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PO25-TH-11 Hemichorea-hemiballism as the first presentation of non-ketotic hyperglycaemia
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19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
contralateral striatal abnormality and rapid resolution of symptoms after glycemic correction. Objective: To report a series of patients showing less usual aspects. Pathophysiological of this clinico-radiological syndrome are also discussed. Methods: we have included in this study patients presenting choreic or ballic involuntary movement and in whom, the aetiological assessment revealed a frank non-ketotic hyperglycaemia, without other abnormalities that could explain this hyperkinetic abnormal movement. All patients had CT or MR brain imaging. Results: 4 patients were included. Typical triad was present in only one case of this study. Less classical aspects were more frequently found: movement disorders revealed diabetes in 2 patients and one patient had generalized chorea and strictly normal neuroimaging. The correction of blood glucose was not sufficient to improve symptoms in 2 cases. In one, movements persist despite treatment with tetrabenazine. Conclusion: Clinical, radiological and outcome spectrum of the syndrome of chorea-ballismus induced by non-ketotic hyperglycaemia is not restricted to a typical triad. PO25-TH-11 Hemichorea-hemiballism as the first presentation of non-ketotic hyperglycaemia M.A. Rafai, M. Guynerane, F.Z. Boulaajaj, B. El Moutawakil. Chu Ibn Rochd, Casablanca, Morocco Introduction: Hemichorea-hemiballism (HCHB) can be the solely presentation of a wide range of non-neurological clinical pictures, such as metabolic or hydro-electrolyte derangements. HCHB as the first presentation of type 2 diabetes mellitus has been rarely described. Case report: A 56-year-old woman presented with one week history of involuntary movements of the left upper and lower limbs. There was no history of diabetes mellitus, other diseases or exposure to neuroleptic medication. No family history of movement disorders was obtained. Fasting blood glucose was obtained (4g/l) and type 2 diabetes mellitus was diagnosed. No ketones were detected in urinalysis and urine pH was normal. Other routine blood tests were normal. A brain computer tomography (CT) showed a slight hyperdense lesion on the right caudate and lenticular nucleus. With the administration of haloperidol (9 mg per day) and glycemia control (10 IU bed time NPH insulin), movement disorder completely disappeared 15 days after the first medical appointment. Discussion: Uncontrolled diabetes may be responsible for various neurological manifestations such as seizures and disorders of consciousness. Involuntary movements, like chorea and hemiballismus were rare. Moreover HCHB syndrome should be regularly included in the differential diagnosis of acute movement disorders, especially in the elder population. PO25-TH-12 Methyl bromide induced myoclonus K. Temkiatvises, A. Pisanpong, K. Boonyapisit. Medicine, Siriraj Hospital, Bangkok, Thailand Methyl bromide is a gas that is currently used in the fumigation of homes and other structures for termites and other pests. It is also used to fumigate soil before planting, and fruits and vegetables after harvest. Acute exposure can cause wide ranging of symptoms such as dizziness, headache, nausea, vomiting, transient blurring of vision, diplopia, confusion, status epilepticus or coma. Case: We present a Thai 53-year-old man with Methy Bromide toxicity who had had status epilepticus and then developed mutifocal myoclonus. He exposed to this gas when he was working on a ship that was carrying rice for transferring. There was a gas leakage in the ship then he had unconsciousness and status epilepticus. He was sent to the nearest hospital. Intravenous antiepileptic medications and respiratory support were given. He
regained consciousness within a week after admission, but later on developed multifocal myoclonus. Conclusion: In conclusion, in severe cases of methyl bromide poisoning, neurological symptoms such as intention tremor and action myoclonus are seen, but the first symptoms are often nonspecific, like headache, dizziness or status epilepticus. PO25-TH-13 Restless legs syndrome, the impact on quality of life A.P.D. Doneva1 , K.P.K. Pili Kuzeva1 , V.P.D. Donev2 . 1 Department of Neurology, Clinical Hospital Dr. T.Panovski, Bitola, Republic of Macedonia; 2 Resbiomed, Bitola, Republic of Macedonia Purpose: Restless Legs Syndrome (RLS) is one of the most common sleep and movement disorder It s characterized by four essential diagnostic criteria: an urge to move the limb, usually associated or caused by unpleasant sensations in the legs symptoms that start or become worse during the period of rest, at least partial relief of symptoms with physical activity, and worsening the symptoms in the evening or in the night (Prevalence, primary care population in Macedonia 8.2%). The aim of this study was to evaluate the severity and the impact of Restless Legs Syndrome on quality of life. Method: Thirty RLS patients, 19 (63.3%) female and 11 male (36.6%) completed: IRLSS (International Restless Legs Severity Scale), SF-36 (Medical Outcomes Study 36-Item Short Form health survey) and EQ-5D. Control group consist of 60 age and gender proper subjects. Results: Regarding the severity three out of 30 patients reported mild (10%) total score 0–10, moderate 13 (43.3%) total score 11–20, severe 11 (36.7%) total score21–30 and very severe 3 (10%) total score >31. Twenty one patients experienced RLS symptoms almost daily. The RLS sample had significantly lower scores on all 8 scales of the SF-36 (worse QOL) compared with control group. The RLS group had lower scores on 6 of the 8 scales. Lower scores were in groups of severe and very severe RLS. Conclusion: Lower scores of the SF-36 and EQ-5D scores were scored in patients with severe and very severe RLS. Compared to general population disorder has a significant impact QOL and daily activities. PO25-TH-14 Effect of botulinum toxin type A in retrocollis patients M. Banach1 , M. Rakowicz1 , J. Antczak1 , A. Krygowska-Wajs2 . Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland; 2 Neurology, Collegium Medicum, Jagiellonian University in Kra, Cracow, Poland 1
Background: Retrocollis (RC) is a rare form of cervical dystonia (CD), characterized by repetitive muscle contraction. Musculoskeletal pain in cervical region and tremor is a very frequent symptom in RC. Botulinum toxin injections have become the first-line treatment for patients with CD. Unfortunately, some patients with RC had only mildly or minimally improved after BTX-A injections. In this study we investigated if the EMG guidance can improve the effectivity of BTX-A in such patients. Method: 10 patients (six women and four men, mean age 42) were assessed using TWSTRS scale and EMG activity. The splenius capitis, trapezius, levator scapulae, semispinalis and obliques were injected with standard BTX-A dose without EMG guidance. 3 months after BTX-A injections EMG has been used to evaluate the pattern of muscle activation in patients with unsatisfactory response for treatment. All the cases were treated with EMG guided BTX-A. Results: Four patients had simple RC. A complex pattern (RC combined with torticollis and/or laterocollis) was found in six patients. Botulinum toxin type A (BTX-A) injection provided very good improvement in 5 patients, moderate to mild improvement in 3 patients. In 2 cases we did not find objective improvement. Head tremor and pain markedly improved in all patients. 3 months after BTX-A injections all patients with unsatisfactory response for treatment (5 patients) were treated with EMG guided
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
contralateral striatal abnormality and rapid resolution of symptoms after glycemic correction. Objective: To report a series of patients showing less usual aspects. Pathophysiological of this clinico-radiological syndrome are also discussed. Methods: we have included in this study patients presenting choreic or ballic involuntary movement and in whom, the aetiological assessment revealed a frank non-ketotic hyperglycaemia, without other abnormalities that could explain this hyperkinetic abnormal movement. All patients had CT or MR brain imaging. Results: 4 patients were included. Typical triad was present in only one case of this study. Less classical aspects were more frequently found: movement disorders revealed diabetes in 2 patients and one patient had generalized chorea and strictly normal neuroimaging. The correction of blood glucose was not sufficient to improve symptoms in 2 cases. In one, movements persist despite treatment with tetrabenazine. Conclusion: Clinical, radiological and outcome spectrum of the syndrome of chorea-ballismus induced by non-ketotic hyperglycaemia is not restricted to a typical triad. PO25-TH-11 Hemichorea-hemiballism as the first presentation of non-ketotic hyperglycaemia M.A. Rafai, M. Guynerane, F.Z. Boulaajaj, B. El Moutawakil. Chu Ibn Rochd, Casablanca, Morocco Introduction: Hemichorea-hemiballism (HCHB) can be the solely presentation of a wide range of non-neurological clinical pictures, such as metabolic or hydro-electrolyte derangements. HCHB as the first presentation of type 2 diabetes mellitus has been rarely described. Case report: A 56-year-old woman presented with one week history of involuntary movements of the left upper and lower limbs. There was no history of diabetes mellitus, other diseases or exposure to neuroleptic medication. No family history of movement disorders was obtained. Fasting blood glucose was obtained (4g/l) and type 2 diabetes mellitus was diagnosed. No ketones were detected in urinalysis and urine pH was normal. Other routine blood tests were normal. A brain computer tomography (CT) showed a slight hyperdense lesion on the right caudate and lenticular nucleus. With the administration of haloperidol (9 mg per day) and glycemia control (10 IU bed time NPH insulin), movement disorder completely disappeared 15 days after the first medical appointment. Discussion: Uncontrolled diabetes may be responsible for various neurological manifestations such as seizures and disorders of consciousness. Involuntary movements, like chorea and hemiballismus were rare. Moreover HCHB syndrome should be regularly included in the differential diagnosis of acute movement disorders, especially in the elder population. PO25-TH-12 Methyl bromide induced myoclonus K. Temkiatvises, A. Pisanpong, K. Boonyapisit. Medicine, Siriraj Hospital, Bangkok, Thailand Methyl bromide is a gas that is currently used in the fumigation of homes and other structures for termites and other pests. It is also used to fumigate soil before planting, and fruits and vegetables after harvest. Acute exposure can cause wide ranging of symptoms such as dizziness, headache, nausea, vomiting, transient blurring of vision, diplopia, confusion, status epilepticus or coma. Case: We present a Thai 53-year-old man with Methy Bromide toxicity who had had status epilepticus and then developed mutifocal myoclonus. He exposed to this gas when he was working on a ship that was carrying rice for transferring. There was a gas leakage in the ship then he had unconsciousness and status epilepticus. He was sent to the nearest hospital. Intravenous antiepileptic medications and respiratory support were given. He
regained consciousness within a week after admission, but later on developed multifocal myoclonus. Conclusion: In conclusion, in severe cases of methyl bromide poisoning, neurological symptoms such as intention tremor and action myoclonus are seen, but the first symptoms are often nonspecific, like headache, dizziness or status epilepticus. PO25-TH-13 Restless legs syndrome, the impact on quality of life A.P.D. Doneva1 , K.P.K. Pili Kuzeva1 , V.P.D. Donev2 . 1 Department of Neurology, Clinical Hospital Dr. T.Panovski, Bitola, Republic of Macedonia; 2 Resbiomed, Bitola, Republic of Macedonia Purpose: Restless Legs Syndrome (RLS) is one of the most common sleep and movement disorder It s characterized by four essential diagnostic criteria: an urge to move the limb, usually associated or caused by unpleasant sensations in the legs symptoms that start or become worse during the period of rest, at least partial relief of symptoms with physical activity, and worsening the symptoms in the evening or in the night (Prevalence, primary care population in Macedonia 8.2%). The aim of this study was to evaluate the severity and the impact of Restless Legs Syndrome on quality of life. Method: Thirty RLS patients, 19 (63.3%) female and 11 male (36.6%) completed: IRLSS (International Restless Legs Severity Scale), SF-36 (Medical Outcomes Study 36-Item Short Form health survey) and EQ-5D. Control group consist of 60 age and gender proper subjects. Results: Regarding the severity three out of 30 patients reported mild (10%) total score 0–10, moderate 13 (43.3%) total score 11–20, severe 11 (36.7%) total score21–30 and very severe 3 (10%) total score >31. Twenty one patients experienced RLS symptoms almost daily. The RLS sample had significantly lower scores on all 8 scales of the SF-36 (worse QOL) compared with control group. The RLS group had lower scores on 6 of the 8 scales. Lower scores were in groups of severe and very severe RLS. Conclusion: Lower scores of the SF-36 and EQ-5D scores were scored in patients with severe and very severe RLS. Compared to general population disorder has a significant impact QOL and daily activities. PO25-TH-14 Effect of botulinum toxin type A in retrocollis patients M. Banach1 , M. Rakowicz1 , J. Antczak1 , A. Krygowska-Wajs2 . Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland; 2 Neurology, Collegium Medicum, Jagiellonian University in Kra, Cracow, Poland 1
Background: Retrocollis (RC) is a rare form of cervical dystonia (CD), characterized by repetitive muscle contraction. Musculoskeletal pain in cervical region and tremor is a very frequent symptom in RC. Botulinum toxin injections have become the first-line treatment for patients with CD. Unfortunately, some patients with RC had only mildly or minimally improved after BTX-A injections. In this study we investigated if the EMG guidance can improve the effectivity of BTX-A in such patients. Method: 10 patients (six women and four men, mean age 42) were assessed using TWSTRS scale and EMG activity. The splenius capitis, trapezius, levator scapulae, semispinalis and obliques were injected with standard BTX-A dose without EMG guidance. 3 months after BTX-A injections EMG has been used to evaluate the pattern of muscle activation in patients with unsatisfactory response for treatment. All the cases were treated with EMG guided BTX-A. Results: Four patients had simple RC. A complex pattern (RC combined with torticollis and/or laterocollis) was found in six patients. Botulinum toxin type A (BTX-A) injection provided very good improvement in 5 patients, moderate to mild improvement in 3 patients. In 2 cases we did not find objective improvement. Head tremor and pain markedly improved in all patients. 3 months after BTX-A injections all patients with unsatisfactory response for treatment (5 patients) were treated with EMG guided