- Email: [email protected]
P344: Inhibitory theta burst stimulation of affected hemisphere in chronic stroke: a proof of principle, sham-controlled study
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
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any medication and their neurological examination was normal. A disposable CNE (37mm × 0.46 mm, 26G) was preferred for acquisition with 2 kHz low-cut filtering. The mean consecutive difference (MCD) was accepted as a jitter. Twenty jitters and the mean value of these were calculated from each muscle. Results: Overall 2760 jitters were calculated from 138 muscles. The mean value of these jitters was 22.6±10.3 μs. The calculated mean value of mean jitters was found 22.6±3.8 μs. To determine the cut-off value, we looked for 18th highest out of 20 jitters of each muscle (n=138, %95 CI). Mean value of these 18th highest jitters was 31.44±6.5 μs and cut-off limit was 45 μs. Conclusion: Jitter values higher than 45 μs calculated from periocular muscles with 37 mm CNE with 2 kHz low-cut frequency filtering may suggest neuromuscular transmission disorder and further investigation should be performed.
Percent decrease in group mean MCD was: T1 −19.8 (15.1); T2 −27.6 (25.5); T3 −20.5 (18.4); at T4 an increase of 22.1 (30.9) was observed. SFEMG became normal in 8 patients (T2 – 4/7, T3 – 5/7, T4 – 1/5). Two of the patients with normal SFEMG at T2 had taken steroids for short term/in suboptimal doses. At T4, SFEMG was still abnormal in 4/5 patients after being normal in 3 of them at T3 – related to poor compliance/inadequate immunosuppression. Conclusions: Serial SFEMG studies demonstrated normalisation of jitter parameters 8-20 months after starting treatment - in 43% with “adequate” treatment and in 14% with “inadequate” treatment. Worsening/persistence of SFEMG abnormalities at 23-35 months, observed in 4 patients, may be due to inadequate immunosuppression/continued disease activity. Serial SFEMG studies may provide useful information for management of restricted form of MG.
P340 Concentric needle versus single fiber needle stimulated single fiber electromyography in orbicularis oculi: comparison of results in consecutive patient cohorts
Poster session 21. Stroke
R. Mercelis 1 , K. Wouters 2 Antwerp University Hospital, Department of Neurology, Edegem, Belgium; 2 Antwerp University Hospital, Department of Medical Statistics, Edegem, Belgium 1
Question: Single fiber EMG (SFEMG) is preferentially done with a reusable single fiber needle electrode (SFN), but for practical reasons, a single use concentric needle EMG-electrode (CN) is often used. Limited reference values are available for CN-SFEMG. Methods: We performed stimulated SFEMG of the Orbicularis oculi muscle (OO) from 1990 on. In 2009 we switched from a SFN to a CN. We reviewed the data of the first two years with the CN with the last two years with the SFN. All examinations were done by the same investigator in a similar way except for the low frequency filter and the required minimum amplitude of the signals. Results: The CN group included 103 patients of whom 33 had a final diagnosis of MG, the SFN group 112 patients with 39 MG. The mean and median of the mean jitter values were 24.8 μs and 18.0 μs for the complete CN group and 22.1 μs and 17.5 μs for the complete SFN group. After exclusion of MG and ALS patients the data were normally distributed. Mean ± standard deviation were 16.8±2.0 μs for the CN group and 16.5±2.1 μs for the SF group. Statistical analysis showed that measurements in the CN and SFN group were equivalent (95% confidence intervals within an equivalence margin of ±1 μs). Conclusion: Our results suggest that stimulated CN-SFEMG of the OO can be interpreted with similar reference values as stimulated SFEMG with SFN.
P341 Serial single fibre electromyography studies in myasthenia gravis V. Mustare, D. Navalli Natiional Institute of Mental Health and Neurosciences, Neurology, Bangalore, India Question: Are serial Single Fibre Electromyography (SFEMG) studies useful in “restricted” form of Myasthenia Gravis (MG)? Methods: 14 patients with MG (ocular-13; ocular/mild generalised-1) underwent SFEMG of Frontalis-14 patients, Orbicularis Oculi (OO)-14 patients, and Extensor digitorum communis (EDC)-1 patient for initial diagnostic evaluation (Tb). SFEMG was done using Medtronic’s SF electrode and Keypoint.NET EMG system. In each muscle, 20 potentials pairs were sampled for jitter analysis. After starting treatment (Prednisolone 0.7 mg/kg/day), repeat SFEMG of the more abnormal muscle (Frontalis-7, OO-6, EDC-1) was performed (32 studies over 35 months). Quantitative MG scores (QMGS) were also assessed. Results: Mean age, gender ratio, and mean duration of symptoms were 37.1 (15.7) years, 12:2, and 2.4 (1.7) months. Repeat QMGS assessment and SFEMG studies were performed at: T1 (4–8 months) – 10 patients; T2 (8–12 months) – 7 patients; T3 (12–15 months) – 7 patients; and T4 (15–35 months) – 5 patients. Relapses were observed in 5/9 patients with poor drug compliance. At Tb, T1, T2, T3 and T4, mean QMGS were 1.5 (0.9), 0.5 (0.9), 2.1 (4.4), 1.1 (2.2), 0.6 (0.6) and QMGS was “0” in 1/14, 7/10, 4/7, 4/7, and 2/5 patients respectively. Group mean MCD values at Tb, T1, T2, T3 and T4 were 55.7 (19.3), 42.9 (11.1), 31.1 (7.9), 30.6 (12.9), 36.9 (7.9).
P343 Influence of a single dose of fluoxetine on brain activity during movement observation and execution, muscle activity and motor function in chronic stroke patients H. Berends 1 , T. Krabben 2 , K. Movig 3 , M. IJzerman 4 , M. van Putten 1 Twente University, MIRA Institute for Biomedical Technology and Technical Medicine, Clinical Neurophysiology, Enschede, Netherlands; 2 Roessingh Research and Development, Enschede, Netherlands; 3 Medisch Spectrum Twente, Pharmacy, Enschede, Netherlands; 4 University of Twente, School for Management & Governance, Health Technology & Services Research, Enschede, Netherlands 1
Question: How does a single dose of fluoxetine influence the cortical activity during movement execution and imagination and how do these changes relate to changes in muscle activation patterns and motor function in chronic stroke patients? Methods: The study was a double-blind, randomized, placebo-controlled, cross-over design. Ten chronic stroke patients were included and received a single dose of 20 mg fluoxetine or placebo on two different days. Identical measurements were done 4 times: before and after the administration of the placebo and of fluoxetine. To examine changes in cortical activity, 64-channel electroencephalography (EEG) was measured during movement execution and imagination, whereafter the event-related synchronization (ERS) was calculated of the theta, alpha and beta frequency bands. To examine peripheral changes, EMG (electromyography) of the extensor carpi radialis and flexor carpi radialis was measured during maximum voluntary isometric wrist extension and flexion (maximum voluntary force (MVF)), and 20% of MVF. Functional motor outcomes were measured using the Fugl Meyer Motor Assessment. Preliminary results (n=5): When using a MANOVA, no significant effects were found for fluoxetine on motor function (FM), on ERS, or on muscle activation patters. Significant differences were found between the affected and the healthy arm when the MVF and the root mean square (RMS) of the EMG of the extensor carpi radialis are considered. Conclusions: In contrast to previous studies, no potential effect of a single dose of fluoxetine on the rehabilitation of motor function after stroke is found.
P344 Inhibitory theta burst stimulation of affected hemisphere in chronic stroke: a proof of principle, sham-controlled study M. Dileone 1 , F. Ranieri 2 , G. Musumeci 2 , F. Capone 2 , P. Talelli 3 , A. Wallace 3 , J.C. Rothwell 3 , V. Di Lazzaro 2 1 San Bortolo Hospital, Neuroscience, Vicenza, Italy; 2 Campus Biomedico University, Neurology, Rome, Italy; 3 Sobell Department, London, United Kingdom Question: Non-invasive brain stimulation is a potential therapeutic intervention for stroke rehabilitation. Following a model of competitive interactions between the hemispheres, these interventions aim to increase the plasticity of stroke hemisphere by applying either excitatory protocols to the damaged hemisphere or inhibitory protocols to the non-stroke hemisphere. Here we test the safety and feasibility of an inhibitory protocol on
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Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
the stroke hemisphere to improve the response to conventional therapy via a homeostatic increase in learning capacity. Methods: 12 chronic stroke patients received TBS to stroke hemisphere (6 patients inhibitory and 6 sham TBS) followed by physical therapy daily for 10 working days. Patients and therapists were blinded to the type of TBS. Action Research Arm Test (ARAT), Nine-Hole Pegboard Test (NHPT) and Jebsen-Taylor Test (JTT) were the primary outcome measures, dynamometry was the secondary outcome measure. Results: All patients improved ARAT and JTT scores for up to 3 months post-treatment. ARAT improved significantly in both real and sham groups, but only patients receiving real TBS significantly improved on the JTT: 3 months post-treatment mean execution time was reduced compared to baseline by 141 s for real group and by 65s for the sham group.
Methods: We included in this report the first 19 patients with subacute ischaemic stroke from this randomized, sham-controlled, single-blinded study. The patients were randomly assigned to one of 2 groups: the first group (n=9) received real ECP; the second group (n=10) received sham ECP, one hour daily for 10 days. Modified Rankin scale (mRS), Purdue pegboard test, and cortical excitability measures including resting motor threshold (RMT) and motor evoked potentials (MEPs) at 130% of RMT recorded from the first dorsal interosseous muscle of each hand were made at baseline, post-intervention day 1 (post1), and post-intervention day 30 (post30). Post-intervention data were normalised to baseline (Post-ECP/Pre-ECP). Results: Compared with the sham ECP group, the real ECP group showed facilitation of ipsilesional MEPs at post1 (real 2.66 (1.78), sham 0.92 (0.21), P<0.001) and post30 (real 2.70 (1.08), sham 1.08 (0.36), P<0.001), and a decrease in the ipsilesional RMT at post1 (real 0.89 (0.11), sham 0.99 (0.03), P=0.002) and post30 (real 0.86 (0.12), sham 0.97 (0.02), P=0.002). No effects were found on contralesional RMT or MEPs. For clinical measurements, the real ECP group improved significantly in mRS and Purdue pegboard test at post1 (mRS: real 0.66 (0.30), sham 1.10 (0.32), P=0.008; Purdue: real 2.55 (1.89), sham 1.06 (0.41), P=0.004) and post30 (mRS: real 0.53 (0.23), sham 0.82 (0.20), P=0.011; Purdue: real 2.71 (2.22), sham 1.41 (0.42), P=0.049). Conclusion: Ten daily sessions of ECP can facilitate ipsilesional corticomotor excitability in subacute stroke patients, probably by enhancing cerebral perfusion. This proof-of-principle study indicates a larger trial to explore the effects on recovery of motor function after stroke is warranted.
P346 Automatized error cueing during impaired execution of action sequence in stroke patients with apraxia M. Bienkiewicz 1 , J. Pfluegler 1 , A. Schlegel 1 , M. Russel 2 , E. Jean-Baptiste 2 , M. Pastorino 3 , J. Hermsdoerfer 1 1 Technical University Munich, Health and Sport Department, Munich, Germany; 2 University of Birmingham, School of Electronic, Electrical and Computer Engineering, Birmingham, United Kingdom; 3 Universidad Politécnica de Madrid, ETSI Telecomunicación, Madrid, Spain
Figure 1
Conclusions: This small exploratory study suggests that ipsilesional inhibitory TBS is safe and that it has the potential to be used in a larger trial to enhance the gain from a late rehabilitation program in chronic stroke patients. References: P. Jung, U. Ziemann, Homeostatic and nonhomeostatic modulation of learning in human motor cortex, J. Neurosci. 29 (2009) 5597-5604. J.F. Muller, Y. Orekhov, Y. Liu, U. Ziemann, Homeostatic plasticity in human motor cortex demonstrated by two consecutive sessions of paired associative stimulation, Eur. J. Neurosci. 25 (2007) 3461-3468. P. Talelli, A. Wallace, M. Dileone, D. Hoad, B. Cheeran, R. Oliver, M. VandenBos,U. Hammerbeck, K. Barratt, C. Gillini, G. Musumeci, M.H. Boudrias, G.C. Cloud, J. Ball, J.F. Marsden, N.S. Ward, V. Di Lazzaro, R.G. Greenwood, J.C. Rothwell, Theta burst stimulation in the rehabilitation of the upper limb: a semirandomized, placebo-controlled trial in chronic stroke patients, Neurorehabil. Neural Rep. 26 (2012) 976-987.
P345 Effects of cerebral blood flow augmentation by external counterpulsation on corticomotor excitability in subacute stroke patients: preliminary results J.Y. Liu 1 , C. Stinear 2 , H. Leung 1 , H.L. Ip 1 , S.Y. Fan 1 , Y.L. Lau 1 , W.H. Leung 1 , X.Y. Chen 1 , K.S. Wong 1 1 The Chinese University of Hong Kong, Department of Medicine & Therapeutics, Faculty of Medicine, Hong Kong, China, Hong Kong; 2 University of Auckland, Clinical Neuroscience Laboratory, Department of Medicine, Auckland, New Zealand, New Zealand Question: External counterpulsation (ECP) is a novel noninvasive method used to augment cerebral perfusion. The purpose of this study was to determine whether improving cerebral perfusion via ECP can facilitate ipsilesional corticomotor excitability in subacute stroke patients.
Question: Stroke frequently causes specific deficits in the execution of action sequences (apraxia). Such symptoms of action disorganisation may affect activities of daily living (ADL) and can therefore prevent independent living after a stroke. An autonomous system is currently under development (EU project CogWatch) that aims to recognize action and detect errors during ADL performance, based on information from various sensors. Here we investigate whether cues that are automatically generated on the basis of the action error information are effective in modifying patients’ behaviour. Methods: Ten stroke patients with left brain damage participated in the experiment. All patients suffered from apraxia according to clinical testing. The patients’ task was to make a cup of tea of choice. Patients’ actions were identified by the examiner and transmitted to the system. If an error was identified or the patient requested help, an adequate cue was emitted. Cues delivered auditory information accompanied by a video that showed the corrected action. Results: The majority of patients committed at least one error in the tea making (e.g. did not boil the water in the kettle). Number of errors was correlated with the severity of apraxia. There were however, patients with signs of apraxia in clinical testing but no error in the tea making task. When errors were cued, the patients typically responded in the intended way and performed the missing action or corrected the error. Compliance with the cue was not related with aphasia as no correlation was found between successful responses and score in the Aachen Aphasia Tests. Some patients with severe apraxia used the help option frequently and benefitted from the cue being presented prospectively. Conclusions: The results showed that automatized cueing could assist patients with apraxia to compensate impairments of the execution of ADL. Multimodal cues were successful in evoking the intended response despite the presence of aphasia in some patients. It is concluded that automatized cueing is a feasible method to support the execution of ADL activities after stroke and as a consequence, to foster independent living in those patients. Acknowledgements: This work was funded by the EU STREP Project CogWatch (FP7-ICT-288912).
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any medication and their neurological examination was normal. A disposable CNE (37mm × 0.46 mm, 26G) was preferred for acquisition with 2 kHz low-cut filtering. The mean consecutive difference (MCD) was accepted as a jitter. Twenty jitters and the mean value of these were calculated from each muscle. Results: Overall 2760 jitters were calculated from 138 muscles. The mean value of these jitters was 22.6±10.3 μs. The calculated mean value of mean jitters was found 22.6±3.8 μs. To determine the cut-off value, we looked for 18th highest out of 20 jitters of each muscle (n=138, %95 CI). Mean value of these 18th highest jitters was 31.44±6.5 μs and cut-off limit was 45 μs. Conclusion: Jitter values higher than 45 μs calculated from periocular muscles with 37 mm CNE with 2 kHz low-cut frequency filtering may suggest neuromuscular transmission disorder and further investigation should be performed.
Percent decrease in group mean MCD was: T1 −19.8 (15.1); T2 −27.6 (25.5); T3 −20.5 (18.4); at T4 an increase of 22.1 (30.9) was observed. SFEMG became normal in 8 patients (T2 – 4/7, T3 – 5/7, T4 – 1/5). Two of the patients with normal SFEMG at T2 had taken steroids for short term/in suboptimal doses. At T4, SFEMG was still abnormal in 4/5 patients after being normal in 3 of them at T3 – related to poor compliance/inadequate immunosuppression. Conclusions: Serial SFEMG studies demonstrated normalisation of jitter parameters 8-20 months after starting treatment - in 43% with “adequate” treatment and in 14% with “inadequate” treatment. Worsening/persistence of SFEMG abnormalities at 23-35 months, observed in 4 patients, may be due to inadequate immunosuppression/continued disease activity. Serial SFEMG studies may provide useful information for management of restricted form of MG.
P340 Concentric needle versus single fiber needle stimulated single fiber electromyography in orbicularis oculi: comparison of results in consecutive patient cohorts
Poster session 21. Stroke
R. Mercelis 1 , K. Wouters 2 Antwerp University Hospital, Department of Neurology, Edegem, Belgium; 2 Antwerp University Hospital, Department of Medical Statistics, Edegem, Belgium 1
Question: Single fiber EMG (SFEMG) is preferentially done with a reusable single fiber needle electrode (SFN), but for practical reasons, a single use concentric needle EMG-electrode (CN) is often used. Limited reference values are available for CN-SFEMG. Methods: We performed stimulated SFEMG of the Orbicularis oculi muscle (OO) from 1990 on. In 2009 we switched from a SFN to a CN. We reviewed the data of the first two years with the CN with the last two years with the SFN. All examinations were done by the same investigator in a similar way except for the low frequency filter and the required minimum amplitude of the signals. Results: The CN group included 103 patients of whom 33 had a final diagnosis of MG, the SFN group 112 patients with 39 MG. The mean and median of the mean jitter values were 24.8 μs and 18.0 μs for the complete CN group and 22.1 μs and 17.5 μs for the complete SFN group. After exclusion of MG and ALS patients the data were normally distributed. Mean ± standard deviation were 16.8±2.0 μs for the CN group and 16.5±2.1 μs for the SF group. Statistical analysis showed that measurements in the CN and SFN group were equivalent (95% confidence intervals within an equivalence margin of ±1 μs). Conclusion: Our results suggest that stimulated CN-SFEMG of the OO can be interpreted with similar reference values as stimulated SFEMG with SFN.
P341 Serial single fibre electromyography studies in myasthenia gravis V. Mustare, D. Navalli Natiional Institute of Mental Health and Neurosciences, Neurology, Bangalore, India Question: Are serial Single Fibre Electromyography (SFEMG) studies useful in “restricted” form of Myasthenia Gravis (MG)? Methods: 14 patients with MG (ocular-13; ocular/mild generalised-1) underwent SFEMG of Frontalis-14 patients, Orbicularis Oculi (OO)-14 patients, and Extensor digitorum communis (EDC)-1 patient for initial diagnostic evaluation (Tb). SFEMG was done using Medtronic’s SF electrode and Keypoint.NET EMG system. In each muscle, 20 potentials pairs were sampled for jitter analysis. After starting treatment (Prednisolone 0.7 mg/kg/day), repeat SFEMG of the more abnormal muscle (Frontalis-7, OO-6, EDC-1) was performed (32 studies over 35 months). Quantitative MG scores (QMGS) were also assessed. Results: Mean age, gender ratio, and mean duration of symptoms were 37.1 (15.7) years, 12:2, and 2.4 (1.7) months. Repeat QMGS assessment and SFEMG studies were performed at: T1 (4–8 months) – 10 patients; T2 (8–12 months) – 7 patients; T3 (12–15 months) – 7 patients; and T4 (15–35 months) – 5 patients. Relapses were observed in 5/9 patients with poor drug compliance. At Tb, T1, T2, T3 and T4, mean QMGS were 1.5 (0.9), 0.5 (0.9), 2.1 (4.4), 1.1 (2.2), 0.6 (0.6) and QMGS was “0” in 1/14, 7/10, 4/7, 4/7, and 2/5 patients respectively. Group mean MCD values at Tb, T1, T2, T3 and T4 were 55.7 (19.3), 42.9 (11.1), 31.1 (7.9), 30.6 (12.9), 36.9 (7.9).
P343 Influence of a single dose of fluoxetine on brain activity during movement observation and execution, muscle activity and motor function in chronic stroke patients H. Berends 1 , T. Krabben 2 , K. Movig 3 , M. IJzerman 4 , M. van Putten 1 Twente University, MIRA Institute for Biomedical Technology and Technical Medicine, Clinical Neurophysiology, Enschede, Netherlands; 2 Roessingh Research and Development, Enschede, Netherlands; 3 Medisch Spectrum Twente, Pharmacy, Enschede, Netherlands; 4 University of Twente, School for Management & Governance, Health Technology & Services Research, Enschede, Netherlands 1
Question: How does a single dose of fluoxetine influence the cortical activity during movement execution and imagination and how do these changes relate to changes in muscle activation patterns and motor function in chronic stroke patients? Methods: The study was a double-blind, randomized, placebo-controlled, cross-over design. Ten chronic stroke patients were included and received a single dose of 20 mg fluoxetine or placebo on two different days. Identical measurements were done 4 times: before and after the administration of the placebo and of fluoxetine. To examine changes in cortical activity, 64-channel electroencephalography (EEG) was measured during movement execution and imagination, whereafter the event-related synchronization (ERS) was calculated of the theta, alpha and beta frequency bands. To examine peripheral changes, EMG (electromyography) of the extensor carpi radialis and flexor carpi radialis was measured during maximum voluntary isometric wrist extension and flexion (maximum voluntary force (MVF)), and 20% of MVF. Functional motor outcomes were measured using the Fugl Meyer Motor Assessment. Preliminary results (n=5): When using a MANOVA, no significant effects were found for fluoxetine on motor function (FM), on ERS, or on muscle activation patters. Significant differences were found between the affected and the healthy arm when the MVF and the root mean square (RMS) of the EMG of the extensor carpi radialis are considered. Conclusions: In contrast to previous studies, no potential effect of a single dose of fluoxetine on the rehabilitation of motor function after stroke is found.
P344 Inhibitory theta burst stimulation of affected hemisphere in chronic stroke: a proof of principle, sham-controlled study M. Dileone 1 , F. Ranieri 2 , G. Musumeci 2 , F. Capone 2 , P. Talelli 3 , A. Wallace 3 , J.C. Rothwell 3 , V. Di Lazzaro 2 1 San Bortolo Hospital, Neuroscience, Vicenza, Italy; 2 Campus Biomedico University, Neurology, Rome, Italy; 3 Sobell Department, London, United Kingdom Question: Non-invasive brain stimulation is a potential therapeutic intervention for stroke rehabilitation. Following a model of competitive interactions between the hemispheres, these interventions aim to increase the plasticity of stroke hemisphere by applying either excitatory protocols to the damaged hemisphere or inhibitory protocols to the non-stroke hemisphere. Here we test the safety and feasibility of an inhibitory protocol on
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Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
the stroke hemisphere to improve the response to conventional therapy via a homeostatic increase in learning capacity. Methods: 12 chronic stroke patients received TBS to stroke hemisphere (6 patients inhibitory and 6 sham TBS) followed by physical therapy daily for 10 working days. Patients and therapists were blinded to the type of TBS. Action Research Arm Test (ARAT), Nine-Hole Pegboard Test (NHPT) and Jebsen-Taylor Test (JTT) were the primary outcome measures, dynamometry was the secondary outcome measure. Results: All patients improved ARAT and JTT scores for up to 3 months post-treatment. ARAT improved significantly in both real and sham groups, but only patients receiving real TBS significantly improved on the JTT: 3 months post-treatment mean execution time was reduced compared to baseline by 141 s for real group and by 65s for the sham group.
Methods: We included in this report the first 19 patients with subacute ischaemic stroke from this randomized, sham-controlled, single-blinded study. The patients were randomly assigned to one of 2 groups: the first group (n=9) received real ECP; the second group (n=10) received sham ECP, one hour daily for 10 days. Modified Rankin scale (mRS), Purdue pegboard test, and cortical excitability measures including resting motor threshold (RMT) and motor evoked potentials (MEPs) at 130% of RMT recorded from the first dorsal interosseous muscle of each hand were made at baseline, post-intervention day 1 (post1), and post-intervention day 30 (post30). Post-intervention data were normalised to baseline (Post-ECP/Pre-ECP). Results: Compared with the sham ECP group, the real ECP group showed facilitation of ipsilesional MEPs at post1 (real 2.66 (1.78), sham 0.92 (0.21), P<0.001) and post30 (real 2.70 (1.08), sham 1.08 (0.36), P<0.001), and a decrease in the ipsilesional RMT at post1 (real 0.89 (0.11), sham 0.99 (0.03), P=0.002) and post30 (real 0.86 (0.12), sham 0.97 (0.02), P=0.002). No effects were found on contralesional RMT or MEPs. For clinical measurements, the real ECP group improved significantly in mRS and Purdue pegboard test at post1 (mRS: real 0.66 (0.30), sham 1.10 (0.32), P=0.008; Purdue: real 2.55 (1.89), sham 1.06 (0.41), P=0.004) and post30 (mRS: real 0.53 (0.23), sham 0.82 (0.20), P=0.011; Purdue: real 2.71 (2.22), sham 1.41 (0.42), P=0.049). Conclusion: Ten daily sessions of ECP can facilitate ipsilesional corticomotor excitability in subacute stroke patients, probably by enhancing cerebral perfusion. This proof-of-principle study indicates a larger trial to explore the effects on recovery of motor function after stroke is warranted.
P346 Automatized error cueing during impaired execution of action sequence in stroke patients with apraxia M. Bienkiewicz 1 , J. Pfluegler 1 , A. Schlegel 1 , M. Russel 2 , E. Jean-Baptiste 2 , M. Pastorino 3 , J. Hermsdoerfer 1 1 Technical University Munich, Health and Sport Department, Munich, Germany; 2 University of Birmingham, School of Electronic, Electrical and Computer Engineering, Birmingham, United Kingdom; 3 Universidad Politécnica de Madrid, ETSI Telecomunicación, Madrid, Spain
Figure 1
Conclusions: This small exploratory study suggests that ipsilesional inhibitory TBS is safe and that it has the potential to be used in a larger trial to enhance the gain from a late rehabilitation program in chronic stroke patients. References: P. Jung, U. Ziemann, Homeostatic and nonhomeostatic modulation of learning in human motor cortex, J. Neurosci. 29 (2009) 5597-5604. J.F. Muller, Y. Orekhov, Y. Liu, U. Ziemann, Homeostatic plasticity in human motor cortex demonstrated by two consecutive sessions of paired associative stimulation, Eur. J. Neurosci. 25 (2007) 3461-3468. P. Talelli, A. Wallace, M. Dileone, D. Hoad, B. Cheeran, R. Oliver, M. VandenBos,U. Hammerbeck, K. Barratt, C. Gillini, G. Musumeci, M.H. Boudrias, G.C. Cloud, J. Ball, J.F. Marsden, N.S. Ward, V. Di Lazzaro, R.G. Greenwood, J.C. Rothwell, Theta burst stimulation in the rehabilitation of the upper limb: a semirandomized, placebo-controlled trial in chronic stroke patients, Neurorehabil. Neural Rep. 26 (2012) 976-987.
P345 Effects of cerebral blood flow augmentation by external counterpulsation on corticomotor excitability in subacute stroke patients: preliminary results J.Y. Liu 1 , C. Stinear 2 , H. Leung 1 , H.L. Ip 1 , S.Y. Fan 1 , Y.L. Lau 1 , W.H. Leung 1 , X.Y. Chen 1 , K.S. Wong 1 1 The Chinese University of Hong Kong, Department of Medicine & Therapeutics, Faculty of Medicine, Hong Kong, China, Hong Kong; 2 University of Auckland, Clinical Neuroscience Laboratory, Department of Medicine, Auckland, New Zealand, New Zealand Question: External counterpulsation (ECP) is a novel noninvasive method used to augment cerebral perfusion. The purpose of this study was to determine whether improving cerebral perfusion via ECP can facilitate ipsilesional corticomotor excitability in subacute stroke patients.
Question: Stroke frequently causes specific deficits in the execution of action sequences (apraxia). Such symptoms of action disorganisation may affect activities of daily living (ADL) and can therefore prevent independent living after a stroke. An autonomous system is currently under development (EU project CogWatch) that aims to recognize action and detect errors during ADL performance, based on information from various sensors. Here we investigate whether cues that are automatically generated on the basis of the action error information are effective in modifying patients’ behaviour. Methods: Ten stroke patients with left brain damage participated in the experiment. All patients suffered from apraxia according to clinical testing. The patients’ task was to make a cup of tea of choice. Patients’ actions were identified by the examiner and transmitted to the system. If an error was identified or the patient requested help, an adequate cue was emitted. Cues delivered auditory information accompanied by a video that showed the corrected action. Results: The majority of patients committed at least one error in the tea making (e.g. did not boil the water in the kettle). Number of errors was correlated with the severity of apraxia. There were however, patients with signs of apraxia in clinical testing but no error in the tea making task. When errors were cued, the patients typically responded in the intended way and performed the missing action or corrected the error. Compliance with the cue was not related with aphasia as no correlation was found between successful responses and score in the Aachen Aphasia Tests. Some patients with severe apraxia used the help option frequently and benefitted from the cue being presented prospectively. Conclusions: The results showed that automatized cueing could assist patients with apraxia to compensate impairments of the execution of ADL. Multimodal cues were successful in evoking the intended response despite the presence of aphasia in some patients. It is concluded that automatized cueing is a feasible method to support the execution of ADL activities after stroke and as a consequence, to foster independent living in those patients. Acknowledgements: This work was funded by the EU STREP Project CogWatch (FP7-ICT-288912).