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P1.222 Extrapontine myelinolysis and reversible parkinsonism
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Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
P1.220 Unilateral deep brain stimulation in Parkinson disease improves ipsilateral symptoms regardless of laterality K. Shemisa1 , H. Fernandez2 . 1 Neurosurgery and Neurology, 2 Neurology, University of Florida, Gainesville, FL, USA Researchers have consistently observed right-handed individuals across normal and disease states, that the “dominant” left hemisphere has greater ipsilateral control of the left side than the right hemisphere and right. We sought to determine whether this ipsilateral influence of the dominant hemisphere in PD extends to treatments such as DBS and affect surgical outcome. We hypothesized that among right-handers, PD patients with dominant left hemisphere, DBS would have greater improvement in their ipsilateral left side compared to patient’s non-dominant right hemisphere DBS would have in their ipsilateral right side. 73 PD patients with unilateral DBS of the STN or GPI were included. The pre- and 4-month post-implantation composite scores of left and right sided of the (UPDRS) motor subscale ratings were used as the primary outcome measures and these were analyzed and compared between groups. On average, the UPDRS improved by 4.96±11.79 points (p < 0.001) post-surgery on the ipsilateral side of the DBS implantation across all parameters: rigidity, tremor, and bradykinesia (1.33, 1.59, 2.04 points, respectively; all values p < 0.001). Contralateral improvement scores post-surgery were 9.6 points across the (2.48, 3.01, 4.11, respectively; all values p < 0.001). Regression analysis revealed that the side (left vs. right) and target (STN vs. GPi) did not differ in effects on ipsilateral motor improvement (p = 0.3557). Therefore, ipsilateral improvements are seen in unilateral DBS that amount to relevant clinical improvement, they occur regardless to site and side of implantation, and should be included as a part of the clinical assessment and surgical decision making. P1.221 Diffusion tensor imaging of the substantia nigra on 3 Tesla MRI: comparison of Parkinson’s disease with age matched controls R. Kumari. Neuroradiology, Institute of Human Behavior and Allied Sciences (IHBAS), Delhi, India Objective: To evaluate the substantia nigra of Parkinson’s disease (PD) patients and normal controls using diffusion tensor imaging (DTI) on 3 Tesla MRI and determine whether there are detectable abnormalities in PD patients as compared with controls. Background: PD is a progressive neurodegenerative disease involving the loss of dopaminergic neurons primarily in the substantia nigra. Using quantitative DTI on a 3 T MR scanner, it is possible to detect the early micro structural changes within these pathways not appreciated on conventional MR sequences thereby improving the detection and characterization of abnormalities in PD. Methods: Twelve patients with denovo PD and ten age matched normal controls were scanned on a 3.0 T MR scanner. DTI data was acquired using a single-shot EPI sequence with diffusion encoding in 32 directions and a voxel size of 2·2·2 mm3 . DTI data were analyzed using the Functool software. Region of interest method was used to calculate the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values within each area of the substantia nigra and statistical significance was determined using the Student t test. Results: DTI images in patients with PD demonstrated significantly reduced FA values (p value <0.05) in the pars compacta and red nuclei of the substantia nigra, with increased ADC values (p value >0.05). This accounted for loss of dopaminergic neurons characteristic of this disease. Conclusions: Visualization of the selective degeneration of individual structures within the substantia nigra using DTI on 3 Tesla adds qualitative data facilitating the early diagnosis of PD.
P1.222 Extrapontine myelinolysis and reversible parkinsonism F. Barinagarrementeria1,2 . 1 Professional and Research Department, Universidad del Valle de M´exico, 2 Department of Neurology, Hospital Angeles de Queretaro, Mexico, Mexico Introduction: Extrapontine myelinolysis (EPM) related with hyponatremia is an uncommon cause of Parkinsonism. Objective: Report a case of reversible parkinsonism due to EPM and review the clinical features and long term prognosis. Case report: A 57-year-old woman with long term hypertension treated with ACE-I and tyazides was admitted to Hospital in March 2005. She developed mental disturbance with confusion and somnolence. A Na level 102 mEq was detected. After 3 days of sodium correction by her internist. She developed gradually emotional lability and gait disturbance. Neurological examination disclosed hipomimia, bilateral bradykinesia, dysartria, bradykinesia and rigidity as well as loss of postural reflexes. Gait with short steps was detected. An MRI disclosed bilateral symmetrical hyperintensities in caudate nucleus and putamen with relative sparing of the pons. The patient received initially levodopa which did not tolerate due to vomiting and then received amantadine with clinical improvement. During the next 2 years she received amantadine which was stopped in the last year. Actually (September 2009) she is neurologically normal. Control MRI disclosed notably reduction in striatal abnormalities. Conclusion: We conclude that EPM is a rare cause of parkinsonism. The prognosis, based also on the long term, (4 and half years) seems favourable. The role of treatment in this patients are not known. P1.223 Study of plantar pressure in Parkinson disease patients X. Chen, C.H. Wang, H.J. Liu, M.H. Ding, M.M. Lin, D.F. Huang, Parkinson Disease Group. Rehabilitation Department, 1st Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Objective: To explore the characteristics of plantar pressure distribution and gait model in Parkinson Disease patients by studing the plantar pressure data and gait cycle, then provide proper rehabilitation suggestion. Methods: 13 Parkinson disease patients were enrolled since Jan 2009 to May 2009. 16 healthy subjects were enrolled for comparison. The static and dynamic plantar pressure were tested and analyzed by the GaitView analysis system. Statistical analyses were preformed using SPSS 13.0, and a = 0.05 was an accepted level. Results: The results of static pressure showed that the plantar pressure of the 5th zone (the 5th metatarsal bone) significantly increased in Parkinson disease patients compared to the control group (P < 0.05). To the pressure order of the 8 plantar zone, the 5th zone and the 6th zone (middle of the foot) gained higher pressure than the 3rd zone (the 1st metatarsal bone) compare to the order of the control group, which meant the center of gravity were more scattered to the two sides of feet. The dynamic pressure shew that in walking condition the gravity center of Parkinson patients mainly focused on the forefeet, with little or without heel strike. Conclusions: Balance training should be the beginning of rehabilitation training in Parkinson disease patients. The improvement of balance capability could modify the plantar pressure in standing and avoid falling. More emphasis on heel strike in walking could lessen the anteversion of gravity center and improve the festinating gait. Plantar pressure has great clinical application value in Parkinson disease patients.
Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
P1.220 Unilateral deep brain stimulation in Parkinson disease improves ipsilateral symptoms regardless of laterality K. Shemisa1 , H. Fernandez2 . 1 Neurosurgery and Neurology, 2 Neurology, University of Florida, Gainesville, FL, USA Researchers have consistently observed right-handed individuals across normal and disease states, that the “dominant” left hemisphere has greater ipsilateral control of the left side than the right hemisphere and right. We sought to determine whether this ipsilateral influence of the dominant hemisphere in PD extends to treatments such as DBS and affect surgical outcome. We hypothesized that among right-handers, PD patients with dominant left hemisphere, DBS would have greater improvement in their ipsilateral left side compared to patient’s non-dominant right hemisphere DBS would have in their ipsilateral right side. 73 PD patients with unilateral DBS of the STN or GPI were included. The pre- and 4-month post-implantation composite scores of left and right sided of the (UPDRS) motor subscale ratings were used as the primary outcome measures and these were analyzed and compared between groups. On average, the UPDRS improved by 4.96±11.79 points (p < 0.001) post-surgery on the ipsilateral side of the DBS implantation across all parameters: rigidity, tremor, and bradykinesia (1.33, 1.59, 2.04 points, respectively; all values p < 0.001). Contralateral improvement scores post-surgery were 9.6 points across the (2.48, 3.01, 4.11, respectively; all values p < 0.001). Regression analysis revealed that the side (left vs. right) and target (STN vs. GPi) did not differ in effects on ipsilateral motor improvement (p = 0.3557). Therefore, ipsilateral improvements are seen in unilateral DBS that amount to relevant clinical improvement, they occur regardless to site and side of implantation, and should be included as a part of the clinical assessment and surgical decision making. P1.221 Diffusion tensor imaging of the substantia nigra on 3 Tesla MRI: comparison of Parkinson’s disease with age matched controls R. Kumari. Neuroradiology, Institute of Human Behavior and Allied Sciences (IHBAS), Delhi, India Objective: To evaluate the substantia nigra of Parkinson’s disease (PD) patients and normal controls using diffusion tensor imaging (DTI) on 3 Tesla MRI and determine whether there are detectable abnormalities in PD patients as compared with controls. Background: PD is a progressive neurodegenerative disease involving the loss of dopaminergic neurons primarily in the substantia nigra. Using quantitative DTI on a 3 T MR scanner, it is possible to detect the early micro structural changes within these pathways not appreciated on conventional MR sequences thereby improving the detection and characterization of abnormalities in PD. Methods: Twelve patients with denovo PD and ten age matched normal controls were scanned on a 3.0 T MR scanner. DTI data was acquired using a single-shot EPI sequence with diffusion encoding in 32 directions and a voxel size of 2·2·2 mm3 . DTI data were analyzed using the Functool software. Region of interest method was used to calculate the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values within each area of the substantia nigra and statistical significance was determined using the Student t test. Results: DTI images in patients with PD demonstrated significantly reduced FA values (p value <0.05) in the pars compacta and red nuclei of the substantia nigra, with increased ADC values (p value >0.05). This accounted for loss of dopaminergic neurons characteristic of this disease. Conclusions: Visualization of the selective degeneration of individual structures within the substantia nigra using DTI on 3 Tesla adds qualitative data facilitating the early diagnosis of PD.
P1.222 Extrapontine myelinolysis and reversible parkinsonism F. Barinagarrementeria1,2 . 1 Professional and Research Department, Universidad del Valle de M´exico, 2 Department of Neurology, Hospital Angeles de Queretaro, Mexico, Mexico Introduction: Extrapontine myelinolysis (EPM) related with hyponatremia is an uncommon cause of Parkinsonism. Objective: Report a case of reversible parkinsonism due to EPM and review the clinical features and long term prognosis. Case report: A 57-year-old woman with long term hypertension treated with ACE-I and tyazides was admitted to Hospital in March 2005. She developed mental disturbance with confusion and somnolence. A Na level 102 mEq was detected. After 3 days of sodium correction by her internist. She developed gradually emotional lability and gait disturbance. Neurological examination disclosed hipomimia, bilateral bradykinesia, dysartria, bradykinesia and rigidity as well as loss of postural reflexes. Gait with short steps was detected. An MRI disclosed bilateral symmetrical hyperintensities in caudate nucleus and putamen with relative sparing of the pons. The patient received initially levodopa which did not tolerate due to vomiting and then received amantadine with clinical improvement. During the next 2 years she received amantadine which was stopped in the last year. Actually (September 2009) she is neurologically normal. Control MRI disclosed notably reduction in striatal abnormalities. Conclusion: We conclude that EPM is a rare cause of parkinsonism. The prognosis, based also on the long term, (4 and half years) seems favourable. The role of treatment in this patients are not known. P1.223 Study of plantar pressure in Parkinson disease patients X. Chen, C.H. Wang, H.J. Liu, M.H. Ding, M.M. Lin, D.F. Huang, Parkinson Disease Group. Rehabilitation Department, 1st Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Objective: To explore the characteristics of plantar pressure distribution and gait model in Parkinson Disease patients by studing the plantar pressure data and gait cycle, then provide proper rehabilitation suggestion. Methods: 13 Parkinson disease patients were enrolled since Jan 2009 to May 2009. 16 healthy subjects were enrolled for comparison. The static and dynamic plantar pressure were tested and analyzed by the GaitView analysis system. Statistical analyses were preformed using SPSS 13.0, and a = 0.05 was an accepted level. Results: The results of static pressure showed that the plantar pressure of the 5th zone (the 5th metatarsal bone) significantly increased in Parkinson disease patients compared to the control group (P < 0.05). To the pressure order of the 8 plantar zone, the 5th zone and the 6th zone (middle of the foot) gained higher pressure than the 3rd zone (the 1st metatarsal bone) compare to the order of the control group, which meant the center of gravity were more scattered to the two sides of feet. The dynamic pressure shew that in walking condition the gravity center of Parkinson patients mainly focused on the forefeet, with little or without heel strike. Conclusions: Balance training should be the beginning of rehabilitation training in Parkinson disease patients. The improvement of balance capability could modify the plantar pressure in standing and avoid falling. More emphasis on heel strike in walking could lessen the anteversion of gravity center and improve the festinating gait. Plantar pressure has great clinical application value in Parkinson disease patients.