$518 Friday, November 11, 2005 Poster Abstracts

Results: In all cases, LTS was performed safely within 3 hours and without any complications. After LTS, there was no aspiration of saliva in any of tile patients. In most subjects, the frequency of suctioning by medical staffs and caregivers was reduced. The frequency of fever/infection by aspiration was also extremely lowered. Follow-up, lasting for 6-20 months, demonstrated that complete control over aspiration was achieved in all of the patients. Some of them were completely self-sufficient in their ability to eat. Some of the other patients were at least able to enjoy the taste. All the patients, families (who were their caregivers), and medical staffs involved in tiffs study were satisfied with the outcome. Conclusion: These results indicate that LTS is a very useful procedure in several aspects: it benefits patients who have a fear of aspiration; it reduces the burden on patients and their families; it promotes their quality of life; and it limits the aspiration-associated demands on medical staffs.

1648 Identification of a Novel Neuropeptide, Neuromedin S, and Its Physiological Function

Miyazato, M ~, Mori, K t, Ida, T 2, Mu rakami, N 2, Serino, R 3, Ueta, Y3, Kojima, M 4, Kangawa, K ~. 2National Cardiovascular Center Research Institute, Osaka, )'apart; 2University of Miyazaki, Miyazaki, Japan; 3University of Occupational and Enviromnen tal Health, Fz&uoka, Japan; 4Kururne University, Fukuoka, Japan

The progress of human genome sequendng has revealed the existence of several hundred orphan G-protein-coupled receptors. Using a reverse-phammcological technique, we purified anorexigenic neuro- peptide neuromedin U (NMU) for FM-3/GPR66 and FM-a/TGR-1 (also called N M U I R and NMU2R, respectively) from rat intestine. In this study, we found a novel agonist activity for N M U 2 R in rat brain extract. This activity was eluted in fractions with a larger molecular mass by gel filtration compared to rat NMU. As a result of purification and structural determination, a novel 36-residue peptide was identified and designated as neuromedin S (NMS), because it is spedfically expressed in the suprachiasmatic nuclei (SCN) of the hypothalamus. The C-terminal amidated seven-residue sequence of NMS is identical to that of NMU. Pharmacological characterization indicated that NMS and N M U share quite similar potency and efficacy for both N M U 1 R and NMU2R. In rat brain, NMS m R N A was specifically expressed in the SCN, which is the site of the master circadian pacemaker. NMS expression in the SCN showed a diurnal peak under light/dark cycling, but remained stable under constant darkness. Intracerebroventricular (ICV) administration of NMS in rats induced nonphotic type phase slfffts in the circadian rhythin of locomotor activity. On the other hand, low level expression of NMS m R N A was also found in the paraventricular nuclei of the hypothalamus, which is closely implicated in the regulation of the feeding. ICV-administered NMS induced more potent suppression of feeding than NMU. These findings suggest that NMS is implicated in the regulation of circadian rhytlml and feeding behaviour.

1649 Teleneurology at a Distance: Patient Satisfaction Survey

Mogelof, JS l, McGrady, A t . ltL4 Hospital Of Central California Health Care System, Fresno, CA, USA

Background: Neurology Consultations occur at the VA Hospital in Fresno, California. For patients that live one to two hours away, their primary care is rendered at Community Based Outpatient Clinics (CBOC). To know whether Neurology Consultations via Telemedidne would be acceptable to this group of patients, they were surveyed as to their impressions. Methods: Videoconferendng using Polycom View Station NIP is available at both the CBOC and VA Hospital sites. All clinics have access to the patient's chart via computerized patient records system

(CPRS) which includes notes, test results, and imaging. Neurology Consult requests were reviewed by the Chief of Neurology to see that their problem could be seen tiffs way. All patients seen during 2004 were sent a cover letter with a questiommire and instructions to answer tile questions and to return it in the self addressed stanlped envelope anonymously. The questionnaire consisted of ten statements rated using the Likert scale. Caregivers accompanying the patient most often were the responders if the patient was not able to complete the form. Results: Twenty of twenty-six responses were received for a 74% response rate. With rare exceptions patients overwhelmingly embraced the Neurotelehealth conferences and found that they were able to ask questions, were informed, had clarity of the broadcast, were given enough time for the visit, saved travel time , felt comfortable in this setting, and would do it again. Conclusion: Teleneurology was felt by patients attd/or caregivers to be all effective method in which to aclffeve a Neurology Consultation.

1650 Infection, Periodontal Disease, inflammation, vascular (capillary) injury, and cognitive decline with ageing: an hypothesis

Myers, John B. 2Vaucluse Hospital, Brunswick, Australia

Background: Risk of myocardial infarction and stroke is increased following respiratory infection, and is related to periodontal disease and inflammatory markers. It has been proposed that the link between inflammation and cardiovascular risk is atherosderosis and throm- bosis. Occurring in large blood vessels these are linked to cognitive decline. However, the connection between inflanmmtion due to infection and cognitive decline involving capillaries, and the ageing process, has escaped us. Hypothesis: Cognitive decline, and indeed, the changes of ageing, may be related to capillary integrity. Inflanmmtion results in increased capillary flow locally and generally to increased flow and thrombotic tendency. Increased flow activates negative feedback mechanisms. Pre- capillary arterioles constrict and reduce the higher flows, raising blood pressure, while heightened thrombotic processes lead to fewer available capillaries and to increased flow in those remaining, reducing their number and tissue perfusion further. Tissue loss occurs. All organs are affected. Larger blood vessels stiffen. In the brain, watershed areas are likely to be first affected, but generally substance loss occurs and function, cognitive and physical, declines. Tiffs may account to some extent for the disparity in rates of functional decline between individuals, as well as to the increased morbidity risk noted following infections. Decline in functional reserve over time, in all organs, categorises the ageing process. Conclusion: Improved outcomes with treatments wlffch reduce predis- posing factors and tile tendency to thrombosis, in capillaries and large blood vessels, and which maintain capillary networks, may provide the window of opportunity for wellbeing coupled with longevity in ageing populations.

1651 Frontal-Subcortical Circuit disruption subsequent to Upper Pontine Infarct

Nislfio, Y~a', Istffi, K z, Kazni, H 2, Ho sokai, y t , Hirono, N 2, Mot'i, E t.z. 1Tohoku University Graduate School of Medicine, Sendal, Yapan; 2Hyogo Institute of Aging Brain and Cognitive Disorders, Himeji, )'apart

Background: Although there is evidence that damage to the mesence- phalic ventral te~nentum causes behavioral alteration in animals and human, the relationship between the pontine structures and behaviors has not been well documented. Method: Stereotaxic MRI lesion localization and statistical analysis of regional cerebral blood flow (rCBF) were performed in two patients with upper pontine infarcts who developed apathy and halludnosis.

Poster Abstracts Friday, November 11, 2005 $519

Results: In both cases the ventral portion of the pontine te~nentum was selectively involved, and rCBF was decreased in the orbitofrontal cortices, basal forebrain, and thalami. Conclusion: The ventral tegmentum of the upper pons is closely com~ected with the frontal-subcortical circuits and contributes to the behavioral control in human.

1652 Pseudoneurologic features in patients with Psychogenic Disorders

Nfifez-Orozeo, L 1, Aguirre-Alvarez, A, Plascencia-Alvarez, N, Mart[nez Lenms, H. JNational Medical Center '~0 de Noviembre", M~xico City, ~f(,x'ico

Background: Neurologic disordes of difficult diagnosis could have a somatomorphic origin, which classification includes: somatization, indifferentiated somatomorptfic disorder, conversion, pain, hypochon- driasis, body dysmorplfic disorder and non-specified. Method: We reviewed the medical records of patients discharged from our service with the diagnosis of pseudoneurological disorders from march 1st 2001 to May 31st of 2004. The symptoms and signs were analized to characterize the disorder and the CT scan, MR[, EEG and other studies, according to the symptomatology were reviewed.. Results: 33 cases (avegare age of 36 years), 29 females (87.94%) y 4 males (12.1%) (P < 0.0001). 7 (21.2%) were teachers, 6 (18.2%) housekeepers, 5 (115.29,'o) secretaries y 4 (12.1%) physicians; 21 (63.6%) were married and 8 (129.27,'o) single. The more frequent neurological features were: pseudoseizures in 15 patients (45.5%), abnormal movements in 4 (12.1%); gait disorders in 4 (12.1%). The other features found were abnormal movements, tremor, herniplegia, blindness, paraplegia, pain and sensitive disorders. All the performed studies resulted normal Conclusions: The knowledge of the pseudoneurologic features is very important for neurologists in order to identify the real disorder and refer the patient to the adequate specialist and prescribe the proper treatment. Systematization of clinical features and apparent signs that are found in this type of patients allow an appropriate approach and avoid unnecessary expenses for the study of the cases.

1653 Acute severe cerebeUar lesions with good recovery

Ognjenovi~ R 1, Kosti~, S 2, Jaukovic, M 3, Vujisic, S. XSpecial Hospital for Orthopedics, Neurosurgery and Neurology', Risan, S&M, Yugoslavia; 2Neurologiea lWard of KBC Zvezdara, Belgrade, S&M, Yugoslavia; 3Neurological Ward of KBC Podgoriea, Yugoslavia

Background: From the group of (total 27) patients hospitalized last year due to acute severe cerebellmn illness, 21 with good recovery were differentiated. Method: One-year follow-up. Results: 9 women and 12 men were treated on the neurological and intensive care ward. 90?,'o of them were under 45. They had extensive ischaemic lesions of cerebellum (2 with bilateral, 2 with additional supratentorial lesions and in the pons, other with unilateral ones) They received no thrombolitic therapy. CT and MR of the endocranium done. All started with early rehabilitation (even on the intensive care ward). In one of remaining 10% of the patients, illness started in an apoplectiform manner, with rapid progression of cerebral deficit. Neuroimaging methods evidenced a clearly confined cerebellum tmnor to the left (immediately operated) During surgery, a hematoma was evidenced and the presence a microangyoma pathohystologically confirmed. In one female patient in the same group, a severe occipital headache (later bilateral cerebellar deficit) developed wen coughing during respiratory infection. CT and MR[ showed two meningeomas (to the riht just below tentoriujm and parasagital to the left) that were operated. The patient with two meningeomas operated has sligter deficit, other one is without deficit. The patients in the cerebrovascular disease group can also move independently. More expressive and long

lasting deficit are noted only in patients with supratentorial and lesions in the pons. Conclusion: In spite of initially present severe cerebellar symptoms, a satisfactory recovery was archJeved, partly attributable to elinfina- tion of causes (tumors and tmnor-like hematoma operated). Signifi- cant is also a premorbid good general condition, youth of the patients with ishaemic lesions, early rehabilitation. Finally, isolated cerebellar lesions apparently have better prognosis than supratentorial ones of the same size.

1654 Is inigraine attack Elieitafion due to disturbed Homeostatic Cortical Excitability?

Antal, A 1, Arlt, S ~, Nitsche, MA ~ , Paulus, W 1. SDepartment of Clinical Neurophysiology, Georg-August University, GO'uingen, Germany

Background: The temporal course of phosphene thresholds (PT) measured by transcranial magnetic stimulation (TMS) has been investigated in subjects with migraine in order to observe whether changes in PTs over time can predict a subsequent migraine attack. Method: PTs were measured in 16 migraineurs (19 with aura (MA) and 7 without aura (MO)) and 9 controls five times over an about ten week period. Results: Mean PTs were not significantly different between migraineurs and controls, however there was a trend in MA showing lower thresholds. Generally, PTs had higher variance in migraineurs than in controls, revealing a significant increase in standard deviation of PYs in MA subjects. There was no significant difference of thresholds from the first to the last stimulation in controls and in MO subjects, however, the 3 ~d, 4 t~ and 5 ± measurements of MA subjects were significantly lower than their 1 ~t measurements. Four migraineurs experienced headache within one day after one of the measurements. They had either very low or very high PTs compared to the PT values which were not followed by a migraine attack. Conclusion: Our results imply that migraineurs show a tfigher variability among PT measurements over time than controls, revealing unstable excitability level in these patients. Additionally, both parti- cularly high and low PTs might predict a subsequent headache in some individuals.

1655 Tile precondifioning-etl~ct of tDCS detennhles the direction of rTMS over the Visual Cortex

Lang, N1, Antal, A~, Chadaide, Z~, Nitsche, M A1, Paulus, W 1. SDepartrnent of Clinical NeurophysiMogy, Georg-August University of GO'ttingen, GO'ttingen, Germany

Background: Repetitive transcranial magnetic stimulation (rTMS) at frequencies >5 Hz produces cortical excitability increase in healthy subjects as was demonstrated over the motor cortex. Here we report that the direction of rTMS induced after-effects in the visual cortex depend on the state of cortical excitability before stimulation. Methods: The experiments combined two tedmiques that can produce long-term effects on the excitability of the visual areas, namely transcranial direct current stimulation (tDCS) and rTMS. Results: Facilitatory pre-conditioning with anodal tDCS resulted in a subsequent period of 5 Hz rTMS to increase phosphene thresholds (PT) to baseline level. Conversely, inhibitory pre-conditioning with cathodal tDCS caused 5 Hz rTMS decreasing PTs to baseline. No changes in excitability occurred when 5 Hz rTMS was preceded by sham-tDCS. Sham rTMS did not modify the original effect of cathodal or anodal stimulations. Conclusions: Our results show that changing the initial excitability level of the visual cortex by a period of DC stimulation reversed the conditioning effects of 5 Hz rTMS. These results suggest that similarly to the motor cortex, in the visual cortex a homeostatic mechanism also exists in order to stabilize cortical exdtability witlfin a physiologically