory of translational brain research, Novosibirsk, Russian Federation Background and aims: The atherosclerotic lesions and deformation of the internal carotid arteries (ICA) are more often causes of the cerebral ischemic disorders. The aim of the study was to quantify the arterial blood flow through the ICA at patients with chronic cerebral ischemia using magnetic resonance imaging. Methods: The 50 control subjects and 0 patients with chronic cerebral ischemia were examined on a.5t MRscanner. The routine brain MR-protocol was used for verification chronic cerebral ischemia. The symmetry, deformation, stenosis of the ICA was determined using 3D phase-contrast magnetic resonance angiography (PC- MRA). The values of peak, mean (linear), flux velocities of arterial blood flow and cross-sectional area depending on of the cardiac cycle were defined through the 5 parts of the ICA (Fig.) using quantitative 2D PC-MRA retrospectively cardiac triggered and post processing program (Fig.2). Results: The absolute values of the flux, mean (linear), peak velocities and cross-sectional area were obtained for control group and patients with chronic cerebral ischemia through the ICA (Fig.3). The reduction of the mean (linear) velocity was the most significant comparison flux and peak velocities. It is about 37% at the cervical ICA segment. Cross-sectional area is significantly highly at all segments of the ICA. The absolute values of the flux velocity (a), peak velocity (b), mean (linear) velocity (c) and cross-sectional area (d) through the investigated parts of the ICA. * - indicate significant differences. Conclusion: Quantitative 2D PC-MRA could be successfully applied to quantification of arterial blood flow. The values of the blood flow velocities and cross-sectional area are significantly different at patients with chronic cerebral ischemia comparison control group through the cervical and intracranial ICA segments. Disclosure: This work was financially supported by the Russian Science Foundation (project # ) Fig. : 3D PC-MRA (coronal projection). The investigated segments of the ICA and the orientation of the quantitative 2D PC-MRA scans. Types of the images obtained by the quantitative 2D PC-MRA technique: a) the fast field echo; b) phase contrast mode; c) the phase difference (rate) - values by brightness; d) colour images; f) - table and curve denpendig velocities on the cardiac cycle. 205 European Journal of Neurology, 22 (Suppl. ),

282 Flash Posters 765 F36 A case of probable sporadic Creutzfeldt- Jakob disease (scjd) with atypical clinical onset, psychiatric features, and positive pulvinar sign mimicking variant Creutzfeldt-Jakob disease (vcjd). M.H. Torregrosa Martinez, M. León Ruiz, M. Molina Sánchez, P. Hernández Navarro, M.Á. García Soldevilla Hospital Universitario Príncipe de Asturias, Neurology, Madrid, Spain Background and aims: CJD is the most frequent of human prion diseases and most of the cases are sporadic. Magnetic Resonance Imaging (MRI) of CJD can show very specific abnormalities, aiding correct diagnosis. Pulvinar thalami symmetrical high signal known as pulvinar sign is characteristic of vcjd and is a diagnostic criteria of probable vcjd. Case Report: A 74-year-old woman suffered a progressive gait and cognitive functions impairment in three months, which was previously preceded by psychiatric symptoms. The initial clinical examination revealed partial disorientation, inattention, and gait and limb ataxia. Following clinical onset, the patient developed progressive deterioration, startle myoclonus, akinetic mutism, and finally died after 3 months. Results: Electroencephalogram had no periodic sharpwave complexes. The protein was positive in cerebrospinal fluid. The MRI showed bilateral and symmetrical lesions in putamen, caudate and pulvinar talami hyperintenses in T2, FLAIR and diffusion signal intensity sequences in MRI, showing the greater hyperintensity in pulvinar. Codon 29 polymorphism: methionine/valine heterozygous (MV2). Necropsy was not possible because of family s refusal. Bilateral and symmetrical lesions in putamen, caudate and pulvinar talami hyperintenses in diffusion signal intensity sequence, showing the greater hyperintensity in pulvinar. Conclusion: A case of probable scjd with pulvinar sign and atypical onset with psychiatric symptoms commonly seen in vcjd has been reported. Clinical similarity between scjd and vcjd is not so uncommon, especially in rare variants of scjd associated with a MV or VV polymorphism on codon 29. These variants of scjd may be also associated with radiologic findings more typical of vcjd. All of this points to the fact that pulvinar sign could be considered indicative of vcjd but not pathognomonic. Bilateral and symmetrical lesions in putamen, caudate and pulvinar talami hyperintenses in FLAIR sequence, showing the greater hyperintensity in pulvinar. 205 European Journal of Neurology, 22 (Suppl. ),

283 766 Flash Posters F362 Hypertensive brainstem encephalopathy: clinical and radiographic features W. Zheng, C. Wu, X. Chen The Second Affiliated Hospital, Medical College of Shantou University, Radiology, Shantou, China Background and aims: Most studies of hypertensive encephalopathy have observed the predominantly supratentorial distribution of these abnormalities. We present four patients with hypertensive encephalopathy and CT/MRI features suggestive of prominent brainstem involvement. Methods: 4 patients were admitted to our hospital for headache for -3 days, two of them also with visual disturbances, and with left-sided weakness. Blood pressure at admission was 220/30-250/50mm Hg. All of their past medical histories were without hypertension. Among them, 3 were with alcohol abuse and was occupationally exposed to,2-dce for six months.emergency computed tomographic (CT) scan of the brain were performed immediately and MRI were performed within 2 days after admission. Results: CT scan of the brain revealed there were relative hypodensity of the brainstem. Brain MRI showed diffuse high-signal intensities on T2-weighted images and without gadolinium enhancement in the pons and midbrain. No high signal intensities in diffusion-weighted images (DWI) and high signal intensities in apparent diffusion coefficient (ADC) images. All the patients showed significant clinical and radiological improvement after prompt treatment of hypertension. Conclusion: Hypertensive encephalopathy presenting with predominant involvement of the brainstem must be differentiated from brainstem infarction toxic encephalopathy or infectious encephalitis. The absence of brainstem signs and symptoms on physical examination, combined with the rapid clinical improvement upon treatment of hypertension, must be correlated with the pattern of brainstem involvement on CT/MR imaging. Disclosure: This study was supported by the Natural Science Foundation of Guangdong Province, China (204), Shantou University Medical College Clinical Research Enhancement Initiative (204), Shantou, China and was sponsored by Science and Technology Planning Project of Shantou City, China (Grant no ), Shantou, China. F363 Dynamics of cerebral blood flow during a prolonged aura M. Yger, B. Bignami 2, A. Léger 2, S. Belkacem 3, Y. Samson 2 hôpital Saint Antoine, neurology, Paris, France, 2 groupe hospitalier Pitié Salépétrière, stroke unit, Paris, France, 3 groupe hospitalier Pitié Salépétrière, neuroradiology, Paris, France Background and aims: The dynamics of cerebral blood flow during a migrainous aura has been described in few cases and remains a matter of debate. We report sequential images of the cerebral blood flow during a prolonged aura, using an arterial spin labeling sequence. Methods: A 49-year-old woman was addressed to our stroke unit because of an acute aphasia. The MRI was done at 3 hours of evolution of the symptomatology, and was normal. We used an arterial spin labeling (ASL) sequence to apprehend the cerebral blood flow during this episode. Other diagnoses than migraine were ruled out by a lumbar puncture and electroencephalography which were unremarkable. Results: The ASL sequence has shown a relative hypoperfusion of the whole left hemisphere at day 0, a relative hyperperfusion of the whole left hemisphere at day and a symmetric perfusion at day 3. Because of the normality of the explorations, we have concluded to a prolonged aura. Conclusion: The ASL, a non invasive sequence, could help clinicians to precise the diagnosis during an acute neurologic episode and may also contribute to decrypt the vascular modifications occurring during migraine. 205 European Journal of Neurology, 22 (Suppl. ),

284 Flash Posters 767 F364 Study of diffusion kurtosis imaging in patients with mild traumatic brain injury L. Kong, W. Fan, W. Zheng, C. Wu The Second Affiliated Hospital, Medical College of Shantou University, Radiology, Shantou, China Diffusional kurtosis imaging (DKI) is an extension of Diffusion tensor imaging but includes non-gaussian diffusion effects, allowing more comprehensive characterization of microstructural changes following traumatic brain injury. In this study, the quantitative MR imaging technique DKI was used to measure microstructural changes in the multiple gray matter and white matter structures within 20 days following mild traumatic brain injury(mtbi). Methods: 22 patients with mtbi (0 female and 2male, age: 35±0.58) and 0 controls (5 female and 5male, age: 28±0.60) underwent both conventional MRI and DKI at GE 3T MR imaging scanner. MD, Da, Dr, MK, Ka and Kr were measured in the the centrum semiovale, genu and splenium of corpus callosum,thalamus, internal capsule,optic radiation, hippocampus, brainstem, middle cerebellar peduncle,vermiform process of cerebellum, cerebellar hemisphere by using region-of-interest analysis. After MRI scan, a neuropsychological battery designed to yield measures. Results: Patients with mtbi showed significant differences to controls for DKI measures in various gray matter and white matter regions. Compared with control group, MD Dr revealed a significant increase in thalamus,hippocampus (p<0.05, all) and MK Ka Kr revealed a significant decrease in thalamus and also in one or more other regions(p<0.05, all). F365 Magnetic resonance changes with spectroscopy and diffusion tensor imaging in patients with Diabetes Mellitus W. Zheng, H. Zhang, L. Chen, C. Wu The Second Affiliated Hospital, Medical College of Shantou University, Radiology, shantou, China Background and aims: To investigate microstructural and metabolite concentrations alterations in patients with diabetes mellitus (DM) by using the diffusion tensor imaging (DTI) and magnetic resonance spectroscopy MRS. Methods: 43 patients with diabetes mellitus (group A) and 39 patients without diabetes mellitus but with hypertension and lipid metabolism disorder (group B ) and 30 age matched healthy control subjects were studied by conventional MR imaging, MRS and DTI. The basic medical history blood glucose level blood lipid level, blood pressure, and cognitive function status assessed by the Mini-Menial State Examination (MMSE) were collected successfully. Results: Conventional MR imaging showed the number of patients with brain atrophy and leukoareosis in group A were obviously higher than those in group B (P<0.0 both). Compared with control group DTI and MRS display mean FA values, NAA/Cr and NAA/Cho values decreased, and mean ADC values increased in centrum semiovale in both group A and B. (P<0.0 all). MMSE were correlated to FA values (r=0.70; P<0.0) but not correlated to ADC values, NAA/Cr values and Cho/Cr values in diabetic group. Fig. ROIs in the centrum semiovale. A. original DKI image B.MD map C.MK map Conclusion: These data demonstrate that DKI facilitate the detection of subtle brain tissue injury in thalamus, hippocampus and white matters of mtbi patients.dki may be sensitive in detecting pathophysiological changes in gray matter and white matter structures associated with mtbi, which is more sensitive than conventional MRI might be useful for explaining cognitive impairment. Disclosure: This study was supported by the Natural Science Foundation of Guangdong Province, China (204), Shantou University Medical College Clinical Research Enhancement Initiative (204), Shantou, China and was sponsored by Science and Technology Planning Project of Shantou City, China (Grant no ), Shantou, China. Location map of MRS and DTI (L: location map of MRS; R: location map of FA map) Conclusion: Patients with DM2 performed worse MMSEscore compared to non- diabetic patients who with hypertension and lipid metabolism disorder. The difference of DTI and MRS between diabetic and controls indicated that there are variation of cerebral white matter fiber bundles and cerebral metabolite in diabetics. MMSE showed strong correlation to DTI in diabetic brains. It provides evidence that DTI identifies axonal disruption in white matter tracts and detects cognitive impairment in DM patients even with no abnormalities brain MRI. Disclosure: This study was supported by the Natural Science Foundation of Guangdong Province, China (204), Shantou University Medical College Clinical Research Enhancement Initiative (204), Shantou, China and was sponsored by Science and Technology Planning Project of Shantou City, China (Grant no ), Shantou, China. 205 European Journal of Neurology, 22 (Suppl. ),

285 768 Flash Posters Tuesday, June Cerebrovascular diseases 6 F400 Abstract cancelled F4002 Features of fatal and nonfatal outcomes I. Severyn Kharkov, Ukraine Background and aims: Identification of factors influencing the outcome of ischemic and hemorrhagic stroke in the acute period. Methods: The data of 09 patients in the acute period of stroke were studied. Results: All patients were divided into 2 groups: -870 survival and group 2: 22 dead. The average age of patients was 66.5 (±0.34) years in the st group, and 68.2 (±0.74) years in the 2 nd. The ratio among men and women in two groups was similar. In ischemic stroke factors affecting the outcome were hypertension, myocardial infarction in history and diabetes mellitus; in acute hemorrhagic stroke none of these risk factors and none of the comorbidities were not associated with outcomes. The mortality rate depended on the previous antihypertensive therapy in patients. The dependence of outcomes on type of the lesion in the brain, its location and size was revealed. Deaths correlated with right-sided localisation of the lesion and its large size. Changes in the patient s system physiological characteristics also had a significant impact on the outcome of stroke. Conclusion: The correlations of stroke outcomes with age, physical characteristics of the patient, comorbidities and risk factors, type of stroke, treatment in the acute period was seen. The enhancing of stroke outcome is possible through improvement of primary and secondary prevention measures, as well as respecting in practice of stroke care modern algorithms on pre-hospital and hospital stages. F4003 The ASCO ischemic stroke phenotyping as compared to TOAST reduces the proportion of the patients with undertermined causes and may be associated with stroke outcome S. Likchachev, E. Sidorovich, Y. Shabalina 2 National Research and Clinical Center Of Neurology and Neurosurgery, neurological, Minsk, Belarus, 2 Minsk city emergency hospital, neurological, Minsk, Belarus Background and aims: ASCO phenotyping (A: atherosclerosis; S: small-vessel disease; C: cardiac pathology; O: other causes) assigns a degree of likelihood of causal relationship to every potential disease commonly encountered in ischemic stroke (IS) describing all underlying diseases in every patient. That s why ASCO phenotyping may be better than other methods for classifying ischemic stroke (IS) in clinical practice. The aim of this study was to assess the advantages of ASCO phenotyping in clinical practice. Methods: We prospectively assigned 223 consecutive IS patients for the subtype classification using TOAST and ASCO phenotyping. Results: In 45 IS patients their etiological subtypes categorised by the TOAST criteria were in agreement with ASCO phenotyping: atherothrombotic IS was diagnosed in 46 (20.6%) patients, cardiogenic stroke - in 44 (9.7%) and small vessel disease was diagnosed in 55 (24.7%) patients. In 73 patients classified by TOAST as cause undetermined the ASCO phenotyping allowed to identify and range the phenotype categories combinations: AS0,3CO0 in 40 (54.8%) patients, AS0,3CO0 - in 5 (20.5%), A0, 3SCO0 in 8 (24.6%) ones, and only 5 (2.2%) patients remained completely undetermined (A0,3S0C0O0). The patients with the overlap of ASCO high risk categories had more severe IS (NIHSS 3.8±6.7 vs 9.8±5.6, P=0.002) and higher mortality (2/73-6.4% vs 7/45-4.8%, P=0.0) compared to the patients with one leading cause. Conclusion: ASCO phenotyping creates the IS etiological profile in order to improve the treatment and prevention strategies for a given patient, reduces the proportion of cause undetermined patients and may be associated with stroke severity and outcome. 205 European Journal of Neurology, 22 (Suppl. ),

286 Flash Posters 769 F4004 Analysis of the outcome and the circumstances of 00 intravenous thrombolyses performed in our ward I. Sipos, A. Lindner, D. Bereczki Semmelweis University, Department of Neurology, Budapest, Hungary Background and aims: 00 intravenous thrombolyses were performed between March 202 and January 205 in our clinic. In this study we established the fields of success and the needs to improve. Methods: Our center provides acute stroke treatment to 800,000 people, approximately. This population could be divided into two groups according two the distance from the hospital: a 3km group (two districts of Budapest) and a 35km group (a suburban county). The time-window of thrombolysis was 4.5 hours. This number of events provides a sufficient data pool for detailed analysis. Results: The mean stroke-to-door time 44 versus 58 minutes, respectively did not differ significantly in the 3km and the 35km subgroups. The average door-to-needle time was 93 minutes. The average age of the patients was 66 and there was no significant difference by the gender representation (5 male and 49 female). The cause of acute ischemic stroke was mainly atherosclerotic origin (7%), while atrial fibrillation was detected in 29% of the cases. The average NHISS score was 2±6.2. The general outcome, measured on the modified Rankin (mr) scale at the patients dismissal, was.9. Among the patients 42% recovered well (mr 0-), 38% improved moderately (mr 2-3) and 20% were not improved (mr 4-5). Hemorrhagic transformation was seen only in one patient, however it was lethal. Conclusion: The success rate of the thrombolysis was good and comparable to the international results. The similar stroke-to-door time in the two subgroups, despite the significant difference in the distance from the hospital, requires further analysis. F4005 Cerebral venous thrombosis: clinical, genetic and neuroradiological study of twenty-five cases M. Sparaco, M. Feleppa A.O. G. Rummo, Neurology, Benevento, Italy Background and aims: Cerebral Venous Thrombosis (CVT) is a multifactorial cerebrovascular disease with a wide spectrum of clinical presentations. Herein we aimed to further study the etiology, clinical presentation and outcome of this disease. Methods: We investigated etiological, clinical and imaging features of 25 consecutive adult patients with CVT (8 F, 7M; mean age 40. yrs) admitted to our department from August 2005 to December 203. Diagnosis of CVT was confirmed by brain MRI and MR-venography. All patients underwent an extensive systematic etiological and genetic work-up at admission. Treatment was based on intravenous unfractionated heparin, followed by oral anticoagulation for 6 months or longer. Outcome was evaluated by modified Rankin Scale (mrs) at 3 months. Results: A genetic prothrombotic condition was identified in 68.% of the cases. Oral contraception (OC) was the main acquired predisposing factor for CVT in females (0/8, 55.5%). Headache was the most frequent symptom (23/25, 92%) and it was the sole manifestation of CVT in 8 patients (32.0%). Other frequent CVT presentation features were seizures (9/25, 36.0%), motor deficits (8/25, 32.0%) and aphasia (6/25, 24.0%). The sinus most frequently involved was the transverse sinus (TS) (24/25, 96.0%), either isolated or in association with other sinuses. A complete recovery (mrs = 0-) was observed in 22/25 (88.0%) cases. Conclusion: The presence of an inherited thrombophilia is frequent in patients with CVT. Headache is the most frequent symptom and may be the only clinical presentation of the disease. CVT seems to have a more benign prognosis than previously considered. F4006 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

287 770 Flash Posters F4007 Post-stroke cognitive impairment and bilingualism: a study from the Hyderabad stroke registry K. Subhash, S. Mekala, T.H. Bak 2, J.R. Chaudhuri 3, E. Mioshi 4, B. Surampudi 5, V. Duggirala 6, A. Rajan, S. Alladi Nizam s Institute of Medical Science, Neurology, Hyderabad, India, 2 University of Edinburgh, Edinburgh, United Kingdom, 3 Yashoda Hospitals, Hyderabad, India, 4 University of Cambridge, Cambridge, United Kingdom, 5 IIIT, Hyderabad, India, 6 Osmania University, Hyderabad, India Background and aims: Recent evidence suggests that bilingualism is associated with a delay in age at onset of degenerative dementias, by enhancing cognitive reserve. We hypothesised that it may also impact cognitive outcome after stroke, a major cause of cognitive impairment globally. Our study examines, therefore, whether bilingualism influences cognitive outcome in a large cohort of stroke patients. Methods: Study subjects were consecutive patients in the NIMS stroke registry, Hyderabad, that was initiated to study clinical profile and outcome in consecutive cases of acute stroke. All patients are evaluated in the memory clinic using a standard protocol. Case records of consecutive ischemic stroke patients evaluated between , >8 years, evaluated 3-24 months after stroke, were reviewed. Results: Of the 54 patients, 89 (34.9%) had vascular dementia (VaD), 59 (29.3%) vascular mild cognitive impairment (VaMCI), and 93 (35.7%) were cognitively intact. 36 (58.4%) patients were bilinguals. There were no significant differences between monolinguals and bilinguals in age, vascular risk factor and stroke characteristics. In terms of cognitive outcome, a larger proportion of bilinguals than monolinguals had normal cognition (45.3% vs 22.2%, p=0.000) while the reverse was true for VaMCI (monolinguals=36% vs bilinguals=24.7%, p=0.036) and VaD (monolinguals= 4.8% vs bilinguals=30.%, p=0.05). The predictive value of bilingualism remained significant even when other variables were taken into account (OR, 3.05, CI , p<0.00). Conclusion: Our study suggests that bilingualism predicts a better cognitive outcome after stroke, probably by enhancing cognitive reserve. Disclosure: This study was funded by the Indian Council of Medical Research. F4008 Prevalence of asymptomatic carotid artery stenosis in a metropolitan city of India K. Subhash, S. Alladi, V. Bandaru Nizam s Institute of Medical Sciences, Hyderabad, India Background and aims: Asymptomatic Carotid Artery Stenosis (ACAS) is a marker for stroke, coronary atherosclerosis and death. This study was aimed to find the prevalence of ACAS in individuals >40 years and whether certain high-risk groups should be routinely screened for it. Pattern of atherosclerosis is known to vary in different parts of the world, and there is no data available on this subject from India. Methods: The design of the study is prospective and descriptive. 500 patients over 40 years of age attending neurological out-patient department, without present or past history of stroke or transient ischemic attacks in ocular or hemispheric distribution were subjected to carotid duplex examination with a 7-0MHz Doppler probe. Results: There were 06 men and 484 women. Mean age was 54. years (range years). Overall, significant stenosis in internal carotid arteries (>50% diameter reduction) was detected in 78 (5.2%) patients. Among the subgroups significant carotid artery atherosclerosis was detected in 44/539 (8.%) in hypertensive, 37/348 (0.6%) in diabetics, 29/2 (3.7%) in smokers, 23/235 (9.7%) in alcoholics and 38/26 (4.58%) in subjects with hyperlipidemia. Further, the prevalence was 25/346 (7.2%) in those with two risk factors, 22/39 (5.8%) in those with three risk factors, 2/48 (25%) in those with more than three risk factors, whereas it was only 9/575 (.5%) in those with no risk factors. Conclusion: Individuals, >40 of age, even if asymptomatic for cerebrovascular disease should be screened for carotid stenosis in India, if they have one or more risk factors. Disclosure: This study was funded by the Indian Council of Medical Research. 205 European Journal of Neurology, 22 (Suppl. ),

288 Flash Posters 77 F4009 Hyperfibrinogenemia predicts long-term risk of death after ischemic stroke M. Swarowska, J. Pera, A. Słowik, T. Dziedzic Department of Neurology, Jagiellonian University Medical College, Krakow, Poland Background and aims: In stroke patients higher levels of plasma fibrinogen are associated with increased risk of unfavourable functional outcome and short- term mortality and new cardiovascular events. The aim of our study was to determine the relationship between plasma fibrinogen level and long- term risk of death in ischemic stroke patients. Methods: 736 patients (median age 7; 47.% men) admitted to the stroke unit within 24h after stroke were included. Plasma fibrinogen level was measured on day of hospitalisation. Hyperfibrinogenemia was defined as plasma fibrinogen concentration >3.5g/L. The maximal follow-up period was 84 months. Results: Hyperfibrinogenemia was found in 25.0% of patients. On multivariate logistic regression analysis, after adjustment for age, stroke severity, atrial fibrillation, smoking, white blood cell count, fever, in-hospital pneumonia and hyperglycemia, hyperfibrinogenemia was associated with increased case fatality (HR.7, 95% CI , P<0.0). The patients with hyperfibrinogenemia more often were male, suffered from previous myocardial infarction, had white blood cell count >0,000/uL and the body temperature >37.5C during first 48h of stroke. Conclusion: Hyperfibrinogenemia predicts the long-term risk of death in ischemic stroke patients. F400 Plasma microparticles (MPs) and some hemostatic parameters in relation to acute ischemic stroke severity M. Świtońska, A. Słomka 2, B. Masłowska, E. Żekanowska 2 Jan Biziel University Hospital 2, Neurology and Stroke Care Unit, Bydgoszcz, Poland, 2 Collegium Medicum of Nicolaus Copernicus University, Department of Pathophysiology, Bydgoszcz, Poland Background and aims: Hemostatic disturbances are common findings in ischemic stroke victims. To clarify the role of MPs, TF (tissue factor) and TFPI (tissue factor pathway inhibitor) in ischemic stroke, we analysed their relationship with the National Institutes of Health Stroke Scale (NIHSS) and the Barthel Index (BI). Methods: A total of 73 ischemic stroke patients (mean age, 69.66±.95 years) and 30 healthy individuals were included in this study. The severity of stroke was assessed using the NIHSS (range, 2 9). The BI was used to measure disability of patients (range, 0 00). Plasma MPs procoagulant activity and levels of MPs TF (tissue factor bearing microparticles), total TF and total TFPI were determined by ELISA at the time of stroke diagnosis. Results: Levels of MPs TF and TFPI in stroke patients were significantly higher than those in controls (median,.63pg/ml vs 0.73pg/mL, p<0.00; 4.26ng/mL vs 78.60ng/mL, p=0.005, respectively), whilst a significantly decreased TF levels were observed (82.27pg/mL vs 97.80pg/mL, p<0.00). Among all hemostatic indicators, only positive correlation between TFPI levels and NIHSS score (R=0.3, p=0.04) was found. Additionally, there was a negative correlation between TFPI and the BI score (R= 0.3, p=0.02). Conclusion: These results confirm that TFPI have relevance to pathophysiology of ischemic stroke. 205 European Journal of Neurology, 22 (Suppl. ),

289 772 Flash Posters F40 Predictive model for poor-grade subarachnoid haemorrhage patients in 30-day observation: a 9 year cohort study. S. Szklener, A. Korchut, K. Rejdak Medical University of Lublin, Neurology, Lublin, Poland Background and aims: The purpose of this study was to identify prognostic factors and to create the predictive model based on poor-grade subarachnoid hemorrhage (SAH) population received only supportive symptomatic treatment. Methods: We prospectively reviewed 0 spontaneous SAH patients disqualified from neurosurgical operative treatment due poor clinical condition. Data were collected in a 9 years period. Unfavorable outcome was defined as a modified Rankin Score 5 at 30 days of observation. A multivariable model was used to determine independent predictors of the outcome. Based on collected data, prognostic model was developed and four risk groups of unfavorable outcome were identified. Results: Multivariable logistic regression analysis indicated the World Federation of Neurosurgical Societies Scale score, increasing age, Fisher grade and admission leukocytosis as independent predictive factors. Proposed scale subdivides the study population into four prognostic groups with significantly different outcomes: grade I: probability of favorable outcome 89.9%; grade II: 47.5%; grade III: 4.2%; grade IV: 0%. The ROC curve for the prediction of outcome performed by the new scale had an AUC=0.90 (excellent accuracy). Conclusion: Unfavorable outcome in nonoperated poorgrade SAH patients is strongly predicted by traditional unmodifiable factors like age, amount of bleeding in CT, level of consciousness as well as leukocytosis. A new predictive scale created on above parameters seems to reliably predict the outcome and may contribute to more effective planning of therapeutic management in patients with poorgrade SAH. F402 Significance of inflammation markers in stroke Y. Tamam, E. Akıl 2, B. Tamam 3 Diyarbakir, 2 Dicle University, Diyarbakir, 3 Adana Mental State Hospital, Adana, Turkey Background and aims: Inflammatory markers including acute phase proteins (APP) have been a focus of study to have significant roles during inflammatory processes in ischemic stroke. Course of changes in the levels these proteins during different phases of stroke is not exactly known. The purpose of this study was to determine the changes in plasma levels of different APPs (i.e. haptoglobin [Hp], ceruloplasmin [Cp], high-sensitive C-reactive protein [h- CRP], complement 3 [C3] and complement 4 [C4]) during the first month after ischemic stroke. Methods: The study group consisted of 48 female and 22 male patients (mean age 65± years), who had ischemic stroke. An age-matched control group (47 female and 22 male subjects, mean age 64±9 years) was also included. To evaluate the plasma levels of APPs, the blood samples of patients were taken on admission (day ), and every week (7, 4, 22 and 30 days) after whereas one measurement was performed in control group. In addition, cerebrovascular risk factors were determined. Results: Levels of inflammatory markers were higher in ischemic group than control group. In serial measurements, the levels of h-crp, Hp, and C3 showed alterations during two weeks days after first stroke. The changes in levels of C4 and Cp were not statistically significant. After stroke, h- CRP, C3 reached their peak values on the first week. Conclusion: Results of this study support the significance of inflammation processes and markers after stroke. The differences in levels of APPs as inflammatory markers could be used as predictors of outcome in stroke patients. 205 European Journal of Neurology, 22 (Suppl. ),

290 Flash Posters 773 F403 CADASIL in the differential diagnosis of multiple sclerosis: five case reports O. Taskapilioglu, O. Gorukmez 2, P. Uzun 3, G. Atasay 3, B. Hakyemez 4, T. Yakut 5, M. Bakar 3 Bursa, Turkey, 2 Sevket Yilmaz Egitim Arastirma Hastanesi, Bursa, Turkey, 3 Uludag University Faculty of Medicine, Department of Neurology, Bursa, Turkey, 4 Uludag University Medical Faculty, Radiology, Bursa, Turkey, 5 Uludag University Faculty of Medicine, Medical Genetics, Bursa, Turkey Background and aims: When multiple sclerosis (MS) is considered as a potential diagnosis of a person with neurological symptoms, other causes must be excluded before an MS diagnosis is considered definitive. Magnetic resonance imaging (MRI) is a tool frequently used by neurologists as a sensitive non-invasive way of imaging the brain, spinal cord or other areas of the body. One of the diseases included in the wide list of differential diagnosis of MS is cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). It may be misdiagnosed as MS especially when its characteristic MRI features, such as anterior temporal pole involvement, are absent. Methods: 5 patients who had been diagnosed as CADASIL during last two years are presented here. 2 of them had received MS diagnosis and treatment for some time. Cranial MRI in 3 of them lead to CADASIL diagnosis. Results: Each case has been discussed. Conclusion: Unfortunately, MS is a disease that has been considered for all white spots in cranial MRI reports in Turkey. Neurologists are trained to evaluate MRI but official reports sometimes may lead them to consider MS in the differential diagnosis of CADASIL even the lesions are not typical of MS. By presenting these five cases we would like to to underline the importance of evaluation of patients as a whole with signs and symptoms, neurological findings, and cranial MRI (not only with cranial MRI). F404 The value of ultrasound detected atherosclerosis in carotid arteries for the prediction of stroke in males and females. T. Tegos, A. Kiryttopoulos, T. Kalatha, S. Kouvavas, K. Notas, A. Petrakis, A. Valavanis, C. Xeras, A. Papadimitriou, A. Orologas AHEPA Hospital, st Department of Neurology, Thessaloniki, Greece Background and aims: Previous studies demonstrated that carotid atherosclerotic ultrasound findings are associated with stroke. The aim of this study was to determine the association of carotid ultrasound findings with stroke in males and females. Methods: Analysis involved imaging by duplex of carotid arteries of 2,360 patients (,286 males,,074 females, mean age: 66.0 years), to detect the presence of plaque and to assess the intima-media thickness (IMT). Stroke (n=49) was one of the reasons for referral to laboratory, as diagnosed on clinical and brain CT grounds. Each vessel was assigned a score (presence of plaque=, absence of plaque=0, IMT 0.8 mm=, IMT<0.8 mm=0) and the total score of the two carotid arteries was calculated per patient (atherosclerotic ultrasonic score-athus). Results: In males (n=286) the prevalence of stroke in various atherosclerosis groups were: group A (ATHUS=0 20.3%), group B (ATHUS= 24.6%), group C (ATHUS=2 2.6%), group D (ATHUS=3 25%), group E (ATHUS=4 33.6%) (p=0.00). In females (n=074) the prevalence of stroke in the corresponding atherosclerosis groups were: group A (ATHUS=0 5.%), group B (ATHUS= 6.5%), group C (ATHUS=2 8.%), group D (ATHUS=3 5%), group E (ATHUS=4 6%) (p=0.8). Conclusion: Our results demonstrated that the degree of atherosclerosis predicted stroke only in males and not in females, suggesting in the latter the value of other stroke risk factors. 205 European Journal of Neurology, 22 (Suppl. ),

291 774 Flash Posters F405 Postpartum posterior reversible encephalopathy syndrome (PRES) with atypical MRI findings D. Kazis, V. Theodoridou, O. Argyropoulou, I. Mavroudis, I. Daglis, S. Bostantjopoulou Aristotle University of Thessaloniki, 3 rd Department of Neurology, Thessaloniki, Greece Background and aims: PRES is a clinico-radiologic syndrome characterised by headache, seizures, visual abnormalities and altered mental status with a unique vasogenic oedema imaging pattern. It has been associated with various conditions, such as hypertensive encephalopathy, renal failure, autoimmune diseases, pregnancy and certain drugs. We present the clinical, MRI and follow-up data of three women who developed postpartum PRES. Case Report: We reviewed last year s (204) admissions in our department and found 3 patients (PtA, PtB, PtC) who developed PRES during postpartum period. Results: PtA (34yo), PtB (35yo), PtC (36yo) admitted with acute onset symptoms after having caesarean section 2, 3 and 5 days earlier, respectively. All had visual disturbances and hypertension (Table). PtA and PtC presented with headache and seizures. Admission s MRI showed high signal intensity (T2 images) predominantly in the parietaloccipital regions. PtB and PtC had same findings in basal ganglia and PtC in brainstem and corpus callosum as well. A second MRI (days 5 to 2) was normal in PtA and with significant improvement in PtB and PtC with complete resolution of abnormal signs in basal ganglia, brainstem and corpus callosum (Fig,2). EEGs became normal during the course of the disease (Table) with concomitant disappearance of seizures. All patients had favorable outcome with complete resolution of their symptoms. Fig. Admission MRI Fig.2 Second MRI, five days later Conclusion: PRES is a serious clinico-neuroradiological complication of pregnancy which is not rare in postpartum period. Atypical areas of high signal in T2 weighted images (basal ganglia, brainstem, corpus callosum) should not dissuade the diagnosis. Prompt recognition of PRES and effective treatment greatly improves prognosis. Table. 205 European Journal of Neurology, 22 (Suppl. ),

292 Flash Posters 775 Cerebrovascular diseases 7 F406 Acute decompensation of old lesion in the structure of recurrent ischemic stroke J. Toshev, Z. Ibodullaev, F. Shermukhamedova Tashkent Medical Academy, Neurology, Tashkent, Uzbekistan Background and aims: The purpose of research is to study clinic acute decompensation of old ischemic lesion (ADOIL) and its differences from recurrent ischemic stroke. Methods: The study included 30 patients with repeated clinical acute cerebrovascular accident (CVA): according to CT in repeated ischemic acute CVA type (group ) was revealed in 8 patients and in 2 new changes were found (2nd). In all patients, a thorough clinical and neurological examination was performed, namely CT and ultrasonography of the main arteries. Interpretation of the CT data was analyzed by conducting visual analysis of CT slices with characteristic pathological focus and the changes in the brain substance. Results: The age of patients was 79.3±4.. The interval of the reoccurring stroke was from 2 to 6 years. Background for ADOIL became progressive atherosclerosis (2 patients), uncontrollable hypertension (2) a combination of both (6), diabetes mellitus (2). Further, focal cerebral symptoms appeared. 8 patients experienced vascular dementia and some pseudo bulbar syndrome (9). Conclusion: Based on the study results, the following conclusions were made. ) The clinical picture of patients with ADOIL corresponds to the patients picture with primary stroke (less severe and focal cerebral symptoms than with repeated acute cerebrovascular accident); 2) In ADOIL a more pronounced constrictive processes are revealed in the main arteries of the head; 3) In ADOIL regression of symptoms begins somewhat faster than in the repeated CVA, but the dynamics of the main symptoms are less severe and persistent symptoms are especially vascular dementia and pseudo bulbar syndrome. F407 Distinctive neurological risk factors of recurrent cerebral strokes and acute decompensation of the old focus J. Toshev, Z. Ibodullaev, Y. Musaeva Tashkent Medical Academy, Neurology, Tashkent, Uzbekistan Background and aims: The purpose of the research is to study and compare the clinical and prognostic features of recurrent cerebral strokes (RCS), and acute decompensation of the old focus (ADOF). Methods: 76 patient diagnosed with RCS were examined during the acute and subacute periods and divided into two groups, the st 38 patients with confirmed RCS (7 men and 2 women), the 2nd 38 patients with no new lesion in the brain (24 men and 4 women). During the study the level of consciousness was evaluated on the Glasgow Coma Scale, the severity of the neurological condition was defined on a scale Gusev - Skvortsova. Results: The followings were registered. The peak of ADOF development is between the ages of 60 to 69. ADOF often develops during vigorous activity (73.6%) and less frequently at night (5.7%), while RCS occurs more at night (44.7%) than during vigorous activity (42.%). Severe neurological defect occur almost twice more in RCS (79%) than in ADOF (47.3%). It was also found that patients with ADOF were conscious (28.9%), and 7 in coma (8.7%), with RCS 6 (5.7%) and (28.9%). Fatal outcome in RCS was observed in patients (28.95%), and 2 (5.2%) in ADOF. Table Conclusion: Results: ) If ADOF fairly common between the ages of 60 to 69 years, the risk of RCS increases with age and is more common in patients older than 70; 2) In RCS deeper disturbances of consciousness and high mortality were observed. 205 European Journal of Neurology, 22 (Suppl. ),

293 776 Flash Posters F408 Neuropsychological disorders after isolated cerebellar infarction and their diagnostics with Stroop test G. Trepet, O. Mialovitska O.O.Bogomolets National Medical University, Neurology, Kiev, Ukraine Background and aims: To assess the significance of Stroop test for the diagnostics of subclinical neuropsychological disorders in patients with isolated cerebellar infarction in acute and recovery periods. Methods: 25 patients (6 men and 9 women, mean age 59.6±8.58) after acute isolated infarction were examined by neurological scales (ICARS, mrs, Barthel Index) and by Stroop Test on the 5-7th, 90th day and over year; brain MRI. Results: 23 of 25 patients after cerebellar infarction showed subclinical cognitive disorders that were closely associated with dysfunction of the prefrontal cortex of associative areas of the frontal lobes of the brain. Cognitive impairments were combined with motor syndrome and were more pronounced in patients with the infarction in the territory of SCA in comparison with infarcts in the territory of PICA, although the difference was not statistically significant (p<0.2). Prospective study at 3 and 2 months showed that cognitive function in patients tended to improve. Conclusion: This study showed that neuropsychological disorders after isolated cerebellar infarction manifested by disturbance of planning the selective attention, decision making and executive functions and didn t depend on involved vascular territory. F409 Neuroprotective therapy for lacunar stroke - which is better Ceraxon or Cerebrolysin? K. Pushkarev, R. Tsoy 2 Kazakh-Russian Medical University, Neurology, Almaty, Kazakhstan, 2 Almaty State Institute of Postgraduate Medical, Neurology, Almaty, Kazakhstan Background and aims: Lacunar strokes make up a quarter of all ischemic strokes. They are small lacunar infarcts diameter of 2 to 20mm in diameter. In 25% of patients, they appear again within 5-6 years. Methods: An analysis of 42 case histories of patients from the period 2000 to 204 with the diagnosis of lacunar stroke who were hospitalised in a stroke center. Results: The patients were from 40 to 76 years. Women were. times more than men 52% and 48% satisfaction. Lacunar stroke right hemisphere was 52% (22 patients), left 7% (7), both at 3% (3). In the history of discirculatory encephalopathy in 93% (39), hypertension in 83.33% (35), chronic diseases of internal organs of 28% (2). Duplex neck vessels showed initial atherosclerosis in 42.2% (9). The retinopathy in patients with essential hypertension diagnosing 52.8% (23). Patients could be divided into two groups, one of which received combined therapy Ceraxon (Citicoline) and the second Cerebrolysin. Duration of stay of patients in the first group was 2 times less than the latter. The positive dynamics of reducing the penumbra zone foci on MRI and regression of neurological deficit was greater in the first group of patients. The positive effect on cognitive function Tseraksona, their improvement by the fifth day since the development of the disease. Conclusion: Thus, lacunar strokes are relevant in today s society, as arise against our usual chronic diseases and passive lifestyle. The Ceraxon neuroprotective therapy in the treatment of lacunar stroke is more effective than therapy cerebrolysin. 205 European Journal of Neurology, 22 (Suppl. ),

294 Flash Posters 777 F4020 New ultrasound ishemic leukoaraiosis indices, increased carotid artery stiffness and characteristics of cerebral hemodynamics in patients with ischemic leukoaraiosis M. Turk, M. Popit, M. Zaletel, J. Kobal, J. Pretnar Oblak 2, M. Zupan, B. Zvan University Medical Centre Ljubljana, Department of Vascular Neurology and Intensive Neurological Therapy, Ljubljana, Slovenia, 2 University Medical centre of Ljubljan, Department of Neurology, Ljubljana, Slovenia Background and aims: The pathophysiology of ischemic leukoaraiosis (ILA) is unknown, but there are growing studies about increased arterial stiffness and changed hemodynamic parameters of intra and extracranial arteries in ILA patients. However, the diagnosis so far is still based on head MRI and exclusion of other causes appearing radiologically similar. Therefore we aimed to find vascular reliable markers of ILA using non-invasive widely available colourcoded duplex ultrasound and Trans Cerebral Doppler sonography (TCD). Methods: We compared local carotid stiffness parameters and different hemodynamic parameters in the middle cerebral artery (MCA) in 53 LA patients to 40 gender and risk factor matched controls with normal MRI of the head. The ILA diagnosis was based on head MRI and the exclusion of other causes of white matter hyperintensities (WMH). We introduced new ILA indices (ILAi) that are ration of carotid stiffness parameters and MCA mean blood flow velocity. The associations between ILAi and ILA and diagnostic significance of ILAi for the prediction of ILA were analysed by SPSS 20.0 Results: We found significantly higher values of pulse wave velocity beta (PWVb, m/s), pressure-strain elasticity modulus (Ep, kpa) and β index and lower diastolic, systolic and mean MCA blood flow velocities (vmcad, vacms, vmcam) in the ILA group (p 0,05). All ILAi significantly differed between the groups (p<0.05) and were significantly associated with ILA (p<0.0.) The ROC curves showed that ILAi are sensitive and specific for predicting ILA (p<0.05). Conclusion: New ILA indices are significant predictors of ILA and they have potentially diagnostic value in ILA patients. F402 Recurrent reversible cerebral vasoconstriction syndrome (RCVS) associated with posterior reversible encephalopathy syndrome (PRES), despite nimodipine treatment C. Valencia, A. Lopez, A. Hernandez 2, N. Giraldo 2, J.J. Bravo 2, A. Parralo 2, M.A. Del Real 2 Ciudad Real, 2 University General Hospital of Ciudad Real, Neurology, Ciudad Real, Spain Background and aims: RCVS is characterized by reversible multifocal vasoconstriction of cerebral arteries, severe headaches, focal neurological deficits or seizures. It may occur spontaneously or be provoked by precipitating factors (frequently postpartum and exposure to vasoactive substances). Recurrence has uncommonly been reported. Case Report: A 56-year-old man presented with acute severe headache, ataxia and diplopia. MRI showed bilateral white matter hyperintensities on cerebellar and cerebral hemispheres. PRES was confirmed by total resolution of the lesions a month later. Diffuse elevated Transcranial Doppler (TD) ultrasound velocities were found, improving progressively during the following three months. Nimodipine was prescribed since the episode. Results: He was referred 8 months later to the emergency room because of acute aphasia and reduced consciousness, reporting cephalalgia and high blood pressure the previous week. MRI was consistent with PRES. An angio-ct confirmed diffuse Willis circle vasoconstriction, with total recovery two weeks later. High doses of nimodipine and Diltiazem were instaured. One month later, significant improvement was found in both MRI and TD. Conclusion: Recurrence is unusual in RCVS (0-8% in two large case series). Serotonin reuptake inhibitors or high blood pressure were proposed as trigger factors in our patient at the second episode. Although nimodipine seemed to reduce the headaches on RCVS, large studies suggest that it does not affect the timecourse of vasoconstriction. In our case nimodipine alone was insufficient to prevent the relapse. PRES is often associated with RCVS, therefore, we remark the usefulness of ultrasonography to assess the presence of vasoconstriction, its reversibility and monitor the potential recurrences. 205 European Journal of Neurology, 22 (Suppl. ),

295 778 Flash Posters F4022 Risk profile in patients undergoing carotid endarterectomy S. Vidale, S. Bellocchi, R. Caronno, M. Arnaboldi, A. Taborelli Sant Anna Hospital, Como, Italy Background and aims: Several clinical trials have demonstrated the efficacy of carotid endarterectomy (CEA) in symptomatic and asymptomatic patients. Early and long-term positive outcome depends on absence of adverse events (death, stroke) and patency of carotid artery. High surgical risk patient is defined by the presence of several vascular risk factors (vrfs) or contralateral carotid thrombosis or female gender. Aim of the present study was to evaluate a possible relationship between comorbidities and short/long-term outcome. Methods: Patients underwent CEA between January 200 and December 203 with complete data about vrfs, clinical features, lipid setting, and clinical and radiological follow-up. Primary outcome considered: death, vascular adverse events (stroke, transient ischemic attack, myocardial infarction) and significative restenosis (>70%). For each patient a cumulative score was calculated. Statistical analysis was performed using chi-square test and analysis of variance (ANOVA). Results: CEA was performed in 84 patients (M/F: /2.9; mean age: 69±7.5 yrs). During follow-up, 4 strokes and 2 restenosis occurred. A statistically significant association was observed between total score value and outcome (p<0.0). No correlation was detected between single vascular risk factors and outcome. Lower values of LDL cholesterol were related to a better outcome (ANOVA; p<0.0). Conclusion: In the present study, patients with several and concomitant comorbidities have a higher risk of negative outcome. The relative low incidence of adverse events could be related to the selection of patients, following current guidelines. F4023 Comparison of intracerebral haemorrhage during Rivaroxaban and Warfarin treatment B. Vudrag, J. Jerše, J. Avsenik 2, K. Šurlan Popović 2, F. Bajrovic University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia, 2 University Medical Centre Ljubljana, Clinical Institute of Radiology, Ljubljana, Slovenia Background and aims: We examined neuroradiological characteristics, functional outcomes and risk factors of patients with intracerebral haemorrhage (ICH) during rivaroxaban and warfarin therapy. Methods: We retrospectively studied 699 consecutive patients with intracranial haemorrhage admitted in 203 and 204. Of all, 63 (9.0%) had intracranial haemorrhage during warfarin therapy, (.6%) during rivaroxaban therapy, 6 (0.9%) during other anticoagulants, and the remaining 69 (88.6%) without anticoagulation therapy. Results: In the rivaroxaban group 9 patients had ICH, while in the warfarin group 57 patients had ICH. Mean HAS- BLED score was 2. in the rivaroxaban group and 2.8 in the warfarin group (p<0.05). Haematoma volume in the rivaroxaban group was lower than in the warfarin group, but not statistically significantly so (median versus 22 ml, respectively; p>0.05). In the rivaroxaban group 4 (36%) patients died, while in the warfarin group 40 (63%) patients died. In the survival subgroups, functional outcome was better in rivaroxaban patients compared to warfarin patients (mean modified Rankin Scale at discharge 3 versus 3.7, respectively; p>0.05). Conclusion: The intracerebral haematoma volume was lower, though not statistically significantly so, in patients recieving rivaroxaban than in patients recieving warfarin. The functional outcomes were also better, though not statistically significantly so, in the rivaroxaban group. Rivaroxaban-associated ICH occured in patients at low risk for major bleeding. 205 European Journal of Neurology, 22 (Suppl. ),

296 Flash Posters 779 F4024 The 7-year experience of endovascular treatment for acute anterior circulation stroke patients in Ramathibodi hospital, Mahidol University, Thailand. T. Worakijthamrongchai, S. Pongpech, P. Jiarakongmun, E. Chanthanapak, C. Kobkitsuksakul Faculty of Medicine Ramathibodi Hospital, Mahidol University, Interventional Neuroradiology unit, Department of Radiology, Bangkok, Thailand Background and aims: Endovascular treatment in large vessel occlusion is an alternative therapy that could increase good functional outcomes and improved survival in stroke patients. The purpose of this study was to evaluate the efficacy and safety of endovascular intervention in strokepatient. Methods: This study is a retrospective descriptive study. We analysed 32 consecutive stroke patients treated with mechanical thrombectomy (Prenumbra device, Solitaire stent and Trevo stent). Successful recanalisation was defined as Thrombolysis in Cerebral Infarction scale (TICI) grade 2b/3. Good clinical outcome was defined as mrs of 0-2 at 3 months. Results: 32 patients were included in the analysis. The median age was 69.5 years. The median baseline NIHSS score was 7 (IQR 4-20). The median of ASPECT score was 6 (IQR 6-7). The median length of occluded-thrombus in intracranial vessel was 2.mm. (IQR ). 9 patients (59.4%) received intravenous rt-pa prior to endovascular treatment. Median time from stroke onset to first picture angiogram was 306 minutes (IQR ) and median time from first picture angiogram to recanalisation was 59 minutes (IQR ). Successful recanalization was achieved in 59.4%. At 3 months, 37.5% of patients had a good clinical outcome. The postprocedure symptomatic intracerebral hemorrhage was 8.8% of patients and the mortality rate was 6.2%. Conclusion: The endovascular treatment is the effective alternative treatment in condition of beyond 4.5 hours-stroke onset or failure treatment of iv rt-pa therapy. F4025 The impact of some risk factors such as arterial hypertension, diabetes and hematocrit levels on ischemic stroke vs myocardial infarction S. Xhaxho, J. Xhaxho, D. Ndoja, J. Kruja, R. Preci 2, B. Xhaxho CUH Mother Theresa, Tirana, Neurology, Tirana, 2 CUH Mother Theresa, Tirana, Cardiology, Tirana, Albania Background and aims: Arterial hypertension and diabetes are very well known factors of risk for having myocardial infarction or ischemic stroke by damaging the small arteries located in the heart or in the brain. Methods: We included in this study 200 patients: 00 of them had an ischemic stroke and 00 of them had myocardial infarction. For every patient we took the factors of risk such as arterial hypertension, diabetes and the hematocrit levels and we compared those levels with 00 persons of the same age presenting no disease. Results: 77% of the patients suffering from ischemic stroke, 70% of the patients suffering from AMI and only 48% from the group of control are also suffering from arterial hypertension. 23% of the patients suffering from ischemic stroke, 30% of the patients suffering from AMI and only 9% from the group of control are also suffering from Diabetes Mellitus. The average of hematocrit levels is 40% of the patients suffering from ischemic stroke, 38% of the patients suffering from AMI and 37.7% for the group of control. Conclusion: The patients suffering from arterial hypertension and presenting higher hematocrit levels are most likely to have an ischemic stroke while the patients suffering from diabetes mellitus are most likely to have an AMI. Arterial hypertension damages mostly the small arteries located in the brain while diabetes mellitus damages mostly the small arteries located in the heart. Hematocrit levels have smaller impact as a risk factor comparing with arterial hypertension and diabetes in both brain and heart. 205 European Journal of Neurology, 22 (Suppl. ),

297 780 Flash Posters F4026 The relationship between carotid artery stenosis and the level of plasminogen activator inhibitor- S.U. Yalınkaya, Ö. Coskun 2 Magosa Devlet Hastahanesi, Neurology, Famagusta, Cyprus, 2 Ankara, Turkey Background and aims: Stroke is a cause of death and disability. Determining the risk factors is important for prevention. Carotid artery stenosis is a risk factor for stroke and a sign of atherosclerosis. Plasminogen activator inhibitor- (PAI-) might have a role in the aethiopathogenesis of atherosclerosis. We aimed to determine the relationship between the carotid artery stenosis and PAI-. Methods: We included 75 patients who had ischemic stroke at least 6 months ago and 25 healthy controls prospectively. Patients under 8 and over 85, patients under anticoagulant therapy, patients with acute infections or hematological/ oncological diseases or kidney/liver failure, pregnant and breastfeeding mothers were excluded. Patients were evaluated in detail, demographic and clinical characteristics and neurological findings were recorded. Carotid artery stenosis was evaluated by magnetic resonance imaging angiography (MRA) (with contrast). Patients were classified into three groups as no carotid artery stenosis (normal) in MRA, carotid artery stenosis and carotid artery occlusion. PAI- levels were measeured from blood samples. Results p<0.05 were accepted as statistically significant. Results: We found negative correlation between blood PAI- and carotid stenosis. The PAI- levels decrease while the degree of stenosis increase. Conclusion: The level of PAI- is an indicator of atherosclerosis and carotid artery stenosis. Further studies with a larger patient population are needed to clarify the effect of PAI- in stroke. The knowledge from our and future studies could provide additional information to distinguish the patients who are under risk for atherosclerosis. Moreover, detecting these patients may help to decrease the disability and mortality caused by stroke. F4027 Clinical and imaging analyses of pure midbrain stroke in 2 cases L. Yin, Q. Sun 2, C. Ma 2 nd Hospital of Dalian Medical University, Department of Neurology, Dalian, China, 2 Dalian Zhongshan District Hospital, Department of Internal Medicine, Dalian, China Background and aims: To explore clinical and imaging features of pure midbrain stroke. Methods: Clinical data of 2 cases with pure midbrain stroke were retrospectively analysed. 5 had midbrain infarction (MBI) and 6 had midbrain hemorrhage (MBH). According to different anatomical levels, midbrain was divided into two anatomical planes, the rostral and caudal segment. Each plane was further divided into 5 locations on axial plane: ventral lateral, ventral medial, dorsal lateral, dorsal medial and centre. The number, location, shape, and volume of the lesion were recorded in each case. Risk factors, clinical and imaging features were investigated. Results: In 5 cases with pure MBI, 3 had atrial fibrillation and had large artery stenosis. In 6 cases with pure MBH, 3 had hypertension, 2 had cavernous hemangioma. According to the imaging findings, lesions were found in the rostral and caudal midbrain in 9 and 5 cases respectively, in both rostral and caudal midbrain in 7 cases. Lesions in the ventral medial, ventral lateral, dorsal medial, dorsal lateral and central portions were found in 4, 8, 0, 3 and 6 cases, respectively. Among the 2 cases, limb paralysis, oculomotor paralysis, sensory disturbance, dysarthria, central facial palsy, and central tongue palsy was found in 6, 0, 8, 8, 6, and 6 cases, respectively. Limb paralysis contralateral to lesion and (or) ipsilateral oculomotor paralysis were common in midbrain stroke. Only one case had classical midbrain syndrome. Conclusion: Midbrain stroke usually occurs in the rostral segment of midbrain, mainly in ventral lateral portion, with complicated and atypical clinical manifestations. F4028 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

298 Flash Posters 78 F4029 Characteristics of young patients with stroke; data from Evangelismos stroke registry P. Zis, P. Leivadeas, M. Lykouri, S. Ververaki, M. Maili, L. Zikou 2, A.M. MOUZAK, E. Alexiou 3, P. Angelidakis, D. Kravaritis, D. Karakalos, A. Tavernarakis Evangelismos General Hospital, Neurology, Athens, Greece, 2 Athens, Greece, 3 Evangelismos General Hospital of Athens, Ophthalmology, Athens, Greece Background and aims: Strokes in young adults are uncommon and often a diagnostic challenge. Incidence, risk factors,and etiology in young adults differ markedly from those observed among older individuals.we aimed to describe the characteristics of young patients with stroke,ischemic (IS) or hemorrhagic (ICH), admitted in Evangelismos General Hospital, a tertiary hospital in Athens, Greece. Methods: We looked into data of all young patients (45 years old or less) admitted with stroke, between 0/20 and 2/204. Demographic and clinical characteristics were recorded. Results: 84 patients (6.9% males) were diagnosed with stroke. Out of them,75 patients suffered an IS (89.3%), and 9 an ICH (0.7%). The mean age was 38.9±5.5 years (range 20-45). Hypercholesterolemia was the most common risk factor (44.0%), followed by arterial hypertension (32.%), smoking (3.0%), hypertriglyceridemia (9.0%), and diabetes mellitus (5.5%). Interestingly, 4.8% of our study population had a history of cancer. On admission mean NIHSS score was 5.8±5.6. Based on the modified Rankin Scale (mrs), at discharge 23.8% of the patients had an mrs score 0, 4.7% score, 5.5% score 2, 3.6% score 3, 4.8% score 4 and 7.3% score 5. Two of the patients(overall mortality rate 2.4%) died,both of ICH (ICH early mortality rate 22.2% versus IS early mortality rate 0.0%, p<0.00). Conclusion: Our results are concordant with other stroke registries, where outcome of stroke in young patients is generally favorable. The incidence of ICH among young stroke sufferers (0.7%) is similar to the incidence observed in older ages. F4030 Internal carotid dissection presenting with unilateral tongue oedema and headache N. Zorko, M. Božič, M. Kolenc, M. Vrabec 2 General Hospital Novo Mesto, Neurology, Novo Mesto, Slovenia, 2 University Medical Centre Ljubljana, Department of Neuroradiology, Ljubljana, Slovenia Background and aims: Up to 2% of spontaneous internal carotid artery dissections (ICAD) present with headache and lower cranial nerve palsy whilst unilateral tongue oedema usually indicates inflammatory, metabolic, neoplastic and rarely allergic pathology. We present a rare case of headache with unilateral tongue oedema. Case Report: 58-year-old man with a medical history of angina pectoris, stent implantation in the left anterior coronary artery and depression presented with acute cough induced throbbing frontal and occipital headache worsening when supine, and a strange sensation of his tongue. His neurological exam was normal with the exception of unilateral right-sided tongue oedema. Computed tomography of the brain was normal as well as cerebrospinal fluid findings. Clinical suspicion of carotid artery dissection was confirmed by magnetic resonance angiography showing a short extracranial right ICAD measuring.6cm with pseudoaneurysmal dilatation, mural thrombus and 60% luminal stenosis. No ischemic intracranial lesions were found. Anticoagulant therapy was initiated and neck immobilised with a cervical collar. Right side tongue oedema No tongue tip deviation 205 European Journal of Neurology, 22 (Suppl. ),

299 782 Flash Posters MRI: right internal carotid artery dissection Results: Two days after admission tongue deviation, weakness and difficulty swallowing developed while the headache and tongue oedema gradually subsided within weeks. Conclusion: Through literature search we found only one other description of ICAD presenting as unilateral tongue oedema showing this is a rare but important clinical sign that should prompt additional radiological diagnostics as early treatment for ischemic thromboembolic stroke prevention is crucial. 205 European Journal of Neurology, 22 (Suppl. ),

300 Flash Posters 783 Neuroimmunology 2 F403 Abstract cancelled F4032 A case of limbic encephalitis with anti-ma2 antibodies and spontaneous stabilization P. Basilico, G.G. Fumagalli, A. Arighi, A.M. Pietroboni, N. Bresolin, E. Scarpini University of Milan, Neurology, Milan, Italy Background and aims: Limbic encephalitis is an immune mediated condition that typically causes short-term memory loss, seizures, irritability, depression and cognitive decline. Major abnormalities usually involve medial temporal lobes. It is usually related to the presence of a tumor and is expected to evolve unless an immune therapy is started and/ or the tumor is recognised and removed. We describe the case of a patient with limbic encephalitis due to Anti-Ma2 who self stabilize without any treatment. Case Report: A 70-year-old man was referred for gradual onset of short-term memory loss. He underwent multiple clinical and neuropsychological assessments, brain MRI, lumbar puncture and dosage of paraneoplastic antibodies. He was also studied for the presence of tumor with total body CT and PET scans and with multiple testicular echography. Results: At first assessment neuropsychological evaluation showed an amnestic mild cognitive impairement and brain MRI left mesiotemporal T2 hyperintensity with a predominant involvement of amygdala. After 4 months a second brain MRI showed bilateral mesiotemporal involvement with T2 hyperintensity and focal atrophy and a first dosage of paraneoplastic antibodies was negative. After another 3 months he was clinically stable, MRI demonstrated bilateral mesiotemporal atrophy, predominant on left side, with involvement of hippocampus bilaterally. We repeated dosage of paraneoplastic antibodies and anti- Ma2 were positive in serum and CSF, while anti-ma were positive only in CSF. No primary malignancy was found. No treatment was started. Conclusion: Limbic encephalitis due to anti-ma2 can present as a self-stabilizing syndrome. F4033 Osmotic demyelination syndrome in a patient with bipolar disorder: a case report T. Bourinaris, G. Xiromerisiou, G. Deretzi, P. Tsitsi, V. Paraskevopoulou, I. Tsiptsios Thessaloniki, Greece Background and aims: Osmotic demyelination syndrome (ODS) is a clinically heterogeneous condition, characterised by acute demyelinating lesions affecting mainly the central pons, as well as other parts of the brain. We present an interesting case of ODS in a 43-year-old female with history of bipolar disorder, presenting with severe neuropsychiatric instability and progressing neurological manifestations. Case Report: A 43-year-old female was presented at the emergency department complaining of dysarthria and dysphagia of acute onset. At presentation she was disoriented and agitated without any focal neurological signs. The symptoms developed after the correction of chronic hyponatremia due to psychogenic polydipsia, while she had a long history of bipolar disorder. The patient gradually developed a decreased level of consciousness, becoming stuporous with global aphasia/mutism and bilateral symmetrical spasticity. Repeated imaging with brain MRI confirmed the diagnosis of ODS with simultaneous central pontine and extrapontine myelinolysis. Results: Both the patient s symptoms and the brain MRI abnormalities were partially resolved after one month of hospitalisation. The follow-up examination after 3 months of rehabilitation showed full recovery apart from slight resting tremor at both hands. Conclusion: ODS covers a broad spectrum of symptoms depending on the affected areas of the brain, often being characterised by a combination of neurological and psychiatric symptoms. As our case demonstrates differential diagnosis can be quite challenging especially in patients with a known history of psychiatric disease. 205 European Journal of Neurology, 22 (Suppl. ),

301 784 Flash Posters F4034 Adult onset opsoclonus-myoclonus syndrome associated with positive voltage-gated potassium channel-complex antibodies Z. Calic, R. Mellick 2 Institute of Neurological Sciences, Prince of Wales Hospital, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia, 2 Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, Australia Background and aims: Opsoclonus-myoclonus syndrome (OMS) is a rare neurological disorder characterized by rapid multidirectional conjugate eye movements accompanied by myoclonus and ataxia. OMS is of parainfectious, paraneoplastic or idiopathic origin. Management involves immunosuppressive therapy with variable outcomes. We report a case of progressive OMS responsive to plasmapheresis and associated with positive serum voltage-gated potassium channel (VGKC)-complex antibodies and positive oligoclonal bands in the CSF. Case Report: A 43-year-old woman of Japanese origin presented with 2-day history of progressive visual disturbance because of opsoclonus and unsteady gait. Examination revealed ocular flutter, opsoclonus-myoclonus, marked truncal ataxia and tremor in the upper limbs. CSF analysis was normal apart from presence of oligoclonal bands. MRI brain with gadolinium was unremarkable. Results: Autoimmune screen and antineuronal antibodies in the serum and CSF were negative. Viral and bacterial serology was normal. SerumVGKC-complex antibodies were positive 23pM (N<85) but antibody to a specific antigenic target (LGI or CAPSR2) was not detected. Tumour markers were normal. Systemic screening for malignancy was negative. Symptoms worsened on high dose methyl-prednisone. Intravenous immunoglobulin (0.4g/kg/day) was added on day 3 and was continued for 0 days without benefit. Plasmapheresis (5-cycles) was commenced on day 5. Dramatic improvement was noted within a few days of starting plasmapheresis. Methyl-prednisone was ceased and tapering dose of prednisone was started. Opsoclonus-myoclonus resolved and she was discharged on day 26 without abnormal signs. Conclusion: We describe the first case of OMS associated with positive VGKC-complex antibodies. Further studies are underway to better understand this specific new phenotypic association. F4035 A case study in a University Hospital regarding Neuro-Behçet s disease A. Ciobotaru, A.C. Mergeani, O. Rusu, C.I. Coclitu, A.M. Cobzaru, C. Tiu, O.A. Bajenaru, F. Antochi University Emergency Hospital Bucharest, Neurology, Bucharest, Romania Background and aims: Behçet s disease (BD) is a multisystem inflammatory disease of unknown etiology in which CNS involvement can present itself in two ways: primarily as an immune-mediated meningoencephalitis, but also secondary to cerebral venous sinus thrombosis.the HLA- B5 serotype shows a high risk of developing the systemic disease however it is less common when there is increased neurological involvement. The aim of this small case series is to describe the clinical characteristics and evolution in patients with Neuro-Behçet s disease (NBD). Case Report: In our study we present four patients (M/F,3/) aged between 29 and 55 years old admitted for different neurological deficits. The cerebral MRI combined with MR-angiography showed the presence of parenchymatous lesions in three cases involving the brainstem especially the upper part and one case with multiple cerebral venous sinus thrombosis extended to the left internal jugular vein. After a comprehensive screening we excluded neoplastic, infectious, specific autoimmune and demyelinating diseases and along with the presence of HLA B5 the diagnosis of NBD was made. Results: Only two pacients presented with systemic BD manifestations prior to the development of NBD, and just one fulfilled the International study group criteria for BD, the other two presented with NBD from onset. The patients received initially corticotherapy followed by immunosuppresants, with favorable clinical and neuro-imaging outcomes. Conclusion: This case series emphasises the diagnostic challenge brought on by the diversity of clinical manifestations and imagistic findings of NBD and also highlighting that the neurological onset may not be preceded by the systemic disease. 205 European Journal of Neurology, 22 (Suppl. ),

302 Flash Posters 785 F4036 Anti-GAD-antibody-positive cerebellar ataxia responsive to 4-aminopyridine and prednisone I. Dejanović, D. Pavlovic 2, S. Knezevic-Apostolski, S. Apostolski Outpatient Neurological Clinic Apostolski, Belgrade, Serbia, 2 Center for hearing and balance, Belgrade, Serbia Background and aims: There are several reports of favorable therapeutic respons of anti-gad- antibody-positive cerebellar ataxia to immunosupression. However, there are small case series reporting therapeutic efficacy of 4-aminopyridine in this condition. Case Report: The 66-year-old woman experienced sudden onset of severe dizziness, nausea, vomiting, unstable gait, blurred vision, and excessive daily sleepiness. She had no family history and all known causes of cerebellar disease were excluded. Symptomatic treatment was not effective. The course of the disease was characterised by three short episodes of mild spontaneous improvement. She deteriorated eighteen months later presenting with diplopia in left gaze, downbeat nystagmus, ataxic dysarthria, positive Romberg s sign, dysmetria, macrographia, and severe wide-based ataxic gate. Caloric examination showed normal peripheral vestibular function, but she had a lot of signs of central vestibular involvement with slow OKN in horizontal and absent OKN in vertical plane. Serum anti-gadantibodies were positive, 839 IU/ml (<0.0 IU/ml). The conventional brain MRI showed atrophic changes of the cerebellar vermis. Results: The treatment was initiated with 4-Aminopyridine (0mg b.i.d.) and prednisone (60mg/day). 3 weeks later the patient improved ocular motor function without diplopia and without downbeat nystagmus which was explained as prominent effect of 4-aminopyridine. 6 weeks later she was able to walk unassisted and her speech, writing and gait significantly improved which was probably the result of concomitant steroid immunosuppression. Conclusion: The combination of 4-aminopyridine and prednisone may be recommended in patients with anti- GAD-antibody-positive cerebellar ataxia. F4037 A patient with back pain and visual disturbance F. Delen, S. Tezcan, Ç. Ulukan, A. Ravandi, H. Atilla 2, C. Yücesan Ankara University, neurology, Ankara, Turkey, 2 Ankara University, Ophtalmology, Ankara, Turkey Background and aims: Sarcoidosis is a chronic, inflammatory granulomatous, multisystemic disorder that may affect the nervous system in 5-0% of the patients. It can affect meninges, neuroendocrine systems, spinal cord, cranial and peripheral nerves. We present an uncommon case of neurosarcoidosis without systemic involvement. Case Report: A 2-year-old male was admitted with headache, backpain and visual disturbance. He had hypertension in the medical history. The physical examination was normal. The neurologic examination revealed loss of deep tendon reflexes except achilles reflexes. Magnetic resonance images demonstrated diffuse meningeal enhancement. Blood and cerebrospinal fluid (CSF) tests including immunological markers, serologic tests and biochemistry, blood counts, thyroid functions, B2, angiotensin converting enzyme (ACE) and PPD were normal. CSF protein was 69mg/dl; opening pressure and cytology were normal. Radiologic investigations for hypertension, malignancy and vasculitis were unremarkable. In ophthalmological consultation, his visual acuities were 20/800 in the right and 20/00 in the left eye. Fundus examination revealed bilateral papilledema, macular exudates and dilated vessels on optic disc surface and peripheral visual field loss of both eyes were detected. These findings were reported to be compatible with the diagnosis of sarcoidosis and steroid treatment was suggested. 000mg IV methylprednisolone was given for three days and followed by maintenance dose of 96mg/day. Results: His headache, backpain, visual complaints improved with this treatment. Conclusion: Neurologic involvement in sarcoidosis is seen usually after the systemic manifestations. Rarely, the disease begins with neurologic symptoms. Simultaneous meningeal involvement and cranial neuropathy secondary to neurosarcoidosis has rarely been reported. Neurosarcoidosis should be considered in these cases, despite of absence of systemic sarcoidosis. F4038 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

303 786 Flash Posters F4039 Cerebrospinal fluid suggestive of central nervous system autoimmunity in a young woman with PTEN-related Cowden syndrome H. Faber, C. Rampp, B. Wollweber, M. Uhr, P.A. Beitinger Max Planck Institute of Psychiatry, Munich, Germany Background and aims: Cowden syndrome (CS) is a rare condition defined by multiple hamartomatous growths with a high risk of cancer development. Mutations in the phosphatase and tensin homolog (PTEN) gene are believed to result in activation of the mtor pathway. Case Report: A 26-year-old woman presented with a severe depressive syndrome dominated by fatigue. The family history was positive for Cowden syndrome in her mother and one sister. PTEN mutations were positive in all three family members. Multiple papillomas of the breasts and an enlarged thyroid gland were found. Spinal fluid repeatedly revealed a highly activated lymphocytic pleocytosis of 27 x 0^6/L, 6 x 0^6/L and 0 x 0^6/L two and six months later, respectively. In these samples, plasma cells, oligoclonal bands, intrathecal IgG synthesis and antibody indices against measles, rubella, zoster and FSME were positive pointing at an autoimmune process. Serological screening for vasculitis, lupus erythematodes, HIV and hepatitis was negative. A small non-enhancing subcortical lesion of the temporal lobe was seen on MRI that did not alter over time. The neurological exam was normal. After more than a year of intensive psychiatric treatment, the depressive symptoms including fatigue improved a lot. At the same time, in a fourth spinal fluid analysis, pleocytosis and the lymphocytic activation pattern were still present but significantly decreased. Conclusion: For the first time, we describe a case of Cowden syndrome related to both CNS autoimmunity and severe depressive symptoms. Further studies are needed to define a possible link to PTEN mutations. F4040 Abstract cancelled F404 Neuropsychological monitoring and immunotherapy outcome of patients with suspected antibody negative autoimmune limbic encephalitis C. Helmstaedter, B. von Rhein, J. Wagner, G. Widman, M.P. Malter 2, C.E. Elger University Bonn, Medical Center, Epileptology, Bonn, Germany, 2 MKH Bergisch Gladbach, Neurology, Bergisch Gladbach, Germany Background and aims: The syndrome of antibody (ab) negative limbic encephalitis (LE) has been rarely described. Treatment guidelines and outcomes results from small sample sizes and case reports. Therefore we investigated the outcome of immunotherapy in a group of 28 ab-negative patients, suggested to suffer from LE because of recent-onset temporal lobe epilepsy, MRI indicators of LE, reported memory decline or psychiatric symptoms. Methods: 28 ab-negative LE patients (5±5 yrs., 32% female) with new onset temporal lobe epilepsy (onset 46±5 yrs.) were investigated in regard to verbal/figural learning and memory, executive functions, and mood before and after immunotherapy (median follow-up 9 months). Results: At baseline 86% of the patients suffered from any cognitive impairment, 33% (of 24) showed hints of depression. All patients received a steroid pulse therapy (MP), 8% had antiepileptic drugs when pulse therapy started. Of the patients 43% became seizure free. On an individual level 57% improved in memory considering 7 parameters (32% worsened), 2% improved in executive functions including 2 parameters (8% worsened). Mood improved or worsened in 7% respectively. Conclusion: In this up-to-now largest group of immunologically treated patients with suggested ab-negative LE some seizure control and improved cognition was observed. Post hoc, however, this cannot be exclusively attributed to immunotherapy. Neither the natural course, nor the response to antiepileptic treatment (67% with altered AED) were controlled. Thus, with mild forms of suggested LE, future studies should better control immunological interventions. Second, an observation interval with multimodal disease monitoring might be indicated before starting immunotherapy. 205 European Journal of Neurology, 22 (Suppl. ),

304 Flash Posters 787 F4042 A rare case of demyelinating polyneuropathy- eosinophilic granulomatosis with polyangiitis Q. Kian Kheng Malaysia Background and aims: As in case report Case Report: A 79-year-old female patient presented with severe burning pain of palms and soles for 5 days. She has allergic rhinitis and sinusitis with poorly controlled asthma since childhood, requiring Seretide, Ventolin and Theophylline. Examination revealed bilateral distal sensorimotor neuropathy with occasional rhonchi on lungs auscultation. Blood investigations revealed anaemia with eosinophilia, and positive anti-mpo antibody. Proteinuria was presence with urine protein/creatinine ratio of 2.53g. Sural nerve biopsy showed severe decrease density of myelinated fibers with active axonal degeneration and perivascular epineural inflammation,without any structural damage to the vessels to indicate vasculitis. Two nerve conduction studies were performed at 2-month interval which revealed rapidly progressive demyelinating polyradiculoneuropathy. Based on history of poorly controlled asthma, sinusitis, eosinophilia and extravascular manifestations (polyneuropathy and renal involvement), the diagnosis of EGPA was made. She was treated with steroid, intravenous immunoglobulin and maintenance oral cyclophosphamide. Physiotherapy in the ward was started and patient improved significantly in her functional status. She was able to walk with a walking stick, from a wheelchair bound status, after the immunosuppressants. No recurrence of the symptoms since 6 months of follow-up. We conclude that EGPA complicated frequently with rapid, severe form of polyneuropathy, which could potentially worsened drastically if the treatment was not started early. Remission depends on early aggressive immunosuppressive therapy and physiotherapy. Overall prognosis of a treated patient appear good with good functional recovery with adequate treatment. Results: As in case report Conclusion: As in case report 205 European Journal of Neurology, 22 (Suppl. ),

305 788 Flash Posters Peripheral nerve disorders 2 F4043 Chronic inflammatory demyelinating polyradiculoneuropathy in Tunisian children S. Mrabet, N. Ben Achour, I. Kraoua, H. Ben Rhouma, H. Klaa, A. Rouissi, I. Ben Youssef Turki National Institute Mongi Ben Hmida of Neurology, Research unit UR2 SP24 and Department of Child and Adolescent Neurology, TUNIS, Tunisia Background and aims: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune mediated polyradiculoneuropathy. It is a rare condition in children. We report on clinical presentation, management, disease course and response to treatment of 5 childhood CIDP Tunisian patients. Methods: A retrospective review was conducted of the medical records of 5 children who presented to our department with CIDP between 2004 and 204. Clinical, electrophysiological, imaging and therapeutic data were analyzed. Results: 2 males and 3 females were included. Mean age of onset was 7.7 years. Lower limb weakness was the most presenting symptom. 4 patients presented with chronic (>8 weeks) symptom-onset while patient showed acute onset of the disease. Motor deficit with hyporeflexia or areflexia were identified in all patients. Cranial nerve palsy was found in 2 patients. Electrophysiology confirmed demyelination and CSF demonstrated albuminocytologic dissociation. MRI showed intrathecal nerve root enhancement in 2 patients. 4 patients showed improvement after first line therapy including immunoglobulin and corticosteroids. Plasmapheresis and azathioprine were necessary in patient with a severe CIDP. Only patient showed a monophasic disease course. An unusual association between CIDP and CMTA disease had been identified in patient. Conclusion: We report on 5 new cases of childhood CIDP. Distinction between acute ( GBS-like ) onset of CIDP and GBS may be difficult. Coexistence of CMTa and CIDP (found in of our patients) is a rare condition. Most of children respond well to first-line therapy with partial or complete recovery. However, they show more often relapsing than monophasic course. F4044 Cerebrospinal fluid (CSF) protein as an early diagnostic marker of Guillain-Barré syndrome (GBS) variants C. Papastergios, G. Matikas, I. Markakis, G. Gekas St. Panteleimon General State Hospital of Piraeus, Neurology, Piraeus, Greece Background and aims: GBS is classified in two main categories, acute axonal motor neuropathy (AMAN) and acute inflammatory demyelinating polyneuropathy (AIDP). CSF analysis is often characterized by albumin-cytological dissociation. Our objective was to evaluate the CSF protein value as a potential early diagnostic marker of these two GBS subtypes. Methods: Our study group consisted of 36 patients, 9 with AIDP and 7 with AMAN that were admitted to our department during a 5 year period. CSF protein was evaluated during the first 48h following admission. Mean time between symptom onset and CSF protein evaluation was 8±6.3 days. The final diagnosis and GBS variant determination was made according to the NINDS clinical and electrophysiological criteria. Results: In 33 of 36 patients the cell count was within normal range (<5cells/μl) while 3 presented a mild pleocytosis (<30cells/μl). Normal protein concentration was found in 9 patients (2 with AIDP and 7 with AMAN variant). Mean protein value was 50.24±29.85mg/dl (range: ) and 73.32±37.05mg/dl (range: 22-39) in AIDP and AMAN patients respectively. Conclusion: Early differentiation between AIDP and AMAN has important implications on patient prognosis, although current treatment guidelines are similar for both disorders. CSF protein may be an early diagnostic marker of clinical severity and outcome in patients presenting with acute polyneuropathy. 205 European Journal of Neurology, 22 (Suppl. ),

306 Flash Posters 789 F4045 A case of Lambert-Eaton myasthenic syndrome with muscular atrophy J. Peres, A. Valverde, L. Santos 2 Hospital Fernando Fonseca, Neurology, Lisbon, Portugal, 2 Hospital Egas Moniz, Neurology, Lisbon, Portugal Introduction: Lambert-Eaton syndrome (LES) is a rare autoimmune neuromuscular disorder. Its early diagnosis is important as 50-60% of the cases are associated with small cell lung neoplasia. It is characterised by a clinical triad of progressive proximal weakness, hyporeflexia and autonomic dysfunction. A particular aspect of the syndrome is the late involvement of the ocular muscles and the absence of significative and asymmetric muscular atrophies. Case Report: A 49-year-old man, presented with progressive proximal muscle weakness of the lower limbs in the previous 2-months. Past history included traumatic rupture of the left thigh muscle at the age of 9 and pulmonary sarcoidosis at age of 2 without sequelae. Neurological examination was notable for a bilateral ptosis, severe muscle atrophy of the left lower limb, proximal paraparesis, Gower s sign and widespread arreflexy. No ocular, bulbar or limb muscles fatigability was demonstrated. EMG showed a presynaptic type transmission disorder. Voltage gate calcium channels anti-antibodies were dramatically increased (532pmol/L). Thoracic CT and body FDG-PET-CT were unremarkable. LES diagnosis was performed, likely not tumor variant (NT-LES), with clinical improvement with pyridostigmine initiation (240 mg/day). Conclusion: The athypies of this particular case include an early bilateral ptosis and a severe atrophy of the left lower limb, both not being associated with the Lambert-Eaton syndrome, which widened the differential and delayed the definitive diagnosis. 205 European Journal of Neurology, 22 (Suppl. ),

307 790 Flash Posters F4046 Chronic sensory-motor polyneuropathy and immune thrombocytopenia - a role for anti-sulfatide antibodies M. Pinto, E. Medeiros, I. Carmo Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Neurology Department, Lisbon, Portugal Background and aims: Sulfatides are cell surface glycosphingolipids present both in platelets and peripheral neurons. Anti-sulfatide neuropathy is reported to be a chronic sensory-motor polyneuropathy sometimes associated with an IgM monoclonal gammopathy, but no cases of simultaneous immune thrombocytopenia have been described. Case Report: We report the case of a previously healthy 72-year-old male who was diagnosed with an immune thrombocytopenic purpura and started treatment with oral corticosteroids. Despite initial mild improvement on platelet counts, the patient developed a progressive symmetric and distal numbness. Two months later, motor compromise ensued with gait and fine manual skill problems. The symptoms worsened gradually over the next months. There were no autonomic or sphincter related symptoms. The examination showed hypoesthesia with a severe large and small fiber polyneuropathy pattern as well as a predominantly distal tetraparesis with marked atrophy and a paraparetic gait. No fasciculations or bulbar signs were seen. The neurophysiologic study disclosed a sensory-motor, predominantly axonal, mixed polyneuropathy with denervation signs on needle EMG. Laboratory investigation was unremarkable except for a strongly positive IgM anti-sulfatide antibody. No evidence for occult neoplasia was detected. Immunologic CSF parameters were normal. Results: Assuming a common etiopathogenesis, intravenous human immunoglobulin was started and motor and platelet count improvement was seen after the first pulse. Conclusion: Association of neuropathy and immune thrombocytopenic purpura are only reported in literature. Immune-mediated and intraneuronal bleed mechanisms have been described. Our case suggests an anti-sulfatide autoimmune pathophysiology to a common epitope. We hypothesise a satisfactory outcome with strong immunomodulatory therapy schemes. F4047 Automated deep tissue manipulation alleviates carpal tunnel syndrome M. Politis USA Introduction: Carpal tunnel syndrome (CTS) is treated with properly applied manipulative therapy, but the required twice daily treatment is costly. To overcome this limitation an automated manipulator (Carpal Rx) was created to substitute human manipulation. The objective was to determine whether in-home usage yielded similar results to those collected under prior controlled conditions. Methods: A telephonic survey represented a VAS and the Michigan Hand Outcomes Questionnaire (MHOQ). 56 patients completed the survey. All patients reported severe symptoms: 37% had confirmed CTS only, while 20% had confirmed wrist tendonitis only. The remaining 57% reported symptoms consistent with either condition, but not previously diagnosed. Baseline symptoms severity data were obtained before device use. Patients were surveyed at 2, 4, 8 weeks. Results: Compared to baseline, 9% and 96% of subjects (diagnosed with CTS or tendonitis, respectively) demonstrated at least a 90% reduction in overall symptoms at 8 weeks. Subjects not diagnosed with either condition yielded 94% and 96% reduction in overall symptoms, respectively. In comparison, prior studies demonstrated overall 93% symptomatic relief in 97% of patients (measured by the same instruments). Conclusion: These data demonstrate similar results of Carpal Rx in relieving CTS or tendonitis when compared to data collected under supervised circumstances. Results were nearly identical with respect to therapeutic outcomes when compared to studies employing a more controlled environment. These data support the use of Carpal Rx as an effective therapy to relieve severe symptoms of carpal tunnel syndrome and wrist tendonitis. 205 European Journal of Neurology, 22 (Suppl. ),

308 Flash Posters 79 F4048 Risk factors for carpal tunnel syndrome in female visual display unit workers M. Ricco, F. Pezzetti 2, C. Signorelli 2 Langhirano, Italy, 2 Università degli Studi di Parma, Department of Biomedical, Biotechnological, and Translational Sciences, Parma, Italy Background and aims: Carpal Tunnel syndrome (CTS) is the commonest nerve entrapment syndrome and has been linked to keyboard and Visual Display Unit (VDU). This cross-sectrional study aims to investigate the prevalence and factors associated with CTS in female VDU workers in Italy. Methods: Participants in this study were female adult subjects, working 20h/week (n=63, mean age 38.4±7.8 years, mean working age 2.90±7.24 years). Signs and symptoms (see Table ) were collected at the compulsory occupational medical surveillance. Multivariate logistic regression was also used to estimate adjusted odds ratios for factors of interest. Table 2. Association between CTS pattern and potential risk factors. Conclusion: Prevalence of CTS in this VDU female population was 7.6%, with an incidence estimated as significantly higher than the general population. Among the risk factors, a 5 years history of OCT, previous trauma of the upper limb and scoliosis appeared associated with a higher risk for CTS patter and earlier presentation. Table. Clinical and diagnostic criteria for CTS used in this study. Results: CTS pattern was reported in 48 cases (7.6%), for an incidence of 5.94/,000 person-years (SIR %CI= ) and was associated with the following demographic factors: previous trauma of upper limb (OR CI%= ), history (> 5 years) of oral contraceptives therapy (OCT) (OR %CI ) and scoliosis (OR %CI= ). In a Cox Regression model, this factors were associated with an earlier presentation (Figure ). In general, CTS cases were younger than negative cases (4.0±7.82 vs 37.9±7.5 years, p=0.003), with a longer working age (6.00±9.36 vs 2.65±7.63 years, p=0.09), but after correction for other risk factors, both appeared unrelated with CTS pattern (Table 2). Figure. Cox Regression Analysis of OCT, scoliosis and previous upper limb trauma on the latency of CTS pattern in the study population. Blue line shows cases positive for the item, green line for negative cases. 205 European Journal of Neurology, 22 (Suppl. ),

309 792 Flash Posters F4049 Chronic sensorimotor polyneuropathy as the inaugural manifestation of primary Sjögren s syndrome I. Rosário Marques, F. Antunes, N.E.T. Ferreira, M.D. Grunho Almada, Portugal Background and aims: Sjögren s syndrome presents with peripheral nervous system involvement in up to 55% of the cases. When present, the polyneuropathy is usually the first manifestation of the disease, occurring mostly at later ages and sometimes preceding the sicca symptoms. Case Report: A 73-year-old previously healthy male presented with progressive gait instability, and dysesthesia and distal weakness of the lower limbs, with no other associated symptoms. Neurological examination revealed hypoesthesia, apallesthesia and decreased postural sensation on feet, distal areflexic paraparesis and steppage gait. Cranial nerves and upper limbs were intact. Lumbar spine CT was unremarkable. EMG confirmed a severe, asymmetrical, distal axonal polyneuropathy and ganglionopathy with lower limb predominance. Blood tests were positive for Anti- SSA/SSB and antinuclear antibodies. Toxic, metabolic and infectious causes were ruled out. Accordingly, directed investigation showed bilateral keratitis, positive Schirmer s test, and salivary gland scintigraphy and biopsy compatible with Sjögren s Syndrome, for which the diagnostic criteria were fulfilled. He started treatment with hydroxychloroquine and cyclophosphamide that halted disease progression. Conclusion: This case report, in which a chronic sensorimotor polyneuropathy was the isolated and inaugural manifestation of Sjögren s syndrome, illustrates the complexity and the high degree of suspicion required for the etiologic investigation of these clinical syndromes. Bearing in mind that the polyneuropathy may precede the typical symptoms of Sjögren s syndrome, it is essential to consider it in the evaluation of chronic axonal polyneuropathies, even in patients without sicca symptoms, given the therapeutic and prognostic implications of a correct and timely diagnosis. F4050 Features of chronic inflammatory Demyelinating polyneuropathy in Belarus M. Sialitski, V. Ponomarev 2, A. Boika 3 Belarusian Medical Academy of Postgraduate Education, Neurological Department, Minsk, Belarus, 2 Belarusian Medical Academy of Postgraduate Education, Head of Department of Neurology and Neurosurgery of BelMAPGE, Minsk, Belarus, 3 5 th City Hospital, Minsk, Neurological Department, Minsk, Belarus Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease affecting predominantly roots and nerves of the extremities. Methods: From 995 till 204, 24 patients (females-48, males-76) were followed-up in the Neurological Department of Hospital 5, Minsk. All the cases meet the international criteria of CIDP diagnostics (INCAT, 200). Clinical, EMG and immunological tests as well as CSF analyses were carried out to all the patients. The course of the disease was studied in 0 patients after their discharge from the hospital. The follow-up period on these patients was from year to 8 years. Results: Etiological factor was identified in only 22.4% of cases (viral and bacterial infections, hypothermia, stress). The prevalence of CIDP was 4.5 cases per 00,000 of population. The maximal sickness rate was noted at the age of 37 to 5 years (27.4%). A progressive form of CIDP was noted in 44 patients (35.48%), 36 patients (29.03%) showed the recurrence of the CIDP. Progressing in age of firstly diagnosed cases were: ±0.7 years; ±4.3 years; ±2.8 years; ±3.6 years, as well as more severe clinical manifestations of CIDP (P<0.05) were revealed. Five-year survival rate in patients with CIDP was 97.58%. The morbidity comprised 2.2 cases per 00,000 of population. Conclusion: The modern pattern of CIDP in Belarus is characterized by more frequent affection of males(ratio.58:), tendency progressing in age of firstly diagnosed cases and more severe clinical manifestations of the CIDP. F405 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

310 Flash Posters 793 F4052 Primary Sjögren s syndrome may be involved in any type of peripheral neuropathy: a report of four novel cases. M. Tan, B. Karakurum Göksel 2, S. Karaca Erdoğan 3 Adana, Turkey, 2 Başkent University, Adana Research and Training Center, Neurology Department, Adana, Turkey, 3 Adana Medline Hospital, Neurology department, Adana, Turkey Background and aims: Primary Sjögren s syndrome (PSS) is an autoimmune disease that mainly affects exocrine glands and is clinically characterised by dryness of the eyes and mouth (keratoconjunctivitisicca and xerotomia). Prevalence of peripheral nervous system (PNS) involvement with pure or predominantly sensory polyneuropathies varies from 0 to 60%. However, PNS involvement rarely occurs prior to diagnosis of PSS. In this work, we summarize the clinical and electrophysiological features of four patients with PSS diagnosed after the onset of the peripheral neuropathies. Methods: We retrospectively analysed the clinical, electrophysiological and outcome characteristics of 4 PSS-patients ( man and 3 females, age range years) prediagnosed as polyneuropathy. Results: PSS-associated polyneuropathy included 4 cases: man with mononeuropathy multiplex, 2 women with polyradiculoneuritis, and woman with acute axonal type motor neuropathy. The time span for the appearance of their peripheralneuropathy ranged from 5 days to 6 months. Two cases with polyradiculoneuritis were treated with plasma exchange and case with acut axonal type motor neuropathy with intravenous immunoglobulin; a patient with mononeuritis was treated with methylprednisolon. Following treatment, neurological deficits significantly improved in all of the patients. The patients were followed up nearly 4 years, resulting in a complete disappearance of the peripheral neuropathy with no recurrence. Conclusion: (i) PSS with polyneuropathy is a completely treatable clinical condition; (ii) neuropathies at the beginning of PSS may appear as poliyradiculoneuropathy, rather than sensory neuropathy; (iii) PSS should always be considered in any kind of peripheral neuropathy. F4053 Guillain-Barré syndrome due to hepatitis E infection A.-C. Troussiere, V. Sudaveschi, J. Servan, A. Lavergne, P. Colardelle 2, F. Pico Hôpital de Versailles, neurology, Versailles, France, 2 Hôpital de Versailles, gastroenterology, Versailles, France Background and aims: Hepatitis E virus (HEV) infection is an emerging cause of acute hepatitis in Europe with several neurological complications including Guillain-Barré syndrome, brachial neuritis or encephalopathy. Fully investigated case reports, using electrophysiological investigations, neuroimaging, serum and cerebrospinal fluid (CSF) immunological and virological analysis have exceptionally been reported. Case Report: We report the case of a patient with Guillain- Barré syndrome and painful T0 radiculopathy with acute hepatitis related to HEV infection. Results: This 60-years-old man with a hypopituitarism correctly supplemented and non-complicated type 2 diabetes had a 0-day history of asthenia and fever. He developed progressive paresthesia and severe proximal weakness of his lower limbs with ataxia and areflexia associated with severe bilateral radicular T0 pain. Spinal MRI was normal. Nerve conduction study found at day 5 nerve trunk and root conduction blocks in the lower limbs. Liver function tests showed ASAT and ALAT 5N and 30N elevation respectively. CSF studies showed moderate elevated proteins 0.53g/L (N 0.45g/L) with 27 white cells, 85% being lymphocytes. Anti VHE IgM were detected in the serum, as was HEV RNA genotypes 3C in serum and CSF confirming the diagnosis of acute VHE infection. Antiganglioside antibodies testing was negative. Symptoms improved gradually after treatment by intraveinous immunoglobulins. HEV RNA was no more detected in serum 3 months later. Conclusion: HEV serology should be performed in patients with Guillain-Barré syndrome with liver cytolysis. 205 European Journal of Neurology, 22 (Suppl. ),

311 794 Flash Posters F4054 Renal failure in Charcot-Marie-Tooth disease due to an INF2 mutation J.A. van Genugten, J. Nicolai Maastricht, The Netherlands Background and aims: Charcot-Marie-Tooth (CMT) is a group of different genetic disorders affecting the peripheral nerves and has been associated with renal disease in literature since 967. Case Report: We report a 9-year-old man with a history of CMT of unknown genetic etiology presenting with symptoms and signs of malignant hypertension due to renal failure. Results: DNA sequence analysis identified a de-novo heterozygote mutation of the INF2 gene (c. 383 T>C p.leu28pro). Conclusion: The combination of CMT and renal failure points to a mutation in the INF2 gene. Often, the polyneuropathy precedes the renal symptoms. In children and adults with CMT of unknown origin, the occurrence of renal disease should be considered in order to offer timely treatment and to prevent secondary complications of end stage renal disease. F4055 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

312 Flash Posters 795 Spinal cord and root disorders F4056 Abstract cancelled F4057 The results of minimally invasive transtubular endoscopic surgery for lumbar disc herniation I. Cusnir, A. Bodiu 2, S. Plesca 3, M. Sangheli 3 Chisinau, 2 SCR, Neurology, Chisinau, 3 INN, Neurology, Chisinau, Moldova Background and aims: We analysed the contribution of endoscopic surgery for lumbar foraminal disc herniation in a series of 00 patients. Methods: All the patients underwent a posterior paramedian endoscopic procedure performed via transtubular minimally invasive approach. This prospective study concerned 00 consecutive patients included between January 2008 and December 20. Outcome was assessed by Euro Quality of Life 5D questionnaire. Oswestry Disability Index criteria were used. Results: Of the 00 patients, questionnaires were returned showing results were excellent in 90 (90%), good in (%) and poor in 9 (9%) patients. The complications observed were: approach of two levels due to incorrect fluoroscopic guidance (n=); dural tear (n=4); partial nerve root lesion (n=); a second operation was necessary in 4 patients but only once at the same level and on the same side. Of the 57 patients who were working before the operation, 50 were able to return to work with an average delay of 2 months, 4 did not return to work and 2 worked only part time. Conclusion: These results associated with a high rate of patient satisfaction demonstrate that endoscopic surgery is an effective technique for the paramedian lumbar disc herniation. Endoscopy allow complete exposure decompression of the nerve root all along the foraminal canal. F4058 Minimally invasive transforaminal lumbar interbody fusion (mini-tlif) in the surgical treatment of degenerative disc disease I. Cusnir, A. Bodiu 2, S. Plesca 3, M. Sangheli 3 Chisinau, Moldova, 2 SCR, Neurology, Chisinau, Moldova, 3 INN, Neurology, Chisinau, Moldova Background and aims: Mini-TLIF using a unilateral or bilateral approach is gaining popularity because of its potential for reducing recovery time. Methods: 43 patients with degenerative lumbar diseases who were treated by TLIF were included in the study. Surgeries were performed using a tubular multi-blade retractor system Quadrant, and a cage was inserted using a unilateral transforaminal approach by a single surgeon. 32 patients were followed up for more than year, and the average follow-up period was 7 months. Single-level TLIF was performed in 35 cases, single-level TLIF plus adjacentlevel decompression was performed in 3 cases, and doublelevel TLIF was performed in 5 cases. Clinical results were assessed using the Oswestry Disability Index (ODI) and a visual analogue scale (VAS), and The Euro Quality of Life score (EQoL-5D). Results: ODI significantly decreased from an average of 32 at the preoperative stage to 2 at the final follow-up. Average VAS scores for lower back pain and radiating pain also significantly decreased from an average of 6.4 to 2.4 and 7.8 to.4, respectively. In the single-level TLIF series, operative time was 242±44 min, and blood loss was 560±80 ml. The EQoL-5D score at year improved from 0.36 preoperatively to 0.8 postoperatively. Ambulation recovery time was 2.4±0.9 days. Conclusion: In author s opinion, mini-tlif technique is an effective and reliable option for the surgical treatment of lumbar degenerative disease in order to obtain faster return to daily activities. 205 European Journal of Neurology, 22 (Suppl. ),

313 796 Flash Posters F4059 Recurrent lumbar disc herniation: the role of repeated surgical treatment I. Cusnir, A. Bodiu 2, S. Plesca 3, M. Sangheli 3 Chisinau, Moldova, 2 SCR, Neurology, Chisinau, Moldova, 3 INN, Neurology, Chisinau, Moldova Background and aims: Recurrent lumbar disc herniation is a common disease process. The removal of recurrent lumbar disc herniation requires meticulous surgical technique. Great care is taken to identify the osseous margins of the previous surgical site. Identification and dissection of scar from the dura mater is greatly aided with the use of a microscope. Methods: This study included patients who underwent re-do surgery for re-herniation of lumbar disc herniation at previous operated level of L4-L5 and L5-S. Data was collected on a proforma containing name, age and sex of patients along with findings of previous surgery, clinical outcome of previous surgery, present neurological status with signs and symptoms, investigations, complications and follow-up findings. Results: 60 patients including 44 (73.3%) male and 6 (26.7%) female were operated upon for recurrent lumbar disc herniation. 39 (65.0%) patients were pain free after surgery. Improvement of radicular pain was 7.6% (n=43/60) after month. Overall complication rate was 32%. 9 (5.0%) patients had dural in which 2 (3.3%) with postop CSF leak, 2 patients (3.3%) had superficial wound infection, patient (.7%) had discitis, patient (.7%) had foot drop and 3 (5.%) had transitory urinary retention. Conclusion: Surgery for recurrent lumbar disc herniation appears to be effective procedure in which better overall outcome and improvement in pain can be achieved. The complication rate of durotomy is a little bit higher that in primary operated patients. F4060 Spinal Cavernomas: a rare cause of adult paraparesis P.M. Gonçalves Correia, A.S. Morgadinho Carvalho, R. Varela Centro Hospitalar e Universitário de Coimbra, Neurologia, Coimbra, Portugal Background and aims: Cavernomas represent 2-7% of all CNS vascular malformations, usually presenting in the supratentorial compartment with spinal lesion being quite uncommon. Clinical complaints usually appear until 30 years of age, with later presentation being more common in women. Case Report: Male, 55 years old, lower back pain with 3 weeks of progression, accompanied by pain and diminished strength in the right leg. Progressive worsening with inability to walk, constipation and urinary retention within 2 days. No trauma history. The neurological examination showed an asymmetric paraparesis with proximal right predominance, lower limb hypotonia and hyporreflexia with abolished right aquilian reflex, suggestion of a T sensory level and abolished propriception in the lower limbs. Normal blood work. Spinal dorsal MRI showed two cavernomas (T0 and T2) with recent bleeding and signs of segmental spinal edema. The patient was started on high dose steroids, with minimal improvement, and a surgical procedure was scheduled. 8 days after admission he developed a sudden clinical worsening, with complete paraplegia, MRI showed bleeding of the T2 cavernoma with edema. Patient was submitted to an emergency laminectomy of T0 and T2, with myelotomy and excision of the intramedulary cavernomas and hematomas. Clinically the patient didn t improve and was started on high intensity rehabilitation. Brain MRI showed a small lesion compatible with small cavernoma. Conclusion: The gender and age of the patient, the number and localisation of the lesions turn this case into a rare presentation of cavernomas. MRI characterization and potential surgery are the two main core approaches of these lesions. 205 European Journal of Neurology, 22 (Suppl. ),

314 Flash Posters 797 F406 Subacute combined degeneration of the spinal cord (Funicular myelosis, Lichtheim s disease): a really forgotten disease returns back H. Manvelyan, L. Harutyunyan Yerevan state medical university, Neurology, Yerevan, Armenia Background and aims: Recently, patients with vitamin B2 deficiency supposed to be extremely rare. This has contributed to many cases when complications of vitamin B2 deficits were underdiagnosed. Especially difficult is right diagnosis establishment in countries like Armenia, where resembling cases are very rare. The recognition and treatment of vitamin B2 deficiency is critical since it is a reversible cause of bone marrow failure and demyelinating nervous system disease. Case Report: A 45-year-old man reported increasing symptoms of painful paresthesias in both legs for the past 0 months. Also he presented spastic weakness of legs. Pressure, vibration and touch sense in his lower extremities were diminished. Babinski sign was positive. 3 years ago the patient had resection of 2/3 of his stomach because of treatment resistant ulcers. The serum vitamin B2 level was 75.4pmol/L (normal: 8-07 picomoles per liter) and the serum homocysteine level was 25.7 (normal: <4). He also had signs of inflammation in the posterior columns of the spinal cord on his MRI images. Results: The patient was treated with high dose of vitamin B2 (000µg intravenously) for 2 weeks and went very well. Before applying to our hospital he was checked in several other clinics and was diagnosed as Strümpell-Lorrain syndrome (Hereditary Spastic Paraplegia). Which was the wrong diagnosis in this case. Conclusion: Such complication of vitamin B2 deficiency like subacute combined degeneration of spinal cord should be diagnosed more carefully, especially in the Third World Countries, because in most cases pathological process is fully reversible. F4062 Conus medullaris infarction: a case report H. Lee, S. Kim 2, Y.J. Chae 3, J.K. Kim, Y. Kim, Y. Seo 4 Busan St.Mary s Hospital, Neurosurgery, Busan, 2 Busan St.Mary s Hospital, Neurology, Busan, 3 Busan St.Mary s Hospital, Rehabilitation, Busan, 4 Busan St.Mary s Hospital, Radiology, Busan, Republic of, Korea Background and aims: Spinal cord infarction occurs much less frequently than cerebral infarction. This can occur anywhere along the length of spinal cord, with infarctions at conus medullaris thought to be particularly rare. We report a case of conus medullaris infarction(cmi) to emphasise the importance of urgent diagnosis, acute management and favorable outcome. Case Report: A 76-year-old woman presented with paresthesia and progressive weakness involving left lower extremity lasting for hours. She showed paraparesis, motor grade as 4/5 on right, and as /5 to 3/5 on left lower extremity with weaker at proximal. Sensation to pin prick was decreased below left L2 level and saddle anesthesia. Deep tendon reflexes were absent. Magnetic resonance imaging(fig.,2) revealed diffuse abnormal high T2 signal within the expanded conus and thecal sac compression by partially calcified intervertebral disc at the corresponding level(l/2). Fig. Saggital T2 weighted MR image of lumbar spine demonstrates diffuse abnormal high signal within the expanded conus. Fig.2 Axial T2 weighted MR image taken at the corresponding level shows abnormal high signal within the expanded conus and thecal sac compression by partially calcified intervertebral disc. 205 European Journal of Neurology, 22 (Suppl. ),

315 798 Flash Posters Results: Following diagnosis of CMI, the patient was admitted to Stroke Center for acute management. In-hospital treatment included anti-platelet medication, risk factor evaluation, physical and occupational therapy. There were no other risk factors than hypertension. Electrophysiologic study was compatible with conus medullaris lesion. The patient regained remarkable strength, with greater and most improvement in the first week. Her paresthesia was getting better as scheduled rehabilitation. At the time of transfer to another hospital, her strength on left lower extremity was nearly intact and neurological symptoms were stable, indicating relatively favorable recovery of CMI. Conclusion: Although rare, CMI is potentially devastating and requires clinical suspicion for timely diagnosis, treatment and optional neurological recovery. F4063 Abstract cancelled F4064 Disorders of defecation in children with spinal pathology. N. Ergasheva, Y. Madjidova, B.Ergasheva Tashkent Pediatric Medical Institute, Neurology, Tashkent, Uzbekistan Background and aims: Disorders of defecation in children with spinal pathology. Manifestations of defecation s disorders are constipations, stool incontinence or associated of these disorders which are evident in various degrees of manifestation observed in organic and inflammatory diseases of the nervous system. To increase efficiency of complex treatment of children with defecation s disorders in spinal pathology. Methods: The research is based on diagnostic and treatment s analysis in 44 children aged from st day till 5 years old with osteoneural myelopathy 67 (46.60%) boys, 77 (53.40%) girls. Computertomography of spine and spinal cord, cranial ultrasonography in children and ultrasonography of internals was provided. Results: Following clinic-morphologic forms of spinal pathology in observed children are verified: -Spina bifida cystica-09(76%) -Spina bifida complicata-3(2%) -Spina bifida occulta-32(22%) Disorders of defecation was observed in 43 (30%) patients as chronic constipation in 55.8%, constipations combined with paradoxical stool incontinence in 28%, anal sphincter deficiency with stool incontinence in 6.2%. Deficiency of anal sphincter with stool incontinence dives into 3 degrees: Regular feeling of urge to defecate and physiological defecation combined with involuntarily episodic delivery of feces in small portions. Feeling of urge to defecate is kept and sometimes voluntarily defecation in big or small portion, perineum and buttock are always soiled with feces. No feelings of urge to defecate and no voluntarily defecation. Conclusion: Disorders of defecation on this pathology demand to conduct differential conservative treatment depending on character and intensity of rectum s function s disorder and it s closing apparatus. 205 European Journal of Neurology, 22 (Suppl. ),

316 Flash Posters 799 F4065 The level of sensory loss on the trunk is not always an accurate guide to the level of the spinal cord tumor: a case report F. Scarlatescu Bucharest, Romania Background and aims: In rare cases of spinal cord tumors there may be a discrepancy between the sensory level and the real site of the tumor. This phenomenon, called false localizing sign is rare but well known and must always be kept in mind when diagnosing spinal cord syndromes. Objectives: To describe a clinical case with a false localizing thoracic sensory level. Methods: A 39-year-old previously healthy female presented for severe knife-like back pain for approximate eight weeks, intensified by coughing and sneezing. The neurological exam was normal except a severe reduction of pain and temperature perception below a T2 level. Results: A magnetic resonance imaging (MRI) at the suspected level was normal. Follow-up MRI revealed an upper thoracic intramedullary tumor (T3-T4). The patient was referred to neurosurgery with successful removal of the tumor (histopathological result: ependymoma) and very good clinical outcome (at three months normal neurological exam). Conclusion: A possible false localising sign should always be considered when investigating a patient with a thoracic level of sensory loss and normal MRI exam at the suspected site of the lesion. Case particularities: the false localising sign was the only pathological sign on physical exam and only a careful and extensive paraclinical exam could help to make an early diagnostic and to establish the appropriate treatment measures. F4066 The effectiveness of applying acupuncture, glucosamine and chondroitin sulfate in the treatment of degenerative disc disease, caused by herniated cervical and lumbar discs. R. Tsoy, T. Tsoy 2 Kazakh Medical University of Continuing Education, Almaty, Kazakhstan, 2 Private Clinic named after Tsoy, Shymkent, Kazakhstan Background and aims: The degenerative disk disease in 86% of cases herniation usually occurs in the adult. Disc herniation may cause radiculopathy which ought to reveal in patients pain, paresthesia, numbness or upper/down extremity weakness and sometimes cauda equina syndrome. To evaluate the effectiveness of acupuncture, glucosamine and chondroitin sulfate. Methods: The study involved 40 patients aged 20 to 50 years. The control group received paracetamol, NSAIDs (long course), muscle relaxants, antidepressants, and to the study group was added acupuncture (bladder meridian and du Vaisseau Gouverneur), chondroprotectors (alflutop.0 i/m, Dona 3.0 i/m 8 injections every other day, Dona.5 g of powder o.m. for 90 days) and short course NSAIDs. In all cases before and after treatment was carried out MRI. Pain syndrome was assessed by visual - analogue scale. Myotonic syndrome was evaluated on a 4-point scale. Radicular syndrome was evaluated on a 4-point scale. Results: The radicular syndrome in was levelled 75% and they have a significant decrease of pain and restore muscle tone (P<0.05). On MRI reducing the size of the herniation from 4.8mm to 2.9mm; from 9mm to 4.7mm; from 7.8mm to 4.2mm after one year of treatment (P<0.05). Conclusion: Patients reported a markedly and significant regression of clinical symptoms. Treatment showed a substantial reduction of the herniations size and in some cases it reversion from extrusion to the protrusion (disc degeneration condition). 205 European Journal of Neurology, 22 (Suppl. ),

317 800 Flash Posters Cerebrovascular diseases 8 F4067 Prehospital stroke education in paramedics D. Baldaranov, M. Kilic, K. Pflug 2, S. Theiss 3, A. Leis 4, J. Pemmerl 5, H. Pels 6, S. Boy, U. Bogdahn, F. Schlachetzki University of Regensburg, Neurology, Regensburg, 2 Ostbayerische Technische Hochschule Regensburg, Regensburg, 3 University of Duesseldorf, Institute for clinical neuroscience and medical psychology, Düsseldorf, 4 University of Regensburg, Regensburg Center of Biomedical Engineering, Regensburg, 5 Malteser Rettungsdienst, Regensburg, 6 Krankenhaus der Barmherzigen Brüder, Neurology, Regensburg, Germany Background and aims: Rapid pre-hospital identification of stroke symptoms result in therapy directed admission to dedicated stroke units. Widespread application of stroke scales reveal high sensitivity but low specificity, especially in non-academic first aid personal. In our previous work we show that prehospital stroke diagnostics based on neurological examination and transcranial color-coded Duplex sonography (TCCS) is feasible and results in high sensitivity and specificity for middle cerebral artery / distal internal carotid artery occlusion. The aim of our ongoing study is to design and evaluate a dedicated stroke educational program for paramedics including transcranial ultrasound. This is a prerequisite for a telemedical decision support system in the absence of stroke experienced emergency doctors. Methods: We currently educate 6 paramedics in advanced stroke neurology and also transcranial ultrasound examination during a course of 2 months. The web-based curriculum was designed in two parts. The first was theoretical and the second will be the real-life training under neurological supervision. For final assessment of the theoretical knowledge a control group will be implemented without specific stroke expertise. The stroke-educated paramedics will have to assist stroke investigation, perform pre-hospital TCCS and enter the date in a mobile telestroke pad. The data set will be send to an in-hospital stroke physician. We will assess the mean time to reach the diagnostic assessment, its sensitivity and specificity and the patient outcome after 30 days. Results: Our study is ongoing Conclusion: The study just reach the 2 part and we will be glad to present our data on the meeting EAN 205. F4068 Stroke after radiofrequency catheter ablation for atrial fibrillation: the role of atrio-esophageal fistula H.M. Delgado, R. Barbosa, N.M.O. Inacio 2, D. Cavaco 3, S.L. Calado CHLO, Neurology, Lisbon, Portugal, 2 HBA, Neurology, Loures, Portugal, 3 CHLO, Cardiologia, Lisbon, Portugal Background and aims: The rate of neurological complications after radiofrequency catheter ablation for atrial fibrillation is small: % and 0.5% for surgical and percutaneous techniques, respectively. However, mortality is high (40-80%) and early recognition and treatment are critical. Case Report: We report a 64-year-old male with atrial fibrillation, known vascular risk factors with atrial fibrillation. Submitted to radiofrequency ablation in May-204, admitted in June-204 with fever, acute left side weakness and dysarthria, with a fluctuating course over the next hours, when also developed right side weakness, aphasia and somnolence. Additionally he started focal motor seizures with generalization, refractory to antiepileptic therapy. He was intubated in a propofol induced-coma. His chest x-ray showed cardiomegaly. Transthoracic echocardiogram revealed gas bubbles in the left ventricle. Thoracic CT scan showed alterations compatible with an atrio-esophageal fistula. He was submitted to emergent surgery. The distal tip of the esophagus was closed and a gastrectomy and gastrostomy were done. After surgery he couldn t be extubated and was in minimally conscious state. Head MRI of July-204 showed a total right and a partial left ACM ischemic stroke, bilateral extensive petechial hemorrhage and cortical frontoparietal bilateral lesions compatible with laminar cortical necrosis. Electroencephalogram showed generalized slowing without epilpetiform discharges. After 8 months without interaction with the environment, appropriate speech began with maintained memory, without newer focal deficits or epileptiform seizures. Conclusion: Atrio-esophageal fistula is one of the rarest complications of atrial fibrillation ablative procedure. This case demonstrates the subsequent neurological complications: bilateral cerebral air embolism, status epilepticus and hypoxic encephalopathy. 205 European Journal of Neurology, 22 (Suppl. ),

318 Flash Posters 80 F4069 Conditions that mimic ischemic stroke at hospital admission M. Delva, N.V. Lytvynenko, I. Delva Ukrainian Medical Stomatological Academy, Neurological Department with Neurosurgery, Poltava, Ukraine Background: Till now the rate of stroke s clinical mimicry is high enough. Aim: To study conditions that mimicked ischemic stroke among patients admitted to neurological department as well as to define their distinctive clinical features. Methods: We analysed medical histories of 2,29 patients admitted to the neurological department of Poltava City Clinical Hospital # with diagnosis «ischemic stroke» during Results: It had been diagnosed stroke mimicry in 8.0% cases. Structure of stroke imitators (Stroke imitators Rate) panic attacks 8 (4.5%) migraine 6 (3.4%) vestibular neuronitis 25 (4.%) benign paroxysmal positional vertigo 2 (.%) conversion disorders 2 (.9%) alcohol delirium 5 (8.5%) Wernicke encephalopathy 3 (7.3%) hypoglycemic condition 5 (2.8%) viral encephalitis 5 (8.5%) peripheral nervous system disorders 6 (9.0%) brain tumors 8 (0.2%) postictal states 7 (9.6%) pulmonary thromboembolism 4 (2.3%) acute pancreatitis 2 (.%) pneumonia 5 (2.9%) Patients with ischemic stroke were significantly older (68.8±0.4 versus 54.9±2.2 years, p<0.05), they significantly more often had ischemic heart disease (RR 6., 95% CI, , p<0.05), diabetes mellitus (RR.9, 95% CI,.-2.9, p<0.05), arterial hypertension (RR 2.0, 95% CI,.5-2.8, p<0.05) and focal neurological symptoms at hospitalization (RR 8., 95% CI, , p<0.05). In cases of stroke mimicry, patients more often had loss of consciousness (RR 4., 95% CI, , p<0.05) and cognitive impairments (RR 2.2, 95% CI,.6-3.2, p<0.05). Conclusion: Knowledge of stroke mimicry clinical peculiarity may be useful for neurologists to make proper diagnostic decisions more quickly and purposefully. F4070 Conditions that mimic transient ischemic attacks at hospital admission M. Delva, N. Lytvynenko, I. Delva Ukrainian Medical Stomatological Academy, Neurological Department with Neurosurgery, Poltava, Ukraine Background: Till now the rate of TIAs clinical mimicry is high enough. Aim: To study conditions that mimicked TIAs among patients admitted to neurological department as well as to define their distinctive clinical features. Methods: We analysed medical histories of 57 patients admitted to the neurological department of Poltava City Clinical Hospital # with diagnosis TIA during years. Results: It had been diagnosed TIA mimicry in 25.3% cases. Structure of TIA imitators (TIA imitators Rate) panic attacks 22 (6.8%) migraine 8 (6.%) vestibular neuronitis 4 (0.7%) benign paroxysmal positional vertigo 5 (.5%) conversion disorders 9 (6.9%) alcohol delirium 2 (.5%) Wernicke encephalopathy 7 (5.3%) hypoglycemic condition 4 (3.%) viral encephalitis 4 (3.%) peripheral nervous system disorders 7 (3.0%) brain tumors 2 (9.2%) postictal states 3 (9.9%) pulmonary thromboembolism (0.8%) pneumonia 3 (2.3%) Patients with TIA were significantly older (6.2±0.4 versus 53.7±2.5 years, p<0.05) and they significantly more often had ischemic heart disease (RR 2.5, 95% CI,.7-3.8, p<0.05). In cases of TIAs, patients more often had loss of consciousness before hospitalization (RR 6.5, 95% CI, , p<0.05), headaches (RR 3.8, 95% CI, , p<0.05) and cognitive impairments (RR 2.9, 95% CI,.8-4.5, p<0.05). Conclusion: Knowledge of TIA mimicry clinical peculiarity may be useful for neurologists to make proper diagnostic decisions more quickly and purposefully. 205 European Journal of Neurology, 22 (Suppl. ),

319 802 Flash Posters F407 Deep cerebral vein thrombosis with 3 prognoses E. Eruyar, Y. Sücüllü-Karadag, S. Bilen, N. Öztekin 2, F. Ak ANH Traning and Research Hospital, Neurology, Ankara, Turkey, 2 Ankara, Turkey Background and aims: Deep cerebral venous thrombosis is a subtype of cerebralvenousthrombosis, and typically involves the internal cerebralveins. Compared to dural venous sinus thrombosis, deep cerebral venous thrombosis, especially when the internal cerebral veins are involved, carries a poorer prognosis. It is more frequently seen in female gender, especially in patients taking pills. Clinical presentation is rapid and the prognosis is poor. Diagnosis can easily be made by CT and MRI. The best diagnostic clue is demonstrating hyperdensity of the veins themselves, often associated with extension of the clot in the vein of Galen and into the straight sinus. Typically the thalami. We present the case of a 4-year-old woman diagnosed with deep cerebral venous thrombosis with good prognosis. Case Report: A 4-year-old female presented with headache, nusea- vomiting, and changes in her consciousness. In neurologic examination the patient was lethargic with no neurologic localising signs. Results: T2 and FLAIR sequences of cranial MRI revealed bilateral thalamic involvement and sagittal sequence swith contrast showed involvement in the sinus rectus suggestive of thrombosis. MR venography revealed thrombosis in the left transverse sinus, sinus rectus and sigmoid sinus. The patient treated with antioedema and anticoagulant srecovered completely without sequele. Conclusion: Deep cerebral venous thrombosis (DCVT) is a rare form of cerebral venous thrombosis with a poorer prognosis. DCVT must be considered in the diagnosis of patients with mental changes, headache, focal neurologic deficits, supported with CT and MRI findings, and appropriate treatment must be started immediately to overcome the poor prognosis. F4072 Internal carotid artery transluminal angioplasty and stenting in patients with acute ischemic stroke which undergo intraarterial treatment C. Estevez-Fraga, P. Agüero Rabes, L. Crespo Araico, E. Viedma Guiard, E. Monreal Laguillo, P. Martinez Ulloa, J.L. Mendez Cendon 2, E. Fandiño Benito 2, A. Alonso Cánovas, J. Masjuan Vallejo, A. Cruz Culebras Hospital Ramón y Cajal, Neurology, Madrid, Spain, 2 Hospital Ramón y Cajal, Radiology, Madrid, Spain Background and aims: The efficacy and safety of stent placement in the ICA in patients with acute ischemic stroke (AIS) during intraarterial treatment are still unknown. We decided to evaluate the efficacy and safety of the ICA angioplasty and stenting in patients with AIS and an ICA stenosis or occlusion who underwent intraarterial treatment. Methods: We prospectively assessed patients admitted to our institution during who required ICA stenting (3,7% of the cases who underwent intraarterial treatment). 0 were male, ages ranged from 65 to 74 (mean: 6). Basal modified Rankin scale (mrs) score was 0 in all of them. Indications for intraarterial treatment were absence of improvement with intravenous alteplase (55%), wake-up stroke (27%) and other (28%). The symptomatic carotid had a stenosis between 70-90% in 8, and 3 had an occlusion or pseudo-occlusion. 0 patients had an occlusion in middle cerebral artery at the M portion ipsilateral to the symptomatic ICA. Median NIHSS was 2. Results: Score on the mrs at 90 days was 0- in 36%, 2 in 27%, 4-5 in 36%. There were no deaths during followup. There were a vasospasm and a distal embolisation both asymptomatic. patient had stent restenosis during followup without associated vascular event. There was symptomatic intracranial hemorrhage 24 hours after treatment. Conclusion: Emergency carotid artery stenting might be necessary during the revascularisation techniques in patients with AIS that undergo intraarterial treatment. It is a safe procedure in experienced centers. Carefully assessment and follow-up are required. 205 European Journal of Neurology, 22 (Suppl. ),

320 Flash Posters 803 F4073 Quality of chronic anticoagulation control with acenocoumarol and the risk of cerebrovascular events C. Estevez-Fraga, L. Crespo Araico, P. Agüero Rabes, M. Molina 2, R. Álvarez Velasco, M.J. López Martínez, E. Viedma Guiard, A. Alonso Cánovas, J. Masjuan Vallejo Hospital Ramón y Cajal, Neurology, Madrid, Spain, 2 Hospital Severo Ochoa, Neurology, Madrid, Spain Background and aims: The influence of the quality of previous anticoagulation control with vitamin K antagonists (AVK) over the risk of transient ischemic attack (TIA), ischemic stroke (IS) or intracranial hemorrhage (ICH) remains unestablished. Therefore we decided to evaluate the quality of previous anticoagulation through the time in therapeutic range (TTR) and individual measurements of international normalized ratios (INR) in patients that suffer a cerebrovascular event. Methods: We prospectively analysed every consecutive patient admitted to our stroke unit (SU) while they were treated with VKAs. We analysed clinical and demographic variables, INR on admission, 7 previous INRs and TTR during the 6 months before the event. Results: During one year 36 patients were admitted to our SU with the diagnosis of TIA (27), IS (85) and ICH (24) while taking VKAs. There were no statistically significant differences between groups in any of the 7 INR s previous to the event. Global TTR was 57% (TIA: 62.7%, IS: 53.7%, ICH: 66.3%). There were statistically significant differences on INR on admission with infratherapeutic values in patients with TIA or IS and supratherapeutic in patients with ICH both in patients anticoagulated because of atrial fibrillation (TIA:.96; IS:,7; ICH: 3.) and in patients with mechanical heart valves (TIA: 2.3; IS: 2.; ICH: 4.5). Conclusion: The risk of having a cerebrovascular event in our patients was not related to the quality of the chronic anticoagulation control but only to the INR on admission. F4074 Cotard delusion after hemorrhagic stroke L.P. Faria de Abreu, A.C. Fonseca, T. Pinho e Melo, P. Canhao Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Neurology, Lisbon, Portugal Background and aims: Cotard syndrome (CS) is a rare delusional state characterised by the conviction of being dead or false nihilistic belief of specific body parts. It is mainly associated with psychiatric disorders. We describe a case of CS in the acute phase of a right hemispheric hematoma. We found other 5 cases of CS in literature associated with right hemispheric vascular lesions. Case Report: A 78-year-old right-handed woman was admitted due to a right occipital-temporal intracerebral hematoma with peripheral edema and some mass effect. Neurological examination revealed left homonymous hemianopia. There was no personal or familiar history of psychiatric disease. On the second day of admission she woke up very anxious, believing that she was dead. The doctor tried to convince her that her heartbeats were perfectly audible and normal, showing her the ECG monitor and auscultating her. She answered how is that possible? I don t have a heart, you are lying to me. She said that she needed an emergent heart transplantation in order to be alive again. The delusion lasted about two hours. There were no new neurological signs or psychiatric symptoms during this episode. She was discharged after ten days, completely asymptomatic. Results: As far as we know there are 5 case reports of CS associated with cerebrovascular diseases, namely ischemic (2) and hemorrhagic () stroke, subdural hematoma () and arteriovenous malformation (). Conclusion: All cases are characterised by the presence of an unilateral right hemispheric lesion in non-psychiatric patients, strengthening the neuroanatomical correlation between this location and CS. 205 European Journal of Neurology, 22 (Suppl. ),

321 804 Flash Posters F4075 Neurological causes of pulmonary embolism D. Fayolle, A. Schnider, B. Leemann Geneva, Switzerland Background and aims: Pulmonary embolism (PE) is a potentially lethal complication of many different neurological diseases. The major risk factors for PE are frequently found in stroke patients: old age, thrombophilia, smoking, metabolic syndrome; in traumatic brain injury: post operative, trauma; and in diverse affections: motor impairment and immobilisation. PE is mostly linked to deep venous thrombosis (DVT). However, the upper venous tree may also be a source of PE, as documented by the cases presented here. Case Report: We report two cases and review the literature. Results: A 49-year-old female with complete paraplegia and type II Arnold Chiari malformation had been treated for hydrocephalus in her childhood by ventriculo-atrial derivation. She presented episodes of PE. Despite the lack of evidence of lower limb DVT, paraplegia was accepted as the cause. Severe pulmonary arterial hypertension insidiously appeared. The ventriculo-atrial derivation is finally considered as the source of her PE. A 63-year-old female with chronic bleeding iron deficiency anaemia was admitted for a superior sagittal sinus thrombosis and concomitant PE. In the absence of evidence for malignancy or limb, pelvic or vena cava thrombosis, the sinus thrombosis remained as the most likely source of PE. Conclusion: In the absence of lower limb DVT it is important to actively search for an upper venous tree source of PE. As shown in large autopsy records (5 039 cases), 2.6% of patients with PE also had upper venous system thrombosis. Ventriculo-atrial shunt, the source of PE in our first patient, has previously been reported as a cause of thromboembolism. F4076 Vitamin D deficiency in CADASIL patients M.A. Carluccio, F. Pescini 2, M. Battaglini, M.B. Franci, D. Inzitari 2, L. Pantoni 2, A. Federico, S. Gonnelli, M.T. Dotti Department of Medicine, Surgery and neuroscience, University of Siena, Siena, Italy, 2 Department of NEUROFARBA, University of Florence, Florence, Italy Background and aims: Vitamin D influence is not limited to skeleton and there is a growing evidence pointing to its protective role on neurodegeneration and endothelial vascular dysfunction. Vitamin D deficiency has been associated with an increased risk of several neurological diseases including neurodegenerative and cerebrovascular disorders. The objective of this study was to verify the hypothesis that low plasma 25(OH)D levels are present in patients with CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), a model of pure subcortical microvasculopathy due to mutations in the NOTCH3 gene. No genotype/phenotype correlation has yet been found, and the influence of other cofactors in modifying the disease clinical expression is still debated. Methods: Serum 25-hydroxyvitamin D level was measured in 65 genetically confirmed CADASIL patients and in 65 controls perfectly matched for age, sex and seasonality. Results: A significant reduction of vitamin D levels in patients with respect to controls was found (p=0.028). Conclusion: Although hypovitaminosis D is now considered pandemic and more prevalent than in the past, the significant prevalence of insufficiency/ deficiency of Vitamin D in this group of patients is remarkable. CADASIL is commonly considered an useful model of pure cerebral small vessel disease. Therefore this study can help in a better understanding of the relationship between vitamin D deficiency and cerebral vascular pathology suggesting that vitamin D deficiency may be a contributing factor to endothelial dysfunction in CADASIL. 205 European Journal of Neurology, 22 (Suppl. ),

322 Flash Posters 805 F4077 Acute ischemic stroke: the last day of the month is critical A. Folyovich, D. Bessenyei, I. Kis, D. Biczo, J. Gimesi-Orszagh, K.A. Beres-Molnar, G. Toldi Szent János Kórház, Department of Neurology and Stroke, Budapest, Hungary Background and aims: The seasonal and daily increase of acute ischemic stroke (AIS) is a known phenomenon. The critical days are influenced by biological and psychological factors. The few data from the literature reported, that the incidence of acute myocardial infarction and death are higher during the first week of the month. There is no data about a same phenomenon related to AIS. Methods: We compared the daily average and the strokeonset dates of patients having thrombolysis treatment (TT) in Hungary between Because of the narrow therapeutic window, TT allowed exact determination of the onset of AIS. Anonymous data were downloaded from the database of the NHIF. Exceptional attention was paid to the last and first day of the months. The data were divided into different groups based on the age (over and below 65 years) and sex of patients. Results: In the reviewed period 6666 TTs (2.3/day) were carried out, 828 of them on the last day of the month (9.24/day) and 357 on the first (3.76/day). The most remarkable difference appeared among the males above 65 years. If the 30th day was the last, the average of TTs was 20.2, if the day before 3., was only Conclusion: A recurrent difference in AIS risk between the last and the first day of the (next) month cannot be credited to biological factors; this phenomenon must be caused by socio-cultural effects. These effects take place primarily by those already vulnerable to AIS. F4078 Carotid endarterectomy versus carotid artery stenting. N. Lesko, V. Han, Z. Gdovinova P.J.Safarik University Kosice, Faculty of Medicine, Department of neurology, Kosice, Slovakia Introduction: For about 2 decades, investigators have been comparing carotid endarterectomy (CEA) with carotid artery stenting (CAS) regarding their effectiveness and safety in treating carotid artery stenosis. The most recent and largest trial (the Carotid Revascularization Endarterectomy vs Stenting Trial [CREST]), showed that CAS and CEA were associated with similar rates of death and disabling stroke. The aim of our study was to compare CEA vs CAS in conditions of L. Pasteur University Hospital (UNLP) and East- Slovakian Institute of Heart Diseases (VUSCH) in Košice, were both treatment modalities are performed. Methods: The sample of 407 patients mean age 67.8 year (280 men - 69% and 27 women - 3%) with CEA or CAS during was analyzed in the study. Outcome and severe complications (stroke and death) within the 30-day periprocedural period and the 3-month period were evaluated. Results: CEA was performed in 69 (42%) and CAS in 238 (58%) patients. In both groups 0 severe complications were present within the 30-day periprocedural period (6 in 202, 4 in 203) what represents 5.9% of CEA group and 4.2% of CAS group respectively. Complications after 3 months were present in 5 CEA patients (3%) and in 6 CAS patients (2.5%). In CEA group disabling strokes prevailed, while restenosis dominated in CAS group. Conclusion: We conclude that in our conditions carotid artery stenting is an equivalent alternative to carotid endarterectomy. According to the 3-month evaluation the most frequent complication was disabling stroke in CEA group and restenosis in CAS group. 205 European Journal of Neurology, 22 (Suppl. ),

323 806 Flash Posters F4079 Vertebral artery dissection: a challenging diagnosis J.J. Bravo, M.J. Corrales Arroyo, N. Giraldo 2, A. Lopez Garcia, A. Parralo 2 Ciudad Real, Spain, 2 University General Hospital of Ciudad Real, Neurology, Ciudad Real, Spain Background: A 34-year-old woman presents with neurological symptoms of sudden onset after a cracking sensation at her neck. Firm clinical suspicion of a vertebral artery dissection led to its confirmation. Case Report: The patient was a smoker and had been diagnosed of narcolepsy and migraine. Throughout the previous month she had been rehearsing a dance performance which included repeated neck movements. Immediately after a cracking sensation at her neck, she refers binocular diplopia and numbness on her right cheek and limbs. On examination, she had anisocoria, bilateral limitation of ocular abduction and supraversion, saccade pursuit with vertical and horizontal nystagmus, hypoesthesia of the right third trigeminal branch, right central facial palsy, mild right hemiparesis and hemihypoesthesia. Results: Initial image studies were normal. A contrast-enhanced cranial computerised tomography was performed, showing a thrombus inside a saccular aneurysm which produced stenosis of the right vertebral artery, plus three saccular dilatations on the left vertebral artery. The final diagnosis was a transient ischemic attack (she recovered from the neurological deficit within 3-4 hours) secondary to vertebral artery dissection and vertebral arteries dysplasia. Anticoagulation therapy with heparin was maintained until the performance of an arteriography, which showed resolution of the dissection and persistence of the aneurysms. Anticoagulation was changed for antiaggregation at discharge. Conclusion: Despite its low prevalence, vertebral artery dissection must be included in the differential diagnosis of neurological symptoms of acute onset. In this case there is a confluence of two entities (neck trauma and underlying dysplasia) which can potentially produce a dissection. F4080 Atherosclerotic retinopathy is predictor of small vessels disease of the brain E. Giyazitdinova, A. Azimov, G. Rakhimbaeva Tashkent, Uzbekistan Background and aims: Cerebral small vessel disease (csvd) is a pathology of small arteries and arterioles in the brain irrigating subcortical structures. One of main cause сsvd is the arteriolosclerosis and/or microatheromatosis of small calibre cerebral arterial vessels caused by various pathologies. The visualization of retinal vessels provides the opportunity to study cerebral small vessel disease, because the retinal arteries reflect the state of cerebral microcirculation. The aim of our study was to determine relation between retinal artery disease and csvd against the background of hypercholesterolemia. Methods: 35 patients with subcortical ischemic vascular dementia (I group), 25 patients with Ill-defined cognitively impaired (II group) and 20 healthy volunteers (III group) of comparable age and sex were studied. We investigated deep white matter and periventricular hyperintensities on magnetic resonance imaging and eyeground, and compared with the level of hypercholesterolemia. Results: White matter lesions and change of fundus as small capillary hemorrhages and lipid (atherosclerotic) deposits were more common in patients with ischemic vascular dementia than in those with Ill-defined cognitively impaired or healthy volunteers (P <0.0). In the first group the levels of cholesterol were varied within mmol/l, in the second group were mmol/l (P <0.00), healthy volunteers had the normal levels of cholesterol (P <0.00). Conclusion: The changes of fundus and correlation of cholesterol is one of manifestation in small vessels disease of the brain and can be used as diagnostic criteria for prognostication ischemic vascular dementia. 205 European Journal of Neurology, 22 (Suppl. ),

324 Flash Posters 807 F408 Dilatation of the Virchow-Robin space is a marker of cerebral small vessels disease E. Giyazitdinova, A. Azimov, Y. Musaeva Tashkent, Uzbekistan Background and aims: Dilatation of the Virchow-Robin space (VRS) is constantly characterised as markers of cerebrovascular disease, and it is predictor of vascular dementia. The aim of our study was to observe differences in magnetic resonance imaging of dilatation of VRS between subjects with the subcortical ischemic vascular dementia (SIVD), ill-defined cognitively impaired patients and cognitively normal healthy control subjects, as well as the association between the dilatation of VRS and degree of development the subcortical ischemic vascular dementia. Methods: 35 subjects with SIVD, 25 Ill-defined cognitively impaired patients and 20 healthy volunteers of comparable age and sex were studied. We found deep white matter, periventricular hyperintensities and the VRS dilatation, as figures of MR images. Magnetic resonance imaging of VRS dilatation was compared across groups and examined by VRS dilatation s location and size. Results: White matter lesions were more common in patients with SIVD than in those with Ill-defined cognitively impaired or healthy volunteers (P<0.0). VRS dilatations figures were significantly higher in patients with vascular dementia and SVR were more dilated and prevalenced than in with Ill-defined cognitively impaired patients (P<0.00). Magnetic resonance images of VRS were normal of healthy volunteers. (P<0.00). Conclusion: Dilatation of the Virchow-Robin Space is one of manifestations in small vessels disease of the brain and can be used as the diagnostic criteria for prognostication ischemic vascular dementia. F4082 The role of toxic proinflammatory mediator-cytokines in ischemic hemispheric stroke E. Giyazitdinova, Y. Musaeva 2, F. Saidvaliev 2 Tashkent, Uzbekistan, 2 Tashkent Medical Academy, Neurology, Tashkent, Uzbekistan Background and aims: The aim of our research is to study the pathological state of microglial cells, which are not recovered to the condition of functional rest and continued to support phlogosis reactions, producing one of toxic proinflammatory mediator-cytokines in ischemic hemispheric stroke (IHS) at different times of the acute period of the disease. Methods: In our observation were 35 patient with IHS, aged 34 to 94 years. Spontaneous produce of cytokines in the cerebrospinal fluid from patients determined using monoclonal antibodies. Results: In patients with IHS on the first day of the disease showed a significant increase in tumor necrosis factor (TNF-α) to 32.8±5.2pg/ml, which is 356% of the benchmark. By the third day of illness content TNF-α decreases slightly, amounting to 25.5±3.7pg/ml (less than the first day of 28.7%). By the tenth day of the disease the content of TNF-α is somewhat reduced, but still has not reached the level of individuals in the control group- 7.9±2.5pg/ml. In 5 patients with IHS the third day of the disease level of TNF-α remained at the same level, and by the tenth day declined slightly. Conclusion: The study of cytokines IHS showed the prevalence of the disease in the first day of the inflammatory cytokine TNF-α, which indicates the presence of an inflammatory response in the brain ischemic injury. Dynamic increase in proinflammatory cytokines indicates an increase in neurological deficit and worsening prognosis. 205 European Journal of Neurology, 22 (Suppl. ),

325 808 Flash Posters Cerebrovascular diseases 9 F4083 Abstract cancelled F4084 Effect of intravenous low intensity laser irradiation of blood on the level of angiogenic T-cells in acute lacunar stroke L. Anatskaia, N. Goncharova 2, I. Seviaryn 2, G.G. Khulup 2, S.S. Marchenko 3, E. Bondareva 3 The Republic Research &Practical Center of Neurology and Neurosurgery, Department of Neurology, Minsk, 2 The Republic Research & Production Center for Transfusiology and Medical Biotechnologies, Laboratory of Stem Cells, Minsk, 3 Emergency Care Hospital, Stroke department, Minsk, Belarus Background and aims: The purpose of our study was to determine effect of low intensity intravenous laser irradiation of blood (ILIB) on the level of angiogenic T-cells (Tang) in patients with acute lacunar stroke (LS) resulting from cerebral small vessel disease. Methods: We have studied the level of Tang (CD3+/ CD3+/CD84+) in 20 patients (mean age 59±4.3 years) at first 48 hours of LS and after 7 days of standard therapy and ILIB by the semi-conductor laser (wave length 0.67µm, radiation power at the end of the light guide mW, time of application 20 minutes, 7 procedures per course) by flow cytometry; once in 0 healthy volunteers, Results: Two subpopulations of circulating Tang (CD3+/ CD3+/CD84+) - with high expression of CD3+ and CD84+ (CD3hiCD84hi) and with high expression of CD3+and low expression of CD84+ (CD3hiCD84low) were determined in the first 48 hours of LS, with significant reduction in the number of Tang CD3hiCD84hi (to 2.89±0.55%, comparing with control data 5.59±.0%, p<0.05). After 7 days of ILIB implication significant increase of Tang CD3hiCD84low level (from 2.45±0.82% to 4.7±0.6%, р<0.05) and CD3hiCD84hi with respect to healthy volunteers data (p<0.05) were detected. Conclusion: A markedly reduced level of circulating Tang (CD3+/CD3+/CD84+) in the first 48 hours of LS is one of the cytological markers of chronic endothelial dysfunction of cerebral small vessels. The results of our study indicate the high potential of ILIB in respect of significant increase of Tang functional activity f and stimulation of reparative function of circulating endothelial progenitor cells F4085 Cerebral microbleeds in patients without severe neurological pathology E. Klocheva, O. Timonina, V. Goldobin, M. Afanasyeva NWSMU n.a. I.I.Mechnikov, Neurology, StPetersburg, Russian Federation Background and aims: Cerebral microbleeds (CM) are one of the forms of cerebral microangiopathies. Pathogenetic basis and prevalence of such condition in patients without or with mild neurological deficit and its value is currently not clear. There was research of CM in patients with neurodegenerative pathology, the connecion of CM with cognitive decline was established. Methods: 70 consecutive patients without severe neurological deficit but with cerebral microbleeds were included (23 men, 47 women, age 60.6±0.2 years). The investigation included standard brain magnetic resonance imaging (MRI) with gradient recalled echo or susceptibility weighted imaging on.5t or 3T MRI machine. Detailed neurological investigation was performed in all patients. Results: Only 40% of the examined were elderly patients. The main complaint and main reason to consult neurologists was headache. Detailed neurologic examination revealed mild hypokynetic syndrom and slight ataxia in most patients. CM into basal ganglia were revealed in 64% of patients, cortical location of CM was seen in 20% and their combination in 6%. Cortical CM were more often in women comparing with men. Thalamic location of CM was seen in 3 (4%) cases and only in men. Conclusion: CM in lack-of-symptoms group of patients were mostly often located in basal ganglia area. Gender difference might take place in CM development in different parts of the brain. 205 European Journal of Neurology, 22 (Suppl. ),

326 Flash Posters 809 F4086 Acute cervical artery dissection after a dental procedure due to a second molar infection M. Gonzalez Delgado, R. García 2, N. Riesco 3, E. Murias 3, J. Pascual 3, S. Calleja 3 Oviedo, Spain, 2 Centro Médico de Asturias, Oviedo, Spain, 3 Hospital Universitario Central de Asturias, Oviedo, Spain Background and aims: Periodontal infections might represent one of the causative factors for cervical artery dissection (CAD). Case Report: A 49-year-old female, former smoker, was admitted complaining of severe headache. The patient had been suffering from a right second inferior molar infection with a cervical phlegmon for one week previous to the admission. The day before she went to the dentist where molar extraction was performed in the morning, under local anesthesia and it required a cervical hyperextension for only a few minutes. In the afternoon, the patient began with right hemifacial pain that progressed towards a bilateral headache. Neurological status at the time of admission showed right miosis, ptosis and conjuntival hyperemia. Cranial CT, lumbar puncture and venous CT were normal. CT angiography showed a right internal carotid artery (ICA) dissection provoking a high degree stenosis and left vertebral artery dissection. Anticoagulation with low molecular weight heparin was initiated. Results: It has been suggested that periodontal infections may cause a direct and indirect inflammatory and immunological response, with activation of cytokines and proteases, that could induce excessive extracellular matrix degradation and thus weaken the vessel wall causing or favoring CAD. In our case, two arteries were affected; the most affected was right ICA in this patient with right molar infection. Conclusion: Periodontal infections may influence inflammatory changes in the cervical arteries favoring dissections with minor traumas. Thus any procedure implicating cervical hyperextension or rotation should be carefully considered in these patients in order to avoid unusual but potentially fatal complications, such as CAD. F4087 Contemporary understanding of the role of GABA in the correction of neurocardiologic pathology S. Kuznetsova, V. Kuznetsov, M. Iegorova, D. Shulzhenko Institute of Gerontology, Kiev, Ukraine Background and aims: Contemporary understanding of the role of neurotransmitter GABA-ergic systems in the formation and regulation of the psycho-emotional and mnemonic functions defines an implementation strategy GABA drugs in angioneurology. Comprehensive analysis of the impact of Gamalate B6 on the functional state of the central nervous and cardiovascular system in patients with cerebral atherosclerosis. Methods: 30 elderly patients before and after a course of Gamalate B6 (gamma-aminobutyric acid, gamma-aminobeta-hydroxybutyric acid, magnesium glutamate hydrobromide and pyridoxine hydrochloride tab 2 times per day for month, underwent neuropsychological testing, analysis of brain activity and ultrasound scan of extra- and intracranial parts of the main cerebral arteries. Results: In patients Gamalate B6 improves short-term and long-term memory, reduces the level of personal and situational anxiety, improves cerebral blood flow: significantly increases linear systolic blood flow velocity in the right and left common carotid artery (before treatment was 75.87±4.2cm/s and 77.87±3.87cm/s, after treatment ±3.92cm/s and 9.78±4.2, respectively) due to lower peripheral resistance index (Ri) in the right internal carotid artery, common carotid artery and left internal carotid artery. Gamalate B6 harmonises the functional state of thalamo-cortical and subcortical brain structures (increases the power of the alpha rhythm amid falling EEG - power subcortical structures, generating slow rhythms) and sympathetic-parasympathetic balance of autonomic nervous system (increased value of triangular index and HF fluctuations). Conclusion: In elderly patients with cerebral atherosclerosis Gamalate B6 improves functional state of central nervous and cardiovascular systems. 205 European Journal of Neurology, 22 (Suppl. ),

327 80 Flash Posters F4088 Predicting early lethal outcome after acute ischemic supratentorial stroke using clinical parameters and parameters of quantitative electroencephalography A. Kuznietsov Zaporizhzhya State Medical University, Neurology, Zaporizhzhya, Ukraine Background and aims: Elaboration of statistical models to predict early lethal outcome (ELO) after acute ischemic supratentorial stroke (AISS) is very important and relevant in modern angioneurology and can help the practicioners to improve treatment approaches. We therefore developed a new model using clinical parameters and parameters of quantitative electroencephalography (QEEG). Methods: 20 patients (mean age 67.8±0.8 years) were studied within first 72 hours after clinical onset of AISS. Clinical examination included evaluation by National Institute of Health Stroke Scale and Full Outline of UnResponsiveness score (FOUR). Separately to affected and intact hemisphere the values of absolute and relative spectrum rhythm power (RSRP) of δ-, θ-, α-, β-ranges, θlo-, θhi-, αlo-, αhi-, βlo-, βhi-subranges were detected. Development of prognostic model was made by logistic regression and ROC-analysis. Results: From 20 stroke patients, 3 (0.8%) were dead. Nearly 60 models were obtained. The model with the largest area under the curve (AUC=0.982) was: β=-0.99* (FOUR score on the 3 rd day) +0.66* (RSRP of δ-range in intact hemisphere). Significance level of Hosmer-Lemeshow-test for selected model p=0.9396, Percent Concordant=98.2. Optimal cut-off value of β, which predicted ELO with sensitivity=92.3% and specificity=94.4%, was determined. Conclusion: Developed prognostic model might be a powerful tool for predicting ELO after AISS and improving effectiveness of treatment. F4089 Comparison of prognostic value of different clinical scales for predicting early lethal outcome after acute ischemic supratentorial stroke O. Kozyolkin, A. Kuznietsov Zaporizhzhya State Medical University, Neurology, Zaporizhzhya, Ukraine Background and aims: Identification of vital prognosis in patients with acute ischemic supratentorial stroke (AISS) using clinical parameters is very important and relevant in modern angioneurology and can help the practicioners to improve treatment approaches. Therefore we decide to verify the clinical scale with the largest prognostic value for predicting early lethal outcome (ELO) after AISS. Methods: 20 patients (mean age 67.8±0.8 years) were studied within first 72 hours after clinical onset of AISS. Clinical examination included evaluation by National Institute of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS) and Full Outline of UnResponsiveness scale (FOUR). Сomparison of prognostic values of FOUR, GCS and NIHSS for predicting ELO after AISS was done using comparative ROC-analysis. Results: From 20 stroke patients, 3 (0.8%) were dead. Predictors of ELO were verified: FOUR score on the st day from the clinical onset of AISS 3 (Se=76.9%, Sp=97.2%) and FOUR score on the 3 rd day from the clinical onset of AISS 2 (Se=84.6%, Sp=98.%). On the st day from the clinical onset of AISS FOUR score has the largest area under the curve (AUC=0.97) for predicting ELO than GCS score (0.8, p<0.05) and NIHSS score (0.9, p<0.05). These differences were found also for scores on the 3 rd day from the clinical onset of AISS. Conclusion: Full Outline of UnResponsiveness scale might be a powerful tool for predicting ELO after AISS and improving effectiveness of treatment. F4090 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

328 Flash Posters 8 F409 Cardiac surgery-associated stroke: is there a chance for endovascular treatment? E. Monreal, A. Escolar Villalba Hospital Ramón y Cajal, Neurology, Madrid, Spain Background and aims: Stroke is a common complication in patients subjected to cardiac surgery. As intravenous fibrinolysis is contraindicated, endovascular treatment remains the only acute reperfusion therapy available in these patients. No studies have addressed the feasibility of endovascular treatment in cardiac surgery-associated stroke. We have reviewed the clinical characteristics and time to neurological consultation in patients with acute cerebrovascular disorders associated with cardiac surgery in a tertiary hospital. Methods: Patients with postsurgical stroke or transient ischemic attack (TIA) associated with cardiac surgery were prospectively registered in a tertiary hospital between 2008 and 203. We retrospectively reviewed the demographic data, cerebrovascular risk factors, surgery duration, extracorporeal circulation time, surgery-symptoms delay, time to neurological attention, diagnosis and modified Rankin Scale (mrs) at discharge. Results: During the study period 39 strokes (37 ischemic and 2 hemorrhagic) and 8 TIA were reported, representing 2.56% of major cardiac surgery patients. Extracorporeal circulation was performed in 89.6% of them. Perception of neurological symptoms was delayed beyond 24 hours in 59.6% of patients. In only 35.4% of the cases neurological consultation was required within 4.5 hours of awareness of symptoms. Endovascular treatment was performed in only one patient. Mortality was 8.75% and 45.8% of patients had mrs 2. Conclusion: Cardiac surgery-associated stroke is an important source of morbidity and mortality. There is a great delay in the perception of symptoms and in neurological consultation, resulting in a very low percentage of endovascular treatments. Implementation of postsurgical neurological evaluation protocols is necessary in cardiac surgery patients in order to improve their neurological prognosis. F4092 Clinical characteristics of transient ischemic attack and its prognosis in a Tunisian population. A. Mouna, B. Faten, D. Nizar, B. Amel, F.A. Mahbouba Chu monastir, neurology, monastir, Tunisia Background and aims: Transient ischemic attack (TIA) defined as a neurologic deficit caused by focal brain ischemia that completely resolves within 24h, is common and precedes 5% of strokes. Therefore effective secondary prevention is important. The aims of this study were to describe the epidemiological and clinical characteristics of the transient ischemic attack and to identify the determinants of prognosis. Methods: A retrospective study carried out in the department of neurology Fattouma Bourguiba Monastir Tunisia. All patients with symptoms of TIA were admitted and they were followed for 90 days Results: A total of 36 patients was admitted for TIA in the department. The mean age was 6.3 years±2 years and sex ratio of.. The risk factors were dominated by hypertension (5.3%). The most frequent symptoms were: motor weakness (79%), speech impairment (64%) and sensory disturbance (22%). The mean duration of symptoms was 73.2± 87.5min. Among the patients, 55 (7.5%) had an ischemic stroke. The rate of stroke predicted from the ABCD2 score was 5.4%, 8.2%, 0.% and 7.5%; 2, 7, 30 and 90 days. In addition, the majority of patients received antiplatelet therapy (9.%). The evolution was favorable in 82.6% of patients within 3 months. Conclusion: Identifing the different risk factors in our population allows us to prevent the channel of TIA in ischemic stroke. 205 European Journal of Neurology, 22 (Suppl. ),

329 82 Flash Posters F4093 Environmental risk factors in carotid and vertebro-basilar artery dissections S. Piffer, M. Acler 2, D.M. Bonifati 2, E. Gremes 2, U. Rozzanigo 3, N. Argawal 3, D. Orrico 2 Verona, 2 Santa Chiara Hospital, Department of Neurological Disorders, Trento, 3 Santa Chiara Hospital, Department of Radiology, Trento, Italy Background and aims: Cervical artery dissection can involve the internal carotid artery (ICAD), the vertebral artery (VAD), or both (multiple artery dissection, MAD). Genetic and environmental factors are implied in etiopathogenesis. We retrospectively analysed cases of anterior and posterior artery dissection focusing on environmental risk factors. Methods: We studied patients with ICAD, VAD or MAD admitted to our Stroke Unit between Complete clinical data were analyzed. Results: ICAD was found in 34 patients (female/male 0.54, age-range years, median 49); VAD in 9 cases (female/male 0.26, age-range 28-7 years, median 52); MAD in 3 women (age-range 4-52 years; median 5). 35 cases occurred in winter and autumn, 2 in summer and spring. We did not find any difference between ICAD and VAD cases considering the following factors: environmental factors (in 43% of all patients), common vascular risk factors (in 59%), co-occurance of both (in 25%). No clear factors were found in 23%. In detail a previous neck trauma/torsion was found in 20% of cases (9 ICAD, VAD, MAD). Thyroid dysfunction in 8% (5 ICAD, 4 VAD, MAD). Upper airway tract infection in 9% (3 CAD, VAD, MAD). Hypercolesterolemia, hypertension, hyperhomocysteinemia, smoke, diabetes were found respectively in 34%, 34%, 4%, %, 9% of all patients. Conclusion: An environmental factor antecedent an arterial dissection was found in 43% of all cases while vascular risk factors were in 57% of cases without a clear difference between VAD and ICAD. Idiopathic cases are still 23%. F4094 Abstract cancelled F4095 Acute post-stroke depression is not related to lesion lateralisation P. Potoczek, P. Moskal 2, K. Kowalska, E. Klimiec, A. Fedyk 3, A. Slowik, A. Klimkowicz-Mrowiec 4 University Hospital, Department of Neurology, Cracow, 2 University Hospital, Cracow, 3 The Institute of Applied Psychology, Jagiellonian University, Cracow, 4 Jagiellonian University, School of Medicine, Department of Neurology, Cracow, Poland Background and aims: Post-stroke depression (PSD) is observed in 20-50% of patients and it is associated with worse outcomes and lower quality of life after stroke. Several studies have evaluated association between the lesion location (left/right side) and the occurrence and severity of depression, however the results are equivocal. The aim of the study was to evaluate association of stroke laterality with severity of depression. Methods: Consecutive patients admitted to the Stroke Unit, Department of Neurology, University Hospital, with supratentorial stroke or TIA were included in the study. Patients were assessed for depression 7-0 days after admission with Patient Health Questionnaire-9 (PHQ-9). We compared the occurrence of depression in patients with left vs. right sided lesions. Severity of depression was defined according to PHQ-9 score: 5-9 for minor, 0 or more points for major depression. Results: 37 of 267 stroke patients were included into the study. PHQ-9 was performed in 78 patients with right sided and 59 with left sided lesions. Depression occurred in 48% (n=87) of patients. Among depressed patients 44% had minor and 56% major depression. There was no significant difference in presence of depression or its severity between left and right sided stroke. Conclusion: Acute post-stroke depression is not related to lesion lateralisation. F4096 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

330 Flash Posters 83 F4097 Impact of the FAST score to distinguish a neurovascular pathology from a differential diagnosis of stroke in 36 patients included in a stroke care pathway V. Quenardelle, V. Lauer, S. Kremer 2, D. Bindila, O. Rouyer, I. Zinchenko, H. Delplancq 3, N. Meyer 4, B. Geny 5, T. Moulin 6, C. Marescaux, V. Wolff Hôpitaux Universitaires de Strasbourg, Unité Neurovasculaire, Service de Neurologie, Strasbourg, 2 Hôpitaux Universitaires de Strasbourg, Service de neuroradiologie, Strasbourg, 3 Hôpitaux Universitaires de Strasbourg, SAMU, Strasbourg, 4 Hôpitaux Universitaires de Strasbourg, Service de santé Publique, Strasbourg, 5 Hôpitaux Universitaires de Strasbourg, Service de Physiologie et des Explorations Fonctionnelles, Strasbourg, 6 Besançon, France Background and aims: Prehospital identification of acute stroke increases the possibility of early thrombolysis treatment. The FAST score was developed in 998 to facilitate the prehospital stroke recognition and consists of 3 items (facial weakness, arm weakness and speech disturbance). Methods: The aim of this study is to analyse the accuracy of the FAST score in patients included in the stroke care pathway of Strasbourg university hospital (France). All consecutive patients admitted in this pathway within a -year period (February 20 to February 202), were prospectively enrolled in this study. The stroke code was activated by calling the 5 number for patients with an acute neurological deficit within the time window for intravenous thrombolysis. A cerebral MRI were performed in all patients. Results: There were 36 consecutive patients admitted for a suspicion of acute stroke. 62% had a neurovascular diagnosis (ischaemic stroke, transient ischaemic attack, intracranial haemorrhage, cerebral venous thrombosis and neurovascular medullar pathology). Differential diagnosis (DD) represented 38% of cases. The FAST score was positive in 80% for the neurovascular group and only in 42% for the DD group (p<0.00). However, the negative predictive value of the FAST score was 64% and the positive predictive value was 76%. Conclusion: FAST score is useful for the recognition of neurological deficits related to stroke by ambulance paramedics, but is moderately performant for distinguish a stroke from a DD. This result highlights that cerebral MRI is expected in all patients with acute neurological symptoms in order to exclude a DD of stroke. 205 European Journal of Neurology, 22 (Suppl. ),

331 84 Flash Posters Movement disorders 5 F4098 Reflexive saccadic eye movements amplitude and peak velocity are evaluated in a 9-month periodical assessment in deep brain stimulation patients with Parkinson s disease S. Szlufik, J. Dutkiewicz, A. Przybyszewski 2, P. Habela 2, D. Koziorowski Medical University Warsaw, Neurology, Warsaw, 2 Polish- Japanese Academy of Information Technology, Informatics, Warsaw, Poland Background and aims: There is an increasing number of publications related to the influence of the Subthalamic Nucleus Deep Brain Stimulation (DBS STN) and L-dopa treatments on latency, duration, amplitude and velocity of reflexive saccades (RS). However, there is no evidence regarding the evaluation of saccades as a monitoring tool of the Parkinson progression in DBS patients. Therefore, the aim of our study was to compare RS parameters in DBS patients in a 9-month period in 4 different phases of treatment. Methods: We conducted RS in horizontal eye movement measurements in 8 PD patients with DBS STN (mean age 5.22±4.7years, mean disease duration 0.66±.44years) in 4 phases: -StimOnMedOn, 2-StimOnMedOff, 3-StimOffMedOn, 4-StimOffMedOff. The assessment was performed twice in 9-month period of time (±3 months). Changes of motor performance, behavioral dysfunction, cognitive impairment and functional disability were evaluated in each session according to the UPDRS. Horizontal saccades were recorded by the head-mounted infrared saccadometer (Ober Consulting, Poland). Results: During 9-months two-time RS evaluation revealed negative relation between mean amplitude (Amp) and peak of velocity (PoV) of saccades in StimOffMedOff session (p<0.05) respectively: Amp.36±4.4deg vs 0.33±3.9deg, PoV 489.3±43.5deg/sek vs 464.6±84.5deg/sek. There was also a significant correlation between saccade latency and UPDRS III score (R=0.42, p<0.05), and between saccade latency and the phase of DBS/L-dopa treatment (R=0.25, p<0.05). Conclusion: RS parameters especially the RS latency correlated with UPDRS III during follow-up period in DBS STN PD patients. Therefore the eye movement (EM) measurements may be a good biomarker of the patient s response to treatment and to the disease progression. Disclosure: This work was supported by Grant 20/03/B/ ST6/0386 from the National Centre for Research and Development, Poland. No conflict of interest exists. F4099 Fragile X-associated tremor/ataxia syndrome, differential diagnosis of essential tremor: a case report G. Tamas, N. Kovacs 2, M.J. Molnár 3, P. Barsi 4, L. Erőss 5, N.Á. Varga 3, I. Balás 2 Semmelweis University, Department of Neurology, Budapest, 2 University of Pécs, Pécs, 3 Semmelweis University, Department of Genomic Medicine and Rare Disorders, Budapest, 4 Semmelweis University, MR Research Centre, Budapest, 5 National Institute of Clinical Neurosciences, Budapest, Hungary Background and aims: Fragile X-associated tremor/ataxia syndrome (FXTAS) is a rare neurodegenerative disorder affecting predominantly men in their sixties; they are carriers of premutation alleles of the FMR gene on the X chromosome. Its initial symptoms are slight cerebellar gait ataxia with action, intention tremor, with one to several years delay followed by a severe, progressive trunk and limb ataxia. At its early phase, clinical features can be similar to essential tremor. Their differential diagnosis can be important during preoperative evaluation of essential tremor. Case Report: A 66-year-old man has been treated for essential tremor for years. 7 years after tremor-onset mild cerebellar gait ataxia developed. An MRI examination showed moderate, global brain atrophy. Bilateral deep brain stimulation of the thalamus ventral intermedius nucleus could achieve only temporary tremor relief. Replacement of the leads to the bilateral subthalamic nucleus also only had a transient improvement. In the meantime, progressive gait ataxia and tetraataxia developed with nystagmus and scanning speech, in correlation with the occurrence of the bilateral, symmetric hyperintensity of the medial cerebellar peduncles, on the cranial T2 weighted MRI scans. Results: Genetic testing revealed the premutation of the FMR gene suggesting fragile X-associated tremor/ataxia syndrome. Thalamotomy in the dominant side could reduce tremor without further progression of the ataxia. Conclusion: Considering a few case reports published inconsistent results regarding efficacy of the deep brain stimulation on tremor, one-sided thalamotomy can also be an option to reduce tremor in FXTAS, although ataxia is the most liable for severe disability. 205 European Journal of Neurology, 22 (Suppl. ),

332 Flash Posters 85 F400 Wrist clonus (video included) I. Tatlidil, Y. Beckmann, N. Gürgör Katip Çelebi University Atatürk Training and Research Hospital,, Neurology, Izmir, Turkey Background and aims: We describe two cases with wrist clonus, which were firstly misdiagnosed as seizure. Case Report: Case-: A 68-year-old-male-patient presented with lethargy, new-onset left hemiparesis and involuntary rhythmic contractions on the right upper limb. He had sequel right hemiparesis caused by left perisylvian infarction. Diffusion-weighted-imaging revealed acute right posterior cerebral artery infarction. Beside lethargy and left hemiparesis the neurological examination showed brisk reflexes, spasticity and clonus provoked by the sudden hyperextension of the wrist on the right side. Case-2: A 6-year-old-female-patient was referred to our clinic with the diagnosis of seizure and loss of consciousness. Intravenous loading dose of fenitoin had been given before admission. She had sequel left hemiparesis due to right frontal hematoma. Neurological examination showed new-onset right hemiparesis. Besides, she had brisk reflexes, spasticity and wrist clonus both spontaneous and provoked by wrist extension on the left side. Brain computed tomography revealed an acute left medial cerebral artery infarction. During her follow-up no seizure was observed. Results: Both of the cases had wrist clonus in the neurological examination. Having extensive hemispheric lesions caused by hematoma and infarction they both were deteriorated and died due to long-term complications of intensive care unit. Conclusion: Clonus is a common symptom of spasticity caused by upper motor neuron lesion. Wrist Clonus is seen rare and confusing, most of time misdiagnosed as tremor, focal seizure and other movement disorders. Differential diagnosis of wrist clonus in patient with moderate spasticity is important for right clinical approach. F40 Insomnia may be an important factor associated with increased need in levodopa Z.D. Tavadyan, S. Khachatryan 2, A. Karamyan 2, H. Bakunts Yerevan State Medical University, Angioneurology, Yerevan, 2 Somnus Sleep and Movement Disorders Clinic, Yerevan, Armenia Background and aims: Parkinson s disease (PD) is frequently associated with nocturnal symptoms and sleep disorders like insomnia, rapid-eye movement sleep behavior disorder and others. Dopaminergic drugs are associated with excessive daytime sleepiness. Our aim was to see if levodopa use is associated with insomnia complaint in patients with PD. Methods: Patients diagnosed based on UK PD Society s diagnostic criteria attending a tertiary movement disorders clinic were enrolled in this study. A complaint of insomnia was recorded by interview asking for both sleep-onset (SOI) and sleep-maintenance insomnia (SMI). Patients were divided into two groups: Insomnia Group (IG) and Non-Insomnia Group (NIG). T-test was utilized for statistical analysis. Results: Overall 9 patients with PD were assessed aged 42-80, mean 64.5, F-50.5% (46), of which 20.% (9) had no insomnia complaint; the rest had SOI, SMI or both. Mean levodopa dosage in NIG was 67mg/day, while PD patients in IG take higher dosages of levodopa (mean 324mg/day). The difference was statistically significant (p<0.05). The groups did not differ in age, disease duration and age of onset. Additional analysis was used to compare UPDRS scores, which did not reveal significant deviation in motor scores (UPDRS III) in favor of IG (p>0.05). Although, we found significant correlation with UPDRS II activities of daily living (p<0.05). Conclusion: Our data suggest PD patients with concomitant insomnia are treated with higher levodopa dosages than patients without insomnia. There could be different explanations for this finding, from insomnia by additional dosages during the night. 205 European Journal of Neurology, 22 (Suppl. ),

333 86 Flash Posters F402 Young-adulthood onset cerebellar ataxia due to Coenzyme Q0 deficiency E. Terecoasa, N. Grecu 2, F. Antochi 2, A.C. Mergeani, C. Tiu 2 Bucharest, Romania, 2 University Emergency Hospital, Neurology, Bucharest, Romania Background and aims: Coenzyme Q0 (CoQ0) deficiency is a clinically and genetically heterogenous syndrome that can be associated with 5 major clinical phenotypes: encephalomyopathy, infantile multisystemic disease, nephropathy, isolated myopathy and cerebellar ataxia, the latter being the most frequent one. Case Report: A 26-year-old male, with no family history of neurologic disease, was hospitalised for generalised ataxia. Previously healthy, at the age of 8 he noticed gait ataxia and difficulty in coordinating the upper limbs. Ataxia progressively involved all limbs, balance worsened and the speech became slurred. At admission he had severe limb ataxia, slow and scanning speech, hyperreflexia, bilateral Babinski sign, impaired vibratory sense in lower limbs. He could not walk more than 00 meters without some support. He had severe deficit in short term memory and severe decrease of mnemonic integration and attention. Results: Electrophysiologic studies showed mild axonal sensitive polyneuropathy. Brain MRI showed atrophy of the cerebellum. The following tests were normal: Ophtalmologic evaluation, CSF analysis, immunologic screening, vitamin E blood level, thyroid hormones, testosterone, serum copper and ceruloplasmin, serum lactate and pyruvate. Serum CoQ0 levels were below 0.05mg/dL (normal range above.3mg/dl). Muscle biopsy showed no significant changes (coenzyme Q0 measurement in muscle was not performed). The patient was treated with CoQ0 2,000mg/ day for three months and symptoms improved. Conclusion: Although the clinical presentation varies considerably, CoQ0 deficiency should be considered in the differential diagnosis of all adulthood-onset cases of cerebellar ataxia because CoQ0 administration may improve the symptoms of an otherwise untreatable disease. F403 Dropped head syndrome with necrotizing myopathy: a drug class effect confirmed by 3 repeated exposures to non ergolinic dopamine agonists, due to L-Dopa phobia A. Thomas, L. Bonanni, A. Di Muzio 2, M. Onofrj University Chieti Pescara, Chieti, 2 Ospedale Chieti, Dept di Neuroscience, Imaging and Medical sciences, Chieti, Italy Background: Dropped head syndrome (DHS) or antecollis is a common complication in multiple system atrophy and a rare complication in L-Dopa responsive Parkinson s disease (PD). Few reports described DHS as a side effect of dopamine agonists (DAs) treatment in PD, mostly in Asian patients. Case Report: We report a single case of DHS in a 56 yearold Caucasian male patient affected by PD. Insistent and repeated DA treatment with pramipexole, ropinirole and rotigotine was due to L-Dopa phobia and DA withdrawal syndrome. Each DA treatment was accompained by DHS recurrence with muscle enzyme increment. Results: The cause of DHS was identified by muscle biopsy as a necrotizing myopathy. Repeated administration of different DAs, inducing recurrence of DHS shows that DHS was due to a drug class effect of non ergolinic dopamine agonists Conclusion: The exposure to three different non ergolinic DA induced DHS in this patients, suggesting a role of DA receptor sensitivity in the pathogenesis of DHS. Our case report also calls attention to possible risks of two other complications of PD treatments, L-Dopa phobia and dopamine agonist withdrawal syndrome, which prompted the repeated exposures. F404 Abstract cancelled 205 European Journal of Neurology, 22 (Suppl. ),

334 Flash Posters 87 F405 Lübeck center for rare diseases bridging a gap of neurological care S. Tunc, J. Graf, E.-J. Vollstedt 2, V. Tadic, S. Zittel 3, A. Weißbach, J. Tübing, D. Alvarez-Fischer 2, J. Bohnenpoll, J. Spiegler 4, S. Ortfeld 4, M. Kasten 2, N. Bruggemann, K. lohmann 3, T. Bäumer 3, C. Klein 3, A. Münchau 3 Institute of Neurogenetics, University of Luebeck, Luebeck, Germany, 2 Institute of Neurogenetics, University of Luebeck, Luebeck, Germany, Department of Psychiatry and Psychotherapy, Lübeck, 3 Institute of Neurogenetics, University of Luebeck, Luebeck, Lübeck, Germany, 4 Department of Pediatrics, University of Lübeck, Lübeck, Germany Background and aims: Although rare diseases may have unique and easily discernable presentations, they often lead to multi-system dysfunctions which need to be put together on the basis of holistic rather than subspecialty knowledge. As an integral part of the Lübeck Center for Rare Diseases, we provide an all-age interdisciplinary perspective and collaborative approach. Methods: Our specialised movement disorders child and adult outpatient unit encompasses a specialised outpatient clinic with expert supervision, genetic counseling, psychological/psychosocial support, elective courses for students of medicine/psychology, case conferences, workshops, and telemedicine. All patients were clinically assessed by experienced experts in the field of movement disorders and neuropsychiatry and diagnosed according to published standard criteria. Results: From January to November 204, 888 patients presented in 896 visits to our clinics, of whom 76 had rare diseases including spinocerebellar ataxias, Huntington s disease, atypical/genetically determined parkinsonism, dystonia, and rare metabolic/neurodegenerative disorders (e.g. Niemann-Pick-Type-C disease). Compared to 203 the percentage of rare diseased patients rose from 3% to 9%. Genetic counselling was provided for 77 patients and relatives. In monthly case conferences, we discussed 22 patients with unknown disorders, of which 5 could be diagnosed afterwards. Telemedicine was conducted for 8 patients. Expert workshops and student teaching courses are well attended. Conclusion: The specialised interdisciplinary all-age approach bridges an important gap in neurological care. We expect that an increasing number of patients with rare and unclear diagnoses will be personally seen in the specialty center in Lübeck. We anticipate that the newly provided service will improve patient wellbeing and quality of life considerably. Disclosure: This research has been supported by Actelion Pharmaceuticals, the Possehl Foundation, and the University Medical Center Schleswig-Holstein (UKSH). F406 Primary autoimmune cerebellar ataxia - a challenging diagnosis R. Varela, S. Batista 2, J. Ribero Coimbra, Portugal, 2 CHUC, Neurology, Coimbra, Portugal Background and aims: Nonhereditary ataxias with adult onset have a wide variety of causes which include exposure to toxic agents, immune-mediated inflammation, paraneoplastic, vitamin deficiency, and chronic infections. Primary autoimmune cerebellar ataxia as a form of organspecific autoimmune disease was recently described and may account for some cases of idiopathic sporadic cerebellar ataxia. Case Report: A 76-year-old man was admitted to the emergency room after a 2-months history of nausea, vomiting, diarrhea and unintended weight loss following a short period of flue-like symptoms. Three weeks prior to admission, the patient developed symptoms of blurred vision and gait impairment. Neurological examination revealed dysartria, bilateral limbs ataxia, severe gait ataxia (ambulation possible only with assistance by another person), and generalised hyporeflexia. Diagnostic workup, including systemic autoimmunity analysis; infectious serology; tumour markers; vitamin E levels; anti-neuronal, anti-gad, anti-gliadin and anti-endomysium antibodies; CSF study; electromyography; brain MRI; thoraco-abdomino-pelvic CT; upper and lower digestive endoscopy and noninvasive cholangiography, was negative. During hospitalisation the patient presented jaundice and increasing levels of transaminases. Liver function tests and positiveness for antimitochondrial and antinuclear antibodies allowed the diagnosis of primary biliary cirrhosis. Results: The patient was treated with g IV methylprednisolone for 5 days followed by prednisolone mg/kg/day with dramatical improvement of neurologic and hepatic symptoms, recovering independent gait. Conclusion: In this case, the association of a subacute cerebellar syndrome with an autoimmune disorder and the marked response to steroids suggest an immune mediated damage to the cerebellum. The negative diagnostic workup favour the diagnosis of primary autoimmune cerebellar ataxia 205 European Journal of Neurology, 22 (Suppl. ),

335 88 Flash Posters F407 QT/QTc evaluation of opicapone in healthy adults. M. Vaz-da-Silva, R. Pinto, N. Lopes, A. Santos, T. Nunes, J.F. Rocha, P. Soares-da-Silva BIAL Portela & Cª S.A., Dept. R&D, S. Mamede do Coronado, Portugal Background and aims: The aim of this study was to investigate the effect of opicapone (OPC), a novel once-daily and long-acting peripheral COMT-inhibitor, on cardiac repolarization in healthy adult volunteers. Methods: This was a single-centre, randomized, doubleblind placebo-controlled, open-label active-controlled, 4-period crossover study conducted in 64 healthy volunteers. Subjects received a single oral dose of either 50mg- OPC, 800mg-OPC, placebo or 400mg moxifloxacin. A 24- hour, 2-lead Holter monitoring was performed on Days - (baseline) and after each single dose. The primary criterion was the individual QT interval corrected for heart rate (QTcI) derived for each subject from the regression model that best fitted the relationship between the QT and RR intervals. Results: The largest upper bounds of the one-sided 95% confidence intervals (CI) for the placebo-corrected QTcI change from baseline were 3.46ms and 4.45ms for 50mg- OPC and 800mg-OPC, respectively, considerably below the 0ms threshold of regulatory concern. Moxifloxacin caused an increase in QTcI with a lower bound of the twosided 95% CI higher than 5ms for the majority of time points, demonstrating assay sensitivity. Conclusion: OPC was not associated with prolongation of the QT interval F408 Evaluation of opicapone s cardiac safety in patients with Parkinson s disease: analysis of the centralized phase III ECG dataset M. Vaz-da-Silva, R. Pinto, N. Lopes, J. Ferreira 2, A. Lees 3, H. Gama, A. Santos, C. Oliveira, T. Nunes, J.F. Rocha, P. Soares-da-Silva BIAL Portela & Cª S.A., Dept. R&D, S. Mamede do Coronado, Portugal, 2 Instituto de Medicina Molecular, Neurological Clinical Research Unit, Lisbon, Portugal, 3 National Hospital for Neurology and Neurosurgery, London, United Kingdom Background and aims: Opicapone (OPC) is a novel oncedaily peripheral COMT-inhibitor shown to be safe and effective in reducing OFF-time in Parkinson s disease (PD) patients with motor fluctuations. The aim of this analysis was to evaluate the effects of OPC compared to placebo on electrocardiographic parameters in patients with PD. Methods: Standard 2-lead ECGs from two multicentre, double-blind, randomised, placebo- and active-controlled studies (BIPARK I and II) were pooled and evaluated. ECGs were recorded at baseline (in triplicate) and endpoint using digital electrocardiographs ELI 250. Changes from baseline were calculated for QT, QTcF, QTcB, PR, QRS and HR. Outliers and morphological abnormalities were evaluated by categorical analyses. Results: 3060 ECGs from 772 subjects (243 in 25mg-OPC, 266 in 50mg-OPC and 263 in placebo) were evaluated. No statistically significant differences between OPC groups and placebo were observed for the changes from baseline in QT/QTc, PR and HR estimates. The mean placebo-adjusted increases in QTcF/QTcB were <4 msec with both OPC doses, and all upper limits of the -sided 95% confidence intervals (CI) were <0 msec. The observed slight increase in QRS interval [.6 msec (90% CI: 0.2, 3.0) and 0.9 msec (90% CI: -0.5, 2.3) with 25mg- and 50mg-OPC, respectively] is not clinically relevant. There were few significant ECG abnormalities, and these were distributed similarly across placebo and OPC groups. Conclusion: OPC treatment was not associated with any relevant effects on ECG intervals or morphology. 205 European Journal of Neurology, 22 (Suppl. ),

336 Flash Posters 89 F409 The efficacy of three dimensional accelerometer evaluating of gait in Parkinson s disease. K. Yoshida, T. Kimura, Y. Aburakawa, Y. Suzuki, K. Kuroda, O. Yahara Asahikawa Medical Center, Neurology, Asahikawa, Japan, Purpose: Parkinson s disease patients have gait disorder and disease severity mainly depends on impaired posture and balance. We investigated whether three dimensional accelerometer is useful to evaluate gait performance and relates staging or not. Methods: Patients who were Horn and Yahr (HY) stage from II to IV were recruited from our hospital. They were measured gait parameters with three dimensional accelerometer. Results: Between April 200 and August 204, 0 patients in HY II, 20 patients in HY III and 20 patients in HY IV were assigned to this study. Gait speed was a significant difference in three groups (77.5m/min, 7.0m/min, 44.0m/ min, P<0.00, Kruskal-Wallis test). Step width was a significant difference in three groups (62.0cm, 56.2cm, 36.5cm, P<0.00, Kruskal-Wallis test). Coefficient of variation of the vertical was a significant difference in three groups (0.,.9, 20.6, P=0. 0, Kruskal-Wallis test). However, coefficient of variation of horizontal was not different in three groups (.2, 0.8, 0.0, P=0. 6, Kruskal-Wallis test). Conclusion: We demonstrated that Parkinson s disease patients more severity HY stage, higher CV of vertical not horizontal with three dimensional accelerometer. Three dimensional accelerometer is quantitative and able to easily perform repeatedly. Therefore, three dimensional accelerometer plays a crucial role in the assessment of gait performance in Parkinson s disease patients. 205 European Journal of Neurology, 22 (Suppl. ),

337 820 Flash Posters MS and related disorders 5 F40 Abstract cancelled F4 Indirect comparison of effects of glatiramer acetate 40mg TIW and 20mg QD dosing regimens on relapse rates: results of a predictive statistical model G. Cutter, J. Wolinsky 2, G. Comi 3, D. Ladkani 4, V. Knappertz 5, A. Vainstein 6, N. Sasson 6, O. Khan 7 Birmingham, USA, 2 University of Texas, Houston, USA, 3 San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Department of Neurology, Milan, Italy, 4 Teva Pharmaceutical Industries, Petach Tiqva, Israel, 5 Teva Pharmaceutical Industries, Frazer, USA, 6 Teva Pharmaceutical Industries, Netanya, Israel, 7 Wayne State University School of Medicine, Detroit, USA Background and aims: The lack of glatiramer acetate (GA) 20mg once daily (QD) in the GALA trial precludes direct comparison with GA 40mg three times per week (TIW). We performed indirect comparisons using regression models to predict annualised relapse rate (ARR) of patients (pts) who received GA 20mg QD in clinical trials if they had received 40mg TIW; and ARR of GALA 40mg TIW pts if they had received GA 20mg QD. Methods: The ARR of GA 40mg TIW in GALA was estimated using negative binomial regression as a function of baseline (BL) characteristics. The final model included 4 covariates predictive of ARR [age, BL EDSS, presence of GdE lesions at BL (0 and ), number of relapses in the year before screening ( and 2)]. Results: Supporting final model validity, predicted ARR for GALA pts receiving GA 40mg TIW was similar to the actual ARR. Predicted ARRs for REGARD and BEYOND pts, had they received GA 40mg TIW, were similar to reported ARRs for GA 20mg QD in REGARD and BEY- OND. Predicted ARR for CONFIRM pts who received GA 40mg TIW was slightly higher than observed ARR. In the model built from FORTE data, predicted ARR for a GALA pts who received GA 20mg QD was similar to the reported ARR. Conclusion: Indirect comparison of ARR of GA 40mg TIW in GALA with GA 20mg QD from large, prospective, well-controlled trials using predictive models demonstrates similar efficacy of the two GA dosing regimens. Disclosure: Study sponsored by Teva Pharmaceutical Industries to evaluate the efficacy and safety of glatiramer acetate 40 mg/ml three times weekly. F42 Comparable clinical and MRI efficacy of glatiramer acetate 40mg TIW and 20mg QD: Results of a systematic review and meta-analysis G. Cutter, J. Wolinsky 2, G. Comi 3, D. Ladkani 4, V. Knappertz 5, A. Vainstein 6, N. Sasson 6, O. Khan 7 Birmingham, USA, 2 University of Texas, Houston, USA, 3 San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Department of Neurology, Milan, Italy, 4 Teva Pharmaceutical Industries, Petach Tiqva, Israel, 5 Teva Pharmaceutical Industries, Frazer, USA, 6 Teva Pharmaceutical Industries, Netanya, Israel, 7 Wayne State University School of Medicine, Detroit, USA Background and aims: To assess the comparability of the GA 40mg TIW and GA 20mg QD efficacy profiles. Methods: A systematic review for meta-analysis resulted in four eligible PBO-controlled studies with GA 20mg QD. Individual and aggregated meta-analyses to reach an overall estimate of GA 20mg QD treatment effect on annualized relapse rate (ARR) and number of new T2 lesions were performed. The RRs for GA 20mg QD vs. PBO were descriptively compared with RRs for GA 40mg TIW vs. PBO in GALA for the same endpoints. Results: GA 20mg QD showed ARR reductions of 28% vs. PBO in a pooled individual patient data (p=.02) and 30% in aggregate data (p<.000). In GALA, the ARR was reduced by 34% with GA 40mg TIW vs. PBO (p<.000). Confidence intervals (CIs) for RRs of GA 20mg QD vs. PBO and GA 40mg TIW vs. PBO on ARR substantially overlapped, indicating similarity of GA 40mg TIW effect to that of GA 20mg QD. GA 20mg QD reduced new T2 lesions by 43% vs. PBO (p=.002) while in GALA, the GA 40mg TIW reduction was 35% (p<.000). The RR CI for GA 40mg TIW was wholly contained within that of GA 20mg QD, suggesting a similar treatment effect on new T2 lesions. Conclusion: In lieu of direct comparison, meta-analyses of data from large, prospective, well-designed and controlled trials support the similar efficacy of GA 40mg TIW and GA 20mg QD for reducing relapses and new T2 lesions in patients with RRMS. Disclosure: Study sponsored by Teva Pharmaceutical Industries to evaluate the efficacy and safety of glatiramer acetate 40mg/ml three times weekly. 205 European Journal of Neurology, 22 (Suppl. ),

338 Flash Posters 82 F43 Prelinary data on Small Intestinal Bacterial Overgrowth (SIBO) syndrome in Relapsing Remitting Multiple Sclerosis (RRMS). F. Corea, V. Giuliano 2, A. Rossi 2, B. Federici 2, P. Qualadrucci 2, A. Solinas 3, M. Zampolini, S. Bucello 4, G. Gasbarrini 5 USL Umbria, Neurorehabilitation, Foligno, 2 Perugia Hospital, Gastroenterology, Perugia, 3 USL Umbria, Gastroenterology, Perugia, 4 ASP Siracusa, Neurology, Syracuse, 5 Universita Cattolica Roma, Gastroenterology, Rome, Italy Background and aims: Several studies have hypothesized an association between neurological diseases and Small intestine bacterial overgrowth (SIBO) since the impaired motility of the gastrointestinal tract is one of the main etiologic factors involved. Gastrointestinal (GI) symptoms of SIBO are nonspecific and include bloating, abdominal distension, abdominal pain or discomfort, diarrhea, fatigue, and weakness. We undertook a screening pilot project on multiple sclerosis (RR MS) outpatients followed up in our service. Methods: During the study period MS outpatients were screened by the neurologist for recurrent GI symptoms. Eight patients out of 40 subjects screened had at least 3 recurrent disabling GI symptoms. Thereby underwent to consulting for SIBO with gastroenterological visit, Lactulose H2 Breath Tests (LHBT), Echography and Roma III questionnaire. The patients enrolled were treated with the following DMAs: 3 fingolimod, 4 IFN, Natalizumab. The GI group consisted in 5 females and 3 males with a median disease duration was 7 years. All had EDSS scores below 4, and were independent in ADLs. Results: The prevalence of recurrent GI symptoms in the survey was 6%. Four patients demonstrated abnormal H2 levels at LHBT >20ppm. Fulfilling LHBT criteria for bacterial overgrowth (graph : LMHT with H2 and CH4 levels fulfilling all criteria). Graph : LHBT with H2 and CH4 levels reaching the criteria for bacterial overgrowth F44 Predictors of first-line treatment persistence in a portuguese cohort of relapsing-remitting multiple sclerosis I. Correia, S. Batista, I. Marques, M. Tábuas-Pereira, A. Gouveia, J. Parra, C. Nunes, M. C. Macário, L. Cunha, L. Sousa Centro Hospitalar e Universitário de Coimbra, Neurology, Coimbra, Portugal Introduction: Injectable disease-modifying therapies (DMT) are the first-line treatment for relapse-remitting multiple sclerosis (RRMS) since they showed to decrease clinical and imagiological disease activity. Treatment persistence is an important indicator of efficacy and tolerability. Methods: Prospective study ( ) with retrospective component. Evaluated treatment persistence (time in months of continuous use) for the first DMT used by RRMS patients between Our Imed database was used. Results: Included 47 patients, 68.6% female, mean age at first treatment 34.2 years with mean disease duration 4.22 months, mean follow-up 6.05 years, median EDSS 2.0. First DMT: glatiramer acetate (GA) in 6 patients, interferon-beta-a22 (IFN-Ba22) 57, interferon-beta-a44 (IFN-Ba44) 26, interferon-beta-a-intramuscular (IFN- BaIM), interferon-beta-b (IFN-Bb) 07. Median EDSS was higher in IFN-Ba22 (2.5) and IFN-Bb (2.0) (p<0.00), without differences between groups on gender, clinical presentation, mean disease duration or age at first treatment. Mean DMT persistence was months and 49.4% discontinued treatment. Initial EDSS above 2 was a predictor of treatment discontinuation (HR=.93, p=0.002). Treatment persistence on IFN-Ba22, adjusted for initial EDSS, was significantly lower than IFN-BaIM (HR=0.43, p=0.02), GA (HR=0.52, p=0.038) and although not significant, IFN-Ba44 (HR=0.67) and IFN-Bb (HR=0.63). After one-year treatment persistence in IFN-BaIM was 9%, IFN-Ba %, IFN-Bb 83.2%, GA 82.8% and IFN- Ba % (p=0.04). The primary reason for treatment discontinuation was inefficacy. Conclusion: Higher EDSS at treatment initiation was the only predictor to treatment discontinuation, the major reason for switching therapies was lack of efficacy and treatment persistence on IFN-Ba22 was lower than other therapies. Conclusion: We speculate how GI symptoms may be subsequent to a possible SIBO over-representation in MS outpatients. A SIBO confirmed diagnosis may lead to specific countermeasures: dietary, antibiotic, probiotics and/or vitamin prescription. Whether SIBO may be considered as associated to MS or an independent condition needs further analysis. 205 European Journal of Neurology, 22 (Suppl. ),

339 822 Flash Posters F45 Cerebellar granule cell neuronopathy in a natalizumab-treated MS patient: the dark side of JC virus infection G. Dalla Costa, L. Moiola, G. Pavan, F. Sangalli, M.A. De Riz 2, S. Gerevini 3, N. Mancini 4, G. Comi, V. Martinelli San Raffaele Hospital, Neurological Department, Milan, Italy, 2 IRCCS Ospedale Maggiore Policlinico, University of Milan, Neurology Unit, Milan, Italy, 3 Ospedale San Raffaele, Neuroradiology, Milan, Italy, 4 San Raffaele Hospital, Unit of Microbiology and Virology, Milan, Italy Background and aims: Progressive multifocal leukoencephalopathy (PML) is a major safety concern in multiple sclerosis (MS) patients treated with natalizumab. PML is the most common manifestation, although the possibility of previously unknown brain manifestations of JCV reactivation has recently emerged. Case Report: We describe clinical, neuroimaging and virologic characteristics of JCV infection in cerebellar gray matter in a natalizumab-treated patient. Results: A 37-year-old patient with MS for 7 years started natalizumab due to inefficacy of IFN-beta. He was JCVseropositive and received 52 drug infusions when he developed severe gait ataxia. A brain MRI was immediately performed and showed no new lesions. He was treated with a 5 days course of iv-steroids and physiotherapy for a suspected relapse but he continued to have slowly progressive cerebellar symptoms. After 3 months and 2 further natalizumab infusions MRI showed marked cerebellar atrophy and JCV was found in CSF confirming the diagnosis of JCV granule cell neuronopathy (GCN). Natalizumab was discontinued and he underwent plasma-exchange. Upon discontinuation he had a worsening of clinical symptoms and the MRIs showed the apperance of PML lesions in brainstem and contrast enhancement in the cerebellum (IRIS). He was treated with steroids and 4 months later there was the resolution of IRIS, after which the patient did not deteriorate further. Conclusion: PML is the most common presentation of JCV, though, as the number of MS patients on natalizumab is increasing, atypical manifestations, such as progressive cerebellar atrophy, should be considered and natalizumab treatment stopped in any case of doubt. F46 Multiple sclerosis with unusual initial symptoms A.T. Evlice, T. Demir, C. Karayalcin, F. Ozcan, D.M. Demirkiran 2 cukurova university, neurology, adana, Turkey, 2 Adana, Turkey Background and aims: Multiple sclerosis (MS) presents with weakness or numbness in about half of the patients. Other common initial symptoms are loss of vision diplopia, and vertigo. Rarely MS may present with atypical manifestations. The purpose of this study is to determine the range of unusual onset symptoms in patients MS. Methods: We retrospectively screened data of 877 patients who were diagnosed with MS between in our department. Unusual onset symptoms such as visual field defects, rare cranial nerve involvement, paroxysmal symptoms, movement disorders, atypical pain, cognitive manifestations were recorded. Neurological examination and laboratory findings of the patients were documented. Atypical patients with magnetic resonance imaging and laboratory findings for MS were excluded from the study. Results: 8 MS patients (2 women, 6 men) were identified as having unusual initial manifestations. None of the cases had typical optic, brainstem, sensory, motor cerebellar signs. 4 cases presented with cervical or lumbar radicular pain syndromes, 6 cases with rare cranial nerve involvement (3 cases with peripheral facial paralysis, case with ptosis, case with dysarthria), 4 cases with movement disorders, 2 cases with paroxysmal symptoms, 2 cases with cognitive defects and case with homonymus hemianopia. Conclusion: This study describes some rare initial manifestations in 8 MS patients. İf the patient presents with unexpected symptoms, differential diagnosis of MS is very difficult. Given the fact that prophylactic treatment should be initiated early, it is crucial to diagnose MS as early as possible. Therefore, the physicians should not overlook the unexpected symptoms for MS. 205 European Journal of Neurology, 22 (Suppl. ),

340 Flash Posters 823 F47 Potential role of ultraviolet radiation therapy in ameliorating the pathogenesis of relapsing remitting multiple sclerosis S. Fathi, F. Taha 2, A. Reda, W. Ezzat Kasralainy - Cairo University, Neurology, Cairo, 2 Kasralainy - Cairo University, Biochemistry, Cairo, Egypt Background and aims: Interest in vitamin D and MS originated from identification of a negative correlation between exposure to sunlight and prevalence of MS (VanAmerongen et al, 2004). Recent work suggests that UVR exposure may be one factor that can attenuate Th-mediated immune responses (Ponsonby et al, 2002). Aim: Detecting the impact of use of ultraviolet radiation (UVR) therapy on relapsing remitting multiple sclerosis (RRMS) patients through clinical, laboratory, radiological & neurophysiological assessment. Methods: Group I: included 20 patients with RRMS received methylprednisolone and UVR therapy sessions (once every other day for 2 sessions) during their remission period. GroupII: included 20 patients with RRMS received methylprednisolone only. patients were submitted to: - Clinical evaluation and scoring: Expanded Disability Status Scale (EDSS), International Prostate Symptom Score (I-PSS), Brief Ataxia Rating Scale (BARS) and Modified Ashworth Scale for grading Spasticity (MAS). 2- Investigations: A- Laboratory: Serum vitamin D level (25-hydroxy-cholecalcifirol): pre, post month and post 3 months of UVR therapy sessions. B- Imaging: MRI brain&spinal cord with contrast. C- Neurophysiology: Visual evoked potential and H-reflex study. Results: A statistically significant decrease in EDSS, I-PSS and BARS scores, with a parallel statistically significant improvement in VEP latency and H-reflex latency post UVR therapy was found. Moreover, a statistically significant increase in serum Vitamin D level following UVR therapy was depicted. Also, we noticed that the number of new attacks post UVR therapy was decreased, although not statistically significant. Conclusion: The role of UVR therapy in the pathogenesis of RRMS - via modulation in Vitamin D status - has a peculiar impact on disease improvement and control. Disclosure: The kits of serum vitamin D was funded by my university for research purposes only with no influence on research process 205 European Journal of Neurology, 22 (Suppl. ),