- Email: [email protected]
Poster 64: Reversible Posterior Leukoencephalopathy Syndrome in Rehabilitation Patients: A Case Series
PM&R
expediting these patients’ return to home by improving their independence and safety awareness. Keywords: Rehabilitation, Epilepsy.
Poster 63 Relationship Between the Efficacy Profile and Pharmacokinetics of Once-Daily, ExtendedRelease Cyclobenzaprine. Mona Darwish, PhD (Cephalon, Inc, Frazer, PA); Charles Altman, MD, MBA; Edward Hellriegel, PhD; Fang Xie, PhD. Disclosures: M. Darwish, Cephalon, Stock options or bond holdings; Cephalon, Employment. Objective: Explore the efficacy of once-daily cyclobenzaprine extended-release (CER) and its relation to plasma concentration-vs-time profile. Design: Retrospective analysis of i) pooled efficacy assessments from 2 randomized, controlled, double-blind clinical studies and ii) systemic exposure data from a pharmacokinetic study (simulated for multiple dosing). Setting: i) outpatient clinics and ii) study sites. Participants: i) Patients with acute muscle spasm (n ⫽ 504) and ii) healthy volunteers. Interventions: CER 15 mg, 30 mg, placebo. Main Outcome Measures: i) Patient’s daily rating of medication helpfulness, relief from local pain, and restriction of movement and ii) average steady-state concentrations (CavSS) of cyclobenzaprine. Results: At day 2, more patients treated with CER 15 mg rated medication helpfulness as “good” to “excellent” than those given placebo (26% vs 21%). This difference was statistically significant at day 4 (CER 15 mg ⫽ 51%, placebo ⫽ 36%; P ⫽ .014) and maintained through day 8 (CER 15 mg ⫽ 62%, placebo ⫽ 48%). For relief of local pain, “some” to “complete” ratings for CER 15 mg vs placebo were 30% vs 27% at day 2, 58% vs 47% at day 4 (P ⫽ .041), and 75% vs 59% at day 8 (P ⫽ .012). For relief from restriction of movement, “some” to “complete” ratings for CER 15 mg were 29% vs 28% at day 2, 58% vs 47% at day 4, and 72% vs 63% at day 8. Onset and maintenance of efficacy corresponded with cyclobenzaprine steady-state concentrations; 62.5% of CavSS was achieved by day 2, 90.4% by day 4, and 100% by day 8, following CER 15 mg. A similar correspondence was seen between the CER 30 mg efficacy and pharmacokinetic data. Conclusions: The efficacy profile of CER over the first 8 days seems to correspond with its plasma concentration-vstime profile. Keywords: Cyclobenzaprine, Efficacy, Muscle spasm.
Vol. 1, Iss. 9S, 2009
S131
Disclosures: S. E. Myers, None. Patients or Programs: Three patients (average age, 47.3 years; 2 female, 1 male) with reversible posterior leukoencephalopathy syndrome (RPLS) referred to PM&R. Program Description: All were diagnosed with RPLS based on initial MRI. Headache and visual changes were presenting symptoms in each patient, while 2 had altered mental status (AMS) and new onset seizures. One patient developed arm numbness 2 days prior to admission and was given intravenous steroids at an outside hospital for head MRI findings consistent with multiple sclerosis. MRI at our academic tertiary care hospital (ATCH) showed increased signal in the parietooccipital and cerebellar regions. Another patient was 2 days status post cervical selective nerve root block. MRI revealed diffuse white matter hyperintensity. The third was admitted with hypertensive emergency and imaging demonstrated signal abnormalities in the brainstem and cerebellum. Setting: ATCH, academic acute inpatient rehabilitation hospital (AIRH). Results: The average length of stay (LOS) at the ATCH was 10 days. PM&R recommended AIRH stay for all 3 patients, and 2 were admitted to our facility. The average LOS was 33.5 days before discharge to home. The average admission functional independence measure (FIM™) and FIM™ change scores were 50 and 45.5, respectively. Discussion: RPLS often presents with visual changes, headache, AMS and seizures. MRI usually shows posterior cerebral white matter edema. Incidence is unknown. It is more common in women but occurs in all age groups. Treatment is largely supportive but blood pressure should be controlled. The significance of 2 patients receiving steroids within 1 week of presentation is unknown. Functional recovery after RPLS has not previously been reported in the rehabilitation literature. Conclusions: Physiatrists must recognize the signs of RPLS since they commonly care for patients with neurologic deficits. Signs of RPLS can mimic other, more common diseases with different treatments. After RPLS is correctly diagnosed, it is important to consider inpatient rehabilitation as it appears these patients have potential to make significant functional gains. Keywords: Rehabilitation, Stroke, Reversible posterior leukoencephalopathy syndrome.
Poster 65
Poster 64
Segmental Zoster Paresis Following Spinal Surgery: A Case Report. James D. Sigler, MD (University of Kansas Medical Center, Kansas City, KS); R. Chris Glattes, MD; Lisa M. Hermes, MD; Larry Ridings, MD.
Reversible Posterior Leukoencephalopathy Syndrome in Rehabilitation Patients: A Case Series. Sara E. Myers, MD (University of Virginia, Charlottesville, VA); Mary G. Bryant, MD.
Disclosures: J. D. Sigler, None. Patients or Programs: A 53-year-old man who developed postherpetic neuralgia and zoster paresis in the C5-C6 myotome following posterior cervical laminoplasty in C3C7.
expediting these patients’ return to home by improving their independence and safety awareness. Keywords: Rehabilitation, Epilepsy.
Poster 63 Relationship Between the Efficacy Profile and Pharmacokinetics of Once-Daily, ExtendedRelease Cyclobenzaprine. Mona Darwish, PhD (Cephalon, Inc, Frazer, PA); Charles Altman, MD, MBA; Edward Hellriegel, PhD; Fang Xie, PhD. Disclosures: M. Darwish, Cephalon, Stock options or bond holdings; Cephalon, Employment. Objective: Explore the efficacy of once-daily cyclobenzaprine extended-release (CER) and its relation to plasma concentration-vs-time profile. Design: Retrospective analysis of i) pooled efficacy assessments from 2 randomized, controlled, double-blind clinical studies and ii) systemic exposure data from a pharmacokinetic study (simulated for multiple dosing). Setting: i) outpatient clinics and ii) study sites. Participants: i) Patients with acute muscle spasm (n ⫽ 504) and ii) healthy volunteers. Interventions: CER 15 mg, 30 mg, placebo. Main Outcome Measures: i) Patient’s daily rating of medication helpfulness, relief from local pain, and restriction of movement and ii) average steady-state concentrations (CavSS) of cyclobenzaprine. Results: At day 2, more patients treated with CER 15 mg rated medication helpfulness as “good” to “excellent” than those given placebo (26% vs 21%). This difference was statistically significant at day 4 (CER 15 mg ⫽ 51%, placebo ⫽ 36%; P ⫽ .014) and maintained through day 8 (CER 15 mg ⫽ 62%, placebo ⫽ 48%). For relief of local pain, “some” to “complete” ratings for CER 15 mg vs placebo were 30% vs 27% at day 2, 58% vs 47% at day 4 (P ⫽ .041), and 75% vs 59% at day 8 (P ⫽ .012). For relief from restriction of movement, “some” to “complete” ratings for CER 15 mg were 29% vs 28% at day 2, 58% vs 47% at day 4, and 72% vs 63% at day 8. Onset and maintenance of efficacy corresponded with cyclobenzaprine steady-state concentrations; 62.5% of CavSS was achieved by day 2, 90.4% by day 4, and 100% by day 8, following CER 15 mg. A similar correspondence was seen between the CER 30 mg efficacy and pharmacokinetic data. Conclusions: The efficacy profile of CER over the first 8 days seems to correspond with its plasma concentration-vstime profile. Keywords: Cyclobenzaprine, Efficacy, Muscle spasm.
Vol. 1, Iss. 9S, 2009
S131
Disclosures: S. E. Myers, None. Patients or Programs: Three patients (average age, 47.3 years; 2 female, 1 male) with reversible posterior leukoencephalopathy syndrome (RPLS) referred to PM&R. Program Description: All were diagnosed with RPLS based on initial MRI. Headache and visual changes were presenting symptoms in each patient, while 2 had altered mental status (AMS) and new onset seizures. One patient developed arm numbness 2 days prior to admission and was given intravenous steroids at an outside hospital for head MRI findings consistent with multiple sclerosis. MRI at our academic tertiary care hospital (ATCH) showed increased signal in the parietooccipital and cerebellar regions. Another patient was 2 days status post cervical selective nerve root block. MRI revealed diffuse white matter hyperintensity. The third was admitted with hypertensive emergency and imaging demonstrated signal abnormalities in the brainstem and cerebellum. Setting: ATCH, academic acute inpatient rehabilitation hospital (AIRH). Results: The average length of stay (LOS) at the ATCH was 10 days. PM&R recommended AIRH stay for all 3 patients, and 2 were admitted to our facility. The average LOS was 33.5 days before discharge to home. The average admission functional independence measure (FIM™) and FIM™ change scores were 50 and 45.5, respectively. Discussion: RPLS often presents with visual changes, headache, AMS and seizures. MRI usually shows posterior cerebral white matter edema. Incidence is unknown. It is more common in women but occurs in all age groups. Treatment is largely supportive but blood pressure should be controlled. The significance of 2 patients receiving steroids within 1 week of presentation is unknown. Functional recovery after RPLS has not previously been reported in the rehabilitation literature. Conclusions: Physiatrists must recognize the signs of RPLS since they commonly care for patients with neurologic deficits. Signs of RPLS can mimic other, more common diseases with different treatments. After RPLS is correctly diagnosed, it is important to consider inpatient rehabilitation as it appears these patients have potential to make significant functional gains. Keywords: Rehabilitation, Stroke, Reversible posterior leukoencephalopathy syndrome.
Poster 65
Poster 64
Segmental Zoster Paresis Following Spinal Surgery: A Case Report. James D. Sigler, MD (University of Kansas Medical Center, Kansas City, KS); R. Chris Glattes, MD; Lisa M. Hermes, MD; Larry Ridings, MD.
Reversible Posterior Leukoencephalopathy Syndrome in Rehabilitation Patients: A Case Series. Sara E. Myers, MD (University of Virginia, Charlottesville, VA); Mary G. Bryant, MD.
Disclosures: J. D. Sigler, None. Patients or Programs: A 53-year-old man who developed postherpetic neuralgia and zoster paresis in the C5-C6 myotome following posterior cervical laminoplasty in C3C7.