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P22-5 Multiple sclerosis (MS)
S234
Posters
were not correlated with cognitive performance. Auditory ERP: Patients had an increase in the N100 amplitudes (p < 0.02), and an increase in the N100 latencies (p < 0.007) which were most pronounced in the frontal and central region. Performance in tests of memory correlated (p < 0.01) to auditory P300 amplitudes in the parietal area. Conclusion: Changes in ERP latency may be a sensitive measure of abnormal cortical activation in MS. A decrease in performance may be compensated for by the recruitment of more neurons causing a stronger and more widely distributed ERP signal. This is in analogy with previous fMRI studies showing stronger activation in MS patients than healthy controls for a given cognitive task. P22-5 Multiple sclerosis (MS) 1
A.I. Sukhanov 1 Rehabilitation Centre of Professor A. I. Sukhanov, Saint-Petersburg, Russia Aim: Nowadays the number of people with the diagnosis multiple sclerosis increases every day, that’s why the main idea of our work is to find new affective methods of treatment of this disease. Materials and Method: We have cured 300 patients for the 1ast 20 years in our clinic (Rehabi1itation Centre of Professor A.I. Sukhanov). The method based on next parts: (1) correction settings of current, in spina1 cord and brain, especially from damaged areas; (2) activation of blood flow in a spina1 cord and brain, especially in damaged areas; (3) improvement nutrition of tendo-muscu1ar corset and rehabi1itation of its functions; (4) restoration of muscular memory and controllabi1ity, creation hea1thy program of CNS; (5) increase on oxygen and energy capacity of tissues. In treatment we used the method, that consist of three parts: firstly, it’s reflex-corrective therapy (RCT), secondly, the specific complex based on yoga, eastern gymnastic and exercises used on the west, and at last microelements that we get from wi1d officina1 herb. Results: After the treatment patients with light degree of MS reaped full functional and structure recovery with subsequent the management and medical supervision by specialists from our c1inic. Patients with middle degree of MS reap functiona1 and structure recovery, status of this patients were satisfactory, and then the management and medica1 supervision by specialists from our c1inic. Patients with heavy degree of MS got an opportunity to ambulate, serve itself and continue the management in our clinic. Conclusion: It is necessary to do complex activation of natural opportunities of an organism, appropriate intensity and treatment duration, good completeness of therapeutic complex and persona1s qua1ity to get good resu1ts. P22-6 Cortical dysfunction appears to underlie the development of disability in multiple sclerosis S. Vucic1,2 , T. Burke1 , M. Kiernan2,3 1 Western Clinical School, University of Sydney, Australia, 2 Prince of Wales Clinical School, University of New South Wales, Australia, 3 Prince of Wales Medical Research Institute, Australia Objectives: Gray matter atrophy, as reflected by pathological and radiological abnormalities, has been implicated in the development of secondary progressive multiple sclerosis [SPMS]. However, these studies do not provide functional information and are not easily accessible in a clinical setting. Gray matter or cortical function is readily assessed by transcranial magnetic stimulation [TMS], and determining whether cortical dysfunction was a biomarker of SPMS could be of diagnostic and therapeutic significance. Consequently, novel paired-pulse threshold tracking TMS techniques were used to assess whether cortical dysfunction was associated with development of SPMS. Methods: Cortical excitability studies were undertaken in 13 SPMS, 15 relapsing-remitting MS patients [RRMS] and 55 controls using a 90 mm circular-coil. Results: SICI was significantly reduced in SPMS [1.4±2.8%] compared to RRMS patients [11.9±2.1%, P < 0.01] and controls [9.0±0.8%, P < 0.01], while intracortical facilitation was increased in SPMS [ 6.5±2.2%] compared to RRMS patients [0.8±2.3, P < 0.05] and controls [ 0.3±0.1, P < 0.01]. Resting motor threshold [RMT] was increased [SPMS 69.8±4.4%; RRMS 55.3±2.2%, P < 0.01; controls 59.5±1.1%, P < 0.001] while the motor evoked potential [MEP] amplitude was reduced [SPMS 11.5±2.4%; RRMS 21.2±5.7%, P < 0.05; controls 26.9±2.2%, P < 0.01] in SPMS patients. Central motor conduction time [CMCT] was prolonged in SPMS [9.6±1.2 ms, P < 0.001] and RRMS [7.0±0.9 ms, P < 0.05] patients
compared to controls [5.1±0.2 ms]. There was a significant correlation between the expanded disability symptom scale and SICI [R = 0.7, P < 0.001], MEP amplitude [R = 0.4, P < 0.05], CMCT [R = 0.7, P < 0.001] and resting motor threshold [R = 0.5, P < 0.01]. Interpretation: Together, these findings suggest that cortical dysfunction is associated with development of disability in MS, and documentation of such cortical dysfunction may serve as a useful biomarker for disease severity in MS. In addition, the present study provides pathophysiological insights, namely cortical hyperexcitability, into the mechanisms underlying the development of long-term disability in MS, thereby providing novel therapeutic targets in treatment of MS. P22-7 Current perception threshold in subacute myelo-optico-neuropathy Y. Suzuki1 , K. Ogawa1 , H. Shiota1 , M. Oishi1 , S. Kamei1 , T. Mizutani1 1 Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan Objective: The cause of subacute myelo-optico-neuropathy (SMON) is an adverse event associated with the use of clioquinol as an antiflatulent and it became a social problem in Japan. Numbness is associated with peculiar symptoms, such as feeling an electric shock, tingling ache, something stuck to the sole, and tight ankles. However, there are many cases where an objective evaluation is difficult. This time, we examined SMON’s sensory disturbance using the CPT. Methods: Ten SMON patients and ten age-matched healthy controls in this study. All patients showed numbness, dysesthesia, or pain in the lower extremities, but they had no sensory disturbances in the upper extremities. The patients who also had other neurological diseases, such as cerebral vascular disease, diabetes mellitus, and lumbar spondylosis, were excluded. The Neurometer CPT/C was used to measure CPT. This device delivers sinusoidal electrical stimuli at frequencies of 5 Hz, 250 Hz, and 2,000 Hz. CPT was measured bilaterally at the index finger and near the external malleolus. Results: The CPT to 2,000 Hz stimulation and the CPT to 250 Hz stimulation near the external malleolus were significantly higher in the SMON group than in the control group, whereas the CPT to 5 Hz stimulation was significantly lower in the SMON group than in the control group. No significant differences were seen in the CPTs to 5 Hz, 250 Hz, and 2,000 Hz stimulations at the index finger between the SMON group and the control group. Conclusions: Diabetic patients and heavy alcohol users may present with paresthesia as observed in SMON. The CPT examination at 5 Hz and 2,000 Hz stimulation increases in diabetic and alcoholic polyneuropathies. Therefore, a CPT examination may be useful to differentiate sensory disorders caused by other diseases, such as diabetes mellitus and heavy alcohol usage. P22-8 Efficacy of therapeutic plasma exchange in acute attacks of neuromyelitis optica Y.-M. Lim1 , B.-H. Kang1 , K.-K. Kim1 1 Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Objective: Acute attacks of neuromyelitis optica (NMO) are usually severe and frequently unresponsive to high-dose steroids. Identification of aquaporin-4 antibodies and the pathologic studies showing immunoglobulin and complement deposition in NMO lesions suggest that humoral immunity plays a major role in its pathogenesis and plasma exchange (PE) can be used to treat NMO. The aim of this study is to evaluate the therapeutic efficacy of PE for acute severe attacks in NMO. Methods: We included 7 NMO-IgG positive patients with NMO who had PE between July 2007 and June 2009 at the Asan Medical Center. The outcome was evaluated based on decrement in the Expanded Disability Status Scale (EDSS) and NMO-IgG titers after PE. Results: All patients were women, and the mean age was 35 years (9 52 years). PE was performed in 7 (50.0%) of total 14 attacks. The target relapses were myelitis (n = 4, 57.1%), optic neuritis (n = 2, 28.6%), and extensive cerebral lesions (n = 1, 14.3%). The mean interval between attacks and PE was 9.3 days (4 20 days). The median NMO-IgG titer at PE onset was 1:480 (1:120 1:960). Six (85.7%) became negative for NMO-IgG after PE and the titer was lowered by 50% in the remainder. The mean EDSS ± SD at PE onset was 6.4±2.1 and the mean decrease of EDSS was 1.7±1.5. Six (85.7%) showed functional improvement one month after PE.
Posters
were not correlated with cognitive performance. Auditory ERP: Patients had an increase in the N100 amplitudes (p < 0.02), and an increase in the N100 latencies (p < 0.007) which were most pronounced in the frontal and central region. Performance in tests of memory correlated (p < 0.01) to auditory P300 amplitudes in the parietal area. Conclusion: Changes in ERP latency may be a sensitive measure of abnormal cortical activation in MS. A decrease in performance may be compensated for by the recruitment of more neurons causing a stronger and more widely distributed ERP signal. This is in analogy with previous fMRI studies showing stronger activation in MS patients than healthy controls for a given cognitive task. P22-5 Multiple sclerosis (MS) 1
A.I. Sukhanov 1 Rehabilitation Centre of Professor A. I. Sukhanov, Saint-Petersburg, Russia Aim: Nowadays the number of people with the diagnosis multiple sclerosis increases every day, that’s why the main idea of our work is to find new affective methods of treatment of this disease. Materials and Method: We have cured 300 patients for the 1ast 20 years in our clinic (Rehabi1itation Centre of Professor A.I. Sukhanov). The method based on next parts: (1) correction settings of current, in spina1 cord and brain, especially from damaged areas; (2) activation of blood flow in a spina1 cord and brain, especially in damaged areas; (3) improvement nutrition of tendo-muscu1ar corset and rehabi1itation of its functions; (4) restoration of muscular memory and controllabi1ity, creation hea1thy program of CNS; (5) increase on oxygen and energy capacity of tissues. In treatment we used the method, that consist of three parts: firstly, it’s reflex-corrective therapy (RCT), secondly, the specific complex based on yoga, eastern gymnastic and exercises used on the west, and at last microelements that we get from wi1d officina1 herb. Results: After the treatment patients with light degree of MS reaped full functional and structure recovery with subsequent the management and medical supervision by specialists from our c1inic. Patients with middle degree of MS reap functiona1 and structure recovery, status of this patients were satisfactory, and then the management and medica1 supervision by specialists from our c1inic. Patients with heavy degree of MS got an opportunity to ambulate, serve itself and continue the management in our clinic. Conclusion: It is necessary to do complex activation of natural opportunities of an organism, appropriate intensity and treatment duration, good completeness of therapeutic complex and persona1s qua1ity to get good resu1ts. P22-6 Cortical dysfunction appears to underlie the development of disability in multiple sclerosis S. Vucic1,2 , T. Burke1 , M. Kiernan2,3 1 Western Clinical School, University of Sydney, Australia, 2 Prince of Wales Clinical School, University of New South Wales, Australia, 3 Prince of Wales Medical Research Institute, Australia Objectives: Gray matter atrophy, as reflected by pathological and radiological abnormalities, has been implicated in the development of secondary progressive multiple sclerosis [SPMS]. However, these studies do not provide functional information and are not easily accessible in a clinical setting. Gray matter or cortical function is readily assessed by transcranial magnetic stimulation [TMS], and determining whether cortical dysfunction was a biomarker of SPMS could be of diagnostic and therapeutic significance. Consequently, novel paired-pulse threshold tracking TMS techniques were used to assess whether cortical dysfunction was associated with development of SPMS. Methods: Cortical excitability studies were undertaken in 13 SPMS, 15 relapsing-remitting MS patients [RRMS] and 55 controls using a 90 mm circular-coil. Results: SICI was significantly reduced in SPMS [1.4±2.8%] compared to RRMS patients [11.9±2.1%, P < 0.01] and controls [9.0±0.8%, P < 0.01], while intracortical facilitation was increased in SPMS [ 6.5±2.2%] compared to RRMS patients [0.8±2.3, P < 0.05] and controls [ 0.3±0.1, P < 0.01]. Resting motor threshold [RMT] was increased [SPMS 69.8±4.4%; RRMS 55.3±2.2%, P < 0.01; controls 59.5±1.1%, P < 0.001] while the motor evoked potential [MEP] amplitude was reduced [SPMS 11.5±2.4%; RRMS 21.2±5.7%, P < 0.05; controls 26.9±2.2%, P < 0.01] in SPMS patients. Central motor conduction time [CMCT] was prolonged in SPMS [9.6±1.2 ms, P < 0.001] and RRMS [7.0±0.9 ms, P < 0.05] patients
compared to controls [5.1±0.2 ms]. There was a significant correlation between the expanded disability symptom scale and SICI [R = 0.7, P < 0.001], MEP amplitude [R = 0.4, P < 0.05], CMCT [R = 0.7, P < 0.001] and resting motor threshold [R = 0.5, P < 0.01]. Interpretation: Together, these findings suggest that cortical dysfunction is associated with development of disability in MS, and documentation of such cortical dysfunction may serve as a useful biomarker for disease severity in MS. In addition, the present study provides pathophysiological insights, namely cortical hyperexcitability, into the mechanisms underlying the development of long-term disability in MS, thereby providing novel therapeutic targets in treatment of MS. P22-7 Current perception threshold in subacute myelo-optico-neuropathy Y. Suzuki1 , K. Ogawa1 , H. Shiota1 , M. Oishi1 , S. Kamei1 , T. Mizutani1 1 Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan Objective: The cause of subacute myelo-optico-neuropathy (SMON) is an adverse event associated with the use of clioquinol as an antiflatulent and it became a social problem in Japan. Numbness is associated with peculiar symptoms, such as feeling an electric shock, tingling ache, something stuck to the sole, and tight ankles. However, there are many cases where an objective evaluation is difficult. This time, we examined SMON’s sensory disturbance using the CPT. Methods: Ten SMON patients and ten age-matched healthy controls in this study. All patients showed numbness, dysesthesia, or pain in the lower extremities, but they had no sensory disturbances in the upper extremities. The patients who also had other neurological diseases, such as cerebral vascular disease, diabetes mellitus, and lumbar spondylosis, were excluded. The Neurometer CPT/C was used to measure CPT. This device delivers sinusoidal electrical stimuli at frequencies of 5 Hz, 250 Hz, and 2,000 Hz. CPT was measured bilaterally at the index finger and near the external malleolus. Results: The CPT to 2,000 Hz stimulation and the CPT to 250 Hz stimulation near the external malleolus were significantly higher in the SMON group than in the control group, whereas the CPT to 5 Hz stimulation was significantly lower in the SMON group than in the control group. No significant differences were seen in the CPTs to 5 Hz, 250 Hz, and 2,000 Hz stimulations at the index finger between the SMON group and the control group. Conclusions: Diabetic patients and heavy alcohol users may present with paresthesia as observed in SMON. The CPT examination at 5 Hz and 2,000 Hz stimulation increases in diabetic and alcoholic polyneuropathies. Therefore, a CPT examination may be useful to differentiate sensory disorders caused by other diseases, such as diabetes mellitus and heavy alcohol usage. P22-8 Efficacy of therapeutic plasma exchange in acute attacks of neuromyelitis optica Y.-M. Lim1 , B.-H. Kang1 , K.-K. Kim1 1 Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Objective: Acute attacks of neuromyelitis optica (NMO) are usually severe and frequently unresponsive to high-dose steroids. Identification of aquaporin-4 antibodies and the pathologic studies showing immunoglobulin and complement deposition in NMO lesions suggest that humoral immunity plays a major role in its pathogenesis and plasma exchange (PE) can be used to treat NMO. The aim of this study is to evaluate the therapeutic efficacy of PE for acute severe attacks in NMO. Methods: We included 7 NMO-IgG positive patients with NMO who had PE between July 2007 and June 2009 at the Asan Medical Center. The outcome was evaluated based on decrement in the Expanded Disability Status Scale (EDSS) and NMO-IgG titers after PE. Results: All patients were women, and the mean age was 35 years (9 52 years). PE was performed in 7 (50.0%) of total 14 attacks. The target relapses were myelitis (n = 4, 57.1%), optic neuritis (n = 2, 28.6%), and extensive cerebral lesions (n = 1, 14.3%). The mean interval between attacks and PE was 9.3 days (4 20 days). The median NMO-IgG titer at PE onset was 1:480 (1:120 1:960). Six (85.7%) became negative for NMO-IgG after PE and the titer was lowered by 50% in the remainder. The mean EDSS ± SD at PE onset was 6.4±2.1 and the mean decrease of EDSS was 1.7±1.5. Six (85.7%) showed functional improvement one month after PE.