- Email: [email protected]
Poster 52 Remarkable Motor and Neurocognitive Recovery in H1N1 Hemorrhagic Encephalitis after Acute Rehabilitation
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Abstracts / PM R 7 (2015) S83-S222
Participants: OEF/OIF Veterans with mTBI (N¼57). The majority of participants were male (89.5%) with a mean age of 32.5 and two combat deployments. Interventions: Not applicable Main Outcome Measures: Clinical interviews were used to assess lifetime history of mTBI and PTSD. Questionnaires included the Moral Injury Events Scale (MIES), Spiritual Health and Life-Orientation Measure (SHALOM), and Brief Multidimensional Measure of Religiousness/ Spirituality (BMMRS). Results or Clinical Course: Participants reported high levels of perceived moral transgressions (M¼20.8, SD¼8.1) and perceived moral betrayals (M¼11.1, SD¼4.5), as well as high rates of PTSD diagnoses (86%). Discrepancies were found between ideal (M¼16.2) and current (M¼12.5) levels of spiritual health. Preliminary results suggest a preference for individuals to identify as spiritual rather than religious (M¼ 2.5, 3.1, respectively, SD¼1). Further, 33.4% of the sample identified as atheist, agnostic, or as having no religion, while 50.8% identified as Christian. Conclusion: Preliminary data reveal rates of moral injury, spiritual health, and post-traumatic stress disorder. Veterans with mTBI reported greater moral injury than has been previously reported in other military samples. Discrepancies found between ideal and current states of spiritual health highlight unsatisfactory spiritual well-being. Religious preferences (or rejection thereof) were noteworthy. These findings call attention to potential factors associated with PCS maintenance, and reinforce the need for continued exploration of moral injury and spirituality.
Poster 50 Progressive Lower Extremity Weakness Due to Nitrous Oxide Induced Myelopathy: A Case Report Matthew Jones, MD (William Beaumont Hospital, Royal Oak, MI, United States), Julie A. Ferris, MD, Ronald S. Taylor, MD Disclosures: M. Jones: I Have No Relevant Financial Relationships To Disclose. Case Description: An 18-year-old female presented to the Emergency Department with hand numbness, progressive lower extremity weakness, and bilateral foot drop. Her symptoms began 2-3 weeks prior to presentation and had been getting worse. She denied bulbar symptoms or bowel and bladder dysfunction. On examination, she was found to have 4/5 (Medical Research Council) bilateral proximal lower extremity muscle strength and 2/5 distal strength. Upper extremity strength was normal. Reflexes were absent in the upper extremities, 2+ for the patellar, and 1+ for the achilles. Her gait was ataxic. On discussion with the patient, she revealed that she was a frequent recreational nitrous oxide user. Setting: Tertiary Care Hospital. Results or Clinical Course: Magnetic resonance imaging (MRI) demonstrated extensive, non-enhancing increase of T2 signal involving the dorsal columns of the cervical spinal cord and scattered areas within the dorsal columns of the thoracic cord. Vitamin B12 and methylmalonic acid levels were drawn which were normal, although the patient had been supplemented with vitamin B12 at an outside hospital prior to her presentation at our institution. Other causes of posterior column degeneration including HIV, syphilis, and heavy metals were ruled out. The patient was diagnosed with nitrous oxide induced myelopathy. She was admitted to inpatient rehabilitation (IPR) where her course was complicated by ataxia and lower extremity weakness. At the time of discharge, she was able to ambulate 100 ft with bilateral AFOs. Discussion: Nitrous oxide induced myelopathy is a known consequence of nitrous oxide abuse due to irreversible oxidation and thus inactivation of vitamin B12. Although vitamin B12 levels are frequently low in this condition, this is not always a requirement. Conclusion: Nitrous oxide is a commonly used recreational drug that can result in devastating consequences. Screening for nitrous oxide
use should be performed in young patients presenting with symptoms of myelopathy.
Poster 51 Electrodiagnostic Findings in Anterior Spinal Cord Syndrome: A Case Report Hana F. Azizi, MD (Montefiore Medical Center, New York, NY, United States), Pegah Dehghan, Dennis D. Kim, MD Disclosures: H. F. Azizi: I Have No Relevant Financial Relationships To Disclose. Case Description: A 75-year-old woman with history of DM, hypertension, and hypercholesterolemia, developed sudden onset of weakness in lower extremities, with severe pain in lower back and lower extremities without numbness. MRI showed severe lumbar stenosis and a questionable area of grey matter ischemia between T10 level and conus medullaris. Patient received conservative treatment including steroids with no significant improvement. Five months later, she was referred for electrodiagnostic evaluation of weakness in bilateral lower extremities. Physical examination revealed severe distal weakness in lower extremities with left foot drop. There was decreased appreciation of light touch in lower extremities with preserved vibration and position sense. Setting: Electrodiagnostic laboratory at teaching hospital. Results or Clinical Course: Electrodiagnostic study showed unobtainable bilateral sural sensory nerves action potentials (SNAP), unobtainable left tibial and peroneal nerves compound muscle action potentials (CMAP), and very low CMAP amplitude in the right tibial and peroneal nerves with decreased conduction velocities. F response was recorded only from the right gastrocnemius-soleus complex. The amplitude was slightly decreased in the left ulnar SNAP with mild prolonged latency. Needle EMG showed very small fibrillation potentials with no voluntary motor units in left gastrocnemius, and small fibrillation potentials, positive sharp waves and 1-2 voluntary motor units of high firing rate in left peroneus longus muscle. Needle insertion in these muscles was associated with a gritty feeling signifying fibrotic changes.There was no significant abnormal EMG findings in other muscle groups including para spinal muscles. Discussion: These findings were most likely consistent with anterior spinal cord ischemia. Unobtainable bilateral sural nerves SNAP and decreased SNAP in ulnar nerve could be explained by old age and diabetes. Anterior spinal cord syndrome results from compression of the anterior spinal artery and often occurs in the absence of traumatic injury. It is frequently asymmetrical and may spare the dorsal columns. Conclusion: Anterior spinal cord syndrome has the worst prognosis among incomplete spinal cord injuries. The chance of motor recovery is low, and supportive devices such as ankle foot orthosis should be considered.
Poster 52 Remarkable Motor and Neurocognitive Recovery in H1N1 Hemorrhagic Encephalitis after Acute Rehabilitation Steven Ross, DO (NYU, New York, NY, United States) Disclosures: S. Ross: I Have No Relevant Financial Relationships To Disclose. Case Description: A 38-year-old previously healthy man presented to the ER with new-onset tonic-clonic seizures. History was significant for a recent visit to Nepal. MRI revealed increased T2/FLAIR signal with bilateral hemisphere involvement with associated hemorrhage in the temporal lobes and thalami consistent with hemorrhagic encephalitis. A positive nasal swab for H1N1 RNA confirmed the diagnosis of H1N1 hemorrhagic encephalitis. Though the acute hospital course was
Abstracts / PM R 7 (2015) S83-S222 significantly complicated including the requirement for tracheotomy, the patient responded to acyclovir. Nearly two months after initial presentation, he was transferred to the traumatic brain injury unit for acute inpatient rehabilitation. Upon admission, the patient’s cognition was globally impaired with transcortical sensory aphasia and generalized weakness. Functionally, he required total assistance for all activities of daily living (ADL) and maximum assistance for transfers. Setting: Inpatient Results or Clinical Course: A program for low arousal brain injured patients was initiated including sensory stimulation and neuropharmacological intervention with amantadine. During the course of recovery, Valproic acid was added to the regimen to control his impulsivity and disinhibition. He was successfully decannulated and at the time of discharge home, he was modified independent with ambulation and ADLs though still required 24 hour supervision for his residual memory deficit and poor safety awareness. He received continued PT/OT as an outpatient after discharge. 24 hour supervision was weaned off and at most recent follow-up 10 months after initial presentation, the patient began to volunteer at a hospital with the goal of eventually returning to work. Discussion: There are few international case reports detailing patients with H1N1 encephalitis with variable functional improvement after acute rehabilitation. To our knowledge, this is the first case report of a patient with H1N1 encephalitis with good functional recovery in multiple domains after acute rehabilitation in the United States. Conclusion: H1N1 hemorrhagic encephalitis can cause serious cognitive and functional impairment despite proper medical treatment. A course of inpatient rehabilitation is appropriate for these patients and can lead to significant neurologic recovery.
Poster 53 The Shape/Texture Identification Test is a Reliable Measure to Assess Active Touch after Stroke Christina Brogardh, PhD (Lund University, Lund, Sweden), Elisabeth Ekstrand, MSc, Jan Lexell, MD, PhD Disclosures: C. Brogardh: I Have No Relevant Financial Relationships To Disclose. Objective: To evaluate the test-retest reliability of the Shape/ Texture Identification test (STI-testTM) in persons with chronic stroke. Design: A test-retest design. Setting: A university hospital outpatient clinic. Participants: A convenience sample of 45 men and women (mean age 65 years) with mild to moderate impairments in the upper extremity at least 6 months post stroke. Interventions: Not applicable. Main Outcome Measures: The STI-test was used to assess active touch of the hands. Active touch of the hand is important to be able to explore shapes, textures, to identify different objects and materials, as well as for the ability to grasp and manipulate objects. The STI-test consists of two different subtests: identification of shapes and textures. There are three different shapes and three textures, each in three different sizes, which should be identified without any help of vision. Both hands were assessed twice, one week apart. The reliability of the data from the two test occasions was evaluated for the total sum score (using weighted kappa statistics and percentage agreement, PA) and for the two subtests (using the Svensson rank-invariant method). Results or Clinical Course: The median total score of the STI-test was 5 points (min-max 0 to 6) for the more affected hand and 6 points (min-max 3 to 6) for the less affected hand at both test occasions. The weighted kappa coefficient was 0.98 for the more affected hand and 0.76 for the less affected hand. The PA (the same score at both test occasions) for the subtest ‘identification of shapes’ was 69% for the more affected hand and 62% for the less affected hand. The corresponding figures for the subtest ‘identification of textures’ were 82% and 91%, respectively. There were no systematic or random disagreements for any of the subtests.
S109
Conclusion: The STI-test is reliable to assess active touch (identification of shapes and textures) for both the more and the less affected hand in persons with chronic stroke. It can be recommended for the evaluation of changes in somatosensory function over time or effects of different somatosensory rehabilitation interventions.
Poster 54 Efficacy and Safety of Repeated IncobotulinumtoxinA Injections for Upper-Limb Post-Stroke Spasticity Elie Elovic, Michael C. Munin, MD (University of Pittsburgh School of Medicine, Pittsburgh, PA, United States), Petr Kanovsky, MD, PhD, Angelika Hanschmann, Reinhard Hiersemenzel, MD, Christina M. Marciniak, MD Disclosures: M. C. Munin: I Have No Relevant Financial Relationships To Disclose. Objective: To investigate efficacy and safety of repeated incobotulinumtoxinA (XeominÒ) injections for upper-limb post-stroke spasticity. Design: 36-week open-label extension (OLEX) of a randomized placebo-controlled Phase 3 trial (NCT01392300) Setting: 46 study sites worldwide. Participants: Subjects (18e80 years) with upper limb post-stroke spasticity, who completed the 12-week randomized placebocontrolled main period (MP). Interventions: Three treatments with incobotulinumtoxinA (fixed total dose 400 U), injected into the affected muscles of one upper limb at fixed 12-week injection intervals. Main Outcome Measures: Evaluation of muscle tone (Ashworth Scale; AS), Disability Assessment Scale (DAS), Carer Burden Scale, and incidence of adverse events (AEs). Results or Clinical Course: Nearly all subjects (296/299) who completed the MP received incobotulinumtoxinA in the OLEX; 248 subjects completed the OLEX. The proportion of subjects with 1 point improvement in AS score from each incobotulinumtoxinA treatment to the respective 4-week post-injection control visit was 52.3e59.2% for wrist flexors, 49.1e52.3% for elbow flexors, 59.8e64.5% for finger flexors, 35.5e41.2% for thumb flexors, and 37.4e39.9% for forearm pronators (P<.0001 for all). The mean DAS score for the principal target domain significantly improved from each incobotulinumtoxinA treatment to the respective 4-week assessment (P<.0001 for all). From the MP baseline to the study-end visit, significant improvements in Carer Burden Scale scores were seen for ‘cleaning palm’ (58/108 subjects, 53.7%; P<.0001), ‘cutting fingernails’ (65/125 subjects, 52.0%; P<.0001), ‘cleaning armpit’ (50/112 subjects, 44.6%; P¼.0023), and ‘putting arm through sleeve’ (59/116 subjects, 50.9%; P<.0001). ‘Applying splint’ improved in 8/14 subjects (57%; P¼.1484).Treatment-related AEs were reported by 9/296 subjects (3.0%) during the OLEX, most frequently pain in the extremity (n¼2, 0.7%) and constipation (n¼2, 0.7%). Serious AEs were reported by 22 subjects (7.4%); none were related to treatment. Conclusion: Repeated incobotulinumtoxinA injections were a welltolerated treatment for upper-limb, post-stroke spasticity and led to reductions in muscle tone that translated into meaningful clinical improvements in disability and carer burden.
Poster 55 Switching Botulinum Toxin Formulations from OnabotulinumtoxinA to IncobotulinumtoxinA: Experience from a Spasticity Outpatient Clinic Prabal K. Datta, MBBS, MD, FRCP (UK) (Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom), Adrian Robertson, MD Disclosures: P. K. Datta: Research Grants - MERZ Pharmaceuticals Objective: To evaluate outcomes, doses and treatment intervals after switching between botulinum neurotoxin type A (BoNT-A) formulations for patients with spasticity.
Abstracts / PM R 7 (2015) S83-S222
Participants: OEF/OIF Veterans with mTBI (N¼57). The majority of participants were male (89.5%) with a mean age of 32.5 and two combat deployments. Interventions: Not applicable Main Outcome Measures: Clinical interviews were used to assess lifetime history of mTBI and PTSD. Questionnaires included the Moral Injury Events Scale (MIES), Spiritual Health and Life-Orientation Measure (SHALOM), and Brief Multidimensional Measure of Religiousness/ Spirituality (BMMRS). Results or Clinical Course: Participants reported high levels of perceived moral transgressions (M¼20.8, SD¼8.1) and perceived moral betrayals (M¼11.1, SD¼4.5), as well as high rates of PTSD diagnoses (86%). Discrepancies were found between ideal (M¼16.2) and current (M¼12.5) levels of spiritual health. Preliminary results suggest a preference for individuals to identify as spiritual rather than religious (M¼ 2.5, 3.1, respectively, SD¼1). Further, 33.4% of the sample identified as atheist, agnostic, or as having no religion, while 50.8% identified as Christian. Conclusion: Preliminary data reveal rates of moral injury, spiritual health, and post-traumatic stress disorder. Veterans with mTBI reported greater moral injury than has been previously reported in other military samples. Discrepancies found between ideal and current states of spiritual health highlight unsatisfactory spiritual well-being. Religious preferences (or rejection thereof) were noteworthy. These findings call attention to potential factors associated with PCS maintenance, and reinforce the need for continued exploration of moral injury and spirituality.
Poster 50 Progressive Lower Extremity Weakness Due to Nitrous Oxide Induced Myelopathy: A Case Report Matthew Jones, MD (William Beaumont Hospital, Royal Oak, MI, United States), Julie A. Ferris, MD, Ronald S. Taylor, MD Disclosures: M. Jones: I Have No Relevant Financial Relationships To Disclose. Case Description: An 18-year-old female presented to the Emergency Department with hand numbness, progressive lower extremity weakness, and bilateral foot drop. Her symptoms began 2-3 weeks prior to presentation and had been getting worse. She denied bulbar symptoms or bowel and bladder dysfunction. On examination, she was found to have 4/5 (Medical Research Council) bilateral proximal lower extremity muscle strength and 2/5 distal strength. Upper extremity strength was normal. Reflexes were absent in the upper extremities, 2+ for the patellar, and 1+ for the achilles. Her gait was ataxic. On discussion with the patient, she revealed that she was a frequent recreational nitrous oxide user. Setting: Tertiary Care Hospital. Results or Clinical Course: Magnetic resonance imaging (MRI) demonstrated extensive, non-enhancing increase of T2 signal involving the dorsal columns of the cervical spinal cord and scattered areas within the dorsal columns of the thoracic cord. Vitamin B12 and methylmalonic acid levels were drawn which were normal, although the patient had been supplemented with vitamin B12 at an outside hospital prior to her presentation at our institution. Other causes of posterior column degeneration including HIV, syphilis, and heavy metals were ruled out. The patient was diagnosed with nitrous oxide induced myelopathy. She was admitted to inpatient rehabilitation (IPR) where her course was complicated by ataxia and lower extremity weakness. At the time of discharge, she was able to ambulate 100 ft with bilateral AFOs. Discussion: Nitrous oxide induced myelopathy is a known consequence of nitrous oxide abuse due to irreversible oxidation and thus inactivation of vitamin B12. Although vitamin B12 levels are frequently low in this condition, this is not always a requirement. Conclusion: Nitrous oxide is a commonly used recreational drug that can result in devastating consequences. Screening for nitrous oxide
use should be performed in young patients presenting with symptoms of myelopathy.
Poster 51 Electrodiagnostic Findings in Anterior Spinal Cord Syndrome: A Case Report Hana F. Azizi, MD (Montefiore Medical Center, New York, NY, United States), Pegah Dehghan, Dennis D. Kim, MD Disclosures: H. F. Azizi: I Have No Relevant Financial Relationships To Disclose. Case Description: A 75-year-old woman with history of DM, hypertension, and hypercholesterolemia, developed sudden onset of weakness in lower extremities, with severe pain in lower back and lower extremities without numbness. MRI showed severe lumbar stenosis and a questionable area of grey matter ischemia between T10 level and conus medullaris. Patient received conservative treatment including steroids with no significant improvement. Five months later, she was referred for electrodiagnostic evaluation of weakness in bilateral lower extremities. Physical examination revealed severe distal weakness in lower extremities with left foot drop. There was decreased appreciation of light touch in lower extremities with preserved vibration and position sense. Setting: Electrodiagnostic laboratory at teaching hospital. Results or Clinical Course: Electrodiagnostic study showed unobtainable bilateral sural sensory nerves action potentials (SNAP), unobtainable left tibial and peroneal nerves compound muscle action potentials (CMAP), and very low CMAP amplitude in the right tibial and peroneal nerves with decreased conduction velocities. F response was recorded only from the right gastrocnemius-soleus complex. The amplitude was slightly decreased in the left ulnar SNAP with mild prolonged latency. Needle EMG showed very small fibrillation potentials with no voluntary motor units in left gastrocnemius, and small fibrillation potentials, positive sharp waves and 1-2 voluntary motor units of high firing rate in left peroneus longus muscle. Needle insertion in these muscles was associated with a gritty feeling signifying fibrotic changes.There was no significant abnormal EMG findings in other muscle groups including para spinal muscles. Discussion: These findings were most likely consistent with anterior spinal cord ischemia. Unobtainable bilateral sural nerves SNAP and decreased SNAP in ulnar nerve could be explained by old age and diabetes. Anterior spinal cord syndrome results from compression of the anterior spinal artery and often occurs in the absence of traumatic injury. It is frequently asymmetrical and may spare the dorsal columns. Conclusion: Anterior spinal cord syndrome has the worst prognosis among incomplete spinal cord injuries. The chance of motor recovery is low, and supportive devices such as ankle foot orthosis should be considered.
Poster 52 Remarkable Motor and Neurocognitive Recovery in H1N1 Hemorrhagic Encephalitis after Acute Rehabilitation Steven Ross, DO (NYU, New York, NY, United States) Disclosures: S. Ross: I Have No Relevant Financial Relationships To Disclose. Case Description: A 38-year-old previously healthy man presented to the ER with new-onset tonic-clonic seizures. History was significant for a recent visit to Nepal. MRI revealed increased T2/FLAIR signal with bilateral hemisphere involvement with associated hemorrhage in the temporal lobes and thalami consistent with hemorrhagic encephalitis. A positive nasal swab for H1N1 RNA confirmed the diagnosis of H1N1 hemorrhagic encephalitis. Though the acute hospital course was
Abstracts / PM R 7 (2015) S83-S222 significantly complicated including the requirement for tracheotomy, the patient responded to acyclovir. Nearly two months after initial presentation, he was transferred to the traumatic brain injury unit for acute inpatient rehabilitation. Upon admission, the patient’s cognition was globally impaired with transcortical sensory aphasia and generalized weakness. Functionally, he required total assistance for all activities of daily living (ADL) and maximum assistance for transfers. Setting: Inpatient Results or Clinical Course: A program for low arousal brain injured patients was initiated including sensory stimulation and neuropharmacological intervention with amantadine. During the course of recovery, Valproic acid was added to the regimen to control his impulsivity and disinhibition. He was successfully decannulated and at the time of discharge home, he was modified independent with ambulation and ADLs though still required 24 hour supervision for his residual memory deficit and poor safety awareness. He received continued PT/OT as an outpatient after discharge. 24 hour supervision was weaned off and at most recent follow-up 10 months after initial presentation, the patient began to volunteer at a hospital with the goal of eventually returning to work. Discussion: There are few international case reports detailing patients with H1N1 encephalitis with variable functional improvement after acute rehabilitation. To our knowledge, this is the first case report of a patient with H1N1 encephalitis with good functional recovery in multiple domains after acute rehabilitation in the United States. Conclusion: H1N1 hemorrhagic encephalitis can cause serious cognitive and functional impairment despite proper medical treatment. A course of inpatient rehabilitation is appropriate for these patients and can lead to significant neurologic recovery.
Poster 53 The Shape/Texture Identification Test is a Reliable Measure to Assess Active Touch after Stroke Christina Brogardh, PhD (Lund University, Lund, Sweden), Elisabeth Ekstrand, MSc, Jan Lexell, MD, PhD Disclosures: C. Brogardh: I Have No Relevant Financial Relationships To Disclose. Objective: To evaluate the test-retest reliability of the Shape/ Texture Identification test (STI-testTM) in persons with chronic stroke. Design: A test-retest design. Setting: A university hospital outpatient clinic. Participants: A convenience sample of 45 men and women (mean age 65 years) with mild to moderate impairments in the upper extremity at least 6 months post stroke. Interventions: Not applicable. Main Outcome Measures: The STI-test was used to assess active touch of the hands. Active touch of the hand is important to be able to explore shapes, textures, to identify different objects and materials, as well as for the ability to grasp and manipulate objects. The STI-test consists of two different subtests: identification of shapes and textures. There are three different shapes and three textures, each in three different sizes, which should be identified without any help of vision. Both hands were assessed twice, one week apart. The reliability of the data from the two test occasions was evaluated for the total sum score (using weighted kappa statistics and percentage agreement, PA) and for the two subtests (using the Svensson rank-invariant method). Results or Clinical Course: The median total score of the STI-test was 5 points (min-max 0 to 6) for the more affected hand and 6 points (min-max 3 to 6) for the less affected hand at both test occasions. The weighted kappa coefficient was 0.98 for the more affected hand and 0.76 for the less affected hand. The PA (the same score at both test occasions) for the subtest ‘identification of shapes’ was 69% for the more affected hand and 62% for the less affected hand. The corresponding figures for the subtest ‘identification of textures’ were 82% and 91%, respectively. There were no systematic or random disagreements for any of the subtests.
S109
Conclusion: The STI-test is reliable to assess active touch (identification of shapes and textures) for both the more and the less affected hand in persons with chronic stroke. It can be recommended for the evaluation of changes in somatosensory function over time or effects of different somatosensory rehabilitation interventions.
Poster 54 Efficacy and Safety of Repeated IncobotulinumtoxinA Injections for Upper-Limb Post-Stroke Spasticity Elie Elovic, Michael C. Munin, MD (University of Pittsburgh School of Medicine, Pittsburgh, PA, United States), Petr Kanovsky, MD, PhD, Angelika Hanschmann, Reinhard Hiersemenzel, MD, Christina M. Marciniak, MD Disclosures: M. C. Munin: I Have No Relevant Financial Relationships To Disclose. Objective: To investigate efficacy and safety of repeated incobotulinumtoxinA (XeominÒ) injections for upper-limb post-stroke spasticity. Design: 36-week open-label extension (OLEX) of a randomized placebo-controlled Phase 3 trial (NCT01392300) Setting: 46 study sites worldwide. Participants: Subjects (18e80 years) with upper limb post-stroke spasticity, who completed the 12-week randomized placebocontrolled main period (MP). Interventions: Three treatments with incobotulinumtoxinA (fixed total dose 400 U), injected into the affected muscles of one upper limb at fixed 12-week injection intervals. Main Outcome Measures: Evaluation of muscle tone (Ashworth Scale; AS), Disability Assessment Scale (DAS), Carer Burden Scale, and incidence of adverse events (AEs). Results or Clinical Course: Nearly all subjects (296/299) who completed the MP received incobotulinumtoxinA in the OLEX; 248 subjects completed the OLEX. The proportion of subjects with 1 point improvement in AS score from each incobotulinumtoxinA treatment to the respective 4-week post-injection control visit was 52.3e59.2% for wrist flexors, 49.1e52.3% for elbow flexors, 59.8e64.5% for finger flexors, 35.5e41.2% for thumb flexors, and 37.4e39.9% for forearm pronators (P<.0001 for all). The mean DAS score for the principal target domain significantly improved from each incobotulinumtoxinA treatment to the respective 4-week assessment (P<.0001 for all). From the MP baseline to the study-end visit, significant improvements in Carer Burden Scale scores were seen for ‘cleaning palm’ (58/108 subjects, 53.7%; P<.0001), ‘cutting fingernails’ (65/125 subjects, 52.0%; P<.0001), ‘cleaning armpit’ (50/112 subjects, 44.6%; P¼.0023), and ‘putting arm through sleeve’ (59/116 subjects, 50.9%; P<.0001). ‘Applying splint’ improved in 8/14 subjects (57%; P¼.1484).Treatment-related AEs were reported by 9/296 subjects (3.0%) during the OLEX, most frequently pain in the extremity (n¼2, 0.7%) and constipation (n¼2, 0.7%). Serious AEs were reported by 22 subjects (7.4%); none were related to treatment. Conclusion: Repeated incobotulinumtoxinA injections were a welltolerated treatment for upper-limb, post-stroke spasticity and led to reductions in muscle tone that translated into meaningful clinical improvements in disability and carer burden.
Poster 55 Switching Botulinum Toxin Formulations from OnabotulinumtoxinA to IncobotulinumtoxinA: Experience from a Spasticity Outpatient Clinic Prabal K. Datta, MBBS, MD, FRCP (UK) (Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom), Adrian Robertson, MD Disclosures: P. K. Datta: Research Grants - MERZ Pharmaceuticals Objective: To evaluate outcomes, doses and treatment intervals after switching between botulinum neurotoxin type A (BoNT-A) formulations for patients with spasticity.