19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339 S297

cognition subscales). The Mann-Whitney U test or Student t-test

were used to examine the difference between the 2 groups.

Independent risk factors were determined by using multiple

regression analysis.

Results: Fifty-three patients with HFS and 32 patients with BS

were participated in the study. The scores of Physical and Mental

Components of HFS-30 in both patients with HFS and BS were

significantly impaired when compared with each control group

(p =0.008 and 0.018 in HFS and p=0.003 and 0.007 in BS,

respectively) In the Physical Component of HFS-30, mobility and

activity of daily living subscales were worse in patients with BS than

those with HFS (p =0.001 and 0.01 respectively). The independent

factors affecting QOL for patients with HFS were disease severity,

peak improvement and the number of injections. For the patients

with BS, factors affecting QOL were patient’s educational level and

peak improvement.

Conclusion: HFS and BS affect QOL both physically and mentally

despite clinical improvement with botulinum toxin.

PO25-TH-06

No secondary treatment failure with Xeomin©

W. Jost. Deutsche Klinik fur Diagnostik, Wiesbaden, Germany

Purpose: Xeomin© has been licensed for the treatment of

spasmodic torticollis and blepharospasm for >4 years in Germany.

In contrast to other botulinum toxin products it is free from

complexing proteins. The formation of neutralising antibodies may

be considerably reduced or even prevented. When investigating

neutralising antibodies, secondary treatment failure is regarded as

the crucial parameter. Based on our experience, antibodies develope

relatively soon and secondary treatment failure can be identified

within the first three years. It would be a crucial clinical benefit,

if neutralising antibodies would not occur with a product of equal

efficacy.

Methods: All de novo patients suffering from spasmodic torticollis

which were treated with Xeomin© were documented. Patients were

analysed retrospectively if they were treated for 3 years and at least

12 times. Those who reported a decrease in or loss of clinical effect

after initially responding to the treatment were to be regarded as

secondary treatment failures. These patients were to be tested for

neutralising antibodies.

Results: 21 patients (13 females) with idiopathic spasmodic

torticollis were included. Mean age was 48.7 years. The patients

received an average of 12.8 injections (approximately every 3

months). The mean dose per injection after 3 years of treatment

was 179 (± 39) units and the mean cumulative dose was 2167 (±485) units. None of the patients required a relevant increase in

dosing. No cases of secondary treatment failure were identified. As

there was no evidence of secondary treatment failure, none of the

patients were tested for neutralising antibodies.

Conclusion: In this study of 21 patients with spasmodic torticollis,

we found no evidence of secondary treatment failure. If formation

of neutralising antibodies would occur to a lesser extent after

Xeomin© treatment, the instruction to administer injections at

intervals of no less than 3 months may become superfluous.

PO25-TH-07

Abstract withdrawn

PO25-TH-08

Chorea-acanthocytosis: the first reported case in Thailand

N. Kanjanasut, P. Jagota, R. Bhidayasiri. Neurology, Chulalongkorn

Hospital, Bangkok, Thailand

Purpose: To delineate the clinical characteristics of ChAc in a Thai

patient.

Method: A 40-year-old male patient who has gradually developed

oromandibular choreiform movements since the age of 37 and then

involved bilateral upper extremities one year later. Before abnormal

movement development, he had a history of mood disorders,

agitation and anxiety.

Result: Peripheral blood smear (PBS) showed acanthocytosis,

more than 20% in the second attempt. Genetic studies including

Huntington’s disease, SCA 1, 2 and 3 were negative. MRI of the

brain revealed atrophy of caudate neucleus. However, genetic test

for VPS13A are not available in Thailand. His family members are

all healthy, except for his older brother who was diagnosed with

psychosis. Unfortunately, he was dead and nobody had noticed any

movement abnormalities.

Conclusion: This patient is most likely a chorea-acanthocytosis

which is the first reported case in Thailand. In fact, the total amount

of the patients in Thailand might be larger than expected because

most of them are under-diagnosed. Technically, the diagnosis of

this syndrome is not too difficult if the attending physicians

recognize that neuroacanthocytosis should be in a differential

diagnosis when they encounter with young-adult patients with

generalized involuntary movements and are more careful to look

for acanthocyte in PBS.

PO25-TH-09

Chorea-Ballism: various radiologic findings from various

etiologies

K. Methawasin1, L. Kaufman2. 1Neurology Division, Department of

Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak

Campus, Nakhornnayok, Thailand; 2Division of Pulmonary and

Critical Care Medicine, Department of Medicine, Faculty of Medicine,

Srinakharinwirot University, Ongkharak Campus, Nakhornnayok,

Thailand

Purpose: We describe clinical manifestations, etiologies, brain

images and treatments of three elderly patients with chorea-

ballism.

Method: Case series.

Results: Three elderly patients visited the neurology clinic at

Srinakharinwirot University Hospital because of acute onset

choreiform movement of their extremities. Two patients had a

previous history of uncontrolled diabetes mellitus and the other

one had long standing hypertension. The first patient abruptly

developed left hemichorea-ballism concurrent with euphoric

mood and uninhibited behavior. Her brain MRI demonstrated

ischemic lesions involving, the infero-medial right thalamus,

right sub-thalamic nucleus, and right midbrain. The second case

presented with left hemichorea-ballism as well, but his brain MRI

showed hemorrhage in the right basal ganglia. The third case

exhibited bilateral chorea-ballism of the upper limbs associated

with non-ketotic hyperglycemia. Her brain MRI revealed bilateral

basal ganglia high intensity abnormalities, possibly representing

changes secondary to elevated plasma glucose. Conventional stroke

management and treatment with atypical antipsychotic drugs

improved the symptoms in the first two cases, while the 3rd

responded to rigid plasma glucose control.

Conclusions: Chorea-ballism is an uncommon hyperkinetic

movement disorder resulting from a variety of conditions. It may

occasionally occur as a clinical manifestation of stroke and/or the

non-ketotic hyperglycemic state. The proper management is to

define the underlying cause and implement specific and appropriate

therapy.

PO25-TH-10

Chorea-Ballismus in non-ketotic hyperglycaemic crisis

H. El Otmani1, F. Moutaouakil1, H. Fadel1, M.A. Rafai2, B. El

Moutawakil2, I. Slassi2. 1Neurology, Al Kortobi hospital, Tangier,

Morocco; 2Neurolgy, Ibn Rochd universitary hospital, Casablanca,

Morocco

Background: Diabetic patients may present during hyperglycemic

crisis a rare syndrome characterized by typical triad: unilateral

involuntary movements (hemichorea-hemiballism), radiological