0994 Apomorphine, in a clozapine-like fashion, increases cutaneous blood flow and inhibits alerting-related cutaneous vasoconstriction in rats

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ratio have no or less frequent history of common cold with high-grade fever. Conclusion: The majority of patients with P D showed an inmmnological phenotype sifted to a Thl inmmne response, suggesting that this disorder is a "Thl disease". The immunological alteration may provide a better understanding in elucidation of PD etiology. The association between clinical features and immunological phenotypes will also be discussed in our presentation. 0991 Dilt'erentiating hemor dominant Parkinson's disease tl'Om ESSential tremor using 1123 Iotlupane single-photon emission computed tomography (SPECT) scanning Bajaj, N l, Kamath, S a, Jones, I ~, Burchill, J~, and Smith, D 4.

1Department of Neurology, Queen's Medical Centre, Nottingham and Department of Neurology, Derbyshire Royal Infirmary, Derby; ZDepartment of Care of the Elderly Medicine, Derbyshire Royal Infirmary, Derby; 3Department of Nuclear Medicine, Derby Hospitals, Derby; 4Department of Radiology, Derby Hospitals, Derby Background: Tremor dominant Parkinson's disease (TDPD) can be difficult to differentiate from essential tremor (ET) in those with asynunetrical dominant tremor or other parkinsonian features (also known as atypical ET). ET is commoner in the relatives of TDPD probands and previous authors have demonstrated ET to be an heterogenous disorder with 20% having parkinsonian features. We describe our experience of using 11~3 Ioflupane SPECT to help differentiate TDPD from a group of atypical ET. Methodology: Retrospective case note audit of a series of atypical ET referred for 1123 Ioflupane SPECI" between 2002-2005 from the movement disorders department of the Derbyshire Royal Infirmary. Patients received a single intravenous injection o f 1.~ I-Ioflupane (111-185 MBq DaTSCAN, GE Healthcare, UK) and underwent a SPECT scan. All cases were assessed clinically by the presenting author and all scans were reported by JB and DS. Results: 21 patients with atypical ET were scamted. 5 had a SPECI" scan suggestive of PD. All patients with positive scans had both an asymmetrical rest tremor and postural tremor. Other parkinsonian features were of poor predictive value in differentiating atypical ET from TDPD. Conclusion: Differentiation of atypical ET from TDPD is difficult on clinical criteria alone although the absence of rest tremor has strong negative predictive value. 1123Ioflupane SPECT is a useful technique in assessing these patients. 0992 Psycho-Education in Parkinson's Disease Directed At Relatives And Caregivers Baybs, A. ~, Crespo, MC. ~, Prats, A. ~, Villa, V. ~, and EduPark Consortium 3. 1Parkinson Unit. Functional Neurosurgery

Foundation, Medical Center Teknon, Barcelona, Spain; 2Spanish Parkinson Federation," XThis study has been conducted with the financial support of the European Community Commission, within the specific program ;;Qualityof Life and Management of Living Resources% QLKt-2002-02674 "EduPark". It neither reflects the Cornission'spoints of view nor anticipates its future policies in this area Background: Educational programs for primary caregivers (PC) have proven to be effective in reducing the quality of life. However, no complete psycho-educational programs are available for PC of Parkinson's Disease (PD) patients. Method: Exploratory study to evaluate the P C satisfaction after receiving psycho-education in PD, following the Psycho-Educational Program designed by the European Consortium EduPark (PPEduPark), as well as the program's usefulness. Subjects: Spanish PC, recruited after collecting their informed consent, who are in charge of PD patients in early and moderate stages.

Poster Abstracts Instruments and procedures: 1) socio-demographic, medical, and psycho-social data were collected. The program contains 7 key components (Information, Self-monitoring, Health empowetment, Stress management, Anxiety and depression, Assertiveness, Social support), that are developed in different sessions 3) A specific questionnaire to measure usefulness as well as satisfaction of tiffs program are provided. Results: N -- 38 PC (87% women), average age -- 60 ± 14 years, most of them married (189%) and retired (151%), or still active (20%), with significant depression symptoms according to SDS. Most of them take care of their spouse (84%). PPEduPark achieves a high degree of satisfaction: The P C consider most useful the components related to "Self-monitoring'" (self-observation and self-coping) and "Anxiety and Depression" (iJrevenfion o f the overworking of the care-taker); they also found useful the exchange of ideas and experiences within the group (88%), and 91% think they would participate in a similar program and 82% would recommend EduPark to other PC. Conclusion: In general terms, PPEduPark achieves a high degree of satisfaction among PC. 0993 Psycho-educational Program For Parkinson's Disease: Pilot Program Bay's A, Prats, A., Crespo, M.C and EduPark Consortium. Par]~insan

Unit. Fundaeitn Neuroeirug[a FuneionaL Medical Center "Teknon". Barcelona. Spain, Study financed by the European Commission. Project No: QLKt-CT-2002-02674 EduPark Background: Although the vital importance of psycho-educational programs in reducing the impact of chronic diseases is recognized, there are no specific one for Parkinson's Disease (PD). Method: Exploratory study to evaluate the benefits of a Psychoeducational Program for PD patients, designed by the European Consortimn EduPark. Subjects: 23 PD patients that voluntarily signed an informed consent. Patients in advanced stages or with dementia were excluded. Instruments and Procedures: 1) Socio-demographic, medical and psychosocial data were collected through UPDRS, H&Y, SDS, PDQ-39, BELA-P-K; 2) EduPark was carried out in a group (14-10 PD patients/group), during which 7 key components were dealt with (Information, Self-monitoring, Health empowetment, Stress management, Anxiety and depression, Assertiveness, Social support); 3) After the program, participants were provided with SDS, PDQ-39 y BELAPK, and with a specific questionnaire developed by the European Consortium EduPark in order to measure perceived usefulness and degree o f satisfaction achieved with EduPark. A Visual Analogue Scale (VAS) on subjective well-being is also provided before and after each session together with a specific questionnaire pursuing feedback from the PD patients at the end of the session. Results: 85?,'; (n -- 17) of the patients concluded that the program had been helpful for them, their subjective well-being perception measured with (VAS) and the psychosocial BELA-P-K scale improved significantly after the program. Significant statistical changes were observed neither in the quality of life (PDQ-39), nor in the depression scales (SDS). Conclusion: The preliminary results show that this psycho-educational program could be useful for copping with PD. 0994 ApOlilO~phine, in a Clozapine-like Fashion, increases cutaneous blood flow and inhibits alerting-related cutaneous vasoconstriction in rats Blessing, WW 1. 1Flinders University,, Adelaide, Australia Apomorphine, important in treating advanced Parkinsonian immobility, causes less hallucinations and disordered thinking than other dopamine receptor agonists. Tiffs is not understood. Apomorphine lowers body temperature. Clozapine, an atypical antipsychotic, alsolowers body temperature partially by inhibiting sympathetic

Poster Abstracts outflow to the cutaneous vasculature, with associated inhibition of alerting-induced sympathetically-mediated cutaneous vasoconstriction (Blessing et al., J. Neuroscience 2003, Psychopharmacology 2004, 2005). The present study detemrined whether apomorplfine has clozapinelike actions on cutaneous blood flow, and whether dopanfine receptor agonism is involved. Tail artery blood flow (chronically implanted Doppler probe) and vasoconstrictor responses to alerting stimuli were recorded after vehicle or apomorphine (0.1-0.5 mg/kg subcutaneously) in conscious freely moving 8prague-Dawley rats. Apomorphine dosedependently (linear regression for log dose, n - 6) increased resting tail blood flow (P < 0.05), reduced the coefficient of variation of flow (P < 0.01), and reduced alerting-related cutaneous vasoconstriction (P < 0.01). Vehicle did not affect these parameters (P > 0.05). After velficle the alerting stinmli caused blood flow to fall to 17± 2°,5 of tire pre-stinmlus value compared with a fall of 7 2 ± 5% after apomorphine 0.5 mg/kg (P < 0.01). Low dose (0.1 mg/kg) spiperone, a doparnine receptor antagonist with additional high affinity at 5-HT receptors prevented apomorphine's effects on cutaneous blood flow. Thus apomophine dose-dependently increases cutaneous blood flow and inhibits the sympathetically-mediated vasoconstrictor episodes induced by alerting stinmli, with the mode of action probably including dopanfine receptor agonism. This clozapine-like action o f apomorplfine could contribute to apomovpine's reduced tendency to induce hallucinations and disordered thinking in Parkinsonian patients. 0996 Neuronal s~ynchrony in Parkinson's Disease: absent intrasaccadie modulation of EEG gamma power

Bodis-Wollner, I, Forgacs, P, Harhula, M, Glassman, S, Selesrdck, I, Lytton, W, yon Gizycki, H, Amassian, V. SUNY, Donstate Medical

Center, Departments of Neurology, Physiology and Pharmacology, Center for Scientific Computing, Brooklyn NY; Dept of Neurolgy, Szeged University, Hungary; Dept of Electrical Engineering, Polytechnic University, Brooklyn, NY Purpose: Brown and Marsden (1998) proposed that voluntary effort, sensory input and sequencing of motor movements suffer in PD due to a deficiency in neuronal binding. We studied predictive neuronal binding associated with voluntary saccades. Background: Microelectrode studies established that "gamma" frequency, roughly around 40 Hz, reflects synchronization o f distinct neuronal groups and their functional binding. Method: The EEG (116 channels) EOG and infrared corneal reflection were recorded in 12 PD patients (n - 12, stage II-IV, MM8 above 24) who executed horizontal voluntary saccdes either in light or blindfolded. Perisaccadic single trial EEG segments were analyzed using Wavelet and Hilbert Transform for 38 Hz. General Linear Model was applied for statistics. Results: In normal subjects ganmra (38Hz) E E G power increases intrasaccadically, peaking prior reaching new fixation. The inverted U-shaped function is the same either in light or darkness. In 9 of 12 patients intrasaccadic gamma modulation was absent. This result was unrelated to saccade amplitude, ocular dysmetria, dementia or medication. Conclusion: The basal ganglia may play a central role in short-term neocortical sensori- motor dyuamics for coupling voluntary saccades to cortical organization. This function is deficient in PD.

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Southfield, MI, USA; 2Wisconsin Institute for Neurological and Sleep Disorders, Milwaukee, WI, USA; 3Fort Wayne Neurological Center, Fort Wayne, IN, USA; 4New York University Medical Center, New York, Nk; USA; 5The Parkinson's and Movement Disorders Institute, Fountain Valley, CA, USA; 6SchwarzBiosciences, .Research Triangle Park, NC, USA; 7Schwarz Biosciences, ]~[onheim, Germany Objectives and Background: To investigate efficacy and safety of adjunctive transdermal rotigotine (Neupro~)), a D3/D2/D1 dopamine receptor agordst, in advanced Parkinson's disease (PD). Methods: PD subjects inadequately controlled with levodopa were randomized to placebo or two target doses of rotigotine (either 40 cm 2 [18.0 rag/day total drug content] or 60 c.m~ [27.0 rag/day total drug content]). This trial had a pre-treatment (14 weeks) phase, a titration phase (5 weeks) and a maintenance phase (24 weeks). The primary efficacy measurement was reduced "oft'" time, expressed in hours and responder rates (patients with at least 30"/0 reduction in "oil'" time). Results: Of 351 randomized subjects (111 to 40 cnr2 and 120 to 60 cnr2; 120 to placebo), 260 (174%) completed the trial. Compared to baseline, mean daily decreases in "off" time were 2.7 (40 cmZ), 2.1 (60 cm~) and 0.9 (placebo) hours. Responder rates were 57%, 55% and 34%, respectively (p < 0.001 and 0.003, respectively for "off" time reductions and <0.001 for responder rates; ANCOVA). Neither group experienced an increase in "on time with troublesome dyskinesias". The most common AEs were application site reactions (41% vs. 13%, combined rotigotnie dose groups vs. placebo), somnolence (31% vs. 27%), nausea (124% vs. 18%), dizziness (19% vs. 15%), dyskinesia (15°,5 vs. 7"/0) and edenra (11°,5 vs. 1°,5). Conclusions: Transdermal rotigotine therapy titrated to 40-60 cnr2 showed clirdcally relevant and statistically significant reductiotts in "off," time as an adjunct to levodopa and good tolerability. There was no increase in "on time with troublesome dyskinesias". 0998 Utility of a brief questiontmixe tot Parkinson's Disease Burifica, O, Pineda, DA, Franco, CA, Aguirre, DC, Arana, A, Uribe, CS, Lopera, F. University of Antioquia, Medellin, Colombia Background: A nine items rating scale for PD has been validate in Spanish, which showed a sensitivity and specificity of 100°,5 when was used for comparing PD and ophthalmologic patients 3. A brief screening questiomraire for Parkinson's disease- had been presented and published previously by Tanner et al (1990) 4. Methods: The brief questionnaire with five questions about the presence of PD cardinal symptoms (tremor, amnesia, rigidity, walk difficulties, and micrographia) was administered to the sample. We used a scale with four options of response: totally disagree (0), partial disagree (1), partial agree (2), and totally agree (14), was designed for each question. Results: The internal consistency for the total sample using the Cronbach's Alpha coefficient was 0.92. For control group the Cronbach's alpha was 0.65, and for the PD group was 0.57. The sensitivity for cut-off point of 4 was 98.1, the specificity was 94.8, and the LR was 16.7. For a cut-off point of 5, the sensitivity was 96.2?,';, the specificity 96.1% and the L R 24.5. Conclusion: A brief questionnaire of five questions for PD symptoms showed a very high sensitivity and specificity for detecting patients with PD. Ttds rating scale could be used as screerdng questionnaire for PD in epidenriological studies, which will allow to recruit very large sanrples from the over 50 years old general population.

0997 Rotigotine Transdermal Sys~tem as adjunctive therapy to levodopa in patients with advanced-stage Parkinson's disease. Results of a randomized, double-blind, placebo-controlled, multicenter, multinational trial

0999 Mechanisms of Subthalamic Deep Brain Stimulation (DBS) Studied with Positron Emission Tomography (PET): Modulation of the Direct Corficosubthalaufic Pathway

Boroojerdi, B 7, LeWitt, P A ~, Nausieda, PA 2, Chang, F 3, Fazzini, E 4, Truong, DD 5, Carpenter, M s. ~Clinical Neuroscience Center,

Ceballos-Baumann, A l'z, Haslinger, B 1, Boecker, H 3, Kuehler, A 1, Schroeder, U 1. ZDept. of Neurology and 3Nuclear Medicine