Dementia

AOCN-0303 Dementia

ASYNTACTIC COMPREHENSION AFFECTED BY GRAMMATICAL

CANONICITY AND THEMATIC-ROLE CANONICITY IN

NONFLUENT/AGRAMMATIC VARIANT OF PRIMARY PROGRESSIVE

APHASIA

R. Kinno1, S. Kurokawa2, Y. Owan1, H. Kasai2, K. Ono1 1Showa University School of Medicine, Department of Neurology, Tokyo, Japan 2Showa University Fujigaoka Hospital, Department of Neurology, Kanagawa, Japan

Nonfluent/agrammatic variant of primary progressive aphasia (naPPA) often causes asyntactic comprehension, which is characterized by impaired comprehension of sentences

with syntactically complex structures. It is greatest for sentences with noncanonical word order. Japanese is a subject-object-verb language with flexible word order and overt

morphology, and therefore, subject-initial word order can be reordered by a transformation called “scrambling”. It is supposed that there are two types of canonicity of word order: grammatical canonicity (the subject appear sentence-initially) and thematic-role canonicity

(the agent appear sentence-initially).We aimed to clarify the significance of grammatical and thematic-role canonicity in asyntactic comprehension. For this purpose, we assessed syntactic

ability of four patients with naPPA and 14 healthy controls using picture-sentence verification tasks with stick figures. Four different sentence types were tested: subject-initial active (+grammatical canonicity, +thematic-role canonicity), subject-initial passive

(+grammatical canonicity, -thematic-role canonicity), scrambled active (-grammatical canonicity, -thematic-role canonicity), and scrambled passive (-grammatical canonicity,

+thematic-role canonicity) sentences. Compared with the healthy controls, each patient showed significantly lower performance accuracy on the scrambled active sentences (Crawford & Howell's t-test, all Ps < 0.00005), but normal accuracy on the subject-initial

active sentences (all Ps > 0.2). Regarding the passive sentences, two patients relatively preserved comprehension (all Ps > 0.07), whereas the other two patients showed significantly

lower performance accuracy (all Ps < 0.03). The impaired comprehension of the scramble active sentences and the individual differences in the performance accuracy on the passive sentences indicates that the both grammatical and thematic-role canonicity affects asyntactic

comprehension in naPPA.

AOCN-0298

Dementia GLIAL FIBRILARRY ACIDIC PROTEIN SERUM IS CORRELATED TO

COGNITIVE DYSFUNCTION AFTER TRAUMATIC BRAIN INJURY D.A. Hamama Pitra1, R. Susanti2, L. Susanti2, Y. Syafrita2 1Baiturrahmah university, Neurology, Padang, Indonesia 2Andalas University, Neurology, Padang, Indonesia

Background : Cognitive dysfunction is a chronic sequalae of traumatic brain injury (TBI) associated with glial cells damage which play a role in learning process and cognition. Proliferation of astrocytes (astrogliosis) is a characteristic of injuries to the central nervous

system and marked by the increase of glial fibrillary acidic protein. GFAP is glial specific biomarker released into bloodstream after injury and had also been shown to correlate with severity and outcome after TBI. Thus, the study about correlation between GFAP and

cognitive dysfunction after TBI is still limited. This study was aimed to determine correlation between GFAP serum levels and cognitive dysfunction after TBI.

Methods : In 25 TBI patients, serum, taken at hospital admission (<24 hour) was analyzed

for GFAP level by ELISA. It was conducted at Dr M.Djamil Hospital Padang from January until June 2015. The cognitive function was assessed with standardized Montreal Cognitive Assesment (MoCA Ina) one month later. The correlation between serum GFAP on admission

and cognitive dysfunction was analyzed with Spearman correlation test.

Result : The median serum GFAP was 2,525 ng/ml (min-max 0,143-30,971). Negative correlation between serum GFAP level with cognitive dysfunction was noted (r=-0,529;

p=0,007).

Conclusion: Higher GFAP level in acute phase was correlated with cognitive dysfunction after TBI. GFAP may serve as prognostic biomarker to cognitive dysfunction after TBI.

AOCN-0274

Dementia RECURRENT TRANSIENT GLOBAL AMNESIA IN A HOT AND HUMID

MACHINERY ROOM J.S. Kim1 1Chungbuk National University, Medical college- Department of neurology, Cheongju, Republic of Korea

Transient global amnesia (TGA) is characterized by abrupt onset temporary dysfunction of anterograde and retrograde amnesia without other neurologic deficits. We encountered a 53-year-old man who developed recurrent TGA while working in a hot and humid machinery

room (33°C and 64% relative humidity). Heat exposure and physical exertion may facilitate the leakage of cytokines into the systemic circulation so as to cause a cerebral endothelial insult. Functional insufficiency of the hippocampus and its connections caused by physical

and environmental factors may be related to recurrent attacks.

AOCN-0266

Dementia THE EFFECT OF FENUGREEK METHANOLIC EXTRACT ON LEARNING AND

MEMORY IN EXPERIMENTAL MODEL OF ALZHEIMER’S DISEASE IN RAT M. Roghani1, Z. Kiasalari1, H. Zardooz2 1Shahed University, Neurophysiology Research Center, tehran, Iran 2Shahed University, School of Medicine, tehran, Iran

Background and Objective: Alzheimer's disease (AD) is regarded as the most prevalent phenotype of dementia. With respect to anti-oxidative and neuroprotective potential of Trigonella foenum-graecum (TFG; fenugreek), this study was conducted to evaluate the

effect of its alcoholic seed extract on learning and spatial memory in an experimental model of AD induced by beta amyloid 25-35 in rats.

Materials and Methods: In this experimental study, 32 male Wistar rats were divided into 4 equal groups, i.e. sham, extract-treated sham, Alzheimer, and Alzheimer group treated with

methanolic seed extract of TFG. For induction of AD, 2 µl of β-amyloid 25-35 (at a dose of 10 µg/2 µl) was bilaterally microinjected into CA1 area of dorsal hippocampus. The

treatment groups received alcoholic extract of TFG (i.p.) at a dose of 200 mg/kg for 1 week till 1 h before the surgery. At 4th week post-surgery, learning and memory was assessed using passive avoidance test and spatial memory was evaluated in Y maze.

Results: Treatment of Alzheimer group with the extract significantly prevented the reduction

of step-through latency as compared to Alzheimer one and extract treatment had no significant effect on spatial memory. In addition, extract treatment did not have a significant

effect in the sham group. There was also no significant difference between the groups regarding the locomotor activity.

Conclusion: Pretreatment of beta amyloid Alzheimeric rats by TFG extract could improve

the ability of information consolidation and retrieval in passive avoidance test, however it could not affect recognitive spatial memory.

AOCN-0257

Dementia MODULATION OF CORTICOSTERONE HOMEOSTATSIS IN HIPPOCAMPUS

LEADS TO MEMORY IMPAIRMENT AND GLUCOSE TRANSPORTER IN

HYPOBARIC HYPOXIA IN FEMALE WISTAR RAT

M. Vati1, V. Sharma1, S. Sinha1 1GGS Indraprastha University, School of Biotechnology, Delhi, India

Objective: Aim of present work to study effects of alternations of corticosterone homeostatsis in hippocampus leads to memory impairment in hypobaric hypoxia in female rat.

Methods: To determine the effect, six groups of Wistar female rat were exposed in a simulated decompression chamber at an altitude of 25 000 ft for 0, 3, 7, 14 and 21 days.

Corticosterone synthesis was blocked using metyrapone (75 mg/kg BW) on the day showing maximum corticosterone level and neuronal damage.

Result: Our study revealed a duration dependent elevation in corticosterone level in plasma

and hippocampus. There was increased ROS generation, decreased antioxidant defence system and compromised neuronal energy status. Exposure to hypobaric hypoxia upregulated the expression of glucocorticoid and mineralocorticoid receptor in a duration dependent

manner. Neuronal glucose transporter Glut3 and blood–brain barrier glucose transporter Glut1 was found to be upregulated during initial period of exposure to hypobaric hypoxia. There was decreased citrate synthase activity and increased glutamate dehydrogenase activity

along with altered expression of proteins (MDR1apG and HSD1) regulating the corticosterone bioavailability in hippocampus. These findings suggest that chronic elevation

in corticosterone level may lead to induction of glutamate excitotoxicity, perturbance in neuronal energy status and enhanced oxidative stress leading to neuronal damage and ultimately to memory impairment following exposure to hypobaric hypoxia as shown by

behaviour studies.

Conclusion: Maintenance of optimal corticosterone level by metyrapone administration however reduced oxidative damage, improved energy status, reduced caspase 3 expression in

CA3 region of the hippocampus indicating reduced neurodegeneration and improved memory functions.

AOCN-0247

Dementia COGNITIVE IMPAIRMENT IN PATIENTS WITH TYPE 2 DIABETES

A. Karimova1, G. Mukhambetova1, A. Izbassarova1, T. Shvedkova2, G. Utina2, Y. Bezina2 1Kazakh National Medical University, Neurology Department, Almaty, Kazakhstan 2Kazakh National Medical University, Internship Department, Almaty, Kazakhstan

Background. In diabetic patients, there are preconditions for the development of cognitive deficit: hyperglycemia, systemic inflammation, microangiopathy, etc. While, cognitive

function is a crucial factor in maintaining the health of diabetic patients.

Objective: identify potential risk factors of cognitive deficit in patients with type 2 diabetes; find the relationship between factors and the level of cognition.

Methods. We examined 50 patients with diabetes aged 45-65 and 20 persons of control

group of the same age. We used general examination, HbA1C, MoCA-test, treatment compliance (questionnaire including questions on adherence of medication, diet, exercise,

timeliness of visits to the doctor).

Results. In patients with diabetes moderate cognitive decline according to the MoCA-test was observed in 36% of cases (18 patients), mild cognitive deficit - in 50% (25 patients). In the control group, the cognitive deficit wasn’t detected.

We compared all received data with the presence of cognitive deficit. It was revealed that

cognitive deficit is dependent on the duration of disease and the level of HbA1c. The average duration of disease in the group with moderate cognitive decline is 11.28 years, in the group

with mild cognitive decline – 10.4, while in the group without cognitive decline – 8.71. In patients with decreased cognitive functions HbA1c levels higher than in patients without cognitive impairment: on the average 9.27 % and 8.45 % accordingly.

We didn’t find relationship with the age, hypertension and smoking.

The treatment compliance was higher in the group without cognitive impairment.

Conclusion. High HbA1c correlates with cognitive decline and pure treatment compliance.

AOCN-0222

Dementia EXPERIMENTAL STUDY OF GLYCOSIDES OF CISTANCHE ON THE

EXPRESSION OF ARP3 IN VASCULAR DEMENTIA RAT Z. yanmei1 1Inner Monogolia People's Hospital, Neurology Department, Huhhot, China

Glycosides of cistanche (GC) is extracted from InnermongoliaCistanche, which has been widely used as a Chinese herb.Although GC is widely used as a Chinese herb with

neuroprotective effects, however its functions largely remain elusive. This study aimed to evaluate the effects of GC on vascular dementia (VD) and explored the mechanism of

associatedprotein-ARP 3.

Materials and methods:

2-VO adult Wister rat model was established, who were treated with GC (10mg/kg body weight /d, i.p.), control group received daily i.p. administration of saline for 14 days. Rat

model cognitive performance was valued by Morris Water Maze test. The hippocampus was dissected and subjected to proteomics and western blot analysis.

Results: Each group showed lower escape latency, the GC group showed significantly lower escape latency than the VD group at 4 and5 days. Compared with VD group, in the

hippocampus 15 protein spots in the GC group showed the different expression. There are three proteins that showed significant difference: two upregulated proteins HSP 75 and ARP

3 and one downregulated protein KRT 6A .Western blot analysis showed that ARP3 protein level was significantly decreased in VD group compared with control group(p<0.05),After GC treatment , ARP3 protein level in VD group was significantly higher than VD group

treated with saline(p<0.05)

Conclusions: GC promotes the growth of the synaptic or cytoskeleton which can improve the cognitive function of rats, and its mechanism may be related to the increase of Arp3 protein

expression.

AOCN-0193

Dementia EFFECT OF CLU GENETIC VARIANTS ON CEREBROSPINAL FLUID AND

NEUROIMAGING MARKERS IN HEALTHY, MILD COGNITIVE IMPAIRMENT

AND ALZHEIMER'S DISEASE COHORTS

L. Tan1, H.F. Wang1, J.T. Yu1, L. Tan1 1QingDao Municipal Hospital East, neurology, QingDao, China

The Clusterin (CLU) gene, also known as apolipoprotein J (ApoJ), is currently the third most associated late-onset Alzheimer’s disease (LOAD) risk gene. However, little was known about the possible effect of CLU genetic variants on AD pathology in brain. Here, we

evaluated the interaction between 7 CLU SNPs (covering 95% of genetic variations) and the role of CLU in β-amyloid (Aβ) deposition, AD-related structure atrophy, abnormal glucose metabolism on neuroimaging and CSF markers to clarify the possible approach by that CLU

impacts AD. Finally, four loci (rs11136000, rs1532278, rs2279590, rs7982) showed significant associations with the Aβ deposition at the baseline level while genotypes of

rs9331888 (P=0.042) increased Aβ deposition. Besides, rs9331888 was significantly associated with baseline volume of left hippocampus (P=0.014). We then further validated the association with Aβ deposition in the AD, mild cognitive impairment (MCI), normal

control (NC) sub-groups. The results in sub-groups confirmed the association between CLU genotypes and Aβ deposition further. Our findings revealed that CLU genotypes could

probably modulate the cerebral the Aβ loads on imaging and volume of hippocampus. These findings raise the possibility that the biological effects of CLU may be relatively confined to neuroimaging trait and hence may offer clues to AD.

AOCN-0192

Dementia DECIPHERING THE MOLECULAR PROFILE OF AMYLOID PATHOLOGY FOR

ALZHEIMER’S DISEASE BY DEEP SEQUENCING L. Tan1, J.T. Yu1, L. Tan1 1QingDao Municipal Hospital East, neurology, QingDao, China

Purpose: The elucidation of the molecular signatures triggered by the amyloid cascade of pathological events is one of the central research questions on the etiology of Alzheimer’s

disease (AD). Next-generation sequencing allows the identification of genes involved in disease progression in an unbiased manner. We here to decipher the molecular profile of

amyloid pathology in transgenic mice for AD by deep sequencing. Methods: We applied this technique with the analysis of APP/PS1 mouse model (cases=10, controls=10) which developed early plaque formation, intraneuronal Aβ aggregation and spatial cognitive

deficits. Using deep RNA sequencing, differentially expressed genes (DEGs), gene expression levels, splicing isoforms and alternative transcript start sites were identified and

subsequently verified by quantitative PCR. Results: Analysis of the hippocampus with both the Cufflinks tool and the Deseq tool revealed 107 DEGs. Network analysis of DEGs modules revealed six hub genes (4732456N10Rik, 4933427G17Rik, A930003A15Rik,

AW551984, Adra1d and Adcyap1) in hippocampus of amyloid mice. We also observed differing expression levels of five DEGs in the temporal lobe and three in the cerebellum.

Gene Ontology term enrichment analysis revealed an overrepresentation of immune gene expression correlated tightly with plaques. Besides, many of the DEGs specific to the APP/PS1 model belong to neuroinflammatory processes typically associated with plaques.

Conclusions: Our study not only provides substantial insights into the different effects of alterations in amyloid pathology but also highlights specific genes associated with plaques.

AOCN-0184

Dementia DESIGN, SYNTHESIS AND EVALUATION OF COUMARIN–BASED HYBRID

COMPOUNDS AS MULTIFUNCTIONAL CHOLINESTERASE INHIBITORS

AGAINST ALZHEIMER’S DISEASE

S. singla1, P. Piplani1 1University Institute of Pharmaceutical Sciences- Panjab University, department of Pharmaceutical Chemistry, chandigarh, India

Alzheimer's disease (AD) is one of the most prevalent neurodegenerative disorder which is the major cause of dementia amongst the aged people. It includes the progressive loss of

cholinergic neurons and formation of beta-amyloid (Aβ) plaques. Current therapies for AD modulates acetylcholine based neurotransmission and clinical benefits are modest as they target only disease symptoms but don’t treat the underlying cause of disease.

Acetylcholinesterase (AChE), an enzyme involved in the hydrolysis of the neurotransmitter acetylcholine, consistently colocalizes with the amyloid deposits through its peripheral

anionc site (PAS) and may contribute to the generation of amyloid plaques. Accordingly, AChE inhibitors that interact with both the catalytic site and PAS might exert a dual pharmacological effect, thus opening the way to a new therapeutic approach to AD.

Following this reasoning, a library of coumarin analogs (1a-1h) decorated with various nitrogen-containing ring structures was synthesized as coumarin moiety has binding ability

towards PAS. The structures of compounds were confirmed by spectral analysis. They were further evaluated for cognition enhancement and AChE inhibition using Morris water maze and

Ellman method. Docking study was performed using vlife 4.3 and crystal structure of TcAChE. Treatment with various synthesized compounds showed significantly decrease in

escape latency in scopolamine treated mice as drugs were acting as a reversing agent on a pre-existent condition of cholinergic disruption. Docking study of analogs revealed that compounds encompass the gorge residues from PAS to catalytic triad. Hence, a novel series

of potent coumarin analogues as dual site AChE inhibitors have been disclosed.

AOCN-0159

Dementia APOLIPOPROTEIN E Ε4 ALLELE FREQUENCY IN KOREAN PATIENTS WITH

PARKINSON'S DISEASE DEMENTIA M. Park1 1Yeungnam University Medical Center, Neurology, Daegu, Republic of Korea

Background: It has been well known that the APOE ε4 allele is a strong risk factor in Alzheimer's disease (AD) and occurs at an increased frequency in dementia with amyloid

pathology. However The clinical significance of the apolipoprotein E (Apo E) ε4 allele in Parkinson's disease dementia (PDD) with synucleinopathy has been a subject of debate. PDD

is one of the second most common subtypes of dementia in Korean population. The Apo E allele frequencies were evaluated in Korean patients with probable PDD diagnosed by the MDS task force criteria for the diagnosis of PDD in this study.

Methods: Forty patients participated in the study, Twenty patients with PDD and 20 age

matched healthy controls. The Apo E genotype was determined by the polymerase chain reaction (PCR) and allele specific hybridization using the Apo E typing test kit.

Results: The Apo E ε4 allele frequency in the PDD group was 28% and was significantly

higher than those of normal controls (15%).

Conclusions: These results that the elevated Apo E ε4 frequency in the PDD groups, in which the overall brain neuritic plaque burden was low, indicates that apoE ε4 might contribute to

neurodegeneration through mechanisms unrelated to amyloid processing.

AOCN-0157

Dementia DEMOGRAPHIC FEATURES OF CEREBRAL MICROBLEEDS (CMBS)

SUBTYPES; AN ANALYSIS OF 217 MEMORY CLINIC PATIENTS H. Matsuyama1, Y. Ii1, M. Maeda2, M. Umino3, Y. Ueda4, K.I. Tabei5, H. Kida5, M. Satoh5,

A. Taniguchi1, H. Tomimoto1 1Mie University Graduate School of Medicine, Neurology, Tsu, Japan 2Mie University Graduate School of Medicine, Advanced Diagnostic Imaging, Tsu, Japan 3Mie University Graduate School of Medicine, Radiology, Tsu, Japan 4Mie University Hospital, Rehabilitation, Tsu, Japan 5Mie University Graduate School of Medicine, Dementia Prevention and Therapeutics, Tsu, Japan

【Introduction】Cerebral microbleeds(CMBs) are frequently encountered in memory clinic outpatient and classified to deep and lobar CMBs. However, a limited number of information

is available on the demographic data and their regional distribution. 【Materials and methods

】We have examined brain MRI in 217 patients who visited our memory clinic using

susceptibility-weighted images (SWI). The demographic data included clinical diagnosis, age, gender, family history of dementia, vascular risk factors, cognitive scale (MMSE) and

use of antithrombotic drugs. Distribution of CMBs has been classified into 4 subtypes (none, lobar, mixed and deep) according to the Microbleed Anatomical Rating Scale (MARS). The

176 patients with cognitive impairment were analyzed, except for 37 with normal cognitive

features or depression.【Results】The age was 75.1±7.4 years (75 males) and the mean

MMSE was 22.4. Clinical diagnosis included Alzheimer’s disease 99, mild cognitive impairment (MCI) 29, mixed dementia 22 and others 26. Distribution subtypes were none,

65; lobar, 35; mixed 54 and deep, 22. Hypertension was more prevalent in the deep subtype than in the none subtypes (p=0.046), while there was a trend towards a family history of dementia in the lobar subtype than in the deep subtype (p=0.073). Regional density of lobar

CMBs was decreased in the frontal lobes. 【Conclusion】 Deep CMBs were related to

hypertension, but not to genetic background, suggesting differential background from lobar CMBs, which may be attributed to cerebral amyloid angiopathy in their pathogenesis.

AOCN-0151

Dementia THE CASE OF CADASIL THAT WAS A CARRIER OF A NEW P.C271Y

MUTATION LOCATED IN EXON 6 OF THE NOTCH-3 GENE Y.J. Kim1 1Sung Ae Hospital, Neurology, Seoul, Republic of Korea

Introduction

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is an autosomal dominant microvasculopathy,

characterised by recurrent lacunar and subcortical white matter ischemic strokes and vascular dementia in middle age patients.

CADASIL results from a mutation on chromosome 19q12 involving the Notch 3 gene. It results in small vessel and arteriole stenosis secondary to fibrotic thickening of the basement membrane of the vessels.

We report the case of CADASIL that was a carrier of a new p.C271Y mutation located in exon 6 of the Notch-3 gene.

Case

A 59-year-old man presented with repetitive questions and personality change. FLAIR MRI

of the brain showed hyperintensities in the anterior temporal lobe, periventricular and deep white matter, and lacunar infarcts.

The genetic analysis identified a new mutation for this disease in codon 271 of exon 6 in the Notch-3 gene that produces a change of amino acid, from cysteine to tyrosine in protein (p.C271Y). He had emotional lability and angry frequently.

Conclusion

This communication reports the case of a family with CADASIL that was a carrier of a new

p.C271Y mutation located in exon 6 of the Notch-3 gene.

AOCN-0119

Dementia EFFICACY OF NIMODIPINE IN THE PREVENTION AND TREATMENT OF

PATIENTS WITH SUBCORTICAL VASCULAR DEMENTIA – A META ANALYSIS

OF TWO DOUBLE BLIND RANDOMIZED CONTROL TRIALS

M.J. Prado1, P. Pasco1 1Philippine General Hospital, Neurosciences, Manila, Philippines

The dihydropyridinic calcium antagonist nimodipine has been proposed as a drug able to improve cognition in vascular dementia and post stroke patients. The purpose of this study is to assess the effects of nimodipine for patients with subcortical vascular dementia in terms of

improving cognition or slowing of cognitive deterioration

We performed a literature search of Medline, Cochrane Library, Embase, Google Scholar, Clinical Key and review of reference list of retrieved journals through August and September, 2015 and identified randomized controlled trials related to nimodipine and vascular dementia.

All randomized trials of nimodipine therapy that reported vascular or subcortical vascular dementia were included. The primary outcome was the final MMSE score after intervention.

Two randomized controlled trials were included.

A total of 246 subjects were included in the active group and 235 in the control group. The result of the meta-analysis showed that patients treated with nimodipine had no significantly improved MMSE score than before treatment and placebo group (MD 0.08 Score, 95% CI -

1.39 to 1.55; I2 = 67%). Some of the limitations of this study include exclusion of studies written in other language, the small number of included studies and the presence of

heterogeneity.

In conclsion, this study shows that the effect of nimodipine in the treatment of vascular dementia is not superior to placebo.

AOCN-0108

Dementia AGING IN THE BRAIN AND ALZHEIMER'S DISEASE CONNECTIONS DERIVED

FROM DYSFUNCTIONAL GENE REGULATORY NETWORKS AND

COMORBIDITY NETWORKS SUGGEST NEW COUNTERACTIONS AND

TREATMENTS Y.S. Peng1, C.W. Tang1, H. Chang1, P.J. Chang1, Y.Y. Peng1, L.C. Wu1, S.L. Guo2, H.C. Lee1,3,4 1National Central University, Department of Biomedical Sciences and Engineering, Taoyuan City, Taiwan 2Cathay General Hospital, Department of Anesthesiology, Taipei City, Taiwan 3Chung Yuan Christian University, Department of Physics, Taoyuan City, Taiwan 4National Central University, Center for Dynamical Biomarkers and Translational Medicine,

Taoyuan City, Taiwan

Alzheimer’s disease (AD) is the most prominent of disorders inflicting mostly the aged (AG) and one of the most challenging social problems of the 21st century. It is characterized by the progressive impairment of cognition and neurodegeneration. The regulatory roles of major culprits such as amyloid-β protein precursor (AβPP) in AD and AG

are still unclear. Recent reports showed type 2 diabetes (T2D) patients have an increased risk of AD and dementia. Here, in order to gain insight in the pathology and symptoms of AG,

multiple region-specific AD, and multiple tissue-specific T2D, we constructed for the three disorders, a dysfunctional gene regulatory network using public gene expression microarray data, and a comorbid disease network using hospital clinical records of patients.

The results revealed AD to be caused by multi- functional gene abnormalities; in most cases, loss of function is much more severe in AD than in AG. New candidate genetic

signatures, including KCNA6 for AG and MRPL12 for AD, were discovered. Significantly dysfunctional co-expressed gene pairs involving AβPP were identified in AD (e.g., APP-KDM2A in hippocampus regions). Significantly differentially expressed genes in pancreatic

islet-T2D and in hippocampus-AD were observed to exhibit a statistically significant inverse correlation. Our comorbidity network also revealed that while AD and T2D may separately

be comorbid with other disorders (e.g., essential hypertension, unspecified, (ICD-9-401.9)) in early stage, these comorbid disorders are mostly disjoint. Our results provide new insights useful for the early detection of AG, AD and T2D, and for devising therapeutic strategies.

AOCN-0107

Dementia RHO KINESE INHIBITOR FASUDIL PROMOTES THE NERVE REGENERATION

IN APP/PS1 TRANSGENIC MICE J.Z. YU1, Y.H. LI1, C.Y. LIU1, Q. WANG2, Q.F. GU1, H.Q. Wang3, G.X. ZHANG4,

B.G. XIAO5, C.G. MA2 1Institute of Brain Science, Shanxi Datong University, Datong, China 2"2011" Collaborative Innovation Center/Research Center of Neurobiology,

Shanxi University of Traditional Chinese Medicine, Taiyuan, China 3Endocrinology Department, The Fifth People's Hospital of Datong, Datong, China 4Department of Neurology, Thomas Jefferson University, Philadelphia, USA 5Institute of Neurology- Huashan Hospital- Institutes of Brain Science and State Key Laboratory of Medical Neurobiology-, Fudan University, Shanghai, China

Background: Alzheimer’s disease (AD) is a complex aging-related disease that can be caused by neuron death. The novel therapeutic strategy for multiple aspects of AD that

protecting neurons and mobilizating neural stem cells, might represent a useful therapeutic perspective for various neurological disorders .

Objective: Based on multi-aspect potential of Rho kinase (ROCK) inhibitor Fasudil on neuroprotection and neuroregeneration, in this study, we further observe therapeutic potential

of Fasudil in AD of APP/PS1 transgenic mice and explore possible mechanisms.

Material and Methods: Male transgenic APP/PS1 mice were treated with Fasudil or saline for 2 months by intraperitoneal injection. The study was approved by the Ethics Committee

of Shanxi Datong University. The effects of Fasudil on the impairment of behavioral performance were evaluated by the Morris water maze test.

Results: Fasudil ameliorated learning and memory deficits in APP/PS1 Tg mice,

accompanied by the stimulation endogenous neural stem cells in SVZ of CNS, the promotion generation of cholinergic neurons and the increase of PSD-95 probably as a critical mechanism supporting the recovery of memories in cortex and hippocampus.

Conclusions: Fasudil exhibited multi-target therapeutic effect in APP/PS1 transgenic mice,

and promoted neuroregeneration or neuroprotection by protecting cholinergic neurons and mobilizating endogenous neural stem cells in APP-PS1 mice model of AD.

(Grant: National NSF of China, 81272163 and 81471412; Research Project Supported by

Datong Municipal Science and Technology Bureau, 2014105-1; Shanxi Scholarship Council of China, 2014-00023).

AOCN-0096

Dementia MEDIATION OF EPISODIC MEMORY PERFORMANCE BY THE EXECUTIVE

FUNCTION NETWORK IN PATIENTS WITH AMNESTIC MILD COGNITIVE

IMPAIRMENT: A RESTING-STATE FUNCTIONAL MRI STUDY

B. yuan1, Z. Zhang1, C. Xie1 1ZhongDa Hospital- Medical School- Southeast University, Department of neurology, Nanjing, China

Background. Deficits in episodic memory (EM) are a hallmark clinical symptom of patients with amnestic mild cognitive impairment (aMCI). Impairments in executive function (EF) are

widely considered to exacerbate memory deficits. However, the specific mechanisms underlying the interaction between executive dysfunction and memory deficits in aMCI patients remain unclear.

Method. The present study utilized resting-state functional magnetic resonance imaging

(fMRI) scans of the EF network and the EM network to investigate this relationship in 79 aMCI patients and 119 healthy controls (HC). The seeds were obtained from the results of a

regional homogeneity (ReHo) analysis. Functional connectivity (FC) within the EM network was determined using a seed in the right retrosplenial cortex (RSC), and FC within EF network was assessed using seeds in the right dorsolateral prefrontal cortex(DLPFC).

Results. There was a significant negative correlation between EM scores and EF scores in

both the aMCI and HC groups. Compared to the HC group, aMCI patients had reduced right RSC connectivity but enhanced right DLPFC connectivity. The overlapping brain regions

between the EM and EF networks were associated with FC in the right inferior parietal lobule (IPL) in the right RSC network, and in the bilateral middle cingulate cortex (MCC) and left IPL in the right DLPFC network. A mediation analysis revealed that the EF network had an

indirect positive effect on EM performance in the aMCI patients.

Conclusions. The present findings provide new insights into the neural mechanisms underlying the interaction between impaired EF and memory deficits in aMCI patients.

AOCN-0077

Dementia AN AUTOPSY CASE OF FRONTOTEMPORAL LOBAR DEGENERATION WITH

APPEARANCE OF FUSED IN SARCOMA INCLUSIONS (BASOPHILIC

INCLUSION BODY DISEASE) CLINICALLY PRESENTING CORTICOBASAL

SYNDROME A. Matsumoto1, H. Suzuki2, R. Fukatsu3, H. Shimizu1, Y. Suzuki4, K. Hisanaga1 1National Hospital Organization- Miyagi Hospital, Neurology and Clinical Research Center,

Yamamoto-cho- Watari-gun- Miyagi, Japan 2National Hospital Organization- Sendai Medical Center,

Pathology and Laboratory Medicine, 8-8- Miyagino 2-Chome- Miyagino-ku- Sendai, Japan 3National Rehabilitation Center for Persons with Disabilities, Clinical Research, 1 Namiki 4-Chome- Tokorozawa City- Saitama, Japan 4National Hospital Organization- Sendai Medical Center, Neurology, 8-8- Miyagino 2-Chome- Miyagino-ku- Sendai, Japan

We report an autopsy case of basophilic inclusion body disease (BIBD), a subtype of frontotemporal lobar degeneration with the appearance of fused in sarcoma inclusions (FTLD-FUS), clinically presenting corticobasal syndrome (CBS). A 54-year-old man initially

developed worsening of stuttering and right hand clumsiness. Neurological examinations revealed rigidity in the right upper and lower extremities, buccofacial apraxia, and right-side

dominant limb-kinetic and ideomotor apraxia. Neuroimaging showed asymmetric left-dominant brain atrophy and a cerebral blood flow reduction in the ipsilateral frontal region. His symptoms progressed and he died nine years after the initial symptoms. The brain

weighed 955 g. Diffuse brain atrophy was most obvious in the bilateral frontotemporal regions. The atrophy of the left superior frontal and precentral gyri and bilateral basal ganglia

was remarkable. Histologically, there was a marked loss of neurons with gliosis in the affected areas, where basophilic neuronal cytoplasmic inclusions were observed. The inclusions were immunoreactive for FUS, p62, and TATA-binding protein-associated factor

15 (TAF15), but not for phosphorylated tau, transactive response DNA-binding protein of 43 kDa (TDP-43), neurofilament protein, or Ewing sarcoma (EWS). Spinal lower motor neurons

were spared in number, similar to primary lateral sclerosis. Mutations in FUS were undetectable. Common background pathologies for CBS include corticobasal degeneration, Alzheimer's disease, PSP, FTLD-TDP, Pick's disease, Lewy body disease, and CJD.

However, FTLD-FUS (BIBD) has been rarely reported. Our case suggested further pathological heterogeneity in CBS than had previously been reported. It is necessary to

consider FTLD-FUS (BIBD) as a background pathology for CBS in the future.

AOCN-0058

Dementia THE EFFECT OF GROUP MUSICAL THERAPY ON COGNITIVE FUNCTION IN

PATIENTS WITH PROBABLE ALZHEIMER&RSQUO;S DISEASE H.J. Han1, S. Lee1, S. Kim1, J. Lee2, S.Y. Lee3 1Myongji hospital, Neurology, Goyang, Republic of Korea 2Myongji hospital, Public Health and Healthcare Service, Goyang, Republic of Korea 3Myongji hospital, Arts and Healing, Goyang, Republic of Korea

Backgrounds: Beside pharmacological treatment, non-pharmacological interventions are a great deal of interest resides on ways that allow modulation of brain plasticity in the elderly.

Music therapy is a potential non-pharmacological treatment for the behavioral and psychological symptoms of dementia, but a few studies reported it to be helpful. The aim of this study was to evaluate the effect of structured musical intervention therapy in patient with

probable AD. Methods: The subjects of the study were a total of sixty patients with probable AD (K-MMSE: 16±3.04, CDR: 1.20±0.38). The musical therapy was applied to the group

twice a week, fifty minutes per session for eight weeks. The data were analyzed by using chi-square and paired t-test before and after musical intervention. Results: The study showed a significant improvement in cognitive function after musical therapy measured with K-MMSE

(p<0.05). Activities daily living(ADL) markedly improved after the all session of musical interventions (p<0.001). Conclusion: Group music therapy is a safe and effective method for

cognitive dysfunction, and also improving ADL in patients with probable AD

AOCN-0035

Dementia THE CLINICAL SIGNIFICANCE OF BRAIN MICROBLEEDS IN PATIENTS WITH

ALZHEIMER&RSQUO;S DISEASE PRELIMINARY STUDY J.Y. Ahn1, H. Kim2, J. Heo1 1Seoul Medical Center, Neurology, Seoul, Republic of Korea 2Hanyang university hospital, neurology, seoul, Republic of Korea

Microbleeds (MBs) were observed frequently in Alzheimer’s disease (AD) and suggested to play a crucial role in the pathophysiology, but the clinical significance of them remains unclear. The study recruited 100 patients with Alzheimer’s dementia who diagnosed at the

memory clinic in Seoul Medical Center in 2014. For each patients, baseline characteristics, neuropsychological tests, cerebrovascular risk factors, medial temporal lobe atrophy, and severity of small vessel disease were evaluated according to the existence of MB. The

prevalence of MBs in patients with Alzheimer’s disease were 33%. The percentage of male gender, the severity of small vessel disease and medial temporal lobe atrophy were

significantly increased in MB (+) group. The MB(+) group showed more severe MTLA and SVD than MB(+) group. These results suggest that MBs may reflect the burden of amyloid pathology and ischemic vascular pathology.

Epilepsy

AOCN-0283 Epilepsy

ANALYSIS OF PATIENTS WITH NON-LESIONAL FOCAL EPILEPSY

ATTENDING A TERTIARY CARE EPILEPSY CLINIC IN SRI LANKA U.G.H. Ishan1, V. Sahathevan1, P. Weerathunga1, K. Vithanage1, R.A.D.R. Lasika1, I.K. Goonarathne1, R. Gamage1 1NHSL, Neurology Unit, Colombo, Sri Lanka

Introduction and Objectives

Focal epilepsy is usually associated with structural epileptogenic lesions on magnetic

resonance imaging (MRI). A small minority show no lesions on MRI. Here we have analyzed data from 61 patients with non-lesional focal epilepsy presenting to a tertiary care epilepsy

clinic in Sri Lanka. Clinical and paraclinical findings were used to diagnose focal epilepsy.

Results

A male preponderance was noted (55.7%). The average age of the population was 24.09±13.26. The age of onset was 8.96±8.48. 60.7% were found to have refractory epilepsy.

Majority were clinically localized to the temporal lobe (57.4%). Clinically lateralization was possible in only 49 of the patients. Of that 20 were to the R/temporal lobe. EEG were normal in 19 (31.1%) whereas 13 (21.3%) showed R/temporal electrical activity.

49.2% (30) were on 4 anti-epileptic drugs (AED) at the time of the research. Carbamazepine

(46), Clobazam (53) and Topiramate (54) were the commonly used AED. 7 had a positive family history of Epilepsy. None of the patients underwent surgery.

No statistical significance between age (p=0.265), age at onset (p=0.119), duration of

treatment (p=0.936) and family history (p=0.58) of the refractory and seizure free patients. Average seizure frequency of the refractory group is 4.92±6.51 and seizure severity is 2.65±1.63. Mean number of AED (p=0.002) is significantly higher in the refractory patients.

Conclusions

Most with non-lesional focal epilepsy were found to have refractory epilepsy which required an increase number of anti-epileptic drugs. The normal findings in conventional MRI

techniques emphasize the need of advanced imaging techniques for better diagnosis and treatment.

AOCN-0261

Epilepsy SURGICAL STRATEGY IN A COMPLICATED TEMPORAL LOBE EPILEPSY

WITH DUAL PATHOLOGY E. Bilir1, I. Capraz1, O. Kurtkaya1, A. Topkan1, G. Kurt2 1Gazi University School of Medicine, Neurology, Ankara, Turkey 2Gazi University School of Medicine, Neurosurgery, Ankara, Turkey

Purpose : Dual pathology is defined as coexistence of hippocampal sclerosis with an additional epileptogenic lesion in extrahippocampal region. The objective of this study was to emphasize the presurgical and surgical strategy in a patient with dual pathology.

Methods: A 20 year old young woman had frequent complex partial seizures several times a

week for 5 years. Multiple medications failed. A multidisciplinary presurgical evaluation was performed, which included FDG-PET, fMRI and neuropsychological tests. Cranial MRI showed dual pathology in right temporal and parietal regions. Then intracranial video-EEG

monitoring is performed. A right temporoparietal grid with multiple subdural strips was implanted for epilepsy monitoring.

Results: We demonstrated ictal onset over the right temporal region. Extraoperative cortical

stimulation is also done, and showed no functional sites in ictal onset and parietal regions. After removal of electrodes, both anterior temporal lobectomy and right parietal topectomy is done. The pathology demonstrated hippocampal sclerosis and oligoastrositom.

Discussion: Epilepsy surgery should be considered in medically intractable patients, even in

those with dual pathology. Before surgery, full diagnostic workup must be done as well as detailed cortical mapping of function. Dual pathology doesn’t mean a poorer prognosis than mesial temporal lobe alone if hippocampus and the additional lesion are both completely

resected.

AOCN-0224 Epilepsy

DECREASED DEFAULT MODE NETWORK IN DRUG-RESISTANT

GENERALIZED TONIC-CLONIC SEIZURES Z. Wang1, T. Qiao2, Z. Wang3, Z. Lu1, Y. Xu1 1Affiliated Drum Tower Hospital of Nanjing University Medical School,

Department of neurology, Nanjing, China 2Drum Tower Hospital of Nanjing Medical Uniersity, Department of neurology, Nanjing,

China 3Affiliated Drum Tower Hospital of Nanjing University Medical School, Department of radiology, Nanjing, China

Purpose: Previous studies have found altered resting-state functional connectivity (rsFC) in patients

with idiopathic generalized epilepsy (IGE), while it is not entirely understood in IGE with drug-resistant epilepsy (DRE). This study is to investigate the alteration of rsFC within the default

mode network (DMN) in drug-resistant IGE characterized by generalized tonic-clonic seizure (GTCS).

Methods: Twenty-four patients with IGE-

GTCS were enrolled retrospectively. According to revised DRE definition of ILAE 2010, 12 individuals were regarded as “drug-resistant”, 12 were evaluated as “drug-responsive”. Resting-

state fMRI data were obtained on a 3T scanner from patients during interictal period and 16 healthy controls. Strength of rsFC in DMN

was calculated using independent component analysis(ICA). Moreover, abnormal DMN activity was correlated with seizure duration in linear models.

Results: Compared with the controls or the drug-

responsive subjects, significant deactivation of DMN was found in the anterior cingulate cortex(ACC) and the posterior cingulate cortex(PCC) in drug-resistant participants. There was no significant difference in DMN strength in ACC when the

drug-responsive patients were compared to the controls. Conversely, the DMN exhibited specifical

ly increased functional connectivity in PCC in drug-responsive patients versus healthy controls. In addition, a negative correlation was demonstrated between the functional connectivity changes in ACC and seizure duration in the drug-

resistant group.

Conclusion: Our findings indicate the presence of impairment of functional interactions among DMN in drug-resistant patients. In drug-

responsive patients, increased connectivity in PCC concomitant lack of change in ACC possibly reflect compensatory mechanisms. DMN connectivity may be helpful for identification of IGE-GTCS with DRE.

AOCN-0177

Epilepsy HLA-B ALLELES ASSOCIATION TO AROMATIC ANTIEPILEPTIC DRUGS-

INDUCED STEVENS-JOHNSON SYNDROME IN MYANMAR A. khor1, S.M.M. Aye2, W.M. Thit3, K.S. Lim4, C.T. Tan4, C.C. Ng1, M.Z. Myint2 1University of Malaya, Genetics and Molecular Biology, Kuala Lumpur, Malaysia 2Yangon General Hospital, Neuromedical department, Yangon, Myanmar Burma 3Yangon General Hospital, Department of Neurology, Yangon, Myanmar Burma 4University of Malaya, Department of Medicine, Kuala Lumpur, Malaysia

Recent emerging studies on the association of HLA-B*15:02 and aromatic anti-epileptic drugs (AED) induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been found in several populations in Southeast Asia. Conversely, studies on Korea and Japan did not detect the asscociation to HLA-B*15:02, showing that the marker is ethnicity

specific. Studies on this is lacking in Myanmar and incidence rate of aromatic AED-induced SJS/TEN is not known. One of the most common HLA-B alleles detected from studies on

HLA alleles frequencies in Myanmar population is HLA-B*15:02 (8.8-23.9%). The alleles frequencies of HLA-B*15 in Myanmar is similar to Thais, Han Chinese from Southeast Asia and Vietnamese. HLA-B genotyping was performed on 54 AED tolerant controls and 4 AED-

induced SJS/TEN patients recruited from Yangon General Hospital, Myanmar. Carrier rate of HLA-B alleles will be analysed between case and tolerant control. The genotyping is in

progress. However, we theorised based on previous reports and high prevelance of HLA-B*15:02 in the general Myanmar population that poses an increased genetic predisposition to aromatic AED-induced SJS/TEN, in which association of AED-induced SJS/TEN and HLA-

B alleles is likely to be detected when analysis is completed.

AOCN-0167

Epilepsy AN AMBISPECTIVE STUDY OF FACTORS RESPONSIBLE FOR

UNCONTROLLED SEIZURES IN PATIENTS WITH JUVENILE MYOCLONIC

EPILEPSY IN RURAL WESTERN INDIA.

D. Desai1, S. Desai2 1Pramukswami Medical College, Anand, India 2Pramukswami Medical College, Neurology, Anand, India

Purpose:

To study prevalence of uncontrolled seizures in patients with juvenile myoclonic epilepsy [JME] and assess factors responsible for it.

Methods:

We ambispectively recruited all patients with JME attending our epilepsy clinic between 1

Jan 2009 to 31 December 2013 and followed them up to 31 Dec 2015 to look for seizure control and related factors

Results:

Amongst 876 patients with epilepsy, 73 patients had JME [8.3%] [33 male, 40 female] [mean

age 27] range (6-57). Amongst JME patients, 53 [72.6 %] had uncontrolled seizures [> 1 generalized tonic clonic seizure/year or >1 myoclonic jerk/month] prior to consultation. We analyzed factors responsible for uncontrolled seizures using structured format.

Pitfalls in diagnosis were: absence of prior neurology consultation [42 (81.1%], missed history of myoclonus in prior consults [39 (73.5 %)], prior EEG showing focal discharges [15 (28.3 %)], being normal [16(30.1 %)], EEG misinterpreted in 10(18.8%).

Pitfalls in management were: incorrect anti-epileptic drug use [37(69.8%)][Phenytoin (11),

Phenobarbitone (9),carbamazepine(9) oxcarbazepine (8)], under dosing of AED (21(39.6 %)], non-compliance with lifestyle (24(45.3%)], noncompliance with medicines[26(49.1%)],

associated psychogenic non-epileptiform events [9(16.9%)], concomitant alternative medicine use [18(33.9%)].

45(84.9 %) patients had “pseudo-refractoriness” [seizures were completely controlled after neurology consultation, counseling, rational medication and lifestyle modification on follow-

up for 2 subsequent years]. Only 8 patients had true refractory seizures.

Conclusion: Three-fourth of patients had uncontrolled seizures initially, due to pitfalls in its diagnosis and management which improved after simple corrective measures.

AOCN-0156

Epilepsy

MEDICATION MANAGEMENT CHALLENGES IN PATIENTS WITH EPILEPSY

AND DEVELOPMENTAL DISABILITY RECEIVING TREATMENT FROM A

TERTIARY HOSPITAL IN KUALA LUMPUR, MALAYSIA

H.G. Lee1, K.S. Lim2, S.S. Chua1, L.C. Ong3, I.C.K. Wong4, C.T. Tan2 1University of Malaya, Department of Pharmacy- Faculty of Medicine, Kuala Lumpur,

Malaysia 2University of Malaya, Neurology Unit- Department of Medicine- Faculty of Medicine, Kuala Lumpur, Malaysia 3University of Malaya, Department of Paediatrics- Faculty of Medicine, Kuala Lumpur, Malaysia 4UCL School of Pharmacy, Research Department of Practice and Policy, London, United Kingdom

People with epilepsy and developmental disability (DD) require assistance from caregivers to manage and administer their medication, hence the challenges they encounter may be very different from those who do not have disability. Physical barriers, social barriers,

communication limitation between patients and caregivers, also limited knowledge about people with disability among healthcare professionals are factors contributing to the challenges. The aim of the study is to identify challenges of caregivers in managing and

administering medication for patients with epilepsy and DD. Patients more than 12 years old, who took antiepileptic drug/s were recruited. The research was a prospective observational

study over 36 months. Data were collected in neurology clinics through informal interviews with caregivers and researcher’s observations during the clinic sessions. A total of 93 patients were recruited and the mean age of patients was 30.3 years (SD 10.9). Majority were male

(53.8%) and ethnic Chinese (53.8%). Almost all were diagnosed with partial seizure and nearly a third experienced seizures monthly (31.9%). About 300 issues related to medication

use and management were identified during the follow-ups. Based on the preliminary results, prominent challenges were side effects of drugs particularly drowsiness which eventually affect the quality of life of patients, caregivers not following drug doses prescribed

intentionally or unintentionally, non-compliance to medications due to polypharmacy and common prescription of restricted psychotropic drugs causing insufficient medication supply;

and issues related to drug dosage forms and dysphagia. The study provided a glimpse of issues faced by caregivers which were not well documented before.

AOCN-0128

Epilepsy UNVERRICHT-LUNDBORG DISEASE: A CASE REPORT

H. Yilmaz1, A. Kisabay1, E. Cakiroglu2, M. Batum1, S. Ustunoglu3, A.E. Lehesjoki4, T. Joensuu4, S. Cam3, D. Selcuki1 1Celal Bayar University School of Medicine, Department of Neurology, Manisa, Turkey 2Manisa Public Hospital, Neurology, Manisa, Turkey 3Celal Bayar University School of Medicine, Department of Genetic, Manisa, Turkey 4Folkhalsan Instıtute of Genetıcs and Neuroscıence Center- Unıversıty of Helsınkı, Genetics, Helsinki, Finland

Unverricht-Lundborg disease is a genetically inherited condition characterized by myoclonic and tonic-clonic seizures and occasionally associated with ataxia and dementia. It is consistent with type I progressive myoclonic epilepsy. Myoclonic seizures may be

segmental, fragmental, or widespread and are usually severe. They may be increased by movement, noise, stress and emotional stimuli. Slow background activity, generalized spike

wave discharges, or generalized spike wave bursts of 3 - 5 Hz frequency are seen on electroencephalogram (EEG). Cranial magnetic resonance imaging (MRI) investigation is normal initially with atrophy developing over time. Unverricht-Lundborg disease is a rare

syndrome of which definitive diagnosis is made with genetically. We aimed to remind the syndrome in the light of literature information by evaluating history, clinical course, adjuvant

investigations, and differential diagnosis of our 25 years old male case with definitive genetic diagnosis.

AOCN-0033

Epilepsy SUCCESSFUL ELECTROCONVULSIVE THERAPY FOR REFRACTORY STATUS

EPILEPTICUS M. Husin1, R. Remli1 1, Ajil, Malaysia

1MazlinaHusin MMed, 1 Zhe Kang Law MRCP, 1Wan NurNafisahMMed, 1RabaniRemliMMed, 1Norlinah Mohamed Ibrahim MRCP, 2Shahizon

AzuraMukariMMed (Radiology), 3Abu Bakar KB, MMed (Anaesthesiology) 4T ManiamMPsych, 1Hui Jan Tan MMed

Status Epilepticus (SE) is the second most frequent neurological emergency after acute stroke. Status epilepticus that persist despite adequate benzodiazepine and at least one

antiepileptic drug is known as refractory status epileptics (RSE). RSE has a high morbidity and mortality. Although the underlying mechanisms are not clear, the imbalance between the

inhibitory GABAergic and excitatory glutaminergic activity may be implicated in its pathogenesis. The role of antiepileptic and anaesthetic agents have been established in the management of RSE. However, the role of electroconvulsive therapy (ECT) in RSE has not

been well establish as there is still little evidence to support this specific treatment. Here we reported two cases of RSE treated with ECT. The first patient was treated for Herpes Simplex

encephalitis but the seizures did not respond to multiple antiepileptic and anesthetic agents. The second patient developed RSE secondary to probable limbic encephalitis.After a prolonged stay in the intensive care unit and failure of the conventional therapy, ECT was

given for 8 consecutive sessions and both patients had seizure control afterward.The use of ECT in RSE has been reported mainly in case reports only in the literature. Our report

highlights that ECT plays a promising role as part of the treatment in RSE. Further research may be warranted to determine the importance of ECT as part of the adjunctive therapy of RSE.

Headache and Pain OR

Neuropaediatrics/

AOCCN

AOCN-0296 Headache and Pain OR Neuropaediatrics/ AOCCN

HIGHER SERUM GLIAL FIBRILLARY ACIDIC PROTEIN LEVEL ARE

ASSOCIATED WITH OUTCOME AND SEVERITY OF TRAUMATIC BRAIN

INJURY: A COHORT STUDY D.A. Hamama Pitra1, L. Susanti2, Y. Syafrita3 1Baiturrahmah university, Neurology, Padang, Indonesia 2Andalas university, Neurology, Padang, Indonesia 3Andalas university, Indonesia

Background: Currently, the initial evaluation of patients with traumatic brain injury depends on the examination of glasgow coma scale (GCS) and imaging. But both modalities have

limitations. Several studies have focused on the use of biomarkers in traumatic brain injury because biomarkers are easily measured. Biomarker that is often used to assess the outcome

severity of traumatic brain injury is serum glial fibrillary acidic protein (GFAP). This study was aimed to find the association between serum GFAP levels with outcome and severity of traumatic brain injury.

Methods: In 60 subjects with TBI recruited, serum, taken at hospital admission, was analyzed for GFAP. Data collected were severity of injury based on the GCS and Rotterdam score based on CT scan. One month later, outcome was assessed based on glasgow outcome

scale (GOS). Beside GFAP, some of the variables that affect the outcome, such as age, pupillary reaction, therapy, hypotension were also analyzed.

Results: There was a highly significant association between serum GFAP levels on

admission with outcome one month after onset (p <0.001). Multivariable analysis showed that GFAP was the strongest in predicting unfavorable outcomes. There was also highly significant association between the levels of GFAP with traumatic brain injury severity

(p<0.001).

Conclusion: The higher levels of serum GFAP contribute to unfavorable outcome and indicate severity of traumatic brain injury.

AOCN-0210

Headache and Pain OR Neuropaediatrics/ AOCCN CUTANEOUS ALLODYNIA AND ITS RISK FACTORS IN KOREAN PATIENTS

WITH MIGRAINE: A SURVEY OF TWO TERTIARY CARE HOSPITALS S.Y. Kim1, S.P. Park2 1Ulsan University Hospital, Neurology, Ulsan, Republic of Korea 2Kyungpook National University, Neurology, Daegu, Republic of Korea

Objectives : Almost two thirds of patients with migraine in Western countries have been reported to have cutaneous allodynia (CA). We examined the frequency of CA and its risk factors in Korean patients with migraine.

Methods: We included consecutive patients with migraine who visited headache clinics at

two tertiary care hospitals. Questionnaires including the 12-item Allodynia Symptom Checklist (ASC-12) and the Migraine Disability Assessment (MIDAS) were administered to the patients. The Mini International Neuropsychiatric Interview-Plus, Version 5.0.0 (MINI)

was performed to diagnose current major depressive disorder (MDD) and current generalized anxiety disorder (GAD).

Results: Three hundred thirty-two patients were eligible for the study. Chronic migraine

(CM) was present in 140 patients (42%). Current MDD and current GAD were identified in 73 (21.9%) and 59 patients (17.7%), respectively. CA was present in 48 patients (14.5%). Univariate analyses indicated CA was associated with female gender, CM, medication

overuse headache, headache intensity, photophobia, phonophobia, MIDAS grade, current MDD, and current GAD. Multivariate analyses revealed current MDD was the strongest risk

factor for CA (adjusted odds ratio [AOR]: 4.552, 95% confidence interval [CI]: 2.300–9.007, p = 0.000), followed by CM (AOR: 3.666, 95% CI: 1.787–7.521, p = 0.000), and photophobia (AOR: 2.707, 95% CI: 1.340–5.469, p = 0.005).

Conclusion: Korean patients with migraine have a low frequency of CA. Both depression and migraine-associated features are important for CA occurrence.

AOCN-0181

Headache and Pain OR Neuropaediatrics/ AOCCN A RARE CASE OF NUMMULAR HEADACHE RESPONDING TO

OXCARBAZEPINE D. Desai1, S. Desai2 1Pramukswami Medical College, Anand, India 2Pramukswami Medical College, Neurology, Anand, India

Purpose : To report a case if a rare type of Epicranial headache syndrome responsive to oxcarbazepine.

Case history: A 54 year old male without any co-morbidity presented with a history of continuous persistent unilateral headache for the last 4 years. The pain was located in left

parietal region of severity 5-6 /10 on a Visual Analogue scale. This headache was sharply contoured, fixed in size. The patient described it to be like a 5 Indian Rupee coin placed on

the left parietal part of his head. It was not associated with any of nausea, vomiting, photo-phonophobia , rhinorrhea, lacrimation, conjunctival injection, or focal neurologic symptoms. His magnetic resonance imaging of head and neck with contrast was normal He had received

multiple treatments in the past and had no response to analgesics including paracetamol, aspirin, indomethacin, etoricoxib, tramoadol. Other agents including amitrytilline, topiramate, verapamil, propanolol, benzodiazepine did not lead to any improvement.

A diagnosis of Nummular headache based on ICHD 3 beta classification was considered. Gabapantine titrated to a dose of 1200mg /day had no benefit. Oxcarbazepine was titrated to a dose of 900 mg /day. He reported complete improvement and continued it for a period of 3

months with complete pain relief. He defaulted oxcarbazepine and had recurrence of symptoms in 2 weeks. Subsequent restarting oxcarbazepine again lead to complete

improvement of all symptoms again.

Conclusion: The link between this syndrome, trigeminal neuralgia and epicrania fugax needs to be studied further considering the improvement in our patient with oxcarbazepine.

AOCN-0125

Headache and Pain OR Neuropaediatrics/ AOCCN THE PRACTICE AND TRAINING OF NEUROLOGY IN THE ASIAN OCEANIAN

REGION – A CROSS-SECTIONAL SURVEY BY THE ASIAN OCEANIAN

ASSOCIATION OF NEUROLOGY

A. Roxas1, M.M. Mehndiratta2 1Philippine General Hospital, Neuroscience, Metro Manila, Philippines 2Janakpuri Super Speciality Hospital, Neurology, Janakpuri- New Delhi, India

Objectives: To survey the 20 member AOAN countries regarding their organizational structure, neurology training programs and deliveries of neurological care.

Methodology: A cross-sectional survey using a 36 item questionnaire done from July 2015 to January 2016. The different country representatives to AOAN were asked to answer the

survey and provide their best estimates to different issues. Results: 15 of the 20 member countries participated in the survey. All have established

organization with membership limited to neurologists in 9 of the 15 countries. Recertification is not required in almost all with 3 countries requiring CME requirements for maintaining membership. Four countries have their own peer-

reviewed journals with at least 2 issues released annually. Internal medicine is required in 7/15 before entering a neurology training program. Subspecialty fellowship programs

are offered in 11 of 15. A general neurology training for foreigners is offered in 5 of 15. The ratio of neurologist to population ranges from 1: 14,000 to as high as 1:31M . Specialized neurological hospitals are available in 4 of 15 countries. For government funded

hospitals, lag time to be seen by a neurologist as well as to have an MRI done ranges from 1 day to 3 months. Numerous and various neuro-related support groups are available except

for one country.

Implications: Having these baseline comparative data can encourage improvement of current practices and promote collaborative work for training and neurological services. The role of telemedicine, academic networking, exchange faculty and resident programs in the

region should be pursued.

AOCN-0079

Headache and Pain OR Neuropaediatrics/ AOCCN PAROXYSMAL HEMICRANIA RESPONSIVE TO ETORICOXIB

S. Desai1 1, Anand, India

Aim: To describe series of patients with paroxysmal hemicrania responding to etoricoxib.

Background: There are few case reports of patients with Paroxysmal Hemicrania responding to etoricoxib. We describe series of such patients from our population.

Methods: We run a Headache disorders Clinic at Shree Krishna Hospital, a rural based

medical teaching hospital associated with Pramukhswami Medical College, Karamsad in Western India. In between April 2010 and January 2015,we prospectively collected clinical data of patients with Trigeminal autonomic cephalalgia. Amongst 65 patients, 24 had Cluster

headache, 27 had paroxysmal hemicrania, 9 had SUNCT and 5 had Hemicrania continua. These diagnoses were made basis of ICHD3 beta Classification.

Results: Amongst27 patients with Paroxysmal Hemicrania; all had good initial response to

indomethacin, but 7 developed severe gastritis and vomiting despite proton pump inhibitor therapy and defaulted with indomethacin leading to recurrence of paroxysmal hemicranias. Despite counselling they were not ready to take indomethacin for fear of Gastritis. Hence ,

these patient were given a trial of etoricoxib in a dose of 90 mg/day. 5 of these patients had good response to etoricoxib with complete resolution of headache. 2 of the patients did not

have improvement with etoricoxib.

Conclusion: Etoricoxib can be a reasonable alternative to Indomethac in in patients with Paroxysmal Hemicrania who cannot tolerate indomethacin.

Neurosciences

(Current status in Stem

Cell Therapy)

AOCN-0335 Neurosciences (Current status in Stem Cell Therapy)

THE EFFECT OF ESTROGEN AND PROGESTERONE MAY ENHANCE THE

NEUROPROTECTIVE BENEFITS OF STEM CELL THERAPY IN PATIENTS

WITH ALS H. Sane1, A. Paranjape1, D. Sawant1, S. Inamdar2, N. Gokulchandran3, P. Badhe3,

A. Sharma4 1NeuroGen Brain and Spine Institute, Department of Research and Development,

Navi Mumbai, India 2NeuroGen Brain and Spine Institute, Department of Neurorehabilitation, Navi Mumbai, India 3NeuroGen Brain and Spine Institute, Department of Medical Services and Clinical research, Navi Mumbai, India 4NeuroGen Brain and Spine Institute, Department of Medical Services and Clinical research., Navi Mumbai, India

Amyotrophic Lateral Sclerosis (ALS) is an incurable, progressive, neurodegenerative disorder with a grim prognosis. Incidence of ALS is low in females as compared to their male counterparts. Historic literature links this to the neuroprotective effect of estrogen and

progesterone in females with ALS. Stem cell therapy holds a promising future in the management of ALS. Methodology: This is a comparative cohort study of total 40 patients (Males=28, Females=12) of definite ALS who underwent intrathecal administration of

autologous bone marrow mononuclear cell transplantation. The comparison was made between 4 groups; premenopausal females, post menopausal females, males below 50 years

of age and males above 50 years of age. The aim of the study was to establish the influence of estrogen and progesterone enhancing the neuroprotective benefits of stem cell therapy in the above patients. The percentage of mortality was calculated. The rate of progression of the

disease was computed using ALS-FRSr scale. Results: Pre menopausal females group showed the lowest percentage of mortality and also the lowest rate of progression on ALS-

FRSr scale. (See the table and graph below). Conclusion: The female hormones (estrogen and progesterone) may enhance the neuroprotective benefits of stem cell therapy in patients with ALS and may also have a positive effect on the rate of progression of the disease. Rigorous

methodology and larger sample size are required for definite and conclusive findings.

Movement Disorder

AOCN-0307 Movement Disorder

QUANTIFICATION OF REM SLEEP WITHOUT ATONIA IN KOREAN REM

SLEEP BEHAVIOR DISORDER PATIENTS: COMPARISON OF MANUAL AND

COMPUTER-ASSISTED SCORING METHODS W. SHIN1 1Kyung Hee University, Neurology, SEOUL, Republic of Korea

Objectives: The polysomnographic hallmark of rapid eye movement (REM) sleep behavior disorder (RBD) is loss of muscle atonia during REM sleep; REM sleep without atonia (RSWA). However, the International Classification of Sleep Disorders (ICSD) criteria did not suggest optimized diagnostic value of RSWA and how to score muscle activity during REM

sleep. Many previous studies have been tried to figure out the objective quantitative cut-off values of RSWA. We investigated RSWA in Korean RBD patients compared with normal

control, to quantify the cut-off value in diagnosis of RBD, using both manual and computer-assisted scoring methods (REM atonia index, RAI). Methods: We retrospectively analyzed polysomnography and clinical data of 40 patients, 10 age-matched controls by ICSD-3

criteria. The quantitative analysis of chin electromyography density during REM sleep was done by both manual and computerized method. The RSWA and RAI were compared within

two groups. Results: In computerized method, the mean RAI of RBD patient was 0.66±0.20, and 0.93±0.38 in control group (p<0.001). Also, in manual method, RSWA were also significantly increased within RBD patient compared with normal controls (tonic activity:

9.1±10.3 vs. 0.1±0.2, phasic activity: 7.5±6.4 vs. 1.6±1.2, p<0.002). Conclusions: We quantify the characteristics of RSWA in Korean RBD patients and suggest that we may

diagnose RBD who present RSWA with 4.1% or more increase in total REM sleep duration and RAI more than 0.84.

AOCN-0284

Movement Disorder CURRENT STATUS OF DYSTROPHINOPATHY NATIONAL REGISTRY IN

JAPAN E. Kimura1, M. Mori-Yoshimura2, S. Mitsuhashi3, F. Takeuchi1, H. Nakamura1, H. Komaki4,

K. Ogata5, I. Nishino3, K. Mitsuru5, S. Takeda4 1National Center of Neurology and Psychiatry, Translational Medical Center, Kodaira, Japan 2National Center of Neurology and Psychiatry, Neurology- Hospital, Kodaira, Japan 3National Center of Neurology and Psychiatry, National Institute of Neuroscience, Kodaira,

Japan 4National Center of Neurology and Psychiatry, Child Neurology- Hospital, Kodaira, Japan 5National Hospital Organization- Higashisaitama Hospital, Neurology, Hasuda, Japan

Background: Rare disease registries are recognized as an important tool of clinical research, such as the Global dystrophinopathy patient registry, a harmonized registry from over 30

national registries. An achievement made possible through collaboration with TREAT-NMD, which was established to accelerate the international clinical developments in neuromuscular diseases.

Objective: To present current status of Japanese dystrophinopathy national registry with

international collaboration, and discuss its utility for clinical development.

Methods: Remudy was established in 2009, then took 1) Patient-reported system, 2) Genetic and Clinical curators, 3) Information committee to judge enquiry from third parties, 4)

Following the Charter for TREAT-NMD Patient Database/Registry, 5) Co-working with MDCTN (Muscular Dystrophy Clinical Trial Network).

Results: By February 2016, total registrants were 1,497: 1,377 completed and 120 during

process. Clinical classifications were DMD: 1,091, IMD: 35 and BMD: 252. Most individuals aged less than 20 years. 39.2% of DMD, 39.4% of IMD and 74.6% of BMD were ambulant, 45.8% of DMD, 36.4% of IMD and 8.4% of BMD were treated with steroids, 38.4% of

DMD, 45.5% of IMD and 30.0% of BMD were diagnosed having cardiac dysfunction, and 26.8% of DMD, 33.3% of IMD and 4.6% of BMD were under the ventilation support.

Remudy contributed to feasibility studies and trial recruitments with TREAT-NMD or domestic groups.

Conclusion: Remudy demonstrated utility in clinical research field and standardization of patients care for dystrophinopathy in Japan, as well as a promising style of patient registry

system with international collaborations.

AOCN-0282

Movement Disorder DEEP BRAIN STIMULATION IN A CASE OF MULTIPLE SYSTEM ATROPHY

MIMICKING PARKINSON’S DISEASE A. Kim1, B. Jeon1 1Seoul National University Hospital, Nerurology, Seoul, Republic of Korea

Subthalamic nucleus (STN) deep brain stimulation (DBS) has been considered as an effective treatment in patients with advanced Parkinson’s disease (PD), but not effective for

multiple system atrophy (MSA). We report the clinical findings of a patient who underwent DBS under the initial diagnosis of PD, but, was finally diagnosed with MSA.

A 35 year-old patient was diagnosed with early onset PD one year after unilateral symptom onset. After 8 years’ treatment, he developed wearing off symptoms and peak-dose

dyskinesia. At the age of 45, he was admitted to our hospital for medication control for motor fluctuation. Bilateral STN DBS was done under the diagnosis of PD. Six month after the

surgery, his symptoms of parkinsonism were aggravated. He became bed-ridden after 4 years. Follow-up brain MRI at 4 years postoperatively showed marked pontocerebellar atrophy and signal increase in middle cerebellar peduncle which were absent in previous images. Hence,

his diagnosis was changed to MSA. He expired at age of 53.

This case highlight that a caution should be taken in a patient selection for STN DBS even though a patient presented typical PD symptoms, levodopa-responsiveness, and motor fluctuations. Recently, there are reports suggesting that DBS may be appropriate for earlier

stages of the disease. If DBS is, however, done early, there increases a possibility of being done in patient misdiagnosed with PD. Early DBS in PD is beneficial, but we also should

consider a negative aspect of an early surgery.

AOCN-0275

Movement Disorder A CASE REPORT OF THORACOLUMBAR PARASPINAL MYOPATHY AS THE

CAUSE OF CAMPTOCORMIA IN A PATIENT WITH PARKINSONISM Y. Kim1, B. Jeon1 1Seoul National University Hospital, Neurology, Seoul, Republic of Korea

Camptocormia is severe flexion of the thoracolumbar spine, exaggerated during standing and walking but minimized in supine position. There is ongoing controversy as to its

mechanisms, the most widely accepted being dystonia-rigidity and extensor truncal myopathy.

We report on a Parkinsonian patient who developed camptocormia at the onset of back pain.

Magnetic resonance imaging (MRI) of the lumbar spine revealed alterations in muscle signal intensity in the right paraspinal muscles at the L1-2 level. In the presence of persistent back pain, a repeat MRI scan was done two months later and showed the increased signal intensity

of paraspinal muscles on T2WI was extended to include the T4 through sacrum bilaterally. About fifteen months after the onset of camptocormia, she finally underwent ultrasound-

guided aspiration biopsy of the paraspinal muscles for evaluation of focal atrophy of the back muscles on the right. The pathologist noted endomysial and perimysial fibrosis of the biopsied muscles but no evidence of active inflammation or other clues with regard to the

cause of fibrosis.

Even though the MRI findings were consistent with nonspecific myopathy at best, the coincidence of back pain with the appearance of camptocormia gives strong evidence of axial

myopathy as the cause for the deformity in this patient. That merely fibrosis was noted in the biopsied muscles is not surprising given a period of more than a year since the onset of back pain. This case suggests that at least in some patients with camptocormia, axial myopathy

plays a central role in its development.

AOCN-0270

Movement Disorder A HIV-POSITIVE PATIENT WITH PARALYTIC SYMPTOMS OF THE UPPER

EXTREMITIES DUE TO HERPES ZOSTER VIRUS INFECTION N. KEN1, T. ASANO1 1KUWANA EAST MEDICAL CENTER, orthopaedics, Kuwana, Japan

We report the case of a 45-year-old male with paresis of the left upper limb complicated with herpes zoster (HZ) virus infection.

He had complained of severe pain and numbness from his left shoulder to his thumb for one week before consulting his doctor.

He was prescribed oral sedatives, but they did not alleviate his symptoms. He continued to exhibit severe symptoms and so visited our emergency department. On physical examination, hypoesthesia of the right C6 dermatome and muscle weakness

(manual muscle test results:elbow flexion: 3+/5, wrist extension: 3+/5) were detected. Except for a blister on the patient’s shoulder, we did not observe any skin eruptions.

The patient was immediately admitted to our hospital for detailed diagnostic tests. As no definitive evidence of severe spondylosis was detected on computed tomography or magnetic resonance imaging, none of the patient’s left upper extremity symptoms

seemed to be related to cervical disorders. One day after his admission, a skin rash was observed on the patient’s left upper limb.

He was diagnosed with shingles and prescribed intravenous acyclovir by a dermatologist. His symptoms gradually improved over 60 days, and he was finally demonstrated to be HIV-positive.

HZ-induced paresis occurs at a frequency of 0.5-31% in shingles patients, and upper limb paresis develops in 14.5% of HZ-induced paresis patients.

In addition, 10% of shingles patients are immunodeficient, and HIV-positive patients only account for 1% of patients with immune system disorders. Therefore, HZ-induced upper limb paresis in HIV-

positive patients is considered to be very rare.

AOCN-0268

Movement Disorder SESAMIN EXERTS NEUROPROTECTIVE EFFECT AGAINST 6-

HYDROXYDOPAMINE NEUROTOXICITY BY INHIBITION OF GLIAL

ACTIVATION, APOPTOSIS, AND OXIDATIVE STRESS

T. Baluchnejadmojarad1, M. Mansouri1, J. Ghalami1, Z. Mokhtari1 1Iran University of Medical Sciences, Physiology, Tehran, Iran

Parkinson’s disease (PD) is one of the most prevalent neurodegenerative disorders. This study was carried out to explore the mechanisms underlying the effect of sesamin, the active constituent of sesame oil, against unilateral striatal 6-hydroxydopamine (6-OHDA) model of

PD. Intrastriatal 6-OHDA-lesioned rats were treated with sesamin at doses of 10 or 20 mg/kg/day started one week before till one h before surgery. Sesamin at a dose of 20 mg/kg attenuated motor imbalance in narrow beam test, lowered striatal level of malondialdehyde

(MDA) and estimated reactive oxygen species (ROS), attenuated striatal glial fibrillary acidic protein (GFAP) immunoreactivity, depressed nigral neuronal apoptosis and prevented

damage of nigral dopaminergic neurons in tyrosine hydroxylase (TH) immunohistochemistry. These findings reveal the reversal effect of sesamin in 6-OHDA model of PD via attenuation of apoptosis, astrogliosis, and oxidative stress.

AOCN-0259 Movement Disorder

TOLOSA-HUNT SYNDROME IN CHLIDREN AS RARE EYE'S AND

NEUROLOGIC DISEASE IN CHILDREN A. Bajraktarevic1, S. Trninic2, E. Lokmic2, B. Djukic3, A. Lokvancic Bekto4, U. Sajra5, B. Krdzalic5, M. Ridzal6, A. Abduzaimovic7, M. Spahovic8, S. Hajric Sabanagic9,

A. Nakicevic9 1Public Health Institution of Health Center Sarajevo, Sarajevo, Bosnia and Herzegovina 2Public Health Institution of Health Center Sarajevo, Oculist Department, Sarajevo, Bosnia and Herzegovina 3First medical Aid, Pediatrics Department, Sarajevo, Bosnia and Herzegovina 4Public Health Institution of Health Center Sarajevo, Pediatrics Department, Sarajevo, Bosnia and Herzegovina 5Pediatrics Clinic Sarajevo, Department for neurology, Sarajevo, Bosnia and Herzegovina 6General Hospital Sarajevo, Neonatal departement, Sarajevo, Bosnia and Herzegovina 7Clinical Medical Center Sarajevo, Department for Biochemistry, Sarajevo,

Bosnia and Herzegovina 8Pharmaceutical faculty Sarajevo, Department for Clinical Pharmacology, Sarajevo,

Bosnia and Herzegovina 9Neurologic Clinic Sarajevo, Neurology fo Children and Teenage, Sarajevo, Bosnia and Herzegovina

Introduction: Tolosa-Hunt syndrome is a rare disorder characterized by severe periorbital

headaches, along with decreased and painful eye movements- ophthalmoplegia. The cause of this syndrome is unknown. Tolosa-Hunt syndrome is idiopathic, sterile inflammation of the cavernous sinus. Painful ophthalmoparesis or ophthalmoplegia is the hallmark of this

syndrome.

Objective: A common finding is abduction deficit associated with esodeviation that increases with gaze to the affected side.

Methods: Tolosa-Hunt syndrome is usually diagnosed via exclusion, and as such a vast

amount of laboratory tests are required to rule out other causes of the patient's symptoms. These tests include a complete blood count, thyroidfunction tests and serum protein electrophoresis. Studies of cerebrospinal fluidmay also be beneficial in distinguishing

between Tolosa-Hunt syndrome and conditions with similar signs and symptoms. Laboratory tests include CBC w diff, RPR, FTA-ABS, ACE, ANA, p-ANCA, c-ANCA, Anti dsDNA,

RF, myasthenia antibodies (binding/blocking/modulating antibodies and anti-MUSK antibodies), TFTs, and fasting glucose.

Results: The major symptoms of Tolosa-Hunt syndrome include chronic periorbital headache

(91.5%), double vision (33.3%), paralysis of certain cranial nerves- oclumotoric or other cranial nerves (96.0%), and chronic fatigue (50.5%) in children from Sarajevo during ten years for 5 cases in children. Ophthalmoparesis or disordered eye movements occur when

cranial nerves III (75%), IV (15%), and VI (10%) are damaged by inflammation in this syndrome.

Conclusions: Tolosa-Hunt syndrome is uncommon in both the world and Europe. Symptomatic improvement after steroid therapy is an essential but not absolute proof of the

syndrome, since lesions such as lymphomas may also respond to steroids.

AOCN-0226

Movement Disorder EFFECTIVENESS OF LEVODOPA AND CARBIDOPA, PROPRIOCEPTIVE

NEUROMUSCULAR FACILITATION, COGNITIVE TRAINING IN REDUCING

THE FALLS, IMPROVING GAIT AND QUALITY OFLIFE IN PEOPLE WITH

PARKINSONS DISEASE S. CHIDAMBARAM THIRUNAVUKARASU1, V. Vijaya1, D. Arumugam1, G.S. Alagumoorthi2, S. Bhahadur Hussain2, R. Farveen2 1INDIRA GANDHI GOVERNMENT GENERAL HOSPITAL AND POST GRADUATE INSTITUTE, NEUROLOGY, PONDICHERRY, India 2Mother Theresa Post graduate and Research Institute of health sciences, Physiotherapy, Pondicherry, India

Need for the study and Objectives:

Difficulty in walking and falls is a common problem experienced by people with Parkinson s disease(PD) Levodopa and carbidopa combination is the main stay in therapeutic treatment

ofPD.Physiotherapeutic aspects of training has been overlooked . Proprioceptive neuromuscular facilitation and multiple task walking training is a good non therapeutic option.In this study we would like to incorporate these techniques along with

pharmacological management and see the outcome in terms of improvement in walking speed and also assess whether there is decrease in the frequency and number of falls.

a) Source of Data:

SAMPLE SIZE: Total n=30,

· Group A, n=10 levodopa &carbidopa.

· Group B, n=10 levodopa &carbidopaand proprioceptive neuromuscular facilitation

· Group C, n =10levodopa&carbidopa, proprioceptive neuromuscular facilitationand cognitive training.

b) Method of collection of data:

· Study design: Experimental study

· Duration : six months.

· Sampling design: convenient sampling, randomized group allocation

· Sampling criteria:

· Inclusion:

o Patients falls under the I –III stages of Hoehn&Yahr scale

o Patients underlevodopa medication

o Both male and female above 50 years of age.

o Walking velocity of individuals less than 1.1 m/s.

· Exclusion

o Withdrawal of medication

o Patients having complaints of defects in postural responses.

o Parkinson’s disease followed by stroke and demyelinating diseases.

o Parkinsons plus syndrome

c) Materials and Methods:

· Hoehn&yahr stages

· Measuring tape

· Stop watch

· Objects used as obstacles.

d) Outcome measures::

· Ten meter walk test

· PDQ 39 questionnaire

· Falls efficacy questionnaire

Results and conclusion:

Patients in group C did well in ten meter walking,PD questionnaire .They also had decreased

incidence of falls when compared to other groups.

AOCN-0217 Movement Disorder

QUALITY OF LIFE IN IDIOPATHIC RAPID EYE MOVEMENT SLEEP

BEHAVIOR DISORDER IN KOREA

Y.W. Cho1, M.S. Cho2, K.T. Kim3, H.J. Moon1, J.G. Lim1 1Keimyung University Dongsan Medical Center, neurology, Daegu, Republic of Korea 2University of Massachusetts Lowell, Biotechnology, Lowell, USA 3Department of Neurology, Seoul National University Hospital, Seoul, South Korea

Background: There have been few quality of life (QoL) studies of patients with rapid eye movement sleep disorder (RBD), especially idiopathic RBD (iRBD). Moreover, it is debatable which affects their QoL, sleep itself or mood disorder. We studied the QoL of

patients with iRBD and compared it to healthy controls and patients with hypertension (HTN), uncomplicated type 2 diabetes mellitus (DM) or restless legs syndrome (RLS).

Methods: A total of 60 consecutive iRBD patients (24 female; mean age 61.43±8.99) were

enrolled. All patients underwent a baseline neurological examination to exclude secondary RBD with neurodegenerative disease. Cognitive function was evaluated using the Mini-Mental State Examination. All patients completed the questionnaires, including all Korean

versions of Short Form 36-item Health Survey for QoL, the insomnia severity index, the Hospital Anxiety Scale, and the Beck Depression Inventory–2. These results were compared with the scores from healthy controls (N=60), patients with HTN (60), DM (60) and RLS

(60).

Results: Total SF-36 score of iRBD patients was lower than healthy controls, but higher than that of HTN, DM and RLS patients. The total SF-36 score has a negative correlation with the

PSQI (r=-0.498, p=0.000), ISI (r=-0.645, p=0.000), HAS (r=-0.497, p=0.000), BDI-2 (r=-0.694, p<0.000) and HDS (r=-0.435, p=0.001). Multiple regression identified that the SF-36

score has a negative correlation with the ISI (β=-0.366, p=0.000) and BDI-2 (β=-0.482, p<0.000).

Conclusions: These findings show that iRBD has a considerable impact on the QoL of Koreans. The QoL impairment relates to the degrees of insomnia and depression.

AOCN-0209

Movement Disorder THE LONGITUDINAL STUDY OF NEUROMELANIN-SENSITIVE MAGNETIC

RESONANCE IMAGING IN PARKINSON’S DISEASE K. Matsuura1, M. Masayuki2, T. Ken-ichi3, U. Maki4, K. Hiroyuki5, S. Masayuki3,

K. Hirotaka3, T. Hidekazu1 1Mie University, Department of Neurology- Graduate School of Medicine-, Tsu, Japan 2Mie University,

Department of Advanced Diagnostic Imaging- Graduate School of Medicine-, Tsu, Japan 3Mie University, Dementia Prevention and Therapeutics, Tsu, Japan 4Mie University, Department of Radiology- Graduate School of Medicine-, Tsu, Japan 5Suzuka Kaisei Hospital, Department of Neurology, Suzuka- Mie- Japan, Japan

Purpose: Neuromelanin-sensitive MR imaging (NMI) is becoming a powerful tool for Parkinson’s Disease (PD) diagnosis. This study was undertaken to evaluate longitudinal change of NMI in PD patients.

Method: We examined longitudinal changes of NMI for longer than 1year in 14 PD patients

The area and contrast ratio (CR) of the substantia nigra pars compacta (SNc) and locus coeruleus (LC) were comparatively analyzed.

Result: The area and CR of the whole SNc in follow-up NMI were significantly smaller than those in initial NMI, respectively (from 33.5±18.9 and 6.35±2.86 to 21.5±16.7 pixels and

4.19±2.11 %, paired t-test, p=0.00015 and 0.028, respectively). In individual case analysis, the area of SNc invariably decreased in follow-up NMI as compared to initial NMI. The area

of the whole LC in follow-up NMI was not significantly smaller than that of initial NMI (from 2.08±2.26 to 1.81±1.78 pixels, Wilcoxon signed-rank test, p=0.51). On the dominant side, the area and CR of SNc in initial NMI were significant greater than those in follow-up

NMI, respectively (from 15.3±9.1 and 6.5±2.7 to 7.9±8.5 and 3.7±2.9, Wilcoxon signed-rank test, p = 0.0018 and paired t-test, p = 0.0071). We further showed that the area and CR of the

whole SNc were closely correlated with disease duration (Pearson correlation coefficient, r = -0.63, p = 0.00026 and r=-0.41, p=0.031, respectively). Conclusion: Neuromelanin-sensitive MR imaging is a reliable tool for detecting temporal

changes of PD patients.

AOCN-0186

Movement Disorder ATYPICAL NUEROAXONAL DYSTROPHY: CASE REPORT

O. alhusaini1, A. Kashi1 1King Saud Bin Abdulaziz University for Health Science, college of medicine, Jeddah,

Kingdom of Saudi Arabia

INTRODUCTION:Neuroaxonal dystrophy is an autosomal recessive neurodegenerative disorder. In its typical infantile form,it is characterized by progressive psychomotor

regression, severe Hypotonia,ataxia with cerebellar atrophy.The adult onset form is characterized by neuropsychiatric manifestations, ataxia, and peripheral neuropathy or

dystonia-Parkinsonism.A genetic mutation in PLA2G6 gene was identified as the underlying cause. CASE DESCRIPTION:

Saudi male patient of non-consanguineous parents presented at age of 35 year old complaining of worsening unsteady gait and falls for several

years.Additionally,he complained of muscle weakness,numbness,tremor,hearing difficulties and decline in social skills.The patient has a past history of depression and psychosis. On examination,He had psychomotor slowing and blunted affect.His sensory examination

showed a length dependent sensory loss in all four extremities.His coordination also was impaired with both appendicular and truncal ataxia. His magnetic resonant brain showed

isolated severe cerebellar atrophy,abnormal Angulation of the posterior splenium and claval hypertrophy. His nerve conduction study showed severe symmetrical axonal sensory motor neuropathy.Genetic testing for PLA2G6 gene mutation showed one heterozygous pathogenic

mutation exon 14 of the PLA2G6 gene,c.1933C>T(p.Arg645*). DISCUSSION:

Neuroaxonal dystrophy (NAD) in its typical infantile form has been substantially reported in the literature. The atypical adult onset cases have been less recognized. To our knowledge this is the first adult onset reported case of atypical NAD in the Middle East. The

high index of suspicion and the suggestive MRI features prompted testing for this disease in this patient. We think atypical NAD should be included in differential diagnosis of any

adult patient presenting with progressive ataxia, neuropathy, and cerebellar atrophy on neuroimaging.

AOCN-0139

Movement Disorder EFFECTIVENESS OF PTERIDINES ANALYSIS FOR DIAGNOSIS OF SEGAWA

DISEASE H. Shintaku1, H. Fujioka1, S. Kudo1, T. Sakaguchi1, T. Hamazaki1 1Osaka City University Graduate School of Medicine, Pediatrics, Osaka, Japan

Objective:

To evaluate the efficacy of pteridines analysis in diagnosis of Segawa disease by using sequencing data and MLPA (Multiplex Ligation-dependent Probe Amplification) analysis

data which can detect large deletions in patients who have no mutations by the direct sequencing method.

Patients and Methods

We diagnosed 25 patients with Segawa disease by clinical symptoms and pteridines analysis

in cerebrospinal fluid (CSF). Among 25 patients with Segawa disease 22 patients were confirmed genetically by direct gene analysis of GCH1. In the other 3 patients we performed

gene analysis by using MLPA methods.

Results

All 25 patients with Segawa disease showed significantly lower levels of both neopterin (N:6.59±4.09 nM) and biopterin (B:5.20±2.85 nM) in CSF than controls (N:19.5±2.10, B:23.7±8.50 nM). Twenty-two patients diagnosed by direct sequencing method had a point

mutation or two bases deletion in one allele and the other 3 patients had a large deletion in their one allele which detected by MLPA method. Both N and B levels in CSF were

significantly lower in the former 22 patients (N:6.92±3.92, B:5.58±2.74 nM) than in the latter 3 patients (N:1.98±0.94, B:1.67±1.46 nM).

Conclusions

All patients with Segawa disease had very low N and B levels in CSF. Especially patients

who had large deletion showed significantly lower levels of both N and B in CSF than the other patients who had a point mutation or 2 bases deletion. Patients suspected to be Segawa disease who had very low N and B levels in CSF should be analyze GCH1 gene by MLPA

method.

AOCN-0135

Movement Disorder IDENTIFYING FREEZING OF GAIT AND FALLS IN PARKINSON'S DISEASE

PATIENTS USING A BODY-WORN SENSOR Y. Okuma1 1Juntendo University Shizuoka Hospital, Neurology, Izunokuni, Japan

OBJECTIVE: The aim of the present study is to objectively detect and quantify freezing of gait (FOG) and falls in Parkinson’s disease (PD) patients during everyday activities.

METHODS: Patients were selected from among 36 patients who participated in our previous prospective study on falls. We developed a motion recorder (body-fixed 3D accelerometer) with a long-lasting battery. Movements of recurrent PD fallers with severe FOG were

recorded using the waist mounted device in the outpatient clinic and during their everyday activities. A newly developed freezing index (cross correlation calculation based on pattern

matching) was calculated and compared with the validated index (ratio of power spectrum, 3-8 Hz/0.5-3Hz).

RESULTS: Characteristic patterns of acceleration signals were recorded for freezing and falls. Knee trembling was recorded as a rapid oscillation of acceleration, and the freezing

index increased during knee trembling. In PD patients, actual falls in everyday life were also detected as abrupt trunk angle changes, and knee trembling was recorded when patients

reported FOG-induced falls. The freezing index increased during the start and turning hesitations, similarly to the index calculated using previously validated method. In the previous method, the largest value of freezing index varied according to the directions

analyzed.

CONCLUSIONS: Motion recording using our wearable sensor is useful for detecting FOG and falls in everyday life in PD freezers, and calculating the freezing index may improve the

quantification of FOG.

AOCN-0127

Movement Disorder NEUROPHYSIOLOGICAL INVESTIGATION OF CONGENITAL MIRROR

MOVEMENTS IN DCC MUTATION CARRIERS V. Beaule-Bulman1, S. Tremblay1, L.P. Lafleur1, D. Vosberg2, M. Leyton2, H. Theoret1 1Université de Montréal, Psychologie, MONTREAL, Canada 2McGill University, Psychology, MONTREAL, Canada

Congenital mirror movements (CMM) is a pathological motor condition in which normal voluntary movements of one side of the body are accompanied by involuntary movements of the homologous muscles in the opposite side. CMM usually affect upper limbs and have been

linked to a mutation on the DCC or RAD51 gene. While the role of RAD51 in CMM is still unclear, DCC gene encodes the receptor for netrin-1 protein which is involved in axonal guidance towards the midline. Transcranial magnetic stimulation, electromyography and

behavioral tasks were used to assess motor function in individuals with a DCC mutation. 26 members of a four-generation French Canadian family with CMM were recruited, 7 of which

had CMM and a DCC mutation. CMM+ and CMM- participants were compared to 14 unrelated healthy controls. Results show that CMM+ participants have an abnormal ipsilateral corticopsinal tract systematically causing CMM but at different extents. Only the

CMM+ group displayed CMM which were less pronounced than the voluntary movements, except in one CMM+ participant. CMM+ participants present weaker interhemispheric

inhibition between their primary motor cortex compared to CMM- and controls. Moreover, CMM+ displayed increased physiological MM after a SRTT motor task which was not the case for CMM- and controls. The present study shows that CMM+ individuals have an

abnormal motor pathway and suggests that individuals with a DCC mutation without CMM have a motor system very similar to that of healthy controls. Thus, although the DCC

mutation inherits in an autosomal dominant fashion, its penetrance is incomplete.

AOCN-0124

Movement Disorder CEREBRAL REGIONAL CHANGE IN GLUCOSE METABOLISM OF PATIENTS

WITH ESSENTIAL TREMOR L. Kwang-Soo1, I.U. Song1, K. Joong-Seok1, P. Jeong-Wook1 1The catholic University of Korea, Neurology, Seoul, Republic of Korea

Background and Objectives There is growing evidence that essential tremor (ET) is a multiple-system disorder. Previous PET studies in ET typically measure the brain oxygen

consumption and the cerebral blood flow. Therefore, we compared ET patients with control subjects to investigate any regional change in cerebral glucose metabolism through statistical

parametric mapping (SPM) analysis of 18F-fluorodeoxyglucose - positron emission tomography (FDG-PET).

Methods We studied 17 patients with ET (17 male, mead age 67.3±4.8 years) and age-sex matched normal subjects. We attempted to measure the severity of tremor symptoms with the

score of the Fahn-Tolosa-Marin rating scale (FTM). The evaluation procedure consisted of taking detailed medical history, neurological examinations, and FDG-PET of brain.

Results The mean age of tremor onset was 57.6±12.9 years and the mean score of FTM is

15.1±4.9. A brain FDG-PET analysis demonstrated hypometabolism in the medial frontal lobe, medial temporal lobe and the precuneus of parietal lobe. But there was no significant difference of glucose metabolism in cerebellum.

Conclusion We assumed that motor symptom of ET was caused by electrophysiological disturbances within cortical–cerebellar networks rather than degenerative process of cerebellum because of normal metabolism of cerebellum at rest. Additionally, abnormal

glucose metabolism in cerebral regions that don’t mainly participate in motor function led to assumption that these regions may play a role in the early marker of non-motor

manifestations.

AOCN-0123

Movement Disorder CHANGE OF CEREBRAL PERFUSION IN PARKINSON’S DISEASE WITH

SUBJECTIVE MEMORY IMPAIRMENT I.U. Song1, P. Jeong-Wook1, L. Kwang-Soo1 1The catholic University of Korea, Neurology, Seoul, Republic of Korea

Background and Objective: Cognitive dysfunction is a common feature of Parkinson’s disease (PD). Recent research has focused on the detection and management of subjective

memory impairment (SMI) as the stage that precedes mild cognitive impairment (MCI). Nevertheless, there have been few clinical studies of biomarkers of SMI in PD. Therefore, we

designed this study to investigate differences in perfusion brain SPECT between PD with SMI (PD+SMI) and PD without SMI (PD-SMI) to identify a potential prodromal biomarker of progression to dementia in patients with PD.

Methods: We recruited 30 PD patients with SMI and 24 PD patients without SMI. All

subjects underwent perfusion brain SPECT and neuropsychological testing. Brain SPECT images were analyzed using the SPM program and were compared for patients with PD+SMI

and PD-SMI.

Results: The PD+SMI and PD-SMI groups did not show any statistically significant differences in neuropsychological tests except for MMSE. Despite a significant difference in MMSE scores, all scores of both groups were in the normal range. Brain SPECT analysis of

PD+SMI patients showed hypoperfusion in the frontal and inferior temporal regions, anterior cingulate and thalamus compared with PD-SMI patients.

Discussion: This pilot study evaluated the role of decreased brain perfusion SPECT findings

in PD+SMI patients compared with PD-SMI patients as a predictive biomarker of pre-dementia as the stage that precedes MCI in PD. Future large, prospective studies are needed

to investigate the pathophysiology of neuronal systems during cognitive decline.

AOCN-0122

Movement Disorder VESTIBULO-OCULAR DYSFUNCTION IN MILD TO MODERATE PARKINSON’S

DISEASE : ROTATIONAL VESTIBULAR CHAIR TEST Y. Yun1, E. Lee2 1, Gwangmyeong-si, Republic of Korea 2kimlee clinic, geriatric medicine, Seoul, Republic of Korea

The eye movements can be functionally classified into saccades, smooth pursuit, optokinetic and vestibular eye movements and are known to engage key structures within

the basal ganglia. Therefore, it is not surprising that PD should be associated with distinctive abnormalities of eye movement control. Abnormality of saccadic eye movement is the most

prominent oculomotor deficit in PD but other eye movements can be affected. Until now, vestibule-ocular reflex(VOR) in PD remains poorly understood. This study was carried out to demonstrate the vestibule-ocular dysfunction in mild to moderate degree of Parkinson’s

disese(PD) using rotational vestibular chair test. We prospectively studied 20 patients who met probable PD according to NINDS clinical diagnositic criteria and 20 age-matched normal volunteers. All patients were studied after they had withheld dopaminergic

treatments for at least 12 hours. The vestibular induced slow eye movements was recorded while subjects were turning on a rotating chair. VOR gain with sinusoidal harmonic

stimulation with fixation at 0.04Hz, and with optokinetic stimuli at 0.16Hz were automatically measured. There were no significant differences in VOR gain at 0.02, 0.04, 0.08, 0.16, and 0.64Hz between two groups. However, VOR gain at 0.32Hz and VFX at

0.04Hz were significantly different in patients group than in control group. Rotational vestibular chair test can find subtle vestibule-ocular dysfunction and impaired VOR

suppression by fixation in mild to moderate stage of PD. In our analysis, neurodegenerative changes in mild to moderate stage of PD appear to have some effect on direct and indirect VOR pathway.

AOCN-0115

Movement Disorder DOPAMINERGIC PET STUDY ON AMYOTROPHIC LATERAL

SCLEROSIS/PARKINSONISM-DEMENTIA COMPLEX OF THE KII PENINSULA,

JAPAN

Y. Kokubo1, K. Ishii2, S. Morimoto3, M. Mimuro4, R. Sasaki5, S. Murayama3, S. Kuzuhara6 1Mie University, Graduate School of Regional Innovation Studies, Tsu, Japan 2Tokyo Metropolitan Institute of Gerontology, Neuroimaging, Tokyo, Japan 3Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Neuropathology, Tokyo, Japan 4Aichi Medical University, Institute for Medical Science of Aging-, Aichi, Japan 5National Mie Hospital, Neurology, Mie, Japan 6Suzuka University of Medical Science, Neurology and Medicine, Mie, Japan

Amyotrophic lateral sclerosis and parkinsonism-dementia complex (ALS/PDC) is an endemic and rare disease accumulated in the Kii peninsula of Japan and the island of Guam. We

conducted positron emission tomography (PET) study using C-11 CFT (2-b-carbomethoxy-3b-(4-fluorophenyl) tropane) and C-11 Raclopride for two patients with Kii ALS/PDC to evaluate pre-and post-synaptic dopaminergic function. Kii ALS/PDC #1 was 64 years old

male having 12 years’ duration of the illness. At the examination of PET study, MMSE was unevaluable and he showed L-dopa resistant parkinsonism of Hoehn-Yahr’s stage 4 and

pyramidal tract signs. ALS/PDC #2 was 68 years old female having 7 years’ duration of the illness. At the examination, the score of MMSE was 28/30 and she showed apathy, L-dopa resistant parkinsonism of Hoehn Yahr’s stage 4.5 and pyramidal tract signs. In Kii ALS/PDC

#1, CFT-PET showed marked decreased uptake in the bilateral corpus striatum, notably almost no signal in the posterior part of the putamen. RAC-PET showed mild decrease in the

bilateral caudate nucleus and slight increase in the posterior part of the putamen. In Kii ALS/PDC #2, CFT-PET showed severe decrease in the bilateral corpus striatum, notably marked decrease in the posterior part of the putamen, and in the caudate nucleus. RAC-PET

showed the mild decrease in the bilateral corpus striatum. Relatively mild increase in the posterior part of the putamen reflected compensatory up-regulation and/or dopaminergic

depletion. These results were compatible with L-dopa resistant parkinsonism and similar to those of PSP.

AOCN-0111

Movement Disorder ACUPUNCTURE IN THE TREATMENT OF FATIGUE IN PARKINSON’S

DISEASE: A PILOT RANDOMIZED, CONTROLLED STUDY K.H. Kong1, L. Tan2, W.L. Au2, K.Y. Tay2 1Tan Tock Seng Hospital, Rehabilitation Medicine, Singapore, Singapore 2National Neuroscience Institute, Neurology, Singapore, Singapore

Background: Fatigue is a common problem in patients with Parkinson's Disease, with reported prevalence of up to 70%.There is currently no satisfactory treatment of fatigue. Acupuncture is effective in the treatment of fatigue, especially that related to

cancer. Its role in Parkinson's Disease-related fatigue is uncertain.

Aims: To evaluate the clinical efficacy of acupuncture treatment in Parkinson's Disease-related fatigue.

Design: A single centre, pilot randomized, controlled study.

Participants: Forty participants with idiopathic Parkinson's Disease will be enrolled.

Interventions: Participants will be randomized to receive verum (real) acupuncture or

placebo acupuncture. Intervention will be administered twice a week for 5 weeks.

Main Outcome Measures: The primary outcome will be the change in general fatigue score of the Multidimensional Fatigue Inventory at week 5. Secondary outcome measures include

other subscales of the Multidimensional Fatigue Inventory, Movement Disorders Society Unified Parkinson's Disease Rating Scale, Parkinson's Disease Questionnaire-39 and Geriatric Depression Scale. All outcome measures

will be assessed at baseline (week 0), completion of intervention (week 5) and 4 weeks after completion of intervention (week 9).

Results: To date, the study has recruited 13 subjects and 2 has completed the study. No

significant adverse events are noted. Potential significance: If the results are as positive, it will provide preliminary scientific evidence for efficacy of acupuncture in Parkinson's Disease-related fatigue, and opens the

door for a larger multicentre trial to be performed. In the longer term, it may lead to the integration of acupuncture in the care of patients with Parkinson's Disease.

AOCN-0110

Movement Disorder A SINGLE CENTER STUDY OF SURVEY ON PARKINSON’S DISEASE NON

MOTOR SYMPTOMS L. Then Yee Yen1 1, Kuching, Malaysia

Complex non motor symptoms (NMS) of Parkinson’s disease (PD) have remained largely neglected despite explosive advancement of

motor treatment past few decades. Local data scarcity has led to underrecognition of NMS burden. The present study examined the

prevalence of NMS among PD patients in local setting. Consecutive consenting idiopathic PD patients of all ages and stages were screened using validated, self-completed, 30-item Non Motor Symptoms Questionnaire (NMSQuest) by formal or telephone interview.

Positive response for each item were scored. The primary outcome was the frequency of NMS reported per patient. The received

treatment for NMS were reviewed concomittantly. Few studies have found positive association between NMS and Hoehn and Yahr (H&Y) stage. We examined other sociodemographic factors such age, gender, education level, marita

l status and disease duration as secondary objectives. Initial results from the analysis above will be presented and analytic issues discussed.

AOCN-0105

Movement Disorder QUANTITATIVE CORRELATION BETWEEN CARDIAC META-

IODOBENZYLGUANIDINE UPTAKE AND REMAINING AXONS OF THE

CARDIAC SYMPATHETIC NERVE IN LEWY BODY DISEASE

S. Orimo1, M. Takahashi1, T. Uchihara2, K. Wakabayashi3, A. Kakita4, M. Yoshida5, S. Toru6, H. Takahashi4 1Kanto Central Hospital, Neurology, Tokyo, Japan 2Tokyo Metropolitan Institute of Medical Science, Laboratory of Structural Neuropathology, Tokyo, Japan 3Hirosaki University Graduate School of Medicine, Department of Neuropathology, Hirosaki, Japan 4Brain Research Institute- University of Niigata, Department of Pathology, Niigata, Japan 5Aichi Medical University, Institute for Medical Science of Aging, Nagakute, Japan 6Nakano General Hospital, Department of Neurology, Tokyo, Japan

Objectives: Meta-iodobenzylguanidine (MIBG) cardiac scintigraphy is a useful imaging tool that possibly differentiates Lewy body disease (LBD) including Parkinson’s disease (PD) and dementia with Lewy bodies (DLB) from other related disorders. Reduced cardiac MIBG

uptake and loss of cardiac sympathetic axons are both recognized in LBD, while their direct correlation has so far remained speculative. Methods: We collected cardiac tissue samples

from 23 patients with autopsy-confirmed LBD (8 PD and 15 DLB) and two non-LBD control patients (one Alzheimer disease and one multiple system atrophy) who underwent MIBG cardiac scintigraphy in life. Samples of the left ventricular anterior wall were stained with

anti-tyrosine hydroxylase (TH) and anti-neurofilament (NF) antibodies as markers of cardiac nerve axons. We quantified the immunolabelled areas and assessed their correlation to

standardised heart to mediastinum (H/M) ratios of MIBG cardiac scintigraphy. Results: Cardiac MIBG uptake in the early and delayed phases was reduced in 90.9% and 95.7% of patients with LBD, respectively. The area of TH-immunoreactive axons correlated

significantly with the H/M ratio in the early (p=0.036) as well as in the delayed (p=0.018) phases. The area of NF-immunoreactive axons also correlated with the H/M ratio in the early

(p=0.003) as well as in the delayed (p=0.001) phases. Conclusions: A strong quantitative correlation between cardiac MIBG uptake and corresponding loss of sympathetic axons in LBD provides a scientific basis to confirm the reliability of MIBG cardiac scintigraphy as a

powerful imaging tool to detect loss of these axons as a biomarker for the presence of LBD.

AOCN-0104

Movement Disorder IDENTIFICATION OF CIRCULATING MIRNAS IN SPORADIC AMYOTROPHIC

LATERAL SCLEROSIS PATIENTS AS A POTENTIAL DISEASE BIOMARKER I. Takahashi1, Y. Hama1, H. Uwatoko1, S. Shirai1, M. Matsushima1, T. Kano1, I. Yabe1,

T. Onodera2, J. Utsumi3, H. Sasaki1 1Hokkaido University Graduate School of Medicine, Department of Neurology, Sapporo, Japan 2Hokkaido University Graduate School of Medicine, Department of Orthopaedic Surgery, Sapporo, Japan 3Japanese Foundation For Cancer Research, Cancer Institute, Tokyo, Japan

Specific biomarkers for amyotrophic lateral sclerosis (ALS) could help in early detection and diagnosis as well as monitor its progression and therapy effectiveness. MicroRNAs

(miRNAs) are small, single stranded non-coding RNA molecules that play important regulatory roles in animals and plants by targeting mRNAs for cleavage or translational

repression, and are essential for nervous system development. We speculated that miRNA could be a potential biomarker for ALS and compared miRNAs in the plasma and cerebrospinal fluids (CSF) from ALS patients and healthy controls. Two cohorts, a discovery

cohort analyzed with microarray and a validation cohort confirmed with qPCR, were used for each analysis. We selected two miRNAs showing the most stable detection in microarray for

internal control in qPCR analysis. Microarray analysis results showed that up-regulated miRNAs were rare, but many miRNAs were significantly down-regulated (120 species in plasma and 63 in CSF). The top six plasma

miRNAs and top five CSF miRNAs with significant expression changes were seen as potential biomarker candidates.

Our data showed, in plasma, hsa-miR-4649-5p was up-regulated but in CSF, no miRNAs were up-regulated. Three miRNAs were significantly down-regulated in CSF, and hsa-miR-4299 was down-regulated in both plasma and CSF. Some miRNAs in the plasma or CSF

were seen to be correlated with clinical characteristics such as rating scale or disease duration. We have shown here the amount of several circulating miRNAs in plasma and CSF

have changed in ALS have the potential to be disease biomarkers.

AOCN-0078

Movement Disorder COMPULSIVE TOBACCO USE IN PATIENTS WITH PARKINSON’S DISEASE ON

DOPAMINE AGONIST /LEVODOPA THERAPY: IS IT ALSO AN IMPULSE

CONTROL DISORDER?

S. Desai1, D. Desai2 1Pramukhswami Medical Colllege, Neurology, Anand, India 2Pramukhswami Medical Colllege, Medicine, Anand, India

Aim: To assess frequency of excessive tobacco use in patients with Parkinson's disease [PD] treated with dopamine agonist [DA] or Levodopa[LD] and assess clinical characteristics of

such patients.

Methods: We noticed that family members of some of our patients with PD complained of the patients having developed increased tobacco use. So we prospectively asked for the presence of history of excessive / increased tobacco use after starting up of DA/LD treatment

for PD.

Results: Of 387 patients seen between April 2010 and December 2015, 19 patients were found to have increased tobacco use. Amongst these, 9 patients had de-novo tobacco use. 10

patients had doubled the amount of tobacco consumption. Tobacco use was in the form of chewing “paan masala”/ smoking bidi /cigarette or paste application on teeth. All the patients reported having issue with tobacco use, thinking too much about using tobacco, having

excess desire to consume tobacco and getting distressed on not using it leading to difficulty in controlling tobacco use. The factors associated with this phenomenon were: male gender,

rigidity predominant PD, young onset of symptoms [<50 years], close friends having habit of tobacco use, presence of dysthymia and constipation, past history of tobacco use.

Conclusions: Excessive compulsive tobacco use should also be considered amongst other an

impulse control disorders seen in patient with PD on DA/ LD therapy especially in areas where tobacco is freely available.

AOCN-0020

Movement Disorder DOES THE TYPE-B BOTSULINUM FORMULATION NERBLOC REPRESENT

THE FRONT-LINE THERAPY FOR CERVICAL DYSTONIA? M. Horiuchi1 1Kawasaki Municipal Tama Hospital, Neurology, Kawasaki, Japan Abstract Text

Patients with dystonia are known to have reduced quality of life with various burdens in their daily life. To evaluate the daily life of patients with dystonia, we conducted a

questionnare-based survey of 226 patients with dystonia who were members of non-profit organization -dystonia friends association- and identified that many individuals were

suffering from financial and psychological stresses. Improving the quality of life of patients with dystonia by reducing those burdens is also a key aspect of the clinical management of this condition.

In 2013, the Type-B botulinum toxin formulation NerBloc was launched, resulting in significant change in the medical treatment of cervical dystonia. In large-scale randomized

trials, the efficacy of NerBloc was demonstrated to be comparable to that of Type-A botsulinum formulations (non-inferiority tests) and that the low-cost of NerBloc is one of the greatest benefits for patients with cervical dystonia.

We will report our experiences and discuss about the use of the Type-B formulation NerBloc, which is growing as a novel medical treatment option.

Multiple Sclerosis

(PACTRIM)

AOCN-0292 Multiple Sclerosis (PACTRIM)

TREATMENT MODALITIES IN MULTIPLE SCLEROSIS AND NMOSD: THE

EFFECT OF ANTI AQP4 ANTIBODY. S. Abdullah1, C.T. Tan1 1University Malaya Medical Centre, Medicine, Kuala Lumpur, Malaysia

Objective: to determine the effect of AQP4 status in relation to treatment response, in patients with IIDDs presented to our centre.

Method: Retrospective analysis of treatment response in patients with IIDD in relation to the

AQP4 status.

Results: 59/ 102 (57.84%) were on at least one treatment. β-Interferon was associated with the highest rate of treatment failure in the seropositive group, 24/ 25 (96.00%) as compared to

2/ 17 (11.76%) in the seronegative group, followed by mitoxantrone. Oral Azathiophrine was the second common treatment modality. However, 12/ 27 (44.44%) developed intolerance to the treatment in the form of persistent neutropenia, pancytopenia, acute hepatitis, and 1 case

with locally invasive breast carcinoma. 6/ 8 (75.00%) experienced no relapse after initiation of IV Rituximab, associated with improvement in term of relapse rate and baseline EDSS

Conclusion: The status of anti AQP4 antibody is important in determining the choice of

disease modifying therapy.

AOCN-0162

Multiple Sclerosis (PACTRIM) MODULATION OF PENDULAR NYSTAGMUS BY VISUAL INPUTS IN

MULTIPLE SCLEROSIS: IMPLICATION FOR MECHANISM M. Ho Park1, I. Jung1, J.S. Kim2 1Korea University Hospital, Neurology, Ansan, Republic of Korea 2Seoul National University College of Medicine- Seoul National University Bundang Hospital, Neurology, Seongnam, Republic of Korea

Acquired pendular nystagmus (APN) may occur in multiple sclerosis (MS). The proposed mechanisms of APN in MS include delayed conduction of the visual information for ocular

stabilization and unstable neural integrator for feedback control. We determined the effects of visual inputs on the nystagmus intensity and the effects of saccades on phase shift of the nystagmus in a patient with monocular pendular nystagmus due to MS. The results of this

study may be summarized as follows. 1) The nystagmus was observed only in the eye with more severe visual loss. 2) The nystagmus disappeared in darkness. 3) Monocular viewing

with either eye markedly suppressed the nystagmus. 4) The nystagmus increased when the difference in visual inputs was increased between the eyes using density filters. 5) Horizontal saccades resulted in a significant phase shift of the nystagmus. Based on these results, we

suggest that the difference in visual inputs between the eyes gives rise to ocular oscillatory signals probably in the neural integrator and untimely feedback due to delayed conduction

results in more severe or monocular nystagmus in the eye with severe visual loss.

AOCN-0102

Multiple Sclerosis (PACTRIM) DIFFERENCES IN THE CLINICAL AND LABORATORY FEATURES

ACCORDING TO THE LESION LENGTH IN NON-INFECTIOUS MYELITIS S.J. Joa1, S.Y. KANG1, J.H. KANG1, J.C. CHOI1, S.K. SONG1, J.H. OH1 1Jeju National University Hospital, Department of Neurology, Jeju-si, Republic of Korea

Non-infectious myelitis consists of post infectious myelopathy, multiple sclerosis (MS), neuromyelitis optica (NMO), myelopathy related with connective tissue or anti-phospholipid

antibody and paraneoplastic syndrome. There is no specific radiological finding to the diagnosis of each disease. We investigated to determine if any difference in the clinical

characteristics of the patients of the non- infectious myelitis as compared with the lesion length. This study is a retrospective cross-sectional study. We included patients who had more than 18 years old and diagnosed of non-infectious myelitis. Each patient was divided

into long and short segments group according to the lesion length by MRI findings. Long segments group was defined as having lesion length more than three vertebral segments and

short segments group had less than three vertebral segments. We compared the clinical and laboratory features between both groups. Of a total of 38 non-infectious myelitis patients, long and short segments group were 23 and 15 patients, respectively. Our study showed

significant differences in CSF oligoclonal band positive rate and CSF protein value between long and short segments group. As both CSF oligoclonal band and protein reflect the

inflammatory condition, we assumed that more severe inflammatory responses were developed in non- infectious myelitis patients with long segments lesion. However the difference in lesion length did not give help to predict the etiology of non-infectious myelitis.

AOCN-0061

Multiple Sclerosis (PACTRIM) DEMOGRAPHICS AND CLINICAL CHARACTERISTICS OF MULTIPLE

SCLEROSIS PATIENTS IN HOSPITAL SEBERANG JAYA, PENANG P.D. Suppiah1 1Hospital Seberang Jaya, Clinical Research Centre, Seberang jaya, Malaysia

Multiple sclerosis (MS) is an uncommon disease in this country and with a low prevalence of 1 to 2 per 100000, data on MS is very limited. The objective of this study is to present the

demographics and clinical characteristics of MS patients in a secondary referral hospital in Northern Malaysia. We reviewed the clinical notes of MS patients with consent and captured

the relevant information using data collection form.

We found a total of fifteen patients with MS were under our follow-up. Similar with the Western population, it is more common in females with a ratio of 4:1. It affects mainly the young with an average age of onset of 30.53 years old. It is more common among the Malays

(53.3%), followed by Chinese (26.7%) and Indians (20%). None of the patients have family history of MS. Uniquely, our patients most commonly presented with motor weakness (80%),

sensory disturbances (73.3%), abnormal gait (46.7%) and only 13.3% had visual symptoms at onset. Interestingly only 6 patients (40%) had consented for lumbar puncture with 3 patients (50%) have oligoclonal band positivity. In terms of clinical course, 86.7% are having

relapsing and remitting disease pattern. The average duration of illness of our patients is 5.93 years and the mean annual relapse rate is 0.524 relapses per year.

MS is rare but it exists in our population. With limited resources, high degree of clinical

suspicion based on clinical presentations should prompt appropriate referral for a neurology opinion and helpful in early diagnosis and management.

Neuromuscular/

Neurophysiology

AOCN-0305 Neuromuscular/Neurophysiology

CLINICAL, ELECTROPHYSIOLOGICAL SUBTYPES OF GUILLAIN-BARRE

SYNDROME B. Rajendran1, P. Chary1 1Kauvery Hospital, Neurosciences, Chennai, India

Introduction:

Guillain-Barré syndrome (GBS) is an autoimmune disorder of the nerves causing varying degrees of flaccid paralysis or tingling sensations.

Based on Electrophysiology, GBS has been categorized into acute inflammatory

demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN).

The prevalence of GBS is estimated to be 6 to 40 cases per 1 million people. Population

studies so far suggest that AMAN and AMSAN occur mainly in northern China, Japan, and Mexico but only make up 5-10% of GBS cases in Europe, North America, and the developed world.

Materials and methods :

The study population included patients with GBS referred for Electrodiagnostic evaluation and also patients admitted to our hospital between August 2015 to March 2016.

Results:

We present 14 patients with GBS ( Male to female ratio: 1.5:1). Of 14 patients, 12 were

adults and 2 were in the paediatric age group. Based on Neurophysiological studies, 7 patients were diagnosed to have AMAN, 5 AIDP and 2 AMSAN. Preceding diarrheal illness was more common in AMAN as compared to AIDP subtype. Both the children showed

features of AMAN.

Conclusion:

Although, the group size is small, our paper highlights the higher incidence of the AMAN type in our population. Recovery was almost complete, irrespective of the subtype but

duration was prolonged with severe axonal involvement. Proper Neurophysiological studies at the appropriate time will help us identify these subtypes for better management.

AOCN-0294

Neuromuscular/Neurophysiology NEUROPHYSIOLOGY IN IDENTIFYING OPTIMAL GLOBUS PALLIDUS TRACK

DURING DEEP BRAIN STIMULATION SURGERY F. Reza1, T. Begum1, A.R. Izaini Ghani1, J. Tharakan1, R. Kandasamy1, Z. Idris1, T.Y. Chin1,

B. Idris1, J.M. Abdullah1 1Universiti Sains Malysia, Neurosciences, Kota Bharu, Malaysia

Movement disorders such as Parkinson’s disease, Tourette’s syndrome, dystonia and other neurological disease like epilepsy needs surgical intervention include Deep Brain Stimulation (DBS) to treat or to reduce the sufferings of those diseases when it’s become intractable to

conventional medicine. The advances in DBS surgery technology have led to stimulate electrically the target neural circuit with proper stimulation programming using stereotaxic technique. In order to stimulate the optimal target, neurophysiological mapping is an essential

part of any neurosurgical technique for treatment. The main goal of this study is to identify the optimal Globus Pallidus Internus Microelectrode recording (MER) trajectory during DBS

surgery by recording electrophysilogical discharges of neurons. The recording of spiky neuronal firing bilaterally from Putamen, Globus Pallidus externus (GPe), Lamina, Globus Pallidus Internus (GPi) and Optic tract from three patients during DBS implant was done.

The mean firing rate, burst index and pause index of spikes were analysed and compared left versus right trajectory. After non-parametric independent t-test, there was no significant

differences found in neurophysiological indices between left versus right from Lamina, GPe , GPi and optic tract. However, the mean firing rate from right putamen discharge was significantly higher compare to left Putamen neuronal discharge, may be due to small number

of patients. Therefore, to figure out the role of Putamen in movement disorder is suggestive in large sample size while the target selection was GPi

AOCN-0289

Neuromuscular/Neurophysiology HERBAL FORMULA, DSGOST, PREVENTS COLD-INDUCED

VASOCONSTIRCTION IN MICE CUTANEOUS VESSELS S.H. Sun7, M. Lee13, K. Lee1, H.Y. Go2, Y. Ko3, J.B. Jang4, J.M. Lee5, K. Park6, T.H. Kim8,

D.J. Choi9, Y.K. Song10, J.H. Park11, B. Park9, C.Y. Jeon11, S.G. Ko12, S. Lee14 1Kyung Hee University, Science in Korean Medicine, Seoul, Republic of Korea 2Semyung University, Korean Internal Medicine, Chungju, Republic of Korea 3Kyung Hee University, Institute of Safety- Efficacy and Effectiveness Evaluation for Korean Medicine, Seoul,

Republic of Korea 4Kyung Hee University, Korean Gynecology, Seoul, Republic of Korea 5Kyung Hee University Hospital at Gangdong,

Obstetrics and Gynecology of Korean Medicine, Seoul, Republic of Korea 6Kyung Hee University Hospital at Gangdong, Korean Gynecology, Seoul, Republic of Korea 7Sangji University, Korean Internal Medicine, Wonju, Republic of Korea 8Kyung Hee University Hospital at Gangdong, Clinical trial center, Seoul, Republic of Korea 9Dong-Guk University, Korean Internal Medicine, Kyung Joo, Republic of Korea 10Gachon University, Korean Rehabilitation Medicine, Seongnam, Republic of Korea 11Gachon University, Gynecology, Seongnam, Republic of Korea 12Kyung Hee University, Preventive Medicine, Seoul, Republic of Korea 13Dept. of Oriental Internal medicine, Gil Oriental Medical Hospital, Gachon University 14Department of Preventive medicine, college of oriental medicine, Sangji University

Danggui-Sayuk-Ga-Osuyu-Senggang-Tang (DSGOST), one of traditional Chinese medicines, has long been prescribed for patients suffering from Raynaud phenomenon (RP) in northeast

Asian countries, China, Japan and Korea. While our previous in vitro study revealed that DSGOST prevents cold-induced RhoA activation and endothelin-1 (ET-1) production in endothelial cells (EC), mechanisms by which DSGOST treats RP are still unclear. Our

present study demonstrates that DSGOST regulates RhoA-mediated pathways in cold-exposed pericytes. In pericytes, DSGOST amplified cold-induced RhoA activation, while

significantly reducing ET-1-induced RhoA activation. Moreover, DSGOST regulation of RhoA was tightly related to ROCK1/TESK1/chronophin but not LIMK1/2, cofilin and MLC. Thus, DSGOST activation of RhoA/ROCK1/TESK1/chronophin in cold-exposed pericytes

appears to be crucial for treating vessel contraction. In addition, DSGOST effect on RhoA-mediated pathway in cold-induced HUVEC or HDMEC was similar to that in ET-1-treated

pericytes but not in cold-induced pericytes. We further confirmed that DSGOST inhibited cold-induced contraction of mouse tail vein, in vivo. Moreover, DSGOST treatment reduced cold-induced α2c-AR expression in mouse tail vessels. Therefore, our data suggest that

DSGOST is useful for treatment of RP-like disease.

AOCN-0267

Neuromuscular/Neurophysiology HERPES ZOSTER RADICULOPATHY IN A SYSTEMIC LUPUS

ERYTHEMATOSUS PATIENT: A CASE REPORT B. Purbasari1, S. Kurniawan1 1Brawijaya University- Saiful Anwar General Hospital, Neurology, Malang, Indonesia

Abstract Background: Motor neuropathy is an extremely rare herpes complication, with a mere

prevalence of 0.5 - 5 %. The case of segmental zoster paresis of limbs resulting from motor radiculopathy is especially limited, with cervical and thoracic segments being the least

frequent. Setting: Neurology Outpatient Clinic, Saiful Anwar General Hospital, Malang, Indonesia Case Description: The authors reported a case of a 16 year-old female who presented a

sudden-onset right upper extremity weakness a week after her herpes zoster lesions first appeared. As she was diagnosed with Systemic Lupus Erythematosus (SLE) 4 months ago,

she routinely consumed steroids and azathioprine. Initial examinations revealed multiple vesicles along right C5-C6 roots dermatome accompanied by upper right extremity weakness with manual muscle test grading system (MMT) 3 corresponding to the myotome of C5-C6

roots. An electromyography (EMG) assessment uncovered results relevant to motor root neuritis in C5-C6. Magnetic resonance imaging (MRI) of the cervical radix with Gadolinium

contrast showed no abnormality. Thus, she received acyclovir, gabapentin, and physiotherapy. Results : A follow-up visit after a fortnight revealed an improvement of the weakness along

C5-C6 myotome (MMT 4). A month later, all motor functions were restored with hypoaesthesia and hypoalgesia sensory sequelae along C5-C6 dermatome. Evaluative EMG

revealed median nerve neuritis. Conclusion: Cellular-mediated immunity holds crucial roles in varicella zoster virus activation. Therefore, SLE and immunosuppression therapy is pertinent to this rare motoric

complication of herpes. Acyclovir, gabapentin and physiotherapy treatments resulted in satisfactory recovery.

AOCN-0255

Neuromuscular/Neurophysiology PROLONGED SURVIVAL OF NON-INVASIVE VENTILATION IN JAPANESE

PATIENTS WITH ALS F. Kimura1, Y. Hasegawa1, T. Hirose1 1Osaka Medical College, Neurology, Takatsuki-city, Japan

OBJECTIVE: Non-invasive (NIV) and tracheostomy/invasive ventilation (TIV) in patients with ALS were common therapeutic options in Japan. NIV is considered a first –line

treatment at respiratory distress since 2000. We evaluated the prognostic factors to survive in concern to NIV. METHODS: A survival data until tracheostomy or death could be obtained

from 200 Japanese patients including 115 patients after 2000. RESULTS: 59 patients (51%) underwent NIV after 2000 and 20 patients out of 59 patients underwent TIV after NIV. NIV prolonged median survivals as compared to natural course (45 months vs 32 months

p<0.001). In survival at post-NIV period, patients with bulbar palsy at the time of initiation of NIV showed significantly shorter survival than those without it in no relation to nutrition

state, but patients with bulbar palsy adopted toward NIV showed longer survival as compared with those in natural course. At any time of pulmonary function state, even under 30% of %FVC, NIV prolonged longer survival in any patients with ALS. Prolonged survival from

symptom onset to tracheostomy free survival was obtained in patients who did undergo at the time over 30% of FVC as compared to those under 30% of FVC. Progression rate at

diagnosis calculated by ALSFRS-R was related to post-NIV period. CONCLUSIONS: NIV offered advantages of being non-invasive, having no risk and being easy to introduce or discontinue. The frequency of use of NIV significantly increased after 2000. Various factors

impact the survival of patients after NIV (bulbar symptom, progression rate at diagnosis).

AOCN-0235

Neuromuscular/Neurophysiology WHOLE EXOME SEQUENCING OF A MALAYSIAN FAMILY WITH CMT

REVEALS A NOVEL CANDIDATE GENE FOR AUTOSOMAL RECESSIVE CMT A. Ahmad Annuar1, S. Tey2, N. Shahrizaila3, S. Samulong4, K.J. Goh3, A. Drew5,

G. Nicholson6, M.L. Kennerson6 1University Malaya, Department of Biomedical Science, Kuala Lumpur, Malaysia 2University of Malaya, Department of Biomedical Science- Faculty of Medicine,

Kuala Lumpur, Malaysia 3University of Malaya, Medicine- Faculty of Medicine, Kuala Lumpur, Malaysia 4University of Malaya, Biomedical Science- Faculty of Medicine, Kuala Lumpur, Malaysia 5ANZAC Research Institute, Northcott Neuroscience Lab, Sydney, Australia 6University of Sydney,

Northcott Neuroscience Lab- ANZAC Research Institute- Molecular Medicine Lab- Concord Hospital- Sydney Medical School, Sydney, Australia

We are studying a Malaysian family of a consanguineous marriage with two sons who are affected with autosomal recessive CMT in which mutations in all known recessive genes have been excluded. We performed linkage mapping on six family members with the Golden

Gate Linkage V panel and several suggestive linkage peaks with LOD scores of more than 2.0 were obtained. Further addition of other unaffected family members reduced the number

of suggestive peaks to two loci on chromosomes 12 and 14. Homozygosity mapping was performed which revealed a region of homozygousity that overlapped with the linkage region on chromosome 14. Whole exome sequencing was performed which identified a non-

synonymous variant within a gene in this region, which may represent a novel gene for CMT. We are conducting functional studies to determine whether this variant interferes with the

normal function of the protein.

AOCN-0220

Neuromuscular/Neurophysiology CEREBELLAR PONTINE ATROPHY AND VENTRAL MEDULLARY

HYPERTROPHY IN A PATIENT WITH JUVENILE ONSET SUBACUTE MYELO-

OPTICO-NEUROPATHY

H. Takada1, M. Konagaya2, F. Nagahata3, K. Odaira4 1Aomori National Hospital, Neurology, Aomori, Japan 2Suzuka National Hospital, Neurology, Suzuka, Japan 3Aomori National Hospital, Radiology, Aomori, Japan 4Aomori National Hospital, Regional medical liaison office, Aomori, Japan

Background: Subacute myelo-optico-neuropathy (SMON) is a severe neuro-degenerative disorder caused by poisoning due to oral administration of clioquinol. It is characterized by impaired vision, optic atrophy, subacute myelopathy, spasticity, and dysesthesia of lower

limbs and trunk. Histologically, degeneration of distal axons of optic pathways, posterior spinal and corticospinal tracts, chromatolysis of lumbosacral anterior horn cells, white matter

gliosis, and degeneration of dorsal root ganglion cells were identified. Hypertrophy of inferior olivary nucleus was also reported in SMON patients with central nervous system manifestation. In Japan, patients over 11,000 were diagnosed as SMON and 3-4% of them

were juvenile onset form. We report characteristic brain MRI findings in a case of juvenile onset SMON.

Case: A 54-year-old woman developed visual loss, gait disturbance, and dysesthesia of lower

limbs when she was 5-years after internal medication of clioquinol. Her symptoms have been fixed as total blindness, complete paraplegia with severe muscle atrophy and joint contructure, and dysesthesia of whole lower limbs. She has very mild bilateral intension

tremor and dysarthria, but is able to keep sitting position. Brain MRI demonstrated atrophy of cerebellar hemisphere and vermis, atrophy of ventral part of pons, and hypertrophy of ventral

part of medulla oblongata.

Discussion: Hypertrophy of ventral part of medulla oblongata provided a potential hypertrophy of inferior olivary nucleus connected to cerebellum. We could not have similar MRI findings in adult onset SMON patients. The MRI findings might reflect developmental

dysfunction of brain tissue because of exposure to clioquinol in childhood.

AOCN-0208

Neuromuscular/Neurophysiology MUSCULAR DYSTROPHY CLINICAL TRIAL NETWORK: PROMOTING

CLINICAL RESEARCH FOR NEUROMUSCULAR DISEASES IN JAPAN K. Ogata1, E. Takeshita2, E. Kimura3, M. Shigemori4, M. Ohata4, H. Komaki5 1National Hospital Organization Higashisaitama Hospital, Institute of Clinical Research / Department of Neurology, Hasuda- Saitama, Japan 2National Center of Neurology and Psychiatry, Department of Child Neurology,

Kodaira- Tokyo, Japan 3National Center of Neurology and Psychiatry, Translational Medical Center,

Kodaira- Tokyo, Japan 4National Center of Neurology and Psychiatry, Department of Clinical Research Promotion, Kodaira- Tokyo, Japan 5National Center of Neurology and Psychiatry, Department of Clinical Research Promotion / Department of Child Neurology,

Kodaira- Tokyo, Japan

Muscular dystrophy is a rare disease, affecting less than 0.01 % of the population. The establishment of clinical trial networks between medical institutes reportedly helps to

improve readiness for trials on rare diseases such as muscular dystrophy. Some networks for clinical research on neuromuscular diseases have already been established in other parts of

the world. The Muscular Dystrophy Clinical Trial Network (MDCTN) was established in 2012 to promote and activate clinical research on neuromuscular diseases in Japan. This network was organized based on an existing study group for clinical myology funded by a

Japanese national research grant and is a network of national hospitals with wards specifically for patients with progressive neuromuscular disorders. As of January 2016, 38

medical institutions had joined this network. Site registry queries have revealed that approximately 6,000 patients with neuromuscular diseases visit the member hospitals annually. The work of the MDCTN includes sharing updates in health-care information,

developing standardized means of evaluation through workshops, supporting clinical trials with feasibility surveys and patient recruitment, and conducting collaborative research.

Working closely with patient registries is one of the keys to the functioning of this network. The MDCTN has collaborated with a Japanese patient registry, Remudy, to support remarkably rapid recruitment of subjects with Duchenne muscular dystrophy who meet

criteria of specific genetic mutations and conditions for some clinical trials. The goal of MDCTN is to be a model for developing pharmaceuticals and medical devices for rare

diseases in Japan.

AOCN-0174

Neuromuscular/Neurophysiology RESPIRATORY CARE SUPPORT TEAM IMPROVES RESPIRATORY

MANAGEMENT OF INPATIENTS WITH AMYOTROPHIC LATERAL

SCLEROSIS

K. Komai1, A. Tagami2, C. Ishida1, K. Takahashi1, Y. Motozaki1, M. Yoshida3, H. Kirisaki4, T. Hirota4 1National Hospital Organization Iou Hospital, Neurology, Kanazawa, Japan 2National Hospital Organization Iou Hospital, Respiratory Medicine, Kanazawa, Japan 3National Hospital Organization Iou Hospital, Nursing, Kanazawa, Japan 4National Hospital Organization Iou Hospital, Rehabilitation, Kanazawa, Japan

Background: Our hospital have been providing long-term medical care for neuromuscular disease patients as the neuromuscular-disease center hospital in Hokuriku area of Japan. To

improve patient’s prognosis or to reduce respiratory complications, we started multidisciplinary respiratory care support team (RST) since 2007.

Methods: We retrospectively reviewed medical records of inpatients with Amyotrophic Lateral Sclerosis (ALS) to elucidate the RST activity from 2010 to 2014. The prognosis after RST intervention of 28 patients was investigated. Twenty cases out of those 28, were assisted

by mechanical ventilator before RST consultation. Results: Thirteen of 28 patients had ended RST intervention. Main reasons for having ended

intervention was discharge from our hospital by having achieved the initial aim of RST intervention. Others were death by pneumonia or respiratory failure. Pneumonia frequency reduction or improving airway clearance were observed by 9 patients who were continuing

the intervention by RST or by floor nursing team. Conclusion: From this retrospective study, the improvement of respiratory conditions like

pneumonia frequency reduction etc, can expect even for severely disabled ALS patients by systematic RST intervention. We concluded multidisciplinary RST intervention can be clinically effective.

AOCN-0155

Neuromuscular/Neurophysiology INCREASED OXYGENATION OF THE CEREBRAL PREFRONTAL CORTEX

AFTER 5 MINUTES MODERATE INTENSITY CYCLING EXERCISE: A NEAR-

INFRARED SPECTROSCOPY STUDY

A. Tsubaki1, N. Takehara1, Y. Tokunaga2, D. Sato1, H. Tamaki1, H. Onishi1 1Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata-city, Japan 2Niigata Rehabilitation Hospital, Deaprtment of Rehabilitation, Niigata-city, Japan

Increased oxygenation (O2Hb) of the cerebral prefrontal cortex (PFC) during exercise and improved cognitive function following exercise were observed. However, the after-effects of exercise on cerebral O2Hb were unknown. The purpose of this study was to investigate O2Hb changes after 5 minutes of moderate intensity cycling exercise.

Nine healthy volunteers (5 females) participated in this study. After a 3-minute rest on the

ergometer, participants performed 5 minutes of exercise at workloads corresponding to 50% VO2 max, followed by 15 minutes of rest. O2Hb from the left PFC and right PFC were

measured using near-infrared spectroscopy. Skin blood flow (SBF) and mean arterial pressure (MAP) were measured synchronously. Averages of O2Hb, SBF, and MAP were expressed as the difference from the average pre-exercise rest phase value and were calculated every

minute. We compared the peak value of the O2Hb during and after the exercise using a paired t-test.

O2Hb increased during the exercise and remained increased following exercise. The peak

value of O2Hb in the left PFC after exercise was significantly higher than during exercise (during: 2.94 ± 1.84 a.u., after: 4.30 ± 2.55 a.u.; p = 0.021). The peak value of O2Hb in the right PFC after exercise had a tendency toward higher values than during exercise (during:

2.68 ± 2.00 a.u., after: 4.17 ± 2.83 a.u.; p = 0.058). SBF and MAP were decreased following exercise.

Our results suggest that improvement of cognitive function following exercise is based on

increased oxygenation of the cerebral PFC.

AOCN-0142

Neuromuscular/Neurophysiology MOLECULAR IMMUNOLOGICAL ACTION OF HUMAN PAPILLOMAVIRUS

VACCINE AND ASSOCIATED NEUROPSYCHIATRIC SIDE EFFECTS N. kanzato1 1Okinawa Prefectural Nanbu Medical Center, Neurology, Haebaru-cho, Japan

Human papillomavirus (HPVs) -associated cancer, such as cervical cancer, can result from persistent infection with the high risk type of HPV 16 and 18, with the characteristic

immuonological escape from cell-mediated immunity of the host. Although, mutations in the long control region (LCR) and the E6 and E7 genes of the virus genome may to be involved

in carcinogenicity, patients’ genetic predispositions are unlikely to contribute to HPV infectivity and carcinogenicity. Prophylactic vaccine of HPVs for cervical cancer was discovered with recombinant gene technology in 1990, and it was adopted in preventive

vaccination law in 2013 in Japan. Aluminum hydroxide(Al(OH)3) has been incorporated in the vaccine, which strongly induces the CD8+ T cell-dominate Th2 responses, although there

has been no independent screening of the safety of the vaccine adjuvant. We report seven patients with neuropsychiatric side effects after the 3rd booster injection of HPVs vaccine. Their clinical manifestations were variable: chronic headache, 5/7 (71%);

depressive state, 5/7 (71%); motor sensory neuritis, 4/7 (57%); neuralgic pain, 3/7 (43%); and cognitive impairment, 2/7 (33%). Their immunological manifestations were: atopic

predisposition with serum IgE elevation, 5/7 (71%); positive for anti NMDA-type Glutamine receptor antibody, 4/7 (57%); positive for anti GM1-IgM antibody, 2/7 (33%); and positive for anti enolase antibody, 1/7 (14%). We suggest that the shift to Th2 responses induced by

HPVs vaccine triggers the various anti-neural antibodies, which disturb the peripheral and central nervous system under the condition of immature epigenetic gene regulation.

AOCN-0140

Neuromuscular/Neurophysiology PONTINE VENOUS MALFORMATION MIMICKING OCULAR MYASTHENIA

GRAVIS J.S. Bae1, L. Min Woo1 1Kangdong Sacred Heart Hospital- Hallym University College of Medicine, Neurology, Seoul, Republic of Korea

Background & Significance : Myasthenia gravis (MG) is a neuromuscular junction transmission disorder, characterized by fluctuating neurological symptoms, such as diplopia, ptosis or limb muscle weakness. There have been several reports of brain stem lesions that

clinically resemble ocular MG. Here, we present a case of pontine venous malformation mimicking ocular MG.

Case : A 29-year-old male with no known medical history presented with fluctuating horizontal diplopia for several years. He complained that diplopia aggravated with exhaustion

or after strenuous exercise and diplopia was absent or minimal in the morning. At the time of initial interview, he complained of horizontal diplopia that was aggravated with gaze to the

right side. His extraocular muscle movement showed no restrictions on all the six directions, bilaterally. Interestingly, his diplopia was aggravated with Valsalva maneuver. Both RNST and AChR antibody test were normal. Brain MRI revealed venous malformations on bilateral

pons and medulla. The draining vein on the right posterior pons was considerably dilated and showed high signal intensity on gadolinium enhanced image.

Conclusions or Commentes : Diagnosis of ocular MG has often been a challenging problem.

Although fluctuation of neurological symptom is the hallmark of MG, other diseases rarely show a similar pattern of fluctuation, like our case. To our knowledge, this is the first case of pontine venous malformation clinically mimicking ocular MG. Venous malformation of

brainstem should be added as one of differential diagnoses for ocular MG. Brain imaging is crucial if this mimic is suspected for the differential diagnosis.

AOCN-0133

Neuromuscular/Neurophysiology PHYSIOLOGICAL FACTORS INFLUENCING MEDIAN NERVE MOBILITY IN

NORMAL SUBJECTS J.I. Seok1, J.A. Park1 1Catholic University of Daegu College of Medicine, Neurology, Daegu, Republic of Korea

Introduction: The purpose of this study is to assess mobility of the median nerve in the axial plane in normal healthy subjects and to evaluate physiological factors associated with lesser

degrees of mobility.

Methods: The present study included 80 healthy volunteers between 20 and 60 years of age. For all subjects, mobility of the median nerve was assessed at the carpal tunnel.

Results: With wrist and finger flexion, the median nerve moved in all 160 wrists; in 78 the

nerve dived deep to the flexor tendons (full), and in 82 it made a partial turn but did drop below the tendons (partial). Of the demographic factors and sonographic measurements, only

height was significantly related to partial mobility.

Discussion: Full or partial mobility of the median nerve with wrist flexion is an attribute of normal subjects; partial mobility is common, particularly in taller individuals.

AOCN-0121

Neuromuscular/Neurophysiology ISCHEMIC MONOMELIC NEUROPATHY

A.C. Hui1, M.C. Dhamne1, G. Shanmugam1 1Ng Teng Fong General Hospital, Medicine, Singapore, Singapore

Case report

Ischaemic neuropathy is a known complication of vascular access placement in patients with end stage renal failure (ESRF). We report a 58 year-old man with type 2 diabetes mellitus requiring hemodialysis. He underwent angioplasty to improve vascular access for an

arteriovenous fistula (AVF) in his right forearm. Operative findings revealed extremely calcified and diseased arteries throughout the arm, with >50% stenosis of distal brachial

artery, stenosis of the radial artery and an occluded ulnar artery. Following the procedure, the patient reported weakness, pain and numbness in his hand. Nerve conduction study showed absent sensory nerve action potentials in multiple nerves with reduced right ulnar and median

nerve compound motor action potential amplitudes. EMG later revealed denervation changes in the right hand and forearm muscles. In summary the clinical and electrophysiological

features were consistent with ischemic monomelic neuropathy (IMN) and a background of diabetic / uremic polyneuropathy.

Discussion

Wilbourn coined the term ischemic monomelic neuropathy (IMN) to describe multiple

axonal-loss mononeuropathy in a limb after graft insertion. It is a form of steal phenomenon as the access surgery diverts blood flow away from distal nerve tissue causing multiple axonal-loss mononeuropathy. IMN is a rare complication, often under-recognized and

misdiagnosed. Typical clinical features include sensory symptoms in the hand and forearm with associated weakness or paralysis of muscles in the same region. The syndrome develops

quickly after AVF formation. Prompt diagnosis and managemnet requires close cooperation between vascular surgery, nephrology and neurology teams.

AOCN-0120

Neuromuscular/Neurophysiology ALSFRS-R IN ALS PATIENTS WITH TRACHEOSTOMY POSITIVE PRESSURE

VENTILATION MANAGEMENT：THE TIME COURSE OF 11 MONTHS N. Shibasaki1, J. Tokunaga2, H. Mochizuki3, T. Numayama2 1Sayama Neurological Hospital, Rehabilitation, sayama-shi, Japan 2Sayama Neurological Hospital, Neurology, sayama-shi, Japan 3Bunkyo Gakuin University, Medical Care Scientific Inquiry, Bunkyo-ku, Japan

Purpose: According to the report by Richard S. Bedlack（Neurology 2016;86:1-4）,

amyotrophic lateral sclerosis (ALS) patients experienced the improvement of lost function. However, the ALS duration of the improved patients who experienced the reversals were

only 1.9±1.0 years, not the advanced stage. Hence, we verified the variation whether the progression of ALS patients with Tracheostomy Positive Pressure Ventilation (TPPV) management can reverse from lost functions in the advanced stage.

Subjects: The subjects were 67 ALS patients under TPPV management. Disease duration was 7.4 ± 4.6 years.

Methods: To analyze the improvement, we measured the total score of Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised (ALSFRS-R) for ALS patients in comparison

with the base line and after 11 months by using the medical record.

Results: The total score of ALSFRS-R averaged 1.7 ± 2.2 points at the baseline and 1.5 ± 1.8 points after 11 months. 4 patients (6.0%) increased the points, 38 patients remain unchanged

and 25 patients decreased. In the subscale of the above, "Speech" was 1 patient, "Salivation" was 3 patients, and “Orthopnea " was 2 patients. No patients were in the other subscale.

Conclusion: ALS patients experienced the reversals under TPPV management at the

advanced stages existed. Surely this could be influenced by external factor such as the communication aids and therefore, ALS patients under TPPV management need an active care.

AOCN-0114

Neuromuscular/Neurophysiology ELECTROPHYSIOLOGICAL DIFFERENCES BETWEEN UPPER LIMB ONSET

AMYOTROPHIC LATERAL SCLEROSIS AND CERVICAL SPONDYLOTIC

AMYOTROPHY

J.S. Park1, J.M. Park2, D. Park3 1Kyungpook National University Hospital, Department of Neurology, Daegu, Republic of Korea 2Dongguk University School of Medicine, Department of Neurology, Gyeongju, Republic of Korea 3Seoul National University Bundang Hospital, Department of Rehabilitation Medicine, Seoul, Republic of Korea

Upper limb onset Amyotrophic lateral sclerosis (ALS) and cervical spondylotic amyotrophy (CSA) can manifest atrophy in the intrinsic hand and forearm muscles in the early stage of the disease and differentiating the two diseases in the early stage is challenging. Split hand

phenomenon is predominantly seen ALS, but only a half of ALS patient show typical spit hand pattern. Therefore finding an additional diagnostic electrophysiologic parameter in ALS patients beside the ADM/APB ratio, can be useful in differentiating these disease.

We retrospectively reviewed the electrophysiological results of 67 upper limbs onset ALS

and 52 CSA cases; 33 healthy individuals were included as controls. We included only ALS and CSA patients with normal ADM/APB ratio (≥0.6, and ≤1.7). 38 among 66 patients with

ALS, 38 among 52 patients with CSA had normal ADM/APB ratio.

There were a statistically significant differences in the terminal latency of median nerve, F wave latency of median nerve, F-M latency of median nerve, and onset latency ratio of ulnar/median nerve between ALS and CSA (p<0.05). Patients with ALS had a tendency of

lower ulnar/median onset latency ratio, lower F wave latency and F-M latency ratio, and delayed F wave latency than CSA and healthy control.

The ulnar/median onset latency ratio may be a more sensitive diagnostic electrophysiological

maker for upper limb onset ALS with normal ADM/APB amplitude ratio, that can be easily used in the clinical practice.

AOCN-0106

Neuromuscular/Neurophysiology DELAYED FACIAL PALSY IN MILLER FISHER SYNDROME

C.Y. Tan1, N. Yuki2, N. Shahrizaila1 1University Malaya Medical Centre, Medicine, Kuala Lumpur, Malaysia 2Yong Loo Lin School of Medicine- National University of Singapore, Medicine and Physiology, Singapore, Singapore

Miller Fisher syndrome is characterised by the triad of ophthalmoplegia, ataxia and areflexia. However, facial palsy can occur during the course of the illness although development of facial palsy when other cardinal signs of Miller Fisher syndrome have reached nadir or

improving, is unusual. This delayed appearance of facial palsy can be easily overlooked by the treating clinician. Here, we report four patients with Miller Fisher syndrome and delayed-onset facial palsy. We discuss the possible underlying reasons behind the delay in facial

palsy.

AOCN-0074

Neuromuscular/Neurophysiology IMPLICATION OF DAMAGE-ASSOCIATED MOLECULAR PATTERNS IN

MYASTHENIA GRAVIS A. Uzawa1, T. Kanai1, N. Kawaguchi1, F. Oda1, Y. Ozawa1, K. Himuro1, S. Kuwabara1 1Chiba University Graduate School of Medicine, Neurology, Chiba, Japan

Myasthenia gravis (MG) is an autoimmune-mediated inflammatory disease at the neuromuscular junction. Anti-muscle nicotinic acetylcholine receptor (AChR) antibody,

complement, and cytokines are likely to be of major importance in the inflammatory mechanisms of MG. However, the inflammatory pathogenesis of MG is yet to be fully

elucidated. Extracellular damage associated molecular patterns (DAMPs) function as inflammatory mediators and are implicated in the pathogenesis of various autoimmune inflammatory diseases. This study aims to clarify the associations between DAMPs, such as

high mobility group box 1 (HMGB1) and peroxiredoxin (PRX), and inflammatory pathogenesis of MG. The levels of serum HMGB1 and PRX5 were measured using an

enzyme- linked immuno-sorbent assay. Serum HMGB1 and PRX5 levels in anti-AChR antibody-positive MG patients were significantly higher than those in controls (mean HMGB1 level, 7.8 (n = 60) vs. 4.1 ng/mL (n = 40); mean PRX5 level, 4.8 (n = 40) vs. 2.8

ng/mL (n = 40); P < 0.05), and HMGB1 levels were decreased after immunosuppressive treatment. MG patients with thymoma showed higher HMGB1 and PRX5 levels than those

without thymoma. There were significant associations between the serum HMGB1 levels and PRX5 levels (r = 0.54, P = 0.001). In conclusion, HMGB1 and PRX5 play pivotal roles in the inflammatory pathogenesis of MG. Measuring these DAMPs is useful to evaluate

neuromuscular junction damage and inflammation in MG. In the future, they may be applied as potent therapeutic targets in MG.

AOCN-0042

Neuromuscular/Neurophysiology HLA-ANALYSIS IN JAPANESE MYASTHENIA GRAVIS PATIENTS

T. Kanai1, A. Ozawa1, N. Kawaguchi1, T. Sakamaki2, Y. Yoshiyama3, K. Himuro1, F. Oda1, S. Kuwabara1 1Chiba University, Neurology, Chiba, Japan 2Chiba-East National Hospital, Department of Clinical Laboratory, Chiba, Japan 3Chiba-East National Hospital, Department of Neurology, Chiba, Japan

Myasthenia gravis (MG) is an autoimmune disorder presumed to be associated with genetic susceptibility. Previous studies have shown that human leukocyte antigen (HLA) is related to

clinical profiles in MG patients such as onset age, thymus pathology, and antibody. This study aims to determine whether HLA is associated with MG in Japanese patients. Seventy-two MG patients including 58 patients with anti-acetylcholine receptor antibody (AChR-MG)

and 14 patients with muscle-specific receptor tyrosine kinase (MuSK-MG) were involved in this study. We determined HLA-A, -B, -DRB1 and -DQB1 types using polymerase chain

reaction with sequence-specific oligonucleotide and primers. AChR-MG was classified into the three subgroups: early-onset MG (EOMG; n = 11), late-onset MG (LOMG; n = 20), and thymoma-associated MG (n = 27). Healthy volunteers (n = 100) served as controls. A

significant positive association was observed between MuSK-MG with the DRB1*14 [57.1%, MuSK-MG vs. 18.0%, healthy controls (HC); odds ratio (OR): 6.1] and DQB1*05

[78.6%, MuSK-MG vs. 30.0%, HC; odds ratio (OR): 8.5]. We found a negative associations between LOMG and DQB1*04 [5.0%, LOMG vs. 37.0%, HC; OR: 0.09]. There was no association between other MG subgroups and HLA alleles. In conclusion, HLA-DRB1*14

and DQB1*05 were associated with MuSK MG across the races and may play important roles in developing the disease.

CNS Infections

AOCN-0306 CNS Infections

CASE REPORT: MIXED INFECTION OF CRYPTOCOCCAL AND

TUBERCULOUS MENINGITIS IN HIV PATIENT J. Harisman1, N. Hapsari1, R. Estiasari1, D. Imran1 1Faculty of Medicine - University of Indonesia- Cipto Mangunkusumo Hospital, Neurology,

DKI Jakarta, Indonesia

Tuberculous and Cryptococcal meningitis are intracranial opportunistic infection that common found in HIV patients. Usually it occurs as single CNS infection. Mixed CNS infection is rarely found. We will report a case of mixed infection of cryptococcal and tuberculous meningitis in HIV patient. A 36-year old man was admitted to our hospital with

chief complaint worsening headache since 7 days. Pain was felt in all head region especially in back of head with visual analog scale (VAS) score 8. Pain was worsened by activity and

cough. Physical examination showed no neurological abnormality but when pain worsen the patient’s verbal contact declined and sometimes incoherent. Lumbal puncture (LP) was performed with opening pressure 55cmH2O. India ink test showed a lot of Cryptococcus

found in CSF. Acid fast bacilli from cytocentrifugation CSF also found. Patient was treated with amphotericin B, fluconazole and antituberculous drug. Second lumbal puncture was

performed in the next day due to worsening headache. The opening pressure 44cmH20. We drained 15ml of CSF. After LP the headache improved. The CD4 level was 51cell/uL. During 2 weeks of treatment patient had performed 5 times LP to relieve his headache. The headache

was improved with VAS score 3. The last LP on 2 weeks of treatment still showed positive india ink. The treatment continue with Fluconazole 800mg and planned to start the

antiretroviral. Mixed CNS infection in HIV patient can simultaneous appear between cryptococcal and tuberculous meningitis. Clinical symptoms and laboratory finding can help to diagnose these diseases.

AOCN-0173

CNS Infections SYMPTOMS AND MRI FINDINGS OF NEURO-BEHCET'S DISEASE.

H. Uwatoko1, K. Sakushima1, A. Nagai1, S. Shirai1, I. Takahashi1, M. Matsushima1, F. Nakano1, M. Hirotani1, T. Kano1, I. Yabe1, H. Sasaki1 1Hokkaido University Graduate School of Medicine, Neurology, Sapporo, Japan

Background: Neurological involvement in Behcet’s disease (BD), known as Neuro-Behcet’s disease (NBD), manifests various neurological symptoms and signs. Since NBD shows

various symptoms and abnormalities on brain MRI, early and precise diagnosis of NBD is often difficult to make. The purpose of this study is to assess relation between symptoms and

MRI finding of NBD.

Methods:We retrospectively reviewed medical records of patients with BD who attended Department of Neurology of Hokkaido University Hospital from April 1986 to March 2012. Diagnosis of BD was based on the International Behcet’s Disease Study Group criteria.

Result: 52 patients with BD were evaluated, of whom 23 patients had NBD. All patients with NBD had parenchymal type disease, 19 (13 men) of them had acute NBD and 4 (3 men) of them had chronic progressive NBD. Among the patients with acute NBD, frequent clinical

manifestations were meningitis (11/19, 57.9%), paralysis (11/19, 57.9%), cerebellar ataxia (6/19, 31.6%), and cranial neuropathy (6/19, 31.6%). Cerebellar ataxia was more common in men (6/13, 46.2%) than in women (0/6, 0%). Common MRI findings were cerebral white

matter lesions (17/19, 89.5%), brain stem lesions (10/19, 52.6%), and basal ganglia lesions (9/19, 42.9%). Lesions in brain stem, basal ganglia and thalamus

were more common in men than in women. Conclusion: Among patients with acute NBD, cerebellar ataxia and MRI abnormal finding in

brain stem, basal ganglia, and thalamus were more common in men compared to women.

Neurorehabilitation

AOCN-0189 Neurorehabilitation

APPLICABILITY OF THE HYBRID ASSISTIVE LIMB ROBOT SUIT (HAL) IN A

PATIENT WITH SPINOCEREBELLAR ATAXIA TYPE 3: A CASE REPORT K. Komai1, S. Tanuma2, E. Tonomura2, K. Serizawa2, A. Morita2, H. Kirisaki2, Y. Ishizaki2, K. Takahashi1, C. Ishida1 1National Hospital Organization Iou Hospital, Neurology, Kanazawa, Japan 2National Hospital Organization Iou Hospital, Rehabilitation, Kanazawa, Japan

Background: Motor rehabilitation program for patients with degenerative spinocerebellar ataxia have not been established. Recently, motor training with the help of robotic devices is an interesting field of research in neurological rehabilitation. And feasibility and safety of

acute phase rehabilitation using the hybrid assistive limb robot (HAL) suit was reported. To evaluate the potential applicability of HAL suit as a tool for training in degenerative

spinocerebellar ataxia, we performed a single case study. Methods: A 49-years-old female with spinocerebellar ataxia type 3 was recruited. Patient

were trained with HAL suit according to the standard gait exercise 11times. At baseline and at the end of training, gait pattern, 10-meter walking test, 3-minite walking test, timed up &

go test (TUG), the 30-second chair stand test (CS-30), and Berg Balance scale (BBS) were evaluated.

Results: At baseline, TUG was 46.10 second, CS-30 was 1time, and BBS was 13 points. At the end of training, TUG became 29.29 second and BBS became 20 points. Other indexes did

not show remarkable change. Conclusion: Motor rehabilitation program using HAL suit could be potentially applicable for

patients with spinocerebellar ataxia type 3.

AOCN-0126

Neurorehabilitation EFFECTS OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT ON

OXIDATIVE STRESS AND ATHEROSCLEROSIS H. Yilmaz1, A. Kisabay1, U.S. Sari2, E. Cakiroglu3, B. Demirel Oktan4, T. Korkmaz1,

G. Dinc Horasan5 1Celal Bayar University School of Medicine, Department of Neurology, Manisa, Turkey 2Balikesir Public Hospital, Neurology, Balikesir, Turkey 3Manisa Public Hospital, Neurology, Manisa, Turkey 4Artvin Public Hospital, Neurology, Artvin, Turkey 5Celal Bayar University School of Medicine, Department of Public Health, Manisa, Turkey

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for development of atherosclerotic processes because it leads to hypertension, impaired

glucose metabolism, obesity and metabolic syndrome, cardiac diseases, elevated blood pressure, and increased level of cholesterol, triglycerides, homocysteine, and coagulation.

MATERIALS AND METHODS: Our aim was to evaluate presence of subclinical

atherosclerosis prior to CPAP treatment in the patients with OSAS without any history of previous diseases and any pathological finding in their investigations. After obtaining approval from the Ethics Board, we planned to compare the results of investigations for risk

factors for atherosclerosis (fasting blood glucose [FBG], total cholesterol, Triglycerides, HDL- and LDL-cholesterol, thyroid function test, homocysteine, fibrinogen, high sensitivity

C-reactive protein [hsCRP]) before and after CPAP treatment and to examine the effect of CPAP treatment on these parameters between July 2013 and July 2015.

FINDINGS: Findings obtained before CPAP treatment (homocysteine, hsCRP, HbA1c, subclinical hypothyroidism) suggested subclinical atherosclerosis. In comparative evaluation

between the findings before and after CPAP treatment, no statistically significant difference was found in levels of triglycerides, HDL-cholesterol and fT4 (P = 0.346, 0.540, 0.060,

respectively) whereas significant differences were found in leukocyte and platelet counts, hemoglobin level, fasting blood glucose, LDL-cholesterol, homocysteine, fibrinogen, fT3, TSH, CRP, and HbA1c (P = 0,003,-0,010,-0,000,-0,001,-0,008-0,004-0,000-0,000-0,025-

0,000-0,000-0,000, respectively). Subclinical hypothyroidism was present in 12 (20%) patients before CPAP and in 5 (7%) patients after CPAP treatment.

CONCLUSIONS: Improvement has been seen even in early markers of atherosclerosis with

effective CPAP.

AOCN-0047

Neurorehabilitation CLINICAL CHARACTERISTICS OF THE FIRST RECURRENCE OF BPPV

B. Kim1 1Eulji Hospital, Neurology, Seoul, Republic of Korea

Objectives: BPPV is most common cause of recurrent vertigo and easily treatable. However many patients experience the recurrence after successful repositioning. Nevertheless, the clinical characteristics of recurred BPPV have not been systematically evaluated. Method:

We analyzed the records of 1853 patients who were examined at the BPPV registry at Eulji Hospital, Korea between May 1999 and February 2015. 531 patients who experienced

recurrence during the follow-up period were enrolled in this study.

Results: The posterior semicircular canal was affected in 62.1% and the horizontal canal in 37.9%. In addition, 78.7% of cases affected the ear ipsilateral to the first episodes of BPPV. Moreover, 71.7% of cases of all recurrences affected the same canal. However, there is no

difference in the rate of recurrence between right- and left-sided BPPV.

Conclusion: Our data revealed that the recurrence of BPPV after repositioning maneuvers commonly affects the posterior semicircular canal and has a preference for the ipsilateral ear

and same canal

Stroke

AOCN-0370 Stroke

PRECIPITATORS OF ACUTE HEMORRHAGIC STROKE IN A TERTIARY

LEVEL HOSPITAL M.R. hasan1 1, dhaka, Bangladesh

Introduction:

Acute hemorrhagic stroke is a fatal disease despite progressing medical knowledge. Acute hemorrhagic stroke appears suddenly without warning unlike ischemic stroke that are often

preceded by Transient Ischemic Attack.Mortality and morbidity of Acute hemorrhagic stroke is high.So far treatment regimen is limited.There are many studies regarding risk

factors of Acute hemorrhagic stroke but unfortunately studies regarding precipitators of acute hemorrhagic stroke is limited. We conducted an observational study to evaluate precipitators of acute hemorrhagic stroke.

Study design:

Cross sectional/Observational. Materials and methods:

This study was carried out on 100 subjects aged 50 to 75 year over 6 months with the

diagnosis Acute hemorrhagic stroke excluding Acute Ischemic Stroke,Subarachnoid hemorrhage and traumatic intracranial bleeding of from 15th November,2015 to 15th

April,2016 encountered in OPD and ER of National institute of Neuroscience hospital,Dhaka 1207, Bangladesh. The objective of the study was discussed in details with attendants of the patient before their decision to willingly enroll into the study.Patients were evaluated with

bullet type questionnaire including detailed history, physical examination, CT scan finding and specially precipitators of acute hemorrhagic stroke.

Results: in our study cases we found in following variables: Average age: 60-69

years,38%(p=0.006),Onset-night 79%(p=0.04),Season-winter76%(p=0.006),During sleep 38%(p=.46),sudden onset:93%(p=.005),Mental stress 89%(p=.46),Missing of

antihypertensive drugs:68%(p=0.004),Associated with seizure 14%(p=0.98)

Conclusion: We can conclude that missing of antihypertensive drugs,sudden excitement in early morning as precipitators and directly related to acute hemorrhagic stroke.Our study was not without

limitation. The sample size of the population was significantly small (n=100) compared to different international studies. Our study period was only for 6 months involving only one

center.

AOCN-0344

Stroke ANALYSIS OF OUTCOME AND PREDICT FACTORS ABOUT 68 ELDERLY

PATIENTS WITH SUBARACHNOID HEMORRHAGE IN A SINGLE CENTER. Y. Onda1, S. Yamaguchi1, Y. Tamai1, K. Kato1, R. Noda1, M. Miyahara1, M. Inoue1,

K. Okamoto1, T. Hara1 1Center Hospital of the National Center for Global Health and Medicine, Neurosurgey, Tokyo, Japan

Objective: In Japan, elderly population is increasing, but outcome of elderly patients with subarachnoid hemorrhage (SAH) remain unclear.

Patients and methods: We retrospectively reviewed the medical records of non-traumatic SAH patients aged 70 years or older, who were hospitalized in a single center between 2011

and 2015.

Results: There were 68 patients (70–91 years old and 66% female), representing 3.2% of all non-traumatic SAH (n = 219). Bleeding origin were 62 intracranial aneurysms, one dissecting aneurysm and remains were unknown. Of those, fifty patients received an intervention (36

clipping and 14 endovascular coiling) and the remaining 18 patients were managed conservatively.Mortality rate was 30.8%, especially early mortality rate within 30 days from

administration after SAH was higher in the conservative group than the intervention group (33% [12/36] and 8% [4/50], p = 0.01). Within 90 days from administration, mortality rate was significantly higher in the conservative group (66% [12/18] and 14% [7/50], p< 0.01). At

the time of discharge, the independence rate of 80 years or younger was higher. (p=0.03) Logistic regression analysis showed that age and degree of consciousness on admission were

significant predictors of outcome in 30 days from administration, and that receiving intervention was significant predictor of outcome in 90 days from administration.

Conclusion: In good consciousness, elderly SAH patients who were older than 70 years at administration, an active intervention could improve the outcome. But concerning

independent rate, we should carefully consider the therapeutic strategy of elderly SAH patients who were older than 80 years.

AOCN-0343

Stroke A CASE REPORT OF LOCKED-IN SYNDROME

J. Noor1 1Ospital ng Makati, Department of Internal Medicine, Makati City, Philippines

LOCKED IN SYNDROME: A Case Report

Jalellah B. Noor, MD1

Synopsis:We report case of 53-year-old male,hypertensive,with left-sided body

weakness,numbness and decreased verbal output. Over 10 days,patient experienced dizziness,became quadriplegic,anarthric and presented period of coma,requiring intubation. He was on a neuroprotectant, LMWH, antiplatelet, antidyslipidemiac and oral

antihypertensive agent. Early intensive rehabilitation and family counselling were done. While admitted,patient developed VAP and eventually expired.

M.B. 53 year old male, Filipino,right handed, with left-sided body weakness and

numbness.10 days PTA, noted intermittent rotatory dizziness with slurred speech.One day PTA, with recurrence of dizziness, consulted in private Clinic. 5hours PTA, noted decreased verbal output.

Patient was awake,BP170/90,HR62, RR20, afebrile, average built,75kg, BMI 27.5 kg/m2.

GCS 11 (E4V2M5), NIHSScore 19, 2-3 mm pupils sluggishly reactive to light, preferential gaze to right, left central facial palsy, bilateral weak gag reflex, cannot shrug left shoulder because of left sided weakness, left hemiplegia of 2/5 upper,1/5 lower extrimities. With the

same degree of painful stimulation, there is a delay in the response over the left sided body.

Plain Cranial CT:chronic infarct,right subinsular region,atherosclerotic intracranial vessel disease. Cranial MRI:acute to subacute infarct, anterior 2/3 pons,atherosclerrotic internal

carotid arteries; occlusion in distal vertebral arteries and proximal basilar artery.Carotid Duplex Scan:more distal occlusive in the posterior circulation.He's on neuroprotection, antiplatelet,LMWH,on ventilatory support,tracheostomy and gastrostomy were done,early

intensive rehabilitation,and family counselling.Patient developed VAP.

Locked In Syndrome is characterized by complete paralysis of voluntary muscles in all parts

of body except control of eye movement.Their means of communication is by blinking or vertical eye movements.

AOCN-0324

Stroke HIGHER SKELETAL MUSCLE MASS MAY PROTECT AGAINST ISCHEMIC

STROKE IN COMMUNITY-DWELLING ADULTS WITHOUT STROKE AND

DEMENTIA: THE PRESENT PROJECT

Y. Minn1, K. Imsuk2 1Hallym University, Neurology, Seoul, Republic of Korea 2National Medical Center, Neurology, Seoul, Republic of Korea

Background: It is known that low skeletal muscle mass (SMM) is associated with cardiovascular risk factor. However, it is unknown that sarcopenia is independent risk factor

for stroke.

Methods: SMM measurements and brain computed tomography were performed in 722 stroke-free and dementia- free subjects (aged 50–75 years). Subjects were divided into quartile by SMM , which was checked by bioelectrical impedance analysis method (InBody

770, InBody, Seoul, Korea). Odd ratios (ORs) of brain white matter changes and/or silent infarction (WMC/SI) about higher SMM groups for the lowest SMM group were calculated.

After 4 groups analysis, subjects were divided 2 groups and analyzed separately by gender.

Result: In four groups analysis, unadjusted ORs of 2nd to 4th quartile were 0.616 (95% confidence interval [CI] 0.372–1.022P=0.085), 0.290 (CI 0.159-0.530P<0.001) and 0.209 (CI 0.108-0.403P<0.001) for risk of WMC/SI. Adjusted ORs for stroke risk were 0.994 (CI

0.513–1.740 P=0.085), 0.669 (CI 0.329-1.362 P=0.268) and 0.464 (CI 0.219-0.984 P=0.045). In two group (dichotomized) analysis, unadjusted ORs for the higher muscle mass groups (3 rd

and 4th quartiles) was 0.313 (CI 0.200–0.491, P < 0.001). Adjusted OR were 0.577 (CI 0.340–0.979, P=0.042) in dichotomized analysis. Considering gender difference, adjusted OR were 0.351 (CI 0.141–0.869, P = 0.024) in men and 0.771 (CI 0.391–1.519, P = 0.452) in

women.

Conclusion: Increase of skeletal muscle mass may be associated with protective effect for brain WMC/SI. These findings are significant only in men but not in women.

AOCN-0323

Stroke STRESS HYPERGLYCEMIA AND STROKE: DOES IT ALTER OUTCOMES?

M. Mukhopadhyay1, A. Mukherjee2 1The Calcutta Medical Research Institute, Department of Family Medicine, Kolkata, India 2The Calcutta Medical Research Institute, Department of Neuromedicine, Kolkata, India

Background: Hyperglycemia on admission is associated with worse outcomes at 90 days (TOAST trial). This includes patients with diabetes mellitus and stress hyperglycemia (SH).

However, the role of stress hyperglycemia in stroke outcomes is not established.

Methods: A longitudinal observational study of 100 patients above 60 years admitted with stroke at Calcutta Medical Research Institute, India was undertaken after application of

inclusion/exclusion criteria. Patients were divided into diabetes, SH and euglycemia (non-diabetics) and followed up for 3 months with NIHSS and Barthel Index (BI).

Results: The prevalence of diabetes, SH and euglycemia was 40%, 21% and 39%. Patients

with SH had higher serum albumin, lower urine albumin/creatinine ratio and lower LDL and TG compared to diabetics, but similar to euglycemics on admission. Mean RBS was significantly lower than diabetics (145±4 vs. 274±61;p<0.01) but higher than euglycemics

(95±2.5;p<0.01). FBS and HbA1c were not different from euglycemia group (p=0.62/0.95). NIHSS0 was highest in diabetics (22.9±4.8) compared to SH (10.9±7.6;p<0.01), but not different between SH and euglycemics (8.5±5.6;p=0.20). The percent improvement in NIHSS

was better for SH than diabetics but similar to euglycemics (52%/42%/54%). SH had significantly higher Barthel scores compared to diabetics (p<0.001). Mortality of

SH/diabetic/euglycemic patients was 10%/31%/18% (p=0.01). The patients of SH/euglycemia who died had higher NIHSS0 scores.

Conclusions: Stress hyperglycemia was associated with significantly lower severity of stroke

and better functional outcomes with lower mortality compared to diabetics. Severity and functional outcomes were similar to euglycemic patients. Diabetes, not stress hyperglycemia, was a significant risk factor for mortality in elderly stroke patients.

AOCN-0322

Stroke PERSISTENTLY POOR GLYCEMIC CONTROL IS ASSOCIATED WITH WORSE

FUNCTIONAL OUTCOMES IN ELDERLY STROKE PATIENTS: A PROSPECTIVE

OBSERVATIONAL STUDY FROM A TERTIARY CENTER IN INDIA

M. Mukhopadhyay1, A. Mukherjee2 1The Calcutta Medical Research Institute, Department of Family Medicine, Kolkata, India 2The Calcutta Medical Research Institute, Department of Neuromedicine, Kolkata, India

Background: Hyperglycemia on admission is a known adverse risk factor for stroke outcome. Diabetes Mellitus is an independent predictor of stroke with higher risk of

mortality. We tried to find the correlation between admission hyperglycemia, post-stroke glycemic control and the outcome of stroke.

Methods: A total of 100 patients > 60 years admitted with stroke at Calcutta Medical Research Institute, India between November 2013 and June 2015 were included, after

application of inclusion/exclusion criteria. Patients were followed up for mortality and outcome at 7days, 28days and 90days.

Results: The mean age was 68.4±5.7 years. Left-sided weakness and ischemic stroke were

more common in diabetics (63%; p=0.035 and 85%; p=0.01). There was no significant difference in blood pressure between diabetics and non-diabetics (p=0.916). Mean LDL was significantly higher in diabetics (141 vs. 125; p=0.003). Mean admission and next-day fasting

glucose levels were significantly elevated in diabetic patients (274/151 vs. 120/91; p<0.01), with higher mean HbA1c levels (8.13 vs. 5.66; p<0.01).

HbA1c at 90 days showed no significant improvement in 85% of diabetics (8.09; p=0.95).

Functional outcome, measured by Barthel Index on days 7/28/90 revealed significant

improvement in non-diabetics (61/72/81; p=0.03) compared to diabetics (14/23/32; p=0.06). HbA1c90 was moderately negatively correlated to Barthel90 (Pearson correlation=-0.6341;

p<0.0001). Mortality was higher in diabetics (31% vs. 8%; p=0.012).

Conclusion: Blood sugar on admission as well as persistently poor glycemic control leads to worse functional outcomes in elderly stroke patients. Further prospective studies are required

to study the effect of post-stroke glycemic control on stroke outcomes.

AOCN-0315

Stroke ASSESSING THE USE OF A NATIONAL INSTITUTES OF HEALTH STROKE

SCALE (NIHSS) VERSION MODIFIED FOR CULTURAL APPROPRIATENESS IN

SINGAPORE

S.H. Lim1, D.A. De Silva2, D. Tay3, F.P. Woon4, S.S. Ho2, S.C. Ng4, S.H. Lim2 1, Singapore 2National Neuroscience Institute Singapore General Hospital Campus,

Department of Neurology, Singapore, Singapore 3Singapore General Hospital, Department of Speech Therapy, Singapore, Singapore 4Singapore General Hospital, Department of Neurology, Singapore, Singapore

Background

The National Institutes of Health Stroke Scale (NIHSS), a widely-used assessment tool to quantify neurological deficits of stroke, was designed for use in the United States of America.

A Singapore healthcare worker survey identified dysphasia objects, phrases and dysarthria words that were culturally inappropriate. We developed a modified version of the NIHSS to

be more culturally appropriate. This study aimed to compare the error rates using the original and modified NIHSS versions in a cohort of Singaporean subjects of stroke-prone age with no dysphasia/dysarthria.

Methods

We recruited 63 English-speaking patients who were ≥60 years old with no dysphasia/dysarthria. NIHSS was administered by a single rater for the dysphasia (item 9) and dysarthria (item 10) components. Paired analyses were conducted to compare error rates

between the original and modified NIHSS versions.

Results

Median error rate for composite items 9 and 10 of the NIHSS was higher with the original version (6%, IQR 6-12%) than the modified version (0%, IQR 0-6%) (p<0.001). For

dysphasia object testing, the median error rate was higher with the original version (17%, IQR 17%-33%) than the modified version (0%, IQR 0%- 17%) (p<0.001). For dysphasia phrases (p=0.317) and dysarthria words (p=0.180), there were no differences between the

original and modified versions.

Conclusion

In patients who are not expected to have errors with items 9 and 10 of the NIHSS, they performed better with the modified version of the NIHSS which was adapted for cultural

appropriateness in Singapore, in particular for the modified dysphasia objects.

AOCN-0304

Stroke EFFECTS OF SINGLE AND DOUBLE LEG SUPPORT ON TRUNK MUSCLE

ACTIVATION DURING BRIDGING EXERCISE IN PERSONS WITH CHRONIC

STROKE

J. Bak1, M. Lee1, Y. Chung1, M. Cho1 1Sahmyook University, Department of Physical Therapy- The Graduate School of Sahmyook University- Seoul- Repu

blic of Korea, Seoul, Republic of Korea

The purpose of this study was to evaluate the effects of the degree of knee flexion and leg rise on trunk muscle activation during bridging exercises in individuals with chronic hemiparetic stroke. The study was also to provide the specific mode of bridging exercise to activate the trunk muscles of the affected side in individuals with chronic hemiparetic stroke. Twenty-

seven patients who had chronic hemiparetic stroke participated in this study. The participants received the bridging exercises in five different conditions, including (1) general condition,

(2) the affected knee in 60° of flexion (3) the non-affected knee in 60° of flexion, (4) the affected leg raised and (5) the non-affected leg raised. While the participants performed the bridging exercises, this study measured trunk muscle activation of the erector spinae, external

oblique, and internal oblique muscles by surface electromyography. The five differe nt condition of bridging exercises were conducted randomly, with data analysis performed using

the mean scores that were obtained after three times for each condition. This study suggests that the activation of the trunk muscles were significantly increased in the leg raised conditions (especially ipsilateral trunk muscles activation) compared to the general condition

during bridging exercises in individuals with chronic hemiparetic stroke. The results of this study suggest that the affected leg raised condition was a beneficial training method to

effectively facilitate trunk muscle activation on the affected side.

AOCN-0302

Stroke THE EFFECTS OF ACTION OBSERVATION WITH REAL-TIME FEEDBACK

TREADMILL TRAINING ON GAIT ON LOWER EXTREMITY JOINT ANGLE

WITH STROKE PATIENTS

Y. Cha1, Y. Chung2, M. Choi2 1Sunlin college, Physical therapy, pohang city, Republic of Korea 2Sahmyook university, Physical Therapy, seoul, Republic of Korea

The purpose of this study was to evaluate the effects of action observation with real-time feedback treadmill training on gaiton lower extremity joint anglewith stroke patients. The

study was a cross sectional study. Ten stroke patients participated in the study and all subjects were observed in (1)action observation with real-time feedback (AORF) treadmill gait training, (2) real-time feedback (RF) treadmill training, (3) treadmill walking conditions

without feedback. The subjects performed each condition in random order. In each of the three conditions, the kinematics parameters were measured during gait on a treadmill usinga

biomechanical system, and the variables of spatial temporalgait were measured by Optogait. There was a significant decrease in cadence with the AORF treadmill gait training condition compared to both RF treadmill training and treadmill walking conditions without

feedback(p<0.05). There was a significant increasein affected and non-affected step lengthin the AORF treadmill gait training condition compared to both RF treadmill training and

treadmill walking conditions without feedback(p<0.05). AORF treadmill gait training and RF treadmill training conditionsshowed a significant increasein maximum affected hip joint angle compared to treadmill walking conditions without feedback(p<0.05). AORF treadmill

gait training condition shows a significant increase in maximum affected knee joint angle compared to treadmill walking conditions without feedback. This study suggests that AORF

treadmill training may be an effective method for motor control in lower extremity joint and gait performance for persons with stroke.

AOCN-0290

Stroke EARLY-ONSET POST-STROKE PSYCHOSIS: A CASE REPORT

B. Purbasari1, S.B. Rianawati1 1Brawijaya University- Saiful Anwar General Hospital, Neurology, Malang, Indonesia

Abstract Background : Psychosis is an exceedingly uncommon post-stroke complication with a prevalence of merely 1-6%. Thus, acute hallucinatory episodes in subjects lacking antecedent

reports of psychiatric manifestations demand thorough examinations to elicit secondary or neurologic causes.

Setting : Neurology Inpatient Unit, Saiful Anwar General Hospital, Malang, Indonesia Case Description: The authors reported a case of a 45-year old female patient who displayed slurred speech upon arrival at the Accident and Emergency (A&E) department. She had been

experiencing visual and auditory hallucinations since 8 hours prior to admission after suffering from severe cephalgia, nausea and blurred vision since the previous day. Despite

finding no abnormalities upon neurologic examinations, laboratory result exhibited leukocytosis, hypertriglyceridemia, and modest hypercreatinaemia. Computed Tomography (CT) imaging of the head revealed sub-acute bilateral parietooccipital watershed cerebral

infarctions as well as sub-acute lacunar infarct at the right caudate nucleus. Discussion : Frontotemporoparietal injuries suffered by the aforementioned subject provoked

neuropsychiatric disorders due to frontal-subcortical circuit disconnection. Early-onset post-stroke psychosis manifested as acute hallucinations is relevant to organic psychosis due to acute vascular events, specifically strategic territory ischaemic infarct as per the

neuroimaging results.

AOCN-0287

Stroke THE EFFECTS OF ACTION OBSERVATION WITH REAL-TIME FEEDBACK

TREADMILL TRAINING ON GAIT, BALANCE, AND QUALITY OF LIFE IN

INDIVIDUALS WITH STROKE

Y. Chung1, C. Yuri1 1Sahmyook university, physical therapy, Seoul, Republic of Korea

The aim of this study was to investigate the effect of action observation with real-time feedback treadmill training on gait, balance and quality of life in individuals with stroke. The study was a randomized control trial with a pretest-posttest control group design. Thirty

persons with chronic hemiparetic stroke participated in this study. Subjects in the experimental group (15 subjects) underwent intensive action observation with real-time feedback treadmill training for a period of 4 weeks (30 min/day, five days/week), while those

in the control group (15 subjects) underwent intensive treadmill training for the same duration. All participants also received general physical therapy for a period of 30 minutes,

two times per day. The outcome measures used were GAITRite, Berg Balance Scale (BBS), and Stroke Specific Quality of Life (SS-QoL) before and after intervention. The results showed that intensive action observation with real-time feedback treadmill training produced

significant improvement in gait velocity, cadence, step length, stride length, single support % Cycle, double support % cycle period, and toe in/out in the affected and unaffected side, as

well as BBS, and SS-QoL scores compared with the control group after training. Findings of this study suggest that intensive action observation with real-time feedback treadmill training improves gait, balance, and quality of life in individuals with chronic hemiparetic stroke, and

that its use in the clinical field for gait training can be recommended.

AOCN-0260

Stroke ASSOCIATION BETWEEN CREATINE KINASE-MYOCARDIAL BAND,

TROPONIN T, HAEMOGLOBIN AND ELECTROLYTE LEVEL WITH ACUTE

STROKE

D. Fahrina1 1, Binjai, Indonesia

Introduction : The studies on creatine kinase-myocardial band (CK-MB), troponin T, haemoglobin and electrolyte level after stroke are relatively scarce. The aims of this study were to investigate about the level of CK-MB, troponin T, haemoglobin and electrolyte and

its relationship with acute stroke.

Methods : This was a cross-sectional study with a total number of 30 randomly selected, clinically and CT proven acute stroke patients were studied at Adam Malik General Hospital. All participants, that had fulfilled inclusion criteria and didn’t have exclusion criteria, were

asked to complete questionnaire about demographic data and then the blood was withdrawn to measure CK-MB, troponin T, haemoglobin, and electrolyte level. Demographic data would

be analyzed using descriptive statistics. To analize association between CK-MB, troponin T, haemoglobin and electrolyte with acute stroke, this study would use Chi Square test. A p value < 0,05 was considered statistically significant.

Results : ongoing (up until now this study have done 50% from total sample)

Conclusion : ongoing

Keywords : Creatine Kinase-Myocardial Band, Troponin T, Haemoglobin, Electrolyte, Stroke.

AOCN-0258

Stroke INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND

HEALTH (ICF) CORE SETS FOR STROKE - INTRAVENOUS R-TPA TREATED

ACUTE ISCHEMIC STROKE PATIENTS

J. Joung1 1Myung neurologic clinic, neurology, Gumi, Republic of Korea

Purpose ; In 2001, WHO recommanded the ICF is not based on only a medical or a social, rather bio-psycho-social and interactive model. It may be useful but the ICF core set for stroke has 130 ctegories are made of 41(body functions), 5(body structures), 51(activities and

participation), and 33(environmental factors). The result of ICF method will have to compare with existing evaluation method. Methods ; We reviewed the data of 45 patients with acute ischemic stroke treated with intravenous t-PA. Clinical states were measured by NIHSS. We

estimated long term outcomes with the mRS after stroke 6 months. Patients disabilities were estimated by KCNSDE method in the Ministry of Health and Welfare and also counted

numbers of the category classification code of ICF core set for stroke. Results ; 12 patients showed complete or good recovery (mRS 0-1/KCNSDE 0/ICF 4.8). 9 patients had mild or minimal symptoms (mRS 2/KCNSDE 5-6/ICF 8.3), 7 patients had moderate disability (mRS

3/KCNSDE 3-4/ICF 9.4), 10 patients had severe disability (mRS 4-5/KCNSDE 1-2/ICF 11.9), and 7 patients were died. Conclusions ; There are many differences and good

correlation between Korean CNS disability evaluation and ICF in this study. It will be important to understand the new concept of ICF in the assessment of functioning or disability for stroke. Korean CNS disability evalaation is concentrated on medical and organic

problems.

AOCN-0254

Stroke ASSOCIATION BETWEEN ESTRADIOL AND CALCIUM LEVEL WITH ACUTE

ISCHEMIC STROKE EVENTS AND HYPERTENSION IN MENOPAUSE WOMEN S. saragih1 1, medan, Indonesia

Introduction : Estradiol and calcium have different role in mechanism of ischemic stroke and hypertension, and the relationship of estradiol and calcium level for becoming ischemic

stroke event and hypertension are still unclear. The purpose of this study is to know about the level of estradiol and calcium when ischemic stroke event and hypertension happened, and

association between them, that are studied in menopause women.

Methods : This was a cross-sectional study that consist of 3 groups with control, patients with acute ischemic stroke and control (n= 29), patients with hypertension and control (n=29), and patients with acute ishemic stroke plus hypertension and control (n=29). Total

sample was 87 and were drawn with consecutive sampling. All participants, that had fulfil inclusion criteria and didn’t have exclusion criteria, were asked to complete questionnaire

about demographic data and then the blood was withdrawn to measure estradiol and calcium level. Demographic data would be analyzed using descriptive statistics. To analize association between estradiol and calcium level between 3 groups with control, this study

would use Mc Nemar test. A p value < 0,05 was considered statistically significant.

Results : ongoing (up until now this study have done 50% from total sample)

Conclusion : ongoing

Keywords : Estradiol, Calcium, Acute Ischemic Stroke, Hypertension, Menopause, Women

AOCN-0245

Stroke ATRIAL FIBRILLATION IS A PREDICTOR OF IN-HOSPITAL MORTALITY IN

ISCHEMIC STROKE PATIENTS C.T. Ong1 1Ditmanson Medical Foundation Chia-Yi Christian Hospita, Neurology, Chiayi, Taiwan

Background/purpose: In-hospital mortality rate of acute ischemic stroke patients remains between 3% and 18%. For improving the quality of stroke care, we investigate the factors

that contribute to the risk of in-hospital mortality in acute ischemic stroke patients.

Methods: Between January 1, 2007 and December 31, 2011, 2556 acute ischemic stroke patients admitted to a stroke unit were included in this study. Factors such as demographic

characteristics, clinical characteristics, comorbidities, and complications related to in-hospital mortality were assessed.

Results: Of the 2556 ischemic stroke patients, 157 received thrombolytic therapy. Eighty of

the 2556 patients (3.1%) died during hospitalization. Of the 157 patients who received thrombolytic therapy, 14 (8.9%) died during hospitalization. History of atrial fibrillation (P < 0.01) and stroke severity (P < 0.01) were independent risk factors of in-hospital mortality.

Atrial fibrillation, stroke severity, cardioembolism stroke and diabetes mellitus were independent risk factors of hemorrhagic transformation. Herniation and sepsis were the most common complication of stroke which attribute to in-hospital mortality. Approximately 70%

of in-hospital mortality is related to stroke severity (total middle cerebral artery occlusion with herniation, .basilar artery occlusion and hemorrhagic transformation). The other 30% of

in-hospital mortality is related to sepsis, heart disease and other complications.

Conclusion: For improving outcome of stroke patients, we need cautiously use anticoagulant to reduce in-hospital mortality and hemorrhage transformation rate. We also need focus to

reduce serious neurological or medical complications.

AOCN-0240

Stroke CLINICAL CHARACTERISTICS OF ISCHEMIC STROKE IN YOUNG ADULTS

S.H. Kim1, J.I. Kim1, J.Y. Lee1, S.S. Lee1 1Yonsei University Wonju College of Medicine, Neurology, Wonju, Republic of Korea

Background & Purpose: Ischemic stroke in young adults is relatively rare but important because it may cause disability or mortality. The aim of our study was investigate the clinical characteristics of ischemic stroke in young adults. Methods: Among 2711 consecutive

patients with acute ischemic stroke, who were admitted within 7 days of the onset, patients with a first-ever stroke were enrolled. Patients were divided into two age groups: group aged

50 or under and group over age 50. Demographics, stroke patterns, and prognosis were compared between the two groups. Results: Among 2119 patients with first-ever stroke, 217 patients (10.2%) belonged to the group aged 50 or under, 1902 (89.8%) to the group over age

50. The distribution ratio was not significantly changed over 6 years. Current smokers and alcoholics were more prevalent in the group aged 50 or under (p <0.01). Hypertension,

diabetes mellitus, and atrial fibrillation were more prevalent in the group over age 50 (p <0.05). Among the determined etiological subtypes of stroke, stroke of other determined etiology was the second most common in the group aged 50 or under. A modified Rankin

Scale score of 0-2 at discharge was more frequently observed in the group aged 50 or under (p <0.01). Conclusions: There were several distinctions of ischemic stroke in young adults.

Smoking and alcoholics are major risk factors in the stroke and life style modification is important for prevention of the stroke in young adults.

AOCN-0236

Stroke RELATIONSHIP BETWEEN SEVERITY OUTCOME AND CRP LEVEL AMONG

INTRACEREBRAL HEMORRHAGE STROKE PATIENTS: A HOSPITAL BASED

STUDY

R. Sagar1 1All India institute of Medical sciences, Department of Neurology, New Delhi, India

Abstract

Background: Stroke is a multifactorial disease. Intracerebral hemorrhage (ICH) having high

morbidity and mortality rates worldwide. ICH affected by both genetic and environmental factors. Biomarkers may be associated with different outcomes in patient with ICH and may

be helpful in predicting the outcome.

Objective: We measured C-reactive protein (CRP) after ICH and its relationship to modified Rankin Scale (mRS) at three months. Our objective was to find out if there is any difference

in the level of CRP among patient with different recovery outcome as measured by mRS at three months.

Methods: In this study, 118 patients recruited within 72 hours of onset from Inpatient Department of Neurology at All India Institute of Medical Sciences, New Delhi. After

obtaining written informed consent from patients/proxy, blood sample collected and analysed for CRP level and telephonically followed by using mRS scales at three months after the

recruitment.

Results: The mean age (SD) of patients is 54.4 (12.7). A total of 81 ( 68.6%) were males. The telephonic follow up for mRS was available for 75 patients. The mean values of CRP at 0,1,2,3,4,5,6 category of mRS were 1, 68.5(38), 52.5 (44.4), 36.1 (24.7), 52.8 (25.5), 49.8

(35.7), 49.8(35.7), 51.1 (23.4) respectively. One way anova test shows no statistical significant difference in the level of CRP amongst various category of mRS.

Conclusion: The findings of present study suggest that there is no difference in the CRP

level amongst ICH patient with their recovery as measured by telephonically after three months of onset.

AOCN-0225

Stroke THE ASSOCIATION OF GLASGOW COMA SCALE ASSESSMENT AND

PNEUMONIA IN ACUTE STROKE PATIENTS: RESULTS FROM THE NATIONAL

NEUROLOGY REGISTRY OF MALAYSIA

M. Neelamegam1, S. Malavade2, I. Looi3, Z. Abdul Aziz4, N.N. Sidek4 1University of South Florida, Department of Epidemiology & Biostatistics, Brandon, USA 2Brandon Regional Hospital, Department of Internal Medicine, Brandon- Florida, USA 3Hospital Seberang Jaya, Department of Internal Medicine, Seberang Jaya, Malaysia 4Hospital Sultanah Nur Zahirah, Department of Neurology, Terengganu, Malaysia

Objective: To determine the association of Glasgow Coma Scale (GCS) assessment with pneumonia and subsequent mortality in acute stroke patients. Methods: Data of 9792 individuals with acute stroke, participating in the National Neurology

Registry of Malaysia were analyzed. Individuals were categorized with severe, moderate or minor brain injury based on the GCS score of 8 and less, 9 to 12 and 13 and greater

respectively. Association of GCS categories with pneumonia and patient mortality was assessed using logistic regression and adjusting for gender, age, education, marital status, race, stroke event, stroke type and stroke severity.

Results: Mean age of participants was 62.5 ± 12.6 years, 45.9% (n=4444) were females, 86.1% (n=8429) were married and 50.2% (n=4915) had 6 or less years of formal education.

21.0% (n=2059) individuals had recurrent stroke and 73.7% (n=7219) of the strokes were ischemic strokes. Based on the GCS assessment, individuals with severe brain injury were more likely to develop pneumonia (OR 3.31; 95% CI 2.74-3.99, p<0.01) and subsequently

die (OR 6.35; 95% CI 5.29-7.64, p<0.01) compared to those with minor brain injury. Similarly, compared to those with minor brain injury, individuals with moderate brain injury

were also more likely to develop pneumonia (OR 2.57; 95% CI 2.20-3.00, p<0.01) and die (OR 2.43; 95% CI 2.05-2.89, p<0.01) Conclusion: In our study, we find that Glasgow Coma Scale assessment at presentation is

significantly associated with the development of pneumonia and increased mortality among acute stroke patients.

AOCN-0223

Stroke SILVER MAN: GENERALIZED ARGYRIA IN A STROKE PATIENT, A CASE

REPORT G.M. Santiago1, M. Balmes1 1East Avenue Medical Center, Department of Internal Medicine, Quezon City, Philippines

Argyria is a rare condition wherein exposure to silver compound causes blue-gray discoloration of skin especially in sun-exposed areas. We are reporting a case of a 62-year

old, male pastor, who came at our institution due to behavioral changes and melena. On further history, it was noted that he had been drinking colloidal silver as a food supplement

for more than a year. He obtained this compound through the internet as advised by a colleague who claimed it being effective in several infectious diseases. On physical examination, we noted grayish discoloration of eye, tongue, face, chest and nail beds. Silver

determination of urine, hair and serum revealed high levels. In the literature, there were case reports of argyria internationally but non in the local settings. No report discussed stroke and

coronary artery disease presenting in a patient with chronic exposure to silver. Up to now, there are still debates on the toxic effects of silver on the brain, heart and liver. This report will discuss the side effects of colloidal silver as an alternative medicine, hence increasing

public awareness on its safety.

AOCN-0216

Stroke EFFECT OF LESION LOCATION ON THE DEVELOPMENT OF DEMENTIA

AFTER ACUTE ISCHEMIC STROKE J.Y. Ahn1, H.T. Kim2, B.K. Kim3 1Seoul Medical Center, Neurology, Seoul, Republic of Korea 2Hanyang university hospital, Neurology, Seoul, Republic of Korea 3Eulji university hospital, Neurology, Seoul, Republic of Korea

Introduction A considerable proportion of individuals who have had a stroke develop post-stroke dementia (PSD), and several factors have been suggested as risk factors. However, the

role of stroke lesion location is not clearly established. We hypothesized that the disruption of specific neural networks by stroke could contribute to PSD.

Methods A matched case-control design was applied to a predetermined cohort with acute ischemic stroke. Cases were defined as newly developed dementia diagnosed more than 3

months after stroke. Each case was matched to 2 controls for age, education, and initial stroke severity. Involvement of major hub locations of the cholinergic pathway, functional neural

networks, central executive network, and salient network were used.

Results We enrolled patients with PSD and matched controls in stroke registry cohort. Male sex, diabetes mellitus, smoking, history of stroke, and several acute and chronic neuroimaging variables were possibly different between the 2 groups (p < 0.2). Acute

ischemic lesions affecting the default mode and central executive networks were consistently associated with PSD in various regression models using several sets of adjusting variables.

Lesion location analysis showed that patients with PSD were more likely to have acute lesions in the left centrum semiovale, hippocampal complex, and posterior parietal cortex.

Conclusion Our results suggest that the disruption of specific location in subcortical white

matter could explain newly developed dementia after acute ischemic stroke.

AOCN-0203

Stroke PAROXYSMAL POSTERIOR VARIANT ALIEN HAND SYNDROME

ASSOCIATED WITH PARIETAL LOBE INFARCTION: CASE PRESENTATION B.E. Demiryurek1 1Sakarya University Medicine Faculty researh and education Hospital, Neurology, Sakarya, Turkey

Alien hand syndrome (AHS) is an involuntary and rare neurological disorder emerges at upper extremity. AHS is a disconnection syndrome with the symptoms of losing sense of agency and sense of ownership, and presence of involuntary autonomic motor activity. There

are frontal, callosal and posterior types of AHS and each of them occurs depend on the lesions of different of the brain. Posterior variant is a rarely encountered AHS type compared to others. AHS, generally regarded as persistent, but rarely may be observed as paroxysmal.

In this article, we present 71 year old patient with right posterior parietal lobe infarction and developed posterior variant AHS on left arm 1 month after discharge from the hospital. To

discriminate AHS from conditions such as extrapyramidal movement disorders and epileptic seizures that take part in differential diagnosis should be kept in mind by the clinicians. Wrong and unnecessary treatments could be prevented in this way.

AOCN-0197

Stroke RELATIONSHIP OF THIOREDOXIN AND THIOREDOXIN INTERACTING

PROTEIN SERUM LEVELS WITH STROKE SEVERITY (PILOT STUDY) B. Shahid1, F. ALHusain2, A. Tariq3, D. Saqr3, A. Muhannad3, B.J. Abdullah3,

A. Mohammed3, A. Fars3, A.R. Khalid1, I. Mohammed1 1King Saud University, Physiology, Riyadh, Kingdom of Saudi Arabia 2King Saud University, Neurology, Riyadh, Kingdom of Saudi Arabia 3King Saud University, Medicine, Riyadh, Kingdom of Saudi Arabia

Few neurological conditions are as complex and devastating as stroke, which is the leading cause of death worldwide. This study aimed to determine the Thioredoxin (TXN), Thioredoxin interacting protein (TXNIP) serum levels and discuss the relationship between TXN, TXNIP and severity in patients with stroke lesion size?

Case-control study in King Khalid University Hospital (KKUH) included 160 participants

(80 patients and 80 control subjects). Data was collected by 2 different sources, which were blood samples (plasma TXN, TXNIP levels were measured by enzyme-linked

immunosorbent assay) and patients MRI. The results indicated that the median serum TRX levels were significantly higher in stroke patients as compared to normal cases. There was a significant positive association between serum TXN, TXNIP levels and severity scores and

lesion volume.

Our study demonstrated that serum TXN, TXNIP levels were associated with stroke severity and lesion volumes. Elevated levels could be considered as a novel, independent diagnosis

marker of stroke.

AOCN-0188

Stroke ASTROCYTE-DERIVED PENTRAXIN 3 SUPPORTS BLOOD-BRAIN BARRIER

INTEGRITY AFTER ISCHEMIC STROKE A. Shindo1, T. Maki2, N. Egawa2, K. Itoh3, A.C. Liang3, E.H. Lo3, K. Arai3, H. Tomimoto1 1Mie University Graduate School of Medicine, Department of Neurology, Tsu, Japan 2Kyoto University, Department of Neurology, Kyoto, Japan 3Massachusetts General Hospital and Harvard Medical School,

Departments of Radiology and Neurology, Charlestown, USA

Background and Purpose: Pentraxin 3 (PTX3) is released upon inflammatory responses in many organs, including brain. However, roles of PTX3 in brain are still mostly unknown. Here we asked whether and how PTX3 contributes to blood-brain barrier (BBB) dysfunction during acute phase of ischemic stroke.

Methods: In vivo, an animal model of white matter stroke was induced in C57/BL6 mice by

injection of endothlin-1. At day 3, brains were analyzed to evaluate PTX3 expression. In vitro, rat primary astrocytes and rat brain endothelial RBE.4 cells were cultured separately.

Astrocyte conditioned media (ACM) were added to RBE.4 cells to measure in vitro endothelial permeability. To confirm this result, mice were administered PTX3 siRNA by intracerebroventricular injection. BBB breakdown after ischemic stroke was assessed by

injection of FITC-dextran.

Results: During the acute phase of stroke, reactive astrocytes in the peri-infarct area expressed PTX3. Media transfer experiments in cell culture system showed that ACM

reduced the in vitro endothelial permeability with increasing the expression levels of tight junction proteins. But after removing PTX3 from ACM, the PTX3-depleted ACM no longer supported the endothelial tightness, suggesting that PTX3 is directly involved in enhancing

endothelial barrier function. Importantly, downregulation of PTX3 exacerbates damage of BBB leakage in peri-infarct area.

Conclusions: Taken together, astrocytes in the peri-infarct area tend to produce/secrete PTX3

after ischemic stroke, which may support BBB integrity. This response in reactive astrocytes may be a compensatory mechanism, and therefore, PTX3 can be an effective therapeutic

target for stroke.

AOCN-0175

Stroke A CASE REPORT OF CENTRAL-VARIANT POSTERIOR REVERSIBLE

ENCEPHALOPATHIC SYNDROME(PRES) COMPLICATED WITH LACUNAR

INFARCTION

L. Fangchen1 1The Second Affiliated Hospital of Chongqing Medical University, neurology, Chongqing, China

Background posterior reversible encephalopathic syndrome(PRES) involves the extracellular edema of the classic parieto-occipital areas,but a tiny minority of cases have

been discovered with edema of central brainstem.Case report A 45-year-old male was admitted with the musule weakness in left lower extremity with no anther neurological symptoms.the MRI of brain shows the abnormal long T1 and T2 signals at bilateral centrum

ovale, basal ganglia area of the cerebral hemisphere, and MRI signal change of T1WI and

T2WI in the central brainstem.、bilateral middle cerebellar peduncle .the blood pressure at

the first visit is 238/138mmHg.after 4-day antihypertensive therapy,the change of the MRI in the central brainstem. and bilateral middle cerebellar peduncle reduce and after half a month

the change almost disappeared.Discussion With the imaging finding disappears after antihypertensive therapy and the hypertension at the first time,we tended to consider that

some trigger factor(hypertension in this case)may lead to vascular contraction and further lead to the intracal perfusion abnormality.the perfusion abnormality trigger the PRES and the lacunar infarction either.the trigger factors involves renal failure, blood pressure

fluctuations, eclampsia and so on.the lesion is always located in the classic parieto-occipital areas where the sympathetic nerve is incompetent.

PIC 1 the T2-flair at the first time shows the edema in the central brainstem.

AOCN-0145

Stroke ONSET-TO-DOOR TIME (OTD) OF STROKE PATIENTS IN HOSPITAL

SEBERANG JAYA: ARE PATIENTS FAST ENOUGH? C.S. Ang1, S.P. Long1, I. Looi1, N.N. Sidek2, Z. Abdul Aziz2 1Hospital Seberang Jaya, Clinical Research Centre, Seberang jaya, Malaysia 2Hospital Sultanah Nur Zahirah, Clinical Research Centre, Kuala Terengganu, Malaysia

Despite the proven effectiveness of intravenous thrombolysis (rTPA), its usage in Malaysia is limited by high cost and lack of expertise. However, even in centers offering rTPA such as Hospital Seberang Jaya (HSJ), many patients are not thrombolysed as they miss the

therapeutic window of 4.5 hours. This is a study to explore factors affecting the duration of patient's symptom onset to hospital arrival time or the “onset-to-door time” (OTD).

All acute stroke patients in HSJ are enrolled prospectively in Acute Stroke Registry Malaysia. We extracted data of all HSJ stroke admission between 1st January 2015 to 31st December

2015 for this study. We excluded missing data, patients who presented one week after onset, uncertain of the time of onset or developed stroke within institutions.

From a total of 248 stroke patients, 24 of them were excluded from the study. The median

OTD was 9.2 hours (inter-quartile range 2.6 to 26.4 hours) and majority of them (62.9%) documented delayed OTD (arrived after 4.5 hours). Only 27.2% achieved OTD within 3 hours and 9.8% arrived between 3 to 4.5 hours. We found that delayed OTD was not

significantly associated with demographic factors (age, gender, ethnicity), mode of transport, first stroke event or stroke severity (NIHSS and MRS).

Much emphasis has been given to “door to needle time” (DTN) but our study found that

62.9% of patients would not be eligible even if we have excellent DTN. Increasing public awareness on the stroke symptoms and speedy hospital arrival is imperative in improving our

stroke care.

AOCN-0137

Stroke ACUTE STROKE-DOOR TO CT BRAIN TIME. ARE WE FAST ENOUGH IN

HOSPITAL SEBERANG JAYA? S.P. Long1, C.S. Ang1, I. Looi1, N.N. Sidek2, Z. Abdul Aziz2 1Hospital Seberang Jaya, Clinical Research Center, Seberang jaya, Malaysia 2Hospital Sultanah Nur Zahirah, Clinical Research Center, Kuala Terengganu, Malaysia

Background:

Intravenous rt-PA is indicated for eligible patients within 4.5 hours of onset of acute ischemic

stroke. International guidelines recommended that the target door to CT brain time to be within 25 minutes. Hospital Seberang Jaya (HSJ) is one of the centers which provides

thrombolysis for ischaemic stroke and this study aims to determine our “Door-to-CT Brain (DTC)” duration and to identify relevant factors associated with delayed DTC.

Method:

Data from National Stroke Registry was extracted and cleaned for HSJ stroke admissions

from 1st January 2015 to 31st December 2015. We excluded missing data, patients who presented 72 hours from onset, uncertain of the time of onset or developed stroke within the hospital.

Result:

Out of 248 stroke patients admitted, 173 patients were included in the study. We found that

the mean DTC was 86.5 (+/- 59.5) minutes and only 7.5% patients managed to achieve DTC within 25 minutes. There were only 47 patients (27%) arrived within 3 hours of symptoms

onset and DTC was 81.79 (+/- 61.7) minutes. There was no significant difference between patients who reach within 3 hours and those with delayed presentation. Further, admissions during office hour (weekdays) or out of office hour (weekend) were not significantly

different in terms of DTC.

Conclusion:

Improving DTC for establishing diagnosis of ischaemic stroke is crucial for clinical decision making. Door to needle time is very much affected by DTC and steps should be taken to

reduce the DTC.

AOCN-0134

Stroke COMPARISON OF THE DIAGNOSTIC ACCURACY OF FACE ARM SPEECH

TEST, RECOGNITION OF STROKE IN EMERGENCY ROOM, AND LOS

ANGELES PREHOSPITAL STROKE SCALE FOR IDENTIFICATION STROKE

S.L. Ginting1, R. Dhanu1, F. Irfani Fitri1 1Faculty of Medicine- Sumatera Utara University/H. Adam Malik Hospital, Neurology, Medan, Indonesia

Background and Purpose

Accurate identification of stroke could expedite triage of patient to acute stroke unit and facilitate delivery of acute stroke therapies in hospital. Rapid care of stroke patient related

with better outcome after treatment.The Face Arm Speech Test is brief, reliable tool that is simple to administer to identification stroke patient. In the past, the Recognition of Stroke in Emergency Room was not better than the FAST for recognition of stroke. The paramedics of

Beijing used Los Angeles Prehospital Stroke Scale as a screening tool to identify stroke and also to exclude stroke mimics.

Objective

The objective of this study was to compare the diagnostic accuracy of FAST, LAPSS,

ROSIER scale for Identification Stroke Patient in Emergency Room.

Methods

This cross sectional study involved 66 subjects of suspected stroke in emergency room. All subjects were examined for FAST, LAPSS, ROSIER scale , Head CT scan and Hachinski

ischemic score.

Results

The FAST showed sensitivity 76.2%, specificity 66.7%, Positive Predictive Value (PPV) 98%, Negative Predictive Value (NPV) 11.8%, Likelihood Rasio (LR)+ = 2.29, LR-= 0.36,

Accuracy 76%. The LAPSS showed sensitivity 39.7%, spesificity 66.7%, PPV 96.2%, NPV 5.0%, LR+ = 1.19, LR- = 0.9, Accuracy 41%. The ROSIER showed sensitivity 66,7%, spesificity 66,7%, PPV 97,7%, NPV 8,7%, LR+ = 2,0, LR-= 0,5, Accuracy 67%.

Conclusion

The FAST is better than LAPSS and ROSIER for identification stroke because of the highest diagnostic accuracy, but the comprehensive clinical and radiologic assessment is still important.

AOCN-0130

Stroke PERSISTENT AND PAROXYSMAL ATRIAL FIBRILLATION WITH MAJOR

CEREBRAL ARTERY OCCLUSION IN PATIENTS WITH CARDIOEMBOLIC

STROKE

I. Deguchi1, M. Takao1, T. Hayashi1, T. Fukuoka1, H. Maruyama1, Y. Horiuchi1, T. Abe1, H. Sano1, Y. Nagamine1, S. Mizuno1, M. Ohira1, N. Tanahashi1 1Saitama Medical University International Medical Center, Neurology, Saitama, Japan

[Background] To clarify the effect of major cerebral artery occlusion on clinical outcome in patients with cardioembolic stroke and non-valvular persistent atrial fibrillation (PeAF) or

paroxysmal atrial fibrillation (PAF).

[Methods] This retrospective study included 716 patients with cardioembolic stroke due to non-valvular atrial fibrillation. We compared the site of occlusion of major cerebral arteries, as determined by magnetic resonance angiography, between patients with PeAF (n = 520,

73%) and those with PAF (n = 196, 27%).

[Results] Age; prevalence of hypertension, heart failure, coronary artery disease, and previous cerebral infarction; National Institutes of Health Stroke Scale score on admission;

CHA2DS2-VASc score; and oral anticoagulant treatment were higher in patients with PeAF than PAF. Major cerebral artery occlusion was more common in patients with PeAF (60%) than PAF (43%, P<0.001). Occlusion of the internal carotid artery or M1 segment of the

middle cerebral artery was significantly higher in PeAF than PAF patients (20% vs. 11%, respectively, P=0.003; 25% vs. 17%, P=0.017).

[Conclusion] Compared with that in PAF patients, occlusion of the internal carotid artery or

M1 segment of the middle cerebral artery occurred more frequently in cardioembolic stroke patients with PeAF and may be associated with their poorer clinical outcome.

AOCN-0117

Stroke RISK FACTORS HYPERTENSION, DYSLIPIDEMIA, SMOKING, GOUT,

OBESITY, DIABETES MELLITUS, AND STROKE IN FAMILY HISTORY OF

STROKE PATIENTS

Q. El Harizah1, D.D. Chan1, I. Nasution1 1Medical Faculty University of North Sumatra, Neurology, Medan, Indonesia

Abstract

Background : Stroke is a neurological syndrome which is a global health problem, a major

cause of disability, and the main cause of mortality worldwide. It is known that there are no special medical measures contribute to the quality of life in old age as the prevention of

cerebrovascular disease. Knowledge of etiologic factors that influence the occurrence of stroke required for the prevention of risk factors. Purposes : The aim of this study to determine the relationship of risk factors for

hypertension, dyslipidemia, smoking, gout, obesity, diabetes mellitus, and family history of stroke in the stroke patients.

Methods : Study was carried out in Haji Adam Malik General Hospital Medan, North Sumatera. A cross sectional data collection with primary data source was designed to find the risk factors for hypertension, dyslipidemia, smoking, gout, obesity, diabetes mellitus, and

family history of stroke.The study consist of 200 patients with 100 strokes (confirmed with CT Scan) and 100 non-strokes.

Results : Chi-square analysis and 95% confidence intervals were indentified, hypertension (P=0.003), dyslipidemia (P=0.785), smoking (P=0.325), gout (P=0.217), diabetes mellitus (P=0.507), obesity (P=0.007), family history of stroke (P=0.442).

Conclusion : This is a study that quantifies the contribution of different factors to the overall risk of stroke. Finding that, hypertension and obesity had significant association risk factors

for all type of strokes, it can be considered as a risk factor for stroke. These are modifiable risks, that can be treated by appropriate medication and life style changes. Keywords : Stroke, Risk factors, cross sectional study, 95% confidence interval.

AOCN-0116

Stroke RELATION BETWEEN BONY CAROTID CANAL DIAMETER AND CLINICAL

MANIFESTATIONS IN PATIENTS WITH MOYAMOYA DISEASE H.C. Choi1, H.K. Song1, S.H. Ahn1, K. Cheol Ho1 1Hallym University, Neurology, Chunchoen city, Republic of Korea

Background and Purpose; Moyamoya disease (MMD) is characterized by a progressive stenosis or occlusion of the intracranial internal carotid artery and/or the proximal portion of

the anterior cerebral artery and middle cerebral artery. Whether the onset time was childhood or adulthood, the bony carotid canal (BCC) diameter might be different and reflecting the

size of internal carotid artery passing through the BCC. In this study, we aimed to identify the relationship between BCC diameter and clinical manifestation.

Methods; A consecutive 146 patients who diagnosed as moyamoya disease by brain imaging studies were included. We measured the diameter of transverse portion of BCC on bone

window of brain CT image. Patients were divided by ischemic or hemorrhagic stroke according to clinical manifestation. Collateral circulation was grouped by 9 patterns and

Suzuki stage was used criteria as disease progression.

Results; The mean age of the 146 patients was 53 years (median). BCC diameter was 3.6±0.5(right), 3.6±0.4(left) in hemorrhagic stroke group, and 3.7±0.4(right), 3.6±0.4(left) in ischemic stroke group. BCC diameter of moyamoya vessels (3.6mm) was smaller than the

diameter of non-moyamoya vessels(3.8mm), significantly(P=0.042). However, there was no difference of collateral patterns and clinical manifestation compare with both groups.

Conclusions; In our study, there was no significant difference of clinical manifestations and

collateral patterns depends on the BCC diameter in patients with MMD. These findings suggest that the clinical presentations of MMD are not related to onset time of disease.

AOCN-0113

Stroke YIELD OF SCREENING TESTS FOR VASCULITIS IN ISCHEMIC STROKE IN

YOUNG ADULTS J.H. Rha1, H.K. Park1, C. Yoon1 1Inha University Hospital, Neurology, Incheon, Republic of Korea

Purpose : Generally, young ischemic stroke patients undergo more extensive diagnostic

tests including vasculitis panel compared to old patients. However, little is known

about the test’s yield. The aim of this study was to investigate the yield of screening

tests for vasculitis in consecutive young patients with ischemic stroke.

Methods : Consecutive patients aged 18 to 45 years with ischemic stroke were included

between January 2011 and April 2015. They all underwent screening tests for vasculitis

including rheumatoid factor (RF), antinuclear antibody (ANA), antineutrophil

cytoplasmic antibodies (ANCAs), anticardiolipin antibody, lupus anticoagulant,

antiphospholipid antibody, anti-DNA antibody, and anti-Ro/SSA and La/SSB

antibodies.

Results : A total of 89 patients were enrolled during study period. The mean age was

39.2 years. Vasculitis panel screening results were positive in three patients (3.4%).

Two female patients (2.2%) with positive ANA and anti-DNA antibody were finally

diagnosed as systemic lupus erythematosus (SLE). They all had clinical symptoms of

SLE including malar rash and Raynaud phenomenon. One male patient showed

positive anti-Ro/SSA antibody, however, he had no primary symptoms of Sjogren’s

syndrome with negative Schirmer's test. Follow up testing resulted in negative finding.

Conclusions : In the absence of systemic symptoms of vasculitis, vasculitis panel

screening in young ischemic stroke patients has a low yield. It’s better to consider

individual clinical features and cost effectiveness before screening tests for vasculitis in

ischemic stroke in young adults.

AOCN-0100

Stroke SINKING SKIN FLAP SYNDROME AFTER DECOMPRESSIVE CRANIOTOMY

S.J. Joa1, S.K. SONG1, S.Y. KANG1, J.H. KANG1, J.C. CHOI1, J.H. OH1 1Jeju National University Hospital, Department of Neurology, Jeju-si, Republic of Korea

Sinking skin flap syndrome (SSFS) is a rare complication of skull defect that after craniotomy. We present a case suggesting that SSFS is able to be developed by the skull defect after the decompressive craniotomy. A 69-year-old woman visited us because of

stupor mentality. She was diagnosed with the left middle cerebral artery infarction. On one day hospitalization, cerebral herniation was developed, so the decompressive craniotomy was

performed. On 25th days hospitalization, her mentality was decreased. Her left pupil was fixed and dilated and the skin of the craniotomy site sunk. Brain CT scans showed the concave feature of craniotomy site with transtentorial herniation. We were supplying

adequate fluids to her, and lowered her head to craniotomy site down. After then, light reflex of pupil were recovered. Also the recovery of sinking skin flap and transtentorial herniation

were observed on follow up CT. SSFS is consists of sinking skin flap with neurologic symptoms. SSFS may be progressed to paradoxical herniation when the intracranial pressure (ICP) falls below the atmospheric pressure. This also can lead to coma or death. Risk factors

of SSFS are thought to be lowering ICP treatment, upright posture, CSF leakage and dehydration. The treatment is proposed to reduce the pressure gradient between ICP and

atmospheric pressure such as head down posture, adequate hydration, cranioplasty. SSFS is a rare complication but maybe fatal, so watchful care is needed to patients had a skull defect.

AOCN-0099

Stroke FEATURES OF ISCHEMIC STROKE IN PATIENTS WITH ANTIPHOSPHOLIPID

SYNDROME A. Kondybayeva1, M. Zhanuzakov2, S. Kamenova1, K. Kuzhibaeva1, Z. Zheldybayeva1 1Asfendiyarov Kazakh National Medical University, Internship and Residency by Neurology, Almaty, Kazakhstan 2Kazakh Medical University of Continuing Education, Internal Medicine, Almaty, Kazakhstan

Antiphospholipid syndrome - a unique model of autoimmune thrombotic vasculopathy with hyper production of antibodies to phospholipids and is characterized by a triad of clinical

signs - venous and / or arterial thrombosis, recurrent miscarriage and thrombocytopenia. Antibodies to phospholipids are identified in patients with ischemic heart disease, ischemic stroke, inflammatory, autoimmune (systemic lupus erythematosus) and infectious diseases

(HIV, hepatitis C, and others.).

Objective: To determine the features of the course of ischemic stroke in patients with antiphospholipid syndrome.

Materials and Methods: We analyzed 80 case histories of patients with ischemic stroke in

the stroke unit of City Clinical Hospital Almaty (Kazakhstan).

Results: Antiphospholipid syndrome was diagnosed in three young patients with ischemic stroke. Given the absence of clinical and laboratory data for a systemic connective tissue

disease, focal neurological symptoms of stroke, high levels of antibodies to phospholipids, as well as the veracity of the data on the imaging of the ischemic lesion was diagnosed: Ischemic stroke, atherothrombotic subtype in the middle cerebral artery. Primary

antiphospholipid syndrome. The characteristic features of ischemic stroke in patients with antiphospholipid syndrome are: more frequent development in women, a tendency to recur in

the absence of secondary prevention of indirect anticoagulants and aspirin, the presence of systemic manifestations (thrombosis of peripheral veins, a history of miscarriage, thrombocytopenia, nephritic syndrome), good regression of neurological symptoms. Based on

this, screening for antiphospholipid syndrome should be conducted for all young patients with ischemic stroke and recurrent stroke, as well as the systemic manifestations of vascular

origin.

AOCN-0098

Stroke DEPRESSION IN PATIENTS WITH ISCHEMIC STROKE.

A. Kondybayeva1, S. Kamenova1, K. Kuzhibaeva1, M. Zhanuzakov2, I. Kalmeneva1, A. Sharapkhanova1 1Asfendiyarov Kazakh National Medical University, Internship and Residency by Neurology, Almaty, Kazakhstan 2Kazakh Medical University of Continuing Education, Internal Medicine, Almaty, Kazakhstan

Actuality: In Kazakhstan, the incidence of stroke ranges from 2.7 to 3.7 per 1000 population.

Objective: The research of cognitive functions in patients with different subtypes of ischemic stroke.

Materials and methods: We have analyzed the results of neuropsychological research 112 patients who had suffered from various subtypes of ischemic stroke in Almaty (Kazakhstan).

The research was conducted at 3 months after stroke. Dynamic observation was carried out at 6 and 12 months after stroke.

The study was conducted on an outpatient basis with the consent of the patients and not contrary to the generally accepted ethical standards.

Results: Post-stroke depression has evolved by the end of the first year after a stroke nearly

41.9% (47) patients. Severity of post-stroke depression depended on many factors. Depression usually develops in people in the older age group 60 - 69 years at men. Among

women, depression appear more frequently in the age group 40-59 years. Of great importance was the localization of the lesions, the severity of the neurological deficit, stroke stage, cognitive defect. So in our observations of post-stroke depression is more common in patients

in the presence of lesions in the left hemisphere, particularly the frontal lobe and left subcortical structures in comparison with the right hemisphere and other regions of the left

hemisphere. In most cases predominant depression of mild degree. Severe depression were detected in 6.2% of patients. Depression often combined with cognitive disorders.

Conclusions: Post-stroke depression is a predictor of unfavorable functional outcome after

ischemic stroke.

AOCN-0097

Stroke MINOCYCLINE ON POST ISCHEMIC STROKE OUTCOMES: METAANALYSIS

OF PLACEBO CONTROLLED TRIALS R.J. Porlas1, N. Bernardo1, P.M. Pasco1 1Philippine General Hospital, Department of Neurosciences, Manila, Philippines

Background and Purpose: To date, only one drug, recombinant tissue plasminogen activator (rTPA) is approved for the

treatment of Acute Ischemic Stroke. With that, comes an ongoing search and trials for a novel neuroprotective agent that could be of adjunct or approximate the effects of rTPA.

Minocycline, a second generation tetracycline, was said to be of promise in several animal and human-in-vitro studies. This study aimed to evaluate validity of existing studies involving the effect of minocycline in post-ischemic stroke outcomes, and directed to pool

the results to make and come up with a more robust statistical data.

Methodology and Results. Two different researchers did a thorough literature search of randomized controlled trials

(RCTs), and other clinical trials. Together, they evaluated the journals gathered. Data was abstracted and another researcher did the statistical analysis using Comprehensive MetaAnalysis software. 17 articles were found to be relevant to the study, but 8 were animal

studies, 3 were human-in-vitro study and 1 was an RCT but was terminated for futility. Only 4 were included in qualitative analysis, and 3 included in the quantitative study. Results

showed that Minocycline has no significant effect on Stroke Outcomes.

Discussion Possible reasons for the problems of translation of findings of in vitro and animal studies to

human studies were differences in the route of drug administration and time of administration (lag time from the onset of ictus). More controlled trials and/or studies are recommended

before using the drug to acute ischemic stroke patients.

AOCN-0080 Stroke

THE EFFECT OF OXYGEN THERAPY REGULARLY FOR OUTCOME OF

ACUTE STROKE PATIENTS L. Adhani Dwi Putri1, Y. Anwar1, P. Pinta1 1Faculty of Medicine- University of North Sumatera, Neurology Department, medan,

Indonesia

Background

Stroke is closely related to the oxygen to the brain. Decreased oxygen to the brain will be

worsen outcome. This study reports the outcome for 2 weeks of the acute phase.

Purpose

To determine the effect of regularly oxygen therapy in outcome of acute stroke patients.

Methods

This cross sectional study consisting 56 patients with acute stroke in general hospital of Haji Adam Malik. Subject retrieval performed consecutively based on inclusion and exclusion

criteria. the patient would be given oxygen therapy 2 L/min via nasal canule for 72 hours. After that the outcome would be assessed using the modified Rankin Scale and Barthel index.

Subsequently the collected data would obtained and analyzed the data.

Results

40 of 56 patients assesed mRS on the third day and the fourteenth day with a percentage of 71 % with the results of modified Rankin Scale < 3 and Barthel Index results obtained P Value

of 0,001

Conclusion

There is no effect of regularly oxygen therapy in modified Rankin Scale of acute stroke patients

AOCN-0070

Stroke INTERRUPTION TO ANTIPLATELET THERAPY EARLY AFTER ACUTE

ISCHAEMIC STROKE: A NESTED CASE-CONTROL STUDY W. Mazlan-Kepli1, R. MacIsaac1, M. Walters1, P. Bath2, J. Dawson1 1University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom 2University of Nottingham, Stroke Trials Unit, Nottingham, United Kingdom

Background Antiplatelet drugs are often discontinued after ischaemic stroke, either because of poor

compliance, complications or withdrawal of care. It is unclear whether this places patients at significant risk early after stroke. Aims

We explored the association between cardiovascular event rate and persistence with prescribed antiplatelet drugs.

Methods We used a matched case-control design using the Virtual International Stroke Trials Archive (VISTA). Cases were patients who had an acute coronary syndrome (ACS), recurrent IS or

transient ischaemic attack (TIA) within 90 days post-stroke and were matched for age ±10 years and sex with up to four controls. Antiplatelet use was categorized as persistent

(continued up to day 90), early cessation (used antiplatelet < 3 days) or stopped/interrupted users (used for > 3 days but stopped prior to day 90). These categories were compared in cases and controls using a conditional logistic regression model that adjusted for potential

confounders. Results

A total of 970 patients were included, of whom 194 were cases and 776 were matched controls. At 90 days, 10 cases (5.2%) and 58 controls (7.5%) stopped/interrupted their antiplatelet. The risk of cardiovascular event was not different in stopped/interrupted users

(adjusted OR=0.702; 95% CI 0.333-1.479, p=0.352) and early cessations (adjusted OR=1.04; 95% CI 0.62-1.74, p=0.876) when compared to persistent users.

Conclusion We found no increased risk in patients who stopped antiplatelets early after stroke but the study was limited by a small sample size and further research is needed.

AOCN-0068

Stroke RELATIONSHIP BETWEEN HYPERTENSION, LIPID PROFILE LEVEL, HBA1C

LEVEL, BODY MASS INDEX (BMI), SMOKING, AND FIBRINOGEN LEVEL

WITH RISK OF ISCHEMIC AND HEMORRHAGIC STROKE INCIDENCE

L. Avitha Sari Harahap1, A. S.Rambe1, C. Aria Arina1 1Faculty of Medicine- North Sumatra University / Haji Adam Malik Hospital, Neurology, Medan, Indonesia

ABSTRACT

Background: Because the pathogenesis of ischemic stroke is different from that of hemorrhagic stroke, their risk factors would not be the same.

Objective : To know about relationship hypertension, lipid profile level, HbA1c level, BMI, smoking, and fibrinogen level with risk of ischemic and hemorrhagic stroke incidence.

Methods : This cross-sectional study consisting of 35 patients with ischemic stroke, 35 patients with hemorrhagic stroke, and 35 patients with non stroke where the study was

conducted in a general hospital of Haji Adam Malik Medan. All of stroke patients examined with Head CT Scan to identify and confirm the diagnosis.

Results : Significant risk factors related to the incidence of ischemic stroke (P value < 0.05) were hypertension (odds ratio [OR] 3.949; 95% CI 0.869 – 17.952), low level of HDL

cholesterol (OR 6.755; 95% CI 1.254 – 36.375), HbA1c level ≥ 6.5% (OR 2.923; 95% CI 0.533 – 16.014), smoking (OR 6.445; 95% CI 1.410 – 29.460), and hyperfibrinogenemia (OR

0.041; 95% CI 0.007 - 0.229). Significant risk factor related to the incidence of hemorrhagic stroke (P value < 0.05) was hypertension (OR 5.712; 95% CI 2.008 - 16.244). Levels of triglycerides, total cholesterol, LDL cholesterol, and BMI were not significantly associated

with risk of ischemic and hemorrhagic stroke incidence (P value > 0.05).

Conclusion : Risk factors that play an important role on the incidence of ischemic stroke and hemorrhagic stroke is very different from one another. Hypertension is a significant risk

factor associated with incidence of ischemic and hemorrhagic stroke.

AOCN-0059

Stroke HUGE INTRACRANIAL HEMATOMA ASSOCIATED WITH NOVEL ORAL

ANTICOAGULANT USED H.L. Yen1, S.C. Tsai1, M.L. Sung2 1Tainan Municipal Hospital, Division of Neurosurgery- Department of Surgery, Tainan, Taiwan 2Tainan Municipal Hospital, Registered professional nurse- Department of Surgery, Tainan,

Taiwan

Introduction

The non-vitamin K antagonist oral anticoagulant (NOAC) has gained FDA approval for the

prevention of ischemic stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Randomized controlled trials of NOACs have revealed that intracranial hemorrhage (ICH) occurs less frequently with NOACs compared with warfarin. However,

the absolute incidence of ICH associated with NOACs has increased with greater use of these anticoagulants. We present a case that suggests that huge hematoma may occur in NOAC-

related ICH.

Case report

An 86-old-man presented with sudden onset loss of consciousness in the morning of admission day. CT scan of the head revealed a huge ICH involving the left temporooccipital

lobe. He had a history of atrial fibrillation with multiple ischemic stroke and had been taking aspirin for years. Due to progress unsteady gait and palpitation for which he was receiving rivaroxaban 10 mg daily since 2 months ago. Due to family refused any treatment, he died 12

hours after admission.

Discussion

The severity of NOACs-related ICH is poorly described. However, two facts make this situation complicated: First, the risk of hematoma expansion is unknown for NOACs.

Second, there is no specific antidote for neither of the NOACs. There was no antidotes for NOACs and reliable laboratory test to measure anticoagulation effects is a clinical challenge

that has catastrophic potential. Understanding the potential salvaging reversal strategies following ICH in patients receiving NOAC is of utmost importance for any practicing neurosurgeon to envisage the expected outcome and prognosticate following this catastrophic

event.

AOCN-0056

Stroke CEREBRAL SMALL VESSEL DISEASE SCORE PREDICTS OUTCOME AFTER

ACUTE ISCHEMIC STROKE T.J. Song1, J. Kim2, D. Song3, J. Yoo3, H.S. Nam3, J.H. Heo3, Y.D. Kim3 1Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea 2Department of Neurology,

CHA Bundang Medical Center- CHA University- Seongnam- Korea, Seongnam, Republic of Korea 3Department of Neurology, Yonsei University College of Medicine- Seoul- Korea, Seoul, Republic of Korea

Objects: The recently developed “total small vessel disease (SVD) score” might appropriately reflect the total burden or severity of cerebral SVD. We investigated whether total SVD score could predict short and long-term outcomes after index stroke in patients

with acute ischemic stroke.

Methods: In total, 1096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total SVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white

matter changes (HWCs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We compared the relationship between functional outcomes at three

months and mortality during long-term follow up according to the total SVD score.

Results: CMBs were found in 26.8% of subjects (294/1096), HWCs in 16.4% (180/1096), HPVSs in 19.3% (211/1096) and ALIs in 38.0% (416/1096). After adjusting for age, sex, and significant variables with p < 0.1 in univariate analysis, the total SVD score was

independently associated with a poor functional outcome (odds ratio 1.30 per 1 point, p = 0.001). In multivariate Cox regression analyses, total SVD score was a predictor for deaths

from all causes (hazard ratio 1.21, p = 0.001), ischemic stroke (hazard ratio 1.23, p = 0.015), and hemorrhagic stroke (hazard ratio 2.08, p = 0.002), but not for cardiac-related death (hazard ratio 1.25, p = 0.382).

Conclusions: Total SVD score is a powerful predictor and potential image biomarker for short-term functional outcome and long-term prognosis in patients with acute ischemic stroke.

AOCN-0021

Stroke PAINFULL ACUTE AORTIC DISSECTION PRESENTING AS AN ACUTE

ISCHEMIC STROKE H. Wang1, Y. Wang2, J. Lu1, Z. Qi3, Q. Cui1, W. Zhao1 1Affiliated Hospital of Chifeng University, Department of Neurology, Chifeng, China 2Affiliated Hospital of Chifeng University, Department of Oncology, Chifeng, China 3Affiliated Hospital of Chifeng University, Department of Radiology, Chifeng, China

Abstract Text

Acute type I aortic dissection (AD) is an uncommon but potentially fatal condition requiring prompt recognition of symptoms and generally surgical intervention. Ischemic stroke

secondary to aortic dissection is not uncommon. We present a 68-year-old female with left hemiplegia secondary to type I AD extending to the supra-aortic vessels. A 68-year-old woman had sudden onset of mild right low chest pain and left hemiparesis. A neurologic

examination disclosed gaze deviation to the right, left homonymous hemianopsia, left central type facial palsy, left hemiplegia (0/5 in upper limb and 3/5 in lower limb) with positive

Babinski sign on the left and left hemianesthesia. Brain MRI revealed acute watershed infarction in right hemisphere (Panel 1). Thoracic and abdominal computed tomography demonstrated a type I DeBakey aortic dissection (AD) (Panel 2). This case highlights the

potential for aortic dissection to be diagnosed through transthoracic echocardiography, chest radiography, and CTA in quick succession.

Figure Legends

Panel 1. Cerebral MRI Diffuse weighted images. White arrows indicate areas of acute infarct

lesions. Panel 2. Angiographies depicted an ascending aortic aneurysm (A,B, white arrows), orifice of

artery rupture at aortic arch (D,E), intimal flap (F, blue arrows), dissection arising from ascending aorta (G and H, red arrows ) and descending aorta (G and H, green arrows), and a filling defect in the right common carotid (I, red arrow). TL, true lumen (red arrow, B and C)

; FL, false lumen (red arrowheads, B and C).